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Symptoms of Alzheimer’s Dementia Symptoms vary among people with Alzheimer’s dementia prostate oncology yakima buy 60 caps confido, and the differences between typical age-related cognitive changes and early signs of Alzheimer’s dementia can be subtle (see Table 2 prostate cancer zonal anatomy purchase 60 caps confido fast delivery, page 9) prostate cancer gleason 9 discount confido 60 caps mastercard. Individuals with Alzheimer’s dementia experience multiple symptoms that change over a period of years mens health rs effective 60 caps confido. These symptoms reflect the degree of damage to neurons in different parts of the brain. The pace at which symptoms advance from mild to moderate to severe varies from person to person. In the mild stage, most people are able to function independently in many areas but are likely to require assistance with some activities to maximize independence and remain safe. Autopsy studies show disease that about half of these cases involve solely Alzheimer’s pathology; many of the remaining cases have evidence of additional pathologic changes related to other dementias. This is called mixed pathology, and if recognized during life is called mixed dementia. Difficulty remembering recent conversations, names or events is often an early clinical symptom; apathy and depression are also often early symptoms. Revised guidelines for diagnosing Alzheimer’s were proposed and published in 2011 (see page 15). They recommend that Alzheimer’s be considered a slowly progressive brain disease that begins well before clinical symptoms emerge. The hallmark pathologies of Alzheimer’s are the progressive accumulation of the protein fragment beta-amyloid (plaques) outside neurons in the brain and twisted strands of the protein tau (tangles) inside neurons. Vascular the brain changes of vascular dementia are found in about 40 percent of brains from individuals with dementia. However, it is very common as a mixed pathology in older individuals with Alzheimer’s dementia, about 50 percent of whom have pathologic evidence of infarcts (silent strokes). In addition to changes in cognition, people with vascular dementia can have difficulty with motor function, especially slow gait and poor balance. Vascular dementia occurs most commonly from blood vessel blockage or damage leading to infarcts (strokes) or bleeding in the brain. In the past, evidence of vascular dementia was used to exclude a diagnosis of Alzheimer’s (and vice versa). That practice is no longer considered consistent with the pathologic evidence, which shows that the brain changes of Alzheimer’s and vascular dementia commonly coexist. When there is clinical evidence of two or more causes of dementia, the individual is considered to have mixed dementia. These features, as well as early visuospatial impairment, may occur in the absence of significant memory impairment. Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein in neurons. When evidence of more than one dementia is recognized during life, the individual is said to have mixed dementia. Nerve cells in the front (frontal lobe) and side regions (temporal lobes) of the brain are especially affected, and these regions become markedly atrophied (shrunken). Creutzfeldt this very rare and rapidly fatal disorder impairs memory and coordination and causes behavior changes. Jakob disease Results from a misfolded protein (prion) that causes other proteins throughout the brain to misfold and malfunction. May be hereditary (caused by a gene that runs in one’s family), sporadic (unknown cause) or caused by a known prion infection. A specific form called variant Creutzfeldt-Jakob disease is believed to be caused by consumption of products from cattle affected by mad cow disease. Normal pressure Symptoms include difficulty walking, memory loss and inability to control urination. Caused by impaired reabsorption of cerebrospinal fluid and the consequent buildup of fluid in the brain, increasing pressure in the brain. People with a history of brain hemorrhage (particularly subarachnoid hemorrhage) and meningitis are at increased risk. Can sometimes be corrected with surgical installation of a shunt in the brain to drain excess fluid. Overview 7 stage, which for some is the longest, individuals may Brain Changes Associated with Alzheimer’s Disease have difficulty performing routine tasks, become A healthy adult brain has about 100 billion neurons, confused about where they are and begin wandering, each with long, branching extensions. These extensions and start having personality and behavioral changes, enable individual neurons to form connections with including suspiciousness and agitation. At such connections, called synapses, stage, individuals require help with basic activities of daily information flows in tiny bursts of chemicals that are living, such as bathing, dressing and using the bathroom. They allow signals to travel rapidly through the brain’s It is in the severe stage of the disease that the effects neuronal circuits, creating the cellular basis of memories, of Alzheimer’s on an individual’s physical health become thoughts, sensations, emotions, movements and skills. Because of damage to areas of the brain involved in movement, individuals become the accumulation of the protein fragment beta-amyloid bed-bound. Being bed-bound makes them vulnerable (called beta-amyloid plaques) outside neurons and the to conditions including blood clots, skin infections and accumulation of an abnormal form of the protein tau sepsis, in which infection-fighting chemicals in the (called tau tangles) inside neurons are two of several bloodstream trigger body-wide inflammation that can brain changes associated with Alzheimer’s. Damage to areas of the brain that plaques are believed to contribute to cell death by control swallowing makes it difficult to eat and drink. Food particles may be deposited in the lungs and cause As the amount of beta-amyloid increases, a tipping point lung infection. This type of infection is called aspiration is reached at which abnormal tau spreads throughout pneumonia, and it is a contributing cause of death among the brain. The presence of toxic beta-amyloid and tau proteins Diagnosis of Alzheimer’s Dementia activates immune system cells in the brain called There is no single test for Alzheimer’s dementia. Microglia try to clear the toxic proteins as well Instead, physicians (often with the help of specialists as widespread debris from dead and dying cells. Chronic such as neurologists and geriatricians) use a variety of inflammation is believed to set in when the microglia can’t approaches and tools to help make a diagnosis. Atrophy, or include the following: shrinkage, of the brain occurs because of cell loss. Normal • Obtaining a medical and family history from the brain function is further compromised by the decreased individual, including psychiatric history and history ability of the brain to metabolize glucose, its main fuel. Research suggests that the brain changes associated with • Asking a family member to provide input about Alzheimer’s may begin 20 or more years before symptoms changes in thinking skills and behavior. When the initial changes occur, the brain • Conducting cognitive tests and physical and compensates for them, enabling individuals to continue neurologic examinations. As neuronal damage increases, the • Having the individual undergo blood tests and brain brain can no longer compensate for the changes and imaging to rule out other potential causes of dementia individuals show subtle cognitive decline. While research settings have the tools and expertise to Diagnosing Alzheimer’s dementia requires a careful and identify some of the early brain changes of Alzheimer’s, comprehensive medical evaluation. Although physicians additional research is needed to fine-tune the tools’ can almost always determine if a person has dementia, it accuracy before they become available for clinical use. Several days In addition, treatments to prevent, slow or stop these or weeks may be needed for an individual to complete the changes are not yet available, although many are being required tests and examinations and for the physician to tested in clinical trials. They may have trouble following a familiar recipe, keeping track balancing a checkbook. Difficulty completing familiar tasks at home, at work or at leisure: People with Alzheimer’s often find Occasionally needing help to use it hard to complete daily tasks. Trouble understanding visual images and spatial relationships: For some people, having vision problems Vision changes related to cataracts, is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or glaucoma or age-related macular contrast, which may cause problems with driving. New problems with words in speaking or writing: People with Alzheimer’s may have trouble following or Sometimes having trouble finding joining a conversation. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name. Misplacing things and losing the ability to retrace steps: People with Alzheimer’s may put things in Misplacing things from time to time unusual places, and lose things and be unable to go back over their steps to find them again. Withdrawal from work or social activities: People with Alzheimer’s may start to remove themselves from Sometimes feeling weary of work, hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports family and social obligations. Developing very specific ways of They can become confused, suspicious, depressed, fearful or anxious. A genetic mutation to the person affected and to family members and friends, is an abnormal change in the sequence of chemical but the individual is still able to carry out everyday activities.

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It is important to prostate 3d buy cheap confido 60 caps help the person find enjoyable activities to prostate yellow sperm buy confido 60 caps free shipping do and tasks that he can successfully perform prostate zinc supplement cheap 60caps confido with amex. Sometimes it is necessary for a doctor to mens health 40 year old cheap 60caps confido with visa prescribe medicine to help brighten the mood of the person with brain injury. He may have only short periods of sleep, or he may sleep a great amount of the time and have problems staying awake. It is very important to establish a normal pattern of sleep for the person who is recovering from brain injury. Lack of sleep will make it even more difficult for him to think clearly and perform tasks. The person should be kept as physically and mentally active as pos sible during the day, so that when evening comes he is tired and ready to sleep properly. Sometimes soft music or the sound of a familiar voice will help the person fall asleep. It may be necessary for a doctor to prescribe medi cine for the person who has great difficulty falling asleep or sleeping through the night. This will depend on how severe the injury was and what parts of the brain were most injured. But a person with a very severe injury can sometimes continue to improve for many years. Even though people with brain injury can improve their abilities, the injury should be thought of as a permanent injury. At this time, there are no medicines or treatments that can replace dead cells with new ones. Therefore, the injured person’s brain cannot return exactly to the way that it was before the injury happened. Changes in vision, touch, hearing, taste and smell • He complains of seeing double or sees only on one side. Rehabilitation For Persons With Traumatic Brain Injury • 21 • He has difficulty understanding the words of others. Other body changes include: • She is always tired – even with only a little activity. Changes in memory and learning • She forgets recent events such as conversations, visitors or activities. She may need to practice many, 22 • Rehabilitation For Persons With Traumatic Brain Injury many times in order to learn it. Changes in thinking and reasoning • He thinks slowly or his thoughts change quickly from one topic to another. Changes in judgment • She does not recognize that a situation or action is unsafe. Rehabilitation For Persons With Traumatic Brain Injury • 23 • He often seems depressed, or he has quick changes of mood or emotions. Lack of awareness of the disability • She has no sense that she has any problems with thinking or movement. She should practice frequently for short periods of time, rather than spending long periods of time doing the same task over and over. Try to keep activities simple and quiet at home if she is upset by noise or by many activities occurring at the same time. Instead, ask questions with two choices, such as: Do you want to help me at the market, or do you want to help your sister with the laundry If this happens, sit with her and give step-by step instructions for the correct completion of the task. If demonstration does not work, place your hand gently over her hand and move it in the manner needed to com plete the task. If the person forgets important information: • Repeat the information as many times as necessary. If the family uses calendars and clocks, point them out to her as you repeat information that includes dates and times. It is important to understand that brain injury may cause the person to have difficulty controlling his feelings and behavior. Rehabilitation For Persons With Traumatic Brain Injury • 25 If the person frequently becomes angry: • Watch to see what situations seem to lead to anger. For example, he may become frustrated when he is unable to understand or to do something that was simple before the brain injury. You may also choose to avoid an activity that often leads to anger or frustration. Do not touch the person until he has calmed, unless you must touch him to prevent him from doing something unsafe. Sexuality includes the sense of being male or female and the expectations that come from social and cultural training. Sexuality includes the ability to feel love and to develop and maintain loving relationships. Brain injury can result in a wide variety of biological, physical and cognitive changes. These changes can have many consequences for the person’s sexuality and personal relation ships. Brain injury may impair the function of brain structures that direct sexual urges. It may change the body’s production of hormones and this can affect sexual desire. Lack of sexual interest is a common problem for a person who has had a brain injury. However, some persons with brain injury may also have decreased ability to control sexual urges, and this can result in problem behaviors. The person with deformed arms or legs may believe she is no longer attractive or desirable to her partner. A person may experience pain from touch, or parts of her body may not feel the touch of a partner. Bowel or bladder control problems after a brain injury and can also affect intimacy and sexual opportunity. Language and communications skills are an important part of sexuality and sexual relations. The person with brain injury and her partner may have to learn new ways to communicate intimate feelings, just as they must learn new ways of communicating about household tasks or self-care needs. Cognitive and behavioral changes from brain injury have the most negative effects on sexuality and personal relationships. Cognitive chang es are sometimes described as personality changes because the person seems so different from before the brain injury. She may not be able to express her emotions or control her emotions as well as before the injury. She may behave inappropriately in public in a way that is embarrassing to her partner. Irritability, memory loss or angry behavior may disrupt home life and weaken even a very strong, loving relationship. For some couples, intimacy may be re-established as the person improves in cognitive and physical skills. Medication or other forms of medical treatment are helpful in some situations, especially to help reduce pain, improve movement, treat problems with erection and control hormone imbalance. It is also important to remember that many loving partners do not have sexual intercourse but find much pleasure and value in simple physical closeness. If counseling is available, a counselor may be able to assist the person and her partner to learn new ways to cope and adjust to the changes that are the result of her brain injury. A counselor may also be able to assist the person and her partner to find solutions to problems with sexual functioning or alternative ways of giving pleasure to each other. A loving partner’s support and understanding can assist a person to continue to have a positive sexual self-image and satisfactory sexual activity in spite of the many losses that result from brain injury. Rehabilitation For Persons With Traumatic Brain Injury • 27 Support and understanding from friends, family and the community is also essential to help the injured person and her partner find a way to continue the relationship, in a way that is as comfortable, personally acceptable and physically satisfactory as possible for both. Family members must have accurate information about medical problems and medical needs.

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Size and burden of mental disorder in Europe: a 21 critical review and appraisal of 27 studies prostate medication confido 60 caps free shipping. Prevalence of obsessive-compulsive disorder in the British nationwide highly responsive to mens health getting abs pdf confido 60 caps cheap psychological treatments that survey of child mental health androgen hormone definition discount confido 60caps amex. Obsessive Altered functioning of specific brain regions (basal compulsive disorder: comorbid conditions prostate cancer xenograft mouse model buy 60caps confido with mastercard. Evidence for this includes high rates of disorder:core interventions in the treatment of obsessive-compulsive disorder and obsessive-compulsive disorder in diseases that affect body dysmorphic disorder. The Yale-Brown obsessive compulsive scale: development, (paediatric autoimmune neuropsychiatric disorders use and reliability. Children’s Yale-Brown obsessive compulsive scale: reliability been recently described and is thought to be secondary and validity. Cognitive-behavioral family to streptococcal infection and mediated by autoanti treatment of childhood obsessive-compulsive disorder:a controlled trial. Continuous exposure and complete response pre research into subtypes, such as compulsive hoarding, vention in the treatment of obsessive-compulsive neurosis. Understanding and treating obsessive-compulsive obsessive-compulsive disorder may exist. A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder [see comment]. Paroxetine versus clomipramine in the treatment of 26 obsessive compulsive disorder. Efficacy of of these disorders are causally related to obsessive sertraline in the long term treatment of obsessive-compulsive disorder. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents be similar to the disorder. Asystematicreview:antipsychoticaugmentationwithtreatment checking in the mirror, can also be difficult to refractory obsessive-compulsive disorder. Distinctneuralcorrelatesofwashing,checkingandhoarding Trichotillomania symptom dimensions in obsessive-compulsive disorder. Obsessions Often confused for one another Obsessions are intrusive, unwanted thoughts that evoke anxiety or distress Mental compulsions are deliberate mental acts designed to neutralize or reduce anxiety or distress Functional Relationship Between Obsessions and Compulsions Q: Most of the time are your compulsions: 44% intended to prevent harm. Responses to Obsessions: A “Functional Class” of Behaviors • Patients often present with no overt rituals such as washing and checking • However, covert rituals and other “neutralizing behaviors” are usually present – Avoidance of obsessional cues – Thought suppression – Mental compulsions. Assessing Obsessions (2) • Feared consequences – What is the worst thing that would happen if you confronted this situation Overestimates of threat Over-importance of Intrusive Thoughts • Having the thought means it’s important and it’s important because I think about it • Having the thought makes the outcome more likely • Having the thought and engaging in the action are morally equivalent “Because I have this Thought, it must be Important” • Circular reasoning thinking a thought is important dwelling on it verifies the importance further dwelling of the thought Challenging Beliefs about the Importance of Thoughts • Psychoeducation – Normalize the experience of intrusive senseless thoughts (sexual, sacrilegious, violent/aggressive) – Provide examples of your own – People develop obsessions about subjects that bother them the most because of an ambivalent sense of self • They fight intrusive thoughts that they worry might be indicative of something awful about themselves (sex, religion, violence) Challenging Beliefs about the Importance of Thoughts • Socratic questioning (exploration/clarification) – How many thoughts do you have each day Challenging Beliefs about the Importance of Thoughts • Continuum technique – Evaluate the belief that thinking about something bad is as serious as actually doing something bad. Tell me what happens Challenging the Need for Thought Control • Psychoeducation – Thought suppression effect – Discuss how this is relevant to the patient’s obsessions – Discuss how need to control thoughts leads to anxiety and neutralizing responses Challenging the Need for Thought Control • Set up an experiment in which the patient alternates each day between suppression and acceptance of intrusive thoughts • have patients make predictions ahead of time Concealment of Obsessions • Form of avoidance that serves to reinforce maladaptive appraisals of intrusive thoughts – Decreased opportunity to receive corrective information about the normalcy of intrusions • Homework assignment to reveal thoughts to others – Note others’ responses • Horror and shock Overestimates of Responsibility • Pie technique – Helps the patient to recognize • the various factors that could be responsible • A more realistic sense of his/her own responsibility Obsession: “My medicine will accidentally drop on the floor of a public place and a child will pick up the pills, take them, and die. The Treatment of Fear • Exposure to fear 100 90 eliciting stimuli or 80 situations 70 60 • Prevention of 50 avoidant behaviors 40 30 20 • Anxiety increases 10 initially, followed by 0 habituation Time Effects of Repeated and Prolonged Exposure 90 80 70 60 Session 1 50 Session 2 40 Session 3 30 Session 4 20 10 0 10 20 30 40 50 60 Time (mins) Types of exposure • Situational (in vivo) – Actual confrontation with situations and stimuli that provoke obsessions (examples) • Sit next to a relative who provokes incest obsessions • Attend a religious service (blasphemous thoughts) • Bathe the baby (thoughts of violence) • Imagininal exposure – Confrontation with the distressing thoughts, ideas, images, impulses themselves • Think about incest • Think blasphemous thoughts or curse words • Think of drowning the baby Why use Imaginal Exposure Collaboratively create a script that evokes or exaggerates the most feared outcome 3. Record the script (audiotape, computer file) – the script could be recorded by the patient (using the first person, “I”) or by the therapist (using the second person, “You”) – the story is told in the present tense Using Imaginal Exposure: Basic Steps (2) 4. Patient listens to the tape repeatedly (eyes closed, no distractions) for at least 45 min in session and for daily homework – Record anxiety ratings during each listening period – Record how beliefs about the scenario change between sessions Imaginal Exposure: Some Tips • Describe the scene with appropriate emotion • Incorporate details that will increase vividness. As you’re waiting for the light to turn so you can cross, the thought of pushing Emily’s stroller into traffic comes to mind. Then, all of a sudden, you can’t stop yourself You push the stroller into the busy street and hear breaks screeching. You imagine what your husband will say when he learns that you’ve killed the baby” Example of Imaginal Exposure (“hit and run” driving obsession) “I was driving through campus and lots of students were crossing the street. They all think they are invincible, so they dart out into traffic thinking the cars will just stop for them. One woman darted out in front of me and then stopped and started back to her side of the street. I hit my breaks but I have doubts about whether I might have hit her she was very close to my car. I was listening to the radio so I might not have been paying enough attention to the road. There were lots of other people there, so they might have taken down my license plates. Kennedy: Department of Psychiatry, (the major metabolite of serotonin) (19–22), whole blood University of Toronto, Toronto, Canada. As already reported, functional neuroimaging studies latency for the antidepressant response induced by the same have demonstrated dysfunction in the orbitofrontal cortex, compounds) and the high doses required (54). Moreover, D8/17 levels have of neurotic or borderline psychotic disorders at any time been found to follow a segregation pattern most consistent before 1977. After ascertainment each twin was interviewed with autosomal recessive inheritance in rheumatic fever using a structured psychiatric interview that recorded life families (89,90). Thus, the author examined interact with the autoimmune mechanisms, making a sub concordances in the larger context of an ‘‘anxiety spectrum. Two important aspects of these studies critically limit There has been considerable controversy regarding the in their usefulness. This is surprising since the familial na ized diagnostic criteria across studies. The investi gators doing the evaluations of the co-twin, knew the diag nosis of the index case. Furthermore, when those twins Two studies were completed that used twins ascertained where zygosity was in doubt were eliminated from the sam through twin registries. Clifford (95) and Clifford and concordance rates are similar to those reported for affective associates (96) analyzed data collected from 419 pairs of and anxiety disorders. In a separate study using twins from phobic neurosis at local hospitals during a 32-year interval the Australian Twin Registry, Andrews and associates (97) (1948 to 1979). Ascertainment was not based on tals’ notes on the index cases and family members were also psychiatric caseness. Altogether, 249 relatives (nearly 60%) were the diagnoses were combined into a single category of ‘‘neu directly interviewed. Furthermore, the two most recent of psychiatric disorders, direct interviews, family history studies (94,97) suggest that some of the same genetic factors data, and medical record data are used to make ‘‘best esti may be important for the manifestation of some other anxi mate’’ diagnoses (104). When Many of the studies completed prior to 1990 are difficult those family history data are included, the recurrence risk to interpret because of differences in diagnostic criteria and among first-degree relatives is 9. Some of the Using this estimate for the risk to relatives, the ranges shortcomings of this early research were addressed in six between 1. A shortcoming of these three studies is that none Finally, in the most recent and methodologically sound included a control sample. Using this estimate of prevalence, the relative available first-degree relatives and obtained family history risk (the ratio of illness among relatives to the population data for all first-degree relatives. Best estimate procedures prevalence) (103) for these two studies ranged between 4. There was no relationship between reliable and valid, it has also become clear over the last risk to relatives and proband factor scores for the other fac decade that there is considerable variability of symptomatol tors. Given that incorporated these factors scores suggested that there this variability, a number of investigators have begun re were different patterns of transmission within families that search to explore the possibility that subtypes/components were related to the factor scores of the probands. However, there is still considerable familial heter familial patterns, it is likely that several genes contribute to ogeneity within this group because a substantial proportion the manifestation of the disorder. Separately examining these components of the phenotype rather than subtypes of pa component parts of the phenotypic spectrum with regard tients is factor analysis. One factor was best characterized by aggressive, sexual, religious, and somatic Segregation Analyses obsessions and related checking behavior (in the most recent set of analyses, this factor appeared to split into two separate Together, the family and twin study data provide compel factors). Furthermore, segregation analyses reveal that the sions, and ordering/arranging compulsions.

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Recommendation 17 Early extracranial surgery in head injury patients can be performed safely under general anaesthesia androgen hormone replacement discount 60caps confido overnight delivery. Extubation of these patients demands consideration of airway patency androgen hormone yoga cheap confido 60caps online, respiratory parameters man health 91605 order 60 caps confido with visa, neurological status and associated injury man health 180 buy discount confido 60caps on-line. Points to be considered include timing and place of extubation, and post-extubation care. In view of limited evidence, the following points are to be considered prior to extubation. It Stormo A et changes the treatment at the referring hospital on the advice of the neurosurgeon (42%). Recommendation 18 Teleconsultation should be used in the management of head injury if available. This will help them to identify alarming features that need immediate medical Kerr J et al. I the discharge form should include facilities contact details in the event of emergency or Fung M et al. Therefore a discharge form should be standardised and comprehensible at all levels. Recommendation 20 Moderate to severe head injury should have scheduled clinic follow-up. Medical outcome after immediate computed tomography or admission for observation in patients with mild head injury: randomised controlled trial. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence based guidelines. The value of scheduled repeat cranial computed tomography after mild head injury: single-center series and meta-analysis. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Prehospital hypertension is predictive of traumatic brain injury and is associated with higher mortality. The relationship between pre-hospital and emergency department Glasgow coma scale scores. Treatments for reversing warfarin anticoagulation in patients with acute intracranial hemorrhage: a structured literature review. Incidence and predictors of intracranial hemorrhage after minor head trauma in patients taking anticoagulant and antiplatelet medication. Guidelines for the management of 30 spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Chan Chi Ho Clinical predictors of minor head injury patients presenting with Glasgow Coma Scale score of 14 or 15 and requiring neurosurgical intervention Hong Kong j. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Restarting anticoagulation therapy after warfarin-associated intracerebral hemorrhage. Clinical Features of Head Injury Patients Presenting With a Glasgow Coma Scale Score of 15 and Who Require Neurosurgical Intervention. Canadian Cervical Spine rule compared with computed tomography: a prospective analysis. Observational approach to subjects with mild-to moderate head injury and initial non-neurosurgical lesions. Prospective validation of a proposal for diagnosis and management of patients attending the emergency department for mild head injury. Which type of observation for patients with high risk mild head injury and negative computed tomography Risk factors for cervical spine injury among patients with traumatic brain injury. A proposal for an evidenced-based emergency department discharge form for mild traumatic brain injury. Prophylaxis of the epilepsies: should anti-epileptic drugs be used for preventing seizures after acute brain injury Comparison of the safety and efficacy of propofol with midazolam for sedation of patients with severe traumatic brain injury: a meta-analysis. The implementation of teleneurosurgery in the management of referrals to a neurosurgical department in hospital sultanah amninah johor bahru. Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk. Health Indicators 2014: Indicators for Monitoring and Evaluation of Strategy Health for All. Recall of discharge advice given to patients with minor head injury presenting to a Singapore emergency department. Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. Factors predicting mortality in victims of blunt trauma brain injury in emergency department settings. A prospective multicenter comparison of levetiracetam versus phenytoin for early posttraumatic seizure prophylaxis. The significance of platelet count in traumatic brain injury patients on antiplatelet therapy. A survey of information given to head-injured patients on direct discharge from emergency departments in Scotland. Diabetic patients with traumatic brain injury: insulin deficiency is associated with increased mortality. Emergency department discharge of patients with a negative cranial computed tomography scan after minimal head injury. Barbiturates use and its effects in patients with severe traumatic brain injury in five European countries. Predictive Factors for Undertriage Among Severe Blunt Trauma Patients: What Enables Them to Slip Through an Established Trauma Triage Protocol Progression of traumatic intracerebral hemorrhage: a prospective observational study. Fixation of femoral fractures in multiple-injury patients with combined chest and head injuries. Risk of Traumatic Intracranial Hemorrhage In Patients With Head Injury and Preinjury Warfarin or Clopidogrel Use. A clinical decision rule to predict adult patients with traumatic intracranial haemorrhage who do not require intensive care unit admission. Utility of platelet transfusion in adult patients with traumatic intracranial hemorrhage and preinjury antiplatelet use: a systematic review. A Review of Traumatic Brain Injury Trauma Center Visits Meeting Physiologic Criteria from the American College of Surgeons Committee on Trauma/Centers for Disease Control and Prevention Field Triage Guidelines. The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury. Brain Injury Special Interest Group of the American Academy of Physical Medicine and Rehabilitation. Factors correlating with delayed trauma center admission following traumatic brain injury. Value of repeat head computed tomography after traumatic brain injury: systematic review and meta-analysis. Key Performance Indicator Medical Programme 2012, Medical Development Division, Ministry of Health Malaysia. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. Do we really need 24-h observation for patients with minimal brain injury and small intracranial bleeding Comparison of the effectiveness of trauma services provided by secondary and tertiary hospitals in Malaysia. Secondary Intracranial Hemorrhage After Mild Head Injury in Patients With Low-Dose Acetylsalicylate Acid Prophylaxis. Computed tomography and the exclusion of upper cervical spine injury in trauma patients with altered mental state. Using the Abbreviated Injury Severity and Glasgow Coma Scale Scores to Predict 2-Week Mortality After Traumatic Brain Injury. Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study.

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