Acute Recovery Phase Research Articles

Factor structure of the agitated behavior scale

The Agitated Behavior Scale (ABS; Corrigan, 1989) is a 14-item scale developed to monitor agitation during the acute phase of recovery from acquired brain injury. While previous studies have supported the reliability, internal consistency, and concurrent validity of the ABS, the current study was designed to investigate its underlying factor structure, as well as to determine systematic effects of time-of-day on the occurrence of agitation. Subjects were 212 patients with traumatic or other recently acquired brain injury who exhibited agitation during their treatment on a specialized brain-injury unit of an acute rehabilitation hospital. Confirmatory factor analysis revealed that agitation is best represented by one general construct with three underlying factors: Aggression, Disinhibition, and Lability. Analysis of agitation by nursing shift in which ratings were made confirmed that overall level was lowest during the night shift; however, the relationship between time-of-day and underlying factors deviated from this pattern. Results are discussed in terms of the necessity for objective measurement, definition of the construct of agitation, and time-of-day issues in sampling agitated behavior.

Effects of salbutamol inhalations on transcutaneous blood gases in children during the acute asthmatic attack: from acute deterioration to recovery

Nine children, 7-16 years of age, were studied repeatedly during an acute asthmatic attack, from acute deterioration to recovery. The transcutaneous blood gases, forced expiratory volume in 1 s (FEV1) and maximum expiratory flow when 25% of vital capacity remained to be expelled (MEF25) were monitored before and after salbutamol inhalation. The flow-volume variables were markedly impaired in the acute phase but improved gradually by the time of recovery. The transcutaneous PO2 (tcPO2) decreased in the acute and early recovery phase but improved by the late recovery phase. In the acute phase, the salbutamol inhalations increased the FEV1, indicating an improvement in central airway function, but also reduced the MEF25 and tcPO2 in some of the children. The changes in tcPO2 after the inhalations correlated with the changes in MEF25 (p < 0.001), thereby indicating a common denominator, probably the condition of the peripheral airways. In the recovery phase, the FEV1, MEF25 and tcPO2 improved after the inhalations (p < 0.05). In conclusion, transcutaneous PO2 can be used to evaluate the effects of treatment in children with acute asthmatic symptoms and may add information about peripheral airway function which may prove particularly valuable in small children where few methods are available for such measurements.

Predicting community integration after traumatic brain injury with neuropsychological measures.

A neuropsychological test battery was administered to 23 subjects with traumatic brain injury during initial inpatient rehabilitation who were participating in the national Traumatic Brain Injury Model Systems study. Trails B and the Rey Auditory Verbal Learning Test total scores obtained during inpatient rehabilitation were significantly correlated with the Community Integration Questionnaire total score that was administered at one year postinjury. These findings suggest that performances on tests of cognitive speed and flexibility, complex attention, and memory during the acute phase of recovery may be useful for the later prediction of "real world" behavior and psychosocial outcome after one year postinjury.

Agitation, cognition and attention during post-traumatic amnesia

During the early phases of recovery from traumatic head injury, the level of functional cognition and the presence of agitation in patients appear to co-vary. However, it has been observed that there appears to be some temporal disassociation in the recovery of cognition and agitation. The purpose of this study was to investigate the degree to which attention accounts for the co-variation previously observed. Over a 1-year period, 130 patient-weeks of independent monitoring of cognition, agitation and attention were obtained from 20 head-injured patients in the acute phase of recovery. Weekly scores for measures of cognition, agitation and attention were each found to share approximately 50% of the variance when paired with one of the other two. When attention was extracted, only 7% of the variation in cognition was accounted for by agitation, and 40% of the variance could not be accounted for by either agitation or attention. These results support previous findings that cognition and agitation co-vary with most of the co-variance due to the effect of attention on each. Concomitantly, these results allow that significant portions of the variance in cognition and agitation may be temporally dissociated during the acute phases of recovery from traumatic head injury.

Predicting clearing of post-traumatic amnesia following closed-head injury

The ability to predict the resolution of post-traumatic amnesia (PTA) early in the course of acute rehabilitation was studied in a sample of 98 closed-head injury (CHI) patients admitted for acute rehabilitation. The subjects' age, length of coma, time post-injury and Orientation Group Monitoring System (OGMS) subscale and aggregate scores were evaluated for the ability to predict if and when a patient would clear PTA. The results indicated that the combination of time post-injury and week one OGMS aggregate score provided the best prediction of whether and when PTA would clear. A shorter time from injury to acute rehabilitation was a positive prognostic indicator, accounting for more variance than either age or duration of coma. Whereas the aggregate OGMS score was a better indicator than any of the subscale scores, the results also suggested that specific aspects of cognition have differential predictive power, which may derive from different types of injury to the brain. Although the prediction model was statistically significant, its practical significance was limited. In particular, the high base rate for clearing PTA, 83.7%, attenuated the potential for differential prediction. Finally, this study provided additional support for the construct validity of the OGMS as a measure of cognitive function during the acute phase of recovery from CHI.

The Use of Physical Restraint in Patients with Cerebral Contusion

Behavioral problems resulting in the use of physical restraint is a clinical problem seen in the acute phase of recovery from cerebral contusion. However, little is known about the frequency of physical restraint, factors that might predispose to its use, the pattern of adjunctive psychotropic drugs used or the outcome for patients needing this form of management. In order to examine these issues, a retrospective study of all patients (N = 34) admitted with cerebral contusion to a neurosurgical service over a one-year period was undertaken. Physical restraint was used in twelve patients (35%) for an average length of 4.3 days. The use of physical restraint was associated with presumptive evidence of alcohol abuse or dependence but not with level of consciousness on admission. Restrained patients were frequently prescribed psychotropic drugs during hospitalization. Patients requiring physical restraint stayed in hospital nearly twice as long as those not needing restraint. Close attention to the identification and treatment of alcohol problems and their complications in this population may reduce the need for physical restraint and shorten length of hospital stay.

Different Perspectives: The Effect of Heart Disease on Patients and Spouses

Nurses working in critical care units play an important role in helping patients and their families cope with illness. In this article, heart disease is used as a paradigm for discussion of the coping processes of patients and families as they adapt to an acute event. Patients and spouses demonstrate different but equally important responses that may increase marital conflict and impede recovery. The denial frequently used by patients is in direct contrast to the oversolicitousness demonstrated by spouses. Early assessment of potential family dysfunction is essential in order to plan and implement interventions that promote family coping. In this article, the interventions available to nurses working with families in an acute care setting are reviewed. Interview data from one study of cardiac patients and their spouses is used to illustrate the family dynamics seen in the acute and chronic phase of recovery and to provide examples of the couples' differing perspectives on the helpfulness of various interventions.

Semantic sensitivity in the acute phase of recovery from moderate and severe closed head injury.

Semantic sensitivity in the acute phase of recovery from moderate and severe closed head injury.

Semantic sensitivity in the acute phase of recovery from moderate and severe closed head injury.

Semantic sensitivity in the acute phase of recovery from moderate and severe closed head injury.

Abstract and concrete thinking in schizophrenia during the prechronic phases.

Ninety-five psychiatric inpatients (25 schizophrenic, 23 borderline, and 47 nonschizophrenic patients) were assessed on six indices of abstract and concrete thinking, during two stages of their disorder (acute phase and phase of partial recovery). The level of abstract and concrete thinking in nonchronic patients was influenced by several factors. (1) During the prechronic phases diagnosis (schizophrenic vs nonschizophrenic) exerted some influence, but was not the most prominent factor. Evidence suggested, however, that during later chronic phases schizophrenic subjects may be extremely concrete. (2) Process schizophrenics tended to be less abstract than reactive schizophrenics. (3) The phase of the disorder exerted some influence (during active or acutely disturbed stages patients were less abstract). (4) The most powerful influence on the abstract-concrete dimension was intelligence. (5) Idiosyncratic thinking was an important negative influence on ability to abstract.

Hydroxyurea effects in the C3H mouse. II. Mammary tumor cell kinetics.

ABSTRACTThe cellular kinetics of C3H mouse mammary tumors were studied following a single dose (3 mg/g body weight) of hydroxyurea (HU). This dose was large enough to cause a significant perturbation in the growth curves of these tumours. This was accomplished by labeling the cells with tritiated 5‐iodo‐2′‐deoxyuridine and performing detailed autoradiographic analysis. This dose of HU caused a temporary inhibition in growth and completely inhibited DNA synthesis for 4–5 hr. The HU‐killed cells (pyknotic and karyorrhectic) reach a maximum around 10–12 hr and are apparently all removed in about 1 day. Tumors from a fast‐growing line (S102F) showed some evidence for cell synchrony upon recovery from HU inhibition but desynchronization occurred within one cell cycle. The cell generation time was not decreased during the acute recovery phase, but the growth fraction shifted from 0·6 to 1·0, and the data suggested that the normal flow of cells from the proliferating pool to the degenerate pool was temporarily interrupted. The cellular kinetic parameters have probably returned to normal by 48 hr after the HU injection.

The effect of enteral absorption of fluids on the recovery of the blood pressure after severe hemorrhage

Dogs under barbital anesthesia were bled 3.2 per cent of their body weight. Blood pressure tracings from the carotid artery were recorded for one and one-half hours subsequently. The effect of absorption from the intestine of water, physiological salt solution and dog serum was studied on the restoration of the blood pressure. It was found that the absorption of normal saline solution or water did not aid in the recovery of the blood pressure. Animals absorbing dog serum showed a somewhat higher blood pressure than the controls. This difference was not statistically significant. Amounts of the various fluids placed in the intestine were absorbed which if given intravenously would be expected to be of distinct aid in restoring the blood pressure. It is concluded that oral administration of fluids during the acute phase of recovery from severe hemorrhage is not of material assistance to the organism as far as the immediate restoration of blood pressure is concerned.