Responsibility of neurosurgeons in cooperation with clinical neuropsychologists to accomplish full social re-entry and good HRQoL for patients following acute brain damage

Objectives: Physical neurologic and neuropsychological rehabilitation has an old tradition in Europe. Clinical recovery of physical neurological impairments following acute brain damaged do not guarantee successful social re-entry when overlooking long-lasting mental – cognitive, behavioural deficits after clinical demission. Problems in emotional adjustment are long-lasting and hinder social re-entry.Patients and methods: Transdisciplinary early neurorehabilitation is based on careful physical and mental - cognitive diagnostics for an individualized therapeutic intervention, when neuropsychology is essential in patients with brain lesions. The role of individually planned early neuro-psychotherapy is underestimated when dealing with patients catastrophic reactions as first described by Kurt Goldstein. This was exemplarily demonstrated in a patient with severe higher cortical functioning disturbances after acute intracerebral haemorrhage and coma, followed by secondary hydrocephalus and major emotional adjustment behavioural disturbances.Results: The 65 years old business man, who suffered from persisting complex mental-cognitive, behavioural, mood and emotional disturbances recovered full social competence due to professional neuropsychological neuropsychiatric treatment. Discussion: Early catastrophic reactions and fear of loss of self-identity are important key issues in the emotional adjustment after brain damaged. Further research is needed to explaining the links between loss of self-esteem, self-identity and the development of depression. Attention needs to be focused on a recovery beyond functional outcome. Conclusion: Neurosurgical-neuropsychological rehabilitation is a method to reconstruct lives within a social context

German validation of Quality of Life after Brain Injury (QOLIBRI) assessment and associated factors

The consequences of traumatic brain injury (TBI) for health-related quality of life (HRQoL) are still poorly understood, and no TBI-specific instrument has hitherto been available. This paper describes in detail the psychometrics and validity of the German version of an internationally developed, self-rated HRQoL tool after TBI—the QOLIBRI (Quality of Life after Brain Injury). Factors associated with HRQoL, such as the impact of cognitive status and awareness, are specifically reported. One-hundred seventy-two participants after TBI were recruited from the records of acute clinics, most of whom having a Glasgow Coma Scale (GCS) 24-hour worst score and a Glasgow Outcome Scale (GOSE) score. Participants had severe (24%), moderate (11%) and mild (56%) injuries as assessed on the GCS, 3 months to 15 years post-injury. The QOLIBRI uses 37 items to measure “satisfaction” in the areas of “Cognition”, “Self”, “Daily Life and Autonomy”, and “Social Relationships”, and “feeling bothered” by “Emotions”and “Physical Problems”. The scales meet standard psychometric criteria (α = .84 to .96; intra-class correlation—ICC = .72 to .91). ICCs (0.68 to 0.90) and αs (.83 to .96) were also good in a subgroup of participants with lower cognitive performance. The six-subscale structure of the international sample was reproduced for the German version using confirmatory factor analyses and Rasch analysis. Scale validity was supported by systematic relationships observed between the QOLIBRI and the GOSE, Patient Competency Rating Scale for Neurorehabilitation (PCRS-NR), Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Short Form 36 (SF-36), and Satisfaction with Life Scale (SWLS). The German QOLIBRI contains novel information not provided by other currently available measures and has good psychometric criteria. It is potentially useful for clinicians and researchers, in post-acute and rehabilitation studies, on a group and individual level.Additional co-authors: Klaus von Wild and Henning Gibbon

Interpreting Quality of Life after Brain Injury (QOLIBRI) scores: Cross-walk with the Short Form-36

The Quality of Life after Brain Injury (QOLIBRI) instruments are traumatic brain injury-specific assessments of health-related quality of life (HRQoL), with established validity and reliability. The purpose of the study is to help improve the interpretability of the two QOLIBRI summary scores (the QOLIBRI Total score and the QOLBRI Overall Scale score). An analysis was conducted of 761 patients with traumatic brain injury (TBI) that took part in the QOLIBRI validation studies. A cross-walk between QOLIBRI scores and the SF-36 Mental Component Summary norm-based scoring system was performed using geometric mean regression analysis. The exercise supports a previous suggestion that QOLIBRI Total scores < 60 indicate low or impaired HRQoL, and indicate that the corresponding score on the QOLIBRI-OS is <52. The percentage of cases in the sample that fell into the ‘impaired HRQoL’ category were 36% for the Mental Component Summary, 38% for the QOLIBRI Total, and 39% for the QOLIBRI-OS. Relationships between the QOLIBRI scales and the Glasgow Outcome Scale – Extended (GOSE), as a measure of global function, are presented in the form of means and standard deviations that allow comparison with other studies, and data on age and gender are presented for the QOLIBRI-OS. While bearing in mind the potential imprecision of the comparison, the findings provide a framework for evaluating QOLIBRI summary scores in relation to generic HRQoL that improves their interpretability

Assessment of Health-Related Quality of Life after TBI: Comparison of a Disease-Specific (QOLIBRI) with a Generic (SF-36) Instrument

Psychosocial, emotional, and physical problems can emerge after traumatic brain njury (TBI), potentially impacting health-related quality of life (HRQoL). Until now, however, neither the discriminatory power of disease-specific (QOLIBRI) and generic (SF-36) HRQoL nor their correlates have been compared in detail. These aspects as well as some psychometric item characteristics were studied in a sample of 795 TBI survivors. The Shannon H耠 index absolute informativity, as an indicator of an instrument’s power to differentiate between individualswithin a specific group or health state,was investigated. Psychometric performance of the two instruments was predominantly good, generally higher, and more homogenous for the QOLIBRI than for the SF-36 subscales. Notably, the SF-36 “Role Physical,” “Role Emotional,” and “Social Functioning” subscales showed less satisfactory discriminatory power than all other dimensions or the sum scores of both instruments. The absolute informativity of disease-specific as well as generic HRQoL instruments concerning the different groups defined by different correlates differed significantly.When the focus is on how a certain subscale or sum score differentiates between individuals in one specific dimension/health state, the QOLIBRI can be recommended as the preferable instrument.Psychosocial, emotional, and physical problems can emerge after traumatic brain injury (TBI), potentially impacting health-related quality of life (HRQoL). Until now, however, neither the discriminatory power of disease-specific (QOLIBRI) and generic (SF-36) HRQoL nor their correlates have been compared in detail. These aspects as well as some psychometric item characteristics were studied in a sample of 795 TBI survivors. The Shannon H耠 index absolute informativity, as an indicator of an instrument’s power to differentiate between individualswithin a specific group or health state,was investigated. Psychometric performance of the two instruments was predominantly good, generally higher, and more homogenous for the QOLIBRI than for the SF-36 subscales. Notably, the SF-36 “Role Physical,” “Role Emotional,” and “Social Functioning” subscales showed less satisfactory discriminatory power than all other dimensions or the sum scores of both instruments. The absolute informativity of disease-specific as well as generic HRQoL instruments concerning the different groups defined by different correlates differed significantly.When the focus is on how a certain subscale or sum score differentiates between individuals in one specific dimension/health state, the QOLIBRI can be recommended as the preferable instrument.Peer reviewe

Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome

BACKGROUND: Some patients awaken from coma (that is, open the eyes) but remain unresponsive (that is, only showing reflex movements without response to command). This syndrome has been coined vegetative state. We here present a new name for this challenging neurological condition: unresponsive wakefulness syndrome (abbreviated UWS). DISCUSSION: Many clinicians feel uncomfortable when referring to patients as vegetative. Indeed, to most of the lay public and media vegetative state has a pejorative connotation and seems inappropriately to refer to these patients as being vegetable-like. Some political and religious groups have hence felt the need to emphasize these vulnerable patients' rights as human beings. Moreover, since its first description over 35 years ago, an increasing number of functional neuroimaging and cognitive evoked potential studies have shown that physicians should be cautious to make strong claims about awareness in some patients without behavioral responses to command. Given these concerns regarding the negative associations intrinsic to the term vegetative state as well as the diagnostic errors and their potential effect on the treatment and care for these patients (who sometimes never recover behavioral signs of consciousness but often recover to what was recently coined a minimally conscious state) we here propose to replace the name. CONCLUSION: Since after 35 years the medical community has been unsuccessful in changing the pejorative image associated with the words vegetative state, we think it would be better to change the term itself. We here offer physicians the possibility to refer to this condition as unresponsive wakefulness syndrome or UWS. As this neutral descriptive term indicates, it refers to patients showing a number of clinical signs (hence syndrome) of unresponsiveness (that is, without response to commands) in the presence of wakefulness (that is, eye opening)

Beschluss der STIKO zur 7. Aktualisierung der COVID-19-Impfempfehlung und die dazugehörige wissenschaftliche Begründung

Die STIKO empfiehlt die Impfung gegen COVID-19 mit einem der beiden zugelassenen mRNA-Impfstoffe (Comirnaty von BioNTech/Pfizer, COVID-19-Vaccine von Moderna) oder einer der bei-den zugelassenen Vektor-basierten Impfstoffe (Vax¬zevria von AstraZeneca, COVID-19 Vaccine Janssen von Janssen-Cilag International). Die Impfung gegen COVID-19 soll allen Personen ab dem Alter von 18 Jahren angeboten werden. Aufgrund des Fortschritts in der Impfkampagne und zunehmender Verfügbarkeit von COVID-19-Impfstoffen ist ein stufenweises Vorgehen (Priorisierungsempfehlung) auf nationaler Ebene nicht mehr notwendig.Peer Reviewe

Beschluss der STIKO zur 9. Aktualisierung der COVID-19-Impfempfehlung und die dazugehörige wissenschaftliche Begründung

Die STIKO empfiehlt auch für alle 12- bis 17-jährigen Kinder und Jugendliche die Impfung gegen COVID-19 mit einem der beiden zugelassenen mRNA-Impfstoffe (Comirnaty von BioNTech/Pfizer und Spikevax von Moderna). Verabreicht werden sollen jeweils zwei Dosen Comirnaty oder Spikevax im Abstand von 3-6 bzw. 4-6 Wochen. Die Aktualisierung der Empfehlung zur COVID-19-Impfung von 12- bis 17-Jährigen basiert auf der Bewertung neuer quantitativer Daten zur Sicherheit der Impfung und zur Krankheitslast sowie einer Modellierung von direkten Effekten der Impfung auf diese Altersgruppe wie auch indirekten Effekten auf andere Altersgruppen. Die STIKO spricht sich jedoch explizit dagegen aus, dass der Zugang von Kindern und Jugendlichen zur Teilhabe an Bildung, Kultur und anderen Aktivitäten des sozialen Lebens vom Vorliegen einer Impfung abhängig gemacht wird.Peer Reviewe

Beschluss der STIKO zur 9. Aktualisierung der COVID-19-Impfempfehlung und die dazugehörige wissenschaftliche Begründung

Die STIKO empfiehlt auch für alle 12- bis 17-jährigen Kinder und Jugendliche die Impfung gegen COVID-19 mit einem der beiden zugelassenen mRNA-Impfstoffe (Comirnaty von BioNTech/Pfizer und Spikevax von Moderna). Verabreicht werden sollen jeweils zwei Dosen Comirnaty oder Spikevax im Abstand von 3-6 bzw. 4-6 Wochen. Die Aktualisierung der Empfehlung zur COVID-19-Impfung von 12- bis 17-Jährigen basiert auf der Bewertung neuer quantitativer Daten zur Sicherheit der Impfung und zur Krankheitslast sowie einer Modellierung von direkten Effekten der Impfung auf diese Altersgruppe wie auch indirekten Effekten auf andere Altersgruppen. Die STIKO spricht sich jedoch explizit dagegen aus, dass der Zugang von Kindern und Jugendlichen zur Teilhabe an Bildung, Kultur und anderen Aktivitäten des sozialen Lebens vom Vorliegen einer Impfung abhängig gemacht wird.Peer Reviewe

Wissenschaftliche Begründung der STIKO für die Modifizierung der COVID-19-Impfempfehlung für Kinder im Alter von 5 – 11 Jahren

Die STIKO empfiehlt Kindern mit Vorerkrankungen weiterhin eine Grundimmunisierung mit 2 Impfstoffdosen sowie eine Auffrischimpfung. Gesunde Kinder sollen eine Grundimmunisierung mit 2 Impfstoffdosen bekommen, wenn sich in deren Umfeld Personen mit hohem Risiko für einen schweren COVID-19-Verlauf befinden, die durch eine Impfung selbst nicht sicher geschützt werden können. Allen anderen Kindern empfiehlt die STIKO zunächst nur eine COVID-19-Impfstoffdosis.Peer Reviewe

Wissenschaftliche Begründung der STIKO für die COVID-19-Impfempfehlung für Kinder im Alter von 6 Monaten bis 4 Jahren sowie zur Anpassung der COVID-19-Impfempfehlung für Kinder im Alter von 5 – 11 Jahren

Am 19.10.2022 wurden in der EU die mRNA-Impfstoffe Comirnaty und Spikevax für die Grundimmunisierung gegen COVID-19 im Kleinkindalter zugelassen. Comirnaty wird in einer Dosierung von 3 μg mit einem 3-Dosenimpfschema für Kinder im Alter von 6 Monaten bis 4 Jahren bereitgestellt. Spikevax ist in einer Dosierung von 25 μg mit einem 2-Dosenimpfschema für Kinder im Alter von 6 Monaten bis 5 Jahren zugelassen. Die STIKO gibt einen Überblick über die wissenschaftlichen Daten aus den Zulassungsstudien der beiden mRNA-Impfstoffe für Kleinkinder im Alter von 6 Monaten bis 4 bzw. 5 Jahren und hat geprüft, ob somit für diese Altersgruppe eine Impfempfehlung ausgesprochen werden soll. Zum anderen hat die STIKO vor dem Hintergrund der aktuellen Evi¬denzlage ihre Impfempfehlungen für Kinder im Alter von 5 bis 11 Jahren angepasst. Dies betrifft vor allem die Grundimmunisierung immungesunder Kinder dieser Altersgruppe, in deren Umfeld sich Angehörige oder andere Kontaktpersonen mit hohem Risiko für einen schweren COVID-19-Verlauf befinden.Peer Reviewe