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Câmara-Costa H, Dellatolas G, Jourdan C, Ruet A, Bayen E, Vallat-Azouvi C, Allain P, Chevignard M, Azouvi P. The 20-item dysexecutive questionnaire after severe traumatic brain injury: Distribution of the total score and its significance. Neuropsychol Rehabil 2024:1-22. [PMID: 39106184 DOI: 10.1080/09602011.2024.2387065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 07/26/2024] [Indexed: 08/09/2024]
Abstract
TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01437683..
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Affiliation(s)
- Hugo Câmara-Costa
- Rehabilitation Department for Children with Acquired Brain Injury; Saint Maurice Hospitals, Saint Maurice, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), F-75006, Paris, France
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, F-75013, Paris, France
| | - Georges Dellatolas
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, F-75013, Paris, France
| | - Claire Jourdan
- Physical Medicine and Rehabilitation Department, Lapeyronie Hospital, CHRU, Montpellier, France
| | - Alexis Ruet
- Physical Medicine and Rehabilitation Department, CHU Caen, INSERM U1077, Caen, France
| | - Eléonore Bayen
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), F-75006, Paris, France
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, F-75013, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière, Service De Médecine Physique et Réadaptation, Paris, France
| | | | - Philippe Allain
- Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, Nantes Université, Maison de la recherche Germaine Tillion, Angers, France
- Département de Neurologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Brain Injury; Saint Maurice Hospitals, Saint Maurice, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), F-75006, Paris, France
- Sorbonne Université, GRC 24 Handicap Moteur Cognitif et Réadaptation (HaMCRe), AP-HP, F-75013, Paris, France
| | - Philippe Azouvi
- AP-HP, GH Paris Saclay, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France
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Glassman SJ. Medical-Legal Issues in Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2024; 35:665-678. [PMID: 38945658 DOI: 10.1016/j.pmr.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Traumatic Brain Injury (TBI) cases often involve both medical and legal issues, litigation and prolonged recovery timelines. As TBI cases are often complex, and can have a significant impact on the lives of the patients and their families/caregivers, having a comprehensive understanding of the causes, diagnoses, treatments and long term outcomes will be valuable in understanding the medical and legal aspects of this type of injury. Patients, families, and health care professionals will all benefit from a deeper understanding of the medical and legal aspects of TBI, which should help improve rehabilitation and recovery outcomes.
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Affiliation(s)
- Stuart J Glassman
- Department of Physical Medicine & Rehabilitation, VA Northern California Healthcare System; 10535 Hospital Way, Mather, CA 95655, USA; Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
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Kelly NA, Kelly RE, Berkeley RP. The Glasgow Coma Scale: A disconnect between medical documentation and traumatic brain injury litigation in the United States. Med Leg J 2023; 91:175-179. [PMID: 37063079 DOI: 10.1177/00258172231161975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Traumatic brain injuries are consistently difficult to objectively measure. This creates significant challenges for medical and legal practitioners who each apply the Glasgow Coma Scale-based traumatic brain injury severity classifications of "mild", "moderate" and "severe". It can be difficult to medically define an often-subjective traumatic brain injury, where the law requires objective evidence of injuries. This descriptive review aims to elucidate the intended purpose of the Glasgow Coma Scale in traumatic brain injury assessment by doctors and attorneys. We highlight two different Glasgow Coma Scale uses, demonstrating a disconnect between the clinical traumatic brain injury adjectival classifications used in medicine and law. The Glasgow Coma Scale-based adjectival traumatic brain injury classifications create a diagnostic label which can affect a patient long after their initial medical assessment, representing a de facto diagnosis to the legal profession which may affect a patient's potential legal financial recovery.
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Affiliation(s)
| | | | - Ross P Berkeley
- Department of Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV, USA
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Liao L, Tang Y, Li B, Tang J, Xu H, Zhao K, Zhang X. Stachydrine, a potential drug for the treatment of cardiovascular system and central nervous system diseases. Biomed Pharmacother 2023; 161:114489. [PMID: 36940619 DOI: 10.1016/j.biopha.2023.114489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/21/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death globally and poses at significant challenge in terms of effective medical treatment. Leonurus japonicus Houtt, a traditional Chinese herb, is widely used in China for the treatment of obstetrical and gynecological disorders, including menstrual disorders, dysmenorrhea, amenorrhea, blood stasis, postpartum bleeding, and blood-related diseases such as CVD. Stachydrine, the main alkaloid component of Leonurus, has been shown to exhibit a wide range of biological activities including anti-inflammatory, antioxidant, anti-coagulant, anti-apoptotic, vasodilator, angiogenic promoter. Additionally, it has been demonstrated to have unique advantages in the prevention and treatment of CVD through regulation of various disease-related signaling pathways and molecular targets. In this comprehensive review, we examine the latest pharmacological effects and molecular mechanisms of Stachydrine in treating cardiovascular and cerebrovascular diseases. Our aim is to solid scientific basis for the development of new CVD drug formulations.
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Affiliation(s)
- Li Liao
- Yibin Second People's Hospital - Yibin Hospital of West China Hospital of Sichuan University, Yibin 644000, China.
| | - Yan Tang
- Yibin Second People's Hospital - Yibin Hospital of West China Hospital of Sichuan University, Yibin 644000, China
| | - Bo Li
- Third Affiliated Hospital of Chengdu Medical College, Chengdu Pidu District People's Hospital, Chengdu 611700, China
| | - Jing Tang
- Yibin Second People's Hospital - Yibin Hospital of West China Hospital of Sichuan University, Yibin 644000, China
| | - Hone Xu
- Yibin Second People's Hospital - Yibin Hospital of West China Hospital of Sichuan University, Yibin 644000, China
| | - Ke Zhao
- Yibin Second People's Hospital - Yibin Hospital of West China Hospital of Sichuan University, Yibin 644000, China
| | - Xiaochun Zhang
- Yibin Second People's Hospital - Yibin Hospital of West China Hospital of Sichuan University, Yibin 644000, China.
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Miller T, Kallenbach MD, Huber DL, Brett BL, Nelson LD. Relationship Between Neighborhood Disadvantage and Mild Traumatic Brain Injury Symptoms. J Head Trauma Rehabil 2023; 38:165-174. [PMID: 36731041 PMCID: PMC9998328 DOI: 10.1097/htr.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To test the hypotheses that (1) higher neighborhood disadvantage is associated with greater injury-related symptom severity in civilians with mild traumatic brain injury (mTBI) and (2) neighborhood disadvantage remains predictive after controlling for other established predictors. SETTING Level 1 trauma center and affiliated academic medical center. PARTICIPANTS N = 171 individuals with mTBI. DESIGN Prospective cohort study. MAIN MEASURES Rivermead Post Concussion Symptoms Questionnaire (RPQ) total score assessed less than 24 hours and at 2 weeks, 3 months, and 6 months postinjury. Linear mixed-effects models were used to assess the relationship between predictor variables and mTBI-related symptom burden (RPQ score). Neighborhood disadvantage was quantified by the Area Deprivation Index (ADI), a composite of 17 markers of socioeconomic position (SEP) scored at the census block group level. RESULTS Individuals in the upper ADI quartile of the national distribution displayed higher RPQ symptoms than those in the lower 3 quartiles ( P < .001), with a nonsignificant ADI × visit interaction ( P = .903). In a multivariable model, the effect of ADI remained significant ( P = .034) after adjusting for demographics, individual SEP, and injury factors. Other unique predictors in the multivariable model were gender (gender × visit P = .035), health insurance type ( P = .017), and injury-related litigation ( P = .012). CONCLUSION Neighborhood disadvantage as quantified by the ADI is robustly associated with greater mTBI-related symptom burden throughout the first 6 months postinjury. That the effect of ADI remained after controlling for demographics, individual SEP, and injury characteristics implies that neighborhood disadvantage is an important, understudied factor contributing to clinical recovery from mTBI.
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Affiliation(s)
- Tessa Miller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
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Bayen E, Ruet A, Jourdan C, Pradat-Diehl P, Charanton J, Nelson G, Azerad S, Meaude L, Vallat-Azouvi C, Azouvi P. Lack of effect of litigation on long-term outcome after severe traumatic brain injury. Ann Phys Rehabil Med 2023; 66:101725. [PMID: 36645967 DOI: 10.1016/j.rehab.2022.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 01/16/2023]
Affiliation(s)
- Eléonore Bayen
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France, Laboratoire d'Imagerie Biomédicale (LIB) Sorbonne Université, Paris, France and Global Brain Health Institute, University of California San Francisco, United-States.
| | - Alexis Ruet
- Physical Medicine and Rehabilitation Department, CHU Caen, INSERM U1077, France
| | - Claire Jourdan
- Physical Medicine and Rehabilitation Department, Lapeyronie Hospital, CHRU, Montpellier, France
| | - Pascale Pradat-Diehl
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France, Laboratoire d'Imagerie Biomédicale (LIB) Sorbonne Université, Paris, France and Global Brain Health Institute, University of California San Francisco, United-States
| | - James Charanton
- Centre Ressource Francilien du Traumatisme Crânien, Paris, France
| | - Gaelle Nelson
- Centre Ressource Francilien du Traumatisme Crânien, Paris, France
| | - Sylvie Azerad
- Unité de Recherche Clinique Paris-Ouest, Hôpital Ambroise Paré, Boulogne, France
| | - Layide Meaude
- Unité de Recherche Clinique Paris-Ouest, Hôpital Ambroise Paré, Boulogne, France
| | | | - Philippe Azouvi
- Physical Medicine and Rehabilitation Department, Raymond Poincaré hospital, AP-HP, GH Paris Saclay, Université Paris-Saclay, Inserm CESP, Villejuif, France
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Choinski K, Sanon O, Tadros R, Koleilat I, Phair J. Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections. Vasc Endovascular Surg 2021; 56:33-39. [PMID: 34159854 DOI: 10.1177/15385744211026455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Aortic aneurysms and dissections are prevalent causes of morbidity and mortality. The management of aortic pathologies may be called into question in malpractice suits. Malpractice claims were analyzed to understand common reasons for litigation, medical specialties involved, patient injuries, and outcomes. METHODS Litigation cases in the Westlaw database from September 1st, 1987 to October 23 rd, 2019 were analyzed. Search terms included "aortic aneurysm" and "aortic dissection." Data on plaintiff, defendant, litigation claims, patient injuries, misdiagnoses, and case outcomes were collected and compared for aortic aneurysms, aortic dissections, and overall cases. RESULTS A total of 346 cases were identified, 196 involving aortic aneurysms and 150 aortic dissections. Physician defendants were emergency medicine (29%), cardiology (20%), internal medicine (14%), radiology (11%), cardiothoracic (10%) and vascular surgery (10%). Litigation claims included "failure to diagnose and treat" (61%), "delayed diagnosis and treatment" (21%), "post-operative complications after open repair" (10%) and "negligent post-operative care" (10%). Patients with aneurysms presented with abdominal (63%) and back pain (37%), while dissections presented with chest pain (78%), abdominal pain (15%), and shortness of breath (14%). Misdiagnoses included gastrointestinal (12%), other cardiovascular (9%), and musculoskeletal conditions (9%), but many were not specified (58%). Overall, 83% of cases were wrongful death suits. Injuries included loss of consortium (23%), emotional distress (19%), and bleeding (17%). In 53% of the cases, the jury ruled in favor of the defendant. 25% of cases ruled for the plaintiff. 22% of cases resulted in a settlement. The mean rewarded for each case was $1,644,590.66 (SD: $5,939,134.58; Range: $17,500-$68,035,462). CONCLUSION For aortic pathologies, post-operative complications were not prominent among the reasons why suits were brought forth. This suggests improvements in education across all involved medical specialties may allow for improved diagnostic accuracy and efficient treatment, which could then translate to a decrease in associated litigation cases.
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Affiliation(s)
- Krystina Choinski
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Omar Sanon
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rami Tadros
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Issam Koleilat
- Department of Surgery, Community Medical Center, RWJ/Barnabus Health, Tom's River, NJ, USA
| | - John Phair
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ruet A, Bayen E, Jourdan C, Vallat-Azouvi C, Azerad S, Grimaldi L, Meaude L, Charanton J, Azouvi P. Potential for recovery between 4 and 8 years after a severe traumatic brain injury. Data from the PariS-TBI longitudinal study. Ann Phys Rehabil Med 2020; 64:101422. [PMID: 32763484 DOI: 10.1016/j.rehab.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/24/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is a leading cause of complex and persistent disability. Yet, long-term change in global functioning and determinants of this change remain unclear. OBJECTIVES This study aimed to assess change in global functioning in the long-term after severe TBI and factors associated with the change. METHODS This was a prospective observational study of an inception cohort of adults with severe TBI in the Paris area (PariS-TBI). Outcome was assessed at 1, 4 and 8 years post-injury. For the included participants (n=257), change in global outcome between 4 and 8 years was evaluated with the Glasgow Outcome Scale Extended (GOSE) score, and its association with pre-injury, injury-related and post-injury variables was tested with univariate and multivariable analyses. RESULTS More than half of the 73 participants evaluated at both 4 and 8 years showed global improvement (of at least one point) in GOSE score and an improvement in mood, executive function, and subjective complaints. On univariate analysis, none of the pre-injury, injury or post-injury variables were associated with GOSE score change between 4 and 8 years, except for GOSE score at 4 years (rho=-0.24, P=0.04). On multivariable analysis, probability of increased GOSE score was associated with more years of education (odds ratio 1.18 [95% confidence interval 1.02-1.37], P=0.03). The change in GOSE score was significantly correlated with change in Hospital Anxiety Depression Scale score between 4 and 8 years (rho=-0.42, P<0.001). CONCLUSIONS Most participants with severe TBI in the present sample showed a late improvement (4 to 8 years post-injury) in global functioning. Of the socio-demographic and injury-related factors, only more years of education was associated with improvement in global functioning. Decreased anxiety and depression symptoms were associated with improved global functioning. Targeting interventions to enhance resilience may be the most effective in the long-term after severe TBI.
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Affiliation(s)
| | - Eléonore Bayen
- Département de rééducation neurologique, faculté de médecine, hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Claire Jourdan
- Département de médecine physique et de réadaptation, CHU de Lapeyronie, Montpellier, France
| | - Claire Vallat-Azouvi
- Antenne UEROS-SAMSAH92-UGECAM IDF, hôpital Raymond-Poincaré, Garches, France; HANDIReSP, EA4047, université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France; EA 2027, laboratoire de psychopathologie et neuropsychologie, Paris, France
| | - Sylvie Azerad
- Unité de recherche clinique, hôpital Ambroise-Paré, AP-HP, Boulogne, France
| | - Lamiae Grimaldi
- Unité de recherche clinique, hôpital Ambroise-Paré, AP-HP, Boulogne, France; LA-SER and Pasteur Institute (Pharmacoepidemiology and Infectious Diseases Unit), Paris, France
| | - Layide Meaude
- Unité de recherche clinique, hôpital Ambroise-Paré, AP-HP, Boulogne, France
| | - James Charanton
- Centre ressources francilien du traumatisme crânien (CRFTC), Paris, France
| | - Philippe Azouvi
- HANDIReSP, EA4047, université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France; Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, AP-HP, Garches, France
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Kowalczyk CL, Eagle SR, Holland CL, Collins MW, Kontos AP. Average symptom severity and related predictors of prolonged recovery in pediatric patients with concussion. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:145-149. [PMID: 32515244 DOI: 10.1080/21622965.2020.1774376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study is to compare the predictive utility of total number of individual symptoms endorsed, total symptom severity, and average symptom severity on prolonged recovery among children/adolescents with a concussion. Patients (n = 115) completed the Post-Concussion Symptom Scale (PCSS) at their initial clinical visit (7.9 ± 6.6 days) days post-injury. PCSS outcomes were total symptom severity (i.e., total PCSS score), number of symptoms endorsed (i.e., number out of 22-items on the PCSS with a symptom score >0) and average symptom severity (i.e., mean of scores for each of the 22-items on the PCSS, not just endorsed symptoms). Logistic regression was performed with all symptom measures and recovery time >30 days as the binary outcome. Logistic regression indicated that average symptom severity (OR = 1.9; p = 0.01) and later time to first clinical visit (OR = 5.0; p < 0.001) were the only significant predictors of recovery time. Average symptom severity at initial clinic visit and earlier clinical visit may be a better predictor of recovery time than total number of symptoms endorsed or total symptom severity among children and adolescents.
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Affiliation(s)
- Claire L Kowalczyk
- UPMC Freddie Fu Sports Medicine Center-Concussion Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn R Eagle
- UPMC Freddie Fu Sports Medicine Center-Concussion Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cyndi L Holland
- UPMC Freddie Fu Sports Medicine Center-Concussion Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael W Collins
- UPMC Freddie Fu Sports Medicine Center-Concussion Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony P Kontos
- UPMC Freddie Fu Sports Medicine Center-Concussion Program, University of Pittsburgh, Pittsburgh, PA, USA
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