Articles: function.
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Cochrane Db Syst Rev · Jun 2017
ReviewCognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes.
Cognitive impairment in people with traumatic brain injury (TBI) could affect multiple facets of their daily functioning. Cognitive rehabilitation brings about clinically significant improvement in certain cognitive skills. However, it is uncertain if these improved cognitive skills lead to betterments in other key aspects of daily living. We evaluated whether cognitive rehabilitation for people with TBI improves return to work, independence in daily activities, community integration and quality of life. ⋯ There is insufficient good-quality evidence to support the role of cognitive rehabilitation when compared to no intervention or conventional rehabilitation in improving return to work, independence in ADL, community integration or quality of life in adults with TBI. There is moderate-quality evidence that cognitive rehabilitation provided as a home programme is similar to hospital-based cognitive rehabilitation in improving return to work status among active duty military personnel with moderate-to-severe TBI. Moderate-quality evidence suggests that one cognitive rehabilitation strategy (cognitive didactic) is no better than another (functional experiential) in achieving return to work in veterans or military personnel with TBI.
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Neuroscientific research has made a concerted effort to determine cortical localization using various functional imaging techniques. This approach has undoubtedly yielded important novel anatomical knowledge, albeit at times contradictory, regarding the structural organization of the vestibular cortex. Unfortunately however, this knowledge has not translated to our understanding regarding how neural mechanisms control vestibular function. ⋯ Contrastingly, in the second half of this review, I present previous findings that show how disrupting interhemispheric interactions can modulate the brainstem-mediated vestibular-ocular reflex (VOR). I conclude by speculating why interhemispheric competition induces correlated biases at the cortical and brainstem level respectively. Specifically, I propose that brainstem-mediated vestibulo-spatial and vestibulo-temporal transformations, in addition to coding for head displacement, underpin a generalized cortical magnitude estimation system which the CNS uses to construct dynamic spatio-temporal maps of the physical world, in-turn ensuring spatial orientation.
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Observational Study
Survival and functional outcomes of patients with metastatic solid organ cancer admitted to the intensive care unit of a tertiary centre.
Metastatic solid organ cancer is associated with a poor prognosis, and admission of patients with these cancers to the intensive care unit remains a dilemma. We aimed to assess outcomesin a cohort of these patients who were admitted to the ICU of a general tertiary centre. ⋯ Survival is poor in patients with metastatic cancer after emergent ICU admission, although functional state is often recovered by 3 months in surviving patients. Albumin level, white cell count and ECOG grade are simple prognostic markers of survival.
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Critical care nurse · Jun 2017
Interprofessional Team's Perception of Care Delivery After Implementation of a Pediatric Pain and Sedation Protocol.
Pain and agitation are common experiences of patients in pediatric cardiac intensive care units. Variability in assessments by health care providers, communication, and treatment of pain and agitation creates challenges in management of pain and sedation. ⋯ Guidelines for pain and sedation management were associated with perceived improvements in team function and patient care by members of the interprofessional team.