The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
-
The Glasgow Coma Scale (GCS) was developed in 1974 to objectively describe neurological status and predict outcome in neuroscience patients. Through the years, the GCS has become the gold standard for coma assessment. Despite its widespread use, the GCS has many limitations that are well documented in the literature. ⋯ The interrater reliability for the GCS was good (k(w) = .738), and that for the FOUR score was excellent (k(w) = .951). Outcome prediction analysis showed that the FOUR score and the GCS are both able to predict in-hospital morbidity and poor outcome at the end of hospitalization. The results from this pediatric study were consistent with the adult studies which suggest that the FOUR score is a reliable and valid tool for use in a wide variety of neuroscience patients.
-
Neuromonitoring with the microdialysis technique is now being utilized at the bedside. Cerebral metabolism monitoring enables identification of clinical events hours or even days before clinical examination changes, providing clinical staff an opportunity for earlier intervention. ⋯ Cerebral metabolism monitoring through microdialysis can guide clinicians to institute therapeutic measures that prevent the occurrence of secondary injury. This article focuses on the state-of-the-art application of cerebral microdialysis, the rationale for its use, and the nursing implications of this technique.
-
Hypothermia has been shown to have neuroprotective effects and may have benefit in the treatment of head injuries. However, it is a controversial treatment in traumatic brain injury, and to date, there are no specific recommendations for its use. This article examines six research studies investigating the use of hypothermia as a treatment in patients with traumatic brain injury. ⋯ However, each study used a different method of cooling, goal temperature, and duration of cooling. Through the comparison of these studies, a recommendation for change in practice cannot be made. Nevertheless, there may be benefits to hypothermia in traumatic brain injury, and suggestions for future research are identified.
-
Performance improvement measures in achieving glycemic control in the acute brain injury population.
Glycemic control is becoming a standard practice in the intensive care environment because it has been shown to produce positive patient outcomes and benefits. A 14-bed neurointensive care unit initiated a strict glycemic protocol and evaluated the results over a 1-year period through a performance improvement initiative. ⋯ The purpose of this article was to explain how a strict glycemic protocol was safely implemented. Further research is necessary to determine long-term benefits of glycemic control in the population with neurocritical illness.
-
Health-related quality of life (HRQOL) research in traumatic brain injury (TBI) populations is beginning to emerge in the literature. Because rehabilitation and reintegration issues are complex with TBI, especially with new combat veterans, it is critical that future HRQOL research be designed to consider these issues. Utilizing explicit definitions and a conceptual model of HRQOL can provide researchers with a holistic base on which to build interventions for successful patient outcomes. ⋯ This review was organized utilizing the model of HRQOL of Ferrans et al. The objective of this review was to identify gaps in current knowledge of HRQOL and TBI. These findings were then used to develop recommendations for future research with combat veterans who have sustained a TBI.