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《Neuro-Chirurgie》2023,69(1):101389
PurposeThe management of posterior fossa dural arteriovenous fistulas (pfDAVFs) is challenging. Here, we show how multidisciplinarity leads to their successful management, even in complex cases.MethodsAll pfDAVFs managed from 2010 to 2019 at our center were reviewed. The preoperative clinical and radiological characteristics, their management and the occlusion rate were retrieved. The radiological and functional outcomes were retrieved at discharge and last follow-up (FU).Resultsn = 27 patients were included (6 females, mean age: 61-years-old, mean FU: 22.5 months). n = 8 patients presented with cerebral hemorrhage. Among patients with ruptured pfDAVFs, n = 7 had headache, n = 4 had ataxia, and n = 2 had impaired level of consciousness. In the unruptured group N (n = 19), n = 7 patients had headache, n = 6 patients had focal neurological deficit, n = 4 patients had tinnitus, n = 3 (had ataxia, and one presented with seizure. n = 24 patients were treated by endovascular therapy (EVT), n = 2 patients were treated by microsurgery (MS) and n = 1 patient was managed with a combined approach. Re-treatment was necessary in n = 6 patients. n = 24 patients showed total exclusion at last FU. n = 2 patients died during the first 30 days; n = 1 patient died during FU.ConclusionsWhile EVT should be advocated as the first line therapy whenever possible, MS should not be banned from the treatment armamentarium. Neurosurgeons must be able to achieve direct surgical occlusion when the angioarchitecture speaks against EVT. 相似文献
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Marie Oxenbøll Collet Eva Laerkner Janet Jensen Ingrid Egerod Jan Christensen Niels Kasper Jørgensen Rikke Schmidt Kjærgaard Sepideh Olausson Hilde Wøien Theis Lange Anne Højager Nielsen Maj-Brit Nørregaard Kjær Camille Rahbek Lysholm Bruun Anders Perner 《Acta anaesthesiologica Scandinavica》2023,67(5):670-674
Background
Long-term cognitive impairment occurs in up to 60% of intensive care unit (ICU) survivors. Early use of functional and cognitive rehabilitation interventions, while patients are still in ICU, may reduce cognitive decline. We aim to describe the functional and cognitive interventions used during the ICU stay, the healthcare professionals providing interventions, and the potential impact on functional and cognitive rehabilitation.Method
In this integrative systematic review, we will include empirical qualitative, quantitative, mixed- and multiple-methods studies assessing the use of functional and cognitive rehabilitation provided in ICU. We will identify studies in relevant electronic databases from 2012 to 2022, which will be screened for eligibility by at least two reviewers. Literature reported as narrative reviews and editorials will be excluded. We will assess the impact of interventions evaluating a cognitive and functional function, quality of life, and all-cause mortality at 6–12 months after ICU discharge. The Revised Cochrane risk-of-bias Tool will be used for assessing risk of bias in clinical trials. For observational studies, we will use the National Institutes of Health Quality Assessment tool for Observational Cohort and Cross-Sectional Studies. Furthermore, we will use the critical appraisal skills programme for qualitative studies and the mixed methods appraisal tool for mixed methods studies. We will construct four matrices, including results describing which ICU patients and healthcare professionals were engaged in rehabilitation, which interventions were included in early rehabilitation in ICU, the potential impact on patient outcomes of rehabilitation interventions provided in ICU and a narrative synthesis of themes. A summary of the main results will be reported using modified GRADE methodology.Impact
This integrative review will inform the feasibility randomised clinical trial testing the development of a complex intervention targeting functional and cognitive rehabilitation for patients in ICU. 相似文献8.
目的分析老年综合评估(CGA)的开展现状。方法采用方便抽样的方法选取自2020年11月至2021年3月申请试用北京医院老年医学科研发的京颐汇老年综合评估系统的全国各地共191个科室进行调查。通过自设问卷调查科室基本情况、CGA开展情况和培训需求。结果 104个科室(54.5%)已开展CGA, 不同医院级别、医院所在地区和医院所在城市的科室开展CGA的比例差异无统计学意义。在已开展CGA的104个科室中, 28个科室(26.9%)开展了门诊CGA, 57个科室(54.8%)由科室随机人员完成CGA, 87个科室(83.7%)使用纸质问卷评估, 51个科室(49.0%)每月评估数量在10例以下。在未开展CGA的87个科室中, 68个科室(78.2%)存在无法收费问题, 64个科室(73.6%)存在缺乏专业人员问题。90%以上科室存在CGA的培训需求。结论 CGA的开展在我国尚处于起步阶段, 各地老年医学科开展CGA情况较差, 普遍面临无法收费、缺乏规范化的困境。 相似文献
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