Cerebral Blood Flow Measurement in Healthy Children and Children Suffering Severe Traumatic Brain Injury—What Do We Know?

Traumatic brain injury is the leading cause of death in children. Children with severe TBI are in need of neurointensive care where the goal is to prevent secondary brain injury by avoiding secondary insults. Monitoring of cerebral blood flow (CBF) and autoregulation in the injured brain is crucial. However, there are limited studies performed in children to investigate this. Current studies report on age dependent increase in CBF with narrow age range. Low initial CBF following TBI has been correlated to poor outcome and may be more prevalent than hyperemia as previously suggested. Impaired cerebral pressure autoregulation is also detected and correlated with poor outcome but it remains to be elucidated if there is a causal relationship. Current studies are few and mainly based on small number of patients between the age of 0–18 years. Considering the changes of CBF and cerebral pressure autoregulation with increasing age, larger studies with more narrow age ranges and multimodality monitoring are required in order to generate data that can optimize the therapy and clinical management of children suffering TBI

Учебная практика «Медицинский уход» – первая ступень к практикоориентированному обучению в медицинском вузе

МЕДИЦИНСКИЕ УЧЕБНЫЕ ЗАВЕДЕНИЯОБРАЗОВАНИЕ МЕДИЦИНСКОЕСТУДЕНТЫ МЕДИЦИНСКИХ УЧЕБНЫХ ЗАВЕДЕНИЙПРАКТИКО-ОРИЕНТИРОВАННЫЙ ПОДХОДПРАКТИКО-ОРИЕНТИРОВАННОЕ ОБУЧЕНИЕУЧЕБНАЯ ПРАКТИКАПРАКТИКА ОБЩАЯУХОД ЗА БОЛЬНЫ

Cerebellar mutism syndrome in children with brain tumours of the posterior fossa

Background: Central nervous system tumours constitute 25% of all childhood cancers; more than half are located in the posterior fossa and surgery is usually part of therapy. One of the most disabling late effects of posterior fossa tumour surgery is the cerebellar mutism syndrome (CMS) which has been reported in up to 39% of the patients but the exact incidence is uncertain since milder cases may be unrecognized. Recovery is usually incomplete. Reported risk factors are tumour type, midline location and brainstem involvement, but the exact aetiology, surgical and other risk factors, the clinical course and strategies for prevention and treatment are yet to be determined. Methods: This observational, prospective, multicentre study will include 500 children with posterior fossa tumours. It opened late 2014 with participation from 20 Nordic and Baltic centres. From 2016, five British centres and four Dutch centres will join with a total annual accrual of 130 patients. Three other major European centres are invited to join from 2016/17. Follow-up will run for 12 months after inclusion of the last patient. All patients are treated according to local practice. Clinical data are collected through standardized online registration at pre-determined time points pre- and postoperatively. Neurological status and speech functions are examined pre- operatively and postoperatively at 1-4 weeks, 2 and 12 months. Pre- and postoperative speech samples are recorded and analysed. Imaging will be reviewed centrally. Pathology is classified according to the 2007 WHO system. Germline DNA will be collected from all patients for associations between CMS characteristics and host genome variants including pathway profiles. Discussion: Through prospective and detailed collection of information on 1) differences in incidence and clinical course of CMS for different patient and tumour characteristics, 2) standardized surgical data and their association with CMS, 3) diversities and results of other therapeutic interventions, and 4) the role of host genome variants, we aim to achieve a better understanding of risk factors for and the clinical course of CMS - with the ultimate goal of defining strategies for prevention and treatment of this severely disabling condition.Peer reviewe

The Brain Monitoring with Information Technology (BrainIT) collaborative network:: Past, Present and Future Direction

The BrainIT group works collaboratively on developing standards for collection and analyses of data from brain injured patients and to facilitate a more efficient infrastructure for assessing new health care technology with the primary objective of improving patient care. European Community funding supported meetings over a year to discuss and define a core dataset to be collected from patients with traumatic brain injury using IT based methods. In this paper, we give an overview of the aims and future directions of the group as well as present the results of an EC funded study with the aim of testing the feasibility of collecting this core dataset across a number of European sites and discuss the future direction of this research network. Over a three year period, data collection client and web-server based tools were developed and core data (grouped into 9 categories) were collected from 200 head-injured patients by local nursing staff in 22 European neuro-intensive care centres. Data were uploaded through the BrainIT web site and random samples of received data were selected automatically by computer for validation by data validation (DV) staff against primary sources held in each local centre. Validated data were compared with originally transmitted data and percentage error rates calculated by data category. Feasibility was assessed in terms of the proportion of missing data, accuracy of data collected andlimitations reported by users of the IT methods. Thirteen percent of data files required cleaning. Thirty “one-off” demographic and clinical data elements had significant amounts of missing data (> 15%). Validation staff conducted 19,461 comparisons between uploaded database data with local data sources and error rates were commonly less than or equal to 6%, the exception being the surgery data class where an unacceptably high error rate of 34% was found. Nearly 10,000therapies were successfully recorded with start-times but approximately a third had inaccurate or missing end times which limits the analysis of duration of therapy. Over 40,000 events and procedures were recorded but events with long durations (such as transfers) were more likely to have “end-times” missed. The BrainIT core dataset is a rich dataset for hypothesis generation and post-hoc analyses provided studies avoid known limitations in the dataset. Limitations in the current IT based data collection tools have been identified and have been addressed. In order for multi-centre data collection projects to be viable the resource intensive validation procedures will require a more automated process and this may include direct electronic access to hospital based clinical data sources for both validation purposes and for minimising the duplication of data entry. This type of infrastructure may foster and facilitate the remote monitoring of patient management and protocol adherence in future trials of patient management and monitoring.&nbsp

Surgery for metastatic lesions of the femur: Good outcome after 245 operations in 216 patients

We report our experience with surgery for femoral metastatic lesions, based on 216 patients who underwent a total of 245 operations for femoral metastatic lesions. The median age was 66 (30-94) years, and the most common diagnosis breast cancer, followed by prostate cancer. All patients had pain on weight bearing, 196 had pain at rest, 147 were unable to walk preoperatively, and 148 were confined to a health-care facility. The patients were operated with bipolar hip prosthesis (n=7), total hip replacement (THR) with Harrington reconstruction of the acetabulum (n=42), ordinary THR (n=108), intramedullary nailing (n=55), and other techniques (n=33). All patients improved as regards pain at rest, pain on weight bearing, walking ability and social independence. The median survival for the 216 patients was 6 (0-123) months. All in all, 47 operations were followed by complications of any kind, where dislocations of hip prostheses and implant breakdown were the commonest, but pulmonary embolism the most serious. Patients with femoral metastatic lesions can be operated safely and with acceptable complication rates. Furthermore, large and long-standing gains as regards pain control and mobility can be expected