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https://www.readbyqxmd.com/read/29150800/beat-to-beat-estimation-of-stroke-volume-using-impedance-cardiography-and-artificial-neural-network
#1
S M M Naidu, Prem C Pandey, Uttam R Bagal, Suhas P Hardas
Impedance cardiography is a low-cost noninvasive technique, based on monitoring of the thoracic impedance, for estimation of stroke volume (SV). Impedance cardiogram (ICG) is the negative of the first derivative of the impedance signal. A technique for beat-to-beat SV estimation using impedance cardiography and artificial neural network (ANN) is proposed. A three-layer feed-forward ANN with error back-propagation algorithm is optimized by examining the effects of number of neurons in the hidden layer, activation function, training algorithm, and set of input parameters...
November 18, 2017: Medical & Biological Engineering & Computing
https://www.readbyqxmd.com/read/29145321/acupuncture-and-constraint-induced-movement-therapy-for-a-patient-with-chronic-stroke-one-year-follow-up-case-report
#2
Yuanyuan Jin, Xiaoqing Jin, Yidan Chen, Jianfang Zhu
RATIONALE: Spasticity is a widespread problem in chronic stroke. To date, no study has reported the long-term (up to 1 year) outcomes of acupuncture in combination with constraint-induced movement therapy in patients with chronic stroke. This report describes the successful addition of acupuncture on spasticity and arm function in a patient with chronic stroke and arm paresis. PATIENT CONCERNS: At screening, the patient was unable to voluntarily extend her interphalangeal or metacarpophalangeal joints beyond the 10 degrees required for constraint-induced movement therapy...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29141649/number-and-type-of-guideline-implementation-tools-varies-by-guideline-clinical-condition-country-of-origin-and-type-of-developer-organization-content-analysis-of-guidelines
#3
Laurel Liang, Jhoni Abi Safi, Anna R Gagliardi
BACKGROUND: Guideline implementation tools (GI tools) can improve clinician behavior and patient outcomes. Analyses of guidelines published before 2010 found that many did not offer GI tools. Since 2010 standards, frameworks and instructions for GI tools have emerged. This study analyzed the number and types of GI tools offered by guidelines published in 2010 or later. METHODS: Content analysis and a published GI tool framework were used to categorize GI tools by condition, country, and type of organization...
November 15, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/29129364/diabetes-control-decreases-morbidity-and-mortality-after-carotid-endarterectomy
#4
Matthew S Parr, Viktor Y Dombrovskiy, Khanjan H Nagarsheth, Randy Shafritz, Saum A Rahimi
BACKGROUND: Single-institution studies have demonstrated a negative effect of diabetes mellitus on outcomes after carotid endarterectomy (CEA). The aim of this study was to compare patients with explicitly controlled and uncontrolled diabetes at the population level. METHODS: Using the National Inpatient Sample 2006-2013, we selected patients undergoing CEA. Rates of stroke, myocardial infarction (MI), and hospital mortality, as well as duration of stay and cost were compared among patients with uncontrolled diabetes (UCDM), well-controlled diabetes (WCDM), and those without diabetes (NDM)...
November 9, 2017: Surgery
https://www.readbyqxmd.com/read/29127194/dump-the-pump-manual-aspiration-thrombectomy-mat-with-a-syringe-is-technically-effective-expeditious-and-cost-efficient
#5
Bradley A Gross, Ashutosh P Jadhav, Tudor G Jovin, Brian Thomas Jankowitz
INTRODUCTION: Syringe aspiration for manual aspiration thrombectomy (MAT) is a cost- and time-efficient alternative to an aspiration pump with likely similar efficacy. It is counterintuitive to expect the pump to perform better than direct vacuum with a syringe, as the pump must deliver vacuum additionally through a canister and meters of tubing. OBJECTIVE: To present in vitro and clinical results of MAT with a syringe. METHODS: An in vitro analysis was performed comparing vacuum pressures generated by syringe aspiration and with pump aspiration...
November 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29118795/cost-analysis-of-the-addition-of-hyperacute-magnetic-resonance-imaging-for-selection-of-patients-for-endovascular-stroke-therapy
#6
Seby John, Nicolas R Thompson, Terry Lesko, Nancy Papesh, Nancy Obuchowski, Dan Tomic, Dolora Wisco, Zeshaun Khawaja, Ken Uchino, Shumei Man, Esteban Cheng-Ching, Gabor Toth, Thomas Masaryk, Paul Ruggieri, Michael Modic, Muhammad Shazam Hussain
Background and Purpose: Patient selection is important to determine the best candidates for endovascular stroke therapy. In application of a hyperacute magnetic resonance imaging (MRI) protocol for patient selection, we have shown decreased utilization with improved outcomes. A cost analysis comparing the pre- and post-MRI protocol time periods was performed to determine if the previous findings translated into cost opportunities. Materials and Methods: We retrospectively identified individuals considered for endovascular stroke therapy from January 2008 to August 2012 who were ≤8 h from stroke symptoms onset...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29106834/-left-atrial-appendage-closure-and-embolic-events
#7
M Akodad, P Garot
Atrial fibrillation (AF) is frequent and responsible for embolic events. Currently, the gold standard to prevent such embolic events is anticoagulant therapy with vitamin K antagonist (VKA) or direct oral anticoagulant in nonvalvular AF. Recently, left atrial appendage closure was proposed as an alternative to anticoagulant inpatient with high embolic risk and contraindication to anticoagulant therapy. Data from randomized trials were consistent with a non-inferiority of left atrial appendage closure in comparison to VKA in terms of stroke and cardiovascular death...
October 26, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29105583/the-economic-cost-of-stroke-associated-pneumonia-in-a-uk-setting
#8
A N Ali, J Howe, A Majid, J Redgrave, S Pownall, A H Abdelhafiz
Introduction Stroke-associated pneumonia (SAP) is common, however, data on the economic impact of SAP are scarce. This study aimed to prospectively evaluate the impact of SAP on acute stroke care costs in a UK setting. Methods Prospective cohort study of 213 consecutive patients with stroke (196 ischemic, 17 hemorrhagic) was admitted to a UK hospital over 1 year. Socio demographic and clinical characteristics were recorded along with all treatments and rehabilitation activity. Patients were classified as having SAP if they fulfilled criteria for "probable" or "definite" respiratory tract infection according to the Centres for Disease Control and Prevention definition, within the first seven days following stroke...
November 4, 2017: Topics in Stroke Rehabilitation
https://www.readbyqxmd.com/read/29105528/cost-effectiveness-analysis-of-tissue-plasminogen-activator-in-acute-ischemic-stroke-in-iran
#9
Asrin Amiri, Reza Goudarzi, Mohammadreza Amiresmaili, Farhad Iranmanesh
AIMS: Tissue plasminogen activator (tPA) is used to treat acute ischemic stroke up to 4.5 hours after symptom onset. Its cost-effectiveness in developing countries is not specified yet. This study aimed to study cost-effectiveness of tPA in Iran. METHODS: This is a cost-effectiveness analysis from the perspective of the third party payer to compare IV tPA with no tPA of ischemic stroke. A Markov model with a lifetime horizon was used to analyze the costs and outcomes...
November 5, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/29100941/impact-of-clinical-pharmacist-services-delivered-via-telemedicine-in-the-outpatient-or-ambulatory-care-setting-a-systematic-review
#10
REVIEW
Joshua D Niznik, Harvey He, Sandra L Kane-Gill
BACKGROUND: Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied. OBJECTIVE: Identify the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings. METHODS: A literature search was conducted from database inception through May 2016 in Medline, SCOPUS, and EMBASE...
October 28, 2017: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/29099363/the-effects-of-oral-health-on-systemic-health
#11
Shawn F Kane
The oral cavity is the intersection of medicine and dentistry and the window into the general health of a patient. Hundreds of diseases and medications impact the oral cavity, and pathologic conditions in the mouth have a greater systemic impact than many providers appreciate. It is unclear whether there is true causality or just an association between periodontal disease and certain other systemic conditions, including atherosclerotic vascular disease, pulmonary disease, diabetes, pregnancy-related complications, osteoporosis, and kidney disease...
November 2017: General Dentistry
https://www.readbyqxmd.com/read/29097056/a-community-based-bionic-leg-rehabilitation-program-for-patients-with-chronic-stroke-clinical-trial-protocol
#12
Amy Wright, Keeron Stone, Danielle Lambrick, Simon Fryer, Lee Stoner, Edward Tasker, Simon Jobson, Grace Smith, John Batten, Jo Batey, Vicky Hudson, Helen Hobbs, James Faulkner
Stroke is a major global health problem whereby many survivors have unmet needs concerning mobility during recovery. As such, the use of robotic-assisted devices (i.e., a bionic leg) within a community setting may be an important adjunct to normal physiotherapy in chronic stroke survivors. This study will be a dual-center, randomized, parallel group clinical trial to investigate the impact of a community-based training program using a bionic leg on biomechanical, cardiovascular, and functional outcomes in stroke survivors...
October 30, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29094912/recurrent-ischemic-stroke-strategies-for-prevention
#13
Rupal Oza, Kristen Rundell, Miriam Garcellano
Recurrent strokes make up almost 25% of the nearly 800,000 strokes that occur annually in the United States. Risk factors for ischemic stroke include hypertension, diabetes mellitus, hyperlipidemia, sleep apnea, and obesity. Lifestyle modifications, including tobacco cessation, decreased alcohol use, and increased physical activity, are also important in the management of patients with a history of stroke or transient ischemic attack. Antiplatelet therapy is recommended to reduce the risk of recurrent ischemic stroke...
October 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/29083968/effect-of-apixaban-versus-warfarin-use-on-health-care-resource-utilization-and-costs-among-elderly-patients-with-nonvalvular-atrial-fibrillation
#14
Steven Deitelzweig, Xuemei Luo, Kiran Gupta, Jeffrey Trocio, Jack Mardekian, Tammy Curtice, Melissa Lingohr-Smith, Brandy Menges, Jay Lin
BACKGROUND: The clinical trial ARISTOTLE showed that apixaban was superior to warfarin in reducing the risks of stroke and bleeding among patients with nonvalvular atrial fibrillation (NVAF). Further study of the effect of apixaban versus warfarin use on health care resource utilization (HCRU) and associated costs in the real-world setting is warranted, especially among elderly patients who are at higher risk of stroke and bleeding. OBJECTIVE: To compare HCRU and costs among elderly NVAF patients treated with apixaban versus warfarin in the United States...
November 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29076745/cost-effectiveness-of-magnetic-resonance-carotid-plaque-imaging-for-primary-stroke-prevention-in-canada
#15
Lechtman E, Balki I, Thomas K, Chen K, Moody Ar, Tyrrell Pn
OBJECTIVES: Magnetic resonance (MR) imaging of the carotid arteries provides important insight into plaque composition and vulnerability in addition to the traditional measure of stenosis. The purpose of this study was to evaluate the cost-effectiveness of MR imaging as a first-line modality to assess carotid disease and guide management for high-risk patients with < 50% stenosis. METHODS: Using TreeAge Pro, a cost effectiveness simulation was conducted comparing two strategies: a) standard of care first-line carotid duplex ultrasound (DUS) with regular follow-up, versus b) first-line MR assessment of stenosis and intraplaque hemorrhage (MRIPH) in which patients with IPH received annual DUS surveillance and immediate carotid endarterectomy in case of plaque progression...
October 27, 2017: British Journal of Radiology
https://www.readbyqxmd.com/read/29072556/a-home-based-telerehabilitation-program-for-patients-with-stroke
#16
Lucy Dodakian, Alison L McKenzie, Vu Le, Jill See, Kristin Pearson-Fuhrhop, Erin Burke Quinlan, Robert J Zhou, Renee Augsberger, Xuan A Tran, Nizan Friedman, David J Reinkensmeyer, Steven C Cramer
BACKGROUND: Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. METHODS: Patients were 3 to 24 months poststroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home...
October 1, 2017: Neurorehabilitation and Neural Repair
https://www.readbyqxmd.com/read/29068166/meta-analysis-of-transfemoral-tavr-versus-surgical-aortic-valve-replacement
#17
Sameer Arora, Satyanarayana R Vaidya, Paula D Strassle, Jacob A Misenheimer, Jeremy A Rhodes, Cassandra J Ramm, Evan N Wheeler, Thomas G Caranasos, Matthew A Cavender, John P Vavalle
BACKGROUND: In the recently concluded PARTNER 2 trial, TF-TAVR cohort was shown to have lower risks of death or disabling strokes as compared to SAVR, whereas the outcomes with transthoracic TAVR were comparable with SAVR. METHODS: We searched PubMed, EMBASE, Web of Science, and Google Scholar for all comparison studies between TAVR and SAVR and mortality as an outcome, irrespective of surgical risk. Randomized controlled trials and propensity-score-matched cohort studies that used a transfemoral approach exclusively or stratified results by route of access and reported data for TF-TAVR patients were eligible for inclusion...
October 25, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29066923/setting-priorities-in-the-health-care-sector-the-case-of-oral-anticoagulants-in-nonvalvular-atrial-fibrillation-in-denmark
#18
Peter Bo Poulsen, Søren Paaske Johnsen, Morten Lock Hansen, Axel Brandes, Steen Husted, Louise Harboe, Lars Dybro
AIM: Resources devoted to health care are limited, therefore setting priorities is required. It differs between countries whether decision-making concerning health care technologies focus on broad economic perspectives or whether focus is narrow on single budgets ("silo mentality"). The cost perspective as one part of the full health economic analysis is important for decision-making. With the case of oral anticoagulants in patients with nonvalvular atrial fibrillation (NVAF), the aim is to discuss the implication of the use of different cost perspectives for decision-making and priority setting...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/29060719/development-and-assessment-of-a-novel-ankle-rehabilitation-system-for-stroke-survivors
#19
Beom-Chan Lee, Dae-Hee Kim, Younsun Son, Kap-Ho Seo, Sung Ho Park, Dongyual Yoo, Alberto Fung
Spasticity after stroke is a common occurrence and requires treatment with rehabilitative regimens (e.g., stretching exercise). Unfortunately, many challenges (e.g., cost, limited availability of physical therapists, limited access to clinical facilities, etc.) can restrict participation in these rehabilitation regimens. Assistive technologies using robotic systems have been developed to provide an alternative to assist with rehabilitative exercises. However, existing assistive technologies are rarely available in clinical settings due to technical limitations (e...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29060542/posturography-stability-score-generation-for-stroke-patient-using-kinect-fuzzy-based-approach
#20
Oishee Mazumder, Kingshuk Chakravarty, Debatri Chatterjee, Aniruddha Sinha, Abhijit Das
Aim of this paper is to formulate a posturography stability score for stroke patients using fuzzy logic. Postural instability is one of the prominent symptoms of stroke, dementia, parkinsons disease, myopathy, etc. and is the major precursor of fall. Conventional scoring techniques used to assess postural stability require manual intervention and are dependent on live interaction with physiotherapist. We propose a novel scoring technique to calculate static stability of a person using posturography features acquired by Kinect sensor, which do not require any manual intervention or expert guidance, is cost effective and hence are ideal for tele rehabilitation purpose...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
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