scholarly journals C.07 Door to decompression should be the benchmark in trauma craniotomies

2016 ◽  
Vol 43 (S2) ◽  
pp. S12-S13
Author(s):  
J Marcoux ◽  
D Bracco
Keyword(s):  
Emergency Department ◽  
System Performance ◽  
Trauma System ◽  
Surgical Time ◽  
Delivery Of Care ◽  
Surgical Positioning ◽  
Anesthesia Time ◽  
The Brain ◽  
Decompression Time

Background: Quality control indicators for mass lesion in TBI use the delay between emergency department (ED) and OR arrival to measure quality of care. It does not provide the timing of brain decompression. The goals of this study are to observe step by step where delays occur from hospital admission until effective decompression of the brain. Methods: A prospective observational data collection of timing from ED admission to decompression was conducted for all emergency trauma craniotomies over a period of 15 months. Results: Sixty-five patients were included. Doing a CT at the outside institution instead of transferring the patient prior to CT resulted in a 112min delay in care. Neurosurgery team notification prior to patient’s arrival to ED shortened delivery of care by 51min. The time elapsed between OR arrival and brain decompression was 50min: anesthesia time 3min, surgical positioning/preparation 29min and surgical time 17min. Burrhole decompression followed by craniotomy (9min) shortened the decompression time by 17min compared to standard 4 holes craniotomy approach (26min). Conclusions: Benchmark for trauma system performance in emergency craniotomies should be door to decompression time. Bypassing CT in local hospitals, pre-alerting neurosurgeons, and burrhole decompression followed by standard craniotomy significantly decrease door to decompression time.

Classification of methods for generating pseudo-CT from MRI images for MRI-alone RT

2017 ◽  
Vol 1 (3) ◽  
pp. 54
Author(s):  
BOUKELLOUZ Wafa ◽  
MOUSSAOUI Abdelouahab
Keyword(s):  
Performance Metrics ◽  
Radiation Treatment ◽  
Hybrid Methods ◽  
Dose Calculation ◽  
Absolute Error ◽  
Ct Images ◽  
General Technique ◽  
Therapy Field ◽  
The Brain

Background: Since the last decades, research have been oriented towards an MRI-alone radiation treatment planning (RTP), where MRI is used as the primary modality for imaging, delineation and dose calculation by assigning to it the needed electron density (ED) information. The idea is to create a computed tomography (CT) image or so-called pseudo-CT from MRI data. In this paper, we review and classify methods for creating pseudo-CT images from MRI data. Each class of methods is explained and a group of works in the literature is presented in detail with statistical performance. We discuss the advantages, drawbacks and limitations of each class of methods. Methods: We classified most recent works in deriving a pseudo-CT from MR images into four classes: segmentation-based, intensity-based, atlas-based and hybrid methods. We based the classification on the general technique applied in the approach. Results: Most of research focused on the brain and the pelvis regions. The mean absolute error (MAE) ranged from 80 HU to 137 HU and from 36.4 HU to 74 HU for the brain and pelvis, respectively. In addition, an interest in the Dixon MR sequence is increasing since it has the advantage of producing multiple contrast images with a single acquisition. Conclusion: Radiation therapy field is emerging towards the generalization of MRI-only RT thanks to the advances in techniques for generation of pseudo-CT images. However, a benchmark is needed to set in common performance metrics to assess the quality of the generated pseudo-CT and judge on the efficiency of a certain method.

Neuro-Optometric Treatment of Complications from a Cerebellar Astrocytoma

2020 ◽  
pp. 304-312
Keyword(s):  
Visual System ◽  
Common Site ◽  
Us Army ◽  
Cranial Nerve Palsies ◽  
Pilocytic Astrocytomas ◽  
The Us ◽  
Extent Of Damage ◽  
Functional Components ◽  
The Brain

Background: Insult to the brain, whether from trauma or other etiologies, can have a devastating effect on an individual. Symptoms can be many and varied, depending on the location and extent of damage. This presentation can be a challenge to the optometrist charged with treating the sequelae of this event as multiple functional components of the visual system can be affected. Case Report: This paper describes the diagnosis and subsequent ophthalmic management of an acquired brain injury in a 22 year old male on active duty in the US Army. After developing acute neurological symptoms, the patient was diagnosed with a pilocytic astrocytoma of the cerebellum. Emergent neurosurgery to treat the neoplasm resulted in iatrogenic cranial nerve palsies and a hemispheric syndrome. Over the next 18 months, he was managed by a series of providers, including a strabismus surgeon, until presenting to our clinic. Lenses, prism, and in-office and out-of-office neurooptometric rehabilitation therapy were utilized to improve his functioning and make progress towards his goals. Conclusions: Pilocytic astrocytomas are the most common primary brain tumors, and the vast majority are benign with excellent surgical prognosis. Although the most common site is the cerebellum, the visual pathway is also frequently affected. If the eye or visual system is affected, optometrists have the ability to drastically improve quality of life with neuro-optometric rehabilitation.

PENGARUH PIJAT BAYI TERHADAP KUALITAS TIDUR BAYI UMUR 0 – 3 BULAN DI WILAYAH KERJA PUSKESMAS SOSIAL PALEMBANG TAHUN 2016

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Juliana Widyastuti Wahyuningsih Juliana Widyastuti Wahyuningsih
Keyword(s):  
Experimental Design ◽  
Growth And Development ◽  
Sampling Technique ◽  
P Value ◽  
Development Phase ◽  
Quality Of Sleep ◽  
Infant Massage ◽  
Before And After ◽  
The Brain

ABSTRAK Tidur merupakan kebutuhan yang harus terpenuhi terutama pada fase perkembangan karena selama tidur akan terjadi perkembangan otak maupun tubuh, sehingga gangguan tidur merupakan masalah yang akan menimbulkan dampak buruk terhadap pertumbuhan dan perkembangan bayi. Kualitas tidur bayi yang baik dapat diciptakan dengan memberikan pemijatan bayi secara rutin. Penelitian ini bertujuan untuk membuktikan bahwa pemijatan dapat mempengaruhi kualitas tidur bayi umur 0-3 bulan. Penelitian ini menggunakan desain penelitian Quasy Eksperimental dengan metode One Group Pretest-Postest. Sampel 22 bayi yang dipilih dengan tehnik Total Sampling yang di observasi sebelum dan sesudah diberikan pemijatan. Variabel yang diukur dalam penelitian ini adalah kualitas tidur bayi 0-3 bulan. Hasil penelitian menunjukkan bahwa ada pengaruh pijat bayi terhadap kualitas tidur bayi umur 0-3 bulan (p value  0,008 < α = 0,05).Berdasarkan hasil penelitian ini disarankan agar keluarga dan masyarakat memberikan pemijatan secara rutin dan mandiri untuk meningkatkan kebutuhan tidur bayi yang berkualitas.   ABSTRACT Sleep is a human necessity that must be met, especially in the development phase because during sleep will occur the brain and body developments, so that sleep disturbance is a problem that would cause adverse effects on infants’ growth and development. The good quality of sleep can be created by providing the infants massage routinely. This study aimed to prove that the massage could affect the quality of sleep on the 0-3 months old baby. This study used Quasy-experimental design with One Group Pretest-Posttest. The sample 22 infants selected by total sampling technique observed on before and after the massage. The variables measured in this study are the quality of sleep. The results of study indicate that there is an effect of infant massage to the sleep quality on 0-3 months old babies (p value 0,008 < α = 0,05).Based on the results of this study it recommended for the families and communities to provide infant massage regularly and independently to increase the quality of sleep on the baby.  

Integrated Biomarkers for Depression in Alzheimer’s Disease: A Critical Review

2017 ◽  
Vol 14 (4) ◽  
pp. 441-452 ◽  
Author(s):  
Sofia Wenzler ◽  
Christian Knochel ◽  
Ceylan Balaban ◽  
Dominik Kraft ◽  
Juliane Kopf ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Affect Regulation ◽  
Current Evidence ◽  
Diagnostic Process ◽  
Neuropsychiatric Manifestation ◽  
The Brain ◽  
Control Functional

Depression is a common neuropsychiatric manifestation among Alzheimer’s disease (AD) patients. It may compromise everyday activities and lead to a faster cognitive decline as well as worse quality of life. The identification of promising biomarkers may therefore help to timely initiate and improve the treatment of preclinical and clinical states of AD, and to improve the long-term functional outcome. In this narrative review, we report studies that investigated biomarkers for AD-related depression. Genetic findings state AD-related depression as a rather complex, multifactorial trait with relevant environmental and inherited contributors. However, one specific set of genes, the brain derived neurotrophic factor (BDNF), specifically the Val66Met polymorphism, may play a crucial role in AD-related depression. Regarding neuroimaging markers, the most promising findings reveal structural impairments in the cortico-subcortical networks that are related to affect regulation and reward / aversion control. Functional imaging studies reveal abnormalities in predominantly frontal and temporal regions. Furthermore, CSF based biomarkers are seen as potentially promising for the diagnostic process showing abnormalities in metabolic pathways that contribute to AD-related depression. However, there is a need for standardization of methodological issues and for replication of current evidence with larger cohorts and prospective studies.

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

The value of trauma patients’ centralization: an analysis of a regional Italian Trauma System performance with TMPM-ICD-9

2021 ◽  
Author(s):  
Paola Fugazzola ◽  
Vanni Agnoletti ◽  
Silvia Bertoni ◽  
Costanza Martino ◽  
Matteo Tomasoni ◽  
...  
Keyword(s):  
System Performance ◽  
Trauma System ◽  
Trauma Patients

Choroidal metastases: case report and review

2020 ◽  
pp. 1-7
Author(s):  
Victor Duque ◽  
Carolina de la Pinta ◽  
Ciriaco Corral ◽  
Carmen Vallejo ◽  
Margarita Martin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Side Effects ◽  
External Beam Radiotherapy ◽  
Choroidal Metastasis ◽  
Good Visual Acuity ◽  
Good Local Control ◽  
Radiological Response ◽  
The Right ◽  
The Brain

Abstract Introduction: Choroidal metastases are the most frequent intraocular secondary tumours, with a prevalence of 2–7% according to the literature. Our aim was to review a clinical case of choroidal metastasis. We present a case of a 63-year-old male patient diagnosed in 2018 with lung adenocarcinoma cT4N0M1. The patient had three metastases in the brain, which were successfully treated with radiosurgery (RS). The patient was treated with chemotherapy with pemetrexed–cisplatin schedule. Five months after diagnosis, the patient presented with decreased vision in the right eye. After ophthalmologic evaluation, he was diagnosed with a right choroidal metastasis, which was treated with external beam radiotherapy with 20 Gy in five fractions, resulting in improved visual acuity and a complete clinical and radiological response. The patient took part in a clinical trial that continued with systemic chemotherapy. Twenty-two months after radiotherapy to the eye, the patient has good visual acuity without any side effects. Conclusions: Choroidal metastasis treated with radiotherapy achieves good local control, with limited side effects, allowing an improvement in visual acuity and consequently, an improvement in the patient´s quality of life.

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