Mortality and one-year functional outcome in elderly and very old patients with severe traumatic brain injuries: observed and predicted

Published version. Source at http://doi.org/10.1155/2015/845491.The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC). Methods. Prospective, national multicenter study including patients with severe TBI ≥65 years. Predicted mortality and outcome were calculated based on clinical information (CRASH basic) (age, GCS score, and pupil reactivity to light), as well as with additional CT findings (CRASH CT). Observed 14-day mortality and favorable/unfavorable outcome according to the Glasgow Outcome Scale at one year was compared to the predicted outcome according to the CRASH models. Results. 97 patients, mean age 75 (SD 7) years, 64% men, were included. Two patients were lost to follow-up; 48 died within 14 days. The predicted versus the observed odds ratio (OR) for mortality was 2.65. Unfavorable outcome (GOSE < 5) was observed at one year follow-up in 72% of patients. The CRASH models predicted unfavorable outcome in all patients. Conclusion. The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI

Internet Use for Obtaining Medicine Information: Cross-sectional Survey

Background: The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information. Objective: The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites. Methods: This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users. Results: A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites. Conclusions: Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities

Designing digital systems for rehabilitation practices

The trajectories of patients in need of long-term rehabilitation services are extremely complex. Therefore, strengthening the rehabilitation field requires increasing organizational resilience to ensure robust processes and efficient collaboration and communication. In this study, we explored how digital systems can promote organizational resilience in rehabilitation practices. Methodologically, we applied an experience-based co-design approach in which we held three day-long creative workshops with approximately 40 participants each in 2021 and 2022. The goal was to design a digitally supported model for the care and rehabilitation of patients with acquired brain injuries. This paper presents the themes related to digitalization that emerged from the discussions in the workshops. The paper develops the argument that designing digital systems for resilient rehabilitation practices is far more than merely a technical issue. It requires broad sociopolitical engagement to put rehabilitation on the political agenda, and designers need to take a stance on both organizational and ethical issues. Analytically, we draw on the theoretical concept of information infrastructure and the theoretical concept of articulation work

Severe traumatic brain injury in Norway: Impact of age on outcome

Objective: The aim of this study was to investigate the influence of age on mortality and 3-month outcome in a Norwegian cohort of patients with severe traumatic brain injury (TBI). Methods: Norwegian residents ≥ 16 years of age who were admitted with a severe TBI to the country’s 4 major trauma centres in 2009 and 2010 were included, as were adults (16– 64 years) and elderly patients (≥ 65 years). Results: Half of the adult subjects and 84% of the elderly subjects were injured by falls. One-third of the adults and half of the elderly subjects were admitted to a local hospital before being transported to a regional trauma hospital. Subdural haematomas were more frequent in the elderly subjects. One-quarter of adults and two-thirds of the elderly subjects died within 3 months. At 3 months, 41% of the adult survivors were still in-patients, mainly in rehabilitation units (92%). Of the surviving elderly subjects, 14% were in-patients and none were in rehabilitation units. There was no difference in functional level for survivors at the 3-month follow-up. Conclusion: Old age is associated with fall-induced severe TBI and high mortality rates. Less intensive treatment strategies were applied to elderly patients in the present study despite high rates of haemorrhage. Few surviving elderly patients received rehabilitation at 3 months post-injury.publishedVersio

Patterns of change and stability in caregiver burden and life satisfaction from 1 to 2 years after severe traumatic brain injury : a Norwegian longitudinal study

Objectives: To assess burden and life satisfaction in caregivers of patients with severe traumatic brain injury (sTBI) at 1 and 2 years post-injury, to examine if change in burden can be predicted by caregiver and patient demographics, patient’s functional status, caregiver’s social network or caregiver’s level of burden at 1 year. Design: Prospective national multicenter study. Self-report from caregivers, patient data collected from a national cohort study on patients with sTBI. Participants: 80 caregivers. Main outcome measure: The Caregiver Burden Scale (CBS), life satisfaction. Results: The total caregiver burden increased significantly between years 1 and 2 post-injury (p=0.04). Life Satisfaction was significantly lower at 2 years follow-up (p=0.03) than at 1 year. Thirty percent of the caregivers reported an increased burden, 55% were stable, and 15% had a decrease in burden between the two follow-up times. Logistic regression analyses revealed that experiencing loneliness was an independent predictor of increased burden from 1 to 2 years post-injury (OR=4.35, p<0.05). Conclusions: The results demonstrate a need for long-term follow-up of patients and caregivers that particularly focuses on professional support to relieve caregiver burden and risk of loneliness or social isolation. This group may benefit from additional follow-up interventions tailored to their needs

Family members' experience with in-hospital health care after severe traumatic brain injury : a national multicentre study.

Background Family member’s experience and satisfaction of health care in the acute care and in-patient rehabilitation are important indicators of the quality of health care services provided to patients with severe traumatic brain injury (TBI). The objective was to assess family members’ experience of the health care provided in-hospital to patients with severe TBI, to relate experiences to family member and patient demographics, patients’ function and rehabilitation pathways. Methods Prospective national multicentre study of 122 family members of patients with severe TBI. The family experience of care questionnaire in severe traumatic brain injury (FECQ-TBI) was applied. Independent sample t-tests or analysis of variance (ANOVA) were used to compare the means between 2 or more groups. Paired samples t-tests were used to investigate differences between experience in the acute and rehabilitation phases. Results Best family members` experience were found regarding information during the acute phase, poorest scores were related to discharge. A significantly better care experience was reported in the acute phase compared with the rehabilitation phase (p &lt; 0.05). Worst family members` experience was related to information about consequences of the injury. Patient’s dependency level (p &lt; 0.05) and transferral to non-specialized rehabilitation were related to a worse family members` experience (p &lt; 0.01). Conclusions This study underscores the need of better information to family members of patients with severe TBI in the rehabilitation as well as the discharge phase. The results may be important to improve the services provided to family members and individuals with severe TBI

Caregivers to patients with severe traumatic brain injury. A national prospective study on caregiver burden, life satisfaction and health care experiences.

Background: Severe traumatic brain injury (TBI) is a major public health challenge as it often has huge consequences for the patient and the family for a long time after the injury. Objective: Assess caregiver burden and predictors of burden 1year post injury, investigate change and stability of caregiver burden and life satisfaction over time. Develop a validated tool to assess family member’s in-hospital health care experiences. Methods: A Norwegian prospective cohort multicenter study including 122 caregivers to patients with severe TBI. A structured questionnaire were used to assess caregiver burden, change in burden and life satisfaction over time and predictors of burden 1 and 2 years post injury. The Family Experiences of in-hospital Care Questionnaire for family members of patients with severe Traumatic Brain Injury (FECQ-TBI) were developed. Results: Paper I and II reported a moderate to high caregiver burden up to 2 years post injury. A poor social network, feeling lonely and taking care of a patient with more functional problems were significant predictors of a high burden. A significantly higher caregiver burden and lower life satisfaction at 2 years compared to 1 year post-injury were found. Paper III describes the development of the FECQ-TBI. Principal component analysis extracted six subscales: acute organization and information, rehabilitation organization, rehabilitation information, discharge, hospital facilities-patient and hospital facilities-family. All subscales had Cronbach´s alpha coefficients > 0.80, confirming the internal consistency. Hypothesis testing supported construct validity. Conclusion: Caregivers of patients with severe TBI experiences a considerable caregiver burden long time post injury.The FECQ-TBI showed good psychometric properties and construct validity, supporting the use of the FEQC-TBI to assess quality of in-hospital care from a family perspective. The results may have clinical implications as improved family-centered acute and rehabilitative care and a long-term follow-up can prevent the perceived caregiver burden over time

Challenges Faced by Health Professionals in Obtaining Correct Medication Information in the Absence of a Shared Digital Medication List

Information about patient medication use is usually registered and stored in different digital systems, making it difficult to share information across health care organisations. The lack of digital systems able to share medication information poses a threat to patient safety and quality of care. We explored the experiences of health professionals with obtaining and exchanging information on patient medication lists in Norwegian primary health care within the context of current digital and non-digital solutions. We used a qualitative research design with semi-structured interviews, including general practitioners (n = 6), pharmacists (n = 3), nurses (n = 17) and medical doctors (n = 6) from six municipalities in Norway. Our findings revealed the following five challenges characterised by being cut off from information on patient medication lists in the current digital and non-digital solutions: ‘fragmentation of information systems’, ‘perceived risk of errors’, ‘excessive time use’, ‘dependency on others’ and ‘uncertainty’. The challenges were particularly related to patient transitions between levels of care. Our study shows an urgent need for digital solutions to ensure seamless, up-to-date information about patient medication lists in order to prevent medication-related problems. Future digital solutions for a shared medication list should address these challenges directly to ensure patient safety and quality of care

Factors Affecting Caregiver Burden 1 Year After Severe Traumatic Brain Injury: A Prospective Nationwide Multicenter Study.

To assess burden in the caregivers of patients with severe traumatic brain injury (TBI) 1 year postinjury, related to caregiver's demographic data and social network, patient's demographic data, injury severity, and functional status

Severe traumatic brain injury in Norway: Impact of age on outcome

Objective: The aim of this study was to investigate the influence of age on mortality and 3-month outcome in a Norwegian cohort of patients with severe traumatic brain injury (TBI). Methods: Norwegian residents ≥ 16 years of age who were admitted with a severe TBI to the country’s 4 major trauma centres in 2009 and 2010 were included, as were adults (16–64 years) and elderly patients (≥ 65 years). Results: Half of the adult subjects and 84% of the elderly subjects were injured by falls. One-third of the adults and half of the elderly subjects were admitted to a local hospital before being transported to a regional trauma hospital. Subdural haematomas were more frequent in the elderly subjects. One-quarter of adults and two-thirds of the elderly subjects died within 3 months. At 3 months, 41% of the adult survivors were still in-patients, mainly in rehabilitation units (92%). Of the surviving elderly subjects, 14% were in-patients and none were in rehabilitation units. There was no difference in functional level for survivors at the 3-month follow-up. Conclusion: Old age is associated with fall-induced severe TBI and high mortality rates. Less intensive treatment strategies were applied to elderly patients in the present study despite high rates of haemorrhage. Few surviving elderly patients received rehabilitation at 3 months post-injury