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Objective We examine the effect of birth weight (BW) for gestational age (GA) on the temperatures reached during the treatment of neonatal hypoxic-ischemic encephalopathy (HIE) with therapeutic hypothermia (TH). Study Design Retrospective data of 1,736 neonates with HIE who received TH were extracted from the Canadian Neonatal Network database for neonates admitted from 2010 to 2017. Neonates were stratified into three BW groups: small for GA < 10th centile, large for GA > 90th centile, and according to GA 10th to 89th centile at a given gestation using Canadian population data norms. Results There was no significant difference in the lowest temperature reached, the likelihood of overshooting temperatures < 32.5°C during TH, or the change of encephalopathy stages among the three groups. Conclusion BW for GA did not appear to influence the temperatures neonates reached during hypothermia or encephalopathy stage following TH. Key Point Therapeutic hypothermia is well tolerated irrespective of weight for age SGA infants achieved and maintained target temperature similar to AGA and LGA babies Change in the Sarnat stage after hypothermia was similar across all birth weight groups [ABSTRACT FROM AUTHOR]

Objective: To compare components of inpatient rehabilitation (IR) for patients with traumatic brain injury (TBI) between Canada and the US facilities. Design: Secondary analysis of the TBI-practice-based evidence dataset. Participants: Patients with TBI who had a higher Functional Independence Measure (FIMTM) cognitive function score (≥21) that were admitted to 1 IR facility in Canada (n = 103) and 9 IR facilities in the US (n = 401). Main measures: demographic and clinical characteristics, type and intensity of activities by discipline, discharge location, FIM-Rasch score, social participation and quality of life. Results: Time from injury to rehabilitation admission was significantly longer in the Canadian cohort and they experienced a longer rehabilitation length of stay (p <.001, Cohen's d >.8). Patients in Canada received a greater total time of individual therapy and lower intensity of interventions per week from all disciplines. They also showed a higher score at discharge in FIM components, while US patients had better cognitive recovery and community participation long-term post-discharge. Conclusions: This study informs stakeholders of the large variation in service provision for patients who were treated in these two countries. These findings suggest the need for robust analyzes to investigate predictors of short and long-term outcomes considering the variation in health-care delivery. List of abbreviations: TBI: traumatic brain injury, CSI: comprehensive severity index, LoS: length of stay, OT: occupational therapy, PT: physical therapy, SLP: speech language pathology, IR: inpatient rehabilitation [ABSTRACT FROM AUTHOR]

ABSTRACT.Aim: A pretest–posttest retrospective design was used to evaluate the impact of a group-based modified constraint-induced movement therapy (mCIMT) program on upper extremity function and occupational performance.Methods: 20 children ages 3 to 18 years with hemiplegia following an acquired brain injury participated in a 2-week group mCIMT program. Upper extremity function was measured with the Assisting Hand Assessment (AHA) and subtests from the Quality of Upper Extremity Skills Test (QUEST). Occupational performance and satisfaction were assessed using the Canadian Occupational Performance Measure (COPM). Data were analyzed using a Wilcoxon signed-ranks test.Results: Group-based analysis revealed upper extremity function and occupational performance attained statistically significant improvements from pre- to postintervention on all outcome measures (AHA: Z = −3.63, p = <.001; QUEST Grasps: Z = −3.10,p= .002; QUEST Dissociated Movement: Z = −2.51,p= .012; COPM Performance: Z = −3.64, p = <.001; COPM Satisfaction: Z = −3.64,p= <.001). Across individuals, clinically significant improvements were found in 65% of participants’ AHA scores. 80% of COPM Performance scores and 70% of COPM Satisfaction scores demonstrated clinically significant improvements in at least one identified goal.Conclusions: This study is an initial step in evaluating and providing preliminary evidence supporting the effectiveness of a group-based mCIMT program for children with hemiplegia following an acquired brain injury. [ABSTRACT FROM PUBLISHER]

OBJECTIVE: To determine factors associated with case management (CM) service use in people with traumatic brain injury (TBI), using a published model for service use. DESIGN: A retrospective cohort, with nested case-control design. Correlational and logistic regression analyses of questionnaires from a longitudinal community data base. STUDY SAMPLE: Questionnaires of 203 users of CM services and 273 non-users, complete for all outcome and predictor variables. Individuals with TBI, 15 years of age and older. Out of a dataset of 1,960 questionnaires, 476 met the inclusion criteria. METHODOLOGY: Eight predictor variables and one outcome variable (use or non-use of the service). Predictor variables considered the framework of the Behaviour Model of Health Service Use (BMHSU); specifically, pre-disposing, need and enabling factor groups as these relate to health service use and access. RESULTS: Analyses revealed significant differences between users and non-users of CM services. In particular, users were significantly younger than non-users as the older the person the less likely to use the service. Also, users had less education and more severe activity limitations and lower community integration. Persons living alone are less likely to use case management. Funding groups also significantly impact users. CONCLUSIONS: This study advances an empirical understanding of equity of access to health services usage in the practice of CM for persons living with TBI as a fairly new area of research, and considers direct relevance to Life Care Planning (LCP). Many life care planers are CM and the genesis of LCP is CM. The findings relate to health service use and access, rather than health outcomes. These findings may assist with development of a modified model for prediction of use to advance future cost of care predictions. [ABSTRACT FROM AUTHOR]

In this article the authors offer their views on a well-crafted analysis regarding the difficulties in the practice of medicine, particularly in end-of-life care for patients with severe traumatic brain injury in Canada. They express approval on the findings of the study, putting emphasis on the reasons of the withdrawal of life-sustaining therapies. The authors commend the work for exploring variations in the timing of withdrawal on such therapies.

This section offers nursing-related news briefs as of October 1, 2013. Emergency nurses are urged to support the Carbon Monoxide Week from November 18 to 24, 2013. The University of York's Centre for Reviews and Dissemination (CRD) endorsed a systematic reviews of interventions for the acute phase of mild traumatic brain injury. The National Institute for Health Care Excellence (NICE) published a guideline for the prevention, detection and treatment of acute kidney injury (AKI).