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https://www.readbyqxmd.com/read/29779129/practical-impact-of-a-decision-support-for-goal-directed-fluid-therapy-on-protocol-adherence-a-clinical-implementation-study-in-patients-undergoing-major-abdominal-surgery
#1
Alexandre Joosten, Reda Hafiane, Marco Pustetto, Luc Van Obbergh, Thierry Quackels, Alexis Buggenhout, Jean-Louis Vincent, Brigitte Ickx, Joseph Rinehart
The purpose of this study was to assess the effects of using a real time clinical decision-support system, "Assisted Fluid Management" (AFM), to guide goal-directed fluid therapy (GDFT) during major abdominal surgery. We compared a group of patients managed using the AFM system with a historical cohort of patients (control group) who had been managed using a manual GDFT strategy. Adherence to the protocol was defined as the relative intraoperative time spent with a stroke volume variation (SVV) < 13%...
May 19, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29778331/goal-directed-perfusion-to-reduce-acute-kidney-injury-a-randomized-trial
#2
Marco Ranucci, Ian Johnson, Timothy Willcox, Robert A Baker, Christa Boer, Andreas Baumann, George A Justison, Filip de Somer, Paul Exton, Seema Agarwal, Rachael Parke, Richard F Newland, Renard G Haumann, Dirk Buchwald, Nathaen Weitzel, Rajamiyer Venkateswaran, Valeria Pistuddi
OBJECTIVE: To determine whether a goal-directed perfusion (GDP) strategy aimed at maintaining oxygen delivery (DO2 ) at ≥280 mL·min-1 ·m-2 reduces the incidence of acute kidney injury (AKI). METHODS: This multicenter randomized trial enrolled a total of 350 patients undergoing cardiac surgery in 9 institutions. Patients were randomized to receive either GDP or conventional perfusion. A total of 326 patients completed the study and were analyzed. Patients in the treatment arm were treated with a GDP strategy during cardiopulmonary bypass (CPB) aimed to maintain DO2 at ≥280 mL·min-1 ·m-2 ...
April 18, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29777165/hiv-1-proteins-dysregulate-motivational-processes-and-dopamine-circuitry
#3
Sarah J Bertrand, Charles F Mactutus, Steven B Harrod, Landhing M Moran, Rosemarie M Booze
Motivational alterations, such as apathy, in HIV-1+ individuals are associated with decreased performance on tasks involving frontal-subcortical circuitry. We used the HIV-1 transgenic (Tg) rat to assess effect of long-term HIV-1 protein exposure on motivated behavior using sucrose (1-30%, w/v) and cocaine (0.01-1.0 mg/kg/infusion) maintained responding with fixed-ratio (FR) and progressive-ratio (PR) schedules of reinforcement. For sucrose-reinforced responding, HIV-1 Tg rats displayed no change in EC50 relative to controls, suggesting no change in sucrose reinforcement but had a downward shifted concentration-response curves, suggesting a decrease in response vigor...
May 18, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29772593/-coagulation-monitoring-and-bleeding-management-in-cardiac-surgery
#4
Berthold Bein, Robert Schiewe
The transfusion of allogeneic blood products is associated with increased morbidity and mortality. An impaired hemostasis is frequently found in patients undergoing cardiac surgery and may in turn cause bleeding and transfusions. A goal directed coagulation management addressing the often complex coagulation disorders needs sophisticated diagnostics. This may improve both patients' outcome and costs. Recent data suggest that coagulation management based on a rational algorithm is more effective than traditional therapy based on conventional laboratory variables such as PT and INR...
May 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29772591/-monitoring-and-modern-hemodynamic-concepts-in-cardiac-anesthesia
#5
Matthias Heringlake, Christian Schmidt, Sebastian Brandt
Patients undergoing cardiac surgery are growing older, present with more comorbidities, and are frequently scheduled for more complex and prolonged surgical procedures. Routine application of neurological as well as extended hemodynamic monitoring combined with goal-directed perioperative hemodynamic optimization, targeting optimization of systemic and cerebral oxygen balance, show promise to reduce postoperative complications and to improve mortality in this high risk population. Expert recommendations suggest to avoid synthetic colloids for fluid optimization...
May 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29770895/implementation-of-goal-directed-therapy-needs-a-boost-and-it-is-called-assisted-fluid-management
#6
EDITORIAL
Paul A van Beest
No abstract text is available yet for this article.
May 16, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29767295/violation-of-expectations-about-movement-and-goal-achievement-leads-to-sense-of-agency-reduction
#7
Riccardo Villa, Emmanuele Tidoni, Giuseppina Porciello, Salvatore Maria Aglioti
The control of one's own movements and of their impact on the external world generates a feeling of control referred to as Sense of Agency (SoA). SoA is experienced when actions match predictions and is reduced by unpredicted events. The present study investigated the contribution of monitoring two fundamental components of action-movement execution and goal achievement-that have been most often explored separately in previous research. We have devised a new paradigm in which participants performed goal-directed actions while viewing an avatar's hand in a mixed-reality scenario...
May 16, 2018: Experimental Brain Research. Experimentelle Hirnforschung. Expérimentation Cérébrale
https://www.readbyqxmd.com/read/29767030/commentary-sleep-deprivation-promotes-habitual-control-over-goal-directed-control-behavioral-and-neuroimaging-evidence
#8
COMMENT
Yannick Boddez, Eike K Buabang, Ann-Kathrin Zenses, Mathilde Descheemaeker
No abstract text is available yet for this article.
2018: Frontiers in Behavioral Neuroscience
https://www.readbyqxmd.com/read/29764869/tele-upcat-study-protocol-of-a-randomised-controlled-trial-of-a-home-based-tele-monitored-upper-limb-children-action-observation-training-for-participants-with-unilateral-cerebral-palsy
#9
Giuseppina Sgandurra, Francesca Cecchi, Elena Beani, Irene Mannari, Martina Maselli, Francesco Paolo Falotico, Emanuela Inguaggiato, Silvia Perazza, Elisa Sicola, Hilde Feys, Katrijn Klingels, Adriano Ferrari, Paolo Dario, Roslyn N Boyd, Giovanni Cioni
INTRODUCTION: A new rehabilitative approach, called UPper Limb Children Action Observation Training (UPCAT), based on the principles of action observation training (AOT), has provided promising results for upper limb rehabilitation in children with unilateral cerebral palsy (UCP). This study will investigate if a new information and communication technology platform, named Tele-UPCAT, is able to deliver AOT in a home setting and will test its efficacy on children and young people with UCP...
May 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29764270/drunk-decisions-alcohol-shifts-choice-from-habitual-towards-goal-directed-control-in-adolescent-intermediate-risk-drinkers
#10
Elisabeth Obst, Daniel J Schad, Quentin Jm Huys, Miriam Sebold, Stephan Nebe, Christian Sommer, Michael N Smolka, Ulrich S Zimmermann
BACKGROUND: Studies in humans and animals suggest a shift from goal-directed to habitual decision-making in addiction. We therefore tested whether acute alcohol administration reduces goal-directed and promotes habitual decision-making, and whether these effects are moderated by self-reported drinking problems. METHODS: Fifty-three socially drinking males completed the two-step task in a randomised crossover design while receiving an intravenous infusion of ethanol (blood alcohol level=80 mg%), or placebo...
May 1, 2018: Journal of Psychopharmacology
https://www.readbyqxmd.com/read/29762648/a-new-framework-for-conceptualizing-symptoms-in-frontotemporal-dementia-from-animal-models-to-the-clinic
#11
Stephanie Wong, Bernard W Balleine, Fiona Kumfor
Behavioural-variant frontotemporal dementia is characterized by a number of ostensibly disparate clinical features, which have largely been considered independently. This Update proposes an integrated conceptual framework for these symptoms, by bringing together findings from animal studies, functional neuroimaging and behavioural neurology. The combined evidence indicates that many of the clinical symptoms--such as altered eating behaviour; overspending and susceptibility to scams; reduced empathy and socially inappropriate behaviour; apathy and stereotyped/ritualistic behaviour--can be conceptualized as a common underlying deficiency in goal-directed behaviour and the concomitant emergence of habits...
May 11, 2018: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/29762102/dynamic-encoding-of-effort-and-reward-throughout-the-execution-of-action-by-external-globus-pallidus-neurons-in-monkeys
#12
Simon Nougaret, Sabrina Ravel
Humans and animals must evaluate the costs and expected benefits of their actions to make adaptive choices. Prior studies have demonstrated the involvement of the BG in this evaluation. However, little is known about the role of the external part of the globus pallidus (GPe), which is well positioned to integrate motor and reward-related information, in this process. To investigate this role, the activity of 126 neurons was recorded in the associative and limbic parts of the GPe of two monkeys performing a behavioral task in which different levels of force were required to obtain different amounts of liquid reward...
May 15, 2018: Journal of Cognitive Neuroscience
https://www.readbyqxmd.com/read/29760060/corticoinsular-circuits-encode-subjective-value-expectation-and-violation-for-effortful-goal-directed-behavior
#13
Amanda R Arulpragasam, Jessica A Cooper, Makiah R Nuutinen, Michael T Treadway
We are presented with choices each day about how to invest our effort to achieve our goals. Critically, these decisions must frequently be made under conditions of incomplete information, where either the effort required or possible reward to be gained is uncertain. Such choices therefore require the development of potential value estimates to guide effortful goal-directed behavior. To date, however, the neural mechanisms for this expectation process are unknown. Here, we used computational fMRI during an effort-based decision-making task where trial-wise information about effort costs and reward magnitudes was presented separately over time, thereby allowing us to model distinct effort/reward computations as choice-relevant information unfolded...
May 14, 2018: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/29758221/inhibition-of-striatal-cholinergic-interneuron-activity-by-the-kv7-opener-retigabine-and-the-nonsteroidal-anti-inflammatory-drug-diclofenac
#14
Rodrigo Manuel Paz, Cecilia Tubert, Agostina Stahl, Analía López Díaz, Roberto Etchenique, Mario Gustavo Murer, Lorena Rela
Striatal cholinergic interneurons provide modulation to striatal circuits involved in voluntary motor control and goal-directed behaviors through their autonomous tonic discharge and their firing "pause" responses to novel and rewarding environmental events. Striatal cholinergic interneuron hyperactivity was linked to the motor deficits associated with Parkinson's disease and the adverse effects of chronic antiparkinsonian therapy like l-DOPA-induced dyskinesia. Here we addressed whether Kv7 channels, which provide negative feedback to excitation in other neuron types, are involved in the control of striatal cholinergic interneuron tonic activity and response to excitatory inputs...
May 11, 2018: Neuropharmacology
https://www.readbyqxmd.com/read/29756693/multi-parametric-functional-hemodynamic-optimization-improves-postsurgical-outcome-after-intermediate-risk-open-gastrointestinal-surgery-a-randomized-controlled-trial
#15
Pavel Szturz, Pavel Folwarczny, Roman Kula, Jan Neiser, Pavel Ševčík, Jan Benes
BACKGROUND: Perioperative goal directed therapy (pGDT) using flow monitoring has been associated with improved outcomes. However, its protocols are often based on stroke volume only: as a target for fluid loading, inotropic support and vasopresors (via mathematical coupling of systemic vascular resistance). In this trial, we have tested the multi- parametric pGDT protocol based on esophageal Doppler variables (corrected flow time, peak velocity) in intermediate-to-high risk patients undergoing gastrointestinal surgery...
May 11, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29754857/comparison-of-normal-saline-versus-lactated-ringer-s-solution-for-fluid-resuscitation-in-patients-with-mild-acute-pancreatitis-a-randomized-controlled-trial
#16
Sararak Choosakul, Kamin Harinwan, Sakkarin Chirapongsathorn, Krit Opuchar, Theeranun Sanpajit, Wanich Piyanirun, Chaipichit Puttapitakpong
BACKGROUND/OBJECTIVES: Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. However, there are few studies which focus on types of fluid therapy. METHODS: We performed a randomized controlled trial in patients with acute pancreatitis. The patients were randomized into two groups. Each group received Normal Saline solution (NSS) or Lactated Ringer's solution (LRS) through a goal-directed fluid resuscitation protocol. Systemic inflammatory response syndrome (SIRS) at 24 and 48 h, mortality, presence of local complications and inflammatory markers were measured...
May 7, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/29750924/predictors-for-follow-up-among-postpartum-patients-enrolled-in-a-clinical-trial
#17
Maureen K Baldwin, Kyle D Hart, Maria I Rodriguez
OBJECTIVE: To identify risk factors for failure to attend postpartum follow-up within three months of delivery, including social support, intrinsic motivation, insurance type, and prenatal care attendance. STUDY DESIGN: This planned secondary analysis is derived from a randomized controlled trial of patients intending intrauterine device (IUD) use following their delivery (n=197). Subjects were postpartum from a vaginal or cesarean birth at≥32weeks gestation. We obtained baseline demographics and certainty about their plan to receive a postpartum IUD...
May 8, 2018: Contraception
https://www.readbyqxmd.com/read/29750699/implementation-of-closed-loop-assisted-intra-operative-goal-directed-fluid-therapy-during-major-abdominal-surgery-a-case-control-study-with-propensity-matching
#18
Alexandre Joosten, Sean Coeckelenbergh, Amelie Delaporte, Brigitte Ickx, Jean Closset, Thierry Roumeguere, Luc Barvais, Luc Van Obbergh, Maxime Cannesson, Joseph Rinehart, Philippe Van der Linden
BACKGROUND: Goal-directed fluid therapy (GDFT) has been associated with improved patient outcomes. However, implementation of GDFT protocols remains low despite growing published evidence and the recommendations of multiple regulatory bodies in Europe. We developed a closed-loop-assisted GDFT management system linked to a pulse contour monitor to assist anaesthesiologists in applying GDFT. OBJECTIVE: To assess the impact of our closed-loop system in patients undergoing major abdominal surgery in an academic hospital without a GDFT programme...
May 9, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29750688/feasibility-of-fully-automated-hypnosis-analgesia-and-fluid-management-using-2-independent-closed-loop-systems-during-major-vascular-surgery-a-pilot-study
#19
Alexandre Joosten, Vincent Jame, Brenton Alexander, Thierry Chazot, Ngai Liu, Maxime Cannesson, Joseph Rinehart, Luc Barvais
Automated titration of intravenous anesthesia and analgesia using processed electroencephalography monitoring is no longer a novel concept. Closed-loop control of fluid administration to provide goal-directed fluid therapy has also been increasingly described. However, simultaneously combining 2 independent closed-loop systems together in patients undergoing major vascular surgery has not been previously detailed. The aim of this pilot study was to evaluate the clinical performance of fully automated hypnosis, analgesia, and fluid management using 2 independent closed-loop controllers in patients undergoing major vascular surgery before implementation within a larger study evaluating true patient outcomes...
May 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29747290/-the-relationship-between-arterial-blood-lactate-clearance-prognosis-and-myocardial-damage-in-patients-with-septic-shock-after-early-goal-directed-therapy
#20
X L Shang, D W Liu, X T Wang, H W He, H M Zhang, L X Su, P Pan
Objective: To evaluate the prognostic value of arterial blood lactate clearance based on central venous oxygen saturation and perfusion index in patients with septic shock related myocardial injury after early goal-directed therapy. Methods: One hundred and fifty-seven patients with septic shock after early resuscitation were enrolled from August 2013 to July 2016 in ICU at Peking Union Medical College Hospital. Parameters indicating early resuscitation included central venous pressure (CVP) 8-12 mmHg (1 mmHg=0...
May 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
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