Patients who suffer from traumatic brain injury often face communication deficits during their hospital stay. This thesis intended to examine approaches the nurse can use to facilitate communication in collaboration with the speech-language pathologist. A review of literature was conducted to examine current research on the most effective devices used to facilitate communication in this patient population. Research revealed that low-technology devices were the most effective means of communicating in the hospital setting. Barriers to effective communication were identified as lack of time, education and access to the devices. Recommendations for future research include developing a documentation component that emphasizes nursing assessment and intervention through collaboration with the SLP. Additional recommendations for research include the examination of impact of AAC use on patient satisfaction and outcomes. Communication using AAC is necessary in order to improve patient outcomes for traumatic brain injured individuals. This can be achieved through increased collaboration with the SLP, and increased nursing knowledge of the available devices and their implementation.

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Impaired wound healing in SCI patients contributes to the progression in severity of PIs. Best practice guidelines suggest that surgical flap reconstruction is an option for chronic stage 4 PIs that have failed to heal with more conservative measures, but little is known about the epidemiology of surgically reconstructed PIs in SCI patients. Rates of surgical wound complications are high, and cost of management is extensive. Accordingly, this study aims to establish a systematic approach for identifying SCI patients with surgically reconstructed PIs, to facilitate study of predictors of sustained wound closure, quantify costs of surgical reconstruction, and evaluate efficiency of treatment and recovery options. To address gaps in the literature, this study’s objectives were: (1) estimate surgical reconstruction hospital costs for stage 4 PIs in SCI patients and characterize the relationship of demographic, socioeconomic and lifestyle factors to cost at discharge, (2) explore a standardized method of identifying these cases in large databases, (3) identify and validate risk factors for complications at discharge from wound care follow-up, and (4) identify long-term cost and health care utilization of persons with SCI who have undergone surgical flap closure. It proved difficult to identify our own cohort of patients using administrative codes applied, making population-based study using administrative data less than ideal. Factors associated with open incision at three-to-six weeks post-index surgery included number of nursing visits in the previous year, and revision surgery within the six-week follow-up period. The cost of persons with SCI and PI was high one year prior to surgery (look-back) and almost double in the first year look-back. However, significant cost and health care utilization was demonstrated in Year 2 and 3 post-index surgery. Further prospective studies exploring models of health care delivery and addressing some of modifiable risk factors may improve cost-effectiveness and outcomes. / Thesis / Doctor of Philosophy (PhD) / Pressure ulcers, also known as pressure injuries (PI) or bedsores, are a common secondary complication in persons with spinal cord injury (SCI). While surgical closure is an option offered to patients, little is known about the long-term outcomes, including cost and use of health care services following the surgery. Risk factors for complications following surgery are known from a physical/co-morbidity/technique perspective, but environmental and behavioural factors have not been included these studies, and the use of health care administrative databases to accurately identify these patients for research has not been studied. A historical cohort study was conducted at one tertiary care centre in Toronto, Canada to identify known cases of SCI and PI reconstruction. Hospital codes were recorded in an algorithm used to evaluate the accuracy in identifying the known cases in the database. Health care usage and costs were also recorded, and risk factors for complications were also evaluated.

Between 1.6 and 3.8 million sports-related concussions are sustained by persons living in the United States annually. While sports-related concussion was once considered to only result in immediate neurocognitive impairment and symptoms that are transient in nature, recent research has correlated long-term neurodegenerative effects with a history of sports-related concussion. Increased awareness and current media attention have contributed to concussions becoming a primary health concern. Although much research has been performed investigating the biomechanics of concussion, little is understood about the biomechanics that cause concussion in humans. The research presented in this dissertation investigates human tolerance to head acceleration using methods that pair biomechanical data collected from human volunteers with clinical data. Head impact exposure and injury risk are quantified and presented. In contrast to the publicly available data on the safety of automobiles, consumers have no analytical mechanism to evaluate the protective performance of football helmets. With this in mind, the Summation of Tests for the Analysis of Risk (STAR) evaluation system was developed to evaluate the impact performance of footballs helmets and provide consumers with information about helmet safety. The STAR evaluation system was designed using real world data that relate impact exposure to injury risk. / Ph. D.

Background Estimates of 1.6 million to 3.8 million concussions or mild traumatic brain injuries (mTBI) occur annually in adolescent athletes participating in contact sports (Daneshvar et al., 2011). Current clinical guidelines call for interventions to include education, assessment, screening, and long term management of injury by the adolescent's primary care provider (PCP) (Giza et al., 2013). Without proper knowledge of the injury's physiological process and progression, providers are possibly increasing the risk of continued brain injury in this population (Reddy & Collins, 2009). Purpose This doctorate of nursing practice project aimed to determine if a gap existed between provider knowledge about the current guidelines for management of mTBI in adolescent athletes of Arizona. Knowledge obtained from this survey could be further used to drive practice change. Methods A quantitative needs assessments study was conducted via data collection obtained through PCP's participation in an anonymous electronic survey using the survey software Qualtrics. Survey links were sent to potential participant's email addresses throughout Yuma County, AZ. An additional survey link was posted to the Arizona Nurses Association e-newsletter. The survey consists of 28 questions divided into three categories of demographics, knowledge, and practice questions. Outcomes Survey results were limited due to only 21 providers responding to the request for participation. From this sampling, it was determined that participant's clinical knowledge and practice related to screening, assessment, long term management, and continuity of care between the ED provider and follow up care with the primary provider were not congruent with current practice guidelines.

BACKGROUND:Trauma remains one of the leading causes of morbidity and mortality worldwide. Generally, the incidence of traumatic injuries is disproportionately high in males. However, trauma in females is underreported.AIM:To study the epidemiology and outcome of different mechanisms and types of traumatic injuries in women.METHODS:We conducted a traditional narrative review using PubMed, MEDLINE and EMBASE, searching for English-language publications for gender-specific trauma between January 1993 and January 2013 using key words "trauma", "gender", "female" and "women".RESULTS:Among 1150 retrieved articles, 71 articles were relevant over 20 years. Although it is an important public health problem, traumatic injuries among females remain under-reported.CONCLUSION:There is a need for further research and evaluation of the exact burden of traumatic injuries among females together with the implementation of effective community based preventive programs.