SUMMARY:The past decade has seen impressive advances in the types of neuroimaging information that can be acquired in patients with traumatic brain injury. However, despite this increase in information, understanding of the contribution of this information to prognostic accuracy and treatment pathways for patients is limited. Available techniques often allow us to infer the presence of microscopic changes indicative of alterations in physiology and function in brain tissue. However, because histologic confirmation is typically lacking, conclusions reached by using these techniques remain solely inferential in almost all cases. Hence, a need exists for validation of these techniques by using data from large population samples that are obtained in a uniform manner, analyzed according to well-accepted procedures, and correlated with closely monitored clinical outcomes. At present, many of these approaches remain confined to population-based research rather than diagnosis at an individual level, particularly with regard to traumatic brain injury that is mild or moderate in degree. A need and a priority exist for patient-centered tools that will allow advanced neuroimaging tools to be brought into clinical settings. One barrier to developing these tools is a lack of an age-, sex-, and comorbidities-stratified, sequence-specific, reference imaging data base that could provide a clear understanding of normal variations across populations. Such a data base would provide researchers and clinicians with the information necessary to develop computational tools for the patient-based interpretation of advanced neuroimaging studies in the clinical setting.The recent "Joint ASNR-ACR HII-ASFNR TBI Workshop: Bringing Advanced Neuroimaging for Traumatic Brain Injury into the Clinic" on May 23, 2014, in Montreal, Quebec, Canada, brought together neuroradiologists, neurologists, psychiatrists, neuropsychologists, neuroimaging scientists, members of the National Institute of Neurologic Disorders and Stroke, industry representatives, and other traumatic brain injury stakeholders to attempt to reach consensus on issues related to and develop consensus recommendations in terms of creating both a well-characterized normative data base of comprehensive imaging and ancillary data to serve as a reference for tools that will allow interpretation of advanced neuroimaging tests at an individual level of a patient with traumatic brain injury. The workshop involved discussions concerning the following: 1) designation of the policies and infrastructure needed for a normative data base, 2) principles for characterizing normal control subjects, and 3) standardizing research neuroimaging protocols for traumatic brain injury. The present article summarizes these recommendations and examines practical steps to achieve them.
This article examines the evidence linking handwashing practices with hospital-acquired infections, the basis for the selection of an appropriate handwashing agent, and ways in which health-care workers may be encouraged to comply with handwashing.
Safe infection control practice implies that caregivers have an insight into the factors that contribute to hospital-acquired infections which enables them to provide informed care and examine patient treatment outcomes. However, results of recent studies suggest that this is far from the case. This article examines why this area of nursing knowledge and practice has remained unquestioned and urges for an examination of how nurses are prepared for safe, informed infection control practice.
The article is based on a research study examining infection control in nurse education and practice. A survey of a large population was carried out to establish the perceived importance of microbiological knowledge to nurses and to ascertain whether this knowledge was present. The results suggest that although microbiological knowledge is considered necessary for safe infection control practice, nurses' actual knowledge falls far short of the level required for 'informed' practice. What this implies in relation to patient care, and recommendations regarding education and practice, are discussed.
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