scholarly journals Lumbar puncture in patients using anticoagulants and antiplatelet agents

2016 ◽  
Vol 74 (8) ◽  
pp. 679-686 ◽  
Author(s):  
Renan Domingues ◽  
Gustavo Bruniera ◽  
Fernando Brunale ◽  
Cristóvão Mangueira ◽  
Carlos Senne
Keyword(s):  
Lumbar Puncture ◽  
Antiplatelet Agents ◽  
Underlying Disease ◽  
Neurological Deficits ◽  
Patient Decision Making ◽  
Thrombotic Risk ◽  
Fluid Analysis ◽  
Patient Decision ◽  
Assistant Physician ◽  
Risk Of Hemorrhage

ABSTRACT The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks.

Lumbar Puncture Opening Pressure in Patients with Spinal Muscular Atrophy

2021 ◽  
Author(s):  
Lena-Luise Becker ◽  
Claudia Weiß ◽  
Anna Tietze ◽  
Viktoria Martiny ◽  
Angela M. Kaindl
Keyword(s):  
Intracranial Pressure ◽  
Spinal Muscular Atrophy ◽  
Lumbar Puncture ◽  
Clinical Data ◽  
Side Effect ◽  
Treatment Initiation ◽  
Muscular Atrophy ◽  
Underlying Disease ◽  
Increased Intracranial Pressure ◽  
Opening Pressure

AbstractThe announcement of a hydrocephalus as a possible side effect in patients with spinal muscular atrophy (SMA) receiving the drug nusinersen, promoted major concern and warrants further evaluation. In this retrospective monocentric study, we analyzed clinical data, lumbar puncture opening pressure (LOP) measurement, and ophthalmologic and neuroimaging results in 34 patients with SMA types 1 to 3 undergoing treatment with nusinersen. None of the patients reported symptoms indicative of increased intracranial pressure. In our cohort, the LOP was >20 cm H2O in 25 patients (70.5%), and within this group ≥28 cm H2O in 12 patients (35.3%), in two patients, it was increased prior to treatment initiation. Signs of increased intracranial pressure in ophthalmological assessments or brain imaging were only seen in one patient. We did not identify a correlation between increased LOP and SMA type, scoliosis, or age of the patients; however, it was slightly higher in patients receiving sedation. Our results raise the question whether the LOP is generally increased in SMA as part of the underlying disease, if so, what the etiology is, and whether the increased LOP needs to be treated.

An economic theory of patient decision-making

2005 ◽  
Vol 2 (3) ◽  
pp. 153-164 ◽  
Author(s):  
Douglas O. Stewart ◽  
Joseph P. DeMarco
Keyword(s):  
Decision Making ◽  
Economic Theory ◽  
Patient Decision Making ◽  
Patient Decision

Views of Psychologists About Their Role in Hastened Death

2021 ◽  
pp. 003022282110451
Author(s):  
Sílvia Marina ◽  
Tony Wainwright ◽  
Miguel Ricou
Keyword(s):  
Terminal Illness ◽  
Active Role ◽  
Cross Sectional ◽  
Patient Decision Making ◽  
Psychological Practice ◽  
Open Questions ◽  
Patient Decision ◽  
Life Issues ◽  
Hastened Death ◽  
End Of Life Issues

Hastened death practices are legal in several countries. Psychologists are increasingly taking a more active role in end-of-life issues, but the role of psychologists in requests to hasten death is not established. This study aims to contribute guidance for psychological practice in the context of requests to hasten death. We conducted a cross-sectional and cross-cultural study with Psychologists from Portugal and Luxembourg who answer closed and open questions to provide views about their role in hastened death. Psychological assessment, psychological support to patient and family, the exploration of patient decision-making and reorientation of patients were viewed as roles for psychologists. However, these roles may differ depending whether the patient has a terminal or non-terminal illness.

Radiation Oncology's Place in Payment Reform: ASTRO Advocates for a Place at the Table

2021 ◽  
pp. OP.21.00294
Author(s):  
Anne Hubbard ◽  
Constantine Mantz ◽  
Najeeb Mohideen ◽  
William Hartsell ◽  
Nikhil G. Thaker ◽  
...  
Keyword(s):  
Radiation Oncology ◽  
Payment Reform ◽  
Patient Decision Making ◽  
Current Form ◽  
True Value ◽  
Reporting Requirements ◽  
Patient Decision ◽  
American Society ◽  
Physician Patient ◽  
Therapy Treatment

In its current form, the Radiation Oncology Model (RO Model) prioritizes payment cuts over true value-based payment transformation. With significant modifications to the payment methodology, the reporting requirements, and recognition of the unique challenges faced by disadvantaged populations, the RO Model can protect patient access to care, preserve the physician-patient decision-making process, and ensure the delivery of high-quality, efficient radiation therapy treatment. The American Society for Radiation Oncology has spent several years advocating for a meaningful alternative payment model for radiation oncology and continues to push The Center for Medicare and Medicaid Innovation for changes to the RO Model that will recognize these key outcomes.

scholarly journals 181. I FOUND IT MOST CONFUSING, I DIDN’T KNOW WHAT TO BELIEVE: EXPLORING PATIENT DECISION MAKING AROUND GOUT AND DIET

Rheumatology ◽  
2017 ◽  
Vol 56 (suppl_2) ◽  
Author(s):  
Jennifer Liddle ◽  
Jane C. Richardson ◽  
Christian D. Mallen ◽  
Samantha L. Hider ◽  
Priyanka Chandratre ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Decision Making ◽  
Patient Decision
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