Abstract:
:Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset. We also review protocols for management of patient physiologic parameters to minimize infarct volumes and recent updates in secondary prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high risk period immediately after stroke. Finally, we discuss emerging therapies and questions for future research.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Phipps MS,Cronin CAdoi
10.1136/bmj.l6983subject
Has Abstractpub_date
2020-02-13 00:00:00pages
l6983eissn
0959-8138issn
1756-1833journal_volume
368pub_type
杂志文章,评审abstract:PROBLEM:Deep infection after joint arthroplasty can be catastrophic, leading to further surgery, loss of the prosthesis, disability, and risk of mortality. Twenty nine new cases of methicillin resistant Staphylococcus aureus occurred in the first year after elective orthopaedic surgery was centralised to a district gen...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.329.7458.149
更新日期:2004-07-17 00:00:00
abstract::The introduction in Britain of advance directives--which allow a person to state in advance of becoming incompetent that they wish to take part in treatment decisions when no longer mentally competent--has now been advocated by the medical and legal establishments. The practical application of directives relating to h...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6974.236
更新日期:1995-01-28 00:00:00
abstract::In July 1992 Dr Keith Mumby, a clinical ecologist, appeared before the professional conduct committee of the General Medical Council on five charges to do with his practice of clinical ecology. He was found guilty of two of the charges--touting for publicity and failing to give a patient adequate medical attention--an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6870.122
更新日期:1993-01-09 00:00:00
abstract:OBJECTIVE:To describe temporal trends in the time interval between first and second attempts at defibrillation and the association between this time interval and outcomes in patients with persistent ventricular tachycardia or ventricular fibrillation (VT/VF) arrest in hospital. DESIGN:Retrospective cohort study SETTI...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.i1653
更新日期:2016-04-06 00:00:00
abstract:OBJECTIVES:To develop prediction models that better estimate the pretest probability of coronary artery disease in low prevalence populations. DESIGN:Retrospective pooled analysis of individual patient data. SETTING:18 hospitals in Europe and the United States. PARTICIPANTS:Patients with stable chest pain without ev...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.e3485
更新日期:2012-06-12 00:00:00
abstract:OBJECTIVE:To analyse the relation between treated blood pressure and concomitant risk factor and morbidity from acute myocardial infarction. DESIGN:Prospective longitudinal study. Treated blood pressures and other variables were used to predict acute myocardial infarction. SETTING:Primary health care in Skaraborg, Sw...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.308.6930.681
更新日期:1994-03-12 00:00:00
abstract::The studyTaylor RS, Walker S, Ciani O, et al. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23:1-98.This project was funded by the NIHR Health Technology Assessment Programme (project number 15/80/30).To read the...
journal_title:BMJ (Clinical research ed.)
pub_type: 评论,杂志文章
doi:10.1136/bmj.l5456
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE:To review the evidence base from randomised controlled trials of combined cardiac resynchronisation therapy and implantable cardioverter defibrillator therapy in left ventricular impairment and symptomatic heart failure. DESIGN:Bayesian network meta-analysis. DATA SOURCES:Medline, Embase, and Cochrane datab...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.39343.511389.BE
更新日期:2007-11-03 00:00:00
abstract:OBJECTIVE:To compare the efficacy of five probiotic preparations recommended to parents in the treatment of acute diarrhoea in children. Design Randomised controlled clinical trial in collaboration with family paediatricians over 12 months. SETTING:Primary care. PARTICIPANTS:Children aged 3-36 months visiting a famil...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.39272.581736.55
更新日期:2007-08-18 00:00:00
abstract:OBJECTIVE:To estimate the risk of acute hepatotoxicity associated with nimesulide compared with other non-steroidal anti-inflammatory drugs. DESIGN:Retrospective cohort and nested case-control study. SETTING:Umbria region, Italy. PARTICIPANTS:400 000 current, recent, and past users (almost 2 million prescriptions) o...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.327.7405.18
更新日期:2003-07-05 00:00:00
abstract:OBJECTIVE:To evaluate the association between use of hormone replacement therapy and the risk of idiopathic venous thromboembolism. DESIGN:Population based case-control study. SETTING:Population enrolled in the General Practice Research Database, United Kingdom. SUBJECTS:A cohort of 347,253 women aged 50 to 79 witho...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7083.796
更新日期:1997-03-15 00:00:00
abstract:OBJECTIVE:To determine whether peer review medical audit in a primary care setting changes clinical behaviour in relation to the management of hypertension. DESIGN:Review of medical records in general practices to identify hypertensive patients followed up by assessment of the pre-educational and post-educational mana...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7085.942
更新日期:1997-03-29 00:00:00
abstract:OBJECTIVE:To test whether the relation between income inequality and mortality found in US states is because of different levels of formal education. DESIGN:Cross sectional, multiple regression analysis. SETTING:All US states and the District of Columbia (n=51). DATA SOURCES:US census statistics and vital statistics...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.324.7328.23
更新日期:2002-01-05 00:00:00
abstract:OBJECTIVE:To describe risk factors for infantile colic. DESIGN:Questionnaire administered by health visitors. SETTING:Sheffield. SUBJECTS:Mothers of 76,747 infants born between 1 August 1975 and 31 May 1988, interviewed when the infant was 1 month old. MAIN OUTCOME MEASURES:Reporting of infantile colic and its dura...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.314.7090.1325
更新日期:1997-05-03 00:00:00
abstract:OBJECTIVE:To assess the impact of construction of microdams on the incidence of malaria in nearby communities in terms of possibly increasing peak incidence and prolonging transmission. DESIGN:Four quarterly cycles of malaria incidence surveys, each taking 30 days, undertaken in eight at risk communities close to dams...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.319.7211.663
更新日期:1999-09-11 00:00:00
abstract:OBJECTIVE:To examine changes in immunisation performance in Grampian region after the introduction of the 1990 contract for general practitioners. DESIGN:Retrospective descriptive study using data held on the Grampian immunisation record system's computer. SETTING:All 95 general practices in Grampian region (313 gene...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6830.816
更新日期:1992-03-28 00:00:00
abstract:OBJECTIVE:To assess the risk of hyperglycaemia with two standard oral rehydration solutions that contain carbohydrate compared with a carbohydrate free solution during rehydration of diabetic patients with acute diarrhoea. DESIGN:Prospective randomised allocation to one of three oral rehydration solutions (World Healt...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.308.6929.624
更新日期:1994-03-05 00:00:00
abstract:OBJECTIVE:To determine whether genetic factors associated with established rheumatoid arthritis could, in combination with rheumatoid factor, predict the development of radiological erosions in patients with early symmetrical (rheumatoid-like) arthritis. DESIGN:Prospective study. SETTING:Teaching hospital, early arth...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6866.1387
更新日期:1992-12-05 00:00:00
abstract:OBJECTIVE:To compare the mortality of patients in a palliative care unit on working days with that on weekends and public holidays. DESIGN:Retrospective database study. SETTING:Palliative care unit in Germany. POPULATION:All admissions to palliative care unit between 1 January 1997 and 31 December 2008. MAIN OUTCOM...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.g7370
更新日期:2014-12-16 00:00:00
abstract:OBJECTIVE:To determine the outcome of administration of neuroleptics to patients with senile dementia of Lewy body type confirmed at necropsy. DESIGN:Retrospective analysis of clinical notes blind to neuropathological diagnosis. SETTING:Specialist psychogeriatric assessment units referring cases for necropsy to a tea...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6855.673
更新日期:1992-09-19 00:00:00
abstract::Telephone helplines are an effective way of dealing with health related incidents in which large numbers of people need personal counselling or information for reassurance or case finding. Helplines often have to be set up at short notice, which is labour intensive and makes recruitment of appropriate staff difficult....
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.309.6946.44
更新日期:1994-07-02 00:00:00
abstract:OBJECTIVE:To analyse the risk of second primary cancers during long term follow up of patients with Hodgkin's disease. DESIGN:Cohort study. SETTING:The British National Lymphoma Investigation (a collaborative group of over 60 participating centres in Britain treating lymphomas). PATIENTS:2846 patients first treated ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6835.1137
更新日期:1992-05-02 00:00:00
abstract:OBJECTIVE:To evaluate an experimental heroin maintenance programme. DESIGN:Randomised trial. SETTING:Outpatient clinic in Geneva, Switzerland. SUBJECTS:Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments. INTERVENTION:...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.317.7150.13
更新日期:1998-07-04 00:00:00
abstract::Objective To determine whether educational attainment is a causal risk factor in the development of coronary heart disease.Design Mendelian randomisation study, using genetic data as proxies for education to minimise confounding.Setting The main analysis used genetic data from two large consortia (CARDIoGRAMplusC4D an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j3542
更新日期:2017-08-30 00:00:00
abstract:OBJECTIVE:Detailed analysis of primary cutaneous melanoma first diagnosed in Scotland in patients aged 65 and over. DESIGN:Comparison of changing incidence, sex distribution, site, histogenetic type, tumour thickness, and prognosis of all primary cutaneous melanomas in patients aged 65 and over diagnosed in Scotland i...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6829.746
更新日期:1992-03-21 00:00:00
abstract::An association between vasectomy and the development of testicular tumors, and the importance of testicular examinations both before and after a vasectomy is discussed. Patients diagnosed with testicular tumors within the last ten years were examined at Bangour General Hospital in Scotland. From 1977-87, 37 patients...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6721.370
更新日期:1990-02-10 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of two mechanical methods of blood conservation in reducing the need for allogeneic red blood cells or coagulation products during cardiac surgery. DESIGN:Randomised controlled trial. SETTING:Regional cardiac centre in a teaching hospital in Southampton. PARTICIPANTS:263 adults ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.324.7349.1299
更新日期:2002-06-01 00:00:00
abstract::Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening complications that occur in patients with diabetes. In addition to timely identification of the precipitating cause, the first step in acute management of these disorders includes aggressive administration of intravenous fluids wi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.l1114
更新日期:2019-05-29 00:00:00
abstract:OBJECTIVE:To explore genetic and environmental contributions to the influence of parental social class and region of upbringing on adult human fatness. DESIGN:Survey of sample of adults who had been adopted in childhood to relate their body mass index to sociodemographic variables in a series of multiple linear regres...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6740.1615
更新日期:1990-06-23 00:00:00
abstract:OBJECTIVES:To compare the frequency of discrepancies in retracted reports of clinical trials with those in adjacent unretracted reports in the same journal. DESIGN:Blinded case-control study. SETTING:Journals in PubMed. POPULATION:50 manuscripts, classified on PubMed as retracted clinical trials, paired with 50 adja...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.h4708
更新日期:2015-09-20 00:00:00