Damos las gracias a los 14 pacientes de lesiones cerebrales que son miembros de la &quot;Amazing&quot; Grupo de Lesiones Cerebrales de Apoyo Survivor en Framingham, MA o acceder a servicios de consulta externa a través de Spaulding Rehabilitation Hospital para participar en el estudio que llevó a este documento. Financiación y otros apoyos para el estudio fueron proporcionados por la Asociación de Lesiones Cerebrales de Massachusetts, el Programa de Salud de lesiones a nivel estatal de la Comisión de Rehabilitación de Massachusetts, y la Agencia para la Investigación de la Calidad y el Instituto Schneider para Políticas de Salud en la Escuela Heller para la Política Social y Gestión, Universidad de Brandeis, a través de una beca de formación de doctorado en investigación de servicios sanitarios y el análisis de políticas.

<ol>
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C., Mauborgne, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fair+process:+Managing+in+the+knowledge+economy.">Fair process: Managing in the knowledge economy.</a> Harvard Business Review. 75, 65-75 (1997).</li><li>Langlois, J. A., Rutland-Brown, W., Thomas, K. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+incidence+of+traumatic+brain+injury+among+children+in+the+United+States+-+Differences+by+race.">The incidence of traumatic brain injury among children in the United States - Differences by race.</a> Journal of Head Trauma Rehabilitation. 20, 229-238 (2005).</li><li>Langlois, J. A., Rutland-Brown, W., Thomas, K. 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S., Berger, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Brain+injury+survivors:+Narratives+of+rehabilitation+and+healing.">Brain injury survivors: Narratives of rehabilitation and healing.</a> Disability in Society. , (2010).</li><li>Lorenz, L. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Discovering+a+new+identity+after+brain+injury.">Discovering a new identity after brain injury.</a> Sociology of Health &#38; Illness. 32, 862-879 (2010).</li><li>Lorenz, L. 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El primer autor ofrece cursos de capacitación en fotovoz y foto obtención a través de las escuelas de medicina y otros espacios educativos. El segundo autor no tiene nada que revelar.

Los encuestados se convierten en socios y desempeñar el papel de &quot;co-experto&quot; papel en el ámbito clínico, cuando su experiencia de vida se busca sólo el paciente puede saber realmente lo que es vivir con una lesión cerebral y la atención de experiencia relacionada. Además, la meta de salud para muchos sobrevivientes de lesiones cerebrales parece ser la curación, no de recuperación. La recuperación implica el deseo de regresar a un estado anterior a la lesión. Los pacientes recientemente lesionado puede ser la esperanza de recuperarse de sus lesiones, pero a largo plazo los sobrevivientes han aceptado que no será capaz de volver a su estado anterior. Ellos ven la curación como cognitivo, físico, emocional e incluso espiritual (Lorenz 2010a). Ellos perciben que siguen progresando con el tiempo, incluso muchos años después de la lesión. Hablar de las fotografías de su vida puede ayudar a los pacientes y los clínicos para identificar centrado en la persona de preocupación y reconocer y apreciar el progreso del paciente en el tiempo. La aplicación de un proceso justo para la atención clínica de los pacientes los medios están profundamente comprometidos, explorar la forma en que su experiencia se puede mejorar, la comprensión de los fundamentos de todas las decisiones clínicas, y la aceptación de su papel y responsabilidad. Proceso justo se activa la motivación del paciente para adherirse a las estrategias de rehabilitación y tomar medidas para avanzar en su curación. Cuando los proveedores de aplicar un proceso justo para la atención clínica, las expectativas del paciente y el proveedor y los objetivos pueden estar mejor alineados. La fotografía se convierte en el foco de la interacción e involucra a los profesionales, así como al paciente en la exploración de la experiencia y la construcción de relaciones. La relación terapéutica se puede mejorar. Además, de acuerdo con el modelo de Kim y Mauborgne, dando como resultado cambios de actitud y comportamiento podría llevar a mejores resultados. Con un proceso justo, el poder en la interacción clínica puede llegar a ser más equilibrado ya que los pacientes sienten que están siendo escuchadas. Hablar de las fotografías y su significado puede ayudar a los pacientes para convertirse en parte de la solución, no sólo el problema. El uso de cámaras no es la única manera de lograr un proceso justo, y no es un enfoque para cada paciente o el médico todos los días. Se trata de una herramienta y una metodología para involucrar a los pacientes, mejorar la comunicación en circunstancias difíciles, y lograr la atención centrada en la persona.

using visual and narrative methods to achieve fair process in clinical care

El Instituto de Medicina se ha centrado en el paciente centrado en un área importante de mejora de la calidad. Una dimensión importante de la centralidad del paciente es el respeto a los valores del paciente, sus preferencias y necesidades expresadas. Sin embargo, los enfoques específicos para obtener este conocimiento y traducirlo a una atención de calidad en la práctica clínica son insuficientes. Desde una perspectiva de calidad de paciente no es un concepto simple, pero se entiende mejor en términos de cinco dimensiones: los resultados técnicos, la toma de decisiones de eficiencia, los servicios y la comodidad, información y apoyo emocional, y la satisfacción del paciente en general. No tener en cuenta la calidad de los resultados de esta perspectiva de cinco puntas en un enfoque en los resultados médicos, sin tener en cuenta los procesos centrales de la calidad desde la perspectiva del paciente y vital para conseguir buenos resultados. En este trabajo, argumentamos a favor de aplicar el concepto de proceso justo en el ámbito clínico. Proceso justo implica el uso de un enfoque de colaboración para explorar los temas de diagnóstico y los tratamientos con los pacientes, explicando las razones de las decisiones, establecer las expectativas sobre los roles y responsabilidades, y la implementación de un plan básico y la evaluación continua. Proceso justo se abre la puerta a la paciente aportando su experiencia en el ámbito clínico y el trabajo de desarrollo de las metas de salud y las estrategias. Este documento ofrece un paso a paso la ilustración de un enfoque visual innovador, llamado fotovoz o foto-obtención, para lograr un proceso justo en el trabajo clínico con los sobrevivientes de lesiones cerebrales adquiridas y otras personas que viven con enfermedades crónicas. La aplicación de esta herramienta visual y la metodología en el ámbito clínico mejorará la comunicación entre paciente y proveedor; involucrar a los pacientes como socios en la identificación de retos, fortalezas, objetivos y estrategias, y evaluación y del progreso en el tiempo. Preguntar a los pacientes para llevar imágenes de su vida en la interacción clínica puede ayudar a esclarecer las lagunas en los conocimientos clínicos, forjar mejores relaciones terapéuticas con los pacientes que viven con enfermedades crónicas como la lesión cerebral, e identificar los objetivos centrados en el paciente y las posibilidades de curación. El proceso se ilustra aquí pueden ser utilizados por los médicos (médicos de atención primaria, terapeutas de rehabilitación, neurólogos, neuropsicólogos, psicólogos, y otros) que trabajan con personas que viven con enfermedades crónicas como la lesión cerebral adquirida, enfermedades mentales, discapacidades físicas, VIH / SIDA, abuso de sustancias o de estrés post-traumático, y por los líderes de los grupos de apoyo para el tipo de pacientes se ha descrito anteriormente y de sus familiares o cuidadores.

Watch this Scientific Journal Video about Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care at JoVE.com

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Este documento ilustra un enfoque innovador visual (fotovoz o foto-provocación) para lograr un proceso justo en la atención clínica de los pacientes que viven con enfermedades crónicas, iluminar lagunas en los conocimientos clínicos, forjar mejores relaciones terapéuticas, e identificar los objetivos centrados en el paciente y las posibilidades de curación .

Uso de métodos visuales y narrativos para lograr un proceso justo en la atención clínica

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

using-visual-narrative-methods-to-achieve-fair-process-clinical

Research

Education

JoVE Journal

JoVE Core

Nursing

Medicine

Unit 1

Ethical and Legal Aspects in Nursing

Healthcare Delivery Systems

SCIENTISTS IN ACTION

23.3K vistas.  Brandeis University. Este documento ilustra un enfoque innovador visual (fotovoz o foto-provocación) para lograr un proceso justo en la atención clínica de los pacientes que viven con enfermedades crónicas, iluminar lagunas en los conocimientos clínicos, forjar mejores relaciones terapéuticas, e identificar los objetivos centrados en el paciente y las posibilidades de curación .

Video: Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

Desarrollo de un entorno de juego basado en audio virtual para ayudar con habilidades de navegación en la ciega

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

Investigación

Medicina

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to assess changes in myelination at the central nervous system (CNS). However, standard measurements, including routine visual tests and MRI scans, are not sensitive enough for this purpose. We present two visual tests addressing dynamic monocular and binocular functions which may closely associate with the extent of myelination along visual pathways. These include Object From Motion (OFM) extraction and Time-constrained stereo protocols. In the OFM test, an array of dots compose an object, by moving the dots within the image rightward while moving the dots outside the image leftward or vice versa. The dot pattern generates a camouflaged object that cannot be detected when the dots are stationary or moving as a whole. Importantly, object recognition is critically dependent on motion perception. In the Time-constrained Stereo protocol, spatially disparate images are presented for a limited length of time, challenging binocular 3-dimensional integration in time. Both tests are appropriate for clinical usage and provide a simple, yet powerful, way to identify and quantify processes of demyelination and remyelination along visual pathways. These protocols may be efficient to diagnose and follow optic neuritis and multiple sclerosis patients.
In the diagnostic process, these protocols may reveal visual deficits that cannot be identified via current standard visual measurements. Moreover, these protocols sensitively identify the basis of the currently unexplained continued visual complaints of patients following recovery of visual acuity. In the longitudinal follow up course, the protocols can be used as a sensitive marker of demyelinating and remyelinating processes along time. These protocols may therefore be used to evaluate the efficacy of current and evolving therapeutic strategies, targeting myelination of the CNS.

Object From Motion (OFM) and Time-constrained stereo protocols are sensitive tools to identify monocular and binocular dynamic visual function deficits, which are uniquely affected in optic neuritis patients. Furthermore, these tests may be used as quantitative noninvasive tools to assess the extent of myelination along visual pathways.

Tests visuales dinámicos para identificar y cuantificar los daños visuales y Reparación Siguiendo desmielinización en neuritis óptica pacientes

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to ...

Catheterization of the Carotid Artery and Jugular Vein to Perform Hemodynamic Measures, Infusions and Blood Sampling in a Conscious Rat Model

The success of a small animal model to study critical illness is, in part, dependent on the ability of the model to simulate the human condition. Intra-tracheal inoculation of a known amount of bacteria has been successfully used to reproduce the pathogenesis of pneumonia which then develops into sepsis. Monitoring hemodynamic parameters and providing standard clinical treatment including infusion of antibiotics, fluids and drugs to maintain blood pressure is critical to simulate routine supportive care in this model but to do so requires both arterial and venous vascular access. The video details the surgical technique for implanting carotid artery and common jugular vein catheters in an anesthetized rat. Following a 72 hr recovery period, the animals will be re-anesthetized and connected to a tether and swivel setup attached to the rodent housing which connects the implanted catheters to the hemodynamic monitoring system. This setup allows free movement of the rat during the study while continuously monitoring pressures, infusing fluids and drugs (antibiotics, vasopressors) and performing blood sampling.

Vascular accesses to measure hemodynamics, provide fluids and perform blood sampling are important to any small animal model study. We present a technique for implanting catheters into the carotid artery and the common jugular vein in an anesthetized rat for connecting to a system to perform monitoring, infusions and sampling.

La cateterización de la arteria carótida y la vena yugular para realizar mediciones hemodinámicas, Infusiones y muestras de sangre en un modelo de rata Consciente

The success of a small animal model to study critical illness is, in part, dependent on the ability of the model to simulate the human condition. ...

Instillation and Fixation Methods Useful in Mouse Lung Cancer Research

The ability to instill live agents, cells, or chemicals directly into the lung without injuring or killing the mice is an important tool in lung cancer research. Although there are a number of methods that have been published showing how to intubate mice for pulmonary function measurements, none are without potential problems for rapid tracheal instillation in large cohorts of mice. In the present paper, a simple and quick method is described that enables an investigator to carry out such instillations in an efficient manner. The method does not require any special tools or lighting and can be learned with very little practice. It involves anesthetizing a mouse, making a small incision in the neck to visualize the trachea, and then inserting an intravenous catheter directly. The small incision is quickly closed with tissue adhesive, and the mice are allowed to recover. A skilled student or technician can do instillations at an average rate of 2 min/mouse. Once the cancer is established, there is frequently a need for quantitative histologic analysis of the lungs. Traditionally pathologists usually do not bother to standardize lung inflation during fixation, and analyses are often based on a scoring system that can be quite subjective. While this may sometime be sufficiently adequate for gross estimates of the size of a lung tumor, any proper stereological quantification of lung structure or cells requires a reproducible fixation procedure and subsequent lung volume measurement. Here we describe simple reliable procedures for both fixing the lungs under pressure and then accurately measuring the fixed lung volume. The only requirement is a laboratory balance that is accurate over a range of 1 mg&#8211;300 g. The procedures presented here thus could greatly improve the ability to create, treat, and analyze lung cancers in mice.

The goal of this paper is to describe simple methods that will greatly aid in the setup and analysis of mouse lungs with lung cancer or other pathologies. We present 3 protocols to simply and reliably carry out lung instillations, fixation, and lung volume measurements.

Instilación y Fijación Métodos Útiles en pulmón de ratón Cancer Research

The ability to instill live agents, cells, or chemicals directly into the lung without injuring or killing the mice is an important tool in lung cancer ...

A Model to Simulate Clinically Relevant Hypoxia in Humans

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to hypoxia sensitive organs such as the brain, compensatory circulatory mechanisms help to maintain an adequate oxygen supply. This is mainly achieved by increased cerebral blood flow. Intermittent hypoxia is a commonly seen phenomenon in patients with obstructive sleep apnea. Acute airway obstruction can also result in hypoxia and hypercapnia. Until now, no adequate model has been established to simulate these dynamics in humans. Previous investigations focusing on human hypoxia used inhaled hypoxic gas mixtures. However, the resulting hypoxia was combined with hyperventilation and is therefore more representative of high altitude environments than of apnea. Furthermore, the transferability of previously performed animal experiments to humans is limited and the pathophysiological background of apnea induced physiological changes is poorly understood. In this study, healthy human apneic divers were utilized to mimic clinically relevant hypoxia and hypercapnia during apnea. Additionally, pulse-oximetry and Near Infrared Spectroscopy (NIRS) were used to evaluate changes in cerebral and peripheral oxygen saturation before, during, and after apnea.

Hypoxia simulation in humans has usually been performed by inhaling hypoxic gas mixtures. For this study, apneic divers were used to simulate dynamic hypoxia in humans. Additionally, physiological changes in desaturation and re-saturation kinetics were evaluated with non-invasive tools such as Near-Infrared-Spectroscopy (NIRS) and peripheral oxygenation saturation (SpO2).

Un modelo para simular la hipoxia clínicamente relevantes en seres humanos

In case of apnea, arterial partial pressure of oxygen (pO2) decreases, while partial pressure of carbon dioxide (pCO2) increases. To avoid damage to ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Un ensayo clínico que evalúa la seguridad, eficacia y entrega de bolsas de tres cámaras basadas en aceite de oliva para la nutrición parenteral

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) may detect adverse events of interventions such as fluid overload at an early stage. The Simple Intensive Care Studies (SICS) is a research line that focuses on the prognostic and diagnostic value of combinations of clinical variables.
The SICS-I specifically focused on the use of clinical variables obtained within 24 h of acute admission for prediction of cardiac output (CO) and mortality. Its sequel, SICS-II, focuses on repeated evaluations during ICU admission. The first clinical examination by trained researchers is performed within 3 h after admission consisting of physical examination and educated guessing. The second clinical examination is performed within 24 h after admission and includes physical examination and educated guessing, biochemical analysis and CCUS assessments of heart, lungs, inferior vena cava (IVC) and kidney. This evaluation is repeated at days 3 and 5 after admission. CCUS images are validated by an independent expert, and all data is registered in an online secured database. Follow-up at 90 days includes registration of complications and survival status according to patient&#39;s medical charts and the municipal person registry. The primary focus of SICS-II is the association between venous congestion and organ dysfunction.
The purpose of publishing this protocol is to provide details on the structure and methods of this on-going prospective observational cohort study allowing answering multiple research questions. The design of the data collection of combined clinical examination and CCUS assessments in critically ill patients are explicated. The SICS-II is open for other centers to participate and is open for other research questions that can be answered with our data.

Structured protocols are necessary to provide answers on research questions in critically ill patients. The Simple Intensive Care Studies (SICS) provides an infrastructure for repeated measurements in critically ill patients including clinical examination, biochemical analysis and ultrasonography. SICS projects have specific focus but the structure is flexible to other investigations.

Protocolo de estudio observacional para examen clínico repetido y crítico cuidado ecografía dentro de los estudios de la Simple unidad de cuidados intensivos

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) ...

Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative musicality to improve infant development, parental well-being, and bonding. It aims at relaxing and nurturing the infant as well as promoting safety and social interaction for the parent-infant dyad. A music therapist specially trained in CMT hums or sings in an infant-directed, improvised, lullaby style continually adjusting to the individual needs, expressions, and breathing pattern of the preterm infant. Based on the principles of family-integrated care, the family is incorporated individually in the therapeutic process, namely by delivering CMT during kangaroo care (KC) and by motivating and facilitating parental vocal interaction with their infant to strengthen the parent-infant bonding. CMT aims at relaxing, stimulating, and coregulating premature infants at a time when many other interventions are still risky and can overwhelm the vulnerable patient group. CMT may be advantageous not by educating and teaching parents, but rather by uncovering the intuitive capacities of parenting that are often overshadowed by the traumatic experience of preterm birth. However, CMT can only be provided when the infants are clinically stable. CMT with parental integration is feasible when parents are available and receptive to participate. This paper presents a detailed protocol on how to use CMT to empower preterm infants and their families.

Creative music therapy for preterm infants and their parents has emerged as a promising family-integrated early intervention. We present a detailed protocol on how to use vocal interaction, humming, or singing to empower preterm infants and their families.

Protocolo de Práctica Clínica de Terapia Musical Creativa para Bebés Prematuros y sus Padres en la Unidad de Cuidados Intensivos Neonatales

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative ...

Assessment of Static Graviceptive Perception in the Roll-Plane using the Subjective Visual Vertical Paradigm

Vestibular disorders are among the most common syndromes in medicine. In recent years, new vestibular diagnostic systems have been introduced that allow the examination of all semicircular canals in the clinical setting. Assessment methods of the otolithic system, which is responsible for the perception of linear acceleration and perception of gravity, are far less in clinical use. There are several experimental approaches for measuring the perception of gravity. The most frequently used method is the determination of the subjective visual vertical. This is usually measured with the head in an upright position. We present here an assessment method for testing otolith function in the roll plane. The subjective visual vertical is measured in the head upright position as well as with head inclination of &#177; 15&#176; and &#177; 30&#176; in the roll plane. This extended functional paradigm is an easy-to-perform clinical test of otolith function and ensures increased information content for the detection of impaired graviceptive perception.

The perception of gravity is commonly determined by the subjective visual vertical in the head upright position. The additional assessment at head tilts of &#177; 15&#176; and &#177; 30&#176; in the roll plane ensures increased information content for the detection of impaired graviceptive perception.

Evaluación de la percepción gravocetiva estática en el roll-plane utilizando el paradigma vertical visual subjetivo

Vestibular disorders are among the most common syndromes in medicine. In recent years, new vestibular diagnostic systems have been introduced that allow ...

Electroretinogram Recording for Infants and Children under Anesthesia to Achieve Optimal Dark Adaptation and International Standards

Electroretinogram (ERG) is the only clinical objective test available to assess retinal function. Full-field ERG (ffERG) measures the panretinal rod and cone photoreceptor function as well as inner retinal function and is an important measure in the diagnosis and management of inherited retinal diseases as well as inflammatory, toxic, and nutritional retinopathies. Adhering to international standards and maintaining retinal dark adaptation are critical to acquire valid and reliable dark-adapted (scotopic) and light-adapted (photopic) ffERG responses. Performing ffERG in infants and children is challenging and often requires general anesthesia in the operating room. However, maintaining retinal dark adaptation in the operating room is becoming increasingly difficult given the numerous light sources from anesthesiology monitoring systems and other equipment. A practical and widely applicable method for ffERG testing is described in the operating room that optimizes retinal dark adaptation. The method reduces operating room time by dark-adapting the patient before general anesthesiology is instituted. The operating room is modified for dark adaptation and any remaining light source in the darkened operating room is minimized with the use of a modified portable foldable darkroom that encloses the patient&#8217;s head and the ERG examiner during ffERG scotopic recordings. The simple method adheres to ffERG international standards and provides valid reliable scotopic and photopic ffERG recordings that are critical to assess objective retinal function in this young age group where subjective assessment of visual function such as visual acuity and visual fields are not possible. Furthermore, the ffERG is the gold standard clinical test in detecting early onset inherited retinal diseases including Leber congenital amaurosis where approved gene therapy has become available. In sedated conditions, very low amplitude ffERG signals can be detected due to minimal orbicularis muscle activity interference, which is particularly relevant in patients after gene therapy to detect improved amplitude responses.

Adhering to international standards and maintaining retinal dark adaptation are critical to acquire valid full-field electroretinogram responses in the diagnosis and management of inherited retinal diseases. A practical protocol using a portable darkroom is provided to obtain full-field&#160;electroretinogram for infants and children under sedation or general anesthesia in the operating room setting.

Grabación de electrorretinogramas para bebés y niños bajo anestesia para lograr una adaptación óptima de la oscuridad y estándares internacionales

Electroretinogram (ERG) is the only clinical objective test available to assess retinal function. Full-field ERG (ffERG) measures the panretinal rod and ...