Rationale, Timeline, Study Design, and Protocol Overview of the Therapeutic Hypothermia After Pediatric Cardiac Arrest Trials.

Rationale, Timeline, Study Design, and Protocol Overview of the Therapeutic Hypothermia After Pediatric Cardiac Arrest Trials.

Pediatr Crit Care Med. 2013 Jul 9;
Moler FW, Silverstein FS, Meert KL, Clark AE, Holubkov R, Browning B, Slomine BS, Christensen JR, Dean JM

To describe the rationale, timeline, study design, and protocol overview of the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials.Multicenter randomized controlled trials.Pediatric intensive care and cardiac ICUs in the United States and Canada.Children from 48 hours to 18 years old, who have return of circulation after cardiac arrest, who meet trial eligibility criteria, and whose guardians provide written consent.Therapeutic hypothermia or therapeutic normothermia.From concept inception in 2002 until trial initiation in 2009, 7 years were required to plan and operationalize the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials. Two National Institute of Child Health and Human Development clinical trial planning grants (R21 and R34) supported feasibility assessment and protocol development. Two clinical research networks, Pediatric Emergency Care Applied Research Network and Collaborative Pediatric Critical Care Research Network, provided infrastructure resources. Two National Heart Lung Blood Institute U01 awards provided funding to conduct separate trials of in-hospital and out-of-hospital cardiac arrest. A pilot vanguard phase that included half the clinical sites began on March 9, 2009, and this was followed by full trial funding through 2015.Over a decade will have been required to plan, design, operationalize, and conduct the Therapeutic Hypothermia after Pediatric Cardiac Arrest trials. Details described in this report, such as participation of clinical research networks and clinical trial planning grants utilization, may be of utility for individuals who are planning investigator-initiated, federally supported clinical trials. HubMed – rehab

State of the art in treatment of facial paralysis with temporalis tendon transfer.

Curr Opin Otolaryngol Head Neck Surg. 2013 Aug; 21(4): 358-364
Sidle DM, Simon P

Temporalis tendon transfer is a technique for dynamic facial reanimation. Since its inception, nearly 80 years ago, it has undergone a wealth of innovation to produce the modern operation. The purpose of this review is to update the literature as to the current techniques and perioperative management of patients undergoing temporalis tendon transfer.The modern technique focuses on the minimally invasive approaches and aesthetic refinements to enhance the final product of the operation. The newest techniques as well as preoperative assessment and postoperative rehabilitation are discussed.When temporalis tendon transfer is indicated for facial reanimation, the modern operation offers a refined technique that produces an aesthetically acceptable outcome. Preoperative smile assessment and postoperative smile rehabilitation are necessary and are important adjuncts to a successful operation. HubMed – rehab

Outcomes after ARDS: a distinct group in the spectrum of disability after complex and protracted critical illness.

Minerva Anestesiol. 2013 Jul; 79(7): 793-803
Pearmain L, Herridge MS

ARDS represents an important public health problem for patients, family caregivers and society. The last decade has seen a burgeoning literature focussed on the outcomes of this patient group and has informed important new knowledge about the devastating and often irreversible morbidity related to nerve, muscle and brain injury More recent studies have reinforced these robust themes of physical and neuropsychological morbidity in other patient groups and have shown that outcomes after ARDS are one segment of a spectrum of disability and may not be widely generalizable across older patients with multiple comorbidities and protracted length of stay in the critical care unit. Our literature has reached theme saturation in terms of morbidity and needs to identify and begin to address the research agenda for the next decade. Several of these themes will be addressed here and include the following: 1) to generate large diverse datasets to understand different outcome trajectories over time to facilitate risk stratification and inform development of rehabilitation programs; 2) to embrace mixed methodology as a new longitudinal study standard to facilitate detailed qualitative observations to augment insights from quantitative data; 3) to educate patients, families, colleagues and decision-makers about outcomes after critical illness to inform policy and decision-making; 4) to embrace family caregivers and provide intervention when needed and ongoing support across transitions of care; 5) prioritize functional outcome measures over those targeted at health-related quality of life for construction of more focussed rehabilitation interventions; 6) embrace translational research programs to elucidate the relationship between functional outcome and molecular mechanism to gain further insight into the pathophysiology of critical illness, muscle and brain injury and potential insights into novel therapeutic strategies. HubMed – rehab

Neuropsychiatric symptoms and the use of mind-body therapies.

J Clin Psychiatry. 2013 Jun; 74(6): e520-e526
Purohit MP, Wells RE, Zafonte R, Davis RB, Yeh GY, Phillips RS

Neuropsychiatric symptoms affect 37% of US adults and present in many important diagnoses including posttraumatic stress disorder, traumatic brain injury, and chronic pain. However, these symptoms are difficult to treat with standard treatments, and patients may seek alternative options. In this study, we examined the use of mind-body therapies by adults with neuropsychiatric symptoms.We compared mind-body therapy use (biofeedback, energy healing, meditation, guided imagery, yoga, deep-breathing exercises, hypnosis, progressive relaxation therapy, qigong, and tai chi) between adults with and without neuropsychiatric symptoms (anxiety, depression, insomnia, headaches, memory deficits, attention deficits, and excessive daytime sleepiness) in the 2007 National Health Interview Survey (N = 23,393). Use of ? 1 of these therapies in the prior 12 months was the primary outcome of interest. We also examined prevalence and reasons for mind-body therapy use in adults with neuropsychiatric symptoms. We performed logistic regression to examine the association between neuropsychiatric symptoms and mind-body therapy use to adjust for sociodemographic and clinical factors.Adults with ? 1 neuropsychiatric symptom used mind-body therapies more than adults without symptoms (25.3% vs 15.0%, P < .001). Prevalence increased with increasing number of symptoms (21.5% for 1 symptom, 32.4% for ? 3 symptoms, P < .001); differences persisted after adjustment for potential confounders (odds ratios, 1.39 [95% CI, 1.26-1.53] and 2.48 [95% CI, 2.18-2.82]). Reasons for mind-body therapy use among adults with ? 1 symptom included the ineffectiveness or expense of conventional medicine (30.2%). Most adults (nearly 70%) with ? 1 symptom did not discuss their mind-body therapy use with a conventional provider.Adults with ? 1 neuropsychiatric symptom use mind-body therapies frequently; more symptoms are associated with increased use. Future research is needed to understand the efficacy of these therapies. HubMed – rehab