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11.
Journal of Neuro-Oncology - Craniopharyngiomas are locally-aggressive tumors arising along the hypothalamic-pituitary axis. Treatment is nuanced as a result of their proximity and adherence to... 相似文献
12.
Tobias Hüppe Sascha Kreuer Hinnerk Wulf Dennik Freitag Martin Seidel Tobias Teucke Felix Maurer Andreas Kirschbaum Tilo Koch Frank Langer Thomas Volk Carsten Feldmann 《Acta anaesthesiologica Scandinavica》2023,67(4):455-461
Background
Volatile propofol can be measured in exhaled air and correlates to plasma concentrations with a time delay. However, the effect of single-lung ventilation on exhaled propofol is unclear. Therefore, our goal was to evaluate exhaled propofol concentrations during single-lung compared to double-lung ventilation using double-lumen tubes.Methods
In a first step, we quantified adhesion of volatile propofol to the inner surface of double-lumen tubes during double- and single-lumen ventilation in vitro. In a second step, we enrolled 30 patients scheduled for lung surgery in two study centers. Anesthesia was provided with propofol and remifentanil. We utilized left-sided double-lumen tubes to separately ventilate each lung. Exhaled propofol concentrations were measured at 1-min intervals and plasma for propofol analyses was sampled every 20 min. To eliminate the influence of dosing on volatile propofol concentration, exhalation rate was normalized to plasma concentration.Results
In-vitro ventilation of double-lumen tubes resulted in increasing propofol concentrations at the distal end of the tube over time. In vitro clamping the bronchial lumen led to an even more pronounced increase (Δ AUC +62%) in propofol gas concentration over time. Normalized propofol exhalation during lung surgery was 31% higher during single-lung compared to double-lung ventilation.Conclusion
During single-lung ventilation, propofol concentration in exhaled air, in contrast to our expectations, increased by approximately one third. However, this observation might not be affected by change in perfusion-ventilation during single-lung ventilation but rather arises from reduced propofol absorption on the inner surface area of the double-lumen tube. Thus, it is only possible to utilize exhaled propofol concentration to a limited extent during single-lung ventilation.Registration of Clinical Trial
DRKS-ID DRKS00014788 ( www.drks.de ). 相似文献13.
Anand Rajan Peerapol Wangrattanapranee Jonathan Kessler Trilokesh Dey Kidambi James H Tabibian 《World journal of gastrointestinal surgery》2022,14(4):286-303
Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs. 相似文献
14.
Stephanie H. Ameis John D. Haltigan Rachael E. Lyon Amanda Sawyer Pat Mirenda Connor M. Kerns Isabel M. Smith Tracy Vaillancourt Joanne Volden Charlotte Waddell Lonnie Zwaigenbaum Teresa Bennett Eric Duku Mayada Elsabbagh Stelios Georgiades Wendy J. Ungar Anat Zaidman-Zait Meng-Chuan Lai Peter Szatmari for the Pathways in ASD Study Team 《Journal of child psychology and psychiatry, and allied disciplines》2022,63(5):553-562
15.
16.
Patrick Demkowicz BS Renelle Pointdujour-Lim MD Sofia Miguez BA Yesung Lee BS Bailey S. C. L. Jones BS Christopher A. Barker MD Marcus Bosenberg MD PhD David H. Abramson MD Alexander N. Shoushtari MD Harriet Kluger MD Jasmine H. Francis MD Mario Sznol MD Mathieu F. Bakhoum MD PhD 《Cancer》2023,129(20):3275-3286
17.
Eileen M. Dryden PhD Meaghan A. Kennedy MD MPH Jennifer Conti MPH Jacqueline H. Boudreau MPH Chitra P. Anwar MA Kathryn Nearing PhD MA Camilla B. Pimentel PhD MPH William W. Hung MD MPH Lauren R. Moo MD 《Health services research》2023,58(Z1):26-35
Objective
Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value.Data Sources
In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits.Study Design
A cross-sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges.Data Collection
We conducted 30 semi-structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach.Principal Findings
Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow-up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age-Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi-complexity).Conclusions
Alignment of patient and caregiver experiences with widely-used models of comprehensive geriatric care indicates that high-quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine. 相似文献18.
19.
Carlton Corinne N. Garcia Katelyn M. Andino Mara Villalongo Ollendick Thomas H. Richey John A. 《Cognitive therapy and research》2022,46(5):916-926
Cognitive Therapy and Research - Individuals with Social Anxiety Disorder (SAD) may be at a higher risk for negative outcomes during the COVID-19 pandemic due to isolation that is both... 相似文献
20.
Cheryl L. Rock PhD RD Cynthia A. Thomson PhD RD Kristen R. Sullivan MS MPH Carol L. Howe MD MLS Lawrence H. Kushi ScD Bette J. Caan DrPH Marian L. Neuhouser PhD RD Elisa V. Bandera MD PhD Ying Wang PhD Kimberly Robien PhD RD Karen M. Basen-Engquist PhD MPH Justin C. Brown PhD Kerry S. Courneya PhD Tracy E. Crane PhD RDN David O. Garcia PhD FACSM Barbara L. Grant MS RDN CSO FAND Kathryn K. Hamilton MA RDN CSO CDN FAND Sheri J. Hartman PhD Stacey A. Kenfield ScD Maria Elena Martinez PhD Jeffrey A. Meyerhardt MD MPH Larissa Nekhlyudov MD MPH Linda Overholser MD Alpa V. Patel PhD Bernardine M. Pinto PhD Mary E. Platek PhD RD CDN Erika Rees-Punia PhD MPH Colleen K. Spees PhD MEd RD LD FAND Susan M. Gapstur PhD Marjorie L. McCullough ScD RD 《CA: a cancer journal for clinicians》2022,72(3):230-262
The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis. 相似文献