Optimizing PTSD Treatments: Acute Treatment and Follow-Up Results

Abstract Background Specialized acute treatment and high-quality follow-up is meant to reduce mortality and disability from stroke. While the acute treatment for stroke takes place in hospitals, the follow-up of stroke survivors largely takes place in general practice. National guidelines give recommendations for the follow-up. However, previous studies suggest that guidelines are not sufficiently adhered to. It has been suggested that this might be due to the complexity of general practice. A part of this complexity is constituted by patients’ multimorbidity; the presence of two or more chronic conditions in the same person. In this study we investigated the extent of multimorbidity among stroke survivors residing in the communities. The aim was to assess the implications of multimorbidity for the follow-up of stroke in general practice. Methods The study was a cross sectional analysis of the prevalence of multimorbidity among stroke survivors in Mid-Norway. We included 51 patients, listed with general practitioners in 18 different clinics. The material consists of the general practitioners’ medical records for these patients. The medical records for each patient were reviewed in a search for diagnoses corresponding to a predefined list of morbidities, resulting in a list of chronic conditions for each participant. These 51 lists were the basis for the subsequent analysis. In this analysis we modelled different hypothetical patients and assessed the implications of adhering to all clinical guidelines affecting their diseases. Result All 51 patients met the criteria for multimorbidity. On average the patients had 4.7 (SD: 1.9) chronic conditions corresponding to the predefined list of morbidities. By modelling implications of guideline adherence for a patient with an average number of co-morbidities, we found that 10–11 annual consultations with the general practitioner were needed for the follow-up of the stable state of the chronic conditions. More consultations were needed for patients with more complex multimorbidity. Conclusions Multimorbidity had a clear impact on the basis for the follow-up of patients with stroke in general practice. Adhering to the guidelines for each condition is challenging, even for patients with few co-morbidities. For patients with complex multimorbidity, adhering to the guidelines is obviously unmanageable.

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Development of new cold antibodies in a patient with a history of warm autoimmune haemolytic anaemia

BMJ Case Reports ◽

10.1136/bcr-2019-232224 ◽

2020 ◽

Vol 13 (6) ◽

pp. e232224 ◽

Cited By ~ 1

Author(s):

Meghan Anderson ◽

Megan Winter ◽

Vinicius Jorge ◽

Claudia Dourado

Keyword(s):

Chest Pain ◽

Haemolytic Anaemia ◽

Acute Treatment ◽

Autoimmune Disorder ◽

Shortness Of Breath ◽

History Of ◽

Mixed Pattern ◽

Lost To Follow Up ◽

Record Review

A 31-year-old male presented to our facility with complaints of shortness of breath and left-sided chest pain. On record review, it was revealed that he had been seen in 2014 for an almost identical presentation and had been found to have haemolytic anaemia with warm autoantibodies. Following his acute treatment during that hospital admission, he was lost to follow-up. During his subsequent admission, 5 years later, he was found to have a systemic autoimmune disorder with a superimposed acute bacterial infection leading to a second case of haemolytic anaemia and at this time with both cold and warm antibodies present. While his diagnosis was initially difficult to make due to both derangements in expected laboratory values and the mixed pattern of the haemolytic anaemia, he was promptly treated with intravenous immune globulin and steroids and was able to make a full recovery.

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Comparing three methods for scoring late breast cosmesis in patients treated with lumpectomy and radiation therapy (RT).

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.26_suppl.128 ◽

2014 ◽

Vol 32 (26_suppl) ◽

pp. 128-128

Author(s):

Andrew Thomas Wong ◽

Celina Robertson-Parris ◽

Sonal Sura ◽

Carol White ◽

Manjeet Chadha

Keyword(s):

Radiation Therapy ◽

Clinical Practice ◽

Clinical Outcomes ◽

Comparative Studies ◽

Acute Treatment ◽

Comparative Review ◽

Small Cohort ◽

Scar Visibility

128 Background: For intact breast, the Harvard and LENTSOMA criteria are widely used to report late cosmesis. These scales require clinician’s interpretation and thus may be subject to variation between evaluators. Computerized tools exempt from evaluator bias are available to assess cosmesis. The objective of this study was to perform a comparative review of late breast cosmesis using the Harvard, LENTSOMA, and BCCT.core scales (Cardoso JS. et al; doi:10.1016/j.artmed.2007.02.007). Methods: A frontal bilateral breast photograph was used for analysis. Late cosmesis was scored with reference to the baseline breast appearance, ~ 1 year from RT distant from the acute treatment effects. Cosmesis was graded as excellent, good, fair, or poor using the Harvard scale. For LENTSOMA, only atrophy/retraction was assessed from the frontal breast photographs. The BCCT.core software was used as a validated tool for objectively scoring cosmesis and computes a score based on symmetry, color, and scar visibility. All outcomes were assessed by the same investigator (AW). Results: A total of 33 patients had 1-year baseline and follow up photographs. All were treated on a 3-week hypofractionated RT schedule, and none received chemotherapy. One hundred photographs, 1 to 5.7 years from end of RT, were scored. Late cosmesis among patients with good/excellent scores at 1-year remained unchanged by all 3 methods. Among patients graded as fair at 1-year, there was improvement in late comesis detected by Harvard and BCCT.core scoring. Late cosmesis by LENTSOMA criteria remained unchanged from baseline. Conclusions: Our experience suggests easy applicability of BCCT.core for scoring cosmesis in clinical practice. We observed no significant differences in cosmetic score by the methods used. However, these observations were made on a small cohort of patients and evaluation on a larger cohort is needed. The role of objective user-independent grading of cosmesis might be helpful in large comparative studies of clinical outcomes. [Table: see text]

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Evaluation of new day hospital for acute treatment: a one year follow up

http://isrctn.org/> ◽

10.1186/isrctn65613466 ◽

2012 ◽

Cited By ~ 1

Author(s):

Stefan Priebe

Keyword(s):

Acute Treatment ◽

Day Hospital ◽

One Year

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Rehabilitation after stroke: nutritional status and its correction

Medical alphabet ◽

10.33667/2078-5631-2020-11-17-20 ◽

2020 ◽

Vol 1 (11) ◽

pp. 17-20

Author(s):

L. R. Akhmadeeva ◽

M. V. Naprienko ◽

O. S. Lazovaya ◽

G. S. Zagidullina ◽

A. F. Timirova ◽

...

Keyword(s):

Nutritional Status ◽

Acute Treatment ◽

Nutritional Deficiency ◽

Medical Rehabilitation ◽

Cerebral Stroke ◽

Rehabilitation Unit ◽

Shoulder Muscles ◽

Increased Risk ◽

Good Support

This article presents the results of our study of the nutritional status of patients after cerebral stroke who were hospitalized to the medical rehabilitation unit. Among all patients, 16 % had an increased risk of nutritional deficiency by all scales with the highest numbers in patients over 65 (44 % had a risk of nutritional deficiency on all scales). Among patients with swallowing disorders, 100 % of patients had a risk of nutritional deficiency. Out of all anthropometric indicators, only the circumference of the shoulder muscles was significantly lower in patients with nutritional deficiency. Assessment and correction of malnutrition during rehabilitation after stroke is recommended during the acute treatment and follow-up. Special clinical nutrition products can be a good support for balanced feeding for more rapid rehabilitation.

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P332Comparative efficacy of intracoronary agents for acute treatment of coronary no-reflow: a network meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz747.0166 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Stibleichinger ◽

J Wendt ◽

F Hofbauer ◽

G Klappacher

Keyword(s):

Coronary Flow ◽

Acute Treatment ◽

Randomised Controlled Trials ◽

Primary Outcome ◽

Meta Analysis ◽

Risk Of Bias ◽

Secondary Outcome ◽

No Reflow ◽

Randomised Controlled

Abstract Background Coronary no-reflow is a potentially lethal complication of percutaneous coronary intervention (PCI). There is a growing body of evidence on how to best prevent this condition by the proper stenting technique and other mechanical measures or adjunctive drug treatments. However, it is still controversial how to tackle coronary no-reflow when it occurs. Purpose We aimed to compare and rank intracoronary agents for acute treatment of coronary no-reflow by considering both indirect and direct evidence from the literature in a network meta-analysis. Methods We searched the databases PubMed, Embase and Central for randomised controlled trials of the acute treatment of coronary no-reflow following primary PCI in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI. Trials with patients suffering from stable angina and/or receiving elective PCI, observational study design and no measure of coronary flow were excluded. Two blinded reviewers independently collected studies, assessed risk of bias with the Cochrane risk of bias tool and extracted data. The primary outcome was a measure of coronary flow immediately following the intervention (TIMI flow grade, TIMI frame count or myocardial bush grade), secondary outcome were major adverse cardiovascular events during follow-up. Pairwise and network meta-analysis were performed using the random-effects model within a frequentist framework. Results 8 studies with a total of 540 participants were identified, including 4 multi-arm studies. This enabled 19 pairwise comparisons of 12 different treatments, all administered via intracoronary route (ADE=adenosine, DIL=diltiazem, DIP=dipyridamole, NIT= nitroglycerin, NPR=nitroprusside, PLA=placebo, TIR=tirofiban, U+V=urokinase combined with verapamil, URA=urapidil, URO=urokinase, VER=verapamil X+T= Xuesaitong combined with tirofiban). Overall, risk of bias in these studies was rated moderate. For graphical representation of the network for the primary outcome, see left panel of the figure. It exhibited a low level of inconsistency and heterogeneity with a global I2 value of 20.9%. Among the different treatments, URA, X+T, and TIR were more effective in re-establishing coronary flow with the caveat that the results of URA depended on one singular trail with a large variance, see right panel of the figure. NIT was even slightly worse than placebo in the primary outcome, the other agents were equivalent with placebo. In terms of major cardiovascular events during follow-up, TIR exhibited a protective effect compared with placebo at borderline statistical significance (OR 0.3843 [95% CI 0.1488; 0.9923]. For URA, data on secondary outcome were not available. Conclusions Urapidil and Tirofiban are potentially effective candidate drugs for larger randomised controlled trials, which are needed to validate the sparse evidence that is available to date on the acute treatment of coronary no-reflow.

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Comparison of plasmapheresis with medical apheresis in terms of efficacy and cost in the acute treatment of hypertriglyceridemia in children with lipoprotein lipase deficiency

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0260 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Sahin Erdol ◽

Huseyin Bilgin ◽

Halil Saglam

Keyword(s):

Lipoprotein Lipase ◽

Triglyceride Level ◽

Acute Treatment ◽

Lipid Lowering ◽

Cost Of Treatment ◽

Before And After ◽

The Mean ◽

The Cost ◽

Turkish Lira

Abstract Objectives We aimed to compare plasmapheresis and medical apheresis as lipid-lowering therapies in children with familial lipoprotein lipase (LPL) deficiency. Methods The data of 13 patients who were followed up after a diagnosis of LPL deficiency were retrospectively analyzed. Plasma triglyceride, cholesterol, amylase, and lipase values and complications were recorded before and after each patient underwent plasmapheresis or medical apheresis. Results The mean follow-up period of the patients was 99.64 ± 52.92 months in the medical apheresis group and 118 ± 16.97 months in the plasmapheresis group. While the mean triglyceride level before plasmapheresis was 1,875.38 ± 547.46 mg/dL, it was 617 ± 228.28 mg/dL after plasmapheresis. While the mean triglyceride level before medical apheresis was 1,756.86 ± 749.27 mg/dL, it was found to be 623.03 ± 51.36 mg/dL after medical apheresis. Triglyceride levels were decreased by 59.62% with medical apheresis and 65.57% with plasmapheresis. The cost of treatment for medical apheresis was found to be lower compared to plasmapheresis 296.93 ± 29.94 Turkish lira (USD 43.34 ± 4.01) vs. 3,845.42 ± 156.17 Turkish lira (USD 561.37 ± 20.93; p<0.001). Conclusions Although there is no standardized strategy for the acute treatment of hypertriglyceridemia due to LPL deficiency, medical apheresis is a safe and effective treatment with a low risk of side effects. Unlike plasmapheresis, medical apheresis can be performed in any center, which is another important advantage of the procedure.

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THE MANAGEMENT OF MIGRAINE IN PRIMARY CARE

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2015-312379.82 ◽

2015 ◽

Vol 86 (11) ◽

pp. e4.176-e4

Author(s):

Katherine Ralston

Keyword(s):

Acute Treatment ◽

Prophylactic Treatment ◽

Improve Patient Care ◽

Line Treatment ◽

Correct Treatment ◽

Nice Guidance ◽

New Diagnosis ◽

Improve Patient ◽

Acute Patients

Migraine is a common and debilitating neurological disorder. This study aimed to audit the management of adults with migraine in a Newcastle GP practice against NICE guidelines (2012) on the acute and prophylactic treatment of migraine.A search of practice records for patients with a new diagnosis of migraine between December 2013–14 identified 38 patients. Medical records were reviewed to determine if their management was consistent with NICE guidance.Acute treatment was indicated in 35 patients, with 27 (77%) receiving correct treatment. 1 patient (3%) received unrecommended treatment, while 7 (20%) received no treatment. Prophylactic treatment was given to 11/13 (85%) patients where it was indicated. Of these, 6 (55%) received first line treatment, 1 (9%) second line treatment and 4 (36%) unrecommended treatment. All patients should be followed up after treatment initiation. This occurred or was planned in 14/35 (40%) acute patients and 6/11 (55%) prophylactic patients.The majority of patients with migraine received the correct acute treatment, however over one third of patients received unconventional preventative medication and follow up was sporadic. A template prompting the correct management of migraine has been incorporated into the computer system following this audit to improve patient care.

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