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Nils Wahlgren - One of the best experts on this subject based on the ideXlab platform.
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Systemic Thrombolysis in Clinical Practice: What Have We Learned after the Safe Implementation of Thrombolysis in Stroke Monitoring Study?
Cerebrovascular Diseases, 2009Co-Authors: Nils WahlgrenAbstract:The Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST) of 6,483 patients treated with intravenous alteplase within 3 h after stroke onset showed that this treatment was as safe
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multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials safe implementation of thrombolysis in stroke Monitoring Study sits most
Stroke, 2008Co-Authors: Nils Wahlgren, Niaz Ahmed, Niclas Eriksson, F Aichner, Erich Bluhmki, Antoni Davalos, Terttu Erila, Gary A Ford, Martin Grond, Werner HackeAbstract:BACKGROUND AND PURPOSE: The Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) unadjusted results demonstrated that intravenous alteplase is well tolerated and that the effects were comparable with those seen in randomized, controlled trials (RCTs) when used in routine clinical practice within 3 hours of ischemic stroke onset. We aimed to identify outcome predictors and adjust the outcomes of the SITS-MOST to the baseline characteristics of RCTs. METHODS: The Study population was SITS-MOST (n=6483) and pooled RCTs (n=464) patients treated with intravenous alteplase within 3 hours of stroke onset. Multivariable, backward stepwise regression analyses (until P or=1 within 7 days with any hemorrhage (RCT definition), mortality, and independency as defined by modified Rankin Score of 0 to 2 at 3 months. RESULTS: The adjusted proportion of symptomatic intracerebral hemorrhage for SITS-MOST was 8.5% (95% CI, 7.9 to 9.0) versus 8.6% (6.3 to 11.6) for pooled RCTs; mortality was 15.5% (14.7 to 16.2) versus 17.3% (14.1 to 21.1); and independency was 50.4% (49.6 to 51.2) versus 50.1% (44.5 to 54.7), respectively. In the multivariable analysis, older age, high blood glucose, high National Institutes of Health Stroke Scale score, and current infarction on imaging scans were related to poor outcome in all parameters. Systolic blood pressure, atrial fibrillation, and weight were additional predictors of symptomatic intracerebral hemorrhage. Current smokers had a lower rate of symptomatic intracerebral hemorrhage. Disability before current stroke (modified Rankin Score 2 to 5), diastolic blood pressure, antiplatelet other than aspirin, congestive heart failure, patients treated in new centers, and male sex were related to high mortality at 3 months. CONCLUSIONS: The adjusted outcomes from SITS-MOST were almost identical to those in relevant RCTs and reinforce the conclusion drawn previously in the unadjusted analysis. We identified several important outcome predictors to better identify patients suitable for thrombolysis.
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thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke Monitoring Study sits most an observational Study
The Lancet, 2007Co-Authors: Nils Wahlgren, Niaz Ahmed, Antoni Davalos, Gary A Ford, Martin Grond, Werner Hacke, Michael G Hennerici, Markku Kaste, Sonja Kuelkens, Vincent LarrueAbstract:Summary Background The aim of the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) was to assess the safety and efficacy of intravenous alteplase as thrombolytic therapy within the first 3 h of onset of acute ischaemic stroke. Under European Union regulations, SITS-MOST was required to assess the safety profile of alteplase in clinical practice by comparison with results in randomised controlled trials. Methods 6483 patients were recruited from 285 centres (50% with little previous experience in stroke thrombolysis) in 14 countries between 2002 and 2006 for this prospective, open, monitored, observational Study. Primary outcomes were symptomatic (a deterioration in National Institutes of Health stroke scale score of ≥4) intracerebral haemorrhage type 2 within 24 h and mortality at 3 months. We compared mortality, the proportion of patients with symptomatic intracerebral haemorrhage as per the Cochrane definition, and functional outcome at 3 months with relevant pooled results from randomised controlled trials. Findings Baseline characteristics of patients in SITS-MOST were much the same as those in the pooled randomised controlled trials. At 24 h, the proportion of patients with symptomatic intracerebral haemorrhage (per the SITS-MOST protocol) was 1·7% (107/6444; 95% CI 1·4–2·0); at 7 days, the proportion with the same condition as per the Cochrane definition was 7·3% (468/6438; 6·7–7·9) compared with 8·6% (40/465; 6·3–11·6) in the pooled randomised controlled trials. The mortality rate at 3 months in SITS-MOST was 11·3% (701/6218; 10·5–12·1) compared with 17·3% (83/479; 14·1–21·1) in the pooled randomised controlled trials. Interpretation These data confirm that intravenous alteplase is safe and effective in routine clinical use when used within 3 h of stroke onset, even by centres with little previous experience of thrombolytic therapy for acute stroke. The findings should encourage wider use of thrombolytic therapy for suitable patients treated in stroke centres.
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thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke Monitoring Study sits most an observational Study
The Lancet, 2007Co-Authors: Nils Wahlgren, Niaz Ahmed, Antoni Davalos, Gary A Ford, Martin Grond, Werner Hacke, Michael G Hennerici, Markku Kaste, Sonja Kuelkens, Vincent LarrueAbstract:Summary Background The aim of the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) was to assess the safety and efficacy of intravenous alteplase as thrombolytic therapy within the first 3 h of onset of acute ischaemic stroke. Under European Union regulations, SITS-MOST was required to assess the safety profile of alteplase in clinical practice by comparison with results in randomised controlled trials. Methods 6483 patients were recruited from 285 centres (50% with little previous experience in stroke thrombolysis) in 14 countries between 2002 and 2006 for this prospective, open, monitored, observational Study. Primary outcomes were symptomatic (a deterioration in National Institutes of Health stroke scale score of ≥4) intracerebral haemorrhage type 2 within 24 h and mortality at 3 months. We compared mortality, the proportion of patients with symptomatic intracerebral haemorrhage as per the Cochrane definition, and functional outcome at 3 months with relevant pooled results from randomised controlled trials. Findings Baseline characteristics of patients in SITS-MOST were much the same as those in the pooled randomised controlled trials. At 24 h, the proportion of patients with symptomatic intracerebral haemorrhage (per the SITS-MOST protocol) was 1·7% (107/6444; 95% CI 1·4–2·0); at 7 days, the proportion with the same condition as per the Cochrane definition was 7·3% (468/6438; 6·7–7·9) compared with 8·6% (40/465; 6·3–11·6) in the pooled randomised controlled trials. The mortality rate at 3 months in SITS-MOST was 11·3% (701/6218; 10·5–12·1) compared with 17·3% (83/479; 14·1–21·1) in the pooled randomised controlled trials. Interpretation These data confirm that intravenous alteplase is safe and effective in routine clinical use when used within 3 h of stroke onset, even by centres with little previous experience of thrombolytic therapy for acute stroke. The findings should encourage wider use of thrombolytic therapy for suitable patients treated in stroke centres.
A De Nijs - One of the best experts on this subject based on the ideXlab platform.
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ais cesio environmental surfactant Monitoring programme part 1 las Monitoring Study in de meern sewage treatment plant and receiving river leidsche rijn
Chemosphere, 1995Co-Authors: Tom C J Feijtel, E Matthijs, Andre Rottiers, G B J Rijs, A T Kiewiet, A De NijsAbstract:Abstract This manuscript reports on the outcome of a 7-day pilot Monitoring Study on the anionic surfactant linear alkyl benzene sulfonate (LAS) at the “de Meem” municipal sewage treatment plant. The receiving surface water, the Leidsche Rijn is a straight river — about 20 m wide and 1.5 m deep — and dilutes the sewage discharge by a factor 3. The Monitoring Study illustrates an effective removal of LAS of 99.9% during dry weather and normal operating conditions. The LAS concentrations in daily composite raw sewage samples varied between 3.1 and 7.2 mg/L, with corresponding effluent concentrations generally under the analytical detection limit of 8.1 ug/L. During this same period, total LAS concentrations in the river varied between
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AIS/CESIO environmental surfactant Monitoring programme. Part 1: LAS Monitoring Study in ``de Meern'' sewage treatment plant and receiving river ``Leidsche Rijn''
Chemosphere, 1995Co-Authors: Tom C J Feijtel, E Matthijs, Andre Rottiers, G B J Rijs, A T Kiewiet, A De NijsAbstract:Abstract This manuscript reports on the outcome of a 7-day pilot Monitoring Study on the anionic surfactant linear alkyl benzene sulfonate (LAS) at the “de Meem” municipal sewage treatment plant. The receiving surface water, the Leidsche Rijn is a straight river — about 20 m wide and 1.5 m deep — and dilutes the sewage discharge by a factor 3. The Monitoring Study illustrates an effective removal of LAS of 99.9% during dry weather and normal operating conditions. The LAS concentrations in daily composite raw sewage samples varied between 3.1 and 7.2 mg/L, with corresponding effluent concentrations generally under the analytical detection limit of 8.1 ug/L. During this same period, total LAS concentrations in the river varied between
Werner Hacke - One of the best experts on this subject based on the ideXlab platform.
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multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials safe implementation of thrombolysis in stroke Monitoring Study sits most
Stroke, 2008Co-Authors: Nils Wahlgren, Niaz Ahmed, Niclas Eriksson, F Aichner, Erich Bluhmki, Antoni Davalos, Terttu Erila, Gary A Ford, Martin Grond, Werner HackeAbstract:BACKGROUND AND PURPOSE: The Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) unadjusted results demonstrated that intravenous alteplase is well tolerated and that the effects were comparable with those seen in randomized, controlled trials (RCTs) when used in routine clinical practice within 3 hours of ischemic stroke onset. We aimed to identify outcome predictors and adjust the outcomes of the SITS-MOST to the baseline characteristics of RCTs. METHODS: The Study population was SITS-MOST (n=6483) and pooled RCTs (n=464) patients treated with intravenous alteplase within 3 hours of stroke onset. Multivariable, backward stepwise regression analyses (until P or=1 within 7 days with any hemorrhage (RCT definition), mortality, and independency as defined by modified Rankin Score of 0 to 2 at 3 months. RESULTS: The adjusted proportion of symptomatic intracerebral hemorrhage for SITS-MOST was 8.5% (95% CI, 7.9 to 9.0) versus 8.6% (6.3 to 11.6) for pooled RCTs; mortality was 15.5% (14.7 to 16.2) versus 17.3% (14.1 to 21.1); and independency was 50.4% (49.6 to 51.2) versus 50.1% (44.5 to 54.7), respectively. In the multivariable analysis, older age, high blood glucose, high National Institutes of Health Stroke Scale score, and current infarction on imaging scans were related to poor outcome in all parameters. Systolic blood pressure, atrial fibrillation, and weight were additional predictors of symptomatic intracerebral hemorrhage. Current smokers had a lower rate of symptomatic intracerebral hemorrhage. Disability before current stroke (modified Rankin Score 2 to 5), diastolic blood pressure, antiplatelet other than aspirin, congestive heart failure, patients treated in new centers, and male sex were related to high mortality at 3 months. CONCLUSIONS: The adjusted outcomes from SITS-MOST were almost identical to those in relevant RCTs and reinforce the conclusion drawn previously in the unadjusted analysis. We identified several important outcome predictors to better identify patients suitable for thrombolysis.
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thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke Monitoring Study sits most an observational Study
The Lancet, 2007Co-Authors: Nils Wahlgren, Niaz Ahmed, Antoni Davalos, Gary A Ford, Martin Grond, Werner Hacke, Michael G Hennerici, Markku Kaste, Sonja Kuelkens, Vincent LarrueAbstract:Summary Background The aim of the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) was to assess the safety and efficacy of intravenous alteplase as thrombolytic therapy within the first 3 h of onset of acute ischaemic stroke. Under European Union regulations, SITS-MOST was required to assess the safety profile of alteplase in clinical practice by comparison with results in randomised controlled trials. Methods 6483 patients were recruited from 285 centres (50% with little previous experience in stroke thrombolysis) in 14 countries between 2002 and 2006 for this prospective, open, monitored, observational Study. Primary outcomes were symptomatic (a deterioration in National Institutes of Health stroke scale score of ≥4) intracerebral haemorrhage type 2 within 24 h and mortality at 3 months. We compared mortality, the proportion of patients with symptomatic intracerebral haemorrhage as per the Cochrane definition, and functional outcome at 3 months with relevant pooled results from randomised controlled trials. Findings Baseline characteristics of patients in SITS-MOST were much the same as those in the pooled randomised controlled trials. At 24 h, the proportion of patients with symptomatic intracerebral haemorrhage (per the SITS-MOST protocol) was 1·7% (107/6444; 95% CI 1·4–2·0); at 7 days, the proportion with the same condition as per the Cochrane definition was 7·3% (468/6438; 6·7–7·9) compared with 8·6% (40/465; 6·3–11·6) in the pooled randomised controlled trials. The mortality rate at 3 months in SITS-MOST was 11·3% (701/6218; 10·5–12·1) compared with 17·3% (83/479; 14·1–21·1) in the pooled randomised controlled trials. Interpretation These data confirm that intravenous alteplase is safe and effective in routine clinical use when used within 3 h of stroke onset, even by centres with little previous experience of thrombolytic therapy for acute stroke. The findings should encourage wider use of thrombolytic therapy for suitable patients treated in stroke centres.
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thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke Monitoring Study sits most an observational Study
The Lancet, 2007Co-Authors: Nils Wahlgren, Niaz Ahmed, Antoni Davalos, Gary A Ford, Martin Grond, Werner Hacke, Michael G Hennerici, Markku Kaste, Sonja Kuelkens, Vincent LarrueAbstract:Summary Background The aim of the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) was to assess the safety and efficacy of intravenous alteplase as thrombolytic therapy within the first 3 h of onset of acute ischaemic stroke. Under European Union regulations, SITS-MOST was required to assess the safety profile of alteplase in clinical practice by comparison with results in randomised controlled trials. Methods 6483 patients were recruited from 285 centres (50% with little previous experience in stroke thrombolysis) in 14 countries between 2002 and 2006 for this prospective, open, monitored, observational Study. Primary outcomes were symptomatic (a deterioration in National Institutes of Health stroke scale score of ≥4) intracerebral haemorrhage type 2 within 24 h and mortality at 3 months. We compared mortality, the proportion of patients with symptomatic intracerebral haemorrhage as per the Cochrane definition, and functional outcome at 3 months with relevant pooled results from randomised controlled trials. Findings Baseline characteristics of patients in SITS-MOST were much the same as those in the pooled randomised controlled trials. At 24 h, the proportion of patients with symptomatic intracerebral haemorrhage (per the SITS-MOST protocol) was 1·7% (107/6444; 95% CI 1·4–2·0); at 7 days, the proportion with the same condition as per the Cochrane definition was 7·3% (468/6438; 6·7–7·9) compared with 8·6% (40/465; 6·3–11·6) in the pooled randomised controlled trials. The mortality rate at 3 months in SITS-MOST was 11·3% (701/6218; 10·5–12·1) compared with 17·3% (83/479; 14·1–21·1) in the pooled randomised controlled trials. Interpretation These data confirm that intravenous alteplase is safe and effective in routine clinical use when used within 3 h of stroke onset, even by centres with little previous experience of thrombolytic therapy for acute stroke. The findings should encourage wider use of thrombolytic therapy for suitable patients treated in stroke centres.
Tom C J Feijtel - One of the best experts on this subject based on the ideXlab platform.
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ais cesio environmental surfactant Monitoring programme part 1 las Monitoring Study in de meern sewage treatment plant and receiving river leidsche rijn
Chemosphere, 1995Co-Authors: Tom C J Feijtel, E Matthijs, Andre Rottiers, G B J Rijs, A T Kiewiet, A De NijsAbstract:Abstract This manuscript reports on the outcome of a 7-day pilot Monitoring Study on the anionic surfactant linear alkyl benzene sulfonate (LAS) at the “de Meem” municipal sewage treatment plant. The receiving surface water, the Leidsche Rijn is a straight river — about 20 m wide and 1.5 m deep — and dilutes the sewage discharge by a factor 3. The Monitoring Study illustrates an effective removal of LAS of 99.9% during dry weather and normal operating conditions. The LAS concentrations in daily composite raw sewage samples varied between 3.1 and 7.2 mg/L, with corresponding effluent concentrations generally under the analytical detection limit of 8.1 ug/L. During this same period, total LAS concentrations in the river varied between
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AIS/CESIO environmental surfactant Monitoring programme. Part 1: LAS Monitoring Study in ``de Meern'' sewage treatment plant and receiving river ``Leidsche Rijn''
Chemosphere, 1995Co-Authors: Tom C J Feijtel, E Matthijs, Andre Rottiers, G B J Rijs, A T Kiewiet, A De NijsAbstract:Abstract This manuscript reports on the outcome of a 7-day pilot Monitoring Study on the anionic surfactant linear alkyl benzene sulfonate (LAS) at the “de Meem” municipal sewage treatment plant. The receiving surface water, the Leidsche Rijn is a straight river — about 20 m wide and 1.5 m deep — and dilutes the sewage discharge by a factor 3. The Monitoring Study illustrates an effective removal of LAS of 99.9% during dry weather and normal operating conditions. The LAS concentrations in daily composite raw sewage samples varied between 3.1 and 7.2 mg/L, with corresponding effluent concentrations generally under the analytical detection limit of 8.1 ug/L. During this same period, total LAS concentrations in the river varied between
Gregory W Randolph - One of the best experts on this subject based on the ideXlab platform.
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international neural Monitoring Study group guideline 2018 part i staging bilateral thyroid surgery with Monitoring loss of signal
Laryngoscope, 2018Co-Authors: Rick Schneider, Gregory W Randolph, Gianlorenzo Dionigi, Marcin Barczynski, Feng Yu Chiang, Zaid Alquaryshi, Peter Angelos, Katrin Brauckhoff, Claudio Roberto CerneaAbstract:This publication offers modern, state-of-the-art International Neural Monitoring Study Group (INMSG) guidelines based on a detailed review of the recent Monitoring literature. The guidelines outline evidence-based definitions of adverse electrophysiologic events, especially loss of signal, and their incorporation in surgical strategy. These recommendations are designed to reduce technique variations, enhance the quality of neural Monitoring, and assist surgeons in the clinical decision-making process involved in surgical management of recurrent laryngeal nerve. The guidelines are published in conjunction with the INMSG Guidelines Part II, Optimal Recurrent Laryngeal Nerve Management for Invasive Thyroid Cancer-Incorporation of Surgical, Laryngeal, and Neural Electrophysiologic Data. Laryngoscope, 128:S1-S17, 2018.
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external branch of the superior laryngeal nerve Monitoring during thyroid and parathyroid surgery international neural Monitoring Study group standards guideline statement
Laryngoscope, 2013Co-Authors: Marcin Barczynski, Gregory W Randolph, Gianlorenzo Dionigi, Claudio Roberto Cernea, Henning Dralle, Piero F Alesina, Radu Mihai, Camille Finck, Davide LombardiAbstract:Intraoperative neural Monitoring (IONM) during thyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual identification of the recurrent laryngeal nerve (RLN). Contrary to routine dissection of the RLN, most surgeons tend to avoid rather than routinely expose and identify the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy or parathyroidectomy. IONM has the potential to be utilized for identification of the EBSLN and functional assessment of its integrity; therefore, IONM might contribute to voice preservation following thyroidectomy or parathyroidectomy. We reviewed the literature and the cumulative experience of the multidisciplinary International Neural Monitoring Study Group (INMSG) with IONM of the EBSLN. A systematic search of the MEDLINE database (from 1950 to the present) with predefined search terms (EBSLN, superior laryngeal nerve, stimulation, neuroMonitoring, identification) was undertaken and supplemented by personal communication between members of the INMSG to identify relevant publications in the field. The hypothesis explored in this review is that the use of a standardized approach to the functional preservation of the EBSLN can be facilitated by application of IONM resulting in improved preservation of voice following thyroidectomy or parathyroidectomy. These guidelines are intended to improve the practice of neural Monitoring of the EBSLN during thyroidectomy or parathyroidectomy and to optimize clinical utility of this technique based on available evidence and consensus of experts. Level of Evidence 5 Laryngoscope, 123:S1–S14, 2013
