other entities (RWI) can be found at https://professional. heart.org/-/media/phd-files/guidelines-and-statements/ policies-devolopment/aha-asa-disclosure-rwi-policy-5118. pdf?la=en.Beginning in 2017, numerous modifications to AHA/ ASA guidelines have been implemented to make guidelines shorter and enhance user-friendliness. Guidelines are written and presented in a modular knowledge chunk format; each chunk includes a table of recommendations, a brief synopsis, recommendation-specific supportive text, and, when appropriate, flow diagrams or additional tables. Hyperlinked references are provided to facilitate quick access and review. Other modifications to the guidelines include the addition of Knowledge Gaps and Future Research segments in some sections and a web guideline supplement (Online Data Supplement) for useful but noncritical tables and figures.
Introduction Delirium predicts higher long-term cognitive morbidity. We previously identified a cohort of patients with spontaneous intracerebral hemorrhage and delirium, and found worse outcomes in Health Related Quality of Life (HRQoL) in the domain of Cognitive Function. We tested the hypothesis that agitation would have additional prognostic significance on later Cognitive Function HRQoL. Materials and Method Prospective identification of 174 patients with acute intracerebral hemorrhage, measuring stroke severity, agitation, and delirium with a standardized protocol and measures. HRQoL was assessed using the Neuro-QOL at 28 days, three months, and one year. Functional outcomes were measured with the modified Rankin Scale. Results Among the 81 patients with health related quality of life follow up data available, patients who had agitation and delirium had worse Cognitive Function HRQoL scores at 28 days (T-scores for delirium with agitation 20.9 ± 7.3, delirium without agitation 30.4 ± 16.5, agitation without delirium 36.6 ± 17.5, neither agitated nor delirious 40.3 ± 15.9, P=0.03), and at 1 year (P=0.006). The effect persisted in mixed models after correction for severity of neurologic injury, age, and time of assessment (P=0.0006), and was not associated with medication use, seizures or infection. Conclusions The presence of agitation with delirium in patients with intracerebral hemorrhage may predict higher risk of unfavorable cognitive outcomes up to one year later.
Background: Status, refractory status and super refractory status epilepticus are common neurologic emergencies. The objective of this study is to investigate the feasibility, safety and effectiveness of a ketogenic diet (KD) for refractory status epilepticus (RSE) in adults in the intensive care unit (ICU).Methods: We performed a retrospective, single-center study of patients between ages 18 and 80 years with RSE treated with a KD treatment algorithm from November 2016 through April 2018. The primary outcome measure was urine ketone body production as a biomarker of feasibility. Secondary measures included resolution of RSE and KDrelated side effects.Results: There were 11 adults who were diagnosed with RSE that were treated with the KD. The mean age was 48 years, and 45% (n = 5) of the patients were women. The patients were prescribed a median of three anti-seizure medications before initiating the KD. The median duration of RSE before initiation of the KD was 1 day. Treatment delays were the result of Propofol administration. 90.9% (n = 10) of patients achieved ketosis within a median of 1 day. RSE resolved in 72.7% (n = 8) of patients; however, 27.3% (n = 3) developed super-refractory status epilepticus. Side effects included metabolic acidosis, hypoglycemia and hyponatremia. One patient (20%) died.Conclusions: KD may be feasible, safe and effective for treatment of RSE in the ICU. A randomized controlled trial (RCT) may be indicated to further test the safety and efficacy of KD.
Acute decline in osmolality was associated with brain swelling and neurologic deterioration in severe hepatic encephalopathy. Minimizing osmolality decline may avoid neurologic deterioration.
Objective Worthwhile interventions for intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) generally hinge on whether they improve the odds of “good outcome.” While good outcome is correlated with mobility, correlations with other domains of health-related quality of life (HRQoL), such as cognitive function (CF) and social functioning, are not well described. We tested the hypothesis that good outcome is more closely associated with mobility than other domains. Design We defined “good outcome” as 0 through 3 (independent ambulation or better) vs. 4 through 5 (dependent) on the modified Rankin Scale (mRS) at one, three and 12 months. We simultaneously assessed the mRS and HRQoL using web-based computer adaptive testing in the domains of mobility, CF (executive function and general concerns), and satisfaction with social roles and activities (SRA). We compared the area under the curve (AUC) between different HRQoL domains. Setting Neurological intensive care unit with web-based follow-up Measurement and Main Results We longitudinally followed 114 survivors with data at one month, 62 patients at three months, and 58 patients at 12 months. At one month, AUC was highest for mobility (0.957, 95% CI 0.904 – 0.98), higher than CF - general concerns (0.819, 95%CI 0.715-0.888, P=0.003 compared to mobility), satisfaction with SRA (0.85, 95%CI 0.753-0.911, P=0.01 compared to mobility) and CF - executive function (0.879, 95%CI 0.782-0.935, P=0.058 compared to mobility). Optimal specificity and sensitivity for ROC analysis were approximately 1.5 SD below the US population mean. Conclusions HRQoL assessments reliably distinguished between good and poor outcome as determined by the mRS. “Good outcome” indicated HRQoL about 1.5 SD below the US population mean. Associations were weaker for CF and social function than mobility.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.