Neurology
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Sedation for the imminently dying (SFTID) is a controversial practice that involves the provision of sedation to imminently dying patients with the intent of relieving their suffering when symptoms are refractory to other interventions. The goal of this research was to ascertain the opinions regarding SFTID that are held by neurologists who are interested in ethics and end-of-life care. ⋯ The overwhelming majority of neurologists surveyed endorse the concept that sedation for the imminently dying differs morally and legally from euthanasia and that it is an acceptable therapeutic option for some but not all patients who are imminently dying of a terminal illness.
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To determine whether insurance status is associated with differential outpatient treatment of migraine in the United States. ⋯ The uninsured, and those with Medicaid, receive substandard therapy for migraine, at least in part because they receive more care in emergency departments and less in physicians' offices.
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The corpus callosum (CC) has been shown to be susceptible to atrophy in Alzheimer disease (AD) as a correlate of wallerian degeneration or retrogenesis. However, when and where these 2 mechanisms intervene is still unclear. ⋯ Callosal changes are already present in patients with amnestic mild cognitive impairment (MCI) and mild Alzheimer disease (AD). The precocious involvement of the anterior callosal subregion in amnestic MCI extends to posterior regions in mild AD. Two different mechanisms might contribute to the white matter changes in mild AD: wallerian degeneration in posterior subregions of the corpus callosum (suggested by increased axial diffusivity without fractional anisotropy modifications) and a retrogenesis process in the anterior callosal subregions (suggested by increased radial diffusivity without axial diffusivity modifications).
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Comparative Study
Outcome prediction in mechanically ventilated neurologic patients by junior neurointensivists.
Physician prediction of outcome in critically ill neurologic patients impacts treatment decisions and goals of care. In this observational study, we prospectively compared predictions by neurointensivists to patient outcomes at 6 months. ⋯ Prediction of long-term functional outcomes in critically ill neurologic patients is challenging. Our neurointensivists were more accurate in predicting poor outcome than good outcome in patients requiring mechanical ventilation >or=72 hours.