Measuring Consciousness in the Clinic

2020 ◽  
pp. 66-77
Author(s):  
Nithin Nagaraj
Keyword(s):  
Clinical Applications ◽  
Clinical Scenario ◽  
Hard Problem ◽  
Life Saving

We don't doubt for a moment that we are conscious, but what is ‘Consciousness'? Understanding consciousness, its nature, and characteristics has remained a hard problem for several centuries. While philosophers, neuroscientists, physicists, psychologists, and psychiatrists grapple with this hard problem, clinicians are in need of a practical way to ‘measure' consciousness (or its surrogate). Determining whether a patient is conscious or not, and measuring the degree of consciousness, could be critical and potentially life-saving in a clinical scenario. In this chapter, we will review recent scientific approaches for modelling and measuring consciousness, and their clinical applications with an emphasis on a host of issues (theoretical, philosophical, methodological, technological, & clinical) and challenges that need to be satisfactorily and convincingly addressed going forward.

scholarly journals Pancreatic Fibrosis and Chronic Pancreatitis: Mini-Review of Non-Histologic Diagnosis for Clinical Applications

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 87 ◽  
Author(s):  
Chung-Tsui Huang ◽  
Cheng-Kuan Lin ◽  
Tzong-Hsi Lee ◽  
Yao-Jen Liang
Keyword(s):  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Acoustic Radiation ◽  
Clinical Applications ◽  
Acoustic Radiation Force Impulse ◽  
Pancreatic Fibrosis ◽  
Pancreatic Tumors ◽  
Clinical Scenario ◽  
Histologic Diagnosis ◽  
Selection Of

Pancreatic fibrosis is the dominant reversible pathological change and diagnostic factor in early chronic pancreatitis, defined by a mechanistic approach proposed in 2016. Main guidelines for chronic pancreatitis were published by the American Pancreas Association in 2014, the Japanese Society of Gastroenterology in 2015, and United European Gastroenterology in 2017. All three sets of guidelines mentioned that the staging of chronic pancreatitis is important but challenging. There are various image modalities for the non-histologic diagnosis of pancreatic fibrosis: (1) shear wave elastography, such as an acoustic radiation force impulse with a cut-off value of 1.4 m/s; (2) strain elastography using grades of strain; (3) endoscopic ultrasonography using the Rosemont criteria or endoscopic ultrasound criteria for early chronic pancreatitis proposed by the Japan Pancreas Society; (4) computed tomography using the Hounsfield scale or number of micro-calcifications; and (5) magnetic resonance imaging using the apparent diffusion coefficient and the T1w flash and T2w HASTE sequences. The clinical applications are to (1) evaluate pancreatic tumors and inflammatory disease; (2) monitor dyspepsia with early chronic pancreatitis; (3) monitor individuals with a high risk of pancreatic cancer; (4) analyze a fatty pancreas with fibrosis; (5) predict a fistula after pancreatic surgery; and (6) predict outcomes for chronic pancreatitis or pancreatic cancer. The selection of tools will be dependent on the clinical scenario. Conclusion: There are various modalities for the non-histologic diagnosis of pancreatic fibrosis. The selection of the optimal device will be dependent on the clinical scenario.

Clinical Applications of Therapeutic Hemapheresis

1996 ◽  
Vol 11 (3) ◽  
pp. 149-161 ◽  
Author(s):  
Sarah Rososhansky ◽  
Irma O. Szymanski
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Clinical Applications ◽  
Goodpasture's Syndrome ◽  
Thrombocytopenic Purpura ◽  
Technical Aspects ◽  
Prompt Treatment ◽  
Life Saving

Therapeutic hemapheresis may be a life-saving treatment for patients with some diseases, such as thrombotic thrombocytopenic purpura (TTF), Goodpasture's syndrome, and leukemia-induced leukocytosis, among others. Although plasma exchange has been applied for treatment of many conditions, during the last decade a consensus has been reached about the specific but limited number of diseases for which it is of definitive benefit. Some patients are severely ill during the course of the disease, and they require prompt treatment in the intensive care unit. Therapy of these patients is discussed in this review in detail, in addition to technical aspects, indications, contraindications, and complications of therapeutic hemapheresis.

Endovascular Treatment of Tracheoinnominate Artery Fistula: A Case Report

2007 ◽  
Vol 41 (3) ◽  
pp. 258-261 ◽  
Author(s):  
Eugene Palchik ◽  
Andrew M. Bakken ◽  
Nael Saad ◽  
Wael A. E. Saad ◽  
Mark G. Davies
Keyword(s):  
Case Report ◽  
Liver Transplant ◽  
Endovascular Repair ◽  
Open Surgery ◽  
Transplant Patient ◽  
Surgical Intervention ◽  
Clinical Scenario ◽  
Liver Transplant Patient ◽  
Life Saving ◽  
Definitive Solution

Tracheoinnominate fistula is a rare but lethal condition that requires emergent surgical intervention to prevent ensuing exsanguinating hemorrhage. In clinical situations where the risk of open surgery is prohibitively high, endovascular repair may provide a life-saving alternative to control hemorrhage and serve as a temporizing or definitive solution based on a given clinical scenario. The authors report successful endovascular repair of the bleeding tracheoinnominate fistula with a stent in a liver transplant patient with high comorbidities and review the current literature.

scholarly journals Emergency percutaneous tracheostomy in two cancer patients with difficult airway: An alternative to cricothyroidotomy?

2012 ◽  
Vol 01 (02) ◽  
pp. 90-92 ◽  
Author(s):  
Prashant Nasa ◽  
Akhilesh Singh ◽  
Deven Juneja ◽  
Nitin Garg ◽  
Omender Singh ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Difficult Airway ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Percutaneous Tracheostomy ◽  
Mouth Opening ◽  
Clinical Scenario ◽  
Life Saving ◽  
Neck Anatomy

AbstractInability to intubate and/or ventilate either due to distorted neck anatomy or restricted mouth opening is uncommon but potentially hazardous clinical scenario in head and neck cancer patients. Emergency cricothyroidotomy in such patients may provide a means of oxygenating the patient, but in practice has limitations and does not establish a definitive airway. We report 2 cases who had distorted face and neck anatomy in which percutaneous tracheostomy was done as an emergency life-saving procedure when other measures to obtain a definitive airway failed.

Specimen Preparation for Clinical Applications of X-Ray Microanalysis

1990 ◽  
Vol 48 (2) ◽  
pp. 328-329
Author(s):  
J.D. Shelburne ◽  
G.M. Roomans
Keyword(s):  
Carbon Coating ◽  
Clinical Applications ◽  
Point Of View ◽  
Practical Significance ◽  
Sweat Test ◽  
Specimen Preparation ◽  
Tissue Preparation ◽  
X Ray ◽  
Gallbladder Stones ◽  
Clinical Problems

Proper preparative procedures are a prerequisite for the validity of the results of x-ray microanalysis of biological tissue. Clinical applications of x-ray microanalysis are often concerned with diagnostic problems and the results may have profound practical significance for the patient. From this point of view it is especially important that specimen preparation for clinical applications is carried out correctly.Some clinical problems require very little tissue preparation. Hair, nails, and kidney and gallbladder stones may be examined and analyzed after carbon coating. High levels of zinc or copper in hair may be indicative of dermatological or systemic diseases. Nail clippings may be analyzed (as an alternative to the more conventional sweat test) to confirm a diagnosis of cystic fibrosis. X-ray microanalysis in combination with scanning electron microscopy has been shown to be the most reliable method for the identification of the components of kidney or gallbladder stones.A quantitatively very important clinical application of x-ray microanalysis is the identification and quantification of asbestos and other exogenous particles in lung.

Reduction of Potassium in Kidney Proximal Tubules to Aid in Electron Probe X-Ray Microanalysis of Calcium

1985 ◽  
Vol 43 ◽  
pp. 474-475
Author(s):  
A. LeFurgey ◽  
P. Ingram ◽  
L.J. Mandel
Keyword(s):  
Smooth Muscle ◽  
Proximal Tubule ◽  
Electron Probe ◽  
Clinical Applications ◽  
Proximal Tubules ◽  
Rabbit Kidney ◽  
Target Cells ◽  
X Ray ◽  
Freeze Dried

For quantitative determination of subcellular Ca distribution by electron probe x-ray microanalysis, decreasing (and/or eliminating) the K content of the cell maximizes the ability to accurately separate the overlapping K Kß and Ca Kα peaks in the x-ray spectra. For example, rubidium has been effectively substituted for potassium in smooth muscle cells, thus giving an improvement in calcium measurements. Ouabain, a cardiac glycoside widely used in experimental and clinical applications, inhibits Na-K ATPase at the cell membrane and thus alters the cytoplasmic ion (Na,K) content of target cells. In epithelial cells primarily involved in active transport, such as the proximal tubule of the rabbit kidney, ouabain rapidly (t1/2= 2 mins) causes a decrease2 in intracellular K, but does not change intracellular total or free Ca for up to 30 mins. In the present study we have taken advantage of this effect of ouabain to determine the mitochondrial and cytoplasmic Ca content in freeze-dried cryosections of kidney proximal tubule by electron probe x-ray microanalysis.

Simple teaching aid with clinical applications

1976 ◽  
Vol 40 (2) ◽  
pp. 106-106
Author(s):  
DL Torney ◽  
HD Espinosa
Keyword(s):  
Clinical Applications ◽  
Teaching Aid

Lexical Comprehension in Young Children With Developmental Delays

1994 ◽  
Vol 3 (1) ◽  
pp. 79-88 ◽  
Author(s):  
Theresa A. Kouri
Keyword(s):  
Young Children ◽  
Developmental Delays ◽  
Normal Development ◽  
Clinical Applications ◽  
Group Status ◽  
Novel Object ◽  
Related Information ◽  
Comprehension Skills ◽  
Lexical Items ◽  
Lexical Concepts

Lexical comprehension skills were examined in 20 young children (aged 28–45 months) with developmental delays (DD) and 20 children (aged 19–34 months) with normal development (ND). Each was assigned to either a story-like script condition or a simple ostensive labeling condition in which the names of three novel object and action items were presented over two experimental sessions. During the experimental sessions, receptive knowledge of the lexical items was assessed through a series of target and generalization probes. Results indicated that all children, irrespective of group status, acquired more lexical concepts in the ostensive labeling condition than in the story narrative condition. Overall, both groups acquired more object than action words, although subjects with ND comprehended more action words than subjects with DD. More target than generalization items were also comprehended by both groups. It is concluded that young children’s comprehension of new lexical concepts is facilitated more by a context in which simple ostensive labels accompany the presentation of specific objects and actions than one in which objects and actions are surrounded by thematic and event-related information. Various clinical applications focusing on the lexical training of young children with DD are discussed.

Responding to Clinicians' Challenges in Working With Geriatric Patients

2011 ◽  
Vol 16 (1) ◽  
pp. 22-29
Author(s):  
Lisa Y. Milliken ◽  
Dawn Ralph ◽  
Sally Jones-McNamara
Keyword(s):  
Health Care ◽  
Geriatric Patients ◽  
Clinical Scenario ◽  
Medical Diagnoses ◽  
Communication Deficits ◽  
Resident Care ◽  
Physical Limitations

Clinicians work with older residents who have not only multiple physical limitations, but cognitive loss, communication deficits, dysphagia, and multiple medical diagnoses. They must work within procedural, regulatory, and reimbursement systems that challenge them to provide optimal resident care. In this article, the authors will discuss some specific challenges brought forth by clinicians in response to a clinical scenario and will provide information and feedback from several health-care consultants.

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