Objective To systematically review the effectiveness of early rehabilitation nursing in improving outcomes for traumatic brain injury (TBI). Methods We searched the China National Knowledge Infrastructure, Wanfang, VIP, China Biomedical Literature Database, Cochrane Library, Web of Science, Embase, and PubMed databases for randomized controlled trials evaluating the effectiveness of early rehabilitation nursing (or combined with usual nursing) versus usual nursing for improving outcomes in patients with TBI. The search period spanned from January 1, 2020, to January 1, 2025. Two research evaluators independently screened the literature, extracted data from included studies, and assessed study quality according to Cochrane Collaboration standards. Meta-analysis was performed using Stata 18.0 software. Results A total of 24 studies involving 2088 patients were included, with 1044 patients in each of the trial and control groups. Meta-analysis results showed that, compared with the control group, the trial group had significantly higher post-intervention scores on the Glasgow Coma Scale [mean difference (MD)=2.93, 95% confidence interval (CI) (2.47, 3.40), P<0.001], Activities of Daily Living Scale [MD=12.68, 95%CI (10.33, 15.03), P<0.001], and Fugl-Meyer Assessment of Limb Function [MD=13.04, 95%CI (8.27, 17.81), P<0.001], and lower post-intervention scores on the National Institutes of Health Stroke Scale [MD=−4.37, 95%CI (−5.27, −3.46), P<0.001] and Self-rating Depression Scale [MD=−8.91, 95%CI (−14.26, −3.56), P=0.001], but the difference in Self-rating Anxiety Scale score was not statistically significant between the two groups [MD=−6.62, 95%CI (−13.49, 0.26), P=0.059]. Conclusions Early rehabilitation nursing is effective in improving neurological function, enhancing independence in activities of daily living, alleviating physical impairments, and reducing depression symptoms in patients with TBI. It is worthy of clinical implementation.
ObjectiveTo explore the application value of Furlow palatoplasty in reconstruction of velopharyngeal insufficiency (VPI) after cleft palate surgery.MethodsBetween August 2015 and January 2017, 48 patients with VPI after cleft palate surgery were treated with Furlow palatoplasty. There were 29 males and 19 females, aged from 4 to 17 years (mean, 6.1 years). There were 16 cases of incomplete cleft palate and 32 cases of complete cleft palate; and 16 cases of soft cleft palate and 32 cases of soft and hard cleft palate. The interval between first cleft palate surgery and Furlow palatoplasty was 3 to 13 years (mean, 5.9 years). The patients were accompanied by significant open rhinolalia and nasal leakage. The degree of velopharyngeal closure assessed by electronic nasopharyngeal fiberoptic endoscopy was grade Ⅲ. The operation time and intraoperative blood loss were recorded. The total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch were measured before operation and at immediate after operation, and the change of the above indexes before and after operation was calculated. According to the results of clinical assessment, the patients were allocated into three groups: velopharyngeal competence (VPC) group, marginal velopharyngeal inadequacy (MVPI) group, and VPI group. The relationship between the soft palate and the posterior pharyngeal wall was evaluated by lateral cephalometric radiographs at 3 months after operation, and the patients were allocated into complete contact group, point contact group, and non-contact group. The velopharyngeal closure was evaluated by electronic nasopharyngeal fiberoptic endoscopy (grade Ⅰ, Ⅱ, Ⅲ). Spearman analysis was used to analyze the correlation between the changes of the total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch before and after operation. The contact degree of soft palate and posterior pharyngeal wall and the closure degree of pharynx and palate were grouped separately, and the above indexes were analyzed statistically.ResultsThe operation time was 35-64 minutes (mean, 41 minutes); the intraoperative blood loss was 3-10 mL (mean, 6 mL). All patients were followed up 3 months. After 3 months of operation, the clinical evaluation results were 34 cases of VPC, 7 cases of MVPI, and 7 cases of VPI. Lateral cephalometric radiographs showed that 30 cases had complete contact with the posterior pharyngeal wall, 11 cases had point contact, and 7 cases had no contact. Electronic nasopharyngeal fiberoptic endoscopy showed that the pharyngeal closure function was improved to varying degrees, 29 cases of grade Ⅰ, 12 cases of grade Ⅱ, and 7 cases of grade Ⅲ. There were significant differences in the total length of palate, the length of soft palate, the depth of pharyngeal cavity, and the width of pharynx and palate arch between pre- and post-operation (P<0.05). Spearman correlation analysis showed a correlation between the change in the total length of palate before and after operation and the change in the length of soft palate (r=0.448, P=0.001). There were significant differences in the changes of total length of palate, the length soft palate, and the depth of pharyngeal cavity before and after operation between VPC, MVPI, and VPI groups (P<0.05); and there was no significant difference in the change of the width of pharynx and palate arch before and after operation between groups (P>0.05). There were significant differences in the changes of total length of palate and the length soft palate before and after operation between complete contact, point contact, and non-contact groups (P<0.05); and there was no significant difference in the change of the depth of pharyngeal cavity and the width of pharynx and palate arch before and after operation between groups (P>0.05).ConclusionFurlow palatoplasty can restore the VPI after cleft palate surgery, which can effectively prolong the soft palate and reduce the depth of the pharynx. It can cover the physiological and anatomical morphology of velopharyngeal closure significantly and improve the velopharyngeal function.