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

Stroke ◽  
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.

scholarly journals Trans-catheter Aortic Valve Implantation Guidelines – Does the Latest Evidence Change our Views?

2011 ◽  
Vol 9 (1) ◽  
pp. 26
Author(s):  
Hannah ZR McConkey ◽  
Bernard Prendergast ◽  
◽  
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Aortic Valve ◽  
Medical Treatment ◽  
Functional Status ◽  
Patient Selection ◽  
High Risk Patients ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

From the wealth of recent registries and trials scrutinising its performance, trans-catheter aortic valve implantation (TAVI) emerges as a viable and rapidly established option, both when compared to medical treatment in inoperable patients and when compared to conventional surgical treatment in high-risk patients. Results consistently demonstrate improvement in functional status and outcome; however, appropriate patient selection remains crucial as high-risk cohorts become apparent.

scholarly journals Decompressive Craniectomy for Malignant Middle Cerebral Artery Stroke

2017 ◽  
Vol 38 (06) ◽  
pp. 737-744 ◽  
Author(s):  
Mark Landreneau ◽  
Kevin Sheth
Keyword(s):  
High Risk ◽  
Patient Selection ◽  
Early Identification ◽  
Older Patients ◽  
Surgical Decompression ◽  
Informed Decision Making ◽  
Mortality Benefit ◽  
The Past ◽  
Middle Cerebral Artery Stroke ◽  
Optimal Approach

AbstractAdvancements in the treatment of ischemic stroke have led to a recent decline in overall stroke mortality, but patients with hemispheric infarcts remain at high risk for death. Recent advances in the approach to this devastating disease include early identification of patients at high risk for swelling and standardized approaches to medical therapy. However, surgical decompression continues to be the most effective treatment for malignant edema from large hemispheric strokes. Patient selection in the past had been strictly limited to younger ages and the nondominant hemisphere. More recent evidence demonstrates a mortality benefit in older patients with a limited impact on morbidity. Judicious patient selection and shared, informed decision making with families remain the optimal approach for this devastating disease.

scholarly journals Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Jiayu He ◽  
Ying Wang ◽  
Zhicheng Du ◽  
Na He ◽  
Yuantao Hao
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Hiv Testing ◽  
Large Scale ◽  
Meta Analysis ◽  
Peer Education ◽  
Risk Groups ◽  
Unprotected Sex ◽  
Cochrane Library ◽  
Better Than

Abstract Background Peer education has become a strategy for health promotion among HIV groups at high-risk worldwide. However, the quantitative effect and its duration of peer education on preventing HIV is still unknown.Method A systematic review and meta-analysis was adopted to assess the effects and its duration of peer education, following the PRISMA guidelines. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on HIV high-risk groups were reviewed. Pooled effects were calculated and the heterogeneity source were explored using meta-regression and subgroup analysis.Results A total of 60 articles with 96484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among high risk groups overall (OR: 0.64; 95%CI: 0.47-0.87). Peer education can promote HIV testing (OR=3.19; 95%CI:2.13,4.79) better than condom use (OR=2.66, 95% CI: 2.11-3.36) and can reduce equipment sharing (OR=0.50; 95%CI:0.33,0.75) better than unprotected sex (OR=0.82; 95%CI: 0.72-0.94). Time trend analysis showed a persistent effect of peer education and the different follow-up time was a source of heterogeneity.Conclusion Peer education is persistently effective for changing behaviors among high-risk groups worldwide, especially for the behaviors of HIV testing and equipment sharing. Low and middle income countries are encouraged to conduct peer education at a large scale.

The Validity of Specific Cognitive Abilities for the Prediction of Training Success in Germany

2014 ◽  
Vol 13 (3) ◽  
pp. 123-133 ◽  
Author(s):  
Wiebke Goertz ◽  
Ute R. Hülsheger ◽  
Günter W. Maier
Keyword(s):  
Cognitive Abilities ◽  
Personnel Selection ◽  
Meta Analysis ◽  
Mental Ability ◽  
Occupational Category ◽  
General Mental Ability ◽  
Training Success ◽  
Specific Cognitive Abilities ◽  
Better Than

General mental ability (GMA) has long been considered one of the best predictors of training success and considerably better than specific cognitive abilities (SCAs). Recently, however, researchers have provided evidence that SCAs may be of similar importance for training success, a finding supporting personnel selection based on job-related requirements. The present meta-analysis therefore seeks to assess validities of SCAs for training success in various occupations in a sample of German primary studies. Our meta-analysis (k = 72) revealed operational validities between ρ = .18 and ρ = .26 for different SCAs. Furthermore, results varied by occupational category, supporting a job-specific benefit of SCAs.

Sign in / Sign up

Export Citation Format

Share Document