Articles: traumatic-brain-injuries.
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Journal of neurotrauma · Jan 2016
Modelling of community integration trajectories in the first 5 years after traumatic brain injury.
The aims of this study were to assess the trajectories of community integration in individuals with traumatic brain injury (TBI) through one, two, and five years post-injury and to examine whether those trajectories could be predicted by demographic and injury characteristics. A longitudinal cohort study was conducted with 105 individuals with moderate-to-severe TBI admitted to a trauma referral center in 2005-2007. Demographics and injury-related factors were extracted from medical records. ⋯ Additionally, higher trajectories of community integration were predicted by being single at the time of injury (p<.001), higher level of education (p=0.006), employment (p<0.001), and a shorter length of PTA (p<0.001). In a follow-up HLM with interaction terms, time*PTA was statistically significant (p<0.001), suggesting that participants with longer PTA increased in community integration more rapidly than those with shorter PTA. The longitudinal course of community integration described in this study may help rehabilitation professionals to plan more extensive follow-ups and targeted rehabilitation programs in the early stage of recovery for patients with specific demographic and injury characteristics.
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Journal of neurotrauma · Jan 2016
Traumatic Brain Injury Impairs SNARE Complex Formation and Alters Synaptic Vesicle Distribution in the Hippocampus.
Traumatic brain injury (TBI) impairs neuronal function and can culminate in lasting cognitive impairment. While impaired neurotransmitter release has been well established after experimental TBI, little is understood about the mechanisms underlying this consequence. In the synapse, vesicular docking and neurotransmitter release requires the formation of the soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex. ⋯ Synapses in the hippocampus were imaged at 100k magnification, and vesicle distribution was assessed in pre-synaptic terminals at the active zone. CCI resulted in a significant reduction in vesicle number within 150 nm of the active zone. These findings provide the first evidence of TBI-induced impairments in synaptic vesicle docking, and suggest that reductions in the pool of readily releasable vesicles and impaired SNARE complex formation are two novel mechanisms contributing to impaired neurotransmission after TBI.
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Brain injury : [BI] · Jan 2016
Prognostic models for prediction of outcomes after traumatic brain injury based on patients admission characteristics.
To identify the best performing prognostic model using admission characteristics to predict mortality at 30 days and functioning outcome at 6-months post-admission in patients with moderate or severe brain injury. ⋯ For clinical decision-making, model-2 is recommended on the basis of good performance in predicting outcomes in patients with moderate or severe TBI in India and other similar countries.
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The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. ⋯ Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches.
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Patients with traumatic brain injury (TBI) need frequent computed tomography (CT) of the head for assessment and management. In view of the associated polytrauma, hemodynamic instability, and various in-dwelling catheters and tubes, shifting of patients for CT scans may be difficult. ⋯ A mobile CT has considerably changed the management response time in the neurosurgical intensive care unit (ICU) setup and decreased patient transfer times and the associated complications. Inclusion of a mobile CT scanner in the armamentarium of a neurosurgeon as a "bedside tool" can dramatically change decision making and the response time. It should be considered as the standard of care in any large-volume emergency department or neurosurgical facility.