PubMed · 3548579
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J E Cutting. 1987. Perception and information.. https://doi.org/10.1146/annurev.ps.38.020187.000425
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BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) and surgical clipping of intracranial aneurysms are associated with substantial morbidity and mortality. OBJECTIVE: To compare cognitive outcome and structural damage in patients with aneurysmal SAH treated with surgical clipping or endovascular coiling. METHODS: Forty case-matched pairs of patients with aneurysmal SAH treated by surgical clipping or endovascular coiling were prospectively assessed by use of a battery of cognitive tests. Twenty-three case-matched pairs underwent MRI 1 year after the procedure. Matching was based on grade of SAH on admission, location of aneurysm, age, and premorbid IQ. RESULTS: Both groups were impaired in all cognitive domains when compared with age-matched healthy control subjects. Comparison of cognitive outcome between the two groups indicated an overall trend toward a poorer cognitive outcome in the surgical group, which achieved significance in four tests. MRI showed focal encephalomalacia exclusively in the surgical group. This group also had a significantly higher incidence of single or multiple small infarcts within the vascular territory of the aneurysm, but both groups had similar incidence of large infarcts and global ischemic damage. CONCLUSION: Endovascular treatment may cause less structural brain damage than surgery and have a more favorable cognitive outcome. However, cognitive outcome appears to be dictated primarily by the complications of SAH.
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BACKGROUND: We previously (1997) demonstrated superior clinical but similar cognitive performance after the new interactive compared to the old ATLS course. The present study is aimed at determining whether this difference was short term or maintained over time (2 years). MATERIALS AND METHODS: Two groups of 13 physicians out of the original 32 physicians were available for the study which compared performance in a 40-item MCQ examination on trauma topics and clinical performance in 4 trauma OSCE stations consisting of simulated trauma patients. Paired and unpaired t tests were used for within- and between-group comparisons, respectively, with P < 0.05 being considered statistically significant. Overall OSCE scores (maximum standard 20), adherence to priority scores (Priority, scale 1 to 7), and overall approach (Approach, scale 1 to 5) scores were analyzed. RESULTS: Values are means +/- SD; (+)-P < 0.05 compared to 1999; *P < 0.05 compared to old group [table in text]. CONCLUSIONS: Although knowledge base decreases similarly with time after both courses, the new interactive course participants maintained a consistently higher clinical skill performance level at 2 years.