Subjects -> OCCUPATIONS AND CAREERS (Total: 33 journals)
Showing 1 - 23 of 23 Journals sorted alphabetically
Advances in Developing Human Resources     Hybrid Journal   (Followers: 33)
American Journal of Pastoral Counseling     Hybrid Journal  
BMC Palliative Care     Open Access   (Followers: 39)
British Journal of Guidance & Counselling     Hybrid Journal   (Followers: 22)
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 10)
Career Development International     Hybrid Journal   (Followers: 19)
Career Development Quarterly     Hybrid Journal   (Followers: 5)
Community Development     Hybrid Journal   (Followers: 25)
Education + Training     Hybrid Journal   (Followers: 28)
Entrepreneurship Research Journal     Hybrid Journal   (Followers: 16)
Equality, Diversity and Inclusion : An International Journal     Hybrid Journal   (Followers: 21)
Field Actions Science Reports     Open Access  
Formation emploi     Open Access  
Health Care Analysis     Hybrid Journal   (Followers: 17)
Human Resource Development Review     Hybrid Journal   (Followers: 33)
Industrial and Organizational Psychology     Hybrid Journal   (Followers: 28)
International Journal for Educational and Vocational Guidance     Hybrid Journal   (Followers: 9)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 41)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 15)
International Journal of Work Innovation     Hybrid Journal   (Followers: 2)
Journal of Career Assessment     Hybrid Journal   (Followers: 9)
Journal of Career Development     Hybrid Journal   (Followers: 12)
Journal of Human Capital     Full-text available via subscription   (Followers: 14)
Journal of Human Development and Capabilities : A Multi-Disciplinary Journal for People-Centered Development     Hybrid Journal   (Followers: 24)
Journal of Multicultural Counseling and Development     Hybrid Journal   (Followers: 7)
Journal of Psychological Issues in Organizational Culture     Hybrid Journal   (Followers: 8)
Journal of Vocational Behavior     Hybrid Journal   (Followers: 28)
Neurocritical Care     Hybrid Journal   (Followers: 17)
Palliative & Supportive Care     Hybrid Journal   (Followers: 37)
Performance Improvement Quarterly     Hybrid Journal   (Followers: 3)
Professions and Professionalism     Open Access   (Followers: 9)
Recherches & éducations     Open Access  
Rehabilitation Counseling Bulletin     Hybrid Journal   (Followers: 3)
Research on Economic Inequality     Hybrid Journal   (Followers: 11)
Trabajo : Revista de la Asociación Estatal de Centros Universitarios de Relaciones Laborales y Ciencias del Trabajo     Open Access  
Vocations and Learning     Hybrid Journal   (Followers: 9)
Work and Occupations     Hybrid Journal   (Followers: 56)
Work, Employment & Society     Hybrid Journal   (Followers: 51)
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Neurocritical Care
Journal Prestige (SJR): 1.311
Citation Impact (citeScore): 3
Number of Followers: 17  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1556-0961 - ISSN (Online) 1541-6933
Published by Springer-Verlag Homepage  [2655 journals]
  • The Historical Trajectory of the Apnea Test in Brain Death Determination
    • PubDate: 2021-03-09
       
  • Prognostic Value of a Structural Brain MRI Score in the Acute Phase of
           Aneurysmal Subarachnoid Hemorrhage: A Pilot Study
    • Abstract: Background/Objective Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality despite advances in management. We evaluated the prognostic significance of a qualitative score using brain magnetic resonance imaging (MRI) features obtained early after aSAH. Methods Patients with aSAH were enrolled in a prospective observational cohort and underwent brain MRI during their acute hospitalization. MRIs were rated using a scoring system that considers the anatomical location of signal intensity changes on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences. The relationship between MRI scores and functional outcome defined by modified Rankin scale (mRS) at 6 months was evaluated in uni- and multivariable models. Results The cohort included 45 aSAH patients (median World Federation of Neurologic Surgeons (IQR) 2 (1–4)) who underwent brain MRI a mean (SD) of 9.0 ± 8.0 days after aSAH. At 6 months after aSAH, 26 patients had achieved a favorable outcome (mRS ≤ 2) while 15 had an unfavorable outcome (mRS > 2). Deep gray nuclei (DGN) score (p = 0.016), cortex + DGN score (p = 0.015), FLAIR score (p = 0.016), DWI score (p = 0.0045), and overall score (p = 0.0081) were significantly lower in patients with favorable outcome compared to those with unfavorable outcome. However, MRI scores were not independent predictors of outcome in multivariable models adjusting for admission Hunt and Hess, Glasgow Coma Scale, or World Federation of Neurologic Surgeons scales. Conclusions In this pilot study, a qualitative scoring system using anatomically defined MRI FLAIR and DWI signal abnormalities identified in the acute phase of aSAH was linked to 6-month functional outcome. However, these scores did not add prognostic value to established indices of neurological severity.
      PubDate: 2021-03-09
       
  • Impact of Arterial Carbon Dioxide and Oxygen Content on Cerebral
           Autoregulation Monitoring Among Children Supported by ECMO
    • Abstract: Background Cerebral autoregulation (CA) impairment is associated with neurological complications among children supported by extracorporeal membrane oxygenation (ECMO). Severe variations of arterial CO2 (PaCO2) and O2 (PaO2) tension after ECMO onset are common and associate with mortality and poor neurological outcome. The impact of gas exchange on CA among critically ill patients is poorly studied. Methods Retrospective analysis of data collected prospectively from 30 children treated with veno-arterial or veno-venous ECMO in the PICU of Nantes University Hospital, France. A correlation coefficient between the variations of regional cerebral oxygen saturation (rSO2) and the variations of mean arterial blood pressure (MAP) was calculated as an index of CA (cerebral oxygenation reactivity index, COx). Cox–MAP plots were investigated allowing determining lower limit of autoregulation (LLA) and upper limit of autoregulation (ULA) limits of autoregulation. Age-based normal blood pressure was used to adjust the MAP, LLA, and ULA data from each patient and then reported as percentage (nMAP, nLLA, and nULA, respectively). RSO2, COx, nMAP, nLLA, and nULA values were averaged over one hour before each arterial blood gas (ABG) sample during ECMO run. Results Thirty children (median age 4.8 months [Interquartile range (IQR) 0.7–39.1], median weight 5 kg [IQR 4–15]) experiencing 31 ECMO runs were included in the study. Three hundred and ninety ABGs were analyzed. The highest values of COx were observed on day 1 (D1) of ECMO. The relationship between COx and PaCO2 was nonlinear, but COx values tended to be lower in case of hypercapnia compared to normocapnia. During the whole ECMO run, a weak but significant correlation between PaCO2 and nULA was observed (R = 0.432, p = 0.02). On D1 of ECMO, this correlation was stronger (R = 0.85, p = 0.03) and a positive correlation between nLLA and PaCO2 was also found (R = 0.726, p < 0.001). A very weak negative correlation between PaO2 and nULA was observed within the whole ECMO run and on D1 of ECMO (R =  −0.07 p = 0.04 and R =  −0.135 p =  <0.001, respectively). The difference between nULA and nLLA representing the span of the autoregulation plateau was positively correlated with PaCO2 and negatively correlated with PaO2 (R = 0.224, p = 0.01 and R =  −0.051, p = 0.004, respectively). Conclusions We observed a complex relationship between PaCO2 and CA, influenced by the level of blood pressure. Hypercapnia seems to be globally protective in normotensive or hypertensive condition, while, in case of very low MAP, hypercapnia may disturb CA as it increases LLA. These data add additional arguments for very cautiously lower PaCO2, especially after ECMO start.
      PubDate: 2021-03-09
       
  • Effect of Race–Ethnicity and CT Angiography on Renal Injury During Blood
           Pressure Treatment for Intracerebral Hemorrhage
    • Abstract: Background Lowering blood pressure intensively in acute intracerebral hemorrhage (ICH) is associated with adverse renal events; Blacks and Hispanics have a higher incidence of ICH and kidney disease than Whites. In addition, CT angiography (CTA), which may also be associated with acute kidney injury (AKI), is often done in acute ICH. Our objective was to investigate the relationship between aggressive BP management, CTA, race–ethnicity and the risk of developing AKI in patients presenting with ICH. Methods We retrospectively calculated the difference between the highest and lowest systolic blood pressure during the first 24 h of admission in patients with spontaneous ICH over 30 months. Creatinine (Cr) levels at admission were compared to the highest Cr level during the first 7 days after admission. AKI was defined as any > 50% increase of baseline Cr during the first 7 days. Logistic regression models were used to assess the association between race–ethnicity and CTA and AKI. We also analyzed the incidence of AKI stratified by race–ethnicity. Results A total of 394 patients were included (mean age ± SD 63 ± 14 years), 160 patients (41%) were women, 162 (41%) Hispanic, 39 (10%) White and 189 (48%) Black. Most of the patients underwent CTA (73%). The prevalence of AKI was (18%), but no difference was found in AKI incidence (19% in Blacks vs. 17% in Whites vs. 18% in Hispanics (p = 0.940). In fully adjusted models, AKI was not associated with race–ethnicity (p = 0.665) or CTA (p = 0.187). The stratified analysis by race–ethnicity did not change our findings. Conclusion We found no association between race–ethnicity or CTA and AKI during the acute management of ICH in a real-life stroke population. Our findings suggest that CTA can be safely obtained in acute ICH, even in populations of diverse race–ethnicity who may be more prone to adverse kidney events. CTA did not contribute to developing AKI.
      PubDate: 2021-03-05
       
  • Increase in Ventricle Size and the Evolution of White Matter Changes on
           Serial Imaging in Critically Ill Patients with COVID-19
    • Abstract: Background Evolution of brain magnetic resonance imaging (MRI) findings in critically ill patients with coronavirus disease 2019 (COVID-19) is unknown. Methods We retrospectively reviewed 4530 critically ill patients with COVID-19 admitted to three tertiary care hospitals in New York City from March 1 to June 30, 2020 to identify patients who had more than one brain MRI. We reviewed the initial and final MRI for each patient to (1) measure the percent change in the bicaudate index and third ventricular diameter and (2) evaluate changes in the presence and severity of white matter changes. Results Twenty-one patients had two MRIs separated by a median of 22 [Interquartile range (IQR) 14–30] days. Ventricle size increased for 15 patients (71%) between scans [median bicaudate index 0.16 (IQR 0.126–0.181) initially and 0.167 (IQR 0.138–0.203) on final imaging (p < 0.001); median third ventricular diameter 6.9 mm (IQR 5.4–10.3) initially and 7.2 mm (IQR 6.4–10.8) on final imaging (p < 0.001)]. Every patient had white matter changes on the initial and final MRI; between images, they worsened for seven patients (33%) and improved for three (14%). Conclusions On serial imaging of critically ill patients with COVID-19, ventricle size frequently increased over several weeks. White matter changes were often unchanged, but in some cases they worsened or improved, demonstrating there is likely a spectrum of pathophysiological processes responsible for these changes.
      PubDate: 2021-03-05
       
  • Serum Biomarkers of Regeneration and Plasticity are Associated with
           Functional Outcome in Pediatric Neurocritical Illness: An Exploratory
           Study
    • Abstract: Background/Objective Pediatric neurocritical care survivorship is frequently accompanied by functional impairments. Lack of prognostic biomarkers is a barrier to early identification and management of impairment. We explored the association between blood biomarkers and functional impairment in children with acute acquired brain injury. Methods This study is a secondary analysis of a randomized control trial evaluating early versus usual care rehabilitation in the pediatric intensive care unit (PICU). Forty-four children (17 [39%] female, median age 11 [interquartile range 6–13] years) with acute acquired brain injury admitted to the PICU were studied. A single center obtained serum samples on admission days 0, 1, 3, 5, and the day closest to hospital discharge. Biomarkers relevant to brain injury (neuron specific enolase [NSE], S100b), inflammation (interleukin [IL-6], C-reactive protein), and regeneration (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF]) were collected. Biomarkers were analyzed using a Luminex® bioassay. Functional status scale (FSS) scores were abstracted from the medical record. New functional impairment was defined as a (worse) FSS score at hospital discharge compared to pre-PICU (baseline). Individual biomarker fluorescence index (FI) values for each sample collection day were correlated with new functional impairment using Spearman rank correlation coefficient (ρ). Trends in repeated measures of biomarker FI over time were explored graphically, and the association between repeated measures of biomarker FI and new functional impairment was analyzed using covariate adjusted linear mixed-effect models. Results Functional impairment was inversely correlated with markers of regeneration and plasticity including BDNF at day 3 (ρ =  − 0.404, p = .015), day 5 (ρ =  − 0.549, p = 0.005) and hospital discharge (ρ =  − 0.420, p = 0.026) and VEGF at day 1 (ρ =  − 0.282, p = 0.008) and hospital discharge (ρ =  − 0.378, p = 0.047), such that lower levels of both markers at each time point were associated with greater impairment. Similarly, repeated measures of BDNF and VEGF were inversely correlated with new functional impairment (B =  − 0.001, p = 0.001 and B =  − 0.001, p = 0.003, respectively). NSE, a biomarker of acute brain injury, showed a positive correlation between day 0 levels and new functional impairment (ρ = 0.320, p = 0.044). Conclusions Blood-based biomarkers of regeneration and plasticity may hold prognostic utility for functional impairment among pediatric patients with neurocritical illness and warrant further investigation.
      PubDate: 2021-03-04
       
  • The Tangled History of Brain–Heart Pathways in Acute Brain Injury
    • PubDate: 2021-03-02
       
  • Critical ICP in Subarachnoid Hemorrhage: How High and How Long'
    • PubDate: 2021-03-02
       
  • The Discovery of Acute Alcohol Withdrawal as a Cause of Delirium
    • PubDate: 2021-03-02
       
  • Secondary Hematoma Evacuation and Outcome After Initial Conservative
           Approach for Patients with Cerebellar Hematoma Larger than 3 cm
    • Abstract: Background In patients with spontaneous cerebellar intracerebral hemorrhage (ICH) guidelines advocate evacuation when the hematoma diameter is > 3 cm. We studied outcome in patients with cerebellar ICH > 3 cm who did not undergo immediate hematoma evacuation. Methods We included consecutive patients with cerebellar ICH > 3 cm at two academic hospitals between 2008 and 2017. Patients who died < 24 h (h) were excluded because of probable confounding by indication. We determined patient characteristics, hematoma volumes, EVD placement, secondary hematoma evacuation, in-hospital and 3-month case-fatality, and functional outcome. Results Of 130 patients with cerebellar ICH, 98 (77%) had a hematoma > 3 cm of whom 22 (23%) died < 24 h and 28 (29%) underwent hematoma evacuation < 24 h. Thus, 48 patients were initially treated conservatively (mean age 70 ± 13, 24 (50%) female). Of these 48 patients, 7 (15%) underwent secondary hematoma evacuation > 24 h, of whom 1 (14%) had received an EVD < 24 h. Five others also received an EVD < 24 h without subsequent hematoma evacuation. Of the 41 patients without secondary hematoma evacuation, 11 (28%) died and 20 (51%) had a favorable outcome (mRS of 0–3) at 3 months. The 7 patients who underwent secondary hematoma evacuation had a decrease in GCS score of at least two points prior to surgery; two (29%) had deceased at 3 months; and 5 (71%) had a good functional outcome (mRS 0–3). Conclusions While cerebellar ICH > 3 cm is often considered an indication for immediate hematoma evacuation, there may be a subgroup of patients in whom surgery can be safely deferred. Further data are needed to assess the optimal timing and indications of surgical treatment in these patients.
      PubDate: 2021-03-02
       
  • Historical Appreciation of Brain Vulnerability from Pure Hypoxemia
    • PubDate: 2021-02-23
       
  • Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A
           Propensity Score-Matched Registry Study
    • Abstract: Background Hypercoagulability in Coronavirus Disease 2019 (COVID-19) causes deep vein thrombosis and pulmonary embolism necessitating systemic anticoagulation. Case reports of intracerebral hemorrhages in ventilated COVID-19 patients warrant precaution. It is unclear, however, if COVID-19 patients with acute respiratory distress syndrome (ARDS) with or without veno-venous extracorporeal membrane oxygenation therapy (VV-ECMO) have more intracerebral hemorrhages (ICH) compared to other ARDS patients. Methods We conducted a retrospective observational single-center study enrolling all patients with ARDS from 01/2018 to 05/2020. PCR-positive SARS-CoV-2 patients with ARDS were allocated to the COVID-19 group. Propensity score matching was performed for age, VV-ECMO, and bleeding risk. Results A total of 163 patients with moderate or severe ARDS were identified, 47 (28.8%) in the COVID-19 group, and 116 (71.2%) in the non-COVID-19 group. In 63/163 cases (38.7%), VV-ECMO therapy was required. The ICU survival was 52.8%. COVID-19 patients were older, more often male, and exhibited a lower SOFA score, but the groups showed similar rates of VV-ECMO therapy. Treatments with antiplatelet agents (p = 0.043) and therapeutic anticoagulation (p = 0.028) were significantly more frequent in the COVID-19 patients. ICH was detected in 22 patients (13.5%) with no statistical difference between the groups (11.2 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.21). Propensity score matching confirmed similar rates of ICH in both groups (12.8 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.57), thus leveling out possible confounders. Conclusions Intracerebral hemorrhage was detected in every tenth patient with ARDS. Despite statistically higher rates of antiplatelet therapy and therapeutic anticoagulation in COVID-19 patients, we found a similar rate of ICH in patients with ARDS due to COVID-19 compared to other causes of ARDS.
      PubDate: 2021-02-23
       
  • Predictors of Surrogate Decision Makers Selecting Life-Sustaining Therapy
           for Severe Acute Brain Injury Patients: An Analysis of US Population
           Survey Data
    • Abstract: Background Patients with a severe acute brain injury admitted to the intensive care unit often have a poor neurological prognosis. In these situations, a clinician is responsible for conducting a goals-of-care conversation with the patient’s surrogate decision makers. The diversity in thought and background of surrogate decision makers can present challenges during these conversations. For this reason, our study aimed to identify predictive characteristics of US surrogate decision makers’ favoring life-sustaining treatment (LST) over comfort measures only for patients with severe acute brain injury. Methods We analyzed data from a cross-sectional survey study that had recruited 1588 subjects from an online probability-based US population sample. Seven hundred and ninety-two subjects had randomly received a hypothetical scenario regarding a relative intubated with severe acute brain injury with a prognosis of severe disability but with the potential to regain some consciousness. Seven hundred and ninety-six subjects had been randomized to a similar scenario in which the relative was projected to remain vegetative. For each scenario, we conducted univariate analyses and binary logistic regressions to determine predictors of LST selection among available respondent characteristics. Results 15.0% of subjects selected LST for the severe disability scenario compared to 11.4% for the vegetative state scenario (p = 0.07), with those selecting LST in both groups expressing less decisional certainty. For the severe disability scenario, independent predictors of LST included having less than a high school education (adjusted OR = 2.87, 95% CI = 1.23–6.76), concern regarding prognostic accuracy (7.64, 3.61–16.15), and concern regarding the cost of care (4.07, 1.80–9.18). For the vegetative scenario, predictors included the youngest age group (30–44 years, 3.33, 1.02–10.86), male gender (3.26, 1.75–6.06), English as a second language (2.94, 1.09–7.89), Evangelical Protestant (3.72, 1.28–10.84) and Catholic (4.01, 1.72–9.36) affiliations, and low income (< $25 K). Conclusion Several demographic and decisional characteristics of US surrogate decision makers predict LST selection for patients with severe brain injury with varying degrees of poor prognosis. Surrogates concerned about the cost of medical care may nevertheless be inclined to select LST, albeit with high levels of decisional uncertainty, for patients projected to have severe disabilities.
      PubDate: 2021-02-23
       
  • To Decompress or Not' An Expected Utility Inspired Approach To Shared
           decision-making For Supratentorial Ischemic Stroke
    • Abstract: Patients with large territorial supratentorial infarctions are at high risk of cerebral edema, increased intracranial pressure, tissue herniation and death. There is strong evidence supporting prompt decompressive craniectomy after large hemispheric ischemic stroke as a means to reduce mortality. Nevertheless, functional outcomes can vary significantly. Clinical trials have traditionally judged these outcomes by a priori dichotomization without taking into account individual patient and caregiver preferences. If these are not incorporated into shared decision-making, there are significant risks in both directions, i.e. producing outcomes that may be judged as unacceptable to survivors, or not offering life-saving treatments to patients that according to their own values could be beneficial. In the absence of decision aids, we explore insights from decision theory and propose an expected utility-inspired approach as a supplementary navigating tool in the decision-making process. Four patient case scenarios are discussed as a demonstration of using individualized rankings of outcome preferences, and deriving expected utilities for interventions such as decompressive craniectomy versus medical therapy. The ultimate aim of the suggested approach is to assure that patient values are elicited and incorporated, and possible range and nature of outcomes are discussed, and by attempting to connect best available means to patient individualized ends.
      PubDate: 2021-02-18
       
  • Structure and Outcomes of Educational Programs for Training
           Non-electroencephalographers in Performing and Screening Adult EEG: A
           Systematic Review
    • Abstract: Objective To qualitatively and quantitatively summarize curricula, teaching methods, and effectiveness of educational programs for training bedside care providers (non-experts) in the performance and screening of adult electroencephalography (EEG) for nonconvulsive seizures and other patterns. Methods PRISMA methodological standards were followed. MEDLINE, EMBASE, Cochrane, CINAHL, WOS, Scopus, and MedEdPORTAL databases were searched from inception until February 26, 2020 with no restrictions. and full-text review was completed in duplicate. Studies were included if they were original research; involved non-experts performing, troubleshooting, or screening adult EEG; and provided qualitative descriptions of curricula and teaching methods and/or quantitative assessment of non-experts (vs gold standard EEG performance by neurodiagnostic technologists or interpretation by neurophysiologists). Data were extracted in duplicate. A content analysis and a meta-narrative review were performed. Results Of 2430 abstracts, 35 studies were included. Sensitivity and specificity of seizure identification varied from 38 to 100% and 65 to 100% for raw EEG; 40 to 93% and 38 to 95% for quantitative EEG, and 95 to 100% and 65 to 85% for sonified EEG, respectively. Non-expert performance of EEG resulted in statistically significant reduced delay (86 min, p < 0.0001; 196 min, p < 0.0001; 667 min, p < 0.005) in EEG completion and changes in management in approximately 40% of patients. Non-experts who were trained included physicians, nurses, neurodiagnostic technicians, and medical students. Numerous teaching methods were utilized and often combined, with instructional and hands-on training being most common. Conclusions Several different bedside providers can be educated to perform and screen adult EEG, particularly for the purpose of diagnosing nonconvulsive seizures. While further rigorous research is warranted, this review demonstrates several potential bridges by which EEG may be integrated into the care of critically ill patients.
      PubDate: 2021-02-16
       
  • Common Data Elements for COVID-19 Neuroimaging: A GCS-NeuroCOVID Proposal
    • PubDate: 2021-02-11
       
  • Von Leyden’s Contribution to the Elusive Syndrome of Acute Basilar
           Artery Occlusion
    • PubDate: 2021-02-09
       
  • Finding the Right Osmotic Agent: Why Mannitol Prevailed
    • PubDate: 2021-02-09
       
  • Response to: Communication and Well-Being Considerations in Disorders of
           Consciousness
    • PubDate: 2021-02-04
      DOI: 10.1007/s12028-020-01174-0
       
  • The State of Autoregulation
    • PubDate: 2021-02-01
       
 
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