Wednesday, October 22, 2014

Error in Intensive Care: Psychological Repercussions and Defense Mechanisms Among Health Professionals

Error in Intensive Care: Psychological Repercussions and Defense Mechanisms Among Health Professionals
Critical Care Medicine - Current Issue

imageObjective: To identify the psychological repercussions of an error on professionals in intensive care and to understand their evolution. To identify the psychological defense mechanisms used by professionals to cope with error. Design: Qualitative study with clinical interviews. We transcribed recordings and analysed the data using an interpretative phenomenological analysis. Setting: Two ICUs in the teaching hospitals of Besançon and Dijon (France). Subjects: Fourteen professionals in intensive care (20 physicians and 20 nurses). Interventions: None. Measurements and Main Results: We conducted 40 individual semistructured interviews. The participants were invited to speak about the experience of error in ICU. The interviews were transcribed and analyzed thematically by three experts. In the month following the error, the professionals described feelings of guilt (53.8%) and shame (42.5%). These feelings were associated with anxiety states with rumination (37.5%) and fear for the patient (23%); a loss of confidence (32.5%); an inability to verbalize one's error (22.5%); questioning oneself at a professional level (20%); and anger toward the team (15%). In the long term, the error remains fixed in memory for many of the subjects (80%); on one hand, for 72.5%, it was associated with an increase in vigilance and verifications in their professional practice, and on the other hand, for three professionals, it was associated with a loss of confidence. Finally, three professionals felt guilt which still persisted at the time of the interview. We also observed different defense mechanisms implemented by the professional to fight against the emotional load inherent in the error: verbalization (70%), developing skills and knowledge (43%), rejecting responsibility (32.5%), and avoidance (23%). We also observed a minimization (60%) of the error during the interviews. Conclusions: It is important to take into account the psychological experience of error and the defense mechanisms developed following an error because they appear to determine the professional's capacity to acknowledge and disclose his/her error and to learn from it.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/11000/Error_in_Intensive_Care___Psychological.7.aspx

Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study

Optimal hypofractionated conformal radiotherapy for large brain metastases in patients with high risk factors: a single-institutional prospective study
Radiation Oncology

Background: A single-institutional prospective study of optimal hypofractionated conformal radiotherapy for large brain metastases with high risk factors was performed based on the risk prediction of radiation-related complications. Methods: Eighty-eight patients with large brain metastases ?10?cm3 in critical areas treated from January 2010 to February 2014 using the CyberKnife were evaluated. The optimal dose and number of fractions were determined based on the surrounding brain volume circumscribed with a single dose equivalent (SDE) of 14?Gy (V14) to be less than 7?cm3 for individual lesions. Univariate and multivariate analyses were conducted. Results: As a result of optimal treatment, 92 tumors ranging from 10 to 74.6?cm3 (median, 16.2?cm3) in volume were treated with a median prescribed isodose of 57% and a median fraction number of five. In order to compare the results according to the tumor volume, the tumors were divided into the following three groups: 1) 10?19.9?cm3, 2) 20?29.9?cm3 and 3) ?30?cm3. The lesions were treated with a median prescribed isodose of 57%, 56% and 55%, respectively, and the median fraction number was five in all three groups. However, all tumors ?20?cm3 were treated with???five fractions. The median SDE of the maximum dose in the three groups was 47.2?Gy, 48.5?Gy and 46.5?Gy, respectively. Local tumor control was obtained in 90.2% of the patients, and the median survival was nine months, with a median follow-up period of seven months (range, 3-41 months). There were no significant differences in the survival rates among the three groups. Six tumors exhibited marginal recurrence 7-36 months after treatment. Ten patients developed symptomatic brain edema or recurrence of pre-existing edema, seven of whom required osmo-steroid therapy. No patients developed radiation necrosis requiring surgical resection. Conclusion: Our findings demonstrate that the administration of optimal hypofractionated conformal radiotherapy based on the dose-volume prediction of complications (risk line for hypofractionation), as well as Kjellberg?s necrosis risk line used in single-session radiosurgery, is effective and safe for large brain metastases or other lesions in critical areas.

Original Article: http://www.ro-journal.com/content/9/1/231

Radiotherapy versus Observation following surgical resection of Atypical Meningioma (the ROAM trial)

Radiotherapy versus Observation following surgical resection of Atypical Meningioma (the ROAM trial)
Neuro-Oncology - current issue



Original Article: http://neuro-oncology.oxfordjournals.org/cgi/content/short/16/11/1560?rss=1

Immunotherapy advances for glioblastoma

Immunotherapy advances for glioblastoma
Neuro-Oncology - current issue

Survival for patients with glioblastoma, the most common high-grade primary CNS tumor, remains poor despite multiple therapeutic interventions including intensifying cytotoxic therapy, targeting dysregulated cell signaling pathways, and blocking angiogenesis. Exciting, durable clinical benefits have recently been demonstrated for a number of other challenging cancers using a variety of immunotherapeutic approaches. Much modern research confirms that the CNS is immunoactive rather than immunoprivileged. Preliminary results of clinical studies demonstrate that varied vaccine strategies have achieved encouraging evidence of clinical benefit for glioblastoma patients, although multiple variables will likely require systematic investigation before optimal outcomes are realized. Initial preclinical studies have also revealed promising results with other immunotherapies including cell-based approaches and immune checkpoint blockade. Clinical studies to evaluate a wide array of immune therapies for malignant glioma patients are being rapidly developed. Important considerations going forward include optimizing response assessment and identifiying correlative biomarkers for predict therapeutic benefit. Finally, the potential of complementary combinatorial immunotherapeutic regimens is highly exciting and warrants expedited investigation.



Original Article: http://neuro-oncology.oxfordjournals.org/cgi/content/short/16/11/1441?rss=1

Primary Intraventricular Central Nervous System Rhabdomyosarcoma

Primary Intraventricular Central Nervous System Rhabdomyosarcoma
Pediatric Neurology

A 10 year old girl presented with one week of new-onset headache and vomiting. Neurologic examination revealed wide-based ataxic gait. Computed tomography (CT) demonstrated a primary intraventricular mass with obstructive hydrocephalus (Figure 1A). The mass showed reduced diffusivity and homogeneous enhancement on magnetic resonance imaging (MRI) (Figure 1B-E). The patient underwent gross total resection of the tumor. Pathology demonstrated a malignant tumor characterized by densely cellular sheets of large eccentrically-placed vesicular nuclei, brisk mitotic activity, and rare cytoplasmic cross-striations.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00513-X/abstract?rss=yes

Blogs for neurosurgeons

Blogs for neurosurgeons
Neurosurgery Blog

Blogs for neurosurgeons

Surg Neurol Int 2012,  3:62

Júlio Leonardo Barbosa Pereira1, Pieter L Kubben2, Lucas Alverne Freitas de Albuquerque1, Gervásio Teles C de Carvalho1, Atos Alves de Sousa3
1 Department of Neurosurgery, Santa Casa Hospital of Belo Horizonte, MG, Brazil
2 Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
3 Department of Neurosurgery, Santa Casa Hospital of Belo Horizonte; Lecturer at the Post-graduate and Research Program at Santa Casa Hospital of Belo Horizonte, MG, Brazil

 Abstract

Blogs are useful tools to research and to disseminate information. As they allow people who do not have specific knowledge on the building of sites to post content on the internet, they turned out to be very popular. In the past years, there has been a rapid expansion of blogs on several subjects and nowadays there are over 156 million blogs online. Neurosurgery was not out of this wave, and several blogs related to it can be found on the internet. The objective of this paper is to describe, in general, the functions of a blog and to provide initial guidance for the creation and the adequate use of neurosurgical blogs. Some interesting blogs and their features are also listed as examples.

Keywords: Actualization, blog, internet, neurosurgery

 

How to cite this article:
Pereira JB, Kubben PL, Freitas de Albuquerque LA, de Carvalho GC, de Sousa AA. Blogs for neurosurgeons. Surg Neurol Int 2012;3:62

How to cite this URL:
Pereira JB, Kubben PL, Freitas de Albuquerque LA, de Carvalho GC, de Sousa AA. Blogs for neurosurgeons. Surg Neurol Int [serial online] 2012 [cited 2014 Oct 19];3:62. Available from: http://www.surgicalneurologyint.com/text.asp?2012/3/1/62/97006

 

The post Blogs for neurosurgeons appeared first on NEUROSURGERY BLOG.



Original Article: http://neurocirurgiabr.com/blogs-for-neurosurgeons-3/?utm_source=rss&utm_medium=rss&utm_campaign=blogs-for-neurosurgeons-3

Monday, October 13, 2014

Neuroscientists use snail research to help explain "chemo brain"

Neuroscientists use snail research to help explain "chemo brain"
Neurology News & Neuroscience News from Medical News Today

It is estimated that as many as half of patients taking cancer drugs experience a decrease in mental sharpness. While there have been many theories, what causes "chemo brain" has eluded scientists.

Original Article: http://www.medicalnewstoday.com/releases/283658.php