WorldWideScience

Sample records for neurocritical care society

  1. The Code of Professional Conduct for the Neurocritical Care Society.

    Science.gov (United States)

    Rubin, Michael; Bonomo, Jordan; Bar, Barak; Collins, Edward; Cruz-Flores, Salvador; Garvin, Rachel; Glickman, Scott; Grossman, Jonah; Henderson, Galen; Lawson, Tom; Mahanes, Dea; McFarlin, Jessica; Monchar, Sarah; Peled, Harry; Szalados, James

    2015-10-01

    Part of the responsibility of a professional society is to establish the expectations for appropriate behavior for its members. Some codes are so essential to a society that the code itself becomes the central document defining the organization and its tenets, as we see with the Hippocratic Oath. In that tradition, we have revised the code of professional conduct for the Neurocritical Care Society into its current version, which emphasizes guidelines for personal behavior, relationships with fellow members, relationships with patients, and our interactions with society as a whole. This will be a living document and updated as the needs of our society change in time.Available online: http://www.neurocriticalcare.org/about-us/bylaws-procedures-and-code-professional-conduct (1) Code of professional conduct (this document) (2) Leadership code of conduct (3) Disciplinary policy.

  2. Pediatric Neurocritical Care

    OpenAIRE

    Murphy, Sarah

    2011-01-01

    Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, n...

  3. The Implementation of Targeted Temperature Management: An Evidence-Based Guideline from the Neurocritical Care Society.

    Science.gov (United States)

    Madden, Lori Kennedy; Hill, Michelle; May, Teresa L; Human, Theresa; Guanci, Mary McKenna; Jacobi, Judith; Moreda, Melissa V; Badjatia, Neeraj

    2017-12-01

    Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges. The Neurocritical Care Society recruited experts in neurocritical care, nursing, and pharmacotherapy to form a writing Committee in 2015. The group generated a set of 16 clinical questions relevant to TTM using the PICO format. With the assistance of a research librarian, the Committee undertook a comprehensive literature search with no back date through November 2016 with additional references up to March 2017. The Committee utilized GRADE methodology to adjudicate the quality of evidence as high, moderate, low, or very low based on their confidence that the estimate of effect approximated the true effect. They generated recommendations regarding the implementation of TTM based on this systematic review only after considering the quality of evidence, relative risks and benefits, patient values and preferences, and resource allocation. This guideline is intended for neurocritical care clinicians who have chosen to use TTM in patient care; it is not meant to provide guidance regarding the clinical indications for TTM itself. While there are areas of TTM practice where clear evidence guides strong recommendations, many of the recommendations are conditional, and must be contextualized to individual patient and system needs.

  4. [Development of neurocritical care].

    Science.gov (United States)

    Piradov, M A; Moroz, V V

    2012-01-01

    In this review we provide the definition, goals and objectives of neurocritical care, evaluation of brief history of its development. Mechanical ventilation, intracranial hypertension, neuromonitoring as underlying basics of neurocritical care approaches are discussed. The main types of pathology and specific methods used in neurocritical care units are discussed. The results of our own research on brain death--the development of national criteria; for Guillain-Barre syndrome--a double decrease in the length of mechanical ventilation and in 2.5 times of the recovery time for independent walking ability; on diphteric polyneuropathy--reduced by 11 times mortality compared with nation-wide indicators of nontraumatic persistent vegetative state--the development of diagnostic and predictive neurophysiologic criteria are demonstrated. Research data of multiple organ disfunction syndrome in severe stroke are described. Further development of neurocritical care is being discussed.

  5. Palliative Care Practice in Neurocritical Care.

    Science.gov (United States)

    Knies, Andrea K; Hwang, David Y

    2016-12-01

    Many neurocritically ill patients and their families have high amounts of palliative care needs. Multiple professional societies relevant to neurocritical care have released consensus statements on meeting palliative care needs in neuroscience intensive care units. In this review, the authors discuss the ongoing debate regarding what model of palliative care delivery is optimal, focus on the process of shared decision making during goals-of-care discussions, and briefly comment on transitions from intensive care to comfort care. Regardless of an institution's model of palliative care practice, every neurocritical care clinician should possess core competencies necessary to provide basic, integrative palliative care for neurocritically ill patients. Given the high proportion of neurocritically ill patients who lack decision-making capacity, communication skills that enable clinicians to facilitate shared decision making with patients' surrogates are of particular relevance, especially when the limitation of life support is in the discussion. High-quality decision aids to assist neurocritical care teams and surrogate decision makers during common goals-of-care discussions may have the potential for further promotion of best palliative care practices. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Neurocritical care update.

    Science.gov (United States)

    Kuroda, Yasuhiro

    2016-01-01

    This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the complicated pathophysiology of the condition. Continuous electroencephalogram monitoring is an essential tool for detecting nonconvulsive status epilepticus in the intensive care unit (ICU). Neurocritical care, including advanced hemodynamic monitoring, is a fundamental approach for delayed cerebral ischemia following subarachnoid hemorrhage. We must be mindful of the high percentage of ICU patients who may develop sepsis-associated brain dysfunction.

  7. Neurocritical care update

    OpenAIRE

    Kuroda, Yasuhiro

    2016-01-01

    This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the c...

  8. Drug Interactions in Neurocritical Care.

    Science.gov (United States)

    Spoelhof, Brian; Farrokh, Salia; Rivera-Lara, Lucia

    2017-10-01

    Drug-drug interactions (DDIs) are common and avoidable complications that are associated with poor patient outcomes. Neurocritical care patients may be at particular risk for DDIs due to alterations in pharmacokinetic profiles and exposure to medications with a high DDI risk. This review describes the principles of DDI pharmacology, common and severe DDIs in Neurocritical care, and recommendations to minimize adverse outcomes. A review of published literature was performed using PubMed by searching for 'Drug Interaction' and several high DDI risk and common neurocritical care medications. Key medication classes included anticoagulants, antimicrobials, antiepileptics, antihypertensives, sedatives, and selective serotonin reuptake inhibitors. Additional literature was also reviewed to determine the risk in neurocritical care and potential therapeutic alternatives. Clinicians should be aware of interactions in this setting, the long-term complications, and therapeutic alternatives.

  9. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine.

    Science.gov (United States)

    Frontera, Jennifer A; Lewin, John J; Rabinstein, Alejandro A; Aisiku, Imo P; Alexandrov, Anne W; Cook, Aaron M; del Zoppo, Gregory J; Kumar, Monisha A; Peerschke, Ellinor I B; Stiefel, Michael F; Teitelbaum, Jeanne S; Wartenberg, Katja E; Zerfoss, Cindy L

    2016-02-01

    The use of antithrombotic agents, including anticoagulants, antiplatelet agents, and thrombolytics has increased over the last decade and is expected to continue to rise. Although antithrombotic-associated intracranial hemorrhage can be devastating, rapid reversal of coagulopathy may help limit hematoma expansion and improve outcomes. The Neurocritical Care Society, in conjunction with the Society of Critical Care Medicine, organized an international, multi-institutional committee with expertise in neurocritical care, neurology, neurosurgery, stroke, hematology, hemato-pathology, emergency medicine, pharmacy, nursing, and guideline development to evaluate the literature and develop an evidence-based practice guideline. Formalized literature searches were conducted, and studies meeting the criteria established by the committee were evaluated. Utilizing the GRADE methodology, the committee developed recommendations for reversal of vitamin K antagonists, direct factor Xa antagonists, direct thrombin inhibitors, unfractionated heparin, low-molecular weight heparin, heparinoids, pentasaccharides, thrombolytics, and antiplatelet agents in the setting of intracranial hemorrhage. This guideline provides timely, evidence-based reversal strategies to assist practitioners in the care of patients with antithrombotic-associated intracranial hemorrhage.

  10. Case Studies in Neurocritical Care.

    Science.gov (United States)

    Sakusic, Amra; Rabinstein, Alejandro A

    2016-08-01

    The practice of neurocritical care encompasses multiple acute neurologic and neurosurgical diseases and requires detailed knowledge of neurology and critical care. This article presents 5 cases that illustrate just some of the conditions encountered in the daily practice of neurocritical care and exemplify some of the common diagnostic, therapeutic, and prognostic challenges facing the neurointensivist. Life-threatening medical complications after severe acute ischemic stroke, seizures and extreme agitation from autoimmune encephalitis, refractory seizures after subdural hemorrhage, neurologic and systemic complications related to aneurysmal subarachnoid hemorrhage, and status epilepticus after cardiac arrest are discussed in this article. Published by Elsevier Inc.

  11. The history of neurocritical care.

    Science.gov (United States)

    Wijdicks, E F M

    2017-01-01

    Critical care medicine came into sharp focus in the second part of the 20th century. The care of acutely ill neurologic patients in the USA may have originated in postoperative neurosurgical units, but for many years patients with neurocritical illness were admitted to intensive care units next to patients with general medical or surgical conditions. Neurologists may have had their first exposure to the complexity of neurocritical care during the poliomyelitis epidemics, but few were interested. Much later, the development of neurocritical care as a legitimate subspecialty was possible as a result of a new cadre of neurologists, with support by departments of neurosurgery and anesthesia, who appreciated their added knowledge and expertise in care of acute neurologic illness. Fellowship programs have matured in the US and training programs in certain European countries. Certification in the USA is possible through the American Academy of Neurology United Council of Neurologic Specialties. Most neurointensivists had a formal neurology training. This chapter is a brief analysis of the development of the specialty critical care neurology and how it gained strength, what it is to be a neurointensivist, what the future of care of these patients may hold, and what it takes for neurointensivists to stay exemplary. This chapter revisits some of the earlier known and previously unknown landmarks in the history of neurocritical care. © 2017 Elsevier B.V. All rights reserved.

  12. Pain Management in Neurocritical Care

    NARCIS (Netherlands)

    Petzold, A.; Girbes, A.R.J.

    2013-01-01

    The core challenge of pain management in neurocritical care is to keep the patient comfortable without masking or overlooking any neurological deterioration. Clearly in patients with a neurological problem there is a conflict of clinical judgement and adequate pain relief. Here we review the

  13. Biomarkers in Neurocritical Care

    OpenAIRE

    Kimberly, W. Taylor

    2011-01-01

    The gold standard for assessing neurological function is the bedside clinical examination. However, in neurocritical patients, the signs and symptoms related to the severity of illness can often be ambiguous. It can be hard to distinguish between a severe but stable disease state and one that is dynamic and in a critical decline. Clinicians and family members alike may struggle with the uncertainty of functional outcome prediction. Intermediate biomarkers of brain injury can assist with ongoi...

  14. Neurocritical Care Education During Residency: Opinions (NEURON) Study.

    Science.gov (United States)

    Lerner, David P; Kim, Jennifer; Izzy, Saef

    2017-02-01

    The American Academy of Neurology (AAN) has established a core curriculum of topics for residency training in neurocritical care. At present there is limited data evaluating neurology residency education within the neurological intensive care unit. This study evaluates learner concerns with the neurological intensive care unit. The Communication Committee and Resident & Fellow Taskforce within the Neurocritical Care Society (NCS) developed an online survey that consisted of 20 selection and free-text based questions. The survey was distributed to NCS members and then to neurology residency program directors. Statistical analysis of neurocritical care exposure were completed with t or Fisher exact test with p-value <0.05 considered significant. A total of 95 individuals from 32 different residency programs (36.5 % response rate) responded to the questionnaire. Most individuals train with neurocritical care attendings, fellows and advanced practitioners and have neurocritical care exposure during multiple years of residency training. 54 % of responders cite improvement in education as a means to improve neurocritical care training. Those that raised concern had no difference in time in the neurocritical care unit (9.4 weeks vs 8.8 weeks), exposure to trained neurointensivists, neurocritical care fellows or advanced providers (p value 0.53, 0.19, 0.83, respectively). There is significant learner concern regarding education within the neurointensive care unit. Although there are educational guidelines and focused neurocritical care educational materials, these alone do not satisfy residents' educational needs. This study demonstrates the need for educational changes, but it does not assess best strategies nor curricular content.

  15. Evidence-Based Neurocritical Care

    OpenAIRE

    Goodman, Diana J.; Kumar, Monisha A.

    2014-01-01

    Neurocritical care is a pioneering subspecialty dedicated to the treatment of patients with life-threatening neurological illnesses, postoperative neurosurgical complications, and neurological manifestations of systemic disease. The care of these patients requires specialized neurological monitoring and specific clinical expertise and has generated a body of literature commensurate with the expansion of the field. This article reviews landmark studies over the last 10 years in the management ...

  16. Decompressive Craniectomy in Neurocritical Care.

    Science.gov (United States)

    Hayman, Erik G; Kurland, David B; Grunwald, Zachary; Urday, Sebastian; Sheth, Kevin N; Simard, J Marc

    2016-12-01

    Neurosurgeons increasingly use decompressive craniectomy (DC) in neurocritical care. In this review, the authors summarize the topic of DC for the neurointensivist. Following a brief overview of the procedure, the major indications for the procedure are described. This includes a review of the literature regarding well-established indications, such as infarction and traumatic brain injury, as well as lesser known indications, including intracerebral hemorrhage, ruptured cerebrovascular malformations, sinus thrombosis, and infection. Complications unique to DC, specifically syndrome of the trephined, hygroma, and hydrocephalus, also are reviewed with a discussion of their management, both in the immediate and the postoperative period. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. [Topical respiratory strategies in neurocritical care].

    Science.gov (United States)

    Nazarenko, M B; Kruglyakov, N M; Semenov, M S; Zabelin, M V; Udalov, Yu D; Samoylov, A S; Popugaev, K A

    2017-01-01

    Management of the respiratory tract and maintenance of adequate gas exchange are the basic goals of critical care. Injury to the nervous system is often accompanied by development of respiratory disorders. On the other hand, changes in the gas composition of arterial blood can cause brain damage. In addition, approaches to the patient with respiratory failure, which are used in general critical care and neurocritical care, may differ. The presented literature review is devoted to modern respiratory strategies used in neurocritical care.

  18. Neurocritical care education during neurology residency

    Science.gov (United States)

    Drogan, O.; Manno, E.; Geocadin, R.G.; Ziai, W.

    2012-01-01

    Objective: Limited information is available regarding the current state of neurocritical care education for neurology residents. The goal of our survey was to assess the need and current state of neurocritical care training for neurology residents. Methods: A survey instrument was developed and, with the support of the American Academy of Neurology, distributed to residency program directors of 132 accredited neurology programs in the United States in 2011. Results: A response rate of 74% (98 of 132) was achieved. A dedicated neuroscience intensive care unit (neuro-ICU) existed in 64%. Fifty-six percent of residency programs offer a dedicated rotation in the neuro-ICU, lasting 4 weeks on average. Where available, the neuro-ICU rotation was required in the vast majority (91%) of programs. Neurology residents' exposure to the fundamental principles of neurocritical care was obtained through a variety of mechanisms. Of program directors, 37% indicated that residents would be interested in performing away rotations in a neuro-ICU. From 2005 to 2010, the number of programs sending at least one resident into a neuro-ICU fellowship increased from 14% to 35%. Conclusions: Despite the expansion of neurocritical care, large proportions of US neurology residents have limited exposure to a neuro-ICU and neurointensivists. Formal training in the principles of neurocritical care may be highly variable. The results of this survey suggest a charge to address the variability of resident education and to develop standardized curricula in neurocritical care for neurology residents. PMID:22573636

  19. Neurocritical Care in Turkey

    OpenAIRE

    Mehmet Akif Topcuoglu; Ayşe Sağduyu Kocaman; Şerefnur Öztürk; Bijen Nazlıel; Hadiye Şirin

    2011-01-01

    Since the last 20 years, entry of neurointensive care units (NICU) has provided a significant increase of survival rate and quality of post-ICU life of the patients with life-threatening neurological and neurosurgical catastrophies. Therefore, NICU has become a fundamental part of contemporary third-level hospitals or reference centers. Because extensiveness of specific examination, monitoring and treatment techniques and methods unique to neurology makes impossible to manage critical neurolo...

  20. Infections in Neurocritical Care.

    Science.gov (United States)

    O'Horo, John C; Sampathkumar, Priya

    2017-12-01

    Neurointensive care (NICU) patients experience complex infectious disease challenges. Central nervous system (CNS) infections are difficult to diagnose and treat, and post-neurosurgical patients are vulnerable to a unique set of healthcare-acquired infections (HAI) in addition to those typical of critically ill patients. The purpose of this review is to summarize the approach to suspected infection in the NICU and discuss management of several infectious syndromes in the NICU setting.

  1. Techniques and strategies in neurocritical care originating from southern Scandinavia

    DEFF Research Database (Denmark)

    Nordström, Carl-Henrik; Nielsen, Troels Halfeld; Jacobsen, Anne

    2013-01-01

    To describe innovations in neurocritical care originating from university hospitals in southern Scandinavia over a period of 50 years.......To describe innovations in neurocritical care originating from university hospitals in southern Scandinavia over a period of 50 years....

  2. Neurocritical care in the treatment of stroke.

    Science.gov (United States)

    Dornbos Iii, David; Powers, Ciaran J; Ding, Yuchuan; Liu, Liping

    2016-06-01

    In this review, we briefly introduce recent developments and updates in neurocritical care in the treatment of stroke, including both ischemic and hemorrhagic stroke. Time to recanalization remains the major rate limiting step in the treatment of acute ischemic stroke as only a minority of patients arrive within a timeframe appropriate for treatment. Whether caring for a patient following ischemic or hemorrhagic stroke, the principle focus of neurocritical care for acute brain catastrophes is the identification and prevention of secondary brain injury. While much advancement is still needed for optimum care of patients suffering from ischemic or hemorrhagic stroke, the field continues to evolve in ways that promote improved patient outcomes.

  3. Management of the Pediatric Neurocritical Care Patient.

    Science.gov (United States)

    Horvat, Christopher M; Mtaweh, Haifa; Bell, Michael J

    2016-12-01

    Pediatric neurocritical care is a growing subspecialty of pediatric intensive care that focuses on the management of acute neurological diseases in children. A brief history of the field of pediatric neurocritical care is provided. Neuromonitoring strategies for children are reviewed. Management of major categories of acute childhood central neurologic diseases are reviewed, including treatment of diseases associated with intracranial hypertension, seizures and status epilepticus, stroke, central nervous system infection and inflammation, and hypoxic-ischemic injury. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. Implementation strategies in pediatric neurocritical care.

    Science.gov (United States)

    Markham, Christopher; Proctor, Enola K; Pineda, Jose A

    2017-06-01

    Brain-directed critical care for children is a relatively new area of subspecialization in pediatric critical care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes. We also provide an overview of the most effective strategies across the field of implementation science that can facilitate deployment of neurocritical care pathways in the pediatric ICU. Implementation strategies can broadly be grouped according to six categories: planning, educating, restructuring, financing, managing quality, and attending to the policy context. Using a combination of these strategies in the last decade, several institutions have improved patient morbidity and mortality. Although much work remains to be done, emerging evidence supports that implementation of evidence-based care pathways for critically ill children with two common neurological diagnoses - status epilepticus and traumatic brain injury - improves outcomes. Pediatric and neonatal neurocritical care programs that support evidence-based care can be effectively structured using appropriately sequenced implementation strategies to improve outcomes across a variety of patient populations and in a variety of healthcare settings.

  5. Blood Pressure Management Controversies in Neurocritical Care.

    Science.gov (United States)

    McNett, Molly; Koren, Jay

    2016-03-01

    Blood pressure (BP) management is essential in neurocritical care settings to ensure adequate cerebral perfusion and prevent secondary brain injury. Despite consensus on the importance of BP monitoring, significant practice variations persist regarding optimal methods for monitoring and treatment of BP values among patients with neurologic injuries. This article provides a summary of research investigating various approaches for BP management in neurocritical care. Evidence-based recommendations, areas for future research, and current technological advancements for BP management are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Multimodal monitoring and neurocritical care bioinformatics.

    Science.gov (United States)

    Hemphill, J Claude; Andrews, Peter; De Georgia, Michael

    2011-07-12

    Neurocritical care bioinformatics is a new field that focuses on the acquisition, storage and analysis of physiological and other data relevant to the bedside care of patients with acute neurological conditions such as traumatic brain injury or stroke. The main focus of neurocritical care for these conditions relates to prevention, detection and management of secondary brain injury, which relies heavily on monitoring of systemic and cerebral parameters (such as blood-pressure level and intracranial pressure). Advanced neuromonitoring tools also exist that enable measurement of brain tissue oxygen tension, cerebral oxygen utilization, and aerobic metabolism. The ability to analyze these advanced data for real-time clinical care, however, remains intuitive and primitive. Advanced statistical and mathematical tools are now being applied to the large volume of clinical physiological data routinely monitored in neurocritical care with the goal of identifying better markers of brain injury and providing clinicians with improved ability to target specific goals in the management of these patients. This Review provides an introduction to the concepts of multimodal monitoring for secondary brain injury in neurocritical care and outlines initial and future approaches using informatics tools for understanding and applying these data to clinical care.

  7. Stress Ulcer Prophylaxis in Neurocritical Care.

    Science.gov (United States)

    Barletta, Jeffrey F; Mangram, Alicia J; Sucher, Joseph F; Zach, Victor

    2017-09-19

    Stress ulcer prophylaxis (SUP) with acid-suppressive drug therapy is widely utilized in critically ill patients following neurologic injury for the prevention of clinically important stress-related gastrointestinal bleeding (CIB). Data supporting SUP, however, largely originates from studies conducted during an era where practices were vastly different than what is considered routine by today's standard. This is particularly true in neurocritical care patients. In fact, the routine provision of SUP has been challenged due to an increasing prevalence of adverse drug events with acid-suppressive therapy and the perception that CIB rates are sparse. This narrative review will discuss current controversies with SUP as they apply to neurocritical care patients. Specifically, the pathophysiology, prevalence, and risk factors for CIB along with the comparative efficacy, safety, and cost-effectiveness of acid-suppressive therapy will be described.

  8. Risk factors for hypoglycaemia in neurocritical care patients

    NARCIS (Netherlands)

    Iersel, F.M. van; Slooter, A.J.; Vroegop, R.; Wolters, A.E.; Tiemessen, C.A.; Rosken, R.H.; Hoeven, J.G. van der; Peelen, L.M.; Hoedemaekers, C.W.E.

    2012-01-01

    PURPOSE: To identify risk factors for hypoglycaemia in neurocritical care patients receiving intensive insulin therapy (IIT). METHODS: We performed a nested case-control study. All first episodes of hypoglycaemia (glucose <80 mg/dL, <4.4 mmol/L) in neurocritical care patients between 1 March

  9. Delivering neurocritical care in resource-challenged environments.

    Science.gov (United States)

    Shrestha, Gentle S; Goffi, Alberto; Aryal, Diptesh

    2016-04-01

    Resource-challenged environments of low and middle-income countries face a significant burden of neurocritical illness. This review attempts to elaborate on the multiple barriers to delivering neurocritical care in these settings and the possible solutions to overcome such barriers. Epidemiology of neurocritical illness appears to have changed over time in low and middle-income countries. In addition to neuro-infection, noncommunicable neurological illnesses like stroke, traumatic brain injury, and traumatic spinal cord injury pose a significant neurocritical burden in resource-limited settings. Many barriers that exist hinder effective delivery of neurocritical care in resource-challenged environments. Very little information exists about the neurocritical care capacity. Research and publications are few. Intensive care unit beds and trained personnel are significantly lacking. Awareness about the risk factors of preventable conditions, including stroke, is lacking. Prehospital care and trauma systems are poorly developed. There should be attempts to leverage neurocritical care in these settings with focus on promoting research, local training, capacity building, preventive measures like vaccination, raising awareness, and developing prehospital care. Considering the disease burden and potentials to improve outcome, attempts should be made to develop neurocritical care in resource-challenged environments. http://links.lww.com/COCC/A11.

  10. Traumatic brain injury: pathophysiology for neurocritical care.

    Science.gov (United States)

    Kinoshita, Kosaku

    2016-01-01

    Severe cases of traumatic brain injury (TBI) require neurocritical care, the goal being to stabilize hemodynamics and systemic oxygenation to prevent secondary brain injury. It is reported that approximately 45 % of dysoxygenation episodes during critical care have both extracranial and intracranial causes, such as intracranial hypertension and brain edema. For this reason, neurocritical care is incomplete if it only focuses on prevention of increased intracranial pressure (ICP) or decreased cerebral perfusion pressure (CPP). Arterial hypotension is a major risk factor for secondary brain injury, but hypertension with a loss of autoregulation response or excess hyperventilation to reduce ICP can also result in a critical condition in the brain and is associated with a poor outcome after TBI. Moreover, brain injury itself stimulates systemic inflammation, leading to increased permeability of the blood-brain barrier, exacerbated by secondary brain injury and resulting in increased ICP. Indeed, systemic inflammatory response syndrome after TBI reflects the extent of tissue damage at onset and predicts further tissue disruption, producing a worsening clinical condition and ultimately a poor outcome. Elevation of blood catecholamine levels after severe brain damage has been reported to contribute to the regulation of the cytokine network, but this phenomenon is a systemic protective response against systemic insults. Catecholamines are directly involved in the regulation of cytokines, and elevated levels appear to influence the immune system during stress. Medical complications are the leading cause of late morbidity and mortality in many types of brain damage. Neurocritical care after severe TBI has therefore been refined to focus not only on secondary brain injury but also on systemic organ damage after excitation of sympathetic nerves following a stress reaction.

  11. Update on Neurocritical Care of Stroke.

    Science.gov (United States)

    Siegel, Jason; Pizzi, Michael A; Brent Peel, J; Alejos, David; Mbabuike, Nnenne; Brown, Benjamin L; Hodge, David; David Freeman, W

    2017-08-01

    This review will highlight the recent advancements in acute ischemic stroke diagnosis and treatment, with special attention to new features and recommendations of stroke care in the neurocritical care unit. New studies suggest that pre-hospital treatment of stroke with mobile stroke units and telestroke technology may lead to earlier stroke therapy with intravenous tissue plasminogen activator (tPA), and recent studies show tPA can be given in previously contraindicated situations. More rapid automated CT perfusion and angiography may demonstrate a vascular penumbra for neuroendovascular intervention. Further, the greatest advance in acute stroke treatment since 2014 is the demonstration that neuroendovascular catheter-based thrombectomy with stent retrievers recanalizing intracranial large vessel occlusion (LVO) improves both recanalization and long-term outcomes in several trials. Hemorrhagic transformation and severe large infarct cerebral edema remain serious post-stroke challenges, with new guidelines describing who and when patients should get medical or surgical intervention. The adage "time is brain" directs the most evidence-based approach for rapid stroke diagnosis for tPA eligible and LVO recanalization using an orchestrated team approach. The neurocritical care unit is the appropriate location to optimize stroke outcomes for the most severely affected stroke patients.

  12. Neurocritical care complications of pregnancy and puerperum.

    Science.gov (United States)

    Frontera, Jennifer A; Ahmed, Wamda

    2014-12-01

    Neurocritical care complications of pregnancy and puerperum such as preeclampsia/eclampsia, hemolysis, elevated liver enzymes, low platelets syndrome, thrombotic thrombocytopenic purpura, seizures, ischemic and hemorrhagic stroke, postpartum angiopathy, cerebral sinus thrombosis, amniotic fluid emboli, choriocarcinoma, and acute fatty liver of pregnancy are rare but can be devastating. These conditions can present a challenge to physicians because pregnancy is a unique physiologic state, most therapeutic options available in the intensive care unit were not studied in pregnant patients, and in many situations, physicians need to deliver care to both the mother and the fetus, simultaneously. Timely recognition and management of critical neurologic complications of pregnancy/puerperum can be life saving for both the mother and fetus. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Mechanical ventilation in neurocritical care patients: a systematic literature review

    NARCIS (Netherlands)

    Borsellino, Beatrice; Schultz, Marcus J.; Gama de Abreu, Marcelo; Robba, Chiara; Bilotta, Federico

    2016-01-01

    Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute

  14. Induced Hypothermia in Neurocritical Care: A Review.

    Science.gov (United States)

    Cook, Courtney J

    2017-02-01

    Induced hypothermia (IH) continues to become a more prevalent treatment modality in neurocritical care. Reducing core temperature has been shown to protect brain tissue during injury and disease. IH has been particularly beneficial in the medical management of refractory intracranial hypertension and malignant cerebral edema. These pathologies are often the result of diffuse cerebral edema after traumatic brain injury, malignant ischemic stroke, or intracerebral hemorrhage. Although there are many benefits to IH, it is not without complications. Chief among these is shivering, which decreases oxygen delivery to brain tissue, increases metabolic demands, and consequently reduces nutrient delivery. This article will review indications for IH administration, methods of providing IH, nursing responsibilities, and identifying and/or managing complications.

  15. Analgesia in Neurocritical Care: An International Survey and Practice Audit.

    Science.gov (United States)

    Zeiler, Frederick A; AlSubaie, Fahd; Zeiler, Kaitlin; Bernard, Francis; Skrobik, Yoanna

    2016-05-01

    To characterize analgesic administration in neurocritical care. ICU pharmacy database analgesic delivery audits from five countries. A 31-question analgesic agent survey was constructed, validated, and e-distributed in four countries. International multicenter neuro-ICU database audit and electronic survey. Six ICUs provided individual, anonymized analgesic delivery data in primary neurological diagnosis patients. Prescriber surveys were disseminated by neurocritical care societies. None. Analgesic delivery data from 173 patients in French, Canadian, American, and Australian and New Zealand ICUs suggest that acetaminophen/paracetamol is the most common first-line analgesic (49.1% of patients); opiates are the "second line" in 31.5% of patients; however, 33% patients received no second agent. In the 2.3% with demyelinating disease, gabapentin was the most likely second analgesic (50.0%). Third-line analgesics were scarce across sites and neuropathologies. Few national or regional differences were found. The analgesic preference rankings noted by the 95 international physicians who completed the survey matched the audits. However, self-reported analgesic prescription rates were much higher than pharmacy records indicate, with self-reported prescribing of both acetaminophen/paracetamol and opiates in 97% of patients and gabapentin in 45% of patients. Third-line analgesic variability appeared to be driven by neuropathology; ibuprofen was preferred for traumatic brain injury, postcraniotomy, and thromboembolic stroke patients, whereas gabapentin/pregabalin were favored in subarachnoid hemorrhage, intracranial hemorrhage, spine, demyelinating disease, and epileptic patients. Opiates and acetaminophen are preferred analgesic agents, and gabapentin is a contextual third choice, in neurocritically ill patients. Other agents are rarely prescribed. The discordance in physician self-reports and objective audits suggest that pain management optimization studies are warranted.

  16. Therapeutic Use of Music and Television in Neurocritical Care: A Practice Survey.

    Science.gov (United States)

    Olson, DaiWai M; Batjer, H Hunt; Zanders, Michael L; Harrison, Kimberly; Suarez, Jose I

    2016-03-01

    Although health care providers often play music via radio, or play television, to calm and soothe patients, limited research is available to guide practice. This study used a 17-item practice survey that was distributed electronically to neurocritical care society members in July 2014. Responses were collated and analyzed using SAS (Version 9.3). There were 118 completed responses, including from 71 attending physicians, 9 resident or fellow physicians, 30 nurses, and 8 affiliate professional members. The majority of respondents sometimes or always play music (65%) and agree that music is therapeutic (70%). However, there was no clear practice pattern regarding when or why music or TV should be used as an intervention in the neurocritical care unit. The use of music and TV is a common intervention in the neurocritical care unit but lacks a strong scientific foundation and is associated with a high practice variance. © The Author(s) 2015.

  17. Nutrition in the neurocritical care unit

    Directory of Open Access Journals (Sweden)

    Swagata Tripathy

    2015-01-01

    Full Text Available The aim of intensive care is to support the physiology of the body till the treatment or the reparative process of the body kicks in to the rescue. Maintaining an adequate nutrition during this period is of vital importance to counteract the catabolic effect of the critical disease process. The guidelines for nutritional care in the neuro intensive care unit (ICU are sparse. This article collates the current evidence and best practice recommendations as applicable to the critically ill patient in the neuro ICU. The use of screening tests to identify patients at a risk of malnutrition and related complications is presently recommended for all patients with an emphasis on early initiation of caloric support. Over-aggressive feeding in an attempt to revert the catabolic effects of critical illness have not proven beneficial, just as the attempts to improve patient outcomes by altering the routes of nutrition administration. Special patient population such as traumatic brain injury, stroke, subarachnoid haemorrhage or spinal cord injury may have varying nutritional requirements; individualised approach in the neurocritical ICU with the help of the intensivist, nutritionist and pharmacology team may be of benefit.

  18. Neurocritical Care in China: Past, Present, and Future.

    Science.gov (United States)

    Huang, Mingwei; Wang, Jian; Ni, Xiaowei; Chen, Gang; Kong, Laifa

    2016-11-01

    Despite the lack of resources and materials, there has been an increasing demand for acute neurologic care owing to the heavy burden of neurocritical illness in most developing countries, including China, where the morbidity and mortality of severe neurologic and neurosurgical disorders remains high. Neurointensive care units did not start appearing in China until the late 1980s. Although great progress has been made over the past 2 decades in the establishment of equipped neurocritical care centers, advancements in medical infrastructure, streamlining of resident training programs, and implementation of multidisciplinary care teams, there remain areas that warrant improvement to care for our growing patient population. Here we review and discuss the history, present state, and future of neurocritical care in the People's Republic of China. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. The State of Neurocritical Care Fellowship Training and Attitudes toward Accreditation and Certification: A Survey of Neurocritical Care Fellowship Program Directors

    Directory of Open Access Journals (Sweden)

    Rajat Dhar

    2017-11-01

    Full Text Available Neurocritical care as a recognized and distinct subspecialty of critical care has grown remarkably since its inception in the 1980s. As of 2016, there were 61 fellowship training programs accredited by the United Council for Neurologic Subspecialties (UCNS in the United States and more than 1,000 UCNS-certified neurointensivists from diverse medical backgrounds. In late 2015, the Program Accreditation, Physician Certification, and Fellowship Training (PACT Committee of the Neurocritical Care Society (NCS was convened to promote and support excellence in the training and certification of neurointensivists. One of the first tasks of the committee was to survey neurocritical care fellowship training program directors to ascertain the current state of fellowship training and attitudes regarding transition to Accreditation Council for Graduate Medical Education (ACGME accreditation of training programs and American Board of Medical Specialties (ABMS certification of physicians. First, the survey revealed significant heterogeneities in the manner of neurocritical care training and a lack of consistency in requirements for fellow procedural competency. Second, although a majority of the 33 respondents indicated that a move toward ACGME accreditation/ABMS certification would facilitate further growth and mainstreaming of training in neurocritical care, many programs do not currently meet administrative requirements and do not receive the level of institutional support that would be needed for such a transition. In summary, the results revealed that there is an opportunity for future harmonization of training standards and that a transition to ACGME accreditation/ABMS certification is preferred. While the results reflect the opinions of more than half of the survey respondents, they represent only a small sample of neurointensivists.

  20. The State of Neurocritical Care Fellowship Training and Attitudes toward Accreditation and Certification: A Survey of Neurocritical Care Fellowship Program Directors.

    Science.gov (United States)

    Dhar, Rajat; Rajajee, Venkatakrishna; Finley Caulfield, Anna; Maas, Matthew B; James, Michael L; Kumar, Avinash Bhargava; Figueroa, Stephen A; McDonagh, David; Ardelt, Agnieszka

    2017-01-01

    Neurocritical care as a recognized and distinct subspecialty of critical care has grown remarkably since its inception in the 1980s. As of 2016, there were 61 fellowship training programs accredited by the United Council for Neurologic Subspecialties (UCNS) in the United States and more than 1,000 UCNS-certified neurointensivists from diverse medical backgrounds. In late 2015, the Program Accreditation, Physician Certification, and Fellowship Training (PACT) Committee of the Neurocritical Care Society (NCS) was convened to promote and support excellence in the training and certification of neurointensivists. One of the first tasks of the committee was to survey neurocritical care fellowship training program directors to ascertain the current state of fellowship training and attitudes regarding transition to Accreditation Council for Graduate Medical Education (ACGME) accreditation of training programs and American Board of Medical Specialties (ABMS) certification of physicians. First, the survey revealed significant heterogeneities in the manner of neurocritical care training and a lack of consistency in requirements for fellow procedural competency. Second, although a majority of the 33 respondents indicated that a move toward ACGME accreditation/ABMS certification would facilitate further growth and mainstreaming of training in neurocritical care, many programs do not currently meet administrative requirements and do not receive the level of institutional support that would be needed for such a transition. In summary, the results revealed that there is an opportunity for future harmonization of training standards and that a transition to ACGME accreditation/ABMS certification is preferred. While the results reflect the opinions of more than half of the survey respondents, they represent only a small sample of neurointensivists.

  1. Monitoring of brain and systemic oxygenation in neurocritical care patients.

    Science.gov (United States)

    Oddo, Mauro; Bösel, Julian

    2014-12-01

    Maintenance of adequate oxygenation is a mainstay of intensive care, however, recommendations on the safety, accuracy, and the potential clinical utility of invasive and non-invasive tools to monitor brain and systemic oxygenation in neurocritical care are lacking. A literature search was conducted for English language articles describing bedside brain and systemic oxygen monitoring in neurocritical care patients from 1980 to August 2013. Imaging techniques e.g., PET are not considered. A total of 281 studies were included, the majority described patients with traumatic brain injury (TBI). All tools for oxygen monitoring are safe. Parenchymal brain oxygen (PbtO2) monitoring is accurate to detect brain hypoxia, and it is recommended to titrate individual targets of cerebral perfusion pressure (CPP), ventilator parameters (PaCO2, PaO2), and transfusion, and to manage intracranial hypertension, in combination with ICP monitoring. SjvO2 is less accurate than PbtO2. Given limited data, NIRS is not recommended at present for adult patients who require neurocritical care. Systemic monitoring of oxygen (PaO2, SaO2, SpO2) and CO2 (PaCO2, end-tidal CO2) is recommended in patients who require neurocritical care.

  2. Neurocritical Care Audit in A Tertiary Institution | Idowu | East and ...

    African Journals Online (AJOL)

    Conclusion: Neurological patients account for most of our ICU admission. Hospitals with ICUs should ensure that they have a proper high dependency unit. We also recommend that appropriate equipments and staff training in the area of neurocritical care be incorporated into existing 'open' ICUs in our environment.

  3. Anemia and red blood cell transfusion in neurocritical care

    Science.gov (United States)

    Kramer, Andreas H; Zygun, David A

    2009-01-01

    Introduction Anemia is one of the most common medical complications to be encountered in critically ill patients. Based on the results of clinical trials, transfusion practices across the world have generally become more restrictive. However, because reduced oxygen delivery contributes to 'secondary' cerebral injury, anemia may not be as well tolerated among neurocritical care patients. Methods The first portion of this paper is a narrative review of the physiologic implications of anemia, hemodilution, and transfusion in the setting of brain-injury and stroke. The second portion is a systematic review to identify studies assessing the association between anemia or the use of red blood cell transfusions and relevant clinical outcomes in various neurocritical care populations. Results There have been no randomized controlled trials that have adequately assessed optimal transfusion thresholds specifically among brain-injured patients. The importance of ischemia and the implications of anemia are not necessarily the same for all neurocritical care conditions. Nevertheless, there exists an extensive body of experimental work, as well as human observational and physiologic studies, which have advanced knowledge in this area and provide some guidance to clinicians. Lower hemoglobin concentrations are consistently associated with worse physiologic parameters and clinical outcomes; however, this relationship may not be altered by more aggressive use of red blood cell transfusions. Conclusions Although hemoglobin concentrations as low as 7 g/dl are well tolerated in most critical care patients, such a severe degree of anemia could be harmful in brain-injured patients. Randomized controlled trials of different transfusion thresholds, specifically in neurocritical care settings, are required. The impact of the duration of blood storage on the neurologic implications of transfusion also requires further investigation. PMID:19519893

  4. Evaluating the use of dexmedetomidine in neurocritical care patients.

    Science.gov (United States)

    Grof, Tina M; Bledsoe, Kathleen A

    2010-06-01

    Dexmedetomidine is a highly selective alpha(2)-adrenoreceptor agonist that produces dose-dependent sedation, anxiolysis, and analgesia without respiratory depression. Dexmedetomidine has been used in critically ill medical, surgical, and pediatric patients, as an adjunct to sedation and/or for treating drug or alcohol withdrawal. Information regarding the dosing and utilization of dexmedetomidine has been derived primarily from studies in critically ill patients in the medical intensive care unit. There has been no study designed specifically to evaluate dexmedetomidine for these therapeutic uses in the neurocritical care population. The primary and secondary objectives were to evaluate the starting dose of dexmedetomidine for neurocritical care patients and to assess the effect on hemodynamic parameters, respectively. This was a prospective, observational study conducted from October 2007 to March 2008. Patients were included if they were admitted to the Neuro-Intensive Care Unit and received dexmedetomidine infusion. Six patients met the criteria for the study. The mean initial dexmedetomidine infusion rate and mean maximum infusion rate were 0.67 +/- 0.2 and 1.3 +/- 0.5 mcg/kg/h, respectively. The mean duration of dexmedetomidine infusion was 66 +/- 10 h. Two patients (33%) experienced a significant change in mean heart rate and systolic blood pressure after starting dexmedetomidine infusion. Neurocritically ill patients may require high doses of dexmedetomidine to achieve desired levels of sedation. The high rates and long duration of dexmedetomidine infusion had a statistically, but not clinically, significant impact on hemodynamic parameters.

  5. Targeted temperature management in neurocritical care: Boon or bust

    Directory of Open Access Journals (Sweden)

    Ashish Bindra

    2016-01-01

    Full Text Available Temperature management in neurocritical care is important and has gained due importance in recent years. Targeted temperature management (TTM includes deliberate reduction of core body temperature to a range of 32–34°C in comatose survivors of cardiac arrest after return of spontaneous circulation and also therapeutic hypothermia (33–35°C in normothermic patients or controlled normothermia (cooling patients to 37°C in hyperthermic patients. This review focuses on the practical aspects of cooling and temperature management in neurocritical care. An electronic search of Google Scholar, MEDLINE (OVID, EMBASE and the Cochrane library was performed. The physiological changes, potential side effects along with significant research and clinical applications in the field of temperature management are main highlights. Currently, the research evidence is available for TTM in adults following cardiac arrest, neonatal hypoxic ischaemic encephalopathy and raised intracranial pressure. Controlled normothermia in neurocritical care population is rapidly gaining popularity. However, data on disease specific therapeutic markers, therapeutic depth and duration and prognostication of this modality are limited. Overall in experienced hands, the technique is safe to execute without the major morbidity and a potential to improve the outcome. Though over the years, clinical applications are unable to consistently demonstrate its benefits, but TTM in neurological insult has become an established and promising concept.

  6. Intersection of prognosis and palliation in neurocritical care.

    Science.gov (United States)

    Rubin, Michael; Bonomo, Jordan; Hemphill, J Claude

    2017-04-01

    Difficult discussions regarding end-of-life care are common in neurocritical care. Because of a patient's neurological impairment, decisions regarding continuing or limiting aggressive care must often be made by patients' families in conjunction with medical providers. This review provides perspective on three major aspects of this circumstance: prognostication, family-physician discussions, and determination of death (specifically as it impacts on organ donation). Numerous studies have now demonstrated that prediction models developed from populations of brain-injured patients may be misleading when applied to individual patients. Early care limitations may lead to the self-fulfilling prophecy of poor outcomes because of care decisions rather than disease course. A shared decision-making approach that emphasizes transmission of information and trust between families and medical providers is ethically appropriate in severely brain-injured patients and as part of the transition to end-of-life palliative care. Standard definitions of death by neurological criteria exist, although worldwide variation and the relationship to organ donation make this complex. End-of-life care in patients with severe brain injuries is common and represents a complex intersection of prognostication, family communication, and decision-making. Skills to optimize this should be emphasized in neurocritical care providers.

  7. Complications of invasive intracranial pressure monitoring devices in neurocritical care.

    Science.gov (United States)

    Tavakoli, Samon; Peitz, Geoffrey; Ares, William; Hafeez, Shaheryar; Grandhi, Ramesh

    2017-11-01

    Intracranial pressure monitoring devices have become the standard of care for the management of patients with pathologies associated with intracranial hypertension. Given the importance of invasive intracranial monitoring devices in the modern neurointensive care setting, gaining a thorough understanding of the potential complications related to device placement-and misplacement-is crucial. The increased prevalence of intracranial pressure monitoring as a management tool for neurosurgical patients has led to the publication of a plethora of papers regarding their indications and complications. The authors aim to provide a concise review of key contemporary articles in the literature concerning important complications with the hope of elucidating practices that improve outcomes for neurocritically ill patients.

  8. Parenchymal brain oxygen monitoring in the neurocritical care unit.

    Science.gov (United States)

    Le Roux, Peter D; Oddo, Mauro

    2013-07-01

    Patients admitted to the neurocritical care unit (NCCU) often have serious conditions that can be associated with high morbidity and mortality. Pharmacologic agents or neuroprotectants have disappointed in the clinical environment. Current NCCU management therefore is directed toward identification, prevention, and treatment of secondary cerebral insults that evolve over time and are known to aggravate outcome. This strategy is based on a variety of monitoring techniques including use of intraparenchymal monitors. This article reviews parenchymal brain oxygen monitors, including the available technologies, practical aspects of use, the physiologic rationale behind their use, and patient management based on brain oxygen. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. S100 B: A new concept in neurocritical care.

    Science.gov (United States)

    Rezaei, Omidvar; Pakdaman, Hossein; Gharehgozli, Kurosh; Simani, Leila; Vahedian-Azimi, Amir; Asaadi, Sina; Sahraei, Zahra; Hajiesmaeili, Mohammadreza

    2017-04-04

    After brain injuries, concentrations of some brain markers such as S100B protein in serum and cerebrospinal fluid (CSF) are correlated with the severity and outcome of brain damage. To perform an updated review of S100B roles in human neurocritical care domain, an electronic literature search was carried among articles published in English prior to March 2017. They were retrieved from PubMed, Scopus, EMBSCO, CINAHL, ISC and the Cochrane Library using keywords including "brain", "neurobiochemical marker", "neurocritical care", and "S100B protein". The integrative review included 48 studies until March 2017. S100B protein can be considered as a marker for blood brain barrier damage. The marker has an important role in the development and recovery of normal central nervous system (CNS) after injury. In addition to extra cerebral sources of S100B, the marker is principally built in the astroglial and Schwann cells. The neurobiochemical marker, S100B, has a pathognomonic role in the diagnosis of a broad spectrum of brain damage including traumatic brain injury (TBI), brain tumor, and stroke. Moreover, a potential predicting role for the neurobiochemical marker has been presumed in the efficiency of brain damage treatment and prognosis. However further animal and human studies are required before widespread routine clinical introduction of S100 protein.

  10. Shared Decision Making in Neurocritical Care.

    Science.gov (United States)

    Khan, Muhammad Waqas; Muehlschlegel, Susanne

    2017-11-01

    Shared decision making is a collaborative decision-making process between health care providers and patients or their surrogates, taking into account the best scientific evidence available while considering the patient's values, goals, and preferences. Decision aids are tools enabling SDM. This article discusses shared decision making in general and in the intensive care unit in particular and facilitators and barriers for the creation and implementation of International Patient Decision Aids Standards Collaboration-compliant decision aids for the intensive care unit and neuro-intensive care unit. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Health indicators in the care for neurocritical patients

    Directory of Open Access Journals (Sweden)

    Elaine Aparecida Silva de Morais

    2014-06-01

    Full Text Available This study aimed to develop indicators to evaluate the care for neurocritical patients. Methodological study for development and validation of indicators of health evaluation, conducted on the Intensive Care Unit of a large hospital. The opinionated validation method was used, where seven experts (five nurses and two doctors participated on the content analysis through operational manual from May to August 2012. The values obtained from the expert judgment were all above 80%, in which the literature reference was above 75%. The results revealed that all the indicators were considered valid as regards the agreement percentage. Therefore, it is possible to establish reliable indicators to evaluate the proposed care and establish the quality of the service. From the theoretical prerequisites, its use will support the control of assistance quality whilst collaborates with designing intervention plans.

  12. Management of infections associated with neurocritical care.

    Science.gov (United States)

    Rivera-Lara, L; Ziai, W; Nyquist, P

    2017-01-01

    The reported incidence of hospital-acquired infections (HAIs) in the neurointensive care unit (NICU) ranges from 20% to 30%. HAIs in US hospitals cost between $28 and $45 billion per year in direct medical costs. These infections are associated with increased length of hospital stay and increased morbidity and mortality. Infection risk is increased in NICU patients due to medication side-effects, catheter and line placement, neurosurgical procedures, and acquired immune suppression secondary to steroid/barbiturate use and brain injury itself. Some of these infections may be preventable but many are not. Their appearance do not always constitute a failure of prevention or physician error. Neurointensivists require indepth knowledge of common nosocomial infections, their diagnosis and treatment, and an approach to evidence-based practices that improve processes of care and reduce HAIs. © 2017 Elsevier B.V. All rights reserved.

  13. Neurocritical care education during neurology residency: AAN survey of US program directors.

    Science.gov (United States)

    Sheth, K N; Drogan, O; Manno, E; Geocadin, R G; Ziai, W

    2012-05-29

    Limited information is available regarding the current state of neurocritical care education for neurology residents. The goal of our survey was to assess the need and current state of neurocritical care training for neurology residents. A survey instrument was developed and, with the support of the American Academy of Neurology, distributed to residency program directors of 132 accredited neurology programs in the United States in 2011. A response rate of 74% (98 of 132) was achieved. A dedicated neuroscience intensive care unit (neuro-ICU) existed in 64%. Fifty-six percent of residency programs offer a dedicated rotation in the neuro-ICU, lasting 4 weeks on average. Where available, the neuro-ICU rotation was required in the vast majority (91%) of programs. Neurology residents' exposure to the fundamental principles of neurocritical care was obtained through a variety of mechanisms. Of program directors, 37% indicated that residents would be interested in performing away rotations in a neuro-ICU. From 2005 to 2010, the number of programs sending at least one resident into a neuro-ICU fellowship increased from 14% to 35%. Despite the expansion of neurocritical care, large proportions of US neurology residents have limited exposure to a neuro-ICU and neurointensivists. Formal training in the principles of neurocritical care may be highly variable. The results of this survey suggest a charge to address the variability of resident education and to develop standardized curricula in neurocritical care for neurology residents.

  14. Neurocritical Care of Acute Subdural Hemorrhage.

    Science.gov (United States)

    Al-Mufti, Fawaz; Mayer, Stephan A

    2017-04-01

    Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary, postoperative critical care is essential to achieve the best possible outcome. Acute SDH complicates approximately 11% of mild to moderate traumatic brain injuries (TBIs) that require hospitalization, and approximately 20% of severe TBIs. Acute SDH usually is related to a clear traumatic event, but in some cases can occur spontaneously. Management of SDH in the setting of TBI typically conforms to the Advanced Trauma Life Support protocol with airway taking priority, and management breathing and circulation occurring in parallel rather than sequence. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Family discussions on life-sustaining interventions in neurocritical care.

    Science.gov (United States)

    Adil, M M; Larriviere, D

    2017-01-01

    Approximately 20% of all deaths in the USA occur in the intensive care unit (ICU) and the majority of ICU deaths involves decision of de-escalation of life-sustaining interventions. Life-sustaining interventions may include intubation and mechanical ventilation, artificial nutrition and hydration, antibiotic treatment, brain surgery, or vasoactive support. Decision making about goals of care can be defined as an end-of-life communication and the decision-making process between a clinician and a patient (or a surrogate decision maker if the patient is incapable) in an institutional setting to establish a plan of care. This process includes deciding whether to use life-sustaining treatments. Therefore, family discussion is a critical element in the decision-making process throughout the patient's stay in the neurocritical care unit. A large part of care in the neurosciences intensive care unit is discussion of proportionality of care. This chapter provides a stepwise approach to hold these conferences and discusses ways to do it effectively. © 2017 Elsevier B.V. All rights reserved.

  16. Informatics in neurocritical care: new ideas for Big Data.

    Science.gov (United States)

    Flechet, Marine; Grandas, Fabian Güiza; Meyfroidt, Geert

    2016-04-01

    Big data is the new hype in business and healthcare. Data storage and processing has become cheap, fast, and easy. Business analysts and scientists are trying to design methods to mine these data for hidden knowledge. Neurocritical care is a field that typically produces large amounts of patient-related data, and these data are increasingly being digitized and stored. This review will try to look beyond the hype, and focus on possible applications in neurointensive care amenable to Big Data research that can potentially improve patient care. The first challenge in Big Data research will be the development of large, multicenter, and high-quality databases. These databases could be used to further investigate recent findings from mathematical models, developed in smaller datasets. Randomized clinical trials and Big Data research are complementary. Big Data research might be used to identify subgroups of patients that could benefit most from a certain intervention, or can be an alternative in areas where randomized clinical trials are not possible. The processing and the analysis of the large amount of patient-related information stored in clinical databases is beyond normal human cognitive ability. Big Data research applications have the potential to discover new medical knowledge, and improve care in the neurointensive care unit.

  17. The potential for bio-mediators and biomarkers in pediatric traumatic brain injury and neurocritical care

    Directory of Open Access Journals (Sweden)

    Patrick M. Kochanek

    2013-04-01

    Full Text Available The use of biomarkers of brain injury in pediatric neurocritical care has been explored for at least 15 years. Two general lines of research on biomarkers in pediatric brain injury have been pursued, 1 studies of bio-mediators in cerebrospinal fluid (CSF of children after traumatic brain injury (TBI to explore the components of the secondary injury cascades in an attempt to identify potential therapeutic targets and 2 studies of the release of structural proteins into the CSF, serum, or urine in order to diagnose, monitor, and/or prognosticate in patients with TBI or other pediatric neurocritical care conditions. Unique age-related differences in brain biology, disease processes, and clinical applications mandate the development and testing of brain injury bio-mediators and biomarkers specifically in pediatric neurocritical care applications. Finally, although much of the early work on biomarkers of brain injury in pediatrics has focused on TBI, new applications are emerging across a wide range of applications specifically for pediatric neurocritical care including abusive head trauma, cardiopulmonary arrest, septic shock, extracorporeal membrane oxygenation, hydrocephalus, and cardiopulmonary bypass. The potential scope of the utility of biomarkers in pediatric neurocritical care is thus also discussed.

  18. Coherent hemodynamics spectroscopy: initial applications in the neurocritical care unit

    Science.gov (United States)

    Tgavalekos, Kristen T.; Sassaroli, Angelo; Cai, Xuemei; Kornbluth, Joshua; Fantini, Sergio

    2017-02-01

    We used coherent hemodynamics spectroscopy (CHS) and near-infrared spectroscopy (NIRS) to measure the absolute cerebral blood flow (CBF) and cerebral autoregulation efficiency of a patient with intraventricular hemorrhage in the neurocritical care unit. Mean arterial pressure oscillations were induced with cyclic thigh cuff inflations at a super-systolic pressure. The oscillations in oxyhemoglobin ([HbO2]) and deoxyhemoglobin ([Hb]) cerebral concentrations were used to compute CHS amplitude and phase spectra that were fit with the frequency-domain equations of our hemodynamic model. From the fitted parameters, we obtained measures of local autoregulation efficiency (cutoff frequency: 0.07 +/- 0.02 Hz) and absolute regional CBF (33 +/- 9 ml/100g/min). We introduce a new approach for computing CHS spectra using coherence criteria and time-varying transfer function analysis. We show that with this approach we can maximize the number of frequency points in the CHS spectra for more effective fitting with our hemodynamic model. Finally, we show how absolute measurements of the cerebral concentrations of [HbO2] and [Hb] at baseline can be used to further enhance the fitting procedure.

  19. Mechanical ventilation in neurocritical care patients: a systematic literature review.

    Science.gov (United States)

    Borsellino, Beatrice; Schultz, Marcus J; Gama de Abreu, Marcelo; Robba, Chiara; Bilotta, Federico

    2016-10-01

    Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute distress respiratory syndrome, has been suggested even on NCC patients. However, PLV can increase intracranial pressure as result of permissive hypercapnia and of high airway pressures during recruitment maneuvers. The aim of this review (PROSPERO registration number: CRD42015027011) is to describe the ventilatory strategies, and in particular PLV, commonly used in NCC patients. We selected a total of 16 clinical studies, searching on PubMed and EMBASE databases, reporting original information on the MV on patients receiving NCC after acute brain injury, published in the last 10 years, in English language. Some of the included studies report data on a limited sample size. Expert commentary: The use of PLV techniques (PEEP, recruitment maneuvers, etc) in NCC patients is controversial. There is a wide variability among different centers in the treatment strategies and respiratory management of NCC patients, and there is the need for shared diagnostics and therapeutic studies, in order to improve the patients' outcome.

  20. Optimizing Medication Outcomes in Neurocritical Care: Focus on Clinical Pharmacology.

    Science.gov (United States)

    Rhoney, Denise H; Morbitzer, Kathryn; Hatton-Kolpek, Jimmi

    2016-12-01

    Drug dosing in neurocritically ill patients presents enormous challenges for clinicians due to the complex pathophysiological alterations. These alterations are dynamic both between and within patients. Unpredictable exposure from standard dosing regimens, which were extrapolated to intensive care unit patients from healthy volunteer studies, may influence medication outcomes. Knowledge of potential alterations in pharmacokinetics/pharmacodynamics in these patients could be applied to maximize the clinical response and minimize adverse effects. Recognizing potential confounding clinical and treatment factors affecting drug response is an important step, but it is not enough. Overcoming absorption and distribution challenges by using specialized formulations and delivery systems is an area of active research. Improved methods for measuring drug concentrations in clinical settings across different matrices are also needed. Even with these advances, defining endogenous mediators signaling drug-target activation is necessary. Identifying biomarkers in disease and changes when a drug has reached its target will be pivotal. This information will improve our understanding of the pharmacogenomic and pharmacokinetic variables affecting pharmacodynamic endpoints across a spectrum of neurologic diseases. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  1. Hyponatremia in the neurocritical care patient: An approach based on current evidence.

    Science.gov (United States)

    Manzanares, W; Aramendi, I; Langlois, P L; Biestro, A

    2015-05-01

    In the neurocritical care setting, hyponatremia is the commonest electrolyte disorder, which is associated with significant morbimortality. Cerebral salt wasting and syndrome of inappropriate antidiuretic hormone have been classically described as the 2 most frequent entities responsible of hyponatremia in neurocritical care patients. Nevertheless, to distinguish between both syndromes is usually difficult and useless as volume status is difficult to be determined, underlying pathophysiological mechanisms are still not fully understood, fluid restriction is usually contraindicated in these patients, and the first option in the therapeutic strategy is always the same: 3% hypertonic saline solution. Therefore, we definitively agree with the current concept of "cerebral salt wasting", which means that whatever is the etiology of hyponatremia, initially in neurocritical care patients the treatment will be the same: hypertonic saline solution. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  2. Aspects on the Physiological and Biochemical Foundations of Neurocritical Care

    Science.gov (United States)

    Nordström, Carl-Henrik; Koskinen, Lars-Owe; Olivecrona, Magnus

    2017-01-01

    Neurocritical care (NCC) is a branch of intensive care medicine characterized by specific physiological and biochemical monitoring techniques necessary for identifying cerebral adverse events and for evaluating specific therapies. Information is primarily obtained from physiological variables related to intracranial pressure (ICP) and cerebral blood flow (CBF) and from physiological and biochemical variables related to cerebral energy metabolism. Non-surgical therapies developed for treating increased ICP are based on knowledge regarding transport of water across the intact and injured blood–brain barrier (BBB) and the regulation of CBF. Brain volume is strictly controlled as the BBB permeability to crystalloids is very low restricting net transport of water across the capillary wall. Cerebral pressure autoregulation prevents changes in intracranial blood volume and intracapillary hydrostatic pressure at variations in arterial blood pressure. Information regarding cerebral oxidative metabolism is obtained from measurements of brain tissue oxygen tension (PbtO2) and biochemical data obtained from intracerebral microdialysis. As interstitial lactate/pyruvate (LP) ratio instantaneously reflects shifts in intracellular cytoplasmatic redox state, it is an important indicator of compromised cerebral oxidative metabolism. The combined information obtained from PbtO2, LP ratio, and the pattern of biochemical variables reveals whether impaired oxidative metabolism is due to insufficient perfusion (ischemia) or mitochondrial dysfunction. Intracerebral microdialysis and PbtO2 give information from a very small volume of tissue. Accordingly, clinical interpretation of the data must be based on information of the probe location in relation to focal brain damage. Attempts to evaluate global cerebral energy state from microdialysis of intraventricular fluid and from the LP ratio of the draining venous blood have recently been presented. To be of clinical relevance, the

  3. Potential brain dead organ donation in neurocritical care mortality.

    Science.gov (United States)

    Spatenkova, Vera; Bradac, Ondrej; Suchomel, Petr

    2017-05-11

    Mortality is a marker of quality in neurocritical care, but it also provides potential for donors after brain death (DBD) following irreversible acute brain damage. The aim of this study was to analyse the neurointensive care unit (NICU) mortality rate and recovery of potential DBD. We performed a 10-year prospective observational cohort computer database analysis of 6138 acute neurological and neurosurgical patients (pts, 58.2% male, mean: age 55.9±14.7 years, body weight 78.3±15.6 kg, body mass index 26.9±4.7, NICU stay 3.8±5.3 days): 3462 (56.4%) pts with brain disease (mostly stroke 43.2%, tumour 31.1%, trauma 13.6%); 10.3% pts with internal carotid artery (ICA) stenosis; 32.6% pts with spine diseases, and others. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission was 10.63±5.2 and Glasgow Coma Scale on admission was 13.79±2.51. There were 159 (2.6%) cases of mortality with a significantly higher mortality rate in pts with brain diseases (95.6% of deceased pts, p<0.001) than in ICA stenosis (0.6%), spine (1.9%) and from others (1.9%). There were 23 (14.5%) pts with clinical signs of brain death, of whom 13 (56.5%) became donors. The main reasons for non-recovery of potential donors were hemodynamic instability (16.7%) and family reluctance (12.5%). The study showed that our NICU mortality was 2.6%. There were relatively few clinical signs of brain death and not all potential donors were recovered.

  4. Aspects on the Physiological and Biochemical Foundations of Neurocritical Care

    Directory of Open Access Journals (Sweden)

    Carl-Henrik Nordström

    2017-06-01

    Full Text Available Neurocritical care (NCC is a branch of intensive care medicine characterized by specific physiological and biochemical monitoring techniques necessary for identifying cerebral adverse events and for evaluating specific therapies. Information is primarily obtained from physiological variables related to intracranial pressure (ICP and cerebral blood flow (CBF and from physiological and biochemical variables related to cerebral energy metabolism. Non-surgical therapies developed for treating increased ICP are based on knowledge regarding transport of water across the intact and injured blood–brain barrier (BBB and the regulation of CBF. Brain volume is strictly controlled as the BBB permeability to crystalloids is very low restricting net transport of water across the capillary wall. Cerebral pressure autoregulation prevents changes in intracranial blood volume and intracapillary hydrostatic pressure at variations in arterial blood pressure. Information regarding cerebral oxidative metabolism is obtained from measurements of brain tissue oxygen tension (PbtO2 and biochemical data obtained from intracerebral microdialysis. As interstitial lactate/pyruvate (LP ratio instantaneously reflects shifts in intracellular cytoplasmatic redox state, it is an important indicator of compromised cerebral oxidative metabolism. The combined information obtained from PbtO2, LP ratio, and the pattern of biochemical variables reveals whether impaired oxidative metabolism is due to insufficient perfusion (ischemia or mitochondrial dysfunction. Intracerebral microdialysis and PbtO2 give information from a very small volume of tissue. Accordingly, clinical interpretation of the data must be based on information of the probe location in relation to focal brain damage. Attempts to evaluate global cerebral energy state from microdialysis of intraventricular fluid and from the LP ratio of the draining venous blood have recently been presented. To be of clinical relevance

  5. Aspects on the Physiological and Biochemical Foundations of Neurocritical Care.

    Science.gov (United States)

    Nordström, Carl-Henrik; Koskinen, Lars-Owe; Olivecrona, Magnus

    2017-01-01

    Neurocritical care (NCC) is a branch of intensive care medicine characterized by specific physiological and biochemical monitoring techniques necessary for identifying cerebral adverse events and for evaluating specific therapies. Information is primarily obtained from physiological variables related to intracranial pressure (ICP) and cerebral blood flow (CBF) and from physiological and biochemical variables related to cerebral energy metabolism. Non-surgical therapies developed for treating increased ICP are based on knowledge regarding transport of water across the intact and injured blood-brain barrier (BBB) and the regulation of CBF. Brain volume is strictly controlled as the BBB permeability to crystalloids is very low restricting net transport of water across the capillary wall. Cerebral pressure autoregulation prevents changes in intracranial blood volume and intracapillary hydrostatic pressure at variations in arterial blood pressure. Information regarding cerebral oxidative metabolism is obtained from measurements of brain tissue oxygen tension (PbtO2) and biochemical data obtained from intracerebral microdialysis. As interstitial lactate/pyruvate (LP) ratio instantaneously reflects shifts in intracellular cytoplasmatic redox state, it is an important indicator of compromised cerebral oxidative metabolism. The combined information obtained from PbtO2, LP ratio, and the pattern of biochemical variables reveals whether impaired oxidative metabolism is due to insufficient perfusion (ischemia) or mitochondrial dysfunction. Intracerebral microdialysis and PbtO2 give information from a very small volume of tissue. Accordingly, clinical interpretation of the data must be based on information of the probe location in relation to focal brain damage. Attempts to evaluate global cerebral energy state from microdialysis of intraventricular fluid and from the LP ratio of the draining venous blood have recently been presented. To be of clinical relevance, the

  6. Intensive Insulin Therapy Increases the Risk of Hypoglycemia in Neurocritical Care Patients

    NARCIS (Netherlands)

    Tiemessen, Charlotte A. M.; Hoedemaekers, Cornelia W. E.; van Iersel, Freya M.; Rosken, Gerrit H. J.; van der Hoeven, Johannes; Biessels, Geert-Jan; Slooter, Arjen J. C.

    Background: Intensive insulin therapy protocols are widely used in intensive care medicine. A disadvantage of these protocols may be the occurrence of hypoglycemic episodes. Neurocritical care patients are particularly vulnerable to the effects of hypoglycemia. We aimed to study the risk of

  7. Intensive insulin therapy increases the risk of hypoglycemia in neurocritical care patients

    NARCIS (Netherlands)

    Tiemessen, C.A.; Hoedemaekers, C.W.E.; Iersel, F.M. van; Rosken, G.H.; Hoeven, J. van der; Biessels, G.J.; Slooter, A.J.

    2011-01-01

    BACKGROUND: Intensive insulin therapy protocols are widely used in intensive care medicine. A disadvantage of these protocols may be the occurrence of hypoglycemic episodes. Neurocritical care patients are particularly vulnerable to the effects of hypoglycemia. We aimed to study the risk of

  8. Effect of Probiotics on the Incidence of Healthcare-Associated Infections in Mechanically Ventilated Neurocritical Care Patients.

    Science.gov (United States)

    Kenna, John; Mahmoud, Leana; Zullo, Andrew R; Potter, N Stevenson; Fehnel, Corey R; Thompson, Bradford B; Wendell, Linda C

    2016-02-01

    Healthcare-associated infections (HAIs) are seen in 17% of critically ill patients. Probiotics, live nonpathogenic microorganisms, may aid in reducing the incidence of infection in critically ill patients. We hypothesized that administration of probiotics would be safe and reduce the incidence of HAIs among mechanically ventilated neurocritical care patients. We assembled 2 retrospective cohorts of mechanically ventilated neurocritical care patients. In the preintervention cohort from July 1, 2011, to December 31, 2011, probiotics were not used. In the postintervention group from July 1, 2012, to December 31, 2012, 1 g of a combination of Lactobacillus acidophilus and Lactobacillus helveticus was administered twice daily to all patients who were mechanically ventilated for more than 24 hours. There were a total of 167 patients included, 80 patients in the preintervention group and 87 patients in the postintervention group. No patients in the preintervention group received probiotics. Eighty-five (98%) patients in the postintervention group received probiotics for a median of 10 days (interquartile range, 4-20 days). There were 14 (18%) HAIs in the preintervention group and 8 (9%) HAIs in the postintervention group (P = .17). Ventilator days, lengths of stay, in-hospital mortality, and discharge disposition were similar between the pre- and postintervention groups. There were no cases of Lactobacillus bacteremia or other adverse events associated with probiotics use. Probiotics are safe to administer in neurocritical care patients; however, this study failed to demonstrate a significant decrease in HAIs or secondary outcomes associated with probiotics. © 2015 American Society for Parenteral and Enteral Nutrition.

  9. A new strategy in neurocritical care nurse continuing stroke education: A hybrid simulation pilot study.

    Science.gov (United States)

    Newey, Christopher Ryan; Bell, Robert; Burks, Melody; Nattanmai, Premkumar

    2017-05-01

    High-fidelity simulation is frequently utilized in medical education. Its use in the neurosciences is limited by the inherent limitations of the manikin to simulate neurological changes. We report here the use of a hybrid simulation - a combination of lecture and high-fidelity manikin - in the education of neurosciences nurses, involved in care of neurocritical care patients. Neurosciences nurses from at the University of Missouri, Columbia, MO, USA, which is an academic, tertiary-care medical center participated in the simulation during Spring of 2016. The simulation involved a patient presenting with acute intracerebral hemorrhage (ICH) who neurologically deteriorated to brain death. Pre- and post-simulation questionnaires were administered using a questionnaire with five-point Liker scale. Seventy-two responses were returned. The majority had 0-5 years of nursing experience with 83.8% having prior critical care experience. Pre-simulation, the majority of nurses (85.7%) agreed or strongly agreed with managing patients with ICH. When the responses of "agree" were compared to "strongly agree", a significant improvement (p<0.001) in all responses except confidence in speaking with other healthcare providers was found. Nurses reported significant improvement in understanding and managing patients with acute ICH and neurological deterioration after participating in a neurocritical care hybrid simulation. This study shows the benefit of using hybrid simulation in the education of neurocritical care nurses.

  10. Neurocritical Care of Emergent Large-Vessel Occlusion: The Era of a New Standard of Care.

    Science.gov (United States)

    Al-Mufti, Fawaz; Dancour, Elie; Amuluru, Krishna; Prestigiacomo, Charles; Mayer, Stephan A; Connolly, E Sander; Claassen, Jan; Willey, Joshua Z; Meyers, Philip M

    2017-07-01

    Acute ischemic stroke continues to be one of the leading causes of morbidity and mortality worldwide. Recent advances in mechanical thrombectomy techniques combined with prereperfusion computed tomographic angiography for patient selection have revolutionized stroke care in the past year. Peri- and postinterventional neurocritical care of the patient who has had an emergent large-vessel occlusion is likely an equally important contributor to the outcome but has been relatively neglected. Critical periprocedural management issues include streamlining care to speed intervention, blood pressure optimization, reversal of anticoagulation, management of agitation, and selection of anesthetic technique (ie, general vs monitored anesthesia care). Postprocedural critical care issues that might modulate neurological outcome include blood pressure and glucose optimization, avoidance of fever or hyperoxia, fluid and nutritional management, and early integration of rehabilitation into the intensive care unit setting. In this review, we sought to lay down an evidence-based strategy for patients with acute ischemic stroke undergoing emergent endovascular reperfusion.

  11. The role of neurocritical care: a brief report on the survey results of neurosciences and critical care specialists.

    Science.gov (United States)

    Markandaya, Manjunath; Thomas, Katherine P; Jahromi, Babak; Koenig, Mathew; Lockwood, Alan H; Nyquist, Paul A; Mirski, Marek; Geocadin, Romergryko; Ziai, Wendy C

    2012-02-01

    Neurocritical care is a new subspecialty field in medicine that intersects with many of the neuroscience and critical care specialties, and continues to evolve in its scope of practice and practitioners. The objective of this study was to assess the perceived need for and roles of neurocritical care intensivists and neurointensive care units among physicians involved with intensive care and the neurosciences. An online survey of physicians practicing critical care medicine, and neurology was performed during the 2008 Leapfrog initiative to formally recognize neurocritical care training. The survey closed in July 2009 and achieved a 13% response rate (980/7524 physicians surveyed). Survey respondents (mostly from North America) included 362 (41.4%) neurologists, 164 (18.8%) internists, 104 (11.9%) pediatric intensivists, 82 (9.4%) anesthesiologists, and 162 (18.5%) from other specialties. Over 70% of respondents reported that the availability of neurocritical care units staffed with neurointensivists would improve the quality of care of critically ill neurological/neurosurgical patients. Neurologists were reported as the most appropriate specialty for training in neurointensive care by 53.3%, and 57% of respondents responded positively that neurology residency programs should offer a separate training track for those interested in neurocritical care. Broad level of support exists among the survey respondents (mostly neurologists and intensivists) for the establishment of neurological critical care units. Since neurology remains the predominant career path from which to draw neurointensivists, there may be a role for more comprehensive neurointensive care training within neurology residencies or an alternative training track for interested residents.

  12. Intensive insulin therapy increases the risk of hypoglycemia in neurocritical care patients.

    Science.gov (United States)

    Tiemessen, Charlotte A M; Hoedemaekers, Cornelia W E; van Iersel, Freya M; Rösken, Gerrit H J; van der Hoeven, Johannes; Biessels, Geert-Jan; Slooter, Arjen J C

    2011-07-01

    Intensive insulin therapy protocols are widely used in intensive care medicine. A disadvantage of these protocols may be the occurrence of hypoglycemic episodes. Neurocritical care patients are particularly vulnerable to the effects of hypoglycemia. We aimed to study the risk of hypoglycemia in neurocritical care patients in relation to intensive insulin therapy. To determine the effects of 2 different intensive insulin therapy protocols on glucose levels and hypoglycemia incidence, we collected data before and after implementation of the protocols in 2 university hospitals. The risk of hypoglycemia (blood glucose level below 3.0 mmol/L) was studied retrospectively with logistic regression analyses. In hospital A, data were obtained on 152 patients before implementation of the protocol and on 649 patients after implementation of the protocol. In hospital B, data were obtained on 111 patients before implementation of the protocol and on 118 patients thereafter. Implementation of intensive insulin therapy protocols increased the time spent in the desired blood glucose range of 4.6 to 6.0 mmol/L in both hospitals, but increased the risk of hypoglycemia: the absolute risk of hypoglycemia during intensive care unit admission increased in hospital A from 14.5% to 20.3% (adjusted odds ratio=1.3; 95% confidence interval: 0.8-2.3) and in hospital B from 3.6% to 29.7% (adjusted odds ratio=28.6; 95% confidence interval: 5.9-138.9). Implementation of intensive insulin therapy protocols in neurocritical care patients not only seems to increase the time spent in the desired blood glucose range, but also seems to increase the risk of hypoglycemia. The risk of hypoglycemia strongly depends on characteristics of the intensive insulin therapy protocol.

  13. The effect of a neurocritical care service without a dedicated neuro-ICU on quality of care in intracerebral hemorrhage.

    Science.gov (United States)

    Burns, Joseph D; Green, Deborah M; Lau, Helena; Winter, Michael; Koyfman, Feliks; DeFusco, Christina M; Holsapple, James W; Kase, Carlos S

    2013-06-01

    Introduction of neurocritical care services to dedicated neuro-ICUs is associated with improved quality of care. The impact of a neurocritical care service without a dedicated neuro-ICU has not been studied. We retrospectively identified all patients admitted to our institution with intracerebral hemorrhage (ICH) in two 12-month periods: immediately before the arrival of the first neurointensivist ("before") and after the neurocritical care service was established ("after"). There was no nursing team, ICU housestaff/physician extender team, or physical unit dedicated to the care of patients with critical neurologic illness during either period. Using an uncontrolled before-after design, we compared clinical outcomes and performance on quality metrics between groups. We included 74 patients with primary supratentorial ICH. Mortality, length of stay (LOS), proportion of patients with modified Rankin Score 0-3, and destination on discharge did not differ between groups when adjusted for confounders. Time to first two consecutive systolic blood pressure (SBP) measurements neuro-ICU at our institution was associated with a trend toward longer ICU LOS and improvement in some key metrics of quality of care for patients with ICH.

  14. Alpha-2 agonists for sedation in mechanically ventilated neurocritical care patients: a systematic review protocol.

    Science.gov (United States)

    Tran, Alexandre; Blinder, Henrietta; Hutton, Brian; English, Shane

    2016-09-08

    Sedation is an important consideration in the care of the neurocritically ill patient. It provides anxiety and relief, facilitates procedures and nursing tasks, and minimizes intolerance of mechanical ventilation. Alpha-2 agonists such as dexmedetomidine and clonidine have been shown to be an effective alternative in the general critical care population by reducing duration of mechanical ventilation and length of stay in the intensive care unit (ICU), as compared to traditional sedative agents such as propofol or benzodiazepines. However, there is a paucity of literature detailing their utility and safety in neurocritical care, a population that presents unique considerations for management of global and cerebral hemodynamics, agitation, and facilitation of neurological assessments. The objective of this review is to assess the efficacy and safety of alpha-2 agonists for non-procedural sedation in mechanically ventilated brain-injured patients. We will search the Embase and MEDLINE databases for all randomized controlled trials, prospective and retrospective cohort studies examining neurocritically ill adult patients aged 18 years and older who are on mechanical ventilation and receiving alpha-2 agonists for non-procedural sedation. Primary outcomes of interest include effect on mean arterial pressure (MAP), intracranial pressure (ICP), and cerebral perfusion pressure (CPP). Secondary outcomes include adverse events, duration of mechanical ventilation, 30-day mortality, ICU length of stay, incidence of delirium, and quality of sedation. Continuous outcomes will be presented as means and mean differences and discrete counting events will be presented as event rates. Pre-defined criteria for heterogeneity are provided for determination of pooling eligibility. Where appropriate, we will pool estimates for individual outcomes. Planned subgroup analyses include specific alpha-2 agonist agent, study design, clinical diagnosis, dosing regimen, and use of adjunctive

  15. Early versus late readmission of subarachnoid haemorrhage patients into neurocritical care.

    Science.gov (United States)

    Low, Jacob C M; Welbourne, Jessie; McMillan, Helen; Whitfield, Peter C

    2016-10-01

    Subarachnoid haemorrhage (SAH) patients will typically require monitoring in a specialised Neurocritical Care Unit (NCCU) regardless of the primary treatment modality. Once discharged from NCCU, readmission within 48 h is regarded as a "failed" discharge. The aims of this study are to (1) Evaluate the readmission rate of SAH patients into NCCU, (2) Identify the indications for readmission, (3) Analyse clinical parameters on discharge between patients readmitted early and late. Retrospective observational study of the Intensive Care National Audit and Research Centre (ICNARC) database of patients from our unit diagnosed with SAH from January 2009-December 2014, who were readmitted into NCCU. Demographic data, World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, length of initial and subsequent NCCU stay, time of readmission, indication for readmission, and mortality rate data were collected. Patients were categorised by early (48 h) readmission, and their clinical parameters on NCCU discharge were statistically analysed. Five hundred and seventy-five SAH patients were admitted into NCCU, of which 49 patients (9%) were readmitted after discharge to ward-level care. The mean age of readmitted patients was 64.1 ± 11.6 years old. The most common indications were delayed cerebral ischaemia (DCI) (50%) and infection (19%). Readmitted SAH patients were typically WFNS grade I-II (n = 22) and Fisher grade III-IV (n = 44). 17 (35%) patients were readmitted early, and were older (p = 0.0049) with a lower GCS (p = 0.0077) compared to patients readmitted later. White cell count and C-reactive protein were higher in patients readmitted early, but did not reach statistical significance (p = 0.09, p = 0.07). DCI and infection were the most common indications for NCCU readmission in SAH patients. "Failed" discharged patients from NCCU are typically older with a lower GCS than patients readmitted after 48 h, and therefore

  16. A Secure, Social Media-Based "Case of the Month" Module in a Neurocritical Care Unit.

    Science.gov (United States)

    Witherspoon, Briana; Braunlin, Kathryn; Kumar, Avinash B

    2016-07-01

    Systems to meet the on-demand learning needs of nurses in intensive care units are not well studied beyond the traditional classroom models. To study the feasibility and effect of implementing an online discussion forum for nurses in a busy neuroscience intensive care unit. A baseline survey was done to highlight the areas of educational need in the unit. Freeform-a password-protected, online discussion forum supported by the university-was used for the pilot project. Freeform has functions similar to Facebook, with "likes," "follow," discussion/comment spaces, and the capacity for uploading images and files. A page called "All things NeuroCritical Care" was created. All nurses working in the intensive care unit were automatically enrolled. Clinical vignettes relevant to neurocritical care were posted once a month with 1 to 2 lead questions. All participation was voluntary, and topics were chosen on the basis of the needs survey. At the end of each case, a recent review article on the topic was posted for secure download. Eight sentinel diagnoses have been presented as clinical vignettes, and 34 of 76 members formally follow the page. The mean number of discussion strings per case is 8.3 posts. The number of unique visitors to the page during active case discussions exceeds 100. A secure, online, problem-based learning discussion format is a feasible point-of-care learning opportunity that can help overcome some of the traditional barriers to ongoing nursing education needs in a busy intensive care unit. ©2016 American Association of Critical-Care Nurses.

  17. Transcranial Doppler Ultrasound: Physical Principles and Principal Applications in Neurocritical Care Unit

    Science.gov (United States)

    D’Andrea, Antonello; Conte, Marianna; Scarafile, Raffaella; Riegler, Lucia; Cocchia, Rosangela; Pezzullo, Enrica; Cavallaro, Massimo; Carbone, Andreina; Natale, Francesco; Russo, Maria Giovanna; Gregorio, Giovanni; Calabrò, Raffaele

    2016-01-01

    Transcranial Doppler (TCD) ultrasonography is a noninvasive ultrasound study, which has been extensively applied on both outpatient and inpatient settings. It involves the use of a low-frequency (≤2 MHz) transducer, placed on the scalp, to insonate the basal cerebral arteries through relatively thin bone windows and to measure the cerebral blood flow velocity and its alteration in many different conditions. In neurointensive care setting, TCD is useful for both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, and brain stem death. It also allows to investigate the cerebrovascular autoregulation in setting of carotid disease and syncope. In this review, we will describe physical principles underlying TCD, flow indices most frequently used in clinical practice and critical care applications in Neurocritical Unit care. PMID:28465958

  18. Transcranial Doppler Ultrasound: Physical Principles and Principal Applications in Neurocritical Care Unit.

    Science.gov (United States)

    D'Andrea, Antonello; Conte, Marianna; Scarafile, Raffaella; Riegler, Lucia; Cocchia, Rosangela; Pezzullo, Enrica; Cavallaro, Massimo; Carbone, Andreina; Natale, Francesco; Russo, Maria Giovanna; Gregorio, Giovanni; Calabrò, Raffaele

    2016-01-01

    Transcranial Doppler (TCD) ultrasonography is a noninvasive ultrasound study, which has been extensively applied on both outpatient and inpatient settings. It involves the use of a low-frequency (≤2 MHz) transducer, placed on the scalp, to insonate the basal cerebral arteries through relatively thin bone windows and to measure the cerebral blood flow velocity and its alteration in many different conditions. In neurointensive care setting, TCD is useful for both adults and children for day-to-day bedside assessment of critical conditions including vasospasm in subarachnoid hemorrhage, traumatic brain injury, acute ischemic stroke, and brain stem death. It also allows to investigate the cerebrovascular autoregulation in setting of carotid disease and syncope. In this review, we will describe physical principles underlying TCD, flow indices most frequently used in clinical practice and critical care applications in Neurocritical Unit care.

  19. ′ROSE concept′ of fluid management: Relevance in neuroanaesthesia and neurocritical care

    Directory of Open Access Journals (Sweden)

    Joseph N Monteiro

    2017-01-01

    Full Text Available Fluid therapy in neurosurgical patients aims to restore intravascular volume, optimise haemodynamic parameters and maintain tissue perfusion, integrity and function. The goal is to minimise the risk of inadequate cerebral perfusion pressure and to maintain good neurosurgical conditions. However, fluid management in brain-injured patients has several distinctive features compared with non-brain-injured critically ill patients. The ROSE concept advocates the restriction of fluids, which is consistent with the prevention of a ′tight brain′ in neurosurgery. Whether this imbalance in fluid management studies between different types of brain injuries is a reflection of differences in clinical relevance of fluid management is not clear. Further randomised controlled trials in the future are essential in subarachnoid haemorrhage and traumatic brain injury patients who are critical and need long-term Intensive Care Unit stay to elucidate and define the role and relevance of the ROSE concept in neuroanaesthesia and neurocritical care.

  20. A Systematic Review of Alpha-2 Agonists for Sedation in Mechanically Ventilated Neurocritical Care Patients.

    Science.gov (United States)

    Tran, Alexandre; Blinder, Henrietta; Hutton, Brian; English, Shane W

    2017-05-25

    The use of sedative medications is commonplace in intensive care units (ICUs) and an invaluable clinical tool for the intensive care physician. Sedation for critically ill, mechanically ventilated patients provides an opportunity to reduce anxiety, discomfort as well as ventilator intolerance and dyssynchrony. Alpha-2 agonists in particular have become increasingly popular for use in the neurocritical care population due to their proposed effectiveness in facilitating examinations and procedures as well as reducing the need for adjunctive agents. However, there is a paucity of literature to assess the safety of their use in the neurocritically ill patients, a population that presents unique sensitivities and considerations for management of global and cerebral hemodynamics, agitation and facilitation of neurological assessments. This review assesses the safety and efficacy of alpha-2 agonists for non-procedural sedation in critically ill brain-injured patients on mechanical ventilation. In June 2016, we searched the EMBASE, MEDLINE and CENTRAL Cochrane Databases for randomized controlled trials, prospective and retrospective cohort studies examining neurocritically ill adult patients aged 18 years and older who are on mechanical ventilation and receiving alpha-2 agonists for non-procedural sedation. Primary outcomes of interest include mean arterial pressure (MAP), intracranial pressure (ICP), and cerebral perfusion pressure (CPP). Secondary outcomes include adverse events, duration of mechanical ventilation, 30-day mortality, ICU length of stay, incidence of delirium, and quality of sedation. We identified 17 studies for inclusion, all reporting on dexmedetomidine use, only 7 of which reported on our primary outcomes of interest. We found mixed results with regard to statistically significant changes in ICP, CPP, and MAP but did not find evidence of severe hemodynamic disturbances. However, the studies are notably limited by lack of reporting on sedative and

  1. Brain Multimodality Monitoring: A New Tool in Neurocritical Care of Comatose Patients.

    Science.gov (United States)

    Tasneem, Nudrat; Samaniego, Edgar A; Pieper, Connie; Leira, Enrique C; Adams, Harold P; Hasan, David; Ortega-Gutierrez, Santiago

    2017-01-01

    Neurocritical care patients are at risk of developing secondary brain injury from inflammation, ischemia, and edema that follows the primary insult. Recognizing clinical deterioration due to secondary injury is frequently challenging in comatose patients. Multimodality monitoring (MMM) encompasses various tools to monitor cerebral metabolism, perfusion, and oxygenation aimed at detecting these changes to help modify therapies before irreversible injury sets in. These tools include intracranial pressure (ICP) monitors, transcranial Doppler (TCD), Hemedex™ (thermal diffusion probe used to measure regional cerebral blood flow), microdialysis catheter (used to measure cerebral metabolism), Licox™ (probe used to measure regional brain tissue oxygen tension), and continuous electroencephalography. Although further research is needed to demonstrate their impact on improving clinical outcomes, their contribution to illuminate the black box of the brain in comatose patients is indisputable. In this review, we further elaborate on commonly used MMM parameters, tools used to measure them, and the indications for monitoring per current consensus guidelines.

  2. Transcranial Doppler: a stethoscope for the brain-neurocritical care use.

    Science.gov (United States)

    Robba, Chiara; Cardim, Danilo; Sekhon, Mypinder; Budohoski, Karol; Czosnyka, Marek

    2017-09-07

    Transcranial Doppler (TCD) ultrasonography is a noninvasive bedside monitoring technique that can evaluate cerebral blood flow hemodynamics in the intracranial arterial vasculature. TCD allows assessment of linear cerebral blood flow velocity, with a high temporal resolution and is inexpensive, reproducible, and portable. The aim of this review is to provide an overview of the most commonly used TCD derived signals and measurements used commonly in neurocritical care. We describe both basic (flow velocity, pulsatility index) and advanced concepts, including critical closing pressure, wall tension, autoregulation, noninvasive intracranial pressure, brain compliance, and cerebrovascular time constant; we also describe the clinical applications of TCD to highlight their utility in the diagnosis and monitoring of cerebrovascular diseases as the "stethoscope for the brain." © 2017 Wiley Periodicals, Inc.

  3. Brain Multimodality Monitoring: A New Tool in Neurocritical Care of Comatose Patients

    Directory of Open Access Journals (Sweden)

    Nudrat Tasneem

    2017-01-01

    Full Text Available Neurocritical care patients are at risk of developing secondary brain injury from inflammation, ischemia, and edema that follows the primary insult. Recognizing clinical deterioration due to secondary injury is frequently challenging in comatose patients. Multimodality monitoring (MMM encompasses various tools to monitor cerebral metabolism, perfusion, and oxygenation aimed at detecting these changes to help modify therapies before irreversible injury sets in. These tools include intracranial pressure (ICP monitors, transcranial Doppler (TCD, Hemedex™ (thermal diffusion probe used to measure regional cerebral blood flow, microdialysis catheter (used to measure cerebral metabolism, Licox™ (probe used to measure regional brain tissue oxygen tension, and continuous electroencephalography. Although further research is needed to demonstrate their impact on improving clinical outcomes, their contribution to illuminate the black box of the brain in comatose patients is indisputable. In this review, we further elaborate on commonly used MMM parameters, tools used to measure them, and the indications for monitoring per current consensus guidelines.

  4. Brainstem Monitoring in the Neurocritical Care Unit: A Rationale for Real-Time, Automated Neurophysiological Monitoring.

    Science.gov (United States)

    Stone, James L; Bailes, Julian E; Hassan, Ahmed N; Sindelar, Brian; Patel, Vimal; Fino, John

    2017-02-01

    Patients with severe traumatic brain injury or large intracranial space-occupying lesions (spontaneous cerebral hemorrhage, infarction, or tumor) commonly present to the neurocritical care unit with an altered mental status. Many experience progressive stupor and coma from mass effects and transtentorial brain herniation compromising the ascending arousal (reticular activating) system. Yet, little progress has been made in the practicality of bedside, noninvasive, real-time, automated, neurophysiological brainstem, or cerebral hemispheric monitoring. In this critical review, we discuss the ascending arousal system, brain herniation, and shortcomings of our current management including the neurological exam, intracranial pressure monitoring, and neuroimaging. We present a rationale for the development of nurse-friendly-continuous, automated, and alarmed-evoked potential monitoring, based upon the clinical and experimental literature, advances in the prognostication of cerebral anoxia, and intraoperative neurophysiological monitoring.

  5. Is there still a role for hypothermia in neurocritical care?

    Science.gov (United States)

    Frank, Florian; Broessner, Gregor

    2017-04-01

    Therapeutic hypothermia (i.e. induced body core temperature ≈ 33-35°C) in neurological patients with cerebrovascular disease and traumatic brain injury is a controversially discussed issue in the literature. In this review, we have included the most recently published research covering the use of therapeutic hypothermia and targeted temperature management in neurologic diseases and translated the results into a clinical decision support for the professional healthcare community. Recent findings from large multicenter studies investigating therapeutic hypothermia in patients with various acute neurologic diseases have revealed that although short-term and long-term temperature modulation on different temperature levels is feasible with the latest device technology, the effect on outcome is controversial. There is overwhelming evidence that fever is an independent predictor of morbidity and mortality in patients with acute severe neurologic diseases. Although therapeutic hypothermia has been proven to be a potent neuroprotective measure acting on various levels in animal models, many questions such as optimal depth of target temperature, speed of rewarming, duration of cooling and management of side-effects accompanying therapeutic hypothermia are unresolved in human. Therefore, the application of therapeutic hypothermia outside of strictly supervised clinical trials must be carefully considered.

  6. 327 A Prospective Analysis of Hypovitaminosis D and Mortality in 400 Patients in the Neurocritical Care Setting.

    Science.gov (United States)

    Guan, Jian; Karsy, Michael; Brock, Andrea Archambault; Eli, Ilyas; Ledyard, Holly; Hawryluk, Gregory W J; Park, Min S

    2016-08-01

    Hypovitaminosis D is highly prevalent among the general population. Studies have shown an association between hypovitaminosis D and multiple negative outcomes in critical care patients, but there has been no prospective evaluation of hypovitaminosis D in the neurological critical care population. The authors examined the impact of vitamin D deficiency on in-hospital mortality and a variety of secondary outcomes in the neurocritical care unit. The authors prospectively collected 25-hydroxy vitamin D levels on all patients admitted to the neurocritical care unit of a quaternary-care center over a 3-month period. Demographic data, illness acuity, in-hospital mortality, infection, and length of hospitalization were collected. Univariate and multivariable logistic regression were used to examine the effects of vitamin D deficiency. Four hundred sixty-one patients met the inclusion criteria. In-hospital mortality was slightly worse (9.3% vs 4.5%, P = .059) among patients with deficient vitamin D (≤20 ng/dL). There was also a higher rate of urinary tract infection in patients with vitamin D deficiency (12.4% vs 4.2%, P = .002). For patients admitted to the neurocritical care unit emergently (n = 285), higher SAPS II score (odds ratio [OR], 13.33; 95% confidence interval [CI], 1.69-100; P = .014) and vitamin D deficiency (OR, 3.03; 95% CI, 1.14-8.06; P = .027) were significantly associated with increased in-hospital mortality on multivariable analysis. In the subset of patients admitted to the neurocritical care unit emergently, vitamin D deficiency is significantly associated with higher in-hospital mortality. Larger studies are needed to confirm these findings and to investigate the role of vitamin D supplementation in these patients.

  7. [Risk of ventriculitis associated to the care of the ventricular drain in neurocritical patients].

    Science.gov (United States)

    Rivas-Rodriguez, Aida; Suarez-Mier, Belén; Rivas-Rodriguez, Lidia; Lana, Alberto

    2016-04-16

    To analyze the risk of ventriculitis associated to the care of the external ventricular drain. Case-control study among a sample of neurocritical patients of the University Hospital of Asturias (Spain) who carried a ventricular catheter (n = 127; 49 cases and 78 controls). Main outcome was the diagnosis of ventriculitus, according to established criteria. Independent variables were related to the catheter management, including nursing cares of the insertion point, administration of intrathecal medication, flushes, changes and mobilization of the catheter. Other variables (age, sex, APACHE score, admission diagnosis, comorbidity, antibiotics, time to insertion and permanence time of the drain) were studied as covariates. Nursing catheter cares (OR 3.8; 95% CI: 1.1-13.9) and administration of intrathecal medication (OR: 7.1; 95% CI: 2.1-23.6) were significantly associated with ventriculitis. After adjustment by the number of days at risk, the effect of nursing cares disappeared (OR 1.4; 95% CI: 0.3-6.6). Intrathecal medication and nursing cares seem to be associated with ventriculitis. The administration of medication by the ventricular drain really reflects that the physicians suspect ventriculitis before the diagnosis is confirmed and, therefore, they prescribe this medication. However, as the duration of drain increases the frequency of nursing cares, it seems prudent to recommend not lengthen the permanence of the ventricular drain and to improve the training of nurses.

  8. Fellowship Training in the Emerging Fields of Fetal-Neonatal Neurology and Neonatal Neurocritical Care.

    Science.gov (United States)

    Smyser, Christopher D; Tam, Emily W Y; Chang, Taeun; Soul, Janet S; Miller, Steven P; Glass, Hannah C

    2016-10-01

    Neonatal neurocritical care is a growing and rapidly evolving medical subspecialty, with increasing numbers of dedicated multidisciplinary clinical, educational, and research programs established at academic institutions. The growth of these programs has provided trainees in neurology, neonatology, and pediatrics with increased exposure to the field, sparking interest in dedicated fellowship training in fetal-neonatal neurology. To meet this rising demand, increasing numbers of training programs are being established to provide trainees with the requisite knowledge and skills to independently deliver care for infants with neurological injury or impairment from the fetal care center and neonatal intensive care unit to the outpatient clinic. This article provides an initial framework for standardization of training across these programs. Recommendations include goals and objectives for training in the field; core areas where clinical competency must be demonstrated; training activities and neuroimaging and neurodiagnostic modalities which require proficiency; and programmatic requirements necessary to support a comprehensive and well-rounded training program. With consistent implementation, the proposed model has the potential to establish recognized standards of professional excellence for training in the field, provide a pathway toward Accreditation Council for Graduate Medical Education certification for program graduates, and lead to continued improvements in medical and neurological care provided to patients in the neonatal intensive care unit. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Current practice in neurocritical care of patients with subarachnoid haemorrhage and severe traumatic brain injury : Results of the Austrian Neurosurvey Study.

    Science.gov (United States)

    Herzer, Günther; Illievich, Udo; Voelckel, Wolfgang G; Trimmel, Helmut

    2016-09-01

    The task force Neuroanaesthesia of the Austrian Society of Anaesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI) is aiming to develop and provide recommendations in order to improve neurocritical care in Austria. Thus, a survey on neurocritical care concepts in Austria regarding intensive care of subarachnoid haemorrhage (SAH) and severe traumatic brain injury (TBI) was performed to assess the current status. An online internet questionnaire comprising 59 items on current concepts of SAH and TBI critical care was sent to 117 anaesthesiology departments. The survey was answered by 30 (25.6 %) of the hospitals, 24 (80 %) of them treating patients with SAH and/or TBI. Data from ten SAH centres reveal that definitive care was achieved within 24 h in all hospitals; a case load >50 per year is noted in 70 % of intensive care units (ICU). In all, 50 % of departments employ written protocols for treatment. Regarding the treatment of TBI patients, 14 answers were received, indicating that 42.9 % of departments provide care for >50 patients per year. Time between arrival and CT scan is discharge from the ICU, there is no evaluation of 1‑year outcome. Definitive care of SAH and TBI patients is achieved timely in Austria. When compared with SAH, more hospitals with lower case loads take care of TBI patients. Written guidelines and protocols at institutional level are often missing. Since routine morbidity and mortality conferences are sparse, and long-term outcome is not assessed, there is room for improvement.

  10. Pediatric neurocritical care in the 21st century: from empiricism to evidence.

    Science.gov (United States)

    Wainwright, Mark S; Hansen, Gregory; Piantino, Juan

    2016-04-01

    Approximately one in five children admitted to a pediatric ICU have a new central nervous system injury or a neurological complication of their critical illness. The spectrum of neurologic insults in children is diverse and clinical practice is largely empirical, as few randomized, controlled trials have been reported. This lack of data poses a substantial challenge to the practice of pediatric neurocritical care (PNCC). PNCC has emerged as a novel subspecialty, and its presence is expanding within tertiary care centers. This review highlights the recent advances in the field, with a focus on traumatic brain injury (TBI), cardiac arrest, and stroke as disease models. Variable approaches to the structure of a PNCC service have been reported, comprising multidisciplinary teams from neurology, critical care, neurosurgery, neuroradiology, and anesthesia. Neurologic morbidity is substantial in critically ill children and the increased use of continuous electroencephalography monitoring has highlighted this burden. Therapeutic hypothermia has not proven effective for treatment of children with severe TBI or out-of-hospital cardiac arrest. However, results of studies of severe TBI suggest that multidisciplinary care in the ICU and adherence to guidelines for care can reduce mortality and improve outcome. There is an unmet need for clinicians with expertise in the practice of brain-directed critical care for children. Although much of the practice of PNCC may remain empiric, a focus on the regionalization of care, creating defined training paths, practice within multidisciplinary teams, protocol-directed care, and improved measures of long-term outcome to quantify the impact of such care can provide evidence to direct the maturation of this field.

  11. Comparison of Two Surface Cooling Devices for Temperature Management in a Neurocritical Care Unit.

    Science.gov (United States)

    Aujla, Gurpreet Singh; Nattanmai, Premkumar; Premkumar, Keerthivaas; Newey, Christopher R

    2017-09-01

    Fever increases mortality and morbidity and length of stay in neurocritically ill patients. Various methods are used in the neuroscience intensive care unit (NSICU) to control fever. Two such methods involve the Arctic Sun hydrogel wraps and the Gaymar cooling wraps. The purpose of our study was to compare these two methods in neurocritical care patients who had temperature >37.5°C for more than three consecutive hours and that was refractory to standard treatments. Data of patients requiring cooling wraps for treatment of hyperthermia at an NSICU at an academic, tertiary referral center were retrospectively reviewed. The average temperature before cooling was 38.5°C ± 0.38°C and 38.4°C ± 0.99°C for the Gaymar and Arctic Sun groups, respectively (p = 0.89). The Gaymar group took on average 16 ± 21.9 hours to reach goal temperature, whereas the Arctic Sun group took 2.22 ± 1.39 hours (p = 0.08). The average time outside of the target temperature was 57.0 ± 58.0 hours in the Gaymar group compared with 13.7 ± 17.1 hours in the Arctic Sun group (p = 0.04). Average duration of using the cooling wraps was similar between the two groups; 81.8% of patients had rebound hyperthermia in the Gaymar group compared with 20% in the Arctic Sun group (p = 0.0089). The Arctic Sun group had a nonsignificant increased incidence of shivering compared with the Gaymar group (40% vs. 18.18%, p = 0.36). We found that Arctic Sun surface cooling device was more efficient in attaining the target temperature, had less incidence of rebound hyperthermia, and was able to maintain normothermia better than Gaymar cooling wraps. The incidence of shivering tended to be more common in the Arctic Sun group.

  12. Safety of Continuous Peripheral Infusion of 3% Sodium Chloride Solution in Neurocritical Care Patients.

    Science.gov (United States)

    Jones, G Morgan; Bode, Lauren; Riha, Heidi; Erdman, Michael J

    2016-12-01

    Numerous drug information resources recommend that continuous intravenous 3% sodium chloride solution be administered via a central catheter. To evaluate the incidence of infusion-related reactions and electrolyte abnormalities in neurocritical care patients treated with continuous intravenous infusion of 3% sodium chloride solution via a peripheral catheter. Data on patients treated with continuous intravenous infusion of 3% sodium chloride solution at 2 academic medical centers were evaluated retrospectively to determine the administration site. Electronic notes on catheter status were reviewed to determine the occurrence of infusion-related reactions. Prespecified thresholds were used to assess electrolyte abnormalities. Of 213 patients who had peripheral continuous intravenous infusions of 3% sodium chloride solution, 15 (7%) had infusion-related reactions. Administration was changed to a central catheter in 56 patients (26.3%), but only 5 changes were due to an infusion-related reaction. Most (157 patients, 73.7%) received their entire treatment peripherally, for a median duration of 44 hours, 3 minutes. The most common electrolyte abnormalities were hyperchloremia in 49.3% and hypokalemia in 46.9% of patients. Current recommendations that a central catheter is required for continuous intravenous infusion of 3% sodium chloride solution should be reevaluated. Only a few patients who had peripheral infusions had infusion-related reactions. Electrolyte abnormalities occurred frequently with peripheral infusion, but the clinical importance of the abnormalities remains unclear. ©2016 American Association of Critical-Care Nurses.

  13. A prospective analysis of hypovitaminosis D and mortality in 400 patients in the neurocritical care setting.

    Science.gov (United States)

    Guan, Jian; Karsy, Michael; Brock, Andrea A; Eli, Ilyas M; Ledyard, Holly K; Hawryluk, Gregory W J; Park, Min S

    2017-07-01

    OBJECTIVE Hypovitaminosis D is highly prevalent among the general population. Studies have shown an association between hypovitaminosis D and multiple negative outcomes in critical care patients, but there has been no prospective evaluation of vitamin D in the neurological critical care population. The authors examined the impact of vitamin D deficiency on in-hospital mortality and a variety of secondary outcomes. METHODS The authors prospectively collected 25-hydroxy vitamin D levels of all patients admitted to the neurocritical care unit (NCCU) of a quaternary-care center over a 3-month period. Demographic data, illness acuity, in-hospital mortality, infection, and length of hospitalization were collected. Univariate and multivariable logistic regression were used to examine the effects of vitamin D deficiency. RESULTS Four hundred fifteen patients met the inclusion criteria. In-hospital mortality was slightly worse (9.3% vs 4.5%; p = 0.059) among patients with deficient vitamin D (≤ 20 ng/dl). There was also a higher rate of urinary tract infection in patients with vitamin D deficiency (12.4% vs 4.2%; p = 0.002). For patients admitted to the NCCU on an emergency basis (n = 285), higher Simplified Acute Physiology Score II (OR 13.8, 95% CI 1.7-110.8; p = 0.014), and vitamin D deficiency (OR 3.0, 95% CI 1.0-8.6; p = 0.042) were significantly associated with increased in-hospital mortality after adjusting for other factors. CONCLUSIONS In the subset of patients admitted to the NCCU on an emergency basis, vitamin D deficiency is significantly associated with higher in-hospital mortality. Larger studies are needed to confirm these findings and to investigate the role of vitamin D supplementation in these patients.

  14. The cost of a pediatric neurocritical care program for traumatic brain injury: a retrospective cohort study.

    Science.gov (United States)

    Howard, Steven W; Zhang, Zidong; Buchanan, Paula; Bernell, Stephanie L; Williams, Christine; Pearson, Lindsey; Huetsch, Michael; Gill, Jeff; Pineda, Jose A

    2018-01-12

    Inpatient care for children with severe traumatic brain injury (sTBI) is expensive, with inpatient charges averaging over $70,000 per case (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). This ranks sTBI in the top quartile of pediatric conditions with the greatest inpatient costs (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). The Brain Trauma Foundation developed sTBI intensive care guidelines in 2003, with revisions in 2012 (Kochanek, Carney, et. al. PCCM 3:S1-S2, 2012). These guidelines have been widely disseminated, and are associated with improved health outcomes (Pineda, Leonard. et. al. LN 12:45-52, 2013), yet research on the cost of associated hospital care is limited. The objective of this study was to assess the costs of providing hospital care to sTBI patients through a guideline-based Pediatric Neurocritical Care Program (PNCP) implemented at St. Louis Children's Hospital, a pediatric academic medical center in the Midwest United States. This is a retrospective cohort study. We used multi-level regression to estimate pre-/post-implementation effects of the PNCP program on inflation adjusted total cost of in-hospital sTBI care. The study population included 58 pediatric patient discharges in the pre-PNCP implementation group (July 15, 1999 - September 17, 2005), and 59 post-implementation patient discharges (September 18, 2005 - January 15, 2012). Implementation of the PNCP was associated with a non-significant difference in the cost of care between the pre- and post-implementation periods (eβ = 1.028, p = 0

  15. Cerebrospinal fluid penetration of meropenem in neurocritical care patients with proven or suspected ventriculitis: a prospective observational study.

    Science.gov (United States)

    Blassmann, Ute; Roehr, Anka C; Frey, Otto R; Vetter-Kerkhoff, Cornelia; Thon, Niklas; Hope, William; Briegel, Josef; Huge, Volker

    2016-10-24

    Ventriculitis is a complication of temporary intraventricular drains. The limited penetration of meropenem into the cerebrospinal fluid (CSF) is well known. However, ventricular CSF pharmacokinetic data in patients with ventriculitis are lacking. The aim of this study was to evaluate meropenem pharmacokinetics in the serum and CSF of neurocritical care patients with proven or suspected ventriculitis. We conducted an observational pharmacokinetic study of neurocritical care patients with proven or suspected ventriculitis receiving meropenem. Multiple blood and CSF samples were taken and were described using nonparametric pharmacokinetic modelling with Pmetrics. In total, 21 patients (median age 52 years, median weight 76 kg) were included. The median (range) of peak and trough concentrations in serum were 20.16 (4.40-69.00) mg/L and 2.54 (0.00-31.40) mg/L, respectively. The corresponding peak and trough concentrations in CSF were 1.20 (0.00-6.20) mg/L and 1.28 (0.00-4.10) mg/L, respectively, with a median CSF/serum ratio (range) of 0.09 (0.03-0.16). Median creatinine clearance ranged from 60.7 to 217.6 ml/minute (median 122.5 ml/minute). A three-compartment linear population pharmacokinetic model was most appropriate. No covariate relationships could be supported for any of the model parameters. Meropenem demonstrated poor penetration into CSF, with a median CSF/serum ratio of 9 % and high interindividual pharmacokinetic variability. Administration of higher-than-standard doses of meropenem and therapeutic drug monitoring in both serum and CSF should be considered to individualise meropenem dosing in neurocritical care patients with ventriculitis.

  16. Comparison of enteral ethanol and benzodiazepines for alcohol withdrawal in neurocritical care patients.

    Science.gov (United States)

    Gipson, Gregory; Tran, Kim; Hoang, Cuong; Treggiari, Miriam

    2016-09-01

    We designed a study to evaluate the use of benzodiazepines and ethanol in patients being assessed for alcohol withdrawal and compare outcomes between the two agents. This is a retrospective chart review of patients admitted to neurocritical care or neurosurgical services who were at risk for ethanol withdrawal between June 2011 and September 2015. Patients were divided into two groups based on the first medication administered for alcohol withdrawal management, either benzodiazepine (n=50) or enteral ethanol (n=50). The primary endpoint was the maximum change in Clinical Institute Withdrawal Assessment of Alcohol scale (CIWA) score within the first 24hours. Secondary endpoints included maximum and minimum CIWA score in 5days, length of stay, and change in Glasgow Coma Scale. Study groups differed by mortality risk, level of coma at admission, and other clinical characteristics, with the ethanol group appearing less severely ill. There was no significant difference between the two groups in the maximum change in CIWA score at 24hours (-0.97, 95%CI: -3.21 to 1.27, p=0.39). Hospital and intensive care unit length of stay was 6.5 days and 1 day shorter for the ethanol group (p=0.03 and p=0.02, respectively). In summary, enteral ethanol was preferentially used in patients who are more likely to be capable of tolerating oral intake. We found that the change from baseline in CIWA score or other physiologic variables was not substantially different between the two agents. The overall utility of benzodiazepines and enteral ethanol remains unclear for this population and further study is needed to determine superiority. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Intravenous Versus Oral Acetaminophen for Pain Control in Neurocritical Care Patients.

    Science.gov (United States)

    Nichols, Dan C; Nadpara, Pramit A; Taylor, Perry D; Brophy, Gretchen M

    2016-12-01

    Acetaminophen (APAP) is used in neurocritical care (NCC) patients for analgesia without sedation or antiplatelet activity. Research suggests that intravenous (IV) APAP produces earlier and higher serum levels compared to oral (PO) APAP. This retrospective study evaluates the associated analgesic effects of IV and PO APAP and use of adjunctive opioids in NCC patients with moderate-severe pain. Patients admitted to the neuroscience intensive care unit (NSICU) between May 2012 and April 2013 who received ≥1 dose of IV APAP were included in the study. IV and PO APAP doses administered with a predose pain score ≥4 within 1 h of dosing were compared. Pain intensity difference (PID) was calculated as the change between the pain score prior to each dose and scores at 30 min, 1, 2, 3, and 6 h postdose. Pre- and postdose morphine milligram equivalents (MME) were also calculated. 309 NSICU patients received 459 doses of IV and 440 doses of PO APAP meeting our inclusion criteria. The PID at 30 min postdosing was significantly higher among those receiving IV APAP compared to those receiving PO APAP (p = 0.003). No significant difference in PID was seen at 1, 2, 3, and 6 h; and there was no significant difference in pre- or postdose MME between the two groups. IV APAP was more effective than PO APAP at relieving pain within 30 min of dosing, but this difference was not sustained over 6 h. Further studies are needed to assess the benefits of this rapid onset of action.

  18. Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury.

    Science.gov (United States)

    Sekhon, Mypinder S; Gooderham, Peter; Toyota, Brian; Kherzi, Navid; Hu, Vivien; Dhingra, Vinay K; Hameed, Morad S; Chittock, Dean R; Griesdale, Donald E

    2017-07-01

    Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

  19. Predictors of Acute Kidney Injury in Neurocritical Care Patients Receiving Continuous Hypertonic Saline.

    Science.gov (United States)

    Erdman, Michael J; Riha, Heidi; Bode, Lauren; Chang, Jason J; Jones, G Morgan

    2017-01-01

    Continuous intravenous 3% hypertonic saline (HTS) infusions are commonly used for the management of cerebral edema following severe neurologic injuries. Despite widespread use, data regarding the incidence and predictors of nephrotoxicity are lacking. The purpose of this study was to describe the incidence and identify predictors of acute kidney injury (AKI) in neurocritical care patients administered continuous infusion HTS. This was an institutional review board-approved, multicenter, retrospective cohort study of patients receiving HTS infusions at 2 academic medical centers. A univariate analysis and multivariable logistic regression were used to identify predictors of AKI. Data regarding AKI were evaluated during treatment with HTS and up to 24 hours after discontinuation. A total of 329 patients were included in our analysis, with 54 (16%) developing AKI. Those who developed AKI experienced significantly longer stays in the intensive care unit (14.8 vs 11.5 days; P = .006) and higher mortality (48.1% vs 21.9%; P < .001). We identified past medical history of chronic kidney disease (odds ratio [OR]: 9.7, 95% confidence interval [CI]: 1.9-50.6; P = .007), serum sodium greater than 155 mmol/L (OR: 4.1, 95% CI: 2.1-8.0; P < .001), concomitant administration of piperacillin/tazobactam (OR: 3.9, 95% CI: 1.7-9.3; P = .002), male gender (OR: 3.2, 95% CI: 1.5-6.6; P = .002), and African American race (OR: 2.6, 95% CI: 1.3-5.2; P = .007) as independent predictors of AKI. Acute kidney injury is relatively common in patients receiving continuous HTS and may significantly impact clinical outcomes.

  20. Procalcitonin is a Poor Predictor of Non-Infectious Fever in the Neurocritical Care Unit.

    Science.gov (United States)

    Halvorson, Karin; Shah, Sameer; Fehnel, Corey; Thompson, Bradford; Stevenson Potter, N; Levy, Mitchell; Wendell, Linda

    2017-10-01

    Fever is a common occurrence in the Neurocritical Care Unit (NCCU). It is reported that up to 50 % of these fevers are associated with a non-infectious source. As this is a diagnosis of exclusion, a complete fever evaluation must be done to rule out infection. Procalcitonin (PCT) has been identified as a possible biomarker to distinguish infectious from non-infectious etiologies of fever. We hypothesized that PCT could be used as a predictor of infectious fever in febrile patients with intracranial hemorrhage admitted to the NCCU. A prospective observational cohort of patients admitted to a 12-bed NCCU in a tertiary-care university hospital from January 1, 2014, to October 1, 2014, was studied. Patients with intracranial hemorrhage (aneurismal subarachnoid hemorrhage, traumatic brain injury, intracerebral hemorrhage, or non-traumatic subdural hemorrhage) and fever defined as ≥101.4 °F were included. All patients had a urinalysis, chest X-ray, two sets of blood cultures, and PCT as part of their fever evaluation. Patients also had urine, sputum, CSF cultures, and Clostridium difficile toxin PCR as clinically indicated. Patients with incomplete fever evaluations were excluded. Seventy-three patients met inclusion criteria: 36 had infections identified and 37 did not. Type of intracranial hemorrhage was similar between groups. For those with identified infection, median PCT was 0.15 ng/mL (IQR 0.06-0.5 ng/mL). For those without identified infection, median PCT was 0.09 ng/mL (IQR 0.05-0.45 ng/mL), p = 0.30. Analyzing subgroups of intracranial hemorrhage patients revealed no group with a significant difference in PCT values. Patients with identified infection did have higher white blood cell counts (median 14.1 × 109/L (11.6-17.4 × 109/L) compared to those without identified infection 12 × 109/L (9.9-14.1 × 109/L), p = 0.02. Among patients with intracranial hemorrhage, PCT did not differentiate infectious fever from non-infectious fever.

  1. Autoregulation monitoring and outcome prediction in neurocritical care patients: Does one index fit all?

    Science.gov (United States)

    Schmidt, Bernhard; Reinhard, Matthias; Lezaic, Vesna; McLeod, Damian D; Weinhold, Marco; Mattes, Heinz; Klingelhöfer, Jürgen

    2016-06-01

    Indexes PRx and Mx have been formerly introduced to assess cerebral autoregulation and have been shown to be associated with 3-month clinical outcome. In a mixed cohort of neurocritical care patients, we retrospectively investigated the impact of selected clinical characteristics on this association. Forty-one patients (18-77 years) with severe traumatic (TBI, N = 20) and non-traumatic (N = 21) brain injuries were studied. Cerebral blood flow velocity, arterial blood pressure and intracranial pressure were repeatedly recorded during 1-h periods. Calculated PRx and Mx were correlated with 3-month clinical outcome score of modified Rankin Scale (mRS) in different subgroups with specific clinical characteristics. Both PRx and Mx correlated significantly with outcome (PRx: r = 0.38, p < 0.05; AUC = 0.64, n.s./Mx: r = 0.48, p < 0.005; AUC = 0.80, p < 0.005) in the overall group, and in patients with hemicraniectomy (N = 17; PRx: r = 0.73, p < 0.001; AUC = 0.89, p < 0.01/Mx: r = 0.69, p < 0.005; AUC = 0.87, p < 0.05). Mx, not PRx, correlated significantly with mRS in patients with heart failure (N = 17; r = 0.69, p < 0.005; AUC = 0.92, p < 0.005), and in non-traumatic patients (r = 0.49, p < 0.05; AUC = 0.79, p < 0.05). PRx, not Mx, correlated significantly with mRS in TBI patients (r = 0.63, p < 0.01; AUC = 0.89, p < 0.01). Both indexes did not correlate with mRS in diabetes patients (N = 15), PRx failed in hypocapnic patients (N = 26). Both PRx and Mx were significantly associated with 3-month clinical outcome, even in patients with hemicraniectomy. PRx was more appropriate for TBI patients, while Mx was better suited for non-traumatic patients and patients with heart failure. Prognostic values of indexes were affected by diabetes (both Mx and PRx) and hypocapnia (PRx only).

  2. Vitamin D status and 3-month Glasgow Outcome Scale scores in patients in neurocritical care: prospective analysis of 497 patients.

    Science.gov (United States)

    Guan, Jian; Karsy, Michael; Brock, Andrea A; Eli, Ilyas M; Manton, Gabrielle M; Ledyard, Holly K; Hawryluk, Gregory W J; Park, Min S

    2017-08-11

    OBJECTIVE Vitamin D deficiency has been associated with a variety of negative outcomes in critically ill patients, but little focused study on the effects of hypovitaminosis D has been performed in the neurocritical care population. In this study, the authors examined the effect of vitamin D deficiency on 3-month outcomes after discharge from a neurocritical care unit (NCCU). METHODS The authors prospectively analyzed 25-hydroxy vitamin D levels in patients admitted to the NCCU of a quaternary care center over a 6-month period. Glasgow Outcome Scale (GOS) scores were used to evaluate their 3-month outcome, and univariate and multivariate logistic regression was used to evaluate the effects of vitamin D deficiency. RESULTS Four hundred ninety-seven patients met the inclusion criteria. In the binomial logistic regression model, patients without vitamin D deficiency (> 20 ng/dl) were significantly more likely to have a 3-month GOS score of 4 or 5 than those who were vitamin D deficient (OR 1.768 [95% CI 1.095-2.852]). Patients with a higher Simplified Acute Physiology Score (SAPS II) (OR 0.925 [95% CI 0.910-0.940]) and those admitted for stroke (OR 0.409 [95% CI 0.209-0.803]) or those with an "other" diagnosis (OR 0.409 [95% CI 0.217-0.772]) were significantly more likely to have a 3-month GOS score of 3 or less. CONCLUSIONS Vitamin D deficiency is associated with worse 3-month postdischarge GOS scores in patients admitted to an NCCU. Additional study is needed to determine the role of vitamin D supplementation in the NCCU population.

  3. If You Build It, They Will Come: Initial Experience with a Multi-Disciplinary Pediatric Neurocritical Care Follow-Up Clinic

    Directory of Open Access Journals (Sweden)

    Cydni N. Williams

    2017-09-01

    Full Text Available Pediatric Neurocritical Care diagnoses account for a large proportion of intensive care admissions. Critical care survivors suffer high rates of long-term morbidity, including physical disability, cognitive impairment, and psychosocial dysfunction. To address these morbidities in Pediatric Neurocritical Care survivors, collaboration between Pediatric Neurology and Pediatric Critical Care created a multidisciplinary follow-up clinic providing specialized evaluations after discharge. Clinic referrals apply to all Pediatric Neurocritical Care patients regardless of admission severity of illness. Here, we report an initial case series, which revealed a population that is heterogenous in age, ranging from 1 month to 18 years, and in diagnoses. Traumatic brain injuries of varying severity as well as neuroinfectious and inflammatory diseases accounted for the majority of referrals. Most patients (87% seen in the clinic had morbidities identified, requiring ongoing evaluation and expansion of the clinic. Cognitive and psychological disturbance were seen in over half of patients at the initial clinic follow-up. Sleep disturbances, daytime fatigue, headache or chronic pain, and vision or hearing concerns were also common at initial follow-up. Data from this initial population of clinic patients reiterates the need for specialized follow-up care, but also highlights the difficulties related to providing this comprehensive care and evaluating interventions to improve outcomes.

  4. If You Build It, They Will Come: Initial Experience with a Multi-Disciplinary Pediatric Neurocritical Care Follow-Up Clinic.

    Science.gov (United States)

    Williams, Cydni N; Kirby, Aileen; Piantino, Juan

    2017-09-19

    Pediatric Neurocritical Care diagnoses account for a large proportion of intensive care admissions. Critical care survivors suffer high rates of long-term morbidity, including physical disability, cognitive impairment, and psychosocial dysfunction. To address these morbidities in Pediatric Neurocritical Care survivors, collaboration between Pediatric Neurology and Pediatric Critical Care created a multidisciplinary follow-up clinic providing specialized evaluations after discharge. Clinic referrals apply to all Pediatric Neurocritical Care patients regardless of admission severity of illness. Here, we report an initial case series, which revealed a population that is heterogenous in age, ranging from 1 month to 18 years, and in diagnoses. Traumatic brain injuries of varying severity as well as neuroinfectious and inflammatory diseases accounted for the majority of referrals. Most patients (87%) seen in the clinic had morbidities identified, requiring ongoing evaluation and expansion of the clinic. Cognitive and psychological disturbance were seen in over half of patients at the initial clinic follow-up. Sleep disturbances, daytime fatigue, headache or chronic pain, and vision or hearing concerns were also common at initial follow-up. Data from this initial population of clinic patients reiterates the need for specialized follow-up care, but also highlights the difficulties related to providing this comprehensive care and evaluating interventions to improve outcomes.

  5. Improvement in Quality Metrics Outcomes and Patient and Family Satisfaction in a Neurosciences Intensive Care Unit after Creation of a Dedicated Neurocritical Care Team

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    Yaw Sarpong

    2017-01-01

    Full Text Available Introduction. Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU. Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU. Methods. This is a retrospective study of data over 36 months from a 14-bed NSICU evaluating quality outcome measures and anonymous patient satisfaction questionnaires before and after neurointensivists appointment. Results. After appointment of neurointensivists, patient acuity of the NSICU increased by 33.4% while LOS decreased by 3.5%. There was a decrease in neurosciences mortality (35.8%, catheter-associated urinary tract infection (50%, central line associated bloodstream infection (100%, and ventilator-associated pneumonia (50%. During the same time, patient satisfaction increased by 28.3% on physicians/nurses consistency (p=0.025, by 69.5% in confidence/trust in physicians (p<0.0001, by 78.3% on physicians treated me with courtesy/respect (p<0.0001, and by 46.4% on physicians’ attentiveness (p<0.0001. Ultimately, patients recommending the hospital to others increased by 67.5% (p<0.0001. Conclusion. Dedicated neurointensivists and the subsequent development of a neurocritical care team positively impacted quality outcome metrics, particularly significantly improving patient satisfaction.

  6. Improvement in Quality Metrics Outcomes and Patient and Family Satisfaction in a Neurosciences Intensive Care Unit after Creation of a Dedicated Neurocritical Care Team.

    Science.gov (United States)

    Sarpong, Yaw; Nattanmai, Premkumar; Schelp, Ginger; Bell, Robert; Premkumar, Keerthivaas; Stapleton, Erin; McCormick, Ashley; Newey, Christopher R

    2017-01-01

    Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU). Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU. This is a retrospective study of data over 36 months from a 14-bed NSICU evaluating quality outcome measures and anonymous patient satisfaction questionnaires before and after neurointensivists appointment. After appointment of neurointensivists, patient acuity of the NSICU increased by 33.4% while LOS decreased by 3.5%. There was a decrease in neurosciences mortality (35.8%), catheter-associated urinary tract infection (50%), central line associated bloodstream infection (100%), and ventilator-associated pneumonia (50%). During the same time, patient satisfaction increased by 28.3% on physicians/nurses consistency (p = 0.025), by 69.5% in confidence/trust in physicians (p < 0.0001), by 78.3% on physicians treated me with courtesy/respect (p < 0.0001), and by 46.4% on physicians' attentiveness (p < 0.0001). Ultimately, patients recommending the hospital to others increased by 67.5% (p < 0.0001). Dedicated neurointensivists and the subsequent development of a neurocritical care team positively impacted quality outcome metrics, particularly significantly improving patient satisfaction.

  7. Real-Time Processing of Continuous Physiological Signals in a Neurocritical Care Unit on a Stream Data Analytics Platform.

    Science.gov (United States)

    Bai, Yong; Sow, Daby; Vespa, Paul; Hu, Xiao

    2016-01-01

    Continuous high-volume and high-frequency brain signals such as intracranial pressure (ICP) and electroencephalographic (EEG) waveforms are commonly collected by bedside monitors in neurocritical care. While such signals often carry early signs of neurological deterioration, detecting these signs in real time with conventional data processing methods mainly designed for retrospective analysis has been extremely challenging. Such methods are not designed to handle the large volumes of waveform data produced by bedside monitors. In this pilot study, we address this challenge by building a prototype system using the IBM InfoSphere Streams platform, a scalable stream computing platform, to detect unstable ICP dynamics in real time. The system continuously receives electrocardiographic and ICP signals and analyzes ICP pulse morphology looking for deviations from a steady state. We also designed a Web interface to display in real time the result of this analysis in a Web browser. With this interface, physicians are able to ubiquitously check on the status of their patients and gain direct insight into and interpretation of the patient's state in real time. The prototype system has been successfully tested prospectively on live hospitalized patients.

  8. Role of Dexmedetomidine for Sedation in Neurocritical Care Patients: A Qualitative Systematic Review and Meta-analysis of Current Evidence.

    Science.gov (United States)

    Tsaousi, Georgia G; Lamperti, Massimo; Bilotta, Federico

    2016-01-01

    This systematic review appraises the clinical evidence on efficacy and safety of dexmedetomidine (DEX), as a sole sedative or as sedative adjunct in adult neurocritical care (NCC) patients. A database search was conducted to identify randomized clinical trials and observational studies reporting the use of DEX alone or as adjunct for sedation in NCC setting. The primary outcome was the occurrence of hemodynamic changes, whereas the secondary outcomes were sedative and analgesic efficacy, quality and time to awakening, and development of adverse events. Eight trials including 3 randomized controlled trials and 5 observational studies, enrolling 650 patients, were selected. All the retrieved studies had a high risk of bias and a low to moderate quality. Dexmedetomidine provided a better sedation score and reduced analgesic requirements when compared to propofol or midazolam sedation. No statistically significant difference in the combined hemodynamic effect (hypotension or bradycardia) between DEX and controls (risk ratio, 1.50; 95% confidence interval, 0.65-3.48; P = 0.34; I = 56%) was identified. Adverse events were not consistently reported. Available clinical literature supporting the efficacy and safety of DEX use in adult NCC setting is of limited quantity and quality. However, from the current evidence on the use of DEX in NCC, as sole sedative agent or as an adjunct, seems to be both efficient and safe.

  9. To wake-up, or not to wake-up: that is the Hamletic neurocritical care question!

    Science.gov (United States)

    2012-01-01

    The need for a reliable neurological evaluation in severely brain-injured patients conflicts with sedation, which is routinely administered. Helbok and colleagues prospectively evaluated in a small cohort of 20 sedated severely brain-injured patients the effects of a wakeup test on intracranial pressure (ICP), brain tissue oxygen tension and brain metabolism. The test has been considered potentially risky on 34% of the study days. When the test is performed, ICP and cerebral perfusion pressure increase, usually slightly, except in a subgroup of patients with lower cerebral compliance where marked ICP and cerebral perfusion pressure changes were recorded. In this cohort, the information gained with the wake-up test has been negligible. Given the current little knowledge about the benefits of interruption of continuous sedation in brain-injured patients, it is extremely important to adopt multiple monitoring modalities in neurocritical care in order to escape wake-up tests in those patients who will potentially be harmed by this procedure. Once the clinical condition will improve, sedation needs to be tapered and suspended as soon as possible. PMID:23273166

  10. The Neurological Wake-up Test—A Role in Neurocritical Care Monitoring of Traumatic Brain Injury Patients?

    Directory of Open Access Journals (Sweden)

    Niklas Marklund

    2017-10-01

    Full Text Available The most fundamental clinical monitoring tool in traumatic brain injury (TBI patients is the repeated clinical examination. In the severe TBI patient treated by continuous sedation in a neurocritical care (NCC unit, sedation interruption is required to enable a clinical evaluation (named the neurological wake-up test; NWT assessing the level of consciousness, pupillary diameter and reactivity to light, and presence of focal neurological deficits. There is a basic conflict regarding the NWT in the NCC setting; can the clinical information obtained by the NWT justify the risk of inducing a stress response in a severe TBI patient? Furthermore, in the presence of advanced multimodal monitoring and neuroimaging, is the NWT necessary to identify important clinical alterations? In studies of severe TBI patients, the NWT was consistently shown to induce a stress reaction including brief increases in intracranial pressure (ICP and changes in cerebral perfusion pressure (CPP. However, it has not been established whether these short-lived ICP and CPP changes are detrimental to the injured brain. Daily interruption of sedation is associated with a reduced ventilator time, shorter hospital stay and reduced mortality in many studies of general intensive care unit patients, although such clinical benefits have not been firmly established in TBI. To date, there is no consensus on the use of the NWT among NCC units and systematic studies are scarce. Thus, additional studies evaluating the role of the NWT in clinical decision-making are needed. Multimodal NCC monitoring may be an adjunct in assessing in which TBI patients the NWT can be safely performed. At present, the NWT remains the golden standard for clinical monitoring and detection of neurological changes in NCC and could be considered in TBI patients with stable baseline ICP and CPP readings. The focus of the present review is an overview of the existing literature on the role of the NWT as a clinical

  11. The Neurological Wake-up Test-A Role in Neurocritical Care Monitoring of Traumatic Brain Injury Patients?

    Science.gov (United States)

    Marklund, Niklas

    2017-01-01

    The most fundamental clinical monitoring tool in traumatic brain injury (TBI) patients is the repeated clinical examination. In the severe TBI patient treated by continuous sedation in a neurocritical care (NCC) unit, sedation interruption is required to enable a clinical evaluation (named the neurological wake-up test; NWT) assessing the level of consciousness, pupillary diameter and reactivity to light, and presence of focal neurological deficits. There is a basic conflict regarding the NWT in the NCC setting; can the clinical information obtained by the NWT justify the risk of inducing a stress response in a severe TBI patient? Furthermore, in the presence of advanced multimodal monitoring and neuroimaging, is the NWT necessary to identify important clinical alterations? In studies of severe TBI patients, the NWT was consistently shown to induce a stress reaction including brief increases in intracranial pressure (ICP) and changes in cerebral perfusion pressure (CPP). However, it has not been established whether these short-lived ICP and CPP changes are detrimental to the injured brain. Daily interruption of sedation is associated with a reduced ventilator time, shorter hospital stay and reduced mortality in many studies of general intensive care unit patients, although such clinical benefits have not been firmly established in TBI. To date, there is no consensus on the use of the NWT among NCC units and systematic studies are scarce. Thus, additional studies evaluating the role of the NWT in clinical decision-making are needed. Multimodal NCC monitoring may be an adjunct in assessing in which TBI patients the NWT can be safely performed. At present, the NWT remains the golden standard for clinical monitoring and detection of neurological changes in NCC and could be considered in TBI patients with stable baseline ICP and CPP readings. The focus of the present review is an overview of the existing literature on the role of the NWT as a clinical monitoring tool

  12. An abrupt reduction in end tidal carbon di oxide concentration in a mechanically ventilated patient in neurocritical care ward: a capnogram artifact.

    Science.gov (United States)

    Vinay, Byrappa

    2017-02-21

    In patients with normal lung and reasonable cardiac function such as head injury patients, the PETCo2 can be used as a surrogate for partial pressure of Carbon dioxide (PaCO2) in mechanically ventilated patients. Thus early interpretation and accurate assessment of capnogram is crucial in neurocritical care patients. Here we present and discuss a scenario where in connection of a jet nebulizer to the ventilator lead to abrupt decrease in end tidal carbon dioxide leading to a diagnostic dilemma. Also this report highlights and discusses the importance of the proper placement of breathing circuit components to ensure accurate CO2 readings in particular the use of a jet nebulizer.

  13. Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study.

    Science.gov (United States)

    Pineda, Jose A; Leonard, Jeffrey R; Mazotas, Ioanna G; Noetzel, Michael; Limbrick, David D; Keller, Martin S; Gill, Jeff; Doctor, Allan

    2013-01-01

    Outcomes after traumatic brain injury are worsened by secondary insults; modern intensive-care units address such challenges through use of best-practice pathways. Organisation of intensive-care units has an important role in pathway effectiveness. We aimed to assess the effect of a paediatric neurocritical care programme (PNCP) on outcomes for children with severe traumatic brain injury. We undertook a retrospective cohort study of 123 paediatric patients with severe traumatic brain injury (Glasgow coma scale scores ≤8, without gunshot or abusive head trauma, cardiac arrest, or Glasgow coma scale scores of 3 with fixed and dilated pupils) admitted to the paediatric intensive-care unit of the St Louis Children's Hospital (St Louis, MO, USA) between July 15, 1999, and Jan 15, 2012. The primary outcome was rate of categorised hospital discharge disposition before and after implementation of a PNCP on Sept 17, 2005. We developed an ordered probit statistical model to assess adjusted outcome as a function of initial injury severity. We assessed care-team behaviour by comparing timing of invasive neuromonitoring and scored intensity of therapies targeting intracranial hypertension. Characteristics of treated patients (aged 3-219 months) were much the same between treatment periods. Before PNCP implementation, 33 (52%) of 63 patients had unfavourable disposition at hospital discharge (death or admission to an inpatient facility) and 30 (48%) had a favourable disposition (home with or without treatment); after PNCP implementation, 20 (33%) of 60 patients had unfavourable disposition and 40 (67%) had favourable disposition (p=0·01). Seven (11%) patients died before PNCP implementation compared with two (3%) deaths after implementation. The probit model indicated that outcome improved across the spectrum of Glasgow coma scale scores after resuscitation (p=0·02); this improvement progressed with increasing injury severity. Kaplan-Meier analysis suggested that

  14. Multimodality monitoring and telemonitoring in neurocritical care: from microdialysis to robotic telepresence.

    Science.gov (United States)

    Vespa, Paul M

    2005-04-01

    This review will highlight the state-of-the-art in brain monitoring in neurointensive care and define methods of integrating this technology into patient care using telemedicine methods. Several new methods of brain monitoring have been established over the last several years including continuous EEG monitoring, brain tissue oxygenation, jugular venous oxygenation, and cerebral microdialysis. Observational research using these monitors has documented that the brain metabolism, blood flow and function are dynamic after a primary insult. The dynamic nature of the brain can predispose the brain to secondary insults that can occur in the setting of intensive care. Several variables of brain metabolism and function can be monitored and directly impact treatment decisions as well as provide diagnostic and prognostic information. General treatment guidelines for brain injury and brain hemorrhage were developed, in part, prior to implementation of use of these monitors, and there is a trend away from adoption of a one-size-fits-all approach and a trend towards monitor-guided therapy. Dealing with the data provided by multimodality monitoring can be overwhelming. Efficient use of such information requires methods to integrate diverse sets of information, and methods to access the online monitoring information remotely and at any time, day or night. Such remote access integration methods will be reviewed. Multimodality and telemedicine techniques have advanced the state of knowledge about brain function in critically ill patients, and are presently being implemented to direct therapy. Increasing complexity of care will become commonplace, but will be facilitated by computer-enhanced tools that permit the intensivist to integrate this information into an improved treatment regimen.

  15. 24/7 Neurocritical Care Nurse Practitioner Coverage Reduced Door-to-Needle Time in Stroke Patients Treated with Tissue Plasminogen Activator.

    Science.gov (United States)

    Moran, Jennifer L; Nakagawa, Kazuma; Asai, Susan M; Koenig, Matthew A

    2016-05-01

    Stroke centers with limited on-site neurovascular physician coverage may experience delays in acute stroke treatment. We sought to assess the impact of providing 24/7 neurocritical care acute care nurse practitioner (ACNP) "stroke code" first responder coverage on treatment delays in acute stroke patients who received tissue plasminogen activator (tPA). Consecutive acute ischemic stroke patients treated with intravenous tPA at a primary stroke center on Oahu between 2009 and 2014were retrospectively studied. 24/7 ACNP stroke code coverage (intervention) was introduced on July 1, 2011. The tPA utilization, door-to-needle (DTN) time, imaging-to-needle (ITN) time, and independent ambulation at hospital discharge were compared between the preintervention period (24 months) and the postintervention period (33 months). We studied 166 stroke code patients who were treated with intravenous tPA, 44 of whom were treated during the preintervention period and 122 of whom were treated during the postintervention period. After the intervention, the median DTN time was reduced from 53 minutes (interquartile range [IQR] 45-73) to 45 minutes (IQR 35-58) (P = .001), and the median ITN time was reduced from 36 minutes (IQR 28-64) to 21 minutes (IQR 16-31) (P < .0001). Compliance with the 60-minute target DTN improved from 61.4% (27 of 44 patients) in the preintervention period to 81.2% (99 of 122 patients) in the postintervention period (P = .004). The tPA treatment rates were similar between the preintervention and postintervention periods (P = .60). Addition of 24/7 on-site neurocritical care ACNP first responder coverage for acute stroke code significantly reduced the DTN time among acute stroke patients treated with tPA. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Implementation of a Neurocritical Care Program: Improved Seizure Detection and Decreased Antiseizure Medication at Discharge in Neonates With Hypoxic-Ischemic Encephalopathy.

    Science.gov (United States)

    Bashir, Rani Ameena; Espinoza, Liza; Vayalthrikkovil, Sakeer; Buchhalter, Jeffrey; Irvine, Leigh; Bello-Espinosa, Luis; Mohammad, Khorshid

    2016-11-01

    We report the impact of implementing continuous video electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy via a protocol in the context of neonatal neuro-critical care program. Neonates with hypoxic-ischemic encephalopathy were studied retrospectively two years before and after implementing continuous video electroencephalography for 72 hours as a care protocol. Before continuous video electroencephalography, a 60-minute routine electroencephalography was performed at the discretion of the provider. electrographic seizure detection; secondary outcome: use of maintenance antiseizure medications, discharge antiseizure medications, and cumulative burden for each antiseizure medication defined as total mg/kg during hospital stay. A total of 157 patients with a median gestation of 40 weeks were analyzed; 103 (66%) underwent therapeutic hypothermia. Baseline and clinical characteristics including disease severity and cooling were similar. Before continuous video-electroencephalography (n = 86), 44 (51.2%) had clinical seizures, of those 35 had available routine electroencephalography; 12 of 35 (34%) had electrographic seizures. None of the infants without clinical seizures showed electrographic seizures. After continuous video-electroencephalography (n = 71), 34 (47.9%) had clinical seizures, of those 18 (53%) had electrographic seizures; five of 37 (14%) of infants with no clinical seizures had electrographic seizures. The introduction of continuous video-electroencephalography significantly increased electrographic seizure detection (P = 0.016). Although there was no significant difference in the initiation and maintenance use of antiseizure medications after continuous video-electroencephalography, fewer infants were discharged on any antiseizure medication (P = 0.008). Also, the mean phenobarbital burden reduced (P = 0.04), without increase in other antiseizure medications use or burden. Use of continuous video

  17. Decannulation and assessment of deglutition in the tracheostomized patient in non-neurocritical intensive care.

    Science.gov (United States)

    Alvo, Andrés; Olavarría, Christian

    2014-01-01

    With intensive care patients, decannulation and deglutition disorders are frequent reasons for otorhinolaryngological assessment. The objective of a tracheostomy is to maintain a patent airway. It does not necessarily prevent episodes of aspiration and may even favour them. When the cause that led to the tracheostomy resolves, a decannulation may be proposed. Deglutition is a complex act involving the coordinated interaction of several structures of the aerodigestive tract. Fibre-optic endoscopy and videofluoroscopy are 2 useful, complementary tools for the evaluation of patients with swallowing disorders. In managing these patients, a thorough knowledge of laryngeal and swallowing physiology, as well as of the different therapeutic alternatives, is required. Although it is not uncommon for swallowing disorders to coexist in tracheostomy patients, decannulation evaluation is not synonymous with deglutition assessment. A patient could be a candidate for decannulation and have a swallowing disorder, or a tracheostomy patient could swallow adequately. Knowing and understanding these concepts will lead to more efficient management and help to clarify communication between the intensive care physician and the otorhinolaryngologist. Ideally, a multidisciplinary team should be formed to evaluate and manage these patients. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  18. Head computed tomography scanning during pediatric neurocritical care: diagnostic yield and the utility of portable studies.

    Science.gov (United States)

    LaRovere, Kerri L; Brett, Molly S; Tasker, Robert C; Strauss, Keith J; Burns, Jeffrey P

    2012-04-01

    We report our use of portable head computed tomography (CT) and the diagnostic yield and radiation dose from head CT in the pediatric intensive care unit (PICU). 204 PICU patients underwent head CT during 2008-2009. Therapeutic interventions and resource intensity during CT were categorized. Severity of illness was summarized using the pediatric risk of mortality (PRISM-III) model. Estimates of patient radiation dose were based on dose measurements made in four anthropomorphic head phantoms. 242 (62%) out of 391 head CT studies were portable. New pathology was identified on 80 (40%) scans. CT findings prompted a change in management in 46 (23%) patients; 25 of these resulted in life-extending treatments and 21 had forgoing of life-sustaining treatments within 24 hours. 26 patients with PRISM score greater than 30% underwent CT; 23 (88%) of these were portable. More portable versus fixed examinations were performed in patients requiring extracorporeal membrane oxygenation, inhaled nitric oxide, high levels of positive end expiratory pressure, and those with high vasopressor scores (P change in management in 1/4 of higher acuity patients scanned. The estimated radiation dose from portable CT is within the current national guidelines.

  19. The SETscore to Predict Tracheostomy Need in Cerebrovascular Neurocritical Care Patients.

    Science.gov (United States)

    Schönenberger, Silvia; Al-Suwaidan, Faisal; Kieser, Meinhard; Uhlmann, Lorenz; Bösel, Julian

    2016-08-01

    Patients with severe stroke who require mechanical ventilation and neurointensive care unit (NICU) management often require a tracheostomy (TT). The optimal time point for TT remains unclear and a controversy in everyday NICU life. Here, we prospectively evaluated a score for prediction of TT need in NICU patients with cerebrovascular disease. Seventy-five consecutively ventilated stroke patients were prospectively included in the study and assessed by the stroke-related early tracheostomy score (SETscore) within the first 24 h of admission. Endpoints were TT need, NICU-length of stay (NICU-LOS), and ventilation time (VT). We examined the correlation of these variables with the SETscore using regression analysis and determined a cut-off by receiver operating characteristic (ROC) analysis. Twenty-six patients had to be tracheostomized. The mean VT was 8.7 ±8 days and the mean NICU-LOS was 11.6 ± 8 days. The SETscore predicted NICU-LOS with a positive predictive value of 0.748 (p < 0.001) and VT with a positive predictive value of 0.799 (p < 0.001). The ROC analysis demonstrated a SETscore value of 8 to be the optimal cut-off to predict prolonged NICU-LOS, VT, and TT need with a sensitivity of 64 % and a specificity of 86 %. Based on this monocentric study, the SETscore seems to be a valid tool to indicate prolonged NICU-LOS and VT, as well as TT need in cerebrovascular NICU patients. Confirmation of these results in larger cohorts with various settings may help to develop the SETscore as a decisive tool on primary TT early in time to avoid extubation failure.

  20. Extubating the Neurocritical Care Patient: A Spontaneous Breathing Trial Algorithmic Approach.

    Science.gov (United States)

    Mullaguri, Naresh; Khan, Zalan; Nattanmai, Premkumar; Newey, Christopher R

    2017-05-25

    Delaying extubation in neurologically impaired patients otherwise ready for extubation is a source for significant morbidity, mortality, and costs. There is no consensus to suggest one spontaneous breathing trial (SBT) over another in predicting extubation success. We studied an algorithm using zero pressure support and zero positive end-expiratory pressure (ZEEP) SBT followed by 5-cm H2O pressure support and 5-cm H2O positive end-expiratory pressure (i.e., 5/5) SBT in those who failed ZEEP SBT. This is a retrospective analysis of intubated patients in a neurosciences intensive care unit. All eligible patients were initially challenged with ZEEP SBT. If failed, a 5/5 SBT was immediately performed. If passed either the ZEEP SBT or the subsequent 5/5 SBT, patients were liberated from mechanical ventilation. In total, 108 adult patients were included. The majority of patients were successfully liberated from mechanical ventilation using ZEEP SBT alone (82.4%; p = 0.0007). Fifteen (13.8%) patients failed ZEEP SBT but immediately passed 5/5 SBT (p = 0.0005). One patient (0.93%) required reintubation. We found high sensitivity of this extubation algorithm (100; 95% CI 95.94-100%) but poor specificity (6.67; 95% CI 0.17-31.95%). This study showed that the majority of patients could be successfully liberated from mechanical ventilation after a ZEEP SBT. In those who failed, a 5/5 SBT increased the successful liberation from mechanical ventilation.

  1. Understanding and Managing the Ictal-Interictal Continuum in Neurocritical Care.

    Science.gov (United States)

    Sivaraju, Adithya; Gilmore, Emily J

    2016-02-01

    Continuous electroencephalographic (EEG) monitoring has become an invaluable tool for the assessment of brain function in critically ill patients. However, interpretation of EEG waveforms, especially in the intensive care unit (ICU) setting is fraught with ambiguity. The term ictal-interictal continuum encompasses EEG patterns that are potentially harmful and can cause neuronal injury. There are no clear guidelines on how to treat EEG patterns that lie on this continuum. We advocate the following approaches in a step wise manner: (1) identify and exclude clear electrographic seizures and status epilepticus (SE), i.e., generalized spike-wave discharges at 3/s or faster; and clearly evolving discharges of any type (rhythmic, periodic, fast activity), whether focal or generalized; (2) exclude clear interictal patterns, i.e., spike-wave discharges, periodic discharges, and rhythmic patterns at 1/s or slower with no evolution, unless accompanied by a clear clinical correlate, which would make them ictal regardless of the frequency; (3) consider any EEG patterns that lie in between the above two categories as being on the ictal-interictal continuum; (4) compare the electrographic pattern of the ictal-incterictal continuum to the normal background and unequivocal seizures (if present) from the same patient; (5) when available, correlate ictal-interictal continuum pattern with other markers of neuronal injury such as neuronal specific enolase (NSE) levels, brain imaging findings, depth electrode recordings, data from microdialysis, intracranial pressure fluctuations, and brain oxygen measurement; and (6) perform a diagnostic trial with preferably a nonsedating antiepileptic drug with the endpoint being both clinical and electrographic improvement. Minimize the use of anesthetics or multiple AEDs unless there is clear supporting evidence from ancillary tests or worsening of the EEG patterns over time, which could indicate possible neuronal injury.

  2. Nutrition in neurocritical care

    OpenAIRE

    Afzal Azim; Armin Ahmed

    2016-01-01

    Adequate nutritional therapy is essential for recovery from critical illness. Nutritional requirement varies in different patients and varies daily in a single patient. Both under and over feeding are associated with complications. Besides this, not all patients behave in a similar way to nutritional therapy. Appropriate nutritional therapy requires identification of patients “at nutritional risk” and providing aggressive nutritional support to them. The current article deals with nutritional...

  3. Postoperative Care of Patients with High-grade Glioma: Is There a Real Need for the Neurocritical ICU and Early CT Scan?

    Science.gov (United States)

    Altieri, Roberto; Cofano, Fabio; Agnoletti, Alessandro; Fornaro, Riccardo; Ajello, Marco; Zenga, Francesco; Ducati, Alessandro; Garbossa, Diego

    2017-03-24

    Background Pressure on economic resources now requires a careful rationalization of services. For adult patients with supratentorial gliomas, there is no consensus on the real need for care in a postoperative neurocritical intensive care unit (NICU) and on the timing of a postsurgical computed tomography (CT) scan. In this retrospective nonrandomized study, we assessed if and when there is a real need for NICU and if an early CT scan could be justified in the absence of neurologic worsening. Methods Of 264 patients, 21 were admitted to the NICU after the procedure as planned before the surgery for their clinical features (Karnofsky performance status  2, or Charlson Comorbidity Index > 5). Results The mean stay in the NICU was 19.7 hours. One of these patients had developed a postoperative hematoma that was subsequently removed, and died afterward. The other 243 patients were followed clinically after the procedure: 219 underwent a cerebral CT scan 24 hours after the procedure and were discharged in good condition. The other 24 patients had a cerebral CT scan within 24 hours after the procedure. The early CT showed the presence of a local edema in five cases and a hematoma surgically treated with a subsequent admission to the NICU in two cases. Conclusion Considering our data, we suggest that NICU should not always be used after craniotomy for supratentorial gliomas. Clinical observation was sufficient to predict early postoperative complications. A CT scan before 24 hours after surgery is not recommended in the absence of clinical worsening. Georg Thieme Verlag KG Stuttgart · New York.

  4. Caring for lesbians in a homophobic society.

    Science.gov (United States)

    Gentry, S E

    1992-01-01

    Lesbians and gays have suffered for centuries from stigmatization by homophobic, heterosexual people in Western society. It is critical for health care providers to have an understanding of alternative life-styles and the unique health concerns of homosexual people in order to provide sensitive and knowledgeable health care. Lesbian health issues such as assessing the sexual orientation of lesbians, parenting issues, lesbian battering, and the older lesbian woman are discussed. My intent in writing this article is to increase the sensitivity, knowledge, and awareness of health care providers caring for lesbians in a homophobic society.

  5. National survey on thromboprophylaxis and anticoagulant or antiplatelet management in neurosurgical and neurocritical patients.

    Science.gov (United States)

    Vázquez-Alonso, E; Fábregas, N; Rama-Maceiras, P; Ingelmo Ingelmo, I; Valero Castell, R; Valencia Sola, L; Iturri Clavero, F

    2015-12-01

    To determine the protocols used by Spanish anaesthesiologists for thromboprophylaxis and anticoagulant or antiplatelet drugs management in neurosurgical or neurocritical care patients. An online survey with 22 questions, with one or multiple options, launched by the Neuroscience Subcommittee of the Spanish Anaesthesia Society and available between June and October 2012. Of the 73 hospitals included in the National Hospitals Catalogue, a valid response to the online questionnaire was received by 41 anaesthesiologists from 37 sites (response rate 50.7%). Only one response per site was used. A specific protocol was available in 27% of these centres. Mechanical thromboprophylaxis is used, intraoperatively or postoperatively, in 80%, and pharmacological treatment is used by 75% of respondents. Enoxaparin was the most frequent heparin used in craniotomy patients (78%). Craniotomies were performed maintaining acetylsalicylic acid treatment in patients with coronary stents and double anti-platelet treatment in a half of the centres. Mechanical thromboprophylaxis is used more frequently than the pharmacological approach in neurosurgical or neurocritical populations in Spanish hospitals. Management of patients under previous anticoagulant treatment was highly heterogeneous among hospitals included in this survey. Previous antiplatelet treatment is modified depending on primary or secondary prescription. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Translating biomarkers from research to clinical use in pediatric neurocritical care: focus on traumatic brain injury and cardiac arrest.

    Science.gov (United States)

    Prout, Andrew J; Wolf, Michael S; Fink, Ericka L

    2017-06-01

    Traumatic brain injury (TBI) and cardiac arrest are important causes of morbidity and mortality in children. Improved diagnosis and outcome prognostication using validated biomarkers could allow clinicians to better tailor therapies for optimal efficacy. Contemporary investigation has yielded plentiful biomarker candidates of central nervous system (CNS) injury, including macromolecules, genetic, inflammatory, oxidative, and metabolic biomarkers. Biomarkers have yet to be validated and translated into bedside point-of-care or cost-effective and efficient laboratory tests. Validation testing should consider developmental status, injury mechanism, and time trajectory with patient-centered outcomes. Recent investigation of biomarkers of CNS injury may soon improve diagnosis, management, and prognostication in children with traumatic brain injury and cardiac arrest.

  7. Early Physiotherapy by Passive Range of Motion Does Not Affect Partial Brain Tissue Oxygenation in Neurocritical Care Patients.

    Science.gov (United States)

    Roth, Christian; Stitz, Hubertus; Kleffmann, Jens; Kaestner, Stefanie; Deinsberger, Wolfgang; Ferbert, Andreas; Gehling, Markus

    2017-01-01

    Background Studies investigating multimodal cerebral monitoring including partial brain tissue oxygen monitoring (ptiO2) in neuro-intensive care patients during physiotherapy are completely lacking in the literature. Materials and Methods We performed a post hoc analysis of prospectively collected data of patients on multimodal cerebral monitoring by intracranial pressure (ICP) and cerebral perfusion pressure (CPP) measurement as well as ptiO2. Patients with severe brain diseases were treated with passive range of motion (PROM). We recorded ICP, CPP, and ptiO2 continuously every minute at baseline (15 minutes), during treatment (26 minutes), and 15 minutes after treatment with PROM. Results Overall, 25 treatment units with PROM in 10 patients with combined ICP/CPP and ptiO2 monitoring were evaluated. Median ICP, CPP, and ptiO2 at baseline were 12 ± 6.1 mm Hg, 86 ± 17.1 mm Hg, and 27 ± 14.3 mm Hg, respectively. Values for ICP, CPP, and ptiO2 did not change significantly when comparing mean values before, during, and after therapy. Conclusions Based on ptiO2 measurements, our data provide new information about the feasibility and safety of physiotherapy in patients with severe brain diseases. Georg Thieme Verlag KG Stuttgart · New York.

  8. Assessment of Platelet Function in Traumatic Brain Injury—A Retrospective Observational Study in the Neuro-Critical Care Setting

    Directory of Open Access Journals (Sweden)

    Caroline Lindblad

    2018-01-01

    Full Text Available BackgroundDespite seemingly functional coagulation, hemorrhagic lesion progression is a common and devastating condition following traumatic brain injury (TBI, stressing the need for new diagnostic techniques. Multiple electrode aggregometry (MEA measures platelet function and could aid in coagulopathy assessment following TBI. The aims of this study were to evaluate MEA temporal dynamics, influence of concomitant therapy, and its capabilities to predict lesion progression and clinical outcome in a TBI cohort.Material and methodsAdult TBI patients in a neurointensive care unit that underwent MEA sampling were retrospectively included. MEA was sampled if the patient was treated with antiplatelet therapy, bled heavily during surgery, or had abnormal baseline coagulation values. We assessed platelet activation pathways involving the arachidonic acid receptor (ASPI, P2Y12 receptor, and thrombin receptor (TRAP. ASPI was the primary focus of analysis. If several samples were obtained, they were included. Retrospective data were extracted from hospital charts. Outcome variables were radiologic hemorrhagic progression and Glasgow Outcome Scale assessed prospectively at 12 months posttrauma. MEA levels were compared between patients on antiplatelet therapy. Linear mixed effect models and uni-/multivariable regression models were used to study longitudinal dynamics, hemorrhagic progression and outcome, respectively.ResultsIn total, 178 patients were included (48% unfavorable outcome. ASPI levels increased from initially low values in a time-dependent fashion (p < 0.001. Patients on cyclooxygenase inhibitors demonstrated low ASPI levels (p < 0.001, while platelet transfusion increased them (p < 0.001. The first ASPI (p = 0.039 and TRAP (p = 0.009 were significant predictors of outcome, but not lesion progression, in univariate analyses. In multivariable analysis, MEA values were not independently correlated with outcome

  9. Biochemical Markers in Neurocritical Care

    Directory of Open Access Journals (Sweden)

    Omidvar Rezae

    2016-07-01

    Full Text Available During the past two decades, a variety of serum or cerebrospinal fluid (CSF biochemical markers in daily clinical practice have been recommended to diagnose and monitor diverse diseases or pathologic situations. It will be essential to develop a panel of biomarkers, to be suitable for evaluation of treatment efficacy, representing distinct phases of injury and recovery and consider the temporal profile of those. Among the possible and different biochemical markers, S100b appeared to fulfill many of optimized criteria of an ideal marker. S100b, a cytosolic low molecular weight dimeric calciumbinding protein from chromosome 21, synthesized in glial cells throughout the CNS, an homodimeric diffusible, belongs to a family of closely related protein, predominantly expressed by astrocytes and Schwann cells and a classic immunohistochemical marker for these cells, is implicated in brain development and neurophysiology. Of the 3 isoforms of S-100, the BB subunit (S100B is present in high concentrations in central and peripheral glial and Schwann cells, Langerhans and anterior pituitary cells, fat, muscle, and bone marrow tissues. The biomarker has shown to be a sensitive marker of clinical and subclinical cerebral damage, such as stroke, traumatic brain injury, and spinal cord injury. Increasing evidence suggests that the biomarker plays a double function as an intracellular regulator and an extracellular signal of the CNS. S100b is found in the cytoplasm in a soluble form and also is associated with intracellular membranes, centrosomes, microtubules, and type III intermediate filaments. Their genomic organization now is known, and many of their target proteins have been identified, although the mechanisms of regulating S100b secretion are not completely understood and appear to be related to many factors, such as the proinflammatory cytokines, tumor necrosis factor alpha (TNF-a, interleukin (IL-1b, and metabolic stress. 

  10. European Cystic Fibrosis Society Standards of Care

    DEFF Research Database (Denmark)

    Stern, Martin; Bertrand, Dominique Pougheon; Bignamini, Elisabetta

    2014-01-01

    therapies, approaches to care and indeed data recording. The quality of care for individuals with CF has become a focus at several levels: patient, centre, regional, national and international. This paper reviews the quality management and improvement issues at each of these levels with particular reference...

  11. Intergenerational care in the Danish welfare society

    DEFF Research Database (Denmark)

    Singla, Rashmi

    2015-01-01

    I denne artikel undersøger vi generationsforholdet mellem yngre voksne og deres forældre i det danske velfærdssamfund. Vores fokus er på omsorgspraksis og på slægtledsforpligtelser (filial responsibility). Artiklen omfatter dybdeanalyser af omsorgspraksis og intergenerationelle normer (filial nor...... individuel livsorientering ikke udelukker intergenerationel solidaritet i den danske velfærdsstat. Keywords: intergenerational care, individualisation, communality/ interconnectedness, social network analysis, ideals, everyday practices, social psychology....

  12. Effectiveness and Tolerability of Conivaptan and Tolvaptan for the Treatment of Hyponatremia in Neurocritically Ill Patients.

    Science.gov (United States)

    Der-Nigoghossian, Caroline; Lesch, Christine; Berger, Karen

    2017-05-01

    To describe the effectiveness and tolerability of conivaptan and tolvaptan for the correction of hyponatremia in neurocritically ill patients. Retrospective cohort study. Neurointensive care units at two academic medical centers. Thirty-six adults admitted to the neurocritical care unit who received at least one dose of conivaptan (5 patients) or tolvaptan (31 patients) between June 2012 and May 2013. A single oral dose or intravenous bolus was administered to 23 (74%) patients who received tolvaptan and 2 (40%) patients who received conivaptan, respectively. The mean maximal increase in serum sodium level at 24 hours following the last dose compared with baseline was 5.2 mEq/L for conivaptan (p=0.05) and 7.9 mEq/L for tolvaptan (ptolvaptan and none of the patients receiving conivaptan. Hypotension occurred in 20% of patients receiving conivaptan and 52% of patients receiving tolvaptan, whereas hypokalemia was observed in 40% of patients receiving conivaptan. Use of vaptans in neurocritically ill patients led to a significant increase in serum sodium level at 24 hours after the last dose, which was sustained for 96 hours, with the majority of patients receiving a single dose. Risk of sodium overcorrection was high and necessitates appropriate patient selection and frequent monitoring. © 2017 Pharmacotherapy Publications, Inc.

  13. [Consensus on hereditary cancer between the Spanish Oncology Society and the primary care societies].

    Science.gov (United States)

    Robles, L; Balmaña, J; Barrel, I; Grandes, S; Graña, B; Guillén, C; Marcos, H; Ramírez, D; Redondo, E; Sánchez, J

    2013-01-01

    It is believed that 5% of all cancers are hereditary, on being caused by mutations in the germinal line in cancer susceptibility genes. The hereditary pattern in the majority of cases is autosomal dominant. Genetic tests are only recommended to individuals whose personal or family history is highly suggestive of a hereditary cancer. The appropriate assessment of these individuals and their families must be performed in Cancer Genetic Counselling Units (UCGC). Representatives of the Spanish Medical Oncology Society (Sociedad Española de Oncología Médica [SEOM]) and the three primary care scientific societies: Spanish Society of Family and Community Medicine (Sociedad Española de Medicina de Familia y Comunitaria [SEMFyC]), Spanish Society of Primary Care Physicians (Sociedad Española de Médicos de Atención Primaria [SEMERGEN]) and the Spanish Society of General and Family Doctors (Sociedad Española de Médicos Generales y de Familia [SEMG]), met to prepare this consensus document on hereditary cancer. The consensus identified the three main aspects: how to identify subjects at risk of hereditary cancer; how to refer to a UCGC; and the usefulness of the assessment and genetic studies. A document, with the text fully agreed by all the participants, has been prepared. It contains a summary of the principal characteristics of the care for individuals with hereditary cancer. It shows how to; identify them, assess them, refer them to a UCGC. How to assess their genetic risk, perform genetic studies, as well as prevention measures and reduction of the risk is also presented. This consensus document is a landmark in the relationships with several Scientific Societies that represent the professionals who provide care to individuals with cancer and their families, and will help to improve care in hereditary cancer in Spain. Copyright © 2013. Publicado por Elsevier España.

  14. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    Science.gov (United States)

    Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A

    2016-02-20

    The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for

  15. Guidelines for Percutaneous Dilatational Tracheostomy (PDT) from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbæk; Guldager, Henrik; Rewers, Mikael

    2011-01-01

    Percutaneous dilatational tracheostomy is a common procedure in intensive care. This guideline from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM) describes indications and contraindications, timing, complications...

  16. [Tuberculosis care and new horizon of Japanese society].

    Science.gov (United States)

    Ishikawa, Nobukatsu; Nagayama, Naohiro

    2012-04-01

    Current tuberculosis (TB) problems are reflections of Japanese society. Living or dying alone among the elderly, difficulty in finding jobs or withdrawal into themselves among the youths are features of modem society. The future needs for TB care were discussed on specific topics of TB among the elderly, foreigners and the homeless. Presenters showed the importance of the patient-centered care in collaboration with public health and welfare services. Both patients and staffs will see others shining, as they touch each other in the deep part of human existence. A diabetic ex-TB patient talked his experience in his treatment. His window of mind was gradually opened from inside with the continuous support in DOTS by the staff of the public health center. To accumulate these experiences of a heartwarming atmosphere will have the effective power on establishment of social supporting systems. This symposium can be a step towards humanized society or a new horizon of public health which can answer to another need of inner cry of a sick people particularly among the socially disadvantaged who are the victims of the weakness of society. 1. Current situation and issues of elderly tuberculosis patients: Eriko SHIGETO (NHO Higashihiroshima Medical Center). By the analysis of 102 tuberculosis patients of 70 years old and above who were registered at Hiroshima Prefectural Health Center in 2009, 41 patients had severe complications such as diabetes mellitus, renal insufficiency, malignancy or cerebrovascular disorder. Their prognosis was rather poor and the ADL tended to be worsened during hospitalization. Though 16 of the 34 deaths were caused with non-tuberculosis diseases, the ratio of the tuberculosis deaths was higher (4/17) among the patients living alone. Sufficient care of the elderly for early diagnosis, care system to treat various complications and patient support are required. 2. Provision of medical interpreters to help foreigners with tuberculosis in Tokyo: Takashi

  17. Caring for ACHD in a market-driven society.

    Science.gov (United States)

    Williams, Roberta G; Lu, Yang

    2011-01-01

    Our cardiology community is responding to the growing number of emerging adults with often complex congenital heart disease. Collaborations are springing up between adult and pediatric cardiologists, advanced practice nurses, patients, and families to address the health care, research, and advocacy needs for this population. Workforce and institutional needs are being defined and research collaborations are being formed. Meanwhile, health care reform is evolving through fits and starts with little predictability regarding its medium and long-term impact. Since ultimately finances trump philosophy, it is essential that we understand the financial underpinnings of healthcare delivery to patients with this unique model of chronic disease in order to carry out these plans. What is unique about this population with chronic disease? The most obvious feature is that they have the potential of contributing to the GDP for 40+ years. Another is that for the more complex lesions, society has already invested a considerable amount to achieve survival into adult life. Finally, the period of early adulthood is relatively uneventful in terms of complications and resource utilization compared with early childhood and later adult life. Thus, the basic needs to maintain cardiovascular status and prevent secondary disability may be modest in comparison with treating some of the severe consequences of their disease, such as poorly managed valve regurgitation or arrhythmia that eventually requires costly solutions such as transplantation. It is important, therefore, to define the resource requirements and potential health outcomes of a healthcare system that would be designed for this population.

  18. Controversies in neurosciences critical care.

    Science.gov (United States)

    Chang, Tiffany R; Naval, Neeraj S; Carhuapoma, J Ricardo

    2012-06-01

    Neurocritical care is an evolving subspecialty with many controversial topics. The focus of this review is (1) transfusion thresholds in patients with acute intracranial bleeding, including packed red blood cell transfusion, platelet transfusion, and reversal of coagulopathy; (2) indications for seizure prophylaxis and choice of antiepileptic agent; and (3) the role of specialized neurocritical care units and specialists in the care of critically ill neurology and neurosurgery patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. American Geriatrics Society care of lesbian, gay, bisexual, and transgender older adults position statement: American Geriatrics Society Ethics Committee.

    Science.gov (United States)

    2015-03-01

    There is ample evidence that lesbian, gay, bisexual, and transgender (LGBT) individuals face discrimination in the healthcare setting. Providing high-quality health care for older LGBT adults will require active steps by organizations, institutions, advocacy groups, and health professionals that create an environment that is free from discrimination. This position statement that the American Geriatrics Society (AGS) Ethics Committee developed addresses the vision of the AGS for the care of LGBT older adults and specific steps that can be taken to ensure that they receive the care that they need. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  20. A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health-care Professionals. A Call for Action.

    Science.gov (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

    2016-07-01

    Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients.

  1. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

    Science.gov (United States)

    Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

    2016-12-01

    Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.

  2. [Challenges and potentials of primary care in a multicultural society].

    Science.gov (United States)

    Bungartz, J; Joos, S; Steinhäuser, J; Szecsenyi, J; Freund, T

    2011-11-01

    The greatest proportion of basic health care for patients with a migrational background living in Germany is provided by general practitioners. There is evidence that patients with a migrational background see a general practitioner as a gate keeper in case of physical or mental complaints even more frequently than the native German population. In contrast, the impact of migration-specific tasks in general practice appears to be relatively low in the medical and public discourse. This article analyzes the current situation of medical care for migrant patients in general practice and shows its potential to offer low-threshold high quality health care services to migrant patients and the whole population. In addition, an overview on migration-specific issues in research, teaching, and continuous medical education of general practitioners is provided. Finally, the implications of these findings for future research questions on migration-sensitive interventions are discussed.

  3. The role of civil society in health care reforms: an arena for hegemonic struggles.

    Science.gov (United States)

    Filc, Dani

    2014-12-01

    The present paper argues that current mainstream understandings of civil society as ontologically different from the state and essentially positive (either normative or functionally) are problematic in order to understand the development of health care reforms. The paper proposes to ground an explanation of the role of civil society in health care reforms in a Gramscian understanding of civil society as analytically different from the state, and as an arena for hegemonic struggles. The study of health care reform in Israel serves as a case study for this claim. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Annual report of Women's Health Care Committee, Japan Society of Obstetrics and Gynecology, 2013.

    Science.gov (United States)

    Douchi, Tsutomu; Wakatsuki, Akihiko

    2014-02-01

    The activity of the Women's Health Care Committee for 1 year up to June 2013 includes: (i) guides for the management of health care in middle-aged women; (ii) postoperative women's health care; (iii) survey on the treatment of pelvic organ prolapse; and (iv) survey of postoperative infection in gynecologic surgery. The detailed activity of the four subcommittees is described in the text. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  5. Spreading depolarization monitoring in neurocritical care of acute brain injury.

    Science.gov (United States)

    Hartings, Jed A

    2017-04-01

    Spreading depolarizations are unique in being discrete pathologic entities that are well characterized experimentally and also occur commonly in patients with substantial acute brain injury. Here, we review essential concepts in depolarization monitoring, highlighting its clinical significance, interpretation, and future potential. Cortical lesion development in diverse animal models is mediated by tissue waves of mass spreading depolarization that cause the toxic loss of ion homeostasis and limit energy substrate supply through associated vasoconstriction. The signatures of such deterioration are observed in electrocorticographic recordings from perilesional cortex of patients with acute stroke or brain trauma. Experimental work suggests that depolarizations are triggered by energy supply-demand mismatch in focal hotspots of the injury penumbra, and depolarizations are usually observed clinically when other monitoring variables are within recommended ranges. These results suggest that depolarizations are a sensitive measure of relative ischemia and ongoing secondary injury, and may serve as a clinical guide for personalized, mechanistically targeted therapy. Both existing and future candidate therapies offer hope to limit depolarization recurrence. Electrocorticographic monitoring of spreading depolarizations in patients with acute brain injury provides a sensitive measure of relative energy shortage in focal, vulnerable brains regions and indicates ongoing secondary damage. Depolarization monitoring holds potential for targeted clinical trial design and implementation of precision medicine approaches to acute brain injury therapy.

  6. Brain injury following cardiac arrest: pathophysiology for neurocritical care.

    Science.gov (United States)

    Uchino, Hiroyuki; Ogihara, Yukihiko; Fukui, Hidekimi; Chijiiwa, Miyuki; Sekine, Shusuke; Hara, Naomi; Elmér, Eskil

    2016-01-01

    Cardiac arrest induces the cessation of cerebral blood flow, which can result in brain damage. The primary intervention to salvage the brain under such a pathological condition is to restore the cerebral blood flow to the ischemic region. Ischemia is defined as a reduction in blood flow to a level that is sufficient to alter normal cellular function. Brain tissue is highly sensitive to ischemia, such that even brief ischemic periods in neurons can initiate a complex sequence of events that may ultimately culminate in cell death. However, paradoxically, restoration of blood flow can cause additional damage and exacerbate the neurocognitive deficits in patients who suffered a brain ischemic event, which is a phenomenon referred to as "reperfusion injury." Transient brain ischemia following cardiac arrest results from the complex interplay of multiple pathways including excitotoxicity, acidotoxicity, ionic imbalance, peri-infarct depolarization, oxidative and nitrative stress, inflammation, and apoptosis. The pathophysiology of post-cardiac arrest brain injury involves a complex cascade of molecular events, most of which remain unknown. Many lines of evidence have shown that mitochondria suffer severe damage in response to ischemic injury. Mitochondrial dysfunction based on the mitochondrial permeability transition after reperfusion, particularly involving the calcineurin/immunophilin signal transduction pathway, appears to play a pivotal role in the induction of neuronal cell death. The aim of this article is to discuss the underlying pathophysiology of brain damage, which is a devastating pathological condition, and highlight the central signal transduction pathway involved in brain damage, which reveals potential targets for therapeutic intervention.

  7. Ethical dilemmas in palliative care in traditional developing societies, with special reference to the Indian setting.

    Science.gov (United States)

    Chaturvedi, S K

    2008-08-01

    There are intriguing and challenging ethical dilemmas in the practice of palliative care in a traditional developing society. To review the different ethical issues involved in cancer and palliative care in developing countries, with special reference to India. Published literature on pain relief and palliative care in the developing countries was reviewed to identify ethical issues and dilemmas related to these, and ways in which ethical principles could be observed in delivery of palliative care in such countries are discussed. The literature review revealed a number of ethical dilemmas and challenges that professionals, cancer patients and their families encountered during palliative care. It was noted that patients' preferences and decisions are influenced by family members. Dilemmas leave the professionals and families confused about how ethical their actions have been. Specific ethical issues were noted in relation to the availability and use of oral morphine for pain relief, spiritual care, lack of adequate palliative care services, and palliative care education. The four principles of ethics posed difficulties in understanding the complex ethical issues in a developing country with a traditional background. Ethical issues need to be handled delicately and sensitively in palliative care settings, within the framework of the traditions and culture of the society and financial constraints. The possible role of ethics committees in palliative care settings to help decision-making needs to be studied and discussed.

  8. European AIDS Clinical Society Second Standard of Care Meeting, Brussels 16-17 November 2016

    DEFF Research Database (Denmark)

    De Wit, S; Battegay, M; D'Arminio Monforte, A

    2017-01-01

    The European AIDS Clinical Society (EACS) organized a second meeting on Standard of Care in Europe on November 16-17 th, 2016. The aims of the meeting were to discuss and propose actions on three topics, namely: Adherence to guidelines for treatment initiation, treatment monitoring and outcomes......, Retention in care and HIV and tuberculosis co-infection. Several actions need to be implemented in order to further improve quality of care and treatment of HIV in Europe. A common ground for standard of care, based on the EACS Guidelines should be established throughout Europe. EACS plans to interact....... Improving integration of services and accessibility to care play a major role. Integration is also key for optimizing care of HIV-tuberculosis co-infection, as well as diagnosis and prevention of tuberculosis in population at risk. The Standard of Care meeting organized every other year by EACS provides...

  9. [The cultural history of palliative care in primitive societies: an integrative review].

    Science.gov (United States)

    Siles González, José; Solano Ruiz, Maria Del Carmen

    2012-08-01

    The objective of this study is to describe the evolution of palliative care in order to reflect on the possibility of its origin in primitive cultures and their relationship with the beginnings of the cult of the dead. It describes the change in the symbolic structures and social interactions involved in palliative care during prehistory: functional unit, functional framework and functional element. The theoretical framework is based on cultural history, the dialectical structural model and symbolic interactionism. Categorization techniques, cultural history and dialectic structuralism analyses were performed. Palliative care existed in primitive societies, mostly associated with the rites of passage with a high symbolic content. The social structures - functional unit, functional framework and functional element - are the pillars that supported palliative care in prehistory societies.

  10. Palliative care in a multicultural society: perceptions of health care professionals.

    Science.gov (United States)

    McNamara, B; Martin, K; Waddell, C; Yuen, K

    1997-09-01

    This study assesses the perceived competence of 191 Australian palliative care professionals in delivering crosscultural care. The relationship between the perceived competence levels of professionals and their experience and training is examined. Strategies to improve crosscultural palliative care, as suggested by palliative care providers, are also presented. Information about perceived competence and the kinds of difficulties encountered in crosscultural palliative care interactions form the basis of suggested guidelines for proposed education programmes. The results of this study suggest that specific education, rather than individual experience of crosscultural interactions, which may not always be positive, is needed to improve the competence of palliative care professionals. Education, therefore, is the key to the provision of culturally appropriate care to patients and their families from all cultural backgrounds.

  11. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections: The Rome Statements

    NARCIS (Netherlands)

    Mussini, C.; Antinori, A.; Bhagani, S.; Branco, T.; Brostrom, M.; Dedes, N.; Bereczky, T.; Girardi, E.; Gökengin, D.; Horban, A.; Lacombe, K.; Lundgren, J. D.; Mendao, L.; Mocroft, A.; Oprea, C.; Porter, K.; Podlekareva, D.; Battegay, M.; d'Arminio Monforte, A.; Mulcahy, Fiona; Geretti, Anna Maria; Clumeck, Nathan; Reiss, Peter; Arribas, Jose; Gatell, Jose; Katlama, Christine; Pozniak, Anton; Rockstroh, Jürgen; Youle, Mike; Friis-Møller, Nina; Rusconi, Stefano; Behrens, Georg; de Wit, Stéphane; Furrer, Hansjakob; Wensing, Annemarie; John Gill, M.; Letendre, Scott

    2016-01-01

    The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. Data-driven presentations were given on specific topics followed by interactive panel

  12. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections : The Rome Statements

    NARCIS (Netherlands)

    Mussini, C.; Antinori, A.; Bhagani, S.; Branco, T.; Brostrom, M.; Dedes, N.; Bereczky, T.; Girardi, E.; Gökengin, D.; Horban, A.; Lacombe, K.; Lundgren, J. D.; Mendao, L.; Mocroft, A.; Oprea, C.; Porter, K.; Podlekareva, D.; Battegay, M.; d'Arminio Monforte, A.; Mulcahy, Fiona; Geretti, Anna Maria; Clumeck, Nathan; Reiss, Peter; Arribas, Jose; Gatell, Jose; Katlama, Christine; Pozniak, Anton; Rockstroh, Jürgen; Youle, Mike; Friis-Møller, Nina; Rusconi, Stefano; Behrens, Georg; De Wit, Stéphane; Furrer, Hansjakob; Wensing, Annemarie|info:eu-repo/dai/nl/30817724X; John Gill, M.; Letendre, Scott

    2016-01-01

    Objectives: The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. Methods: Data-driven presentations were given on specific topics followed

  13. European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

    NARCIS (Netherlands)

    McDonagh, Theresa A.; Blue, Lynda; Clark, Andrew L.; Dahlstroem, Ulf; Ekman, Inger; Lainscak, Mitja; McDonald, Kenneth; Ryder, Mary; Stroemberg, Anna; Jaarsma, Tiny

    The management of heart failure (HF) is complex. As a consequence, most cardiology society guidelines now state that HF care should be delivered in a multiprofessional manner. The evidence base for this approach now means that the establishment of HF management programmes is a priority. This

  14. Disparities in psychosocial cancer care: a report from the International Federation of Psycho-oncology Societies.

    Science.gov (United States)

    Grassi, Luigi; Fujisawa, Daisuke; Odyio, Philip; Asuzu, Chioma; Ashley, Laura; Bultz, Barry; Travado, Luzia; Fielding, Richard

    2016-10-01

    The aim of the study was to understand the characteristics of the International Federation of Psycho-oncology Societies (FPOS) and possible disparities in providing psychosocial care in countries where psycho-oncology societies exist. A survey was conducted among 29 leaders of 28 countries represented within the FPOS by using a questionnaire covering (i) characteristics of the society; (ii) characteristics of the national health care system; (iii) level of implementation of psycho-oncology; and (iv) main problems of psycho-oncology in the country. Twenty-six (90%) FPOS returned the questionnaires. One-third reported to have links with and support from their government, while almost all had links with other scientific societies. The FPOS varied in their composition of members' professions. Psychosocial care provision was covered by state-funded health services in a minority of countries. Disparities between countries arose from different causes and were problematic in some parts of the world (eg, Africa and SE Asia). Elsewhere (eg, Southern Europe and Eastern Europe), austerity policies were reportedly responsible for resource shortages with negative consequences on psychosocial cancer care. Half of FPOS rated themselves to be integrated into mainstream provision of care, although lack of funding was the most common complain. The development and implementation of psycho-oncology is fragmented and undeveloped, particularly in some parts of the world. More effort is needed at national level by strong coalitions with oncology societies, better national research initiatives, cancer plans, and patient advocacy, as well as by stronger partnership with international organizations (eg, World Health Organization and Union for International Cancer Control). Copyright © 2016 John Wiley & Sons, Ltd.

  15. Annual report of the Women's Health Care Committee, Japan Society of Obstetrics and Gynecology, 2016.

    Science.gov (United States)

    Takamatsu, Kiyoshi; Kitawaki, Jo

    2016-11-01

    In order to improve women's quality of life, over the year leading up to June 2016, the Women's Health Care Committee of the Japan Society of Obstetrics and Gynecology focused upon: (i) breast management; (ii) influence of a therapy for gynecologic disease on physical condition; (iii) nonsurgical management of pelvic organ prolapse; (iv) survey of infectious diseases in Obstetrics and Gynecology in Japan; (v) health care for female athletes; (vi) a training program for women's health-care advisers; and (vii) revising the Japanese guideline on hormone-replacement therapy. In order to publicize the activities of our committee widely, the detailed activities of the seven subcommittees are described in this report, which is based on the Japanese version of the annual report (Acta Obst Gynaec Jpn 2016; 68 (6): 1404-1416). © 2016 Japan Society of Obstetrics and Gynecology.

  16. 2014 President's plenary international psycho-oncology society: moving toward cancer care for the whole patient.

    Science.gov (United States)

    Bultz, Barry D; Travado, Luzia; Jacobsen, Paul B; Turner, Jane; Borras, Josep M; Ullrich, Andreas W H

    2015-12-01

    The International Psycho-oncology Society (IPOS) has just celebrated its 30th anniversary. The growth of psychosocial oncology has been exponential, and this relatively new field is becoming a core service that focuses on prevention, reducing the burden of cancer, and enhancing the quality of life from time of diagnosis, through treatment, survivorship, and palliative care. Looking back over the past 30 years, we see that cancer care globally has evolved to a new and higher standard. Today, 'cancer care for the whole patient' is being accomplished with an evidence-based model that addresses psychosocial needs and integrates psycho-oncology into the treatment and care of patients. The President's Plenary Session in Lisbon, Portugal, highlighted the IPOS Mission of promoting global excellence in psychosocial care of people affected by cancer through our research, public policy, advocacy, and education. The internationally endorsed IPOS Standard of Quality Cancer Care, for example, clearly states the necessity of integrating the psychosocial domain into routine care, and that distress should be measured as the sixth vital sign after temperature, blood pressure, pulse, respiratory rate, and pain. The plenary paper also discussed the global progress being made in Europe, North America, and Australia in providing quality cancer care for the whole patient. Collaborative partnerships between IPOS and organizations such as the European Partnership Action Against Cancer and the World Health Organization are essential in building capacity for the delivery of high-quality psycho-oncology services in the future. Copyright © 2015 John Wiley & Sons, Ltd.

  17. Annual report of the Women's Health Care Committee, Japan Society of Obstetrics and Gynecology, 2015.

    Science.gov (United States)

    Wakatsuki, Akihiko; Takamatsu, Kiyoshi

    2016-02-01

    The activity of the Women's Health Care Committee over a two year period up to June 2015 focused upon: (i) management of breast diseases in obstetrics and gynecology; (ii) investigation of lifestyle-related disease and bone mineral density after gynecologic cancer therapy; (iii) postoperative women's health care; (iv) current surgical treatment for pelvic organ prolapse among gynecologists in Japan; (v) cesarean indication for pregnant women with active/inactive genital viral lesions; (vi) health care of young female athletes concerned about menstrual cycle abnormalities, stress fractures and premenstrual syndrome/premenstrual dysphoric disorder; (vii) a training program for women's health care advisers; and (viii) a new edition of the oral contraceptive and low-dose estrogen-progestogen guideline. Detailed activities of the eight subcommittees are described in the text. © 2015 Japan Society of Obstetrics and Gynecology.

  18. Prostate cancer survivorship care guideline: American Society of Clinical Oncology Clinical Practice Guideline endorsement.

    Science.gov (United States)

    Resnick, Matthew J; Lacchetti, Christina; Bergman, Jonathan; Hauke, Ralph J; Hoffman, Karen E; Kungel, Terrence M; Morgans, Alicia K; Penson, David F

    2015-03-20

    The guideline aims to optimize health and quality of life for the post-treatment prostate cancer survivor by comprehensively addressing components of follow-up care, including health promotion, prostate cancer surveillance, screening for new cancers, long-term and late functional effects of the disease and its treatment, psychosocial issues, and coordination of care between the survivor's primary care physician and prostate cancer specialist. The American Cancer Society (ACS) Prostate Cancer Survivorship Care Guidelines were reviewed for developmental rigor by methodologists. The American Society of Clinical Oncology (ASCO) Endorsement Panel reviewed the content and recommendations, offering modifications and/or qualifying statements when deemed necessary. The ASCO Endorsement Panel determined that the recommendations from the 2014 ACS Prostate Cancer Survivorship Care Guidelines are clear, thorough, and relevant, despite the limited availability of high-quality evidence to support many of the recommendations. ASCO endorses the ACS Prostate Cancer Survivorship Care Guidelines, with a number of qualifying statements and modifications. Assess information needs related to prostate cancer, prostate cancer treatment, adverse effects, and other health concerns and provide or refer survivors to appropriate resources. Measure prostate-specific antigen (PSA) level every 6 to 12 months for the first 5 years and then annually, considering more frequent evaluation in men at high risk for recurrence and in candidates for salvage therapy. Refer survivors with elevated or increasing PSA levels back to their primary treating physician for evaluation and management. Adhere to ACS guidelines for the early detection of cancer. Assess and manage physical and psychosocial effects of prostate cancer and its treatment. Annually assess for the presence of long-term or late effects of prostate cancer and its treatment. © 2015 by American Society of Clinical Oncology.

  19. An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Healthcare Professionals: A Call for Action.

    Science.gov (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

    2016-07-01

    Burnout syndrome (BOS) occurs in all types of healthcare professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other healthcare professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care healthcare professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care healthcare professionals and diminish the harmful consequences of BOS, both for critical care healthcare professionals and for patients.

  20. Quality of Care for Percutaneous Coronary Intervention: Development of Canadian Cardiovascular Society Quality Indicators.

    Science.gov (United States)

    Quraishi, Ata Ur Rehman; Lambert, Laurie J; Madan, Mina; Gong, Yanyan; Forsey, Anne; Galbraith, Diane; Gill, Neala; Oakes, Garth H; Lavoie, Andrea; Carere, Ronald G; Welsh, Robert C

    2016-12-01

    Currently there are more than 40 centres in Canada that perform more than 65,000 percutaneous coronary interventions (PCIs) in a year. Considering the high volume of procedures and number of operators, the potential for variation in processes of care is high, and might lead to variation in the quality of care. As part of its quality initiative, the Canadian Cardiovascular Society convened a working group to develop a set of PCI Quality Indicators (QIs) that would be relevant, scientifically acceptable, and feasible to measure and report. The working group was comprised of clinical experts from across Canada and members of provincial and federal organizations involved in promoting the quality of health care. Using the Canadian Cardiovascular Society "Best Practices for Developing Cardiovascular Quality Indicators" methodology, a total of 23 QIs were proposed. Subsequent ranking and discussion led to the selection of 8 QIs. The selection and ranking of QIs were on the basis of clinical importance and relevance, scientific acceptability, and feasibility of their operationalization at a national level. The data definitions and technical notes of the QIs were refined after feasibility testing and Web consultation. Feasibility testing indicated that standardization and enhancements of knowledge infrastructure are essential to provide the comprehensive patient data necessary to evaluate the quality of PCI across Canada. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  1. Predicting hospital mortality using APACHE II scores in neurocritically ill patients: a prospective study.

    Science.gov (United States)

    Su, Ying-Ying; Li, Xia; Li, Si-jie; Luo, Rong; Ding, Jian-ping; Wang, Lin; Cao, Gui-hua; Wang, Dong-yu; Gao, Jin-xia

    2009-09-01

    Four versions of Acute Physiology and Chronic Health Evaluation are limited in predicting hospital mortality for neurocritically ill patients. This prospective study aimed to develop and assess the accuracy of a modified APACHE II model in predicting mortality in neurologic intensive care unit (N-ICU). A total of 653 patients entered the study. APACHE II scores on admission, and worst 24-, 48-, and 72-h scores were obtained. Neurologic diagnoses on admission were classified into five categories: cerebral infarction, intracranial hemorrhage, neurologic infection, neuromuscular disease, and other neurologic diseases. We developed a modified APACHE II model based on the variables of the 72-h APACHE II score and disease category using a multivariate logistic regression procedure to estimate probability of death. We assessed the calibration and discrimination of the modified APACHE II model using the Hosmer-Lemeshow goodness-of-fit chi-squared statistic and area under the receiver operating characteristic curve (AU-ROC). The modified APACHE II model had good discrimination (AU-ROC = 0.88) and calibration (Hosmer-Lemeshow statistic: chi (2) = 3.707, P = 0.834). The discrimination of the 72-h APACHE II score for cerebral infarction, intracerebral hemorrhage, and neurologic infection was satisfactory, with AU-ROC of 0.858, 0.863, and 1.000, respectively, but it was poor in discriminating for the categories of other neurologic diseases and neuromuscular disease. The results showed that our modified APACHE II model can accurately predict hospital mortality for patients in N-ICU. It is more applicable to clinical practice than the previous model because of its simplicity and ease of use.

  2. An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action.

    Science.gov (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

    2016-07-01

    Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  3. [In defense of society: the invention of palliative care and the production of subjectivities].

    Science.gov (United States)

    da Silva, Karen Schein; Kruse, Maria Henriqueta Luce

    2012-04-01

    This article is a theoretical reflection that is part of a study named Em Defesa da Sociedade: a invenção dos Cuidados Paliativos (In Defense of Society: the invention of Palliative Care). In order to articulate this discussion, we used the 2007edition of the Palliative Care Manual published by the World Health Organization (WHO), as we understand it is part of a body of work capable of producing subjectivities and ruling conduct. In this sense, we intend to understand how the discourses on palliative care are associated and promote the invention of a new subject that would work as a bio-political strategy in order to defend society. Based on the textual analysis of the discourse presented in the manual, with the help of the Cultural Studies framework and inspired by the works of Michel Foucault, we present one of the possible meanings derived from the readings of the WHO Guide. Thus, we observe the (re)organization and (re)invention of a subject that invests in the subjectivity of individuals and constitutes an actual framework that regulates and rules the population.

  4. An official American Thoracic Society workshop report: the Integrated Care of The COPD Patient.

    Science.gov (United States)

    Nici, Linda; ZuWallack, Richard

    2012-03-01

    The optimal care of the patient with chronic obstructive pulmonary disease (COPD) requires an individualized, patient-centered approach that recognizes and treats all aspects of the disease, addresses the systemic effects and comorbidities, and integrates medical care among healthcare professionals and across healthcare sectors. In many ways the integration of medical care for COPD is still in its infancy, and its implementation will undoubtedly represent a paradigm shift in our thinking. This article summarizes the proceedings of a workshop, The Integrated Care of the COPD Patient, which was funded by the American Thoracic Society. This workshop included participants who were chosen because of their expertise in the area as well as their firsthand experience with disease management models. Our summary describes the concepts of integrated care and chronic disease management, details specific components of disease management as they may apply to the patient with COPD, and provides several innovative examples of COPD disease management programs originating from different healthcare systems. It became clear from the discussions and review of the literature that more high-quality research in this area is vital. It is our hope that the information presented here provides a "call to arms" in this regard.

  5. Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Pulmonary Hypertension.

    Science.gov (United States)

    Kim, John S; McSweeney, Julia; Lee, Joanne; Ivy, Dunbar

    2016-03-01

    To review the pharmacologic treatment options for pulmonary arterial hypertension in the cardiac intensive care setting and summarize the most-recent literature supporting these therapies. Literature search for prospective studies, retrospective analyses, and case reports evaluating the safety and efficacy of pulmonary arterial hypertension therapies. Mechanisms of action and pharmacokinetics, treatment recommendations, safety considerations, and outcomes for specific medical therapies. Specific targeted therapies developed for the treatment of adult patients with pulmonary arterial hypertension have been applied for the benefit of children with pulmonary arterial hypertension. With the exception of inhaled nitric oxide, there are no pulmonary arterial hypertension medications approved for children in the United States by the Food and Drug Administration. Unfortunately, data on treatment strategies in children with pulmonary arterial hypertension are limited by the small number of randomized controlled clinical trials evaluating the safety and efficacy of specific treatments. The treatment options for pulmonary arterial hypertension in children focus on endothelial-based pathways. Calcium channel blockers are recommended for use in a very small, select group of children who are responsive to vasoreactivity testing at cardiac catheterization. Phosphodiesterase type 5 inhibitor therapy is the most-commonly recommended oral treatment option in children with pulmonary arterial hypertension. Prostacyclins provide adjunctive therapy for the treatment of pulmonary arterial hypertension as infusions (IV and subcutaneous) and inhalation agents. Inhaled nitric oxide is the first-line vasodilator therapy in persistent pulmonary hypertension of the newborn and is commonly used in the treatment of pulmonary arterial hypertension in the ICU. Endothelin receptor antagonists have been shown to improve exercise tolerance and survival in adult patients with pulmonary arterial

  6. The primary care sports medicine fellowship: American Medical Society for Sports Medicine proposed standards of excellence.

    Science.gov (United States)

    Asif, Irfan M; Stovak, Mark; Ray, Tracy; Weiss-Kelly, Amanda

    2017-09-01

    The American Medical Society for Sports Medicine recognises a need to provide direction and continually enhance the quality of sports medicine fellowship training programmes. This document was developed to be an educational resource for sports medicine physicians who teach in a 1-year primary care sports medicine fellowship training programme. It is meant to provide high standards and targets for fellowship training programmes that choose to re-assess their curriculum and seek to make improvements. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. An evaluation of adherence to society of pharmacists' standards care in pharmacy information systems in Iran.

    Science.gov (United States)

    Saghaeiannejad-Isfahani, Sakineh; Sharifi-Rad, Javad; Raeisi, Ahmadreza; Ehteshami, Asghar; Mirzaeian, Razieh

    2015-01-01

    Pharmacy information system (PIS) is a complex computerized system used for collecting, storing, and managing the medication therapy data in the course of patients' care. The purpose of this study was to evaluate the level of adherence to the standards established by the societies of pharmacists in the PISs employed in the hospitals in Isfahan, Iran. The present study was an applied, descriptive-analytical study conducted on the PISs of 19 teaching, private and social insurance hospitals in Isfahan in 2011. Study population consisted of the PISs available in the hospitals under study. Study sample was the same as the study population. The data collection instrument was a self-developed checklist based on the guidelines of the American Society of Health-System Pharmacists and Pharmaceutical Society of Australia, whose validity was assessed and confirmed by expert professors' views. Having been collected by observation and interview methods, data were analyzed by SPSS 18 software using Mann-Whitney statistical test. The findings of the study revealed that the highest rank in adherence to the standards of societies of pharmacists was obtained by social services hospitals (32.75%), while the private hospitals obtained the lowest rank (23.32%). Based on the findings, in the PISs in the hospitals under study, some standards of the society of pharmacists were ignored. Hence, prior to designing and implementing PIS, a needs analysis is required to increase its users' motivation to identify the system potentialities and to allow the system development in compliance with the world technology advancement.

  8. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections

    DEFF Research Database (Denmark)

    Mussini, C; Antinori, A; Bhagani, S

    2016-01-01

    diagnosed multi-drug-resistant cases. Hepatitis C is widespread in selected geographical areas and risk groups. CONCLUSIONS: The key conclusion from the meeting was that a high-priority group of actions could be identified, including: increasing HIV awareness and testing, improving training for health care......OBJECTIVES: The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. METHODS: Data-driven presentations were given on specific topics followed...... by interactive panel discussions. RESULTS: In Eastern European countries, the epidemic is largely driven by injecting drug use, in contrast with Western Europe where the infection mainly occurs through heterosexual contact. A high proportion of people living with HIV remain unaware of their infection...

  9. Health care prioritization in ageing societies: influence of age, education, health literacy and culture.

    Science.gov (United States)

    Mak, Benise; Woo, Jean; Bowling, Ann; Wong, Florens; Chau, Pui Hing

    2011-05-01

    To examine how Chinese people in Hong Kong view health care prioritization and to compare the findings with those from a United Kingdom survey. A cross-sectional opinion survey was conducted in Hong Kong and 1512 participants were interviewed. Data show that the highest rankings were accorded to "treatment for children" and "high technology services." Services for the elderly, whether in the community or in hospitals, and including end-of-life care, were ranked among the lowest. This view was also shared by healthcare professionals. Compared with the UK findings, there are stark contrasts in the low ranking of end-of-life care and the high ranking of high technology services among the HK population. It is evident that most people would give priority to the young over the old in distributing a given amount of healthcare services. To meet the needs of ageing societies and to meet the needs of all users equitably, health care policy needs to acknowledge constraints and the needs for prioritization. Both the public and professionals should engage with policy makers in formulating a policy based on cost benefit considerations as well as overall societal view of prioritization that is not based on age alone. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  10. Illustration of informal caregiving within Saudi society: demography, scope of care and enabling arrangements.

    Science.gov (United States)

    Alrashed, Abeer M

    2017-06-01

    Although informal caregiving is a vital element in the process of supporting individuals with dependency, it is unrecognised most of the time, particularly by caregivers themselves. In Saudi Arabia, little attention has been devoted to informal caregivers; therefore, scarce coverage of this topic is obvious within the literature. This descriptive cross-sectional study was carried to explore informal caregiving within Saudi society by (i) describing informal caregivers and their care recipients and (ii) measuring the scope of care and enabling arrangements in the lives of informal caregivers. Numerical measures of frequency distribution were used to describe the participants and the correlate of demography among 341 female primary caregivers of the elderly (40%), individuals with disabilities (10%) or/and children aged five or younger (51%). Inferential statistics were used to test for significant associations among study variables. The majority of the participants were married with children and were middle-aged. However, the majority of care recipients were living with their caregivers; in addition, they were primarily females cared for by a mother or, less often, by a daughter (in-law). Enabling arrangements were on a moderate level, mainly in healthcare access, financial resources and family support, with lower signs detected in the quality of sleep indicator. These arrangements were significantly associated with caregiver age, education, career status and source of assistance. In conclusion, the statistics revealed by this survey indicated certain challenges that have been encountered by informal caregivers, primarily involving financial and social support. More coverage within the formal system of childcare must be provided to facilitate healthier childhoods. The long-term needs of individuals with dependency must be considered in the planning process of healthcare services, as well, remembering the needs and expectations of informal caregivers. © 2016 Nordic

  11. [The patient blood management concept : Joint recommendation of the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery].

    Science.gov (United States)

    Meybohm, P; Schmitz-Rixen, T; Steinbicker, A; Schwenk, W; Zacharowski, K

    2017-10-01

    Patient blood management is a multimodal concept that aims to detect, prevent and treat anemia, optimize hemostasis, minimize iatrogenic blood loss, and support a patient-centered decision to provide optimal use of allogeneic blood products. Although the World Health Organization (WHO) has already recommended patient blood management as a new standard in 2010, many hospitals have not implemented it at all or only in part in clinical practice. The German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery therefore demand that i) all professionals involved in the treatment should implement important aspects of patient blood management considering local conditions, and ii) the structural, administrative and budgetary conditions should be created in the health care system to implement more intensively many of the measures in Germany.

  12. History of the international societies in health technology assessment: International Society for Technology Assessment in Health Care and Health Technology Assessment International.

    Science.gov (United States)

    Banta, David; Jonsson, Egon; Childs, Paul

    2009-07-01

    The International Society for Technology Assessment in Health Care (ISTAHC) was formed in 1985. It grew out of the increasing awareness of the international dimensions of health technology assessment (HTA) and the need for new communication methods at the international level. The main function of ISTAHC was to present an annual conference, which gradually grew in size, and also to generally improve in quality from to year. ISTAHC overextended itself financially early in the first decade of the 2000s and had to cease its existence. A new society, Health Technology Assessment international (HTAi), based on many of the same ideas and people, grew up beginning in the year 2003. The two societies have played a large role in making the field of HTA visible to people around the world and providing a forum for discussion on the methods and role of HTA.

  13. Surgery Goes Social: The Extent and Patterns of Social Media Utilization by Major Trauma, Acute and Critical Care Surgery Societies.

    Science.gov (United States)

    Khalifeh, Jawad M; Kaafarani, Haytham M A

    2017-01-01

    The evolving influence of social media in trauma, acute, and critical care surgery (TACCS) cannot be ignored. We sought to investigate the extent and patterns of use of social networks by major regional, national and international TACCS societies. The two leading social networking sites, Facebook (FB) and Twitter (TW), were thoroughly examined for the presence of official accounts for each of the major TACCS societies. An official FB or TW account was defined as one which has a blue verified badge and/or is linked the society's official website. For societies with confirmed official accounts, the extent and patterns of use of the two platforms were systematically examined over a 2-week period through: (1) manual inspection of the societies' FB and TW pages, (2) the SQLite database containing downloaded samples of posts, and (3) the TW analytics database, symplur.com. Standardized social media metrics were calculated for each society. Posted content was categorized as being: (1) society news updates, (2) event announcements, or (3) general medical information. From a total of 64 TACCS societies, only 27 (42%) had FB and/or TW accounts. Ten out of the 12 American societies had accounts compared to 13/39 of European, 2/9 of Australasian, and 0/2 of international societies. For the societies with social media presence, the mean numbers of monthly tweets and FB posts per society were 22 and 8, respectively. We summarize the FB and TW activity of the studied TACCS societies. Most tweets/posts were society news updates and event announcements intended to the society's constituents not the general public. A text cloud was constructed to summarize the major featured topics. Less than half of the TACCS societies are currently using social media; those that do are arguably underutilizing its potential. Non-American societies in particular lag behind in their use of social networking.

  14. Shared Decision Making in Intensive Care Units: An American College of Critical Care Medicine and American Thoracic Society Policy Statement

    Science.gov (United States)

    Kon, Alexander A.; Davidson, Judy E.; Morrison, Wynne; Danis, Marion; White, Douglas B.

    2015-01-01

    Objectives Shared decision-making (SDM) is endorsed by critical care organizations, however there remains confusion about what SDM is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define SDM, recommend when SDM should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. Methods The American College of Critical Care Medicine (ACCM) and American Thoracic Society (ATS) Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of ACCM and ATS were included in the statement. Main Results Six recommendations were endorsed: 1) Definition: Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a SDM process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Conclusions Patient and surrogate preferences for decision-making roles regarding value

  15. Head and Neck Cancer Survivorship Care Guideline: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Cancer Society Guideline.

    Science.gov (United States)

    Nekhlyudov, Larissa; Lacchetti, Christina; Davis, Nancy B; Garvey, Thomas Q; Goldstein, David P; Nunnink, J Chris; Ninfea, Jose I Ruades; Salner, Andrew L; Salz, Talya; Siu, Lillian L

    2017-05-10

    Purpose This guideline provides recommendations on the management of adults after head and neck cancer (HNC) treatment, focusing on surveillance and screening for recurrence or second primary cancers, assessment and management of long-term and late effects, health promotion, care coordination, and practice implications. Methods ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. The American Cancer Society (ACS) HNC Survivorship Care Guideline was reviewed for developmental rigor by methodologists. An ASCO Expert Panel reviewed the content and recommendations, offering modifications and/or qualifying statements when deemed necessary. Results The ASCO Expert Panel determined that the ACS HNC Survivorship Care Guideline, published in 2016, is clear, thorough, clinically practical, and helpful, despite the limited availability of high-quality evidence to support many of the recommendations. ASCO endorsed the ACS HNC Survivorship Care Guideline, adding qualifying statements aimed at promoting team-based, multispecialty, multidisciplinary, collaborative head and neck survivorship care. Recommendations The ASCO Expert Panel emphasized that caring for HNC survivors requires a team-based approach that includes primary care clinicians, oncology specialists, otolaryngologists, dentists, and other allied professionals. The HNC treatment team should educate the primary care clinicians and patients about the type(s) of treatment received, the likelihood of potential recurrence, and the potential late and long-term complications. Primary care clinicians should recognize symptoms of recurrence and coordinate a prompt evaluation. They should also be prepared to manage late effects either directly or by referral to appropriate specialists. Health promotion is critical, particularly regarding tobacco cessation and dental care. Additional information is available at www

  16. [Factors influencing Central America's civil society organization's capacity to provide AIDS related care].

    Science.gov (United States)

    Gómez-Jáuregui, Jesica; Caballero, Marta; Infante, César; Cruz, Rosibel; Cuadra, Rosario; González, Tonatiuh

    2013-07-01

    To analyze the capacities of Central American civil society organizations (CSOs) to implement HIV prevention and care strategies in mobile groups within the HIV Mesoamerican Project. During the year 2008, 14 key actors of nine Central American civil society organizations participating in the Mesoamerican Project were interviewed. The information collected was systematized using Atlas-TI software, and content analysis was performed according to its categories and dimensions. These items were a contribution to capacity: the previous work of CSOs allowed the sensibilization of population and authorities to STD-HIV and to the implemented program; the coordination with government and other involved actors. a good but informal coordination with the government; the worsening economic situation reduced available resources; attended communities are isolated and unsecure. To improve the capacities of CSOs in developing this type of project, it is recommended: that an initial community diagnosis be performed in order to better adapt the proposed interventions; to improve administrative efficiency; to formalize collaborative links with the government; and to seek counseling in the development of HIV prevention strategies that consider population mobility.

  17. [Suicide prevention activities of psychiatry-related professional societies: the promotion of suicide prevention in psychiatric care].

    Science.gov (United States)

    Otsuka, Kotaro; Kawanishi, Chiaki

    2014-01-01

    Suicide prevention is promoted nationally in Japan. In the General Principles of Suicide Prevention Policy determined in 2007, the areas in which, psychiatry contributed were shown to be important, for example, psychiatric care, suicide, aftercare program for suicide attempters, mental health promotion, and actual elucidation of the cause of suicide. At a part of these national measures, guidelines on suicide attempters' care are devised by the Japanese Society for Emergency Medicine and the Japanese Association for Emergency Psychiatry, and a training workshop on caring for suicide attempters was held by the Ministry of Health, Labour and Welfare. The Japanese society for Emergency Medicine devised an educational program of care for patients with mental health problems in emergency care in cooperation with the Japanese Association for Emergency Psychiatry and Japanese Society of General Hospital Psychiatry. On the other hand, suicide prevention and staff care at hospitals are important problems, and the Japan Council for Quality Health Care devised a program and conducted a training workshop. Also, the Japanese Association for Suicide Prevention conducted workshops for both the educational program of cognitive-behavioral therapy and facilitator training program for gatekeeper. The Japanese Society of Mood Disorders conducted a training workshop involving clinical high-risk case discussion. Also, the Japanese Society of Psychiatry and Neurology devised clinical guidelines for suicide prevention and distributed them to all society members. In this society, on-site discussion of the guidelines and the holding of workshops are expected in the future. It is hoped that these guidelines will be utilized and training workshops will be held in the future.

  18. Renal replacement therapy in adult and pediatric intensive care : Recommendations by an expert panel from the French Intensive Care Society (SRLF) with the French Society of Anesthesia Intensive Care (SFAR) French Group for Pediatric Intensive Care Emergencies (GFRUP) the French Dialysis Society (SFD).

    Science.gov (United States)

    Vinsonneau, Christophe; Allain-Launay, Emma; Blayau, Clarisse; Darmon, Michael; Ducheyron, Damien; Gaillot, Theophile; Honore, Patrick M; Javouhey, Etienne; Krummel, Thierry; Lahoche, Annie; Letacon, Serge; Legrand, Matthieu; Monchi, Mehran; Ridel, Christophe; Robert, René; Schortgen, Frederique; Souweine, Bertrand; Vaillant, Patrick; Velly, Lionel; Osman, David; Van Vong, Ly

    2015-12-01

    Acute renal failure (ARF) in critically ill patients is currently very frequent and requires renal replacement therapy (RRT) in many patients. During the last 15 years, several studies have considered important issues regarding the use of RRT in ARF, like the time to initiate the therapy, the dialysis dose, the types of catheter, the choice of technique, and anticoagulation. However, despite an abundant literature, conflicting results do not provide evidence on RRT implementation. We present herein recommendations for the use of RRT in adult and pediatric intensive care developed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of French Intensive Care Society (SRLF), with the participation of the French Society of Anesthesia and Intensive Care (SFAR), the French Group for Pediatric Intensive Care and Emergencies (GFRUP), and the French Dialysis Society (SFD). The recommendations cover 4 fields: criteria for RRT initiation, technical aspects (access routes, membranes, anticoagulation, reverse osmosis water), practical aspects (choice of the method, peritoneal dialysis, dialysis dose, adjustments), and safety (procedures and training, dialysis catheter management, extracorporeal circuit set-up). These recommendations have been designed on a practical point of view to provide guidance for intensivists in their daily practice.

  19. Cultural influences upon advance care planning in a family-centric society.

    Science.gov (United States)

    Tay, Keson; Yu Lee, Rachel Jia; Sim, Shin Wei; Menon, Sumytra; Kanesvaran, Ravindran; Radha Krishna, Lalit Kumar

    2017-12-01

    Advanced care plans (ACPs) are designed to convey the wishes of patients with regards to their care in the event of incapacity. There are a number of prerequisites for creation of an effective ACP. First, the patient must be aware of their condition, their prognosis, the likely trajectory of the illness, and the potential treatment options available to them. Second, patient input into ACP must be free of any coercive factors. Third, the patient must be able to remain involved in adapting their ACP as their condition evolves. Continued use of familial determination and collusion within the local healthcare system, however, has raised concerns that the basic requirements for effective ACP cannot be met. To assess the credibility of these concerns, we employed a video vignette approach depicting a family of three adult children discussing whether or not to reveal a cancer diagnosis to their mother. Semistructured interviews with 72 oncology patients and 60 of their caregivers were conducted afterwards to explore the views of the participants on the different positions taken by the children. Collusion, family-centric decision making, adulteration of information provided to patients, and circumnavigation of patient involvement appear to be context-dependent. Patients and families alike believe that patients should be told of their conditions. However, the incidence of collusion and familial determination increases with determinations of a poor prognosis, a poor anticipated response to chemotherapy, and a poor premorbid health status. Financial considerations with respect to care determinations remain secondary considerations. Our data suggest that ACPs can be effectively constructed in family-centric societies so long as healthcare professionals continue to update and educate families on the patient's situation. Collusion and familial intervention in the decision-making process are part of efforts to protect the patient from distress and are neither solely dependent on

  20. Outcome Criteria for Discharging the Patient With a New Ostomy From Home Health Care: A WOCN Society Consensus Conference.

    Science.gov (United States)

    Colwell, Janice C; Kupsick, Phyllis T; McNichol, Laurie L

    2016-01-01

    The Wound, Ostomy and Continence Nurses Society hosted a consensus panel of expert ostomy clinicians who were tasked with identifying minimal discharge criteria for home care patients with a new fecal or urinary diversion. Shortened hospital inpatient stays, higher patient acuity, and limited access to ostomy specialists send patients with new ostomies home with multiple educational and adjustment needs related to a new stoma. The Society recognized the lack of evidence-based ostomy practice and supported the work of the panel to develop statements that defined elements of the care plan for the patient or caregiver in home care who is adapting to living with a stoma. Eighteen statements were developed that provide minimum discharge criteria for the patient with a new ostomy in the home care setting. Support based upon current evidence as well as expert opinion with implementation strategies are offered for each statement.

  1. 2013 President's plenary international psycho-oncology society : embracing the IPOS standards as a means of enhancing comprehensive cancer care

    NARCIS (Netherlands)

    Bultz, B. D.; Cummings, G. G.; Grassi, L.; Travado, L.; Hoekstra-Weebers, J.; Watson, M.

    Background: The second President's Plenary at the 2013 International Psycho-oncology Society's World Congress in Rotterdam, the Netherlands aimed to progress and, where needed, initiate changes to achieve comprehensive cancer care. Recent initiatives have been driven by the need to see psychosocial

  2. Japan as the front-runner of super-aged societies: Perspectives from medicine and medical care in Japan.

    Science.gov (United States)

    Arai, Hidenori; Ouchi, Yasuyoshi; Toba, Kenji; Endo, Tamao; Shimokado, Kentaro; Tsubota, Kazuo; Matsuo, Seiichi; Mori, Hidezo; Yumura, Wako; Yokode, Masayuki; Rakugi, Hiromi; Ohshima, Shinichi

    2015-06-01

    The demographic structure of a country changes dramatically with increasing trends toward general population aging and declining birth rates. In Japan, the percentage of the elderly population (aged ≥65 years) reached 25% in 2013; it is expected to exceed 30% in 2025 and reach 39.9% in 2060. The national total population has been decreasing steadily since its peak reached in 2008, and it is expected to fall to the order of 80 million in 2060. Of the total population, those aged ≥75 years accounted for 12.3% as of 2013, and this is expected to reach 26.9% in 2060. As the demographic structure changes, the disease structure changes, and therefore the medical care demand changes. To accommodate the medical care demand changes, it is necessary to secure a system for providing medical care. Japan has thus far attained remarkable achievements in medical care, seeking a better prognosis for survival; however, its medical care demand is anticipated to change both qualitatively and quantitatively. As diseases in the elderly, particularly in the old-old population, are often intractable, conventional medical care must be upgraded to one suitable for an aged society. What is required to this end is a shift from "cure-seeking medical care" focusing on disease treatment on an organ-specific basis to "cure and support-seeking medical care" with treatments reprioritized to maximize the quality of life (QOL) for the patient, or a change from "hospital-centered medical care" to "community-oriented medical care" in correlation with nursing care and welfare. (1)  Necessity for a paradigm shift to "cure-and-support seeking medical care" In addition to the process of aging with functional deterioration of multiple organs, the elderly often suffer from systemically disordering diseases, such as lifestyle-related diseases, as well as geriatric syndrome and daily activity dysfunction; therefore, integrated and comprehensive medical care is required. In addition, with regard to

  3. Intensivist/patient ratios in closed ICUs: a statement from the Society of Critical Care Medicine Taskforce on ICU Staffing.

    Science.gov (United States)

    Ward, Nicholas S; Afessa, Bekele; Kleinpell, Ruth; Tisherman, Samuel; Ries, Michael; Howell, Michael; Halpern, Neil; Kahn, Jeremy

    2013-02-01

    Increases in the number, size, and occupancy rates of ICUs have not been accompanied by a commensurate growth in the number of critical care physicians leading to a workforce shortage. Due to concern that understaffing may exist, the Society of Critical Care Medicine created a taskforce to generate guidelines on maximum intensivists/patient ratios. A multidisciplinary taskforce conducted a review of published literature on intensivist staffing and related topics, a survey of pulmonary/Critical Care physicians, and held an expert roundtable conference. A statement was generated and revised by the taskforce members using an iterative consensus process and submitted for review to the leadership council of the Society of Critical Care Medicine. For the purposes of this statement, the taskforce limited its recommendations to ICUs that use a "closed" model where the intensivists control triage and patient care. The taskforce concluded that while advocating a specific maximum number of patients cared for is unrealistic, an approach that uses the following principles is essential: 1) proper staffing impacts patient care; 2) large caseloads should not preclude rounding in a timely fashion; 3) staffing decisions should factor surge capacity and nondirect patient care activities; 4) institutions should regularly reassess their staffing; 5) high staff turnover or decreases in quality-of-care indicators in an ICU may be markers of overload; 6) telemedicine, advanced practice professionals, or nonintensivist medical staff may be useful to alleviate overburdening the intensivist, but should be evaluated using rigorous methods; 7) in teaching institutions, feedback from faculty and trainees should be sought to understand the implications of potential understaffing on medical education; and 8) in academic medical ICUs, there is evidence that intensivist/patient ratios less favorable than 1:14 negatively impact education, staff well-being, and patient care.

  4. This journal is sponsored by the Critical Care Society of Southern ...

    African Journals Online (AJOL)

    1 Netcare 911, Netcare (Pty) Ltd., Midrand, South Africa. 2 Critical Care Transport Unit, Department of Health, Gauteng Provincial Government, South Africa. 3 Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa. 4 Department of Emergency Medical Care, Faculty of ...

  5. 2015 President's Plenary International Psycho-oncology Society: psychosocial care as a human rights issue–challenges and opportunities

    Science.gov (United States)

    Travado, Luzia; Breitbart, William; Grassi, Luigi; Fujisawa, Daisuke; Patenaude, Andrea; Baider, Lea; Connor, Stephen; Fingeret, Michelle

    2017-01-01

    The International Psycho-Oncology Society (IPOS) Human Rights Task Force has been working since 2008 to raise awareness and support, for the relevance of psychosocial cancer care as a human rights issue. In 2014 the “Lisbon Declaration: Psychosocial Cancer Care as a Universal Human Right” was fully endorsed by IPOS. Subsequently, the IPOS Standard on Quality Cancer Care, endorsed by 75 cancer organizations worldwide, has been updated and now includes 3 core principles: Psychosocial cancer care should be recognised as a universal human right; Quality cancer care must integrate the psychosocial domain into routine care; Distress should be measured as the 6th vital sign. The President's plenary held at the 2015 World Congress of Psycho-Oncology in Washington DC was devoted to discussing psychosocial care as a human rights issue. Many challenges and opportunities are illustrated in different continents and contexts: from Africa where resources for basic cancer treatment are scarce and children and their parents face significant difficulties with hospital detention practices; to Europe where for many countries psychosocial care is still seen as a luxury; and the Middle East where Muslim women face stigma and a culture of silence over cancer. We further discuss how to move the Lisbon Declaration forward towards its implementation into clinical practice globally, using the successful example of the World Health Assembly resolution supporting palliative care as a human right which has achieved widespread approval, and identifying the vital role the IPOS Federation of National Psychoncology Societies plays worldwide to move this agenda forward. PMID:27530206

  6. 2015 President's Plenary International Psycho-oncology Society: psychosocial care as a human rights issue-challenges and opportunities.

    Science.gov (United States)

    Travado, Luzia; Breitbart, William; Grassi, Luigi; Fujisawa, Daisuke; Patenaude, Andrea; Baider, Lea; Connor, Stephen; Fingeret, Michelle

    2017-04-01

    The International Psycho-Oncology Society (IPOS) Human Rights Task Force has been working since 2008 to raise awareness and support, for the relevance of psychosocial cancer care as a human rights issue. In 2014 the "Lisbon Declaration: Psychosocial Cancer Care as a Universal Human Right" was fully endorsed by IPOS. Subsequently, the IPOS Standard on Quality Cancer Care, endorsed by 75 cancer organizations worldwide, has been updated and now includes 3 core principles: Psychosocial cancer care should be recognised as a universal human right; Quality cancer care must integrate the psychosocial domain into routine care; Distress should be measured as the 6th vital sign. The President's plenary held at the 2015 World Congress of Psycho-Oncology in Washington DC was devoted to discussing psychosocial care as a human rights issue. Many challenges and opportunities are illustrated in different continents and contexts: from Africa where resources for basic cancer treatment are scarce and children and their parents face significant difficulties with hospital detention practices; to Europe where for many countries psychosocial care is still seen as a luxury; and the Middle East where Muslim women face stigma and a culture of silence over cancer. We further discuss how to move the Lisbon Declaration forward towards its implementation into clinical practice globally, using the successful example of the World Health Assembly resolution supporting palliative care as a human right which has achieved widespread approval, and identifying the vital role the IPOS Federation of National Psychoncology Societies plays worldwide to move this agenda forward. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Transition of gastroenterological patients from paediatric to adult care: A position statement by the Italian Societies of Gastroenterology.

    Science.gov (United States)

    Elli, Luca; Maieron, Roberto; Martelossi, Stefano; Guariso, Graziella; Buscarini, Elisabetta; Conte, Dario; di Giulio, Emilio; Staiano, Annamaria; Barp, Jacopo; Bassotti, Gabrio; Bianco, Maria Antonia; Buri, Luigi; Carrara, Maurizio; Ghidini, Benedetta; Giannini, Olivia; Knafelz, Daniela; Miele, Erasmo; Peralta, Sergio; Riccio, Elisabetta; Tomba, Carolina; Zilli, Maurizio; Guadagnini, Tiziana

    2015-09-01

    In 2013, four Italian Gastroenterological Societies (the Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition, the Italian Society of Hospital Gastroenterologists and Endoscopists, the Italian Society of Endoscopy, and the Italian Society of Gastroenterology) formed a joint panel of experts with the aim of preparing an official statement on transition medicine in Gastroenterology. The transition of adolescents from paediatric to adult care is a crucial moment in managing chronic diseases such as celiac disease, inflammatory bowel disease, liver disease and liver transplantation. Improved medical treatment and availability of new drugs and surgical techniques have improved the prognosis of many paediatric disorders, prolonging survival, thus making the transition to adulthood possible and necessary. An inappropriate transition or the incomplete transmission of data from the paediatrician to the adult Gastroenterologist can dramatically decrease compliance to treatment and prognosis of a young patient, particularly in the case of severe disorders. For these reasons, the Italian gastroenterological societies decided to develop an official shared transition protocol. The resulting document discusses the factors influencing the transition process and highlights the main points to accomplish to optimize compliance and prognosis of gastroenterological patients during the difficult transition from childhood to adolescence and adulthood. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  8. Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies

    DEFF Research Database (Denmark)

    Gagnon, Anita J; DeBruyn, Rebecca; Essén, Birgitta

    2014-01-01

    with international experts in migrant reproductive health and research resulted in the MFMCQ, a questionnaire measuring key aspects of migrant-sensitive maternity care. The MFMCQ is available for further translation and use to examine and compare care and perceptions of care within and across countries, and by key......BACKGROUND: Through the World Health Assembly Resolution, 'Health of Migrants', the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital...... in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC...

  9. Triple aim improvement for individuals, services and society in dementia care : The DementiaNet collaborative care approach

    NARCIS (Netherlands)

    Nieuwboer, M.S.; Richters, A.; Marck, M.A. van der

    2017-01-01

    BACKGROUND: A redesigning of primary care is required to meet dementia patients' needs. In the Netherlands, current dementia care still falls short in areas including ad hoc collaboration, lack of feedback on quality to professionals involved, and insufficient implementation of established

  10. Assessing the prognoses on Health care in the information society 2013--thirteen years after

    NARCIS (Netherlands)

    Knaup, Petra; Ammenwerth, Elske; Dujat, Carl; Grant, Andrew; Hasman, Arie; Hein, Andreas; Hochlehnert, Achim; Kulikowski, Casimir; Mantas, John; Maojo, Victor; Marschollek, Michael; Moura, Lincoln; Plischke, Maik; Röhrig, Rainer; Stausberg, Jürgen; Takabayashi, Katsuhiko; Uckert, Frank; Winter, Alfred; Wolf, Klaus-Hendrik; Haux, Reinhold

    2014-01-01

    Health care and information technology in health care is advancing at tremendous speed. We analysed whether the prognoses by Haux et al. - first presented in 2000 and published in 2002 - have been fulfilled in 2013 and which might be the reasons for match or mismatch. Twenty international experts in

  11. The Ethic of Care in Globalized Societies: Implications for Citizenship Education

    Science.gov (United States)

    Zembylas, Michalinos

    2010-01-01

    Illustrating the tensions and possibilities that the notion of the ethic of care as a democratic and citizenship issue may have in discourses of citizenship education in western states is the focus of this article. I first consider some theoretical debates on the definition of an ethic of care, especially in relation to issues of justice and…

  12. Scrutinizing the balance: parental care versus educational responsibilities in a changing society

    NARCIS (Netherlands)

    Smit, F.; Driessen, G.; Sleegers, P.J.C.; Teelken, C.

    2008-01-01

    This paper focuses on the pedagogical responsibilities of parents and schools, as well as the care provided by socializing agencies and local communities. A review of the literature has been carried out on the tasks of schools and parents and the relations between education, parenting and care in a

  13. European Society of Cardiology smartphone and tablet applications for patients with atrial fibrillation and their health care providers.

    Science.gov (United States)

    Kotecha, Dipak; Chua, Winnie W L; Fabritz, Larissa; Hendriks, Jeroen; Casadei, Barbara; Schotten, Ulrich; Vardas, Panos; Heidbuchel, Hein; Dean, Veronica; Kirchhof, Paulus

    2018-02-01

    We are in the midst of a digital revolution in health care, although the application of new and useful technology in routine clinical practice is variable. The Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly (CATCH ME) Consortium, in collaboration with the European Society of Cardiology (ESC), has funded the creation of two applications (apps) in atrial fibrillation (AF) for use in smartphones and tablets. The patient app aims to enhance patient education, improve communication between patients and health care professionals, and encourage active patient involvement in the management of their condition. The health care professional app is designed as an interactive management tool incorporating the new ESC Practice Guidelines on AF and supported by the European Heart Rhythm Association (EHRA), with the aim of improving best practice approaches for the care of patients with AF. Both stand-alone apps are now freely available for Android and iOS devices though the Google Play, Amazon, and Apple stores. In this article, we outline the rationale for the design and implementation of these apps. Our objective is to demonstrate the value of integrating novel digital technology into clinical practice, with the potential for patient engagement, optimization of pharmacological and interventional therapy in AF, and ultimately to improve patient outcomes. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology.

  14. Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition

    NARCIS (Netherlands)

    Morin, Luc; Ray, Samiran; Wilson, Clare; Remy, Solenn; Benissa, Mohamed Rida; Jansen, Nicolaas J. G.|info:eu-repo/dai/nl/085432083; Javouhey, Etienne; Peters, Mark J.; Kneyber, Martin; De Luca, Daniele; Nadel, Simon; Schlapbach, Luregn Jan; Maclaren, Graeme; Tissieres, Pierre

    2016-01-01

    Purpose Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and

  15. Refractory septic shock in children : a European Society of Paediatric and Neonatal Intensive Care definition

    NARCIS (Netherlands)

    Morin, Luc; Ray, Samiran; Wilson, Clare; Remy, Solenn; Benissa, Mohamed Rida; Jansen, Nicolaas J. G.; Javouhey, Etienne; Peters, Mark J.; Kneyber, Martin; De Luca, Daniele; Nadel, Simon; Schlapbach, Luregn Jan; Maclaren, Graeme; Tissieres, Pierre

    2016-01-01

    Although overall paediatric septic shock mortality is decreasing, refractory septic shock (RSS) is still associated with high mortality. A definition for RSS is urgently needed to facilitate earlier identification and treatment. We aim to establish a European society of paediatric and neonatal

  16. Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care

    Directory of Open Access Journals (Sweden)

    Muhammad Tahir Khalily

    2011-10-01

    Full Text Available Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector.Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy.Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

  17. Population aging in Albanian post-socialist society: Implications for care and family life

    Directory of Open Access Journals (Sweden)

    Meçe Merita

    2015-12-01

    Full Text Available Population aging is becoming an inevitable phenomenon in Albanian post-socialist society, posing multi-faceted challenges to its individuals, families and society as a whole. Since 1991, the Albanian population has been exposed to intensive demographic changes caused by unintended aspects of socio-economic transition from a planned socialist economy to a market-oriented capitalist one (Hoff, 2008. Ongoing processes of re-organization of social institutions increased its socio-economic insecurity leading to the application of various coping mechanisms. While adjusting themselves to other aspects of life, people changed their decisions of having children and leaving the country (Hoff, 2008. On the other hand, replacement of former traditional extended family forms with diverse living arrangements and family structures has been the outcome of the combination of three factors: falling fertility, increasing life expectancy and increasing migration (INSTAT, 2014.

  18. Ethical aspects of future health care: globalisation of markets and differentiation of societies - ethical challenges.

    Science.gov (United States)

    Kluge, Eike-Henner W

    2008-01-01

    The shift in health care to an aggregate corporate and distributed model dominated by electronic methods of diagnosis, record-keeping and communication spanning jurisdictional boundaries raises technical, social and paradigmatic issues. The technical issues concern the material natures of the tools, devices, procedures and protocols; the social issues gravitate around abstract matters like individual rights and models of responsibility within a corporate setting and accountability in inter-jurisdictional contexts; the paradigmatic issues centre in the question of how the rights and duties of traditional and direct health care translate into the mediated context of the globally expanded corporate model of eHealth and telemedicine. The present discussion presents a brief overview of the issues and sketches some of their implications for the evolution of contemporary health care.

  19. Prediction of potential for organ donation after circulatory death in neurocritical patients.

    Science.gov (United States)

    Xu, Guixing; Guo, Zhiyong; Liang, Wenhua; Xin, Erye; Liu, Bin; Xu, Ye; Luan, Zhongqin; Schroder, Paul Michael; Manyalich, Martí; Ko, Dicken Shiu-Chung; He, Xiaoshun

    2018-03-01

    The success or failure of donation after circulatory death depends largely on the functional warm ischemia time, which is closely related to the duration between withdrawal of life-sustaining treatment and circulatory arrest. However, a reliable predictive model for the duration is absent. We aimed to compare the performance of the Chinese Donation after Circulatory Death Nomogram (C-DCD-Nomogram) and 3 other tools in a cohort of potential donors. In this prospective, multicenter, observational study, data were obtained from 219 consecutive neurocritical patients in China. The patients were followed until circulatory death after withdrawal of life-sustaining treatment. The C-DCD-Nomogram performed well in predicting patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment with c-statistics of 0.87, 0.88, 0.86 and 0.95, respectively. The DCD-N score was a poor predictor of death within 30, 60 and 240 minutes, with c-statistics of 0.63, 0.69 and 0.59, respectively, although it was able to predict patient death within 120 minutes, with a c-statistic of 0.73. Neither the University of Wisconsin DCD evaluation tool (UWDCD) nor the United Network for Organ Sharing (UNOS) criteria was able to predict patient death within 30, 60, 120 and 240 minutes after withdrawal of life-sustaining treatment (UWDCD tool: 0.48, 0.45, 0.49 and 0.57; UNOS criteria: 0.50, 0.53, 0.51 and 0.63). The C-DCD-Nomogram is superior to the other 3 tools for predicting death within a limited duration after withdrawal of life-sustaining treatment in Chinese neurocritical patients. Thus, it appears to be a reliable tool identifying potential donors after circulatory death. Copyright © 2018. Published by Elsevier Inc.

  20. Brain death organ donation potential and life support therapy limitation in neurocritical patients.

    Science.gov (United States)

    Bodí, M A; Pont, T; Sandiumenge, A; Oliver, E; Gener, J; Badía, M; Mestre, J; Muñoz, E; Esquirol, X; Llauradó, M; Twose, J; Quintana, S

    2015-01-01

    To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients. A multicenter prospective study was carried out. Nine hospitals authorized for organ harvesting for transplantation. All patients consecutively admitted to the hospital with GCS death (BD) and organ donation incidence were recorded. A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole. LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  1. Assessing the prognoses on Health care in the information society 2013--thirteen years after.

    Science.gov (United States)

    Knaup, Petra; Ammenwerth, Elske; Dujat, Carl; Grant, Andrew; Hasman, Arie; Hein, Andreas; Hochlehnert, Achim; Kulikowski, Casimir; Mantas, John; Maojo, Victor; Marschollek, Michael; Moura, Lincoln; Plischke, Maik; Röhrig, Rainer; Stausberg, Jürgen; Takabayashi, Katsuhiko; Uckert, Frank; Winter, Alfred; Wolf, Klaus-Hendrik; Haux, Reinhold

    2014-07-01

    Health care and information technology in health care is advancing at tremendous speed. We analysed whether the prognoses by Haux et al. - first presented in 2000 and published in 2002 - have been fulfilled in 2013 and which might be the reasons for match or mismatch. Twenty international experts in biomedical and health informatics met in May 2013 in a workshop to discuss match or mismatch of each of the 71 prognoses. After this meeting a web-based survey among workshop participants took place. Thirty-three prognoses were assessed matching; they reflect e.g. that there is good progress in storing patient data electronically in health care institutions. Twenty-three prognoses were assessed mismatching; they reflect e.g. that telemedicine and home monitoring as well as electronic exchange of patient data between institutions is not established as widespread as expected. Fifteen prognoses were assessed neither matching nor mismatching. ICT tools have considerably influenced health care in the last decade, but in many cases not as far as it was expected by Haux et al. in 2002. In most cases this is not a matter of the availability of technical solutions but of organizational and ethical issues. We need innovative and modern information system architectures which support multiple use of data for patient care as well as for research and reporting and which are able to integrate data from home monitoring into a patient centered health record. Since innovative technology is available the efficient and wide-spread use in health care has to be enabled by systematic information management.

  2. Building a Caring Economy and Society Beyond Capitalism, Socialism, and Other Old Isms

    Directory of Open Access Journals (Sweden)

    Riane Eisler

    2013-05-01

    Full Text Available Old economic approaches are not capable of meeting our economic, environmental, and social challenges. To effectively meet these challenges, we need a perspective that goes beyond the conventional capitalism vs. socialism debate. This paper places economic valua- tions in their social context from the perspective of two new social categories. It describes building blocks for a new paradigm for economics, focusing on new measurements, policies, and practices that support caring for people, starting in early childhood, as well as caring for our natural environment.

  3. Paediatric radiation oncology in the care of childhood cancer: A position paper by the International Paediatric Radiation Oncology Society (PROS).

    Science.gov (United States)

    Kortmann, Rolf-Dieter; Freeman, Carolyn; Marcus, Karen; Claude, Line; Dieckmann, Karin; Halperin, Edward; Esiashvili, Natia; Paulino, Arnold; Mahajan, Anita; Seiersen, Klaus; Ahern, Verity; Ricardi, Umberto; Carrie, Christian

    2016-05-01

    Paediatric malignancies are a challenge for the radiation oncologist due to their rarity, the great variety of histological types, and the complexity of treatment concepts that evolve over time. The Paediatric Radiation Oncology Society (PROS) is the only internationally operating society for paediatric radiation oncology. The objectives of PROS are to set a world-wide standard of excellence with respect to radiation oncology aspects in curing children and adolescents with cancer, to provide a forum for communication between radiation oncologists, and to exchange information with all professionals involved in the management of paediatric and adolescent cancer. Challenges include the need to promote education and support practice in low and middle income countries (LMIC) as well as the cost and availability of modern treatment technologies for all but most especially these countries. Collaborations with other societies that include for example the education programmes provided jointly with ESTRO, and the upgraded technical platform of the PROS web site offer new possibilities to enhance the efficacy of PROS in education and support of paediatric radiation oncology practice world-wide. PROS has made an important contribution to the management of childhood malignancies over the past decade and new and developing collaborations between PROS and other societies or organizations will ultimately lead to a reduction in world-wide health care inequalities. Copyright © 2016. Published by Elsevier Ireland Ltd.

  4. The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru.

    Science.gov (United States)

    Samuel, Jeannie

    2016-01-01

    Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP) that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women themselves, can play an important role in holding the state accountable for

  5. The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru

    Science.gov (United States)

    Samuel, Jeannie

    2016-01-01

    Background and objective Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP) that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Design Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Results Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Conclusions Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women themselves, can play an

  6. An Official American Thoracic Society/European Respiratory Society Workshop Report: Evaluation of Respiratory Mechanics and Function in the Pediatric and Neonatal Intensive Care Units.

    Science.gov (United States)

    Peterson-Carmichael, Stacey; Seddon, Paul C; Cheifetz, Ira M; Frerichs, Inéz; Hall, Graham L; Hammer, Jürg; Hantos, Zoltán; van Kaam, Anton H; McEvoy, Cindy T; Newth, Christopher J L; Pillow, J Jane; Rafferty, Gerrard F; Rosenfeld, Margaret; Stocks, Janet; Ranganathan, Sarath C

    2016-02-01

    Ready access to physiologic measures, including respiratory mechanics, lung volumes, and ventilation/perfusion inhomogeneity, could optimize the clinical management of the critically ill pediatric or neonatal patient and minimize lung injury. There are many techniques for measuring respiratory function in infants and children but very limited information on the technical ease and applicability of these tests in the pediatric and neonatal intensive care unit (PICU, NICU) environments. This report summarizes the proceedings of a 2011 American Thoracic Society Workshop critically reviewing techniques available for ventilated and spontaneously breathing infants and children in the ICU. It outlines for each test how readily it is performed at the bedside and how it may impact patient management as well as indicating future areas of potential research collaboration. From expert panel discussions and literature reviews, we conclude that many of the techniques can aid in optimizing respiratory support in the PICU and NICU, quantifying the effect of therapeutic interventions, and guiding ventilator weaning and extubation. Most techniques now have commercially available equipment for the PICU and NICU, and many can generate continuous data points to help with ventilator weaning and other interventions. Technical and validation studies in the PICU and NICU are published for the majority of techniques; some have been used as outcome measures in clinical trials, but few have been assessed specifically for their ability to improve clinical outcomes. Although they show considerable promise, these techniques still require further study in the PICU and NICU together with increased availability of commercial equipment before wider incorporation into daily clinical practice.

  7. Improving quality and decreasing cost in gynecologic oncology care. Society of gynecologic oncology recommendations for clinical practice.

    Science.gov (United States)

    Rimel, B J; Burke, William M; Higgins, Robert V; Lee, Paula S; Lutman, Christopher V; Parker, Lynn

    2015-05-01

    To identify potential cost savings in gynecologic oncology care without sacrificing quality. Members of the Clinical Practice Committee of the Society of Gynecologic Oncology were asked to review current practice patterns in gynecologic oncology and assess the potential for cost savings founded on evidence-based medicine and current guidelines. Five clinical practices were identified including the following: vaginal cytology for endometrial cancer survivors; colposcopy for low grade cytologic abnormalities for cervical cancer survivors; routine imaging studies for gynecologic cancer survivors; screening for ovarian cancer with serum biomarkers and ultrasound; and improving palliative care for gynecologic cancer patients. Review of the published literature and guidelines were performed to make evidence-based recommendations for cost effective quality gynecologic oncology care. • Do not perform Pap tests of the vaginal cuff in patients with a history of endometrial cancer. • Do not perform colposcopy for low grade Pap tests in women with a history of cervical cancer. • Avoid routine imaging for cancer surveillance in asymptomatic women with gynecologic cancer, specifically ovarian, endometrial, cervical, vulvar and vaginal cancer. • Do not screen women at low risk for ovarian cancer with ultrasound or CA-125 or other biomarkers. • Do not delay basic level palliative care for women with advanced or relapsed gynecologic cancer, do refer to a palliative care specialist when needed, and avoid unnecessary treatments at life's end. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. An electronic delphi study to establish pediatric intensive care nursing research priorities in twenty European countries*.

    Science.gov (United States)

    Tume, Lyvonne N; van den Hoogen, Agnes; Wielenga, Joke M; Latour, Jos M

    2014-06-01

    To identify and to establish research priorities for pediatric intensive care nursing science across Europe. A modified three-round electronic Delphi technique was applied. Questionnaires were translated into seven different languages. European PICUs. The participants included pediatric intensive care clinical nurses, managers, educators, and researchers. In round 1, the qualitative responses were analyzed by content analysis and a list of research statements and domains was generated. In rounds 2 and 3, the statements were ranked on a scale of one to six (not important to most important). Mean scores and SDs were calculated for rounds 2 and 3. None. Round 1 started with 90 participants, with round 3 completed by 64 (71%). The seven highest ranking statements (≥ 5.0 mean score) were related to end-of-life care, decision making around forgoing and sustaining treatment, prevention of pain, education and competencies for pediatric intensive care nurses, reducing healthcare-associated infections, identifying appropriate nurse staffing levels, and implementing evidence into nursing practice. Nine research domains were prioritized, and these were as follows: 1) clinical nursing care practices, 2) pain and sedation, 3) quality and safety, 4) respiratory and mechanical ventilation, 5) child- and family-centered care, 6) ethics, 7) professional issues in nursing, 8) hemodynamcis and resuscitation, and 9) trauma and neurocritical care. The results of this study inform the European Society of Pediatric and Neonatal Intensive Care's nursing research agenda in the future. The results allow nurse researchers within Europe to encourage collaborative initiatives for nursing research.

  9. The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men.

    Science.gov (United States)

    Dean, John D; McMahon, Chris G; Guay, Andre T; Morgentaler, Abraham; Althof, Stanley E; Becher, Edgardo F; Bivalacqua, Trinity J; Burnett, Arthur L; Buvat, Jacques; El Meliegy, Amr; Hellstrom, Wayne J G; Jannini, Emmanuele A; Maggi, Mario; McCullough, Andrew; Torres, Luiz Otavio; Zitzmann, Michael

    2015-08-01

    In 2014, the International Society for Sexual Medicine (ISSM) convened a panel of experts to develop an evidence-based process of care for the diagnosis and management of testosterone deficiency (TD) in adult men. The panel considered the definition, epidemiology, etiology, physiologic effects, diagnosis, assessment and treatment of TD. It also considered the treatment of TD in special populations and commented on contemporary controversies about testosterone replacement therapy, cardiovascular risk and prostate cancer. The aim was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of diagnosis and management of TD for clinicians without expertise in endocrinology, such as physicians in family medicine and general urology practice. A comprehensive literature review was performed, followed by a structured, 3-day panel meeting and 6-month panel consultation process using electronic communication. The final guideline was compiled from reports by individual panel members on areas reflecting their special expertise, and then agreed by all through an iterative process. This article contains the report of the ISSM TD Process of Care Committee. It offers a definition of TD and recommendations for assessment and treatment in different populations. Finally, best practice treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with TD. Development of a process of care is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to new insights into the pathophysiology of TD, as well as new, efficacious and safe treatments. We recommend that this process of care be reevaluated and updated by the ISSM in 4 years. © 2015 International Society for Sexual Medicine.

  10. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine.

    Science.gov (United States)

    Marshall, John C; Bosco, Laura; Adhikari, Neill K; Connolly, Bronwen; Diaz, Janet V; Dorman, Todd; Fowler, Robert A; Meyfroidt, Geert; Nakagawa, Satoshi; Pelosi, Paolo; Vincent, Jean-Louis; Vollman, Kathleen; Zimmerman, Janice

    2017-02-01

    Since their widespread introduction more than half a century ago, intensive care units (ICUs) have become an integral part of the health care system. Although most ICUs are found in high-income countries, they are increasingly a feature of health care systems in low- and middle-income countries. The World Federation of Societies of Intensive and Critical Care Medicine convened a task force whose objective was to answer the question "What is an ICU?" in an internationally meaningful manner and to develop a system for stratifying ICUs on the basis of the intensity of the care they provide. We undertook a scoping review of the peer-reviewed and gray literature to assemble existing models for ICU stratification. Based on these and on discussions among task force members by teleconference and 2 face-to-face meetings, we present a proposed definition and classification of ICUs. An ICU is an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of life-threatening organ system insufficiency. Although an ICU is based in a defined geographic area of a hospital, its activities often extend beyond the walls of the physical space to include the emergency department, hospital ward, and follow-up clinic. A level 1 ICU is capable of providing oxygen, noninvasive monitoring, and more intensive nursing care than on a ward, whereas a level 2 ICU can provide invasive monitoring and basic life support for a short period. A level 3 ICU provides a full spectrum of monitoring and life support technologies, serves as a regional resource for the care of critically ill patients, and may play an active role in developing the specialty of intensive care through research and education. A formal definition and descriptive framework for ICUs can inform health care decision-makers in planning and

  11. Using Qualitative Research to Inform Development of Professional Guidelines: A Case Study of the Society of Critical Care Medicine Family-Centered Care Guidelines.

    Science.gov (United States)

    Coombs, Maureen A; Davidson, Judy E; Nunnally, Mark E; Wickline, Mary A; Curtis, J Randall

    2017-08-01

    To explore the importance, challenges, and opportunities using qualitative research to enhance development of clinical practice guidelines, using recent guidelines for family-centered care in the ICU as an example. In developing the Society of Critical Care Medicine guidelines for family-centered care in the neonatal ICU, PICU, and adult ICU, we developed an innovative adaptation of the Grading of Recommendations, Assessments, Development and Evaluations approach to explicitly incorporate qualitative research. Using Grading of Recommendations, Assessments, Development and Evaluations and the Council of Medical Specialty Societies principles, we conducted a systematic review of qualitative research to establish family-centered domains and outcomes. Thematic analyses were undertaken on study findings and used to support Population, Intervention, Comparison, Outcome question development. We identified and employed three approaches using qualitative research in these guidelines. First, previously published qualitative research was used to identify important domains for the Population, Intervention, Comparison, Outcome questions. Second, this qualitative research was used to identify and prioritize key outcomes to be evaluated. Finally, we used qualitative methods, member checking with patients and families, to validate the process and outcome of the guideline development. In this, a novel report, we provide direction for standardizing the use of qualitative evidence in future guidelines. Recommendations are made to incorporate qualitative literature review and appraisal, include qualitative methodologists in guideline taskforce teams, and develop training for evaluation of qualitative research into guideline development procedures. Effective methods of involving patients and families as members of guideline development represent opportunities for future work.

  12. Who Wants a Fat Child?: Care for Obese Children in Weight Obsessed Societies

    Directory of Open Access Journals (Sweden)

    W.A. Bogart

    2015-03-01

    Full Text Available The treatment of obese people in our society, especially fat children gives rise to much indignation ("Fat", "fatness" - rather than "obese, obesity" - are preferred terms among groups and individuals protesting societal and traditional public health treatment of large persons. Not all obese individuals are poor; but being excessively overweight tends to be inversely related to socio economic status among women and their children in post industrial societies. Poor children who are fat often have the hardest experiences because they are large, are in poverty, and are dependent on parents and others for their welfare. Fat people are not protected from discrimination in most jurisdictions. Human rights laws should be amended to shield obese individuals from prejudicial actions. In addition, activism, public health models, and various legal interventions, to be discussed, need to focus on people, especially children, eating/drinking nutritiously and being physically active - with their weight being a secondary consideration. These issues are illustrated by discussing programs in the United States designed to assist poor families to eat and drink more nutritiously. El tratamiento de las personas obesas en nuestra sociedad, especialmente en el caso de los niños, da lugar a mucha indignación (se usan términos como "gordo", "gordura", en lugar de "obeso, obesidad", entre los grupos e individuos que protestan por el tratamiento social y la sanidad púbica tradicional para tratar a las personas grandes. No todas las personas obesas son pobres; pero en las sociedades postindustriales, entre mujeres y sus hijos tener un sobrepeso excesivo tiende a estar inversamente relacionado con la posición socioeconómico. Los niños pobres que están gordos sufren, a menudo, las experiencias más duras, porque son grandes, están en situación de pobreza, y su bienestar depende de sus padres y otras personas. En la mayoría de jurisdicciones, las personas gordas no

  13. Culture and biomedical care in Africa: the influence of culture on biomedical care in a traditional African society, Nigeria, West Africa.

    Science.gov (United States)

    Chukwuneke, F N; Ezeonu, C T; Onyire, B N; Ezeonu, P O

    2012-01-01

    Biomedical Care in Africa and the influence of culture on the health-seeking behaviour of Africans can not be underestimated; many African cultures have different understanding of the causes of disease which more often affect our public health system, policy, planning and implementations. The traditional African healer unlike a doctor trained in western biomedicine, looks for the cause of the patient's ailments as misfortune in relationship between the patient and the social, natural and spiritual environments. The complexity of African society with different cultural and religious practices also reflects on the people's attitude and understanding of their health matters. This paper is an overview of the cultural influence on biomedical care in a traditional African society, Nigeria, West Africa. A research on the patients' health seeking behaviour and Primary Health Care service organization in 10 health centres in the five eastern states of the Federal Republic of Nigeria was carried out using a multistage cross-sectional study. A semi-structured questionnaire was administered to the health care providers and patients while an in-depth semi- structured interview was also conducted. We observed there is underutilization of health care services at the primary level because most people do not accept the model of health care system provided for them. Most people believe diseases are caused by supernatural beings, the handiwork of neighbours or vengeance from an offended god as a result of transgressions committed in the past by an individual or parents. This group of people therefore prefers seeking traditional medicine to seeking orthodox medicine and often ends up in the hands of witch doctors who claim to have cure to almost all the diseases. Biomedical care in Africa is influence by culture because of different understanding of what ailment is and also due to limited knowledge of health matters, poverty and ignorance. There is a need therefore to focus on health

  14. Health care cost disease as a threat to Iranian aging society.

    Science.gov (United States)

    Basakha, Mehdi; Yavari, Kazem; Sadeghi, Hosein; Naseri, Alireza

    2014-01-01

    Because of the rapid aging rate, the share of health expenditure in gross domestic product rises irreversibly and increases concern among politicians and the general public. The aim of this study was to examine the accuracy of the Baumol's model of unbalanced growth in Iran over the period 1981-2010. This theoretical-analytical study was conducted in 2012 to investigate the various determinants of ongoing rise in the health expenditures. To this end, an Error Correction Model was derived from the long run cointegrating equation to inquire the veracity of Baumol's theory. Estimating the short run and long run equations by using time series data shows that the rate of increase in health expenditure is aligned with the difference between wage increases in and growth of productivity in the health sector. Besides, results show that both the per capita income and the inflation rate of health care had significant effects on raising the share of health sector in domestic economy. According to rapid population aging and existence of Baumol's cost disease in Iranian health sector, we predict much more rise in health expenditure in a few decades.

  15. [Knowledge about Biosimilars in Primary Care: a study by the Spanish Society of Primary Care Physicians (SEMERGEN)].

    Science.gov (United States)

    Micó-Pérez, R M; Payares-Herrera, C; Palomo-Jiménez, P I; Sánchez-Fierro, J; Avendaño-Solá, C; Llisterri-Caro, J L

    2018-02-16

    The objective of this study was to evaluate the awareness and training needs on biosimilar drugs in Primary Care (PC) physicians. Descriptive cross-sectional study based on an on-line questionnaire with a total of 34 multiple choice questions, published on the SEMERGEN website. The main Knowledge areas were: biosimilar definition; regulatory and legal framework; prescription, traceability, interchangeability and pharmacovigilance; availability of biosimilars in the PC setting, and the biosimilars contribution to sustainability. The software used for the analysis and data processing was the Barbwin 7.5. An analysis was performed on the responses from 701 questionnaires completed. There was a slight majority (57%) of women participants. The majority of participant worked in urban centres (60.91%). The definition of biosimilar was not known by 58% of those that responded, and 73% were unaware that the management of biosimilars and generics was not comparable. Most (84%) of those that responded were not aware that the studies required for the approval of biosimilars is different from reference biological medicines. Around two-thirds (66%) those that responded did not know of any biosimilars available in PC setting, and the 94% were also unaware of the Spanish legal framework for the management of biosimilar medicines. The current knowledge about biosimilars among PC physicians is low. The critical areas in need of further training include specific information on biosimilars currently available in PC setting, as well as key aspects regarding prescription, interchangeability and pharmacovigilance requirements. Six out of ten doctors do not know of any biosimilar used in PC in Spain. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Automatic detection of rhythmic and periodic patterns in critical care EEG based on American Clinical Neurophysiology Society (ACNS) standardized terminology.

    Science.gov (United States)

    Fürbass, F; Hartmann, M M; Halford, J J; Koren, J; Herta, J; Gruber, A; Baumgartner, C; Kluge, T

    2015-09-01

    Continuous EEG from critical care patients needs to be evaluated time efficiently to maximize the treatment effect. A computational method will be presented that detects rhythmic and periodic patterns according to the critical care EEG terminology (CCET) of the American Clinical Neurophysiology Society (ACNS). The aim is to show that these detected patterns support EEG experts in writing neurophysiological reports. First of all, three case reports exemplify the evaluation procedure using graphically presented detections. Second, 187 hours of EEG from 10 critical care patients were used in a comparative trial study. For each patient the result of a review session using the EEG and the visualized pattern detections was compared to the original neurophysiology report. In three out of five patients with reported seizures, all seizures were reported correctly. In two patients, several subtle clinical seizures with unclear EEG correlation were missed. Lateralized periodic patterns (LPD) were correctly found in 2/2 patients and EEG slowing was correctly found in 7/9 patients. In 8/10 patients, additional EEG features were found including LPDs, EEG slowing, and seizures. The use of automatic pattern detection will assist in review of EEG and increase efficiency. The implementation of bedside surveillance devices using our detection algorithm appears to be feasible and remains to be confirmed in further multicenter studies. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia - a short version for primary care.

    Science.gov (United States)

    Hasan, Alkomiet; Falkai, Peter; Wobrock, Thomas; Lieberman, Jeffrey; Glenthøj, Birte; Gattaz, Wagner F; Thibaut, Florence; Möller, Hans-Jürgen

    2017-06-01

    Schizophrenia is a severe mental disorder and many patients are treated in primary care settings. Apart from the pharmacological management of disease-associated symptoms, the detection and treatment of side effects is of the utmost importance in clinical practice. The purpose of this publication is to offer relevant evidence-based recommendations for the biological treatment of schizophrenia in primary care. This publication is a short and practice-oriented summary of Parts I-III of the World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia. The recommendations were developed by the authors and consented by a task force of international experts. Guideline recommendations are based on randomized-controlled trials and supplemented with non-randomized trials and meta-analyses where necessary. Antipsychotics of different chemical classes are the first-line pharmacological treatments for schizophrenia. Specific circumstances (e.g., suicidality, depression, substance dependence) may need additional treatment options. The pharmacological and non-pharmacological management of side effects is of crucial importance for the long-term treatment in all settings of the healthcare system. This summary of the three available evidence-based guidelines has the potential to support clinical decisions and can improve treatment of schizophrenia in primary care settings.

  18. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.

    Science.gov (United States)

    Cecconi, Maurizio; De Backer, Daniel; Antonelli, Massimo; Beale, Richard; Bakker, Jan; Hofer, Christoph; Jaeschke, Roman; Mebazaa, Alexandre; Pinsky, Michael R; Teboul, Jean Louis; Vincent, Jean Louis; Rhodes, Andrew

    2014-12-01

    Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit? (2) Should we monitor preload and fluid responsiveness in shock? (3) How and when should we monitor stroke volume or cardiac output in shock? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock? Four types of statements were used: definition, recommendation, best practice and statement of fact. Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock.

  19. Caring for people with dementia in general hospitals: an education curriculum from the Alzheimer's Society of Lower Saxony, Germany.

    Science.gov (United States)

    Gurlit, S; Thiesemann, R; Wolff, B; Brommer, J; Gogol, M

    2013-04-01

    Since 2006, the Alzheimer's Society of Lower Saxony, Germany, has been working to improve care and medical treatment for people with cognitive impairment or dementia in general hospitals. An interdisciplinary team systematically worked on the topic for several years and presented results at various symposia. In 2011, a two-stage curriculum was completed and sent in combination with additional training documents to all hospitals and nursing training colleges in Lower Saxony, Germany. The manual comprised a two-step approach with a 14-h training for hospital staff and a 160-h training for qualification of trainers and dementia appointees/chaperones. In addition, the manual included a list of 13 essential points for "dealing with demented people in a general hospital," the information sheet of the German Alzheimer's Society on aspects requiring special attention when a demented person is admitted to a hospital, short descriptions of best practice models, a list of established speakers in the field, and a 30-min film. In 2012, the project won the "Preis für Engagement und Selbsthilfe" of the Hertie Foundation and the "Niedersächsischen Gesundheitspreis" awarded by the Lower Saxon Ministry for Social, Women, Family, and Health Affairs.

  20. [Euthanasia, assisted suicide and palliative care: a review by the Ethics Committee of the French Society of Anaesthesia and Intensive Care].

    Science.gov (United States)

    Beydon, L; Pelluchon, C; Beloucif, S; Baghdadi, H; Baumann, A; Bazin, J-E; Bizouarn, P; Crozier, S; Devalois, B; Eon, B; Fieux, F; Frot, C; Gisquet, E; Guibet Lafaye, C; Kentish-Barnes, N; Muzard, O; Nicolas-Robin, A; Lopez, M O; Roussin, F; Puybasset, L

    2012-09-01

    Management of the end of life is a major social issue which was addressed in France by law, on April 22nd 2005. Nevertheless, a debate has emerged within French society about the legalization of euthanasia and/or assisted suicide (E/AS). This issue raises questions for doctors and most especially for anesthetists and intensive care physicians. To highlight, dispassionately and without dogmatism, key points taken from the published literature and the experience of countries which have legislated for E/AS. The current French law addresses most of the end of life issues an intensive care physician might encounter. It is credited for imposing palliative care when therapies have become senseless and are withdrawn. However, this requirement for palliative care is generally applied too late in the course of a fatal illness. There is a great need for more education and stronger incentives for early action in this area. On the rare occasions when E/AS is requested, either by the patient or their loved-ones, it often results from a failure to consider that treatments have become senseless and conflict with patient's best interest. The implementation of E/AS cannot be reduced to a simple affirmation of the Principle of autonomy. Such procedures present genuine difficulties and the risk of drift. We deliver a message of prudence and caution. Should we address painful end of life and moral suffering issues, by suppressing the subject, i.e. ending the patient's life, when comprehensive palliative care has not first been fully granted to all patients in need of it ? Copyright © 2012 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  1. Malignant Posterior Reversible Encephalopathy Syndrome-An Exacting Challenge for Neurocritical Care Physicians.

    Science.gov (United States)

    Magsi, Shahvaiz; Zafar, Atif

    2017-10-01

    We report a case of malignant posterior reversible encephalopathy syndrome (PRES) in a 62-year-old Caucasian female with a complex medical history and comorbidities admitted for bowel resection and lysis of iatrogenic bowel adhesions and enterocutaneous fistulas. Postoperatively, the patient developed sudden bilateral visual loss with no other neurologic deficits. Computed tomography scan showed very severe PRES-like changes, confirmed on magnetic resonance imaging (MRI). Systolic blood pressure remained around 170 mm HG. The patient was obtunded and remained unresponsive after MRI, with minimal response and a deteriorating clinical condition. The patient was given hyperosmolar therapy with a mannitol bolus. She recovered well with near resolution of imaging findings.

  2. Effect of IV Acetaminophen on Patients in the Neurocritical Care Unit

    Science.gov (United States)

    2016-12-08

    Post-operative Craniotomy Patients; Carotid Endarterectomy and Carotid Artery Stenosis Patients; Post-op Spine Patients Admitted to the NCCU; Endovascular Patients Undergoing Intracranial Intervention; Traumatic Brain Injuries NPO for at Least 12 Hours

  3. Scoliosis Research Society

    Science.gov (United States)

    Scoliosis Research Society Close Menu Member Login Become a Member Home Find a Specialist | Calendar Contact | Donate ... a Member Find a Specialist Calendar Contact Donate Scoliosis Research Society Dedicated to the optimal care of ...

  4. "Do not do" recommendations of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy. "Commitment to Quality by Scientific Societies" Project.

    Science.gov (United States)

    Quecedo Gutiérrez, L; Ruiz Abascal, R; Calvo Vecino, J M; Peral García, A I; Matute González, E; Muñoz Alameda, L E; Guasch Arévalo, E; Gilsanz Rodríguez, F

    2016-11-01

    In April 2013 the Ministry of Health (MSSSI) adopted the project called "Commitment to Quality by Scientific Societies in Spain", in response to social and professional demands for sustainability of the health system. The initiative is part of the activities of the Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System, and is coordinated jointly by the Quality and Cohesion Department, the Aragon Institute of Health Sciences (IACS), and the Spanish Society of Internal Medicine (SEMI). All the scientific societies in Spain have been included in this project, and its main objective is to reduce the unnecessary use of health interventions in order to agree "do not do" recommendations, based on scientific evidence. The primary objective was to identify interventions that have not proven effective, have limited or doubtful effectiveness, are not cost-effective, or do not have priority. Secondary objectives were: reducing variability in clinical practice, to spread information between doctors and patients to guide decision-making, the appropriate use of health resources and, the promotion of clinical safety and reducing iatrogenesis. The selection process of the 5 "do not do" recommendations was made by Delphi methodology. A total of 25 panellists (all anaesthesiologists) chose between 15 proposals based on: evidence that supports quality, relevance, or clinical impact, and the people they affect. The 5 recommendations proposed were: Do not maintain deep levels of sedation in critically ill patients without a specific indication; Do not perform preoperative chest radiography in patients under 40 years-old with ASA physical status I or II; Do not systematically perform preoperative tests in cataract surgery unless otherwise indicated based on clinical history and physical examination; Do not perform elective surgery in patients with anaemia at risk of bleeding until a diagnostic workup is performed and treatment is given

  5. Accessing timely rehabilitation services for a global aging society? Exploring the realities within Canada's universal health care system.

    Science.gov (United States)

    Landry, Michel D; Raman, Sudha; Al-Hamdan, Elham

    2010-07-01

    The proportion of older persons is increasing in developed and developing countries: this aging trend can be viewed as a two-edged sword. On the one hand, it represents remarkable successes regarding advances in health care; and on the other hand, it represents a considerable challenge for health systems to meet growing demand. A growing disequilibrium between supply and demand may be particularly challenging within publicly funding health systems that 'guarantee' services to eligible populations. Rehabilitation, including physical therapy, is a service that if provided in a timely manner, can maximize function and mobility for older persons, which may in turn optimize efficiency and effectiveness of overall health care systems. However, physical therapy services are not considered an insured service under the legislative framework of the Canadian health system, and as such, a complex public/private mix of funding and delivery has emerged. In this article, we explore the consequences of a public/private mix of physical therapy on timely access to services, and use the World Health Organization (WHO) health system performance framework to assess the extent to which the emerging system influences the goal of aggregated and equitable health. Overall, we argue that a shift to a public/private mix may not have positive influences at the population level, and that innovative approaches to deliver services would be desirable to strengthening rather than weaken the publicly funded system. We signal that strategies aimed at scaling up rehabilitation interventions are required in order to improve health outcomes in an evolving global aging society.

  6. Civil society and the Health and Social Care Act in England and Wales: theory and praxis for the twenty-first century.

    Science.gov (United States)

    Scambler, Graham; Scambler, Sasha; Speed, Ewen

    2014-12-01

    In this paper we revisit the notion of civil society in the light of recent attempts to privatize health care in England via the passing of the Health and Social Care Act of 2013. This legislation promises a re-commodification of the National Health Service (NHS) in England. The Bill was bitterly contested during its passage through parliament, most vigorously in 2011. Much of the opposition occurred at a time of widespread, global rebellion, most notably in the 'Arab uprisings' and through the 'occupy movement'. Despite a plethora of protests, we argue, a non-porous boundary between what we call the 'protest sector' of civil society and the wider public sphere of the lifeworld has become apparent in England. A good deal of collective action, whether campaign-focused (like opposition to the Health and Social Care Bill) or more generalized (like rejections of corporate greed), has so far proved ineffective, at least in the short-term; no crisis of legitimation is apparent. We highlight a new 'class/command dynamic', leading to oligarchic rule, in the present era of financial capitalism. We use this health care case-study to re-examine the notion of civil society and its changing properties in what Castells calls a 'networked society'. The contribution ends with a discussion of the role of the sociologist re-civil society and the advocacy of both 'action' and 'foresight sociologies'. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery.

    Science.gov (United States)

    Tchervenkov, Christo I; Jacobs, Jeffrey Phillip; Bernier, Pierre-Luc; Stellin, Giovanni; Kurosawa, Hiromi; Mavroudis, Constantine; Jonas, Richard A; Cicek, Sertac M; Al-Halees, Zohair; Elliott, Martin J; Jatene, Marcelo B; Kinsley, Robin H; Kreutzer, Christian; Leon-Wyss, Juan; Liu, Jinfen; Maruszewski, Bohdan; Nunn, Graham R; Ramirez-Marroquin, Samuel; Sandoval, Nestor; Sano, Shunji; Sarris, George E; Sharma, Rajesh; Shoeb, Ayman; Spray, Thomas L; Ungerleider, Ross M; Yangni-Angate, Hervé; Ziemer, Gerhard

    2008-12-01

    The diagnosis and treatment for paediatric and congenital cardiac disease has undergone remarkable progress over the last 60 years. Unfortunately, this progress has been largely limited to the developed world. Yet every year approximately 90% of the more than 1,000,000 children who are born with congenital cardiac disease across the world receive either suboptimal care or are totally denied care.While in the developed world the focus has changed from an effort to decrease post-operative mortality to now improving quality of life and decreasing morbidity, which is the focus of this Supplement, the rest of the world still needs to develop basic access to congenital cardiac care. The World Society for Pediatric and Congenital Heart Surgery [http://www.wspchs.org/] was established in 2006. The Vision of the World Society is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The Mission of the World Society is to promote the highest quality comprehensive care to all patients with pediatric and/or congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with emphasis on excellence in education, research and community service.We present in this article an overview of the epidemiology of congenital cardiac disease, the current and future challenges to improve care in the developed and developing world, the impact of the globalization of cardiac surgery, and the role that the World Society should play. The World Society for Pediatric and Congenital Heart Surgery is in a unique position to influence and truly improve the global care of children and adults with congenital cardiac disease throughout the world [http://www.wspchs.org/].

  8. Intensive care management of patients with liver disease: proceedings of a single-topic conference sponsored by the Brazilian Society of Hepatology

    Directory of Open Access Journals (Sweden)

    Paulo Lisboa Bittencourt

    Full Text Available ABSTRACT Survival rates of critically ill patients with liver disease has sharply increased in recent years due to several improvements in the management of decompensated cirrhosis and acute liver failure. This is ascribed to the incorporation of evidence-based strategies from clinical trials aiming to reduce mortality. In order to discuss the cutting-edge evidence regarding critical care of patients with liver disease, a joint single topic conference was recently sponsored by the Brazilian Society of Hepatology in cooperation with the Brazilian Society of Intensive Care Medicine and the Brazilian Association for Organ Transplantation. This paper summarizes the proceedings of the aforementioned meeting and it is intended to guide intensive care physicians, gastroenterologists and hepatologists in the care management of patients with liver disease.

  9. [Evaluation of the status of patients with severe infection, criteria for intensive care unit admittance. Spanish Society for Infectious Diseases and Clinical Microbiology. Spanish Society of Intensive and Critical Medicine and Coronary Units].

    Science.gov (United States)

    Olaechea, Pedro M; Alvarez-Lerma, Francisco; Sánchez, Miguel; Torres, Antonio; Palomar, Mercedes; Fernández, Pedro; Miró, José M; Cisneros, José Miguel; Torres, Manuel

    2009-06-01

    Recent studies have shown that early attention in patients with serious infections is associated with a better outcome. Assistance in intensive care units (ICU) can effectively provide this attention; hence patients should be admitted to the ICU as soon as possible, before clinical deterioration becomes irreversible. The objective of this article is to compile the recommendations for evaluating disease severity in patients with infections and describe the criteria for ICU admission, updating the criteria published 10 years ago. A literature review was carried out, compiling the opinions of experts from the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC, Spanish Society for Infectious Diseases and Clinical Microbiology) and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC, Spanish Society for Intensive Medicine, Critical Care and Coronary Units) as well as the working groups for infections in critically ill patients (GEIPC-SEIMC and GTEI-SEMICYUC). We describe the specific recommendations for ICU admission related to the most common infections affecting patients, who will potentially benefit from critical care. Assessment of the severity of the patient's condition to enable early intensive care is stressed.

  10. Respectful maternity care in three health facilities in Burkina Faso: the experience of the Society of Gynaecologists and Obstetricians of Burkina Faso.

    Science.gov (United States)

    Ouédraogo, Ali; Kiemtoré, Sibraogo; Zamané, Hyacinthe; Bonané, Blandine T; Akotionga, Michel; Lankoande, Jean

    2014-10-01

    The Society of Gynaecologists and Obstetricians of Burkina Faso (SOGOB) conducted a project to reinforce skills in respectful maternity care among its members and health workers at three facilities. The participatory process allowed health workers to self-diagnose quality of care, recognize their own responsibility, propose solutions, and pledge respectful care commitments that were specific for each unit. Key commitments included good reception; humanistic clinical examination; attentive listening and responsiveness to patient needs; privacy, discretion, and confidentiality; availability; and comfort. These commitments can potentially be modified after each evaluation by SOGOB. Poor working conditions were found to negatively impact on quality of care. High staff turnover, frequent technical malfunctions, and inadequate infrastructure were identified as issues that require future focus to ensure improvements in quality of care are sustainable. Programs that aim to improve the maternity experience by linking good practice with humanistic care merit rollout to all healthcare facilities in Burkina Faso. Copyright © 2014. Published by Elsevier Ireland Ltd.

  11. Impact of Society of Cardiovascular Patient Care accreditation on quality: an ACTION Registry®-Get With The Guidelines™ analysis.

    Science.gov (United States)

    Peacock, W Frank; Kontos, Michael C; Amsterdam, Ezra; Cannon, Christopher P; Diercks, Deborah; Garvey, Lee; Graff, Louis; Holmes, DaJuanicia; Holmes, Kay Styer; McCord, James; Newby, Kristin; Roe, Matthew; Dadkhah, Shahriar; Siler-Fisher, Angela; Ross, Michael

    2013-09-01

    The Society of Cardiovascular Patient Care (SCPC) accredits hospital acute coronary syndrome management. The influence of accreditation on the subset of patients diagnosed with acute myocardial infarction (AMI) is unknown. Our purpose was to describe the association between SCPC accreditation and hospital quality metric performance among AMI patients enrolled in ACTION Registry-GWTG (ACTION-GWTG). This program is a voluntary registry that receives self-reported hospital AMI quality metrics data and provides quarterly feedback to 487 US hospitals. Using urban nonacademic hospital registry data from January 1, 2007, to June 30, 2010, we performed a 1 to 2 matched pairs analysis, selecting 14 of 733 (1.9%) SCPC accredited and 28 of 309 (9.1%) nonaccredited registry facilities to compare changes in quality metrics between the year before and after SCPC accreditation. All hospitals improved quality metric compliance during the study period. Nonaccredited hospitals started with slightly lower rates of AMI composite score 1 year before accreditation. Although improvement compared with baseline was greater for nonaccredited hospitals (odds ratio = 1.27; 95% confidence interval: 1.20, 1.35) than accredited hospitals (odds ratio = 1.15; 95% confidence interval: 1.07, 1.23) (P = 0.022), the group ended with similar compliance scores (92.1% vs. 92.2%, respectively). Improvements in evaluating left ventricular function (P = 0.0001), adult smoking cessation advice (P = 0.0063), and cardiac rehab referral (P = 0.0020) were greater among nonaccredited hospitals, whereas accredited hospitals had greater improvement in discharge angiotensin-converting-enzyme inhibitor or angiotensin II receptor blocker use for left ventricular systolic dysfunction (P = 0.0238). All hospitals had high rates of quality metric compliance and finished with similar overall AMI performance composite scores after 1 year.

  12. Introduction to "Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations".

    Science.gov (United States)

    Ehrich, Jochen; Namazova-Baranova, Leyla; Pettoello-Mantovani, Massimo

    2016-10-01

    The field of pediatrics in Europe is characterized by the diversities, variations, and heterogeneities of child health care services provided in 53 European countries with more than 200 million children below 18 years of age. Managing the health care of infants, children, and adolescents in Europe requires balancing clinical aims, research findings, and socioeconomic goals within a typical environment characterized by cultural and economic complexity and large disparity in availability, affordability, and accessibility of pediatric care. Since its foundation in 1976, the European Paediatric Association-Union of National European Paediatric Societies and Associations has worked to improve both medical care of all children and cooperation of their caretakers in Europe. Such a report has been conceived in the strong belief that broadening of the intellectual basis of the European Paediatric Association-Union of National European Paediatric Societies and Associations and creating a multidisciplinary society will be necessary to reduce fragmentation of pediatrics and tackle the legal, economic, and organizational challenges of child health care in Europe. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Differences in blood pressure by measurement technique in neurocritically ill patients: A technological assessment.

    Science.gov (United States)

    Lele, Abhijit V; Wilson, Daren; Chalise, Prabhakar; Nazzaro, Jules; Krishnamoorthy, Vijay; Vavilala, Monica S

    2018-01-01

    Blood pressure data may vary by measurement technique. We performed a technological assessment of differences in blood pressure measurement between non-invasive blood pressure (NIBP) and invasive arterial blood pressure (ABP) in neurocritically ill patients. After IRB approval, a prospective observational study was performed to study differences in systolic blood pressure (SBP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) values measured by NIBP arm, ABP at level of the phlebostatic axis (ABP heart) and ABP at level of the external auditory meatus (ABP brain) at 30 and 45-degree head of bed elevation (HOB) using repeated measure analysis of covariance and correlation coefficients. Overall, 168 patients were studied with median age of 57 ± 15 years, were mostly female (57%), with body mass index ≤30 (66%). Twenty-three percent (n = 39) had indwelling intracranial pressure monitors, and 19.7% (n = 33) received vasoactive agents. ABP heart overestimated ABP brain for SBP (11.5 ± 2.7 mmHg, p < .001), MAP (mean difference 13.3 ± 0.5 mmHg, p < .001) and CPP (13.4 ± 3.2 mmHg, p < .001). ABP heart overestimated NIBP arm for SBP (8 ± 1.5 mmHg, p < .001), MAP (mean difference 8.6 ± 0.8 mmHg, p < .001), and CPP (mean difference 9.8 ± 3.2 mmHg, p < .001). Regardless of HOB elevation, ABP heart overestimates MAP compared to ABP brain and NIBP arm. Using ABP heart data overestimates CPP and may be responsible for not achieving SBP, MAP or CPP targets aimed at the brain. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. [Burnout-associated factors in anesthesia and intensive care medicine. 2009 survey of the French Society of anesthesiology and intensive care].

    Science.gov (United States)

    Mion, G; Libert, N; Journois, D

    2013-03-01

    To assess factors related to burnout in anesthesia and intensive care. National prospective observational study. Questionnaire posted on the French Society of anesthesia website from 3rd June 2009 to 27th August 2009: Maslach Burnout Inventory (MBI), Fast Alcohol Consumption Evaluation (FACE) and The Harvard National Depression Screening Day Scale (HANDS) scales and questions to assess health, work and personal life. One thousand six hundred and three questionnaires returned: 1091 anesthetists (67.6%), 241 intensivists (14.9%), 204 nurses (12.6%), emergency physicians (2.8%), supervisor nurses (0.9%). Seven hundred and sixty three in a university hospital (47.3%), 259 in a regional hospital (16.1%), 405 in a private structure (25.1%), 71 in a non-lucrative private structure (4.4%), 75 in a military hospital (4.6%). Rest of safety: 69.2% of institutions. Depression: 38.7%. Drug or chemicals addicted: 10.6%. Alcohol addicts: 10.6%. Among them, 62.3% of individuals were in burnout. Burnout was linked to fragmented sleep (Pdepression (P=0.00001), alcohol (Pburnout intended more frequently to leave the profession (Pburnout: quality of work, of personal life, of fatigue, depression, conflicts with colleagues and patients, regretting the choice of specialty. This study of the largest cohort of anesthesia personnel performed in France detects a high proportion of burnout. It highlights links with tensors that may constitute possibilities of prevention of the burnout syndrome. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  15. Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement.

    Science.gov (United States)

    Bickel, Kathleen E; McNiff, Kristen; Buss, Mary K; Kamal, Arif; Lupu, Dale; Abernethy, Amy P; Broder, Michael S; Shapiro, Charles L; Acheson, Anupama Kurup; Malin, Jennifer; Evans, Tracey; Krzyzanowska, Monika K

    2016-09-01

    Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts. Copyright © 2016 by American Society of Clinical Oncology.

  16. Lessons learned from the science of caring: Extending the reach of psychosocial oncology: The International Psycho-Oncology Society 2016 Sutherland Award Lecture.

    Science.gov (United States)

    Bultz, Barry D

    2017-06-01

    In medicine, referral to a medical oncology specialty is based on recent history, physical examination, pathology, surgery reports, imaging, blood work, and the patient's vital signs. By contrast, referral to a psychosocial specialist has typically been based on the patients expressed request for psychosocial support or the health care team's observation of the patient's limited adjustment or poor coping with the diagnosis, treatment, or end-of-life distress. These observations are usually based on clinical acumen not on metrics. In psychosocial oncology, by committing to the science of caring and relying on the use of standardized tools to screen for distress, the multidisciplinary cancer care team assess, communicate, and intervene on what is measured. That is, health care providers can begin to address the patients' identified concerns. Branding distress as the 6th vital sign and incorporating screening for distress into standard cancer practice can be an effective strategy to challenging the resistance in implementation of psychosocial oncology in cancer care institutions. Accreditation agencies are endorsing the need to assess patient distress and better manage symptoms of distress as part of routine and standardized patient care. While many international organizations and societies support the importance of screening, implementing screening for distress still has a long way to go to be operationalized in many cancer care programs. Screening for distress when implemented does, however, create an opportunity for psychosocial oncology to extend its reach into cancer care programs and institutions. Copyright © 2017 John Wiley & Sons, Ltd.

  17. Development and Pilot Evaluation of a Novel Dignity-Conserving End-of-Life (EoL) Care Model for Nursing Homes in Chinese Societies.

    Science.gov (United States)

    Ho, Andy H Y; Dai, Annie A N; Lam, Shu-Hang; Wong, Sandy W P; Tsui, Amy L M; Tang, Jervis C S; Lou, Vivian W Q

    2016-06-01

    The provision of end-of-life (EoL) care in long-term-care settings remains largely underdeveloped in most Chinese societies, and nursing home residents often fail to obtain good care as they approach death. This paper systematically describes the development and implementation mechanisms of a novel Dignity-Conserving EoL Care model that has been successfully adopted by three nursing homes in Hong Kong and presents preliminary evidence of its effectiveness on enhancing dignity and quality of life (QoL) of terminally ill residents. Nine terminally ill nursing home residents completed the McGill Quality of Life Questionnaire and the Nursing Facilities Quality of Life Questionnaire at baseline and 6 months post-EoL program enrollment. Wilcoxon signed rank test was used to detect significance changes in each QoL domains across time. Although significant deterioration was recorded for physical QoL, significant improvement was observed for social QoL. Moreover, a clear trend toward significant improvements was identified for the QoL domains of individuality and relationships. A holistic and compassionate caring environment, together with the core principles of family-centered care, interagency and interdisciplinary teamwork, as well as cultural-specific psycho-socio-spiritual support, are all essential elements for optimizing QoL and promoting death with dignity for nursing home residents facing morality. This study provides a useful framework to facilitate the future development of EoL care in long-term-care settings in the Chinese context. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Partnership of the Sociedade Brasileira de Oncologia Pediátrica and International Society of Pediatric Oncology to improve nutritional care for children with cancer in Brazil.

    Science.gov (United States)

    Viani, Karina; Filho, Vicente Odone; Ferman, Sima; Fonseca, Teresa Cristina Cardoso; Oliveira, Vanessa da Cunha; Lemos, Priscila Dos Santos Maia; Barr, Ronald D; Ladas, Elena J

    The authors present a proposal of a partnership between the Sociedade Brasileira de Oncologia Pediátrica (SOBOPE) and the International Society of Pediatric Oncology (SIOP) to promote the standardization and improvement of nutritional care of kids under cancer treatment in Brazil. The results of the first meeting in Brazil as well as plans for future meetings are described. Copyright © 2017 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved.

  19. Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process.

    Science.gov (United States)

    Gagnon, Anita J; DeBruyn, Rebecca; Essén, Birgitta; Gissler, Mika; Heaman, Maureen; Jeambey, Zeinab; Korfker, Dineke; McCourt, Christine; Roth, Carolyn; Zeitlin, Jennifer; Small, Rhonda

    2014-06-10

    Through the World Health Assembly Resolution, 'Health of Migrants', the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada. A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created--the Migrant Friendly Maternity Care Questionnaire (MFMCQ)--in three languages (English, French and Spanish). It is completed in 45 minutes via interview

  20. [Models of care and classification of "Children with special health care needs-CSHCN": Recommendations from the CSHCN Committee, Chilean Paediatric Society].

    Science.gov (United States)

    Flores Cano, Juan Carlos; Lizama Calvo, Macarena; Rodríguez Zamora, Natalie; Ávalos Anguita, María Eugenia; Galanti De La Paz, Mónica; Barja Yañez, Salesa; Becerra Flores, Carlos; Sanhueza Sepúlveda, Carolina; Cabezas Tamayo, Ana María; Orellana Welch, Jorge; Zillmann Geerdts, Gisela; Antilef, Rosa María; Cox Melane, Alfonso; Valle Maluenda, Marcelo; Vargas Catalán, Nelson

    2016-01-01

    "Children with special health care needs" (CSHCN) is an emerging and heterogeneous group of paediatric patients, with a wide variety of medical conditions and with different uses of health care services. There is consensus on how to classify and assess these patients according to their needs, but not for their specific diagnosis. Needs are classified into 6 areas: a) specialised medical care; b) use or need of prescription medication; c) special nutrition; d) dependence on technology; e) rehabilitation therapy for functional limitation; and f) special education services. From the evaluation of each area, a classification for CSHCN is proposed according to low, medium, or high complexity health needs, to guide and distribute their care at an appropriate level of the health care system. Low complexity CSHCN should be incorporated into Primary Care services, to improve benefits for patients and families at this level. It is critical to train health care professionals in taking care of CSHCN, promoting a coordinated, dynamic and communicated work between different levels of the health care system. Compliance with these guidelines will achieve a high quality and integrated care for this vulnerable group of children. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Intensive Care Society's APACHE II study in Britain and Ireland--I: Variations in case mix of adult admissions to general intensive care units and impact on outcome.

    Science.gov (United States)

    Rowan, K M; Kerr, J H; Major, E; McPherson, K; Short, A; Vessey, M P

    1993-10-16

    To describe the extent of variation in the case mix of adult admissions to general intensive care units in Britain and Ireland and investigate the impact of such variation on outcome. Prospective, cohort study of consecutive admissions to intensive care units. 26 general intensive care units in Britain and Ireland. 9099 admissions to the intensive care units studied. Death or survival at discharge before and after adjustment of case mix (age, history of chronic conditions, surgical status, diagnosis, and severity of illness) according to the APACHE II method. Important differences in case mix were found, with large variations between the units. Hospital mortality was significantly associated with most of the case mix factors investigated. Comparing crude death rates in hospital between intensive care units may be misleading indicators of performance. The collection of data on case mix needs to be standardised and differences in case mix adjusted for when comparing outcome between different intensive care units.

  2. Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017); Venice (Italy); October 31-November 4, 2017; Session "Quality Improvement, Parents Centered Care"

    OpenAIRE

    --- Various Authors

    2017-01-01

    Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017); Venice (Italy); October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR), European Society for Neonatology (ESN), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI)ORGANIZING COMMITTEELuc Zi...

  3. An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death.

    Science.gov (United States)

    Gries, Cynthia J; White, Douglas B; Truog, Robert D; Dubois, James; Cosio, Carmen C; Dhanani, Sonny; Chan, Kevin M; Corris, Paul; Dark, John; Fulda, Gerald; Glazier, Alexandra K; Higgins, Robert; Love, Robert; Mason, David P; Nakagawa, Thomas A; Shapiro, Ron; Shemie, Sam; Tracy, Mary Fran; Travaline, John M; Valapour, Maryam; West, Lori; Zaas, David; Halpern, Scott D

    2013-07-01

    Donation after circulatory determination of death (DCDD) has the potential to increase the number of organs available for transplantation. Because consent and management of potential donors must occur before death, DCDD raises unique ethical and policy issues. To develop an ethics and health policy statement on adult and pediatric DCDD relevant to critical care and transplantation stakeholders. A multidisciplinary panel of stakeholders was convened to develop an ethics and health policy statement. The panel consisted of representatives from the American Thoracic Society, Society of Critical Care Medicine, International Society for Heart and Lung Transplantation, Association of Organ Procurement Organizations, and the United Network of Organ Sharing. The panel reviewed the literature, discussed important ethics and health policy considerations, and developed a guiding framework for decision making by stakeholders. A framework to guide ethics and health policy statement was established, which addressed the consent process, pre- and post mortem interventions, the determination of death, provisions of end-of-life care, and pediatric DCDD. The information presented in this Statement is based on the current evidence, experience, and clinical rationale. New clinical research and the development and dissemination of new technologies will eventually necessitate an update of this Statement.

  4. Palliative care in heart failure : a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology

    NARCIS (Netherlands)

    Jaarsma, Tiny; Beattie, James M.; Ryder, Mary; Rutten, Frans H.; McDonagh, Theresa; Mohacsi, Paul; Murray, Scott A.; Grodzicki, Thomas; Bergh, Ingrid; Metra, Marco; Ekman, Inger; Angermann, Christiane; Leventhal, Marcia; Pitsis, Antonis; Anker, Stefan D.; Gavazzi, Antonello; Ponikowski, Piotr; Dickstein, Kenneth; Delacretaz, Etienne; Blue, Lynda; Strasser, Florian; McMurray, John

    Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as

  5. Web-based educational activities developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC): the experience of process, utilization, and expert evaluation.

    Science.gov (United States)

    Sharma, Deepak; Bilotta, Federico; Moore, Laurel E; Bebawy, John F; Flexman, Alana M; Rochlen, Lauryn; Gorji, Reza; Avitsian, Rafi

    2014-01-01

    Web-based delivery of educational material by scientific societies appears to have increased recently. However, the utilization of such efforts by the members of professional societies is unknown. We report the experience with delivery of educational resources on the Web site of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), and utilization of those resources by members. Three web-based educational initiatives were developed over 1 year to be disseminated through the SNACC Web site (http://www.snacc.org) for society members: (1) The SNACC Bibliography; (2) "Chat with the Author"; and (3) Clinical Case Discussions. Content experts and authors of important new research publications were invited to contribute. Member utilization data were abstracted with the help of the webmaster. For the bibliography, there were 1175 page requests during the 6-month period after its launch by 122/664 (19%) distinct SNACC members. The bibliography was utilized by 107/553 (19%) of the active members and 15/91 (16.5%) of the trainee members. The "Chats with the Authors" were viewed by 56 (9%) members and the Clinical Case Discussions by 51 (8%) members. Educational resources can be developed in a timely manner utilizing member contributions without additional financial implications. However, the member utilization of these resources was lower than expected. These are first estimates of utilization of web-based educational resources by members of a scientific society. Further evaluation of such utilization by members of other societies as well as measures of the effectiveness and impact of such activities is needed.

  6. Transfer of nurse education to universities under a model of person-centred care: A consequence of changes in Spanish society during the democratic transition.

    Science.gov (United States)

    Rodrigo, Olga; Caïs, Jordi; Monforte-Royo, Cristina

    2017-07-01

    In Spain the transfer of nurse education to universities was accompanied by a shift towards a model of person-centred care. To explore whether the change in nurses' professional profile (from physician assistant to providers of person-centred care) was a response to changing needs in Spanish society. Qualitative study. Theoretical sampling and in-depth interviews using an inductive analytical approach. Four categories described the nursing profession in Spain prior to the introduction of university training: the era of medical assistants; technologisation of hospitals; personal care of the patient based on Christian values; professional socialisation differentiated by gender. Further analysis showed that these categories could be subsumed under a broader core category: the transfer of nurse education to universities as part of Spain's transition to democracy. The transfer of nurse education to universities was one of several changes occurring in Spanish society during the country's transition to democratic government. The redefined public health system required a highly skilled workforce, with improved employment rights being given to female health professionals, notably nurses. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Is the American Society of Shoulder and Elbow Therapists' rehabilitation guideline better than standard care when applied to Bankart-operated patients? A controlled study.

    Science.gov (United States)

    Damkjær, Lars; Petersen, Tom; Juul-Kristensen, Birgit

    2015-02-01

    To determine whether there is a difference in shoulder-related physical function and quality of life between postoperative rehabilitation patients receiving standard care and those receiving care according to the American Society of Shoulder and Elbow Therapists' rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. Descriptive studies with comparison between a retrospective and a prospective cohort. Municipal outpatient rehabilitation centre. A total of 96 arthroscopic Bankart-operated patients. A total of 52 patients received standard care; 44 patients underwent rehabilitation according to the American Society of Shoulder and Elbow Therapists' rehabilitation guideline. Primary outcome variable was Western Ontario Shoulder Instability Index. Secondary outcome measures were Patient-Specific Functional Scale, shoulder range of motion, return to work, return to sports, and costs. There was no significant difference in adjusted mean change scores between the standard care group and the guideline group in the primary outcome variable (Western Ontario Shoulder Instability Index total = 574.85 vs. 644.48) or the secondary outcomes (Patient-Specific Functional Scale = 4.6 vs. 5.0; range of motion in forward flexion = 46.49° vs. 49.58°; external rotation in adduction = 28.58° vs. 34.18°; external rotation in abduction = 51.29° vs. 47.55°; weeks until return to work = 5.2 vs. 6.9; weeks until return to sports =13.9 vs. 13.1; costs = number of visits; 18.5 vs. 15.9). There were no significant between-group differences in shoulder-related physical function and quality of life between the standard care group and the guideline group, following Bankart operations. © The Author(s) 2014.

  8. World Federation of Societies of Biological Psychiatry guidelines for the pharmacological treatment of dementias in primary care

    DEFF Research Database (Denmark)

    Ihl, Ralf; Bunevicius, Robertas; Frölich, Lutz

    2015-01-01

    OBJECTIVE: To define a practice guideline for biological treatment of dementias for general practitioners in primary care. METHODS: This paper is a short and practical summary of the World Federation of Biological Psychiatry (WFSBP) guidelines for the Biological treatment of Alzheimer's disease a...

  9. Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: An international Delphi consensus process

    NARCIS (Netherlands)

    Gagnon, A.J.; DeBruyn, R.; Essén, B.; Gissler, M.; Heaman, M.; Jeambey, Z.; Korfker, D.; McCourt, C.; Roth, C.; Zeitlin, J.; Small, R.; Alexander, S.; Racapé, J.; Arntzen, A.; Barros, H.; Blondel, B.; Merry, L.; Glazier, R.; Kirby, R.; Mohangoo, A.; Macfarlane, A.; Dattani, N.; Nybo Andersen, A.M.; Mortensen, L.; Villadsen, S.; Davey, M.A.; Sievers, E.; Stray-Pedersen, B.; Urquia, M.; Janevic, T.; Guendelman, S.; Bolumar, F.; Río Sánchez, M.I.; Hjern, A.; Vangen, S.

    2014-01-01

    Background: Through the World Health Assembly Resolution, 'Health of Migrants', the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital

  10. Casualties of the Global War on Terror and their future impact on health care and society: a looming public health crisis.

    Science.gov (United States)

    Baker, Michael S

    2014-04-01

    This article is a primer to understand the medical advances and the future health care consequences of the current conflicts in the Middle East and Southwest Asia, known as the Global War on Terror. There have been significant advances in health care learned in caring for those injured by the conflict--often a polytrauma blast victim, but there are also very high incidence rates of the hidden injuries of war--traumatic brain injury, post-traumatic stress disorder, suicide, and depression. These lead to disruptive behaviors, homelessness, and family violence. Global War on Terror returnees are using medical services and applying for disability at higher rates than in previous conflicts. The costs for veterans' care may peak 30 to 40 years or longer following the conflict, and will inflict an enormous burden on services and resources. The effects of the war will linger for years and impact across generations because of the stress on families and children. We must mobilize government agencies, create public-private partnerships, and invest our resources now to mitigate the approaching tsunami of veterans' health care needs, the impact on our social services, and the devastating costs to society. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  11. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition.

    Science.gov (United States)

    Mehta, Nilesh M; Skillman, Heather E; Irving, Sharon Y; Coss-Bu, Jorge A; Vermilyea, Sarah; Farrington, Elizabeth Anne; McKeever, Liam; Hall, Amber M; Goday, Praveen S; Braunschweig, Carol

    2017-07-01

    This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and 2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance. The PubMed/MEDLINE search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutrition assessment-particularly, the detection of malnourished patients who are most vulnerable and therefore may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The

  12. Autism Society

    Science.gov (United States)

    ... Español Improving the lives of all affected by autism. The Autism Society is the nation's leading grassroots ... more Improving the lives of all affected by autism. The Autism Society is the nation's leading grassroots ...

  13. From the Euthanasia Society to physician orders for life-sustaining treatment: end-of-life care in the United States.

    Science.gov (United States)

    Miljković, Miloš D; Jones, Barbara L; Miller, Kenneth

    2013-01-01

    Advances in medical care and increasing prevalence of noncommunicable illnesses such as cardiovascular disease and cancer had raised concerns about respecting the patients' dying wishes as early as 1938, when the Euthanasia Society of America was formed. Many high-profile cases and landmark court decisions later, there are now several ways in which different states regulate the patients' end-of-life wishes. How these laws evolved, how seminal cases and medical and ethical advances helped shape the current state of end-of-life legislation, and how patients-especially those with cancer-began adopting various forms of advance directives will be the topic of this article.

  14. The Role of Health Care Transformation for the Chinese Dream: Powering Economic Growth, Promoting a Harmonious Society.

    Science.gov (United States)

    Mattke, Soeren; Liu, Hangsheng; Hunter, Lauren E; Gu, Kun; Newberry, Sydne

    2014-12-30

    After having successfully expanded health insurance coverage, China now faces the challenge of building an effective and efficient delivery system to serve its large and aging population. The country finds itself at a crossroads-it can emulate the models of Western countries with their well-known limitations, or embark on an ambitious endeavor to create an innovative and sustainable model. We recommend that China choose the second option and design and implement a health care system based on population health management principles and sophisticated health information technology. Taking this path could yield a triple dividend for China: Health care will contribute to the growth of service sector employment, stimulate domestic demand by unlocking savings, and enable China to export its health system development capabilities to other emerging economies, mirroring its success in building other critical infrastructure. These forces can help turn the Chinese Dream into a reality.

  15. Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on national membership survey by the American Society for Radiation Oncology (ASTRO).

    Science.gov (United States)

    Wei, Randy L; Mattes, Malcolm D; Yu, James; Thrasher, Adrienne; Shu, Hui-Kuo; Paganetti, Harald; De Los Santos, Jennifer; Koontz, Bridget; Abraham, Christopher; Balboni, Tracy

    Radiation oncologists are frequently involved in providing palliative and supportive care (PSC) for patients with advanced cancers through delivery of palliative radiation. Whether they are confident in their ability to assess and initiate treatments for pain, nonpain, and psychosocial distress is unknown. The American Society for Radiation Oncology surveyed its practicing members in the United States on self-assessment of their primary PSC skills and access to continuing medical education on PSC. We electronically surveyed 4093 practicing radiation oncologists in the United States. The survey consisted of 16-questions in 5 sections1: demographics,2 PSC training,3 domains of PSC,4 perceived barriers as a radiation oncologist to initiate advanced care planning, and5 discussion of prognosis. The survey was e-mailed to 4093 American Society for Radiation Oncology members, and 649 responses were received (response rate 16%). The majority (91%) of radiation oncologists surveyed believe PSC is an important competency for radiation oncologists. Most radiation oncologists reported that they are moderately confident in their ability to assess and manage pain and gastrointestinal symptoms, but less confident in their ability to manage anorexia, anxiety, and depression. Despite areas of decreased confidence, a large number (42%) of radiation oncologists do not receive any additional PSC education beyond their residency training. Lastly, a perceived fear of upsetting referring medical oncologists and lack of clinic time are concerns for radiation oncologists who may want to initiate goals of care/advance care planning discussions with patients and their families. Radiation oncologists are more confident in their ability to assess and manage pain than in their ability to manage depression, anxiety, anorexia, and fatigue. There is a need for increasing continuing medical educational efforts in PSC for practicing radiation oncologists, and strengthening PSC training in residency

  16. The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO).

    Science.gov (United States)

    Popescu, R A; Schäfer, R; Califano, R; Eckert, R; Coleman, R; Douillard, J-Y; Cervantes, A; Casali, P G; Sessa, C; Van Cutsem, E; de Vries, E; Pavlidis, N; Fumasoli, K; Wörmann, B; Samonigg, H; Cascinu, S; Cruz Hernández, J J; Howard, A J; Ciardiello, F; Stahel, R A; Piccart, M

    2014-01-01

    The number of cancer patients in Europe is rising and significant advances in basic and applied cancer research are making the provision of optimal care more challenging. The concept of cancer as a systemic, highly heterogeneous and complex disease has increased the awareness that quality cancer care should be provided by a multidisciplinary team (MDT) of highly qualified healthcare professionals. Cancer patients also have the right to benefit from medical progress by receiving optimal treatment from adequately trained and highly skilled medical professionals. Built on the highest standards of professional training and continuing medical education, medical oncology is recognised as an independent medical specialty in many European countries. Medical oncology is a core member of the MDT and offers cancer patients a comprehensive and systemic approach to treatment and care, while ensuring evidence-based, safe and cost-effective use of cancer drugs and preserving the quality of life of cancer patients through the entire 'cancer journey'. Medical oncologists are also engaged in clinical and translational research to promote innovation and new therapies and they contribute to cancer diagnosis, prevention and research, making a difference for patients in a dynamic, stimulating professional environment. Medical oncologists play an important role in shaping the future of healthcare through innovation and are also actively involved at the political level to ensure a maximum contribution of the profession to Society and to tackle future challenges. This position paper summarises the multifarious and vital contributions of medical oncology and medical oncologists to today's and tomorrow's professional cancer care.

  17. American Society of Clinical Oncology Multidisciplinary Cancer Management Course: Connecting Lives, Cancer Care, Education, and Compassion in Zimbabwe-A Pilot for Efforts of Sustainable Benefit?

    Science.gov (United States)

    Ndarukwa, Sandra; Nyakabau, Anna Mary; Chagpar, Anees B; Raben, David; Ndlovu, Ntokozo; Kadzatsa, Webster; Eaton, Vanessa J; Mafunda, Paida; Razis, Evangelia

    2017-08-01

    The burden of cancer in low- to middle-income countries is growing and is expected to rise dramatically while resources to manage this disease remain inadequate. All authorities for the management of cancer recommend multidisciplinary care. Educational efforts by international organizations to assist local professionals in caring for their patients tend to have a lasting impact because they empower local professionals and enhance their skills. A multidisciplinary cancer management course was designed by American Society of Clinical Oncology staff and local experts to provide a roadmap for cross-specialty interaction and coordination of care in Zimbabwe. The outcome of the course was measured through feedback obtained from participants and impact on local workforce. The cancer management course was relevant to daily practice and fostered long-lasting partnerships and collaborations. Furthermore, it resulted in a more motivated local workforce and strengthened existing multidisciplinary practices. Cancer care is in a critical state in low- to middle-income countries. Educational efforts and collaborative partnerships may provide a cost-effective strategy with sustainable benefits. A multidisciplinary approach to optimize therapy is desirable. Evaluation of the course impact after a period of 6 months to 1 year is needed to determine the sustainability and impact of such efforts.

  18. Mass Society

    DEFF Research Database (Denmark)

    Borch, Christian

    2017-01-01

    the negative features usually ascribed by late nineteenth-century crowd psychology to spontaneous crowds, and attributes these to the entire social fabric. However, in contrast to crowd psychology, theorists of mass society often place greater emphasis on how capitalism, technological advances, or demographic......Mass society is a societal diagnosis that emphasizes – usually in a pejorative, modernity critical manner – a series of traits allegedly associated with modern society, such as the leveling of individuality, moral decay, alienation, and isolation. As such, the notion of mass society generalizes...... developments condition such negative features, and some theorists argue that mass society produces a propensity to totalitarianism. Discussions of mass society culminated in the early and mid-twentieth century....

  19. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.

    Science.gov (United States)

    Patel, Manesh R; Bailey, Steven R; Bonow, Robert O; Chambers, Charles E; Chan, Paul S; Dehmer, Gregory J; Kirtane, Ajay J; Wann, L Samuel; Ward, R Parker

    2012-05-29

    The American College of Cardiology Foundation, in collaboration with the Society for Cardiovascular Angiography and Interventions and key specialty and subspecialty societies, conducted a review of common clinical scenarios where diagnostic catheterization is frequently considered. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of studies examining the implementation of noninvasive imaging appropriate use criteria. The 166 indications in this document were developed by a diverse writing group and scored by a separate independent technical panel on a scale of 1 to 9, to designate appropriate use (median 7 to 9), uncertain use (median 4 to 6), and inappropriate use (median 1 to 3). Diagnostic catheterization may include several different procedure components. The indications developed focused primarily on 2 aspects of diagnostic catheterization. Many indications focused on the performance of coronary angiography for the detection of coronary artery disease with other procedure components (e.g., hemodynamic measurements, ventriculography) at the discretion of the operator. The majority of the remaining indications focused on hemodynamic measurements to evaluate valvular heart disease, pulmonary hypertension, cardiomyopathy, and other conditions, with the use of coronary angiography at the discretion of the operator. Seventy-five indications were rated as appropriate, 49 were rated as uncertain, and 42 were rated as inappropriate. The appropriate use criteria for diagnostic catheterization have the potential to impact physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research.

  20. Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology.

    Science.gov (United States)

    Adamič, M; Pavlović, M D; Troilius Rubin, A; Palmetun-Ekbäck, M; Boixeda, P

    2015-09-01

    Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions. These guidelines were produced by a Consensus Panel made up of experts in the field of vascular laser surgery under the auspices of the European Society of Laser Dermatology. Recommendations on the use of vascular lasers and IPLS were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. Lasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects. © 2015 European Academy of Dermatology and Venereology.

  1. Society of Behavioral Medicine position statement: early care and education (ECE) policies can impact obesity prevention among preschool-aged children.

    Science.gov (United States)

    Buscemi, Joanna; Kanwischer, Katelyn; Becker, Adam B; Ward, Dianne S; Fitzgibbon, Marian L

    2015-03-01

    The Society of Behavioral Medicine (SBM) urges policymakers to help prevent childhood obesity by improving state regulations for early care and education (ECE) settings related to child nutrition, physical activity, and screen time. More than three quarters of preschool-aged children in the USA attend ECE settings, and many spend up to 40 h per week under ECE care. ECE settings provide meals and snacks, as well as opportunities for increasing daily physical activity and reducing sedentary screen time. However, many states' current policies do not adequately address these important elements of obesity prevention. A growing number of cities and states, child health organizations, medical and early childhood associations, and academic researchers are beginning to identify specific elements of policy and regulations that could transform ECE settings into environments that contribute to obesity prevention. Let's Move! Child Care recommends a set of straightforward regulations addressing nutrition, physical activity, and screen time in ECE settings. These emerging models provide local and state leaders with concrete steps to implement obesity prevention initiatives. We provide a set of recommendations based upon these models that will help state and local policymakers to improve current policies in ECE settings.

  2. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients.

    Science.gov (United States)

    Hernández-Tejedor, A; Peñuelas, O; Sirgo Rodríguez, G; Llompart-Pou, J A; Palencia Herrejón, E; Estella, A; Fuset Cabanes, M P; Alcalá-Llorente, M A; Ramírez Galleymore, P; Obón Azuara, B; Lorente Balanza, J A; Vaquerizo Alonso, C; Ballesteros Sanz, M A; García García, M; Caballero López, J; Socias Mir, A; Serrano Lázaro, A; Pérez Villares, J M; Herrera-Gutiérrez, M E

    The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. An official American thoracic society statement: position statement on ATS activities for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States.

    Science.gov (United States)

    Brown, Lee K; Angus, Derek C; Marin, Matthew G; Balmes, John R; Barker, Alan F; Ewart, Gary; Halbower, Ann C; Lutz, Peter O; Mularski, Richard A; Nathanson, Ian T; Sanders, Mark H; Stewart, George L; Upson, Dona J

    2009-11-15

    The 1997 American Thoracic Society (ATS) statement "A Framework for Health Care Policy in the United States" outlined core principles for the Society's activities in the public health arena. In the succeeding 10 years, profound changes have taken place in the United States health care environment. In addition, the 2005 publication of the Society's Vision highlighted some differences between the original Statement and our current priorities. Therefore, the Health Policy Committee embarked on a re-analysis and re-statement of the Society's attitudes and strategies with respect to health and public policy. This Statement reflects the findings of the Committee. To outline the key aspects of an internal ATS strategy for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States. Committee discussion and consensus-building occurred both before and after individual members performed literature searches and drafted sections of the document. Comments were solicited on the draft document from ATS committee and assembly chairs and the Executive Committee, resulting in substantive revisions of the final document. Specific strategies are suggested for the ATS in the arenas of research, training and education, patient care, and advocacy so as to enhance the delivery of health care in the fields of respiratory medicine, sleep medicine, and critical care. The American Thoracic Society's Mission, Core Principles, and Vision provide clear guidance for the formulation of specific strategies that will serve to promote improved respiratory health and care of the critically ill in the United States.

  4. Current rehabilitation practices in intensive care units: a preliminary survey by the Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC Clinical Trial Group

    Directory of Open Access Journals (Sweden)

    Shunsuke Taito

    2016-10-01

    Full Text Available Abstract We conducted an internet survey targeting healthcare providers in intensive care units (ICUs in Japan and received 318 responses. Eighteen percent of respondents replied that full-time physical therapists (PTs exist in their ICUs. Practicing sitting upright or sitting in a chair is frequently performed, while standing and walking are occasionally performed for patients undergoing mechanical ventilation. However, only 16 % of respondents use staged rehabilitation protocols. This preliminary survey suggests that full-time involvement of PTs in the ICU and introduction of rehabilitation protocols may not be common in Japanese ICUs.

  5. Current rehabilitation practices in intensive care units: a preliminary survey by the Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group.

    Science.gov (United States)

    Taito, Shunsuke; Sanui, Masamitsu; Yasuda, Hideto; Shime, Nobuaki; Lefor, Alan Kawarai

    2016-01-01

    We conducted an internet survey targeting healthcare providers in intensive care units (ICUs) in Japan and received 318 responses. Eighteen percent of respondents replied that full-time physical therapists (PTs) exist in their ICUs. Practicing sitting upright or sitting in a chair is frequently performed, while standing and walking are occasionally performed for patients undergoing mechanical ventilation. However, only 16 % of respondents use staged rehabilitation protocols. This preliminary survey suggests that full-time involvement of PTs in the ICU and introduction of rehabilitation protocols may not be common in Japanese ICUs.

  6. European society of intensive care medicine study of therapeutic hypothermia (32-35°C for intracranial pressure reduction after traumatic brain injury (the Eurotherm3235Trial

    Directory of Open Access Journals (Sweden)

    Stocchetti Nino

    2011-01-01

    Full Text Available Abstract Background Traumatic brain injury is a major cause of death and severe disability worldwide with 1,000,000 hospital admissions per annum throughout the European Union. Therapeutic hypothermia to reduce intracranial hypertension may improve patient outcome but key issues are length of hypothermia treatment and speed of re-warming. A recent meta-analysis showed improved outcome when hypothermia was continued for between 48 hours and 5 days and patients were re-warmed slowly (1°C/4 hours. Previous experience with cooling also appears to be important if complications, which may outweigh the benefits of hypothermia, are to be avoided. Methods/design This is a pragmatic, multi-centre randomised controlled trial examining the effects of hypothermia 32-35°C, titrated to reduce intracranial pressure Participants are randomised to either standard care or standard care with titrated therapeutic hypothermia. Hypothermia is initiated with 20-30 ml/kg of intravenous, refrigerated 0.9% saline and maintained using each centre's usual cooling technique. There is a guideline for detection and treatment of shivering in the intervention group. Hypothermia is maintained for at least 48 hours in the treatment group and continued for as long as is necessary to maintain intracranial pressure 20 mmHg in accordance with the Brain Trauma Foundation Guidelines, 2007. Discussion The Eurotherm3235Trial is the most important clinical trial in critical care ever conceived by European intensive care medicine, because it was launched and funded by the European Society of Intensive Care Medicine and will be the largest non-commercial randomised controlled trial due to the substantial number of centres required to deliver the target number of patients. It represents a new and fundamental step for intensive care medicine in Europe. Recruitment will continue until January 2013 and interested clinicians from intensive care units worldwide can still join this important

  7. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America.

    Science.gov (United States)

    Aberg, Judith A; Gallant, Joel E; Ghanem, Khalil G; Emmanuel, Patricia; Zingman, Barry S; Horberg, Michael A

    2014-01-01

    Evidence-based guidelines for the management of persons infected with human immunodeficiency virus (HIV) were prepared by an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America. These updated guidelines replace those published in 2009. The guidelines are intended for use by healthcare providers who care for HIV-infected patients. Since 2009, new antiretroviral drugs and classes have become available, and the prognosis of persons with HIV infection continues to improve. However, with fewer complications and increased survival, HIV-infected persons are increasingly developing common health problems that also affect the general population. Some of these conditions may be related to HIV infection itself or its treatment. HIV-infected persons should be managed and monitored for all relevant age- and sex-specific health problems. New information based on publications from the period 2009-2013 has been incorporated into this document.

  8. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement.

    Science.gov (United States)

    Chen, Ronald C; Rumble, R Bryan; Loblaw, D Andrew; Finelli, Antonio; Ehdaie, Behfar; Cooperberg, Matthew R; Morgan, Scott C; Tyldesley, Scott; Haluschak, John J; Tan, Winston; Justman, Stewart; Jain, Suneil

    2016-06-20

    To endorse Cancer Care Ontario's guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations. The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommendations. The ASCO Endorsement Panel determined that the recommendations from the Active Surveillance for the Management of Localized Prostate Cancer guideline, published in May 2015, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the Active Surveillance for the Management of Localized Prostate Cancer guideline with added qualifying statements. The Cancer Care Ontario recommendation regarding 5-alpha reductase inhibitors was not endorsed by the ASCO panel. For most patients with low-risk (Gleason score ≤ 6) localized prostate cancer, active surveillance is the recommended disease management strategy. Factors including younger age, prostate cancer volume, patient preference, and ethnicity should be taken into account when making management decisions. Select patients with low-volume, intermediate-risk (Gleason 3 + 4 = 7) prostate cancer may be offered active surveillance. Active surveillance protocols should include prostate-specific antigen testing, digital rectal examinations, and serial prostate biopsies. Ancillary radiologic and genomic tests are investigational but may have a role in patients with discordant clinical and/or pathologic findings. Patients who are reclassified to a higher-risk category (Gleason score ≥ 7) or who have significant increases in tumor volume on subsequent biopsies should be offered active therapy. © 2016 by American Society of Clinical Oncology.

  9. FOUNDING SOCIETIES

    National Research Council Canada - National Science Library

    Henry Petroski

    2008-01-01

      [...] with the development of the railroads, the telegraph, and other marvels of the Industrial Revolution, a civil engineering society did not provide a sufficiently broad umbrella under which mining...

  10. Prevention of influenza in long-term-care facilities. Long-Term-Care Committee of the Society for Healthcare Epidemiology of America.

    Science.gov (United States)

    Bradley, S F

    1999-09-01

    Influenza is a frequent cause of epidemic and endemic respiratory illness in long-term-care facilities (LTCFs), resulting in considerable morbidity and mortality. Detection of influenza outbreaks in this setting can be difficult, because the clinical presentation in older adults is atypical and other pathogens also cause influenza-like illness (ILI) during the influenza season. Use of the standard case definition for influenza has not been effective in detecting episodes in residents of LTCFs. Alternative case-definitions that reflect the atypical presentation of influenza in this population have been recommended but not validated. The use of rapid tests for the detection of influenza in conjunction with more sensitive case definitions of ILI may lead to the earlier detection of influenza outbreaks in LTCFs, earlier initiation of infection control measures, and reduction in transmission. The definition of outbreak, eg, the number of episodes of ILI or episodes of confirmed influenza A that would result in the initiation of antiviral chemoprophylaxis, remains controversial in this setting. The use of newer antivirals could limit the side effects seen in older adults in LTCFs. However, annual vaccination of residents and staff remains the most effective way to prevent the introduction of influenza A or influenza B into LTCFs. In addition, vaccination of LTCF residents reduces rates of illness and pneumonia due to influenza, as well as cardiopulmonary exacerbation, hospitalization, and death.

  11. Clinical practice guidelines of the French Association for Supportive Care in Cancer and the French Society for Psycho-oncology: refusal of treatment by adults afflicted with cancer.

    Science.gov (United States)

    Faivre, J C; Adam, V; Block, V; Metzger, M; Salleron, J; Dauchy, S

    2017-11-01

    The study's purpose was to develop practical guidelines for assessment and management of refusal of treatment by adults afflicted with cancer. The French Association for Supportive Care in Cancer and the French Society for Psycho-oncology gathered a task force that applied a consensus methodology to draft guidelines studied predisposing situations, the diagnosis, regulatory aspects, and the management of refusal of treatment by adults afflicted with cancer. We propose five guidelines: (1) be aware of the conditions/profiles of patients most often associated with refusal of treatment so as to adequately underpin the care and support measures; (2) understand the complexity of the process of refusal and knowing how to accurately identify the type and the modalities of the refused treatments; (3) apply a way to systematically analyze refusal, thereby promoting progression from a situation of disaccord toward a consensual decision; (4) devise procedures, according to the legal context, to address refusal of treatment that safeguards the stakeholders in situations of sustained disaccord; and (5) know the indications for ethical collective decision-making. The quality of the relationship between patients and health professionals, and the communication between them are essential components involved in reaching a point of consent or refusal of treatment. A process of systematic analysis of refusal is recommended as the only way to ensure that all of the physiological, psychological, and contextual elements that are potentially involved are taken into account.

  12. Enteral Feeding Practices in Infants With Congenital Heart Disease Across European PICUs: A European Society of Pediatric and Neonatal Intensive Care Survey.

    Science.gov (United States)

    Tume, Lyvonne N; Balmaks, Reinis; da Cruz, Eduardo; Latten, Lynne; Verbruggen, Sascha; Valla, Frédéric V

    2018-02-01

    To describe enteral feeding practices in pre and postoperative infants with congenital heart disease in European PICUs. Cross-sectional electronic survey. European PICUs that admit infants with congenital heart disease pre- and postoperatively. One senior PICU physician or designated person per unit. None. Fifty-nine PICUs from 18 European countries responded to the survey. PICU physicians were involved in the nutritional care of children with congenital heart disease in most (76%) PICUs, but less than 60% of units had a dedicated dietician. Infants with congenital heart disease were routinely fed preoperatively in only 63% of the PICUs, due to ongoing concerns around prostaglandin E1 infusion, the presence of umbilical venous and/or arterial catheters, and the use of vasoactive drugs. In three quarters of the PICUs (76%), infants were routinely fed during the first 24 hours postoperatively. Units cited, the most common feeding method, both pre and postoperatively, was intermittent bolus feeds via the gastric route. Importantly, 69% of European PICUs still did not have written guidelines for feeding, but this varied for pre and postoperative patients. Wide variations in practices exist in the nutritional care between European PICUs, which reflects the absence of local protocols and scientific society-endorsed guidelines. This is likely to contribute to suboptimal energy delivery in this particularly vulnerable group.

  13. Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society.

    Science.gov (United States)

    Dort, Joseph C; Farwell, D Gregory; Findlay, Merran; Huber, Gerhard F; Kerr, Paul; Shea-Budgell, Melissa A; Simon, Christian; Uppington, Jeffrey; Zygun, David; Ljungqvist, Olle; Harris, Jeffrey

    2017-03-01

    Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative

  14. Physician preferences and knowledge regarding the care of childhood cancer survivors in Japan: a mailed survey of the Japanese Society of Pediatric Oncology.

    Science.gov (United States)

    Ishida, Yasushi; Takahashi, Miyako; Maru, Mitsue; Mori, Michiko; Henderson, Tara O; Daugherty, Christopher K; Manabe, Atsushi

    2012-06-01

    Japanese physicians' attitudes regarding the health-care needs of young adult childhood cancer survivors (CCSs) are not well described. Thus, we examined the self-reported preferences and knowledge of pediatric oncologists and surgeons. A mailed survey was sent to 858 physician members of the Japanese Society of Pediatric Oncology. We compared the responses of pediatric oncologists and pediatric surgeons. The pediatric oncologists' response rate was 56% (300 out of 533) and that of pediatric surgeons 32% (105 out of 325). The median age of respondents was 46 and 48 years, respectively; 79 and 84% were men. When comfort levels in caring for CCSs were described (i.e. 1 = very uncomfortable; 7 = very comfortable), the mean levels were 4.4 and 3.8 with CCSs ≤ 21 years, 3.6 and 3.6 with 21 years 30 years, respectively. In clinical vignette questions, 62% of the pediatric oncologists and 43% of the surgeons answered three or more questions appropriately. Pediatric surgeons reported significantly lower familiarity with long-term follow-up guidelines than pediatric oncologists. Most pediatric oncologists and many surgeons conducted truth-telling of cancer diagnosis to adult CCSs now. They thought that the most important issues are an original long-term follow-up guideline suitable for the Japanese situation and collaborations with adult-based general physicians. Many Japanese pediatric oncologists are uncomfortable with caring for survivors as they age and have suboptimal knowledge regarding late effects. The change in truth-telling situation and preference for collaboration with adult-based physicians was demonstrated also in Japan.

  15. Multi-parameter brain tissue microsensor and interface systems: calibration, reliability and user experiences of pressure and temperature sensors in the setting of neurointensive care.

    Science.gov (United States)

    Childs, Charmaine; Wang, Li; Neoh, Boon Kwee; Goh, Hok Liok; Zu, Mya Myint; Aung, Phyo Wai; Yeo, Tseng Tsai

    2014-10-01

    The objective was to investigate sensor measurement uncertainty for intracerebral probes inserted during neurosurgery and remaining in situ during neurocritical care. This describes a prospective observational study of two sensor types and including performance of the complete sensor-bedside monitoring and readout system. Sensors from 16 patients with severe traumatic brain injury (TBI) were obtained at the time of removal from the brain. When tested, 40% of sensors achieved the manufacturer temperature specification of 0.1 °C. Pressure sensors calibration differed from the manufacturers at all test pressures in 8/20 sensors. The largest pressure measurement error was in the intraparenchymal triple sensor. Measurement uncertainty is not influenced by duration in situ. User experiences reveal problems with sensor 'handling', alarms and firmware. Rigorous investigation of the performance of intracerebral sensors in the laboratory and at the bedside has established measurement uncertainty in the 'real world' setting of neurocritical care.

  16. Society of Critical Care Medicine

    Science.gov (United States)

    ... Membership ICU Design Citation ICU Heroes Lifetime Achievement Norma J. Shoemaker Presidential Citation Safar Global Partner Shubin- ... Central Undergraduate Research/Quality Quality Thrive Guidelines Grants Norma J. Shoemaker Grant SCCM-Weil Research Grant Recipients ...

  17. The gut-brain axis in the critically ill: Is glucagon-like peptide-1 protective in neurocritical care?

    Science.gov (United States)

    2013-01-01

    Enteral nutrient is a potent glucagon-like peptide-1 (GLP-1) secretagogue. In vitro and animal studies indicate that GLP-1 has immune-modulatory and neuroprotective effects. To determine whether these immune-modulatory and neuroprotective effects of GLP-1 are beneficial in the critically ill, studies achieving pharmacological GLP-1 concentrations are warranted. PMID:23837691

  18. Network Society

    DEFF Research Database (Denmark)

    Clausen, Lars; Tække, Jesper

    2018-01-01

    the five strands of theory on the network society. Each theoretical position has its specific implications for acting toward strategic goals. In its entirety, the five perspectives give a thorough understanding of the conditions for successful strategic communication in the 21st century....

  19. Network Society

    DEFF Research Database (Denmark)

    Clausen, Lars; Tække, Jesper

    2017-01-01

    the five strands of theory on the network society. Each theoretical position has its specific implications for acting toward strategic goals. In its entirety, the five perspectives give a thorough understanding of the conditions for successful strategic communication in the 21st century....

  20. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement.

    Science.gov (United States)

    Meyerhardt, Jeffrey A; Mangu, Pamela B; Flynn, Patrick J; Korde, Larissa; Loprinzi, Charles L; Minsky, Bruce D; Petrelli, Nicholas J; Ryan, Kim; Schrag, Deborah H; Wong, Sandra L; Benson, Al B

    2013-12-10

    The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing recent clinical practice guidelines that have been developed by other professional organizations. The Cancer Care Ontario (CCO) Guideline on Follow-up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer was reviewed by ASCO for methodologic rigor and considered for endorsement. The ASCO Panel concurred with the CCO recommendations and recommended endorsement, with the addition of several qualifying statements. Surveillance should be guided by presumed risk of recurrence and functional status of the patient (important within the first 2 to 4 years). Medical history, physical examination, and carcinoembryonic antigen testing should be performed every 3 to 6 months for 5 years. Patients at higher risk of recurrence should be considered for testing in the more frequent end of the range. A computed tomography scan (abdominal and chest) is recommended annually for 3 years, in most cases. Positron emission tomography scans should not be used for surveillance outside of a clinical trial. A surveillance colonoscopy should be performed 1 year after the initial surgery and then every 5 years, dictated by the findings of the previous one. If a colonoscopy was not preformed before diagnosis, it should be done after completion of adjuvant therapy (before 1 year). Secondary prevention (maintaining a healthy body weight and active lifestyle) is recommended. If a patient is not a candidate for surgery or systemic therapy because of severe comorbid conditions, surveillance tests should not be performed. A treatment plan from the specialist should have clear directions on appropriate follow-up by a nonspecialist.

  1. Systemic Therapy in Men With Metastatic Castration-Resistant Prostate Cancer: American Society of Clinical Oncology and Cancer Care Ontario Clinical Practice Guideline

    Science.gov (United States)

    Basch, Ethan; Loblaw, D. Andrew; Oliver, Thomas K.; Carducci, Michael; Chen, Ronald C.; Frame, James N.; Garrels, Kristina; Hotte, Sebastien; Kattan, Michael W.; Raghavan, Derek; Saad, Fred; Taplin, Mary-Ellen; Walker-Dilks, Cindy; Williams, James; Winquist, Eric; Bennett, Charles L.; Wootton, Ted; Rumble, R. Bryan; Dusetzina, Stacie B.; Virgo, Katherine S.

    2014-01-01

    Purpose To provide treatment recommendations for men with metastatic castration-resistant prostate cancer (CRPC). Methods The American Society of Clinical Oncology and Cancer Care Ontario convened an expert panel to develop evidence-based recommendations informed by a systematic review of the literature. Results When added to androgen deprivation, therapies demonstrating improved survival, improved quality of life (QOL), and favorable benefit-harm balance include abiraterone acetate/prednisone, enzalutamide, and radium-223 (223Ra; for men with predominantly bone metastases). Improved survival and QOL with moderate toxicity risk are associated with docetaxel/prednisone. For asymptomatic/minimally symptomatic men, improved survival with unclear QOL impact and low toxicity are associated with sipuleucel-T. For men who previously received docetaxel, improved survival, unclear QOL impact, and moderate to high toxicity risk are associated with cabazitaxel/prednisone. Modest QOL benefit (without survival benefit) and high toxicity risk are associated with mitoxantrone/prednisone after docetaxel. No benefit and excess toxicity are observed with bevacizumab, estramustine, and sunitinib. Recommendations Continue androgen deprivation (pharmaceutical or surgical) indefinitely. Abiraterone acetate/prednisone, enzalutamide, or 223Ra should be offered; docetaxel/prednisone should also be offered, accompanied by discussion of toxicity risk. Sipuleucel-T may be offered to asymptomatic/minimally symptomatic men. For men who have experienced progression with docetaxel, cabazitaxel may be offered, accompanied by discussion of toxicity risk. Mitoxantrone may be offered, accompanied by discussion of limited clinical benefit and toxicity risk. Ketoconazole or antiandrogens (eg, bicalutamide, flutamide, nilutamide) may be offered, accompanied by discussion of limited known clinical benefit. Bevacizumab, estramustine, and sunitinib should not be offered. There is insufficient evidence to

  2. [Outcome of the 6-year curriculum for pharmacy education: "Contribution to medical care and society: how will I act as a pharmacist in the future?"--A report on the 3rd National Student Workshop].

    Science.gov (United States)

    Kamei, Miwako; Imoto, Yumi; Otowa, Ryo; Shida, Miharu; Hirai, Yumi; Nakamura, Akihiro

    2015-01-01

    In August 2013, the Pharmaceutical Society of Japan held the Third National Student Workshop in Tokyo. A total of 88 people-70 sixth-year undergraduate students from 70 universities, and 18 alumni who had participated in the First and the Second Workshops-attended this Workshop. The theme of this Workshop was "Contribution to medical care and society: How will I act as a pharmacist in the future?" The first day took the form of a World Café, with participants exchanging information on such topics as, "The purpose for choosing a pharmacy major, and my achievement status", "My favorite aspects of my college", and "My dreams and paths: Painting my future image". Later that day, participants discussed and gave presentations on the ways they would be contributing as pharmacists to society and medical care. On the second day, participants discussed and gave presentations on the efforts they would like to make as pharmacists to contribute to society and medical care. The final session was a general assembly for discussion on the ways they would be contributing as pharmacists to society and medical care. Throughout the two days, attendees participated in discussions with an awareness of their common ground, in that they all had national qualification in spite of different intended paths. In this article, 4 sixth-year students (their status at the time of the symposium) from the Workshop introduce outlines of the discussions and products from each group.

  3. Standards for quality care in respiratory rehabilitation in patients with chronic pulmonary disease. Quality Healthcare Committee. Spanish Society of Pneumology and Thoracic Surgery (SEPAR).

    Science.gov (United States)

    Güell, Maria Rosa; Cejudo, Pilar; Rodríguez-Trigo, Gema; Gàldiz, Juan Bautista; Casolive, Vinyet; Regueiro, Mônica; Soler-Cataluña, Juan Jose

    2012-11-01

    Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection. Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.

  4. Statistical process control of mortality series in the Australian and New Zealand Intensive Care Society (ANZICS) adult patient database: implications of the data generating process.

    Science.gov (United States)

    Moran, John L; Solomon, Patricia J

    2013-05-24

    Statistical process control (SPC), an industrial sphere initiative, has recently been applied in health care and public health surveillance. SPC methods assume independent observations and process autocorrelation has been associated with increase in false alarm frequency. Monthly mean raw mortality (at hospital discharge) time series, 1995-2009, at the individual Intensive Care unit (ICU) level, were generated from the Australia and New Zealand Intensive Care Society adult patient database. Evidence for series (i) autocorrelation and seasonality was demonstrated using (partial)-autocorrelation ((P)ACF) function displays and classical series decomposition and (ii) "in-control" status was sought using risk-adjusted (RA) exponentially weighted moving average (EWMA) control limits (3 sigma). Risk adjustment was achieved using a random coefficient (intercept as ICU site and slope as APACHE III score) logistic regression model, generating an expected mortality series. Application of time-series to an exemplar complete ICU series (1995-(end)2009) was via Box-Jenkins methodology: autoregressive moving average (ARMA) and (G)ARCH ((Generalised) Autoregressive Conditional Heteroscedasticity) models, the latter addressing volatility of the series variance. The overall data set, 1995-2009, consisted of 491324 records from 137 ICU sites; average raw mortality was 14.07%; average(SD) raw and expected mortalities ranged from 0.012(0.113) and 0.013(0.045) to 0.296(0.457) and 0.278(0.247) respectively. For the raw mortality series: 71 sites had continuous data for assessment up to or beyond lag40 and 35% had autocorrelation through to lag40; and of 36 sites with continuous data for ≥ 72 months, all demonstrated marked seasonality. Similar numbers and percentages were seen with the expected series. Out-of-control signalling was evident for the raw mortality series with respect to RA-EWMA control limits; a seasonal ARMA model, with GARCH effects, displayed white-noise residuals

  5. Cryptozoology Society

    Science.gov (United States)

    Richman, Barbara T.

    Reports of Loch Ness monsters, Bigfoot, and the Yeti spring u p from time to time, sparking scientific controversy about the veracity of these observations. Now an organization has been established to help cull, analyze, and disseminate information on the alleged creatures. The International Society of Cryptozoology, formed at a January meeting at the U.S. National Museum of Natural History of the Smithsonian Institution, will serve as the focal point for the investigation, analysis, publication, and discussion of animals of unexpected form or size or of unexpected occurrences in time or space.

  6. Research in cardiovascular care : A position statement of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology

    NARCIS (Netherlands)

    Jaarsma, T.; Deaton, C.; Fitzsimmons, D.; Fridlund, B.; Hardig, B.M.; Mahrer-Imhof, R.; Moons, P.; Noureddine, S.; O'Donnell, S.; Pedersen, S.S.; Stewart, S.; Stromberg, A.; Thompson, D.R.; Tokem, Y.; Kjellstrom, B.

    2014-01-01

    To deliver optimal patient care, evidence-based care is advocated and research is needed to support health care staff of all disciplines in deciding which options to use in their daily practice. Due to the increasing complexity of cardiac care across the life span of patients combined with the

  7. The Survey of Iran’s New Accreditation System Challenges Based on International Society for Quality in Health Care (ISQua Requirements

    Directory of Open Access Journals (Sweden)

    Farid Gharibi

    2015-08-01

    Full Text Available Background and objectives : Nowadays, successful health systems are focused on performance indicators especially on quality and continuous improvement is taken as a sign of organization’s success and survival. Regarding the fact that accreditation is one of the main fields in health systems management and has great effects on quality improvement, this study aimed to assess the weaknesses and strengths of Iran’s new accreditation system based on the International Society for Quality in Health care (ISQua requirements.   Material and Methods : Data were collected using ISQua questionnaire. First, the questionnaire was translated and its content validity was assessed by experts’ opinions based on 5 items in the quality of questions. Then, its reliability was evaluated and finally a questionnaire with 39 questions in four aspects was approved. In the following, opinions of 20 experts were obtained and the results were reported by frequency (percent.  Data were analyzed using SPSS16 software. Results: The results showed that Iran’s new accreditation system deals with great problems in “Policy, Values and Cultures”, “Organization and Structure”, “Methodology” and “Resources” areas, meaning that the system was approved only in one third of the questions. The results indicated that this system has the most problems in “Resources” aspect and the least in “Methodology” but obtained scores were not acceptable in none of the aspects. Conclusion: This study showed that this accreditation system has critical problems and its successful application requires resolving them. No doubt that identified problems and delivered advices in this study are valuable guides to policy-makers of this program.

  8. Workshops to disseminate the Canadian Thoracic Society guidelines for chronic obstructive pulmonary disease to health care professionals in Ontario: impact on knowledge, perceived health care practices and participant satisfaction.

    Science.gov (United States)

    Moosa, Dilshad; Blouin, Maria; Hill, Kylie; Goldstein, Roger

    2009-01-01

    The Canadian Thoracic Society (CTS) has developed a clinical practice guideline (CPG) regarding the management of patients with chronic obstructive pulmonary disease (COPD). Implementation of this CPG in the primary care setting requires an effective dissemination strategy. To examine the change in knowledge, participant satisfaction and perceived changes in clinical practice among health care professionals working in the primary care setting following attendance at a workshop to disseminate the CTS CPG for COPD. A 2.5 h workshop was conducted in three community health sites within Ontario. Each workshop comprised a didactic presentation and interactive case study discussions. Before, and one month following the workshop, a structured knowledge assessment questionnaire was administered. A structured satisfaction questionnaire and evaluative form that examined the impact of the workshop on the clinical management of COPD patients were administered immediately and three months following completion of the workshop, respectively. Sixty-nine participants attended the workshop. The mean score for the structured knowledge assessment questionnaire increased from 8.5+/-2.7 to 10.6+/-2.0 following the workshop (P=0.008). Eighty-nine per cent and 96% of participants indicated that they would recommend the workshop to a colleague and had greater confidence in their management of COPD patients, respectively. Following attendance of the workshop, 73%, 69% and 46% described increased patient education, patient monitoring and the use of objective testing in clinical practice, respectively. Workshop attendance was associated with high levels of satisfaction and important self-reported changes in clinical practice, which may reflect improved knowledge of the CTS CPG for COPD.

  9. Improving Child Care Quality: A Comparison of Military and Civilian Approaches. Charting Civil Society: A Series by the Center on Nonprofits and Philanthropy.

    Science.gov (United States)

    De Vita, Carol J.; Montilla, Maria

    Information on early childhood learning and increasing demand for child care services have placed a spotlight on the need to improve the quality of early education and care in the United States. This report focuses on five factors tied to the success of military efforts to develop an exemplary model of quality and affordable care in the Military…

  10. Knowledge Gaps in Cardiovascular Care of the Older Adult Population: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Geriatrics Society.

    Science.gov (United States)

    Rich, Michael W; Chyun, Deborah A; Skolnick, Adam H; Alexander, Karen P; Forman, Daniel E; Kitzman, Dalane W; Maurer, Mathew S; McClurken, James B; Resnick, Barbara M; Shen, Win K; Tirschwell, David L

    2016-05-24

    results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world. © 2016 by the American Heart Association, Inc., the American College of Cardiology Foundation, and the American Geriatrics Society.

  11. Knowledge Gaps in Cardiovascular Care of Older Adults: A Scientific Statement from the American Heart Association, American College of Cardiology, and American Geriatrics Society: Executive Summary.

    Science.gov (United States)

    Rich, Michael W; Chyun, Deborah A; Skolnick, Adam H; Alexander, Karen P; Forman, Daniel E; Kitzman, Dalane W; Maurer, Mathew S; McClurken, James B; Resnick, Barbara M; Shen, Win K; Tirschwell, David L

    2016-11-01

    future evidence-based guidelines applicable to older adults and enhance person-centered care of older individuals with CVD in the United States and around the world. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  12. Indian Vacuum Society: The Indian Vacuum Society

    Science.gov (United States)

    Saha, T. K.

    2008-03-01

    The Indian Vacuum Society (IVS) was established in 1970. It has over 800 members including many from Industry and R & D Institutions spread throughout India. The society has an active chapter at Kolkata. The society was formed with the main aim to promote, encourage and develop the growth of Vacuum Science, Techniques and Applications in India. In order to achieve this aim it has conducted a number of short term courses at graduate and technician levels on vacuum science and technology on topics ranging from low vacuum to ultrahigh vacuum So far it has conducted 39 such courses at different parts of the country and imparted training to more than 1200 persons in the field. Some of these courses were in-plant training courses conducted on the premises of the establishment and designed to take care of the special needs of the establishment. IVS also regularly conducts national and international seminars and symposia on vacuum science and technology with special emphasis on some theme related to applications of vacuum. A large number of delegates from all over India take part in the deliberations of such seminars and symposia and present their work. IVS also arranges technical visits to different industries and research institutes. The society also helped in the UNESCO sponsored post-graduate level courses in vacuum science, technology and applications conducted by Mumbai University. The society has also designed a certificate and diploma course for graduate level students studying vacuum science and technology and has submitted a syllabus to the academic council of the University of Mumbai for their approval, we hope that some colleges affiliated to the university will start this course from the coming academic year. IVS extended its support in standardizing many of the vacuum instruments and played a vital role in helping to set up a Regional Testing Centre along with BARC. As part of the development of vacuum education, the society arranges the participation of

  13. The care of adults with congenital heart disease across the globe: Current assessment and future perspective: A position statement from the International Society for Adult Congenital Heart Disease (ISACHD).

    Science.gov (United States)

    Webb, Gary; Mulder, Barbara J; Aboulhosn, Jamil; Daniels, Curt J; Elizari, Maria Amalia; Hong, Gu; Horlick, Eric; Landzberg, Michael J; Marelli, Ariane J; O'Donnell, Clare P; Oechslin, Erwin N; Pearson, Dorothy D; Pieper, Els P G; Saxena, Anita; Schwerzmann, Markus; Stout, Karen K; Warnes, Carole A; Khairy, Paul

    2015-09-15

    The number of adults with congenital heart disease (CHD) has increased markedly over the past few decades as a result of astounding successes in pediatric cardiac care. Nevertheless, it is now well understood that CHD is not cured but palliated, such that life-long expert care is required to optimize outcomes. All countries in the world that experience improved survival in CHD must face new challenges inherent to the emergence of a growing and aging CHD population with changing needs and medical and psychosocial issues. Founded in 1992, the International Society for Adult Congenital Heart Disease (ISACHD) is the leading global organization of professionals dedicated to pursuing excellence in the care of adults with CHD worldwide. Recognizing the unique and varied issues involved in caring for adults with CHD, ISACHD established a task force to assess the current status of care for adults with CHD across the globe, highlight major challenges and priorities, and provide future direction. The writing committee consisted of experts from North America, South America, Europe, South Asia, East Asia, and Oceania. The committee was divided into subgroups to review key aspects of adult CHD (ACHD) care. Regional representatives were tasked with investigating and reporting on relevant local issues as accurately as possible, within the constraints of available data. The resulting ISACHD position statement addresses changing patterns of worldwide epidemiology, models of care and organization of care, education and training, and the global research landscape in ACHD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Animal care practices in experiments on biological rhythms and sleep: report of the Joint Task Force of the Society for Research on Biological Rhythms and the Sleep Research Society.

    Science.gov (United States)

    Bittman, Eric L; Kilduff, Thomas S; Kriegsfeld, Lance J; Szymusiak, Ronald; Toth, Linda A; Turek, Fred W

    2013-07-01

    Many physiological and molecular processes are strongly rhythmic and profoundly influenced by sleep. The continuing effort of biological, medical, and veterinary science to understand the temporal organization of cellular, physiological, behavioral and cognitive function holds great promise for the improvement of the welfare of animals and human beings. As a result, attending veterinarians and IACUC are often charged with the responsibility of evaluating experiments on such rhythms or the effects of sleep (or its deprivation) in vertebrate animals. To produce interpretable data, animals used in such research must often be maintained in carefully controlled (often constant) conditions with minimal disruption. The lighting environment must be strictly controlled, frequent changes of cages and bedding are undesirable, and daily visual checks are often not possible. Thus deviations from the standard housing procedures specified in the Guide for the Care and Use of Laboratory Animals are often necessary. This report reviews requirements for experiments on biological rhythms and sleep and discusses how scientific considerations can be reconciled with the recommendations of the Guide.

  15. Optic Nerve Sheath Diameter Ultrasound Evaluation in Intensive Care Unit: Possible Role and Clinical Aspects in Neurological Critical Patients' Daily Monitoring.

    Science.gov (United States)

    Toscano, M; Spadetta, G; Pulitano, P; Rocco, M; Di Piero, V; Mecarelli, O; Vicenzini, E

    2017-01-01

    Background. The increase of the optic nerve sheath diameter (ONSD) is a reliable, noninvasive sonographic marker of intracranial hypertension. Aim of the study was to demonstrate the efficacy of ONSD evaluation, when monitoring neurocritical patients, to early identify malignant intracranial hypertension in patients with brain death (BD). Methods. Data from ultrasound ONSD evaluation have been retrospectively analyzed in 21 sedated critical patients with neurological diseases who, during their clinical course, developed BD. 31 nonneurological controls were used for standard ONSD reference. Results. Patients with neurological diseases, before BD, showed higher ONSD values than control group (CTRL: RT 0.45 ± 0.03 cm; LT 0.45 ± 0.02 cm; pre-BD: RT 0.54 ± 0.02 cm; LT 0.55 ± 0.02 cm; p evaluated with invasive monitoring. ONSD was further significantly markedly increased in respect to the pre-BD evaluation in neurocritical patients after BD, with mean values above 0.7 cm (RT 0.7 ± 0.02 cm; LT 0.71 ± 0.02 cm; p monitoring could be of help in Intensive Care Units when invasive intracranial pressure monitoring is not available, to early recognize intracranial hypertension and to suspect BD in neurocritical patients.

  16. Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC).

    Science.gov (United States)

    Chaves, Fernando; Garnacho-Montero, José; Del Pozo, José Luis; Bouza, Emilio; Capdevila, José Antonio; de Cueto, Marina; Domínguez, M Ángeles; Esteban, Jaime; Fernández-Hidalgo, Nuria; Fernández Sampedro, Marta; Fortún, Jesús; Guembe, María; Lorente, Leonardo; Paño, Jose Ramón; Ramírez, Paula; Salavert, Miguel; Sánchez, Miguel; Vallés, Jordi

    2018-02-01

    Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  17. [Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): oncohematological patient].

    Science.gov (United States)

    Planas, M; Fernández-Ortega, J F; Abilés, J

    2011-11-01

    Patients with cancer, irrespective of the stage of their disease, can require admission to the intensive care unit as a result of the complications of their underlying process or the surgical or pharmacological treatment provided. The cancer itself, as well as the critical status that can result from the complications of the disease, frequently lead to a high degree of hypermetabolism and inadequate energy intake, causing a high incidence of malnutrition in these patients. Moreover, cancer causes anomalous use of nutritional substrates and therefore the route of administration and proportion and intake of nutrients may differ in these patients from those in non-cancer patients. Copyright © 2011 Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L. All rights reserved.

  18. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT).

    Science.gov (United States)

    Torres, Antoni; Niederman, Michael S; Chastre, Jean; Ewig, Santiago; Fernandez-Vandellos, Patricia; Hanberger, Hakan; Kollef, Marin; Li Bassi, Gianluigi; Luna, Carlos M; Martin-Loeches, Ignacio; Paiva, J Artur; Read, Robert C; Rigau, David; Timsit, Jean François; Welte, Tobias; Wunderink, Richard

    2017-09-01

    The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention. Copyright ©ERS 2017.

  19. [Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): nutritional assessment].

    Science.gov (United States)

    Ruiz-Santana, S; Arboleda Sánchez, J A; Abilés, J

    2011-11-01

    Current parameters to assess nutritional status in critically-ill patients are useful to evaluate nutritional status prior to admission to the intensive care unit. However, these parameters are of little utility once the patient's nutritional status has been altered by the acute process and its treatment. Changes in water distribution affect anthropometric variables and biochemical biomarkers, which in turn are affected by synthesis and degradation processes. Increased plasma levels of prealbumin and retinol -proteins with a short half-life- can indicate adequate response to nutritional support, while reduced levels of these proteins indicate further metabolic stress. The parameters used in functional assessment, such as those employed to assess muscular or immune function, are often altered by drugs or the presence of infection or polyneuropathy. However, some parameters can be used to monitor metabolic response and refeeding or can aid prognostic evaluation. Copyright © 2011 Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L. All rights reserved.

  20. Patient navigation and the American Cancer Society.

    Science.gov (United States)

    Esparza, Angelina

    2013-05-01

    To review the evolution, implementation, and development of the American Cancer Society's Navigator program. American Cancer Society reports and published articles The American Cancer Society has a long history of supporting the growth and development of navigation, from provision of funding for Dr Freeman's pilot program, to developing a program that includes training, policy development, and research. The Society continues to play a key role in providing leadership to advance patient navigation as a means to improve patients' access to care, movement through the health care system while furthering patient centered care, patients' quality of life and eliminating health outcome disparities. With the American Cancer Society navigation model, navigators are trained to meet with patients, identify barriers to care, and work with institutional health care teams to support patients and assist staff with aspects of care that can be managed by non-medical personnel. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. [Transfer of allogeneic stem cell transplant recipients to the intensive care unit: Guidelines from the Francophone society of marrow transplantation and cellular therapy (SFGM-TC)].

    Science.gov (United States)

    Moreau, Anne-Sophie; Bourhis, Jean-Henri; Contentin, Nathalie; Couturier, Marie-Anne; Delage, Jeremy; Dumesnil, Cécile; Gandemer, Virginie; Hichri, Yosr; Jost, Edgar; Platon, Laura; Jourdain, Mercé; Pène, Frédéric; Yakoub-Agha, Ibrahim

    2016-11-01

    Transferring a patient undergoing an allogeneic stem cell transplantation to the intensive care unit (ICU) is always a challenging situation on a medical and psychological point of view for the patient and his relatives as well as for the medical staff. Despite the progress in hematology and intensive care during the last decade, the prognosis of these patients admitted to the ICU remains poor and mortality is around 50 %. The harmonization working party of the SFGM-TC assembled hematologists and intensive care specialist in order to improve conditions and modalities of the transfer of a patient after allogeneic stem cell transplantation to the ICU. We propose a structured medical form comprising all essential information necessary for optimal medical care on ICU. Copyright © 2016. Published by Elsevier Masson SAS.

  2. An Investigation of Factors Influencing High Usage of Medical and Long-Term Care Services in an Aging Society in Japan.

    Science.gov (United States)

    Kazawa, Kana; Rahman, Md Moshiur; Moriyama, Michiko

    2018-01-01

    Medical and long-term care costs are increasing all over the world. In this study, we investigated the characteristics of groups with high cost of medical and long-term care to define targets for curbing social security costs. As a result, for the population covered by the National Health Insurance, a large portion of medical costs were incurred for mental disorders, malignant neoplasms, and lifestyle-related diseases. For those covered by the Late Elderly Health Insurance System, most medical costs were incurred for lifestyle-related diseases, femoral fractures, neurological diseases, mental disorders, pneumonia, malignant neoplasms, and Alzheimer's disease. From multiple regression analysis, the hospitalization days, use of advanced medical treatment, outpatient days, and high long-term care level influenced the increased costs. On the other hand, disease characteristics had only a very low effect. These findings suggest that the target population has complex medical and long-term care needs because they have multiple diseases.

  3. Geriatric assessment in daily oncology practice for nurses and allied health care professionals: Opinion paper of the Nursing and Allied Health Interest Group of the International Society of Geriatric Oncology (SIOG).

    Science.gov (United States)

    Burhenn, Peggy S; McCarthy, Alexandra L; Begue, Aaron; Nightingale, Ginah; Cheng, Karis; Kenis, Cindy

    2016-09-01

    The management of older persons with cancer has become a major public health concern in developed countries because of the aging of the population and the steady increase in cancer incidence with advancing age. Nurses and allied health care professionals are challenged to address the needs of this growing population. The International Society of Geriatric Oncology (SIOG) Nursing and Allied Health (NAH) Interest Group described key issues that nurses and allied health care professionals face when caring for older persons with cancer. The domains of the Geriatric Assessment (GA) are used as a guiding framework. The following geriatric domains are described: demographic data and social support, functional status, cognition, mental health, nutritional status, fatigue, comorbidities, polypharmacy, and other geriatric syndromes (e.g. falls, delirium). In addition to these geriatric domains, quality of life (QoL) is described based on the overall importance in this particular population. Advice for integration of assessment of these geriatric domains into daily oncology practice is made. Research has mainly focused on the role of treating physicians but the involvement of nurses and allied health care professionals is crucial in the care of older persons with cancer through the GA process. The ability of nurses and allied health care professionals to perform this assessment requires specialized training and education beyond standard oncology knowledge. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. A58 CRITICAL CARE CASE REPORTS: NEURO-CRITICAL CARE: Zika Virus-Associated Guillain-Barre Syndrome In A Returning United States Traveler

    National Research Council Canada - National Science Library

    J Beattie; S Parajuli; M Sanger; G Lee; P Pleninger; G Crowley; S Kwon; V Murthy; J Manko; A Caplan; E Dufort; J E Staples; D Pastula; A Nolan

    2017-01-01

    ZIKV has also been associated with Guillain-Barré syndrome (GBS), an acute autoimmune attack on the peripheral nerves and/or nerve roots resulting in progressive weakness with significant morbidity and potential mortality...

  5. [Introduction of the psychoprophylactic method and its influence on the prenatal care program for institutional parturition in Japan: the practice in the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, 1953-1964].

    Science.gov (United States)

    Fujihara, Satoko; Tsukisawa, Miyoko

    2014-03-01

    The psychoprophylactic method is one of the methods for providing 'painless childbirth without drugs' and was invented by applying I. Pavlov's theory of higher nervous activity. In 1951, it was adopted as a national policy in the Union of Soviet Socialist Republics. This method was then introduced in the People's Republic of China in 1952. In 1953, it was brought to Japan by Masatomo SUGAI, an obstetrician, and was introduced into the Central Hospital of Maternity of the Japanese Red Cross Society with the support of the director, Naotarou KUJI. The practice of this method by the research team, which consisted of the obstetricians and midwives of the Central Hospital of Maternity of the Japanese Red Cross Society and Oomori Red Cross Hospital, resulted in the initiation and characterization of the prenatal care program to encourage the autonomy of the pregnant women for normal parturition in the institutions of Japan.

  6. Adult congenital heart disease nurse coordination: Essential skills and role in optimizing team-based care a position statement from the International Society for Adult Congenital Heart Disease (ISACHD).

    Science.gov (United States)

    Sillman, Christina; Morin, Joanne; Thomet, Corina; Barber, Deena; Mizuno, Yoshiko; Yang, Hsiao-Ling; Malpas, Theresa; Flocco, Serena Francesca; Finlay, Clare; Chen, Chi-Wen; Balon, Yvonne; Fernandes, Susan M

    2017-02-15

    Founded in 1992, the International Society for Adult Congenital Heart Disease (ISACHD) is the leading global organization of professionals dedicated to pursuing excellence in the care of adults with congenital heart disease (CHD) worldwide. Among ISACHD's objectives is to "promote a holistic team-based approach to the care of the adult with CHD that is comprehensive, patient-centered, and interdisciplinary" (http://www.isachd.org). This emphasis on team-based care reflects the fact that adults with CHD constitute a heterogeneous population with a wide spectrum of disease complexity, frequent association with other organ involvement, and varied co-morbidities and psychosocial issues. Recognizing the vital role of the adult CHD (ACHD) nurse coordinator (ACHD-NC) in optimizing team-based care, ISACHD established a task force to elucidate and provide guidance on the roles and responsibilities of the ACHD-NC. Acknowledging that nursing roles can vary widely from region to region based on factors such as credentials, scopes of practice, regulations, and local culture and tradition, an international panel was assembled with experts from North America, Europe, East Asia, and Oceania. The writing committee was tasked with reviewing key aspects of the ACHD-NC's role in team-based ACHD care. The resulting ISACHD position statement addresses the ACHD-NC's role and skills required in organizing, coordinating, and facilitating the care of adults with CHD, holistic assessment of the ACHD patient, patient education and counseling, and support for self-care management and self-advocacy. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  7. Contribution of the ethics committee of the French Intensive Care Society to describing a scenario for implementing organ donation after Maastricht type III cardiocirculatory death in France

    Science.gov (United States)

    2012-01-01

    French law allows organ donation after death due to cardiocirculatory arrest. In the Maastricht classification, type III non-heart-beating donors are those who experience cardiocirculatory arrest after the withdrawal of life-sustaining treatments. French authorities in charge of regulating organ donation (Agence de la Biomédecine, ABM) are considering organ collection from Maastricht type III donors. We describe a scenario for Maastricht type III organ donation that fully complies with the ethical norms governing care to dying patients. That organ donation may occur after death should have no impact on the care given to the patient and family. The dead-donor rule must be followed scrupulously: the organ retrieval procedure must neither cause nor hasten death. The decision to withdraw life-sustaining treatments, withdrawal modalities, and care provided to the patient and family must adhere strictly to the requirements set forth in patient-rights legislation (the 2005 Léonetti law in France) and should not be influenced in any way by the possibility of organ donation. A major ethical issue regarding the family is how best to transition from discussing treatment-withdrawal decisions to discussing possible organ retrieval for donation should the patient die rapidly after treatment withdrawal. Close cooperation between the healthcare team and the organ retrieval team is crucial to minimize the distress of family members during this transition. Modalities for implementing Maastricht type III organ donation are discussed here, including the best location for withdrawing life-sustaining treatments (operating room or intensive care unit). PMID:22747673

  8. Community acquired pneumonia in the elderly: the Pneumonia in Italian Acute Care for Elderly units (PIACE study protocol by the Italian Society of Hospital and Community Geriatrics (SIGOT

    Directory of Open Access Journals (Sweden)

    Filippo Luca Fimognari

    2017-01-01

    Full Text Available Pneumonia is a frequent cause of hospital admission in elderly patients. Diagnosis of pneumonia in elderly persons with comorbidity may be challenging, due to atypical presentation and complex clinical scenarios. Community-acquired pneumonia (CAP arises out-of-hospital in subjects without previous contact with the healthcare system. Healthcare associated pneumonia (HCAP occurs in patients who have frequent contacts with the healthcare system and should be treated with empiric broad spectrum antibiotic therapy also covering multi-drug resistant (MDR pathogens. Recent findings, however, have questioned this approach, because the worse prognosis of HCAP compared to CAP may better reflect increased level of comorbidity and frailty (poor functional status, older age of HCAP patients, as well as poorer quality of hospital care provided to such patients, rather than pneumonia etiology by MDR pathogens. The Pneumonia in Italian Acute Care for Elderly units (PIACE Study, promoted by the Società Italiana di Geriatria Ospedale e Territorio (SIGOT, is an observational prospective cohort study of patients consecutively admitted because of pneumonia to hospital acute care units of Geriatrics throughout Italy. Detailed information regarding clinical presentation, diagnosis, etiology, comprehensive geriatric assessment, antibiotic therapy, possible complications and comorbidities was recorded to identify factors potentially predicting in-hospital mortality (primary endpoint, 3-month mortality, length of hospital stay, postdischarge rate of institutionalization and other secondary endpoints. This paper describes the rationale and method of PIACE Study and reviews the main evidence on pneumonia in the elderly.

  9. [Coordinated care after myocardial infarction. The statement of the Polish Cardiac Society and the Agency for Health Technology Assessment and Tariff System].

    Science.gov (United States)

    Jankowski, Piotr; Gąsior, Mariusz; Gierlotka, Marek; Cegłowska, Urszula; Słomka, Marta; Eysymontt, Zbigniew; Gałaszek, Michał; Buszman, Piotr; Kalarus, Zbigniew; Kaźmierczak, Jarosław; Legutko, Jacek; Sujkowska, Gabriela; Matusewicz, Wojciech; Opolski, Grzegorz; Hoffman, Piotr

    2016-01-01

    The in-hospital mortality following myocardial infarction has decreased substantially over the last two decades in Poland. However, according to the available evidence approximately every 10th patient discharged after myocardial infarction (MI) dies during next 12 months. We identified the most important barriers (e.g. insufficient risk factors control, insufficient and delayed cardiac rehabilitation, suboptimal pharmacotherapy, delayed complete myocardial revascularisation) and proposed a new nation-wide system of coordinated care after MI. The system should consist of four modules: complete revascularisation, education and rehabilitation programme, electrotherapy (including ICDs and BiVs when appropriate) and periodical cardiac consultations. At first stage the coordinated care programme should last 12 months. The proposal contains also the quality of care assessment based on clinical measures (e.g. risk factors control, rate of complete myocardial revascularisation, etc.) as well as on the rate of cardiovascular events. The wide implementation of the proposed system is expected to decrease one year mortality after MI and allow for better financial resources allocation in Poland.

  10. Citizenship in civil society?

    NARCIS (Netherlands)

    Ossewaarde, Marinus R.R.

    2007-01-01

    This article seeks to provide a conceptual framework to complement and guide the empirical analysis of civil society. The core argument is that civil society must be understood, not as a category of (post)industrialized society, but as one of individualized society. Civil society is characterized by

  11. Critical care of tropical disease in low income countries: Report from the Task Force on Tropical Diseases by the World Federation of Societies of Intensive and Critical Care Medicine.

    Science.gov (United States)

    Baker, Tim; Khalid, Karima; Acicbe, Ozlem; McGloughlin, Steve; Amin, Pravin

    2017-12-01

    Tropical disease results in a great burden of critical illness. The same life-saving and supportive therapies to maintain vital organ functions that comprise critical care are required by these patients as for all other diseases. In low income countries, the little available data points towards high mortality rates and big challenges in the provision of critical care. Improving critical care in low income countries requires a focus on hospital design, training, triage, monitoring & treatment modifications, the basic principles of critical care, hygiene and the involvement of multi-disciplinary teams. As a large proportion of critical illness from tropical disease is in low income countries, the impact and reductions in mortality rates of improved critical care in such settings could be substantial. Copyright © 2017. Published by Elsevier Inc.

  12. Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI

    Directory of Open Access Journals (Sweden)

    Reinhart, K.

    2010-01-01

    Full Text Available Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1st revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the “German Instrument for Methodological Guideline Appraisal” of the Association of the Scientific Medical Societies (AWMF. In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

  13. Viral hemorrhagic fever in the tropics: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine.

    Science.gov (United States)

    Hidalgo, Jorge; Richards, Guy A; Jiménez, Juan Ignacio Silesky; Baker, Tim; Amin, Pravin

    2017-12-01

    Viral hemorrhagic fevers (VHFs) are a group of illnesses caused by four families of viruses namely Arenaviruses, Filoviruses, Bunyaviruses, and Flaviviruses. Humans are not the natural reservoir for any of these organisms and acquire the disease through vectors from animal reservoirs. In some conditions human to human transmission is possible increasing the risk to healthy individuals in the vicinity, more so to Health Care Workers (HCW). The pathogenesis of VHF, though poorly understood, varies according to the viruses involved. The resultant microvascular damage leads to increased vascular permeability, organ dysfunction and even death. The management is generally supportive but antiviral agents are of benefit in certain circumstances. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Building a National Framework for Adolescent and Young Adult Hematology and Oncology and Transition from Pediatric to Adult Care: Report of the Inaugural Meeting of the "AjET" Working Group of the German Society for Pediatric Oncology and Hematology.

    Science.gov (United States)

    Escherich, Gabriele; Bielack, Stefan; Maier, Stephan; Braungart, Ralf; Brümmendorf, Tim H; Freund, Mathias; Grosse, Regine; Hoferer, Anette; Kampschulte, Rebecca; Koch, Barbara; Lauten, Melchior; Milani, Valeria; Ross, Henning; Schilling, Freimut; Wöhrle, Dieter; Cario, Holger; Dirksen, Uta

    2017-06-01

    Adolescents and young adults (AYAs) with hemato-oncological problems constitute a heterogenous group with characteristic particularities, specific needs, and age-related clinical and unique psychosocial features. Strong collaboration between pediatric and adult hemato-oncology settings is essential to address their needs appropriately. This is not only true for patients who first become ill during adolescence or young adulthood, but equally so for people who contract hemato-oncological diseases congenitally or as younger children and who are now becoming old enough to leave the pediatric setting and have to transit into "adult" medical care. Efforts to create environments that meet the specific needs of the AYA population affected by hemato-oncological diseases have been initiated in many countries. Due to international variations between societies in general and healthcare infrastructures in particular, the challenges posed to creating such environments vary considerably from country to country. Aiming at addressing these on a national basis for Germany, a dedicated Working Group on Adolescents, Young Adults, and Transition (Arbeitsgemeinschaft Adoleszenten, junge Erwachsene, Transition, AjET) was established. This meeting report depicts the content and discussions of the first interdisciplinary conference on treatment, transition, and long-term follow-up in AYAs with cancer or chronic/inborn hematological diseases. The AjET group of the German Society for Pediatric Oncology and Hematology (GPOH) intends to increase the national awareness for AYAs; strengthen the collaboration of pediatric and adult care givers; and initiate, promote, and coordinate collaborative activities in the fields of basic and translational research, clinical care, and long-term follow-up aimed at improving the current situation.

  15. Relations between professional medical associations and the health-care industry, concerning scientific communication and continuing medical education: a policy statement from the European Society of Cardiology.

    Science.gov (United States)

    2012-06-01

    Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry.

  16. Quality standards in a rheumatology Day-Care Hospital Unit. The proposal of the Spanish Society of Rheumatology Day Hospitals' Working Group.

    Science.gov (United States)

    García-Vicuña, Rosario; Montoro, María; Egües Dubuc, César Antonio; Bustabad Reyes, Sagrario; Gómez-Centeno, Antonio; Muñoz-Fernández, Santiago; Pérez Pampín, Eva; Román Ivorra, Jose Andrés; Balsa, Alejandro; Loza, Estíbaliz

    2014-01-01

    In recent years, the Rheumatology Day-Care Hospital Units (DHU have undergone extensive development. However, the quality standards are poorly documented and mainly limited to structure items rather than including broad and specific areas of this specialty. To develop specific quality standards for Rheumatology DHU. After a systematic review of the literature and related documents, a working group (WG) involving 8 DHU-experienced rheumatologists developed an initial proposal of the quality standards, under the supervision of an expert methodologist. A second round was held by the WG group to review the initial proposal and to consider further suggestions. Once the content was agreed upon by consensus, a final report was prepared. 17 structure standards, 25 process standards and 10 results standards were defined, with special emphasis on specific aspects of the Rheumatology DHU. The proposal includes: 1) essential standards to 2) excellent standards, 3) a Rheumatology DHU services portfolio and 4) performance criteria. The proposed quality standards are the basis for developing the indicators and other management tools for Rheumatology DHU, thereby ensuring a patient-oriented practice based on both the evidence and the experience. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  17. Health and social care needs of Somali refugees with visual impairment (VIP) living in the United Kingdom: a focused ethnography with Somali people with VIP, their caregivers, service providers, and members of the Horn of Africa Blind Society.

    Science.gov (United States)

    Higginbottom, Gina M A; Rivers, Kaltum; Story, Robin

    2014-04-01

    To explore the health and social care needs of Somali refugees with visual impairment (VIP). We conducted a three-phased focused ethnography in collaboration with the Horn of Africa Blind Society (HABS) through all stages from research design to findings dissemination. Engaging in participatory research, HABS members (n = 26), service providers (n = 10), and two Somali community groups (n = 8 and n = 7) whose members were sighted (Phase 1) took part in four focus group interviews. Phases 2 and 3 consisted of interviews with Somali refugees with VIP (n = 32) and their informal carers (n = 5). We used framework data analysis methodology. Four major themes emerged: (1) sociocultural perceptions of blindness and visual impairment, (2) access to services, (3) isolation and insecurity, and (4) mobility. Somali people with VIP experience profound unmet social and health care needs related largely to social support, awareness of mobility options, and the stigmatization of visual impairment. Appropriate community outreach may improve access to services and quality of life for Somali people with VIP. Tailored information is needed to increase awareness of mobility and security services. Significant considerations exist when planning discharge from acute care settings to ensure continuity of support.

  18. A manifesto of community-focused psychotherapy for the social participation: Does individual and group psychotherapy still meet the care needs of the society?

    Directory of Open Access Journals (Sweden)

    Simone Bruschetta

    2015-10-01

    Full Text Available This paper presents a critical, on a social-political level, of development of psychotherapy, seen as the health discipline, especially in that part of the world called West, scientifically established itself through the evaluation of the effectiveness of its two most common types of setting: Individual and Group- Psychotherapy. Through a social-anthropological interpretation of mental processes which it underpins, and a group analytical analysis of organizational and institutional dynamics that led to its evolution, the authors highlight the significant impasse in which psychotherapy finds itself today compared to new and more pervasive forms of mental suffering. Following on of the latest scientific research on the functioning of the mind and of new policy proposals from the World Health Organization, it is suggested so a form of basic psychotherapy, focused on the quality of the mental health of human contexts, defined Community-Focused Psychotherapy. This new form of psychotherapy is wrong simply understood as a new setting, alongside the classic individual, group, or family setting, but as a political-cultural background and a theoretical-methodological framework, so for different psychotherapeutic treatment (individual, group , family put in place in cases of specific psychopathological symptoms, as for a number of other clinical and social programs, carried out by professionals, workers and (formerly users, who support the empowerment of people, with serious psychological disorders or severe mental illness, in their own social contexts of belonging, and in their own recovery, through the active participation of all those therapeutic processes that support their care

  19. The South African Society of Psychiatrists (SASOP and SASOP State Employed Special Interest Group (SESIG position statements on psychiatric care in the public sector

    Directory of Open Access Journals (Sweden)

    Bernard Janse van Rensburg

    2012-08-01

    others, become the universal goals by which we measure service provision, should be adopted as soon as possible. Culture, mental health and psychiatry: culture, religion and spirituality should be considered in the current approach to the local practice and training of specialist psychiatry, within the professional and ethical scope of the discipline. Forensic psychiatry: an important and significant field within the scope of state-employed psychiatrists, with 3 recognised groups of patients (persons referred for forensic psychiatric observation, state patients, and mentally ill prisoners, each with specific needs, problems and possible solutions. Security in psychiatric hospitals and units: it is necessary to protect public sector mental healthcare practitioners from assault and injury as a result of performing their clinical duties by, among others, ensuring that adequate security procedures are implemented, appropriate for the level of care required, and that appointed security staff members are appropriately trained and equipped.

  20. How and when to refer patients diagnosed with primary headache and craniofacial neuralgia in the Emergency department or Primary Care: Recommendations of the Spanish Society of Neurology's Headache Study Group.

    Science.gov (United States)

    Gago-Veiga, A B; García-Azorín, D; Mas-Sala, N; Ordás, C M; Ruiz-Piñero, M; Torres-Ferrús, M; Santos-Lasaosa, S; Viguera Romero, J; Pozo-Rosich, P

    2017-09-01

    When a patient is diagnosed with primary headache or craniofacial neuralgia in the emergency department or in primary care, and is referred to a neurologist due to the complexity of the case, it is useful to know whether additional examination should be sought and the priority (urgent, preferential or normal) with which the patient should be seen. This will avoid unnecessary delays in patients with disabling headache and where organic causes are suspected. In order to issue recommendations on this matter, the Spanish Society of Neurology's Headache Study Group has decided to create a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgia. Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with Spanish Society of Neurology's Headache Study Group Executive Committee. For practical reasons, the document was divided into 2 articles: this first article focuses on primary headaches and craniofacial neuralgias and the second on secondary headaches. In order for the recommendations to be helpful for daily practice they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists. We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  1. Guidelines for developing admission and discharge policies for the pediatric intensive care unit. Pediatric Section Task Force on Admission and Discharge Criteria, Society of Critical Care Medicine in conjunction with the American College of Critical Care Medicine and the Committee on Hospital Care of the American Academy of Pediatrics.

    Science.gov (United States)

    1999-04-01

    These guidelines were developed to provide a reference for preparing policies on admission and discharge for pediatric intensive care units (PICUs). They represent a consensus opinion of physicians, nurses, and allied health care professionals. By using this document as a framework for developing multidisciplinary admission and discharge policies, utilization of pediatric intensive care units can be optimized and patients can receive the level of care appropriate for their condition.

  2. Reclaiming Society Publishing

    Directory of Open Access Journals (Sweden)

    Philip E. Steinberg

    2015-07-01

    Full Text Available Learned societies have become aligned with commercial publishers, who have increasingly taken over the latter’s function as independent providers of scholarly information. Using the example of geographical societies, the advantages and disadvantages of this trend are examined. It is argued that in an era of digital publication, learned societies can offer leadership with a new model of open access that can guarantee high quality scholarly material whose publication costs are supported by society membership dues.

  3. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients : a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT)

    NARCIS (Netherlands)

    Elad, Sharon; Raber-Durlacher, Judith E.; Brennan, Michael T.; Saunders, Deborah P.; Mank, Arno P.; Zadik, Yehuda; Quinn, Barry; Epstein, Joel B.; Blijlevens, Nicole M. A.; Waltimo, Tuomas; Passweg, Jakob R.; Correa, M. Elvira P.; Dahllof, Goran; Garming-Legert, Karin U. E.; Logan, Richard M.; Potting, Carin M. J.; Shapira, Michael Y.; Soga, Yoshihiko; Stringer, Jacqui; Stokman, Monique A.; Vokurka, Samuel; Wallhult, Elisabeth; Yarom, Noam; Jensen, Siri Beier

    Hematology-oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and

  4. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT)

    NARCIS (Netherlands)

    Elad, Sharon; Raber-Durlacher, Judith E.; Brennan, Michael T.; Saunders, Deborah P.; Mank, Arno P.; Zadik, Yehuda; Quinn, Barry; Epstein, Joel B.; Blijlevens, Nicole M. A.; Waltimo, Tuomas; Passweg, Jakob R.; Correa, M. Elvira P.; Dahllöf, Göran; Garming-Legert, Karin U. E.; Logan, Richard M.; Potting, Carin M. J.; Shapira, Michael Y.; Soga, Yoshihiko; Stringer, Jacqui; Stokman, Monique A.; Vokurka, Samuel; Wallhult, Elisabeth; Yarom, Noam; Jensen, Siri Beier

    2015-01-01

    Hematology-oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and

  5. The Information Society

    Directory of Open Access Journals (Sweden)

    Hiranya Nath

    2017-03-01

    Full Text Available This article briefly discusses various definitions and concepts of the so-called information society. The term information society has been proposed to refer to the post-industrial society in which information plays a pivotal role. The definitions that have been proposed over the years highlight five underlying characterisations of an information society: technological, economic, sociological, spatial, and cultural. This article discusses those characteristics. While the emergence of an information society may be just a figment of one’s imagination, the concept could be a good organising principle to describe and analyse the changes of the past 50 years and of the future in the 21st century.

  6. Basic oral care for hematology?oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT)

    OpenAIRE

    Elad, Sharon; Raber-Durlacher, Judith E.; Brennan, Michael T.; Saunders, Deborah P.; Mank, Arno P.; Zadik, Yehuda; Quinn, Barry; Epstein, Joel B.; Blijlevens, Nicole M. A.; Waltimo, Tuomas; Passweg, Jakob R.; Correa, M. Elvira P.; Dahll?f, G?ran; Garming-Legert, Karin U. E.; Logan, Richard M.

    2014-01-01

    Purpose Hematology?oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and following chemotherapy/HSCT. While scientific evidence is available to support some of the clinical practices used to manage the oral complications, expert opinion is needed to shape the current ...

  7. Roots of Empathy: responsive parenting, caring societies.

    Science.gov (United States)

    Gordon, Mary

    2003-12-01

    What is common in aggression and in abusive/neglectful parenting is low levels of empathy. Fostering empathy--the ability to identify with another person's feelings--can serve as an antidote to aggression and is crucial to good parenting. Poor parenting and aggression cut across all socioeconomic levels of the community and, as such, empathy needs to be fostered in all children. During the period of rapid brain development, adversity has a devastating impact on the baby's developing brain. Repeated experiences of stress are hardwired into the brain, creating damaging pathways. Risk factors such as domestic violence, child abuse and neglect, maternal depression, maternal addictions, and poverty are not just additive to the vulnerable developing brain; they are multiplicative in their impact. The parent is the baby's lifeline, mitigating stress for them and helping them to learn to regulate their emotions. The impact of poor parenting on a child's life is profound, resulting in insecure attachments which lead to a spectrum of inadequate coping mechanisms, poor emotional regulation, diminished learning potential and low competence. Responsive and nurturing parenting is the key to optimal early childhood development; it allows the young brain to develop in a way that is less aggressive and more emotionally stable, social and empathic. Good early childhood development leads to good human development. We must match our investment where the opportunity is most ripe--building parenting capacity. The 'Roots of Empathy' program offers real hope in breaking the intergenerational transference of poor parenting and violence.

  8. Contraception and society.

    Science.gov (United States)

    Diczfalusy, E

    2002-12-01

    When an idea meets the exigencies of an epoch, it becomes stronger than any form of political power and it becomes the common property of humankind. Such an idea was the development of contraceptives. In retrospect, the invention of contraceptives was as fundamental for the evolution of humankind as the invention of the wheel; today more than 550 million couples are using contraceptive methods. The large-scale use of contraceptives triggered the most powerful social revolutions of a century in reproductive health and gender equity, and substantially contributed to an unparalleled demographic change, characterized by a rapid aging of populations. One of the important reasons for population aging is a significant decline in fertility rates, resulting in gradually changing population structures with fewer and fewer children and more and more elderly persons. The causes underlying these demographic changes are complex and manifold; they reflect major societal changes of historical dimensions. Many of our institutions cater increasingly for a population structure that no longer exists. There is therefore an increasing need for institutional reforms in social security, health care, housing and education. In addition, several surveys conducted in the developed world have indicated an erosion of confidence in our basic institutions, e.g. courts and justice, the Church and Parliament. Whereas modem sociologists are concerned about an increase in crime, decrease in trust and depleted social capital, one can also observe an accelerated perception of our global destiny and a re-awakening of the moral impulse with a strong demand for increased transparency in public affairs. Also, various global communities have assumed a growing importance. It can be predicted that international professional communities, such as the European Society of Contraception, will play an increasingly important future role in influencing policies in general and health policies in particular. because of

  9. Civil Society and Governance

    DEFF Research Database (Denmark)

    Hulgård, Lars

    An illustration of how important the relationship is between civil society anbd governance. A short historic journey with four snapshots of times and situations that have provided interesting evidence about the connection between civil society and governance. My goal for the short historic journey...... is to make clear and hopefully even verify that providing knowledge about the impact of civil society and citizens’ participation on governance is one of the most urgent research tasks in the current period of time....

  10. Comparison between National Institute for Health and Care Excellence (NICE) and European Society of Cardiology (ESC) guidelines for the diagnosis and management of stable angina: implications for clinical practice.

    Science.gov (United States)

    Archbold, R Andrew

    2016-01-01

    Cardiologists in the UK use clinical practice guidelines from the National Institute for Health and Care Excellence (NICE) and from the European Society of Cardiology (ESC) to aid clinical decision-making. This review compares their recommendations regarding stable angina. NICE's diagnostic algorithm changed clinical practice in the UK, with most cardiologists moving from the exercise ECG towards newer, more accurate imaging modalities such as CT and MRI for diagnostic testing in patients with a low or medium probability of coronary artery disease (CAD), and directly to invasive coronary angiography in patients with a high probability of CAD. ESC guidelines are based around stress imaging for most patient groups. Both guidelines stress the importance of optimal medical therapy for patients with stable angina. NICE recommends coronary artery bypass graft surgery to improve prognosis for patients with left main stem and/or proximal 3-vessel disease, whereas the ESC also includes proximal left anterior descending artery disease among its indications for revascularisation to improve prognosis, particularly if there is evidence of myocardial ischaemia. The relation between disease complexity and 5-year clinical outcomes after revascularisation in patients with left main stem and/or 3-vessel CAD has been integrated into ESC guidance through the use of the SYNTAX score to aid treatment selection in this group of patients. Patients with stable angina who have disease involving the proximal left anterior descending artery are less likely to undergo myocardial revascularisation if they are managed according to NICE's guidance compared with the ESC's guidance.

  11. [Guidelines for health surveillance of health care workers exposed to biological risks set up by the Italian Society for Occupational Health and Industrial Hygiene: application in health facilities of the Regional Health Administration--District No. 7, Ancona].

    Science.gov (United States)

    Copertaro, A; Barbaresi, Mariella; Bevilacqua, G; Novelli, A M; Aprile, A

    2005-01-01

    Evidence Based Medicine and the need to achieve better management of health budgets call for verification and, if necessary, revision of the criteria used in Occupational Health, in order to ensure appropriate measures as regards protection of health at the workplace. In December 2003, the Marche Region initiated a process of reform of the regional health service, which will be completed in two years, and will provide a new regional health organization that will improve the quality and appropriateness of health services available to the population. The reform also involves the Occupational Health Services responsible for prevention activities for 20,000 health care workers employed in regional public health facilities. The need was strongly felt to set up a network that would meet the health needs of health care workers, by adopting a common language among occupational health physicians, by eliminating reported criticism, which is due not only to lack of communication between different structures and profiles, but also to the different methods of approach, evaluation and management of occupational risks. From a historical point of view, the health sector has the biggest as regards prevention of biological risk. Therefore, with a view to harmonizing actions and approach among occupational health physicians in the evaluation of this risk, the publication by the Italian Society for Occupational of Health and Industrial Hygiene of Guidelines for health surveillance of health care workers exposed to biological risks, produced by the working group under the leadership of Prof. Lorenzo Alessio, was considered to offer an interesting opportunity to verify the reproducibility of methods and the quality of results, as applied to health facilities under the Regional Health Administration in Ancona (District No. 7). The Guidelines fully confirmed the need to plan activities, starting from analysis of epidemiological and occupational data, thus assuring good results both in

  12. Education Societies in London.

    Science.gov (United States)

    Scottish Educational Review, 1985

    1985-01-01

    Describes origins, membership criteria, activities, and publications of the Scottish branches of six educational societies: British Association of Early Childhood Education, British Psychological Society, National Association for Gifted Children, National Council for Special Education, United Kingdom Reading Association, and Education Otherwise.…

  13. Fieldwork in Transforming Societies

    DEFF Research Database (Denmark)

    Clark, Ed; Michailova, Snejina

    The contributors to this text discuss the personal and professional challenges of conducting fieldwork in the difficult, sometimes threatening contexts of the transforming societies of post-socialist Europe and China.......The contributors to this text discuss the personal and professional challenges of conducting fieldwork in the difficult, sometimes threatening contexts of the transforming societies of post-socialist Europe and China....

  14. Refractions of Civil Society

    DEFF Research Database (Denmark)

    Kuzmanovic, Daniella

    The thesis investigates various perceptions of civil society among civic activists in Turkey, and how these perceptions are produced and shaped. The thesis is an anthropological contribution to studies of civil society in general, as well as to studies on political culture in Turkey....

  15. Glaciers and society

    DEFF Research Database (Denmark)

    Gagné, Karine; Rasmussen, Mattias Borg; Orlove, Ben

    2014-01-01

    toward technological methodologies. Yet, as elements of the landscape, glaciers are strongly integrated to various societies around the world in ways that exceed their role as provider of fundamental sources of water. The relation between glaciers and societies is therefore marked by processes...

  16. World Society and Globalisation

    Science.gov (United States)

    Wittmann, Veronika

    2014-01-01

    Purpose: The purpose of this paper is to illustrate discourses on globalisation and world society and to disclose the commonalities and differences of both scientific debates. In particular, it draws attention to theoretical concepts of globalisation and world society. This is considered fruitful for comprehending the complex mechanisms of…

  17. Islam dan Civil Society

    Directory of Open Access Journals (Sweden)

    Imam Sukardi

    2010-05-01

    Full Text Available The article tries to address the concept of civil society from varied perspectives. From a historical point of view, civil society demands not only the absent domination of state but also liberates individuals from the hegemony of state. The article shows that in Indonesia and Malaysian discourse, masyarakat madani is often used to represent the term of civil society. Using this conception, major values of civil society also share with basic ideas within the Medina Treaty in the history of Islam. These ideas include egalitarianism, human rights protection, participation, law and justice enforcement and pluralism. In this frame, the question on whether or not Islam is compatible with the concept of civil society is clearly answered. Muslims could benefit such a concept to build their awareness of being progressive and adaptive to social changes.

  18. Paperless or vanishing society

    Science.gov (United States)

    Turner Luke, Joy

    2002-06-01

    In the 1940s color photography became available and within a few years, extremely popular. As people switched from black and white photographs made with the old metallic silver process to the new color films, pictures taken to record their lives and families began a slow disappearing act. The various color processes, coupled with the substrates they were printed on, affected their longevity, but many color photographs taken from the late 1950s through the 1970s, and even into the 1980s, faded not only when exposed to the light, but also when stored in the dark. Henry Wilhelm's excellent book 'The Permanence and Care of Color Photographs' documents this history in detail. Today we are making another transition in the storage of pictures and information. There are questions about the longevity of different types of digital storage, and also of the images printed by various types of inkjet printers, or by laser printers using colored toners. Very expensive and very beautiful works of art produced on Iris printers are appearing in art exhibitions. Some of these are referred to as Giclee prints and are offered on excellent papers. Artists are told the prints will last a lifetime; and if by change they don't it is only necessary to make another print. Henry Wilhelm has begun to test and rate these images for lightfastness; however, his test method was developed for examining longevity in colored photographs. It is of interest to find out how these prints will hold up in the tests required for fine art materials. Thus far companies producing digital inks and printers have not invested the time and money necessary to develop an American Society for Testing and Materials (ASTM) standard method for evaluating the lightfastness of digital prints. However, it is possible to use ASTM D 5383, Standard Practice for Visual Determination of the Lightfastness of Art Materials by Art Technologists, to pinpoint colors that will fade in a short time, even though the test is not as

  19. Information society studies

    CERN Document Server

    Duff, Alistair S

    2013-01-01

    We are often told that we are ""living in an information society"" or that we are ""information workers."" But what exactly do these claims mean, and how might they be verified? In this important methodological study, Alistair S. Duff cuts through the rhetoric to get to the bottom of the ""information society thesis."" Wide-ranging in coverage, this study will be of interest to scholars in information science, communication and media studies and social theory. It is a key text for the newly-unified specialism of information society studies, and an indispensable guide to the future of this disc

  20. Climate and Ancient Societies

    DEFF Research Database (Denmark)

    Climate, and human responses to it, have a strongly interconnected relationship. This when climate change occurs, the result of either natural or human causes, societies should react and adapt to these. But do they? If so, what is the nature of that change, and are the responses positive...... or negative for the long-term survival of social groups? In this volume, scholars from diverse disciplines including archaeology, geology and climate sciences explore scientific and material evidence for climate changes in the past, their causes, their effects on ancient societies and how those societies...

  1. Valie EXPORT Society. Overlok

    Index Scriptorium Estoniae

    2001-01-01

    Valie EXPORT Society asutasid 23. okt. 1999. a. Frankfurdis Kadi Estland, Killu Sukmit ja Mari Laanemets, kui olid külastanud austria naiskunstniku Valie Exporti näitust. Rühmituse aktsioonide kirjeldus

  2. Valie EXPORT Society Rooseumis

    Index Scriptorium Estoniae

    2002-01-01

    Malmös Rooseumi Kaasaegse Kunsti Keskuses näitus "Baltic Babel". Projekt koosneb Läänemeremaade linnades tegutsevate innovatiivsete gruppide aktsioonidest. Kuraator Charles Esche. Esinejatest (Eestist Valie Export Society: Kadi Estland, Killu Sukmit)

  3. American Geriatrics Society

    Science.gov (United States)

    ... Learn More Social Media Facebook Twitter LinkedIn Instagram Social Media Bar Right Menu Annual Meeting Donate to our Foundation Contact Us American Geriatrics Society 40 Fulton St., 18th Floor New York, NY ...

  4. The global knowledge society

    National Research Council Canada - National Science Library

    Fedoroff, Nina V

    2012-01-01

    Knowledge societies rest on a foundation of educational and research excellence. The Internet, advances in communications technology, and the rapidly expanding global fiber optic network are necessary, but not sufficient...

  5. American Rhinologic Society

    Science.gov (United States)

    ... 6th Bulgarian-Italian Rhinology Friendship Meeting Sofia Hotel Balkan, Sofia, Bulgaria, December 1-3, 2017 9.17. ... you there! Terms of Use | Site Map © 2011 American Rhinologic Society All Rights Reserved

  6. Producing Civil Society

    DEFF Research Database (Denmark)

    Feldt, Liv Egholm; Hein Jessen, Mathias

    Since the beginning of the 1990’s, civil society has attracted both scholarly and political interest as the ‘third sphere’ outside the state and the market not only a normatively privileged site of communication and ‘the public sphere’, but also as a resource for democratization processes......’ and as such dominates our way of thinking about civil society. Yet, this view hinders the understanding of how civil society is not a pre-existing or given sphere, but a sphere which is constantly produced both discursively, conceptually and practically. Through two examples; 1,the case of philanthropy in the beginning...... of the century. 2, the laws and strategies of implementing regarding the regulation of civil societal institutions (folkeoplysningsloven) since the 1970’s this paper shows how civil society in 20th century Denmark was produced both conceptually and practically and how this entailed a specific vision and version...

  7. American Society of Echocardiography

    Science.gov (United States)

    ... Good News About Echo Marketing and Promotional Opportunities Social Media Mobile Resources About ▼ About ASE Board of Directors Committees and Councils Industry Roundtable Partners Contact Us American Society of Echocardiography 2100 Gateway Centre Boulevard, Ste. 310 ...

  8. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... SAMBA Link Digital Newsletter Educational Bibliography Research IARS/Anesthesia & Analgesia SCOR About SCOR Sponsor SAMBA Meetings Affinity Sponsor Program We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, ...

  9. National Multiple Sclerosis Society

    Science.gov (United States)

    ... Have you met? d Our Healthcare Voice National Multiple Sclerosis Society International Progressive MS Alliance live from Paris ... Persist for Years October 25, 2017 View All Multiple Sclerosis News & Press View All Clinical Trial Alerts Every ...

  10. Transnationalising Civil Society?

    DEFF Research Database (Denmark)

    Jørgensen, Martin Bak

    The paper takes a transnational perspective on developing an analytical framework for understanding how transnationalism interacts with civil society and how immigrant organisations use transnational strategies to challenge the pre-given positions of immigrants within given integration...

  11. Changing Anthropology, Changing Society

    Science.gov (United States)

    Varughese, Heather

    2009-01-01

    Fifty years after the founding of the field of medical anthropology, the Society for Medical Anthropology of the American Anthropological Association held its first independent meeting on September 24-27, 2009, at Yale University. PMID:20027281

  12. American Society of Hematology

    Science.gov (United States)

    ... Navigation Account Navigation Main Content American Society of Hematology ASH Store ASH Job Center ASH Apps Share ... youtube linkedin Research In This Section Agenda for Hematology Research Sickle Cell Priorities Lymphoma Roadmap Moonshot Initiative ...

  13. The Tranquebarian Society

    DEFF Research Database (Denmark)

    Jensen, Niklas Thode

    2015-01-01

    of this development was the establishment of the Tranquebarian Society, the third learned society east of the Cape of Good Hope. The article examines the unique assemblage of scientific networks, people, instruments, institutions, and ideas of local and global origin that converged in Tranquebar, and it investigates...... the fusion of local problems and radical ideas of enlightenment, education, and improvement that united government, mission, and merchants in Tranquebar in the quest for ‘useful knowledge’....

  14. The Society for Scandinavian Art

    DEFF Research Database (Denmark)

    Grand, Karina Lykke

    2016-01-01

    The Society for Nordic Art & the Scandinavian Society [Selskabet for Nordisk Kunst & Skandinavisk Selskab]......The Society for Nordic Art & the Scandinavian Society [Selskabet for Nordisk Kunst & Skandinavisk Selskab]...

  15. Laboratory testing in the emergency department: an Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report.

    Science.gov (United States)

    Lippi, Giuseppe; Panteghini, Mauro; Bernardini, Sergio; Bonfanti, Laura; Carraro, Paolo; Casagranda, Ivo; Cavazza, Mario; Ceriotti, Ferruccio; Ciaccio, Marcello; Coen, Daniele; Giavarina, Davide; Giostra, Fabrizio; Paolillo, Ciro; Plebani, Mario; Ricci, Giorgio; Cervellin, Gianfranco

    2017-03-31

    The mainstay of patient-oriented laboratory testing in emergency settings entails selecting a number and the type of tests according to valid criteria of appropriateness. Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) for reaching tentative consensus about the most informative diagnostic tests in emergency settings. A survey, containing the most commonly ordered urgent laboratory tests and the relative clinical indications, was disseminated to eight relevant members of AcEMC and eight relevant members of SIBioC. All contributors were asked to provide numerical scores for the different laboratory parameters, where 1 indicated "strongly recommended", 2 "recommended in specific circumstances", and 3 "strongly discouraged". The mean results of the survey were presented as the mean of responders' values, and the parameters were finally classified as "strongly recommended" (mean value, 1.00-1.49), "weakly recommended" (mean value, 1.50-1.99), "discouraged" (mean value, 2.00-2.49) and "strongly discouraged" (mean value, 2.50-3.00). The results of the survey allowed defining a hierarchy of priority, wherein 24 tests were "strongly recommended". The use of five common tests was instead "strongly discouraged". For 16 additional parameters in the list, the consensus ranged between "weakly recommended" and "discouraged". We hope that results presented in this joint AcEMC-SIBioC consensus document may help harmonizing panel of tests and requesting patterns in emergency setting, at least at a national level.

  16. Laboratory testing in the emergency department: an Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC and Academy of Emergency Medicine and Care (AcEMC consensus report

    Directory of Open Access Journals (Sweden)

    Giuseppe Lippi

    2017-04-01

    Full Text Available The mainstay of patient-oriented laboratory testing in emergency settings entails selecting number and type of tests according to valid criteria of appropriateness. Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC for reaching tentative consensus about the most informative diagnostic tests in emergency settings. A survey, containing the most commonly performed urgent laboratory tests and the relative clinical indications, was disseminated to eight relevant members of AcEMC and eight relevant members of SIBioC. All contributors were asked to provide numerical scores for the different laboratory parameters, where 1 indicated strongly recommended, 2 recommended in specific circumstances, and 3 strongly discouraged. The mean results of the survey were presented as the mean of responders’ values, and the parameters were finally classified as strongly recommended (mean value, 1.0-1.5, somehow recommended (mean value, 1.5-2.0, discouraged (mean value, 2.0-2.5 and strongly discouraged (mean value, 2.5-3.0. The results of the survey allowed defining a hierarchy of priority, wherein 24 tests were strongly recommended. The use of 5 common tests was instead strongly discouraged. For 16 additional parameters in the list, the consensus ranged between somehow recommended and discouraged. We hope that results presented in this joint AcEMC-SIBioC consensus document may help harmonizing panel of tests and requesting patters in emergency setting, at least at a national level.

  17. Appropriate Use of Opioid Analgesics and Redional Alliance in Cancer Pain Palliation(Symposium,Palliative Care,The 72nd General Meeting of the Society of Tokyo Women's Medical University)

    OpenAIRE

    伊東, 俊雅; 木村, 桂子; 小島, 正照; 佐川, 賢一; Toshimasa, ITOH; Keiko, KIMURA; Masateru, KOJIMA; Ken-ichi, SAGAWA

    2007-01-01

    We start the palliative care team of all wards consultation type in October, 2005, and the palliative care addition in a medical examination and treatment reward is active with a consultation request from the chief physician department although We do not calculate it. In this June, the palliative care was the times when we medical worker must wrestle with palliative medical care by an anti-cancer measure basic enactment carefully. It seems that the chief physician department and establishment...

  18. Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 2017; Session "Quality Improvement, Parents Centered Care"

    Directory of Open Access Journals (Sweden)

    --- Various Authors

    2017-10-01

    Full Text Available Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR, European Society for Neonatology (ESN, Union of European Neonatal & Perinatal Societies (UENPS, European Foundation for the Care of Newborn Infants (EFCNIORGANIZING COMMITTEELuc Zimmermann (President of ESPR, Morten Breindahl (President of ESN, Manuel Sánchez Luna (President of UENPS, Silke Mader (Chairwoman of the Executive Board and Co-Founder of EFCNISCIENTIFIC COMMITTEEVirgilio P. Carnielli (Congress President Chair, Pierre Gressens (Past Scientific President, Umberto Simeoni, Manon Benders, Neil Marlow, Ola D. Saugstad, Petra Hüppi, Agnes van den HoogenSession "Quality Improvement, Parents Centered Care"ABS 1. REDUCING MEDICATION ERRORS IN NICU – A QUALITY IMPROVEMENT PROJECT • D.A. Al Masri, B. Ofoegbu, L. Yahya, K. Catroon, A. Saliba, H. IbrahimABS 2. PRETERM INFANTS WITH MEDICAL COM­PLEXITY: IMPACT ON HEALTH CARE RESOURCE USE, FAMILY EMPLOYMENT AND NEURODEVELOPMENTAL OUTCOMES • D. Nassel, C. Chartrand, M.-J. Doré-Bergeron, M. Ballantyne, F. Lefebvre, T.M. LuuABS 3. BREAST MILK DONATION IN THE MUSLIM POPULATION • S. Jebali, E. Ayachi, R. Terki Hassaine, A. Giuseppi, D. Vaiman, S. Brunet, V. RigourdABS 4. CORE OUTCOMES IN NEONATOLOGY: PRELIMINARY RESULTS • J. Webbe, N. Modi, C. Gale, on behalf of the COIN Steering GroupABS 5. A PILOT STUDY ASSESSING THE EFFECTIVENESS OF A FAMILY-CENTERED CARE INTERVENTION IN PRETERM INFANTS IN CHINA • R. Zhang, R. Huang, X. Gao, X. Peng, L. Zhu, R. Ramanathan, J. LatourABS 6. TO DETERMINE HOW MANY MOTHERS OF PRETERM BABIES, WHO WERE DELIVERED BETWEEN 24 AND 34 WEEKS GESTATION AND WERE ADMITTED TO NEONATAL UNIT AT ST. MARY’ S HOSPITAL, DID NOT RECEIVE ANTENATAL STEROIDS • A. Arunoday, A. Manou

  19. Advanced information society(2)

    Science.gov (United States)

    Masuyama, Keiichi

    Our modern life is full of information and information infiltrates into our daily life. Networking of the telecommunication is extended to society, company, and individual level. Although we have just entered the advanced information society, business world and our daily life have been steadily transformed by the advancement of information network. This advancement of information brings a big influence on economy, and will play they the main role in the expansion of domestic demands. This paper tries to view the image of coming advanced information society, focusing on the transforming businessman's life and the situation of our daily life, which became wealthy by the spread of daily life information and the visual information by satellite system, in the development of the intelligent city.

  20. Civil society sphericules

    DEFF Research Database (Denmark)

    Tufte, Thomas

    2014-01-01

    the organization strategizes about and seeks to articulate amongst Tanzanian youth. Situated in the ‘perverse confluence’ (Dagnino, 2011) between neoliberal and radical democratic agendas in the communicative practices of civil society-driven media platforms, Femina navigates between identities as an NGO, a social...... movement and a media initiative. In the context of the growing literature on social networking sites and their affordances, dynamics and structures, the case of Femina illustrates how a civil society sphericule emerges within the dynamic co-evolution of new and old media platforms. The study is furthermore...... an example of the difficult shift in civil society practice, from service provision to an agenda of public service monitoring, social accountability and community engagement....

  1. Branding Cities, Changing Societies

    DEFF Research Database (Denmark)

    Ooi, Can-Seng

    Societal changes are seldom discussed in the literature on city branding. The time element is important because it highlights the fluctuating reality of society. The city brand message freezes the place but in fact, the city branding exercise is a continuous process. Society emerges too. City...... brands are supposed to accentuate the uniqueness of the city, be built from the bottom-up and reflect the city's identity. This paper highlights three paradoxes, pointing out that city branding processes can also make cities more alike, bring about societal changes and forge new city identities. A city...

  2. Advanced information society(7)

    Science.gov (United States)

    Chiba, Toshihiro

    Various threats are hiding in advanced informationalized society. As we see car accident problems in motorization society light aspects necessarily accompy shady ones. Under the changing circumstances of advanced informationalization added values of information has become much higher. It causes computer crime, hacker, computer virus to come to the surface. In addition it can be said that infringement of intellectual property and privacy are threats brought by advanced information. Against these threats legal, institutional and insurance measures have been progressed, and newly security industry has been established. However, they are not adequate individually or totally. The future vision should be clarified, and countermeasures according to the visions have to be considered.

  3. Science and Society Colloquium

    CERN Multimedia

    Randi, J

    1991-01-01

    Mr. Randi will give an update of his lecture to the American Physical Society on the occasion of his award of the 1989 Forum Prize. The citation said: "for his unique defense of Science and the scientific method in many disciplines, including physics, against pseudoscience, frauds and charlatans. His use of scientific techniques has contributed to refuting suspicious and fraudulent claims of paranormal results. He has contributed significantly to public understanding of important issues where science and society interact". He is a professional magician and author of many books. He worked with John Maddox, the Editor of Nature to investigate the claims of "water with memory".

  4. Big Society, Big Deal?

    Science.gov (United States)

    Thomson, Alastair

    2011-01-01

    Political leaders like to put forward guiding ideas or themes which pull their individual decisions into a broader narrative. For John Major it was Back to Basics, for Tony Blair it was the Third Way and for David Cameron it is the Big Society. While Mr. Blair relied on Lord Giddens to add intellectual weight to his idea, Mr. Cameron's legacy idea…

  5. Literacy in Traditional Societies.

    Science.gov (United States)

    Goody, Jack, Ed.

    This series of essays derives from an interest in communications, in media and their effect upon human intercourse. Primarily, this concern with the technology of the intellect centers upon the effect of literacy on human culture, especially in 'traditional' or pre-industrial societies. In most of the essays, the effects of literacy are considered…

  6. Education for Jobless Society

    Science.gov (United States)

    Sidorkin, Alexander M.

    2017-01-01

    The advent of societies with low employment rates will present a challenge to education. Education must move away from the discourse of skills and towards the discourse of meaning and motivation. The paper considers three kinds of non-waged optional labor that may form the basis of the future economy: prosumption, volunteering, and self-design.…

  7. Rationality in Society

    NARCIS (Netherlands)

    Flache, Andreas; Dijkstra, Jacob; Wright, James D.

    2015-01-01

    Contemporary theories of rational behavior in human society augment the orthodox model of rationality both by adding various forms of bounded rationality and relaxing the assumptions of self-interest and materialistic preferences. This entry discusses how these extensions of the theory of rational

  8. SOCIETY: LESSONS FORZUNIVERSITIES

    African Journals Online (AJOL)

    In this paper, the interaction model of knowledge utilization is engaged to ... and organizational diversity,” (4) “social accountability and reflexivity,” and (5) ... The system of reference for knowledge production under Mode 2 is the network of ... based society characterized by increased demand for transfer and utilization of.

  9. The Civil Society Sector

    OpenAIRE

    Anheier, Helmut K.; Lester M. Salamon

    2015-01-01

    Salamon and Anheier bring the civil society sector - the plethora of private, nonprofit, and nongovernmental organizations that have emerged in recent decades - into better focus conceptually as well as empirically. They draw on the results of a major inquiry into the scope, structure, financing and role of the "nonprofit sector" in a broad cross-section of countries around the world.

  10. Society of Thoracic Surgeons

    Science.gov (United States)

    ... STS The Society of Thoracic Surgeons Facebook Twitter LinkedIn YouTube Instagram Flickr About STS Governance and Leadership ... All Events » Tweets by @STS_CTsurgery Facebook Twitter LinkedIn YouTube Instagram Flickr Footer menu Home Contact Us ...

  11. Connecting Science with Society

    DEFF Research Database (Denmark)

    awareness of the important questions of our society reflected in scientific research and of the answers produced by these research activities. The CRIS2010 conference, entitled “Bringing Science to Society”, therefore seeks to highlight the role of Current Research Information Systems for communicating...

  12. MARX EMBRYOLOGY OF SOCIETY

    NARCIS (Netherlands)

    WOUTERS, A

    This article presents a new interpretation of Marx's dialectical method. Marx conceived dialectics as a method for constructing a model of society. The way this model is developed is analogous to the way organisms develop according to the German embryologist Karl Ernst von Baer, and, indeed, Marx's

  13. American Epilepsy Society

    Science.gov (United States)

    ... and Coding Episodes of Care Practice Management Course Quality Measures PRACTICE TOOLS Cognitive Behavior Employment Resources Medications that provoke seizures Transition Tools: Adolescents Women with Epilepsy EPILEPSY MONITORING UNITS EMU FAQs EMU Safety Find an Epilepsy Center ...

  14. Consumption in the Information Society

    Science.gov (United States)

    Zherebin, V. M.; Ermakova, N. A.; Makhrova, O. N.

    2010-01-01

    The current state of the economy in the developed countries make it possible to characterize them using concepts and terms such as the postindustrial society, the new economy, the service economy, the creative economy, the posteconomic society, the information society, the knowledge society, and the consumer society. Among these terms and…

  15. Technology and society building our sociotechnical future

    CERN Document Server

    Wetmore, Jameson M

    2009-01-01

    Technological change does not happen in a vacuum; decisions about which technologies to develop, fund, market, and use engage ideas about values as well as calculations of costs and benefits. This anthology focuses on the interconnections of technology, society, and values. It offers writings by authorities as varied as Freeman Dyson, Laurence Lessig, Bruno Latour, and Judy Wajcman that will introduce readers to recent thinking about technology and provide them with conceptual tools, a theoretical framework, and knowledge to help understand how technology shapes society and how society shapes technology. It offers readers a new perspective on such current issues as globalization, the balance between security and privacy, environmental justice, and poverty in the developing world. The careful ordering of the selections and the editors' introductions give Technology and Society a coherence and flow that is unusual in anthologies. The book is suitable for use in undergraduate courses in STS and other disciplines...

  16. The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit

    Directory of Open Access Journals (Sweden)

    Daniel Agustin Godoy

    2013-09-01

    Full Text Available Myasthenia gravis (MG is an autoimmune disorder affecting neuromuscular transmission leading to generalized or localized muscle weakness due most frequently to the presence of autoantibodies against acetylcholine receptors in the postsynaptic motor end-plate. Myasthenic crisis (MC is a complication of MG characterized by worsening muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. It also includes postsurgical patients, in whom exacerbation of muscle weakness from MG causes a delay in extubation. MC is a very important, serious, and reversible neurological emergency that affects 20–30% of the myasthenic patients, usually within the first year of illness and maybe the debut form of the disease. Most patients have a predisposing factor that triggers the crisis, generally an infection of the respiratory tract. Immunoglobulins, plasma exchange, and steroids are the cornerstones of immunotherapy. Today with the modern neurocritical care, mortality rate of MC is less than 5%.

  17. l'Internet Society

    CERN Multimedia

    CERN

    1997-01-01

    Conference of Vinton "Vint" Gray Cerf in the Intercontinental Hostel. Vinton Gray Cerf (born June 23, 1943) is an American computer scientist who is commonly referred to as one of the "founding fathers of the Internet" for his key technical and managerial role, together with Bob Kahn, in the creation of the Internet and the TCP/IP protocols which it uses. He was also a co-founder (in 1992) of the Internet Society (ISOC) which is intended to both promote the views of ordinary users of the Internet, and also serve as an umbrella body for the technical groups developing the Internet (such as the Internet Engineering Task Force). He served as the first president of the Internet Society from 1992-1995.

  18. Discrimination in Modern Society

    OpenAIRE

    Schekach, E. V.; Щекач, Е. В.

    2013-01-01

    Issues of discrimination in modern society are examined in the article. Types of discrimination, ways of demonstration, methods of combating discrimination and inequality are described. Particular attention is paid to the legal basis and the real life stories, which serve as a material base for judgments how to prevent discrimination. Possible ways are suggested to eliminate such a negative phenomenon of society like discrimination. Статья посвящена вопросам дискриминации в современном общ...

  19. Cooking and Society

    OpenAIRE

    Teplá, Hedvika

    2012-01-01

    The bachelor thesis "Cooking and Society" focuses on cooking, a process of food preparation. The thesis analyzes cooking as a leisure activity, type of housework and it also discusses the relation between cooking and cultural identity. It focuses on the importance of national and ethnic cuisine and deals with the differences in cooking influenced by religion and social stratification. The thesis also deals with the acquisition of cooing skills and transgeneral transfer of cooking skills. It d...

  20. European Physical Society awards

    CERN Multimedia

    2004-01-01

    The winners of the 2004 Accelerator Prizes, awarded by the European Physical Society's Interdivisional Group on Accelerators (EPS-IGA), have been announced. Vladmir Shiltsev (Fermilab) and Igor Meshkov (JINR, Joint Institute of Nuclear Research, Dubna) will be presented with their awards during the 9th European Particle Accelerator Conference, EPAC'04, on 8 July 2004 in Lucerne. Both physicists will also give a talk about their work. More details on: http://epac.web.cern.ch/

  1. Society and Social Power

    Directory of Open Access Journals (Sweden)

    Janani Harish

    2014-10-01

    Full Text Available Society is the source of immense power. Over the past few centuries humanity has record­ed phenomenal growth in its collective capacity for accomplishment, as reflected in the 12-fold growth in global per capita income since 1800. The remarkable achievements in living standards, longevity, science, technology, industry, education, democracy, human rights, peace and global governance are the result of the exponential development of the capacity of society to harness human energies and convert them into social power for productive purposes. Today, humanity possesses the power and capabilities needed to fully meet the multi-dimensional challenges confronting global society. The source of this energy is people. Human energy is transformed into social power by the increasing reach, frequency and complexity of human relationships. Society is a complex living network of organized relationships between people. Its power issues from channelizing our collective energies in productive ways by means of organizing principles such as coordination, systems, specialization of function, hierarchy of authority, and integration. This immense social power remains largely underutilized. Social science needs to evolve a comprehensive, trans-disciplinary understanding of the roots of social power and the process by which it is generated, distributed and applied. This knowledge is the essential foundation for formulating effective social policies capable of eradicating forever persistent poverty, unemployment and social inequality. This article is based on a series of lectures delivered by the author in the WAAS-WUC course on “Toward a Trans-disciplinary Science of Society” at Dubrovnik on September 1-3, 2014. It traces the development of social power in different fields to show that human and social capital are inexhaustible in potential. The more we harness them, the more they grow. Unleashing, directing, channeling and converting human potential into social

  2. Leadership in Small Societies

    OpenAIRE

    Stephen Younger

    2010-01-01

    Multi-agent simulation was used to study several styles of leadership in small societies. Populations of 50 and100 agents inhabited a bounded landscape containing a fixed number of food sources. Agents moved about the landscape in search of food, mated, produced offspring, and died either of hunger or at a predetermined maximum age. Leadership models focused on the collection and redistribution of food. The simulations suggest that individual households were more effective at meeting their ne...

  3. The new totalitarian society

    Directory of Open Access Journals (Sweden)

    Vlajki Emil

    2011-01-01

    Full Text Available The new totalitarian society is a euphemized expression denoting the New World Order, which in itself denotes the American globalization. The underpinning of this mindset is rationality, which is characteristic of Western civilization. Christianity engendered rationality by introducing it through St. Thomas Aquinas, Aristotle, and especially formal logic. Since it is obvious that religion and logic cannot ultimately be harmonized, this combination has proven lethal in many cases throughout history. For instance, the Inquisition, which, contrary to what happened at scholastic universities, severely berated rational thinking in practice. Catholicism helped carry out genocide against the Jews, and Orthodoxy is in a certain manner tied in with Stalinism. The new totalitarian society is anchored in American Protestantism. On the whole, Christian rationalism is a sphere of science, techniques and technologies efficiently employed to promote the West to the status of a society of plenty and the conception of human rights, which turn into their opposite and irrational behavior of the worst kind. An example of such inhumanity is the attack against Yugoslavia/Serbia in 1999.

  4. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiología Intervencionista; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention).

    Science.gov (United States)

    Rihal, Charanjit S; Naidu, Srihari S; Givertz, Michael M; Szeto, Wilson Y; Burke, James A; Kapur, Navin K; Kern, Morton; Garratt, Kirk N; Goldstein, James A; Dimas, Vivian; Tu, Thomas

    2015-06-01

    This article provides a brief summary of the relevant recommendations and references related to percutaneous mechanical circulatory support. The goal was to provide the clinician with concise, evidence-based contemporary recommendations, and the supporting documentation to encourage their application. The full text includes disclosure of all relevant relationships with industry for each writing committee member. A fundamental aspect of all expert consensus statements is that these carefully developed, evidence-based documents can neither encompass all clinical circumstances, nor replace the judgment of individual physicians in management of each patient. The science of medicine is rooted in evidence, and the art of medicine is based on the application of this evidence to the individual patient. This expert consensus statement has adhered to these principles for optimal management of patients requiring percutaneous mechanical circulatory support. © 2015 by The Society for Cardiovascular Angiography and Interventions, The American College of Cardiology Foundation, the Heart Failure Society of America, and The Society for Thoracic Surgery.

  5. Palliative Care Needs in the Neuro-ICU

    Science.gov (United States)

    Creutzfeldt, Claire J.; Engelberg, Ruth A.; Healey, Larry; Cheever, Chong (Sherry); Becker, Kyra J.; Holloway, Robert G.; Curtis, J. Randall

    2015-01-01

    Objective Patients admitted to the neurological or neurosurgical intensive care unit (neuro-ICU) are likely to have palliative care needs. The goals of this project are to encourage the ICU team to identify palliative care needs for patients and their families and potential ways to meet those needs. Design Quality improvement project using a parallel-group prospective cohort design. Setting Single neuro-ICU at a large, academic medical center. Patients All patients admitted to the neuro-ICU from September 1, 2013 to November 30, 2013. Intervention We developed a Palliative Care Needs Screening Tool consisting of 4 questions: (1) Does the patient have distressing physical or psychological symptoms? (2) Are there specific support needs for patient or family? (3) Are treatment options matched with patient-centered goals? (4) Are there disagreements among teams and family? We implemented this daily screening tool on morning rounds for 1 of 2 neurocritical care services that alternate admitting days to a single neuro-ICU. We examined prevalence and nature of palliative care needs and actions to address those needs, comparing the services with and without screening. Measurements and main results Over the 3-month period, 130 patients were admitted to the service with screening, and 132 patients to the service without screening. The two groups did not differ in regards to age, gender, Glasgow coma scale or diagnosis. Palliative care needs were identified in 62% of screened patients (80/130). Needs were mainly social support (53%) and establishing goals of care (28%). Screening was associated with more documented family conferences (p=0.019) and a trend towards more palliative care consultations (p=0.056). Conclusions We developed a brief palliative care needs screening tool that identified palliative care needs for 62% neuro-ICU patients. This tool was associated with actions to meet these needs, potentially improving care for patients and their families. PMID:25867905

  6. Science, Society and Policy

    Science.gov (United States)

    White, K. S.; Teich, A. H.

    2010-12-01

    Apart from the journals they produce, scientific societies play an important role in communicating scientific findings and norms to the broader society. The American Association for the Advancement of Science (AAAS) includes among its goals to promote and defend the integrity of science and its use; provide a voice for science on societal issues; promote the responsible use of science in public policy; and increase public engagement with science and technology. AAAS websites and programs, including Communicating Science (www.aaas.org/communicatingscience), Working with Congress (http://www.aaas.org/spp/cstc/wwc/book.htm) and ScienceCareers.org (http://sciencecareers.sciencemag.org), provide tools for scientists to become more directly engaged in effectively communicating their findings and involved in the policy process. Education programs work to build the next generation of scientists and a science-literate public. To bridge the current communication gap between scientists, the public and policymakers, AAAS, like other scientific societies, maintains policy and outreach programs with limited budgets and staff. AAAS works to engage policymakers and provide scientific underpinning to key issues through congressional briefings, meetings, policy briefs, and media outreach. AAAS responds to challenges to accepted scientific findings and processes through op-eds, letters to government officials, resolutions, and Board statements. Some of these initiatives occur on a local level in partnership with local civic leaders, whose endorsement makes them more powerful. On a national scale, they assure that the voice of science is included in the debate. The changing media landscape presents opportunities and challenges for future AAAS endeavors.

  7. Popular Music and Society

    DEFF Research Database (Denmark)

    2007-01-01

    or the Russkii Rok-Klub v Amerike (Russian Rock Club of America).   This special edition of Popular Music and Society aims to present research on contemporary popular music (broadly defined) in the former Soviet republics and their diasporas.  A central issue will be how the musical landscape has changed since...... the collapse of the Soviet Union: What present trends can be observed?  How has the Soviet context influenced the popular music of today?  How is music performed and consumed?  How has the interrelationship between cultural industry and performers developed?  How are nationalist sensibilities affecting popular...

  8. Disciplining Global Society

    Directory of Open Access Journals (Sweden)

    Tony Evans

    2007-06-01

    Full Text Available One of the puzzles of the current era is the divide between optimists and pessimists on the question of human rights. The prominence of human rights on the international political agenda sustains the optimist’s hopes for the future, while pessimists point to continued and widespread reports of civil, political, economic, social and cultural violations. This article looks at the tensions and apparent contradictions between these two approaches. Following a discussion on the construction of global human rights discourse(s, the article concludes that the pretensions of law act to mask the socioeconomic normative framework that acts to discipline global society.

  9. Disciplining Global Society

    Directory of Open Access Journals (Sweden)

    Tony Evans

    2007-12-01

    Full Text Available One of the puzzles of the current era is the divide between optimists and pessimists on the question of human rights. The prominence of human rights on the international political agenda sustains the optimist’s hopes for the future, while pessimists point to continued and widespread reports of civil, political, economic, social and cultural violations. This article looks at the tensions and apparent contradictions between these two approaches. Following a discussion on the construction of global human rights discourse(s, the article concludes that the pretensions of law act to mask the socioeconomic normative framework that acts to discipline global society.

  10. Membership in cooperative societies

    Directory of Open Access Journals (Sweden)

    Eba Gaminde Egia

    2017-12-01

    Full Text Available In this work we will analyze the practical application of one of the cooperative principles, «voluntary and free membership», referring to the entering of members in cooperative societies. We will first explain the meaning of this principle, and then bring up its normative regulation, with special emphasis on those aspects in which our autonomic laws differ, and ending with a brief reference to the economic aspect and the different ways to make contributions and their consequences.Received: 31 May 2017Accepted: 14 October 2017Published online: 22 December 2017

  11. Structure, Process, and Culture of Intensive Care Units Treating Patients with Severe Traumatic Brain Injury: Survey of Centers Participating in the American College of Surgeons Trauma Quality Improvement Program.

    Science.gov (United States)

    Alali, Aziz S; McCredie, Victoria A; Mainprize, Todd G; Gomez, David; Nathens, Avery B

    2017-10-01

    Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI. One hundred forty-two TMDs (76%) completed the survey. Severe TBI patients are admitted to dedicated neurocritical care units in 52 hospitals (37%), trauma ICUs in 44 hospitals (31%), general ICUs in 34 hospitals (24%), and surgical ICUs in 11 hospitals (8%). Fifty-seven percent are closed units. Board-certified intensivists directed 89% of ICUs, whereas 17% were led by neurointensivists. Sixty percent of ICU directors were general surgeons. Thirty-nine percent of hospitals had critical care fellowships and 11% had neurocritical care fellowships. Fifty-nine percent of ICUs had standard order sets and 61% had standard protocols specific for TBI, with the most common protocol relating to intracranial pressure management (53%). Only 43% of TMDs were satisfied with the current level of neurosurgeons' engagement in the ICU management of TBI; 46% believed that neurosurgeons should be more engaged; 11% believed they should be less engaged. In the largest survey of North American ICUs caring for TBI patients, there is substantial variation in the current approaches to ICU care for TBI, highlighting multiple opportunities for comparative effectiveness research.

  12. Communicating Science to Society

    Science.gov (United States)

    Illingworth, Samuel; Muller, Jennifer; Leather, Kimberley; Morgan, William; O'Meara, Simon; Topping, David; Booth, Alastair; Llyod, Gary; Young, Dominique; Bannan, Thomas; Simpson, Emma; Percival, Carl; Allen, Grant; Clark, Elaine; Muller, Catherine; Graves, Rosemarie

    2014-05-01

    "Nothing in science has any value to society if it is not communicated." So goes the 1952 quote from Anne Roe, the noted twentieth century American psychologist and writer. She went on to say that "scientists are beginning to learn their social obligations", and now over 60 years later there is certainly evidence to support her assertions. As scientists, by communicating our research to the general public we not only better inform the tax payer where their money is being spent, but are also able to help put into context the topical environmental challenges and issues that society faces, as well as inspiring a whole new generation of future scientists. This process of communication is very much a two-way street; by presenting our work to people outside of our usual spheres of contemporaries, we expose ourselves to alternative thoughts and insights that can inspire us, as scientists, to take another look at our research from angles that we had never before considered. This work presents the results and experiences from a number of public engagement and outreach activities across the UK, in which geoscientists engaged and interacted with members of the general public. These include the design and implementation of Raspberry Pi based outreach activities for several hundred high school students; the process of running a successful podcast (http://thebarometer.podbean.com); hosting and participating in science events for thousands of members of the general public (e.g. http://www.manchestersciencefestival.com and http://sse.royalsociety.org/2013); and creating a citizen science activity that involved primary school children from across the UK. In communicating their research it is imperative that scientists interact with their audience in an effective and engaging manner, whether in an international conference, a classroom, or indeed down the pub. This work also presents a discussion of how these skills can be developed at an early stage in the careers of a research

  13. Making Sense for Society

    Science.gov (United States)

    van der Heide, J. J.; Grus, M. M.; Nouwens, J. C. A. J.

    2017-09-01

    The Netherlands is a densely populated country. Cities in the metropolitan area (Randstad) will be growing at a fast pace in the coming decades1. Cities like Amsterdam and Rotterdam are being overrun by tourists. Climate change effects are noticed in cities (heavy rains for instance). Call for circular economy rises. Traffic increases. People are more self-reliant. Public space is shared by many functions. These challenges call for smart answers, more specific and directly than ever before. Sensor data is a cornerstone of these answers. In this paper we'll discuss the approaches of Dutch initiatives using sensor data as the new language to live a happy life in our cities. Those initiatives have been bundled in a knowledge platform called "Making sense for society" 1 https://www.cbs.nl/nl-nl/nieuws/2016/37/pbl-cbs-prognose-groei-steden-zet-door (in dutch)

  14. War and society

    Directory of Open Access Journals (Sweden)

    Upeniece V.

    2016-01-01

    Full Text Available A discussion of effects of war on society is desirable as it can stimulate nations and their politicians to refrain in their international and non-international relations from the threat or use of force against the territorial integrity or political independence of the state. The prohibition of the use of force is a valid norm of customary international law and is fixed in the Charter of the United Nations. Any specific use of force can be lawful only if it is based on exceptions of this rule (action of self-defence under the Article 51 or action under specific authorization by the Security Council under Chapter VII. However the main issue is how to ensure that the other states respect this principle of non-use of force.

  15. Behaviorism and Society.

    Science.gov (United States)

    Krapfl, Jon E

    2016-05-01

    A probable list of causes for the limited acceptance of behaviorism in our society is identified. This is followed by a summary review of the proposed solutions identified in other papers in this special issue of The Behavior Analyst, most of which relate to either better marketing of either the behavior analytic process or the results achieved as a consequence. One paper proposes a more broad conception of behavior analysis. This paper endorses the solutions identified in previous papers and then goes on to propose an even more broad conception of behavior analysis and makes the point that behavior analysis is unlikely to flourish unless behavior analysts understand a good deal more about the cultural and other contextual features of the environments in which they work.

  16. Libraries in Society

    DEFF Research Database (Denmark)

    Kristiansson, Michael; Skouvig, Laura

    The purpose of the paper is to investigate the phenomenon of openness in relation to library development. The term openness is presented and related to library development from historical and theoretical perspectives. The paper elaborates on the differences over time on to how openness has been...... understood in a library setting. Historically, openness in form of the open shelves played a crucial role in developing the modern public library. The paper examines this openness-centred library policy as adopted by Danish public libraries in the beginning of the 20th century by applying the theories...... by Michel Foucault on discourse and power to the introduction of open shelves. Furthermore, the paper discusses current challenges facing the modern public library in coping with openness issues that follow from changes in society and advances in technology. These influences and developments are not least...

  17. Advanced information society (1)

    Science.gov (United States)

    Ohira, Gosei

    In considering the relationship of informationization and industrial structure, this paper analize some factors such as information revolution, informationization of industries and industrialization of information as background of informationization of Japanese society. Next, some information indicators such as, information coefficient of household which is a share of information related expenditure, information coefficient of industry which is a share of information related cost to total cost of production, and information transmission census developed by Ministry of Post and Telecommunication are introduced. Then new information indicator by Economic Planning Agency, that is, electronic info-communication indicator is showed. In this study, the information activities are defined to produce message or to supply services on process, stores or sale of message using electronic information equipment. International comparisons of information labor force are also presented.

  18. Reintegrating ghettos into society

    DEFF Research Database (Denmark)

    Mechlenborg, Mette

    2018-01-01

    international regeneration programmes in order to close the socio-economic gap between housing areas and residents. Based on the recent architectural evaluation of social housing renewals for the Danish National Building Foundation (Bech-Danielsen & Mechlenborg 2017) and with a Lefebvrean perspective......In 2010, the Danish government launched a ghetto strategy with 32 initiatives in order to “dissolve parallel communities” in Danish housing areas and to (re)integrate them into Danish society (Statsministeret, 2010). Despite its negative offspring in the Muhammed riots (Freiesleben 2016, Houlind...... 2016), the strategy arguably presented a strategy for revalorization of space and, thereby, a new strategic approach combining social and physical initiatives in order to permanently transform deprived housing areas in a Danish contexts. With the ghetto strategy, Denmark is aligned with similar...

  19. Nuclear Research and Society

    Energy Technology Data Exchange (ETDEWEB)

    Eggermont, G

    2000-07-01

    In 1998, SCK-CEN took the initiative to include social sciences and humanities into its research programme. Within this context, four projects were defined, respectively on sustainability and nuclear development; transgenerational ethics related to the disposal of long-lived radioactive waste; legal aspects and liability; emergency communication and risk perception. Two reflection groups were established, on expert culture and ethical choices respectively, in order to deepen insight while creating exchange of disciplinary approaches of the committed SCK-CEN researchers and social scientists. Within the context of SCK-CEN's social sciences and humanities programme, collaborations with various universities were initiated, teams consisting of young doctorate and post-doctorate researchers and university promotors with experience in interaction processes of technology with society were established and steering committees with actors and external experts were set up for each project. The objectives and main achievements in the four projects are summarised.

  20. Science, Technology and Society

    Science.gov (United States)

    Bridgstock, Martin; Burch, David; Forge, John; Laurent, John; Lowe, Ian

    1998-03-01

    This book provides a comprehensive introduction to the human, social and economic aspects of science and technology. It examines a broad range of issues from a variety of perspectives, using examples and experiences from around the world. The authors present complex issues, including the responsibilities of scientists, ethical dilemmas and controversies, the Industrial Revolution, economic issues, public policy, and science and technology in developing countries. The book ends with a thoughtful and provocative look toward the future. It features extensive guides to further reading, as well as a useful section on information searching skills. This book will provoke, engage, inform and stimulate thoughtful discussion about culture, society and science. Broad and interdisciplinary, it will be of considerable value to both students and teachers.

  1. Afghanistan, state and society

    DEFF Research Database (Denmark)

    Kværnø, Ole

    of both governmental and nongovernmental institutions from more than 20 states. Its theme was to discuss the problems that Afghanistan faces in the wake of the U.S.-led attack on al Qaeda training camps and the Taliban government; examine the challenges confronting the NATO International Security......In June 2007, the RAND Corporation and the Royal Danish Defence College hosted a conference titled “Afghanistan: State and Society, Great Power Politics, and the Way Ahead”. The two-day event, held in Copenhagen, was attended by more than 100 politicians, scholars, academics, and representative...... Assistance Force as it coordinates nation-building activities in Afghanistan; and suggest ways to address these issues. This volume compiles 11 of the papers presented at the conference; themes include the importance of historical precedents, coordination among relevant parties, and the development of an all...

  2. July 2013 Arizona thoracic society notes

    OpenAIRE

    Robbins RA

    2013-01-01

    No abstract available. Article truncated after 150 words. The first Arizona Thoracic Society meeting in Tucson was held on Wednesday, 7/24/2013 at Kiewit Auditorium on the University of Arizona Medical Center campus beginning at 6:30 PM. There were 36 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. Dinner was sponsored by Accredo Health Group. A brief discussion was held of plans to have the December 2013 meeting in Tucson on a weekend as p...

  3. Ancient Hindu Society and Eliot's Ideal Christian Society

    OpenAIRE

    Bhela, Anita

    2012-01-01

    In her article "Ancient Hindu Society and Eliot's Ideal Christian Society" Anita Bhela examines the influence of Hindu thought and Hindu philosophy on T.S. Eliot's critical writings. In The Idea of a Christian Society Eliot gives a hypothetical account of an ideal society that would contribute towards the well-being of all its members, while in Notes towards the Definition of Culture he enumerates the essential conditions needed for the growth and survival of culture. Bhela argues that religi...

  4. Civil Society and Islamism in Iraq | CRDI - Centre de recherches ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    A vibrant civil society sector in some Middle Eastern states has managed over the years to fill a role traditionally held by state institutions, that of providing social services such as health care, education and housing. Islamic civil society organizations have been especially successful in this role, and in doing so have acquired ...

  5. In a Bookless Society, Why Start With Books? | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2010-12-22

    Dec 22, 2010 ... The USAID officer, committed and caring fellow, said to me: "Richard, computers in schools? Uganda is still a bookless society. They need books, not computers!" I had to think about this before replying: "In a bookless society, why start with books?"—a digital variant of Wayne Gretsky's injunction to "skate to ...

  6. A Swedish Mutual Support Society of Problem Gamblers

    Science.gov (United States)

    Binde, Per

    2012-01-01

    Mutual support societies for problem gamblers have existed in Sweden for 20 years. They have helped more people with gambling problems than any other institution inside or outside the Swedish health care system. This paper outlines the background of these societies and describes the meetings of one of them. Data come from interviews with members…

  7. Future mobility in an ageing society : Where are we heading?

    NARCIS (Netherlands)

    Shergold, I.; Lyons, G.; Hubers, C.

    2014-01-01

    The demographic profile of UK society is changing as people live longer. Maintaining the wellbeing and quality of life of an ageing society is set to be extremely challenging. To what extent can the state afford to meet a potentially burgeoning demand for social care? What expectations will be

  8. Future mobility in an ageing society : Where are we heading?

    NARCIS (Netherlands)

    Shergold, I.; Lyons, G.; Hubers, C.G.T.M.

    2015-01-01

    The demographic profile of UK society is changing as people live longer. Maintaining the wellbeing and quality of life of an ageing society is set to be extremely challenging. To what extent can the state afford to meet a potentially burgeoning demand for social care? What expectations will be

  9. November 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2017 Arizona Thoracic Society meeting was held on Wednesday, November 15, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with a lecture followed by case presentations. There were 15 in attendance representing the pulmonary, critical care, sleep, allergy, infectious disease and radiology communities. At the beginning of the meeting several issues were discussed: 1. CME offered by the Southwest Journal of Pulmonary and Critical Care Medicine (SWJPCC is currently offered to only the Southwest state thoracic societies and the Mayo Clinic. After discussion it was felt that this restriction of access was no longer appropriate and CME credits should be available to all. 2. Efforts continue to obtain CME for the Arizona Thoracic Society meetings. Our Chapter Representative, Dr. Gerry Schwartzberg, is approaching this with the American Thoracic Society. Locally, HonorHealth sent out a survey on CME needs. Members were encouraged …

  10. Health care operations management

    NARCIS (Netherlands)

    Carter, M.W.; Hans, Elias W.; Kolisch, R.

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully

  11. The Society for Translational Medicine

    DEFF Research Database (Denmark)

    Gao, Shugeng; Zhang, Zhongheng; Aragón, Javier

    2017-01-01

    The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendati......The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy...

  12. Indicators of Information Society Measurement :

    Directory of Open Access Journals (Sweden)

    Hind Elwy

    2006-09-01

    Full Text Available The indicator of information society describe the infrastructure of information and communication technology ; as well as it’s use and it’s production in different estate of society. The importance economic and social of tic is crescent in modern society. and the presentation of tendency inform above the situation of information society . in this article we want to describe the indicator of tic in Algeria according to librarian’s vision in Mentouri university

  13. Civil Society in Fragile Contexts

    NARCIS (Netherlands)

    Leeuwen, M. van; Verkoren, W.M.

    2014-01-01

    Policies to promote peace in conflict-torn societies increasingly include “civil society (CS) building” as an aim; however, in such settings, it is often difficult – if not impossible – to distinguish between state and society, or between “civil” and “uncivil”. Local legitimacy (representativeness

  14. An updated history of the Teratology Society.

    Science.gov (United States)

    Shepard, Thomas H; Barr, Mason; Brent, Robert L; Hendrickx, Andrew; Kochhar, Devendra; Oakley, Godfrey; Scott, William J; Rogers, John M

    2010-05-01

    The 49-year history of the Teratology Society is reviewed. An abbreviated history is outlined in table form, with listings of the Warkany Lectures, the Continuing Education Courses, and officers of the society. The original article was updated to include the years 2000 to 2010. A year-by-year description of the events is given, including the scientific and social content of the annual meetings and changes in the business of the society, in many cases using comments from the past presidents. The valuable and unique diversity of the members is discussed and illustrated, presenting the disciplines and main research areas of the presidents. The number of submitted abstracts and the various categories are tabulated, averaging the number and type over successive periods. A significant increase in the number of abstracts dealing with epidemiology and developmental biology is evident. The society's development is compared to that of a human, and the question was asked by Shephard et al. (2000): Have we reached the maturational stage of old age or senescence, or is the society still maturing gracefully? This question needs further discussion by all the members. By 2010, many positive changes are happening to revitalize the society. During the past 50 years, we have developed the scientific basis to prevent birth defects caused by rubella, alcoholism, and folate deficiency, as well as other prenatal exposures. We are now taking advantage of advances in many fields to begin shaping the Teratology Society of the 21st century. We must now engage in political battles to obtain the resources needed to conduct further research and to implement prevention programs, as well as to provide care and rehabilitation for persons with birth defects. 2010 Wiley-Liss, Inc.

  15. [ANOREXIA AND BULIMIA: IMPACT ON NETWORK SOCIETY].

    Science.gov (United States)

    Alex Sánchez, María Dolores

    2015-01-01

    The Information and Communication Technologies (ICT) have an increasing influence on the way we relate and in shaping personal identity. The phenomenon of online social networking emerges strongly and contributes to the development of new spaces breaking with the official discourse that marks the scientific evidence on health. This paper analyzes the impact of ICT in relation to the identity of the digital natives and eating disorders (ED). Particular attention to how the network society determines the response of young people in situations of social tension is dedicated. To do this, provides a perspective on the concept of interaction from the analysis of the discourse on anorexia and bulimia in the network, and how to care nurses should consider these factors to improve efficiency and quality in clinical care and patient care.

  16. CERN & Society launches donation portal

    CERN Multimedia

    Cian O'Luanaigh

    2014-01-01

    The CERN & Society programme brings together projects in the areas of education and outreach, innovation and knowledge exchange, and culture and arts, that spread the CERN spirit of scientific curiosity for the inspiration and benefit of society. Today, CERN & Society is launching its "giving" website – a portal to allow donors to contribute to various projects and forge new relationships with CERN.   "The CERN & Society initiative in its embryonic form began almost three years ago, with the feeling that the laboratory could play a bigger role for the benefit of society," says Matteo Castoldi, Head of the CERN Development Office, who, with his team, is seeking supporters and ambassadors for the CERN & Society initiative. "The concept is not completely new – in some sense it is embedded in CERN’s DNA, as the laboratory helps society by creating knowledge and new technologies – but we would like to d...

  17. Contribution of the ethics committee of the French society of intensive care medicine to a scenario for the implementation of organ donation after Maastricht III-type cardiac death in France.

    Science.gov (United States)

    Graftieaux, J-P; Bollaert, P-E; Haddad, L; Kentish-Barnes, N; Nitenberg, G; Robert, R; Villers, D; Dreyfuss, D

    2014-02-01

    French law allows organ donation after death due to cardiocirculatory arrest. In the Maastricht classification, type III non-heart-beating donors are those who experience cardiocirculatory arrest after the withdrawal of life-sustaining treatments. French authorities in charge of regulating organ donation (Agence de la Biomédecine, ABM) are considering organ collection from Maastricht type III donors. We describe a scenario for Maastricht type III organ donation that fully complies with the ethical norms governing care to dying patients. That organ donation may occur after death should have no impact on the care given to the patient and family. The dead-donor rule must be followed scrupulously: the organ retrieval procedure must neither cause nor hasten death. The decision to withdraw life-sustaining treatments, withdrawal modalities, and care provided to the patient and family must adhere strictly to the requirements set forth in patient-rights legislation (the 2005 Léonetti law in France) and should not be influenced in any way by the possibility of organ donation. A major ethical issue regarding the family is how best to transition from discussing treatment-withdrawal decisions to discussing possible organ retrieval for donation should the patient die rapidly after treatment withdrawal. Close cooperation between the healthcare team and the organ retrieval team is crucial to minimize the distress of family members during this transition. Modalities for implementing Maastricht type III organ donation are discussed here, including the best location for withdrawing life-sustaining treatments (operating room or intensive care unit). Copyright © 2014. Published by Elsevier SAS.

  18. Violence in society

    Directory of Open Access Journals (Sweden)

    António Pedro de Andrade Dores

    2014-07-01

    Full Text Available The recent interest in the sociology of violence has arisen at the same time that western societies are being urged to consider the profound social crisis provoked by global financial turmoil. Social changes demand the evo- lution of sociological practices. The analysis herein proposed, based on the studies of M. Wieviorka, La Violence (2005, and of R. Collins, Violence: A Micro-sociological Theory (2008, concludes that violence is subject to sociological treatments cen- tered on the aggressors, on the struggles for power and on male gender. There is a lack of connection between prac- tical proposals for violence prevention and the sociol- ogy of violence. It is accepted that violence as a subject of study has the potential, as well as the theoretical and social centrality, to promote the debate necessary to bring social theory up to date. This process is more likely to oc- cur in periods of social transformation, when sociology is open to considering subjects that are still taboo in its study of violence, such as the female gender and the state. The rise of the sociology of violence confronts us with a dilemma. We can either collaborate with the construc- tion of a sub discipline that reproduces the limitations and taboos of current social theory, or we can use the fact that violence has become a “hot topic” as an opportunity to open sociology to themes that are taboo in social the- ory (such as the vital and harmonious character of the biological aspects of social mechanisms or the normative aspects of social settings. ResumenEl interés reciente en la sociología de la violencia ha surgido al mismo tiempo que las sociedades occidenta- les están requiriendo considerar la profunda crisis social provocada por la agitación financiera global. Los cambios sociales demandan la evolución de las prácticas socioló- gicas. El análisis aquí expuesto, basado en los estudios de M. Wieviorka, La Violence (2005, and of R. Collins

  19. [GEIPC-SEIMC (Study Group for Infections in the Critically Ill Patient of the Spanish Society for Infectious Diseases and Clinical Microbiology) and GTEI-SEMICYUC ( Working Group on Infectious Diseases of the Spanish Society of Intensive Medicine, Critical Care, and Coronary Units) recommendations for antibiotic treatment of gram-positive cocci infections in the critical patient].

    Science.gov (United States)

    Astigarraga, P M Olaechea; Montero, J Garnacho; Cerrato, S Grau; Colomo, O Rodríguez; Martínez, M Palomar; Crespo, R Zaragoza; García-Paredes, P Muñoz; Cerdá, E Cerdá; Lerma, F Alvarez

    2007-01-01

    In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.

  20. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings – Guideline of the German Society for Hospital Hygiene (DGKH

    Directory of Open Access Journals (Sweden)

    Külpmann, Rüdiger

    2016-02-01

    Full Text Available Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems in hospitals” ( in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  1. Science communication at scientific societies.

    Science.gov (United States)

    Braha, Jeanne

    2017-10-01

    Scientific societies can play a key role in bridging the research and practice of scientists' engagement of public audiences. Societies are beginning to support translation of science communication research, connections between scientists and audiences, and the creation of opportunities for scientists to engage publics without extensive customization. This article suggests roles, strategies, and mechanisms for scientific societies to promote and enhance their member's engagement of public audiences. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. May 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-06-01

    Full Text Available No abstract available. Article truncated after first 150 words. The May 2014 Arizona Thoracic Society meeting was held on Wednesday, 5/28/2014 at Scottsdale Shea Hospital beginning at 6:30 PM. There were 13 in attendance representing the pulmonary, critical care, sleep and radiology communities. A discussion was held regarding the Arizona Thoracic Society relationship with the American Lung Association. Several members volunteered to talk to the lung association regarding common ground to strengthen the relationship. The wine tasting with the California, New Mexico and Colorado Thoracic Societies at the American Thoracic Society International Meeting was a big success. There were about 55 at the meeting. The tasting will probably be held again next year. At the ATS meeting data was presented that pirfenidone was effective in reducing the progression of idiopathic pulmonary fibrosis (IPF. The data was published in the New England Journal of Medicine on 8/29/14 (1. Lewis Wesselius is one of the investigators enrolling patients in a phase ...

  3. April 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated at 150 words. The April 2014 Arizona Thoracic Society meeting was held on Wednesday, 4/23/2014 at Scottsdale Shea Hospital beginning at 6:30 PM. There were 15 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. It was announced that there will be a wine tasting with the California, New Mexico and Colorado Thoracic Societies at the American Thoracic Society International Meeting. The tasting will be led by Peter Wagner and is scheduled for the Cobalt Room in the Hilton San Diego Bayfront on Tuesday, May 20, from 4-8 PM. Guideline development was again discussed. The consensus was to await publication of the IDSA Cocci Guidelines and respond appropriately. George Parides, Arizona Chapter Representative, gave a presentation on Hill Day. Representatives of the Arizona, New Mexico and Washington Thoracic Societies met with their Congressional delegations, including Rep. David Schweikert, to discuss the Cigar Bill, NIH funding, and the Medicare Sustainable Growth ...

  4. April 2013 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-04-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on Wednesday, 4/24/2013 at Scottsdale Shea beginning at 6:30 PM. There were 13 in attendance representing the pulmonary, critical care, sleep, infectious disease, and radiology communities. Drs. Gotway and August, thoracic radiologists, were both unable to attend. Dr. Tilman Kolesch from Maricopa more than capably filled in as our radiologist. The meeting was preceded by a discussion on Pharma and the availability of physicians who accept money, including dinners, from pharmaceutical companies. The Arizona Thoracic Society is sponsored by pharmaceutical companies. Ken Knox asked if Arizona Thoracic Society meetings could be held in Tucson during July and December, the two months meetings have not been scheduled. The attendees enthusiastically endorsed this expansion of the Arizona Thoracic Society meetings. In addition, Dr. Knox wishes to sponsor a winter symposium in Tucson in collaboration with the Arizona Thoracic Society. The attendees also enthusiastically endorsed this meeting. Four …

  5. Digital Denmark: From Information Society to Network Society

    DEFF Research Database (Denmark)

    Henten, Anders; Falch, Morten

    2000-01-01

    for a welfare society. However, globalisation and the spreading use of new information and communication technologies and services challenge this position. This article examines Denmark's performance in implementing its IS 2000 plans, the background to the Digital Denmark report, and its implications......The Danish Government recently issued a new policy report, Digital Denmark, on the "conversion to a network society", as a successor to its Information Society 2000 report (1994). This is part of a new round of information society policy vision statements that are, or will be forthcoming from...... national governments everywhere. Denmark provides an interesting case study because it ranks high in the benchmark indicators of information network society developments. This position has been obtained largely by public sector initiatives and without erosion of the highly reputed Scandinavian model...

  6. Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology.

    Science.gov (United States)

    Alexander, Karen P; Newby, L Kristin; Cannon, Christopher P; Armstrong, Paul W; Gibler, W Brian; Rich, Michael W; Van de Werf, Frans; White, Harvey D; Weaver, W Douglas; Naylor, Mary D; Gore, Joel M; Krumholz, Harlan M; Ohman, E Magnus

    2007-05-15

    Age is an important determinant of outcomes for patients with acute coronary syndromes (ACS); however, community practice reveals a disproportionately lower use of cardiovascular medications and invasive treatment even among elderly patients with ACS who would stand to benefit. Reasons include limited trial data to guide the care of older adults and uncertainty about benefits and risks, particularly with newer medications or invasive treatments and in the setting of advanced age or complex health status. This 2-part American Heart Association scientific statement summarizes evidence on patient heterogeneity, clinical presentation, and treatment of non-ST-elevation ACS in relation to age ( or = 85 years). In addition, we review methodological issues that influence the acquisition and application of evidence to the elderly patients treated in community practice. A writing group combining international cardiovascular and geriatric perspectives convened to summarize available data from trials (5 combined Virtual Coordinating Center for Global Collaborative Cardiovascular Research [VIGOUR] trials) and 3 registries (Global Registry of Acute Coronary Events, National Registry of Myocardial Infarction, and the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association guidelines national quality improvement initiative [CRUSADE]) to provide a conceptual framework for future work in the care of the elderly with acute cardiac disease. Treatment for non-ST-segment-elevation ACS (Part I) and ST-segment-elevation myocardial infarction (Part II) are reviewed. In addition, ethical considerations pertaining to acute care and secondary prevention are considered (Part II). The primary goal is to identify the areas in which sufficient evidence is available to guide practice, as well as to determine areas that warrant further study. Although treatment-related benefits

  7. March 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated after 150 words. The March 2014 Arizona Thoracic Society meeting was a special meeting. In conjunction with the Valley Fever Center for Excellence and the Arizona Respiratory Center the Eighteenth Annual Farness Lecture was held in the Sonntag Pavilion at St. Joseph's Hospital at 6 PM on Friday, April 4, 2014. The guest speaker was Antonio "Tony" Catanzaro, MD from the University of California San Diego and current president of the Cocci Study Group. There were 57 in attendance representing the pulmonary, critical care, sleep, and infectious disease communities. After opening remarks by Arizona Thoracic Society president, Lewis Wesselius (a former fellow under Dr. Catanzaro at UCSD, John Galgiani, director of the Valley Fever Center for Excellence, gave a brief history of the Farness lecture before introducing Dr. Catanzaro. The lecture is named for Orin J. Farness, a Tucson physician, who was the first to report culture positive coccidioidomycosis (cocci or Valley Fever. ...

  8. Materials and society -- Impacts and responsibilities

    Energy Technology Data Exchange (ETDEWEB)

    Westwood, A.R.C.

    1995-11-01

    The needs of today`s advanced societies have moved well beyond the requirements for food and shelter, etc., and now are focused on such concerns as international peace and domestic security, affordable health care, the swift and secure transmission of information, the conservation of resources, and a clean environment. Progress in materials science and engineering is impacting each of these concerns. This paper will present some examples of how this is occurring, and then comment on ethical dilemmas that can arise as a consequence of technological advances. The need for engineers to participate more fully in the development of public policies that help resolve such dilemmas, and so promote the benefits of advancing technology to society, will be discussed.

  9. How and when to refer patients diagnosed with secondary headache and other craniofacial pain in the Emergency Department and Primary Care: Recommendations of the Spanish Society of Neurology's Headache Study Group.

    Science.gov (United States)

    Gago-Veiga, A B; Díaz de Terán, J; González-García, N; González-Oria, C; González-Quintanilla, V; Minguez-Olaondo, A; Santos-Lasaosa, S; Viguera Romero, J; Pozo-Rosich, P

    2017-09-01

    When secondary headache is suspected and the patient is referred to the emergency department or to the outpatient neurology clinic, it is important to know which are the appropriate complementary examinations to perform and the suitable referral pathway for patients to follow. In order to establish recommendations on this matter, the Spanish Society of Neurology's Headache Study Group (GECSEN) has decided to issue a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgias. Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with GECSEN's Executive Committee. For practical reasons, the document was divided into 2 articles: the first focuses on primary headaches and craniofacial neuralgias and this second article on secondary headaches and other craniofacial pain. In order for the recommendations to be helpful for daily practice, they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists. We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  10. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings - Guideline of the German Society for Hospital Hygiene (DGKH).

    Science.gov (United States)

    Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo

    2016-01-01

    Since the publication of the first "Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals" (http://www.krankenhaushygiene.de/informationen/fachinformationen/leitlinien/12) in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section "Ventilation and air conditioning technology" attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  11. [Living in a Temporary Society.

    Science.gov (United States)

    Bennis, Warren G.

    Society is in the process of accelerated change and the institutionalization of this change through research and technology. Other factors affecting American society are an increase in affluence, an elevation of the educational level of the population, and a growing interdependence of institutions. The fact that this country is currently going…

  12. The governance of cooperative societies

    Directory of Open Access Journals (Sweden)

    Yaiza Juanes Sobradillo

    2005-12-01

    Full Text Available The present work aims to expose the appropriate legislation for cooperative societies to which Article 129 of the Spanish Constitution refers, deepen the analysis of the organs of management and control based on the Spanish and Basque Laws on Cooperatives and the Statute for the European Cooperative Societies.

  13. Public Libraries in postindustrial societies

    DEFF Research Database (Denmark)

    Elbeshausen, Hans

    2015-01-01

    The article’s focus is on how public libraries are affected by structural changes in the wake of the transition to the knowledge society. Their attempts to match the knowledge society are illustrated by processes of sensemaking and sensegiving made in public libraries in Canada, the UK and Denmark....

  14. What is the Knowledge Society?

    Directory of Open Access Journals (Sweden)

    Marin Dinu

    2008-02-01

    Full Text Available This study sets out to establish conceptual delimitations, more concordant to the theoretical acquisitions with regard to the knowledge society. The author considers it opportune to situate in the center of the definition of the concept of knowledge society the problem of prevalence in the typology of resources. Thus, the knowledge society appears as a form of organization in which scientific knowledge predominates, be that informatics as well. The concordances of essence are discovered through the discerning of the functional relationship knowledge society – global society. In the spectrum of meanings specific to this highway of post-postmodernist configuration of the world, the priorities of the project of the second modernity – the paradigmatic matrix of globalization – are approached. In fact, the study argues in favor of refocusing globalization on the humane, on its distinctive values which substantiate and lend sense to the evolutions of the world. Postreferentiality is the rational expression of humanity coming back to itself.

  15. An Official American Thoracic Society Research Statement

    DEFF Research Database (Denmark)

    Slatore, Christopher G; Horeweg, Nanda; Jett, James R

    2015-01-01

    : In this research statement from the American Thoracic Society, a multidisciplinary group of clinicians, researchers, and patient advocates reviewed available evidence for pulmonary nodule evaluation, characterized six focus areas to direct future research efforts, and identified fundamental gaps in knowledge...... for identifying cancerous nodules. Before they are used in clinical practice, however, better evidence is needed to show that they improve more distal outcomes of importance to patients. In addition, the pace of research and the quality of clinical care would be improved by the development of registries that link...

  16. International Skeletal Society outreach 2013: Rwanda.

    Science.gov (United States)

    Teh, James; Taljanovic, Mihra S; Monu, Johnny

    2014-05-01

    It has been almost 20 years since the horrific events of the Rwandan genocide. Since that time, the country has made a remarkable recovery owing to good government and a great deal of aid. Health-care services are well organized, but remain short of resources and expertise. Musculoskeletal imaging (and treatment) is in its infancy. Given the huge strides that have been made in social order and stability, there is great hope for the future. It is proposed that future International Skeletal Society (ISS) outreach programs plan to make a meaningful commitment to developing expertise in specific hospitals.

  17. Withholding and withdrawing dialysis in the intensive care unit: benefits derived from consulting the renal physicians association/american society of nephrology clinical practice guideline, shared decision-making in the appropriate initiation of and withdrawal from dialysis.

    Science.gov (United States)

    Patel, Samir S; Holley, Jean L

    2008-03-01

    Despite advances in the technology of dialysis, mortality in patients who develop acute renal failure remains high. Scoring systems have been developed to improve the ability to define prognosis in seriously ill patients with acute renal failure but predicting outcomes for individual patients is uncertain. Decisions to withhold or withdraw dialysis in seriously ill patients are difficult for patients, families, and health care providers. The clinical practice guideline, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis, provides evidence-based recommendations to aid nephrologists in discussions and the process of medical decision-making about starting and stopping dialysis. Estimating prognosis and addressing the issues of advance directives and patient and family preferences through the process of shared decision-making can clarify appropriate strategies for clinical management and interventions. Time-limited trials of dialysis may be an invaluable tool in this process. Increasing nephrologists' awareness of the guideline may facilitate decision-making around the issues of withholding and withdrawing dialysis in part by clarifying patients and situations in which it may be appropriate to withhold or withdraw dialysis.

  18. Guidelines and checklists for short-term missions in global pediatric surgery: Recommendations from the American Academy of Pediatrics Delivery of Surgical Care Global Health Subcommittee, American Pediatric Surgical Association Global Pediatric Surgery Committee, Society for Pediatric Anesthesia Committee on International Education and Service, and American Pediatric Surgical Nurses Association, Inc. Global Health Special Interest Group.

    Science.gov (United States)

    Butler, Marilyn; Drum, Elizabeth; Evans, Faye M; Fitzgerald, Tamara; Fraser, Jason; Holterman, Ai-Xuan; Jen, Howard; Kynes, J Matthew; Kreiss, Jenny; McClain, Craig D; Newton, Mark; Nwomeh, Benedict; O'Neill, James; Ozgediz, Doruk; Politis, George; Rice, Henry; Rothstein, David; Sanchez, Julie; Singleton, Mark; Yudkowitz, Francine S

    2017-11-15

    Pediatric surgeons, anesthesia providers, and nurses from North America and other high-income countries (HICs) are increasingly engaged in resource-limited areas, with short-term missions (STMs) as the most common form of involvement. However, consensus recommendations currently do not exist for STMs in pediatric general surgery and associated perioperative care. The American Academy of Pediatrics (AAP) Delivery of Surgical Care Subcommittee and American Pediatric Surgical Association (APSA) Global Pediatric Surgery Committee, with the American Pediatric Surgical Nurses Association, Inc. (APSNA) Global Health Special Interest Group, and the Society for Pediatric Anesthesia (SPA) Committee on International Education and Service generated consensus recommendations for STMs based on extensive experience with STMs. Three distinct, but related areas were identified: 1) Broad goals of surgical partnerships between HICs- and low and middle-income countries (LMICs). A previous set of guidelines published by the Global Paediatric Surgery Network Collaborative (GPSN), was endorsed by all groups; 2) Guidelines for the conduct of STMs were developed, including planning, in-country perioperative patient care, post-trip follow-up, and sustainability; 3) travel and safety considerations critical to STM success were enumerated. A diverse group of stakeholders developed these guidelines for STMs in LMICs. These guidelines may be a useful tool to ensure safe, responsible, and ethical STMs given increasing engagement of HIC providers in this work. 5. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Earthquake science in resilient societies

    Science.gov (United States)

    Stahl, T.; Clark, M. K.; Zekkos, D.; Athanasopoulos-Zekkos, A.; Willis, M.; Medwedeff, William; Knoper, Logan; Townsend, Kirk; Jin, Jonson

    2017-04-01

    Earthquake science is critical in reducing vulnerability to a broad range of seismic hazards. Evidence-based studies drawing from several branches of the Earth sciences and engineering can effectively mitigate losses experienced in earthquakes. Societies that invest in this research have lower fatality rates in earthquakes and can recover more rapidly. This commentary explores the scientific pathways through which earthquake-resilient societies are developed. We highlight recent case studies of evidence-based decision making and how modern research is improving the way societies respond to earthquakes.

  20. Safety management of the patient with tracheostomy from a critical care unit.

    Directory of Open Access Journals (Sweden)

    Marleny CASASOLA-GIRÓN

    2017-11-01

    Full Text Available Introduction and objectives: A patient with a tracheostomy has a high morbidity and mortality when comes to a general ward from the critical care unit. This situation has led us to develop a quality and safety program, in order to improve care and reduce the number of incidents that could endanger his life.Methodology: Adapting to our environment the recommendations of literature, the program is composed of four elements: standardized information, training of the staff involved, patient follow up and general scheme.Results: The elaborate documentation, offers the way of assessing a patient with tracheostomy, and carry out its assistance. Through interactive workshops, this information is transmitted to the staff responsible for these patients. The periodic inspection by an Otolaryngologist (ENT, an ENT nurse and an intensive care physicians, allows to register the clinical situation and possible complications, applying specific protocols of decannulation and swallowing. Finally we add a set of general rules, in order to decrease variability.Discussion: The multidisciplinary care in the patient with a tracheostomy is a complex intervention where the lack of previous data, the important number of neurocritically ill patients, the multiplicity of general wards that can accommodate these patients and its clinical diversity, make difficult proper monitoring.Conclusions: We are confident that this project can reach its goals, improving the quality and safety of patient carrier of a tracheal cannula.

  1. New York Zoological Society Library.

    Science.gov (United States)

    Johnson, Steven P.

    1988-01-01

    Describes the institutional setting, history, and services of the New York Zoological Society Library. Topics covered include clientele; library collections and special collections; library staffing and organizational structure; computer applications; and relationships with other libraries. (11 references) (CLB)

  2. The Ambivalences of Civil Society

    Directory of Open Access Journals (Sweden)

    Henrik Kaare Nielsen

    2008-07-01

    Full Text Available This article discusses the conceptual heterogeneity in the field of ‘civil society’ in the light of a distinction between positions that reflect civil society as a democratic-emancipatory category and positions that consider civil society from the perspective of the state: as an instrumental resource for the technocratic planning of the competitive nation state.The article discusses the implications and perspectives in these two different strategic scenarios for conceptualizing civil society. The argument is made that civil society in relation to democratic citizenship should basically rather be understood as a concept for specific, communicative principles for institutionalizing societal relations and organizing public experience than as an overall concept for third sector organizations.

  3. School in the knowledge society

    DEFF Research Database (Denmark)

    Sørensen, Birgitte Holm; Levinsen, Karin

    2011-01-01

      Implementation of ICT in Danish and Nordic schools gradually moves from an industrial towards an emerging knowledge society school paradigm. Simultaneously it, digital literacy and the school's physical and social organization are constantly negotiated. In schools that proactively meet the chal......  Implementation of ICT in Danish and Nordic schools gradually moves from an industrial towards an emerging knowledge society school paradigm. Simultaneously it, digital literacy and the school's physical and social organization are constantly negotiated. In schools that proactively meet...... the challenges new designs for teaching and learning emerge while teacher-student relations transform and the children and young people's competencies are resources in the processes of learning. The chapter present research based on the proactive schools and exemplifies possible outlines of the school...... in the knowledge society. Finally the findings are extrapolated into a vision of the future local global school in the knowledge society....

  4. Science in Society in Europe

    DEFF Research Database (Denmark)

    Mejlgaard, Niels; Bloch, Carter Walter

    2012-01-01

    This paper introduces a special section of Science and Public Policy on science in society in Europe. Based on extensive data collected for the Monitoring Policy and Research Activities on Science in Society in Europe (MASIS) project, contributions to this special section explore pertinent issues...... related to the location, role and responsibility of science across EU member states and associated countries. By developing analytical typologies and classifying countries, the collection of papers provides a novel and detailed picture of Europe. It reveals considerable variation regarding...... the interactions of science and society at the national level, and it offers a platform for international learning. The identification of patterns and trends concerning the place of science in society may also feed into emerging European discussions about ‘responsible research and innovation’....

  5. Risk society and amoral morality

    Directory of Open Access Journals (Sweden)

    Nedeljković Radica M.

    2017-01-01

    Full Text Available The modern world is the world of change. Modernity changed all aspects of life in width and depth. The changes are so fast and so many people have impression that they are trapped in a multitude of events that they cannot understand nor control. Instead of society as a system, we are talking about society as a network of different relationships of individuals and social groups. Instead of a harmonious society as a space in which the man resides, developing their potential and needs, we are talking about society as a threatening force that destroys everything in its way as 'Moloch' (Giddens, the 'risk society' (Beck in which the doctrine produced in equal measure the conditions for prosperity, but also the risks and destruction; the simulation of society (Baudrillard which glorifies lies and deceit. Instead of society as a community, we are talking about the disappearance of society (Popper. Can we, therefore, rationally understand and express the world, the world of modernity; this world of profound change resembles the maze in which we are lost and wandering without meaning? Starting with Ulrich Beck and his theory of the risk society, the author points out that the way in which the western civilization started, which is imposed as a mandatory form for the rest of the world, leads to amoral morality. The ideology of progress, which is irrational and without a clear vision and clearly defined values, pushes us into an uncertain future of numerous risks and ever growing individualism. Thus we come to the conviction that without common values, collective values, we are lost in this world of risk. Solidarity and trust are the key values for the stable community, but they are non-existent in the risk society dominated by individualism. In the period of uncertainty in the risk society, only religion provides a healthy basis for communal living. Therefore, the way out of the crisis is not in politics, which is placed at the service of the economy, but

  6. Educating for Democratic Societies: Impediments

    OpenAIRE

    Stephen LAFER; Aydin, Hasan

    2012-01-01

    The paper offers a robust definition of democracy that focuses upon the decision making processes of democratic societies that are dependent on the ability and willingness of citizens to enter into a democratic dialectic in which informed opinions contend with one another in the public forum so that the best possible decisions can be made in regard to public policy and action. Opinion, informed and justified in reason, is to be respected in such societies and cultivated through a proper syste...

  7. Towards a cyber secure society

    CSIR Research Space (South Africa)

    Labuschagne, WA

    2012-10-01

    Full Text Available Secure Society 4th Biennial Conference Presented by WA Labuschagne 9 October 2012 ? CSIR 2012 Slide 2 Critical Infrastructure ?Describe assets that are essential for the functioning of a society and economy (Wikipedia) ? CSIR 2012 Slide 3... in Bahrain Syria ? CSIR 2012 Slide 12 What is possible ? CSIR 2012 Slide 13 Cyber Defence Areas ? CSIR 2012 Slide 14 Network Attack Prediction Security Awareness Social Engineering Network Attack Prediction ? CSIR 2012 Slide 15 Network Attack...

  8. Finnish Society of Soil Sciences

    Science.gov (United States)

    Rankinen, Katri; Hänninen, Pekka; Soinne, Helena; Leppälammi-Kujansuu, Jaana; Salo, Tapio; Pennanen, Taina

    2017-04-01

    In 1998 the organization of the International Union of Soil Sciences (IUSS) was renewed to better support national activities. That was also the new start in the operation of the Finnish Society of Soil Sciences, which became affiliated to the IUSS. The society was originally established in 1971 but it remained relatively inactive. Currently, there are around 200 members in the Finnish Society of Soil Sciences. The members of the executive board cover different fields of soil science from geology to microbiology. Mission statement of the society is to promote the soil sciences and their application in Finland, to act as a forum for creation of better links between soil scientists, interested end users and the public, and to promote distribution and appreciation of general and Finnish research findings in soil science. Every second year the society organizes a national two-day long conference. In 2017 the theme 'circular economy' collected all together 57 presentations. The members of the incoming student division carried responsibility in practical co-ordination committee, acting also as session chairs. In the intervening years the society organizes a weekend excursion to neighboring areas. Lately we have explored the use of biochar in landscaping of Stockholm.

  9. Disability, family and society: new thinking of an old debate.

    Science.gov (United States)

    Goldson, Edward

    2016-10-01

    The debate about disability, family and society is an old one. The needs of individuals with disabilities have not been a priority in most societies. However, this population is increasing with the advances in our medical technology and we can no longer ignore them. Overall care, from diagnosis to treatment and integration into society has been fragmented and disorganized. Thus, new thinking about individuals with disabilities has to take place. This article suggests the need for a paradigm shift has to how individuals with disabilities should be viewed and suggests a different model for the development of systems to meet the needs of this growing population.

  10. Society for Academic Emergency Medicine Statement on Plagiarism.

    Science.gov (United States)

    Asher, Shellie L; Iserson, Kenneth V; Merck, Lisa H

    2017-10-01

    The integrity of the research enterprise is of the utmost importance for the advancement of safe and effective medical practice for patients and for maintaining the public trust in health care. Academic societies and editors of journals are key participants in guarding scientific integrity. Avoiding and preventing plagiarism helps to preserve the scientific integrity of professional presentations and publications. The Society for Academic Emergency Medicine (SAEM) Ethics Committee discusses current issues in scientific publishing integrity and provides a guideline to avoid plagiarism in SAEM presentations and publications. © 2017 by the Society for Academic Emergency Medicine.

  11. Teaching leadership: the medical student society model.

    Science.gov (United States)

    Matthews, Jacob H; Morley, Gabriella L; Crossley, Eleanor; Bhanderi, Shivam

    2017-05-05

    All health care professionals in the UK are expected to have the medical leadership and management (MLM) skills necessary for improving patient care, as stipulated by the UK General Medical Council (GMC). Newly graduated doctors reported insufficient knowledge about leadership and quality improvement skills, despite all UK medical schools reporting that MLM is taught within their curriculum. A medical student society organised a series of extracurricular educational events focusing on leadership topics. The society recognised that the events needed to be useful and interesting to attract audiences. Therefore, clinical leaders in exciting fields were invited to talk about their experiences and case studies of personal leadership challenges. The emphasis on personal stories, from respected leaders, was a deliberate strategy to attract students and enhance learning. Evaluation data were collected from the audiences to improve the quality of the events and to support a business case for an intercalated degree in MLM. When leadership and management concepts are taught through personal stories, students find it interesting and are prepared to give up their leisure time to engage with the subject. Students appear to recognise the importance of MLM knowledge to their future careers, and are able to organise their own, and their peers', learning and development. Organising these events and collecting feedback can provide students with opportunities to practise leadership, management and quality improvement skills. These extracurricular events, delivered through a student society, allow for subjects to be discussed in more depth and can complement an already crowded undergraduate curriculum. Newly graduated doctors reported insufficient knowledge about leadership and quality improvement skills. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  12. Is society of knowledge a new type of society

    Directory of Open Access Journals (Sweden)

    Avramović Zoran

    2008-01-01

    Full Text Available In the article author critical examines concept of society of knowledge as a new type of social whole. In keeping with the lines of leading theoretician in this field Peter Drucker. author gives main characteristic of this social type: employment, competition, mobility, organization as a locus of realization of knowledge, longlife learning, educated person. In the second part author maintains in favor of knowledge as a structural factor of every social form in the history. Concluding part contains main critical estimation that knowledge can not be taken as a typological trait for new type of society.

  13. [2013: The Seville document on consensus on the alternatives to allogenic blood transfusion. Update to the Seville document. Spanish Societies of Anaesthesiology (SEDAR), Haematology and Haemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Haemostasis (SETH) and Blood Transfusion (SETS)].

    Science.gov (United States)

    Leal-Noval, S R; Muñoz, M; Asuero, M; Contreras, E; García-Erce, J A; Llau, J V; Moral, V; Páramo, J A; Quintana, M

    2013-01-01

    As allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to TSA (AABT) have emerged, but there is a huge variability with respect to their indications and appropriate use. This variability results from the interplay of a number of factors, which include physicians specialty, knowledge and preferences, degree of anaemia, transfusion policy, and AABT availability. Since the ABBT are not harmless and may not meet costeffectiveness criteria, such avariability is unacceptable. The Spanish Societies of Anaesthesiology (SEDAR), Haematology and Haemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Haemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these six Societies have conducted a systematic review of the medical literature and developed the «2013. Seville Document of Consensus on Alternatives to Allogeneic Blood Transfusion», which only considers those AABT aimed to decrease the transfusion of packed red cells. The AABTs are defined as any pharmacological and non-pharmacological measure aimed to decrease the transfusion of of red blood cell concentrates, while preserving the patient safety. For each AABT, the main question is formulated, positively or negatively, as: «Does or does not this particular AABT reduce the transfusion rate?» All the recommendations on the use of AABTs were formulated according to the GRADE (Grades of Recommendation Assessment, Development and Evaluation) methodology. Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.

  14. Parameters of care for craniosynostosis

    DEFF Research Database (Denmark)

    Vargervik, Karin; Rubin, Marcie S; Grayson, Barry H

    2012-01-01

    A multidisciplinary conference was convened in March 2010 with the charge to develop parameters of care for patients with craniosynostosis. The 52 participants represented 16 medical specialties and 16 professional societies. Herein, we present the dental, orthodontic, and surgical care recommend......A multidisciplinary conference was convened in March 2010 with the charge to develop parameters of care for patients with craniosynostosis. The 52 participants represented 16 medical specialties and 16 professional societies. Herein, we present the dental, orthodontic, and surgical care...

  15. Creonization of health care.

    Science.gov (United States)

    Bulger, R J

    1990-01-01

    As prefigured in the Greek tragedy Antigone, one of the primary conflicts in contemporary health care is that between humane concern for the individual and concern for society at large and administrative rules. The computerization of the health care system and development of large data bases will create new forms of this conflict that will challenge the self-definition of health care and health care professionals.

  16. Europeanizing civil society: how the EU shapes civil society organizations

    NARCIS (Netherlands)

    Sanchez Salgado, R.

    2014-01-01

    The European Union (EU) has clearly made a difference for Civil Society Organizations (CSOs). EU officials and European political entrepreneurs have been crucial in the promotion of funding and access opportunities, but they have been proven to have little capacity to create CSOs from scratch or to

  17. Civil society, political society and politics of disorder in Cambodia

    NARCIS (Netherlands)

    Arnold, D.

    This paper questions under what conditions the social foundation necessary for the construction and sustenance of civil society are present in post-colonial social formations, and the extent to which there has been a need to develop concessionary politics to maintain a project of rule. It utilizes

  18. Caring for Pierced Ears

    Science.gov (United States)

    ... benefits Become a member DermCare Team Professionalism and ethics My account Member directory Publications JAAD JAAD Case ... SkinPAC State societies Scope of practice Truth in advertising Public and patients SPOT Skin Cancer™ Community programs & ...

  19. A atenção e o cuidado à gravidez na adolescência nos âmbitos familiar, político e na sociedade: uma revisão da literatura Assistance and care provided for teenage pregnancies in the family, in public policies and in the society: a literature review

    Directory of Open Access Journals (Sweden)

    Juliane Pariz

    2012-09-01

    Full Text Available O presente trabalho pretendeu analisar a questão da gravidez na adolescência, observando o modo como família, política e sociedade têm cuidado dessas jovens. Para tanto, foi realizada uma revisão sistemática da literatura científica nacional com acesso livre nas principais bases de dados entre os anos de 1998 a 2008. Os resultados apontaram dificuldades de comunicação entre cada uma das três esferas estudadas e as adolescentes, fato que vem acarretando um déficit na orientação dos adolescentes que não têm encontrado, na família, na sociedade ou nas políticas públicas a clareza necessária para fazer escolhas mais conscientes e assertivas. Além disso, muitos estudos têm sugerido estratégias de enfrentamento em relação a engravidar durante a adolescência, mas esses achados não têm sido traduzidos em ações ou projetos. Percebe-se que, tanto a adolescência quanto a gravidez nessa etapa da vida, ainda ocupam um lugar confuso na família, política e sociedade e pode-se dizer que, no Brasil, também não está claro o papel de cada uma dessas esferas para atender e cuidar dessa população.The present article intends to analyze teenage pregnancies observing the ways in which families, policies and society have been taking care of these young women. To achieve this, a systematic review of the national scientific literature was carried out, and the main databases were accessed between the years of 1998 and 2008. The results showed that communication was difficult between each of the three studied spheres and the adolescents, a fact that has produced a deficit in the orientation of these young women, who have not been finding in their family, in society or in public policies, the clarity they need in order to make conscientious and assertive choices. Furthermore, many studies have suggested coping strategies to face difficulties related to teenage pregnancies, although few of the findings have been applied to real actions or

  20. Inequality in nature and society.

    Science.gov (United States)

    Scheffer, Marten; van Bavel, Bas; van de Leemput, Ingrid A; van Nes, Egbert H

    2017-12-12

    Most societies are economically dominated by a small elite, and similarly, natural communities are typically dominated by a small fraction of the species. Here we reveal a strong similarity between patterns of inequality in nature and society, hinting at fundamental unifying mechanisms. We show that chance alone will drive 1% or less of the community to dominate 50% of all resources in situations where gains and losses are multiplicative, as in returns on assets or growth rates of populations. Key mechanisms that counteract such hyperdominance include natural enemies in nature and wealth-equalizing institutions in society. However, historical research of European developments over the past millennium suggests that such institutions become ineffective in times of societal upscaling. A corollary is that in a globalizing world, wealth will inevitably be appropriated by a very small fraction of the population unless effective wealth-equalizing institutions emerge at the global level. Copyright © 2017 the Author(s). Published by PNAS.

  1. Social Power, Law and Society

    Directory of Open Access Journals (Sweden)

    Saulo Casali Bahia

    2016-10-01

    Full Text Available The article aims to discuss some aspects of the formal centers of social power. Thus, it seeks to answer how power becomes institutionalized in formal social organizations; what is the source of political power and how it is converted into institutions of governance; how legal power is generated by society and how it grows; what is the relationship between legal power and those who are governed; what is the role of the legal system and human rights in fostering the distribution of social power; and how a society has enhanced access to and equitable distribution of power in recent centuries.

  2. Broadband society and generational changes

    CERN Document Server

    Colombo, Fausto

    2011-01-01

    The role generations play in accepting and shaping digital technologies, and possibly vice versa, is an increasingly relevant issue in contemporary society. For the first time in the academic debate, this volume outlines the theoretical issues and explores some results from empirical researches on the relationship between generations and the media in digital society. The first part of the book deals with the theoretical debate on generations, from Mannheim's to the revisiting of some classical notions shaped by disciplines as history, demography, marketing and sociology. The second part gather

  3. The Cardiovascular Society in the GDR (German Democratic Republic).

    Science.gov (United States)

    Pfeiffer, D

    2002-01-01

    The "Society of Cardiology and Angiology of the German Democratic Republic (GDR)" was the substitute for the "German Cardiac Society" between 1965 and 1992 in Eastern Germany, when the closed borders (since 1961) pevented free private and official communications. The society experienced 12 elections for the board, it had 792 members in 1989, several working groups and organized 14 cardiovascular congresses and hundreds of meetings. The society was very active in education of physicians and assistance personnel and developed an educational program for specialists in cardiology and angiology in 1977. The society supported the foundation of heart centers and the centralized long-term care of patients with heart failure, arrhythmias, congenital defects, pacemakers or peripheral arterial disease. Scientific results as transvasal closure of the ductus arteriosus Botalli, investigations of the energy metabolism of myocardial fibers, endomyocardial biopsy and several drugs, as ajmaline, talinolol, trapidil, PAMBA and hirudin are used up to these days. The tasks of the society ended with the collapse of the GDR in 1989 and therefore the society was liquidated in 1992, when its functions were taken over again by the German Cardiac Society.

  4. Characteristics, expectations and needs of the dutch endometriosis society members

    NARCIS (Netherlands)

    Roos-Eysbouts, Y.K.; Bie-Rocks, B. De; Dijk, J. van; Nap, A.W.

    2015-01-01

    Background/Aim Study Question: Endometriosis is associated with a significant reduction in the quality of life and higher depression and anxiety rates. The Dutch Endometriosis Society (ES) was founded to increase the recognition and knowledge in patients and health care professionals, stimulate

  5. REMARKS ON THE CHURCH IN THE CONSUMER SOCIETY ...

    African Journals Online (AJOL)

    a competitive market, companies realise that the customers are the most important assets ... church can learn from consumer society how to deliver its product (re- ligious services and pastoral care) and how to service its congregation. (customers). The article will ... The heyday of church loyalty has passed. People attend a ...

  6. Just caring.

    Science.gov (United States)

    Hussey, Trevor

    2012-01-01

    Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: 'Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.' This thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. © 2011 Blackwell Publishing Ltd.

  7. Science in the Information Society

    CERN Multimedia

    2003-01-01

    CERN will host the Role of Science in the Information Society (RSIS) conference on Monday and Tuesday, focusing on how science-driven information and communication technologies can help close the digital divide. There will be an army of bodyguards at CERN at the beginning of December. CERN will not only host the official visits, but also around 500 scientists, politicians, and members of civil society who will descend on the Main Auditorium for the Role of Science in the Information Society (RSIS) conference on 8-9 December. The RSIS conference hosted by CERN is a high-profile event focusing on how to make information technologies work for the greatest human benefit - a marked change from keeping a relatively low profile so far, making its discoveries available to all with little input in how they are applied. The RSIS, held 8-9 December at CERN, will be a Summit Event of the World Summit on the Information Society taking place at Palexpo on 9-13 December. RSIS participants will apply a scientific point of...

  8. Reconstructing Death in Postmodern Society.

    Science.gov (United States)

    Kastenbaum, Robert

    1993-01-01

    Examines interaction between emerging thanatological movement and its sociohistorical context. Notes that thanatology will take on new shape as individuals and society attempt to cope with postmodernistic forces and deconstructive mentality. Considers prospect for authentic solidarity against distress in reconstructed death system. (Author/NB)

  9. Experts in science and society

    CERN Document Server

    Gigerenzer, Gerd

    2004-01-01

    In today's complex world, we have come to rely increasingly on those who have expertise in specific areas and can bring their knowledge to bear on crucial social, political and scientific questions. Taking the viewpoint that experts are consulted when there is something important at stake for an individual, a group, or society at large, Experts in Science and Society explores expertise as a relational concept. How do experts balance their commitment to science with that to society? How does a society actually determine that a person has expertise? What personal traits are valued in an expert? From where does the expert derive authority? What makes new forms of expertise emerge? These and related questions are addressed from a wide range of areas in order to be inclusive, as well as to demonstrate similarities across areas. Likewise, in order to be culturally comparative, this volume includes examples and discussions of experts in different countries and even in different time periods. The topics include the r...

  10. Education for the Good Society

    Science.gov (United States)

    Lawson, Neal; Spours, Ken

    2011-01-01

    The Left is facing a crisis of its approach to education highlighted by the "education revolution" of the Coalition Government. The authors argue that it is important to step back and present a positive vision of education based on the key pillars of the Good Society--fairness, democracy, sustainability and well-being. This values-led…

  11. Socialization for the Knowledge Society

    Science.gov (United States)

    Karpov, Alexander O.

    2016-01-01

    The purpose of the study is to give an overview and present special features of socialization of the research type that prepares young people for life in the knowledge society. Methods of cultural and historical epistemology, of hermeneutic and structural-functional analysis of social action have been used in the study, as well as elements of the…

  12. Governance and European Civil Society

    DEFF Research Database (Denmark)

    Kutay, Acar

    This book provides a critical analysis of the European Union’s approach to ‘governance’, focusing on the way in which civil society is incorporated within the EU decision-making process and arguing that it is not conducive to the democratisation of EU governance.\

  13. Architecture in the network society

    DEFF Research Database (Denmark)

    2004-01-01

    Under the theme Architecture in the Network Society, participants were invited to focus on the dialog and sharing of knowledge between architects and other disciplines and to reflect on, and propose, new methods in the design process, to enhance and improve the impact of information technology...

  14. Adult Learning, Economy and Society

    DEFF Research Database (Denmark)

    Olesen, Henning Salling

    2010-01-01

    The article relates the different types of adult education, continuing education and training to an overall societal context of socio-economic modernization by focussing on the multiple functions of adult learning. Each of well known empirical categories is seen in its historical relation to mode...... embracing form which set a new framework for human participation in the new global society....

  15. Internal Conflicts in Muslim Societies

    Directory of Open Access Journals (Sweden)

    Ashiq Ali Shah

    2001-12-01

    Full Text Available An analysis of psychological theories and the social dynamics of the society help identify salient attributes and processes relevant to conflict among Muslims. The psychodynamic concept of personality and frustration-aggression hypothesis account for the socialization practices in the Muslim societies, emotional instability, unfavorable evaluation of those holding a different viewpoint and venting out one's aggression on the weaker. The tendency of the Muslims to praise their sect/tribe/religious group leads to a groupthink situation that polarizes intergroup relationships. The acts of categorization in group and out group, as postulated by the social identity theory, contribute towards the distorted perception of each other. The Islamic notions of brotherhood, unity and ethnic identity as means of personal identification and social interaction seems to have been forgotten by the Muslims. Though the Western social-psychological constructs are helpful in understanding the causes of conflict among Muslims, they are not germane to Muslim societies. The group belongingness and group favouritism is not necessarily a tool of discrimination and conflict but is an essential component of one's survival in a collectivist society. The Western theories also do not address the economic and political circumstances responsible for the multitude of conflicts among Muslims.

  16. Privacy and the Connected Society

    DEFF Research Database (Denmark)

    Sørensen, Lene Tolstrup; Khajuria, Samant; Skouby, Knud Erik

    The Vision of the 5G enabled connected society is highly based on the evolution and implementation of Internet of Things. This involves, amongst others, a significant raise in devices, sensors and communication in pervasive interconnections as well as cooperation amongst devices and entities acro...

  17. Older adult education in Lithuanian ageing society

    Directory of Open Access Journals (Sweden)

    Zemaitaityte I.

    2016-01-01

    Full Text Available The article analyzes the phenomenon of the demographic ageing of the population and educational opportunities for older adults in Lithuania. Ageing population is a natural outcome of demographic evolution of society. However, a growing number of older people in Lithuania as well as in other European countries requires continuous revision of societal resources in social security, economics, education, health care areas and their adjustment to the new demands. Though current discussion in Lithuania highlights the inclusion of older adults into active social life through educational activities, the studies in diverse areas show that a small number of older people take part in lifelong learning. For this reason and in the attempt to make older people feel satisfaction with life it is necessary to encourage their activity, to promote their social roles, to give them opportunities to take up voluntary tasks, educational and cultural functions and study new subjects.

  18. Care and the Construction of Hacker Identities, Communities, and Society

    Science.gov (United States)

    Toombs, Austin Lewis

    2016-01-01

    Recent scholarship in Human-Computer Interaction, science and technology studies, and design research has focused on hacker communities as sites of innovation and entrepreneurship, novel forms of education, and the democratization of technological production. However, hacking practices are more than new technical practices; they are also…

  19. French Intensive Care Society, International congress ? R?animation 2016

    OpenAIRE

    Jaillette, Emmanuelle; Girault, Christophe; Brunin, Guillaume; Zerimech, Farid; Chiche, Arnaud; Broucqsault-Dedrie, C?line; Fayolle, Cyril; Minacori, Franck; Alves, Isabelle; Barrailler, Stephanie; Robriquet, Laurent; Delaporte, Emmanuel; Thellier, Damien; Delcourte, Claire; Duhamel, Alain

    2016-01-01

    Table of contents PHYSICIANS ABSTRACTS O1 Impact of tracheal cuff shape on microaspiration of gastric contents in intubated critically ill patients: a multicenter randomized controlled study (BEST CUFF) Emmanuelle Jaillette, Christophe Girault, Guillaume Brunin, Farid Zerimech, Arnaud Chiche, C?line Broucqsault-Dedrie, Cyril Fayolle, Franck Minacori, Isabelle Alves, Stephanie Barrailler, Laurent Robriquet, Fabienne Tamion, Emmanuel Delaporte, Damien Thellier, Claire Delcourte, Alain Duhamel, ...

  20. Intent, the ethos of a caring society and justice.

    Science.gov (United States)

    Gillett, Grant; Gillett, Matthew

    2008-10-01

    A paradoxical New Zealand case of a father who killed his five-month-old severely impaired daughter is discussed. The jury found the father not guilty of murder despite his confession that he acted so as to bring about her death. Standard constructions do not capture any reason for the jury to acquit him on the ground of lack of intent. The case also raises the issue of social mores in relation to difficult ethical decisions and the problems in trying to capture those in legislation or guidelines. The analysis discusses an alternative conception of intent according to a broader understanding of the patient's life story and the events surrounding the act in question and also the reasons why policy and legislative needs may distort bioethical analysis and argument in relation to difficult human situations.

  1. The 21st-century challenge to neurocritical care: the rise of the superbug Acinetobacter baumannii. A meta-analysis of the role of intrathecal or intraventricular antimicrobial therapy in reduction of mortality.

    Science.gov (United States)

    Mohammed, Nasser; Savardekar, Amey R; Patra, Devi Prasad; Narayan, Vinayak; Nanda, Anil

    2017-11-01

    OBJECTIVE Neurosurgical infections due to multidrug-resistant organisms have become a nightmare that neurosurgeons are facing in the 21st century. This is the dawn of the so-called postantibiotic era. There is an urgent need to review and evaluate ways to reduce the high mortality rates due to these infections. The present study evaluates the efficacy of combined intravenous plus intrathecal or intraventricular (IV + IT) therapy versus only intravenous (IV) therapy in treating postneurosurgical Acinetobacter baumannii infections. METHODS The authors performed a meta-analysis of all peer-reviewed studies from the PubMed, Cochrane Library database, ScienceDirect, and EMBASE in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five studies were finally included in the present analysis: 126 patients were studied who had postneurosurgical A. baumannii infection. The Cochrane collaboration tool was used to evaluate risk of bias, and a test of heterogeneity was performed. The I2 statistic was calculated. The patients were divided into 2 groups: the IV group received only intravenous therapy and the IV + IT group received both intravenous and intrathecal or intraventricular antimicrobial therapy. The outcome was mortality attributed specifically to A. baumannii infection in postneurosurgical cases. The pooled data were analyzed using the Cochran-Mantel-Haenszel method in a fixed-effects model. RESULTS The total number of patients in the IV-only group was 73, and the number of patients in the IV + IT group was 53. The mean duration of intravenous therapy was 27 days. The mean duration of intrathecal colistin was 21 days. The intravenous dose of colistin ranged from 3.75 to 8.8 MIU per day. The dose of intrathecal colistin ranged between 125,000 and 250,000 IU per day. The overall calculated odds ratio for mortality for the IV + IT group after pooling the data was 0.16 (95% CI 0.06-0.40, p < 0.0001). The patients who received IV + IT therapy had an 84% lower risk of dying due to the infection compared with those who received only IV therapy. CONCLUSIONS There is an 84% lower risk of mortality in patients who have been treated with combined intrathecal or intraventricular plus intravenous antimicrobial therapy versus those who have been treated with intravenous therapy alone. The intrathecal or intraventricular route should be strongly considered when dealing with postneurosurgical multidrug-resistant A. baumannii infections.

  2. Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy: comparison of acute treatment strategies using vitamin K, fresh frozen plasma, and prothrombin complex concentrates.

    Science.gov (United States)

    Huttner, Hagen B; Schellinger, Peter D; Hartmann, Marius; Köhrmann, Martin; Juettler, Eric; Wikner, Johannes; Mueller, Stephan; Meyding-Lamade, Uta; Strobl, Ralf; Mansmann, Ulrich; Schwab, Stefan; Steiner, Thorsten

    2006-06-01

    Intracerebral hemorrhage (ICH) is the most serious and potentially fatal complication of oral anticoagulant therapy (OAT). Still, there are no universally accepted treatment regimens for patients with OAT-ICH, and randomized controlled trials do not exist. The aim of the present study was to compare the acute treatment strategies of OAT-associated ICH using vitamin K (VAK), fresh frozen plasma (FFP), and prothrombin complex concentrates (PCCs) with regard to hematoma growth and outcome. In this retrospective study, a total of 55 treated patients were analyzed. Three groups were compared by reviewing the clinical, laboratory, and neuroradiological parameters: (1) patients who received PCCs alone or in combination with FFP or VAK (n=31), (2) patients treated with FFP alone or in combination with VAK (n=18), and (3) patients who received VAK as a monotherapy (n=6). The end points of early hematoma growth and outcome after 12 months were analyzed including multivariate analysis. Hematoma growth within 24 hours occurred in 27% of patients. Incidence and extent of hematoma growth were significantly lower in patients receiving PCCs (19%/44%) compared with FFP (33%/54%) and VAK (50%/59%). However, this effect was no longer seen between PCC- and FFP-treated patients if international normalized ratio (INR) was completely reversed within 2 hours after admission. The overall outcome was poor (modified Rankin scale 4 to 6 in 77%). Predictors for hematoma growth were an increased INR after 2 hours, whereas administration of PCCs was significantly protective in multivariate analyses. Predictors for a poor outcome were age, baseline hematoma volume, and occurrence of hematoma growth. Overall, PCC was associated with a reduced incidence and extent of hematoma growth compared with FFP and VAK. This effect seems to be related to a more rapid INR reversal. Randomized controlled trials are needed to identify the most effective acute treatment regimen for lasting INR reversal because increased levels of INR were predisposing for hematoma enlargement.

  3. Functional progression of patients with neurological diseases in a tertiary paediatric intensive care unit: Our experience.

    Science.gov (United States)

    Madurga Revilla, P; López Pisón, J; Samper Villagrasa, P; García Íñiguez, J P; Garcés Gómez, R; Domínguez Cajal, M; Gil Hernández, I

    2017-11-23

    Neurological diseases explain a considerable proportion of admissions to paediatric intensive care units (PICU), and are a significant cause of morbidity and mortality. This study aims to analyse the functional progression of children with critical neurological conditions. Retrospective descriptive study of children admitted to PICU with neurological diseases over a period of 3 years (2012-2014), assessing vital and functional prognosis at PICU discharge and at one year according to the Pediatric Cerebral and Overall Performance Category scales (PCPC-POPC) and the Functional Status Scale (FSS). The results are compared with our previous data (1990-1999), and those of the international multicentre PANGEA study. A total of 266 children were studied. The mortality rate was 3%; the PRISM-III and PIM2 models did not show predictive ability. Clinically significant worsening was observed in functional health at discharge in 30% of the sample, according to POPC, 15% according to PCPC, and 5% according to FSS. After one year, functional performance improved according to PCPC-POPC, but not according to FSS. Children with no underlying neurological disease had a higher degree of functional impairment; this was prolonged over time. We observed a decrease in overall and neurocritical mortality compared with our previous data (5.60 vs. 2.1%, P=.0003, and 8.44 vs. 2.63%, P=.0014, respectively). Compared with the PANGEA study, both mortality and cerebral functional impairment in neurocritical children were lower in our study (1.05 vs. 13.32%, P<.0001, and 10.47% vs. 23.79%, P<.0001, respectively). Nearly one-third of critically ill children have neurological diseases. A significant percentage, mainly children without underlying neurological diseases, had a clinically significant functional impact at PICU discharge and after a year. Neuromonitoring and neuroprotection measures and the evaluation of functional progression are necessary to improve critical child care. Copyright

  4. November 2014 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2014-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2014 Arizona Thoracic Society meeting was held on Wednesday, November 19, 2014 at the Scottsdale Shea Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were about 30 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. Jud Tillinghast was nominated as the Arizona Thoracic Society physician of the year. Three cases were presented: 1. George Parides presented a case of a 70-year-old woman with a 3 areas of ground glass picked up incidentally on CT scan. She had some wheezing. A needle biopsy revealed adenocarcinoma. The biopsy and radiologic pattern were consistent with adenocarcinoma in situ or minimally invasive adenocarcinoma. Discussion centered around treatment. Most felt that if the areas could be removed that surgical resection was indicated (1. 2. Lewis Wesselius presented a 60-year-old man with Marfan's syndrome and a history of an aortic valve replacement on chronic ...

  5. March 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-03-01

    Full Text Available No abstract available. Article truncated after 150 words. The March 2017 Arizona Thoracic Society meeting was held on Wednesday, March 22, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There 11 attendance representing the pulmonary, critical care, sleep, thoracic surgery and radiology communities. There was a discussion of supporting the Tobacco 21 bill which had been introduced into the Arizona State Legislature. The bill was assigned to the House Commerce Committee but was not scheduled for a hearing by the Chair-Representative, Jeff Wininger from Chandler. It seems likely that the bill will be reintroduced in the future and the Arizona Thoracic Society will support the bill in the future. Three cases were presented: 1. Dr. Bridgett Ronan presented a 57-year-old man with cough and shortness of breath. His physical examination and spirometry were unremarkable. A thoracic CT scan showed large calcified and noncalcified pleural plaques and mediastinal lymphadenopathy. …

  6. Indian family systems, collectivistic society and psychotherapy.

    Science.gov (United States)

    Chadda, Rakesh K; Deb, Koushik Sinha

    2013-01-01

    Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in today's changed scenario, the family forms a resource for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders. This paper elaborates the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practice of family therapy in India.

  7. September 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-09-01

    Full Text Available No abstract available. Article truncated at 150 words. The September 2017 Arizona Thoracic Society meeting was held on Wednesday, September 27, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with case presentations. There were 16 in attendance representing the pulmonary, critical care, sleep, and radiology communities. There was a discussion of the Tobacco 21 bill which had been introduced the last session in the Arizona State Legislature. Since it seems likely that the bill will be reintroduced, the Arizona Thoracic Society will support the bill in the future. Dr. Rick Robbins announced that the SWJPCC has applied to be included in PubMed. In addition, Dr. Robbins was assigned the task of tracking down the campaign contributions to congressional members from the tobacco PAC before the next election. There were 7 case presentations: 1.\tAshley L. Garrett, MD, pulmonary fellow at Mayo, presented an elderly man with insulin-dependent diabetes who felt he …

  8. [Representation of women in health-related scientific societies in Spain in 2014].

    Science.gov (United States)

    Casado-Mejía, Rosa; Botello-Hermosa, Alicia

    2015-01-01

    To describe the presence of women in the governance of health-related scientific societies in Spain today. Spanish scientific societies were identified by vising the websites of the Ministry of Health, Social Services and Equality, and Fisterra. The sex of the president, executive officers and the board of directors was identified. Data were analyzed according to the overall percentage of women and by profession and setting. Of 173 scientific societies in July 2014, 41 had a female president (22.53%). Women held 35.45% of executive positions and accounted for 36.32% of the boards of directors. Only 16.07% of medical societies had a female president compared with 76.92% of nursing societies. Primary care societies had more women in executive positions (54.55%) than societies in which the professional activity of members involved both primary and secondary care (35.74%) and societies related to hospital care (27.93%). There is a lack of parity, which is greater in nursing and primary care societies than in medical and hospital-related societies. Parity decreases as the level of responsibility rises. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  9. Human cloning and 'posthuman' society.

    Science.gov (United States)

    Blackford, Russell

    2005-01-01

    Since early 1997, when the creation of Dolly the sheep by somatic cell nuclear transfer was announced in Nature, numerous government reports, essays, articles and books have considered the ethical problems and policy issues surrounding human reproductive cloning. In this article, I consider what response a modern liberal society should give to the prospect of human cloning, if it became safe and practical. Some opponents of human cloning have argued that permitting it would place us on a slippery slope to a repugnant future society, comparable to that portrayed in Aldous Huxley's novel, Brave New World. I conclude that, leaving aside concerns about safety, none of the psychological or social considerations discussed in this article provides an adequate policy justification for invoking the state's coercive powers to prevent human cloning.

  10. Space Weather, Environment and Societies

    CERN Document Server

    Lilensten, Jean

    2006-01-01

    Our planet exists within a space environment affected by constantly changing solar atmosphere producing cosmic particles and electromagnetic waves. This "space weather" profoundly influences the performance of our technology because we primarily use two means for transmitting information and energy; namely, electromagnetic waves and electricity. On an everyday basis, we have developed methods to cope with the normal conditions. However, the sun remains a fiery star whose 'angry' outbursts can potentially destroy spacecrafts, kill astronauts, melt electricity transformers, stop trains, and generally wreak havoc with human activities. Space Weather is the developing field within astronomy that aims at predicting the sun’s violent activity and minimizing the impacts on our daily lives. Space Weather, Environment, and Societies explains why our technological societies are so dependent on solar activity and how the Sun disturbs the transmission of information and energy. Footnotes expand specific points and the ...

  11. Leadership in an Egalitarian Society

    Science.gov (United States)

    von Rueden, Christopher; Gurven, Michael; Kaplan, Hillard; Stieglitz, Jonathan

    2014-01-01

    Leadership is instrumental to resolution of collective action dilemmas, particularly in large, heterogeneous groups. Less is known about the characteristics or effectiveness of leadership in small-scale, homogeneous, and relatively egalitarian societies, in which humans have spent most of our existence. Among Tsimane’ forager-horticulturalists of Bolivia, we (1) assess traits of elected leaders under experimental and naturalistic conditions and (2) test whether leaders impact collective action outcomes. We find that elected leaders are physically strong and have more kin and other exchange partners. Their ranks on physical dominance, kin support, and trustworthiness predict how well their groups perform, but only where group members have a history of collaborative interaction. Leaders do not take more of the spoils. We discuss why physically strong leaders can be compatible with egalitarianism, and we suggest that leaders in egalitarian societies may be more motivated by maintaining an altruistic reputation than by short-term rewards of collective action. PMID:25240393

  12. between the Law and Society

    Directory of Open Access Journals (Sweden)

    Arnar Þór Jónsson

    2015-06-01

    Full Text Available This article is focused on two basic concepts: Law and Society. Older sources do not clearly indicate that a sharp distinction was commonly drawn between the society on one hand and the law on the other. Regardless of the evolution and progress which has been made in both areas the ties between these two subjects have not been disconnected. In fact, one does not have to reflect long on the matter to understand the obvious and necessary coherence. The influence is interactive. This reciprocity means, inter alia, that rights cannot be claimed without the shouldering of corresponding duties. Comprehension of this basic strand in the concept of law demarcates the basis for our everyday existence.

  13. INFORMATION SOCIETY EVOLUTION AND EFFECTS

    DEFF Research Database (Denmark)

    Brooks, Anthony Lewis

    2016-01-01

    The evolution and effects of the information society can be exemplified via many threads, both in hard and soft science, according to ones’ discipline and field. In this contribution, the speaker’s three decades of applied research acts as a vehicle to demonstrate development and impact via...... commercial product, national and international projects, and industry startups (including impactful third party research investigations) form the basis for discussion. Beyond this, a wider more generic perspective reflects on product adoption that illustrate todays’ contemporary e-society tendencies where...... recent influx and uptake of consumer-targeted artificial reality products point to society’s desire for alternative sensory experiences. Posited is how aligned with this desire there is a need for new ethical considerations in research as was found in the speaker’s research at the end of the 20th century...

  14. Leadership in an egalitarian society.

    Science.gov (United States)

    von Rueden, Christopher; Gurven, Michael; Kaplan, Hillard; Stieglitz, Jonathan

    2014-12-01

    Leadership is instrumental to resolution of collective action dilemmas, particularly in large, heterogeneous groups. Less is known about the characteristics or effectiveness of leadership in small-scale, homogeneous, and relatively egalitarian societies, in which humans have spent most of our existence. Among Tsimane' forager-horticulturalists of Bolivia, we (1) assess traits of elected leaders under experimental and naturalistic conditions and (2) test whether leaders impact or differentially benefit from collective action outcomes. We find that elected leaders are physically strong and have more kin and other exchange partners. Their ranks on physical dominance, kin support, and trustworthiness predict how well their groups perform, but only where group members have a history of collaborative interaction. Leaders do not take more of the spoils. We discuss why physically strong leaders can be compatible with egalitarianism, and we suggest that leaders in egalitarian societies may be more motivated by maintaining an altruistic reputation than by short-term rewards of collective action.

  15. Equalitarian Societies are Economically Impossible

    OpenAIRE

    Bojin Zheng; Wenhua Du; Wanneng Shu; Jianmin Wang; Deyi Li

    2012-01-01

    The inequality of wealth distribution is a universal phenomenon in the civilized nations, and it is often imputed to the Matthew effect, that is, the rich get richer and the poor get poorer. Some philosophers unjustified this phenomenon and tried to put the human civilization upon the evenness of wealth. Noticing the facts that 1) the emergence of the centralism is the starting point of human civilization, i.e., people in a society were organized hierarchically, 2) the inequality of wealth em...

  16. Art education, Creativity and Society

    OpenAIRE

    Filip, Michal

    2012-01-01

    Title: Art education, Creativity and Society Author: Michal Filip Department: Department of Art Education Supervisor: doc. PaedDr. Pavel Šamšula, CSc. Abstract: The dissertation addresses the issue of creativity in art education. The theoretical part of the work first explains the general foundation of the social context, which plays a key role in education focused on the development of creativity. The author outlines the historical roots of the relationship between art education and creativi...

  17. [Civil bioethics in pluralistics societies].

    Science.gov (United States)

    Cortina, A

    2000-01-01

    The author examines how Bioethics should be approached in a pluralist society. She argues that through the gradual discovery of shared ethical values and principles for judging which practices are humanizing and which or not, ever-more dense civil Bioethics helps bring out--in contrast to relativism and subjectivism--an ethical intersubjectiveness, the fundaments of which should be addressed by moral philosophy if it hopes to fulfill one of its main tasks.

  18. Knowledge society and digital environment

    Directory of Open Access Journals (Sweden)

    Clara BARROSO JEREZ

    2013-12-01

    Full Text Available The existence and extension of the digital environment has made possible the broad distribution of computer equipment, allowing greater access to information than ever before in human history. Although the consequences of this phenomenon have been analysed and the possible undesirable effects of ‘digital divides’ caused by different levels of access to the information society due to socio-economic reasons identified, there has been little study of what the digital environment supposes for the construction of knowledge and the development of the knowledge society. Although the digital environment is a powerful means of accessing information, it does not necessarily increase the possibilities of constructing knowledge and human development. This may lead to a new risk of the ‘digital divide’, tied to the growing inequality in the abilities of those who have mastered the basic capabilities and strategies needed to build knowledge, and those who are merely passive users of the information that can be accessed through the digital environment. This work explores issues related to individual differences in the capabilities needed to use the digital environment to access and construct valid knowledge, and defends that prior domain knowledge, mediate the processes involved in building knowledge from the information that all individuals access through the digital environment, defining their social role as an individual capable of participating in the development of the knowledge society.

  19. Educating for Democratic Societies: Impediments

    Directory of Open Access Journals (Sweden)

    Stephen LAFER

    2012-11-01

    Full Text Available The paper offers a robust definition of democracy that focuses upon the decision making processes of democratic societies that are dependent on the ability and willingness of citizens to enter into a democratic dialectic in which informed opinions contend with one another in the public forum so that the best possible decisions can be made in regard to public policy and action. Opinion, informed and justified in reason, is to be respected in such societies and cultivated through a proper system of education that teaches students how to determine the respectability of opinions offered and to formulate and articulate opinions worthy of respect. Impediments to the development of skills, knowledge, and dispositions essential to the development of opinion worthy of respect and the critique of opinion for its respect-worthiness are considered, particularly those generated by forces of economy (business, religion, and notions of state and nation. The conclusion argues for schools that are respectful of the individual capacities of students, particularly their ability to formulate unique understandings of the phenomenon that come before them and to offer to society novel ideas, in the form of opinion, that deserve the consideration of others in the democratic decision making process

  20. Cerebral Microdialysis Monitoring to Improve Individualized Neurointensive Care Therapy: An Update of Recent Clinical Data.

    Science.gov (United States)

    Carteron, Laurent; Bouzat, Pierre; Oddo, Mauro

    2017-01-01

    Cerebral microdialysis (CMD) allows bedside semicontinuous monitoring of patient brain extracellular fluid. Clinical indications of CMD monitoring are focused on the management of secondary cerebral and systemic insults in acute brain injury (ABI) patients [mainly, traumatic brain injury (TBI), subarachnoid hemorrhage, and intracerebral hemorrhage (ICH)], specifically to tailor several routine interventions-such as optimization of cerebral perfusion pressure, blood transfusion, glycemic control and oxygen therapy-in the individual patient. Using CMD as clinical research tool has greatly contributed to identify and better understand important post-injury mechanisms-such as energy dysfunction, posttraumatic glycolysis, post-aneurysmal early brain injury, cortical spreading depressions, and subclinical seizures. Main CMD metabolites (namely, lactate/pyruvate ratio, and glucose) can be used to monitor the brain response to specific interventions, to assess the extent of injury, and to inform about prognosis. Recent consensus statements have provided guidelines and recommendations for CMD monitoring in neurocritical care. Here, we summarize recent clinical investigation conducted in ABI patients, specifically focusing on the role of CMD to guide individualized intensive care therapy and to improve our understanding of the complex disease mechanisms occurring in the immediate phase following ABI. Promising brain biomarkers will also be described.