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https://www.readbyqxmd.com/read/28894384/technology-that-achieves-the-triple-aim-an-economic-analysis-of-the-brainpath%C3%A2-approach-in-neurosurgery
#1
Sidney P Norton, Evan M Dickerson, Charles G Kulwin, Mitesh V Shah
BACKGROUND: The Triple Aim is defined as: improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care. The purpose of this analysis was to evaluate the economic value of a new neurosurgical technique, the BrainPath™ approach, for use in patients with subcortical tumors and intracerebral hemorrhage (ICH). METHODS: Inpatient length of stay (LOS) data were collected for ICH and brain tumor surgical patient cases between August 2013 and November 2015...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28841802/advanced-magnetic-resonance-imaging-in-glioblastoma-a-review
#2
Gaurav Shukla, Gregory S Alexander, Spyridon Bakas, Rahul Nikam, Kiran Talekar, Joshua D Palmer, Wenyin Shi
Glioblastoma, the most common and most rapidly progressing primary malignant tumor of the central nervous system, continues to portend a dismal prognosis, despite improvements in diagnostic and therapeutic strategies over the last 20 years. The standard of care radiographic characterization of glioblastoma is magnetic resonance imaging (MRI), which is a widely utilized examination in the diagnosis and post-treatment management of patients with glioblastoma. Basic MRI modalities available from any clinical scanner, including native T1-weighted (T1w) and contrast-enhanced (T1CE), T2-weighted (T2w), and T2-fluid-attenuated inversion recovery (T2-FLAIR) sequences, provide critical clinical information about various processes in the tumor environment...
August 2017: Chinese Clinical Oncology
https://www.readbyqxmd.com/read/28744879/procarbazine-lomustine-and-vincristine-for-recurrent-high-grade-glioma
#3
REVIEW
Saurabh Parasramka, Goutham Talari, Myrna Rosenfeld, Jing Guo, John L Villano
BACKGROUND: Recurrent high-grade glioma (HGG) carries an extremely poor prognosis. There is no current standard of care or guideline-based recommendations. Nitrosourea-based multidrug chemotherapy or PCV - procarbazine, lomustine (CCNU) and vincristine - is one of the treatment options at recurrence. There has been no meta-analysis which looks at the benefits and harms of PCV chemotherapy in adults with recurrent HGG. OBJECTIVES: To assess the effectiveness and safety of procarbazine, lomustine, and vincristine (PCV) chemotherapy with other interventions in adults with recurrent high-grade glioma...
July 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28721340/post-intensive-care-syndrome-an-overview
#4
Gautam Rawal, Sankalp Yadav, Raj Kumar
Survival of critically unwell patients has improved in the last decade due to advances in critical care medicine. Some of these survivors develop cognitive, psychiatric and /or physical disability after treatment in intensive care unit (ICU), which is now recognized as post intensive care syndrome (PICS). Given the limited awareness about PICS in the medical faculty this aspect is often overlooked which may lead to reduced quality of life and cause a lot of suffering of these patients and their families. Efforts should be directed towards preventing PICS by minimizing sedation and early mobilization during ICU...
June 2017: Journal of Translational Internal Medicine
https://www.readbyqxmd.com/read/28688998/targeted-temperature-management-in-the-icu-guidelines-from-a-french-expert-panel
#5
Alain Cariou, Jean-Francois Payen, Karim Asehnoune, Gérard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigué, Laure de Saint Blanquat, Cyrille Mathien, Lionel Velly
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method...
July 5, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28681208/surgical-considerations-in-the-optimal-management-of-patients-with-malignant-brain-tumors
#6
REVIEW
Jaclyn J Renfrow, Roy E Strowd, Adrian W Laxton, Stephen B Tatter, Carol P Geer, Glenn J Lesser
Advances in technology are revolutionizing medicine and the limits of what we can offer to our patients. In neurosurgery, technology continues to reduce morbidity, increase surgical accuracy, facilitate tissue acquisition, and promote novel techniques for prolonging survival in patients with neuro-oncologic disease. Surgery has been the backbone of glioma diagnosis and treatment by providing adequate, high quality material for precise histologic diagnosis, and genomic characterization in the setting of significant intratumoral heterogeneity, thus allowing personalized treatment selection in the clinic...
August 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28631089/targeted-temperature-management-in-the-icu-guidelines-from-a-french-expert-panel
#7
REVIEW
Alain Cariou, Jean-François Payen, Karim Asehnoune, Gerard Audibert, Astrid Botte, Olivier Brissaud, Guillaume Debaty, Sandrine Deltour, Nicolas Deye, Nicolas Engrand, Gilles Francony, Stéphane Legriel, Bruno Levy, Philippe Meyer, Jean-Christophe Orban, Sylvain Renolleau, Bernard Vigue, Laure De Saint Blanquat, Cyrille Mathien, Lionel Velly
Over the recent period, the use of induced hypothermia has gained an increasing interest for critically ill patients, in particular in brain-injured patients. The term "targeted temperature management" (TTM) has now emerged as the most appropriate when referring to interventions used to reach and maintain a specific level temperature for each individual. TTM may be used to prevent fever, to maintain normothermia, or to lower core temperature. This treatment is widely used in intensive care units, mostly as a primary neuroprotective method...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28578120/intraspinal-pressure-monitoring-and-extensive-duroplasty-in-the-acute-phase-of-traumatic-spinal-cord-injury-a-systematic-review
#8
REVIEW
Tomasz Tykocki, Łukasz Poniatowski, Marcin Czyż, Michael Koziara, Guy Wynne-Jones
OBJECTIVE: The prognosis in cervical spinal cord injury is poor, and surgical and neurointensive care management need further improvement. Monitoring of the intraspinal pressure (ISP) at an early stage after traumatic spinal cord injury (tSCI) is useful clinically. MATERIALS AND METHODS: Obtaining continuous spinal cord perfusion pressure (SCPP) measurements based on the difference between mean arterial pressure and ISP allows offering best medical and surgical treatment during this critical phase of tSCI...
September 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28497934/cerebral-autoregulation-monitoring-in-acute-traumatic-brain-injury-what-s-the-evidence
#9
Leanne A Calviello, Joseph Donnelly, Frederick A Zeiler, Eric P Thelin, Peter Smielewski, Marek Czosnyka
Cerebral autoregulation is conceptualized as a vascular self-regulatory mechanism within the brain. Controlled by elusive relationships between various biophysical processes, it functions to protect the brain against potential damages caused by sudden changes in cerebral perfusion pressures and flow. Following events such as traumatic brain injuries (TBI), autoregulation may be compromised, potentially leading to an unfavorable outcome. In spite of its complexity, autoregulation has been able to be quantified non-invasively within the neuro-critical care setting with the aid of transcranial Doppler...
May 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28449491/characteristics-and-provision-of-care-of-patients-with-the-acute-respiratory-distress-syndrome-descriptive-findings-from-the-dacapo-cohort-baseline-and-comparison-with-international-findings
#10
Frank Dodoo-Schittko, Susanne Brandstetter, Magdalena Brandl, Sebastian Blecha, Michael Quintel, Steffen Weber-Carstens, Stefan Kluge, Patrick Meybohm, Caroline Rolfes, Björn Ellger, Friedhelm Bach, Tobias Welte, Thomas Muders, Kathrin Thomann-Hackner, Thomas Bein, Christian Apfelbacher
BACKGROUND: Little is known about the characteristics and real world life circumstances of ARDS (acute respiratory distress syndrome) patient populations. This knowledge is essential for transferring evidence-based therapy into routine healthcare. The aim of this study was to report socio-demographic and clinical characteristics in an unselected population of ARDS patients and to compare these results to findings from other large ARDS cohorts. METHODS: A German based cross-sectional observational study was carried out...
March 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28367540/task-based-regularization-design-for-detection-of-intracranial-hemorrhage-in-cone-beam-ct
#11
H Dang, J W Stayman, J Xu, A Sisniega, W Zbijewski, X Wang, D H Foos, N Aygun, V E Koliatsos, J H Siewerdsen
Prompt and reliable detection of acute intracranial hemorrhage (ICH) is critical to treatment of a number of neurological disorders. Cone-beam CT (CBCT) systems are potentially suitable for detecting ICH (contrast 40-80 HU, size down to 1 mm) at the point of care but face major challenges in image quality requirements. Statistical reconstruction demonstrates improved noise-resolution tradeoffs in CBCT head imaging, but its capability in improving image quality with respect to the task of ICH detection remains to be fully investigated...
July 2016: Conference Proceedings of International Conference on Image Formation in X-Ray Computed Tomography
https://www.readbyqxmd.com/read/28265859/new-cancer-pain-treatment-options
#12
REVIEW
Kenneth D Candido, Teresa M Kusper, Nebojsa Nick Knezevic
PURPOSE OF REVIEW: Cancer pain is often incapacitating and discouraging to patients; is demoralizing to family members and care takers; and is taxing and difficult to subdue for the pain specialists. The consequences of implementing suboptimal treatment are far-reaching; therefore, effective treatment methods are in a great demand. The face of cancer pain management has changed in considerable ways, and interventional procedures have become an integral part of providing multimodal analgesia in cancer pain treatment...
February 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28259296/critical-review-of-the-addition-of-tumor-treating-fields-ttfields-to-the-existing-standard-of-care-for-newly-diagnosed-glioblastoma-patients
#13
REVIEW
M Mehta, P Wen, R Nishikawa, D Reardon, K Peters
Since 2005, the standard of care for patients with newly diagnosed glioblastoma (GBM) has consisted of maximal resection followed by radiotherapy plus daily temozolomide (TMZ), followed by maintenance TMZ. In patients selected for clinical trials, median overall survival (OS) and progression-free survival (PFS) with this regimen is 15-17 months and 6-7 months, respectively. There have been various, largely unsuccessful attempts to improve on this standard of care. With the FDA approval of the tumor-treating fields (TTFields) device, Optune, for recurrent GBM (2011), and the more recent EF-14 interim trial results and approval for newly diagnosed GBM patients, several questions have arisen...
March 2017: Critical Reviews in Oncology/hematology
https://www.readbyqxmd.com/read/28162168/-analysis-of-clinical-characteristics-and-outcomes-of-mechanically-ventilated-patients-with-anti-n-methyl-d-aspartate-receptor-encephalitis
#14
Y Zhang, Y Y Su, D Q Gao, H Ye
Objective: To explore the clinical characteristics and long-term outcomes of mechanically ventilated patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Methods: In this observational study, patients with anti-NMDAR encephalitis were enrolled, who were admitted into Xuanwu Hospital of Capital Medical University from Jan 2012 to Jun 2015.All patients accepted tumor screening, symptomatic therapy, and immunotherapy.Outcomes were assessed by modified Rankin Scale (mRS) after immunotherapy every 6 months, and mRS 0-2 was defined as favorable outcome...
January 17, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28145850/characterization-of-end-of-life-electroencephalographic-surges-in-critically-ill-patients
#15
Lakhmir S Chawla, Megan Terek, Christopher Junker, Seth Akst, Bona Yoon, Ermira Brasha-Mitchell, Michael G Seneff
Neuromonitoring devices to assess level of sedation are now used commonly in many hospital settings. The authors previously reported that electroencephalicgraphic (EEG) spikes frequently occurred after the time of death in patients being neuromonitored at the time of cessation of circulation. In addition to the initial report, end-of-life electrical surges (ELES) have been subsequently documented in animal and human studies by other investigators. The frequency, character, intensity, and significance of ELES are unknown...
July 2017: Death Studies
https://www.readbyqxmd.com/read/28112704/evaluation-and-treatment-of-hyperglycemia-in-critically-ill-patients
#16
Andrea Balloni, Federico Lari, Fabrizio Giostra
The hyperglycemic reaction to stress is part of adaptive metabolic response to critical illness, especially hypoxia, hemorrhage and sepsis. It involves neuro-endocrine and immune pathways leading to the development of insulin resistance and hepatic glucose production by gluconeogenesis and glycogenolysis. Over the last years the concept of stress related hyperglycemia has been replaced by the concept of dysglycemia and its three domains: hyperglycemia, hypoglycemia and glycemic variability. Each of the three domains is independently associated with increased risk of mortality in patients admitted in intensive care unit and non critically ill patients, both medical and surgical...
January 16, 2017: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/28000130/early-mobilization-in-the-neuro-icu-how-far-can-we-go
#17
Brian F Olkowski, Syed Omar Shah
Immobility that is frequently encountered in the intensive care unit (ICU) can lead to patient complications. Early mobilization of patients in the ICU has been shown to reduce the complications associated with critical illness; however, early mobilization in the neurological intensive care unit (NICU) presents a unique challenge for the multidisciplinary team. The early mobilization of patients with acute neurologic injuries such as acute ischemic stroke, aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, and neurotrauma varies because of differing disease processes and management...
August 2017: Neurocritical Care
https://www.readbyqxmd.com/read/27987330/protection-of-dexmedetomidine-against-ischemia-reperfusion-induced-apoptotic-insults-to-neuronal-cells-occurs-via-an-intrinsic-mitochondria-dependent-pathway
#18
Gong-Jhe Wu, Jui-Tai Chen, Hsiao-Chien Tsai, Ta-Liang Chen, Shing-Hwa Liu, Ruei-Ming Chen
Dexmedetomidine, an agonist of alpha2-adrenergic receptors, is used for critically ill patients to induce and maintain sedation and analgesia. Brain ischemia/reperfusion (I/R) usually causes severe neuronal injuries to intensive care unit patients. This study was aimed to evaluate the effects of dexmedetomidine on I/R-induced insults to neuronal cells and the possible mechanisms. Treatment of neuro-2a cells with dexmedetomidine did not affect cell viability but could protect against I/R-induced cell death. Separately, the I/R-triggered cell shrinkage, DNA fragmentation, and apoptosis in neuro-2a cells were alleviated by dexmedetomidine...
September 2017: Journal of Cellular Biochemistry
https://www.readbyqxmd.com/read/27833207/brain-death-and-true-patient-care
#19
Doyen Nguyen
The "brain death" standard as a criterion of death is closely associated with the need for transplantable organs from heart-beating donors. Are all of these potential donors really dead, or does the documented evidence of patients destined for organ harvesting who improve, or even recover to live normal lives, call into question the premise underlying "brain death"? The aim of this paper is to re-examine the notion of "brain death," especially its clinical test-criteria, in light of a broad framework, including medical knowledge in the field of neuro-intensive care and the traditional ethics of the medical profession...
August 2016: Linacre Quarterly
https://www.readbyqxmd.com/read/27779577/extracorporeal-membrane-oxygenation-for-adult-respiratory-distress-syndrome-in-trauma-patients-a-case-series-and-systematic-literature-review
#20
REVIEW
Chiara Robba, Andrea Ortu, Federico Bilotta, Alessandra Lombardo, Mypinder S Sekhon, Fabio Gallo, Basil F Matta
BACKGROUND: Venovenous extracorporeal membrane oxygenation (vv-ECMO) is an established salvage therapy for severe respiratory failure, and may provide an alternative form of treatment for trauma-induced adult respiratory distress syndrome (ARDS) when conventional treatments have failed. The need for systemic anticoagulation is a relative contraindication for patients with bleeding risks, especially in multitraumatic injury. METHODS: We describe a case series of four trauma patients with ARDS who were managed with ECMO admitted to the neuro critical care unit at Addenbrooke's Hospital, Cambridge (UK), from January 2000 to January 2016...
January 2017: Journal of Trauma and Acute Care Surgery
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