Showing papers by "Nancy Carney published in 2022"
TL;DR: This pilot study will serve as a first step to identify variables that are critical to successful implementation, to be considered for the design of a future large-scale international study to measure the effectiveness of resource-based protocols and to improve outcomes from sTBI.
Abstract: BACKGROUND: Severe traumatic brain injury (sTBI) is a public health issue with great disparity among low- and middle-income countries where the implementation of evidence-based guidelines is challenging because resources are often unavailable. A consensus process including experts in the prehospital, emergency department, neurosurgery, and intensive care unit took place in Colombia to develop a set of stratified protocols called BOOTStraP, targeting resource-poor environments, but it has not been systematically implemented and tested. OBJECTIVE: To identify the facilitators of, and barriers to, collecting data about patients with sTBI and to implement a stratified protocol across the treatment phases of prehospital, emergency department, neurosurgery, and intensive care unit in low-resource settings. We also aim to identify a possible association between adherence to these protocols and outcomes for these patients. METHODS: A prospective, observational, before and after, pilot study will be performed in three phases as follows: before implementation, implementation, and after implementation. The BOOTStraP protocols will be implemented in three Colombian centers. EXPECTED OUTCOMES: We expect to find numerous barriers during the implementation phase. We also expect moderate adherence to the protocols. However, we expect to find an increase in the survival rate to hospital discharge and an improvement in neurological outcomes at discharge. DISCUSSION: This pilot study will serve as a first step to identify variables that are critical to successful implementation, to be considered for the design of a future large-scale international study to measure the effectiveness of resource-based protocols and to improve outcomes from sTBI.
2 citations
TL;DR: The first edition of the guidelines for the acute medical management of severe traumatic brain injury (TBI) in infants, children, and adolescents was published by the Brain Trauma Foundation (BTF) as mentioned in this paper .
Abstract: To the Editor: We were pleased to read the publication “Evolution and Impact of the Brain Trauma Foundation Guidelines” and are proud to be among the many people over the years who have contributed to the important work of the Brain Trauma Foundation (BTF).1 Thank you for bringing this history together. We are writing with one clarification and one comment. Our clarification is about the Guidelines for the Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolescents, first edition.2 The first edition was an independent project and not supported by the BTF. The administrative machinery to carry out the extensive, 3-year project was provided by the Evidence-based Practice Center located at Oregon Health & Science University. Investigators, authors, and administrative staff were volunteers; funding for the simultaneous publication in 3 journals was provided by the National Institute of Neurological Disorders and Stroke, and the National Center for Medical Rehabilitation Research of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Oregon Health & Science University team subsequently partnered with the BTF to generate further editions of the pediatric, adult, and prehospital guidelines.3-8 Our comment is in reference to the statement from the publication regarding the third edition of the pediatric guidelines: “The treatment algorithm which accompanies the third edition was conceived independent of other projects such as the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) algorithms. Of interest, the panelists who have participated in the creation of the pediatric guidelines largely differ from those of the adult guidelines. Because of this, differences between the recommendations for adult and pediatric patients inspire reflection as to whether they reflect a true difference in adult and pediatric best care or whether they reflect a distinct interpretation of similar literature.” We find this reflection to be somewhat paradoxical to the direction of the field of neurocritical care in the treatment of severe traumatic brain injury (TBI). It is unlikely that best care for a 3-month-old victim of abusive head trauma would be equally well-directed by an algorithm generated from studies that included elderly adults who suffer TBI, or even young adults, for that matter. It is surprising in this era where in both pediatric and adult TBI we seek to endophenotype to direct precision care. For example, a recent work by Woods et al9 questions whether an intracranial pressure threshold of 15 mm Hg might be more appropriate in pediatrics at the same time that the adult threshold has risen to 22 mm Hg.7 Propofol use in adults but not children is another key difference that is impossible to ignore and well beyond interpretation.5 Similarly, given the concerns over apoptosis in the developing brain, optimal medications for sedation have not been well elucidated.10 Finally, issues of sex differences across ages have not been studied. We believe that we should be redoubling our efforts to better understand and further enhance precision care within the age epochs of both pediatric and adult neurocritical care in severe TBI, learning from the studies across the entire field and continuing the dialog. Thank you for the opportunity to clarify and contribute to this dialog.
1 citations
TL;DR: It is concluded that diagram-based approaches like causal-loop diagramming have the potential to support the development of a shared paradigm of TBI that incorporates social support aspects of recovery and simulation modeling presents opportunities for improving individualized treatment and care delivery.
Abstract: Traumatic brain injury (TBI) is a highly complex phenomenon involving a cascade of disruptions across biomechanical, neurochemical, neurological, cognitive, emotional, and social systems. Researchers and clinicians urgently need a rigorous conceptualization of brain injury that encompasses nonlinear and mutually causal relations among the factors involved, as well as sources of individual variation in recovery trajectories. System dynamics, an approach from systems science, has been used for decades in fields such as management and ecology to model nonlinear feedback dynamics in complex systems. In this mini-review, we summarize some recent uses of this approach to better understand acute injury mechanisms, recovery dynamics, and care delivery for TBI. We conclude that diagram-based approaches like causal-loop diagramming have the potential to support the development of a shared paradigm of TBI that incorporates social support aspects of recovery. When developed using adequate data from large-scale studies, simulation modeling presents opportunities for improving individualized treatment and care delivery.
TL;DR: This review aims to map the use of resource-stratified guidelines across all fields of medicine and seeks to answer three questions for the identified guidelines: what was the method of development, have they been implemented and, if so, has they been validated.
Abstract: Introduction Nearly every field of medicine has some form of clinical practice guidelines. However, only within the past 5–10 years has the medical community acknowledged the need for well-developed guidelines tailored to the local healthcare needs and the resources available. In most low-income and middle-income countries (LMICs), healthcare workers depend on guidelines developed in high-income countries (HICs), yet many interventions validated in a HIC are ineffective when implemented in an LMIC. The variation in infrastructure, medical personnel, technology and environmental conditions exhibited in LMICs relative to HICs necessitates a careful appraisal of the evidence base used in clinical guideline recommendations. This review aims to map the use of resource-stratified guidelines across all fields of medicine. The review seeks to answer three questions for the identified guidelines: (1) what was the method of development, (2) have they been implemented and, if so, (3) have they been validated. Methods The search strategy will aim to locate studies from inception to November 2021. An initial limited search of PubMed and Scopus was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy for PubMed and Scopus. This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Data to be extracted from each study will include population characteristics of both developers and intended implementation population, medical specialty, validation status, method of guideline development, whether the study is consensus or evidence-based in addition to a summary of recommendations for practice. Ethics and dissemination Ethical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal.