Performance of individuals after trauma brain injuries in N-Back auditory task

INTRODUÇÃO: O termo memória operacional (MO) refere-se a um constructo cognitivo capaz de armazenar e manter a informação acessível para uso determinado por um tempo limitado, possibilitando a manipulação de diversas informações simultâneas e sequenciais como operações matemáticas longas ou complexas, compreensão de palavras pouco frequentes, extensas ou frases complexas. A linguagem está entre as funções cognitivas que dependem do funcionamento da memória operacional e pode estar comprometida em várias condições patológicas, dentre elas o traumatismo cranioencefálico (TCE). Dados da literatura referentes a essa população ainda são restritos ou pouco consistentes. OBJETIVOS: investigar se o teste n-back é uma medida válida para identificar o déficit de memória em pacientes com TCE, estabelecer nota de corte e curva ROC do teste n-back, comparar o desempenho entre os indivíduos saudáveis e aqueles que sofreram TCE, comparar o teste n-back com os testes de linguagem e aspectos da lesão neurológica, tais como gravidade e tempo, tempo de coma e localização hemisférica da lesão nos resultados para verificar o desempenho e a relevância na separação dos casos em pacientes e controles.MÉTODOS: 53 indivíduos brasileiros (26 adultos com TCE e 30 adultos saudáveis) foram avaliados por bateria de estímulos verbais auditivos para verificar diferenças inter-grupos na capacidade de processamento da memória operacional, quanto ao numero de respostas corretas (acurácia), capacidade máxima de processamento na memória operacional (span) e também verificar a relação da memória operacional com habilidades linguísticas, através da comparação de testes. RESULTADOS: na comparação entre os pacientes e os indivíduos do grupo controle observou-se diferença estatisticamente significante entre os grupos tanto para os testes de base quanto para os resultados do n-back. Os grupos foram estatisticamente pareados em relação às variáveis sócio-demográficas (idade, escolaridade e gênero). O modelo estatístico com as variáveis do teste n-back demonstrou ótima separação dos casos em pacientes/ controle com a área sob a curva ROC de 89%. O modelo também mostrou convergência com os testes de linguagem para compreensão auditiva de sentenças, fluência verbal e aspectos discursivos-pragmáticos e com o nível cognitivo. O lado da lesão foi estatisticamente significante para o n-back, fluência verbal e discurso conversacional. CONCLUSÃO: Os resultados mostram que o n-back na maneira como foi desenhado é capaz de diferenciar os indivíduos alterados e os normais na habilidade de memória operacional. No estudo foi possível discriminar o comportamento de indivíduos com lesão encefálica adquirida e indivíduos saudáveis quanto à medida de acurácia e capacidade máxima de manipulação da informação na memória operacional. Esse comportamento reflete o funcionamento linguístico e cognitivo que se correlaciona com o mecanismo de memória operacionalINTRODUCTION: The term working memory (WM) refers to a construct cognitive capability of storing and keeping information on line to a determined use for a limited time, enabling the manipulation of diverse simultaneous and sequential information such as long or complex mathematical operations, comprehension of less frequent words, extensive or complex sentences. The language is among the cognitive functions which depends on the operational memory behavior and may be engaged in many pathological conditions, among them the TBI (traumatic brain injury). Literature dada relative to such population are still restrict or weak. AIM: investigate whether the n -back task is a valid measure for identifying memory deficits in patients with TBI; establish cutoff and ROC curve of n-back task; to compare performance between normals individuals and those who have suffered TBI; to compare n-back task with tests of language and aspects of neurological injury, such as severity, coma and hemispheric laterality of the lesion to verify the performance and relevance in the separation of cases. METHODOS: 53 individuals Brazilians (26 adults with TBI and 30 healthy adults) were assessed by a battery of auditory verbal stimuli for detecting differences between groups in the processing capacity of working memory, as the accuracy and span also check the relationship of working memory to language skills, through the comparison tests. RESULTS: in the comparison between patients and control subjects was observed statistically significant differences between groups thus to the tests as the basis tests as to results of the n -back. The groups were statistically matched in relation to socio-demographic variables (age, education and gender). The statistical model with variables of the n -back test showed good separation of cases where patients / control with the area under the ROC curve of 89 % . The model also showed convergence with language tests for auditory comprehension of sentences, verbal fluency and pragmatic - discursive aspects and the cognitive level. The side of the lesion was statistically significant for the n -back, verbal fluency and conversational discourse. CONCLUSION: the results demonstrated that the n-back on the way it was designed is able to distinguish the changed individuals and the normal on the working memory ability. On the study it was possible to discriminate the behaviors of individuals with acquired brain injury and healthy individuals regarding the accuracy and maximum capacity of manipulating information on the working memory. Such behavior reflects the linguistic and cognitive function which correlates with the working memory mechanis

Cognitive rehabilitation following traumatic brain injury

Abstract Annually, some 500,000 people are hospitalized with brain lesions acquired after traumatic brain injury (TBI) in Brazil. Between 75,000 and 100,000 individuals die within hours of the event and 70,000 to 90,000 evolve to irreversible loss of some neurological function. The principal causes of TBI include motor vehicle accidents (50%), falls (21%), assaults and robberies (12%) and accidents during leisure activities (10%). Within this context, cognitive rehabilitation, a clinical area encompassing interdisciplinary action aimed at recovery as well as compensation of cognitive functions altered as a result of cerebral injury, is extremely important for these individuals. Therefore, the aim of this study was to review the basic concepts related to TBI, including mechanisms of injury, severity levels of TBI, the most common findings in moderate and severe TBI survivors, and the most frequent cognitive impairments following TBI, and also to discuss the strategies used to handle patients post-TBI. The study results yielded relevant information on a structured cognitive rehabilitation service, representing an alternative for patients and families afflicted by TBI, enabling the generation of multiple research protocols

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research