Background: Spinal cord injury (SCI) is a devastating trauma suffered by many of the victims of an earthquake that struck Northern Pakistan on October 8, 2005. It rendered approximately 600 patients paraplegic, which is the highest number ever reported in any disaster. This study was conducted to evaluate the risk of complications. Methods:The cross-sectional retrospective study covering a 2-month period was conducted on 194 patients admitted to the surgical/neurosurgical wards of Rawalpindi Medical College and allied hospitals (Holy Family Hospital, Rawalpindi General Hospital, and District Headquarter Hospital) and Melody Relief and Rehabilitation Center, Islamabad. Results:The male-to-female ratio was approximately 1:3 (n ¼ 50 [26%] and n ¼ 144 [74%], respectively). The majority (78% [n ¼ 151]) were 16 to 39 years of age; 62% (n ¼ 120) had lumbar-level injuries, 25% (n ¼ 48) had thoracic-level injuries, 9% (n ¼ 18) had thoracolumbar-level injuries, and a few had cervical-or sacral-level injuries. Forty-six percent (n ¼ 90) had American Spinal Injury Association type A injuries; 4% (n ¼ 8) were graded B, 11% (n ¼ 21) were graded C, 9% (n ¼ 18) were graded D, and 14% (n ¼ 27) were graded E. Twenty percent (n ¼ 39) developed pressure ulcers, of which 38% (n ¼ 15) had grade 1, 36% (n ¼ 14) had grade 2, 23% (n ¼ 9) had grade 3, and 3% (n ¼ 1) had grade 4. All patients developed urinary tract infections; 15% (n ¼ 30) had bowel complaints; 2% (n ¼ 3) developed deep-vein thrombosis (1 died of pulmonary embolism); and 0.05% (n ¼ 1) developed wound infection.Conclusion: Awareness of potential complications in patients with paraplegia is essential to care planning in the disaster setting. The priorities include skin, bowel, and bladder care and provision of prophylactic heparin. SCI post-disaster care requires comprehensive long-term planning.

The objective of this work was to provide computer and telecommunications skill training for paraplegics using a telemedicine training center in a curriculum that would support connectivity and offer new skills for career applications in the rehabilitation phase and beyond. This was a hospital-based, cross-sectional study. The study was conducted from October 10, 2005 to May 10, 2006 in the hospitals of Rawalpindi Medical College and the Melody Rehabilitation Center, Rawalpindi, Pakistan. These centers provided care for casualties of the October 2005 earthquake in Pakistan. One hundred and ninety four (194) paraplegics were admitted to Rawalpindi Medical College allied hospitals after injuries in the rural mountains near the epicenter. Surveys assessed the education level of the patients, and a sample of 12 patients was enrolled in computer training classes. Of the 194 patients, 144 were female and 50 were male. The majority, 78% (151) were 16-39 years of age. Although only 60% were literate, the overall literacy rate of Pakistan is just 48.7%. Telephone service at home was available after discharge for 40% of patients. Only 8% of patients had basic computer skills. All patients participated in the survey and sought to take the course. All the enrolled patients demonstrated full competency in the skills taught. The social disruption of disaster plus the new challenge of a neurological deficit in paraplegia did not deter a remarkable number of patients from a rural area from engaging in computer and telemedicine training. This study demonstrated the feasibility of educating rural paraplegics in computer skills for telemedicine. The telemedicine training center was used for this task without special equipment or personnel, thereby increasing the utilization of the facility.

A cross sectional retrospective data linkage study of older adults discharged from local hospital avoidance program between January 2017 and January 2018 was undertaken (N=286; mean age 80.5 years). The prevalence of death at 3 months, 6 months, 12 months, 18 months and 33 months was calculated. Patient demographic characteristics associated with participant’s risk of mortality at 33 months after discharge was examined using Cox multivariable regression. Patient demographic and health characteristics associated with participant mortality within 12 months of discharge was examined using multivariable logistic regression for patients with complete health characteristic data (n=195). The mortality prevalence was 17% at six months and the cumulative prevalence at one year, 18 months and 33 months post discharge were 24%, 29% and 36% respectively. Patient demographic characteristics associated with participants’ risk of mortality at 33 months after discharge were gender, age and household arrangements. Health and demographic characteristics associated with mortality within 12 months of discharge were lower cognition, increased burden of comorbidity, decreased physical function, a weight less than 55 kilograms, older age and male gender. These results indicate that a significant proportion of people attending a hospital avoidance program are likely to be entering into the final year of their life. This suggests that hospital avoidance programs should routinely identify patients who are likely nearing end of life, and support advance care planning for this patient group.

Aim Following discharge from a hospital avoidance program, to examine the prevalence of patient mortality, demographic characteristics associated with risk of mortality up to 33 months, patient demographic and health characteristics associated with mortality within 1 year. Methods A retrospective data linkage study of older adults with mean age of 80.5 years discharged from a hospital avoidance program between January 2017 and January 2018. The prevalence of death at 3, 6, 12, 18 and 33 months was calculated. Patient demographic and health characteristics associated with participant mortality within 12 (n = 195) and 33 (n = 185) months of discharge was examined using Cox multivariable regression for patients with complete health characteristic data. Results The mortality prevalence was 17% at 6 months and cumulative prevalence at 1 year, 18 months and 33 months post‐discharge were 24%, 29% and 36% respectively. Characteristics associated with mortality within 12 months of discharge were lower cognition, increased burden of comorbidity, decreased physical function, weight <55 kg and male sex. The same variables were associated with death up to 33 months as well as age, interaction between household arrangement and time, and albumin. Conclusions The establishment of potential risk indicators allows greater specificity for identifying older people at risk of dying in the next 12 months and an opportunity to discuss their advanced care planning. Geriatr Gerontol Int 2021; ••: ••–••.