Mental Injury Research Articles

A Contemporary Analysis of Delayed Diagnoses After Traumatic Injury : The Role of Operative Therapy.

Factors associated with delayed injury diagnosis (DID) have been examined, but incompletely researched. We evaluated demographics, mechanism, and measures of mental status and injury severity among 10 years' worth of adult trauma patients at our center for association with DID in a multivariable regression model. Descriptions of DID injuries were reviewed to highlight characteristics of these injuries. We included 13 509 patients, 89 (0.7%) of whom had a recognized DID. In regression analysis, ISS (OR 1.04 per point, 95% CI 1.02-1.06) and number of injuries (OR 1.08 per injury, 95% CI 1.04-1.11) were associated with DID. Operative patients had twice the odds of DID (OR 2.02, 95% CI 1.18-3.44). The most common category of DID was orthopedic extremity injury (22/89). DID is associated with injury severity and operative intervention. This suggests that the presence of an injury requiring operation may distract the trauma team from additional injuries.

Some remarks derived from the preparatory stages of the 1974 Athens Convention and its 2002 protocol

The preparatory stages of the 2002 Athens Convention are helpful in finding answers to some of the questions of interpretation. Within this context, the observations and the decisions of the IMO Legal Committee, as well as the proposals and observations submitted by the delegations participating its sessions during the preparation of the draft text of the 2002 Protocol, might guide one to draw a conclusion. Among these questions exist the manner of application of the provision regarding the liability of the carrier in terms of the contributory fault or neglect of the passenger, or his or hers mental injury, or the possibility of maintenance of personal accident insurance. Additionally, the 1974 Athens Conference might also be regarded as helpful in order to interpret the rules relating to the performing carrier and the situation of the gratuitous carriage in terms of the Convention.

Transoral Endoscopic Thyroidectomy via Vestibular Approach With 4 Trocars: A New Technique.

The objective of this study was to report the feasibility and safety of a novel 4-trocar approach for transoral endoscopic thyroidectomy via the vestibular. In this study, we first used 4 trocars via vestibular area to perform transoral endoscopic thyroidectomy. We reported the safety and surgical feasibility of transoral endoscopic thyroidectomy using a 4-trocar technique in our institute from February 1, 2020, to May 10, 2020. Transoral endoscopic thyroidectomy via the vestibular approach using 4 trocars was carried out in 5 patients. No complications such as bleeding, mental nerve injury, recurrent laryngeal nerve injury, or hypoparathyroidism were reported. All patients were completely satisfied with the cosmetic results. Transoral endoscopic thyroidectomy with 4 trocars via vestibular approach is an effective and feasible method. Markedly, this technique can assist surgeons to expose and preserve both parathyroid glands and recurrent laryngeal nerve easily when performing transoral endoscopic thyroidectomy.

Anatomic Variations From 120 Mental Nerve Dissections: Lessons for Transoral Thyroidectomy

BackgroundTransoral endoscopic thyroidectomy vestibular approach (TOETVA) is a promising technique for eliminating a neck incision. A new risk of TOETVA is the potential for injury to the mental nerves during placement of three oral endoscopic ports. A better understanding of the variations in mental nerve anatomy is needed to inform safer TOETVA technique. Materials and methodsWe performed 120 dissections of mental nerve branches exiting the mental foramen in 60 human cadavers. Anatomic distances and relationships of the foramen to the midline were evaluated. Mental nerve branching patterns were studied and compared with previously reported classification systems to determine surgical safe zones free of nerve branches. ResultsThe mean midline-to-mental foramen distance was 29.2 ± 3.3 mm, with high variability across individuals (18.8-36.8 mm). There were differences in this distance between the left and right foramina (29.8 ± 3.2 versus 28.8 ± 3.3 mm, P = 0.03). All mental nerve branches exiting the mental foramen distributed medially. The branching patterns were classified into eight distinct categories, three of which are previously undescribed. One of these novel patterns, occurring in 9.2% of cases, had a dense and wide clustering of branches traveling toward the midline. ConclusionsThe location of the mental foramen and mental nerve branching patterns demonstrate high variability. To avoid mental nerve injury in TOETVA, we identify a safe zone for lateral port placement lateral to the plane of the mental foramen. Placement and extension of the middle port incision should proceed with caution, as clustering of mental nerve branches in this area can frequently be present.

Sensory, Affective, and Cognitive Effects of Trigeminal Injury in Mice

To characterize adequate study of chronic neuropathic orofacial pain induced by a mental nerve injury in a mouse model, we propose a behavioral assessment of its dimensions: sensory, affective, and cognitive. Trigeminal injury was induced by a chronic mental nerve constriction (MnC). Behavioral tests were conducted to assess the different dimensions of pain and to evaluate the general well-being of mice. Rodents who went through MnC showed signs of mechanical hyperalgesia and increased escape/avoidance behavior. They showed no alterations in general well-being behaviors, yet the injury was sufficient to induce impairment in the ability to adapt to the environmental requirements. MnC injury is an efficient model for the study of orofacial pain in mice, capable of inducing impairment in the different dimensions of pain. Intensity and temporality of its effects make our model less aggressive, yet effective to generate cognitive impairment. This work provides a solid foundation for the study of the neural circuits involved in the processing of neuropathic orofacial pain.

Veterans suffering from post-traumatic stress disorder – literature analyzing: symptoms, statistics and therapies

Introduction: Post-traumatic stress disorder (PTSD) is a condition that affects 10-20% of people who will experience a serious mental injury in their lives. Soldiers are one of the most vulnerable social groups to develop PTSD as they reach several factors which may induce the PTSD. The aim of the study: The purpose of this work was to find literature on PTSD among people in the military service. Material and method: Literature has been found and selected among articles found in the websides such as PubMed and Google Scholar. Description of the state of knowledge: Literature describes both - factors predisposing to PTSD, and describtions of numerous methods of therapy for soldiers such as cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), cognitive processing therapy (CPT) and Exposure Therapy. In addition, the literature provides many innovative methods to help combat the PTSD. It is important not only to inform the soldier about the therapy, but also to enable him to undergo it regularly. It is worth mentioning, for example, video to home - VTH, which is an extension of Exposure Therapy. Thanks to it, even if someone for some reason cannot participate in therapy in the place where it takes place, it can be done at home without fear of getting to the therapy. Summary: There are many methods of PTSD therapy. In addition to pharmacological, psychotherapy is very important. Soldiers should undergo these therapies and should be encouraged to complete cycles so that they can feel the effects of the therapy.

Main directions and types of medical rehabilitation

Medical rehabilitation refers to the process of systematic and continuous restoration of a patient’s physical and mental health and ability to work, basis for the development of which is physical or mental injuries, occupational diseases, or severe organic lesions of organs and systems. The purpose of medical rehabilitation is to organize quick and effective return of the patients to society to fulfill work skills and domestic functions which they lost. The main objective of medical rehabilitation is prevention of disability, recovery and extension of active life, social integration and ensuring the proper level of quality of life. The “maximum” program during medical rehabilitation consists in achieving the full social and everyday level that existed before the disease or injury; the “minimum” program is to ensure the patient’s ability to elementary self-care.

Hospitalizations among children involved in the child protection system: A long-term birth cohort study from infancy to adulthood using administrative data

BackgroundDespite considerable health consequences of child abuse and neglect, there is limited evidence on hospitalizations in this population. ObjectivesTo describe frequency and reasons for hospitalization by lifetime child protection system (CPS) involvement. Participants608,540 children born from January 1, 1986 to June 30, 2017 in South Australia, Australia MethodsUsing linked administrative data on CPS involvement and hospitalizations, we descriptively examined cumulative incidence, cumulative count and reasons for hospitalization from infancy to early adulthood by CPS involvement. ResultsBy 16.5 years of age, cumulative incidence of ever-being hospitalized was 58% (95% CI 58-58) for children with no CPS involvement and significantly higher (72% (95% CI 71-73) to 88% (95% CI 86-90), P < 0.001) among those with different levels of CPS involvement. Cumulative mean counts of hospitalizations were highest at every age for those placed in out-of-home-care (reaching 7.7 by 16.5 years), almost four times higher than for children with no CPS involvement (2.0 by 16.5 years). Most frequent reasons for hospitalizations were similar across CPS involvement in the early years. From adolescence through early adulthood, mental health, and ‘injury, poisoning or toxic effects of drugs’ were frequent reasons for hospitalization among individuals with CPS involvement. ConclusionsThis study highlights the vulnerability of children who have been maltreated, or are at risk of maltreatment, and the urgency of implementing effective preventive strategies early in life including consideration of adequate responses of child protection services. Frequent hospitalizations for mental health and injury confirms the potentially preventable nature of these hospitalizations.

Sensory change in the chin and neck after transoral thyroidectomy: Prospective study of mental nerve injury.

The study aimed to evaluate the sensory changes on the chin and neck in transoral thyroidectomy. We prospectively assessed the cutaneous sensation of 10 zones of the chin, face, and neck in 43 patients who underwent transoral robotic or endoscopic thyroidectomy using the Semmes-Weinstein monofilaments test, preoperatively and postoperatively at 1 week, 1 month, and 3 months. The sensation of the chin and lower lip did not differ before and after surgery. However, the pressure threshold of the submental and level VI area increased significantly after surgery, and returned to the preoperative level 1 month and 3 months postoperatively, respectively. In terms of mental nerve injury, transoral thyroidectomy is safe when performed successfully. However, proper placement of oral vestibular incisions and minimal dissection of the chin is essential to avoid mental nerve injury.

A-40 Predictors of Failed Effort Testing at Initial Clinic Visit for Concussion Rehabilitation and Outcomes

Abstract Objective Neuropsychological evaluation of concussion typically includes performance validity testing to assess effort. The aim of this study was to explore the usefulness of effort testing as part of initial screening for concussion rehabilitation, including determining the factors that predict effort testing and evaluate outcomes between “good effort” and “failed effort” groups. Method Records of 76 patients aged 16–66 years old (M = 40.58 years, SD = 14.18) seen for rehabilitation of non-sport concussion from 2018–2019 were reviewed. Patients completed clinical interview, neurocognitive screening (ImPACT), effort testing (Word Memory Test), vestibular/oculomotor screening (VOMS), and the post-concussion symptom scale (PCSS). A logistic regression (LR) was conducted to predict effort, with predictors including mental health history, secondary gain, work injury, days post-injury, and PCSS. A series of one-way ANOVAs evaluated outcomes from concussion rehabilitation between the good and failed effort groups. Results Failed effort occurred in 42% of cases. The LR accurately classified 81.8% of individuals, with mental health history (p = .01) and PCSS (p = .02) as the only significant predictors of effort. There were no differences in recovery time (p = .56) between effort groups, but the failed effort group took longer to return to work (p = .03). Half of individuals who failed effort were seen until discharge, and 69% of them reported no symptoms/mild symptoms at discharge. Conclusions Failure of effort testing was predicted by a history of mental health and high symptom burden. Individuals who fail effort testing at initial visit for concussion rehabilitation take longer to return to functional activity but are capable of achieving recovery with compliance and appropriate rehabilitation.

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) for Thyroid Nodules: A Series of the First 10 Patients in a Single Institution

ABSTRACT&#x0D; Objective: To present the perioperative data of patients with solitary or multinodular goiter and/ or papillary thyroid carcinoma who underwent Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in a single tertiary medical center.&#x0D; Methods: &#x0D; Design: Case series&#x0D; Setting: Tertiary Government Hospital&#x0D; Participants: Records of 10 patients who underwent TOETVA from June 2018 to July 2019 (9 thyroid lobectomies, 1 total thyroidectomy) were reviewed. Outcomes and measures included conversion to open surgery, operative time, intraoperative blood loss, size of the thyroid gland, postoperative hospital stay, visual analogue pain scores (VAS), and postoperative complications.&#x0D; Results: None of the 10 patients were converted to an open procedure. The average preoperative thyroid size was 4.73 cm in widest diameter using thyroid ultrasound (±1.88 cm, range 3.6 to 6.5 cm). Mean operative time for thyroid lobectomy and total thyroidectomy was 4 hours and 29 minutes and 4 hours and 15 minutes, respectively. Mean intraoperative blood loss was 140 ml (±47.96 ml, range 80 to 200 ml) for thyroid lobectomy and 100 ml for total thyroidectomy. The average intraoperative size of the thyroid gland measured in widest diameter (larger lobe for total thyroidectomy) was 4.48 cm (±0.919 cm, range 3 to 5.5 cm). Median postoperative hospital stay was 2 days (±1.55 days, range 2 to 12 days). Mean VAS pain scores for postoperative days 1, 2, 3, and 7 were 5, 3, 2, and 0, respectively. Transient recurrent laryngeal nerve injury (of 3 months duration) occurred in 1 patient. Two cases had surgical site infection, 2 had wound dehiscence, 1 had seroma and 1 had skin burn as a complication. None had hypocalcemia or mental nerve injury in the series.&#x0D; Conclusions: TOETVA was replicated in the local setting and a presentation of the perioperative data of all the patients who underwent this novel technique, the indications, as well as surgical and patient outcomes, were described.&#x0D; Keywords: TOETVA; thyroidectomy; transoral; endoscopic; minimally invasive

The Influence of Cosmetic Concerns on Patient Preferences for Approaches to Thyroid Lobectomy: A Discrete Choice Experiment.

Background: Newer transoral thyroidectomy techniques that aim to avoid scars in the neck and maximize cosmetic outcomes have become more prevalent. We conducted a discrete choice experiment (DCE) to evaluate the influence of cosmetic concerns and other factors on patients' decision-making processes when choosing among different thyroidectomy approaches. Methods: A questionnaire was developed to identify key attributes driving patient preferences around thyroidectomy approaches using mixed analyses of patient focus groups, expert opinion, and literature review. These attributes included (i) risk of recurrent laryngeal nerve (RLN) injury, (ii) risk of mental nerve injury, (iii) travel distance for surgery, (iv) out-of-pocket cost, and (v) incision site. Using fractional factorial design, discrete choice sets consisting of randomly generated hypothetical scenarios across all attributes were created. A face-to-face DCE survey was administered to patients being evaluated in clinic for thyroid lobectomy for noncancerous thyroid disease. Participants chose among scenarios constructed from the choice sets of attributes. Analyses were conducted using a mixed logit model, and the trade-offs between different attributes that patients were willing to accept were quantified. Results: The DCE was completed by 109 participants (86 [79%] women; mean age 51.3 ± 3.0 years). Overall, the risk of having RLN and/or mental nerve injury, travel distance, and cost were the most influential attributes. Participants aged ≤60 years significantly preferred an approach without a neck incision and were willing to accept an additional $2332 USD in out-of-pocket cost, 693 miles of travel distance, 0.6% increased risk of RLN injury, and 2.2% risk of mental nerve injury. Patients aged >60 years significantly preferred a conventional neck incision and were willing to pay an additional $3401 out-of-pocket and travel 1011 miles to avoid a scarless approach. Conclusions: The risk of nerve injury, travel distance, and cost were the most important drivers for patients choosing among surgical approaches for thyroidectomy. Cosmetic considerations also influenced patient choices, but in opposing ways depending on patient age.

The Miserable Loss from Yemeni Conflict: Can International Law Provide Reparation for Mental Injury?

As the home of the world’s worst humanitarian crisis, Yemen can be an example to reveal how horrifying the mental health issues in conflicting areas can be. Since 2014, the ongoing conflict in Yemen has been resulting not merely in physical losses and injuries, but also mental catastrophe as its inevitable consequence. This article is a legal research that aims to analyze how mental injuries or psychological damages are being acknowledged as a real impact of armed conflict, to further be considered as a precondition for the reparation at the end of the conflict. The article suggests that the acknowledgment of the mental impacts of armed conflict needs to be taken into concern and consideration, especially from the perspective of hard laws related to the IHL. Besides, the approach of soft law can be applied in attribution with the ongoing conflict in Yemen.

A role for cognitive remediation therapy for job seekers with neuropsychiatric disorders

AbstractPeople with mental illness and traumatic brain injury experience difficulties in gaining and maintaining employment and have a higher unemployment rate because of their symptoms and poor social skills including cognitive impairments. Cognitive remediation is an intervention developed to improve cognitive functioning such as attention, memory, and problem-solving, by providing them with specific designed cognitive exercises. After practicing those cognitive tasks repetitively and massively, people with cognitive deficits will improve cognitive processes which lead to better cognitive performance. There is evidence supporting the benefits of cognitive remediation in improving employment-related outcome. Thus, it might have a role for job seekers with neuropsychiatric disorders and cognitive dysfunctions.

The development of a return to work intervention programme for stroke survivor (SReTWIP): a Delphi survey

BackgroundEven though clearly defined pathways for vocational re-entry are well recognized for conditions such as mental health, musculoskeletal dysfunction (MSD) and traumatic brain injury (TBI), none has been identified for stroke. There has been a lack of consensus regarding such clear pathways to vocational re-entry and the essential contents of return to work (RTW) interventions for stroke survivors. As part of a larger study aimed to design a RTW programme for stroke survivors, this study describes the concluding process through which Stroke Return to Work Intervention Programme (SReTWIP) was developed.MethodsExperts in the field of neurorehabilitation and vocational rehabilitation (VR) from 6 countries participated in this 3-round Delphi survey via e-mail. Concept mapping was used to triangulate findings from the Delphi with previous phases of the larger study. Content thematic analysis was conducted on qualitative data while descriptive statistic was used to analyze quantitative data.ResultsFifteen experts with a mean age and mean duration of practice of 44.73 ± 9.48 years and 18.26 ± 8.71 years respectively participated in this study. The developed RTW programme (SReTWIP) is a 12 week programme that consisted of four interconnected phases of intervention viz.: an assessment phase, clinic-based work and non-work specific intervention phase, a work test placement phase and a client full participation in worker role phase. The experts agreed on a set of implementation strategies that included the use of interdisciplinary team, the tailoring of intervention to meet stroke survivor’s need, as well as the use of case management approach.ConclusionThe SReTWIP is the first step in developing a VR pathway that can ultimately enhance the RTW rates and quick resumption of the worker role of stroke survivors. The stroke survivor can move along the different phases of the SReTWIP after achieving competency in a preceding phase. Future work will include a feasibility study with other key stakeholders involved in RTW such as employers, informal caregivers and stroke survivors before its implementation.

The examination of mental toughness, sleep, mood and injury rates in an Arctic ultra-marathon

There is scarcity of research examining the physiological and psychological effects of ultra-endurance racing on athletes in extreme conditions. The purpose of the current study was to identify common injury patterns and illness, profile mood states and sleep patterns and finally examine the relationships between mental toughness, sleep, mood and injury rates during a 120 mile, three-day Arctic ultra-marathon. Twelve participants (3 females, 9 males) with a mean age of 42 ± 5.35 yrs participated in the study. Mental toughness was measured using the MT18 questionnaire. Injuries were clinically assessed and recorded each day. Temperatures ranged from −20 to −6 degrees Celsius throughout the race. Sleep quantity and mood state were recorded using the BRUMS questionnaire. 10 out of the 12 participants experienced injuries; almost half of the participants had injuries that carried over a number of days. Mean sleep duration over the three days was 4.07 h, with an average of 0.78 injuries per day. Significant changes in mood were recorded across the three days, specifically a reduction in vigour (p = .029) and increase in fatigue (p = .014). Neither sleep quantity nor mental toughness was correlated with injury rate. Interestingly, sleep quantity was not related to changes in mood, as previously shown in ultra-marathons. Mental toughness had a moderate negative correlation (p < 0.01) with depression (−.623), reduced anger (−.616), confusion (−.558), increased vigour (.497) and tension (−.420) during the race. Success in this type of event involves significant psychological and physiological preparation to minimize the effects of sleep deprivation and avoidance of injuries.

What is the Role of Transoral Thyroidectomy?

What is the Role of Transoral Thyroidectomy?

READING THE WOUND: TRAUMA IN LISA SEE’S SHANGHAI GIRLS

The paper is an endeavor to negotiate the implications of trauma which is entrenched in Chinese women’s life through a reading of Lisa See’s Shanghai Girls. It tends to advocate how mental wound surpasses physical agony which creates a rift in a victim’s personality. As trauma is an inseparable part of human challenges, for Chinese women it validates the shadowed part of their existence in a patriarchal society coupled with devastation following war. Various traumatic events engulf Chinese women and psychical trauma enters the mind which remains inseparable from their memory. The novel entails how a person inflicted with severe mental injury negotiate trauma.

Transoral Endoscopic Thyroidectomy Vestibular Approach: An Initial Experience in Vietnam.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be applied to many health facilities worldwide, even in places whose medical facilities have not developed yet. To that end, our hospital is the first hospital to deploy this novel technique in Vietnam. In the study, the authors will evaluate the safety and efficacy of TOETVA, which was initially performed on patients in Vietnam. A TOETVA research was conducted on 28 patients in hospital K from January 1, 2018 to May 31, 2019. The surgical outcomes, cosmetic results, and complications were evaluated. The mean operative time was 91 minutes (70 to 130 min). There were no cases with temporary and permanent hypoparathyroidism in the patients. One patient had temporary mental nerve injury recovered completely after 14-day surgery. No case used drains in patients. All patients were highly satisfied with the surgical outcome, especially, cosmetic results. TOETVA is a safe and feasible technique with acceptable complication rates and good outcomes. The authors will carry on this procedure for selected patients. TOETVA should not only be performed in some countries with well-developed health care systems but also be done in other developing countries worldwide.

Transoral thyroid surgery vestibular approach: does size matter anymore?

Various approaches for endoscopic and minimally invasive thyroid operations have been reported, with some becoming popular to date. The aim of these procedures is to reduce and prevent visible scars in the neck. This led to the transoral endoscopic thyroidectomy vestibular approach (TOETVA) technique applicable in small thyroid specimen. To amend TOETVA and to broaden the indication for transoral thyroid surgery, our aim was to combine the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach. After successful implementation of the TOETVA technique in 2017, we evaluated the transoral technique regarding feasibility and safety in well-selected patients in Germany and Austria. With the combination of TOETVA and EndoCATS, we were able to optimize the extraction process of the specimen by avoiding damage to the thyroid capsule and to broaden the indication of transoral surgery by operating on thyroid glands with higher volume. Patients' characteristics, surgical outcome and complications were determined. Seventy-one transoral procedures were performed in 70 patients. The TOETVA procedure was performed in 60 patients, and 10 female patients underwent TOVARA with transoral thyroid lobe mobilization and removal of the specimen via the retroauricular access. Overall, median operation time was 205min (range 96-370min) and permanent RLNP rate was 1% accordant to 99 nerves at risk (39 hemithyroidectomies, 29 total thyroidectomies, 2 parathyroid resections, and 1 thyroglossal cyst resection). No conversion to conventional open surgery was necessary. Long-term mental nerve injury occurred in two patients. No infection was identified. Transoral thyroid and parathyroid surgery via the vestibular approach is both feasible and safe in Western Europe. The combination of the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach, called TOVARA, is a promising opportunity to allow for thyroid surgery without a visible scar in specimen with volume of more than 40ml also.