A systematic review of clinical trials of pharmacological interventions for acute ischaemic stroke (1955-2008) that were completed, but not published in full

<p>Abstract</p> <p>Background</p> <p>We assessed the prevalence, and potential impact of, trials of pharmacological agents for acute stroke that were completed but not published in full. Failure to publish trial data is to be deprecated as it sets aside the altruism of participants' consent to be exposed to the risks of experimental interventions, potentially biases the assessment of the effects of therapies, and may lead to premature discontinuation of research into promising treatments.</p> <p>Methods</p> <p>We searched the Cochrane Stroke Group's Specialised Register of Trials in June 2008 for completed trials of pharmacological interventions for acute ischaemic stroke, and searched MEDLINE and EMBASE (January 2007 - March 2009) for references to recent full publications. We assessed trial completion status from trial reports, online trials registers and correspondence with experts.</p> <p>Results</p> <p>We identified 940 trials. Of these, 125 (19.6%, 95% confidence interval 16.5-22.6) were completed but not published in full by the point prevalence date. They included 16,058 participants (16 trials had over 300 participants each) and tested 89 different interventions. Twenty-two trials with a total of 4,251 participants reported the number of deaths. In these trials, 636/4251 (15.0%) died.</p> <p>Conclusions</p> <p>Our data suggest that, at the point prevalence date, a substantial body of evidence that was of relevance both to clinical practice in acute stroke and future research in the field was not published in full. Over 16,000 patients had given informed consent and were exposed to the risks of therapy. Responsibility for non-publication lies with investigators, but pharmaceutical companies, research ethics committees, journals and governments can all encourage the timely publication of trial data.</p

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Evaluation of Leg-foot Range of Motion: Which Measurement Method is Most Reliable?

Category: Ankle Introduction/Purpose: The measurement of the ankle's range of motion is now considered of great importance for the diagnosis, therapeutic choice, and follow-up of the evolution of the treatment in patients with pathologies, both of the ankle and the whole hindfoot. However, there is no established method of choice for the safety assessment of talocrural mobility. Therefore, to evaluate the methods of measuring leg-foot movement in normal ankles and feet by comparing the results of clinical measurements with those of radiographic measurement and to determine the range of leg-foot movement considered normal. Methods: The leg-foot movement was measured in 44 patients (60 feet) using a traditional goniometer, digital goniometer, inclinometer, smartphone application, and radiographic measurement (considered gold standard). Maximum dorsiflexion was achieved by asking the patient to take a step forward with the contralateral foot and perform as much dorsiflexion as possible in the ankle studied without removing the heel from the ground. For maximum plantar flexion, the patient was asked to take a step back with the contralateral foot and make as much plantar flexion as possible without removing the studied forefoot from the ground. Results: The values obtained in radiographic measurement were higher than those obtained with clinical measurement. When we compared only the results of clinical measurement, the traditional goniometer was inaccurate. According to the radiographic method, the mean leg-foot range of motion was 65.6 degrees. The mean maximum plantar flexion was 34.9 degrees, and the mean maximum dorsiflexion was 30.7 degrees. Conclusion: The most appropriate method for evaluating the leg-foot range of motion is the radiographic one. The traditional goniometer proved to be the most imprecise clinical method. The mean leg-foot range of motion in healthy young adults was 65 degrees

Itinerário percorrido pelas mulheres na descoberta do câncer Camino recorrido por las mujeres en la descubierta del cáncer The journey experienced by women through a cancer diagnosis

Este estudo se propõe a desvelar o itinerário vivenciado pelas mulheres no processo de descoberta do diagnóstico de câncer. Como estratégia teórico-metodológica, foram utilizados o Interacionismo Simbólico e a Grounded Theory. Foram informantes do estudo 20 indivíduos 10 mulheres portadoras de câncer e seus respectivos familiares significantes. Os resultados mostram desde o momento em que elas vivenciam as primeiras percepções sobre a alteração fisiológica em seu corpo, passando pela busca de ajuda profissional, até o recebimento do diagnóstico de câncer. O itinerário apresentado permite conhecer aspectos da realidade experienciada anteriormente ao recebimento do diagnóstico e ressalta a importância de os profissionais valorizarem mais as queixas das pessoas que os procuram, percebendo que se esta procura aconteceu é porque a pessoa está preocupada. Esta atitude pode favorecer a identificação precoce do problema e, por conseguinte, garantir melhor prognóstico e qualidade de vida.<br>Este estudio propone revelar el camino vivido por las mujeres en el proceso de descubierta del diagnóstico de cáncer. Como estrategia teórico-metodológica fueron utilizados el Interaccionismo Simbólico y la Grounded Theory. Fueron investigados durante el estudio 20 individuos 10 mujeres portadoras de cáncer y sus respectivos familiares próximos. Los resultados muestran desde el momento en que ellas notan las primeras diferencias sobre la alteración fisiológica en su cuerpo, pasando por la búsqueda de ayuda profesional hasta el recibimiento del diagnóstico de cáncer. El camino presentado permite conocer aspectos de la realidad vivida anteriormente al recibimiento del diagnóstico y resalta la importancia de que los profesionales valoren más las quejas de las personas que los buscan, percibiendo que si esta búsqueda ocurrió es porque la persona está preocupada. Esta actitud puede facilitar la identificación precoz del problema y, por consiguiente, garantizar un mejor pronóstico y una mejor calidad de vida.<br>This study intends to reveal the journey experienced by women in the process of facing a cancer diagnosis. Symbolic Interactionism and Grounded Theory were used as theoretical-methodological strategies. Twenty individuals took part in the study - 10 female cancer bearers and their respective significant others. The results are described starting from the moment they experience their first perceptions of the physiologic changes in their bodies, through the search for professional help, to the acknowledgement of a cancer diagnosis. The given itinerary presents aspects of the patients' reality prior to the diagnosis, and emphasizes the importance of professionals giving more credence to the complaints of patients who seek them if the patient made an appointment, it is because that person is concerned. This attitude can promote the early identification of the problem, and consequently guarantee a better prognosis and quality of life

Invasive fungal diseases in haematopoietic cell transplant recipients and in patients with acute myeloid leukaemia or myelodysplasia in Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Invasive fungal disease (IFD) shows distinct regional incidence patterns and epidemiological features depending on the geographic region. We conducted a prospective survey in eight centres in Brazil from May 2007 to July 2009. All haematopoietic cell transplant (HCT) recipients and patients with acute myeloid leukaemia (AML) or myelodysplasia (MDS) were followed from admission until 1year (HCT) or end of consolidation therapy (AML/MDS). The 12-month cumulative incidence (CI) of proven or probable IFD was calculated, and curves were compared using the Grey test. Among 237 AML/MDS patients and 700 HCT recipients (378 allogeneic, 322 autologous), the 1-year CI of IFD in AML/MDS, allogeneic HCT and autologous HCT was 18.7%, 11.3% and 1.9% (p<0.001), respectively. Fusariosis (23 episodes), aspergillosis (20 episodes) and candidiasis (11 episodes) were the most frequent IFD. The 1-year CI of aspergillosis and fusariosis in AML/MDS, allogeneic HCT and autologous HCT were 13.4%, 2.3% and 0% (p<0.001), and 5.2%, 3.8% and 0.6% (p0.01), respectively. The 6-week probability of survival was 53%, and was lower in cases of fusariosis (41%). We observed a high burden of IFD and a high incidence and mortality for fusariosis in this first multicentre epidemiological study of IFD in haematological patients in Brazil.198745751Pfizer Inc.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)CNPq [472154/2008-7, 301025/2008-8