Background and aims: Clinical predictive models for stroke recovery could offer the opportunity of targeted early intervention and more specific information for patients and carers. In this study, we developed and validated a patientspecific prognostic model for monitoring recovery after stroke and assessed its clinical utility.Methods: Four hundred and ninety-five patients from the population-based South London Stroke Register were included in a substudy between 2002 and 2004. Activities of daily living were assessed using Barthel Index) at one, two, three, four, six, eight, 12, 26, and 52 weeks after stroke. Penalized linear mixed models were developed to predict patients' functional recovery trajectories. An external validation cohort included 1049 newly registered stroke patients between 2005 and 2011. Prediction errors on discrimination and calibration were assessed. The potential clinical utility was evaluated using prognostic accuracy measurements and decision curve analysis.Results: Predictive recovery curves showed good accuracy, with root mean squared deviation of 3 Barthel Index points and a R 2 of 83% up to one year after stroke in the external cohort. The negative predictive values of the risk of poor recovery (Barthel Index <8) at three and 12 months were also excellent, 96% (95% CI [93.6-97.4]) and 93% [90.8-95.3], respectively, with a potential clinical utility measured by likelihood ratios .8] at three months and LRþ:11 [6.5-17.2] at 12 months). Decision curve analysis showed an increased clinical benefit, particularly at threshold probabilities of above 5% for predictive risk of poor outcomes.Conclusions: A recovery curves tool seems to accurately predict progression of functional recovery in poststroke patients.
A 7.5‐year‐old, 5.6 kg female Patagonian cavy (Dolichotis patagonum) in thin body condition presented for bilateral pelvic limb paresis. Lumbar intervertebral disk extrusion was diagnosed using MRI and neurological examination. Emergency hemilaminectomy was done on the same day of diagnostics. The cavy was premedicated with intravenous (IV) midazolam (0.3 mg/kg) and ketamine (5 mg/kg) followed by alphaxalone (to effect) for induction and tracheal intubation. Anaesthesia was maintained with isoflurane‐in‐oxygen and an IV constant rate infusion (CRI) of ketamine and lidocaine (both 0.3 mg/kg/h) and morphine (0.1 mg/kg, once). The CRI continued for 24 hours followed by once daily intravenous buprenorphine (0.03 mg/kg) and subcutaneous meloxicam (0.5 mg/kg). Recovery was calm. The cavy returned to its preoperative behaviour within hours and began eating soon after anaesthesia. Subjectively, the analgesic plan was successful in mitigating post‐operative pathological pain. This case report discusses the perianaesthetic management for spinal surgery in a cavy.
A 4.5‐year‐old male neutered Siamese cat was admitted to referral hospital for medical work‐up of chronic anorexia and emesis. No severe abnormalities were detected on routine blood work; however thickened gastric wall and small intestines were noted on abdominal ultrasonography. The cat was premedicated with buprenorphine followed by a diazepam‐propofol co‐induction. Endotracheal intubation was performed, and anaesthesia was maintained using isoflurane in oxygen for endoscopic investigation of the thickened gastric wall and biopsies retrieval. During the anaesthetic recovery, the animal went into cardiopulmonary arrest. Successful ROSC (return of spontaneous circulation) was achieved at approximate 40 minutes (prolonged) post‐arrest, and the animal had a survived event (ROSC > 20 minutes). However, failure to identify the inciting cause of the CPA and laxity in the post‐cardiac arrest care resulted in rearrest of the cat, 77 hours after the initial ROSC with no success of a second ROSC.
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