Academic Library and Publisher Collaboration: Utilizing an Institutional Repository to Maximize the Visibility and Impact of Articles by University Authors

The George A. Smathers Libraries (Libraries) (http://www.uflib.ufl.edu/) at the University of Florida (UF) (http://www.ufl.edu/) and Elsevier (http://www.elsevier.com) have embarked on a pilot project to maximize visibility, impact, and dissemination of articles by UF researchers who have published in Elsevier journals. Article links and metadata are automatically delivered to UF’s Institutional Repository, the IR@UF (http://ufdc.ufl.edu/ir), in the IR@UF-Elsevier Collection (http://ufdc.ufl.edu/ielsevier). The metadata, with links for approximately 31,000 articles by UF authors, is made possible through integration of the IR@UF with the ScienceDirect application programming interfaces (APIs) (https://www.elsevier.com/solutions/sciencedirect/support/institutional-repository) that are freely available to libraries. Access to the full text on ScienceDirect is available for all institutional repository users affiliated with a subscribing institution. In the next phase users without subscriptions will be able to access the manuscripts of articles published from 2013 forward. This will be done by embedding metadata and links to accepted manuscripts available on ScienceDirect into the IR@UF. We will conduct user and usability testing of this cross-platform user experience. This article provides an overview of the project’s current status, how it works, what it delivers, and next steps expanding the project to include articles by UF authors from other publishers. It concludes with strategic considerations, future developments, and reflections on the value of library/publisher collaboration

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma

Introduction: A common neurosurgical condition, chronic subdural haematoma (cSDH) typically affects older people with other underlying health conditions. The care of this potentially vulnerable cohort is often, however, fragmented and suboptimal. In other complex conditions, multidisciplinary guidelines have transformed patient experience and outcomes, but no such framework exists for cSDH. This paper outlines a protocol to develop the first comprehensive multidisciplinary guideline from diagnosis to long-term recovery with cSDH. Methods: The project will be guided by a steering group of key stakeholders and professional organisations and will feature patient and public involvement. Multidisciplinary thematic working groups will examine key aspects of care to formulate appropriate, patient-centered research questions, targeted with evidence review using the GRADE framework. The working groups will then formulate draft clinical recommendations to be used in a modified Delphi process to build consensus on guideline contents. Conclusions: We present a protocol for the development of a multidisciplinary guideline to inform the care of patients with a cSDH, developed by cross-disciplinary working groups and arrived at through a consensus-building process, including a modified online Delphi.</p

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Dexamethasone Use in Perioperative Neuroscience : Boon or Bane, or Both?

Dexamethasone is a synthetic corticosteroid that acts almost exclusively on glucocorticoid receptors. Its purported benefits are wide-ranging, and its use in neurosurgery and neuroanesthesia is ubiquitous. The ability of dexamethasone to reduce peritumoral cerebral edema was heralded as “one of the greatest translational research discoveries in neurosurgery.”1 In neuroanesthesia, the many benefits of dexamethasone have made it one of the anesthetist’s “go to” drugs for most neurosurgical cases, not just intracranial procedures. Currently, this enthusiasm does not seem to be dampened by the drug’s many adverse effects or the lack of evidence for optimal dosing. Therefore, before we reach for the syringe, the potential benefits of dexamethasone must be weighed against dexamethasone-associated morbidity

General Anesthesia Versus Conscious Sedation for Mechanical Thrombectomy in Acute Anterior Circulation Ischemic Stroke

Background Retrospective studies suggested that general anesthesia (GA) for mechanical thrombectomy has worse outcomes compared with conscious sedation (CS). However, randomized single‐center trials suggested noninferiority of GA to CS. We investigated the impact of anesthesia techniques on thrombectomy, and hypothesized that the routine use of GA with a defined protocol would not adversely affect thrombectomy delivery or outcomes. Methods A total of 451 consecutive patients receiving mechanical thrombectomy for anterior circulation ischemic stroke from 2016 to 2019 were identified from the local registry. Patients were divided into cohort A when both GA and CS were used, and cohort B (from October 2017) when GA became the default method. Favorable functional outcome was defined as modified Rankin scale of 0 to 2 at 3 months. Intraprocedural blood pressures were audited annually. Results In cohort A, compared with patients receiving CS, patients with GA had prolonged median arrival to arterial puncture time (26 versus 18 minutes; P<0.001) and comparable favorable functional outcome at 3 months (37.7% versus 45.1%; P=0.355). In cohort B, the median arrival to arterial puncture was reduced to 10 minutes, with comparable favorable functional outcome of 46.7%, and reduced mortality compared with cohort A (14.2% versus 22.7%; P=0.024). Yearly audits demonstrated good adherence to the protocol. Binary logistic regression analysis showed only old age (odds ratio [OR], 1.04; 95% CI, 1.02–1.07 [P=0.003]), high National Institute of Health Stroke Scale at presentation (OR, 1.17; 95% CI, 1.08–1.26 [P<0.001]), and poor collateral status (OR, 0.29; 95% CI, 0.12–0.72 [P=0.008]) were independent factors predicting for poor prognosis, not GA (OR, 0.71; 95% CI, 0.32–1.60 [P=0.408]). Conclusions Patients treated under GA for mechanical thrombectomy achieved comparable functional outcome at 3 months compared with those under CS. Through practice and a defined protocol, GA for mechanical thrombectomy can achieve sustainable good functional outcomes. Large clinical trials are needed to confirm these findings