Dilemma of seizure prophylaxis in sub-arachnoid haemorrhage

There is around 10% risk of developing seizures in post subarachnoid hemorrhage (SAH) period. This is considered to be linked to decreased oxygenation of brain due to increase in intra-cranial pressure obviating use of anti-epileptic drugs (AED) as a prophylactic measure. This review was done to study the effect and changes of blood brain barrier permeability in subarachnoid hemorrhage with regard to the present knowledge available and how it could be utilized to open arenas for future research for the rationalization of therapy for such patients. There is no consensus till date on the etiopathogenesis due to which no established guidelines are present for the management of such patients. It is safer to approach the patient on a case by case basis and assess whether to give prophylaxis or not based on the risk of development of seizures and adverse event profile of drugs. Also, there is a need to conduct prospective studies in this arena so as to get some meaningful interpretations which could be of some use to the future therapeutic guidelines.

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Fields of spatial research on urban areas in the context of organisational solutions to new forms of transportation

Urban Development Issues ◽

10.2478/udi-2018-0023 ◽

2018 ◽

Vol 58 (1) ◽

pp. 53-60

Author(s):

Bartosz Czarnecki

Keyword(s):

Urban Areas ◽

Transportation System ◽

Present Knowledge ◽

Future Research ◽

Use Of Self ◽

Large Share ◽

Main Achievement ◽

Self Driving Cars

Abstract The paper discusses the spatial consequences of the widespread use of self-driving cars and the resulting changes in the structure of urban areas. Analysing present knowledge on the technology, functionality and future forms of organisation of mobility with this type of means of transportation, conclusions are presented concerning the expected changes in the organisation of space in urban areas. The main achievement of the investigation is an outline of the fields of future research on the spatial consequences of a transportation system with a large share of self-driving cars.

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Application of electronic trigger tools to identify targets for improving diagnostic safety

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-008086 ◽

2018 ◽

Vol 28 (2) ◽

pp. 151-159 ◽

Cited By ~ 21

Author(s):

Daniel R Murphy ◽

Ashley ND Meyer ◽

Dean F Sittig ◽

Derek W Meeks ◽

Eric J Thomas ◽

...

Keyword(s):

Adverse Event ◽

Patient Safety ◽

High Risk ◽

Health Systems ◽

Language Processing ◽

Diagnostic Errors ◽

Diagnostic Process ◽

Future Research ◽

Implementation Challenges ◽

Preventable Harm

Progress in reducing diagnostic errors remains slow partly due to poorly defined methods to identify errors, high-risk situations, and adverse events. Electronic trigger (e-trigger) tools, which mine vast amounts of patient data to identify signals indicative of a likely error or adverse event, offer a promising method to efficiently identify errors. The increasing amounts of longitudinal electronic data and maturing data warehousing techniques and infrastructure offer an unprecedented opportunity to implement new types of e-trigger tools that use algorithms to identify risks and events related to the diagnostic process. We present a knowledge discovery framework, the Safer Dx Trigger Tools Framework, that enables health systems to develop and implement e-trigger tools to identify and measure diagnostic errors using comprehensive electronic health record (EHR) data. Safer Dx e-trigger tools detect potential diagnostic events, allowing health systems to monitor event rates, study contributory factors and identify targets for improving diagnostic safety. In addition to promoting organisational learning, some e-triggers can monitor data prospectively and help identify patients at high-risk for a future adverse event, enabling clinicians, patients or safety personnel to take preventive actions proactively. Successful application of electronic algorithms requires health systems to invest in clinical informaticists, information technology professionals, patient safety professionals and clinicians, all of who work closely together to overcome development and implementation challenges. We outline key future research, including advances in natural language processing and machine learning, needed to improve effectiveness of e-triggers. Integrating diagnostic safety e-triggers in institutional patient safety strategies can accelerate progress in reducing preventable harm from diagnostic errors.

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Evaluation of the adverse event profile and pharmacodynamics of toceranib phosphate administered to dogs with solid tumors at doses below the maximum tolerated dose

BMC Veterinary Research ◽

10.1186/1746-6148-9-190 ◽

2013 ◽

Vol 9 (1) ◽

pp. 190 ◽

Cited By ~ 43

Author(s):

Luis Bernabe ◽

Roberta Portela ◽

Sandra Nguyen ◽

William C Kisseberth ◽

Michael Pennell ◽

...

Keyword(s):

Adverse Event ◽

Solid Tumors ◽

Maximum Tolerated Dose ◽

Adverse Event Profile

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Abstract 2792: Cardiac Complications After Aneurysmal Subarachnoid Hemorrhage Are Associated With Outcome: A Meta-analysis

Circulation ◽

10.1161/circ.116.suppl_16.ii_620-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Ivo A van der Bilt ◽

Djo Hasan ◽

W. P Vandertop ◽

Arthur A Wilde ◽

Ale Algra ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Prognostic Significance ◽

Delayed Cerebral Ischemia ◽

Myocardial Damage ◽

Future Research ◽

Cardiac Complications ◽

Pathophysiological Mechanism ◽

Cardiac Abnormalities

Cardiac complications after subarachnoid hemorrhage (SAH) occur frequently, but their prognostic significance remains unclear. We performed a meta-analysis to assess whether echocardiographic wall motion abnormalities (WMA), electrocardiographic (ECG) changes, or elevated markers for myocardial damage are related to the occurrence of delayed cerebral ischemia (DCI) or death. Methods All articles that reported on cardiac abnormalities after aneurysmal SAH, that met predefined criteria, and were published between 1960 and 2007 were assessed. Data were extracted on predefined methodological criteria, patient characteristics, prevalence of cardiac abnormalities, and DCI or death. We calculated pooled relative risks (RR) with corresponding 95% confidence intervals (CI) for the separate cardiac abnormalities and outcome. Results We included 25 studies (16 prospective), comprising 2690 patients (mean age 53 years; 35% was male). The figure shows the univariable RRs of the determinants for death. For DCI we found a significant association with WMA (RR 2.10 [CI 1.17, 3.78]); Troponin RR 3.15 [CI 2.27, 4.38]; CK-MB RR: 2.90 [CI 1.86, 4.52]; BNP RR: 4.52 [CI 1.79, 11.39]; and ST depression RR: 2.40 [CI 1.2, 4.9]. No significant associations were found for DCI and ST elevation RR: 2.1 [CI 0.7, 5.7]; T wave abnormality RR: 0.9 [CI 0.5, 1.7]; U wave RR: 0.7 [CI 0.4, 1.3] or prolonged QT RR: 1.0 [CI 0.5, 2.3]. Conclusion Cardiac abnormalities increase the risk of DCI and death after SAH. Future research should be directed towards elucidating the multivariable relationship between the cardiac prognosticators, the pathophysiological mechanism and potential treatment options.

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