Publications by authors named "Silverberg N"

Outpatient care following nonhospitalized traumatic brain injury (TBI) is variable, and often sparse. The National Academies of Sciences, Engineering, and Medicine's 2022 report on highlighted the need to improve the consistency and quality of TBI care in the community. In response, the present study aimed to identify existing evidence-based guidance and specific clinical actions over the days to months following nonhospitalized TBI that should be prioritized for implementation in primary care.

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Objective: Mild traumatic brain injury (mTBI) is frequently overlooked in polytrauma patients due to the overshadowing of more severe injuries, a fact that makes its identification in post-acute settings challenging since symptoms overlap with other conditions and no validated diagnostic tools exist. To address this gap, this scoping review explored the literature on mTBI diagnosis in post-acute civilian polytrauma settings.

Methods: By utilizing the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on studies from 2010 to 2024 related to delayed mTBI diagnosis in adults.

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Background: Upper limb activity following stroke is low, which may limit recovery. We investigated whether a virtually-delivered upper limb program, that included a wearable device with reach-to-grasp feedback, would increase upper limb activity after stroke.

Methods: This was a parallel-group, assessor-blinded, randomized control trial conducted at 6 sites across 5 provinces of the CanStroke Recovery Trials Platform between 2020 to 2022.

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Background: International Dermatology Outcome Measures (IDEOM) is a non-profit organization whose mission is to improve the availability of evidence-based, consensus-driven outcome measures for dermatological diseases. IDEOM facilitates collaboration between stakeholders from various backgrounds, including researchers, patients, physicians, and industry representatives, to develop objective benchmark metrics that enable better treatment and management of dermatologic conditions.

Summary: The 2023 IDEOM Annual Meeting was held June 23-24, 2023.

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  • Concussions are common among young adults and can lead to persistent symptoms complicated by anxiety, which may affect recovery; a new program called TOR-C is designed to address both issues to improve outcomes after concussion.
  • The study involved five young adults participating in four weekly video sessions with a clinician, focusing on various psychological factors and measuring symptoms and feelings before, after, and three months later.
  • Results showed high feasibility and satisfaction, with strong adherence rates to the treatment and homework; most participants found the program credible and beneficial, indicating its potential for helping with concussion recovery.
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  • The study aimed to evaluate the Toolkit for Optimal Recovery after Concussion (TOR-C) and its effectiveness in preventing continuous concussion symptoms in young adults with anxiety compared to an active control group (HE-C).
  • A total of 50 participants aged 18-35, who had suffered a concussion within the last 3-10 weeks and displayed anxiety, engaged in four 45-minute Zoom sessions focused on different interventions.
  • Results showed that both intervention groups met feasibility benchmarks and experienced notable improvements in various outcomes like concussion symptoms and anxiety levels, with the TOR-C group specifically showing greater progress in certain areas like mindfulness and all-or-nothing behavior.
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Our recent improved understanding of traumatic brain injury (TBI) comes largely from cohort studies of TBI patients with indication for computed tomography (CT). Using CT head as an inclusion criterion may overestimate poor outcomes after TBI with Glasgow Coma Scale (GCS) 13-15. We aimed to compare outcomes after TBI in adults who had a head CT scan (with negative findings) versus those who had no CT when presenting to an emergency department.

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  • * This study aims to test the effectiveness of GAIN Lite, a new intervention combined with standard care, for adults experiencing persistent post-concussion symptoms (PPCS).
  • * GAIN Lite includes remote interviews, e-learning, and counseling from therapists, potentially providing better access to treatment and reducing chronic issues for those with transportation difficulties.
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Background: Functional cognitive disorder (FCD) may be common after a concussion, and no evidence-based treatment options are available. The current study evaluated the feasibility of a novel cognitive-behavioural therapy (CBT) protocol tailored to FCD after concussion.

Methods: Participants were randomised to CBT (n=11) or the current standard of care, cognitive rehabilitation (n=13).

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  • The IDEOM Vitiligo Workgroup aims to create a standardized approach for reporting the severity of vitiligo, as current methods are inconsistent and lack uniformity.
  • A literature review identified 50 clinical trials focusing on topical treatments for vitiligo, revealing various grading systems for measuring repigmentation and quality of life.
  • The study suggests employing metrics like body surface area scoring and the Vitiligo Area Scoring Index to improve data collection, while also considering new factors like treatment burden and cost-effectiveness.
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  • * A clinical trial with 90 adults who had persistent post-concussion symptoms was analyzed, comparing the single-item measure to a more comprehensive fear avoidance tool (FAB-TBI), as well as other mental health indicators like anxiety and depression.
  • * Results showed that the single-item measure strongly correlated with the FAB-TBI tool both before and after treatment, indicating it could be an effective and practical option for assessing fear avoidance in mTBI patients.
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Fear avoidance behaviour is associated with slow recovery from mild traumatic brain injury (mTBI). This study is a preliminary evaluation of graded exposure therapy (GET), which directly targets fear avoidance behaviour, for reducing post-concussion symptoms (PCS) and disability following mTBI. In a historical comparison design, we compared two groups from independent randomized trials.

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Background: The pathophysiology of protracted symptoms after COVID-19 is unclear. This study aimed to determine if long-COVID is associated with differences in baseline characteristics, markers of white matter diffusivity in the brain, and lower scores on objective cognitive testing.

Methods: Individuals who experienced COVID-19 symptoms for more than 60 days post-infection (long-COVID) (n = 56) were compared to individuals who recovered from COVID-19 within 60 days of infection (normal recovery) (n = 35).

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Atopic dermatitis (AD) is a multi-system inflammatory skin disorder with early onset in the skin. It is well known that Black and Hispanic children in the United States experience specific barriers in regards to accessing care for AD, including greater severity on presentation and more need for care including increased usage of emergency services. Understanding these social determinants is vital if social change is to be made and if policies are to be constructed to create enduring reductions in disparity in a meaningful way that can potentially level disease severity and access to care for all segments of the family.

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Atopic dermatitis (AD) begins in early childhood in the majority of children. Addressing AD in small children includes recognition of the early presentations of disease in all skin types, triggers, comorbidities, and therapeutics. These include risk of medication absorption, more xerosis, infections, and creating management plans that are acceptable to parents/caregivers, while offering safety.

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  • * The review introduces a mnemonic, VINDICATE-P, to categorize the various comorbidities linked with AD, including cardiovascular, infectious, and neurological conditions, among others.
  • * Understanding these comorbidities can differ based on the patient's age, and further research is necessary to explore how they develop and how best to screen for them in AD patients.
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Atopic dermatitis is an inflammatory skin condition that largely affects children. Atopic dermatitis has the potential to persist into adulthood and continue to negatively affect the lives of those who are burdened with it. This condition can have a large impact on the quality of life of those who are affected from birth through senescence.

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  • - Mental health issues are widespread in individuals who have experienced mild traumatic brain injury (mTBI) and can worsen postconcussive symptoms; better early detection of these disorders could enhance treatment outcomes.
  • - The study aimed to evaluate the diagnostic effectiveness of three mental health screening tools (PHQ-9, GAD-7, PC-PTSD-5) in mTBI patients, comparing their results against a structured diagnostic interview conducted via videoconference.
  • - Findings from 499 participants showed that all three screening tools had strong diagnostic accuracy for detecting major depression, anxiety disorders, and PTSD among adults with mTBI, indicating their potential usefulness in clinical settings.
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  • * A randomized controlled trial will involve 220 participants from various Canadian clinics, assigning them to GET, aerobic exercise, or enhanced usual care, with symptom severity as the main outcome measured 14-18 weeks post-treatment.
  • * All ethical approvals and informed consent processes are in place for the study, and if GET is shown to be effective, the results will be shared to improve treatment options for mTBI patients.
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