A small but significant number of patients appear to improve clinically following cranioplasty. The so-called syndrome of the trephined may be more common than had been previously appreciated.

Substantial physical recovery beyond 18 months after decompressive craniectomy for severe TBI was not observed; however, many patients appeared to have recalibrated their expectations regarding what they believed to be an acceptable quality of life.

If the use of bifrontal decompressive craniectomies continues to increase it is important that those involved in the rehabilitation process are familiar with this rare condition. Early recognition is important so that patients can receive timely intervention and it also avoids valuable health resources being allocated to patients who cannot receive maximal benefit.

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GPs should be aware of barriers to statin therapy and useful approaches to overcome them. They could be supported by guideline recommendations that are more closely aligned to primary care as well as comprehensible patient information about lipid-lowering therapy. Future studies, exploring patients' specific needs and involving them in improving adherence behaviour, are recommended.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Results: FIM assessment was performed on all fifty patients and a Cognistat 49 assessment was performed on forty seven patients. Most improvements were seen in 50 the Cognistat scores however there appeared to be no specific areas in which there 51 was consistent improvement. There were substantial improvements in the Cognistat 52 assessment in nine patients. One patient had a much-improved FIM assessment 53 (improved from 18 to 34), but a Cognistat assessment was not possible due to poor 54 neurological function. These results suggested that improvements after cranioplasty 55 were more likely to occur in the domain of cognitive function than motor function, 56 although overall these results did not reach statistically significance. 57Bifrontal (versus unilateral) cranioplasty, timing between decompression and 58 cranioplasty and age of the patients did not appear to affect the postoperative FIM 59 scores, after adjusting for preoperative FIM scores and surgical complications. 60 Conclusions:A small but significant number of patients appear to improve clinically 61 following cranioplasty. Neurological susceptibility to a skull defect may be more 62 common than had been previously appreciated.

Introduction: Social prescribing (SP) aims to provide targeted psychosocial support and close the gap between medical and non-medical services. This review assesses the effectiveness of community-based SP interventions. Methods:We performed a systematic review and qualitative synthesis of interventional studies of community referral interventions focused on facilitating psychosocial support. We considered health-related endpoints, other patient reported outcomes, or health care utilization. Six databases, grey literature, and additional trials registers were searched. Results were screened in a two-step process, followed by data extraction, each by two independent reviewers. If data permitted such, effect sizes were calculated. Risk of bias was assessed with the EPHPP and the Cochrane RoB2 tools. Results:We identified 68 reports from 53 different projects, three were controlled studies. Uncontrolled studies with shorter time frames frequently reported positive effects. This could largely not be seen in controlled settings and for longer follow-up periods. Designs, populations, and outcomes evaluated were heterogeneous with high risk of bias for most studies.Discussion and conclusion: Current evidence suggests positive effects of SP on a variety of relevant endpoints. Due to quality deficits in the available studies, scope for conclusions concerning clinical relevance and sustainability is limited. Further methodologically rigorous controlled trials are needed. ZUSAMMENFASSUNGEinleitung: Social prescribing (SP) soll gezielte psychosoziale Unterstützung ermöglichen und die Lücke zwischen medizinischen und nicht-medizinischen Angeboten schließen. Diese Übersichtsarbeit untersucht die Wirksamkeit von gemeindebasierten SP-Interventionen.

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