Mean Initial Score Research Articles

Implementation of the physical function ICU test tool in a resource constrained intensive care unit to promote early mobilisation of critically ill patients- a feasibility study.

BackgroundThe shift of focus in outcome measures from mortality to assessment of functional status in intensive care unit (ICU) patients has resulted in the emergence of mobilisation of critically ill patients as a standard physiotherapy practice in most medium and high income countries. The aim of this study was to determine the feasibility of an early mobilisation program and to report on the changes in patient clinical outcomes following the intervention in a low income country.MethodsA prospective cohort study was carried out at one public hospital. An adult cohort of 35 patients was recruited within 24 h of being admitted into the unit, irrespective of ventilation method over a period of three months. An early mobilisation programme was implemented and prescribed using the Physical Function ICU Test (PFIT-s) which commenced in either the ICU or high dependent unit.ResultsThe median age of the 35 patients was 29 years (IQR = 24–45 years). More than half of the patients had undergone surgery due to either gastrointestinal problems or obstetrical complications. A total of 94 out of a possible of 219 exercise sessions were delivered to the patients (43.0 %). The tool was implemented in 32 (91.4 %) patients on the initial PFIT-s measurement and 16 (45.7 %) of the patients required the assistance of two people to stand. The Initial PFIT-s mean score was 5.3 ± 1.8. On final PFIT-s measurement, out of the 30 (85.7 %) patients seen, 15 (42.9 %) of the patients did not require any assistance to stand and the final PFIT-s mean score was 7.0 ± 1.9. There was a significant difference in both the initial PFIT-s total score (t-value = 2.34, df = 30, p = .03) and the final PFIT-s score (t-value = 3.66, df = 28, p = .001) between males and females. During the treatment, no adverse event occurred in any of the patients.ConclusionAn early mobilisation program using PFIT-s was feasible and safe. There was a difference in functional capability based on gender, with males being more functionally active. Specific inclusion and exclusion criteria can lead to a delayed early mobilisation activities in ICU patients.Trial registrationPan African Clinical Trials Registry PACTR201408000829202. Registered 15 August 2014.

Integrating palliative care services in oncology clinics: An application of the Edmonton Symptom Assessment System (ESAS).

168 Background: Research inpalliative care has shown improvements in overall survival, quality of life, symptom management, care satisfaction and reductions in the cost of care. Therefore, the American Society of Clinical Oncology has recommended early concurrent palliative care in patients with advanced cancer and with high symptom burden. Despite this recommendation, integrating palliative services at our NCI-designated cancer center has been challenging. The aims of this project were to quantitatively describe the symptom burden of patients in ambulatory oncology clinics; facilitate the establishment of an effective referral system by detecting discrepancies between symptom burden and referral practices; and improve the integration of palliative care services by implementing the Edmonton Symptom Assessment System (ESAS) tool into 5 of our oncology clinics. Methods: ESAS forms consist of 10 questions assessing patient symptom burden and quality of life. Total scores range from 0 to 100. This tool was distributed to patients at two breast, two gastrointestinal and the thoracic clinics at each visit. The provider reviewed the forms and decided if a palliative care referral was appropriate based on patient responses. The forms as well as referral decisions were entered into REDCap. Over a 5 month period, 607 patients completed the initial assessment and 430 follow up forms were collected, resulting in a total of 1,037 scores collected. Results: The mean ESAS score for all patient visits was 20.7 (SD = 18.7). Only 3.5% (n = 21) of all patients were initially referred to palliative care and 2.6% (n = 11) of patients were referred on follow up visits. Those with an initial referral had an initial mean score of 39.0 (SD = 19.0) and a mean follow up score of 31.9 (SD = 19.5). Conclusions: This project highlights the low palliative care consultation rate and the under-utilization of services by most oncologists at the cancer center despite using the ESAS tool. However, those who received a referral had lower ESAS scores at follow-up. We propose utilizing a trigger that would capture a preset percentage of patients who indicated scores reflective of high symptom burden and distress.

Factors influencing the quality of life in traumatic brain injury: Tunisian experience

The aim of this study was to investigate the quality of life of patients with severe traumatic brain injury and their relatives by a visual analogue scale (0–10) and a distress companion score (1–6) and to establish correlations between Glasgow Coma Scale (GCS), Glasgow out scale (GOS), the Functional Independence Measure (FIM) and QOL. Retrospective study conducted in the department of physical and rehabilitation medicine of Kassab Institute of Traumatology and Orthopaedics concerning patients followed for severe traumatic brain injury sequalea. Thirty patients were included in the study. The mean initial GCS score was of 5.74/15. The GOS was of 5 in eleven patients, 4 in eight, and 3 in eleven. The mean FIM was 104/126 (74–126) but dependence in advanced activities was more severe than in elementary activities. The subjective QOL of patients was discretely lower ( m = 4.7/10) than that estimated by close relatives ( m = 5). The relatives QOL was similarly reduced ( m = 4.47). The mean distress accompanying score was 3.7/6. The factors most influencing the patients and relatives QOL were the dependence in the advanced activities and the GOS. The reduction of patient and “relatives” QOL was mainly influenced by functional dependence however, new influencing factors have to be more studied, such as impairment, disability and handicap.

Predictors of poor outcomes in First-Event Ischemic Stroke as assessed by Magnetic Resonance Imaging.

Stroke is the third most common cause of mortality worldwide and is a major cause of permanent disability. The purposed of the study was to better understand the risk factors for poor outcomes following ischemic stroke requiring treatment. Three hundred seventy patients with first-event ischemic stroke were enrolled. Good outcomes was defined as a using the Modified Rankin Scale (MRS) score ≤3 without any cardiovascular event, while poor outcomes were any of the following end points: MRS >3 at 3 months, recurrent stroke or death. Prognostic variables for poor outcomes were analyzed based on a stepwise logistic regression model. Seventy-eight patients had poor outcomes (21%, 78/370), assessed at a minimum of six-month follow-up. Higher mean National Institutes of Health Stroke Scale (NIHSS) scores at presentation, presence of early neurologic deterioration (END) and higher mean high-sensitivity C-reactive protein (hs-CRP) levels were associated with poor outcomes at discharge. Furthermore, both NIHSS at presentation and the presence of END were associated with poor outcomes, assessed at a minimum of six-month follow-up. A higher mean initial NIHSS score implies not only severe neurologic deficits but also an increased risk of poor outcomes. Since END following ischemic stroke is frequently associated with poor outcomes, more attention should be directed to providing adequate treatment to patients in the acute stage, especially for high risk patients.

Stent-Retriever Thrombectomy for Acute Anterior Ischemic Stroke with Tandem Occlusion: A Systematic Review and Meta-Analysis.

To assess the efficacy and safety profile of stent-retriever thrombectomy (SRT) in acute anterior ischemic stroke patients with tandem occlusion. Using the MEDLINE database, we conducted a systematic review and meta-analysis of all studies that included patients with acute ischemic stroke attributable to tandem occlusion who received treatment with SRT between November 2010 and May 2015. The literature search identified 11 previous studies involving a total of 237 subjects out of whom 193 (81.4%) were treated with acute stent placement for the extracranial internal carotid artery occlusion. Mean initial NIHSS score was 17, and median time from onset to recanalization was 283.5min. Mean intravenous thrombolysis rate was 63.8%. In the meta-analysis, the recanalization rate reached 81% (95% CI, 73-89). Meta-analysis of clinical outcomes showed a pooled estimate of 44% (95% CI, 33-55; 10 studies) for favourable outcome, 13% (95% CI, 8-20; 10 studies) for mortality, and 7% (95% CI, 2-13; eight studies) for symptomatic intracranial haemorrhage. SRT with emergency carotid stenting is associated with acceptable safety and efficacy in acute anterior stroke patients with tandem occlusion compared to natural history. However, the best modality to treat proximal stenosis is based on an individual case basis. • Stent retriever thrombectomy of tandem occlusion is efficient and safe. • Emergent carotid stenting during thrombectomy increase symptomatic intracranial haemorrhage without impact mortality. • Thrombectomy of tandem anterior circulation occlusion may be the first therapeutic option.

Relationship between Gyrus Rectus Resection and Cognitive Impairment after Surgery for Ruptured Anterior Communicating Artery Aneurysms.

ObjectiveThe gyrus rectus (GR) is known as a non-functional gyrus; hence, its resection is agreed to be a safe procedure frequently practiced to achieve a better surgical view during specific surgeries. This study aimed at comparing the cognitive outcomes following GR resection in patients who underwent surgery for ruptured anterior communicating artery (ACoA) aneurysms.Materials and MethodsFrom 2012 to 2015, 39 patients underwent surgical clipping for ruptured ACoA aneurysms. Mini-mental state examinations (MMSE) were performed in 2 different periods. The statistical relationship between GR resection and MMSE results was evaluated, and further analysis of MMSE subgroup was performed.ResultsTwenty-five out of the 39 patients (64.19%) underwent GR resection. Mean initial and final MMSE scores in the GR resection group were 16.3 ± 9.8 and 20.8 ± 7.3, respectively. In the non-resection group, the mean initial and final MMSE scores were 17.1 ± 8.6 and 21.9 ± 4.5, respectively. Neither group's scores showed a significant change. Subgroup analysis of initial MMSE showed a significant difference in memory recall and language (p = 0.02) but not in the final MMSE scores.ConclusionThere was no significant relationship between the GR resection and cognitive outcomes in terms of total MMSE scores after surgery for ruptured ACoA aneurysm. However, subgroup analysis revealed a temporary negative effect of GR resection in the categories of language and memory recall. This study suggests that GR resection should be executed superficially, owing to its close anatomical relationship with the limbic system.

Continuous Renal Replacement Therapy for Acute Renal Failure in Patients with Traumatic Brain Injury.

ObjectiveThe purpose of this study was to investigate the impact of continuous renal replacement therapy (CRRT) on survival and relevant factors in patients who underwent CRRT after traumatic brain injury (TBI).MethodsWe retrospectively reviewed the laboratory, clinical, and radiological data of 29 patients who underwent CRRT among 1,190 TBI patients treated at our institution between April 2011 and June 2015. There were 20 men and 9 women, and the mean age was 60.2 years. The mean initial Glasgow Coma Scale score was 9.2, and the mean injury severity score was 24. Kaplan-Meier method and Cox regression were used for analysis of survival and relevant factors.ResultsThe actuarial median survival time of the 29 patients was 163 days (range, 3-317). Among the above 29 patients, 22 died with a median survival time of 8 days (range, 3-55). The causes of death were TBI-related in 8, sepsis due to pneumonia or acute respiratory distress syndrome (ARDS) in 4, and multi-organ failure in 10. Among the various factors, urine quantity of more than 500 mL for 24-hours before receiving CRRT was a significant and favorable factor for survival in the multivariate analysis (p=0.026).ConclusionAccording to our results, we suggest that early intervention with CRRT may be beneficial in the treatment of TBI patients with impending acute renal failure (ARF). To define the therapeutic advantages of early CRRT in the TBI patients with ARF, a well-designed and controlled study with more cases is required.

How to train your surgical assistant? Assessment of "in-service training" program for orthopedic surgical assistants in a rural mission hospital

Context: While lack of physicians and surgeons in rural India has received wide publicity, minimal attention has been spared for lack of ancillary personnel, such as surgical assistants. Personnel with no formal training often play the role of surgical assistant. This study evaluates the efficacy of In-service training of orthopedic surgical assistants in a rural mission hospital. Methodology: A retrospective, one group pre- and post-test experimental study was designed to evaluate the effectiveness of the In-service training program for surgical assistants who participated in orthopedic procedures conducted over a 5-year period (2011-2016), at a rural mission hospital. Data were collected from the hospital's Orthopedic Department database from July 2011 to March 2016. All orthopedic surgical assistants included in the study were classified according to their highest educational qualification and duration of In-service training program. Initial and final level of competence of each orthopedic surgical assistant after In-service training was evaluated. Paired t-test was used for statistical assessment. Results: A total of 1156 orthopedic procedures were carried out from 2011 to 2016. Twenty-eight personnel including nine General Nursing and Midwifery nurses, two Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy doctors, one dentist, one physiotherapist, one MBBS doctor, 12 medical student volunteers and two college graduates participated in In-service training program as orthopedic surgical assistants in the rural mission hospital. The participants had no prior training in operation theater technique or orthopedic procedure. Mean initial competence score was 1.00357 (standard deviation [SD] = 0.1889) and mean final competence score was 3.3928 (SD = 0.9165). This difference was statistically significant with P < 0.00001. Conclusions: In-service training program at the rural mission hospital increased the competence level of orthopedic surgical assistants. This is a novel method to overcome the human resource deficit in rural health-care sector.

Cyclical hypofractionated radiotherapy technique for palliative treatment of locally advanced head and neck cancer: institutional experience and review of palliative regimens.

Effective palliation in patients with locally advanced head and neck cancer is important. Cyclical hypofractionated radiotherapy (Quad Shot) is a short-course palliative regimen with good patient compliance, low rates of acute toxicity, and delayed late fibrosis. To review use of the Quad Shot technique at our institution in order to quantify the palliative response in locally advanced head and neck cancer. The medical records of 70 patients with head and neck squamous cell carcinoma who had been treated with the Quad Shot technique were analyzed retrospectively (36 had been treated with intensity-modulated radiation therapy and 34 with 3-D conformal radiotherapy). They had received cyclical hypofractionated radiotherapy administrated as 14.8 Gy in 4 fractions over 2 days, twice daily, repeated every 3 weeks for a total of 3 cycles. The total prescribed dose was 44.4 Gy. Primary endpoints were improvement in pain using a verbal numeric pain rating scale (range 1-10, 10 being severe pain) and dysphagia using the Food Intake Level Scale, and the secondary endpoints included overall survival (OS), local regional recurrence-free survival (LRRFS), progression-free survival (PFS) and time to progression. Pain response occurred in 61% of the patients. The mean pain scores decreased significantly from pre to post treatment (5.81 to 2.55, 𝑃 = .009). The mean initial dysphagia score improved from 2.20 to 4.77 55 (𝑃 = .045). 26% of patients developed mucositis (≤ grade 2), with 9% developing grade 3-level mucositis. 12 patients had tumor recurrence. The estimated 1-year PFS was 20.7%. The median survival was 3.85 months with an estimated 1-year OS of 22.6%. Pain response (hazard ratio [HR], 2.69; 95% confidence index [CI], I.552-1.77) and completion of all 3 cycles (HR, 1.71; 95% CI, 1.003-2.907) were predictive for improved OS. This study is a retrospective analysis. Quad Shot is an appropriate palliative regimen for locally advanced head and neck cancer.

Initial symptom burden predicts duration of symptoms after concussion.

To determine which variables predict prolonged (>28 days) duration of symptoms after a concussion. We conducted a prospective cohort study of adult (>18yo) patients cared for in a specialty concussion clinic. Symptoms were assessed using the Post-Concussion Symptom Scale (PCSS) developed at the 3rd International Conference on Concussion in Sports. Possible predictors including age, sex, loss of consciousness, amnesia, history of prior concussion, prior treatment for headaches, history of migraines, and family history of concussions, were measured by self-report. We recorded a PCSS score at each clinical visit and defined time to symptom resolution as the number of days between the date of injury and date of last symptoms. Of 64 adult patients included in the study, 53.3% were male; 20.3% reported experiencing a loss of consciousness at the time of injury while 23.4% reported amnesia. Patients ranged in age from 18 to 27 years (mean 21±2 years). Most concussions (92.2%) occurred during sports. The mean initial PCSS score for those suffering symptoms for longer than 28 days was significantly higher than those who symptoms resolved within 28 days (42.5 vs. 19.2, p<0.01). Of all potential predictor variables, only the initial PCSS score was independently associated with the odds of symptoms lasting longer than 28 days (aOR 1.037; 95% CI 1.011, 1.063). Among adult patients with concussions, those with a higher symptom burden after injury have an increased odds of suffering from prolonged symptoms. Other potential predictor variables are not associated with the risk of prolonged recovery.

Changes in At-Risk Boys’ Intrinsic Motivation Toward Physical Activity: A Three-Year Longitudinal Study

Intrinsic motivation (IM) is an important predictor of children’s physical activity participation. The present 3-year longitudinal study examined changes in IM toward physical activity among a group of at-risk boys (N = 92) at a summer sports camp. Results showed the boys were intrinsically motivated in their first camp year, but their IM levels declined throughout 3 years of participation. This decline might be due to insufficient instructor support and repetitively scheduled activities at the camp. There were no ethnic differences in the initial IM mean scores or rates of IM change. Such homogeneity might be attributable to the boys’ similar demographic characteristics. Future research should identify possible causes of declined IM for camp coordinators and instructors to better design and implement sports and physical activities to sustain the boys’ IM.

Do questions help? The impact of audience response systems on medical student learning: a randomised controlled trial

BackgroundAudience response systems (ARSs) are electronic devices that allow educators to pose questions during lectures and receive immediate feedback on student knowledge. The current literature on the effectiveness of ARSs...

The analysis of functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fractures

IntroductionBurst fractures of the low lumbar spine constitute approximately one percent of all lumbar fractures. There is still no consensus on the optimal treatment of low lumbar burst factures. We aimed to evaluate the functional and radiographic outcomes of conservative treatment in patients with low lumbar burst fracture. Methods15 patients (11 males, 4 females; mean age 32±8) who had low lumbar spine burst fracture treated with a custom-moulded thoracolumbosacral orthosis (TLSO) with a thigh extension were enrolled. The mean follow-up period was 22±6 months. 14 patients were neurologically intact and one had isolated nerve root injury. There were 24% type A fractures and 76% type B fractures according to the Denis classification system. Functional outcomes were evaluated by using Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and Visual Analogue Scale (VAS). Radiographic outcome was analyzed by measuring anterior vertebral height loss, kyphosis angle, amount of canal retropulsion. Functional and radiographic outcomes were reviewed initially and at 1, 3, 6, 12 months, and at the latest follow-up. Functional and radiographic improvements were analyzed statistically. ResultsThe mean bracing period was 11.9±1.7 weeks. The mean initial ODI, SF-36, and VAS score of the patients was 78.3±9.6, 23.7±8.9, and 8.7±0.7, respectively. The mean ODI, SF-36, and VAS score of the patients at the final follow-up was 26.4±6.5, 68.1±11.2, and 2.8±1.7, respectively. The improvement in functional outcomes was measured to be significant (p<0.05 for ODI, SF-36 and VAS). The mean initial anterior vertebral height loss, kyphosis angle, amount of canal retropulsion was found to be 27.2%±9.6%, −6.8°±3.2°, 37.4%±10.2%, respectively. The mean anterior vertebral height loss, kyphosis angle, and amount of canal retropulsion at the final follow-up was 23.1%±.6.7%, −4.2°±2.4°, 19.6%±7.7%, respectively. Among the radiographic outcomes, only the amount of canal retropulsion improved statistically (p=0.042). ConclusionConservative treatment using a custom-moulded thoracolumbosacral orthosis with a thigh extension is a safe and effective method in patients with low lumbar spine burst fractures and can improve functional and radiographic outcomes.

Clinical Utility of an Automated Pupillometer in Patients with Acute Brain Lesion.

ObjectiveThe purpose of this study was to evaluate the clinical utility and validity of using a pupillometer to assess patients with acute brain lesions.MethodsPupillary examinations using an automated pupillometer (NeurOptics®NPi™-100 Pupillometer) were performed every 4 hours and were simultaneously assessed using the Glasgow Coma Scale (GCS) and for intracranial pressure (ICP), from admission to discharge or expire in neuro-intensive care unit (NICU). Manual pupillary examinations were also recorded for comparison. By comparing these data, we evaluated the validity of using automated pupillometers to predict clinical outcomes.ResultsThe mean values of the Neurologic Pupillary index (NPi) were different in the groups examined manually. The GCS correlated well with NPi values, especially in severe brain injury patients (GCS below 9). However, the NPi values were weakly correlated with intracranial pressure (ICP) when the ICP was lower than 30 cm H2O. The NPi value was not affected by age or intensity of illumination. In patients with a "poor" prognosis who had a Glasgow Outcome Scale (GOS) of 1 or 2, the mean initial NPi score was 0.88±1.68, whereas the value was 3.89±0.97 in patients with a "favorable" prognosis who had a GOS greater than 2 (p<0.001). For predicting clinical outcomes, the initial NPi value of 3.4 had the highest sensitivity and specificity.ConclusionAn automated pupillometer can serve as a simple and useful tool for the accurate measurement of pupillary reactivity in patients with acute brain lesions.

Physical self-concept and participation in physical activity in college students.

The purpose of this study was to test for reciprocal relations between physical self-concept (PSC) and participation in physical activity (PA). We hypothesized specific bidirectional relations between PSC dimensions (i.e., perceived endurance, sport competence, and strength and body attractiveness) and participation in corresponding types of PA (i.e., aerobic exercise, team or individual sports, and strength training). Data were gathered from a questionnaire administered to 386 college students on two occasions (3-month interval) to assess PSC and participation in PA. Structural equation modeling revealed significant paths between each PSC dimension and a corresponding type of PA. Students reported more frequent participation in a specific PA when their PSC concerning the activity was high. However, participation in a given PA did not predict subsequent PSC in the corresponding PA, suggesting unidirectional effects of previous PSC on subsequent participation in PA. These results suggest that strategies that contribute to reinforce PSC are primordial and should be targeted as key components for designing effective PA behavior change interventions among college students.

Growth curve analyses of the relationship between early maternal age and children’s mathematics and reading performance

Regarding the methods used to examine the early maternal age-child academic outcomes relationship, the extant literature has tended to examine change using statistical analyses that fail to appreciate that individuals vary in their rates of growth. Of the one study I have been able to find that employs a true growth model to estimate this relationship, the authors only controlled for characteristics of the maternal household after family formation; confounding background factors of mothers that might select them into early childbearing, a possible source of bias, were ignored. The authors’ findings nonetheless suggested an inverse relationship between early maternal age, i.e., a first birth between the ages of 13 and 17, and Canadian adolescents’ mean math performance at age 10. Early maternal age was not related to the linear slope of age. To elucidate whether the early maternal age-child academic outcomes association, treated in a growth context, is consistent with this finding, the present study built on it using US data and explored children’s mathematics and reading trajectories from age 5 on. Its unique contribution is that it further explicitly controlled for maternal background factors and employed a three-level growth model with repeated measures of children nested within their mothers. Though the strength of the relationship varied between mean initial academic performance and mean academic growth, results confirmed that early maternal age was negatively related to children’s mathematics and reading achievement, net of post-teen first birth child-specific and maternal household factors. Once maternal background factors were included, there was no statistically significant relationship between early maternal age and either children’s mean initial mathematics and reading scores or their mean mathematics and reading growth.

Study of hypovitaminosis D as a cause of chronic widespread pain in patients presenting to rheumatology clinic

Background and aims: Hypovitaminosis D is common in south-east Asian countries. Deficient vitamin-D level is likely to be associated with chronic muscular pains. We do not have data from our country regarding the magnitude of this problem. Methods: A prospective open labeled study at rheumatology opd from December 2009 to December 2012. Patients with chronic widespread pain and bone pains of &gt;3 months duration were included in the study. Hypothyroidism, chronic renal failure and other rheumatological diagnosis except fibromyalgia were excluded. Visual analogue score (VAS) for pain and serum Vitamin-D levels were measured. Patients with low Vitamin-D were given oral Vitamin-D 60,000IU for 6 months. Response to therapy was evaluated using improvement in VAS. Results: Among 1680 patients, 66?2% were females. Hypovitaminosis-D was seen in 1388(82?6%), of which 27?5% had severe deficiency with Vitamin D levels &lt;10ng/ml. Fibromyalgia overlap present in 25?7%. Mean initial VAS score was 8?7, 8?2 and 7?4 for patients in severe deficiency, mild deficiency and insufficiency group respectively. At 6 months follow-up, the VAS scores were 0, 2?1 and 3?6 respectively. After 6 months of treatment, no improvement was seen in 196 patients (11?6%) and all non-responders had fibromyalgia overlap. Vitamin- D level was checked again in non-responders and repeat vitamin-D levels were still low in 10 of them. Conclusions: Hypovitaminosis-D can be a significant cause of Chronic widespread pain in the general population and seems to aggravate the pain of fibromyalgia. Improvement was rapid and better in severe cases. DOI: http://dx.doi.org/10.3126/jaim.v3i1.10694 Journal of Advances in Internal Medicine 2014;03(01):1-4

AB0290 United States Rheumatologists Who Consistently Measure Disease Activity in Rheumatoid Arthritis (RA) are Achieving Low Disease Activity (LDA) and Remission (R)

BackgroundThe public database JointMan® was launched January 2012 with a mission to provide a practical outcome tool to manage patients with RA in a clinical setting. This was not constructed...

Emergency carotid artery stenting in patients with acute ischemic stroke due to occlusion or stenosis of the proximal internal carotid artery: a single-center experience

BackgroundThe feasibility, safety and effectiveness of emergency carotid artery stenting (eCAS) in patients with acute ischemic stroke (AIS) due to proximal internal carotid artery (ICA) stenosis or occlusion are still...

‘BEING WITH YOU’. EVALUATION OF A NOVEL ‘VOLUNTEER COMPANIONSHIP TRAINING PROGRAMME’ FOR SUPPORTING END-OF-LIFE CARE WITHIN AN ACUTE HOSPITAL SETTING

BackgroundAlthough the value of hospice volunteers is widely recognised, their role within the hospital setting is less established. An end-of-life volunteer companionship programme was established within an UK hospital to...