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Minimally conscious

Choung Ah Lee, Joon Pil Cho, Sang Cheon Choi, Hyuk Hoon Kim, Ju Ok Park
OBJECTIVE: Discharge against medical advice (DAMA) from the emergency department (ED) accounts for 0.1% to 2.7% of all ED discharges. DAMA carries a risk of increased mortality and readmissions. Our aim was to investigate the general characteristics of DAMA patients and the differences between them and non-DAMA patients. METHODS: We reviewed data collected by the National Emergency Medical Center between 2010 and 2011. Subjects were categorized into 2 groups, namely, the DAMA group and the non-DAMA group...
June 2016: Clin Exp Emerg Med
Joachim Liepert
PURPOSE OF REVIEW: This article evaluates whether specific drugs are able to facilitate motor recovery after stroke or improve the level of consciousness, cognitive, or behavioral symptoms after traumatic brain injury. RECENT FINDINGS: After stroke, serotonin reuptake inhibitors can enhance restitution of motor functions in depressed as well as in nondepressed patients. Erythropoietin and progesterone administered within hours after moderate to severe traumatic brain injury failed to improve the outcome...
September 28, 2016: Current Opinion in Neurology
Francesca Pistoia, Simona Sacco, Janet Stewart, Marco Sarà, Antonio Carolei
The experience of pain in disorders of consciousness is still debated. Neuroimaging studies, using functional Magnetic Resonance Imaging (fMRI), Positron Emission Tomography (PET), multichannel electroencephalography (EEG) and laser-evoked potentials, suggest that the perception of pain increases with the level of consciousness. Brain activation in response to noxious stimuli has been observed in patients with unresponsive wakefulness syndrome (UWS), which is also referred to as a vegetative state (VS), as well as those in a minimally conscious state (MCS)...
October 8, 2016: Brain Sciences
Samantha I Cunningham, Dardo Tomasi, Nora D Volkow
Neuroimaging studies have identified functional interactions between the thalamus, precuneus, and default mode network (DMN) in studies of consciousness. However, less is known about the structural connectivity of the precuneus and thalamus to regions within the DMN. We used diffusion tensor imaging (DTI) to parcellate the precuneus and thalamus based on their probabilistic white matter connectivity to each other and DMN regions of interest (ROIs) in 37 healthy subjects from the Human Connectome Database. We further assessed resting-state functional connectivity (RSFC) among the precuneus, thalamus, and DMN ROIs...
October 14, 2016: Human Brain Mapping
Anna Nigri, Eleonora Catricalà, Stefania Ferraro, Maria Grazia Bruzzone, Ludovico D'Incerti, Davide Sattin, Davide Rossi Sebastiano, Silvana Franceschetti, Giorgio Marotta, Riccardo Benti, Matilde Leonardi, Stefano F Cappa
There is a growing interest in the use of functional imaging to assess brain activity in the absence of behavioural responses in patients with disorders of consciousness (DOC). In the present study, we applied a hierarchical auditory stimulation paradigm to functional magnetic resonance (fMRI) in a group of long-term DOC adult patients. Brain response to pairs of pseudowords, of unrelated words and of semantically related words, i.e. stimuli differing in lexical status (words vs. pseudowords) and semantic relatedness (related vs...
October 13, 2016: Brain Imaging and Behavior
Adam Fusheini, John Eyles
BACKGROUND: Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy...
October 7, 2016: BMC Health Services Research
Silvia Casarotto, Angela Comanducci, Mario Rosanova, Simone Sarasso, Matteo Fecchio, Martino Napolitani, Andrea Pigorini, Adenauer G Casali, Pietro D Trimarchi, Melanie Boly, Olivia Gosseries, Olivier Bodart, Francesco Curto, Cristina Landi, Maurizio Mariotti, Guya Devalle, Steven Laureys, Giulio Tononi, Marcello Massimini
Objective Validating objective, brain-based indices of consciousness in behaviorally unresponsive patients represents a challenge due to the impossibility of obtaining independent evidence through subjective reports. Here we address this problem by first validating a promising metric of consciousness - the perturbational complexity index (PCI) - in a benchmark population who could confirm the presence or absence of consciousness through subjective reports, and then applying the same index to patients with disorders of consciousness (DOC)...
September 22, 2016: Annals of Neurology
Jun Matsumoto-Miyazaki, Yoshitaka Asano, Shingo Yonezawa, Yuichi Nomura, Yuka Ikegame, Tatsuki Aki, Shunsuke Takenaka, Jun Shinoda
OBJECTIVE: To evaluate the immediate effect of acupuncture on cortico spinal tract (CST) activity in patients with chronic disorders of consciousness (DOC) after traumatic brain injury (TBI) by measuring motor-evoked potential (MEP) using transcranial magnetic stimulation (TMS). DESIGN: Changes in several variables in the acupuncture session were compared with those in the control session without acupuncture in the same patients. SETTING: Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Gifu, Japan...
September 23, 2016: Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy
F Goeser, S Schlabe, C E Ruiner, L Kramer, C P Strassburg, U Spengler
Fecal microbiota transplantation has gathered much attention due to its high efficacy in resolving recurrent Clostridium difficile infection. Until today, it is recognized as a safe procedure without any severe side effects. Patients with impaired conscious states suffering from recurrent episodes of aspiration are at increased risk by endoscopic interventions needed during standard approaches for fecal microbiota transplantation application.Here, we illustrate the case of a tetraplegic patient undergoing fecal microbiota transplantation due to his fifth recurrent episode of Clostridium difficile infection using a self-advancing nasal jejunal feeding tube as effective minimal-invasive option of fecal microbiota transplantation application...
October 2016: Zeitschrift Für Gastroenterologie
Josef Zicha, Michal Behuliak, Ivana Vaneckova
OBJECTIVE: Comparing BP response to Ca channel opener BAY K8644 prior and after Rho kinase inhibition we demonstrated lowered calcium sensitization in spontaneously hypertensive rats (SHR), although BP response of intact SHR to Rho kinase inhibitor fasudil was enhanced (Behuliak et al. J Hypertens 31:2025,2013). The aim of the present study was to evaluate calcium sensitization in hypertensive TGR and their normotensive HanSD controls using the same methods. We also tried to elucidate the interference of baroreflex-activated sympathetic activity with BP response to fasudil...
September 2016: Journal of Hypertension
Afshin A Anoushiravani, Zain Sayeed, Mouhanad M El-Othmani, Peter K Wong, Khaled J Saleh
As health care reimbursement models shift from volume-based to value-based models, orthopedic surgeons must provide patients with highly reliable care, while consciously minimizing cost, maintaining quality, and providing timely interventions. An established means of achieving these goals is by implementing a highly reliable care model; however, before such a model can be initiated, a safety culture, robust improvement strategies, and committed leadership are needed. This article discusses interdependent and critical changes required to implement a highly reliable care system...
October 2016: Orthopedic Clinics of North America
Tehsina F Devji, Arin L Madenci, Elizabeth Carpino, Izabela C Leahy, Mihail Samnaliev, Jennifer L Dearden, Brent R Weil, Christopher B Weldon, Joseph Cravero
PURPOSE: The current emphasis on fiscally responsible health spending in the era of the Affordable Care Act and other health care reform necessitates cost-conscious delivery of care. "Value" in health care is defined as the quality of care divided by the cost. As such, health systems optimize value by providing the most cost-effective care possible without sacrificing safety or outcomes. Elective, minimal risk surgical procedures in children may be value-enhanced by moving from an operating room (OR) to a more cost-efficient setting...
November 2016: Journal of Pediatric Surgery
E Gedda, A Robbins, M Hentzien, A Giltat, V Pinel-Petit, J Souille, Y N'Guyen
INTRODUCTION: We assessed (i) the frequency of consultations for faintness in the Emergency department (ED) of a University hospital centre (UHC), (ii) clinical epidemiology and (iii) cost of faintness, taking a particular interest into the determining risk factors for hospitalization. METHODS: This epidemiological study has been conducted retrospectively, from data obtained for every patient having consulted for faintness in ED of Reims UHC (01/01/12-03/31/12)...
September 9, 2016: La Revue de Médecine Interne
Zhong S Zheng, Nicco Reggente, Evan Lutkenhoff, Adrian M Owen, Martin M Monti
Previous studies have suggested that disorders of consciousness (DOC) after severe brain injury may result from disconnections of the thalamo-cortical system. However, thalamo-cortical connectivity differences between vegetative state (VS), minimally conscious state minus (MCS-, i.e., low-level behavior such as visual pursuit), and minimally conscious state plus (MCS+, i.e., high-level behavior such as language processing) remain unclear. Probabilistic tractography in a sample of 25 DOC patients was employed to assess whether structural connectivity in various thalamo-cortical circuits could differentiate between VS, MCS-, and MCS+ patients...
September 13, 2016: Human Brain Mapping
Steve Beukema, Laura E Gonzalez-Lara, Paola Finoia, Evelyn Kamau, Judith Allanson, Srivas Chennu, Raechelle M Gibson, John D Pickard, Adrian M Owen, Damian Cruse
Functional neuroimaging of covert perceptual and cognitive processes can inform the diagnoses and prognoses of patients with disorders of consciousness, such as the vegetative and minimally conscious states (VS;MCS). Here we report an event-related potential (ERP) paradigm for detecting a hierarchy of auditory processes in a group of healthy individuals and patients with disorders of consciousness. Simple cortical responses to sounds were observed in all 16 patients; 7/16 (44%) patients exhibited markers of the differential processing of speech and noise; and 1 patient produced evidence of the semantic processing of speech (i...
2016: NeuroImage: Clinical
R M Gibson, A M Owen, D Cruse
The disorders of consciousness refer to clinical conditions that follow a severe head injury. Patients diagnosed as in a vegetative state lack awareness, while patients diagnosed as in a minimally conscious state retain fluctuating awareness. However, it is a challenge to accurately diagnose these disorders with clinical assessments of behavior. To improve diagnostic accuracy, neuroimaging-based approaches have been developed to detect the presence or absence of awareness in patients who lack overt responsiveness...
2016: Progress in Brain Research
Henk J Eilander, Viona J M Wijnen, Evert J Schouten, Jan C M Lavrijsen
OBJECTIVE: To explore the long-term outcome of young patients with disorders of consciousness who had received intensive neurorehabilitation. METHODS: A cross-sectional cohort study, in which the survival, level of consciousness, functional independence, mobility, communication and living situation were determined by means of a structured questionnaire. The cohort consisted of 44 children and young adults, originally either in a prolonged Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS, n = 33) or a Minimally Conscious State (MCS, n = 11) who had received a specialized neurorehabilitation programme 10-12 years earlier...
2016: Brain Injury: [BI]
Stephanie M Beeman, Andrew R Kemper, Stefan M Duma
OBJECTIVE: The objective of this study was to quantify the effects of active muscles (e.g. conscious bracing, resting tone, and reflex response) and acceleration severity on the neck forces and moments generated during low-speed frontal sled tests with adult male human volunteers and post mortem human surrogates (PMHSs). METHODS: A total of 24 frontal sled tests were analyzed including male volunteers of approximately 50th percentile height and weight (n = 5) and PMHSs (n = 2)...
September 2016: Traffic Injury Prevention
Giulio E Lancioni, Nirbhay Singh, Mark F O'Reilly, Jeff Sigafoos, Fiora D'Amico, Francesca Buonocunto, Jorge Navarro, Crocifissa Lanzilotti, Pietro Fiore, Marisa Megna, Sabino Damiani, Riccardo Marvulli
BACKGROUND: Post-coma persons in a minimally conscious state (MCS) and with extensive motor impairment cannot independently access and control environmental stimulation. AIM: Assessing the effects of a microswitch-aided program aimed at helping MCS persons develop responding and stimulation control and conducting a social validation/evaluation of the program. DESIGN: A single-subject ABAB design was used for each participant to determine the impact of the program on his or her responding...
September 1, 2016: European Journal of Physical and Rehabilitation Medicine
Sindhu R Kaitha, George Salem, Yan D Zhao, Mohammad F Madhoun, Allshine Chen, William M Tierney
OBJECTIVES: The need to define the cost of endoscopic procedures becomes increasingly important in an era of providing low-cost, high-quality care. We examined the impact of informing endoscopists of the cost of accessories and pathology specimens as a cost-minimization strategy. METHODS: We conducted a prospective observational cohort study of therapeutic outpatient esophagogastroduodenoscopy (EGD) and colonoscopy. During the pre-intervention phase (phase 1), the endoscopists were not briefed on the cost of accessories or pathology specimens obtained during the procedure...
August 30, 2016: American Journal of Gastroenterology
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