[Neurorehabilitation, neurology, rehabilitation medicine]. / Neurorehabilitáció, neurológia, rehabilitácios medicina.

We have read several publications of great authority on the neurological profession in the last two years in which were expressed assessments of the current situation combined with opinions about neurology and the necessity to reorganize neurological patient care. These articles took up the question of neurorehabilitation too. The authors, who on a daily basis, deal with the rehabilitation of people with disabilities as a consequence of neurological conditions, summarize some important definitions of rehabilitation medicine and the present system of neurological rehabilitation, as it is defined by the rehabilitation profession.

[The role of pharmacotherapy audit in the improvement of drug therapy during inpatient rehabilitation care. Experience at the National Institute of Medical Rehabilitation, Hungary]. / Gyógyszerauditok szerepe a gyógyszeres terápia javításában a kórházi rehabilitációs ellátásban. Tapasztalatok az Országos Orvosi Rehabilitációs Intézetben.

UNLABELLED: Pharmacotherapy is one of the most important and dangerous area in hospital health care, that explains why innumerable efforts are made worldwide to improve this process and prevent mistakes. Although clinical audit is a well known and widely used method, it is very rarely used for this purpose and scientific papers dealing with this topic can be scarcely found. In the last 20 years different quality management systems were introduced into the Hungarian hospitals, but most of them are not specific for the medical care. The most important element of quality management systems is the internal, professional audit that serves patient safety. AIMS AND METHODS: Authors report their experience on pharmacotherapy audits performed for over a decade at the National Institute of Medical Rehabilitation, Hungary. They review the method of audit meetings in details and discuss the most frequent problems. RESULTS: The results indicate that characteristics of therapeutic mistakes in the rehabilitation practice are similar to those reported in scientific literature. CONCLUSIONS: Improving knowledge on pharmacotherapy audits of rehabilitation specialists may be an important part of continuous professional advancement providing facility for dispute on other issues of patient care.

[Organization of rehabilitation for people with disabilities as a consequence of neurological conditions in Hungary]. / A neurológiai alapbetegség miatt fogyatékossá vált emberek rehabilitációjának szervezése Magyarországon.

The history of rehabilitation of people with disabilities as a consequence of neurological conditions goes back to more than four decades in Hungary. The authors describe its history, how this service is organized nowadays, questions of specialization, scientific activity and quality improvement. They emphasise: any form of neurorehabilitation service (special neurorehabilitation department or programme of a multiprofile rehabilitation unit) must meet the same criteria. Quality assurance will be provided by a new accreditation system.

[Significance of hydrocephalus following severe brain injury during post-acute rehabilitation]. / A súlyos agykárosodást követoen kialakuló hydrocephalus jelentosége a rehabilitáció során.

OBJECTIVES: We report our experiences with hydrocephalus in early rehabilitation over a seven-year period. METHOD: Retrospective study in Brain Injury Rehabilitation Unit of the National Institute for Medical Rehabilitation, between 1 January 2002 and 31 December 2008. RESULTS: At our institute in the last seven years, we treated 83 patients with secondary and six patients with primary hydrocephalus. The majority of hydrocephalus was of post traumatic origin (52) and remaining 23 following stroke (SAH, AVM, ICH) or brain operation (tumour--seven, and one cranioplasty), and all these patients had undergone ventricular shunt implantation. Mean age of patients was 36 (14-80) years. Hydrocephalus was diagnosed in our rehabilitation unit in 20 of 83 cases and the other patients were shunted before transfer to our unit. The median time point of shunting was 70 (range: 20-270) days after trauma, brain surgery or stroke. Post-operative complications were seen in 12 of 89 patients: six infections and six shunt failure and revision was necessary in 14%. In PTH cases, the post-operative improvement was seen in 40 of 52 patients being shunted and corresponded to FIM scores. At the other 31 cases, with non-traumatic origin, only two patients remain unchanged. CONCLUSIONS: Hydrocephalus is considered to be a frequent and important complication after severe brain damage. The incidence of hydrocephalus treated with shunt implantation in our neuro-rehabilitation unit was 4.4%. The postoperative improvement was 77%. Posttraumatic hydrocephalus concerns 5.2% of patients with severe TBI during last seven years in our institution. Diagnosis of posttraumatic hydrocephalus was established in 24%, and complication after shunt implantation (14%) was also recognized in the post-acute rehabilitation unit. It is strongly recommended for the team working at such type of units to obtain clinical practice. Teamwork, good cooperation between acute and postacute-care is necessary for successful rehabilitation of these patients.

Comparison of Single-Level Open and Minimally Invasive Transforaminal Lumbar Interbody Fusions Presenting a Learning Curve.

BACKGROUND: Comparison of single-level open and minimally invasive transforaminal lumbar interbody fusions (O-TLIF and MI-TLIF) of a single surgeon and presentation of his MI-TLIF learning curve in a retrospective observational cohort study. METHODS: 27 MI-TLIF and 31 O-TLIF patients, performed between 03/01/2013 and 03/31/2018, were compared regarding the operative time, blood loss, blood transfusion frequency, postoperative length of stay (LOS), and adverse events. An overall comparison of pre- and postoperative Oswestry Disability Index (ODI) results and Visual Analog Score (VAS) results of low back and leg pain was performed in the case of the two techniques. For a learning curve presentation, the MI-TLIF cases were compared and the optimal operative time was determined. RESULTS: The gender ratio and age did not differ in the groups. Operative time showed no difference (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (p=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (. CONCLUSIONS: Similar operative time and postoperative quality of life improvement can be achieved by MI-TLIF procedure as with O-TLIF, and additionally LOS and blood loss can be reduced. When comparing parameters, MI-TLIF can be an alternative option for O-TLIF with a similar complication profile. The learning curve of MI-TLIF can be steep, although it depends on the circumstances.

Complication during postacute rehabilitation: patients with posttraumatic hydrocephalus.

The objective of this study was to determine the incidence of posttraumatic hydrocephalus (PTH) among patients in our rehabilitation unit for traumatic brain injury. Furthermore, we aimed to assess the effect of shunt implantation and to identify the postoperative complication rate. This is a retrospective cohort study, in which between 2000 and 2009, data were collected from inpatients with traumatic brain injury complicated by PTH. During this period, 55 patients in our unit presented with PTH; all of these patients underwent ventricular shunt implantation. The incidence of PTH treated with shunt implantation was 4.8%. The mean age of the patients was 32 years (range 14-75 years). In 22 cases, the hydrocephalus was diagnosed in our rehabilitation unit (40%). Other patients were diagnosed and shunted before being transferred to our department. The median time of shunting was 80 days (range 20-270 days) after brain trauma. On the basis of scores of the functional independence measure, improvement could be observed in 43 cases (78%), the mean score improvement was 40 (2-81). Postoperative complications were seen in 10 patients (18%): four due to infections and six due to shunt failure. Revision was necessary in all 10 cases. Almost half of the diagnoses of PTH were established in the postacute rehabilitation unit, and all complications after shunt implantation were also recognized there. Precise clinical observation is necessary for diagnosis of PTH. Early diagnosis and treatment are important to prevent secondary complications. Teamwork and good cooperation between acute and postacute care are necessary for successful rehabilitation of patients with traumatic brain injury.