Brandtcantu4276

Targeted temperature management (TTM) is a recognized treatment to decrease mortality and improve neurological function in hypoxic ischemic encephalopathy. An esophageal cooling device (ECD) has been studied in animal models, but human data are limited. An ECD appears to offer similar benefits to intravascular cooling catheters, with potentially less risk to the patient. We studied whether the ECD could act as a substitute for intravascular cooling catheters in delivering adequate TTM after cardiac arrest. Nine patients admitted to the intensive care unit after cardiac arrest who required TTM were enrolled prospectively. The primary outcome measures were timeliness of insertion, ease of insertion, user Likert ratings, time to achieve a target temperature of 36°C, and time during which target temperature was maintained within 1°C of the 36°C goal for 24 hours by using an ECD. Time to reach target temperature was 0 to 540 minutes (mean 113.33 minutes, median 0 minute, standard deviation [SD] 179.22). Maintenance of a target temperature of 36°C over 24 hours had a range of 58.33% to 100% (mean 91.67%, median 95.83%, SD 13.34). Ease of insertion related to Likert ratings with a range of 1-9 (mean 5.38, median 5.5, SD 3.43) and a simplicity of ECD uses a range of 4-10 (mean 7.63, median 8.0, SD 1.65). Overall, there was preference for the ECD over intravascular cooling methods (mean 6.71, mean 6, SD 3.01) and external cooling methods (mean 8.0, median 9.0, SD 2.33). For patients requiring TTM, use of an ECD adequately allowed for TTM goals to be achieved and maintained. Overall, user evaluation was positive.For patients with psychiatric disorders, current diagnostic and treatment approaches are far from optimal. The clinical interview drives the standard approach-matching symptoms to diagnostic criteria-and results in standardized pharmacological and behavioral treatments, often, with inadequate outcome; but now, recent imaging advances can correlate behavioral assessments with brain function and measure them against normative databases to provide data critical for the reevaluation of patient diagnosis and treatment. Ivosidenib This article addresses the data that support a redefinition of our current paradigm. We believe a neurobehavioral approach provides for more personalized treatment approaches unbound from classically defined diagnostic biases.Using a mixed-methods design, the present study examined intimate partner surveillance among a diverse sample of intimate partner abuse (IPA) survivors (n = 246), including women of Mexican (n = 83), Korean (n = 50), Vietnamese (n = 49), and European descent (n = 64). Most survivors (57%) described surveillance in either survey or interview; inductive thematic analysis revealed seven forms of surveillance. Finally, two-step cluster analysis identified two patterns of victimization most clearly differentiated by surveillance, but ethnic group differences in rates and patterns of abuse did not emerge. Implications for both clinicians and researchers are discussed.Eating disorders are mental illnesses that can have a significant and persistent physical impact, especially for those who are not treated early in their disease trajectory. Although many persons with eating disorders may make a full recovery, some may not; this is especially the case when it comes to persons with severe and enduring anorexia nervosa (SEAN), namely, those who have had anorexia for between 6 and 12 years or more. Given that persons with SEAN are less likely to make a full recovery, a different treatment philosophy might be ethically warranted. One potential yet scarcely considered way to treat persons with SEAN is that of a harm reduction approach. A harm reduction philosophy is deemed widely defensible in certain contexts (e.g. in the substance use and addictions domain), and in this paper we argue that it may be similarly ethically defensible for treating persons with SEAN in some circumstances.Purpose This study evaluated Japanese patients' adherence to first-line therapy and physicians' compliance with the guidelines (GLs) for glaucoma in daily practice. Methods This retrospective, noninterventional cohort study used a Japanese health care/pharmacy claims database from 2011 to 2016. We compared adherence based on the primary outcomes assessed as proportion of days covered (PDC) and persistence between patients who received first-line monotherapy followed by second-line fixed-combination therapy (GL-compliant cohort) and those who received first-line fixed-combination therapy (GL-noncompliant cohort). Furthermore, we explored treatment patterns, glaucoma consultation, and key factors associated with GL noncompliance. Results Among 11,666 patients who received first-line therapy, 1,183 (10.1%) and 542 (4.6%) were in the GL-compliant and GL-noncompliant cohorts, respectively. Prostaglandin (70.7%) and subsequent prostaglandin/β blocker (BB) (20.9%) within 12 months were most used by the GL-compliant cohort. Prostaglandin/BB (48.9%) and carbonic anhydrase inhibitor/BB (51.1%) were prescribed for the GL-noncompliant cohort. The mean PDC [standard deviation (SD)], persistence rate (95% confidence interval), and consultation (SD) over 12 months were 60.9% (34.0), 16.0% (14.0-18.1), and 5.23 (3.21) times, respectively, in the GL-compliant cohort and 59.7% (35.8), 22.0% (18.6-25.5), and 4.76 (3.19) times, respectively, in the GL-noncompliant cohort. No significant differences were observed between the 2 cohorts. No clinically relevant factor associated with GL noncompliance was found. Conclusions Around 5% of patients were prescribed a fixed-combination eye drop as first-line therapy not in accordance with GLs. The similarity of adherence and persistence between the 2 cohorts indicates that first-line fixed-combination therapy could be considered for glaucoma treatment.Purpose To evaluate safety and tolerability on the ocular surface of an anti-septic formulation containing 0.6% povidone-iodine (0.6% PVI) for a 4 week period. Methods An observational, prospective study included 20 mild-moderate dry eye disease (DED) patients who enrolled at the Ocular Surface Disease Unit of the University of Messina, receiving 0.6% PVI eye drops for 28 days, 2 drops twice daily (BID). The assessment included the Ocular Surface Disease Index questionnaire; symptoms score (0 = absent to 3 = severe) for burning, ocular dryness, foreign body sensation, watery eyes, tearing, photophobia, and ocular pain; fluorescein tear break-up time (TBUT); and corneal-conjunctival staining, performed at baseline (T0), after 7 (T7) and 28 (T28). Schirmer I-test, corneal endothelial cell count, intraocular pressure, and fundus examination were performed at T0 and T28. The main outcome measures were TBUT and corneal-conjunctival staining as markers of ocular surface homeostasis. For statistical analysis, Student's T-test and Wilcoxon test were used as appropriate.