Observational Data to Improve Clinical Decision Making in Acute Care

The premise of Big Data in acute medicine is to make medicine more efficient and effective. However, the translation of large observational data to knowledge is difficult. This thesis explores and discusses the three main types of research questions which can be asked from large observational data:1. What is current clinical practice?2. What is best practice?3. What patients need to be prioritised?This thesis will focus on traumatic brain injury and in-hospital cardiac arrest.<br/

Trauma and Emergency Surgery

Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. Emergency surgery is surgery to treat trauma or acute illness after an emergency presentation. This book examines trauma and emergency surgery for abdominal, aortic, chest, brain, and burn injuries

CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society

Clinical dilemmas in acute neurological disorders

This thesis introduces the evolving landscape of acute neurology and the challenges it presents to clinicians in the emergency department (ED).In Chapter 2, the focus is on mild traumatic brain injury (mTBI) in patients on anticoagulation therapy. The study, involving 905 patients, reveals that delayed intracranial hemorrhage within 24 hours is very rare after a normal cranial CT, suggesting that routine hospitalization may be unnecessary.Chapter 3 delves into alcohol intoxication as a stroke mimic, especially in posterior circulation cases. The study, involving 974 patients, emphasizes considering measuring blood ethanol levels in patients with a possible stroke of the posterior circulation presenting after working hours. Nevertheless, elevated blood ethanol levels should not withhold clinicians from administering reperfusion therapy.Chapter 4 explores the association between low blood pressure and outcomes after acute ischemic stroke (AIS). Analyzing data from 2124 patients, the study finds that low systolic blood pressure is linked to increased in-hospital mortality and complications, urging clinicians to investigate potential underlying conditions.In Chapter 5, the focus shifts to AIS patients with active cancer undergoing endovascular treatment. The study, involving 2583 patients, indicates that despite technical success, those with active cancer experience significantly worse outcomes and an increased risk of recurrent stroke after EVT. Still, about a quarter of the patients regained functional independence, and the risk of other complications was not increased.This thesis collectively highlights the importance of nuanced decision-making in acute neurology, offering insights into specific clinical dilemmas and proposing considerations for optimized patient care

Treatment, outcome and predictionafter mild traumatic brain injury

Traumatic brain injury (TBI) is a sudden change in brain function or damage to the brain, caused by an external force. The majority of patients present with “mild” TBI. A substantial proportion of these patients suffer long term consequences in terms of physical disability, and incomplete return to the preinjury level of functioning. In this thesis, we aim to provide a better insight into the treatment and outcome of (mild) TBI and relations with sex/gender, age and comorbidity (PART 1), and to improve the identification of mild TBI patients with a higher risk of suboptimal short-term and longer-term outcomes (PART 2)

Behavioural Approaches in Neuropsychological Rehabilitation

The potential of behavioural approaches for improving the lives of people with acquired brain injury is immense. Here that potential is laid out and explored with a thoroughgoing regard for clinical practice and the theoretical frameworks that underpin that practice. This book will prove an invaluable resource for clinical psychologists and the whole range of therapists working with patients suffering from acquired brain damage