Nerve stimulation

神经刺激
  • 文章类型: Journal Article
    目标:这篇综述旨在介绍注意力缺陷/多动障碍(ADHD)护理的最新创新和进步。包括国际共识声明,新的药物配方,数字疗法,和神经刺激装置。方法:对近5年发表的相关文章进行全面文献检索,强调证据基础,功效,安全,以及这些进步的实际意义。结果:世界多动症联盟共识声明提供了根植于全球科学证据的最新诊断和治疗框架。有几种较新的多动症药物配方,包括非兴奋剂(维洛嗪缓释)和第一个批准用于治疗ADHD的经皮苯丙胺贴剂。这些选项提供了一些独特的好处,可以根据症状概况个性化治疗,生活方式,preferences,和回应。数字工具为患有多动症的个人提供了重建环境的额外手段,减少损害和对他人的依赖。此外,数字疗法增强了访问,负担能力,个性化,多动症护理的可行性,补充或加强现有的干预措施。三叉神经刺激是一种耐受性良好的非药物治疗,基于设备的小儿多动症治疗,初步试验表明,效果大小与非兴奋剂药物相当。结论:ADHD护理的这些创新代表了临床上重要的新治疗选择和个性化护理的机会。卫生保健专业人员应将这些发展融入临床实践,注意个体患者和家庭的需求和偏好。未来的研究应该评估长期结果,成本效益,以及这些创新的可接受性。
    Objectives: This review aims to present recent innovations and advancements in attention-deficit/hyperactivity disorder (ADHD) care, encompassing international consensus statement, new medication formulations, digital therapeutics, and neurostimulation devices. Methods: A comprehensive literature search of relevant articles published in the past five years was conducted, emphasizing the evidence base, efficacy, safety, and practical implications of these advancements. Results: The World Federation of ADHD Consensus Statement offers an updated diagnostic and treatment framework rooted in global scientific evidence. There are several newer ADHD medication formulations, including a nonstimulant (Viloxazine extended release) and the first transdermal amphetamine patch approved to treat ADHD. These options offer some unique benefits to personalize treatment based on symptom profile, lifestyle, preferences, and response. Digital tools offer additional means to restructure environments for individuals with ADHD, reducing impairment and reliance on others. In addition, digital therapeutics enhance access, affordability, personalization, and feasibility of ADHD care, complementing or augmenting existing interventions. Trigeminal nerve stimulation emerges as a well-tolerated nonpharmacological, device-based treatment for pediatric ADHD, with initial trials indicating effect sizes comparable to nonstimulant medications. Conclusions: These innovations in ADHD care represent clinically significant new treatment options and opportunities for personalized care. Health care professionals should integrate these developments into clinical practice, mindful of individual patient and family needs and preferences. Future research should assess long-term outcomes, cost-effectiveness, and acceptability of these innovations.
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  • 文章类型: Journal Article
    甲状腺手术期间的术中神经监测(IONM)已被广泛接受,作为视觉识别喉返神经(RLN)的金标准的辅助手段。与常规的RLN解剖相反,在甲状腺切除术或甲状旁腺切除术期间,大多数外科医生倾向于避免而不是常规地暴露和识别喉上神经(EBSLN)的外部分支.IONM有可能用于识别EBSLN和对其完整性进行功能评估;因此,IONM可能有助于甲状腺切除术或甲状旁腺切除术后的语音保留。我们回顾了多学科国际神经监测研究组(INMSG)与EBSLNIONM的文献和累积经验。使用预定义的搜索词(EBSLN,喉上神经,刺激,神经监测,识别)由INMSG成员之间的个人通信进行和补充,以识别该领域的相关出版物。这篇综述中探讨的假设是,通过应用IONM可以促进使用标准化方法来保护EBSLN的功能,从而改善甲状腺切除术或甲状旁腺切除术后的语音保存。这些指南旨在改善甲状腺切除术或甲状旁腺切除术期间EBSLN的神经监测实践,并根据现有证据和专家共识优化该技术的临床实用性。
    方法:5
    Intraoperative neural monitoring (IONM) during thyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual identification of the recurrent laryngeal nerve (RLN). Contrary to routine dissection of the RLN, most surgeons tend to avoid rather than routinely expose and identify the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy or parathyroidectomy. IONM has the potential to be utilized for identification of the EBSLN and functional assessment of its integrity; therefore, IONM might contribute to voice preservation following thyroidectomy or parathyroidectomy. We reviewed the literature and the cumulative experience of the multidisciplinary International Neural Monitoring Study Group (INMSG) with IONM of the EBSLN. A systematic search of the MEDLINE database (from 1950 to the present) with predefined search terms (EBSLN, superior laryngeal nerve, stimulation, neuromonitoring, identification) was undertaken and supplemented by personal communication between members of the INMSG to identify relevant publications in the field. The hypothesis explored in this review is that the use of a standardized approach to the functional preservation of the EBSLN can be facilitated by application of IONM resulting in improved preservation of voice following thyroidectomy or parathyroidectomy. These guidelines are intended to improve the practice of neural monitoring of the EBSLN during thyroidectomy or parathyroidectomy and to optimize clinical utility of this technique based on available evidence and consensus of experts.
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