Abstract P233: Descriptions of the Meaning of Modified Rankin Scale Outcomes in Acute Stroke Clinical Trials: Meta-Analysis and Call to Corrective Action

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Napasri Chaisinanunkul ◽  
Jeffrey L Saver
Keyword(s):  
Acute Stroke ◽  
Hemorrhagic Stroke ◽  
Meta Analysis ◽  
Health State ◽  
Modified Rankin Scale ◽  
Policy Makers ◽  
Endovascular Thrombectomy ◽  
The Past ◽  
Large N ◽  
Clinical Meaning

Background: The modified Rankin scale, a 7-level, clinician-reported, measure of global disability, is the most widely employed outcome scale in acute stroke trials. As the meaning of technical mRS scores (e.g. mRS 1, mRS 4) is not well-known among general clinicians, patients, and policy-makers, trialists sometimes apply valence (e.g. “excellent”, “good”) and health-state (e.g. “disabled”, “dependent”) terms to convey the clinical meaning of trial findings. The terms employed have not been well-delineated. Methods: Systematic meta-analysis assessing mRS descriptive terms across all large (n ≥ 100) RCTs for acute ischemic or hemorrhagic stroke reported 2000 - 2020, following PRISMA guidelines. Results: Among the 60 RCTs meeting study entry criteria, patient populations were acute ischemic stroke (AIS) in 88%, intracerebral hemorrhage in 8%, both in 3%. Among the 55 AIS trials, tested agents included: antiplatelet - 28%, endovascular thrombectomy - 20%, IV lytics - 20%, neuroprotective - 11%. The mRS was a major endpoint measure in 82% of trials (primary in 60%, secondary in 22%). Table 1 shows frequency of different valence terms (1A) and health state terms (1B) for 9 types of mRS analysis. Trials often used mutually contradictory terms for particular mRS outcomes. e.g. “good outcome” was applied to outcomes mRS 0-1 (2 trials), mRS 0-2 (2 trials), mRS 0-3 (1 trial), and ordinal mRS (3 trials); “favorable” was applied to mRS 0-1 (5 trials), mRS 0-2 (6 trials), and ordinal mRS (6 trials). Also many trials provided no meaningful descriptor (no valence descriptor in 82%, no health state descriptor in 58%). Conclusion: Across major acute stroke trials of the past 20 years, the valence and health state terms for different mRS outcomes have been often mutually contradictory or not provided at all. A standardized nomenclature for mRS outcome description would improve clinician and policy-maker understanding of trial results

Successful mechanical thrombectomy in acute ischemic stroke: revascularization grade and functional independence

2022 ◽  
pp. neurintsurg-2021-018436
Author(s):  
Sherief Ghozy ◽  
Salah Eddine Oussama Kacimi ◽  
Ahmed Y Azzam ◽  
Ramadan Abdelmoez Farahat ◽  
Abdelaziz Abdelaal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Functional Independence ◽  
Complete Revascularization ◽  
Modified Rankin Scale ◽  
Technical Success ◽  
Endovascular Thrombectomy ◽  
Quantitative Synthesis

Most studies define the technical success of endovascular thrombectomy (EVT) as a Thrombolysis in Cerebral Infarction (TICI) revascularization grade of 2b or higher. However, growing evidence suggests that TICI 3 is the best angiographic predictor of improved functional outcomes. To assess the association between successful TICI revascularization grades and functional independence at 90 days, we performed a systematic review and network meta-analysis of thrombectomy studies that reported TICI scores and functional outcomes, measured by the modified Rankin Scale, using the semi-automated AutoLit software platform. Forty studies with 8691 patients were included in the quantitative synthesis. Across TICI, modified TICI (mTICI), and expanded TICI (eTICI), the highest rate of good functional outcomes was observed in patients with TICI 3 recanalization, followed by those with TICI 2c and TICI 2b recanalization, respectively. Rates of good functional outcomes were similar among patients with either TICI 2c or TICI 3 grades. On further sensitivity analysis of the eTICI scale, the rates of good functional outcomes were equivalent between eTICI 2b50 and eTICI 2b67 (OR 0.81, 95% CI 0.52 to 1.25). We conclude that near complete or complete revascularization (TICI 2c/3) is associated with higher rates of functional outcomes after EVT.

scholarly journals Toward a more inclusive paradigm: thrombectomy for stroke patients with pre-existing disabilities

2020 ◽  
pp. neurintsurg-2020-016783 ◽  
Author(s):  
Robert W Regenhardt ◽  
Michael J Young ◽  
Mark R Etherton ◽  
Alvin S Das ◽  
Christopher J Stapleton ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Infarct Size ◽  
Acute Stroke ◽  
Medical History ◽  
Coronary Disease ◽  
Vulnerable Population ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Final Infarct Size

BackgroundPersons with pre-existing disabilities represent over one-third of acute stroke presentations, but account for a far smaller proportion of those receiving endovascular thrombectomy (EVT) and thrombolysis. This is despite existing ethical, economic, legal, and social directives to maximize equity for this vulnerable population. We sought to determine associations between baseline modified Rankin Scale (mRS) and outcomes after EVT.MethodsIndividuals who underwent EVT were identified from a prospectively maintained database. Demographics, medical history, presentations, treatments, and outcomes were recorded. Baseline disability was defined as baseline mRS≥2. Accumulated disability was defined as the delta between baseline mRS and absolute 90-day mRS.ResultsOf 381 individuals, 49 had baseline disability (five with mRS=4, 23 mRS=3, 21 mRS=2). Those with baseline disability were older (81 vs 68 years, P<0.0001), more likely female (65% vs 49%, P=0.032), had more coronary disease (39% vs 20%, P=0.006), stroke/TIA history (35% vs 15%, P=0.002), and higher NIH Stroke Scale (19 vs 16, P=0.001). Baseline mRS was associated with absolute 90-day mRS ≤2 (OR=0.509, 95%CI=0.370–0.700). However, baseline mRS bore no association with accumulated disability by delta mRS ≤0 (ie, return to baseline, OR=1.247, 95%CI=0.943–1.648), delta mRS ≤1 (OR=1.149, 95%CI=0.906–1.458), delta mRS ≤2 (OR 1.097, 95% CI 0.869–1.386), TICI 2b–3 reperfusion (OR=0.914, 95%CI=0.712–1.173), final infarct size (P=0.853, β=−0.014), or intracerebral hemorrhage (OR=0.521, 95%CI=0.244–1.112).ConclusionsWhile baseline mRS was associated with absolute 90-day disability, there was no association with accumulated disability or other outcomes. Patients with baseline disability should not be routinely excluded from EVT based on baseline mRS alone.

Redefining ‘success’: a systematic review and meta-analysis comparing outcomes between incomplete and complete revascularization

2018 ◽  
Vol 11 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Asim Rizvi ◽  
Seyed Mohammad Seyedsaadat ◽  
Mohammad Hassan Murad ◽  
Waleed Brinjikji ◽  
Sean T Fitzgerald ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Complete Revascularization ◽  
Modified Rankin Scale ◽  
Endovascular Thrombectomy ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Good Neurologic Outcome

BackgroundConventionally, ‘successful’ endovascular thrombectomy (EVT) had been defined as achieving revascularization of thrombolysis in cerebral infarction (TICI)−2B or greater, rather than as ‘complete’ (TICI-3) versus ‘incomplete’ (TICI-2B) revascularization.PurposeWe performed a systematic review and meta-analysis of studies comparing clinical outcomes between patients with TICI-2B and TICI-3 revascularization.MethodsMultiple databases were searched for relevant publications between January 2003 and March 2018. Studies comparing outcomes between the TICI-2B and the TICI-3 group of acute ischemic stroke (AIS) patients treated with EVT were included. Random effects meta-analysis was performed to evaluate outcomes among TICI-2B and TICI-3 groups. The following outcomes were assessed: good neurologic outcome (modified Rankin Scale (mRS)≤2 at day 90), mortality, and intracerebral hemorrhage (ICH).ResultsTwenty-one studies comprising 2747 patients were identified. Patients with TICI-2B revascularization had mRS≤2 at day 90 rates of 46% (391/847) compared with 66% (522/791) for TICI-3 patients (OR 0.46, 95% CI 0.37 to 0.57). Mortality rates were significantly higher in the TICI-2B group (78/570, 14%) than in the TICI-3 group (55/709, 8%) (OR 2.00, 95% CI 1.38 to 2.91). The ICH rates were also significantly higher in the TICI-2B group as compared with the TICI-3 group (31% [134/439] vs. 22% [108/490]; OR 2.20, 95% CI 1.47 to 3.30).ConclusionsDifferences in all major outcome measures were markedly better in patients with complete versus incomplete but still ‘successful’ revascularization using prior thresholds, with ORs in the order of those seen in recent definitive trials comparing EVT to an intravenous tissue plasminogen activator.

scholarly journals Intravenous Magnesium Sulfate in Acute Stroke

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 931-938 ◽  
Author(s):  
Konstantinos I. Avgerinos ◽  
Athanasios Chatzisotiriou ◽  
Anna-Bettina Haidich ◽  
Apostolos Tsapas ◽  
Vasileios-Arsenios Lioutas
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Weighted Mean ◽  
Randomized Controlled ◽  
Mean Differences

Background and Purpose— Acute stroke treatment is challenging, and stroke remains a major cause of death and disability. The purpose of this meta-analysis is to investigate the effects of postacute stroke intravenous administration of the neuroprotectant magnesium sulfate (MgSO 4 ) on global outcome, functional outcome, and mortality 90 days poststroke (ischemic and nonischemic). Methods— We searched in Pubmed, Science Direct, CENTRAL, and ClinicalTrials.gov, up to November 11, 2017, and we conducted a systematic review and meta-analysis of randomized controlled trials. We synthesized results by using random-effects model, weighted mean differences, standardized mean differences, and odds ratios. Results— Seven randomized controlled trials (4347 patients) met our criteria. Compared with placebo, treatment did not improve functional outcome defined as Barthel Index >60 (odds ratio =1.05; 95% CI, 0.92–1.19) and >95 (odds ratio =0.95; 95% CI, 0.76–1.20), 90 days poststroke. It also did not improve global outcome measured with modified Rankin Scale (standardized mean difference =−0.01; 95% CI, −0.12 to 0.10), 90 days poststroke. In an additional subgroup meta-analysis that exclusively included ischemic stroke patients, intravenous MgSO 4 resulted in lower modified Rankin Scale score (improved global outcome; weighted mean difference =−0.96; 95% CI, −1.34 to −0.58; I 2 =0%], 90 days poststroke. Finally, mortality stayed unaltered (odds ratio =1.10; 95% CI, 0.94–1.29). Conclusions— The findings of our meta-analysis showed that intravenous MgSO 4 generally did not improve global/functional outcomes and mortality at 90 days after stroke (combined ischemic stroke and nonischemic stroke). The finding of favorable neurological outcome, selectively in ischemic stroke patients, should be viewed with extreme caution given the limited number of patients included in this subgroup meta-analysis.

The Ego Could Be Depleted, Providing Initial Exertion Is Depleting

2017 ◽  
Vol 48 (4) ◽  
pp. 242-245 ◽  
Author(s):  
Junhua Dang ◽  
Ying Liu ◽  
Xiaoping Liu ◽  
Lihua Mao
Keyword(s):  
Stroop Task ◽  
Meta Analysis ◽  
Ego Depletion ◽  
Current Experiment ◽  
The Past ◽  
Depletion Effect

Abstract. The ego depletion effect has been examined by over 300 independent studies during the past two decades. Despite its pervasive influence, recently this effect has been severely challenged and asserted to be a fake. Based on an up-to-date meta-analysis that examined the effectiveness of each frequently used depleting task, we preregistered the current experiment with the aim to examine whether there would be an ego depletion effect when the Stroop task is used as the depleting task. The results demonstrated a significant ego depletion effect. The current research highlights the importance of the depleting task’s effectiveness. That is to say, the “ego” could be “depleted,” but only when initial exertion is “depleting.”

Identifying Barriers to Integration of Technology into Traditional Approach of Teaching: A Case Study of Mathematics Teachers in Former Transkei in the Eastern Cape

10.31355/12 ◽  
2017 ◽  
Vol 1 ◽  
pp. 063-071
Author(s):  
Agyei Fosu
Keyword(s):  
High School ◽  
Mathematics Teachers ◽  
Traditional Approach ◽  
High School Education ◽  
Eastern Cape ◽  
High School Mathematics ◽  
Policy Makers ◽  
The Past ◽  
Integration Of Technology ◽  
Teaching Of Mathematics

NOTE: THIS ARTICLE WAS PUBLISHED WITH THE INFORMING SCIENCE INSTITUTE. Aim/Purpose................................................................................................................................................................................................. The main aim of the study is to identify some of the barriers to the integration of technology into the teaching of mathematics in high schools. Background................................................................................................................................................................................................. Writing on chalkboards as a method of transferring knowledge is a key feature of traditional approach to teaching may have been successful in the past, but the minds of the current generation vary from those of the previous generation. Today’s students are immersed in technology. They are much more up-to-date on the latest technology and gadgets. Technology has certainly changed how students access and integrate information, so it plausible that technology has also changed the way students thinks. Growing up with cutting-edge technologies has left them thinking differently than students of past generations. This call for new innovative approaches to teaching that will cater to the students of today. Of course it is not wise to discard the traditional way of teaching that the past teachers have painstakingly created because of its past and some current success. This is why it is recommended to use this approach as a base for the new ones. Thus, if there is a way to transfer the advantages of this approach of teaching to new innovative approach then teachers should do everything in their power to merge the past and the present into one innovative teaching approach. Methodology................................................................................................................................................................................................. Purposeful sampling was used to survey a total of 116 high school mathematics teachers in the former Transkei Homelands. But only 97 questionnaires were deemed usable because of the way they have answered the questions. Microsoft excel was used in the descriptive statistics Contribution................................................................................................................................................................................................. To identify some barriers that need to be addressed by stakeholders, policy makers in high school education so that high school mathematics teachers will be able to integrate technology into their classroom teaching to meet today students’ learning needs. Findings...................................................................................................................................................................................................... The results indicated that the participating teachers need to be trained and supported in the use of the new technologies applicable to teaching mathematics. Recommendations for Practitioners.......................................................................................................................................................... The Eastern Cape department of education needs to consider the lacked of technology training as a barrier to the integration of technology into the teaching of mathematics and take necessary steps to address it. Recommendation for Researchers........................................................................................................................................................... There is the need to explore in depth whether the factors of gender and age also act as barriers. Impact on Society....................................................................................................................................................................................... The research will assist stakeholders, policy makers of high school education to identify the needs of mathematics teachers. That is to say, the skill sets, experience and expertise, as well as teaching equipment and classroom design and environment required by mathematics teachers. Future Research........................................................................................................................................................................................... More work needs to be done to check whether gender, age of the teachers have some effects on their attitude towards technology integration as well as evaluate the role played by choice of teaching methodology and teaching objectives.

Acupuncture Efficacy on Acute Stroke Patients: A Meta-analysis

2018 ◽  
Vol 28 (3) ◽  
pp. 62
Author(s):  
Jiaqing LIU ◽  
Tongyan LIU ◽  
Yun XIANG ◽  
Ning ZHAO ◽  
Hong ZHANG
Keyword(s):  
Acute Stroke ◽  
Meta Analysis ◽  
Stroke Patients

Toward Unity among Environmentalists

1995 ◽  
Author(s):  
Bryan G. Norton
Keyword(s):  
Resource Use ◽  
Wide Spectrum ◽  
Strong Support ◽  
Environmental Issues ◽  
Value Systems ◽  
Special Interests ◽  
Unified Approach ◽  
Policy Makers ◽  
The Past ◽  
Control Growth

Today, six out of ten Americans describe themselves as "active" environmentalists or as "sympathetic" to the movement's concerns. The movement, in turn, reflects this millions-strong support in its diversity, encompassing a wide spectrum of causes, groups, and sometimes conflicting special interests. For far-sighted activists and policy makers, the question is how this diversity affects the ability to achieve key goals in the battle against pollution, erosion, and out-of-control growth. This insightful book offers an overview of the movement -- its past as well as its present -- and issues the most persuasive call yet for a unified approach to solving environmental problems. Focusing on examples from resource use, pollution control, protection of species and habitats, and land use, the author shows how the dynamics of diversity have actually hindered environmentalists in the past, but also how a convergence of these interests around forward-looking policies can be effected, despite variance in value systems espoused. The book is thus not only an assessment of today's movement, but a blueprint for action that can help pull together many different concerns under a common banner. Anyone interested in environmental issues and active approaches to their solution will find the author's observations both astute and creative.

Anti-corruption in History

2017 ◽  
Keyword(s):  
Financial Institutions ◽  
Global Media ◽  
Policy Makers ◽  
The Past ◽  
Human Wellbeing ◽  
Modern Period ◽  
Legitimate Power ◽  
Wide Range ◽  
Scant Attention ◽  
Over Time

Anticorruption in History is the first major collection of case studies on how past societies and polities, in and beyond Europe, defined legitimate power in terms of fighting corruption and designed specific mechanisms to pursue that agenda. It is a timely book: corruption is widely seen today as a major problem, undermining trust in government, financial institutions, economic efficiency, the principle of equality before the law and human wellbeing in general. Corruption, in short, is a major hurdle on the “path to Denmark”—a feted blueprint for stable and successful statebuilding. The resonance of this view explains why efforts to promote anticorruption policies have proliferated in recent years. But while the subjects of corruption and anticorruption have captured the attention of politicians, scholars, NGOs and the global media, scant attention has been paid to the link between corruption and the change of anticorruption policies over time and place. Such a historical approach could help explain major moments of change in the past as well as reasons for the success and failure of specific anticorruption policies and their relation to a country’s image (of itself or as construed from outside) as being more or less corrupt. It is precisely this scholarly lacuna that the present volume intends to begin to fill. A wide range of historical contexts are addressed, ranging from the ancient to the modern period, with specific insights for policy makers offered throughout.

How Spatially Concentrated Are Industrial Clusters?: A Meta-analysis

2021 ◽  
pp. 088541222110129
Author(s):  
Li Fang ◽  
Joshua Drucker
Keyword(s):  
Spatial Scale ◽  
Knowledge Spillovers ◽  
Meta Analysis ◽  
Empirical Studies ◽  
Industrial Clusters ◽  
Policy Makers ◽  
Unit Of Analysis ◽  
Industry Sector

This study conducts a meta-analysis of empirical studies that have measured the spatial scale of industrial clustering. Two types of scales are examined: the peak scale (at which cluster effects are maximized) and the maximum reach (beyond which cluster effects are undetectable). We find that the scale varies significantly by the unit of analysis, industry sector, country of study, and the sources of cluster effects examined (e.g., knowledge spillovers, localization, and urbanization). Planners and policy makers should tailor the geographies embodied in cluster strategies to match the specific local needs and circumstances.

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