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However, the compliance rate was low. Adherence to metformin XR was 52% (IQR42% to 61%) based on the remaining tablets in the container after 4months of intervention. None of the reported side effects were deemed to be related to the study treatment and no significant differences were observed between the metformin XR and the control group.
Treatment with Metformin XR in participants admitted with stroke and with pre-diabetes is feasible and safe. Strategies are needed to improve adherence in future trials.
Treatment with Metformin XR in participants admitted with stroke and with pre-diabetes is feasible and safe. Strategies are needed to improve adherence in future trials.
Endovascular thrombectomy (EVT) is the first-line treatment for patients with acute ischemic stroke (AIS). However, the optimal anesthetic modality during EVT is unclear. Therefore, this systematic review and meta-analysis is aimed to summarize the current literatures from RCTs to provide new clinical evidence of choosing anesthetic modality for AIS patients when receiving EVT.
Literature search was conducted in following databases, EMBASE, MEDLINE, Web of Science, and the Cochrane Library, for relevant randomized controlled trials (RCTs) comparing general anesthesia (GA) and conscious sedation (CS) for AIS patients during EVT. We used the Cochrane Collaboration criteria for assessment of risk bias of included studies. The heterogeneity of outcomes was assessed by I
statistic.
5 RCTs with 498 patients were included. GA was conducted in 251 patients and CS in 247 patients. EVT under GA in AIS patients had higher rates of successful recanalization (RR 1.13, 95% CI 1.04-1.23; P=0.004; I
=40.6%) and functe new clinical evidence of anesthetic modality selection during EVT in the future.The standard of care for idiopathic normal pressure hydrocephalus (iNPH) is placement of a ventriculoperitoneal (VP) shunt. However, VP shunts require intracranial intervention and are associated with notable postoperative complications, with some groups reporting complication rates for VP shunts ranging from 17 to 33%, along with failure rates up to 17.7%. Lumboperitoneal (LP) shunts are an alternative for cerebrospinal fluid diversion that do not require intracranial surgery, thus providing utility in patients where intracranial surgery is not possible or preferred. StemRegenin1 Here we retrospectively reviewed our 25 patients with LP horizontal-vertical (LP-HV) shunts placement for initial treatment for iNPH from 2014 to 2019. All patients had preoperative gait dysfunction, 16 (64%) had urinary incontinence, and 21 (84%) exhibited cognitive insufficiency. Two weeks post-shunt placement, 23/25 (92%) patients demonstrated improvement in gait, 11/16 (68%) had improvement in incontinence, and 14/21 (66%) had improvement cognitive insufficiency. At six months or greater follow up 13/20 (65%) had improvement in gait, 7/15 (47%) showed improvement in incontinence, and 11/15 (73%) demonstrated improvement in cognitive function. Six patients (24%) required at least one revision of the LP shunt. Shunt malfunctions resulted from CSF leak in one patient, shunt catheter migration in two patients, peritoneal catheter pain in one patient, and clinical symptoms for overdrainage in two patients. Thus, we demonstrate that LP-HV shunt placement is safe and efficacious alternative to VP shunting for iNPH, resulting in notable symptomatic improvement and low risk of overdrainage, and may be considered for patients where cranial approaches should be avoided.Numerous studies show the risk of a breakdown in the continuity of care when a patient leaves hospital. A study was carried out of hospital-based nurses, to find out their representations with regard to their role in the hospital-home transition. The results enable areas of improvement to be identified.Coercive measures such as seclusion and restraint, which are sometimes used in psychiatry, remain current practices. According to literature, these interventions are particularly complex for the nurses implementing them. In situations of seclusion and restraint, these professionals focus in particular on the nurse-patient relationship, the patient's safety and the respect of their humanity. Training is possible to help nurses manage these situations and improve their approach to the clinical judgement.Abroad, advanced practice in emergency medicine has had positive effects on populations. In France, following the reform of emergency departments, advanced practice nurses in emergency medicine will become a reality. This new profession raises certain fears. Their contribution must be alongside the patients and in the organisations. For this, patient pathways need to be identified and cooperation between the advanced practice nurses and emergency room doctors must be established.In the context of the rebuilding of the emergency services a new health care provider has been identified to reorganize emergency medicine in order to meet the expectations of the population, institutions and professionals. The nurse in advanced practice with extended skills must be able to fit into a pre-existing organization, in collaboration with the actors already present, but also represent an innovative care offer with regard to intra-hospital and pre-hospital needs as well as in terms of regulation. Student proposals.The first challenge, after graduating as an advanced practice nurse is to establish a new model of care in one's place of practice. The feedback from the creation of an advanced practice nurse position in oncology in Amiens-Picardie university hospital, using a population-based approach, illustrates the roles and skills required in this new health profession.Le Mans general hospital has created an advanced practice nurse position in memory clinics in geriatrics. The activity began in September 2019. During the first year, 189 consultations with the nurse were carried out, despite the difficult health context. Most of the activity has focused on consultations. However, the nurse's other skills have also been deployed. An analysis of the activity enables the areas to improve to be identified in order to continue creating advanced practice nursing positions within the hospital and across the country.
