Grieving over Complications Associated with Neuro-Endovascular Treatment

Neuro-endovascular therapy is regarded as one of the greatest achievements of modern medicine because of its effectiveness and low-invasiveness in the treatment of difficult neurovascular diseases. On the other side of the coin however, occasionally complications may occur which not only have a profound neurological effect, but also have a severe effect on the vital prognosis. The nightmare of a neuro-endovascular therapist is a catastrophe resulting from a preventive treatment for an asymptomatic or minimally symptomatic patient with a potentially dangerous disease. Therefore, grave psychic distress tends to occur on both sides of the patient-doctor relationship. Once severe complications occur, we have simultaneously to take care of not only the psychic trauma of a patient and/or family but also our own psychic trauma. If treatment is not appropriate, we might invite malpractice suits or end up in occupational burnout. In order to study the adaptive mechanisms that allow our continued survival in this new specialty of medicine, we administered a questionnaire survey to members of the Japanese Society of Neuro-endovascular Treatment. 51% of 300 respondents stated that they had been the targets of severe recriminations by patients and/or families as a result of complications. 284 respondents had multiple (2.5 on average) signs and symptoms of psychic trauma. Also 23% of respondents were unable to continue the clinical practice of neuro-endovascular therapy or resorted to conservative treatment. Only 7% of respondents had medical curriculum or residency program training on the psychological problems of complications. There is no systematic approach to education regarding physician grief in clinical practice. Many respondents tend to focus their attention solely on the details of failed interventional procedures and repeatedly “undo” actions and relive past events. However, the study showed that intellectualization of the tragic experiences without accepting and working through grief only adds to the physician's grief. The correlation was evaluated between the respondents' initial response to grieving and their change of attitude regarding their ability or willingness to performing the procedure after they had experienced devastating complications. It may be said that by facing the emotional truths of responsibility and grief, physicians can develop the ability to empathize with patients and their families. Mention is also made of the patient-doctor relationship, medical education, and the relationship with fellow physicians and medical lawsuits.

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Interventional radiology and artificial intelligence in radiology: Is it time to enhance the vision of our medical students?

Insights into Imaging ◽

10.1186/s13244-020-00942-y ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Pierre Auloge ◽

Julien Garnon ◽

Joey Marie Robinson ◽

Sarah Dbouk ◽

Jean Sibilia ◽

...

Keyword(s):

Artificial Intelligence ◽

Interventional Radiology ◽

Clinical Practice ◽

Medical Students ◽

Medical Curriculum ◽

New Technology ◽

Large Population ◽

The Other ◽

Clinical Phase ◽

Preclinical Phase

Abstract Objectives To assess awareness and knowledge of Interventional Radiology (IR) in a large population of medical students in 2019. Methods An anonymous survey was distributed electronically to 9546 medical students from first to sixth year at three European medical schools. The survey contained 14 questions, including two general questions on diagnostic radiology (DR) and artificial intelligence (AI), and 11 on IR. Responses were analyzed for all students and compared between preclinical (PCs) (first to third year) and clinical phase (Cs) (fourth to sixth year) of medical school. Of 9546 students, 1459 students (15.3%) answered the survey. Results On DR questions, 34.8% answered that AI is a threat for radiologists (PCs: 246/725 (33.9%); Cs: 248/734 (36%)) and 91.1% thought that radiology has a future (PCs: 668/725 (92.1%); Cs: 657/734 (89.5%)). On IR questions, 80.8% (1179/1459) students had already heard of IR; 75.7% (1104/1459) stated that their knowledge of IR wasn’t as good as the other specialties and 80% would like more lectures on IR. Finally, 24.2% (353/1459) indicated an interest in a career in IR with a majority of women in preclinical phase, but this trend reverses in clinical phase. Conclusions Development of new technology supporting advances in artificial intelligence will likely continue to change the landscape of radiology; however, medical students remain confident in the need for specialty-trained human physicians in the future of radiology as a clinical practice. A large majority of medical students would like more information about IR in their medical curriculum; almost a quarter of students would be interested in a career in IR.

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Abstract 2825: History of Cancer Predicts Mortality After Acute Endovascular Treatment for Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a2825 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Karl Meisel ◽

Mahesh Jayaraman ◽

Jonathan Grossberg ◽

Anthony Kim

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Hospice Care ◽

Exploratory Analysis ◽

Endovascular Intervention ◽

Consecutive Series ◽

History Of ◽

History Of Cancer

Introduction: Endovascular treatment is an emerging therapy for acute ischemic stroke. There is no clear consensus about how best to select patients that may benefit from intervention. We conducted an exploratory analysis of clinical risk factors to predict mortality after endovascular intervention in order to better understand how to improve outcomes for patients with acute ischemic stroke. Methods: We identified consecutive series of patients treated with endovascular therapy for acute ischemic stroke at two academic hospitals between 2005 to 2010. Key clinical data elements and clinical outcomes at the time of discharge were abstracted from medical records. We evaluated univariate and multivariable associations using logistic regression and compared mean NIH Stroke Scale between those with and without a history of cancer using the t-test. Results: We identified 88 patients who received endovascular intervention with intra-arterial tissue plasminogen activator (t-PA) and/or mechanical thrombectomy. The mean age of the cohort was 68.2 (SD 16.6) and 44 (55%) were female. A total of 23 (26.1%) patients died during the index hospitalization or were discharged to hospice care. A history of cancer was documented in 20 (22.7%) patients. A history of cancer was associated with a 3.2-fold (95% CI 1.1-9.1) higher odds of mortality. This association persisted after adjusting for age greater than 80 years and hypertension (OR of 4.0, 95% CI 1.3-12). The average NIH Stroke Scale was 15.6 in those with cancer compared to 14.6 without (p=0.53). A history of cancer was not associated with parenchymal hemorrhagic transformation (OR 1.2, 95% CI 0.3-4.9), IV tPA (OR 0.5, 95% CI 0.1-2.3), a TIMI score of 2b or 3 (OR 0.5, 95% CI 0.2-1.3), or an internal carotid artery occlusion (OR 1.7, 95% CI 0.5-5.1). Conclusions: In an exploratory analysis of consecutive patients with acute ischemic stroke treated with endovascular therapy, a history of cancer was strongly associated with significantly increased odds of mortality. One possible explanation could be that patients with cancer may have earlier withdrawal of care but the reasons for this observed association are unclear. Further investigation is necessary to verify and explain the reasons for this observation in order to improve outcomes for acute ischemic stroke patients.

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Abstract WP87: Endovascular Treatment of Very Small Ruptured Intracranial Aneurysms: Complications, Occlusion Rates and Prediction of Outcome

Stroke ◽

10.1161/str.44.suppl_1.awp87 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Robert M Starke ◽

Nohra Chalouhi ◽

Muhammad S Ali ◽

David L Penn ◽

Stavropoula I Tjoumakaris ◽

...

Keyword(s):

Multivariate Analysis ◽

Endovascular Treatment ◽

Endovascular Therapy ◽

Intracranial Aneurysms ◽

Aneurysm Rupture ◽

Post Treatment ◽

Favorable Outcome ◽

Predictors Of Outcome ◽

Aneurysm Size ◽

Ruptured Intracranial Aneurysms

Purpose: In this study we assess predictors of outcome following endovascular treatment of small ruptured intracranial aneurysms (SRA). Methods: Between 2004 and 2011, 91 patients with SRA (≤ 3 mm) were treated at our institution. Multivariate analysis was carried out to assess predictors of endovascular related complications, aneurysm obliteration (>95%), recanalization, and favorable outcome (Glasgow Outcome Scale 3-5). Results: Endovascular treatment was aborted in 9 of 91 patients (9.9%). Procedure-related complications occurred in 8 of 82 patients (9.8%) of which 5 were transient and 3 were permanent. Three patients (3.7%) undergoing endovascular therapy experienced an intra-procedural aneurysm rupture. Three of 9 patients (33.3%) treated with stent or balloon assisted coiling experienced peri-procedural complications compared to 5 of 73 patients (6.8%) receiving only coils or Onyx (p=0.039). There were no procedural deaths or rehemorrhages. Rates of recanalization and retreatment were 18.2% and 12.7%, respectively. No factors predicted initial occlusion or recanalization. In multivariate analysis pre-treatment factors predictive of favorable outcome included younger age (OR=0.94; 95% CI 0.91-0.99, p=0.017), larger aneurysm size (OR=3.4; 95% CI 1.02-11.11, p=0.045), Hunt and Hess grade (OR=0.38; 95% CI 0.19-0.75, p=0.005), and location (OR=5.12; 95% CI 1.29-20.25, p=0.02). When assessing treatment and post-treatment variables, vasospasm was the only additional covariate predictive of poor outcome (OR=5.90; 95% CI 1.34=25.93, p=0.019). Conclusions: The majority of SRA can be treated with endovascular therapy and limited complications. Overall predictors of outcome for patients undergoing endovascular treatment of SRA include age, aneurysm size, Hunt and Hess grade, location, and post-treatment vasospasm.

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The 9th Santorini Conference: Systems Medicine, Personalised Health and Therapy. “The Odyssey from Hope to Practice”, Santorini, Greece, 30 September–3 October 2018

Journal of Personalized Medicine ◽

10.3390/jpm8040043 ◽

2018 ◽

Vol 8 (4) ◽

pp. 43

Author(s):

Sophie Visvikis-Siest ◽

Vesna Gorenjak ◽

Maria Stathopoulou ◽

Alexandros Petrelis ◽

Georges Weryha ◽

...

Keyword(s):

Big Data ◽

Clinical Practice ◽

Metabolic Diseases ◽

Personalised Medicine ◽

Modern Medicine ◽

Greek Mythology ◽

Scientific Program ◽

Systems Medicine ◽

Gene Environment ◽

Personalised Therapy

The 9th traditional biannual conference on Systems Medicine, Personalised Health & Therapy—“The Odyssey from Hope to Practice”, inspired by the Greek mythology, was a call to search for practical solutions in cardio-metabolic diseases and cancer, to resolve and overcome the obstacles in modern medicine by creating more interactions among disciplines, as well as between academic and industrial research, directed towards an effective ‘roadmap’ for personalised health and therapy. The 9th Santorini Conference, under the Presidency of Sofia Siest, the director of the INSERM U1122; IGE-PCV (www.u1122.inserm.fr), University of Lorraine, France, offered a rich and innovative scientific program. It gathered 34 worldwide distinguished speakers, who shared their passion for personalised medicine with 160 attendees in nine specific sessions on the following topics: First day: The Odyssey from hope to practice: Personalised medicine—landmarks and challenges Second day: Diseases to therapeutics—genotype to phenotype an “-OMICS” approach: focus on personalised therapy and precision medicine Third day: Gene-environment interactions and pharmacovigilance: a pharmacogenetics approach for deciphering disease “bench to clinic to reality” Fourth day: Pharmacogenomics to drug discovery: a big data approach and focus on clinical data and clinical practice. In this article we present the topics shared among the participants of the conference and we highlight the key messages.

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Haemodynamic and anaesthetic management of patients undergoing endovascular therapy for cerebral vasospasm

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.139114 ◽

2014 ◽

Vol 01 (03) ◽

pp. 204-209

Author(s):

Audrey Tan ◽

Suresh Tharmaradinam ◽

Ramamani Mariappan ◽

Pirjo Manninen ◽

Lakshmi Venkatraghavan

Keyword(s):

Blood Pressure ◽

Endovascular Treatment ◽

Cerebral Vasospasm ◽

Endovascular Therapy ◽

Anaesthetic Management ◽

Rehabilitation Centre ◽

Endovascular Interventions ◽

Anaesthetic Care ◽

Hospital To Home ◽

Hypertensive Therapy

Abstract Background: Cerebral vasospasm is a common and devastating complication after a subarachnoid haemorrhage (SAH). Current guidelines for treatment recommend hypertension with euvolaemia. Endovascular therapy with cerebral angioplasty and possible administration of intra-arterial vasodilators is indicated in patients who fail medical treatment. The objective of our study was to review the haemodynamic management and anaesthetic care of patients undergoing endovascular therapy for cerebral vasospasm in our institution. Materials and Methods: The medical records of all patients who underwent endovascular therapy for cerebral vasospasm between, April 2006 and September 2012, were reviewed retrospectively. Patients with clinical vasospasm were treated initially by inducing hypertension to systolic pressures of 140 to 170 mmHg; Endovascular treatment was performed, if there was no clinical improvement. Data was collected on blood pressure measurements, anaesthetic management, duration and complications of hypertensive therapy and outcome. The differences in the pre- and post-angioplasty systolic blood pressure were statistically analysed. Results: A total of 45 patients had 47 endovascular interventions, with balloon angioplasty for proximal vessel spasm and 16 (34%) patients had additional intra-arterial injection of a vasodilator agent. Onset of vasospasm was 7 days (range 2-15 days) after SAH. Vasospasm was usually seen in multiple vessels in the same patient regardless of the site of ruptured aneurysm and was present unilaterally in 80% of the patients. All patients had a general anaesthesia for the procedure. Prior to endovascular treatment 68.9% patients required vasopressors, but post angioplasty 93.3% required them. Norepinephrine was the most commonly used (66.2%). Angioplasty was successful in reversing the cerebral vasospasm as assessed by angiography in all patients with no intra-procedure complications. Overall 80% of patients were discharged from hospital to home or to a rehabilitation centre. Conclusion: Cerebral vasospasm affects multiple vessels in the same patient. Despite endovascular therapy being a successful intervention for proximal vessel spasm, most patients still required induced hypertension with even higher levels post angioplasty compared to pre angioplasty.

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So What? Implications of Network Theory for Research and Practice

10.31234/osf.io/6bqdx ◽

2021 ◽

Author(s):

Payton J. Jones ◽

Donald Robinaugh

Keyword(s):

Clinical Practice ◽

Network Theory ◽

Medical Model ◽

Signs And Symptoms ◽

Psychological Problems ◽

Research And Practice ◽

Behavioral Therapies ◽

Cognitive Behavioral Therapies ◽

Disease Entities ◽

The Brain

Research and practice in psychiatry and clinical psychology have been guided by differing schools of thought over the years. Recently, the network theory of psychopathology has arisen as a framework for thinking about mental health. Network theory challenges three assumptions common in the field: (1) psychological problems are caused by disease entities that exist independently of their signs and symptoms, (2) classification and diagnosis of psychological problems should follow a medical model, and (3) psychological problems are caused by diseases or aberrations in the brain. Conversely, it embraces many other assumptions that are already well accepted in clinical practice (e.g., the interaction of thoughts, behaviors, and emotions, as posited in cognitive-behavioral therapies) and integrates those assumptions into a coherent framework for research and practice. We review developments in the network theory with a focus on anxiety-related conditions, discuss future areas for change, and outline implications of the theory for both research and clinical practice.

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A CRITICAL REVIEW ARTICLE ON PANDU W.S.R. ANAEMIA

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj3409092021 ◽

2021 ◽

Vol 9 (9) ◽

pp. 2144-2150

Author(s):

Shivam Kumar Nigam ◽

Rita Singh ◽

Sanjay Srivastava

Keyword(s):

Medical Science ◽

Clinical Signs ◽

Public Health Problem ◽

Signs And Symptoms ◽

Modern Medicine ◽

Review Article ◽

Global Public Health ◽

The World ◽

Clinical Signs And Symptoms ◽

Global Public Health Problem

Pandu Roga is one of the diseases mentioned in Ayurveda characterized by the changes in the skin colour to white (Shweta), yellowish (Peeta), greenish (Harita) etc. which is one of the “Varnopalakshita Roga" i.e., a disease characterized by the change in the colour. The clinical condition of Pandu in Ayurveda can be co-related with Anaemia described in Modern Medical Science, due to the resemblance in the clinical signs and symptoms. In Modern Medicine, Pandu is a pale appearance which may be due to the decreased blood supply to the skin or de- creased visibility of oxyhemoglobin. Anaemia is a major global public health problem and the most prevalent nu- tritional deficiency disorder in the world. This article presents the Ayurvedic concept of Pandu Roga (Anaemia). Keywords: Pandu, Vyadhi, Srotas, Anaemia, Pallor,

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AYURVEDIC MANAGEMENT OF DUCHENNE MUSCULAR DYSTROPHY: A SHORT REVIEW

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v7.i1.2019.1046 ◽

2019 ◽

Vol 7 (1) ◽

pp. 179-183

Author(s):

Akshay A Patankar ◽

Renu B Rathi

Keyword(s):

Duchenne Muscular Dystrophy ◽

Muscular Dystrophy ◽

Social Contact ◽

Signs And Symptoms ◽

Short Review ◽

Receptive Language ◽

Modern Medicine ◽

Autism Spectrum ◽

Neuromuscular Disorder ◽

Significant Treatment

Duchenne muscular dystrophy is a neuromuscular disorder characterized by deficient dystrophin protein in the muscle. The main symptoms the patient presented were delay in expressive and receptive language development, visual discontent, hyperkinetic behaviour, and inability to initiate and maintain social contact with peers. The data obtained from the family, following clinical examination, laboratory investigation results and assessment of mental status were significant for the diagnosis of Autism Spectrum Disorder, hyperkinetic behaviour and Duchenne Muscular Dystrophy. In Ayurveda it has been classified under Medomamsa dusti further vitiates the Vata doshas occurs due to the Bheejabagahaavyava Dusti. In modern medicine there is no significant treatment available for this diseases while in Ayurvedic panchakrma therapy shows significant results in all signs and symptoms of this diseases.

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Hypothyroidism with special reference to kaphavruta udana vayu – an overview study.

National Journal of Research in Ayurved Science ◽

10.52482/ayurlog.v8i03.607 ◽

2020 ◽

Vol 8 (03) ◽

Author(s):

Pragati Dwivedi

Keyword(s):

Clinical Trials ◽

Differential Diagnosis ◽

Positive Result ◽

Special Reference ◽

Prevalence Rate ◽

Signs And Symptoms ◽

Autoimmune Disorder ◽

Modern Medicine ◽

Clinical Correlation ◽

Health Issues

Hypothyroidism is one of the fastest rising health issues in India, with the prevalence rate of 10.95% ~1 in 10 adults. Thus, it is of great need to deal with this ever-emerging disease. In Ayurveda, Hypothyroidism is often taken as Rasa - pradoshaja vyadhi and treated accordingly but the outcome is not as expected always. So, there is a need to find out other conditions which shows similar signs and symptoms as hypothyroidism and that can be considered in differential diagnosis. In Modern medicine the causes of Hypothyroidism are differentiated in deficiency, insufficiency of hormone, inefficiency of gland, autoimmune disorder, Cancer etc. In our study we will refer it with Kaphavruta udana vayu vikriti with the help of classical textual references which will be helpful in the treatment precisely. Aims & objective – 1. To evaluate co-relation between hypothyroidism with kaphavruta udana vayu vikruti 2. To evaluate action of erand sneh in kaphavruta udana vayu vikruti Methodology – All classical texts were referred like Bruhtrayi & Laghutrayi and others to evaluate the clinical correlation of hypothyroidism and kaphavruta udana vayu vikruti. Whether line of treatment mentioned in kaphavruta udana vayu vikruti shows the positive result in hypothyroidism. Conclusion –It was observed that the signs and symptoms of hypothyroidism were very much similar with kapha vruta udana vayu vikruti. Hypothyroidism can successes fully be referred as Kaphavruta udana yavu vikruti. According to textual references we can utilize Eranda Sneha Nasya & Paan in the management of hypothyroidism. Thus, it has significant role in reducing the signs and Symptoms of Hypothyroidism because of its Vata - kaphhara, srotovishodhan, Anulomana, vrushya actions. Further studies and clinical trials are essential to evaluate the efficacy of erand sneha and correlation between hypothyroidism & kaphavruta udana vayu vikriti.

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THE MEDICAL PHYSICIST - SCIENTIST BEHIND THE CURTAIN

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i4.1280 ◽

2021 ◽

Vol 10 (4) ◽

pp. 3212-3213

Author(s):

Anurag A. Luharia

Keyword(s):

Quality Assurance ◽

Clinical Practice ◽

Radiation Protection ◽

Medical Physics ◽

Analytical Techniques ◽

Modern Medicine ◽

Quality Assurance Program ◽

Medical Physicist ◽

Accurate Treatment ◽

Medical Physicists

Ionizing radiation has validated its existence and effectiveness in modern medicine for both diagnostic and therapeutic use. For the last decade rapid growth in medical radiation application has witnessed in India towards the betterment of mankind, for safe and quality clinical practice, radiation protection and quality assurance. At the end of the 19th century Physics brought paradigm shift in the field of radiation-based medical diagnosis and treatment and giving rise to the modern medical physicist profession and revolutionized the practice of medicine. Medical Physicists are the scientists with Post graduation / PhD degrees, and certified from A.E.R.B as Radiological Safety Officer, deals with utilization of Physics knowledge in developing not only lifesaving tools & technology but also diagnosis and treatments of various medical conditions that help humans live longer and healthier. Medical Physicists are responsible to carry out the commissioning, establishment of entire Radiation facility and get the clearance of statutory compliances form authorities in order to start the clinical practice are also responsible for research, developing and evaluating new analytical techniques, planning and ensuring safe and accurate treatment of patients also provide advice about radiation protection, training and updating healthcare, scientific and technical staff , managing radiotherapy quality assurance program, mathematical modeling ,maintaining equipment ,writing reports, teaching ,laboratory management and administration. Now it’s a time to raise the curtain from the Medical Physics profession and utilize their services up to maximum extent in the field of scientific research, academic, teaching, diagnosis, treatment and safety.

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