The national DBS brain tissue network pilot study: need for more tissue and more standardization.

Over 70,000 DBS devices have been implanted worldwide; however, there remains a paucity of well-characterized post-mortem DBS brains available to researchers. We propose that the overall understanding of DBS can be improved through the establishment of a Deep Brain Stimulation-Brain Tissue Network (DBS-BTN), which will further our understanding of DBS and brain function. The objectives of the tissue bank are twofold: (a) to provide a complete (clinical, imaging and pathological) database for DBS brain tissue samples, and (b) to make available DBS tissue samples to researchers, which will help our understanding of disease and underlying brain circuitry. Standard operating procedures for processing DBS brains were developed as part of the pilot project. Complete data files were created for individual patients and included demographic information, clinical information, imaging data, pathology, and DBS lead locations/settings. 19 DBS brains were collected from 11 geographically dispersed centers from across the U.S. The average age at the time of death was 69.3 years (51-92, with a standard deviation or SD of 10.13). The male:female ratio was almost 3:1. Average post-mortem interval from death to brain collection was 10.6 h (SD of 7.17). The DBS targets included: subthalamic nucleus, globus pallidus interna, and ventralis intermedius nucleus of the thalamus. In 16.7% of cases the clinical diagnosis failed to match the pathological diagnosis. We provide neuropathological findings from the cohort, and perilead responses to DBS. One of the most important observations made in this pilot study was the missing data, which was approximately 25% of all available data fields. Preliminary results demonstrated the feasibility and utility of creating a National DBS-BTN resource for the scientific community. We plan to improve our techniques to remedy omitted clinical/research data, and expand the Network to include a larger donor pool. We will enhance sample preparation to facilitate advanced molecular studies and progenitor cell retrieval.

Immobilizing the cervical spine using a collar. Complications and nursing management.

Using a collar to immobilize the cervical spine is a standard health care intervention for patients with cervical spine injuries. Although there is little research into the nature and extent of possible iatrogenic complications resulting from this intervention, anecdotal information suggests that prolonged use a cervical collar may case skin ulcers and infections. Further, the stabilizing effect of a cervical collar may impart a false sense of security as it permits fine flexion and extension movements. Compounding the potential untoward effects of this intervention, is the lack of research concerning nursing care implications. As a first step to examining the problem, the author surveyed trauma and neuroscience centres throughout Canada to determine: what immobilization devices are currently used; patient problems associated with these devices; nursing care interventions employed including hygiene and transfer techniques; and the outcomes of these interventions. The findings describe the relative efficacy of different products and nursing interventions as reported by the surveyed groups. Further, the findings offer direction for future research that will quantitatively investigate the patient care outcomes associated with specific interventions.