The treatment of spontaneous intracerebral hemorrhage

1989 ◽  
Vol 70 (5) ◽  
pp. 755-758 ◽  
Author(s):  
Seppo Juvela ◽  
Olli Heiskanen ◽  
Antti Poranen ◽  
Simo Valtonen ◽  
Timo Kuurne ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Conservative Treatment ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
Conservative Group ◽  
Level Of Consciousness ◽  
A Prospective Study ◽  
To Receive ◽  
Surgical Group

✓ In a prospective study, 52 patients with a spontaneous supratentorial intracerebral hematoma (ICH) were randomly assigned to receive emergency surgery or conservative treatment within 48 hours after the bleed. Patients with a decreased level of consciousness and/or a severe neurological deficit were admitted to the study. The overall mortality rate at 6 months was 42%: 10 (38%) of the 26 patients in the conservative group and 12 (46%) of the 26 in the surgical group. Six (20%) of the 30 survivors at 6 months were able to conduct their activities of daily living independently: five (31%) of the 16 patients in the conservative group and one (7%) of the 14 in the operative group. These differences are not statistically significant. The mortality rate of semicomatose or stuporous patients (Glasgow Coma Scale score 7 to 10) was statistically significantly lower in the surgical group (none of the four patients) than in the conservative group (four of five patients) (p < 0.05); however, all surviving patients in this subgroup were severely disabled. The study suggests that surgical treatment of this category of patients with ICH does not offer any definite advantage over conservative treatment. In semicomatose or stuporous patients, surgery may improve the length of survival, but the quality of life remains poor.

Brain shift, level of consciousness, and restoration of consciousness in patients with acute intracranial hematoma

1989 ◽  
Vol 71 (4) ◽  
pp. 498-502 ◽  
Author(s):  
Donald A. Ross ◽  
Walter L. Olsen ◽  
Amy M. Ross ◽  
Brian T. Andrews ◽  
Lawrence H. Pitts
Keyword(s):  
Statistical Significance ◽  
Intracerebral Hematoma ◽  
Brain Shift ◽  
Content Type ◽  
Poor Outcome ◽  
Level Of Consciousness ◽  
The Mean ◽  
A Prospective Study ◽  
Mass Lesions

✓ Recently, Ropper reported that horizontal brain shift caused by acute unilateral mass lesions correlated closely with consciousness, and suggested that recovery of consciousness was unlikely to occur after surgical evacuation if the shift was insufficient to explain the observed diminution of consciousness. The authors have sought to confirm the correlation of pineal shift with level of consciousness and to assess the prognostic value of brain shift measurements in a prospective study. Forty-six patients (19 with subdural hematoma, 14 with intracerebral hematoma, and 13 with epidural hematoma) were accrued to the study group consecutively. A correlation was found between a decrease in the level of consciousness and a significant increase in the mean lateral brain displacement at the pineal gland (from 3.8 to 7.0 mm) and septum (5.4 to 12.2 mm). When outcome was examined in patients who were stuporous or comatose on admission, a significant increase in septal shift was found among patients with a poor outcome, but there was no significant relationship between outcome and degree of pineal or aqueductal shift. A poor outcome was more likely with effacement of both perimesencephalic cisterns or the ipsilateral cistern, but not the contralateral cistern, although this difference did not reach statistical significance. These results do not substantiate the value of brain shift as an independent prognostic factor after evacuation of an acute unilateral mass lesion. The decision to operate and the determination of prognosis should be based rather on established criteria such as the clinical examination, age of the patient, and the mechanism of injury.

Would integrating women's professional care of pelvic organ prolapse improve the symptoms and quality of life: an integrative literature review

2020 ◽  
Vol 28 (2) ◽  
pp. 119-133
Author(s):  
Nicola Davies ◽  
Teresa Burdett
Keyword(s):  
Quality Of Life ◽  
Pelvic Organ Prolapse ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Integrated Approach ◽  
Pelvic Organ ◽  
Social Implications ◽  
Content Type ◽  
Practical Implications

PurposeIntegrated healthcare is a central tenant of the NHS Long Term Plan (NHS, 2019). NICE in 2019 published guidelines; advising the integration of multidisciplinary professionals which may lead to an improvement in conservative treatment methods of pelvic organ prolapse. Therefore, current literature on the conservative treatments for pelvic organ prolapse needs to be reviewed to ascertain if an integrated approach would improve the symptoms and quality of life for women.Design/methodology/approachA systematic review of the literature between 2013 and 2018 was implemented. Papers included were written in English, peer-reviewed and consisted of treatments of pelvic organ prolapse in women. Papers containing surgical interventions, postpartum participants, reviews, evaluations, guidelines, follow-up studies, focusing on cost effectiveness, sexual function were excluded.FindingsSeven studies in total were included, and two overarching themes were identified: quality of life after treatment and the effect of conservative treatment on pelvic organ prolapse symptoms. The literature suggested that integrating care had a more positive outcome on pelvic organ symptoms and quality of life.Research limitations/implicationsTo develop a robust enhanced model of care for conservative treatment of pelvic organ prolapse through more mixed method or qualitative research, that incorporates integrative treatment methods with collaboration from multidisciplinary professionals.Practical implicationsThe practical implications of integrating the conservative management of pelvic organ prolapse is the communication between the multidisciplinary team must be exceptional to ensure everyone understands and agrees the treatment that is being provided to patient. Also, effective teamwork is important to ensure the patient receives the best care with input from the correct disciplines. The multi-professional team will need to have regular meetings to discuss and implement care plans for patients that might prove difficult to schedule due to differing commitments and priorities. This must be overcome to insure a successful and effective integrated approach to pelvic organ prolapse is delivered.Social implicationsThe social implications of integrating the professional approach to women's care of pelvic organ prolapse involves reducing the severity of the symptoms therefore, increasing the quality of life. This may result in the reduction of surgical intervention due to the patient being satisfied with the conservative management. Through integrating the management of the prolapse the patient will receive an accessible individualised care plan pathway that focuses on treating or reducing the impact of the symptoms that are bothersome to the patient whilst managing patient expectations. Patients will also, be reassured by the number of multi-disciplinary professionals involved in their care.Originality/valueGlobal integration of conservative treatments and multidisciplinary-professionals specialising in pelvic organ prolapse and pelvic floor dysfunction is needed.

Cross-sectional study of the quality of neonatal care services in Armenia

2019 ◽  
Vol 32 (8) ◽  
pp. 1145-1161
Author(s):  
Suren H. Galstyan ◽  
Hrant Z. Kalenteryan ◽  
Arshak S. Djerdjerian ◽  
Hovhannes S. Ghazaryan ◽  
Naira T. Gharakhanyan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Quality Assessment ◽  
Neonatal Care ◽  
Health Facilities ◽  
Cross Sectional ◽  
Content Type ◽  
Neonatal Deaths ◽  
Live Births ◽  
Care Services

Purpose The purpose of this paper is to report the assessment results of the quality of neonatal care services in Armenia and to describe the identified obstacles to improving the quality of care for newborn infants. Design/methodology/approach The study carried out a cross-sectional descriptive design. The data were collected in health facilities with different levels of neonatal care that were selected employing a multi-stage, stratified purposeful sampling design. The quality of neonatal services was assessed using the generic WHO tool. Data collection was performed using face-to-face semi-structured interviews, hospital statistics, medical records and direct observations. Findings In 31 study hospitals, 31,976 deliveries were performed resulting in 31,701 live births and 734 stillbirths. About 85 percent of all neonatal deaths was attributable to early neonatal deaths with over 48 percent occurring during the first 24 h of life. The proportion of neonatal deaths was highest in infants with low birth weight constituting 92.8 percent of all neonatal deaths. The total neonatal mortality rate was 3.50 per 1,000 live births, whereas stillbirth rate and perinatal mortality rate were 22.60 and 25.26 per 1,000 total births in 2015. Specific indicators with relatively lower mean scores included neonatal resuscitation, early breastfeeding, monitoring of newborn conditions, neonatal sepsis, feeding standards, total parenteral nutrition, and infection treatment. Originality/value Given the limited scope of research on quality assessment, this paper provides valuable information on the status of quality of neonatal care services in Armenian health facilities. This work also extends the existing studies focused on quality assessment through applying the model of Avedis Donabedian with the structure–process–outcomes approach as a theoretical basis.

Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study

1989 ◽  
Vol 70 (4) ◽  
pp. 530-535 ◽  
Author(s):  
Ludwig M. Auer ◽  
Wolfgang Deinsberger ◽  
Kurt Niederkorn ◽  
Günther Gell ◽  
Reinhold Kleinert ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Medical Treatment ◽  
Functional Recovery ◽  
Randomized Study ◽  
Treated Group ◽  
Surgical Patients ◽  
Lower Mortality ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
Fine Print

✓ A controlled randomized study of endoscopic evacuation versus medical treatment was performed in 100 patients with spontaneous supratentorial intracerebral (subcortical, putaminal, and thalamic) hematomas. Patients with aneurysms, arteriovenous malformations, brain tumors, or head injuries were excluded. Criteria for inclusion were as follows: patients' age between 30 and 80 years; a hematoma volume of more than 10 cu cm; the presence of neurological or consciousness impairment; the appropriateness of surgery from a medical and anesthesiological point of view; and the initiation of treatment within 48 hours after hemorrhage. The criteria of randomization were the location, size, and side of the hematoma as well as the patient's age, state of consciousness, and history of hypertension. Evaluation of outcome was performed 6 months after hemorrhage. Surgical patients with subcortical hematomas showed a significantly lower mortality rate (30%) than their medically treated counterparts (70%, p < 0.05). Moreover, 40% of these patients had a good outcome with no or only a minimal deficit versus 25% in the medically treated group; the difference was statistically significant for operated patients with no postoperative deficit (p < 0.01). Surgical patients with hematomas smaller than 50 cu cm made a significantly better functional recovery than did patients of the medically treated group, but had a comparable mortality rate. By contrast, patients with larger hematomas showed significantly lower mortality rates after operation but had no better functional recovery than the medically treated group. This effect from surgery was limited to patients in a preoperatively alert or somnolent state; stuporous or comatose patients had no better outcome after surgery. The outcome of surgical patients with putaminal or thalamic hemorrhage was no better than for those with medical treatment; however, there was a trend toward better quality of survival and chance of survival in the operated group.

Intracranial arterial aneurysms in children and adolescents

1983 ◽  
Vol 58 (6) ◽  
pp. 832-837 ◽  
Author(s):  
John R. Østergaard ◽  
Bo Voldby
Keyword(s):  
Mortality Rate ◽  
Prognostic Significance ◽  
Aneurysm Rupture ◽  
Intracerebral Hematoma ◽  
Neurosurgical Department ◽  
Content Type ◽  
Subarachnoid Bleeding ◽  
The University ◽  
Arterial Aneurysms ◽  
Overall Mortality

✓ Throughout the period 1943 to 1980, 1368 patients with verified intracranial saccular aneurysms were treated in the University of Aarhus neurosurgical department. Forty-three (3.1%) patients (25 boys and 18 girls) were 19 years old or younger, and 33 (77%) had an onset of symptoms typical of subarachnoid bleeding. Using the classification system of Hunt and Hess as a basis for clinical assessment on admission, 58% of the patients could be placed in Grade I or II. Cerebral vasospasm was demonstrated in 53% of the patients undergoing angiography between the 4th and 16th day after hemorrhage. There was no increased morbidity or mortality in the group of patients with vasospasm, and no cerebral infarction was demonstrated at necropsy. Therefore, it is possible that vasospasm is of minor prognostic significance in children. In 15 patients (37%), aneurysm rupture was accompanied by intracerebral hematoma. The mortality rate in this group of 15 patients was 50%, whereas in the group without hematoma it was 26%. The overall mortality rate was 33%. The surviving 29 patients were followed for 3 months to 14 years. Twenty-three patients made a good recovery (80% of survivors and 54% of the total series), five were moderately disabled, and one was severely disabled.

scholarly journals Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke

2020 ◽  
Vol 78 (6) ◽  
pp. 349-355
Author(s):  
Isaac Holanda Mendes MAIA ◽  
Thaissa Pinto de MELO ◽  
Fabrício Oliveira LIMA ◽  
João José de Freitas CARVALHO ◽  
Francisco José Arruda MONT’ALVERNE ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Decompressive Craniectomy ◽  
Statistical Significance ◽  
Northeastern Brazil ◽  
Malignant Infarction ◽  
To Receive ◽  
Surgical Group

ABSTRACT Background: Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. Objective: To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. Methods: Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. Results: A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). Conclusion: In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability.

scholarly journals Mortality, weight loss and quality of life of patients with morbid obesity: evaluation of the surgical and medical treatment after 2 years

2010 ◽  
Vol 47 (3) ◽  
pp. 263-269 ◽  
Author(s):  
Gunther Peres Pimenta ◽  
Robson Tadashi Saruwatari ◽  
Manoela Regina Alves Corrêa ◽  
Pedro Luiz Genaro ◽  
José Eduardo de Aguilar-Nascimento
Keyword(s):  
Quality Of Life ◽  
Morbid Obesity ◽  
Weight Loss ◽  
Mortality Rate ◽  
Surgical Patients ◽  
Long Term Results ◽  
Medical Attention ◽  
Medical Group ◽  
Surgical Group

CONTEXT: The surgical treatment for morbid obesity is becoming common in this country. Only a few papers reported the long-term results of the surgical approach for morbid obesity, mainly in terms of quality of life. OBJECTIVE: To compare mortality rate, weight loss, improvement of both diabetes and hypertension, and quality of life of patients from the public healthcare in Cuiabá, MT, Brazil, who underwent either medical or surgical interventions after a minimum of 2 years. METHODS: The population of this study was constituted by morbidly obese patients who initiated treatment between June 2002 and December 2006. The casuistic consisted of 89 patients submitted to medical therapy and 76 patients who underwent surgical procedures. The main variables were weight loss, improvement of hypertension and diabetes, quality of life, and mortality. RESULTS: The overall results showed that weight loss was significant in the two groups (P<0.001); however surgical patients showed a greater loss than the medical group (P = 0.05). The improvement of diabetes and hypertension was significantly greater in the surgical group (P<0.001), in which no cases of diabetes persisted. There was an increase in cases of hypertension among patients receiving medical attention. Mortality occurred in six cases (6.7%) of the medical group and in five cases (6.6%) of the surgical group (P = 0.97). The median grade of the quality of life score obtained by surgical patients (2.37 [range: -2.50 to 3.00]) was significantly greater (P<0.001) when compared to the medical group (1.25 [range: -1.50 to 3.00]). CONCLUSION: The surgical group presented better results regarding the weight loss, quality of life and improvement of hypertension and diabetes. There was no significant difference in mortality rate between the two groups after a minimum of 2 years.

Building better HR departments

2016 ◽  
Vol 15 (3) ◽  
pp. 129-136 ◽  
Author(s):  
Jon Ingham ◽  
Dave Ulrich
Keyword(s):  
Human Resources ◽  
Design Methodology ◽  
Future Research ◽  
Content Type ◽  
The People ◽  
The Right ◽  
To Receive ◽  
Practical Implications ◽  
Do So

Purpose The purpose of this paper is to provide answers to four questions on building a better human resources (HR) department: why?, who?, what? and how? Design/methodology/approach The paper is based on the accumulated experience of the co-authors. Findings The paper finds that better HR departments create better organizations and will often do this by enabling better relationships between the people working in them. Developing the right relationships is also an increasingly important part of creating an effective HR organization. Research limitations/implications Much attention has been spent on developing HR professionals. The authors also want to make HR departments better. This paper steers future research on HR effectiveness in this direction. Practical implications Senior HR leaders charged with improving their HR department may do so with the roadmap offered by the authors. Originality/value For businesses to receive full value from HR, it is very important to upgrade the quality of HR professionals. It is even more important to upgrade HR departments. This paper suggests how this can be done.

Double-blind evaluation of intradiscal chymopapain for herniated lumbar discs

1976 ◽  
Vol 45 (6) ◽  
pp. 622-627 ◽  
Author(s):  
P. Robert Schwetschenau ◽  
Archimedes Ramirez ◽  
James Johnston ◽  
Elnora Barnes ◽  
Albert N. Martins
Keyword(s):  
Conservative Treatment ◽  
Lumbar Disc ◽  
Intractable Pain ◽  
Double Blind ◽  
Content Type ◽  
Early Results ◽  
Significant Difference ◽  
Herniated Lumbar Disc ◽  
Fine Print

✓ The authors report 66 patients with signs, symptoms, and a myelographic abnormality of herniated lumbar disc, who were not responsive to conservative treatment. The discs were injected at random with either chymopapain or a placebo. Neither patient nor surgeon knew which agent was used until after the results had been tabulated. Unless early laminectomy was necessary for intractable pain, all patients were followed for 2 months or more. There was no statistically significant difference in incidence or quality of improvement between the two groups: chymopapain was successful in 58% while placebo was successful in 49% (p = 0.15). Early results from this study indicate that most, if not all, of the putative effectiveness of chemonucleolysis probably derives from a placebo effect.

scholarly journals Does surgical treatment increase the progression of spinal cord injury in patients with ossification of posterior longitudinal ligament of cervical spine? A systematic review and meta-analysis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902098178
Author(s):  
Bi Zhang ◽  
Yufei Zhang ◽  
Bin Ma ◽  
Junchi Ma ◽  
Xiaoyong Chen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Posterior Longitudinal Ligament ◽  
Conservative Group ◽  
Cord Injury ◽  
Surgical Group

Purpose: The purpose of this study is to explore if the surgical treatment will accelerate the progression of spinal cord injury (SCI) in patients with cervical Ossification of the posterior longitudinal ligament (OPLL) and if surgery will have better curative effect than conservative treatment. Methods: An extensive search of literature was implemented in PubMed, EMBASE, and other online databases. The quality of the included articles was evaluated according to the Newcastle-Ottawa Quality Assessment Scale, as recommended by the Cochrane manual, and meta-analysis was performed using the review manage5.3 software. Results: No obvious statistical difference was observed in the rate of SCI progression (P > 0.05, OR 1.15 [0.66, 2.00]), cervical range of motion, (P > 0.05, weighted mean difference (WMD) 4.52 [−5.75, 14.79]), and Japanese Orthopedic Association scores before surgery (P > 0.05, WMD −2.78 [−7.87, 2.32]) between the surgical group and conservative treatment group. However the surgical group illustrated obviously higher neurofunctional recovery rate (P < 0.05, OR 6.07 [1.55, 23.78]) and postoperative JOA score of the surgery group (P < 0.05, WMD −0.77 [−1.21, −0.33]) than conservative group. Conclusions: Based on this meta-analysis, there is not enough evidence to indicate that surgery will accelerate the progress of SCI with OPLL. However, the superiority of surgical efficacy can be observed over conservative treatment in terms of relieving neurological symptoms.

Sign in / Sign up

Export Citation Format

Share Document