When has service provision for transient ischaemic attack improved enough? A discrete event simulation economic modelling study.

Objectives: The aim of this study was to examine the impact of transient ischaemic attack (TIA) service modification in two hospitals on costs and clinical outcomes.

Design: Discrete event simulation model using data from routine electronic health records from 2011.

Participants: Patients with suspected TIA were followed from symptom onset to presentation, referral to specialist clinics, treatment and subsequent stroke.

Decisions and delays within stroke patients' route to the hospital: a qualitative study.

Study Objective: We examine acute stroke patients' decisions and delays en route to the hospital after onset of symptoms.

Methods: This was a qualitative study carried out in the West Midlands, United Kingdom. Semistructured interviews were conducted with 30 patients (6 accompanied by partners).

Cost-effectiveness of optimizing acute stroke care services for thrombolysis.

Background And Purpose: Thrombolysis in acute stroke is effective up to 4.5 hours after symptom onset but relies on early recognition, prompt arrival in hospital, and timely brain scanning. This study aimed to establish the cost-effectiveness of increasing thrombolysis rates through a series of hypothetical change strategies designed to optimize the acute care pathway for stroke.

The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study.

Background: Hospital prealerting in acute stroke improves the timeliness of subsequent treatment, but little is known about the impact of prehospital assessments on in-hospital care.

Objective: Examine the association between prehospital assessments and notification by emergency medical service staff on the subsequent acute stroke care pathway.

Methods: This was a cohort study of linked patient medical records.

Limitations of the DF-4 defibrillator connector necessitating device removal.

The DF-4 implantable defibrillator connector was recently released for clinical practice. This connector facilitates lead to device connection, reduces bulk in the device pocket, and eliminates the risk of incorrect device connection. Unfortunately, new technology often introduces new challenges.

Atrial pacing or ventricular backup-only pacing in implantable cardioverter-defibrillator patients.

Background: The need for pacing support in typical ICD patients is unknown.

Objective: This study sought to determine whether atrial pacing with ventricular backup pacing is equivalent to ventricular backup pacing only in implantable cardioverter-defibrillator (ICD) patients.

Methods: We randomized 1,030 patients from 84 sites with indications for ICDs, with sinus rhythm, and without symptomatic bradycardia to atrial pacing with ventricular backup at 60 beats/min (518) or ventricular backup pacing at 40 beats/min (512).

State of the art in developmental toxicity screening methods and a way forward: a meeting report addressing embryonic stem cells, whole embryo culture, and zebrafish.

A meeting was convened so that users of three models for in vitro developmental toxicity (embryonic stem cells, whole embryo culture, and zebrafish) could share their experiences with each model, and explore the areas for improvement. We present a summary of this meeting and the recommendations of the group.

The ramp power test: a power assessment during a functional task for older individuals.

Background: Power is critical to mobility and activities of daily living and is a key determinant of independence and falls prevention. Therefore, the quantification of power in older persons is critical. The power tests currently available are often expensive, potentially dangerous, and not reflective of everyday activities.

The gallon-jug shelf-transfer test: an instrument to evaluate deteriorating function in older adults.

This study examined the validity, reliability, and discriminatory capacity of the gallon-jug shelf-transfer (GJST) test. Six hundred fifty-three independent-living older adults (463 women age 72.9 +/- 7.

MRI in patients with cardiac devices.

Given the advances of MRI and cardiovascular technology, it is becoming increasingly likely that a patient with a cardiovascular device will be a candidate for an MRI procedure. However, many cardiac devices are currently considered to be contraindicated in the MR environment. This may prove to be a significant public health problem as many patients in need of MRI are denied the procedure because of the presence of a cardiovascular device.

Defibrillation energy requirements using a left anterior chest cutaneous to subcutaneous shocking vector: implications for a total subcutaneous implantable defibrillator.

Background: Subcutaneous implantable defibrillators (ICDs) are being developed to facilitate ICD implantation.

Objective: The purpose of this study was to estimate the human defibrillation energy requirement (DER) using a left chest cutaneous (Q) to subcutaneous (SQ) shocking vector.

Methods: Twenty patients undergoing implantation of an indicated ICD were enrolled (15 males, age = 63 +/- 12 years; ejection fraction = 0.

Correlation analyses and regression modeling between isokinetic testing and on-court performance in competitive adolescent tennis players.

Tennis requires skill, physical attributes, and strategy. Ball velocity and placement are two of the most important components in winning the faster-paced modern game. Although isokinetic testing has been used to evaluate physical characteristics and injury potential in tennis players, few studies have compared isokinetics and on-court performance.

Is intravenous recombinant tissue plasminogen activator (rt-PA) safe for use in patients over 80 years old with acute ischaemic stroke? - The Calgary experience.

Background: Acute ischaemic stroke is common in older people. There is one licensed acute treatment, intravenous recombinant tissue plasminogen activator, but little information is available on its safety in over 80 year olds.

Design: Review of prospectively collected data on 62 consecutive patients, aged 80 years and over, treated with recombinant tissue plasminogen activator in a tertiary centre.

Neurobehavioral assessment: a survey of use and value in safety assessment studies.

This report describes the results of a survey designed to evaluate the contribution of F1 neurobehavioral testing to hazard identification and characterization in safety assessment studies. (To review the details of the distributed survey, please see the supplementary data for this article on the journal's Web site.) The survey provided information about studies completed in industrial laboratories in the United States, Europe, and Japan since 1990 on 174 compounds.

Intraperitoneal pocket for left ventricular assist device placement.

Background: Implantation of the HeartMate Implanted Pneumatic or Vented Electric Ventricular Assist Device requires that the pump be implanted either in the peritoneal cavity or in the abdominal wall. Both sites have been problematic.

Methods: We describe a new technique in which an intraperitoneal pocket is created, using Gore-Tex Dual Mesh Plus Biomaterial with Holes, to contain the ventricular assist device.