The prolonged mechanical ventilation that is often required by patients with severe COVID-19 is expected to result in significant intensive care unit-acquired weakness (ICUAW) in many of the ...survivors. However, in our post-COVID-19 follow-up clinic we have found that, as well as the anticipated global weakness related to loss of muscle mass, a significant proportion of these patients also have disabling focal neurological deficits relating to multiple axonal mononeuropathies. Amongst the 69 patients with severe COVID-19 that have been discharged from the intensive care units in our hospital, we have seen 11 individuals (16%) with such a mononeuritis multiplex. In many instances, the multi-focal nature of the weakness in these patients was initially unrecognised as symptoms were wrongly assumed to relate simply to “critical illness neuromyopathy”. While mononeuropathy is well recognised as an occasional complication of intensive care, our experience suggests that such deficits are surprisingly frequent and often disabling in patients recovering from severe COVID-19.
Introductions: Reduplicative paramnesia (RP) is a rare and poorly understood phenomenon in which a person believes the place they are in has been replicated and exists in two places at once. There is ...minimal extant theoretical work addressing possible cognitive mechanisms subtending RP.
Method: We present a new case of RP and discuss the therapeutic and theoretical implications of this case for the management and understanding of this phenomenon. Using the hypothetico-deductive approach to a neuropsychological case, we examine the phenomenon in the light of one and two-factor approaches to understanding the genesis of delusions.
Results: The individual discussed in this case showed some evidence of relatively efficient incorporation of new evidence (belief updating) despite concurrently maintaining a delusional belief system.
Conclusion: This case raises novel challenges for the two-factor account of neurological delusions.
Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson’s disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to ...unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoea is typically reserved as a last resort for patients. IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US and UK marketing authorization for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults. In this review, we discuss and compare the frequency and method of administration, location of treatment delivery, approximate annual costs and main side effects of botulinum toxin and different anticholinergic drugs. Management of patients with chronic neurological conditions requires input from multiple specialist teams and thus a multidisciplinary team (MDT) approach is considered fundamental to ensure that care is consistent and tailored to patients’ needs. To ensure that adult patients with neurological conditions receive the best care and sialorrhoea is well managed, we suggest a potential clinical care pathway for sialorrhoea with a MDT approach, which healthcare professionals could aspire to.
Healthcare is delivered in a very complicated environment where numerous variables affect the patient related outcomes. A multidisciplinary team that places a high priority on patient satisfaction ...and healthcare quality can help to simplify and manage the environment of complex healthcare delivery. The foundation of rehabilitation treatments is a multidisciplinary team approach to provide interventions and care for the patients. Regardless of the population studied, multidisciplinary rehabilitation has been shown to be more effective than therapy delivered by individual therapists in a number of different populations. Due to the patient's complex impairments, a team-based approach is necessary for assessments and facilitates coordinated care planning in the rehabilitation settings. The aim of this paper is to offer a narrative review of the advantages and challenges of multidisciplinary team working. The key components of teamwork in rehabilitation are the individualization of patient care and effective team communication.
Purpose This paper aims to provide a focused review of international business (IB) literature on research and development (R&D) internationalization, assessing the progress and proposing future ...research directions. Design/methodology/approach Total 167 peer-reviewed articles from IB journals (following the ABS list 2021 from 4* to 2) published between 1996 and 2022 are critically reviewed using a science-mapping approach. This paper used Bibliometrix R-package to analyze the retrieved bibliometric data. Additionally, a strategic diagram was developed to comprehend the maturity stage of various R&D internationalization concepts. Findings Most studies on R&D internationalization are influenced by perspectives from advanced-economy multinational enterprises (AMNEs), while perspectives from emerging-economy multinational enterprises (EMNEs) are underrepresented. Considering the characteristics of emerging economies, firms from these locations might embark on and develop their R&D internationalization strategies differently. Investigating the emerging economy perspectives will enrich the understanding of R&D internationalization strategies for both AMNEs and EMNEs. Additionally, bringing different underutilized theoretical perspectives will help to untangle the anomalies observed in extant literature. Originality/value This paper is among the few to scrutinize the IB literature on R&D internationalization by applying a unique combination of bibliometric techniques and a content analysis approach. By complementing existing reviews and providing fresh insights into the phenomenon, it offers a conceptual framework that can be used as a basis for further research on R&D internationalization.
Background
The outcome following traumatic brain injury (TBI) is heterogeneous and poorly defined and physical disability scales like the extended Glasgow Outcome Score (GOSE) while providing ...valuation information in terms of broad categorisation of outcome are unlikely to capture the full spectrum of deficits. Quality of life questionnaires such as SF-36 are emerging as potential tools to help characterise factors important to patients’ recovery. This study assessed the association between physical disability and subjective health rating. The relationship is of value as it may help evaluate the impact of TBI on patients’ lives and facilitate the delivery of appropriate neuro-rehabilitation services.
Methods
A single-centre retrospective study was undertaken to assess the relationship between physical outcome as measured by GOSE and quality of life captured by the SF-36 questionnaire. Cronbach’s alpha was calculated for each of the eight SF-36 domains to measure internal consistency of the test. Multivariate analysis of variance was conducted to look at the association between GOSE and the physical (PCS) and mental (MCS) component scores on the SF-36. Finally, we performed a generalised linear mixed model (GLMM) to assess the relative contribution of GOSE score, age at the time of trauma, sex and TBI duration towards MCS and PCS rating.
Results
There is a statistically significant difference in the MCS and PCS scores based on patients’ GOSE scores. The mean scores of the eight SF-36 domains showed significant association with GOSE. GLMM demonstrated that GOSE was the strongest predictor of PCS and MCS. Age was an important variable in the PCS score while time following trauma was a significant predictor of MCS rating.
Conclusions
This study highlights that patients’ physical outcome following TBI is a strong predictor of the subjective mental and physical health. Nevertheless, there remains tremendous variability in individual SF-36 scores for each GOSE category, highlighting that additional factors play a role in determining quality of life.
Traumatic brain injury (TBI) is a global public health challenge, affecting about 69 million individuals annually and being one of the leading causes of mortality. It has adverse consequences in ...terms of cognitive and physical functioning, which makes rehabilitation interventions an integral part of its management. Early neuro-rehabilitation guidelines for traumatic brain injury have not yet been developed and implemented in most of Africa especially Sub-Saharan Africa. BODY: We aimed with this Opinion to propose a collective reflection on the development and implementation of early neuro-rehabilitation guidelines as an integral part of the care in traumatic brain injury. The different aspects to be considered for reflection have been highlighted: Traumatic brain injury severity to be considered in early neuro-rehabilitation; who should be assessed and receive early neurorehabilitation, barriers to be considered for early neurorehabilitation; what early neurorehabilitation to be considered; the different phases involved in rehabilitation after mild, moderate, and severe TBI; and lastly, what perspective for the creation of neurorehabilitation teams. In conclusion, neuro-rehabilitation should start at the time of admission and should continue from the intensive care unit through the community for the moderate-to-severe traumatic brain injury population. However, mild TBI should also be considered for long-term follow-up in the community due to the fact that some mild traumatic brain injury patients might develop chronic cognitive problems or fatigue with time.
Neurorehabilitation should start at the time of admission and continue from the intensive care unit through the community for the moderate-to-severe traumatic brain injury population. There is a need to develop, agree on, and implement guidelines on early neuro-rehabilitation interventions for patients with moderate to severe traumatic brain injury in the African region, where disparities in care are common reality.
Background
Cranioplasty is an increasingly common procedure performed in neurosurgical centres following a decompressive craniectomy (DC), however, timing of the procedure varies greatly.
Objectives
...The aim of this study is to compare the surgical outcomes of an early compared to a late cranioplasty procedure.
Methods
Ninety adult patients who underwent a prosthetic cranioplasty between 2014 and 2017 were studied retrospectively. Timing of operation, perioperative complications and length of stay were assessed. Early and late cranioplasties were defined as less or more than 3 months since craniectomy respectively.
Results
Of the 90 patients, 73% received a late cranioplasty and 27% received an early cranioplasty. The median interval between craniectomy and cranioplasty was 13 months range 3–84 in late group versus 54 days range 33–90 in early group. Twenty-two patients in the early group (91%) received a cranioplasty during the original admission while undergoing rehabilitation. Complications were seen in 25 patients (28%). These included wound or cranioplasty infection, hydrocephalus, symptomatic pneumocephalus, post-operative haematoma and cosmetic issues. The complication rate was 21% in the early group and 30% in the late group (
P
value 0.46). There was no significant difference in the rate of infection or hydrocephalus between the two groups. Length of stay was not significantly increased in patients who received an early cranioplasty during their initial admission (median length of stay 77 days versus 63 days,
P
value 0.28).
Conclusion
We have demonstrated the potential for early cranioplasty to be a safe and viable option, when compared to delayed cranioplasty.
Background
Equestrian sports are regaining popularity in the United Kingdom. Due to horses’ considerable weight and speed, serious injuries can occur. Riding style and equipment differ between North ...America and the United Kingdom with previous studies focusing on the former.
Objective
This study aims to assess the pattern of horse-related injury admissions to a major trauma centre in the United Kingdom.
Methods
A retrospective study of our hospital’s trauma registry between years 2012 and 2020 was performed. Cases included those admitted for severe horse-related injuries (irrespective of age/sex) with Injury Severity Score (ISS) of ≥ 4. Demographics, injury characteristics (ISS, Glasgow Coma Scale (GCS), injury region and operations), hospital stay and Glasgow Outcome Scale (GOS) on discharge were extracted. Four groups were formed based on mechanism of injury: fall from horse, fall and horse landing on top (FL group), kicked, and fall and kicked (FK group). Comparisons in injury and outcomes were analysed between these groups.
Results
301 (2.8%) eligible cases were identified from 10,911 cases. 70.8% were female with mean (± SD) age of 42.7 (± 16.5) years. Most common mechanism of injury was fall (72.8%) then kicked (14.6%) with groups FL and FK forming < 10% each. No significant difference was found between the groups initial GCS, ISS, total or ICU length of stay and GOS (p > 0.05). Most common regions of injury were orthopaedic (41.9%), spinal (26.2%), thoracic (20.1%) and head injuries (19.3%). 75% had good recovery on GOS though there were 3 fatalities relating to severe traumatic brain injury.
Conclusion
Orthopaedic limb injuries form the majority of horse-related injuries which contrasts the 1970s where head injury prevailed which is likely due to the widespread use of better head protection. Consideration should be given to enhanced limb safety equipment to prevent injury.
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