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Sample records for care including thrombolysis

  1. Infarct volume predicts critical care needs in stroke patients treated with intravenous thrombolysis

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    Faigle, Roland; Marsh, Elisabeth B.; Llinas, Rafael H.; Urrutia, Victor C. [Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD (United States); Wozniak, Amy W. [Johns Hopkins University, Department of Biostatistics, Bloomberg School of Public Health, Baltimore, MD (United States)

    2014-10-26

    Patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (IVT) for ischemic stroke are monitored in an intensive care unit (ICU) or a comparable unit capable of ICU interventions due to the high frequency of standardized neurological exams and vital sign checks. The present study evaluates quantitative infarct volume on early post-IVT MRI as a predictor of critical care needs and aims to identify patients who may not require resource intense monitoring. We identified 46 patients who underwent MRI within 6 h of IVT. Infarct volume was measured using semiautomated software. Logistic regression and receiver operating characteristics (ROC) analysis were used to determine factors associated with ICU needs. Infarct volume was an independent predictor of ICU need after adjusting for age, sex, race, systolic blood pressure, NIH Stroke Scale (NIHSS), and coronary artery disease (odds ratio 1.031 per cm{sup 3} increase in volume, 95 % confidence interval [CI] 1.004-1.058, p = 0.024). The ROC curve with infarct volume alone achieved an area under the curve (AUC) of 0.766 (95 % CI 0.605-0.927), while the AUC was 0.906 (95 % CI 0.814-0.998) after adjusting for race, systolic blood pressure, and NIHSS. Maximum Youden index calculations identified an optimal infarct volume cut point of 6.8 cm{sup 3} (sensitivity 75.0 %, specificity 76.7 %). Infarct volume greater than 3 cm{sup 3} predicted need for critical care interventions with 81.3 % sensitivity and 66.7 % specificity. Infarct volume may predict needs for ICU monitoring and interventions in stroke patients treated with IVT. (orig.)

  2. APPROACHES TO INCREASE THE AVAILABILITY AND EFFECTIVENESS OF PRE-HOSPITAL THROMBOLYSIS IN REAL CLINICAL PRACTICE

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    L. A. Ostroumova

    2012-01-01

    Full Text Available Aim. To identify the factors of the increasing the availability and effectiveness of pre-hospital thrombolytic therapy of patients with ST segment elevation acute coronary syndrome (STEACS. Material and methods. STEACS patients (n=70 were included in the study and stratified into two groups. Patients of the 1st group (n=30 received emergency medical assistance from the feldsher teams and patients of the 2nd group (n=40 — from the doctor teams. Expert estimation approach was used for the real practice assessment. Results. The hospital-matched diagnose rate was 97.5% in the doctor teams in comparison with 76.7% in feldsher teams (p<0.05. The efficiency of pre-hospital thrombolysis in 90 minutes after its beginning was 60.1% for the doctor teams versus 73.3% for the feldsher teams (p>0.05. The deviation from the standard operating procedure of the medical care for myocardial infarction patients was observed more often in the doctor teams in comparison with this in the feldsher teams. Time for the decision about pre-hospital thrombolysis start, the rate of unreasonable use or unreasonable refusal of thrombolysis did not differ significantly in feldsher and doctor teams. Conclusion. To increase the effectiveness of pre-hospital thrombolysis therapy it is necessary to follow strictly the standard of the medical care for patients with acute coronary syndrome. One of the main approaches to improve the availability of up to date medical care technologies in STEACS treatment is implementation of pre-hospital thrombolysis in practice of feldsher teams.

  3. Combined treatment of subacute and acute synthetic and venous bypass-graft occlusions with percutaneous mechanical thrombectomy and thrombolysis

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    Hundt, Walter, E-mail: hundt@med.uni-marburg.de [Department of Radiology, Philipps University Marburg (Germany); Kalinowski, Mark; Stamm, Anna C. [Department of Radiology, Philipps University Marburg (Germany); Portig, Irene [Department of Cardiology, Division of Angiology, Philipps University Marburg (Germany); Swaid, Zaher; Dietz, Carsten; Geks, Josef [Department of Surgery, Philipps University Marburg (Germany); Burbelko, Mykhaylo [Department of Radiology, Philipps University Marburg (Germany)

    2013-12-01

    Introduction: Percutaneous mechanical thrombectomy (PMT) is a third choice of treatment for acute arterial occlusions, in addition to thrombolysis and surgical thrombectomy. The aim of this retrospective study was to compare the combined treatment of PMT and local thrombolysis with thrombolysis therapy alone. Materials and methods: Sixty-nine patients with acute (<14 days [n = 35]) or subacute (14–42 days [n = 34]) femoropopliteal bypass occlusions were treated with PMT combined with thrombolysis. Seventy-two patients with acute [n = 40] or subacute [n = 32] femoropopliteal bypass occlusions were treated with thrombolysis alone. The thrombolysis in myocardial infarction (TIMI) classification was used to assess the bypass occlusion. Local thrombolysis time and dosage, reopening time, time in the intensive care unit, necessary surgical re-interventions, and clinical outcome were compared between the 2 groups. Results: The TIMI scores were significantly higher in the PMT plus thrombolysis group than in the thrombolysis group (acute occlusions 1188 versus 935, p < 0.001; subacute occlusions 935 versus 605, p < 0.001). The total urokinase dosage, the total hours of thrombolysis, time in the intensive care unit, and total hospital stay in the acute PMT plus thrombolysis group were significantly lesser than those in the thrombolysis group. After 24 h of treatment, the ankle-brachial index improved in all groups (p < 0.001): in the acute and subacute PMT plus thrombolysis group to 0.63 ± 0.14 and 0.43 ± 0.08, respectively; and in the acute and subacute thrombolysis group to 0.51 ± 0.11 and 0.41 ± 0.04, respectively. Conclusions: PMT combined with thrombolysis is a safe and very effective therapy for acute and subacute femoropopliteal bypass occlusions compared to treatment with thrombolysis alone.

  4. Neonatal renal vein thrombosis: role of anticoagulation and thrombolysis--an institutional review.

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    Bidadi, Behzad; Nageswara Rao, Amulya A; Kaur, Dominder; Khan, Shakila P; Rodriguez, Vilmarie

    2016-02-01

    Neonatal renal vein thrombosis (NRVT) is a rare thromboembolic complication in the neonatal period, and sequelae from renal dysfunction can cause significant morbidity. The authors retrospectively reviewed 10 patients with NRVT treated at their institution. The majority of the cohort were male (n = 9), preterm (n = 6), and had unilateral NRVT (n = 6). Six patients received thrombolysis and/or anticoagulation, and 4 patients received supportive care only. Two of the 6 patients treated with anticoagulation who had bilateral NRVT and anuria received thrombolysis with low-dose tissue plasminogen activator. Thrombolysis was not associated with any major adverse events, and both patients had marked improvement of renal function. Eight patients subsequently developed renal atrophy (3 received anticoagulation, 2 received thrombolysis with anticoagulation, and 3 received supportive care). Anticoagulation/thrombolysis did not appear to prevent renal atrophy. The role of thrombolysis needs to be further studied and considered in the setting of bilateral NRVT and acute renal failure.

  5. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

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    V. V. Omel'yanovskiy

    2011-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  6. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

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    V. V. Omel'yanovskiy

    2016-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  7. Association of mechanical chest compression and prehospital thrombolysis.

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    Chenaitia, Hichem; Fournier, Marc; Brun, Jean Paul; Michelet, Pierre; Auffray, Jean Pierre

    2012-07-01

    Pulmonary embolism (PE) is a common cause of sudden death; the use of prehospital thrombolysis is currently a last-resort option and requires a prolonged cardiopulmonary resuscitation (CPR). Novel mechanical devices have recently been introduced that provides automatic mechanical chest compression (AMCC) according to the guidelines and continually without decrease efficiency throughout prolonged resuscitation. A 54 year-old woman with a history of breast cancer experienced sudden chest pain and severe dyspnea. A mobile intensive care unit was dispatched to her home. During physical examination, she suddenly collapsed with pulseless electrical activity as the initial rhythm. Prehospital thrombolysis during CPR combined with use of AMCC was performed based on a strongly suspected diagnosis of massive PE. After 75 minutes of effective CPR, return of spontaneous circulation was attained. After admission to an intensive care unit, computed tomographic scan confirmed bilateral PE. The patient was discharged 3 weeks after CPR in good neurologic condition. To our knowledge, this is the first case describing combined use of thrombolysis and AMCC in out-ofhospital cardiac arrest. However, for the time being, prehospital thrombolysis in CPR continues to be a measure that should only be performed on a case-by-case basis based on informed decision. Further studies are needed to evaluate the efficacy and safety of AMCC with thrombolysis and thus prolonged CPR.

  8. Child Care Teachers' Perspectives on Including Children with Challenging Behavior in Child Care Settings

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    Quesenberry, Amanda C.; Hemmeter, Mary Louise; Ostrosky, Michaelene M.; Hamann, Kira

    2014-01-01

    In this study, 9 teachers from 5 child care centers were interviewed to examine their perceptions on including children with challenging behavior in their classrooms. The findings provide a firsthand view into how child care teachers support children's social and emotional development and address challenging behavior. Results confirm previous…

  9. Catheter-Directed Thrombolysis

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    ... a free-flowing liquid to a semi-solid gel, or blood clots. A blood clot, or thrombus, ... doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially ...

  10. Investigation of the causes of clinical symptom aggravation in process of intravenous thrombolysis with alteplase

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    LI Chen-hua

    2013-04-01

    Full Text Available Objective To explore the causes of aggravation of microcirculation disorders in the process of intravenous thrombolysis with alteplase and the clinical outcomes. Methods The clinical data of the aggravated signs and symptoms of 13 cases treated by alteplase were reported, and the onset characteristics and clinical outcomes were analysed to summarize emergency experiences. Results There were 13 patients with stenosis of intracranial large arteries occurred perforating branch infarctions caused by the blocking of carried arteries (8 cases in internal carotid system, 5 cases in vertebral-basilar system. In the process of thrombolytic therapy, main aggravated presentations including cortical ischemic symptom, quadriplegia, exacerbated disturbance of consciousness were seen. Imaging examinations showed multiple new petechial ischemic foci in cortex and watershed region or increasing of infarct foci in cerebellum and brain stem. The prognosis was favorable after expectant treatment. NIHSS score was 8.69 ± 3.42 at 24 h after treatment, and mRS score was 0.94 ±0.37 at 3 month-follow-up. Neurologic deficit and quality of life were evidently improved. Conclusion In the course of intravenous thrombolytic therapy with alteplase. Aggravated clinical signs and symptoms may be related to various factors. Emboli disintegration inducing microcirculation disorder is inferred to be the main cause. For patients presenting aggravated signs and symptoms in thrombolysis process, favorable outcomes may occur as long as intensive care and timely treatment are performed.

  11. Prehospital thrombolysis in acute myocardial infarction: the Belgian eminase prehospital study (BEPS). BEPS Collaborative Group.

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    1991-09-01

    Interest in early thrombolysis has prompted a study on the feasibility and time course of prehospital thrombolysis in patients with acute myocardial infarction (AMI) in six centres in Belgium. Patients with clinically suspected AMI and with typical ECG changes presenting within 4 h after onset of pain were treated with 30 units of Anisoylated Plasminogen Streptokinase Activator Complex (APSAC, eminase) intravenously by a mobile intensive care unit (MICU). Sixty-two patients were included in the study and an AMI was confirmed in 60. The mean time (+/- 1 SD) from onset of pain to injection of APSAC was 95 +/- 47 min and the mean estimated time gain, calculated as the time difference between the arrival of the MICU at home and the arrival of the MICU at the emergency department, was 50 +/- 17 min. In the prehospital period four patients developed ventricular fibrillation and one cardiogenic shock. During hospital stay severe complications were observed in four patients. Two events were fatal, one diffuse haemorrhage and one septal rupture; two events were non fatal, one feasible and that an estimated time gain of 50 min can be obtained. Potential risks and benefits remain to be demonstrated in a large controlled clinical trial.

  12. S WAVE IN PULMONARY EMBOLISM, A NEW ECG SIGN TO AID THROMBOLYSIS

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    Thomas John

    2012-11-01

    Full Text Available Acute pulmonary embolism is a devastating disease that often leads to mortality . Previous investigators have found that thrombolysis reduces mortality in men but not significantly in women with pulmonary embolism. Many of the previous studies are with tenecteplase and alteplase. Here, we describe intra - venous thrombolysis with streptokinase in seven patients with pulmonary embolism who survived including two women. Further, we have one patient who had a new onset of S wave in lead I which subsequently disappeared after embolectomy. We also comment on the usefulness of shock sign in 2 deciding on thrombolysis .We propose a new sign for noninvasive assessment of need for thrombolysis in pulmonary embolism. New onset S wave in Lead I in pulmonary embolism can be used as a new sign for deciding the need for thrombolysis. When added to the shock sign it can be used in the emergency deparment to decide the need for thrombolysis. Further, there are no clear end points as to when to stop thrombolysis. In all 4 patients we switched to heparin when spontaneous bleeding or oozing started. In all 4 patients subsequent CT scans showed that the patient has mild to moderate resolution of the pulmonary embolism and patients remained stable and have been discharged and are under regular follow up. Hence we propose that bleeding can be used as an end point for thrombolysis in acute pulmonary embolism. We also describe a patient who had new onset S wave that disappeared after successful pulmonary embolectomy. Probably, the S wave is a marker of main pulmonary artery branch occlusions.

  13. Catheter-directed thrombolysis in the treatment of acute deep venous thrombosis: a meta-analysis.

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    Zheng, J J; Zhang, Z H; Shan, Z; Wang, W J; Li, X X; Wang, S M; Li, Y-X; Cheng, G-S

    2014-07-24

    We performed a meta-analysis for systematic evaluation of the status quo of catheter thrombolysis for the treatment of acute lower limb deep vein thrombosis in China. We searched the China Biomedical bibliographic database (CBM), China National Knowledge Infrastructure (CNKI), Weipu full-text electronic journals, Wanfang full-text database, and Medline (1990 through June 2011) for clinical randomized controlled trials of catheter-directed thrombolysis and superficial venous thrombolysis to compare their efficacies for the treatment of acute deep vein thrombosis. The results were analyzed by using the Cochrane-recommended RevMan 4.2 software package, and the odds ratio (OR) was used as the combined measure of efficacy. The search retrieved 8 randomized controlled trials, and meta-analysis using the total rate of effective treatment as the clinical observation index found that the combined OR for the catheter thrombolysis group versus the superficial venous thrombolysis group was significant (P venous thrombolysis for the treatment of acute deep vein thrombosis in the lower limb in Chinese individuals. However, the included trials were only of medium quality, so more rational and scientific clinical trials are needed to validate this conclusion.

  14. Ultrasound Assisted Catheter Directed Thrombolysis in the Management of a Right Atrial Thrombus: A New Weapon in the Armamentarium?

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    Kaur, Ramanjit; Javed, Arshad; Elder, Mahir; Afonso, Luis; Kaki, Amir

    2016-01-01

    Catheter related thrombosis (CRT) is a commonly encountered entity fraught with substantial risk for mortality secondary to various complications including pulmonary embolism (PE), tricuspid regurgitation, endocarditis, right sided heart failure, and cardiogenic and septic shock. CRT carries a mortality rate of 18% in hemodialysis patients and more than 40% in nonhemodialysis patients. Management strategies include systemic anticoagulation, systemic thrombolysis, surgical evacuation, and percutaneous retrieval with no established guidelines. Ultrasound assisted catheter directed thrombolysis emerges as promising modality with a relatively lower risk of hemorrhage compared to systemic thrombolysis. We report a case of a 75-year-old man with dialysis catheter related thrombosis without PE for which ultrasound assisted catheter directed thrombolysis was used successfully as an alternative therapy. PMID:27648311

  15. Isolated pharmacomechanical thrombolysis using the Trellis system

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    O’Sullivan, GJ

    2010-01-01

    While anticoagulation remains the current gold standard for treating acute deep vein thrombosis,1 there is a growing body of evidence that rapid thrombus removal results in better short- and long-term outcomes.2–5 This is a practical guide to achieve rapid thrombus removal with isolated pharmacomechanical thrombolysis using the Trellis® peripheral infusion system.\\r\

  16. Prediction of stroke thrombolysis outcome using CT brain machine learning

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    Paul Bentley

    2014-01-01

    Full Text Available A critical decision-step in the emergency treatment of ischemic stroke is whether or not to administer thrombolysis — a treatment that can result in good recovery, or deterioration due to symptomatic intracranial haemorrhage (SICH. Certain imaging features based upon early computerized tomography (CT, in combination with clinical variables, have been found to predict SICH, albeit with modest accuracy. In this proof-of-concept study, we determine whether machine learning of CT images can predict which patients receiving tPA will develop SICH as opposed to showing clinical improvement with no haemorrhage. Clinical records and CT brains of 116 acute ischemic stroke patients treated with intravenous thrombolysis were collected retrospectively (including 16 who developed SICH. The sample was split into training (n = 106 and test sets (n = 10, repeatedly for 1760 different combinations. CT brain images acted as inputs into a support vector machine (SVM, along with clinical severity. Performance of the SVM was compared with established prognostication tools (SEDAN and HAT scores; original, or after adaptation to our cohort. Predictive performance, assessed as area under receiver-operating-characteristic curve (AUC, of the SVM (0.744 compared favourably with that of prognostic scores (original and adapted versions: 0.626–0.720; p < 0.01. The SVM also identified 9 out of 16 SICHs, as opposed to 1–5 using prognostic scores, assuming a 10% SICH frequency (p < 0.001. In summary, machine learning methods applied to acute stroke CT images offer automation, and potentially improved performance, for prediction of SICH following thrombolysis. Larger-scale cohorts, and incorporation of advanced imaging, should be tested with such methods.

  17. 78 FR 25304 - Siemens Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology), Including On...

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    2013-04-30

    ... Employment and Training Administration Siemens Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology), Including On-Site Leased Workers From Source Right Solutions, Concord, California, Now Located... 5, 2012, applicable to workers of Siemens Medical Solutions, USA, Inc., Oncology Care...

  18. Catheter-directed thrombolysis of below-knee deep venous thrombosis of the lower extremities

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    Roh, Byung Suk; Sohn, Young Jun; Heo, Eun A; Cho, Hyun Sun; Park, Seong Hoon; Lee, Young Hwan [Wonkwang University Hospital, Iksan (Korea, Republic of)

    2008-02-15

    To evaluate the technical feasibility and clinical efficacy of the use of local thrombolysis for below-knee deep vein thrombosis (DVT). From a population of 41 patients with a lower extremity DVT, the prospective clinical trial included 11 patients (7 female, 4 male, average age 61.4 years) treated with catheter-directed thrombolysis with urokinase for below-knee DVT. After removal of the proximal ilofemoral DVT, additional interventional procedures to remove the residual thrombosis and restore the venous flow from the below-knee vein were performed in cases of continuous occlusion of venous flow from the popliteal and tibial veins. Under ultrasound (US) guidance, catheter-directed thrombolysis with urokinase was performed through the ipsilateral popliteal vein. After administration of oral anticoagulation therapy, CT and venography were performed to identify patency and the presence of a recurrent thrombosis. Successful removal of the thrombus and restoration of venous flow were achieved in all of the patients (100%). Restoration of flow with a residual thrombus occurred in one case. Focal venous stenosis was discovered in four cases. The duration of urokinase infusion was 1-4 days (average 2.36 days), which was considered long. For 15.2 months, the venous lumen of all cases was preserved without a recurrent thrombosis. Catheter-directed thrombolysis is an effective procedure for recanalization of below-knee DVT in patients with a lower extremity DVT.

  19. Reducing door to needle time for stroke thrombolysis.

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    Gill, Sumanjit

    2014-01-01

    Better outcomes are obtained with stroke thrombolysis the more rapidly it is given, both in terms of the patient's level of functional ability and also mortality. Current UK performance targets (outside London) aim for a time of 45 minutes or less. Thrombolysis pathways involve multidisciplinary working across departmental boundaries as well as senior level decision making. Our system used telemedicine out of hours adding additional complexity to the pathway. The initial planning stages started by auditing current practice and mapping the existing pathway. The figures for door to needle times were held on a database on the stroke unit and collected in detail for the purposes of national reporting. The pathway was mapped by combining personal experience of working within the stroke service with the experiences of the general medical registrars who worked the system out of hours. The initial action was to present this information throughout the hospital at departmental meetings. Opinions were canvassed at these meetings on where the biggest barriers were within the pathway and how we could address them. An awareness campaign was held by advertising over the intranet. An intervention comprising the following elements was introduced over the period of a year: introduction of an ambulance pre-alert, revision of the existing pathway, and education to all those involved in thrombolysis. The cases where particularly long delays were noted were audited in more depth to identify barriers to flow through the system. This was reported in ward meetings for staff to contribute experience and to offer solutions. We went to commissioning group meetings to gain the support of the local ambulance service, and talked to A&E seniors about the project and the ways in which they could help. Median times were calculated from a stroke database. There was a fall in median door to needle time of 65.5 to 49 minutes over a period of 18 months. A complex intervention to improve door to needle

  20. Safety and efficacy of catheter-directed thrombolysis

    DEFF Research Database (Denmark)

    Bækgaard, N; Klitfod, Lotte; Broholm, R

    2012-01-01

    To describe the background for--and mechanism of--catheter-directed thrombolysis (CDT) for iliofemoral deep venous thrombosis (DVT) accessed via the popliteal vein. Focus is on safety and efficacy.......To describe the background for--and mechanism of--catheter-directed thrombolysis (CDT) for iliofemoral deep venous thrombosis (DVT) accessed via the popliteal vein. Focus is on safety and efficacy....

  1. Salvage intraosseous thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism.

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    Northey, Luke Cameron; Shiraev, Timothy; Omari, Abdullah

    2015-01-01

    Intraosseous access is an alternative route of pharmacotherapy during cardiopulmonary resuscitation. Extracorporeal membrane oxygenation (ECMO) provides cardiac and respiratory support when conventional therapies fail. This case reports the use of intraosseous thrombolysis and ECMO in a patient with acute massive pulmonary embolism (PE). A 34-year-old female presented to the emergency department with sudden onset severe shortness of breath. Due to difficulty establishing intravenous access, an intraosseous needle was inserted into the left tibia. Echocardiography identified severe right ventricular dilatation with global systolic impairment and failure, indicative of PE. Due to the patient's hemodynamic compromise a recombinant tissue plasminogen activator (Alteplase) bolus was administered through the intraosseous route. After transfer to the intensive care unit, venous-arterial ECMO was initiated as further therapy. The patient recovered and was discharged 36 days after admission. This is the first report of combination intraosseous thrombolysis and ECMO as salvage therapy for massive PE.

  2. Salvage intraosseous thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism

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    Luke Cameron Northey

    2015-01-01

    Full Text Available Intraosseous access is an alternative route of pharmacotherapy during cardiopulmonary resuscitation. Extracorporeal membrane oxygenation (ECMO provides cardiac and respiratory support when conventional therapies fail. This case reports the use of intraosseous thrombolysis and ECMO in a patient with acute massive pulmonary embolism (PE. A 34-year-old female presented to the emergency department with sudden onset severe shortness of breath. Due to difficulty establishing intravenous access, an intraosseous needle was inserted into the left tibia. Echocardiography identified severe right ventricular dilatation with global systolic impairment and failure, indicative of PE. Due to the patient′s hemodynamic compromise a recombinant tissue plasminogen activator (Alteplase bolus was administered through the intraosseous route. After transfer to the intensive care unit, venous-arterial ECMO was initiated as further therapy. The patient recovered and was discharged 36 days after admission. This is the first report of combination intraosseous thrombolysis and ECMO as salvage therapy for massive PE.

  3. Effectiveness of palliative care including physiotherapy in hiv patients a review of the literature

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    J. Uwimana

    2007-02-01

    Full Text Available It is estimated that 41 million people throughout the world are living with HIV/AIDS and of these 39 million are in sub-Saharan Africa(UNAIDS 2004.  The HIV/AIDS epidemic is devastating the African continent.In Africa poorly resourced health care infrastructure further impairs the quality of life in HIV sufferers. Palliative care is an approach that aims to improve the quality of life of people living with threatening diseases such as cancer and HIV/AIDS. This review aimed to determine the efficacy of palliative care. Complementary therapies such as Cognitive Behavioural Therapy, peer/counselling group therapy, massage  therapy, and exercise therapy constitute palliative care. Seventeen articles published in peer reviewed journals during the period 1990-2005 were reviewed. The findings of our review demonstrate that there are indications that palliative care can be effective in improving the quality of life in patients with life threatening diseases such HIV/AIDS. Research in this field is complicated by the heterogeneity of study samples, difficulty in patient recruitment, and death before the end of the intervention period. Future research in this area should aim to include larger study samples, using valid tools to assess quality of life and to employ qualitative methods in studies to assess the effectiveness of palliative care.

  4. Reliability Analysis of Brittle Material Structures - Including MEMS(?) - With the CARES/Life Program

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    Nemeth, Noel N.

    2002-01-01

    Brittle materials are being used, or considered, for a wide variety of high tech applications that operate in harsh environments, including static and rotating turbine parts. thermal protection systems, dental prosthetics, fuel cells, oxygen transport membranes, radomes, and MEMS. Designing components to sustain repeated load without fracturing while using the minimum amount of material requires the use of a probabilistic design methodology. The CARES/Life code provides a general-purpose analysis tool that predicts the probability of failure of a ceramic component as a function of its time in service. For this presentation an interview of the CARES/Life program will be provided. Emphasis will be placed on describing the latest enhancements to the code for reliability analysis with time varying loads and temperatures (fully transient reliability analysis). Also, early efforts in investigating the validity of using Weibull statistics, the basis of the CARES/Life program, to characterize the strength of MEMS structures will be described as as well as the version of CARES/Life for MEMS (CARES/MEMS) being prepared which incorporates single crystal and edge flaw reliability analysis capability. It is hoped this talk will open a dialog for potential collaboration in the area of MEMS testing and life prediction.

  5. Clinical implications of ST-segment non-resolution after thrombolysis for myocardial infarction.

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    Bhatia, L; Clesham, G J; Turner, D R

    2004-12-01

    Failed reperfusion after thrombolytic therapy for acute myocardial infarction is common and signifies a poor prognosis. We investigated the clinical consequences of non-resolution of the ST segment after thrombolytic therapy for acute ST-elevation myocardial infarction, in 85 consecutive patients admitted to a coronary care unit lacking rapid access to angioplasty. Failed thrombolysis was defined as <50% ST-segment resolution 180 minutes after the start of thrombolytic treatment. Outcomes were measured in terms of in-hospital adverse events, length of hospital stay, and mortality at 6 weeks and 1 year. Thrombolysis was successful, in terms of ST-segment resolution, in 45 patients (53%). After adjustment for other factors, ST resolution was the only independent predictor of an uncomplicated recovery in hospital (odds ratio 6.8, 95% confidence interval 2.3 to 19.9; P<0.001). At 6 weeks and 1 year, overall mortality was lower in the ST resolution group, though these differences became non-significant on multivariate analysis. In patients who survived to hospital discharge, median length of stay was greater in successfully thrombolysed patients (9 days versus 8 days) despite their lower rate of complications. ST-segment resolution is a useful marker of successful thrombolysis and relates to clinical outcome. If assessed routinely it might assist, along with other clinical markers, in the identification of low-risk patients who can be discharged early.

  6. Expanding dental hygiene to include dental therapy: improving access to care for children.

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    Nash, David A

    2009-01-01

    Oral Health in America: A Report of the Surgeon General, and the subsequent National Call to Action to Promote Oral Health contributed significantly to raising the awareness of the American public and the dental profession regarding the lack of access to oral health care by many Americans, especially minorities and low income populations, with resulting disparities in oral health. The problem is particularly acute among children. The current workforce of dentists in the United States is inadequate to meet the oral health care needs of children in terms of numbers of dentists, as well as their distribution, ethnicity, education, and practice orientation. Dental hygienists trained in an expanded scope of practice, can help address the workforce inadequacy. Dental therapists, educated in 2-year programs of postsecondary education, comparable to America's associate degree dental hygiene programs, have been used throughout the world to provide basic, primary oral health care for children. Research has documented that utilizing dental therapists is a cost effective method of improving access to care for children. Countries that have led the way in introducing dental therapists to care for their children are now integrating their separate 2-year curriculum in dental therapy and dental hygiene into a 3-year curriculum to prepare a clinician dually trained in both dental therapy and dental hygiene. This clinician is being designated an oral health therapist. Expanding the education of dental hygienists in the United States to include skills of the internationally acclaimed dental therapist can produce oral health therapists, individuals capable of addressing the basic preventive, restorative, and minor surgical needs of children, but also able to continue to address the preventive and periodontal needs of adults.

  7. Interdisciplinary palliative care, including massage, in treatment of amyotrophic lateral sclerosis.

    Science.gov (United States)

    Blatzheim, Kendra

    2009-10-01

    Amyotrophic lateral sclerosis (ALS) is a progressive fatal neurological disease that affects approximately 20,000 Americans. Symptoms include muscle weakness, fatigue, twitching, atrophy, spasticity, pain, oropharyngeal dysfunction, pseudobulbar affect, weight loss, and respiratory impairment. Death occurs within 3-5 yr after onset of symptoms, with diagnosis taking from 11 to 17.5 months. The only FDA-approved drug for ALS is Riluzole, which only increases the life expectancy by a few months. All other treatments for ALS provide symptom management to improve the patient's quality of life. An interdisciplinary palliative care team for the ALS patient helps to reduce the stress that the illness places on families. Massage can be a useful adjunctive treatment for spasticity and pain when medication side effects are unwanted. A holistic interdisciplinary palliative care team supports both the patient and the family improving their quality of life.

  8. External validation of the ability of the DRAGON score to predict outcome after thrombolysis treatment

    DEFF Research Database (Denmark)

    Ovesen, C; Christensen, A; Nielsen, J K;

    2013-01-01

    Easy-to-perform and valid assessment scales for the effect of thrombolysis are essential in hyperacute stroke settings. Because of this we performed an external validation of the DRAGON scale proposed by Strbian et al. in a Danish cohort. All patients treated with intravenous recombinant plasmino......Easy-to-perform and valid assessment scales for the effect of thrombolysis are essential in hyperacute stroke settings. Because of this we performed an external validation of the DRAGON scale proposed by Strbian et al. in a Danish cohort. All patients treated with intravenous recombinant...... and their modified Rankin Scale (mRS) was assessed after 3 months. Three hundred and three patients were included in the analysis. The DRAGON scale proved to have a good discriminative ability for predicting highly unfavourable outcome (mRS 5-6) (area under the curve-receiver operating characteristic [AUC-ROC]: 0...

  9. Combined Pharmacomechanical Thrombolysis of Complete Portomesenteric Thrombosis in a Liver Transplant Recipient

    Energy Technology Data Exchange (ETDEWEB)

    Lorenz, Jonathan M., E-mail: jlorenz@radiology.bsd.uchicago.edu; Bennett, Shelby; Patel, Jay; Ha, Thuong G. Van; Funaki, Brian [The University of Chicago Hospital, Department of Radiology (United States)

    2013-01-30

    Treatment options for portomesenteric venous thrombosis range from anticoagulation to surgery, depending on chronicity, severity of symptoms, extent of thrombosis, and the availability of local expertise. For acute and subacute cases, a variety of endovascular options have been described in limited published series and case reports, including thrombolysis and mechanical thrombectomy. We report what is to our knowledge the first case in which the Trellis pharmacomechanical thrombolysis device was used successfully to treat complete acute thrombosis of the entire superior mesenteric vein and the entire portal vein with extension into all segmental intrahepatic portal branches in a young adult after liver transplantation. This device, coupled with adjunctive techniques using balloon catheters, facilitated complete restoration of flow, resulting in graft salvage and long-term patency.

  10. Local thrombolysis for patients of severe cerebral venous sinus thrombosis during puerperium

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Xin-bin, E-mail: gxb3906080@sina.com [Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052 (China); Fu, Zhenqiang, E-mail: fuzhenqiang1005@163.com [Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052 (China); Song, Lai-jun, E-mail: laijunsong@sina.com [Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052 (China); Guan, Sheng, E-mail: gsradio@126.com [Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052 (China)

    2013-01-15

    Objective: To explore and evaluate the efficacy of intrasinus thrombolysis (IST) in patients with cerebral venous sinus thrombosis (CVST) during postpartum period. Methods: 11 patients during postpartum period with CVST who received IST during July 2007–November 2011 were included. Urokinase was infused into the sinuses via a microcatheter. Magnetic resonance venography (MRV) was performed to assess the recanalization of venous sinuses. Results: Before discharge, the intracranial pressure in 11 patients was under 200 mmH{sub 2}O. MRV confirmed that venous sinus of 9 patients were smooth. The cortex venous and deep venous recovered to normal. Venous sinus of 2 patients recanalized partly, and cortex venous and deep venous had compensation. 9 patients had good outcome and 2 patients had only mild deficits. Conclusion: Intrasinus thrombolysis is safe and effective in patients with severe cerebral venous sinus thrombosis during postpartum period.

  11. Advancements in Catheter-Directed Ultrasound-Accelerated Thrombolysis

    NARCIS (Netherlands)

    Doomernik, Denise E.; Schrijver, A. Marjolein; Zeebregts, Clark J.; de Vries, Jean-Paul P. M.; Reijnen, Michel M. P. J.

    2011-01-01

    Purpose: To review all available literature on catheter-directed ultrasound-accelerated thrombolysis for peripheral artery occlusions, stroke, deep venous thrombosis, and pulmonary embolism. Methods: A systematic literature search was performed, using MEDLINE, EMBASE and Cochrane databases. A total

  12. Advancements in catheter-directed ultrasound-accelerated thrombolysis.

    NARCIS (Netherlands)

    Doomernik, D.E.; Schrijver, A.M.; Zeebregts, C.J.A.; Vries, J.P. de; Reijnen, M.M.P.J.

    2011-01-01

    PURPOSE: To review all available literature on catheter-directed ultrasound-accelerated thrombolysis for peripheral artery occlusions, stroke, deep venous thrombosis, and pulmonary embolism. METHODS: A systematic literature search was performed, using MEDLINE, EMBASE and Cochrane databases. A total

  13. Intravenous thrombolysis is unsafe in stroke due to infective endocarditis.

    Science.gov (United States)

    Brownlee, W J; Anderson, N E; Barber, P A

    2014-02-01

    Embolic stroke is the most common neurological complication of infective endocarditis and a major source of morbidity and mortality. Septic embolism is considered a contraindication to intravenous thrombolysis in patients with ischaemic stroke because of concerns over an increased risk of intracranial haemorrhage. We describe a patient with occult endocarditis who was treated with thrombolysis for acute stroke and review other cases reported in the literature.

  14. Management of acute central retinal artery occlusion: Intravenous thrombolysis is feasible and safe.

    Science.gov (United States)

    Préterre, Cécile; Godeneche, Gaelle; Vandamme, Xavier; Ronzière, Thomas; Lamy, Matthias; Breuilly, Christophe; Urbanczyk, Cédric; Wolff, Valérie; Lebranchu, Pierre; Sevin-Allouet, Mathieu; Guillon, Benoit

    2017-01-01

    Background Although acute central retinal artery occlusion is as a stroke in the carotid territory (retinal artery), its management remains controversial. The aim of this study was to assess the feasibility and safety of intravenous thrombolysis delivered within 6 h of central retinal artery occlusion in French stroke units. Methods We performed a retrospective analysis of patients treated with intravenous alteplase (recombinant tissue-plasminogen activator), based on stroke units thrombolysis registers from June 2005 to June 2015, and we selected those who had acute central retinal artery occlusion. The feasibility was assessed by the ratio of patients that had received intravenous alteplase within 6 h after central retinal artery occlusion onset among those who had been admitted to the same hospital for acute central retinal artery occlusion. All adverse events were documented. Results Thirty patients were included. Visual acuity before treatment was limited to "hand motion", or worse, in 90% of the cases. The mean onset-to-needle time was 273 min. The individuals treated with intravenous alteplase for central retinal artery occlusion represented 10.2% of all of the patients hospitalized for central retinal artery occlusion in 2013 and 2014. We observed one occurrence of major bleeding, a symptomatic intracerebral hemorrhage. Conclusion When applied early on, intravenous thrombolysis appears to be feasible and safe, provided that contraindications are given due consideration. Whether intravenous thrombolysis is more effective than conservative therapy remains to be determined. In order to conduct a well-designed prospective randomized control trial, an organized network should be in place.

  15. Insulin Resistance Is Associated With a Poor Response to Intravenous Thrombolysis in Acute Ischemic Stroke

    Science.gov (United States)

    Calleja, Ana I.; García-Bermejo, Pablo; Cortijo, Elisa; Bustamante, Rosa; Rojo Martínez, Esther; González Sarmiento, Enrique; Fernández-Herranz, Rosa; Arenillas, Juan F.

    2011-01-01

    OBJECTIVE Insulin resistance (IR) may not only increase stroke risk, but could also contribute to aggravate stroke prognosis. Mainly through a derangement in endogenous fibrinolysis, IR could affect the response to intravenous thrombolysis, currently the only therapy proved to be efficacious for acute ischemic stroke. We hypothesized that high IR is associated with more persistent arterial occlusions and poorer long-term outcome after stroke thrombolysis. RESEARCH DESIGN AND METHODS We performed a prospective, observational, longitudinal study in consecutive acute ischemic stroke patients presenting with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis. Patients with acute hyperglycemia (≥155 mg/dL) receiving insulin were excluded. IR was determined during admission by the homeostatic model assessment index (HOMA-IR). Poor long-term outcome, as defined by a day 90 modified Rankin scale score ≥3, was considered the primary outcome variable. Transcranial Duplex-assessed resistance to MCA recanalization and symptomatic hemorrhagic transformation were considered secondary end points. RESULTS A total of 109 thrombolysed MCA ischemic stroke patients were included (43.1% women, mean age 71 years). The HOMA-IR was higher in the group of patients with poor outcome (P = 0.02). The probability of good outcome decreased gradually with increasing HOMA-IR tertiles (80.6%, 1st tertile; 71.4%, 2nd tertile; and 55.3%, upper tertile). A HOMA-IR in the upper tertile was independently associated with poor outcome when compared with the lower tertile (odds ratio [OR] 8.54 [95% CI 1.67–43.55]; P = 0.01) and was associated with more persistent MCA occlusions (OR 8.2 [1.23–54.44]; P = 0.029). CONCLUSIONS High IR may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis. PMID:21911778

  16. A one-to-one telestroke network: the first Italian study of a web-based telemedicine system for thrombolysis delivery and patient monitoring.

    Science.gov (United States)

    Nardetto, Lucia; Dario, Claudio; Tonello, Simone; Brunelli, Marta Carla; Lisiero, Manola; Carraro, Maria Grazia; Saccavini, Claudio; Scannapieco, Gianluigi; Giometto, Bruno

    2016-05-01

    Over 10 years after European approval, thrombolysis is still limited by a restricted time window and non-optimal territorial coverage. Implementation of telestroke can give a growing number of patients access to treatment. We hereby present the first Italian telemedicine study applied to both the acute and the monitoring phase of stroke care. From January 2011 to December 2013, we tested a web-based, drip, and treat interaction model, connecting the cerebrovascular specialist of one hub center to the Emergency Department of a Spoke center. We then compared thrombolysis delivered using the telestroke model with thrombolysis provided at the Hub Stroke Unit at the time when the telemedicine program was activated. Telethrombolysis data were then compared with data from the two main international telestroke projects (TEMPiS and REACH), and other European telestroke studies performed at the time of writing. We collected a total of 131 thrombolysis procedures (25 telethrombolysis and 106 thrombolysis patients at the Stroke Unit). Statistical analysis with the t test yielded no statistically significant differences between the two populations in door-to-scan, door-to-needle (DTN), and onset-to-treatment times (OTT). Our OTT and DTN pathway times were longer than the TEMPiS and REACH studies but comparable with other European telemedicine trials, despite different models of interaction and number of centers. Our study in a northeastern province of Italy confirms the potential of applying telemedicine to a cerebrovascular pathology.

  17. Thrombolysis, Complete Recanalization, Diffusion Reversal, and Luxury Perfusion in Hyperacute Stroke.

    Science.gov (United States)

    Sakamoto, Yuki; Ouchi, Takahiro; Okubo, Seiji; Abe, Arata; Aoki, Junya; Nogami, Akane; Sato, Takahiro; Hokama, Hiroyuki; Ogawa, Yutaro; Suzuki, Shizuka; Mishina, Masahiro; Kimura, Kazumi

    2016-01-01

    A 59-year old man was admitted to our stroke care unit 1.8 hours after onset of cardioembolic stroke. Administration of issue-plasminogen activator achieved complete recanalization, and his lesion on diffusion-weighted imaging (DWI) disappeared and single photon emission computed tomography showed luxury perfusion. DWI reversal and luxury perfusion were sometimes observed in hyperacute stroke patients, especially timely reperfusion was achieved. However, the relationships between DWI reversal and luxury perfusion were not well known. Transient DWI reversal may be associated with luxury perfusion in patients treated with t-PA, via early complete recanalization achieved by thrombolysis.

  18. Systematic review and meta-analysis for thrombolysis treatment in patients with acute submassive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Cao Y

    2014-02-01

    Full Text Available Yaoqian Cao,* Haiyan Zhao,* Wanpeng Gao, Yan Wang, Jie Cao Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, People's Republic of China *These two authors contributed equally to this work Purpose: The aim of this systematic review was to evaluate the efficacy and safety of thrombolytic treatment in patients with submassive pulmonary embolism (PE. Methods: An electronic search was carried out based on the databases from MEDLINE, Embase, Science Citation Index (SCI, and the Cochrane Library. We included prospective, randomized, and clinical trials in thrombolysis with heparin alone in adults who had evidence of right ventricular dysfunction and normotension. The main endpoints consist of mortality, recurrent PE, and bleeding risk. The relative risk (RR and the relevant 95% confidence intervals were determined by the dichotomous variable. Results: Only seven studies involving 594 patients met the inclusion criteria for further review. The cumulative effect of thrombolysis, compared with intravenous heparin, demonstrated no statistically significant difference in mortality (2.7% versus 4.3%; RR =0.64 [0.29–1.40]; P=0.27 or recurrent PE (2% versus 5%; RR =0.44 [0.19–1.05]; P=0.06. Thrombolytic therapy did not increase major hemorrhage compared with intravenous heparin (4.5% versus 3.3%; RR =1.16 [0.51–2.60]; P=0.73, but it was associated with an increased minor hemorrhage (41% versus 9%; RR =3.91 [1.46–10.48]; P=0.007. Conclusion: Compared with heparin alone, neither mortality nor recurrent PE is reduced by thrombolysis in patients with submassive PE, and it does not reveal an increasing risk of major bleeding. In addition, thrombolysis also produces the increased risk of minor bleeding; however, no sufficient evidence verifies the thrombolytic benefit in this review, because the number of patients enrolled in the trials is limited. Therefore, a large, double-blind clinical trial is required to prove the

  19. Neuroprotective effect of shenfu injection after intra-arterial thrombolysis

    Institute of Scientific and Technical Information of China (English)

    Huaijun Liu; Xiuchuan Jia; Jiping Yang; Zengpin Liu; Guoshi Wang; Linfang Li

    2006-01-01

    BACKGROUND: Within 3 hours after ischemic stroke, thrombolysis can improve prognosis of patients; however, cerebral edema and cerebral hemorrhage induced by vascular recanalization at an early phase can influence on therapeutic effect of thrombolysis; therefore, thrombolysis is combined with neuroprotective agent for recently clinical treatment.OBJECTIVE: To evaluate the neuroprotective effect of shenfu injection on patients with ischemic stroke after arterial thrombolysis and compare with the controls. DESIGN: Case-controlled study. SETTING : Department of Medical Image, Second Hospital of Hebei Medical University. PARIICIPANTS: A total of 45 patients with acute stroke were selected from Emergency Department or Neurological Department of the Second Hospital of Hebei Medical University from August 2005 to May 2006. All patients were met the diagnosis criteria published by the Fourth National Stroke Conference and had middle cerebral arterial embolism with angiography. Attacked course was less than 6 hours. Patients did not have a history of stroke. Scores of the National Institutes of Health Stroke Scale (NIHSS) were not less than 4 points and patients were aged from 18 to 80 years. All subjects consented of the whole therapeutic process. METHODS: ① Intermittent perfusion was used to treat intra-arterial thrombolysis. Thirty patients with vascular recanalization or partially vascular recanalization (18 males and 12 females) were randomly divided into treatment group and control group with 15 in each group. There was no significant difference of baseline data between the two groups. After recanalization, patients in treatment group were given 20 mL shenfu injection, which consisted of ginseng saponin and aconitine (Ya'an Sanjiu Pharmaceutical Company, batch number: 041013, 10 mL/ampoule) and slowly injected into vein for longer than 5 minutes. And then, patients were intravenously dripped with 50 mL shenfu injection and 50 g/L 250 mL glucose solution once a day

  20. The perspectives on including palliative care in the Indian undergraduate physiotherapy curriculum.

    Science.gov (United States)

    Veqar, Zubia

    2013-04-01

    According to the guidelines which were published by WHO in 2008, palliative care has been defined as "An approach that improves the quality of life of the patients and their families who face the problems which are associated with life-threatening illnesses, through the prevention and relief of suffering by means of an early identification, an impeccable assessment and the treatment of pain and other problems, physical, psychosocial and spiritual". The intervention which is provided as a part of the palliative care has to be provided by health professionals who strictly work as a part of multidisciplinary team and have been specifically trained to an optimal level of competency in the field. The impairment of the physical function and pain are two key problem areas in palliative care, which a physiotherapist deals with. Is a physiotherapist who is trained in India, trained to work as an efficient member of the team in this field? THIS ARTICLE DEALS WITH THE FOLLOWING: What is palliative care and what is its importance?A multidisciplinary approach to palliative careThe scenario of palliative care in IndiaThe role of physiotherapy in palliative care.The current scenario of physiotherapy education vis a vis palliative care.

  1. Successful thrombolysis of a thrombosed prosthetic mitral valve using a synthetic tissue plasminogen activator: a case report

    Directory of Open Access Journals (Sweden)

    Al-Fadhli Jamal

    2010-08-01

    Full Text Available Abstract Introduction Prosthetic valve thrombosis is a rare but life-threatening condition that requires careful evaluation and prompt treatment. While surgical intervention remains the gold standard, thrombolytic therapy is now emerging as a potential substitute. Various thrombolytic treatments including streptokinase, urokinase and recombinant tissue plasminogen activators have been reported with variable success rates. However, the data on the use of tenecteplase (a synthetic tissue plasminogen activator is limited. Case presentation A 44-year-old Middle Eastern man with a previously implanted prosthetic mitral valve presented with exertional dyspnea and orthopnea. Investigations revealed a thrombosed prosthetic mitral valve. Successful thrombolysis was achieved using tenecteplase which lead to the complete restoration of valve function with no risk to the patient. Conclusion Prosthetic valve thrombosis is a rare but life threatening condition, the diagnosis of which requires a high index of suspicion. Tenecteplase can be used successfully in the management of such cases. It has proved to be useful with no extra risk to the patient.

  2. AToMS: A Ubiquitous Teleconsultation System for Supporting AMI Patients with Prehospital Thrombolysis

    Directory of Open Access Journals (Sweden)

    Bruno S. P. M. Correa

    2011-01-01

    Full Text Available The latest population-based studies in the medical literature worldwide indicate that acute myocardial infarction (AMI patients still experience prolonged delay to be rescued, which often results in morbidity and mortality. This paper reports from a technological standpoint a teleconsultation and monitoring system named AToMS. This system addresses the problem of prehospital delivery of thrombolysis to AMI patients by enabling the remote interaction of the paramedics and a cardiologist available at a Coronary Care Unit (CCU. Such interaction allows the diagnosis of the patient eligibility to the immediate application of thrombolysis, which is meant to reduce the delay between the onset of symptoms and the eventual application of proper treatment. Such delay reduction is meant to increase the AMI patient's chances of survival and decrease the risks of postinfarction sequels. The teleconsultation is held with the support of wireless and mobile technologies, which also allows the cardiologist to monitor the patient while he/she is being taken to the nearest CCU. All exchanged messages among paramedics and cardiologists are recorded to render an auditable system. AToMS has been deployed in a first stage in the city of Rio de Janeiro, where the medical team involved in the project has conducted commissioned tests.

  3. [Home thrombolysis: an original experience of SAMU 51].

    Science.gov (United States)

    Debonne, T; Journe, B; Defoin, J F; Bertault, R; Buffet, M; Jaussaud, M; Seraphin, J

    1991-01-01

    S.A.M.U. 51 practises thrombolysis in patient's house associated with cardiologists of the University Hospital and of a Private Hospital, in indication and following for treatment. This way of working gives a large security for using this therapeutic to the whole population whatever the chosen hospital.

  4. Carotid endarterectomy after intravenous thrombolysis for acute cerebral ischaemic attack

    DEFF Research Database (Denmark)

    Rathenborg, Lisbet Knudsen; Jensen, L P; Baekgaard, N;

    2013-01-01

    Intravenous thrombolysis (IVT) has proven effective in the treatment of acute cerebral ischaemic attack in selected cases. In the presence of a carotid artery stenosis, such patients may be candidates for carotid endarterectomy (CEA). Few studies have been made on the safety of CEA performed afte...

  5. Successful thrombolysis of major pulmonary embolism 5 days after lobectomy

    DEFF Research Database (Denmark)

    Eckardt, Jens; Licht, Peter B

    2012-01-01

    Aggressive intravenous thrombolysis of pulmonary emboli after major thoracic surgery has rarely been reported and is controversial because of an assumed risk of fatal bleeding. We report a 62-year old female who underwent left upper lobectomy. Her postoperative course was complicated...

  6. Segmentally enclosed thrombolysis in percutaneous transluminal angioplasty for femoropopliteal occlusions

    DEFF Research Database (Denmark)

    Jørgensen, B; Tønnesen, K H; Nielsen, J D;

    1991-01-01

    Segmentally enclosed thrombolysis (SET) was performed immediately following 34 percutaneous transluminal angioplasties (PTAs) for femoropopliteal occlusions. The dilated segment was sealed off with a double balloon catheter, and recombinant tissue plasminogen activator (rt-PA) 1 mg/ml and heparin...

  7. Mechanism of the potentiation of thrombolysis by pentoxifylline (Trental)

    Energy Technology Data Exchange (ETDEWEB)

    Ambrus, J.L.; Ambrus, C.M.; Mahfzah, M.; Markus, J.A.; Klein, E.; Gastpar, H.

    1987-01-01

    Streptokinase induced thrombolysis of radioactive labeled human fibrin clots was potentiated by simultaneous treatment with pentoxifylline (Trental). This appears to be due in part to the prevention of platelet aggregation on the clot. In addition, release of t-PA and PgI2 from the endothelium and increases in red cell deformability may also play a role.

  8. Thrombolysis in Acute Ischemic Stroke: The North American Experience

    Institute of Scientific and Technical Information of China (English)

    Justin Zivin

    2000-01-01

    @@It has been understood for well over a century that clots in cerebral arteries are the usual cause of strokes, but it was only in 1995 that the techniques necessary to reduce neurologic damage were identified. A lengthy and difficult effort was required to prove the value of acute stroke thrombolysis and this has become controversial topic.

  9. Patient Experienced Continuity of Care in the Psychiatric Healthcare System—A Study Including Immigrants, Refugees and Ethnic Danes

    Directory of Open Access Journals (Sweden)

    Natasja Koitzsch Jensen

    2014-09-01

    Full Text Available Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes. Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. Conclusions: The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.

  10. Effect of modulated ultrasound parameters on ultrasound-induced thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Soltani, Azita; Volz, Kim R; Hansmann, Doulas R [Research and Development Department, EKOS Corporation, 11911 N Creek Parkway S, Bothell, WA 98011 (United States)], E-mail: asoltani@ekoscorp.com

    2008-12-07

    The potential of ultrasound to enhance enzyme-mediated thrombolysis by application of constant operating parameters (COP) has been widely demonstrated. In this study, the effect of ultrasound with modulated operating parameters (MOP) on enzyme-mediated thrombolysis was investigated. The MOP protocol was applied to an in vitro model of thrombolysis. The results were compared to a COP with the equivalent soft tissue thermal index (TIS) over the duration of ultrasound exposure of 30 min (p < 0.14). To explore potential differences in the mechanism responsible for ultrasound-induced thrombolysis, a perfusion model was used to measure changes in average fibrin pore size of clot before, after and during exposure to MOP and COP protocols and cavitational activity was monitored in real time for both protocols using a passive cavitation detection system. The relative lysis enhancement by each COP and MOP protocol compared to alteplase alone yielded values of 33.69 {+-} 12.09% and 63.89 {+-} 15.02% in a thrombolysis model, respectively (p < 0.007). Both COP and MOP protocols caused an equivalent significant increase in average clot pore size of 2.09 x 10{sup -2} {+-} 0.01 {mu}m and 1.99 x 10{sup -2} {+-} 0.004 {mu}m, respectively (p < 0.74). No signatures of inertial or stable cavitation were observed for either acoustic protocol. In conclusion, due to mechanisms other than cavitation, application of ultrasound with modulated operating parameters has the potential to significantly enhance the relative lysis enhancement compared to application of ultrasound with constant operating parameters.

  11. An instrument for broadened risk assessment in antenatal health care including non-medical issues

    Directory of Open Access Journals (Sweden)

    Amber Amanda Vos

    2015-03-01

    Full Text Available Introduction: Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenatal detection of risk factors and tailored prevention in an integrated care setting.Methods: A review of published instruments complemented with evidence from cohort studies. Selection and standardization of risk factors associated with small for gestational age, preterm birth, congenital anomalies and perinatal mortality. Risk factors were weighted to obtain a cumulative risk score. Responses were then connected to corresponding care pathways. A cumulative risk threshold was defined, which can be adapted to the population and the availability of preventive facilities. A score above the threshold implies multidisciplinary consultation between caregivers.Results: The resulting digital score card consisted of 70 items, subdivided into four non-medical and two medical domains. Weighing of risk factors was based on existing evidence. Pilot-evidence from a cohort of 218 pregnancies in a multi-practice urban setting showed a cut-off of 16 points would imply 20% of all pregnant women to be assessed in a multidisciplinary setting. A total of 28 care pathways were defined.Conclusion: The resulting score card is a universal risk screening instrument which incorporates recent evidence on non-medical risk factors for adverse pregnancy outcomes and enables systematic risk management in an integrated antenatal health care setting.

  12. An instrument for broadened risk assessment in antenatal health care including non-medical issues

    Directory of Open Access Journals (Sweden)

    Amber Amanda Vos

    2015-03-01

    Full Text Available Introduction: Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenatal detection of risk factors and tailored prevention in an integrated care setting. Methods: A review of published instruments complemented with evidence from cohort studies. Selection and standardization of risk factors associated with small for gestational age, preterm birth, congenital anomalies and perinatal mortality. Risk factors were weighted to obtain a cumulative risk score. Responses were then connected to corresponding care pathways. A cumulative risk threshold was defined, which can be adapted to the population and the availability of preventive facilities. A score above the threshold implies multidisciplinary consultation between caregivers. Results: The resulting digital score card consisted of 70 items, subdivided into four non-medical and two medical domains. Weighing of risk factors was based on existing evidence. Pilot-evidence from a cohort of 218 pregnancies in a multi-practice urban setting showed a cut-off of 16 points would imply 20% of all pregnant women to be assessed in a multidisciplinary setting. A total of 28 care pathways were defined. Conclusion: The resulting score card is a universal risk screening instrument which incorporates recent evidence on non-medical risk factors for adverse pregnancy outcomes and enables systematic risk management in an integrated antenatal health care setting.

  13. Kundalini yoga as mutual recovery: a feasibility study including children in care and their carers

    OpenAIRE

    Perez, Elvira; Ball, Mark; Brown, Poppy; Crepaz-Keay, David; Haslam-Jones, Emily; Crawford, Paul

    2016-01-01

    This is a mixed-methods feasibility study to test whether incorporating a 20-week Kundalini yoga program into a children’s home community improves wellbeing outcomes. Feasibility was assessed through recruitment and retention rates as well as participants’ self-report perceptions on social inclusion, mental health, wellbeing and semi-structured interviews on the benefits of the study. Mutual recovery entailed that children in care (CiC), youth practitioners, and management participated togeth...

  14. Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.

    Directory of Open Access Journals (Sweden)

    K M Holtzer-Goor

    Full Text Available Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS located with the general practitioner (GP. This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer, home care, informal care, and implementation costs.With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%, or receive care for containment only. In both of these groups no health gains were achieved.Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.

  15. Micro CT imaging assessment for spatial distribution of magnetic nanoparticles in an ex vivo thrombolysis model

    Science.gov (United States)

    Wang, Fu-Sheng; Chao, Tsi-Chian; Tu, Shu-Ju

    2012-03-01

    In recent nanotechnology development, iron-based magnetic nanoparticles (MNPs) have been used in several investigations on biomedical research for small animal experiments. Their important applications include targeted drug delivery for therapeutic purpose, contrast agent for magnetic resonance imaging, and hyperthermia treatment for tumors. These MNPs can be guided by an external magnetic field due to their physical characteristics of superparamagnetism. In a recent report, authors indicated that covalently bound recombinant tissue plasminogen activator (rtPA) to MNP (MNPrtPA) with preserved enzyme activity may be guided by a bar magnet and induce target thrombolysis in an embolic model in rats. Delivery of rtPA by binding the thrombolytic drug to MNPs will improve the possibility of the drug to be delivered under magnetic guidance and retained in a local targeted area in the circulation system. In this work, an ex vivo intravascular thrombolysis model was developed to study the impact of external magnetic field on the penetration of MNP-rtPA in the blood clot samples. The samples were then scanned by a micro CT system for quantification. Images of MNPs show strong contrast with their surrounding blood clot materials. The optimum drug loading was found when 0.5 mg/ml rtPA is conjugated with 10 mg SiO2-MNP where 98% drug was attached to the carrier with full retention of its thrombolytic activity. Effective thrombolysis with tPA bound to SiO2-MNP under magnetic guidance was demonstrated in our ex vivo model where substantial reduction in time for blood clot lysis was observed compared with control groups without magnetic field application.

  16. Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

    Energy Technology Data Exchange (ETDEWEB)

    Si, T.-G. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China); Guo, Z. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)], E-mail: dr.guozhi@yahoo.com.cn; Hao, X.-S. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)

    2008-10-15

    Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

  17. PRE-HOSPITAL THROMBOLYSIS IN KRASNOYARSK: RESULTS OF A RETROSPECTIVE COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    S. A. Skripkin

    2011-01-01

    Full Text Available Aim. To compare the safety and efficacy of pre-hospital thrombolysis with tenecteplase and hospital thrombolysis with alteplase. Material and Methods. Pre-hospital thrombolytic therapy with tenecteplase (n=15 and hospital thrombolysis with alteplaza (n=60 in patients with acute coronary syndrome and acute ST-segment elevation myocardial infarction were analyzed in retrospective comparative study. Time characteristics of thrombolysis and its efficacy and safety were assessed. Results. The mean time from patients emergency medical service call to pre-hospital thrombolysis was 51.8±1.23 min, whereas to hospital thrombolysis 106.5±2.15 min (p<0.05. The effective hospital thrombolysis was observed in 68.3 and 83.3% of patients according to ECG (>50% resolution of ST-segment elevation and coronary angiography criteria, respectively. The effective pre-hospital thrombolysis was registered in 93.3% of patients as demonstrated with ECG and coronary angiography. Conclusion. Pre-hospital thrombolysis in patients with acute coronary syndrome was performed by 54.7 min earlier than hospital thrombolysis was. This can improve the patient prognosis.

  18. THROMBOLYSIS OR PRIMARY PCI FOR MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION? THE STREAM TRIAL (STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2013-01-01

    Full Text Available Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI in the early after acute ST-segment elevation myocardial infarction (STEMI, there are now.In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a primary PCI b prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary endpoint occurred in 116 of 939 patients (12.4 % of the thrombolysis group and in 135 of 943 patients (14.3% of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21. Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45. The rate of non- intracranial bleeding in two treatment groups did not differ.Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective

  19. THROMBOLYSIS OR PRIMARY PCI FOR MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION? THE STREAM TRIAL (STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2015-09-01

    Full Text Available Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI in the early after acute ST-segment elevation myocardial infarction (STEMI, there are now.In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a primary PCI b prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary endpoint occurred in 116 of 939 patients (12.4 % of the thrombolysis group and in 135 of 943 patients (14.3% of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21. Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45. The rate of non- intracranial bleeding in two treatment groups did not differ.Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective

  20. Dutch randomized trial comparing standard catheter-directed thrombolysis versus Ultrasound-accElerated Thrombolysis for thromboembolic infrainguinal disease (DUET: design and rationale

    Directory of Open Access Journals (Sweden)

    Fioole Bram

    2011-01-01

    Full Text Available Abstract Background The use of thrombolytic therapy in the treatment of thrombosed infrainguinal native arteries and bypass grafts has increased over the years. Main limitation of this treatment modality, however, is the occurrence of bleeding complications. Low intensity ultrasound (US has been shown to accelerate enzymatic thrombolysis, thereby reducing therapy time. So far, no randomized trials have investigated the application of US-accelerated thrombolysis in the treatment of thrombosed infra-inguinal native arteries or bypass grafts. The DUET study (Dutch randomized trial comparing standard catheter-directed thrombolysis versus Ultrasound-accElerated Thrombolysis for thrombo-embolic infrainguinal disease is designed to assess whether US-accelerated thrombolysis will reduce therapy time significantly compared with standard catheter-directed thrombolysis. Methods/design Sixty adult patients with recently (between 1 and 7 weeks thrombosed infrainguinal native arteries or bypass grafts with acute limb ischemia class I or IIa, according to the Rutherford classification for acute ischemia, will be randomly allocated to either standard thrombolysis (group A or US-accelerated thrombolysis (group B. Patients will be recruited from 5 teaching hospitals in the Netherlands during a 2-year period. The primary endpoint is the duration of catheter-directed thrombolysis needed for uninterrupted flow in the thrombosed infrainguinal native artery or bypass graft, with outflow through at least 1 crural artery. Discussion The DUET study is a randomized controlled trial that will provide evidence of whether US-accelerated thrombolysis will significantly reduce therapy time in patients with recently thrombosed infrainguinal native arteries or bypass grafts, without an increase in complications. Trial registration Current Controlled Trials ISRCTN72676102

  1. 75 FR 65515 - NRC Corporation, USPS Help Desk of Customer Care Center, Including On-Site Leased Workers of Volt...

    Science.gov (United States)

    2010-10-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration NRC Corporation, USPS Help Desk of Customer Care Center, Including On-Site Leased Workers of Volt Consulting, West Columbia, SC; Notice of Affirmative...

  2. Intra-Arterial Thrombolysis for Deep Vein Thrombosis of the Lower Extremity: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Moo Sang; Roh, Byung Suk [Dept. of Radiology, Wonkwang University School of Medicine, Iksan (Korea, Republic of)

    2011-09-15

    If the appropriate catheterization of the affected vein was not possible because of a narrowed or thrombus-filled venous lumen, successful treatment gets into trouble during catheter directed regional thrombolysis for treatment of deep vein thrombosis. In this situation, intra-arterial thrombolysis can be considered as an alternative treatment, but to the best of our knowledge, only two reports have been described. We present here cases of successful intra-arterial thrombolysis in patients with deep vein thrombosis.

  3. Implementation of a multidisciplinary team that includes a registered dietitian in a neonatal intensive care unit improved nutrition outcomes.

    Science.gov (United States)

    Sneve, Jennifer; Kattelmann, Kendra; Ren, Cuirong; Stevens, Dennis C

    This study determined whether nutrition outcomes of neonates who were receiving neonatal intensive care were improved with the implementation of a fully functioning multidisciplinary team that included a registered dietitian. A medical record review was conducted of neonates with birth weights of 1500 g or less who were cared for in Sanford Children's Hospital neonatal intensive care unit from January 1 to December 31, 2001 (prior to functioning multidisciplinary team establishment) and January 1 to December 31, 2004 (subsequent to establishment of a multidisciplinary team). Data from charts in the 2 time periods were examined for differences in nutrition outcomes. Outcome variables included length of stay, birth weight, discharge weight, weight gained for specified time periods, weight at full feeds, weight gain per day, length, head circumference, and number of days to start enteral feeding. Analysis of covariance, controlling for the effect of birth weight, was used to determine differences and was considered significant at P multidisciplinary team (1099 g, 95% CI: 955-1165 vs 1164 g, 95% CI: 1067-1211, respectively). Weight at discharge, total weight gained, total daily weight gained, daily weight gain from birth to the initiation of enteral feeds, daily weight gain from birth to full feeds, and head circumference growth were significantly greater for neonates in the postgroup than in the pre-multidisciplinary team group. Implementation of a multidisciplinary team that included a registered dietitian improved the nutrition outcomes of low birth weight infants in a neonatal intensive care unit.

  4. Which criteria demand additive stenting during catheter-directed thrombolysis?

    DEFF Research Database (Denmark)

    Bækgaard, N; Just, S; Foegh, P

    2014-01-01

    Many factors are necessary for obtaining satisfactory results after catheter-directed thrombolysis (CDT) for iliofemoral deep venous thrombosis (DVT). Selections of patients, composition of the thrombolytic fluid, anticoagulation per- and post-procedural, recognition and treatment of persistent...... is used for iliofemoral DVT, but strict criteria for stenting are not available in the existing literature. The potential value of intravascular ultrasound (IVUS) is also discussed....

  5. Generalized Safety and Efficacy of Simplified Intravenous Thrombolysis Treatment (SMART) Criteria in Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Sørensen, Sigrid B; Barazangi, Nobl; Chen, Charlene;

    2016-01-01

    BACKGROUND: Common intravenous recombinant tissue plasminogen activator (IV rt-PA) exclusion criteria may substantially limit the use of thrombolysis. Preliminary data have shown that the SMART (Simplified Management of Acute stroke using Revised Treatment) criteria greatly expand patient...... eligibility by reducing thrombolysis exclusions, but they have not been assessed on a large scale. We evaluated the safety and efficacy of general adoption of SMART thrombolysis criteria to a large regional stroke network. METHODS: Retrospective analysis of consecutive patients who received IV thrombolysis...... application of SMART criteria is safe and effective. Widespread application of these criteria could substantially increase the proportion of patients who might qualify for treatment....

  6. Feasibility and efficacy of thrombolysis in acute ischemic stroke: A study from National Institute of Neurological and Allied Sciences, Kathmandu, Nepal

    Science.gov (United States)

    Thapa, Lekhjung; Shrestha, Shikher; Shrestha, Pratyush; Bhattarai, Suman; Gongal, D N; Devkota, U P

    2016-01-01

    Background: Stroke is the major cause of morbidity and mortality worldwide. The number of stroke patients receiving recombinant tissue plasminogen activator (rt-PA), also known as Alteplase, in the developing world is extremely low. We aim to study the feasibility and efficacy of thrombolysis for the 1st time in our country. Materials and Methods: In this retrospective study (July 2012-August 2015), acute ischemic stroke patients who were thrombolyzed within 3 h of stroke onset were included. Their demographic profiles, clinical profiles, risk factors, type of thrombolytic used, and outcomes were systematically recorded and analyzed. Results: A total of 9 patients were thrombolyzed. The mean time from the onset of stroke symptoms to first dose of rt-PA (onset to treatment) was 1.2 h. Six patients had good neurological outcome as measured by modified Rankin Scale (mRS). The median mRS at discharge was 3. Thrombolysis-related post treatment complication was noted in 44.4%, of which nonfatal intracranial bleed occurred only in 2 patients (22.2%). None of the patients receiving intravenous tenecteplase had thrombolysis-related complications, and none of the patients had fatal intracranial bleed. Conclusion: This study clearly demonstrates the beginning of a feasible and effective thrombolysis in the treatment of acute ischemic stroke in Nepal. PMID:26933345

  7. Feasibility and efficacy of thrombolysis in acute ischemic stroke: A study from National Institute of Neurological and Allied Sciences, Kathmandu, Nepal

    Directory of Open Access Journals (Sweden)

    Lekhjung Thapa

    2016-01-01

    Full Text Available Background: Stroke is the major cause of morbidity and mortality worldwide. The number of stroke patients receiving recombinant tissue plasminogen activator (rt-PA, also known as Alteplase, in the developing world is extremely low. We aim to study the feasibility and efficacy of thrombolysis for the 1st time in our country. Materials and Methods: In this retrospective study (July 2012-August 2015, acute ischemic stroke patients who were thrombolyzed within 3 h of stroke onset were included. Their demographic profiles, clinical profiles, risk factors, type of thrombolytic used, and outcomes were systematically recorded and analyzed. Results: A total of 9 patients were thrombolyzed. The mean time from the onset of stroke symptoms to first dose of rt-PA (onset to treatment was 1.2 h. Six patients had good neurological outcome as measured by modified Rankin Scale (mRS. The median mRS at discharge was 3. Thrombolysis-related post treatment complication was noted in 44.4%, of which nonfatal intracranial bleed occurred only in 2 patients (22.2%. None of the patients receiving intravenous tenecteplase had thrombolysis-related complications, and none of the patients had fatal intracranial bleed. Conclusion: This study clearly demonstrates the beginning of a feasible and effective thrombolysis in the treatment of acute ischemic stroke in Nepal.

  8. Bilateral catheter-directed thrombolysis in a patient with deep venous thrombosis caused by a hypoplastic inferior vena cava

    NARCIS (Netherlands)

    Sloot, S.; Van Nierop, J.; Kootstra, J. J.; Wittens, C.; Fritschy, W. M.

    2015-01-01

    Introduction Deep venous thrombosis treatment using catheter-directed thrombolysis is advocated over systemic thrombolysis because it reduces bleeding complications. With the development of a catheter that combines ultrasound vibrations and the local delivering of thrombolytics, new and safer treatm

  9. Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study.

    Science.gov (United States)

    Paciaroni, Maurizio; Inzitari, Domenico; Agnelli, Giancarlo; Caso, Valeria; Balucani, Clotilde; Grotta, James C; Sarraj, Amrou; Sung-Il, Sohn; Chamorro, Angel; Urra, Xabier; Leys, Didier; Henon, Hilde; Cordonnier, Charlotte; Dequatre, Nelly; Aguettaz, Pierre; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Zini, Andrea; Vallone, Stefano; Dell'Acqua, Maria Luisa; Menetti, Federico; Nencini, Patrizia; Mangiafico, Salvatore; Barlinn, Kristian; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Bovi, Paolo; Cappellari, Manuel; Linfante, Italo; Dabus, Guilherme; Marcheselli, Simona; Pezzini, Alessandro; Padovani, Alessandro; Alexandrov, Andrei V; Shahripour, Reza Bavarsad; Sessa, Maria; Giacalone, Giacomo; Silvestrelli, Giorgio; Lanari, Alessia; Ciccone, Alfonso; De Vito, Alessandro; Azzini, Cristiano; Saletti, Andrea; Fainardi, Enrico; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Silvestrini, Mauro; Ferrarese, Carlo; Beretta, Simone; Tassi, Rossana; Martini, Giuseppe; Tsivgoulis, Georgios; Vasdekis, Spyros N; Consoli, Domenico; Baldi, Antonio; D'Anna, Sebastiano; Luda, Emilio; Varbella, Ferdinando; Galletti, Giampiero; Invernizzi, Paolo; Donati, Edoardo; De Lodovici, Maria Luisa; Bono, Giorgio; Corea, Francesco; Sette, Massimo Del; Monaco, Serena; Riva, Maurizio; Tassinari, Tiziana; Scoditti, Umberto; Toni, Danilo

    2015-02-01

    The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0-2) or unfavourable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88-1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40-0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5-6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86-1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of

  10. LASER THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTION - RESULTS OF A CLINICAL FEASIBILITY STUDY

    NARCIS (Netherlands)

    DENHEIJER, P; VANDIJK, RB; PENTINGA, ML; HILLEGE, HL; LIE, KI

    1994-01-01

    Laser thrombolysis is a new, experimental, catheter based intervention aimed at selectivity removing intracoronary thrombus. This first clinical study was performed to assess the feasibility and safety of laser thrombolysis, as well as its potential therapeutic place in acute myocardial infarction.

  11. Thrombolysis in patients with acute ischemic stroke due to arterial extracranial dissection

    NARCIS (Netherlands)

    M.D.I. Vergouwen; P.A.C.A. Beentjes; P.J. Nederkoorn

    2009-01-01

    No data of randomized controlled trials investigating the effect of thrombolysis in patients with ischemic stroke caused by an extracranial dissection are available. Previous case series suggested that thrombolysis in this group of patients is safe and improves outcome, however publication bias may

  12. Cortical myoclonus during IV thrombolysis for ischemic stroke

    Directory of Open Access Journals (Sweden)

    Carla Bentes

    2014-01-01

    Full Text Available We describe a patient with an acute middle cerebral artery ischemic stroke developing subtle involuntary movements of the paretic upper limb with cortical origin during rt-PA perfusion. Despite the multiple potential pathophysiological mechanisms for the relationship between thrombolysis and epileptic activity, seizures during this procedure are scarcely reported. Our hypothesis is that subtle and transient clinical seizures, like those described in our patient, may not be detected or are misdiagnosed as nonepileptic involuntary movements. We aimed to draw attention to the recognition challenge of this paroxysmal motor behavior, highlighting this clinical and neurophysiological identification using video recording and back-average analysis of the EEG.

  13. No Impact of Body Mass Index on Outcome in Stroke Patients Treated with IV Thrombolysis BMI and IV Thrombolysis Outcome

    Science.gov (United States)

    Schneider, Juliane; Michel, Patrik; Eskioglou, Elissavet; Kaegi, Georg; Stark, Robert; Fischer, Urs; Jung, Simon; Arnold, Marcel; Wertli, Maria; Held, Ulrike; Wegener, Susanne; Luft, Andreas; Sarikaya, Hakan

    2016-01-01

    Background and Purpose The impact of excess body weight on prognosis after stroke is controversial. Many studies report higher survival rates in obese patients (“obesity paradox”). Recently, obesity has been linked to worse outcomes after intravenous (IV) thrombolysis, but the number and sample size of these studies were small. Here, we aimed to assess the relationship between body weight and stroke outcome after IV thrombolysis in a large cohort study. Methods In a prospective observational multicenter study, we analyzed baseline and outcome data of 896 ischemic stroke patients who underwent IV thrombolysis. Patients were categorized according to body mass index (BMI) as underweight (35 kg/m2). Using uni- and multivariate modeling, we assessed the relationship of BMI with favorable outcome (defined as modified Rankin Scale 0 or 1) and mortality 3 months after stroke as well as the occurrence of symptomatic intracerebral hemorrhages (sICH). We also measured the incidence of patients that had an early neurological improvement of >40% on the National Institutes of Health Stroke Scale (NIHSS) after 24 hours. Results Among 896 patients, 321 were normal weight (35.8%), 22 underweight (2.5%), 378 overweight (42.2%), 123 obese (13.7%) and 52 severely obese (5.8%). Three-month mortality was comparable in obese vs. non-obese patients (8.1% vs. 8.3%) and did not differ significantly among different BMI groups. This was also true for favorable clinical outcome, risk of sICH and early neurological improvement on NIHSS at 24 hours. These results remained unchanged after adjusting for potential confounding factors in the multivariate analyses. Conclusion BMI was not related to clinical outcomes in stroke patients treated with IVT. Our data suggest that the current weight-adapted dosage scheme of IV alteplase is appropriate for different body weight groups, and challenge the existence of the obesity paradox after stroke. PMID:27727305

  14. Safety of Early Carotid Artery Stenting after Systemic Thrombolysis: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Fabrizio Sallustio

    2012-01-01

    Full Text Available Background. Patients with acute ischemic stroke due to internal carotid artery (ICA disease are at high risk of early stroke recurrence. A combination of IV thrombolysis and early carotid artery stenting (CAS may result in more effective secondary stroke prevention. Objective. We tested safety and durability of early CAS following IV thrombolysis in stroke patients with residual stenosis in the symptomatic ICA. Methods. Of consecutive patients treated with IV rtPA, those with residual ICA stenosis ≥70% or 24 hours. The protocol included pre-rtPA MRI and MR angiography, and post-rtPA carotid ultrasound and CT angiography. Stroke severity was assessed by the NIH Stroke Scale (NIHSS. Three- and twelve-month stent patency was assessed by ultrasound. Twelve-month functional outcome was assessed by the modified Rankin Scale (mRS. Results. Of 145 consecutive IV rtPA-treated patients, 6 (4% underwent early CAS. Median age was 76 (range 67–78 years, median NIHSS at stroke onset was 12 (range 9–16 and 7 (range 7-8 before CAS. Median onset-to-CAS time was 48 (range 30–94 hours. A single self-expandable stent was implanted to cover the entire lesion in all patients. The procedure was uneventful in all patients. After 12 months, all patients had stent patency, and the functional outcome was favourable (mRS ≤ 2 in all but 1 patient experiencing a recurrent stroke for new-onset atrial fibrillation. Conclusion. This small case series of a single centre suggests that early CAS may be considered a safe alternative to CEA after IV rtPA administration in selected patients at high risk of stroke recurrence.

  15. Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of symptomatic lower extremity deep venous thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Sh, Hongjian [Department of Radiology, Affiliated Wujin Hospital of Jiangsu University, 2 North Yongning Road, Changzhou 213002 (China)], E-mail: shihongjian@sina.com; Huang Youhua; Shen Tao; Xu Qiang [Department of Radiology, Affiliated Wujin Hospital of Jiangsu University, 2 North Yongning Road, Changzhou 213002 (China)

    2009-08-15

    Purpose: To evaluate the efficacy of percutaneous mechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) in the treatment of massive symptomatic lower limb deep venous thrombosis (DVT). Materials and methods: One hundred and three clinically confirmed DVT patients were discharged from our institution. Sixteen patients with massive lower limb DVT were included in this retrospective study. After prophylactic placement of inferior vena cava filters (IVCFs), percutaneous mechanical thrombectomy (ATD, n = 10; Straub, n = 6) and catheter-directed thrombolysis were performed in all patients. Complementary therapy included percutaneous transluminal venous angioplasty (PTA, n = 3) and stent placement (n = 1). The doses of thrombolytic agents, length of hospital stay, peri-procedure complications and discharge status were reviewed. Oral anticoagulation was continued for at least 6 months during follow-up. Results: The average hospital stay was 7 days. The technical success rate (complete and partial lysis of clot) was 89%, the other 11% patients only achieved less than 50% clot lysis. The mean dose of urokinase was 3.3 million IU. There were no significant differences of clinical outcome between the ATD and Straub catheter group. The only major complication was an elderly male who experienced a fatal intracranial hemorrhage while still in the hospital (0.97%, 1/103). Minor complications consisted of three instances of subcutaneous bleeding. No transfusions were required. Vascular patency was achieved in 12 limbs during follow-up. No pulmonary emboli occurred. There is one recurrent DVT 4.5 months after the treatment. Conclusions: Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is an effective and safe method for the treatment of symptomatic DVT. A randomized prospective study is warranted.

  16. 尿激酶动脉溶栓与重组组织型纤溶酶原激活剂静脉溶栓治疗急性缺血性卒中的疗效比较%Comparative efficacy of intra-arterial thrombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    周俊山; 徐梦怡

    2010-01-01

    Objective To evaluate the efficacy and safety of intra-arterial thrombolysis with urokinase and intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) for acute ischemic stroke. Methods A total of 43 patients with acute ischemic stroke within 6 hours of onset were included, 31 of them underwent superselective intra-arterial thrombolysis in the intra-arterial thrombolysis group and 12 of them underwent intravenous thrombolysis with rtPA in the intravenous thrombolysis group. Vascular recanalization was observed in the intra-arterial thrombolysis group, and the modified Rankin scale (mRS) scores at day 90 were used to evaluate the outcomes in both groups. Results Eighteen patients (58.1%) had complete recanalization and 7 (22.6%) had partial recanalization in the intra-arterial thrombolysis group. The recanalization rate was 80.6%, 3 complicated symptomatic intracranial hemorrhage, and 1 died. There vere no significant differences between the good outcome rate (74.2% vs. 66.7%, x2 =0.24, P=0.622) and the incidence of symptomatic intracranial hemorrhage at 90 d (9. 68% vs. 8. 33%, x2 =0. 19, P =0. 892). Conclusions Urokinase intra arterial thrombolysis within the time window can significantly improve the recanalization rate of the occluded vessels and improve the clinical symptoms of the patents in acute phase and long term outcomes. Their short-term efficacy and long-term outcomes are almost the same with intrave nous thrombolysis with rtPA.%目的 评价尿激酶动脉溶栓与重组组织纤溶酶原激活剂(recombinant tissue plasminogen activator,rtPA)静脉溶栓治疗急性缺血性卒中的疗效和安全性.方法 发病6 h内的急性脑梗死患者43例,其中动脉溶栓组31例行超选择性动脉溶栓,静脉溶栓组12例行rtPA静脉溶栓.观察动脉溶栓组血管再通.90 d时改良Rankin量表(modified Ranlkin scale,mRS)评分评价2组转归.结果 动脉溶栓组完全再通18例(58.1%),部分再通7例(22.6%),

  17. Intra-arterial pulmonary thrombolysis at the postoperative period of brain aneurysm clamping: case report.

    Science.gov (United States)

    Rojas, Salomón Soriano Ordinola; Veiga, Viviane Cordeiro; Carvalho, Júlio César de; Campodônico, Luis Enrique Amaya; Assis, Fabrizio Rodrigues; Shimizu, Sandra Patrícia; Morais, Elaine Aparecida; Buesio, Roberto; Marchesini, Andréia Maria; Junqueira, Ligia Maria Coscrato; Holanda, Carlos Vanderlei

    2008-09-01

    Pulmonary thromboembolism is a major cause of morbidity and mortality of patients undergoing neurosurgical procedures. The purpose of this study was to present a case of intra-arterial pulmonary thrombolysis in recent neurosurgery postoperative period. Male patient, undergoing neurosurgery, presented as a complication on the seventh day of postoperative massive pulmonary embolism with hemodynamic instability and intraarterial pulmonary thrombolysis with alteplase was indicated. Evolution was satisfactory without bleeding complications and patient was discharged. Pulmonary thromboembolism is a high morbidity and mortality condition at neurosurgical postoperative period and thrombolysis should be an alternative therapy in cases refractory to clinical treatment.

  18. Design of a Standard Iranian Protocol of Intravenous Thrombolysis with Tissue Plasminogen Activator: A National Project

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2013-04-01

    Full Text Available Standard protocols should be established for treating eligible stroke patients with tissue plasminogen activator (TPA (recommendation class I, level of evidence B. The Iranian standard protocol of intravenous thrombolysis with recombinant tissue plasminogen activator (IVTTPA is the best possible and easy to use method for performing intravenous thrombolysis in Iran. This protocol overcomes problems and limitations of IVTTPA in Iran. The protocol achieves the best selection criteria and assessment method of IVTTPA for our residents and neurologists. This protocol was provided in Persian language and could be easily downloaded from Google site by writing Thrombolysis and Iran in Persian.

  19. Catheter directed thrombolysis for deep vein thrombosis during the first trimester of pregnancy: two case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Kwun, Woo Hyung; Suh, Bo Yang [College of Medicine, Yeungnam University, Daegu (Korea, Republic of); Park, Kyeong Seok [Yeungnam University, Medical Center, Daegu (Korea, Republic of)

    2008-02-15

    Anticoagulation with heparin has been the standard management therapy of deep vein thrombosis during pregnancy. Pregnancy is generally considered as a contraindication for thrombolysis. However, anticoagulation therapy alone does not protect the limbs from post-thrombotic syndrome and venous valve insufficiency. Catheter-directed thrombolysis, combined with angioplasty and stenting, can remove the thrombus and restore patency of the veins, resulting in prevention of post-thrombotic syndrome and valve insufficiency. We report successful catheter-directed thrombolysis and stenting in two early gestation patients with a deep vein thrombosis of the left lower extremity.

  20. Analysis thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis in the lower extremities

    Institute of Scientific and Technical Information of China (English)

    刘心; 张梅; 刘陕西; 祈光裕; 刘亚民

    2003-01-01

    Objective: To explore the effect of thrombolysis with anticoagulation treatment for early stage of deep vein thrombosis of lower extremity. Methods: The clinical data of 106 patients at the early stage of deep vein thrombosis (DVT) in the lower extremities treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results: The thrombolytic effect was significant. After treatment, the deep veins were recanalized without regurgitation in 75.3% of the patients. The total effective rate was 100%. Only three patients had hemorrhagic complication, but none of the patients died. Conclusion: Thrombolysis with anticoagulation treatment is an effective and safe method for DVT at the early stage.

  1. 急性缺血性卒中患者不同强度康复训练对超早期溶栓及非溶栓远期功能改善的影响%Long-term Effect of Different Intensities of Rehabilitation Training in Acute Ischemic Stroke Patients with Ultra-early Thrombolysis Therapy or without Thrombolysis

    Institute of Scientific and Technical Information of China (English)

    张京; 吴海艳; 韩淑玲; 姚济荣; 贺茂林

    2014-01-01

    ObjectiveToinvestigatetheeffectsofdifferentintensitiesofrehabilitationtraininginacuteischemicpa-tients with thrombolysis or without thrombolysis .Methods From January 2009 to December 2012 in Beijing Shijitan Hospital , 87 cases of acute ischemic stroke patients administrated with ultra early thrombolytic therapy ( thrombolysis group ) and 93 cases of a-cute ischemic stroke patients without thrombolysis ( non-thrombolysis group ) were enrolled in this study , then every group were randomly divided into four groups and administrated with different intensities of rehabilitation training , named thrombolysis plus low intensity group (A group, 19 cases), thrombolysis plus moderate intensity group (B group, 23 cases), thrombolysis plus sub-high intensity group (C group, 21 cases), thrombolysis plus high intensity group (D group, 24 cases), non-thrombol-ysis plus low intensity group ( E group, 22 cases), non -thrombolysis plus moderate intensity group ( F group, 25 cases), non-thrombolysis plus sub -high intensity group ( G group, 24 cases ) and non thrombolysis plus high intensity group ( H group, 22 cases) respectively.Thrombolysis groups were given intravenous thrombolysis of alteplase and non -thrombolysis groups were given conventional treatments including antiplatelet , anticoagulant , brain protection , neurotrophic treatment .Rehabilitation training was started within 48 hours when the patients in stable condition .Every patients were received 4 weeks rehabilitation train-ing, which included: normal limb position, bed chair transfer, sitting and vertical position balance training , gait training, stair exercise and hand function training .Using 3 international stroke scales ( FMA, FIM, SS-QOL) to assess motor function , self-help ability and quality of life in eight groups before and after the training then compare the effect of training and thrombolys -is the 2 factors on the above scales in 8 groups.Results There was no significant difference in 3 stroke

  2. Intravenous thrombolysis is more safe and effective for posterior circulation stroke: Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China).

    Science.gov (United States)

    Tong, Xu; Liao, Xiaoling; Pan, Yuesong; Cao, Yibin; Wang, Chunjuan; Liu, Liping; Zheng, Huaguang; Zhao, Xingquan; Wang, Chunxue; Wang, Yilong; Wang, Yongjun

    2016-06-01

    We aimed to compare the safety and efficacy of intravenous thrombolysis (IVT) with alteplase for anterior circulation stroke (ACS) and posterior circulation stroke (PCS). From a large multicenter prospective registry-the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database-all patients who received IVT within 4.5 hours after stroke onset was reviewed. According to the clinical presentations and imaging findings, the eligible patients were divided into ACS and PCS groups. The safety and efficacy outcome measures included post-IVT symptomatic intracranial hemorrhage (sICH), parenchymal hematoma, and all intracranial hemorrhage (aICH) within 7 days, mortality within 90 days, excellent recovery (modified Rankin Scale 0-1), and functional independence (modified Rankin Scale 0-2) at 90 days. For comparing the outcomes between both groups, the odds ratios (ORs) with 95% confidence intervals (CIs) and the adjusted ORs with 95% CIs were analyzed by univariate and multivariate logistic regression models. Of 953 patients enrolled, 829 patients had ACS and 124 had PCS. The patients with PCS had less often atrial fibrillation (11.3% vs 19.8%; P = 0.02), higher blood glucose level (8.31 vs 7.63 mmol/L; P = 0.02), and more white blood cell counts (8.79 vs 7.75 × 10/L; P = 0.001) than those with ACS. After adjustment for the potential confounders, multivariate logistic analysis showed that PCS patients had not only lower rates of sICH (3.2% vs 7.7%; OR 0.28, 95% CI 0.09-0.90), parenchymal hematoma (1.6% vs 9.2%; OR 0.13, 95% CI 0.03-0.57), and aICH (8.1% vs 20.4%; OR 0.26, 95% CI 0.12-0.54), but also higher proportions of excellent recovery (55.7% vs 41.6%; OR 2.27, 95% CI 1.42-3.61) and functional independence (63.9% vs 53.0%; OR 2.33, 95% CI 1.40-3.89) compared with ACS patients. However, there was no significant difference in the occurrence of mortality (OR 0.86, 95% CI 0.39-1.91) between both groups in the multivariate model, although

  3. Telestroke a viable option to improve stroke care in India.

    Science.gov (United States)

    Srivastava, Padma V; Sudhan, Paulin; Khurana, Dheeraj; Bhatia, Rohit; Kaul, Subash; Sylaja, P N; Moonis, Majaz; Pandian, Jeyaraj Durai

    2014-10-01

    In India, stroke care services are not well developed. There is a need to explore alternative options to tackle the rising burden of stroke. Telemedicine has been used by the Indian Space Research Organization (ISRO) to meet the needs of remote hospitals in India. The telemedicine network implemented by ISRO in 2001 presently stretches to around 100 hospitals all over the country, with 78 remote/rural/district health centers connected to 22 specialty hospitals in major cities, thus providing treatment to more than 25 000 patients, which includes stroke patients. Telemedicine is currently used in India for diagnosing stroke patients, subtyping stroke as ischemic or hemorrhagic, and treating accordingly. However, a dedicated telestroke system for providing acute stroke care is needed. Keeping in mind India's flourishing technology sector and leading communication networks, the hub-and-spoke model could work out really well in the upcoming years. Until then, simpler alternatives like smartphones, online data transfer, and new mobile applications like WhatsApp could be used. Telestroke facilities could increase the pool of patients eligible for thrombolysis. But this primary aim of telestroke can be achieved in India only if thrombolysis and imaging techniques are made available at all levels of health care.

  4. Hemorrhagic transformation in ischemic stroke and its treatment during thrombolysis

    Directory of Open Access Journals (Sweden)

    Maurizio Paciaroni

    2011-08-01

    Full Text Available Haemorrhagic transformation (HT of brain infarction or hemorrhagic infarction is a complication of acute ischemic stroke, especially in cardioembolic stroke, and represents the most feared complication of thrombolysis. HT is a multifocal secondary bleeding into brain infarcts with innumerable foci of capillary and venular extravasation either remaining as discrete petechiae or emerging to form confluent purpura. HT is evidenced as a parenchymal area of increased density within an area of low attenuation in a typical vascular distribution on non-contrasted CT scans and is subdivided into two major categories on the basis of standardised definition: haemorrhagic infarct (HI and parenchymal haematoma (PH. PH has been associated to poor outcome in ischemic stroke patients. Thus, its prevention, early detection and adequate treatment represent key points in the management of acute stroke.

  5. Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects

    Directory of Open Access Journals (Sweden)

    Maarten M. H. Lahr

    2017-01-01

    Full Text Available Abstract Background Centralisation of thrombolysis may offer substantial benefits. The aim of this study was to assess short term costs and effects of centralisation of thrombolysis and optimised care in a decentralised system. Methods Using simulation modelling, three scenarios to improve decentralised settings in the North of Netherlands were compared from the perspective of the policy maker and compared to current decentralised care: (1 improving stroke care at nine separate hospitals, (2 centralising and improving thrombolysis treatment to four, and (3 two hospitals. Outcomes were annual mean and incremental costs per patient up to the treatment with thrombolysis, incremental cost-effectiveness ratio (iCER per 1% increase in thrombolysis rate, and the proportion treated with thrombolysis. Results Compared to current decentralised care, improving stroke care at individual community hospitals led to mean annual costs per patient of $US 1,834 (95% CI, 1,823–1,843 whereas centralising to four and two hospitals led to $US 1,462 (95% CI, 1,451–1,473 and $US 1,317 (95% CI, 1,306–1,328, respectively (P < 0.001. The iCER of improving community hospitals was $US 113 (95% CI, 91–150 and $US 71 (95% CI, 59–94, $US 56 (95% CI, 44–74 when centralising to four and two hospitals, respectively. Thrombolysis rates decreased from 22.4 to 21.8% and 21.2% (P = 0.120 and P = 0.001 in case of increasing centralisation. Conclusions Centralising thrombolysis substantially lowers mean annual costs per patient compared to raising stroke care at community hospitals simultaneously. Small, but negative effects on thrombolysis rates may be expected.

  6. Pregnancy after catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis

    DEFF Research Database (Denmark)

    Jørgensen, M; Broholm, R; Bækgaard, N

    2013-01-01

    To assess the safety and efficacy of low-molecular-weight heparin (LMWH) in pregnancy and puerperium in women with previous acute iliofemoral deep venous thrombosis (DVT) treated with catheter-directed thrombolysis (CDT).......To assess the safety and efficacy of low-molecular-weight heparin (LMWH) in pregnancy and puerperium in women with previous acute iliofemoral deep venous thrombosis (DVT) treated with catheter-directed thrombolysis (CDT)....

  7. Regional thrombolysis with tenecteplase during extracorporeal membrane oxygenation: a new approach for left ventricular thrombosis.

    Science.gov (United States)

    Sangalli, Fabio; Greco, Gianluca; Galbiati, Lucia; Formica, Francesco; Calcinati, Serena; Avalli, Leonello

    2015-06-01

    We present the case of a woman assisted with veno-arterial extracorporeal membrane oxygenation (v-a ECMO) for postischemic cardiogenic shock, who developed left ventricular thrombosis despite systemic anticoagulation and left ventricular apical venting. We successfully achieved local thrombolysis with tenecteplase administered through the venting cannula to obtain local thrombolysis while reducing systemic effects to a minimum. The procedure was effective with mild systemic bleeding and the patient was successfully weaned off the extracorporeal support a few days thereafter.

  8. Small primary care practices face four hurdles--including a physician-centric mind-set--in becoming medical homes.

    Science.gov (United States)

    Nutting, Paul A; Crabtree, Benjamin F; McDaniel, Reuben R

    2012-11-01

    Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.

  9. Examining the "liberal media" claim: journalists' views on politics, economic and social policy (including health care), and media coverage.

    Science.gov (United States)

    Croteau, D

    1999-01-01

    The conservative critique of the news media rests on two general propositions: journalists hold views that are to the left of the public, and journalists frame news content in a way that accentuates these left perspectives. Previous research has revealed persuasive evidence against the latter claim, but the validity of the former claim has often been taken for granted. This research project examined the supposed left orientation of media personnel by surveying Washington-based journalists who cover national politics and/or economic policy at U.S. outlets. The findings include: (1) On select issues from corporate power and trade to Social Security and Medicare to health care and taxes, journalists are actually more conservative than the general public. (2) Journalists are mostly centrist in their political orientation. (3) The minority of journalists who do not identify with the "center" are more likely to identify with the "right" when it comes to economic issues and to identify with the "left" when it comes to social issues. (4) Journalists report that "business-oriented news outlets" and "major daily newspapers" provide the highest quality coverage of economic policy issues, while "broadcast network TV news" and "cable news services" provide the worst.

  10. Percutaneous Treatment of Failed Native Dialysis Fistulas: Use of Pulse-Spray Pharmacomechanical Thrombolysis as the Primary Mode of Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sung Ki; Shin, Sung Wook; Do, Young Soo; Park, Kwang Bo; Choo, Sung Wook; Choo, In Wook [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Han, Heon; Kim, Sam Soo; Lee, Ji Yeon [Kangwon National University College of Medicine, Kangreung (Korea, Republic of)

    2006-09-15

    To determine the efficacy and outcome of percutaneous treatment in restoring the function of failed native arteriovenous fistulas (AVFs) where pulse-spray pharmacomechanical thrombolysis was used as the primary mode of therapy. From June 2001 to July 2005, 14 patients who had thrombosis of native AVFs underwent percutaneous restoration following 20 episodes of thrombosis. These included 6 repeated episodes in one forearm AVF and two episodes in another forearm AVF. All patients except one were treated with urokinase injection utilizing the pulse-spray technique and had subsequent balloon angioplasty. One patient was treated by percutaneous angioplasty alone. We retrospectively evaluated the feasibility of percutaneous treatment in restoring the function of the failed AVFs. The primary and secondary patencies were calculated by using a Kaplan-Meier analysis. Both technical and clinical success were achieved in 15 (75%) of 20 AVFs. Four of the five technical failures resulted from a failure to cross the occluded segment. One patient refused further participation in the trial through a brachial artery access following failure to cross the occluded segment via an initial retrograde venous puncture. There were no major procedure related complications observed. Including the initial technical failures, primary patency rates at six and 12 months were 64% and 55%, respectively. Secondary patency rates at six and 12 months were 71% and 63%, respectively. Pulse-spray pharmacomechanical thrombolysis for treatment of the thrombosed AVFs is safe, effective and durable. This procedure should be considered as an option for the management of failed AVFs prior to surgical intervention.

  11. Catheter-Directed Thrombolysis via Small Saphenous Veins for Treating Acute Deep Venous Thrombosis.

    Science.gov (United States)

    Yang, Bin; Xu, Xiao-Dong; Gao, Peng; Yu, Ji-Xiang; Li, Yu; Zhu, Ai-Dong; Meng, Ran-Ran

    2016-08-23

    BACKGROUND There is little data comparing catheter-directed thrombolysis (CDT) via small saphenous veins vs. systematic thrombolysis on complications and efficacy in acute deep venous thrombosis patients. The aim of our study was to compare the efficacy and safety of CDT via the small saphenous veins with systematic thrombolysis for patients with acute deep venous thrombosis (DVT). MATERIAL AND METHODS Sixty-six patients with acute DVT admitted from June 2012 to December 2013 were divided into 2 groups: 27 patients received systemic thrombolysis (ST group) and 39 patients received CDT via the small saphenous veins (CDT group). The thrombolysis efficiency, limb circumference differences, and complications such as post-thrombotic syndrome (PTS) in the 2 groups were recorded. RESULTS The angiograms demonstrated that all or part of the fresh thrombus was dissolved. There was a significant difference regarding thrombolysis efficiency between the CDT group and ST group (71.26% vs. 48.26%, P=0.001). In both groups the postoperative limb circumference changes were higher compared to the preoperative values. The differences between postoperative limb circumferences on postoperative days 7 and 14 were significantly higher in the CDT group than in the ST group (all Pdeep venous thrombosis.

  12. Adult Asylum Seekers from the Middle East Including Syria in Central Europe: What Are Their Health Care Problems?

    Directory of Open Access Journals (Sweden)

    Carmen Andrea Pfortmueller

    Full Text Available Forced displacement related to persecution and violent conflict has reached a new peak in recent years. The primary aim of this study is to provide an initial overview of the acute and chronic health care problems of asylum seekers from the Middle East, with special emphasis on asylum seekers from Syria.Our retrospective data analysis comprised adult patients presenting to our emergency department between 01.11.2011 and 30.06.2014 with the official resident status of an "asylum seeker" or "refugee" from the Middle East.In total, 880 patients were included in the study. Of these, 625 (71.0% were male and 255 (29.0% female. The median age was 34 (range 16-84. 222 (25.2% of our patients were from Syria. The most common reason for presentation was surgical (381, 43.3%, followed by medical (321, 36.5% and psychiatric (137, 15.6%. In patients with surgical presentations, trauma-related problems were most common (n = 196, 50.6%. Within the group of patients with medical presentation, acute infectious diseases were most common (n = 141, 43.9%, followed by neurological problems (n = 70, 21.8% and gastrointestinal problems (n = 47, 14.6%. There were no differences between Syrian and non-Syrian refugees concerning surgical or medical admissions. The most common chronic disorder of unclear significance was chronic gastrointestinal problems (n = 132, 15%, followed by chronic musculoskeletal problems (n = 108, 12.3% and chronic headaches (n = 78, 8.9%. Patients from Syria were significantly younger and more often suffered from a post-traumatic stress disorder than patients of other nationalities (p<0.0001, and p = 0.05, respectively.Overall a remarkable number of our very young group of patients suffered from psychiatric disorders and unspecified somatic symptoms. Asylum seekers should be carefully evaluated when presenting to a medical facility and physicians should be aware of the high incidence of unspecified somatic symptoms in this patient population

  13. Catheter-directed thrombolysis in inflammatory bowel diseases: Report of a case

    Institute of Scientific and Technical Information of China (English)

    Péter Ilonczai; Judit Tóth; László Tóth; István Altorjay; Zoltán Boda; Károly Palatka

    2012-01-01

    In patients with inflammatory bowel diseases (IBD)the prevalence of thrombosis is 6.2%,the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population.The TE is a common extraintestinal complication of IBD,squarely associated with the IBD activity.The application of anticoagulant and thrombolytic therapy in severe IBD is an unresolved issue.Herein we report the first case in literature of an active IBD patient with an upper limb acute arterial occlusion and successful catheter-directed thrombolysis (CDT).A 46-year-old male patient is reported who had Crohn's disease for 10 years.His right hand suddenly became cold and painful.Angiography proved acute occlusion of the brachial and radial artery.Vascular surgery intervention was not applicable.Endoscopy showed extended,severe inflammation of the colon.Despite the severe endoscopic findings,frequent bloody stools and moderate anaemia,CDT with recombinant tissue plasminogen activator was performed.The control angiography proved improvement,the radial artery pulse appeared.No bleeding complication was observed.This case supports that CDT-after careful estimation of the bleeding risk-can be effective and safe in patients with severe or life-threatening TE and active IBD.

  14. Short-Term Catheter-Directed Thrombolysis with Low-Dose Urokinase Followed by Aspiration Thrombectomy for Treatment of Symptomatic Lower Extremity Deep Venous Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Se Hee; Lim, Nam Yeul; Song, Jang Hyeon [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Kim, Jae Kyu; Lim, Jae Hoon [Dept. of Radiology, Hospital, Ulsan University School of Medicine, Gweangju (Korea, Republic of); Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Choi, Soo Jin Na; Chung, Sang Young [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju (Korea, Republic of)

    2011-10-15

    To evaluate the venous patency in patients treated by catheter-directed thrombolysis with low-dose urokinase (UK) for symptomatic lower extremity deep venous thrombosis (DVT). Eighty-nine consecutive patients (46 women and 43 men; mean age, 58.1 years), treated by catheter-directed thrombolysis with low-dose UK were included in this study. Immediate venous patency was evaluated in terms of technical success (successful restoration of antegrade in-line flow in the treated vein with residual stenosis rate of less than 30%) and clinical success (significant reduction of clinical symptoms before hospital discharge). Late venous patency was evaluated in terms of primary patency rate and clinical success. Immediate technical success was achieved in all patients and immediate clinical success in 80 (90%) patients. There was no major systemic bleeding complication. The primary patency rate at 6 months and 12 months was 84% and 79%, respectively. Fifty-six (63%) patients were asymptomatic after a median clinical follow-up of 18 months, eleven (12%) patients improved moderately, seven (8%) patients remained unchanged, and fifteen (17%) patients had no clinical follow-up. Short-term catheter-directed thrombolysis with low-dose UK can be an effective, safe method to manage DVT of the lower extremities.

  15. Digestive and urologic hemorrhage after intravenous thrombolysis for acute ischemic stroke: Data from a Chinese stroke center.

    Science.gov (United States)

    Chang, Hong; Wang, Xiaojuan; Yang, Xin; Song, Haiqing; Qiao, Yuchen; Liu, Jia

    2017-02-01

    Objective Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) is considered the most effective treatment method for AIS; however, it is associated with a risk of hemorrhage. We analyzed the risk factors for digestive and urologic hemorrhage during rt-PA therapy. Methods We retrospectively analyzed patients with AIS who underwent intravenous thrombolysis with rt-PA during a 5-year period in a Chinese stroke center. Data on the demographics, medical history, laboratory test results, and clinical outcomes were collected. Results 338 patients with AIS were eligible and included. Logistic regression multivariate analysis showed that gastric catheter was significantly correlated with digestive hemorrhage, while age and urinary catheter were significantly correlated with urologic hemorrhage. Most hemorrhagic events were associated with catheterization after 1 to 24 hours of rt-PA therapy. Conclusions In summary, gastric and urinary catheters were correlated with digestive and urologic hemorrhage in patients with AIS undergoing rt-PA therapy. Well-designed controlled studies with large samples are required to confirm our findings.

  16. Safety and Efficacy of Low Dosage of Urokinase for Catheter-directed Thrombolysis of Deep Venous Thrombosis

    Institute of Scientific and Technical Information of China (English)

    Xiao-Long Du; Ling-Shang Kong; Qing-You Meng; Aimin Qian; Wen-Dong Li; Hong Chen; Xiao-Qiang Li

    2015-01-01

    Background:Catheter-directed thrombolysis (CDT) has been a mainstay in treating deep venous thrombosis (DVT).However,the optimal dosage of a thrombolytic agent is still controversial.The goal of this study was to evaluate the safety and efficacy of low dosage urokinase with CDT for DVT.Methods:A retrospective analysis was performed using data from a total of 427 patients with DVT treated with CDT in our single center between July 2009 and December 2012.Early efficacy of thrombolysis was assessed with a thrombus score based on daily venography.The therapeutic safety was evaluated by adverse events.A venography or duplex ultrasound was performed to assess the outcome at 6 months,1 year and 2 years postoperatively.Results:The mean total dose of 3.34 (standard deviation [SD] 1.38) million units of urokinase was administered during a mean of 5.18 (SD 2.28) days.Prior to discharge,Grade Ⅲ (complete lysis) was achieved in 154 (36%) patients;Grade Ⅱ (50-99% lysis) in 222 (52%);and Grade Ⅰ (50% lysis) in 51 (12%).The major complications included one intracranial hemorrhage,one hematochezia,five gross hematuria,and one pulmonary embolism.Moreover,no death occurred in the study.Conclusions:Treatment of low-dose catheter-directed thrombosis is an efficacious and safe therapeutic approach in patients with DVT offering good long-term outcomes and minimal complications.

  17. EFFECTS OF THROMBOLYSIS WITH ULTRASOUND ON THE STRUCTURE OF ERYTHROCYTE AND ITS SAFETY THRESHOLD

    Institute of Scientific and Technical Information of China (English)

    Yan Bige

    2006-01-01

    The study was to investigate thrombolysis in vitro with ultrasound, and to discuss effects of thrombolysis with ultrasound on the structure of erythrocyte and its safety threshold under different ultrasound intensity and exposure time. The structure of erythrocyte in thrombus was evaluated under light microscope. The relationship between the structure of erythrocyte in thrombus and ultrasound intensity and exposure time was obtained. The results showed that ultrasound eliminated the thrombus. According to the change of the structure of erythrocyte in thrombus and ultrasound intensity and exposure time, the effects of thrombolysis with ultrasound could be divided into three kinds of areas: the A, B, C area. The area A was the safe area, the area B was the relatively safe area, and the area C was the irreversible damage area. The study suggested that ultrasound intensity and exposure time had significant impact on the structure of erythrocyte. Stronger ultrasound intensity or longer exposure time could cause erythrocytes irreversible damage. It could accelerate thrombolysis and shorten the exposure time that the ultrasound intensity was little bit increased. The study of effects of thrombolysis with ultrasound on the structure of erythrocyte and its safety threshold were important for practical applications.

  18. Catheter-directed thrombolysis for double inferior vena cava with deep venous thrombosis: A case report and literature review.

    Science.gov (United States)

    Wang, Xiaodong; Chen, Zhengxin; Cai, Qianrong

    2014-08-01

    Double inferior vena cava (DIVC) with deep venous thrombosis (DVT) is rare, and there is only one reported case of DIVC with DVT treated by catheter-directed thrombolysis. We report a case of a 32-year-old man with an extensive venous clot involving the infrarenal segment of a double IVC who received filter implantation and catheter-directed thrombolysis.

  19. External validation of the MRI-DRAGON score: early prediction of stroke outcome after intravenous thrombolysis.

    Directory of Open Access Journals (Sweden)

    Guillaume Turc

    Full Text Available The aim of our study was to validate in an independent cohort the MRI-DRAGON score, an adaptation of the (CT- DRAGON score to predict 3-month outcome in acute ischemic stroke patients undergoing MRI before intravenous thrombolysis (IV-tPA.We reviewed consecutive (2009-2013 anterior circulation stroke patients treated within 4.5 hours by IV-tPA in the Lille stroke unit (France, where MRI is the first-line pretherapeutic work-up. We assessed the discrimination and calibration of the MRI-DRAGON score to predict poor 3-month outcome, defined as modified Rankin Score >2, using c-statistic and the Hosmer-Lemeshow test, respectively.We included 230 patients (mean ±SD age 70.4±16.0 years, median [IQR] baseline NIHSS 8 [5]-[14]; poor outcome in 78(34% patients. The c-statistic was 0.81 (95%CI 0.75-0.87, and the Hosmer-Lemeshow test was not significant (p = 0.54.The MRI-DRAGON score showed good prognostic performance in the external validation cohort. It could therefore be used to inform the patient's relatives about long-term prognosis and help to identify poor responders to IV-tPA alone, who may be candidates for additional therapeutic strategies, if they are otherwise eligible for such procedures based on the institutional criteria.

  20. Vitreo-Retinal Hemorrhage After Thrombolysis In A Patient With Acute Ischemic Stroke: A Case Report.

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    Mary eHormese

    2012-05-01

    Full Text Available Purpose: Bleeding is the major side effect of thrombolysis with alteplase (tissue plasminogen activator, t-PA used for the treatment of acute ischemic stroke. Life-threatening intracranial, retroperitoneal, gastrointestinal, respiratory, and genitourinary bleeding can occur with the use of t-PA. Vitreo-retinal bleeding in the context of acute ischemic stroke treatment has not been reported in the literature before and therefore is not posed as a potential risk during decision making. Here we describe the first reported case of vitreo-retinal hemorrhage due to alteplase administration in a patient with acute ischemic stroke.Summary: An 84 year old white male presented to the emergency room with complaints of right arm and leg weakness. The onset of symptoms was approximately 30 minutes prior to presentation to the emergency room. After ruling out contraindications including the presence of hemorrhage on head CT scan, patient was administered alteplase within 2 hours of symptom onset. Four hours after the administration of alteplase, the patient developed right-sided vision changes. A repeat CT scan demonstrated a newly developed right intraocular hemorrhage. Throughout the hospital course, patient’s neurological status improved, but he continued to have right-sided visual loss.Conclusion: Clinicians should be aware of the potential for ocular hemorrhage especially in high-risk patients. The likelihood of a subsequent vision-loss needs to be therefore discussed with the patient and family in such situations.

  1. [Thrombolysis of the basilar artery: 5-year results from the Saarland stroke registry].

    Science.gov (United States)

    Grunwald, I Q; Struffert, T; Roth, C; Papanagiotou, P; Scheuermann, J; Voges, M; Reith, W

    2005-05-01

    Acute thrombosis of the basilar artery has a fatal outcome if left untreated. The relatively good prognosis with intra-arterial thrombolysis makes it the therapy of choice for acute basilar thrombosis. In the Saarland stroke registry, we analyzed 47 patients with angiographically proven basilar artery thrombosis within the last 5 years. We observed a better outcome in patients with good income, with recanalization, and a short time between onset of symptoms and start of thrombolysis. The complications, such as intracerebral bleedings, occurred only in the group treated with rt-PA. Intra-arterial thrombolysis with urokinase or rt-PA is a relatively safe therapy, but should be performed in neuroradiological centers. With progressing symptoms the therapeutic window can be stretched up to 12 h, but coma lasting for more than 4 h is related to a bad outcome.

  2. Effect of Fagonia Arabica (Dhamasa on in vitro thrombolysis

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    Taori Girdhar M

    2007-11-01

    Full Text Available Abstract Background Atherothrombotic diseases such as myocardial or cerebral infarction are serious consequences of the thrombus formed in blood vessels. Thrombolytic agents are used to dissolve the already formed clots in the blood vessels; however, these drugs have certain limitations which cause serious and sometimes fatal consequences. Herbal preparations have been used since ancient times for the treatment of several diseases. Herbs and their components possessing antithrombotic activity have been reported before; however, herbs that could be used for thrombolysis has not been reported so far. This study's aim was to investigate whether herbal preparations (aqueous extract possess thrombolytic activity or not. Methods An in vitro thrombolytic model was used to check the clot lysis effect of six aqueous herbal extracts viz., Tinospora cordifolia, Rubia cordifolia, Hemidesmus indicus, Glycyrrhiza glabra Linn, Fagonia Arabica and Bacopa monnieri Linn along with Streptokinase as a positive control and water as a negative control. Results Using an in vitro thrombolytic model, Tinospora cordifolia, Rubia cordifolia, Hemidesmus indicus, Glycyrrhiza glabra Linn, Fagonia Arabica and Bacopa monnieri Linn showed 19.3%, 14.5%, 20.3%, 17.8%, 75.6% and 41.8% clot lysis respectively . Among the herbs studied Fagonia arabica showed significant % of clot lysis (75.6% with reference to Streptokinase (86.2%. Conclusion Through our study it was found that Dhamasa possesses thrombolytic properties that could lyse blood clots in vitro; however, in vivo clot dissolving properties and active component(s of Dhamasa for clot lysis are yet to be discovered. Once found Dhamasa could be incorporated as a thrombolytic agent for the improvement of patients suffering from Atherothrombotic diseases.

  3. Ultrasound-Accelerated Thrombolysis in Patients With Intracardiac Thrombi: A Case Series.

    Science.gov (United States)

    Yadlapati, Ajay; Sweis, Ranya; Schimmel, Daniel

    2016-03-01

    We describe a case series of 3 patients presenting with intracardiac thrombi treated with standard anticoagulation therapy and intervention with ultrasound-accelerated thrombolysis therapy. Right-sided intracardiac thrombi portend significant mortality due to their susceptibility for embolization and pulmonary embolus despite the continuation of current standard of therapy of parenteral anticoagulation and surgical embolectomy if warranted. We demonstrate the safety and clinical efficacy of ultrasound-accelerated thrombolysis therapy with the EkoSonic Endovascular System infusion catheter system (EKOS Corporation) and highlight its use in resolving intracardiac thrombi and impeding the propagation of pulmonary emboli.

  4. Thrombolysis significantly reduces transient myocardial ischaemia following first acute myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H; Pless, P; Nielsen, J R

    1992-01-01

    In order to investigate whether thrombolysis affects residual myocardial ischaemia, we prospectively performed a predischarge maximal exercise test and early out-of-hospital ambulatory ST segment monitoring in 123 consecutive men surviving a first acute myocardial infarction (AMI). Seventy...... less than 0.02). Thrombolysis resulted in a non-significant reduction in exercise-induced ST segment depression: prevalence 43% vs 62% in controls. However, during ambulatory monitoring the duration of transient myocardial ischaemia was significantly reduced in thrombolysed patients: 322 min vs 1144...... myocardial ischaemia. This may explain the improvement in myocardial function during physical activities, which was also observed in this study....

  5. Retrospective Analysis of Thrombolysis Therapy for 64 Cases of Acute Myocardial Infarction with Elevated ST Segment

    Institute of Scientific and Technical Information of China (English)

    傅晓霞; 肖文剑; 吕健; 吴乐文; 杨帆

    2009-01-01

    Objective:To explore the cardiac protective effect of integrative therapy in acute myocardial infarction(AMI) with elevated ST segment after reperfusion.Methods:Sixty-four AMI patients who having received decimalization by thrombolysis were assigned to two groups by retrospective analysis,36 patients in the treated group and 28 in the control group.Both were treated by intravenous administering of urokinase for thrombolysis,and to the treated group,intravenous dripping of Xueshuantong Injection(血栓通注射液,XS...

  6. The Effects of a Family Support Program Including Respite Care on Parenting Stress and Family Quality of Life Perceived by Primary Caregivers of Children with Disabilities in Korea

    Science.gov (United States)

    Sung, Minjung; Park, Jiyeon

    2012-01-01

    In this study, a family support program was carried out for primary caregivers of children with disabilities. The program included respite care, recreation programs, counseling, and social support coordination based on individual needs of each family. In order to verify the intervention effects, parenting stress and family quality of life were…

  7. Recombinant Tissue Plasminogen Activator Induces Neurological Side Effects Independent on Thrombolysis in Mechanical Animal Models of Focal Cerebral Infarction: A Systematic Review and Meta-Analysis.

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    Mei-Xue Dong

    Full Text Available Recombinant tissue plasminogen activator (rtPA is the only effective drug approved by US FDA to treat ischemic stroke, and it contains pleiotropic effects besides thrombolysis. We performed a meta-analysis to clarify effect of tissue plasminogen activator (tPA on cerebral infarction besides its thrombolysis property in mechanical animal stroke.Relevant studies were identified by two reviewers after searching online databases, including Pubmed, Embase, and ScienceDirect, from 1979 to 2016. We identified 6, 65, 17, 12, 16, 12 and 13 comparisons reporting effect of endogenous tPA on infarction volume and effects of rtPA on infarction volume, blood-brain barrier, brain edema, intracerebral hemorrhage, neurological function and mortality rate in all 47 included studies. Standardized mean differences for continuous measures and risk ratio for dichotomous measures were calculated to assess the effects of endogenous tPA and rtPA on cerebral infarction in animals. The quality of included studies was assessed using the Stroke Therapy Academic Industry Roundtable score. Subgroup analysis, meta-regression and sensitivity analysis were performed to explore sources of heterogeneity. Funnel plot, Trim and Fill method and Egger's test were obtained to detect publication bias.We found that both endogenous tPA and rtPA had not enlarged infarction volume, or deteriorated neurological function. However, rtPA would disrupt blood-brain barrier, aggravate brain edema, induce intracerebral hemorrhage and increase mortality rate.This meta-analysis reveals rtPA can lead to neurological side effects besides thrombolysis in mechanical animal stroke, which may account for clinical exacerbation for stroke patients that do not achieve vascular recanalization with rtPA.

  8. Recombinant Tissue Plasminogen Activator Induces Neurological Side Effects Independent on Thrombolysis in Mechanical Animal Models of Focal Cerebral Infarction: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Wei, You-Dong; Liu, Yi-Yun; Ren, Yi-Fei; Liang, Zi-Hong; Wang, Hai-Yang; Zhao, Li-Bo; Xie, Peng

    2016-01-01

    Background and Purpose Recombinant tissue plasminogen activator (rtPA) is the only effective drug approved by US FDA to treat ischemic stroke, and it contains pleiotropic effects besides thrombolysis. We performed a meta-analysis to clarify effect of tissue plasminogen activator (tPA) on cerebral infarction besides its thrombolysis property in mechanical animal stroke. Methods Relevant studies were identified by two reviewers after searching online databases, including Pubmed, Embase, and ScienceDirect, from 1979 to 2016. We identified 6, 65, 17, 12, 16, 12 and 13 comparisons reporting effect of endogenous tPA on infarction volume and effects of rtPA on infarction volume, blood-brain barrier, brain edema, intracerebral hemorrhage, neurological function and mortality rate in all 47 included studies. Standardized mean differences for continuous measures and risk ratio for dichotomous measures were calculated to assess the effects of endogenous tPA and rtPA on cerebral infarction in animals. The quality of included studies was assessed using the Stroke Therapy Academic Industry Roundtable score. Subgroup analysis, meta-regression and sensitivity analysis were performed to explore sources of heterogeneity. Funnel plot, Trim and Fill method and Egger’s test were obtained to detect publication bias. Results We found that both endogenous tPA and rtPA had not enlarged infarction volume, or deteriorated neurological function. However, rtPA would disrupt blood-brain barrier, aggravate brain edema, induce intracerebral hemorrhage and increase mortality rate. Conclusions This meta-analysis reveals rtPA can lead to neurological side effects besides thrombolysis in mechanical animal stroke, which may account for clinical exacerbation for stroke patients that do not achieve vascular recanalization with rtPA. PMID:27387385

  9. Direct thrombolysis of multiple thrombi in both right and left heart atrium in a patient on extracorporeal membrane oxygenation support following urgent double-lung transplantation: a case report

    Directory of Open Access Journals (Sweden)

    Pollert L

    2016-06-01

    Full Text Available Lukas Pollert,1 Zuzana Prikrylova,1 Jan Berousek,1 Frantisek Mosna,1 Robert Lischke2 1Department of Anaesthesiology and Intensive Care, 2nd Faculty of Medicine, 23rd Surgical Department, 1st Faculty of Medicine, Charles University in Prague and Motol University Hospital, Praha, Czech Republic Background: Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO. An antithrombotic strategy to mitigate ECMO bleeding and thrombotic complications is necessary. The use of thrombolytic therapy is recommended for patients with acute symptomatic embolism with associated hypotension or shock. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk.Case presentation: This case report describes a 32-year-old woman suffering from lymphangioleiomyomatosis, who underwent urgent double-lung transplantation. This patient was maintained on ECMO preoperatively, perioperatively, and postoperatively due to life-threatening hypoxemia caused by the progression of her pulmonary tissue damage. Multiple thrombi developed in the early postoperative period, in both right and left heart atria. Direct thrombolysis was successfully performed on the first postoperative day.Conclusion: According to the current published literature, direct thrombolysis of thrombi in both right and left atria in a patient supported on ECMO following urgent double-lung transplantation is an extremely rare treatment method. Even when taking into account all of the risks

  10. Reasons for exclusion from intravenous thrombolysis in stroke patients admitted to the Stroke Unit.

    Science.gov (United States)

    Cappellari, Manuel; Bosco, Mariachiara; Forlivesi, Stefano; Tomelleri, Giampaolo; Micheletti, Nicola; Carletti, Monica; Bovi, Paolo

    2016-11-01

    Intravenous (IV) thrombolysis is the treatment in ischemic stroke, but only the minority of patients receive this medication. The primary objective of this study was to explore the reasons associated with the decision not to offer IV thrombolysis to stroke patients admitted to the Stroke Unit (SU). We conducted a retrospective analysis based on data collected from 876 consecutive stroke patients admitted to the SU 4.5 h (p = 0.001) and unknown time of onset (or stroke present on awakening) (p = 0.004) were reasons listed in the current SPC of Actilyse reasons for exclusion even they occurred singly, whereas mild deficit (or rapidly improving symptoms) (p exclusion even when it occurred singly, whereas early CT hypodensity (p exclusion, early CT hypodensity was associated with decision not offer IV thrombolysis in patients with mild deficit (p 80 years (p 4.5 h (p = 0.005), and unknown time of onset (p = 0.037), while severe pre-stroke disability (p = 0.025) and admission under non-stroke specialist neurologist assessment (p = 0.018) in patients with age >80 years. There are often unjustified reasons for exclusion from IV thrombolysis in SU.

  11. Successful catheter directed thrombolysis of IVC and renal vein occlusive thrombus.

    LENUS (Irish Health Repository)

    McCarthy, E

    2011-11-01

    Thrombus formation is a recognised complication of IVC filter placement, however IVC and bilateral renal vein occlusion secondary to thrombus is much less common. We present a case of infrahepatic caval and bilateral renal vein occlusion secondary to thrombosis of a suprarenal IVC filter. With progressive clinical deterioration and failure of conservative medical management the patient underwent successful mechanical disruption and catheter directed thrombolysis.

  12. Catheter-directed thrombolysis in the treatment of iliofemoral venous thrombosis. A review

    DEFF Research Database (Denmark)

    Broholm, Rikke; Jensen, Leif Panduro; Bækgaard, Niels

    2010-01-01

    Patients with acute iliofemoral venous thrombosis treated with anticoagulation only are at high risk of developing postthrombotic syndrome. Immediate removal of the thrombus by catheter-directed thrombolysis (CDT) may increase patency, prevent damage of the venous valves, and prevent reflux and P...

  13. [Bilateral deep venous thrombosis and vena cava aplasia treated with local thrombolysis

    DEFF Research Database (Denmark)

    Pelta, A.M.; Jørgensen, Maja; Just, Sven Richardt Lundgren;

    2008-01-01

    In this case report the treatment of a young man with bilateral iliaco-femoral DVT and vena cava aplasia is presented. The patient was treated with catheter-directed thrombolysis; the catheters were introduced in the thrombus of both legs via v. popliteae. The treatment led to almost complete...

  14. Editor's choice - Safety of carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke

    DEFF Research Database (Denmark)

    Rathenborg, L K; Venermo, M; Troëng, T

    2014-01-01

    OBJECTIVE: Few studies have been published on the safety of carotid endarterectomy (CEA) after intravenous thrombolysis (IVT). Registry reports have been recommended in order to gather large study groups. DESIGN: A retrospective, registry based, case controlled study on prospectively gathered data...

  15. Myocardial salvage after intracoronary thrombolysis with streptokinase in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Markis, J.E.; Malagold, M.; Parker, J.A.; Silverman, K.J.; Barry, W.H.; Als, A.V.; Paulin, S.; Grossman, W.; Braunwald, E.

    1981-10-01

    Nine patients with acute myocardial infarction had cardiac catheterization and intracoronary infusions of streptokinase 2.3 to 4.3 hours (mean, 3.5) after the onset of symptoms. Occluded coronary arteries were opened within approximately 20 minutes in all patients, but reocclusion occurred in one patient. The immediate effect of thrombolysis on myocardial salvage was assessed with the intracoronary injection of thallium-201. Improved regional perfusion, indicating myocardial salvage after recanalization, was observed in seven of the nine patients. One patient, who had also sustained a nontransmural infarction one week before, had no change after thrombolysis. In the ninth patient, recanalization of a coronary artery was followed by reocclusion and worsening of the myocardial-perfusion defect. Intracoronary thallium-201 studies two weeks and three months after streptokinase infusion in two patients were unchanged in comparison with scintiscans performed 1.5 hours after thrombolysis. These short-term observations suggest that recanalization of obstructed coronary arteries after intracoronary thrombolysis can salvage jeopardized myocardium, However, evaluation of the long-term effects of this procedure on survival and myocardial function will require controlled clinical trials.

  16. Eligibility of stroke units in Poland for administration of intravenous thrombolysis.

    Science.gov (United States)

    Członkowska, A; Sarzyńska-Długosz, I; Niewada, M; Kobayashi, A

    2006-03-01

    Systemic thrombolysis treatment was approved in Poland in 2003 and should be performed in specialist stroke units (SU). We performed a survey to determine stroke service preparedness for thrombolysis treatment in Poland. We sent a questionnaire evaluating the neurological departments in Poland, where stroke patients are treated. We divided them into four categories: (i) class A SU (fulfilling criteria of the National Program for Stroke Prevention and Therapy and European Stroke Initiative guidelines), (ii) class B (conditionally fulfilling criteria), (iii) class C (not fulfilling criteria), and (iv) departments without SU. Only class A units are eligible for implementing thrombolysis. We obtained response from 194 of 222 (87.4%) departments; 90 (46.4%) declared having an SU. According to criteria, 20 class A, 56 class B, 14 class C. During one year, 71 208 patients were admitted to hospitals; 69,982 (98.2%) to neurological departments. A total of 10,959 (15.4%) were treated in class A SU, 23,650 (33.2%) in class B, 5153 (7.2%) in class C, whereas 30,220 (42.4%) in neurological departments without SU. Our survey showed that only 15.4% stroke patients in Poland are admitted to high-quality SU, where thrombolysis may potentially be administered. Improvement of SU quality in Poland is necessary for wide implementation of new methods of stroke therapy.

  17. Effect of cause of iliac vein stenosis and extent of thrombus in the lower extremity on patency of iliac venous stent placed after catheter-directed thrombolysis of acute deep venous thrombosis in the lower extremity

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    Jung, Sung Il; Choi, Young Ho; Yoon, Chang Jin; Lee, Min Woo; Chung, Jin Wook; Park, Jae Hyung [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2003-10-01

    To assess the CT findings of acute deep venous thrombosis (DVT) in a lower extremity prior to catheter-directed thrombolysis, and to evaluate their relevance to the patency of an iliac venous stent placed with the help of CT after catheter-directed thrombolysis of DVT. Fourteen patients [M:F=3:11; age, 33-68 (mean, 50.1) years] with acute symptomatic DVD of a lower extremity underwent CT before and after catheter-directed thrombolysis using an iliac venous stent. The mean duration of clinical symptoms was 5.0 (range, 1-14 days. The CT findings prior to thrombolysis were evaluated in terms of their anatomic cause and the extent of the thrombus, and in all patients, the patency of the iliac venous stent was assessed at CT performed during a follow-up period lasting 6-31 (mean, 18.9) months. All patients were assigned to the patent stent group (n=9) or the occluded stent group (n=5). In the former, the anatomic cause of patency included typical iliac vein compression (May-Thurner syndrome) (n=9), and a relatively short segmental thrombus occurring between the common iliac and the popliteal vein (n=8). Thrombi occurred in the iliac vein (n=3), between the common iliac and the femoral vein (n=3), and between the common iliac and the popliteal vein (n=2). In one case, a relatively long segmental thrombus occurred between the common iliac vein and the calf vein. In the occluded stent group, anatomic causes included atypical iliac vein compression (n=3) and a relatively long segmental thrombus between the common iliac and the calf vein (n=4). Typical iliac vein compression (May-Thurner syndrome) occurred in two cases, and a relatively short segmental thrombus between the external iliac and the common femoral vein in one. Factors which can affect the patency of an iliac venous stent positioned after catheter-directed thrombolysis are the anatomic cause of the stenosis, and the extent of a thrombus revealed at CT of acute DVT and occurring in a lower extremity prior to

  18. The outcome of patients with mild stroke improves after treatment with systemic thrombolysis.

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    Xabier Urra

    Full Text Available INTRODUCTION: In up to one third of patients with mild stroke suitable to receive systemic thrombolysis the treatment is not administered because the treating physicians estimate a good spontaneous recovery. However, it is not settled whether the fate of these patients is equivalent to those who are thrombolysed. METHODS: We analyzed 203 consecutive patients (134 men and 69 women, mean age 69±14 years without premorbid disability and a NIHSS score ≤5 at admission [median 3 (IQR 2-4]. Intravenous thrombolysis was administered within 4.5 hours from stroke onset (n = 119, or it was withheld (n = 84 whenever the treating physician predicted a spontaneous recovery. The baseline risk factors, clinical course, infarction volume, bleeding complications, and functional outcome at 3 months were analyzed and declared to a Web-based registry which was accessible to the local Health Authorities. RESULTS: Expectedly, not thrombolysed patients had the mildest strokes at admission [median 2 (IQR 1-3.75]. At day 2 to 5, the infarct volume on DWI-MRI was similar in both groups. There were no symptomatic cerebral bleedings in the study. An ordinal regression model adjusted for baseline stroke severity showed that thrombolysis was associated with a greater proportion of patients who shifted down on the modified Rankin Scale score at 3 months (OR 2.66; 95% CI 1.49-4.74, p = 0.001. CONCLUSIONS: Intravenous thrombolysis seems to be safe in patients with mild stroke and may be associated with improved outcome compared with untreated patients. These results support the evaluation of the efficacy of intravenous thrombolysis in mild stroke patients in randomized clinical trials.

  19. Comparison the effect of two ways of tube feeding including bolus and continuous infusion on gastric residual volume and diarrhea in patients hospitalized in Intensive Care Unit

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    Shahriari M

    2015-05-01

    Full Text Available Background and Objective: Proper nutritional support is one of the important caring aspects in patients who were hospitalized in Intensive Care Unit. Although the several studies have been done concerning the selection of proper nutrition method for patients, but there is no agreement on this issue. The aim of current study was the compare the effect of two ways of tube feeding including bolus and continuous infusion on gastric residual volume and diarrhea in patients hospitalized in Intensive Care Unit.  Materials and Method: The current clinical trial was conducted on patients who were hospitalized in intensive care unit in Alzahra hospital in Isfahan, 2013. Fifty patients were selected through convenient sampling and were randomly assigned into two groups of 25 people of intervention and control. Nutrition was done through infusion pump in intervention group and by bolus in control group. Gastric residual volume and diarrhea was assessed each four hours for four days. Data were gathered through checklist and were analyzed by SPSS18 using descriptive and inferential statistics including independent T-test, Fisher's exact test and repeated measures ANOVA.  Results: The results showed that the mean of gastric residual volume in control group was more than the intervention group on the third day (p=0.04. Also, the mean of gastric residual volume did not show significant difference at different times in intervention group, but the mean of gastric residual volume was significantly increased in control group at different times (p=0.04. Fisher's exact test showed no significant difference between two groups concerning the diarrhea frequency.  Conclusion: In nutritional support with continuous infusion method, gastric residual volume was not increased and gastric emptying rate was not diminished. Therefore, this method can be used as an appropriate nutritional support in intensive care unit.

  20. Developing and testing a patient information booklet for thrombolysis used in acute stroke.

    Science.gov (United States)

    Knapp, Peter; Wanklyn, Peter; Raynor, D K; Waxman, Robin

    2010-12-01

    Objective  Thrombolysis decreases the chance of post-stroke dependence, although its use carries significant risk, notably of intra-cerebral haemorrhage. Patients (and families) face an important risk/benefit decision before consenting. We drafted a patient information booklet for this purpose, and applied performance-based readability testing with the aim that the most important information in the booklet could be found and understood. Methods  The booklet was developed with reference to best practice in information writing and design. We User-Tested its performance on 56 people without prior experience of stroke. After reading the booklet they were asked to find and explain 15 pieces of information. The booklet was revised according to its performance and re-tested, until each item was found and understood by at least 80% of participants. Key findings  The four-page information booklet contained approximately 900 words, organised into six sections. A risk-palette graphic showed the chance of positive and negative outcomes. The booklet was tested on four participant cohorts and revised, including more bold text, re-wording, changing the title and changing the graphic to a coloured bar chart. Testing the final version on the fourth cohort of 20 people showed that each of the 15 tested items of information met the target of at least 80% participants being able to find and understand it. Conclusions  The use of information design and User Testing produced a booklet that is understandable by people with no prior experience of stroke. User Testing is an inexpensive and quick method to ensure that information intended for patients is usable.

  1. Stroke outcomes in Thai elderly patients treated with and without intravenous thrombolysis

    Directory of Open Access Journals (Sweden)

    Pornpatr A. Dharmasaroja

    2013-08-01

    Full Text Available Higher mortality was found in very old patients with acute ischemic stroke treated with intravenous recombinant tissue-plasminogen activator (rtPA as compared to younger patients. The benefit of thrombolytic treatment in this particular subgroup is still a subject of debate. The purpose of this study was to compare stroke outcomes in Thai patients aged over 70 years treated with and without intravenous rtPA. This was a retrospective review of sequential cases and was not a randomized controlled study. One-hundred and five patients with acute ischemic stroke aged over 70 years who were treated with intravenous rtPA and 105 patients without rtPA treatment (control group were included in the study. Patients’ base-line characteristics and study outcomes of interest were compared. There were significant differences in the base-line characteristics of the two groups. However, for the subgroup of patients aged over 80 years, these characteristics were similar. Those who were treated with intravenous rtPA had a higher rate of favorable outcomes (40% vs 16%; P=0.137 and a lower rate of mortality (22% vs 44%; P=0.128 than patients who did not receive rtPA treatment. In well-matched subgroups of patients aged over 80 years, our retrospective review revealed there was a trend of a higher rate of favorable outcome and lower mortality in patients receiving rtPA treatment. More study is needed to further confirm the suggested benefit of thrombolysis in Asian octogenarian acute stroke patients.

  2. Catheter-Directed Thrombolysis with a Continuous Infusion of Low-Dose Urokinase for Non-Acute Deep Venous Thrombosis of the Lower Extremity

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    Gao, Binbin; Zhang, Jingyong; Wu, Xuejun; Han, Zonglin; Zhou, Hua; Dong, Dianning; Jin, Xing [Shandong Provincial Hospital, Shandong University, Ji' nan (China)

    2011-02-15

    We wanted to evaluate the feasibility of catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for treating non-acute (less than 14 days) deep venous thrombosis of the lower extremity. The clinical data of 110 patients who were treated by catheter-directed thrombolysis with a continuous infusion of low-dose urokinase for lower extremity deep venous thrombosis was analysed. Adjunctive angioplasty or/and stenting was performed for the residual stenosis. Venous recanalization was graded by pre- and posttreatment venography. Follow-up was performed by clinical evaluation and Doppler ultrasound. A total of 112 limbs with deep venous thrombosis with a mean symptom duration of 22.7 days (range: 15-38 days) were treated with a urokinase infusion (mean: 3.5 million IU) for a mean of 196 hours. After thrombolysis, stent placement was performed in 25 iliac vein lesions and percutaneous angioplasty (PTA) alone was done in fi ve iliac veins. Clinically significant recanalization was achieved in 81% (90 of 112) of the treated limbs: complete recanalization was achieved in 28% (31 of 112) and partial recanalization was achieved in 53% (59 of 112). Minor bleeding occurred in 14 (13%) patients, but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. During followup (mean: 15.2 months, range: 3-24 months), the veins were patent in 74 (67%) limbs. Thirty seven limbs (32%) showed progression of the stenosis with luminal narrowing more than 50%, including three with rethrombosis, while one revealed an asymptomatic iliac vein occlusion: 25 limbs (22%) developed mild post-thrombotic syndrome, and none had severe post-thrombotic syndrome. Valvular reflux occurred in 24 (21%) limbs. Catheter-directed thrombolysis with a continuous infusion of low-dose urokinase combined with adjunctive iliac vein stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower

  3. Thrombolysis in a Stroke Patient on Dabigatran Anticoagulation: Case Report and Synopsis of Published Cases

    Directory of Open Access Journals (Sweden)

    Waltraud Pfeilschifter

    2013-03-01

    Full Text Available We present the case of an aphasic 77-year-old stroke patient with left distal M1 occlusion who received rt-PA for thrombolysis while on oral anticoagulant treatment with dabigatran (150 mg b.i.d.. Coagulation parameters were normal (thrombin time 20 s, aPTT 20 s, INR 1.08 and the patient improved from an NIHSS of 15 to 5 within 24 h with sonographic evidence of M1 recanalization. She did not develop intracranial bleeding complications but showed unusually large diffuse skin ecchymoses. In our report, we give an overview of all reported cases of thrombolysis under dabigatran anticoagulation and discuss the questions of medication adherence under novel oral anticoagulants (NOA and the safety of NOA in terms of secondary intracerebral hemorrhage after stroke.

  4. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    Science.gov (United States)

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients.

  5. Pharmacomechanical thrombolysis for renal salvage after filter migration and renal vein thrombosis.

    Science.gov (United States)

    Kiguchi, Misaki; McDonald, Kerry-Ann; Govindarajan, Siddarth; Makaroun, Michel S; Chaer, Rabih A

    2011-05-01

    A 64-year-old woman underwent prophylactic inferior vena cava filter placement immediately after spinal surgery for pulmonary embolus prophylaxis. One week after surgery, acute renal failure developed, and she required hemodialysis secondary to filter migration with iliocaval and renal vein thrombosis. Pharmacomechanical thrombolysis was performed, with complete recovery of renal function and no evidence of recurrence on follow-up imaging. This report highlights an important and rare complication of filter placement and the importance of prompt thrombus debulking to preserve end organ function while reducing the risks of hemorrhagic complications. Pharmacomechanical thrombolysis allows prompt clearance of venous outflow channels and is attractive in patients with end-organ compromise and high risk for bleeding.

  6. Thrombolysis outcomes in acute ischemic stroke patients with prior stroke and diabetes mellitus

    DEFF Research Database (Denmark)

    Mishra, N K; Ahmed, N; Davalos, A;

    2011-01-01

    in Stroke-International Stroke Thrombolysis Register) compared to nonthrombolyzed controls (C; data from Virtual International Stroke Trials Archive). METHODS: We selected ischemic stroke patients on whom we held data on age, baseline NIH Stroke Scale score (NIHSS), and 90-day modified Rankin Scale score (m......BACKGROUND: Patients with concomitant diabetes mellitus (DM) and prior stroke (PS) were excluded from European approval of alteplase in stroke. We examined the influence of DM and PS on the outcomes of patients who received thrombolytic therapy (T; data from Safe Implementation of Thrombolysis......RS). We compared the distribution of mRS between T and C by Cochran-Mantel-Haenszel (CMH) test and proportional odds logistic regression, after adjustment for age and baseline NIHSS, in patients with and without DM, PS, or the combination. We report odds ratios (OR) for improved distribution of m...

  7. Renal infarction caused by spontaneous renal artery dissection: treatment with catheter-directed thrombolysis and stenting.

    Science.gov (United States)

    Jeon, Yong Sun; Cho, Soon Gu; Hong, Ki Cheon

    2009-03-01

    Spontaneous renal artery dissection (SRAD) is rare and presents a diagnostic and therapeutic challenge. We report a case of a 36-year-old man who had an SRAD-complicated renal infarction. The patient experienced severe unilateral flank pain. Enhanced abdominal computed axial tomography scan showed renal infarction, and urinalysis showed no hematuria. Selective renal angiography was essential to evaluate the extent of dissection and suitability for repair. The patient was treated with catheter-directed thrombolysis and frenal artery stenting.

  8. Acute suprachoroidal haemorrhage post-tenecteplase thrombolysis for myocardial infarction: management considerations.

    Science.gov (United States)

    Trikha, Sameer; Lockwood, Alastair; Puvanachandra, Narman; Kirwan, James

    2010-05-13

    We report a case of a 63-year-old man who received intravenous tenecteplase as thrombolytic therapy for an inferior ST elevation myocardial infarction. Three hours later he complained of blurred vision in the right eye and on examination had sustained a suprachoroidal haemorrhage. With conservative treatment the haemorrhage resolved, leading to a normalisation of visual acuity. To the authors' knowledge, no case reports exist of this rare complication following intravenous tenecteplase. We discuss implications for further thrombolysis and anticoagulation.

  9. Dependence of pulsed focused ultrasound induced thrombolysis on duty cycle and cavitation bubble size distribution.

    Science.gov (United States)

    Xu, Shanshan; Zong, Yujin; Feng, Yi; Liu, Runna; Liu, Xiaodong; Hu, Yaxin; Han, Shimin; Wan, Mingxi

    2015-01-01

    In this study, we investigated the relationship between the efficiency of pulsed, focused ultrasound (FUS)-induced thrombolysis, the duty cycle (2.3%, 9%, and 18%) and the size distribution of cavitation bubbles. The efficiency of thrombolysis was evaluated through the degree of mechanical fragmentation, namely the number, mass, and size of clot debris particles. First, we found that the total number and mass of clot debris particles were highest when a duty cycle of 9% was used and that the mean diameter of clot debris particles was smallest. Second, we found that the size distribution of cavitation bubbles was mainly centered around the linear resonance radius (2.5μm) of the emission frequency (1.2MHz) of the FUS transducer when a 9% duty cycle was used, while the majority of cavitation bubbles became smaller or larger than the linear resonance radius when a 2.3% or 18% duty cycle was used. In addition, the inertial cavitation dose from the treatment performed at 9% duty cycle was much higher than the dose obtained with the other two duty cycles. The data presented here suggest that there is an optimal duty cycle at which the thrombolysis efficiency and cavitation activity are strongest. They further indicate that using a pulsed FUS may help control the size distribution of cavitation nuclei within an active size range, which we found to be near the linear resonance radius of the emission frequency of the FUS transducer.

  10. Intravenous Thrombolysis after Reversal of Dabigatran by Idarucizumab: A Case Report

    Science.gov (United States)

    Kafke, Waldemar; Kraft, Peter

    2016-01-01

    We describe a 75-year-old female patient with nonvalvular atrial fibrillation who presented with acute ischemic stroke during treatment with dabigatran 2 × 110 mg per day. After informed consent, we reversed the anticoagulant effects of dabigatran using idarucizumab and applied an intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (off-label use). An intracerebral hemorrhage was excluded after systemic thrombolysis. Despite the IVT, the patient's clinical condition deteriorated and she developed an ischemic lesion in the right pons, the right thalamus and right cerebellum. To date, the literature lacks data concerning the thrombolytic treatment of acute ischemic stroke in patients after specific reversal of the non-vitamin K oral anticoagulant dabigatran using idarucizumab. Given the rapid and sustainable efficacy of idarucizumab, the reversal of dabigatran followed by thrombolysis seems to be safe, but further studies and register data are still needed to confirm our preliminary observation, especially to provide additional data concerning the risk-benefit evaluation. PMID:27482196

  11. Selective thrombolysis performed through meningo-ophthalmic artery in central retinal artery occlusion.

    Science.gov (United States)

    Cohen, José E; Moscovici, Samuel; Halpert, Michael; Itshayek, Eyal

    2012-03-01

    The poor natural history of central retinal artery occlusion (CRAO) is usually not modified with conventional, conservative management techniques. Guidelines for selective intraarterial ophthalmic thrombolysis are still lacking. While many centers continue to perform this procedure with promising results, others are reluctant due to conflicting findings in recent studies. We present our experience in a 36-year-old male with CRAO. Based on the patient's clinical presentation, we planned to perform selective intraarterial ophthalmic thrombolysis via the ophthalmic artery. When angiography demonstrated that the retina was not supplied by the ophthalmic artery, but by a meningo-ophthalmic artery branching from the internal maxillary artery, we instead administered thrombolytic agents via the meningo-ophthalmic artery. The patient's vision recovered completely, with visual acuity and visual field examination at 30 day follow up comparable to his pre-treatment status. This case emphasizes the need for external carotid artery examination in cases of nonvisualization of the ophthalmic artery. In addition, it illustrates the successful use of the meningo-ophthalmic artery to perform selective intraarterial thrombolysis for CRAO.

  12. Local intra-arterial thrombolysis in the carotid territory: does recanalization depend on the thromboembolus type?

    Energy Technology Data Exchange (ETDEWEB)

    Urbach, H.; Wilhelm, K.; Flacke, S.; Schild, H.H. [Department of Radiology/Neuroradiology, University of Bonn, Sigmund Freud Strasse 25, 53105 Bonn (Germany); Hartmann, A.; Pohl, C.; Klockgether, T. [Department of Neurology, University of Bonn, Sigmund Freud Strasse 25, 53105 Bonn (Germany); Omran, H. [Department of Cardiology, University of Bonn, Sigmund Freud Strasse 25, 53105 Bonn (Germany)

    2002-08-01

    Little is known about whether recanalization of carotid territory occlusions by local intra-arterial thrombolysis (LIT) depends on the type of the occluding thromboembolus. We retrospectively analysed the records of 62 patients with thromboembolic occlusions of the intracranial internal carotid artery (ICA) bifurcation or the middle cerebral artery who were undergoing LIT with urokinase within 6 h of symptom onset. We determined the influence of thromboembolus type (according to the TOAST criteria), thromboembolus location, leptomeningeal collaterals, time interval from onset of symptoms to onset of thrombolysis, and patient's age on recanalization. The thromboembolus type was atherosclerotic in six patients, cardioembolic in 29, of other determined etiology in four, and of undetermined etiology in 23 patients. Thirty-three (53%) thromboembolic occlusions were recanalized. The thromboembolus location but not the TOAST stroke type nor other parameters affected recanalization. In the TOAST group of patients with cardioembolic occlusions recanalization occurred significantly less frequently when transoesophageal echocardiography showed cardiac thrombus. The present study underlines the thromboembolus location as being the most important parameter affecting recanalization. The fact that thromboembolic occlusions originating from cardiac thrombi had a lower likelihood of being resolved by thrombolysis indicates the thromboembolus type as another parameter affecting recanalization. (orig.)

  13. Acute extensive portal and mesenteric venous thrombosis after splenectomy: Treated by interventional thrombolysis with transjugular approach

    Institute of Scientific and Technical Information of China (English)

    Mao-Qiang Wang; Han-Ying Lin; Li-Ping Guo; Feng-Yong Liu; Feng Duan; Zhi-Jun Wang

    2009-01-01

    AIM: To present a series of cases with symptomatic acute extensive portal vein (PV) and superior mesenteric vein (SMV) thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS: A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis.The mean age of the patients was 41.2 years. After access to the portal system via the transjugular approach, pigtail catheter fragmentation of clots,local urokinase injection, and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis, followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV, which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization, and after discharge. RESULTS: Technical success was achieved in all 6 patients. Clinical improvement was seen in these patients within 12-24 h of the procedure. No complications were observed. The 6 patients were discharged 6-14 d (8 ± 2.5 d) after admission. The mean duration of follow-up after hospital discharge was 40 ± 16.5 mo. Ultrasound and contrast-enhanced computed tomography confirmed patency of the PV and SMV, and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period .CONCLUSION: Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

  14. Endovascular Treatment of Left Iliofemoral Deep Vein Thrombosis Using Urokinase Thrombolysis and Adjunctive Aspiration Thrombectomy

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Sang Hyun; Lee, Do Yun; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    To evaluate the efficacy of adjunctive aspiration thrombectomy for the treatment of iliofemoral deep vein thrombosis (DVT). 24 patients (9 males and 15 females; mean age, 53 years), treated by aspiration thrombectomy were enrolled in this study. The day after undergoing urokinase (UK) thrombolysis, any residual thrombus over a long segment was treated by aspiration thrombectomy using a 12 Fr long sheath. Residual short-segment (< 10 cm) iliac vein thrombus and/or stenosis were treated with a stent. The evaluation of venous patency was conducted by color Doppler ultrasonography, venography and/or computed tomography. The technical and clinical success rates were 100% and 92%, respectively. Twenty-three patients were treated by UK thrombolysis and iliac stent. The overall patency rate at 1, 2 and 3 years was 85%, 82% and 81%, respectively. Over the course of the follow-up period, occlusion was observed in 4 cases (1 acute and 3 chronic cases). Periprocedural complication occurred in 4 cases (17%) in the form of a minimal hematoma or pain on the puncture site as well as a case of pulmonary embolism at one month after treatment. The adjunctive aspiration thrombectomy with conventional thrombolysis and stent placement can be an effective and safe method in the treatment of left iliofemoral DVT

  15. The challenge of basilar artery occlusion wake-up stroke: too late for intravenous thrombolysis?

    Science.gov (United States)

    Caliandro, Pietro; Reale, Giuseppe; Tartaglione, Tommaso; Rossini, Paolo Maria

    2016-07-01

    We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy.

  16. Cost-effectiveness of recurrence risk guided care versus care as usual in women who suffered from early-onset preeclampsia including HELLP syndrome in their previous pregnancy (the PreCare study

    Directory of Open Access Journals (Sweden)

    de Wit-Zuurendonk Laura D

    2010-10-01

    Full Text Available Abstract Background Preeclampsia and HELLP syndrome may have serious consequences for both mother and fetus. Women who have suffered from preeclampsia or the HELLP syndrome, have an increased risk of developing preeclampsia in a subsequent pregnancy. However, most women will develop no or only minor complications. In this study, we intend to determine cost-effectiveness of recurrence risk guided care versus care as usual in pregnant women with a history of early-onset preeclampsia. Methods/design We developed a prediction model to estimate the individual risk of recurrence of early-onset preeclampsia and the HELLP syndrome. In a before-after study, pregnant women with preeclampsia or HELLP syndrome in their previous pregnancy receiving care as usual (before introduction of the prediction model will be compared with women receiving recurrence risk guided care (after introduction of the prediction model. Eligible and pregnant women will be recruited at six university hospitals and seven large non-university tertiary referral hospitals in the Netherlands. The primary outcome measure is the recurrence of early-onset preeclampsia or HELLP syndrome in women allocated to the regular monitoring group. For the economic evaluation, a modelling approach will be used. Costs and effects of recurrence risk guided care with those of care as usual will be compared by means of a decision model. Two incremental cost-effectiveness ratios will be calculated: 1 cost per Quality Adjusted Life Year (mother unit of analysis and 2 cost per live born child (child unit of analysis. Discussion This is, to our knowledge, the first study that evaluates prospectively the efficacy of a multivariable prediction rule for recurrent hypertensive disease in pregnancy. Results of this study could either be integrated into the current guideline on Hypertensive Disorders in Pregnancy, or be used to develop a new guideline.

  17. Simultaneous determination of multiclass preservatives including isothiazolinones and benzophenone-type UV filters in household and personal care products by micellar electrokinetic chromatography.

    Science.gov (United States)

    Lopez-Gazpio, Josu; Garcia-Arrona, Rosa; Millán, Esmeralda

    2015-04-01

    In this work, a simple and reliable micellar electrokinetic chromatography method for the separation and quantification of 14 preservatives, including isothiazolinones, and two benzophenone-type UV filters in household, cosmetic and personal care products was developed. The selected priority compounds are widely used as ingredients in many personal care products, and are included in the European Regulation concerning cosmetic products. The electrophoretic separation parameters were optimized by means of a modified chromatographic response function in combination with an experimental design, namely a central composite design. After optimization of experimental conditions, the BGE selected for the separation of the targets consisted of 60 mM SDS, 18 mM sodium tetraborate, pH 9.4 and 10% v/v methanol. The MEKC method was checked in terms of linearity, LODs and quantification, repeatability, intermediate precision, and accuracy, providing appropriate values (i.e. R(2) ≥ 0.992, repeatability RSD values ˂9%, and accuracy 90-115%). Applicability of the validated method was successfully assessed by quantifying preservatives and UV filters in commercial consumer products.

  18. Bioconjugation of recombinant tissue plasminogen activator to magnetic nanocarriers for targeted thrombolysis

    Directory of Open Access Journals (Sweden)

    Yang HW

    2012-10-01

    Full Text Available Hung-Wei Yang,1,* Mu-Yi Hua,1,* Kun-Ju Lin,2,* Shiaw-Pyng Wey,3 Rung-Ywan Tsai,4 Siao-Yun Wu,5 Yi-Ching Lu,5 Hao-Li Liu,6 Tony Wu,7 Yunn-Hwa Ma5 1Chang Gung Molecular Medicine Research Center, Department of Chemical and Materials Engineering, 2Molecular Imaging Center, Department of Nuclear Medicine, Chang Gung Memorial Hospital, Kuei-Shan, Tao-Yuan, Taiwan, Republic of China; 3Department of Medical Imaging and Radiological Sciences, 4Electronics and Optoelectronics Research Laboratories, Industrial Technology Research Institute, Hsin-chu, Taiwan, Republic of China; 5Department of Physiology and Pharmacology and Healthy Aging Research Center, 6Department of Electrical Engineering, Chang Gung University, Kuei-Shan, Tao-Yuan, Taiwan, Republic of China; 7Department of Neurology, Chang Gung University College of Medicine and Memorial Hospital, Tao-Yuan, Taiwan, Republic of China*These authors contributed equally to this workAbstract: Low-toxicity magnetic nanocarriers (MNCs composed of a shell of poly [aniline-co-N-(1-one-butyric acid aniline] over a Fe3O4 magnetic nanoparticle core were developed to carry recombinant tissue plasminogen activator (rtPA in MNC-rtPA for targeted thrombolysis. With an average diameter of 14.8 nm, the MNCs exerted superparamagnetic properties. Up to 276 µg of active rtPA was immobilized per mg of MNCs, and the stability of the immobilized rtPA was greatly improved during storage at 4°C and 25°C. In vitro thrombolysis testing with a tubing system demonstrated that magnet-guided MNC-rtPA showed significantly improved thrombolysis compared with free rtPA and reduced the clot lysis time from 39.2 ± 3.2 minutes to 10.8 ± 4.2 minutes. In addition, magnet-guided MNC-rtPA at 20% of the regular rtPA dose restored blood flow within 15–25 minutes of treatment in a rat embolism model without triggering hematological toxicity. In conclusion, this improved system is based on magnetic targeting accelerated thrombolysis and is

  19. Economic evaluation of angiographic interventions including a whole-radiology in- and outpatient care; Wirtschaftliche Evaluation angiographischer Interventionen einschliesslich einer radiologischen stationaeren und ambulanten Patientenbetreuung

    Energy Technology Data Exchange (ETDEWEB)

    Nolte-Ernsting, C.; Abel, K.; Krupski, G.; Lorenzen, J.; Adam, G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany)

    2006-01-01

    Purpose: To determine the economic efficiency of a whole-radiology in- and outpatient treatment with angiographic interventions performed as the main or sole therapy. Materials and Methods: The calculations represent the data of a university radiology department, including the following angiographic interventions (neuroradiology not considered): Vascular intervention (PTA, stent implantation) of kidneys and extremities, recanalization of hemodialysis access, chemoembolization, diagnostic arterioportal liver CT, port implantation, varicocele embolization, PTCD, percutaneous implantation of biliary stent. First, the different angiographic interventions are categorized with reference to the German DRG system 2005. Considering the example of a university hospital, the individual cost of each intervention is calculated and correlated with reimbursements by G-DRG2005 and so-called ''ambulant operation'' (EBM200plus). With these data, profits and losses are calculated for both in- and outpatient care. Results: Radiologic interventions of inpatients yield a profit in the majority of cases. With a base rate of 2900 Euro, the profits in our university hospital range between -872 Euro and +3411 Euro (mean: +1348 Euro). On the other hand, those angiographic interventions suitable for ''ambulant operation'' generate average profits of +372 Euro, if only direct costs are considered. The data of outpatient radiological interventions average between 381 Euro up to 1612 Euro lower than compared with profits obtained from in patient care. (orig.)

  20. Mechanical Recanalization following i.v. Thrombolysis: A Retrospective Analysis regarding Secondary Hemorrhagic Infarctions and Parenchymal Hematomas

    Science.gov (United States)

    Höltje, J.; Bonk, F.; Anstadt, A.; Terborg, C.; Pohlmann, C.; Urban, P. P.; Brüning, R.

    2015-01-01

    Introduction. In acute stroke by occlusion of the proximal medial cerebral artery (MCA) or the distal internal carotid artery, intravenous thrombolysis is an established treatment. Another option is mechanical recanalization. It remains unclear if the combination of both methods poses an additional bleeding risk. The aim of this retrospective analysis is to determine the proportion of hemorrhagic infarctions and parenchymal hematomas. Methods. Inclusion criteria were an occlusion of the carotid T or proximal MCA treated with full dose thrombolysis and mechanical recanalization. 31 patients were selected. Devices used were Trevo, Penumbra Aspiration system, Penumbra 3D Retriever, and Revive. The initial control by computed tomography was carried out with a mean delay to intervention of 10.9 hours (SD: 8.5 hours). Results. A slight hemorrhagic infarction (HI1) was observed in 2/31 patients, and a more severe HI2 occurred in two cases. A smaller parenchymal hematoma (PH1) was not seen and a space-occupying PH2 was seen in 2/31 cases. There was no significant difference in the probability of intracranial bleeding after successful (thrombolysis in cerebral infarctions 2b and 3) or unsuccessful recanalization. Conclusion. The proportion of intracranial bleeding using mechanical recanalization following intravenous thrombolysis appears comparable with reports using thrombolysis alone. PMID:26640710

  1. Mechanical Recanalization following i.v. Thrombolysis: A Retrospective Analysis regarding Secondary Hemorrhagic Infarctions and Parenchymal Hematomas

    Directory of Open Access Journals (Sweden)

    J. Höltje

    2015-01-01

    Full Text Available Introduction. In acute stroke by occlusion of the proximal medial cerebral artery (MCA or the distal internal carotid artery, intravenous thrombolysis is an established treatment. Another option is mechanical recanalization. It remains unclear if the combination of both methods poses an additional bleeding risk. The aim of this retrospective analysis is to determine the proportion of hemorrhagic infarctions and parenchymal hematomas. Methods. Inclusion criteria were an occlusion of the carotid T or proximal MCA treated with full dose thrombolysis and mechanical recanalization. 31 patients were selected. Devices used were Trevo, Penumbra Aspiration system, Penumbra 3D Retriever, and Revive. The initial control by computed tomography was carried out with a mean delay to intervention of 10.9 hours (SD: 8.5 hours. Results. A slight hemorrhagic infarction (HI1 was observed in 2/31 patients, and a more severe HI2 occurred in two cases. A smaller parenchymal hematoma (PH1 was not seen and a space-occupying PH2 was seen in 2/31 cases. There was no significant difference in the probability of intracranial bleeding after successful (thrombolysis in cerebral infarctions 2b and 3 or unsuccessful recanalization. Conclusion. The proportion of intracranial bleeding using mechanical recanalization following intravenous thrombolysis appears comparable with reports using thrombolysis alone.

  2. Assessment of coagulation function and ultrasound features after reteplase and recombinant streptokinase thrombolysis of lower extremity deep venous thrombosis

    Institute of Scientific and Technical Information of China (English)

    Wei Xiong

    2016-01-01

    Objective: To assess coagulation function and ultrasound features after reteplase and recombinant streptokinase thrombolysis of lower extremity deep venous thrombosis. Methods:A total of 78 cases of patients with lower extremity deep venous thrombosis who were treated in our hospital were selected as research subjects and divided into observation group 39 cases and control group 39 cases according to different treatment regimens. Control group received recombinant streptokinase thrombolysis, observation group received reteplase thrombolysis, and then the effect of the two thrombolytic ways was evaluated by color Doppler ultrasonography and circulating blood test. Results:Ultrasound showed that complete recanalization rate of thrombus of observation group after treatment was higher than that of control group;plasma PT, APTT and TT values of observation group after thrombolysis were higher than those of control group, FIB, D-D, NO, ET, E-selectin, P-selectin, Hcy, CRP, IL-6, IL-8 and TNF-αvalues were lower than those of control group, and WBC, Nc and Mc cell number were less than those of control group. Conclusion:Reteplase for thrombolysis of lower extremity deep venous thrombosis has more distinguished effect on dissolving thrombus as well as optimizing body’s coagulation, inflammatory system state and other aspects, and is a more ideal thrombolytic drug.

  3. Acute iliofemoral venous thrombosis in patients with atresia of the inferior vena cava can be treated successfully with catheter-directed thrombolysis

    DEFF Research Database (Denmark)

    Broholm, Rikke; Jørgensen, Maja; Just, Sven;

    2011-01-01

    To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT).......To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT)....

  4. Efficacy and safety of rt-PA intravenous thrombolysis in the treatment of acute ischemic stroke with hyperdense middle cerebral artery sign: a systematic review

    Directory of Open Access Journals (Sweden)

    Xin TAN

    2016-01-01

    Full Text Available Objective To systematically review the efficacy and safety of recombinant tissue-type plasminogen activator (rt-PA intravenous thrombolysis in the treatment of acute ischemic stroke with hyperdense middle cerebral artery sign (HMCAS on CT images. Methods Search online databases such as PubMed, EMBASE/SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL and China Biology Medicine (CBM from January 1994 to December 2014 with key words: hyperdense middle cerebral artery sign/HMCAS/hyperdense artery sign/hyperdense cerebral artery sign, ischemic stroke/cerebral infarction/brain infarction/cerebral embolism, thrombolysis/thrombolytic therapy/rt-PA/recombinant tissue plasminogen activator both in Chinese and English, to collect randomized controlled trials (RCTs or non-RCTs about rt-PA treating patients with acute ischemic stroke and HMCAS. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Newcastle-Ottawa Scale (NOS was used for quality assessment, and Meta-analysis was performed using RevMan 5.2 software. Results A total of 8 studies were included after excluding duplicate ones and those which did not meet the inclusion criteria from 166 articles. There were 11 373 patients, including 2455 cases complicated with HMCAS (2316 treated by rt-PA and 139 treated by placebo and 8918 cases without HMCAS. Meta-analysis showed the occurrence of unfavorable outcome in rt-PA treatment was significantly decreased compared to placebo in HMCAS-positive patients (OR = 0.360,95%CI: 0.150-0.850; P = 0.020, while there was no statistical difference in the occurrence of symptomatic intracerebral hemorrhage (sICH between rt-PA and placebo treatment in HMCAS-positive patients (OR = 1.640, 95%CI: 0.380-7.040; P = 0.500. Meta-analysis also showed unfavorable outcome of rt-PA treatment was significantly higher in HMCAS-positive than in HMCAS

  5. rt-PA导管接触溶栓联合腔内介入治疗下肢缺血的术中护理%Nursing of Lower Limb Ischemia by Rt-PA Catheter Contact Thrombolysis Combined with Endovascular Interventional Therapy

    Institute of Scientific and Technical Information of China (English)

    李桂香

    2015-01-01

    目的:探讨溶栓介入治疗的术中护理方式.方法:对84例急性或亚急性下肢缺血患者在溶栓介入治疗术中采取相应护理措施.结果:84例患者均成功完成溶栓介入治疗,效果满意.结论:血管外科专科护士参与溶栓介入治疗的术中护理对手术顺利进行及护理质量的提高.%Objective: To explore the nursing methods in the treatment of interventional treatment of thrombolysis.Methods:84 patients with acute or subacute lower limb ischemia were treated with appropriate nursing care in the treatment of thrombolysis.Results:All 84 patients were successfully completed the treatment of thrombolysis, the effect was satisfactory.Conclusions:The nursing care of patients with vascular surgery specialist in the treatment of interventional therapy for the treatment of patients with thrombolytic therapy and the improvement of nursing quality.

  6. Prognosis in the thrombolysis in myocardial ischemia III registry according to the Braunwald unstable angina pectoris classification.

    Science.gov (United States)

    Scirica, Benjamin M; Cannon, Christopher P; McCabe, Carolyn H; Murphy, Sabina A; Anderson, H Vernon; Rogers, William J; Stone, Peter H; Braunwald, Eugene

    2002-10-15

    The unstable angina pectoris (UAP) classification proposed by Braunwald in 1989, although often used, has never been validated in a large, prospective multicenter study in which all subgroups of patients were included. Patients with UAP or non-ST-elevation myocardial infarction (NSTEMI) were enrolled in the Thrombolysis In Myocardial Ischemia III Registry and classified according to the Braunwald classification for UAP. Clinical end points were compared at 6 weeks and 1 year. Of 3,318 patients, those with primary UAP had lower rates of recurrent myocardial infarction (MI) or death when compared with patients with secondary UAP and post-MI UAP at 6 weeks (4.1% vs 6.4% vs 13.4%, respectively; p Braunwald classification of UAP predicts prognosis with secondary UAP, post-MI UAP, and patients with pain at rest who have a higher risk for death or recurrent cardiac events. Given their high risk for adverse events, patients with secondary UAP should be treated aggressively.

  7. Stroke Care in Young Patients

    Directory of Open Access Journals (Sweden)

    L. Tancredi

    2013-01-01

    Full Text Available The aims of this study were (i to evaluate the clinical features of a consecutive series of young patients with ischemic stroke and (ii to assess the changes in the clinical management of these patients over the study period. All consecutive cases of young adults aged 16 to 44 years, with ischemic stroke, that were admitted between 2000 and 2005 in 10 Italian hospitals were included. We retrospectively identified 324 patients. One or more vascular risk factors were present in 71.5% of the patients. With respect to the diagnostic process, an increase in the frequency of cerebral noninvasive angiographic studies and a decrease in the use of digital subtraction angiography were observed ( and , resp.. Undetermined causes decreased over 5-year period of study (. The diagnosis of cardioembolism increased. Thrombolysis was performed for 7.7% of the patients. PFO closure (8% was the most frequently employed surgical procedure. In conclusion, the clinical care that is given to young patients with ischemic stroke changed over the study period. In particular, we detected an evolution in the diagnostic process and a reduction in the number of undetermined cases.

  8. Efficacy of recombinant tissue-type plasminogen activator thrombolysis and primary coronary stenting after acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    陈步星; 王伟民; 赵红; 胡大一; 徐成斌; 赵明中; 卢明瑜; 刘健; 吴淳

    2003-01-01

    Objective To compare the efficacy of low dose recombinant tissue-type plasminogen activator (rt-PA) thrombolysis with primary coronary stenting after acute myocardial infarction.Methods Of 261 patients with first acute myocardial infarction, 131 were given low dose rt-PA intravenous thrombolysis, and 130 primary coronary stenting.Results The age, time from onset of chest pain to hospital presentation and infarct location between these two groups were comparable. The patency rate of the infarct-related artery (IRA) in patients in the thrombolysis group was significantly lower than that of patients in the primary stenting group (P0.05).Conclusion Comparing with low dose rt-PA thrombolytic therapy after acute myocardial infarction, primary coronary stenting has a higher patency rate of the IRA, better cardiac function and shorter hospitalization time.

  9. Predictors of major neurological improvement after intravenous thrombolysis in acute ischemic stroke: A hospital-based study from south India

    Directory of Open Access Journals (Sweden)

    Boddu Demudu

    2010-01-01

    Full Text Available Background : Despite the increasing use of recombinant tissue plasminogen activator (rt-PA in acute ischemic stroke, uncertainty persists about the short- and long-term outcome of the thrombolysed patients. Objective : To identify predictors of major neurological improvement at 24 h after intravenous rt-PA administration in patients of acute ischemic stroke and their relationship with outcome at 12 months. Materials and Methods : We analyzed the data of the patients with acute ischemic stroke treated as per the National Institute of Neurological Disorders and Stroke (NINDS criteria with intravenous rt-PA between January 2000 and June 2009 at a tertiary care center in south India. Major neurological improvement was defined by an 8-point improvement in National Institute of Health Stroke Scale (NIHSS score or an NIHSS score of 0 or 1 at 24 h. Good outcome was defined as a 12-month modified Rankin Scale (mRS of 0 to 1. Results : Of the 72 patients with acute ischemic stroke treated with intravenous rt-PA, 23 (32% patients had major neurological improvement at 24 h. Age <60 years (OR 1.9, 95% CI 1.7 to3.2, admission glucose levels <8 mmol/L (OR 3.87, 95% CI 1.9 to 9.2 and mild to moderate baseline stroke severity (NIHSS median score 10+ 6 were associated with major neurological improvement after adjusting for co variables. Major neurological improvement at 24 h was an independent predictor of good outcome (mRS=1 at 12 months (OR 13.9, 95% CI 6.84 to 40.2. Conclusions : Age <60 years, glucose levels <8 mmol/L and mild to moderate stroke severity (NIHSS median score 10±6 was associated with major neurological improvement after intravenous rt-PA. Major neurological improvement at 24 h after the administration of intravenous thrombolysis independently predicted good outcome at 12 months.

  10. Successful treatment of massive pulmonary embolism with prolonged catheter-directed thrombolysis.

    LENUS (Irish Health Repository)

    Kelly, Peter

    2012-02-03

    This is a case report of a young woman who presented with an extensive pulmonary embolism and echocardiographic evidence of right ventricular dysfunction. Although hemodynamically stable, the patient\\'s clinical condition failed to improve with standard heparin anticoagulation. Successful local catheter-directed thrombolysis was performed over an extended period of 48 h with regular monitoring of response to therapy by computed tomography-pulmonary angiography and echocardiography. To our knowledge, treatment of a pulmonary embolism by catheter-directed thrombolytic infusion over an extended period of 48 h has not previously been described.

  11. Renal Subcapsular Hematoma after Intravenous Thrombolysis in a Patient with Acute Cerebral Infarction.

    Science.gov (United States)

    La, Yun Kyung; Kim, Ji Hwa; Lee, Kyung-Yul

    2016-09-01

    A 74-year-old female with acute cerebral infarction was treated with intravenous recombinant tissue plasminogen activator. Subsequent percutaneous transfemoral angiography and mechanical thrombectomy were performed due to a right middle cerebral artery occlusion, which was successfully recanalized. Two days after treatment, the patient complained of vague right abdominal pain and a laboratory test showed anemia. Abdominal computed tomography showed a right renal subcapsular hematoma. After conservative management, the patient was discharged without complications. We report a rare complication after intravenous thrombolysis in a patient with acute cerebral infarction.

  12. Delayed Surgery for Aortic Dissection after Intravenous Thrombolysis in Acute Ischemic Stroke

    Science.gov (United States)

    Choi, Nari; Yoon, Jee-Eun; Park, Byoung-Won; Chang, Won-Ho; Kim, Hyun-Jo; Lee, Kyung Bok

    2016-01-01

    We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding. PMID:27734002

  13. Simple mechanical thrombectomy with intrapulmonary arterial thrombolysis in pulmonary thromboembolism:a small case series

    Institute of Scientific and Technical Information of China (English)

    Khurshid Ahmed; Muhammad Munawar; Dian Andina Munawar; Beny Hartono

    2014-01-01

    Pulmonary thromboembolism (PTE) is a life-threatening condition with a high early mortality rate caused by acute right ventricular failure and cardiogenic shock. We report a series of three patients who presented with acute and subacute submassive PTE. They were suc-cessfully treated by simple catheter-based mechanical thrombectomy and intrapulmonary arterial thrombolysis. Mechanical fragmentation and aspiration of thrombus was performed by commonly used J-wire, multi-purpose and Judkin Right guiding catheters and this obviated the need of specific thrombectomy devices.

  14. Acute stroke: postprocedural care and management of complications.

    Science.gov (United States)

    de Carvalho, Flávio Augusto; de Figueiredo, Marcelo Marinho; Silva, Gisele Sampaio

    2012-03-01

    Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. Neurocritical care is essential to reduce and appropriately treat complications after endovascular procedures. Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke.

  15. Relation of impaired Thrombolysis In Myocardial Infarction myocardial perfusion grades to residual thrombus following the restoration of epicardial patency in ST-elevation myocardial infarction.

    Science.gov (United States)

    Kirtane, Ajay J; Weisbord, Aaron; Karmpaliotis, Dimitrios; Murphy, Sabina A; Giugliano, Robert P; Cannon, Christopher P; Antman, Elliott M; Ohman, E Magnus; Roe, Matthew T; Braunwald, Eugene; Gibson, C Michael

    2005-01-15

    Clinical and angiographic data were analyzed from 929 patients who had ST-elevation myocardial infarction and open epicardial arteries after fibrinolytic therapy. Residual angiographically evident thrombus was associated with more frequent Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow (33.6% vs 26.8%, p = 0.03), higher corrected TIMI frame counts (34 vs 31 frames, p = 0.0003), and lower TIMI myocardial perfusion grades (43.0% vs 32.0% TIMI myocardial perfusion grades 0/1, p = 0.001) among all patients and among patients who had TIMI grade 3 flow (33.5% vs 26.0% TIMI myocardial perfusion grades 0/1, p = 0.043). In multivariate analyses, angiographically evident thrombus was associated with higher corrected TIMI frame counts and worsened myocardial perfusion independent of clinical and angiographic covariates, including TIMI grade 3 flow.

  16. Ultrasound-enhanced thrombolysis using Definity as a cavitation nucleation agent.

    Science.gov (United States)

    Datta, Saurabh; Coussios, Constantin-C; Ammi, Azzdine Y; Mast, T Douglas; de Courten-Myers, Gabrielle M; Holland, Christy K

    2008-09-01

    Ultrasound has been shown previously to act synergistically with a thrombolytic agent, such as recombinant tissue plasminogen activator (rt-PA) to accelerate thrombolysis. In this in vitro study, a commercial contrast agent, Definity, was used to promote and sustain the nucleation of cavitation during pulsed ultrasound exposure at 120 kHz. Ultraharmonic signals, broadband emissions and harmonics of the fundamental were measured acoustically by using a focused hydrophone as a passive cavitation detector and used to quantify the level of cavitation activity. Human whole blood clots suspended in human plasma were exposed to a combination of rt-PA, Definity and ultrasound at a range of ultrasound peak-to-peak pressure amplitudes, which were selected to expose clots to various degrees of cavitation activity. Thrombolytic efficacy was determined by measuring clot mass loss before and after the treatment and correlated with the degree of cavitation activity. The penetration depth of rt-PA and plasminogen was also evaluated in the presence of cavitating microbubbles using a dual-antibody fluorescence imaging technique. The largest mass loss (26.2%) was observed for clots treated with 120-kHz ultrasound (0.32-MPa peak-to-peak pressure amplitude), rt-PA and stable cavitation nucleated by Definity. A significant correlation was observed between mass loss and ultraharmonic signals (r = 0.85, p cavitation activity. Stable cavitation activity plays an important role in enhancement of thrombolysis and can be monitored to evaluate the efficacy of thrombolytic treatment.

  17. [Limitation of myocardial expansion in late thrombolysis evaluated by two-dimensional echocardiography].

    Science.gov (United States)

    Romero, M A; Espinosa Vázquez, A; Ramos Corrales, M A; Solorio, S; Lepe Montoya, L; Badui, E; Ocampo, S; Carrillo, A M

    1996-01-01

    Myocardial expansion in acute myocardial infarction (AMI) is present in about 45% of the patients within the first 72 hours. This is associated with ventricular aneurysm formation, myocardial rupture, heart failure and early death. Experimental studies in animals with AMI have used late reperfusion to decrease the incidence of expansion with success. The present is a prospective, longitudinal, open and randomized study in 21 patients with anterior AMI, to evaluate if the late reperfusion (6 to 12 hours) can decrease the incidence of myocardial expansion graded quantitatively with bidimensional echocardiography. Two groups were made: group A (n = 12) who received thrombolysis with streptokinase 1.5 mill. IU plus oral aspirin 150 mg OD (n = 9). Both groups had the same characteristics of AMI and functional class of Killip and Kimball (I-II class). Intrahospital treatment was given freely in both groups. The expansion was evaluated with bidimensional echocardiography used Jugdutt's method. In group A, expansion was present in 25% of the cases, while in group B was 66.6% (p < 0.0005). The distortion area, distortion peak, septal thickness and large asynergic segment were more sensitive parameters to identify myocardial expansion. Our results are similar to some experimental studies. We conclude that late thrombolysis can be useful in decreasing the incidence of myocardial expansion. Bidimensional echocardiography is a useful, fast and safe method to identify myocardial expansion.

  18. Estimating implementation and operational costs of an integrated tiered CD4 service including laboratory and point of care testing in a remote health district in South Africa.

    Directory of Open Access Journals (Sweden)

    Naseem Cassim

    Full Text Available An integrated tiered service delivery model (ITSDM has been proposed to provide 'full-coverage' of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1 Tier-1/decentralized point-of-care service (POC in a single site; Tier-2/POC-hub servicing processing 600 samples/day and serving > 100 or > 200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa.Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time.The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively, but with related increased LTR-TAT of > 24-48 hours. Full service coverage with TAT < 6-hours could be achieved with placement of twenty-seven Tier-1/POC or eight Tier-2/POC-hubs, at a cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured 'full service coverage' and < 24 hour LTR-TAT for the district at $7.42 per-test.Implementing a single Tier-3/community laboratory to extend and improve delivery of services in Pixley-ka-Seme, with an estimated local ∼ 12-24-hour LTR-TAT, is ∼ $2 more than existing referred services per-test, but 2-4 fold cheaper than implementing eight Tier-2/POC-hubs or providing twenty-seven Tier-1/POCT CD4

  19. Intravenous thrombolysis in acute ischaemic stroke: from trial exclusion criteria to clinical contraindications. An international Delphi study

    NARCIS (Netherlands)

    M. Dirks (Maaike); L.W. Niessen (Louis Wilhelmus); C.L. Franke (Cees); R.J. van Oostenbrugge (Robert Jan); D.W.J. Dippel (Diederik); P.J. Koudstaal (Peter Jan)

    2007-01-01

    textabstractOBJECTIVE: Several studies indicate that only a small proportion of patients with acute ischaemic stroke are treated with intravenous thrombolysis. Indications and contraindications for this treatment are usually based on the inclusion and exclusion criteria of randomised clinical trials

  20. Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemic stroke

    DEFF Research Database (Denmark)

    Ehlers, Lars; Andersen, Grethe; Clausen, Lone Beltoft

    2006-01-01

    was designed to calculate the marginal cost-effectiveness ratios for time spans of 1, 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment...

  1. Efficacy analysis of intravenous thrombolysis after cardiopulmonary resuscitation for patients with acute myocardial infarction and cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    张晓丽

    2014-01-01

    Objective To explore the clinical value of intravenous thrombolysis in the treatment of patients with acute myocardial infarction(AMI)and cardiac arrest after cardiopulmonary resuscitation.Methods 120 patients with AMI and cardiac arrest admitted in our hospital from Mar2009 to Mar 2013 were divided into thrombolytic group(n=50)and control group(n=70)according to the

  2. Prolonged binding of radiolabeled recombinant tissue-type plasminogen activator after angioplasty and enclosed thrombolysis of the femoropopliteal arteries

    DEFF Research Database (Denmark)

    Tønnesen, K H; Vinberg, N; Folkenborg, O

    1992-01-01

    The authors measured the binding of indium-111-labeled recombinant tissue-type plasminogen activator (rt-PA) within the recanalized femoropopliteal segment after percutaneous transluminal angioplasty (PTA) and enclosed thrombolysis. In patients with long occlusions (n = 3), 91 micrograms of rt...

  3. [Assessment of the technology of care relations in the health services: perception of the elderly included in the family health strategy in Bambuí, Brazil].

    Science.gov (United States)

    Santos, Wagner Jorge dos; Giacomin, Karla Cristina; Firmo, Josélia Oliveira Araújo

    2014-08-01

    In the health field, technologies of care relations are in the scope of the worker-user encounter, implying intersubjectivity with the development of relationships between subjects, resulting in action. Evaluation studies synthesize knowledge produced on the consequences of using these technologies for society. This anthropological study aims to understand the perception of the elderly regarding the resolution capability and effectiveness of the acts produced in health care relationships in the context of the Family Health Strategy (ESF). The group studied consisted of 57 elderly residents in Bambui, State of Minas Gerais, Brazil. The model of signs, meanings and actions was used for collecting and analyzing data and the semi-structured interview was applied as a research technique. Elderly individuals assess resolution capability and effectiveness of the acts of care in the ESF as negative, with relation to the quality of user and professional interaction. The ESF is not effective and the desired change in the health care model has not occurred in practice. It repeats the centrality of the medical-drug-procedure model that treats the disease rather than the patient, perceiving old age as a disease and illness as being related to aging.

  4. Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol

    NARCIS (Netherlands)

    Archambault, P.M.; Turgeon, A.F.; Witteman, H.O.; Lauzier, F.; Moore, L.; Lamontagne, F.; Horsley, T.; Gagnon, M.P.; Droit, A.; Weiss, M.; Tremblay, S.; Lachaine, J.; Sage, N. Le; Emond, M.; Berthelot, S.; Plaisance, A.; Lapointe, J.; Razek, T.; Belt, T.H. van de; Brand, K; Berube, M.; Clement, J.; Iii, F.J. Grajales; Eysenbach, G.; Kuziemsky, C.; Friedman, D.; Lang, E.; Muscedere, J.; Rizoli, S.; Roberts, D.J.; Scales, D.C.; Sinuff, T.; Stelfox, H.T.; Gagnon, I.; Chabot, C.; Grenier, R.; Legare, F.

    2015-01-01

    BACKGROUND: Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the qu

  5. Artery and deep Venous Catheter Thrombolysis for deep Venous Thrombosis Synchroni-zation%动脉加深静脉置管同步溶栓治疗深静脉血栓

    Institute of Scientific and Technical Information of China (English)

    黄永东; 毛健; 梁枫; 张振岳

    2015-01-01

    目的:评价经动脉加深静脉置管同步溶栓治疗下肢深静脉血栓( DVT)的疗效。方法回顾性分析27例下肢深静脉血栓溶栓治疗患者,在行下腔静脉滤器置入术后,其中15例患者行动脉加深静脉置管同步溶栓治疗下肢深静脉血栓及抗凝治疗。另12例患者行单纯患肢深静脉置入溶栓导管溶栓治疗加抗凝治疗。结果随访27例患者均未出现大出血和致死性肺动脉栓塞等严重并发症,22例患者下肢DVT完全或大部分溶解,下肢肿胀恢复正常。5例达到部分溶解,但深静脉主干有血流通过,并有较多侧枝循环。肿胀明显缓解。其中经动脉加深静脉置管同步溶栓治疗的患者中,完全或大部分溶解15例,单纯静脉溶栓完全或大部分溶解的有5例。结论动脉加深静脉置管同步溶栓下肢深静脉血栓一种安全可行、疗效好、起效快的方法,较单纯静脉溶栓时间缩短,而且静脉血栓完全溶解率较高。%Objective To evaluate the artery and deep venous catheter synchronous thrombolysis for lower extremity deep venous thrombosis( DVT) effect. Methods A retrospective analysis of 27 cases of lower extremity deep venous thrombolytic therapy for patients,in inferior vena cava filter placement,including 15 ca-ses of patients with deep vein tube indwelling arterial and synchronous thrombolysis for lower extremity deep venous thrombosis and anticoagulation therapy. The other 12 patients were treated with simple limb vein insert-ed catheter thrombolysis therapy and anticoagulation thrombolysis. Results The serious complications of bleeding and fatal pulmonary embolism were not found in follow-up of 27 patients,22 cases of patients with lower extremity DVT completely or mostly dissolved,lower limb swelling back to normal. 5 patients achieved a partial dissolution,but deep vein blood flow through,and there is more collateral circulation. Swelling signifi-cantly ease. The arterial and deep venous

  6. Distance to thrombus on MR angiography predicts outcome of middle cerebral artery occlusion treated with IV thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Gawlitza, Matthias; Quaeschling, Ulf; Schob, Stefan; Hoffmann, Karl-Titus; Lobsien, Donald [University Hospital Leipzig, Department of Neuroradiology, Leipzig (Germany); Friedrich, Benjamin; Schaudinn, Alexander [University Hospital Leipzig, Department of Diagnostic and Interventional Radiology, Leipzig (Germany); Hobohm, Carsten [University Hospital Leipzig, Department of Neurology, Leipzig (Germany)

    2015-10-15

    The distance to thrombus (DT) on CT angiography was recently proposed as a predictor of outcome in patients treated by intravenous thrombolysis (IVT) for stroke due to occlusion of the middle cerebral artery (MCA). The purpose of the present study was to validate its inter-rater reliability and its prognostic value on contrast-enhanced magnetic resonance angiography (CE-MRA). Furthermore, we investigated the relation between DT and FLAIR-vascular hyperintensities (FVH) as a surrogate of collateral circulation and hypoperfusion. Patients with acute MCA occlusions treated by IVT and diagnosed with magnetic resonance imaging (MRI) were included. Two readers measured DT. FVH and acute DWI lesion volumes were quantified. Clinical status was determined using the initial NIH stroke scale (NIHSS) and 90-day modified Rankin Scale (90d mRS). Sixty-one patients showed a lesion on diffusion-weighted magnetic resonance images and an occlusion of the MCA on CE-MRA. We found significant inverse correlations between DT and NIHSS scores at admission (ρ = -0.29; P = 0.02), DT and mRS at 90 days (ρ = -0.29; P = 0.04), and between DT and FVH (ρ = -0.32; P = 0.01). For a DT <22 mm, the likelihood of an unfavorable outcome (90d mRS 3-6 or NIHSS score improvement of ≤10 points at discharge) was >50 %. Initial DWI lesion volumes showed no correlation with the outcome. Excellent inter-rater agreement for DT was observed (Cronbach's α = 0.98; P < 0.001). DT on CE-MRA is reliably measurable, correlates inversely with FLAIR-vascular hyperintensities, and predicts outcome in patients with acute MCA occlusion treated with IVT. (orig.)

  7. Angiojet thrombolysis and vena cava filter insertion in a case of a duplicated inferior vena cava

    Directory of Open Access Journals (Sweden)

    Stuart Blackwood

    2015-02-01

    Full Text Available Objectives: Duplication of the inferior vena cava (IVC complicates interventional procedures. This case report aims to shed light on this unusual anomaly and the preoperative considerations necessary when treatment of venous thromboembolism is undertaken. Methods: An IRB approved case report of a 58 year old woman presented emergently with right lower extremity phlegmasia due to extensive thrombosis of her right iliofemoral and infrarenal portion of her duplicated IVC. Results: The patient underwent IVC filter placement and rheolytic thrombectomy with thrombolysis using the Angiojet device followed by venoplasty and stenting of the iliofemoral system and right IVC. Complete symptomatic and radiographic resolution on duplex imaging was achieved at 1 year follow up. Conclusions: With adequate preoperative awareness of IVC anomalies and treatment options available satisfactory results can be achieved and complications minimized for this unique patient population.

  8. Variation in Clinical Practice of Intravenous Thrombolysis in Stroke in the Netherlands

    Directory of Open Access Journals (Sweden)

    Auke Bauer

    2013-04-01

    Full Text Available In the Netherlands in 2010, 11% of patients with ischemic stroke received intravenous thrombolysis (IVT, varying from 4 to 26% between hospitals. The aim of this study was to investigate variation in clinical practice and organization of IVT in relationship to performance and outcome. In all 84 Dutch hospitals performing IVT, a stroke neurologist was approached using a web-based survey. The response rate was 82%. The study showed considerable variation. For example, door-to-needle time ranged from 25 to 80 min. High blood pressure was actively lowered before performing IVT by 57% of neurologists, while 35% chose to wait. 28% started IVT without knowledge of laboratory results. Better follow-up data are needed to see whether this variation results in differences in outcome.

  9. [Genetic analysis of multidrug-resistant Streptococcus pneumoniae including meropenem resistance that was isolated from elderly residents with pneumonia in nursing-care facilities].

    Science.gov (United States)

    Ota, Kazuko; Chiba, Naoko; Sato, Kentaro; Nara, Syoetu; Kato, Satoko; Kanazawa, Hisao; Ikejima, Shin; Takahashi, Yoshihiro; Iwata, Satoshi; Ubukata, Kimiko

    2014-07-01

    From February to December 20XX, penicillin-resistant Streptococcus pneumoniae (PRSP) showing MICs of 16-32 microg/mL to cefotaxime (CTX) and 4-8 microg/mL to meropenem (MEPM) were isolated from 6 patients hospitalized at the general hospital S (2 cases) and hospital A (4 cases), close to the hospital S. Five elderly patients among these six cases came from nursing care facilities or nursing care-related medical facilities. All elderly persons (mean age: 81.7 years) were diagnosed as having pneumonia at the time of admission and the problematic PRSP was isolated from sputum samples collected on admission. Notably, all of these PRSP isolates simultaneously showed high resistance to macrolide agents mediated by an erm (B) gene and to fluoroquinolone agents via mutations in the gyrA and parC genes. Eventually, they were identified as multidrug-resistant S. pneumoniae (MDRSP) with high resistance to many agents. The capsule type of all strains was serotype 19F and multilocus sequence typing (MLST) revealed that they belonged to clonal complex (CC) 7993, which has not been reported before. It was thus concluded that the MDRSP that had spread within the nursing facilities was transmitted to the general hospitals via the elderly inpatients with pneumonia caused by these agents. Although one case finally had a poor outcome, the pneumococcal infection was not the direct trigger of the event. The current ratio of MDRSP is concluded to be very low. However, general hospitals that accept patients for therapeutic purposes from nursing-care facilities have to share epidemiological information in a timely manner with the nursing homes to prevent nosocomial infections.

  10. Increased Plasma Matrix Metalloproteinase-9 Levels Contribute to Intracerebral Hemorrhage during Thrombolysis after Concomitant Stroke and Influenza Infection

    Directory of Open Access Journals (Sweden)

    Sajjad Muhammad

    2016-08-01

    Full Text Available Background: Thrombolysis is the only approved therapy for acute stroke. However, life-threatening complications such as intracerebral hemorrhage (ICH can develop after intravenous administration of tissue plasminogen activator (tPA. Both infection and thrombolysis during cerebral ischemia disrupt the blood-brain barrier (BBB. tPA can induce matrix metalloproteinase-9 (MMP-9, which is known to be involved in BBB disruption. However, it has still not been investigated whether preexisting influenza virus infection during thrombolysis after acute stroke affects systemic levels of MMP-9 and its inhibitor TIMP-1 and whether increased systemic MMP-9 levels affect ICH. This study aimed to investigate the influence of influenza virus infection on plasma levels of MMP-9 and TIMP-1 after thrombolysis in acute stroke, and to determine whether the infection correlates with intracerebral bleeding. Methods: C57BL/6 mice were infected by administering 1 × 105 plaque-forming units of human influenza (H1N1 virus intranasally. After 3 days of infection the middle cerebral artery was occluded for 45 min and then reperfused. Intravenous tPA (10 mg/kg treatment was started 10 min after stroke onset. Twenty-four hours after stroke onset, mice were deeply anesthetized with ketamine, venous blood was drawn from the caval vein and centrifuged at 2,000 rpm, and the supernatant was collected and frozen at -80°C. Plasma levels of MMP-9 and TIMP-1 were quantified by using ELISA. Results: After stroke, plasma MMP-9 was significantly increased in mice with a concomitant influenza infection that were treated with tPA (9.99 ± 0.62 ng/ml, n = 7 as compared to noninfected control mice that were treated with tPA (4.74 ± 0.48 ng/ml, n = 8. Moreover, plasma levels of TIMP-1, an inhibitor of MMP-9, were also significantly increased in mice treated with tPA after concomitant infection and stroke (42.17 ± 7.02 ng/ml, n = 7 as compared to noninfected control mice that were treated

  11. Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 expression in early focal cerebral infarction following urokinase thrombolysis in rats

    Institute of Scientific and Technical Information of China (English)

    Yuqiang Song; Hongli Zou; Guofeng Wang; Hongxia Yang; Zhaohong Xie; Jianzhong Bi

    2012-01-01

    Activity of matrix metalloproteinase-9 increases following cerebral ischemia/reperfusion, and is associated with cerebral microvascular permeability, blood-brain barrier destruction, inflammatory cell infiltration and brain edema. Matrix metalloproteinase-9 also likely participates in thrombolysis. A rat model of middle cerebral artery infarction was established by injecting autologous blood clots into the internal carotid artery. At 3 hours following model induction, urokinase was injected into the caudal vein. Decreased neurological severity score, reduced infarct volume, and increased expression of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 were observed in the cerebral cortex 24 hours after urokinase thrombolysis. These results suggest that urokinase can suppress damage in the acute-early stage of cerebral infarction.

  12. Efficacy of Lower-Extremity Venous Thrombolysis in the Setting of Congenital Absence or Atresia of the Inferior Vena Cava

    Energy Technology Data Exchange (ETDEWEB)

    Ganguli, Suvranu, E-mail: sganguli@partners.org; Kalva, Sanjeeva; Oklu, Rahmi; Walker, T. Gregory; Datta, Neil [Massachusetts General Hospital and Harvard Medical School, Division of Vascular Imaging and Intervention, Department of Imaging (United States); Grabowski, Eric F. [Massachusetts General Hospital and Harvard Medical School, Division of Hematology and Oncology, Department of Pediatrics (United States); Wicky, Stephan [Massachusetts General Hospital and Harvard Medical School, Division of Vascular Imaging and Intervention, Department of Imaging (United States)

    2012-10-15

    Purpose: A rare but described risk factor for deep venous thrombosis (DVT), predominately in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia. Materials and Methods: Between November of 2005 and May of 2010, six patients (three women [average age 21 years]) were referred to our department with acute lower-extremity DVT and subsequently found to have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6 months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound. Results: All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6 h (range 12-72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8 {+-} 20.2 months (range 3.8-54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome. Conclusions: PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.

  13. Catheter-Directed Thrombolysis of Deep Vein Thrombosis in a Patient with Churg-Strauss Syndrome: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jun Beom; Kim, See Hyung; Choi, Jin Soo; Kim, Young Hwan [Dongsan Hospital, Keimyung University, Daegu (Korea, Republic of)

    2010-10-15

    Vasculitis by Churg-Strauss Syndrome (CSS) is an uncommon disease characterized by the inflammation of blood vessel walls and can involve many organs. The clinical manifestations and courses of vasculitis are highly variable. Deep vein thrombosis has rarely been reported in vasculitis by CSS. We report a case of deep vein thrombosis associated with CSS that was successfully treated by catheter-directed thrombolysis.

  14. Catheter-related septic thrombophlebitis of the great central veins successfully treated with low-dose streptokinase thrombolysis and antimicrobials

    Directory of Open Access Journals (Sweden)

    Baltazares-Lipp Enrique

    2005-08-01

    Full Text Available Abstract Background Septic thrombophlebitis is an iatrogenic life-threatening disease associated with use of central venous devices and intravenous (IV therapy. In cancer patients receiving chemotherapy, vein resection or surgical thrombectomy in large central venous lines is time-consuming, can delay administration of chemotherapy, and therefore can compromise tumor control. Experience with thrombolysis has been published for catheter-related thrombosis but for septic thrombosis, this experience is scarce. Results We describe three patients with cancer and septic thrombophlebitis of central veins caused by Staphylococcus aureus treated with catheter removal, thrombolysis, and intravenous (IV antibiotics. In our reported cases, an initial bolus of 250,000 international units (IU of streptokinase administered during the first h followed by an infusion of 20,000–40,000 IU/h for 24–36 h through a proximal peripheral vein was sufficient to dissolve the thrombus. After thrombolyisis and parenteral antibiotic for 4–6 weeks the septic thrombosis due to Staphylococcus aureus solved in all cases. No surgical procedure was needed, and potential placement of a catheter in the same vein was permitted. Conclusion Thrombolysis with streptokinase solved symptoms, cured infection, prevented embolus, and in all cases achieved complete thrombus lysis, avoiding permanent central-vein occlusion.

  15. Improving post-stroke recovery: the role of the multidisciplinary health care team

    OpenAIRE

    Clarke, DJ; Forster, A.

    2015-01-01

    David J Clarke, Anne Forster Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after ...

  16. Palliative Care

    Science.gov (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  17. Mass loading and removal of pharmaceuticals and personal care products including psychoactives, antihypertensives, and antibiotics in two sewage treatment plants in southern India.

    Science.gov (United States)

    Subedi, Bikram; Balakrishna, Keshava; Joshua, Derrick Ian; Kannan, Kurunthachalam

    2017-01-01

    Environmental contamination by pharmaceuticals and personal care products (PPCPs) is barely studied in India despite being one of the largest global producers and consumers of pharmaceuticals. In this study, 29 pharmaceuticals and six metabolites were determined in sewage treatment plants (STPs) in Udupi (STPU: population served ∼150,000) and Mangalore (STPM: population served ∼450,000); the measured mean concentrations ranged from 12 to 61,000 ng/L and 5.0 to 31,000 ng/L, respectively. Atorvastatin (the most prescribed antihypercholesterolemic in India), mefenamic acid, and paraxanthine were found for the first time in wastewater in India at the mean concentrations of 395 ng/L, 1100 ng/L, and 13,000 ng/L, respectively. Select pharmaceutical metabolites (norverapamil and clopidogrel carboxylic acid) were found at concentrations of upto 7 times higher than their parent drugs in wastewater influent and effluent. This is the first study in India to report mass loading and emission of PPCPs and their select metabolites in STPs. The total mass load of all PPCPs analyzed in this study at STPU (4.97 g/d/1000 inhabitants) was 3.6 times higher than calculated for STPM. Select recalcitrant PPCPs (carbamazepine, diazepam, and clopidogrel) were found to have negative or no removal from STPU while additional treatment with upflow anaerobic sludge blanket reactor at STPM removed (up to 95%) these PPCPs from STPM. Overall, 5.1 kg of caffeine, 4.1 kg of atenolol, 2.7 kg of ibuprofen, and 1.9 kg of triclocarban were discharged annually from STPU. The PPCP contamination profile in the Indian STP was compared with a similar study in the USA.

  18. Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators

    Directory of Open Access Journals (Sweden)

    Purvis T

    2014-09-01

    Full Text Available Tara Purvis,1,2 Karen Moss,2 Sonia Denisenko,3 Chris Bladin,2,5 Dominique A Cadilhac1,2,4 1Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Monash Medical Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia; 2Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia; 3Commission for Hospital Improvement, Department of Health Victoria, VIC, Australia; 4Department of Medicine, University of Melbourne, Parkville, VIC, Australia; 5Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia Abstract: A stroke care strategy was developed in 2007 to improve stroke services in Victoria, Australia. Eight stroke network facilitators (SNFs were appointed in selected hospitals to enable the establishment of stroke units, develop thrombolysis services, and implement protocols. We aimed to explain the main issues being faced by clinicians in providing evidence-based stroke care, and to determine if the appointment of an SNF was perceived as an acceptable strategy to improve stroke care. Face-to-face semistructured interviews were used in a qualitative research design. Interview transcripts were verified by respondents prior to coding. Two researchers conducted thematic analysis of major themes and subthemes. Overall, 84 hospital staff participated in 33 interviews during 2008. The common factors found to impact on stroke care included staff and equipment availability, location of care, inconsistent use of clinical pathways, and professional beliefs. Other barriers included limited access to specialist clinicians and workload demands. The establishment of dedicated stroke units was considered essential to improve the quality of care. The SNF role was valued for identifying gaps in care and providing capacity to change clinical processes. This is the first large, qualitative multicenter study to

  19. Combined intra-arterial thrombolysis and neuprotectant agents reduce cerebral infarction in rabbits with experimental acute cerebral ischemia

    Institute of Scientific and Technical Information of China (English)

    Pei Shi

    2006-01-01

    BACKGROUND:The intra-arterial thrombolytic therapy is one of main methods for more patients to obtain bene-fits.The percentage of arterial recanalization treated with intre-arterial therapy is higher than with intra-venous therapy.next,the dose of thrombolytic medicines is lower and the therapeutic time window may be possibly longer.Related researches are focus on intra-artedal thrombolysis combining with neuprotectant agents to treat acute ischemic stroke.The results show that combination of them can further prolong the therapeutic time window.improve the percentage of arterial recanalization and reduce cerebral infarction volume.OBJECTIVE:To observe the effect of single thmmbolitic therapy combined with neuroprotectant agents in the treatment of acute ischemic stroke.DESIGN:Randomized block design.SETTING:Xinhua Hospital of Xixiang City.Henan Province.MATERIALS:Thirty-six adult male white rabbits.weighing 1.5-2.0 kg.dean grade.were provided by Expedmental Animal Center of Xinxiang Medical College.All rabbits were randomly divided into three groups:intra-arterial thrombolysis control group.corenalin control group and combination group with 12 in each group.Urekinase was provided by Beijing Saisheng Pharmaceutical Co.,Ltd.(batch number:020923);corenalin by Sanjing Pharmaceutical Co.,Ltd.of Harbin Pharmacautical Group(batch number:021106):nimodipine by Shandong Xihua Pharmaceutical Co.,Ltd.(batch number:020611):contrast medium IOPAMlR0300 by Bracco s.P.a.Milano italian (batch number:0584);2,3,5-triphenyltetrazolium chloride(TTC)by Beijing Mashi Fine ChemicaL Product Co.,Ltd.(batch number:020926).METHODS: The experiment was camed out in the Department of Intervention. Second People's Hospital of Xinxiang from September 2002 to May 2003.①According to techniques of Benes et al and Zhu et al,animal models with acute ischemia were established.Two hours later.the therapy began.Intra-artedal thrombolysis control group:5 000 U/kg urokinase was dripped in Ieft common

  20. 急性脑梗死患者合并脑微出血的静脉溶栓治疗%Intravenous thrombolysis in acute cerebral infarction with cerebral microbleeds

    Institute of Scientific and Technical Information of China (English)

    林清原; 杨继党

    2014-01-01

    Objective To investigate the influence of intravenous thrombolysis to acute cerebral infarction with cerebral microbleeds (CMB). Methods Eight-nine patients with cerebral infarction in the Neurological Department of the Second Affiliated Hospital of Guangzhou Medical College from January 1st , 2011 to December 31st, 2012 were enrolled in this study. All patients were scanned with MRI and GRE. According to the presence of CMB, the patients were classified into two groups, including CMB group and non-CMB group. Past history of smoking, drinking, hypertension, lacunar infarction, diabetes and leukoaraiosis situation were recorded and risk factors of CMB were explored. All patients were treated with intravenous thrombolysis and rescanned with MRI to compare the total number of CMB 24 hours after thrombolysis. Results In the CMB group, the number of patients with mild CMB decreased and the number of patients with serious CMB increased after thrombolysis. CMB was associated with sex, age, hypertension, lacunar infarction and leukoaraiosis. Conclusions Sex, age, hypertension, lacunar infarction and leukoaraiosis were the risk factors of CMB in acute cerebral infarction. Thrombolysis in acute cerebral infarction augments the incidence of CMB and promotes the hemorrhagic transformation.%目的:探讨急性脑梗死合并脑微出血(CMB)的患者在静脉溶栓后脑微出血的变化。方法:收集2011年1月1日至2012年12月31日在广州医学院第二附属医院神经内科住院的89例急性脑梗死患者,入院时均行常规 MRI 加梯度回波序列 T2加权检查,根据是否存在 CMB 分为有 CMB 组、无 CMB 组。记录两组患者的吸烟、饮酒、高血压、腔隙性脑梗死、糖尿病、白质疏松等既往史,并探讨CMB 的危险因素。患者经溶栓治疗后,观察CMB数目的变化。结果:经溶栓治疗后24 h复查,有CMB 组的CMB 个数与治疗前相比,轻度CMB 患者减少,重度CMB 患者增多;性

  1. LEVEL OF AWARENESS OF REPUBLIC BULGARIA'S POPULATION FOR TREATMENT OF ISCHEMIC STROKE VIA THROMBOLYSIS

    Directory of Open Access Journals (Sweden)

    GRETA KOLEVA

    2016-07-01

    Full Text Available The stroke is a socially significant disease that is characterized with high levels of morbidity and mortality, causing severe disability worldwide. It is the second most significant cause of death among the people in the western world, falling back only to the heart diseases and preceding the cancer, as it causes 10% of the mortal cases in the world. Since 2009 the Bulgarian association of neurosonology and cerebral hemodynamics(BANCH organizes different initiatives of training doctors to conduct a thrombolytic treatment to acute ischemic stroke(AIS. The intravenous thrombolysis has not been established as a leading differential treatment of AIS in Bulgaria, and the thrombolytic therapy is still not well developed in Bulgaria.The suport of national and local institutions is crucial for insuring and guarantee for a proper stroke treatment. Efforts are necessary for adequate financing of the health facilities, as well as professional preparation of the human resource, and training the population via creating an integrated national strategy for its application and control, which can underlie as a state politics in healthcare at optimal usage of public-private partnership.

  2. Fibrinogen nitrotyrosination after ischemic stroke impairs thrombolysis and promotes neuronal death.

    Science.gov (United States)

    Ill-Raga, Gerard; Palomer, Ernest; Ramos-Fernández, Eva; Guix, Francesc X; Bosch-Morató, Mònica; Guivernau, Biuse; Tajes, Marta; Valls-Comamala, Victòria; Jiménez-Conde, Jordi; Ois, Angel; Pérez-Asensio, Fernando; Reyes-Navarro, Mario; Caballo, Carolina; Gil-Gómez, Gabriel; Lopez-Vilchez, Irene; Galan, Ana M; Alameda, Francesc; Escolar, Gines; Opazo, Carlos; Planas, Anna M; Roquer, Jaume; Valverde, Miguel A; Muñoz, Francisco J

    2015-03-01

    Ischemic stroke is an acute vascular event that compromises neuronal viability, and identification of the pathophysiological mechanisms is critical for its correct management. Ischemia produces increased nitric oxide synthesis to recover blood flow but also induces a free radical burst. Nitric oxide and superoxide anion react to generate peroxynitrite that nitrates tyrosines. We found that fibrinogen nitrotyrosination was detected in plasma after the initiation of ischemic stroke in human patients. Electron microscopy and protein intrinsic fluorescence showed that in vitro nitrotyrosination of fibrinogen affected its structure. Thromboelastography showed that initially fibrinogen nitrotyrosination retarded clot formation but later made the clot more resistant to fibrinolysis. This result was independent of any effect on thrombin production. Immunofluorescence analysis of affected human brain areas also showed that both fibrinogen and nitrotyrosinated fibrinogen spread into the brain parenchyma after ischemic stroke. Therefore, we assayed the toxicity of fibrinogen and nitrotyrosinated fibrinogen in a human neuroblastoma cell line. For that purpose we measured the activity of caspase-3, a key enzyme in the apoptotic pathway, and cell survival. We found that nitrotyrosinated fibrinogen induced higher activation of caspase 3. Accordingly, cell survival assays showed a more neurotoxic effect of nitrotyrosinated fibrinogen at all concentrations tested. In summary, nitrotyrosinated fibrinogen would be of pathophysiological interest in ischemic stroke due to both its impact on hemostasis - it impairs thrombolysis, the main target in stroke treatments - and its neurotoxicity that would contribute to the death of the brain tissue surrounding the infarcted area.

  3. Preparation of thermosensitive magnetic liposome encapsulated recombinant tissue plasminogen activator for targeted thrombolysis

    Science.gov (United States)

    Hsu, Hao-Lung; Chen, Jyh-Ping

    2017-04-01

    Recombinant tissue plasminogen activator (rtPA) was encapsulated in thermosensitive magnetic liposome (TML) prepared from 1,2-dipalmitoyl-sn-glycero-3-phosphocholine, distearolyphosphatidyl ethanolamine-N-poly(ethylene glycol) 2000, cholesterol and Fe3O4 magnetic nanoparticles by solvent evaporation/sonication and freeze-thaw cycles method. Response surface methodology was proved to be a powerful tool to predict the drug encapsulation efficiency and temperature-sensitive drug release. Validation experiments verified the accuracy of the model that provides a simple and effective method for fabricating TML with controllable encapsulation efficiency and predictable temperature-sensitive drug release behavior. The prepared samples were characterized for physico-chemical properties by dynamic light scattering, transmission electron microscopy, X-ray diffraction and differential scanning calorimetry. Temperature-sensitive release of rtPA could be confirmed from in vitro thrombolysis experiments. A thrombolytic drug delivery system using TML could be proposed for magnetic targeted delivery of rtPA to the site of thrombus followed by temperature-triggered controlled drug release in an alternating magnetic field.

  4. Influence of ultrasound operating parameters on ultrasound-induced thrombolysis in vitro.

    Science.gov (United States)

    Schäfer, Simon; Kliner, Stefan; Klinghammer, Lutz; Kaarmann, Hans; Lucic, Ivan; Nixdorff, Uwe; Rosenschein, Uri; Daniel, Werner G; Flachskampf, Frank A

    2005-06-01

    The effect of operating parameters on the thrombolytic potency of ultrasound (US) is important for potential therapeutic applications, but is not fully understood. Fresh human whole-blood thrombi were exposed in vitro to focused US from a diagnostic transducer driven by an impulse generator via an amplifier to vary duration (10 to 60 min), intensity (7 to 90 W/cm(2)), frequency (2 to 4.5 MHz), pulsed wave duty cycle (1:5 to 1:100 and continuous wave mode) and pulse length (100 to 400 micros). Segments of thrombi (498 +/- 73 mg) were submersed and insonated in saline solution. Thrombolytic efficiency was expressed as percentage loss of mass compared with controls (noninsonified thrombi). Ultrasound exposure achieved a significantly higher thrombolysis than no US, 56 +/- 16 % vs. 29 +/- 11 % (n = 232, p logarithmic relationship with duty cycle in pulsed mode (r(2) = 0.86) and a modest direct effect of pulse length (r(2) = 0.57, p < 10(-5)). Thus, thrombolytic efficiency of US depends directly on duration, intensity, duty cycle and pulse length and inversely, on frequency.

  5. Impact of leukoaraiosis on parenchymal hemorrhage in elderly patients treated with thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Nighoghossian, Norbert; Cho, Tae-Hee; Cottaz, Vincent; Mechtouff, Laura; Derex, Laurent [Universite Lyon 1, Department of Stroke, Neurological Hospital, Lyon (France); Abbas, Fatima; Schott, Anne Marie [Hospices Civils de Lyon, Pole Information Medicale Evaluation Recherche, Lyon (France); Geraldo, Ana Filipa; Janecek, Elie; Hermier, Marc; Tisserand, Louis Guy; Amelie, Roxana; Chamard, Leila; Berthezene, Yves [Universite Lyon 1, Department of Neuroradiology, Neurological Hospital, Bron, Lyon (France); Bischoff, Magali; El Khoury, Carlos [RESUVAL Stroke Network, Lyon (France)

    2016-10-15

    Severity of vascular damage of white matter may predict hemorrhagic transformation (HT). We assess the relationship between leukoaraiosis (LA) severity and the type of hemorrhagic transformation in elderly patients treated with thrombolysis. We retrospectively analyzed the clinical data and pretreatment magnetic resonance imaging (MRI) of 180 consecutive ischemic stroke patients aged over 75 years. LA severity was graded according to the Fazekas scale, and acute diffusion-weighted-imaging (DWI) lesion volumes were semi-automatically outlined. Predictors of hemorrhagic infarction (HI) and parenchymal hemorrhage (PH) were identified using logistic regression analysis and exact multinomial logistic analysis. HT occurred in 31 patients (17 %). Baseline National Institute of Health Stroke Score (NIHSS; p = 0.008), severe LA (p = 0.02), and diffusion lesion volume (p = 0.02) were predictors of HT in univariable logistic regression. Adjusted to lesion volume and baseline NIHSS score, exact multinomial logistic analysis showed that severe LA was the only independent predictor of parenchymal hemorrhage (p = 0.03). In elderly patients, LA severity better predicts parenchymal hemorrhage than infarct size. (orig.)

  6. Intravenous thrombolysis is more effective in ischemic cardioembolic strokes than in non-cardioembolic?

    Directory of Open Access Journals (Sweden)

    Sofia Rocha

    2011-12-01

    Full Text Available It was suggested that intravenous thrombolysis (IT leads to larger extent recanalization in cardioembolic stroke. In this work we assess if this has beneficial clinical traduction. METHOD: We evaluated 177 patients undergoing IT, which were categorized into cardioembolic (CE and non-cardioembolic (NCE. National Institutes of Health Stroke Scale (NIHSS and modified Rankin scale were compared. RESULTS: The mean age was 67.4±12.01 and 53.8% were male. The mean NIHSS was: 14 (admission, 9 (24 h and 6 (discharge, similar in subgroups. The difference between NIHSS at admission and 24 hours was 4.17±4.92 (CE: 4.08±4.71; NCE: 4.27±5.17, p=0.900 and at admission and discharge there was an average difference of 6.74±5.58 (CE: 6.97±5.68; NCE: 6.49±5.49, p=0.622. The mRS at discharge and 3 months was not significantly different by subtype, although individuals whose event was NCE are more independent at 3 months. CONCLUSION: Ours findings argue against a specific paper of IT in CE. It can result from heterogeneity of NCE group.

  7. 下肢动脉血栓内置管微量泵溶栓的观察及护理%THROMBOLYSIS THROUGH BUILT-IN MICRO-TUBE PUMP TO TREAT LOWER EXTREMITY ARTERIAL THROMBOSIS

    Institute of Scientific and Technical Information of China (English)

    孙艳艳

    2009-01-01

    Objective To explore the clinical effects and nursing mmethods of thrombolysis through built-in micro-tube pump to treat lower extremity arterial thrombosis.Methods 30 cases of lower extremity arterial thrombosis received built-in thrombosis through percutaneous femoral artery and had the micro-pumps reserved.Results 25 cases(83.3%) had their thrombosis completely dissolved and 5 cases (16.7%) got partiallly dissolved.5 cases got puncture point bleeding,3 cases got gum bleeding,2 cases got nasal bleeding and other 2 cases got hematuria.Conclusion Built-in micro-tube thrombolysis can be used effectively to treat Lower extremity arterial thrombosis and good nursing care is also needed to reduce complications.%目的 探讨急性下肢动脉血栓内置管联合微量泵溶栓的临床效果及护理方法.方法 对30例下肢动脉血栓患者经皮穿刺股动脉行内置管溶栓并保留导管接微量泵继续溶栓,观察其临床效果.结果 30例患者中,血栓完全溶解开通者25例(83.3%),部分溶解开通5例(16.7%).并发症:穿刺点出血5例,牙龈出血3例,鼻出血2例,血尿2例.结论 内置管联合微量泵溶栓是治疗急性下肢动脉血栓的有效方法,精心的护理可以减少并发症的发生.

  8. Effect of panax notoginseng saponins on efficacy and hemorrhagic transformation of rt-PA intravenous thrombolysis in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Chun-sheng LI

    2016-11-01

    Full Text Available Objective To study the effect of panax notoginseng saponins (PNS on the efficacy and hemorrhagic transformation (HT of recombinant tissue-type plasminogen activator (rt-PA intravenous thrombolysis in patients with acute ischemic stroke.  Methods A total of 200 patients with early acute ischemic stroke (the length of time between attack and hospital admission < 4.50 h were divided into 2 groups according to random number table method: treatment group (N = 100 and control group (N = 100. The control group was treated with routine rt-PA intravenous thrombolysis treatment, and the treatment group was treated with rt-PA intravenous thrombolysis plus PNS injection. The ischemia-reperfusion injury index [malondialdehyde (MDA and superoxide dismutase (SOD], hemorrhagic transformation prediction index [matrix metalloproteinase-9 (MMP-9 and fibronectin (FN] and nerve function index [National Institutes of Health Stroke Scale (NIHSS and Barthel Index (BI] were measured and compared before treatment, 24 h after thrombolysis and 14 d after thrombolysis. Adverse drug reactions and hemorrhagic transformation rate were observed 14 d after thrombolysis, and the prognosis (mortality and BI was evaluated 12 months after thrombolysis.  Results Compared with control group, serum SOD (P = 0.000 and BI (P = 0.000 in treatment group were significantly higher, while serum MDA (P = 0.001, MMP-9 (P = 0.001, plasma FN (P = 0.000 and NIHSS score (P = 0.006 were significantly lower. In treatment group, 24 h after rt-PA intravenous thrombolysis plus PNS injection, serum MDA (P = 0.000, MMP-9 (P = 0.000 and BI (P = 0.000 were significantly increased, while NIHSS score (P = 0.000 was significantly decreased; 14 d after treatment, serum MDA (P = 0.000 and MMP-9 (P = 0.000 were decreased, serum SOD (P = 0.000 and BI (P = 0.000 were continuously increased, plasma FN (P = 0.000 and NIHSS score (P = 0.000 were continuously decreased. On the 14th day after thrombolysis

  9. Effect of X-Ray Attenuation of Arterial Obstructions on Intravenous Thrombolysis and Outcome after Ischemic Stroke.

    Directory of Open Access Journals (Sweden)

    Grant Mair

    Full Text Available To assess whether the x-ray attenuation of intra-arterial obstruction measured on non-contrast CT in ischemic stroke can predict response to thrombolysis and subsequent functional outcome.The Third International Stroke Trial (IST-3 was a multicenter randomized-controlled trial of intravenous thrombolysis (rt-PA given within six hours of ischemic stroke. Ethical approval and informed consent were obtained. In a subgroup of 109 IST-3 patients (38 men, median age 82 years, a single reader, masked to all clinical and other imaging data, manually measured x-ray attenuation (Hounsfield Units, HU on non-contrast CT at the location of angiographically-proven intra-arterial obstructions, pre-randomization and at 24-48 hour follow-up. We calculated change in attenuation between scans. We assessed the impact of pre-randomization arterial obstruction attenuation on six-month functional outcome.Most arterial obstructions (64/109, 59% were hyperattenuating (mean 51.0 HU. Compared with control, treatment with rt-PA was associated with a greater, but non-significant, reduction in obstruction attenuation at follow-up (-8.0 HU versus -1.4 HU in patients allocated control, p = 0.117. In multivariable ordinal regression analysis controlled for patient age, stroke severity, location and extent of obstruction, time from stroke onset to baseline scan and rt-PA treatment allocation, the attenuation of pre-randomization arterial obstruction was not independently associated with six-month outcome (odds ratio = 0.99, 95% confidence interval = 0.94-1.03, p = 0.516.In ischemic stroke, the x-ray attenuation of the arterial obstruction may decline more rapidly from baseline to 24-48 hours following treatment with thrombolysis but we found no evidence that baseline arterial obstruction attenuation predicts six-month outcome.

  10. Temporal dependence of beneficial effects of coronary thrombolysis characterized by positron tomography

    Energy Technology Data Exchange (ETDEWEB)

    Bergmann, S.R.; Lerch, R.A.; Fox, K.A.; Ludbrook, P.A.; Welch, M.J.; Ter-Pogossian, M.M.; Sobel, B.E.

    1982-10-01

    To delineate beneficial effects of intracoronary thrombolysis on myocardial metabolism in vivo and their dependence on the interval after coronary occlusion prior to reperfusion, we studied 23 closed-chest dogs. Coronary occlusion was produced with a thrombogenic copper coil to performance of cardiac positron emission tomography with /sup 11/C-palmitate. Jeopardized zones were calculated by summation by myocardial regions exhibiting less than 50 percent of the peak left ventricular wall radioactivity, and residual metabolic activity within jeopardized zones quantified based on the average counts compared with average counts in normal myocardium. After tomography, streptokinase was infused into the coronary artery (4,000 units per minute), resulting in angiographically demonstrable restoration of patency. Repeat tomography performed 90 minutes after the initial study with a second injection of /sup 11/C-palmitate demonstrated reduction of jeopardized zones by 51 +/- 6.3 percent (SE) and by 21 +/- 1.8 (p less than 0.01 based on paired comparisons) when refusion was initiated 1 to 2 (in four dogs) or 2 to 4 (in six dogs) hours after occlusion. Metabolic activity in initially jeopardized regions increased by 111 +/- 24.3 percent and 61.8 +/- 12.6 (p less than 0.01 for each). When streptokinase was infused later after occlusion, significant salutary metabolic effects did not occur. These results indicate that positron tomography may be useful in the clinical delineation of the efficacy of thrombolytic therapy in restoring myocardial metabolism and underscore the marked dependence of such efficacy on the duration of the interval of ischemia prior to the onset of reperfusion.

  11. Early outcome after intravenous thrombolysis in patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Pornpatr A Dharmasaroja

    2011-01-01

    Full Text Available Background : Patients with acute ischemic stroke who had early neurological improvement had better functional outcome. The purpose of this study was to determine factors associated with early clinical improvement and early worsening in patients with acute ischemic stroke treated with intravenous thrombolysis. Patients and Methods : Patients treated with intravenous recombinant tissue plasminogen activator (rtPA between August 2008 and November 2010 were the subjects of this study. Early improvement was defined by marked, clinical improvement or complete recovery at 24 h (National Institutes of Health Stroke Scale (NIHSS 0-4 at 24 h. Early worsening was defined by an increase in NIHSS ≥1 from baseline. The baseline characteristics were compared between patients with and without outcome of interest. Results : Of the 203 patients studied, 19 (9.4% patients had complete recovery and 68 (33.5% patients had marked clinical improvement (NIHSS 1-4 at 24 h. Most patients with early clinical improvement (86% had favorable outcome at three months. Of the 22 (10.8% patients who had early clinical worsening, only three (14% patients achieved favorable outcome at three months and six (29% patients died. Multivariate analysis revealed that older age (≥70 years old (odd ratio (OR 0.498, P = 0.049, severe stroke (NIHSS ≥15 (OR 0.154, P < 0.0001 and having intracerebral hemorrhage (ICH (OR 0.364, P = 0.032 were inversely associated with early improvement. History of transient ischemic attack (TIA (OR 7.724, P = 0.043 and ICH (OR 4.477, P = 0.008 were related to early worsening. Conclusions : The presence of early clinical improvement or worsening within 24 h after treatment with rtPA had major impact on the outcome at three months.

  12. Percutaneous aspiration thrombectomy for the treatment of acute lower extremity deep vein thrombosis: is thrombolysis needed?

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, S.H. [Department of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Oh, J.H. [Department of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of)], E-mail: radkwon@dreamwiz.com; Seo, T.-S. [Department of Radiology, Korea University Guro Hospital, Seoul (Korea, Republic of); Ahn, H.J.; Park, H.C. [Department of Surgery, Kyung Hee University Medical Center, Seoul (Korea, Republic of)

    2009-05-15

    Aim: To assess the technical feasibility and initial success of aspiration thrombectomy as a potential alternative to lytic therapy in initial endovascular management of acute lower extremity deep vein thrombosis (DVT). Materials and Methods: From July 2004 to October 2007, a retrospective analysis of 27 patients (male:female 5:22; mean age 59 years) with acute iliofemoral or femoropopliteal DVT of less than 2 weeks was performed. All patients underwent sonography of the lower extremities, and 13 patients underwent computed tomography (CT) venography. All patients received an inferior vena cava (IVC) filter and were initially treated with aspiration thrombectomy using the pullback technique with or without basket thrombus fragmentation. If persistent stenotic portions (>50% luminal narrowing) were noted, balloon angioplasty or stent placement was performed. Successful recanalization was defined as successful restoration of antegrade flow in the treated vein with elimination of any underlying obstructive lesion. Results: The mean procedure time was 65 min (range 40-100 min). Successful initial recanalization was achieved in 24 patients (88.9%) without complications. Urokinase was required for three patients (11.1%) due to a hard thrombus remaining in the iliac vein. Of the 27 patients, 23 had residual venous stenosis in the common iliac vein or external iliac vein. Therefore, balloon angioplasty (n = 23) and stent placement (n = 22) was performed. The remaining four patients were treated using only aspiration thrombectomy without angioplasty or stent placement. Conclusion: Aspiration thrombectomy without catheter-directed thrombolysis is a safe and effective treatment for acute DVT of the lower extremities, and minimizes the risk of haemorrhagic complications.

  13. Hospice care

    Science.gov (United States)

    ... family a break (called respite care). Doctor services. Nursing care. Home health aide and homemaker services. Counseling. Medical ... may be given in other locations, including: A nursing home A ... in charge of care is called the primary care giver. This may ...

  14. Ultrasound enhanced prehospital thrombolysis using microbubbles infusion in patients with acute ST elevation myocardial infarction: Rationale and design of the Sonolysis study

    Directory of Open Access Journals (Sweden)

    van Dijk Arie PJ

    2008-12-01

    Full Text Available Abstract Background - Experimental studies have shown that ultrasound contrast agents enhance the effectiveness of thrombolytic agents in the presence of ultrasound in vitro and in vivo. Recently, we have launched a clinical pilot study, called "Sonolysis", to study this effect in patients with ST-elevation myocardial infarction based on proximal lesions of the infarct-related artery. Methods/design - In our multicenter, randomized, placebo controlled clinical trial we will include patients between 18 and 80 years of age with their first ST-elevation myocardial infarction based on a proximal lesion of the infarct-related artery. After receiving a single bolus alteplase 50 mg IV (Actilyse® Boehringer Ingelheim GmbH, a loading dose of aspirin 500 mg, and heparin 5000 IU in the ambulance according to the prehospital thrombolysis protocol, patients, following oral informed consent, are randomized to undergo 15 minutes of pulsatile ultrasound with intravenous administration of ultrasound contrast agent or placebo without ultrasound. Afterwards coronary angiography and, if indicated, percutaneous coronary intervention will take place. A total of 60 patients will be enrolled in approximately 1 year. The primary endpoints are based on the coronary angiogram and consist of TIMI flow, corrected TIMI frame count, and myocardial blush grade. Follow-up includes 12-lead ECG, 2D-echocardiography, cardiac MRI, and enzyme markers to obtain our secondary endpoints, including the infarct size, wall motion abnormalities, and the global left ventricular function. Discussion - The Sonolysis study is the first multicenter, randomized, placebo controlled clinical trial investigating the therapeutic application of ultrasound and microbubbles in acute ST-elevation myocardial infarction patients. A positive finding may stimulate further research and technical innovations to implement the treatment in the ambulance and maybe obtain even more patency at an earlier stage

  15. Reducing Haemorrhagic Transformation after Thrombolysis for Stroke: A Strategy Utilising Minocycline

    Directory of Open Access Journals (Sweden)

    David J. Blacker

    2013-01-01

    Full Text Available Haemorrhagic transformation (HT of recently ischaemic brain is a feared complication of thrombolytic therapy that may be caused or compounded by ischaemia-induced activation of matrix metalloproteinases (MMPs. The tetracycline antibiotic minocycline inhibits matrix MMPs and reduces macroscopic HT in rodents with stroke treated with tissue plasminogen activator (tPA. The West Australian Intravenous Minocycline and TPA Stroke Study (WAIMATSS aims to determine the safety and efficacy of adding minocycline to tPA in acute ischaemic stroke. The WAIMATSS is a multicentre, prospective, and randomised pilot study of intravenous minocycline, 200 mg 12 hourly for 5 doses, compared with standard care, in patients with ischaemic stroke treated with intravenous tPA. The primary endpoint is HT diagnosed by brain CT and MRI. Secondary endpoints include clinical outcome measures. Some illustrative cases from the early recruitment phase of this study will be presented, and future perspectives will be discussed.

  16. PPAR-Alpha Agonist Used at the Acute Phase of Experimental Ischemic Stroke Reduces Occurrence of Thrombolysis-Induced Hemorrhage in Rats

    Directory of Open Access Journals (Sweden)

    Sophie Gautier

    2015-01-01

    Full Text Available The impact of fenofibrate, a peroxisome proliferator-activated receptor-alpha (PPAR-α agonist, on the risk of thrombolysis-induced hemorrhage during the acute phase of stroke in a rat model of stroke was studied. One-hour middle cerebral artery occlusion followed by thrombolysis with tissue plasminogen activator was made in rats receiving either fenofibrate or vehicle for 72 h after stroke. Evaluation of infarct, hemorrhage, middle cerebral artery vasoreactivity, and immunochemistry (CD11b for microglial activation, myeloperoxidase, and ICAM-1 for neutrophil infiltration was performed. The PPAR-alpha agonist significantly reduced the risk of hemorrhage after thrombolysis in parallel with a decrease in the infarct volume and in the stroke-induced vascular endothelial dysfunction. These effects are concomitant with a reduction in microglial activation and neutrophil infiltration in infarct area. Our results strengthen the idea that using drugs such as fenofibrate, with pleiotropic properties due to PPAR-alpha agonism, may be of value to reduce thrombolysis-induced hemorrhage during acute stroke.

  17. A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    傅向华

    2003-01-01

    A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction!050000$河北医科大学第二医院河北医科大学心脏介入中心@傅向华

  18. Transport for abciximab facilitated primary angioplasty versus on-site thrombolysis with a liberal rescue policy : the randomised Holland Infarction Study (HIS)

    NARCIS (Netherlands)

    Dieker, Hendrik-Jan; van Horssen, Elvira V.; Hersbach, Ferry M. R. J.; van Boven, Ad J.; van't Hof, Arnoud W. J.; Aengevaeren, Wim R. M.; Verheugt, Freek W. A.; Baer, Frits W. H. M.

    2006-01-01

    Aims: As of to date, the only large transportation trial comparing on-site fibrin-specific thrombolysis with transfer for primary angioplasty in patients presenting in a referral centre is the DANAMI-2 trial, with only 3% rescue angioplasty. The Holland Infarction Study (HIS) compared abciximab faci

  19. Perfusion-CT guided intravenous thrombolysis in patients with unknown-onset stroke: a randomized, double-blind, placebo-controlled, pilot feasibility trial

    Energy Technology Data Exchange (ETDEWEB)

    Michel, Patrik [Center Hospitalier Universitaire Vaudois and University of Lausanne, Department of Neurology Service, Lausanne (Switzerland); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Neurology Service, Lausanne (Switzerland); Ntaios, George; Reichhart, Marc [Center Hospitalier Universitaire Vaudois and University of Lausanne, Department of Neurology Service, Lausanne (Switzerland); Schindler, Christian [Center Hospitalier Universitaire Vaudois and University of Lausanne, Pharmacy Department, Lausanne (Switzerland); Bogousslavsky, Julien [Genolier Swiss Medical Network, Glion (Switzerland); Maeder, Philip; Meuli, Reto [Center Hospitalier Universitaire Vaudois and University of Lausanne, Department of Radiology, Lausanne (Switzerland); Wintermark, Max [University of Virginia, Department of Radiology, Division of Neuroradiology, Charlottesville, VA (United States)

    2012-06-15

    Patients with unknown stroke onset are generally excluded from acute recanalisation treatments. We designed a pilot study to assess feasibility of a trial of perfusion computed tomography (PCT)-guided thrombolysis in patients with ischemic tissue at risk of infarction and unknown stroke onset. Patients with a supratentorial stroke of unknown onset in the middle cerebral artery territory and significant volume of at-risk tissue on PCT were randomized to intravenous thrombolysis with alteplase (0.9 mg/kg) or placebo. Feasibility endpoints were randomization and blinded treatment of patients within 2 h after hospital arrival, and the correct application (estimation) of the perfusion imaging criteria. At baseline, there was a trend towards older age [69.5 (57-78) vs. 49 (44-78) years] in the thrombolysis group (n = 6) compared to placebo (n = 6). Regarding feasibility, hospital arrival to treatment delay was above the allowed 2 h in three patients (25%). There were two protocol violations (17%) regarding PCT, both underestimating the predicted infarct in patients randomized in the placebo group. No symptomatic hemorrhage or death occurred during the first 7 days. Three of the four (75%) and one of the five (20%) patients were recanalized in the thrombolysis and placebo group respectively. The volume of non-infarcted at-risk tissue was 84 (44-206) cm{sup 3} in the treatment arm and 29 (8-105) cm{sup 3} in the placebo arm. This pilot study shows that a randomized PCT-guided thrombolysis trial in patients with stroke of unknown onset may be feasible if issues such as treatment delays and reliable identification of tissue at risk of infarction tissue are resolved. Safety and efficiency of such an approach need to be established. (orig.)

  20. 3-year midterm results following hydrolyser{sup TM} thrombolysis; Langzeit-Ergebnisse nach Hydrolyser-unterstuetzter Angioplastie - eine prospektive Studie

    Energy Technology Data Exchange (ETDEWEB)

    Beyer-Enke, S.A.; Deichen, J.; Zeitler, E. [Staedtisches Klinikum Nuernberg-Nord (Germany). Inst. fuer Diagnostische und interventionelle Radiologie

    1999-08-01

    Purpose: Data of a three-year follow-up after mechanical thrombolysis with the Hydrolyser catheter were evaluated. Patients have otherwise been treated by local thrombolysis. Method: 35 patients were treated by thrombolysis, balloon angioplasty, aspiration, local thrombolysis, and stent placement, if necessary. Morphological results following Hydrolyser treatment and additional treatment were evaluated. Results: Following Hydrolyser treatment a significant reduction of the degree and length of the occlusion was observed. Primary clinical success was 80%. Patency rate after 3 years was 0.5. 23% of all patients died in the follow-up period. Conclusion: The Hydrolyser treatment is a relevant alternative to local thrombolysis. This method reduces the time of treatment. The authors favor the lateral opening of the catheter to remove mural thrombus. (orig.) [German] Ziel: Auswertung der Nachkontrollen von Patienten, die anstelle einer lokalen Lyse mit dem Hydrolyser {sup trademark} -Thrombektomiekatheter (HT), Ballondilatation (PTA), Aspirationsthrombektomie (PAT) oder Stent behandelt wurden. Methode: 35 Patienten wurden behandelt und ueber drei Jahre nachbeobachtet. Alle Patienten hatten thromotische/thrombembolische Verschluesse der unteren Extremitaet. Die Laesionen wurden alle mit dem Hydrolyser {sup trademark} -Katheter behandelt. Abhaengig von der Art der Laesion wurden die unterschiedlichen Zusatzverfahren eingesetzt. Das morphologische Resultat wurde sowohl nach dem Einsatz des Hydrolysers {sup trademark} als auch nach der sekundaeren Therapie beurteilt. Ergebnis: Nach Verwendung des Hydrolysers konnte in 21 Faellen eine weitgehende Rekanalisation erreicht werden. Nach sekundaerer Angioplastie wurde in 31 Faellen ein zufrieden-stellendes Resultat (keine relevante Reststenose) erzielt. Die primaere klinische Erfolgsrate lag bei 28/35 (80%). Die Offenheitsrate nach drei Jahren betrug 0,5. 8 Patienten (23%) waren verstorben. Schlussfolgerung: Das System verkuerzt

  1. rt-PA 早期静脉溶栓24h 疗效的相关因素临床分析%Clinical analysis of factors influencing the efficay of rt-PA earlystage intravenous thrombolysis treatment

    Institute of Scientific and Technical Information of China (English)

    毕晓霞; 汪慧; 陈黔妹; 周翠萍; 吴大鹏; 刘芳

    2015-01-01

    、溶栓前血糖水平无明显升高( OR=0.98,95%Cl 0.94~1.02,P<0.01)是影响静脉溶栓治疗24h后症状改善情况的独立预测因素。%Objective To discuss the related factors of clinical symptoms improved after intravenous thrombolysis treatment on acute ischemic stroke patients .Methods Clinical data of all acute ischemic stroke patients admitted to Huaxin hospital from January 2013 to March 2015 receiving intravenous thrombolysis were analyzed retrospectively .The patients were divided into two groups according to NIHSS rubric markings:an effective group and an ineffective group .The clinical data of the two groups of patients were compared to analyze the contributory factors of prognosis .Results 27 consecutive acute ischemic stroke patients were included in the analysis .Single-factor analysis indicated that by comparing the effective group ( 11 cases ) with the ineffective group ( 16 cases ) , blood glucose level prior to thrombolysis (6.54±1.81 vs 10.06±3.75,P<0.05), total serum cholesterol(4.02±0.90 vs 4.93± 1.09,P<0.05), baseline NIHSS score prior to thrombolysis (7.64±2.73 vs 12.25±5.0,P<0.05), timespan from beginning of treatment to stroke onset (2.17±0.75 vs 3.00±0.98,P<0.05), fibrinogen level(2.34±0.56,vs 3.04± 0.64,P<0.05), were statistically significant .Early-stage recovery was not related to age , smoking, blood pressure levels, history of cerebral infarction, atrium fibrillation, low-density lipoprotein, platelets and INR.Logistic regression analysis indicated that lower NIHSS score , shorter timespan from beginning of treatment to stroke onset and lower blood glucose level were the independent prognostic factors of the treatment .Conclusion Pre-thrombolysis blood glucose level , total cholesterol , pre-thrombolysis NIHSS score , timespan from beginning of thrombolysis to stroke onset, fibrinogen, etc.Are factors that affect earlystage recovery in thrombolysis treatment .Lower NIHSS score, shorter

  2. Including as a Care-ful Journey: A Parent's Perspective

    Science.gov (United States)

    Scorgie, Kate; Wilgosh, Lorraine

    2009-01-01

    The authors argue for the need of a cyclical, rather than a linear, model of family coping and life management when a child has a disability. Longitudinal support for such a cyclical model of family life management is presented, with recognition that parental control of outcome lessens as the young person ages, because the adult world is not…

  3. An Investigation into the Treatment of Acute ST Segment Elevated Myocardial Infarction with Early and Selective PCI after Thrombolysis with Urokinase and Recanalization%尿激酶溶栓再通后早期与择期 PCI 术治疗急性 ST 段抬高型心肌梗死的研究

    Institute of Scientific and Technical Information of China (English)

    吴坤生

    2015-01-01

    Objective:To study the treatment of acute ST segment elevated myocardial infarction with early and selective PCI after thrombolysis with urokinase and recanalization .Methods:Select 90 patients with acute ST segment elevated myocardial infarction received in cardiology department in some hospital during the period from .and randomly divided them into control group and intervention group (n =45).the patients in both group received thrombolysis with urokinase,the intervention group underwent PCI 6 hours later after they had thrombolysis had been recanalized ,the control group had selective PCI in 10 days after they had thrombolysis had been recanalized.observe the occurrence rate of MACE during their stay ,and compare the recovery patients'cardic function and their walking distance with 6min 1 week and 6 months later after they had PCI .Results:(1 )the total incidence of MACE of intervention group is lower than that of the control group,the difference is statistically significant (P 0.05 );6 months later after PCI,in intervention group ,the index values of cardiac function,including left ventricular end-systolic dimension,left ventricular end-diastolic dimension and LVEF and walking distance in 6 min were superior to that of the control group,the differences were statistically significant (P 0.05);PCI 术后6月,干预组患者的心功能指标值(左室收缩末内径、舒张末内径、左室射血分数)及6min 步行距离均优于对照组,差异具有统计学意义(P <0.01)。结论:急性 ST 段抬高型心肌梗死溶栓后早期行 PCI 术治疗,能有效改善患者术后心功能指标恢复,降低不良事件的发生率。

  4. Effects of organic extracts of six Bangladeshi plants on in vitro thrombolysis and cytotoxicity

    Directory of Open Access Journals (Sweden)

    Rahman M Atiar

    2013-01-01

    Full Text Available Abstract Background Thrombus formed in blood vessels lead to atherothrombotic diseases such as myocardial or cerebral infarction. Thrombolytic agents are used to dissolve the already formed clots in the blood vessels; however, these drugs sometimes cause serious and fatal consequences. Herbal preparations have been used since ancient times for the treatment of several diseases although they show little toxicity in some cases. Aqueous extracts of herbs used in thrombolysis have been reported before with cytotoxic data, however, the organic extracts of herbs have not been documented. This study aims to investigate whether organic extracts possess thrombolytic properties with minimal or no toxicity. Methods An in vitro thrombolytic model was used to check the clot lysis effect of six Bangladeshi herbal extracts viz., Ageratum conyzoides L., Clausena suffruticosa, Leea indica (Burm.f. Merr., Leucas aspera Willd., Senna sophera L. Roxb., and Solanum torvum Swartz. using streptokinase as a positive control and water as a negative control. Briefly, venous blood drawn from twenty healthy volunteers was allowed to form clots which were weighed and treated with the test plant materials to disrupt the clots. Weight of clot after and before treatment provided a percentage of clot lysis. Cytotoxicity was screened by brine shrimp lethality bioassay using vincristine sulfate as positive control. Results Using an in vitro thrombolytic model, Ageratum conyzoides, Clausena suffruticosa, Leea indica, Leucas aspera, Senna sophera and Solanum torvum showed 18.12 ± 2.34%, 48.9 ± 2.44%, 39.30 ± 0.96%, 37.32 ± 2.00%, 31.61 ± 2.97% and 31.51 ± 0.57% and clot lysis respectively. Among the herbs studied Clausena suffruticosa, Leea indica and Leucas aspera showed very significant (p Ageratum conyzoides, Clausena suffruticosa, Leea indica, Leucas aspera, Senna sophera and Solanum torvum showed LC50 values 508.86 ± 6.62,41.16 ± 1.26, 2.65 ± 0.16, 181.67 ± 1.65, 233

  5. Preserved Renal Function in Kidney Transplantation over a Thrombosed Aortobifemoral Bypass Graft: The Role of Retrograde Flow and Early Thrombolysis

    Directory of Open Access Journals (Sweden)

    Saúl Pampa-Saico

    2016-01-01

    Full Text Available Aortobifemoral bypass (ABFB thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries. This unusual situation not previously reported in a kidney transplant setting, together with an early diagnosis, allowed graft survival until an early local thrombolysis resolved the problem. Two years later, renal function remains normal.

  6. Endovascular Mechanical Recanalisation After Intravenous Thrombolysis in Acute Anterior Circulation Stroke: The Impact of a New Temporary Stent

    Energy Technology Data Exchange (ETDEWEB)

    Fesl, Gunther, E-mail: gunther.fesl@med.uni-muenchen.de; Patzig, Maximilian; Holtmannspoetter, Markus [University of Munich, Department of Neuroradiology (Germany); Mayer, Thomas E. [University of Jena, Department of Neuroradiology (Germany); Pfefferkorn, Thomas; Opherk, Christian [University of Munich, Department of Neurology (Germany); Brueckmann, Hartmut [University of Munich, Department of Neuroradiology (Germany); Wiesmann, Martin [University Hospital, Department of Diagnostic and Interventional Neuroradiology (Germany)

    2012-12-15

    Purpose: Treatment of acute stroke by endovascular mechanical recanalisation (EMR) has shown promising results and continues to be further refined. We evaluated the impact of a temporary stent compared with our results using other mechanical devices. Materials and Methods: We analysed clinical and radiological data of all patients who were treated by EMR after intravenous thrombolysis for acute carotid T- and middle-cerebral artery (M1) occlusions at our centre between 2007 and 2011. A comparison was performed between those patients in whom solely the stent-retriever was applied (group S) and those treated with other devices (group C). Results: We identified 14 patients for group S and 16 patients for group C. Mean age, National Institute of Health Stroke Scale score, and time to treatment were 67.1 years and 16.5 and 4.0 h for group S and 61.1 years and 17.6 and 4.5 h for group C, respectively. Successful recanalisation (thrombolysis in cerebral infarction scores {>=}IIb) was achieved in 93% of patients in group S and 56% of patients in group C (P < 0.05). Mean recanalisation times for M1 occlusions were 23 min (group S) and 29 min (group C) and for carotid-T occlusions were 39 min (group S) and 50 min (group C), and 45% of the patients in group S and 33% in group C had a favourable outcome (Modified Rankin Scale score {<=}2). Conclusion: The findings suggest an improvement in recanalisation success by the application of a temporary stent compared with previously used devices. These results are to be confirmed by larger studies.

  7. In vitro evaluation of dual mode ultrasonic thrombolysis method for transcranial application with an occlusive thrombosis model.

    Science.gov (United States)

    Wang, Zuojun; Moehring, Mark A; Voie, Arne H; Furuhata, Hiroshi

    2008-01-01

    A recent clinical trial of transcranial low-frequency ultrasound-mediated tPA thrombolysis (LFUT) showed cerebral hemorrhages associated with high spatial peak pulse average intensity (I(SPPA)), wide beam and long pulse duration. We developed an alternative approach to LFUT wherein diagnostic power M-mode Doppler (PMD) ultrasound is combined with LFUT, with a goal of increased safety. The effectiveness of such a dual mode ultrasonic thrombolysis (DMUT) was explored in vitro. The DMUT system emitted PMD (2 MHz) and LFUT (550 kHz) beams in alternating fashion from a small 12 mm diameter probe. The LFUT had a low I(SPPA) (2 W/cm(2)) and a short pulse duration (55 micros). Occlusive clots made in plastic tips from bovine plasma and thrombin were placed in flow models pressurized to 800 mH(2)O, with 600 IU/mL monteplase injected upstream. Recanalization times were then compared among three groups: the control (monteplase alone), PMD (monteplase + PMD) and DMUT (monteplase + PMD + LFUT). The capability of the DMUT device to monitor recanalization was demonstrated by observing with Doppler the degree of flow of a blood-mimicking fluid in the vicinity of the clot. Recanalization times were 37.9 +/- 22.9, 38.9 +/- 12.4 and 18.5 +/- 8.0 min, respectively, for the control, PMD and DMUT. There were significant differences between DMUT and the control (p = 0.0004) and between DMUT and PMD (p = 0.0004). Recanalization flows were clearly detected. It is anticipated that this DMUT method presents a safer and more efficient approach than normal LFUT.

  8. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

  9. The role of additional computed tomography in the decision-making process on the secondary prevention in patients after systemic cerebral thrombolysis

    Directory of Open Access Journals (Sweden)

    Sobolewski P

    2015-12-01

    Full Text Available Piotr Sobolewski,1 Grzegorz Kozera,2 Wiktor Szczuchniak,1 Walenty M Nyka2 1Department of Neurology and Stroke, Unit of Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland; 2Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland Introduction: Patients with ischemic stroke undergoing intravenous (iv-thrombolysis are routinely controlled with computed tomography on the second day to assess stroke evolution and hemorrhagic transformation (HT. However, the benefits of an additional computed tomography (aCT performed over the next days after iv-thrombolysis have not been determined.Methods: We retrospectively screened 287 Caucasian patients with ischemic stroke who were consecutively treated with iv-thrombolysis from 2008 to 2012. The results of computed tomography performed on the second (control computed tomography and seventh (aCT day after iv-thrombolysis were compared in 274 patients (95.5%; 13 subjects (4.5%, who died before the seventh day from admission were excluded from the analysis.Results: aCTs revealed a higher incidence of HT than control computed tomographies (14.2% vs 6.6%; P=0.003. Patients with HT in aCT showed higher median of National Institutes of Health Stroke Scale score on admission than those without HT (13.0 vs 10.0; P=0.01 and higher presence of ischemic changes >1/3 middle cerebral artery territory (66.7% vs 35.2%; P<0.01. Correlations between presence of HT in aCT and National Institutes of Health Stroke Scale score on admission (rpbi 0.15; P<0.01, and the ischemic changes >1/3 middle cerebral artery (phi=0.03 existed, and the presence of HT in aCT was associated with 3-month mortality (phi=0.03.Conclusion: aCT after iv-thrombolysis enables higher detection of HT, which is related to higher 3-month mortality. Thus, patients with severe middle cerebral artery infarction may benefit from aCT in the decision-making process on the secondary prophylaxis. Keywords: ischemic stroke, iv-thrombolysis

  10. Management of upper respiratory tract infections by different medical practices, including homeopathy, and consumption of antibiotics in primary care: the EPI3 cohort study in France 2007-2008.

    Directory of Open Access Journals (Sweden)

    Lamiae Grimaldi-Bensouda

    Full Text Available BACKGROUND: Prescribing of antibiotics for upper respiratory tract infections (URTI varies substantially in primary care. OBJECTIVES: To describe and compare antibiotic and antipyretic/anti-inflammatory drugs use, URTI symptoms' resolution and occurrence of potentially-associated infections in patients seeking care from general practitioners (GPs who exclusively prescribe conventional medications (GP-CM, regularly prescribe homeopathy within a mixed practice (GP-Mx, or are certified homeopathic GPs (GP-Ho. METHOD: The EPI3 survey was a nationwide population-based study of a representative sample of 825 GPs and their patients in France (2007-2008. GP recruitment was stratified by self-declared homeopathic prescribing preferences. Adults and children with confirmed URTI were asked to participate in a standardized telephone interview at inclusion, one-, three- and twelve-month follow up. Study outcomes included medication consumption, URTI symptoms' resolution and potentially-associated infections (sinusitis or otitis media/externa as reported by patients. Analyses included calibration to account for non-respondents and groups were compared using multivate analyses adjusting for baseline differences with a propensity score. RESULTS: 518 adults and children with URTI (79.3% rhinopharyngitis were included (36.9% response rate comparable between groups. As opposed to GP-CM patients, patients in the GP-Ho group showed significantly lower consumption of antibiotics (Odds ratio (OR = 0.43, 95% confidence interval (CI: 0.27-0.68 and antipyretic/anti-inflammatory drugs (OR = 0.54, 95% CI: 0.38-0.76 with similar evolution in related symptoms (OR = 1.16, 95% CI: 0.64-2.10. An excess of potentially-associated infections (OR = 1.70, 95% CI: 0.90-3.20 was observed in the GP-Ho group (not statistically significant. No difference was found between GP-CM and GP-Mx patients. CONCLUSION: Patients who chose to consult GPs certified in homeopathy used

  11. Effects of acupressure combined with thrombolysis on limbs disturbance of acute cerebral infarction patients%穴位按摩配合溶栓治疗急性脑梗死患者肢体功能障碍的效果

    Institute of Scientific and Technical Information of China (English)

    乔宝红; 王玉婵; 陈春萍; 许根荣; 张英姿; 杨松柏; 李正秋; 刘杰; 裴树亮

    2015-01-01

    目的 研究穴位按摩对急性脑梗死静脉溶栓术后的肢体功能的改善. 方法 采用随机对照研究,收集2011年1月—2014年6月就诊于中国中医科学院望京医院内科急诊的急性脑梗死静脉溶栓术后患者71例,采用随机数字表法分为两组,对照组32例给予常规护理,穴位按摩组39例在常规护理的基础上联合穴位按摩. 在治疗前后用NIHSS评分、Barthel指数评定表及成人握力评定标准对疗效进行评价. 结果 穴位按摩组受试者的NIHSS评分、Barthel评分均低于对照组,差异具有统计学意义(P0. 05). 结论 采用穴位按摩能够改善急性脑梗死静脉溶栓术后患者的肢体功能,该疗法的安全性良好.%Objective To investigate the acupressure to improve limbs function for acute cerebral infarction ( ACI) patients after intravenous thrombolysis. Methods Using randomized controlled study, a total of 71 patients, who visited doctor from January 2011 to June 2014 in Emergency Department Wangjing Hospital of Chinese Academy of Traditional Chinese Medicine and treated acute cerebral infarction by intravenous thrombolysis, were divided into control group (32 cases) and experimental group (39 cases). The patients of control group received conventional care, while the patients of experimental group treated with acupressure on the basis of the conventional care. The NIHSS score, Barthel index rating scale and adult grip strength assessment were used to evaluate the effects at the beginning and ending of treatments. Results The NIHSS score and Barthel score for participates in the experimental group were significantly lower than those of the control group (P0. 05). Conclusions The utilization of acupressure can improve the limbs function of ACI patients after thrombolysis, and this therapy is safe to use.

  12. Clinical study on HAT and SEDAN score scales and related risk factors for predicting hemorrhagic transformation following thrombolysis in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Heng WEI

    2015-03-01

    Full Text Available Objective To investigate the value of HAT and SEDAN score scales in predicting hemorrhagic transformation (HT following the recombinant tissue-type plasminogen activator (rt-PA intravenous thrombolysis in acute ischemic stroke patients and risk factors affecting HT.  Methods A total of 143 patients with acute ischemic stroke underwent rt-PA intravenous thrombolysis within 4.50 h of onset and their clinical data were collected. According to head CT after thrombolysis, patients were divided into HT group (18 cases and non-HT group (125 cases. Single factor analysis was used to assess differences in HAT and SEDAN score scales and related risk factors of ischemic stroke in 2 groups, and further Logistic regression analysis was used to investigate independent predictors of HT. Receiver operating characteristic (ROC curve was used to evaluate the sensitivity and specificity of HAT and SEDAN score scales in predicting HT.  Results Univariate Logistic regression analysis showed that history of atrial fibrillation (AF, admission systolic blood pressure (SBP, admission blood glucose level, early low density of head CT, thrombolytic time window, National Institute of Health Stroke Scale (NIHSS, HAT and SEDAN scores were all risk factors for HT after thrombolysis (P < 0.05, for all. Multivariate Logistic regression analysis showed that history of AF (OR = 1.677, 95% CI: 1.332-2.111; P = 0.000, admission SBP (OR = 1.102, 95% CI: 1.009-1.204; P = 0.031, admission blood glucose level (OR = 1.870, 95% CI: 1.119-3.125; P = 0.017, thrombolysis time window (OR = 1.030, 95%CI: 1.009-1.052; P = 0.005, NIHSS score (OR = 1.574, 95%CI: 1.186-2.090; P = 0.002, HAT score (OR = 2.515, 95%CI: 1.273-4.970;P = 0.008 and SEDAN score (OR = 2.413, 95%CI: 1.123-5.185; P = 0.024 were risk factors for HT after thrombolysis. ROC curve analysis showed that HAT score could predict HT with 94.40% sensitivity and 41.60% specificity, and area under curve (AUC was 0.70. SEDAN

  13. Transhepatic catheter-directed thrombolysis for portal vein thrombosis after partial splenic embolization in combination with balloon-occluded retrograde transvenous obliteration of splenorenal shunt

    Institute of Scientific and Technical Information of China (English)

    Motoki Nakai; Morio Sato; Shinya Sahara; Nobuyuki Kawai; Masashi Kimura; Yoshimasa Maeda; Yumiko Ibata; Katsuhiko Higashi

    2006-01-01

    A 66-year-old woman underwent partial splenic embolization (PSE) for hypersplenism with idiopathic portal hypertension (IPH). One week later, contrastenhanced CT revealed extensive portal vein thrombosis (PVT) and dilated portosystemic shunts. The PVT was not dissolved by the intravenous administration of urokinase.The right portal vein was canulated via the percutaneous transhepatic route under ultrasonic guidance and a 4Fr. straight catheter was advanced into the portal vein through the thrombus. Transhepatic catheter-directed thrombolysis was performed to dissolve the PVT and a splenorenal shunt was concurrently occluded to increase portal blood flow, using balloon-occluded retrograde transvenous obliteration (BRTO) technique. Subsequent contrast-enhanced CT showed good patency of the portal vein and thrombosed splenorenal shunt.Transhepatic catheter-directed thrombolysis combined with BRTO is feasible and effective for PVT with portosystemic shunts.

  14. The role of additional computed tomography in the decision-making process on the secondary prevention in patients after systemic cerebral thrombolysis

    OpenAIRE

    2015-01-01

    Piotr Sobolewski,1 Grzegorz Kozera,2 Wiktor Szczuchniak,1 Walenty M Nyka2 1Department of Neurology and Stroke, Unit of Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland; 2Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland Introduction: Patients with ischemic stroke undergoing intravenous (iv)-thrombolysis are routinely controlled with computed tomography on the second day to assess stroke evolution and hemorrhagic transformation (HT). However, the...

  15. The therapeutic effect and prognosis of acute cerebral infarction patients with atrial fibrillation treated by intravenous thrombolysis with recombinant tissue plasminogen activator

    Institute of Scientific and Technical Information of China (English)

    尤寿江

    2013-01-01

    Objective To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute cerebral infarct patients with atrial fibrillation (AF) and the predicting factors of poor prognosis.Methods Totally 162 patients with acute cerebral infarct were treated with rt-PA within 4.5hours from the onset.According to past history and the electrocardiogram,the patients was classified into AF

  16. Successful outcome after endovascular thrombolysis for acute ischemic stroke with basis on perfusion-diffusion mismatch after 24 h of symptoms onset

    Science.gov (United States)

    Mattei, Tobias A.; Rehman, Azeem A.; Goulart, Carlos R.; Sória, Marília G.; Rizelio, Vanessa; Meneses, Murilo S.

    2016-01-01

    Background: Although intravenous thrombolysis is the Food and Drug Administration-approved treatment for acute ischemic stroke (AIS) within 3 h, combined intravenous and intra-arterial thrombolysis with endovascular techniques may be able to extend this traditional time window. Case Description: We present the clinical evolution of a 45-year-old male presenting with acute left hemiparesis. Magnetic resonance imaging revealed a small diffusion restriction at the right basal ganglia with perfusion compromise in the entire right middle cerebral artery (MCA) territory. Angiography revealed a complete occlusion of MCA at its M1 segment. The patient underwent endovascular mechanical thrombectomy with additional intra-arterial thrombolysis more than 24 hours after the onset of the initial symptoms and experienced complete vessel recanalization. At 1 year, the patient had global independence with minor residual motor impairment in the left arm. Conclusions: We report the case of a successful thrombolytic therapy following AIS performed more than 24 h after the initial symptoms based on the presence of a perfusion-diffusion mismatch. This report is expected to stimulate the development of future prospective studies with special focus on the role of perfusion-diffusion mismatch in patient selection for treatment of AIS, especially in those presenting outside the traditional time window. PMID:27313971

  17. Update on the third international stroke trial (IST-3 of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited

    Directory of Open Access Journals (Sweden)

    Sandercock Peter

    2011-11-01

    Full Text Available Abstract Background Intravenous recombinant tissue plasminogen activator (rtPA is approved in Europe for use in patients with acute ischaemic stroke who meet strictly defined criteria. IST-3 sought to improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety of rtPA in acute ischaemic stroke, and to determine whether a wider range of patients might benefit. Design International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE trial of intravenous rtPA in acute ischaemic stroke. Suitable patients had to be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracranial haemorrhage and stroke mimics. Results The initial pilot phase was double blind and then, on 01/08/2003, changed to an open design. Recruitment began on 05/05/2000 and closed on 31/07/2011, by which time 3035 patients had been included, only 61 (2% of whom met the criteria for the 2003 European approval for thrombolysis. 1617 patients were aged over 80 years at trial entry. The analysis plan will be finalised, without reference to the unblinded data, and published before the trial data are unblinded in early 2012. The main trial results will be presented at the European Stroke Conference in Lisbon in May 2012 with the aim to publish simultaneously in a peer-reviewed journal. The trial result will be presented in the context of an updated Cochrane systematic review. We also intend to include the trial data in an individual patient data meta-analysis of all the relevant randomised trials. Conclusion The data from the trial will: improve the external validity and precision of the estimates of the overall treatment effects (efficacy and safety of iv rtPA in acute ischaemic stroke; provide: new evidence on the balance of risk and benefit of intravenous rtPA among types of patients who do not clearly meet the terms of the current EU approval; and

  18. Reproduction of a new inferior vena cava thrombosis model and study of the evolutionary process of thrombolysis in rats

    Directory of Open Access Journals (Sweden)

    Jian FU

    2015-10-01

    Full Text Available Objective To investigate the reproduction of a new model of thrombosis of inferior vena cava (IVC, and explore the natural process of thrombolysis and its mechanism in rats. Methods Forty-eight SD rats were randomly classified into experimental group and control group. In the experimental group, the lumen of the vena cava was blocked by about 80%-90% with a ligature of IVC below the left renal vein, and then the animals were redivided into three subgroups (n=12, each. In group A, the IVC endothelium was damaged and its tributaries were ligated. In group B, the IVC endothelium was damaged and its tributaries were not ligated. In group C, no damage was done to the endothelium of the IVC but all its tributaries were ligated. A sham-operated group served as control. The length and weight of the vinous thrombus and the percentage of the IVC luminal area were compared after operation to determine the optimum animal model of venous thrombosis. According to the best mode to establish the model, the thrombus specimens were collected and detected by HE and Masson staining, and the ED-1 expressions were examined by immunohistochemical staining after thrombus formation in 30 rats. The natural evolution of intravenous thrombolysis was analyzed dynamically and the cell types involved in this process were observed. Results Gross observation showed that the experimental group was successfully induced thrombus formation. The thrombus length and weight in group A was significantly higher than that in group B and group C, and no difference between group B and C. The thrombus area in group A was significantly higher than that in groups B and group C, which identified the group A was the optimal model group of venous thrombosis. In the group reproduced by the best mode of the model, HE and Masson staining results showed that new capillaries and the components of collagen and extracellular matrix increased gradually with the passage of time in the process of

  19. The Susceptibility Vessel Sign of the Middle Cerebral Artery on the T2-Weighted Gradient Echo Imaging: Semi-quantification to Predict the Response to Multimodal Intra-Arterial Thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Youn, Sung Won [Catholic University of Daegu Medical Center, Daegu (Korea, Republic of); Jung, Cheol Kyu; Choi, Byung Se; Kim, Jae Hyoung; Kwon, O Ki; Han, Moon Ku; Bae, Hee Joon [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Kwon, Bae Ju [Kwandong University Myongji Hospital, Goyang (Korea, Republic of); Han, Moon Hee [Seoul National University Hospital, Seoul (Korea, Republic of)

    2011-01-15

    We wanted to determine whether or not the 'susceptibility asymmetry index' (SAI) of acute stroke on the T2-weighted image is related with successful recanalization using multimodal intra-arterial thrombolysis (IAT). The 81 patients who underwent multimodal IAT for middle cerebral artery (MCA) territory acute stroke were included in this retrospective study. The multimodal IAT included intra-arterial urokinase infusion, clot disruption by a microwire, microcatheter and balloon manipulation, and balloon angioplasty and/or stenting for the flow-limiting stenosis. The diameter of the susceptibility vessel sign was measured on the T2-weighted gradient echo imaging (GRE), and the diameter of the contralateral normal MCA at the corresponding level was measured on magnetic resonance angiography (MRA): the ratio between these two diameters was defined as the susceptibility asymmetry index. The relation between the TICI (Thrombolysis In Cerebral Infarction) score of 2-3 after multimodal IAT and the SAI was assessed. The receiver operating characteristic (ROC) curve analysis was performed on the SAI to predict a TICI score of 2-3 after multimodal IAT. The mean SAI of 81 patients was 1.66 {+-} 0.66. Seventy nine percent of the patients had a TICI of 2-3 after multimodal IAT. According to the ROC curve analysis, an SAI less than 1.3 was optimal for predicting the presence of stenotic lesion after recanalization (area under the curve: 0.821, sensitivity: 88.2%, specificity: 69.8%, p=0.0001), and the SAI {<=}1.61 (area under the curve: 0.652, sensitivity: 60.9%, specificity: 70.6%, p=0.0226) could predict a TICI score of 2-3. The TICI score of 2-3 after multimodal IAT was achieved in 88.6% of the cases with a SAI {<=} 1.61 and in 67.6% of the cases with a SAI >1.61 (p=0.028). The lower SAI on T2-GRE could predict stenotic lesion and successful recanalization after performing IAT

  20. Clinical study of emergency ICU intravenous thrombolysis in patients with acute myocardial infarction%急性心肌梗死急诊ICU静脉溶栓的临床研究

    Institute of Scientific and Technical Information of China (English)

    阿布力孜•阿布都吉力力

    2016-01-01

    Objective:To investigate the timing, methods and effects of emergency ICU intravenous thrombolysis in acute myocardial infarction.Methods:50 patients with acute myocardial infarction were selected.They were divided into two groups,25 cases in each.Emergency intensive care treatment as the observation group,department of cardiology ward treatment for the control group.Two groups were treated with thrombolytic therapy,but the treatment time was different.Therapeutic effect was observed.Results:The observation group visits to the thrombolytic treatment time,recanalization rate and mortality within four weeks were better than the control group(P<0.05).Conclusion:Emergency care for patients with acute myocardial infarction in patients with thrombolytic therapy can improve the treatment effect,ensure the safety of patients.%目的:探讨急性心肌梗死急诊ICU静脉溶栓的治疗时机、方法及其效果。方法:收治急性心肌梗死患者50例,分两组,各25例,急诊重症监护室内治疗为观察组,心内科病房内治疗为对照组,两组均接受溶栓治疗,但治疗时机不同。观察治疗效果。结果:观察组就诊到溶栓治疗的时间、血栓再通率及4周内死亡率均优于对照组(P<0.05)。结论:急诊监护室内对急性心肌梗死患者行溶栓治疗能够提高治疗效果,保障患者的生命安全。

  1. Prehospital thrombolysis in acute myocardia infarction:a meta-analysis%急性心肌梗死院前溶栓治疗的Meta分析

    Institute of Scientific and Technical Information of China (English)

    姚蓝; 谢小铭

    2010-01-01

    目的 本研究应用Meta分析方法对多个急性心肌梗死院前溶栓治疗的临床研究进行综合分析和评价,以期找到科学的证据指导临床治疗.方法 检索1989年1月至2009年4月在国内外公开发布的关于急性心肌梗死院前溶栓治疗的文献,以冠状动脉再通率、并发症发生率、短期(<30d)死亡率作为效应指标,应用RevMan4.2.8软件进行Meta分析.结果 Meta分析结果显示,院前溶栓组冠脉再通率优于院内溶栓组[OR 2.67,P<0.01],短期(<30 d)死亡率低于院内溶栓组[OR 0.71,P<0.01],两者在并发症发生率上差异无统计学意义[OR 0.84,P=0.94].与PCI组相比,院前溶栓组并发症发生率高于PCI组[OR 2.91,P=0.005],短期(<30 d)死亡率两者差异无统计学意义[OR 1.11,P=0.56],但其存在发表偏倚,敏感性相对差,院前溶栓疗效与预后均优于院内溶栓,而并发症发生率无明显增加,是一种安全有效的治疗方法,具有显著的临床意义.结论 与PCI相比,院前溶栓疗效及预后与PCI相当,但并发症发生率较高,但因存在发表偏倚,敏感性相对差,仍需要更多高质量的研究来进一步证实.%Objective A meta-analysis of clinical trials of prehospital thrombolysis versus in-hospital thrombolysis or PCI for acute myocardia infarction (AMI). Method We collected the literature on prehospital thrombolysis for AMI published at home and abroad from January 1989 to April 2009. Recanalization rate of infarct-related arter, complication incidence and mortality ( < 30 d) were regarded as result indicators. Software RevMan 4.2.8 was used to process meta-analysis. Results There were only 27 literatures selected. Prehospital thrombolysis was associated with higher recanalization rate of infarct-related arter[OR 2.67,95%CI(1.86 ~ 3.85);P <0.01] and lower mortality ( < 30 d ) [OR 0.71,95%CI(0.64 ~ 0.78); P < 0.01] than in-hospital thrombolysis. There was no significant difference in

  2. Catheter-directed Thrombolysis with Argatroban and tPA for Massive Iliac and Femoropopliteal Vein Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Sharifi, Mohsen, E-mail: seyedmohsensharifi@yahoo.com [Arizona Cardiovascular Consultants (United States); Bay, Curt [A. T. Still University (United States); Nowroozi, Sasan; Bentz, Suzanne; Valeros, Gayle; Memari, Sara [Arizona Cardiovascular Consultants (United States)

    2013-12-15

    Purpose: Catheter-directed thrombolysis (CDT) is a highly effective approach in the treatment of deep venous thrombosis (DVT). There are no data on the primary use of CDT with argatroban and tissue plasminogen activator (tPA) in patients without heparin-induced thrombocytopenia (HIT). The aim of this study was to evaluate the efficacy and safety of the combined administration of argatroban and tPA during CDT for massive DVT in patients without HIT. Methods: Thirty-three patients with massive symptomatic iliac and femoropopliteal DVT underwent CDT with tPA and argatroban within 28 {+-} 6 h of presentation. The dose of tPA was 0.75-1 mg/h through the infusion port and that of argatroban at 0.3-1 {mu}g/kg/min through the side port of the sheath. The patients were evaluated for the efficacy and safety of CDT and recurrent symptomatic venous thromboembolism (VTE) at a mean follow-up of 22 months. Results: There was no bleeding or iatrogenic pulmonary embolism with the CDT regimen we used. Grade III lysis (complete resolution of thrombus on venography) was achieved in 30 patients (91 %). In 3 patients with additional inferior vena cava filter thrombosis, further thrombectomy of the filter was required. No patient developed recurrent VTE. Conclusion: Concomitant administration of argatroban and tPA is a highly safe and effective regimen for CDT for massive DVT.

  3. A pilot study on the assessment of trace organic contaminants including pharmaceuticals and personal care products from on-site wastewater treatment systems along Skaneateles Lake in New York State, USA.

    Science.gov (United States)

    Subedi, Bikram; Codru, Neculai; Dziewulski, David M; Wilson, Lloyd R; Xue, Jingchuan; Yun, Sehun; Braun-Howland, Ellen; Minihane, Christine; Kannan, Kurunthachalam

    2015-04-01

    On-site wastewater treatment systems (OWTSs or septic systems) are designed to treat and dispose effluents on the same property that produces the wastewater. Approximately 25% of the U.S. population is served by such facilities. Nevertheless, studies on the treatment efficiency and discharge of organic contaminants through septic effluents are lacking. This pilot study showed the occurrence of organic contaminants including pharmaceuticals and personal care products (PPCPs), perfluoroalkyl surfactants (PFASs), polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs) in septic effluents, adjacent lake water samples, household drinking water in homes that use lake water or a well adjacent to the lake as a source of drinking water, and offshore lake water samples. Septic effluent as well as lake and tap water samples were collected from several households with OWTSs around Skaneateles Lake located in central New York. The advanced on-site systems were installed in some households for the purpose of limiting nutrient levels in the effluent to protect the local surface water. Additionally, because many of these systems serve homes with limited land, advanced treatment systems were needed. The median concentrations of ten PPCPs (ranged from 0.45 to 388 ng/L) and eleven PFASs (ranged from 0.20 to 14.6 ng/L) in septic water were significantly higher (p ≤ 0.01) than in lake water samples. The median concentrations of PPCPs and PFASs in lake and tap water samples were not significantly different (p ≥ 0.65). The median concentrations of ∑PBDEs in septic, lake, and tap water samples were 7.47, 3.49, and 2.22 ng/L, respectively, and those for ∑PCBs were 33.1, 29.2, and 28.6 ng/L, respectively. The mass flux of PPCPs (i.e. the mass flow of PPCPs per unit area per unit time) through the disposal of treated septic effluent from textile biofilter and aerobic treatments to the dispersal unit ranged from 12 (carbamazepine) to 66900 μg/m(2)/day

  4. 糖尿病患者静脉溶栓治疗急性心肌梗塞临床对比研究%A contrast study on clinical effect of intravenous thrombolysis therapy on acute myocardial infarction patients with diabetes and wjthout diabetes

    Institute of Scientific and Technical Information of China (English)

    郑刚; 蒋文超; 刘兆昶; 张丽华; 杨顺来; 刘继会

    2000-01-01

    Objective The aim of this study was to observe the clinical effect of intravenous thrombolysis therapy on diabetic patients with acute myocardial infarction. Methods In the coronary care unit (CCU) at our hospital, 182 of the patients with acute myocardial infarction were divided into two groups with (DM-AMI) and without diabetes (NDM-AMI). All patients were treated with intravenous thrombolysis therapy. Results ①Hospital mortality in DMAMI groups was 15.15%, and 6. 03% in NDM-AMI (χ2= 4. 17, P <0. 05). The reperfusion rate of infarct-related artery (IRA) was 45.45% in DM-AMI groups, and 62. 93% in NDM-AMI groups (χ2=5.23, P <0. 05). ②BS、CR、BUN、TC and TG in DM-AMI groups were significantly higher than in NDM-AMI groups ( P <0. 001、 P <0. 05). ③Complications of AMI were significantly higher in DM-AMI groups than in NDM-AMI, with left ventricular failure significantly higher (36. 36% vs 12. 97%,χ2= 13. 72, P <0. 001)and cardial shock significantly higher (16. 67% vs 6.03%,χ2 = 5. 33, P < 0. 05). Conclusion This study showed that intravenous thrombolysis therapy exerted a beneficial effect on the early-term prognosis of AMI patients without diabetes. But for the patients with diabetes intravenous thrombolysis therapy did not show a beneficial effect.%目的探讨糖尿病患者静脉溶栓治疗急性心肌梗塞临床近期疗效。方法冠心病监护病房(CCU)收治的182例急性心肌梗塞患者,分成糖尿病(DM-AMI)组、非糖尿病(NDM-AMI)组。其中DM-AMI组66例、NDM-AMI组116例。两组同时给予国产尿激酶静脉溶栓治疗。结果①DM-AMI组住院病死率为15.15%,明显高于NDM-AMI组的6.03%(χ2=4.17,P<0.05);DM-AMI组静脉尿激酶溶栓治疗梗塞相关血管(IRA)的再通率为45.45%,明显低于NDM-AMI组的62.93%(χ2=5.23,P<0.05),②DM-AMI组静脉血糖(BS)、肌酐(CR)、尿素氮(BUN)、胆固醇(TC)和甘油三酯(TG)浓度均显著高于NDM-AMI组(P<0

  5. Acute Superior Mesenteric Venous Thrombosis: Transcatheter Thrombolysis and Aspiration Thrombectomy Therapy by Combined Route of Superior Mesenteric Vein and Artery in Eight Patients

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Shuofei, E-mail: yangshuofei@gmail.com; Liu, Baochen, E-mail: 306446264@qq.com; Ding, Weiwei, E-mail: dingwei-nju@hotmail.com; He, Changsheng, E-mail: hechsh@163.com; Wu, Xingjiang, E-mail: wuxingjiang@sohu.com; Li, Jieshou, E-mail: lijieshou2013@sohu.com [Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University (China)

    2015-02-15

    PurposeTo assess the feasibility, effectiveness, and safety of catheter-directed thrombolysis and aspiration thrombectomy therapy by combined route of superior mesenteric vein and artery (SMV+SMA) for acute superior mesenteric venous thrombosis (ASMVT).MethodsThis retrospective study reviewed eight ASMVT patients with transcatheter direct thrombolysis and aspiration thrombectomy therapy via SMV and indirect thrombolysis via SMA during a period of 14 months. The demographics, etiology, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. Anatomic and imaging classification of location and extent of thrombus at diagnosis and degree of thrombus lysis were described.ResultsTechnical success was achieved with substantial improvement in symptoms and thrombus resolution after thrombolytic therapy in all patients. The local urokinase infusion by SMA and SMV was performed for 5–7 (6.13 ± 0.83) and 7–15 (12 ± 2.51) days. Anticoagulation was performed catheter-directed and then orally throughout hospitalization and after discharge. Four patients required delayed localized bowel resection after thrombolytic therapy with no death. Thrombolytic therapy was not interrupted despite minor bleeding at the puncture site in two patients and sepsis in another two postoperatively. Nearly complete removal of thrombus was demonstrated by contrast-enhanced CT scan and portography before discharge. Patients were discharged in 10–27 (19.25 ± 4.89) days after admission. No recurrence developed during the follow-up of 10–13 (12.13 ± 0.99) months.ConclusionsCatheter-directed thrombolytic and aspiration therapy via SMV+SMA is beneficial for ASMVT in avoiding patient death, efficient resolving thrombus, rapid improving symptoms, reversing extensive intestinal ischemia, averting bowel resection, or localizing infarcted bowel segment and preventing short bowel syndrome.

  6. Thrombolysis of the basilar artery: 5-year results from the Saarland stroke registry; Thrombolyse der A. basilaris: Ergebnisse im Saarland ueber einen Zeitraum von 5 Jahren

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Struffert, T.; Roth, C.; Papanagiotou, P.; Scheuermann, J.; Voges, M.; Reith, W. [Universitaetsklinikum des Saarlandes Homburg (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie

    2005-05-01

    Acute thrombosis of the basilar artery has a fatal outcome if left untreated. The relatively good prognosis with intra-arterial thrombolysis makes it the therapy of choice for acute basilar thrombosis. In the Saarland stroke registry, we analyzed 47 patients with angiographically proven basilar artery thrombosis within the last 5 years. We observed a better outcome in patients with good income, with recanalization, and a short time between onset of symptoms and start of thrombolysis. The complications, such as intracerebral bleedings, occurred only in the group treated with rt-PA. Intra-arterial thrombolysis with urokinase or rt-PA is a relatively safe therapy, but should be performed in neuroradiological centers. With progressing symptoms the therapeutic window can be stretched up to 12 h, but coma lasting for more than 4 h is related to a bad outcome. (orig.) [German] Der akute Verschluss der A. basilaris fuehrt unbehandelt in der Regel rasch zum Tod. Aufgrund des zumeist fatalen Ausgangs unbehandelter Basilaristhrombosen und der relativ guten Prognose bei Behandlung mit lokaler intraarterieller Thrombolyse wird diese Therapie als das Mittel der Wahl bei akuter Basilaristhrombose angesehen. Anhand des Saarlaendischen Schlaganfallregisters wurden 47 Patienten mit einer nachgewiesenen Basilaristhrombose ueber einen Zeitraum von 5 Jahren in diese Studie eingeschlossen. Es konnte nachgewiesen werden, dass eine kurze Zeit bis zum Therapiebeginn, ein gutes Income sowie eine erfolgreiche Rekanalisation mit einem guten klinischen Outcome korreliert waren. Komplikationen traten ausnahmslos bei einer Lysetherapie mit rt-PA auf. Die intraarterielle Behandlung von Basilarisverschluessen mit Urokinase oder rt-PA sollte an spezialisierten, interventionellangiographisch taetigen Zentren vorgenommen werden. Bei fluktuierendem Beginn kann das Zeitfenster bis zu 12 h betragen, nach einer Komadauer von mehr als 4 h ist in der Regel kein guenstiges Outcome zu erwarten. (orig.)

  7. 窦内尿激酶溶栓可改善脑静脉窦血栓形成患者的转归%Intra-sinus thrombolysis by using urokinase may improve the outcomes in patients with cerebral venous sinus thrombosis

    Institute of Scientific and Technical Information of China (English)

    孫成梅; 居克舉; 李明超; 徐運

    2014-01-01

    Objective To compare the effects of intra-sinus thrombolysis by using urokinase and heparin anticoagulation alone for cerebral venous sinus thrombosis (CVST).Methods Consecutive inpatients with CVST were enrolled retrospectively.Their demographic and clinical data were collected.The treatment mainly consists of intra-sinus thrombolysis by using urokinase and heparin anticoagulation alone.The outcomes were evaluated according to the modified Rankin scale (mRS) at 6 months.The mRS score < 2 was defined as good outcome,and ≥2 was defined as poor outcome.Results A total of 36 patients were enrolled,including intra-sinus thrombolysis by using urokinase (n =18) and heparin anticoagulation alone (n =18).Twenty-one had good outcomes and 15 had poor outcomes.After treatment,the recanalization rate (94.4% vs.66.7% ;x2 =3.850,P=0.041) of the urokinase thrombolysis group and the good outcome rate at 6 months (72.2% vs.44.4% ; x2 =3.827,P =0.046) were significantly higher than those of the heparin anticoagulation group.The proportion of the patients receiving intra-sinus thrombolysis by using urokinase of the good outcome group was significantly higher than that of the heparin anticoagulation group (60.0% vs.18.2 % ; x2 =5.360,P =0.021).Multivariate logistic regression analysis showed that the intrasinus thrombolysis by using urokinase was an independent protective factor for good outcomes in patients with CVST (odds ratio,1.085,95% confidence interval 1.024-1.361; P=0.023),and the high coagulation state was its independent risk factor (odds ratio,0.185,95% confidence interval 0.049-0.611;P=0.004).None of the patients occurred symptomatic cerebral hemorrhage.Conclusions Intra-sinus thrombolysis with urokinase may improve the outcomes for patients with CVST,and it is superior to the heparin anticoagulation alone.%目的 比较窦内尿激酶溶栓与单纯肝素抗凝治疗脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的效果.方法 回顾

  8. Timely and Effective Care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - national data. This data set includes national-level data for measures of heart attack care, heart failure care, pneumonia care,...

  9. Timely and Effective Care - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of heart attack care, heart failure care, pneumonia care,...

  10. Broken toe - self-care

    Science.gov (United States)

    Fractured toe - self-care; Broken bone - toe - self-care; Fracture - toe - self-care; Fracture phalanx - toe ... often treated without surgery and can be taken care of at home. Severe injuries include: Breaks that ...

  11. Timely and Effective Care - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - state data. This data set includes state-level data for measures of heart attack care, heart failure care, pneumonia care,...

  12. 急性脑梗死早期行微导管动脉溶栓治疗的护理%The nursing coordination of acute cerebral infarction patients undergoing early arterial thrombolysis

    Institute of Scientific and Technical Information of China (English)

    陈叶香; 易萍; 吕美云

    2011-01-01

    目的 探讨急性脑梗死早期动脉溶栓治疗护理配合的重要性.方法 对37例急性脑梗死早期选择性行微导管动脉溶栓治疗的患者,进行规范的术前准备、术中护理配合、术后的病情观察与护理.结果 37例患者治疗3个月后随访,21例发病6 h内行动脉溶栓治疗预后好的患者占80.95%,16例发病6~24 h行动脉溶栓治疗预后好的患者占68.75%,提高了患者的生存质量.结论 急性脑梗死早期选择性行微导管动脉溶栓治疗疗效良好,行微导管动脉溶栓治疗中规范的术前准备、术中护理配合、术后的病情观察与护理至关重要.%Objective To approach the importance of nursing coordination of early arterial thrombolysis in acute cerebral infarction (ACI). Methods 37 cases of ACI early selective micro-catheter arterial thrombolytic therapy were observed and nursed after the standard preoperative preparation, intraoperative nursing coordination, postoperative condition observation and nursing care. Results 80.95% of 21cases had much improvement of symptoms after arterial thrombolytic therapy and care within 6h;68.75% within 6 ~ 24 h. The rate of disability in patients with ACI were significantly reduced and the quality of life of patients were improved.Conclusions Early selective micro-catheter arterial thrombolytic therapy is of benefit for the acute cerebral infarction patient. The standard preoperative preparation, intraoperative nursing coordination, postoperative condition observation and nursing care are essential.

  13. Acute embolic occlusion of the right common iliac artery after revision total hip arthroplasty treated with catheter-directed thrombolysis and balloon angioplasty: A case report

    Directory of Open Access Journals (Sweden)

    Hongqi Yang

    2015-07-01

    Full Text Available Methods: A 63-year-old woman with atrial fibrillation presented clinical symptoms and signs of acute ischemia in the right lower extremity on the 17th postoperative day after revision total hip arthroplasty of the left hip for aseptic loosening of femoral component. Aspirin was discontinued 7 days before surgery. Both computed tomography angiography and digital subtraction angiography demonstrated complete occlusion of the right common iliac artery. An emergency catheter-directed thrombolysis with urokinase combined with balloon angioplasty was performed to obtain complete patency of the right common iliac artery. Results: The patient received anticoagulation and antiplatelet therapy postoperatively and was fine at the 2-year follow-up. Conclusions: This case demonstrated that catheter-directed thrombolysis combined with balloon angioplasty could be an efficacious, minimally invasive approach for the treatment of acute embolic occlusion of the common iliac artery. Preoperative anticoagulation for patients undergoing total hip arthroplasty with long-term use of aspirin for atrial fibrillation needs further investigation.

  14. Introduction of a new model for time-continuous and non-contact investigations of in-vitro thrombolysis under physiological flow conditions

    Directory of Open Access Journals (Sweden)

    Trillenberg Peter

    2011-05-01

    Full Text Available Abstract Background Thrombolysis is a dynamic and time-dependent process influenced by the haemodynamic conditions. Currently there is no model that allows for time-continuous, non-contact measurements under physiological flow conditions. The aim of this work was to introduce such a model. Methods The model is based on a computer-controlled pump providing variable constant or pulsatile flows in a tube system filled with blood substitute. Clots can be fixed in a custom-built clot carrier within the tube system. The pressure decline at the clot carrier is measured as a novel way to measure lysis of the clot. With different experiments the hydrodynamic properties and reliability of the model were analyzed. Finally, the lysis rate of clots generated from human platelet rich plasma (PRP was measured during a one hour combined application of diagnostic ultrasound (2 MHz, 0.179 W/cm2 and a thrombolytic agent (rt-PA as it is commonly used for clinical sonothrombolysis treatments. Results All hydrodynamic parameters can be adjusted and measured with high accuracy. First experiments with sonothrombolysis demonstrated the feasibility of the model despite low lysis rates. Conclusions The model allows to adjust accurately all hydrodynamic parameters affecting thrombolysis under physiological flow conditions and for non-contact, time-continuous measurements. Low lysis rates of first sonothrombolysis experiments are primarily attributable to the high stability of the used PRP-clots.

  15. Complete renal recovery from severe acute renal failure after thrombolysis of bilateral renal vein thrombosis.

    Science.gov (United States)

    Ramadoss, Suresh; Jones, Robert G; Foggensteiner, Lukas; Willis, Andrew P; Duddy, Martin J

    2012-10-01

    A previously healthy young man presented with acute renal failure due to extensive spontaneous deep vein thrombosis, including the inferior vena cava (IVC) and both renal veins. The patient was treated with selectively delivered thrombolytic therapy over a 7-day-period, which resulted in renal vein patency and complete recovery of renal function. A stent was placed over a segment stenosis of the IVC. No thrombophilic factors were identified. Bilateral renal vein thrombosis in young fit individuals is an unusual cause of acute renal failure. Thrombolytic therapy, even with delay, can completely restore renal function.

  16. Fluoroscopy-guided thrombolysis of mechanical mitral valve thrombosis in a young female with antiphospholipid antibody syndrome.

    Science.gov (United States)

    Ikram, Sohail; Pant, Sadip; Hussain, Zeeshan; Brown, Lorrel

    2015-05-07

    Prosthetic valve thrombosis (PVT) is a rare but potentially fatal complication of mechanical valve prosthesis. The differential diagnoses for prosthetic valve obstruction includes pannus formation, prosthetic valve dehiscence, prosthetic valve endocarditis, chordae entrapment, patient-prosthesis mismatch and primary device failure. Establishing a diagnosis requires an understanding of prosthetic valve haemodynamics and careful correlation of clinical and imaging findings. Definitive therapy must be individualised based on various patient-specific factors. We present a case of mechanical mitral PVT in a young woman with antiphospholipid antibody syndrome, and outline the diagnostic and therapeutic approach utilised for successful treatment. The success and complication rates of various therapeutic strategies are also discussed, and highlight the need for individualised decision-making rather than a one-size-fits-all approach to PVT.

  17. Factors Associated with In-Hospital Delay in Intravenous Thrombolysis for Acute Ischemic Stroke: Lessons from China.

    Directory of Open Access Journals (Sweden)

    Qiang Huang

    Full Text Available In-hospital delay reduces the benefit of intravenous thrombolysis (IVT in acute ischemic stroke (AIS, while factors affecting in-hospital delay are less well known in Chinese. We are aiming at determining the specific factors associated with in-hospital delay through a hospital based cohort. In-hospital delay was defined as door-to-needle time (DTN ≥60 min (standard delay criteria or ≥75% percentile of all DTNs (severe delay criteria. Demographic data, time intervals [onset-to-door time (OTD, DTN, door-to-examination time (DTE, door-to-imaging time (DTI, door-to-laboratory time (DTL and final-test-to-needle time (FTN, the time interval between the time obtaining the result of the last screening test and the needle time], medical history and additional variables were calculated using Mann-Whitney U or Pearson Chi-Square tests for group comparison, and multivariate linear regression analysis was performed to identify independent variables of in-hospital delay. A total of 202 IVT cases were enrolled. The median age was 61 years and 25.2% were female. The cutoff points for the upper quartile of DTN (severe delay criteria was 135 min.When compared with the reference group without in-hospital delay, older age, shorter OTD and less referral were found in the standard delay group and male sex, presence with transient ischemic attacks or rapidly improving symptom, and with multi-model CT imaging were more frequent in the severe delay group. In the multivariate linear regression analysis, FTN (P<0.001 and DTL (P = 0.002 were significantly associated with standard delay; while DTE (P = 0.005, DTI (P = 0.033, DTL (P<0.001, and FTN (P<0.001 were positively associated with severe delay. There was not a significant change in the trend of DTNs during the study period (P = 0.054. In-hospital delay was due to multifactors in China, in which time delays of decision-making process and laboratory tests contributed the most. Efforts aiming at reducing the delay

  18. Upper limb artery segmental occlusions due to chronic use of ergotamine combined with itraconazole, treated by thrombolysis

    Directory of Open Access Journals (Sweden)

    Nodari Franco

    2011-08-01

    Full Text Available Abstract Background The ergotamine tartrate associated with certain categories of drugs can lead to critical ischemia of the extremities. Discontinuation of taking ergotamine is usually sufficient for the total regression of ischemia, but in some cases it could be necessary thrombolytic and anticoagulant therapy to avoid amputation. Case report A woman of 62 years presented with a severe pain left forearm appeared 10 days ago, with a worsening trend. The same symptoms appeared after 5 days also in the right forearm. Physical examination showed the right arm slightly hypothermic, with radial reduced pulse in presence of reduced sensitivity. The left arm was frankly hypothermic, pulse less on radial and with an ulnar humeral reduced pulse, associated to a decreased sensitivity and motility. Clinical history shows a chronic headache for which the patient took a daily basis for years Cafergot suppository (equivalent to 3.2 mg of ergotamine. From about ten days had begun therapy with itraconazole for vaginal candidiasis. The Color-Doppler ultrasound shown arterial thrombosis of the upper limbs (humeral and radial bilateral, with minimal residual flow to the right and no signal on the humeral and radial left artery. Results Angiography revealed progressive reduction in size of the axillary artery and right humeral artery stenosis with right segmental occlusions and multiple hypertrophic collateral circulations at the elbow joint. At the level of the right forearm was recognizable only the radial artery, decreased in size. Does not recognize the ulnar, interosseous artery was thin. To the left showed progressive reduction in size of the distal subclavian and humeral artery, determined by multiple segmental steno-occlusion with collateral vessels serving only a thin hypotrophic interosseous artery. Arteriographic findings were compatible with systemic drug-induced disease. The immediate implementation of thrombolysis, continued for 26 hours, with

  19. Factors Associated with In-Hospital Delay in Intravenous Thrombolysis for Acute Ischemic Stroke: Lessons from China.

    Science.gov (United States)

    Huang, Qiang; Ma, Qing-feng; Feng, Juan; Cheng, Wei-yang; Jia, Jian-ping; Song, Hai-qing; Chang, Hong; Wu, Jian

    2015-01-01

    In-hospital delay reduces the benefit of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS), while factors affecting in-hospital delay are less well known in Chinese. We are aiming at determining the specific factors associated with in-hospital delay through a hospital based cohort. In-hospital delay was defined as door-to-needle time (DTN) ≥60 min (standard delay criteria) or ≥75% percentile of all DTNs (severe delay criteria). Demographic data, time intervals [onset-to-door time (OTD), DTN, door-to-examination time (DTE), door-to-imaging time (DTI), door-to-laboratory time (DTL) and final-test-to-needle time (FTN, the time interval between the time obtaining the result of the last screening test and the needle time)], medical history and additional variables were calculated using Mann-Whitney U or Pearson Chi-Square tests for group comparison, and multivariate linear regression analysis was performed to identify independent variables of in-hospital delay. A total of 202 IVT cases were enrolled. The median age was 61 years and 25.2% were female. The cutoff points for the upper quartile of DTN (severe delay criteria) was 135 min.When compared with the reference group without in-hospital delay, older age, shorter OTD and less referral were found in the standard delay group and male sex, presence with transient ischemic attacks or rapidly improving symptom, and with multi-model CT imaging were more frequent in the severe delay group. In the multivariate linear regression analysis, FTN (PDTL (P = 0.002) were significantly associated with standard delay; while DTE (P = 0.005), DTI (P = 0.033), DTL (P<0.001), and FTN (P<0.001) were positively associated with severe delay. There was not a significant change in the trend of DTNs during the study period (P = 0.054). In-hospital delay was due to multifactors in China, in which time delays of decision-making process and laboratory tests contributed the most. Efforts aiming at reducing the delay should be

  20. Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-Thrombolysis in Myocardial Infarction 38.

    NARCIS (Netherlands)

    Wiviott, S.D.; Braunwald, E.; Angiolillo, D.J.; Meisel, S.; Dalby, A.J.; Verheugt, F.W.A.; Goodman, S.G.; Corbalan, R.; Purdy, D.A.; Murphy, S.A.; McCabe, C.H.; Antman, E.M.

    2008-01-01

    BACKGROUND: Patients with diabetes mellitus (DM) are at high risk for recurrent cardiovascular events after acute coronary syndromes, in part because of increased platelet reactivity. The Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysi

  1. Rescue Thrombectomy in Large Vessel Occlusion Strokes Leads to Better Outcomes than Intravenous Thrombolysis Alone: A ‘Real World’ Applicability of the Recent Trials

    Science.gov (United States)

    Nogueira, Raul G.; Zaidat, Osama O.; Castonguay, Alicia C.; Haussen, Diogo C.; Martin, Coleman O.; Holloway, William E.; Mueller-Kronast, Nils; English, Joey; Linfante, Italo; Dabus, Guilherme; Malisch, Tim W.; Marden, Franklin A.; Bozorgchami, Hormozd; Xavier, Andrew; Rai, Ansaar T.; Froehler, Michael T.; Badruddin, Aamir; Nguyen, Thanh N.; Taqi, M. Asif; Abraham, Michael G.; Janardhan, Vallabh; Yoo, Albert J.; Shaltoni, Hashem; Abou-Chebl, Alex; Chen, Peng R.; Britz, Gavin W.; Novakovic, Roberta; Nanda, Ashish; Kaushal, Ritesh; Issa, Mohammad A.; Frankel, Michael R.; Gupta, Rishi

    2016-01-01

    Background The Interventional Management of Stroke III (IMS-III) trial demonstrated no benefit for intravenous recombinant tissue plasminogen activator (IV rt-PA) followed by endovascular therapy versus IV rt-PA alone. However, IMS-III mostly included earlier generation devices. The recent thrombectomy trials have incorporated the stent-retriever technology, but their generalizability remains unknown. Methods The North American Solitaire Acute Stroke (NASA) registry recruited patients treated with the Solitaire FR™ device between March 2012 and February 2013. The NASA-IMS-III-Like Group (NILG baseline NIHSS score ≥10 who received IV rt-PA) was compared to the IV rt-PA and IV + intra-arterial (IA)-IMS-III groups and the MR CLEAN, ESCAPE, SWIFT Prime, and REVASCAT trial controls to assess the stent-retriever treatment in the ‘real-world’ setting. The NILG was also compared to non-IV rt-PA NASA patients to evaluate the impact of IV rt-PA on thrombectomy. Results A total of 136 of the 354 NASA patients fulfilled criteria for the NILG. Baseline characteristics were well balanced across groups. Time from onset to puncture was higher in NILG than IV+IA-IMS-III patients (274 ± 112 vs. 208 ± 47 min, p < 0.0001). Occlusions involving the intracranial ICA, MCA-M1, or basilar arteries were more common in NILG than IV+IA-IMS-III patients (91.2 vs. 47.2%, p < 0.00001). Modified thrombolysis in cerebral infarction ≥2b reperfusion was higher in NILG than IV+IA-IMS-III patients (74.3 vs. 39.6%, p < 0.00001). A 90-day modified Rankin Scale score ≤2 was more frequent in the NILG than IV+IA-IMS-III patients (51.9 vs. 40.8%, p = 0.03) and MR CLEAN (51.9 vs. 19.1%, p < 0.00001), ESCAPE (51.9 vs. 29.3%, p = 0.0002), SWIFT Prime (51.9 vs. 35.5%, p = 0.02), and REVASCAT (51.9 vs. 28.2%, p = 0.0003) controls. Symptomatic intracranial hemorrhage definitions varied across the different studies with rates ranging from 2.7% (ESCAPE) to 11.9% (NILG). The NILG 90-day mortality (24

  2. The third international stroke trial (IST-3 of thrombolysis for acute ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Cantisani Teresa

    2008-06-01

    Full Text Available Abstract Background Intravenous recombinant tissue plasminogen activator (rt-PA is approved for use in selected patients with ischaemic stroke within 3 hours of symptom onset. IST-3 seeks to determine whether a wider range of patients may benefit. Design International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE trial of intravenous rt-PA in acute ischaemic stroke. Suitable patients must be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracerebral haemorrhage. With 1000 patients, the trial can detect a 7% absolute difference in the primary outcome. With3500 patients, it can detect a 4.0% absolute benefit & with 6000, (mostly treated between 3 & 6 hours, it can detect a 3% benefit. Trial procedures Patients are entered into the trial by telephoning a fast, secure computerised central randomisation system or via a secure web interface. Repeat brain imaging must be performed at 24–48 hours. The scans are reviewed 'blind' by expert readers. The primary measure of outcome is the proportion of patients alive and independent (Modified Rankin 0–2 at six months (assessed via a postal questionnaire mailed directly to the patient. Secondary outcomes include: events within 7 days (death, recurrent stroke, symptomatic intracranial haemorrhage, outcome at six months (death, functional status, EuroQol. Trial registration ISRCTN25765518

  3. Feasibility and outcomes of intravenous thrombolysis 3-4.5 hours after stroke in Chinese patients.

    Science.gov (United States)

    Xu, Zhi-Peng; Li, Hong-Hua; Li, Ya-Hong; Zhang, Yong; Wu, Qiang; Lin, Lang

    2014-05-01

    The time window for intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment in acute ischemic stroke (AIS) patients has been extended to 4.5 hours. But little is known about the safety and efficacy of IV rt-PA treatment in the 3-4.5 hour time window in Chinese patients with AIS. A total of 119 patients who were treated with standard IV rt-PA therapy within 4.5 hours after symptom onset were included in this study: 85 were treated within 0-3 hours and 34 were treated within 3-4.5 hours. Favorable outcome was defined as a modified Rankin scale (mRS) score of 0-1 at 6 months. The safety of IV rt-PA treatment was assessed by the rate of mortality, symptomatic intracerebral hemorrhage (SICH) and other common complications. There were no significant differences in SICH rates (2.94% versus 2.35%; p=0.85) at 24-36 hours, mortality (5.88% versus 3.53%; p=0.56), other complications (14.71% versus 11.76%; p=0.66), National Institutes of Health Stroke Scale (NIHSS) score improvement at 24 hours (41.18% versus 45.88%; p=0.64) and favorable mRS at 6 months (52.94% versus 54.12%; p=0.91) between the two time window groups. Multivariate analysis showed that advanced age, lower admission NIHSS score and shorter time from symptom onset to treatment were associated with a favorable clinical outcome. This finding showed an additional 29% of patients received IV rt-PA because of the treatment window expansion to 4.5 hours. IV rt-PA was feasible and safe for treating AIS patients in the 3-4.5 hour time window in our Chinese population.

  4. Comparison and Evaluation on Supperselected Intraaterial Thrombolysis and Venous Thrombolysis in Treating Acute Cerebral Infarction%超选择性动脉溶栓与静脉溶栓治疗急性脑梗死的对比分析

    Institute of Scientific and Technical Information of China (English)

    刘晓林; 刘宓宓

    2015-01-01

    目的:对比分析应用超选择性动脉溶栓与静脉溶栓治疗急性脑梗死的临床疗效和可靠性。方法按照数字表法将2013年4月~2014年4月我院148例应用尿激酶溶栓治疗的急性脑梗死患者分成对照组(静脉溶栓)和观察组(超选择性动脉溶栓)各74例,对两组患者治疗后1个月的临床显效率以及NIHSS评分进行比较。结果观察组治疗后的临床总有效率86.49%,对照组治疗后的临床总有效率68.92%,两组比较差异具有统计学意义(P<0.05);观察组治疗后30 min、12 h、1 d、7 d NIHSS评分均低于对照组,两组比较差异具有统计学意义(P<0.05)。结论急性脑梗死患者应用尿激酶超选择性动脉溶栓治疗对NIHSS评分的改善以及临床的治疗效果均好于静脉溶栓治疗,临床应用安全可靠,具有临床推广应用价值。%Objective To comparison and Evaluation the clinical curative effect and reliability security of supperselected intraaterial thrombolysis and venous thrombolysis in treating acute cerebral infarction. Methods According to the digital meter method,148 cases patients with acute cerebral infarction were divided into observation groups(supperselected intraaterial thrombolysis) and control groups(venous thrombolysis),each group has 74 cases. to compare the total effective rate and the NIHSS score after treatment.Results The total effective rate of control group was 68.92%after one month treatment, The total effective rate of observation group was 86.49% after one month treatment, the difference between two group was significant (P<0.05);The NIHSS score of the observation group was lower than control group after their treatment in 30 min、12 h、1 d、、7 d later,the difference between two group was significant(P<0.05). Conclusion The improve of NIHSS score and the clinical curative effect of supperselected intraaterial thrombolysis was better than that of venous thrombolysis with

  5. Introduction: December 2015 HeartWeek Issue of Cardiology in the Young - Highlights of HeartWeek 2015: Challenges and Dilemmas of Pediatric Cardiac Care including Heart Failure in Children and Congenital Abnormalities of the Coronary Arteries.

    Science.gov (United States)

    Jacobs, Jeffrey P

    2015-12-01

    This December Issue of Cardiology in the Young represents the 13th annual publication in Cardiology in the Young generated from the two meetings that composed "HeartWeek in Florida". "HeartWeek in Florida", the joint collaborative project sponsored by the Cardiac Centre at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, together with Johns Hopkins All Children's Heart Institute of Saint Petersburg, Florida, averages over 1000 attendees every year and is now recognised as one of the major planks of continuing medical and nursing education for those working in the fields of diagnosis and treatment of cardiac disease in the foetus, neonate, infant, child, and adult. "HeartWeek in Florida" combines the International Symposium on Congenital Heart Disease, organised by All Children's Hospital and Johns Hopkins Medicine, and entering its 16th year, with the Annual Postgraduate Course in Paediatric Cardiovascular Disease, organised by The Children's Hospital of Philadelphia entering its 19th year. This December 2015 Issue of Cardiology in the Young features highlights of the two meetings that compose HeartWeek. Johns Hopkins All Children's Heart Institute's 15th Annual International Symposium on Congenital Heart Disease was held at the Renaissance Vinoy Resort & Golf Club, Saint Petersburg, Florida, from Friday, 6 February, 2015, to Monday, 9 February, 2015. This Symposium was co-sponsored by The American Association for Thoracic Surgery and its special focus was "Congenital Abnormalities of the Coronary Arteries". The Children's Hospital of Philadelphia's annual meeting - Cardiology 2015, the 18th Annual Update on Paediatric and Congenital Cardiovascular Disease: "Challenges and Dilemmas" - was held at the Hyatt Regency Scottsdale Resort and Spa at Gainey Ranch, Scottsdale, Arizona, from Wednesday, 11 February, 2015, to Sunday, 15 February, 2015. We would like to acknowledge the tremendous contributions made to paediatric and congenital cardiac care

  6. Optical modulator including grapene

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Ming; Yin, Xiaobo; Zhang, Xiang

    2016-06-07

    The present invention provides for a one or more layer graphene optical modulator. In a first exemplary embodiment the optical modulator includes an optical waveguide, a nanoscale oxide spacer adjacent to a working region of the waveguide, and a monolayer graphene sheet adjacent to the spacer. In a second exemplary embodiment, the optical modulator includes at least one pair of active media, where the pair includes an oxide spacer, a first monolayer graphene sheet adjacent to a first side of the spacer, and a second monolayer graphene sheet adjacent to a second side of the spacer, and at least one optical waveguide adjacent to the pair.

  7. Visual Impairment, Including Blindness

    Science.gov (United States)

    ... Who Knows What? Survey Item Bank Search for: Visual Impairment, Including Blindness Links updated, April 2017 En ... doesn’t wear his glasses. Back to top Visual Impairments in Children Vision is one of our ...

  8. Thrombolysis in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Santiago Herrero; Jose Antonio Lapuerta-Irigoyen

    2007-01-01

    The elderly population consists of those over age 75 years and appears to represent the fastest-growing segment of the population.Intravenous thrombolytic therapy (TT) is the most common strategy for the treament of acute myocardial infarction (AMI) in many parts of the world. However, TT carries a higher risk of intra-cranial hemorrhage (ICH) in the elderly patients. Primary percutaneous transluminal coronary angioplasty and stenting (PCI) represents an important alternative in these elderly individuals with contraindications to TT. In developing countries, or in areas without availability of primary PCI, TT remains the only therapeutic modality. Dedicated randomized trials are needed to provide a comprehensive understanding of AMI management in the elderly group.

  9. Pharmacomechanical thrombectomy and catheter-directed thrombolysis of acute lower extremity deep venous thrombosis in a 9-year-old boy with inferior vena cava atresia.

    Science.gov (United States)

    Hamidian Jahromi, Alireza; Coulter, Amy H; Bass, Patrick; Zhang, Wayne W; Tan, Tze-Woei

    2015-04-01

    Lower extremity deep venous thrombosis (DVT) is uncommon in the pediatric population, but it can be associated with severe symptoms and potential long-term morbidity secondary to post-thrombotic syndrome. Inferior vena cava (IVC) atresia can predispose a patient to the development of extremity DVT. There is no clear consensus on optimal management of extensive extremity DVT in pediatric patients, especially in patients with IVC anomalies. We report a case of iliofemoral DVT in a 9-year-old boy with IVC atresia and presumed protein S deficiency that was treated successfully using pharmacomechanical thrombectomy and catheter-directed thrombolysis. He was maintained on long-term anticoagulation and remained symptom free at 6 months' follow-up.

  10. Day Care Centers

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of day care centers for 50 states and Washington D.C. and Puerto Rico. The dataset only includes center based day care locations...

  11. National Health Care Survey

    Science.gov (United States)

    This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.

  12. Analytic device including nanostructures

    KAUST Repository

    Di, Fabrizio, E.

    2015-07-02

    A device for detecting an analyte in a sample comprising: an array including a plurality of pixels, each pixel including a nanochain comprising: a first nanostructure, a second nanostructure, and a third nanostructure, wherein size of the first nanostructure is larger than that of the second nanostructure, and size of the second nanostructure is larger than that of the third nanostructure, and wherein the first nanostructure, the second nanostructure, and the third nanostructure are positioned on a substrate such that when the nanochain is excited by an energy, an optical field between the second nanostructure and the third nanostructure is stronger than an optical field between the first nanostructure and the second nanostructure, wherein the array is configured to receive a sample; and a detector arranged to collect spectral data from a plurality of pixels of the array.

  13. Glossary of Managed Care Definitions

    Science.gov (United States)

    ... care provided to a patient by a health care provider. The medical record includes notes from physician visits, hospitalization records, test results, and consultations by specialists. Each health care provider who treats a patient usually creates and maintains ...

  14. Improving post-stroke recovery: the role of the multidisciplinary health care team.

    Science.gov (United States)

    Clarke, David J; Forster, Anne

    2015-01-01

    Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.

  15. Being Included and Excluded

    DEFF Research Database (Denmark)

    Korzenevica, Marina

    2016-01-01

    Following the civil war of 1996–2006, there was a dramatic increase in the labor mobility of young men and the inclusion of young women in formal education, which led to the transformation of the political landscape of rural Nepal. Mobility and schooling represent a level of prestige that rural...... people regard as a prerequisite for participating in local community politics. Based on a fieldwork in two villages of Panchthar district in eastern Nepal, this article explores how these changes strengthen or weaken women’s political agency and how this is reflected in their participation in community...... politics. It analyzes how formal education and mobility either challenge or reinforce traditional gendered norms which dictate a lowly position for young married women in the household and their absence from community politics. The article concludes that women are simultaneously excluded and included from...

  16. Value of care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Value of care displays – national data. This data set includes national-level data for the value of care displays associated with a 30-day episode of care for...

  17. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications ... a team of specially-trained health care providers. Critical care usually takes place in an intensive care ...

  18. Tracheostomy care

    Science.gov (United States)

    Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care ... Before you leave the hospital, health care providers will teach you how ... and suction the tube Keep the air you breathe moist Clean ...

  19. Measuring Quality Improvement in Acute Ischemic Stroke Care: Interrupted Time Series Analysis of Door-to-Needle Time

    Directory of Open Access Journals (Sweden)

    Anne Margreet van Dishoeck

    2014-06-01

    Full Text Available Background: In patients with acute ischemic stroke, early treatment with recombinant tissue plasminogen activator (rtPA improves functional outcome by effectively reducing disability and dependency. Timely thrombolysis, within 1 h, is a vital aspect of acute stroke treatment, and is reflected in the widely used performance indicator ‘door-to-needle time' (DNT. DNT measures the time from the moment the patient enters the emergency department until he/she receives intravenous rtPA. The purpose of the study was to measure quality improvement from the first implementation of thrombolysis in stroke patients in a university hospital in the Netherlands. We further aimed to identify specific interventions that affect DNT. Methods: We included all patients with acute ischemic stroke consecutively admitted to a large university hospital in the Netherlands between January 2006 and December 2012, and focused on those treated with thrombolytic therapy on admission. Data were collected routinely for research purposes and internal quality measurement (the Erasmus Stroke Study. We used a retrospective interrupted time series design to study the trend in DNT, analyzed by means of segmented regression. Results: Between January 2006 and December 2012, 1,703 patients with ischemic stroke were admitted and 262 (17% were treated with rtPA. Patients treated with thrombolysis were on average 63 years old at the time of the stroke and 52% were male. Mean age (p = 0.58 and sex distribution (p = 0.98 did not change over the years. The proportion treated with thrombolysis increased from 5% in 2006 to 22% in 2012. In 2006, none of the patients were treated within 1 h. In 2012, this had increased to 81%. In a logistic regression analysis, this trend was significant (OR 1.6 per year, CI 1.4-1.8. The median DNT was reduced from 75 min in 2006 to 45 min in 2012 (p Conclusion and Implications: The DNT steadily improved from the first implementation of thrombolysis. Specific

  20. 急性缺血性脑卒中溶栓治疗进展%Progress of treatment by thrombolysis for acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    陈效琴; 赵诤; 邓有琦; 任静

    2016-01-01

    急性缺血性脑卒中又称为脑梗死,主要是由于脑动脉闭塞等引发脑组织发生梗死状态,并伴有神经元、胶质细胞、少突胶质细胞损伤情况,其致残率与致死率均较高,属于临床上较为严重的一类中枢神经系统血管疾病。本文对急性缺血性脑卒中疾病患者采取溶栓治疗方案,并将相关资料阐述如下。%Acute ischemic stroke, also known as cerebral infarction, is the infarction state in brain tissue induced by cerebral artery occlusion, along with complicated injured nerve cell, spongiocyte and oligodendrocyte. As a severe central nervous system vascular disease, it shows high disability rate and mortality rate. This research applied thrombolysis in the treatment of acute ischemic stroke patients, and elaborated related data as follows.

  1. Mobile CT. Technical aspects of prehospital stroke imaging before intravenous thrombolysis; CT im Notarztwagen. Technische Aspekte der praehospitalen radiologischen Schlaganfalldiagnostik vor systemischer Thrombolyse

    Energy Technology Data Exchange (ETDEWEB)

    Gierhake, Daniel; Villringer, K.; Fiebach, J.B. [Charite - Universitaetsmedizin Berlin (Germany). Center for Stroke Research Berlin (CSB); Weber, J.E.; Audebert, H.J. [Charite - Universitaetsmedizin Berlin (Germany). Center for Stroke Research Berlin (CSB); Charite - Universitaetsmedizin Berlin (Germany). Klinik fuer Neurologie; Ebinger, M. [Charite - Universitaetsmedizin Berlin (Germany). Center for Stroke Research Berlin (CSB); Charite - Universitaetsmedizin Berlin (Germany). Klinik und Hochschulambulanz fuer Neurologie

    2013-01-15

    To reduce the time from symptom onset to treatment with tissue plasminogen activator (tPA) in ischemic stroke, an ambulance was equipped with a CT scanner. We analyzed process and image quality of CT scanning during the pilot study regarding image quality and safety issues. The pilot study of a stroke emergency mobile unit (STEMO) ran over a period of 12 weeks on 5 weekdays from 7a. m. to 6:30 p. m. A teleradiological service for the justifying indication and reporting was established. The radiographer was responsible for the performance of the CT scan on the ambulance. 64 cranial CT scans and 1 intracranial CT angiography were performed. We compared times from ambulance alarm to treatment decision (time of last brain scan) with a cohort of 50 consecutive tPA treatments before implementation of STEMO. 62 (95 %) of the 65 scans performed had sufficient quality for reading. Technical quality was not optimal in 45 cases (69 %) mainly caused by suboptimal positioning of patient or eye lense protection. Motion artefacts were observed in 8 exams (12 %). No safety issues occurred for team or patients. 23 patients were treated with thrombolysis. Time from alarm to last CT scan was 18 minutes shorter than in the tPA cohort before STEMO implementation. A teleradiological support for primary stroke imaging by CT on-site is feasible, quality-wise of diagnostic value and has not raised safety issues. (orig.)

  2. CT venography for deep venous thrombosis: can it predict catheter-directed thrombolysis prognosis in patients with iliac vein compression syndrome?

    Science.gov (United States)

    Choi, Jin Woo; Jae, Hwan Jun; Kim, Hyo-Cheol; Min, Sang-Il; Min, Seung-Kee; Lee, Whal; Chung, Jin Wook

    2015-02-01

    To evaluate the prognostic value of CT venography for catheter-directed thrombolysis (CDT) in iliac vein compression syndrome (IVCS) patients with deep venous thrombosis (DVT). The institutional review board approved this retrospective study and waived informed consent. Among the 201 consecutive patients treated in our interventional suite for DVT from January 2001 to June 2013, 48 IVCS patients (12 men, 36 women) who underwent pre-procedural CT venography, CDT with stenting, and follow-up imaging were analyzed. To identify possible determinants of 6-month patency, CT venography was evaluated with Fisher's exact test and logistic regression analyses. Based on the analyses, image-based criteria were established and compared to the current symptom duration-based approach by receiver-operating-characteristic curve analyses and the McNemar test. Recoiling of external iliac vein (EIV) diameter (enhancement (HR 20.545, p = .016) were significant risk factors for venous occlusion within 6 months of CDT. The dual-parameter image-based criteria were significantly superior to the current symptom duration-based approach in terms of area under the curve value (p = .010) and predictive accuracy (p = .031). With a 2-point cut-off, the proposed criteria demonstrated a 66.7 % sensitivity, 100.0 % specificity, and 92.9 % predictive accuracy for identifying non-responders of CDT. CT venography may be useful in assessing CDT prognoses in IVCS patients, particularly to identify non-responders who demonstrate recoiling of EIV diameter and rim enhancement on CT venography.

  3. Stimulatory effect of an algal fucoidan on the release of vascular endothelial tissue-type plasminogen activator as a mechanism of fucoidan-mediated thrombolysis.

    Science.gov (United States)

    Min, Soon-Ki; Han, Sung-Mi; Jang, Jae-Seok; Kim, Jong-Ki

    2016-07-01

    Identifying a pharmacological means for increasing the production of tissue-type plasminogen activator (t-PA) is always desirable to cure impaired production of this enzyme. An algal fucoidan has been shown to exhibit both novel thrombolytic and synergistic stimulatory effects in a mouse thrombosis model. The plasma levels of active t-PA were measured in mouse arterial thrombus models that were treated with various fucoidans to investigate the mechanism of thrombolysis. The mean plasma level of active t-PA after the infusion of fucoidan was 2.136 ± 0.231 ng/ml for nonthrombolytic Fucus fucoidan and 3.917 ± 0.0.529 ng/ml for thrombolytic Undaria fucoidan, which resulted in a 1.56-2.29-fold increase compared with the healthy control group (1.706 ± 0.194 ng/ml) and the untreated thrombus group (2.506 ± 0.301 ng/ml) (P fucoidan has demonstrated to exert a thrombolytic and stimulatory effect via the induction of t-PA release in a dose-dependent manner in an arterial thrombosis model.

  4. 病前抗血小板治疗对急性缺血性脑卒中静脉溶栓效果的影响%Effect of Premorbid Antiplatelet Therapy on Travenous Thrombolysis for A-cute Ischemic Stroke

    Institute of Scientific and Technical Information of China (English)

    程锐

    2015-01-01

    [Abtract] Objective To analyze and study the impact of premorbid antiplatelet therapy on the efficacy and safety of travenous thrombolysis for patients with acute ischemic stroke. Methods The clinical data of 258 patients with acute ischemic stroke who were admitted and treated with travenous thrombolysis within 6 hours after the onset in our hospital during September 2010 and December 2012 were retrospectively analyzed. 125 patients who were given premorbid antiplatelet therapy and the other 133 who were not given were assigned to observation group and control group, respectively. The recovery of neurological function was eval-uated by using modified Rankin scale. Results Within 90 days after travenous thrombolysis, the rate of intracranial hemorrhage, mortality and good prognosis of the observation group and those of the control groups were 11.2%, 5.6%, 5.52% and 8.27%, 4.51%, 5.93%, respectively, and the differences between the indicators above of the two groups were not statistically significant (P>0.05). Conclusion Premorbid antiplatelet therapy, which has little effect on the efficacy of travenous thrombolysis for patients with acute ischemic stroke, is not the reference index which must be considered for intravenous thrombolysis.

  5. Pediatric Primary Care as a Component of Systems of Care

    Science.gov (United States)

    Brown, Jonathan D.

    2010-01-01

    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of…

  6. Finnish care integrated?

    Directory of Open Access Journals (Sweden)

    Jouni Niskanen

    2002-06-01

    Full Text Available The public Finnish social and health care system has been challenged by the economic crisis, administrative reforms and increased demands. Better integration as a solution includes many examples, which have been taken to use. The most important are the rewritten national and municipals strategies and quality recommendations, where the different sectors and the levels of care are seen as one entity. Many reorganisations have taken place, both nationally and locally, and welfare clusters have been established. The best examples of integrated care are the forms of teamwork, care management, emphasis on non-institutional care and the information technology.

  7. Spiritual Care Education of Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Donia Baldacchino

    2015-05-01

    Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.

  8. Hospice Care

    Science.gov (United States)

    Hospice care is end-of-life care. A team of health care professionals and volunteers provides it. ... can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's ...

  9. Intercultural caring-an abductive model.

    Science.gov (United States)

    Wikberg, Anita; Eriksson, Katie

    2008-09-01

    The aim of this study was to increase the understanding of caring from a transcultural perspective and to develop the first outline of a theory. The theoretical perspective includes Eriksson's theory of caritative caring. Texts on caring by the transcultural theorists, including Campinha-Bacote, Kim-Godwin, Leininger and Ray, are analysed using content analysis. The overall theme that resulted from this analysis was that caring is a complex whole. Three main categories of caring emerged: inner caring, outer caring and the goal of caring. Inner caring consists of caring is a relationship, and caring and culture are seen in different dimensions. Outer caring refers to caring affected by educational, administrative and social and other structures. The goal of caring consists of caring leading to change towards health and well-being. The main categories include categories and subcategories that are compared with Eriksson's theory of caritative caring. A model for intercultural caring is generated abductively. Caring and culture appear in three dimensions: caring as ontology independent of context; caring as a phenomenon emphasised differently in different cultures; caring as nursing care activities is unique. Caring alleviates suffering and leads to health and well-being. This model describes caring from an intercultural perspective as a mutual but asymmetric relationship between the nurse and the patient, including the patient's family and community. The patient's cultural background and acculturation influence caring. The cultural background, cultural competence and organisation of the nurse also influence caring. Caring is seen as a complex whole. This study integrates Campinha-Bacote's, Kim-Godwin's, Leininger's and Ray's views of caring with Eriksson's caritative caring and presents caring from a transcultural perspective in a new way as a model for intercultural caring, which can benefit nursing care, education, research and administration.

  10. Careful science?

    DEFF Research Database (Denmark)

    Jespersen, Astrid P; Bønnelycke, Julie; Eriksen, Hanne Hellerup

    2014-01-01

    Concern about obesity has prompted numerous public health campaigns that urge people to be more physically active. The campaigns often include normative statements and attempt to impose restrictions on individuals' lives without considering the complexities of daily life. We suggest that broadening...... into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday lives...

  11. The Epital Care Model

    DEFF Research Database (Denmark)

    Phanareth, Klaus; Vingtoft, Søren; Christensen, Anders Skovbo

    2017-01-01

    and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports...... the intentions of the World Health Organization (WHO) to have integrated people-centered care. OBJECTIVE: To design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care...... and face-to-face support for COPD management. In step five the initial model was extended with elements that support continuity of care. Beginning in the autumn of 2013, 1102 frail elderly individuals were included and offered two additional services: an outgoing acute medical team and a local subacute bed...

  12. Palliative Care

    Science.gov (United States)

    ... you are a partner with the palliative care team as you all work toward the same goal — providing the best quality of life for your child for as ... Care for Children With Terminal Illness Managing Home Health Care Taking Care of You: Support ...

  13. Clinical Studies of Cerebral Edema Recanalization After Thrombolysis in Acute Cerebral Infarction%急性脑梗死动脉溶栓血管再通后的脑水肿临床研究

    Institute of Scientific and Technical Information of China (English)

    王喜春; 马冲; 张健莉; 于杰

    2015-01-01

    目的:探讨急性缺血性脑卒中动脉溶栓血管再通后脑水肿的临床研究,旨在为此类疾病患者的下一步临床工作提供借鉴。方法选择通过动脉溶栓血管再通的患者40例。将患者分为1~3 h组(A组)、>3~6h组(B组)。头颅CT监测、随访脑水肿情况。记录溶栓前、术后1周及1年NIHSS评分、MRS评分及BI指数。结果动脉溶栓血管再通后脑水肿发生率为100%,随访发现脑水肿局部有明显软化灶。两组患者脑水肿及临床结局比较差异无统计学意义(P>0.05)。结论动脉溶栓血管再通后脑水肿的及其脑组织缺失发生率极高,脑水肿局部有明显软化灶,良好的脑内局部循环和全身状况是改善此类脑水肿的重要因素。%Objective To investigate the acute arterial ischemic stroke thrombolytic recanalization clinical studies of cerebral edema, designed to provide a reference for the next clinical disease in these patients.Methods arterial thrombolysis recanalization by 40 patients. Patients were divided into 1 ~ 3h group (A),> 3 ~ 6h group (group B). Cranial CT monitoring, follow-up of brain edema. Recorded before thrombolysis, after 1 week and 1 year NIHSS score, MRS score and BI index.Results arterial thrombolysis recanalization rate was 97.5% of cerebral edema, cerebral edema partial follow-up found a significant malacia. Two groups of patients and clinical outcomes of cerebral edema was no significant difference (P> 0.05).Conclusion The arterial thrombolysis recanalization of cerebral edema and high incidence of brain tissue loss, good local circulation in the brain and body condition is such an important factor in improving brain edema.

  14. Lower Costs, Better Care- Reforming Our Health Care Delivery

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...

  15. Prenatal Care: Third Trimester Visits

    Science.gov (United States)

    Healthy Lifestyle Pregnancy week by week During the third trimester, prenatal care might include vaginal exams to check the baby's ... 2015 Original article: http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art- ...

  16. Prenatal Care: Second Trimester Visits

    Science.gov (United States)

    Healthy Lifestyle Pregnancy week by week During the second trimester, prenatal care includes routine lab tests and measurements of your ... 2015 Original article: http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art- ...

  17. Pharmacists belong in accountable care organizations and integrated care teams.

    Science.gov (United States)

    Smith, Marie; Bates, David W; Bodenheimer, Thomas S

    2013-11-01

    Effective health care workforce development requires the adoption of team-based care delivery models, in which participating professionals practice at the full extent of their training in pursuit of care quality and cost goals. The proliferation of such new models as medical homes, accountable care organizations, and community-based care teams is creating new opportunities for pharmacists to assume roles and responsibilities commensurate with their capabilities. Some challenges to including pharmacists in team-based care delivery models, including the lack of payment mechanisms that explicitly provide for pharmacist services, have yet to be fully addressed by policy makers and others. Nevertheless, evolving models and strategies reveal a variety of ways to draw on pharmacists' expertise in such critical areas as medication management for high-risk patients. As Affordable Care Act provisions are implemented, health care workforce projections need to consider the growing number of pharmacists expected to play an increasing role in delivering primary care services.

  18. Endovascular therapy including thrombectomy for acute ischemic stroke: A systematic review and meta-analysis with trial sequential analysis.

    Science.gov (United States)

    Phan, Kevin; Zhao, Dong Fang; Phan, Steven; Huo, Ya Ruth; Mobbs, Ralph J; Rao, Prashanth J; Mortimer, Alex M

    2016-07-01

    One of the primary strategies for the management of acute ischemic stroke is intravenous (IV) thrombolysis with tissue plasminogen activator (t-PA). Over the past decade, endovascular therapies such as the use of stent retrievers to perform mechanical thrombectomy have been found to improve functional outcomes compared to t-PA alone. We aimed to reassess the functional outcomes and complications of IV thrombolysis with and without endovascular treatment for acute ischemic stroke using conventional meta-analysis and trial sequential analysis. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated for the effect of IV thrombolysis with and without endovascular therapy on functional outcome, mortality and symptomatic intracranial hemorrhage (SICH). Trial sequential analysis was done to strengthen the meta-analysis. We analyzed six randomized controlled trials involving 1943 patients. Patients who received IV thrombolysis with endovascular treatment showed significantly higher rates of excellent functional outcomes (modified Rankin Scale [mRS] 0-1) (RR, 1.75 [95% CI, 1.29-2.39]) compared to those who received IV thrombolysis alone. A similar association was seen for good functional outcomes (mRS 0-2) (RR, 1.56 [95% CI, 1.24-1.96]). Trial sequential analysis demonstrated endovascular treatment increased the RR of a good functional outcome by at least 30% compared to IV thrombolysis alone. There was no significant difference in all-cause mortality for mechanical thrombectomy compared to IV thrombolysis alone or the incidence of SICH at 3month follow-up. Endovascular treatment is more likely to result in a better functional outcome for patients compared to IV thrombolysis alone for acute ischemic stroke.

  19. Improved wound care product

    DEFF Research Database (Denmark)

    2012-01-01

    The present invention pertains to use of sodium diacetate (NaHAc 2) as an antimicrobial agent against bacteria growing in biofilms. The aspects of the invention include a wound care product comprising sodium diacetate, a kit comprising a wound care product,and a methodof treating an infected wound....

  20. Care, Europeanization and Gender

    DEFF Research Database (Denmark)

    Dyrberg, Torben Bech

    This book adresses the recent underexamined developments concerning care in Europe, including the negotiations about care at the top EU level to that of individual workers. Through a comparative and interdisciplinary approach, this collection examines and further develops current theoretical and ...

  1. 急性缺血性卒中动脉溶栓后造影剂渗出的临床分析%Clinical analysis on contrast extravasation after intra-arterial thrombolysis for acute ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    付睿; 贺茂林; 赵星辉; 黄栋; 席春江; 张彤; 戴威

    2013-01-01

    Objective To evaluate the risk factors and the prognosis for contrast extravasation after intraarterial(IA)thrombolysis for acute ischemic stroke.Methods A prospective and open-label trial was performed on 78 patients at the department of neurology in Beijing Shijitan Hospital from April 2008 to June 2012.Patients with acute ischemic stroke in the carotid artery system within 6 hours of symptom onset were treated with recombinant tissue plasminogen activator(rtPA) or urokinase (UK)by intra-artery thrombolysis approach.Arterial recanalization was assessed by the thrombolysis in cerebral infarction (TICI) classification.The functional outcome in 3-month was measured by mRS score.Contrast extravasation were observed by the baseline CT and postprocedure CTs.Results According to the results of digital subtraction angiography(DSA),30 patients had the internal carotid artery (ICA) occlusion and 48 patients had the middle cerebral artery(MCA) occlusion.The rote of recanalization after IA thrombolysis was 78.2% (61/78),the rate of contrast extravasation was 20.5% (16/78).Contrast extravasation were noted on immediate CT scans after intra-arterial thrombolysis in 4 patients with the ICA occlusion and 12 patients with the MCA occlusion.Patients with contrast extravasation had a partial or complete vascular recanalization.Favorable prognosis outcome,defined as a modified Rankin Score of 0-2 at 90 days,were significantly higher in patients without contrast extravasation than in patients with contrast extravasation(74.2% vs.43.8%) (P =0.020).The rate of symptomatic intracerebral hemorrhage (SICH)were significantly higher in patients with contrast extravasation than in patients without contrast extravasation(25% vs.3.2%)(P =0.017).Baseline NIHSS score >16 points (< 22 points),systolic pressure was more than 160 mm Hg during intra-arterial thrombolysis,vascular recanalization after intra-arterial thrombolysis,mechanical thrombus disruption by microcatheter and

  2. Advance Care Planning.

    Science.gov (United States)

    Stallworthy, Elizabeth J

    2013-04-16

    Advance care planning should be available to all patients with chronic kidney disease, including end-stage kidney disease on renal replacement therapy. Advance care planning is a process of patient-centred discussion, ideally involving family/significant others, to assist the patient to understand how their illness might affect them, identify their goals and establish how medical treatment might help them to achieve these. An Advance Care Plan is only one useful outcome from the Advance Care Planning process, the education of patient and family around prognosis and treatment options is likely to be beneficial whether or not a plan is written or the individual loses decision making capacity at the end of life. Facilitating Advance Care Planning discussions requires an understanding of their purpose and communication skills which need to be taught. Advance Care Planning needs to be supported by effective systems to enable the discussions and any resulting Plans to be used to aid subsequent decision making.

  3. Application of tirofiban in ischemic stoke thrombolysis and endovascular therapy%替罗非班在缺血性卒中溶栓和血管内治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    孙钦建; 郑兴月; 屈传强

    2014-01-01

    血小板糖蛋白(platelet glycoprotein,GP)Ⅱb/Ⅲa受体拮抗药替罗非班已广泛应用于急性冠状动脉综合征(acute coronary syndrome,ACS)和经皮冠状动脉介入(percutaneous transluninal coronary intervention,PCI)的治疗.文章介绍了替罗非班的作用机制以及在缺血性卒中静脉溶栓、动脉溶栓、血管内治疗中的应用,强调了替罗非班在急诊脑血管成形术中应用的安全性和有效性.%Tirofiban,a platelet glycoprotein (GP) Ⅱ b/Ⅲ a receptor antagonist has been widely used in the treatment of acute coronary syndrome (ACS) and percutaneous transluminal coronary intervention.This article introduces the mechanism of action of tirofiban and its application in intravenous thrombolysis,intraarterial thrombolysis,and endovascular therapy in ischemic stroke,emphasizing the safety and effectiveness of tirofiban in the application of the emergency cerebral angioplasty.

  4. Importance of thrombosis and thrombolysis in silent ischaemia: comparison of patients with acute myocardial infarction and unstable angina.

    Science.gov (United States)

    Gurfinkel, E.; Altman, R.; Scazziota, A.; Rouvier, J.; Mautner, B.

    1994-01-01

    OBJECTIVE--To investigate whether plaque rupture and thrombosis have a role in silent ischaemia as well as in unstable angina. DESIGN--Prospective analysis of the results of haemostatic diagnostic tests at the moment of developing silent ischaemia at rest. SETTING--Coronary care unit. PATIENTS--22 patients with acute myocardial infarction, 12 patients with symptomatic angina (unstable angina), and 10 normal volunteers (control group). INTERVENTIONS--Continuous cardiac monitoring detected 15 asymptomatic episodes (silent ischaemia) in 6 patients with unstable angina. Blood samples were obtained at admission and when an asymptomatic alteration was detected and 10 minutes later. MAIN OUTCOME MEASURES--Comparisons of concentrations of tissue plasminogen activator, urokinase type plasminogen activator, tissue plasminogen activator inhibitor-1, cross-linked fibrin degradation products, von Willebrand factor, and thrombin-antithrombin III complexes in patients and controls at admission; same comparisons in patients with silent ischaemia at the start of an episode and 10 minutes later. RESULTS--Tissue plasminogen activator concentrations were raised at admission in patients with acute myocardial infarction (mean (SD) 14.2 (6) ng/ml) and in patients with unstable angina (10.1 (2.5) ng/ml) in comparison with controls (5.1 (2.7) ng/ml, p < 0.01 and < 0.05 respectively). There was no differences between the two groups of patients, however. Similar results were observed at the start of a silent ischaemic episode (9.8 (1.9) ng/ml) and 10 minutes later (10.5 (2.9) ng/ml) compared with controls (p < 0.05). Tissue plasminogen activator inhibitor-1 concentrations were raised in patients with acute myocardial infarction (45.1 (15) ng/ml) compared with volunteers (20.6 (16) ng/ml, p < 0.01). In patients with silent ischaemia tissue plasminogen activator inhibitor-1 concentrations were slightly but not significantly increased. Concentrations of cross-linked fibrin degradation products

  5. 导管溶栓治疗对急性深静脉血栓形成转归的影响%Outcome comparisons of anticoagulation, systematic thrombolysis and catheter-directed thrombolysis in the treatment of lower extremity acute deep venous thrombosis

    Institute of Scientific and Technical Information of China (English)

    张智辉; 单臻; 王文见; 李晓曦; 王深明

    2013-01-01

    目的 探讨抗凝、系统溶栓与导管溶栓治疗下肢急性深静脉血栓形成(DVT)的远期疗效及对深静脉血栓后综合征(PTS)的影响.方法 随访2005年1月至2009年12月在中山大学附属第一医院及广州医学院第二附属医院血管外科收治的下肢急性DVT患者(152例)的临床资料,根据治疗方法分为单纯抗凝组(A组)、系统溶栓联合抗凝组(B组)和导管溶栓联合抗凝组(C组).随访时行静脉彩超或下肢顺行静脉造影了解患肢静脉通畅情况,用Villalta评分法调查各组患者PTS的发生率,用CIVIQ-2调查表研究各组患者的生活质量,分析各组患者出院后抗凝时间及弹力袜使用情况.结果 (1)A、B、C3组患者静脉通畅率分别为69.1%、70.8%、85.1%,C组与A组差异有统计学意义(P<0.05),C组虽然高于B组,但差异尚无统计学意义(P>0.05),A、B两组间差异无统计学意义(P>0.05).(2)A、B、C3组PTS的发生率分别为56.8%、54.2%、38.3%,C组与A、B两组间差异有统计学意义(P<0.05),A、B两组间的差异无统计学意义(P>0.05).(3)A、B、C3组CIVIQ-2评分为20±14、20±12、17±11,C组较A、B两组分数低,但差异尚无统计学意义(P>0.05).(4)A、B、C3组出院后平均抗凝及弹力袜时间差异无统计学意义(P>0.05).结论 与单纯抗凝及系统溶栓相比较,导管溶栓联合抗凝能降低急性下肢DVT转归为PTS的发生率,改善临床症状,提高生活质量.%Objective To explore the outcomes of anticoagulation,systematic thrombolysis and catheter-directed thrombolysis (CDT) in the treatment of lower extremity acute deep venous thrombosis (DVT).Methods The clinical data of 152 patients with lower extremity acute DVT from January 2005 to December 2009 were analyzed retrospectively.They were divided into single anticoagulation group (A),systematic thrombolysis plus anticoagulation group (B) and CDT plus anticoagulation group (C).Follow-up studies were performed

  6. Efficacy of intravenous thrombolysis for the treatment of wake-up ischemic stroke under the guidance of multimode CT%多模式CT指导下静脉溶栓治疗觉醒型缺血性卒中的效果

    Institute of Scientific and Technical Information of China (English)

    兰俊; 朱少铭; 陈立兵; 黄桂梅; 刘秀建; 宋典意; 李国臣

    2015-01-01

    并发症发生。对照组1例出现应激性胃溃疡并胃出血,未发生症状性脑出血。结论多模式CT指导可作为WUS患者扩大静脉溶栓时间窗的可靠影像学依据,在多模式CT指导下应用rt-PA静脉溶栓治疗有一定疗效。%Objective To observe the efficacy and safety of recombinant tissue type plasminogen activa-tor (rt-PA)for the treatment of the patients with wake-up ischemic stroke (WUS)under the guidance of multimode CT. Methods Eighteen patients with WUS (a thrombolytic group)suitable for intravenous thrombolysis after multimode CT imaging screen at the Department of Neurology,Shiyan Hospital of Integrated Traditional and Western Medicine,Hubei Province from October 2012 to October 2014 were enrolled retrospectively. Twenty patients with WUS (a control group)who underwent multimode CT imaging screen were suitable for intravenous thrombolysis,but because of exceeding time window or rejecting thrombolysis and other reasons without having intravenous thrombolysis from February 2012 to February 2014 were enrolled retrospectively. The control group was treated with conventional therapy and the thrombolytic group was treated with rt-PA (0. 9 mg/kg)intravenous thrombolytic therapy. The indicators including fibrinogen (Fib),coagulation function (prothrombin time [PT ]),activated partial thromboplastin time (APTT ), platelet (PLT ),high-sensitivity C-reactive protein (hs-CRP ),National Institute of Health Stroke Scale (NIHSS )scores,and activities of daily living scores (Barthel index)at before treatment and 24 h,7 and 14 days after treatment were observed respectively. The adverse events and complications were documented and compared with the control group. Results There were no significant differences in Fib,PT,APTT, PLT,hs-CRP,NIHSS score and Barthel index before treatment between the thrombolytic group and the con-trol group (all P>0. 05);at day 7 and 14 after treatment in the thrombolytic group,compared with before treatment,Fib (14 d after

  7. Pin care

    Science.gov (United States)

    ... gov/pubmed/24302374 . Nagy K. Discharge instructions for wound cares. The American Association of the Surgery of Trauma. www.aast.org/discharge-instructions-for-wound-cares . Accessed May 13, 2016.

  8. Palliative Care

    Science.gov (United States)

    ... possessions to others, write a letter or a poem or compose a song, or decide what they ... One Year Off Treatment Transitioning to Adult Care Long-Term Follow-Up Care Coping With Cancer Overview ...

  9. Comparing Care

    NARCIS (Netherlands)

    Evert Pommer; Isolde Woittiez; John Stevens

    2007-01-01

    Home care is one of the most important means of compensating for disabilities and ensuring continuity in people's daily functioning. Home care services in the Netherlands have recently been transferred from a national social security provision for long-term care to a local social service. In most ot

  10. Preconception Care and Prenatal Care

    Science.gov (United States)

    ... at risk for complications? How does stress affect pregnancy? NICHD Research Information Clinical Trials Resources and Publications Preconception Care and Prenatal Care: Condition Information Skip sharing on social media links Share this: Page Content What is preconception ...

  11. Virtual care

    DEFF Research Database (Denmark)

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... and professionals, and they instigate change in organization and professional identities. Studies, which more specifically deal with telecare, stress how virtualization alters the character of the observations care workers are able to make, and how the validity of the patients’ own measurements and observations...... point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....

  12. Who Cares for Care Leavers?

    Science.gov (United States)

    Askew, Julie; Rodgers, Paul; West, Andrew

    2016-01-01

    This chapter describes a programme of learning and development at the University of Sheffield, United Kingdom, to support looked-after children and care leavers (youth previously provided care outside or beyond family) throughout the student lifecycle. In this context, looked-after children are those cared for by a town/city authority where…

  13. Speak Up: Help Prevent Errors in Your Care: Laboratory Services

    Science.gov (United States)

    SpeakUP TM Help Prevent Errors in Your Care Laboratory Services To prevent health care errors, patients are ... making health care safe. That includes doctors, nurses, laboratory technologists, phlebotomists (health care staff who take blood), ...

  14. Improving post-stroke recovery: the role of the multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Clarke DJ

    2015-09-01

    Full Text Available David J Clarke, Anne Forster Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway. Keywords: stroke care, rehabilitation, multidisciplinary, interdisciplinary, team working

  15. Advance care directives

    Science.gov (United States)

    ... advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - ...

  16. Integrating palliative care into the trajectory of cancer care.

    Science.gov (United States)

    Hui, David; Bruera, Eduardo

    2016-03-01

    Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, illness understanding, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We also discuss how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available.

  17. Study of the effect of humanistic nursing care model wards in Children Caring Ward School on the nurses' caring ability

    Institute of Scientific and Technical Information of China (English)

    Jiao He; De-Ying Hu; Yi-Lan Liu; Li-Fen Wu; Lian Liu

    2016-01-01

    Objective: To understand the effect of humanistic nursing care model wards in Children Caring Ward School (CCWS) on the nurses' caring ability. Methods: Questionnaire 25 nurses of humanistic nursing care model wards in CCWS using the Nkongho Caring Ability Inventory (CAI) before and after implement the humanistic nursing care model, including reform the systems of nursing care, introduce humanistic care model, implement the humanistic care, to measure the nurses' caring ability. Results: The nurses' caring ability had significantly developed on total, cognition dimension, courage dimension and patience dimension after all measures considered (p Conclusions: The humanistic nursing care model wards in CCWS has a positive effect on the nurses' caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients' satisfaction.

  18. The interventional thrombolysis and stenting of acute internal carotid occlusion%颈内动脉急性闭塞的溶栓及支架置入治疗

    Institute of Scientific and Technical Information of China (English)

    廖凯兵; 祝望才; 郑传胜

    2014-01-01

    Objective:To investigate the efficacy and safety of the interventional thrombolysis and stenting in patients with acute internal carotid occlusion.Methods:Intra-arterial thrombolysis was carried out and followed by stent implantation for the residual vascular stenosis in 6 patients with acute internal carotid occlusion.The neurological impairment score be-fore the treatment and at 24 hours after the treatment were evaluated.The incidence of complications and the changes in limbs activity and consciousness were observed.Results:6 patients got arterial recanalization and the blood flow recovered. The clinical symptoms were improved rapidly.At 24 hours after the treatment,the muscle strength increased by 3 grades in 4 patients and 2 grades in 2 patients.Conclusion:The efficacy of the interventional thrombolysis and stenting in acute inter-nal carotid occlusion is positive.It is more effective and safer when the treatment is given earlier.%目的:探讨颈内动脉急性闭塞的溶栓及支架置入治疗的有效性及安全性。方法:对6例颈内动脉急性闭塞的患者行动脉内溶栓治疗,其后对残余狭窄行支架置入治疗。溶栓前及治疗后24 h 进行神经功能缺损评分,同时观察脑内及其他系统有无出血并发症,并观察肢体活动及意识改善情况。结果:6例患者颈内动脉完全再通,血流量恢复,临床症状改善迅速,24h后4例瘫痪肢体肌力提高3级,2例提高2级。结论:颈内动脉急性闭塞患者的溶栓及支架置入治疗的疗效是值得肯定的。治疗时间越早疗效越好,安全性越高。

  19. [Home care in Sapporo].

    Science.gov (United States)

    Yazaki, Kazuo

    2003-12-01

    We established a clinic specialized in home care in Sapporo in July 2001. In these 2 years we have provided medical home care service to 160 patients, and 97 are still receiving regular service. At first we accepted any patients living within 16 km from the clinic. However, bad traffic conditions in winter made it difficult to visit patients living in districts far away from the clinic. Therefore, we planned a network of home care physicians in Sapporo. Now 12 home care physicians hold monthly meetings. In Sapporo, meetings of home care related workers are organized in each ward, as suggested by the Sapporo Medical Association. There is a relatively good supply of home care related services and resources, including availability of an important number of visiting nurses. Patients being taken care of at home who present an acute exacerbation of symptoms are relatively easily accepted by acute hospitals. But those who have difficulties in continuing home care due to a sudden change in family conditions are not easily accepted by nursing hospitals. Recently, the number of group homes and lodging houses for elderly persons has markedly increased in Sapporo. It might have some problems in medical support in the near future.

  20. Primary care for refugees.

    Science.gov (United States)

    Eckstein, Barbara

    2011-02-15

    Over the past decade, at least 600,000 refugees from more than 60 different countries have been resettled in the United States. The personal history of a refugee is often marked by physical and emotional trauma. Although refugees come from many different countries and cultures, their shared pattern of experiences allows for some generalizations to be made about their health care needs and challenges. Before being accepted for resettlement in the United States, all refugees must pass an overseas medical screening examination, the purpose of which is to identify conditions that could result in ineligibility for admission to the United States. Primary care physicians have the opportunity to care for members of this unique population once they resettle. Refugees present to primary care physicians with a variety of health problems, including musculoskeletal and pain issues, mental and social health problems, infectious diseases, and longstanding undiagnosed chronic illnesses. Important infectious diseases to consider in the symptomatic patient include tuberculosis, parasites, and malaria. Health maintenance and immunizations should also be addressed. Language barriers, cross-cultural medicine issues, and low levels of health literacy provide additional challenges to caring for this population. The purpose of this article is to provide primary care physicians with a guide to some of the common issues that arise when caring for refugee patients.

  1. Hair care and dyeing.

    Science.gov (United States)

    Draelos, Zoe Diana

    2015-01-01

    Alopecia can be effectively camouflaged or worsened through the use of hair care techniques and dyeing. Proper hair care, involving hair styling and the use of mild shampoos and body-building conditioners, can amplify thinning scalp hair; however, chemical processing, including hair dyeing, permanent waving, and hair straightening, can encourage further hair loss through breakage. Many patients suffering from alopecia attempt to improve their hair through extensive manipulation, which only increases problems. Frequent haircuts to minimize split ends, accompanied by gentle handling of the fragile fibers, is best. This chapter offers the dermatologist insight into hair care recommendations for the alopecia patient.

  2. 76 FR 2288 - TRICARE; Changes Included in the National Defense Authorization Act for Fiscal Year 2010...

    Science.gov (United States)

    2011-01-13

    ... active duty for more than 30 days, thus providing care to the Reserve member in both military dental... dental benefits for Reserve Component members includes space available care in military dental treatment... Reserve Component members include space available care in military dental treatment...

  3. Integrating palliative care with usual care of diabetic foot wounds.

    Science.gov (United States)

    Dunning, Trisha

    2016-01-01

    Palliative care is a philosophy and a system for deciding care and can be used alone or integrated with usual chronic disease care. Palliative care encompasses end-of-life care. Palliative care aims to enhance quality of life, optimize function and manage symptoms including early in the course of chronic diseases. The purposes of this article are to outline palliative care and discuss how it can be integrated with usual care of diabetic foot wounds. Many people with diabetes who have foot wounds also have other comorbidities and diabetes complications such as cardiovascular and renal disease and depression, which affect medicine and other treatment choices, functional status, surgical risk and quality of life. Two broad of diabetic foot disease exist: those likely to heal but who could still benefit from integrated palliative care such as managing pain and those where healing is unlikely where palliation can be the primary focus. People with diabetes can die suddenly, although the life course is usually long with periods of stable and unstable disease. Many health professionals are reluctant to discuss palliative care or suggest people to document their end-of-life care preferences. If such preferences are not documented, the person might not achieve their desired death or place of death and health professionals and families can be confronted with difficult decisions. Palliative care can be integrated with usual foot care and is associated with improved function, better quality of life and greater patient and family satisfaction.

  4. Prehospital cardiac care Cuban style.

    Science.gov (United States)

    Báez, Amado Alejandro; Sadosty, Annie T

    2004-09-01

    The Cuban national Integrated Medical Emergeny System or "Sistema Integrado de Urgencias Medicas" (SIUM) was formed in 1997. In 1998, the SIUM began an active out-of-hospital thrombolysis program using Heberkinasa, the only streptokinase obtained through recombinant DNA techniques, produced by the Cuban Center for Genetic Engineering and Biotechnology. An active community training program has also been implemented, standardizing training for the almost 20,000 members of the national emergency medical services.

  5. [Telemedicine in acute stroke care--a health economics view].

    Science.gov (United States)

    Günzel, F; Theiss, S; Knüppel, P; Halberstadt, S; Rose, G; Raith, M

    2010-05-01

    Specialized stroke units offer optimal treatment of patients with an acute stroke. Unfortunately, their installation is limited by an acute lack of experienced neurologists and the small number of stroke patients in sparsely populated rural areas. This problem is increasingly being solved by the use of telemedicine, so that neurological expertise is made available to basic and regular care. It has been demonstrated by national and international pilot studies that solidly based and rapid decisions can be made by telemedicine regrading the use of thrombolysis, as the most important acute treatment, but also of other interventions. So far studies have only evaluated improvement in the quality of care achieved by networking, but not of any lasting effect on any economic benefit. Complementary to a medical evaluation, the qualitative economic assessment presented here of German and American concepts of telemetric care indicate no difference in efficacy between various ways of networking. Most noteworthy, when comparing two large American and German studies, is the difference in their priorities. While the American networks achieved targeted improvements in efficacy of care that go beyond the immediate wishes of the doctors involved, this was of only secondary importance in the German studies. Also, in contrast to several American networks, the German telemetry networks have not tended to be organized for future growth. In terms of economic benefits, decentralized organized networks offer a greater potential of efficacy than purely local ones. Furthermore, the integration of inducements into the design of business models is a fundamental factor for achieving successful and lasting existence, especially within a highly competitive market.

  6. Thrombolysis in Acute Cerebrovascular Disease

    Institute of Scientific and Technical Information of China (English)

    刘泽霖

    2003-01-01

    @@ Large-scale trials have shown that thrombolytic therapy reduces mortality and preserves left ventricular function in patients with acute myocardial infarction (AMI). That's a rationale for the use of thrombolytic agents in the management of ischemic stroke.

  7. Indications for stenting during thrombolysis

    DEFF Research Database (Denmark)

    Bækgaard, N; Broholm, R; Just, Sven Richardt Lundgren

    2013-01-01

    The most important vein segment to thrombolyse after deep venous thrombosis (DVT) is the outflow tract meaning the iliofemoral vein. Iliofemoral DVT is defined as DVT in the iliac vein and the common femoral vein. Spontaneous recanalization is less than 50%, particularly on the left side. The com...

  8. Critical Care of Pet Birds.

    Science.gov (United States)

    Jenkins, Jeffrey Rowe

    2016-05-01

    Successful care of the critical pet bird patient is dependent on preparation and planning and begins with the veterinarian and hospital staff. An understanding of avian physiology and pathophysiology is key. Physical preparation of the hospital or clinic includes proper equipment and understanding of the procedures necessary to provide therapeutic and supportive care to the avian patient. An overview of patient intake and assessment, intensive care environment, and fluid therapy is included.

  9. Accountable Care Units: A Disruptive Innovation in Acute Care Delivery.

    Science.gov (United States)

    Castle, Bryan W; Shapiro, Susan E

    2016-01-01

    Accountable Care Units are a disruptive innovation that has moved care on acute care units from a traditional silo model, in which each discipline works separately from all others, to one in which multiple disciplines work together with patients and their families to move patients safely through their hospital stay. This article describes the "what," "how," and "why" of the Accountable Care Units model as it has evolved in different locations across a single health system and includes the lessons learned as different units and hospitals continue working to implement the model in their complex care environments.

  10. Theory including future not excluded

    DEFF Research Database (Denmark)

    Nagao, K.; Nielsen, H.B.

    2013-01-01

    We study a complex action theory (CAT) whose path runs over not only past but also future. We show that, if we regard a matrix element defined in terms of the future state at time T and the past state at time TA as an expectation value in the CAT, then we are allowed to have the Heisenberg equation......, Ehrenfest's theorem, and the conserved probability current density. In addition,we showthat the expectation value at the present time t of a future-included theory for large T - t and large t - T corresponds to that of a future-not-included theory with a proper inner product for large t - T. Hence, the CAT...

  11. Catheter-directed thrombolysis for acute iliofemorai deep vein thrombosis via the ipsilateral great saphenous vein approach: a comparative clinical study%经患侧大隐静脉入路置管溶栓治疗急性髂股静脉血栓的临床对比研究

    Institute of Scientific and Technical Information of China (English)

    苏浩波; 顾建平; 楼文胜; 何旭; 陈亮; 陈国平; 宋进华; 汪涛

    2011-01-01

    study.Methods The prospective study included 93 cases of IFVT proved by venography.All patients were divided into three groups randomly.In group A,31 patients received CDT via the ipsilateral great saphenous vein.In group B,27 patients received CDT via the ipsilateral popliteal vein.In group C,35 patients received anterograde thrombolysis via an ipsilateral dorsalis pedis vein.Urokinase was adopted as the thrombolytic agent in all cases.The assessment of the curative effect include therapeutic effective rate,rate of edema reduction and venous patency which were observed according to the clinical symptoms and the follow-up venograms obtained 5 days after thrombolysis.The time and comfort scores of procedures was recorded and compared between group A and B using two independent samples t test.The rate of edema reduction and venous patency were assessed using analysis of variance (LSD method).Therapeutic effective rate and complication rate were assessed using Chi-square test.Results The total effective rate of the three groups were 90.3% (28/31),92.6% (25/27) and 68.6% (24/35) respectively.The limbs edema reduction rate were (83.5 ±21.1)%,(82.4 ±20.1)%,and(67.0±23.3)% respectively(F=6.059,P = 0.003 ).The venous patency rate after thrombolysis were (61.2 ± 20.2) %,(55.7 ± 20.5 ) %,and (44.2 ±23.6)% respectively.There was no significant difference between group A and B in therapeutic effective rate( x2 =0.09,P =0.759),rate of edema reduction( P =0.822 ) and venous patency ( P =0.343 ).There was a significant difference statistically in therapeutic effective rate(x2 =4.65,P =0.031 ),rate of edema reduction (P = 0.002) and venous patency (P = 0.002) between group A and C.Compared with group A and B,the procedure time [group A (8.3 ±3.1) min,group B (16.3 ±3.5) min,t =9.379,P <0.05],comfort scores during treatment [ group A (2.2 ± 1.2),group B (5.0 ± 1.4 ),t = 8.129,P < 0.05 ] had statistical significant difference.The CDT

  12. Prenatal Care: First Trimester Visits

    Science.gov (United States)

    ... include your partner in the appointment as well. Medical history Your health care provider will ask many questions, including details about: Your ... He or she will check for any undiagnosed medical conditions. Your health care provider will also examine your vagina and the opening ...

  13. The value of transcranial doppler on therapeutic effects of intravenous thrombolysis for patients with acute cerebral infarction%经颅多普勒在急性脑梗死静脉溶栓治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    邓宇平; 罗伟良

    2010-01-01

    Objective To explore the role of transcranial doppler(TCD) on therapeutic effects of intravenous thrombolysis for patients with acute cerebral infarction by using transcranial doppler to make dynamic detection pre and pro-intravenous thrombolysis. Methods 60 patients with the final diagnosis of acute cerebral infarction were selected according to the inclusion criteria and exclusion criteria standard promissory. Recombinant tissue type plasminogen activator as the intravenous thrombolysis agent was used 4.5h later onset of the disease in all these cases, and TCD monitoring was preformed to understand the sitiations of the target blood vessels pre and pro-thrombloysis treatment on the 6,12 hours and 24 hours,the 2st day and the 7th day,all the data offered by which was used to adjust the treatment protocois of antiplatelet and anticoagulant therapy after 24 hours. All patients were followed up for 3 months,among whom prognostic evaluation, situations of revascularization was carried out as well as the complications of secondary intracranial hemorrhages and reocclusion basing on the neurologic impairment Score and the Thrombolysis in Brain lschemia(TIBI) respectively. Results No patient was dead after following-up for 3 months and 17 cases with basi- healing(28.3%) ,20 cases with excellence(33.3%), 16 cases got better(26.7%) ,3 cases with inefficiency (5.0%), and 4 cases became deterioration (6.7%). According to the Thrombolysis in Brain lschemia( TIBI), 22 cases got 4-5 level( 36.7 %), 31 cases with 2-3 level ( 51.7% ), and 7 cases got 0-1 level ( 11.6 % ). Among all these cases ,4 cases were found with secondary intracranial hemorrhages (6. 7% ) and 5 cases with reocclusion ( 8.3% ) Conclusion Dynamic detection with transcranial doppler pre and pro-intravenous thrombolysis could improve the therapeutic effect on patients with acute cerebral infarction, and reduce its complication, which is important for the clinical wrok and deserving consulting.%目的 利用经

  14. Biodiversity conservation including uncharismatic species

    DEFF Research Database (Denmark)

    Muñoz, Joaquin

    2007-01-01

    Recent papers mention ideas on the topics of biodiversity conservation strategies and priorities (Redford et al. 2003; Lamoreux et al. 2006; Rodrı´guez et al. 2006), the current status of biodiversity (Loreau et al. 2006), the obligations of conservation biologists regarding management policies...... (Chapron 2006; Schwartz 2006), and the main threats to biodiversity (including invasive species) (Bawa 2006). I suggest, however, that these articles do not really deal with biodiversity. Rather, they all focus on a few obviously charismatic groups (mammals, birds, some plants, fishes, human culture...

  15. Relación entre el estado nutricional y el riesgo de presentar úlceras por presión en pacientes incluidos en el programa de atención domiciliaria = Relationship between nutritional status and the risk of having pressure ulcers in patients included in a home care program

    NARCIS (Netherlands)

    Sancho, A.; Albiol, R.; Mach Casellas, N.

    2012-01-01

    Objective: The objective of the present study was to evaluate the relationship between the nutritional status and the risk of pressure ulcers (PU) in patients within home care programs (ATDOM). We also evaluated the relationship between the level of cognitive impairment, physical dependence, underly

  16. Clinical Analysis of Catheter Direct Thrombolysis Therapy in 28 Patients with Acute Deep V ein Throm-bosis of Lower Limbs%导管直接溶栓治疗28例急性下肢深静脉血栓临床分析

    Institute of Scientific and Technical Information of China (English)

    宋海龙; 闫笑迎; 李宏

    2015-01-01

    目的:分析研究导管溶栓术( CDT)治疗急性下肢深静脉血栓形成( DVT)的早中期疗效。方法分析2009年1月~2014年9月CDT治疗的28例急性下肢DVT患者的临床资料。全部患者均行患肢静脉造影,以判断疗效。结果28例CDT手术技术成功率100%,全组患者术中、术后均无严重并发症发生。溶栓前后静脉通畅评分比较差异显著(t=13.926,P<0.01)。溶栓后静脉通畅率为(60±19)%。结论 CDT治疗急性下肢DVT早中期疗效较好,并发症少,值得在临床上使用。%Objective To analyze therapeutic effect of early and middle-stage catheter direct thrombolysis therapy in the treatment of acute deep vein thrombosis of lower limbs.Mtehods We retrospectively analyzed the clinical infor-mation among 28patients of acute deep vein thrombosis in lower limbs , who were treated with catheter direct thrombolysis therapy in our hospital from January 2009 to September2014.All patients were detected with the venography at the af -fected limbs,to determine the efficacy.Results The success rate of catheter direct thrombolysis therapy was 100% in 28 patients of acute deep vein thrombosis in lower limbs.No intraoperative and postoperative complications were found. There were significant differences in the venous patency scores before and after thrombolysis therapy ( t=13.926, P<0.01).The venous patency rate was (60 ±19)%after thrombolysis.Conclusions Catheter direct thrombolysis therapy has early and middle-stage efficacy in treatment of acute deep vein thrombosis of lower limbs, and induces few compli-cations, therefore it deserves clinical application.

  17. Enhance End-of-Life Care

    Science.gov (United States)

    ... the lead at NIH in end-of-life care research. NINR funds studies aimed at improving the care of the dying, as well as communication among ... Ideally, all health care planning should include palliative care at the time of ... Nursing Research Studies , from which these capsule research stories were taken, ...

  18. A Framework for Including Family Health Spillovers in Economic Evaluation.

    Science.gov (United States)

    Al-Janabi, Hareth; van Exel, Job; Brouwer, Werner; Coast, Joanna

    2016-02-01

    Health care interventions may affect the health of patients' family networks. It has been suggested that these "health spillovers" should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the "health care perspective"). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society.

  19. CARES Foundation

    Science.gov (United States)

    ... today and CARES will receive 5% of your purchase! THEIR HISTORY: In 2001, Lauren’s Hope introduced the ... Go to the staff directory Find Us on Facebook Recent Tweets In case you missed it! http:// ...

  20. Dysarthria - care

    Science.gov (United States)

    Speech and language disorder - dysarthria care; Slurred speech - dysarthria; Articulation disorder - dysarthria ... Dysarthria is a condition that occurs when there are problems with the muscles that help you talk. ...

  1. Residential Care

    Science.gov (United States)

    ... Last name: Email: * Zip: * *required We will not sell or share your name. Residential Care Tweet Bookmark ... for the future. Use Alzheimer's Navigator ™ - our free online tool - to guide you as you map out ...

  2. Including Magnetostriction in Micromagnetic Models

    Science.gov (United States)

    Conbhuí, Pádraig Ó.; Williams, Wyn; Fabian, Karl; Nagy, Lesleis

    2016-04-01

    The magnetic anomalies that identify crustal spreading are predominantly recorded by basalts formed at the mid-ocean ridges, whose magnetic signals are dominated by iron-titanium-oxides (Fe3-xTixO4), so called "titanomagnetites", of which the Fe2.4Ti0.6O4 (TM60) phase is the most common. With sufficient quantities of titanium present, these minerals exhibit strong magnetostriction. To date, models of these grains in the pseudo-single domain (PSD) range have failed to accurately account for this effect. In particular, a popular analytic treatment provided by Kittel (1949) for describing the magnetostrictive energy as an effective increase of the anisotropy constant can produce unphysical strains for non-uniform magnetizations. I will present a rigorous approach based on work by Brown (1966) and by Kroner (1958) for including magnetostriction in micromagnetic codes which is suitable for modelling hysteresis loops and finding remanent states in the PSD regime. Preliminary results suggest the more rigorously defined micromagnetic models exhibit higher coercivities and extended single domain ranges when compared to more simplistic approaches.

  3. Caring Encounters

    Science.gov (United States)

    Gunn, Alyson

    2012-01-01

    Children with autism may seem to not care about things or have the same range of emotions as those of us who see them and care for them. But they do have empathy and they can be taught how to communicate it, says the author, a teacher of children with autism. We simply need to listen to them, watch them, and be with them in their moment.

  4. Integrating Care in Complex Cardiac Care: the Tech Touch

    OpenAIRE

    Stellato, Kira; Radini, Donatella; Pellizzari, Mara; Pordenon, Marta; Pletti, Luciano; Humar, Franco; Apuzzo, Matteo; Fragiacomo, Emanuela; Delli Quadri, Nicola; Di Lenarda, Andrea

    2016-01-01

    Background: The ageing of European population and the steady increasing of complex chronic disease pose substantial challenges to the sustainability of health and social care services and to the quality of life of European citizens . The testing of new frontiers of eCare for outpatient domiciliary monitoring of elderly citizens is essential in order to assess efficacy and sustainability of new technologies for integrated care, including telehealth and telemonitoring platforms. Friuli-Venezia ...

  5. Designing robots for care: care centered value-sensitive design.

    Science.gov (United States)

    van Wynsberghe, Aimee

    2013-06-01

    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship--what I refer to as care robots--require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What's more, given the stage of their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future.

  6. Integrating Palliative Care into Primary Care.

    Science.gov (United States)

    Gorman, Rosemary D

    2016-09-01

    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers.

  7. Controversies in neurosciences critical care.

    Science.gov (United States)

    Chang, Tiffany R; Naval, Neeraj S; Carhuapoma, J Ricardo

    2012-06-01

    Neurocritical care is an evolving subspecialty with many controversial topics. The focus of this review is (1) transfusion thresholds in patients with acute intracranial bleeding, including packed red blood cell transfusion, platelet transfusion, and reversal of coagulopathy; (2) indications for seizure prophylaxis and choice of antiepileptic agent; and (3) the role of specialized neurocritical care units and specialists in the care of critically ill neurology and neurosurgery patients.

  8. Nursing care community health

    Directory of Open Access Journals (Sweden)

    Diana Acosta-Salazar

    2016-07-01

    Full Text Available Process Nursing Care (PAE is a systematic tool that facilitates the scientificity of care in community practice nurse, the application of scientific method in community practice, allows nursing to provide care in logical, systematic and comprehensive reassessing interventions to achieve the proposed results. It began with the valuation of Marjory Gordon Functional Patterns and then at the stage of diagnosis and planning North American Nursing Diagnosis Association (NANDA, Nursing Interventions Classification (NIC and Nursing Outcomes Classification (NOC is interrelate. It is a descriptive and prospective study. Diagnosis was made by applying the instruments measuring scale of the socio-demographic characteristics, symptom questionnaire for early detection of mental disorders in the community and appreciation for functional patterns. The PAE includes more frequent diagnoses, criteria outcomes, indicators, interventions and activities to manage community issues. alteration was evidenced in patterns: Adaptation and Stress Tolerance, Self-perception-Self-concept-, Role-Relationships, sleep and rest and Perception and Health Management. A standardized NANDA-NIC-NOC can provide inter care holistic care from the perspective of community mental health with a degree of scientific nature that frames the professional work projecting the individual, family and community care.

  9. Access and care issues in urban urgent care clinic patients

    Directory of Open Access Journals (Sweden)

    Adams Jill C

    2009-12-01

    Full Text Available Abstract Background Although primary care should be the cornerstone of medical practice, inappropriate use of urgent care for non-urgent patients is a growing problem that has significant economic and healthcare consequences. The characteristics of patients who choose the urgent care setting, as well as the reasoning behind their decisions, is not well established. The purpose of this study was to determine the motivation behind, and characteristics of, adult patients who choose to access health care in our urgent care clinic. The relevance of understanding the motivation driving this patient population is especially pertinent given recent trends towards universal healthcare and the unclear impact it may have on the demands of urgent care. Methods We conducted a cross-sectional survey of patients seeking care at an urgent care clinic (UCC within a large acute care safety-net urban hospital over a six-week period. Survey data included demographics, social and economic information, reasons that patients chose a UCC, previous primary care exposure, reasons for delaying care, and preventive care needs. Results A total of 1, 006 patients were randomly surveyed. Twenty-five percent of patients identified Spanish as their preferred language. Fifty-four percent of patients reported choosing the UCC due to not having to make an appointment, 51.2% because it was convenient, 43.9% because of same day test results, 42.7% because of ability to get same-day medications and 15.1% because co-payment was not mandatory. Lack of a regular physician was reported by 67.9% of patients and 57.2% lacked a regular source of care. Patients reported delaying access to care for a variety of reasons. Conclusion Despite a common belief that patients seek care in the urgent care setting primarily for economic reasons, this study suggests that patients choose the urgent care setting based largely on convenience and more timely care. This information is especially applicable to

  10. Spectator Medical Care.

    Science.gov (United States)

    Carlson, L

    1992-01-01

    Recent world events-including the fear of terrorism during last year's Super Bowl-illustrate how vulnerable spectators can be to medical emergencies during sporting events. A physician who studies and coordinates crowd care for events ranging from the Super Bowl to local fairs gives tips on planning and executing a spectator medical plan.

  11. Care Ethics in Education.

    Science.gov (United States)

    Shelby, Candice L.

    2003-01-01

    Difficulties with current models of ethics education (correct reasoning, virtue theory, directive moral education) include emphasis on reward/punishment and a presumptive bias toward abstract reasoning. Teaching a care-based ethics would promote a fuller notion of mature moral agents and broaden the school climate beyond compliance. (Contains 19…

  12. Introduction to CARE

    CERN Document Server

    Guignard, G

    2005-01-01

    The main objective of the CARE project is to generate a structured and integrated European area in the field of accelerator research and related R&D. The program includes the most advanced scientific and technological developments relevant to accelerator research for Particle Physics.

  13. Animal Care Use Committees.

    Science.gov (United States)

    Snyder, Margaret D.; And Others

    1992-01-01

    Describes the structure, activities, responsibilities, and practices of animal care and use committees established to review classroom activities and student research using animals. Provides six hypothetical situations with suggested solutions to test a committee's decision-making ability. Includes a proposed activity form for teachers. (MDH)

  14. Wound Care.

    Science.gov (United States)

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve.

  15. Payment and value of care - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment measures and value of care displays – provider data. This data set includes provider data for the payment measures and value of care displays associated...

  16. Palliative Care as a Standard of Care in Pediatric Oncology.

    Science.gov (United States)

    Weaver, Meaghann S; Heinze, Katherine E; Kelly, Katherine P; Wiener, Lori; Casey, Robert L; Bell, Cynthia J; Wolfe, Joanne; Garee, Amy M; Watson, Anne; Hinds, Pamela S

    2015-12-01

    The study team conducted a systematic review of pediatric and adolescent palliative cancer care literature from 1995 to 2015 using four databases to inform development of a palliative care psychosocial standard. A total of 209 papers were reviewed with inclusion of 73 papers for final synthesis. Revealed topics of urgent consideration include the following: symptom assessment and intervention, direct patient report, effective communication, and shared decision-making. Standardization of palliative care assessments and interventions in pediatric oncology has the potential to foster improved quality of care across the cancer trajectory for children and adolescents with cancer and their family members.

  17. 脑钠肽前体对急性心肌梗死溶栓治疗预后的评价%Evaluate of NT-proBNP in Prognostic Evaluation in Patients with Successful Thrombolysis

    Institute of Scientific and Technical Information of China (English)

    刘爱华; 王绪芳

    2014-01-01

    目的:本研究旨在观察成功溶栓患者中是否发生早期心血管事件,比较其NT-proBNP的差异,并研究其与血清肌钙蛋白T(cTnT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、左室射血分数(LVEF)、左室舒张末期直径(LVEDD)之间的相关性,探讨测定血浆NT-proBNP水平在评价急性心肌梗死(AMI)成功溶栓治疗的患者病情严重程度和预后的意义。方法:采用酶联免疫吸附法对61例ST段抬高型AMI患者应用瑞替普酶静脉溶栓治疗前测定NT-proBNP。随访30 d,观察30 d内是否发生心血管死亡、心力衰竭、再发心肌梗死、梗死后心绞痛等情况。结果:血浆NT-proBNP水平在早期有心血管事件组高于无心血管事件组,两组比较差异有统计学意义(P<0.05)。血浆NT-proBNP水平与cTnT、CK、CK-MB、LVEDD存在正相关(P<0.05),与LVEF存在负相关(P<0.05)。结论:测定入院时血浆NT-proBNP水平对评估AMI经过成功溶栓治疗的患者30 d内发生心血管事件有重要的临床价值。%Objective:To observe whether early cardiovascular events occurred in patients with successful thrombolysis to explore the differences of NT-proBNP,and to detect its correlation with cTnT,CK,CK-MB,LVEF, LVEDD,and discuss the value of plasma NT-proBNP for severity and prognostic significance in the AMI patients with successful thrombolysis.Method:The plasma NT-proBNP collecting before thrombolytic therapy in 61patients with AMI was measured by enzyme-lined imunosorbent assay. All patients were followed up for 30 days,the occurrence of cardiovascular death,heart failure,recurrent AMI in 30 days,post-infarction angina,etc were observed. Result:The plasma NT-proBNP levels in the occurred vascular events group in the early periods were significantly higher than the non-occurred vascular events group,the difference was significant(P<0.05). The plasma NT-proBNP level with cTnT,CK, CK-MB,LVEDD existed

  18. [Relaxation and hypnosis in care].

    Science.gov (United States)

    Tonyé-Geoffroy, Louise

    2016-04-01

    Pain is multifactorial, requiring multi-dimensional treatment. The cross-disciplinary care provided in pain assessment and treatment centres offers patients a global treatment. As a complement to conventional treatment, the patient's care pathway may include psycho-corporal therapy with psychotherapeutic input.

  19. The Caring Relation in Teaching

    Science.gov (United States)

    Noddings, Nel

    2012-01-01

    According to John Macmurray, "teaching is one of the foremost of personal relations". This paper describes that relation in some detail from the perspective of care ethics. This involves a discussion of the central elements in establishing and maintaining relations of care and trust which include listening, dialogue, critical thinking, reflective…

  20. NIH Standard. Animal Care Equipment.

    Science.gov (United States)

    National Institutes of Health (DHEW), Bethesda, MD. Office of Administrative Management.

    The National Institutes of Health standardized animal care equipment is presented in this catalog. Each piece of equipment is illustrated and described in terms of overall dimensions, construction, and general usage. A price list is included to estimate costs in budgeting, planning, and requisitioning animal care equipment. The standards and…

  1. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs

    Science.gov (United States)

    van der Lee, Arnold; de Haan, Lieuwe; Beekman, Aartjan

    2016-01-01

    Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes. PMID:27275609

  2. Symptom management in palliative care and end of life care.

    Science.gov (United States)

    Bookbinder, Marilyn; McHugh, Marlene E

    2010-09-01

    There is a need for generalist- and specialist-level palliative care clinicians proficient in symptom management and care coordination. Major factors contributing to this need include changed disease processes and trajectories, improved medical techniques and diagnostic testing, successful screening for chronic conditions, and drugs that often prolong life. The rapid progressive illnesses and deaths that plagued the first half of the twentieth century have been replaced in the twenty-first century by increased survival rates. Conditions that require ongoing medical care beyond a year define the current chronic illness population. Long years of survival are often accompanied by a reduced quality of life that requires more medical and nursing care and longer home care. This article reviews the management of selected symptoms in palliative and end of life care.

  3. Hospice Care

    Science.gov (United States)

    ... Hospice is a combination of services designed to address not only the physical needs of patients, but also the psychosocial needs of patients, their loved ones. Hospice combines pain control, symptom ... plan to address each patient’s individual needs. The hospice care team ...

  4. Respite Care

    Science.gov (United States)

    ... provided in a home, an adult day-care program or over a weekend in a nursing home or an assisted living facility. For more information on the NFCSP visit the Administration on Aging website at http://www.aoa.gov/ ...

  5. Prenatal Care.

    Science.gov (United States)

    Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Office for Maternal and Child Health Services.

    This booklet is the first in a series of publications designed to provide parents with useful information about childrearing. Contents are organized into three parts. Part I focuses on the pregnancy, prenatal care, development of the baby, pregnant lifestyles, nutrition, common discomforts, and problems of pregnancy. Part II provides information…

  6. Diaspora, disease, and health care.

    Science.gov (United States)

    Wick, Jeannette Y; Zanni, Guido R

    2007-03-01

    When groups of people relocate from their homelands to other nations, especially if the movement is involuntary, minority populations are created in the countries that receive them. The issues related to these diaspora and diasporic communities--any groups that have been dispersed outside their traditional homelands--are financial, social, historical, political, or religious. In health care, issues include heritable diseases, cultural barriers, patients' health care beliefs, and unique disease presentations. In long-term care, many residents and health care providers have relocated to the United States from other countries.

  7. Legal implications of managed care arrangements.

    Science.gov (United States)

    Knox, W A; Epstein, D M

    1994-09-01

    Prior to the 1980s, managed care was virtually nonexistent as a force in health care. Presently, 64 percent of employees in America are covered by managed care plans, including health maintenance organizations (20 percent) and preferred provider organizations (44 percent). In contrast, only 29 percent of employees were enrolled in managed care plans in 1988 and only 47 percent in 1991. To date, the primary reason for this incredible growth in managed care has been economic-market pressure to reduce health care costs. For the foreseeable future, political pressures are likely to fuel this growth, as managed care is at the center of President Clinton's national health care plan. Although there are numerous legal issues surrounding managed care, this article focuses primarily on antitrust implications when forming managed care entities. In addition, the corporate practice of medicine doctrine, certain tax issues, and the fraud and abuse laws are discussed.

  8. Caring for Latino patients.

    Science.gov (United States)

    Juckett, Gregory

    2013-01-01

    Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. Barriers to care have resulted in striking disparities in quality of health care for these patients. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Latinos have disproportionately higher rates of obesity and diabetes mellitus. Other health problems include stress, neurocysticercosis, and tuberculosis. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. Many-but not all-folk and herbal treatments can be safely accommodated with conventional therapy. Physicians must be sensitive to Latino cultural values of simpatia (kindness), personalismo (relationship), respeto (respect), and modestia (modesty). The LEARN technique can facilitate cross-cultural interviews. Some cultural barriers may be overcome by using the "teach back" technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients.

  9. The hospital delay analysis of intravenous thrombolysis process among ischemic stroke patients based on value stream mapping%基于价值流程图的缺血性脑卒中患者静脉溶栓院内延迟现状分析

    Institute of Scientific and Technical Information of China (English)

    苏林霞; 杨莘; 常红; 梁潇; 吉训明; 武剑; 刘力松

    2015-01-01

    Objective:To analyze systematically the effect of value stream map of intravenous thrombolysis process among ischemic stroke patients and to provide the basis for process optimization. Methods:Totally 31 ischemic stroke patients with intravenous thrombolysis were recruited by purposive sampling methods and were followed up throughout the whole study. We drawed the value stream map and analyzed the activities in the hospital. Results:The mean time of hospital intravenous thrombolysis among ischemic stroke patients was 81-196 minutes, the process time was 45-98 minutes, the delay time was 36-98 minutes. Conclusion:The intravenous thrombolysis process among ischemic stroke patients has a great improvement space. The key measures to optimize intravenous thrombolysis process were timely and accurate evaluation, the cooperation and communication of each department, visual management, and diverse informed consent form.%目的:系统分析缺血性脑卒中患者静脉溶栓院内价值流程图,为流程的优化提供依据。方法:采用目的抽样法,对31例缺血性脑卒中静脉溶栓患者进行全程跟踪调查,绘制价值流程图并分析院内各环节的活动。结果:缺血性脑卒中患者静脉溶栓院内总流程时间为81~196min,总工作时间为45~98min,总延误时间为36~98min;结论:缺血性脑卒中患者静脉溶栓院内流程存在较大改进空间,快速的预检分诊、科室间的团队合作、可视化管理、多样化的病情告知方式等是优化缺血性脑卒中患者静脉溶栓院内流程的关键措施。

  10. Critical issues in burn care.

    Science.gov (United States)

    Holmes, James H

    2008-01-01

    Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in collaboration with other organizations. The American Burn Association has recommended that patients with serious burns be referred to a designated burn center, ie, a hospital outfitted with specialized personnel and equipment dedicated to burn care. Burn centers have been operational for over 50 years, but the complexity and costs of providing specialized burn care have given rise to a number of critical administrative and political issues. These include logistical limitations imposed by the uneven national distribution of burn centers and a potential shortage of burn beds, both during everyday conditions and in the event of a mass disaster. Burn surgeon shortages have also been identified, stemming, in part, from a lack of specialized burn care training opportunities. There is currently a lack of quality outcome data to support evidence-based recommendations for burn care, and burn care centers are compromised by problems obtaining reimbursement for the care of uninsured and publicly insured out-of-state burn patients. Initiatives are underway to maintain efficient burn care facilities that are fully funded, easily accessible, and most importantly, provide optimal, evidence-based care on a daily basis, and are well-equipped to handle a surge of patients during a disaster situation.

  11. 29 CFR 825.125 - Definition of health care provider.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Definition of health care provider. 825.125 Section 825.125... Definition of health care provider. (a) The Act defines “health care provider” as: (1) A doctor of medicine... providing health care services. (b) Others “capable of providing health care services” include only:...

  12. FastStats: Hospice Care

    Science.gov (United States)

    ... Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap Tests Disability ... Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  13. NIDCAP and developmental care

    Directory of Open Access Journals (Sweden)

    Dominique Haumont

    2014-06-01

    Full Text Available Perinatal mortality in very low birth weight infants has dramatically decreased during the last decades. However, 15-25% of these infants will show neurodevelopmental impairment later on. The aim of implementing early developmental care (EDC, emerged as a new field in neonatology, is to create an intervention program designed to provide support for optimal neurobehavioral development during this highly vulnerable period of brain growth. The theoretical framework, which underlies the approach, is supported by research in different scientific fields, including neuroscience, psychology, medicine and nursing. EDC utilizes a range of medical and nursing interventions that aim to decrease the stress of preterm neonates in neonatal intensive care units (NICUs. The Neonatal Individualized Developmental Care Assessment Program (NIDCAP is an integrated and holistic form of family-centered developmental care. Changing the traditional NICU towards an EDC-NICU includes training nursing and medical staff, investing in their quality and most importantly keeping parents in proximity to the infants. The new challenge of modern neonatology is to restore the mother-infant dyad applying “couplet care” starting at birth until discharge. Most of the European NICUs apply some elements of EDC, but it is more consistent in northern Europe. The development of NIDCAP training centers in Europe demonstrates the evolution of care. It is likely that future research and intervention programs will optimize our practices. Developmental care could prove to be an important recent step in improving outcome in extremely preterm neonates. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  14. Care Transitions in Long-term Care and Acute Care: Health Information Exchange and Readmission Rates.

    Science.gov (United States)

    Yeaman, Brian; Ko, Kelly J; Alvarez del Castillo, Rodolfo

    2015-09-30

    Care transitions between settings are a well-known cause of medical errors. A key component of transition is information exchange, especially in long-term care (LTC). However, LTC is behind other settings in adoption of health information technologies (HIT). In this article, we provide some brief background information about care transitions in LTC and concerns related to technology. We describe a pilot project using HIT and secure messaging in LTC to facilitate electronic information exchange during care transitions. Five LTC facilities were included, all located within Oklahoma and serviced by the same regional health system. The study duration was 20 months. Both inpatient readmission and return emergency department (ED) visit rates were lower than baseline following implementation. We provide discussion of positive outcomes, lessons learned, and limitations. Finally, we offer implications for practice and research for implementation of HIT and information exchange across care settings that may contribute to reduction in readmission rates in acute care and ED settings.

  15. Primary care for the Roma in Europe: Position paper of the European forum for primary care

    Science.gov (United States)

    Rotar Pavlič, Danica; Zelko, Erika; Vintges, Marga; Willems, Sara; Hanssens, Lise

    2016-01-01

    Abstract Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations. At local level, establishing collaboration with Roma organisations helps primary care to improve mutual relations and quality of care. Mediation has proved to be an effective tool. Skills training of primary care practitioners may enhance their individual competences. Research and international sharing of experiences are further tools to improve primary care for the Roma people. PMID:27703542

  16. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2014-01-01

    Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good...... outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining...... this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach...

  17. Medical Care during Pregnancy

    Science.gov (United States)

    ... 1- to 2-Year-Old Medical Care During Pregnancy KidsHealth > For Parents > Medical Care During Pregnancy A ... both moms and their babies. Prenatal Care Before Pregnancy Prenatal care should start before you get pregnant. ...

  18. What is palliative care?

    Science.gov (United States)

    Comfort care; End of life - palliative care; Hospice - palliative care ... The goal of palliative care is to help people with serious illnesses feel better. It prevents or treats symptoms and side effects of disease and ...

  19. Pastoral care: marketing "high touch".

    Science.gov (United States)

    Finn, M

    1986-01-01

    Marketing pastoral care skills is important both within and without the health care organization. To increase administrators' awareness of the value of the pastoral care department, for example, chaplains must be able to demonstrate that their activities can affect the bottom line. They must therefore develop a system of accountability that defines and measures their services in objective terms. Such a system would include the reporting of monthly visit statistics as well as the collection of data from patients and personnel on the adequacy of pastoral care services. Other awareness-building activities could include participation in nursing practice rounds, in-service presentations, involvement in hospital social events, and placement of articles about pastoral care in hospital publications. Activities that would help to foster good community relations and thereby improve census include participation in the area clergy association, work with local church groups that visit the sick and the homebound, providing speakers to community organizations, and sponsoring a memorial Mass for families of patients who have died at the hospital. Pastoral care staff should not feel threatened by the changing health care environment. Instead they must recognize the opportunity it provides to create ways to minister to a new mix of patients and to reach new groups.

  20. Health Care Industry

    Science.gov (United States)

    2007-01-01

    Doctor of Osteopathy ) degree and practice general or specialized medicine such as anesthesiology or oncology (IBISWorld, 2006, Offices of Dentists...Carroll, 2003). Complementary and Alternative Medicine includes a wide variety of treatments and therapies that are generally not supported by scientific...correlation between increased health care costs and obesity. According to a 2005 CDC study, “ physical inactivity, overweight, and obesity were associated

  1. Improving assisted living care.

    Science.gov (United States)

    Gregory, Nancy; Gesell, Sabina B; Widmer, Tom

    2007-01-01

    In the absence of a national measurement system, private vendors of satisfaction measurement and improvement services have played a crucial role in the quality movement in the assisted living industry. Survey responses from 175 resident-family dyads at 20 facilities were analyzed to identify priorities for service improvement from the customers' perspective. They include improving care provided by aides and management, meal service, and activities. Practical solutions for addressing these issues are presented.

  2. Systematic Review and Pooled Analyses of Recent Neurointerventional Randomized Controlled Trials: Setting a New Standard of Care for Acute Ischemic Stroke Treatment after 20 Years

    Science.gov (United States)

    Hussain, Mohammed; Moussavi, Mohammad; Korya, Daniel; Mehta, Siddhart; Brar, Jaskiran; Chahal, Harina; Qureshi, Ihtesham; Mehta, Tapan; Ahmad, Javaad; Zaidat, Osama O.; Kirmani, Jawad F.

    2016-01-01

    Background Recent advances in the treatment of ischemic stroke have focused on revascularization and led to better clinical and functional outcomes. A systematic review and pooled analyses of 6 recent multicentered prospective randomized controlled trials (MPRCT) were performed to compare intravenous tissue plasminogen activator (IV tPA) and endovascular therapy (intervention) with IV tPA alone (control) for anterior circulation ischemic stroke (AIS) secondary to large vessel occlusion (LVO). Objectives Six MPRCTs (MR CLEAN, ESCAPE, EXTEND IA, SWIFT PRIME, REVASCAT and THERAPY) incorporating image-based LVO AIS were selected for assessing the following: (1) prespecified primary clinical outcomes of AIS patients in intervention and control arms: good outcomes were defined by a modified Rankin Scale score of 0-2 at 90 days; (2) secondary clinical outcomes were: (a) revascularization rates [favorable outcomes defined as modified Thrombolysis in Cerebral Infarction scale (mTICI) score of 2b/3]; (b) symptomatic intracranial hemorrhage (sICH) rates and mortality; (c) derivation of number needed to harm (NNH), number needed to treat (NNT), and relative percent difference (RPD) between intervention and control groups, and (d) random effects model to determine overall significance (forest and funnel plots). Results A total of 1,386 patients were included. Good outcomes at 90 days were seen in 46% of patients in the intervention (p < 0.00001) and in 27% of patients in the control groups (p < 0.00002). An mTICI score of 2b/3 was achieved in 70.2% of patients in the intervention arm. The sICH and mortality in the intervention arm compared with the control arm were 4.7 and 14.3% versus 7.9 and 17.8%, respectively. The NNT and NNH in the intervention and control groups were 5.3 and 9.1, respectively. Patients in the intervention arm had a 50.1% (RPD) better chance of achieving a good 90-day outcome as compared to controls. Conclusions Endovascular therapy combined with IV t

  3. The German health care system and health care reform.

    Science.gov (United States)

    Kamke, K

    1998-02-01

    This article presents a structured survey of the German health care and health insurance system, and analyzes major developments of current German health policy. The German statutory health insurance system has been known as a system that provides all citizens with ready access to comprehensive high quality medical care at a cost the country considered socially acceptable. However, an increasing concern for rapidly rising health care expenditure led to a number of cost-containment measures since 1977. The aim was to bring the growth of health care expenditure in line with the growth of wages and salaries of the sickness fund members. The recent health care reforms of 1989 and 1993 yielded only short-term reductions of health care expenditure, with increases in the subsequent years. 'Stability of the contribution rate' is the uppermost political objective of current health care reform initiatives. Options under discussion include reductions in the benefit package and increases of patients' co-payments. The article concludes with the possible consequences of the 1997 health care reform of which the major part became effective 1 July 1997.

  4. Committee Opinion No. 666: Optimizing Postpartum Care.

    Science.gov (United States)

    2016-06-01

    In the weeks after birth, postpartum care often is fragmented among maternal and pediatric health care providers, and communication between inpatient and outpatient settings is inconsistent. To optimize postpartum care, anticipatory guidance should begin during pregnancy. During antenatal care, it is recommended that the patient and her obstetrician-gynecologist or other obstetric care provider formulate a postpartum care plan and identify the health care professionals who will comprise the postpartum care team for the woman and her infant. Ideally, during the postpartum period, a single health care practice assumes responsibility for coordinating the woman's care. At discharge from maternity care, the woman should receive contact information for her postpartum care team and written instructions regarding the timing of follow-up postpartum care. It is recommended that all women undergo a comprehensive postpartum visit within the first 6 weeks after birth. This visit should include a full assessment of physical, social, and psychological well-being. Systems should be implemented to ensure each woman can receive her desired form of contraception during the comprehensive postpartum visit, if not done earlier. At the conclusion of the postpartum visit, the woman and her obstetrician-gynecologist or other obstetric care provider should determine who will assume primary responsibility for her ongoing care. If responsibility is transferred to another primary care provider, the obstetrician-gynecologist or other obstetric care provider is responsible for ensuring that there is communication with the primary care provider so that he or she can understand the implications of any pregnancy complications for the woman's future health and maintain continuity of care.

  5. Tracheostomy care and complications in the intensive care unit.

    Science.gov (United States)

    Morris, Linda L; Whitmer, Andrea; McIntosh, Erik

    2013-10-01

    Tracheotomy is a common procedure in intensive care units, and nurses must provide proper care to tracheostomy patients to prevent complications. One of the most important considerations is effective mobilization of secretions, and a suction catheter is the most important tool for that purpose. Each bedside should be equipped with a functional suctioning system, an oxygen source, a manual resuscitation bag, and a complete tracheostomy kit, which should accompany patients wherever they go in the hospital. Complications include infection, tracheomalacia, skin breakdown, and tracheoesophageal fistula. Tracheostomy emergencies include hemorrhage, tube dislodgement and loss of airway, and tube obstruction; such emergencies are managed more effectively when all necessary supplies are readily available at the bedside. This article describes how to provide proper care in the intensive care unit, strategies for preventing complications, and management of tracheostomy emergencies.

  6. Palliative wound care: principles of care.

    Science.gov (United States)

    Dale, Barbara; Emmons, Kevin R

    2014-01-01

    Home care nursing occurs in a complex care environment. Nurses working in this setting care for a wide array of individuals who often are sicker and more complex than ever before. The high prevalence of wounds among these individuals requires that home care nurses have a certain level of knowledge to provide excellent care. Many times, individuals with wounds do not have the capacity to heal or are burdened with numerous symptoms affecting quality of life. In these cases, the home care nurse must understand concepts of palliative wound care to alleviate symptoms with the goal of improving quality of life.

  7. Pediatric intensive care in Argentina.

    Science.gov (United States)

    Schnitzler, E J

    1993-09-01

    8.2% of the gross domestic product is spent annually on health care in Argentina, a country of 32 million people. There is 1 medical doctor of every 147,000 beds in a total 3180 hospitals. The infant mortality rate in Argentina is 24.5/1000 live births which is high compared to developed countries. Perinatal causes and congenital anomalies are the main cause of death after the neonatal period, and accidents, cardiac disease, and respiratory tract infections are the main causes of death among children over age 1 year. Argentina has approximately 35 pediatric intensive care units (ICU), but 154 of 244 beds are within or near the capital. Only 2 hospitals have pediatric intensive care fellowship programs, so full time dedicated staff is rare. 250 registered pediatricians dedicated to intensive care are in the Argentine Pediatric Society and the nurse/bed ratio is 1:2-1:3. Moreover, the country has neither postanesthesia recuperation units, burn units, chronic ventilation units, nor approved home assistance programs, and intermediate care is not clearly standardized. These inadequacies have led to a shortage of beds and the caring for of critically ill children in general pediatric or emergency wards in hospitals which lack adequate equipment; patients are often discharged inappropriately to clear bed space. Even so, prehospital and emergency room care tends to be provided without the necessary coordination with the pediatric ICU, and structural conditions regarding electrical self-sufficiency, air conditioning, and circulation are met in only few units. Despite the existence of these adverse conditions for the care of critically ill children, a pediatric organ transplant program developed since 1987 has demonstrated 70% to 100% survival rates for 16l orthotopic liver and 9 heart transplants, respectively. Alternatives to improving intensive care in Argentina include optimizing the response of emergency and critical care delivery systems, categorizing hospitals and

  8. Health care engineering

    CERN Document Server

    Frize, Monique

    2013-01-01

    Part II of Health Care Engineering begins with statistics on the occurrence of medical errors and adverse events, and includes some technological solutions. A chapter on electronic medical records follows. The knowledge management process divided into four steps is described; this includes a discussion on data acquisition, storage, and retrieval. The next two chapters discuss the other three steps of the knowledge management process (knowledge discovery, knowledge translation, knowledge integration and sharing). The last chapter briefly discusses usability studies and clinical trials.This two-

  9. Home Care

    Science.gov (United States)

    ... triggering an emergency response or checkup phone call. Healthcare professionals are finding that portable or mobile testing technology (home diagnostics), including x-rays and electrocardiograms (ECGs), ...

  10. Multidisciplinary care planning in the primary care management of completed stroke: a systematic review

    Directory of Open Access Journals (Sweden)

    Erikssen Lars

    2008-08-01

    Full Text Available Abstract Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006, Cochrane Library (Issue 1 2006, and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1 a multi-disciplinary primary care team or 2 through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact

  11. Caring for the Transgender Individual.

    Science.gov (United States)

    Sedlak, Carol A; Veney, Amy J; Doheny, Margaret OʼBryan

    2016-01-01

    Issues about transgender individuals (TIs) as a disparate population are now being more openly discussed in the general public. However, healthcare providers often express feeling uncomfortable in interacting with TIs because they have not been educated about care of TIs and often base their care on insensitive stereotyping. The purpose of this informational article is to provide a foundation of knowledge for nurses and healthcare professionals for providing competent patient-centered care for TIs. Topics discussed include a description of the transgender population, commonly used terms to describe TIs, health risks and healthcare needs of TIs, and how to provide quality healthcare for TIs.

  12. 中央型急性期下肢DVT置管溶栓与外周溶栓的比较%Outcomes of anticoagulation and thrombolysis for acute deep venous thrombosis via central venous catheter and peripheral venous injection

    Institute of Scientific and Technical Information of China (English)

    朱少问; 郑小兵; 冯翔

    2013-01-01

    目的:比较中央型急性期DVT经外周静脉溶栓与局部置管溶栓治疗的效果,以指导临床治疗.方法:通过回顾性分析我院及江苏南通大学附属医院2010年9月~2012年7月期间收治的共42例下肢深静脉血栓形成患者的临床资料,按照治疗方法分为置管溶栓组(A组)、外周溶栓组(B组).其中外周溶栓组共20例,左侧13例,右侧6例,双侧1例.置管溶栓组共22例,左侧15例,右侧6例,双侧1例.通过监测患者临床症状,测量下肢周径变化比较两组治疗效果.结果:置管溶栓治疗方法具有平均起效时间快、总溶栓疗程短、溶栓药物总剂量低、并发症发生率及PTS发生率低等优点,而远期复发率与外周溶栓组无明显差异.结论:置管溶栓治疗方法优于外周溶栓治疗.%Objective :To compare the curative efficacy of anticoagulation and thrombolysis for acute deep venous thrombosis( DVT ) via central venous catheter management or peripheral venous management for summary of the clinical experience. Methods :The clinical data were reviewed in 42 patients with DVT undergone treatment respectively in our institution and the Affiliated Hospital of Nantong University between Sept. 2010 and Jul. 2012. The patients were randomized into either group A( n=22; 15 were symptoms of left lower extremity,6 of right and 1 of both extremities ) by thrombolytic therapy via central venous catheter or group B( n =20; 13 were acute episode of left lower limb, 6 of right and 1 of both lower limbs. ) managed with peripheral venous anticoagulation and thrombolysis. Two groups of patients were assessed for the curative efficacy by observing the relief of clinical symptoms and measuring the changes of the limb circumference. Results:Thrombolytic therapy for acute DVT via central venous catheter demonstrated advantages by earlier effects, shortened therapy duration, requirement of lower drug dosage, fewer incidence of complications and risk of developing the

  13. Integrated care: a Danish perspective

    DEFF Research Database (Denmark)

    Rudkjøbing, Andreas; Olejaz, Maria; Birk, Hans Okkels

    2012-01-01

    that it generally provides high quality services and patient satisfaction with primary care and hospital services is high. Nevertheless, despite a raft of policies aimed at integrating health services, the Danish system still suffers from a lack of coordination of care. Although Denmark’s health information systems...... are widely admired, barriers to integration include organisational fragmentation, perverse financial incentives, and the absence of a single electronic medical record....

  14. Music in child care

    Directory of Open Access Journals (Sweden)

    Maria Polikandrioti

    2007-07-01

    Full Text Available Music has been used therapeutically for many centuries, and numerous studies have researched the curative and preventative powers of music in several diseases. Music, as a therapy was shown to have positive effects in child care, such as in premature infants, children in emergency care, children receiving surgery, children in oncology departments and handicapped children. The aim of this review was to study the therapeutic effects of music in child care at hospital. The method οf this study included bibliography research from both the review and the research internatio nal literature, which was referred to the therapeutic effects of music in Children's Hospital. Results: Most studies focus on the beneficial effects of music to child. The results of the study showed that music is widely used to enhance well‐being and appears to exert direct effects to child, which are mainly related to physiology and psychology, including changes in the vital signs, reductions in anxiety and pain, distraction of attention from unpleasant sensations and better communication with the environment at hospital. Furthermore, music exerts indirect effects to child since is able to cause positive modifications in nurses' behaviour and conduces to better performance in their duties. Conclusions: Music consists a low-cost "therapeutic instrument" for nurses to apply to child-patient and is found to be effective in producing positive outcomes. The nurses' knowledge of music therapy need to be improved and the therapeutic impact of music must be a result from systematic professional application.

  15. Redesigning ambulatory care business processes supporting clinical care delivery.

    Science.gov (United States)

    Patterson, C; Sinkewich, M; Short, J; Callas, E

    1997-04-01

    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.

  16. Achieving Excellence in Palliative Care: Perspectives of Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Margaret I Fitch

    2016-01-01

    Full Text Available Caring for individuals at the end of life in the hospital environment is a challenging proposition. Understanding the challenges to provide quality end of life care is an important first step in order to develop appropriate approaches to support and educate staff members and facilitate their capacity remaining "caring." Four studies were undertaken at our facility to increase our understanding about the challenges health professionals experience in caring for patients at end of life and how staff members could be supported in providing care to patients and families: (1 In-depth interviews were used with cancer nurses (n = 30 to explore the challenges talking about death and dying with patients and families; (2 Surveys were used with nurses (n = 27 and radiation therapists (n = 30 to measure quality of work life; (3 and interprofessional focus groups were used to explore what it means "to care" (five groups held; and (4 interprofessional focus groups were held to understand what "support strategies for staff" ought to look like (six groups held. In all cases, staff members confirmed that interactions concerning death and dying are challenging. Lack of preparation (knowledge and skill in palliative care and lack of support from managers and colleagues are significant barriers. Key strategies staff members thought would be helpful included: (1 Ensuring all team members were communicating and following the same plan of care, (2 providing skill-based education on palliative care, and (3 facilitating "debriefing" opportunities (either one-on-one or in a group. For staff to be able to continue caring for patients at the end of life with compassion and sensitivity, they need to be adequately prepared and supported appropriately.

  17. Perioperative Care of Prisoners: Providing Safe Care.

    Science.gov (United States)

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel.

  18. Clinical efficacy of metoprolol for early thrombolysis in treatment of acute myocardial infarction%美托洛尔用于急性心梗早期溶栓治疗临床观察

    Institute of Scientific and Technical Information of China (English)

    唐隆文; 郑天骑

    2013-01-01

    目的探讨美托洛尔用于急性心梗早期溶栓治疗临床效果。方法选取我院收治急性心梗患者50例,采用随机数字表法分为对照组和观察组;其中对照组患者25例,给予常规抗心梗药物治疗;观察组患者25例,在对照组治疗基础上,加用美托洛尔治疗;比较两组患者心源性猝死率、心源性休克率、再梗死率、死亡率及治疗前后QRS积分等。结果观察组患者心源性猝死率、再梗死率及死亡率均明显低于对照组,组间比较差异显著(P0.05);两组患者治疗后QRS评分均明显低于治疗前,且观察组患者下降程度均明显优于对照组,组间比较无显著差异(P0.05). Both groups showed significant decreases in QRS scores after treatment, and the observation group had a significantly higher decrease than the control group (P<0.05). Conclusion Metoprolol can effectively reduce the recurrence of infarction and mortality risk and improve prognosis when used for early thrombolysis in the treatment of acute myocardial infarction.

  19. Reconfiguring Maternity Care?

    DEFF Research Database (Denmark)

    Johannsen, Nis

    This dissertation constitutes a reflection on two initiatives seeking to reconfigure maternity care. One initiative sought to digitalise maternity records and included a pilot run of an electronic maternity record in a Danish county. The other consisted of a collaboration between a maternity ward...... the initiatives were not successful the ambitions remained. To approach the consequences and politics of the proposed changes an experiment is instead carried out. This experiment draws on the interests involved in the initiatives and the three logics, while it constructs a conceptual frame within which three...... experimental designs are constructed. The consequences and the politics of the proposed changes are engaged with in laboratory manner through collaborative development of the designs and through exposing them to members of field of maternity care...

  20. 腔内导管抽栓或联合溶栓在肠系膜上动脉栓塞中的应用%Catheter aspiration alone or combined with thrombolysis in the treatment of superior mesenteric artery embolism

    Institute of Scientific and Technical Information of China (English)

    黄渊全; 贾中芝; 王祁; 陈文华; 何忠明; 张俊; 王凯; 田丰

    2014-01-01

    目的:探讨腔内导管抽栓或联合溶栓在肠系膜上动脉栓塞(SMAE)治疗中的应用价值。方法回顾性分析江苏省常州市第一和第二人民医院于2005年1月至2013年7月期间接受导管抽栓或联合尿激酶溶栓治疗的25例SMAE患者的临床及影像资料。患者均经数字减影血管造影(DSA)确诊后即采用右侧股动脉穿刺,在导丝的配合下,将肾动脉导管送至栓塞部位反复抽吸进行抽栓治疗;若残留栓子堵塞远端或分支血管,则经导管缓慢推注尿激酶进行溶栓治疗。结果对25例患者中初诊为主干栓塞的20例SMAE行导管抽栓治疗后,主干均完全开通,但有6例其残留或破碎的小栓子脱落栓塞至远端分支血管。对初诊为分支动脉栓塞的5例SMAE以及抽栓治疗导致分支动脉栓塞的6例共计11例患者,采用抽栓联合尿激酶溶栓治疗,其中5例分支动脉完全开通,3例部分开通,另3例虽未开通但侧枝循环明显增多。1例患者治疗24 h后发现小肠坏死,行肠切除术后出现短肠综合征。其余24例患者治疗后随访(4.1±2.2)月,临床症状均缓解,消化功能均恢复正常。结论导管抽栓或联合尿激酶溶栓治疗SMAE疗效满意。%Objective To investigate the efficacy of catheter aspiration or combined with thrombolysis in the treatment of superior mesenteric artery embolism (SMAE). Methods Clinical and imaging data of 25 SMAE patients who underwent catheter aspiration or combined with urokinase thrombolysis in the First People′s Hospital and the Second People′s Hospital of Changzhou from January 2005 to July 2013 were retrospectively analyzed. Results Twenty patients were confirmed as SMA trunk embolism and 5 as SMA branch artery embolism. The embolic SMA trunks were completely recannulated by catheter aspiration in the above 20 cases, but small emboli embolized distal branch artery in 6 cases. These 6 patients plus above 5

  1. Exposing Baccalaureate Nursing Students to Transitional Care.

    Science.gov (United States)

    OʼConnor, Melissa; Arcamone, Angelina; Amorim, Frances; Hoban, Mary Beth; Boyd, Regina M; Fowler, Lauren; Marcelli, Theresa; Smith, Jacalyn; Nassar, Kathleen; Fitzpatrick, M Louise

    2016-10-01

    Management and facilitation of care transitions from hospital to alternative settings requires skill and attention to avoid adverse events. Several interprofessional organizations and nurse leaders have called for the expansion and redesign of undergraduate nursing curricula to include care transitions. Yet there is little evidence describing how undergraduate baccalaureate nursing students are educated on this critical topic or how successful they are in improving student knowledge about care transitions. To address this gap, an in-classroom and clinical experience was implemented to prepare students to manage and facilitate care transitions from the hospital to alternative settings-including the home. Perceptions of undergraduate nursing students and home healthcare nurse preceptors were assessed via an electronic survey that was emailed to participants. Forty-eight responses to the survey were received. Students agreed this experience contributed to their understanding of caring for adults and older adults who are experiencing a care transition and they had a good understanding of care transitions to apply to their future nursing courses. Home healthcare nurse preceptors agreed they were able to demonstrate transitional care and that students were engaged. Future work should include expanding transitional care immersion to other care settings as well as the inclusion of additional healthcare disciplines in care transition education.

  2. Developing a service model that integrates palliative care throughout cancer care: the time is now.

    Science.gov (United States)

    Partridge, Ann H; Seah, Davinia S E; King, Tari; Leighl, Natasha B; Hauke, Ralph; Wollins, Dana S; Von Roenn, Jamie Hayden

    2014-10-10

    Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care; coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships; prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings; and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal.

  3. Strengthening care of injured children globally.

    Science.gov (United States)

    Mock, Charles; Abantanga, Francis; Goosen, Jacques; Joshipura, Manjul; Juillard, Catherine

    2009-05-01

    Part of the solution to the growing problem of child injury is to strengthen the care that injured children receive. This paper will point out the potential health gains to be made by doing this and will then review recent advances in the care of injured children in individual institutions and countries. It will discuss how these individual efforts have been aided by increased international attention to trauma care. Although there are no major, well-funded global programmes to improve trauma care, recent guidance documents developed by WHO and a broad network of collaborators have stimulated increased global attention to improving planning and resources for trauma care. This has in turn led to increased attention to strengthening trauma care capabilities in countries, including needs assessments and implementation of WHO recommendations in national policy. Most of these global efforts, however, have not yet specifically addressed children. Given the special needs of the injured child and the high burden of injury-related death and disability among children, clearly greater emphasis on childhood trauma care is needed. Trauma care needs assessments being conducted in a growing number of countries need to focus more on capabilities for care of injured children. Trauma care policy development needs to better encompass childhood trauma care. More broadly, the growing network of individuals and groups collaborating to strengthen trauma care globally needs to engage a broader range of stakeholders who will focus on and champion the improvement of care for injured children.

  4. Self-care as a health resource of elders

    DEFF Research Database (Denmark)

    Høy, Bente; Wagner, Lis; Hall, Elisabeth O.C.

    2007-01-01

    of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self-care at the expense of health care, and self-care was seen more as supplementary to professional health care rather than as a health-promoting approach in health care. METHOD......: In this integrative review from 2006, we selected theoretical and empirical articles published between 1990 and 2006, where self-care was related to elders' health promotion. Data were extracted from primary sources and included definitions of self-care, critical attributes, antecedents, goals and outcomes. We...... interactively compared data and display matrices to describe self-care as a health resource. RESULTS: Fifty-seven articles addressed health self-care and were integrated into a framework of self-care as a health resource of elders. Self-care was identified as a two-dimensional construct including action...

  5. Acne - self-care

    Science.gov (United States)

    Acne vulgaris - self-care; Cystic acne - self-care; Pimples - self-care; Zits - self-care ... If daily skin care does not clear up blemishes, try over-the-counter acne medicines that you apply to your skin. These products ...

  6. Understanding palliative care.

    Science.gov (United States)

    Martin, Caren McHenry

    2006-09-01

    While most pharmacists and other health care practitioners are familiar with the programs and philosophy of hospice, they may lack a clear understanding of palliative care. Because myths and misconceptions about palliative care abound, a review of the definitions and components of palliative care can enhance the practice of all practitioners who care for patients with chronic diseases.

  7. Improving care coordination using organisational routines: care pathways as a coordination mechanism

    DEFF Research Database (Denmark)

    Prætorius, Thim

    2016-01-01

    Purpose: This conceptual article systematically applies theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can...... be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Design/methodology/approach: Theory of routines is systematically applied to the concept of care pathways in order to develop theoretically derived propositions. Findings: Care pathways mirror....... Originality/value: Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination....

  8. Primary care for the Roma in Europe: Position paper of the European forum for primary care

    OpenAIRE

    de Graaf Pim; Rotar Pavlič Danica; Zelko Erika; Vintges Marga; Willems Sara; Hanssens Lise

    2016-01-01

    Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations.

  9. Taking Care of the Kids: The Corporate Role in Providing Child Care.

    Science.gov (United States)

    Friedman, Dana E.

    1985-01-01

    More and more people are beginning to look to their employers for a solution to the child care dilemma. Various types of employer supported child care are described, including day care centers, after school programs, summer day camps, financial assistance, flexible benefit plans, and information and referral services. (CB)

  10. Primary care for the Roma in Europe: Position paper of the European forum for primary care

    Directory of Open Access Journals (Sweden)

    de Graaf Pim

    2016-09-01

    Full Text Available Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations.

  11. Open access in the critical care environment.

    Science.gov (United States)

    South, Tabitha; Adair, Brigette

    2014-12-01

    Open access has become an important topic in critical care over the last 3 years. In the past, critical care had restricted access and set visitation guidelines to protect patients. This article provides a review of the literature related to open access in the critical care environment, including the impact on patients, families, and health care providers. The ultimate goal is to provide care centered on patients and families and to create a healing environment to ensure safe passage of patients through their hospital stays. This outcome could lead to increased patient/family satisfaction.

  12. American Association of Critical-Care Nurses

    Science.gov (United States)

    ... range of topics including regulatory issues, advanced practice, ethics, end-of-life care, legal issues and research. Browse Topics Volunteer Share your nursing expertise as a volunteer, which includes becoming an ...

  13. Epilepsy care in general practice.

    LENUS (Irish Health Repository)

    Varley, J

    2009-06-01

    Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

  14. Epilepsy care in general practice.

    Science.gov (United States)

    Varley, J; Fitzsimons, M; Delanty, N; Collins, C; Boland, M; Normand, C

    2009-06-01

    Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.

  15. A Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Health-care Professionals. A Call for Action.

    Science.gov (United States)

    Moss, Marc; Good, Vicki S; Gozal, David; Kleinpell, Ruth; Sessler, Curtis N

    2016-07-01

    Burnout syndrome (BOS) occurs in all types of health-care professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other health-care professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care health-care professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care health-care professionals and diminish the harmful consequences of BOS, both for critical care health-care professionals and for patients.

  16. The Concept of the Care Worker : A Clue to the Issue of Care Work

    OpenAIRE

    野中, ますみ

    2010-01-01

    In Europe and the United States, the term "care worker" covers a much wider field than the one it covers in Japan. The job of the care worker in the West, which is not limited to the care for the senior citizen, often includes non-skilled and menial labor. Care workers, including certified ones, not only suffer from chronic unpaid overwork, lumbago, psychosomatic disorder and burnout, but are often exposed to danger of violence and infectious diseases from care receivers. Their poor working c...

  17. Emergency care toolkits.

    Science.gov (United States)

    Black, Steven

    2004-06-01

    Emergency care services are the focus of a series of toolkits developed by the NHS National electronic Library for Health to provide resources for emergency care leads and others involved in modernising emergency care, writes Steven Black.

  18. Your cancer care team

    Science.gov (United States)

    ... gov/ency/patientinstructions/000929.htm Your cancer care team To use the sharing features on this page, ... help your body heal. Working with Your Care Team Each member of your care team plays an ...

  19. Office of Child Care

    Science.gov (United States)

    ... for Children & Families Office of Child Care By Office Administration for Native Americans (ANA) Administration on Children, ... Care Partnerships. Review the profiles. > What is the Office of Child Care (OCC)? The Office of Child ...

  20. Sexual and Reproductive Health Care for Women with Intellectual Disabilities: A Primary Care Perspective

    OpenAIRE

    Greenwood, Nechama W.; Joanne Wilkinson

    2013-01-01

    Adults with intellectual disabilities (ID) face multiple health disparities and challenges to accessing health care. Little is known about sexual health care of this population and about how to optimize women's reproductive health care for women with intellectual disabilities. Women with ID face important barriers to care, including lack of provider training and experience, hesitancy to broach the topic of sexual health, a lack of sexual knowledge and limited opportunities for sex education, ...

  1. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2001-03-01

    Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

  2. Developing the Care in Pharmaceutical Care.

    Science.gov (United States)

    Fjortoft, Nancy F.; Zgarrick, David P.

    The purpose of this study was to assess the level of caring ability of a sample of pharmacy students and assess the relationship between selected predictor variables and pharmacy students' caring ability. Caring was viewed as the ability to assume responsibility for the protection and welfare of another without being perfunctory or begrudging.…

  3. The Ups and Downs of Child Care: Variations in Child Care Quality and Exposure across the Early Years

    Science.gov (United States)

    Hynes, Kathryn; Habasevich-Brooks, Tara

    2008-01-01

    There is considerable policy interest in understanding the role of child care in children's development. Yet little research has examined whether individual children experience changes in child care quality across their early years, and less has included children's varying levels of exposure to care in analyses of child care trajectories. Using…

  4. Moving Parkinson care to the home.

    Science.gov (United States)

    Dorsey, E Ray; Vlaanderen, Floris P; Engelen, Lucien Jlpg; Kieburtz, Karl; Zhu, William; Biglan, Kevin M; Faber, Marjan J; Bloem, Bastiaan R

    2016-09-01

    In many ways, the care of individuals with Parkinson disease does not meet their needs. Despite the documented benefits of receiving care from clinicians with Parkinson disease expertise, many patients (if not most) do not. Moreover, current care models frequently require older individuals with impaired mobility, cognition, and driving ability to be driven by overburdened caregivers to large, complex urban medical centers. Moving care to the patient's home would make Parkinson disease care more patient-centered. Demographic factors, including aging populations, and social factors, such as the splintering of the extended family, will increase the need for home-based care. Technological advances, especially the ability to assess and deliver care remotely, will enable the transition of care back to the home. However, despite its promise, this next generation of home-based care will have to overcome barriers, including outdated insurance models and a technological divide. Once these barriers are addressed, home-based care will increase access to high quality care for the growing number of individuals with Parkinson disease. © 2016 International Parkinson and Movement Disorder Society.

  5. Sepsis in critical care.

    Science.gov (United States)

    King, Joan E

    2007-03-01

    Sepsis is a syndrome produced by the accelerated activity of the inflammatory immune response, the clotting cascade, and endothelial damage. It is a systematic process that can progress easily into septic shock and MODS. The chemical mediators or cytokines produce a complex self-perpetuating process that impacts all body systems. It is critical for the nurse first to identify patients at risk for developing sepsis and to assess patients who have SIRS and sepsis continually for signs and symptoms of organ involvement and organ dysfunction. Once sepsis has been diagnosed, evidence-based practice indicates initiation of fluid resuscitation. Vasopressor therapy, positive inotropic support, and appropriate antibiotic therapy should be started within the first hour. Within a 6-hour timeframe the goal is stabilization of the CVP, MAP, and UOP to prevent further organ damage. The challenge for nurses caring for septic patients is to support the treatment goals, to prevent added complications including stress ulcers, DVTs, aspiration pneumonia, and the progression to MODS, and to address the patient's and the family's psychosocial needs. As complex as the pathophysiology of sepsis is, the nursing care is equally complex but also rewarding. Patients who previously might have died now recover as vigilant nursing care combines forces with new drug therapies and evidence-based practice guidelines.

  6. Palliative and end of life care for people living with dementia in care homes: part 1.

    Science.gov (United States)

    Mitchell, Gary; Agnelli, Joanne; McGreevy, Jessie; Diamond, Monica; Roble, Herlindina; McShane, Elaine; Strain, Joanne

    2016-06-22

    The terms palliative and end of life care are often used interchangeably and healthcare practitioners may perceive that palliative care is only appropriate during the terminal stages of an illness. This article, the first of two parts, provides healthcare practitioners with an overview of the concept of palliative care. It explains how this can be differentiated from end of life care and how it should be commenced in a timely manner, so that people who are living with dementia can contribute to the planning of their future care and death. The policies and tools used in the provision of palliative and end of life care are discussed, including advance care planning and The Gold Standards Framework. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. The second part of this article will discuss end of life care and the best practices for providing end of life care, including nutrition and hydration, oral hygiene, pain management and spiritual care.

  7. Perioperative Care Coordination Measurement: A Tool to Support Care Integration of Pediatric Surgical Patients.

    Science.gov (United States)

    Ferrari, Lynne R; Ziniel, Sonja I; Antonelli, Richard C

    2016-03-01

    The relationship of care coordination activities and outcomes to resource utilization and personnel costs has been evaluated for a number of pediatric medical home practices. One of the first tools designed to evaluate the activities and outcomes for pediatric care coordination is the Care Coordination Measurement Tool (CCMT). It has become widely used as an instrument for health care providers in both primary and subspecialty care settings. This tool enables the user to stratify patients based on acuity and complexity while documenting the activities and outcomes of care coordination. We tested the feasibility of adapting the CCMT to a pediatric surgical population at Boston Children's Hospital. The tool was used to assess the preoperative care coordination activities. Care coordination activities were tracked during the interval from the date the patient was scheduled for a surgical or interventional procedure through the day of the procedure. A care coordination encounter was defined as any task, whether face to face or not, supporting the development or implementation of a plan of care. Data were collected to enable analysis of 5675 care coordination encounters supporting the care provided to 3406 individual surgical cases (patients). The outcomes of care coordination, as documented by the preoperative nursing staff, included the elaboration of the care plan through patient-focused communication among specialist, facilities, perioperative team, and primary care physicians in 80.5% of cases. The average time spent on care coordination activities increased incrementally by 30 minutes with each additional care coordination encounter for a surgical case. Surgical cases with 1 care coordination encounter took an average of 35.7 minutes of preoperative care coordination, whereas those with ≥4 care coordination encounters reported an average of 121.6 minutes. We successfully adapted and implemented the CCMT for a pediatric surgical population and measured nonface

  8. Planning elderly and palliative care in Montenegro

    Directory of Open Access Journals (Sweden)

    Mark McCarthy

    2009-04-01

    Full Text Available Introduction: Montenegro, a newly independent Balkan state with a population of 650,000, has a health care reform programme supported by the World Bank. This paper describes planning for integrated elderly and palliative care. Description: The current service is provided only through a single long-stay hospital, which has institutionalised patients and limited facilities. Broad estimates were made of current financial expenditures on elderly care. A consultation was undertaken with stakeholders to propose an integrated system linking primary and secondary health care with social care; supporting people to live, and die well, at home; developing local nursing homes for people with higher dependency; creating specialised elderly-care services within hospitals; and providing good end-of-life care for all who need it. Effectiveness may be measured by monitoring patient and carers’ perceptions of the care experience. Discussion: Changes in provision of elderly care may be achieved through redirection of existing resources, but the health and social care services also need to enhance elderly care budgets. The challenges for implementation include management skills, engaging professionals and political commitment. Conclusion: Middle-income countries such as Montenegro can develop elderly and palliative care services through redirection of existing finance if accompanied by new service objectives, staff skills and integrated management.

  9. Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations.

    Science.gov (United States)

    Weissman, David E; Morrison, R Sean; Meier, Diane E

    2010-02-01

    Data collection and analysis are vital for strategic planning, quality improvement, and demonstration of palliative care program impact to hospital administrators, private funders and policymakers. Since 2000, the Center to Advance Palliative Care (CAPC) has provided technical assistance to hospitals, health systems and hospices working to start, sustain, and grow nonhospice palliative care programs. CAPC convened a consensus panel in 2008 to develop recommendations for specific clinical and customer metrics that programs should track. The panel agreed on four key domains of clinical metrics and two domains of customer metrics. Clinical metrics include: daily assessment of physical/psychological/spiritual symptoms by a symptom assessment tool; establishment of patient-centered goals of care; support to patient/family caregivers; and management of transitions across care sites. For customer metrics, consensus was reached on two domains that should be tracked to assess satisfaction: patient/family satisfaction, and referring clinician satisfaction. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care programs are encouraged to collect and report outcomes for each of the metric domains described here.

  10. Haemophilus influenzae Disease (Including Hib) Symptoms

    Science.gov (United States)

    ... Search The CDC Cancel Submit Search The CDC Haemophilus influenzae Disease (Including Hib) Note: Javascript is disabled or ... and Symptoms Recommend on Facebook Tweet Share Compartir Haemophilus influenzae , including Hib, disease causes different symptoms depending on ...

  11. Patient Satisfaction with Virtual Obstetric Care.

    Science.gov (United States)

    Pflugeisen, Bethann Mangel; Mou, Jin

    2017-02-07

    Introduction The importance of patient satisfaction in US healthcare is increasing, in tandem with the advent of new patient care modalities, including virtual care. The purpose of this study was to compare the satisfaction of obstetric patients who received one-third of their antenatal visits in videoconference ("Virtual-care") compared to those who received 12-14 face-to-face visits in-clinic with their physician/midwife ("Traditional-care"). Methods We developed a four-domain satisfaction questionnaire; Virtual-care patients were asked additional questions about technology. Using a modified Dillman method, satisfaction surveys were sent to Virtual-care (N = 378) and Traditional-care (N = 795) patients who received obstetric services at our institution between January 2013 and June 2015. Chi-squared tests of association, t-tests, logistic regression, and ANOVA models were used to evaluate differences in satisfaction and self-reported demographics between respondents. Results Overall satisfaction was significantly higher in the Virtual-care cohort (4.76 ± 0.44 vs. 4.47 ± 0.59; p Virtual-care selection (OR = 2.4, 95% CI: 1.5-3.8; p Virtual-care respondents was not significantly impacted by the incorporation of videoconferencing, Doppler, and blood pressure monitoring technology into their care. The questionnaire demonstrated high internal consistency as measured by domain-based correlations and Cronbach's alpha. Discussion Respondents from both models were highly satisfied with care, but those who had selected the Virtual-care model reported significantly higher mean satisfaction scores. The Virtual-care model was selected by significantly more women who already have children than those experiencing pregnancy for the first time. This model of care may be a reasonable alternative to traditional care.

  12. Article Including Environmental Barrier Coating System

    Science.gov (United States)

    Lee, Kang N. (Inventor)

    2015-01-01

    An enhanced environmental barrier coating for a silicon containing substrate. The enhanced barrier coating may include a bond coat doped with at least one of an alkali metal oxide and an alkali earth metal oxide. The enhanced barrier coating may include a composite mullite bond coat including BSAS and another distinct second phase oxide applied over said surface.

  13. Static, Lightweight Includes Resolution for PHP

    NARCIS (Netherlands)

    Hills, M.A.; Klint, P.; Vinju, J.J.

    2014-01-01

    Dynamic languages include a number of features that are challenging to model properly in static analysis tools. In PHP, one of these features is the include expression, where an arbitrary expression provides the path of the file to include at runtime. In this paper we present two complementary analy

  14. Strengthening of primary health care: Key to deliver inclusive health care

    Directory of Open Access Journals (Sweden)

    Rajiv Yeravdekar

    2013-01-01

    Full Text Available Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in ′Right to Life.′ It is imperative to define ′essential health care,′ which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of ′family physician′ in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery.

  15. An instrument for broadened risk assessment in antenatal health care including non-medical issues.

    NARCIS (Netherlands)

    A.A. Vos (Amber); M.J. van Veen (Mieke); E. Birnie (Erwin); S. Denktaş (Semiha); E.A.P. Steegers (Eric); G.J. Bonsel (Gouke)

    2015-01-01

    markdownabstractGrowing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed

  16. An instrument for broadened risk assessment in antenatal health care including non-medical issues

    OpenAIRE

    Amber Amanda Vos; Mieke J van Veen; Erwin Birnie; Semiha Denktas; Eric AP Steegers; Bonsel, Gouke J

    2015-01-01

    Introduction: Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenata...

  17. The value of including spirometry in health checks - a randomized controlled study in primary health care

    DEFF Research Database (Denmark)

    Ørts, Lene Maria; Ottesen, Anders Løkke; Bjerregaard, Anne-Louise

    aged 30-49 years will be randomized into two groups: The intervention group receives an invitation which highlights the value of spirometry as part of a health check and information about lung diseases. The control group will receive a standard invitation. Primary outcome measure is effect...... on attendance. The characteristics of the 2 groups will be described according to sex, age, smoking history, spirometry values and lung symptoms. Results This is a presentation of the method, therefore we do not have any results yet. Conclusion The results from the present study are expected to contribute...... with important knowledge about the value of information on spirometry in invitations to health checks measured at different levels of attendance – as described above. Point of discussion The study is part of a Ph.D. project evaluating the use of spirometry as an element in preventive health checks. Further...

  18. 76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-02-17

    ..., Baltimore, MD 21244-1850. 4. By hand or courier. If you prefer, you may deliver (by hand or courier) your... arrival with one of our staff members. Comments mailed to the addresses indicated as appropriate for hand... Budget Office CDC Centers for Disease Control and Prevention DVT Deep vein thrombosis ESRD...

  19. 76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-06-06

    ... Artery Bypass Graft (CABG)--Mediastinitis. + Bariatric Surgery. --Laparoscopic Gastric Bypass... Surgical Site Infection following CABG or Bariatric surgery, are not typically applicable to pediatric or..., Bariatric Surgery, or Orthopedic procedures is not typically applicable to children and pregnant...

  20. Putting the 'care' back into aged care.

    Science.gov (United States)

    Beadnell, Cathy

    2006-04-01

    Aged care is well and truly back on the political agenda in Australia. While the mainstream media has recently exposed a number of horrific cases of alleged abuse in aged care facilities it has done little to highlight the failings of social policy over time or to foster debate on how to improve the care of older Australians. What are the barriers to providing safe and quality aged care to a growing number of our citizens and how do we overcome them? If you relied on the recent media coverage for your impression of aged care you could be forgiven for thinking it is all bad news. But there are facilities providing high quality care and stories of nurses working wonders in the face of adversity. Cathy Beadnell considers some of the broader cultural and workforce issues in aged care.

  1. Integrated working between residential care homes and primary care: a survey of care homes in England

    Directory of Open Access Journals (Sweden)

    Gage Heather

    2012-11-01

    Full Text Available Abstract Background Older people living in care homes in England have complex health needs due to a range of medical conditions, mental health needs and frailty. Despite an increasing policy expectation that professionals should operate in an integrated way across organisational boundaries, there is a lack of understanding between care homes and the National Health Service (NHS about how the two sectors should work together, meaning that residents can experience a poor "fit" between their needs, and services they can access. This paper describes a survey to establish the current extent of integrated working that exists between care homes and primary and community health and social services. Methods A self-completion, online questionnaire was designed by the research team. Items on the different dimensions of integration (funding, administrative, organisational, service delivery, clinical care were included. The survey was sent to a random sample of residential care homes with more than 25 beds (n = 621 in England in 2009. Responses were analysed using quantitative and qualitative methods. Results The survey achieved an overall response rate of 15.8%. Most care homes (78.7% worked with more than one general practice. Respondents indicated that a mean of 14.1 professionals/ services (other than GPs had visited the care homes in the last six months (SD 5.11, median 14; a mean of .39 (SD.163 professionals/services per bed. The most frequent services visiting were district nursing, chiropody and community psychiatric nurses. Many (60% managers considered that they worked with the NHS in an integrated way, including sharing documents, engaging in integrated care planning and joint learning and training. However, some care home managers cited working practices dictated by NHS methods of service delivery and priorities for care, rather than those of the care home or residents, a lack of willingness by NHS professionals to share information, and low

  2. The second national audit of intermediate care.

    Science.gov (United States)

    Young, John; Gladman, John R F; Forsyth, Duncan R; Holditch, Claire

    2015-03-01

    Intermediate care services have developed internationally to expedite discharge from hospital and to provide an alternative to an emergency hospital admission. Inconsistencies in the evidence base and under-developed governance structures led to concerns about the care quality, outcomes and provision of intermediate care in the NHS. The National Audit of Intermediate Care was therefore established by an interdisciplinary group. The second national audit reported in 2013 and included crisis response teams, home-based and bed-based services in approximately a half of the NHS. The main findings were evidence of weak local strategic planning, considerable under-provision, delays in accessing the services and lack of mental health involvement in care. There was a very high level of positive patient experience reported across all types of intermediate care, though reported involvement with care decisions was less satisfactory.

  3. Assessment of coagulation function and ultrasound features after reteplase and recombinant streptokinase thrombolysis of lower extremity deep venous thrombosis%瑞替普酶和重组链激酶溶栓治疗下肢深静脉血栓的凝血功能及超声特征评估

    Institute of Scientific and Technical Information of China (English)

    熊伟

    2016-01-01

    Objective:To assess coagulation function and ultrasound features after reteplase and recombinant streptoki-nase thrombolysis of lower extremity deep venous thrombosis.Methods:A total of 78 patients with lower extremity deep ve-nous thrombosis who were treated in our hospital were selected as research subjects and divided into observation group (39 ca-ses)and control group (39 cases)according to different treatment regimens.Control group received recombinant streptokinase thrombolysis,observation group received reteplase thrombolysis,and then the effect of the two thrombolytic ways was evalua-ted by color Doppler ultrasonography and circulating blood test.Results:Ultrasound showed that complete recanalization rate of thrombus of observation group after treatment was higher than that of control group (P <0.05);plasma PT,APTT and TT values of observation group after thrombolysis were higher than those of control group,FIB,D-D,NO,ET,E-selectin,P-se-lectin,Hcy,CRP,IL-6,IL-8 and TNF-αvalues were lower than those of control group,and WBC,Nc and Mc cell number were less than those of control group (P < 0.05 ).Conclusion:Reteplase for thrombolysis of lower extremity deep venous thrombosis has more distinguished effects on dissolving thrombus as well as optimizing body's coagulation,inflammatory sys-tem state and other aspects,and is a more ideal thrombolytic drug.%目的::评估瑞替普酶和重组链激酶溶栓治疗下肢深静脉血栓的凝血功能及超声特征.方法:取本院收治的78例下肢深静脉血栓患者作为研究对象,根据具体治疗方案不同被分为观察组及对照组各39例.对照组接受重组链激酶溶栓治疗,观察组接受瑞替普酶溶栓治疗,经彩色多普勒超声检查及循环血检测后评价两种溶栓方式的效果.结果:观察组接受治疗后超声显示血栓完全再通率高于对照组(P <0.05);观察组的溶栓治疗后血浆 PT、APTT、TT 值高于对照组,FIB、D-D、NO、ET、E-选

  4. Perioperative Care of the Transgender Patient.

    Science.gov (United States)

    Smith, Francis Duval

    2016-02-01

    Transgender patients are individuals whose gender identity is not related to their biological sex. Assuming a new gender identity that does not conform to societal norms often results in discrimination and barriers to health care. The exact number of transgender patients is unknown; however, these patients are increasingly seen in health care. Transgender individuals may experience provider-generated discrimination in health care facilities, including refusal of service, disrespect, and abuse, which contribute to depression and low self-esteem. Transgender therapies include mental health counseling for depression and low self-esteem, hormone therapy, and sex reassignment surgery. Health care professionals require cultural competence, an understanding of the different forms of patient identification, and adaptive approaches to care for transgender patients. VA (Veterans Affairs) hospitals provide a model for the care for transgender patients and staff.

  5. Evolution of US Health Care Reform.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

    2017-03-01

    Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

  6. Self-care as a health resource of elders

    DEFF Research Database (Denmark)

    Høy, Bente; Hall, E.O.C.; Wagner, L.

    2007-01-01

    AIM: To review the literature related to self-care and health promotion for elders and to develop an understanding of self-care as a health resource. BACKGROUND: Self-care may improve health and prevent illness and disabilities in elders. Although studies of self-care are numerous, the significance...... of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self-care at the expense of health care, and self-care was seen more as supplementary to professional health care rather than as a health-promoting approach in health care. METHOD......: In this integrative review from 2006, we selected theoretical and empirical articles published between 1990 and 2006, where self-care was related to elders' health promotion. Data were extracted from primary sources and included definitions of self-care, critical attributes, antecedents, goals and outcomes. We...

  7. Multimorbidity and quality of preventive care in Swiss university primary care cohorts.

    Directory of Open Access Journals (Sweden)

    Sven Streit

    Full Text Available BACKGROUND: Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings. METHODS: We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50-80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND's Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator. RESULTS: Participants (mean age 63.5 years, 44% women had a mean of 2.6 (SD 1.9 comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9. Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47% and those with schizophrenia (35%. CONCLUSIONS: In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.

  8. Basic infertility including polycystic ovary syndrome.

    Science.gov (United States)

    Brassard, Maryse; AinMelk, Youssef; Baillargeon, Jean-Patrice

    2008-09-01

    Infertility in women has many possible causes and must be approached systematically. The most common cause of medically treatable infertility is the polycystic ovary syndrome (PCOS). This syndrome is common in young women and is the cause of anovulatory infertility in 70% of cases. It is therefore an important condition to screen and manage in primary care medical settings. In the past 10 years, insulin sensitization with weight loss or metformin has been shown to be a safe and effective treatment for PCOS infertility that eliminates the risk of multiple pregnancy and may reduce the risk of early pregnancy loss as compared with ovulation-inductor drugs. The authors believe metformin should be considered as first-line therapy because it has the advantage to allow for normal single ovulation, for reduced early pregnancy loss, and, most importantly, lifestyle modifications and weight loss before pregnancy. Losing weight not only improves fertility but also reduces adverse pregnancy outcomes associated with obesity.

  9. Designing Robots for Care: Care Centered Value-Sensitive Design

    NARCIS (Netherlands)

    Wynsberghe, van A.

    2013-01-01

    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vu

  10. 尿激酶在老年急性心肌梗死中溶栓效果观察%Efifcacy of Urokinase on Thrombolysis in Elderly Patients With Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    邵军军; 辛建文

    2016-01-01

    Objective To observe the thrombolysis effect of urokinase in elderly patients with acute myocardial infarction (AMI). Methods 45 cases of elderly patients with AMI in our hospital were divided into observation group (n=23) and control group (n=22) according to medication, control group received conventional treatment, treatment group was given urokinase based on control group. Results The IRA opening time of observation group was shorter than that of control group, the difference was statistically significant (P0.05). The clinical recanalization rate of observation group was higher, and the incidence of arrhythmia and bleeding complications were signiifcantly lower than that of control group (P<0.05). Conclusion Urokinase for the treatment of AMI has high clinical recanalization rate, with low incidence of arrhythmia and fewer bleeding complications, worthy of clinical application.%目的:观察尿激酶在老年急性心肌梗死患者中的溶栓效果。方法选取我院45例急性心肌梗死老年患者作为研究对象,根据不同用药,分为观察组(n=23)和对照组(n=22),对照组给予常规治疗,观察组在对照组治疗基础上给予尿激酶。结果观察组IRA开通时间短于对照组(P<0.05)。观察组CK、CK-MB峰值时间与对照组比较,差异无统计学意义(P>0.05)。观察组临床再通率高于对照组,心率失常发生率及出血并发症发生率均显著低于对照组(P<0.05)。结论尿激酶对治疗老年急性心肌梗死有临床再通率高,心率失常发生率及出血并发症少优。

  11. Novel approach to evaluation of medical care quality delivered to patients with ST-segment elevation acute coronary syndrome: course to clinical result

    Directory of Open Access Journals (Sweden)

    Posnenkova О.М.

    2014-09-01

    Full Text Available The purpose was to implement system analysis of clinical cases for development of healthcare quality indicators for STe-ACS patients, aimed at achievement of clinical result — decrease of in-hospital mortality. Mathehal and Methods. National recommendations on diagnostic and treatment of patients with myocardial infarction with ST-segment elevation on ECG (2007 were used to determine clinical result of treatment and key measures of medical care. To reveal major causes of clinical result non-achievement fishbone diagram was used. Results. Early reperfusion and optimal medical therapy were determined as the key measures of medical care delivered to patients with STe-ACS. The following indicators were developed to control these measures: «Primary reperfusion», «Thrombolysis in 30 minutes», «Primary percutaneous coronary intervention in 90 minutes», «Dual antiplatelet therapy in hospital», «Beta-blockers administration», «ACE-is/ARBs administration». The major causes of in-hospital mortality were separated. Indicators for assessment the major causes of clinical result non-achievement were proposed. Principal stages of performance measures creation were posed. Conclusion. Recommendation-based and clear definition of clinical result of treatment and key measures of the result achievement combined with methods of systems analysis allows development of evidence-based measures for assessment the quality of care delivered to patients with STe-ACS.

  12. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

    Directory of Open Access Journals (Sweden)

    Sword Wendy

    2012-04-01

    Full Text Available Abstract Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of

  13. Pediatric intensive care.

    Science.gov (United States)

    Macintire, D K

    1999-07-01

    To provide optimal care, a veterinarian in a pediatric intensive care situation for a puppy or kitten should be familiar with normal and abnormal vital signs, nursing care and monitoring considerations, and probable diseases. This article is a brief discussion of the pediatric intensive care commonly required to treat puppies or kittens in emergency situations and for canine parvovirus type 2 enteritis.

  14. Depression in primary care: assessing suicide risk

    Science.gov (United States)

    Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping

    2017-01-01

    Major depression is a common condition seen in the primary care setting. This article describes the suicide risk assessment of a depressed patient, including practical aspects of history-taking, consideration of factors in deciding if a patient requires immediate transfer for inpatient care and measures to be taken if the patient is not hospitalised. It follows on our earlier article about the approach to management of depression in primary care. PMID:28210741

  15. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

    2016-01-01

    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective.......77) and general health scores (EQ-5D +0.03, CI 0.00 to 0.05) improved significantly at 24 months of intervention. Intervention costs summed up to 10 United States dollars per patient per month. Limitations: Limitations included a small number of primary care practices and a low intensity of intervention......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2...

  16. Promoting Safe Nursing Care by Bringing Visibility to the Disciplinary Aspects of Interdisciplinary Care

    Science.gov (United States)

    Keenan, Gail; Yakel, Elizabeth

    2005-01-01

    The provision of safe and effective interdisciplinary care requires making the unique and interdependent aspects of disciplinary care visible and understandable. Ideally, the electronic health record (EHR) should capture both disciplinary and interdisciplinary care. This paper reports on a “real time” pilot of a technology supported method of documenting, communicating, and tracking the nursing component of the patient’s plan of care for eventual integration into an EHR. An intensive care unit tested the intervention that included the adoption and use of the NANDA, NOC, and NIC terminologies. Multiple methods were used to evaluate the impact of the care planning method for a 12 month period. We found that the increased visibility of nursing care promoted greater awareness and understanding (collective mind) of care and in turn enhanced continuity. The results of the pilot were used to further refine our theoretical framework and method for the multi-site study currently underway. PMID:16779067

  17. Can We Help Care Providers Communicate More Effectively With Persons Having Dementia Living in Long-Term Care Homes?

    Science.gov (United States)

    Rochon, Elizabeth; Sidani, Souraya; Shaw, Alexander; Ben-David, Boaz M.; Saragosa, Marianne; Boscart, Veronique M.; Wilson, Rozanne; Galimidi-Epstein, Karmit K.

    2016-01-01

    Background: Effective communication between residents with dementia and care providers in long-term care homes (LTCHs) is essential to resident-centered care. Purpose: To determine the effects of a communication intervention on residents’ quality of life (QOL) and care, as well as care providers’ perceived knowledge, mood, and burden. Method: The intervention included (1) individualized communication plans, (2) a dementia care workshop, and (3) a care provider support system. Pre- and postintervention scores were compared to evaluate the effects of the intervention. A total of 12 residents and 20 care providers in an LTCH participated in the feasibility study. Results: The rate of care providers’ adherence to the communication plans was 91%. Postintervention, residents experienced a significant increase in overall QOL. Care providers had significant improvement in mood and perceived reduced burden. Conclusion: The results suggest that the communication intervention demonstrates preliminary evidence of positive effects on residents’ QOL and care providers’ mood and burden. PMID:27899433

  18. [Music therapy and child care].

    Science.gov (United States)

    Chang, Shu-Min; Sung, Huei-Chuan

    2005-12-01

    Music therapy was shown many years ago to have positive effects in various age groups of patients in the Western world. Music can produce physiological and psychological effects, including changes in the vital signs, reductions in anxiety, improvements in the immune system, decreases in cortisol levels, the reduction of stress and the promotion of well-being. Music therapy is an inexpensive and effective intervention for nurses to apply to patients. The application of such therapy to children, however, is different from that to adults due to their limited cognitive and language development. In Taiwan, nurses' knowledge of music therapy is limited, and it is rarely used in child care. This article introduces music therapy and its effects in child care, such as in premature infants, children in emergency care, handicapped children, and children receiving surgery. Music therapy is often used as an assisted intervention for patient care in clinical settings. Health care professionals can perform some of the music therapy activities for patients appropriately even if they have not been trained in music. This article aims to improve nurses' knowledge of music therapy and to provide a useful reference for those involved in child care.

  19. About Skin-to-Skin Care (Kangaroo Care)

    Science.gov (United States)

    ... Size Email Print Share About Skin-to-Skin Care Page Content Article Body You may be able ... care, also called kangaroo care. What is Kangaroo Care? Kangaroo care was developed in South America as ...

  20. Caring during clinical practice: Midwives’ perspective

    Directory of Open Access Journals (Sweden)

    Mmajapi E. Chokwe

    2013-09-01

    Full Text Available Background: Caring forms the core of nursing and midwifery. Despite caring being an important emotional aspect of midwifery and nursing, there are general public complaints about uncaring behaviour in midwifery. Therefore, there is a need to explore caring from midwives’ point of view with the hope of identifying solutions and recommendations for midwifery practice. Furthermore, the study aimed to stimulate debate and discussion about the caring behaviour of midwives.Objective: To explore caring during clinical practice as perceived and experienced by midwives.Method: The study was contextual, exploratory and qualitative. The participants were midwives working in state and private hospitals in Tshwane,South Africa where BTech II and III midwifery learners were allocated for work integrated learning (WIL. Data collection was carried out through self-report using a questionnaire and focus group. Questionnaires were distributed to 40 midwives at private and state hospitals in Tshwane. This was followed by two focus group sessions to ensure that data is enriched. The hermeneutic interpretive approach was used to analyse data, and analysis continued until saturation.Results: Themes of caring and uncaring related to patient care and midwives emerged. Thefindings illustrated that the midwives had excellent theoretical knowledge of caring, but someof them did not display caring behaviour during clinical practice.Conclusion: Some of the midwives did not display caring behaviour. Implication for practicewas provided based on the research findings. Recommendations included measures of improving caring behaviours during midwifery practice.

  1. Working with a palliative care team.

    Science.gov (United States)

    Wiebe, Lauren A; Von Roenn, Jamie H

    2010-01-01

    The interdisciplinary team is fundamental to the successful delivery of quality palliative care. Ideally, the oncologist is an integral part of either the palliative care or hospice team and serves to maintain continuity of care through the end of life. In the United States, barriers can complicate the oncologist's easy integration into the hospice team as patients often remain at home. Also, there may be philosophical or clinical practice differences between oncology and palliative care at first glance. This article focuses on ways to overcome these potential obstacles and use differences in training to strengthen the team's impact. A significant part of oncology practice includes managing difficult symptoms, mitigating suffering, and discussing priorities of care--all elements of palliative medicine that oncologists perform daily. Participating on a palliative care team may be natural for oncologists, and some might elect to provide integrated palliative cancer care for patients throughout the course of their disease and at the end of life. Thus, there is a need to enrich the general oncologist's knowledge of specialized palliative medicine, as recommended by the major cancer organizations, including the American Society of Clinical Oncology and the European Society of Medical Oncology.It is important to know when to incorporate a palliative or hospice care team into the routine management of a cancer patient and what benefits these referrals can provide. Oncologists have an obligation to provide high-quality palliative care to all patients in an integrated fashion, including patients with advanced cancer enrolled in clinical trials for early therapeutics.

  2. Evidence-based models of care for people with epilepsy.

    LENUS (Irish Health Repository)

    Fitzsimons, Mary

    2012-02-01

    Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

  3. Applying activity-based costing in long-term care.

    Science.gov (United States)

    Wodchis, W P

    1998-01-01

    As greater numbers of the elderly use health services, and as health care costs climb, effective financial tracking is essential. Cost management in health care can benefit if costs are linked to the care activities where they are incurred. Activity-based costing (ABC) provides a useful approach. The framework aligns costs (inputs), through activities (process), to outputs and outcomes. It allocates costs based on client care needs rather than management structure. The ABC framework was tested in a residential care facility and in supportive housing apartments. The results demonstrate the feasibility and advantages of ABC for long term care agencies, including community-based care.

  4. Regulatory requirements for providing adequate veterinary care to research animals.

    Science.gov (United States)

    Pinson, David M

    2013-09-01

    Provision of adequate veterinary care is a required component of animal care and use programs in the United States. Program participants other than veterinarians, including non-medically trained research personnel and technicians, also provide veterinary care to animals, and administrators are responsible for assuring compliance with federal mandates regarding adequate veterinary care. All program participants therefore should understand the regulatory requirements for providing such care. The author provides a training primer on the US regulatory requirements for the provision of veterinary care to research animals. Understanding the legal basis and conditions of a program of veterinary care will help program participants to meet the requirements advanced in the laws and policies.

  5. Taking Care After A Concussion

    Centers for Disease Control (CDC) Podcasts

    2010-03-17

    This podcast describes how to take care of yourself after a concussion, including proper recognition and response recommendations.  Created: 3/17/2010 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 3/17/2010.

  6. Phytotherapy in primary health care

    Science.gov (United States)

    Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio

    2014-01-01

    OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949

  7. Home Health Care: What It Is and What to Expect

    Science.gov (United States)

    ... care you get in a hospital or skilled nursing facility (SNF). Examples of skilled home health services include: Wound care for pressure sores or a surgical wound Patient and caregiver education Intravenous or nutrition ...

  8. The Affordable Care Act and integrated care.

    Science.gov (United States)

    Kuramoto, Ford

    2014-01-01

    The Patient Protection and Affordable Care Act (ACA) of 2010 offers a comprehensive, integrated health insurance reform program for those who are eligible to enroll. A core feature of the ACA is the integration of primary health, behavioral health, and related services in a new national program for the first time. This article traces the history of past federal services integration efforts and identify varying approaches for implementing them to improve care, especially for underserved populations. The business case for integrated care, reducing escalating health care costs and overcoming barriers to implementation, is also discussed.

  9. Designing Robots for Care: Care Centered Value-Sensitive Design

    OpenAIRE

    2012-01-01

    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What’s more, given the stage of their develo...

  10. Anal Health Care Basics.

    Science.gov (United States)

    Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar

    2016-01-01

    Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.

  11. Anal Health Care Basics

    Science.gov (United States)

    Chang, Jason; McLemore, Elisabeth; Tejirian, Talar

    2016-01-01

    Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy. The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate. Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area. Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases. In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists. PMID:27723447

  12. Kidney stones - self-care

    Science.gov (United States)

    ... self-care; Nephrolithiasis and self-care; Stones and kidney - self-care; Calcium stones and self-care; Oxalate ... provider or the hospital because you have a kidney stone. You will need to take self-care ...

  13. Genital herpes - self-care

    Science.gov (United States)

    Herpes - genital -self-care; Herpes simplex - genital - self-care; Herpesvirus 2 - self-care; HSV-2 - self-care ... genital herpes can be treated. Follow your health care provider's instructions for treatment and follow-up.

  14. Family-Centered Care in Neonatal Intensive Care Unit: A Concept Analysis

    Science.gov (United States)

    Ramezani, Tahereh; Hadian Shirazi, Zahra; Sabet Sarvestani, Raheleh; Moattari, Marzieh

    2014-01-01

    Background: The concept of family- centered care in neonatal intensive care unit has changed drastically in protracted years and has been used in various contexts differently. Since we require clarity in our understanding, we aimed to analyze this concept. Methods: This study was done on the basis of developmental approach of Rodgers’s concept analysis. We reviewed the existing literature in Science direct, PubMed, Google Scholar, Scopus, and Iran Medex databases from 1980 to 2012. The keywords were family-centered care, family-oriented care, and neonatal intensive care unit. After all, 59 out of 244 English and Persian articles and books (more than 20%) were selected. Results: The attributes of family-centered care in neonatal intensive care unit were recognized as care taking of family (assessment of family and its needs, providing family needs), equal family participation (participation in care planning, decision making, and providing care from routine to special ones), collaboration (inter-professional collaboration with family, family involvement in regulating and implementing care plans), regarding family’s respect and dignity (importance of families’ differences, recognizing families’ tendencies), and knowledge transformation (information sharing between healthcare workers and family, complete information sharing according to family learning style). Besides, the recognized antecedents were professional and management-organizational factors. Finally, the consequences included benefits related to neonate, family, and organization. Conclusion: The findings revealed that family centered-care was a comprehensive and holistic caring approach in neonatal intensive care. Therefore, it is highly recommended to change the current care approach and philosophy and provide facilities for conducting family-centered care in neonatal intensive care unit.  PMID:25349870

  15. 28 CFR 20.32 - Includable offenses.

    Science.gov (United States)

    2010-07-01

    ...., drunkenness, vagrancy, disturbing the peace, curfew violation, loitering, false fire alarm, non-specific charges of suspicion or investigation, and traffic violations (except data will be included on arrests...

  16. Births and deaths including fetal deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

  17. Lung Disease Including Asthma and Adult Vaccination

    Science.gov (United States)

    ... Healthcare Professionals Lung Disease including Asthma and Adult Vaccination Language: English Español (Spanish) Recommend on Facebook Tweet ... more about health insurance options. Learn about adult vaccination and other health conditions Asplenia Diabetes Heart Disease, ...

  18. Including Indigenous Minorities in Decision-Making

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene

    Based on theories of public sphere participation and deliberative democracy, this book presents empirical results from a study of experiences with including Aboriginal and Maori groups in political decision-making in respectively Western Australia and New Zealand......Based on theories of public sphere participation and deliberative democracy, this book presents empirical results from a study of experiences with including Aboriginal and Maori groups in political decision-making in respectively Western Australia and New Zealand...

  19. Day Care Services: Industry's Involvement. Bulletin 296.

    Science.gov (United States)

    Besner, Arthur

    This bulletin provides an overview of the need for services for the children of working mothers. Topics discussed include historical developments in industry day care programs, alternative roles for industry involvement, costs of operating day care centers, and income tax allowances. Also given are examples of unique programs which suggest various…

  20. Suicidal ideation in German primary care

    NARCIS (Netherlands)

    Wiborg, J.F.; Gieseler, D.; Lowe, B.

    2013-01-01

    OBJECTIVE: To examine suicidal ideation in a sample of German primary care patients. METHODS: We conducted a cross-sectional study and included 1455 primary care patients who visited 1 of 41 general practitioners (GPs) working at 19 different sites. Suicidal ideation and psychopathology were assesse

  1. Special Issue: The Family and Health Care.

    Science.gov (United States)

    Doherty, William J., Ed.; McCubbin, Hamilton I., Ed.

    1985-01-01

    Discusses research and interventions related to family health care. Topics include health promotion; risk behaviors; vulnerability and illness onset; choosing health care systems; stress; caregiving and coping; family counseling; and family responses to Alzheimer's Disease, pediatric cancer, cystic fibrosis, diabetes, and obesity. (JAC)

  2. An Integrated Biochemistry Laboratory, Including Molecular Modeling

    Science.gov (United States)

    Hall, Adele J. Wolfson Mona L.; Branham, Thomas R.

    1996-11-01

    The dilemma of designing an advanced undergraduate laboratory lies in the desire to teach and reinforce basic principles and techniques while at the same time exposing students to the excitement of research. We report here on a one-semester, project-based biochemistry laboratory that combines the best features of a cookbook approach (high success rate, achievement of defined goals) with those of an investigative, discovery-based approach (student involvement in the experimental design, excitement of real research). Individual modules may be selected and combined to meet the needs of different courses and different institutions. The central theme of this lab is protein purification and design. This laboratory accompanies the first semester of biochemistry (Structure and Function of Macromolecules, a course taken mainly by junior and senior chemistry and biological chemistry majors). The protein chosen as the object of study is the enzyme lysozyme, which is utilized in all projects. It is suitable for a student lab because it is easily and inexpensively obtained from egg white and is extremely stable, and its high isoelectric point (pI = 11) allows for efficient separation from other proteins by ion-exchange chromatography. Furthermore, a literature search conducted by the resourceful student reveals a wealth of information, since lysozyme has been the subject of numerous studies. It was the first enzyme whose structure was determined by crystallography (1). Hendrickson et al. (2) have previously described an intensive one-month laboratory course centered around lysozyme, although their emphasis is on protein stability rather than purification and engineering. Lysozyme continues to be the focus of much exciting new work on protein folding and dynamics, structure and activity (3 - 5). This lab course includes the following features: (i) reinforcement of basic techniques, such as preparation of buffers, simple enzyme kinetics, and absorption spectroscopy; (ii

  3. Gerodontology - Orodental care for elderly

    OpenAIRE

    Vinay Kumar Bhardwaj

    2012-01-01

    Changing demographics, including an increase in life expectancy and the growing numbers of elderly, has recently focused attention on the need for geriatric dental care. Ageing affects oral tissues in addition to other parts of the human body, and oral health (including oral mucosa, lips, teeth and associated structures, and their functional activity) is an integral component of general health. Oral disease can cause pain, difficulty in speaking, mastication, swallowing, maintaining a balance...

  4. Teamwork in health care.

    Science.gov (United States)

    Landman, Natalie; Aannestad, Liv K; Smoldt, Robert K; Cortese, Denis A

    2014-01-01

    It is becoming increasingly clear that maintaining and improving the health of the population, and doing so in a financially sustainable manner, requires the coordination of acute medical care with long-term care, and social support services, that is, team-based care. Despite a growing body of evidence on the benefits of team-based care, the health care ecosystem remains "resistant" to a broader implementation of such care models. This resistance is a function of both system-wide and organizational barriers, which result primarily from fragmentation in reimbursement for health care services, regulatory restrictions, and the siloed nature of health professional education. To promote the broader adoption of team-based care models, the health care system must transition to pay for value reimbursement, as well as break down the educational silos and move toward team-based and value-based education of health professionals.

  5. A human rights framework for midwifery care.

    Science.gov (United States)

    Thompson, Joyce Beebe

    2004-01-01

    This article presents a rights-based model for midwifery care of women and childbearing families. Salient features include discussion of the influence of values on how women are viewed within cultures and societies, universal ethical principles applicable to health care services, and human rights based on the view of women as persons rather than as objects or chattel. Examples of the health impact on women of persistent violation of basic human rights are used to support the need for using a human rights framework for midwifery care--a model supported by codes of ethics, the midwifery philosophy of care, and standards of practice.

  6. Mental health integration: normalizing team care.

    Science.gov (United States)

    Reiss-Brennan, Brenda

    2014-01-01

    This article examines the impact of integrating mental health into primary health care. Mental Health Integration (MHI) within Intermountain Healthcare has changed the culture of primary health care by standardizing a team-based care process that includes mental health as a normal part of the routine medical encounter. Using a quantitative statistical analysis of qualitative reports (mixed methods study), the study reports on health outcomes associated with MHI for patients and staff. Researchers interviewed 59 patients and 50 staff to evaluate the impact of MHI on depression care. Patients receiving MHI reported an improved relationship with caregivers (P approach to improve outcomes.

  7. Research in cardiovascular care

    DEFF Research Database (Denmark)

    Jaarsma, Tiny; Deaton, Christi; Fitzsimmons, Donna

    2014-01-01

    To deliver optimal patient care, evidence-based care is advocated and research is needed to support health care staff of all disciplines in deciding which options to use in their daily practice. Due to the increasing complexity of cardiac care across the life span of patients combined...... of the body of knowledge that is needed to further improve cardiovascular care. In this paper, knowledge gaps in current research related to cardiovascular patient care are identified, upcoming challenges are explored and recommendations for future research are given....

  8. Care of central venous catheters in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Thomai Kollia

    2015-04-01

    Full Text Available Introduction: Central venous catheters (CVC are part of daily clinical practice, regarding treatment of critically ill patients in the Intensive Care Unit (ICU. Infections associated with CVC, are a serious cause of morbidity and mortality, thus making as a demanding need the adoption of clinical protocols for the care in ICU. Aim: The aim of this review was to explore the nursing care to prevent CVC’s infections in ICU. Method and material: The methodology followed included reviews and research studies. The studies were carried out during the period 2000-2014 and were drawn from foreign electronic databases (Pubmed, Medline, Cochrane and Greek (Iatrotek, on the nursing care of CVC, in the ICU to prevent infections. Results: The literature review showed that the right choice of dressings on the point of entry, the antiseptic treatment solution, the time for replacement infusion sets, the flushing of central venous catheter, the hand disinfection and finally the training of nursing staff, are the key points to prevent CVC’s infections in ICU. Conclusions: Education and compliance of nurses regarding the instructions of CVC's care, are the gold standard in the prevention of infections.

  9. Electric Power Monthly, August 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-11-29

    The Electric Power Monthly (EPM) presents monthly summaries of electric utility statistics at the national, Census division, and State level. The purpose of this publication is to provide energy decisionmakers with accurate and timely information that may be used in forming various perspectives on electric issues that lie ahead. Data includes generation by energy source (coal, oil, gas, hydroelectric, and nuclear); generation by region; consumption of fossil fuels for power generation; sales of electric power, cost data; and unusual occurrences. A glossary is included.

  10. [Family oriented nursing care].

    Science.gov (United States)

    Lima-Rodríguez, Joaquin Salvador; Lima-Serrano, Marta; Sáez-Bueno, Africa

    2009-01-01

    Nursing has experienced an important methodological development, in which it gives priority to the individual, although at a socioeconomic level a marked interest is seen in the health care of the family unit and the NANDA (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification) and NOC (Nursing Outcomes Classification) nursing guidelines, using diagnoses, criteria of results and interventions orientated towards this aim. We consider to the family as an opened system consisted of human elements, with a common history, which they form a functional unit been ruled by own procedure. In this paper we look at those aspects that must be taken into account in nursing assessment of families from a systemic perspective, including some tools for data collection and analysis of information. In addition, we identify specific areas of intervention. We believe that the family must be studied from a nursing care point of view with its own characteristics as opposed to those possessed individually by each of its members. We also believe that, when assessment is centred on the Henderson unaided activities study or the Gordon functional health patterns, they are not useful in assessing the family unit. This work offers an assessment method centred on the family unit, which helps to identify the nursing diagnoses applicable to it. Our proposal, which has been successfully used by nursing students over the last few years, hopes to contribute to quality clinical practice with a tool orientated towards the family.

  11. Personal Care in Learning Health Care Systems.

    Science.gov (United States)

    Miller, Franklin G; Kim, Scott Y H

    2015-12-01

    The idea of a "learning health care system"--one that systematically integrates clinical research with medical care--has received considerable attention recently. Some commentators argue that under certain conditions pragmatic comparative effectiveness randomized trials can be conducted ethically within the context of a learning health care system without the informed consent of patients for research participation. In this article, we challenge this perspective and contend that conducting randomized trials of individual treatment options without consent is neither necessary nor desirable to promote and sustain learning health care systems. Our argument draws on the normative conception of personal care developed by Charles Fried in a landmark 1974 book on the ethics of randomized controlled trials.

  12. Challenges for IT-supported shared care

    DEFF Research Database (Denmark)

    Granlien, Maren Fich; Simonsen, Jesper

    2007-01-01

    Purpose: To investigate the circumstances as to why it is so difficult in the primary care sector to implement IT based infrastructures supporting shared care. Case study: The qualitative analysis includes two separate case studies of IT-supported shared care implemented in two different regions...... of Denmark throughout 2005. The study comprises 21 interviews and 35 hours of observations. The data were analysed through a coding process that led to the emergence of three main challenges impeding the organisational implementation of IT-supported shared care. Discussion and conclusion: The two cases faced...... the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general...

  13. Barriers to emergency obstetric care services

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique

    2014-01-01

    Introduction: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore...... decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay...... was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Conclusion: Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching...

  14. Navigating the field of temporally framed care in the Danish home care sector.

    Science.gov (United States)

    Tufte, Pernille; Dahl, Hanne Marlene

    2016-01-01

    The organisational and temporal framing of elderly care in Europe has changed in the wake of new public management reforms and standardised care services, the strict measurement of time and work schedules have become central aspects of care work. The article investigates the crafting of care in this framing: how care workers approach the services specified in their rotas and navigate between needs, demands and opportunities in the daily performance of duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two Danish municipalities. Data are derived predominantly from participant observation. The article identifies two overarching temporal dilemmas in different home care situations: one where process time prevails over clock time and another where the care workers balance the two. Focusing on how care workers respond to these dilemmas in practice, the article identifies various navigation tactics, including leaving time outside, individualised routinisation, working on different paths simultaneously and postponing tasks. By assessing care workers' performance in the temporal framing of work and focusing on care workers' mediation between different time logics, this study provides an in-depth perspective on the broader feminist literature on the dilemmas of care.

  15. Preserving community in health care.

    Science.gov (United States)

    Emanuel, E J; Emanuel, L L

    1997-02-01

    There are two prominent trends in health care today: first, increasing demands for accountabilty, and second, increasing provision of care through managed care organizations. These trends promote the question: What form of account-ability is appropriate to managed care plans? Accountability is the process by which a party justifies its actions and policies. Components of accountability include parties that can be held or hold others accountable, domains and content areas being assessed, and procedures of assessment. Traditionally, the professional model of accountability has operated in medical care. In this model, physicians establish the standards of accountability and hold each other accountable through professional organizations. This form of accountability seems outdated and inapplicable to managed care plans. The alternatives are the economic and the political models of accountability. In the economic model, medicine becomes more like a commodity, and "exit" (consumers changing providers for reasons of cost and quality) is the dominant procedure of accountability. In the political model, medicine becomes more like a community good, and "voice" (citizens communicating their views in public forums or on policy committees, or in elections for representatives) is the dominant procedure of accountability. The economic model's advantages affirm American individualism, make minimal demands on consumers, and use a powerful incentive, money. Its disadvantages undermine health care as a nonmarket good, undermine individual autonomy, undermine good medical practice, impose significant demands on consumers to be informed, sustain differentials of power, and use indirect procedures of accountability. The political model's advantages affirm health care as a matter of justice, permit selecting domains other than price and quality for accountability, reinforce good medical practice, and equalize power between patients and physicians. Its disadvantages include inefficiency in

  16. Chiropractic care and public health

    DEFF Research Database (Denmark)

    Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre

    2012-01-01

    through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries...... in children? What ways can doctors of chiropractic stay updated on evidence-based information about vaccines and immunization throughout the lifespan? Can smoking cessation be a prevention strategy for back pain? Does chiropractic have relevance within the VA Health Care System for chronic pain and comorbid...... to public health? What public health roles can chiropractic interns perform for underserved communities in a collaborative environment? Can the chiropractic profession contribute to community health? What opportunities do doctors of chiropractic have to be involved in health care reform in the areas...

  17. Rural migration and health care

    DEFF Research Database (Denmark)

    Svendsen, Gunnar Lind Haase; Jensen, Marit Vatn

    This literature study focuses on possible links between access to health services and migration in rural areas. Why do people move to or from rural areas or why do they stay? What determines where people settle? And, in this context, do local health care services play an important or minor role......, or no role at all? First, the paper reports on key findings from rural migration studies, in order to shed light on two migration trends: urbanization and counter-urbanization. Then we take a closer look on settlement preferences in rural areas, including the impact of health care facilities. Finally, we end...... up with a more deepgoing review of the relatively small number of studies, which explicitly deal with settlement preferences related to access to health care....

  18. Contraceptive care for the adolescent.

    Science.gov (United States)

    Feldman, Elizabeth

    2006-06-01

    Despite recent improvements in rates of teen pregnancy, abortion, birth,and contraceptive use, effective contraceptive counseling for adolescents should be a high priority for the primary care provider in the office setting. Adolescent psychosocial risk screening and appropriate counseling about sexual decision-making is necessary. Contraceptive services visits include, relevant history, limited physical examination, provision of information, anticipatory guidance about sexual behaviors, and the provision of contraceptive methods. Teens should always be encouraged to use a male condom during sex to reduce STI risk. A variety of barrier and hormonal contraceptive methods are available for the adolescent population. Education about and provision of EC is effective in reducing the rate of unintended pregnancy and abortion in the United States. Contraceptive care for adolescents is a rewarding experience for primary care providers.

  19. Including the Excluded: One School for All.

    Science.gov (United States)

    EFA 2000 Bulletin, 1998

    1998-01-01

    This issue of "EFA 2000" focuses on the theme of inclusive education, i.e., including children with disabilities in general education classrooms. The cover story discusses a 1995 UNESCO survey of 63 countries that showed that integration of children with disabilities in regular schools is a declared policy in almost every country.…

  20. 47 CFR 65.820 - Included items.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Included items. 65.820 Section 65.820 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERSTATE RATE...) Cash working capital. The average amount of investor-supplied capital needed to provide funds for...

  1. Nuclear Chemistry: Include It in Your Curriculum.

    Science.gov (United States)

    Atwood, Charles H.; Sheline, R. K.

    1989-01-01

    Some of the topics that might be included in a nuclear chemistry section are explored. Offers radioactivity, closed shells in nuclei, energy of nuclear processes, nuclear reactions, and fission and fusion as topics of interest. Provided are ideas and examples for each. (MVL)

  2. Musculoskeletal ultrasound including definitions for ultrasonographic pathology

    DEFF Research Database (Denmark)

    Wakefield, RJ; Balint, PV; Szkudlarek, Marcin

    2005-01-01

    Ultrasound (US) has great potential as an outcome in rheumatoid arthritis trials for detecting bone erosions, synovitis, tendon disease, and enthesopathy. It has a number of distinct advantages over magnetic resonance imaging, including good patient tolerability and ability to scan multiple joint...

  3. An acoustic finite element including viscothermal effects

    NARCIS (Netherlands)

    Nijhof, M.J.J.; Wijnant, Y.H.; Boer, de A.

    2007-01-01

    In acoustics it is generally assumed that viscous- en thermal boundary layer effects play a minor role in the propagation of sound waves. Hence, these effects are neglected in the basic set of equations describing the sound field. However, for geometries that include small confinements of air or thi

  4. Numerical simulation of spark ignition including ionization

    NARCIS (Netherlands)

    Thiele, M; Selle, S; Riedel, U; Warnatz, J; Maas, U

    2000-01-01

    A detailed understanding of the processes associated Midi spark ignition, as a first step during combustion, is of great importance fur clean operation of spark ignition engines. In the past 10 years. a growing concern for environmental protection, including low emission of pollutants, has increased

  5. FastStats: Home Health Care

    Science.gov (United States)

    ... Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap Tests Disability ... Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  6. Adherence and health care costs

    Directory of Open Access Journals (Sweden)

    Iuga AO

    2014-02-01

    Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

  7. Shifting boundaries in professional care.

    Science.gov (United States)

    Hopkins, A; Solomon, J; Abelson, J

    1996-07-01

    The nature of the work undertaken by different health professionals and inter-professional boundaries are constantly shifting. The greater knowledge of users of health care, and the increasing technical and organizational complexity of modern medicine, have partly eroded the control of health professionals over the substance of their work. The definition of a field of work as lying within the province of any one profession is culturally rather than scientifically determined. It is evident that care of good quality should be delivered at the lowest possible cost. This might include delivery of care by a less trained person than heretofore, or by someone with limited but focused training. Sharing of skills is a more sensible subject for discussion than transfer of tasks. We review a number of studies which show the effectiveness of inter-professional substitution in various care settings, and also the effectiveness of substitution by those other than health professionals. The views of users of health services on inter-professional substitution need to be considered. Health professionals and others need to work together to devise innovative ways of delivering effective health care. The legal issues need clarification.

  8. Managed care demands flexibility, creativity.

    Science.gov (United States)

    1996-05-01

    The definition of hospice care is changing as home care providers come under managed care regulations. Hospice care for AIDS patients is demanding, requiring extra time from home care providers. The managed care cost-cutting measures require creativitity and patience. The Visiting Nurses and Hospice of San Francisco (VNH) has held seminars to help providers adapt to managed care.

  9. Surgical Critical Care Initiative

    Data.gov (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  10. US EPA CARE Grants

    Data.gov (United States)

    U.S. Environmental Protection Agency — This is a provisional dataset that contains point locations for the subset of Community Action for a Renewed Environment (CARE) grants given out by the US EPA. CARE...

  11. Children's hospice care.

    Science.gov (United States)

    Armstrong-Dailey, A

    1990-01-01

    Facing the inevitable death of a child is a difficult reality for many parents and health care providers as well. Children's Hospice International offers a variety of information and education services to support the provision of children's hospice care.

  12. Does Care Matter?

    DEFF Research Database (Denmark)

    Loft, Lisbeth Trille Gylling; Hogan, Dennis P.

    2014-01-01

    employment during the first 36 weeks following a birth, and its association with experienced non-parental child care use before labor force entry. Using data from the Early Childhood Longitudinal Survey – Birth Cohort (N = 10,400 mothers), results from discrete-time hazard models show that use of non......The aim of this study is to introduce the concept of care capital and provide an example of its application in the context of child care and maternal employment using the currently most suitable American data. We define care capital as the nexus of available, accessible, and experienced resources...... for care. The American setting is an ideal context to investigate the linkages between child care capital and maternal employment as the patterns of child care use tend to be more diverse compared to other national context. In the presented application of care capital, we examine mothers’ entry to paid...

  13. [Representational structure of intensive care for professionals working in mobile intensive care units].

    Science.gov (United States)

    do Nascimento, Keyla Cristiane; Gomes, Antônio Marcos Tosoli; Erdmann, Alacoque Lorenzini

    2013-02-01

    This qualitative study was performed based on the Social Representations Theory, using a structured approach. The objective was to analyze the social representations of intensive care for professionals who work in mobile intensive care units, given the determination of the central nucleus and the peripheral system. This study included the participation of 73 health care professionals from an Emergency Mobile Care Service. Data collection was performed through free association with the inducing term care for people in a life threatening situation, and analyzed using EVOC software. It is observed that a nucleus is structured in knowledge and responsibility, while contrasting elements present lexicons such as agility, care, stress, and humanization. The representational structure revealed by participants in this study refer particularly to the functionality of intensive care, distinguishing itself by the challenges and encouragements provided to anyone working in this area.

  14. Factors affecting burnout when caring for older adults needing long-term care services in Korea.

    Science.gov (United States)

    Won, Seojin; Song, Inuk

    2012-01-01

    The purpose of this study was to address factors related to caregiver burnout as a result of caring for an older adult with a chronic disease. Characteristics of care recipients and caregivers as well as social support were included to identify the relationships with caregiver burnout. The analysis was based on a sample of 334 older adults and their caregivers in Korea. The logistic regression results indicated that the period of being in need of another's help among care-recipients, co-residence, caregivers' health condition, previous care experience, and caregivers' free time were correlated with the caregivers' future caregiving. Interestingly, the more experience caregivers had in caring for older adults, the more willing they were to provide care in the future. Thus, the discussion focuses on services for those who are new to providing care for older adults because they tend to have less coping skills.

  15. Adolf Hitler's medical care.

    Science.gov (United States)

    Doyle, D

    2005-02-01

    For the last nine years of his life Adolf Hitler, a lifelong hypochondriac had as his physician Dr Theodor Morell. Hitler's mood swings, Parkinson's disease, gastro-intestinal symptoms, skin problems and steady decline until his suicide in 1945 are documented by reliable observers and historians, and in Morell's diaries. The bizarre and unorthodox medications given to Hitler, often for undisclosed reasons, include topical cocaine, injected amphetamines, glucose, testosterone, estradiol, and corticosteroids. In addition, he was given a preparation made from a gun cleaner, a compound of strychnine and atropine, an extract of seminal vesicles, and numerous vitamins and 'tonics'. It seems possible that some of Hitler's behaviour, illnesses and suffering can be attributed to his medical care. Whether he blindly accepted such unorthodox medications or demanded them is unclear.

  16. Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema

    Science.gov (United States)

    ... Whooping Cough or Pertussis Family Life Marriage and Divorce Health Care and Insurance Access to Health Care ... Inflicted Injury Life Stages and Populations Age Groups Adolescent Health Child Health Infant Health Older Persons' Health ...

  17. [Biophysical Characterization of Biopharmaceuticals, Including Antibody Drugs].

    Science.gov (United States)

    Uchiyama, Susumu

    2016-01-01

    Biopharmaceuticals, including antibody drugs, are now popular because of their high specificity with low adverse effects, especially in the treatment of cancer and autoimmune diseases. However, because the active pharmaceutical ingredients of biopharmaceuticals are proteins, biophysical characterization of these therapeutic proteins should be required. In this manuscript, methods of chemical and physical characterization of therapeutic proteins are described. In terms of chemical characterization, analysis of chemical modifications of the constituent amino acids is explained. Physical characterization includes higher order structural analysis and assessment of protein aggregates. Quantification methods of aggregates with different sizes, recently encouraged by the U.S. Food and Drug Administration (FDA), are introduced. As for the stability of therapeutic proteins, the importance of chemical and physical stability is explained. Finally, the contribution of colloidal and structural stability to the production of an antibody drug less prone to aggregation is introduced.

  18. SKIRT: Stellar Kinematics Including Radiative Transfer

    Science.gov (United States)

    Baes, Maarten; Dejonghe, Herwig; Davies, Jonathan

    2011-09-01

    SKIRT is a radiative transfer code based on the Monte Carlo technique. The name SKIRT, acronym for Stellar Kinematics Including Radiative Transfer, reflects the original motivation for its creation: it has been developed to study the effects of dust absorption and scattering on the observed kinematics of dusty galaxies. In a second stage, the SKIRT code was extended with a module to self-consistently calculate the dust emission spectrum under the assumption of local thermal equilibrium. This LTE version of SKIRT has been used to model the dust extinction and emission of various types of galaxies, as well as circumstellar discs and clumpy tori around active galactic nuclei. A new, extended version of SKIRT code can perform efficient 3D radiative transfer calculations including a self-consistent calculation of the dust temperature distribution and the associated FIR/submm emission with a full incorporation of the emission of transiently heated grains and PAH molecules.

  19. Rotor assembly including superconducting magnetic coil

    Energy Technology Data Exchange (ETDEWEB)

    Snitchler, Gregory L. (Shrewsbury, MA); Gamble, Bruce B. (Wellesley, MA); Voccio, John P. (Somerville, MA)

    2003-01-01

    Superconducting coils and methods of manufacture include a superconductor tape wound concentrically about and disposed along an axis of the coil to define an opening having a dimension which gradually decreases, in the direction along the axis, from a first end to a second end of the coil. Each turn of the superconductor tape has a broad surface maintained substantially parallel to the axis of the coil.

  20. Electric power monthly, September 1990. [Glossary included

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-17

    The purpose of this report is to provide energy decision makers with accurate and timely information that may be used in forming various perspectives on electric issues. The power plants considered include coal, petroleum, natural gas, hydroelectric, and nuclear power plants. Data are presented for power generation, fuel consumption, fuel receipts and cost, sales of electricity, and unusual occurrences at power plants. Data are compared at the national, Census division, and state levels. 4 figs., 52 tabs. (CK)