The evidence for the cost-effectiveness of rehabilitation following acquired brain injury.
Explore the source record for details and available documents.
Aftercare↗
Biomedical subjects
Lynne Turner-Stokes
Publications and source records attributed to Lynne Turner-Stokes.
Rehabilitation following acquired brain injury: concise guidance.
The national clinical guidelines for Rehabilitation following acquired brain injury were developed by a multidisciplinary working party convened by the British Society of Rehabilitation Medicine, and are published in collaboration with the Royal College of Physicians (2003). They have been produced to complement the National Institute of Clinical Excellence head injury guidelines, and to address the medium- to longer-term needs of patients with acquired brain injury and of their families/carers. This article serves as an introduction to make physicians aware of the guidelines, and to highlight in particular the advice to doctors in the acute services regarding early discharge and referral to rehabilitation.
Adult↗
Prophylaxis and treatment of infective endocarditis in adults: a concise guide.
Infective endocarditis (IE) is a life-threatening disease with substantial morbidity and mortality which affects individuals with underlying structural cardiac defects who develop bacteraemia, often as a result of dental, gastrointestinal, genitourinary, respiratory or cardiac invasive/surgical procedures. Prompt recognition of the clinical diagnosis by a wide variety of medical personnel, early involvement of specialist cardiologists, cardiac surgeon and a microbiologist, and prompt treatment with the most appropriate antimicrobial agents offer the greatest chance of improving the outcome for these patients. The guidance given here to clinicians involved in the management of patients with IE briefly covers diagnosis, antibiotic prophylaxis, medical treatment and the indications for surgery.
Anti-Bacterial Agents↗
The National Service Framework for long term conditions: the challenges ahead.
National Service Frameworks (NSFs) set out standards for health and social care provided by the NHS and social services in England. The latest in this series--the NSF for Long Term Conditions--was published recently. This editorial discusses some of the challenges for its development and implementation.
Aged↗
Use of antidepressant medication following acquired brain injury: concise guidance.
Depression is increasingly recognised as a common sequel to acquired brain injury and the use of antidepressant medication in this context has increased markedly over recent years. However, these drugs are not without side effects--some of them serious--and they should not be used without proper evaluation and monitoring. This set of concise guidance was developed jointly by the British Society of Rehabilitation Medicine, the British Geriatrics Society and the Royal College of Physicians, to guide clinicians working with people who have brain injury of any cause (i.e. stroke, trauma, anoxia, infection etc). The guidance covers (a) screening and assessment of depression in the context of brain injury, (b) issues to consider and discuss with the patient and their family before starting treatment, and (c) proper treatment planning and evaluation--including planned withdrawal at the end of treatment.
Antidepressive Agents↗
Generating the evidence base for the National Service Framework for Long Term Conditions: a new research typology.
The UK National Service Framework (NSF) for Long Term Conditions was published in May 2005. This article describes the challenges and some proffered solutions towards development of the evidence base to support best practice in the management of life-long neurological conditions, which are the principal focus of the NSF. The inherent limits in current systems for appraisal of evidence and their lack of applicability to these conditions are discussed. A new typology of evidence is proposed, which acknowledges the importance of expert opinion from users, carers and professionals as well as encompassing a broad range of research designs. To apply the typology, a brief evaluation tool is presented, which provides simple assessment of both qualitative and quantitative research evidence in terms of design, quality and applicability, and is practical for use by clinicians. Preliminary testing and application in development of the evidence base for the NSF are described.
Evidence-Based Medicine↗
Development of a pictorial scale of pain intensity for patients with communication impairments: initial validation in a general population.
This study evaluated a new six-point ordinal scale for measuring pain intensity. Seventy-two participants aged between 23 and 87 years rated the intensity of 'present pain' as well as remembered episodes of 'severe' and 'mild' pain on the scale of pain intensity (SPIN), a 10 cm visual analogue scale (VAS) and a 0-10 numeric scale, in random order. Retesting followed an intervening assessment. Participants' comments on the scales were analysed thematically. Spearman's correlation between scales all exceeded 0.78 (p<O.O01). Test-retest of the SPIN gave percentage agreements (weighted kappa) of present pain 69% (0.83), severe pain 94% (0.94) and mild pain 83% (0.85). Most participants preferred using an ordinal scale to the continuous VAS. Some found numbers easier to use whereas others found the SPIN more helpful. We conclude that the SPIN provides a valid measure of pain intensity in patients fully able to communicate their views and experiences. Investigation in patients with cognitive or communication impairments is now required.
Adult↗