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Fernandez LL, Griswold D, Khun I, Rodriguez De Francisco DV. Innovative Solutions for Patients Who Undergo Craniectomy: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e50647. [PMID: 38451601 PMCID: PMC10958337 DOI: 10.2196/50647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Decompressive craniectomy (DC) is a widely used procedure to alleviate high intracranial pressure. Multidisciplinary teams have designed and implemented external medical prototypes to improve patient life quality and avoid complications following DC in patients awaiting cranioplasty (CP), including 3D printing and plaster prototypes when available. OBJECTIVE This scoping review aims to understand the extent and type of evidence about innovative external prototypes for patients who undergo DC while awaiting CP. METHODS This scoping review will use the Joanna Briggs Institute methodology for scoping reviews. This scoping review will include noninvasive medical devices for adult patients who undergo DC while waiting for CP. The search strategy will be implemented in MEDLINE, Embase, Web of Science, Scielo, Scopus, and the World Health Organization (WHO) Global Health Index Medicus. Patent documents were also allocated in Espacenet, Google Patents, and the World Intellectual Property Organization (WIPO) database. RESULTS This scoping review is not subject to ethical approval as there will be no involvement of patients. The dissemination plan includes publishing the review findings in a peer-reviewed journal and presenting results at conferences that engage the most pertinent stakeholders in innovation and neurosurgery. CONCLUSIONS This scoping review will serve as a baseline to provide evidence for multidisciplinary teams currently designing these noninvasive innovations to reduce the risk of associated complications after DC, hoping that more cost-effective models can be implemented, especially in low- and middle-income countries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50647.
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Affiliation(s)
- Laura L Fernandez
- Clinical & Translational Science Institute and Center for Global Surgery, University of Utah, Salt Lake City, UT, United States
| | - Dylan Griswold
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Isla Khun
- University of Cambridge, Cambridge, United Kingdom
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Zhang X, Wang C, Pan L, Li Y. Effects of evidence-based nursing care interventions on wound pain and wound complications following surgery for finger tendon injury. Int Wound J 2024; 21:e14818. [PMID: 38444052 PMCID: PMC10915127 DOI: 10.1111/iwj.14818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024] Open
Abstract
We conducted this study aimed to examine the impact of evidence-based nursing interventions on postoperative wound pain and complications after surgery for finger tendon injury. A total of 86 patients treated for finger tendon injuries at our hospital from January 2021 to October 2023 were selected and randomly divided into an experimental group and a control group. The control group received conventional nursing care, while the experimental group received evidence-based nursing interventions. The study compared the postoperative wound pain intensity, incidence of complications and patient satisfaction with nursing care between the two groups. The analysis revealed that compared with conventional care, evidence-based nursing interventions significantly reduced the level of wound pain (p = 0.034) and the incidence of complications (4.65% vs. 18.60%, p = 0.043). It also increased patient satisfaction with the nursing care (97.67% vs. 83.72%, p = 0.026). The study indicates that the application of evidence-based nursing interventions for patients with finger tendon injuries can reduce postoperative wound pain, decrease the incidence of complications and enhance patient satisfaction with nursing care.
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Affiliation(s)
- Xin‐Lan Zhang
- Department of Orthopedic Microsurgery Hand and Foot Repair and Reconstruction WardThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Chun‐Yan Wang
- Department of Orthopedic Microsurgery Hand and Foot Repair and Reconstruction WardThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Liu‐Liu Pan
- Department of Orthopedic Microsurgery Hand and Foot Repair and Reconstruction WardThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Yu‐Jie Li
- Department of Orthopedic Microsurgery Hand and Foot Repair and Reconstruction WardThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
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Wilson SE, Ashcraft S. Stroke: Hospital Nursing Management Within the First 24 Hours. Nurs Clin North Am 2023; 58:309-324. [PMID: 37536783 DOI: 10.1016/j.cnur.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Within the United States, someone will have a stroke approximately every 40 seconds. Eighty-five percent of strokes are ischemic, with 15% classified as either intracranial or subarachnoid hemorrhage. Stroke care is complex, and nurses play a critical role in identification, assessment, management, and coordination throughout the stroke continuum of care. This article will explore the nursing care of the patient with ischemic and hemorrhagic stroke during the first 24 hours.
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Affiliation(s)
- Susan E Wilson
- Department of Neurology, University of North Carolina at Chapel Hill, CB# 7025, 170 Manning Drive, Chapel Hill, NC 27599-7025, USA.
| | - Susan Ashcraft
- Neurocritical Care Clinical Nurse Specialist, Novant Health, Inc., 1918 Randolph Road Suite LL175A, Charlotte, NC 28207, USA
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Ulmeanu ME, Mateș IM, Doicin CV, Mitrică M, Chirteș VA, Ciobotaru G, Semenescu A. Bespoke Implants for Cranial Reconstructions: Preoperative to Postoperative Surgery Management System. Bioengineering (Basel) 2023; 10:bioengineering10050544. [PMID: 37237614 DOI: 10.3390/bioengineering10050544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury is a leading cause of death and disability worldwide, with nearly 90% of the deaths coming from low- and middle-income countries. Severe cases of brain injury often require a craniectomy, succeeded by cranioplasty surgery to restore the integrity of the skull for both cerebral protection and cosmetic purposes. The current paper proposes a study on developing and implementing an integrative surgery management system for cranial reconstructions using bespoke implants as an accessible and cost-effective solution. Bespoke cranial implants were designed for three patients and subsequent cranioplasties were performed. Overall dimensional accuracy was evaluated on all three axes and surface roughness was measured with a minimum value of 2.209 μm for Ra on the convex and concave surfaces of the 3D-printed prototype implants. Improvements in patient compliance and quality of life were reported in postoperative evaluations of all patients involved in the study. No complications were registered from both short-term and long-term monitoring. Material and processing costs were lower compared to a metal 3D-printed implants through the usage of readily available tools and materials, such as standardized and regulated bone cement materials, for the manufacturing of the final bespoke cranial implants. Intraoperative times were reduced through the pre-planning management stages, leading to a better implant fit and overall patient satisfaction.
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Affiliation(s)
- Mihaela-Elena Ulmeanu
- Faculty of Industrial Engineering and Robotics, University POLITEHNICA of Bucharest, 060042 Bucharest, Romania
| | - Ileana Mariana Mateș
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Cristian-Vasile Doicin
- Faculty of Industrial Engineering and Robotics, University POLITEHNICA of Bucharest, 060042 Bucharest, Romania
| | - Marian Mitrică
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Vasile Alin Chirteș
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Georgian Ciobotaru
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Augustin Semenescu
- Faculty of Materials Science and Engineering, University POLITEHNICA of Bucharest, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov St., 050044 Bucharest, Romania
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Pandit AS, Singhal P, Khawari S, Luoma AMV, Ajina S, Toma AK. The Need for Head Protection Protocols for Craniectomy Patients during Rest, Transfers and Turning. Front Surg 2022; 9:918886. [PMID: 35686210 PMCID: PMC9172832 DOI: 10.3389/fsurg.2022.918886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
After craniectomy, patients are generally advised to wear a helmet when mobilising to protect the unshielded brain from damage. However, there exists limited guidance regarding head protection for patients at rest and when being transferred or turned. Here, we emphasise the need for such protocols and utilise evidence from several sources to affirm our viewpoint. A literature search was first performed using MEDLINE and EMBASE, looking for published material relating to head protection for patients post-craniectomy during rest, transfer or turning. No articles were identified using a wide-ranging search strategy. Next, we surveyed and interviewed staff and patients from our neurosurgical centre to ascertain how often their craniectomy site was exposed to external pressure and the precautions taken to prevent this. 59% of patients admitted resting in contact with the craniectomy site, in agreement with the observations of 67% of staff. In 63% of these patients, this occurred on a daily basis and for some, was associated with symptoms suggestive of raised intracranial pressure. 44% of staff did not use a method to prevent craniectomy site contact while 65% utilised no additional precautions during transfer or turning. 63% of patients received no information about avoiding craniectomy site contact upon discharge, and almost all surveyed wished for resting head protection if it were available. We argue that pragmatic guidelines are needed and that our results support this perspective. As such, we offer a simple, practical protocol which can be adopted and iteratively improved as further evidence becomes available in this area.
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Affiliation(s)
- Anand S. Pandit
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery (NHNN), London, United Kingdom
- Correspondence: Anand Pandit
| | - Prabhav Singhal
- UCL Medical School, Faculty of Medicine, UCL, London, United Kingdom
| | - Sogha Khawari
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery (NHNN), London, United Kingdom
| | - Astri M. V. Luoma
- Department of Neuroanaesthesia and Neurocritical Care, NHNN, London, United Kingdom
| | - Sara Ajina
- Department of Neuro-rehabilitation, NHNN, London, United Kingdom
| | - Ahmed K. Toma
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery (NHNN), London, United Kingdom
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Chua KSG, Krishnan RR, Yen JM, Plunkett TK, Soh YM, Lim CJ, Chia CM, Looi JC, Ng SG, Rao J. 3D-printed external cranial protection following decompressive craniectomy after brain injury: A pilot feasibility cohort study. PLoS One 2021; 16:e0258296. [PMID: 34710123 PMCID: PMC8553164 DOI: 10.1371/journal.pone.0258296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 09/20/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES 3D-printed (3DP) customized temporary cranial protection solutions following decompressive craniectomy (DC) are currently not widely practiced. A pilot trial of a 3DP customized head protection prototype device (HPPD) on 10 subjects was conducted during the subacute rehabilitation phase. MATERIALS AND METHODS Subjects > 30 days post-DC with stable cranial flaps and healed wounds were enrolled. HPPD were uniquely designed based on individuals' CT scan, where the base conformed to the surface of the individual's skin covering the cranial defect, and the lateral surface three-dimensionally mirrored, the contralateral healthy head. Each HPPD was fabricated using the fused deposition modeling method. These HPPD were then fitted on subjects using a progressive wearing schedule and monitored over 1, 2, 4, 6 and 8 follow-up (FU) weeks. Outcomes during FU included; reported wearing time/day (hours), subjective pain, discomfort, pruritus, dislodgment, cosmesis ratings; and observed wound changes. The primary outcome was safety and tolerability without pain or wound changes within 30 minutes of HPPD fitting. RESULTS In all, 10 enrolled subjects received 12 HPPDs [5/10 male, mean (SD) age 46 (14) years, mean (SD) duration post-DC 110 days (76)] and all subjects tolerated 30 minutes of initial HPPD fitting without wound changes. The mean (SD) HPPD mass was 61.2 g (SD 19.88). During 8 weeks of FU, no HPPD-related skin dehiscence was observed, while 20% (2/10) had transient skin imprints, and 80% (8/10) reported self-limiting pressure and pruritis. DISCUSSION Findings from this exploratory study demonstrated preliminary feasibility and safety for a customized 3DP HPPD for temporary post-DC head protection over 8 weeks of follow-up. Monitoring and regular rest breaks during HPPD wear were important to prevent skin complications. CONCLUSION This study suggests the potential for wider 3DP technology applications to provide cranial protection for this vulnerable population.
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Affiliation(s)
- Karen Sui Geok Chua
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
- * E-mail:
| | - Rathi Ratha Krishnan
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jia Min Yen
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tegan Kate Plunkett
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yan Ming Soh
- Tan Tock Seng Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chien Joo Lim
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Suan Gek Ng
- Department of Neurosurgery, National Neuroscience Institute, TTSH Campus, Singapore, Singapore
| | - Jai Rao
- Department of Neurosurgery, National Neuroscience Institute, TTSH Campus, Singapore, Singapore
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Kim Y, Kim SY, Lee K. Association between registered nurse staffing levels and in-hospital mortality in craniotomy patients using Korean National Health Insurance data. BMC Nurs 2020; 19:36. [PMID: 32410879 PMCID: PMC7206788 DOI: 10.1186/s12912-020-00430-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The level of registered nurse (RN) staffing is a fundamental factor influencing patient safety. Craniotomy patients need intensive care after surgery, the majority of which is provided by RNs. METHODS This study was conducted to investigate the relationship of the RN staffing level of general wards and intensive care units (ICUs) with in-hospital mortality after craniotomy using Korean National Health Insurance claim data. The RN staffing level was categorized based on the bed-to-RN ratio. RESULTS The in-hospital mortality rate of craniotomy patients was elevated at hospitals with a high bed-to-RN ratio in general wards, ICUs, and hospitals overall. It was determined that in-hospital mortality of craniotomy patients could be decreased by more than 50% by reducing the bed-to-RN ratio from 4.5 or more to less than 3.5 in general wards, from 1.25 or more to less than 0.88 in ICUs, and from 2.5 or more to less than 1.67 in hospitals overall. CONCLUSIONS Since the RN staffing level is related to the in-hospital mortality rate of craniotomy patients, a sufficient staffing level of RNs should be ensured to reduce the mortality of craniotomy patients.
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Affiliation(s)
- Yunmi Kim
- College of Nursing, Eulji University, 553, Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do Republic of Korea
| | - Se Young Kim
- Department of Nursing, Changwon National University, 20 Changwondaehak-ro, Uichang-gu, Changwon-si, Gyeongsangnam-do Republic of Korea
| | - Kyounga Lee
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
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Abstract
Malignant hemispheric stroke occurs in 10% of ischemic strokes and has one of the highest mortality and morbidity rates. This stroke, also known as malignant middle cerebral artery stroke, may cause ischemia to an entire hemisphere causing edema, herniation, and death. A collaborative interdisciplinary team approach is needed to manage these complex stroke patients. The nurse plays a vital role in bedside management and support of the patient and family through this complex course of care. This article discusses malignant middle cerebral artery stroke pathophysiology, techniques to predict patients at risk for herniation, collaborative care strategies, and nursing care.
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Affiliation(s)
- Mary McKenna Guanci
- Massachusetts General Hospital, Lunder Building 6th Floor ICU, 55 Fruit St, Boston, MA 02114, USA.
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Freeman WD, Smith CC, Brown SM. Letter by Freeman et Al regarding article, "evidence-based nursing review of craniectomy care". Stroke 2014; 46:e48. [PMID: 25550367 DOI: 10.1161/strokeaha.114.007926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William D Freeman
- Departments of Neurology, Neurosurgery, and Critical Care at Mayo Clinic, Jacksonville, FL
| | - Christina C Smith
- Departments of Neurosurgery and Critical Care at Mayo Clinic, Jacksonville, FL
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