scholarly journals Ruling Out Brain CT Contraindications prior to Intravenous Thrombolysis: Diagnostic Equivalence between a Primary Interpretation Workstation and a Mobile Tablet Computer

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Antonio J. Salazar ◽  
Nicolás Useche ◽  
Manuel Granja ◽  
Aníbal J. Morillo ◽  
Sonia Bermúdez
Keyword(s):  
Retrospective Study ◽  
Diagnostic Performance ◽  
Intravenous Thrombolysis ◽  
Ethics Committee ◽  
Tablet Computer ◽  
Intracranial Artery ◽  
Ischemic Lesion ◽  
Brain Ct ◽  
Diagnostic Workstation ◽  
Reading System

Objective. The aim of this study was to evaluate the equivalence of brain CT interpretations performed using a diagnostic workstation and a mobile tablet computer, in a telestroke service.Materials and Methods. The ethics committee of our institution approved this retrospective study. A factorial design with 1452 interpretations was used. The assessed variables were the type of stroke classification, the presence of contraindications to the tPA administration, the presence of a hyperdense intracranial artery sign (HMCA), and the Alberta Stroke Program Early CT Score (ASPECTS) score. These variables were evaluated to determine the effect that the reading system had on their magnitudes.Results. The achieved distribution of observed lesions using both the reading systems was not statistically different. The differences between the two reading systems to claim equivalence were 1.6% for hemorrhagic lesions, 4.5% for cases without lesion, and 5.2 for overall ischemic lesion. Equivalence was achieved at 2.1% for ASPECTS ≤ 6, 6.5% for the presence of imaging contraindication to the tPA administration, and 7.2% for the presence of HMCA.Conclusion. The diagnostic performance for detecting acute stroke is likely equivalent whether a tablet computer or a diagnostic workstation is used or not.

CT of the head for acute stroke: Diagnostic performance of a tablet computer prior to intravenous thrombolysis

2017 ◽  
Vol 61 (3) ◽  
pp. 334-338 ◽  
Author(s):  
Patrick D McLaughlin ◽  
Fiachra Moloney ◽  
Siobhan B O'Neill ◽  
Karl James ◽  
Lee Crush ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Diagnostic Performance ◽  
Intravenous Thrombolysis ◽  
Tablet Computer

scholarly journals Mobile device for thrombolysis decisions for telestroke

2018 ◽  
pp. 254-260 ◽  
Author(s):  
Antonio J Salazar ◽  
Nicolás Useche ◽  
Manuel F Granja ◽  
Aníbal J Morillo ◽  
Sonia Bermúdez ◽  
...  
Keyword(s):  
Low Cost ◽  
Observer Agreement ◽  
Tissue Type ◽  
Ischemic Lesion ◽  
Brain Ct ◽  
Acute Lesion ◽  
Diagnostic Workstation ◽  
Type Plasminogen Activator ◽  
Good Agreement ◽  
Lesion Classification

Aim: This study compares the reliability of brain CT interpretations performed using a diagnostic workstation and a mobile tablet computer in a telestroke context. Methods: A factorial design with 1,452 interpretations was used. Reliability was evaluated using the Fleiss’ kappa coefficient on the agreements of the interpretation results on the lesion classification, presence of imaging contraindications to the intravenous recombinant tissue-type plasminogen activator (t-PA) administration, and on the Alberta Stroke Program Early CT Score (ASPECTS). Results: The intra-observer agreements were as follows: good agreement on the overall lesion classification (κ= 0.63, p<0.001), very good agreement on hemorrhagic lesions (κ= 0.89, p<0.001), and moderate agreements on both without acute lesion classification and acute ischemic lesion classification (κ= 0.59 and κ= 0.58 respectively, p<0.001). There was good intra-observer agreement on the dichotomized-ASPECTS (κ= 0.65, p<0.001). Conclusions: The results of our study allow us to conclude that the reliability of the mobile solution for interpreting brain CT images of patients with acute stroke was assured, which would allow efficient and low-cost telestroke services.

scholarly journals Stroke Care During the First and the Second Waves of the COVID-19 Pandemic in a Community Hospital

2021 ◽  
Vol 12 ◽  
Author(s):  
Piotr Sobolewski ◽  
Wiktor Szczuchniak ◽  
Danuta Grzesiak-Witek ◽  
Jacek Wilczyński ◽  
Karol Paciura ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Stroke Unit ◽  
Community Hospital ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Staff Members ◽  
Second Wave

Objective: The coronavirus disease 2019 (COVID-19) infection may alter a stroke course; thus, we compared stroke course during subsequent pandemic waves in a stroke unit (SU) from a hospital located in a rural area.Methods: A retrospective study included all patients consecutively admitted to the SU between March 15 and May 31, 2020 (“first wave”), and between September 15 and November 30, 2020 (“second wave”). We compared demographic and clinical data, treatments, and outcomes of patients between the first and the second waves of the pandemic and between subjects with and without COVID-19.Results: During the “first wave,” 1.4% of 71 patients were hospitalized due to stroke/TIA, and 41.8% of 91 during the “second wave” were infected with SARS-CoV-2 (p &lt; 0.001). During the “second wave,” more SU staff members were infected with COVID-19 than during the “first wave” (45.6 vs. 8.7%, p &lt; 0.001). Nevertheless, more patients underwent intravenous thrombolysis (26.4 vs. 9.9%, p &lt; 0.008) and endovascular thrombectomy (5.3 vs. 0.0%, p &lt; 0.001) during the second than the first wave. Large vessel occlusion (LVO) (OR 8.74; 95% CI 1.60–47.82; p = 0.012) and higher 30-day mortality (OR 6.01; 95% CI 1.04–34.78; p = 0.045) were associated with patients infected with COVID-19. No differences regarding proportions between ischemic and hemorrhagic strokes and TIAs between both waves or subgroups with and without COVID-19 existed.Conclusion: Despite the greater COVID-19 infection rate among both SU patients and staff during the “second wave” of the pandemic, a higher percentage of reperfusion procedures has been performed then. COVID-19 infection was associated with a higher rate of the LVO and 30-day mortality.

Antibodies to phosphatidylserine/prothrombin (aPS/PT) enhanced the diagnostic performance in Chinese patients with antiphospholipid syndrome

2018 ◽  
Vol 56 (6) ◽  
pp. 939-946 ◽  
Author(s):  
Shulan Zhang ◽  
Ziyan Wu ◽  
Wen Zhang ◽  
Jiuliang Zhao ◽  
Gary L. Norman ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Arterial Thrombosis ◽  
Diagnostic Performance ◽  
Positive Likelihood Ratio ◽  
Chinese Patients ◽  
Healthy Controls ◽  
Patients At Risk

AbstractBackground:Increasing evidence has highlighted the role of non-criteria antiphospholipid antibodies (aPLs) as important supplements to the current criteria aPLs for the diagnosis of antiphospholipid syndrome (APS). In this retrospective study, we evaluated the clinical relevance of antibodies to phosphatidylserine/prothrombin (aPS/PT) in Chinese patients with APS.Methods:A total of 441 subjects were tested, including 101 patients with primary APS (PAPS), 140 patients with secondary APS (SAPS), 161 disease controls (DCs) and 39 healthy controls (HCs). Serum IgG/IgM aPS/PT was determined by ELISA.Results:The levels of IgG/IgM aPS/PT were significantly increased in patients with APS compared with DCs and HCs. IgG and IgM aPS/PT were present in 29.7% and 54.5% of PAPS, and 42.1% and 53.6% of SAPS, respectively. For diagnosis of APS, IgG aCL exhibited the highest positive likelihood ratio (LR+) of 21.60, followed by LA (13.84), IgG aβ2GP1 (9.19) and IgG aPS/PT (8.49). aPS/PT was detected in 13.3% of seronegative PAPS patients and 31.3% of seronegative SAPS patients. LA exhibited the highest OR of 3.64 in identifying patients with thrombosis, followed by IgG aCL (OR, 2.63), IgG aPS/PT (OR, 2.55) and IgG aβ2GP1 (OR, 2.33). LA and IgG aCL were correlated with both arterial and venous thrombosis, whereas IgG aPS/PT and IgG aβ2GP1 correlated with venous or arterial thrombosis, respectively.Conclusions:Our findings suggest that the inclusion of IgG/IgM aPS/PT may enhance the diagnostic performance for APS, especially in those in whom APS is highly suspected, but conventional aPLs are repeatedly negative. In addition, IgG aPS/PT may contribute to identify patients at risk of thrombosis.

Diagnostic performance of transient elastography for detection of methotrexate-induced liver injury using Roenigk classification in Asian patients with psoriasis: a retrospective study

2017 ◽  
Vol 309 (5) ◽  
pp. 403-408 ◽  
Author(s):  
Pasinee Rongngern ◽  
Leena Chularojanamontri ◽  
Chanisada Wongpraparut ◽  
Narumol Silpa-Archa ◽  
Watcharasak Chotiyaputta ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Liver Injury ◽  
Diagnostic Performance ◽  
Transient Elastography ◽  
Asian Patients

scholarly journals A Retrospective Study on the Diagnostic Performance of Mammography

1993 ◽  
Vol 2 (1) ◽  
pp. 53-61
Author(s):  
Toru Matsumoto ◽  
Choichiro Kido ◽  
Fumio Sasaki ◽  
Tokiko Endo ◽  
Takeshi Iinuma ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Diagnostic Performance

scholarly journals Thrombolysis With Alteplase at 0.6 mg/kg for Stroke With Unknown Time of Onset

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1530-1538 ◽  
Author(s):  
Masatoshi Koga ◽  
Haruko Yamamoto ◽  
Manabu Inoue ◽  
Koko Asakura ◽  
Junya Aoki ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Inversion Recovery ◽  
Favorable Outcome ◽  
Control Group ◽  
Open Label ◽  
Unique Identifier ◽  
Ischemic Lesion ◽  
Fluid Attenuated Inversion Recovery ◽  
Standard Medical Treatment ◽  
And Control

Background and Purpose— We assessed whether lower-dose alteplase at 0.6 mg/kg is efficacious and safe for acute fluid-attenuated inversion recovery-negative stroke with unknown time of onset. Methods— This was an investigator-initiated, multicenter, randomized, open-label, blinded-end point trial. Patients met the standard indication criteria for intravenous thrombolysis other than a time last-known-well >4.5 hours (eg, wake-up stroke). Patients were randomly assigned (1:1) to receive alteplase at 0.6 mg/kg or standard medical treatment if magnetic resonance imaging showed acute ischemic lesion on diffusion-weighted imaging and no marked corresponding hyperintensity on fluid-attenuated inversion recovery. The primary outcome was a favorable outcome (90-day modified Rankin Scale score of 0–1). Results— Following the early stop and positive results of the WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke), this trial was prematurely terminated with 131 of the anticipated 300 patients (55 women; mean age, 74.4±12.2 years). Favorable outcome was comparable between the alteplase group (32/68, 47.1%) and the control group (28/58, 48.3%; relative risk [RR], 0.97 [95% CI, 0.68–1.41]; P =0.892). Symptomatic intracranial hemorrhage within 22 to 36 hours occurred in 1/71 and 0/60 (RR, infinity [95% CI, 0.06 to infinity]; P >0.999), respectively. Death at 90 days occurred in 2/71 and 2/60 (RR, 0.85 [95% CI, 0.06–12.58]; P >0.999), respectively. Conclusions— No difference in favorable outcome was seen between alteplase and control groups among patients with ischemic stroke with unknown time of onset. The safety of alteplase at 0.6 mg/kg was comparable to that of standard treatment. Early study termination precludes any definitive conclusions. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02002325.

Treatment of Carpal and Digital Ganglions by Simple Aspiration, or Aspiration and Injection of Corticosteroid And/Or Hyaluronidase

1997 ◽  
Vol 5 (4) ◽  
pp. 233-237 ◽  
Author(s):  
John T Seki ◽  
Michael Sg Bell
Keyword(s):  
Clinical Trial ◽  
Retrospective Study ◽  
Triamcinolone Acetonide ◽  
Nonoperative Management ◽  
Ethics Committee ◽  
Anatomical Location ◽  
Success Rates ◽  
Prospective Randomized Clinical Trial ◽  
Ganglion Cysts ◽  
Cure Rates

This retrospective study examined the treatment outcome of 178 carpal and digital ganglion cysts by simple aspiration or aspiration and injection of corticosteroid (triamcinolone acetonide 40 mg/mL) and/or hyaluronidase in 174 patients between 1987 and 1995. A total of 106 ganglions were treated with aspiration and triamcinolone acetonide injection; the cumulative cure rates were 45.3%, 50.0% and 53.8% following one, two or three treatments, respectively. The cure rates were similar in 23 ganglions in the hyaluronidase group: 43.5%, 52.2% and 56.5%, respectively. Seventeen of the 23 ganglions treated with a combination of triamcinolone acetonide and hyaluronidase recurred, yielding success rates of 17.4% and 26.1% following two or three treatments, respectively. Twenty-six ganglions were treated with simple aspiration. Of these, 23 were volar digital ganglions. The success rates were 61.5% and 69.2% following one or two treatments, respectively. The overall success rate was 94 of 178 (52.8%) after a maximum of three treatments, regardless of the type of treatment and the anatomical location of the ganglions. This study provided baseline data following nonoperative management of ganglions; the data can be compared with those from a planned prospective randomized clinical trial involving the use of rolitetracycline as a sclerosing agent, which is currently under review by the Ethics Committee at the authors’ institution.

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