Resultados del estudio piloto de 2001 diseñado para evaluar la frecuencia en que se daban experiencias cercanas a la muerte en personas que habían sobrevivido a paros cardíacos, así como para determinar las características de estas experiencias. Para más detalles visitar: http://www.afanporsaber.es/2014/01/experiencias-cercanas-a-la-muerte-i/
Isolated Cerebellar Stroke Masquerades as DepressionZahiruddin Othman
There are numerous reports on neurological conditions masquerading as psychiatric disorders. However, cerebellar
stroke is not established as one of it. The 2 case reports will highlight that this masquerade is possible and the physician's
high index of suspicion is the key to accurate diagnosis.
The near death experience scale. Construction, reliability, and validityJosé Luis Moreno Garvayo
En este artículo se expone un criterio de demarcación para las experiencias cercanas a la muerte conocido como “escala de Greyson”: se trata de un cuestionario formado por 16 preguntas agrupadas en cuatro bloques (componentes cognitivo, afectivo, paranormal y trascendental) en las que el entrevistado debe marcar la respuesta que más se acerque a la experiencia vivida (con un 0 si no la ha experimentado, un 1 si lo ha hecho de forma poco intensa, o un 2 si ha sido muy intensa). El análisis de los resultados sirve para evaluar si el sujeto vivió una ECM (alcanzado una puntuación mínima de 7 según los postulados de Greyson), permitiendo descartar un síndrome orgánico del cerebro o una respuesta no específica al estrés sufrido por el “miedo a morir”. Para más detalles visitar: http://www.afanporsaber.es/2014/01/experiencias-cercanas-a-la-muerte-i/
Isolated Cerebellar Stroke Masquerades as DepressionZahiruddin Othman
There are numerous reports on neurological conditions masquerading as psychiatric disorders. However, cerebellar
stroke is not established as one of it. The 2 case reports will highlight that this masquerade is possible and the physician's
high index of suspicion is the key to accurate diagnosis.
The near death experience scale. Construction, reliability, and validityJosé Luis Moreno Garvayo
En este artículo se expone un criterio de demarcación para las experiencias cercanas a la muerte conocido como “escala de Greyson”: se trata de un cuestionario formado por 16 preguntas agrupadas en cuatro bloques (componentes cognitivo, afectivo, paranormal y trascendental) en las que el entrevistado debe marcar la respuesta que más se acerque a la experiencia vivida (con un 0 si no la ha experimentado, un 1 si lo ha hecho de forma poco intensa, o un 2 si ha sido muy intensa). El análisis de los resultados sirve para evaluar si el sujeto vivió una ECM (alcanzado una puntuación mínima de 7 según los postulados de Greyson), permitiendo descartar un síndrome orgánico del cerebro o una respuesta no específica al estrés sufrido por el “miedo a morir”. Para más detalles visitar: http://www.afanporsaber.es/2014/01/experiencias-cercanas-a-la-muerte-i/
Through the Eyes of Taiwanese Palliative Care Providers: End-of-life Treatmen...inventionjournals
The growth of medical knowledge and enhanced technology has increasingly blurred the line between life and death. Resuscitation procedures and life-sustaining devices such as mechanical ventilators, defibrillators, hemodialysis, and parenteral nutrition were introduced just a few decades ago, but have brought significant changes to the treatment of EOL patients. These treatments have given physicians the ability to prolong the process of dying; yet, the decision of when and how to use them has become complicated. An understanding of these controversial life-sustaining procedures and knowledge of current legal guidelines in the American EOL treatment context is necessary when palliative care in Taiwan seems to follow the Western experience in legislation regarding life-sustaining treatment. In this article, how EOL decisions made in the United States is summarized through the eyes of Taiwanese palliative care providers.
The rise of international travel has given previously region-specific diseases a global presence. The book is aimed at students, interns, fellows and health care providers.It contains chapters devoted to clinical examination and an outline of how to approach common problems encountered at the bedside. The format and style of the book allows common clinical problems to be identified and recognised within the framework of a global perspective.
More info: http://www.mcgraw-hill.com.au/html/9780070285576.html
Entrevista completa que le hizo la periodista Marie A. Belloc a Julio Verne en otoño de 1894, y que fue publicada en la revista Strand Magazine en febrero de 1895.
Este artículo expone la idea de que las operaciones neocorticales son multisensoriales, es decir, suponen la integración de información de múltiples fuentes sensitivas
Se describe uno de los primeros casos documentados de percepción multisensorial: lo que desde entonces se denomina “efecto McGurk”. Si vemos un video sin sonido donde una persona vocaliza y repite la sílaba “ga” y simultáneamente escuchamos una grabación de esa misma persona que pronuncia la sílaba “ba”, lo que oímos es que pronuncia la sílaba “da”. Las “ga” mudas alteran nuestra percepción de las “ba” sonoras porque el cerebro integra lo que vemos y oímos al mismo tiempo
Interleukin-1 targeting drugs in familial mediterranean fever: a case series ...José Luis Moreno Garvayo
Revisión de los artículos publicados que describen el uso de medicamentos cuyo objetivo es la interleucina-1 en el tratamiento de la fiebre mediterránea familiar. Se describen siete casos en todos los cuales el uso de estos medicamentos fue beneficioso.
Este artículo muestra los resultados de un experimento con un test (llamado cognitive reflection test ―CRT por sus siglas en inglés y cuya traducción puede ser “prueba de reflexión cognitiva”) diseñado por Shane Frederick, profesor de mercadotecnia en la Universidad de Yale. Se realizaron una serie de encuestas a estudiantes de varias universidades norteamericanas (entre ellas el MIT, la Universidad de Princeton, Carnegie Mellon y Harvard) con el objetivo de averiguar qué tipo de razonamiento sigue una persona al enfrentarse a un problema en su vida cotidiana.
Artículo de Pim Van Lommel donde reflexiona en profundidad sobre las experiencias cercanas a la muerte y acude a la mecánica cuántica como forma de explicar esa otra “dimensión” donde se hallaría la consciencia.
Through the Eyes of Taiwanese Palliative Care Providers: End-of-life Treatmen...inventionjournals
The growth of medical knowledge and enhanced technology has increasingly blurred the line between life and death. Resuscitation procedures and life-sustaining devices such as mechanical ventilators, defibrillators, hemodialysis, and parenteral nutrition were introduced just a few decades ago, but have brought significant changes to the treatment of EOL patients. These treatments have given physicians the ability to prolong the process of dying; yet, the decision of when and how to use them has become complicated. An understanding of these controversial life-sustaining procedures and knowledge of current legal guidelines in the American EOL treatment context is necessary when palliative care in Taiwan seems to follow the Western experience in legislation regarding life-sustaining treatment. In this article, how EOL decisions made in the United States is summarized through the eyes of Taiwanese palliative care providers.
The rise of international travel has given previously region-specific diseases a global presence. The book is aimed at students, interns, fellows and health care providers.It contains chapters devoted to clinical examination and an outline of how to approach common problems encountered at the bedside. The format and style of the book allows common clinical problems to be identified and recognised within the framework of a global perspective.
More info: http://www.mcgraw-hill.com.au/html/9780070285576.html
Entrevista completa que le hizo la periodista Marie A. Belloc a Julio Verne en otoño de 1894, y que fue publicada en la revista Strand Magazine en febrero de 1895.
Este artículo expone la idea de que las operaciones neocorticales son multisensoriales, es decir, suponen la integración de información de múltiples fuentes sensitivas
Se describe uno de los primeros casos documentados de percepción multisensorial: lo que desde entonces se denomina “efecto McGurk”. Si vemos un video sin sonido donde una persona vocaliza y repite la sílaba “ga” y simultáneamente escuchamos una grabación de esa misma persona que pronuncia la sílaba “ba”, lo que oímos es que pronuncia la sílaba “da”. Las “ga” mudas alteran nuestra percepción de las “ba” sonoras porque el cerebro integra lo que vemos y oímos al mismo tiempo
Interleukin-1 targeting drugs in familial mediterranean fever: a case series ...José Luis Moreno Garvayo
Revisión de los artículos publicados que describen el uso de medicamentos cuyo objetivo es la interleucina-1 en el tratamiento de la fiebre mediterránea familiar. Se describen siete casos en todos los cuales el uso de estos medicamentos fue beneficioso.
Este artículo muestra los resultados de un experimento con un test (llamado cognitive reflection test ―CRT por sus siglas en inglés y cuya traducción puede ser “prueba de reflexión cognitiva”) diseñado por Shane Frederick, profesor de mercadotecnia en la Universidad de Yale. Se realizaron una serie de encuestas a estudiantes de varias universidades norteamericanas (entre ellas el MIT, la Universidad de Princeton, Carnegie Mellon y Harvard) con el objetivo de averiguar qué tipo de razonamiento sigue una persona al enfrentarse a un problema en su vida cotidiana.
Artículo de Pim Van Lommel donde reflexiona en profundidad sobre las experiencias cercanas a la muerte y acude a la mecánica cuántica como forma de explicar esa otra “dimensión” donde se hallaría la consciencia.
Heart failure refers to a condition whereby the heart fails to pump sufficiently to maintain a
blood flow which will meet the body’s need, and is the common final pathway for various cardiac
diseases. Despite advances in heart failure treatment, the prognosis remains poor with high rates of
hospitalisation, morbidity and mortality. Recent data has reported that all-cause mortality is up to
32.1% at 2 years and 54% at 5 years for heart failure patients [1].These data highlight the importance
of identifying all modifiable conditions that may aggravate heart failure in these patients.
Central Nervous System Histoplasmosis Related to Bioprosthetic Endocarditisasclepiuspdfs
Endocarditis caused by Histoplasma capsulatum is a rare occurrence. Involvement of the central nervous system by Histoplasma is also relatively uncommon. This paper reports a case of a 62-year-old woman with a past medical history significant for a myocardial infarct 5 years prior which necessitated coronary artery bypass graft surgery, prosthetic aortic valve replacement 4 years prior, and sarcoidosis, diagnosed 1 year prior, which was treated with methotrexate. She presented with fevers, generalized weakness, night sweats, and chest and throat pain. An echocardiogram done as part of her evaluation showed a vegetation on her prosthetic aortic valve. H. capsulatum was identified on blood cultures, and she was started on antibiotics. She expired shortly thereafter. At autopsy, a diagnosis of Histoplasma endocarditis was confirmed with evidence of embolic disease involving kidneys and digits of the hand. Hilar lymph nodes showed evidence of the fungus. Examination of the brain showed multiple widespread microscopic foci of macrophages, lymphocytes, and microglial cells with associated Histoplasma organisms, highlighted on Gomori methenamine silver staining. This paper will discuss central nervous system involvement by Histoplasma.
This is a presentation summarizing 150 years of afterlife experience presented at the Science of Mediumship Event at the Novotel Hotel in Toronto, Canada. This presentation includes survival of consciousness evidence pertaining to mental and physical mediumship, near death experiences, out of body experiences, electric voice phenomenon and past life regression therapy
Diapositivas de la charla que ofrecí sobre ciencia, arqueología y pensamiento crítico, en el marco de la segunda edición de las charlas Hablando de Ciencia en Málaga 2015
Recopilación de todos los resúmenes y comentarios que se han realizado en el blog Tertulias Literarias de Ciencia acerca del libro Mala Ciencia de Ben Goldacre
Se han hecho públicos los resultados de un prometedor trabajo encabezado por investigadores del Hospital Infantil de Boston y la Facultad de Medicina de Harvard, que ha conseguido recuperar, utilizando terapia génica, parte de la audición de ratones sordos. El artículo, que ha merecido la portada de la prestigiosa revista Science Translational Medicine, promete abrir un abanico terapéutico para el tratamiento de la sordera genética en los seres humanos.
The evolutionary history of the hominin hand since the last common ancestor o...José Luis Moreno Garvayo
Tocheri y colaboradores sostienen que las pruebas moleculares y fósiles tienen importantes consecuencias para la interpretación de la historia evolutiva de la mano dentro de la tribu Hominini. En primer lugar, la parsimonia apoya la hipótesis de que la mano del último ancestro común de los humanos y chimpancés es más probable que es pareciera a la de un gran simio actual en general (Pan, Gorilla, y Pongo), que a la de un simio africano en particular. En segundo lugar, proporciona un contexto para la interpretación de los cambios derivados de la mano que se han desarrollado en diferentes homínidos. Sin embargo, la mayoría de las características primitivas que es probable que estuvieran presentes en el último ancestro común de Pan y Homo se mantienen en las manos de Australopithecus, Paranthropus/primeros humanos, y Homo floresiensis.
Análisis de las proporciones internas de la mano (la longitud de los huesos largos del pulgar y el cuarto dedo) en relación con el tamaño corporal de una muestra de primates actuales y extintos. La muestra la conforma un total de 274 primates entre los que se incluyen macacos, mandriles, gibones, orangutanes, gorilas, chimpancés y Homo sapiens; además de algunas especies extintas de homininos (Ardipithecus ramidus, Australopithecus sediba y Homo neanderthalensis).
El principal objetivo de este trabajo ha consistido en establecer una cronología y datación precisas de los yacimientos Musterienses de Eurasia, ya que éstos contienen las mejores pruebas de la sustitución de un grupo humano (los Neandertales) por otro (AMHs)
The authors report the discovery of Lomekwi 3, a 3.3-million-year-old archaeological site where in situ stone artefacts occur in spatiotemporal association with Pliocene hominin fossils in a wooded palaeoenvironment.
Descripción del mecanismo de acción de la colchina en el tratamiento de la fiebre mediterránea familiar, y de los nuevos medicamentos que se están empleando para tratar esta dolencia.
Evidence based recommendations for the practical management of familial medit...José Luis Moreno Garvayo
Revisión de la literatura acerca de cuestiones prácticas en relación con la fiebre mediterránea familiar. Sobre la base del análisis de los artículos publicados se exponen las recomendaciones de los expertos tras la celebración de una reunión en Israel donde se expusieron todos los puntos de vista.
Guión de la charla que di en Málaga el pasado día 24 de octubre de 2014. En la cultura popular aún persiste la idea que el hombre desciende del chimpancé, esto es, que somos el hermano evolucionado de este simio. Con esta charla trato de corregir ese error mediante un breve repaso de los restos fósiles de nuestros antepasados y de cómo la teoría de la evolución explica cómo hemos llegado aquí.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. 150
S. Parnia et al. / Resuscitation 48 (2001) 149–156
1. Introduction
In the 1970s it was reported that many people
who were near death but survived described similar unusual experiences [1]. This led to a number
of retrospective studies [1–5]. Subjects described
seeing tunnels, lights, deceased relatives, a perception of separation from the body (out of body
experience), and often apparently had these experiences at a time when they were unconscious. These
experiences are lucid and often have life changing
effects. They are now commonly termed the ‘near
death experience’ (NDE). Explanations of these
experiences have ranged from regarding them as
either confusional hallucinations or fabrication, to
confirmation of the existence of life after death [6].
More than 20 years later the debate on NDEs still
continues. Most authors now accept that they do
occur and are not fabrication.
Accounts of NDE’s have been found in many
different cultures and throughout historical time,
for example they are described in Plato’s Republic
[7], in a 15th century painting [8], in 19th century
accounts of survivors of Swiss mountaineering
accidents [9] and more recently, by survivors of a
Chinese earthquake [10]. Much research has now
been done on this subject, including NDEs in
children [11 – 14]. The youngest case in the literature has been reported in a 6-month-old baby [15].
A survey in the US in the 1980s has shown that
the NDE is widely distributed and is reported to
have occurred in 8 million Americans [16].
There are currently three different sets of explanations for the occurrence of NDEs: (1) physiological or pharmacological processes accompanying
the process of dying; (2) a psychological response
to the perceived threat of death; (3) a transcendental experience in the same category as the mystical
(peak) experiences described by Bucke [17] and
later by Mazlow.
Many physiological and pharmacological cerebral mediators have been proposed to account for
the experiences, although none have yet been
shown to be responsible for the phenomenon.
These include endorphins [18,19], cerebral hypoxia
[20], hypercarbia [21], various drugs in particular
hallucinogenic agents such as ketamine and phencyclidine [22], the NMDA receptor [22], serotonin
pathways [23], activation of the limbic system
[24,25], and temporal lobe anoxic seizures [26].
The argument in favour of a psychological explanation is based on observations made from
retrospective cases indicating that NDEs may have
occurred in those who have not been physically
close to death [27] or in those who have experienced such a phenomena just before a life threatening accident in which they did not lose
consciousness [28]. Other studies have indicated
cultural differences between NDEs, although some
of the core features are similar [29–31].
The authors have collected approximately 750
retrospective cases of near death and/or out of
body experiences. It is never clear from the accounts whether an experience occurred before,
during or on recovery from a period of unconsciousness. To date there have been no published
prospective studies looking at the incidence or the
subjective experiences and correlating these with
objective physiological measurements.
It was therefore decided to set up a pilot
prospective study to assess the frequency and possible causes of NDEs in cardiac arrest survivors.
Cardiac arrest survivors were used as models, as
the experience has been frequently reported after
cardiac arrests. These patients are resuscitated using a standard protocol, and thus are given similar
drugs and resuscitative procedures. Moreover the
mental state of cardiac arrest survivors is the
closest model to that of a dying brain. This is due
to the fact that cardiac arrest patients by definition
exhibit two out of three criteria required to pronounce an individual dead (no cardiac output, no
spontaneous respiratory effort) and usually in the
clinical setting of an arrest they develop all three
(fixed dilated pupils1) due to the loss of brainstem
activity [32,33].
2. Method
Over a 1-year period all survivors from cardiac
arrests on the medical, emergency, and coronary
care units of Southampton General Hospital were
identified and interviewed while in hospital. The
main hospital switchboard keeps records of all
cardiac arrest calls and these were used to identify
1
It must be pointed out that atropine and epinephrine (adrenaline)
which are often administered in cardiac arrests may cause dilated
pupils that appear to be fixed. However in a cardiac arrest, brainstem
activity is rapidly lost which would lead to the loss of pupillary
reflexes irrespective of any administered drugs.
3. S. Parnia et al. / Resuscitation 48 (2001) 149–156
the patients. The local ethics committee approved
the study protocol. The inclusion criteria for the
study were: (1) cardiac arrest survivor on any of
the medical/emergency or coronary care units; (2)
age over 18; (3) mental test score of 10/10 (based
upon the 10 point mini mental test and aimed to
exclude any potentially confused patient); (4)
agreement to the interview by the medical and
nursing staff caring for the patient; (5) informed
consent by all patients before being interviewed.
Patients were told that the researchers were
interested in finding out more about any memories
recalled by those who had been in a coma following a cardiac arrest and were asked an open
question regarding any memories occurring during
unconsciousness. Any experiences reported were
recorded and analysed. No direct or specific questions were asked regarding near death, out of
body or any related experiences.
The experiences were assessed according to the
Greyson NDE scale [34]. The Greyson scale is a
standardised 16 point questionnaire used to assess
the core components of the NDE. A score of 7 or
over has been accepted as compatible with a NDE.
This was used to allocate the patients’ replies into:
(a) ‘near death experience’/study group; and (b)
‘non near death experience’/control group.
Possible physiological and pharmacological
causes of the NDE considered were hypoxia and
hypercarbia, electrolyte disturbances, administered
drugs and specific cardiac dysrhythmias. (Certain
electrical rhythms, such as asystole are associated
with a higher fatality rate and one might expect to
find a higher association of such rhythms with
NDEs.) The oxygen, carbon dioxide, sodium and
potassium levels obtained from arterial blood gas
analysis and peripheral blood taken during the
arrest were extracted from the medical notes.
Records of drugs administered around the period
of the arrest, and of any abnormality of cardiac
rhythm during the arrest were also noted. The
only psychological factors investigated were the
patients’ particular religious backgrounds and
whether they were practising members of their
faith. They were not asked about their fear of
death at the time of the arrest.
There are retrospective anecdotal accounts of
patients who during a NDE have described ‘seeing’, as if from a position on the ceiling, resuscitation processes which took place while they were
‘unconscious’, and which they could not have seen
151
from their position on the bed. Some of these
claims have later been verified by the medical and
nursing staff present [35]. In order to test prospectively the possible veridical nature of out of body
experiences, boards were suspended from the ceiling of the wards prior to the commencement of the
study. These had various figures on the surface
facing the ceiling which were not visible from the
floor. If out of body experiences are indeed veridical, anybody who claimed to have left their body
and be near the ceiling during resuscitation attempts would be expected to identify those targets.
If, however, such perceptions are psychological,
then one would obviously not expect the targets to
be identified.
3. Results
During the 1 year period 63 patients survived
and were interviewed. Of those, 56 (88.8%) had no
memory recall of their period of unconsciousness;
the remaining seven survivors (11.1%) had some
memory. These patients’ memories were then assessed using the Greyson NDE scale. According to
this criterion four patients (6.3%) had had NDEs.
The other three patients (4.8%) did not fulfil the
criteria required for a NDE. Interestingly, however, the memories of two (3.2%) out of those
three had some features of a NDE (including
feelings of peace or seeing deceased relatives) but
not enough to pass the Greyson criterion. Only
one person (1.6%) had a memory but showed no
features of a NDE.
3.1. Mental states of the cardiac arrest sur6i6ors
The patients are divided into three groups: (a)
those with no memory, these will not be discussed
further; (b) those whose memories were consistent
with a NDE (Tables 1 and 2); (c) those whose
memories were inconsistent with a NDEs (Table
3).
3.2. The NDE group
The frequencies of the different features recalled
by those in the NDE group were tabulated. All
four patients in the NDE group sensed a point of
no return. Three of the four also experienced
4. S. Parnia et al. / Resuscitation 48 (2001) 149–156
152
Table 1
Features recounted by near death experience (NDE) patients
Gender
MTSa
Features
Greyson score Religious views
Patient 1
Male
10/10
Feelings of peace/pleasantness
Feelings of joy
Felt a sense of harmony
Saw a bright light
Heightened senses
Encountered a mystical being (not recognised)
Encountered a barrier or point of no return.
2
2
1
2
2
2
2
Total 13/32
Non practicing
Catholic and Pagan
Patient 2
Female
10/10
Heightened understanding about herself/others
Feelings of peace and pleasantness
Feelings of joy
Feeling of harmony
Felt aware of things as if by extra sensory perception
Lost awareness of body
Entered some other world
Saw deceased relative
Came to a point of no return
1
1
1
1
1
1
1
2
1
Total 10/32
Non practicing C of E
Patient 3
Male
10/10
Time speeded up
Feelings of peace/pleasantness
Feelings of joy
Saw a bright light
Heightened senses
Entered another world
Came to a border of no return
2
1
1
2
1
2
1
Total 10/32
Non practicing C of E
Patient 4
Female
10/10
Time speeded up
Saw a bright light
Aware of things as if by extra sensory perception
Lost awareness of body
Felt as if encountered deceased relative (father)
Came to a border of no return
2
2
1
1
2
2
Total 10/32
Non practicing C of E
a
Mini mental state test score.
seeing a bright light, and feelings of peace, pleasantness and joy. Two of the four saw deceased
relatives, entered a new domain, felt that time had
speeded up, lost awareness of their bodies, experienced harmony and had heightened senses. Two
features of the Greyson Scale, having heightened
understanding and encountering a mystical being,
were only experienced by one of the four patients.
None of the patients experienced the out of body
phenomenon (Tables 1 and 2).
All the NDE group were Christians. However,
none of them described themselves as practising
members and nor did they see a figure during their
NDE specifically related to Christianity.
One of the four also described himself as a
Pagan. As no one claimed to have had an out of
body experience during this study there was no
opportunity to test the veridical nature of these
experiences. Finally it was noted that none of
those who had a NDE found it to be traumatic.
5. S. Parnia et al. / Resuscitation 48 (2001) 149–156
153
Table 2
Frequency of Greyson scale features of near death experience
(NDE) group
Greyson scale features
1
2
3
4
5
6
7
8
9
10
11
12
13
No.
Came to point/border of no return
Feelings of peace and pleasantness
Feelings of joy
Saw a bright light
Lost awareness of body
Awareness as if by extra sensory means
Entered another domain
Saw deceased relatives
Felt harmony
Felt that time speeded up
Feelings of heightened senses
Heightened sense of understanding
Encountered a mystical being (not
recognised)
%
4
3
3
3
2
2
2
2
2
2
2
1
1
100
75
75
75
50
50
50
50
50
50
50
25
25
3.3. Those without an NDE but with memories
The frequencies of the features recalled by those
not in the NDE group were also tabulated. Two of
the three patients experienced some features of the
NDE, while the third had a confusional experience
with no NDE features (Table 3).
3.4. Physiological changes during cardiac arrest
Physiological factors (arterial blood gases, electrolytes) as well as pharmacological factors (administered drugs) were assessed. For the purposes
of this section those who had a NDE (n= 4) made
up the study group. Those who had no memory
Table 3
Features recounted by the non near death experience (NDE)
patient group
Feature(s) recalled
Patient 1
Thoughts speeded up
Senses more vivid than usual
Saw deceased relatives
Patient 2
Heightened sense of peace
Patient 3
Saw some unknown people jumping off a
mountain
Greyson score
1
1
2
Total 4/32
2
Total 2/32
0
Total 0/32
Fig. 1. Comparison of mean blood measures. Columns 1–5
control group; 6 – 10 study group. Columns 1, 2, 6 and 7:
mean peripheral blood levels of sodium and potassium mEq/l.
Column 3 and 8: O2 saturations. Columns 4 and 9: partial
pressure of oxygen, kPa. Columns 5 and 10 partial pressure of
CO2 kPa in arterial blood.
(n=56) together with those who had a memory
but did not fulfil the criteria of a NDE (n =3)
made up the control group.
As only four patients were enrolled in the study
(NDE) group, the numbers were not sufficient for
statistical significance testing, so only the mean
and standard deviation of the arterial blood gas
results, electrolyte levels and cardiac rhythms in
the two groups are described. Three of the four
people in the NDE group had pulseless VT/VF,
the fourth was in asystole (control figures: VF/
VT =36, asystole =7, not recorded in medical
notes, or not available=16)2 (If during the resuscitation the cardiac rhythm changed the initial
rhythm is stated). Interestingly, those who had a
NDE had a PaO2 level (33.1 (S.D. 18.37) kPa)
which was double the control group (16.8 (S.D.
11.73) kPa). The administered drugs were not
compared further as all patients followed a standard resuscitation protocol.
3.5. Comparison of blood parameters
There was little difference between the mean
sodium, potassium and CO2 levels (Fig. 1).
2
Unlike the blood parameters which were recorded from the time
of the initial stay of the cardiac arrest patients on the ward some of
the cardiac rhythms were recorded retrospectively, and unfortunately
not all the medical notes were retrieved.
6. 154
S. Parnia et al. / Resuscitation 48 (2001) 149–156
4. Discussion
This prospective study suggests that the incidence of memories after a cardiac arrest and resuscitation is 11.1%. Of these, 6.3% had lucid
memories and a similar mental state, consistent
with the previously described NDE and scored
above 7 on the Greyson NDE scale. The features
were dissimilar to those of confusional hallucinations, as they were highly structured, narrative,
easily recalled, and clear. 4.8% had memories
which did not reach the Greyson criteria (score
below 7) and of these, 1.6% had a memory which
had none of the accepted features of the NDE.
NDEs occurred in the sample in a small minority of cardiac arrest survivors. Nobody found the
experience to be distressing, rather it was described as pleasant. A continuum of NDE phenomena was found: although 4.8% of the patients
did not reach the Greyson criteria, their experiences were essentially similar to the NDE group.
Only one patient had experiences which clearly lay
outside those of the NDE, and appeared more
typical of a confusional episode. In this series,
NDE phenomena characterized the mental states
of the majority of patients who were unconscious
and reported memories during cardiac arrest.
In this study possible physiological causative
factors could not be investigated adequately in
view of the relatively small number in the study
(NDE) group. Nevertheless it was interesting that
patients in the study group had higher oxygen
levels than those in the control group. This may
simply be a skewed result due to the low patient
numbers. Alternatively it may indicate that patients who had NDEs had better oxygenation during the resuscitation, allowing better cortical
function. Provided that blood oxygen levels reflect
cerebral oxygen levels, the findings suggest that in
this cardiac arrest model, cerebral anoxia may not
be an important causative factor in these experiences, and indeed may mitigate against them.
There is support for this in other models of the
NDE, where psychological causes are thought to
trigger the experience such as in those occurring
just before a major accident, the cerebral circulation is not compromised and hypoxia cannot be a
factor. However, it would be unwise, with such
small numbers, to draw any significant conclusion
from this finding.
It is not clear whether the experiences of patients, who report that they have ‘left their bodies’
and viewed their own resuscitation procedures are
veridical or are hallucinations. Some patients do
appear to have obtained information which they
could not have obtained during unconsciousness
[35]. If this is so, it would suggest that some
element of human consciousness is capable of
separating from the body and obtaining information at a distance [36–38]. However, it is also
possible that the information that they report may
have been gained from ordinary sensory sources.
In this study, no out of body experiences occurred.
The authors know of no prospective studies which
have helped clarify this point.
The data suggests that in this cardiac arrest
model, the NDE arises during unconsciousness.
This is a surprising conclusion, because when the
brain is so dysfunctional that the patient is deeply
comatose, the cerebral structures which underpin
subjective experience and memory must be
severely impaired. Complex experiences such as
are reported in the NDE should not arise or be
retained in memory. Such patients would be expected to have no subjective experience (as was the
case in 88.8% of patients in this study) or at best
a confusional state if some brain function is retained. Even if the unconscious brain is flooded by
neurotransmitters [18,19,22] this should not produce clear, lucid remembered experiences, as those
cerebral modules which generate conscious experience and underpin memory are impaired by cerebral anoxia. The fact that in a cardiac arrest loss
of cortical function precedes the rapid loss of
brainstem activity lends further support to this
view.
An alternative explanation would be that the
observed experiences arise during the loss of, or on
regaining, consciousness. However, it is unlikely
that the NDE arises either when the cortical modules are failing, that is, during the process of
becoming unconscious, or when the cortical modules are coming back on line, that is, when consciousness is returning. Experiences arising during
loss of consciousness in fainting arise in conjunction with ongoing mental experience at the beginning of the episode [39] and there were no reports
from the subjects which suggested that this was
the case. The EEG data during fainting shows a
gradual slowing of the cerebral rhythms with the
appearance of delta activity before finally, in a
7. S. Parnia et al. / Resuscitation 48 (2001) 149–156
minority of cases, the EEG becomes flat [40]. In
the case of cardiac arrest, the process is accelerated, with the EEG showing changes within a few
seconds [32]. The transition from consciousness to
unconsciousness is thus rapid, appearing immediate to the subjects. Experiences which occur during the recovery of consciousness are confusional,
which these were not. Further data to confirm the
timing of the experience is clearly required.
This study indicates that the NDEs following
cardiac arrest are relatively rare and that they
probably occur during ‘unconsciousness’. Of the
memories which do apparently occur during ‘unconsciousness’, the majority have features of the
NDE. The study has confirmed the stereotyped
nature of the NDE. For an adequate prospective
sample to be collected so that both the psychological (including out of body experiences) and physiological aspects of the experience can be looked at
in detail, a multi-centre trial is needed.
Acknowledgements
This study was funded by the department. We
would like to thank Professor B. Elahi for his help
with the design of this study as well as his continuos support and suggestions throughout. Thanks
also go to Professor C. Cooper, Professor S. Holgate, Dr J Heyworth, Dr M Clancy, Dr N Sheron,
Dr G. Lewith, for their support as well as suggestions regarding the manuscript. In addition we
would like to thank all the medical and nursing
staff at Southampton General Hospital, especially
on CCU, the Medical Unit and in the Emergency
Department as well as the staff of the Drug Information Unit.
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