Assessment of health-related quality of life among Afghan refugees in Quetta, Pakistan.

The study aims to assess the health-related Quality of Life (HRQOL) and its association with socio-demographic factors among the Afghan refugees residing in Quetta, Pakistan. For this purpose, a cross-sectional, descriptive study design by adopting Euro QOL five dimensions questionnaire (EQ-5D) for the assessment of HRQOL was conducted by approaching Afghan refugees from the camp and other areas of Quetta, Pakistan. Furthermore, this study also involved descriptive analysis to expound participant's demographic characteristics while inferential statistics (Kruskal-Wallis and Mann-Whitney test, P < 0.05) were used to compare EQ-5D scale scores. All analyses were performed using SPSS v 20. Herein, a total of 729 participants were enrolled and were subsequently (n = 246, 33.7%) categorized based on their age of 22-31 years (31.30 ± 15.40). The results of mean EQ-5D descriptive score (0.85 ± 0.20) and EQ-VAS score (78.60 ± 11.10) indicated better HRQOL in the current study respondents as compared to studies conducted in other refugee camps around the globe. In addition, demographic characteristics including age, marital status, locality, years of living as refugees, life as a refugee residing out of Pakistan, place of residence in Afghanistan, educational qualification, occupation, and arrested for crime were the statistically significant predictors (P < 0.05) of EQ-5D index scores. However, gender, living status, monthly income, preferred place of treatment were non-significant predictors (P > 0.05). The results of current study provided evidence for a model that correlated with participant's socio-demographic information and HRQOL. Moreover, this study also revealed a baseline assessment for the health status of Afghan refugees, interestingly, these results could be applied for improving HRQOL of the given participants. In conclusion, the HRQOL of Afghan refugees residing in Quetta, Pakistan can largely be improved by providing adequate healthcare facilities, education and employment opportunities, mental and social support, and providing adequate housing and basic necessities of life.

Is the effect of a health crisis symmetric for physical and digital financial assets? An assessment of gold and bitcoin during the pandemic.

The emergence of the covid-19 health crisis, in this advanced technological era where connections between markets, nations, and economies have grown stronger than ever before, the shock of the COVID-19 pandemic quickly had an impact on both physical and digital financial assets. The Chinese financial market experienced the first consequences of the covid-19 pandemic, then spilled over to other financial markets, including those for cryptocurrencies and the precious metals. This study examines the impact of the covid-19 pandemic on the volatilities of the dynamics of bitcoin and gold. Both assets share some characteristics, such as online trading platforms, however, gold is a tangible financial asset unlike bitcoin, which is digitally generated without any physical form. This study argues that the similarities and differences between bitcoin and gold play major roles in how the covid-19 crisis affected their respective dynamics. Using daily data ranging from 9/22/2014 to 1/31/2023 and employing ARMA as the mean equation for GARCH model, the impact of the health crisis (covid-19) is examined on the volatilities of the prices and volumes of bitcoin and gold. Empirical evidence points out that, the pandemic has a symmetric impact on the volatilities of bitcoin and gold price returns, causing them to be more volatile. The impact of the covid-19 observed on the volume returns of the assets, however, is asymmetrical. The empirical results give evidence to the role that the vital differences existing between these assets played during the covid-19 pandemic.

Long Covid active case finding study protocol: A co-produced community-based pilot within the STIMULATE-ICP study (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways).

BACKGROUND AND AIM: Long Covid is a significant public health concern with potentially negative implications for health inequalities. We know that those who are already socially disadvantaged in society are more exposed to COVID-19, experience the worst health outcomes and are more likely to suffer economically. We also know that these groups are more likely to experience stigma and have negative healthcare experiences even before the pandemic. However, little is known about disadvantaged groups' experiences of Long Covid, and preliminary evidence suggests they may be under-represented in those who access formal care. We will conduct a pilot study in a defined geographical area in London, United Kingdom to test the feasibility of a community-based approach of identifying Long Covid cases that have not been clinically diagnosed and have not been referred to Long Covid specialist services. We will explore the barriers to accessing recognition, care, and support, as well as experiences of stigma and perceived discrimination. METHODS: This protocol and study materials were co-produced with a Community Advisory Board (CAB) made up primarily of people living with Long Covid. Working with voluntary organisations, a study leaflet will be distributed in the local community to highlight Long Covid symptoms and invite those experiencing them to participate in the study if they are not formally diagnosed. Potential participants will be assessed according to the study's inclusion criteria and offered the opportunity to participate if they fit them. Awareness of Long Covid and associated symptoms, experiences of trying to access care, as well as stigma and discrimination will be explored through qualitative interviews with participants. Upon completion of the interviews, participants will be offered a referral to the local social prescribing team to receive support that is personalised to them potentially including, but not restricted to, liaising with their primary care provider and the regional Long Covid clinic.

Contamination level, source identification and health risk assessment of potentially toxic elements in drinking water sources of mining and non-mining areas of Khyber Pakhtunkhwa, Pakistan.

Accelerated mining activities have increased water contamination with potentially toxic elements (PTEs) and their associated human health risk in developing countries. The current study investigated the distribution of PTEs, their potential sources and health risk assessment in both ground and surface water sources in mining and non-mining areas of Khyber Pakhtunkhwa, Pakistan. Water samples (n = 150) were taken from selected sites and were analyzed for six PTEs (Ni, Cr, Zn, Cu, Pb and Mn). Among PTEs, Cr showed a high mean concentration (497) µg L-1, followed by Zn (414) µg L-1 in the mining area, while Zn showed the lowest mean value (4.44) µg L-1 in non-mining areas. Elevated concentrations of Ni, Cr and a moderate level of Pb in ground and surface water of Mohmand District exceeded the permissible limits set by WHO. Multivariate statistical analyses showed that the pollution sources of PTEs were mainly from mafic-ultramafic rocks, acid mine drainage, open dumping of mine wastes and mine tailings. The hazard quotient (HQ) was the highest for children relative to that for adults, but not higher than the USEPA limits. The hazard index (HI) for ingestions of all selected PTEs was lower than the threshold value (HIing < 1), except for Mohmand District, which showed a value of HI >1 in mining areas through ingestion. Moreover, the carcinogenic risk (CR) values exceeded the threshold limits for Ni and Cr set by the USEPA (1.0E-04-1.0E-06). In order to protect the drinking water sources of the study areas from further contamination, management techniques and policy for mining operations need to be implemented.

Improving equity, efficiency and adherence to referral in Pakistan's eye health programmes: Pre- and post-pandemic onset.

Background: Over one billion people worldwide live with avoidable blindness or vision impairment. Eye Health Programmes tackle this by providing screening, primary eye care, refractive correction, and referral to hospital eye services. One point where patients can be lost in the treatment journey is adherence to hospital referral. Context: Peek Vision's software solutions have been used in Pakistan with the goal of increasing eye health programme coverage and effectiveness. This involved collaboration between health system stakeholders, international partners, local community leaders, social organizers and "Lady Health Workers". Results: From the beginning of the programmes in November 2018, to the end of December 2021, 393,759 people have been screened, 26% of whom (n = 101,236) needed refractive services or secondary eye care, and so were referred onwards to the triage centers or hospital services. Except for a short period affected heavily by COVID-19 pandemic, the programmes reached an increasing number of people over time: screening coverage improved from 774 people per month to over 28,300 people per month. Gathering and discussing data regularly with stakeholders and implementers has enabled continuous improvement to service delivery. The quality of screening and adherence to hospital visits, gender balance differences and waiting time to hospital visits were also improved. Overall attendance to hospital appointments improved in 2020 compared to 2019 from 45% (95% CI: 42-48%) to 78% (95% CI: 76-80%) in women, and from 48% (95% CI: 45-52%) to 70% (95% CI: 68-73%) in men. These patients also accessed treatment more quickly: 30-day hospital referral adherence improved from 12% in 2019 to 66% in 2020. This approach helped to utilize refractive services more efficiently, reducing false positive referrals to triage from 10.6 to 5.9%. Hospital-based services were also utilized more efficiently, as primary eye care services and refractive services were mainly delivered at the primary healthcare level. Discussion: Despite various challenges, we demonstrate how data-driven decisions can lead to health programme systems changes, including patient counseling and appointment reminders, which can effectively improve adherence to referral, allowing programmes to better meet their community's needs.

Assessment of Adverse Drug Events, Their Risk Factors, and Management Among Patients Treated for Multidrug-Resistant TB: A Prospective Cohort Study From Pakistan.

Background: Multidrug-resistant tuberculosis (MDR-TB) is a growing public health problem. Treatment regimens used against MDR-TB are costly, prolonged, and associated with more side effects as compared with the drug-susceptible tuberculosis. This study was framed to determine the incidence of adverse drug events, risk factors, and their management in MDR-TB patients. Methods: This prospective follow-up cohort study was conducted at the site of programmatic management of drug-resistant TB located at the Pakistan Institute of Medical Sciences, Islamabad. All patients, irrespective of their age, gender, and ethnicity, were included in the study. Adverse drug events were observed in patients at different time points during the study. Patients enrolled for the treatment from January 2018 were prospectively followed till December 2020 up to their end treatment outcomes. Results: Out of 126 MDR-TB patients enrolled for treatment, 116 met the inclusion criteria and were included in the final analysis. Most patients (50.9%) were between 18 and 45 years of age. A minimum of one adverse event was experienced by (50.9%) patients. Of all the adverse events, gastrointestinal disorders were more frequent (47.4%), followed by arthralgia (28.4%) and psychiatric disturbance (20.6%). Furthermore, multivariate analysis showed a significant association with the incidence of adverse events in patients with age group above 60 years (odds ratio (OR) 4.50; 95% CI 1.05-19.2), active smokers (OR 4.20; 95% CI 1.31-13.4), delayed reporting to the TB center (OR 4.03; 95% CI 1.34-12.1), and treatment without bedaquiline regime (OR 3.54; 95% CI 1.23-10.1). Most of the patients (94.6%), counseled by the pharmacist, were found to be satisfied with the information provided and looked for more pharmacist counseling opportunities in the management of MDR-TB. Conclusion: Current findings recommend that ADEs might be well managed by timely identification and reporting. Bedaquiline coupled with other active medications lowered the chance of ADEs in MDR-TB patients. Elderly patients, active smoking behavior, and those who have a delay in the treatment initiation are more prone to ADEs. Clinical pharmacist's contribution to TB control programs may help caregivers and patients concerning the rational use of medication, early detection, and management of ADEs.

Bronchial thermoplasty: State of the art.

Since the publication of a sham-controlled, randomized trial (AIR2) and subsequent marketing approval by the US Food and Drug Administration, we have significantly advanced our understanding of bronchial thermoplasty (BT)'s scientific basis, long-term safety, clinical efficacy and cost-effectiveness. In particular, the last 2 years have witnessed multiple research publications on several of these counts. In this review, we critically appraise our evolving understanding of BT's biologic underpinnings and clinical impact, offer an evidence-based patient workflow guide for the busy pulmonologist and highlight both current challenges as well as potential solutions for the researcher and the clinician.

The probabilities of type I and II error of null of cointegration tests: A Monte Carlo comparison.

This paper evaluates the performance of eight tests with null hypothesis of cointegration on basis of probabilities of type I and II errors using Monte Carlo simulations. This study uses a variety of 132 different data generations covering three cases of deterministic part and four sample sizes. The three cases of deterministic part considered are: absence of both intercept and linear time trend, presence of only the intercept and presence of both the intercept and linear time trend. It is found that all of tests have either larger or smaller probabilities of type I error and concluded that tests face either problems of over rejection or under rejection, when asymptotic critical values are used. It is also concluded that use of simulated critical values leads to controlled probability of type I error. So, the use of asymptotic critical values may be avoided, and the use of simulated critical values is highly recommended. It is found and concluded that the simple LM test based on KPSS statistic performs better than rest for all specifications of deterministic part and sample sizes.

Heterocyclic amines in cooked meat products, shortcomings during evaluation, factors influencing formation, risk assessment and mitigation strategies.

At this point in time, the evidence of a link between well-done meat intake and the incidence of cancer is stronger than it was 20 years ago. Several cohort and case-control studies have confirmed this evidence, and have shown a higher odd ratio and increased exposure to heterocyclic amines (HCAs) among those who frequently consume red meat. However, in most epidemiological studies, dietary assessment, combined with analytical data, is used to estimate the intake of HCAs, which has many inconsistencies. In addition, there is a lack of findings indicating a substantial correlation between various factors, like types of raw meat, types of meat products, and cooking methods that directly or indirectly influence the occurrence of cancer. Although numerous mitigation strategies have been developed to reduce HCAs levels in meat, there is still a high prevalence of carcinogenesis caused by HCAs in humans. The aim of this review is to summarise conflicting reports, address shortcomings and identify emerging trends of cutting-edge research related to HCAs.

Assessment of mortality from COVID-19 in a multicultural multi-ethnic patient population.

BACKGROUND: Studies indicate that ethnicity and socioeconomic disparity are significant facilitators for COVID-19 mortality. The United Arab Emirates, distinctly has a population of almost 12% citizens and the rest, immigrants, are mainly unskilled labourers. The disparate socio-economic structure, crowded housing conditions, and multi-ethnic population offer a unique set of challenges in COVID-19 management. METHODS: Patient characteristics, comorbidities, and clinical outcomes data from the electronic patient medical records were retrospectively extracted from the hospital information system of the two designated public COVID-19 referral hospitals. Chi-square test, logistic regression, and odds ratio were used to analyse the variables. RESULTS: From, the total of 3072 patients, less than one-fifth were females; the Asian population (71.2%);followed by Middle Eastern Arabs (23.3%) were the most infected by the virus. Diabetes Mellitus (26.8%), hypertension (25.7%) and heart disease (9.6%) were the most prevalent comorbidities observed among COVID-19 patients. Kidney disease as comorbidity significantly diminished the survival rates (Crude OR 9.6, 95% CI (5.6-16.6), p < 0.001) and (Adjusted OR 5.7 95% CI (3.0 - 10.8), p < 0.001), as compared to those patients without kidney disease. Similarly, the higher age of patients between 51 and 65 years, significantly decreased the odds for survival (Crude OR 14.1 95% CI (3.4-58.4), p < 0.001) and (Adjusted OR 12.3 95% CI (2.9 - 52.4), p < 0.001). Patient age beyond 66 years, further significantly decreased the odds for survival (Crude OR 36.1 95% CI (8.5-154.1), p < 0.001), and (Adjusted OR 26.6 95% CI (5.7 - 123.8), p < 0.001). CONCLUSION: Our study indicates that older ages above 51 years and kidney disease increased mortality significantly in COVID-19 patients. Ethnicity was not significantly associated with mortality in the UAE population. Our findings are important in the management of the COVID-19 disease in the region with similar economic, social, cultural, and ethnic backgrounds.

Iron turning waste: Low cost and sustainable permeable reactive barrier media for remediating dieldrin, endrin, DDT and lindane in groundwater.

The feasibility and effectiveness of iron turning waste as low cost and sustainable permeable reactive barrier (PRB) media for remediating dieldrin, endrin, dichlorodiphenyltrichloroethane (DDT), and lindane individually (batch system) and combined (continuous flow column) in water were investigated. After 10 min of reaction in a batch system, removal of endrin, dieldrin, and DDT was higher (86-91 %) than lindane (41 %) using 1 g of iron turning waste in 200 mL of pesticide solution (20 µg/L for each pesticide). Among the studied pesticides, only lindane removal decreased substantially in the presence of nitrate (37 %) and magnesium (18 %). Acidic water environment (pH = 4) favored the pesticide removal than neutral and basic environments. For the column experiments, sand alone as PRB media was ineffective for remediating the pesticides in water. When only iron turning was used, the removal efficiencies of lindane, endrin, and dieldrin were 83-88 % and remained stable during 60 min of the experiments. DDT removal was less than other pesticides (58 %). Sandwiching the iron turning waste media between two sand layers improved DDT removal (79 %) as well as limited the iron content below a permissible level in product water. In a long-term PRB column performance evaluation, iron turning waste (150 g) removed all pesticides in water (initial concentration of each pesticide = 2 µg/L) effectively (≥94 %) at a hydraulic retention time of 1.6 h. Iron turning waste, which was mainly in the form of zerovalent iron (Fe0), was oxidized to ferrous (Fe2+) and ferric (Fe3+) iron during its reaction with pesticides, and electrons donated by Fe0 and Fe2+ were responsible for complete dechlorination of all the pesticides. Therefore, it can be used as inexpensive and sustainable PRB media for groundwater remediation especially in developing countries where groundwater contamination with pesticides is more prevalent.

Global economic impact of antibiotic resistance: A review.

The pandemic of antibiotic resistance has become a serious threat to the therapeutic efficacy of the available antibiotics and their prescribed regimens. The problem is multifaceted as it encompasses medical, social, economic and anthropogenic spheres. The present review reports the global economic impact of antibiotic resistance among humans on the basis of published research as well as reports of national and international organisations. The impact is catastrophic because it includes patients, healthcare providers, researchers, pharmaceutical organisations, healthcare businesses and, moreover, national and international policy-makers. We found very serious economic impacts of the existing and emerging antibiotic resistance conditions. This study is divided into geographical regions to see the total impact. The risk of medical poverty trap is more significant in low-resource settings.

The cost of mapping trachoma: Data from the Global Trachoma Mapping Project.

BACKGROUND: The Global Trachoma Mapping Project (GTMP) was implemented with the aim of completing the baseline map of trachoma globally. Over 2.6 million people were examined in 1,546 districts across 29 countries between December 2012 and January 2016. The aim of the analysis was to estimate the unit cost and to identify the key cost drivers of trachoma prevalence surveys conducted as part of GTMP. METHODOLOGY AND PRINCIPAL FINDINGS: In-country and global support costs were obtained using GTMP financial records. In-country expenditure was analysed for 1,164 districts across 17 countries. The mean survey cost was $13,113 per district [median: $11,675; IQR = $8,365-$14,618], $17,566 per evaluation unit [median: $15,839; IQR = $10,773-$19,915], $692 per cluster [median: $625; IQR = $452-$847] and $6.0 per person screened [median: $4.9; IQR = $3.7-$7.9]. Survey unit costs varied substantially across settings, and were driven by parameters such as geographic location, demographic characteristics, seasonal effects, and local operational constraints. Analysis by activities showed that fieldwork constituted the largest share of in-country survey costs (74%), followed by training of survey teams (11%). The main drivers of in-country survey costs were personnel (49%) and transportation (44%). Global support expenditure for all surveyed districts amounted to $5.1m, which included grant management, epidemiological support, and data stewardship. CONCLUSION: This study provides the most extensive analysis of the cost of conducting trachoma prevalence surveys to date. The findings can aid planning and budgeting for future trachoma surveys required to measure the impact of trachoma elimination activities. Furthermore, the results of this study can also be used as a cost basis for other disease mapping programmes, where disease or context-specific survey cost data are not available.

Rurality and Self-Reported Health in Women with a History of Intimate Partner Violence.

OBJECTIVE: To investigate differences in self-reported health among Australian women with a history of intimate partner violence (IPV) in relation to rurality of residence. METHODS: Data were drawn from six survey waves of the Australian Longitudinal Study on Women's Health 1973-78 birth cohort. Self-reported general and mental health scores derived from the SF-36 scale were compared for women with a history of IPV living in metropolitan, regional and rural areas. Multivariable generalised estimating equations were constructed adjusting for income hardship, number of children, education, social support, age and marital status. RESULTS: Women with a history of IPV living in regional and rural areas had no significant differences in self-reported general health scores compared to their metropolitan counterparts. Rural women affected by IPV had slightly better self-reported mental health than equivalent women living in metropolitan or regional areas. The socio-demographic factors with the strongest association with self-reported health were income, education, social support, and number of children. CONCLUSIONS: Women in regional and rural areas were no more disadvantaged, in terms of self-reported general health or mental health, than IPV affected women living in major cities in Australia.

Genotoxic assessment of chlorhexidine mouthwash on exfoliated buccal epithelial cells in chronic gingivitis patients.

BACKGROUND: Chlorhexidine (CHX) is the gold standard of all chemical plaque control agents and the most commonly prescribed mouthwash. However, several studies have shown cytotoxic and genotoxic effects of CHX on various eukaryotic cells. In this study, we have used micronuclei as a biomarker of DNA damage in buccal epithelial cells of chronic gingivitis patients who were given adjunct 0.2% CHX for plaque control. MATERIALS AND METHODS: Chronic gingivitis patients who were exclusively on mechanical plaque control methods were taken as control (Group A) (n = 101), and chronic gingivitis patients who along with mechanical plaque control measures were taking 0.2% chlorhexidine mouthwash as adjunct were taken as cases (Group B) (n = 255). The Group B was further divided into 5 subgroups (B1, B2, B3, B4, B5) (n = 51) on increasing duration of usage of CHX from ≤1 week to 24 weeks. Buccal epithelial cells were gently scrapped from the buccal mucosa using soft toothbrush. The epithelial cells were collected in buffer solution and centrifuged at 8000 rpm for 5 min. The buccal epithelial cells were air dried, fixed, and stained with 5% Giemsa stain on preheated glass microscopic slides and observed under microscope to screen 2000 nucleated cells per individual for number of micronucleated cells and micronuclei as genotoxic measure. RESULTS: The mean number of micronucleated cells was found to be 0.41 ± 0.71 for Group A as compared values ranging from 1.65 ± 2.09 (Group B1) to 11.7 ± 1.87 (Group B5) in different subgroups of Group B, and similarly, the mean number of micronuclei was found to be 0.48 ± 0.80 for Group A as compared to values ranging from 2.57 ± 1.64 (Group B1) to 14.5 ± 2.49 (Group B5) in different subgroups of Group B using analysis of variance (P < 0.001). CONCLUSION: We conclude that CHX mouthwash is genotoxic to buccal epithelial cells and there is incremental trend in genotoxicity as the duration of usage is increased.

Incidence and predictive factors for dysphagia after thermal burn injury: a prospective cohort study.

The objective of this study is to determine dysphagia incidence for a consecutively admitted population of thermal burn injury patients and to determine admitting characteristics that can be used to reliably predict patients at risk of developing dysphagia after thermal burn. Four hundred thirty-eight patients with thermal burns, with or without inhalation injury, who were consecutively admitted to and received management at a state-wide burn center over a 2-year period (2007-2009) were included. All patients meeting the project's inclusion criteria underwent clinical swallowing assessment to determine the presence or absence of dysphagia. Dysphagia incidence was found to be 11.18% (n = 49) in the admitted population. Dysphagia severity at initial assessment was classified as severe for 40.82%, moderate for 30.61%, and mild for 28.57%. Statistical analysis revealed a core set of statistically significant parameters known within the first 24 hours postinjury that showed strong sensitivity and specificity for detection of dysphagia risk. These include, in isolation or in combination, with the consideration of increasing age, TBSA burnt ≥18%, head and neck burns, need for escharotomy, inhalation injury, need for intensive care admission, and need for mechanical ventilation. This is the first large, prospective cohort study to document dysphagia incidence within the thermal burn population and to validate key predictors for dysphagia risk in this population. These data will assist the allocation and planning of speech pathology services and provide an evidence-based pathway for ensuring early identification and management of patients at high risk of dysphagia after thermal burn injury.

Fundamental movement skills and self-concept of children who are overweight.

OBJECTIVE: Differences in fundamental movement skills and self-perceptions of physical ability and physical appearance of overweight and non-overweight children were investigated. METHOD: Overweight (n = 89, mean age = 8.75 ± 1.4 years, BMI z-score = 2.22, SD = 0.46, 46% male) and non-overweight (n = 27, mean age = 8.25 ± 1.5 years, BMI z-score = 0.03, SD = 0.73, 62.1% male) participants enrolled in the KOALA (Kinder Overweight Activity Lifestyle Actions) project were included. The overall objective of the KOALA project was to determine in a randomized controlled trial the effect of a Triple P (Positive Parenting Program), and a family 'Eat Well Be Active' Scouts Camp program on BMI in overweight children. Baseline between-group differences on measures of fundamental movement skills and self-concept perceptions were analyzed using independent samples t-tests. Relationships between BMI and these variables were investigated with multiple linear regression. RESULTS: Overweight children had lower scores on Bruninks-Oseretsky Test of Motor Performance-2 subtests (Bilateral Coordination, Upper Limb Coordination, Strength, Balance, and Running Speed and Agility), and Physical abilities self-concept than non-overweight children. CONCLUSIONS: Children who were overweight had significant fundamental movement skill difficulties, as well as having poorer Physical abilities self-concept perceptions compared to non-overweight children. The association between increasing BMI and poor performance of gross motor tasks has potential implications for physical activity participation. Future research is needed to determine if fundamental movement skill difficulties and low physical ability self-concept are predisposing factors for children who are overweight or associated outcomes.

Decreased Length of stay, cost savings and descriptive findings of enhanced patient care resulting from and integrated traumatic brain injury programme.

Traumatic brain injury (TBI) has enormous economic consequences. The primary objective was to evaluate the effect of implementation of an integrated TBI programme on patient-care. The research design was a retrospective institutional review for which 1875 patient records were reviewed, healthcare professionals were interviewed, patient care was observed, and a literature review of the prognostic variables for mild, moderate and severe TBI was conducted. The implementation of an integrated TBI programme has reduced the average length of stay from 30.5 to 12 days and resulted in tremendous cost savings of $21.8 million over 6 years. 'Blueprinting' the continuum of TBI patients' care identified the weakest links to be the transfer of patients from the tertiary-care TBI programme to rehabilitation institutions and provision of long-term rehabilitative care due to information asymmetry. This was addressed by the development of comprehensive on-line TBI transfer documents. This study emphasizes the importance of comprehensive neurotrauma programmes.