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  • Ovid Technologies (Wolters Kluwer Health)  (3)
  • 2010-2014  (3)
  • 1
    Online Resource
    Online Resource
    C-Reactive Protein as a Prognostic Marker After Lacunar Stroke : Levels of Inflammatory Markers in the Treatment of Stroke Study
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 3 ( 2014-03), p. 707-716
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 3 ( 2014-03), p. 707-716
    Abstract: Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke. Methods— Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use. Results— Among 1244 patients with lacunar stroke (mean age, 63.3±10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes) and 115 major vascular events (stroke, myocardial infarction, and vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP 〉 4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR, 2.54; 95% CI, 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR, 2.32; 95% CI, 1.15–4.68). hsCRP predicted increased risk of major vascular events (top quartile adjusted HR, 2.04; 95% CI, 1.14–3.67). There was no interaction with randomized antiplatelet treatment. Conclusions— Among recent lacunar stroke patients, hsCRP levels predict the risk of recurrent strokes and other vascular events. hsCRP did not predict the response to dual antiplatelets. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00059306.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.004562
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Abstract 346: Passive Ventilation During Cardiopulmonary Resuscitation Inside the Emergency Department
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: Background: Continuing high quality chest compressions (CC) without interruption for active positive pressure ventilation (PPV) early in CPR has been demonstrated to improve patient outcomes in out-of-hospital cardiac arrest (OHCA). During the first minutes of CPR, passive oxygenation may be sufficient for oxygenating vital tissues. However, less is known about the later minutes of CPR. To evaluate this issue, in OHCA patients after hospital arrival, we quantified ventilation volumes during CCs in the ED. Methods: CPR quality metrics were obtained on patients who had CPR inside the ED with the E-Series defibrillator/monitor (Zoll Medical). Detailed ventilation data were obtained using a Non-Invasive Cardiac Output (NICO) Monitor (Philips/Respironics) with a CO2/flow sensor placed at the endotracheal tube. NICO waveform and breath-by-breath data were captured to measure ventilation volume associated with CCs. Results: Data files on 21 cardiac arrest patients who presented to the ED were included. [Male: 17, median age: 59 (IQR 47, 72)]. A total of 29,935 compressions (CCs) were analyzed [median depth 2.1 in (IQR=1.9, 2.5), median rate 126 CC/min (IQR=122-129). The median passive tidal volume during CCs was 5.8 mL, (IQR 3.4, 11.0). The highest volume was 124 mL, however 81% of the measured tidal volumes were 〈 20 mL. Conclusion: This quantified analysis of ventilation volumes during chest compressions in the ED suggests that significant passive ventilation volumes may not occur later in CPR. Even in patients who were receiving effective compressions, passive tidal volumes were extremely low overall, suggesting that the value of compression only CPR may, in part, be due to the avoidance of the harmful effects of hyperventilation rather than any potential effect of passive ventilation.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.346
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1466401-X
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  • 3
    Online Resource
    Online Resource
    Self-Reported Long-Term Needs After Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 5 ( 2011-05), p. 1398-1403
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 5 ( 2011-05), p. 1398-1403
    Abstract: Development of interventions to manage patients with stroke after discharge from the hospital requires estimates of need. This study estimates the prevalence of self-reported need in community-dwelling stroke survivors across the United Kingdom. Methods— We conducted a survey of stroke survivors 1 to 5 years poststroke recruited through Medical Research Council General Practice Research Framework general practices and 2 population-based stroke registers. Levels and type of need were calculated with comparisons among sociodemographic groups, disability level, and cognitive status using the χ 2 test or Fisher exact test, as appropriate. Results— From 1251 participants, response rates were 60% (national sample) and 78% (population registers sample) with few differences in levels of reported need between the 2 samples. Over half (51%) reported no unmet needs; among the remainder, the median number of unmet needs was 3 (range, 1 to 13). Proportions reporting unmet clinical needs ranged from 15% to 59%; 54% reported an unmet need for stroke information; 52% reported reduction in or loss of work activities, significantly more from black ethnic groups ( P =0.006); 18% reported a loss in income and 31% an increase in expenses with differences by age, ethnic group, and deprivation score. In multivariable analysis, ethnicity ( P =0.032) and disability ( P =0.014) were associated with total number of unmet needs. Conclusions— Multiple long-term clinical and social needs remain unmet long after incident stroke. Higher levels of unmet need were reported by people with disabilities, from ethnic minority groups, and from those living in the most deprived areas. Development and testing of novel methods to meet unmet needs are required.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.598839
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
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    Online Resource
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