Patient Selection and Treatment Protocol

Background: The role of CT perfusion (CTP) in thrombolysis decisions remains controversial and there are no studies that compare outcomes of thrombolysis in patients with or without mismatch on CT perfusion imaging. Methods: We analysed registry data between Jan 2009 and December 2010 for patients thrombolysed within 0-4.5 hours of stroke onset in whom CTP studies were performed prior to thrombolysis. The centre followed thrombolysis guidelines but patients >80 years were included. CTP was not obligatory in the treatment protocol and failure to demonstrate a mismatch was not a contraindication to thrombolysis. We retrospectively analysed data for estimated CTP mismatch of ≥ 100% according to pre-defined criteria and compared outcomes of thrombolysed patients showing perfusion mismatch with those showing no mismatch. Findings: The sample included 160 patients aged between 32-95 years of whom 63 had no mismatch and 97 had a significant mismatch. The two groups were comparable for mean age (73 v 70 years, p=0.18), sex (49% v 54% male, p=0.75), premorbid Rankin Score (mRS) 0-2 (81% v 92%, p=0.77), vascular risk factors profile, mean baseline BP (148/87 v 148/79 mm Hg, p=0.92), mean blood glucose (6.6 v 6.6 mmols/L, p=0.98) and mean National Institute of Health Stroke Scale (NIHSS) score (14.0 v 12.6,p=0.12). Patients who had mismatch prior to thrombolysis showed lower mean 24 hour NIHSS score (7.6 v 11.8, p=0.002) and greater mean 24 hour improvement in NIHSS score (5.1 v 2.0, p=0.010). A higher proportion of patients with mismatch achieved mRS 0-1 and mRS 0-2 at 3 months (36% v 18%, p= 0.012 and 51% v 32%, p=0.015 respectively) but there were no differences in symptomatic sICH rates (1.1% v 0%). Mortality (29% v 18%) and any intracranial haemorrhages (19% v 13%) were lower in mismatch patients but did not achieve significance. Regression analyses showed that PCT mismatch prior to thrombolysis was an independent predictor of both early improvement and functional outcomes at 3 months. Conclusion: Stroke patients who have perfusion mismatch on CTP imaging prior to thrombolysis within the 4.5 hour time window show better early and 3 month outcomes compared with those in whom mismatch cannot be demonstrated. Patient selection using multimodal CT may improve the effectiveness of thrombolysis.

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Immunoexpression of PD-L1 and PD-1 and Its Clinicopathological Correlation in Urothelial Carcinomas

Journal of Laboratory Physicians ◽

10.1055/s-0041-1736480 ◽

2021 ◽

Author(s):

Utpal Kumar ◽

Michael Leonard Anthony ◽

Rishabh Sahai ◽

Ankur Mittal ◽

Prashant Durgapal ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Patient Selection ◽

Immune Checkpoint ◽

Checkpoint Inhibitors ◽

Tumor Resection ◽

Treatment Protocol ◽

High Expression ◽

Urothelial Carcinomas ◽

Multiple Drugs ◽

Age And Sex

Abstract Introduction Urothelial carcinomas are the most common types of bladder tumors that have recently shown a changing trend in treatment protocols with the introduction and approval of immune checkpoint inhibitors. The most important immune checkpoint lies with the PD-1–PD-L1 axis. Although multiple drugs have been approved, there is uncertainty about patient selection criteria and diagnostic assays. Recent studies related to the laboratory-developed tests have opened up the horizon of PD-1 and PD-L1 immunohistochemistry even at resource-constrained laboratories. We propose to study these immunohistochemistry markers in our laboratory using newer clones. Materials and Methods We selected 116 consecutive cases of transurethral bladder tumor resection from our laboratory archive and applied PD-1 and PD-L1 immunohistochemistry. The study was approved by the institution's ethics committee. Results We found high expression of PD-1 and PD-L1 in urothelial carcinoma even with different cut-offs of PD-L1. Muscle invasion, lamina invasion, and grade of carcinoma had a statistically significant effect on the expression; however, age and sex did not affect the expression. Conclusion Based on our current study, we can conclude that the clones used in our study show high expression in urothelial carcinoma and can aid in patient selection and treatment protocol, irrespective of age and sex.

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Abstract WP283: Medical Treatment Matters: Using Headdfirst Results To Enhance The Lessons From The European Hemicraniectomy Trials For Stroke

Stroke ◽

10.1161/str.44.suppl_1.awp283 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Jeffrey I Frank ◽

Phil Schumm ◽

Ronald Thisted ◽

Keyword(s):

High Risk ◽

Medical Treatment ◽

Patient Selection ◽

Meta Analysis ◽

Treatment Protocol ◽

Surgical Decompression ◽

Brain Swelling ◽

Strict Adherence ◽

Better Than ◽

Hemispheric Infarction

Introduction: HeADDFIRST was a randomized trial to evaluate the benefit of surgical decompression for brain swelling from large supratentorial cerebral hemispheric infarction (LSCHI). Subsequently, several similar European trials have been completed. Several unique aspects about HeADDFIRST findings provide specific lessons about patient selection and the significance of medical management to outcome, particularly in the context of these trials. Methods: All patients were screened for eligibility (age 18-75, NIHSS > 18, and CT demonstrating at least compete MCA territory infarction by specific imaging criteria). Those without exclusions and consented were treated by a standardized medical treatment protocol. Those with > 4 mm of pineal shift or > 7.5 mm of anteroseptal shift within 96 hours of stroke onset were randomized to the medical treatment only (MTO) or surgical + medical treatment (SMT) arms with struct adherence. Results: 40 patients were registered, and 26 developed the requisite brain swelling for randomization. All of those consented who failed to develop the degree of brain swelling required for randomization survived. The 180-day mortality was 40% and 35.7% in the MTO and SMT arms, respectively. From the pooled meta-analysis of the European trials’ the 12-month mortality was 71% and 22% in the medical and surgical arms. Conclusion: 1. HeADDFIRST medical treatment outcomes were profoundly better than the European trials, suggesting some significance to our medical treatment protocol differences and the strict adherence. 2. HeADDFIRST randomization criteria accurately differentiates between survivors vs. those with a high risk of non-survival with LSCHI.

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Palliative Care for Advanced Heart Failure in a Department of Veterans Affairs Regional Hospice Program: Patient Selection, a Treatment Protocol, and Clinical Course

Journal of Palliative Medicine ◽

10.1089/jpm.2017.0035 ◽

2017 ◽

Vol 20 (10) ◽

pp. 1068-1073 ◽

Cited By ~ 6

Author(s):

George J. Taylor ◽

Dorothy M. Lee ◽

Catalin F. Baicu ◽

Michael R. Zile

Keyword(s):

Heart Failure ◽

Palliative Care ◽

Patient Selection ◽

Clinical Course ◽

Treatment Protocol ◽

Veterans Affairs ◽

Advanced Heart Failure ◽

Department Of Veterans Affairs

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The removal and morphology of intact biofilms from implanted venous access devices

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100141470 ◽

1995 ◽

Vol 53 ◽

pp. 1020-1021

Author(s):

M.A. Gregory ◽

G.P. Hadley

Keyword(s):

Patient Selection ◽

Surgical Oncology ◽

Venous Access ◽

Common Procedure ◽

Indwelling Catheters ◽

Careful Patient ◽

Novel Method ◽

The Subject ◽

Vascular Catheters ◽

Venous Access Devices

The insertion of implanted venous access systems for children undergoing prolonged courses of chemotherapy has become a common procedure in pediatric surgical oncology. While not permanently implanted, the devices are expected to remain functional until cure of the primary disease is assured. Despite careful patient selection and standardised insertion and access techniques, some devices fail. The most commonly encountered problems are colonisation of the device with bacteria and catheter occlusion. Both of these difficulties relate to the development of a biofilm within the port and catheter. The morphology and evolution of biofilms in indwelling vascular catheters is the subject of ongoing investigation. To date, however, such investigations have been confined to the examination of fragments of biofilm scraped or sonicated from sections of catheter. This report describes a novel method for the extraction of intact biofilms from indwelling catheters.15 children with Wilm’s tumour and who had received venous implants were studied. Catheters were removed because of infection (n=6) or electively at the end of chemotherapy.

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Treatment Fidelity Procedures for an Aphasia Intervention Within a Randomized Controlled Trial: Design, Feasibility, and Results

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-cac48-18-0227 ◽

2020 ◽

Vol 29 (1S) ◽

pp. 412-424

Author(s):

Elissa L. Conlon ◽

Emily J. Braun ◽

Edna M. Babbitt ◽

Leora R. Cherney

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Treatment Protocol ◽

Treatment Fidelity ◽

Protocol Adherence ◽

Study Condition ◽

Randomized Controlled ◽

Aphasia Therapy ◽

Percent Accuracy ◽

Over Time

Purpose This study reports on the treatment fidelity procedures implemented during a 5-year randomized controlled trial comparing intensive and distributed comprehensive aphasia therapy. Specifically, the results of 1 treatment, verb network strengthening treatment (VNeST), are examined. Method Eight participants were recruited for each of 7 consecutive cohorts for a total of 56 participants. Participants completed 60 hr of aphasia therapy, including 15 hr of VNeST. Two experienced speech-language pathologists delivered the treatment. To promote treatment fidelity, the study team developed a detailed manual of procedures and fidelity checklists, completed role plays to standardize treatment administration, and video-recorded all treatment sessions for review. To assess protocol adherence during treatment delivery, trained research assistants not involved in the treatment reviewed video recordings of a subset of randomly selected VNeST treatment sessions and completed the fidelity checklists. This process was completed for 32 participants representing 2 early cohorts and 2 later cohorts, which allowed for measurement of protocol adherence over time. Percent accuracy of protocol adherence was calculated across clinicians, cohorts, and study condition (intensive vs. distributed therapy). Results The fidelity procedures were sufficient to promote and verify a high level of adherence to the treatment protocol across clinicians, cohorts, and study condition. Conclusion Treatment fidelity strategies and monitoring are feasible when incorporated into the study design. Treatment fidelity monitoring should be completed at regular intervals during the course of a study to ensure that high levels of protocol adherence are maintained over time and across conditions.

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Maximizing Outcomes in Group Treatment of Aphasia: Lessons Learned From a Community-Based Center

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld24.3.100 ◽

2014 ◽

Vol 24 (3) ◽

pp. 100-105 ◽

Cited By ~ 1

Author(s):

Darlene Williamson

Keyword(s):

Group Treatment ◽

Treatment Protocol ◽

Lessons Learned ◽

Group Program ◽

Community Based ◽

Multiple Treatment ◽

Use Of Technology ◽

Communication Impairments ◽

Treatment Settings

Given the potential of long term intervention to positively influence speech/language and psychosocial domains, a treatment protocol was developed at the Stroke Comeback Center which addresses communication impairments arising from chronic aphasia. This article presents the details of this program including the group purposes and principles, the use of technology in groups, and the applicability of a group program across multiple treatment settings.

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