scholarly journals The pattern of hospital-community-home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: is it feasible?

2020 ◽  
Author(s):  
Xiangyi Yin ◽  
Jie Wu ◽  
Lihui Zhou ◽  
Chunyan Ni ◽  
Minyan Xiao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Nursing Care ◽  
Severe Traumatic Brain Injury ◽  
Barthel Index ◽  
Control Group ◽  
Severe Tbi

Abstract Background Tracheostomy is very common in patients with severe traumatic brain injury (TBI), and long-term nursing care are needed for those patients. We aimed to evaluate the effects of hospital-community-home (HCH) nursing in those patients. Methods Tracheostomy patients with severe TBI were included. Glasgow coma score (GCS), Karnofsky, Self-Anxiety Scale (SAS) and Barthel assessment at the discharge and two months after discharge were evaluated. Results A total of 60 patients were included. There weren’t significant differences between two groups in the GCS, Karnofsky, SAS and Barthel index at discharge((all p > 0.05), the GCS, Karnofsky and Barthel index was all significantly increased after two months follow-up for two groups (all p < 0.05), and the GCS, Karnofsky and Barthel index at two months follow-up in HCH group was significantly higher than that of control group(all p < 0.05), but the SAS at two months follow-up in HCH group was significantly less than that of control group(p = 0.009). The incidence of block of artificial tracheal cannula and readmission in HCH group were significant less than that of control group (all p < 0.05). Conclusion HCH nursing care is feasible in tracheostomy patients with severe TBI, future studies are needed to further evaluate the role of HCH nursing care.

scholarly journals The pattern of hospital-community-home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: is it feasible?

2020 ◽  
Author(s):  
Xiangyi Yin ◽  
Jie Wu ◽  
Lihui Zhou ◽  
Chunyan Ni ◽  
Minyan Xiao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Nursing Care ◽  
Severe Traumatic Brain Injury ◽  
Barthel Index ◽  
Control Group ◽  
Term Care ◽  
Severe Tbi

Abstract Background: Tracheostomy is very common in patients with severe traumatic brain injury (TBI), and long-term nursing care are needed for those patients. We aimed to evaluate the effects of hospital-community-home (HCH) nursing in those patients. Methods: Tracheostomy patients with severe TBI needing long-term care were included. All patients underwent two months long follow-up. Glasgow coma score (GCS), Karnofsky, Self-Anxiety Scale (SAS) (SAS) and Barthel assessment at the discharge and two months after discharge were evaluated. The tracheostomy related complications were recorded and compared.Results: A total of 60 patients were included. There weren’t significant differences between two groups in the GCS, Karnofsky, SAS and Barthel index at discharge((all p>0.05), the GCS, Karnofsky and Barthel index was all significantly increased after two months follow-up for two groups (all p<0.05), and the GCS, Karnofsky and Barthel index at two months follow-up in HCH group was significantly higher than that of control group(all p<0.05), but the SAS at two months follow-up in HCH group was significantly less than that of control group(p=0.009). The incidence of block of artificial tracheal cannula and readmission in HCH group were significant less than that of control group (all p<0.05).Conclusion: HCH nursing care is feasible in tracheostomy patients with severe TBI, future studies are needed to further evaluate the role of HCH nursing care.

Do long-term results justify decompressive craniectomy after severe traumatic brain injury?

2008 ◽  
Vol 109 (4) ◽  
pp. 685-690 ◽  
Author(s):  
Matthias H. Morgalla ◽  
Bernd E. Will ◽  
Florian Roser ◽  
Marcos Tatagiba
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Barthel Index ◽  
Case Series ◽  
Clinical Results ◽  
Long Term Results

Object A decompressive craniectomy can be a life-saving procedure to relieve critically increased intracranial pressure. The survival of a patient is important as well as the subsequent and long-term quality of life. In this paper the authors' goal was to investigate whether long-term clinical results justify the use of a decompressive craniectomy. Methods Thirty-three patients (20 males and 13 females) with a mean age of 36.3 years (range 13–60 years) with severe traumatic brain injury (Grades III and IV) and subsequent massive brain swelling were examined. For postoperative assessment the Barthel Index was used. A surgical intervention was based on the following criteria: 1) The intracranial pressure could not be controlled by conservative treatment and constantly exceeded 30 mm Hg (cerebral perfusion pressure < 50 mm Hg). 2) Transcranial Doppler ultrasonography revealed only a systolic flow pattern or systolic peaks. 3) There were no other major injuries. 4) The patient was not older than 60 years. Results One-fifth of all patients died and one-fifth remained in a vegetative state. Mild deficits were seen in 6 of 33 patients. A full rehabilitation (Barthel Index 90–100) was achieved in 13 patients (39.4%). Five patients could resume their former occupation, and another 4 had to change jobs. Conclusions Age remains to be one of the most important exclusion factors. Decompressive craniectomy provided good clinical results in nearly 40% of patients who were otherwise most likely to die. Therefore, long-term results justify the use of decompressive craniectomy in this case series.

scholarly journals Prognostic Value of Admission Parameters in a Machine Learning Predictive Model in Patients With Severe Traumatic Brain Injury and Acute Subdural Hematomas

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Kevin John ◽  
Aaron McPheters ◽  
Andrew Donovan ◽  
Nicolas K Khattar ◽  
Jacob R Shpilberg ◽  
...  
Keyword(s):  
Machine Learning ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Predictive Model ◽  
Severe Traumatic Brain Injury ◽  
Acute Subdural Hematoma ◽  
High Morbidity ◽  
Radiographic Findings ◽  
Severe Tbi

Abstract INTRODUCTION Acute subdural hematoma (aSDH) in the context of severe traumatic brain injury (TBI) is a neurosurgical emergency. Predictive models have been used in an attempt to modulate the morbidity and mortality of patient outcomes. We used machine learning (ML) to identify admission risk factors predictive of long-term morbidity in the severe TBI patient population with aSDH. METHODS Between 2013 and 2016, 85 patients with severe TBI and aSDH were included in the analysis. Random forest, ML architecture, was used to create a predictive model of long-term morbidity stratification. About 46 patients were included in the high morbidity group [Glasgow Outcome Scale (GOS) 1-2] and 39 patients were in the low morbidity group (GOS 3-5). We included 30 admission input variables including medical and surgical co-morbidities, neurological examination, laboratory values, and radiographic findings. RESULTS The predictive model showed a 78% precision. The highest scoring input variable was the pupillary examination in predicting high vs low morbidity (bilaterally unreactive vs symmetrically reactive; P < .0001). GCS on admission was higher in the low morbidity group (4 [3-7] vs 7 [3-7]; P < .0101). Rotterdam scores were higher in the high-morbidity group (3 [3-5] vs 4 [4-5]; P < .0032). GCS motor examination on admission was higher in the low-morbidity group (5 [1-5] vs. 2 [1-5]; P < .0106). The basal cisterns were found to be more patent in patients with the low-morbidity group (P = .0012). CONCLUSION ML is an efficient tool that can provide a reasonable level of accuracy in predicting long-term morbidity in patients with severe TBI and aSDH. Monitoring these admission criteria can help with risk-stratification of patients into higher and low risk tracks. Integration of ML into the treatment algorithm may allow the development of more refined guidelines to guide goal-directed therapy.

Respiratory, Physical, and Psychological Benefits of Breath-Focused Yoga for Adults with Severe Traumatic Brain Injury (TBI): A Brief Pilot Study Report

2012 ◽  
Vol 22 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Colin Silverthorne ◽  
Sat Bir Khalsa ◽  
Robin Gueth ◽  
Nicole DeAvilla ◽  
Janie Pansini
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pilot Study ◽  
Severe Traumatic Brain Injury ◽  
Well Being ◽  
Small Sample ◽  
Longitudinal Change ◽  
Control Group ◽  
Psychological Well Being ◽  
Severe Tbi

Objective: This pilot study was designed to identify the potential benefits of breath-focused yoga on respiratory, physical, and psychological functioning for adults with severe traumatic brain injury (TBI). Participants: Ten individuals with severe TBI who self-selected to attend weekly yoga classes and 4 no-treatment controls were evaluated. Methods: Participants were assessed at pretreatment baseline and at 3-month intervals for a total of 4 time points over 40 weeks. Outcomes of interest included observed exhale strength, ability to hold a breath or a tone, breathing rate, counted breaths (inhale and exhale), and heart rate, as well as self-reported physical and psycho-logical well-being. Results: Repeated within-group analyses of variance revealed that the yoga group demonstrated significant longitudinal change on several measures of observed respiratory functioning and self-reported physical and psychological well-being over a 40-week period. Those in the control group showed marginal improvement on 2 of the 6 measures of respiratory health, physical and social functioning, emotional well-being, and general health. The small sample sizes precluded the analysis of between group differences. Conclusion: This study provides preliminary evidence that breath-focused yoga may improve respiratory functioning and self-perceived physical and psychological well-being of adults with severe TBI.

scholarly journals Early Dynamics of Cerebrospinal CD14+ Monocytes and CD15+ Granulocytes in Patients after Severe Traumatic Brain Injury: A Cohort Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Lukas Kurt Postl ◽  
Viktoria Bogner ◽  
Martijn van Griensven ◽  
Marc Beirer ◽  
Karl Georg Kanz ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Serum Albumin ◽  
Significant Influence ◽  
Severe Traumatic Brain Injury ◽  
Elective Surgery ◽  
Flow Analysis ◽  
Severe Tbi

In traumatic brain injury (TBI) the analysis of neuroinflammatory mechanisms gained increasing interest. In this context certain immunocompetent cells might play an important role. Interestingly, in the actual literature there exist only a few studies focusing on the role of monocytes and granulocytes in TBI patients. In this regard it has recently reported that the choroid plexus represents an early, selective barrier for leukocytes after brain injury. Therefore the aim of this study was to evaluate the very early dynamics of CD14+ monocytes and CD15+ granulocyte in CSF of patients following severe TBI with regard to the integrity of the BBB. Cytometric flow analysis was performed to analyze the CD14+ monocyte and CD15+ granulocyte population in CSF of TBI patients. The ratio of CSF and serum albumin as a measure for the BBB’s integrity was assessed in parallel. CSF samples of patients receiving lumbar puncture for elective surgery were obtained as controls. Overall 15 patients following severe TBI were enrolled. 10 patients were examined as controls. In patients, the monocyte population as well as the granulocyte population was significantly increased within 72 hours after TBI. The BBB’s integrity did not have a significant influence on the cell count in the CSF.

Is Computerized Cognitive Testing Useful in Children and Adolescents with Moderate-to-Severe Traumatic Brain Injury?

2017 ◽  
Vol 23 (4) ◽  
pp. 304-313 ◽  
Author(s):  
Vickie Plourde ◽  
Brian L. Brooks
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Reaction Time ◽  
Cognitive Functioning ◽  
Children And Adolescents ◽  
Severe Traumatic Brain Injury ◽  
Effect Sizes ◽  
Medium Effect ◽  
Control Group ◽  
Severe Tbi

AbstractObjectives: Children and adolescents with moderate-to-severe traumatic brain injury (TBI) present with short and long-term neuropsychological deficits following their injury. The aim of this study was to investigate the utility of a brief computerized test battery for evaluating cognitive functioning sub-acutely following a TBI. Methods: Participants (n=33) sustained a moderate-to-severe TBI, were between 8 and 18 years old, and were assessed using CNS Vital Signs (CNSVS) within 6 months post-injury (median=0.6 month). Participants with TBI were matched to 33 healthy controls based on age, sex, and handedness to compare their cognitive functioning on the CNSVS battery. Results: Children and adolescents with moderate-to-severe TBI had significantly lower scores and large effect sizes on Reaction Time, Complex Attention, and Cognitive Flexibility domains, as well as medium effect sizes on two Visual Memory test scores and one Psychomotor Speed test score. A significantly higher percentage of participants with TBI had cognitive impairment on Reaction Time domain score compared to the control group. Finally, CNSVS domain scores correctly categorized 76% of participants as either group with TBI or control group. Conclusions: CNSVS may be a useful tool for screening cognitive abilities in children and adolescents who are early in their recovery from a moderate-to-severe TBI, particularly when a rapid screening evaluation can help guide management, interventions, and track recovery. (JINS, 2017, 23, 304–313)

scholarly journals Electro-acupuncture Improved the Outcome of the Patient with Severe Traumatic Brain Injury: A Case Report.

2020 ◽  
pp. 1-4
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Traffic Accident ◽  
Vital Signs ◽  
Consciousness Disturbance ◽  
Strong Stimulation

Abstract This case report demonstrated that electro-acupuncture treatment has improved the outcome of an adolescent with severe traumatic brain injury due to a traffic accident. The patient had a bilateral frontal hematoma, subdural hematoma, subarachnoid hemorrhage, stem hematoma and diffuse parenchymal swelling with the initial Glasgow Coma Scale score of E1V1M1. Daily electro-acupuncture therapy was prescribed with strong stimulation at GV 26 (Shuigou), PC6 (Neiguan) and EX-UE11(Shixuan) when the vital signs of the patient became stable. The patient had a full recovery of the consciousness in 30 days. The follow-up observation found that he has also restored the motor and speech functions. This result suggested a potential role of electro-acupuncture in the treatment of consciousness disturbance for patient with traumatic brain injury.

scholarly journals Home Environment as a Predictor of Long-Term Executive Functioning following Early Childhood Traumatic Brain Injury

2017 ◽  
Vol 24 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Christianne Laliberté Durish ◽  
Keith Owen Yeates ◽  
Terry Stancin ◽  
H. Gerry Taylor ◽  
Nicolay C. Walz ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Early Childhood ◽  
Brain Injury ◽  
Executive Functioning ◽  
Home Environment ◽  
Group Differences ◽  
Severe Tbi

AbstractObjectives:This study examined the relationship of the home environment to long-term executive functioning (EF) following early childhood traumatic brain injury (TBI).Methods:Participants (N=134) were drawn from a larger parent study of 3- to 6-year-old children hospitalized for severe TBI (n=16), complicated mild/moderate TBI (n=44), or orthopedic injury (OI;n=74), recruited prospectively at four tertiary care hospitals in the United States and followed for an average of 6.8 years post-injury. Quality of the home environment, caregiver psychological distress, and general family functioning were assessed shortly after injury (i.e., early home) and again at follow-up (i.e., late home). Participants completed several performance-based measures of EF at follow-up. Hierarchical regression analyses examined the early and late home environment measures as predictors of EF, both as main effects and as moderators of group differences.Results:The early and late home environment were inconsistent predictors of long-term EF across groups. Group differences in EF were significant for only the TEA-Ch Walk/Don’t Walk subtest, with poorer performance in the severe TBI group. However, several significant interactions suggested that the home environment moderated group differences in EF, particularly after complicated mild/moderate TBI.Conclusions:The home environment is not a consistent predictor of long-term EF in children with early TBI and OI, but may moderate the effects of TBI on EF. The findings suggest that interventions designed to improve the quality of stimulation in children’s home environments might reduce the long-term effects of early childhood TBI on EF. (JINS, 2018,24, 11–21)

BIOCHEMICAL PREDICTORS OF EARLY AND LONG-TERM OUTCOMES OF TRAUMATIC BRAIN INJURY IN CHILDREN

2021 ◽  
Author(s):  
Elena Sorokina ◽  
◽  
Zhanna Semenova ◽  
Valery Ivanovich Lukianov ◽  
Olga Karaseva ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Blood Serum ◽  
Glutamate Receptors ◽  
Severe Traumatic Brain Injury ◽  
Adverse Outcomes ◽  
Long Term Outcomes ◽  
Damage Repair

In children with mild and severe traumatic brain injury (TBI), the role of various damage/repair neuromarkers in the outcomes of trauma was studied. It has been shown that in the first days after TBI with adverse outcomes, there was a significant increase in NSE, S100b, NO products and a decrease in the content of BDNF and autoantibodies to NMDA (NR2) glutamate receptors (Glu) in the blood serum. After 6 months with unfavorable outcomes, there was an increase in aAb to S100b and a decrease in BDNF.

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