Microthrombosis after experimental subarachnoid hemorrhage: time course and effect of red blood cell-bound thrombin-activated pro-urokinase and clazosentan.

Delayed cerebral ischemia (DCI) is a significant cause of morbidity and mortality for patients surviving the rupture of an intracranial aneurysm. Despite an association between vasospasm and DCI, thrombosis and thromboembolism may also contribute to DCI. In this study we investigate the time course of intravascular microclot formation after experimental subarachnoid hemorrhage (SAH) and assess the effects of the following two drugs on microclot burden: mutant thrombin-activated urokinase-type plasminogen activator (scFv/uPA-T), which is bound to red blood cells for use as a thromboprophylactic agent, and clazosentan, an endothelin antagonist.

Geographic variation in outcomes from severe traumatic brain injury.

Background: Recent reports have documented a wide range of outcomes after treatment of severe traumatic brain injury at trauma centers throughout the world.

Methods: In an effort to test the contribution of geography to treatment outcome, we compared case series published from 1975 to 2009. Trauma centers were divided into those from the United States, other developed countries, and the developing world.

150 years of treating severe traumatic brain injury: a systematic review of progress in mortality.

Considerable effort and resources have been devoted to preserving life in patients with severe closed traumatic brain injury (TBI). We sought to identify temporal trends in mortality rates of these patients from the late 1800s to the present. We searched the literature for articles on severe TBI, abstracting numbers of patients studied, numbers of deaths, and years of patient entry.

How private, voluntary health insurance can work in developing countries.

Could voluntary insurance markets exist in developing countries? We used data from the World Health Survey for eleven countries to estimate, at different income levels, variation in total medical spending and spending for hospitals, physicians, and outpatient drugs. The goal was to generate estimates of risk premiums that consumers might pay for insurance coverage and to calculate likely insurance administrative costs. We conclude that insurance covering either hospital spending or total spending is feasible for much of the population, but not insurance for physician services or medicines.

Relationship of aggressive monitoring and treatment to improved outcomes in severe traumatic brain injury.

Object: Despite being common practice for decades and being recommended by national guidelines, aggressive monitoring and treatment of patients with severe traumatic brain injury (TBI) have not been supported by convincing evidence.

Methods: The authors reviewed trials and case series reported after 1970 in which patients were treated for severe closed TBI, and mortality rates and favorable outcomes at 6 months after injury were analyzed. The patient groups were divided into those with and without intracranial pressure (ICP) monitoring and intensive therapy, and the authors performed a meta-analysis to assess the effects of treatment intensity on outcome.