Surgical trial in traumatic intracerebral haemorrhage (STITCH) : A randomised controlled trial of early surgery compared with Initial conservative treatment

Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme.Peer reviewedPublisher PD

Therapeutic hypothermia in patients following traumatic brain injury: a systematic review

Background The efficacy of therapeutic hypothermia in adult patients with traumatic brain injury is not fully understood. The historical use of therapeutic hypothermia at extreme temperatures was associated with severe complications and led to it being discredited. Positive results from animal studies using milder temperatures led to renewed interest. However, recent studies have not convincingly demonstrated the beneficial effects of therapeutic hypothermia in practice. Aim This review aims to answer the question: in adults with a severe traumatic brain injury (TBI), does the use of therapeutic hypothermia compared with normothermia affect neurological outcome? Design Systematic review. Method Four major electronic databases were searched, and a hand search was undertaken using selected key search terms. Inclusion and exclusion criteria were applied. The studies were appraised using a systematic approach, and four themes addressing the research question were identified and critically evaluated. Results A total of eight peer-reviewed studies were found, and the results show there is some evidence that therapeutic hypothermia may be effective in improving neurological outcome in adult patients with traumatic brain injury. However, the majority of the trials report conflicting results. Therapeutic hypothermia is reported to be effective at lowering intracranial pressure; however, its efficacy in improving neurological outcome is not fully demonstrated. This review suggests that therapeutic hypothermia had increased benefits in patients with haematoma-type injuries as opposed to those with diffuse injury and contusions. It also suggests that cooling should recommence if rebound intracranial hypertension is observed. Conclusion Although the data indicates a trend towards better neurological outcome and reduced mortality rates, higher quality multi-centred randomized controlled trials are required before therapeutic hypothermia is implemented as a standard adjuvant therapy for treating traumatic brain injury. Relevance to clinical practice Therapeutic hypothermia can have a positive impact on patient outcome, but more research is required

Preparing nurses for COVID-19 response efforts through involvement in antimicrobial stewardship programmes

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread internationally with 5 593 631 cases reported globally including 353 334 deaths [ 1 ] . Its rapid emergence and dissemination have highlighted multiple areas in which competencies in antimicrobial stewardship (AMS) (the safe and effective use of antimicrobials), specifically by nurses, can support response efforts. There have been calls for nurses to be recognised as legitimate contributors to AMS team efforts [ 2 , 3 , 4 , 5 ].Unfortunately, nurse’s role in these efforts, have received minimal mention in international and national policy [ 4 , 6 , 7 , 8 , 9 , 10 ]. It is reported that nurses’ knowledge of antibiotics is poor [ 11 , 12 ], and that AMS taught in nurse undergraduate programmes is disparate or lacking [ 13 ]. To address this gap, AMS consensus based international competency statements have been developed, focussed on six domains (Infection prevention and control, antimicrobials and antimicrobial resistance, the diagnosis of infection and use of antibiotics, antimicrobial prescribing practice, person centred care, interprofessional collaborative practice), which are (seen as) priorities/minimum requirements for nurses [ 14 , 15 ]

Peace Mediation and Diplomacy: Joining Forces for More Effective Cooperation

This edition of the MSN Discussion Points aims to explore cooperation between diplomatic and mediation actors who are involved in peace processes and to give recommendations to increase the effectiveness of this cooperation. The paper draws on a perception study that was conducted by Clingendael Academy in 2020 and 2021 on third-party cooperation. The paper further draws on discussions that took place during the annual Mediation Support Network (MSN) meeting in the Hague in spring 2022. Mediation support experts exchanged perspectives and discussed challenges and opportunities in cooperation between diplomats, mediators, and mediation support organizations.Diese Ausgabe der MSN Discussion Points zielt darauf ab, die Zusammenarbeit zwischen diplomatischen und Mediationsakteuren, die an Friedensprozessen beteiligt sind, zu untersuchen und Empfehlungen zur Steigerung der Effektivität dieser Zusammenarbeit zu geben. Die Publikation stützt sich auf eine Wahrnehmungsstudie, die von der Clingendael Academy in den Jahren 2020 und 2021 zur Zusammenarbeit mit Drittparteien durchgeführt wurde. Die Publikation stützt sich ferner auf Diskussionen, die während des jährlichen Mediation Support Network (MSN)-Treffens in Den Haag im Frühjahr 2022 stattfanden. Experten für Mediationsunterstützung tauschten Perspektiven aus und diskutierten Herausforderungen und Chancen in der Zusammenarbeit zwischen Diplomaten, Mediatoren und Mediationsunterstützungsorganisationen.ISSN:2413-202

Covariate adjustment increased power in randomized controlled trials: an example in traumatic brain injury.

OBJECTIVE: We aimed to determine to what extent covariate adjustment could affect power in a randomized controlled trial (RCT) of a heterogeneous population with traumatic brain injury (TBI). STUDY DESIGN AND SETTING: We analyzed 14-day mortality in 9,497 participants in the Corticosteroid Randomization After Significant Head Injury (CRASH) RCT of corticosteroid vs. placebo. Adjustment was made using logistic regression for baseline covariates of two validated risk models derived from external data (International Mission on Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury [IMPACT]) and from the CRASH data. The relative sample size (RESS) measure, defined as the ratio of the sample size required by an adjusted analysis to attain the same power as the unadjusted reference analysis, was used to assess the impact of adjustment. RESULTS: Corticosteroid was associated with higher mortality compared with placebo (odds ratio=1.25, 95% confidence interval=1.13-1.39). RESS of 0.79 and 0.73 were obtained by adjustment using the IMPACT and CRASH models, respectively, which, for example, implies an increase from 80% to 88% and 91% power, respectively. CONCLUSION: Moderate gains in power may be obtained using covariate adjustment from logistic regression in heterogeneous conditions such as TBI. Although analyses of RCTs might consider covariate adjustment to improve power, we caution against this approach in the planning of RCTs