scholarly journals The Effect of Telemedicine Consultation on Outcomes in Patients with Intracerebral Hemorrhage

2020 ◽  
Vol 8 (4) ◽  
pp. 391-395
Author(s):  
A. M. Alasheyev ◽  
A. A. Smolkin ◽  
E. V. Prazdnichkova ◽  
A. A. Belkin
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Intracerebral Hematoma ◽  
Highly Qualified ◽  
Conflicts Of Interests ◽  
Percentage Points ◽  
Telemedicine Consultation ◽  
Qualified Personnel ◽  
The Difference ◽  
Vascular Center

RELEVANCE. Telemedicine solves the problem of the availability of highly qualified personnel at the decision-making stage in the management of patients with intracerebral hemorrhage. AIM OF STuDY We set out to evaluate the effect of teleconsultation on outcomes in patients with intracerebral hemorrhage 30 days after the event.MATERIAL AND METHODS. A prospective, open, nonrandomized clinical trial in two parallel groups. The first group included adult patients up to 80 years of age with a hemorrhagic stroke from 4 to 36 points according to NIHSS due to unilateral supratentorial intracerebral hematoma of non-aneurysmal genesis, who were examined by a neurosurgeon and resuscitator of the Regional Vascular Center in a ward. The second group included similar patients, but they received telemedicine consultation of the above specialists. The primary endpoint of the study was mortality 30 days after the onset of the stroke. The hypothesis of non-superiority was tested where the 95% confidence interval (CI) for the difference in mortality between the groups should not go over 15 percentage points.RESULTS. A total of 140 patients (70 in each group) with intracerebral hematomas were studied. Mortality in the bedside group was 14.3% (CI 7.1%; 24.7%), and in the remote group it was 25.7% (16.0%; 37.6%), p=0.091. However, there was no evidence of superiority, since the difference between the groups in mortality was 11.4 with CI from –0.07 to 24.5 percentage points, which was beyond the predefined limit.CONCLUSIONS. At the current level of development of medicine and information technology, telemedicine cannot fully replace the traditional (bedside) consultation of an expert level of neurosurgeon and neuroresuscitator in patients with intracerebral hematomas.Authors declare lack of the conflicts of interests.

Diagnosis of cerebral hemorrhage before the era of computed tomography

2013 ◽  
Vol 154 (44) ◽  
pp. 1743-1746
Author(s):  
Gergely Hofgárt ◽  
Rita Szepesi ◽  
Bertalan Vámosi ◽  
László Csiba
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Hemorrhagic Stroke ◽  
Cranial Computed Tomography ◽  
Cerebral Stroke ◽  
Daily Routine ◽  
Stroke Patients ◽  
The Difference

Introduction: During the past decades there has been a great progress in neuroimaging methods. Cranial computed tomography is part of the daily routine now and its use allows a fast diagnosis of parenchymal hemorrhage. However, before the availability of computed tomography the differentiation between ischemic and hemorrhagic stroke was based on patient history, physical examination, percutan angiography and cerebrospinal fluid sampling, and the clinical utility could be evaluated by autopsy of deceased patients. Aim: The authors explored the diagnostic performance of cerebrospinal fluid examination for the diagnosis of ischemic and hemorrhagic stroke. Method: Data of 200 deceased stroke patients were retrospectively evaluated. All patients had liquor sampling at admission and all of them had brain autopsy. Results: Bloody or yellowish cerebrospinal fluid at admission had a positive predictive value of 87.5% for hemorrhagic stroke confirmed by autopsy, while clear cerebrospinal fluid had positive predictive value of 90.7% for ischemic stroke. Patients who had clear liquor, but autopsy revealed hemorrhagic stroke had higher protein level in the cerebrospinal fluid, but the difference was not statistically significant (p = 0.09). Conclusions: The results confirm the importance of pathological evaluation of the brain in cases deceased from cerebral stroke. With this article the authors wanted to salute for those who contributed to the development of the Hungarian neuropathology. In this year we remember the 110th anniversary of the birth, and the 60th anniversary of the death of professor Kálmán Sántha. Professor László Molnár would be 90 years old in 2013. Orv. Hetil., 154 (44), 1743–1746.

Intracerebral Hematoma, Perihemorrhagic Edema and Urinary Excreted Cysteinyl Leukotrienes Correlation Study

2014 ◽  
Vol 68 (2) ◽  
pp. 85-88
Author(s):  
Natalija Dolnenec-Baneva ◽  
Dijana Nikodijevic ◽  
Gordana Kiteva-Trenchevska ◽  
Igor Petrov ◽  
Dragana Petrovska-Cvetkovska ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Brain Edema ◽  
Correlation Study ◽  
Intracerebral Hematoma ◽  
Moderate Correlation ◽  
Hematoma Volume ◽  
Cysteinyl Leukotrienes ◽  
Edema Volume ◽  
Perihemorrhagic Edema

AbstractIntroduction.Several mechanisms in formation of perihemorrhagic edema are activated after contact of brain tissue-extravasated blood in intracerebral hemorrhage. Cysteinyl leukotrienes (cysLT) (C4, D4, E4) are included in this process as significant edema factors and they determine the neurological deficit and outcome. The study aim was a 5-day follow-up (admission/3 day/5 day) of urinary cysLT, hematoma volume, edema volume values and their correlation in patients after spontaneous, primary supratentorial intracerebral hemorrhage.Methods.An enzyme immunoassay was used for urinary cysLT measured in 62 patients and 80 healthy controls. Hematoma and edema volumes were visualized and measured by computed tomography and mathematically calculated with a special spheroid shape formula (V=AxBxC/2).Results.CysLT of hemorrhagic patients (1842.20±1413.2, 1181.54±906.2, 982.30±774.2pg/ml/mg creatinine) were significantly excreted (p<0.01). Brain edema (12.86±13.5, 22.38±21.1, 28.45±29.4cm3) was significantly increased (p<0.01). Hematoma volume values (13.05±14.5, 13.13±14.7, 12.99±14.7cm3) were not significant (p>0.05). A high correlation (multiple regression) between cysLT, hematoma and edema was found on the 3rdday (R=0.6) and a moderate correlation at admission (R=0.3) and on the 5thday (R=0.3).Conclusion.In our 5-day follow-up study a significant cysLT brain synthesis and significant brain edema progression versus constant hematoma volume values in hemorrhagic patients was found. A high correlation between cysLT, hematoma and edema volume was found on the 3rdday, a moderate correlation on admission and on the 5thday, which means that high cysLT and hematoma values were associated with high/moderate edema values.

The interaction of higher education system with the labor market: A study of the labor market in the regions of the Volga Federal District

2020 ◽  
Vol 26 (2) ◽  
pp. 456-480
Author(s):  
R.B. Galeeva
Keyword(s):  
Higher Education ◽  
Labor Market ◽  
Education System ◽  
Federal District ◽  
Highly Qualified ◽  
Expert Survey ◽  
Higher Education System ◽  
Qualified Personnel ◽  
The Republic ◽  
The One

Subject .This article discusses the need to bring into line with the future activities of specialists the content of their preparation, the formation of a system model of higher education, which takes into account today's and prospective requirements of the labor market. Objectives. The article aims to research the labor market in four regions of the Volga Federal District of the Russian Federation: the Republic of Tatarstan, Mari El Republic, Chuvash Republic, and the Ulyanovsk oblast, as well as discuss problems and prospects of interaction of universities with enterprises and organizations of these regions. Methods. For the study, I used the methods of logical and statistical analyses, and in-depth expert survey. Results. The article analyzes the state of regional labor markets, presents the results of the expert survey of labor market representatives and heads of the regional education system, and it defines possible ways of harmonizing the interaction of universities with the labor market. Conclusions. The article notes that although the number of employed with higher education is growing, at the same time there is a shortage of highly qualified personnel in certain professions, on the one hand, and unskilled workers, on the other. Also, the article says that the universities do not prepare the necessary for the regions specialists in a number of professions or they provide a set of competencies different from the requirements of the labor market, so it is necessary to form and develop effective directions of cooperation between educational institutions and employers.

Differential diagnosis of spontaneous intracranial hemorrhage in young

2021 ◽  
Vol 22 (1) ◽  
pp. 83-86
Author(s):  
O. A. Kicherova ◽  
◽  
L. I. Reikhert ◽  
O. N. Bovt ◽  
◽  
...  
Keyword(s):  
Hemorrhagic Stroke ◽  
Young Patients ◽  
Vascular Diseases ◽  
Cerebrovascular Diseases ◽  
Intracerebral Hematoma ◽  
Toxic Substances ◽  
Brain Substance ◽  
Secondary All ◽  
Visualization Techniques ◽  
The Brain

In recent years, cerebral vascular diseases have been increasingly detected in young patients. It is due not only to better physicians’ knowledge about this pathology, but also to the improvement of its diagnosis methods. Modern neuroimaging techniques allow us to clarify the nature of hemorrhage, to determine the volume and location of intracerebral hematoma, and to establish the degree of concomitant edema and dislocation of the brain. However, despite the high accuracy of the research, it is not always possible to establish the cause that led to a brain accident, which greatly affects the tactics of management and outcomes in this category of patients. A special feature of the structure of cerebrovascular diseases of young people is the high proportion of hemorrhagic stroke, the causes of which are most often arterio-venous malformations. Meanwhile, there are a number of other causes that can lead to hemorrhage into the brain substance. These include disorders of blood clotting, and various vasculitis, and exposure to toxic substances and drugs, and tumor formations (primary and secondary). All these pathological factors outline the range of diagnostic search in young patients who underwent hemorrhagic stroke. Diagnosis of these pathological conditions with the help of modern visualization techniques is considered to be easy, but this is not always the case. In this article, the authors give their own clinical observation of a hemorrhagic stroke in a young patient, which demonstrates the complexity of the diagnostic search in patients with this pathology.

Peculiarities of Interaction Among Professional Educational Institutions, Employers and Social Partners

2021 ◽  
pp. 45-52
Author(s):  
V. Lysenko
Keyword(s):  
Social Order ◽  
Vocational Training ◽  
Educational Institutions ◽  
Highly Qualified ◽  
Education Production ◽  
Qualified Personnel ◽  
Social Partners ◽  
New Type ◽  
The One ◽  
Advanced Vocational Training

The social order posed by the society to the training of highly qualified personnel for the strategic needs of the labor market is associated with the changes in the economy, including the processes of its computerization and digitalization. Transformations in the digital economy determine new requirements for specialists’ training, their competences and qualification. The rapid changes in socio-economic conditions cause the need to transform the system of vocational training in order to meet the demands for competencies that correspond to the current technologic trends and methods of production. The reforms of vocational education system can be significant in resolving contradictions between the quality of training, on the one hand, and public and employers’ demands, on the other hand. Close cooperation of professional educational institutions, employers and social partners through their joint design and development of teaching technologies and methods for advanced vocational training of qualified specialists can be considered as one of the most efficient factors and conditions for resolving the above mentioned contradictions. These new conditions have already been created in the Centers for Advanced Vocational Training (CAVT), which can be characterized as a new type of infrastructural solution to the problem of aggregation of advanced vocational training programs and material and technical resources owned by science, education, production. The article focuses on some features of interaction and cooperation among vocational educational institutions, employers and social partners (social and public-private partnerships, networking cooperation, educational and technological cluster), which are taken into account in the performance of the Center for Advanced Vocational Training of the Kemerovo region.

Functional-predictive Model Environments of Students in Graduate School as a Means of Scientific and Scientific-pedagogical Training of Highly Qualified Personnel

2020 ◽  
pp. 43-53
Author(s):  
Vladimir Sergeevich Malyshev ◽  
Keyword(s):  
Predictive Model ◽  
Graduate Student ◽  
Graduate School ◽  
Educational Process ◽  
Highly Qualified ◽  
Way Of Life ◽  
Pedagogical Training ◽  
Qualified Personnel ◽  
Scientific Pedagogical ◽  
The Way

Introduction to the problem. The relevance of the analysis of the environment of a graduate student from the position of searching for a pedagogical means of managing his formation as a highly qualified specialist is due to the multidimensional goals and objectives of postgraduate training, which are based on the conditions of real life. The purpose of the article is to identify and justify the functional and predictive model of the environment of students in graduate school as a means of scientific and scientific-pedagogical training of highly qualified personnel. The methodology of the study. Theoretical bases of the description of a model of students in graduate school made presentation on environmental design, as part of a technology of the environmental approach in education, as well as theoretical and practical experience of understanding the way of life as a condition of personality during the educational process. An important role was played by the results of the study of the use of information and communication technologies as a system-forming factor in the training of highly qualified personnel in graduate school, conducted by the author since 2017. Results and conclusion. The environment of students in graduate school is presented as an integral tool that includes the parameters of the possibility, probability and reliability of achieving an educational goal in the environment and with the help of the environment. These parameters are revealed in the course of a sequential solution of nine tasks to describe the environment of students in graduate school, based on the rules of combining parts of the environmental approach in order to realize the educational potential inherent in it. The way of life of a graduate student is considered as a condition for becoming a highly qualified specialist with scientific and scientific-pedagogical training as a result of the interaction of the student with the environment.

scholarly journals Time versus State in Insurance: Experimental Evidence from Contract Farming in Kenya

2018 ◽  
Vol 108 (12) ◽  
pp. 3778-3813 ◽  
Author(s):  
Lorenzo Casaburi ◽  
Jack Willis
Keyword(s):  
Crop Insurance ◽  
Counterparty Risk ◽  
Harvest Time ◽  
Contract Farming ◽  
Present Bias ◽  
The Poor ◽  
Percentage Points ◽  
Randomized Control ◽  
The Difference

The gains from insurance arise from the transfer of income across states. Yet, by requiring that the premium be paid up front, standard insurance products also transfer income across time. We show that this intertemporal transfer can help explain low insurance demand, especially among the poor, and in a randomized control trial in Kenya we test a crop insurance product which removes it. The product is interlinked with a contract farming scheme: as with other inputs, the buyer of the crop offers the insurance and deducts the premium from farmer revenues at harvest time. The take-up rate for pay-at-harvest insurance is 72 percent, compared to 5 percent for the standard pay-up-front contract, and the difference is largest among poorer farmers. Additional experiments and outcomes provide evidence on the role of liquidity constraints, present bias, and counterparty risk, and find that enabling farmers to commit to pay the premium just 1 month later increases demand by 21 percentage points. (JEL G22, I32, O13, O16, Q12, Q14)

scholarly journals Digital transformation in the regions of Russia: estimates and reality

2021 ◽  
Vol 11 (3) ◽  
pp. 11-22
Author(s):  
M. A. Abramova
Keyword(s):  
Development Program ◽  
Institutional Development ◽  
Detailed Examination ◽  
Successful Implementation ◽  
Russian Society ◽  
Highly Qualified ◽  
Digital Inequality ◽  
Qualified Personnel ◽  
The One ◽  
Regions Of Russia

The article presents the problem of a comprehensive analysis of the socio-cultural prerequisites that determine the successful or unsuccessful implementation of the program of digitalization of the regions of Russia. A detailed examination of the tools for assessing the level of digitalization on the example of the methods for calculating the Skolkovo “Digital Russia” index and the regional digitalization index by I. V. Groshev and A. A. Krasnoslobodtsev showed their low informative value for understanding the factors leading to the formation of digital inequality in regions. The actuality of the problem is due not only to the need for an adequate assessment of the tools offered as convenient for comparing regions, but also by the following facts. On the one hand, the tasks of digitalization of education are of paramount importance in the framework of the federal development program. On the other hand, their implementation depends both on the local state of educational institutions and on solving a wider range of issues: staff training, providing employment opportunities for graduates, forming the need for highly qualified personnel in the region, etc. The novelty of the work is that the author consider the problem of studying the digital inequality of the regions of Russia with an emphasis on the issue of digitalization of education in the context of the existing regional socio-cultural prerequisites that determine the successful implementation of programs or prevent it. The application of institutional and functional approaches is of particular research interest, these approaches allow us to study the existing socio-cultural prerequisites in the regions as factors of stratification of Russian society that strengthen or weaken social inequality in the context of the development of a digital society. The author concludes that the solution of the problem of a comprehensive assessment of the socio-cultural prerequisites of the regional level of digitalization requires a detailed multi-factor analysis on a specific problem and direction of digitalization. The comparison of such data requires separate consideration of the indicators of socio-economic, demographic, and institutional development of the regions.

scholarly journals Mitochondria: Novel Mechanisms and Therapeutic Targets for Secondary Brain Injury After Intracerebral Hemorrhage

2021 ◽  
Vol 12 ◽  
Author(s):  
Weixiang Chen ◽  
Chao Guo ◽  
Hua Feng ◽  
Yujie Chen
Keyword(s):  
Brain Injury ◽  
Intracerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Secondary Brain Injury ◽  
Valuable Insight ◽  
Potential Therapeutic Target ◽  
Pathological Mechanism ◽  
Clinical Strategies ◽  
Inflammatory Activation ◽  
Insight Into

Intracerebral hemorrhage (ICH) is a destructive form of stroke that often results in death or disability. However, the survivors usually experience sequelae of neurological impairments and psychiatric disorders, which affect their daily functionality and working capacity. The recent MISTIE III and STICH II trials have confirmed that early surgical clearance of hematomas does not improve the prognosis of survivors of ICH, so it is vital to find the intervention target of secondary brain injury (SBI) after ICH. Mitochondrial dysfunction, which may be induced by oxidative stress, neuroinflammation, and autophagy, among others, is considered to be a novel pathological mechanism of ICH. Moreover, mitochondria play an important role in promoting neuronal survival and improving neurological function after a hemorrhagic stroke. This review summarizes the mitochondrial mechanism involved in cell death, reactive oxygen species (ROS) production, inflammatory activation, blood–brain barrier (BBB) disruption, and brain edema underlying ICH. We emphasize the potential of mitochondrial protection as a potential therapeutic target for SBI after stroke and provide valuable insight into clinical strategies.

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