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Nagore D, Candela A, Bürge M, Tamayo E, Murie-Fernández M, Vives M, Monedero P, Álvarez J, Mendez E, Pasqualetto A, Mon T, Pita R, Varela MA, Esteva C, Pereira MA, Sanchez J, Rodriguez MA, Garcia A, Carmona P, López M, Pajares A, Vicente R, Aparicio R, Gragera I, Calderón E, Marcos JM, Gómez L, Rodríguez JM, Matilla A, Medina A, Hernández A, Morales L, Santana L, Garcia E, Montesinos S, Muñoz P, Bravo B, Blanco V. Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00094-5. [PMID: 38704092 DOI: 10.1016/j.redare.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 05/06/2024]
Abstract
PURPOSE It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN Multicenter prospective international cohort study. SETTING Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.
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Affiliation(s)
- D Nagore
- Departamento de Anestesia y Medicina Perioperatoria, Grupo Quirón - Policlínica Guipúzcoa, San Sebastián, Spain; Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Candela
- Departamento de Anestesia y Medicina Perioperatoria, Grupo Quirón - Policlínica Guipúzcoa, San Sebastián, Spain; Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Bürge
- Departamento de Anestesia y Medicina Perioperatoria, Barts Heart Centre, St Bartholomew's Hospital, Londres, UK
| | - E Tamayo
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - M Vives
- Departamento de Anestesiología & Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain; Departamento de Anestesiología y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain.
| | - P Monedero
- Departamento de Anestesiología & Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Spain
| | - J Álvarez
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - E Mendez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Pasqualetto
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - T Mon
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Pita
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Alvaro Cunqueiro Vigo, Vigo, Spain
| | - M A Varela
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Alvaro Cunqueiro Vigo, Vigo, Spain
| | - C Esteva
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Alvaro Cunqueiro Vigo, Vigo, Spain
| | - M A Pereira
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Alvaro Cunqueiro Vigo, Vigo, Spain
| | - J Sanchez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M A Rodriguez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Garcia
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Carmona
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - M López
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - A Pajares
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - R Vicente
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - R Aparicio
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - I Gragera
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Infanta Cristina, Badajoz, Spain
| | - E Calderón
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Puerta de Mar, Cádiz, Spain
| | - J M Marcos
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de León, León, Spain
| | - L Gómez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - J M Rodríguez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Salamanca, Salamanca, Spain
| | - A Matilla
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Salamanca, Salamanca, Spain
| | - A Medina
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario de Málaga, Málaga, Spain
| | - A Hernández
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Policlínica Ibiza, Ibiza, Spain
| | - L Morales
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital Universitario Dr, Negrín, Las Palmas de Gran Canaria, Spain
| | - L Santana
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital Universitario Dr, Negrín, Las Palmas de Gran Canaria, Spain
| | - E Garcia
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - S Montesinos
- Departamento de Anestesiología y Medicina Perioperatoria, Centro Médico Teknon Barcelona, Barcelona, Spain
| | - P Muñoz
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital 12 de octubre, Madrid, Spain
| | - B Bravo
- Servicio de Anestesiología y Medicina Perioperatoria, Hospital de Cruces de Bizkaia, Bilbao, Spain
| | - V Blanco
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
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Murie-Fernández M, Bahamonde C, Graffigna D, Hontanilla B. Botulinum toxin type A infiltration in spasticity and cervical dystonia. Muscle morphology: an overlooked factor. Neurologia 2023:S2173-5808(23)00028-7. [PMID: 37116692 DOI: 10.1016/j.nrleng.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 04/30/2023] Open
Abstract
INTRODUCTION Botulinum toxin type A is used to treat spasticity and dystonia. However, its relationship with muscle morphology has not been studied. The action mechanism of botulinum toxin is based on the inhibition of acetylcholine release. Therefore, larger doses of toxin would be needed to treat larger muscles. This study aims to establish whether there is a discrepancy between muscle morphology and the botulinum toxin doses administered. METHODS We dissected, and subsequently measured and weighed, muscles from the upper and lower limbs and the head of a fresh cadaver. We consulted the summary of product characteristics for botulinum toxin type A to establish the recommended doses for each muscle and calculated the number of units infiltrated per gramme of muscle. RESULTS Different muscles present considerable morphological variability, and the doses of botulinum toxin administered to each muscle are very similar. We observed great variability in the amount of botulinum toxin administered per gramme of muscle, ranging from 0.3 U/g in the biceps femoris to 14.6 U/g in the scalene muscles. The mean dose was 2.55 U/g. The doses administered for nearly all lower limb muscles were below this value. CONCLUSIONS There are significant differences in morphology between the muscles of the lower limbs, upper limbs, and head, but similar doses of botulinum toxin are administered to each muscle. These differences result in great variability in the number of units of botulinum toxin administered per gramme of muscle.
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Affiliation(s)
- M Murie-Fernández
- Unidad de Neurorrehabilitación. Hospital Ciudad de Telde. Las Palmas de Gran Canaria.
| | - C Bahamonde
- Unidad de Neurorrehabilitación. Hospital Ciudad de Telde. Las Palmas de Gran Canaria
| | - D Graffigna
- Unidad de Neurorrehabilitación. Hospital Ciudad de Telde. Las Palmas de Gran Canaria
| | - B Hontanilla
- Departamento de cirugía plástica. Clínica Universidad de Navarra
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Cáceres Santana E, Bermúdez Moreno C, Ramírez Suarez J, Bahamonde Román C, Murie-Fernández M. Incidence of falls in long-stay hospitals: risk factors and strategies for prevention. Neurologia (Engl Ed) 2022; 37:165-170. [PMID: 35465909 DOI: 10.1016/j.nrleng.2019.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/03/2019] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Falls are a major health problem in elderly institutionalised patients, due to the associated high morbidity and mortality rates and the impact on future quality of life. OBJECTIVE To analyse the incidence and patient profile for falls, and to identify potential causes and effects. We also assess the efficacy of intervention in selected patients in preventing further falls. METHODS We performed a prospective study at a long-term care centre for 12 months. Data were collected via fall reports. The falls committee drafted a monthly data collection form. RESULTS A total of 155 falls were recorded in 80 patients, with 40% presenting more than one fall. Patients aged over 70 years accounted for 84.5% of falls; 42.7% of patients are able to walk independently; 55.5% of falls occurred in the bedroom; 74.8% of patients had been prescribed sedatives or psychoactive, or antihypertensive drugs; 27.7% of falls were due to loss of balance and 22.5% were due to patients performing an activity for which they did not have the capacity. Fractures occurred in 1.9% of patients. CONCLUSIONS Patients aged over 70 years, walking independently, receiving sedatives or psychoactive or antihypertensive drugs, and with history of falls were at greatest risk. The majority of falls occurred in the bedroom. Physiotherapy interventions were highly effective in cases selected by the falls committee.
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Affiliation(s)
- E Cáceres Santana
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain
| | - C Bermúdez Moreno
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain
| | - J Ramírez Suarez
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain
| | - C Bahamonde Román
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain
| | - M Murie-Fernández
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain.
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Cáceres Santana E, Bermúdez Moreno C, Ramírez Suarez J, Bahamonde Román C, Murie-Fernández M. Incidence of falls in long-stay hospitals: risk factors and strategies for prevention. Neurologia 2022; 37:165-170. [PMID: 31056217 DOI: 10.1016/j.nrl.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/13/2019] [Accepted: 03/03/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Falls are a major health problem in elderly institutionalised patients, due to the associated high morbidity and mortality rates and the impact on future quality of life. OBJECTIVE To analyse the incidence and patient profile for falls, and to identify potential causes and effects. We also assess the efficacy of intervention in selected patients in preventing further falls. METHODS We performed a prospective study at a long-term care centre for 12 months. Data were collected via fall reports. The falls committee drafted a monthly data collection form. RESULTS A total of 155 falls were recorded in 80 patients, with 40% presenting more than one fall. Patients aged over 70 years accounted for 84.5% of falls; 42.7% of patients are able to walk independently; 74.8% of patients had been prescribed sedatives or psychoactive, or antihypertensive drugs; 55.5% of falls occurred in the bedroom; 27.7% of falls were due to loss of balance and 22.5% were due to patients performing an activity for which they did not have the capacity. Fractures occurred in 1.9% of patients. CONCLUSIONS Patients aged over 70 years, walking independently, receiving sedatives or psychoactive or antihypertensive drugs, and with history of falls were at greatest risk. The majority of falls occurred in the bedroom. Physiotherapy interventions were highly effective in cases selected by the falls committee.
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Affiliation(s)
- E Cáceres Santana
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España
| | - C Bermúdez Moreno
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España
| | - J Ramírez Suarez
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España
| | - C Bahamonde Román
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España
| | - M Murie-Fernández
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España.
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Laxe S, Ferri J, Juárez-Belaunde A, Ríos-Lago M, Rodríguez-Duarte R, Murie-Fernández M. Neurorehabilitation in the times of Covid-19: insights from the Spanish Neurorehabilitation Society (SENR). Brain Inj 2020; 34:1691-1692. [PMID: 33104386 DOI: 10.1080/02699052.2020.1830172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The entire world is experiencing an unprecedented global health crisis and Spain has been one of the most heavily affected countries within Europe. Unexpected rapid changes and reorganization of medical services that occurred during the pandemic lead to an impact in the practice of neurorehabilitation. The idiosyncrasies typical of neurorehabilitation management, specially in acute facilities, that makes it susceptible as a vector of dissemination of Covid but also because of the need of finding new wards and intensive care units for Covid patients, the interventions in neurorehabilitation has suffered enormous changes. There is a need for rethinking the future to treat a new wave of patients with neurorehabilitation necessities such as those recovering from Covid 19 with neurological sequelae but also of those neurorehab patients who were unable to access the health system during the locke down period. This article is intended to invite to reflect on and discuss the redesign of our current neurorehabilitation plans after the experience on the Covid 19 pandemic.
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Affiliation(s)
- S Laxe
- Sociedad Española de Neurorrehabilitación (SENR).,Physical Medicine and Rehabilitation Department, ICEMEQ, Hospital Clinic , Barcelona, Spain
| | - J Ferri
- Sociedad Española de Neurorrehabilitación (SENR).,NEURORHB, Neurorehabilitation Department, Vithas Hospital , València, Spain.,Fundación Salud y Cerebro , València, Spain.,Fundación Hospitales Vithas , València, Spain
| | - A Juárez-Belaunde
- Sociedad Española de Neurorrehabilitación (SENR).,Neurorehabilitation Unit Hospital Los Madroños , Madrid, Spain
| | - M Ríos-Lago
- Sociedad Española de Neurorrehabilitación (SENR).,Brain Injury Unit, Hospital Beata María Ana , Madrid, Spain.,Dpto. Psicología Básica, UNED , Madrid, Spain
| | - R Rodríguez-Duarte
- Sociedad Española de Neurorrehabilitación (SENR).,Neurorehabilitation Center Charbel, Jerez De La Frontera , Cádiz, Spain
| | - M Murie-Fernández
- Neurorehabilitation Unit Hospital Ciudad de Telde , Las Palmas De Gran Canaria, Spain
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Murie-Fernández M, Laxe S. Neurorrehabilitación del ictus en España, comparativa con Europa. Neurologia 2020; 35:354-355. [DOI: 10.1016/j.nrl.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022] Open
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Murie-Fernández M, Laxe S. Comparison of stroke neurorehabilitation in Spain and in Europe. Neurología (English Edition) 2020. [DOI: 10.1016/j.nrleng.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Rapoport MJ, Weegar K, Kadulina Y, Bédard M, Carr D, Charlton JL, Dow J, Gillespie IA, Hawley CA, Koppel S, McCullagh S, Molnar F, Murie-Fernández M, Naglie G, O'Neill D, Shortt S, Simpson C, Tuokko HA, Vrkljan BH, Marshall S. An international study of the quality of national-level guidelines on driving with medical illness. QJM 2015; 108:859-69. [PMID: 25660605 PMCID: PMC4620729 DOI: 10.1093/qjmed/hcv038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. AIM To systematically evaluate the quality of selected national guidelines about driving with medical illness. DESIGN A literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised. METHODS Eighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. RESULTS Relative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57-0.79). CONCLUSIONS This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.
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Affiliation(s)
- M J Rapoport
- From the Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada, University of Toronto, Toronto, ON M5S 2J7, Canada
| | - K Weegar
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8M2, Canada
| | - Y Kadulina
- University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - M Bédard
- Centre for Research on Driving, Lakehead University, Thunder Bay, ON P7B 5E1, Canada, St. Joseph's Care Group, Thunder Bay, ON P7B 5G7, Canada
| | - D Carr
- Washington University in St. Louis, St. Louis, MO 63130, USA
| | - J L Charlton
- Monash University Accident Research Centre, Victoria 3800, Australia
| | - J Dow
- Société de l'assurance automobile du Québec, Québec, QC G1K 8J6, Canada
| | - I A Gillespie
- British Columbia Medical Association, Vancouver, BC V6J 5A4, Canada
| | - C A Hawley
- University of Warwick, Coventry CV4 7AL, UK
| | - S Koppel
- Monash University Accident Research Centre, Victoria 3800, Australia
| | - S McCullagh
- Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada, McMaster University, Hamilton, ON L8S 1C7, Canada
| | - F Molnar
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8M2, Canada, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - G Naglie
- University of Toronto, Toronto, ON M5S 2J7, Canada, Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada
| | - D O'Neill
- Trinity College Dublin, Dublin, 2, Ireland,
| | - S Shortt
- Canadian Medical Association, Ottawa, ON K1G 5W8, Canada
| | - C Simpson
- Kingston General Hospital, Kingston, ON K7L 2V7, Canada, Queen's University, Kingston, ON K7L 3N6, Canada and
| | - H A Tuokko
- University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - B H Vrkljan
- McMaster University, Hamilton, ON L8S 1C7, Canada
| | - S Marshall
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8M2, Canada, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Murie-Fernández M, Carmona Iragui M, Gnanakumar V, Meyer M, Foley N, Teasell R. Painful hemiplegic shoulder in stroke patients: Causes and management. Neurología (English Edition) 2012. [DOI: 10.1016/j.nrleng.2012.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Murie-Fernández M, Carmona Iragui M, Gnanakumar V, Meyer M, Foley N, Teasell R. [Painful hemiplegic shoulder in stroke patients: causes and management]. Neurologia 2011; 27:234-44. [PMID: 21514698 DOI: 10.1016/j.nrl.2011.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome. DEVELOPMENT We conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions. CONCLUSIONS Shoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain.
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Affiliation(s)
- M Murie-Fernández
- Departamento de Neurología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, España.
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Murie-Fernández M, Irimia P, Martínez-Vila E, John Meyer M, Teasell R. [Neuro-rehabilitation after stroke]. Neurologia 2010; 25:189-196. [PMID: 20492866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION the high incidence of stroke results in significant mortality and disability leading to immense health care costs. These costs lead to socioeconomic, budgetary, and staffing repercussions in developing countries. Improvements in stroke management focus mainly on acute neurological treatment, admission to stroke units, fibrinolytic treatment for ischaemic strokes and rehabilitation processes. Among these, rehabilitation has the longest therapeutic window, can be applied in both ischaemic and haemorrhagic strokes, and can improve functional outcomes months after stroke. DEVELOPMENT Neurologists, because of their knowledge in neuroanatomy, physiopathology, neuro-pharmacology, and brain plasticity, are in an ideal position to actively participate in the neurorehabilitation process. Several processes have been shown to play a role in determining the efficacy of rehabilitation; time from stroke onset to rehabilitation admission and the duration and intensity of treatment. CONCLUSIONS neurorehabilitation is a sub-speciality in which neurologists should be incorporated into multidisciplinary neurorehabilitation teams. Early time to rehabilitation admission and greater intensity and duration of treatment are associated with better functional outcomes, lower mortality/institutionalisation, and shorter length of stay. In order to be efficient, a concerted effort must be made to ensure patients receive neurorehabilitation treatment in a timely manner with appropriate intensity to maximize patient outcomes during both inpatient and outpatient rehabilitation.
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Affiliation(s)
- M Murie-Fernández
- Departamento de Rehabilitación y Medicina Física, St Joseph's Health Care London, Parkwood Hospital, Universidad de Western Ontario, London, Ontario, Canadá.
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Gállego Pérez-Larraya J, Murie-Fernández M, Irimia P. [On the future of the young neurologist in Spain]. Neurologia 2006; 21:393-4. [PMID: 16977564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
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