Central Nervous System Complications in Cardiac Surgery: Retrograde Cerebral Perfusion, Pressure, Pulsatility, Temperature, and pH Management During Cardiopulmonary Bypass

2000 ◽  
Vol 4 (2) ◽  
pp. 65-69
Author(s):  
John M. Murkin
Keyword(s):  
Circulatory Arrest ◽  
Management Strategies ◽  
Arterial Line ◽  
Neurological Outcomes ◽  
Hypothermic Perfusion ◽  
Management Techniques ◽  
Ph Management ◽  
Pulmonary Bypass ◽  
The Impact ◽  
The Brain

Currently, clinical management strategies during cardio pulmonary bypass (CPB) are undergoing profound changes. Renewed interest in normothermic versus hypothermic perfusion during CPB has resulted in appar ently contradictory results regarding patient outcomes. Much effort has been devoted to defining physiological responses of the brain to various alterations during CPB (eg, pH strategy, normothermia versus hypothermia, pulsatile or nonpulsatile perfusion, use of arterial line filtration, circulatory arrest, retrograde cerebral perfu sion). In addition, prospective studies are examining the impact of diverse strategies on neuropsychological and neurological outcomes after CPB, to define optimal management techniques.

Management of the Geriatric Patient

2018 ◽  
Author(s):  
Michelle Martinchek
Keyword(s):  
Weight Loss ◽  
Management Strategies ◽  
Outpatient Setting ◽  
Nursing Facilities ◽  
Geriatric Syndromes ◽  
Contributing Factors ◽  
Team Members ◽  
Patients At Risk ◽  
Management Techniques ◽  
The Impact

Geriatric syndromes are complex conditions in older adults that often have many contributing factors. Examples of common geriatric syndromes include cognitive impairment, delirium, falls, frailty, weight loss, and pressure ulcers. Identifying the patients at risk for these syndromes and enacting preventive measures are also important to try to reduce the impact that many of these syndromes may have on outcomes. These syndromes can happen across many different care settings including in the community, outpatient setting, hospital, and nursing facilities. Once these syndromes are identified, management techniques often include multifactorial approaches and use both nonpharmacologic and pharmacologic means. Management strategies may include assistance from interdisciplinary team members, families, and caregivers of the patient. This review contains 30 references, 4 figures, and 4 tables. Key Words: cognition, delirium, dementia, fall, frailty, gait, geriatric, malnutrition, pressure ulcer, weight loss

Do not forget alcohol damage – Cognitive impairments related to alcohol

2017 ◽  
Vol 41 (S1) ◽  
pp. s868-s868
Author(s):  
M. Lázaro ◽  
L. Carvalhão Gil ◽  
A. Ponte ◽  
T. Mota
Keyword(s):  
Literature Search ◽  
Cognitive Impairments ◽  
Management Strategies ◽  
Brain Regions ◽  
Clinical Impact ◽  
Excessive Alcohol Consumption ◽  
Excessive Alcohol ◽  
Competing Interest ◽  
The Impact ◽  
The Brain

IntroductionChronic excessive alcohol consumption may lead to structural and functional damage of the brain. Alcohol-related cognitive impairments are well-established and confirmed by neuropsychological and neuroimaging studies. However, the influence of each neuropathological mechanisms is still under discussion. This topic is increasingly becoming focus of attention in psychiatry.ObjectivesReview the neuropathology, clinical features, neuropsychology and management of alcohol-related cognitive impairments.AimsEvaluate clinical impact, management and prognosis of alcohol-related cognitive impairments.MethodsA literature search was performed on PubMed and Medscape database.ResultsAccording to our literature research, there is a debate concerning the relative contributions of the direct toxic effect of alcohol and the impact of thiamine deficiency on the alcohol-related cognitive impairments. Research about this issue is challenging, considering the multiple patterns of alcohol abuse, the personal and lifestyle factors, and the vulnerability of specific brain regions. The cognitive decline is linked to neuroanatomical alterations and primarily affects executive functions, episodic memory, and visuospatial capacities. These deficits may range from mild to severe but usually remain undiagnosed, unless they are specifically investigated. Maintenance of lasting abstinence is associated with cognitive recovery, but some impairments may persist and interfere with the prognosis.ConclusionRecognizing and screening for alcohol-related cognitive impairments is crucial to offer significant benefits to patients by optimising management strategies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Mild Hyperthermia Aggravates Glucose Metabolic Consequences in Repetitive Concussion

2020 ◽  
Vol 21 (2) ◽  
pp. 609
Author(s):  
Meghan Blaya ◽  
Jessie Truettner ◽  
Weizhao Zhao ◽  
Helen Bramlett ◽  
William Dalton Dietrich
Keyword(s):  
Brain Injury ◽  
Glucose Metabolism ◽  
Brain Temperature ◽  
Brain Regions ◽  
Cerebral Glucose Metabolism ◽  
Temperature Management ◽  
Diagnostic Tools ◽  
Neurological Outcomes ◽  
The Impact ◽  
The Brain

Traumatic brain injury (TBI) is one of the leading causes of mortality and disability around the world. Mild TBI (mTBI) makes up approximately 80% of reported cases and often results in transient psychological abnormalities and cognitive disruption. At-risk populations for mTBI include athletes and other active individuals who may sustain repetitive concussive injury during periods of exercise and exertion when core temperatures are elevated. Previous studies have emphasized the impact that increased brain temperature has on adverse neurological outcomes. A lack of diagnostic tools to assess concussive mTBI limits the ability to effectively identify the post-concussive period during which the brain is uniquely susceptible to damage upon sustaining additional injury. Studies have suggested that a temporal window of increased vulnerability that exists corresponds to a period of injury-induced depression of cerebral glucose metabolism. In the current study, we sought to evaluate the relationship between repetitive concussion, local cerebral glucose metabolism, and brain temperature using the Marmarou weight drop model to generate mTBI. Animals were injured three consecutive times over a period of 7 days while exposed to either normothermic or hyperthermic temperatures for 15 min prior to and 1 h post each injury. A 14C-2-deoxy-d-glucose (2DG) autoradiography was used to measure local cerebral metabolic rate of glucose (lCMRGlc) in 10 diverse brain regions across nine bregma levels 8 days after the initial insult. We found that repetitive mTBI significantly decreased glucose utilization bilaterally in several cortical areas, such as the cingulate, visual, motor, and retrosplenial cortices, as well as in subcortical areas, including the caudate putamen and striatum, compared to sham control animals. lCMRGlc was significant in both normothermic and hyperthermic repetitive mTBI animals relative to the sham group, but to a greater degree when exposed to hyperthermic conditions. Taken together, we report significant injury-induced glucose hypometabolism after repetitive concussion in the brain, and additionally highlight the importance of temperature management in the acute period after brain injury.

Management of the Geriatric Patient

2018 ◽  
Author(s):  
Michelle Martinchek
Keyword(s):  
Weight Loss ◽  
Management Strategies ◽  
Outpatient Setting ◽  
Nursing Facilities ◽  
Geriatric Syndromes ◽  
Contributing Factors ◽  
Team Members ◽  
Patients At Risk ◽  
Management Techniques ◽  
The Impact

Geriatric syndromes are complex conditions in older adults that often have many contributing factors. Examples of common geriatric syndromes include cognitive impairment, delirium, falls, frailty, weight loss, and pressure ulcers. Identifying the patients at risk for these syndromes and enacting preventive measures are also important to try to reduce the impact that many of these syndromes may have on outcomes. These syndromes can happen across many different care settings including in the community, outpatient setting, hospital, and nursing facilities. Once these syndromes are identified, management techniques often include multifactorial approaches and use both nonpharmacologic and pharmacologic means. Management strategies may include assistance from interdisciplinary team members, families, and caregivers of the patient. This review contains 30 references, 4 figures, and 4 tables. Key Words: cognition, delirium, dementia, fall, frailty, gait, geriatric, malnutrition, pressure ulcer, weight loss

scholarly journals Understanding the physiological changes induced by mannitol: From the theory to the clinical practice in neuroanaesthesia

2017 ◽  
Vol 04 (03) ◽  
pp. 138-146
Author(s):  
Wilson Fandino
Keyword(s):  
Kidney Injury ◽  
Current Evidence ◽  
Physiological Changes ◽  
Neurological Outcomes ◽  
Brain Relaxation ◽  
High Doses ◽  
The Impact ◽  
Osmotic Effects ◽  
The Brain

AbstractIn this narrative review, the current evidence for the use of mannitol in neuroanaesthesia is presented, with focus on its pharmacokinetics and its main physiologic effects. Mannitol is a naturally occurring polyol that undergoes no biotransformation and is freely filtered in the kidney. Due to its strong osmotic effects, it induces key physiological changes, mainly in the cardiovascular system, the kidney and the brain. While it is clear that hypertonic solutions are effective in the treatment of intracranial hypertension in patients with acute brain injury, the role of mannitol in the context of intracranial haemorrhage, acute stroke and brain relaxation remains controversial. Furthermore, it possesses important side effects including acute kidney injury and electrolyte imbalances, particularly related to high doses in predisposing patients. Other aspects including the capability to modify neurological outcomes, the impact on mortality, the utility in patients with disrupted blood–brain barrier and the alternative use of hypertonic saline are also discussed. Further research is needed to make clear recommendations on these aspects.

THE IMPACT OF WORLD WAR II ON COST ACCOUNTING AT THE SPERRY CORPORATION

2003 ◽  
Vol 30 (2) ◽  
pp. 67-104 ◽  
Author(s):  
Richard K. Fleischman ◽  
R. Penny Marquette
Keyword(s):  
World War Ii ◽  
Performance Management ◽  
Scientific Management ◽  
World War ◽  
Military Contractors ◽  
Management Techniques ◽  
Cost Awareness ◽  
The Impact ◽  
Positive Effect ◽  
The U.S

The impact of World War II on cost accountancy in the U.S. may be viewed as a double-edged sword. Its most positive effect was engendering greater cost awareness, particularly among companies that served as military contractors and, thus, had to make full representation to contracting agencies for reimbursement. On the negative side, the dislocations of war, especially shortages in the factors of production and capacity constraints, meant that such “scientific management” techniques as existed (standard costing, time-study, specific detailing of task routines) fell by the wayside. This paper utilizes the archive of the Sperry Corporation, a leading governmental contractor, to chart the firm's accounting during World War II. It is concluded that any techniques that had developed from Taylorite principles were suspended, while methods similar to contemporary performance management, such as subcontracting, emphasis on the design phase of products, and substantial expenditure on research and development, flourished.

scholarly journals Immunization Strategies for Funding Multiple Inflation-Linked Retirement Income Benefits

Risks ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 60
Author(s):  
Cláudia Simões ◽  
Luís Oliveira ◽  
Jorge M. Bravo
Keyword(s):  
Interest Rate ◽  
Yield Curve ◽  
Risk Measure ◽  
Management Strategies ◽  
Interest Rate Risk ◽  
Insurance Companies ◽  
Retirement Income ◽  
Investment Strategies ◽  
Immunization Strategies ◽  
The Impact

Protecting against unexpected yield curve, inflation, and longevity shifts are some of the most critical issues institutional and private investors must solve when managing post-retirement income benefits. This paper empirically investigates the performance of alternative immunization strategies for funding targeted multiple liabilities that are fixed in timing but random in size (inflation-linked), i.e., that change stochastically according to consumer price or wage level indexes. The immunization procedure is based on a targeted minimax strategy considering the M-Absolute as the interest rate risk measure. We investigate to what extent the inflation-hedging properties of ILBs in asset liability management strategies targeted to immunize multiple liabilities of random size are superior to that of nominal bonds. We use two alternative datasets comprising daily closing prices for U.S. Treasuries and U.S. inflation-linked bonds from 2000 to 2018. The immunization performance is tested over 3-year and 5-year investment horizons, uses real and not simulated bond data and takes into consideration the impact of transaction costs in the performance of immunization strategies and in the selection of optimal investment strategies. The results show that the multiple liability immunization strategy using inflation-linked bonds outperforms the equivalent strategy using nominal bonds and is robust even in a nearly zero interest rate scenario. These results have important implications in the design and structuring of ALM liability-driven investment strategies, particularly for retirement income providers such as pension schemes or life insurance companies.

scholarly journals Understanding the Impact of Different Landscape-Level Fuel Management Strategies on Wildfire Hazard in Central Portugal

Forests ◽  
2021 ◽  
Vol 12 (5) ◽  
pp. 522
Author(s):  
Akli Benali ◽  
Ana C. L. Sá ◽  
João Pinho ◽  
Paulo M. Fernandes ◽  
José M. C. Pereira
Keyword(s):  
Management Strategies ◽  
Treatment Strategies ◽  
Fire Season ◽  
Burned Area ◽  
Treatment Area ◽  
Fuel Treatment ◽  
The North ◽  
Wildfire Hazard ◽  
Central Portugal ◽  
The Impact

The extreme 2017 fire season in Portugal led to widespread recognition of the need for a paradigm shift in forest and wildfire management. We focused our study on Alvares, a parish in central Portugal located in a fire-prone area, which had 60% of its area burned in 2017. We evaluated how different fuel treatment strategies may reduce wildfire hazard in Alvares through (i) a fuel break network with different extents corresponding to different levels of priority and (ii) random fuel treatments resulting from a potential increase in stand-level management intensity. To assess this, we developed a stochastic wildfire simulation system (FUNC-SIM) that integrates uncertainties in fuel distribution over the landscape. If the landscape remains unchanged, Alvares will have large burn probabilities in the north, northeast and center-east areas of the parish that are very often associated with high fireline intensities. The different fuel treatment scenarios decreased burned area between 12.1–31.2%, resulting from 1–4.6% increases in the annual treatment area and reduced the likelihood of wildfires larger than 5000 ha by 10–40%. On average, simulated burned area decreased 0.22% per each ha treated, and cost-effectiveness decreased with increasing area treated. Overall, both fuel treatment strategies effectively reduced wildfire hazard and should be part of a larger, holistic and integrated plan to reduce the vulnerability of the Alvares parish to wildfires.

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