Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues

AbstractPurpose of reviewAs one of the fastest growing portions of the population, nonagenarians will constitute a significant percentage of the stroke patient population in the near future. Nonagenarians are nevertheless not specifically targeted by most clinical guidelines. In this review, we aimed to summarise the available evidence guiding stroke prevention and treatment in this age group.Recent findingsSeveral recent observational studies have shown that the benefits of anticoagulation for the oldest old patients with atrial fibrillation may outweigh the bleeding risk. A sub-analysis of the IST-3 trial has shown for the first time that thrombolysis treatment in acute ischaemic stroke may be beneficial and safe even in octogenarian patients and older. Several recent observational studies have assessed thrombolysis in nonagenarians. The latest of these has shown better disability outcomes without increased rates of symptomatic intracerebral haemorrhage with thrombolysis.SummaryNonagenarian stroke patients may benefit from similar preventative and therapeutic strategies as their younger counterparts. A few important exceptions include primary prevention using aspirin or statins. Patient selection is nevertheless essential given the increased adverse event rates. Patient preference should play a key role in the decision-making process. Clinical trials including more nonagenarian patients are required to yield more robust evidence.
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research

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Authors: Bharadwaj AS, Swamy PM, Mamas MA Abstract Introduction: There are numerous shared risk factors in the etiopathogenesis of coronary artery disease (CAD) and cancer both at the epidemiologic and molecular level. Additionally, the different modalities of treatment of cancer such as radiation, chemotherapy, immunotherapy and hormonal therapies further increase the risk of CAD and acute coronary syndrome. Most large database analysis and single center experiences have shown that cancer patients undergoing PCI are at an increased risk of in-hospital mortality, bleeding repeat revascularization.Areas covered: In ...
Source: Expert Review of Cardiovascular Therapy - Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research
We have a total of 42 ICU beds in our community hospital. Acuity is high as we have a large catchment area and we serve as a referral site for surrounding hospitals. Trauma center and comprehensive stroke center. Trying to see how we could make things better. Currently we have 2 intensivists and 1 NP/PA on days. Open ICU and we see everyone on the vent and on vasoactive agents plus others if we are asked to help. We do multidis rounds on every patient in the unit, regardless of whether we... How is your ICU staffed?
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Critical Care Source Type: forums
Publication date: February 2020Source: Annals of Emergency Medicine, Volume 75, Issue 2Author(s): Éric Mercier, Alexandra Nadeau, Audrey-Anne Brousseau, Marcel Émond, Judy Lowthian, Simon Berthelot, Andrew P. Costa, Fabrice Mowbray, Don Melady, Krishan Yadav, Christian Nickel, Peter A. CameronThis scoping review aimed to synthesize the available evidence on the epidemiology, patient- and caregiver-associated factors, clinical characteristics, screening tools, prevention, interventions, and perspectives of health care professionals in regard to elder abuse in the out-of-hospital or emergency department (ED) se...
Source: Annals of Emergency Medicine - Category: Emergency Medicine Source Type: research
ConclusionPatients receiving preinjury warfarin or a combination of aspirin and clopidogrel were at increased risk for significant intracranial injury, but not those receiving aspirin alone. Clinicians should have a low threshold for neuroimaging when evaluating patients receiving warfarin or a combination of aspirin and clopidogrel.
Source: Annals of Emergency Medicine - Category: Emergency Medicine Source Type: research
ConclusionIt is envisaged that the current review will add value to more scientific research on M. flabellifolius and enhance/promote the increased interest in the sustainable commercialization of M. flabellifolius herbal tea as well as lead to the validation of unverified ethnobotanical claims.Graphical abstract
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
We describe below the design of dal-GenE, a precision medicine, placebo-controlled clinical outcome trial of dalcetrapib in patients with a recent acute myocardial infarction with the unique feature of selecting only those with the AA genotype at rs1967309 in the ADCY9 gene.
Source: American Heart Journal - Category: Cardiology Source Type: research
CONCLUSION: CSP for advanced, non-pedunculated lesions is feasible, effective and extremely safe. PMID: 31950801 [PubMed - in process]
Source: Acta Gastro-Enterologica Belgica - Category: Gastroenterology Tags: Acta Gastroenterol Belg Source Type: research
The objective of this study was to compare the effect of the dietary beer trub, alone or in combination with linseed, on meat quality, oxidative status and cholesterol content of rabbit. Eighty New Zealand White rabbits were divided at weaning (30 d) into four dietary groups: control (C) fed a standard diet, trub (T, 2% of lyophilized trub), linseed (L, 3% of extruded linseed), and trub-linseed in combination (TL, 2% of lyophilized trub and 3% of extruded linseed). At slaughtering (80 d) the oxidative parameters of blood and quality of Longissimus thoracis et lumborum were analysed. The in vivo lipid oxidation was similar ...
Source: Meat Science - Category: Food Science Source Type: research
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Source: Food Research International - Category: Food Science Source Type: research
Conclusions: The assessment of HL using the16-item HLS-EU questionnaire may be a useful tool to enable health behaviours and utilisation of health care resources by society to be predicted.
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Article Source Type: research
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