The past, present, and future of comparative effectiveness research in the US Department of Veterans Affairs.

A particular challenge for the healthcare provider and the patient is to choose among competing therapeutic approaches for a particular condition. Often, the relative benefits and risks of potential therapies are not uniformly available from the existing scientific information. Many have pointed to the need for more comparative effectiveness research (CER) to aide in these decisions.

Motivation for traumatic brain injury rehabilitation questionnaire (MOT-Q): reliability, factor analysis, and relationship to MMPI-2 variables.

A Likert scale questionnaire was developed to assess motivation for postacute rehabilitation by traumatic brain injury patients. Items were designed to reflect head-injured individuals' statements about their attitudes toward head injury rehabilitation. Factors such as denial of illness, anger, compliance with treatment, and medical information seeking behavior were used to assess unfavorable and favorable components of motivation.

Biomechanics and neuropathology of adult and paediatric head injury.

The objective of this study was to understand the biomechanics in age-related primary traumatic brain injuries (TBI) causing initial severity and secondary progressive damage and to develop strategy reducing TBI outcome variability using biomechanical reconstruction to identify types of causal mechanisms prior to clinical trials of neuro-protective treatment. The methods included the explanation of TBI biomechanics and physiopathological mechanisms from dual perspectives of neurosurgery and biomechanical engineering. Scaling of tolerances for skull failure and brain injuries in infants, children and adults are developed.

Quantitative imaging in late TBI. Part II: cognition and work after closed and penetrating head injury: a report of the Vietnam head injury study.

Context: Functional outcome in relation to CT findings in traumatic brain injured (TBI) patients is not well established in relation to cognitive and vocational outcome.

Objective: To investigate the possible correlation between relatively simple quantitative radiological measurements and cognitive and vocational outcome.

Design: Retrospective analysis of quantitative assessment of CT studies in relation to post-injury cognitive changes and vocational outcome.

Quantitive imaging in late traumatic brain injury. Part I: late imaging parameters in closed and penetrating head injuries.

Objective: To ascertain the value of relatively simple quantitative radiologic measurements after head injury. Despite major advances in neuroradiology, analysis and reporting of imaging studies is based primarily on individual subjective and local experience, rather than on reproducible, standardized parameters; reliance on newer technologies can improve care, but also raises diagnostic costs.

Design: Blinded, retrospective, quantitative assessment of computerized tomography studies done some 14 years post-injury.

More on assessing outcomes of emergency care.

New methods of assessing the outcomes of emergency department care are needed to provide information to purchasers, plans, providers, and patients to prove improvements in EMS system organization, quality, efficiency, and patient satisfaction. This commentary expands on the important components of an outcomes research agenda for ED care.

Outcome after traumatic brain injury in the U.S. military medical system.

Personality and behavioral change after traumatic brain injury (TBI) are often the most significant concerns for the families of TBI patients. This report examines discharge from military service after TBI for medical and behavioral criteria. When compared with the total discharge population (n = 1,879,724), the relative risk for behavioral discharge was 1.

Causation, incidence, and costs of traumatic brain injury in the U.S. military medical system.

Hospital discharge records from military facilities and private facilities reimbursed by Civilian Health and Medical Program of the Uniformed Services for fiscal year 1992 were reviewed to identify head injury admissions. Incidence rates, case fatality rates, causes of head injuries, and direct cost for hospital admissions were computed in this well-defined population. For fiscal year 1992, there were 5,568 hospitalized cases of noncombat head injury in the military medical system.

Head injury mechanisms and the concept of preventive management: a review and critical synthesis.

Recent advances in head injury research have produced a plethora of useful data coupled with a paucity of conceptual integration across the four ways in which this research is pursued. These research orientations are the epidemiological, biomechanical, basic neuroscientific, and clinicopathologic/therapeutic (including rehabilitation). This overview of the history and current state of the art assumes that biomechanics is the basic science of causation in head injury research and when fully integrated with its counterparts, physiology and pathology, it can serve to overcome our conceptual handicaps.

Massive cortical reorganization after sensory deafferentation in adult macaques.

After limited sensory deafferentations in adult primates, somatosensory cortical maps reorganize over a distance of 1 to 2 millimeters mediolaterally, that is, in the dimension along which different body parts are represented. This amount of reorganization was considered to be an upper limit imposed by the size of the projection zones of individual thalamocortical axons, which typically also extend a mediolateral distance of 1 to 2 millimeters. However, after extensive long-term deafferentations in adult primates, changes in cortical maps were found to be an order of magnitude greater than those previously described.

Implantable devices for chronic access and drug delivery to the central nervous system.

This is a review of implantable devices for chronic access and drug delivery to the central nervous system (CNS) via the cerebrospinal fluid, extracellular fluid, and vascular pathways. The current applications of such devices in the management of mycotic meningitis, meningeal leukemia and carcinomatosis, solid malignant tumors of the CNS, intractable cancer-associated pain, unresectable cystic tumors and in cytologic, pharmacologic, and experimental studies on the cerebrospinal fluid (CSF) are assessed. Specific attention is paid to the applications of the most commonly used device, a subcutaneous reservoir and pump (SRP), including its major uses and complications.

Cerebral abscesses produced by bacterial implantation and septic embolisation in primates.

The degree of brain abscess encapsulation is positively related to surgical mortality and methods to enhance capsule wall formation, therefore, have therapeutic relevance. Two primate models are described which may be useful in the investigation of encapsulation of traumatic and metastatic brain abscesses. Direct intracerebral inoculation induces abscesses displaying more prominent inflammatory responses and encapsulation than does septic embolisation, despite similar abscess age and size.