scholarly journals Use of non-invasive sensor to assess intracranial compliance in the management of migraine patients: case report

2021 ◽  
Author(s):  
Luiz Gabriel Gonçalves Cherain ◽  
Mateus Gonçalves de Sena Barbosa ◽  
Rafaela Luiza Vilela de Souza ◽  
Rafaela de Souza Paula ◽  
Geovana Ribeiro Campos ◽  
...  
Keyword(s):  
Case Report ◽  
Clinical Decision Making ◽  
Surgical Intervention ◽  
Clinical Decision ◽  
Opening Pressure ◽  
Non Invasive ◽  
Intracranial Compliance ◽  
One Year ◽  
Underlying Diseases

Abstract The objective of this study is to report the use of a non-invasive sensor to assess intracranial compliance (ICC) in patients complaining of migraine. This case report presents a 34-year-old, female patient that was treated for idiopathic intracranial hypertension (IIH) by placing a non-adjustable lumboperitoneal shunt. After one year, she presented with headache and signs of overdrainage. Non-invasive monitoring of ICC was done, suggesting a reduction in the ICC, but no change in the opening pressure of the valve. A diagnosis of migraine was made, with improvement after brain monitoring, leading treatment without any new surgical intervention. With this case, we conclude that the use of non-invasive sensor helped the medical team to understand the information obtained by the ICP curve in the office, and in the management of patients with headache complaints, supporting clinical decision making, improving the quality of care, correlated with underlying diseases and procedural and patient safety.

scholarly journals Application of the proposed flowchart for assessing intracranial compliance with a non-invasive b4c sensor in the management of critical patients

2021 ◽  
Author(s):  
Gustavo Frigieri ◽  
Marina Venancio ◽  
Carlos Bremer ◽  
Elaine Peixoto
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Medical Team ◽  
Rocuronium Bromide ◽  
Non Invasive ◽  
Intracranial Compliance ◽  
Ventilatory Parameters ◽  
Hemodynamic Improvement ◽  
Critical Patients

Introduction: Volume variations that result in increases in intracranial pressure (ICP) are directly associated with a reduction in intracranial compliance (ICC) and its non-invasive monitoring allows changes to be identified early. Objectives: To evaluate the application of an ICC assessment flowchart in a patient with traumatic brain injury (TBI). Methods: This is a case report of the application of the ICC assessment flowchart to a patient with TBI. Results: 40-year-old male patient with TBI, subarachnoid hematoma. The first monitoring showed a curve with an altered ICC, a P2/P1 ratio of 1.2, suggesting a reduction in the ICC, with the presence of Lundberg B waves, and the administration of rocuronium bromide started. After 24 hours, it presented a P2/P1 ratio of 0.88, suggesting adequate ICC, the medical team opted to reduce norepinephrine and sedation. On the following day, the patient was agitated, saturating 86%, blood pressure 113 x 60 mmHg, and a P2/P1 ratio of 1.08, suggesting a reduction in ICC. The clinical team deepened the sedation, resulting in decrease a P2/P1 ratio to 0.73, suggesting a possible risk to low cerebral blood flow, resulting in a new adjustment of sedation and ventilatory parameters, evolving with hemodynamic improvement and a P2/P1 ratio of 0.82, suggesting adequate ICC. Conclusions: The flowchart guided the medical team to use the information of ICP curve by the non-invasive sensor, supporting clinical decision making and improving the quality of the patient care and safety.

scholarly journals A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 221S-230S ◽  
Author(s):  
Michael G. Fehlings ◽  
Allan R. Martin ◽  
Lindsay A. Tetreault ◽  
Bizhan Aarabi ◽  
Paul Anderson ◽  
...  
Keyword(s):  
Decision Making ◽  
Outcome Prediction ◽  
Clinical Decision Making ◽  
Surgical Intervention ◽  
Clinical Decision ◽  
Clinical Expertise ◽  
Resonance Imaging ◽  
Cord Injury

Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.

scholarly journals Warning systems in a computerized nursing process for Intensive Care Units

2014 ◽  
Vol 48 (1) ◽  
pp. 125-132 ◽  
Author(s):  
Daniela Couto Carvalho Barra ◽  
Grace Teresinha Marcon Dal Sasso ◽  
Camila Rosália Antunes Baccin
Keyword(s):  
Patient Safety ◽  
Intensive Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Research ◽  
Pelvic Surgery ◽  
Warning Systems ◽  
Nursing Process ◽  
Promote Patient Safety

A hybrid study combining technological production and methodological research aiming to establish associations between the data and information that are part of a Computerized Nursing Process according to the ICNP® Version 1.0, indicators of patient safety and quality of care. Based on the guidelines of the Agency for Healthcare Research and Quality and the American Association of Critical Care Nurses for the expansion of warning systems, five warning systems were developed: potential for iatrogenic pneumothorax, potential for care-related infections, potential for suture dehiscence in patients after abdominal or pelvic surgery, potential for loss of vascular access, and potential for endotracheal extubation. The warning systems are a continuous computerized resource of essential situations that promote patient safety and enable the construction of a way to stimulate clinical reasoning and support clinical decision making of nurses in intensive care.

scholarly journals Opioid Analgesia: Perspectives on Right Use and Utility

2007 ◽  
Vol 3;10 (5;3) ◽  
pp. 479-491 ◽  
Author(s):  
Jane C. Ballantyne
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Side Effects ◽  
Clinical Decision Making ◽  
Analgesic Efficacy ◽  
Clinical Decision ◽  
Opioid Analgesia ◽  
Opioid Treatment

The ability of opioids to effectively and safely control acute and cancer pain has been one of several arguments used to support extending opioid treatment to patients with chronic pain, against a backdrop of considerable caution that has been based upon fears of addiction. Of course, opioids may cause addiction, but the “principle of balance” may justify that “…efforts to address abuse should not interfere with legitimate medical practice and patient care.” Yet, situations are increasingly encountered in which opioid-maintained patients are refractory to analgesia during periods of pain, or even during the course of chronic treatment. The real question is whether analgesic efficacy of opioids can be maintained over time. Overall, the evidence supporting long-term analgesic efficacy is weak. The putative mechanisms for failed opioid analgesia may be related to tolerance or opioid-induced hyperalgesia. Advances in basic sciences may help in understanding these phenomena, but the question of whether long-term opioid treatment can improve patients’ function or quality of life remains a broader issue. Opioid side effects are well known, but with chronic use, most (except constipation) subside. Still, side effects can negatively affect the outcomes and continuity of therapy. This paper addresses 1) what evidence supports the long-term utility of opioids for chronic pain; 2) how side effects may alter quality of life; 3) the nature of addiction and why it is different in pain patients, and 4) on what grounds could pain medication be denied? These questions are discussed in light of patients’ rights, and warrant balancing particular responsibilities with risks. These are framed within the Hippocratic tradition of “producing good for the patient and protecting from harm,” so as to enable 1) more informed clinical decision making, and 2) progress towards right use and utility of opioid treatment for chronic pain. Key Words: Opioids, chronic pain, addiction, side effects, utility, ethics

Beyond the Development of Health-Related Quality-of-Life (HRQOL) Measures: A Checklist for Evaluating HRQOL Outcomes in Cancer Clinical Trials—Does HRQOL Evaluation in Prostate Cancer Research Inform Clinical Decision Making?

2003 ◽  
Vol 21 (18) ◽  
pp. 3502-3511 ◽  
Author(s):  
Fabio Efficace ◽  
Andrew Bottomley ◽  
David Osoba ◽  
Carolyn Gotay ◽  
Henning Flechtner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cancer Clinical Trials ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Purpose: The aim of this study was to evaluate whether the inclusion of health-related quality of life (HRQOL), as a part of the trial design in a randomized controlled trial (RCT) setting, has supported clinical decision making for the planning of future medical treatments in prostate cancer. Materials and Methods: A minimum standard checklist for evaluating HRQOL outcomes in cancer clinical trials was devised to assess the quality of the HRQOL reporting and to classify the studies on the grounds of their robustness. It comprises 11 key HRQOL issues grouped into four broader sections: conceptual, measurement, methodology, and interpretation. Relevant studies were identified in a number of databases, including MEDLINE and the Cochrane Controlled Trials Register. Both their HRQOL and traditional clinical reported outcomes were systematically analyzed to evaluate their consistency and their relevance for supporting clinical decision making. Results: Although 54% of the identified studies did not show any differences in traditional clinical end points between treatment arms and 17% showed a difference in overall survival, 74% of the studies showed some difference in terms of HRQOL outcomes. One third of the RCTs provided a comprehensive picture of the whole treatment including HRQOL outcomes to support their conclusions. Conclusion: A minimum set of criteria for assessing the reported outcomes in cancer clinical trials is necessary to make informed decisions in clinical practice. Using a checklist developed for this study, it was found that HRQOL is a valuable source of information in RCTs of treatment in metastatic prostate cancer.

scholarly journals Quality of life of elderly patients with solid tumours undergoing adjuvant cancer therapy: a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e018101 ◽  
Author(s):  
Karis Kin-Fong Cheng ◽  
Ethel Yee-Ting Lim ◽  
Ravindran Kanesvaran
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Elderly Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Risk Of Bias ◽  
Solid Tumours

ObjectivesThe measurement of quality of life (QoL) in elderly cancer population is increasingly being recognised as an important element of clinical decision-making and the evaluation of treatment outcome. This systematic review aimed to summarise the evidence of QoL during and after adjuvant therapy in elderly patients with cancer.MethodsA systematic search was conducted of studies published in CINAHL plus, CENTRAL, PubMed, PsycINFO and Web of Science from the inception of these databases to December 2016. Eligible studies included RCTs and non-RCTs in which QoL was measured in elderly patients (aged 65 years or above) with stage I–III solid tumours who were undergoing adjuvant chemotherapy and/or radiotherapy. Because of the heterogeneity and the insufficient data among the included studies, the results were synthesised narratively.ResultsWe included 4 RCTs and 14 non-RCTs on 1785 participants. In all four RCTs, the risk of bias was low or unclear for most items but high for detection. Of the 14 non-RCTs, 5 studies were judged to have a low or moderate risk of bias for all domains, and the other 9 studies had a serious risk of bias in at least one domain. The bias was observed mainly in the confounding and in the selection of participants for the study. For most elderly patients with breast cancer, the non-significant negative change in the QoL was transient. A significant increase in the QoL during the course of temozolomide in elderly patients with glioblastoma but a decreasing trend in QoL after radiotherapy was shown. This review also shows a uniform trend of stable or improved QoL during adjuvant therapy and at follow-up evaluations across the studies with prostate, colon or cervical cancer population.ConclusionsThis review suggests that adjuvant chemotherapy and radiotherapy may not have detrimental effects on QoL in most elderly patients with solid tumours.

The Use of Artificial Intelligence Systems for Support of Medical Decision-Making

2011 ◽  
pp. 1017-1029
Author(s):  
William Claster ◽  
Nader Ghotbi ◽  
Subana Shanmuganathan
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Statistical Analysis ◽  
Medical Records ◽  
Clinical Decision Making ◽  
Ct Scanning ◽  
Clinical Decision ◽  
Radiology Department ◽  
Self Organizing Map ◽  
One Year

There is a treasure trove of hidden information in the textual and narrative data of medical records that can be deciphered by text-mining techniques. The information provided by these methods can provide a basis for medical artificial intelligence and help support or improve clinical decision making by medical doctors. In this paper we extend previous work in an effort to extract meaningful information from free text medical records. We discuss a methodology for the analysis of medical records using some statistical analysis and the Kohonen Self-Organizing Map (SOM). The medical data derive from about 700 pediatric patients’ radiology department records where CT (Computed Tomography) scanning was used as part of a diagnostic exploration. The patients underwent CT scanning (single and multiple) throughout a one-year period in 2004 at the Nagasaki University Medical Hospital. Our approach led to a model based on SOM clusters and statistical analysis which may suggest a strategy for limiting CT scan requests. This is important because radiation at levels ordinarily used for CT scanning may pose significant health risks especially to children.

Myocarditis

2018 ◽  
pp. 290-308
Author(s):  
Vanessa M Ferreira ◽  
Juliano L Fernandes ◽  
Cristina Basso ◽  
Matthias G Friedrich
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Myocardial Inflammation ◽  
Aged Patients ◽  
Non Invasive ◽  
Quantitative Mapping ◽  
Patients With Heart Failure ◽  
High Prevalence ◽  
Mapping Techniques

Myocarditis has a high prevalence, especially in young and middle-aged patients. It is the most important differential diagnosis in patients with acute cardiac disease and evidence for cellular injury (positive troponin). In clinical decision-making, it is important to rule in or rule out myocardial inflammation. While endomyocardial biopsy, which remains the gold standard to achieve an aetiopathogenetic diagnosis, can be helpful in patients with heart failure, it is less used in the majority of cases. Cardiovascular magnetic resonance (CMR) imaging has become the most efficient non-invasive diagnostic tool for patients with suspected myocarditis. Its unique value is based on the ability to identify inflammation and myocardial injury, in combination with an accurate assessment of ventricular volumes, as well as regional and global function. In many centres, myocarditis is the most frequent indication for CMR. The diagnostic criteria include markers for myocardial oedema, hyperaemia, and necrosis, while regional or global dysfunction and pericardial effusion serve as supportive criteria. Novel markers, such as quantitative mapping techniques, may allow for even better identification and classification of myocarditis.

scholarly journals A Re-assessment of the Safety and Efficacy of Interleukin-2 for the Treatment of Renal Cell Carcinoma

2009 ◽  
Vol 1 ◽  
pp. CMT.S2037 ◽  
Author(s):  
Anthony Jarkowski ◽  
Michael K.K. Wong
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clinical Decision Making ◽  
Interleukin 2 ◽  
Clinical Decision ◽  
High Dose ◽  
Perceived Morbidity

Interleukin-2 (IL-2) can provide long term durable remissions for patients with advanced or metastatic renal cell carcinoma. The perceived morbidity and the difficulties in delivering this treatment hampered its widespread use in these patients. This review aims to place IL-2 in the modern milieu by reviewing the pharmacology, efficacy and toxicity of this drug. These will be contrasted and compared with the new targeted-agents. The methodology of providing high dose IL-2 treatment, follow-up care and its impact on patient quality of life will be discussed. Importantly, the ability of these agents to provide durable, complete remissions for RCC patients will be placed in context. The goal is to provide the perspective and framework for the reader to balance the important attributes of each of these drugs during the clinical decision making process.

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