Estimating Total Program Cost of a Long-Term, High-Technology, High-Risk Project with Task Durations and Costs That May Increase Over Time

This chapter considers issues in patients with multiple concussions. These patients must consider when to retire from contact sports. Help the patient, family, and peers think through the decision carefully. Educate them about the risk of serious and currently untreatable long-term problems such as chronic traumatic encephalopathy (CTE). Discuss potential for a future professional sports career versus other career as well as interpersonal and family aspirations. Patients want to know if they have CTE. There is no way to tell for sure while they are alive. High-risk features may include progressive worsening over time, prominent mood and behavioral abnormalities, parkinsonism, and a cavum septum pellucidum on MRI scan. Treatment is entirely based on relieving symptoms and keeping the patient safe.

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Residual Pituitary Function after Brain Injury-Induced Hypopituitarism: A Prospective 12-Month Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2005-0504 ◽

2005 ◽

Vol 90 (11) ◽

pp. 6085-6092 ◽

Cited By ~ 224

Author(s):

Gianluca Aimaretti ◽

Maria Rosaria Ambrosio ◽

Carolina Di Somma ◽

Maurizio Gasperi ◽

Salvatore Cannavò ◽

...

Keyword(s):

Brain Injury ◽

High Risk ◽

Gh Deficiency ◽

Pituitary Function ◽

Brain Injured ◽

Injured Patients ◽

The Brain ◽

Over Time

Abstract Context: Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are conditions at high risk for the development of hypopituitarism. Objective: The objective of the study was to clarify whether pituitary deficiencies and normal pituitary function recorded at 3 months would improve or worsen at 12 months after the brain injury. Design and Patients: Pituitary function was tested at 3 and 12 months in patients who had TBI (n = 70) or SAH (n = 32). Results: In TBI, the 3-month evaluation had shown hypopituitarism (H) in 32.8%. Panhypopituitarism (PH), multiple (MH), and isolated (IH) hypopituitarism had been demonstrated in 5.7, 5.7, and 21.4%, respectively. The retesting demonstrated some degree of H in 22.7%. PH, MH, and IH were present in 5.7, 4.2, and 12.8%, respectively. PH was always confirmed at 12 months, whereas MH and IH were confirmed in 25% only. In 5.5% of TBI with no deficit at 3 months, IH was recorded at retesting. In 13.3% of TBI with IH at 3 months, MH was demonstrated at 12-month retesting. In SAH, the 3-month evaluation had shown H in 46.8%. MH and IH had been demonstrated in 6.2 and 40.6%, respectively. The retesting demonstrated H in 37.5%. MH and IH were present in 6.2 and 31.3%, respectively. Although no MH was confirmed at 12 months, two patients with IH at 3 months showed MH at retesting; 30.7% of SAH with IH at 3 months displayed normal pituitary function at retesting. In SAH, normal pituitary function was always confirmed. In TBI and SAH, the most common deficit was always severe GH deficiency. Conclusion: There is high risk for H in TBI and SAH patients. Early diagnosis of PH is always confirmed in the long term. Pituitary function in brain-injured patients may improve over time but, although rarely, may also worsen. Thus, brain-injured patients must undergo neuroendocrine follow-up over time.

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Bulletin: New findings show Vascepa significantly reduces cardiovascular events in high-risk patients; Pediatric telemedicine visits yield more antibiotic prescriptions; National data trends show long-term opioid prescriptions increased over time; FDA takes major step to lower insulin prices

Pharmacy Today ◽

10.1016/j.ptdy.2019.04.001 ◽

2019 ◽

Vol 25 (5) ◽

pp. 2-3

Keyword(s):

High Risk ◽

Cardiovascular Events ◽

National Data ◽

Major Step ◽

High Risk Patients ◽

New Findings ◽

Risk Patients ◽

Over Time

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Enhancing Value and Uptake for Whole-Population Cohorts of Children and Parents: Methods to Integrate Registries into the Generation Victoria Cohort

Children ◽

10.3390/children8040285 ◽

2021 ◽

Vol 8 (4) ◽

pp. 285

Author(s):

Valerie Sung ◽

Katrina Williams ◽

Ella Perlow ◽

Yanhong J. Hu ◽

Susannah Ahern ◽

...

Keyword(s):

Quality Of Care ◽

High Risk ◽

Long Term Outcomes ◽

Children And Parents ◽

Funding Bias ◽

Almost All ◽

Over Time ◽

Morbid Conditions

Health registries are critical to understanding, benchmarking and improving quality of care for specific diseases and conditions, but face hurdles including funding, bias towards clinical rather than population samples, lack of pre-morbid and outcomes data, and absent cross-registry harmonisation and coordination. Children are particularly under-represented in registry research. This paper lays out novel principles, methods and governance to integrate diverse registries within or alongside a planned children’s mega-cohort to rapidly generate translatable evidence. GenV (Generation Victoria) will approach for recruitment parents of all newborns (estimated 150,000) over two years from mid-2021 in the state of Victoria (population 6.5 million), Australia. Its sample size and population denominator mean it will contain almost all children with uncommon or co-morbid conditions as they emerge over time. By design, it will include linked datasets, biosamples (including from pregnancy), phenotypes and participant-reported measures, all of which will span pre-morbid to long-term outcomes. We provide a vignette of a planned new registry for high-risk pregnancies to illustrate the possibilities. To our knowledge, this is the first paper to describe such a methodology designed prospectively to enhance both the clinical relevance of a large multipurpose cohort and the value and inclusivity of registries in a population.

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