Study design An online survey. Objectives To follow-up with and re-query the international spinal cord community's response to the Coronavirus Disease 2019 (COVID-19) pandemic by revisiting questions posed in a previous survey and investigating new lines of inquiry. Setting An international collaboration of authors and participants. Methods Two identical surveys (one in English and one in Spanish) were distributed via the internet. Responses from both surveys were pooled and analyzed for demographic and response data. Results Three hundred and sixty-six respondents were gathered from multiple continents and regions. The majority (63.1%) were rehabilitation physicians and only 12.1% had patients with spinal cord injury/disease (SCI/D) that they knew had COVID-19. Participants reported that the COVID-19 pandemic had caused limited access to clinician and support services and worsening medical complications. Nearly 40% of inpatient clinicians reported that "some or all" of their facilities' beds were being used by medical and surgical patients, rather than by individuals requiring inpatient rehabilitation. Respondents reported a 25.1% increase in use of telemedicine during the pandemic (35% used it before; 60.1% during), though over 60% felt the technology incompletely met their patients' needs. Conclusion The COVID-19 pandemic has negatively impacted the ability of individuals with SCI/D to obtain their "usual level of care." Moving forward into a potential "second wave" of COVID-19, patient advocacy and efforts to secure access to thorough and accessible care are essential.
Study design A cross-sectional multi-center study using an on-line survey addressing utilization, knowledge, and perceptions of medicinal cannabis (MC) by people with spinal cord injury (SCI). Objective To characterize differences between current (CU), past (PU), and never users (NU) of MC with SCI; to determine why people with SCI use MC; to examine reports of MCs' efficacy and tolerability by individuals with SCI. Setting Three academic medical centers in the United States. Methods Comparison of demographic and attitudinal differences between CU, PU, and NU and differences in the groups' reports of pain, health, and quality of life (QOL). Evaluation of utilization patterns and perceived efficacy of MC among CU and PU and reports of side effects of MC versus prescription medications. Data were analyzed using either Chi Square, distribution-free exact statistics, or t-tests for continuous data. Results Among a nationwide sample (n = 353) of individuals with SCI, NU were less likely than CU and PU to believe that cannabis ought to be legalized and more likely to endorse risks of use. Current users and PU reported greater pain interference in daily life than did NU, but there were no between group differences in QOL or physical or emotional health. Current users and PU took MC to address pain (65.30%), spasms (63.30%), sleeplessness (32.70%), and anxiety (24.00%), and 63.30% reported it offered "great relief" from symptoms. Participants reported that MC is more effective and carries fewer side effects than prescription medications. Conclusions Medicinal cannabis is an effective and well-tolerated treatment for a number of SCI-related symptoms.
Study design An observational study based on an online survey addressing attitudes toward and knowledge of cannabis among people living with spinal cord injury (SCI). Objectives To characterize attitudes toward and knowledge of cannabis among a nationwide sample (n = 353) of people with SCI. To determine if knowledge and attitudes are influenced by socio-demographic and injury-specific factors. Setting Three academic medical centers in the US. Methods Distribution of an online survey through email lists maintained by 3 SCI centers. Results Participants largely believed that cannabis use is safe, has potential therapeutic benefits, and ought to be legal. Substantial pluralities felt that cannabis use is attended by moderate to great health-related and social risks (15.5% and 25.5%, respectively), and a majority (55.9%) felt it is attended by moderate to great legal risks. Subjects' duration of injury, employment status, and personal history of controlled or illicit substances influenced certain beliefs and attitudes. Conclusions This study is the first to assess beliefs about and attitudes toward cannabis use among a nationwide sample of people with SCI. While limited, it provides a roadmap for future research. It also offers medical providers an initial understanding of which factors may encourage or dissuade their patients with SCI from seeking medical cannabis treatment.
Study design An online questionnaire. Objectives To gauge spinal cord injury (SCI) specialists' assessment of their communications with general practitioners (GPs). To determine whether economic or health-care system-related factors enhance or inhibit such communication. Setting A collaboration of co-authors from a health-care system. Methods An online survey interrogating a number of aspects of communication between SCI specialists and GPs was developed, distributed, and made available for 4 months. Responses were analyzed for the entire cohort then according to descriptions of participants' home nations' economies and the type of health-care delivery systems in which they work. Results A total of 88 responses were submitted. The majority (64%) were from nations with developed economies, a plurality (47.1%) were from countries that offer universal health coverage, and half used a combination of paper and electronic health records. A majority of respondents (61.8%) reported routinely communicating with their patients' GPs, but most (53.4%) rated those communications as only "fair". The most commonly listed barriers to communication with GPs were lack of time (46.3%) and a perceived lack of receptivity by GPs (26.9%). Nearly all respondents (91.6%) believed that the care they provide would be enhanced by improved communication with GPs. Participants who used electronic means of communication were more likely to communicate with GPs and to describe those interactions as "positive". Conclusions Although there are a number of barriers to communication between SCI specialists and GPs, most SCI specialists are eager for such inter-physician communication and believe it would enhance their care they deliver.
Ventilator-associated pneumonia has significant mortality (33%-50%). The highest risk of ventilator-associated pneumonia is early in mechanical ventilation with an increase in morbidity and mortality seen with late-onset ventilator-associated pneumonia. Prevention strategies have been recommended for acute care facilities, but there is lack of evidence-based data and recommendations for acute rehabilitation units. A multidisciplinary team designed an evidence-based ventilator-associated pneumonia prevention policy based on the Institute for Healthcare Improvement ventilator bundle. Education of rehabilitation staff and implementation of the protocol were done. Results showed that the ventilator-associated pneumonia rate decreased from 7.5 to 0 per 1000 patient ventilator days. Translating evidence-based guidelines into practice can be accomplished using a multidisciplinary team.
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