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  • 1
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 6 ( 2010-06), p. 1084-1099
    Kurzfassung: Background and Purpose— The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods— Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results— Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent “silo” mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a “Brain Health” concept that enables promotion of preventive measures. Conclusions— To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2010
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    In: International Journal of Stroke, SAGE Publications, Vol. 5, No. 4 ( 2010-08), p. 238-256
    Kurzfassung: The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by seven working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology : There is a need to develop: ( 1 ) New systems of working together to break down the prevalent ‘silo’ mentality; ( 2 ) New models of vertically integrated basic, clinical, and epidemiological disciplines; and ( 3 ) Efficient methods of identifying other relevant areas of science. Stroke Prevention : ( 1 ) Establish a global chronic disease prevention initiative with stroke as a major focus. ( 2 ) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. ( 3 ) Develop, implement and evaluate a population approach for stroke prevention. ( 4 ) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management : Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation : ( 1 ) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. ( 2 ) Standardize poststroke rehabilitation based on best evidence. ( 3 ) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. ( 4 ) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications :( 1 ) Work toward global unrestricted access to stroke-related information. ( 2 ) Build centralized electronic archives and registries. Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care. Educate and energize professionals, patients, the public and policy makers by using a ***‘Brain Health’ concept that enables promotion of preventive measures. Conclusions To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.
    Materialart: Online-Ressource
    ISSN: 1747-4930 , 1747-4949
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2010
    ZDB Id: 2211666-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 30, No. 2 ( 2010), p. 127-147
    Materialart: Online-Ressource
    ISSN: 1421-9786 , 1015-9770
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2010
    ZDB Id: 1482069-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 12 ( 2016-12), p. 2979-2985
    Kurzfassung: The advent of intra-arterial neurothrombectomy (IAT) for acute ischemic stroke opens a potentially transformative opportunity to improve neuroprotection studies. Combining a putative neuroprotectant with recanalization could produce more powerful trials but could introduce heterogeneity and adverse event possibilities. We sought to demonstrate feasibility of IAT in neuroprotectant trials by defining IAT selection criteria for an ongoing neuroprotectant clinical trial. Methods— The study drug, 3K3A-APC, is a pleiotropic cytoprotectant and may reduce thrombolysis-associated hemorrhage. The NeuroNEXT trial NN104 (RHAPSODY) is designed to establish a maximally tolerated dose of 3K3A-APC. Each trial site provided their IAT selection criteria. An expert panel reviewed site criteria and published evidence. Finally, the trial leadership designed IAT selection criteria. Results— Derived selection criteria reflected consistency among the sites and comparability to published IAT trials. A protocol amendment allowing IAT (and relaxed age, National Institutes of Health Stroke Scale, and time limits) in the RHAPSODY trial was implemented on June 15, 2015. Recruitment before and after the amendment improved from 8 enrolled patients (601 screened, 1.3%) to 51 patients (821 screened, 6.2%; odds ratio [95% confidence limit] of 4.9 [2.3–10.4] ; P 〈 0.001). Gross recruitment was 0.11 patients per site month versus 0.43 patients per site per month, respectively, before and after the amendment. Conclusions— It is feasible to include IAT in a neuroprotectant trial for acute ischemic stroke. Criteria are presented for including such patients in a manner that is consistent with published evidence for IAT while still preserving the ability to test the role of the putative neuroprotectant. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT02222714.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    In: International Journal of Stroke, SAGE Publications, Vol. 9, No. 6 ( 2014-08), p. 683-695
    Kurzfassung: We are entering a challenging but exciting period when many new interventions may appear for stroke based on the use of devices. Hopefully these will lead to improved outcomes at a cost that can be afforded in most parts of the world. Nevertheless, it is vital that lessons are learnt from failures in the development of pharmacological interventions (and from some early device studies), including inadequate preclinical testing, suboptimal trial design and analysis, and underpowered studies. The device industry is far more disparate than that seen for pharmaceuticals; companies are very variable in size and experience in stroke, and are developing interventions across a wide range of stroke treatment and prevention. It is vital that companies work together where sales and marketing are not involved, including in understanding basic stroke mechanisms, prospective systematic reviews, and education of physicians. Where possible, industry and academics should also work closely together to ensure trials are designed to be relevant to patient care and outcomes. Additionally, regulation of the device industry lags behind that for pharmaceuticals, and it is critical that new interventions are shown to be safe and effective rather than just feasible. Phase IV postmarketing surveillance studies will also be needed to ensure that devices are safe when used in the ‘real-world’ and to pick up uncommon adverse events.
    Materialart: Online-Ressource
    ISSN: 1747-4930 , 1747-4949
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2014
    ZDB Id: 2211666-7
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Kurzfassung: Introduction: The THRIVE score strongly predicts clinical outcome, mortality, and risk of thrombolytic hemorrhage in ischemic stroke patients, and performs similarly well in patients receiving IV tPA, endovascular stroke treatment (EST), or no acute treatment. We recently validated the performance of the THRIVE score in the TREVO-2 trial of a third generation EST device, the Trevo device Methods: We examined the relationship between THRIVE and clinical outcomes (good outcome [mRS 0-2] or death at 90 days) among patients in SWIFT and STAR. Receiver-Operator Characteristics (ROC) curve analysis was used to compare THRIVE score performance to other stroke prediction scores. Multivariable logistic regression was used to confirm the independence of THRIVE score from procedure-specific predictors (target vessel recanalization or device used in SWIFT) of outcome. Results: THRIVE score strongly predicted good outcome (Figure, A) and death (Figure, B) among patients treated with the Solitaire device in SWIFT and STAR (Mantel-Haenztel Chi-square test for trend P 〈 0.001 for good outcome, P=0.01 for death). In ROC curve comparisons, THRIVE was superior to SPAN-100 (P 〈 0.001) and performed similarly to HIAT (P=0.98) and HIAT-2 (P=0.54). In logistic regression, THRIVE’s prediction of good outcome was not altered after controlling for recanalization (in all Solitaire patients) or after controlling for device used (in the SWIFT RCT). Conclusions: The THRIVE score strongly predicts clinical outcome and mortality in patients treated with the Solitaire device in the SWIFT and STAR trials. The lack of interaction between THRIVE and procedure-specific elements such as vessel recanalization or device choice supports the use of the THRIVE score as an a priori selection criterion in stroke clinical trials.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2014
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
    Online-Ressource
    Online-Ressource
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 10, No. suppl_3 ( 2017-03)
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. suppl_3 ( 2017-03)
    Kurzfassung: Background: Hospital profiling is typically undertaken using risk standardized 30-day mortality but obtaining this data is complicated as it requires tracking patients post discharge. We undertook this analysis to determine if risk standardized in-hospital mortality could serve as an adequate proxy for risk standardized 30-day mortality data for the purposes of identifying outlier hospitals with high or low ischemic stroke mortality. Methods: Acute ischemic stroke cases entered into Get With The Guidelines (GWTG)-Stroke between 2003-2013 were linked to fee-for-service Medicare files. Hospitals with fewer than 25 cases were excluded. Risk-standardized mortality rates (RSMR) for both in-hospital and 30-day mortality were generated using a previously developed risk model, and the proportion of hospitals classified as statistical outliers (based on random effects models) were compared between the two. To assess the impact of stroke severity we conducted a sensitivity analysis limiting cases to those with NIHSS data. Results: A total of 535,332 ischemic stroke patients from 1494 GWTG-Stroke hospitals were included; mean age was 80 years, 59% were female, 19% were non-white, NIHSS (mean = 7.7) was recorded in 58%. Average in-hospital and 30-day mortality was 5.7% and 14.5%, respectively. At the hospital level, mean in-hospital RSMR and 30-day RSMR was 6.0% (SD 1.9) and 14.6% (SD 2.0), respectively, but the correlation between the two was only modest (r = 0.53). Overall agreement between the designation of outlier hospitals based on in-hospital and 30-day RSMRs was 78% (Table), but after correcting for chance agreement, concordance was quite modest (Kappa = 0.29). Findings based on models that included NIHSS were similar. Conclusions: When used to identify outlier hospitals with high or low ischemic stroke mortality the agreement between in-hospital mortality and 30-day mortality was only modest. Using in-hospital mortality data proved to be a poor proxy for 30-day mortality.
    Materialart: Online-Ressource
    ISSN: 1941-7713 , 1941-7705
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2017
    ZDB Id: 2453882-6
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
    Online-Ressource
    Online-Ressource
    Elsevier BV ; 2013
    In:  Clinical Neurology and Neurosurgery Vol. 115, No. 10 ( 2013-10), p. 2124-2129
    In: Clinical Neurology and Neurosurgery, Elsevier BV, Vol. 115, No. 10 ( 2013-10), p. 2124-2129
    Materialart: Online-Ressource
    ISSN: 0303-8467
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2013
    ZDB Id: 2004613-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
    Online-Ressource
    Online-Ressource
    Journal of Neurosurgery Publishing Group (JNSPG) ; 1997
    In:  Journal of Neurosurgery Vol. 87, No. 6 ( 1997-12), p. 955-960
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 87, No. 6 ( 1997-12), p. 955-960
    Kurzfassung: ✓ The authors report on a series of patients with idiopathic Parkinson's disease (IPD) who underwent stereotactic radiofrequency (RF) pallidotomies, three of whom suffered delayed postoperative strokes. These three belonged to a group consisting of 42 patients with medically intractable IPD in whom 50 pallidotomies were performed. All three patients had significant previous vascular disease and were in a high-risk group for cerebral infarction. A postoperative magnetic resonance (MR) image was obtained immediately after the pallidotomy was performed to document the placement of the RF lesion and to rule out any hematoma. The delayed strokes occurred on postoperative Days 10, 51, and 117 in patients with previous vascular disease (Group 1, 11 patients). No strokes occurred in the group with the vascular disease risk factor (Group 2, 11 patients) or in the group with no risk factors for vascular disease (Group 3, 20 patients). This observation is statistically significant (p 〈 0.05). The T 2 -weighted MR images showed the lesions as high-intensity signals extending to the posterior limb of the internal capsule ipsilateral to the pallidotomy site. The poststroke T 1 -weighted images obtained in two patients showed persistent contrast enhancement of the RF lesion and no enhancement around the stroke lesion. Clinically and radiographically, these discrete new lesions represent delayed infarctions, suggesting that RF lesioning can induce delayed injury in adjacent tissue. Patients with previously identified vasculopathy may be at risk for delayed capsular infarction following RF pallidotomy.
    Materialart: Online-Ressource
    ISSN: 0022-3085
    RVK:
    RVK:
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 1997
    ZDB Id: 2026156-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Kurzfassung: Background: Intravenous tissue plasminogen activator (IVtPA) is the only approved treatment for acute ischemic stroke (AIS), but is used in only 4-6% of potentially eligible patients. The risk of hemorrhage is fairly easy to communicate, but the benefits of treatment in reducing disability are difficult to estimate for individual patients. During development of an evidence-based tool to encourage participation of stroke survivors and families in tPA treatment decisions, we conducted qualitative interviews to learn how best to present risk/benefit data. Methods: We conducted 3 focus groups to determine effective strategies for presenting the beneficial outcome (modified Rankin Scale; mRS) and the risk of bleeding. Twelve stroke survivors (mean age = 54; 4 female) and 3 family members (mean age = 68; 3 female) participated at 2 different sites. Results: The majority of survivors do not recall being educated about acute stroke or treatment, though families provide vivid recollection. Four themes emerged as they expressed a need for more information (subject identified by Patient/Caregiver, gender, study number, and site): A ‘good’ outcome is a mRS of 0,1, or 2 - “¼I think that 0-2 is REALLY a good outcome as [I’ve] seen severely disabled patients throughout recovery” (PM04LA). Preferred both overall and personalized outcomes estimates: “Tell me my individual risk and then show me how that compares to the general population. As far as the general population, maybe your risk is higher than others.” (PM07KC). Present risk as ‘positive’ outcomes (e.g. the likelihood of mRS 0-2, rather than 3-6): “’Bad outcome’, I don’t like those words. You’re talking about somebody I love, you know.” (CF10KC). Present both risks and benefits of tPA: “I would be open to take a risk if I thought there would be a good chance of a major improvement” (PM08KC). Conclusions: Stroke survivors and families desire more information at the time of acute stroke and agreed that mRS of 0-2 constitutes a good outcome. They articulated what information would be important for deciding about treatment with IVtPA and this will be used to create a decision aid to deliver individualized risk/benefit estimates in an understandable format that can support communication and shared medical decision-making.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2013
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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