Provision of Sedation and Treatment of Seizures During Neonatal Therapeutic Hypothermia

2020 ◽  
Vol 39 (4) ◽  
pp. 227-235
Author(s):  
Christopher McPherson ◽  
Keliana O'Mara
Keyword(s):  
Therapeutic Hypothermia ◽  
Adverse Outcomes ◽  
High Rate ◽  
Neonatal Seizures ◽  
Long Term Effects ◽  
First Line Therapy ◽  
Pharmacokinetic Properties ◽  
Traditional Therapies ◽  
Interesting Alternative

Hypoxic-ischemic encephalopathy (HIE) produces a high rate of long-term neurodevelopmental disability in survivors. Therapeutic hypothermia dramatically improves the incidence of intact survival, but does not eliminate adverse outcomes. The ideal provision of sedation and treatment of seizures during therapeutic hypothermia represent therapeutic targets requiring optimization in practice. Physiologic stress from therapeutic hypothermia may obviate some of the benefits of this therapy. Morphine is commonly utilized to provide comfort, despite limited empiric evidence supporting safety and efficacy. Dexmedetomidine represents an interesting alternative, with preclinical data suggesting direct efficacy against shivering during induced hypothermia and neuroprotection in the setting of HIE. Pharmacokinetic properties must be considered when utilizing either agent, with safety dependent on conservative dosing and careful monitoring. HIE is the leading cause of neonatal seizures. Traditional therapies, including phenobarbital, fosphenytoin, and benzodiazepines, control seizures in the vast majority of neonates. Concerns about the acute and long-term effects of these agents have led to the exploration of alternative anticonvulsants, including levetiracetam. Unfortunately, levetiracetam is inferior to phenobarbital as first-line therapy for neonatal seizures. Considering both the benefits and risks of traditional anticonvulsant agents, treatment should be limited to the shortest duration indicated, with maintenance therapy reserved for neonates at high risk for recurrent seizures.

scholarly journals A Cohort Study on Long-Term Adverse Effects of Parental Drinking: Background and Study Design

2015 ◽  
Vol 9s2 ◽  
pp. SART.S23329 ◽  
Author(s):  
Ingunn Olea Lund ◽  
Anne Bukten ◽  
Elisabet E. Storvoll ◽  
Inger Synnøve Moan ◽  
Svetlana Skurtveit ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Adverse Outcomes ◽  
Registry Data ◽  
Long Term Effects ◽  
Risk Levels ◽  
General Population Cohort ◽  
Parental Drinking ◽  
The Rich ◽  
Long Term Adverse Effects

Although many studies have addressed adverse outcomes in children of parents with alcohol abuse/dependence, less is known about the possible long-term effects of more normative patterns of parental alcohol consumption, including drinking at lower risk levels and heavy episodic or binge drinking. The extent of harm from parental drinking may therefore be underestimated. With this research proposal, we describe a project that aims to assess possible long-term adverse effects of parental drinking by combining survey and nationwide registry data. Advantages of a longitudinal general population cohort design include that it allows for detailed information on parental drinking through survey data and identification of possible negative long-term health and social outcomes from exposure to parental drinking 1–19 years after exposure through continuously updated nationwide registers. The rich information available from combining survey and registry data allows us to take into account important confounders, mediators, and moderators.

Concordance with National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines (CPGs): A Quality of Care Tool for Newly Diagnosed Patients (pts) with Mantle Cell Lymphoma (MCL).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3328-3328
Author(s):  
Maria Alma Rodriguez ◽  
Anna Ter Veer ◽  
Auayporn Nademanee ◽  
Joyce Niland ◽  
Eva Lepisto ◽  
...  
Keyword(s):  
Standard Dose ◽  
High Rate ◽  
Stage Iii ◽  
Newly Diagnosed ◽  
First Line ◽  
Nccn Guidelines ◽  
First Line Therapy ◽  
Line Therapy

Abstract Introduction: In 1999, the NCCN published its first NHL CPG and in 2000, established the NCCN NHL Outcomes Database Project to monitor patterns of care, CPG concordance and outcomes in participating institutions. We report here on clinical characteristics and CPG concordance among newly diagnosed (dx) pts with MCL in the database. Methods: We prospectively collected demographic, staging, and treatment information on consecutive pts with MCL presenting at 5 geographically diverse NCCN institutions (Dana-Farber, Roswell Park, City of Hope, Fox Chase and MD Anderson). We assessed concordance with 2 CPG’s relevant to the concordance impacting the majority of pts: 1) bone marrow biopsy (BMBx) as part of the initial work-up and 2) use of an endorsed first line regimen among pts with stage III/IV disease. CPG concordance was assessed by comparing each pt’s care against the version on the NCCN guideline in effect at the time the pt was diagnosed. Results: Between 7/2000 and 10/2005, we enrolled 132 MC evaluable pts. Median age was 58; 43% had high-intermediate or high risk disease according to the IPI at presentation; 123 (93%) pts presented with stage III/IV disease. The median follow-up was 22.6 months. Overall, 91% of pts underwent a staging BMBx as recommended by the guidelines. Concordance varied by institution, low 78% to high 98%. Among 123 pts with stage III/IV disease, first-line therapy was concordant with CPG recommendations in only 59%. Use of rituximab accounted for 92% of all non-concordance. When the guidelines were modified in 2003 to include rituximab as an option for first-line therapy of MCL, concordance rose from 31% (2000) to 100% (2003–5). Of concordant pts receiving combination chemotherapy, 33% received CHOP-based standard dose therapy and 62% received dose-intense therapy. NCCN guidelines consider all therapy administered as part of a clinical trial to be concordant; trial-directed treatment accounted for 42% of concordant care. Conclusions: Our data suggest that the majority of MCL pts in these centers receive care that is concordant with current standards. In this subgroup of patients, participation in clinical trials occurred at an impressively high rate. However, not all pts undergo BMBx as a routine component of staging as recommended by NCCN guidelines suggesting that this is an area for potential quality improvement. This study also highlights that differences in management exist even within national comprehensive cancer centers. Because long-term follow-up is possible with this database, future studies will assess the initial treatment and guideline concordance on long-term outcomes in this unique group of pts.

The Long-Term Effects of Neonatal Seizures

2009 ◽  
Vol 36 (4) ◽  
pp. 901-914 ◽  
Author(s):  
Gregory L. Holmes
Keyword(s):  
Neonatal Seizures ◽  
Long Term Effects

scholarly journals Current evidence and the emerging role of eltrombopag in severe aplastic anemia

2021 ◽  
Vol 12 ◽  
pp. 204062072199812
Author(s):  
Beatrice Drexler ◽  
Jakob Passweg
Keyword(s):  
Aplastic Anemia ◽  
Clonal Evolution ◽  
Single Agent ◽  
High Rate ◽  
Current Evidence ◽  
Long Term Effects ◽  
Hematopoietic Stem ◽  
High Doses

Acquired aplastic anemia (AA) is characterized by a reduced stem cell reserve. Several preclinical studies have confirmed the beneficial effect of thrombopoietin (TPO) on the expansion and maintenance of hematopoietic stem cells (HSCs). Thus, TPO receptor agonists seem to be an ideal therapeutic agent for AA to augment marrow function. First studies with eltrombopag as a single agent at 150 mg/day showed an overall response rate of 40–50% in patients with refractory severe AA (rSAA). Subsequent studies examined the first-line use of eltrombopag together with horse antithymocyte globulin and cyclosporine, reaching response rates up to 94%. Although used at high doses, known adverse events in the form of skin, gastrointestinal, or hepatic impairment are feasible in AA, however first data show a relatively high rate of clonal evolution in the form of karyotypic aberrations in patients with rAA. Nonetheless, there is a strong rationale that eltrombopag can contribute to restoring hematopoiesis in SAA by stimulating HSCs. Further studies are needed to decide if eltrombopag is clearly superior to current established treatments and to determine optimal treatment duration, dosage, and long-term effects.

The Long-Term Effects of Facial Implants: Preliminary Study

1995 ◽  
Vol 12 (2) ◽  
pp. 133-138
Author(s):  
Alvin I. Glasgold ◽  
Frederick H. Silver
Keyword(s):  
Patient Satisfaction ◽  
Connective Tissue ◽  
Systemic Disease ◽  
Senior Author ◽  
High Rate ◽  
Silicone Implants ◽  
Long Term Effects ◽  
Implant Surgery ◽  
Preliminary Study

The objective was to study the long-term safety and benefits of facial implants. This was a retrospective study of patients undergoing facial implant surgery over a 10-year period. All surgery was performed by the senior author in a hospital or ambulatory facility. Four hundred and eighty-four questionnaires were sent to patients of the senior author who underwent malar or mandibular augmentation with preformed silicone implants during the years 1982 to 1992. Two hundred and seven replies were received. Patient satisfaction rate of 99% was recorded. No serious complications occurred. There were no instances of connective tissue or other related systemic disease in any of our patients following facial implant surgery. Silastic implants in the malar and mandibular areas are safe procedures with a very high rate of patient satisfaction and a very low complication rate. Based on our study and those of others, there does not seem to be a relationship between silicone implants and the development of connective tissue disease.

scholarly journals Effects of technology-based mindfulness training on wellbeing and stress

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tatjana Schauer ◽  
Sarah Diefenbach
Keyword(s):  
Mindfulness Training ◽  
Future Research ◽  
Positive And Negative Affect ◽  
Smartphone Apps ◽  
Long Term Effects ◽  
Single Item ◽  
Indirect Measures ◽  
Design Factors ◽  
Interesting Alternative

More and more people practice mindfulness to reduce stress and improve their wellbeing. In this regards, technology-based interventions such as smartphone apps provide an interesting potential. Our study explores effects on users' perceived wellbeing and stress on the example of the mindfulness-based app My Blossom. Forty-four new users answered four online questionnaires in one-week intervals, containing established multi-item wellbeing and stress scales for as well as single-item direct explicit questions about perceived changes in wellbeing and stress. In combination, these two forms of assessment provided insights to what degree users are conscious of a possible change and whether these perceptions are in parallel to the more indirect measures. Paired t tests show significant improvements in positive and negative affect, mood and stress in both scales and overall ratings after three weeks of mindfulness-training with My Blossom compared to the pre-intervention baseline. These findings suggest mindfulness-training in form of an app as an interesting alternative to mindfulness-trainings under instructions of a physically present trainer and the power to increase wellbeing and decrease stress. Future research should concentrate on the specific mechanisms and possible design factors of app-based mindfulness-trainings (e.g., variety of training offers, degree of guidance, reminder functions) as well as long term effects.

Students with Parents Involved in Substance Abuse or Dependence

2020 ◽  
pp. 181-194
Author(s):  
Celeste M. Malone ◽  
Tierra T. Ellis ◽  
DeLon Isom
Keyword(s):  
Substance Use ◽  
Behavioral Outcomes ◽  
Adverse Outcomes ◽  
Long Term Effects ◽  
Social Emotional ◽  
Wide Range ◽  
Short And Long Term ◽  
Parental Substance Use ◽  
The Individual

Substance use affects more than the individual user; all those who have relationships with the person using are impacted and suffer the consequences of substance use. Parental substance use places children at risk for a wide range of adverse physical, psychological, social-emotional, and behavioral outcomes at all stages of the developmental continuum. However, schools can help mitigate those adverse outcomes by providing children with access to social support and helping them to develop coping skills. This chapter provides an overview of the short- and long-term effects of parental substance use and its impact on youth functioning and provides educators with strategies and resources to support these students and meet their needs.

Long-term effects of ibrutinib on blood pressure in patients with chronic lymphocytic leukemia (CLL).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19009-e19009 ◽  
Author(s):  
Jade Jones ◽  
Binsah George ◽  
Christine B Peterson ◽  
Jan Andreas Burger ◽  
Nitin Jain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Tobacco Use ◽  
Term Treatment ◽  
Lymphocytic Leukemia ◽  
High Rate ◽  
Long Term Effects ◽  
Obstructive Sleep ◽  
Long Term Treatment

e19009 Background: Ibrutinb is approved for treatment of CLL. Hypertension (HTN) has been reported as a side effect of ibrutinib in 1-23% of patients. We previously reported HTN in CLL patients after 6 months of treatment with ibrutinib. In this study we describe the effects of long-term treatment with ibrutinib on blood pressure (BP). Methods: We performed a retrospective study, evaluating 150 CLL patients on ibrutinib-based clinical trials from 2010 to 2015. Patient demographics, co-morbidities, tobacco use, anti-HTN therapy were recorded. BP was evaluated at baseline and sequentially for up to 5 yrs. New onset HTN was defined as systolic BP (SBP) of ≥ 130 mmHg and/or diastolic BP (DBP) ≥ 80 on two separate visits with no prior HTN or anti-HTN therapy. An increase in baseline SBP by ≥10 and/or increase in DBP by ≥10 was considered significant regardless of the absolute BP. Univariate logistic regression analysis was performed to assess relationship of HTN risk factors and new HTN. Results: Patients’ median age was 65 yrs (68% male and 88% white). Median follow-up was 3 yrs. Pre-existing HTN was present in 44% of patients, 40% were on anti-HTN therapy prior to ibrutinib. New HTN developed in 65% of patients without prior diagnosis of HTN; 32 % of patients were started on anti-HTN therapy or received additional anti-HTN therapy. Of the patients who experienced an increase in BP, 33% experienced isolated systolic HTN. Median SBP was 130 at baseline, 132 at 1mo, 137 at 3mo, 135 at 6mo, 139 at 12mo, 138 at 3yrs, 144 at 5yrs (mean increase in SBP: 7.2, P < 0.001). In patients whose SBP was < 130 at baseline the median SBP was 119 at baseline, 122 at 1mo, 134 at 3mo, 130 at 6mo, 134 at 12mo, 135 at 3yrs and 141 at 5yrs (mean increase in SBP: 15.7, p < 0.001). 74% of patients experienced and increase in SBP ≥10. New HTN on ibrutinib was not associated with: tobacco use, obesity, chronic kidney disease or obstructive sleep apnea (p > 0.05). Conclusions: In this study we demonstrated a high rate of new HTN in patients on prolonged ibrutinib treatment. HTN in these patients is persistent, linear and independent of other risk factors. The increase in BP remained despite initiation of anti-HTN therapy. Additional studies are ongoing to define cardiovascular and renal complications associated with HTN in these patients.

scholarly journals Study protocol: The Dutch 20|30 Postmeningitis study: a cross-sectional follow-up of two historical childhood bacterial meningitis cohorts on long-term outcomes

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
O. El Tahir ◽  
R. C. J. de Jonge ◽  
S. Ouburg ◽  
S. A. Morré ◽  
A. M. van Furth
Keyword(s):  
Quality Of Life ◽  
Bacterial Meningitis ◽  
Prediction Models ◽  
Adverse Outcomes ◽  
Long Term Effects ◽  
Long Term Outcomes ◽  
Cross Sectional

Abstract Background Bacterial meningitis (BM) is a serious, life-threatening infectious disease of the central nervous system that often occurs in young children. The most common severe to moderate sequelae following BM are sensorineural hearing loss, neuromotor disabilities and mental retardation, while subtle sequelae include academic and behavioral disabilities. It is largely unknown whether these more subtle sequelae persist into adolescence and adulthood. Therefore, this study will investigate the very long-term effects of childhood BM in later life. Better understanding of long-term effects and early identification of adverse outcomes after BM are essential for more timely interventions. Additionally, certain single nucleotide polymorphisms (SNPs) are associated with disease severity and might predict adverse sequelae. These include SNPs in genes encoding for pathogen recognition and immune response upon infection. Accordingly, a secondary objective of this study is to investigate the role of genetic variation in BM and use any insights to predict short- and long-term outcomes. Methods In the Dutch 20|30 Postmeningitis study, adolescents and young adults (n = 947) from two historical cohorts with a prior episode of BM during childhood will be enrolled into a cross-sectional follow-up investigation using mainly questionnaires that examine executive and behavioral functioning, health-related quality of life, subjective hearing, mood and sleeping disorders, academic performance, and economic self-sufficiency. The results will be compared to normative data by one-sample t-tests. Multivariable regression analysis will be used to assess for any associations with causative pathogens and severity of BM. Participants that complete the questionnaires will be approached to provide a swab for buccal DNA and subsequent sequencing analyses. Logistic regression models will be used to predict sequelae. Discussion The unique follow-up duration of this cohort will enable us to gain insights into the possible very long-term adverse effects of childhood BM and how these might impact on quality of life. The investigation of host genetic factors will contribute to the development of prediction models which will serve as prognostic tools to identify children who are at high risk of adverse outcome after BM. Trial Registration Dutch Trial Register NTR-6891. Retrospectively registered 28 December 2017.

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