|
#47
13.11.2006, 11:06
|
|||
|
|||
|
Цитата:
 Думаю что разные вопросы будут появляться регулярно, но не так часто (на большинство уже есть готовые ответы). 
|
|
#49
17.11.2006, 19:35
|
|||
|
|||
|
Вот еще противоречивые данные:
Early Recanalization After Intravenous Administration of Recombinant Tissue Plasminogen Activator as Assessed by Pre- and Post-Thrombolytic Angiography in Acute Ischemic Stroke Patients Background and Purpose--Recanalization rates after the intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment have been poorly studied in acute stroke. Methods--CT angiography was performed before IV rt-PA in all patients and digital subtraction angiography was undertaken for intra-arterial thrombolysis in cases of no improvement after rt-PA infusion. Results--Forty-five patients were treated with IV rt-PA. Initial CT angiography showed relevant arterial occlusions in 35 patients. Recanalization after rt-PA therapy was demonstrated by digital subtraction angiography in 7 of the 31 patients with the occlusion on initial CT angiography: 2/16 in the internal carotid or proximal middle cerebral artery, 3/11 in the distal middle cerebral artery and 2/4 in the basilar artery occlusion. Conclusions--  The early recanalization rate after IV rt-PA use was very low in cases with large proximal arterial occlusions. CT angiography before IV rt-PA may be useful for the prediction of its efficacy.
|
|
#50
20.11.2006, 16:55
|
|||
|
|||
Уважаемый админ! И все-таки закрывайте тему: это в нашей стране никому нафиг не надо! Лечитесь, бабушки и дедушки пирацетамом, кавинтоном, глиатилином и т.п., и глядишь, - придет оно озарение Божие в виде исчезновения пареэов и параличей, улучшений когнитивных функций!!! А все остальные страны - дураки, столько бабла выкидывают на весь этот тромболитический бред!
|
|
#51
25.11.2006, 01:12
|
|||
|
|||
Вот новая статья - и опять не все просто и однозначно:
Cost-Effectiveness of Intravenous Thrombolysis With Alteplase Within a 3-Hour Window After Acute Ischemic Stroke Lars Ehlers PhD, MSc (econ)*; Grethe Andersen DMSc, PhD, MD; Lone Beltoft Clausen MSc; Merete Bech MSc; and Mette Kjølby PhD, DDS 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 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-effective. The long-term computations (30 years) showed that thrombolysis was a dominant strategy compared with conservative treatment given the model premises. Conclusions--A high-quality thrombolysis treatment with 24-hour in-house neurology coverage and magnetic resonance imaging might not be cost-effective in the short term compared with conservative treatment. In the long term, there are potentially large-scale health economic cost savings.
|
|
#53
25.11.2006, 07:46
|
|||
|
|||
|
ЗРЯ. Работы представлены достойные!
|
|
#54
25.11.2006, 09:45
|
|||
|
|||
|
Цитата:
|
|
#55
25.11.2006, 12:12
|
|||
|
|||
Уважаемый papadoctor! Вот ссылка, откуда вся эта инфа:[Ссылки доступны только зарегистрированным пользователям ]
На халяву доступно в формате "Abstract",чтоб иметь Full text, надо зарегистрироваться и, заодно, выложить около 300 североамериканских рублей за год. Да, все наши "Visa Electron`ы - не катят. 
|
|
#57
26.11.2006, 19:22
|
|||
|
|||
|
Проехали! Моя проблема в том, что этими больными я не занимаюсь. Но Ваши ссылки, читаю с большим интересом для повышения собственного образования.
|
|
#59
28.11.2006, 08:01
|
|||
|
|||
Вот, немного, поподробнее:
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 harm associated with rt-PA for stroke.
|
|
#60
28.11.2006, 08:05
|
|||
|
|||
|
ПрдолжениеIn this issue of Stroke, Kent et al7 developed a Stroke-Thrombolytic Predictive Instrument (TPI) to aid physicians considering thrombolysis for a patient with acute ischemic stroke. The authors used data from 5 major randomized clinical trials testing rt-PA in acute ischemic stroke. They developed logistic regression equations using clinical variables as potential predictors of a good outcome (defined as modified Rankin Scale score 1) and potential predictors of a catastrophic outcome (defined as modified Rankin Scale score 5) with and without use of rt-PA. To predict good outcome, the rt-PA treatment, age, diabetes, stroke severity, gender, prior stroke, systolic blood pressure, and time from symptom onset significantly affected prognosis. To predict catastrophic outcome, only age, stroke severity, and serum glucose significantly affected prognosis; rt-PA did not. The Stroke-TPI that was created is capable of predicting good and bad functional outcomes for acute ischemic stroke patients with and without thrombolysis.
Consider the following 2 acute ischemic stroke scenarios: In the first scenario, a 77-year-old woman with a history of diabetes mellitus presented to the emergency department relatively late in the course of her stroke symptoms. Her systolic blood pressure was 140 mm Hg, her serum glucose was 15.2 mmol/L, and her National Institute of Health Stroke Scale (NIHSS) score was low, only 5. By the time she had her intravenous lines placed, blood tests drawn and processed, and computed tomography of brain conducted and interpreted, the 3-hour window was nearly closed, at 179 minutes. The treating physician, patient, and accompanying family members had a critical decision to make and essentially no time in which to make it. The physician drew on traditionally available resources and clinical experience. In the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study, on average, an acute ischemic stroke patient treated with rt-PA might expect an absolute risk reduction ranging from 11% to 15%, depending on the functional outcome scale.8 The physician attempted to balance that estimated treatment effect with the potential risk of harm from a symptomatic intracranial hemorrhage, quoted as 6.4%. The physician acknowledged that the later the treatment is administered, the lower the likelihood of a favorable outcome.9 A summary of postmarketing reports of rt-PA use in ischemic stroke has demonstrated that failure to adhere to indications and contraindications outlined in the guidelines, including time window, is associated with an increased risk of hemorrhagic complications.10 Finally, the treating physician’s common experience has been that there is invariably a good spontaneous recovery associated with a mild stroke, NIHSS score of 5, regardless of treatment.10 Ultimately, a decision was made to withhold rt-PA as the perceived risk outweighed the perceived benefit.
|
Линейный вид
