Delirium is common in intensive care patients. Dexmedetomidine is increasingly used for sedation in this setting, but its effect on delirium remains unclear. The primary aim of this review was to examine whether dexmedetomidine reduces the incidence of delirium and agitation in intensive care patients. We sought randomised clinical trials in MEDLINE, EMBASE, PubMed and CENTRAL from their inception until June 2018. Observational studies, case reports, case series and non-systematic reviews were excluded. Twenty-five trials including 3240 patients were eligible for inclusion in the data synthesis. In the patients who received dexmedetomidine (eight trials, 1425 patients), delirium was reduced, odds ratio (95%CI) 0.36 (0.26-0.51), p
An 8-year-old child of Bajau Laut descent (a stateless tribe in Eastern Borneo and the Sulu archipelago) presented following a fall, with penetrating injury through the axilla caused by a stilt pole, exiting at the supero-anterior aspect of the left shoulder. Due to the lack of comprehension of modern medical treatment and poor language skills, the parents refused to consent for detailed radioimaging studies, nor surgical removal and exploration in the operating theatre. The removal of retained stilt pole was done in casualty area in Hospital Tawau, followed by local exploration under sedation and local analgesia. Despite the horrific injury, there was no limb-threatening neurovascular injury sustained. Management of such injury in the nomadic Bajau Laut population provides valuable insight and about the challenges and decisions of management.
This study aims to investigate the generalizability of the semi-metric analysis of the functional connectivity (FC) for functional near-infrared spectroscopy (fNIRS) by applying it to detect the dichotomy in differential FC under affective and neutral emotional states in nursing students and registered nurses during decision making. The proposed method employs wavelet transform coherence to construct FC networks and explores semi-metric analysis to extract network redundancy features, which has not been considered in conventional fNIRS-based FC analyses. The trials of the proposed method were performed on 19 nursing students and 19 registered nurses via a decision-making task under different emotional states induced by affective and neutral emotional stimuli. The cognitive activities were recorded using fNIRS, and the emotional stimuli were adopted from the International Affective Digitized Sound System (IADS). The induction of emotional effects was validated by heart rate variability (HRV) analysis. The experimental results by the proposed method showed significant difference (FDR-adjusted p = 0.004) in the nursing students' cognitive FC network under the two different emotional conditions, and the semi-metric percentage (SMP) of the right prefrontal cortex (PFC) was found to be significantly higher than the left PFC (FDR-adjusted p = 0.036). The benchmark method (a typical weighted graph theory analysis) gave no significant results. In essence, the results support that the semi-metric analysis can be generalized and extended to fNIRS-based functional connectivity estimation.