Subjects -> OCCUPATIONS AND CAREERS (Total: 33 journals)
Showing 1 - 23 of 23 Journals sorted alphabetically
Advances in Developing Human Resources     Hybrid Journal   (Followers: 33)
American Journal of Pastoral Counseling     Hybrid Journal  
BMC Palliative Care     Open Access   (Followers: 39)
British Journal of Guidance & Counselling     Hybrid Journal   (Followers: 22)
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 10)
Career Development International     Hybrid Journal   (Followers: 19)
Career Development Quarterly     Hybrid Journal   (Followers: 5)
Community Development     Hybrid Journal   (Followers: 26)
Education + Training     Hybrid Journal   (Followers: 28)
Entrepreneurship Research Journal     Hybrid Journal   (Followers: 16)
Equality, Diversity and Inclusion : An International Journal     Hybrid Journal   (Followers: 21)
Field Actions Science Reports     Open Access  
Formation emploi     Open Access  
Health Care Analysis     Hybrid Journal   (Followers: 17)
Human Resource Development Review     Hybrid Journal   (Followers: 33)
Industrial and Organizational Psychology     Hybrid Journal   (Followers: 27)
International Journal for Educational and Vocational Guidance     Hybrid Journal   (Followers: 9)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 41)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 15)
International Journal of Work Innovation     Hybrid Journal   (Followers: 2)
Journal of Career Assessment     Hybrid Journal   (Followers: 9)
Journal of Career Development     Hybrid Journal   (Followers: 12)
Journal of Human Capital     Full-text available via subscription   (Followers: 13)
Journal of Human Development and Capabilities : A Multi-Disciplinary Journal for People-Centered Development     Hybrid Journal   (Followers: 24)
Journal of Multicultural Counseling and Development     Hybrid Journal   (Followers: 8)
Journal of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 8)
Journal of Vocational Behavior     Hybrid Journal   (Followers: 28)
Neurocritical Care     Hybrid Journal   (Followers: 17)
Palliative & Supportive Care     Hybrid Journal   (Followers: 37)
Performance Improvement Quarterly     Hybrid Journal   (Followers: 3)
Professions and Professionalism     Open Access   (Followers: 9)
Recherches & éducations     Open Access  
Rehabilitation Counseling Bulletin     Hybrid Journal   (Followers: 3)
Research on Economic Inequality     Hybrid Journal   (Followers: 11)
Trabajo : Revista de la Asociación Estatal de Centros Universitarios de Relaciones Laborales y Ciencias del Trabajo     Open Access  
Vocations and Learning     Hybrid Journal   (Followers: 9)
Work and Occupations     Hybrid Journal   (Followers: 56)
Work, Employment & Society     Hybrid Journal   (Followers: 52)
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Neurocritical Care
Journal Prestige (SJR): 1.311
Citation Impact (citeScore): 3
Number of Followers: 17  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1556-0961 - ISSN (Online) 1541-6933
Published by Springer-Verlag Homepage  [2657 journals]
  • Response to Dr. Panda and Colleagues
    • PubDate: 2021-05-12
       
  • Role of Neurostimulants During Acute Stroke Care: Do they Improve
           Wakefulness'
    • PubDate: 2021-05-12
       
  • Application of Near-Infrared Spectroscopy for the Detection of Delayed
           Cerebral Ischemia in Poor-Grade Subarachnoid Hemorrhage
    • Abstract: Background The objective of this study was to investigate the clinical feasibility of near-infrared spectroscopy (NIRS) for the detection of delayed cerebral ischemia (DCI) in patients with poor-grade subarachnoid hemorrhage (SAH) treated with coil embolization. Methods Cerebral regional oxygen saturation (rSO2) was continuously monitored via two-channel NIRS for 14 days following SAH. The rSO2 levels according to DCI were analyzed by using the Mann–Whitney U-test. A receiver operating characteristic curve was generated on the basis of changes in rSO2 by using the rSO2 level on day 1 as a reference value to determine the optimal cutoff value for identifying DCI. Results Twenty-four patients with poor-grade SAH were included (DCI, n = 8 [33.3%]; non-DCI, n = 16 [66.7%]). The rSO2 levels of patients with DCI were significantly lowered from 6 to 9 days compared with those in without DCI. The rSO2 level was 62.55% (58.30–63.40%) on day 6 in patients with DCI versus 65.40% (60.90–68.70%) in those without DCI. By day 7, it was 60.40% (58.10–61.90%) in patients with DCI versus 64.25% (62.50–67.10%) those without DCI. By day 8, it was 58.90% (56.50–63.10%) in patients with DCI versus 66.05% (59.90–69.20%) in those without DCI, and by day 9, it was 60.85% (58.40–65.20%) in patients with DCI versus 65.80% (62.70–68.30%) in those without DCI. A decline of greater than 14.5% in the rSO2 rate yielded a sensitivity of 92.86% (95% confidence interval: 66.1–99.8%) and a specificity of 88.24% (95% confidence interval: 72.5–96.7%) for identifying DCI. A decrease by more than 14.7% of the rSO2 level indicates a sensitivity of 85.7% and a specificity of 85.7% for identifying DCI. Conclusions Near-infrared spectroscopy shows some promising results for the detection of DCI in patients with poor-grade SAH. Further studies involving a large cohort of the SAH population are required to confirm our results.
      PubDate: 2021-05-07
       
  • Relationship Between Non-contrast Computed Tomography Imaging Markers and
           Perihemorrhagic Edema Growth in Intracerebral Hemorrhage
    • Abstract: Objectives Perihemorrhagic edema (PHE) growth has been gradually considered as predictor for outcome of Intracerebral hemorrhage (ICH) patients. The aim of our study was to investigate correlation between non-contrast computed tomography (CT) markers and early PHE growth. Methods ICH patients between July 2011 and March 2017 were included in this retrospective analysis. ICH and PHE volumes were measured by using a validated semiautomatic volumetric algorithm. Nonparametric test was used for comparing PHE volume at different time points of non-contrast computed tomography (NCCT) imaging markers. Multivariable linear regression was constructed to study the relationship between NCCT imaging markers and PHE growth over 36 h. Results A total of 214 patients were included. Nonparametric test showed that PHE volume was significantly different between patients with and without NCCT imaging markers. (all p < 0.05) In multivariable linear regression analysis adjusted for ICH characteristics, blend sign (p = 0.011), black hole sign (p = 0.002), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001) were correlated with PHE growth. Follow-up PHE volume within 36 h after baseline CT scan was associated with blend sign (p = 0.001), island sign (p < 0.001), and expansion-prone hematoma (p < 0.001). Conclusion NCCT imaging markers of hematoma expansion are associated with PHE growth. This suggests that early PHE growth can be predicted using radiology markers on admission CT scan.
      PubDate: 2021-05-03
       
  • Complex Approaches for a Complex Organ
    • PubDate: 2021-04-30
       
  • Precise Clinical Outcome in High-Grade Aneurysmal Subarachnoid Hemorrhage:
           Brain Oxygenation Matters!
    • PubDate: 2021-04-27
       
  • Response to: “Precise Clinical Outcome in High-Grade Aneurysmal
           Subarachnoid Hemorrhage: Brain Oxygenation Matters!”
    • PubDate: 2021-04-27
       
  • Can a Dyadic Resiliency Program Improve Quality of Life in Cognitively
           Intact Dyads of Neuro-ICU Survivors and Informal Caregivers' Results
           from a Pilot RCT
    • Abstract: Background Neuro-ICU hospitalization for an acute neurological illness is often traumatic and associated with heightened emotional distress and reduced quality of life (QoL) for both survivors and their informal caregivers (i.e., family and friends providing unpaid care). In a pilot study, we previously showed that a dyadic (survivor and caregiver together) resiliency intervention (Recovering Together [RT]) was feasible and associated with sustained improvement in emotional distress when compared with an attention placebo educational control. Here we report on changes in secondary outcomes assessing QoL. Methods Survivors (n = 58) and informal caregivers (n = 58) completed assessments at bedside and were randomly assigned to participate together as a dyad in the RT or control intervention (both 6 weeks, two in-person sessions at bedside and four sessions via live video post discharge). We measured QoL domain scores (physical health, psychological, social relations, and environmental), general QoL, and QoL satisfaction using the World Health Organization Quality of Life Abbreviated Instrument at baseline, post treatment, and 3 months’ follow-up. We conducted mixed model analyses of variance with linear contrasts to estimate (1) within-group changes in QoL from baseline to post treatment and from post treatment to 3 months’ follow-up and (2) between-group differences in changes in QoL from baseline to post treatment and from post treatment to 3 months’ follow-up. Results We found significant within-group improvements from baseline to post treatment among RT survivors for physical health QoL (mean difference 1.73; 95% confidence interval [CI] 0.39–3.06; p = 0.012), environmental QoL (mean difference 1.29; 95% CI 0.21–2.36; p = 0.020), general QoL (mean difference 0.55; 95% CI 0.13–0.973; p = 0.011), and QoL satisfaction (mean difference 0.87; 95% CI 0.36–1.37; p = 0.001), and those improvements sustained through the 3-month follow-up. We found no significant between-group improvements for survivors or caregivers from baseline to post treatment or from post treatment to 3 months’ follow-up for any QoL variables (i.e., domains, general QoL, and QoL satisfaction together). Conclusions In this pilot study, we found improved QoL among survivors, but not in caregivers, who received RT and improvements sustained over time. These RT-related improvements were not significantly greater than those observed in the control. Results support a fully powered randomized controlled trial to allow for a definitive evaluation of RT-related effects among dyads of survivors of acute brain injury and their caregivers.
      PubDate: 2021-04-21
       
  • The Antiedematous Effect of Exogenous Lactate Therapy in Traumatic Brain
           Injury: A Physiological and Mechanistic Approach
    • Abstract: Background Sodium lactate (SL) has been described as an efficient therapy in treating raised intracranial pressure (ICP). However, the precise mechanism by which SL reduces intracranial hypertension is not well defined. An antiedematous effect has been proposed but never demonstrated. In this context, the involvement of chloride channels, aquaporins, or K–Cl cotransporters has also been suggested, but these mechanisms have never been assessed when using SL. Methods In a rat model of traumatic brain injury (TBI), we compared the effect of SL versus mannitol 20% on ICP, cerebral tissue oxygen pressure, and brain water content. We attempted to clarify the involvement of chloride channels in the antiedematous effects associated with lactate therapy in TBI. Results An equimolar single bolus of SL and mannitol significantly reduced brain water content and ICP and improved cerebral tissue oxygen pressure 4 h after severe TBI. The effect of SL on brain water content was much longer than that of mannitol and persisted at 24 h post TBI. Western blot and immunofluorescence staining analyses performed 24 h after TBI revealed that SL infusion is associated with an upregulation of aquaporin 4 and K–Cl cotransporter 2. Conclusions SL is an effective therapy for treating brain edema after TBI. This study suggests, for the first time, the potential role of chloride channels in the antiedematous effect induced by exogenous SL.
      PubDate: 2021-04-20
       
  • Correction to: Intracerebral Hemorrhage in COVID-19 Patients with
           Pulmonary Failure: A Propensity Score-Matched Registry Study
    • Abstract: A correction to this paper has been published: https://doi.org/10.1007/s12028-021-01225-0
      PubDate: 2021-04-12
       
  • Association of Dose of Intracranial Hypertension with Outcome in
           Subarachnoid Hemorrhage
    • Abstract: Background In patients with aneurysmal subarachnoid hemorrhage (aSAH) the burden of intracranial pressure (ICP) and its contribution to outcomes remains unclear. In this multicenter study, the independent association between intensity and duration, or “dose,” of episodes of intracranial hypertension and 12-month neurological outcomes was investigated. Methods This was a retrospective analysis of multicenter prospectively collected data of 98 adult patients with aSAH amendable to treatment. Patients were admitted to the intensive care unit of two European centers (Medical University of Innsbruck [Austria] and San Gerardo University Hospital of Monza [Italy]) from 2009 to 2013. The dose of intracranial hypertension was visualized. The obtained visualizations allowed us to investigate the association between intensity and duration of episodes of intracranial hypertension and the 12-month neurological outcomes of the patients, assessed with the Glasgow Outcome Score. The independent association between the cumulative dose of intracranial hypertension and outcome for each patient was investigated by using multivariable logistic regression models corrected for age, occurrence of delayed cerebral ischemia, and the Glasgow Coma Scale score at admission. Results The combination of duration and intensity defined the tolerance to intracranial hypertension for the two cohorts of patients. A semiexponential transition divided ICP doses that were associated with better outcomes (in blue) with ICP doses associated with worse outcomes (in red). In addition, in both cohorts, an independent association was found between the cumulative time that the patient experienced ICP doses in the red area and long-term neurological outcomes. The ICP pressure–time burden was a stronger predictor of outcomes than the cumulative time spent by the patients with an ICP greater than 20 mmHg. Conclusions In two cohorts of patients with aSAH, an association between duration and intensity of episodes of elevated ICP and 12-month neurological outcomes could be demonstrated and was visualized in a color-coded plot.
      PubDate: 2021-04-12
       
  • Thromboelastography is a Marker for Clinically Significant Progressive
           Hemorrhagic Injury in Severe Traumatic Brain Injury
    • Abstract: Background Coagulopathy in traumatic brain injury (TBI) is associated with increased risk of poor outcomes, but accurate prediction of clinically significant progressive hemorrhagic injury (PHI) in patients with severe TBI remains a challenge. Thromboelastography (TEG) is a real-time test of whole blood coagulation that provides dynamic information about global hemostasis. This study aimed to identify differences in TEG values between patients with severe TBI who did or did not experience clinically significant PHI. Methods This was a single-center retrospective cohort study of adult patients with severe TBI. Patients were eligible for inclusion if initial Glasgow coma scale (GCS) was ≤ 8 and baseline head computed tomography (CT) imaging and TEG were available. Exclusion criteria included receipt of hemostatic agents prior to TEG. PHI was defined as bleeding expansion on CT within 24 h associated with 2-point drop in GCS, neurosurgical intervention, or mortality within 24 h. The primary endpoint was TEG value differences between patients with and without PHI. Secondary endpoints included differences in conventional coagulation tests (CCTs) between groups. Results Of the 526 patients evaluated, 141 met inclusion criteria. The most common reason for exclusion was lack of baseline TEG and receipt of reversal product prior to TEG. Sixty-four patients experienced PHI in the first 24 h after presentation. K time (2.03 min vs. 1.33 min, P = 0.035) and alpha angle (65° vs. 69°, P = 0.015) were found to be significantly different in patients experiencing PHI. R time (5.25 min vs. 4.71 min), maximum amplitude (61 mm vs. 63 mm), and clot lysis at 30 min after maximum clot strength (3.5% vs. 1.7%) were not significantly different between groups. Of the CCTs, only activated partial thromboplastin time (30.3 s vs. 27.6 s, P = 0.014) was found to be different in patients with PHI. Conclusions Prolonged K time and narrower alpha angle were found to be associated with developing clinically significant PHI in patients with severe TBI. Despite differences detected in alpha angle, median values in both groups were within normal reference ranges. These abnormalities may reflect pathologic hypoactivity of fibrinogen, and further study is warranted to evaluate TEG-guided cryoprecipitate administration in this patient population.
      PubDate: 2021-04-12
       
  • Association Between Ionized Calcium Level and Neurological Outcome in
           Endovascularly Treated Patients with Spontaneous Subarachnoid Hemorrhage:
           A Retrospective Cohort Study
    • Abstract: Background Spontaneous subarachnoid hemorrhage (SSAH) is associated with significant morbidity and mortality. Pathophysiological processes following initial bleeding are complex and not fully understood. In this study, we aimed to determine whether a low level of ionized calcium (Ca++), an essential cofactor in the coagulation cascade and other cellular processes, is associated with adverse neurological outcome, development of early hydrocephalus, and symptomatic vasospasm among patients with SSAH. Methods This was a retrospective single-center cohort study of all patients admitted for SSAH between January 1, 2009, and April 31, 2020. The primary outcome was an unfavorable neurological status at discharge, defined as a modified Rankin Scale score greater than or equal to 3. Secondary outcomes were the development of early hydrocephalus and symptomatic vasospasm. Multivariable logistic regression was performed to determine whether Ca++ was an independent predictor of these outcomes. Results A total of 255 patients were included in the final analysis. Hypocalcemia, older age, admission Glasgow Coma Scale (GCS) score, and admission Hunt–Hess classification scale (H&H) grades IV and V were independently associated with unfavorable neurological outcome, with adjusted odds ratios (ORs) of 1.93 (95% confidence interval [CI] 1.1–3.4; p = 0.02) for each 0.1 mmol L−1 decrease in the Ca++ level, 1.04 (95% CI 1.01–1.08; p = 0.02) for each year increase, 0.82 (95% CI 0.68–0.99; p = 0.04), and 6.29 (95% CI 1.14–34.6; p = 0.03), respectively. Risk factors for the development of hydrocephalus were hypocalcemia and GCS score, with ORs of 1.85 (95% CI 1.26–2.71; p = 0.002) for each 0.1 mmol L−1 decrease in the Ca++ level and 0.83 (95% CI 0.73–0.94; p = 0.005), respectively. Ca++ was not associated with symptomatic vasospasm (OR 1.04 [95% CI 0.76–1.41]; p = 0.81). Among patients with admission H&H grade I–III bleeding, hypocalcemia was independently associated with unfavorable neurological outcome at discharge, with an adjusted OR of 1.99 (95% CI 1.03–3.84; p = 0.04) for each 0.1 mmol L−1 decrease in the Ca++ level. Hypocalcemia was also an independent risk factor for the development of early hydrocephalus, with an adjusted OR of 2.95 (95% CI 1.49–5.84; p = 0.002) for each 0.1 mmol L−1 decrease in the Ca++ level. Ca++ was not associated with symptomatic vasospasm. No association was found between Ca++ and predefined outcomes among patients with admission H&H grade IV and V bleeding. Conclusions Our study shows that hypocalcemia is associated with worse neurological outcome at discharge and development of early hydrocephalus in endovascularly treated patients with SSAH. Potential mechanisms include calcium-induced coagulopathy and higher blood pressure. Trials are needed to assess whether correction of hypocalcemia will lead to improved outcomes.
      PubDate: 2021-04-07
       
  • Prothrombin Complex Concentrate for Emergent Reversal of Intracranial
           Hemorrhage in Patients with Ventricular Assist Devices
    • Abstract: Background Intracranial hemorrhage (ICH) is a devastating complication for patients with ventricular assist devices (VADs). The safety of emergent anticoagulation reversal with four-factor prothrombin complex concentrate (PCC) and optimal timing of anticoagulation resumption are not clear. In addition, lactate dehydrogenase (LDH) is used as a biomarker for thromboembolic risk, but its utility in guiding anticoagulation management after reversal with PCC has not be described. Methods We retrospectively reviewed a consecutive series of patients with VADs presenting with ICH between 2014 and 2020 who received four-factor PCC for rapid anticoagulation reversal. We collected the timing of PCC administration, timing of resumption of anticoagulation, survival, occurrence of thromboembolic events, and LDH levels throughout hospitalization. Results We identified 16 ICH events in 14 patients with VADs treated with rapid anticoagulation reversal using four-factor PCC (11 intraparenchymal, 4 subdural, 1 subarachnoid hemorrhage). PCC was administered at a mean of 3.3 ± 0.3 h after imaging diagnosis of ICH. Overall mortality was 63%. Survivors had higher presenting Glasgow Coma Scale (median 15, interquartile range [IQR] 15–15 versus 14, IQR 8–14.7, P = 0.041). In all six instances where the patient survived, anticoagulation was resumed on average 9.16 ± 1.62 days after reversal. There were no thromboembolic events prior to resumption of anticoagulation. Three events occurred after anticoagulation resumption and within 3 months of reversal: VAD thrombosis in a patient with thrombosis at the time of reversal, ischemic stroke, and readmission for elevated LDH in the setting of subtherapeutic international normalized ratio. Conclusions Our limited series found no thromboembolic complications immediately following anticoagulation reversal with PCC prior to resumption of anticoagulation. LDH trends may be useful to monitor thromboembolic risk after reversal.
      PubDate: 2021-04-05
       
  • Predictors of Family Dissatisfaction with Support During Neurocritical
           Care Shared Decision-Making
    • Abstract: Background There is a critical need to improve support for families making difficult shared decisions about patient care with clinicians in the neuroscience ICU (neuro-ICU). The aim of this study is to identify patient- and family-related factors associated with dissatisfaction with shared decision-making support among families of neuro-critically ill patients. Methods We conducted a retrospective observational cohort study using survey data that had been collected from a consecutive sample of family members of patients in the neuro-ICU (one family member per patient) at two US academic centers. Satisfaction with shared decision-making support on ICU discharge had been measured among family members using one specific Likert scale item on the Family Satisfaction in the ICU 24 survey, a validated survey instrument for families of patients in the ICU. We dichotomized top-box responses for this particular item as an outcome variable and identified available patient- and family-related covariates associated with dissatisfaction (i.e., less than complete satisfaction) via univariate and multivariate analyses. Results Among 355 surveys, 180 (49.5%) of the surveys indicated dissatisfaction with support during decision-making. In a multivariate model, no preexisting characteristics of families or patients ascertainable on ICU admission were predictive of dissatisfaction. However, among family factors determined during the ICU course, experiencing three or fewer formal family meetings (odds ratio 1.93 [confidence interval 1.13–3.31]; p = 0.01) was significantly predictive of dissatisfaction with decisional support in this cohort with an average patient length of stay of 8.6 days (SD 8.4). There was also a trend toward a family’s decision to keep a patient as full code, without treatment limitations, being predictive of dissatisfaction (odds ratio 1.80 [confidence interval 0.93–3.51]; p = 0.08). Conclusions Family dissatisfaction with neuro-ICU shared decision-making support is not necessarily predicted by any preexisting family or patient variables but appears to correlate with participating in fewer formal family meetings during ICU admission. Future studies to improve family satisfaction with neurocritical care decision-making support should have broad inclusion criteria for participants and should consider promoting frequency of family meetings as a core strategy.
      PubDate: 2021-04-05
       
  • Invited Commentary on Intracerebral Hemorrhage in COVID-19 Patients with
           Pulmonary Failure: A Propensity Score-Matched Registry Study
    • PubDate: 2021-04-02
       
  • Implementation of Multimodality Neurologic Monitoring Reporting in
           Pediatric Traumatic Brain Injury Management
    • Abstract: Background/Objective Multimodality neurologic monitoring (MMM) is an emerging technique for management of traumatic brain injury (TBI). An increasing array of MMM-derived biomarkers now exist that are associated with injury severity and functional outcomes after TBI. A standardized MMM reporting process has not been well described, and a paucity of evidence exists relating MMM reporting in TBI management with functional outcomes or adverse events. Methods Prospective implementation of standardized MMM reporting at a single pediatric intensive care unit (PICU) is described that included monitoring of intracranial pressure (ICP), cerebral oxygenation and electroencephalography (EEG). The incidence of clinical decisions made using MMM reporting is described, including timing of neuroimaging, ICP monitoring discontinuation, use of paralytic, hyperosmolar and pentobarbital therapies, neurosurgical interventions, ventilator and CPP adjustments and neurologic prognostication discussions. Retrospective analysis was performed on the association of MMM reporting with initial Glasgow Coma Scale (GCS) and Pediatric Risk of Mortality III (PRISM III) scores, duration of total hospitalization and PICU hospitalization, duration of mechanical ventilation and invasive ICP monitoring, inpatient complications, time with ICP > 20 mmHg, time with cerebral perfusion pressure (CPP) < 40 mmHg and 12-month Glasgow Outcome Scale—Extended Pediatrics (GOSE-Peds) scores. Association of outcomes with MMM reporting was investigated using the Wilcoxon rank-sum test or Fisher’s exact test, as appropriate. Results Eighty-five children with TBI underwent MMM over 6 years, among which 18 underwent daily MMM reporting over a 21-month period. Clinical decision-making influenced by MMM reporting included timing of neuroimaging (100.0%), ICP monitoring discontinuation (100.0%), timing of extubation trials of surviving patients (100.0%), body repositioning (11.1%), paralytic therapy (16.7%), hyperosmolar therapy (22.2%), pentobarbital therapy (33.3%), provocative cerebral autoregulation testing (16.7%), adjustments in CPP thresholds (16.7%), adjustments in PaCO2 thresholds (11.1%), neurosurgical interventions (16.7%) and neurologic prognostication discussions (11.1%). The implementation of MMM reporting was associated with a reduction in ICP monitoring duration (p = 0.0017) and mechanical ventilator duration (p = 0.0018). No significant differences were observed in initial GCS or PRISM III scores, total hospitalization length, PICU hospitalization length, total complications, time with ICP > 20 mmHg, time with CPP < 40 mmHg, use of tier 2 therapy, or 12-month GOS-E Peds scores. Conclusion Implementation of MMM reporting in pediatric TBI management is feasible and can be impactful in tailoring clinical decisions. Prospective work is needed to understand the impact of MMM and MMM reporting systems on functional outcomes and clinical care efficacy.
      PubDate: 2021-03-31
       
  • Impact of Fever Prevention in Brain-Injured Patients (INTREPID): Study
           Protocol for a Randomized Controlled Trial
    • Abstract: Background Multiple studies demonstrate that fever/elevated temperature is associated with poor outcomes in patients with vascular brain injury; however, there are no conclusive studies that demonstrate that fever prevention/controlled normothermia is associated with better outcomes. The primary objective of the INTREPID (Impact of Fever Prevention in Brain-Injured Patients) trial is to test the hypothesis that fever prevention is superior to standard temperature management in patients with acute vascular brain injury. Methods INTREPID is a prospective randomized open blinded endpoint study of fever prevention versus usual care in patients with ischemic or hemorrhagic stroke. The fever prevention intervention utilizes the Arctic Sun System and will be compared to standard care patients in whom fever may spontaneously develop. Ischemic stroke, intracerebral hemorrhage or subarachnoid hemorrhage patients will be included within disease-specific time-windows. Both awake and sedated patients will be included, and treatment is initiated immediately upon enrollment. Eligible patients are expected to require intensive care for at least 72 h post-injury, will not be deemed unlikely to survive without severe disability, and will be treated for up to 14 days, or until deemed ready for discharge from the ICU, whichever comes first. Fifty sites in the USA and worldwide will participate, with a target enrollment of 1176 patients (1000 evaluable). The target temperature is 37.0 °C. The primary efficacy outcome is the total fever burden by °C-h, defined as the area under the temperature curve above 37.9 °C. The primary secondary outcome, on which the sample size is based, is the modified Rankin Scale Score at 3 months. All efficacy analyses including the primary and key secondary endpoints will be primarily based on an intention-to-treat population. Analysis of the as-treated and per protocol populations will also be performed on the primary and key secondary endpoints as sensitivity analyses. Discussion The INTREPID trial will provide the first results of the impact of a pivotal fever prevention intervention in patients with acute stroke (www.clinicaltrials.gov; NCT02996266; registered prospectively 05DEC2016).
      PubDate: 2021-03-24
       
  • Comment on “Temporal Dynamics of ICP, CPP, PRx, and CPPopt in High-Grade
           Aneurysmal Subarachnoid Hemorrhage and the Relation to Clinical Outcome”
           
    • PubDate: 2021-03-22
       
  • Pay Attention to Blood Pressure and Oxygen Supply for Neurocritically Ill
           Patients: Each Pathology Deserves a Specific Treatment
    • PubDate: 2021-03-22
       
 
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