Outcome from head injury related to patient' age

1988 ◽  
Vol 68 (3) ◽  
pp. 409-416 ◽  
Author(s):  
Thomas G. Luerssen ◽  
Melville R. Klauber ◽  
Lawrence F. Marshall
Keyword(s):  
Mortality Rate ◽  
Pediatric Population ◽  
Adult Population ◽  
Content Type ◽  
Head Injured ◽  
Injured Patients ◽  
Age Range ◽  
Relationship Of ◽  
The Relationship ◽  
Pupillary Reactivity

✓ A series of 8814 head-injured patients admitted to 41 hospitals in three separate metropolitan areas were prospectively studied. Of these, 1906 patients (21.6%) were 14 years of age or less. This “pediatric population” was compared to the remaining “adult population” for mechanism of injury, admission Glasgow Coma Scale score, motor score, blood pressure, pupillary reactivity, the presence of associated injuries, and the presence of subdural or epidural hematoma. The relationship of each of these factors was then correlated with posttraumatic mortality. Except for patients found to have subdural hematoma and those who were profoundly hypotensive, the pediatric patients exhibited a significantly lower mortality rate compared to the adults, thus confirming this generally held view. This study indicates that age itself, even within the pediatric age range, is a major independent factor affecting the mortality rate in head-injured patients.

Cerebral autoregulation following head injury

2001 ◽  
Vol 95 (5) ◽  
pp. 756-763 ◽  
Author(s):  
Marek Czosnyka ◽  
Piotr Smielewski ◽  
Stefan Piechnik ◽  
Luzius A. Steiner ◽  
John D. Pickard
Keyword(s):  
Head Injury ◽  
Cerebral Autoregulation ◽  
Perfusion Pressure ◽  
Content Type ◽  
Arterial Blood ◽  
Head Injured ◽  
The Mean ◽  
Injured Patients ◽  
The Relationship ◽  
Fine Print

Object. The goal of this study was to examine the relationship between cerebral autoregulation, intracranial pressure (ICP), arterial blood pressure (ABP), and cerebral perfusion pressure (CPP) after head injury by using transcranial Doppler (TCD) ultrasonography. Methods. Using ICP monitoring and TCD ultrasonography, the authors previously investigated whether the response of flow velocity (FV) in the middle cerebral artery to spontaneous variations in ABP or CPP provides reliable information about cerebral autoregulatory reserve. In the present study, this method was validated in 187 head-injured patients who were sedated and receiving mechanical ventilation. Waveforms of ICP, ABP, and FV were recorded over intervals lasting 20 to 120 minutes. Time-averaged mean FV and CPP were determined. The correlation coefficient index between FV and CPP (the mean index of autoregulation [Mx]) was calculated over 4-minute epochs and averaged for each investigation. The distribution of averaged mean FV values converged with the shape of the autoregulatory curve, indicating lower (CPP < 55 mm Hg) and upper (CPP > 105 mm Hg) thresholds of autoregulation. The relationship between the Mx and either the CPP or ABP was depicted as a U-shaped curve. Autoregulation was disturbed in the presence of intracranial hypertension (ICP ≥ 25 mm Hg) and when mean ABP was too low (ABP < 75 mm Hg) or too high (ABP > 125 mm Hg). Disturbed autoregulation (p < 0.005) and higher ICP (p < 0.005) occurred more often in patients with unfavorable outcomes than in those with favorable outcomes. Conclusions. Autoregulation not only is impaired when associated with a high ICP or low ABP, but it can also be disturbed by too high a CPP. The Mx can be used to guide intensive care therapy when CPP-oriented protocols are used.

Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients

1996 ◽  
Vol 85 (3) ◽  
pp. 419-424 ◽  
Author(s):  
Kathryn L. Holloway ◽  
Tom Barnes ◽  
Sung Choi ◽  
Ross Bullock ◽  
Lawrence F. Marshall ◽  
...  
Keyword(s):  
Data Bank ◽  
Content Type ◽  
Medical College ◽  
Catheter Exchange ◽  
Head Injured ◽  
Risk Patients ◽  
Lower Infection ◽  
Prolonged Monitoring ◽  
Injured Patients ◽  
Relationship Of

✓ The investigators undertook a retrospective analysis of ventriculostomy infections to evaluate their relationship to monitoring duration and prophylactic catheter exchange. In 1984, the results of an epidemiological study of ventriculostomy-related infection were published. One of the conclusions of the paper was that the incidence of ventriculostomy-related infections rose after 5 days of monitoring. This led to the recommendation that catheters be prophylactically changed at 5-day intervals if prolonged monitoring was required. A recent randomized prospective study on central venous catheters showed no reduction in infection with prophylactic catheter exchanges. This has led the authors to reexamine their experience with ventriculostomy infections. Data on 584 severely head injured patients with ventriculostomies were prospectively collected in two data banks, The Traumatic Coma Data Bank and The Medical College of Virginia Neurocore Data Bank. These data were retrospectively analyzed for factors associated with ventriculostomy related infections. It was found that there is a relationship of ventriculitis to monitoring duration but it is not simple or linear. There is a rising risk of infection over the first 10 days, but infection then becomes very unlikely despite a population that continues to be at risk. Patients in whom catheters were replaced prior to 5 days did not have a lower infection rate than those whose catheters were exchanged at more than 5-day intervals. Based on these data, it is recommended that ventriculostomy catheters for intracranial pressure monitoring be removed as quickly as possible, and in circumstances in which prolonged monitoring is required, there appears to be no benefit from catheter exchange.

Neuropsychological deficit and emotional disturbance in head-injured patients

1989 ◽  
Vol 70 (4) ◽  
pp. 509-513 ◽  
Author(s):  
Robert A. Bornstein ◽  
Harry B. Miller ◽  
J. Tinnie van Schoor
Keyword(s):  
Emotional Disturbance ◽  
Head Injuries ◽  
Emotional Adjustment ◽  
Skull Fracture ◽  
Content Type ◽  
Neuropsychological Deficit ◽  
Work Related ◽  
Head Injured ◽  
Injured Patients ◽  
The Relationship

✓ The relationship between neuropsychological deficit and emotional disturbance was examined in a sample of 124 patients who sustained work-related head injuries. Most injuries met criteria for minor head injury. Since all patients were receiving compensation, the relationship between emotional disturbance and neuro-behavioral deficit does not appear to be related to compensation or litigation factors. There was a positive relationship between degree of neurobehavioral and emotional abnormality. This was not due to the interval between injury and examination, and did not appear to be related to duration of unconsciousness or amnesia, or to the presence of skull fracture or posttraumatic seizures. The findings are discussed in relation to previous research and to their implications regarding posttraumatic emotional adjustment.

Verbal learning deficits following severe head injury: heterogeneity in recovery over 1 year

1991 ◽  
Vol 75 (Supplement) ◽  
pp. S50-S58 ◽  
Author(s):  
Ronald M. Ruff ◽  
David Young ◽  
Theresa Gautille ◽  
Lawrence F. Marshall ◽  
Jeff Barth ◽  
...  
Keyword(s):  
Memory Performance ◽  
Verbal Learning ◽  
Data Bank ◽  
Learning Deficits ◽  
Content Type ◽  
Recovery Curve ◽  
Recovery Curves ◽  
Head Injured ◽  
Injured Patients ◽  
Case Basis

✓ A total of 40 severely head-injured patients were selected from the Traumatic Coma Data Bank, supported by the National Institute of Neurological Disorders and Stroke, to analyze the recovery of verbal learning across baseline and 6- and 12-month evaluations postinjury. During the initial 6 months, the group demonstrated marked recovery, followed by an absence of improvement over the latter part of the year. Analysis of this recovery curve on a case by case basis revealed three recovery subtypes: namely, a flat curve, a peak-drop curve, or an improvement curve. These three subtypes proved to have concurrent validity when compared with another memory test. Adding 19 new patients to the sample cross-validated the subtypes. However, the memory performance of the 59 patients was dissociated from other neuropsychological tests which showed recovery at more equivalent rates across the subtypes. Analysis of the demographic and neurological characteristics disclosed that the group with a peak-drop recovery curve was less well educated and the group with a flat curve demonstrated a trend toward higher levels of hypoxia. Moreover, the three subgroups were rated by their relatives to have equivalent levels of depression at baseline and at 6 months, but only the improved subgroup demonstrated reduced depression at 1 year. The clinical relevancy of these differential recovery curves is discussed.

scholarly journals Relationship of patient shame to working alliance and satisfaction: a preliminary investigation

2019 ◽  
Vol 14 (4) ◽  
pp. 251-263
Author(s):  
Daniel J. Carabellese ◽  
Michael J. Proeve ◽  
Rachel M. Roberts
Keyword(s):  
Patient Satisfaction ◽  
Working Alliance ◽  
Preliminary Investigation ◽  
Community Members ◽  
Content Type ◽  
Mediation Analyses ◽  
External Shame ◽  
Relationship Of ◽  
The Relationship

Purpose The purpose of this paper is to explore the relationship of two distinct variants of dispositional shame (internal and external shame) with collaborative, purpose-driven aspects of the patient–provider relationship (working alliance) and patient satisfaction. The aim of this research was to conduct a preliminary investigation into the relevance of dispositional shame in a general healthcare population. Design/methodology/approach In total, 127 community members (mean age 25.9 years) who reported that they had regularly seen a GP over the past year were recruited at an Australian university. Participants were asked to reflect on their relationship with their GP, and completed instruments assessing various domains of shame, as well as working alliance and patient satisfaction. Findings Non-parametric correlations were examined to determine the direction and strength of relationships, as well as conducting mediation analyses where applicable. Small, negative correlations were evident between external shame and working alliance. Both external and internal shame measures were also negatively correlated with patient satisfaction. Finally, the relationship of external shame to patient satisfaction was partially mediated by working alliance. Practical implications Both the reported quality of patient–provider working alliance, and level of patient satisfaction are related to levels of dispositional shame in patients, and working alliance may act as a mediator for this relationship. Originality/value The findings from this preliminary study suggest that internal and external shame are important factors to consider in the provision of medical care to maximise the quality of patient experience and working alliance.

The effects of mass-induced intracranial pressures on arterial hypertension and survival in awake cats

1972 ◽  
Vol 37 (5) ◽  
pp. 514-527 ◽  
Author(s):  
Stanley J. Goodman ◽  
Donald P. Becker ◽  
John Seelig
Keyword(s):  
Intracranial Pressure ◽  
Systemic Hypertension ◽  
Content Type ◽  
Arterial Blood ◽  
Mass Size ◽  
Intracranial Pressures ◽  
Relationship Of ◽  
The Relationship ◽  
Awake Cats ◽  
Supratentorial Mass

✓ Intracranial pressures above and below the tentorium, arterial blood pressure, heart rate, and respiratory rate were recorded continuously before, during, and after expansion of a supratentorial mass in awake unsedated cats. In general, as the mass enlarged, the intracranial pressure rose; however, considerable variation was observed among animals with respect to specific mass size and associated intracranial pressures. There was considerable variation in the relationship of supratentorial pressure to infratentorial pressure. No animal survived that had sustained a mass-induced pressure exceeding 1100 mm H2O, and survival was shorter with greater pressures. Systemic hypertension occurred always and only when the infratentorial pressure exceeded 600 mm H2O, regardless of the magnitude of the associated supratentorial intracranial pressure. The methodological limitations of previous studies of mass-induced intracranial hypertension appear to have been substantially reduced by the technique described.

Knowledge management implementation in Indian automobile ancillary industries

2016 ◽  
Vol 11 (3) ◽  
pp. 802-810 ◽  
Author(s):  
Nitin Yashwant Patil ◽  
Ravi M. Warkhedkar
Keyword(s):  
Knowledge Management ◽  
Industrial Area ◽  
Total Quality ◽  
Limited Data ◽  
Interpretive Structural Modeling ◽  
Content Type ◽  
Relationship Of ◽  
Power And Dependence ◽  
The Relationship

Purpose In the past decade, much has been written about knowledge management (KM) in the manufacturing; however, less attention has been paid to the Indian automobile ancillary industries located in Chinchwad, Pune. It is suitable to find out the relationship of the factors of the study. It helps in identifying the hierarchy of factors to be taken, and interlinking of production department with KM improves the productivity of the industries. Categorization of these principles based on their driving power (principles which hold other principles) and dependence (principles which are dependent on other principles) has also been examined for KM implementation to study the driving power and dependence power of these principles. This paper aims to determine the roadmap of KM implementation and categorize KM principles based on their driving power for manufacturing industries with the use of the interpretive structural modeling (ISM)-based model. The results indicate that the principles possessing higher driving power, such as KM, inventory control, quality control, productivity and scheduling and their interlinking. The major contribution of this research lies in the development of contextual relationship among various identified factors of KM and determination of their driving and dependence power through a single systemic framework. Design/methodology/approach In this paper, author find out the suitability ISM for Indian Automobile industries to find the relation among the variables. Findings ISM model has been developed for the hierarchy of the identified KM. As ISM model results a hypothetical hierarchy which needs a proper quantitative analysis to evaluate their percentage effectiveness in the hierarchy. Research limitations/implications It is applied to automobile industries with limited number of variables that will show the dependence variable and driving variables and their interrelations. It can be applied other fields to fine the relationship of variables. Practical implications The ISM may be used in supply chain management and total quality management to find interlinking between the variables. Originality/value The limited data collected from Pimpri Chinchwad industrial area of Pune from Maharashtra state (India).

The dimensional linkage between public service motivation and innovative behavior in public sector institutions; the mediating role of psychological empowerment

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Muhammad Asim Rafique ◽  
Yumei Hou ◽  
Muhammad Adnan Zahid Chudhery ◽  
Nida Gull ◽  
Syed Jameel Ahmed
Keyword(s):  
Public Sector ◽  
Public Service ◽  
Psychological Empowerment ◽  
Public Service Motivation ◽  
Innovative Behavior ◽  
Content Type ◽  
Mediating Role ◽  
Relationship Of ◽  
The Relationship

PurposeInnovations are imperative for organizational growth and sustainability. This study focuses on the employees' innovative behavior, a source of organizational innovations, which has received substantial attention from the researchers. Based on the psychological empowerment theory, the study exposes the effect of the various dimensions of public service motivation (PSM) on employees' innovative behavior (IB) in public sector institutions especially in the context of developing countries such as Pakistan. Moreover, the study also investigates the mediating role of psychological empowerment (PSE) between the dimensions of PSM and IB.Design/methodology/approachThis study used the cross-sectional research design. By using random sampling, the adapted survey questionnaires were used to collect data from 346 faculty members of public sector universities located in provincial capitals of Pakistan. A partial least square–structural equation modeling (PLS-SEM) tool was used to assess the proposed hypotheses through SMART-PLS software.FindingsResults revealed that attraction to policymaking (APM), compassion (COM), self-sacrifice (SS) have a significant impact on employees' PSE and their innovative behavior, while the relationship of commitment to the public interest (CPI) with PSE and IB was found insignificant. Moreover, PSE partially mediated the relationship between PSM dimensions and employees' IB.Originality/valueThere was a scarcity of research on IB especially in public sector institutions such as academia. This study theoretically contributed to the literature by providing a refined picture in assessing the proposed relationship of the constructs. This is also one of the original studies that examine the relationship between the dimensions of PSM and IB.

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