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https://www.readbyqxmd.com/read/28646587/perioperative-pain-management-after-fibular-free-flap-harvesting-for-head-and-neck-reconstruction-using-mini-catheters-to-inject-local-anesthetic-a-pilot-study
#1
Andrea Ferri, Andrea Varazzani, Adriana Valente, Giuseppe Pedrazzi, Bernardo Bianchi, Silvano Ferrari, Enrico Sesenna
BACKGROUND: Fibular donor site pain management in the early postoperative period can help minimize complications, patient discomfort, and agitation. Traditional management of postoperative pain consists of systemic administration of opioids and NSAIDS. The use of local anesthetics in addition to systemic analgesics has the potential to improve pain control. Purpose of the study is to evaluate the efficacy of mini-catheters used to inject local anesthetic into the fibular donor site after flap harvesting for reconstruction of the head-and-neck area...
June 24, 2017: Microsurgery
https://www.readbyqxmd.com/read/28646267/quantitative-eeg-metrics-differ-between-outcome-groups-and-change-over-the-first-72%C3%A2-h-in-comatose-cardiac-arrest-patients
#2
Sara Leingang Wiley, Babak Razavi, Prashanth Krishnamohan, Michael Mlynash, Irina Eyngorn, Kimford J Meador, Karen G Hirsch
BACKGROUND: Forty to sixty-six percent of patients resuscitated from cardiac arrest remain comatose, and historic outcome predictors are unreliable. Quantitative spectral analysis of continuous electroencephalography (cEEG) may differ between patients with good and poor outcomes. METHODS: Consecutive patients with post-cardiac arrest hypoxic-ischemic coma undergoing cEEG were enrolled. Spectral analysis was conducted on artifact-free contiguous 5-min cEEG epochs from each hour...
June 23, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28646035/a-matter-of-life-and-death
#3
Justice Baker
Cases concerning the withdrawal or withholding of artificial nutrition and hydration from patients in a vegetative or minimally conscious state raise difficult medical, legal and ethical questions including the diagnosis and classification of disorders of consciousness, the legal processes to be followed, and the legal and ethical principles to be applied when making decisions. There is also an issue as to whether it is necessary or appropriate for such decisions to be taken by judges. This article, based on a lecture given in Oxford in October 2016, considers a number of these issues and concludes that any consideration of the question from the patient's point of view must include an objective analysis of what is in his or her best interests, as well as subjective expressions of wishes and feelings...
June 23, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28644080/determination-of-gastrointestinal-transit-times-in-barred-owls-strix-varia-by-contrast-fluoroscopy
#4
Grayson A Doss, Jackie M Williams, Christoph Mans
Contrast imaging studies are routinely performed in avian patients when an underlying abnormality of the gastrointestinal (GI) tract is suspected. Fluoroscopy offers several advantages over traditional radiography and can be performed in conscious animals with minimal stress and restraint. Although birds of prey are commonly encountered as patients, little is known about GI transit times and contrast imaging studies in these species, especially owls. Owls are commonly encountered in zoological, educational, and wildlife settings...
June 2017: Journal of Avian Medicine and Surgery
https://www.readbyqxmd.com/read/28643814/-unresponsive-wakefulness-syndrome-clinical-predictors-of-late-recovery
#5
Gianfranco Lamberti, Elena Antoniono, Francesca Gozzerino, Donatella Giraudo
Patients affected by the outcomes of serious traumatic and/or non-traumatic brain injury may show progressive recovery characterized by a broad spectrum of clinical conditions, which are often not completely different, but of differing seriousness. The unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) are syndromes that may characterize progression from the coma state and may be temporary clinical conditions, or in some cases, the final outcome of acute brain injury. The eventual recovery of consciousness is a dynamic process, in constant progress following the acute event...
May 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28642353/when-sanctity-of-life-and-self-determination-clash-briggs-versus-briggs-2016-ewcop-53-implications-for-policy-and-practice
#6
Jenny Kitzinger, Celia Kitzinger, Jakki Cowley
In a landmark judgment in the English Court of Protection, the judge (Charles J) found it to be in the best interests of a minimally conscious patient for clinically assisted nutrition and hydration (CANH) to be withdrawn, with the inevitable consequence that the patient would die. In making this judgment, it was accepted that the patient's level of consciousness - if CANH were continued and rehabilitation provided - might improve, and that he might become capable of expressing emotions and making simple choices...
June 22, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28633545/late-recovery-of-awareness-in-prolonged-disorders-of-consciousness-a-cross-sectional-cohort-study
#7
Kudret Yelden, Sophie Duport, Leon M James, Agnieszka Kempny, Simon F Farmer, Alex P Leff, E Diane Playford
PURPOSE: To detect any improvement of awareness in prolonged disorders of consciousness in the long term. METHODS: A total of 34 patients with prolonged disorders of consciousness (27 vegetative state and seven minimally conscious state; 16 males; aged 21-73) were included in the study. All patients were initially diagnosed with vegetative/minimally conscious state on admission to our specialist neurological rehabilitation unit. Re-assessment was performed 2-16 years later using Coma Recovery Scale-Revised...
June 21, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28621625/editorial-thalamic-stimulation-in-vegetative-or-minimally-conscious-patients
#8
Emad Eskandar
No abstract text is available yet for this article.
June 16, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28621620/deep-brain-stimulation-for-the-early-treatment-of-the-minimally-conscious-state-and-vegetative-state-experience-in-14-patients
#9
Darko Chudy, Vedran Deletis, Fadi Almahariq, Petar Marčinković, Jasenka Škrlin, Veronika Paradžik
OBJECTIVE An effective treatment of patients in a minimally conscious state (MCS) or vegetative state (VS) caused by hypoxic encephalopathy or traumatic brain injury (TBI) is not yet available. Deep brain stimulation (DBS) of the thalamic reticular nuclei has been attempted as a therapeutic procedure mainly in patients with TBI. The purpose of this study was to investigate the therapeutic use of DBS for patients in VS or MCS. METHODS Fourteen of 49 patients in VS or MCS qualified for inclusion in this study and underwent DBS...
June 16, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28615196/withdrawing-clinically-assisted-nutrition-and-hydration-canh-in-patients-with-prolonged-disorders-of-consciousness-is-there-still-a-role-for-the-courts
#10
Veronica English, Julian C Sheather
Currently, in England and Wales, Court of Protection's Practice Directive 9E (PD9E) requires all cases of proposed withdrawal or withholding of life-sustaining treatment in relation to adults in a permanent vegetative state (PVS) or minimally conscious state be referred to the Court. This paper looks at the origins of PD9E and contrasts the routine requirement to refer cases to court with the complex clinical terrain that comprises those suffering from prolonged disorders of consciousness. We look at the role of the court in decision making in these contexts and we ask what role the courts are called on to play in these decisions...
June 14, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28603646/ten-year-experience-with-endobronchial-ultrasound-guided-transbronchial-needle-aspiration-single-center-results-in-mediastinal-diagnostic-and-staging
#11
Lorenzo Rosso, Stefano Ferrero, Paolo Mendogni, Eleonora Bonaparte, Rosaria Carrinola, Alessandro Palleschi, Ilaria Righi, Matteo Montoli, Francesco Damarco, Davide Tosi
BACKGROUND: Endobronchial ultrasonography with transbronchial needle aspiration (EBUS-TBNA) is recognized as an accurate and minimal invasive procedure for diagnosis and staging of lung cancer and lymph nodal malignancies. EBUS is recommended as the first choice procedure for mediastinal staging in lung cancer in international guidelines. METHODS: A retrospective evaluation was performed on single center experience with EBUS-TBNA in our thoracic surgery department in a 10-year time frame...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28601477/family-perspectives-of-traumatically-brain-injured-patient-pain-behaviors-in-the-intensive-care-unit
#12
Brandy L Vanderbyl, Céline Gélinas
Behavioral scales allow for the pain assessment of vulnerable critically ill patients who are unable to self-report. However, validity of the use of such scales is limited in traumatic brain injury patients with an altered level of consciousness as a result of the different way that these patients express pain. Family participation is considered as an important component of pain assessment for those unable to self-report, but research in this area is minimal so far. This study aimed to describe what behaviors family caregivers deemed relevant to pain for patients with a traumatic brain injury with an altered level of consciousness in the intensive care unit...
June 7, 2017: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/28594194/conducting-preference-assessments-for-youth-with-disorders-of-consciousness-during-rehabilitation
#13
Adrianna Amari, Stacy J Suskauer, Valerie Paasch, Lauren K Grodin, Beth S Slomine
PURPOSE: Care and rehabilitation for individuals with disorders of consciousness (DOC) can be challenging; the use of observational data collection, individualized treatment programs, and incorporation of preferred, personally meaningful and salient items may be helpful in addressing such challenges during assessment and intervention. In this article, we extend the predominantly adult literature on use of salient items to promote differential responding by describing our methodology to identify preferred items across sensory domains for application during inpatient rehabilitation with children with DOC...
June 8, 2017: Rehabilitation Psychology
https://www.readbyqxmd.com/read/28588463/looking-for-the-self-phenomenology-neurophysiology-and-philosophical-significance-of-drug-induced-ego-dissolution
#14
Raphaël Millière
There is converging evidence that high doses of hallucinogenic drugs can produce significant alterations of self-experience, described as the dissolution of the sense of self and the loss of boundaries between self and world. This article discusses the relevance of this phenomenon, known as "drug-induced ego dissolution (DIED)", for cognitive neuroscience, psychology and philosophy of mind. Data from self-report questionnaires suggest that three neuropharmacological classes of drugs can induce ego dissolution: classical psychedelics, dissociative anesthetics and agonists of the kappa opioid receptor (KOR)...
2017: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/28581253/severe-hypoglycemia-among-patients-with-type-2-diabetes-requiring-emergency-hospital-admission-the-hipos-er-study
#15
João Conceição, Jorge Dores, Francisco Araújo, Pedro Laires, Richard D Carr, Kimberly Brodovicz, Larry Radican, Ana Maria Nogueira
AIMS: In this study we analysed the prevalence of severe hypoglycaemia in patients with type 2 diabetes treated with antihyperglycemic agents (AHA) and requiring emergency room (ER) assistance. This analysis was also done by AHA therapy. MATERIALS AND METHODS: The HIPOS-ER study was a cross-sectional, observational, multicenter, nationwide, study with specific hypoglycemia source data collection. RESULTS: Within the study period, a total of 425,706 admissions were recorded at the ER of participating hospitals...
June 5, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28573080/rapid-identification-of-psychoactive-drugs-in-drained-gastric-lavage-fluid-and-whole-blood-specimens-of-drug-overdose-patients-using-ambient-mass-spectrometry
#16
Chi-Wei Lee, Hung Su, You-Da Cai, Ming-Tsang Wu, Den-Chyang Wu, Jentaie Shiea
Psychoactive drug overdoses are life-threatening and require prompt and proper treatment in the emergency room to minimize morbidity and mortality. Prompt identification of the ingested psychoactive drugs is challenging, since witness recall is unreliable and patients' symptoms do not necessarily explain their loss of consciousness. Gas and liquid chromatography mass spectrometric analyses have been the traditionally employed methods to detect and identify abused substances; however, these techniques are time-consuming and labor-intensive...
2017: Mass Spectrometry
https://www.readbyqxmd.com/read/28569534/family-caregivers-opinions-about-interaction-with-the-environment-in-consciousness-disorders
#17
Pasquale Moretta, Luigi Trojano, Orsola Masotta, Viviana Cardinale, Vincenzo Loreto, Anna Estraneo
OBJECTIVES: To assess family caregivers' opinions about level of interaction with the environment in their relatives with disorders of consciousness (DOCs) and to explore psychological features of caregivers whose opinions diverge from clinicians' diagnosis. METHOD: Forty-five family caregivers of 38 DOC inpatients without communication abilities answered 2 questions assessing their opinion about level of interaction with the environment in their relatives. Self-report questionnaires were used to evaluate caregivers' depression, anxiety, psychophysiological disturbances, prolonged grief disorder, coping strategies, quality of perceived needs and social support...
May 2017: Rehabilitation Psychology
https://www.readbyqxmd.com/read/28554611/a-mathematical-model-of-embodied-consciousness
#18
David Rudrauf, Daniel Bennequin, Isabela Granic, Gregory Landini, Karl Friston, Kenneth Williford
We introduce a mathematical model of embodied consciousness, the Projective Consciousness Model (PCM), which is based on the hypothesis that the spatial field of consciousness (FoC) is structured by a projective geometry and under the control of a process of active inference. The FoC in the PCM combines multisensory evidence with prior beliefs in memory and frames them by selecting points of view and perspectives according to preferences. The choice of projective frames governs how expectations are transformed by consciousness...
May 26, 2017: Journal of Theoretical Biology
https://www.readbyqxmd.com/read/28553427/functional-evaluation-of-awareness-in-vegetative-and-minimally-conscious-state
#19
Silvia Marino, Lilla Bonanno, Rosella Ciurleo, Annalisa Baglieri, Rosa Morabito, Silvia Guerrera, Carmela Rifici, Antonio Giorgio, Placido Bramanti, Nicola De Stefano
OBJECTIVE: The aim of this study was to assess differences in brain activation in a large sample of Vegetative State (VS) and Minimally Conscious State (MCS) patients, using functional magnetic resonance imaging (fMRI). METHODS: We studied 50 patients four to seven months after brain injury. By using international clinical criteria and validated behavioural scales such as the Glasgow Coma Scale and the Clinical Unawareness Assessment Scale, the patients were grouped into VS (n=23) and MCS (n=27)...
2017: Open Neuroimaging Journal
https://www.readbyqxmd.com/read/28534673/effects-of-preference-and-sensory-modality-on-behavioural-reaction-in-patients-with-disorders-of-consciousness
#20
L Heine, B Tillmann, M Hauet, A Juliat, A Dubois, S Laureys, M Kandel, J Plailly, J Luauté, F Perrin
BACKGROUND: Reliable evaluation of patients with unresponsive wakefulness syndrome (UWS) or in a minimally conscious state (MCS) remains a major challenge. It has been suggested that the expression of residual cerebral function could be improved by allowing patients to listen to their favourite music. However, the potential effect of music on behavioural responsiveness, as well as the effect of preferred stimuli in other sensory modalities (e.g. olfaction), remain poorly understood. OBJECTIVE: The aim of our study was to investigate the effect of sensory modality (auditory versus olfactory) and preference (preferred versus neutral) of the test stimuli on patients' subsequent performance on the Coma Recovery Scale-Revised (CRS-R)...
May 23, 2017: Brain Injury: [BI]
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