Clinical and economic outcomes in thrombolytic treatment of peripheral arterial occlusive disease and deep venous thrombosis

PurposeOver the past 2 decades the use of thrombolytic therapy in the management of peripheral occlusive diseases, most notably peripheral arterial occlusion (PAO) and deep venous thrombosis (DVT), has become an accepted and potentially preferable alternative to surgery. We examined the period when urokinase was in short supply and subsequently unavailable, to explore potential differences in clinical outcome and economic effect between urokinase and recombinant tissue plasminogen activator (rt-PA).Material and methodsData were obtained from the Premier Perspective Database, a broad clinical database that contains information on inpatient medical practices and resource use. The study population included all patients hospitalized in 1999 and 2000 with a primary or secondary diagnosis of PAO or DVT. Incidence was calculated for common adverse events, including bleeding complications, intracranial hemorrhage, amputation, and death. Cost data were also abstracted from the database, and are expressed as mean ± SD.ResultsDemographic variables were similar in the urokinase and rt-PA groups. The rate of bleeding complications was similar in the urokinase and rt-PA groups. There were no intracranial hemorrhages in the urokinase group, compared with a rate of 1.5% in the rt-PA PAO group (P = .087) and 1.9% in the rt-PA DVT group (P = .175). The in-hospital mortality rate was lower in the urokinase-treated PAO subgroup (3.6% vs 8.5%; P = .026), but a similar finding in the DVT subgroup did not achieve statistical significance (4% vs 9.8%; P = .069). While pharmacy costs were greater in the urokinase-treated group ($5472 ±$5579 vs $3644 ±$6009, P < .001; PAO subgroup, $11,070 ±$15,409 vs $6150 ±$12,398, P = .003), overall hospital costs did not differ significantly between the 2 groups. This finding appears to be explained by a shorter hospital stay and reduced room and board costs in the urokinase-treated group.ConclusionThere were significant differences in outcome in patients with PAO and DVT who received treatment with urokinase and rt-PA. While pharmacy costs were significantly greater when urokinase was used, reduction in length of stay accounted for similar total hospital costs compared with rt-PA. These findings must be considered in the context of the retrospective nature of the analysis and the potential to use dosing regimens that differ from those in this study

L'homme derrière l'auteur de théâtre, le Tchekhov de Brook

De nos jours, lorsque l'on songe à Anton Tchekhov, nombreux sont ceux qui le considèrent comme un nouveau type d'homme dont notre siècle aurait tellement besoin. Peter Brook adhère certainement à cette opinion et comme beaucoup, il est certainement désolé qu'un tel type d'homme n'existe pas encore. En 1981, Peter Brook montait La Cerisaie de Tchekhov au Théâtre des Bouffes du Nord à Paris. Des acteurs connus, comme Michel Piccoli, la femme de Brook, Natasha Parry et d'autres, participèrent à ..

Les acteurs de Peter Brook

Lorsqu'en 1970, Peter Brook pénétra pour la première fois avec Micheline ROZAN Directrice de son Théâtre, dans la salle des Bouffes du Nord à Paris, il dit immédiatement : « il sera un jour nécessaire que ces murs chantent ». Depuis naturellement, la musique a pris une part considérable dans son travail théâtral, jusqu'à ce qu'un jour il décide de mettre en scène un opéra. Bien évidemment, il se heurtera aux limites dues à l'architecture même de la salle et de la scène car il n'y a pas de pla..

Investigating social gaze as an action-perception online performance

Gaze represents a major non-verbal communication channel in social interactions. In this respect, when facing another person, one's gaze should not be examined as a purely perceptive process but also as an action-perception online performance. However, little is known about processes involved in the real-time self-regulation of social gaze. The present study investigates the impact of a gaze-contingent viewing window on fixation patterns and the awareness of being the agent moving the window. In face-to-face scenarios played by a virtual human character, the task for the 18 adult participants was to interpret an equivocal sentence which could be disambiguated by examining the emotional expressions of the character speaking. The virtual character was embedded in naturalistic backgrounds to enhance realism. Eye-tracking data showed that the viewing window induced changes in gaze behavior, notably longer visual fixations. Notwithstanding, only half of the participants ascribed the window displacements to their eye movements. These participants also spent more time looking at the eyes and mouth regions of the virtual human character. The outcomes of the study highlight the dissociation between non-volitional gaze adaptation and the self-ascription of agency. Such dissociation provides support for a two-step account of the sense of agency composed of pre-noetic monitoring mechanisms and reflexive processes, linked by bottom-up and top-down processes. We comment upon these results, which illustrate the relevance of our method for studying online social cognition, in particular concerning autism spectrum disorders (ASD) where the poor pragmatic understanding of oral speech is considered linked to visual peculiarities that impede facial exploration

Acute Embolic Occlusion of the Left Common Iliac Artery Treated With Intra-Arterial Thrombolysis and Percutaneous Thrombectomy

Acute embolic occlusion of the common iliac artery is a rare medical emergency that is not only limb-threatening, but also potentially life-threatening. Several treatment options exist for acute limb ischemia, although no treatment is clearly best. We report a case of acute embolic occlusion of the left common iliac artery in a patient with atrial fibrillation who was treated successfully using mechanical thrombectomy following intra-arterial thrombolysis

Sense of agency in joint action: a critical review of we-agency

The sense of agency refers to the experience of control over voluntary actions and their effects. There is growing interest in the notion of we-agency, whereby individual sense of agency is supplanted by a collective agentic experience. The existence of this unique agentic state would have profound implications for human responsibility, and, as such, warrants further scrutiny. In this paper, we review the concept of we-agency and examine whether evidence supports it. We argue that this concept entails multiplying hypothetical agentic states associated with joint action, thus ending up with an entangled phenomenology that appears somewhat speculative when weighted against the available evidence. In light of this, we suggest that the concept of we-agency should be abandoned in favour of a more parsimonious framework for the sense of agency in joint action