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  • Gruen, Russell L.  (13)
  • Rosenfeld, Jeffrey V
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  • 1
    Language: English
    In: Global Spine Journal, December 2013, Vol.3(4), pp.265-271
    Description: Study Design Systematic review. Objective We assessed the current state of spine registries by collecting spine trauma data and assessing their compliance to defined registry standards of being clinical quality. We ascertained if these registries collected spinal cord injury data alone or with spine column trauma data. Methods A systematic review was performed using MEDLINE and Embase databases for articles describing dedicated spinal cord and spine column databases published between January 1990 and April 2011. Correspondence with these registries was performed via e-mail or post. When no correspondence was possible, the registries were analyzed with best information available. Results Three hundred eight full-text articles were reviewed. Of 41 registries identified, 20 registries fulfilled the criteria of being clinical quality. The main reason for failure to attain clinical quality designation was due to the unavailability of patient outcomes. Eight registries collected both spine column and spinal cord injury data with 33 collecting only traumatic spinal cord injury data. Conclusion There is currently a paucity of clinical quality spine trauma registries. Clinical quality registries are important tools for demonstrating trends and outcomes, monitoring care quality, and resolving controversies in the management of spine trauma. An international spine trauma data set (containing both spinal cord and spine column injury data) and standardized approach to recording and analysis are needed to allow international multicenter collaboration and benchmarking.
    Keywords: Clinical Quality ; Registry ; Database ; Spine Trauma ; Benchmarking
    ISSN: 2192-5682
    E-ISSN: 2192-5690
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  • 2
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1088-1098
    Description: Severe traumatic brain injury remains a major health-care problem worldwide. Although major progress has been made in understanding of the pathophysiology of this injury, this has not yet led to substantial improvements in outcome. In this report, we address present knowledge and its limitations, research innovations, and clinical implications. Improved outcomes for patients with severe traumatic brain injury could result from progress in pharmacological and other treatments, neural repair and regeneration, optimisation of surgical indications and techniques, and combination and individually targeted treatments. Expanded classification of traumatic brain injury and innovations in research design will underpin these advances. We are optimistic that further gains in outcome for patients with severe traumatic brain injury will be achieved in the next decade.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 3
    In: Spine, 2011, Vol.36(23), pp.1997-1997
    Keywords: Terminology As Topic ; Cervical Vertebrae -- Pathology ; Physicians -- Standards ; Spinal Fractures -- Classification;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 4
    In: Spine, 2013, Vol.38(2), pp.169-177
    Description: STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To identify early independent mortality predictors after spine trauma. SUMMARY OF BACKGROUND DATA.: Spine trauma consists of spinal cord and spine column injury. The ability to identify early (within 24 hours) risk factors predictive of mortality in spine trauma has the potential to reduce mortality and improve spine trauma management. METHODS.: Analysis was performed on 215 spine column and/or spinal cord injured patients from July 2008 to August 2011. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, mechanism of injury, blood glucose level, vital signs, brain trauma severity, morbidity before trauma, coagulation profile, neurological status, and spine injuries on the risk of in-hospital death. RESULTS.: Applying a multivariate logistic regression model, there were 7 independent early predictive factors for mortality after spine injury. They were (1) Injury Severity Score more than 15 (odds ratio [OR] = 3.67; P = 0.009), (2) abnormal coagulation profile (OR = 6; P 〈 0.0001), (3) patients 65 years or older (OR = 3.49; P = 0.007), (4) hypotension (OR = 2.9; P = 0.033), (5) tachycardia (OR = 4.04; P = 0.005), (6) hypoxia (OR = 2.9; P = 0.033), and (7) multiple comorbidities (OR = 3.49; P = 0.007). Severe traumatic brain injury was also associated with mortality but was excluded from multivariate analysis because there were no patients with this variable in the comparison group. CONCLUSION.: Mortality predictors for spine trauma patients are similar to those for general trauma patients. Spine injury variables were shown not to be independent predictors of spine trauma mortality.
    Keywords: Aged–Epidemiology ; Australia–Diagnosis ; Cause of Death–Mortality ; Comorbidity–Diagnosis ; Early Diagnosis–Mortality ; Female–Mortality ; Humans–Mortality ; Male–Mortality ; Prognosis–Mortality ; Retrospective Studies–Mortality ; Risk Factors–Mortality ; Spinal Cord Injuries–Mortality ; Spinal Injuries–Mortality ; Survival Rate–Mortality ; Time Factors–Mortality ; Trauma Severity Indices–Mortality ; Vital Signs–Mortality;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 5
    Language: English
    In: Clinical Neurology and Neurosurgery, December 2016, Vol.151, pp.145-145
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.clineuro.2016.10.010 Byline: Justin M. Moore (a), Piers A.W. Thomas (a), Russell L. Gruen (b)(c)(d), Patrick Chan (a), Jeffrey V. Rosenfeld (a)(c)(d)(e) Author Affiliation: (a) Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia (b) Trauma Service, The Alfred Hospital, Melbourne, Australia (c) Department of Surgery, Monash University, Melbourne, Australia (d) National Trauma Research Institute, Melbourne, Australia (e) Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of The Health Sciences (USUHS), Bethesda, MD, USA
    Keywords: Medicine
    ISSN: 0303-8467
    E-ISSN: 1872-6968
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  • 6
    Language: English
    In: Clinical Neurology and Neurosurgery, September 2016, Vol.148, pp.13-16
    Description: Head injury commonly presents in association with torso or limb injuries, especially in blunt trauma mechanisms. Stopping life-threatening thoraco-abdominal hemorrhage and preventing secondary brain injury are time critical priorities. Although simultaneous operative management by multiple teams has been common practice in the recent wars in Iraq and Afghanistan, simultaneous surgery is rare in most civilian settings. Nevertheless, situations arise whereby simultaneous craniotomy and chest or abdominal surgery is necessary to prevent mortality or reduce severe morbidity. We discuss two recent cases at our level one trauma centre, the challenges that surgeons and the operating room staff face and propose that with appropriate planning this surgical capability can be integrated into the systems of contemporary advanced trauma units.
    Keywords: Trauma ; Craniotomy ; Laparotomy ; Simultaneous Surgery ; Surgical Risk ; Medicine
    ISSN: 0303-8467
    E-ISSN: 1872-6968
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  • 7
    Language: English
    In: Journal of neurotrauma, 15 August 2016, Vol.33(16), pp.1461-78
    Description: Moderate-to-severe traumatic brain injury (TBI) remains a major global challenge, with rising incidence, unchanging mortality and lifelong impairments. State-of-the-science reviews are important for research planning and clinical decision support. This review aimed to identify randomized controlled trials (RCTs) evaluating interventions for acute management of moderate/severe TBI, synthesize key RCT characteristics and findings, and determine their implications on clinical practice and future research. RCTs were identified through comprehensive database and other searches. Key characteristics, outcomes, risk of bias, and analysis approach were extracted. Data were narratively synthesized, with a focus on robust (multi-center, low risk of bias, n 〉 100) RCTs, and three-dimensional graphical figures also were used to explore relationships between RCT characteristics and findings. A total of 207 RCTs were identified. The 191 completed RCTs enrolled 35,340 participants (median, 66). Most (72%) were single center and enrolled less than 100 participants (69%). There were 26 robust RCTs across 18 different interventions. For 74% of 392 comparisons across all included RCTs, there was no significant difference between groups. Positive findings were broadly distributed with respect to RCT characteristics. Less than one-third of RCTs demonstrated low risk of bias for random sequence generation or allocation concealment, less than one-quarter used covariate adjustment, and only 7% employed an ordinal analysis approach. Considerable investment of resources in producing 191 completed RCTs for acute TBI management has resulted in very little translatable evidence. This may result from broad distribution of research effort, small samples, preponderance of single-center RCTs, and methodological shortcomings. More sophisticated RCT design, large multi-center RCTs in priority areas, increased focus on pre-clinical research, and alternatives to RCTs, such as comparative effectiveness research and precision medicine, are needed to fully realize the potential of acute TBI research to benefit patients.
    Keywords: Clinical Trial ; Review ; Traumatic Brain Injury ; Randomized Controlled Trials As Topic ; Brain Injuries, Traumatic -- Therapy
    ISSN: 08977151
    E-ISSN: 1557-9042
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  • 8
    Language: English
    In: Cochrane Database of Systematic Reviews, 08/18/2014
    ISSN: Cochrane Database of Systematic Reviews
    ISSN: 1469493X
    E-ISSN: 14651858
    E-ISSN: 1469493X
    Source: Wiley (via CrossRef)
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  • 9
    Language: English
    In: Implementation Science, 01 August 2012, Vol.7(1), p.74
    Description: Abstract The Neurotrauma Evidence Translation (NET) program was funded in 2009 to increase the uptake of research evidence in the clinical care of patients who have sustained traumatic brain injury. This paper reports the rationale and plan for this five-year knowledge translation research...
    Keywords: Knowledge Translation Research ; Study Protocol ; Neurotrauma ; Traumatic Brain Injury ; Public Health
    ISSN: 1748-5908
    E-ISSN: 1748-5908
    Source: Directory of Open Access Journals (DOAJ)
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  • 10
    Language: English
    In: Implementation science : IS, 07 August 2012, Vol.7, pp.74
    Description: The Neurotrauma Evidence Translation (NET) program was funded in 2009 to increase the uptake of research evidence in the clinical care of patients who have sustained traumatic brain injury. This paper reports the rationale and plan for this five-year knowledge translation research program. The overarching aims of the program are threefold: to improve outcomes for people with traumatic brain injury; to create a network of neurotrauma clinicians and researchers with expertise in knowledge translation and evidence-based practice; and to contribute knowledge to the field of knowledge translation research. The program comprises a series of interlinked projects spanning varying clinical environments and disciplines relevant to neurotrauma, anchored within four themes representing core knowledge translation activities: reviewing research evidence; understanding practice; developing and testing interventions for practice change; and building capacity for knowledge translation in neurotrauma. The program uses a range of different methods and study designs, including: an evidence fellowship program; conduct of and training in systematic reviews; mixed method study designs to describe and understand factors that influence current practices (e.g., semi-structured interviews and surveys); theory-based methods to develop targeted interventions aiming to change practice; a cluster randomised trial to test the effectiveness of a targeted theory-informed intervention; stakeholder involvement activities; and knowledge translation events such as consensus conferences.
    Keywords: Clinical Protocols ; Brain Injuries -- Therapy ; Translational Medical Research -- Organization & Administration
    E-ISSN: 1748-5908
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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