Accuracy and Safety of External Ventricular Drain Placement by Physician Assistants and Nurse Practitioners in Aneurysmal Acute Subarachnoid Hemorrhage

2018 ◽  
Vol 29 (3) ◽  
pp. 435-442 ◽  
Author(s):  
Alejandro Enriquez-Marulanda ◽  
Luis C. Ascanio ◽  
Mohamed M. Salem ◽  
Georgios A. Maragkos ◽  
Ray Jhun ◽  
...  
2019 ◽  
Vol 121 ◽  
pp. e535-e542 ◽  
Author(s):  
Markus Lenski ◽  
Annamaria Biczok ◽  
Volker Huge ◽  
Robert Forbrig ◽  
Josef Briegel ◽  
...  

2020 ◽  
Vol 81 ◽  
pp. 180-185
Author(s):  
Victor M. Lu ◽  
Christopher S. Graffeo ◽  
Avital Perry ◽  
Lucas P Carlstrom ◽  
Amanda M. Casabella ◽  
...  

2020 ◽  
Vol 130 (11) ◽  
pp. 1166-1169
Author(s):  
Panagiotis Kerezoudis ◽  
Thomas J. Sorenson ◽  
Joseph R. Kapurch ◽  
Michael J. Link ◽  
Eelco F. Wijdicks ◽  
...  

2017 ◽  
Vol 27 (3) ◽  
pp. 350-355 ◽  
Author(s):  
Andrew P. Gard ◽  
Brian D. Sayles ◽  
J. Will Robbins ◽  
William E. Thorell ◽  
Daniel L. Surdell

2021 ◽  
Vol 134 (1) ◽  
pp. 95-101 ◽  
Author(s):  
R. Loch Macdonald ◽  
Daniel Hänggi ◽  
Poul Strange ◽  
Hans Jakob Steiger ◽  
J Mocco ◽  
...  

OBJECTIVEThe objective of this study was to measure the concentration of nimodipine in CSF and plasma after intraventricular injection of a sustained-release formulation of nimodipine (EG-1962) in patients with aneurysmal subarachnoid hemorrhage (SAH).METHODSPatients with SAH repaired by clip placement or coil embolization were randomized to EG-1962 or oral nimodipine. Patients were classified as grade 2–4 on the World Federation of Neurosurgical Societies grading scale for SAH and had an external ventricular drain inserted as part of their standard of care. Cohorts of 12 patients received 100–1200 mg of EG-1962 as a single intraventricular injection (9 per cohort) or they remained on oral nimodipine (3 per cohort). Plasma and CSF were collected from each patient for measurement of nimodipine concentrations and calculation of maximum plasma and CSF concentration, area under the concentration-time curve from day 0 to 14, and steady-state concentration.RESULTSFifty-four patients in North America were randomized to EG-1962 and 18 to oral nimodipine. Plasma concentrations increased with escalating doses of EG-1962, remained stable for 14 to 21 days, and were detectable at day 30. Plasma concentrations in the oral nimodipine group were more variable than for EG-1962 and were approximately equal to those occurring at the EG-1962 800-mg dose. CSF concentrations of nimodipine in the EG-1962 groups were 2–3 orders of magnitude higher than in the oral nimodipine group, in which nimodipine was only detected at low concentrations in 10% (21/213) of samples. In the EG-1962 groups, CSF nimodipine concentrations were 1000 times higher than plasma concentrations.CONCLUSIONSPlasma concentrations of nimodipine similar to those achieved with oral nimodipine and lasting for 21 days could be achieved after a single intraventricular injection of EG-1962. The CSF concentrations from EG-1962, however, were at least 2 orders of magnitude higher than those with oral nimodipine. These results supported a phase 3 study that demonstrated a favorable safety profile for EG-1962 but yielded inconclusive efficacy results due to notable differences in clinical outcome based on baseline disease severity.Clinical trial registration no.: NCT01893190 (ClinicalTrials.gov).


2019 ◽  
Vol 17 (6 (part 1)) ◽  
pp. 31-34
Author(s):  
R. Ya. Shpaner ◽  
◽  
A. Zh. Bayalieva ◽  
◽  

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maureen O’Brien Pott ◽  
Anissa S. Blanshan ◽  
Kelly M. Huneke ◽  
Barbara L. Baasch Thomas ◽  
David A. Cook

Abstract Background CPD educators and CME providers would benefit from further insight regarding barriers and supports in obtaining CME, including sources of information about CME. To address this gap, we sought to explore challenges that clinicians encounter as they seek CME, and time and monetary support allotted for CME. Methods In August 2018, we surveyed licensed US clinicians (physicians, nurse practitioners, and physician assistants), sampling 100 respondents each of family medicine physicians, internal medicine and hospitalist physicians, medicine specialist physicians, nurse practitioners, and physician assistants (1895 invited, 500 [26.3%] responded). The Internet-based questionnaire addressed barriers to obtaining CME, sources of CME information, and time and monetary support for CME. Results The most often-selected barriers were expense (338/500 [68%]) and travel time (N = 286 [57%]). The source of information about CME activities most commonly selected was online search (N = 348 [70%]). Direct email, professional associations, direct mail, and journals were also each selected by > 50% of respondents. Most respondents reported receiving 1–6 days (N = 301 [60%]) and $1000–$5000 (n = 263 [53%]) per year to use in CME activities. Most (> 70%) also reported no change in time or monetary support over the past 24 months. We found few significant differences in responses across clinician type or age group. In open-ended responses, respondents suggested eight ways to enhance CME: optimize location, reduce cost, publicize effectively, offer more courses and content, allow flexibility, ensure accessibility, make content clinically relevant, and encourage application. Conclusions Clinicians report that expense and travel time are the biggest barriers to CME. Time and money support is limited, and not increasing. Online search and email are the most frequently-used sources of information about CME. Those who organize and market CME should explore options that reduce barriers of time and money, and creatively use online tools to publicize new offerings.


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