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No / Sport as a whole has recently been under greater scrutiny over the safety of its participants. The tragic death of Australian Test Cricketer Philip Hughes brought into stark focus the risk of head injury but there has also been greater awareness of hypertrophic cardiomyopathy, concussion and use of performance enhancing drugs. Much of the research around concussion arises from what could be described as “collision” sports such as American football and ice hockey. The catalyst for discussions around concussion has tended to originate from these American sport. The significance of this increased awareness of safety has not been lost on the sport of rugby which has caused changes in practice in terms of concussion management but what appears not to have been fully appreciated is the additional risk of cervical spine injury associated with the sport.

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 153-165).

This study aimed to explore and develop a fresh understanding of the community service needs of persons with spinal injuries. Different concepts of need were explored, which required multiple methodologies including a review of government policies and legislation, analysis of demographic, injury related and service usage data obtained from a survey, and analysis of interviews with persons with spinal injuries and their carers. Normative need was interpreted by government and service providers in terms of functional impairment and economic disadvantage, which did not reflect the individual needs of persons with spinal injuries. Neither were services for persons with spinal injuries provided to individuals according to the criteria of their felt or expressed need for services, their perceptions of the intrinsic importance of services, nor on the basis of redressing comparative inequities in service distribution. Persons with spinal injuries’ need for community services could only be understood on the basis of the contribution services made to the realisation of their plans of life, that is, to be ordinary. In order to parallel plans of ordinariness, services need to be offered in partnership with, or under the control of the person with spinal injuries, foster an essential relationship between the provider and the person with spinal injuries, and not inappropriately assess and judge the life plans of persons with spinal injuries based upon providers’ perceptions of difference. / Doctor of Philosophy (PhD)

Orientadores: Helder Tedeschi, Fernando Cendes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T08:02:43Z (GMT). No. of bitstreams: 1 Joaquim_AndreiFernandes_D.pdf: 4024017 bytes, checksum: 07aa608b9ff2ad5bb02def9744f9f733 (MD5) Previous issue date: 2011 / Resumo: Introdução: Muitas classificações das lesões traumáticas da coluna torácica e lombar são encontradas na literatura, porém com inúmeras limitações, tais como falta de aplicabilidade ou reprodutibilidade. O TLICS (Thoracolumbar Injury Classification System) constitui-se em uma nova classificação desenvolvida com o intuito de suprir as limitações dos sistemas de classificação anteriores. Devido à ausência de estudos que comprovem sua eficácia, elaboramos pesquisa para avaliar a validade da sua utilização. Métodos: Realizou-se análise retrospectiva de 458 pacientes com traumatismo na coluna torácica e lombar tratados entre 2000 e 2010 em um centro médico terciário da Universidade de Utah, nos Estados Unidos. Foram avaliados dados clínicos e radiológicos e as formas de tratamento dos pacientes (conservador ou cirúrgico), classificando-se as lesões quanto ao status neurológico; de acordo com a classificação de Magerl/ AO (Arbeitsgemeinschaft für Osteosynthesefragen) e segundo o TLICS. Resultados: 310 pacientes (67,6%) foram tratados inicialmente de forma conservadora (G1), enquanto que 148 pacientes (32,3%) foram tratados cirurgicamente (G2). Todos os pacientes do G1 eram ASIA (American Spine Injury Association) E, exceto um (ASIA C). 305 pacientes (98%) tinham fraturas do tipo A da AO. O TLICS escore variou de 1 a 7 (média-1,53; mediana-1 e desvio padrão-0,82). 307/310 pacientes tinham TLICS ? 4, exceto três com lesões em distração com lesão ligamentar posterior e sem déficits neurológicos (TLICS de 7), tratados inicialmente como fraturas em explosão. Nove pacientes foram operados por falha no tratamento conservador. No G2, 105 pacientes (70,9%) eram ASIA E, enquanto que 43 (29%) tinham déficit neurológico (ASIA A-D). 103 pacientes (69,5%) tinham fratura tipo A, 36 (24,3%) tinham lesões tipo B e 9 (6%) com lesões tipo C. O TLICS score variou de 2 a 10 (média-4,29, mediana-2 e desvio padrão-2,67); 79 pacientes (53,3%) tinham o TLICS de 2 pontos (fraturas em explosão sem déficits). Um paciente morreu de tromboembolismo pulmonar após a cirurgia. Também não houve deterioração neurológica neste grupo. Conclusões: O TLICS foi concordante com o tratamento conservador em 301/310 pacientes (97,1%). Contudo, no grupo cirúrgico, 53,3% dos casos tinham TLICS < 4, todos com fraturas em explosão sem déficit neurológico (TLICS de 2), refletindo assim as controvérsias na conduta do tratamento das fraturas em explosão na ausência de déficits neurológicos / Abstract: Introduction: Several classification schemes for thoracolumbar spine trauma have been described yet none has achieved widespread acceptance due to its limitations. The TLICS (Thoracolumbar Injury Classification System) system has recently been described but only with limited clinical data. Methods: We performed a retrospective analysis of 458 patients treated for thoracic or lumbar spine trauma from 2000 to 2010 at a single, tertiary medical center. The treatment chosen was evaluated (conservative versus surgical), as well as the clinical and radiological, classifying the injuries by neurological status, by the Magerl/AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification, and according to the TLICS score. Results: 310 patients (67.6%) were treated conservatively (G1), whereas 148 patients (32.3%) were surgically (G2) treated. All patients in G1 were ASIA (American Spine Injury Association) E, except one (ASIA C). In this group, 305 patients (98%) had an AO type A fracture. The TLICS score range from 1 to 7 (mean-1.53, median-1; standard deviation-0.82). 307/310 patients matched the TLICS treatment (TLICS ? 4), except three with distractive injuries and posterior ligamentous complex injury (TLICS 7) initially described as burst fractures. Nine patients failed the conservative treatment. There were no neurological complications in the non-operative group. In G2, 105 (70.9%) were ASIA E while 43 (29%) had some neurological deficit (ASIA A-D). One hundred and three patients (69.5%) had an AO type A, 36 had a type B (24.3%) and 9 a type C injury (6%). The TLICS score in this group ranged from 2 to 10 (mean-4.29, median-2; standard deviation- 2.67); 79 patients (53.3%) had a TLICS of 2 points (burst fractures without neurological injury). One patient died due to pulmonary embolism after surgery. No neurological deterioration occurred in this group either. Conclusions: The TLICS treatment recommendation matched successful treatment in 301/310 patients (97.1%) in the conservative group. However, in the surgical group, 53.3% of the cases had a TLICS <4, all of them with burst fractures without neurological injury (TLICS of 2). This reflects continued inconsistencies in the treatment of burst fractures / Doutorado / Neurologia / Doutor em Ciências Médicas

Submitted by Carvalho Dias João Paulo (joao.dias@famerp.br) on 2018-04-05T13:53:11Z No. of bitstreams: 1 joao de melo neto_dissert.pdf: 3143812 bytes, checksum: f3defb0dcc5ec74209b625250898be75 (MD5) / Made available in DSpace on 2018-04-05T13:53:11Z (GMT). No. of bitstreams: 1 joao de melo neto_dissert.pdf: 3143812 bytes, checksum: f3defb0dcc5ec74209b625250898be75 (MD5) Previous issue date: 2016-12-16 / Introduction: Spinal cord injury (SCI) has a negative impact on quality of life and healthcare costs. In recent years, with the age pyramid inversion, there is a high prevalence of SCI in the elderly. In addition, the most common SCI-related lesion is Traumatic brain injury (TBI). Treatment planning depends on many factors, and is determining for the presence of morbidity and mortality. These factors must be explored so that we can have investments for the prevention and treatment of these patients. Objectives: To identify the characteristics and clinical features of patients with SCI, specifically: the elderly; individuals with TBI-related SCI and individuals undergoing surgery. Methods: Prospective study, including 321 previously selected patients with SCI. Clinical and socio-demographic variables were collected and analyzed. Patients were characterized and morbidity and mortality predictors in the elderly (≥60 years) (n=62) were analyzed, as well as individuals who had TBI-related SCI (n=52), and patients undergoing surgical treatment (n=211). Results: The comparison between the two genders showed that women have compression fracture associated to the thoracolumbar transition region; men presented listhesis more related to cervical lesions and increase in the number of complications; the need for surgical intervention is higher in men; among other factors. When we compared older and younger patients (<60 years; n = 259), we found that the morphological diagnosis, compression fracture and dislocation fracture are more associated with age ≥60 to <60, respectively; elderly after SCI had a greater association with late hemodynamic instability. With regards to patients who had TBI-related SCI, male gender (85%), age group between 21-30 years (25%), individuals who have a common-law marriage status (56%), low level of education (69%) and the Roman Catholic religion (77%) had a higher number of patients. The cervical segment had higher risk of injury (RR=3.48, CI: 1.856 to 6.526; p <0.0001). The neurological status ASIA-E (52%), syndromic presentation of neck pain (35%) and mild TBI (65%) were the most frequent. Complications were observed in 13 patients, and pneumonia was the most prevalent (62%). Hospital stay was significantly higher (20±28 days), and 17% of patients died. Men (RR=2.513, CI: 1.777 to 3.554; p=0.028) and individuals exposed to car accidents (RR=1.91, CI: 1.00 to 1.579; p=0.022) showed a greater risk to suffer these lesions concomitantly. Furthermore, these patients had a 2.48 (CI: 1.372 to 4.477; p<0.01) higher risk of death than patients with SCI alone. Finally, regarding the choice of treatment, fall and upper cervical and lumbosacral injuries were associated with conservative treatment. Patients with lesions in the lower cervical area, worse neurological status and unstable lesions were associated with surgery. Complications in the postoperative period occurred mainly in patients undergoing surgery. Afterwards, we assessed whether age influenced the characteristics of patients undergoing surgery. Subjects <60 years of age were associated with motorcycle accidents and the morphologic diagnosis of injury was listhesis. Subsequently, we analyzed the influence of gender on the characteristics of these patients. Women who had car accidents were associated with surgery. Women were associated with paraparesis and morphologic diagnosis of burst fracture, especially in the thoracolumbar and lumbosacral transition. Men who had TBI and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated with complications. Men and cervical region were the most affected and therefore, these patients were analyzed separately (n = 92). The presence of complications increases hospital stay. Patients with simultaneous morphological diagnosis, worse neurological status, quadriplegia and sensorimotor changes had more complications. Mortality was higher in cases with clinical pneumonia and thoracic trauma. Conclusion: There are clinical and demographic factors that are specific to the elderly, as well as to patients who have had TBI-related SCI and individuals undergoing surgical treatment. The understanding of these factors enables investments in prevention, rehabilitation and treatment aiming at reducing morbidity and mortality, losses in quality of life and hospital service expenditures. / Introdução: O traumatismo raquimedular (TRM) ocasiona prejuízos na qualidade de vida e gastos aos sistemas de saúde. Nos últimos anos, com a inversão da pirâmide etária, há alta prevalência de TRM em idosos. Além disso, a lesão associada ao TRM mais apresentada é o Traumatismo Cranioencefálico (TCE). O direcionamento do tratamento depende de inúmeros fatores, sendo determinante para a presença de morbimortalidade. Neste contexto, estes fatores precisam ser explorados para haver investimentos na prevenção e terapêutica destes pacientes. Objetivos: Identificar as características e aspectos clínicos de pacientes com traumatismo raquimedular, especificamente: idosos; indivíduos com TRM associado ao TCE; e sujeitos submetidos à cirurgia. Métodos: Estudo retrospectivo, sendo previamente selecionados 321 pacientes com TRM. As variáveis clínicas e sócio-demográficas foram coletadas e analisadas. Os pacientes foram caracterizados e analisados os fatores preditores de morbimortalidade em idosos (≥60 anos) (n=62), sujeitos que sofreram TCE associado ao TRM (n=52), e em pacientes submetidos a tratamento cirúrgico (n=211). Resultados: Durante a análise entre os diferentes sexos, observou-se que mulheres apresentam fratura compressão associada à região de transição toracolombar; homens apresentam listese mais relacionada com lesões na cervical e aumento no número de complicações; a necessidade de intervenção cirúrgica é maior em homens. Durante a comparação entre idosos e indivíduos jovens (<60 anos; n=259), observou-se que os diagnósticos morfológicos, fratura compressão e fratura luxação, são mais associados com idade ≥60 e <60, respectivamente; idosos após TRM tiveram maior associação com instabilidade hemodinâmica tardia. Com relação aos pacientes que sofreram TRM associado à TCE, o sexo masculino (85%), a faixa etária entre 21-30 anos (25%), o estado civil de união estável (56%), o baixo nível de escolaridade (69%). O acidente automobilístico (58%) foi a principal etiologia. O segmento cervical teve maior risco de lesão (RR=3,48, IC: 1,856-6,526; p<0,0001). O estado neurológico ASIA-E (52%), o quadro sindrômico de cervicalgia (35%) e o índice de TCE leve (65%) foram os mais frequentes. As complicações atingiram 13 pacientes, sendo pneumonia a de maior frequência (62%). O tempo de internação foi significativamente maior nos pacientes com TCE (20±28 dias), e 17% dos pacientes foram a óbito. Os homens (RR=2,513, IC: 1,777-3,554; p=0,028) e indivíduos expostos a acidentes com veículo automotor (RR=1,91, IC: 1,00-1,579; p=0,022) apresentaram maior risco de sofrer essas lesões concomitantemente. Além disso, esses pacientes apresentaram 2,48 (IC: 1,372-4,477; p<0,01) mais risco de morte que vítimas de TRM isolado. Por fim, com relação à escolha do tratamento, a queda e lesões nas regiões cervical superior e lombosacral foram associadas com tratamento conservador. Pacientes com lesões nas regiões cervical inferior, pior status neurológico e lesões instáveis foram associados com cirurgia. Complicações no pós-operatório ocorreram principalmente em pacientes que realizaram cirurgia, sendo pneumonia a mais frequente, visto que os pacientes que são submetidos a este tipo de intervenção é porque apresentam um pior quadro clínico na admissão. Posteriormente, durante a análise para verificar se a idade influenciava as características dos pacientes submetidos à cirurgia, observou-se que sujeitos com <60 anos foram associados com acidente motociclístico e com o diagnóstico morfológico de lesão: lístese. Subsequentemente, nós analisamos a influência do sexo sobre as características destes pacientes. Mulheres que sofreram acidente automobilístico foram associadas à cirurgia. Mulheres foram associadas com paraparesia e diagnóstico morfológico: fratura explosão, principalmente nas regiões de transição tóraco-lombar e lombo-sacral. Homens que apresentaram TCE e trauma torácico foram relacionados à cirurgia. Estes indivíduos tiveram um pior status neurológico e foram associados à complicação. Homens e a região cervical foram mais afetados, assim, estes pacientes foram analisados isoladamente (n=92). A presença de complicações aumenta a permanência hospitalar. Pacientes com diagnósticos morfológicos em multiníveis vertebrais e com pior status neurológico apresentaram mais complicações. A mortalidade foi maior nos casos clínicos com Pneumonia e traumatismo torácico. Conclusão: Existem fatores clínicos e demográficos específicos em idosos; assim como em pacientes que sofreram TRM associado ao TCE; e em indivíduos submetidos ao tratamento cirúrgico. O conhecimento destes fatores possibilitam investimentos em prevenção, reabilitação e tratamento, visando reduzir a morbimortalidade, prejuízos na qualidade de vida e gastos com os serviços hospitalares.

Lyginant su kitomis užsienio šalimis, Lietuvoje stuburo sužalojimai patiriami dažniau. Dažnai stuburo sužalojimą patyręs asmuo lieka neįgalus visą likusį gyvenimą. Valstybė ir artimieji patiria didelius nuostolius dėl prarastų pajamų, išlaidų gydymui ir išlaikymui. Paciento patyrusio stuburo sužalojimą tolimesnė gydymo ir sveikatos grąžinimo perspektyvos labai priklauso ir nuo pirmosios pagalbos teikimo ikistacionariniame etape. Tyrimo tikslas – įvertinti greitosios medicinos pagalbos tarnybų galimybes teikti pagalbą, kai yra stuburo sužalojimai. Tyrimą sudarė trys etapai. Tirta greitosios medicinos pagalbos tarnybų medikų teorinis ir praktinis pasiruošimas, materialinė techninė bazė ir procedūros taikomos pacientams patyrusiems didelės kinetinės energijos traumas. Tyrimo uždaviniai: 1. Įvertinti greitosios medicinos pagalbos darbuotojų teorinį ir praktinį pasirengimą teikti pagalbą pacientams, kuriems įtariamas stuburo sužalojimas po patirtos didelės kinetinės energijos traumos. 2. Įvertinti greitosios medicinos pagalbos materialinę ir techninę bazę, reikalingą teikiant pagalbą stuburo sužalojimų atvejais. 3. Nustatyti klinikinių procedūrų, atliekamų asmenims, patyrusiems stuburo sužalojimus, rūšį ir dažnį. 4. Nustatyti teikiamos pagalbos, asmenims su įtariamu stuburo sužalojimu, atitikimą pasaulio sveikatos organizacijų rekomendacijoms. / Spinal cord injuries incidence is higher in Lithuania than in other countries. Patient after experienced spinal cord injury often remains disabled for the rest of its life. Community and relatives have to suffer big losses for the lost incomes and expenses related to treatment and maintenance. Patient treatment and heath retain prognosis strongly depends on firs medical aid supplied at prehospital level. The aim of study – evaluate emergency medicine services abilities to provide first medical aid in cases of spinal injuries. The study consisted of three stages. We investigated the theoretical and skill readiness of emergency medicine services personnel, physical resources provision and procedures applied to the patients which have undergone high energy traumas. The objectives of the study: 1. To evaluate the theoretical knowledge level and skills required to provide first medical aid for patients which undergone high energy trauma and are suspected for spinal injury. 2. To evaluate physical resources of the emergency medicine institutions which are used for the first medical aid supplied to the patients with spinal injury. 3. To determine the availability of emergency medicine services and the kind and extent of clinical procedures applied to patients with spinal injury suspected. 4. To evaluate the conformance of the clinical procedures applied to patients with spinal injury to the recommendations of the world health institutions.