CONTINUUM Lifelong Learning in Neurology最新文献_第5页

Prognostication in Neurocritical Care. 神经重症监护中的预诊。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001433

Susanne Muehlschlegel

{"title":"Prognostication in Neurocritical Care.","authors":"Susanne Muehlschlegel","doi":"10.1212/CON.0000000000001433","DOIUrl":"10.1212/CON.0000000000001433","url":null,"abstract":"Objective: This article synthesizes the current literature on prognostication in neurocritical care, identifies existing challenges, and proposes future research directions to reduce variability and enhance scientific and patient-centered approaches to neuroprognostication.Latest developments: Patients with severe acute brain injury often lack the capacity to make their own medical decisions, leaving surrogate decision makers responsible for life-or-death choices. These decisions heavily rely on clinicians' prognostication, which is still considered an art because of the previous lack of specific guidelines. Consequently, there is significant variability in neuroprognostication practices. This article examines various aspects of neuroprognostication. It explores the cognitive approach to prognostication, highlights the use of statistical modeling such as Bayesian models and machine learning, emphasizes the importance of clinician-family communication during prognostic disclosures, and proposes shared decision making for more patient-centered care.Essential points: This article identifies ongoing challenges in the field and emphasizes the need for future research to ameliorate variability in neuroprognostication. By focusing on scientific methodologies and patient-centered approaches, this research aims to provide guidance and tools that may enhance neuroprognostication in neurocritical care.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"30 3","pages":"878-903"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neurocritical Care and the Death of Therapeutic Nihilism. 神经重症监护与治疗虚无主义的消亡。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001460

Lyell K Jones

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Key Points for Issue. 问题要点。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/01.CON.0001023508.89865.f6

引用次数: 0

SELF-ASSESSMENT AND CME. 自我评估和 CME。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001443

引用次数: 0

List of Abbreviations. 缩写表。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/01.CON.0001024616.05589.d1

引用次数: 0

Teleneurology and Artificial Intelligence in Clinical Practice. 远程神经学和人工智能在临床实践中的应用。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001430

Elaine C Jones, Benjamin R Kummer, Jayne R Wilkinson

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Traumatic Brain Injury and Traumatic Spinal Cord Injury. 创伤性脑损伤和创伤性脊髓损伤。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001423

Jamie E Podell, Nicholas A Morris

{"title":"Traumatic Brain Injury and Traumatic Spinal Cord Injury.","authors":"Jamie E Podell, Nicholas A Morris","doi":"10.1212/CON.0000000000001423","DOIUrl":"10.1212/CON.0000000000001423","url":null,"abstract":"Objective: This article reviews the mechanisms of primary traumatic injury to the brain and spinal cord, with an emphasis on grading severity, identifying surgical indications, anticipating complications, and managing secondary injury.Latest developments: Serum biomarkers have emerged for clinical decision making and prognosis after traumatic injury. Cortical spreading depolarization has been identified as a potentially modifiable mechanism of secondary injury after traumatic brain injury. Innovative methods to detect covert consciousness may inform prognosis and enrich future studies of coma recovery. The time-sensitive nature of spinal decompression is being elucidated.Essential points: Proven management strategies for patients with severe neurotrauma in the intensive care unit include surgical decompression when appropriate, the optimization of perfusion, and the anticipation and treatment of complications. Despite validated models, predicting outcomes after traumatic brain injury remains challenging, requiring prognostic humility and a model of shared decision making with surrogate decision makers to establish care goals. Penetrating injuries, especially gunshot wounds, are often devastating and require public health and policy approaches that target prevention.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"30 3","pages":"721-756"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Emergent Management of Status Epilepticus. 癫痫状态的紧急处理。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001445

Clio Rubinos

{"title":"Emergent Management of Status Epilepticus.","authors":"Clio Rubinos","doi":"10.1212/CON.0000000000001445","DOIUrl":"10.1212/CON.0000000000001445","url":null,"abstract":"Objective: Status epilepticus is a neurologic emergency that can be life- threatening. The key to effective management is recognition and prompt initiation of treatment. Management of status epilepticus requires a patient-specific-approach framework, consisting of four axes: (1) semiology, (2) etiology, (3) EEG correlate, and (4) age. This article provides a comprehensive overview of status epilepticus, highlighting the current treatment approaches and strategies for management and control.Latest developments: Administering appropriate doses of antiseizure medication in a timely manner is vital for halting seizure activity. Benzodiazepines are the first-line treatment, as demonstrated by three randomized controlled trials in the hospital and prehospital settings. Benzodiazepines can be administered through IV, intramuscular, rectal, or intranasal routes. If seizures persist, second-line treatments such as phenytoin and fosphenytoin, valproate, or levetiracetam are warranted. The recently published Established Status Epilepticus Treatment Trial found that all three of these drugs are similarly effective in achieving seizure cessation in approximately half of patients. For cases of refractory and super-refractory status epilepticus, IV anesthetics, including ketamine and γ-aminobutyric acid-mediated (GABA-ergic) medications, are necessary. There is an increasing body of evidence supporting the use of ketamine, not only in the early phases of stage 3 status epilepticus but also as a second-line treatment option.Essential points: As with other neurologic emergencies, \"time is brain\" when treating status epilepticus. Antiseizure medication should be initiated quickly to achieve seizure cessation. There is a need to explore newer generations of antiseizure medications and nonpharmacologic modalities to treat status epilepticus.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"30 3","pages":"682-720"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neuromuscular Emergencies. 神经肌肉急症

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001424

Catherine S W Albin

{"title":"Neuromuscular Emergencies.","authors":"Catherine S W Albin","doi":"10.1212/CON.0000000000001424","DOIUrl":"10.1212/CON.0000000000001424","url":null,"abstract":"Objective: This article aims to familiarize the reader with the clinical approach, diagnostic considerations, and treatment strategies for patients presenting with abrupt-onset or acutely worsening weakness due to neuromuscular disorders.Latest developments: Neuromuscular weakness is often the result of an inflammatory process. In recent years, there has been growing recognition of pathologic antibodies that cause neuromuscular injury. This has allowed clinicians to make a more accurate diagnosis. Additionally, neuromuscular junction disorders and myopathies are increasingly identified as the adverse effects of novel anticancer therapies, namely immune checkpoint inhibitors. More data are being incorporated into frameworks for neuroprognostication after neuromuscular emergencies, especially for commonly encountered disorders such as Guillain-Barré syndrome.Essential points: Care of patients with neuromuscular emergencies requires prompt attention to respiratory status. Once supportive measures are in place to protect the airway and facilitate effective ventilation, diagnostic considerations should hinge on appropriate neurologic localization. Aggressive immunosuppression is often required for immune-mediated neuromuscular disorders, and clinicians must be thoughtful in selecting a strategy that best aligns with each patient's risk factors and comorbidities.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":"30 3","pages":"818-844"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Learning Objectives and Core Competencies. 学习目标和核心能力。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001442

引用次数: 0