Gender Differences in Psychosocial and Physical Outcomes in Haitian Amputees.

OBJECTIVE: The purpose of this study was to investigate the gender differences in psychosocial and physical outcomes in users of lower-extremity prostheses who became amputees after the 2010 earthquake in Haiti. METHOD: We enrolled 140 unilateral amputees in this cross-sectional study in Port-au-Prince, Haiti. Trained staff administered the assessments by reading the questions aloud to participants. Participants completed the Trinity Amputation and Prosthesis Experience Scales and Locomotor Capabilities Index about 2 yr after the earthquake. RESULTS: We found no gender differences in psychosocial adjustment and physical outcomes, except for strenuous physical activities and phantom pain, and both genders reported difficulty in social adjustment. After controlling for strenuous physical activities and phantom pain, we found that men showed worse psychosocial adjustment than women. CONCLUSION: Services for psychosocial adjustment are critical for traumatic amputees and should be incorporated into rehabilitation programs after a disaster. Interventions should consider gender roles in the indigenous culture.

Illustrating and Analyzing the Processes of Interprofessional Collaboration: A Lesson Learned from Palliative Care in Deconstructing the Concept.

BACKGROUND: A basic tenet of palliative care is interprofessional collaboration. Palliative care educators and practitioners lead the way in responding to the Institute of Medicine's (2003) challenge to transform educational and health care systems through interprofessional collaboration. Through exemplary commitment to interprofessional collaboration, a college's academic and palliative care leader, in collaboration with Department Chairs and Directors of nursing and allied health professions, can illustrate and analyze the processes of interprofessional collaboration through the development of a simulated case study of a combat veteran with traumatic brain injury. METHODS: Methodologic components: (1) interprofessional development of a palliative care case study and (2) debriefing interviews regarding the experience of collaboration of interprofessional team members. RESULTS: The results provide the identification of steps of the interprofessional process and the shared and unique disciplinary competencies in determining a comprehensive health history, physical examination, identifying and prioritizing diagnoses, and determining collaborative discipline-specific interventions. Content analysis of debriefing team interviews provides a description of group composition, structure, process, development, and performance, as well as team member's perceptions of what fosters and challenges collaboration, benefits, and drawbacks, and what could have been done differently in developing an interprofessional initiative. DISCUSSION: Transformative change in healthcare education and clinical practice involves interprofessional collaboration of colleagues within, across, and beyond universities/colleges and healthcare systems and agencies. Advocating for teamwork has to go beyond talking about being a team player or not to having the language and behaviors we need to observe and measure. This article not only provides key processes in interprofessional collaboration but also identifies key attitudes and behaviors critical to teamwork. It provides a starting point to determine observable and measurable outcomes for interprofessional education, practice, and research. This article highlights expert behavior to move professionals from being novices in interprofessional collaboration to mastering the skills.

Functional and psychosocial status of Haitians who became users of lower extremity prostheses as a result of the 2010 earthquake.

The January 12, 2010 earthquake devastated Port-Au-Prince, the capital of the Republic of Haiti, and its surroundings. Among the 300,000 injured, 1,200 to 1,500 people underwent traumatic /surgical amputations. The purpose of this study was to describe the functional and psychosocial impact of prostheses users who suffered a traumatic lower-limb amputation after the earthquake of 2010 in Haiti. We recruited 140 participants in collaboration with a large health care organization in Port-au-Prince from October 2011 to May 2012. Participants underwent an evaluation of physical impairments and completed questionnaires translated into Haitian Creole. The Trinity Amputation and Prosthesis Experience Scale (TAPES), and the Locomotor Capabilities Index (LCI) were used in this study. The questionnaires were administered verbally in Haitian Creole by a trained staff. We conducted descriptive statistics and t-tests using SPSS for data analysis. Participants had a mean age of 34.9 ± 12.0; 51.4% were women; 48.6% were transfemoral amputees. The mean of TAPES general adjustment (3.65 ± 0.59) and adjust to limitation (3.67 ± 0.86) were higher than the score for the social adjustment (2.58 ± 0.49). The LCI showed over 90% of subjects were physically independent in self-care; fewer were independent walking on uneven ground or inclement weather (69%). The relatively poor social adjustment is consistent with the literature that describes limited acceptance of people with physical disabilities in Haitian society. Prostheses users in Haiti would benefit from a health delivery infrastructure that also addresses the psychosocial reintegration of individuals with physical disabilities.

Peri-infarct reorganization of motor function in patients with pontine infarct.

OBJECTIVES: Combined functional MRI (fMRI) and diffusion tensor tractography (DTT) imaging provides a powerful vehicle for the investigation of motor recovery mechanisms. Using this combined method, we investigated the motor recovery mechanism in patients with pontine infarct. DESIGN: We evaluated six healthy control subjects and two patients with pontine infarct at 6 months from onset. fMRI was performed at 1.5 T with timed hand grasp-release movements. For DTT, we used each of the 32 noncollinear diffusion-sensitizing gradients. Three-dimensional reconstructions of the fiber tracts were obtained with FA <0.3, angle >45 degrees as termination criteria. RESULTS: fMRI data revealed activation only in the contralateral primary sensorimotor cortex during movement of either hand. DTI findings from controls and the unaffected hemisphere of the patients showed that the corticospinal tract descended through the known corticospinal tract pathway. However, the tracts of the affected hemisphere in the patients were observed to pass along peri-infarct areas (patient 1: lateral, patient 2: posterior) in the pons. CONCLUSIONS: It seems that the peri-infarct areas compensate for corticospinal tract damage at the pons; this may be one mechanism of motor recovery for patients with pontine infarct.