Показать сообщение отдельно
  #62  
Старый 28.11.2006, 08:14
vladmokh vladmokh вне форума Пол мужской
Начинающий участник
 
Регистрация: 24.01.2006
Город: Санкт - Петербург
Сообщений: 30
Сказал(а) спасибо: 1
vladmokh этот участник имеет хорошую репутацию на форуме
Exclamation

В заключении; probability of a catastrophic outcome was very high, 51%, whether rt-PA was used or not. It was also confirmed that the probability of a good outcome, without rt-PA, was extremely low, 4%. What was better presented using the Stroke-TPI tool was the 9% probability of a good outcome with administration of rt-PA. If the husband of this woman was presented quantitative estimates of various outcomes, in this fashion, the ultimate treatment decision may have been a different one. Although he already appreciated that there was a fifty-fifty chance of catastrophic outcome regardless of treatment choice, he could now see that his wife had a 1 in 11 (9%) chance of making a good recovery with rt-PA versus a 1 in 25 (4%) chance without rt-PA. Armed with this quantitative information, a treatment attempt with rt-PA might not seem quite so futile. These case examples illustrate how this predictive instrument could potentially support point-of-care physician decision-making and counseling of patients and families.
A few limitations exist. The authors point out that the predictive equations are based on outcomes achieved in major randomized clinical trials. Thus, the outcome predictions may not be reliable for patients who are not well represented in the database (eg, the very elderly and those with pre-existing disability) and for instances when there is less than strict adherence to treatment protocols.
The Stroke-TPI appears to be a well-conceived, valid, and potentially useful predictive instrument. The next natural step would be to study the effect it has on physician clinical decision-making and on patient outcomes.
The Stroke-Thrombolytic Predictive Instrument Provides Valid Quantitative Estimates of Outcome Probabilities and Aids Clinical Decision-Making
Key Words: acute care • acute stroke • emergency medicine • thrombolysis • thrombolytic RX
Computerized clinical decision support systems are increasingly popular in health sciences and have been demonstrated to improve practitioner performance.1 For an emergency closely related to ischemic stroke, acute myocardial infarction, a thrombolytic predictive instrument was developed for real-time use in emergency medical-service settings to identify patients likely to benefit from thrombolysis and to facilitate the earliest possible use of this therapy.2,3 A similar instrument, designed for ischemic stroke, could also prove to be useful. Thrombolysis for ischemic stroke remains underused even under ideal circumstances. Approximately 40% of emergency physicians in a national survey report that they would not use recombinant tissue plasminogen activator (rt-PA) for stroke, citing the risk of symptomatic intracranial hemorrhage and relative lack of benefit.4 Similar results were reported by Bobrow et al in a survey of the Arizona chapter of the American College of Emergency Physicians. Only 52% of the emergency physicians who responded to the survey indicated that they would endorse rt-PA use for stroke under ideal conditions.5 Physicians’ perceptions of risks and benefits of rt-PA for stroke are not uniformly accurate.6 Merino et al reported that only 11% (95% CI, 0 to 22) of surveyed emergency medicine physicians and neurologists could correctly convey the expected magnitude of beneficial effect of rt-PA, and that only 39% (95% CI, 21 to 57) could accurately report the expected rate of symptomatic and fatal intracranial hemorrhage of rt-PA.6 This misperception may interfere with their willingness to endorse this treatment. It would be helpful to draw a distinction between true and perceived efficacy and between true and perceived

Комментарии к сообщению:
Кондратьев Олег одобрил(а):
Ответить с цитированием