10 results on '"R.H.M.A. Bartels"'
Search Results
2. The diagnostic value of the pulsatility curve to predict shunt responsiveness in patients with idiopathic normal pressure hydrocephalus
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M. W. T. van Bilsen, L. van den Abbeele, V. Volovici, H. D. Boogaarts, R.H.M.A. Bartels, E. J. van Lindert, and Neurosurgery
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Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Surgery ,Neurology (clinical) - Abstract
Objective The aim of this study was to investigate the diagnostic accuracy of the pulsatility curve to predict shunt response in patients with idiopathic normal pressure hydrocephalus (iNPH). Methods Lumbar cerebrospinal fluid dynamics were derived from an automatic lumbar infusion test (LIT) protocol. All patients were treated with ventriculoperitoneal shunting and re-examined 6 months after shunting. Patient demographics and outcomes were gathered in a prospective, electronic database that spanned from January 2012 to January 2020. A validated iNPH scale was used to assess patients preoperatively and 6 months postoperatively. The relationship of the relative pulse pressure coefficient (RPPC), delta amplitude, successful lowering of amplitude, and the pressure-value at a hypothetical amplitude of zero (P0), resistance to outflow (Rout), and outcome, were assessed using receiver operating characteristic (ROC) curves. Results We included 38 patients. The RPPC, delta amplitude, successful lowering of amplitude, and P0 parameters did not predict shunt response. Mean P0 was 0.5 (IQR 0.4–0.9) in improved patients and 0.4 (IQR 0–1.2) in non-improved patients. The delta amplitude was 0.16 kPa (IQR 0.10–0.23) in improved patients and 0.18 kPa (IQR 0.11–0.24) in non-improved patients. Furthermore, we found a technical failure rate of pulsatility curve measurements of 32%. Conclusion Pulsatility curve results were not suitable in predicting shunt response in our cohort. The diagnostic value of LIT in case of normal pressure hydrocephalus should be subject to more rigorous research.
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- 2022
3. Correction to: Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study
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Braden Te Ao, R.H.M.A. Bartels, Paul M. Parizel, Thomas Van Essen, Marco Carbonara, Daniel Kondziella, Guy Williams, Maria A. Poca, Kevin Wang, Juan Sahuquillo, Oliver Sakowitz, Maria Luisa Azzolini, Rafael Badenes, Joukje Van der Naalt, Johnny Collett, Lars Wessels, Mathieu Van der Jagt, Steven Laureys, Peter Ylen, Ana M Castaño-Leon, Emma Donoghue, Nada Andelic, Ari Ercole, Valery L. Feigin, Thijs Vande Vyvere, Willem Cornelis Peul, Anneliese Synnot, Vanni Agnoletti, Stephen Macdonald, Antonio Belli, Morten Blaabjerg, David Nelson, Giuseppe Citerio, Victor Volovici, Rahul Raj, Linda Lanyon, Edgar Santos, Jussi Posti, Renán Sánchez-Porras, Andreea Rădoi, Sandra Rossi, Peter Bragge, Pedro Gomez, Virginia Newcombe, William Stewart, Diederik Dippel, Carmen Vleggeert-Lankamp, Helen Dawes, Matej Oresic, Didier Herman MARTIN, Alfonso Lagares, Schipper Inger, Arminas Ragauskas, Dashiell Gantner, Derick Wade, Bart Depreitere, and Emmanuel Andreas Stamatakis
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030506 rehabilitation ,medicine.medical_specialty ,Decompressive Craniectomy ,genetic structures ,Traumatic brain injury ,Clinical Decision-Making ,03 medical and health sciences ,0302 clinical medicine ,Trauma Centers ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,medicine ,Humans ,Neuroradiology ,Monitoring, Physiologic ,business.industry ,Correction ,medicine.disease ,eye diseases ,Europe ,Neurosurgeons ,Physical therapy ,Surgery ,Neurology (clinical) ,Neurosurgery ,0305 other medical science ,business ,030217 neurology & neurosurgery - Abstract
Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe.A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP).The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions.Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care.
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- 2019
4. Prognostic Validation of the NINDS Common Data Elements for the Radiologic Reporting of Acute Traumatic Brain Injuries: A CENTER-TBI Study
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R.H.M.A. Bartels, Paul M. Parizel, Thomas Van Essen, Daniel Kondziella, Juan Sahuquillo, Oliver Sakowitz, Steven Laureys, Angelos Kolias, Ana M Castaño-Leon, Matti Pirinen, Thijs Vande Vyvere, Morten Blaabjerg, Giuseppe Citerio, Rahul Raj, Jussi Posti, Renán Sánchez-Porras, Andreea Rădoi, D. James Cooper, Sandra Rossi, Pedro Gomez, Virginia Newcombe, William Stewart, Jonathan Coles, Frederick Zeiler, Aarno Palotie, Arminas Ragauskas, Vande Vyvere, Thij, De La Rosa, Ezequiel, Wilms, Guido, Nieboer, Daan, Steyerberg, Ewout, Maas, Andrew I R, Verheyden, Jan, van den Hauwe, Luc, Parizel, Paul M (CENTER-TBI Participants and Investigators), Beretta, Luigi, Molecular Neuroscience and Ageing Research (MOLAR), Vande Vyvere, T, De La Rosa, E, Wilms, G, Nieboer, D, Steyerberg, E, Maas, A, Verheyden, J, Van Den Hauwe, L, Parizel, P, Citerio, G, CTR-TBI Participants Investigators, and Public Health
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Adult ,Male ,Research Report ,SELECTION ,medicine.medical_specialty ,Neurology ,Adolescent ,Databases, Factual ,Traumatic brain injury ,INTRACEREBRAL HEMORRHAGE ,Poison control ,Logistic regression ,Young Adult ,Common Data Element ,Internal medicine ,TOMOGRAPHY ,Injury prevention ,Brain Injuries, Traumatic ,medicine ,Humans ,National Institute of Neurological Disorders and Stroke (U.S.) ,Longitudinal Studies ,structured reporting ,Child ,Stroke ,Aged ,Intracerebral hemorrhage ,Aged, 80 and over ,Common Data Elements ,business.industry ,Glasgow Outcome Scale ,traumatic brain injury ,Infant, Newborn ,Infant ,Reproducibility of Results ,computed tomography ,Middle Aged ,medicine.disease ,Prognosis ,United States ,Child, Preschool ,SIMULATION ,Female ,Neurology (clinical) ,Human medicine ,business ,Tomography, X-Ray Computed - Abstract
The aim of this study is to investigate the prognostic value of using the National Institute of Neurological Disorders and Stroke (NINDS) standardized imaging-based pathoanatomic descriptors for the evaluation and reporting of acute traumatic brain injury (TBI) lesions. For a total of 3392 patients (2244 males and 1148 females, median age = 51 years) enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we extracted 96 Common Data Elements (CDEs) from the structured reports, spanning all three levels of pathoanatomic information (i.e., 20 "basic," 60 "descriptive," and 16 "advanced" CDE variables per patient). Six-month clinical outcome scores were dichotomized into favorable (Glasgow Outcome Scale Extended [GOS-E] = 5-8) versus unfavorable (GOS-E = 1-4). Regularized logistic regression models were constructed and compared using the optimism-corrected area under the curve (AUC). An abnormality was reported for the majority of patients (64.51%). In 79.11% of those patients, there was at least one coexisting pathoanatomic lesion or associated finding. An increase in lesion severity, laterality, and volume was associated with more unfavorable outcomes. Compared with the full set of pathoanatomic descriptors (i.e., all three categories of information), reporting "basic" CDE information provides at least equal discrimination between patients with favorable versus unfavorable outcome (AUC = 0.8121 vs. 0.8155, respectively). Addition of a selected subset of "descriptive" detail to the basic CDEs could improve outcome prediction (AUC = 0.8248). Addition of "advanced" or "emerging/exploratory" information had minimal prognostic value. Our results show that the NINDS standardized-imaging based pathoanatomic descriptors can be used in large-scale studies and provide important insights into acute TBI lesion patterns. When used in clinical predictive models, they can provide excellent discrimination between patients with favorable and unfavorable 6-month outcomes. If further validated, our findings could support the development of structured and itemized templates in routine clinical radiology.
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- 2020
5. Comparison of Care System and Treatment Approaches for Patients with Traumatic Brain Injury in China versus Europe: A CENTER-TBI Survey Study
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Marek Majdan, R.H.M.A. Bartels, Thomas Van Essen, Daniel Kondziella, Juan Sahuquillo, Oliver Sakowitz, Steven Laureys, Angelos Kolias, Ana M Castaño-Leon, Matti Pirinen, Thijs Vande Vyvere, Giuseppe Citerio, Rahul Raj, Jussi Posti, Renán Sánchez-Porras, Andreea Rădoi, Peter Hutchinson, D. James Cooper, Sandra Rossi, Pedro Gomez, Virginia Newcombe, William Stewart, Jonathan Coles, Frederick Zeiler, Aarno Palotie, Paul Dark, Arminas Ragauskas, Intensive Care, Public Health, Feng, J, van Veen, E, Yang, C, Huijben, J, Lingsma, H, Gao, G, Jiang, J, Maas, A, Citerio, G, Molecular Neuroscience and Ageing Research (MOLAR), Psychology 3, Section Neuropsychology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Psychiatrie & Neuropsychologie, Collaborative European Neuro Trauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants, Feng, Junfeng, van Veen, Ernest, Yang, Chun, Huijben, Jilske A, Lingsma, Hester F, Gao, Guoyi, Jiang, Jiyao, Maas, Andrew I R (Collaborative European Neuro Trauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants), and Beretta, L
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China ,Emergency Medical Services ,030506 rehabilitation ,medicine.medical_specialty ,NEUROTRAUMA EFFECTIVENESS RESEARCH ,Neurologi ,Traumatic brain injury ,Concordance ,medicine.medical_treatment ,Best practice ,Comparative effectiveness research ,Provider profiling ,TBI care ,03 medical and health sciences ,0302 clinical medicine ,Trauma Centers ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,medicine ,MANAGEMENT ,Humans ,CRITERIA ,COMPUTED-TOMOGRAPHY ,CLINICAL DECISION INSTRUMENTS ,business.industry ,Public health ,traumatic brain injury ,comparison, provider profiling, TBI care, traumatic brain injury, variation ,provider profiling ,ADULTS ,medicine.disease ,3. Good health ,Europe ,Intensive Care Units ,Treatment Outcome ,Neurology ,CT HEAD RULE ,comparison ,Family medicine ,Decompressive craniectomy ,Human medicine ,Neurology (clinical) ,variation ,0305 other medical science ,business ,Craniotomy ,030217 neurology & neurosurgery - Abstract
Traumatic brain injury (TBI) poses a huge public health and societal problem worldwide. Uncertainty exists on how care system and treatment approaches for TBI worked in China may differ from those in Europe. Better knowledge on this is important to facilitate interpretation of findings reported by Chinese researchers and to inform opportunities for collaborative studies. We aimed to investigate concordance and variations in TBI care between Chinese and European neurotrauma centers. Investigators from 52 centers in China and 68 in Europe involved in the Collaborative European Neuro Trauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study were invited to complete provider profiling (PP) questionnaires, which covered the main aspects of care system and treatment approaches of TBI care. Participating Chinese and European centers were mainly publicly funded and academic. More centers in China indicated available dedicated neuro-intensive care than those in Europe (98% vs. 60%), and treatment decisions in the ICU were mainly determined by neurosurgeons (58%) in China while in Europe, (neuro)intensivists often took the lead (61%). The ambulance dispatching system was automatic in half of Chinese centers (49%), whereas selective dispatching was more common in European centers (74%). For treatment of refractory intracranial hypertension, a decompressive craniectomy was more frequently regarded as general policy in China compared with in Europe (89% vs. 45%). We observed both concordance and substantial variations with regard to the various aspects of TBI care between Chinese and European centers. These findings are fundamental to guide future research and offer opportunities for collaborative comparative effectiveness research to identify best practices., Funding Agencies:National Natural Science Foundation of China (NSFC)Hannelore Kohl Stiftung (Germany) OneMind (USA) Integra LifeSciences Corporation (USA)
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- 2020
6. Central versus local radiological reading of acute computed tomography characteristics in multi-center traumatic brain injury research
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R.H.M.A. Bartels, Paul M. Parizel, Thomas Van Essen, Daniel Kondziella, Maria A. Poca, Juan Sahuquillo, Oliver Sakowitz, Rafael Badenes, Johnny Collett, Lars Wessels, Angelos Kolias, Ana M Castaño-Leon, Thijs Vande Vyvere, Morten Blaabjerg, Giuseppe Citerio, Rahul Raj, Linda Lanyon, Edgar Santos, Jussi Posti, Renán Sánchez-Porras, Andreea Rădoi, Sandra Rossi, Pedro Gomez, Virginia Newcombe, William Stewart, Jonathan Coles, Diederik Dippel, Helen Dawes, Arminas Ragauskas, Vande Vyvere, T, Wilms, G, Claes, L, Martin Leon, F, Nieboer, D, Verheyden, J, Van Den Hauwe, L, Pullens, P, Maas, A, Parizel, P, Citerio, G, CENTER-TBI Investigators, Molecular Neuroscience and Ageing Research (MOLAR), Section Neuropsychology, Psychiatrie & Neuropsychologie, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Public Health, Neurosurgery, Vande Vyvere, Thij, Wilms, Guido, Claes, Lene, Martin Leon, Francisco, Nieboer, Daan, Verheyden, Jan, van den Hauwe, Luc, Pullens, Pim, Maas, Andrew I R, Parizel, Paul M, and Beretta, Luigi
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030506 rehabilitation ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Traumatic brain injury ,FEATURES ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,DIAGNOSIS ,HEMORRHAGE ,03 medical and health sciences ,0302 clinical medicine ,McNemar's test ,Cohen's kappa ,Midline shift ,Brain Injuries, Traumatic ,medicine ,Humans ,Observer Variation ,central radiology review ,business.industry ,Research ,traumatic brain injury ,Head injury ,agreement, central radiology review, traumatic brain injury ,HEAD-INJURY ,Brain ,Reproducibility of Results ,COMMON DATA ELEMENTS ,medicine.disease ,ta3124 ,PROGNOSTIC VALUE ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Radiological weapon ,Human medicine ,Neurology (clinical) ,Radiology ,Tomography, X-Ray Computed ,0305 other medical science ,business ,agreement ,SCAN ,030217 neurology & neurosurgery ,Kappa ,CT - Abstract
Contains fulltext : 206372.pdf (Publisher’s version ) (Closed access) Observer variability in local radiological reading is a major concern in large-scale multi-center traumatic brain injury (TBI) studies. A central review process has been advocated to minimize this variability. The aim of this study is to compare central with local reading of TBI imaging datasets and to investigate the added value of central review. A total of 2050 admission computed tomography (CT) scans from subjects enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study were analyzed for seven main CT characteristics. Kappa statistics were used to calculate agreement between central and local evaluations and a center-specific analysis was performed. The McNemar test was used to detect whether discordances were significant. Central interobserver and intra-observer agreement was calculated in a subset of patients. Good agreement was found between central and local assessment for the presence or absence of structural pathology (CT+, CT-, kappa = 0.73) and most CT characteristics (kappa = 0.62 to 0.71), except for traumatic axonal injury lesions (kappa = 0.37). Despite good kappa values, discordances were significant in four of seven CT characteristics (i.e., midline shift, contusion, traumatic subarachnoid hemorrhage, and cisternal compression; p = 0.0005). Central reviewers showed substantial to excellent interobserver and intra-observer agreement (kappa = 0.73 to kappa = 0.96), contrasted by considerable variability in local radiological reading. Compared with local evaluation, a central review process offers a more consistent radiological reading of acute CT characteristics in TBI. It generates reliable, reproducible data and should be recommended for use in multi-center TBI studies.
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- 2019
7. 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
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R.H.M.A. Bartels, Paul M. Parizel, Thomas Van Essen, Daniel Kondziella, Juan Sahuquillo, Oliver Sakowitz, Rafael Badenes, Marek Czosnyka, Mathieu Van der Jagt, Steven Laureys, Angelos Kolias, Ana M Castaño-Leon, Ari Ercole, Thijs Vande Vyvere, Morten Blaabjerg, David Nelson, Giuseppe Citerio, Victor Volovici, Rahul Raj, Linda Lanyon, Pim Pullens, Edgar Santos, Renán Sánchez-Porras, Peter Hutchinson, Sandra Rossi, Pedro Gomez, Virginia Newcombe, William Stewart, Jonathan Coles, Monika Bullinger, Diederik Dippel, Helen Dawes, Jilske (Antonia) Huijben, Alfonso Lagares, Arminas Ragauskas, Barbara Sahakian, Emmanuel Andreas Stamatakis, Ragauskas, Arminas, Ročka, Saulius, Vilcinis, Rimantas, Molecular Neuroscience and Ageing Research (MOLAR), CTR-TBI Investigators Participants, Neurokirurgian yksikkö, Clinicum, Huijben, Jilske A, Volovici, Victor, Cnossen, Maryse C, Haitsma, Iain K, Stocchetti, Nino, Maas, Andrew IR, Menon, David K, Ercole, Ari, Citerio, Giuseppe, Nelson, David, Polinder, Suzanne, Steyerberg, Ewout W, Lingsma, Hester F, Van der Jagt, Mathieu (CENTER-TBI investigators and participants), Beretta, Luigi, Rocka, Saulius, „Springer' grupė, Public Health, Neurosurgery, Intensive Care, Menon, David [0000-0002-3228-9692], Ercole, Ari [0000-0001-8350-8093], Apollo - University of Cambridge Repository, Section Neuropsychology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Psychiatrie & Neuropsychologie, Huijben, J, Volovici, V, Cnossen, M, Haitsma, I, Stocchetti, N, Maas, A, Menon, D, Ercole, A, Citerio, G, Nelson, D, Polinder, S, Steyerberg, E, Lingsma, H, and van der Jagt, M
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Male ,Comparative Effectiveness Research ,Placebo-controlled study ,use of corticosteroid ,Critical Care and Intensive Care Medicine ,PLACEBO-CONTROLLED TRIAL ,GUIDELINES ,VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Nevrologi: 752 ,3124 Neurology and psychiatry ,law.invention ,survey, Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury, CENTER-TBI, circulatory and respiratory management ,0302 clinical medicine ,Traumatic brain injury ,seizure prophylaxis and treatment ,Trauma Centers ,law ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,Medicine and Health Sciences ,Surveys and Questionnaire ,intensive care unit ,traumatic brain injury ,glucose ,nutrition ,fever ,ventilation ,blood pressure ,seizure ,survey ,Europe ,fever control ,Survey ,Intracranial pressure ,OUTCOMES ,Trauma Center ,Brain Injuries, Traumatic/therapy ,RESUSCITATION ,nutrition and glucose management ,Head injury ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,INTRACRANIAL HYPERTENSION ,Intensive care unit ,Seizure ,3. Good health ,Intensive Care Units ,Blood pressure ,Female ,CRITICALLY-ILL PATIENTS ,Human ,Adult ,medicine.medical_specialty ,Fever ,Comparative effectiveness research ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,IMPROVEMENT ,ALBUMIN ,Glucose ,Nutrition ,Ventilation ,Quality of Health Care/standards ,03 medical and health sciences ,medicine ,Humans ,Cerebral perfusion pressure ,Quality of Health Care ,MRC CRASH ,Intensive Care Units/organization & administration ,business.industry ,Research ,HEAD-INJURY ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,medicine.disease ,3126 Surgery, anesthesiology, intensive care, radiology ,Trauma Centers/organization & administration ,Program Evaluation/statistics & numerical data ,Emergency medicine ,VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Neurology: 752 ,MODERATE ,Human medicine ,business ,030217 neurology & neurosurgery ,Program Evaluation - 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)
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- 2018
8. History of the Surgical Treatment of Ulnar Nerve Compression at the Elbow
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R.H.M.A. Bartels
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Surgery ,Neurology (clinical) - Published
- 2001
9. In Reply
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R.H.M.A. Bartels
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Surgery ,Neurology (clinical) - Published
- 2010
10. Cervical radiculopathy: is a prosthesis preferred over fusion surgery? A systematic review.
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Goedmakers CMW, Janssen T, Yang X, Arts MP, Bartels RHMA, and Vleggeert-Lankamp CLA
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- Cervical Vertebrae surgery, Diskectomy, Humans, Prostheses and Implants, Treatment Outcome, Radiculopathy surgery, Spinal Fusion
- Abstract
Background: Meta-analyses on the comparison between fusion and prosthesis in the treatment of cervical radiculopathy mainly analyse studies including mixed patient populations: patients with radiculopathy with and without myelopathy. The outcome for patients with myelopathy is different compared to those without. Furthermore, apart from decompression of the spinal cord, restriction of motion is one of the cornerstones of the surgical treatment of spondylotic myelopathy. From this point of view, the results for arthroplasty might be suboptimal for this category of patients. Comparing clinical outcome in patients exclusively suffering from radiculopathy is therefore a more valid method to compare the true clinical effect of the prosthesis to that of fusion surgery., Aim: The objective of this study was to compare clinical outcome of cervical arthroplasty (ACDA) to the clinical outcome of fusion (ACDF) after anterior cervical discectomy in patients exclusively suffering from radiculopathy, and to evaluate differences with mixed patient populations., Methods: A literature search was completed in PubMed, EMBASE, Web of Science, COCHRANE, CENTRAL and CINAHL using a sensitive search strategy. Studies were selected by predefined selection criteria (i.a.) patients exclusively suffering from cervical radiculopathy), and risk of bias was assessed using a validated Cochrane Checklist adjusted for this purpose. An additional overview of results was added from articles considering a mix of patients suffering from myelopathy with or without radiculopathy., Results: Eight studies were included that exclusively compared intervertebral devices in radiculopathy patients. Additionally, 29 articles concerning patients with myelopathy with or without radiculopathy were studied in a separate results table. All articles showed intermediate to high risk of bias. There was neither a difference in decrease in mean NDI score between the prosthesis (20.6 points) and the fusion (20.3 points) group, nor was there a clinically important difference in neck pain (VAS). Comparing these data to the mixed population data demonstrated comparable mean values, except for the 2-year follow-up NDI values in the prosthesis group: mixed group patients that received a prosthesis reported a mean NDI score of 15.6, indicating better clinical outcome than the radiculopathy patients that received a prosthesis though not reaching clinical importance., Conclusions: ACDF and ACDA are comparably effective in treating cervical radiculopathy due to a herniated disc in radiculopathy patients. Comparing the 8 radiculopathy with the 29 mixed population studies demonstrated that no clinically relevant differences were present in clinical outcome between the two types of patients. These slides can be retrieved under Electronic Supplementary Material.
- Published
- 2020
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