Raj Kumar, Suraj Kumar, H. Prajapati, G. Potturi, Rahul Sharma
Abstract Background and Purpose Altered levels of consciousness resulting from a vascular insult to the brain can vary from confusion to coma. A disruption in the function of the brain stem reticular activating system in the brain stem or both cerebral hemispheres and thalami causes coma. This study is aimed at finding the effect of transcranial direct current stimulation (tDCS) on motor recovery in altered conscious patients after traumatic brain injury and cerebrovascular accident. Materials and Methods A total of 100 patients admitted to the neurology and neurosurgery unit of the university hospital were screened and 40 subjects who satisfied inclusion criteria were recruited and randomly divided into two groups, group A (experimental) ( n = 20) and group B (control)(n = 20), by computerized randomization. Written informed consent was taken from all the caregivers before recruitment. After taking the preliminary assessment, anodal tDCS is given to the motor area (C3/C4 ipsilesional), sensory area (P3/P4 ipsilesional), and left dorsolateral prefrontal cortex (F3) according to the 10/20 electroencephalogram montage for two sessions of 20 min/day for 7 consecutive days. Routine physiotherapy was also given the same as group B. Results At baseline, there were no significant group differences in the baseline characteristics. The groups passed the normality test. The results were tested for statistical significance between the groups by Mann–Whitney U test and by one-way analysis of variance and Tukey Honest Significant Difference for post-hoc comparison; the results were statistically different with p -value less than 0.05 with a large effect size. Conclusion We conclude, based on the results of this study, that tDCS can be effective in motor recovery in altered consciousness patients. It is noninvasive, cost-effective with minimal contraindications, and does not interfere with other modalities in the intensive care unit. Hence, it can be administered safely under the supervision of a qualified therapist.
{"title":"Effect of Transcranial Direct Current Stimulation on Motor Recovery in Altered Conscious Patients after Traumatic Brain Injury and Cerebrovascular Accident: A Randomized Clinical Trial","authors":"Raj Kumar, Suraj Kumar, H. Prajapati, G. Potturi, Rahul Sharma","doi":"10.1055/s-0043-1761937","DOIUrl":"https://doi.org/10.1055/s-0043-1761937","url":null,"abstract":"Abstract Background and Purpose Altered levels of consciousness resulting from a vascular insult to the brain can vary from confusion to coma. A disruption in the function of the brain stem reticular activating system in the brain stem or both cerebral hemispheres and thalami causes coma. This study is aimed at finding the effect of transcranial direct current stimulation (tDCS) on motor recovery in altered conscious patients after traumatic brain injury and cerebrovascular accident. Materials and Methods A total of 100 patients admitted to the neurology and neurosurgery unit of the university hospital were screened and 40 subjects who satisfied inclusion criteria were recruited and randomly divided into two groups, group A (experimental) ( n = 20) and group B (control)(n = 20), by computerized randomization. Written informed consent was taken from all the caregivers before recruitment. After taking the preliminary assessment, anodal tDCS is given to the motor area (C3/C4 ipsilesional), sensory area (P3/P4 ipsilesional), and left dorsolateral prefrontal cortex (F3) according to the 10/20 electroencephalogram montage for two sessions of 20 min/day for 7 consecutive days. Routine physiotherapy was also given the same as group B. Results At baseline, there were no significant group differences in the baseline characteristics. The groups passed the normality test. The results were tested for statistical significance between the groups by Mann–Whitney U test and by one-way analysis of variance and Tukey Honest Significant Difference for post-hoc comparison; the results were statistically different with p -value less than 0.05 with a large effect size. Conclusion We conclude, based on the results of this study, that tDCS can be effective in motor recovery in altered consciousness patients. It is noninvasive, cost-effective with minimal contraindications, and does not interfere with other modalities in the intensive care unit. Hence, it can be administered safely under the supervision of a qualified therapist.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83573619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vijayasekhar Venkata Manda, Rajesh Pathi, K. Swaroop, T. Phaneeswar, K. Satyavaraprasad
Abstract Introduction Traumatic brain injury (TBI) is a major cause of death and disability worldwide and early initiation of physiotherapy with continuing rehabilitation may improve outcomes. Methods All adult TBI patients with GCS 5–12 admitted from May 2018 to December 2019 were included. Early physiotherapy was initiated before the fifth day of admission and continued post discharge. Patients and families were educated in a rehabilitation program with printed handouts and video clips. All patients are followed up via telephone/video calls after discharge. We assessed the Glasgow Outcome Score (GOS) and disability at 15, 30, and 90 days post discharge, and 180 days follow-up was also suggested but only a few (38) patients reported. Data were compared with matched patients treated in previous years. Results A total of 1,233 patients were studied. At 3-month follow-up by telephonic and video calls, GOS 5 was noted (63.7%; 174/ 273) in 2019 compared with (41.3%; 41/ 98) in 2018. The number of discharges increased after initiation of physiotherapy and rehabilitation programs (38%; 288/759 in 2019 versus 24%; 115/474 in 2018). Post-discharge deaths were also less (5.9%; 17/288) in 2019 compared with (14.8%; 17/115) in 2018. Conclusion Early rehabilitation and post-discharge therapy are associated with improved outcomes of TBI patients. Refinements in data collection and communication improve patient follow-up and functional outcomes.
{"title":"Outcome in TBI Patients with Early Physiotherapy and Post-discharge Rehabilitation: Indian Experience","authors":"Vijayasekhar Venkata Manda, Rajesh Pathi, K. Swaroop, T. Phaneeswar, K. Satyavaraprasad","doi":"10.1055/s-0042-1759852","DOIUrl":"https://doi.org/10.1055/s-0042-1759852","url":null,"abstract":"Abstract Introduction Traumatic brain injury (TBI) is a major cause of death and disability worldwide and early initiation of physiotherapy with continuing rehabilitation may improve outcomes. Methods All adult TBI patients with GCS 5–12 admitted from May 2018 to December 2019 were included. Early physiotherapy was initiated before the fifth day of admission and continued post discharge. Patients and families were educated in a rehabilitation program with printed handouts and video clips. All patients are followed up via telephone/video calls after discharge. We assessed the Glasgow Outcome Score (GOS) and disability at 15, 30, and 90 days post discharge, and 180 days follow-up was also suggested but only a few (38) patients reported. Data were compared with matched patients treated in previous years. Results A total of 1,233 patients were studied. At 3-month follow-up by telephonic and video calls, GOS 5 was noted (63.7%; 174/ 273) in 2019 compared with (41.3%; 41/ 98) in 2018. The number of discharges increased after initiation of physiotherapy and rehabilitation programs (38%; 288/759 in 2019 versus 24%; 115/474 in 2018). Post-discharge deaths were also less (5.9%; 17/288) in 2019 compared with (14.8%; 17/115) in 2018. Conclusion Early rehabilitation and post-discharge therapy are associated with improved outcomes of TBI patients. Refinements in data collection and communication improve patient follow-up and functional outcomes.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85206823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Vijayasekhar, P. Rajesh, K. Swaroop, M.P.A. Babu Nagendra, Satyavaraprasad Kadali
Abstract Background Majority of road accidents are treated at nearby private hospitals. Head injury patients whose identity is not established are invariably being treated at government hospitals. The factors influencing the management and outcome of such unknown patients are possible only in government hospitals. Limited studies are available related to these unknown patients. Objective This study attempted to analyze the management issues in such patients and tried to find solutions that will improve the outcome. Methods It was an observational study over 2 years. All patients whose identity could not be established at admission were studied. Standard traumatic brain injury protocols were followed. Issues and challenges in managing these patients were noted. Many challenges popped up once patient was shifted out of intensive care unit and were studied. Results Eighty-five patients were studied with male preponderance. Common age group was 41 to 60 years. The main cause of head injury was road traffic accident. Seventy-six patients were severely injured. Acute subdural hematomas was the most common computed tomography finding (36 patients). Sixty-nine patients were managed conservatively and 16 needed surgery. Forty-nine patients died in hospital, and other patients recovered well. Twenty-two patients were discharged home and 11 took discharge against medical advice after being identified by relatives. None were accommodated into destitute homes even after recovery. Conclusion Unknown patients usually have poor outcome with more deaths in spite of standard care. Their management is fraught with challenges. They need special care for which staff should be motivated; hospital must have good network to establish identity.
{"title":"Practical Challenges in the Management and Outcome of Unknown Patients with Head Injury","authors":"M. Vijayasekhar, P. Rajesh, K. Swaroop, M.P.A. Babu Nagendra, Satyavaraprasad Kadali","doi":"10.1055/s-0042-1759871","DOIUrl":"https://doi.org/10.1055/s-0042-1759871","url":null,"abstract":"Abstract Background Majority of road accidents are treated at nearby private hospitals. Head injury patients whose identity is not established are invariably being treated at government hospitals. The factors influencing the management and outcome of such unknown patients are possible only in government hospitals. Limited studies are available related to these unknown patients. Objective This study attempted to analyze the management issues in such patients and tried to find solutions that will improve the outcome. Methods It was an observational study over 2 years. All patients whose identity could not be established at admission were studied. Standard traumatic brain injury protocols were followed. Issues and challenges in managing these patients were noted. Many challenges popped up once patient was shifted out of intensive care unit and were studied. Results Eighty-five patients were studied with male preponderance. Common age group was 41 to 60 years. The main cause of head injury was road traffic accident. Seventy-six patients were severely injured. Acute subdural hematomas was the most common computed tomography finding (36 patients). Sixty-nine patients were managed conservatively and 16 needed surgery. Forty-nine patients died in hospital, and other patients recovered well. Twenty-two patients were discharged home and 11 took discharge against medical advice after being identified by relatives. None were accommodated into destitute homes even after recovery. Conclusion Unknown patients usually have poor outcome with more deaths in spite of standard care. Their management is fraught with challenges. They need special care for which staff should be motivated; hospital must have good network to establish identity.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88570785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sivaraman Kumarasamy, K. Garg, H. Gurjar, Kokkula Praneeth, Rajesh Meena, R. Doddamani, Amandeep Kumar, Shashwat Mishra, V. Tandon, Pankaj Singh, D. Agrawal
Abstract Background Decompressive craniectomy (DC) is a frequently performed procedure to treat intracranial hypertension following traumatic brain injury (TBI) and stroke. DC is a salvage procedure that reduces mortality at the expense of severe disability and compromises the quality of life. The procedure is not without serious complications. Methods We describe the complications following DC and its management in a case-based review in this article. Results Complications after DC are classified as early or late complications based on the time of occurrence. Early complication includes hemorrhage, external cerebral herniation, wound complications, CSF leak/fistula, and seizures/epilepsy. Contusion expansion, new contralateral epidural, and subdural hematoma in the immediate postoperative period mandate surgical intervention. It is necessary to repeat non-contrast CT head at 24 hours and 48 hours following DC. Late complication includes subdural hygroma, hydrocephalus, syndrome of the trephined, bone resorption, and falls on the unprotected cranium. An early cranioplasty is an effective strategy to mitigate most of the late complications. Conclusions DC can be associated with a number of complications. One should be aware of the possible complications, and timely intervention is required.
{"title":"Complications of Decompressive Craniectomy: A Case-Based Review","authors":"Sivaraman Kumarasamy, K. Garg, H. Gurjar, Kokkula Praneeth, Rajesh Meena, R. Doddamani, Amandeep Kumar, Shashwat Mishra, V. Tandon, Pankaj Singh, D. Agrawal","doi":"10.1055/s-0043-1760724","DOIUrl":"https://doi.org/10.1055/s-0043-1760724","url":null,"abstract":"Abstract Background Decompressive craniectomy (DC) is a frequently performed procedure to treat intracranial hypertension following traumatic brain injury (TBI) and stroke. DC is a salvage procedure that reduces mortality at the expense of severe disability and compromises the quality of life. The procedure is not without serious complications. Methods We describe the complications following DC and its management in a case-based review in this article. Results Complications after DC are classified as early or late complications based on the time of occurrence. Early complication includes hemorrhage, external cerebral herniation, wound complications, CSF leak/fistula, and seizures/epilepsy. Contusion expansion, new contralateral epidural, and subdural hematoma in the immediate postoperative period mandate surgical intervention. It is necessary to repeat non-contrast CT head at 24 hours and 48 hours following DC. Late complication includes subdural hygroma, hydrocephalus, syndrome of the trephined, bone resorption, and falls on the unprotected cranium. An early cranioplasty is an effective strategy to mitigate most of the late complications. Conclusions DC can be associated with a number of complications. One should be aware of the possible complications, and timely intervention is required.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72941089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Delayed tension pneumocephalus is a rare entity. Twelve cases of posttraumatic delayed tension pneumocephalus have been reported. This study is a case report of a patient presenting with delayed posttraumatic tension pneumocephalus, and highlights the nuances of management.
{"title":"Delayed Posttraumatic Tension Pneumocephalus: Case Report and Review of Literature","authors":"C. Jain, Ajinkya Rewatkar, A. Roy, B. Indira Devi","doi":"10.1055/s-0043-1760726","DOIUrl":"https://doi.org/10.1055/s-0043-1760726","url":null,"abstract":"Abstract Delayed tension pneumocephalus is a rare entity. Twelve cases of posttraumatic delayed tension pneumocephalus have been reported. This study is a case report of a patient presenting with delayed posttraumatic tension pneumocephalus, and highlights the nuances of management.","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78614228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tariq Janjua, A. Agrawal, A. Pacheco-Hernandez, Y. Picón-Jaimes, I. Lozada‐Martínez, L. Moscote-Salazar
Training at the level of undergraduate and postgraduate (including fellowship) in neurotrauma and neurointensive care has been gaining more relevance. A key factor for this trend is the fact that traumatic brain injury is a public health problem.1 One of the new paradigms in education is the incorporation of the concept of medical education based on competencies.2Medical education requires the development of multiple skills on the part of the trainee that will result in benefit to address this public health problem.3,4 The competency-based medical training center is the key for trainees and the learning requirements. In contrast, when the development of competencies is established, the training andevaluationprocesses are individualized toachieve training objectives.Here thequestionarisesaboutwhat is themodel for competency-based training? Competence can be staged as the performance of an individual in a certain activity that is the productof the learningprocess. This requires the integrationof knowledge, skills, and attitudes adapted to the social context where it operates. The next question to address is if a training model based on competencies in neurotrauma and neurointensive care is valid? Competency-based education has been considered for training in critical care, in thiswaywe believe that given the complexity of medical care in neurotrauma and neurointensive care, this learning model encompasses all the care processes of the neurotrauma patient. From pre-hospital care, emergency management, transfer to hospitalization, neurointensive care, neurorehabilitation, and follow-up can be adapted to the competency-based learning model. We still need to addresswhat strategies can be established to implement a competency-based training model in neurotrauma and neurointensive care. Among the strategies that can be used are medical simulation, clinical case simulation in neurotrauma, and repeated evaluation. These strategies will increase interest and focus among the trainee in the management of patients with traumatic brain injury. The simulation of neurosurgical procedures and/or interventions in neurotrauma and simulation of procedures such as central line insertion are a few examples to be utilized for different trainees based upon the field of training they belong to. The data gathered from neurointensive care especially neurotrauma has to be utilized in real-time for the education, testing, simulation, and publication by the trainee (►Fig. 1). Periodic feedback should also include noncognitive elements such as student motivation, strengthening learning styles, and individualized aspects of each student. Also, human training stimulates ethical considerations of patient management andmakes the resident and specialist a respectful, analytical, and prudent human being. In conclusion, medical education in neurotrauma and neurointensive care is a multidisciplinary process. There are multiple key players in the process and all of them need to work in
{"title":"Competency-Based Medical Education in Neurotrauma and Neurocritical Care","authors":"Tariq Janjua, A. Agrawal, A. Pacheco-Hernandez, Y. Picón-Jaimes, I. Lozada‐Martínez, L. Moscote-Salazar","doi":"10.1055/s-0043-1760721","DOIUrl":"https://doi.org/10.1055/s-0043-1760721","url":null,"abstract":"Training at the level of undergraduate and postgraduate (including fellowship) in neurotrauma and neurointensive care has been gaining more relevance. A key factor for this trend is the fact that traumatic brain injury is a public health problem.1 One of the new paradigms in education is the incorporation of the concept of medical education based on competencies.2Medical education requires the development of multiple skills on the part of the trainee that will result in benefit to address this public health problem.3,4 The competency-based medical training center is the key for trainees and the learning requirements. In contrast, when the development of competencies is established, the training andevaluationprocesses are individualized toachieve training objectives.Here thequestionarisesaboutwhat is themodel for competency-based training? Competence can be staged as the performance of an individual in a certain activity that is the productof the learningprocess. This requires the integrationof knowledge, skills, and attitudes adapted to the social context where it operates. The next question to address is if a training model based on competencies in neurotrauma and neurointensive care is valid? Competency-based education has been considered for training in critical care, in thiswaywe believe that given the complexity of medical care in neurotrauma and neurointensive care, this learning model encompasses all the care processes of the neurotrauma patient. From pre-hospital care, emergency management, transfer to hospitalization, neurointensive care, neurorehabilitation, and follow-up can be adapted to the competency-based learning model. We still need to addresswhat strategies can be established to implement a competency-based training model in neurotrauma and neurointensive care. Among the strategies that can be used are medical simulation, clinical case simulation in neurotrauma, and repeated evaluation. These strategies will increase interest and focus among the trainee in the management of patients with traumatic brain injury. The simulation of neurosurgical procedures and/or interventions in neurotrauma and simulation of procedures such as central line insertion are a few examples to be utilized for different trainees based upon the field of training they belong to. The data gathered from neurointensive care especially neurotrauma has to be utilized in real-time for the education, testing, simulation, and publication by the trainee (►Fig. 1). Periodic feedback should also include noncognitive elements such as student motivation, strengthening learning styles, and individualized aspects of each student. Also, human training stimulates ethical considerations of patient management andmakes the resident and specialist a respectful, analytical, and prudent human being. In conclusion, medical education in neurotrauma and neurointensive care is a multidisciplinary process. There are multiple key players in the process and all of them need to work in ","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76059432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Moscote-Salazar, W. Florez-Perdomo, A. Pacheco-Hernandez, Sara Carolina Granados-Mendoza, Tariq Janjua
{"title":"Arrogance in Neurosurgery and Neurocritical Care: A Barrier to Effective Teamwork","authors":"L. Moscote-Salazar, W. Florez-Perdomo, A. Pacheco-Hernandez, Sara Carolina Granados-Mendoza, Tariq Janjua","doi":"10.1055/s-0043-1760722","DOIUrl":"https://doi.org/10.1055/s-0043-1760722","url":null,"abstract":"","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91301522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Optimism Bias in Neurocritical Care and Neurotrauma: The Proof is in the Pudding!","authors":"Tariq Janjua, L. Moscote-Salazar","doi":"10.1055/s-0043-1760725","DOIUrl":"https://doi.org/10.1055/s-0043-1760725","url":null,"abstract":"","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82407208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Moscote-Salazar, W. Florez-Perdomo, A. Pacheco-Hernandez, Tariq Janjua
Decision fatigue is a recognized phenomenon in healthcare psychology. Prolonged activities can lead to stress and fatigue, a familiar term in neurocognition. This is called decision fatigue; it is related to the ability to make the best decisions that decline with the course of the day. There are three key attributes to be included in this process; behavioral, cognitive, and physiological. 1 The management of the neurosurgical patient is a complex process. Multiple fi elds of medicine have shown that there is this decision fatigue due to multiple complex processes in place to practice medicine. As the US president correctly said, “… I am trying to pare down decisions. I don ’ t want to make decisions about what I am eating or wearing. Because I have too many other decisions to make. You need to focus your decision-making energy …” . 2 The pandemic of COVID-19 has shown that this enemy is real and bedside intensive care nurses were the most impacted. 3 The practice of surgery is also known to have decision fatigue.Apatientwhoisseenattheendoftheworkinghoursof orthopedic
{"title":"Decision Fatigue and Neurosurgeons' Clinical Decision Making: An Enemy in the Shadow","authors":"L. Moscote-Salazar, W. Florez-Perdomo, A. Pacheco-Hernandez, Tariq Janjua","doi":"10.1055/s-0043-1760723","DOIUrl":"https://doi.org/10.1055/s-0043-1760723","url":null,"abstract":"Decision fatigue is a recognized phenomenon in healthcare psychology. Prolonged activities can lead to stress and fatigue, a familiar term in neurocognition. This is called decision fatigue; it is related to the ability to make the best decisions that decline with the course of the day. There are three key attributes to be included in this process; behavioral, cognitive, and physiological. 1 The management of the neurosurgical patient is a complex process. Multiple fi elds of medicine have shown that there is this decision fatigue due to multiple complex processes in place to practice medicine. As the US president correctly said, “… I am trying to pare down decisions. I don ’ t want to make decisions about what I am eating or wearing. Because I have too many other decisions to make. You need to focus your decision-making energy …” . 2 The pandemic of COVID-19 has shown that this enemy is real and bedside intensive care nurses were the most impacted. 3 The practice of surgery is also known to have decision fatigue.Apatientwhoisseenattheendoftheworkinghoursof orthopedic","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77812389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background The mechanism of injury, type of pathology, mode of management and specific problems, in the pediatric age group make these a unique population. The COVID-19 pandemic and lockdown caused a significant reduction in the number of road traffic accidents during the same period and the resultant number of head injuries in children. Methods This was a descriptive study of 76 consecutive pediatric patients admitted with head injury between June and December 2020. Children under 18 years with head injury admitted in our hospital were included. Results The most common etiology of pediatric head injury was found to be fall from height (61.8%) followed by road traffic accidents (27.6%). The most common age group affected was 1 to 5 years with a mean of 6.3 ± 5 years. Road traffic accidents were commonly seen in the 15 to 18 age group. The Glasgow Outcome Score (GOS) of 1 (death) was seen in one patient (1.3%) and low disability in 98.7% of patients. Conclusion Falls formed the most important cause of pediatric head injury during this pandemic, and carefulness on the part of parents can help avoid dangerous consequences for the children. Recovery with minimal disability was observed in approximately all cases in this study. The number of severe traumatic brain injury was very low in this study. This can be attributed to the COVID-19 pandemic causing significant reduction in road traffic accidents and the number of severe head injury
{"title":"Clinico-Etiological Profile of Children Admitted with Head Injury in a Tertiary Health Care Centre During the COVID Pandemic","authors":"Lemin Mohan Puravankara, A. Peethambaran","doi":"10.1055/s-0042-1760448","DOIUrl":"https://doi.org/10.1055/s-0042-1760448","url":null,"abstract":"Abstract Background The mechanism of injury, type of pathology, mode of management and specific problems, in the pediatric age group make these a unique population. The COVID-19 pandemic and lockdown caused a significant reduction in the number of road traffic accidents during the same period and the resultant number of head injuries in children. Methods This was a descriptive study of 76 consecutive pediatric patients admitted with head injury between June and December 2020. Children under 18 years with head injury admitted in our hospital were included. Results The most common etiology of pediatric head injury was found to be fall from height (61.8%) followed by road traffic accidents (27.6%). The most common age group affected was 1 to 5 years with a mean of 6.3 ± 5 years. Road traffic accidents were commonly seen in the 15 to 18 age group. The Glasgow Outcome Score (GOS) of 1 (death) was seen in one patient (1.3%) and low disability in 98.7% of patients. Conclusion Falls formed the most important cause of pediatric head injury during this pandemic, and carefulness on the part of parents can help avoid dangerous consequences for the children. Recovery with minimal disability was observed in approximately all cases in this study. The number of severe traumatic brain injury was very low in this study. This can be attributed to the COVID-19 pandemic causing significant reduction in road traffic accidents and the number of severe head injury","PeriodicalId":43198,"journal":{"name":"Indian Journal of Neurotrauma","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90528237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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