Is it time to rethink our management of dialysis patients undergoing elective ventral hernia repair? Analysis of the ACS NSQIP database.

PURPOSE: The number of patients on chronic dialysis is steadily increasing each year. There is little data that describes the outcomes in dialysis patients following elective ventral hernia repair, one of the most common general surgery procedures. Our objective was to compare the mortality and morbidity rates in dialysis versus nondialysis patients following elective ventral hernia repair. METHODS: We analysed the ACS NSQIP database to identify patients that underwent elective ventral hernia repair from 2005 to 2010. Univariate analysis and multivariate logistic regression was performed on all patients included. The main outcome variables were mortality and morbidity, length of hospital stay, and return to the operating room. RESULTS: Following elective ventral hernia repair, dialysis patients were more likely to die within 30 days or experience at least one morbidity. Dialysis patients were more likely to experience an infectious, pulmonary or vascular complication. Patients on dialysis also had a 2-fold greater risk of returning to the operating room within 30 days and stayed in the hospital an average of 1.3 days longer than nondialysis patients. Similar results were found after adjustment for demographics and comorbidities using multivariable logistic regression. CONCLUSION: This is one of the largest studies demonstrating the outcomes of a specific general surgery procedure in dialysis patients. Chronic dialysis prior to elective ventral hernia repair is associated with an increased risk of 30-day mortality, morbidity, and return to the operating room. Dialysis patients are susceptible to infectious, pulmonary, and vascular post-operative complications.

A randomized clinical trial study on the effectiveness of a tele-analogy-based problem-solving programme for people with acquired brain injury (ABI).

PRIMARY OBJECTIVE: The present study reports the results of 103 persons with acquired brain injury who were randomly assigned to one of three 20-session analogy problem-solving skill training groups, namely: online training (through computer video conferencing with interactive software); computer-assisted training (through interactive patient-directed software); therapist administered training (face-to-face therapist guided training activities); and a "no-treatment" control group. RESEARCH DESIGN: Pre- and post-test quasi-experimental design. MAIN OUTCOME AND RESULTS: Individuals' problem-solving skills and self-efficacy in all four groups were assessed over a four-week period. Overall, the training methods were found to be effective in improving problem solving skills regardless of the modes of delivery (except in the case of the control group). The continuous "human touch" characteristics of the therapist-administered group showed significant better improvements in self-efficacy in problem-solving. CONCLUSION: The statistically significantly improvement in problem solving skills in the online-group suggests that this approach could effectively improve cognitive functions of person with ABI and yield training outcomes comparable to other modes of delivery such as the face-to-face training. The conceptualization and applicability of tele-cognitive rehabilitation, its implications for persons with ABI, and future studies in this research area are also discussed.

Self-efficacy outcomes of people with brain injury in cognitive skill training using different types of trainer-trainee interaction.

PRIMARY OBJECTIVE: To evaluate the effects of different trainer-trainee interaction patterns on the self-efficacy outcomes of trainees with brain injury. RESEARCH DESIGN: A pre-test and post-test randomized clinical trial design. METHODS AND PROCEDURES: One hundred and three subjects with brain injury were recruited and 83 subjects participated in analogical problem-solving training that was delivered in three respective interaction modes: (a) direct trainer-trainee interaction, (b) self-paced computer-assisted and (c) on-line training with real-time audio-visual interaction. Quizzes on daily behavioural problem- solving and a problem-solving self-efficacy rating scale were adopted as outcome measures. The trainees in the trainer-administered group that received instructions in person with a continuous 'human touch' showed more significant improvement in their problem-solving self-efficacy than the two other groups. CONCLUSIONS: Interactive modes of cognitive skill training can be flexible enough to match the needs of individual trainees. However, human interaction is considered important in promoting self-efficacy in trainees with brain injury.

Computerized errorless learning-based memory rehabilitation for Chinese patients with brain injury: a preliminary quasi-experimental clinical design study.

AIM: To evaluate the effectiveness of a computerized, errorless learning-based memory rehabilitation program for Chinese patients with traumatic brain injury (TBI). METHODS: This study adopted a pre- and post-test quasi-experimental design. A total of 37 patients with TBI were randomly assigned to a Computer-Assisted Memory Training Group (CAMG), a Therapist-administered Memory Training Group (TAMG) and a Control Group (CG). Except for the CG, the patients in both the CAMG and TAMG groups received, respectively, 1-month memory training programmes that were similar in content but differed in delivery mode. All patients were followed up 1 month after treatment. The outcome measures that were taken were the Neurobehavioural Cognitive Status Examination (NCSE or Cognistat), the Rivermead Behavioural Memory Test (RBMT) and The Hong Kong List Learning Test (HKLLT). Repeated measure analyses were performed to investigate differences among the three groups. RESULTS: The patients in the Computer-assisted Memory Rehabilitation (CAMG) and Therapist-administered Memory Rehabilitation group (TAMG) were found to perform better than the CG in the NCSE and RBMT, but no significant differences were found between the CAMG and TAMG. The CAMG showed significant improvement in their HKLLT assessment as compared with the TAMG and CG. No statistically significant differences were found between the CAMG and TAMG when comparing the post-training outcome measures with the follow-up results. CONCLUSION: There is no difference between CAMG and TAMG, but the efficacy has been demonstrated when comparing with CG. It is suggested that the combined use of an errorless learning and a computerized approach may be an effective way of enhancing the memories of patients with TBI. This new method may smooth the progress of the whole human memory process and produce a better carryover treatment effect.

Development and pilot trial of a web-based job placement information network.

The purpose of this project was to develop and pilot a web-based job placement information network aiming at enhancing the work trial and job placement opportunities of people with disabilities (PWD). Efficient uses of information technology in vocational rehabilitation were suggested to help improve PWD employment opportunities and thus enable them to contribute as responsible citizens to the society. In this preliminary study, a web-based employer network was so developed to explore Hong Kong employers' needs and intentions in employing PWD. The results indicated that Hong Kong employers generally agreed to arrange work trials for PWD whose work abilities match job requirements. They also expressed that they would offer permanent job placements to those PWD who showed satisfactory performance in work trials. The present study evidenced that using an information network could expedite communications between employers and job placement services, and thus job placement service outcomes. It is hoped that a job placement databank could thus be developed through accumulating responses from potential employers.

Community-based cognitive rehabilitation services for persons with traumatic brain injuries in China.

The present study aims to explore the need for cognitive rehabilitation services (CRS) in the community for persons with brain injuries and to understand the level of knowledge and attitudes towards cognitive rehabilitation of health care professionals in the city of Guangzhou in southern China, including their use of innovative CRS. One hundred and fifty-five medical and allied health professionals responded to a self-administered questionnaire. Of this number, 128 completed questionnaires were returned; a response rate of 82.58%. Of the respondents, 95.4% agreed with the need to develop CRS in China. They identified four areas as those for which CRS is most urgently needed: language, memory, orientation and attention rehabilitation. The relative appropriateness of settings for such CRS delivery was ranked, from most to least, as the home, hospital and community, respectively. In prioritising the modes of CRS, it was suggested that the order of preference would be face-to-face, computer-assisted and online/web-based. Home-based intervention was also ranked top among the service treatment settings. The respondents also showed a preference for the innovative online mode, which they felt should be conducted in a home rather than a hospital setting.

Learning to live independently with expert systems in memory rehabilitation.

Expert systems (ES), which are a branch of artificial intelligence, has been widely used in different applications, including medical consultation and more recently in rehabilitation for assessment and intervention. The development and validation of an expert system for memory rehabilitation (ES-MR) is reported here. Through a web-based platform, ES-MR can provide experts with better decision making in providing intervention for persons with brain injuries, stroke, and dementia. The application and possible commercial production of a simultaneously developed version for "non-expert" users is proposed. This is especially useful for providing remote assistance to persons with permanent memory impairment when they reach a plateau of cognitive training and demand a prosthetic system to enhance memory for day-to-day independence. The potential use of ES-MR as a cognitive aid in conjunction with WAP mobile phones, Bluetooth technology, and Personal Digital Assistants (PDAs) is suggested as an avenue for future study.

Gender difference in self-esteem of Hong Kong Chinese with cardiac diseases.

Self-esteem is an indicator of a person's subjective quality of life due to its close relationship to a person's behavioural competence, positive self-experience, and sense of self-actualization. The present study aimed to investigate the basis of self-esteem in people with cardiac diseases, according to gender, after their cardiac surgery. The findings showed that there were prominent gender differences in the subjects' self-esteem. Women (aged<60) showed statistically significant higher ratings in the importance of 11 life events importance and the satisfaction of three life events than men. The study also found cultural uniqueness: Hong Kong Chinese (both men and women) with cardiac diseases generally indicated that social (interpersonal) self-concept dimensions were more important than achievement (personal) self-concept dimensions in their life perception. These findings are noteworthy for setting optimum goals of rehabilitation apart from return to work.

Effectiveness of a multimedia programme and therapist-instructed training for children with autism.

The present study aimed to evaluate the effectiveness of an interactive multimedia training programme and a conventional therapist-instructed training in improving the learning behaviours of children with autism. A multiple-subject, single case-study time-series research design was adopted in the study. Six children with autism, aged 2 years 4 months to 2 years 10 months, were recruited by convenience sampling. They attended a 12-session training programme on basic concepts (e.g. colours, shapes) that was presented as an interactive multimedia training programme and also as a conventional, therapist-led training programme. The attending behaviours and appropriate responses of the subjects were videotaped for further analysis. Participants who attended the conventional therapist-instructed training programme generally showed improvement in attending behaviours and response rates; participants attending the multimedia programme also showed improvement in their attending behaviours and response rates. The results support the hypothesis that both training programmes are effective in improving the attending behaviours and appropriate responses of children with autism. The authors suggest that, because children with autism respond differently to different training approaches, customized training programmes should be considered for individual children. The implications of the methodology and the potential impact of the present study on the training of children with autism are discussed.

The effects of a computer skill training programme adopting social comparison and self-efficacy enhancement strategies on self-concept and skill outcome in trainees with physical disabilities.

PURPOSE: The aim of this controlled, quasi-experimental study was to evaluate the effects of both self-efficacy enhancement and social comparison training strategy on computer skills learning and self-concept outcome of trainees with physical disabilities. METHOD: The self-efficacy enhancement group comprised 16 trainees, the tutorial training group comprised 15 trainees, and there were 25 subjects in the control group. Both the self-efficacy enhancement group and the tutorial training group received a 15 week computer skills training course, including generic Chinese computer operation, Chinese word processing and Chinese desktop publishing skills. The self-efficacy enhancement group received training with tutorial instructions that incorporated self-efficacy enhancement strategies and experienced self-enhancing social comparisons. The tutorial training group received behavioural learning-based tutorials only, and the control group did not receive any training. The following measurements were employed to evaluate the outcomes: the Self-Concept Questionnaire for the Physically Disabled Hong Kong Chinese (SCQPD), the computer self-efficacy rating scale and the computer performance rating scale. RESULTS: The self-efficacy enhancement group showed significantly better computer skills learning outcome, total self-concept, and social self-concept than the tutorial training group. The self-efficacy enhancement group did not show significant changes in their computer self-efficacy: however, the tutorial training group showed a significant lowering of their computer self-efficacy. CONCLUSIONS: The training strategy that incorporated self-efficacy enhancement and positive social comparison experiences maintained the computer self-efficacy of trainees with physical disabilities. This strategy was more effective in improving the learning outcome (p = 0.01) and self-concept (p = 0.05) of the trainees than the conventional tutorial-based training strategy.

Effect of exercise-based cardiac rehabilitation on mobility and self-esteem of persons after cardiac surgery.

This study adopted an experimental design with using a nonequivalent, posttest only control group to study the rehabilitation outcomes of 152 persons who received cardiac surgery. 37 subjects in a rehabilitation group participated in a 2-mo. exercise-based cardiac rehabilitation programme, and another 115 subjects who did not attend the programme formed the control group. The subjects' self-esteem was measured on the Adult Source of Self-esteem Inventory by Elvoson and Fleming, and their mobility skill was measured by a simple mobility test based on New York Heart Association Classification. Analysis of covariance (with covariance analysis of the subjects' age, years of education, occupational skill, and mobility skill) indicated that the experimental group scored higher on positive self esteem and showed significantly better improvement in mobility skill. The exercise-based cardiac rehabilitation programme positively affected physical and psychological outcomes. Also, subjects' self-esteem was significantly correlated with their mobility skills (r=.21, p<.05) among those aged under 60 years (n=96) but not among those aged 60 or above (n=53).

Self-concepts of hospitalized and day-care psychiatric patients.

The authors administered questionnaires to 44 hospitalized and 55 day-care psychiatric patients in Hong Kong. The groups were similar in sex, age, and education. The hospitalized participants, compared with the day-care participants, showed significantly higher self-concepts in general as well as in the particular aspects of social and personal aspirations. The findings indicate that support at the community level is important to help the psychiatric patients' transition from hospital care to day care.

Comparing the self-concepts of persons with and without physical disabilities.

Tam and Watkins (1995b) explored the basis of self-concepts of physically disabled and nondisabled Hong Kong Chinese adults and developed the hierarchical multidimensional self-concept models. Two questionnaires that measure self-concept were developed and validated for those groups. The questionnaires share 41 common items in 6 self-concept areas. In the present study, the 2 groups' responses were compared via univariate analysis of variance. The nondisabled participants (n = 200) were found to have statistically significantly higher means than their disabled counterparts (n = 214) in total self-concept, material self-concepts, and physical self-concepts. There were no significant differences in their family, social, and work self-concepts. The nondisabled participants reported greater openness (indicated by higher self-criticism scores).

Quality of life: theory and methodology in rehabilitation.

Rehabilitation professionals understand and respect the specific life goals of people with disabilities. Rehabilitation efforts aim at facilitating their participation in rehabilitation activities that can promote their functional independence and lead to a better life quality ultimately. However, it is essential for the rehabilitation practitioners and researchers, through scientific studies, to identify factors that contribute to their client's quality of life on the basis of their assumptions, perceptions, goals, and values. Both culturally relevant theoretical foundation and measurement methodology are essential for the development of valid and reliable life quality measuring tools for rehabilitation programme evaluation.

Efficacy outcome and sex difference in learning of hypermedia programming skills.

86 occupational therapy students participated in a 20-hr, training course in hypermedia programming for selecting functions for development of rehabilitation software. Analyses showed that the training program significantly enhanced their self-efficacy in development of software for clinical practice. The students generally showed a positive attitude towards the feasibility and significance of applying hypermedia programming in occupational therapy, but no significant sex difference in programming self-efficacy was found.

Relationship of self-concept and social desirability tendency of Hong Kong Chinese adults with physical disabilities.

A study was performed to investigate the relationship of scores on self-concept and social desirability of 214 Hong Kong Chinese adults with physical disabilities. No significant correlations were found between self-concept and social desirability; however, their social desirability scores were significantly related to their age, education, and occupational status.