1.
[Protection of Transcutaneous Acupoint Electrical Stimulation for Brain Injury Undergoing Intervention: a Clinical Observation].
Yuan, J, Wu, Y, Li, JY, Zhang, L, Chen, X, Chen, HX
Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine. 2015;(8):971-4
Abstract
OBJECTIVE To observe the effect of transcutaneous acupoint electrical stimulation (TAES) combined dexmedetomidine on hemodynamic of intracranial aneurysmal subarachnoid hemorrhage patients undergoing intervention, and their protection for brain Injury. METHODS Totally 108 intracranial aneurysmal subarachnoid hemorrhage patients undergoing intervention were randomly assigned to the electroacupuncture (EA) group and the control group according to random digit table, 54 in each group. All patients were anesthetized with dexmedetomidine. Patients in the EA group were needled at bilateral Neiguan (PC6), Lieque (LU7), and Yunmen (LU2). Parameter setting was as follows: The dilatational wave at 1. 5 Hz, strength 2 - 4 mA, 30 min. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were compared between the two groups immediately after entry into the room (T0), after administration (T1), intubating (T2), resuscitation (T3), extubation (T4), and leaving the operating room (T5). Levels of S100β protein (S100β) and neuron specific enolase (NSE) were compared between the two groups at T0, immediately after surgery (T6), 6 h after operation (T7), 12 h after operation (T8), and 24 h after operation (T9). RESULTS Compared with the same group at T0, SBP, DBP, MAP, and HR were significantly reduced in the two groups at T1-T5(P <0. 05), serum levels of S100β and NSE in the two groups were significantly increased at T6-T9 (P<0. 05). Compared with the control group at T1 - T5, SBP, DBP, MAP, and HR decreased in the EA group (P <0. 05). Compared with the control group at T6-T9, serum levels of S100β and NSE decreased in the EA group (P <0. 05). CONCLUSION TAES combined dexmedetomidine could effectively maintain stable hemodynamics of intracranial aneurysmal subarachnoid hemorrhage patients undergoing intervention, and regulate their serum levels of S100β and NSE.
2.
Cranial neurosurgical 30-day readmissions by clinical indication.
Moghavem, N, Morrison, D, Ratliff, JK, Hernandez-Boussard, T
Journal of neurosurgery. 2015;(1):189-97
Abstract
OBJECT Postsurgical readmissions are common and vary by procedure. They are significant drivers of increased expenditures in the health care system. Reducing readmissions is a national priority that has summoned significant effort and resources. Before the impact of quality improvement efforts can be measured, baseline procedure-related 30-day all-cause readmission rates are needed. The objects of this study were to determine population-level, 30-day, all-cause readmission rates for cranial neurosurgery and identify factors associated with readmission. METHODS The authors identified patient discharge records for cranial neurosurgery and their 30-day all-cause readmissions using the Agency for Healthcare Research and Quality (AHRQ) State Inpatient Databases for California, Florida, and New York. Patients were categorized into 4 groups representing procedure indication based on ICD-9-CM diagnosis codes. Logistic regression models were developed to identify patient characteristics associated with readmissions. The main outcome measure was unplanned inpatient admission within 30 days of discharge. RESULTS A total of 43,356 patients underwent cranial neurosurgery for neoplasm (44.23%), seizure (2.80%), vascular conditions (26.04%), and trauma (26.93%). Inpatient mortality was highest for vascular admissions (19.30%) and lowest for neoplasm admissions (1.87%; p < 0.001). Thirty-day readmissions were 17.27% for the neoplasm group, 13.89% for the seizure group, 23.89% for the vascular group, and 19.82% for the trauma group (p < 0.001). Significant predictors of 30-day readmission for neoplasm were Medicaid payer (OR 1.33, 95% CI 1.15-1.54) and fluid/electrolyte disorder (OR 1.44, 95% CI 1.29-1.62); for seizure, male sex (OR 1.74, 95% CI 1.17-2.60) and index admission through the emergency department (OR 2.22, 95% CI 1.45-3.43); for vascular, Medicare payer (OR 1.21, 95% CI 1.05-1.39) and renal failure (OR 1.52, 95% CI 1.29-1.80); and for trauma, congestive heart failure (OR 1.44, 95% CI 1.16-1.80) and coagulopathy (OR 1.51, 95% CI 1.25-1.84). Many readmissions had primary diagnoses identified by the AHRQ as potentially preventable. CONCLUSIONS The frequency of 30-day readmission rates for patients undergoing cranial neurosurgery varied by diagnosis between 14% and 24%. Important patient characteristics and comorbidities that were associated with an increased readmission risk were identified. Some hospital-level characteristics appeared to be associated with a decreased readmission risk. These baseline readmission rates can be used to inform future efforts in quality improvement and readmission reduction.
3.
Assessment of dietary adequacy for important brain micronutrients in patients presenting to a traumatic brain injury clinic for evaluation.
Wahls, T, Rubenstein, L, Hall, M, Snetselaar, L
Nutritional neuroscience. 2014;(6):252-9
Abstract
OBJECTIVE To evaluate dietary adequacy of patients presenting for evaluation at an outpatient traumatic brain injury (TBI) clinic. METHODS We identified 14 key micronutrients with defined dietary intake reference ranges that are considered important for brain health. Adult patients completed the Brief NutritionQuest Food Frequency Questionnaire (FFQ) to calculate estimated nutrient intake. Medical records were abstracted for diagnoses, body mass index, and neurobehavioral subscale scores. Nutrients were assessed individually and were also summarized into a summary score. Associations between individual nutrients, summary nutrient intake, and neurobehavioral scores were assessed. RESULTS A total of 39 FFQs were completed by subjects, and 25 (64%) had recorded neurobehavioral scores. No subjects met the recommended dietary allowances (RDAs) for all 14 micronutrients. Ten (26%) met the RDAs for 6 or fewer nutrients, and 10 met the RDAs for 11-12 nutrients. Of 12 nutrients with sufficient sample size for analysis, 11 (92%) were associated with worse mean somatic scores, 9 (75%) were associated with worse cognitive scores, and 8 (67%) were linked with worse affective scores for those with the lowest nutrient intake compared with those who had the highest intake. However, only four nutrients were statistically associated with the somatic mean score: folate (P = 0.010), magnesium (P = 0.082), vitamin C (P = 0.021), and vitamin K (P = 0.024). None were linked with cognitive or affective scores. DISCUSSION Diets failing to meet RDAs for important brain nutrients were common in an outpatient TBI clinic, with the worst mean neurobehavioral scores for those patients not meeting the estimated average requirements.