scholarly journals Does the Addition of Non-Approved Inclusion and Exclusion Criteria for rtPA Impact Treatment Rates? Findings in Australia, the UK, and the USA

2018 ◽  
Vol 8 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Louise E. Craig ◽  
Sandy Middleton ◽  
Helen Hamilton ◽  
Fern Cudlip ◽  
Victoria Swatzell ◽  
...  
Keyword(s):  
Ct Perfusion ◽  
Recombinant Tissue Plasminogen Activator ◽  
National Institutes Of Health ◽  
Exclusion Criteria ◽  
Eligibility Criteria ◽  
Median Percentage ◽  
Tissue Plasminogen ◽  
The Usa ◽  
English Speaking ◽  
The Uk

Background: Strict criteria for recombinant tissue plasminogen activator (rtPA) eligibility are stipulated on licences for use in ischaemic stroke; however, practitioners may also add non-standard rtPA criteria. We examined eligibility criteria variation in 3 English-speaking countries including use of non-standard criteria, in relation to rtPA treatment rates. Methods: Surveys were mailed to 566 eligible hospitals in Australia (AUS), the UK, and the USA. Criteria were pre-classified as standard (approved indication and contraindications) or non-standard (approved warning or researcher “decoy”). Percentage for criterion selection was calculated/compared; linear regression was used to assess the association between use of non-standard criteria and rtPA treatment rates, and to identify factors associated with addition of non-standard criteria. Results: Response rates were 74% AUS, 65% UK, and 68% USA; mean rtPA treatment rates were 8.7% AUS, 12.7% UK, and 8.7% USA. Median percentage of non-standard inclusions was 33% (all 3 countries) and included National Institutes of Health Stroke Scale (NIHSS) scores > 4, computed tomography (CT) angiography documented occlusion, and favourable CT perfusion. Median percentage of non-standard exclusions was 25% AUS, 28% UK, and 60% USA, and included depressed consciousness, NIHSS > 25, and use of antihypertensive infusions. No AUS or UK sites selected 100% of standard exclusions. Conclusions: Non-standard criteria for rtPA eligibility were evident in all three countries and could, in part, explain comparably low use of rtPA. Differences in the use of standard criteria may signify practitioner intolerance for those derived from original efficacy studies that are no longer relevant.

scholarly journals Safety of Glycoprotein IIb-IIIa Inhibitors Used in Stroke-Related Treatment: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 26 ◽  
pp. 107602962094259
Author(s):  
Xiaolin Zhu ◽  
Genmao Cao
Keyword(s):  
Intracranial Hemorrhage ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Antiplatelet Agents ◽  
National Institutes Of Health ◽  
Randomized Controlled ◽  
Tissue Plasminogen ◽  
Treatment Administration ◽  
Symptomatic Intracranial Hemorrhage

Background: Endovascular therapy and intravenous thrombolysis with recombinant tissue plasminogen activator are the 2 most recommended treatments for acute ischemic stroke (AIS). Glycoprotein (GP) IIb-IIIa inhibitors are short-acting selective reversible antiplatelet agents that emerged as promising therapeutic agents for AIS about 10 years ago. Given the unclear safety profile and application coverage of GP inhibitors, we conducted this meta-analysis to explore the same. Methods: We used GP IIb-IIIa inhibitors, intracranial hemorrhage, and mortality as the key words on Medline, Web of Science, and the Embase databases. Randomized controlled trials, prospective literatures, and retrospective studies in English published between 1990 and 2020 were screened. The outcomes were relative risk (RR) of death and 90-day intracerebral hemorrhage (ICH). We pooled the results in 2 categories and conducted a subgroup analysis stratified by different drugs. The choice of the effects model depended on the value of I 2. Results: In all, 3700 patients from 20 studies were included. No GP IIb-IIIa inhibitors were found to have a remarkable influence on the ICH rate. The RR values of symptomatic ICH for abciximab and eptifibatide were 4.26 (1.89, 9.59) and 0.17 (0.04, 0.69), respectively. Both tirofiban and abciximab could decrease the mortality rate within 90 days. Age > 70 years, National Institutes of Health Stroke Scale > 15, and overall dose > 10 mg are risk factors for ICH events with tirofiban usage. Thrombectomy combined with tirofiban was safe for arterial reocclusion prevention. Conclusions: In stroke-related treatment, administration of GP IIb-IIIa inhibitors could be safe, but care should be taken regarding drug species and doses. Abciximab can increase the risk of symptomatic intracranial hemorrhage. Tirofiban and eptifibatide can be considered safe in low doses. Suitable patients should be selected using strict criteria.

scholarly journals Glimpses of semantic restructuring of English emotion-laden words of American English L1 users residing outside the USA

2017 ◽  
Vol 8 (3) ◽  
pp. 320-342 ◽  
Author(s):  
Jean-Marc Dewaele
Keyword(s):  
Exploratory Study ◽  
American English ◽  
Statistical Analyses ◽  
The Self ◽  
Semantic Representations ◽  
Frequency Of Use ◽  
Dependent Variables ◽  
The Usa ◽  
English Speaking ◽  
The Uk

Abstract The present exploratory study focuses on the effect of living outside the USA on the understanding of the meaning, the perceived offensiveness and the self-reported frequency of use of four English emotion-laden words of British origin and four English emotion-laden words of American origin among 556 first (L1) users of American English. Statistical analyses revealed that the scores of the Americans living in the UK or in non-English-speaking countries differed significantly from those of compatriots living in the USA. Positive relationships emerged between multilingualism and scores on the dependent variables for the four British words, but no link emerged between languages known and the dependent variables for the American words. This is interpreted as an indication that semantic representations of emotion-laden words originating from another variety of the L1 are relatively weaker and are more likely to shift as a result of exposure to their use in other varieties, and the knowledge of other languages.

Comparative Attributes of Effective Health Services Managers and Definitions of Organizational Effectiveness in Australia, the UK and the USA

1996 ◽  
Vol 9 (1) ◽  
pp. 1-9 ◽  
Author(s):  
D. Boldy ◽  
S. Jain ◽  
G. Chen
Keyword(s):  
Health Services ◽  
Organizational Effectiveness ◽  
Management Skills ◽  
Political Skills ◽  
The Usa ◽  
English Speaking ◽  
Country Differences ◽  
Perceived Relevance ◽  
The Uk

This paper explores and contrasts the perceptions of 855, mainly health services managers and 1452 students from three major English-speaking countries regarding the attributes needed for becoming effective managers in their country. Also addressed are country differences and similarities in the perceived relevance of particular indicators of organizational effectiveness. Despite Australia's British heritage, respondents from this country were found to be more similar to those from the USA, than those from the UK, in their views regarding the attributes of effective managers. Australian and American respondents rated ‘nurturing’ personality skills relatively highly, as they did ‘classical’ management skills. UK respondents rated ‘classical’ management skills as more important than ‘political’ skills.

scholarly journals Endovascular Therapy Demonstrates Benefit over Intravenous Recombinant Tissue Plasminogen Activator Based on Repeatedly Measured National Institutes of Health Stroke Scale

2016 ◽  
Vol 6 (1-2) ◽  
pp. 25-30
Author(s):  
Liqiong Fan ◽  
Sharon D. Yeatts ◽  
Lydia D. Foster ◽  
Pooja Khatri ◽  
Thomas Tomsick ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Endovascular Therapy ◽  
Treatment Effect ◽  
Covariance Structure ◽  
Recombinant Tissue Plasminogen Activator ◽  
National Institutes Of Health ◽  
Structure Model ◽  
Tissue Plasminogen ◽  
Covariance Structure Model ◽  
Over Time

Background and Purpose: The Interventional Management of Stroke (IMS) III trial was a randomized controlled trial designed to compare the effect of endovascular therapy after intravenous recombinant tissue plasminogen activator (i.v. rt-PA) as compared to i.v. rt-PA alone. The primary outcome was modified Rankin Scale at 90 days. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS), which was assessed repeatedly through 90 days. The objective of this analysis is to evaluate the treatment effect of endovascular therapy over time on NIHSS. Methods: 656 subjects were enrolled in the IMS III trial, including 434 subjects randomized to endovascular therapy and 222 to i.v. rt-PA only. NIHSS scores evaluated at 40 min, 24 h, Day 5, and Day 90 were included in the analysis. A covariance structure model was used to investigate the treatment effect on NIHSS over time, adjusting for relevant covariates including baseline stroke severity. Model assumptions were valid. Results: Based on the covariance structure model, after adjusting for relevant baseline covariates, a significant time-by-treatment interaction effect (p = 0.0137) was observed. Only NIHSS at Day 90 showed a significant treatment effect (p = 0.0473), with subjects in the endovascular arm having a lower NIHSS (less neurologic deficit) compared to the i.v. rt-PA arm. Conclusions: The IMS III trial demonstrated an endovascular treatment effect based on the secondary outcome of NIHSS. However, the magnitude of this treatment effect varied by the time of assessment. It was only at Day 90 that the endovascular arm had a significantly lower NIHSS compared to that in the i.v. rt-PA arm.

scholarly journals Nutritional quality of food items on fast-food ‘kids’ menus’: comparisons across countries and companies

2013 ◽  
Vol 17 (10) ◽  
pp. 2263-2269 ◽  
Author(s):  
Erin Hobin ◽  
Christine White ◽  
Ye Li ◽  
Maria Chiu ◽  
Mary Fodor O'Brien ◽  
...  
Keyword(s):  
Fast Food ◽  
Nutritional Quality ◽  
Saturated Fat ◽  
Food Chains ◽  
Food Items ◽  
The Usa ◽  
English Speaking ◽  
Total Fat ◽  
The Uk

AbstractObjectiveTo compare energy (calories), total and saturated fats, and Na levels for ‘kids’ menu’ food items offered by four leading multinational fast-food chains across five countries.DesignA content analysis was used to create a profile of the nutritional content of food items on kids’ menus available for lunch and dinner in four leading fast-food chains in Australia, Canada, New Zealand, the UK and the USA.SettingFood items from kids’ menus were included from four fast-food companies: Burger King, Kentucky Fried Chicken (KFC), McDonald's and Subway. These fast-food chains were selected because they are among the top ten largest multinational fast-food chains for sales in 2010, operate in high-income English-speaking countries, and have a specific section of their restaurant menus labelled ‘kids’ menus’.ResultsThe results by country indicate that kids’ menu foods contain less energy (fewer calories) in restaurants in the USA and lower Na in restaurants in the UK. The results across companies suggest that kids’ menu foods offered at Subway restaurants are lower in total fat than food items offered at Burger King and KFC, and food items offered at KFC are lower in saturated fat than items offered at Burger King.ConclusionsAlthough the reasons for the variation in the nutritional quality of foods on kids’ menus are not clear, it is likely that fast-food companies could substantially improve the nutritional quality of their kids’ menu food products, translating to large gains for population health.

Continuity, Dissonance and Location: An Anglosphere Research Agenda

2019 ◽  
pp. 1-18
Author(s):  
Andrew Mycock ◽  
Ben Wellings
Keyword(s):  
United Kingdom ◽  
New Zealand ◽  
Political Ideology ◽  
Research Agenda ◽  
The United Kingdom ◽  
Aotearoa New Zealand ◽  
The Usa ◽  
English Speaking ◽  
Anglo American ◽  
The Uk

This chapter maps out an agenda for those wishing to research the Anglosphere. It does so by examining the elements of political and ideational continuity between the present-day Anglosphere and its antecedents such as Greater Britain and the English-speaking peoples. It also analyses the dissonance within and amongst members of the Anglosphere and thus assesses the potential for the realisation of the diverse political goals that its proponents claim. In searching for the locations where this idea has been realised, it suggests that Brexit increased the salience of the Anglosphere in the United Kingdom and beyond. The chapter notes the changing scope of definitions of the Anglosphere from proponents and analysts alike. It focuses on the five ‘core’ states of the Anglosphere – the USA, the UK, Canada, Australia and Aotearoa/New Zealand – but is sensitive to overlapping and intersecting relationships, such as the Commonwealth and the Anglo-American ‘special relationship’. By examining the narratives that the idea of the Anglosphere generates this chapter argues that the hierarchies and tensions intersecting it both sustain and constrain this durable yet thin political ideology.

A CT perfusion based model predicts outcome in wake-up stroke patients treated with recombinant tissue plasminogen activator

2020 ◽  
Vol 41 (7) ◽  
pp. 075011 ◽  
Author(s):  
Miloš Ajčević ◽  
Giovanni Furlanis ◽  
Alex Buoite Stella ◽  
Tommaso Cillotto ◽  
Paola Caruso ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Ct Perfusion ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Patients ◽  
Tissue Plasminogen
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