Mobile stroke unit use for prehospital stroke treatment-an update.

BACKGROUND: Acute ischemic stroke is a treatable disease. Moreover, there is increasing evidence supporting mechanical recanalization for large-vessel occlusion, even beyond a strict time window. However, only small numbers of patients receive causal treatment. METHODS: One of the main reasons that patients do not receive causal therapy is their late arrival at the correct target hospital, which, depending on the type of stroke, is either a regional stroke unit or a comprehensive stroke center for interventional treatment. In order to triage patients correctly, a fast and complex diagnostic work-up is necessary, allowing a stroke specialist to decide on the best therapy option. As treatment possibilities become more comprehensive with the need for individualized decisions, the gap between treatment options and practical implementation is increasing. RESULTS: The "mobile stroke unit" concept encompasses the administration of prehospital acute stroke diagnostic work-up, therapy initiation, and triage to the correct hospital using a specially equipped ambulance, staffed with a team specialized in stroke. The concept, which was conceived and first put into practice in Homburg/Saar, Germany, in 2008, is currently spreading with more than 20 active mobile stroke unit centers worldwide. The use of mobile stroke units can reduce the time until stroke treatment by 50% with a tenfold increase of patients treated within the first 60 min of symptom onset. CONCLUSION: The mobile stroke unit concept for acute stroke prehospital management is spreading worldwide. Intensive research is still needed to analyze the best setting for prehospital stroke management.

Prehospital Imaging-Based Triage of Head Trauma with a Mobile Stroke Unit: First Evidence and Literature Review.

BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, point-of-care laboratory, and telemedicine capabilities (Mobile Stroke Unit [MSU]) has been shown to enable delivery of thrombolysis to stroke patients at the emergency site, thereby significantly decreasing time to treatment. However, the MSU frequently assesses patients with cerebral disorders other than stroke. For some of these disorders, prehospital CT scanning may also be beneficial. METHODS: Our institution manages a program investigating prehospital stroke treatment of patients with neurological emergencies. We assessed a patient with head trauma for whom prehospital CT scanning and laboratory tests allowed cause-based triage to the most appropriate hospital. We examined implications of this case for clinical practice in light of a literature review. RESULTS: The MSU was dispatched to assess a 74-year-old woman with suspected head trauma or stroke, found lying on the floor with a left frontal laceration. Her Glasgow Coma Scale score was 13, apart from drowsiness she exhibited no neurologic deficit. A CT scan ruled out intracranial hemorrhage and skull fracture. On the basis of these prehospital diagnostic findings, the patient was taken to the nearest primary care hospital rather than to a trauma center with neurosurgery facilities. CONCLUSION: Patients with neurologic disorders other than stroke, such as traumatic brain injury, may also benefit from prehospital CT studies. This case report and the results of our analysis of the literature support the potential benefit of prehospital imaging in correctly triaging patients with suspected traumatic brain injury to the appropriate target hospital.

Socio-demographic and medical characteristics of advanced cancer patients using conventional or complementary medicine.

BACKGROUND: To provide prospective comparative data describing the profiles of two patient populations attending conventional or complementary medicine institutions. PATIENTS AND METHODS: A registration study was set up in an oncology ward at the Institute for Medical Oncology (IMO) of the University Hospital in Bern, and at the Lukas Clinic (LC) for Anthroposophical Cancer Treatment in Arlesheim, Switzerland. The same eligibility criteria were applied to enrol into the study all newly referred or newly diagnosed patients with advanced cancer over a 2-year period. Their socio- demographic and clinical characteristics at presentation have been compared between the two institutions. RESULTS: Patients at LC are primarily females, of higher educational level, and living in an urban environment. Patients at LC are also more frequently of poorer performance status but present with less comorbidity and a longer interval between diagnosis of metastatic disease and accrual into the study. CONCLUSION: This study suggests that the respective merits of these two schools of medicine can be assessed successfully only through a concrete research partnership based on rigorously controlled clinical trials.

Attitudes and Beliefs towards Disease and Treatment in Patients with Advanced Cancer Using Anthroposophical Medicine.

BACKGROUND: In Switzerland, anthroposophical medicine has a long tradition, offers a special tumor treatment, is frequently used by cancer patients, and has been approved in 1998 by the Swiss government to be reimbursed by health insurances. This popularity contrasts with the fact that to date no sound evidence of the effectiveness of anthroposophical cancer treatments exists. In this study we draw a profile on a population of patients with advanced disease attending treatment at the anthroposophical Lukas Clinic (LC) regarding patients' attitudes, experiences and expectations. PATIENTS AND METHODS: All newly admitted patients with a diagnosis of locally advanced or metastasized breast, gastrointestinal, lung or gynecological cancer were recruited into a registration study. In parallel, a population of patients with the same inclusion criteria attending a conventional institution (Institute of Medical Oncology, University of Bern, IMO) was taken as a reference sample. Data were collected by means of a fully structured interview, and simple descriptive statistics was used for evaluation. RESULTS: 221 and 280 patients accrued at LC and at IMO, respectively. LC patients were mainly women (87%), had a good education (36% with completed college or university education), and were admitted on average 3.5 months after the diagnosis of advanced disease. With respect to their advanced cancer, they put very little hope in the effectiveness of conventional medicine, but expected great help from anthroposophical treatment. Compared with the reference population they cared more for psychological well-being and quality of life, but an important factor for choosing treatment at the LC was clearly the patients' strong belief in the effectiveness of anthroposophical treatment. CONCLUSIONS: With its holistic approach, anthroposophical medicine intends to provide tumor treatment together with supportive care throughout the course of the illness. To some patients this is an attractive alternative to conventional medicine, which too often focuses on tumor treatment only. Conventional medicine should clearly be advised to give higher priority to supportive care already early in the course of the disease. We acknowledge some patients' need for a more holistic approach, but anthroposophical medicine or any other providers of alternative or complementary cancer therapies should evaluate treatment effectiveness more thoroughly according to the principles of evidence-based medicine. Copyright 2000 S. Karger GmbH, Freiburg

The cognitive-spiritual dimension--an important addition to the assessment of quality of life: validation of a questionnaire (SELT-M) in patients with advanced cancer.

UNLABELLED: Questions of meaning and challenge by illness, i.e., the spiritual dimension of quality of life (QL) traditionally played an important role in anthroposophically oriented medicine and have gained importance in palliative medicine and supportive care. In the context of a research project on QL in patients with advanced cancer, we therefore investigated the psychometric properties of a questionnaire covering spiritual QL issues, with the aim of providing a module for the assessment of cognitive-spiritual QL. PATIENTS AND METHODS: We investigated 89 patients with advanced breast and gastro-intestinal cancer. Construct validity of a modified version of the SELT (Skalen zur Erfassung von Lebensqualität bei Tumorkranken), the SELT-M was tested by multitrait scaling analysis. Discriminant and convergent validity were also tested. The EORTC QLQ-C30 was used as a standard for validation. Results showed the SELT-M as feasible in administration. Four of the five SELT-M subscales were internally consistent (Cronbach's Alpha = > 0.7). The subscale on spiritual QL showed higher within than outside subscale correlations for six of its eight items. Association of the SELT-M with the EORTC QLQ-C30 was good for the items and subscales covering the same aspects of QL in both questionnaires: emotional (Spearman r = 0.61), physical functioning (r = -0.54) and fatigue (r = -0.75). In accordance with expectations, there was no association between spiritual QL with any EORTC QLQ-C30 subscales. Self-assessed spiritual QL in the SELT-M corresponded well with interviewer assessments (test for trend accross ordered groups, P = 0.0023). CONCLUSIONS: Overall there is confirming evidence for the hypothesised structure of the SELT-M, especially for the newly developed module on spiritual QL. This module may be used as a module together with other cancer specific QL questionnaires.

[Studies on the effectiveness of a new model for treating tuberculosis with prolonged administration of isoniazid]. / Badania nad skutecznoscia nowego modelu leczenia gruzlicy z przedluzonym stosowaniem hydrazydu kwasu izonikotynowego.

The aim of the study was to determine the therapeutical effectiveness of a new regimen in freshly diagnosed cases of pulmonary tuberculosis. In this model PZA and SM were excluded, but INH administration was prolonged. Instead of INH and RMP a combined drug was given--RIFAMAZIDE (Polfa). Therapy was carried out in three stages: I stage lasting 3 months during which Rifamazide (600 mg RMP, 300 mg INH) and EMB (25 mg per kg b.w.) was given; II stage-during which Rifamazide was given (2 tablets.) for 3 months; III stage--INH monotherapy (300 mg daily) was continued for 6 months. During the first stage all patients were hospitalized at the Institute of Tuberculosis. The second stage was carried out under supervision of an out-patient clinic. During the third stage patients received their INH at their homes. The study group consisted initially of 58 patients, of which 11 were dropped out due to primary resistance, change of therapy, non-compliance, and non-tolerance of drugs. The final evaluation was carried out basing on results from 47 patients. In all patients a negative sputum culture was achieved. In most during the first two months of therapy. All demonstrated improvement in radiological evaluation. In 38 patients the follow-up lasted 2-6 years, in the remaining nine 2 years. Recurrencies were not observed. Good acceptation by the patients of Rifamazide was found.