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Sample records for care including thrombolysis

  1. The programmed nursing care for lower extremity deep venous thrombus patients receiving interventional thrombolysis: its effect on living quality

    International Nuclear Information System (INIS)

    Objective: Tu study the effect of comprehensive programmed nursing intervention on the living quality in patients with lower extremity deep venous thrombus who receive interventional thrombolysis therapy. Methods: A total of 60 patients receiving interventional thrombolysis due to lower extremity deep venous thrombus were randomly and equally divided into two groups. Patients in study group (n=30) was treated with comprehensive programmed nursing intervention in addition to the conventional therapy and routine nursing care, while patients in control group (n=30) was treated with the conventional therapy and routine nursing care only. The conventional therapy and routine nursing care included the nursing assessment before the operation, observation of the vital signs and the cooperation psychological care during the operation, the performance of medication according to the doctor's orders after the operation, etc. The comprehensive programmed nursing intervention included the nursing assessment of the patient before operation and the scientifically making of the nursing plan, which mainly referred to the cognitive behavior, the psychological care and the health education. They were systematically carried out during the perioperative period. One month after discharge the patients were asked to pay a return visit. The living quality was evaluated with relevant standards, and the results were compared between the two groups. Results: The score of living quality in the study group was significantly higher than that in the control group (P<0.01). Conclusion: The comprehensive programmed nursing intervention can significantly improve the living quality of lower extremity deep venous thrombosis patients who receive interventional thrombolysis therapy. (authors)

  2. Nursing care of catheter-directed thrombolysis therapy for acute arterial embolism of lower extremities

    International Nuclear Information System (INIS)

    Objective: To discuss the clinical effect of nursing intervention for interventional catheter-directed thrombolysis therapy in patients with acute arterial embolism of lower extremities. Methods: The experience of nursing care for 48 cases with acute arterial embolism of lower extremities which was treated with interventional catheter-directed thrombolysis was retrospectively analyzed. Results: With the help of active nursing care and rational treatment the occluded arteries were completely reopened in 40 cases and partially reopened in 8 cases. Complete relief from the clinical symptoms was obtained in 42 cases and partial remission was seen in 6 cases. Conclusion: For getting a complete recovery and improving living quality after catheter-directed thrombolysis in patients with acute arterial embolism of lower extremities, the key points are sufficient preoperative preparation, perioperative painstaking nursing care as well as postoperative correct guidance of exercise program. (authors)

  3. Nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in hemodialysis patients

    International Nuclear Information System (INIS)

    Objective: To summarize the experience of the nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in eight hemodialysis patients. Methods: After breaking thrombus through indwelling catheter, both bolus injection and micro-pump continuous infusion of urokinase was employed in eight hemodialysis patients with acute thrombosis in the arteriovenous fistula. The necessary nursing measures were carried out to assist the whole therapeutic procedure. Results: All the patients could well cooperate with the procedure of indwelling catheter thrombolysis and urokinase infusion. The reopening rate of the obstructed fistula was 100%. Conclusion: Indwelling catheter thrombolysis with urokinase infusion is a simple, effective and safe treatment for acute thrombosis in the arteriovenous fistula in hemodialysis patients. In order to obtain optimal results, necessary nursing measures must be carried out. (authors)

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

    International Nuclear Information System (INIS)

    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 cm3 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 cm3 (sensitivity 75.0 %, specificity 76.7 %). Infarct volume greater than 3 cm3 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  6. What Does Long-Term Care Include?

    Medline Plus

    Full Text Available Video: "What Does Long-Term Care Include?" Long-term care involves a variety of services designed to meet a person's health or personal care needs during a short or long period of ...

  7. Thrombolysis in vascular surgery

    OpenAIRE

    Smith, Linn

    2015-01-01

    Background and aims: Thrombolysis is in common use in the treatment of acute forms of vascular disease. It may be used both systemically and locally, in the latter case through an endovascular approach, socalled catheter-directed thrombolysis. The aims of this thesis were to investigate how thrombolysis affects performance-related outcomes pertaining to vascular patency after thrombolysis, and how it affects patient safety and the development of complications. Metho...

  8. Simulations of laser thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Chapyak, E.J.; Godwin, R.P.

    1999-03-01

    The authors have shown that bubble expansion and collapse near the interface between two materials with modest property differences produces jet-like interpenetration of the two materials. The bubble dynamics at a water-viscous fluid interface is compared with that at the interface of water with a weak elastic-plastic material. The authors find that, despite rather similar behavior during bubble growth and the initial portion of bubble collapse, the terminal jetting behavior is quite different, even in direction. The elastic-plastic properties chosen realistically represent real and surrogate thrombus. Simulations using the elastic-plastic model quantitatively agree with laboratory thrombolysis mass removal experiments. In the earlier simulations of laboratory experiments, walls have been remote so as to not effect the dynamics. Here the authors present two-dimensional simulations of thrombolysis with water over elastic-plastic surrogate thrombus in a geometry representative of the clinical situation. The calculations include thin cylindrical elastic walls with properties and dimensions appropriate for arteries. The presence of these artery walls does not substantially change the interface jetting predicted in unconfined simulations.

  9. Thrombolysis in acute ischemic stroke: a simulation study to improve pre- and in-hospital delays in community hospitals.

    Directory of Open Access Journals (Sweden)

    Maarten M H Lahr

    Full Text Available BACKGROUND: Various studies demonstrate better patient outcome and higher thrombolysis rates achieved by centralized stroke care compared to decentralized care, i.e. community hospitals. It remains largely unclear how to improve thrombolysis rate in decentralized care. The aim of this simulation study was to assess the impact of previously identified success factors in a central model on thrombolysis rates and patient outcome when implemented for a decentral model. METHODS: Based on a prospectively collected dataset of 1084 ischemic stroke patients, simulation was used to replicate current practice and estimate the effect of re-organizing decentralized stroke care to resemble a centralized model. Factors simulated included symptom onset call to help, emergency medical services transportation, and in-hospital diagnostic workup delays. Primary outcome was proportion of patients treated with thrombolysis; secondary endpoints were good functional outcome at 90 days, Onset-Treatment-Time (OTT, and OTT intervals, respectively. RESULTS: Combining all factors might increase thrombolysis rate by 7.9%, of which 6.6% ascribed to pre-hospital and 1.3% to in-hospital factors. Good functional outcome increased by 11.4%, 8.7% ascribed to pre-hospital and 2.7% to in-hospital factors. The OTT decreased 17 minutes, 7 minutes ascribed to pre-hospital and 10 minutes to in-hospital factors. An increase was observed in the proportion thrombolyzed within 1.5 hours; increasing by 14.1%, of which 5.6% ascribed to pre-hospital and 8.5% to in-hospital factors. CONCLUSIONS: Simulation technique may target opportunities for improving thrombolysis rates in acute stroke. Pre-hospital factors proved to be the most promising for improving thrombolysis rates in an implementation study.

  10. Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Sagar Badachi

    2015-01-01

    Full Text Available Background: Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance. Aim: To analyze the obstacles for thrombolysis in acute stroke patients. Materials and Methods: The study was conducted in a tertiary care center in South India. A total of hundred consecutive patients of acute ischemic stroke who were not thrombolysed, but otherwise fulfilled the criteria for thrombolysis were evaluated prospectively for various factors that prevented thrombolysis. The constraints to thrombolysis were categorized into: i Failure of patient to recognize stroke symptoms, ii patient′s awareness of thrombolysis as a treatment modality for stroke, iii failure of patient′s relative to recognize stroke, iv failure of primary care physician to recognize stroke, v transport delays, vi lack of neuroimaging and thrombolysis facility, and vii nonaffordability. Results: The biggest hurdle for early hospital presentation is failure of patients to recognize stroke (73%, followed by lack of neuroimaging facility (58%, nonaffordability (56%, failure of patient′s relative to recognize stroke (38%, failure of the primary care physician to recognize stroke (21%, and transport problems (13%. Awareness of thrombolysis as a treatment modality for stroke was seen only in 2%. Conclusion: Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for improvement to overcome various hurdles that prevent thrombolysis.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Science.gov (United States)

    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.

  13. Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients

    OpenAIRE

    Sagar Badachi; Thomas Mathew; Arvind Prabhu; Raghunandan Nadig; Gosala R. K Sarma

    2015-01-01

    Background: Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance. Aim: To analyze the obstacles for thrombolysis in acute stroke patients. Materials and Methods: The study was conducted in a tertiary care center in South India. A total of hundred consecu...

  14. Thrombolysis in Acute Ischemic Stroke : A Simulation Study to Improve Pre-and in-Hospital Delays in Community Hospitals

    NARCIS (Netherlands)

    Lahr, Maarten M.H.; van der Zee, Durk-Jouke; Vroomen, Patrick C. A. J.; Luijckx, Gert-Jan; Buskens, Erik

    2013-01-01

    Background: Various studies demonstrate better patient outcome and higher thrombolysis rates achieved by centralized stroke care compared to decentralized care, i.e. community hospitals. It remains largely unclear how to improve thrombolysis rate in decentralized care. The aim of this simulation stu

  15. Physical mechanisms of importance to laser thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Chapyak, E.J.; Godwin, R.P.

    1998-12-31

    Bubble dynamics plays a key role in many medical procedures including Laser Thrombolysis (L-T), acoustic and laser lithotripsy, interocular laser surgery, photoacoustic drug delivery, and perhaps ultrasonic imaging. The authors are investigating the effect that interfaces of different materials, especially biological and biomedical materials, have on the dynamics of nearby bubbles. Collapsing bubbles often become nonspherical, resulting in spectacular directed motion with potentially both beneficial and undesirable consequences. This directed motion may explain L-T mass removal and some types of laser-induced tissue damage.

  16. Physical mechanisms of importance to laser thrombolysis

    Science.gov (United States)

    Chapyak, Edward J.; Godwin, Robert P.

    1998-07-01

    Bubble dynamics plays a key role in many medical procedures including Laser Thrombolysis (L-T), acoustic and laser lithotripsy, interocular laser surgery, photoacoustic drug delivery, and perhaps ultrasonic imaging. We are investigating the effect that interfaces of different materials, especially biological and biomedical materials, have on the dynamics of nearby bubbles. Collapsing bubbles often become nonspherical, resulting in spectacular directed motion with potentially both beneficial and undesirable consequences. This directed motion may explain L-T mass removal and some types of laser-induced tissue damage.

  17. Efficacy and Safety Evaluation on Arterial Thrombolysis in Treating Acute Cerebral Infarction.

    Science.gov (United States)

    Shen, Baozhong; Liu, Qingan; Gu, Yingli; Wang, Yan; Zhang, Zhuobo

    2015-11-01

    The objective of this study was to evaluate the efficacy and safety of intra-arterial thrombolysis in treating acute cerebral infarction and further discuss the indications of acute cerebral infarction treatment, in order to enhance the therapeutic effects of arterial thrombolysis. The data of 164 patients with acute cerebral infarction who accepted intra-arterial thrombolysis treatment by using rt-PA or reteplase between 2009 and 2014 at the Department of Neurology of our hospital, were collected, including patients' medical history, characteristics of the onset procedure, intervals between onset and intra-arterial thrombolysis, bleeding or death, and the changing process of patient's main neurologic function after the treatment. The neurological functions including muscle strength, speech, and level of consciousness were chosen for evaluation. Through a review of cerebral angiography, we collected the digital subtraction angiography (DSA) morphological changes of blood vessels before and after arterial thrombolysis to evaluate whether those blood vessels had been reperfused. Thereafter, we analyzed and statistically processed above-mentioned data. The mean time of arterial thrombolysis was 5.7 h. DSA results were as follows: 22 patients had complete internal carotid artery (ICA) occlusion; 49 patients middle cerebral artery's (MCA's) Ml or M2 segment occlusion; 6 patients anterior cerebral artery (ACA) occlusion; 58 patients reperfusion after thrombolysis, and the recanalization rate was 76 %. Based on vertebral-basilar artery (VBA) system, 18 patients had complete occlusion, 11 patients had reperfusion after thrombolysis, and the recanalization rate was 61 %. A total of 63 patients had severe stenosis, and they had significantly improved after thrombolysis. The clinical symptoms of patients were improved: 79 out of 164 patients with paralysis had partially recovered their limb muscle strength after operation, while 33 patients had completely recovered, and

  18. 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...... with catheter-directed thrombolysis of iliofemoral deep venous thrombosis....... of a stent in this position is the treatment of choice facilitating the venous flow into an unobstructed outflow tract either from the femoral vein or the deep femoral vein or both. The stent, made of stainless steel or nitinol, has to be self-expandable and flexible with radial force to overcome...

  19. Computational modeling of laser thrombolysis for stroke treatment

    Energy Technology Data Exchange (ETDEWEB)

    Strauss, M.; Amendt, P.; London, R.A.; Maitland, D.J.; Glinsky, M.E.; Celliers, P.; Bailey, D.S.; Young, D.A.; Jacques, S.L.

    1996-02-01

    Many aspects of the physical process involved in a pulsed laser interacting with an occlusion in the intra-cranial vascular system are included in the simulation codes LATIS and LATIS3d. Laser light propagation and thermomechanical effects on the occlusion can be calculated by these codes. The hydrodynamic response uses a realistic equation of state which included melting and evaporation. Simple material strength and failure models now included in these codes are required to describe clot breakup. The goal is to ascertain the feasibility of laser thrombolysis, and to help optimize the laser parameters for such therapy. In this paper detailed numerical results for laser interaction with water is considered as an initial model for laser thrombolysis of soft blood clots which have high water content.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  3. Meeting the milestones. Strategies for including high-value care education in pulmonary and critical care fellowship training.

    Science.gov (United States)

    Courtright, Katherine R; Weinberger, Steven E; Wagner, Jason

    2015-04-01

    Physician decision making is partially responsible for the roughly 30% of U.S. healthcare expenditures that are wasted annually on low-value care. In response to both the widespread public demand for higher-quality care and the cost crisis, payers are transitioning toward value-based payment models whereby physicians are rewarded for high-value, cost-conscious care. Furthermore, to target physicians in training to practice with cost awareness, the Accreditation Council for Graduate Medical Education has created both individual objective milestones and institutional requirements to incorporate quality improvement and cost awareness into fellowship training. Subsequently, some professional medical societies have initiated high-value care educational campaigns, but the overwhelming majority target either medical students or residents in training. Currently, there are few resources available to help guide subspecialty fellowship programs to successfully design durable high-value care curricula. The resource-intensive nature of pulmonary and critical care medicine offers unique opportunities for the specialty to lead in modeling and teaching high-value care. To ensure that fellows graduate with the capability to practice high-value care, we recommend that fellowship programs focus on four major educational domains. These include fostering a value-based culture, providing a robust didactic experience, engaging trainees in process improvement projects, and encouraging scholarship. In doing so, pulmonary and critical care educators can strive to train future physicians who are prepared to provide care that is both high quality and informed by cost awareness. PMID:25714122

  4. Sequestrated Thrombolysis: Comparative Evaluation In Vivo

    International Nuclear Information System (INIS)

    Purpose: Lysis of a thrombus is a function of the local concentration of thrombolytic enzymes. This study was designed to determine in a porcine model of acute deep vein thrombosis (DVT) whether perithrombic sequestration of small volumes of a concentrated enzyme solution can accelerate the process of thrombolysis.Methods: DVT was induced in both hind limbs using a previously described technique (n = 32). Thirty minutes later the animal was heparinized and unilateral thrombolysis was attempted using 8 mg recombinant tissue plasminogen activator (rt-PA); saline was administered in the opposite leg. For conventional high-volume infusion (CI) (n = 5) rt-PA (0.067 mg/ml) was infused at 1 ml/min. For sequestrated thrombolysis the external iliac vein was endoluminally occluded, and rt-PA (0.25 mg/ml) administered either for proximal injection (ST-P) (n = 5), as a bolus every 3 min through a microcatheter placed via the balloon catheter, or for transthrombic injection (ST-T) (n = 5), as a bolus every 3 min through a Katzen wire in the balloon catheter. At autopsy, the thrombus mass in the iliofemoral veins was measured, and the extent of residual thrombosis in the venous tributaries graded at four sites. From these data a thrombolysis score was calculated.Results: One pig died before thrombolysis could be performed. Only with ST-T was residual thrombus mass in the test limb normalized to control, residual thrombus index (RTI), consistently less than unity. The median RTI of this group was 0.50 (range 0.39-0.97) compared with 1.22 (0.64-1.38) for ST-P and 0.88 (0.37-1.13) for CI. Compared with contralateral controls, a lower grade of residual thrombosis in tributaries was observed in test limbs at more venous sites with ST-T (8/20; 95% confidence interval 5-13) and ST-P (9/20; confidence interval 5-13) than with CI (2/20; confidence interval 0-5) (p= 0.04). A trend toward lower thrombolysis scores was observed with ST-T (p = 0.08). Systemic fibrinogenolysis was not

  5. Evaluation of interventional angioplasty by using thrombolysis and balloon dilatation in treating pulmonary embolism

    International Nuclear Information System (INIS)

    Objective: To evaluate the interventional angioplasty by using thrombolysis and balloon dilatation in the treatment of pulmonary embolism. Methods: Eight patients with pulmonary embolism were treated with interventional management including fragmentation of the thrombus, thrombolysis with urokinase flush infusion, balloon dilatation and continuing low-dose infusion for 24 hours. Anticoagulation with heparin was given simultaneously. Results: The pulmonary artery was completely recanalized in three patients, and partially recanalized in five patients. The blood oxygen saturation reached 100% in 3 cases and was over 93% in 5 cases. Conclusion: Interventional angioplasty by means of thrombolysis or balloon dilatation is an effective therapy for pulmonary embolism in reopening the embolized pulmonary artery, bringing the pulmonary hemodynamics to normal condition and correcting the hypoxemia. (authors)

  6. Isolated pharmacomechanical thrombolysis using the Trellis system

    LENUS (Irish Health Repository)

    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\

  7. Successful thrombolysis for prosthetic pulmonary valve obstruction.

    OpenAIRE

    Lopez, J. A.; Strickman, N E; Jin, B S; X. G. Li; Phan, B; Zeluff, B J; Wilansky, S

    1995-01-01

    Thrombosis is a serious complication of prosthetic heart valve operations. In recent years, systemic thrombolysis has emerged as a suitable alternative to surgery. Experience with thrombosis of pulmonary prosthetic valves is very limited. We report a case of successful administration of intravenous streptokinase for thrombosis of a St. Jude Medical prosthetic valve 3 weeks after pulmonary valve replacement.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Safe intravenous thrombolysis in acute stroke despite treatment with rivaroxaban.

    Science.gov (United States)

    Bornkamm, Katharina; Harloff, Andreas

    2014-11-01

    Data regarding intravenous thrombolysis in stroke patients receiving new oral anticoagulant drugs (nOAC) is sparse. In the near future, however, an increasing number of patients with atrial fibrillation will suffer recurrent stroke despite treatment with nOAC. This will cause a significant therapeutic dilemma as thrombolysis is contraindicated under such circumstances. We describe an 81-year-old patient presenting with acute ischemic stroke who was successfully treated with intravenous thrombolysis despite ongoing treatment with rivaroxaban. Our case report indicates that thrombolysis under nOAC may be safe under certain conditions and emphasizes the importance of establishing and performing specific anticoagulation tests for nOAC. PMID:24938385

  10. Basic ablation phenomena during laser thrombolysis

    Science.gov (United States)

    Sathyam, Ujwal S.; Shearin, Alan; Prahl, Scott A.

    1997-05-01

    This paper presents studies of microsecond ablation phenomena that take place during laser thrombolysis. The main goals were to optimize laser parameters for efficient ablation, and to investigate the ablation mechanism. Gelatin containing an absorbing dye was used as the clot model. A parametric study was performed to identify the optimal wavelength, spot size, pulse energies, and repetition rate for maximum material removal. The minimum radiant exposures to achieve ablation at any wavelength were measured. The results suggest that most visible wavelengths were equally efficient at removing material at radiant exposures above threshold. Ablation was initiated at surface temperatures just above 100 degrees Celsius. A vapor bubble was formed during ablation. Less than 5% of the total pulse energy is coupled into the bubble energy. A large part of the delivered energy is unaccounted for and is likely released partly as acoustic transients from the vapor expansion and partly wasted as heat. The current laser and delivery systems may not be able to completely remove large clot burden that is sometimes encountered in heart attacks. However, laser thrombolysis may emerge as a favored treatment for strokes where the occlusion is generally smaller and rapid recanalization is of paramount importance. A final hypothesis is that laser thrombolysis should be done at radiant exposures close to threshold to minimize any damaging effects of the bubble dynamics on the vessel wall.

  11. 78 FR 25304 - Siemens Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology), Including On...

    Science.gov (United States)

    2013-04-30

    ... services. The notice was published in the Federal Register on April 18, 2012 (75 FR 23289). At the request... 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...

  12. Nursing for the catheter thrombolysis to the deep vein and inferior vena cava thrombosis%下肢深静脉合并下腔静脉血栓导管溶栓治疗的护理

    Institute of Scientific and Technical Information of China (English)

    杨云英; 叶思欣; 杨梅

    2015-01-01

    Objective To investigate the use of catheter thrombolysis therapy to the deep vein and inferior vena cava thrombosis and summarize the nursing points. Method Eight patients (13 limbs) deep vein thrombosis with inferior vena cava thrombosis adopted the catheter thrombolysis, under this procedure we did the care including the limbs and thrombolysis, and observed the complications. Result Five patients (9 limbs) had the thrombus completely dissolved, 3 cases (4 limbs) had the partial dissolution of thrombus. Conclusion Holding limb effective position, close observation of the disease and prevention of complications are very important to improve the efficacy for the catheter thrombolysis.%目的:探讨下肢深静脉合并下腔静脉血栓导管溶栓治疗的护理要点。方法对8例(13条患肢)下肢深静脉血栓合并下腔静脉血栓患者采用导管溶栓治疗,此过程做好患肢护理、溶栓护理、病情及并发症观察。结果5例(9条患肢)血栓完全溶解,3例(4条患肢)血栓部分溶解。结论保持患肢有效体位,严密病情观察及并发症的预防,对提高下肢深静脉合并下腔静脉血栓溶栓治疗效果具有重要意义。

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  14. Reducing door to needle time for stroke thrombolysis.

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  16. 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....

  17. Integrative Therapies for Low Back Pain That Include Complementary and Alternative Medicine Care: A Systematic Review

    OpenAIRE

    Kizhakkeveettil, Anupama; Rose, Kevin; Kadar, Gena E.

    2014-01-01

    Study Design: Systematic review of the literature. Objective: To evaluate whether an integrated approach that includes different Complementary and Alternative Medicine (CAM) therapies combined or CAM therapies combined with conventional medical care is more effective for the management of low back pain (LBP) than single modalities alone. Summary of Background Data: LBP is one of the leading causes of disability worldwide, yet its optimal management is still unresolved. Methods: The PRISMA Sta...

  18. Differential diagnosis of hyperdensities on computed tomography immediately after intra-arterial thrombolysis in patients with acute ischemic stroke

    International Nuclear Information System (INIS)

    Objective: The present study was to differentiate the hyperdensities on CT immediately after intra-arterial thrombolysis in patients with acute ischemic stroke. Methods: Twenty two patients with acute ischemic stroke were treated with intra-arterial combining with intravenous thrombolysis within 6 hours after onset. All patients underwent nonenhanced CT scans before, immediately and 24 hours after thrombolytic therapy. The hyperdensities on CT after intra-arterial thrombolysis were analyzed retrospectively. Results: Five hyperdense areas were seen in 22 patients immediately after thrombolytic therapy. According to their locations, CT values and follow-up CT scans, the hyperdensities on CT imaging were classified into two groups: contrast enhancement and hemorrhagic transformation. The former was characterized by rapid clearance of the hyperdensity lesion with maximum Hounsifild Unit 90. Two of the five hyperdense lesion patients were confirmed to be contrast enhancement with location in cerebral cortex, the other were hemorrhagic transformation, mostly located in basal ganglia. Hyperdensity in patients with contrast enhancement showed neurological improvement although no further medical cares were offered. Conclusions: Different kind of hyperdensity on CT immediately after intra-arterial thrombolysis in patients with acute ischemic stroke can be differentiated according to its location, CT value and follow-up CT scan. When contrast enhancement occurred, no further medical care is needed. (authors)

  19. Experimental thrombolysis of middle cerebral artery thromboemboli

    International Nuclear Information System (INIS)

    Since the majority of ischaemic cerebral infarcts is caused by thromboemboli, we determined the benefit of firbrinolytic therapy in acute stroke. Thromboemboli were induced in the middle cerebral artery of 21 dogs. Urokinase was started at different time intervals after infarction (1, 3 and 5 hours) at a rate of 1000 IU/kg/min. Angiographically controlled thrombolysis was achieved in all 15 treated cases, whereas in the control group (n=6) no case of recanalisation was observed. Systemic fibrinolysis occurred in all cases. Postmortem examinations of the brains showed no intracerebral haemorrhages. Our findings indicate the urokinase treatment may be of value in acute ischaemic stroke. (orig.)

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

    Science.gov (United States)

    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.

  1. Thrombolysis and neuroprotection in cerebral ischemia.

    Science.gov (United States)

    Gutiérrez, M; Díez Tejedor, E; Alonso de Leciñana, M; Fuentes, B; Carceller, F; Roda, J M

    2006-01-01

    Stroke is a major cause of death and disability worldwide. The resulting burden on society grows with the increase in the incidence of stroke. The term brain attack was introduced to describe the acute presentation of stroke and emphasize the need for urgent action to remedy the situation. Though a large number of therapeutic agents, like thrombolytics, NMDA receptor antagonists, calcium channel blockers and antioxidants, have been used or are being evaluated, there is still a large gap between the benefits of these agents and the properties of an ideal drug for stroke. So far, only thrombolysis with rtPA within a 3-hour time window has been shown to improve the outcome of patients with ischemic stroke. Understanding the mechanisms of injury and neuroprotection in these diseases is important to target news sites for treating ischemia. Better evaluation of the drugs and increased similarity between the results of animal experimentation and in the clinical setting requires critical assessment of the selection of animal models and the parameters to be evaluated. Our laboratory has employed a rat embolic stroke model to investigate the combination of rtPA with citicoline as compared to monotherapy alone and investigated whether neuroprotection should be provided before or after thrombolysis in order to achieve a greater reduction of ischemic brain damage. PMID:16651822

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

    DEFF Research Database (Denmark)

    Ovesen, Christian Aavang; Christensen, Anders; 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...

  3. 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.

  4. 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.

  5. 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...

  6. 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.

  7. The cost effectiveness of integrated care for people living with HIV including antiretroviral treatment in a primary health care centre in Bujumbura, Burundi

    OpenAIRE

    Renaud, Adrien; Basenya, Olivier; De Borman, Nicolas; Greindl, Isaline; Meyer-Rath, Gesine

    2009-01-01

    The incremental cost effectiveness of an integrated care package (i.e. medical care including antiretroviral therapy and other services such as psychological and social support) for people living with HIV/AIDS was calculated in a not-for-profit primary health care centre in Bujumbura run by Society of Women Against Aids (SWAA) - Burundi, an African non-governmental organisation (NGO). Results are expressed as cost-effectiveness ratio 2007, constant US$ per Disability-Adjusted Life Year (DALY)...

  8. The cost effectiveness of integrated care for people living with HIV including antiretroviral treatment in a primary health care centre in Bujumbura, Burundi

    OpenAIRE

    2009-01-01

    Abstract The incremental cost effectiveness of an integrated care package (i.e. medical care including antiretroviral therapy and other services such as psychological and social support) for people living with HIV/AIDS was calculated in a not-for-profit primary health care centre in Bujumbura run by Society of Women Against Aids (SWAA) - Burundi, an African non-governmental organisation (NGO). Results are expressed as cost-effectiveness ratio 2007, constant US$ per Disability-Ad...

  9. The Costs and Benefits of Community Thrombolysis for Acute Myocardial Infarction: A Decision-Analytic Model

    OpenAIRE

    Luke Vale; Harvey Steffens; Cam Donaldson

    2004-01-01

    Background: There is evidence that the earlier a patient reaches hospital and receives thrombolysis, the better the outcome. The GREAT (Grampian Region Early Anistreplase Trial) directly addressed the issue of early thrombolysis by evaluating, in a randomised controlled trial, the efficacy of thrombolysis in the community compared with that administered in hospital. Objective: This paper aimed to model the cost and benefits of community compared with hospital thrombolysis from the UK NHS pers...

  10. 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

  11. Mechanisms of thrombolysis acceleration by cavitation

    Science.gov (United States)

    Weiss, Hope; Selvaraj, Prashanth; Ahadi, Golnaz; Voie, Arne; Hoelscher, Thilo; Okita, Kohei; Matsumoto, Yoichiro; Szeri, Andrew

    2012-11-01

    Recent studies, in vitro and in vivo, have shown that High Intensity Focused Ultrasound (HIFU) accelerates thrombolysis, the dissolution of blood clots, for ischemic stroke. Although the mechanisms are not fully understood, cavitation is thought to play an important role in sonothrombolysis. The damage to a blood clot's fibrin fiber network from cavitation in a HIFU field is studied using two independent approaches for an embedded bubble. One method is extended to the more important scenario of a bubble outside a blood clot that collapses asymmetrically creating a jet towards the clot. There is significantly more damage potential from a bubble undergoing cavitation collapse outside the clot compared to a rapidly expanding bubble embedded within the clot structure. Also, the effects of the physical properties of skull bone when a HIFU wave propagates through it are examined by use of computer simulation. The dynamics of a test bubble placed at the focus is used in understanding of the pressure field. All other things being equal, the analysis suggests that skull thickness can alter the wave at the focus, which in turn can change the nature of cavitation bubble dynamics and the amount of energy available for clot damage. Now at MSOE.

  12. 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

  13. Efficacy and safety of thrombolysis in patients aged 80 years or above with major acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sang-Chul Kim

    2012-01-01

    Full Text Available Background: Elderly patients with major ischemic strokes may remain severely disabled or dead. However, efficacy and safety of thrombolysis in this have not been fully explored. Materials and Methods: Data from the case records of patients aged >80 years with acute ischemic stroke with admission National Institute of Health Stroke Scale (NIHSS score ≥10 admitted between April 2009 and May 2011 were retrieved. Outcomes in patients treated with thrombolysis and control subjects were compared. Primary outcome was 3-month modified Rankin Scale (mRS score 0-2. Secondary outcomes were 3-month mRS score 0-3, mRS score 5-6, mortality, and improvement NIHHS score at discharge. Safety outcome was hemorrhagic transformation. Results: Study subjects included 22 patients treated with thrombolysis and 23 controls not treated with thrombolysis. Age, stroke severity, and proportion of identified major vessel occlusions were the variables for comparison between the two groups. More patients in the thrombolyzed group had mRS 0-2 outcome than in non-thrombolyzed group (18.2% vs. 0%; P = 0.049. Proportion of patients with mRS 0-3 outcome was also higher in thrombolyzed group than in non-thrombolyzed group (22.7% vs. 0%; P = 0.022. Patients in the thrombolyzed group had higher mortality, non-significant when compared to patients in the non-thrombolyzed group (18.2% vs. 8.7%; P = 0.414. However, lesser number of patients in the thrombolyzed group had mRS 5-6 outcome (35% vs. 65%; P = 0.075. Median improvement in NIHSS score at discharge also showed a more favorable trend in thrombolyzed group (10 vs. 2; P = 0.082. Rates of symptomatic and asymptomatic hemorrhagic transformations in thrombolyzed group were 4.5% and 27.3% respectively. Conclusion: For elderly patients with major ischemic strokes, thrombolysis offers a greater chance of functional independence.

  14. Stroke thrombolysis in New Zealand: data from the first 6 months of the New Zealand Thrombolysis Register.

    Science.gov (United States)

    Joshi, Purwa; Fink, John; Barber, Peter Alan; Davis, Alan; Lanford, Jeremy; Seymour, Andrea; Wright, Peter; Busby, Wendy; Abernethy, Ginny; Ranta, Annemarei Anna

    2016-01-01

    The New Zealand National Stroke Network introduced a National Stroke Thrombolysis Register on the first of January 2015 to assist with quality assurance and continuous service improvement. In the first 6 months, there were 179 [75 women, mean (SD) age 69.9 (14) years] treated with stroke thrombolysis out of a total of 2,796 ischaemic stroke patients, giving a national thrombolysis rate of 6.4%. The median [Inter-quartile range (IQR)] onset-to-treatment time was 154 (125-190) minutes, and the median (IQR) door-to-needle time was 74.5 (55.7-105.0) minutes. The rate of symptomatic intracranial haemorrhage following thrombolysis was 4.4%. These results are similar to other international centres, and indicate an approximate doubling of the proportion of stroke patients treated with stroke thrombolysis since a 2009 national audit. However, there is need for on-going efforts to improve treatment rates and process efficiency, particularly door-toneedle times. PMID:27447135

  15. 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.

  16. 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.

  17. 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.

  18. Determinants of outcome in patients eligible for thrombolysis for ischemic stroke

    Science.gov (United States)

    Caso, Valeria; Paciaroni, Maurizio; Venti, Michele; Palmerini, Francesco; Silvestrelli, Giorgio; Milia, Paolo; Biagini, Sergio; Agnelli, Giancarlo

    2007-01-01

    Objectives Eligibility criteria for thrombolysis in ischemic stroke have been clearly defined. However, not all eligible patients benefit from this treatment. This study aimed to assess the determinants for clinical outcome in consecutive, eligible patients with ischemic stroke treated with thrombolysis in a single-center study. Methods Consecutive patients with ischemic stroke were treated with tissue plasminogen activator (t-PA) following the established eligibility National Institute of Neurological Disorders and Stroke (NINDS) and European Stroke Initiative (EUSI) criteria. Risk factors including blood pressure and pre-treatment glycemia were properly managed. Death and disability at 3 months were the study outcomes. Disability was evaluated by the Rankin-scale. Favorable outcome was defined as 0–2 and adverse outcome as 3–6 including death. Results Seventy-eight patients were included in the study in a single stroke unit. The mean age was 70.9 ± 13.2 years (range 36–94). Follow-up at 3 months was completed in 73 patients. A favorable outcome was observed in 37 patients (50%) and adverse outcome in 36 (36%). Nine patients (12.3%) died within 3 months. The presence of an occluded carotid artery was a strong predictor for adverse outcome (p < 0.0001). A low NIH Stroke Scale-Score (NIHSS) at admission was a associated with a favorable outcome, while history of diabetes mellitus led to an unfavorable outcome. Conclusion Among patients eligible for thrombolysis, many do not benefit from this treatment. These include patients with carotid occlusion and diabetes. PMID:18078026

  19. 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.

  20. 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.

  1. 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...

  2. 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 after...

  3. 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

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

    International Nuclear Information System (INIS)

    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

  5. 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.

  6. Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Beekman Aartjan TF

    2007-03-01

    Full Text Available Abstract Background Depressive disorder is currently one of the most burdensome disorders worldwide. Evidence-based treatments for depressive disorder are already available, but these are used insufficiently, and with less positive results than possible. Earlier research in the USA has shown good results in the treatment of depressive disorder based on a collaborative care approach with Problem Solving Treatment and an antidepressant treatment algorithm, and research in the UK has also shown good results with Problem Solving Treatment. These treatment strategies may also work very well in the Netherlands too, even though health care systems differ between countries. Methods/design This study is a two-armed randomised clinical trial, with randomization on patient-level. The aim of the trial is to evaluate the treatment of depressive disorder in primary care in the Netherlands by means of an adapted collaborative care framework, including contracting and adherence-improving strategies, combined with Problem Solving Treatment and antidepressant medication according to a treatment algorithm. Forty general practices will be randomised to either the intervention group or the control group. Included will be patients who are diagnosed with moderate to severe depression, based on DSM-IV criteria, and stratified according to comorbid chronic physical illness. Patients in the intervention group will receive treatment based on the collaborative care approach, and patients in the control group will receive care as usual. Baseline measurements and follow up measures (3, 6, 9 and 12 months are assessed using questionnaires and an interview. The primary outcome measure is severity of depressive symptoms, according to the PHQ9. Secondary outcome measures are remission as measured with the PHQ9 and the IDS-SR, and cost-effectiveness measured with the TiC-P, the EQ-5D and the SF-36. Discussion In this study, an American model to enhance care for patients with a

  7. 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

  8. 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

  9. 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;

    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......Background Lung diseases are among the most frequent and most serious ailments in Denmark. Preventive health checks including spirometry can be used to detect lung diseases earlier. Over time the attendance at preventive health checks has decreased and at present the response rate is approximately...... 50%. Little is known about initiatives that can influence the attendance rate. Objectives To examine whether focused information on spirometry in the invitation material will influence the attendance in preventive health checks. Materiel/Methods Design: A randomized controlled study on information...

  10. 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

  11. 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.

  12. The application of multi-modal MRI in venous thrombolysis therapy for hyperacute cerebral arterial thrombosis

    International Nuclear Information System (INIS)

    Objective: To investigate the value of MRI in thrombolytic therapy of hyperacute cerebral arterial thrombosis. Methods: One hundred and sixteen patients with acute cerebral arterial thrombosis were recruited, plain CT and multi-modal MRI were performed in all patients. Thirty-three patients with hyperacute cerebral infarction were treated by recombinant tissue plasminogen activator(rt-PA) and followed-up periodically using MRI. Results: The 33 patients with thrombolysis selected by MRI demonstrated clinical improvement, 90 d modified Rankin scale scores (mRs) were less than 2 and life quality Barthal indexes(BI) were from 80 to 100. The complication included one asymptomatic parenchymal hematoma(PH 1) one weeks after thrombolytic therapy and 4 (12.2%) hemorrhagic infarction(HI) 6 to 24 hours after thrombolytic therapy. Conclusions: MRI has significant clinical value for the screening and follow-up of intravenous thrombolytic therapy of hyperacute ischemic stroke. MRI-based thrombolysis is a safe and effective method for hyperacute ischemic stroke. (authors)

  13. Synthetic thrombus model for in vitro studies of laser thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Hermes, R.E.; Trajkovska, K.

    1998-07-01

    Laser thrombolysis is the controlled ablation of a thrombus (blood clot) blockage in a living arterial system. Theoretical modeling of the interaction of laser light with thrombi relies on the ability to perform in vitro experiments with well characterized surrogate materials. A synthetic thrombus formulation may offer more accurate results when compared to in vivo clinical experiments. The authors describe the development of new surrogate materials based on formulations incorporating chick egg, guar gum, modified food starch, and a laser light absorbing dye. The sound speed and physical consistency of the materials were very close to porcine (arterial) and human (venous) thrombi. Photographic and videotape recordings of pulsed dye laser ablation experiments under various experimental conditions were used to evaluate the new material as compared to in vitro tests with human (venous) thrombus. The characteristics of ablation and mass removal were similar to that of real thrombi, and therefore provide a more realistic model for in vitro laser thrombolysis when compared to gelatin.

  14. Superselective ophthalmic intraarterial thrombolysis for central retinal artery thrombosis

    International Nuclear Information System (INIS)

    Objective: To investigate the effect of superselective ophthalmic artery thrombolysis for treatment of central retinal artery (CRAT). Methods: 250000-500000 u urokinase was directly perfused via ophthalmic artery (OA) through the retained superselective catheter after angiography into 8 eyes of 8 patients with CRAT. Results: The visual acuity (VA) was significantly improved in 4 eyes. the VA of 3 eyes reached 0.1-0.3 after 6 months follow-up. the other 3 eyes achieved no significant improvement of VA. The VA of 1 eye decreased from finger count (FC) to light perception (LP). Conclusions: Early diagnosis and early superselective trans-micro catheter thrombolysis would be more effective than traditional treatment. (authors)

  15. 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....

  16. Enhancement of purely ultrasound thrombolysis efficiency using a bifrequency excitation

    Science.gov (United States)

    Saletes, I.; Gilles, B.; Bera, J. C.

    2010-03-01

    It has been shown that high-intensity focused ultrasound can be an efficient method to induce thrombolysis, but the choice of the pulsed-wave parameters is critical and the risk of thermal lesions in neighbouring tissues is still an important issue. The present work aims at using a bifrequency excitation combining two neighbouring frequencies to reduce the intensity needed to achieve thombolysis without any pharmacological agent. In vitro clots of human blood are inserted in small tubes filled with physiological saline, and placed at the focus of a piezoelectric transducer. The typical clot weight before sonication is 700 mg. Ultrasound excitation consists in monofrequency (resp. bifrequency) pulsed wave at 550 kHz (resp. 535 kHz and 565 kHz), with a pulse length of 27 ms and a duty cycle of 1:10, emitted during 5 min. Efficiency of the thrombolysis is obtained weighting each clot after filtration on a 25 μm filter before and after sonication. The efficiencies of mono- and bi-frequency excitations are compared for intensities ranging from Isppa = 200 W/cm2 (Ispta = 20 W/cm2) to Isppa = 1700 W/cm2 (Ispta = 70 W/cm2). For each set of experiments, a control group of 3 non sonicated clots is used. In the conditions of the experiment, an intensity of Isppa = 1500 W/cm2 (Ispta = 150 W/cm2) is needed to achieve 80% of thrombolysis when monofrequency emission is used. With a bifrequency excitation, this intensity is reduced by 45%: the same thrombolysis efficiency is achieved with intensities of Isppa = 800 W/cm2 (Ispta = 80 W/cm2).

  17. Intravenous Thrombolysis for Embolic Stroke due to Cardiac Myxoma

    Directory of Open Access Journals (Sweden)

    Mu-Chien Sun

    2011-01-01

    Full Text Available Cardiac myxoma is a rare but curable cause of ischemic stroke. Current guidelines do not address the use of intravenous thrombolysis for embolic stroke caused by cardiac myxoma. The risk of hemorrhage due to occult tumor emboli or microaneurysms is a major concern. We describe a 45-year-old man who had an embolic stroke in the left middle cerebral artery. The initial National Institutes of Health Stroke Scale (NIHSS score was 16. He received intravenous thrombolysis 2 h and 52 min after stroke onset. No intracranial hemorrhage developed. A cardiac mass was found in the left atrium and removed surgically 84 h after stroke. Pathological study showed a myxoma with extensive hemorrhage and thrombus over the surface. At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3. Our experience with this patient supports the hypothesis that intravenous thrombolysis may be safely used in the treatment of embolic stroke due to cardiac myxoma.

  18. Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Marcos Mello Moreira

    2008-11-01

    Full Text Available Marcos Mello Moreira1, Renato G G Terzi1, Carlos Heitor N Carvalho2, Antonio Francisco de Oliveira Neto3, Mônica Corso Pereira4, Ilma Aparecida Paschoal41Department of Surgery, State University of Campinas, School of Medical Sciences; 2Department of Cardiology, State University of Campinas, School of Medical Sciences; 3Intensive Care Unit of the State University of Campinas, School of Medical Sciences; 4Department of Pulmonology, State University of Campinas, School of Medical Sciences, Campinas, BrazilAbstract: Pulmonary embolism (PE is a common condition. The central aim of this study was to describe the use of volumetric capnography (VCap before and after fibrinolytic treatment of major PE. Lung scintigraphy was used as a base of comparison for the results of this treatment. We describe the cases of two conscious and spontaneously breathing patients (20- and 24-year-old women with major PE undergoing thrombolysis. Curves of CO2 were obtained by VCap and associated with arterial blood gas analysis and D-dimer. The pattern of VCap was compared with the VCap of health volunteers. Parameters also calculated were: P(a-etCO2 gradient, alveolar dead space fraction (AVDSf , late dead space fraction (f Dlate, and slope phase III (Slp III. The VCap results before and after thrombolysis for patients 1 and 2 were, respectively, P(a-etCO2: 12.6 to 5.8 and 7.9 to 1.6 (mmHg; AVDSf: 0.46 to 0.18 and 0.25 to 0.05; fDlate: 0.46 to 0.21 and 0.24 to 0.04; Slp III: 1.75 to 5.10 and 1.21 to 5.61 (mmHg/L. Lung scintigraphy was used to compare VCap results from the two subjects with VCap results from healthy volunteers and pigs before and after treatment associated with arterial blood gas, D-dimer, and showed satisfactory agreement.Keywords: pulmonary embolism, capnography, respiratory dead space, thrombolysis, fibrin fibrinogen degradation products/fibrin fragment D

  19. 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

  20. 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

  1. 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.

  2. 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

  3. Stroke early Venous Thrombolysis in Patients with Psychological Nursing%脑卒中早期静脉溶栓患者的心理护理

    Institute of Scientific and Technical Information of China (English)

    朱喜春

    2014-01-01

    Objective To study the psychological nursing for the influence of early intravenous thrombolysis in patients with cerebral apoplexy.Methods The I branch since January 2013 to December 2013, 96 patients with acute venous thrombolysis in thrombolysis before, during and after the necessary psychological counseling and care.Results The necessary psychological nursing can eliminate the patient and family to psychological anxiety and fear, easing the burden on patients thought, sets up the treatment confidence,actively cooperate with, first aid and rehabilitation effect is remarkable.Conclusion Nursing care and psychological counseling for early intravenous thrombolysis in patients with acute cerebral apoplexy emergency treatment and rehabilitation and its important significance.%目的:探讨心理护理对脑卒中早期静脉溶栓患者的影响。方法对我科2013年1月至12月96例进行急性静脉溶栓的患者在溶栓前、中、后进行必要的心理疏导及护理。结果经过针对性的心理护理,96例患者均痊愈出院,无1例发生并发症。结论心理疏导和护理对急性脑卒中早期静脉溶栓患者的急救及康复有及其重要的意义。

  4. 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.

  5. 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

  6. Nursing of deep venous thrombosis after catheter directed thrombolysis%下肢深静脉血栓形成导管溶栓的术后护理

    Institute of Scientific and Technical Information of China (English)

    王洁; 黄庆红

    2011-01-01

    Objective To discuss the nursing of deep venous thrombosis treated with inferior vena cava filter implantation and catheter directed thrombolysis. Methods To summarize the experience of how to observe the effects and nursing 37 patients with deep venous thrombosis after inferior vena cava filter implantation with catheter directed thrombolysis. Results All these 37 patients gained effective treatment, the limb swelling subsided and there were no pulmonary embolism. Conclusion To give patients active, careful and effective nursing is important for successful treatment after they accept inferior vena cava filter implantation with catheter directed thrombolysis.%目的 探讨下腔静脉滤器置入联合导管溶栓治疗下肢深静脉血栓的护理.方法 总结37例下肢深静脉血栓形成患者置入下腔静脉滤器联合导管溶栓治疗的疗效及护理.结果 37例下腔静脉滤器置入联合导管溶栓的患者均得到有效的治疗,患肢肿胀消退,未发生肺栓塞.结论 下腔静脉滤器置入联合导管溶栓后积极、细致、有效的护理是保证治疗成功的重要环节.

  7. 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.

  8. [Pharmacogenetics of the local thrombolysis in patients with deep vein thrombosis].

    Science.gov (United States)

    Falkowski, Aleksander; Kaczmarczyk, Mariusz; Goracy, Iwona; Górecka-Szyld, Barbara; Poncyljusz, Wojciech; Parczewski, Miłosz; Ciechanowicz, Andrzej

    2005-07-01

    Thrombophilia, the state of increased tendency for blood clotting, is considered the disorder of a complex etiology, caused by both environmental and genetic factors. As gene variants predisposing to thrombophilia and influencing the increased risk of vein thrombosis might influence response to local thrombolysis, the aim of the work was to characterize the pharmacogenetic conditions for local streptokinase treatment in patients with a deep vein thrombosis (DVT) of lower extremities based on the following polymorphism analyses: G1691A polymorphism of factor V (FV), G20210A polymorphism of prothrombin (PT), A4250G (Thr312Ala) polymorphism of fibrinogen-alpha (FGA), G(-455)A polymorphism of fibrinogen-beta (FGB), 4G/5G polymorphism of plasminogen activator inhibitor type 1(PAI-1) and insertion/deletion (I/D) polymorphism of tissue plasminogen activator (t-PA). The study included 40 DVT patients who underwent a local thrombolytic treatment within 14-day period from diagnosis. Full recanalization was achieved in 20 subjects (50%) [group R(+)], whereas incomplete or total lack of recanalization was identified in the remaining 20 patients [group R(-)]. No major complications of thrombolytic treatment occurred in the studied group. In the case of prothrombin gene all individuals carried homozygous wild type genotype (GG). Prevalence of the genotypes and alleles of the remaining five polymorphisms did not differ significantly between the groups R(+) and R(-). Neither sex nor age, smoking or time period from diagnosis to introduction of the thrombolytic treatment significantly influenced treatment efficacy. The results of the study suggest that a local thrombolysis with streptokinase introduced within two week period from the diagnosis is a safe and efficient method of treatment for deep vein thrombosis of lower extremities. However, size of the group is insufficient to clearly determine the association between investigated polymorphisms and efficacy of local treatment with

  9. 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.

  10. 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%),

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Nursing Care of 4 Patients with Inferior Vena Cava Thrombosis Treated by Temporary Inferior Vena Cava Filter plus Catheter-directed Thrombolysis%4例肾静脉以上临时性腔静脉滤器植入联合导管溶栓治疗下腔静脉血栓患者的护理

    Institute of Scientific and Technical Information of China (English)

    周菊珍; 金伟飞; 蒋美; 姚碧连

    2012-01-01

    This paper summarized the nursing experience of four cases of patients with inferior vena cava thrombosis, which were treated with temporary inferior vena cava filter (IVCF) combined with catheter-directed thrombolysis. The importance of nursing went to the placement of IVCF to prevent its displacement, limb nursing and catheter-directed thrombolysis. All the laboratory indexes were under the monitoring and measures were taken for the prevention of complication of pulmonary embolism and education for discharge was conducted as well. During the treatment, bleeding in puncture point occurred in one case, displacement of catheter one case and gastrointestinal bleeding one case and after treatment, all the swelling of extremities and inferior vena cava thrombosis disappeared. IVCF was removed 3 to 4 weeks after discharge and after 3 to 38 months follow-ups, no thrombosis reoccurred.%总结4例下腔静脉血栓患者行肾静脉以上临时腔静脉滤器植入联合腔内导管溶栓治疗的护理经验.做好临时性腔静脉滤器置入的护理,严防滤器移位;做好肢体护理及导管溶栓护理;密切观察患者出血情况,监测实验室指标;预防和观察肺栓塞并发症;做好出院指导.4例患者患肢肿胀消退,下腔静脉血栓均消失,出现穿刺点出血1例,导管移位1例,消化道出血1例,经及时发现积极治疗护理,痊愈出院,术后3~4 周拔除临时滤器,随防3~38 个月无血栓复发.

  17. 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

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

    OpenAIRE

    Lekhjung Thapa; Shikher Shrestha; Pratyush Shrestha; Suman Bhattarai; D N Gongal; 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....

  19. Catheter-directed thrombolysis for the treatment of acute lower limb ischemia: report of 30 cases

    International Nuclear Information System (INIS)

    Objective: To discuss the efficacy and safety of catheter-directed thrombolysis in treating acute lower limb ischemia. Methods: During the period from October 2009 to October 2012, 30 patients with acute lower limb ischemia were admitted to authors' hospital and received catheter-directed thrombolysis. The clinical data were retrospectively analyzed. Results: Direct effective response was obtained in 24 patients. Fogarty catheter embolectomy under DSA monitoring had to be carried out in 2 patients as they failed to respond catheter-directed thrombolysis. Two patients underwent amputation as a result of irreversible limb necrosis. One patient died from acute myocardial infarction. One patient died from multiple organs dysfunction caused by the absorption of toxins from the putrid limb. Conclusion: As a kind of minimally- invasive technique for acute lower limb ischemia, catheter-directed thrombolysis is safe and effective. (authors)

  20. 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.

  1. Intra-arterial thrombolysis in acute embolic stroke

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and safety of intra-arterial thrombolysis in acute embolic stroke (AES). Methods: 21 patients with AES were undertaken urokinase or recombinated tissue plasminogen activator through percutaneous femoral intraarterial thrombolysis (IAT) as the treated group, and another 42 patients without thrombolytic treatment were assigned as the control group, which were matched to the baseline National Institutes of Health Stroke Scale (NIHSS) scores with selected gender and age. 24 h NIHSS scores, 90 d modified Rankin Scale (mRS) scores, incidences of hemorrhagic transformation (HT) and mortalities of the two groups were compared after the treatment. Results: (1) The results of cerebral angiography showed that the total re-perfusion rate was 61.90%. The middle cerebral artery (MCA), the internal carotid artery (ICA) and the basilar artery (BA) re-perfusion rates were 83.33%, 28.57% and 50.00%, respectively. (2) The NIHSS scores after 24 h were lower in the treated (IAT) group than those in the control group (12.05±5.61 vs, 14.83±4.05, P<0.05). A favorable outcome (mRS of 0-2) was more frequently observed in the 1AT group (66.67%) than that in the control group (35.71%, P<0.05). (3) There was no significant difference between the rates of HT (28.57% vs. 16.77%) and also the similar mortality rates (19.05% vs. 16.67%) not significant between the two groups. No patient died of HT in both two groups. Conclusion: IAT may be an effective treatment for AES with comparative safety. (authors)

  2. Determinants of outcome in patients eligible for thrombolysis for ischemic stroke

    OpenAIRE

    Caso, Valeria; Paciaroni, Maurizio; Venti, Michele; Palmerini, Francesco; Silvestrelli, Giorgio; Milia, Paolo; Biagini, Sergio; Agnelli, Giancarlo

    2007-01-01

    Objectives Eligibility criteria for thrombolysis in ischemic stroke have been clearly defined. However, not all eligible patients benefit from this treatment. This study aimed to assess the determinants for clinical outcome in consecutive, eligible patients with ischemic stroke treated with thrombolysis in a single-center study. Methods Consecutive patients with ischemic stroke were treated with tissue plasminogen activator (t-PA) following the established eligibility National Institute of Ne...

  3. 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)....

  4. Cytomegalovirus-associated superior mesenteric vein thrombosis treated with systemic and in-situ thrombolysis

    OpenAIRE

    Van Moerkercke, Wouter; Pauwelyn, Karen; Brugman, Eddy Maurice Paul; Verhamme, Marc

    2009-01-01

    A 56-year-old patient, first diagnosed with an acute cytomegalovirus infection, presented with progressive abdominal pain because of a superior mesenteric vein thrombosis for which he was treated with systemic thrombolysis and heparin in continuous infusion. As this therapy did not have the intended success after 5 days, an interventional radiological procedure was performed with local thrombolysis in the superior mesenteric artery resulting in recanalisation of the vein. Oral anticoagulation...

  5. 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.

  6. 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.

  7. Relationship of Early Spontaneous Type V Blood Pressure Fluctuation after Thrombolysis in Acute Cerebral Infarction Patients and the Prognosis

    OpenAIRE

    Lian Zuo; Ting Wan; Xiahong Xu; Feifeng Liu; Changsong Li; Ying Li; Yue Zhang; Jing Zhang; Huan Bao; Gang Li

    2016-01-01

    We examined the relationship between an early spontaneous type V blood pressure fluctuation and the post-thrombolysis prognosis of patients with acute cerebral infarction. Patients were admitted consecutively. All patients were categorized into the type V blood pressure fluctuation group or non-type V blood pressure group. Their blood pressure was monitored before thrombolysis and until 6 h after thrombolysis. Baseline data and clinical outcomes were compared. Of 170 patients, 43 (25.2%) had ...

  8. Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data

    OpenAIRE

    Zinkstok, S.M.; Vergouwen, M D I; Engelter, S. T.; Lyrer, P A; Bonati, L.H.; Arnold, M; Mattle, H.P.; Fischer, U; Sarikaya, H; Baumgartner, R W; Georgiadis, D; Odier, C; Michel, P.; Putaala, J; Griebenow, M

    2011-01-01

    BACKGROUND AND PURPOSE: The safety and efficacy of thrombolysis in cervical artery dissection (CAD) are controversial. The aim of this meta-analysis was to pool all individual patient data and provide a valid estimate of safety and outcome of thrombolysis in CAD. METHODS: We performed a systematic literature search on intravenous and intra-arterial thrombolysis in CAD. We calculated the rates of pooled symptomatic intracranial hemorrhage and mortality and indirectly compared them wit...

  9. 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.

  10. 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.

  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

    2016-01-01

    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 P<0.05). The incidence of postoperative PTS in the CDT group (17.9%) was significantly lower in comparison to the ST group (51.85%) during the follow-up (P=0.007). CONCLUSIONS Catheter-directed thrombolysis via the small saphenous veins is an effective, safe, and feasible approach for treating acute deep venous thrombosis. PMID:27552357

  12. Use of web services for computerized medical decision support, including infection control and antibiotic management, in the intensive care unit.

    Science.gov (United States)

    Steurbaut, Kristof; Van Hoecke, Sofie; Colpaert, Kirsten; Lamont, Kristof; Taveirne, Kristof; Depuydt, Pieter; Benoit, Dominique; Decruyenaere, Johan; De Turck, Filip

    2010-01-01

    The increasing complexity of procedures in the intensive care unit (ICU) requires complex software services, to reduce improper use of antibiotics and inappropriate therapies, and to offer earlier and more accurate detection of infections and antibiotic resistance. We investigated whether web-based software can facilitate the computerization of complex medical processes in the ICU. The COSARA application contains the following modules: Infection overview, Thorax, Microbiology, Antibiotic therapy overview, Admission cause with comorbidity and admission diagnosis, Infection linking and registration, and Feedback. After the implementation and test phase, the COSARA software was installed on a physician's office PC and then on the bedside PCs of the patients. Initial evaluation indicated that the services had been integrated easily into the daily clinical workflow of the medical staff. The use of a service oriented architecture with web service technology for the development of advanced decision support in the ICU offers several advantages over classical software design approaches. PMID:20086264

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

    Science.gov (United States)

    Bækgaard, N; Just, S; Foegh, P

    2014-05-19

    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 obstructive lesions of the iliac veins are the most important contributors. Stenting has been known for 15 to 20 years. The first publication on CDT in 1991 was combined with ballooning the iliac vein, an additive procedure which has been abandoned as an isolated procedure. This chapter will discuss selection, indication, such as an iliac compression syndrome, and outcome of iliac stenting in combination with CDT. The reported frequency of stenting used after CDT is very inconsistent, therefore this will be discussed in details. It is concluded that selection for stenting is of the greatest importance, when CDT 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. PMID:24843096

  14. 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.

  15. 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…

  16. 急性脑梗死早期溶栓的观察与护理%Early Thrombolysis in Acute Cerebral Infarction and Nursing

    Institute of Scientific and Technical Information of China (English)

    杨境云

    2015-01-01

    目的:探讨和评价对急性脑梗死患者早期溶栓治疗的观察体会和临床护理效果。方法选择2012年1月~2014年7月在我院接受治疗的168例急性脑梗死患者为研究对象,对这168例入院患者采用静脉滴注溶栓剂进行治疗,并进行优质护理,观察溶栓前与溶栓后的机体各项指标情况,结果所有患者在溶栓后2 h有效率为70.24%,溶栓后2~12 h为79.76%,溶栓后12~24 h为91.07%,溶栓后24~48 h为97.62%不同时间段比较具有统计学意义(P<0.05);并发胃肠道出血和头痛呕吐患者各2例,占总人数的2.38%。结论急性脑梗死患者行早期溶栓处理,并采取优质护理,可提高血管通畅性,对减小患者死亡率、提高治愈率具有非常重要的临床意义,值得进一步推广。%Objective January 2012~July 2014 in our hospital treated 168 cases of acute cerebral infarction patients for the study,these 168 cases of hospitalized patients with intravenous thrombolytic agent for treatment,and quality care,observation before thrombolysis with various indicators of the body after thrombolysis,Results Al patients in the two hours after thrombolysis effective rate of 70.24%,2~12 h after thrombolysis was 79.76%,12 ~ 24h after thrombolysis was 91.07%,Compare with a 24~48 h to 97.62% in different time periods after thrombolysis significantly (P<0.05);2.38% concurrent gastrointestinal bleeding and headaches and vomiting in patients with various two cases,the total number.ConclusionPatients with acute cerebral infarction thrombolytic treatment,and take high-quality care,can improve blood vessel patency,in reducing mortality,improve the cure rate has very important clinical significance,worthy of further promotion.

  17. 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.

  18. 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.

  19. Early and Late Coronary Angiographic Changes After Thrombolysis in Acute Myocardial Infarciton

    Institute of Scientific and Technical Information of China (English)

    LU Dongfeng; Li Zhaovi; Xiong Ronggeng; Liu Shiming; Li Guoqiang; Xu Boshang; Cheng Linning

    2000-01-01

    Objective The coronary anatomic feature and development after thrombolysis in acute myocardial infarction (AMI) were studied.Mehtods 100 patients with AMI received urokinase and strepokinase. Coronary angiography (CAG) was performed at 90 minuts and again at 3 to 4 weeks.Results Successful thrombolysis occurred in 60 cases,but failed in 40. The ratio of reperfusion was 60%.CAG showed there were residual thrombi in 84 patients (84%) and complete coronary occlusion in 40(40% ).Angiography at 3 to 4 weeks after thrombolysis showed the stenosis worsened in 8 patients and improved in 10.Conclusion AMI is caused by sudden coronary thrombotic occlusion and can be repeffused by using thrombolytic agent or mechanical methods. Thrombolytic agents usually can not resolve thrombi completely. So percutaneous transluminal coronary angiography (PTCA) is recommended as an important method to improve serious residual stenosis.

  20. Impact of resuscitation and thrombolysis on mortality rate from acute myocardial infarction.

    Science.gov (United States)

    Trent, R; Adams, J; Jennings, K; Rawles, J

    1995-03-24

    Our objective was to estimate the saving of life by thrombolysis and resuscitation in acute myocardial infarction (AMI) before and after hospital admission. We studied all 1516 patients admitted to a Scottish teaching hospital in 1990 and 1992 who had a final diagnosis of AMI, and 311 patients enrolled in the Grampian region early anistreplase trial (GREAT). Cardiac arrest occurred in 250/1516 (16%) hospital patients. Of these, 77 (31%) were discharged alive--a saving of 51 lives per thousand cases. 797 (53%) patients received thrombolysis, of whom 114 (14%) died. Assuming the same relative reduction in mortality as in the second international study of infarct survival (ISIS-2; 23%), 34 lives were saved by thrombolytic therapy, representing 22 lives per thousand cases. Of 311 patients in GREAT, 15 (5%) had prehospital cardiac arrest, with 7 patients surviving to discharge (48%)--a saving of 23 lives per thousand cases. Those patients given domiciliary thrombolysis had a one month mortality of 6.7% (11/163) compared with 12.2% (18/148) for those receiving hospital thrombolysis--a saving of 55 lives per thousand cases for prehospital thrombolysis. This is additional to 28 lives per thousand estimated for thrombolytic therapy in hospital, totalling 83 lives saved per thousand cases of AMI receiving thrombolytic therapy prehospital. In hospital, more lives were saved by resuscitation than by thrombolytic therapy, but this ratio was reversed in the period before hospital admission. These results emphasise the paramount importance of resuscitation in hospital, and the enhanced efficacy of thrombolysis when given at the earliest opportunity. PMID:7607764

  1. 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...

  2. 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....

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Obstacles to implementing evidence-based practice in Belgium: a context-specific qualitative evidence synthesis including findings from different health care disciplines.

    Science.gov (United States)

    Hannes, K; Goedhuys, J; Aertgeerts, B

    2012-01-01

    A number of barriers to the implementation of evidence-based practice have already been inventoried. However, little attention has been given to their context-specific nature. This qualitative evidence synthesis examines commonalities in the obstacles perceived by different groups of health care practitioners working in the Belgian health care system and sets out to discuss potential strategies to bridge some of these barriers. We actively searched for primary studies addressing our topic of interest in international and national databases (1990 to May 2008), consulted experts and screened references of retrieved studies. We opted for the meta-aggregative approach, developed by the Joanna Briggs Institute, to analyse our findings. The findings indicate that (1) evidence might have a limited role in decision-making processes; (2) aspects other than quality of care steer the evidence-based practice agenda; (3) some health care providers benefit less from evidence-based practice than others and (4) there is a lack of competences to put the evidence-based principles in practice. Belgian policy makers might consider health care system characteristics from and strategies developed or suggested by others to respond to country-specific obstacles. Examples include but are not limited to; (a) providing incentives for patient-centred care coordination and patient communication, (b) supporting practitioners interested in applying research-related activities, (c) considering direct access systems and interprofessional learning to respond to the demand for autonomous decision-making from satellite professional groups, (d) systematically involving allied health professionals in important governmental advisory boards, (e) considering pharmaceutical companies perceived as 'the enemy' an ally in filling in research gaps, (f) embedding the evaluation of evidence-based knowledge and skills in examinations (g) moving from (in)formative learning to transformative learning and (h

  5. 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

  6. 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.

    Directory of Open Access Journals (Sweden)

    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.

  7. Relationship of Early Spontaneous Type V Blood Pressure Fluctuation after Thrombolysis in Acute Cerebral Infarction Patients and the Prognosis.

    Science.gov (United States)

    Zuo, Lian; Wan, Ting; Xu, Xiahong; Liu, Feifeng; Li, Changsong; Li, Ying; Zhang, Yue; Zhang, Jing; Bao, Huan; Li, Gang

    2016-01-01

    We examined the relationship between an early spontaneous type V blood pressure fluctuation and the post-thrombolysis prognosis of patients with acute cerebral infarction. Patients were admitted consecutively. All patients were categorized into the type V blood pressure fluctuation group or non-type V blood pressure group. Their blood pressure was monitored before thrombolysis and until 6 h after thrombolysis. Baseline data and clinical outcomes were compared. Of 170 patients, 43 (25.2%) had an early type V blood pressure fluctuation. The National Institute of Health Stroke Scale (NIHSS) score before thrombolysis and 24 h after thrombolysis, and the modified Rankin scale score at 90 days differed significantly between the two groups (P V blood pressure fluctuation is common in patients with acute cerebral infarction who received venous thrombolysis, especially if they have a higher NIHSS score before thrombolysis. The type V blood pressure fluctuation may not influence patients' prognosis; however, this needs to be confirmed in future trials. PMID:27278121

  8. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

  9. 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.

  10. Successful Medical Management of a Left Ventricular Thrombus and Aneurysm Following Failed Thrombolysis in Myocardial Infarction

    OpenAIRE

    Oyedeji, Adebayo T.; Christopher Lee; Owojori, Olukolade O.; Ajegbomogun, Olabanji J; Adeseye A Akintunde

    2013-01-01

    We report the case of a patient with an extensive anterior myocardial infarction complicated by left ventricular systolic dysfunction, left ventricular apical thrombus and an apical left ventricular aneurysm following failed thrombolysis. We obtained serial two-dimensional echocardiograms at short intervals in the acute phase and also during the months of recovery and follow up. The patient was successfully and exclusively medically managed.

  11. Sustained thrombolysis with DNA-recombinant tissue type plasminogen activator in rabbits

    International Nuclear Information System (INIS)

    Tissue type plasminogen activator (t-PA) is an effective thrombolytic agent in experimental animals. The duration of the thrombolytic effect of infused t-PA is unknown. The authors compared the duration of the thrombolytic effect of t-PA with streptokinase by measuring the lysis of 125I-fibrin-labeled thrombi in rabbit jugular veins at different times after a bolus injection of the fibrinolytic agents. The pharmacodynamics of both thrombolytic agents were determined in rabbits using a sensitive ex vivo fibrinolytic assay. Streptokinase and t-PA were given as a bolus dose of 15,000 U/kg. There was no detectable circulating fibrinolytic activity 30 minutes after the bolus dose of t-PA and 120 minutes after the bolus dose of streptokinase. The t-PA injection produced 34% thrombolysis at 30 minutes, 90% thrombolysis at 120 minutes, and 96% thrombolysis at 240 minutes. The streptokinase injection produced 17% thrombolysis at 30 minutes, 34% at 120 minutes, and 34% at 240 minutes. These observations indicate that the thrombolytic effect of t-PA is sustained beyond its time of clearance from the circulation whereas the thrombolytic effect of streptokinase closely parallels its activity in the circulation

  12. Lipid profile, statin use, and outcome after intravenous thrombolysis for acute ischaemic stroke

    NARCIS (Netherlands)

    Uyttenboogaart, M; Koch, M W; Koopman, K; Vroomen, P C; Luijckx, G J; De Keyser, J

    2008-01-01

    BACKGROUND: Low cholesterol levels have been associated with an increased risk of haemorrhagic stroke. This study investigated whether lipid levels or prior statin use influence outcome in patients with acute ischaemic stroke treated with IV thrombolysis. METHODS: The relation between admission lipi

  13. 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.

  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. 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.

  16. EFFICACY OF DELAYED RECANALIZATION AND THROMBOLYSIS ON ATRIOVENTRICULAR BLOCK IN ACUTE INFERIOR MYOCARDIAL INFARCTION

    Institute of Scientific and Technical Information of China (English)

    金炜; 何奔; 孙宝贵; 李为真; 张国兵; 周国围

    2002-01-01

    Objective To investigate the effects of delayed recanalization and thrombolysis on atrioventricular(AV) block in acute inferior myocardial infarction(AIMI).Methods A total of 212 patients, including 30 patients(group A)who underwent delayed recanalization of infarct-related artery (IRA) by PTCA within 12~18 hours after onset, 50 patients(group B) who received intravenous thrombolytic therapy within 12 hours of AIMI onset, 132 patients(group C) with AIMI who received conventional therapy, were enrolled in this study.Results In group A, the occurrence of AV block was decreased significantly (26.7% vs 6.7%, P<0.01) at 24 hours after delayed recanalization of IRA by PTCA; in group B, the occurrence rate of A-V block was also decreased significantly(24.0% vs 6.0%, P<0.01) at 24 hours after thrombolytic therapy; while in group C, 28.8% patients presented A-V block at 24 hours after admission. The occurrence of AV block was significantly lower in group A than in group C(6.7% vs 28.8%, P<0.01). Compared with group C, the inpatient mortality rate in group A was also decreased by 6.5% (3.3% vs9.8%,P>O.05).Conclusion The delayed recanalization of IRA by PTCA within 12~48 hours after the onset of AIMI can reduce the incidence of A-V block and probably decrease the in-hospital mortality rate.

  17. 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.

  18. Observation on thrombelastogram of blood coagulable states before and after Alteplase intravenous thrombolysis in patients with acute ischemic stroke%急性缺血性脑卒中患者阿替普酶静脉溶栓前后血凝状态的血栓弹力图观测

    Institute of Scientific and Technical Information of China (English)

    王自然; 崔言森; 雷红艳; 郑梅; 杨代群; 孙全余

    2015-01-01

    Objective To study the changes of blood coagulable states before and after Alteplase intravenous thromboly-sis in patients with acute ischemic stroke. Methods Forty cases of patients with acute ischemic stroke who used Al-teplase for intravenous thrombolysis were selected, the thrombelastogram before thrombolysis and 1, 3, 12 h after thrombolysis was detected. The detected parameters included R value (blood clotting response time), K value (blood co-agulation formation time), α angle (solidified angle), MA value (the most wide distance between the two sides of the curve or called maximum amplitude). Results Before thrombolysis, the R value of all patients were shortened compared with normal value, K value, α angle and MA value was normal; 1 h after thrombolysis, R, K values were increased compared with before thrombolysis; MA value and α angel was decreased, the differences were statistically significant (P0.05). Conclusion The thrombelastogram can observe the blood coagulable states before and after Alteplase intravenous thrombolysis in patients with acute ischemic stroke, which is of great importance for further clinical guiding pharmacy.%目的:研究急性缺血性脑卒中患者阿替普酶静脉溶栓前后血凝状态的变化。方法选取静脉应用阿替普酶溶栓的急性缺血性脑卒中患者40例,测定溶栓前及溶栓后1、3、12 h的血栓弹力图。测定参数包括R值(凝血反应时间)、K值(凝血形成时间)、Angle角(凝固角)、MA值(两侧曲线最宽距离或称最大振幅)。结果溶栓前所有患者R值较正常值缩短,K值、Angle角和MA值正常;溶栓后1 h,R、K值较溶栓前增加;MA值、Angel角减小,差异有统计学意义(P<0.05),溶栓后3、12 h数值基本接近于溶栓前状态,差异无统计学意义(P跃0.05)。结论血栓弹力图可以观察急性缺血性脑卒中患者阿替普酶静脉溶栓前后血凝状态的变化,对下一步临床治疗指导用药具有重要意义。

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  20. 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.

  1. Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis in a Patient with Acute Ischemic Stroke Secondary to Aortic Dissection

    OpenAIRE

    Hong, Keun-Sik; Park, So-Young; Whang, Seon-Il; Seo, So-Young; Lee, Dong-Ha; Kim, Han-Joon; Cho, Joong-Yang; Cho, Yong-Jin; Jang, Woo-Ik; Kim, Chang Young

    2008-01-01

    Background Acute ischemic stroke secondary to aortic dissection (AoD) is challenging in the era of thrombolysis owing to the diagnostic difficulty within a narrow time window and the high risk of complications. Case Report A 64-year-old woman with middle cerebral artery occlusion syndrome admitted to the emergency room within intravenous recombinant tissue plasminogen activator (rt-PA) time window. Her neurological symptoms improved during thrombolysis, but chest and abdominal pain developed....

  2. Efficacy and safety of thrombolysis in patients aged 80 years or above with major acute ischemic stroke

    OpenAIRE

    Sang-Chul Kim; Keun-Sik Hong; Yong-Jin Cho; Joong-Yang Cho; Hee-Kyung Park; Pamela Song

    2012-01-01

    Background: Elderly patients with major ischemic strokes may remain severely disabled or dead. However, efficacy and safety of thrombolysis in this have not been fully explored. Materials and Methods: Data from the case records of patients aged >80 years with acute ischemic stroke with admission National Institute of Health Stroke Scale (NIHSS) score ≥10 admitted between April 2009 and May 2011 were retrieved. Outcomes in patients treated with thrombolysis and control subjects were compared. ...

  3. 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.)

  4. 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.

  5. An embolus in the right atrium caught in the Chiari network and resistant to thrombolysis.

    Science.gov (United States)

    Zuzana, Motovska; Petr, Widimsky; Dana, Bilkova; Martin, Penicka; Hana, Linkova; Dana, Kautznerova; Miroslav, Kolesar; Ludmila, Koldová; Jan, Kvasnicka

    2010-01-01

    This case report describes a patient with thromboemboli trapped in the Chiari network within the right side of the heart and resistant to thrombolysis. The right atrial masses were completely removed under cardiopulmonary bypass. Histological evaluation confirmed a mixed thromboemboli, with thrombus structures showing signs of organisation and surrounded by a fibrous capsule. The plasma level of the plasminogen activator inhibitor type-1 (PAI-1) was 50% higher than the normal upper limit. In this presented case, the Chiari network displayed a protective function but the expansion and organisation of the thromboembolus found there made it resistant to lytic treatment. Another important factor that could have influenced the resistance to thrombolysis was the high level of PAI-1. PMID:22791494

  6. Synthetic thrombus model for in-vitro studies of laser thrombolysis

    Science.gov (United States)

    Hermes, Robert E.; Trajkovska, Keti

    1998-05-01

    Laser thrombolysis is the controlled ablation of a thrombus (blood clot) blockage in a living arterial system. Theoretical modeling of the interaction of laser light with thrombi relies on the ability to perform in vitro experiments with well characterized surrogate materials. A synthetic thrombus formulation may offer more accurate results when compared to in vivo clinical experiments. We describe here the development of new surrogate materials based on formulations incorporating chicken egg, guar gum, modified food starch, and a laser light absorbing dye. The sound speed and physical consistency of the materials were very close to porcine (arterial) and human (venous) thrombi. Photographic and videotape recordings of pulsed dye laser ablation experiments under various experimental conditions were used to evaluate the new material as compared to in vitro tests with human (venous) thrombus. The characteristics of ablation and mass removal were similar to that of real thrombi, and therefore provide a more realistic model for in vitro laser thrombolysis when compared to gelatin.

  7. 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.

  8. 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.

  9. 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...

  10. Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism, Thrombolysis, Catheter Fragmentation, and Embolectomy

    OpenAIRE

    Wiedenroth, Christoph B.; Guth, Stefan; Rolf, Andreas; Mayer, Eckhard

    2014-01-01

    A 21-year-old male patient with massive acute pulmonary embolism was treated by thrombolysis, interventional thrombus fragmentation, and surgical pulmonary embolectomy. Within the following 2 years, the patient developed progressive dyspnea at exertion. Chronic thromboembolic pulmonary hypertension was diagnosed by right-heart catheter, VQ scan, magnetic resonance, and conventional pulmonary angiography. A normalization of the patient's exercise capacity and pulmonary hemodynamics could be ac...

  11. 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.

  12. Free radical activity and left ventricular function after thrombolysis for acute infarction.

    OpenAIRE

    Davies, S. W.; Ranjadayalan, K; Wickens, D G; Dormandy, T. L.; Umachandran, V.; Timmis, A D

    1993-01-01

    BACKGROUND--Experimental data suggest that reperfusion injury involving free radicals contributes to the impairment of left ventricular function after successful thrombolysis. METHODS--In 72 patients presenting with acute myocardial infarction, markers of free radical activity were measured before streptokinase and two hours later. Thiobarbituric acid reactive material (TBA-RM) reflects lipid peroxidation by free radicals, and the concentration of plasma total thiols (34 patients) reflects ox...

  13. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

    OpenAIRE

    Gerard O’Connor; Gareth Fitzpatrick; Ayman El-Gammal; Peadar Gilligan

    2015-01-01

    More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scena...

  14. Systemic thrombolysis in anterior spinal artery syndrome: what has to be considered?

    Science.gov (United States)

    Koch, Mia; Sepp, Dominik; Prothmann, Sascha; Poppert, Holger; Seifert, Christian L

    2016-04-01

    Anterior spinal artery syndrome (ASAS) often leads to complete motor paralysis with poor clinical outcome. There is a lack of controlled clinical trials on acute treatment strategies in ASAS. However, systemic thrombolysis with recombinant tissue-plasminogen activator (rt-PA) might be a useful therapeutic option in ASAS. We report the management of a patient with ASAS below thoracic level 10, who was treated with intravenous thrombolysis. An 81 year old patient presented with flaccid paraplegia. After exclusion of aortal dissection, spinal tumour or haemorrhage, the patient was treated with intravenous rt-PA 3 h 40 min after symptom onset. The follow up magnetic resonance imaging (MRI) showed spinal infarction below thoracic segment 10. In the clinical course, the patient partially recovered lower limb muscle strength and was able to walk with assistance. To the best of our knowledge, this is the first case in the literature of ASAS with MRI-proven spinal ischemia and the application of rt-PA. Systemic thrombolysis seems to be justifiable in patients with ASAS after the rule-out of aortal dissection and spinal bleeding. PMID:26386968

  15. 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

  16. 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.)

  17. 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.

  18. 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

  19. 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.

  20. Stenting of iliac vein obstruction following catheter-directed thrombolysis in lower extremity deep vein thrombosis

    Institute of Scientific and Technical Information of China (English)

    MENG Qing-you; LI Xiao-qiang; JIANG Kun; QIAN Ai-min; SANG Hong-fei; RONG Jian-jie; DUAN Peng-fei

    2013-01-01

    Background Catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) of the lower extremity has good effect,but whether iliac vein stent placement after thrombolytic therapy is still controversial.The goal of this study was to evaluate the efficacy of stent placement in the iliac vein following CDT in lower extremity DVT.Methods This was a single-center,prospective,randomized controlled clinical trial.After receiving CDT,the major branch of the distal iliac vein was completely patent in 155 patients with lower extremity DVT,and 74 of these patients with iliac vein residual stenosis of >50% were randomly divided into a control group (n=29) and a test group (n=45).In the test group,stents were implanted in the iliac vein,whereas no stents were implanted in the control group.We evaluated the clinical indicators,including patency of the deep vein,C in CEAP classification,Venous Clinical Severity Score (VCSS),and Chronic Venous Insufficiency Questionnaire (CIVIQ) Score.Results All patients had postoperative follow-up visits for a period of 6-24 months.Venography or color ultrasound was conducted in subjects.There was a significant difference between the patency rate at the last follow-up visit (87.5% vs.29.6%) and the 1-year patency rate (86.0% vs.54.8%) between the test and control groups.The change in the C in CEAP classification pre-and post-procedure was significantly different between the test and control groups (1.61±0.21 vs.0.69±0.23).In addition,at the last follow-up visit,VCSS and CIVIQ Score were both significantly different between the test and control groups (7.57±0.27 vs.0.69±0.23; 22.67±3.01 vs.39.34±6.66,respectively).Conclusion The stenting of iliac vein obstruction following CDT in lower extremity DVT may increase the patency of the deep vein,and thus provides better efficacy and quality of life.

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

    International Nuclear Information System (INIS)

    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. Clinical importance of hyperemic coronary blood flow (thrombolysis in myocardial infarction-intravenous flow) after primary percutaneous coronary intervention.

    Science.gov (United States)

    Karakoyun, Süleyman; Tanboga, Ibrahim Halil; Kurt, Mustafa; Aksakal, Enbiya; Kaya, Ahmet; Isik, Turgay; Ekinci, Mehmet; Sevimli, Serdar; Acikel, Mahmut

    2014-10-01

    We aimed to investigate clinical, demographic and angiographic factors associated with hyperemic coronary blood flow (HCBF) and the relation of HCBF with mortality at 30 days. Our study included 809 consecutive patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention (PCI). We divided corrected thrombolysis in myocardial infarction (TIMI) frame count (TFC) values into three tertiles: less than 14, 14-28 and more than 28. Corrected TFC less than 14 was defined as HCBF or TIMI intravenous flow. The primary end-point of the present study was all-cause mortality within 30 days. Among the HCBF group (n = 58), the patients with poor myocardial perfusion demonstrated the highest mortality rate within the 30-day follow-up period (33%). Low TIMI myocardial perfusion grade, history of no smoking, left ventricular ejection fraction (LVEF), and high Killip status and low LVEF were found to be independently associated with 1-month all-cause mortality. The present study showed that HCBF after primary PCI has a high 30-day mortality when associated with impaired reperfusion. PMID:24842315

  5. 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.

  6. 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...... at Aarhus Hospital, Denmark, and from previously published literature. RESULTS: The calculated cost-effectiveness ratio after the first year was $55,591 US per quality-adjusted life-year (base case). After the second year, computation of the cost-effectiveness ratio showed that thrombolysis was cost......BACKGROUND AND PURPOSE: The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging. METHODS: A health economic model...

  7. 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.

  8. 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

  9. Successful repeated thrombolysis in a patient with HeartWare thrombosis - the importance of Doppler flow pattern.

    Science.gov (United States)

    Paluszkiewicz, Lech; Morshuis, Michiel; Hakim-Meibodi, Kavous; Ensminger, Stephan; Gummert, Jan

    2014-12-01

    Here we present a patient after implantation of a left ventricular assist device (HeartWare) for destination therapy complicated by recurrent thrombosis of the device. At 14 months after implantation, the patient presented with a pump thrombosis after an INR incompliance period. A surgical pump exchange was performed and the patient recovered uneventfully. Five months later a pump thrombosis occurred again, and the patient refused surgery. Systemic thrombolysis was carried out this time. Three and 6 months later the same clinical picture was presented again, and repeat thrombolysis was performed successfully. The patient was discharged and has remained stable since, without any symptoms of thrombosis of the device. PMID:26336463

  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. 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

  12. 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.

  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 thr...... thrombus resolution and no valvular incompetence at three months follow-up. In our opinion this treatment should be offered even in complex cases of acute proximal deep venous thrombosis Udgivelsesdato: 2008/5/19...

  14. 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.

  15. Prehospital thrombolysis perfomed by a ship's nurse with on-line physician consultation.

    Science.gov (United States)

    Väisänen, Olli; Mäkijärvi, Markku; Silfvast, Tom

    2005-02-01

    Prehospital thrombolysis for acute ST-elevation myocardial infarction (STEMI) has been shown to improve recovery from myocardial function. We describe prehospital thrombolytic treatment in two patients suffering from STEMI complicated by ventricular fibrillation (VF) on a passenger ship. The importance of a functioning Emergency Medical Service (EMS) system providing guidance for paramedical personnel is discussed briefly. Both our patients survived and returned back to normal life. It is concluded that EMS physician guided prehospital thrombolytic treatment may offer an important therapeutic option for nurses or paramedics in locations out of reach of ordinary EMS services. PMID:15680535

  16. 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.

  17. 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

  18. Thrombolysis: A Critical First-Line Therapy with an Unfulfilled Potential.

    Science.gov (United States)

    Gurewich, Victor

    2016-06-01

    A blood clot or thrombus triggers the onset of most vascular diseases, like stroke or heart attack. Thrombolysis is the only treatment that can restore blood flow rapidly and easily. Unfortunately, the standard thrombolytic, tissue plasminogen activator (tPA), has proven inadequate and is being replaced by invasive endovascular procedures, which are time consuming and limited in their availability in relation to the scope of the problem. Historically, when tPA clinical trials began, it was not recognized sufficiently that without the other natural plasminogen activator, prourokinase (proUK), thrombolysis by tPA was seriously compromised. The reason is that the 2 activators have complementary mechanisms of action in fibrinolysis, making their combination a requirement for optimal efficacy and synergy. Biological fibrinolysis also uses both activators, explaining why such low endogenous concentrations are sufficient. A low-dose sequential combination of tPA and proUK was tested in acute myocardial infarction, where it was exceptionally effective and safe. Because native proUK at pharmacological doses was vulnerable to spontaneous conversion to urokinase, jeopardizing safety, a site-directed mutant was developed that improved proUK's plasma stability fivefold without interfering with its mode of action. Mini-bolus tPA followed by low-dose proUK infusion is a simple, safe, effective, and promising first-line treatment of acute thrombotic disorders. PMID:26714208

  19. Fiberoptic observation of thrombosis and thrombolysis in isolated human coronary arteries.

    Science.gov (United States)

    Uchida, Y; Masuo, M; Tomaru, T; Kato, A; Sugimoto, T

    1986-10-01

    Coronary arteries isolated from cadavers autopsied within 7 hours after death were perfused with canine arterial blood, and the processes of thrombus formation at the segments stenosed with atheroma and the thrombolytic effects of urokinase were investigated by angioscopy. Ten minutes of blood perfusion caused thin mural thrombi localized at the stenotic or nonstenotic segments. During 30 minutes of blood perfusion, the thin mural thrombi of the outlet or inlet of the segment grew into a doughnut-shaped thrombus. Also, the thin mural thrombi in the stenotic segment grew into a streamer-like thrombus and drifted downstream. These thrombi grew in size with increasing perfusion time and finally obstructed the stenotic segment. Globular thrombi close to the outlet also were formed in a few preparations. Unlike the thrombi at the stenotic segment, the mural thrombi in the nonstenotic segments did not grow into massive thrombi. The thrombi were reduced in size within 10 minutes of perfusion with 320 U/ml or more of urokinase. During thrombolysis, sandstorm-like dispersion of the blood cells occurred, small fragments detached from the mother thrombus and flew downstream, or the fibrin core of the thrombus was exposed. The results indicate the usefulness of angioscopy for the dynamic and serial investigation of thrombosis and thrombolysis. PMID:3766368

  20. The clinical value of antiplatelet therapy for patients with hemorrhage after thrombolysis based on susceptibility-weighted imaging: A prospective pilot study

    International Nuclear Information System (INIS)

    Purpose: To evaluate treatment decision-making based on susceptibility-weighted imaging (SWI) in patients with hemorrhage after thrombolysis. Materials and methods: One hundred and forty-six patients without intracranial hemorrhage on CT after receiving recombinant tissue plasminogen activator (rt-PA) were allocated to two groups: antiplatelets (n = 72), who received antiplatelet therapy 24 h after rt-PA for 10 days; and non-antiplatelets (n = 74), who received no antiplatelet therapy. Twenty-two patients with SWI-detected microbleeds (MBs) or hemorrhagic transformation (HT) in the antiplatelets group (Group A) and 28 with MB or HT in the non-antiplatelets group (Group B) were included in this study. Results: Sixteen patients had MB and six HT in Group A; 18 had MB, six HT, and four parenchymal hemorrhage (PH) in Group B. National Institutes of Health Stroke Scale (NIHSS) scores at 7 and 14 days and the Modified Rankin Scale (mRS) at 90 days post-rt-PA were significantly lower in Group B than in Group A, duration of hospitalization was significantly shorter, and the favorable outcome rate was higher at 90 days (P < 0.05). There were no other significant differences. SWI evaluation at 14 days revealed eight patients with MB, 11 HT, and three PH in Group A; in Group B, 16 had MB, five HT, and one PH, with resolution of hemorrhage in six patients. Conclusions: Treatment decision-making based on SWI in acute stroke after thrombolysis was validated by the significantly reduced NIHSS score after 7/14 days, improved outcome, and reduced mRS in hemorrhage patients without antiplatelet therapy.

  1. The clinical value of antiplatelet therapy for patients with hemorrhage after thrombolysis based on susceptibility-weighted imaging: A prospective pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Jing; Li, Yue-Hua [Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated People' s Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai 200233 (China); Li, Yong-Dong, E-mail: liyongdong2009@tom.cm [Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated People' s Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai 200233 (China); Li, Ming-Hua; Zhao, Jun-Gong; Chen, Shi-Wen [Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated People' s Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai 200233 (China)

    2012-12-15

    Purpose: To evaluate treatment decision-making based on susceptibility-weighted imaging (SWI) in patients with hemorrhage after thrombolysis. Materials and methods: One hundred and forty-six patients without intracranial hemorrhage on CT after receiving recombinant tissue plasminogen activator (rt-PA) were allocated to two groups: antiplatelets (n = 72), who received antiplatelet therapy 24 h after rt-PA for 10 days; and non-antiplatelets (n = 74), who received no antiplatelet therapy. Twenty-two patients with SWI-detected microbleeds (MBs) or hemorrhagic transformation (HT) in the antiplatelets group (Group A) and 28 with MB or HT in the non-antiplatelets group (Group B) were included in this study. Results: Sixteen patients had MB and six HT in Group A; 18 had MB, six HT, and four parenchymal hemorrhage (PH) in Group B. National Institutes of Health Stroke Scale (NIHSS) scores at 7 and 14 days and the Modified Rankin Scale (mRS) at 90 days post-rt-PA were significantly lower in Group B than in Group A, duration of hospitalization was significantly shorter, and the favorable outcome rate was higher at 90 days (P < 0.05). There were no other significant differences. SWI evaluation at 14 days revealed eight patients with MB, 11 HT, and three PH in Group A; in Group B, 16 had MB, five HT, and one PH, with resolution of hemorrhage in six patients. Conclusions: Treatment decision-making based on SWI in acute stroke after thrombolysis was validated by the significantly reduced NIHSS score after 7/14 days, improved outcome, and reduced mRS in hemorrhage patients without antiplatelet therapy.

  2. 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

  3. 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

  4. 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...

  5. Statin use and lipid profile in relation to safety and functional outcome after thrombolysis in ischemic stroke

    NARCIS (Netherlands)

    Miedema, Irene; Uyttenboogaart, Maarten; Luijckx, Gert-Jan

    2012-01-01

    Evaluation of: Rocco A, Sykora M, Ringleb P, Diedler J. Impact of statin use and lipid profile on symptomatic intracerebral haemorrhage, outcome and mortality after intravenous thrombolysis in acute stroke. Cerebrovasc. Dis. 33(4), 362-368 (2012). Statins are widely used in the primary and secondary

  6. Acute Ischemic Stroke and Long-Term Outcome After Thrombolysis

    DEFF Research Database (Denmark)

    Schmitz, Marie Louise; Simonsen, Claus Z; Hundborg, Heidi;

    2014-01-01

    BACKGROUND AND PURPOSE: Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding......, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. METHODS: We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used...... to compute adjusted hazard ratios for all outcomes. RESULTS: Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long...

  7. 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

  8. 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.)

  9. Anticoagulation effect of low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis for acute cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However, the optimal timing and means of anticoagulation therapy remain unclear.OBJECTIVE: To observe the effects and safety of heparin treatment within 24 hours after intravenous thrombolysis for acute cerebral infarction.DESIGN: Observation experiment.SETTING: Department of Neurology, the 306 Hospital of Chinese PLA.PARTICIPANTS: Fifteen acute cerebral infarction patients complicated by moderate and severe neurologic function deficits within 6 hours after attack admitted to Department of Neurology, the 306 Hospital of Chinese PLA between January 2005 and December 2006 were recruited in this study. The involved patients,11 male and 4 female, were aged 46 - 79 years. They all met the diagnosis criteria for various cerebrovascular diseases formulated by the 4th National Conference for Cerebrovascular Disease (1995) and confirmed as cerebral infarction by skull CT or MRI imageology. Informed consents were obtained from the patients or their relatives.METHODS: On admission, patients received thrombolysis with urokinase. Immediately after thrombolysis,skull CT was rechecked. Intracranial hemorrhage signs were not found by skull CT. Hemorrhage was also not found in skin, mucous membrane and internal organs. Six hours later, low-dose low-intensity heparin 4 - 8 IU/kg per hour was intravenously administrated for anticoagulation for 7 - 10 days successively.MAIN OUTCOME MEASURES: Neurologic function was evaluated before, immediately 6 hours and 14 days after thrombolysis by scoring standard of clinical neurologic function deficit degree for stroke patients (1995). Activities of daily living of patients with stroke were evaluated 90 days after thrombolysis by modified Rankin Scale.RESULTS: Fifteen involved patients participated in the final analysis. ① Comparison of clinical neurologic function deficit degree of

  10. 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.

  11. [Intra-arterial thrombolysis of a basilar vascular accident during coronary angiography].

    Science.gov (United States)

    Battikh, K; Rihani, R; Lemahieu, J M; Mokahal, M; Houchaymi, Z; Cornaert, P; Dutoit, A

    2001-09-01

    The authors report the case of a 67 year old man with a previous history of aortobifemoral arterial graft who had unstable angina after carotid endarterectomy. Coronary angiography by the right brachial artery was complicated by a cerebrovascular accident with a reactive coma, convulsions and respiratory problems. Selective angiography of the right vertebral artery showed an image of occlusive thrombosis of the basilar artery. In view of the clinical state and angiographic appearances, the authors decided on immediate intra-arterial thrombolysis with Urokinase which dissolved the clot and reestablished flow in the basilar artery, the cerebellar and posterior cerebral arteries. The outcome was favourable with immediate and good recovery of consciousness and hospital discharge on the sixth day without neurological or radiological sequellae. Cerebrovascular accident is a rare and potentially serious complication of left heart catheterisation which requires immediate cerebral angiography to determine the mechanism and propose an appropriate therapeutic approach. PMID:11603067

  12. ASTRAL-R score predicts non-recanalisation after intravenous thrombolysis in acute ischaemic stroke.

    Science.gov (United States)

    Vanacker, Peter; Heldner, Mirjam R; Seiffge, David; Mueller, Hubertus; Eskandari, Ashraf; Traenka, Christopher; Ntaios, George; Mosimann, Pascal J; Sztajzel, Roman; Mendes Pereira, Vitor; Cras, Patrick; Engelter, Stefan; Lyrer, Philippe; Fischer, Urs; Lambrou, Dimitris; Arnold, Marcel; Michel, Patrik

    2015-05-01

    Intravenous thrombolysis (IVT) as treatment in acute ischaemic strokes may be insufficient to achieve recanalisation in certain patients. Predicting probability of non-recanalisation after IVT may have the potential to influence patient selection to more aggressive management strategies. We aimed at deriving and internally validating a predictive score for post-thrombolytic non-recanalisation, using clinical and radiological variables. In thrombolysis registries from four Swiss academic stroke centres (Lausanne, Bern, Basel and Geneva), patients were selected with large arterial occlusion on acute imaging and with repeated arterial assessment at 24 hours. Based on a logistic regression analysis, an integer-based score for each covariate of the fitted multivariate model was generated. Performance of integer-based predictive model was assessed by bootstrapping available data and cross validation (delete-d method). In 599 thrombolysed strokes, five variables were identified as independent predictors of absence of recanalisation: Acute glucose > 7 mmol/l (A), significant extracranial vessel STenosis (ST), decreased Range of visual fields (R), large Arterial occlusion (A) and decreased Level of consciousness (L). All variables were weighted 1, except for (L) which obtained 2 points based on β-coefficients on the logistic scale. ASTRAL-R scores 0, 3 and 6 corresponded to non-recanalisation probabilities of 18, 44 and 74 % respectively. Predictive ability showed AUC of 0.66 (95 %CI, 0.61-0.70) when using bootstrap and 0.66 (0.63-0.68) when using delete-d cross validation. In conclusion, the 5-item ASTRAL-R score moderately predicts non-recanalisation at 24 hours in thrombolysed ischaemic strokes. If its performance can be confirmed by external validation and its clinical usefulness can be proven, the score may influence patient selection for more aggressive revascularisation strategies in routine clinical practice. PMID:25589216

  13. A plasmin-activatable thrombin inhibitor reduces experimental thrombosis and assists experimental thrombolysis in murine models.

    Science.gov (United States)

    Sheffield, W P; Eltringham-Smith, L J; Gataiance, S; Bhakta, V

    2015-05-01

    The leech protein hirudin is a potent natural thrombin inhibitor. Its potential as an antithrombotic agent is limited by its promotion of bleeding. We attempted to modify this profile by positioning albumin and a plasmin cleavage site on its N-terminus, in recombinant protein HSACHV3 [comprising hirudin variant 3 (HV3) fused to the C-terminus of human serum albumin (HSA) via a plasmin cleavage site (C)], Previously we showed that HSACHV3 inhibited thrombin in a plasmin-dependent manner, and that, unlike HV3, it did not increase bleeding in vivo when administered to mice. Here we tested HSACHV3 for the ability to reduce thrombosis and assist enzymatic thrombolysis in animal models. Intravenous administration of HSACHV3, but not a control protein lacking the plasmin cleavage site (HSAHV3), reduced thrombus weight by 2.1-fold in the ferric chloride-injured mouse vena cava. Similarly, thrombi formed in a rabbit jugular vein stasis model were 1.7-fold lighter in animals treated with HSACHV3 compared to those receiving HSAHV3. Administration of 60 mg/kg body weight HSACHV3 prolonged the time to occlusion in the ferric chloride-injured mouse carotid artery by threefold compared to vehicle controls, while equimolar HSAHV3 had no effect. HSACHV3 had no ability to restore flow to the murine carotid arteries occluded by ferric chloride treatment, but combining HSACHV3 (60 mg/kg) with recombinant mutant tissue plasminogen activator (TNKase) significantly reduced the time to restore patency to the artery compared to TNKase alone. Unlike unfused HV3, HSACHV3 did not increase bleeding in a mouse liver laceration model. Our results show that HSACHV3 acts as an antithrombotic agent that does not promote bleeding and which speeds the time to flow restoration when used as an adjunct to pharmacological thrombolysis in animal models. PMID:25481811

  14. Transcatheter thrombolysis combined with damage control surgery for treatment of acute mesenteric venous thrombosis associated with bowel necrosis: a retrospective study

    OpenAIRE

    Liu, Kai; Meng, Jiaxiang; Yang, Shuofei; Liu, Baochen; Ding, Weiwei; Wu, Xingjiang; Li, Jieshou

    2015-01-01

    Objective This study aims to evaluate the clinical outcomes of transcatheter thrombolysis in acute superior mesenteric venous thrombosis (ASMVT) associated with bowel necrosis. Methods A retrospective study of six patients with ASMVT treated with catheter-directed thrombectomy/thrombolysis and damage control surgery at Jinling Hospital (Nanjing, China) between 2010 and 2013 was conducted. Demographics, past medical history, risk factors, therapeutic methods and effects, mortality, and follow-...

  15. Transjugular Intrahepatic Portosystemic Shunt, Mechanical Aspiration Thrombectomy, and Direct Thrombolysis in the Treatment of Acute Portal and Superior Mesenteric Vein Thrombosis

    International Nuclear Information System (INIS)

    A patient was admitted because of severe abdominal pain, anorexia, and intestinal bleeding. Contrast-enhanced multidetector computed tomography demonstrated acute portal and superior mesenteric vein thrombosis (PSMVT). The patient was treated percutaneously with transjugular intrahepatic portosystemic shunt (TIPS), mechanical aspiration thrombectomy, and direct thrombolysis, and 1 week after the procedure, complete patency of the portal and superior mesenteric veins was demonstrated. TIPS, mechanical aspiration thrombectomy, and direct thrombolysis together are promising endovascular techniques for the treatment of symptomatic acute PSMVT

  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. 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

  18. 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

  19. 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.

  20. Successful repeated thrombolysis in a patient with HeartWare thrombosis – the importance of Doppler flow pattern

    OpenAIRE

    Paluszkiewicz, Lech; Morshuis, Michiel; Hakim-Meibodi, Kavous; Ensminger, Stephan; Gummert, Jan

    2014-01-01

    Here we present a patient after implantation of a left ventricular assist device (HeartWare) for destination therapy complicated by recurrent thrombosis of the device. At 14 months after implantation, the patient presented with a pump thrombosis after an INR incompliance period. A surgical pump exchange was performed and the patient recovered uneventfully. Five months later a pump thrombosis occurred again, and the patient refused surgery. Systemic thrombolysis was carried out this time. Thre...

  1. Thrombolysis by intravenous tissue plasminogen activator (t-PA). Current status and future direction

    International Nuclear Information System (INIS)

    In Japan, the intravenous tissue plasminogen activator (t-PA) Alteplase (0.6 mg/kg) administration of the within 3 h of the onset of acute ischemic stroke was approved for therapeutic use in the year 2006. t-PA induces thrombolysis in patients with acute ischemic stroke, and this method has gradually gained recognition among physicians and the general population. However, the number of patients who were treated using Alteplase is low (4,000-5,000 patients/year), and this figure accounts for only 2-3% of the annual number of cases of ischemic stroke. There is little doubt that Alteplase treatment is a potentially effective modality for some patients with acute ischemic stroke. The post-marketing surveillance of 4,749 Japanese patients treated using Alteplase showed that 33% of the patients had modified Rankin scale (mRS) scores of 0-1, 17% of patients died and 4.5% presented with symptomatic intracerebral hemorrhage (ICH); these results were comparable to those from other countries. The expansion of the therapeutic time window has been a matter of concern. The investigators of the European Cooperative Acute Stroke Study (ECASS) have reported that there was significant improvement in the clinical outcomes of patients with acute ischemie stroke when Alteplase was administered 3-4.5 h after the onset of the symptoms. Mismatches in perfusion- and diffusion-weighted (DW) magnetic resonance imaging (MRI) images have been used for selecting patients 3 h after the onset of symptoms, and the findings from MRI, dwimages (DWI) and MR angiography are practical predictors of t-PA therapy within 3 h of onset. The Middle Cerebral Artery Embolism Local Fibrinolytic Intervention Trial (MELT) Japan study showed that local intra-arterial fibrinolysis is effective in patients with embolic MCA occlusion within 6 h of the onset of symptoms. Combining the initiation of intravenous t-PA administration with further intra-arterial fibrinolysis or mechanical thrombolectomy may improve the

  2. Implication of the recent positive endovascular intervention trials for organizing acute stroke care: European perspective.

    Science.gov (United States)

    Tatlisumak, Turgut

    2015-06-01

    Timely recanalization leads to improved patient outcomes in acute ischemic stroke. Recent trial results demonstrated a strong benefit for endovascular therapies over standard medical care in patients with acute ischemic stroke and a major intracranial artery occlusion≤6 hours or even beyond from symptom onset and independent of patients' age. Previous studies have shown the benefit of intravenous thrombolysis that had gradually, albeit slowly, reshaped acute stroke care worldwide. Now, given the superior benefits of endovascular intervention, the whole structure of acute stroke care needs to be reorganized to meet patient needs and to deliver evidence-based treatments effectively. However, a blueprint for success with novel stroke treatments should be composed of numerous elements and requires efforts from various parties. Regarding the endovascular therapies, the strengths of Europe include highly organized democratic society structures, high rate of urbanization, well-developed revenue-based healthcare systems, and high income levels, whereas the obstacles include the east-west disparity in wealth, the ongoing economic crisis hindering spread of fairly costly new treatments, and the quickly aging population putting more demands on health care in general. Regional and national plans for covering whole population with 24/7 adequate acute stroke care are necessary in close cooperation of professionals and decision-makers. Europe-wide new training programs for expert physicians in stroke care should be initiated shortly. European Stroke Organisation has a unique role in providing expertise, consultation, guidelines, and versatile training in meeting new demands in stroke care. This article discusses the current situation, prospects, and challenges in Europe offering personal views on potential solutions.

  3. 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

  4. 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

  5. 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.

  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. Factors influencing the efficiency and safety of systemic thrombolysis in patients with ischemic stroke

    Directory of Open Access Journals (Sweden)

    N. A. Shamalov

    2014-10-01

    Full Text Available Systemic thrombolysis using recombinant tissue plasminogen activator is the most effective and safe therapy option for ischemic stroke (IS in the first 4.5 hours after onset of the disease. The safety and efficiency (or inefficiency of perfusion therapy in patients with IS may be affected by a multitude of factors associated with the time of the therapy, patient age, the presence and size of a brain region with potentially reversible changes, the location of a cerebral lesion region, the specific features of systemic and local hemodynamics, and the degree of blood-brain barrier impairment. The hemorrhagic transformation of a brain lesion focus in IS is a serious complication of thrombolytic therapy (TT. The analysis and detection of predictors for hemorrhagic complications, TT in terms of the clinical and pathogenetic features of the disease, the location of a lesion focus and the degree of early neuroimaging signs, and data of additional studies will contribute to the safer and more effectiveuse of this treatment in patients with IS.

  8. Early ischemic CT changes before thrombolysis: The influence of age and diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Lars Thomassen

    2008-09-01

    Full Text Available Lars Thomassen, Ulrike Waje-Andreassen, Halvor NaessDepartment of Neurology, Haukeland University Hospital, Bergen, NorwayObjectives: The significance of early ischemic changes (EIC on computed tomography (CT within 3 hours after stroke onset remains controversial. The semi-quantitative Alberta Stroke Program Early CT Score (ASPECTS is found to have prognostic value in early stroke. This study assesses factors associated with the presence of EIC and the relation between EIC and clinical outcome.Materials and methods: CT scans from 61 consecutive patients receiving thrombolytic therapy were reviewed by 3 experienced stroke neurologists, assessing EIC (ASPECTS and vascular signs (hyperdense middle cerebral artery stem and/or branches. Short-term outcome was assessed with the National Institute of Health Stroke Scale at 24 hours and long-term outcome with the modified Rankin Scale score after 3 months.Results: The prevalence of EIC was 54% and the agreement between assessors was good (kappa 0.52–0.67. EIC was independently associated with younger age and absence of diabetes mellitus. Neither EIC nor vascular signs were associated with 3-months outcome.Conclusions: ASPECTS is as simple, systematic approach to assessing EIC, and the interobserver agreement is good. Patient age and diabetes mellitus influence the presence of EIC.Keywords: acute stroke, computed tomography, ischemia, thrombolysis

  9. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Gerard O’Connor

    2015-01-01

    Full Text Available More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI or pulmonary embolism (PE. Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR. We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient’s cardiac arrest, the extremely low end-tidal CO2 suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC and did not result in haemorrhage or an adverse effect.

  10. Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest.

    Science.gov (United States)

    O'Connor, Gerard; Fitzpatrick, Gareth; El-Gammal, Ayman; Gilligan, Peadar

    2015-01-01

    More than 70% of cardiac arrest cases are caused by acute myocardial infarction (AMI) or pulmonary embolism (PE). Although thrombolytic therapy is a recognised therapy for both AMI and PE, its indiscriminate use is not routinely recommended during cardiopulmonary resuscitation (CPR). We present a case describing the successful use of double dose thrombolysis during cardiac arrest caused by pulmonary embolism. Notwithstanding the relative lack of high-level evidence, this case suggests a scenario in which recombinant tissue Plasminogen Activator (rtPA) may be beneficial in cardiac arrest. In addition to the strong clinical suspicion of pulmonary embolism as the causative agent of the patient's cardiac arrest, the extremely low end-tidal CO2 suggested a massive PE. The absence of dilatation of the right heart on subxiphoid ultrasound argued against the diagnosis of PE, but not conclusively so. In the context of the circulatory collapse induced by cardiac arrest, this aspect was relegated in terms of importance. The second dose of rtPA utilised in this case resulted in return of spontaneous circulation (ROSC) and did not result in haemorrhage or an adverse effect. PMID:26664765

  11. 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

  12. The velocity of collateral filling predicts recanalization in acute ischemic stroke after intravenous thrombolysis.

    Science.gov (United States)

    Zhang, Sheng; Zhang, Xiaocheng; Yan, Shenqiang; Lai, Yangxiao; Han, Quan; Sun, Jianzhong; Zhang, Minming; Parsons, Mark W; Wang, Shaoshi; Lou, Min

    2016-01-01

    The aim of this study was to evaluate the impact of pretreatment quality of collaterals, involving velocity and extent of collateral filling, on recanalization after intravenous thrombolysis (IVT). A retrospective analysis was performed of 66 patients with acute middle cerebral artery (MCA) M1 segment occlusion who underwent MR perfusion (MRP) imaging before IVT. The velocity of collateral filling was defined as arrival time delay (ATD) of contrast bolus to Sylvian fissure between the normal and the affected hemisphere. The extent of collateral filling was assessed according to the Alberta Stroke Program Early CT (ASPECT) score on temporally fused maximum intensity projections (tMIP). Arterial occlusive lesion (AOL) score was used to assess the degree of arterial recanalization. ATD (OR = 0.775, 95% CI = 0.626-0.960, p = 0.020), but not tMIP-ASPECT score (OR = 1.073, 95% CI = 0.820-1.405, p = 0.607), was independently associated with recanalization (AOL score of 2 and 3) at 24 hours after IVT. When recanalization was achieved, hemorrhagic transformation (HT) occurred more frequently in patients with slow collaterals (ATD ≥ 2.3 seconds) than those with rapid collaterals (ATD < 2.3 seconds) (88.9% vs 38.1%, p = 0.011). In conclusion, the velocity of collaterals related to recanalization, which may guide the decision-making of revascularization therapy in acute ischemic stroke. PMID:27296511

  13. The role of connexin43 in hemorrhagic transformation after thrombolysis in vivo and in vitro.

    Science.gov (United States)

    Yang, Xiaobo; Chu, Heling; Tang, Yuping; Dong, Qiang

    2016-08-01

    Thrombolysis with recombinant tissue plasminogen activator (rtPA) is the most effective drug treatment for acute ischemic stroke within 4.5h after symptom onset. However, the use of rtPA may increase the risk of hemorrhagic transformation (HT), particularly when it is administered after the first 4.5h. However, no effective treatments are available to reduce the HT risk. Disruption of the blood-brain barrier (BBB) is central to the genesis of HT. Connexin43 (Cx43)-mediated gap junction intercellular communication (GJIC) has been demonstrated to regulate the integrity of the BBB in ischemia. We investigated the effect of Cx43 on BBB permeability during rtPA-induced HT. Spontaneously hypertensive rats (SHRs) underwent a 1.5-h middle cerebral artery occlusion and were treated with rtPA at 4.5h. The rats were sacrificed at 24h, and their brains were evaluated for BBB permeability and the expression of tight junction (TJ) proteins and Cx43. We examined whether the effects were Cx43 dependent using multiple Cx43 inhibitors. Phosphorylated Cx43 (p-Cx43) but not total Cx43 protein expression was increased after rtPA treatment. Delayed rtPA administration induced significant HT and BBB disruption. These effects were attenuated by inhibitors that blocked GJIC and Cx43 phosphorylation and expression but not Cx43 redistribution. Additionally, rtPA administration upregulated p-Cx43 expression in hypoxia/reoxygenation (H/R)-exposed brain endothelial cells. These effects were suppressed by the phosphatidylinositol 3'-kinase (PI3K) inhibitor LY294002 and the extracellular signal-regulated kinase 1/2 (ERK1/2) inhibitor U0126. We suggest that rtPA-associated hemorrhage due to an alteration in the integrity of the BBB is highly associated with an increase in p-Cx43 resulting from the activation of the PI3K and ERK pathways. PMID:27138645

  14. 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.

  15. 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.

  16. Engagement of non-government organisations and community care workers in collaborative TB/HIV activities including prevention of mother to child transmission in South Africa: Opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Uwimana Jeannine

    2012-08-01

    Full Text Available Abstract Background The implementation of collaborative TB/HIV activities may help to mitigate the impact of the dual epidemic on patients and communities. Such implementation requires integrated interventions across facilities and levels of government, and with communities. Engaging Community Care Workers (CCWs in the delivery of integrated TB/HIV services may enhance universal coverage and treatment outcomes, and address human resource needs in sub-Saharan Africa. Methods Using pre-intervention research in Sisonke district, KwaZulu-Natal, South Africa as a case study, we report on three study objectives: (1 to determine the extent of the engagement of NGOs and CCWs in the implementation of collaborative TB/HIV including PMTCT; (2 to identify constraints related to provision of TB/HIV/PMTCT integrated care at community level; and (3 to explore ways of enhancing the engagement of CCWs to provide integrated TB/HIV/PMTCT services. Our mixed method study included facility and NGO audits, a household survey (n = 3867, 33 key informant interviews with provincial, district, facility, and NGO managers, and six CCW and patient focus group discussions. Results Most contracted NGOs were providing TB or HIV support and care with little support for PMTCT. Only 11% of facilities’ TB and HIV patients needing care and support at the community level were receiving support from CCWs. Only 2% of pregnant women reported being counseled by CCWs on infant feeding options and HIV testing. Most facilities (83% did not have any structural linkage with NGOs. Major constraints identified were system-related: structural, organizational and managerial constraints; inadequate CCW training and supervision; limited scope of CCW practice; inadequate funding; and inconsistency in supplies and equipment. Individual and community factors, such as lack of disclosure, stigma related to HIV, and cultural beliefs were also identified as constraints. Conclusions NGO

  17. 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…

  18. Visible Thrombolysis Acceleration of a Nanomachine Powered by Light-Driving F0F1-ATPase Motor

    Science.gov (United States)

    Duan, Xiaoxia; Liu, Lifeng; Jiang, Weijian; Yue, Jiachang

    2015-05-01

    We report on thrombolysis acceleration of a nanomachine powered by light-driving δ-subunit-free F0F1-ATPase motor. It is composed of a mechanical device, locating device, energy storage device, and propeller. The rotory δ-subunit-free F0F1-ATPase motor acts as a mechanical device, which was obtained by reconstructing an original chromatophore extracted from Rhodospirillum rubrum. We found that the bioactivity of the F0F1-ATPase motor improved greatly after reconstruction. The zeta potential of the nanomachine is about -23.4 mV. Cytotoxicity induced by the nanomachine was measured using cell counting kit (CCK)-8 assay. The A549 cells incubated with different fractional concentrations of the nanomachine within 48 h did not show obvious cytotoxicity. The locating device helps the nanomachine bind to the thrombi. Energy was easily stored by exposing the nanomachine to 600-nm-wavelength irradiation, which promoted activity of the motor. The rotation of the long propeller accelerated thrombolysis of a blood clot in vitro in the presence of urokinase (UK). This result was based on visual inspection and confirmed by a series of tests.

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. 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 ...

  4. 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.)

  5. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    International Nuclear Information System (INIS)

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  6. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    Energy Technology Data Exchange (ETDEWEB)

    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin [Hannover Medical School, Department of Neurology and Clinical Neurophysiology, Hannover (Germany); Becker, Hartmut; Goetz, Friedrich [Hannover Medical School, Department of Neuroradiology, Hannover (Germany)

    2008-01-15

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

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

    International Nuclear Information System (INIS)

    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) cm3 in the treatment arm and 29 (8-105) cm3 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.)

  8. 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。

  9. 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.

  10. Hyperacute thrombolysis with recombinant tissue plasminogen activator of acute ischemic stroke: Feasibility and effectivity from an Indian perspective

    Directory of Open Access Journals (Sweden)

    Sharma S

    2008-01-01

    Full Text Available Given the constraints of resources, thrombolysis for acute ischemic stroke (AIS is under evaluation in developing countries like India, especially in areas such as western Utter Pradesh, where it is overly crowded and there is poor affordability. Aim: This study was done to evaluate recombinant tissue plasminogen activator r-tpa in acute ischemic stroke in hyper acute phase, in selected patients of western Utter Pradesh, in terms of feasibility and effectivity. Design: Open, non randomized study. Materials and Methods: Thirty two patients were classified using Trial of ORG 10172 in Acute Stroke treatment (TOAST criteria (large artery atherosclerotic = 8; cardio embolic = 6; small vessel occlusion = 14; other determined etiology = 2; undetermined etiology = 2. The mean time to reach the hospital was 2 h (1.15-3.0, the mean door to CT scan 20 min (10-40 and door to r-tpa injection was 30 min (24-68. The National Institute of Health Stroke Scale (NIHSS scores ranged from 11-22 (mean 15.5 +2.7. The dose of r-tpa administered was 0.9 mg/kg. Results: Twenty one patients (65.6% showed significant improvement on the NIHSS score, at 48 h (4 points. (Mean change = 10; range = 4-17. At one month, 25 (78% recorded improvement on the Barthel index (mean change = 45%. One developed frontal lobe hemorrhage and another developed recurrent stroke; one died of aspiration; and four showed no improvement. Modified Rankin score (m RS was administered at the end of three months to 28 patients (90%; however, the rest could not be directly observed. The average modified Rankin Score was 1.2 (0-2. Conclusions: Hyperacute thrombolysis was found feasible and effective in selected patients with AIS from western Utter Pradesh and who had poor affordability.

  11. 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.

  12. 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

  13. 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

  14. 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.

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

    OpenAIRE

    V. A. Sulimov

    2015-01-01

    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 t...

  17. Does the ‘diffusion of innovations’ model enrich understanding of research use? Case studies of the implementation of thrombolysis services for stroke

    OpenAIRE

    Boaz, Annette; Baeza, Juan; Fraser, Alec

    2016-01-01

    Objectives: To test the applicability of the model of diffusion of innovations as an analytical framework to explore the implementation of evidence based thrombolysis services for stroke patients. Methods: Four empirical case studies of the implementation of evidence into stroke services in England and Sweden. Data were drawn from 95 semi structured interviews with a range of clinical and managerial staff within four hospitals, working in stroke units, emergency medicine, radiology, the ambul...

  18. Large cerebral artery occlusion and recanalisation in stroke patients treated with intravenous thrombolysis : clinical and radiological markers and their clinical relevance

    OpenAIRE

    Kharitonova, Tatiana

    2011-01-01

    Large cerebral artery occlusion accounts for 40-46% of ischemic strokes. These strokes are characterized by extensive neurological deficit, poor functional outcome, and increased mortality (up to 40-80% in the most severe clinical syndromes). Intravenous thrombolysis is approved treatment across severity grades, except for the extremely severe, although alternative strategies are under evaluation, such as mechanical thrombectomy. The aim of the present thesis was to study the occu...

  19. 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

  20. 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

  1. Stroke Statistics in Korea: Part II Stroke Awareness and Acute Stroke Care, A Report from the Korean Stroke Society and Clinical Research Center For Stroke

    OpenAIRE

    Hong, Keun-Sik; Bang, Oh Young; Kim, Jong S.; Heo, Ji Hoe; Yu, Kyung-Ho; Bae, Hee-Joon; Kang, Dong-Wha; Lee, Jin Soo; Kwon, Sun U.; Oh, Chang Wan; Lee, Byung-Chul; Yoon, Byung-Woo

    2013-01-01

    The aim of the current Part II of Stroke Statistics in Korea is to summarize nationally representative data on public awareness, pre-hospital delay, thrombolysis, and quality of acute stroke care in a single document. The public's knowledge of stroke definition, risk factors, warning signs, and act on stroke generally remains low. According to studies using open-ended questions, the correct definition of stroke was recognized in less than 50%, hypertension as a stroke risk factor in less than...

  2. 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

  3. 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

  4. Acute care in stroke: the importance of early intervention to achieve better brain protection.

    Science.gov (United States)

    Díez-Tejedor, E; Fuentes, B

    2004-01-01

    It is known that 'time is brain', and only early therapies in acute stroke have been effective, like thrombolysis within the first 3 h, and useful neuroprotective drugs are searched for that probably would be effective only with their very early administration. General care (respiratory and cardiac care, fluid and metabolic management, especially blood glucose and blood pressure control, early treatment of hyperthermia, and prevention and treatment of neurological and systemic complications) in acute stroke patients is essential and must already start in the prehospital setting and continue at the patient's arrival to hospital in the emergency room and in the stroke unit. A review of published studies analyzing the influence of general care on stroke outcome and the personal experience from observational studies was performed. Glucose levels >8 mmol/l have been found to be predictive of a poor prognosis after correcting for age, stroke severity, and stroke subtype. Although a clinical trial of glucose-insulin-potassium infusions is ongoing, increased plasma glucose levels should be treated. Moreover, insulin therapy in critically ill patients, including stroke patients, is safe and determines lower mortality and complication rates. Both high and low blood pressure levels have been related to a poor prognosis in acute stroke, although the target levels have not been defined yet in clinical trials. The body temperature has been shown to have a negative effect on stroke outcome, and its control and early treatment of hyperthermia are important. Hypoxemia also worsens the stroke prognosis, and oxygen therapy in case of prehospital level from the very beginning. This could help to save more brain tissue to get the best conditions for further specific stroke therapies such as the use of neuroprotective or thrombolytic drugs in the hospital. PMID:14694290

  5. Hospice Care

    Science.gov (United States)

    ... your care. Other team members may include a music therapist, physical therapist, speech therapist or occupational therapist. ... to the Terms and Conditions and Privacy Policy Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium ...

  6. Speak Up: Help Prevent Errors in Your Care: Ambulatory Care

    Science.gov (United States)

    ... role in making health care safe. That includes doctors, nurses and other health care professionals. Health care organizations ... embarrassed if you don't understand what your doctor, nurse or other health care professional tells you. • Don’ ...

  7. Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis.

    OpenAIRE

    Pell, Alastair C. H.; Miller, Hugh C.; Robertson, Colin E; Fox, Keith A

    1992-01-01

    OBJECTIVE:To evaluate the impact of a fast track triage system for patients with acute myocardial infarction.DESIGN:Comparison of delays in admission to hospital and in receiving thrombolytic treatment before and after introducing fast track system with delays recorded in 1987-8. Patients fulfilling clinical and electrocardiographic criteria for myocardial infarction were selected for rapid access to the cardiac care team, bypassing evaluation by the medical registrar.SETTING:Major accident a...

  8. Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism

    OpenAIRE

    Marcos Mello Moreira; Renato G.G. Terzi; Carlos Heitor N Carvalho; Antonio Francisco de Oliveira Neto; Mônica Corso Pereira; Ilma Aparecida Paschoal

    2009-01-01

    Marcos Mello Moreira1, Renato G G Terzi1, Carlos Heitor N Carvalho2, Antonio Francisco de Oliveira Neto3, Mônica Corso Pereira4, Ilma Aparecida Paschoal41Department of Surgery, State University of Campinas, School of Medical Sciences; 2Department of Cardiology, State University of Campinas, School of Medical Sciences; 3Intensive Care Unit of the State University of Campinas, School of Medical Sciences; 4Department of Pulmonology, State University of Campinas, School of Medical Scien...

  9. Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism

    OpenAIRE

    Moreira, Marcos

    2008-01-01

    Marcos Mello Moreira1, Renato G G Terzi1, Carlos Heitor N Carvalho2, Antonio Francisco de Oliveira Neto3, Mônica Corso Pereira4, Ilma Aparecida Paschoal41Department of Surgery, State University of Campinas, School of Medical Sciences; 2Department of Cardiology, State University of Campinas, School of Medical Sciences; 3Intensive Care Unit of the State University of Campinas, School of Medical Sciences; 4Department of Pulmonology, State University of Campinas, School of Medical Scien...

  10. Interventional recanalization of artificial arteriovenous fistula and graft for hemodialysis: angioplasty and pulsed-spray thrombolysis with Urokinase

    International Nuclear Information System (INIS)

    To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) and pul-sed-spray pharmaco-mechanical thrombolysis (PSPMT) using urokinase for the management of insufficient hemodialysis access. Between September 1996 and May 1998, 21 insufficient hemodialysis accesses were treated in 16 patients(3 artificial arteriovenous fistulae, AVF; and 13 arteriovenous graft, AVG). PTA and PSPMT were performed in 6 and 15 cases, respectively, and success and long-term patency rates were evaluated. The overall success rate of PTA and PSPMT for insufficient hemodialysis access was 76. 2%(16/21). The success rates of PTA and PSPMT were 83.3%(5/6) and 73.3%(11/15), respectively. The primary patency rates of PSPMT were 69±12.8% at 6 months and 38±18.6% at 12 months. One of the two initially successful PTAs had been patent for 7 months, and the second PTA was performed at that time due to venous stenosis. The other was patent for 15 months throughout the follow-up period. PTA and PSPMT are effective primary methods for the treatment of insufficient hemodialysis access;success and patency rates were high, and the procedures can be performed repeatedly.=20

  11. 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.

  12. Catheter-directed thrombolysis for acute superior mesenteric venous thrombosis via superior mesenteric vein and artery%急性肠系膜上静脉血栓的动静脉联合导管溶栓治疗

    Institute of Scientific and Technical Information of China (English)

    杨硕菲; 吴性江; 黎介寿

    2014-01-01

    superior mesenteric venous thrombosis (SMVT), which is conducted mainly through percutaneous transhepatic , transjugular intrahepatic, or superior mesen-teric artery approach .This study is to assess the feasibility , effectiveness and safety of catheter-directed thrombolysis via the superior mesenteric vein and artery for acute SMVT . Methods We retrospectively reviewed 8 cases of acute extensive SMVT treated by tran-scatheter thrombolysis via superior mesenteric vein and artery in our institute .We collected and analyzed the general information , case history, etiology, risk factors, imaging characteristics, treatment procedures, complications, and follow-up data of the patients summa-rized the experience in the treatment of acute extensive SMVT by catheter-directed thrombolysis . Results Technical success was a-chieved with substantial symptoms improvement after thrombolytic therapy in all the cases .The local urokinase infusion via the superior mesenteric artery and vein was performed for (6.13 ±0.83) and (12 ±2.51) d.Four patients required delayed localized bowel resection of (1.63 ±0.48) m, with satisfactory recovery after intensive care and organ function support .Contrast-enhanced CT scan and portogra-phy demonstrated complete thrombus resolution in all the patients before discharged after a hospital stay of (19.25 ±4.89) d.Minor bleeding at the puncture site occurred in 2 cases and sepsis developed in another 2 postoperatively .No recurrence and complications were ob-served during the follow-up of (12.13 ±0.99) mo. Conclusion For acute extensive SMVT , catheter-directed thrombolytic therapy via superior mesenteric vein and artery can accelerate thrombus resolution , stimulate collateral vessel development , reverse extensive intestinal is-chemia, avert bowel resection , localize infarcted bowel segment to pre-vent short bowel syndrome , and effectively speed up the recovery and significantly increase the survival rate of the patients .

  13. 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,...

  14. 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 ... yourself healthy can also minimize the risk of future outbreaks. Things you can do include: Get plenty ...

  15. 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 ...

  16. Supportive Care.

    Science.gov (United States)

    Olsen, Pia Riis; Lorenzo, Rosalía

    2016-01-01

    This chapter takes its point of departure in psychosocial aspects of supportive care in adolescent and young adult cancer care. The purpose is to describe some of the challenges that these young people face following a cancer diagnosis and guide healthcare professionals in how to provide care that improves the quality of life. In most hospitals and healthcare systems, adolescents and young adults are cared for and treated in settings for children or adults. Accordingly, healthcare professionals may lack attention to and knowledge about what characterize young peoples' life situation, their special needs and how to meet them. The topics we include in the chapter are the following: the youth friendly environment, social support and social network, parents, information during a psychosocial crisis event, the use of HEADSS, peer support, fertility, body image and self-esteem, after treatment and future challenges and palliative and end of life care. PMID:27595353

  17. 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

  18. 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.

  19. The Fate of High-Density Lesions on the Non-contrast CT Obtained Immediately After Intra-arterial Thrombolysis in Ischemic Stroke Patients

    International Nuclear Information System (INIS)

    Hyperdense lesions can frequently be observed on the CT obtained immediately after intra-arterial (IA) thrombolysis, and it is sometimes difficult to differentiate contrast extravasation from the hemorrhagic lesions. The purposes of this study are to classify the hyperdense lesions according to their morphologic features and to track the outcome of those lesions. Among the 94 patients who suffered with anterior circulation ischemic stroke and who were treated with IA thrombolysis, 31 patients revealed hyperdense lesions on the CT obtained immediately after the procedure. The lesions were categorized into four types according to their volume, shape, location and density: cortical high density (HD), soft HD, metallic HD and diffuse HD. The follow-up images were obtained 3 5 days later in order to visualize the morphologic changes and hemorrhagic transformation of the lesions. Among the 31 patients with HD lesions, 18 (58%) showed hemorrhagic transformation of their lesion, and six of them were significant. All the cortical HD lesions (n = 4) revealed spontaneous resolution. Seven of the soft HD lesions (n = 13) showed spontaneous resolution, while the rest of the group showed hemorrhagic transformation. Among them the hemorrhage was significant in only two patients (2/6) who did not achieve successful recanalization. All the metallic HD lesions (n = 10) resulted in hemorrhagic transformation; among them, three cases (30%) with a maximum CT value more than 150 HU (Hounsfield unit) subsequently showed significant hemorrhagic transformation on the follow-up CT. There were four diffuse HD lesions, and two of them showed hemorrhagic transformation. The parenchymal hyperdense lesions observed on the CT obtained immediately after IA thrombolysis in ischemic stroke patients exhibited varying features and they were not always hemorrhagic. Most of the soft HD lesions were benign, and although all of the metallic HD lesions were hemorrhagic, some of them were ultimately found

  20. The Fate of High-Density Lesions on the Non-contrast CT Obtained Immediately After Intra-arterial Thrombolysis in Ischemic Stroke Patients

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Yu Mi; Lee, Deok Hee; Kim, Ho Sung; Ryu, Chang Woo; Lee, Jeong Hyun; Choi, Choong Gon; Kim, Sang Joon; Suh, Dae Chul [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2006-12-15

    Hyperdense lesions can frequently be observed on the CT obtained immediately after intra-arterial (IA) thrombolysis, and it is sometimes difficult to differentiate contrast extravasation from the hemorrhagic lesions. The purposes of this study are to classify the hyperdense lesions according to their morphologic features and to track the outcome of those lesions. Among the 94 patients who suffered with anterior circulation ischemic stroke and who were treated with IA thrombolysis, 31 patients revealed hyperdense lesions on the CT obtained immediately after the procedure. The lesions were categorized into four types according to their volume, shape, location and density: cortical high density (HD), soft HD, metallic HD and diffuse HD. The follow-up images were obtained 3 5 days later in order to visualize the morphologic changes and hemorrhagic transformation of the lesions. Among the 31 patients with HD lesions, 18 (58%) showed hemorrhagic transformation of their lesion, and six of them were significant. All the cortical HD lesions (n = 4) revealed spontaneous resolution. Seven of the soft HD lesions (n = 13) showed spontaneous resolution, while the rest of the group showed hemorrhagic transformation. Among them the hemorrhage was significant in only two patients (2/6) who did not achieve successful recanalization. All the metallic HD lesions (n = 10) resulted in hemorrhagic transformation; among them, three cases (30%) with a maximum CT value more than 150 HU (Hounsfield unit) subsequently showed significant hemorrhagic transformation on the follow-up CT. There were four diffuse HD lesions, and two of them showed hemorrhagic transformation. The parenchymal hyperdense lesions observed on the CT obtained immediately after IA thrombolysis in ischemic stroke patients exhibited varying features and they were not always hemorrhagic. Most of the soft HD lesions were benign, and although all of the metallic HD lesions were hemorrhagic, some of them were ultimately found

  1. Intra-arterial thrombolysis in basilar artery occlusions combination of intra-arterial thrombolytics and Gp IIb/IIIa inhibitors in basilar artery thrombosis

    Directory of Open Access Journals (Sweden)

    Gaikwad S

    2009-01-01

    Full Text Available Basilar artery thrombosis has high morbidity and mortality. Though intra-arterial thrombolytics have proven efficacy in the treatment of acute basilar artery occlusion, the elevation of procoagulant factors in the blood after intra-arterial thrombolysis could result in subsequent thrombus formation and clinical deterioration. Glycoprotein IIb/IIIa inhibitors have been shown to reduce this elevation in procoagulants. We present a pilot study of three cases of acute basilar artery occlusion treated with a combination of intra-arterial thrombolytics and Gp IIb/IIIa inhibitor with remarkable clinical recovery seen in all the patients.

  2. Pediatric Palliative Care

    OpenAIRE

    Johnston, Donna L.; Hentz, Tracy A.; Friedman, Debra L.

    2005-01-01

    Pediatric palliative care provides benefit to children living with life-threatening or terminal conditions. Palliative care should be available to all seriously ill children. Palliative care includes the treatment of symptoms such as pain, nausea, dyspnea, constipation, anorexia, and sialorrhea. This care can occur in a variety of settings, from home to hospice to hospital, and must include bereavement care and follow up after the death of a child. There are many challenges in pediatric palli...

  3. 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

  4. Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke.

    Science.gov (United States)

    Groot, Adrien E; van Schaik, Ivo N; Visser, Marieke C; Nederkoorn, Paul J; Limburg, Martien; Aramideh, Majid; de Beer, Frank; Zwetsloot, Caspar P; Halkes, Patricia; de Kruijk, Jelle; Kruyt, Nyika D; van der Meulen, Willem; Spaander, Fianne; van der Ree, Taco; Kwa, Vincent I H; Van den Berg-Vos, Renske M; Roos, Yvo B; Coutinho, Jonathan M

    2016-04-01

    Centralization of intravenous thrombolysis (IVT) for acute ischemic stroke in high-volume centers is believed to improve the door-to-needle times (DNT), but limited data support this assumption. We examined the association between DNT and IVT volume in a large Dutch province. We identified consecutive patients treated with IVT between January 2009 and 2013. Based on annualized IVT volume, hospitals were categorized as low-volume (≤ 24), medium-volume (25-49) or high-volume (≥ 50). In logistic regression analysis, low-volume hospitals were used as reference category. Of 17,332 stroke patients from 11 participating hospitals, 1962 received IVT (11.3 %). We excluded 140 patients because of unknown DNT (n = 86) or in-hospital stroke (n = 54). There were two low-volume (total 101 patients), five medium-volume (747 patients) and four high-volume hospitals (974 patients). Median DNT was shorter in high-volume hospitals (30 min) than in medium-volume (42 min, p < 0.001) and low-volume hospitals (38 min, p < 0.001). Patients admitted to high-volume hospitals had a higher chance of DNT < 30 min (adjusted OR 3.13, 95 % CI 1.70-5.75), lower risk of symptomatic intracerebral hemorrhage (adjusted OR 0.39, 95 % CI 0.16-0.92), and a lower mortality risk (adjusted OR 0.45, 95 % CI 0.21-1.01), compared to low-volume centers. There was no difference in DNT between low- and medium-volume hospitals. Onset-to-needle times (ONT) did not differ between the groups. Hospitals in this Dutch province generally achieved short DNTs. Despite this overall good performance, higher IVT volumes were associated with shorter DNTs and lower complication risks. The ONT was not associated with IVT volume. PMID:26946499

  5. Influential factors of clinical outcome of local intra-arterial thrombolysis using urokinase in patients with hyperacute ischemic stroke

    International Nuclear Information System (INIS)

    To evaluate the clinical outcome and other relevant factors in cases where local intra-arterial thrombolysis (LIT) is used for the treatment of hyperacute ischemic stroke. Forty-eight hyperacute ischemic stroke patients were treated by LIT, using urokinase, within six hours of ictus, and for evaluation of their neurological status, the national institutes of health stroke scale (NIHSS) score was used. Angiography recanalization was classified according to Mori recanalization grades. Three months after LIT, the outcome was assessed by clinical examination using the modified rankin scale (good outcome: RS=0-3; poor outcome: RS=4-6). In all patients, the findings of pre- and post- LIT CT, and angiography, as well as neurological status and hemorrhagic complications, were also analysed. Thirty-three patients had occlusions of the middle cerebral artery (MCA), and 15, of the internal carotid artery (ICA). The NIHSS score averaged 16.9 at the onset of therapy and 13.5 at 24 hours later. Successful recanalization (Mori grade 3,4) was achieved in 28 (58.3%) of 48 patients, but in 20 (41.7%) the attempt failed. Twenty-two (45.8%) of the 48 patients had a good outcome, but in (54.2%) the outcome was poor. Thirteen (40.6%) of 32 patients with MCA occlusions and 13 (81.2%) of 16 with ICA occlusions had a poor outcome. Eight patients (16.7%) died. Overall, hemorrhages occured in 20 (41.7%) of 48 patients, with symptomatic hemorrhage in ten. Five (50%) of these ten died. LIT using urokinase for hyperacute ischemic stroke is feasible; patients with MCA occlusions had better outcomes than those with ICA occlusions. Hemorrhagic complications of LIT were frequent, and in cases of symptomatic hemorrhage a fatal outcome may be expected

  6. Influential factors of clinical outcome of local intra-arterial thrombolysis using urokinase in patients with hyperacute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jae Min; Yoon, Woong; Kim, Jae Kyu; Seo, Jeong Jin; Heo, Sook Hee; Park, Jin Gyoon; Jeong, Yoon Yeon; Kang, Heoung Keun [Chonam University Hospital, Kwangju (Korea, Republic of)

    2002-10-01

    To evaluate the clinical outcome and other relevant factors in cases where local intra-arterial thrombolysis (LIT) is used for the treatment of hyperacute ischemic stroke. Forty-eight hyperacute ischemic stroke patients were treated by LIT, using urokinase, within six hours of ictus, and for evaluation of their neurological status, the national institutes of health stroke scale (NIHSS) score was used. Angiography recanalization was classified according to Mori recanalization grades. Three months after LIT, the outcome was assessed by clinical examination using the modified rankin scale (good outcome: RS=0-3; poor outcome: RS=4-6). In all patients, the findings of pre- and post- LIT CT, and angiography, as well as neurological status and hemorrhagic complications, were also analysed. Thirty-three patients had occlusions of the middle cerebral artery (MCA), and 15, of the internal carotid artery (ICA). The NIHSS score averaged 16.9 at the onset of therapy and 13.5 at 24 hours later. Successful recanalization (Mori grade 3,4) was achieved in 28 (58.3%) of 48 patients, but in 20 (41.7%) the attempt failed. Twenty-two (45.8%) of the 48 patients had a good outcome, but in (54.2%) the outcome was poor. Thirteen (40.6%) of 32 patients with MCA occlusions and 13 (81.2%) of 16 with ICA occlusions had a poor outcome. Eight patients (16.7%) died. Overall, hemorrhages occured in 20 (41.7%) of 48 patients, with symptomatic hemorrhage in ten. Five (50%) of these ten died. LIT using urokinase for hyperacute ischemic stroke is feasible; patients with MCA occlusions had better outcomes than those with ICA occlusions. Hemorrhagic complications of LIT were frequent, and in cases of symptomatic hemorrhage a fatal outcome may be expected.

  7. 中国缺血性卒中早期静脉溶栓的现状、阻碍因素及改进策略%The Current State, Barriers and Improving Strategies of Intravenous Thrombolysis for Acute Ischemic Stroke in China

    Institute of Scientific and Technical Information of China (English)

    徐安定; 丁燕; 李牧

    2014-01-01

    Intravenous recombinant tissue-type plasminogen activator (rt-PA) is proven to be the most effective method to improve outcomes for acute ischemic stroke (AIS), and the earlier use is companied with the better effects and safeties. However, the low utilization of intravenous rt-PA is a global problem, due to pre-and in-hospital delays. Meanwhile, it has been demonstrated that the thrombolysis rate can be increased and the delays can be shortened after diversity of measurements. After reviewing the advanced correspondent studies in China and developed countries, this article reviews the current state of intravenous thrombolysis for AIS in China, analyzes the barriers to stroke thrombolysis, and puts forwards the improvements in the future, including stroke health education to public and health professional, promoting stroke center certiifcation, and optimizing the pre-and in-hospital processes and the organized administration, etc.%静脉应用重组组织型纤维蛋白酶原激活剂是治疗急性缺血性卒中(acute ischemic stroke, AIS)最有效的方法,且越早治疗获益越多。但全球都存在溶栓率低下,院前、院内延误明显的现象,而针对性干预可以提高溶栓率,缩短从发病至开始溶栓时间。本文结合国内外最新研究结果,对我国AIS的早期静脉溶栓现状进行总结,分析其阻碍因素,并提出我国相应的改进策略。这些措施主要包括加强针对公众和相关行业人员的卒中健康教育,实施卒中中心认证,对院前、院内各环节实施组织化和优化管理等。

  8. And why not thrombolysis in the ambulance (at least for some)?

    Science.gov (United States)

    Rosenberg, Gilad; Steiner, Israel

    2016-07-12

    The fear that alteplase may aggravate primary intracerebral hemorrhages has led to the mandatory prerequisite for prealteplase imaging in all acute stroke patients in order to exclude such hemorrhages. Consequently, in a situation in which "time is brain," administration of alteplase is delayed until the patients are transferred to a hospital where such imaging is available, at the cost of additional ischemic damage to the brain parenchyma. Yet, theoretical considerations and empirical data suggest that alteplase's effects on primary intracerebral hemorrhages may not be that detrimental. Moreover, at least some of the patients who are at a high risk of having primary cerebral bleeds, or at a high risk of developing symptomatic secondary bleeds, can be excluded from alteplase therapy on clinical grounds, and using nonimaging point-of-care devices, before their hospital arrival. We propose that clinical research should be initiated to define a population of stroke patients in whom alteplase may be administered preimaging, resulting in a greater benefit than harm and in improved functional outcome compared to deferred, postimaging, alteplase treatment. PMID:27306629

  9. Custo-efetividade da trombólise pré-hospitalar vs intra-hospitalar no infarto agudo do miocárdio Cost-effectiveness of prehospital versus inhospital thrombolysis in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Denizar Vianna Araújo

    2008-02-01

    Full Text Available FUNDAMENTO: Existe evidência de que a trombólise pré-hospitalar melhora os desfechos no infarto agudo do miocárdio (IAM com supradesnivelamento do segmento ST. OBJETIVO: Comparar as relações de custo-efetividade entre trombólise pré-hospitalar e trombólise intra-hospitalar para o IAM com supradesnivelamento do segmento ST, pela perspectiva do Sistema Único de Saúde. MÉTODOS: Modelo analítico de decisão foi utilizado para comparar as duas estratégias. O desfecho do estudo foi "anos de vida ganhos". O uso de recursos e os custos foram estimados pela perspectiva do Sistema Único de Saúde. Árvore de decisão e modelo de Markov foram construídos com resultados de ensaios clínicos publicados. Os custos foram valorados em real (R$, para o ano de 2005. RESULTADOS: Para um horizonte de tempo de vinte anos, a expectativa de vida média com a trombólise pré-hospitalar foi de 11,48 anos e a trombólise intra-hospitalar proporcionou expectativa de vida média de 11,32 anos. Os custos foram de R$ 5.640,00 para a trombólise pré-hospitalar e de R$ 5.816,00 para a trombólise intra-hospitalar. Houve custo adicional de R$ 176,00 por paciente com a trombólise intra-hospitalar. A trombólise pré-hospitalar proporcionou adicional de 0,15 ano de expectativa de vida comparado à trombólise intra-hospitalar. CONCLUSÃO: Esse modelo sugere que, pela perspectiva do Sistema Único de Saúde, implementar a trombólise pré-hospitalar para o IAM com supradesnivelamento do segmento ST pode representar sobrevida extra e menor custo que comparativamente à trombólise intra-hospitalar.BACKGROUND: There is evidence that prehospital thrombolysis improves the outcome in ST-elevation myocardial infarction (STEMI. OBJECTIVE: This study aimed at comparing the cost-effectiveness of prehospital compared to inhospital thrombolysis for STEMI from the National Health System perspective. METHODS: A decision-analytic model was used to compare these two strategies

  10. 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.

  11. 急性高危肺栓塞介入取栓、溶栓中应用 r-tPA 与尿激酶溶栓时间及疗效比较%Comparison of curative effect and thrombolysis time between r-tPA application and urokinase in the interventional thrombectomy and thrombolysis for acute and severe pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    冯琦琛; 李选; 董国祥; 傅军; 王昌明

    2014-01-01

    Objective:To study the influence of r-tPA and urokinase in curative effect and thrombolysis time on patients with acute and severe pulmonary embolism after interventional thrombectomy .Methods:After reviewing and analyzing the clinical data of 19 acute and severe pulmonary embolism patients , we classified them into two groups in accordance with the application of r-tPA and urokinase to compare the changes of their heart rate , blood pressure , pulmonary arterial pressure , arterial partial pressure of oxygen and hemachrome before and after thrombolysis , as well as the thrombolysis effect time the two groups took.Results: The heart rate, blood pressure, pulmonary arterial pressure , arterial partial pressure of oxygen of the patients in both groups gained remarkable improvement after operation ( P0.05); the pulmonary arterial pressure of the urokinase patient group dropped significantly compared with that study before operation ( P0 .05 );the thrombolysis effect time by adop-ting r-tPA was remarkably shorter than that caused in thrombolysis by adopting urokinase ( P<0 .05 ) . Conclusion: Both r-tPA and urokinase are effective in interventional thrombolysis for acute and severe pulmonary embolism .However , r-tPA could significantly shorten the time caused in thrombolysis without increasing any bleeding risk.%目的:探讨急性高危型肺栓塞患者经介入取栓后,应用r-tPA和尿激酶行介入溶栓治疗,对疗效和溶栓时间的影响。方法:回顾性分析19例急性高危型肺栓塞患者的临床资料,根据其应用r-tPA或尿激酶行介入溶栓分为两组,比较两组间溶栓前后心率、血压、肺动脉压、动脉血氧分压和血红蛋白的变化,以及两组的溶栓时间。结果:各组患者术前和术后心率、血压、动脉血氧分压均有明显改善(P<0.05);应用r-tPA组患者术后肺动脉压较术前有所降低,但差异无统计学意义(P>0.05),应用尿激酶组患者术

  12. Multidisciplinary Care.

    Science.gov (United States)

    Daly, Megan E; Riess, Jonathan W

    2016-01-01

    Optimal multidisciplinary care of the lung cancer patient at all stages should encompass integration of the key relevant medical specialties, including not only medical, surgical, and radiation oncology, but also pulmonology, interventional and diagnostic radiology, pathology, palliative care, and supportive services such as physical therapy, case management, smoking cessation, and nutrition. Multidisciplinary management starts at staging and tissue diagnosis with pathologic and molecular phenotyping, extends through selection of a treatment modality or modalities, management of treatment and cancer-related symptoms, and to survivorship and end-of-life care. Well-integrated multidisciplinary care may reduce treatment delays, improve cancer-specific outcomes, and enhance quality of life. We address key topics and areas of ongoing investigation in multidisciplinary decision making at each stage of the lung cancer treatment course for early-stage, locally advanced, and metastatic lung cancer patients. PMID:27535399

  13. The prehospital phase of acute myocardial infarction in the era of thrombolysis.

    Science.gov (United States)

    Schmidt, S B; Borsch, M A

    1990-06-15

    To evaluate the factors affecting the time between symptom onset and hospital arrival in patients with acute myocardial infarction (AMI), we gave a detailed questionnaire to all who were admitted or transferred with AMI from January 1988 to February 1989. In these 126 patients (94 men, 32 women) the mean prehospital time was 5.9 +/- 11.0 hours (median 2.0, range 0.4 to 69.0). The time between symptom onset and reaching a decision that medical care should be sought was 62% of the mean prehospital time. In 100 (79%) patients, the prehospital time was less than or equal to 6 hours; of these, 61 (61%) were retrospectively judged to have been optimal candidates for lytic therapy. Stepwise multiple regression selected the following 4 variables as independent predictors of prehospital time: slow symptom progression; low income; female gender; and advanced age. All of these variables are predictive (p less than 0.03) of increased prehospital time; absence of prior AMI was of borderline additional significance (p = 0.053). Similarly, logistic regression analysis selected slow symptom progression, female gender and low income as significant (p less than or equal to 0.02) independent predictors of prehospital time greater than 6 hours. The logistic regression model incorporating these 3 variables had a sensitivity of 54%, a specificity of 95% and a positive predictive value of 72% in identifying patients with prehospital time greater than 6 hours. Thus, these data indicate it is possible to characterize patients likely to experience undue prehospital delay during AMI, which may be of importance to future public education efforts. PMID:2353644

  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. Mismatch of Low Perfusion and High Permeability Predicts Hemorrhagic Transformation Region in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolysis.

    Science.gov (United States)

    Chen, Hui; Liu, Nan; Li, Ying; Wintermark, Max; Jackson, Alan; Wu, Bing; Su, Zihua; Chen, Fei; Hu, Jun; Zhang, Yongwei; Zhu, Guangming

    2016-01-01

    This study sought to determine whether the permeability related parameter K(trans), derived from computed tomography perfusion (CTP) imaging, can predict hemorrhagic transformation (HT) in patients with acute ischemic stroke who receive intra-arterial thrombolysis. Data from patients meeting the criterion were examined. CTP was performed and K(trans) maps were used to assess the permeability values in HT and non-HT regions. A receiver operating characteristic (ROC) curve was calculated, showing the sensitivity and specificity of K(trans) for predicting HT risk. Composite images were produced to illustrate the spatial correlations among perfusion, permeability changes and HT. This study examined 41 patients. Twenty-six patients had hemorrhagic infarction and 15 had parenchymal hemorrhage. The mean K(trans) value in HT regions was significantly lower than that in the non-HT regions (0.26 ± 0.21/min vs. 0.78 ± 0.64/min; P < 0.001). The ROC curve analysis identified an optimal cutoff value of 0.334/min for K(trans) to predict HT risk. Composite images suggested ischemic regions with low permeability, or the mismatch area of low perfusion and high permeability, more likely have HT. HT regions after intra-arterial thrombolysis had lower permeability values on K(trans) maps. The mismatch area of lower perfusion and higher permeability are more likely to develop HT. PMID:27302077

  16. 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

  17. [Treatment of arterial and venous brain ischemia. Experts' recommendations: stroke management in the intensive care unit].

    Science.gov (United States)

    Calvet, D; Bracard, S; Mas, J-L

    2012-06-01

    With thrombolysis, intravenous alteplase (0.9 mg/kg body weight, maximum 90 mg), with 10% of the dose given as a bolus followed by a 60-minute infusion, is recommended within 4.5 hours of onset of ischemic stroke. When indicated, intravenous thrombolysis must be initiated as soon as possible. It is possible to use intravenous alteplase in patients with seizures at stroke onset, if the neurological deficit is related to acute cerebral ischemia. Intravenous alteplase can be discussed for use on a case-by-case basis, according to risk of bleeding, in selected patients under 18 years and over 80 years of age, although for the current European recommendations this would be an off-label use. In hospitals with a stroke unit, intravenous thrombolysis is prescribed by a neurologist (current French labelling) or a physician having the French certification for neurovascular diseases (outside the current French labelling). The patient must be monitored in the stroke unit or in case of multiple organ failure in an intensive and critical care unit. In hospitals without a stroke unit, thrombolysis must be decided by the neurologist from the corresponding stroke unit via telemedicine. It is recommended to perform brain imaging 24 hours after thromboysis. Intra-arterial thrombolysis can be contemplated on a case-by-case basis after multidisciplinary discussion within a 6-hour time window for patients with acute middle cerebral artery or carotid occlusions, and within a larger time window for patients with basilar artery occlusion, because of their very poor spontaneous prognosis. Mechanical thrombectomy can also be contemplated in the same situations. With antiplatelet agents, it is recommended that patients receive aspirin (160 mg-325 mg) within 48 hours of ischemic stroke onset. When thrombolysis is performed or contemplated, it is recommended to delay the initiation of aspirin or other antithrombotic drugs for 24 hours. The use of antiplatelet agents that inhibit the

  18. Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke.

    Science.gov (United States)

    Hsieh, Fang-I; Jeng, Jiann-Shing; Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

    2016-01-01

    In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States. PMID:27487190

  19. Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke

    Science.gov (United States)

    Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A.; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

    2016-01-01

    In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010–2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006–08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, pcollaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States. PMID:27487190

  20. 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.

  1. 动脉溶栓术后动脉压迫器止血引起皮下血肿的原因及护理策略%The Reason of Subcutaneous Hematoma after Arterial Thrombolysis by Using Arterial Compression Device for hemostasis and Its Nursing Strategy

    Institute of Scientific and Technical Information of China (English)

    杨瑾; 潘慧; 陆晨辉; 曹传武; 钱佳; 张家兴; 李茂全

    2013-01-01

    目的:分析介入溶栓术后应用动脉压迫器压迫股动脉止血引起皮下血肿的原因。方法选择2009年1-8月在我院行下肢股动脉穿刺置管行动脉溶栓术的32例患者作为研究对象。对溶栓术后应用动脉压迫器压迫股动脉穿刺点止血并引起皮下血肿的原因和结果进行观察和分析。结果32例患者术后,应用动脉压迫器常规压迫8.5 h 后,拆除动脉压迫器,未出现皮下血肿22例;因出凝血时间延长,导致皮下血肿3例;因患肢活动导致压迫器位移,引起皮下血肿5例;穿刺点位置过高,致使动脉压迫器固定欠妥,引起皮下血肿2例,所有患者长期随访并未出现功能及行走异常。结论动脉溶栓介入治疗患者术后发生穿刺点皮下血肿的预防,重要的是患者围手术期护理及巡视观察。术前患者的入科宣教和专科知识指导。术后严密周到的观察及有针对性的护理是降低皮下血肿发生率的关键。%Objective To analyze the causes of subcutaneous hematoma after using artery compression device for patients received an interventional procedure of arterial thrombolysis. Methods A total of 32 patients with subcutaneous hematoma were included into the analysis, who had used the artery compression device to compress the femoral artery puncture point after arterial thrombolysis from January 2009 to August 2011. Results All the 32 patients were treated with the artery compression device for routine 8.5 hours after arterial thrombolysis. Twenty-two cases did not manifested subcutaneous hematoma, 3 cases with subcutaneous hematoma were caused by the prolonged clotting time, 5 cases with subcutaneous hematoma were caused by the unexpected movement of the affected limb, which therefore leading to a dislocation of the compression device, 2 cases with subcutaneous hematoma were caused by the higher puncture position, which leading to an unstable ifxing of the compression device

  2. 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.

  3. 介入导管直接溶栓与静脉溶栓并抗凝治疗下肢深静脉血栓的对比研究/%Comparative study between intervention transcatheter direct thrombolysis and vein thrombolysis plus anti-coagulation therapy for treating lower extremity deep venous thrombosis

    Institute of Scientific and Technical Information of China (English)

    徐国建

    2015-01-01

    目的:对比导管直接溶栓和静脉溶栓加抗凝治疗下肢深静脉血栓的临床疗效。方法:选择符合纳入标准的下肢深静脉血栓患者61人,随机分为介入直接溶栓组(30例,介入组)和静脉溶栓+抗凝组(溶栓+抗凝组,31例)。治疗4周为一疗程。结果:介入组总有效率为93.33%,显著高于溶栓+抗凝组的64.52%(χ2=4.987,P =0.032)。两组治疗前血液流变学指标差异无统计学意义(P >0.05)。与治疗前比较,治疗后介入组全血高切粘度、全血低切粘度、血浆粘度及纤维蛋白原水平均显著降低(P 均<0.05);溶栓+抗凝组只有血浆粘度、纤维蛋白原水平显著降低(P 均<0.05);与溶栓+抗凝组比较,治疗后介入组全血低切粘度[(12.10±2.13)mPa·s 比(11.08±1.67)mPa·s]和血浆粘度[(1.85±0.13)mPa·s 比(1.31±0.09)mPa·s]显著降低(P 均<0.05)。治疗后介入组血管开通总有效率为90.00%,显著高于溶栓+抗凝组的61.29%,χ2=4.173,P =0.047。结论:对于急性期深静脉血栓形成并且无手术禁忌证的患者,导管直接溶栓疗效更显著,能明显改善血液流变学和提高血管开通率,可推荐为临床首选。%Objective:To compare the therapeutic effect of intervention transcatheter direct thrombolysis and vein thrombolysis and anti-coagulation drugs on lower extremity deep venous thrombosis (DVT).Methods:A total of 61 patients with lower extremity DVT accorded with inclusion standards were selected.They were randomly divided in-to intervention transcatheter direct thrombolysis group (n=30,intervention group)and vein thrombolysis and anti-coagulation group (n=31,thrombolysis+anti-coagulation group).Patients were treated for four weeks as a course. Results:Total effective rate of intervention group was significantly higher than that of thrombolysis+anti-coagula-tion group (93.33% vs.64.52%),χ2

  4. 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

  5. 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

  6. 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

  7. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  8. 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

  9. 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...

  10. 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.

  11. 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

  12. Thrombolysis in anterior versus posterior circulation strokes: timing of recanalization, ischemic tolerance, and other differences.

    Science.gov (United States)

    Pagola, Jorge; Ribo, Marc; Alvarez-Sabin, José; Rubiera, Marta; Santamarina, Estevo; Maisterra, Olga; Delgado-Mederos, Raquel; Ortega, Gemma; Quintana, Manuel; Molina, Carlos A

    2011-04-01

    Previous studies have suggested a greater ischemic tolerance in posterior circulation as compared to anterior cerebral circulation. We aimed to investigate whether a differential response exists between anterior and posterior circulation strokes. Two hundred and four middle cerebral artery (MCA) patients and 28 basilar artery occlusion (BAO) patients treated with intravenous recombinant tissue plasminogen activator were included. Transcranial Doppler assessed recanalization at different time points. Patients were divided in three groups: total time of ischemia (TTI)24 hours. We calculated the percentage of recovery (admission National Institutes of Health Stroke Scale [NIHSS]- discharge NIHSS/admission NIHSS)×100. Mean time to treatment was longer in BAO patients (P=.031). Early recanalization was more frequent among MCA occlusions (41% vs 29%; P=.039); the rate of persisting occlusion at 24 hours was similar (P=.933). Clinical recovery according to TTI was similar in each group: 24 hours: BAO -44%/MCA 11% (P=.23). For each hour of ischemia MCA patients worsened 1.78% (P=.035) and BAO 1.76% (P=.421). MCA occlusions compared to BAO were independently associated with hemorrhagic transformation (OR: 8.2; P=.043). Our data do not support the theory of increased ischemic tolerance in posterior circulation. Despite longer time-to-treatment, BAO were more resistant to hemorrhagic transformations. PMID:20040010

  13. Laser mass ablation efficiency measurements indicate bubble-driven dynamics dominates laser thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Godwin, R.P.; Chapyak, E.J. [Los Alamos National Lab., NM (United States). Applied Theoretical and Computational Physics Div.; Prahl, S.A.; Shangguan, H.Q. [Providence St. Vincent Hospital, Portland, OR (United States). Oregon medical Laser Center

    1998-03-01

    Mass removal experiments have been performed at the Oregon Medical Laser Center with 10 to 100 mJ 1 {micro}s laser pulses at optical wavelengths. Above the energy threshold for bubble formation, the laser mass ablation efficiency ({micro}g/mJ) for removal of gel surrogate thrombus is nearly constant for a given experimental geometry and gel absorption coefficient. The efficiency in contact experiments, in which the optical fiber delivering the energy is in close proximity to the absorbing gel, is approximately three times that of non-contact experiments, in which the optical fiber is {approximately}1 mm from the gel. Mass removal occurs hundreds of microseconds after the laser deposition. Experimental data and numerical simulations are consistent with the hypothesis that jet formation during bubble collapse plays a dominant role in mass removal. This hypothesis suggests a model in which the mass removed scales linearly with the maximum bubble volume and explains the distinctive features, including the magnitude, of the mass removal.

  14. Maternal care

    OpenAIRE

    2001-01-01

    In June 2000 a distinguished group of obstetricians, midwives, general practitioners, and medical statisticians came together to discuss maternal care. Chaired by Professor James Drife from Leeds, discussion ranged over many topics, including: the changing role of the obstetrician, general practitioners, and the increasing status and responsibility of midwives. Other subjects include the induction of labour, obstetric analgesia and anaesthesia, and debates about the place and kind of delivery...

  15. Intravenous thrombolysis in acute ischemic stroke patients with negative CT perfusion: a case series

    International Nuclear Information System (INIS)

    Computed tomography perfusion (CTP) is a commonly used modality of neurophysiologic imaging to aid the selection of acute ischemic stroke patients for neuroendovascular intervention by identifying the presence of penumbra versus infarcted brain tissue. However many patients present with evidence of cerebral ischemia with normal CTP, and in that case, should intravenous thrombolytics be given? To demonstrate if tissue-type plasminogen activator (tPA)-eligible stroke patients without perfusion defects demonstrated on CTP would benefit from administration of intravenous thrombolytics. We retrospectively identified patients presenting with acute ischemic symptoms who received intravenous tPA (IV-tPA) from January to June 2012 without a perfusion defect on CTP. Clinical and radiographic findings including the NIHSS at presentation, 24 h, and at discharge, symptomatic and asymptomatic hemorrhagic transformation, and the modified Rankin score at 30 days were collected. A reduction of NIHSS of greater than 4 points or resolution of symptoms was considered significant. Seventeen patients were identified with a mean NIHSS of 8.2 prior to administration of intravenous thrombolytics, 3.5 after 24 h, and 2.5 at discharge. Among them, 13 patients had significant improvement of NIHSS with a mean reduction of 6.15 points at 24 h. One patient initially improved but had delayed hemorrhagic transformation and died. Two patients had improvement in NIHSS but were not significant and two patients had increased in NIHSS at 24 h, although one eventually improved at discharge. There was no asymptomatic hemorrhagic transformation. Mean mRS at 3 months is 1.76. The failure to identify a perfusion deficit by CTP should not be used as a contraindication for intravenous thrombolytics. Criteria for administration of intravenous thrombolytics should still be based on time from symptom onset as previously published by NINDS

  16. Impact of cardiac care variation on ST-elevation myocardial infarction outcomes in Malaysia.

    Science.gov (United States)

    Selvarajah, Sharmini; Fong, Alan Y Y; Selvaraj, Gunavathy; Haniff, Jamaiyah; Hairi, Noran N; Bulgiba, Awang; Bots, Michiel L

    2013-05-01

    Developing countries face challenges in providing the best reperfusion strategy for patients with ST-segment elevation myocardial infarction because of limited resources. This causes wide variation in the provision of cardiac care. The aim of this study was to assess the impact of variation in cardiac care provision and reperfusion strategies on patient outcomes in Malaysia. Data from a prospective national registry of acute coronary syndromes were used. Thirty-day all-cause mortality in 4,562 patients with ST-segment elevation myocardial infarctions was assessed by (1) cardiac care provision (specialist vs nonspecialist centers), and (2) primary reperfusion therapy (thrombolysis or primary percutaneous coronary intervention [P-PCI]). All patients were risk adjusted by Thrombolysis In Myocardial Infarction (TIMI) risk score. Thrombolytic therapy was administered to 75% of patients with ST-segment elevation myocardial infarctions (12% prehospital and 63% in-hospital fibrinolytics), 7.6% underwent P-PCI, and the remainder received conservative management. In-hospital acute reperfusion therapy was administered to 68% and 73% of patients at specialist and nonspecialist cardiac care facilities, respectively. Timely reperfusion was low, at 24% versus 31%, respectively, for in-hospital fibrinolysis and 28% for P-PCI. Specialist centers had statistically significantly higher use of evidence-based treatments. The adjusted 30-day mortality rates for in-hospital fibrinolytics and P-PCI were 7% (95% confidence interval 5% to 9%) and 7% (95% confidence interval 3% to 11%), respectively (p = 0.75). In conclusion, variation in cardiac care provision and reperfusion strategy did not adversely affect patient outcomes. However, to further improve cardiac care, increased use of evidence-based resources, improvement in the quality of P-PCI care, and reduction in door-to-reperfusion times should be achieved.

  17. 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.

  18. Progressive Care of Obese Patients.

    Science.gov (United States)

    Dambaugh, Lori A; Ecklund, Margaret M

    2016-08-01

    Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36[4]:58-63). PMID:27481802

  19. 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...

  20. 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...

  1. Phlegmasia Caerulea Dolens in a Patient With an Inferior Vena Cava Filter: Treatment of Massive Iliocaval Thrombosis Using Local Intravenous Catheter-Directed Thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Cookson, Daniel, E-mail: danielthomascookson@yahoo.co.uk [Middlemore Hospital, Department of Radiology (New Zealand); Caldwell, Stuart, E-mail: stuart.caldwell@middlemore.co.nz [Middlemore Hospital, Department of Vascular Surgery (New Zealand)

    2012-10-15

    Phlegmasia caerulea dolens (PCD) is a potentially disastrous complication of inferior vena cava filter insertion, and its optimum management has not been clearly established. We present a case report of a patient with pulmonary embolism and acute adrenal haemorrhage who developed PCD secondary to massive iliocaval thrombosis after insertion of a Cook Celect removable filter. Local intravenous catheter-directed thrombolysis (CDT), followed by systemic anticoagulation, achieved limb salvage and virtual resolution of symptoms at 3 months without complications. CDT can be a successful primary treatment of filter-associated PCD and can be safe in selected patients with acute nontraumatic haemorrhage. Systemic anticoagulation may subsequently restore complete venous patency and may therefore be a useful approach to postthrombolysis management of residual iliocaval thrombus when filter removal is indicated.

  2. 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.

  3. Pre- and in-hospital intersection of stroke care.

    Science.gov (United States)

    Meretoja, Atte; Kaste, Markku

    2012-09-01

    Acute ischemic stroke is a time-critical emergency for which thrombolytic therapy is the only medical treatment. Many patients who would benefit from this treatment are deprived of it due to delays. Failure to call for help rapidly is the main obstacle, but even when the call is made in time, the prehospital evaluation, transportation, and emergency department (ED) diagnostics often take too long to treat the patient with thrombolysis. Interventions to reduce pre- and in-hospital delays have been described; although no single intervention is likely to make a major difference, a whole set of interventions needs to be implemented. The intersection of the pre- and in-hospital care is of special importance. With successful protocols and good communication between the emergency medical service and ED, delays can be significantly reduced. On the basis of our experience, 94% of patients can be treated within 60 min of arrival, based largely on using the prehospital time effectively. PMID:22994234

  4. Catheter-Directed Thrombolysis

    Science.gov (United States)

    ... a specially trained interventional radiologist in an interventional radiology suite or occasionally in the operating room. You ... page Additional Information and Resources Society of Interventional Radiology (SIR) - Patient Section top of page This page ...

  5. 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.

  6. Penumbra Stroke System as an ''add-on'' for the treatment of large vessel occlusive disease following thrombolysis: first results

    Energy Technology Data Exchange (ETDEWEB)

    Struffert, Tobias; Engelhorn, Tobias; Richter, Gregor; Doerfler, Arnd [University of Erlangen-Nuremberg, Department of Neuroradiology, Erlangen (Germany); Koehrmann, Martin; Nowe, Tim; Schellinger, Peter D.; Schwab, Stefan [University of Erlangen-Nuremberg, Department of Neurology, Erlangen (Germany)

    2009-09-15

    The Penumbra Stroke System (PSS) was cleared for use in patients with ischemic stroke by the FDA in January 2008. We describe our experience of using this new system in acute large vessel occlusive disease following thrombolysis. Fifteen consecutive patients (mean age 60 years) suffering from acute ischemic stroke were treated with the PSS after intravenous or intra-arterial standard treatment with tissue plasminogen activator (n = 14) or ReoPro (n = 1). All patients presented with TIMI 3 before use of the PSS. Carotid stenting (n = 3) and intracranial balloon angioplasty or stenting (n = 2) were performed if indicated. Neurological evaluation was performed using the NIHSS score and the mRS score. Initial median NIHSS score in 12 patients with occlusions in the anterior circulation was 15; three patients with basilar artery occlusion presented with coma. Median symptom to procedure start time was 151 min. In the anterior circulation, 9 of the 12 target vessels were recanalised successfully (TIMI 2 and 3). The rate of patients with independent clinical outcome (mRS {<=} 2) was 42%. One patient died 5 days after unsuccessful treatment, one after 28 days and one after 85 days owing to heart attack. Basilar artery occlusions could be recanalised in all cases to TIMI 3. The clinical result after 90 days was mRS 4 in two cases and mRS 5 in one case. Symptomatic haemorrhage did not occur. The PSS can safely be used for recanalisation in patients with acute ischemic stroke due to large vessel occlusion, who have already received thrombolysis treatment. The recanalisation rate was 80%. Symptomatic haemorrhage did not occur. Randomized trials may demonstrate that endovascular mechanical thrombectomy improves patient outcome. (orig.)

  7. 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...

  8. Changes and prognosis of quantitative electroencephalograph for rt-PA intravenous thrombolysis in cerebral infarction patient%rt-PA静脉溶栓治疗脑梗死患者定量脑电图变化与预后

    Institute of Scientific and Technical Information of China (English)

    杨娟; 赵晓晖; 白青科; 隋海晶

    2015-01-01

    activator(rt-PA) in patients with cerebral infarction. Methods A total of 76 ischemic stroke patients onset time within 4.5-hour were enrolled, which included 39 males and 37 females, aged 51-79 years old with mean age of 60.0 years old. The rt-PA intravenous thrombolysis was performed, and the scores before treatment and 2-hour, 24-hour, 7-day, 14-day and 90-day after treatment were observed by QEEG and evaluated with United States National Institutes of Health Stroke Scale(NIHSS). The brain symmetry index(BSI) of electroencephalograph,δ+θandα+βwave ratio(DTABR) were observed. Accorded to NIHSS score, patients with rt-PA treatment were divided into 2 groups, which were improvement group(NIHSS score improved at 14-day) and non-improvement group. Results The changes of NIHSS score in 2 groups showed that: there was statistical significant difference of NIHSS score at 7-day between 2 groups. The NIHSS score in improvement group was better than that in non-improvement group. Importantly, the changes of NIHSS score in improvement group was better at 7-day than 24-hour, but it was no change in non-improvement group(P<0.01). There was statistical significant difference of NIHSS score at 90-day between 2 groups, and the score in improvement group was better than that in non-improvement group ( P<0.01). The changes of electroencephalograph in 2 groups showed that:the changes of BSI in improvement group was better at 24-hour and DTABR at 7-day (P<0.01). In non-improvement group, BSI and DTABR were deteriorated at 24-hour but BSI improved at 7-day and DTABR improved at 14-day. The NIHSS score of patients with effective thrombolysis was improved significantly at 7-day and sustained remission to 90-day. The sooner NIHSS score improvement of rt-PA intravenous thrombolysis, the better prognosis at 90-day. The sooner BSI and DTABR improvement, the better NIHSS score, but NIHSS score improved more lately in early deterioration BSI and DTABR. Conclusion It is demonstrated that the

  9. Evaluation of right heart function by echocardiography after thrombolysis in patients with acute pulmonary embolism%超声心动图评价急性肺栓塞患者溶栓前后右心功能指标

    Institute of Scientific and Technical Information of China (English)

    解东兴; 史妍; 郑琨; 刘慧林; 邓晓蕴

    2012-01-01

    目的 采用超声心动图测量急性肺栓塞患者溶栓前后右心功能指标以评价溶栓效果.方法 80例急性肺栓塞患者均接受溶栓治疗.溶栓前和溶栓后24 h采用超声心动图检查患者右心室前壁厚度(RVAWT)、右心室舒张末期前后径(RVED)、主肺动脉内径(PAD)、右心室舒张期横径(RVDD)、右心房舒张期横径(RADD)、三尖瓣反流压差(TRPG)及肺动脉收缩压(SPAP).结果 80例急性肺栓塞患者溶栓后RVAWT、RVED、PAD、RVDD、TRPG、SPAP分别为(4.23±1.02)mm、(26.20±3.01) mm、(26.67±2.36)mm、(36.23±4.36)mm、(31.68±2.33)mm Hg(1 mm Hg=0.133 kPa)、(37.52±3.20)mm Hg,较溶栓前的(7.56±1.22)mm、(31.78±3.26)mm、(29.44±2.20)mm、(40.20±5.01)mm、(48.98±3.80) mm Hg、(57.25±4.23)mm Hg均降低,且差异均有统计学意义(t值分别为3.01、2.78、2.35、2.75、2.98、3.55,P均<0.01或0.05);溶栓后患者RADD为(37.55±5.25)mm,与溶栓前的(38.25±4.25)mm比较差异无统计学意义(t=1.32,P=0.18).结论 超声心动图对急性肺栓塞患者溶栓前后右心功能评价有重要意义.溶栓治疗可改善急性肺栓塞患者右心功能.%Objective To evaluate the effect of thrombolysis through measuring right heart function index in patients with acute pulmonary embolism by ultrasound examination. Methods A total of 42 patients with acute pulmonary embolism were performed echocardiography before and after thrombolytic therapy . And the following indexed were measured, including right ventricular anterior wall thickness ( RVAWT ), right ventricular end-diastolic( RVED ), pulmonary artery diameter ( PAD ), right ventricular diastolic diameters ( RVDD ), right atrium diastolic diameters ( RADD ), tricuspid regurgitant pressure gradient( TRPG ) and systolic pulmonary artery pressure ( SPAP ). Results Between the value obtained before and then after thrombolysis,there were significant difference for RVAWT [ ( 4. 23 ±1. 02 )mm vs ( 7. 56 ± 1. 22 )mm ) ], RVED[ ( 26

  10. Just caring.

    Science.gov (United States)

    Hussey, Trevor

    2012-01-01

    Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: 'Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.' This thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. PMID:22176544

  11. Integrating palliative care into comprehensive cancer care.

    Science.gov (United States)

    Abrahm, Janet L

    2012-10-01

    While there are operational, financial, and workforce barriers to integrating oncology with palliative care, part of the problem lies in ourselves, not in our systems. First, there is oncologists' "learned helplessness" from years of practice without effective medications to manage symptoms or training in how to handle the tough communication challenges every oncologist faces. Unless they and the fellows they train have had the opportunity to work with a palliative care team, they are unlikely to be fully aware of what palliative care has to offer to their patients at the time of diagnosis, during active therapy, or after developing advanced disease, or may believe that, "I already do that." The second barrier to better integration is the compassion fatigue many oncologists develop from caring for so many years for patients who, despite the oncologists' best efforts, suffer and die. The cumulative grief oncologists experience may go unnamed and unacknowledged, contributing to this compassion fatigue and burnout, both of which inhibit the integration of oncology and palliative care. Solutions include training fellows and practicing oncologists in palliative care skills (eg, in symptom management, psychological disorders, communication), preventing and treating compassion fatigue, and enhancing collaboration with palliative care specialists in caring for patients with refractory distress at any stage of disease. As more oncologists develop these skills, process their grief, and recognize the breadth of additional expertise offered by their palliative care colleagues, palliative care will become integrated into comprehensive cancer care. PMID:23054873

  12. 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

  13. Care for the Health Care Provider.

    Science.gov (United States)

    Kunin, Sharon Brown; Kanze, David Mitchell

    2016-03-01

    Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning. PMID:26900113

  14. 溶栓药物在肢体缺血治疗中的地位及评价%The status and value of thrombolysis drugs in the treatment of limb ischemia

    Institute of Scientific and Technical Information of China (English)

    黄晓钟; 张纪蔚

    2011-01-01

    Artery thromboembolism of limbs accouts for a large proportion in peripheral vascular diseases with high morbidity and mortality. It could harm the preservation of limbs and human health. Fibrinolytic therapy is one of the most important ways of the treatment. In recent years thrombolysis drug use and research have made a lot of progress. Concentrated in two ways: (1) Deep and further understanding of the traditional thrombolysis drugs, achieveing the precise use. (2) New thrombolysis drugs success to fibrinolytic therapy bring new opportunities.%肢体动脉血栓在周围血管疾病中占很大比例,并以其高发病率、致残率和病死率严重危害人类健康,溶栓疗法是目前最重要的治疗方法之一.近年来溶栓药物的使用与研究有了很大的进展,主要集中在两大方面:(1)对传统溶栓药物的进一步深刻了解,并对其精确使用;(2)新型溶栓药物的研究成功,如通过生物技术改造的新型纤溶酶原激活剂、新型经改造的天然来源溶栓药,给溶栓治疗带来新的契机.

  15. 导管接触溶栓治疗深静脉血栓形成的研究进展%The Research Progress of Catheter-directed Thrombolysis in the Treatment of Deep Venous Thrombosis

    Institute of Scientific and Technical Information of China (English)

    姜振; 张玥; 颜征

    2016-01-01

    In recent years,the incidence of deep venous thrombosis is increasing.With the development of interventional technology,catheter-directed thrombolysis is an important way to promote the development of thrombosis.In the past few years,the research of catheter directed thrombolysis is reviewed in this paper.The feasibility,effectiveness and safety of catheter directed thrombolysis were discussed from four aspects:the way of thrombolytic therapy,the application of thrombolytic therapy,the application of thrombolytic agents and the complications.%近年来深静脉血栓形成的发病率不断攀升,随着介入技术的发展,导管接触溶栓因其微创、高效而成为促进血栓再通的重要方式。现将近几年学者针对导管接触溶栓的研究进行综述,从溶栓途径、溶栓入路、溶栓药物的应用及并发症四个方面探讨导管接触溶栓治疗的可行性、有效性及安全性。

  16. 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.

  17. Should thrombolytic therapy be administered in the mobile intensive care unit in patients with evolving myocardial infarction? A pilot study.

    Science.gov (United States)

    Roth, A; Barbash, G I; Hod, H; Miller, H I; Rath, S; Modan, M; Har-Zahav, Y; Keren, G; Bassan, S; Kaplinsky, E

    1990-04-01

    The growing recognition of the importance of early thrombolysis in evolving myocardial infarction was the basis for the present study, which evaluated the effectiveness, feasibility and safety of prehospital thrombolytic therapy. In a relatively small study, 118 patients were allocated to receive either prehospital treatment with recombinant tissue-type plasminogen activator (rt-PA) in the mobile intensive care unit (group A, 74 patients) or hospital treatment (group B, 44 patients). A total of 120 mg of rt-PA was infused over a period of 6 h. All patients were fully heparinized and underwent radionuclide left ventriculography and coronary angiography during hospitalization. Although group A was treated significantly earlier than group B after onset of symptoms (94 +/- 36 versus 137 +/- 45 min, respectively; p less than 0.001), no significant differences were observed between the groups in 1) extent of myocardial necrosis, 2) global left ventricular ejection fraction at discharge, 3) patency of infarct-related artery, 4) length of hospital stay, and 5) mortality at 60 days. However, a trend to a lower incidence of congestive heart failure at hospital discharge was observed in the prehospital-treated compared with the hospital-treated group (7% versus 16%, respectively; p = NS). No major complications occurred during transportation. It is concluded that myocardial infarction can be accurately diagnosed and thrombolytic therapy initiated relatively safely during the prehospital phase by the mobile intensive care team, thus instituting a beneficial clinical trend in favor of prehospital thrombolysis. PMID:2107239

  18. Prenatal Care

    Science.gov (United States)

    ... am thinking about getting pregnant. How can I take care of myself? You should start taking care of ... What should I do — or not do — to take care of myself and my unborn baby? Follow these ...

  19. Critical Care

    Science.gov (United States)

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

  20. Self Care

    Science.gov (United States)

    ... Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic ... help you cope can make a real difference. Self-care techniques are things you can do for ...

  1. Construction and evaluation of Fe₃O₄-based PLGA nanoparticles carrying rtPA used in the detection of thrombosis and in targeted thrombolysis.

    Science.gov (United States)

    Zhou, Jun; Guo, Dajing; Zhang, Yu; Wu, Wei; Ran, Haitao; Wang, Zhigang

    2014-04-23

    Thrombotic disease is extremely harmful to human health, but early detection and treatment can help improve prognoses and reduce mortality. To date, few studies have used MR molecular imaging in the early detection of thrombi and in the dynamic monitoring of the thrombolytic efficiency. In this article, we construct Fe3O4-based poly(lactic-co-glycolic acid) (PLGA) nanoparticles to use in the detection of thrombi and in targeted thrombolysis using MRI monitoring. Cyclic arginine-glycine-aspartic peptide (cRGD) was grafted onto the chitosan (CS) surface to synthesize a CS-cRGD film using carbodiimide-mediated amide bond formation. A double emulsion solvent evaporation method (water in oil in water [W/O/W]) was used to construct Fe3O4-based PLGA nanoparticles carrying recombinant tissue plasminogen activator (rtPA) (Fe3O4-PLGA-rtPA/CS-cRGD). Fe3O4-PLGA, Fe3O4-PLGA-rtPA, and Fe3O4-PLGA-rtPA/CS nanoparticles were constructed using the same W/O/W method. The results showed that the Fe3O4-based nanoparticles were constructed successfully and have a regular shape, a relatively uniform size, a high carrier rate of Fe3O4 and encapsulation efficiency of rtPA, and a relatively high activity of released rtPA. Transmission electron microscope (TEM) images revealed that the iron oxide particles were relatively uniformly distributed in the nano-spherical shell. The Fe3O4-based nanoparticles could be imaged using a clinical MRI scanner, and there were no significant differences in the transverse relaxation rate (R2*) or in the signal-to-noise ratio (SNR) values between the Fe3O4-based nanoparticles and an Fe3O4 solution with the same concentration of Fe3O4. In vitro and in vivo experiments confirmed that the Fe3O4-PLGA-rtPA/CS-cRGD nanoparticles specifically accumulated on the edge of the thrombus and that they had a significant effect on the thrombolysis compared with the Fe3O4-PLGA, Fe3O4-PLGA-rtPA, and Fe3O4-PLGA-rtPA/CS nanoparticles and with free rtPA solution. These results

  2. 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. PMID:18840233

  3. 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.

  4. Update on acute endovascular and surgical stroke treatment

    DEFF Research Database (Denmark)

    Kondziella, D; Cortsen, M; Eskesen, V;

    2013-01-01

    Emergency stroke care has become a natural part of the emerging discipline of neurocritical care and demands close cooperation between the neurologist and neurointerventionists, neurosurgeons, and anesthesiologists. Endovascular treatment (EVT), including intra-arterial thrombolysis, mechanical...... thrombectomy and angioplasty/stenting, is under rapid development. Although EVT has yet to be shown in randomized controlled trials to improve clinical outcome compared to intravenous thrombolysis, it is far better in achieving recanalization of occluded large cerebral vessels, which is crucial for rescuing...

  5. 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

  6. 256层螺旋CT在肺动脉栓塞诊断及溶栓治疗效果评价%Evaluation of Diagnosis and Thrombolysis Effect on Pulmonary Embolism by 256 Slice Spiral Computed Tomography

    Institute of Scientific and Technical Information of China (English)

    周涛; 潘爱珍

    2015-01-01

    Objective To Evaluation of diagnosis and thrombolysis effect on pulmonary embolism by 256 slice spiral computed Tomography.Methods 33 patients were analyzed with pulmonary embolism 256 slice spiral CT pulmonary angiography, including 18 cases who were reviewed after thrombolytic therapy.Results 215 embolism pulmonary artery were detected in the group of 33 patients.They located in respectively the pulmonary artery: left/right pulmonary artery: lobe pulmonary artery: period of pulmonary artery branch: the period of the pulmonary artery = 3:35:40:114-23. Meanwhile, there were 25 cases of bilateral pulmonary embolism, 8 cases of unilateral pulmonary embolism, and only 18 cases turned up the presence of pulmonary intravascular filling defect to dissolution or disappear in some extent after thrombolytic therapy.Conclusion MSCTA can be a kind of fast safe and effective inspection method to clearly show the shape, size and range which are formed by endovascular thrombosis embolism, and has important clinical value to diagnose of PE guiding treatment and judging curative effect.%目的:探讨256层螺旋CT(iCT)在肺动脉栓塞的诊断和溶栓效果评价的应用价值。方法分析33例肺动脉栓塞患者的256层螺旋CT肺动脉造影资料,其中18例溶栓治疗后复查。结果本组33例患者,共发现栓塞肺动脉215支,分别为肺动脉干:左/右肺动脉:叶肺动脉:段肺动脉支:亚段肺动脉=3:35:40:114:23支。25例双侧肺动脉栓塞,8例仅单侧肺动脉栓塞;18溶栓治疗后复查肺动脉血管内充盈缺损均有不同程度缩小或消失。结论256层螺旋CT肺动脉造影能清晰显示栓塞血管内血栓的形态、大小、范围,是一种快速安全有效的检查方法,在PE的诊断、指导治疗及判断疗效方面具有重要临床应用价值。

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

    OpenAIRE

    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 a...

  8. 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.)

  9. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Letsch, Suzanne W.

    1993-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  10. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Cowan, Cathy A.

    1992-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  11. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Sensenig, Arthur L.

    1994-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  12. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Sivarajan, Lekha

    1993-01-01

    This regular feature of the journal includes a discussion of each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avail...

  13. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Sensenig, Arthur L.; Heffler, Stephen K.

    1995-01-01

    This regular feature of the journal includes a discussion of each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avail...

  14. Health Care Indicators

    OpenAIRE

    Maple, Brenda T.; Cowan, Cathy A.; Donham, Carolyn S.; Letsch, Suzanne W.

    1991-01-01

    This regular feature of the journal includes a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of...

  15. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Sensenig, Arthur L.; Heffler, Stephen K.

    1995-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  16. Health Care Indicators

    OpenAIRE

    Cowan, Cathy A.; Donham, Carolyn S.; Letsch, Suzanne W.; Maple, Brenda T.; Lazenby, Helen C.

    1992-01-01

    This regular feature of the journal includes a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of...

  17. 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...

  18. 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.

  19. Do We Value Caring?

    Science.gov (United States)

    Weissbourd, Richard; Anderson, Trisha Ross

    2016-01-01

    When asked about their child-rearing priorities, parents in the United States are likely to say it's more important to raise children who are caring than to raise high achievers. Schools, too, typically trumpet values such as caring, honesty, and fairness. These values are posted on walls, reiterated in assemblies, and included in mission…

  20. Health Care Waste Management

    OpenAIRE

    World Bank

    2003-01-01

    Health care waste management (HCWM) is a process to help ensure proper hospital hygiene and safety of health care workers and communities. It includes planning and procurement, construction, staff training and behavior, proper use of tools, machines and pharmaceuticals, proper disposal methods inside and outside the hospital, and evaluation. Its many dimensions require a broader focus than ...

  1. 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 ...

  2. 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....

  3. Caring for the caregiver.

    Science.gov (United States)

    2008-01-01

    Caring for the Caregiver is information for persons helping to care for people with cancer. The emphasis is on what caregivers can do to help themselves at this stressful time. Topics included are: Who Is a Caregiver, Your Feelings, Asking For Help, Caring for Yourself, Going With Your Loved One to Medical Visits, Talking With Others, Remember, Other Resources for Caregivers. The information is written on a basic level and it is very suitable for health professionals to share with persons helping to care for family members or friends who have cancer. The National Cancer Institute posted this information on its website last June 29. PMID:19062356

  4. Trombólise intra-arterial pulmonar no pós-operatório de clipagem de aneurisma cerebral: relato de caso Intra-arterial pulmonary thrombolysis at the postoperative period of brain aneurysm clamping: case report

    Directory of Open Access Journals (Sweden)

    Salomón Soriano Ordinola Rojas

    2008-09-01

    Full Text Available O tromboembolismo pulmonar (TEP é uma importante causa de morbimortalidade nos pacientes submetidos a procedimentos neurocirúrgicos. O objetivo deste estudo foi apresentar um caso de trombólise intra-arterial pulmonar em pós-operatório recente de neurocirurgia. Paciente do sexo masculino, sendo submetido a clipagem de aneurisma de artéria comunicante anterior, apresentou como complicação no sétimo dia de pós-operatório, tromboembolismo pulmonar maciço, apresentando instabilidade hemodinâmica, sendo optado pela trombólise intra-arterial pulmonar com alteplase. Apresentou evolução satisfatória, sem complicações hemorrágicas, recebendo alta hospitalar. O tromboembolismo pulmonar é uma condição com alta morbi-mortalidade no pós-operatório de neurocirurgia, devendo ser a trombólise ser uma alternativa terapêutica nos casos refratários ao tratamento clínico.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.

  5. Tracheostomy care

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000076.htm Tracheostomy care To use the sharing features on this ... through your nose and mouth. Caring for Your Tracheostomy Once the hole in your neck is not ...

  6. Daily Care

    Science.gov (United States)

    ... to Know Online Tools Enhancing Daily Life Daily Plan Activities Communication Food & Eating Music & Art Personal Care Incontinence Bathing ... Tweet Email | Print Create a Daily Routine Daily Plan Activities Communication Food/Eating Get Tips on Personal Care Bathing ...

  7. Continuing Care

    Science.gov (United States)

    ... Care Obesity at Midlife May Speed Alzheimer’s Onset Hello from my mom Easing the Behavior Problems of ... Managers Continuing Care FOR MORE ARTICLES CLICK HERE Hello from my mom Common Estate Planning Errors Alzheimer’s ...

  8. 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.

  9. Community-Based Care

    Science.gov (United States)

    ... respite care, transportation, medication coverage, rehabilitation (including maintenance physical and occupational therapy ), hearing aids, eyeglasses, and a variety of other benefits. The program also has the flexibility to pay ...

  10. Skin Care and Aging

    Science.gov (United States)

    ... page please turn Javascript on. Skin Care and Aging How Aging Affects Skin Your skin changes with age. It ... if they bother you. See additional resources on aging skin, including information on treatment options, specific conditions, ...

  11. 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...... the focus to reflect everyday practices would foster better targeted public health campaigns. This article is based on our participation in FINE, a multidisciplinary Danish research project. The core methodology of FINE was a randomised controlled trial in which 61 moderately overweight men were put...... 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...

  12. 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.

  13. Observation and nursing of early thrombolysis treatment of acute cerebral infarction%超早期溶栓治疗急性脑梗塞的观察与护理

    Institute of Scientific and Technical Information of China (English)

    朱银花; 阚鲁; 孙敏; 石爱梅; 吴小新

    2012-01-01

      目的观察超早期溶栓治疗急性脑梗塞的疗效与护理方法.方法将80例急性脑梗塞患者随机分为两组,对照组50例患者予以扩容,改善脑部循环,营养神经等对症支持治疗;溶栓组30例在对症治疗基础上予以超早期溶栓治疗.结果溶栓组神经功能缺损程度评分较对照组改善,两组比较有极显著性差异(P0.05).结论超早期溶栓治疗急性脑梗塞效果显著,能明显降低致残率,提高患者的生活质量.在溶栓过程中严密观察病情,预防和及时处理并发症,是顺利完成溶栓治疗的保证.%  Objective: To observe the effectiveness of the reorganization type tissue plasminogen activator(rt-PA) treatment of acute cerebral infarction(ACI) and nursing. Methods:80 patients were randomly divided into two groups, fluid expansion, improving cerebral circulation and nourishing brain cel treatment were applied in the controlgroup(n=50) and on the basis of it, rt-PAwas used in the thrombolysis group (n=30). Results: The neurologic impairment score was improved in the thrombolysis group than that in the control group (P0.05). Conclusion: Thrombolysis of ACI is satisfied and can clearly shorten the course of disease and reduce disability and improve the quality of life of patients. It is very important in the process of thrombolysis that observing closely to provent the complications.

  14. 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

  15. Why Should We Care about Child Care? [Video].

    Science.gov (United States)

    Families and Work Inst., New York, NY.

    Produced as a touchstone for the White House Conference on Child Care, this brief video (5 minutes) presents a collage of voices speaking on the need for quality child care. The voices include those of parents, physicians and child development experts, and child care workers. Among the threads touched upon by these voices are working mothers, the…

  16. The effect of out of hours presentation with acute stroke on processes of care and outcomes: analysis of data from the Stroke Improvement National Audit Programme (SINAP.

    Directory of Open Access Journals (Sweden)

    James T P Campbell

    Full Text Available BACKGROUND: There is inconsistent evidence that patients with stroke admitted to hospital out of regular working hours (such as weekends experience worse outcomes. We aimed to identify if inequalities in the quality of care and mortality exist in contemporary stroke care in England. METHODS: SINAP is a prospective database of acute stroke patients, documenting details of processes of care over the first 72 hours. We compared quality of care indicators and mortality at 72 hours, 7 days and 30 days, for patients who arrived within normal hours (Monday-Friday 8am to 6pm and for those who arrived out of hours, using multivariable logistic and Cox proportional hazard models. Quality of care was defined according to time from arrival at hospital to interventions (e.g., brain scan, and whether the patient received therapeutic interventions (such as thrombolysis. RESULTS: 45,726 stroke patients were admitted to 130 hospitals in England between 1 April 2010 and 31 January 2012. Patients admitted out of hours (n = 23779 had more features indicative of worse prognosis (haemorrhagic stroke, reduced consciousness, pre stroke dependency. Out of hours admission was significantly associated with longer delays in receiving a CT scan or being admitted to a stroke unit, and reduced odds of receiving thrombolysis. After adjusting for casemix, there was no consistent evidence of higher mortality for patients admitted out of hours, but patients admitted at the weekends had a higher risk of 30 day mortality (OR 1.14, 95% CI 1.06-1.21. CONCLUSION: Inequalities in the provision of stroke care for people admitted out of regular hours persist in contemporary stroke in England. The association with mortality is small and largely attributable to higher illness severity in patients admitted out of hours.

  17. Outbreaks in Health Care Settings.

    Science.gov (United States)

    Sood, Geeta; Perl, Trish M

    2016-09-01

    Outbreaks and pseudo-outbreaks in health care settings can be complex and should be evaluated systematically using epidemiologic tools. Laboratory testing is an important part of an outbreak evaluation. Health care personnel, equipment, supplies, water, ventilation systems, and the hospital environment have been associated with health care outbreaks. Settings including the neonatal intensive care unit, endoscopy, oncology, and transplant units are areas that have specific issues which impact the approach to outbreak investigation and control. Certain organisms have a predilection for health care settings because of the illnesses of patients, the procedures performed, and the care provided. PMID:27515142

  18. Illinois: Child Care Collaboration Program

    Science.gov (United States)

    Center for Law and Social Policy, Inc. (CLASP), 2012

    2012-01-01

    The Illinois Child Care Collaboration Program promotes collaboration between child care and other early care and education providers, including Early Head Start (EHS), by creating policies to ease blending of funds to extend the day or year of existing services. While no funding is provided through the initiative, participating programs may take…

  19. Patient-centered Care.

    Science.gov (United States)

    Reynolds, April

    2009-01-01

    Patient-centered care focuses on the patient and the individual's particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. This requires that physicians, radiologic technologists and other health care providers develop good communication skills and address patient needs effectively. Patient-centered care also requires that the health care provider become a patient advocate and strive to provide care that not only is effective but also safe. For radiologic technologists, patient-centered care encompasses principles such as the as low as reasonably achievable (ALARA) concept and contrast media safety. Patient-centered care is associated with a higher rate of patient satisfaction, adherence to suggested lifestyle changes and prescribed treatment, better outcomes and more cost-effective care. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to www.asrt.org/store. According to one theory, most patients judge the quality of their healthcare much like they rate an airplane flight. They assume that the airplane is technically viable and is being piloted by competent people. Criteria for judging a particular airline are personal and include aspects like comfort, friendly service and on-time schedules. Similarly, patients judge the standard of their healthcare on nontechnical aspects, such as a healthcare practitioner's communication and "soft skills." Most are unable to evaluate a practitioner's level of technical skill or training, so the qualities they can assess become of the utmost importance in satisfying patients and providing patient-centered care.(1). PMID:19901351

  20. 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 - ...

  1. 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.

  2. 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.

  3. Comparing percutaneous coronary intervention and thrombolysis in patients with return of spontaneous circulation after out-of-hospital cardiac arrest%介入与溶栓疗法救治院外心脏骤停的比较

    Institute of Scientific and Technical Information of China (English)

    李颖庆; 柳娜; 胡春林; 魏红艳; 李慧; 李欣; 廖晓星

    2013-01-01

    coronary intervention (PCI) or thrombolysis,in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA),in the presence of ST-elevation myocardial infarction (STEMI).We demonstrated the benefits of the two therapies on ROSC patients in hospital discharge and neurological recovery,and clarified the importance of ROSC,so as to guide the treatments for OHCA in the presence of STEMI.Methods It was performed a meta-analysis of clinical studies located in PUBMED and MEDLINE databases from January 1995 to October 2011.OHCA patients with ROSC were as our study objects,the hospital discharge and neurological recovery rates,of patients with and without PCI or thrombolysis,were assessed in patients with ROSC after OHCA in the presence of STEMI.In the same Cohort Study,between received and rejected PCI,or between received and rejected thrombolysis in OHCA patients with ROSC as treated group and control group,using Review Manager 5.1 software to analyze,respectively.Furthermore,we also compared the differences in hospital discharge and neurological recovery rates between patient groups who received PCI or thrombolysis by Pearson x2 analysis.Results The meta-analysis showed that the rate of hospital discharge improved with both PCI (odds ratio [OR],1.65 ; 95% confidence interval [CI],1.05-2.59,P < 0.01)and thrombolysis (OR,2.03 ; 95% CI,1.24-3.34,P < 0.01) in patients with ROSC after OHCA,in the presence of STEMI.We also found that there were not significant differences between with PCI and with thrombolysis in the rate of hospital discharge (63.00% vs.65.19%,P =0.548) and neurological recovery (88.62% vs.91.25%,P =0.351) for the patients with ROSC after OHCA (P >0.05).Conclusions In patients with ROSC after OHCA in the presence of STEMI,both PCI and thrombolysis improved hospital discharge rates.Furthermore,there were similar efficacy in hospital discharge and neurological recovery rates between with PCI and with thrombolysis.

  4. Quality of Care for Patients with Acute Myocardial Infarction. Cienfuegos 2013

    Directory of Open Access Journals (Sweden)

    Hilda María Delgado Acosta

    2016-02-01

    Full Text Available Background: is a priority of the National Health System providing quality care to patients with acute myocardial infarction. Objective: to assess medical care to patients with acute myocardial infarction admitted to the Dr. Gustavo Aldereguía Lima Hospital in Cienfuegos in June 2013 to compare the results with previous assessments. Methods: a research on health systems and services was conducted. The variables used were related to the structure (human and material resources, processes (compliance with established care protocols and results (topography of infarction, hospital stay and impact on mortality. A questionnaire was applied to 20 patients admitted with the diagnosis of acute infarction during the study period. An observation guide was also used. Data were processed using the SPSS 15.0 program and expressed in absolute values and percentages. Results: male patients predominated in the series studied and the most common risk factors were hypertension in 50 % of cases, smoking in 45 % and diabetes mellitus in 25 %. Difficulties with medical and nursing staffing were detected in the emergency department and cardiology ward, respectively. There were difficulties in the use of beta blockers and aspirin in prehospital care, especially in patients with non- ST- segment elevation acute coronary syndromes. Early arrival at the medical services led to greater opportunity to perform a thrombolysis. There were no deaths. Conclusions: although results we better in comparison with the assessment of 2011, there are still gaps in care provided to these patients.

  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. Application value of ultrasound in transcatheter thrombolysis of acute lower limb deep phlebothrombosis%超声在急性下肢深静脉血栓形成局部置管溶栓中的应用价值

    Institute of Scientific and Technical Information of China (English)

    魏俊涛

    2012-01-01

    Objective To explore the application value of ultrasound in transcatheter thrombolysis of acute lower limb deep phlebothrombosis. Methods Thirty-eight patients with acute lower limb deep phlebothrombosis were enrolled in this study, Before the operation, an inferior vena cava filter was inserted through the femoral vein or the internal jugular vein on the healthy side. Under ultrasound localization and guidance, the popliteal vein was punctured and the thrombolysis catheter was inserted, then urokinase was continuously poured by using the micro pump, 24~48 h later, ultrasonography was preformed again. Results Puncture needle was successfully inserted in the popliteal vein, and the thrombolysis catheter was placed into the suitable position. Ultrasound guidance successed in 38 patients. During the treatment, the position of the catheter was changed with ultrasound guidance according to the thrombolysis condition in 4 patients. 2~7 d later, 33 patients were cured basically, 4 patients were improvrd, 1 patient was invalid. No massive hemorrhage or pulmonary embolism happened. Conclusion Ultrasound has important clinical value in preoperative diagnosis, intraoperative guidance, postoperative medication and curative effect evaluation of transcatheter thrombolysis in patients with acute lower limb deep phlebothrombosis.%目的 探讨超声在急性下肢深静脉血栓形成(DVT)患者局部置管溶栓中的应用价值.方法 38例急性下肢DVT患者,术前经健侧股静脉或颈内静脉置入下腔静脉滤器.在超声定位和引导下,穿刺患侧腘静脉,置入溶栓导管.微泵持续注入尿激酶,24~48 h后超声监测.结果 超声定位下穿刺针均顺利进入腘静脉;超声引导下溶栓导管均被置入血栓合适位置,38例超声引导全部成功.治疗过程中,根据血栓消融情况,4例在超声引导下调整了溶栓导管位置.经过2~7 d溶栓治疗后行超声检查,33例基本治愈,4例好转,1例无效.无一例发生

  7. 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.

  8. 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.

  9. 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. PMID:26370650

  10. 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.

  11. Health Care Indicators

    OpenAIRE

    Cowan, Cathy A.; Letsch, Suzanne W.; Levit, Katharine R.; Maple, Brenda T.; Stewart, Madie W.

    1991-01-01

    This regular feature of the journal includes a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of more compre...

  12. Analysis of Serum NSE Levels in Hemorrhagic Transformation of Acute Cerebral Infarction Without Thrombolysis%非溶栓性急性脑梗死后出血性转化患者血清NSE相关性分析

    Institute of Scientific and Technical Information of China (English)

    程鹤云; 赵幸娟

    2015-01-01

    Objective Discuss the correlationg between the levels of serum neuron-specific enolase ( NSE) and the risk of hemorrhagic transformation( HT) of acute cerebral without thrombolysis. Method 96 cases whose admission time <72 hours was selected in accordance with the WHO criteria for the di-agnosis of cerebral infarction, and head CT ruled out bleeding in patients with acute infarction. After 7 to 10 days after the review of magnetic resonance imaging ( MRI) gradient echo sequence showed low signal for hemorrhagic transformation. The level of NSE was detectioned by Elisa, and we also stuied the corre-lation between NSE and HT. Results 36 of 96 pations come to hemorrhagic transformation, other 60 pa-tions were no transformaion group. The NSE levels was higher in hemorrhagic transformation group than no transformation group, and the differences were significant (P<0. 05). Factors affecting the hemor-rhagic transformation included by history of atrial fibrillation, hypertension, low density lipoprotein cho-lesterol ( hdl-c ) and NSE level ( P<0 . 05 ) . Logistic stepwise polynomial regression analisis indicated that serum NSE level and atrial fibrillation were risk factors for hemorrhage transformation. Conclusion Testing the level of NSE was relationship with the risk of HT in actue cerebral infavction patients in the early stage, and this could be the independent risk factor of HT.%目的:探讨未进行溶栓的急性脑梗死患者血浆神经烯醇化酶( NSE)水平与出血性转化的相关性。方法选择96例入院时间<72 h,符合WHO脑梗死诊断标准,且头部CT排除出血的急性脑梗死患者,发病7~10 d后复查MRI梯度回波序列显示低信号为出血性转化;Elisa法定量检测血浆NSE水平;并探讨其与出血性转化的相关性。结果96例患者中36例出现出血性转化(转化组),其余60例为非转化组,出血性转化脑梗死组神经烯醇化酶水平高于非出血性转化组,差异有统计学意义(P<0.05),

  13. 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. PMID:27131161

  14. 下肢动脉闭塞症介入术后留置动脉导管溶栓治疗的护理体会%Nursing experience of the arterial catheter thrombolysis therapy after lower extremity arterial occlusive disease intervention

    Institute of Scientific and Technical Information of China (English)

    杨洁

    2014-01-01

    Objective:To explore the nursing measures of artery indwelling catheter thrombolysis therapy.Methods:We retrospective analyzed the data of 132 patients with arterial catheter treatment and care information.Results:4 cases were pipe blockage, 2 cases were part of the prolapse sheath,4 cases were puncture site hematoma,5 cases were hemorrhage of puncture point,22 cases were hyperperfusion syndrome,1 cases was thromboembolism,5 cases were subcutaneous hemorrhage,3 cases were other organ hemorrhage.3 cases had no improved and discharged,3 cases were turned to bone surgical treated by amputation,1 cases died of heart failure,125 cases were improved and discharged.Conclusion:Nurses' professional knowledge and technology, careful nursing,Shendu spirit is a prerequisite to ensure the correct position,use accurate arterial catheter,time accurate,it also is an important link to ensure the treatment effect.%目的:探讨动脉留置导管溶栓治疗的护理措施。方法:回顾132例动脉留置导管患者的治疗护理资料。结果:堵管4例,鞘管部分脱出2例,穿刺点血肿4例,穿刺点出血5例,过度灌注综合征22例,血栓栓塞1例,皮下出血5例,其他脏器出血3例。3例无好转出院,3例转骨外科截肢治疗,1例死于心力衰竭,125例好转出院。结论:护士的专业知识和技术、精心护理、慎独精神是保证动脉导管位置正确、用药精确、时间准确的前提,是保证治疗效果的重要环节。

  15. Including Language Access into Medicaid ACO Design.

    Science.gov (United States)

    Gershon, Rachel; Morris, Lisa; Ferguson, Warren

    2016-09-01

    Quality health care relies upon communication in a patient's preferred language. Language access in health care occurs when individuals are: (1) Welcomed by providers regardless of language ability; and (2) Offered quality language services as part of their care. Federal law generally requires access to health care and quality language services for deaf and Limited English Proficient (LEP) patients in health care settings, but these patients still find it hard to access health care and quality language services.Meanwhile, several states are implementing Medicaid Accountable Care Organization (ACO) initiatives to reduce health care costs and improve health care quality. Alternative payment methods used in these initiatives can give Accountable Care Organizations more flexibility to design linguistically accessible care, but they can also put ACOs at increased financial risk for the cost of care. If these new payment methods do not account for differences in patient language needs, ACO initiatives could have the unintended consequence of rewarding ACOs who do not reach out to deaf and LEP communities or offer quality language services.We reviewed public documents related to Medicaid ACO initiatives in six states. Some of these documents address language access. More could be done, however, to pay for language access efforts. This article describes Medicaid ACO initiatives and explores how different payment tools could be leveraged to reward ACOs for increased access to care and quality language services. We find that a combination of payment tools might be helpful to encourage both access and quality. PMID:27587453

  16. [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.

  17. Theory including future not excluded

    DEFF Research Database (Denmark)

    Nagao, K.; Nielsen, H.B.

    2013-01-01

    , 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......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...

  18. Role of spirituality in hospice care.

    Science.gov (United States)

    Bollwinkel, E M

    1994-03-01

    Spirituality plays an integral role in the care of the terminally ill. Hospice philosophy promotes patient/family centred care that is palliative, holistic and interdisciplinary. Historically, spiritual care has been a major component of hospice care that is consistent with these values. Some issues related to the role of spirituality in medicine and hospice care include the difference between spirituality and religion, the patient-physician relationship, provision of spiritual care, and who provides this care. Guidelines for spiritual caregiving include self-knowledge of one's own spiritual needs, authenticity and honesty and respect for the beliefs and practices of the patient and family.

  19. 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

  20. Defining Quality Child Care: Multiple Stakeholder Perspectives

    Science.gov (United States)

    Harrist, Amanda W.; Thompson, Stacy D.; Norris, Deborah J.

    2007-01-01

    Multiple perspectives regarding the definition of quality child care, and how child care quality can be improved, were examined using a focus group methodology. Participants were representatives from stakeholder groups in the child care profession, including child care center owners and directors (3 groups), parents (3 groups), child caregivers (3…

  1. Intravenous thrombolysis with recombinant tissue plasminogen activator for ischemic stroke patients over 80 years old: the Fukuoka Stroke Registry.

    Directory of Open Access Journals (Sweden)

    Ryu Matsuo

    Full Text Available The benefit of intravenous recombinant tissue plasminogen activator (rt-PA therapy for very old patients with acute ischemic stroke remains unclear. The aim of this study was to elucidate the efficacy and safety of intravenous rt-PA therapy for patients over 80 years old.Of 13,521 stroke patients registered in the Fukuoka Stroke Registry in Japan from June 1999 to February 2013, 953 ischemic stroke patients who were over 80 years old, hospitalized within 3 h of onset, and not treated with endovascular therapy were included in this study. Among them, 153 patients were treated with intravenous rt-PA (0.6 mg/kg. For propensity score (PS-matched case-control analysis, 148 patients treated with rt-PA and 148 PS-matched patients without rt-PA therapy were selected by 1:1 matching with propensity for using rt-PA. Clinical outcomes were neurological improvement, good functional outcome at discharge, in-hospital mortality, and hemorrhagic complications (any intracranial hemorrhage [ICH], symptomatic ICH, and gastrointestinal bleeding.In the full cohort of 953 patients, rt-PA use was associated positively with neurological improvement and good functional outcome, and negatively with in-hospital mortality after adjustment for multiple confounding factors. In PS-matched case-control analysis, patients treated with rt-PA were still at lower risk for unfavorable clinical outcomes than non-treated patients (neurological improvement, odds ratio 2.67, 95% confidence interval 1.61-4.40; good functional outcome, odds ratio 2.23, 95% confidence interval 1.16-4.29; in-hospital mortality, odds ratio 0.30, 95% confidence interval 0.13-0.65. There was no significant association between rt-PA use and risk of hemorrhagic complications in the full and PS-matched cohorts.Intravenous rt-PA therapy was associated with improved clinical outcomes without significant increase in risk of hemorrhagic complications in very old patients (aged>80 years with acute ischemic stroke.

  2. 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。

  3. 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...

  4. 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.

  5. 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.

  6. Families classification including multiopposition asteroids

    Science.gov (United States)

    Milani, Andrea; Spoto, Federica; Knežević, Zoran; Novaković, Bojan; Tsirvoulis, Georgios

    2016-01-01

    In this paper we present the results of our new classification of asteroid families, upgraded by using catalog with > 500,000 asteroids. We discuss the outcome of the most recent update of the family list and of their membership. We found enough evidence to perform 9 mergers of the previously independent families. By introducing an improved method of estimation of the expected family growth in the less populous regions (e.g. at high inclination) we were able to reliably decide on rejection of one tiny group as a probable statistical fluke. Thus we reduced our current list to 115 families. We also present newly determined ages for 6 families, including complex 135 and 221, improving also our understanding of the dynamical vs. collisional families relationship. We conclude with some recommendations for the future work and for the family name problem.

  7. Early routine post-thrombolysis percutaneous coronary intervention vs.primary PCI in ST-segment elevated myocardial infarction: a comparative study%急性ST段抬高心肌梗死溶栓后早期介入治疗与直接介入治疗的对比研究

    Institute of Scientific and Technical Information of China (English)

    万方; 张拓; 沈玲红; 卜军; 宋玮; 杜勇平; 金叔宣; 沈节艳; 何奔

    2013-01-01

    目的 评估急性ST段抬高心肌梗死(STEMI)溶栓后早期经皮冠状动脉介入治疗(PCI)与直接PCI有效性及安全性的差异.方法 纳入2010年1月至2011年12月期间在我中心行早期PCI及直接PCI治疗的急性STEMI患者,比较两组住院期间临床终点事件的发生率.采用多因素回归以及倾向积分法计算再灌注策略对临床终点事件的校正相对危险度(RR).结果 早期PCI组共纳入51例患者,直接PCI组共纳入159例患者.两组主要心血管不良事件发生率分别为:早期PCI组4.0%和直接PCI组5.7% (RR =0.647,95% CI:0.155 ~3.103).多因素回归校正RR为0.663(95% CI:0.131 ~3.351),倾向积分法校正RR为0.316(95% CI:0.026 ~3.879).安全性终点方面,两组TIMI出血发生率分别为早期PCI组4.0%和直接PCI组1.9%(RR=2.078,95% CI:0.357~12.095).多因素回归校正RR为2.122(95% CI:0.345~ 13.070),倾向积分法校正RR为0.302(95% CI:0.010 ~9.228).所有结果均未显示差异具有统计学意义.结论 对于直接PCI可能延迟的STEMI患者,溶栓后早期PCI治疗是一种有效、安全的替代再灌注策略.%Objective Compare the efficacy and safety of early routine post-thrombolysis percutaneous coronary intervention (early PCI) with primary percutaneous coronary interventionin(PPCI) for acute ST-segment elevated myocardial infarction ( STEMI). Methods From January 2010 to December 2011 , patients receiving early PCI or primary PCI in our center were screened and enrolled into this study. Incidences of in-hospital clinical events of two groups were compared. The risk ratios of efficacy and safety endpoints were adjusted by multivariable logistic regression and propensity score. Results 51 patients in early PCI group and 159 in PPCI group were finally included. The major cardio-cerebro vascular adverse event rates were 4. 0% in early PCI group and 5. 7% in PPCI Group (RR =0. 647,95% confidence interval 95% CI:0. 155 -3. 103). For safety

  8. Quality of care of nurse-led and allied health personnel-led primary care clinics

    OpenAIRE

    Chin, WY; Lam, CLK; Lo, SV

    2011-01-01

    Objectives To review the literature regarding quality of care of nurse-led and allied health personnel-led primary care clinics with specific attention to the quality indicators for fall prevention, continence care, pulmonary rehabilitation, mental health, pharmaceutical care, and wound care services. Data sources Literature search from 1990 to 2010 including Ovid Medline, Cochrane Database, RAND (Research and Development) Corporation Health Database, the ACOVE (Assessing the Care of Vulnerab...

  9. 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.

  10. Including lifestyle medicine in undergraduate medical curricula

    Directory of Open Access Journals (Sweden)

    Edward Phillips

    2015-02-01

    Full Text Available Purpose: Currently, there is no model to integrate the discipline of lifestyle medicine (LM into undergraduate medical education. Furthermore, there are no guidelines, validated assessment tools, or evaluation or implementation plans in place. Background: The World Health Organization predicts that by 2020, two-thirds of disease worldwide will be the result of poor lifestyle choices. Fewer than 50% of US primary care physicians routinely provide specific guidance on nutrition, physical activity, or weight control. Methods: We are establishing a plan to integrate LM into medical school education in collaboration with the investing stakeholders, including medical school deans and students, medical curriculum developers and researchers, medical societies, governing bodies, and policy institutes. Three planning and strategy meetings are being held to address key areas of focus – with a particular interest in nutrition, physical activity, student self-care, and behavior change – to develop specific implementation guidelines and landmarks. Results: After the first two meetings, the proposed areas of focus were determined to be: 1 supporting of deans and key personnel, 2 creation of federal and state policy commitments, 3 use of assessment as a driver of LM, 4 provision of high-quality evidence-based curricular material on an easily navigated site, and 5 engaging student interest. Implementation strategies for each focus area will be addressed in an upcoming planning meeting in early 2015. Conclusion: This initiative is expected to have important public health implications by efficiently promoting the prevention and treatment of non-communicable chronic disease with a scalable and sustainable model to educate physicians in training and practice.

  11. 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.

  12. 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.

  13. Wound Care in Primary Health Care

    OpenAIRE

    Nail Ersoz; Ismail Hakki Ozerhan; Fatih Zor

    2008-01-01

    Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull 2008; 7(1.000): 71-74

  14. Wound Care in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Nail Ersoz

    2008-02-01

    Full Text Available Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull. 2008; 7(1: 71-74

  15. Wound Care in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Nail Ersoz

    2008-02-01

    Full Text Available Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull 2008; 7(1.000: 71-74

  16. Neurocritical care update.

    Science.gov (United States)

    Kuroda, Yasuhiro

    2016-01-01

    This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the complicated pathophysiology of the condition. Continuous electroencephalogram monitoring is an essential tool for detecting nonconvulsive status epilepticus in the intensive care unit (ICU). Neurocritical care, including advanced hemodynamic monitoring, is a fundamental approach for delayed cerebral ischemia following subarachnoid hemorrhage. We must be mindful of the high percentage of ICU patients who may develop sepsis-associated brain dysfunction. PMID:27239312

  17. 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

  18. Integrating Bipolar Disorder Management in Primary Care

    OpenAIRE

    Kilbourne, Amy M.; Goodrich, David E.; O’Donnell, Allison N.; Miller, Christopher J.

    2012-01-01

    There is growing realization that persons with bipolar disorder may exclusively be seen in primary (general medical) care settings, notably because of limited access to mental health care and stigma in seeking mental health treatment. At least two clinical practice guidelines for bipolar disorder recommend collaborative chronic care models (CCMs) to help integrate mental health care to better manage this illness. CCMs, which include provider guideline support, self-management support, care ma...

  19. 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.

  20. 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

  1. Assessing the Safety of Selectively Early Administration of Dual Antiplatelet Therapy in Patients with Cerebral Infarction after Intravenous Thrombolysis%脑梗死静脉溶栓后24 h内选择性双联抗血小板治疗的安全性观察

    Institute of Scientific and Technical Information of China (English)

    王欢; 李玮; 刘承春; 吴娅; 易旭; 张志宏; 李小树; 张猛

    2014-01-01

    Objective To evaluate the safety of selectively early administration of oral antiplatelet therapy within 1 hour after recombinant tissue type plasminogen activator (rt-PA) treatment in patients with acute ischemic stroke. Methods A total of 112 acute ischemic stroke patients with relatively low hemorrhagic transformation (HT) risk according to multimode imaging and hemorrhage after thrombolysis (HAT) score were selected for this clinical trial from Department of Neurology of The Third Afifliated Hospital of Third Military Medical University, from January 2011 to April 2014. Sixty-six patients were treated with oral 100 mg aspirin and 75 mg clopidogrel within 1 hour after the intravenous rt-PA administration with the informed consent from the patients or their legal representatives. In the other 46 patients, oral antiplatelet therapy started 24 hours after rt-PA treatment according to the will of the patients or their family, who preferred to follow the current guidelines. The primary safety endpoint was the reocclusion in 1 d after the thrombolysis, HT in 3 d, the score of National Institutes of Health Stroke Scale (NIHSS) in 7 d, and the death of the patients. Results There was no significant difference in the baseline (including gender, age, level of blood pressure, blood glucose and cholesterin before thrombolysis, the history of transient ischemic attack or cardiac valvular disease, etc.) between two groups. Importantly, no signiifcant difference was found in HT (7.6%vs 6.5%,P=1.000), while the number of symptomatic intracerebral hemorrhage and death in both groups were zero. We even found decreasing tendency of NIHSS score at 7 d after the thrombolysis (NIHSS=6vs NIHSS=7,P=0.143) and the frequency of reocclusion (4.5%vs 15.2 %,P=0.107) in early antiplatelet administration group was reduced although no signiifcance was achieved. Conclusion Administration of oral antiplatelet therapy within 1 hour after patients with acute ischemic stroke treated with rt-PA does

  2. 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. PMID:26022525

  3. 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.

  4. 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.

  5. Wound care centers

    Science.gov (United States)

    ... different types of dressings, including: Gels Foams Gauze Films Your provider may use one or multiple types ... Care (AAWC). 2010. http://aawconline.org/wp-content/uploads/2011/08/AAWCPressureUlcerGuidelineofGuidelinesAug11.pdf. Accessed June 11, 2014. ...

  6. 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…

  7. BNFL and environmental care

    International Nuclear Information System (INIS)

    British Nuclear Fuel plc (BNFL) acknowledge a duty of care for the environment and aims to reduce the effects of its activities on the environment to as low as reasonably practicable. Its environmental policy statement is presented and its approach, investment policies and activities to implement this policy are outlined. The activities include energy efficiency, recycling, surveillance and research, conservation and open information. (UK)

  8. 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...

  9. 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.

  10. [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. PMID:27063877

  11. 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…

  12. Day Care for America's Children.

    Science.gov (United States)

    LaCrosse, E. Robert

    High quality day care is a pressing social need for the 1970's. Factors responsible for the strong interest in day care include pressures for welfare reform, the growing number of women in the labor force, minority pressures for equal opportunities, and research findings stressing the importance of development during the early years of a child's…

  13. [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.

  14. 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

  15. Home Care

    Science.gov (United States)

    ... care is especially useful for persons who need nursing, therapy, or aide services. You may need help if you are dealing with one or more of the following: You have trouble getting around (for example, after a hospital stay or an accident) You have wounds that need to be cleaned, ...

  16. 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.

  17. Furthering caring through nursing education

    Directory of Open Access Journals (Sweden)

    D van der Wal

    1999-09-01

    Full Text Available The nursing students’ main quest is for self actualization by attributing meaning to life through caring. To assist student nurses in this quest, the nurse educator needs to plan educational interventions according to an anthropological model that posits care and caring as innate human attributes. Further, the structural essence of what professional nursing caring entails should also be posited as a point of departure for curriculum planning. The author proposes such models. The main implications include that the nursing curriculum must increasingly attend to the emotional needs of nursing students. Curricular content and teaching strategies toward this goal are suggested.

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

    Science.gov (United States)

    ... role in making health care safe. That includes doctors, nurses, laboratory technologists, phlebotomists (health care staff who take ... if you don't understand something that your doctor, nurse, or other health care professional tells you. • Don’ ...

  19. 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. PMID:23317025

  20. 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.

  1. 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.

  2. [Quality of health care].

    Science.gov (United States)

    Medina, J L; De Melo, P C

    2000-01-01

    Quality assurance is a relatively recent concern but already plays a major role in health care management and provision. Quality involves the definition of a comprehensive programme tailored by realistic and effective objectives and norms that include the structured review of procedures (namely clinical audits) and the use of up-to-date protocols. The involvement and motivation of health professionals, together with an adequate internal and external communication strategy, play a key role in the planning and application of these programmes. The use of programmed assessment, based on a solid knowledge of current practice, should have practical implications, optimising procedures in order to improve the quality of care. This commitment towards quality in health care should go far beyond governmental policy and should have clear support from health professionals. PMID:11234496

  3. Rabbit care and husbandry.

    Science.gov (United States)

    Bradley, Teresa

    2004-05-01

    This article provides information for the veterinary staff to be better prepared to care for the special needs of rabbit patients as they are presented in increased frequency for veterinary care. Housing, nutrition,restraint, and recognizing illness are covered in detail. Descriptions of techniques for blood collection, oral medication administration, and injection sites are included. Preventive care recommendations for examinations from first visit to geriatric visits are outlined as well as indications for spaying and neutering. Also provided are lists that will aid the veterinary staff in providing instructions when the appointment is made, recommendations for boarding, surgical, and anesthetic considerations and clinical signs that are associated with pain in rabbits. PMID:15145392

  4. Home Health Care: What It Is and What to Expect

    Science.gov (United States)

    ... of care + Share widget - Select to show What’s home health care & what should I expect? What's home health care? Home health care is a wide ... or skilled nursing facility (SNF). Examples of skilled home health services include: Wound care for pressure sores ...

  5. Health care technology assessment

    Science.gov (United States)

    Goodman, Clifford

    1994-12-01

    The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.

  6. Multidisciplinary care in haemoglobinopathies

    Directory of Open Access Journals (Sweden)

    Adriana Ceci

    2014-12-01

    Full Text Available While most complications are related to haemoglobinopathies and their treatment, it is also possible to observe substantial differences in comorbidities’ onset and seriousness which depend also to the different HPs genotypes. These differences should be carefully considered when health authorities set up and manage adequate care systems and treatments plans. We describe services organisation in Italy including the availability of multispecialty care and tools, in the HPs units participating to the HTA-THAL Multiregional Registry, with the aim to derive the impact of the services and multispecialty care availability on the management of the disease and on the patients wellbeing. The high dispersion and heterogeneity of services demonstrated, exposes the Italian system to a high risk of: a inappropriate use of economical and medical resources, b limited access to multidisciplinary care of some patients with apparent inequality among different centres, and c low patients satisfaction with the services provided. The identification of a ‘standard for HPs services’ is necessary not only at national but also at interventional level in order to implement collaborative research and the identification and networking of reference’ centres worldwide. Following the big efforts provided in the last years here there is a new challenging mission for the TIF.

  7. 提高急性缺血性卒中静脉溶栓有效性和安全性的研究进展%Study Progress of Improvement of Safety and Efifcacy of Intravenous Thrombolysis on Acute Ischaemic Stroke

    Institute of Scientific and Technical Information of China (English)

    吴岩峰; 刘庆萍; 丁红

    2016-01-01

    The recombinant tissue plasminogen activator alteplase (rt-PA) is the most effective therapeutic drug used in intravenous thrombolysis for patients with acute ischaemic stroke presenting within 4.5h after symptom onset. Nevertheless, intravenous thrombolysis is accompanied with hemorrhagic transformation (HT), increased risk of symptomatic intracranial haemorrhage (sICH), poor prognosis and even deaths. Therefore, study on inlfuential factors on treatment and prognosis and improvement of efifcacy and safety of intravenous thrombolysis has important signiifcance for prognosis of patients with acute ischemic stroke.%重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator alteplase,rt-PA)是目前急性缺血性卒中时间窗内静脉溶栓最有效的治疗药物,然而,静脉溶栓也伴随着出血转化、症状性颅内出血风险的增加,导致患者预后不良,甚至死亡。因此,研究静脉溶栓治疗及预后的影响因素,提高静脉溶栓治疗的有效性及安全性,对急性缺血性卒中患者的预后有着重大意义。

  8. What to include in your birth plan

    Science.gov (United States)

    Pregnancy - birth plan ... Birth plans are guides that parents-to-be make to help their health care providers best support them during ... things to consider before you make a birth plan. This is a great time to learn about ...

  9. Primary care for urban adolescent girls from ethnically diverse populations: foregone care and access to confidential care.

    Science.gov (United States)

    McKee, Diane; Fletcher, Jason

    2006-11-01

    Adolescent girls face unique challenges in health care utilization, which can result in unmet needs. We sought to describe settings of usual care and primary care use, and to identify predictors of foregone care and experience of confidential care in a primarily racial/ethnic minority low-income sample. We conducted an anonymous computer-assisted self-administered survey of 9th-12th grade girls (n=819) in three Bronx public high schools, the majority of whom were Hispanic (69.8%) and Black (21.4%). Most (80%) reported having a usual source of care. Of these, 77.2% had a regular doctor. Those least likely to have a usual source of care were non-U.S. born girls (73.1% vs. 83.1%) and less acculturated girls. Predictors of foregone care in the last year include being sexually active, poor family social support, and low self esteem. Predictors of access to confidential care at last visit were age, self-efficacy for confidential care, having a regular doctor, setting of care, and having had a recent physical exam. Many urban adolescent girls, especially non-U.S. born girls, lack a usual source of care and regular health care provider. Continued attention to reducing both financial and non-financial barriers to care is required to ensure access to and quality of care for diverse populations. PMID:17242529

  10. Intergenerational pathways leading to foster care placement of foster care alumni’s children

    OpenAIRE

    Jackson Foster, Lovie J.; Beadnell, Blair; Pecora, Peter J.

    2013-01-01

    This study examined a path model that postulated intergenerational relationships between biological parent psychosocial functioning and foster care alumni mental health, economic status, and social support; and from these to the likelihood of children of foster care alumni being placed in foster care. The sample included 742 adults who spent time in foster care as children with a private foster care agency and who reported having at least one biological child. A full pathway was found between...

  11. Can Managed Health Care Help Manage Health Care-Associated Infections?

    OpenAIRE

    Platt, Richard; Caldwell, Blake

    2001-01-01

    Managed-care organizations have a unique opportunity, still largely unrealized, to collaborate with health-care providers and epidemiologists to prevent health care-associated infections. Several attributes make these organizations logical collaborators for infection control programs: they have responsibility for defined populations of enrollees and for their overall health, including preventive care; they possess unique data resources about their members and their care; and they are able to ...

  12. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2014-01-01

    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......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...

  13. Caring for Multiples

    Science.gov (United States)

    ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Tools & ... Home > Complications & Loss > The newborn intensive care unit (NICU) > Caring for multiples Caring for multiples E-mail ...

  14. 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。

  15. Who cares!

    Institute of Scientific and Technical Information of China (English)

    老晃

    2013-01-01

    1有人再三怂恿,希望我能吐槽《富春山居图》,务求鞭辟入里,揭露丑恶真相。我舍不得,舍不得浪费纸。好吧,小吐一下。传说,在《富春山居图》开拍之前有心人提醒导演孙健君,剧本有硬伤,得改,例举一三三四……话没说完,孙勃然大怒,"Who cares!"这位目空一切的君王,他什么都不care,所以他花钱砸的那堆玩意儿,根本也不是电影。这就是真相。值得一说的,是此刻红得发紫,摸都摸不得的《小时代》。

  16. 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.

  17. Quality of diabetes care in general practice

    OpenAIRE

    van Bruggen, J.A.R.

    2009-01-01

    In the Netherlands, a quality incentive is expected to ensue from improved collaboration between healthcare professionals. Whether this view is supported by sufficient evidence is, however, questionable. Therefore, the first study included in this thesis is a systematic review of studies on the effects of sharing and delegating diabetes care tasks. It became apparent that sharing and delegating care tasks can improve the process of care and glycaemic control. Sharing or delegating care, howev...

  18. 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. PMID:27214194

  19. 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.

  20. Oregon's Coordinated Care Organizations Increased Timely Prenatal Care Initiation And Decreased Disparities.

    Science.gov (United States)

    Muoto, Ifeoma; Luck, Jeff; Yoon, Jangho; Bernell, Stephanie; Snowden, Jonathan M

    2016-09-01

    Policies at the state and federal levels affect access to health services, including prenatal care. In 2012 the State of Oregon implemented a major reform of its Medicaid program. The new model, called a coordinated care organization (CCO), is designed to improve the coordination of care for Medicaid beneficiaries. This reform effort provides an ideal opportunity to evaluate the impact of broad financing and delivery reforms on prenatal care use. Using birth certificate data from Oregon and Washington State, we evaluated the effect of CCO implementation on the probability of early prenatal care initiation, prenatal care adequacy, and disparities in prenatal care use by type of insurance. Following CCO implementation, we found significant increases in early prenatal care initiation and a reduction in disparities across insurance types but no difference in overall prenatal care adequacy. Oregon's reforms could serve as a model for other Medicaid and commercial health plans seeking to improve prenatal care quality and reduce disparities. PMID:27605642

  1. 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-

  2. Health care delivery in Malaysia: changes, challenges and champions

    OpenAIRE

    Susan Thomas; LooSee Beh; Rusli Nordin

    2011-01-01

    Since 1957, there has been major reorganization of health care services in Malaysia. This article assesses the changes and challenges in health care delivery in Malaysia and how the management in health care processes has evolved over the years including equitable health care and health care financing. The health care service in Malaysia is changing towards wellness service as opposed to illness service. The Malaysian Ministry of Health (MOH), being the main provider of health services, may n...

  3. 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

  4. 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

  5. Maternal Care Determinant of Longevity?

    Science.gov (United States)

    Giorgio, Marco; Renzi, Chiara; Oliveri, Serena; Pravettoni, Gabriella

    2016-04-01

    Maternal care is an essential early environment in mammals that ensures emotional regulation and adaptive fitness of progeny. Longevity and healthy aging are associated with favorable environmental factors including fitting social and behavioral features. In the present review, we discuss the findings that link rearing conditions and early maternal care with life span and aging from an evolutionary, psychological, and molecular perspective. The quality of maternal care may influence internal adaptation through a variety of parallel mechanisms including emotional regulation, stress sensitivity, coping and other behavioral strategies in response to events requiring adaptation. From a biological perspective, it regulates physiological pathways that may persist in adulthood through epigenetic mechanisms, influencing disease susceptibility and, potentially, longevity. Abnormal maternal care induces maladaptation that persists over the life span, may accelerate the onset of aging associated diseases, and shorten life span. This may have important implications in the development of preventive approaches and early interventions. PMID:27548096

  6. 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.

  7. Health care in correctional facilities.

    OpenAIRE

    Thorburn, K M

    1995-01-01

    More than 1.3 million adults are in correctional facilities, including jails and federal and state prisons, in the United States. Health care of the inmates is an integral component of correctional management. Health services in correctional facilities underwent dramatic improvements during the 1970s. Public policy trends beginning in the early 1980s substantially affected the demographics and health status of jail and prison populations and threatened earlier gains in the health care of inma...

  8. 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.

  9. 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. PMID:10181605

  10. 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.

  11. 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.

  12. Health care operations management

    OpenAIRE

    Carter, M W; Hans, E.W.; Kolisch, R.

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully selected papers dealing with optimization and decision analysis problems in the field of health care operations management.

  13. 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.

  14. Pediatric palliative care online: the views of health care professionals.

    Science.gov (United States)

    Ens, Carla D L; Chochinov, Harvey M; Bérard, Josette L M; Harlos, Mike S; Stenekes, Simone J; Wowchuk, Suzanne M

    2008-01-01

    The purpose of the study was to evaluate the role of an online resource for dying children, their family members, and health care providers from the perspective of pediatric palliative care experts. Semistructured interviews with 12 leaders in pediatric palliative care in North America were conducted, exploring their perceptions and attitudes towards various aspects of Web-based resources for dying children and their care providers. Informants felt that an online resource may allow for a different form of expression, a connection between people undergoing a rare event, and an increase in education and support. Major challenges, such as accessibility, monitoring, and remaining current, would be ongoing. Other key themes included access, information, and anonymity. The data suggest that developing Web-based resources for dying young patients and their families may have merit. Should this take place, a feasibility study will be necessary to further determine the value of such a Web site for these vulnerable populations. PMID:18459596

  15. Comprehensive Child Care Program: Phase 1 - Evaluation Results.

    Science.gov (United States)

    Harachi, Tracy; Anthony, Emily; Bleisner, Siri

    Seattle's Comprehensive Child Care Program (CCCP) (Washington) is made up of a child care subsidy to offset child care costs for working and student families with low incomes, and quality assurance and technical assistance for 150 child care providers, including on-site evaluations, public health consulting, continuing education for providers, and…

  16. 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.

  17. Learning from UK primary care.

    Science.gov (United States)

    Hays, Richard

    2009-03-01

    The Australian Government is wise to examine other health care systems as it strives to improve the quality of care and address rising costs to both governments and individuals. Focus is currently on the United Kingdom, whose National Health Service (NHS) stands out as one that delivers good care at a reasonable price to all who need it. The Australian and UK systems have many similarities: universal access, tax payer support, no or low cost at point of delivery, and good population health outcomes. They also face similar pressures on services from aging, increasingly unwell yet expectant populations.However, there are also differences, largely in the way that health care is funded, organised and delivered. The NHS is a huge system for 60 million people in four home countries with diverging policies. Within England, the system is managed through 10 strategic health authorities, each responsible for about 5 million people and having the right to interpret national policy. Population based health care, including tertiary care, is funded locally via primary care trusts. PMID:19283244

  18. An Official 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. PMID:27369038

  19. 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. PMID:27367887

  20. Adoption & Foster Care

    Science.gov (United States)

    ... Children > Family Life > Family Dynamics > Adoption & Foster Care Adoption & Foster Care Article Body ​Each year, many children join families through adoption and foster care. These families may face unique ...

  1. About Critical Care Nursing

    Science.gov (United States)

    ... requiring intense and vigilant nursing care. Number of Critical Care Nurses in the United States According to "The Registered ... nurses who work in a hospital setting. Where Critical Care Nurses Work According to "The Registered Nurse Population" study, ...

  2. 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, ...

  3. Oncology and palliative care

    OpenAIRE

    Bausewein, Claudia; Hartenstein, R.

    2000-01-01

    Oncology developed as a discipline over the last decades. Treatment is concentrated on cure or palliation of the illness with the help of chemotherapy, radiotherapy or surgery. Palliative care has its origin in the hospice movement that started around 1960 in the UK. Centre of care is the patient and his family. Focus of care has moved from quantity to quality of life. Symptom control, communication, rehabilitation and care for the dying are main areas of palliative care. Palliative care and ...

  4. Critical care during epidemics

    OpenAIRE

    Rubinson, Lewis; O'Toole, Tara

    2005-01-01

    We recommend several actions that could improve hospitals' abilities to deliver critical care during epidemics involving large numbers of victims. In the absence of careful pre-event planning, demand for critical care services may quickly exceed available intensive care unit (ICU) staff, beds and equipment, leaving the bulk of the infected populace without benefit of potentially lifesaving critical care. The toll of death may be inversely proportional to the ability to augment critical care c...

  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. 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.

  7. 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. PMID:27501323

  8. Instruments to assess integrated care

    DEFF Research Database (Denmark)

    Lyngsø, Anne Marie; Godtfredsen, Nina Skavlan; Høst, Dorte;

    2014-01-01

    INTRODUCTION: Although several measurement instruments have been developed to measure the level of integrated health care delivery, no standardised, validated instrument exists covering all aspects of integrated care. The purpose of this review is to identify the instruments concerning how...... to measure the level of integration across health-care sectors and to assess and evaluate the organisational elements within the instruments identified. METHODS: An extensive, systematic literature review in PubMed, CINAHL, PsycINFO, Cochrane Library, Web of Science for the years 1980-2011. Selected...... and six include cultural aspects; 14 explicitly stated using a theoretical framework. CONCLUSION AND DISCUSSION: This review did not identify any measurement instrument covering all aspects of integrated care. Further, a lack of uniform use of the eight organisational elements across the studies...

  9. 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

  10. 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. PMID:27332611

  11. Analysis on prognostic predictors of introvenous thrombolysis with alteplase for acute ischemic stroke%阿替普酶静脉溶栓治疗急性脑梗死预后的影响因素分析

    Institute of Scientific and Technical Information of China (English)

    王立志; 罗伟良; 李博生

    2012-01-01

    目的:分析影响阿替普酶(重组组织型纤溶酶原激活剂,rt-PA)静脉溶栓治疗急性脑梗死预后的因素.方法:接受rt-PA静脉溶栓治疗的46例急性脑梗死患者按治疗后第90日改良Rankin量表(mRS)评分,分为预后良好组(mRS评分0~1分)及预后不良组(mRS评分2~6分),比较两组患者的临床资料,采用Logistic回归分析影响预后的危险因素.结果:预后良好组(19例)与预后不良组(27例)相比,合并房颤率低(P=0.031),溶栓前血糖较低(P=0.001),CT示早期缺血率低(P=0.043),溶栓前美国国立卫生研究院卒中量表(NIHSS)低(P=0.001),发病至溶栓开始的时间短(p=0.001).Logistic回归分析表明溶栓前NIHSS低、发病至溶栓开始的时间短、溶栓前血糖低是预后的独立预测因素.结论:溶栓前NIHSS低、发病至溶栓开始的时间短、溶栓前血糖低是影响rt-PA静脉溶栓治疗急性脑梗死预后的独立预测因素.%Objective: To analyze the prognostic risk factors of intravenous thrombolysis with alteplase for acute ischemic stroke. Methods: Forty-six patients of acute ischemic stroke treated with introvenous alteplase were divided into two groups according to modified rankin scale (mRS) score 90 days after treatment MRS score of 0 to 1 was defined as good outcome and mRS score of 2 to 6 as poor outcome. The baseline characteristics were compared between two groups and the prognostic risk factors were analyzed via logistic regression. Results: The morbidity of atrial fibrillation (P = 0. 031), blood glucose level ( P = 0.001), early ischemic changes on CT (P = 0.043), baseline NIHSS score (P=0.001) and time span from stroke onset to the start of treatment (P=0.001) were lower in patients with good outcome (19 cases) than those with poor outcome (27 cases). Logistic regression analysis showed that high baseline NIHSS score, long time span from stroke onset to the start of treatment and high blood glucose were related to poor outcome

  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. 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.

  14. 产褥期下肢静脉血栓形成溶栓治疗的临床应用%Application of thrombolysis treatment for puerperium venous thrombosis of the lower limbs

    Institute of Scientific and Technical Information of China (English)

    张慧敏; 黄建宇; 黄丰华

    2012-01-01

    Objective To explore practical method of thrombolysis treatment of puerperium venous thrombosis of the lower limbs.Methods Fifty-six cases with puerperium venous thrombosis of the lower limbs were treated with urokinase 400 thousand U for thrombosis,ivgtt,bid,large dose impact treatment,the venous of affected limb ankle transfusion medication,compression tourniquet was applied on the 1/3 upper affected limb thigh with 60 mm Hg compression.Strictly monitored the coagulation function and the effect of the treatment and adjusted doses of medicine in time.Results The clinical effect rate was 100%,the cure rate was 95.6%.Conclusions It is effective,safe,convenient for the patients who receive the treatment of puerperium venous thrombosis of the lower limbs and it is easily applied in clinical treatment.%目的 探讨产褥期下肢静脉血栓形成溶栓治疗的实用方法.方法 对56例产褥期下肢静脉血栓形成患者应用40万U尿激酶,每天2次静脉滴注,大剂量冲击治疗,患肢踝部输液用药,加压带在患肢大腿上1/3加压60 mm Hg(1 mm Hg=0.133 kPa),严密监测凝血功能及时调整剂量.结果 56例有效率为100%,治愈率为95.6%.结论 产褥期下肢静脉血栓形成患者应用该治疗方案疗效好且安全,方法简便,易于推广应用.

  15. Trombólise tardia e espontânea de artéria renal sem comprometimento funcional Late and spontaneous thrombolysis of renal artery without functional impairtment

    Directory of Open Access Journals (Sweden)

    Claudio Pinho

    2009-09-01

    Full Text Available A aterosclerose em artérias renais é um importante fator desencadeante de tromboses com subsequente comprometimento da função e da viabilidade renal. A oclusão aguda das artérias renais por trombo ou êmbolo é causa incomum e potencialmente reversível de falência renal. Todavia, a duração e o grau de oclusão arterial compatível com a manutenção da viabilidade do parênquima renal ainda não estão bem estabelecidos, razão pela qual o diagnóstico precoce e a intervenção são importantes. O objetivo deste artigo é descrever um caso de trombose de artéria renal de rim funcional único, com lise espontânea e tardia do trombo seguida de recuperação funcional inesperada.Renal artery atherosclerosis is an important triggering factor for thrombosis followed by impairment of renal function and viability. The acute occlusion of the renal artery by a thrombus or an embolus is an unusual and potentially reversible cause of renal failure. However, the duration and degree of arterial occlusion compatible with the viability of the renal parenchyma have not been well established, hence the importance of early diagnosis and intervention. The purpose of this study is to describe a case of renal artery thrombosis of a functionally single kidney, with late and spontaneous thrombolysis followed by unexpected functional recovery.

  16. 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

  17. 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.

  18. 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

  19. 76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-02-17

    ... Budget Office CDC Centers for Disease Control and Prevention DVT Deep vein thrombosis ESRD End-stage renal disease DRA Deficit Reduction Act of 2005 (Pub. L. 109-171, enacted on February 8, 2006) FFP... Restrictive Surgery. + Orthopedic Procedures. - Spine. - Neck. - Shoulder. ] - Elbow. Deep Vein...

  20. 76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-06-06

    ... Office CDC Centers for Disease Control and Prevention DVT Deep vein thrombosis ESRD End-stage renal.... --Elbow. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE). + Total Knee Replacement. + Hip Replacement... defined as the full list of Medicare's HAC, with the exception of Deep Vein Thrombosis/Pulmonary...

  1. 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

  2. Action Planning for Daily Mouth Care in Long-Term Care: The Brushing Up on Mouth Care Project

    Directory of Open Access Journals (Sweden)

    Mary E. McNally

    2012-01-01

    Full Text Available Research focusing on the introduction of daily mouth care programs for dependent older adults in long-term care has met with limited success. There is a need for greater awareness about the importance of oral health, more education for those providing oral care, and organizational structures that provide policy and administrative support for daily mouth care. The purpose of this paper is to describe the establishment of an oral care action plan for long-term care using an interdisciplinary collaborative approach. Methods. Elements of a program planning cycle that includes assessment, planning, implementation, and evaluation guided this work and are described in this paper. Findings associated with assessment and planning are detailed. Assessment involved exploration of internal and external factors influencing oral care in long-term care and included document review, focus groups and one-on-one interviews with end-users. The planning phase brought care providers, stakeholders, and researchers together to design a set of actions to integrate oral care into the organizational policy and practice of the research settings. Findings. The establishment of a meaningful and productive collaboration was beneficial for developing realistic goals, understanding context and institutional culture, creating actions suitable and applicable for end-users, and laying a foundation for broader networking with relevant stakeholders and health policy makers.

  3. 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.

  4. 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

  5. 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. PMID:26849981

  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. Update in Critical Care 2015.

    Science.gov (United States)

    Dres, Martin; Mancebo, Jordi; Curley, Gerard F

    2016-07-01

    This review documents important progress made in 2015 in the field of critical care. Significant advances in 2015 included further evidence for early implementation of low tidal volume ventilation as well as new insights into the role of open lung biopsy, diaphragmatic dysfunction, and a potential mechanism for ventilator-induced fibroproliferation. New therapies, including a novel low-flow extracorporeal CO2 removal technique and mesenchymal stem cell-derived microparticles, have also been studied. Several studies examining the role of improved diagnosis and prevention of ventilator-associated pneumonia also showed relevant results. This review examines articles published in the American Journal of Respiratory and Critical Care Medicine and other major journals that have made significant advances in the field of critical care in 2015. PMID:27367886

  9. Models of Comprehensive Care

    Science.gov (United States)

    The second plenary of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans reviews the various models for integration of hospice and palliative care into traditional cancer care that have been shown to improve outcomes.

  10. 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

  11. [Sexuality and Alzheimer's in care facilities].

    Science.gov (United States)

    Dupras, André; Boucher, Sonya

    2014-01-01

    Sexuality of people with Alzheimer's disease is often prohibited in care facilities because its manitestations are considered harmful for the residents and the facility. Ethics of welfare implemented in care facilities require respect for the emotional and sexual lives of residents. Restoring sexual desire in care facilities can be achieved by adopting a humanistic approach that focuses on the development and personal fulfilment of individuals in every sphere of their lives, including sexuality. PMID:25373262

  12. The Relevance of the Affordable Care Act for Improving Mental Health Care.

    Science.gov (United States)

    Mechanic, David; Olfson, Mark

    2016-03-28

    Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce. PMID:26666969

  13. Patients’ narratives of lived experiences of intensive care during after-care

    DEFF Research Database (Denmark)

    Nilsson, Karen; Berner, Susanne; Hertz, Iben;

    2013-01-01

    INTRODUCTION. Current evidence indicates that emotional problems after intensive care are related both to subjective and objective indicators of a patient0s intensive care experience. Research of rehabilitation after critical illness has during the latest years focused on the use of diary and after...... individuals during the trajectory of intensive care and after-care. This, in relation to further develop and targeting after-care interventions in an intensive care unit (ICU) which uses diary as well as after-care as telephone consultations, nurse conversations combined with visits in the ICU at four, eight...... included. Data was obtained using individual interviews twice during after-care: nurse conversations combined with visits in the ICU at 4 months after discharge. Additionally was field notes obtained during the visit in the ICU. Data were analyzed at three levels: naive reading, structural analysis...

  14. 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......: 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...... diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action planning...

  15. Does managed care reduce health care expenditure? Evidence from spatial panel data.

    Science.gov (United States)

    Ehlert, Andree; Oberschachtsiek, Dirk

    2014-09-01

    Similar to, for example, the US, Switzerland or Great Britain the German health care sector has recently undergone a series of reforms towards managed care. These measures are intended to yield both a higher quality of care and cost containment. In our study we ask whether managed care reduces health care expenditure at the market level. We apply a macroeconomic evaluation approach based on a regional panel data set which is as yet unique in the context of managed care. Econometrically, we account for both unobserved heterogeneity and spatial dependence, i.e. regional interrelations in health care. We discuss alternative model specifications and include a range of sensitivity analyses. Our results suggest that in contrast to public perception the share of managed care contracts has a positive impact on pharmaceutical spending, in particular through regional spillover effects. PMID:24691774

  16. Controversies in faith and health care.

    Science.gov (United States)

    Tomkins, Andrew; Duff, Jean; Fitzgibbon, Atallah; Karam, Azza; Mills, Edward J; Munnings, Keith; Smith, Sally; Seshadri, Shreelata Rao; Steinberg, Avraham; Vitillo, Robert; Yugi, Philemon

    2015-10-31

    Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care. PMID:26159392

  17. 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.

  18. 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.

  19. Composite Pressure Vessel Including Crack Arresting Barrier

    Science.gov (United States)

    DeLay, Thomas K. (Inventor)

    2013-01-01

    A pressure vessel includes a ported fitting having an annular flange formed on an end thereof and a tank that envelopes the annular flange. A crack arresting barrier is bonded to and forming a lining of the tank within the outer surface thereof. The crack arresting barrier includes a cured resin having a post-curing ductility rating of at least approximately 60% through the cured resin, and further includes randomly-oriented fibers positioned in and throughout the cured resin.

  20. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: A case study

    OpenAIRE

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, H.J.M.

    2015-01-01

    Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. Methods An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model...