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Ten-year trends in traumatic brain injury: a retrospective cohort study of California emergency department and hospital revisits and readmissions.
OBJECTIVE:To describe visits and visit rates of adults presenting to emergency departments (EDs) with a diagnosis of traumatic brain injury (TBI). TBI is a major cause of death and disability in the USA; yet, current literature is limited because few studies examine longer-term ED revisits and hospital readmission patterns of TBI patients across a broad spectrum of injury severity, which can help inform potential unmet healthcare needs. DESIGN:We performed a retrospective cohort study. SETTING:We analysed non-public patient-level data from California's Office of Statewide Health Planning and Development for years 2005 to 2014. PARTICIPANTS:We identified 1.2 million adult patients aged ≥18 years presenting to California EDs and hospitals with an index diagnosis of TBI. PRIMARY AND SECONDARY OUTCOME MEASURES:Our main outcomes included revisits, readmissions and mortality over time. We also examined demographics, mechanism and severity of injury and disposition at discharge. RESULTS:We found a 57.7% increase in the number of TBI ED visits, representing a 40.5% increase in TBI visit rates over the 10-year period (346-487 per 100 000 residents). During this time, there was also a 33.8% decrease in the proportion of patients admitted to the hospital. Older, publicly insured and black populations had the highest visit rates, and falls were the most common mechanism of injury (45.5% of visits). Of all patients with an index TBI visit, 40.5% of them had a revisit during the first year, with 46.7% of them seeking care at a different hospital from their initial hospital or ED visit. Additionally, of revisits within the first year, 13.4% of them resulted in hospital readmission. CONCLUSIONS:The large proportion of patients with TBI who are discharged directly from the ED, along with the high rates of revisits and readmissions, suggest a role for an established system for follow-up, treatment and care of TBI
Strategies for building pathology reports in an urban rehabilitation process: Project of the Old City Centre of Coimbra
The increasing interest on architectural heritage associated to the recognised building value, at economic, social and cultural levels have stimulated, in the recent decades, the urban rehabilitation and renovation o several cities in Europe.
Despite the strategy or method adopted in a city renovation process, its efficiency depends mainly on: type of buildings (structural systems, construction techniques and materials); intervention level (singular buildings, groups of buildings, urban zones, etc.); and, project objective (risk assessment, decision making to support future rehabilitation projects, definition of council maintenance policies, etc.).
In what concerns large renovation programs of old city centres, choosing the most adequate approach for inspection, appraisal and diagnosis is a complex task that can determine the success or failure of the project purpose.
This paper describes the preparation phase of the inspection of 700 buildings located in the old city centre of Coimbra (Portugal), where a global renovation process is planned for the forthcoming years.
In the scope of the renovation and rehabilitation process, the city council contract a complete identification and inspection survey of the buildings, directed on three different domains: (a) architectural typologies, (b) constructive and pathological condition of buildings, and (c) socio-demographic characterisation, of this part of the city. It will be present the check-lists developed and some of the obtained results on point (b), related to roofing systems, and exterior façades.
This diagnosis procedure shows that the inspection results quality is quite dependent on the items surveyed for each construction element (roof, façade, internal members, installation efficiency), as well as on the possibility of their correlation for a single building. The adopted method has been applied on 70% of the buildings inspected within the project perimeter.
Further treatment of the inspection and appraisal data will allow the developing pathology reports and list repair actions, and estimating rehabilitation costs. It will also help to produce defect level diagrams and seismic building risk maps, but, most important, to improve and guide a renewal strategy and intervention methodology for old buildings
Service delivery for people with hereditary spastic paraparesis living in the South West of England.
PURPOSE: Hereditary Spastic Paraplegia (HSP) is an inherited nervous system disorder characterized by development of leg weakness, spasms and stiffness. While generally acknowledged that health and social care services can minimise symptoms and improve quality of life, there is a lack of research exploring this from the perspective of people affected by HSP. This qualitative study explored the users and providers experience of using rural services. METHOD: Focus groups and interviews were undertaken of people with HSP (n = 14), carers (n = 6) and professionals (n = 12), to describe their experience of service provision and to suggest improvements for care. These were taped, transcribed and analysed. RESULTS: Four themes emerged: (1) Diagnosis, symptoms and finding support; (2) Therapy, treatment and the delivery of care; (3) Managing the disease together; and (4) The way forward. CONCLUSIONS: Rehabilitation and support for self-management is valued by those affected with HSP throughout the disease trajectory from diagnosis onwards. Key to this is the development of a partnership approach which includes carers. Single point, well-informed, gatekeepers may enhance the coordination and delivery of care in rural areas. These findings underline current guidance promoting a holistic approach for people with neurological conditions
Imaging diagnosis: magnetic resonance imaging of diffuse leptomeningeal oligodendrogliomatosis in a dog with "dural tail sign"
A case of diffuse leptomeningeal oligodendrogliomatosis affecting the brain and spinal cord of a dog is presented. A 7.5-year old, male neutered Staffordshire bull terrier presented for evaluation of a chronic history of tetraparesis and seizures, with a multifocal neuroanatomical localization was determined. Extra-axial intradural lesions with an atypical presentation of a dural tail sign were seen on MRI. Histologically, the lesions were consistent with leptomeningeal oligodendrogliomatosis. To the authors’ knowledge, a dural tail sign has not previously been reported as an MRI characteristic of diffuse leptomeningeal oligodendrogliomatosis in dogs
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