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Stoke-on-Trent, United Kingdom

Kaiser S.,Midlands Center for Spinal Injuries | Kennedy P.,National Spinal Injuries Center
Psychology, Health and Medicine

This study explored the cognitive appraisals that people make following spinal cord injury (SCI) about their situation and their ability to cope with it. Appraisals are thought to be important in determining individual responses to different events and have been shown to predict psychological well-being following injury. A cross-sectional interview study was used. Ten individuals who had recently started rehabilitation at the National Spinal Injuries Centre following an SCI were interviewed. Eight men and two women with a variety of injury level and completeness participated. Interviews were semi-structured and aimed to elicit participants' appraisals of their experiences and their ability to cope. Interviews were analysed qualitatively using interpretative phenomenological analysis. Four super-ordinate themes emerged from the interviews. These were making sense of a traumatic experience, impact of the SCI, coping and altered view of self and life. The interviews revealed that appraisals following SCI are complex and relate not only to the individual but also to their context, life stage, roles and relationships. The study adds to the theoretical understanding of the appraisal process following SCI. Ideas for further research are generated and clinical implications for improving patient experiences and developing appraisal-focused interventions are considered. Copyright © 2011 Taylor and Francis Group, LLC. Source

Pull Ter Gunne A.F.,Radboud University Nijmegen | Hosman A.J.F.,Radboud University Nijmegen | Cohen D.B.,Johns Hopkins Hospital | Habil D.,Queensland University of Technology | And 3 more authors.

STUDY DESIGN.: A methodological systematic review. OBJECTIVE.: To critically appraise the validity of risk factors for surgical site infection (SSI) after spinal surgery. SUMMARY OF BACKGROUND DATA.: SSIs lead to higher morbidity, mortality, and increased health care costs. Understanding which factors lead to an increased risk of SSI is important for the development of prophylactic protocols to counter this risk. To date, however, no review appraising the methodological quality of studies evaluating risk factors for spinal SSIs has been published. METHODS.: Contemporary studies identifying risk factors for SSI after spinal surgery were searched through the Medline and EMBASE databases (January 2001 to December 2010). References were retrieved and bias-prone study features were abstracted individually and independently by 2 authors. RESULTS.: Twenty-four eligible studies were identified, including 9 (nested) case-control studies and 15 case series. Included studies covered wide variations of indications and surgical procedures. A total of 73 different types of factors were evaluated for the risk of an SSI of which 34 (47%) were reported to be significantly related to at least 1 study. Only the following risk factors-diabetes mellitus, obesity, and previous SSI-were confirmed more often (n = 11, 8, and 3, respectively) as a significant risk factor for an SSI than they were disproved (n = 7, 6, and 1, respectively). Various sources of heterogeneity were observed, including patient selection, selection and analysis of putative risk factors, and definitions of SSI outcomes. CONCLUSION.: There is an abundance of conflicting data on risk factors for SSI after spinal surgery. Given various sources of heterogeneity observed in observational literature, there is a paucity of solid evidence for the proof of robust risk factors. The authors recommend the introduction, validation, and use of a standardized set of strongly justified eligibility criteria and well-defined candidate risk factors and spinal SSI outcomes. Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Source

Van Middendorp J.J.,National Spinal Injuries Center | Van Middendorp J.J.,Manchester College | Van Middendorp J.J.,University of Queensland | Hosman A.J.F.,Radboud University Nijmegen | Doi S.A.R.,University of Queensland
Journal of Neurotrauma

The debate over the effects of the timing of surgical spinal decompression after traumatic spinal cord injury (tSCI) has remained unresolved for over a century. The aim of the current study was to perform a systematic review and quality-adjusted meta-analysis of studies evaluating the effects of the timing of spinal surgery after tSCI. Studies were searched for through the MEDLINE ® database (1966 to August 2012) and a 15-item, tailored scoring system was used for assessing the included studies' susceptibility to bias. Random effects and quality effects meta-analyses were performed. Models were tested for robustness using one way and criterion-based sensitivity analysis and funnel plots. Results are presented as weighted mean differences (WMDs) and odds ratios (ORs) with 95% confidence intervals (CIs). A total of 18 studies were analyzed. Heterogeneity was evident among the studies included. Quality effects models showed that-when compared with "late" surgery-"early" spinal surgery was significantly associated with a higher total motor score improvement (WMD: 5.94 points, 95% CI:0.74,11.15) in seven studies, neurological improvement rate (OR: 2.23, 95% CI:1.35,3.67) in six studies, and shorter length of hospital stay (WMD:-9.98 days, 95% CI:-13.10,-6.85) in six studies. However, one way and criterion-based sensitivity analyses demonstrated a profound lack of robustness among pooled estimates. Funnel plots showed significant proof of publication bias. In conclusion, despite the fact that "early" spinal surgery was significantly associated with improved neurological and length of stay outcomes, the evidence supporting "early" spinal surgery after tSCI lacks robustness as a result of different sources of heterogeneity within and between original studies. Where the conduct of a surgical, randomized controlled trial seems to be an unfeasible undertaking in acute tSCI, methodological safeguards require the utmost attention in future cohort studies. (Prospero registration number: PROSPERO CRD42012003182. See also http://www.crd.york.ac.uk/NIHR- PROSPERO/) © Copyright 2013, Mary Ann Liebert, Inc. 2013. Source

Wang D.,National Spinal Injuries Center | Sun T.,Beijing Army General Hospital
Spinal Cord

Study design: Literature review. Objective: To study the progress that has been made in neural plasticity for the past few decades. Setting: United Kingdom/China. Methods: An electronic search of relevant publications through PubMed was conducted using two key words: 'axonal regeneration' and 'neural plasticity'. The search included publications of the past three decades of all languages and of both animal and human studies. After confirmation of immense increase of publications on neural plasticity, reviewing of neural plasticity alone was conducted. The review covered only the most important and clinically relevant publications. For convenience of reading by busy clinicians, discussions focused on cellular and functional levels, and only the most investigated molecules were mentioned. The size of references is also planned to be concise rather than comprehensive into three digits. Results: Neural plasticity is about memory and learning. The entire process of neural plasticity is presented in the sequence of (1) lesion-induced plasticity, (2) clearance of debris, (3) collateral sprouting (4) potentiation. The recent discovery and understanding of the important role of Chondroitinase in clearance of debris is discussed in detail. Conclusion: Neural plasticity has enormous potentials in facilitating functional recovery. It is a realistic target than structural axonal regeneration at current level of neuroscience. © 2011 International Spinal Cord Society All rights reserved. Source

A single centre survey. The objective of this study is to (1) assess patients' food intake and (2) measure satisfaction with current food provision, as judged by patients and by stakeholders (medical and nursing staff, managers and catering staff). Standardised questionnaires were used to record food intake over a 24-h period, and to evaluate the quality, ordering, delivery and overall acceptability of food provided. The food intake of 67 patients with spinal cord injury (SCI) was recorded (64% response rate) and 166 evaluations (50% response rate) were returned. Twenty-nine patients (48%) consumed three full meals a day, 17 (26%) received oral nutritional supplements, 22 (34%) received vitamin/mineral supplements, and 23 (35%) required assistance to eat. Some patients and stakeholders expressed satisfaction with the current food provision: taste good: 25 versus 17% (for patients and stakeholders, respectively); appropriate texture: 22 versus 21%; appropriate temperature: 55 versus 72% (P = 0.002); well presented: 43 versus 28%; good choice: 49 versus 59%; received meal ordered: 65 versus 37% (P < 0.001); meal served on time: 71 versus 58%; and no interruption during mealtimes: 62 versus 46%. Principal component analyses of item scores identified three main factors (food quality, food presentation and food delivery (logistics). The present study identified some areas where there appeared to have been improvement in SCI hospital catering, but with much still to be achieved. Hospital-catering systems should be tailored to meet the demands of the different patient groups to optimise nutritional intake. Periodic quality control is essential to meet recommendations and patients' expectations. Source

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