Disability in young people and adults one year after head injury: prospective cohort study

OBJECTIVE: To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community. DESIGN: Prospective, hospital based cohort study, with one year follow up of sample stratified by coma score. SETTING: Five acute hospitals in Glasgow. SUBJECTS: 2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated. MAIN OUTCOME MEASURES: Glasgow outcome scale and problem orientated questionnaire. RESULTS: Survival with moderate or severe disability was common after mild head injury (47%, 95% confidence interval 42% to 52%) and similar to that after moderate (45%, 35% to 56%) or severe injury (48%, 36% to 60%). By extrapolation from the population identified (90% of whom had mild injuries), it was estimated that annually in Glasgow (population 909 498) 1400 young people and adults are still disabled one year after head injury. CONCLUSION: The incidence of disability in young people and adults admitted with a head injury is higher than expected. This reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury

EBIC-guidelines for management of severe head injury in adults

Guidelines for the management of severe head injury in adults as evolved by the European Brain Injury Consortium are presented and discussed. The importance of preventing and treating secondary insults is emphasized and the principles on which treatment is based are reviewed. Guidelines presented are of a pragmatic nature, based on consensus and expert opinion, covering the treatment from accident site to intensive care unit. Specific aspects pertaining to the conduct of clinical trials in head injury are highlighted. The adopted approach is further discussed in relation to other approaches to the development of guidelines, such as evidence based analysis

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

The association between APOE ?4, age and outcome after head injury: a prospective cohort study

Previous preliminary studies have suggested that possession of the APOE ?4 allele is associated with a poor outcome after head injury. This study was designed to confirm and extend those observations in a larger study with examination of additional variables. We prospectively identified admissions to a Neurosurgical Unit for head injury, collected demographic and clinical data, determined APOE genotypes and obtained follow-up information at 6 months. A total of 1094 subjects were enrolled (age range: 0–93 years, mean 37 years). Outcome was assessed using the Glasgow Outcome Scale. There was no overall association between APOE genotype and outcome, with 36% of APOE ?4 carriers having an unfavourable outcome compared with 33% of non-carriers of APOE ?4. However, there was evidence of an interaction between age and APOE genotype on outcome (P = 0.007) such that possession of APOE ?4 reduced the prospect of a favourable outcome in children and young adults. The influence of APOE genotype in younger patients after head injury can be expressed as, at age &lt;15 years, carriage of APOE ?4 being equivalent to ageing by 25 years. This finding is consistent with experimental data suggesting that the effect of APOE genotype on outcome after head injury may be expressed through the processes of repair and recovery

Heiratstafeln versus Familienstandstafeln Ein kritischer Vergleich

Bibliothek Weltwirtschaft Kiel C 135,199 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Intracranial haemorrhage induced at arterial pressure in the rat: Part 1: Description of technique, ICP changes and neuropathological findings

Intracranial haemorrhage was produced in the caudate nucleus or the lateral ventricle of Sprague Dawley Rats by connecting a stereotactically inserted cannula to the femoral artery. Two types of lesion resulted from this type of arterial-pressure haemorrhage: Contained intracerebral haemorrhage (ICH) and Uncontained haemorrhage. When the haemorrhage was uncontained, a large and transient rise in intracranial pressure (ICP) (to 65mmHg mean) was accompanied by a fall in cerebral perfusion pressure. By contrast, with contained intracerebral haemorrhage, the rise in ICP was smaller (to 18mmHg mean) and neuropathological evidence of ischaemic brain damage was found in areas surrounding the clot. This observation suggests that with ICH there may be a local reduction in flow in tissue immediately surrounding the haematoma