title: Providing Care Beyond the Hospital: Perspective of a Tertiary Care Hospital from a Developing Country.
abstract: BACKGROUND
  Neurorehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing frequently is unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by a professional nurse.
  
  
  METHODS
  This was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of 2 groups. Group 1 (consisting of patients cared for by a professional nurse) included 94 patients and group 2 (patients cared for by family members) included 102. All these patients had activity of daily living score of ≥3. Glasgow Outcomes Scale score, time to decannulation, development/worsening of bedsores, and mortality were recorded and compared between the groups at follow-up.
  
  
  RESULTS
  The study included 196 patients. Traumatic brain injury was the most common diagnosis. Nursing requirements were similar between the 2 groups and included tracheostomy care, percutaneous endoscopic gastrostomy tube care, peripherally inserted central catheter line care, care of patients with no bone flap, and log-rolling. The outcomes of the 2 groups were comparable and included bedsore development/worsening of grade, Glasgow Outcomes Scale score at follow-up, time to decannulation, and 30-day mortality.
  
  
  CONCLUSIONS
  There was no statistically significant difference in outcomes of patients nursed by family members compared with the patients looked after by professional nurses.
authors.affiliation: Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Saad Akhtar
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Waqas
authors.affiliation: Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Badar Uddin
authors.initials: BU
authors.lastname: Ujjan
authors.affiliation: Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Adnan
authors.initials: A
authors.lastname: Salim
authors.affiliation: Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan. Electronic address: gohar.javed@aku.edu.
authors.forename: Gohar
authors.initials: G
authors.lastname: Javed
authors.affiliation: Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Syed Ijlal
authors.initials: SI
authors.lastname: Ahmed
authors.affiliation: Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Malikah
authors.initials: M
authors.lastname: Surani
authors.affiliation: Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Marium
authors.initials: M
authors.lastname: Khan
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001930:Brain Injuries / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D017028:Caregivers / Q000706:statistics & numerical data*; D019049:Developed Countries / Q000706:statistics & numerical data; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D000066530:Neurological Rehabilitation / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000534:rehabilitation*; D009732:Nursing Care / Q000706:statistics & numerical data*; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Disability; Neurosurgery; Nursing; Rehabilitation