Articles: function.
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Pol. Arch. Med. Wewn. · Nov 2022
Relative superiority of the Lund-Malmö revised equation for glomerular filtration rate estimation in patients with end-stage renal disease not on dialysis among 23 equations.
The glomerular filtration rate (GFR) is an important indicator of renal function, and its precise measurement is essential for guiding clinical management. However, studies evaluating the performance of GFRestimation equations in undialyzed patients with end‑stage renal disease (ESRD) remain scarce. ⋯ Based on comparison of 23 equations, we recommend using the LMR equation, despite its large deviations, to estimate GFR in undialyzed patients with ESRD.
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Cochrane Db Syst Rev · Nov 2022
ReviewInterventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation.
Cognitive deficits are common in people who have received cranial irradiation and have a serious impact on daily functioning and quality of life. The benefit of pharmacological and non-pharmacological treatment of cognitive deficits in this population is unclear. This is an updated version of the original Cochrane Review published in Issue 12, 2014. ⋯ In this update, limited additional evidence was found for the treatment or amelioration of cognitive deficits in adults treated with cranial irradiation. As concluded in the original review, there is supportive evidence that memantine may help prevent cognitive deficits for adults with brain metastases receiving cranial irradiation. There is supportive evidence that donepezil, methylphenidate and modafinil may have a role in treating cognitive deficits in adults with brain tumours who have been treated with cranial irradiation; patient withdrawal affected the statistical power of these studies. Further research that tries to minimise the withdrawal of consent, and subsequently reduce the requirement for imputation procedures, may offer a higher certainty of evidence. There is evidence from only a single small study to support non-pharmacological interventions in the amelioration of cognitive deficits. Further research is required.
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Pol. Arch. Med. Wewn. · Nov 2022
ReviewChallenges in pulmonary rehabilitation: COVID-19 and beyond.
Pulmonary rehabilitation is a comprehensive multidisciplinary intervention requiring a team involving an expert chest physician, an exercise training specialist, a nutritional expert, a psychologist, a social worker, and an occupational therapist, who together aim at improving respiratory functional capacity in patients with chronic obstructive pulmonary disease (COPD). We aimed at evaluating the effectiveness of pulmonary rehabilitation in a large number of trials, systematic reviews, and meta‑analyses in pre-COVID-19 conditions, and the impact of pulmonary rehabilitation during the COVID‑19 pandemic was estimated based on results of abundant available studies. ⋯ The response to rehabilitation in patients with COVID‑19 is also satisfactory. The effectiveness of pulmonary rehabilitation in COPD patients shows an evolving need for health care professionals to design an individually tailored pulmonary rehabilitation program for patients with COVID-19 to alleviate the chronic symptoms and reduce complications.
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Cochrane Db Syst Rev · Nov 2022
ReviewSurgical decompression for malignant cerebral oedema after ischaemic stroke.
Large territory middle cerebral artery (MCA) ischaemic strokes account for around 10% of all ischaemic strokes and have a particularly devastating prognosis when associated with malignant oedema. Progressive cerebral oedema starts developing in the first 24 to 48 hours of stroke ictus with an associated rise in intracranial pressure. The rise in intracranial pressure may eventually overwhelm compensatory mechanisms leading to a cascading secondary damage to surrounding unaffected parenchyma. This downward spiral can rapidly progress to death or severe neurological disability. Early decompressive craniectomy to relieve intracranial pressure and associated tissue shift can help ameliorate this secondary damage and improve outcomes. Evidence has been accumulating of the benefit of early surgical decompression in stroke patients. Earlier studies have excluded people above the age of 60 due to associated poor outcomes; however, newer trials have included this patient subgroup. This review follows a Cochrane Review published in 2012. ⋯ Surgical decompression improves outcomes in the management of malignant oedema after acute ischaemic stroke, including a considerable reduction in death or severe disability (mRS > 4) and a reduction in death or moderate disability (mRS > 3). Whilst there is evidence that this positive treatment effect is present in patients > 60 years old, it is important to take into account that these patients have a poorer prospect of functional survival independent of this treatment effect. In interpreting these results it must also be considered that the data demonstrating benefit are drawn from a unique patient subset with profound neurological deficit, reduced level of consciousness, and no pre-morbid disability or severe comorbidity.