Good Functional Outcome In Patients Research Articles

Intravenous Glycoprotein IIb/IIIa Inhibitor (Tirofiban) Followed by Low-dose Intra-Arterial Urokinase and Mechanical Thrombolysis for the Treatment of Stroke

We investigated the efficacy and safety of the combined use of IV tirofiban and IA urokinase and/or mechanical thrombolysis for treating acute stroke patients. Thirteen, consecutive patients who were treated with IV tirofiban and IA thrombolysis with mechanical and/or local IA urokinase infusion, were evaluated retrospectively. The amount of time before the beginning of treatment, urokinase dose, recanalization rates, and symptomatic hemorrhage were analyzed. Clinical outcome measures were assessed on admission, at discharge (National Institute of Health Stroke scale[NIHASS]), and three months after the end of their treatment (modified Rankin Scale scores[mRS]). There were 11 patients with internal carotid or middle cerebral artery occlusion treated within six hours of the onset of symptoms and two patients with basilar artery occlusion treated within 12 hours of their symptom onset. The median NIHSS score on admission was 18. The median amount of time from symptom onset to IV tirofiban infusion was 135 minutes, and the median time from symptom onset to IA therapy was 180 minutes. The median dose of urokinase was 200,000 U. Recanalization (thrombolysis in myocardial infarction grade 2 or 3) was achieved in 11 patients. No procedure-related complications were observed. There was one symptomatic hemorrhage. At discharge, the mean NIHSS score was 6.6 (range, 0- 15). Overall, at the time of the three-month follow-up the functional outcome was favorable (modified Rankin Scale score 0 -2) in eight of 13 (62%) patients. Death at 90 days occurred in two of the 13 (15%) patients. Combined IV tirofiban and IA thrombolysis with mechanical clot disruption seems to be a feasible treatment in acute stroke and may be successful in reestablishing vessel patency and result in a good functional outcome in patients with major cerebral arteries occlusions.

Improvement in memory deficits following computer assisted cognitive remediation in patients with a mood disorder

Event Abstract Back to Event Improvement in memory deficits following computer assisted cognitive remediation in patients with a mood disorder G. B. Hall1, 2, G. M. MacQueen3, 4, M. C. McKinnon1, 2 and L. Meusel1, 2* 1 St. Joseph's Healthcare , Mood Disorders Program, Canada 2 McMaster University, Department of Psychiatry and Behavioural Neurosciences, Canada 3 Calgary Health Region , Department of Psychiatry, Canada 4 University of Calgary, Department of Medicine, Canada Background: Major depressive disorder (MDD) and bipolar disorder (BD) are characterized by impairments in cognitive performance across multiple domains, impacting quality of life in these individuals. Cognitive remediation interventions designed to target neuropsychological deficits have been successfully implemented for patients with schizophrenia, however only one study has explored their efficacy for patients with MDD. Methods: Patients with MDD or BD completed a 10-week cognitive remediation program aimed at improving cognitive performance across four domains: attention, memory, psychomotor speed, and executive function. Cognitive functioning was assessed with a battery of standardized neuropsychological tests at baseline and immediately following the intervention. Results: Mixed-effects linear modeling showed greater relative improvement on memory tasks (delayed verbal recall, p = .05; backward digit span, p= .04; digit symbol subtest front, p= .04 and back, p= .004) in patients receiving the cognitive remediation intervention (n= 18) relative to wait-listed patients (n = 18) and a healthy control group (n = 18). Conclusions: Findings from this study will help establish the utility of cognitive remediation programs for patients with a mood disorder. Implementation of such programs may eventually translate into decreased medical-related disability and better functional outcome for patients with illness-related cognitive impairment. Conference: The 20th Annual Rotman Research Institute Conference, The frontal lobes, Toronto, Canada, 22 Mar - 26 Mar, 2010. Presentation Type: Poster Presentation Topic: Neurorehabilitation Citation: Hall GB, MacQueen GM, McKinnon MC and Meusel L (2010). Improvement in memory deficits following computer assisted cognitive remediation in patients with a mood disorder. Conference Abstract: The 20th Annual Rotman Research Institute Conference, The frontal lobes. doi: 10.3389/conf.fnins.2010.14.00109 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 29 Jun 2010; Published Online: 29 Jun 2010. * Correspondence: L. Meusel, St. Joseph's Healthcare, Mood Disorders Program, Hamilton, Canada, lmeusel@stjoes.ca Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers G. B Hall G. M MacQueen M. C McKinnon L. Meusel Google G. B Hall G. M MacQueen M. C McKinnon L. Meusel Google Scholar G. B Hall G. M MacQueen M. C McKinnon L. Meusel PubMed G. B Hall G. M MacQueen M. C McKinnon L. Meusel Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Early and intensive rehabilitation predicts good functional outcomes in patients admitted to the stroke intensive care unit

Purpose. Earlier and more intense rehabilitation benefit stroke patients. Yet, studies have caution intensive therapy during acute brain injury. This study examined the rehabilitation commencement time and intensity as predictors of functional outcomes in acute stroke patients admitted to the stroke intensive care unit (ICU).Method. Sociodemographic, medical, rehabilitative and functional data were collected on 154 acute stroke patients. Regression analyses were used to identify predictors for the basic activities of daily living (Barthel Index, BI) and the walking ability at discharge.Result. Rehabilitation commencement time and intensity significantly predicted the BI score at discharge after adjusting for initial severity (National Institute of Health Stroke Scale, NIHSS) and age (p < 0.05). For the walking function at discharge, only the rehabilitation intensity was a significant predictor after adjusting for initial severity and age (p < 0.05). Furthermore, with increasing rehabilitation intensity, patients with severe stroke benefited more than those with moderate stroke.Conclusion. Rehabilitation commencement time and intensity, after adjusting for admission functional status and severity of stroke, remained to be important predictors of stroke functional outcomes. This study supported the recommendation to commence rehabilitation early and intensively and provided evidence that this claim can be extended to acute stroke patients admitted to an ICU.

Anaemia and its treatment in neurologically critically ill patients: being reasonable is easy without prospective trials

Most healthy humans have a haemoglobin concentration of 12 to 15 g/dL and most intensivists now transfuse packed red blood cells for haemoglobin <7 g/dL. Higher haemoglobin is associated with improved intermediate and clinical outcomes after subarachnoid hemorrhage (from ruptured brain aneurysm) or neurotrauma. An observational study in a recent issue shows that higher haemoglobin was associated with better functional outcomes in patients with spontaneous intracerebral haemorrhage; few patients received a packed red blood cell transfusion, so it is not known if that treatment is better than the disease. The mechanism of anaemia's purported impact on outcome is unclear, although altered metabolism in brain tissue that is sensitive to reduced oxygen delivery is plausible. These data may intensify the differences of opinion between intensivists: whether neurologic patients are better served by higher haemoglobin and potentially by more packed red blood cell transfusion, or simply need to be studied more in prospective clinical trials, remains unclear.

Prospective evaluation of comorbidity and psychosocial need in children and adolescents with anorectal malformation. Part one: paediatric surgical evaluation and treatment of defecating disorder

Anorectal malformations represent a continuing challenge for the paediatric surgeon. Faecal and urinary incontinence can occur even with an excellent anatomic repair. We undertook a prospective evaluation of comorbidity and psychosocial needs in children and adolescents with anorectal malformation to test the hypothesis whether psychosocial workup in concert with an improved continence situation would lead to a better functional outcome in patients suffering from defecating disorders. Treatment of defecating disorder was based on differentiation between overflow pseudo-incontinence and true faecal incontinence. Patients who presented with soiling regardless of the type of anomaly were included in the study: 44 patients were investigated, 14 patients did not meet the criteria of the study, 30 patients aged 4-18 were evaluated. The surgical diagnostic program comprised a careful clinical history, physical examination, exact classification of the malformation, evaluation for associated defects, stool protocol. Patients were grouped in two different management programs according to their continence situation. Patients with pseudo-incontinence were treated with enemas, diet, anal hygiene, behavioural therapy and physiotherapy. Patients with true faecal incontinence were included in a bowel management program: 28 patients were free of symptoms of soiling after 3 days of hospital treatment and remained free of symptoms 6 months and 1 year later at re-evaluation. Two patients did not follow the therapeutic regime and therefore did not show an improved condition concerning soiling in the long run. Differentiating between overflow pseudo-incontinence and true faecal incontinence is the basis of an effective treatment of defecating disorders. All patients born with anorectal malformation can be kept clean of stool if they are subjected to an adequate treatment. A multidisciplinary approach is a valuable supplement to standard therapy.

Long-term Experience with Chiari's Osteotomy

Fifty-six years after the introduction of Chiari's pelvic osteotomy, we report the long-term function scores and radiographic grade of osteoarthritis in 66 patients with 80 pelvic osteotomies with a minimum followup time of 27 years (average, 32 years; range, 27-48 years). These 66 patients were those who could be contacted and who returned for a followup visit from among 450 patients operated between 1961 and 1981. Thirty-two hips (40%) in 28 patients had undergone a total joint arthroplasty after an average 26 years (range, 13-41 years). Forty-eight hips in 41 patients (60%) were not replaced, their Harris hip score being a median of 82 points (range, 37-100 points). For the 22 patients for whom we had complete radiographs the average preoperative CE angle was 11.6 degrees, 48.6 degrees (range, 31 degrees-82.8 degrees) immediately postoperatively, and 41.6 degrees (range, 13.7 degrees-90 degrees) at last followup . Despite a functional hip score in most patients retaining their native hip, the degree of osteoarthritis progressed at last followup. We observed a similar mean age at the time of osteotomy in patients converted to total hip arthroplasty and those retaining their native hip. Age at time of surgery was inversely correlated (r = -0.78) with the interval between the osteotomy and THA. In this select patient group we found good functional outcome in patients who underwent Chiari pelvic osteotomy, with a conversion rate of 40% to total hip arthroplasty a mean of 32 years after the procedure. Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Functional Outcome Study of Mega-Endoprosthetic Reconstruction in Limbs With Bone Tumour Surgery

Amputation is no longer the sole contribution of the orthopaedic surgeon to the management of primary bone tumours. Improvements in the design of endoprostheses and surgical reconstructive techniques have combined with advances in chemotherapeutic regimens to result in surgical procedures for salvaging limbs with aggressive sarcomas and in limb reconstruction. This has made limb salvage a viable alternative to amputation in many cases. The aim of this study was to evaluate functional outcome and complications of patients with primary bone tumours who were treated with re-section and mega-endoprosthetic replacement. Nineteen patients with bone tumours were retrospectively reviewed. These patients had wide local re-section and mega-endoprosthetic reconstruction performed between 1999 and 2006 in a tertiary hospital. Functional evaluation was performed based on the Musculoskeletal Tumour Society (MSTS) scoring system, with numerical values from 0 to 5 points assigned for each of the following 6 categories: pain, function, emotional acceptance, use of supports, walking ability and gait. These values were added, and the functional score was presented as a percentage of the maximum possible score. Complications were also analysed. The final mean functional score was 78.3% +/- 16.6%. Eight patients had complications related to surgery, including infection and subluxation of hip implant. Six patients had infection, while 2 had subluxation of hip implants. Infection was a common complication in our study. None had implant breakage, loosening or fracture. We found no statistical difference in the functional outcome between upper limb and lower limb procedures, and between hip and knee procedures. T-test also showed no evidence of gender differences in functional outcome. Kaplan-Meier survival analysis revealed the mean survival duration of megaprosthesis to be 75.6 months. Mega-endoprosthetic reconstruction in limb salvage provides good functional outcome in patients with bone tumours. The early results from patients treated with mega-endoprosthesis have been encouraging.

High initial systolic and diastolic BP is associated with good functional outcome in patients with ischaemic stroke receiving nimodipine,

High initial systolic and diastolic BP is associated with good functional outcome in patients with ischaemic stroke receiving nimodipine,

Rescue use of abciximab improves regional left ventricular function after early incomplete reperfusion in acute myocardial infarction.

Abciximab was shown to have important beneficial effects beyond the maintenance of epicardial coronary artery patency. However, it remains uncertain whether abciximab may lead to a better functional outcome in patients with acute myocardial infarction (AMI) and with incomplete reperfusion after primary angioplasty (PA). The study aimed to evaluate whether rescue use of abciximab may lead to a better functional outcome in such patients. The study included 25 patients with first AMI who met the following criteria: (1) total occlusion of the infarct-related artery, (2) PA within 12 h of symptom onset, (3) postprocedural diameter stenosis < 30%, and final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2. Echocardiographic examination was performed before and on Days 7 and 30 after PA. The study population was divided into two groups: Group 1 (usual care, n = 13) and Group 2 (rescue use of abciximab, n = 12). Baseline characteristics were similar between the two groups. Peak level of creatine kinase was higher in Group 1 than in Group 2 (5,800+/-2,700 vs. 3,800+/-2,000 U/I, p < 0.05). At 1 month follow-up, infarct zone wall motion score index (2.71+/-0.26 vs. 2.05+/-0.63, p < 0.01) and left ventricular (LV) volume indices were smaller in Group 2 than in Group 1, whereas LV ejection fraction was higher in Group 2 than in Group 1 (52.1+/-7.8 vs. 42.1+/-6.4, p < 0.01). At 1-month, abciximab was the only independent predictor of wall motion recovery index by multiple regression analysis. Rescue use of abciximab may reduce the infarct size in patients with AMI and TIMI grade 2 flow after PA, which may improve the recovery of regional LV function.