Brief Psychosocial Intervention to Address Poststroke Depression May Also Benefit Fatigue and Sleep-Wake Disturbance.

Purpose: This study aimed to determine if brief psychosocial/behavioral therapy directed to reduce poststroke depression would decrease fatigue and improve sleep-wake disturbance.

Design: A preplanned secondary data analysis from a completed clinical trial was conducted.

Methods: One hundred participants received usual care, in-person intervention, or telephone intervention.

Stroke impact symptoms are associated with sleep-related impairment.

Background: Sleep-related impairment is a common but under-appreciated complication after stroke and may impede stroke recovery. Yet little is known about factors associated with sleep-related impairment after stroke.

Objective: The purpose of this analysis was to examine the relationship between stroke impact symptoms and sleep-related impairment among stroke survivors.

Randomized trial of telephone versus in-person delivery of a brief psychosocial intervention in post-stroke depression.

Background: A psychosocial behavioral intervention delivered in-person by advanced practice nurses has been shown effective in substantially reducing post-stroke depression (PSD). This follow-up trial compared the effectiveness of a shortened intervention delivered by either telephone or in-person to usual care. To our knowledge, this is the first of current behavioral therapy trials to expand the protocol in a new clinical sample.

Chapter 5 cerebral perfusion pressure and intracranial pressure in traumatic brain injury.

Nearly 300,000 children and adults are hospitalized annually with traumatic brain injury (TBI) and monitored for many vital signs, including intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Nurses use these monitored values to infer the risk of secondary brain injury. The purpose of this chapter is to review nursing research on the monitoring of ICP and CPP in TBI.

Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association.

Purpose: The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH).

Methods: A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables.

Hypothermia and rapid rewarming is associated with worse outcome following traumatic brain injury.

Purpose: The purpose of the present study was to determine (1) the prevalence and degree of hypothermia in patients on emergency department admission and (2) the effect of hypothermia and rate of rewarming on patient outcomes.

Methods: Secondary data analysis was conducted on patients admitted to a level I trauma center following severe traumatic brain injury (n = 147). Patients were grouped according to temperature on admission according to hypothermia status and rate of rewarming (rapid or slow).

An approach to determining intracranial pressure variability capable of predicting decreased intracranial adaptive capacity in patients with traumatic brain injury.

Nurses caring for traumatic brain injury (TBI) patients with intracranial hypertension (ICH) recognize that patients whose intracranial adaptive capacity is reduced are susceptible to periods of disproportionate increase in intracranial pressure (DIICP) in response to a variety of stimuli. It is possible that DIICP signals potential secondary brain damage due to sustained or intermittent ICH. However, there are few clinically accessible intracranial pressure (ICP) measurement parameters that allow nurses and other critical care clinicians to identify patients at risk of DIICP.

Intracranial and blood pressure variability and long-term outcome after aneurysmal sub-arachnoid hemorrhage.

Background: Care of brain-injured patients in intensive care units has focused on maintaining arterial blood pressure and intracranial pressure within prescribed ranges. Research suggests, however, that the dynamic variability of these pressure signals provides additional information about physiological functioning and may reflect adaptive capacity.

Objectives: To see if long-term outcomes can be predicted from variability of arterial blood pressure and intracranial pressure in patients with aneurysmal subarachnoid hemorrhage.

Detrended fluctuation analysis of intracranial pressure predicts outcome following traumatic brain injury.

Detrended fluctuation analysis (DFA) is a recently developed technique suitable for describing scaling behavior of variability in physiological signals. The purpose of this study is to explore applicability of DFA methods to intracranial pressure (ICP) signals recorded in patients with traumatic brain injury (TBI). In addition to establishing the degree of fit of the power-law scaling model of detrended fluctuations of ICP in TBI patients, we also examined the relationship of DFA coefficients (scaling exponent and intercept) to: 1) measures of initial neurological functioning; 2) measures of functional outcome at six month follow-up; and 3) measures of outcome, controlling for patient characteristics, and initial neurological status.

Intracranial pressure waveform morphology and intracranial adaptive capacity.

Background: Intracranial hypertension due to primary and secondary injuries is a prime concern when providing care to patients with severe traumatic brain injury. Increases in intracranial pressure vary depending on compensatory processes within the craniospinal space, also referred to as intracranial adaptive capacity. In patients with traumatic brain injury and decreased intracranial adaptive capacity, intracranial pressure increases disproportionately in response to a variety of stimuli.

The impact of a highly visible display of cerebral perfusion pressure on outcome in individuals with cerebral aneurysms.

Background: Nurses' ability to rapidly detect decreases in cerebral perfusion pressure (CPP), which may contribute to secondary brain injury, may be limited by poor visibility of CPP displays.

Objective: To evaluate the impact of a highly visible CPP display on the functional outcome in individuals with cerebral aneurysms.

Methods: Patients with cerebral aneurysms (n = 100) who underwent continuous CPP monitoring were enrolled and randomized to beds with or without the additional CPP display.

Intracranial pressure variability and long-term outcome following traumatic brain injury.

Background: Research suggests that intracranial pressure (ICP) dynamics beyond just absolute ICP level provide information reflecting intracranial adaptive capacity. Specifically, evidence indicates that physiologic variability provides information about system functioning that may reflect dimensions of adaptive capacity. The purpose of this study was to examine the association between ICP variability in patients following moderate to severe traumatic brain injury (TBI) and outcome at hospital discharge and 6 months post-injury.

Temperature rhythm in aneurysmal subarachnoid hemorrhage.

Introduction: In the acute phase following brain injury, alterations in temperature regulation occur commonly and are associated with poorer outcome. However, few studies have examined temperature rhythm following brain insult, such as rupture and surgical management of ruptured cerebral aneurysms, and its association with clinical factors and outcome.

Methods: This study describes diurnal temperature patterns in patients hospitalized for acute management of cerebral aneurysms (n = 86).

Fever management practices of neuroscience nurses, part II: nurse, patient, and barriers.

Fever is frequently encountered by neuroscience nurses in patients with neurological insults and often results in worsened patient outcomes when compared with similar patients who do not have fever. Best practices in fever management are then essential to optimizing patient outcomes. Yet the topic of best nursing practices for fever management is largely ignored in the clinical and research literature, which can complicate the achievement of best practices.

Fever management practices of neuroscience nurses: national and regional perspectives.

Neuroscience patients with fever may have worse outcomes than those who are afebrile. However, neuroscience nurses who encounter this common problem face a translational gap between patient-outcomes research and bedside practice because there is no current evidence-based standard of care for fever management of the neurologically vulnerable patient. The aim of this study was to determine if there are trends in national practices for fever and hyperthermia management of the neurologically vulnerable patient.

Neurointensive care; impaired cerebral autoregulation in infants and young children early after inflicted traumatic brain injury: a preliminary report.

The objective of this report is to describe cerebral autoregulation after severe inflicted pediatric traumatic brain injury (iTBI). We examined cerebral autoregulation of both cerebral hemispheres (mean autoregulatory index; ARI) in children <5 years with Glasgow Coma Scale (GCS) score of <9 and no evidence of brain death within the first 48 h of pediatric intensive care unit (PICU) admission. Discharge and 6-month Glasgow Outcome Scale (GOS) scores were collected.

Intensive care unit management of fever following traumatic brain injury.

Fever, in the presence of traumatic brain injury (TBI), is associated with worsened neurologic outcomes. Studies prior to the publication of management guidelines revealed an undertreatment of fever in patients with neurologic insults. Presently the adult TBI guidelines state that maintenance of normothermia should be a standard of care therefore improvement in management of fever in these patients would be expected.

Effect of continuous display of cerebral perfusion pressure on outcomes in patients with traumatic brain injury.

Background: Clinical bedside monitoring systems do not provide prominent displays of data on cerebral perfusion pressure (CPP). Immediate visual feedback would allow more rapid intervention to prevent or minimize suboptimal pressures.

Objective: To evaluate the effect of a highly visible CPP display on immediate and long-term functional outcome in patients with traumatic brain injury.

Cerebral blood flow monitoring in clinical practice.

The brain depends on a continuous flow of blood to provide it with oxygen and glucose needed to maintain normal function and structural integrity, thus cerebral blood flow is normally tightly regulated. A decrease in cerebral blood flow to ischemic levels may be tolerated for only minutes to hours, depending on the severity of the ischemia. If cerebral blood flow ceases completely, brain cell death occurs within minutes.

Is there a sex difference in the course following traumatic brain injury?

Traumatic brain injury (TBI) is a significant cause of death and disability in the United States. Sex has not been thoroughly examined as a factor that may influence outcome following TBI. Clinical studies involving humans that have focused on sex and TBI outcome have yielded inconclusive results, yet sex-related physiologic differences have been demonstrated in animal studies.

The impact of aneurysmal subarachnoid hemorrhage on functional outcome.

Despite advances in the management of aneurysmal subarachnoid hemorrhage (SAH), a significant percentage of survivors are left with persistent cognitive, behavioral, and emotional changes that affect their day-to-day lives. This article describes outcome at 3 months after aneurysmal SAH in 61 patients, using the Extended Glasgow Outcome Scale (GOSE) and the Functional Status Examination (FSE). The GOSE provides a measure of overall functional outcome but does not address the specifics of functional limitations.