Midterm outcomes of paclitaxel-eluting stents for the treatment of intracranial posterior circulation stenoses

OBJECT: Symptomatic intracranial vertebral and basilar artery atherosclerotic stenoses carry a high risk of stroke and permanent disability if refractory to maximal medical therapy. The authors conducted a study to determine the technical feasibility and midterm clinical and angiographic outcomes in patients in whom paclitaxel-eluting stents were placed for the treatment of symptomatic intracranial posterior circulation stenoses. METHODS: A retrospective review of medical records and imaging studies was performed for 13 consecutive patients in whom paclitaxel-coated stents were used to treat symptomatic posterior circulation intracranial stenoses between 2002 and 2005. Clinical follow-up data were supplemented by telephone interviews. The technical success rate for stent placement was 100%. One patient (8%) suffered a periprocedural stroke. Twelve patients (92%) underwent clinical follow up for a minimum of 3 months postsurgery, and 11 (92%) of these patients remained asymptomatic after a mean period of 10.9 months. Nine patients (69%) underwent catheter angiographic follow up, and no patient had significant in-stent recurrence of stenosis after a mean period of 5.4 months. CONCLUSIONS: Treatment of intracranial posterior circulation stenoses with drug-eluting stents is technically feasible, and the rate of clinically significant periprocedural complications is low. Rates of stenosis recurrence are reduced compared with those of bare-metal stents in the midterm. Midterm clinical outcome is excellent; no symptom recurrence was observed in this patient cohort.4 page(s

Orientações ao paciente portador de epilepsia submetido ao vídeo-EEG: comparação dos níveis de ansiedade com o uso de diferentes estratégias Orientations to epileptic patient undergoing a video-EEG monitoring: comparison of anxiety levels using different strategies

OBJETIVO: Comparar os níveis de ansiedade de dois grupos de pacientes submetidos ao vídeo-EEG que tiveram diferentes estratégias de orientação para o exame; o controle teve apenas orientações verbais e o experimental também recebeu um manual de orientações. MÉTODO: Cada grupo foi aleatoriamente composto por 30 pacientes. Para avaliar as estratégias de orientação, a ansiedade dos grupos foi comparada por meio da aplicação do Inventário de Ansiedade Traço-Estado, sendo o estado de ansiedade avaliado pré e pós-exame. RESULTADOS: O grupo experimental apresentou perfil de ansiedade superior, porém, estado de ansiedade inferior, antes do exame, em relação ao controle. A ansiedade do grupo experimental foi mais baixa, pré-exame do que seu perfil, entretanto, o mesmo não ocorreu com o controle. Pós-exame, ambos os grupos apresentaram ansiedade baixa e menor que seu perfil. CONCLUSÃO: A estratégia de orientação com o manual beneficiou os pacientes, reduzindo a ansiedade antes do exame.<br>OBJETIVO: To identify and compare the anxiety level between two groups of epileptic patients undergoing a video-EEG monitoring using different patients guidelines strategies. METHOD: The random sample was composed by two groups of 30 patients each one. The control group only had verbal orientations and the experimental group, beyond the same orientations received a written guide (a booklet) with all the procedures too. The anxiety was assessed using State-Trait Anxiety Inventory with the STAI-S being applied for both groups before and after examination as described above. RESULTS: Demonstrated that, before video-EEG, the anxiety-trait score of the experimental group was higher and the anxiety-state was lower than the control group. After video-EEG, the majority of both groups demonstrated low anxiety-state score and lower than their anxiety-trait score. CONCLUSION: The strategy used with the written guide associated to verbal orientations helps to reduce the anxiety level before the video-EEG

Knowledge transfer and improvement of primary and ambulatory care for patients with anxiety.

Contains fulltext : 69560.pdf (publisher's version ) (Closed access)OBJECTIVE: To summarize current evidence on the effectiveness of different knowledge transfer and change interventions for improving primary and ambulatory anxiety care to provide guidance to professionals and policy-makers in mental health care. METHOD: We searched electronic medical and psychological databases, conducted correspondence with authors, and checked reference lists. Studies examining the effectiveness of knowledge transfer and interventions targeted at improvement of the recognition or management of anxiety in primary and ambulatory health care settings were included. Methodological details and outcomes were independently extracted and checked by 2 reviewers. Where appropriate, data concerning the impact of interventions on symptoms of anxiety were pooled using metaanalytical procedures. RESULTS: We identified 24 studies that met our inclusion criteria. Seven professional-directed interventions and 17 organizational interventions (including patient-oriented interventions) were identified. The methodological quality of studies was variable. Professional-directed interventions only impact the process and outcome of care when embedded in some sort of organizational intervention. Metaanalysis (n = 8 studies) showed no effect of diverse organizational interventions on patients' anxiety symptoms (effect size, -0.08; 95% confidence interval, -0.31 to 0.15; P = 0.50). Collaborative care interventions proved to be the most effective organizational intervention strategies. Six studies reported economic results: 4 studies showed that intervention had a high probability of being cost-effective. CONCLUSIONS: Collaborative care seems to be very promising for improving primary and ambulatory care for anxiety. At the level of management and policy, the results of this review mandate the need to offer fair and reasonable reimbursement for collaborative care programs