scholarly journals Does access to acute intensive trauma rehabilitation (AITR) programs affect the disposition of brain injury patients?

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256314
Author(s):  
Sharfuddin Chowdhury ◽  
Luke P. H. Leenen
Keyword(s):  
Brain Injury ◽  
Length Of Hospital Stay ◽  
Severe Disabilities ◽  
Early Integration ◽  
Rehabilitation Care ◽  
Rehabilitation Programs ◽  
Before And After ◽  
Chi Squared ◽  
Medical City ◽  
Discharge From Hospital

Early incorporation of rehabilitation services for severe traumatic brain injury (TBI) patients is expected to improve outcomes and quality of life. This study aimed to compare the outcomes regarding the discharge destination and length of hospital stay of selected TBI patients before and after launching an acute intensive trauma rehabilitation (AITR) program at King Saud Medical City. It was a retrospective observational before-and-after study of TBI patients who were selected and received AITR between December 2018 and December 2019. Participants’ demographics, mechanisms of injury, baseline characteristics, and outcomes were compared with TBI patients who were selected for rehabilitation care in the pre-AITR period between August 2017 and November 2018. A total of 108 and 111 patients were managed before and after the introduction of the AITR program, respectively. In the pre-AITR period, 63 (58.3%) patients were discharged home, compared to 87 (78.4%) patients after AITR (p = 0.001, chi-squared 10.2). The pre-AITR group’s time to discharge from hospital was 52.4 (SD 30.4) days, which improved to 38.7 (SD 23.2) days in the AITR (p < 0.001; 95% CI 6.6–20.9) group. The early integration of AITR significantly reduced the percentage of patients referred to another rehabilitation or long-term facility. We also emphasize the importance of physical medicine and rehabilitation (PM&R) specialists as the coordinators of structured, comprehensive, and holistic rehabilitation programs delivered by the multi-professional team working in an interdisciplinary way. The leadership and coordination of the PM&R physicians are likely to be effective, especially for those with severe disabilities after brain injury.

scholarly journals Introduction of the Community Rehabilitation Northern Queensland Service

2017 ◽  
Vol 12 (1) ◽  
pp. 47-61
Author(s):  
Merehau Cindy Mervin ◽  
Ruth Barker ◽  
Cindy Stealey ◽  
Tracy Comans
Keyword(s):  
Nervous System ◽  
Length Of Stay ◽  
Average Length ◽  
Diagnosis Related Groups ◽  
Length Of Hospital Stay ◽  
Rehabilitation Care ◽  
Average Length Of Stay ◽  
Community Rehabilitation ◽  
Before And After ◽  
Data Custodian

Objective: To analyse trends in length of hospital stay before and after the implementation of the Community Rehabilitation Northern Queensland Service (CRNQ) in Townsville, Australia. Design: Retrospective analysis of collected administrative data provided by the data custodian Townsville Hospital Health Service District. Setting: All patients discharged from the Townsville hospital between 1 July 2008 and 30 June 2013 for whom the Australian Refined Diagnosis Related Groups were stroke (B70), degenerative nervous system disorders (B67) or rehabilitation (Z60). Main outcome measures: Average length of stay and total number of inpatient episodes coded stroke, degenerative nervous system disorders or rehabilitation. Results: Length of stay for the selected diagnosis related groups was consistently ranging from 23 days to 25 days for the period 2008-2012. In the first year of full operational capacity of CRNQ (2012-13), there was an average reduction of six days in length of stay. The major reductions in length of stay occurred in patients admitted for rehabilitation care. Conclusions: This study adds additional evidence that earlier discharge can be facilitated for patients with neurological conditions living outside metropolitan areas when appropriate rehabilitation services are available in the community. Abbreviations: AR-DRG – Australian Refined Diagnosis Related Groups; CRNQ – Community Rehabilitation Northern Queensland Service.

Artifact removal from neurophysiological signals: impact on intracranial and arterial pressure monitoring in traumatic brain injury

2020 ◽  
Vol 132 (6) ◽  
pp. 1952-1960 ◽  
Author(s):  
Seung-Bo Lee ◽  
Hakseung Kim ◽  
Young-Tak Kim ◽  
Frederick A. Zeiler ◽  
Peter Smielewski ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Neurological Status ◽  
Cerebrovascular Reactivity ◽  
Cerebral Hypoperfusion ◽  
Clinical Parameters ◽  
Artifact Removal ◽  
Clinical Events ◽  
Arterial Blood ◽  
Before And After

OBJECTIVEMonitoring intracranial and arterial blood pressure (ICP and ABP, respectively) provides crucial information regarding the neurological status of patients with traumatic brain injury (TBI). However, these signals are often heavily affected by artifacts, which may significantly reduce the reliability of the clinical determinations derived from the signals. The goal of this work was to eliminate signal artifacts from continuous ICP and ABP monitoring via deep learning techniques and to assess the changes in the prognostic capacities of clinical parameters after artifact elimination.METHODSThe first 24 hours of monitoring ICP and ABP in a total of 309 patients with TBI was retrospectively analyzed. An artifact elimination model for ICP and ABP was constructed via a stacked convolutional autoencoder (SCAE) and convolutional neural network (CNN) with 10-fold cross-validation tests. The prevalence and prognostic capacity of ICP- and ABP-related clinical events were compared before and after artifact elimination.RESULTSThe proposed SCAE-CNN model exhibited reliable accuracy in eliminating ABP and ICP artifacts (net prediction rates of 97% and 94%, respectively). The prevalence of ICP- and ABP-related clinical events (i.e., systemic hypotension, intracranial hypertension, cerebral hypoperfusion, and poor cerebrovascular reactivity) all decreased significantly after artifact removal.CONCLUSIONSThe SCAE-CNN model can be reliably used to eliminate artifacts, which significantly improves the reliability and efficacy of ICP- and ABP-derived clinical parameters for prognostic determinations after TBI.

scholarly journals Psychotropic and pain medication use in individuals with traumatic brain injury—a Swedish total population cohort study of 240 000 persons

2021 ◽  
Vol 92 (5) ◽  
pp. 519-527
Author(s):  
Yasmina Molero ◽  
David James Sharp ◽  
Brian Matthew D'Onofrio ◽  
Henrik Larsson ◽  
Seena Fazel
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Total Population ◽  
Medication Use ◽  
Population Based ◽  
Pain Medication ◽  
Short Term ◽  
Pain Medications ◽  
Before And After

ObjectiveTo examine psychotropic and pain medication use in a population-based cohort of individuals with traumatic brain injury (TBI), and compare them with controls from similar backgrounds.MethodsWe assessed Swedish nationwide registers to include all individuals diagnosed with incident TBI between 2006 and 2012 in hospitals or specialist outpatient care. Full siblings never diagnosed with TBI acted as controls. We examined dispensed prescriptions for psychotropic and pain medications for the 12 months before and after the TBI.ResultsWe identified 239 425 individuals with incident TBI, and 199 658 unaffected sibling controls. In the TBI cohort, 36.6% had collected at least one prescription for a psychotropic or pain medication in the 12 months before the TBI. In the 12 months after, medication use increased to 45.0%, an absolute rate increase of 8.4% (p<0.001). The largest post-TBI increases were found for opioids (from 16.3% to 21.6%, p<0.001), and non-opioid pain medications (from 20.3% to 26.6%, p<0.001). The majority of prescriptions were short-term; 20.6% of those prescribed opioids and 37.3% of those with benzodiazepines collected prescriptions for more than 6 months. Increased odds of any psychotropic or pain medication were associated with individuals before (OR: 1.62, 95% CI: 1.59 to 1.65), and after the TBI (OR: 2.30, 95% CI: 2.26 to 2.34) as compared with sibling controls, and ORs were consistently increased for all medication classes.ConclusionHigh rates of psychotropic and pain medications after a TBI suggest that medical follow-up should be routine and review medication use.

PP164 Identifying Complications Of Partial Nephrectomy Using Physician Claims

2018 ◽  
Vol 34 (S1) ◽  
pp. 130-131
Author(s):  
Jian Sun ◽  
Tania Stafinski ◽  
Fernanda Inagaki Nagase ◽  
Devidas Menon
Keyword(s):  
Ambulatory Care ◽  
Partial Nephrectomy ◽  
Kidney Cancer ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Incidence Rates ◽  
Open Group ◽  
Robot Assisted ◽  
Before And After ◽  
Chi Squared

Introduction:Many population-based studies identify surgical complications using hospital discharge abstract databases (DAD). With DAD, however, complications occurring after the discharge date cannot be followed up. This study used physician claims data to identify the complications of partial nephrectomy, and to compare the rates of complications of open, laparoscopic, and robot-assisted nephrectomies.Methods:Physician claims, DAD, and ambulatory care data from April 2003 to March 2016 were provided by Alberta Health. DAD and ambulatory care data were used to extract information on patients with kidney cancer who underwent partial nephrectomy. All physician claims within 30 days before and after surgery for the cohort were extracted. The numbers of the same International Classification of Diseases, Ninth Revision (ICD-9), codes before and after surgery were compared. If a number increased after surgery, this diagnosis was initially identified as a complication. All diagnoses with neoplasms were excluded. The incidence rates of complications for the three surgery groups were calculated. Chi-squared tests were conducted for the following nephrectomy comparisons: laparoscopic versus open; robot-assisted versus open; and robot-assisted versus laparoscopic.Results:A total of 1,890 kidney cancer patients had partial nephrectomies. Among them, 1,080, 411, and 399 had open, laparoscopic, and robot-assisted nephrectomies, respectively. One patient who had two different nephrectomies on the same day was excluded from analysis. The robot-assisted group had lower rates of digestive complications (ICD-9: 537–578, 787, 789, 998.6) and infections (ICD-9: 004–041, 998.5) than the open group, and higher rates of genitourinary complications (ICD-9: 584–599, 788, 997.5) than the laparoscopy group. The robot-assisted group had lower rates than the open group for most of the complication categories, but the differences were not statistically significant.Conclusions:Robot-assisted surgery appears to be superior to open surgery, but no better than laparoscopic surgery, in terms of minimizing the risk of complications following partial nephrectomy.

scholarly journals Gametocyte carriage after seasonal malaria chemoprevention in Plasmodium falciparum infected asymptomatic children

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Abdullahi Ahmad ◽  
Aurelia Prom ◽  
John Bradley ◽  
Mamadou Ndiath ◽  
Blessed Etoketim ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Comparison Group ◽  
Conditional Logistic Regression ◽  
Gametocyte Carriage ◽  
Asymptomatic Children ◽  
Seasonal Malaria Chemoprevention ◽  
Before And After ◽  
Chi Squared ◽  
Comparison Groups ◽  
To Receive

Abstract Background Treatment of clinical Plasmodium falciparum malaria with sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) is associated with increased post-treatment gametocyte carriage. The effect of seasonal malaria chemoprevention (SMC) with SP and AQ on gametocyte carriage was assessed in asymptomatic P. falciparum infected children. Methods The study was carried out in eastern Gambia. Asymptomatic P. falciparum malaria infected children aged 24–59 months old who were eligible to receive SMC (SMC group) and children 5–8 years that were not eligible to receive SMC (comparison group) were recruited. Gametocytaemia was determined by molecular methods before and after SMC administration. Gametocyte carriage between the groups was compared using the chi-squared test and within-person using conditional logistic regression. Results During the 2017 and 2018 malaria transmission seasons, 65 and 75 children were recruited in the SMC and comparison groups, respectively. Before SMC administration, gametocyte prevalence was 10.7% (7/65) in the SMC group and 13.3% (10/75) in the comparison group (p = 0.64). At day 13 (IQR 12, 13) after SMC administration, this was 9.4% (5/53) in children who received at least the first dose of SMC treatment and 12.7% (9/71) for those in the comparison group (p = 0.57). Similarly, there was no difference in prevalence of gametocytes between children that adhered to all 3-day doses of SMC treatment 15.6% (5/32) and those in the comparison group (p = 0.68). In the SMC group, within-group gametocyte carriage was similar before and after SMC administration in children that received at least the first dose of SMC treatment (OR 0.6, 95% CI 0.14–2.51; p = 0.48) and in those that adhered to all 3-day doses of SMC treatment (OR 1.0, 95% CI 0.20–4.95; p = 1.0). Conclusion In this study with relative low gametocyte prevalence prior to SMC treatment, no evidence was observed that SMC treatment increased gametocyte carriage in asymptomatic P. falciparum malaria infected children.

scholarly journals Consent for the discontinuation of life-prolonging treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

2020 ◽  
Author(s):  
YuJin Chung ◽  
JinHo Beom ◽  
JiEun Lee ◽  
Incheol Park ◽  
Junho Cho
Keyword(s):  
Emergency Room ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Life Extension ◽  
Medical Decision ◽  
Patient Consent ◽  
Before And After ◽  
The Law

Abstract Background The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of nonsensical life-prolonging treatment, and its enactment raised big controversy in Korean society. However, there is no study on whether the actual life-prolonging treatment for patients has decreased after enforcing the law. This study aimed to compare the provision of patient consent before and after the enforcement of the law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of the law on cancer patients' clinical care. Methods This retrospective single cohort study included advanced cancer patients over 19 years of age who visited the emergency room at a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the average length of hospital stay. The consent rate for cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes. Results The average length of hospital stay decreased after the law was enforced, from 4 days to 2 days (p= 0.001). The rates of direct transfers to secondary and nursing hospitals increased from 8.2% to 21.2% (p=0.001) and from 1.0% to 9.7%, respectively (p<0.001). The rate of provision of consent for admission to the ICU decreased from 6.7% to 2.3% (p=0.032). For CPR and CRRT, the rate of provision of consent decreased from 1.0% to 0.0% and from 13.9% to 8.8%, respectively, but the differences were not significant (p=0.226 and p=0.109, respectively). Conclusion According to previous research, for patients wishing only conservative treatment, the reduction in hospital stays at tertiary hospitals ultimately reduces the physical, emotional, financial burdens and also improves the quality of end-of-life at home or in a hospice facility. In this context, this research ultimately show that the purpose of the LEMD law has been achieved. Further research in several hospitals including those patients who completed the consent after hospitalization is needed to generalize the clinical implication of the LEMD law.

scholarly journals Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized pilot and feasibility trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245425
Author(s):  
Tomas Vilimovsky ◽  
Peii Chen ◽  
Kristyna Hoidekrova ◽  
Jakub Petioky ◽  
Pavel Harsa
Keyword(s):  
Brain Injury ◽  
Large Scale ◽  
Statistical Significance ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Program ◽  
Prism Adaptation ◽  
Spatial Neglect ◽  
Feasibility Trial ◽  
Control Group ◽  
Rehabilitation Care

Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.

Abstract WMP89: Stroke Code De-escalation: Safety and Outcomes

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jessica Jarnot ◽  
Christopher Streib ◽  
Angela Heyer ◽  
Amy Reichert ◽  
David Anderson ◽  
...  
Keyword(s):  
Chart Review ◽  
Healthcare Providers ◽  
Retrospective Chart Review ◽  
Before And After ◽  
Chi Squared ◽  
Cost Implications ◽  
The Impact ◽  
Timely Treatment ◽  
Iv Tpa ◽  
Missed Opportunity

Introduction: “Stroke codes” (SCs) facilitate the timely treatment of acute ischemic stroke (AIS) with IV tPA or intra-arterial thrombectomy (IAT), but are inherently resource-intensive and can expose patients to unnecessary and potentially harmful interventions. While all healthcare providers are encouraged to activate SCs, this might lead to low SC-to-treatment-ratios (SCTR). We examined the impact of de-escalation of stroke codes (DSCs) on SCTR. Methods: DSCs were initiated in our institution in January 2015. All DSCs were reviewed for the patient’s eligibility for IV tPA or IAT, and reason for de-escalation. We reviewed all stroke codes 12 months before and after the initiation of this process and compared the SCTR by chi-squared testing. Results: In 2014, prior to DSCs, 253 SCs resulted in 22 AIS interventions (22 IV tPA) for a SCTR of 8.7%. In 2015, 348 SCs were activated with 64 subsequent DSCs (18.4%) and 45 AIS interventions (38 IV tPA, 7 IAT, 7 both), for a SCTR of 15.8%. The improvement in SCTR after introducing DSCs was statistically significant (p=0.012). When restricting the analysis to IV tPA interventions alone, there remained a trend (p=0.068) towards improvement in SCTR. Retrospective chart review did not reveal any DSC cases that resulted in missed opportunity for IV TPA or IAT treatment. No DSCs were due to an acute ICH. Justifications for de-escalations are summarized in figure 1. Conclusions: The introduction of DSCs resulted in a statistically significant absolute improvement in SCTR of 7.1%. Importantly, DSCs did not result in any eligible AIS patient forgoing IV tPA or IAT, nor missed ICH. More research is needed to increase the yield of stroke codes, refine the criteria for both activating and de-escalating them, and quantify the resource and cost implications of such de-escalations.

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