CCL

Összesen 5 találat.
#/oldal:
Részletezés:
Rendezés:

1.

001-es BibID:BIBFORM107337
035-os BibID:(cikkazonosító)228 (scopus)85135370588 (wos)000831208500002
Első szerző:Åkerlund, Cecilia
Cím:Clustering identifies endotypes of traumatic brain injury in an intensive care cohort : a CENTER-TBI study / Ảkerlund Cecilia A. I., Holst Anders, Stocchetti Nino, Steyerberg Ewout W., Menon David K., Ercole Ari, Nelson David W., CENTER-TBI Participants and Investigators
Dátum:2022
ISSN:1364-8535
Megjegyzések:Abstract Background: While the Glasgow coma scale (GCS) is one of the strongest outcome predictors, the current classifcation of traumatic brain injury (TBI) as ♭mild', ♭moderate' or ♭severe' based on this fails to capture enormous heterogeneity in pathophysiology and treatment response. We hypothesized that data-driven characterization of TBI could identify distinct endotypes and give mechanistic insights. Methods: We developed an unsupervised statistical clustering model based on a mixture of probabilistic graphs for presentation (<24 h) demographic, clinical, physiological, laboratory and imaging data to identify subgroups of TBI patients admitted to the intensive care unit in the CENTER-TBI dataset (N=1,728). A cluster similarity index was used for robust determination of optimal cluster number. Mutual information was used to quantify feature importance and for cluster interpretation. Results: Six stable endotypes were identifed with distinct GCS and composite systemic metabolic stress profles, distinguished by GCS, blood lactate, oxygen saturation, serum creatinine, glucose, base excess, pH, arterial partial pressure of carbon dioxide, and body temperature. Notably, a cluster with ♭moderate' TBI (by traditional classifcation) and deranged metabolic profle, had a worse outcome than a cluster with ♭severe' GCS and a normal metabolic profle. Addition of cluster labels signifcantly improved the prognostic precision of the IMPACT (International Mission for Prognosis and Analysis of Clinical trials in TBI) extended model, for prediction of both unfavourable outcome and mortality (both p<0.001). Conclusions: Six stable and clinically distinct TBI endotypes were identifed by probabilistic unsupervised clustering. In addition to presenting neurology, a profle of biochemical derangement was found to be an important distinguishing feature that was both biologically plausible and associated with outcome. Our work motivates refning current TBI classifcations with factors describing metabolic stress. Such data-driven clusters suggest TBI endotypes that merit investigation to identify bespoke treatment strategies to improve care. Trial registration The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identifcation Portal (RRID: SCR_015582)
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Traumatic brain injury
Endotypes
Intensive care unit
Critical care
Unsupervised clustering
Machine learning
Megjelenés:Critical Care. - 26 : 1 (2022), p. 1-15. -
További szerzők:Holst, Anders Stocchetti, Nino Steyerberg, Ewout W. Menon, David Krishna Ercole, Ari Nelson, David W. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
Internet cím:Szerző által megadott URL
DOI
Intézményi repozitóriumban (DEA) tárolt változat
Borító:

2.

001-es BibID:BIBFORM070421
Első szerző:Cnossen, Maryse C.
Cím:Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury : a survey in 66 neurotrauma centers participating in the CENTER-TBI study / Maryse C. Cnossen, Jilske A. Huijben, Mathieu van der Jagt, Victor Volovici, Thomas van Essen, Suzanne Polinder, David Nelson, Ari Ercole, Nino Stocchetti, Giuseppe Citerio, Wilco C. Peul, Andrew I. R. Maas, David Menon, Ewout W. Steyerberg, Hester F. Lingsma, CENTER-TBI Investigators and Participants
Dátum:2017
ISSN:1364-8535 1466-609X
Megjegyzések:Background: No definitive evidence exists on how intracranial hypertension should be treated in patients withtraumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefitsand risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim ofthis study was to examine variation in monitoring and treatment policies for intracranial hypertension in patientswith TBI.Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expertopinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participatingin the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study.Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals(n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines wereused in 49 (74%) centers. Approximately 90% of the participants (n = 58) indicated placing an ICP monitor inpatients with severe TBI and computed tomographic abnormalities. There was no consensus on other indicationsor on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevatedICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring andtreatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%).Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI andintracranial hypertension. The results of this survey indicate a lack of consensus between European neurotraumacenters and provide an opportunity and necessity for comparative effectiveness research.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Traumatic brain injury
Intracranial hypertension
ICP
ICU
Comparative effectiveness research
Survey
Megjelenés:Critical Care. - 21/2017 (2017), p. 233-245. -
További szerzők:Huijben, Jilske A. van der Jagt, Mathieu Volovici, Victor van Essen, Thomas Polinder, Suzanne Nelson, David Ercole, Ari Stocchetti, Nino Citerio, Giuseppe Peul, Wilco C. Maas, Andrew I. R. Menon, David Krishna Steyerberg, Ewout W. Lingsma, Hester Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
Pályázati támogatás:CENTER-TBI
Egyéb
Internet cím:Szerző által megadott URL
DOI
Intézményi repozitóriumban (DEA) tárolt változat
Borító:

3.

001-es BibID:BIBFORM104936
035-os BibID:(Scopus)85045401878 (WOS)000429979700001 (cikkazonosító)90
Első szerző:Huijben, Jilske A.
Cím:Variation in general supportive and preventive intensive care management of traumatic brain injury : a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study / Jilske A. Huijben, Victor Volovici, Maryse C. Cnossen, Iain K. Haitsma, Nino Stocchetti, Andrew I. R. Maas, David K. Menon, Ari Ercole, Giuseppe Citerio, David Nelson, Suzanne Polinder, Ewout W. Steyerberg, Hester F. Lingsma, Mathieu van der Jagt, CENTER-TBI Investigators and Participants
Dátum:2018
ISSN:1364-8535
Megjegyzések:Abstract Background: General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. Methods: We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. Results: The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36?40 mmHg (4.8?5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30-35 mmHg (4?4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam wasmostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). Conclusions: Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome.
Tárgyszavak:Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Critical Care. - 22 : 1 (2018), p. 1-9. -
További szerzők:Volovici, Victor Cnossen, Maryse C. Haitsma, Iain Stocchetti, Nino Maas, Andrew I. R. Menon, David Krishna Ercole, Ari Citerio, Giuseppe Nelson, David Polinder, Suzanne Steyerberg, Ewout W. Lingsma, Hester Jagt, Mathieu van der Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
Internet cím:Szerző által megadott URL
DOI
Intézményi repozitóriumban (DEA) tárolt változat
Borító:

4.

001-es BibID:BIBFORM107438
035-os BibID:(scopus)85085505275 (wos)000581019400002
Első szerző:van Wijk, Roel P. J.
Cím:Informed consent procedures in patients with an acute inability to provide informed consent : Policy and practice in the CENTER-TBI study / van Wijk Roel P. J., van Dijck Jeroen T. J. M., Timmers Marjolein, van Veen Ernest, Citerio Giuseppe, Lingsma Hester F., Maas Andrew I. R., Menon David K., Peul Wilco C., Stocchetti Nino, Kompanje Erwin J. O., CENTER-TBI investigators and participants
Dátum:2020
ISSN:0883-9441
Megjegyzések:Purpose: Enrolling traumatic brain injury (TBI) patients with an inability to provide informed consent in research is challenging. Alternatives to patient consent are not sufficiently embedded in European and national legislation, which allows procedural variation and bias. We aimed to quantify variations in informed consent policy and prac- tice. Methods: Variation was explored in the CENTER-TBI study. Policies were reported by using a questionnaire and national legislation. Data on used informed consent procedures were available for 4498 patients from 57 centres across 17 European countries. Results: Variation in the use of informed consent procedures was found between and within EU member states. Proxy informed consent (N = 1377;64%) was the most frequently used type of consent in the ICU, followed by patient informed consent (N = 426;20%) and deferred consent (N = 334;16%). Deferred consent was only ac- tively used in 15 centres (26%), although it was considered valid in 47 centres (82%). Conclusions: Alternatives to patient consent are essential for TBI research. While there seems to be concordance amongst national legislations, there is regional variability in institutional practices with respect to the use of dif- ferent informed consent procedures. Variation could be caused by several reasons, including inconsistencies in clear legislation or knowledge of such legislation amongst researchers.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Traumatic brain injury
Informed consent
European Union Ethics
Megjelenés:Journal Of Critical Care. - 59 (2020), p. 6-15. -
További szerzők:van Dijck, Jeroen T. J. M. Timmers, Marjolein van Veen, Ernest Citerio, Giuseppe Lingsma, Hester Maas, Andrew I. R. Menon, David Krishna Peul, Wilco C. Stocchetti, Nino Kompanje, Erwin J. O. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
Internet cím:Szerző által megadott URL
DOI
Intézményi repozitóriumban (DEA) tárolt változat
Borító:

5.

001-es BibID:BIBFORM107505
035-os BibID:(WOS)000450478400002 (Scopus)85056714365 (cikkazonosító)306
Első szerző:Veen, Ernest van
Cím:Brain death and postmortem organ donation : report of a questionnaire from the CENTER-TBI study / Ernest van Veen, Mathieu van der Jagt, Maryse C. Cnossen, Andrew I. R. Maas, Inez D. de Beaufort, David K. Menon, Giuseppe Citerio, Nino Stocchetti, Wim J. R. Rietdijk, Jeroen T. J. M. van Dijck, Erwin J. O. Kompanje, CENTER-TBI investigators and participants
Dátum:2018
ISSN:1364-8535
Megjegyzések:Abstract Background: We aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation. Methods: Investigators from 67 Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study centers completed several questionnaires (response rate: 99%). Results: Regarding practices around brain death, we found agreement on the clinical evaluation (prerequisites and neurological assessment) for brain death determination (BDD) in 100% of the centers. However, ancillary tests were required for BDD in 64% of the centers. BDD for nondonor patients was deemed mandatory in 18% of the centers before withdrawing life-sustaining measures (LSM). Also, practices around postmortem organ donation varied. Organ donation after circulatory arrest was forbidden in 45% of the centers. When withdrawal of LSM was contemplated, in 67% of centers the patients with a ventricular drain in situ had this removed, either sometimes or all of the time. Conclusions: This study showed both agreement and some regional differences regarding practices around brain death and postmortem organ donation. We hope our results help quantify and understand potential differences, and provide impetus for current dialogs toward further harmonization of practices around brain death and postmortem organ donation
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Traumatic brain injury
Brain death
Ethics
Postmortem organ donation
Withdrawing life-sustaining measures
Ventricular drainage
Megjelenés:Critical Care. - 22 : 1 (2018), p. 1-11. -
További szerzők:Jagt, Mathieu van der Cnossen, Maryse C. Maas, Andrew I. R. Beaufort, Inez D. de Menon, David Krishna Citerio, Giuseppe Stocchetti, Nino Rietdijk, Wim J. R. Dijck, Jeroen T. J. M. van Kompanje, Erwin J. O. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
Internet cím:Szerző által megadott URL
DOI
Intézményi repozitóriumban (DEA) tárolt változat
Borító:
Rekordok letöltése1 
Corvina könyvtári katalógus v8.2.27 © 2023 Monguz kft. Minden jog fenntartva.