response to E!

[louvitti]

Some of you got me wrong. It's not about finding the way to get a pure drug and then get blitzed by making it more powerful. These techniques are all over the net. You can affect your brain and all its pathways. Read the article below about TBI. The use of illegal drugs with other drugs can create compound effects. Yes, at any time your cardio-vascular system could go into a heart attack or stroke. Also, With E! and other drugs, when you wake up do you know what happened or was done to you the night before. Is there a memory loss. I had an excellent psychologist who said that every time you do something, as a substance, be happy you are still alive. I know a lot of you are young and I am concerned about your well being. I was once where you are today and yes, I got blitzed, but those were different times and the available paraphanalia out there was not as strong or synthetically made. There was green, other things and Woodstock. Today, many of the items out there are addictive and cheaper than green. There is something wrong about what I just said. Cheaper items are more expensive. Who is making us an addictive dependent group of people. There are many answers. Please-Be Careful about your temple-YOU.

Rehabilitation for Traumatic Brain Injury
Summary
Evidence Report/Technology Assessment: Number 2

Please Note: The evidence report this summary was derived from has not been updated within the past 5 years and is therefore no longer considered current. It is maintained for archival purposes only.

Under its Evidence-based Practice Program, the Agency for Health Care Policy and Research (AHCPR) is developing scientific information for other agencies and organizations on which to base clinical guidelines, performance measures, and other quality improvement tools. Contractor institutions review all relevant scientific literature on assigned clinical care topics and produce evidence reports and technology assessments, conduct research on methodologies and the effectiveness of their implementation, and participate in technical assistance activities.

Overview / Impact of TBI / Key Questions / Reporting the Evidence / Methodology / Findings / Future Research / Availability of Full Report

Overview

Advances in medical technology and improvements in regional trauma services have increased the number of survivors of traumatic brain injury (TBI), producing the social consequences and medical challenges of a growing pool of people with disabilities. Wider awareness of the scope of the problem and its consequences for society has led to rapid growth in the rehabilitation industry. Because of this growth and particularly because clinical rehabilitation strategies vary widely, many groups are interested in the effectiveness of rehabilitation for TBI.

To address this need to identify and assess evidence on TBI rehabilitation, the Agency for Health Care Policy and Research (AHCPR) awarded a contract to Oregon Health Sciences University for a review of published reports and compilation of an evidence report. This summary highlights information presented in the full report.

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Impact of Traumatic Brain Injury

Injury is the leading cause of mortality among Americans under 45 years of age; TBI is responsible for the majority of these deaths. An estimated 56,000 lives are lost in the United States each year to TBI. Motor vehicle accidents, followed by gunshot injuries and falls, are the leading causes of injuries resulting in death from TBI. Males are 3.4 times as likely as females to die of TBI. About 50 percent of people who sustain TBI are intoxicated at the time of injury.

In a recent analysis based on hospital discharge data and vital statistics, the annual incidence of TBI in the United States was estimated to be 102.8 per 100,000. In males, the incidence peaks between the ages of 15 and 24 (248.3 per 100,000) and again above 75 years of age (243.4 per 100,000). The incidence in females peaks in the same age groups, but the absolute rates are lower (101.6 and 154.9, respectively). These rates underestimate the true incidence of head trauma because patients with milder symptoms at the time of injury are usually not hospitalized.

About three-quarters of traumatic brain injuries that require hospitalization are nonfatal. Each year, about 80,000 survivors of TBI will incur some disability or require increased medical care. Direct medical costs for TBI treatment have been estimated at $48.3 billion per year, including the costs of hospitalization for acute care and various rehabilitation services.

In the years 1988 to 1992, reports of average length of stay (LOS) for the initial admission for inpatient rehabilitation range from 40 to 165 days. In one multicenter study (the Model Systems study), the average rehabilitation LOS was 61 days, and the average charge was $64,648 exclusive of physician fees. Total charges averaged $154,256. In more recent studies performed in the early 1990s, rehabilitation LOS and charges were lower, ranging from 19 days and $24,000 for patients with milder injuries to 27 days and $38,000 for those with severe injuries. In the Medicare population in 1994, mean charges for patients admitted for brain injury (excluding stroke) were $42,056.

To focus attention on important questions, the life of an adult survivor of TBI was characterized by the developers of the report in terms of five phases. The first phase is pre-injury. Medical treatment is divided into two phases: the acute (or immediate) treatment phase and the intensive treatment phase, lasting days to weeks. The rehabilitation phase may last months to years. The survivor phase implies the remaining life of the person with TBI and involves continual development and adjustment. This division into phases clarifies the three challenges to assessing the efficacy of rehabilitation discussed above. For each phase, patient populations, interventions, and outcome measures were identified, and the literature was reviewed to answer key questions identified by technical experts.

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Key Questions About Traumatic Brain Injury

The following three questions about the status of brain injury research underlie uncertainty about the effectiveness of rehabilitation services.

1. How should fundamental concepts such as recovery, functional status, and disability be defined? Because brain function is highly complex, TBI has an extremely wide range of potential outcomes, including cognitive deficits, motor disabilities, emotional and social dysfunction, personality changes, and changes in appearance. As a result, therapeutic aims and perspectives vary widely among studies, as do definitions of outcomes, making valid comparisons across studies difficult.
2. How should the type and severity of the injury itself be measured? Variations in methods to assess the severity of injury in patients entering rehabilitation make it difficult to estimate the effectiveness of different rehabilitation methods.
3. Which therapies are effective, and what is the best way to match patients with treatment approaches likely to be effective for them?

Today, a person's path to rehabilitation after sustaining brain injury may be determined by the mechanism of injury, the resources of the community, the person's employment or financial status, the consent of the family, and/or the accuracy of the emergency department diagnosis. While a few metropolitan areas have organized referral systems that connect patients with resources and rehabilitation programs, systematic methods for evaluating the needs of people who have sustained brain injury and referring them to appropriate programs are unusual. Without knowing the efficacy of rehabilitation methods in their specific applications, systematic referral that produces the desired result is not possible.

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Reporting the Evidence
DON'T LET IT HAPPEN TO YOU-THINK!