Guidelines For Healthcare Professionals Research Articles

The Role of the Acute Occupational Therapist in Patients Returning to Driving

Abstract Background Drving evaluation is a complex process in which Occupational Therapists (OTs) are often viewed as ideally suited to assist with given our extensive cognitive and upper limb assessments and interventions. As per National Guidelines, health professionals have an ethical obligation, and potentially a legal one, to give clear advice to the driver in cases where an illness or injury may elevate risk of impairment while driving. At present, a pathway does not exist to guide OTs on the extent of our role in supporting patients who plan to return to driving; thus, it remains unclear what is current practice for OTs working in the acute setting. Methods We completed a cross-sectional survey to determine current practice among the Dublin Academic Teaching Hospitals. Results 42 occupational therapists across 9 different specialities with varying levels of experience, from new staff grade to clinical specialists responded to the survey. The survey identified several commonly perceived areas of ambiguity for acute OTs, including, (1) if their workplace has a policy or pathway on the subject and, (2) the Road Safety Authority’s Guidelines for healthcare professionals in relation to medical fitness to drive. It highlighted a lack of knowledge in relation to onward services OTs can and/or should be linking their patients with for outpatient follow-up. Conclusion It is evident that there is a distinct lack of knowledge among acute OTs in our role in patients returning to driving following an inpatient admission. Additionally, it highlights a need for a resource to bridge this gap and for future work in building a clinical pathway to minimize ambiguity in this area and ensure we are delivering a service that is both legally and morally sound and fulfilling our duty of care.

Guidelines for Seizure Prophylaxis in Adults Hospitalized with Moderate-Severe Traumatic Brain Injury: A Clinical Practice Guideline for Health Care Professionals from the Neurocritical Care Society.

There is practice heterogeneity in the use, type, and duration of prophylactic antiseizure medications (ASMs) in patients with moderate-severe traumatic brain injury (TBI). We conducted a systematic review and meta-analysis of articles assessing ASM prophylaxis in adults with moderate-severe TBI (acute radiographic findings and requiring hospitalization). The population, intervention, comparator, and outcome (PICO) questions were as follows: (1) Should ASM versus no ASM be used in patients with moderate-severe TBI and no history of clinical or electrographic seizures? (2) If an ASM is used, should levetiracetam (LEV) or phenytoin/fosphenytoin (PHT/fPHT) be preferentially used? (3) If an ASM is used, should a long versus short (> 7 vs. ≤ 7days) duration of prophylaxis be used? The main outcomes were early seizure, late seizure, adverse events, mortality, and functional outcomes. We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to generate recommendations. The initial literature search yielded 1998 articles, of which 33 formed the basis of the recommendations: PICO 1: We did not detect any significant positive or negative effect of ASM compared to no ASM on the outcomes of early seizure, late seizure, adverse events, or mortality. PICO 2: We did not detect any significant positive or negative effect of PHT/fPHT compared to LEV for early seizures or mortality, though point estimates suggest fewer late seizures and fewer adverse events with LEV. PICO 3: There were no significant differences in early or late seizures with longer versus shorter ASM use, though cognitive outcomes and adverse events appear worse with protracted use. Based on GRADE criteria, we suggest that ASM or no ASM may be used in patients hospitalized with moderate-severe TBI (weak recommendation, low quality of evidence). If used, we suggest LEV over PHT/fPHT (weak recommendation, very low quality of evidence) for a short duration (≤ 7days, weak recommendation, low quality of evidence).

Step forward towards treat-to-target management of giant cell arteritis: patients stratification aiming to targeted remission – updated guidelines

BackgroundThe aim of this work is to develop guidelines for health care professionals in the giant cell arteritis diagnosis and management, based on patients’ stratification and targeted outcome measures.ResultsFourteen expert panel had completed the two rounds surveys. After the end of round two, twenty three recommendations were released distributed on 8 domains. The percentage of the agreement on the recommendations was 76.9% to 100%. All 23 key questions were answered at the end of the second round with agreement upon.ConclusionPatient stratification facilitate the initiation of an appropriate management approach for patients with giant cell arteritis aiming at achieving targeted disease remission state and prevention of visual loss and/or development of ischaemic events. Treat to Target approach is a new concept in giant cell arteritis management which aims to provide tight control to achieve and maintain disease remission. This work defined the treatment targets in relation to the disease stage.

A unique collaborative model providing supportive and self-advocacy tools to the rare disease community

The National Ehlers-Danlos Syndromes (EDS) service is a highly specialised NHS commissioned service for diagnosing and supporting people with a rare, monogenic type of EDS. The service consists of a team of medical specialists and genetic counsellors. The EDS service has strong ties with national and international EDS charities, and together they participate in working and strategy groups alongside patients and carers. Acquired funding for research means that the service contributes to international knowledge regarding diagnosis and management of rare, monogenic EDS types. As a result of being a highly specialised service, there are multiple points of contact with patients, providing frequent opportunities for feedback. Patient data, surveys and collaborative working have enabled the development not only of extensive information resources and self-advocacy tools for patients, but also guidelines for health care professionals on the best ways to support their rare disease patients. The main challenges faced by patients affected by rare disease and the importance of self-advocacy are discussed, with the highly specialised National EDS service and the patients seen in this service as an example. The recommendations from this unique collaborative model include eight specific domains of self-advocacy: increasing knowledge of rare disease, taking care of mental well-being, taking care of physical well-being including routine care, the development of good working relationships between patients and health care professionals, information accessibility, emergency preparedness, taking part in education and outreach, and involvement in research and feedback opportunities. The service aims to be an example of patient-centred innovation and progress, providing a patient-focused supportive model that can be adapted by the rare disease community and other health care professionals.

Optimizing Chest Trauma Management: Strategies and Guidelines

Introduction; Chest trauma, resulting from both blunt and penetrating mechanisms, poses a significant health threat, and its management demands precise strategies and adherence to established guidelines. This presentation introduces a comprehensive presentation on optimizing chest trauma management, delving into essential strategies and guidelines for healthcare professionals.
 The presentation begins by outlining the various types and mechanisms of chest trauma, such as blunt and penetrating injuries, with a focus on their significance and prevalence in healthcare settings.
 Subsequently, the initial assessment of chest trauma patients takes center stage. This involves a primary survey encompassing airway assessment and management, breathing assessment and intervention, circulation assessment and resuscitation, disability assessment, and environmental control. It continues with a secondary survey, including history-taking and a detailed physical examination, accompanied by diagnostic modalities like chest X-rays, computed tomography scans, ultrasound, and arterial blood gas analysis.
 The presentation then proceeds to address specific chest trauma injuries, including rib fractures, flail chest, pneumothorax, hemothorax, cardiac injuries, pulmonary contusion, and tracheobronchial injuries. The various management approaches are discussed, ranging from pain management, oxygen therapy, chest tube placement, surgical interventions, cardiac tamponade management, to controlling massive hemorrhage.
 Additionally, it highlights complications and outcomes related to chest trauma, including long-term effects, rehabilitation, and follow-up. The critical role of prevention, pre-hospital care, and guidelines and protocols such as Advanced Trauma Life Support (ATLS) and those from the Eastern Association for the Surgery of Trauma (EAST) are emphasized.
 Real-life case studies are presented to provide practical insights into chest trauma management, ensuring a comprehensive understanding of the topic.
 In conclusion, the abstract emphasizes the significance of early recognition, appropriate management, and continuous education and training in chest trauma cases to optimize patient outcomes.
 This presentation offers a holistic perspective on chest trauma management and equips healthcare professionals with the knowledge and tools to enhance the care provided to patients with chest trauma.

Clinical guideline highlights for the hospitalist: 2022 American Heart Association/American Stroke Association Guideline for the management of patients with spontaneous intracerebral hemorrhage.

2022 Guideline for the Management of Patients with Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association RELEASE DATE: May 2022 PRIOR VERSION: Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association 2015 DEVELOPER: American Heart Association and American Stroke Association FUNDING SOURCE: None TARGET POPULATION: Adult Patients with Spontaneous Intracerebral Hemorrhage.

Abstract TP53: Geomagnetic Storms Do Not Predict The Occurrence Of LVO Stroke Clusters Necessitating Endovascular Intervention

Intro: Space weather induced geomagnetic storms have been associated with an increased risk of stroke occurrence. Data on image-proven, temporally related large vessel occlusion stroke (LVO) and geomagnetic storms are lacking. We sought to investigate this potential association to determine whether space weather forecasts can be used to predict incoming cluster events. Methods: Data from a Comprehensive Stroke Center were collected from January 1, 2017, to April 15, 2022. Space weather data were downloaded from the World Data Centre for Geomagnetism, Kyoto homepage (http://wdc.kugi.kyoto-u.ac.jp/kp/index.html#LIST) The indications for mechanical endovascular reperfusion (MER) were in accordance with the Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Univariate binary logistic regression was performed to assess the potential associations between space weather data and LVO MER cases with 48 hour lag effect. Geomagnetic activity was defined by the National Oceanic and Atmospheric Administration’s (NOAA) Space Weather Prediction Centre (SWPC) space weather scales. Results: Of the 1931 days included in this study, there were 538 (27.86%) days with at least one LVO MER (450 (23.3%) with 1, 81 (4.19%) with 2, and 7 (0.36%) with 3. There were 1784 days without geomagnetic storm activity and 147 days with minor to severe storms. 290 MER cases occurred out 1014 days of minimal activity (28.6%) 133 MER cases out 497 days of unsettled activity (26.76%) 0.91(0.72-116), 78 MER cases out of 273 days of active activity (28.57%) 1.00(0.74-1.34), 25 MER cases out 109 days of minor storm (22.94%) 0.74(0.47-1.19) and 12 MER cases out of the 38 days of moderate to extreme storms (31.58%) 1.15(0.57-2.31) p-value 0.697. Conclusion: There was no statistically significant association with geomagnetic storms and the occurrence of large vessel stroke interventions taking into consideration a 48 hour lag effect. Comprehensive stroke center readiness is of utmost importance, but space weather forecasts are unlikely to be helpful in predicting LVO stroke cluster events.

Mobile Health Apps for the Control and Self-management of Type 2 Diabetes Mellitus: Qualitative Study on Users’ Acceptability and Acceptance

Mobile health apps are promising tools to help patients with type 2 diabetes mellitus (T2DM) improve their health status and thereby achieve diabetes control and self-management. Although there is a wide array of mobile health apps for T2DM available at present, apps are not yet integrated into routine diabetes care. Acceptability and acceptance among patients with T2DM is a major challenge and prerequisite for the successful implementation of apps in diabetes care. This study provides an in-depth understanding of the perceptions of patients with T2DM before use (acceptability) and after use (acceptance) regarding 4 different mobile health apps for diabetes control and self-management. A descriptive qualitative research design was used in this study. Participants could choose 1 of the 4 selected apps for diabetes control and self-management (ie, Clear.bio in combination with FreeStyle Libre, mySugr, MiGuide, and Selfcare). The selection was based on a systematic analysis of the criteria for (functional) requirements regarding monitoring, data collection, provision of information, coaching, privacy, and security. To explore acceptability, 25 semistructured in-depth interviews were conducted with patients with T2DM before use. This was followed by 4 focus groups to discuss the acceptance after use. The study had a citizen science approach, that is, patients with T2DM collaborated with researchers as coresearchers. All coresearchers actively participated in the preparation of the study, data collection, and data analysis. Data were collected between April and September 2021. Thematic analysis was conducted using a deductive approach using AtlasTi9. In total, 25 coresearchers with T2DM participated in this study. Of them, 12 coresearchers tested Clear, 5 MiGuide, 4 mySugr, and 4 Selfcare. All coresearchers participated in semistructured interviews, and 18 of them attended focus groups. Personal health was the main driver of app use. Most coresearchers were convinced that a healthy lifestyle would improve blood glucose levels. Although most coresearchers did not expect that they need to put much effort into using the apps, the additional effort to familiarize themselves with the app use was experienced as quite high. None of the coresearchers had a health care professional who provided suggestions on using the apps. Reimbursement from insurance companies and the acceptance of apps for diabetes control and self-management by the health care system were mentioned as important facilitating conditions. The research showed that mobile health apps provide support for diabetes control and self-management in patients with T2DM. Integrating app use in care as usual and guidelines for health care professionals are recommended. Future research is needed on how to increase the implementation of mobile health apps in current care pathways. In addition, health care professionals need to improve their digital skills, and lifelong learning is recommended.

Efficacy and safety of fire needle combined with cupping for acute herpes zoster and postherpetic neuralgia: A protocol for systemic review and meta-analysis.

Herpes zoster and post-herpetic neuralgia showed an increasing incidence during past two decades. Most of herpes zoster and post-herpetic neuralgia patients suffered from pain, anxiety, and depression. Fire needle combined with cupping is becoming a popular way to relieve the pain caused by herpes zoster and decrease the incidence of post-herpetic neuralgia. In this study, we aim to investigating the efficacy and safety of fire needle combined with cupping for the treatment of acute herpes zoster and postherpetic neuralgia (PHN). The literature search will be carried out in following databases: PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data. Published and unpublished controlled trials compared fire needle combined with cupping to other treatments for acute herpes zoster or PHN will be included. Data from eligible studies will be extracted by 2 independent reviewers. Different scales will be used to assess the risk of bias based on the study design. Pain intensity and PHN are primary outcomes. The final effect size will be reported using 95% confidence interval at 0.05 significance level. This review will provide certain evidence to compare the efficacy and safety of combined acupuncture and cupping with guideline recommended drug or nerve block therapy for the treatment of herpes zoster and post-herpetic neuralgia. It will potentially provide more clinical suggestions and guidelines for health care professionals, policymakers, and researchers.

Amputation and prosthetics of the lower extremity: The 2020 Dutch evidence-based multidisciplinary guideline.

Lower-limb amputations are rare but debilitating events in the lives of affected persons. Treatment of persons with amputation inherently involves many different health care professions at different stages leading to and after an amputation. There are prevailing clinical questions within the work field related to different facets of care including peri/postoperative aspects, prosthetic components, rehabilitation treatment, and health care processes. To provide an up-to-date multidisciplinary evidence-based guideline for health care professionals involved in the treatment of persons with lower-limb amputation in the Netherlands. Identification of key questions in a focus group, systematic review of the evidence (up to March 2019, using Embase and MEDLINE databases), and weighing considerations, culminating in clinical recommendations. Twelve key questions were formulated. Recommendations of two key questions were upheld in line with the previous 2012 guideline. Ten systematic literature searches were performed, leading to the inclusion of 59 studies. A summary of evidence-based conclusions, considerations, and recommendations of the 2020 guideline is presented.

Development of humanistic nursing practice guidelines for stroke patients.

PurposeTo construct humanistic nursing practice guidelines suitable for stroke patients.DesignThis study was a development and validation study of guidelines using multiple methods, including literature review, qualitative research, questionnaire survey, thematic discussion, and Delphi expert consultation.MethodsTwenty-five experts from seven provinces and municipalities in China were interviewed over two rounds from December 2020 to February 2021. The first-level index was scored for importance and rationality, while the second-level index was scored for importance and feasibility using a five-point Likert scale. Delphi data was collected via a paper version of the questionnaire. The coefficients of variation and coordination were used to represent the degree of dispersion of expert opinions.FindingsIn the two rounds of letter consultation, the questionnaire's recovery and effective rates were both 100%, while the opinion submission rates of the two rounds were 84 and 52%, respectively. Moreover, the expert authority coefficient was 0.91, and the coordination coefficients of expert opinions in the first round were as follows: importance of 0.03 and rationality of 0.07 for the first-level index; importance of 0.09 and feasibility of 0.11 for the secondary index. In round two, the coordination coefficients of expert opinions were as follows: importance of 0.04 and rationality of 0.05 for the first-level indicators; importance of 0.12 and feasibility of 0.10 for the secondary index. The results for the secondary index were P < 0.001 for the two rounds. The humanistic nursing practice guidelines for stroke patients that were ultimately formed included five first-level indicators (physiological care, safety care, emotional care, dignity care, and rehabilitation needs) and 46 s-level indicators.ConclusionOur results show that the “Practice Guidelines for Humanistic Nursing for Stroke” established by experts adopts Maslow's hierarchy of needs as its structural framework. It meets people's basic needs and can provide a reference for the construction of a humanistic nursing specialty practice for stroke patients.Clinical relevanceHumanistic nursing guidelines for stroke could provide a reference for the construction of humanistic nursing practice in the stroke specialty.Clinical resourcesCopeptin and long-term risk of recurrent vascular events after transient ischemic attack and ischemic stroke: population-based study https://pubmed.ncbi.nlm.nih.gov/26451023/. Effectiveness and usage of a decision support system to improve stroke prevention in general practice: a cluster randomized controlled trial https://pubmed.ncbi.nlm.nih.gov/28245247/. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association https://pubmed.ncbi.nlm.nih.gov/27145936/.

M1, M2: Time to Bid Adieu!

M1, M2: Time to Bid Adieu!

Commentary on “Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists versus Neurointerventional Physicians”

The article “Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists versus Neurointerventional Physicians” addresses an important and controversial issue of whether nonneuroscience interventional physicians should be performing stroke thrombectomy ( 1 Sacks D. Dhand S. Hegg R. et al. Outcomes of stroke thrombectomy performed by interventional radiologists versus neurointerventional physicians. J Vasc Interv Radiol. 2022; 33: 619-626 Google Scholar ). There is convincing evidence that stroke thrombectomy improves the clinical outcomes of large vessel occlusion (LVO) anterior circulation strokes and that it is cost effective ( 2 Powers W.J. Rabinstein A.A. Ackerson T. et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50: e344-e418 Crossref PubMed Scopus (1847) Google Scholar , 3 Bulwa Z. Chen M. Stroke center designations, neurointerventionalist demand, and the finances of stroke thrombectomy in the United States. Neurology. 2021; 97: S17-S24 Crossref PubMed Scopus (2) Google Scholar ). This article provides data to support the position that interventional radiology (IR) physicians with additional training can achieve technical and clinical outcomes similar to those obtained by neurointerventional (NI) physicians. We do not take sides in this controversy. The purposes of this commentary are to appraise the current article critically, to examine its potential implications, and to provide an update on the issues of the supply of, demand for, and access to stroke thrombectomy. Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists versus Neurointerventional PhysiciansJournal of Vascular and Interventional RadiologyVol. 33Issue 6PreviewTo test the hypothesis that interventional radiologists (IRs) and neurointerventional (NI) physicians have similar outcomes of endovascular stroke thrombectomy (EVT), which could be used to improve the availability of thrombectomy. Full-Text PDF

Women Caring for Husbands Living with Parkinson's Disease: A Phenomenological Study Protocol.

Parkinson’s disease (PD) is an emerging pandemic caused by aging, longevity, and industrialization. Most people diagnosed with PD initially experience mild symptoms, but over time the symptoms become debilitating. Given their intensive care requirement, most married people living with PD receive care from their spouses; most are female caregivers. Because caregiving is hard work with long hours, caregivers experience stress, fatigue, and depression, often leading to exhaustion and burnout. The purpose of this descriptive phenomenological study is to understand the lived experience of women caregivers of husbands living with PD. As part of this study protocol, women caring at home for their husbands diagnosed with PD will be purposely recruited from the Colorado Parkinson Foundation. Semi-structured interviews will be conducted by Zoom© until data saturation is achieved. Colaizzi’s seven-step process will be used to analyze the data in Atlas.ti. Strategies have been incorporated into the study protocol to maximize trustworthiness and to insure methodological rigor. The study will be reported using recommendations from the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research. Findings from this study may guide intervention development to improve the caregiving experience and to inform clinical practice guidelines for health care professionals.

Nutrition in acute stroke management: food for thought

Nutrition is crucial in the management of patients with acute stroke. 1 Dziewas R Michou E Trapl-Grundschober M et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6: LXXXIX-LXXCXV Crossref PubMed Scopus (0) Google Scholar Clinical features putting patients at risk of malnutrition include dysphagia, impaired consciousness, perception deficits, and cognitive dysfunction. Being malnourished or at risk of malnutrition on admission to hospital after stroke is linked with poor functional outcomes and mortality, and worsening of nutritional status during the acute stage post-stroke is associated with similar adverse outcomes. 2 Dennis M Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke. 2003; 34: 1450-1456 Crossref PubMed Scopus (0) Google Scholar Therefore, guidelines dedicated to acute stroke care generally include nutritional management. 1 Dziewas R Michou E Trapl-Grundschober M et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6: LXXXIX-LXXCXV Crossref PubMed Scopus (0) Google Scholar , 3 Powers WJ Rabinstein AA Ackerson T et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50: e344-e418 Crossref PubMed Scopus (1816) Google Scholar , 4 Boulanger JM Lindsay MP Gubitz G et al. Canadian stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 6th edition, update 2018. Int J Stroke. 2018; 13: 949-984 Crossref PubMed Scopus (154) Google Scholar , 5 Burgos R Bretón I Cereda E et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr. 2018; 37: 354-396 Summary Full Text Full Text PDF PubMed Scopus (175) Google Scholar The guideline for the diagnosis and treatment of post-stroke dysphagia from the European Stroke Organization and European Society for Swallowing Disorders, for example, recommends early enteral nutrition via a nasogastric tube if sufficient oral nutrition is not possible. 1 Dziewas R Michou E Trapl-Grundschober M et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6: LXXXIX-LXXCXV Crossref PubMed Scopus (0) Google Scholar This recommendation relies mainly on the second substudy of the Feed or Ordinary Diet (FOOD) trial, in which 859 patients with dysphagia after stroke were randomly assigned to either early tube feeding or delayed feeding starting later than 7 days after random assignment. Allocation to early tube feeding was associated with a non-significant reduction in mortality by 5·8% (there were 182 deaths in 429 patients randomly assigned to early tube feeding vs 207 deaths in 430 patients in the delayed feeding group; p=0·09). There were no differences in other outcomes, including severe disability or death (339 of 429 patients in the early-feeding group vs 344 of 430 patients in the delayed feeding group; p=0·7), pneumonia (132 of 429 patients in the early-feeding group vs 133 of 430 patients in the delayed feeding group; p>0·9), and percutaneous endoscopic gastrostomy placement at follow-up (30 of 429 patients in the early-feeding group vs 23 of 430 patients in the delayed feeding group). 6 Dennis M Lewis S Cranswick G Forbes J FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technol Assess. 2006; 10: 1-120 Crossref Google Scholar Safety and efficacy of three enteral feeding strategies in patients with severe stroke in China (OPENS): a multicentre, prospective, randomised, open-label, blinded-endpoint trialIn the early phase of severe stroke, modified full enteral nutrition or hypocaloric enteral nutrition did not significantly reduce the risk of a poor outcomes compared with full enteral nutrition over a 90-day period. Hypocaloric enteral nutrition might be associated with increased mortality compared with modified full enteral nutrition. Further studies are needed to investigate whether modified full enteral nutrition might be the optimal strategy. Full-Text PDF

Do guidelines for care practice address the stability of home-based care arrangements for people with dementia?-A document analysis

The care of people with dementia (PwD) living at home is mainly provided by family carers who intend to maintain care at home for as long as possible. In the DZNE-SoCA project, amiddle range theory of stability of home-based care arrangements for people living with dementia (SoCA-Dem theory) has been developed. The theory helps to understand the complex phenomenon of stability, provides atheoretical framework that can guide future research and can be used for the (further) development of home care structures. The aim of this substudy of the SoCA project was to examine whether the SoCA-Dem theory can guide German health and social care practice in dealing with family carers of PwD. The two guidelines for healthcare professionals, the concept of the Centre for Quality in Care (ZQP) "Quality framework for counselling in care" and the DEGAM guidelines for general practitioners "Family carers of adults", were evaluated using acontent analysis with respect to the SoCA-Dem theory. Most concepts that constitute stability are addressed in both guidelines. The SoCA-Dem theory illustrates the importance of the interaction between the different concepts for the stability of home-based care arrangements. In the guidelines, the dynamic interplay remains unclear. The SoCA-Dem theory seems to be compatible with the German health care context and can support afuture shift from astress-oriented view of giving care to amore comprehensive one.

Beliefs and Experiences of Individuals Following a Zero-Carb Diet.

The adoption of carbohydrate-restrictive diets to improve health is increasing in popularity, but there is a dearth of research on individuals who choose to severely restrict or entirely exclude carbohydrates. The present study investigated the beliefs and experiences of individuals following a diet that severely limits, or entirely excludes, dietary carbohydrates, colloquially known as a ‘zero-carb’ diet, for at least 6 months. Zero-carb dieters (n = 170) recruited via a social networking site completed an online qualitative survey prompting them to discuss their motives, rationale, and experiences of following a low-carb diet. Transcripts of participants’ responses were analyzed using inductive thematic analysis. Results revealed that participants’ decision to follow a zero-carb diet was driven by health concerns and benefits. Participants expressed a strong social identity and belongingness to online zero-carb communities. Participants reported strong intentions to follow the diet indefinitely. Shortcomings of the diet centered on experienced stigma; lack of support from healthcare providers and significant others; limited access to, and high cost of, foods; and limited scientific data on the diet. Further research into the benefits and shortcomings of zero-carb diets across settings and populations is warranted, and guidelines for healthcare professionals on how to support individuals following a zero-carb diet are needed.

VERTEBRAL ARTERY DISSECTION AND INCIDENTAL FINDING OF FIBROMUSCULAR DYSPLASIA: A CASE REPORT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Fibromuscular Dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease. It is a rare condition that occurs more frequently in middle-aged Caucasian women. Its prevalence is not well known. We present a case of FMD in a man with stroke secondary to dissection of the vertebral artery. Increased reporting of FMD cases in recent studies raises concern about under-diagnosis of the condition. CASE PRESENTATION: A 61-year-old Caucasian male with a past medical history of hypertension presented with dysarthria, extreme disequilibrium, and left-sided headache. The patient had normal strength and sensation in all four extremities and negative cerebellar testing on physical exam. He also had a productive cough upon presentation. Computed tomography (CT) head revealed a 3 cm acute non-hemorrhagic left cerebellar infarction. Computed tomography angiography (CTA) Head and Neck showed evidence of vertebral artery dissection on the left side, including the origin of the left posterior inferior cerebellar artery (PICA). The patient had a trial of cerebral angiogram for the vertebral artery dissection, which showed incidental evidence of FMD in the femoral arteries bilaterally. The patient also had vasospasm with the angiography that resolved post-injection of five milligrams of Verapamil intraarterial, and the procedure was discontinued. He was discharged on aspirin and statin, and anticoagulation starting in two weeks. DISCUSSION: There is no clear consensus on the prevalence of FMD in the general population [1]. However, many studies have assessed the prevalence in different patient populations to be around 3%-4% [2]. The United States Registry of FMD revealed the incidence of dissection of the carotid artery in the FMD patient population to be about 75% [1]. The incidence of dissection of the vertebral artery in patients diagnosed with FMD is much lower, about 17% [1]. The most common manifestations of cervical artery dissection (CeAD) are cerebral infarction and transient ischemic attack (TIA). In FMD patients with ischemic stroke or TIA secondary to CeAD, general guidelines for thrombolysis and thrombectomy should be followed. Most recent guidelines recommend treatment with either an anticoagulant or an antiplatelet agent for at least 3–6 months [3]. Endovascular or surgical repairs are mainly reserved for patients with recurrent ischemia despite initial antithrombotic therapy. CONCLUSIONS: FMD is an intriguing vascular disorder with unclear underlying etiology, challenging manifestations, and complex clinical diagnosis. Increased reporting of FMD cases in recent literature raises concern for underdiagnosis. Furthermore, in our case, FMD was incidentally discovered during a diagnostic procedure to evaluate the vertebral artery dissection. Therefore, we recommend further screening of any patient who presents with cephalo-cervical dissection or aneurysm for underlying FMD. REFERENCE #1: Olin, J.W., Froehlich, J., Gu, X., et al. 2012, "The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients", Circulation, vol. 125, no. 25, pp. 3182-3190. REFERENCE #2: Hendricks, N.J., Matsumoto, A.H., Angle, J.F., et al. 2014, "Is fibromuscular dysplasia underdiagnosed? A comparison of the prevalence of FMD seen in CORAL trial participants versus a single institution population of renal donor candidates", Vascular medicine (London, England), vol. 19, no. 5, pp. 363-367. REFERENCE #3: Powers, W.J., Rabinstein, A.A., Ackerson, et al. "2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association", Stroke, vol. 49, no. 3, pp. e46-e110. DISCLOSURES: No relevant relationships by Elizabeth Mause, source=Web Response No relevant relationships by Mohammad Selim, source=Web Response

Postoperative Stroke after Anterior Cervical Discectomy and Fusion: A Clinical Case Report

Anterior cervical discectomy and fusion (ACDF) spine surgery has been performed extensively for the treatment of degenerative spine diseases with relatively low rates of complications. The reported incidence of postoperative cerebrovascular events associated with ACDF is only 0.13%, representing 1.51% of all complications. However, this complication is often highly disastrous and can lead to paralysis, and even death. In this study, a 42year-old male underwent anterior cervical discectomy and fusion (ACDF) at C34 and C45 levels through a right-sided approach. Three hours after the surgery, the patient suddenly developed left hemiplegia and facial palsy.. The patient was treated with aspirin and cerebromysin and fully recovered from motor and sensory deficits after 1 month.&#x0D; Keywords: Anterior cervical discectomy and fusion, postoperative stroke.&#x0D; References&#x0D; [1] P. S. Romano, D. R. Campa, J. A. Rainwater, Elective Cervical Discectomy in California: Postoperative in Hospital Complications And Their Risk Factors, Spine, Vol. 22, No. 1, 1997, pp. 2677-2692, https://doi.org/10.1097/00007632-199711150-00018.[2] B. S. Chozick, P. Watson, S. H. Greenblatt, Internal Carotid Artery Thrombosis After Cervical Corpectomy, Spine, Vol. 19, 1994, pp. 2230-2232, https://doi.org/10.1097/00007632-199410000-00020.[3] Y. C. Yeh, W. Z. Sun, C. P. Lin et al., Prolonged Retraction on The Normal Common Carotid Artery Induced Lethal Stroke After Cervical Spine Surgery, Spine, Vol. 29, No. 3, 2004, pp. 431-434, https://doi.org/10.1097/01.brs.0000141177.95850.b1.[4] J. E. Loret, P. Francois, C. Papagiannaki, Internal Sarotid Artery Dissection After Anterior Cervical Disc Replacement: First Case Report And Literature Review of Vascular Complications of The Approach, Eur J Orthop Surg Traumatol, Vol. 23, No. 1, 2013, pp. 107-110, https://doi.org/10.1007/s00590-013-1228-8.[5] M. Radhakrishnan, S. Bansal, G. S. Srihari, Perioperative Stroke Following Anterior Cervical Discectomy, Br J Neurosurg, Vol. 24, No. 1, 2010, pp. 592-594, https://doi.org/10.3109/02688691003711575.[6] Q. D. Yue, Carotid Artery Related Perioperative Stroke Following Anterior Cervical Spine Surgery: A Series of 3 Cases and Literature Review, Journal of Stroke And Cerebrovascular Diseases, Vol. 28, No. 2, 2019, pp. 458-463, https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.10.024.[7] E. Matthew, Changes in Carotid Artery Blood Flow During Anterior Cervical Spine Surgery, Spine, Vol. 27, No. 2, 2002, pp. 152-155, https://doi.org/10.1177/2192568216688192.[8] D. C. Brooks, J. L. Schindler, Perioperative Stroke: Risk Assessment, Prevention and Treatment, Curr Treat Options Cardiovasc, Meds, Vol. 16, No. 1, 2014, pp. 282, https://doi.org/10.1007/s11936-013-0282-1.[9] E. C. Jauch, J. L. Saver, J. Adams, Guidelines for The Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from The American Heart Association, American Stroke Association, Vol. 44, No. 1, 2013, pp. 870-947, https://doi.org/10.1161/STR.0b013e318284056a.[10] J. M. Cuellar, A. Petrizzo, R. Vaswani, Does Aspirin Administration Increase Perioperative Morbidity in Patients With Cardiac Stents Undergoing Spinal Surgery, Spine, Vol. 44, No. 1, 2015, pp. 629-635, https://doi.org/10.1097/BRS.0000000000000695.&#x0D; &#x0D;

ORAL ANTICOAGULANTS: CHALLENGES IN PAKISTAN. DO WE HAVE A SOLUTION?

ORAL ANTICOAGULANTS: CHALLENGES IN PAKISTAN. DO WE HAVE A SOLUTION?