scholarly journals The Benefit of Neuromuscular Blockade in Patients with Postanoxic Myoclonus Otherwise Obscuring Continuous Electroencephalography (CEEG)

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Christopher R. Newey ◽  
Alejandro Hornik ◽  
Meziane Guerch ◽  
Anantha Veripuram ◽  
Sushma Yerram ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Status Epilepticus ◽  
Neuromuscular Blockade ◽  
Burst Suppression ◽  
Inclusion Criteria ◽  
Cerebral Activity ◽  
Periodic Discharges ◽  
Continuous Electroencephalography ◽  
Continuous Eeg

Introduction. Myoclonus status epilepticus is independently associated with poor outcome in coma patients after cardiac arrest. Determining if myoclonus is of cortical origin on continuous electroencephalography (CEEG) can be difficult secondary to the muscle artifact obscuring the underlying CEEG. The use of a neuromuscular blocker can be useful in these cases. Methods. Retrospective review of CEEG in patients with postanoxic myoclonus who received cisatracurium while being monitored. Results. Twelve patients (mean age: 53.3 years; 58.3% male) met inclusion criteria of clinical postanoxic myoclonus. The initial CEEG patterns immediately prior to neuromuscular blockade showed myoclonic artifact with continuous slowing (50%), burst suppression with myoclonic artifact (41.7%), and continuous myogenic artifact obscuring CEEG (8.3%). After intravenous administration of cisatracurium (0.1 mg–2 mg), reduction in artifact improved quality of CEEG recordings in 9/12 (75%), revealing previously unrecognized patterns: continuous EEG seizures (33.3%), lateralizing slowing (16.7%), burst suppression (16.7%), generalized periodic discharges (8.3%), and, in the patient who had an initially uninterpretable CEEG from myogenic artifact, continuous slowing. Conclusion. Short-acting neuromuscular blockade is useful in determining background cerebral activity on CEEG otherwise partially or completely obscured by muscle artifact in patients with postanoxic myoclonus. Fully understanding background cerebral activity is important in prognostication and treatment, particularly when there are underlying EEG seizures.

Abstract 257: Combining the Initial Four B Score and Continuous EEG to Predict Survival After Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chun Song Youn ◽  
Clifton W Callaway ◽  
Jon C Rittenberger
Keyword(s):  
Cardiac Arrest ◽  
Status Epilepticus ◽  
Hospital Discharge ◽  
Discharge Rate ◽  
Pupillary Light Reflex ◽  
Convulsive Status Epilepticus ◽  
Light Reflex ◽  
Pupillary Light ◽  
Continuous Eeg ◽  
Corneal Reflex

Background: Outcome prediction after cardiac arrest is a challenging problem and multiple tests should be performed to predict outcome accurately. We tested whether the combination of initial brainstem reflex examination (FOUR_B score) and continuous EEG were superior to either test alone for predicting survival after cardiac arrest. Methods: Review of consecutive patients receiving continuous EEG monitoring between April 2010 and June 2013. Patients were divided into three groups according to initial FOUR_B score; FOUR_B = 0-1, FOUR_B = 2 and FOUR_B = 4. A blinded rater dichotomized continuous EEG patterns during the first 48 hours into malignant patterns (non-convulsive status epilepticus, convulsive status epilepticus, myoclonic status epilepticus and generalized periodic epileptiform discharges). The primary outcome was survival to hospital discharge. Results: Of 380 subjects, 45 were excluded (44 missing initial FOUR_B score, 1 with age of 16 years). Mean (SD) age was 58 (17) and 208 (62.1%) subjects were male. Ventricular fibrillation was initial rhythm for 95 (28.4%) subjects. Survival to hospital discharge rate was 7.8% for FOUR_B 0-1, 32.0% for FOUR_B 2 and 51.9% for FOUR_B 4, respectively. Among subjects with malignant cEEG, survival to hospital discharge rate was 0% for FOUR_B 0-1, 8.1% for FOUR_B 2 and 12.5% for FOUR_B 4, respectively. All 42 subjects with no pupillary light reflex, no corneal reflex and malignant cEEG, had poor outcome (false positive rate 0; 95% CI, 0-7%). In the multivariate analysis, survival was independently associated with shockable rhythm (OR 5.76; 95% C.I. 2.88-11.54), FOUR_B 2 (OR 7.36; 95% C.I. 2.83-19.90), FOUR_B 4 (OR 8.99; 95% C.I. 3.58-22.56) and non-malignant cEEG (OR 19.91; 95% C.I. 6.44-61.51). Conclusion: Initial FOUR_B score and malignant cEEG pattern were independently associated with survival to hospital discharge. All subjects who have no pupillary light reflex, no corneal reflex and malignant cEEG did not survive to hospital discharge.

An Evaluation of Cognitive Behavioral Therapy for Insomnia: A Systematic Review and Application of Tolin’s Criteria for Empirically Supported Treatments

2019 ◽  
Author(s):  
Cassandra L. Boness ◽  
Rachel Hershenberg ◽  
Joanna Kaye ◽  
Margaret-Anne Mackintosh ◽  
Damion Grasso ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Empirically Supported Treatments ◽  
Inclusion Criteria ◽  
American Psychological ◽  
Strong Recommendation ◽  
Empirically Supported ◽  
High Quality Evidence

The American Psychological Association’s Society of Clinical Psychology recently adopted the “Tolin Criteria” to evaluate empirically supported treatments. These criteria better account for strength and quality of rapidly accumulating evidence bases for various treatments. Here we apply this framework to Cognitive Behavioral Therapy for Insomnia (CBT-I). Following procedures outlined by Tolin and colleagues (2015), Step 1 included an examination of quantitative systematic reviews; nine met inclusion criteria. Step 2 evaluated review quality and effect size data. We found high-quality evidence that CBT-I produces clinically and statistically significant effects on insomnia and other sleep-related outcomes. Based on the Tolin Criteria, the literature merits a “strong” recommendation for CBT-I. This report is a working model for subsequent applications of the Tolin Criteria.

scholarly journals Physical activity in patients with rheumatoid arthritis - an agile lifelong behaviour: a qualitative meta-synthesis

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001635
Author(s):  
Emma Swärdh ◽  
Christina Opava ◽  
Nina Brodin
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Web Of Science ◽  
Body Awareness ◽  
Main Theme ◽  
Inclusion Criteria ◽  
Online Databases ◽  
Taking Action ◽  
The Impact

BackgroundPhysical activity (PA) in rheumatoid arthritis (RA) is considered a cornerstone in the treatment. To highlight aspects involved in supporting a positive PA behaviour, it is important to understand the patients’ perceptions of the phenomenon.ObjectiveThe aim of this qualitative meta-synthesis was to explore and synthesise patient perceptions of PA in RA.MethodsA purposeful search was conducted across three online databases (PubMed, CINAHL and Web of Science). The methodological quality of the included studies was appraised, and data were extracted and analysed using an interpretive inductive thematic synthesis.ResultsFifteen studies met the inclusion criteria and were included. PA was identified as an agile lifelong behaviour, with one main theme: The disease as a persistent catalyst for or against PA illustrating how the constant presence of the disease itself underlies the entire process of a life with or without regular PA. Seven subthemes: ‘considering aggravated symptoms’, ‘acknowledging the impact on health’, ‘becoming empowered and taking action’, ‘keeping informed to increase awareness’, ‘creating body awareness’, ‘dealing with social support’ and ‘feeling satisfied with circumstances and achievements’ were interpreted as facilitators and/or challenges.ConclusionThis synthesis has identified PA as an agile lifelong behaviour in which the disease pervades all aspects of an individuals’ perception of PA. Placed in a theoretical context, our findings outline a model for tailoring PA support to the drivers and determinants of a certain individual, which will improve clinical practice for the benefit of both health professionals and patients with RA.

scholarly journals How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries

2021 ◽  
pp. 153575972199832
Author(s):  
Karnig Kazazian ◽  
Marissa Kellogg ◽  
Nora Wong ◽  
Krista Eschbach ◽  
Raquel Farias Moeller ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Epilepsy Syndrome ◽  
Neurologic Disorder ◽  
Mortality And Morbidity ◽  
Refractory Status ◽  
Rigorous Research ◽  
Active Epilepsy ◽  
New Onset

New-onset refractory status epilepticus (NORSE) is a rare clinical presentation of refractory status epilepticus (RSE) that occurs in people without active epilepsy or preexisting neurologic disorder. Febrile infection-related epilepsy syndrome (FIRES) is a subcategory of NORSE. New-onset refractory status epilepticus/FIRES are becoming increasingly recognized; however, information pertaining to disease course, clinical outcomes, and survivorship remains limited, and mortality and morbidity are variable, but often high. The objective of the NORSE/FIRES Family Registry is to (1) provide an easily accessible and internationally available multilingual registry into which survivors or NORSE/FIRES surrogates or family members of people affected by NORSE/FIRES or their physicians can enter data in a systematic and rigorous research study from anywhere in the world where internet is available; and (2) to examine past medical history, outcomes, and quality of life for people affected by NORSE/FIRES.

scholarly journals Health-related quality of life after out-of-hospital cardiac arrest – a five-year follow-up studyJūratė Šaltytė Benth

Resuscitation ◽  
2021 ◽  
Author(s):  
Henning Wimmer ◽  
Christofer Lundqvist ◽  
Jūratė Šaltytė Benth ◽  
Knut Stavem ◽  
Geir Ø. Andersen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Arrest ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Hospital Cardiac Arrest

Venous leg symptoms, ecchymosis, and coldness in patients with peripheral varicose vein: A multicenter assessment and validation study (VEIN-VIOLET study)

Vascular ◽  
2020 ◽  
pp. 170853812098020
Author(s):  
Ertan Yetkin ◽  
Makbule Kutlu Karadag ◽  
Mehmet Ileri ◽  
Ramazan Atak ◽  
Nevzat Erdil ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Regression Analysis ◽  
Varicose Vein ◽  
Odds Ratio ◽  
Venous Insufficiency ◽  
Study Quality ◽  
Inclusion Criteria ◽  
Economic Study ◽  
Independent Association

Objectives We aimed to evaluate peripheral varicose vein symptoms including ecchymosis and coldness by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire. Methods A total of 1120 patients were enrolled to the analysis after the exclusion of 199 patients who did not match the inclusion criteria. Patients were asked to answer the VEINES-Sym questionnaire and questions about ecchymosis and coldness. Scores of ecchymosis and coldness were calculated similar to VEINES-Sym questionnaire. Classifications of peripheral varicose vein were made according to the clinical part of clinical, etiological, anatomical, and pathophysiological classification system and patients with grade 2 or higher were considered as positive for peripheral varicose vein. Results Frequency of symptoms present in the VEINES-Sym instrument, ecchymosis and coldness were significantly higher in patients with peripheral varicose vein. Mean score of each symptom was significantly lower in peripheral varicose vein patients including scores of ecchymosis and coldness. Logistic regression analysis revealed that presence of hemorrhoids and all symptoms in VEINES-Sym questionnaire except restless leg were significantly and independently associated with peripheral varicose vein. Besides, ecchymosis (odds ratio: 2.04, 95% confidence interval: 1.34–3.08, p = 0.008) but not coldness was significantly and independently associated with peripheral varicose vein. There was also significant correlation of VEINES-Sym score with ecchymosis ( r = 0.43, p < 0.001) and coldness ( r = 0.47, p < 0.001). Conclusions Venous leg symptoms present in VEINES-Sym questionnaire except restless legs, presence of hemorrhoids and ecchymosis are significantly and independently associated with peripheral varicose vein. Not only ecchymosis but also coldness has shown an independent association with total VEINES-Sym score.

scholarly journals Associations between posttraumatic stress symptoms and quality of life in cardiac arrest survivors and informal caregivers: A pilot survey study

2021 ◽  
Vol 5 ◽  
pp. 100085
Author(s):  
Alex Presciutti ◽  
Mary M. Newman ◽  
Jim Grigsby ◽  
Ana-Maria Vranceanu ◽  
Jonathan A. Shaffer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Arrest ◽  
Posttraumatic Stress ◽  
Informal Caregivers ◽  
Posttraumatic Stress Symptoms ◽  
Survey Study ◽  
Pilot Survey ◽  
Stress Symptoms

scholarly journals Medicines Related Problems (MRPs) Originating in Primary Care Settings in Older Adults - A Systematic Review

2021 ◽  
pp. 089719002110236
Author(s):  
Rosetta Chinyere Ude-Okeleke ◽  
Zoe Aslanpour ◽  
Soraya Dhillon ◽  
Nkiruka Umaru
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Library Science ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Data Bases ◽  
Primary Care Settings ◽  
Preventative Interventions ◽  
Use Of Health Services

Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.

Sign in / Sign up

Export Citation Format

Share Document