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This comprehensive guide thoroughly covers all aspects of neuropalliative care, from symptom-specific considerations, to improving communication between clinicians, patients and families. Neuropalliative Care: A Guide to Improving the Lives of Patients and Families Affected by Neurologic Disease addresses clinical considerations for diseases such as dementia, multiple sclerosis, and severe acute brain injury, as well discussing the other challenges facing palliative care patients that are not currently sufficiently met under current models of care. This includes methods of effective communication, supporting the caregiver, how to make difficult treatment decisions in the face of uncertainty, managing grief, guilt and anger, and treating the pain itself. Written by leaders in the field of neuropalliative care, this book is an exceptional, well-rounded resource of neuropalliative care, serving as a reference for all clinicians caring for patients with neurological disease and their families: neurologists and palliative care specialists, physicians, nurses, chaplains, social workers, as well as trainees in these areas.
Chronic disorders of consciousness comprise a tragic group of conditions for which determining prognosis is a prerequisite for clinical decision-making. The Vegetative State (VS) and the Minimally Conscious State (MCS) are syndromes, encompassing a spectrum of severity with various etiologies, most commonly traumatic brain injury or hypoxic-ischemic or hemorrhagic neuronal injury. They can be a transient stage during recovery from an acute brain insult or can be chronic and stable, usually after a variable period of coma. Recent advances in neuroimaging are providing new insights into cerebral activity in patients with severe brain damage. The mapping of cognitive processes (mostly by measuring regional changes in blood flow, initially by PET and currently by fMRI, and by measuring regional metabolic changes by MRSI) is providing insight into the functional neuroanatomy and metabolic assessment of consciousness. However, differential diagnosis of SV and MCS is still difficult and their complex management involves many different and skilled healthcare professionals. This book is aimed at examining the pathophysiology of consciousness disorders with their multifaceted assessment and treatment, including new diagnostic tools and novel prognostic markers, and the important bioethical issues concerning "the end of life" and the "dignity of the person".
This open access book focuses on practical clinical problems that are frequently encountered in stroke rehabilitation. Consequences of diseases, e.g. impairments and activity limitations, are addressed in rehabilitation with the overall goal to reduce disability and promote participation. Based on the available best external evidence, clinical pathways are described for stroke rehabilitation bridging the gap between clinical evidence and clinical decision-making. The clinical pathways answer the questions which rehabilitation treatment options are beneficial to overcome specific impairment constellations and activity limitations and are well acceptable to stroke survivors, as well as when and in which settings to provide rehabilitation over the course of recovery post stroke. Each chapter starts with a description of the clinical problem encountered. This is followed by a systematic, but concise review of the evidence (RCTs, systematic reviews and meta-analyses) that is relevant for clinical decision-making, and comments on assessment, therapy (training, technology, medication), and the use of technical aids as appropriate. Based on these summaries, clinical algorithms / pathways are provided and the main clinical-decision situations are portrayed. The book is invaluable for all neurorehabilitation team members, clinicians, nurses, and therapists in neurology, physical medicine and rehabilitation, and related fields. It is a World Federation for NeuroRehabilitation (WFNR) educational initiative, bridging the gap between the rapidly expanding clinical research in stroke rehabilitation and clinical practice across societies and continents. It can be used for both clinical decision-making for individuals and as well as clinical background knowledge for stroke rehabilitation service development initiatives.
Over the past decade, the hospitalist model has become a dominant system for the delivery of inpatient care. Forces such as national mandates to improve safety and quality, and intense pressure to safely reduce length of hospital stays, are now exerting pressure on neurologists. To meet these challenges, a new neurohospitalist model is emerging. This is the first authoritative text to detail the advances and strategies for treating neurologic disease in a hospital setting. It includes chapters on specific acute neurologic diseases including stroke, epilepsy, neuromuscular disease and traumatic brain injury and also addresses common reasons for neurologic consultation in the hospital including encephalopathy, electrolyte disturbances and neurologic complications of pregnancy. Ethical and structural issues commonly encountered in neurologic inpatients are also addressed. This will be a key resource for any clinician or trainee caring for neurologic patients in the hospital including practising neurologists, internists and trainees across multiple subspecialities.
Plum and Posner's Diagnosis and Treatment of Stupor and Coma, 5th edition, is a major update of the classic work on diagnosing the cause of coma, with the addition of completely new sections on treatment of comatose patients, by Dr. Jan Claassen, the Director of the Neuro-ICU at Columbia New York Presbyterian Hospital. The first chapter of the book provides an up-to-date review on the brain mechanisms that maintain a conscious state in humans, and how lesions that damage these mechanisms cause loss of consciousness or coma. The second chapter reviews the neurological examination of the comatose patient, which provides the basis for determining whether the patient is suffering from a structural brain injury causing the coma, or from a metabolic disorder of consciousness. The third and fourth chapters review the pathophysiology of structural lesions causing coma, and the specific disease states that result in coma. Chapter five is a comprehensive treatment of the many causes of metabolic coma. Chapter 6 review psychiatric causes of unresponsiveness and how to identify and treat them. Chapters 7 and 8 review the overall emergency treatment of comatose patients, followed by the treatment of specific causes of coma. Chapter 9 examines the long term outcomes of coma, including the minimally conscious state and the persistent vegetative state, and how they can be distinguished, and their implications for eventual useful recovery. Chapter 10 reviews the topic of brain death and the standards for examination of a patient that are required to make the determination of brain death. The final chapter 11 is by J.J. Fins, a medical ethicist who was invited by the other authors to write an essay on the ethics of diagnosis and treatment of patients who, by definition, have no way to approve of or communicate about their wishes. While providing detailed background for neurological and neurosurgical specialists, the practical nature of the material in this book has found its greatest use among Internists, Emergency Medicine, and Intensive Care specialists, who deal with comatose patients frequently, but who may not have had extensive neurological training.
Whenever the legitimacy of a new or ethically contentious medical intervention is considered, a range of influences will determine whether the treatment becomes accepted as lawful medical treatment. The development and introduction of abortion, organ donation, gender reassignment, and non-therapeutic cosmetic surgery have, for example, all raised ethical, legal, and clinical issues. This book examines the various factors that legitimatise a medical procedure. Bringing together a range of internationally and nationally recognised academics from law, philosophy, medicine, health, economics, and sociology, the book explores the notion of a treatment, practice, or procedure being proper medical treatment, and considers the range of diverse factors which might influence the acceptance of a particular procedure as appropriate in the medical context. Contributors address such issues as clinical judgement and professional autonomy, the role of public interest, and the influence of resource allocation in decision-making. Chapter 6 of this book is freely available as a downloadable Open Access PDF at http://www.taylorfrancis.com under a Creative Commons Attribution-Non Commercial-No Derivatives (CC-BY-NC-ND) 3.0 license.
A comprehensive survey of best practice in using diagnostic imaging in acute neurologic conditions. The symptom-based approach guides the choice of the available imaging tools for efficient, accurate, and cost-effective diagnosis. Effective examination algorithms integrate neurological and imaging concepts with the practical demands and constraints of emergency care.
These proceeding cover new trends presented at the IV Congress of the International Society of Reconstructive Neurosurgery (ISRN), 2015. ISRN is an “open” multidisciplinary society that deals with advances in spine and peripheral-nerve reconstructive surgery, central nervous system revascularization (surgical, radio interventional), neuromodulation, bioengineering and transplantation, which are the latest tools used to promote reconstruction, restoration and rehabilitation.
A survey of the medical, ethical and legal issues that surround this controversial topic.
Joseph J. Fins calls for a reconsideration of severe brain injury treatment, including discussion of public policy and physician advocacy.