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Giometto S, Finocchietti M, Paoletti O, Lombardi N, Celani MG, Sciancalepore F, Lucenteforte E, Kirchmayer U. Adherence to riluzole therapy in patients with amyotrophic lateral sclerosis in three Italian regions-The CAESAR study. Pharmacoepidemiol Drug Saf 2024; 33:e5736. [PMID: 38014926 DOI: 10.1002/pds.5736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease. Riluzole may increase survival and delay the need for mechanical ventilation. The CAESAR project ('Comparative evaluation of the efficacy and safety of drugs used in rare neuromuscular and neurodegenerative diseases', FV AIFA project 2012-2013-2014) involves evaluating prescribing patterns, and analysing effectiveness and comparative safety of drugs, in patients with neurodegenerative diseases. The aim of this study is to evaluate adherence to riluzole in patients with ALS during the first year of use, identifying adherence clusters. METHODS A retrospective cohort study was conducted using administrative data from Latium, Tuscany, and Umbria. We identified subjects with a new diagnosis of ALS between 2014 and 2019, with the first dispensation of riluzole within 180 days of diagnosis. We considered a two-year look-back period for the characterization of patients, and we followed them from the date of first dispensing of riluzole for 1 year. We calculated 12 monthly adherence measures, through a modified version of the Medication Possession Ratio, estimating drug coverage with Defined Daily Dose. Adherence trajectories were identified using a three-step method: (1) calculation of statistical measures; (2) principal component analysis; (3) cluster analysis. Patient characteristics at baseline and during follow-up were described and compared between adherence groups identified. RESULTS We included 264 ALS patients as new users of riluzole in Latium, 344 in Tuscany, and 63 in Umbria. We observed a higher frequency of males (56.2%) and a mean age of 67.4 (standard deviation, SD, 10.4) in the overall population. We identified two clusters in all regions: one more numerous, including adherent patients (60%, 74%, 88%, respectively), and another one including patients who discontinued therapy (40%, 26%, 12%, respectively). In Tuscany patients discontinuing riluzole more frequently died (28.6% vs. 15.4%, p-value <0.01). Additionally, low-adherers had a higher frequency of central nervous system disorders (69.0% vs. 52.5%, p-value 0.01), and a greater use of non-pharmacological treatments (p-values ≤0.01 for invasive ventilation and tracheostomy). We did not observe any differences in Lazio, whereas in Umbria we observed a higher use of drugs for dementia-related psychiatric problems among low-adherers (57.1% vs. 7.8%, respectively, p-value <0.01), although with small numbers. CONCLUSION Most ALS patients who start riluzole adhere to therapy during the first year. Patients who discontinue therapy early show greater fragility and mortality.
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Affiliation(s)
- Sabrina Giometto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Niccolò Lombardi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Francesco Sciancalepore
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Rasoini R, De Fiore R, Ambrosino F, Celani MG, Formoso G, Alderighi C. Children are not invisible: contextualizing the Informed Health Choices critical skills curriculum in Italian schools. Recenti Prog Med 2023; 114:515-516. [PMID: 37529998 DOI: 10.1701/4088.40791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
| | | | - Fabio Ambrosino
- Associazione Alessandro Liberati - Cochrane Affiliate Centre
| | | | - Giulio Formoso
- Associazione Alessandro Liberati - Cochrane Affiliate Centre
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Aprea MG, Schiavetti I, Portaccio E, Ballerini C, Battaglia MA, Bergamaschi R, Brichetto G, Bunul SD, Calabrese M, Capobianco M, Cavalla P, Celani MG, Clerico M, Cocco E, Comi G, Confalonieri P, Conte A, Cordioli C, De Luca G, De Rossi N, Filippi M, Gumes H, Immovilli P, Inglese M, Karabudak R, Landi D, Lanzillo R, L’Episcopo MR, Lorefice L, Mantero V, Marangoni S, Marfia GA, Masciulli C, Milano E, Moiola L, Orlandi R, Patti F, Perini P, Pesci I, Pucci E, Puthenparampil M, Radaelli M, Salvetti M, Sartori A, Scandellari C, Sen S, Siva A, Strumia S, Teatini F, Tedeschi G, Trojano M, Tutuncu M, Vaula G, Sormani MP, Amato MP. Sars-CoV2 infection in pregnant women with multiple sclerosis. Mult Scler 2023; 29:1090-1098. [PMID: 37232279 PMCID: PMC10225808 DOI: 10.1177/13524585231176174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the general population, maternal SARS-CoV-2 infection during pregnancy is associated with worse maternal outcomes; however, only one study so far has evaluated COVID-19 clinical outcomes in pregnant and postpartum women with multiple sclerosis, showing no higher risk for poor COVID-19 outcomes in these patients. OBJECTIVE In this multicenter study, we aimed to evaluate COVID-19 clinical outcomes in pregnant patients with multiple sclerosis. METHODS We recruited 85 pregnant patients with multiple sclerosis who contracted COVID-19 after conception and were prospectively followed-up in Italian and Turkish Centers, in the period 2020-2022. A control group of 1354 women was extracted from the database of the Multiple Sclerosis and COVID-19 (MuSC-19). Univariate and subsequent logistic regression models were fitted to search for risk factors associated with severe COVID-19 course (at least one outcome among hospitalization, intensive care unit [ICU] admission and death). RESULTS In the multivariable analysis, independent predictors of severe COVID-19 were age, body mass index ⩾ 30, treatment with anti-CD20 and recent use of methylprednisolone. Vaccination before infection was a protective factor. Vaccination before infection was a protective factor. Pregnancy was not a risk nor a protective factor for severe COVID-19 course. CONCLUSION Our data show no significant increase of severe COVID-19 outcomes in patients with multiple sclerosis who contracted the infection during pregnancy.
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Affiliation(s)
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Chiara Ballerini
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Mario Alberto Battaglia
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genova, Italy/Department of Life Sciences, University of Siena, Siena, Italy
| | | | | | - S Destan Bunul
- Kocaeli University School of Medicine, Kocaeli, Kocaeli, Turkey
| | - Massimiliano Calabrese
- The Multiple Sclerosis Centre, Department of Neurosciences, Biomedicine and Movement, University Hospital of Verona, Verona, Italy
| | - Marco Capobianco
- Department of Neurology, Santa Croce and Carle Hospital, Cuneo, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience, City of Health and Science, University Hospital of Turin, Turin, Italy
| | - Maria Grazia Celani
- Servizio Malattie Demielinizzanti, SC di Neurofisiopatologia, AO di Perugia, Perugia, UK
| | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Turin, Turin, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | | | - Paolo Confalonieri
- Multiple Sclerosis Centre, IRCCS Foundation “Carlo Besta” Neurological Institute, Milan, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Cinzia Cordioli
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Giovanna De Luca
- MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Nicola De Rossi
- Centro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy/MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Haluk Gumes
- Selcuk University School of Medicine, Konya, Turkey
| | - Paolo Immovilli
- Emergency Department, Neurology Unit, G. da Saliceto Hospital, Piacenza, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, Genova, Italy
| | | | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy/Neurology Unit, Michele e Pietro Ferrero Hospital, Verduno, Italy
| | | | | | - Vittorio Mantero
- UOC Neurologia—Stroke Unit, Presidio “A. Manzoni,” ASST Lecco, Italy/Department of Neurology, Ospedale Santa Chiara, Trento, Italy
| | - Sabrina Marangoni
- Department of Systems Medicine, Multiple Sclerosis Clinical & Research Center, “Tor Vergata” University, Rome, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Eva Milano
- SC Neurologia 1, Ospedale Maria Vittoria, Torino, Italy
| | - Lucia Moiola
- Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Riccardo Orlandi
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Patti
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Paola Perini
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza, Fidenza, Italy
| | | | - Marco Puthenparampil
- Centro Regionale Sclerosi Multipla, Dipartimento di Neuroscienze, Azienda Ospedale Università di Padova, Padova, Italy
| | - Marta Radaelli
- Centro Sclerosi Multipla Ospedale Binaghi, Cagliari, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli (IS), Department of Human Neuroscience, Sapienza University, Rome, Italy/Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Arianna Sartori
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Cinzia Scandellari
- IRCCS Institute of Neurological Sciences, UOSI Multiple Sclerosis Rehabilitation, Bologna, Italy
| | - Sedat Sen
- Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Aksel Siva
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Silvia Strumia
- UOC di Neurologia, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Francesco Teatini
- Multiple Sclerosis Outpatient Clinic, Clinical Neurology and Stroke Unit, Central Country Hospital, Bolzano, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - Melih Tutuncu
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Istanbul, Turkey
| | - Giovanna Vaula
- Department of Neuroscience, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Alderighi C, Rasoini R, Formoso G, Celani MG, Rosenbaum SE. Feasibility of contextualizing the Informed Health Choices learning resources in Italy: A pilot study in a primary school in Florence. F1000Res 2022; 11:1167. [PMID: 36329796 PMCID: PMC9617069 DOI: 10.12688/f1000research.123728.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 01/13/2023] Open
Abstract
Background The Informed Health Choices (IHC) project team developed learning resources for primary school children to teach critical thinking about treatments claims and health choices and evaluated their effect in a randomized controlled trial of 120 schools in Uganda. Children taught with these resources showed a better ability to think critically about treatments claims and health choices than children not taught with these resources. Teams in multiple countries are contextualising the IHC resources for use in other languages and settings; in this pilot we describe contextualization for use in Italian primary school. Methods After translating the IHC resources to Italian and holding an introductory workshop with participating schoolteachers, we piloted the resources with two classes of a primary school in Florence over nine lessons. Our aims were: 1) to assess the feasibility of introducing the IHC curriculum in Italian primary school; 2) to evaluate students' ability to assess health claims and make informed health choices; to explore 3) students' and 4) teachers' experiences with the IHC learning resources; 5) to identify barriers and facilitators to implementation of IHC learning resources in Italian primary school. To assess these objectives, we used qualitative and quantitative methods. Results Both qualitative and quantitative analyses consistently showed that the IHC learning resources had a positive impact on the objectives examined. The resources integrated well into the Italian primary school curriculum. Both students and teachers considered these resources comprehensible, appealing in design and content, and stimulating for the development of a critical attitude. The only barrier teachers and students expressed was using the resources in a remote learning context. Conclusions Findings from our contextualisation of IHC learning resources in Italian primary school indicate that these resources are well-suited for Italian teachers and students in a primary school context and compatible with the Italian primary school curriculum.
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Affiliation(s)
- Camilla Alderighi
- Associazione Alessandro Liberati Cochrane Affiliate Centre, Lauria, Italy
| | - Raffaele Rasoini
- Associazione Alessandro Liberati Cochrane Affiliate Centre, Lauria, Italy
| | - Giulio Formoso
- Associazione Alessandro Liberati Cochrane Affiliate Centre, Lauria, Italy,Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Grazia Celani
- Associazione Alessandro Liberati Cochrane Affiliate Centre, Lauria, Italy,Cochrane Neurological Science Field, Perugia, Italy,Direzione Regionale Salute, Regione Umbria, Perugia, Italy
| | - Sarah E. Rosenbaum
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway,
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Celani MG, Nonino F, Mahan K, Orso M, Ridley B, Baldin E, Bignamini AA, D'Amico R, Cantisani TA, Colombo C, Khan F, Köpke S, Laurson-Doube J, Schvarz C, Young CA, Peryer G, Rosati P, Filippini G. Identifying unanswered questions and setting the agenda for future systematic research in Multiple Sclerosis. A worldwide, multi-stakeholder Priority Setting project. Mult Scler Relat Disord 2022; 60:103688. [PMID: 35245817 DOI: 10.1016/j.msard.2022.103688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/20/2022] [Accepted: 02/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Eliciting the research priorities of people affected by a condition, carers and health care professionals can increase research value and reduce research waste. The Cochrane Multiple Sclerosis and Rare Disease of CNS Group, in collaboration with the Cochrane Neurological Sciences Field, launched a priority setting exercise with the aim of prioritizing pressing questions to ensure that future systematic reviews are as useful as possible to the people who need them, in all countries, regardless of their economic status. METHOD Sixteen high priority questions on different aspects of MS were developed by members of a multi-stakeholder priority setting Steering Group (SG). In an anonymous online survey translated into 12 languages researchers, clinicians, people with MS (PwMS) and carers were asked to identify and rank, 5 out of 16 questions as high priority and to provide an explanation for their choice. An additional free-text priority research topic suggestion was allowed. RESULTS The survey was accessible through MS advocacy associations' social media and Cochrane web pages from October 20, 2020 to February 6, 2021. 1.190 responses (86.73% of all web contacts) were evaluable and included in the analysis. Responses came from 55 countries worldwide, 7 of which provided >75% of respondents and 95% of which were high and upper-middle income countries. 58.8% of respondents live in the EU, 23% in the Americas, 8.9% in the Western Pacific, 2.8% in the Eastern Mediterranean and 0.3% in South Eastern Asia. About 75% of the respondents were PwMS. The five research questions to be answered with the highest priority were: Question (Q)1 "Does MRI help predict disability worsening of PwMS?" (19.9%), Q5 "What are the benefits and harms of treating PwMS with one disease-modifying drug compared to another?" (19.3%), Q3 "Does multidisciplinary care by teams of different social and health professionals improve health outcomes and experiences for PwMS?" (11.9%), Q16 "Does psychological health affect disease progression in PwMS?" (9.2%) and Q10 "What are the benefits and harms of exercise for PwMS?" (7.2%). The multivariable logistic regression analysis indicated a significant influence of geographic area and income level on the ranking of Q1 and a marginal for Q16 as top a priority after accounting for the effect of all other predictors. Approximately 50% of the respondents indicated that they had an important additional suggestion to be considered. CONCLUSION This international collaborative initiative in the field of MS offers a worldwide perspective on the research questions perceived as pivotal by a geographically representative sample of multiple stakeholders in the field of MS. The results of the survey could guide the prioritization of research on pharmacological and non-pharmacological interventions which could be meaningful and useful for PwMS and carers, avoiding the duplication of efforts and research waste. High quality systematic reviews elicited by priority setting exercises may offer the best available evidence and inform decisions by healthcare providers and policy-makers which can be adapted to the different realities around the world.
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Affiliation(s)
- Maria Grazia Celani
- Cochrane Neurological Sciences Fields, Direzione Regionale Salute, Regione Umbria, Via M. Angeloni 61, 06124 Perugia.
| | - Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Kathryn Mahan
- Cochrane Neurological Sciences Fields, Direzione Regionale Salute, Regione Umbria, Via M. Angeloni 61, 06124 Perugia
| | - Massimiliano Orso
- Cochrane Neurological Sciences Fields, Direzione Regionale Salute, Regione Umbria, Via M. Angeloni 61, 06124 Perugia
| | - Ben Ridley
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elisa Baldin
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Roberto D'Amico
- Italian Cochrane Centre, University of Modena and Reggio Emilia, Modena, Italy
| | - Teresa Anna Cantisani
- Cochrane Neurological Sciences Fields, Direzione Regionale Salute, Regione Umbria, Via M. Angeloni 61, 06124 Perugia
| | - Cinzia Colombo
- Laboratory of Research and Consumer Involvement, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Fary Khan
- Department of Rehabilitation Medicine Royal Melbourne Hospital, Royal Park Campus. Melbourne Victoria, Australia
| | - Sascha Köpke
- Institute of Nursing Science. University of Cologne, Cologne, Germany
| | | | | | | | - Guy Peryer
- School of Health Sciences, University of East Anglia, Norwich, UK, NIHR ARC East of England Palliative and Life Care Theme
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Celani MG, Cantisani T, Nonino F, Baldin E, Mahan K, Orso M, Filippini G. Identify unanswered questions in multiple sclerosis. A Cochrane strategy to prioritize future research. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brunori P, Celani MG, Bignamini AA, Carlini M, Papetti R, Ercolani MV, Baiocco L, Armato G, Cantisani TA. People with amyotrophic lateral sclerosis and their caregivers: what matters most? BMJ Support Palliat Care 2021:bmjspcare-2020-002741. [PMID: 33832968 DOI: 10.1136/bmjspcare-2020-002741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aim of this study is to collect the perspectives and values of people affected by amyotrophic lateral sclerosis (ALS) and their carers to offer clinicians, researchers and policymakers aspects which are precious in prioritising future research questions and reshaping care service organisations in a participatory approach. DESIGN AND SETTING Cohort study using ALS Umbria, the electronic database in Italy. PARTICIPANTS Eleven patients and 33 carers who agreed to participate in the study were divided into six focus groups by 'status' (patient or carer) and by four severity levels of 'burden of disease'. METHODS A semiquantitative analysis was undertaken. Each recorded group discussion was transcribed into text file and independently read by two psychologists and two ALS specialists to blindly identify needs, emotions and medical issues, which are the key semantic meanings expressed. Any disagreement in interpretation was resolved through consultation among authors. RESULTS Carers pronounced significantly more words related to patient's disease burden they cared. 40% of subjects expressed the need for 'assistance', regardless of the disease burden. 'Anger' alone represented more than 1/4 of all expressed emotions and was more common in patients than in carers (73% vs 36%, p=0.077). The most frequent medical issue expressed by 1/3 of participants was 'difficulty in communication'. CONCLUSION This study has given voice to the expectations of those affected by the burden of ALS. 'Welfare assistance', 'anger management' and resolution of 'difficulties in communication' represent issues that need to be analysed in a common prioritised research agenda with sensible and shared outcome measures to implement patient-centred medicine.
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Affiliation(s)
- Paola Brunori
- Neurophysiopathology, Perugia Hospital, Perugia, Italy
| | | | | | | | | | | | - Luisa Baiocco
- Neurophysiopathology, Perugia Hospital, Perugia, Italy
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Celani MG, Carrai R, Cantisani TA, Scarpino M, Ercolani MV, Lolli F, Lanzo G, Costa P, Lanteri P, Bignamini AA, Amantini A, Grippo A. Is there inter-observer variation in the interpretation of SSEPs in comatose cardiac arrest survivors? Further considerations following the Italian multicenter ProNeCa study. Resuscitation 2020; 155:207-210. [PMID: 32795599 DOI: 10.1016/j.resuscitation.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bilateral absence of N20 peak in median nerve Somatosensory Evoked Potentials (SSEPs) is considered the most valid predictor of poor outcome in comatose survivors after cardiopulmonary resuscitation. We investigated the consistency in interpreting SSEP recordings in a multicentre study. METHODS 44 SSEP recordings randomly extracted from 600 recordings of 392 patients included in the "Prognostication of Neurological outcome after Cardiac Arrest (ProNeCa) study" were blindly read by three expert neurophysiologists. Agreement between raters, and individual agreement of each rater vs. reference standard (RS), were calculated using Kappa Coefficients. Inter-rater reliability was calculated with Intra-class Correlation Coefficient (ICC). RESULTS When raters had to evaluate the presence of N20 with normal amplitude, the inter-rater agreement was very high (Kappa = 0.84). In the case of N20 absence the agreement was good (Kappa = 0.66), but when N20 amplitude was low, the agreement decreased to moderate (Kappa = 0.579) becoming even weaker when it was "Non Assessable" (Kappa = 0.107). The agreement of each rater with the RS had a range from moderate to very good; rater1 Kappa = 0.589 (95%CI 0.397-0.781; p < 0.001), rater2 Kappa = 0.644 (95%CI 0.460-0.828; p < 0.001), rater3 Kappa = 0.859 (95%CI 0.698-1.000; p < 0.001). The ICC was barely good, 0.682 (95%CI 0.539-0.798; p = 0.0075). CONCLUSION Different health professionals, using different equipment in a multicentre study, had very good inter-rater agreement in interpreting SSEP records. The interpretation of "Non Assessable" SEPPs, mainly in relation to noise level, is still a crucial issue because it increases rater uncertainty. For this reason, it is important to focus on improving recording quality and interpretation of records.
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Affiliation(s)
| | - Riccardo Carrai
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | | | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | | | - Francesco Lolli
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli Studi di Firenze, Italy
| | - Giovanni Lanzo
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | - Paolo Costa
- Neurofisiologia Clinica, Dpt. Di Neuroscience e Salute Mentale, Ospedale CTO, Città della Salute e della Scienza di Torino, Italy
| | - Paola Lanteri
- Neurofisiopatologia, Dpt di Tecnologia Diagnostica ed Applicata, Fondazione IRCCS Istituto Neurologico "C. Besta" Milano, Italy
| | | | | | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
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Scarpino M, Lolli F, Lanzo G, Carrai R, Spalletti M, Valzania F, Lombardi M, Audenino D, Celani MG, Marrelli A, Contardi S, Peris A, Amantini A, Sandroni C, Grippo A, Amantini A, Carrai R, Grippo A, Lanzo G, Lolli F, Masi G, Moretti M, Peris A, Scarpino M, Spalletti M, Bandinelli C, Lombardi M, Contardi S, Marudi A, Audenino D, Rikani K, Ospedale Galliera E, Marrelli A, Cantisani TA, Celani MG, Fiacca A, Sabadini R, Valzania F. Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest: The ProNeCA prospective multicentre prognostication study. Resuscitation 2019; 143:115-123. [DOI: 10.1016/j.resuscitation.2019.07.032] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/16/2019] [Accepted: 07/28/2019] [Indexed: 11/30/2022]
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Di Genova L, Perruccio K, Celani MG, Mastrodicasa E, Cantisani TA, Esposito S, Caniglia M. Chemotherapy-Related Encephalopathy With Super-Refractory Status Epilepticus in a Child With Osteosarcoma: A Case Report With a Review of Literature. Front Pharmacol 2019; 10:963. [PMID: 31551775 PMCID: PMC6734028 DOI: 10.3389/fphar.2019.00963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/29/2019] [Indexed: 01/05/2023] Open
Abstract
Osteosarcoma is the most frequent primary cancer of the bones, and a combination of primary chemotherapy, surgery, and adjuvant chemotherapy is its current treatment. In adults, some authors have reported problems with memory and concentration following chemotherapy, but in children, severe neurologic dysfunction has been rarely reported. This report describes a 13-year-old patient with primary high-grade nonmetastatic osteosarcoma of the tibia who developed encephalopathy with super-refractory status epilepticus related to chemotherapy. He received methotrexate (MTX) and cisplatin (CDDP)-containing polychemotherapy, and after the first course of drug administration, he developed fever, confusion, a state of psychomotor agitation, and super-refractory status epilepticus with normal laboratory and imaging findings. The causal relationship between the administration of the first polychemotherapy course and his neurological manifestations may be supported by the evaluation and exclusion of other causes. The administration of antiepileptic drugs and off-label atypical antipsychotics was necessary to treat his neurological complications and behavioral changes. This patient represents the first known example of super-refractory status epilepticus in a child treated with MTX and CDDP-containing chemotherapy. Physicians should be aware that encephalopathy and seizures are possible consequences of CDDP therapy when administered alone or in combination with other chemotherapeutic agents. Further studies are needed to better define this relationship in children.
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Affiliation(s)
- Lorenza Di Genova
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Katia Perruccio
- Pediatric Oncohematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Maria Grazia Celani
- Neurophysiology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Elena Mastrodicasa
- Pediatric Oncohematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Maurizio Caniglia
- Pediatric Oncohematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
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Formoso G, Celani MG, Minozzi S, Cinquini M, Mosconi P, Pistotti V, Cantisani T, D'Amico R. Heated tobacco and politics in Italy. BMJ 2019; 365:l4189. [PMID: 31208961 DOI: 10.1136/bmj.l4189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Giulio Formoso
- Local Health Authority, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Maria Grazia Celani
- Azienda Ospedaliera di Perugia-Cochrane Neurological Sciences Field, Perugia, Italy
| | - Silvia Minozzi
- Cochrane Review Group on Drugs and Alcohol, Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Michela Cinquini
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Paola Mosconi
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Vanna Pistotti
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Teresa Cantisani
- Azienda Ospedaliera di Perugia-Cochrane Neurological Sciences Field, Perugia, Italy
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Scarpino M, Carrai R, Lolli F, Lanzo G, Spalletti M, Audenino D, Callegarin C, Celani MG, Lombardi M, Marrelli A, Mecarelli O, Minardi C, Minicucci F, Motti L, Politini L, Valzania F, Vitelli E, Peris A, Amantini A, Grippo A. Electroencephalogram and somatosensory evoked potential evaluation for good and poor neurological prognosis after cardiac arrest: a prospective multicenter cohort trial (ProNeCA). Future Neurology 2019. [DOI: 10.2217/fnl-2018-0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Aim: Hypoxic-ischemic-encephalopathy is a severe and frequent neurological complication of successful cardiopulmonary-resuscitation after cardiac arrest. Prognosticating neurological outcomes in patients with hypoxic-ischemic-encephalopathy is challenging and recent guidelines suggest a multimodal approach. Only few studies have analyzed the prognostic power of the association between instrumental tests and, in addition, most of them were monocentric, retrospective and evaluating only poor outcome. Methods/design: We designed a multicenter prospective cohort study to assessing the prognostic power of the association of electroencephalogram and somatosensory evoked potentials for the prediction of both poor and good neurological outcomes at different times after cardiac arrest. Discussion: The results of our study will provide a high level of evidence for the use of neurophysiological evaluation in the current clinical practice.
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Affiliation(s)
| | - Riccardo Carrai
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | - Francesco Lolli
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli studi di Firenze, Italy
| | - Giovanni Lanzo
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | - Maddalena Spalletti
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | | | - Claudio Callegarin
- UO Neurologia e Neurofisiopatologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Maria Grazia Celani
- UO Neurofisiopatologia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | | | - Alfonso Marrelli
- UOC Neurofisiopatologia, Ospedale San Salvatore, L’Aquila, Italy
| | - Oriano Mecarelli
- UOC Neurofisiopatologia, Policlinico Umberto primo, Università La Sapienza, Roma, Italy
| | | | - Fabio Minicucci
- UO Neurofisiopatologia, Ospedale San Raffaele IRCCS, Milano, Italy
| | - Luisa Motti
- UO Neurofisiopatologia Arcispedale. Santa Maria Nuova, Reggio nell’Emilia, Italy
| | | | - Franco Valzania
- Neurofisiopatologia Interventiva, Osp Civile di Baggiovara, Modena, Italy
| | | | - Adriano Peris
- SODc Cure intensive per il trauma ed i supporti extracorporei, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | - Aldo Amantini
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
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Celani MG, Cantisani TA, Bignamini A, Macone S, Papetti R, Baiocco L. Is it worth it, or possible, to measure what matters to patients with epilepsy and their caregivers? Epilepsy Behav 2018; 78:273-279. [PMID: 29128470 DOI: 10.1016/j.yebeh.2017.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/19/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to collect perspectives, ideas, and values of people affected by epilepsy and their carer to include them in new research in this area. DESIGN This is a semiquantitative study analyzing needs, emotions, and medical issues emerging from focus groups with patients and carers divided in three severity levels of disease. PARTICIPANTS The participants were 25 patients and 36 carers attending outpatients' service of tertiary epilepsy center in Umbria, Italy. RESULTS Assistance was the need expressed by more than 40% of the participants followed by experience-sharing, knowledge, control, clarity, and security. The only significant effect in logistic regression analysis after adjusting for severity was the patients' expressed need for "experience-sharing" more than their carers (OR 7.29, 95%CI: 1.76-30.18). Hope was the emotion expressed by more than 50% of the participants, followed by anger, fear, and resignation. After adjusting for severity, carers were more likely to express anger, in comparison with patients (OR 17.23, 95%CI: 3.55-83.74; P<0.001). The patients were 6.88 times more likely (95%CI 1.84-25.75; P=0.004) to express "resignation" than their carers. The most frequent medical issues were related to: "medications", "frequency of crises", "work impact", "quality of life", "psychomedical integration of care", and "development of new drugs". After adjusting for severity in a logistic regression analysis, patients were more likely to express concerns for the frequency of crises than carers (OR 3.57, 95%CI: 1.16-11.04; P=0.027). CONCLUSIONS Patients' and carers' priorities, based on intense personal insight, represent a starting point to work for shared outcome measures in clinical trials and shared agenda in research, including research of strong evidence in complex intervention as service models for people with epilepsy.
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Affiliation(s)
- Maria Grazia Celani
- Department of Neurophysiopathology, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; Cochrane Neurosciences Field, Direzione Salute Welfare, Region of Umbria, Perugia, Italy.
| | - Teresa Anna Cantisani
- Cochrane Neurosciences Field, Direzione Salute Welfare, Region of Umbria, Perugia, Italy; Perugia Hospital, Neurophysiopathology Unit, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy
| | - Angelo Bignamini
- School of Specialisation in Hospital Pharmacy, Dept. of Pharmaceutical Sciences, University of Milan, Italy
| | - Sara Macone
- Cochrane Neurosciences Field, Direzione Salute Welfare, Region of Umbria, Perugia, Italy; University of Kansas Medical Center, Department of Dietetics and Nutrition, USA
| | - Rossella Papetti
- Perugia Hospital, Neurophysiopathology Unit, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy
| | - Luisa Baiocco
- Perugia Hospital, Neurophysiopathology Unit, Azienda Ospedaliera di Perugia, Ospedale S. Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy
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Celani MG, Bassi MC, Bignamini A, Candelaresi P, Carlini M, Cecconi M, Congedo M, Cusi C, Cuzzubbo S, Guerra D, Macone S, Melis M, Motto C, Nardi K, Oppo V, Papetti R, Piersanti C, Piras V, Serafini A, Sgoifo AL, Susani E, Tremolizzo L, Cantisani TA. Do outcome measures used in neurological clinical research realistically represent the needs and the expectations of patients and their care givers? Trials 2015. [PMCID: PMC4460782 DOI: 10.1186/1745-6215-16-s1-p8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Celani MG, Papetti R, Piersanti C, Macone S, Sgoifo A, Bianchi M, Bignamini A, Cantisani T, Mahan K. Assessment of patients' and caregiver’s perceived need to start actively participated outcome measures in neurological research. Trials 2015. [PMCID: PMC4460684 DOI: 10.1186/1745-6215-16-s1-o2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
BACKGROUND Explanations for the effectiveness of stroke units compared with general wards in reducing mortality, institutionalisation and dependence of people with stroke remain undetermined, and the discussion on the most effective stroke unit model is still up for debate. The intensity of non-invasive mechanical monitoring in many western countries is one of the main issues regarding the different models. This is because of its strong impact on the organisation of the stroke unit in terms of the number of personnel, their expertise, the infrastructure and costs. OBJECTIVES To assess whether continuous intensive monitoring compared with intermittent monitoring of physiological variables in people with acute stroke can change their prognosis in terms of mortality or disability. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (November 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 8), MEDLINE (1966 to November 2012), EMBASE (1980 to November 2012), CINAHL (1982 to November 2012) and the British Nursing Index (1985 to November 2012). In an effort to identify further published, unpublished and ongoing trials we searched trials registers (November 2012) and reference lists, handsearched conference proceedings and contacted trial authors. SELECTION CRITERIA We included all randomised, cluster randomised and quasi-randomised controlled trials comparing continuous monitoring with intermittent monitoring in people within three days of stroke onset. We excluded studies confounded by the delivery of care in different settings (that is studies in which the location of the intervention was not in the same ward in the two arms of the trial). DATA COLLECTION AND ANALYSIS Three review authors independently selected studies for inclusion, assessed methodological quality and extracted data. We sought original data from trialists in two trials and verified the inclusion criteria in another four trials (three presented at conferences and one was from the Chinese Clinical Trial Registry). Where possible, we extracted data on the threshold level of abnormality that triggered intervention for a given physiological variable, the specific intervention given to correct the abnormality and compliance with the allocated therapy. MAIN RESULTS Three studies, involving a total of 354 participants, met our inclusion criteria for the primary outcome. Compared with intermittent monitoring, continuous monitoring significantly reduced death and disability at three months or discharge (odds ratio (OR) 0.27, 95% confidence interval (CI) 0.13 to 0.56) and was associated with a non-significant reduction in deaths from any cause at discharge (OR 0.72, 95% CI 0.28 to 1.85). These significant results depend on one study that has a high risk of bias.Continuous monitoring was associated with a non-significant reduction of dependency (OR 0.79, 95% CI 0.30 to 2.06), death from vascular causes (OR 0.48, 95% CI 0.10 to 2.39), neurological complications (OR 0.81, 95% CI 0.46 to 1.43), length of stay (mean difference (MD) -5.24, 95% CI -10.51 to 0.03) and institutionalisation (OR 0.83, 95% CI 0.04 to 15.72) (secondary outcomes). For the last two outcomes we detected consistent heterogeneity across trials.Cardiac complications (OR 8.65, 95% CI 2.52 to 29.66), fever (OR 2.17, 95% CI 1.22 to 3.84) and hypotension (OR 4.32, 95% CI 1.68 to 14.38) were detected significantly more often in participants who received continuous monitoring (surrogate outcomes).We detected no significant increase in adverse events due to immobility (pneumonia, other infections or deep vein thrombosis) in participants who were continuously monitored compared with those allocated to intermittent monitoring. AUTHORS' CONCLUSIONS Continuous monitoring of physiological variables for the first two to three days may improve outcomes and prevent complications. Attention to the changes in physiological variables is a key feature of a stroke unit, and can most likely be aided by continuous monitoring without complications related to immobility or to treatments triggered by the relief of abnormal physiological variables. Well-designed, high-quality studies are needed because many questions remain open and deserve further research. These include when to start continuous monitoring, when to interrupt it, which people should be given priority, and which treatments are most appropriate after the identification of abnormalities in physiological variables.
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Affiliation(s)
- Alfonso Ciccone
- Department ofNeurology and Stroke Unit, “Carlo Poma”Hospital,Mantua, Italy.
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Affiliation(s)
- Teresa Anna Cantisani
- Cochrane Neurological Field, c/o Direzione salute, coesione sociale e società della conoscenza, Regione Umbria, Perugia, Italy.
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Cantisani TA, Celani MG, Hankey GJ, Sandercock PAG. Secondary progressive multiple sclerosis: a shared therapeutic decision. J Neurol Neurosurg Psychiatry 2013; 84:365. [PMID: 23223334 DOI: 10.1136/jnnp-2012-303884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND Piracetam has neuroprotective and antithrombotic effects that may help to reduce death and disability in people with acute stroke. This is an update of a Cochrane Review first published in 1999, and previously updated in 2006 and 2009. OBJECTIVES To assess the effects of piracetam in acute, presumed ischaemic stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched 15 May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1966 to May 2011), EMBASE (1980 to May 2011), and ISI Science Citation Index (1981 to May 2011). We also contacted the manufacturer of piracetam to identify further published and unpublished studies. SELECTION CRITERIA Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within three days of stroke onset. DATA COLLECTION AND ANALYSIS Two review authors extracted data and assessed trial quality and this was checked by the other two review authors. We contacted study authors for missing information. MAIN RESULTS We included three trials involving 1002 patients, with one trial contributing 93% of the data. Participants' ages ranged from 40 to 85 years, and both sexes were equally represented. Piracetam was associated with a statistically non-significant increase in death at one month (approximately 31% increase, 95% confidence interval 81% increase to 5% reduction). This trend was no longer apparent in the large trial after correction for imbalance in stroke severity. Limited data showed no difference between the treatment and control groups for functional outcome, dependence or proportion of patients dead or dependent. Adverse effects were not reported. AUTHORS' CONCLUSIONS There is some suggestion (but no statistically significant result) of an unfavourable effect of piracetam on early death, but this may have been caused by baseline differences in stroke severity in the trials. There is not enough evidence to assess the effect of piracetam on dependence.
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Affiliation(s)
- Stefano Ricci
- UO Neurologia, ASL 1 dell’ Umbria, Città di Castello, Italy.
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Brazzelli M, Sandercock PA, Celani MG, Righetti E, Chappell FM, Arestis N, Wardlaw JM, Deeks JJ. MRI Versus CT for Detection of Acute Vascular Lesions in Patients Presenting With Stroke Symptoms. Stroke 2010. [DOI: 10.1161/strokeaha.109.568667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Miriam Brazzelli
- From the Division of Clinical Neurosciences (M.B., P.A.G.S., F.M.C., J.M.W.), University of Edinburgh, Western General Hospital, Edinburgh, UK; Servizio Aziendale per le Malattie Cerebrovascolari (G.C., E.R.), Ospedale BG Villa, Citta’ della Pieve, Italy; Radiology Department (N.A.), Western General Hospital, Edinburgh, UK; Department of Public Health & Epidemiology (J.J.D.), University of Birmingham, UK
| | - Peter A.G. Sandercock
- From the Division of Clinical Neurosciences (M.B., P.A.G.S., F.M.C., J.M.W.), University of Edinburgh, Western General Hospital, Edinburgh, UK; Servizio Aziendale per le Malattie Cerebrovascolari (G.C., E.R.), Ospedale BG Villa, Citta’ della Pieve, Italy; Radiology Department (N.A.), Western General Hospital, Edinburgh, UK; Department of Public Health & Epidemiology (J.J.D.), University of Birmingham, UK
| | - Maria Grazia Celani
- From the Division of Clinical Neurosciences (M.B., P.A.G.S., F.M.C., J.M.W.), University of Edinburgh, Western General Hospital, Edinburgh, UK; Servizio Aziendale per le Malattie Cerebrovascolari (G.C., E.R.), Ospedale BG Villa, Citta’ della Pieve, Italy; Radiology Department (N.A.), Western General Hospital, Edinburgh, UK; Department of Public Health & Epidemiology (J.J.D.), University of Birmingham, UK
| | - Enrico Righetti
- From the Division of Clinical Neurosciences (M.B., P.A.G.S., F.M.C., J.M.W.), University of Edinburgh, Western General Hospital, Edinburgh, UK; Servizio Aziendale per le Malattie Cerebrovascolari (G.C., E.R.), Ospedale BG Villa, Citta’ della Pieve, Italy; Radiology Department (N.A.), Western General Hospital, Edinburgh, UK; Department of Public Health & Epidemiology (J.J.D.), University of Birmingham, UK
| | - Francesca M. Chappell
- From the Division of Clinical Neurosciences (M.B., P.A.G.S., F.M.C., J.M.W.), University of Edinburgh, Western General Hospital, Edinburgh, UK; Servizio Aziendale per le Malattie Cerebrovascolari (G.C., E.R.), Ospedale BG Villa, Citta’ della Pieve, Italy; Radiology Department (N.A.), Western General Hospital, Edinburgh, UK; Department of Public Health & Epidemiology (J.J.D.), University of Birmingham, UK
| | - Nikolas Arestis
- From the Division of Clinical Neurosciences (M.B., P.A.G.S., F.M.C., J.M.W.), University of Edinburgh, Western General Hospital, Edinburgh, UK; Servizio Aziendale per le Malattie Cerebrovascolari (G.C., E.R.), Ospedale BG Villa, Citta’ della Pieve, Italy; Radiology Department (N.A.), Western General Hospital, Edinburgh, UK; Department of Public Health & Epidemiology (J.J.D.), University of Birmingham, UK
| | - Joanna M. Wardlaw
- From the Division of Clinical Neurosciences (M.B., P.A.G.S., F.M.C., J.M.W.), University of Edinburgh, Western General Hospital, Edinburgh, UK; Servizio Aziendale per le Malattie Cerebrovascolari (G.C., E.R.), Ospedale BG Villa, Citta’ della Pieve, Italy; Radiology Department (N.A.), Western General Hospital, Edinburgh, UK; Department of Public Health & Epidemiology (J.J.D.), University of Birmingham, UK
| | - Jonathan J. Deeks
- From the Division of Clinical Neurosciences (M.B., P.A.G.S., F.M.C., J.M.W.), University of Edinburgh, Western General Hospital, Edinburgh, UK; Servizio Aziendale per le Malattie Cerebrovascolari (G.C., E.R.), Ospedale BG Villa, Citta’ della Pieve, Italy; Radiology Department (N.A.), Western General Hospital, Edinburgh, UK; Department of Public Health & Epidemiology (J.J.D.), University of Birmingham, UK
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Brazzelli M, Sandercock PA, Chappell FM, Celani MG, Righetti E, Arestis N, Wardlaw JM, Deeks JJ. Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. Cochrane Database Syst Rev 2009:CD007424. [PMID: 19821415 DOI: 10.1002/14651858.cd007424.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is increasingly used for the diagnosis of acute ischaemic stroke but its sensitivity for the early detection of intracerebral haemorrhage has been debated. Computed tomography (CT) is extensively used in the clinical management of acute stroke, especially for the rapid exclusion of intracerebral haemorrhage. OBJECTIVES To compare the diagnostic accuracy of diffusion-weighted MRI (DWI) and CT for acute ischaemic stroke, and to estimate the diagnostic accuracy of MRI for acute haemorrhagic stroke. SEARCH STRATEGY We searched MEDLINE and EMBASE (January 1995 to March 2009) and perused bibliographies of relevant studies for additional references. SELECTION CRITERIA We selected studies that either compared DWI and CT in the same patients for detection of ischaemic stroke or examined the utility of MRI for detection of haemorrhagic stroke, had imaging performed within 12 hours of stroke onset, and presented sufficient data to allow construction of contingency tables. DATA COLLECTION AND ANALYSIS Three authors independently extracted data on study characteristics and measures of accuracy. We assessed data on ischaemic stroke using random-effects and fixed-effect meta-analyses. MAIN RESULTS Eight studies with a total of 308 participants met our inclusion criteria. Seven studies contributed to the assessment of ischaemic stroke and two studies to the assessment of haemorrhagic stroke. The spectrum of patients was relatively narrow in all studies, sample sizes were small, there was substantial incorporation bias, and blinding procedures were often incomplete. Amongst the patients subsequently confirmed to have acute ischaemic stroke (161/226), the summary estimates for DWI were: sensitivity 0.99 (95% CI 0.23 to 1.00), specificity 0.92 (95% CI 0.83 to 0.97). The summary estimates for CT were: sensitivity 0.39 (95% CI 0.16 to 0.69), specificity 1.00 (95% CI 0.94 to 1.00). The two studies on haemorrhagic stroke reported high estimates for diffusion-weighted and gradient-echo sequences but had inconsistent reference standards. We did not calculate overall estimates for these two studies. We were not able to assess practicality or cost-effectiveness issues. AUTHORS' CONCLUSIONS DWI appears to be more sensitive than CT for the early detection of ischaemic stroke in highly selected patients. However, the variability in the quality of included studies and the presence of spectrum and incorporation biases render the reliability and generalisability of observed results questionable. Further well-designed studies without methodological biases, in more representative patient samples, with practicality and cost estimates are now needed to determine which patients should undergo MRI and which CT in suspected acute stroke.
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Affiliation(s)
- Miriam Brazzelli
- Division of Clinical Neurosciences, University of Edinburgh, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU
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Celani MG, Sandercock P, Hankey GJ. Commentary on 'Azathioprine for multiple sclerosis'. Journal of Neurology, Neurosurgery & Psychiatry 2009. [DOI: 10.1136/jnnp.2008.158253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brazzelli M, Sandercock PAG, Chappell FM, Celani MG, Righetti E, Arestis N, Lewis SC, Wardlaw JM, Deeks JJ. Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Slot KB, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P. Third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke. Trials 2008; 9:37. [PMID: 18559104 PMCID: PMC2442584 DOI: 10.1186/1745-6215-9-37] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 06/17/2008] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Intravenous recombinant tissue plasminogen activator (rt-PA) is approved for use in selected patients with ischaemic stroke within 3 hours of symptom onset. IST-3 seeks to determine whether a wider range of patients may benefit. DESIGN International, multi-centre, prospective, randomized, open, blinded endpoint (PROBE) trial of intravenous rt-PA in acute ischaemic stroke. Suitable patients must be assessed and able to start treatment within 6 hours of developing symptoms, and brain imaging must have excluded intracerebral haemorrhage. With 1000 patients, the trial can detect a 7% absolute difference in the primary outcome. With 3500 patients, it can detect a 4.0% absolute benefit & with 6000, (mostly treated between 3 & 6 hours), it can detect a 3% benefit. TRIAL PROCEDURES: Patients are entered into the trial by telephoning a fast, secure computerised central randomisation system or via a secure web interface. Repeat brain imaging must be performed at 24-48 hours. The scans are reviewed 'blind' by expert readers. The primary measure of outcome is the proportion of patients alive and independent (Modified Rankin 0-2) at six months (assessed via a postal questionnaire mailed directly to the patient). Secondary outcomes include: events within 7 days (death, recurrent stroke, symptomatic intracranial haemorrhage), outcome at six months (death, functional status, EuroQol). TRIAL REGISTRATION ISRCTN25765518.
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Affiliation(s)
- Peter Sandercock
- The IST-3 Co-ordinating Centre, Neurosciences Trials Unit, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - Richard Lindley
- The University of Sydney, Discipline of Medicine, Westmead Hospital (C24), The University of Sydney NSW 2006, Australia
| | - Joanna Wardlaw
- The IST-3 Co-ordinating Centre, Neurosciences Trials Unit, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - Martin Dennis
- The IST-3 Co-ordinating Centre, Neurosciences Trials Unit, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - Steff Lewis
- The IST-3 Co-ordinating Centre, Neurosciences Trials Unit, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - Graham Venables
- Neurology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
| | - Adam Kobayashi
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego Str 9, 02-957 Warsaw, Poland
| | - Anna Czlonkowska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, ul.Krakowskie Przedmiescie 26/28, 00-927 Warsaw, Poland
| | - Eivind Berge
- Department of Internal Medicine, Ullevaal University Hospital, NO-0407 Oslo, Norway
| | - Karsten Bruins Slot
- Department of Internal Medicine, Ullevaal University Hospital, NO-0407 Oslo, Norway
| | - Veronica Murray
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, SE-182 88 Stockholm, Sweden
| | - Andre Peeters
- Service de neurologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Bruxelles, Belgium
| | - Graeme Hankey
- Royal Perth Hospital, Wellington Street, GPO Box X2213, Perth, Western Australia, 6001, Australia
| | - Karl Matz
- Landesklinikum Donauregion Tulln, Neurologische Abteilung, Alter Ziegelweg 10, 3430 Tulln, Austria
| | - Michael Brainin
- Landesklinikum Donauregion Tulln, Neurologische Abteilung, Alter Ziegelweg 10, 3430 Tulln, Austria
| | - Stefano Ricci
- Ospedale Beato Giacoma Villa, Citta della Pieve, 06062-Perugia, Italy
| | | | - Enrico Righetti
- Ospedale Beato Giacoma Villa, Citta della Pieve, 06062-Perugia, Italy
| | - Teresa Cantisani
- S C di Neurofisiopatologia, Azienda Ospedaliera di Perugia, Italy
| | - Gord Gubitz
- Division of Neurology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
| | - Steve Phillips
- Division of Neurology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax Infirmary, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
| | - Antonio Arauz
- Instituto Nacional de Neurologia, Insurgentes sur 3877, La Fama, 14269 Mexico DF, Mexico
| | - Kameshwar Prasad
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Manuel Correia
- Neurology Department, Hospital Geral de Santo Antonio, Largo Prof Abel Salazar, 4050 Porto, Portugal
| | - Phillippe Lyrer
- Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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Cusi C, Cantisani TA, Celani MG, Incorvaia B, Righetti E, Candelise L. Galantamine for Alzheimer’s Disease and Mild Cognitive Impairment. Neuroepidemiology 2007; 28:116-7. [PMID: 17409773 DOI: 10.1159/000101510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Massucci M, Perdon L, Agosti M, Celani MG, Righetti E, Recupero E, Todeschini E, Franceschini M. Prognostic factors of activity limitation and discharge destination after stroke rehabilitation. Am J Phys Med Rehabil 2006; 85:963-70. [PMID: 17033592 DOI: 10.1097/01.phm.0000242620.44924.1b] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify predictive variables related to activity limitation and home destination of a large sample of first-time stroke patients at discharge from a rehabilitation hospital. DESIGN A multicenter observational study was conducted among 1023 first-time stroke patients who were admitted to 18 different Italian inpatient rehabilitation centers between February 1999 and November 2000. Only 997 patients were considered eligible. At admission, sociodemographic and clinical data were considered as independent variables. The outcome measures evaluated the ability to become functionally independent (independence gain [Barthel Index score > or =18]) at discharge and home return. RESULTS The study data suggest that independence gain is associated with an earlier rehabilitation intervention, being male, and low or absent cognitive deficit. Home return is associated with no indwelling bladder catheterization, no dysphagia, and living with a companion (roommate or family member) before the stroke. CONCLUSIONS In postacute stroke rehabilitation, level of cognitive impairment, bladder dysfunction and dysphagia, early diagnosis and treatment, early rehabilitation intervention, and living status (whether the person was residing with a companion before the stroke) are important criteria for outcome measurement at the time of admission. These previous characteristics will most certainly provide clinicians with useful information during the acute phase.
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Affiliation(s)
- Maurizio Massucci
- Department of Rehabilitation, Hospital of Passignano, Passignano, Italy
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Abstract
The key elements for developing a clinical guideline are (a) guidelines are developed by multidisciplinary groups, (b) they are based on a systematic review of the scientific evidence, and (c) recommendations are explicitly linked to the supporting evidence and graded according to the strength of that evidence. Besides reporting the statistical strength of the randomised controlled trial results, it is necessary to consider the strength of the evidence, the methodological quality of the studies and the external validity by applying a "considered judgement" to the whole amount of the data. The Scottish Intercollegiate Guidelines Network (SIGN) process for developing guidelines is based on 4 steps: (a) methodological evaluation, (b) synthesis of evidence, (c) considered judgement and (d) grading system. The judgement on grading of recommendations is made on the basis of an (objective) assessment of the study design and quality, and a (perhaps more subjective) judgement of the consistency, clinical relevance and external validity of the evidence. The SPREAD group decided to adopt this methodology starting from the 3rd edition (2003); however, it was agreed to integrate the principles of the SIGN [4] with the statistical considerations on alpha and beta error size suggested by the Centre for Evidence-Based Medicine methodology [6], to give a more comprehensive evaluation of the available evidence. By being the product of a multidisciplinary approach, being explicit and providing information on the way agreement has been reached or on the reasons of disagreement, the SPREAD guidelines seem to fulfil the needs for shared guidelines, and to avoid the concerns related to pitfalls in the transparency of the process and in the reaching of a consensus.
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Affiliation(s)
- S Ricci
- UOSD Neurologia e Ictus, USL 2, Perugia, Italy.
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Hankey GJ, Ricci S, Celani MG, Cantisani TA, Righetti E. Piracetam for Acute Ischemic Stroke. Stroke 2006. [DOI: 10.1161/01.str.0000231643.42650.a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Graeme J. Hankey
- From the UOCD Neurologia e Ictus, USL 2 dell’ Umbria, Perugia, Italy; and Neurofisiopatologia (T.A.C.), Azienda Ospedaliera, Perugia, Italy
| | - Stefano Ricci
- From the UOCD Neurologia e Ictus, USL 2 dell’ Umbria, Perugia, Italy; and Neurofisiopatologia (T.A.C.), Azienda Ospedaliera, Perugia, Italy
| | - Maria Grazia Celani
- From the UOCD Neurologia e Ictus, USL 2 dell’ Umbria, Perugia, Italy; and Neurofisiopatologia (T.A.C.), Azienda Ospedaliera, Perugia, Italy
| | - Teresa Anna Cantisani
- From the UOCD Neurologia e Ictus, USL 2 dell’ Umbria, Perugia, Italy; and Neurofisiopatologia (T.A.C.), Azienda Ospedaliera, Perugia, Italy
| | - Enrico Righetti
- From the UOCD Neurologia e Ictus, USL 2 dell’ Umbria, Perugia, Italy; and Neurofisiopatologia (T.A.C.), Azienda Ospedaliera, Perugia, Italy
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Abstract
BACKGROUND Piracetam has neuroprotective and antithrombotic effects which may help to reduce death and disability in people with acute stroke. OBJECTIVES The objective of this review was to assess the effects of piracetam in acute presumed ischaemic stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched 20 June 2005). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to April 2005), EMBASE (1980 to April 2005), and ISI Science Citation Index (1981 to April 2005). We also contacted the manufacturer of piracetam to identify further published and unpublished studies. SELECTION CRITERIA Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within approximately 48 hours of stroke onset. DATA COLLECTION AND ANALYSIS Two authors extracted data and assessed trial quality and this was checked by the other two authors. Study authors were contacted for missing information. MAIN RESULTS Three trials involving 1002 people were included, with one trial contributing 93% of the data. Participants' ages ranged from 40 to 85, and both sexes were equally represented. Piracetam was associated with a statistically non-significant increase in death at one month (approximately 31% increase, 95% confidence interval 81% increase to 5% reduction). This trend was no longer apparent in the large trial after correction for imbalance in stroke severity. Limited data showed no difference between the treatment and control groups for functional outcome, dependency or proportion of patients dead or dependent. Adverse effects were not reported. AUTHORS' CONCLUSIONS There is some suggestion (but no statistically significant result) of an unfavourable effect of piracetam on early death, but this may have been caused by baseline differences in stroke severity in the trials. There is not enough evidence to assess the effect of piracetam on dependency.
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Affiliation(s)
- S Ricci
- USL 2, Servizio di Neurologia e Ictus, Via Cestellini, Perugia, 06087, Italy.
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Cantisani TA, Celani MG, Righetti E. Does rivastigmine improve cognitive functions or disability in patients with Alzheimer's disease? Neuroepidemiology 2004; 23:209-10. [PMID: 15272224 DOI: 10.1159/000078507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ricci S, Celani MG, Righetti E. New Trial(s) on Antiedema Treatment in Stroke? Stroke 2004; 35:e93. [PMID: 15044765 DOI: 10.1161/01.str.0000125306.61072.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Brain oedema is a major cause of early death after stroke. A 10% solution of glycerol is a hyperosmolar agent that is claimed to reduce brain oedema. OBJECTIVES To determine whether intravenous (I.V.) glycerol treatment in acute stroke, either ischaemic or haemorrhagic, influences death rates and functional outcome in the short or long term, and whether the treatment is safe. SEARCH STRATEGY The Cochrane Stroke Group trials register was searched (January 2003), and some trialists were personally contacted. SELECTION CRITERIA All completed, randomised and quasi-randomised, controlled, published and unpublished comparisons, evaluating clinical outcome in which I.V. glycerol treatment was initiated within the first days after stroke onset. DATA COLLECTION AND ANALYSIS Two reviewers independently applied the inclusion criteria, assessed the trial quality and extracted data and this was checked with all co-reviewers. Death from all causes, functional outcome, and adverse effects were analysed. MAIN RESULTS Eleven completed, randomised trials comparing I.V. glycerol and control were considered. Analysis of death during the scheduled treatment period for acute ischaemic and/or haemorrhagic stroke was possible in 10 trials where 482 glycerol treated patients were compared with 463 control patients. Glycerol was associated with a non-significant reduction in the odds of death within the scheduled treatment period (Odds Ratio (OR) 0.78, 95% Confidence Intervals (CI) 0.58 to 1.06). Among patients with definite or probable ischaemic stroke, glycerol was associated with a significant reduction in the odds of death during the scheduled treatment period (OR 0.65, 95% CI 0.44 to 0.97). However, at the end of the scheduled follow up period, there was no significant difference in the odds of death (OR 0.98, 95% CI 0.73 to 1.31). Functional outcome was reported in only two studies but there were non-significantly more patients who had a good outcome at the end of scheduled follow up (OR 0.73, 95% CI 0.37 to 1.42). Haemolysis seems to be the only relevant adverse effect of glycerol treatment. REVIEWERS' CONCLUSIONS This systematic review suggests a favourable effect of glycerol treatment on short term survival in patients with probable or definite ischaemic stroke but the confidence intervals were wide and the magnitude of the treatment effect may be only minimal. Due to the relatively small number of patients, and that the trials were performed in the pre-CT era, the results must be interpreted cautiously. The lack of evidence of benefit in long term survival does not support the routine or selective use of glycerol treatment in patients with acute stroke.
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Affiliation(s)
- Enrico Righetti
- USL 2Servizio di Neurologia e Ictus Via Cestellini PerugiaItaly06087
| | | | - Teresa Anna Cantisani
- Azienda Ospedaliera PerugiaNeurofisiopatologiaS. Andrea Delle FratteSan SistoPerugiaUMBRIAItaly06156
| | - Roberto Sterzi
- Azienda Ospedaliera Sant'AnnaDirettore UO NeurologiaVia Napoleona, 50ComoItaly22100
| | - Gudrun Boysen
- Bispebjerg HospitalDepartment of Neurology, University of CopenhagenBispebjerg Bakke 23DK 2400 Copenhagen NVDenmark
| | - Stefano Ricci
- USL 2Servizio di Neurologia e IctusVia Cestellini PerugiaItaly06087
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Pagliacci MC, Celani MG, Spizzichino L, Zampolini M, Aito S, Citterio A, Finali G, Loria D, Ricci S, Taricco M, Franceschini M. Spinal cord lesion management in Italy: a 2-year survey. Spinal Cord 2003; 41:620-8. [PMID: 14569263 DOI: 10.1038/sj.sc.3101521] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
DESIGN Prospective 2-year survey from 1 February 1997 to 31 January 1999. OBJECTIVES To compare the route from injury to rehabilitation, and the outcome of care in a large sample of traumatic (T) and nontraumatic (NT) spinal cord lesion (SCL) patients at their 'first admission'. SETTING T and NT SCI patients consecutively admitted to 37 SCL centres in Italy. METHOD Data were recorded on simple, computerised, closed-question forms, which were Centrally collected and analysed. Descriptive and inferential analysis was conducted to define the characteristics and compare the T and NT populations, and to identify correlations among the variables examined: time from the event to admission (TEA); pressure sores (PS) on admission; length of stay (LoS) and destination on discharge. RESULTS A total of 1014 SCL patients, 67.5% with a lesion of T and 32.5% of NT aetiology were analysed. The subjects in the T group were younger (median 34 versus 58 years), with higher probability of cervical involvement (OR 2.47, CI 1.8-3.4) and completeness of the lesion (OR 3.0, CI 2.3-4.0), shorter median TEA (37 versus 64 days, P<0.0001) and less frequent admission from home (3.6 versus 17.4%) compared to the NT group. TEA and PS on admission were analysed as indicators of the efficacy of the courses from injury to rehabilitation. Longer TEA was reported for people with NT aetiology, admitted to rehabilitation centre (RC), not locally resident, transferred from certain wards and to a lesser degree female subjects and those with complications on admission. PS were associated to completeness of lesion, longer TEA, admission to RC, nonlocal residence and coming from general intensive care units, or general surgery wards. Median LoS was 99 days (mean 116 and range 0-672), and was statistically shorter in the NT group (122 versus 57 median, P<0.00001). Upon discharge, bladder and bowel autonomy were, respectively, obtained in 68.1 and 64.5% of the whole population without significant difference between the T and NT groups. A total of 80.2% of patients were discharged home and the following factors: not living alone, being discharged after longer LoS, having sphincterial autonomy and no PS, were all independent predictors of outcome. CONCLUSION There are important obstacles in the admission route to rehabilitation facilities, greater for NT, as longer TEA and more complications on admission testify. Moreover, the LoS is shorter for NT population. Our findings suggest that rehabilitation outcome could be improved through an early multidisciplinary approach and better continuity between acute and rehabilitation care, especially for the 'neglected' NT SCL patients.
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Affiliation(s)
- M C Pagliacci
- Unità Spinale Unipolare, Azienda Ospedaliera di Perugia, Perugia, Italy
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Abstract
Brain oedema is a major cause of early death after stroke. Glycerol is a hyperosmolar agent that is claimed to reduce brain oedema. We sought to determine whether I. V. glycerol treatment in acute stroke, either ischaemic or haemorrhagic, influences death rates and functional outcome in the short or long term and whether the treatment is safe. The Cochrane Stroke Group Trials Register was searched, conference proceedings were screened and some trialists were personally contacted. We considered all completed, controlled, published and unpublished comparisons, evaluating clinical outcome, in which intravenous glycerol treatment was initiated within the first days after stroke onset. Death from all causes, functional outcome and adverse effects were analysed. Analysis of short term death for acute ischaemic and/or haemorrhagic stroke was possible in ten trials where 482 glycerol treated patients were compared with 463 control patients. Glycerol was associated with a non-significant reduction in the odds of death within the scheduled treatment period (OR 0.78, 95 % Confidence Intervals 0.58-1.06). Among patients with definite or probable ischaemic stroke, glycerol was associated with a significant reduction in the odds of death during the scheduled treatment period (odds ratio 0.65, 95 % CI 0.44-0.97). However, at the end of the scheduled follow up period there was no significant difference in the odds of death (odds ratio 0.98, 95 % CI 0.73-1.31). Functional outcome was reported in only two studies and there was a non-significant positive effect on outcome at the end of scheduled follow up (odds ratio 0.73, 95 % CI 0.37-1.42). Haemolysis seems to be the only relevant adverse effect of glycerol treatment. This systematic review suggests a favourable effect of glycerol treatment on short term survival in probable or definite ischaemic stroke, but the magnitude of the treatment effect may be minimal (as low as a 3 % reduction in odds). Because of the relatively small number of patients and because the trials have been performed in the pre-CT era, the results must be interpreted cautiously. The lack of evidence of benefit in long term survival does not support the routine or selective use of glycerol treatment in patients with acute stroke.
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Affiliation(s)
- Enrico Righetti
- Servizio Malattie Cerebrovascolari, USL 2, Via Guerra 21, 06127 Perugia, Italy.
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Balestra E, Celani MG, Del Santo R, Di Giulio P, Falcou A, Gualtieri A, Spairani C, Sterzi R, Raganini G, Zito E. [Variability in the delivery of care in stroke units: analysis of the protocols]. Assist Inferm Ric 2002; 21:6-13. [PMID: 11998348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
In spite of the existing guidelines, the strategies and behaviours adopted in the care of the patients admitted to stroke units may vary widely across centres. The aim of this study was to quantify and quality the degree of real variability of the protocols enforced a sample of 13 of such units. There is no uniform behaviour for the monitoring of patients admitted with a stroke: vital signs are collected with different range intervals, i.e. blood pressure 15 for the first 6 hours, from every 15 minutes to 2-3 hours. The assessment of dysphagia can be performed with the swallow test or having the patient drink a spoonful 10 ml of water, or 50 ml without stopping. The variability of behaviours is not, per se, a negative characteristic but it becomes a potential and unacceptable risk when solid evidences of effective practice are available. In the absence of clear cut recommendations the protocols should be defined trying to find a balance between effectiveness of the behaviours recommended and workload for nurses.
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Celani MG, Cantisani TA, Righetti E, Spizzichino L, Ricci S. Different measures for assessing stroke outcome: an analysis from the International Stroke Trial in Italy. Stroke 2002; 33:218-23. [PMID: 11779913 DOI: 10.1161/hs0102.100532] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We sought to assess the relationship between 2 simple questions on recovery (question 1: do you feel that you have made a complete recovery from your stroke?) and dependency (question 2: do you require help from another person for everyday activities?) and the Barthel Index (BI) and Oxford Handicap Scale (OHS), as well as the relationship between BI and OHS, in a large number of Italian stroke survivors who participated in the International Stroke Trial (IST). METHODS We used data from 2423 patients interviewed by telephone at 6 months after the event. The kappa statistic, sensitivity, and specificity were calculated for several comparisons. Internal consistency for BI was calculated. RESULTS The reliability of the dependency question compared with BI=20 (kappa=0.93) and the reliability of the recovery question compared with OHS=0 (kappa=0.89) were good. Sensitivity of the dependency question in predicting whether patients scored BI >18 was 0.98; sensitivity of the recovery question in predicting whether patients scored OHS=0 was 0.99. The reliability of BI=20 compared with OHS <3 was good (kappa=0.87). Internal consistency of BI was very high (Cronbach's alpha=0.96). CONCLUSIONS The 2 simple questions are a good means of evaluating outcome from a patient's view and of dichotomizing the stroke survivor in a time-effective and reliable way.
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Abstract
OBJECTIVE To investigate certain factors influencing the length of stay (LOS) in a rehabilitation center, the incidence of pressure ulcers, and the neurologic improvement of patients with traumatic (T/SCI) and nontraumatic spinal cord injury (NT/SCI). DESIGN A multicenter retrospective study of patients with SCI admitted to rehabilitation centers between 1 January 1989 and 31 December 1994 (only first admissions). SETTING Seven Italian rehabilitation centers. PATIENTS A total of 859 consecutively admitted adult patients with SCI. INTERVENTION Examined medical records of patients admitted to rehabilitation centers. MAIN OUTCOME MEASURES Pressure ulcers on admission as an indicator of nursing care in acute phase, LOS in rehabilitation centers, and neurologic improvement on discharge (using the Frankel classification system). Other measures included level of lesion, associated lesions (if T/SCI), surgical stabilization (if T/SCI), and time from the event to admission to a rehabilitation center. RESULTS In all cases, the time from event to admission to a rehabilitation center exceeded 30 days (average +/- standard deviation: T/SCI, 54.6 +/- 43.7d; NT/SCI, 166.9 +/- 574d); pressure ulcers on admission were present in 34.1% of T/SCI and 17.1% of NT/SCI patients. The average LOS in a rehabilitation center was 143.1 +/- 89.1 days for T/SCI and 91.7 +/- 78.9 days for NT/SCI; Frankel grades improved by 1 or more in 34.4% of T/SCI and 34.1% of NT/SCI patients. The presence of pressure ulcers on admission, rehabilitation LOS, and neurologic improvement on discharge correlated highly with severe neurologic damage on admission in both T/SCI and NT/SCI patients as well as with management of the patient immediately before admission to a rehabilitation center, mainly in NT/SCI patients. CONCLUSIONS Severe neurologic damage is the major determining factor in predicting neurologic recovery. Pressure ulcer prevention is statistically associated with neurologic improvement and the shortening of rehabilitation LOS. Patient management immediately before admission to rehabilitation has a statistical correlation with neurologic improvement in all patients studied and on both rehabilitation LOS and incidence of pressure ulcers in the NT/SCI patients.
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Affiliation(s)
- M G Celani
- Servizio per le Malattie Cerebrovascolari, Perugia, Dipartimento di Geriatria e Riabilitazione, Parma, Italy
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Abstract
BACKGROUND Carotid endarterectomy is conventionally undertaken by a longitudinal arteriotomy. Eversion carotid endarterectomy (CEA), which employs a transverse arteriotomy and reimplantation of the carotid artery, is reported to be associated with low perioperative stroke and restenosis rates but an increased risk of complications associated with a distal intimal flap. OBJECTIVES The objective of this review was to determine whether eversion CEA was safe and more effective than conventional CEA. The null-hypothesis was that there was no difference between the eversion and the conventional CEA techniques (performed either with primary closure or patch angioplasty). SEARCH STRATEGY The reviewers searched MEDLINE and the Cochrane Stroke Group Trials Register (last searched: December 1999), and hand searched eight surgical journals and conference proceedings. Researchers were contacted to identify additional published and unpublished studies. SELECTION CRITERIA All randomised trials comparing eversion to conventional techniques in patients undergoing carotid endarterectomy were examined in this review. Outcomes were stroke and death, carotid restenosis/occlusion and local complications. DATA COLLECTION AND ANALYSIS Data were extracted independently by two reviewers to assess eligibility and describe trial characteristics, and by one reviewer for the meta-analyses. Discrepancies were resolved by discussion. When possible, unpublished data were obtained from investigators. MAIN RESULTS Five trials were included for a total of 2465 patients and 2590 arteries. Three trials included bilateral carotid endarterectomies. In one trial, arteries rather than patients were randomised so that it was not clear how many patients had been randomised in each group, therefore, information on the risk of stroke and death from this study were considered in a separate analysis. There were no significant differences in the rate of perioperative stroke and/or death (1.7% vs 2.6%, odds ratio [OR] 0.44, 95% confidence interval [CI] 0.10-1.82) and stroke during follow-up (1.4% vs 1.7%, OR: 0.84, 95% CI: 0.43-1.64) between eversion and conventional CEA techniques. Eversion CEA was associated with a significantly lower rate of restenosis >50% during follow-up (2.5% vs 5.2%, OR: 0.48, 95% CI: 0.32 -0.72). However, there was no evidence that the eversion technique for CEA was associated with a lower rate of neurological events when compared to conventional CEA. There were no statistically significant differences in local complications between the eversion and conventional group. No data were available to define the cost-benefit of eversion CEA technique. REVIEWER'S CONCLUSIONS Eversion CEA may be associated with low risk of arterial occlusion and restenosis. However, numbers are too small to definitively assess benefits or harms. Reduced restenosis rates did not appear to be associated with clinical benefit in terms of reduced stroke risk, either perioperatively or later. Until further evidence is available, the choice of the CEA technique should depend on the experience and familiarity of the individual surgeon.
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Affiliation(s)
- P G Cao
- Unita' Operativa di Chirurgia Vascolare, Via Brunamonti, Perugia, Italy, 06122.
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Abstract
We studied whether the administration of piracetam in acute, presumed ischemic stroke affects case fatality and functional outcome. The Cochrane Stroke Group strategy was used to evaluate all randomized controlled trials of patients with presumed ischemic stroke examined within 48 h; death and (when available) functional outcome were used as end points. Three studies were included; the most recent one contributed more than 97% of the data. There were 501 patients treated with piracetam and 501 controls. Piracetam was associated with a nonsignificant 31% increase in the odds of death (95% CI -5% to 81%). This result was due almost completely to the effect of the larger trial, which, however, reported that the difference in case fatality rate between piracetam and control disappeared after correcting for the imbalance in stroke severity between the two groups. Data on functional outcome were available only for the largest study, and no difference was reported. Data obtained from the manufacturer suggested a nonsignificant trend (-10%) towards reduction in dependency with piracetam (CI -33% to 20%); the proportions of patients dead or dependent in the two groups were the same. Relevant adverse effects were not reported. The evidence from this review does not support routine administration of piracetam in patients with acute ischemic stroke; however, since a possible beneficial effect cannot completely be ruled out, further controlled trials are warranted.
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Affiliation(s)
- S Ricci
- Servizio Malattie Cerebrovascolari, Perugia, Italy,
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Abstract
BACKGROUND Infarct-related oedema following ischaemic stroke is thought to be a major cause of early death. Intravenous glycerol may reduce the oedema, increase cerebral blood flow and improve cerebral metabolism. OBJECTIVES The objective of this review was to assess the effect of glycerol in acute ischaemic stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group trials register, Medline and Embase. SELECTION CRITERIA Randomised trials of intravenous glycerol compared with control in people with definite or presumed ischaemic stroke. Trials were included if treatment was initiated within the first four days of stroke onset. DATA COLLECTION AND ANALYSIS Two reviewers assessed trial quality and independently extracted the data. MAIN RESULTS Eight trials involving 649 people were included. Based on 454 patients in six trials, glycerol was associated with a decrease in deaths within 14 days of stroke onset (odds ratio of 0.58, 95% confidence interval 0.36 to 0.91). Based on 431 patients in five trials, there was a non-significant decrease in deaths within the first year of stroke onset (odds ratio of 0.82, 95% confidence interval 0.54 to 1.23). The effect of treatment on functional outcome was not clear. Haemolysis appeared to be the only adverse effect. REVIEWER'S CONCLUSIONS There is not enough evidence to evaluate glycerol treatment for people with acute ischaemic stroke.
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Affiliation(s)
- E Righetti
- Stroke Service, USL 2, Via Guerra 17, Perugia, ITALY, 06127.
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Abstract
BACKGROUND Piracetam has neuroprotective and antithrombotic effects which may help to reduce death and disability in people with acute stroke. OBJECTIVES The objective of this review was to assess the effects of piracetam in acute presumed ischaemic stroke. SEARCH STRATEGY We searched the Cochrane Stroke Review Group trials register, Medline (from 1965), Embase (from 1980), BIDIS ISI (from 1981). We also contacted manufacturers and handsearched 15 journals. SELECTION CRITERIA Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within approximately 48 hours of stroke onset. DATA COLLECTION AND ANALYSIS Two reviewers extracted data and assessed trial quality and this was checked by the other two reviewers. Study authors were contacted for missing information. MAIN RESULTS Three trials involving 1002 people were included, with one trial contributing 97% of the data. Participants' ages ranged from 40 to 85, and both sexes were equally represented. Piracetam was associated with a statistically non significant increase in death (31% increase, 95% confidence interval 81% increase to 5% reduction). This trend was no longer apparent in the large trial after correction for imbalance in stroke severity. Limited data showed no difference between the treatment and control groups for functional outcome, dependency or proportion of patients dead or dependent. Adverse effects were not reported. REVIEWER'S CONCLUSIONS There is some suggestion of an unfavourable effect of piracetam on early death, but this may have been caused by baseline differences in stroke severity in the trials. Piracetam does not appear to reduce dependency for stroke patients.
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Affiliation(s)
- S Ricci
- Stroke Service, USL 2, Via Guerra 17, 06127 Perugia, Italy.
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Minotti V, De Angelis V, Righetti E, Celani MG, Rossetti R, Lupatelli M, Tonato M, Pisati R, Monza G, Fumi G, Del Favero A. Double-blind evaluation of short-term analgesic efficacy of orally administered diclofenac, diclofenac plus codeine, and diclofenac plus imipramine in chronic cancer pain. Pain 1998; 74:133-7. [PMID: 9520227 DOI: 10.1016/s0304-3959(97)00157-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A prospective double-blind randomized trial was conducted on 184 cancer patients with moderate to severe chronic pain to evaluate the analgesic efficacy and tolerability of diclofenac alone (50 mg q.i.d.) or in combination with a weak opioid (codeine 40 mg q.i.d.), or with an anti-depressant (imipramine, 10 or 25 mg t.i.d.). All demographic and clinical characteristics including cancer type, presence of bone metastases, baseline pain severity, neuropathic and nociceptive pain, and depressive state, were well balanced between the three treatment groups. The main analysis of the study was on the VAS scores at visit 2 (day 4). The mean VAS values for both associations imipramine plus diclofenac and codeine plus diclofenac were similar to the association placebo plus diclofenac. Patients on imipramine plus diclofenac and on placebo plus diclofenac were withdrawn mainly for inadequate efficacy, while patients on codeine plus diclofenac discontinued equally for inadequate efficacy or adverse events. In conclusion, in a short-term evaluation the addition of a tricyclic anti-depressant or a weak opioid to diclofenac did not provide further analgesia with respect to diclofenac administration alone.
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Affiliation(s)
- V Minotti
- Divisione Oncologia Medica, Policlinico Monteluce, Perugia, Italy
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Ricci S, Cantisani TA, Celani MG, Righetti E. Interpretation of IST and CAST stroke trials. International Stroke Trial. Chinese Acute Stroke Trial. Lancet 1997; 350:441; author reply 443-4. [PMID: 9259674 DOI: 10.1016/s0140-6736(05)64163-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ricci S, Celani MG, Righetti E, Caruso A, De Medio G, Trovarelli G, Romoli S, Stragliotto E, Spizzichino L. Fatty acid dietary intake and the risk of ischaemic stroke: a multicentre case-control study. UFA Study Group. J Neurol 1997; 244:360-4. [PMID: 9249620 DOI: 10.1007/s004150050102] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A low dietary intake of unsaturated fatty acids has been found in male patients with stroke as compared with controls in Italy, and a high consumption of meat has been associated with an increased risk of stroke in Australia. We present a case-control study, comparing the unsaturated and saturated fatty acids content of red cell membranes (which reflects the dietary intake of saturated and unsaturated fats) in 89 patients with ischaemic stroke and 89 controls matched for age and sex. In univariate analysis, besides hypertension, atrial fibrillation, ischaemic changes in ECG and hypercholesterolaemia, stroke patients showed a lower level of oleic acid (P = 0.000), but a higher level of eicosatrienoic acid (P = 0.009). Conditional logistic regression (dependent variable; being a case) showed that the best model included atrial fibrillation, hypertension, oleic acid and eicosatrienoic acids. These results confirm a possible protective role of unsaturated fatty acids against vascular diseases; however, we did not find any difference in the content of omega3 acids, which have been considered in the past to protect against coronary heart disease. We conclude that the preceding diet of patients with ischaemic stroke may be poor in unsaturated fatty acids (namely, oleic acid), and this defect is independent of other vascular risk factors. Only further studies will show whether changes in diet and/or supplement of unsaturated fatty acids might reduce the incidence of ischaemic stroke.
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Affiliation(s)
- S Ricci
- Centro di Coordinamento IST-Italia, Ospedale Silvestrini, Perugia, Italy.
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Ricci S, Celani MG, Righetti E. [Diagnostic approach to the patient with stroke]. Ann Ital Med Int 1996; 11 Suppl 2:99S-101S. [PMID: 9004831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In the case of a patient with sudden-onset focal neurological deficit, clinicians must answer three fundamental questions: is it a stroke? is it ischemia or hemorrhage? and what kind of ischemic stroke is it? Clinical information (i.e., history and examination) is available in any situation, and its role in answering these questions is extremely important, even though certainty can only be achieved from instrumental diagnostic tools. In fact, when diagnosis is based on properly designed clinical criteria, the percentage of mistakes is quite low. Clinical methods are still the best way to orient topographic and etiologic diagnosis, as well as estimate prognosis. In addition, time might be saved if randomization in clinical trials were performed using clinical methods before initiating complex investigations.
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Affiliation(s)
- S Ricci
- Centro di Coordinamento IST-Italia di Perugia
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Celani MG, Righetti E, Migliacci R, Zampolini M, Antoniutti L, Grandi FC, Ricci S. Stroke scoring systems. Lancet 1994; 344:1781-2. [PMID: 7997037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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