102,295 research outputs found
Decision Algorithms for Direct Oral Anticoagulant Use in Patients With Nonvalvular Atrial Fibrillation: A Practical Guide for Neurologists
No full textDirect oral anticoagulants (DOACs) are valid alternative options to vitamin K antagonists due to their limited interactions
with drugs or food and the fact that they do not require regular coagulation monitoring. To this regard, recent practice
guidelines recommend that DOACs should be considered as first-line anticoagulant therapy for stroke prevention in
patients with nonvalvular atrial fibrillation (NVAF). This review (1) outlines current international guidelines for the management
of DOACs to prevent stroke in patients with NVAF, (2) outlines indications for elderly patients as well as specific
settings including acute coronary syndromes and intracranial hemorrhage, and (3) offers a practical guide for the use of
DOACs in neurological settings.Direct oral anticoagulants (DOACs) are valid alternative options to vitamin K antagonists due to their limited interactions with drugs or food and the fact that they do not require regular coagulation monitoring. To this regard, recent practice guidelines recommend that DOACs should be considered as first-line anticoagulant therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). This review (1) outlines current international guidelines for the management of DOACs to prevent stroke in patients with NVAF, (2) outlines indications for elderly patients as well as specific settings including acute coronary syndromes and intracranial hemorrhage, and (3) offers a practical guide for the use of DOACs in neurological settings
Chronic paroxysmal hemicrania: a chronobiological study (case report).
No full textIn this study the 24-h pattern of blood pressure (BP), heart rate (HR), plasma catecholamine (CA), beta-endorphin (beta-EP), beta-lipotropin (beta-LPH) and RIII threshold was investigated in a patient suffering from chronic paroxysmal hemicrania (CPH). The investigation was carried out before and during indomethacin therapy in order to assess the presence or otherwise of a disordered biorhythmic organization resembling that documented in cluster headache (CH). A severe alteration in the majority of the rhythms explored was found not only during the drug-free phase, but also in the indomethacin phase of the investigation. These data are similar to those obtained in CH studies and point to the possibility of a common pathophysiological mechanism
Guideline Compliance Improves Stroke Outcome- A Preliminary Study in 4 Districts in the Italian Region of Lombardia.
No full textBACKGROUND AND PURPOSE:
Guidelines for medical practice in stroke have been proposed in different countries, but their impact on stroke outcome has not been verified to date. The aim of this study was to evaluate the impact of the American Heart Association guidelines for acute stroke and for transient ischemic attack on first-ever stroke patients.
METHODS:
Three hundred eighty-six first-ever ischemic stroke patients were admitted to the study. Those observed within 6 hours from stroke onset were eligible for the acute clinical phase of the study, while all were admitted to the early clinical phase. The follow-up lasted 6 months. Primary end points were survival and the effectiveness of treatment on disability, measured as the proportion of potential improvement in the Barthel Index score achieved during treatment. A rating of noncompliance with the guideline recommendations was calculated for each patient, and its association with the end points was investigated. The Kaplan-Meier method and log-rank test were used to estimate and compare survival curves between groups; Cox proportional hazards model and logistic regression were used to identify risk factors for mortality; and correlation tests and regression analysis were used to evaluate the influence of guideline compliance on disability. Both univariate and multivariate statistical analyses were performed.
RESULTS:
Survival and treatment effectiveness were directly correlated with guideline compliance. The relative risk of death for patients with a noncompliance rating > or =5 was 2.26 with respect to patients with a noncompliance rating <5 (95% CI, 1.51 to 4.67; P<0.0007). In this latter group, at 6 months we detected a 15% decrease in mortality (95% CI, 9.1% to 17.5%). Treatment effectiveness showed a Spearman's rank correlation with the noncompliance rating of -0.3 (P<0.001). At discharge we observed a 13% increase in treatment effectiveness, while no significant differences were detectable at 3 and 6 months. These associations were confirmed by the multivariate analysis, in which we included, together with the noncompliance rating, all the variables previously identified as independent predictors of mortality and disability.
CONCLUSIONS:
This study demonstrates an association between adherence to guidelines and stroke outcome, and it can be viewed as a study that prepares the way for a randomized controlled trial in this area. It also emphasizes the need to develop personnel and structures devoted to stroke care because an evidence-based clinical approach could significantly reduce the risk of death
Sympathergic/neuroendocrine reactivity as a marker of adaptive processes underlying migraine susceptibility.
No full textValutazione dei processi adattativi allo stress in pazienti affetti da emicrania, con particolare riferimento all'attività simpato-adrenergica e alle secrezioni neuroendocrin
CIRCADIAN CHANGES OF NOCICEPTIVE FLEXION REFLEX THRESHOLD IN MAN
No full textCIRCADIAN CHANGES OF NOCICEPTIVE FLEXION REFLEX THRESHOLD IN MA
A knowledge-intensive approach to process similarity calculation
No full textProcess model comparison and similar processes retrieval are key issues to be addressed in many real world situations, and particularly relevant ones in some applications (e.g., in medicine), where similarity quantification can be exploited in a quality assessment perspective. Most of the process comparison techniques described in the literature suffer from two main limitations: (1) they adopt a purely syntactic (vs. semantic) approach in process activity comparison, and/or (2) they ignore complex control flow information (i.e., other than sequence). These limitations oversimplify the problem, and make the results of similarity-based process retrieval less reliable, especially when domain knowledge is available, and can be adopted to quantify activity or control flow construct differences. In this paper, we aim at overcoming both limitations, by introducing a framework which allows to extract the actual process model from the available process execution traces, through process mining techniques, and then to compare (mined) process models, by relying on a novel distance measure. The novel distance measure, which represents the main contribution of this paper, is able to address issues (1) and (2) above, since: (1) it provides a semantic, knowledge-intensive approach to process activity comparison, by making use of domain knowledge; (2) it explicitly takes into account complex control flow constructs (such as AND and XOR splits/joins), thus fully considering the different semantic meaning of control flow connections in a reliable way. The positive impact of the framework in practice has been tested in stroke management, where our approach has outperformed a state-of-the art literature metric on a real world event log, providing results that were closer to those of a human expert. Experiments in other domains are foreseen in the future
- …
