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https://www.readbyqxmd.com/read/28646035/a-matter-of-life-and-death
#1
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/28643814/-unresponsive-wakefulness-syndrome-clinical-predictors-of-late-recovery
#2
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
#3
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be in the best interests of a minimally conscious patient for clinically assisted nutrition and hydration (CANH) to be withdrawn, with the inevitable consequence that the patient would die.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/28642208/assessing-the-efficacy-of-imagery-enhanced-cognitive-behavioral-group-therapy-for-social-anxiety-disorder-study-protocol-for-a-randomized-controlled-trial
#4
Peter M McEvoy, Michelle L Moulds, Jessica R Grisham, Emily A Holmes, David A Moscovitch, Delia Hendrie, Lisa M Saulsman, Ottmar V Lipp, Robert T Kane, Ronald M Rapee, Matthew P Hyett, David M Erceg-Hurn
Cognitive behavior group therapy (CBGT) is effective for social anxiety disorder (SAD), but a substantial proportion of patients do not typically achieve normative functioning. Cognitive behavioral models of SAD emphasize negative self-imagery as an important maintaining factor, and evidence suggests that imagery is a powerful cognitive mode for facilitating affective change. This study will compare two group CBGT interventions, one that predominantly uses verbally-based strategies (VB-CBGT) and another that predominantly uses imagery-enhanced strategies (IE-CBGT), in terms of (a) efficacy, (b) mechanisms of change, and (c) cost-effectiveness...
June 19, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28641040/-drunkorexia-understanding-eating-and-physical-activity-behaviors-of-weight-conscious-drinkers-in-a-sample-of-college-students
#5
Amanda H Wilkerson, Christine L Hackman, Sarah E Rush, Stuart L Usdan, Corinne S Smith
OBJECTIVE: Behaviors of weight conscious drinkers (BWCD) include disordered eating, excessive physical activity, and heavy episodic drinking. Considering approximately 25% of college students report BWCD, it is important to investigate what characteristics increase the likelihood of college students engaging in BWCD for both moderate and vigorous physical activity. PARTICIPANTS: 510 college students recruited from a large, public southeastern university. METHODS: Participants completed a cross-sectional survey during the spring 2015 semester...
June 22, 2017: Journal of American College Health: J of ACH
https://www.readbyqxmd.com/read/28633545/late-recovery-of-awareness-in-prolonged-disorders-of-consciousness-a-cross-sectional-cohort-study
#6
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/28630376/functional-connectivity-disturbances-of-the-ascending-reticular-activating-system-in-temporal-lobe-epilepsy
#7
Dario J Englot, Pierre-Francois D'Haese, Peter E Konrad, Monica L Jacobs, John C Gore, Bassel W Abou-Khalil, Victoria L Morgan
OBJECTIVE: Seizures in temporal lobe epilepsy (TLE) disturb brain networks and lead to connectivity disturbances. We previously hypothesised that recurrent seizures in TLE may lead to abnormal connections involving subcortical activating structures including the ascending reticular activating system (ARAS), contributing to neocortical dysfunction and neurocognitive impairments. However, no studies of ARAS connectivity have been previously reported in patients with epilepsy. METHODS: We used resting-state functional MRI recordings in 27 patients with TLE (67% right sided) and 27 matched controls to examine functional connectivity (partial correlation) between eight brainstem ARAS structures and 105 cortical/subcortical regions...
June 19, 2017: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/28630253/cold-induced-thermogenesis-and-inflammation-associated-cold-seeking-behavior-are-represented-by-different-dorsomedial-hypothalamic-sites-a-three-dimensional-functional-topography-study-in-conscious-rats
#8
Samuel P Wanner, M Camila Almeida, Yury P Shimansky, Daniela L Oliveira, Justin R Eales, Cândido C Coimbra, Andrej A Romanovsky
In the past, we showed that large electrolytic lesions of the dorsomedial hypothalamus (DMH) promoted hypothermia in cold-exposed restrained rats, but attenuated hypothermia in rats challenged with a high dose of bacterial lipopolysaccharide (LPS) in a thermogradient apparatus. The goal of this study was to identify the thermoeffector mechanisms and DMH representation of the two phenomena and, hence, understand how the same lesion could produce two opposite effects on body temperature. We found that the permissive effect of large electrolytic DMH lesions on cold-induced hypothermia was due to suppressed thermogenesis...
June 19, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28625002/changes-in-dietary-intake-and-eating-behavior-in-adolescents-after-bariatric-surgery-an-ancillary-study-to-the-teen-labs-consortium
#9
David B Sarwer, Rebecca J Dilks, Jacqueline C Spitzer, Robert I Berkowitz, Thomas A Wadden, Renee H Moore, Jesse L Chittams, Mary L Brandt, Mike K Chen, Anita P Courcoulas, Carroll M Harmon, Michael A Helmrath, Marc P Michalsky, Stavra A Xanthakos, Meg H Zeller, Todd M Jenkins, Thomas H Inge
BACKGROUND: A growing number of studies suggest that bariatric surgery is safe and effective for adolescents with severe obesity. However, surprisingly little is known about changes in dietary intake and eating behavior of adolescents who undergo bariatric surgery. OBJECTIVE: Investigate changes in dietary intake and eating behavior of adolescents with obesity who underwent bariatric surgery (n = 119) or lifestyle modification (LM) (n = 169). SETTING: University-based health systems METHODS: A prospective investigation of 288 participants (219 female and 69 male) prior to bariatric surgery or LM and again 6, 12, and 24 months (surgery patients only) after treatment...
June 17, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28619656/the-large-scale-functional-connectivity-correlates-of-consciousness-and-arousal-during-the-healthy-and-pathological-human-sleep-cycle
#10
REVIEW
Enzo Tagliazucchi, Eus J W van Someren
Advances in neuroimaging have greatly improved our understanding of human sleep from a systems neuroscience perspective. However, cognition and awareness are reduced during sleep, hindering the applicability of standard task-based paradigms. Methods recently developed to study spontaneous brain activity fluctuations have proven useful to overcome this limitation. In this review, we focus on the concept of functional connectivity (FC, i.e. statistical covariance between brain activity signals) and its application to functional magnetic resonance imaging (fMRI) data acquired during sleep...
June 12, 2017: NeuroImage
https://www.readbyqxmd.com/read/28615894/unknown-patients-and-neurology-casualty-services-in-an-indian-metropolitan-city-a-decades-experience
#11
Achary Umesh, Guru S Gowda, Channaveerachari Naveen Kumar, Dwarakanath Srinivas, Bharath Rose Dawn, Ragasudha Botta, Ravi Yadav, Suresh Bada Math
OBJECTIVES: A large number of unknown patients without any personal, family, or other identification details represent a unique problem in the neurological emergency services of developing countries like India in a context of legal, humanitarian, and treatment issues. These patients pose a diagnostic and management challenge to treating physicians and staff. There are sparse data on these patients. The objective of this study was to know the clinical, socio-demographic, and investigational profile of "unknown" patients...
April 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/28615674/meta-analysis-of-genome-wide-snp-and-pathway-based-associations-for-facets-of-neuroticism
#12
Song E Kim, Han-Na Kim, Yeo-Jun Yun, Seong Gu Heo, Juhee Cho, Min-Jung Kwon, Yoosoo Chang, Seungho Ryu, Hocheol Shin, Chol Shin, Nam H Cho, Yeon Ah Sung, Hyung-Lae Kim
Neuroticism is a heritable personality trait that is comprised of distinct sub-factors, or facets. Sub-factors of neuroticism are linked to different emotional states or psychiatric symptoms and studying the genetic variants associated with these facets may help reveal the biological mechanisms underlying psychiatric disorders. In the present study, a meta-analysis of genome-wide association studies for six facets of neuroticism was performed in 5584 participants from three cohorts. Additionally, a Gene Set Enrichment Analysis was conducted to find biological pathways associated with each facet...
June 15, 2017: Journal of Human Genetics
https://www.readbyqxmd.com/read/28615277/alterations-in-the-brain-s-connectome-during-recovery-from-severe-traumatic-brain-injury-protocol-for-a-longitudinal-prospective-study
#13
Virginia Conde, Sara Hesby Andreasen, Tue Hvass Petersen, Karen Busted Larsen, Karine Madsen, Kasper Winther Andersen, Irina Akopian, Kristoffer Hougaard Madsen, Christian Pilebæk Hansen, Ingrid Poulsen, Lars Peter Kammersgaard, Hartwig Roman Siebner
INTRODUCTION: Traumatic brain injury (TBI) is considered one of the most pervasive causes of disability in people under the age of 45. TBI often results in disorders of consciousness, and clinical assessment of the state of consciousness in these patients is challenging due to the lack of behavioural responsiveness. Functional neuroimaging offers a means to assess these patients without the need for behavioural signs, indicating that brain connectivity plays a major role in consciousness emergence and maintenance...
June 14, 2017: BMJ Open
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
#14
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/28610950/coherence-in-p300-as-a-predictor-for-the-recovery-from-disorders-of-consciousness
#15
Ye Zhang, Ran Li, Jubao Du, Su Huo, Jianhui Hao, Weiqun Song
Accurate and reliable prognostic judgments for disorders of consciousness (DOCs) can provide useful information for clinicians in the establishment of appropriate care plan, and may affect end-of-life decisions of caregivers. But until now no certain or standardized prognostic indicator has been constructed to predict the probability of awareness recovery. This study aims to assess higher-order cortical information processing in DOCs by event-related potential (ERP) and determine the value of P300 to predict the long-term prognosis...
June 10, 2017: Neuroscience Letters
https://www.readbyqxmd.com/read/28606234/-efficacy-and-safety-of-cyclophosphamide-as-a-sequential-immunotherapy-drug-for-anti-n-methyl-d-aspartate-receptor-encephalitis-in-children
#16
Wei-Wen Zhu, Wei-Ping Liao, Yong-Hong Yi, Xing-Wang Song
OBJECTIVE: To evaluate the efficacy and safety of cyclophosphamide as a second-line drug in the treatment of children with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. METHODS: Six children with anti-NMDAR encephalitis, who showed poor response to steroids and intravenous immunoglobulin, were given cyclophosphamide as a second-line immunotherapy. Follow-up was performed to evaluate the efficacy and safety of cyclophosphamide. RESULTS: After first-line immunotherapy for 1-4 weeks, the six patients had reduced psychiatric symptoms, seizures, and involuntary movements; three patients had an improved level of consciousness and were able to make simple conversations...
June 2017: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/28605973/a-comparative-study-on-assessment-procedures-and-metric-properties-of-two-scoring-systems-of-the-coma-recovery-scale-revised-items-standard-and-modified-scores
#17
Davide Sattin, Piergiorgio Lovaglio, Greta Brenna, Venusia Covelli, Davide Rossi Sebastiano, Dunja Duran, Ludovico Minati, Ambra Mara Giovannetti, Cristina Rosazza, Anna Bersano, Anna Nigri, Stefania Ferraro, Matilde Leonardi
OBJECTIVE: The study compared the metric characteristics (discriminant capacity and factorial structure) of two different methods for scoring the items of the Coma Recovery Scale-Revised and it analysed scale scores collected using the standard assessment procedure and a new proposed method. DESIGN: Cross sectional design/methodological study. SETTING: Inpatient, neurological unit. PARTICIPANTS: A total of 153 patients with disorders of consciousness were consecutively enrolled between 2011 and 2013...
March 1, 2017: Clinical Rehabilitation
https://www.readbyqxmd.com/read/28597413/late-onset-ornithine-transcarbamylase-deficiency-associated-with-hyperammonemia
#18
Kana Daijo, Tomokazu Kawaoka, Takashi Nakahara, Yuko Nagaoki, Masataka Tsuge, Akira Hiramatsu, Michio Imamura, Yoshiiku Kawakami, Hiroshi Aikata, Keiichi Hara, Go Tajima, Masao Kobayashi, Kazuaki Chayama
The urea cycle converts ammonia and produces urea. One form of urea cycle abnormality is ornithine transcarbamylase (OTC) deficiency. This hereditary disorder is associated with hyperammonemia. OTC deficiency commonly appears during neonatal and early childhood life and is rare in adults. We report a 69-year-old man who presented at the local hospital with 3-day loss of appetite, early morning vomiting, and state of confusion. Blood ammonia was 293 μg/dl. At 2-3 h after admission, the patient went into a deep coma...
June 9, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/28594194/conducting-preference-assessments-for-youth-with-disorders-of-consciousness-during-rehabilitation
#19
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/28592738/a-case-of-hereditary-hemorrhagic-telangiectasia-with-hepatic-encephalopathy-due-to-portal-hepatic-venous-shunt
#20
Kazumasa Ono, Toshimasa Obara, Miki Takeshita, Shinichiro Inoue, Shinjirou Mizukawa, Hiroshi Hasegawa, Koichi Kozaki
An 86-year-old male who was able to perform all activities of daily living (ADL) was diagnosed with hereditary hemorrhagic telangiectasia (HHT) at 70 years of age. Following his diagnosis, he had been receiving treatment at our hospital. After the sudden onset of a consciousness disorder, he was admitted to our hospital's emergency department with asterixis, a high serum ammonia level, and hepatic encephalopathy. After angiography, he was diagnosed with hepatic encephalopathy due to portal hepatic venous shunts...
2017: Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
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