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Care Transitions to and from the National Intrepid Center of Excellence (NICoE) for Service Members with TraumaticBrainInjury Improvised explosive devices (IEDs) have been one of the leading causes of death and injury among U.S. troops. Those who survive an IED blast or other injuries may be left with a traumaticbraininjury (TBI) and attendant or co-occurring psychological symptoms. In response to the need for specialized services for these populations, the U.S. Department of Defense (DoD
Hypothermia for Intracranial Hypertension after TraumaticBrainInjury. In patients with traumaticbraininjury, hypothermia can reduce intracranial hypertension. The benefit of hypothermia on functional outcome is unclear.We randomly assigned adults with an intracranial pressure of more than 20 mm Hg despite stage 1 treatments (including mechanical ventilation and sedation management) to standard care (control group) or hypothermia (32 to 35°C) plus standard care. In the control group, stage 2 (...) traumaticbraininjury, therapeutic hypothermia plus standard care to reduce intracranial pressure did not result in outcomes better than those with standard care alone. (Funded by the National Institute for Health Research Health Technology Assessment program; Current Controlled Trials number, ISRCTN34555414.).
Telerehabilitation for Pediatric Patients with TraumaticBrainInjury: Clinical Effectiveness, Cost-Effectiveness, and Guidelines Telerehabilitation for Pediatric Patients with TraumaticBrainInjury: Clinical Effectiveness, Cost-Effectiveness, and Guidelines | CADTH.ca Find the information you need Telerehabilitation for Pediatric Patients with TraumaticBrainInjury: Clinical Effectiveness, Cost-Effectiveness, and Guidelines Telerehabilitation for Pediatric Patients with TraumaticBrain (...) Injury: Clinical Effectiveness, Cost-Effectiveness, and Guidelines Published on: July 17, 2015 Project Number: RB0887-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report Question What is the clinical effectiveness of telerehabilitation for pediatric patients with traumaticbraininjury? What is the cost-effectiveness of telerehabilitation for pediatric patients with traumaticbraininjury? What are the evidence-based guidelines regarding the use
Visual Dysfunction in Patients with TraumaticBrainInjury Management Briefs eBrief-no96 -- Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs eBrief-no96 -- Health Services Research & Development Management eBrief no. 96 » Issue 96 April 2015 Visual Dysfunction in Patients with TraumaticBrainInjury: A Systematic Review Given that visual function depends on complex brain interactions (...) , it's reasonable to consider when and whether traumaticbraininjury (TBI) is related to visual dysfunction. Such questions are particularly pertinent to the VA since an estimated 15% of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Service Members (390,000 of 2.6 million) have incurred TBI during deployment. By comparison, just more than 1% of the U.S. population sought treatment for TBI in 2009. In an attempt to discover the frequency and type of visual
) (BOOST 2). www.clinicaltrials.gov/show/ NCT00974259. Aries, M. J., M. Czosnyka, K. P. Budohoski, L. A. Steiner, A. Lavinio, A. G. Kolias, P. J. Hutchinson, K. M. Brady, D. K. Menon, J. D. Pickard and P. Smielewski. 24Continuous determination of optimal cerebral perfusion pressure in traumaticbraininjury. Crit Care Med 40(8): 2456-2463. 2012 Hlatky, R., A. B. Valadka and C. S. Robertson. Intracranial pressure response to induced hypertension: role of dynamic pressure autoregulation. Neurosurgery 57 (...) (5): 917-923; discussion 917-923. 2005 Howells, T., K. Elf, P. A. Jones, E. Ronne-Engstrom, I. Piper, P. Nilsson, P. Andrews and P. Enblad. Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma. J Neurosurg 102(2): 311-317. 2005 Lazaridis, C., S. M. DeSantis, P. Smielewski, D. K. Menon, P. Hutchinson, J. D. Pickard and M. Czosnyka. Patient- specific thresholds of intracranial pressure in severe traumaticbraininjury. J Neurosurg 120(4): 893
Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumaticbraininjury: a randomised trial Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe braininjury?A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis.Thirty-six adults (...) with severe traumaticbraininjury and ankle plantarflexion contractures.All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone.The primary outcome was passive ankle dorsiflexion with a 12Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9Nm); spasticity; the walking item of the Functional Independence Measure; walking speed
Very early administration of progesterone for acute traumaticbraininjury. Traumaticbraininjury (TBI) is a major cause of death and disability worldwide. Progesterone has been shown to improve neurologic outcome in multiple experimental models and two early-phase trials involving patients with TBI.We conducted a double-blind, multicenter clinical trial in which patients with severe, moderate-to-severe, or moderate acute TBI (Glasgow Coma Scale score of 4 to 12, on a scale from 3 to 15 (...) , with lower scores indicating a lower level of consciousness) were randomly assigned to intravenous progesterone or placebo, with the study treatment initiated within 4 hours after injury and administered for a total of 96 hours. Efficacy was defined as an increase of 10 percentage points in the proportion of patients with a favorable outcome, as determined with the use of the stratified dichotomy of the Extended Glasgow Outcome Scale score at 6 months after injury. Secondary outcomes included mortality
A clinical trial of progesterone for severe traumaticbraininjury. Progesterone has been associated with robust positive effects in animal models of traumaticbraininjury (TBI) and with clinical benefits in two phase 2 randomized, controlled trials. We investigated the efficacy and safety of progesterone in a large, prospective, phase 3 randomized clinical trial.We conducted a multinational placebo-controlled trial, in which 1195 patients, 16 to 70 years of age, with severe TBI (Glasgow Coma (...) Scale score, ≤8 [on a scale of 3 to 15, with lower scores indicating a reduced level of consciousness] and at least one reactive pupil) were randomly assigned to receive progesterone or placebo. Dosing began within 8 hours after injury and continued for 120 hours. The primary efficacy end point was the Glasgow Outcome Scale score at 6 months after the injury.Proportional-odds analysis with covariate adjustment showed no treatment effect of progesterone as compared with placebo (odds ratio, 0.96
Progesterone for TraumaticBrainInjury - Resisting the Sirens' Song. 25493975 2015 01 09 2018 12 02 1533-4406 371 26 2014 Dec 25 The New England journal of medicine N. Engl. J. Med. Progesterone for traumaticbraininjury--resisting the sirens' song. 2522-3 10.1056/NEJMe1412951 Schwamm Lee H LH From the Department of Neurology, TeleStroke and Acute Stroke Services, and Institute for Heart, Vascular, and Stroke Care, Massachusetts General Hospital, and the Department of Neurology, Harvard (...) Medical School - both in Boston. eng Editorial Comment 2014 12 10 United States N Engl J Med 0255562 0028-4793 4G7DS2Q64Y Progesterone AIM IM N Engl J Med. 2014 Dec 25;371(26):2467-76 25493978 N Engl J Med. 2014 Dec 25;371(26):2457-66 25493974 BrainInjuries drug therapy Female Humans Male Progesterone administration & dosage 2014 12 11 6 0 2014 12 11 6 0 2015 1 13 6 0 ppublish 25493975 10.1056/NEJMe1412951
C, Kondiles B, Cyborski C, Larson EB. The Rehabilitation Institute of Chicago Military TraumaticBrainInjury Screening Instrument: determination of sensitivity, specificity, and predictive value. J Head Trauma Rehabil. 2014 Jan-Feb;29(1):99-107. PubMed: PM23756432 34. Wong GK, Ngai K, Lam SW, Wong A, Mok V, Poon WS. Validity of the Montreal Cognitive Assessment for traumaticbraininjury patients with intracranial haemorrhage. Brain Inj. 2013;27(4):394-8. PubMed: PM23473067 35. Blyth T, Scott (...) Screening Tools to Identify Adults with Cognitive Impairment Associated with a Cerebrovascular Accident or TraumaticBrainInjury TITLE: Screening Tools to Identify Adults with Cognitive Impairment Associated with a Cerebrovascular Accident or TraumaticBrainInjury: Diagnostic Accuracy DATE: 13 November 2014 RESEARCH QUESTION What is the diagnostic accuracy of screening tools to identify adults with cognitive impairment associated with a cerebrovascular accident (CVA) or traumaticbraininjury
Modest cooling therapies (35ºC to 37.5ºC) for traumaticbraininjury. Animal models of traumaticbraininjury suggest that induced normothermia (36.5 or 37 ºC), compared to induced hyperthermia (39 ºC), improves histopathological and neurobehavioural outcomes. Observational clinical studies of patients with TBI suggest an association between raised body temperature and unfavourable outcome, although this relationship is inconsistent.To assess the effects of modest cooling therapies (defined (...) as any drug or physical therapy aimed at maintaining body temperature between 35 ºC and 37.5 ºC) when applied to patients in the first week after traumaticbrain injury.The most recent search was run on 23(rd) September 2013. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library (CENTRAL), MEDLINE (OvidSP), Embase (OvidSP), ISI WOS: SCI-EXPANDED (1970) & CPCI-S (1990), PubMed and trials registries together with reference checking.All completed randomised, controlled
Health-related quality of life 3 years after moderate to severe traumaticbraininjury: a prospective cohort study To evaluate the time course of health-related quality of life (HRQoL) after moderate to severe traumaticbraininjury (TBI) and to identify its predictors.Prospective cohort study with follow-up measurements at 3, 6, 12, 18, 24, and 36 months after TBI.Patients with moderate to severe TBI discharged from 3 level-1 trauma centers.Patients (N=97, 72% men) with a mean age ± SD of 32.8
Screening tools to identify adults with cognitive impairment associated with a cerebrovascular accident or traumaticbraininjury: diagnostic accuracy Screening tools to identify adults with cognitive impairment associated with a cerebrovascular accident or traumaticbraininjury: diagnostic accuracy Screening tools to identify adults with cognitive impairment associated with a cerebrovascular accident or traumaticbraininjury: diagnostic accuracy CADTH Record Status This is a bibliographic (...) record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation CADTH. Screening tools to identify adults with cognitive impairment associated with a cerebrovascular accident or traumaticbraininjury: diagnostic accuracy. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Rapid Response: summary of abstracts. 2014 Authors' conclusions Nine systematic reviews and meta-analyses
Effect of erythropoietin and transfusion threshold on neurological recovery after traumaticbraininjury: a randomized clinical trial. There is limited information about the effect of erythropoietin or a high hemoglobin transfusion threshold after a traumaticbrain injury.To compare the effects of erythropoietin and 2 hemoglobin transfusion thresholds (7 and 10 g/dL) on neurological recovery after traumaticbrain injury.Randomized clinical trial of 200 patients (erythropoietin, n = 102; placebo (...) , n = 98) with closed head injury who were unable to follow commands and were enrolled within 6 hours of injury at neurosurgical intensive care units in 2 US level I trauma centers between May 2006 and August 2012. The study used a factorial design to test whether erythropoietin would fail to improve favorable outcomes by 20% and whether a hemoglobin transfusion threshold of greater than 10 g/dL would increase favorable outcomes without increasing complications. Erythropoietin or placebo
Optimal oxygen saturation range for adults suffering from traumaticbraininjury: a review of patient benefit, harms, and guidelines Optimal oxygen saturation range for adults suffering from traumaticbraininjury: a review of patient benefit, harms, and guidelines Optimal oxygen saturation range for adults suffering from traumaticbraininjury: a review of patient benefit, harms, and guidelines CADTH Record Status This is a bibliographic record of a published health technology assessment from (...) a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation CADTH. Optimal oxygen saturation range for adults suffering from traumaticbraininjury: a review of patient benefit, harms, and guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Rapid Response. 2014 Authors' conclusions According to retrospective studies, hyperoxia appears to be associated with a lower likelihood of in-hospital survival compared to normoxia
The Lund concept for severe traumaticbraininjury. Severe traumaticbraininjury is a significant cause of morbidity and mortality. Treatment strategies in management of such injuries are directed to the prevention of secondary brain ischaemia, as a consequence of disturbed post-traumaticcerebral blood flow. They are usually concerned with avoiding high intracranial pressure (ICP) or adequate cerebral perfusion pressure (CPP). An alternative to this conventional treatment is the Lund concept (...) , which emphasises a reduction in microvascular pressures.To assess the role of the Lund concept versus other treatment modalities such as ICP-targeted therapy, CPP-targeted therapy or other possible treatment strategies in the management of severe traumaticbrain injury.We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL; Issue 10, 2013), MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL Plus (EBSCO Host), ISI Web of Science (SCI-EXPANDED