Rehabilitation from meningioma.

This chapter discusses the complex process of acute rehabilitation of patients after meningioma. Acute inpatient rehabilitation after meningioma utilizes an interdisciplinary approach to provide comprehensive rehabilitation through a team of physical, occupational, and speech therapists, nurses, doctors, recreational therapists, neuropsychologists, case managers and social workers, all of whom specialize in providing rehabilitation care. The prognosis of rehabilitation outcomes in this population is similar to that of the stroke population, and patients benefit from rehabilitation to maximize function in the setting of ongoing treatment. Common functional deficits include speech, cognitive, motor, and visual deficits. Medical complications include heterotopic ossification, venous thromboembolism, bowel and bladder complications, and pain. Patients must also be managed for behavioral complications such as agitation and maintenance of the sleep-wake cycle. The wide variety of functional outcomes following meningioma diagnosis and treatment necessitates a flexible rehabilitation course including testing for deficits, monitoring of outcomes, and ongoing therapy support.

SCiPad: Effective Implementation of Telemedicine Using iPads with Individuals with Spinal Cord Injuries, a Case Series.

BACKGROUND: Individuals with spinal cord injury (SCI) must often travel long distances to see a rehabilitation specialist. While telemedicine (TM) for pressure ulcer management has been used in this population, real-time video telecommunication using iPad has never been described. OBJECTIVE: The objective of this study was to provide specialized care for persons with SCI through TM consultation expediently in order to address medical needs, manage secondary complications, and to improve quality of life (QoL) of individuals with SCI. METHODS: Ten individuals with SCI participated in the TM program using iPads for 6 months as a feasibility study at a single-center, county hospital. The participants contacted the project staff for SCI-related conditions and were then connected to an SCI-trained health-care provider within 24 hours via FaceTime. Main outcome measures included health-care utilization; QoL and psychosocial measures collected at baseline and at 6 months: Reintegration to Normal Living Index (RNLI), Life Satisfaction Index A (LSI-A), and Patient Health Questionnaire 9 (PHQ-9); and a Program Satisfaction Survey. RESULTS: Ten patients (seven with tetraplegia, three with paraplegia; eight males and two females) with an average age of 34.4 (18-54) years were enrolled. The average baseline and 6-month follow-up scores were RNLI-70.1 ± 19.7 and 74.7 ± 21.8, respectively; LSI-A-25.4 ± 7.4 and 26.4 ± 8.2, respectively; and PHQ-9 were 6.8 ± 7.2 and 8.6 ± 6.1, respectively. TM encounters included topics such as pain, bladder and skin management, medication changes, and lab results. The Program Satisfaction Survey yielded positive results with 100% of program completers stating they would recommend the program and would like to continue having TM. CONCLUSION: This is the first known successful project using iPad to provide TM in the SCI population. This study discusses the implementation of such a TM program in a health system including limitations. It describes the clinical viability of TM using iPads in the SCI population for care beyond that of just pressure ulcer management. This project provides evidence for using a tablet device like an iPad as an effective and efficient patient management tool.

Amphetamine abuse in emergency department patients undergoing psychiatric evaluation.

BACKGROUND: Amphetamine abuse accounts for numerous Emergency Department (ED) visits and is often associated with psychiatric disease, with many patients requiring involuntary psychiatric hold placement. It is a common practice in EDs to obtain a urine drug screen (UDS) as part of the "medical clearance" process for psychiatric patients. However, the prevalence of amphetamine-positive UDS in ED patients with psychiatric disease is unknown, as is the relationship of the UDS test to the final patient disposition. OBJECTIVES: The objectives of this study were to determine the prevalence of amphetamine-positive UDS in ED patients undergoing psychiatric evaluation, and whether amphetamine-positive UDS is associated with involuntary psychiatric hold placement. METHODS: This was a retrospective study of adult patients seen in a single urban university ED who had a psychiatric evaluation and a UDS over a 1-year period. Eligible patients had results of the UDS, placement of involuntary holds, past psychiatric history, chief complaint, insurance status, and demographic information recorded. Regression analysis was performed, adjusting for the listed covariates, to evaluate the independent association of amphetamine-positive UDS and involuntary psychiatric hold placement. RESULTS: A total of 1207 patients were included for analysis. Amphetamine-positive UDS were found in 14.8% of patients. Multivariate analysis showed no association of a psychiatric hold due to presence of amphetamines on UDS (adjusted odds ratio [OR] 0.76, 95% confidence interval [CI] 0.55-1.05, p=0.1). The only significant factor in placement of an involuntary hold was a past psychiatric history (adjusted OR 1.8, 95% CI 1.2-2.7, p=0.005). CONCLUSIONS: The prevalence of amphetamine-positive UDS was high in the study population; however, there was no independent association of amphetamine-positive UDS with involuntary psychiatric hospitalization.