“五常法”在颅脑损伤患者康复病房管理中的应用

目的探讨＂五常法＂在颅脑损伤患者康复病房管理中的作用。方法采用＂五常法＂理论加强病房规范化管理,并对76名颅脑损伤患者康复病房应用＂五常法＂管理前后物品完好率、患者家属满意率等进行对比。结果医护人员的工作环境及患者住院环境得到改善,团队协作精神、物品完好率、患者家属满意率得到提高。差异均有统计学意义（P〈0.05）。结论 ＂五常法＂是有效的科学管理方法,容易实施,效果明显,可有效提高颅脑损伤患者康复病房的服务质量,值得推广。     

Preserved Knowledge of Maps of Countries: Implications for the Organization of Semantic Memory

We describe two patients with selectively preserved knowledge of the category of countries. Following a series of cerebral infarcts, patient DB presented with severe perceptual impairment, including dense apperceptive agnosia, prosopagnosia, and topographical agnosia. Despite these deficits, he could effortlessly name countries from their outline maps. Patient WH, who suffered from semantic dementia, had severe naming and comprehension difficulties, with extremely sparse residual semantic knowledge. Remarkably, the category of countries was preserved. First, we argue that, for both patients, this category preservation occurs at a semantic level. Second, we discuss our findings in the context of three current models of category-specific effects (perceptual, ontogenetic, and evolutionary models). We argue that the perceptual model (Humphreys and colleagues) cannot easily accommodate our findings. By contrast, the ontogenetic (Warrington and colleagues) and evolutionary models (Caramazza and colleagues) can explain our findings. However, some modifications to both models are required. The ontogenetic model needs to envisage a spatial channel for the development of map knowledge, which is anatomically separate from channels of other categories of knowledge. The evolutionary model needs to envisage the possibility that some categories of knowledge, such as countries, may not be prewired, but learned during ontogenetic development.     

Faire des courses avec des atteintes cognitives : l’influence des facteurs environnementaux

People who have suffered a traumatic brain injury (TBI) often experience a decreased ability to carry out complex daily activities such as shopping, and these difficulties are likely amplified when confronted with a shopping environment that is not adapted to their cognitive difficulties.GoalThe purpose of this study was to identify the environmental factors present within a grocery store that influence, positively or negatively, the independence of persons who have suffered a TBI within the activity of shopping for groceries. This is an exploratory study in the form of a qualitative analysis of the performance of 10 participants with moderate or severe TBI who completed the “shopping for groceries” task of the IADL Profile. The main facilitators observed at the grocery store were the organization of food and the presence of signs. The main obstacles were the distractions, the wide variety of food and recent changes in food placement. Frequenting a supermarket appears to cause an increase in the use of environmental facilitators. This study highlights the various environmental factors that help or hinder grocery shopping for individuals with cognitive deficits. Particular attention should be paid to environmental obstacles in a grocery store when working with these individuals.     

Bony Protuberances on the Anterior and Posterior Clinoid Processes Lead to Traumatic Internal Carotid Artery Aneurysm Following Craniofacial Injury

Traumatic intracranial aneurysms are rare, comprising 1% or less of all cerebral aneurysms. The majority of these aneurysms arise at the skull base or in the distal anterior and middle cerebral arteries or their branches following direct mural injury or acceleration-induced shearing force. We present a 50-year-old patient in whom subarachnoid hemorrhage (SAH) was developed as a result of traumatic aneurysm rupture after a closed craniofacial injury. Through careful evaluation of the three-dimensional computed tomography and conventional angiographies, the possible mechanism of the traumatic internal carotid artery trunk aneurysm is correlated with a hit injury by the bony protuberances on the anterior and posterior clinoid processes. This traumatic aneurysm was successfully obliterated with clipping and wrapping technique. The possibility of a traumatic intracranial aneurysm should be considered when patient with SAH demonstrates bony protuberances on the clinoid process as a traumatic aneurysm may result from mechanical injury by the sharp bony edges.     

Autopsy practice in forensic pathology – Evidence-based or experience-based? A review of autopsies performed on victims of traumatic asphyxia in a mass disaster

Current autopsy practice in forensic pathology is to a large extent based on experience and individual customary practices as opposed to evidence and consensus based practices. As a result there is the potential for substantial variation in how knowledge is applied in each case. In the present case series, we describe the variation observed in autopsy reports by five different pathologists of eight victims who died simultaneously from traumatic asphyxia due to compression during a human stampede. We observed that there was no mention of the availability of medical charts in five of the reports, of potentially confounding resuscitation efforts in three reports, of cardinal signs in seven reports and of associated injuries to a various degree in all reports. Further, there was mention of supplemental histological examination in two reports and of pre-autopsy radiograph in six reports. We inferred that reliance on experience and individual customary practices led to disparities between the autopsy reports as well as omissions of important information such as cardinal signs, and conclude that such reliance increases the potential for error in autopsy practice. We suggest that pre-autopsy data-gathering and the use of check lists specific to certain injury causes are likely to result in less deviation from evidence-based practices in forensic pathology. Pre-autopsy data-gathering and check lists will help ensure a higher degree of standardization in autopsy reports thus enhancing the quality and accuracy of the report as a legal document as well as rendering it more useful for data-gathering efforts.     

Impaired self-awareness after traumatic brain injury: a systematic review. Part 1: Assessment,clinical aspects and recovery

BackgroundImpaired self-awareness (ISA) has frequently been found to be both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI).ObjectivesThe present paper is the first of a two-part systematic review of ISA after traumatic brain injury (TBI), focusing on assessment methods, clinical aspects and recovery.MethodsFollowing the PRISMA guidelines, 95 articles meeting the inclusion criteria were included.ResultsISA occurs in 30% to 50% of patients with moderate to severe TBI, although it tends to improve with time. There is no one single gold-standard measure of ISA. Self-proxy discrepancy scores, with scales such as the Patient Competency Rating Scale or the Awareness Questionnaire, or a structured interview such as the Self Awareness of Deficits Interview, are the most frequently used assessment methods, with adequate psychometric properties. Scores on these different scales correlate only moderately with each other, which suggests that they may address different aspects of self-awareness. ISA mainly concerns cognitive and behavioral problems rather than physical or sensory impairments and may concern different areas of functioning, such as anticipatory, emergent or meta-cognitive awareness.ConclusionISA is a complex and multifaceted issue that should be systematically assessed in rehabilitation settings using a range of relatively well-validated tools. The consequences and predictors of ISA after TBI will be addressed in a companion paper.