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Biomedical subjects

M K Bader

Publications and source records attributed to M K Bader.

12 recordsLinked to original sources
PubMed2001

The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines. Americans Associations for Neurologic Surgeons.

BACKGROUND: Traumatic brain injury poses a serious public health challenge. Treatment paradigms have dramatically shifted with the introduction of the American Association of Neurologic Surgeons (AANS) Guidelines for the Management of Severe Head Injury. Implementation of the AANS guidelines positively affects patient outcomes and can be successfully introduced in a community hospital setting. METHODS: Data were collected both retrospectively and prospectively from the records of all trauma patients between 1994 and 1999. A cohort of 93 patients was selected. Thirty-seven patients were treated before the implementation of the AANS guidelines, and these were statistically compared with 56 patients treated after the implementation of the guidelines. RESULTS: Implementation of the recommendations in the AANS guidelines in a standardized protocol resulted in a 9.13 times higher odds ratio of a good outcome relative to the odds of a poor outcome or death compared with a group managed before the practice change. A Glasgow Coma Scale (GCS) admission score > 8 was associated with a 6.58 times higher odds ratio of a good outcome compared with a GCS admission score < or = 8. Odds ratio of a good outcome decreased by a factor of 0.92 for each year increase in age of patients starting at age 9. A dedicated neurotrauma team and comprehensive treatment algorithms are critical elements to this success. Hospital charges increased by more than $97,000 per patient, but are justifiable in the face of significantly improved outcomes. CONCLUSION: Implementation of a traumatic brain injury protocol in a community hospital setting is practical and efficacious. Appropriate invasive monitoring of systemic and cerebral parameters guides care decisions. The protocol results in an increase in resource usage, but it also results in statistically improved outcomes justifying the increase in expenditures.

Adolescent↗
PubMed2000

Keeping the brain in the zone. Applying the severe head injury guidelines to practice.

Providing care to the TBI patient population with severe injuries requires an integrated multidisciplinary approach. The team in clinical practice must be willing to examine its own practice, seek out the latest information on TBI, and critically analyze the information. Members must be open to changing their own practice when the data presented support change. Interventions based on scientific evidence provide a strong foundation for delivering care. The standardization of these interventions into protocols facilitates team communication and coordination. Measuring outcomes is imperative for evaluating the effectiveness of current treatment algorithms. Changes in treatment practice should be based on the measured outcomes and advances in the scientific literature.

Adult↗
PubMed1998

Case presentations of neuroradiologic interventions for acute cerebrovascular disease.

The treatment options and management of ischemic and hemorrhagic stroke are expanding. Neuroradiologic interventions are being used in acute care settings to change the course of these devastating processes. These interventions include the injection of intra-arterial urokinase for ischemic stroke, use of coils to secure aneurysms, and balloon angioplasty for increasing the lumen of spastic cerebral arteries in patients with cerebral vasospasm. Using a case study approach, these three options for managing stroke patients will be integrated, and nursing strategies for delivering care to the stroke patient will be profiled.

Aged↗
PubMed1997

The complexity of caring for patients with ruptured cerebral aneurysm: case studies.

Ruptured intracerebral aneurysm causes instantaneous neurologic chaos and is associated with high morbidity ad mortality. The event initiates a cascade of physiologic and structural changes that manifest themselves in a variety of clinical symptoms. The critical care team of nurses, physicians, and therapists must rapidly identify the cause; understand the pathology; and use advanced assessment techniques, medications, and interventions to stabilize the patient and to counter the horrendous effects of the injury. Interventions that include endovascular aneurysm coiling and cerebral angioplasty are providing new options for isolating the aneurysm and countering the effects of vasospasm. Through an integrated team approach, recovery from ruptured aneurysm will be maximized.

Adult↗
PubMed1997

Stroke and women.

An important aspect of nursing care is to assist patients in the process of adaptation as proposed by Roy. An individual's response to the diagnosis of stroke and the everchanging environment affords the nurse a tremendous opportunity to assess the patient and factors that may ultimately influence quality of living. Given the devastating consequences of stroke, the efforts directed at improving patient compliance are well placed. Nurses have the opportunity to teach those patients under their direct care as well as those individuals in the community setting. Nurses can also play an instrumental role in health promotion strategies, incorporating lifestyle modifications as well as information based on medication therapy. Taking advantage of professional organizations such as the National Stroke Association, the American Heart Association, and the multiple neuroscience organizations who have developed the Brain Attack Coalition, materials can be accessed and used for acute care and community health education programs. Acute care nurses interact with a variety of women on a daily basis. Each patient presents with her unique physiology and associated risk factors. Acute care nurses must be attuned to these factors and be ready to intervene with assessment, education, and collaboration with the health care team in order to reduce the incidence of stroke in women.

Aged↗
PubMed1993

Case study of two methods for enteral phenytoin administration.

Phenytoin is a medication administered for the treatment or prophylaxis of seizures in head-injured patients. When enterally administered, serum phenytoin levels fall dramatically and are often subtherapeutic. The exact cause for this phenomenon has not been determined. The purpose in this case study was to evaluate the effect of two methods of administering phenytoin suspension in head-injured patients receiving concurrent enteral feedings by measuring subsequent serum phenytoin levels. Purposive sampling was used which included two female participants. For participant 1, data revealed dilution of the suspension and irrigation of the tube produced higher phenytoin levels than administering the suspension undiluted. Both serum phenytoin levels were profoundly subtherapeutic in participant 2. Factors such as simultaneous administration of other enteral medications to the second participant might have interfered with phenytoin absorption.

Administration, Oral↗
PubMedDate not supplied

Ventriculostomy and intracranial pressure monitoring: in search of a 0% infection rate.

External ventriculostomy intracranial pressure (ICP) monitoring provides bedside practitioners with essential information about cranial dynamics as well as a means to maintain the balance within the cranium. Infection has been cited in the literature as the most common complication associated with ICP monitoring. This article reviews the research literature for the risk factors suggested to increase infection, presents data and practice guidelines from one institution where ICP monitors have been maintained infection free for more than 10 years, and summarizes the experiences of another institution where the 6-month infection rate of 55% associated with external ventriculostomy was reduced to 0% in the subsequent 6-month period. The actions taken by the multidisciplinary team to reduce the risk of infection are detailed. Recommendations for minimizing the risk of infection are made by the authors and are based on research studies and experience.

Catheters, Indwelling↗
PubMedDate not supplied

New neurointerventional therapies for stroke patients.

New neurointerventional procedures affect patient outcomes following stroke. Intraarterial thrombolysis, cerebral angioplasty, coils placed inside aneurysms, and vessel occlusion with embolic agents serve as options for stroke patients with conditions not as amenable to traditional surgical or medical management. By understanding these new neurointerventional therapies, critical care nurses can utilize a focused neurological assessment to intervene and maintain perfusion to the brain following the procedures.

Cerebrovascular Disorders↗