Management of Severe Traumatic Brain Injury

Prehospital emergency care has an important role in the management of both moderate and severe TBI. The aim of the treatment and care is to prevent and decrease secondary injuries. Securing the airway, maintaining adequate blood pressure, oxygenation and ventilation are the key factors. Additionally, a rapid transport to a hospital with neurosurgical facilities is crucial.2nd editio

Aivovammapotilaan tehohoito

Teema : tehohoitolääketiede. English summaryPeer reviewe

Co-Teaching in Northern Rural Finnish Schools

Peer reviewedPublisher PD

Erityisopettajan työ osa-aikaisessa erityisopetuksessa

Part-time special education has had a central role in supporting students in mainstream education since the beginning of Finnish comprehensive school. As the number of students in need of support has risen, the content of special education teachers’ work has changed, and there have been concerns regarding the breadth of their job description. In our research, we study the views of special education teachers about their job description and their suggestions on how to improve it. The data for this research consists of 249 special education teachers’ responses to an electronic questionnaire. Our data enables comparisons between elementary and lower secondary school special education teachers’ views. The data for the study was collected with a questionnaire that was distributed in special education groups on Facebook in December 2022 and January 2023. By means of content analysis, three categories describing the content of the work were created. These were 1) teaching and supporting students, 2) collaboration in support and consultation and multiprofessional collaboration, and 3) work development, follow up and planning. We also detected three areas which the respondents saw in need of improvement. These were 1) limiting the number of work assignments, 2) developing work through legislation, and 3) emphasizing a student-centred work approach. We conclude that the work of special education teachers focuses not only on supporting students but also on supporting teachers. Early intervention is possible through collaboration. According to special education teachers, flexible support requires changes to the job description. Special education teachers have a key role in developing inclusive schools.Osa-aikainen erityisopetus on ollut koko suomalaisen perusopetuksen historian ajan tärkeässä asemassa oppilaiden koulunkäynnin tukea järjestettäessä. Oppilaiden määrän kasvun myötä erityisopettajien työn sisältö on muuttunut ja on nostettu esille huoli työnkuvan liiallisesta laajenemisesta. Tässä tutkimuksessa tarkastelemme perusopetuksen osa-aikaisessa erityisopetuksessa työskentelevien erityisopettajien näkemyksiä työnkuvastaan sekä sen kehittämistarpeista. Tutkimukseen osallistui 249 erityisopettajaa. Tutkimuksen aineisto kerättiin kyselylomakkeella, jota jaettiin Facebookin erityisopettajaryhmissä joulukuussa 2022 ja tammikuussa 2023. Aineisto analysoitiin sisällönanalyysin keinoin ja siitä paikannettiin kolme työn sisältöä kuvaavaa kategoriaa: 1) opetuksen ja tuen antaminen oppilaille, 2) tuen toteuttaminen yhteistyössä: konsultaatio ja moniammatillinen yhteistyö ja 3) työn kehittäminen, seuranta ja suunnittelu. Lisäksi paikansimme kolme työn kehityskohdetta: 1) työtehtävien rajaaminen, 2) työn kehittäminen lainsäädännön kautta sekä 3) kuntoutuksellisen ja yksilöllisen työotteen painottaminen. Johtopäätöksenä toteamme, että laaja-alainen erityisopettaja tukee koulussa oppilaita ja myös luokan- ja aineenopettajia. Yhteistyöllä pystytään tukemaan oppilaita jo varhaisessa vaiheessa. Tuen joustava antaminen niin kollegoille kuin oppilaillekin edellyttää erityisopettajien mukaan muutoksia työnkuvan määrittelyyn. Erityisopettajat ovat avainasemassa edistämässä inklusiivisen koulun kehitystä

Acute hormonal findings after aneurysmal subarachnoid hemorrhage - report from a single center

Purpose: The aim was to assess anterior pituitary hormone levels during the acute phase of aneurysmal subarachnoid hemorrhage (aSAH) and analyze the possible association with the clinical condition and outcome. Material and methods: Forty patients with aSAH whose aneurysm was secured by endovascular coiling were enrolled. Basal secretions of cortisol, testosterone, luteinizing hormone (LH), prolactin (PRL), and sex hormone binding globulin (SHBG) levels were measured up to 14 days after the incident. Results: The main finding was that hypocortisolism was rare whereas testosterone deficiency was common in male patients. Furthermore, various other hormone deviations were frequent and there was wide interindividual variability. We found no association between delayed cerebral ischemia (DCI), outcome of the patients or aneurysm location, and hormone abnormalities, while both Hunt & Hess and Fisher grade were associated with low PRL levels. Hunt & Hess 5 was associated with low PRL concentration when compared to grades 1 (OR = 4.81, 95% CI 1.15-20.14, p = 0.03), 3 (OR 7.73, 95% CI 1.33-45.01, p = 0.02), and 4 (OR = 6.86 95% CI 1.28-26.83, p = 0.02). Fisher grade 4 was associated with low PRL concentration when compared to grades 3 (OR 3.37, 95% CI 1.06-10.73, p = 0.03) and 2 (OR 9.71, 95% CI 1.22-77.10, p = 0.04). Conclusion: Deviations from normal and huge interindividual differences are common in hormone levels during the acute phase of aSAH. Routine assessment of anterior pituitary function in the acute phase of aSAH is not warranted. During the follow-up in the outpatient clinic, hormone concentrations were not measured, which would have brought a more long-term perspective into our findings.Peer reviewe

Cerebral autoregulation after aneurysmal subarachnoid haemorrhage. A preliminary study comparing dexmedetomidine to propofol and/or midazolam

Abstract Background Cerebral autoregulation is often impaired after aneurysmal subarachnoid haemorrhage (aSAH). Dexmedetomidine is being increasingly used, but its effects on cerebral autoregulation in patients with aSAH have not been studied before. Dexmedetomidine could be a useful sedative in patients with aSAH as it enables neurological assessment during the infusion. The aim of this preliminary study was to compare the effects of dexmedetomidine on dynamic and static cerebral autoregulation with propofol and/or midazolam in patients with aSAH. Methods Ten patients were recruited. Dynamic and static cerebral autoregulation were assessed using transcranial Doppler ultrasound during propofol and/or midazolam infusion and then during three increasing doses of dexmedetomidine infusion (0.7, 1.0 and 1.4 µg/kg/h). Transient hyperaemic response ratio (THRR) and strength of autoregulation (SA) were calculated to assess dynamic cerebral autoregulation. Static rate of autoregulation (sRoR)% was calculated by using noradrenaline infusion to increase the mean arterial pressure 20 mmHg above the baseline. Results Data from 9 patients were analysed. Compared to baseline, we found no statistically significant changes in THRR or sROR%. THRR was (mean±SD) 1.20 ±0.14, 1.17±0.13(p=0.93), 1.14±0.09 (p=0.72) and 1.19±0.18 (p=1.0) and sROR% was 150.89±84.37, 75.22±27.75 (p=0.08), 128.25±58.35 (p=0.84) and 104.82±36.92 (p=0.42) at baseline and during 0.7, 1.0 and 1.4 µg/kg/h dexmedetomidine infusion, respectively. Dynamic SA was significantly reduced after 1.0 µg/kg/h dexmedetomidine (p=0.02). Conclusions Compared to propofol and/or midazolam, dexmedetomidine did not alter static cerebral autoregulation in aSAH patients, whereas a significant change was observed in dynamic SA. Further and larger studies with dexmedetomidine in aSAH patients are warranted.Peer reviewe

Interleukin 10 and Heart Fatty Acid-Binding Protein as Early Outcome Predictors in Patients With Traumatic Brain Injury

Background: Patients with traumatic brain injury (TBI) exhibit a variable and unpredictable outcome. The proteins interleukin 10 (IL-10) and heart fatty acid-binding protein (H-FABP) have shown predictive values for the presence of intracranial lesions. Aim: To evaluate the individual and combined outcome prediction ability of IL-10 and H-FABP, and to compare them to the more studied proteins S100β, glial fibrillary acidic protein (GFAP), and neurofilament light (NF-L), both with and without clinical predictors. Methods: Blood samples from patients with acute TBI (all severities) were collected &lt;24 h post trauma. The outcome was measured &gt;6 months post injury using the Glasgow Outcome Scale Extended (GOSE) score, dichotomizing patients into: (i) those with favorable (GOSE≥5)/unfavorable outcome (GOSE ≤ 4) and complete (GOSE = 8)/incomplete (GOSE ≤ 7) recovery, and (ii) patients with mild TBI (mTBI) and patients with TBIs of all severities. Results: When sensitivity was set at 95-100%, the proteins' individual specificities remained low. H-FABP showed the best specificity (%) and sensitivity (100%) in predicting complete recovery in patients with mTBI. IL-10 had the best specificity (50%) and sensitivity (96%) in identifying patients with favorable outcome in patients with TBIs of all severities. When individual proteins were combined with clinical parameters, a model including H-FABP, NF-L, and ISS yielded a specificity of 56% and a sensitivity of 96% in predicting complete recovery in patients with mTBI. In predicting favorable outcome, a model consisting IL-10, age, and TBI severity reached a specificity of 80% and a sensitivity of 96% in patients with TBIs of all severities. Conclusion: Combining novel TBI biomarkers H-FABP and IL-10 with GFAP, NF-L and S100β and clinical parameters improves outcome prediction models in TBI.</p