Role transition: A descriptive exploratory study of assistant nurse clinicians in Singapore.

Aim: To explore the role-transition experiences of assistant nurse clinicians after their first year of appointment.

Background: The National Nursing Taskforce was set up in Singapore to examine the professional development and recognition of nurses. It created the assistant nurse clinician role as an avenue for the nurses' career development.

Use of programmable versus nonprogrammable shunts in the management of hydrocephalus secondary to aneurysmal subarachnoid hemorrhage: a retrospective study with cost-benefit analysis.

Objectives: The choice of programmable or nonprogrammable shunts for the management of hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) remains undefined. Variable intracranial pressures make optimal management difficult. Programmable shunts have been shown to reduce problems with drainage, but at 3 times the cost of nonprogrammable shunts.

Post-traumatic hydrocephalus after ventricular shunt placement in a Singaporean neurosurgical unit.

Ventricular enlargement is a common finding after severe head injury and has a poor prognosis if associated with post-traumatic hydrocephalus (PTH). We retrospectively reviewed our head injury database and identified patients who suffered from severe head injury and subsequently had shunt insertion after a diagnosis of PTH. A total of 871 patients with severe head injury were admitted from April 1999 to December 2006.

A randomized, placebo-controlled pilot study of patients with spontaneous intraventricular haemorrhage treated with intraventricular thrombolysis.

Intraventricular hemorrhage (IVH) occurring after spontaneous intracerebral hemorrhage (ICH) is an independent risk factor for mortality. The use of intraventricular urokinase (Uk) to reduce intraventricular blood clot volume and improve outcome was investigated. Patients with IVH requiring external ventricular drainage were recruited and randomized into a double-blind placebo controlled study.

Go green! Reusing brain monitoring data containing missing values: a feasibility study with traumatic brain injury patients.

Background: Despite the wealth of information carried, periodic brain monitoring data are often incomplete with a significant amount of missing values. Incomplete monitoring data are usually discarded to ensure purity of data. However, this approach leads to the loss of statistical power, potentially biased study and a great waste of resources.

Prediction of outcome utilizing both physiological and biochemical parameters in severe head injury.

Traumatic brain injury is a major socioeconomic burden, and the use of statistical models to predict outcomes after head injury can help to allocate limited health resources. Earlier prediction models analyzing admission data have been used to achieve prediction accuracies of up to 80%. Our aim was to design statistical models utilizing a combination of both physiological and biochemical variables obtained from multimodal monitoring in the neurocritical care setting as a complement to earlier models.

Outcome of severe head injured patients admitted to intensive care during weekday shifts compared to nights and weekends.

Introduction: Some studies have demonstrated an increased risk of death for patients admitted at nights or during weekends. This study was undertaken to investigate the demographic profile, medical interventions and outcome of severe head injury patients stratified according to day and time of admission to a specialised neurosciences intensive care unit (NICU).

Materials And Methods: A retrospective study using a prospectively maintained severe head injury database in a tertiary hospital.

Cerebral oxygenation, vascular reactivity, and neurochemistry following decompressive craniectomy for severe traumatic brain injury.

Object: This study addresses the changes in brain oxygenation, cerebrovascular reactivity, and cerebral neurochemistry in patients following decompressive craniectomy for the control of elevated intracranial pressure (ICP) after severe traumatic brain injury (TBI).

Methods: Sixteen consecutive patients with isolated TBI and elevated ICP, who were refractory to maximal medical therapy, underwent decompressive craniectomy over a 1-year period. Thirteen patients were male and 3 were female.

Effects of glycaemic control on cerebral neurochemistry in primary intracerebral haemorrhage.

This was a pilot study to compare the cerebral haemodynamics and neurochemical changes in patients with primary basal ganglia haemorrhage (PBGH), who underwent conventional blood glucose level (BGL) control and intensive BGL control with continuous titrated insulin therapy. Patients admitted over an 18-month period with PBGH after evacuation of haematoma were retrospectively divided into two groups according to the method used for BGL control: the 'intensive' group consisted of patients who underwent continuous titrated insulin infusion to maintain a lower normoglycemic level of 4-8 mmol/L, and the 'conventional' group consisted of patients whose BGL was maintained at between 8.1 and 10.

Effects of temperature changes on cerebral biochemistry in spontaneous intracerebral hematoma.

Background: Fever worsens outcome in acute brain injury, presumably by accelerating secondary damage. Improved understanding of the pathophysiological processes that occur in spontaneous intracerebral hemorrhage (ICH) may help to determine if controlled normothermia might be of clinical benefit.

Methods: In this prospective observational study over a period of 18 months at the National Neuroscience Institute, Singapore, we examined the effects of temperature changes on brain biochemistry and tissue oxygenation in 25 consecutive patients with spontaneous primary putaminal hemorrhage.

Prediction of early mortality in primary intracerebral hemorrhage in an Asian population.

Background: Primary intracerebral hemorrhage accounts for the relative minority of all strokes and yet is more fatal and disabling. Various prognostic models for mortality and functional outcome following primary intracerebral hemorrhage have been proposed, however there is little data which focuses on a multi-racial population profile characteristic of communities in South-East Asia. A reliable grading scale for this condition will allow for accurate risk stratification, treatment selection, resource allocation and possibly also aid in the definition of common enrollment criteria for clinical trials.

Changes in brain biochemistry and oxygenation in the zone surrounding primary intracerebral hemorrhage.

Background: While the management of primary intracerebral hemorrhage (ICH) remains controversial, there remains a subset of patients that undergo clot evacuation. This study aims to characterize brain physiology and biochemistry after surgery for this condition.

Methods: Thirty-six consecutive patients requiring ventilation for primary ICH had intracranial pressure (ICP), tissue oxygenation (PbO2) and cerebral microdialysis (CMD) monitoring.

Hybrid outcome prediction model for severe traumatic brain injury.

Numerous studies addressing different methods of head injury prognostication have been published. Unfortunately, these studies often incorporate different head injury prognostication models and study populations, thus making direct comparison difficult, if not impossible. Furthermore, newer artificial intelligence tools such as machine learning methods have evolved in the field of data analysis, alongside more traditional methods of analysis.