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PubMed1993

[A method of analysing the reasoning applied in nursing in neuroscience].

It is a preliminary study testing the applicability of a method for knowledge characterization based on graphs theory. 11 (eleven) nurses working in a medical surgical intensive care unit including neurological patients constructed graphs to explain the diagnostic process. The results show that: the knowledge structure is in a developing stage; there is agreement regarding to diagnosis formulation and the data base on which it is founded is diversified and link to a specified form of related causes. The method demonstrated to be feasible and should be reapplied on a larger population.

Adult↗
PubMed2001

A brief review of Dr F Gotoh's contribution to neuroscience: research in the field of cerebral blood flow and stroke.

Professor Emeritus Fumio Gotoh began and continues his remarkable career in medicine at Keio University. Since his graduation from medical school there in 1951, Dr. Gotoh has devoted himself to neurology, especially in the enigmatic field of stroke science. He is most renown for his groundbreaking research and leadership in the study of cerebral blood flow and metabolism. Beginning with his doctoral thesis paper in 1959 entitled "Effects of blood pressure on cerebral circulation," our article briefly delineates how Prof. Gotoh has paved the path for current and future discoveries in modern medicine. Although wholly difficult to sum up Dr. Gotoh's extensive career in such a short article, we have attempted to chronologically list and furthermore to describe his numerous works. Herein we describe his expansion to the international arena with his contributions at Wayne State University as well as his novel cerebral blood gas monitoring techniques now used in modified fashion throughout the world. From his CO2-based investigations in animals to his study of the autonomic nervous system's role in human cerebrovascular control, we remark on Dr. Gotoh's accomplishments without the use of functional imaging. Yet despite the basic science theme of his research, he has always kept them clinically correlated to entities such as Cheyne-Stokes phenomenon and Shy-Drager syndrome. Prof. Gotoh has been asked to head some of the most influential stroke societies and was the second president of the International Stroke Society. In conjunction with leading authorities, he developed a quantifiable, evidence-based stroke scale which was introduced in the International Journal of Stroke in 2001. Today despite his retirement, Dr. Gotoh continues his work in cerebral blood flow and metabolism.

Cerebrovascular Circulation↗
PubMed2006

Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit.

OBJECT: The aim of this study was to evaluate the impact of a newly appointed neurointensivist on outcomes in head-injured patients in the neurological/neurosurgical intensive care unit (NICU). METHODS: The mortality rate, length of stay (LOS), and discharge disposition of all patients with head trauma who had been admitted to a 10-bed tertiary care university hospital NICU were compared between two 19-month periods, before and after the appointment of a neurointensivist. Data regarding these patients were collected using the hospital database and the University HealthSystem Consortium (UHC) database. Samples of medical records were reviewed for Glasgow Coma Scale (GCS) score documentation. The authors analyzed data pertaining to 328 patients before and 264 after the neurointensivist's appointment. The unadjusted mean in-hospital mortality rate increased 1.1% in the after period, but this increase was significantly lower compared with the UHC-based expected increase of 8.1% in the mortality rate during the same period (p < 0.0001). The unadjusted mean mortality rate in the NICU decreased from 13.4 to 12.9% (relative mortality rate reduction 4%) and the mean NICU LOS increased from 3.1 to 3.6 days (relative NICU LOS increase 16%), both nonsignificantly. A 51% reduction in the NICU-associated mortality rate (p = 0.01), a 12% shorter hospital LOS (p = 0.026), and 57% greater odds of being discharged to home or to rehabilitation (p = 0.009) were found in the after period in multivariate models after controlling for baseline differences between the two time periods. Better documentation of the GCS score by the NICU team was also found in the after period (from 60.4 to 82%, p = 0.02). CONCLUSIONS: The institution of a neurointensivist-led team model had an independent, positive impact on patient outcomes, including a lower NICU-associated mortality rate and hospital LOS, improved disposition, and better chart documentation.

Adult↗
PubMed2004

How we use rules to select actions: a review of evidence from cognitive neuroscience.

Much of our behavior is guided by rules, or prescribed guides for action. In this review, I consider the current state of knowledge of how rules are learned, stored in the brain, and retrieved and used as the need arises. The focus is primarily on studies in humans, but the review is informed by relevant studies in nonhuman primates. Ventrolateral prefrontal cortex (VLPFC) has been implicated in rule learning, retrieval from long-term memory, and on-line maintenance during task preparation. Interactions between VLPFC and temporal cortex are required for rule retrieval in nonhuman primates, and brain imaging findings in humans suggest that rule knowledge is stored in the posterior middle temporal gyrus. Dorsolateral PFC appears to be more closely related to rule-based response selection than to rule retrieval. An important task for the future is to explain how PFC, basal ganglia, and temporal, parietal, and motor cortices interact to produce rule-guided behavior.

Cognition↗