108 research outputs found
Evaluating the effectiveness of the Emergency Neurological Life Support educational framework in low-income countries.
BackgroundThe Emergency Neurological Life Support (ENLS) is an educational initiative designed to improve the acute management of neurological injuries. However, the applicability of the course in low-income countries in unknown. We evaluated the impact of the course on knowledge, decision-making skills and preparedness to manage neurological emergencies in a resource-limited country.MethodsA prospective cohort study design was implemented for the first ENLS course held in Asia. Knowledge and decision-making skills for neurological emergencies were assessed at baseline, post-course and at 6 months following course completion. To determine perceived knowledge and preparedness, data were collected using surveys administered immediately post-course and 6 months later.ResultsA total of 34 acute care physicians from across Nepal attended the course. Knowledge and decision-making skills significantly improved following the course (p=0.0008). Knowledge and decision-making skills remained significantly improved after 6 months, compared with before the course (p=0.02), with no significant loss of skills immediately following the course to the 6-month follow-up (p=0.16). At 6 months, the willingness to participate in continuing medical education activities remained evident, with 77% (10/13) of participants reporting a change in their clinical practice and decision-making, with the repeated use of ENLS protocols as the main driver of change.ConclusionsUsing the ENLS framework, neurocritical care education can be delivered in low-income countries to improve knowledge uptake, with evidence of knowledge retention up to 6 months
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The Curing Coma Campaign: Framing Initial Scientific Challenges—Proceedings of the First Curing Coma Campaign Scientific Advisory Council Meeting
Abstract: Coma and disordered consciousness are common manifestations of acute neurological conditions and are among the most pervasive and challenging aspects of treatment in neurocritical care. Gaps exist in patient assessment, outcome prognostication, and treatment directed specifically at improving consciousness and cognitive recovery. In 2019, the Neurocritical Care Society (NCS) launched the Curing Coma Campaign in order to address the “grand challenge” of improving the management of patients with coma and decreased consciousness. One of the first steps was to bring together a Scientific Advisory Council including coma scientists, neurointensivists, neurorehabilitationists, and implementation experts in order to address the current scientific landscape and begin to develop a framework on how to move forward. This manuscript describes the proceedings of the first Curing Coma Campaign Scientific Advisory Council meeting which occurred in conjunction with the NCS Annual Meeting in October 2019 in Vancouver. Specifically, three major pillars were identified which should be considered: endotyping of coma and disorders of consciousness, biomarkers, and proof-of-concept clinical trials. Each is summarized with regard to current approach, benefits to the patient, family, and clinicians, and next steps. Integration of these three pillars will be essential to the success of the Curing Coma Campaign as will expanding the “curing coma community” to ensure broad participation of clinicians, scientists, and patient advocates with the goal of identifying and implementing treatments to fundamentally improve the outcome of patients
Advanced cerebral monitoring in neurocritical care
New cerebral monitoring techniques allow direct measurement of brain
oxygenation and metabolism. Investigation using these new tools has
provided additional insight into the understanding of the
pathophysiology of acute brain injury and suggested new ways to guide
management of secondary brain injury. Studies of focal brain tissue
oxygen monitoring have suggested ischemic thresholds in focal regions
of brain injury and demonstrated the interrelationship between brain
tissue oxygen tension (P bt O 2 ) and other cerebral physiologic and
metabolic parameters. Jugular venous oxygen saturation (SjVO 2 )
monitoring may evaluate global brain oxygen delivery and consumption,
providing thresholds for detecting brain hypoperfusion and
hyperperfusion. Furthermore, critically low values of P bt O 2 and SjVO
2 have also been predictive of mortality and worsened functional
outcome, especially after head trauma. Cerebral microdialysis measures
the concentrations of extracellular metabolites which may be relevant
to cerebral metabolism or ischemia in focal areas of injury. Cerebral
blood flow may be measured in the neurointensive care unit using
continuous methods such as thermal diffusion and laser Doppler
flowmetry. Initial studies have also attempted to correlate findings
from advanced neuromonitoring with neuroimaging using dynamic perfusion
computed tomography, positron emission tomography, and Xenon computed
tomography. Additionally, new methods of data acquisition, storage, and
analysis are being developed to address the increasing burden of
patient data from neuromonitoring. Advanced informatics techniques such
as hierarchical data clustering, generalized linear models, and heat
map dendrograms are now being applied to multivariable patient data in
order to better develop physiologic patient profiles to improve
diagnosis and treatment
Management of intracerebral hemorrhage
Intracerebral hemorrhage (ICH) is a potentially devastating neurologic injury representing 10–15% of stroke cases in the USA each year. Numerous risk factors, including age, hypertension, male gender, coagulopathy, genetic susceptibility, and ethnic descent, have been identified. Timely identification, workup, and management of this condition remain a challenge for clinicians as numerous factors can present obstacles to achieving good functional outcomes. Several large clinical trials have been conducted over the prior decade regarding medical and surgical interventions. However, no specific treatment has shown a major impact on clinical outcome. Current management guidelines do exist based on medical evidence and consensus and these provide a framework for care. While management of hypertension and coagulopathy are generally considered basic tenets of ICH management, a variety of measures for surgical hematoma evacuation, intracranial pressure control, and intraventricular hemorrhage can be further pursued in the emergent setting for selected patients. The complexity of management in parenchymal cerebral hemorrhage remains challenging and offers many areas for further investigation. A systematic approach to the background, pathology, and early management of spontaneous parenchymal hemorrhage is provided
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Neurologists' Duties in Planning for Triage of Critical Care Resources during the COVID-19 Pandemic.
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