Notes

Glial cells have an overabundance of part inside tDCS-induced mental faculties actions instead of nerves.
rved in performance.BACKGROUND There are increasing numbers of cancer patients with brain metastases, and there is a high potential for caregiving burden. Little work has explored caregiving responsibilities and psychosocial well-being in informal family caregivers (FCGs) of cancer patients with brain metastases. This study aimed to address this gap in the literature. METHODS Data were drawn from baseline pilot study data. Caregivers completed demographic information and provided a self-report of their caring responsibilities and psychosocial well-being via questionnaire. RESULTS Participants were 21 FCGs of patients with brain metastases. Many caregivers are devoting extensive time to providing care; there was high variability in the number and types of caregiving activities reported. Although many caregivers report feeling well supported, other aspects of psychosocial well-being were less robust, including anxiety, depression, burden, and coping self-efficacy. CONCLUSION Although FCGs reported mitigating factors such as social support, they still experience significant distress. Findings support previous work suggesting that neuro-oncology caregiving is burdensome, with adverse effects on health and well-being. Foundational work, such as this, will set the stage to identify areas for future intervention.BACKGROUND Pupillary light reflex (PLR) has traditionally been assessed using a pen torch (light). Although the terms "brisk" or "sluggish" are often used, it is unclear what characteristics of the PLR result in this description. More recently, automated infrared pupillometry has enabled us to quantify the different components of a PLR. METHODS We conducted a 2-part questionnaire survey of pediatric intensive care unit (PICU) nurses. In part 1, nurses were requested to describe the key characteristics that they associate with a brisk or sluggish PLR in free-text responses. In part 2, after an introduction to pupillometry and the different components of a PLR, nurses were asked to rank the relative importance of latency (time taken for pupil to start reacting to light), percentage change (in pupil size after light stimulus), and constriction velocity (rate of constriction after light stimulus) in relation to a pupil being described as "brisk" and "sluggish. RESULTS Fifty nurses responded. In part 1, "Quick" was the commonest term used (36% of respondents) to describe a brisk PLR, and 72% used "slow" for a sluggish PLR. Most descriptions most closely mapped to features of latency and/or constriction velocity. In part 2, latency was ranked the most important component on pupillometry for describing brisk (32%) and sluggish (34%) PLRs. Constriction velocity was ranked as the most important by 18% (brisk) and 20% (sluggish), whereas 44% (brisk) and 46% (sluggish) ranked percentage change behind the other 2 characteristics. CONCLUSION Latency, followed by the constriction velocity, was felt by PICU nurses to be the most important characteristic of the PLR that results in terms "brisk" or "sluggish" being used at the bedside to describe a PLR. We plan to compare these subjective opinions with objective findings from pupillometry.BACKGROUND Stereoelectroencephalography (SEEG) is an invasive diagnostic surgical procedure used to identify specific areas of seizure activity in the brain. SEEG has been shown in both adult and pediatric populations to be a safe and effective tool for preoperative decision making. USES This is used in patients with medically refractory epilepsy who are potential candidates for brain surgery to control seizures. It is preferred over other invasive diagnostic procedures because of lower risk, reduced discomfort, and shorter operating times. selleck OUTCOMES It has a distinct role in obtaining meaningful data that leads to more precise surgical options. All of this results in better seizure control and improved quality of life for the patients. CONCLUSION Knowledge of the SEEG procedure, its benefits, complications, and the neuroscience nurse's role will improve care for surgical patients and improve outcomes.BACKGROUND Coping with a diagnosis of multiple sclerosis (MS) is challenging. MS is one of the most common causes of nontraumatic disability in young adults, and patients may need assistance with daily life activities. This article explores the relation between quality of life (QOL) and the perceived available social support among patients with MS and their families. METHODS The study included 120 subjects (60 patient-caregiver dyads). The average age of the patients was 53.95 ± 10.19 years, and for caregivers, it was 50.8 ± 13.3 years. The study used 2 subscales of the Berlin Social Support Scale (perceived availability of social support and need for social support) and the World Health Organization Quality of Life questionnaire for the assessment of QOL. RESULTS QOL in MS is lower compared with that of their caregivers in all dimensions except the social domain (P less then .001, r = 0.54-0.64). A higher need for social support was experienced by caregivers. The need for support in this group is affected by 3 predictors QOL in the environmental domain and in the physical domain as well as their subjective health. An improvement in QOL in all the domains is related to an increase of perceived available support, in both the group of patients and that of their caregivers (P less then .05, ρ = 0.28-0.59). CONCLUSIONS Perceived available support is of great importance for both patients and their caregivers to enable them to function better in the physical, mental, social, and environmental domains of their QOL, where social relationships play a predictive role.BACKGROUND Anaesthesia reduces mean arterial pressure (MAP), and to preserve organ perfusion, vasopressors are often used to maintain MAP above 60 mmHg. Cognitive dysfunction is common following major surgery and may relate to intra-operative cerebral hypoperfusion. OBJECTIVE The aim of this study was to evaluate whether internal carotid artery (ICA) blood flow increases when MAP is kept higher than 60 mmHg using noradrenaline. DESIGN A randomised, cross-over trial. SETTING Department of Anaesthesia, Rigshospitalet, Copenhagen, Denmark, from December 2017 to April 2018. PATIENTS Patients with median [IQR] age 71 [63 to 75] years underwent pancreaticoduodenectomy (n = 19), total pancreatic resection (n = 1) or gastro-entero anastomosis (n = 2) during combined propofol-remifentanil and thoracic epidural anaesthesia. INTERVENTION MAP was maintained between 60 to 65, 70 to 75 and 80 to 85 mmHg, in a random order, by noradrenaline infusion at a stable level of anaesthesia. MAIN OUTCOME MEASURES Primary outcome was change in ICA flow at MAP 60 to 65 vs. 80 to 85 mmHg. Secondary outcomes were change in ICA flow at MAP 60 to 65 vs. 70 to 75 and 70 to 75 vs. 80 to 85 mmHg. Duplex ultrasound evaluated ICA flow. RESULTS A (mean ± SD) increase in MAP from 62 ± 1 to 82 ± 1 mmHg elevated ICA flow from 196 ± 53 to 226 ± 61 ml min (mean difference 31 ml min; 95% CI 19 to 42; P  less then  0.0001). An increase in MAP from 62 ± 1 to 72 ± 1 mmHg elevated ICA flow to 210 ± 52 ml min (P = 0.0271) and ICA flow increased further (P = 0.0165) when MAP was elevated to 82 ± 1 mmHg. CONCLUSION During combined propofol-remifentanil and thoracic epidural anaesthesia, ICA flow increased by approximately 15% when the MAP was elevated from about 60 to 80 mmHg. Treatment of a reduction in MAP brought about by anaesthesia seems to enhance ICA flow. TRIAL REGISTRATION Clinicaltrials.gov ID NCT03309917.BACKGROUND Real-life experience with idarucizumab, which reverses the anticoagulant effect of dabigatran, is currently limited. OBJECTIVE To evaluate efficacy and safety of the clinical use of idarucizumab after its availability in Slovenia. METHODS We analysed consecutive cases treated with idarucizumab in Slovenia from January to October 2016. The decision to reverse dabigatran with idarucizumab was made by the treating clinicians, as was the assessment of clinical outcomes and blood sampling/monitoring (activated partial thromboplastin time, thrombin time and diluted thrombin time) before and after use. RESULTS Idarucizumab was used in 17 cases. One patient was treated with the antidote twice with an interval of 2 months between treatments. The indications for idarucizumab use were emergency surgery (4/17), severe bleeding (11/17; seven with intracranial bleeding) and ischaemic stroke (2/17). During surgery, no excessive bleeding was reported. Five patients died due to cardiogenic, haemorrhagic or septic shock, intracranial bleeding or multiple organ failure. Among cases with laboratory data available, baseline coagulation tests were prolonged in 12/13 cases with bleeding or emergency surgery. After idarucizumab administration, normal coagulation parameters were confirmed in 10/11. However, re-occurrence of dabigatran effect was noted later in four patients with creatinine clearance less than 30 ml min, and one patient with persistent bleeding required retreatment with idarucizumab. CONCLUSION Our first experiences with idarucizumab use in daily-care settings support a rapid and efficient decrease in the anticoagulant effect of dabigatran in emergency situations. Late re-occurrence of dabigatran effect was noted in a subset of patients with severe renal failure.BACKGROUND Pre-operative risk assessment is important to quantify the patient's risks of morbidity and mortality, but its quality differs. We created a process-oriented score (PRO-score) for risk evaluation of adults as a three-stage warning score checklist with concrete guidance. It contains the contents of current guidelines and the assessment of vital signs. OBJECTIVES We investigated whether the PRO-score is suitable to detect 'red flag' warning signs not only in American Society of Anesthesiologists (ASA) physical status (PS) 3 or 4 patients but also in ASA-PS 1 or 2 patients. Resulting medical, therapeutic or structural consequences were recorded. DESIGN Prospective single-centre study. SETTING The study was performed in a German university hospital between November 2015 and December 2018. PATIENTS We included 54 455 adult patients undergoing a pre-operative risk assessment for general or regional anaesthesia and elective noncardiac surgery. RESULTS In all, 388 patients presented 'red flag' warning signamination should include the assessment of vital signs.BACKGROUND Several studies have shown an analgesic efficacy of a transversus abdominis plane block (TAPB) in reducing opioid requirements during and after cadaveric renal transplantation surgery, but the effect of a quadratus lumborum block (QLB) in this type of surgery is unclear. OBJECTIVES The main objective of this prospective, randomised, double-centre clinical study was to compare the analgesic efficacy of a one-sided lateral approach TAPB with a unilateral QLB type 2 in cadaveric renal transplantation surgery. DESIGN Single-blinded, randomised trial. SETTING Two University-affiliated tertiary care hospitals between April 2016 and May 2017. PATIENTS A total of 101 patients aged more than 18 years, scheduled for cadaveric renal transplantation. INTERVENTIONS On receiving ethical board approval and individual informed consent, consecutive patients were allocated randomly to receive either an ultrasound-guided single-shot lateral TAPB or an ultrasound-guided single-shot QLB type 2 on the surgical side using 20 ml of bupivacaine 0.
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