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https://www.readbyqxmd.com/read/28211020/goal-directed-fluid-restriction-during-brain-surgery-a-prospective-randomized-controlled-trial
#1
Jinfeng Luo, Jing Xue, Jin Liu, Bin Liu, Li Liu, Guo Chen
BACKGROUND: The value of goal-directed fluid therapy in neurosurgical patients, where brain swelling is a major concern, is unknown. The aim of our study was to evaluate the effect of an intraoperative goal-directed fluid restriction (GDFR) strategy on the postoperative outcome of high-risk patients undergoing brain surgery. METHODS: High-risk patients undergoing brain surgery were randomly assigned to a usual care group (control group) or a GDFR group. In the GDFR group, (1) fluid maintenance was restricted to 3 ml/kg/h of a crystalloid solution and (2) colloid boluses were allowed only in case of hypotension associated with a low cardiac index and a high stroke volume variation...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28207400/a-low-cost-adaptive-balance-training-platform-for-stroke-patients-a-usability-study
#2
Sunny Verma, Deepesh Kumar, Animesh Kumawat, Anirban Dutta, Uttama Lahiri
Stroke patients usually suffer from asymmetric posture due to hemi-paresis that can result in reduced postural controllability leading to a balance deficit. This deficit increases the risk of falls, which often makes them dependent on caregivers for community ambulation, thus deteriorating their quality of life. Conventional balance training involves rehabilitation exercises performed under physiotherapist's supervision where the scarcity of trained professionals as well as the cost of clinic-based rehabilitation programs can deter stroke survivors from undergoing regular balance training...
February 9, 2017: IEEE Transactions on Neural Systems and Rehabilitation Engineering
https://www.readbyqxmd.com/read/28206829/validity-of-low-contrast-letter-acuity-as-a-visual-performance-outcome-measure-for-multiple-sclerosis
#3
Laura J Balcer, Jenelle Raynowska, Rachel Nolan, Steven L Galetta, Raju Kapoor, Ralph Benedict, Glenn Phillips, Nicholas LaRocca, Lynn Hudson, Richard Rudick
Low-contrast letter acuity (LCLA) has emerged as the leading outcome measure to assess visual disability in multiple sclerosis (MS) research. As visual dysfunction is one of the most common manifestations of MS, sensitive visual outcome measures are important in examining the effect of treatment. Low-contrast acuity captures visual loss not seen in high-contrast visual acuity (HCVA) measurements. These issues are addressed by the MS Outcome Assessments Consortium (MSOAC), including representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS...
February 1, 2017: Multiple Sclerosis: Clinical and Laboratory Research
https://www.readbyqxmd.com/read/28206828/validity-of-the-timed-25-foot-walk-as-an-ambulatory-performance-outcome-measure-for-multiple-sclerosis
#4
Robert W Motl, Jeffrey A Cohen, Ralph Benedict, Glenn Phillips, Nicholas LaRocca, Lynn D Hudson, Richard Rudick
The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with multiple sclerosis (MS). One of the MSOAC goals is acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful in MS...
February 1, 2017: Multiple Sclerosis: Clinical and Laboratory Research
https://www.readbyqxmd.com/read/28206827/validity-of-the-symbol-digit-modalities-test-as-a-cognition-performance-outcome-measure-for-multiple-sclerosis
#5
Ralph Hb Benedict, John DeLuca, Glenn Phillips, Nicholas LaRocca, Lynn D Hudson, Richard Rudick
Cognitive and motor performance measures are commonly employed in multiple sclerosis (MS) research, particularly when the purpose is to determine the efficacy of treatment. The increasing focus of new therapies on slowing progression or reversing neurological disability makes the utilization of sensitive, reproducible, and valid measures essential. Processing speed is a basic elemental cognitive function that likely influences downstream processes such as memory. The Multiple Sclerosis Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS...
February 1, 2017: Multiple Sclerosis: Clinical and Laboratory Research
https://www.readbyqxmd.com/read/28206826/the-nine-hole-peg-test-as-a-manual-dexterity-performance-measure-for-multiple-sclerosis
#6
Peter Feys, Ilse Lamers, Gordon Francis, Ralph Benedict, Glenn Phillips, Nicholas LaRocca, Lynn D Hudson, Richard Rudick
Impaired manual dexterity is a frequently reported disability in people with multiple sclerosis (MS) and is increasingly prevalent with worsening disease. While various tests and patient-reported outcome measures are available, the Nine-Hole Peg Test (NHPT) is considered as a gold standard measure of manual dexterity and most frequently used in MS research and clinical practice. The MS Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS...
February 1, 2017: Multiple Sclerosis: Clinical and Laboratory Research
https://www.readbyqxmd.com/read/28198661/cost-effectiveness-of-the-occupation-based-approach-for-subacute-stroke-patients-result-of-a-randomized-controlled-trial
#7
Hirofumi Nagayama, Kounosuke Tomori, Kanta Ohno, Kayoko Takahashi, Ryutaro Nagatani, Ryota Izumi, Kensuke Moriwaki, Keita Yamauchi
BACKGROUND AND PURPOSE: The cost effectiveness of occupational therapy for subacute stroke patients is unclear in the extant literature. Consequently, this study determined the cost effectiveness of the occupation-based approach using Aid for Decision-Making in Occupation Choice (ADOC) for subacute stroke patients compared with an impairment-based approach. METHODS: We conducted an economic evaluation from a societal perspective alongside a pilot randomized controlled trial, with a single blind assessor for participants in 10 subacute rehabilitation units in Japan...
February 15, 2017: Topics in Stroke Rehabilitation
https://www.readbyqxmd.com/read/28197341/a-mixed-methods-small-pilot-study-to-describe-the-effects-of-upper-limb-training-using-a-virtual-reality-gaming-system-in-people-with-chronic-stroke
#8
Rachel C Stockley, Deborah A O'Connor, Phil Smith, Sylvia Moss, Lizzie Allsop, Wendy Edge
Introduction. This small pilot study aimed to examine the feasibility of an upper limb rehabilitation system (the YouGrabber) in a community rehabilitation centre, qualitatively explore participant experiences, and describe changes after using it. Methods and Material. Chronic stroke participants attending a community rehabilitation centre in the UK were randomised to either a YouGrabber or a gym group and completed 18 training sessions over 12 weeks. The motor activity log, box and block, and fatigue severity score were administered by a blinded assessor before and after the intervention...
2017: Rehabilitation Research and Practice
https://www.readbyqxmd.com/read/28185308/medical-cost-savings-in-sakado-city-and-worldwide-achieved-by-preventing-disease-by-folic-acid-fortification
#9
REVIEW
Yasuo Kagawa, Mami Hiraoka, Mitsuyo Kageyama, Yoshiko Kontai, Mayumi Yurimoto, Chiharu Nishijima, Kaori Sakamoto
The introduction of mandatory fortification of grains with folate in 1998 in the United States resulted in 767 fewer spina bifida cases annually and a cost savings of $603 million per year. However, far more significant medical cost savings result from preventing common diseases, including myocardial infarction, stroke, dementia and osteoporosis. A cost-effectiveness analysis showed a gain of 266,649 quality-adjusted life-years and $3.6 billion saved annually, mainly due to the reduction of cardiac infarction...
February 9, 2017: Congenital Anomalies
https://www.readbyqxmd.com/read/28182800/cost-of-acute-kidney-injury-in-hospitalized-patients
#10
Samuel A Silver, Jin Long, Yuanchao Zheng, Glenn M Chertow
BACKGROUND: The economic burden of acute kidney injury (AKI) is not well understood. OBJECTIVE: To estimate the effects of AKI on hospitalization costs and length of stay (LOS). DESIGN: Using data from the 2012 National Inpatient Sample, we compared hospitalization costs and LOS with and without AKI. We used a generalized linear model with a gamma distribution and a log link fitted to AKI to adjust for demographics, hospital differences, and comorbidities...
February 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28182166/reducing-the-risk-of-stroke-in-elderly-patients-with-non-valvular-atrial-fibrillation-a-practical-guide-for-clinicians
#11
REVIEW
Joanne M Foody
Non-valvular atrial fibrillation (NVAF) significantly contributes to the burden of stroke, particularly in elderly patients. The challenge of optimizing anticoagulation therapy is balancing efficacy and bleeding risk, especially as the same patients at high risk of stroke also tend to be at high risk of bleeding. Treating the elderly patient with NVAF presents special challenges because of their heightened risk for both stroke and bleeding. Despite clinical trial data and evidence-based guidelines, surveys indicate that physicians underuse anticoagulation in older patients for reasons that include overemphasis of bleeding risk, particularly with the increased risk of falling, at the cost of thromboembolic risk...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/28181204/physical-activity-and-exercise-as-countermeasures-to-physical-frailty-and-sarcopenia
#12
Emanuele Marzetti, Riccardo Calvani, Matteo Tosato, Matteo Cesari, Mauro Di Bari, Antonio Cherubini, Marianna Broccatelli, Giulia Savera, Mariaelena D'Elia, Marco Pahor, Roberto Bernabei, Francesco Landi
The identification of cost-effective interventions that improve the health status and prevent disability in old age is one of the most important public health challenges. Regular physical activity is the only intervention that has consistently been shown to improve functional health and energy balance and to reduce the risk of cardiovascular disease, stroke, diabetes, several cancers, depression and falls. In advanced age, physical activity is also effective at mitigating sarcopenia, restoring robustness, and preventing/delaying the development of disability...
February 8, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28178979/managed-care-and-inpatient-mortality-in-adults-effect-of-primary-payer
#13
Anika L Hines, Susan O Raetzman, Marguerite L Barrett, Ernest Moy, Roxanne M Andrews
BACKGROUND: Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor...
February 8, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28178370/barriers-and-enablers-to-adherence-to-anticoagulation-in-heart-failure-with-atrial-fibrillation-patient-and-provider-perspectives
#14
Caleb Ferguson, Sally C Inglis, Phillip J Newton, Sandy Middleton, Peter S Macdonald, Patricia M Davidson
AIMS & OBJECTIVES: The purpose of this study was to elucidate the barriers and enablers to adherence to anticoagulation in individuals with chronic heart failure (CHF) with concomitant atrial fibrillation (AF) from the perspective of patients and providers. BACKGROUND: CHF and AF commonly coexist and are associated with increased stroke risk and mortality. Oral anticoagulation significantly reduces stroke risk and improves outcomes. Yet, in approximately 30% of cases anticoagulation is not commenced for a variety of reasons...
February 8, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28166784/randomized-controlled-trial-of-a-coordinated-care-intervention-to-improve-risk-factor-control-after-stroke-or-transient-ischemic-attack-in-the-safety-net-secondary-stroke-prevention-by-uniting-community-and-chronic-care-model-teams-early-to-end-disparities
#15
Amytis Towfighi, Eric M Cheng, Monica Ayala-Rivera, Heather McCreath, Nerses Sanossian, Tara Dutta, Bijal Mehta, Robert Bryg, Neal Rao, Shlee Song, Ali Razmara, Magaly Ramirez, Theresa Sivers-Teixeira, Jamie Tran, Elizabeth Mojarro-Huang, Ana Montoya, Marilyn Corrales, Beatrice Martinez, Phyllis Willis, Mireya Macias, Nancy Ibrahim, Shinyi Wu, Jeremy Wacksman, Hilary Haber, Adam Richards, Frances Barry, Valerie Hill, Brian Mittman, William Cunningham, Honghu Liu, David A Ganz, Diane Factor, Barbara G Vickrey
BACKGROUND: Recurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease...
February 6, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28163878/foraging-in-an-unsteady-world-bumblebee-flight-performance-in-field-realistic-turbulence
#16
J D Crall, J J Chang, R L Oppenheimer, S A Combes
Natural environments are characterized by variable wind that can pose significant challenges for flying animals and robots. However, our understanding of the flow conditions that animals experience outdoors and how these impact flight performance remains limited. Here, we combine laboratory and field experiments to characterize wind conditions encountered by foraging bumblebees in outdoor environments and test the effects of these conditions on flight. We used radio-frequency tags to track foraging activity of uniquely identified bumblebee (Bombus impatiens) workers, while simultaneously recording local wind flows...
February 6, 2017: Interface Focus
https://www.readbyqxmd.com/read/28153648/cost-effectiveness-of-subsidizing-fruit-and-vegetable-purchases-through-the-supplemental-nutrition-assistance-program
#17
Sung Eun Choi, Hilary Seligman, Sanjay Basu
INTRODUCTION: A diet high in fruits and vegetables (FV) is associated with reduced risk of chronic disease. One strategy to incentivize FV consumption among low-income households is to make them more affordable through the Supplemental Nutrition Assistance Program (SNAP). This study aims to identify the cost effectiveness of subsidizing FV purchases among the one in seven Americans who participate in SNAP. METHODS: A cost-effectiveness analysis was conducted from a societal perspective to estimate lifetime costs and health gains associated with subsidizing FV purchases...
January 30, 2017: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/28137521/gender-based-differences-in-mortality-and-complementary-therapies-for-patients-with-stroke-in-taiwan
#18
Chun-Ting Liu, Bei-Yu Wu, Wen-Long Hu, Yu-Chiang Hung
BACKGROUND: Stroke is a leading cause of death worldwide. In this retrospective study, we investigated the different effects of gender on medical behavior, medical service, medical cost, and death from stroke in Taiwan. METHODS: We collected data on the stroke-associated mortality rate according to gender and age group for the period between 2009 and 2013 from the official registry of Ministry of Health and Welfare, Taiwan. We analyzed the data related to stroke-associated medical care and costs in 2013 from the National Health Insurance Research Database (NHIRD)...
February 2017: Complementary Therapies in Medicine
https://www.readbyqxmd.com/read/28134125/hierarchical-testing-of-composite-endpoints-applying-the-win-ratio-to-percutaneous-coronary-intervention-versus-coronary-artery-bypass-grafting-in-the-syntax-trial
#19
Milan Milojevic, Stuart J Head, Eleni-Rosalina Andrinopoulou, Patrick W Serruys, Friedrich W Mohr, Jan G Tijssen, A Pieter Kappetein
AIMS: Compare long-term outcomes of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG), accounting for the clinical impact of individual components in the composite endpoints and prioritizing these using the win ratio (Rw). METHODS AND RESULTS: The win ratio was compared with conventional methods of analyses [hazard ratio (HR) and relative risk] in the SYNTAX trial (n=1800). For the composite of death/stroke/myocardial infarction (MI), the win ratio favoured CABG and was 1...
January 31, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28121957/prevalence-and-risk-factors-for-atherosclerotic-carotid-stenosis-and-plaque-a-population-based-screening-study
#20
Shin Young Woo, Jin Hyun Joh, Sang-Ah Han, Ho-Chul Park
Atherosclerotic carotid stenosis (ACS) is a major cause of ischemic stroke. Screening for asymptomatic ACS is important to identify the patients who require longitudinal surveillance, medication, or endovascular surgery. The aim of this study was to assess the prevalence and risk factors for ACS and carotid plaque (CP) in Korea using a population-based screening study.We recruited participants during visits to several community welfare centers in Korea. The baseline characteristics of the study population were collected...
January 2017: Medicine (Baltimore)
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