Patch: platelet transfusion in cerebral haemorrhage: study protocol for a multicentre, randomised, controlled trial

<p>Abstract</p> <p>Background</p> <p>Patients suffering from intracerebral haemorrhage have a poor prognosis, especially if they are using antiplatelet therapy. Currently, no effective acute treatment option for intracerebral haemorrhage exists. Limiting the early growth of intracerebral haemorrhage volume which continues the first hours after admission seems a promising strategy. Because intracerebral haemorrhage patients who are on antiplatelet therapy have been shown to be particularly at risk of early haematoma growth, platelet transfusion may have a beneficial effect.</p> <p>Methods/Design</p> <p>The primary objective is to investigate whether platelet transfusion improves outcome in intracerebral haemorrhage patients who are on antiplatelet treatment. The PATCH study is a prospective, randomised, multi-centre study with open treatment and blind endpoint evaluation. Patients will be randomised to receive platelet transfusion within six hours or standard care. The primary endpoint is functional health after three months. The main secondary endpoints are safety of platelet transfusion and the occurrence of haematoma growth. To detect an absolute poor outcome reduction of 20%, a total of 190 patients will be included.</p> <p>Discussion</p> <p>To our knowledge this is the first randomised controlled trial of platelet transfusion for an acute haemorrhagic disease.</p> <p>Trial registration</p> <p>The Netherlands National Trial Register (NTR1303)</p

Drug adherence and multidisciplinary care in patients with multiple sclerosis: Protocol of a prospective, web-based, patient-centred, nation-wide, Dutch cohort study in glatiramer acetate treated patients (CAIR study)

Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system, for which no definitive treatment is available. Most patients start with a relapsing-remitting course (RRMS). Disease-modifying drugs (DMDs) reduce relapses and disability progression. First line DMDs include glatiramer acetate (GA), interferon-beta (INFb)-1a and INFb-1b, which are all administered via injections. Effectiveness of DMD treatment depends on adequate adherence, meaning year-long continuation of injections with a minimum of missed doses. In real-life practice DMD-treated patients miss 30% of doses. The 6-month discontinuation rate is up to 27% and most patients who discontinue do so in the first 12 months.Treatment adherence is influenced by the socio-economic situation, health care and caregivers, disease, treatment and patient characteristics. Only a few studies have dealt with adherence-related factors in DMD-treated patients. Self-efficacy expectations were found to be related to GA adherence. Patient education and optimal support improve adherence in general. Knowledge of the aspects of care that significantly relate to adherence could lead to adherence-improving measures. Moreover, identification of patients at risk of inadequate adherence could lead to more efficient care.In the near future new drugs will become available for RRMS. Detailed knowledge on factors prognostic of adherence and on care aspects that are associated with adequate adherence will improve the chances of these drugs becoming effective treatments. We investigate in RRMS patients the relationship between drug adherence and multidisciplinary care, as well as factors associated with adherence. Given the differences in the frequency of administration and in the side effects between the DMDs we decided to study patients treated with the same DMD, GA.Methods/design: The Correlative analyses of Adherence In Relapsing remitting MS (CAIR) study is an investigator-initiated, prospective, web-based, patient-centred, nation-wide cohort study in the Netherlands.The primary objective is to investigate whether GA adherence is associated with specific disciplines of care or quantities of specific care. The secondary objective is to investigate whether GA adherence is associated with specific aspects of the socio-economic situation, health care and caregivers, disease, treatment or patient characteristics.All data are acquired on-line via a study website. All RRMS patients in the Netherlands starting GA treatment are eligible. Patients are informed by neurologists, nurses, and websites from national MS patient organisations. All data, except on disability, are obtained by patient self-reports on pre-defined and random time points. The number of missed doses and the number of patients having discontinued GA treatment at 6 and 12 months are measures of adherence. Per care discipline the number of sessions and the total duration of care are measures of received care. The full spectrum of non-experimental care that is available in the Netherlands is assessed. Care includes 'physical' contacts, contacts by telephone or internet, health-promoting activities and community care activities. Care received over the preceding 14 days is assessed by patients at baseline and every other week thereafter up to month 12. Every 3 months neurologists and nurses record care disciplines to which patients have been referred.The Dutch Adherence Questionnaire-90 (DAQ-90) is a 90-item questionnaire based on the World Health Organisation (WHO) 2003 report on adherence and comprehensively assesses five domains of evidence-based determinants of adherence: socio-economic, health care and caregivers, disease, treatment, and patient-related factors. In addition, self-efficacy is assessed by the MS Self-Efficacy Scale (MSSES), and mood and health-related quality of life (HRQoL) by the Multiple Sclerosis Quality of Life-54 questionnaire (MSQoL-54). Relapses and adverse events probably or definitively related to GA are also reported.Discussion: In this study data is mainly acquired by patients' self-reporting via the internet. On-line data acquisition by patients does not require study visits to the hospital and can easily be integrated into daily life. The web-based nature of the study is believed to prevent missing data and study drop-outs. Moreover, the automated process of filling in questionnaires ensures completeness and consistency, thus improving data quality. The combination of patient-reported outcomes, fully web-based data capture and nation-wide information to all eligible patients are distinguishing features of the study and contribute to its scientific potential.Trial registration: Netherlands Trial Register (NTR): NTR2432

Опыт использования акустического доплеровского измерителя течений (АDCP) в условиях Черного моря

В статье излагается методика проведения измерений Lowered ADCP и обработки первичной информации. При последующей обработке данных широко использовался опыт МГИ НАНУ с аналогичными акустическими измерителями течений в 80-е гг. В результате обобщен опыт применения Lowered ADCP в условиях Черного моря, даны алгоритмы обработки данных, приведены профили абсолютной скорости течений на ряде станций и показано, что предлагаемый подход дает более адекватную качественную и количественную оценку профиля скорости течения, чем известные методы.The methods of measurements with Lowered ADCP and processing of the initial information are presented. During the following data processing the experience of Marine Hydrophysical Institute of NAS of Ukraine with the similar acoustic currents meters in the 80-ies was widely applied. As a result the experience of Lowered ADCP application under the Black Sea conditions is generalized, the algorithms of data processing are given, the profiles of absolute speed of currents are given on the series of stations. It is shown that the proposed approach provides more adequate qualitative and quantitative estimation of the current velocity profile than the known methods do

Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke

Centralization of intravenous thrombolysis (IVT) for acute ischemic stroke in high-volume centers is believed to improve the door-to-needle times (DNT), but limited data support this assumption. We examined the association between DNT and IVT volume in a large Dutch province. We identified consecutive patients treated with IVT between January 2009 and 2013. Based on annualized IVT volume, hospitals were categorized as low-volume (≤ 24), medium-volume (25-49) or high-volume (≥ 50). In logistic regression analysis, low-volume hospitals were used as reference category. Of 17,332 stroke patients from 11 participating hospitals, 1962 received IVT (11.3 %). We excluded 140 patients because of unknown DNT (n = 86) or in-hospital stroke (n = 54). There were two low-volume (total 101 patients), five medium-volume (747 patients) and four high-volume hospitals (974 patients). Median DNT was shorter in high-volume hospitals (30 min) than in medium-volume (42 min, p < 0.001) and low-volume hospitals (38 min, p < 0.001). Patients admitted to high-volume hospitals had a higher chance of DNT < 30 min (adjusted OR 3.13, 95 % CI 1.70-5.75), lower risk of symptomatic intracerebral hemorrhage (adjusted OR 0.39, 95 % CI 0.16-0.92), and a lower mortality risk (adjusted OR 0.45, 95 % CI 0.21-1.01), compared to low-volume centers. There was no difference in DNT between low- and medium-volume hospitals. Onset-to-needle times (ONT) did not differ between the groups. Hospitals in this Dutch province generally achieved short DNTs. Despite this overall good performance, higher IVT volumes were associated with shorter DNTs and lower complication risks. The ONT was not associated with IVT volum

Gereedschapsstalen: stempels en matrijzen 2: VM 48

Voor u ligt de voorlichtingspublicatie "Gereedschapsstalen". Deze voorlichtingspublicatie is bedoeld voor allen die te maken hebben of te maken krijgen met toepassing van gereedschapsstalen. Daarbij moet worden gedacht aan bijvoorbeeld constructeurs, lastechnici, werkvoorbereiders, enzovoorts. Deze publicatie is in 1975 samengesteld door een commissie van de FSMG, de Vereniging van Fabrikanten van Stempels, Matrijzen en andere speciale Gereedschappen. In 2008 is de publicatie herzien door TNO Industrie en Techniek. De publicatie VM 48 is er één uit de reeks publicaties over Stempels en Matrijzen voor spaanloze vormgeving van metalen producten. De updating was noodzakelijk daar zich in de afgelopen jaren een groot aantal belangrijke ontwikkelingen heeft voorgedaan op het gebied van gereedschapsstalen

Kwaliteitsborgingsaspecten bij de vervaardiging van gelaste constructies: VM 85

De eerste uitgave van deze publicatie is in 1991 samengesteld onder auspiciën van de werkgroep "Kwaliteitsborgingsaspecten bij de vervaardiging van gelaste constructie" ressorterend onder de stuurgroep van het NIL Collectieve Onderzoeksproject "Lassen in de Ketel- en Apparatenbouw". In 2009 is deze publicatie aangepast aan de huidige stand der techniek. De inhoud van deze publicatie gaat in op de verschillende normen ten aanzien van kwaliteitsborging en de warmtehuishouding bij het lassen. Tevens wordt getracht informatie te verschaffen met betrekking tot het hoe en waarom van de "variabelen" die staan vermeld op de lasmethodebeschrijving. Dit laatst genoemde document zal in belangrijkheid gaan toenemen als instrument bij een verantwoord kwaliteitsbeleid. Bij gelaste constructies wordt uitgegaan van een minimum wanddikte van 3 mm

Buigen - vormgeven van dunne metaalplaat: VM 113

De eerste uitgave van deze publicatie is in 1996 samengesteld door de werkgroep "Buigen van dunne plaat" en geeft gerichte theoretische en praktische informatie ten behoeve van respectievelijk de gebruikers van het buigproces, geïnteresseerden in dit proces, technische cursussen en opleidingen. In 2009 is deze publicatie aangepast aan de huidige stand der techniek. De inhoud van deze publicatie behandelt de aspecten welke voor het vormgeven van plaat door middel van buigen van belang zijn. De achterin toegevoegde supplementen over materialen en over machines en gereedschappen geven processpecifieke informatie over de desbetreffende onderwerpen. In de voorlichtingspublikaties VM 111 "Materialen" en VM 112 "Machines en gereedschappen" worden de algemene gegevens over deze onderwerpen behandeld