Additional file 1: of Variability and dimensionality of students’ and supervisors’ mini-CEX scores in undergraduate medical clerkships – a multilevel factor analysis

Appendix. SAS code for the multilevel factor analysis, exemplified for clinical supervisors. (DOCX 19 kb

Availability and need of home adaptations for personal mobility among individuals with spinal cord injury

<p><b>Objective</b>: To identify the availability and unmet need of home adaptations (HAs) among the Swiss population with spinal cord injury (SCI).</p> <p><b>Design</b>: Cross-sectional study.</p> <p><b>Setting</b>: Swiss Spinal Cord Injury Community Survey 2012.</p> <p><b>Participants</b>: Individuals aged 16 or older with chronic SCI living in Switzerland.</p> <p><b>Interventions</b>: Not applicable.</p> <p><b>Outcome measures</b>: The availability of ten HAs (self-report) was analyzed by sex, age, living situation, indoor mobility, SCI severity, SCI etiology and time since SCI. The unmet need (self-report of not having a HA but needing it) of HAs was analyzed by financial hardship.</p> <p><b>Results</b>: Among the 482 study participants (mean age 55.2 years, standard deviation 15.0 years, 71.6% males), 85.1% had at least one HA. The most frequent HA was a wheelchair accessible shower (62.7%). Availability of HAs markedly varied with indoor mobility (e.g. 38.4% of participants using a wheelchair had a stair lift compared to 17.4% of those walking) and with SCI severity (e.g. 54.8% of those with complete paraplegia had a wheelchair accessible kitchen worktop compared to 26.0% of those with incomplete paraplegia). Unmet need was highest for adjustable kitchen worktops (78.7% of those with a need) and adjustable kitchen cabinets (75.7%) and lowest for wheelchair accessible showers (9.4%) and grab bars next to the toilet (8.5%). No significant differences in unmet need were found when stratifying for financial hardship.</p> <p><b>Conclusion</b>: Availability of HAs is dependent on indoor mobility and SCI severity. There is a considerable degree of unmet need for selected HAs, which couldn't be explained by financial hardship.</p

Satisfaction with access and quality of healthcare services for people with spinal cord injury living in the community

<p><b>Objective:</b> To identify barriers to access healthcare services and reveal determinants of satisfaction with healthcare services in people with chronic spinal cord injury (SCI).</p> <p><b>Design:</b> Cross-sectional survey.</p> <p><b>Setting</b>: Community setting in Switzerland.</p> <p><b>Participants</b>: People with chronic SCI.</p> <p><b>Interventions</b>: Non-applicable.</p> <p><b>Outcome Measures</b>: Questionnaire-based evaluation of availability and quality of healthcare services for secondary health conditions, satisfaction with fulfillment of healthcare needs, and preference for care from a hypothetical service provider with limited specialized SCI care expertise but in close proximity over comprehensive care from an existing specialized SCI center located at a greater distance.</p> <p><b>Results:</b> Close to three-quarter of participants (70%) indicated satisfaction with healthcare services received for SCI related health conditions. Elderly individuals (61+ years old) rated the availability and quality of healthcare 6% to 11% higher than younger individuals. The perceived fulfillment of healthcare needs was lower in people with incomplete paraplegia (odds ratio (OR) 2.11, 95%-credibility interval (CI) 1.18–3.84), chronic pain (OR 1.85, CI 1.12–3.08), insufficient access to long distance transportation (OR 5.81, CI 2.74–12.82), and longer travel distances to specialized SCI centers.</p> <p><b>Conclusion:</b> Perceived inadequateness of access to healthcare services was partly related to transportation barriers, suggesting that outreach services or support with transportation are possible solutions. People with incomplete paralysis and pain consistently rated the fulfillment of care needs associated with SCI less favorably, pointing to the need for enhanced advocacy for this vulnerable groups.</p

Additional file 1 of Use of professional home care in persons with spinal cord injury in Switzerland: a cross-sectional study

Additional file 1

Treatment approaches of stage III and IV pressure injury in people with spinal cord injury: A scoping review

The treatment of pressure injury (PI) stage III and IV in people with spinal cord injury or spinal cord disorder (SCI/D) requires a multidisciplinary and surgical involvement. This scoping review aims to identify published relevant surgical multidisciplinary treatment approaches, describe the elements and evaluate the effectiveness of the approaches. We searched PubMed and Medline databases for studies about treatment approaches for people aged ≥18 years with chronic SCI/D and PI stage III or IV over ischium, trochanter or sacrum published between January 1990 and December 2021 in English or German language. Two independent reviewers screened the articles. One reviewer extracted information on study author(s), year of publication, study title, study design, country of origin, sample size as well as data on elements and effectiveness of the approaches. 10 different approaches were described in two retrospective cohort studies, three case series, five discussion papers, one review and one guideline. All approaches included debridement, flap surgery, pressure relief and immobilization as well as infection control. Some approaches described elements such as risk screening (7/10), osteomyelitis treatment (8/10), nutritional therapy (8/10), physiotherapy, occupational therapy and psychology (6/10), spasticity control (7/10), and prevention and education (6/10). Only one study reported on the effectiveness of the approaches. There are key elements for surgical multidisciplinary treatment approaches. However, due to differences in the content of some of these elements and missing elements in some approaches, comparability is difficult and the effectiveness of the complex approaches remains uncertain.</p