scholarly journals The Skill for the Administration of Neuromuscular Relaxant and Monitoring of Neuromuscular Block in the Clinical Settings

2007 ◽  
Vol 27 (3) ◽  
pp. 197-206
Author(s):  
Yuhji SAITOH
Keyword(s):  
Neuromuscular Block ◽  
Clinical Settings ◽  
Neuromuscular Relaxant

Early Reversal of Rapacuronium with Neostigmine 

1999 ◽  
Vol 91 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Robert Purdy ◽  
David R. Bevan ◽  
Francois Donati ◽  
Lance J. Lichtor
Keyword(s):  
Neuromuscular Block ◽  
Rapid Onset ◽  
Force Of Contraction ◽  
Mean Values ◽  
Neuromuscular Relaxant ◽  
Treatment Groups ◽  
Nitrous Oxide Oxygen ◽  
Train Of Four ◽  
To Receive ◽  
Different Doses

Background Rapacuronium is a rapid-onset, short-acting neuromuscular relaxant. This multiple-center study determined neuromuscular recovery when neostigmine was given 2 or 5 min after rapacuronium. Methods One hundred seventeen patients were randomized to receive two different doses of rapacuronium and to receive neostigmine in two different doses and at two different times. During propofol anesthesia with nitrous oxide, oxygen, and fentanyl, 1.5 or 2.5 mg/kg rapacuronium was given 1 min before tracheal intubation. Neuromuscular block was measured by train-of-four ulnar nerve stimulation every 12 s: The adductor pollicis force of contraction was recorded mechanomyographically. Two or five minutes after rapacuronium was administered, 0.05 or 0.07 mg/kg neostigmine was administered and recovery was compared with that of control patients who received no neostigmine. Results Both doses of rapacuronium produced 100% block in all but one patient, who exhibited 97% block. Neostigmine accelerated recovery in all groups. After 1.5 mg/kg rapacuronium, the time to 25% T1 twitch recovery decreased from a mean of 16 min in control patients to mean values of 8-10 min in the treatment groups: The time to train-of-four ratio of 0.7 decreased from 38 min to 17-19 min. After 2.5 mg/kg rapacuronium, the time to 25% T1 was reduced from 23 min to 11-12 min, and the time to train-of-four ratio of 0.7 decreased from 54 min to 26-32 min. Recovery was not different among the the groups that received different doses and timing of neostigmine. Conclusions Recovery of intense rapacuronium block was accelerated by early neostigmine administration. When given 2 min after rapacuronium, neostigmine was as effective as after 5 min, and 0.05 mg/kg neostigmine was comparable to 0.07 mg/kg neostigmine.

The Clinician Directed Hierarchy: A Clinical Training Tool

2008 ◽  
Vol 11 (2) ◽  
pp. 56-60 ◽  
Author(s):  
Jill K. Duthie
Keyword(s):  
Clinical Supervision ◽  
Clinical Training ◽  
Clinical Teaching ◽  
Clinical Skills ◽  
Clinical Settings ◽  
Specific Level ◽  
Problem Solving Skills ◽  
Training Tool ◽  
Target Behaviors ◽  
Intervention Process

Abstract Clinical supervisors in university based clinical settings are challenged by numerous tasks to promote the development of self-analysis and problem-solving skills of the clinical student (American Speech-Language-Hearing Association, ASHA, 1985). The Clinician Directed Hierarchy is a clinical training tool that assists the clinical teaching process by directing the student clinician’s focus to a specific level of intervention. At each of five levels of intervention, the clinician develops an understanding of the client’s speech/language target behaviors and matches clinical support accordingly. Additionally, principles and activities of generalization are highlighted for each intervention level. Preliminary findings suggest this is a useful training tool for university clinical settings. An essential goal of effective clinical supervision is the provision of support and guidance in the student clinician’s development of independent clinical skills (Larson, 2007). The student clinician is challenged with identifying client behaviors in the therapeutic process and learning to match his or her instructions, models, prompts, reinforcement, and use of stimuli appropriately according to the client’s needs. In addition, the student clinician must be aware of techniques in the intervention process that will promote generalization of new communication behaviors. Throughout the intervention process, clinicians are charged with identifying appropriate target behaviors, quantifying the progress of the client’s acquisition of the targets, and making adjustments within and between sessions as necessary. Central to the development of clinical skills is the feedback provided by the clinical supervisor (Brasseur, 1989; Moss, 2007). Particularly in the early stages of clinical skills development, the supervisor is challenged with addressing numerous aspects of clinical performance and awareness, while ensuring the client’s welfare (Moss). To address the management of clinician and client behaviors while developing an understanding of the clinical intervention process, the University of the Pacific has developed and begun to implement the Clinician Directed Hierarchy.

692 A novel prognostic index including comorbidities for stable heart failure validated in different clinical settings

2006 ◽  
Vol 5 (1) ◽  
pp. 156-156
Author(s):  
M SENNI ◽  
G SANTILLI ◽  
P PARRELLA ◽  
R DEMARIA ◽  
G ALARI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Index ◽  
Clinical Settings

Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation

2016 ◽  
Vol 21 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Silvia Convento ◽  
Cristina Russo ◽  
Luca Zigiotto ◽  
Nadia Bolognini
Keyword(s):  
Electrical Stimulation ◽  
Cognitive Rehabilitation ◽  
Cognitive Disorders ◽  
Spatial Neglect ◽  
Transcranial Electrical Stimulation ◽  
Clinical Settings ◽  
Post Stroke ◽  
Neuropsychological Disorders ◽  
Current State ◽  
Stimulation Technique

Abstract. Cognitive rehabilitation is an important area of neurological rehabilitation, which aims at the treatment of cognitive disorders due to acquired brain damage of different etiology, including stroke. Although the importance of cognitive rehabilitation for stroke survivors is well recognized, available cognitive treatments for neuropsychological disorders, such as spatial neglect, hemianopia, apraxia, and working memory, are overall still unsatisfactory. The growing body of evidence supporting the potential of the transcranial Electrical Stimulation (tES) as tool for interacting with neuroplasticity in the human brain, in turn for enhancing perceptual and cognitive functions, has obvious implications for the translation of this noninvasive brain stimulation technique into clinical settings, in particular for the development of tES as adjuvant tool for cognitive rehabilitation. The present review aims at presenting the current state of art concerning the use of tES for the improvement of post-stroke visual and cognitive deficits (except for aphasia and memory disorders), showing the therapeutic promises of this technique and offering some suggestions for the design of future clinical trials. Although this line of research is still in infancy, as compared to the progresses made in the last years in other neurorehabilitation domains, current findings appear very encouraging, supporting the development of tES for the treatment of post-stroke cognitive impairments.

Measurement Invariance of the Parent Version of the Strengths and Difficulties Questionnaire (SDQ) Across Community and Clinical Populations

2018 ◽  
Vol 34 (4) ◽  
pp. 238-246 ◽  
Author(s):  
Iris A. M. Smits ◽  
Meinou H. C. Theunissen ◽  
Sijmen A. Reijneveld ◽  
Maaike H. Nauta ◽  
Marieke E. Timmerman
Keyword(s):  
Measurement Invariance ◽  
Clinical Sample ◽  
Community Sample ◽  
Strengths And Difficulties Questionnaire ◽  
Emotional And Behavioral Problems ◽  
Clinical Settings ◽  
Favorable Result ◽  
Strengths And Difficulties ◽  
Parent Version ◽  
Clinical Populations

Abstract. The Strengths and Difficulties Questionnaire (SDQ) is a popular screening instrument for the detection of social-emotional and behavioral problems in children in community and clinical settings. To sensibly compare SDQ scores across these settings, the SDQ should measure psychosocial difficulties and strengths in the same way across community and clinical populations, that is, the SDQ should be measurement invariant across both populations. We examined whether measurement invariance of the parent version of the SDQ holds using data from a community sample (N = 707) and a clinical sample (N = 931). The results of our analysis suggest that measurement invariance of the SDQ parent version across community and clinical populations is tenable, implying that one can compare the SDQ scores of children across these populations. This is a favorable result since it is common clinical practice to interpret the scores of a clinical individual relative to norm scores that are based on community samples. The findings of this study support the continued use of the parent version of the SDQ in community and clinical settings.

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