Personal reflections on lessons learned from randomized trials involving newborn infants from 1951 to 1967

2004 ◽  
Vol 1 (2) ◽  
pp. 179-184 ◽  
Author(s):  
William A. Silverman
Keyword(s):  
Randomized Trials ◽  
Newborn Infants ◽  
Lessons Learned ◽  
Personal Reflections

scholarly journals An Update on the Controversies in Anemia Management in Chronic Kidney Disease: Lessons Learned and Lost

Anemia ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Geoffrey Teehan ◽  
Robert L. Benz
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Randomized Trials ◽  
Lessons Learned ◽  
Patients With Diabetes ◽  
Anemia Management ◽  
Erythropoietin Deficiency ◽  
Stage Renal Disease ◽  
End Stage

Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial.Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT.Results. CHOIR (N=1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03–1.74,P=.03). CREATE (N=603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38–2.68;P<.001) in TREAT (N=4038).Conclusions. There is no benefit to an Hb outside the 10–12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.

scholarly journals Endovascular treatment of acute ischemic stroke: the end or just the beginning?

2014 ◽  
Vol 36 (1) ◽  
pp. E5 ◽  
Author(s):  
Maxim Mokin ◽  
Alexander A. Khalessi ◽  
J Mocco ◽  
Giuseppe Lanzino ◽  
Travis M. Dumont ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Trials ◽  
Intravenous Thrombolysis ◽  
Lessons Learned ◽  
Neurological Deficits ◽  
Medical Community ◽  
Current Status

Various endovascular intraarterial approaches are available for treating patients with acute ischemic stroke who present with severe neurological deficits. Three recent randomized trials—Interventional Management of Stroke (IMS) III, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE), and Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke (SYNTHESIS Expansion)—evaluated the efficacy of endovascular treatment of acute ischemic stroke and, after failing to demonstrate any significant clinical benefit of endovascular therapies, raised concerns and questions in the medical community regarding the future of endovascular treatment for acute ischemic stroke. In this paper, the authors review the evolution of endovascular treatment strategies for the treatment of acute stroke and provide their interpretation of findings and potential limitations of the three recently published randomized trials. The authors discuss the advantage of stent-retriever technology over earlier endovascular approaches and review the current status and future directions of endovascular acute stroke studies based on lessons learned from previous trials.

scholarly journals Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA

2013 ◽  
Vol 20 (6) ◽  
pp. 969-975 ◽  
Author(s):  
Lawrence M. Phillips ◽  
Rory Hachamovitch ◽  
Daniel S. Berman ◽  
Ami E. Iskandrian ◽  
James K. Min ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Randomized Trials ◽  
Lessons Learned ◽  
Ischemic Heart ◽  
Stable Ischemic Heart Disease

Reflections on Knowledge, Power, and Professional Privilege: A Healthcare Professional as a Healthcare Patient

2006 ◽  
Vol 10 (1) ◽  
pp. 17-21
Author(s):  
Jan Duke
Keyword(s):  
Healthcare Professional ◽  
Cancer Patient ◽  
Professional Practice ◽  
Healthcare Providers ◽  
Lessons Learned ◽  
Personal Knowing ◽  
Personal Reflections ◽  
The Impact

This essay, based on my personal reflections as a cancer patient, examines the impact that knowledge and power associated with professional position has on the care given to healthcare providers when they become patients. Lessons learned through this experience, which can enhance future professional practice, include never underestimating a patient’s personal knowing, taking notice when a patient says that enough is enough, and never using coercion and allowing caring to become oppressive and disempowering.

scholarly journals Spontaneous Intracerebral and Intraventricular Hemorrhage

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S142-S150 ◽  
Author(s):  
Mahua Dey ◽  
Agnieszka Stadnik ◽  
Issam A. Awad
Keyword(s):  
Randomized Trials ◽  
Lessons Learned ◽  
National Institutes Of Health ◽  
Phase Iii ◽  
Recent Experience ◽  
Preliminary Treatment ◽  
Phase Ii Trials ◽  
Invasive Techniques ◽  
The Impact

Abstract Optimal management of spontaneous intracerebral hemorrhage (ICH) remains one of the highly debated areas in the field of neurosurgery. Earlier studies comparing open surgical intervention with best medical management failed to show a clear benefit. More recent experience with minimally invasive techniques has shown greater promise. Well-designed phase II trials have confirmed the safety and preliminary treatment effect of thrombolytic aspiration and clearance of spontaneous ICH and associated intraventricular obstructive hemorrhage. Those trials are reviewed, including respective protocols and technical nuances, and lessons learned regarding patient selection, the concept of hemorrhage stabilization, optimization of the surgical procedure, and thrombolytic dosing decisions. These concepts have been incorporated in the design of ongoing definite phase III randomized trials (MISTIE and CLEAR) funded by the National Institutes of Health. These are presented including the role of surgical leadership in the training and monitoring of the surgical task and quality assurance. The impact of these techniques on neurosurgical practice is discussed.

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