Randomized clinical trial comparing percutaneous closure of patent foramen ovale (PFO) using the Amplatzer PFO Occluder with medical treatment in patients with cryptogenic embolism (PC-Trial): rationale and design

<p>Abstract</p> <p>Background</p> <p>Several studies have shown an association of cryptogenic stroke and embolism with patent foramen ovale (PFO), but the question how to prevent further events in such patients is unresolved. Options include antithrombotic treatment with warfarin or antiplatelet agents or surgical or endovascular closure of the PFO. The PC-Trial was set up to compare endovascular closure and best medical treatment for prevention of recurrent events.</p> <p>Methods</p> <p>The PC-Trial is a randomized clinical trial comparing the efficacy of percutaneous closure of the PFO using the Amplatzer PFO occluder with best medical treatment in patients with cryptogenic embolism, i.e. mostly cryptogenic stroke. Warfarin for 6 months followed by antiplatelet agents is recommended as medical treatment. Randomization is stratified according to patients age (<45 versus ≥45 years), presence of atrial septal aneurysm (ASA yes or no) and number of embolic events before randomization (one versus more than one event). Primary endpoints are death, nonfatal stroke and peripheral embolism.</p> <p>Discussion</p> <p>patients were randomized in 29 centers of Europe, Canada, and Australia. Randomization started February 2000. Enrollment of 414 patients was completed in February 2009. All patients will be followed-up longitudinally. Follow-up is maintained until the last enrolled patient is beyond 2.5 years of follow-up (expected in 2011).</p> <p>Trial Registration</p> <p>Trial listed in ClinicalTrials.gov as <a href="http://www.clinicaltrials.gov/ct2/show/NCT00166257">NCT00166257</a> and sponsored by AGA Medical, Plymouth, MN, USA</p

Progress along developmental tracks for electronic health records implementation in the United States

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States

Health Care for Youth Involved with the Correctional System

Adolescents with involvement in the correctional system have significant health risks and needs. Professional guidelines and policies related to health services in correctional settings can help health care providers who work in youth detention facilities and those who see youth for follow-up care after incarceration. Several challenges exist to providing care in detention facilities, but overcoming these barriers to optimally serve youth is critical. When youth are released to their homes, community providers must understand the extent of care offered in detention facilities, the unique considerations for youth on probation, and the aspects of follow-up care that should be addressed

Succession Planning in Academic Libraries: A Reconsideration

It has been widely projected in the library literature that a substantial number of librarians will retire in the near future leaving significant gaps in the workforce, especially in library leadership. Many of those concerned with organizational development in libraries have promoted succession planning as an essential tool for addressing this much-anticipated wave of retirements. The purpose of this chapter is to argue that succession planning is the wrong approach for academic libraries. This chapter provides a review of the library literature on succession planning, as well as studies analyzing position announcements in librarianship which provide evidence as to the extent to which academic librarianship has changed in recent years. In a review of the library literature, the author found no sound explanation of why succession planning is an appropriate method for filling anticipated vacancies and no substantive evidence that succession planning programs in libraries are successful. Rather than filling anticipated vacancies with librarians prepared to fill specific positions by means of a succession planning program, the author recommends that academic library leaders should focus on the continual evaluation of current library needs and future library goals, and treat each vacancy as an opportunity to create a new position that will best satisfy the strategic goals of the library. In contrast to the nearly universal support for succession planning found in the library literature, this chapter offers a different point of view

Homelessness during winter 1988-89 [microform] : prospects for change : hearing before the Ad Hoc Task Force on the Homeless and Housing of the Committee on the Budget, House of Representatives, One Hundredth Congress, second session, December 20, 1988.

CIS Microfiche Accession Numbers: CIS 89 H261-4Microfiche.Mode of access: Internet