3 results
1 Post-stroke Apathy, Pseudobulbar Affect and Memory Loss Hinder Return-to-Work After CVA
- Mario F Dulay, Jennifer L Thompson, Tracey H Hicks, Emma Lai, Jerome S Caroselli
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 301-302
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Objective:
Post-stroke depression (PSD) and anxiety disorders are the most common psychiatric issues that occur after cerebrovascular accident (CVA), with prevalence rates of up to 50%. Less studied, post-stroke apathy and pseudobulbar affect (PBA) also occur in a subset of individuals after CVA leading to reduced quality of life. Cognitive impairments also persist, especially memory, language, and executive difficulties. Residual cognitive and emotional sequelae after CVA limit return-to-work with between 20-60% becoming disabled or retiring early. This study examined the frequency and relative contribution of cognitive, behavioral and emotional factors for not returning-to-work after CVA.
Participants and Methods:Participants included 242 stroke survivors (54% women, average age of 59.2 years) who underwent an outpatient neuropsychological evaluation approximately 13 months after unilateral focal CVA. Exclusion criteria were a diagnosis of dementia, comprehension issues identified during assessment, multifocal or bilateral CVA, and inpatients. Predictors of return-to-work included in logistic regression analyses were psychological (depressive and anxiety disorders, apathy, PBA, history of psychiatric treatment before stroke) and neuropsychological (memory, executive functioning) variables. Depression and anxiety were diagnosed using DSM-IV-TR or -5 criteria. Apathy was operationalized as diminished goal-directed behavior, reduced initiation and decreased interest that impacted daily life more than expected from physical issues after stroke (including self- and family-report using the Frontal Systems Behavior Scale [FrSBe]). PBA was defined by the Center for Neurologic Study-Lability Scale and clinical judgment based on chart review.
Results:Post-stroke apathy persisted in 27.3% of patients 13 months after stroke, PBA persisted in 28.2% of patients (i.e., uncontrollable crying spellings not simply attributable to depression alone, uncontrollable laughing spells), anxiety disorders persisted in 18.6% of patients (mainly panic attacks), and PSD persisted in 29.8% of patients. Memory loss persisted in 67.4% of patients and executive difficulties persisted in 74.4% of patients. Thirteen months after stroke, 34.7% of individuals had returned-to-work and 47.1% had not returned-to-work. The other 18.2% were not working either at the time of their stroke or after the stroke. Logistic regression indicated that post-stroke apathy, PBA, and memory loss were significant predictors of not returning-to-work (odds ratio p < 0.001). Patients who experienced post-stroke apathy were 7.1 times more likely to not return-to-work after stroke (p=0.008), those who suffered from PBA were 4.8 times more likely to not return-to-work (p=0.028), and those with memory loss were 6.6 times more likely to not return-to-work (p=0.005). PSD, history of treatment for psychiatric issues before the stroke, presence of an anxiety disorder after stroke, and executive difficulties were not significant predictors (p’s>0.05).
Conclusions:Results replicate the finding that return-to-work is hindered by residual cognitive deficits after stroke and extends previous research by clarifying the multifactorial emotional and behavioral barriers to not returning-to-work. Results highlight the importance of quantifying post-stroke apathy and pseudobulbar affect in a standard neuropsychological work-up after stroke to identify candidates for services to facilitate efforts in returning to work (e.g., vocational rehabilitation services, psychotherapy, interventions for decreased initiation).
Pediatric musculoskeletal pain in the emergency department: a medical record review of practice variation
- Janeva Kircher, Amy L. Drendel, Amanda S. Newton, Sukhdeep Dulai, Ben Vandermeer, Samina Ali
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 16 / Issue 6 / November 2014
- Published online by Cambridge University Press:
- 04 March 2015, pp. 449-457
- Print publication:
- November 2014
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Objective:
Musculoskeletal (MSK) injuries are a common, painful pediatric presentation to the emergency department (ED). The primary objective of this study was to describe current analgesic administration practices for the outpatient management of children’s MSK pain, both in the ED and postdischarge.
Methods:We reviewed the medical records of consecutive pediatric patients evaluated in either a pediatric or a general ED (Edmonton, Alberta) during four evenly distributed calendar months, with a diagnosis of fracture, dislocation, strain, or sprain of a limb. Abstracted data included demographics, administered analgesics, pain scores, discharge medication advice, and timing of clinical care.
Results:A total of 543 medical records were reviewed (n 5 468 pediatric ED, n 5 75 general ED). Nineteen percent had documented prehospital analgesics, 34% had documented in-ED analgesics, 13% reported procedural sedation, and 24% documented discharge analgesia advice. Of those children receiving analgesics in the ED, 59% (126 of 214) received ibuprofen. Pain scores were recorded for 6% of patients. At discharge, ibuprofen was recommended to 47% and codeine-containing compounds to 21% of children. The average time from triage to first analgesic in the ED was 121 6 84 minutes.
Conclusions:Documentation of the assessment and management of children’s pain in the ED is poor, and pain management appears to be suboptimal. When provided, ibuprofen is the most common analgesic used for children with MSK pain. Pediatric patients with MSK pain do not receive timely medication, and interventions must be developed to improve the ‘‘door to analgesia’’ time for children in pain.
Results on the survival of cryptobiotic cyanobacteria samples after exposure to Mars-like environmental conditions
- J. -P. de Vera, S. Dulai, A. Kereszturi, L. Koncz, A. Lorek, D. Mohlmann, M. Marschall, T. Pocs
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- Journal:
- International Journal of Astrobiology / Volume 13 / Issue 1 / January 2014
- Published online by Cambridge University Press:
- 17 October 2013, pp. 35-44
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Tests on cyanobacteria communities embedded in cryptobiotic crusts collected in hot and cold deserts on Earth were performed under Mars-like conditions. The simulations were realized as a survey, to find the best samples for future research. During the tests organisms have to resist Mars-like conditions such as atmospheric composition, pressure, variable humidity (saturated and dry conditions) and partly strong UV irradiation. Organisms were tested within their original habitat inside the crust. Nearly half of the cryptobiotic samples from various sites showed survival of a substantial part of their coexisting organisms. The survival in general depended more on the nature of the original habitat and type of the sample than on the different conditions they were exposed to. The best survival was observed in samples from United Arab Emirates (Jebel Ali, 25 km SW of Dubai town) and from Western Australia (near the South edge of Lake Barley), by taxa: Tolypothrix byssoidea, Gloeocapsopsis pleurocapsoides, Nostoc microscopicum, Leptolyngbya or Symploca sp. At both places in salty desert areas members of the Chenopodiaceae family dominated among the higher plants and in the cryptobiotic crust cyanobacterial taxa Tolypothrix was dominant. These organisms were all living in salty locations with dry conditions most of the year. Among them Tolypothrix, Gloeocapsopsis and Symploca sp. were tested in Mars simulation chambers for the first time. The results suggest that extremophiles should be tested with taken into account the context of their original microenvironment, and also the importance to analyse communities of microbes beside single organisms.