Thesis (M.S.)--University of Michigan, 1993. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1993. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1992.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 64-71).

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2006 / Typescript (photocopy)

Disputats, Umeå universitet, 2006. / Härtill 3 uppsatser.

Καθημερινά στα εξωτερικά ιατρεία των νοσοκομείων μας αντιμετωπίζονται πάρα πολλά περιστατικά ελαφρών κρανιοεγκεφαλικων κακώσεων. Πολλά από αυτά ακολουθούνται από παράπονα για εμφάνιση μετατραυματικων συμπτωμάτων όπως ζαλάδες ή και μερικές φορές πιο σοβαρών, το σύνολο των οποίων αποτελούν το μεταδιασεισικό σύνδρομο. Ο συνδυασμός των κρανιοεγκεφαλικών κακώσεων και του μεταδιασεισικού συνδρόμου αποτελούν σοβαρό πρόβλημα στις σύγχρονες κοινωνίες γιατί είναι η αιτία για την επαγγελματική ανικανότητα των πασχόντων αποτελώντας έτσι σοβαρό οικονομικό αντίκτυπο. Σκοπός της παρούσας μελέτης είναι η οικοδόμηση ενός εργαλείου υποστήριξης ιατρικών αποφάσεων που θα μπορεί να εκτιμήσει ποσοτικά την πιθανότητα εμφάνισης του μεταδιασεισικού συνδρόμου σε κάποιον ασθενή με ήπια κρανιοεγκεφαλική κάκωση, στηριζόμενο σε προγνωστικούς παράγοντες που αναδείχθηκαν από δεδομένα που συγκεντρώθηκαν στις εξετάσεις που πραγματοποιούνται στα εξωτερικά ιατρεία. Υλικό-Μέθοδοι: Η μελέτη πραγματοποιήθηκε στο Πανεπιστημιακό Γενικό Νοσοκομείο Πατρών, στη Δυτική Ελλάδα. Η συλλογή των μετρήσεων έγινε στα πλαίσια διδακτορικής διατριβής της Νευροχειρουργικής Κλινικής του Τμήματος Ιατρικής Οι μετρήσεις αυτές χρησιμοποιήθηκαν στη παρούσα μελέτη για την εξαγωγή των δικών μας αποτελεσμάτων. Συνολικά καταγράφηκαν μετρήσεις από 539 ασθενείς με ήπια κρανιοεγκεφαλική κάκωση. 223 από αυτούς τους ασθενείς πληρούσαν τα κριτήρια του "Colorado Medical Society Guidelines" για τον καθορισμό της διάσεισης, με μέση ηλικία τα 30 έτη (εύρος: 18.5-57.5). Για την εξαγωγή των αποτελεσμάτων κατασκευάστηκε ένα δίκτυο πεποίθησης και εντάχθηκε στο λογισμικό Netica για την μαθηματική του ανάλυση. Συμπεράσματα: Μετά την εξεργασία των μετρήσεων πρόεκυψαν ενδιαφέροντα αποτελέσματα σχετικά με την πρόβλεψη εμφάνισης του μεταδιασεισικου συνδρόμου. Φάνηκε λοιπόν ότι δυο από τους πλέον σημαντικούς παράγοντες είναι το φύλο και το είδος του ατυχήματος εξαιτίας του οποίου υπέστη ο ασθενής την κρανιοεγκεφαλικη κάκωση. Χαρακτηριστικά μπορούμε να δούμε ότι η πιθανότητα εμφάνισης για μια γυναίκα που ενεπλακη σε αυτοκινητιστικό δυστύχημα είναι 42,7%, ενώ αντίστοιχα για έναν άντρα είναι 19,8%. Επίσης σε μια γυναίκα που δέχτηκε επίθεση η πιθανότητα είναι 37,4%, ενώ για έναν άντρα είναι 16,5%. Μέσω της χρήσης του Δικτύου Πεποίθησης μπορούμε να ξέρουμε από πριν ποιες είναι εκείνες οι μεταβλητές που με την παρουσία τους αυξάνουν ή ελαττώνουν την πιθανότητα εμφάνισης του μεταδιασεισικού συνδρόμου και να ποσοτικοποιήσουμε αυτή την επίδραση. / Outpatient departments in hospitals treat many cases of mild traumatic brain injury daily. Many of these complaints are followed by the appearance of post traumatic symptoms as dizziness or sometimes more serious, which comprise the post-concussion syndrome. The combination of craniocerebral injuries and post-concussion syndrome is a serious problem in modern societies because it is the cause of occupational disability of patients, thus constituting a serious economic impact. The purpose of this study is to combine the main prognostic factors that lead to post-concussion syndrome in an adult Greek population after a traumatic brain injury into a decision support tool that could be useful in the outpatient department. Material-Methods: The study was conducted at the University Hospital of Patras, Western Greece. The collection of the measurements which were used in this study were made in the context of a doctoral thesis of the Neurosurgery Department. Overall, 539 patients with mild head-injuries were recorded. Of these, 223 patients patients met the criteria of "Colorado Medical Society Guidelines" to determine concussion, with a mean age of 30 years (range: 18.5-57.5). Based on these data, a naïve Bayesian Network was constructed and Netica software for the mathematical analysis that followed. Results: The use of the Bayesian Network allows us to measure the impact of certain prognostic factors to the probability of occurrence of post-concussion syndrome. It was found, that two of the most important factors is the gender and the type of accident which the patient suffered a traumatic brain injury. As an example, the estimated probability to develop a post-concussion syndrome for a woman who was involved in a car accident is 42.7%, while for a man is 19.8%. Also, for a woman who was attacked, the probability is 37.4%, while for a man is 16.5%.

Pain is a frequent symptom following Traumatic Brain Injury (TBI) and its experience should be better explored in the field of neuroscience. The aim of the study was to evaluate pain and their care process in adult patients after TBI. A cross-sectional quantitative research developed at the outpatient clinic of the Federal University of Sergipe (UFS) and emergency room of the Emergency Hospital of Sergipe (HUSE), after approval of the ethics committee.Data collection was carried out from August 2016 to May 2017, through interviews with the application form of the evaluation of pain were based on the functional health standards of Marjory Gordon, adapted by Pimenta and Cruz, which includes the McGill pain assessment questionnaire and Scales of verbal and numerical category, besides the analysis of the medical records of 40 patients with TBI. To evaluate the association between ordinal and nominal variables, the Rank-Bisserial correlation (Rrb) we used. The binomial test was applied to assess whether the proportion of cases that CTE pain affected Gordon's functional health standards. The significance level adopted was 5% and the software used was the R Core Team 2017. The results indicated that the patients were mostly young men who suffered TBI with hematoma due to the motorcycle accident and did not use equipments for individual protection.All patients evaluated with had pain ranging from moderate to unbearable or from moderate to severe on the verbal and numerical categories scales respectively. The most painful site in the body diagram was the head region. The descriptors of the most representative McGill questionnaire were the pain characterized as "Sickening", "Throbbing" and "Jumping". There was a shortage of record of the painful complaint in the medical record in the hospital, in contrast there was record of the pain in the totality of the medical records of the outpatient clinic. Most of patients with aggression, falls or other types of occurrence reported moderate pain, while victims of transport accidents presented severe or unbearable pain. Although, all patients had referred feeling pain, and daily life activities were not harmed. It is concluded that pain is a frequent symptom in the patient after the TBI, especially the headache and needs the evaluation of the health team, in order to provide a humanized and qualified care. / A dor é um sintoma frequente após o Trauma Cranioencefálico (TCE) e sua experiência deve ser melhor explorada no campo da neurociência. O estudo objetivou avaliar a dor e seu processo de cuidado em pacientes adultos após o TCE. Pesquisa quantitativa de corte transversal desenvolvido no ambulatório do hospital-escola da Universidade Federal de Sergipe (UFS) e pronto-socorro do Hospital de Urgências de Sergipe (HUSE), após aprovação do comitê de ética. A coleta de dados foi realizada em agosto de 2016 a maio de 2017, por meio de entrevistas com aplicação de formulário de avaliação da dor baseado nos padrões funcionais de saúde de Marjory Gordon, adaptado por Pimenta e Cruz que contempla o questionário de avaliação da dor McGill e escalas de categoria verbal e numérica, além da análise dos prontuários de 40 pacientes com TCE. Para avaliar a associação entre variáveis ordinais e nominais utilizamos a correlação Rank-Bisserial (Rrb). Foi aplicado o teste binomial para avaliar a proporção de casos que a dor pós TCE, afetava os padrões funcionais de saúde de Gordon. O nível de significância adotado foi de 5% e o software utilizado foi o R Core Team 2017. Os resultados apontaram que os pacientes em sua maioria era homens jovens que sofreram lesão cerebral traumática do tipo hematoma decorrente de acidente motociclístico e não utilizavam equipamento de proteção individual. Os pacientes avaliados, afirmaram sentir dor com variação de moderada a insuportável ou de moderada a intensa nas escalas de categorias verbal e numérica respectivamente. O local mais doloroso apontado no diagrama corporal foi a região da cabeça. Os descritores do questionário de McGill, com maior representatividade foram a dor caracterizada como “Enjoada”, “Latejante” e “Pontada”. Houve escassez de registro da queixa dolorosa no prontuário no hospital. Todavia, havia registro da dor na totalidade dos prontuários do ambulatório. A maioria dos pacientes de agressão, queda ou outros tipos de ocorrência relataram dor moderada, enquanto as vítimas de acidentes de transporte apresentaram dor forte ou insuportável. Embora todos pacientes tenham referido sentir dor, a realização das atividades de vida diária não foi prejudicada. Conclui-se que a dor é um sintoma frequente no paciente após o TCE, sobretudo a cefaleia e necessita da avaliação da equipe de saúde, a fim de proporcionar um cuidado humanizado e qualificado. / Aracaju, SE

Introdução: A lesão cerebral traumática decorrente do traumatismo crânio encefálico (TCE) é uma das principais causas de morte e incapacidade em todo o mundo. A estimativa do prognóstico é, por definição, um desafio multivariável. Objetivos: Estabelecer modelo prognóstico para avaliação das probabilidades de sobrevida após TCE com base nas características de admissão, incluindo lesões extracranianas, de doentes não sedados e estáveis quanto a hemodinâmica e respiração, apresentando tomografia de crânio com alterações. Doentes e Métodos: Um estudo de coorte avaliou 1275 doentes com TCE e tomografia do crânio (TC) anormais na admissão na unidade de emergência do HCFMUSP e analisou a mortalidade final. Realizou-se uma análise de regressão logística para determinar a relação de cada variável independente no desfecho final. Resultados: Quatro variáveis foram consideradas significativas no modelo: idade (anos), Escala de Coma de Glasgow (3-15), Escala de Marshall (estratificada em 2,3 ou 4,5,6, de acordo com o melhor grupo positivo (Valor preditivo) e anisocoria (sim / não). Obteve-se uma fórmula que está em um modelo logístico (USP índex do TCE) que estima a probabilidade de morte dos doentes de acordo com características da admissão. Conclusão: O modelo de probabilidade matemática (USP Index do TCE) é prático e acessível aos serviços de neurocirurgia. Foi criado para melhorar a qualidade da informação sobre a possibilidade de morte durante a hospitalização dos doentes acometidos pelo TCE, e pode ser aplicado pelos médicos para auxiliar à tomada de decisões / Introduction: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Estimation of prognosis is by definition a multivariable challenge. Objectives: The authors aimed to develop prognostic model for assessment of survival chances after TBI based on admission characteristics, including extracranial injuries of non-sedated and stable patients regarding hemodynamics and respiration, which would allow application of the model before in-hospital therapeutic interventions. Patients and Methods: 1275 patients were evaluated in a cohort study with TBI and abnormal CT scans upon admission to the emergency unit of Hospital das Clinicas of University of Sao Paulo. Mortality was analyzed as the final outcome. A logistic regression analysis was undertaken to determine the adjusted weigh of each independent variable in the outcome. Results: Four variables were found to be significant in the model: age (years), Glasgow Coma Scale (3-15), Marshall Scale (MS, stratified into 2,3 or 4,5,6; according to the best group positive predictive value) and anysochoria (yes/no). The formula in a logistic model (USP index to head injury) estimates the probability of death of patients according to characteristics that influence on mortality. Conclusion: The mathematical probability model (USP Index of TBI) is practical and accessible to neurosurgery services. It was created to improve the quality of information about the possibility of death during hospitalization of patients affected by the TBI and can be applied by doctors to aid in decision making

This descriptive exploratory study was designed to determine the perceived importance of selected needs of family members of critically ill brain-injured patients. In addition, the personal/demographic factors which may have influenced the needs of these family members were investigated, as well as the reasons family members perceived these needs as important or unimportant. A convenience sample of one family member for each of 15 critically ill brain-injured patients was selected from two tertiary care hospitals and the community. Family members were interviewed using a pre-determined interview guide and asked to verbally rate 20 need statements on a four-point Likert-type scale. Generally, family members perceived all 20 needs to be important. However, the importance of each need was influenced by the family members' personal/demographic factors. No significant statistical relationship was found between personal/demographic factors and the family members' perceptions of the importance of selected needs. However, the findings of the study suggest that family members relate their needs to their present experience, and thus individual assessment of family members' needs is crucial. / Applied Science, Faculty of / Nursing, School of / Graduate