Advances in stroke medicine.

Advances in stroke medicine. Med J Aust. 2019 May;210(8):367-374 Authors: Campbell BC Abstract In recent years, reperfusion therapies such as intravenous thrombolysis and endovascular thrombectomy for ischaemic stroke have dramatically reduced disability and revolutionised stroke management. Thrombolysis with alteplase is effective when administered to patients with potentially disabling stroke, who are not at high risk of bleeding, within 4.5 hours of the time the patient was last known to be well. Emerging evidence suggests that other thrombolytics such as tenecteplase may be even more effective. Treatment may be possible beyond 4.5 hours in patients selected using brain imaging. Endovascular thrombectomy (via angiography) effectively reduces risk of death or dependency in patients with large vessel occlusion (internal carotid, proximal middle cerebral and basilar arteries) if applied within 6 hours of the time they were last known to be well. Endovascular thrombectomy is also beneficial 6-24 hours from the last known well time in selected patients with favourable brain imaging. Thus, some patients with wake-up stroke are now treatable, and protocols for stroke need to include computed tomography (CT) perfusion scan and CT angiography as routine, in addition to the non-contrast CT brain scan. Optimised pre-hospital and emergency department systems (eg, code stroke response teams, pre-notification by ambulance, direct transport from triage to CT scanner)...
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research

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CONCLUSIONS: A deterioration prediction model was developed using patient demographics, ward-based observations, laboratory values, and their trends. The model’s outputs were converted to a deterioration index that was successfully integrated into a live hospital electronic medical record. The sensitivity and specificity of the tool to detect inpatient deterioration were superior to traditional early warning scores.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research
CONCLUSIONS: Currently, available evidence does not unequivocally support the clinical effectiveness of andexanet alfa or prothrombin complex concentrate to reverse factor Xa inhibitor-associated acute major bleeding, nor does it permit conventional meta-analysis of potential superiority. Neither reversal agent was significantly associated with increased effectiveness or a higher rate of venous thromboembolic event. These results underscore the importance of randomized controlled trials comparing the two reversal agents and may provide guidance in designing institutional guidelines.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Online Review Article Source Type: research
No abstract available
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Online Letters to the Editor Source Type: research
OBJECTIVES: We performed a comprehensive health assessment in mechanically ventilated coronavirus disease 2019 survivors to assess the impact of respiratory and skeletal muscle injury sustained during ICU stay on physical performance at 3 months following hospital discharge. DESIGN: Preregistered prospective observational cohort study. SETTING: University hospital ICU. PATIENTS: All mechanically ventilated coronavirus disease 2019 patients admitted to our ICU during the first European pandemic wave. MEASUREMENTS AND MAIN RESULTS: At 3 months after hospital discharge, 46 survivors underwent a...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Clinical investigations Source Type: research
OBJECTIVES: Nonpharmaceutical interventions are implemented internationally to mitigate the spread of severe acute respiratory syndrome coronavirus 2 with the aim to reduce coronavirus disease 2019–related deaths and to protect the health system, particularly intensive care facilities from being overwhelmed. The aim of this study is to describe the impact of nonpharmaceutical interventions on ICU admissions of non–coronavirus disease 2019–related patients. DESIGN: Retrospective cohort study. SETTING: Analysis of all reported adult patient admissions to New Zealand ICUs during Level 3 and...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Clinical investigations Source Type: research
We examined the incidence and impact of early multiple organ dysfunction syndrome on clinical, functional, and disability outcomes over the year following traumatic brain injury. DESIGN: Retrospective cohort study. SETTING: Patients enrolled in the Transforming Clinical Research and Knowledge in Traumatic Brain Injury study, an 18-center prospective cohort study of traumatic brain injury patients evaluated in participating level 1 trauma centers. SUBJECTS: Adult (age> 17 yr) patients with moderate-severe traumatic brain injury (Glasgow Coma Scale
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research
AbstractTo study the effects of psoralen on the intestinal barrier and alveolar bone loss (ABL) in rats with chronic periodontitis. Fifty-two 8-week-old specific pathogen-free (SPF) male Sprague-Dawley (SD) rats were randomly divided into the following four groups: Control group (Control), psoralen group of healthy rats (Pso), periodontitis model group (Model), and psoralen group of periodontitis rats (Peri+Pso). The alveolar bone resorption of maxillary molars was observed via haematoxylin-eosin staining and micro-computed tomography. The expression level of receptor activator of nuclear factor- κB ligand (RANKL) an...
Source: Inflammation - Category: Allergy & Immunology Source Type: research
If it hurts – take notice, and avoid it. Learn from it. If there are other people around, make sure your behaviour is noticeable so they take care of you and don’t do what you just did. If they look after you, you’ll probably do the same thing again when you hurt, if they don’t you probably won’t. This is one description of pain behaviour and how it works. It’s the only part of our pain experience that we can share directly with one another (actions and words). The “doing” part is also the part that is most affected by pain – even distress is signalled to others &nd...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Uncategorized Chronic pain Clinical reasoning pain management Research Source Type: blogs
List of hints and tips on how to enjoy a healthier, happier life based on recent research that applies to people of all ages
Source: Disabled World - Category: Disability Tags: Fitness - Nutrition Source Type: news
AbstractThe development of molecular imaging agents used for imaging of cancer tissue is of great importance for the early detection of cancer. Positron emission tomography (PET) radiopharmaceuticals consists of a positron-emitting radionuclide and a molecularstructure.89Zr-labeled monoclonal antibodies (mAbs), peptides, nanoparticles, proteins, and other compounds are called89Zr-Immuno-PET and are used in cancer tissue imaging. This review provides a general overview of the potential of molecules labeled with89Zr radionuclide, which is chosen due to its long half-life, in preclinical and clinical studies. In light of thes...
Source: Journal of Radioanalytical and Nuclear Chemistry - Category: Nuclear Medicine Source Type: research
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