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https://www.readbyqxmd.com/read/29666704/practice-patterns-and-barriers-for-intravenous-thrombolysis-a-survey-of-neurologists-in-saudi-arabia
#1
Mohammed H Alanazy, Rima B Barakeh, Alanood Asiri, Maha F Edrees, Ahmad R Abuzinadah, Bandar N Aljafen, Taim Muayqil
Only a small fraction of patients with acute ischemic stroke receive intravenous thrombolysis (IVT). We sought to assess barriers and practice patterns in using IVT for acute ischemic stroke among neurologists in Saudi Arabia. An electronic survey was sent to all neurologists registered with the Saudi Commission for Health Specialties. A total of 148 (77.5%) neurologists responded. The most common reported barriers for IVT administration were delayed presentation to hospitals (82.4%) and unclear time of symptom onset (50...
2018: Neurology Research International
https://www.readbyqxmd.com/read/29664857/restrictive-versus-liberal-strategy-for-red-blood-cell-transfusion-a-systematic-review-and-meta-analysis-in-orthopaedic-patients
#2
Wan-Jie Gu, Xiao-Ping Gu, Xiang-Dong Wu, Hao Chen, Joey S W Kwong, Lu-Yang Zhou, Shuo Chen, Zheng-Liang Ma
BACKGROUND: Current guidelines recommend restrictive criteria for red blood-cell transfusion in most clinical settings. However, patients undergoing orthopaedic surgery may require distinct transfusion criteria since benefits and potential harm often vary considerably based on patient characteristics and surgical procedures. We aimed to assess the efficacy and safety of restrictive transfusion in patients undergoing orthopaedic surgery, especially in important subgroups. METHODS: Electronic databases were searched to identify randomized controlled trials investigating restrictive (mostly a hemoglobin level of 8...
April 18, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29663986/-interpretation-of-2018-guidelines-for-the-early-management-of-patients-with-acute-ischemic-stroke
#3
Gang Wang, Bangjiang Fang, Xuezhong Yu, Zhijun Li
In 2018, the American Heart Association/American Stroke Association (AHA/ASA) has developed the latest 2018 guidelines for the early management of patients with acute ischemic stroke (AIS), based on the latest evidences. The 2018 guidelines including recommendations on pre-hospital and in-hospital management treatment, has revised and add new recommendations from 2013 guideline. The major changes in 2018 guideline involve applications of brain imaging in early stage, intravenous thrombolysis and mechanical thrombectomy, et al...
April 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29663464/uninterrupted-administration-of-edoxaban-vs-vitamin-k-antagonists-in-patients-undergoing-atrial-fibrillation-catheter-ablation-rationale-and-design-of-the-eliminate-af-study
#4
Stefan H Hohnloser, John Camm, Riccardo Cappato, Hans-Christoph Diener, Hein Heidbuchel, Hans-Joachim Lanz, Lluís Mont, Carlos A Morillo, Rüdiger Smolnik, Ophelia Q P Yin, Josef Kautzner
Patients with atrial fibrillation (AF) are at an approximately 0.5% to 3% increased risk of thromboembolism during and immediately after catheter ablation. Treatment guidelines recommend periprocedural oral anticoagulation plus unfractionated heparin during ablation. Rivaroxaban and dabigatran are the only non-vitamin K oral anticoagulants for which there are randomized controlled trials assessing uninterrupted anticoagulation in patients undergoing catheter ablation of AF. Edoxaban, a direct factor Xa inhibitor, is noninferior vs warfarin for the prevention of stroke or systemic embolism with less major bleeding in patients with nonvalvular AF...
April 17, 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29661944/atrial-fibrillation-burden-moving-beyond-atrial-fibrillation-as-a-binary-entity-a-scientific-statement-from-the-american-heart-association
#5
REVIEW
Lin Y Chen, Mina K Chung, Larry A Allen, Michael Ezekowitz, Karen L Furie, Pamela McCabe, Peter A Noseworthy, Marco V Perez, Mintu P Turakhia
Our understanding of the risk factors and complications of atrial fibrillation (AF) is based mostly on studies that have evaluated AF in a binary fashion (present or absent) and have not investigated AF burden. This scientific statement discusses the published literature and knowledge gaps related to methods of defining and measuring AF burden, the relationship of AF burden to cardiovascular and neurological outcomes, and the effect of lifestyle and risk factor modification on AF burden. Many studies examine outcomes by AF burden classified by AF type (paroxysmal versus nonparoxysmal); however, quantitatively, AF burden can be defined by longest duration, number of AF episodes during a monitoring period, and the proportion of time an individual is in AF during a monitoring period (expressed as a percentage)...
April 16, 2018: Circulation
https://www.readbyqxmd.com/read/29656606/a-meta-analysis-on-the-surgical-management-of-paraganglioma-of-the-carotid-body-per-shamblin-class
#6
Thijs T G Jansen, Henri A M Marres, Johannes H A M Kaanders, Henricus P M Kunst
OBJECTIVE: The aim of the current study is to evaluate the risk associated with different types of surgery for carotid body paraganglioma of different Shamblin class. A meta-analysis was conducted to evaluate per tumour class, the local control, cranial nerve damage and complication rates of different techniques using internal carotid artery (ICA) and external carotid artery (ECA) ligation, clamping or bypassing, as well as the cranio-caudal versus caudo-cranial techniques. DESIGN: A meta-analysis is conducted after a systematic search in PubMed and the Cochrane library, in accordance with the PRISMA guidelines...
April 15, 2018: Clinical Otolaryngology
https://www.readbyqxmd.com/read/29656002/dangers-of-outpatient-nimodipine-use-after-spontaneous-subarachnoid-hemorrhage-in-accordance-with-the-comprehensive-stroke-center-guidelines
#7
Ching-Jen Chen, Cassie Turnage, Jennifer D Sokolowski, Jeyan S Kumar, M Yashar Kalani, Min S Park
Despite the adverse effects and unclear benefit of the complete 21-day course of nimodipine therapy, The Joint Commission mandates adherence to nimodipine treatment for 21 days after hemorrhage or after hospital discharge if discharged within 21 days for Comprehensive Stroke Center (CSC) certification. We hereby present a 67 year-old male patient with Hunt-Hess grade 2 and Fisher grade 3 non-aneurysmal spontaneous subarachnoid hemorrhage who was discharged with oral nimodipine as stipulated by the CSC guidelines, and subsequently developed symptomatic hypotension...
April 11, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29655505/midterm-outcome-of-transcatheter-versus-surgical-aortic-valve-replacement-in-low-to-intermediate-risk-patients-a-meta-analysis-of-randomized-controlled-trials
#8
Yanwei Wang, Yijiang Zhou, Li Zhang, Jianhua Zhu
BACKGROUND: Current guidelines recommend transcatheter aortic valve replacement (TAVR) in patients with severe symptomatic aortic stenosis (AS) who are not suitable for conventional surgical aortic valve replacement (SAVR). In light of the recent trend in performing TAVR in patients with lower risk profile, we assessed the midterm outcome comparing TAVR and SAVR for the treatment of patients with severe AS at low to intermediate risk. METHODS: PubMed, EBSCO, and Cochrane CENTRAL were systematically searched for randomized controlled trials that reported the clinical outcomes of TAVR versus SAVR in patients at low to intermediate surgical risk with at least 2 years of follow-up...
June 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29651371/tenecteplase-versus-alteplase-for-the-management-of-acute-ischemic-stroke-in-a-low-income-country-nepal-cost-efficacy-and-safety
#9
REVIEW
Gaurav Nepal, Ghanshyam Kharel, Shaik Tanveer Ahamad, Babin Basnet
Intravenous alteplase is the only approved treatment for acute ischemic stroke. Tenecteplase, a genetically engineered, mutant tissue plasminogen activator, is an alternative thrombolytic agent. The economic feasibility of stroke treatment has been a matter of huge debate and discussion thus far. The use of thrombolytics for the management of ischemic stroke has recently begun in Nepal. In low-income countries like Nepal, where the per capita income falls at just $691.7 and 25.2% of the population are under the poverty line, stroke patients cannot meet treatment expenses...
February 9, 2018: Curēus
https://www.readbyqxmd.com/read/29649992/protocol-for-promoting-recovery-optimization-of-walking-activity-in-stroke-prowalks-a-randomized-controlled-trial
#10
Henry Wright, Tamara Wright, Ryan T Pohlig, Scott E Kasner, Jonathan Raser-Schramm, Darcy Reisman
BACKGROUND: Stroke survivors are more physically inactive than even the most sedentary older adults, and low activity is associated with increased risk of recurrent stroke, medical complications, and mortality. We hypothesize that the combination of a fast walking intervention that improves walking capacity, with a step activity monitoring program that facilitates translation of gains from the clinic to the "real-world", would generate greater improvements in real world walking activity than with either intervention alone...
April 12, 2018: BMC Neurology
https://www.readbyqxmd.com/read/29649643/estimating-the-global-incidence-of-aneurysmal-subarachnoid-hemorrhage-a-systematic-review-for-central-nervous-system-vascular-lesions-and-meta-analysis-of-ruptured-aneurysms
#11
REVIEW
Joshua D Hughes, Kamila M Bond, Rania A Mekary, Michael C Dewan, Abbas Rattani, Ronnie Baticulon, Yoko Kato, Hildo Azevedo-Filho, Jacques J Morcos, Kee B Park
INTRODUCTION: There is increasing acknowledgement that surgical care is important in global health initiatives. In particular, neurosurgical care is as limited as 1-to-10 million people in parts of the world. We performed a systematic literature review to examine the worldwide incidence of central nervous system vascular lesions (CNS-VL) and a meta-analysis of aneurysmal subarachnoid hemorrhage (ASAH) in order to define the disease burden and inform neurosurgical global health efforts...
April 9, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29644927/disease-specific-clinical-pathways-are-they-feasible-in-primary-care-a-mixed-methods-study
#12
Anders Grimsmo, Audhild Løhre, Tove Røsstad, Ingunn Gjerde, Ina Heiberg, Aslak Steinsbekk
OBJECTIVE: To explore the feasibility of disease-specific clinical pathways when used in primary care. DESIGN: A mixed-method sequential exploratory design was used. First, merging and exploring quality interview data across two cases of collaboration between the specialist care and primary care on the introduction of clinical pathways for four selected chronic diseases. Secondly, using quantitative data covering a population of 214,700 to validate and test hypothesis derived from the qualitative findings...
April 12, 2018: Scandinavian Journal of Primary Health Care
https://www.readbyqxmd.com/read/29644411/noac-monotherapy-in-patients-with-concomitant-indications-for-oral-anticoagulation-undergoing-transcatheter-aortic-valve-implantation
#13
Nicolas A Geis, Christina Kiriakou, Emmanuel Chorianopoulos, Lorenz Uhlmann, Hugo A Katus, Raffi Bekeredjian
AIMS: Antithrombotic therapy after transcatheter aortic valve implantation (TAVI) is highly controversial and guideline recommendations are not evidence based. We assessed efficacy and safety of non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy in patients with concomitant indications for OAC undergoing TAVI. METHODS: Among more than 1300 TAVI patients since 2008, 154 patients were identified who received postinterventional NOAC monotherapy. Outcomes were compared to 172 patients treated with vitamin K antagonist (VKA) monotherapy...
April 11, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29643066/early-ambulation-among-hospitalized-heart-failure-patients-is-associated-with-reduced-length-of-stay-and-30-day-readmissions
#14
Lisa M Fleming, Xin Zhao, Adam D DeVore, Paul A Heidenreich, Clyde W Yancy, Gregg C Fonarow, Adrian F Hernandez, Robb D Kociol
BACKGROUND: Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality. METHODS AND RESULTS: The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry...
April 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29629256/european-society-of-cardiology-proposed-diagnostic-echocardiographic-algorithm-in-elective-patients-with-clinical-suspicion-of-infective-endocarditis-diagnostic-yield-and-prognostic-implications-in-clinical-practice
#15
Andrea Barbieri, Francesca Mantovani, Roberta Lugli, Francesca Bursi, Matteo Fabbri, Ylenia Bartolacelli, Marcella Manicardi, Guglielmo Stefanelli, Cristina Mussini, Giuseppe Boriani
Background: Echocardiography plays a central role in diagnosing infective endocarditis (IE). Accordingly, the European Society of Cardiology (ESC) has proposed a diagnostic echocardiographic algorithm. However, new studies are still needed to evaluate the degree of implementation of these guidelines in clinical practice and their consequences on incidence and prognosis of IE. Aim: This study aims to investigate the diagnostic yield of the ESC proposed echocardiographic algorithm in patients with suspected IE...
January 2018: Journal of Cardiovascular Echography
https://www.readbyqxmd.com/read/29627171/comparison-of-nicardipine-with-clevidipine-in-the-management-of-hypertension-in-acute-cerebrovascular-diseases
#16
Zachary Rosenfeldt, Katelyn Conklen, Breck Jones, Don Ferrill, Maithili Deshpande, Fazeel M Siddiqui
BACKGROUND AND PURPOSE: In acute stroke, hypertension worsens outcomes. Guidelines do not mention a preferred antihypertensive agent. This present study aimed to compare the efficacy and safety of nicardipine and clevidipine in acute stroke. METHODS: This retrospective review compared nicardipine with clevidipine for hypertension in acute stroke patients from March 17, 2015 to December 23, 2016. Ischemic and hemorrhagic stroke types were evaluated. Patients were excluded if under 18 years, had traumatic brain injury, had intracranial neoplasm, were on dialysis, had both study drugs during the stroke admission, or the study drug was infused for less than 1 hour...
April 4, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29622972/elevated-troponin-in-patients-with-acute-stroke-is-it-a-true-heart-attack
#17
REVIEW
George V Dous, Angela C Grigos, Richard Grodman
Although the prognostic value of a positive troponin in an acute stroke patient is still uncertain, it is a commonly encountered clinical situation given that Ischemic Heart Disease (IHD) and cerebrovascular disease (CVD) frequently co-exist in the same patient and share similar risk factors. Our objectives in this review are to (1) identify the biologic relationship between acute cerebrovascular stroke and elevated troponin levels, (2) determine the pathophysiologic differences between positive troponin in the setting of acute stroke versus acute myocardial infarction (AMI), and (3) examine whether positive troponin in the setting of acute stroke has prognostic significance...
September 2017: The Egyptian heart journal: (EHJ): official bulletin of the Egyptian Society of Cardiology
https://www.readbyqxmd.com/read/29622180/roles-of-transesophageal-echocardiography-and-cardiac-computed-tomography-for-evaluation-of-left-atrial-thrombus-and-associated-pathology-a-review-and-critical-analysis
#18
REVIEW
Faraz Pathan, Harvey Hecht, Jagat Narula, Thomas H Marwick
Evaluation of the left atrium and left atrial appendage for the presence of thrombus prior to cardioversion and pulmonary vein isolation, and of the entire heart for embolic sources in the setting of cryptogenic stroke, has long been standard medical care. Guidelines have uniformly recommended transesophageal echocardiography (TEE) to accomplish these goals. In recent years, computed tomographic angiography has demonstrated diagnostic accuracy similar to that of TEE for the detection of thrombus. Analysis of the pertinent data and relative merits of the 2 technologies leads to the conclusions that: 1) both modalities have some unique, nonoverlapping capabilities that may dictate their use in specific situations; 2) computed tomographic angiography is a reasonable alternative to TEE when the primary aim is to exclude left atrial and left atrial appendage thrombus and in patients in whom the risks associated with TEE outweigh the benefits; and 3) both options should be discussed with the patient in the setting of shared decision making...
April 2018: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29621328/differences-in-prevalence-of-hypertension-and-associated-risk-factors-in-urban-and-rural-residents-of-the-northeastern-region-of-the-people-s-republic-of-china-a-cross-sectional-study
#19
Junnan Wang, Wei Sun, George A Wells, Zhibo Li, Tianyi Li, Junduo Wu, Yangyu Zhang, Yingyu Liu, Longbo Li, Yunpeng Yu, Yihang Liu, Chao Qi, Yang Lu, Ning Liu, Youyou Yan, Lulu Liu, Gang Hui, Bin Liu
BACKGROUND: Hypertension is a significant global public health problem and recognized as an important risk factor for cardiovascular diseases. This study was designed to assess the current prevalence of hypertension and to explore risk factors associated with hypertension by urban and rural status to guide the prevention and control of hypertension in Jilin province. METHODS: A multi-stage stratified random cluster sampling method was used to obtain data on hypertension, which was investigated by physical examination and face-to-face questionnaire in July 2014-December 2015...
2018: PloS One
https://www.readbyqxmd.com/read/29621071/back-to-basics-adherence-with-guidelines-for-glucose-and-temperature-control-in-an-american-comprehensive-stroke-center-sample
#20
Anne W Alexandrov, Paola Palazzo, Sharon Biby, Abbigayle Doerr, Wendy Dusenbury, Rhonda Young, Anne Lindstrom, Mary Grove, Georgios Tsivgoulis, Sandy Middleton, Andrei V Alexandrov
BACKGROUND: Variance from guideline-directed care for glucose and temperature control remains unknown in the United States at a time when priorities have shifted to ensure rapid diagnosis and treatment of acute stroke patients. However, protocol-driven nursing surveillance for control of hyperglycemia and hyperthermia has been shown to improve patient outcomes. METHODS: We conducted an observational pilot study to assess compliance with American guidelines for glucose and temperature control and association with discharge outcomes in consecutive acute stroke patients admitted to 5 US comprehensive stroke centers...
April 4, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
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