Will Decompressive Craniectomies Lead to Worse Outcomes for TBI Victims?

Posted on April 27, 2011 by Kristine Meredith

Decompressive craniectomies are an aggressive surgical strategy increasingly used at trauma centers for victims of diffuse traumatic brain injury. Although surgical methods vary, the decompressive craniectomy involves temporarily removing a portion of the skull to relieve the pressure from the swelling of the injured brain.

As recently reported in the New England Journal of Medicine, results of a randomized trial show that although decompressive craniectomy reduced intracranial pressure and the length of stay in the intensive care unit, it was also associated with a greater risk for unfavorable outcome at 6 months for patients with diffuse traumatic brain injury (TBI) compared with standard care. The standard care involves lowering the patient's body temperature and administering barbiturates.Rates of death didn't differ between groups, but scores on the Extended Glasgow Outcomes Scale were lower in the group undergoing bifrontotemporoparietal craniectomy, and there was a significant increase in risk, more than double, for an unfavorable outcome on that same scale, the researchers report. The unfavorable outcomes included vegetative state and conscious but disabled.

Our findings differ from those of most nonrandomized studies and are contrary to our hypothesis," the researchers, with lead study author D. James Cooper, MD, from the Department of Intensive Care at Alfred Hospital, Monash University, in Melbourne, Australia, acknowledge. " Our unexpected findings underscore the critical importance of performing such trials to test common therapies, particularly in patients with complex critical illnesses."

Experts stress that that the procedure should not be abandoned on the basis of these results. Surgeons must think more carefully about the risks and benefits of the decompressive craniectomy before performing the procedure and must work to further define appropriate clinical settings for this procedure.
 

 

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PG&E Says Its Rights Are Being Violated

Posted on April 19, 2011 by Mike Danko

Without a judge to preside over their claims, the San Bruno fire victims' lawsuits have, up until now, been in limbo. That will soon change, as Judge Steven Dylina has just been assigned to hear all the suits arising from the PG&E fire, wherever those suits may have been filed. The first hearing in the cases should be scheduled within the next two weeks. The order assigning Judge Dylina is here.

Meanwhile, the California Public Utilities Commision continues to investigate PG&E's management and maintenance practices. But PG&E is already crying foul. According to Steve Johnson's latest article in the San Jose Mercury News, PG&E objects to the CPUC's "tone":

In a testy response to the commission's order that by Monday it answer questions about its record-keeping practices, PG&E's attorneys said the agency seems to be starting "with a presumption of guilt" that is "contrary to American precepts of due process."

It's a bit ironic to hear PG&E complain that it has not been afforded "due process," given that its victims have been waiting for months for their chance to be heard at all. 

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Cal-OSHA and the Homeowner

Posted on April 11, 2011 by Kristine Meredith

Homeowners who hire workers must comply with Cal-OSHA safety regulations. Those regulations require the homeowner, as an employer, to furnish a “safe and healthful” place of employment. “Employment” means "the carrying on of any trade, enterprise, project, industry, business, occupation, or work, including all excavation, demolition, and construction work, or any process or operation in any way related thereto, in which any person is engaged or permitted to work for hire, except household domestic service."

The question, then, is what type of work qualifies as “construction” (so that Cal-OSHA applies), and what type is “household domestic service” (so that it doesn’t)?

The courts say that “household domestic service” means household maintenance both inside and outside the residence. If a homeowner hires a worker to clean house, garden or trim trees, Cal-OSHA doesn’t apply under the “household domestic services” exception. But the homeowner must comply with Cal-OSHA when hiring workers for extensive remodeling. The Court recently determined that Cal-OSHA applies to a remodeling project calling for the demolition and rebuilding of significant portions of a house and the construction of new rooms. And, the homeowner may be liable for injuries to a worker caused by failure to comply with Cal-OSHA.

Because Cal-OSHA will apply to an extensive remodeling project, the homeowner who handles his own project must be sure to implement and administer his own Cal-OSHA compliance programs, or to hire licensed independent contractors to do that for them, and to place safety compliance obligations squarely with their contractors through appropriate language in the construction agreements.
 

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