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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes mellitus represents a major cause of cardiovascular morbidity and mortality in developed countries, and atherothrombosis accounts for most deaths among patients with diabetes mellitus. Atherothrombosis is defined as atherosclerotic lesion disruption with superimposed thrombus formation. As a long-term, progressive disease process, atherosclerosis often results in an acute atherothrombotic event through plaque rupture and formation of a platelet-rich thrombus. The principal clinical manifestations of atherothrombosis are sudden cardiac death, myocardial infarction, ischaemic stroke, and peripheral arterial ischaemia comprising both intermittent claudication and critical limb ischaemia. Atherosclerosis is the leading cause of morbidity and mortality in the industrialized world, and diabetes mellitus magnifies the risk of cardiovascular events. In addition to the well-known microvascular complications of diabetes mellitus - such as nephropathy, retinopathy and neuropathy - the risk of macrovascular complications affecting the large conduit arteries markedly increases in patients with diabetes mellitus.
Best Pract Res Clin Endocrinol Metab 2009 Jun
PMID:Atherogenesis and atherothrombosis--focus on diabetes mellitus. 1952 Mar 4

Diabetes mellitus is frequently associated with atherosclerotic vascular disease involving the coronary, peripheral and cerebrovascular circulation. Compared with non-diabetic counterparts, peripheral arterial disease (PAD) in diabetic individuals is more diffuse and often involves the popliteal and below-knee arteries. The goal of treatment in diabetic patients with PAD, as in other patients with this condition, is to aggressively treat atherosclerotic risk factors to reduce future cardiovascular events as well as to improve symptoms of claudication and prevent limb amputation. Diabetes is also associated with a heightened risk of stroke which is a common cause of morbidity and mortality in diabetic individuals. Optimal blood pressure control is paramount in reducing the future risk of stroke in these patients. Clinicians need to be aware of the strong association between diabetes and non-coronary atherosclerosis and use appropriate medical and interventional treatments to reduce the associated disability and mortality in these patients.
Best Pract Res Clin Endocrinol Metab 2009 Jun
PMID:Peripheral and cerebrovascular atherosclerotic disease in diabetes mellitus. 1952 Mar 7

Constipation and faecal incontinence are common symptoms among patients with spinal cord injury (SCI), myelomeningocoele (MMC), multiple sclerosis (MS), Parkinson's disease (PD) and stroke. Faecal incontinence in SCI, MMC and MS is mainly due to abnormal rectosigmoid compliance and rectoanal reflexes, loss of rectoanal sensibility and loss of voluntary control of the external anal sphincter. Constipation in SCI, MMC and MS is probably due to immobilisation, abnormal colonic contractility, tone and rectoanal reflexes or side effects from medication. In PD, dystonia of the external anal sphincter causes difficult rectal evacuation and the loss of dopaminergic neurons in the enteric nervous system probably causes slow-transit constipation. Changes after stroke remain to be studied. Though dietary adjustments, oral laxatives, suppositories and other conservative treatment modalities are commonly used, evidence for their use in patients with central neurological disorders is scarce. For patients with severe symptoms trans-anal irrigation, the Malone appendicostomy or a colostomy can be recommended.
Best Pract Res Clin Gastroenterol 2009
PMID:Neurogenic colorectal and pelvic floor dysfunction. 1964 88

Hypovolaemia is a common cause of circulatory failure in the perioperative period. However, only 50% of critically ill patients respond to volume expansion with an adequate increase in cardiac output. Therefore, in daily clinical practice it is still a challenge to assess each subject's individual position on the Starling curve in order to optimize cardiac preload and avoid deleterious fluid overload. Recently, systolic pressure variation, stroke volume variation, and pulse pressure variation have been introduced as dynamic variables of fluid responsiveness which reflect ventilation-induced cyclic changes in left ventricular stroke volume. The concept of fluid responsiveness has been recognized for more than 20 years, and several studies have shown the superiority of these dynamic variables compared to static filling pressures. However, the usefulness of dynamic variables in critically ill patients is limited by several factors that the clinician needs to know for proper interpretation.
Best Pract Res Clin Anaesthesiol 2009 Jun
PMID:Monitoring fluid therapy. 1965 36

Major surgery is associated with significant trauma and is a potential cause of multiple system organ failure and death. Measurement of cardiac output using a variety of techniques during the perioperative period has enabled practitioners to proactively optimise stroke volume and cardiac output in an attempt to reduce postoperative complications. Although pulmonary artery catheter has been widely used and considered as the gold standard for measuring cardiac output, recent advancement of technology has seen the development of a number of less-invasive haemodynamic monitors. Oesophageal Doppler ultrasonography is a minimally invasive method for measuring stroke volume and cardiac output. It is user-friendly and is one of the few low-invasive technologies to date, which has been used successfully to guide intra-operative fluid administration, resulting in improvement in outcome and significant reduction in duration of hospital stay.
Best Pract Res Clin Anaesthesiol 2009 Sep
PMID:Goal-directed fluid management with trans-oesophageal Doppler. 1986 91

The dislodgement of atheroma from the ascending aorta and proximal arch is a major cause of stroke and neurological injury following cardiac surgery. The accurate detection of atheroma prior to aortic manipulation is necessary to facilitate surgical strategies to reduce the risk of embolisation. The traditional method for atheroma detection is manual palpation by the surgeon. This technique misses about half the number of the atheroma lesions, as the soft (non-calcified) lesions offer little resistance to the surgeon's fingers. Trans-oesophageal echocardiography (TOE) is commonly used in cardiac surgery, but the interposition of the bronchus between the aorta and the oesophagus causes an ultrasound 'blind spot' in the ascending aorta and proximal arch, such that it does not offer improved detection compared to manual palpation. Accurate detection of atheroma requires direct ultrasound assessment using epiaortic scanning, with a high-frequency, linear-array probe. This allows the surgeon to correctly assess and localise any atheroma. In this article, a suggested epiaortic examination sequence is described and strategies for surgeons to avoid atheroma are discussed.
Best Pract Res Clin Anaesthesiol 2009 Sep
PMID:Epiaortic ultrasound assessment of the aorta in cardiac surgery. 1986 92

Today's nurse faces many challenges in the workplace. Required to keep up in a constantly changing knowledge-based environment, he or she must balance complex professional responsibilities, staffing shortages, and increased acuity among the patient population. Continuing education must, therefore, be highly flexible and responsive to the personal and professional needs of the nurse learner. Technology-supported continuing education is suggested to be an appropriate way of meeting the learning needs of busy working nurses. The Stroke Best Practices for Nursing project used three complementary and integrated educational technologies-a-Web-based learning site, Web casting (live and archived), and two-way interactive videoconferencing--to deliver a minicourse focused on best practice stroke care to nurses working in northeastern and northwestern Ontario, a geographical area of approximately 600 km. In total, 96 nurses participated in the educational part of the program; 46 of the 96 (47%) took part in the assessment of the program. On the basis of this assessment strategy and the nurses' requests for other programs that do not use traditional face-to-face classrooms and lecture, the value of using educational technologies in health-based continuing education was strongly identified. This article describes key components of the project and celebrates the partnership among the organizing stakeholders: faculty in the school of nursing at the Laurentian University, the West Greater Toronto Area Stroke Network, and the Ontario Telemedicine Network. The article further describes findings related to the program's impact on participants' perceptions of competence as caregivers for stroke patients, participants' confidence using technology for educational purposes, and participants' satisfaction with the overall program.
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PMID:Stroke education for nurses through a technology-enabled program. 1999 85

An Inertial Gait Phase Detection system was developed to replace heel switches and footswitches currently being used for the triggering of drop foot stimulators. A series of four algorithms utilising accelerometers and gyroscopes individually and in combination were tested and initial results are shown. Sensors were positioned on the outside of the upper shank. Tests were performed on data gathered from a subject, sufferer of stroke, implanted with a drop foot stimulator and triggered with the current trigger, the heel switch. Data tested includes a variety of activities representing everyday life. Flat surface walking, rough terrain and carpet walking show 100% detection and the ability of the algorithms to ignore non-gait events such as weight shifts. Timing analysis is performed against the current triggering method, the heel switch. After evaluating the heel switch timing against a reference system, namely the Vicon 370 marker and force plates system. Initial results show a close correlation between the current trigger detection and the inertial sensor based triggering algorithms. Algorithms were tested for stairs up and stairs down. Best results are observed for algorithms using gyroscope data. Algorithms were designed using threshold techniques for lowest possible computational load and with least possible sensor components to minimize power requirements and to allow for potential future implantation of sensor system.
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PMID:Inertial Gait Phase Detection for control of a drop foot stimulator Inertial sensing for gait phase detection. 2015 37

An accurate prediction of system-specific recovery after stroke is essential to provide rehabilitation therapy based on the individual needs. We explored the usefulness of functional magnetic resonance imaging scans from an auditory language comprehension experiment to predict individual language recovery in 21 aphasic stroke patients. Subjects with an at least moderate language impairment received extensive language testing 2 weeks and 6 months after left-hemispheric stroke. A multivariate machine learning technique was used to predict language outcome 6 months after stroke. In addition, we aimed to predict the degree of language improvement over 6 months. 76% of patients were correctly separated into those with good and bad language performance 6 months after stroke when based on functional magnetic resonance imaging data from language relevant areas. Accuracy further improved (86% correct assignments) when age and language score were entered alongside functional magnetic resonance imaging data into the fully automatic classifier. A similar accuracy was reached when predicting the degree of language improvement based on imaging, age and language performance. No prediction better than chance level was achieved when exploring the usefulness of diffusion weighted imaging as well as functional magnetic resonance imaging acquired two days after stroke. This study demonstrates the high potential of current machine learning techniques to predict system-specific clinical outcome even for a disease as heterogeneous as stroke. Best prediction of language recovery is achieved when the brain activation potential after system-specific stimulation is assessed in the second week post stroke. More intensive early rehabilitation could be provided for those with a predicted poor recovery and the extension to other systems, for example, motor and attention seems feasible.
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PMID:Early functional magnetic resonance imaging activations predict language outcome after stroke. 2029 89

Two-stroke apparent motion offers a challenge to current theoretical models of motion processing and is thus a useful tool for investigating motion sensor input. The stimulus involves repeated presentation of two pattern frames containing a spatial displacement, with a blank inter-stimulus interval (ISI) at one of the two-frame transitions. The resulting impression of continuous motion was measured here using both direction discrimination and motion after-effect duration in order to assess the extent to which data using the two measures can be explained by a computational model without reference to attentive tracking mechanisms. The motion-energy model was found to offer a very good account of the psychophysical data using similar parameters for both tasks. The experiment was run under both photopic and scotopic retinal illumination. Data revealed that the optimum ISI for perceiving two-stroke apparent motion shifts to longer ISIs under scotopic conditions, providing evidence for a biphasic impulse response at low luminance. Best-fitting model parameters indicate that motion sensors receive inputs from temporal filters whose central temporal frequency shifts from 2.5 to 3.0Hz at high retinal illuminance to 1.0-1.5Hz at low retinal illuminance.
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PMID:A motion-energy model predicts the direction discrimination and MAE duration of two-stroke apparent motion at high and low retinal illuminance. 2038 Aug 46


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