Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2002
Appropriate analysis and presentation of data is a must for good clinical practice.
Good Clinical Practice (GCP) is defined as an international ethical and scientific quality standard for designing, conducting, monitoring, auditing, analyzing and reporting trials that involve the participation of human subjects. This paper focuses mainly on the issues that need attention at the time of statistical analysis and reporting of results. Findings from a review of published articles in Turkey are also presented. ⋯ The review of a stratified sample of research articles from 60 journals published in 1992 in Turkey revealed that in 56% of the cases the statistical methods were improper or inadequate. In 15% of the articles the authors failed to select an appropriate design for the proposed aim mentioned in the manuscript. Despite the recent improvements, the necessity and the value of performing and presenting research according to the international standards remains to be assimilated better by Turkish investigators.
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Acta Neurochir. Suppl. · Jan 2002
Can hyperventilation improve cerebral microcirculation in patients with high ICP?
Gosling's pulsatility index (PI) is generally thought to reflect cerebrovascular resistance. Hyperventilation and increased intracranial pressure (ICP) usually increase PI. In this study, the effect of hyperventilation on PI was assessed in head injured patients with and without elevated ICP. ⋯ High baseline ICP, low initial GCS and impaired hCO2R were associated with the decrease of PI. Hyperventilation unexpectedly reduced PI in patients with high ICP. Because decreased PI suggests decreased CVR, it is postulated that hyperventilation in the setting of raised ICP improves cerebral microcirculation.
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Acta Neurochir. Suppl. · Jan 2002
Effects of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure.
The effect of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) has been reported by several investigators, without any consensus being reached. Acute neurological and neurosurgical patients suffer intracranial hypertension and acute lung injury with hypoxemia. Since PEEP may improve hypoxemia but elevate ICP and decrease CPP, it is important to determine the influence of varying levels of PEEP on ICP and CPP. ⋯ PEEP was raised from 5 (basal) to 15 cm H2O in steps of 5 cm H2O. After at least 10 minutes of each new PEEP setting, ICP and CPP were measured. PEEP at 10 and 15 cm H2O produced a significant (p < 0.05) increase in intracranial pressure 11.6 +/- 5.6 and 14.6 +/- 6.28 mm Hg, respectively; no significant (p = 0.819) change occurred in CPP.
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Acta Neurochir. Suppl. · Jan 2002
Neurological and social long-term outcome after early rehabilitation following traumatic brain injury. 5-year report on 240 TBI patients.
The long term courses of patients after traumatic brain injury (TBI) are particularly influenced by the quality of neuropsychological rehabilitation and social reintegration. Though we do have data from different European countries about the success of surgery and intensive care, we don't know much about the long term courses, mirrored by the patients, their relatives and local physicians in their domestic environment. Supported by a pilot project of the government of Nordrhein--Westfalia we reviewed 252 patients with different grades of TBI, which were treated in our department from emergency to the end of early rehabilitation. ⋯ So we observe a significant gap between a high impact clinical medicine on one side and a deficient outpatient treatment on the other. At least many patients are standing alone after discharge from rehabilitation hospitals, resulting in prolonged stationary treatment with extensive costs to minimize damage from this situation. Our consequence for a more efficient treatment is, that we substantially need better programs by local administrations, insurance companies and employers for better and earlier reintegration to avoid isolation and unnecessary invalidation, especially of those patients with the best medical prognosis.
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Disturbed cerebral autoregulation is believed to be associated with an unfavourable outcome following head injury. Previously, using ICP monitoring and transcranial Doppler ultrasonography, we investigated whether cerebral response to spontaneous variations in arterial pressure (ABP) or cerebral perfusion pressure (CPP) provide reliable information on cerebral autoregulatory reserve. In the present study we have correlated these methods with clinical findings. ⋯ Positive values of indices of autoregulation, expressing positive association between slow waves of CPP and blood flow velocity or ABP and ICP, indicate disturbed autoregulation. These indices correlate with unfavourable outcome following head injury and should be used to guide intensive therapy.