scholarly journals Analgesic treatment limits surrogate parameters for early stress and pain response after experimental subarachnoid hemorrhage

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Irina Staib-Lasarzik ◽  
Nadine Nagel ◽  
Anne Sebastiani ◽  
Eva-Verena Griemert ◽  
Serge C. Thal
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Food Intake ◽  
Pain Treatment ◽  
Well Being ◽  
Control Group ◽  
Analgesic Treatment ◽  
Perioperative Analgesia ◽  
Sham Surgery ◽  
Stress Levels

Abstract Background In animal research, authorities require a classification of anticipated pain levels and a perioperative analgesia protocol prior to approval of the experiments. However, data on this topic is rare and so is the reported use of analgesics. We determined surrogate parameters of pain and general well-being after subarachnoid hemorrhage (SAH), as well as the potential for improvement by different systemic analgesia paradigms. Brain injury was induced by filament perforation to mimic SAH. Sham-operated mice were included as surgical control groups with either neck or no-neck preparation. Mice with controlled cortical impact (CCI) injury were included as a control group with traumatic brain injury (TBI), but without neck preparation. Mice were randomized to buprenorphine, carprofen, meloxicam, or vehicle treatment. 24 h after SAH, CCI or sham surgery, pain and stress levels were assessed with a visual assessment score and the amount of food intake was recorded. Results Neck preparation, which is required to expose the surgical field for SAH induction, already increased pain/stress levels and sham surgeries for both CCI and SAH reduced food intake. Pain/stress levels were higher and food intake was lower after SAH compared with CCI. Pain/stress levels after CCI without analgesic treatment were similar to levels after SAH sham surgery. Pain treatment with buprenorphine was effective to reduce pain after SAH, whereas lower pain/stress intensity levels after CCI were not improved. Conclusion This study emphasizes the importance of pain and stress assessment after surgeries and the efficacy of buprenorphine to improve pain and comfort levels after experimental SAH.

Effect of heparin on secondary brain injury in patients with subarachnoid hemorrhage: an additional ‘H’ therapy in vasospasm treatment

2017 ◽  
Vol 9 (7) ◽  
pp. 659-663 ◽  
Author(s):  
Markus Bruder ◽  
Sae-Yeon Won ◽  
Sepide Kashefiolasl ◽  
Marlies Wagner ◽  
Nina Brawanski ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Favorable Outcome ◽  
Matched Pair ◽  
Control Group ◽  
High Morbidity ◽  
Secondary Brain Injury ◽  
Heparin Group ◽  
Vasomotor Function

ObjectiveSecondary brain injury leads to high morbidity and mortality rates in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, evidence-based treatment strategies are sparse. Since heparin has various effects on neuroinflammation, microthromboembolism and vasomotor function, our objective was to determine whether heparin can be used as a multitarget prophylactic agent to ameliorate morbidity in SAH.MethodsBetween June 1999 and December 2014, 718 patients received endovascular treatment after rupture of an intracranial aneurysm at our institution; 197 of them were treated with continuous unfractionated heparin in therapeutic dosages after the endovascular procedure. We performed a matched pair analysis to evaluate the effect of heparin on cerebral vasospasm (CVS), cerebral infarction (CI), and outcome.ResultsThe rate of severe CVS was significantly reduced in the heparin group compared with the control group (14.2% vs 25.4%; p=0.005). CI and multiple ischemic lesions were less often present in patients with heparin treatment. These effects were enhanced if patients were treated with heparin for >48 hours, but the difference was not significant. Favorable outcome at 6-month follow-up was achieved in 69% in the heparin group and in 65% in the control group.ConclusionsPatients receiving unfractionated continuous heparin after endovascular aneurysm occlusion have a significant reduction in the rate of severe CVS, have CI less often, and tend to have a favorable outcome more often. Our findings support the potential beneficial effects of heparin as a multitarget therapy in patients with SAH, resulting in an additional ‘H’ therapy in vasospasm treatment.

Respiratory, Physical, and Psychological Benefits of Breath-Focused Yoga for Adults with Severe Traumatic Brain Injury (TBI): A Brief Pilot Study Report

2012 ◽  
Vol 22 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Colin Silverthorne ◽  
Sat Bir Khalsa ◽  
Robin Gueth ◽  
Nicole DeAvilla ◽  
Janie Pansini
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pilot Study ◽  
Severe Traumatic Brain Injury ◽  
Well Being ◽  
Small Sample ◽  
Longitudinal Change ◽  
Control Group ◽  
Psychological Well Being ◽  
Severe Tbi

Objective: This pilot study was designed to identify the potential benefits of breath-focused yoga on respiratory, physical, and psychological functioning for adults with severe traumatic brain injury (TBI). Participants: Ten individuals with severe TBI who self-selected to attend weekly yoga classes and 4 no-treatment controls were evaluated. Methods: Participants were assessed at pretreatment baseline and at 3-month intervals for a total of 4 time points over 40 weeks. Outcomes of interest included observed exhale strength, ability to hold a breath or a tone, breathing rate, counted breaths (inhale and exhale), and heart rate, as well as self-reported physical and psycho-logical well-being. Results: Repeated within-group analyses of variance revealed that the yoga group demonstrated significant longitudinal change on several measures of observed respiratory functioning and self-reported physical and psychological well-being over a 40-week period. Those in the control group showed marginal improvement on 2 of the 6 measures of respiratory health, physical and social functioning, emotional well-being, and general health. The small sample sizes precluded the analysis of between group differences. Conclusion: This study provides preliminary evidence that breath-focused yoga may improve respiratory functioning and self-perceived physical and psychological well-being of adults with severe TBI.

scholarly journals Effect of Meditation and Breathing Exercises on the Well-being of Patients with SARS-CoV-2 Infection under Institutional Isolation: A Randomized Control Trial

2021 ◽  
Vol 0 ◽  
pp. 1-5
Author(s):  
Kiran Mahendru ◽  
Anuja Pandit ◽  
Vishwajeet Singh ◽  
Nandan Choudhary ◽  
Anant Mohan ◽  
...  
Keyword(s):  
Randomized Control Trial ◽  
Well Being ◽  
Control Group ◽  
Quality Of Sleep ◽  
Positive Effects ◽  
Breathing Exercises ◽  
Falling Asleep ◽  
Stress Levels ◽  
Randomized Control

Objectives: The corona virus disease-19 (COVID-19) pandemic has affected every domain of human health be it physical or mental. The uncertainty of disease progression in patients with SARS-CoV-2 infection can lead to major psychological and psychiatric concerns that should not be overlooked. The interventions should be directed to the vulnerable population to help them mitigate the stress and anxiety caused by the infection and isolation. We evaluated the effect of meditation and breathing exercises on the well-being of patients with SARS-CoV-2 infection under institutional isolation. Materials and Methods: We conducted a randomized control trial on 84 subjects, 18 years and above, asymptomatic, or mildly symptomatic SARS-CoV-2 infected patients under institutional isolation. Subjects were randomly and equally divided into a control group and interventional group. We measured the depression, anxiety, and stress levels as well as quality of sleep in patients after 7 days of meditation and breathing exercises in the intervention group versus standard care in the control group. Results: Mediation and breathing exercises had a statistically significant effect on the depression level (P < 0.001), stress level (P = 0.004), and the quality of sleep [trouble falling asleep (P = 0.007), trouble staying asleep (P = 0.004), and feel tired after waking up in the morning (P = 0.003)]. Further, the positive effect of intervention on the level of anxiety in patients under isolation was also observed; however, the difference was not found to be statistically significant (P = 0.528). Conclusion: Meditation and breathing exercises have positive effects on depression, stress levels, and quality of sleep in COVID-19 positive patients under strict institutional isolation.

scholarly journals Management of Minor Traumatic Brain Injury in an ED Observation Unit

2021 ◽  
Vol 22 (4) ◽  
pp. 943-950
Author(s):  
Matthew Wheatley ◽  
Shikha Kapil ◽  
Amanda Lewis ◽  
Jessica O’Sullivan ◽  
Joshua Armentrout ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Length Of Stay ◽  
Skull Fracture ◽  
Trauma Surgery ◽  
Control Group ◽  
Short Period ◽  
Minor Traumatic Brain Injury ◽  
Neurosurgical Intervention

Introduction: Traumatic intracranial hemorrhages (TIH) have traditionally been managed in the intensive care unit (ICU) setting with neurosurgery consultation and repeat head CT (HCT) for each patient. Recent publications indicate patients with small TIH and normal neurological examinations who are not on anticoagulation do not require ICU-level care, repeat HCT, or neurosurgical consultation. It has been suggested that these patients can be safely discharged home after a short period of observation in emergency department observation units (EDOU) provided their symptoms do not progress. Methods: This study is a retrospective cross-sectional evaluation of an EDOU protocol for minor traumatic brain injury (mTBI). It was conducted at a Level I trauma center. The protocol was developed by emergency medicine, neurosurgery and trauma surgery and modeled after the Brain Injury Guidelines (BIG). All patients were managed by attendings in the ED with discretionary neurosurgery and trauma surgery consultations. Patients were eligible for the mTBI protocol if they met BIG 1 or BIG 2 criteria (no intoxication, no anticoagulation, normal neurological examination, no or non-displaced skull fracture, subdural or intraparenchymal hematoma up to 7 millimeters, trace to localized subarachnoid hemorrhage), and had no other injuries or medical co-morbidities requiring admission. Protocol in the EDOU included routine neurological checks, symptom management, and repeat HCT for progression of symptoms. The EDOU group was compared with historical controls admitted with primary diagnosis of TIH over the 12 months prior to the initiation of the mTBI protocols. Primary outcome was reduction in EDOU length of stay (LOS) as compared to inpatient LOS. Secondary outcomes included rates of neurosurgical consultation, repeat HCT, conversion to inpatient admission, and need for emergent neurosurgical intervention. Results: There were 169 patients placed on the mTBI protocol between September 1, 2016 and August 31, 2019. The control group consisted of 53 inpatients. Median LOS (interquartile range [IQR]) for EDOU patients was 24.8 (IQR: 18.8 – 29.9) hours compared with a median LOS for the comparison group of 60.2 (IQR: 45.1 – 85.0) hours (P < .001). In the EDOU group 47 (27.8%) patients got a repeat HCT compared with 40 (75.5%) inpatients, and 106 (62.7%) had a neurosurgical consultation compared with 53 (100%) inpatients. Subdural hematoma was the most common type of hemorrhage. It was found in 60 (35.5%) patients, and subarachnoid hemorrhage was found in 56 cases (33.1%). Eleven patients had multicompartment hemorrhage of various classifications. Twelve (7.1%) patients required hospital admission from the EDOU. None of the EDOU patients required emergent neurosurgical intervention. Conclusion: Patients with minor TIH can be managed in an EDOU using an mTBI protocol and discretionary neurosurgical consults and repeat HCT. This is associated with a significant reduction in length of stay.

scholarly journals Open-Label Placebo Interventions With Drinking Water and Their Influence on Perceived Physical and Mental Well-Being

2021 ◽  
Vol 12 ◽  
Author(s):  
Marco Rathschlag ◽  
Stefanie Klatt
Keyword(s):  
Drinking Water ◽  
Pain Treatment ◽  
Well Being ◽  
Post Treatment ◽  
The Other ◽  
Control Group ◽  
Treatment Level ◽  
Open Label ◽  
Performance Capability ◽  
Mental Well Being

In recent years, the postulation that deception is necessary for placebos to have an effect on pain relief or increased well-being has come into question. Latest studies have shown that an openly administered mock drug works just as well as a deceptively administered placebo on certain complaints. This open-label placebo effect has primarily been used in the area of pain treatment so far. This study is the first to examine the effect of such placebos on healthy individuals with the use of drinking water. In two experiments, participants were required to use certain specified water bottles for their daily drinking water consumption. At the beginning of Experiment 1, all participants (N = 68) received one bottle of water, which they were asked to refill themselves each day during a 2-week intervention period. In Experiment 2, participants (N = 75) received a new sealed water bottle every day. In both experiments, participants were randomly assigned to one of four groups: no treatment (control group CG), open-label placebo without rationale (OPR–), open-label placebo with rationale (OPR+), and open-label placebo with additional rationale in a suggested relaxed state (group OPR++). We conducted baseline and post-treatment measurements of the subjective perceived physical and mental well-being of the participants. In Experiment 1, only the OPR++ group reported enhanced vitality at the post-treatment level compared to the other groups. In Experiment 2, post-treatment measurements showed improvements for the OPR++ group in the Physical Performance Capability, Mental Performance Capability, Emotional Balance, Overall Recovery, Negative Emotional State, and Overall Stress categories compared to the other groups. Our results support the idea that placebos with an additional rationale in a suggestive relaxed state are more effective than with just a rationale in a normal state. Furthermore, our study shows the tendency that OLP++ in the form of water with health claims may be more effective when the water is given in several sealed bottles separately than in one sealed but refillable bottle.

Sleep and quality of life in children with traumatic brain injury and ADHD

2017 ◽  
Vol 52 (1) ◽  
pp. 72-87 ◽  
Author(s):  
Ozalp Ekinci ◽  
Çetin Okuyaz ◽  
Serkan Günes ◽  
Nuran Ekinci ◽  
Gülhan Örekeci ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sleep Problems ◽  
Well Being ◽  
Control Group ◽  
Life Questionnaire ◽  
Adhd Symptoms ◽  
Sleep Habits

Objective Attention problems are common in children who sustain a traumatic brain injury (TBI). The differential features of TBI-related Attention Deficit Hyperactivity Disorder (ADHD) and primary ADHD are largely unknown. This study aimed to compare sleep problems and quality of life between children with TBI and ADHD and children with primary ADHD. Methods Twenty children with TBI (mean age = 12.7 ± 3.1 years) who had clinically significant ADHD symptoms according to the structured diagnostic interview and rating scales and a control group with primary ADHD (n = 20) were included. Parents completed Children’s Sleep Habits Questionnaire (CSHQ) and Kinder Lebensqualitätsfragebogen: Children’s Quality of Life Questionnaire-revised (KINDL-R). Neurology clinic charts were reviewed for TBI-related variables. Results When compared to children with primary ADHD, the Total Score and Sleep Onset Delay, Daytime Sleepiness, Parasomnias, and Sleep Disordered Breathing subscores of CSHQ were found to be higher in children with TBI and ADHD. The Total Score and Emotional Well-Being and Self-Esteem subscores of the KINDL-R were found to be low (poorer) in children with TBI and ADHD. The Total Score and certain subscores of KINDL-R were found to be lower in TBI patients with a CSHQ > 56 (corresponds to significant sleep problems) when compared to those with a CSHQ < 56. CSHQ Total Score was negatively correlated with age. Conclusion Children with TBI and ADHD symptoms were found to have a poorer sleep quality and quality of life than children with primary ADHD. ADHD in TBI may be considered as a highly impairing condition which must be early diagnosed and treated.

scholarly journals Effectiveness of a Mindfulness and Self-Compassion Standard Training Program versus an Abbreviated Training Program on Stress in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain

2021 ◽  
Vol 18 (19) ◽  
pp. 10230
Author(s):  
Juan Carlos Verdes-Montenegro-Atalaya ◽  
Luis Ángel Pérula-de Torres ◽  
Norberto Lietor-Villajos ◽  
Cruz Bartolomé-Moreno ◽  
Herminia Moreno-Martos ◽  
...  
Keyword(s):  
Training Program ◽  
Stress Reduction ◽  
Training Programs ◽  
National Health System ◽  
Well Being ◽  
Community Medicine ◽  
Control Group ◽  
Intergroup Comparison ◽  
Stress Levels ◽  
Standard Training

Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F(2,91) = 5.165; p = 0.008; η2 = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.

A Pilot Study on the Efficacy of Volunteer Mentorship for Young Adults With Self-Harm Behaviors Using a Quasi-Experimental Design

Crisis ◽  
2016 ◽  
Vol 37 (6) ◽  
pp. 415-426 ◽  
Author(s):  
Yik-Wa Law ◽  
Paul S. F. Yip ◽  
Carmen C. S. Lai ◽  
Chi Leung Kwok ◽  
Paul W. C. Wong ◽  
...  
Keyword(s):  
Experimental Design ◽  
Suicide Ideation ◽  
Intervention Group ◽  
Well Being ◽  
Control Group ◽  
Treatment As Usual ◽  
Prevention Services ◽  
Quasi Experimental ◽  
Self Harm ◽  
Volunteer Support

Abstract. Background: Studies have shown that postdischarge care for self-harm patients is effective in reducing repeated suicidal behaviors. Little is known about whether volunteer support can help reduce self-harm repetition and improve psychosocial well-being. Aim: This study investigated the efficacy of volunteer support in preventing repetition of self-harm. Method: This study used a quasi-experimental design by assigning self-harm patients admitted to the emergency departments to an intervention group with volunteer support and treatment as usual (TAU) for 9 months and to a control group of TAU. Outcome measures include repetition of self-harm, suicidal ideation, hopelessness, and level of depressive and anxiety symptoms. Results: A total of 74 cases were recruited (38 participants; 36 controls). There were no significant differences in age, gender, and clinical condition between the two groups at the baseline. The intervention group showed significant improvements in hopelessness and depressive symptoms. However, the number of cases of suicide ideation and of repetition of self-harm episodes was similar for both groups at the postintervention period. Conclusion: Postdischarge care provided by volunteers showed significant improvement in hopelessness and depression. Volunteers have been commonly involved in suicide prevention services. Further research using rigorous methods is recommended for improving service quality in the long term.

The Effects of a Caffeine Placebo and Experimenter Expectation on Blood Pressure, Heart Rate, Well-Being, and Cognitive Performance

2001 ◽  
Vol 6 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Harald Walach ◽  
Stefan Schmidt ◽  
Yvonne-Michelle Bihr ◽  
Susanne Wiesch
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cognitive Task ◽  
Well Being ◽  
Control Group ◽  
Double Blind ◽  
Main Effect ◽  
The Difference ◽  
Being There ◽  
To Receive

We studied the effect of experimenter expectations and different instructions in a balanced placebo design. 157 subjects were randomized into a 2 × 4 factorial design. Two experimenters were led to expect placebos either to produce physiological effects or not (pro- vs. antiplacebo). All subjects except a control group received a caffeine placebo. They were either made to expect coffee, no coffee, or were in a double-blind condition. Dependent measures were blood pressure, heart rate, well-being, and a cognitive task. There was one main effect on the instruction factor (p = 0.03) with the group “told no caffeine” reporting significantly better well-being. There was one main effect on the experimenter factor with subjects instructed by experimenter “proplacebo” having higher systolic blood pressure (p = 0.008). There was one interaction with subjects instructed by experimenter “proplacebo” to receive coffee doing worse in the cognitive task than the rest. Subjects instructed by experimenter “antiplacebo” were significantly less likely to believe the experimental instruction, and that mostly if they had been instructed to receive coffee. Contrary to the literature we could not show an effect of instruction, but there was an effect of experimenters. It is likely, however, that these experimenter effects were not due to experimental manipulations, but to the difference in personalities.

Cortisol stress reactivity and spiritual well-being after traumatic brain injury

2010 ◽  
Author(s):  
Paul C. Hubbarth ◽  
Lisa J. Rapport ◽  
Brigid Waldron-Perrine ◽  
Sarah-Jane Meachen
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Stress Reactivity ◽  
Well Being ◽  
Spiritual Well Being
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