You can try and find out what the priority is, I found nothing.
The NHS Long Term Plan will make sure the NHS is fit for the future - Stroke
Showing posts with label priorities. Show all posts
Showing posts with label priorities. Show all posts
Saturday, February 16, 2019
Friday, January 20, 2017
2016 Stroke Research Highlights
You will notice that not one study of rehabilitation or the neuronal cascade of death was mentioned. All because we have NO fucking strategy to systematically solve all the fucking problems in stroke.
http://www.medscape.com/viewarticle/874534?src=wnl_edit_tpal
Hans-Christoph Diener, MD, PhD
Dear colleagues, I am Christoph Diener, a neurologist from the University of Essen in Germany. In this video, I would like to summarize the important studies in stroke that came out in 2016.
We had two remarkable publications on primary prevention this year. One was a burden-of-disease study published in The Lancet,[1] and the other was the case-control INTERSTROKE study with more than 27,000 patients.[2] Both studies clearly show that 90% of the risk for stroke is due to treatable risk factors. I sometimes think that we have the priorities wrong;(You do have your priorities wrong, survivor needs are much more important than what doctors and researchers think is important) we should contemplate much more on the primary prevention of stroke rather than on treating and secondary stroke prevention.(Wrong, wrong, wrong you fucking idiot)
We had results from one randomized trial (ACT 1)[3] and a 10-year follow-up study from the CREST trial[4] comparing stenting and curative surgery with asymptomatic aortic stenosis. It is no surprise that there was no difference between stenting and surgery. Unfortunately, the most important question—whether best medical treatment would be as effective as surgery or stenting—was not answered.
Next we come to the acute treatment of ischemic stroke. The IST-3 study[5] published a subgroup analysis comparing tissue plasminogen activator alteplase (tPA) and no treatment in the time window of up to 6 hours. What the study showed, which is extremely important, is that people above the age of 80 also benefit from tPA, as did those with severe strokes and who had high blood pressure at admission. They also showed that there is an increased risk for intracerebral bleeding if people who receive tPA are pretreated with antiplatelet drugs.
The ENCHANTED trial[6] compared two doses of alteplase—the standard dose of 0.9 mg/kg body weight and the reduced dose of 0.6 mg/kg body weight. There was no major difference, but I think that one subgroup is important: The study showed that people who are pretreated with antiplatelet therapy obviously have a benefit from the low dose of tPA in terms of preventing bleeding.
The results of the DIAS-4 trial[7] were also published. Desmoteplase was used in a time window of 4.5-9 hours and compared with placebo. The study was negative.
There [was also research][8] that looked at predictors of intracranial or intracerebral bleed after tPA. The results showed that a known high load of microbleeds or severe white matter lesions increases the risk of bleeding.
We had multiple trials[9,10] that showed thrombectomy to be highly effective. The numbers needed to treat to achieve a good outcome are between 2.6 and 4. The major challenge now is to implement thrombectomy on a wide basis. There was a randomized study from Heidelberg[11] showing that the outcome is identical, regardless of whether people receive thrombectomy with sedation or global anesthesia.
When it comes to secondary stroke prevention, there was a meta-analysis[12] of the early efficacy of aspirin. It is amazing how effective aspirin is compared with no treatment or placebo in the first 2 weeks after an ischemic stroke. The risk reduction is 55%. We should start aspirin as quickly as possible.
The SOCRATES trial[13] compared ticagrelor and aspirin in people with high-risk transient ischemic attack or mild strokes. There was no benefit of ticagrelor over aspirin for the combined endpoint of stroke or myocardial infarction.
At the moment, we have two ongoing [unpublished] studies in embolic stroke of indeterminate source. These studies compare dabigatran or rivaroxaban with aspirin in this important subgroup of patients.
There was a meta-analysis[14] on the treatment of hypertension in secondary stroke prevention with 39,000 patients, which showed that the best efficacy is achieved with angiotensin-converting enzyme (ACE) inhibitors and diuretics. Unfortunately, in all of the trials, which look at the treatment of diabetes in secondary stroke prevention, there was no positive outcome.
The last area is intracerebral bleeding. We now have data[15] on aggressive lowering of blood pressure in people who have an intracerebral bleed and high blood pressure. Unfortunately, findings did not show a benefit of aggressive lowering of blood pressure.
The good news is that we now have reversal agents for the new oral anticoagulants, and this has implications. There are now 12 cases reported from Germany who had an intracerebral bleed on dabigatran, who were all treated with the reversal agent idarucizumab. In only one patient there was a growth of the hematoma and the patient died. The mortality in this group went down to 9% compared with the usual 50% that we see in anticoagulation-induced bleeding.
Ladies and gentlemen, 2016 was an exciting year for stroke. We learned a lot about how to manage our patients.
I am Christoph Diener from the department of neurology at the University of Essen in Germany. Thank you very much for listening.
http://www.medscape.com/viewarticle/874534?src=wnl_edit_tpal
Hans-Christoph Diener, MD, PhD
Dear colleagues, I am Christoph Diener, a neurologist from the University of Essen in Germany. In this video, I would like to summarize the important studies in stroke that came out in 2016.
We had two remarkable publications on primary prevention this year. One was a burden-of-disease study published in The Lancet,[1] and the other was the case-control INTERSTROKE study with more than 27,000 patients.[2] Both studies clearly show that 90% of the risk for stroke is due to treatable risk factors. I sometimes think that we have the priorities wrong;(You do have your priorities wrong, survivor needs are much more important than what doctors and researchers think is important) we should contemplate much more on the primary prevention of stroke rather than on treating and secondary stroke prevention.(Wrong, wrong, wrong you fucking idiot)
We had results from one randomized trial (ACT 1)[3] and a 10-year follow-up study from the CREST trial[4] comparing stenting and curative surgery with asymptomatic aortic stenosis. It is no surprise that there was no difference between stenting and surgery. Unfortunately, the most important question—whether best medical treatment would be as effective as surgery or stenting—was not answered.
Next we come to the acute treatment of ischemic stroke. The IST-3 study[5] published a subgroup analysis comparing tissue plasminogen activator alteplase (tPA) and no treatment in the time window of up to 6 hours. What the study showed, which is extremely important, is that people above the age of 80 also benefit from tPA, as did those with severe strokes and who had high blood pressure at admission. They also showed that there is an increased risk for intracerebral bleeding if people who receive tPA are pretreated with antiplatelet drugs.
The ENCHANTED trial[6] compared two doses of alteplase—the standard dose of 0.9 mg/kg body weight and the reduced dose of 0.6 mg/kg body weight. There was no major difference, but I think that one subgroup is important: The study showed that people who are pretreated with antiplatelet therapy obviously have a benefit from the low dose of tPA in terms of preventing bleeding.
The results of the DIAS-4 trial[7] were also published. Desmoteplase was used in a time window of 4.5-9 hours and compared with placebo. The study was negative.
There [was also research][8] that looked at predictors of intracranial or intracerebral bleed after tPA. The results showed that a known high load of microbleeds or severe white matter lesions increases the risk of bleeding.
We had multiple trials[9,10] that showed thrombectomy to be highly effective. The numbers needed to treat to achieve a good outcome are between 2.6 and 4. The major challenge now is to implement thrombectomy on a wide basis. There was a randomized study from Heidelberg[11] showing that the outcome is identical, regardless of whether people receive thrombectomy with sedation or global anesthesia.
When it comes to secondary stroke prevention, there was a meta-analysis[12] of the early efficacy of aspirin. It is amazing how effective aspirin is compared with no treatment or placebo in the first 2 weeks after an ischemic stroke. The risk reduction is 55%. We should start aspirin as quickly as possible.
The SOCRATES trial[13] compared ticagrelor and aspirin in people with high-risk transient ischemic attack or mild strokes. There was no benefit of ticagrelor over aspirin for the combined endpoint of stroke or myocardial infarction.
At the moment, we have two ongoing [unpublished] studies in embolic stroke of indeterminate source. These studies compare dabigatran or rivaroxaban with aspirin in this important subgroup of patients.
There was a meta-analysis[14] on the treatment of hypertension in secondary stroke prevention with 39,000 patients, which showed that the best efficacy is achieved with angiotensin-converting enzyme (ACE) inhibitors and diuretics. Unfortunately, in all of the trials, which look at the treatment of diabetes in secondary stroke prevention, there was no positive outcome.
The last area is intracerebral bleeding. We now have data[15] on aggressive lowering of blood pressure in people who have an intracerebral bleed and high blood pressure. Unfortunately, findings did not show a benefit of aggressive lowering of blood pressure.
The good news is that we now have reversal agents for the new oral anticoagulants, and this has implications. There are now 12 cases reported from Germany who had an intracerebral bleed on dabigatran, who were all treated with the reversal agent idarucizumab. In only one patient there was a growth of the hematoma and the patient died. The mortality in this group went down to 9% compared with the usual 50% that we see in anticoagulation-induced bleeding.
Ladies and gentlemen, 2016 was an exciting year for stroke. We learned a lot about how to manage our patients.
I am Christoph Diener from the department of neurology at the University of Essen in Germany. Thank you very much for listening.
References
- Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15:913-924. Abstract
- O'Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388:761-775. Abstract
- Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 2016;374:1011-1020. Abstract
- Brott TG, Howard G, Roubin GS, et al. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374:1021-1031. Abstract
- Berge E, Cohen G, Roaldsen MB, et al. Effects of alteplase on survival after ischaemic stroke (IST-3): 3 year follow-up of a randomised, controlled, open-label trial. Lancet Neurol. 2016;15:1028-1034. Abstract
- Anderson CS, Robinson T, Lindley RI, et al. Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke. N Engl J Med. 2016;374:2313-2323. Abstract
- von Kummer R, Mori E, Truelsen T, et al. Desmoteplase 3 to 9 hours after major artery occlusion stroke: the DIAS-4 trial (efficacy and safety study of desmoteplase to treat acute ischemic stroke). Stroke. 2016;47:2880-2887. Abstract
- Lin Q, Li Z, Wei R, Lei Q, Liu Y, Cai X. Increased risk of post-thrombolysis intracranial hemorrhage in acute ischemic stroke patients with leukoaraiosis: a meta-analysis. PLoS One. 2016;11:e0153486. doi: 10.1371/journal.pone.0153486. eCollection 2016.
- Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016;316:1279-1288. Abstract
- Goyal M, Menon BK, Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-1731. Abstract
- Schönenberger S, Uhlmann L, Hacke W, et al. Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA. 2016;316:1986-1996. Abstract
- Rothwell PM, Algra A, Chen Z, Diener HC, Norrving B, Mehta Z. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet. 2016;388:365-375. Abstract
- Johnston SC, Amarenco P, Albers GW, et al. Ticagrelor versus aspirin in acute stroke or transient ischemic attack. N Engl J Med. 2016;375:35-43. Abstract
- Katsanos AH, Filippatou A, Manios E, et al. Blood pressure reduction and secondary stroke prevention: a systematic review and metaregression analysis of randomized clinical trials. Hypertension. 2016 Oct 31. [Epub ahead of print]
- Qureshi AI, Palesch YY, Barsan WG, et al; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033-1043. Abstract
Friday, November 27, 2015
Top priorities named in hearing loss research - Stroke???
What the fuck are the top priorities in stroke research? Do we even know what we should be researching? Or is this just a crapshoot hoping to find something useful? A great stroke association would have a defined strategy on what research should be funded next in order to solve all the fucking problems in stroke.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=158821&CultureCode=en
Experts have published a list of the most urgent priorities for researching a debilitating condition that affects more than 10 million people in the UK.
Published in The Lancet, the top 10 research priorities for tackling mild to moderate hearing loss aims to re-focus future studies on areas which could potentially have the greatest impact in furthering understanding of the condition and developing successful new treatments.
Co-author Dr Helen Henshaw, a University of Nottingham academic based at the National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, said: “Although hearing loss is not deadly, it can have a profound impact on people’s ability to maintain relationships, lead a normal life and go out to work.
“With such a huge proportion of the population affected by this condition, it is vital that hearing research funding is prioritised for the questions which are most important to them.”
Despite being one of the six health priority areas for the NIHR, significantly less is spent on hearing research – just £47 per one lost year of healthy life compared to other priority conditions such as sight loss (£99) and diabetes (£399).
Currently, evidence which underpins clinical practice is typically provided by researchers in universities that are far-removed from frontline clinical services and which often does not take into account the views and experiences of key stakeholders.
The list of Top 10 hearing loss priorities were identified by an innovative partnership, the James Lind Alliance, which brings together patients, carers and clinicians to identify the unanswered questions about the effects of treatments that they agree are the most important.
It canvassed the views of more than 460 people on what they believed were the most significant treatment uncertainties before asking them to rank the importance of more than 80 research questions connected to these areas on a scale of importance. The top 30 ranked questions were then taken forward to a final prioritisation workshop, which then narrowed these down to the final top 10 based on consensus from a group of patients, family, friends and clinicians.
The final top 10 includes questions about the prevention (or cure), diagnosis and treatment, with the majority of treatment questions concerned with aspects of hearing aid provision.
All of the uncertainties identified by the James Lind Alliance Priority Setting Partnership, including the top 10, will be uploaded to the Database of Uncertainties About the Effects of Treatments to be made widely to the public, the research community, research commissioners and research funders.
The project was supported by funding awarded by the Nottingham University Hospitals Charity and the National Institute for Health Research Biomedical Research Unit Programme.
Full bibliographic informationHelen Henshaw, Linda Sharkey, David Crowe, Melanie Ferguson; Research priorities for mild-to-moderate hearing loss in adults;
The Lancet Vol 386 November 28, 2015; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01048-X/abstract
http://www.alphagalileo.org/ViewItem.aspx?ItemId=158821&CultureCode=en
Experts have published a list of the most urgent priorities for researching a debilitating condition that affects more than 10 million people in the UK.
Published in The Lancet, the top 10 research priorities for tackling mild to moderate hearing loss aims to re-focus future studies on areas which could potentially have the greatest impact in furthering understanding of the condition and developing successful new treatments.
Co-author Dr Helen Henshaw, a University of Nottingham academic based at the National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, said: “Although hearing loss is not deadly, it can have a profound impact on people’s ability to maintain relationships, lead a normal life and go out to work.
“With such a huge proportion of the population affected by this condition, it is vital that hearing research funding is prioritised for the questions which are most important to them.”
Despite being one of the six health priority areas for the NIHR, significantly less is spent on hearing research – just £47 per one lost year of healthy life compared to other priority conditions such as sight loss (£99) and diabetes (£399).
Currently, evidence which underpins clinical practice is typically provided by researchers in universities that are far-removed from frontline clinical services and which often does not take into account the views and experiences of key stakeholders.
The list of Top 10 hearing loss priorities were identified by an innovative partnership, the James Lind Alliance, which brings together patients, carers and clinicians to identify the unanswered questions about the effects of treatments that they agree are the most important.
It canvassed the views of more than 460 people on what they believed were the most significant treatment uncertainties before asking them to rank the importance of more than 80 research questions connected to these areas on a scale of importance. The top 30 ranked questions were then taken forward to a final prioritisation workshop, which then narrowed these down to the final top 10 based on consensus from a group of patients, family, friends and clinicians.
The final top 10 includes questions about the prevention (or cure), diagnosis and treatment, with the majority of treatment questions concerned with aspects of hearing aid provision.
All of the uncertainties identified by the James Lind Alliance Priority Setting Partnership, including the top 10, will be uploaded to the Database of Uncertainties About the Effects of Treatments to be made widely to the public, the research community, research commissioners and research funders.
The project was supported by funding awarded by the Nottingham University Hospitals Charity and the National Institute for Health Research Biomedical Research Unit Programme.
Full bibliographic informationHelen Henshaw, Linda Sharkey, David Crowe, Melanie Ferguson; Research priorities for mild-to-moderate hearing loss in adults;
The Lancet Vol 386 November 28, 2015; http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01048-X/abstract
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