Ketamine as a Prehospital Analgesic: A Systematic Review

2020 ◽  
Vol 35 (3) ◽  
pp. 314-321
Author(s):  
Akhil Bansal ◽  
Matthew Miller ◽  
Ian Ferguson ◽  
Brian Burns
Keyword(s):  
Analgesic Efficacy ◽  
Nmda Receptor Antagonist ◽  
Prehospital Setting ◽  
Low Grade ◽  
Future Studies ◽  
The Us ◽  
Royal Australian College ◽  
Controversial Topic ◽  
High Level

AbstractObjective:Analgesia in the prehospital setting is an extremely important, yet controversial topic. Ketamine, a N-methyl D-aspartate (NMDA) receptor antagonist, has been commonly used in the prehospital setting, including recommendations by the US Department of Defense and by the Royal Australian College of Pain Medicine, despite the paucity of high-level evidence.Methods:Accordingly, a review of the literature was conducted using several electronic medical literature databases from the earliest available records to the time at which the search was conducted (October 2018).Results:The search strategy yielded a total of 707 unique papers, of which 43 were short-listed for full review, and ultimately, ten papers were identified as meeting all the relevant inclusion criteria. The included studies varied significantly in the prehospital context and in the means of administering ketamine. There was only low-grade evidence that ketamine offered a safe and effective analgesia when used as the only analgesic, and only low-grade evidence that it was as effective as alternative opioid options. However, there was moderate evidence that co-administration of ketamine with morphine may improve analgesic efficacy and reduce morphine requirement.Conclusions:Overall, ketamine as a prehospital analgesic may be best used in combination with opioids to reduce opioid requirement. It is suggested that future studies should use a standardized approach to measuring pain reduction. Future studies should also investigate short-term side effects and long-term complications or benefits of prehospital ketamine.

Citizen Chen: a challenging test for bilateral diplomacy

2013 ◽  
Vol 3 (5) ◽  
pp. 1-9
Author(s):  
Barthélémy Michalon
Keyword(s):  
Legal Aspects ◽  
Subject Area ◽  
Chinese Government ◽  
Specific Situation ◽  
Content Type ◽  
The Us ◽  
The Usa ◽  
High Level

Subject area Diplomatic and consular policies; legal aspects of international relations and Asia regional scenario. Study level/applicability Undergraduate. Case overview In April 2012, high-level officials from China and the USA were about to meet in Beijing in the framework of the bilateral Strategic and Economic Dialogue, organized on a yearly basis. The event was always delicate, due to the ambiguous relationship existing between the two countries, which were at the same time rivals and dependent on one another. That time, the tension previous to the meeting increased significantly: a Chinese human rights activist had just sought and obtained diplomatic protection in the US Embassy in Beijing, thus creating an embarrassing situation for both States' foreign departments […] How could they possibly solve this contentious issue without affecting their already sensitive relationship? Expected learning outcomes Analytical: to be aware of the political nature of the current Chinese Government; to realize the concrete and practical implications of an Embassy's special status; to balance two contradictory objectives, in a specific situation where none of them can be fully discarded; to contrast and try to combine long-term goals (in this case, to maintain a functioning relationship between two main world powers) with short-term objectives (in this case, how to deal with a Chinese activist that required protection against his own country's security forces); to find a modus vivendi (conciliation) between values and interests; to get convinced that certain kinds of negotiations cannot be conceived through a “win or lose” approach: in this case, the only way out must be respectful of the two parties' core interests; and to take into account that image preservation (“face-saving”) must be included within any country's objectives in any situation involving diplomatic means. Conceptual: the purpose is to familiarize the students with specific concepts, such as: best alternative to a negotiated agreement (BATNA), which is to be mentioned as part of the discussion (it is not included in the case study itself); interdependence; (purported) Group of Two; asylum and refuge; Immunity; and sending state/receiving state. Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email [email protected] to request teaching notes.

Alchemical Transformations? Fictions of the Nuclear State after 1989

2016 ◽  
Author(s):  
Daniel Grausam
Keyword(s):  
Thomas Pynchon ◽  
Real Life ◽  
Nuclear Age ◽  
Nuclear Site ◽  
The Us ◽  
Aesthetic Practice ◽  
Plutonium Production ◽  
High Level ◽  
The Cold War

James Flint’s novel The Book of Ash (2004) is a book concerned with the toxic legacy of the Cold War and the literary challenge of representing the security state inherited from Thomas Pynchon. The plot concerns Cooper James, a computer programmer employed by the US military at Featherbrooks, an RAF outpost in North Yorkshire, and his search for the truth about his father. The figure of the father is inspired by the real-life American sculptor James Acord (1944–2011), the only private citizen in the world licensed to own and handle high-level radioactive materials. In 1989 Acord moved close to Hanford, site of US plutonium production and the most polluted nuclear site in the US, where he sought to create something like a nuclear Stonehenge as a long-term memorial to the nuclear age, and to develop artistic practices for transmuting radioactive waste into less harmful substances. Acord imagined his own aesthetic practice to be a kind of alchemy, and The Book of Ash is precisely in this same style, making alchemical transformation a literary subject but also a literary technique: it is a radioactive novel in its subject matter and the way it transmutes novelistic style and content over time.

Characteristics of Patients with Stage I Follicular Lymphoma (FL) Selected for Watchful Waiting (WW) in the US: Report from the National LymphoCare Study (NLCS).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3315-3315 ◽  
Author(s):  
Jonathan W. Friedberg ◽  
Elaine Wong ◽  
Michael Taylor ◽  
Ming Lin ◽  
Mohamed Darif ◽  
...  
Keyword(s):  
Watchful Waiting ◽  
Age Distribution ◽  
Initial Therapy ◽  
Older Age ◽  
Stage I ◽  
Low Grade ◽  
Lower Grade ◽  
The Us ◽  
Unit Increase

Abstract The NLCS is a multi-center, disease-based, longitudinal, observational study designed to collect information on treatment regimens and outcomes for patients (pts) with newly-diagnosed FL in the US. We have previously demonstrated that demographics of enrolled patients are similar to the SEER and FLIPI databases. There remains controversy and lack of consensus regarding the appropriate initial therapy for pts with FL. Historically, randomized trials have indicated no benefit to early therapeutic intervention, and many pts were managed by a “watchful waiting” (WW), or observation, approach. More recently, studies have suggested that initial treatment of FL may influence survival, calling into question the role of WW today. The National Comprehensive Cancer Network (NCCN) guidelines identify locoregional radiotherapy (RT) as the treatment of choice for stage I and II FL pts, whereas WW is reserved for select pts where toxicity of RT outweighs potential clinical benefit. The NLCS has over 2700 pts enrolled, and, of these, 455 were managed with WW as their initial therapy as of 1/31/07. This analysis focuses on the 134 stage I FL pts (29.3% of all stage I pts) in the NLCS database who were initially managed with WW, and examined their baseline characteristics as possible predisposing factors to a WW approach. The cohort of WW pts includes pts meeting both of the following criteria: initially reported to be managed by WW by the investigator, and were not administered treatment within 3 months of diagnosis. Age distribution was 6.0% <45 yr, 20.9% 45–59 yr, 39.6% 60–74 yr, and 33.6% 75+ yr. Low grade disease predominated (82.8% grades 1–2, 10.4% grade 3, 6.7% unknown/mixed grade). Nearly all pts had good (83.5%) or intermediate (15.5%) FLIPI score, and 97.5% had ECOG PS <2. B symptoms were present in 7.5%, and LDH was elevated in 6.0%. Interestingly, 75% of these pts had both good FLIPI score and PS 0. 61.7% pts of patients with a good FLIPI score were ≥60 yr at diagnosis, and 70.2% pts with PS 0 were ≥60 yr at diagnosis. Multivariate logistic regression comparing the stage I pts who were managed with WW vs. active treatment suggests older age (odds ratio [OR] = 1.025 for one-year increase), lower grade (OR=0.612 for one-unit increase), and lower PS (OR=0.485 for one-unit increase) are significantly associated with WW. FLIPI and B symptoms were not identified as significant predictors in the multivariate model. In conclusion, although therapies have recently demonstrated benefits in several endpoints, WW continues to be utilized relatively frequently in the US. Stage I pts who were initially managed by WW tended to have at last one of the following characteristics: older age, lower disease grade, good PS, or FLIPI score. This group is of particular interest, given that RT as an alternative active therapeutic modality has the potential for long term progression-free survival. The design of the NLCS with comprehensive data collection and long-term follow-up will enable this unique, large pt cohort to be followed through the natural history of this indolent disease.

scholarly journals A randomized trial of stereotactic versus conventional radiotherapy in young patients with low-grade brain tumors: occupational therapy-based neurocognitive data

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Abhishek Chatterjee ◽  
Jayant S Goda ◽  
Tejpal Gupta ◽  
Rashmi Kamble ◽  
Smruti Mokal ◽  
...  
Keyword(s):  
Occupational Therapy ◽  
Brain Tumors ◽  
Randomized Trial ◽  
Spatial Perception ◽  
Young Patients ◽  
Conformal Radiotherapy ◽  
Low Grade ◽  
Level Of Evidence ◽  
High Level

Abstract Background Radiotherapy for brain tumors in young patients is not only associated with improved survival but also long-term neurocognitive sequelae. We aimed to compare group differences in the executive neurocognitive outcomes in young patients with low-grade brain tumors treated with stereotactic conformal radiotherapy (SCRT) and conventional RT (ConvRT) techniques. Methods This a phase 3 randomized trial that enrolled 200 young patients with benign brain tumors and low-grade gliomas. Patients were randomly allocated (1:1) to either SCRT or ConvRT arms and treated to a dose of 54 Gy in 30 fractions over 6 weeks. Lowenstein Occupational Therapy Cognitive Assessment battery was performed at preradiotherapy baseline, 6 months, and annually thereafter until 5 years. Executive functions measures included orientation, visual perception, spatial perception, motor praxis, visuomotor organization, thinking operations, and attention and concentration. The trajectory of these parameters was compared between the treatment arms over 5 years. Results Two hundred patients were enrolled in the study (SCRT: 104 and ConvRT: 96). The median age was 13 years (interquartile range: 9–17); mean total neurocognitive scores over 5 years were significantly superior in SCRT arm as compared to ConvRT (difference in slope: 2.27, P = .024). Outcomes improved in the SCRT arm vis-à-vis ConvRT for the subdomain of visuomotor organization (difference in slope: 0.66, P &lt; .001). Visuomotor organization scores significantly improved in majority of the substratification groups. Spatial perception improved in craniopharyngioma patients with SCRT technique as opposed to ConvRT. Conclusions SCRT achieved superior outcomes compared to ConvRT in certain executive neurocognitive functional domains. We provide high level of evidence in favor of SCRT. Trial Registration. ClinicalTrials.gov Identifier: NCT00517959.

Vivid Imagers Are Better at Detecting Salient Changes

2006 ◽  
Vol 27 (4) ◽  
pp. 218-228 ◽  
Author(s):  
Paul Rodway ◽  
Karen Gillies ◽  
Astrid Schepman
Keyword(s):  
Individual Differences ◽  
Change Detection ◽  
Visual Imagery ◽  
Detection Task ◽  
Level Of Detail ◽  
Detection Accuracy ◽  
Change Detection Task ◽  
Term Change ◽  
High Level

This study examined whether individual differences in the vividness of visual imagery influenced performance on a novel long-term change detection task. Participants were presented with a sequence of pictures, with each picture and its title displayed for 17  s, and then presented with changed or unchanged versions of those pictures and asked to detect whether the picture had been changed. Cuing the retrieval of the picture's image, by presenting the picture's title before the arrival of the changed picture, facilitated change detection accuracy. This suggests that the retrieval of the picture's representation immunizes it against overwriting by the arrival of the changed picture. The high and low vividness participants did not differ in overall levels of change detection accuracy. However, in replication of Gur and Hilgard (1975) , high vividness participants were significantly more accurate at detecting salient changes to pictures compared to low vividness participants. The results suggest that vivid images are not characterised by a high level of detail and that vivid imagery enhances memory for the salient aspects of a scene but not all of the details of a scene. Possible causes of this difference, and how they may lead to an understanding of individual differences in change detection, are considered.

Moving past the vaccine/autism controversy - to examine potential vaccine neurological harms

2020 ◽  
pp. 1-15
Author(s):  
Peter R. Breggin
Keyword(s):  
Neurological Disorders ◽  
Developmental Disorder ◽  
Physical Symptoms ◽  
Psychosocial Disorders ◽  
The Us ◽  
Potential Vaccine ◽  
Research And Education ◽  
The Brain ◽  
New Vaccines

BACKGROUND: The vaccine/autism controversy has caused vast scientific and public confusion, and it has set back research and education into genuine vaccine-induced neurological disorders. The great strawman of autism has been so emphasized by the vaccine industry that it, and it alone, often appears in authoritative discussions of adverse effects of the MMR and other vaccines. By dismissing the chimerical vaccine/autism controversy, vaccine defenders often dismiss all genuinely neurological aftereffects of the MMR (measles, mumps, and rubella) and other vaccines, including well-documented events, such as relatively rare cases of encephalopathy and encephalitis. OBJECTIVE: This report explains that autism is not a physical or neurological disorder. It is not caused by injury or disease of the brain. It is a developmental disorder that has no physical origins and no physical symptoms. It is extremely unlikely that vaccines are causing autism; but it is extremely likely that they are causing more neurological damage than currently appreciated, some of it resulting in psychosocial disabilities that can be confused with autism and other psychosocial disorders. This confusion between a developmental, psychosocial disorder and a physical neurological disease has played into the hands of interest groups who want to deny that vaccines have any neurological and associated neuropsychiatric effects. METHODS: A review of the scientific literature, textbooks, and related media commentary is integrated with basic clinical knowledge. RESULTS: This report shows how scientific sources have used the vaccine/autism controversy to avoid dealing with genuine neurological risks associated with vaccines and summarizes evidence that vaccines, including the MMR, can cause serious neurological disorders. Manufacturers have been allowed by the US Food and Drug Administration (FDA) to gain vaccine approval without placebo-controlled clinical trials. CONCLUSIONS: The misleading vaccine autism controversy must be set aside in favor of examining actual neurological harms associated with vaccines, including building on existing research that has been ignored. Manufacturers of vaccines must be required to conduct placebo-controlled clinical studies for existing vaccines and for government approval of new vaccines. Many probable or confirmed neurological adverse events occur within a few days or weeks after immunization and could be detected if the trials were sufficiently large. Contrary to current opinion, large, long-term placebo-controlled trials of existing and new vaccines would be relatively easy and safe to conduct.

Sanctions of the USA and the Policy of Bank of Russia:double Blow to the National Economy

2014 ◽  
pp. 13-29 ◽  
Author(s):  
S. Glazyev
Keyword(s):  
National Security ◽  
Economic Sanctions ◽  
Capital Flight ◽  
Practical Advice ◽  
The Us ◽  
Monetary Authorities ◽  
The Usa ◽  
Simultaneous Adoption ◽  
The Eu

This article examines fundamental questions of monetary policy in the context of challenges to the national security of Russia in connection with the imposition of economic sanctions by the US and the EU. It is proved that the policy of the Russian monetary authorities, particularly the Central Bank, artificially limiting the money supply in the domestic market and pandering to the export of capital, compounds the effects of economic sanctions and plunges the economy into depression. The article presents practical advice on the transition from external to domestic sources of long-term credit with the simultaneous adoption of measures to prevent capital flight.

Endurance of Transnationalism in Bolivia’s Valle Alto

2006 ◽  
Vol 3 (1) ◽  
pp. 63-74 ◽  
Author(s):  
Richard C. Jones ◽  
Leonardo De la Torre
Keyword(s):  
Random Sample ◽  
Work Experience ◽  
Household Income ◽  
Return Migration ◽  
Ethnographic Interviews ◽  
The Us ◽  
Foreign Work ◽  
Intentions To Return ◽  
Economic Ties

The increasing difficulty of return migration and the demands for assimilation into host societies suggest a long-term cutting of ties to origin areas—likely accentuated in the Bolivian case by the recent shift in destinations from Argentina to the US and Spain. Making use of a stratified random sample of 417 families as well as ethnographic interviews in the provinces of Punata, Esteban Arze, and Jordán in the Valle Alto region the authors investigate these issues. Results suggest that for families with greater than ten years cumulated foreign work experience, there are significantly more absentees and lower levels of remittances as a percentage of household income. Although cultural ties remain strong after ten years, intentions to return to Bolivia decline markedly. The question of whether the dimunition of economic ties results in long-term village decline in the Valle Alto remains an unanswered.   

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