[Intravenous thrombolytic therapy with Revelisa of ischemic stroke in real-world clinical practice: interim results of an open-label, prospective, multicenter, non-interventional study IVT-AIS-R]. / Vnutrivennaya tromboliticheskaya terapiya ishemicheskogo insul'ta preparatom Reveliza v real'noi klinicheskoi praktike: promezhutochnye rezul'taty issledovaniya IVT-AIS-R.

OBJECTIVE: To assess the safety and efficacy of Revelisa in patients with ischemic stroke in real-world clinical practice. MATERIAL AND METHODS: The interim analysis of an open-label, prospective, multicenter, non-interventional study IVT-AIS-R included 223 patients (50.2% women and 49.8% men, mean age 66.6 (13.5) years) with ischemic stroke who were admitted to the study sites since July 2019 and who, in the absence of contraindications, underwent thrombolytic therapy (TLT) with Revelisa within the first 4.5 hours from the onset of stroke. Data were collected as a continuous sample. According to the reperfusion therapy protocol for ischemic stroke, all patients included in the study underwent clinical examination, investigations and laboratory tests before TLT and within the first days after it. Symptomatic hemorrhagic transformation was determined in accordance with the ECASS 3 criteria. RESULTS: Most of the patients (96%) had hypertension, 74% of patients had chronic heart failure, 57.4% had coronary artery disease, of which 8.5% were patients with a previous myocardial infarction. Various cardiac arrhythmias were observed in 33.2% of cases, 21.5% of patients had type 2 diabetes, 18.4% had a history of previous acute cerebrovascular accidents. Hemorrhagic transformation (HT) of a cerebral lesion developed in 7.1% of cases, with the frequency of symptomatic HT being 3.1% (7 patients). The hospital mortality rate was 13.9%. The median NIHSS score was 4 points (p<0.0001) on day 7 versus baseline. The proportion of patients with good functional recovery (the modified Rankin scale score 0-2) at discharge was 48.2%. CONCLUSION: The data obtained with the use of Revelisa in patients with ischemic stroke in real-world clinical practice allow drawing conclusions about a comparable safety and efficacy profile to that in previously published registry studies of alteplase.

Gender, family status, and career patterns of graduates of the University of Calgary Faculty of Medicine.

In 1986 the authors sent a questionnaire to 745 physicians who had graduated between 1973 and 1985 from The University of Calgary Faculty of Medicine. The survey obtained information on the graduates' status as parents, the "breaks" they had taken from their practices, and the hours per week they devoted to direct patient care, in order to observe what relationship the graduates' gender and status as parents had on the other variables. The women were far more likely to have taken breaks for parental leave, but the differences in the frequencies of breaks taken by the men and the women for other reasons were less striking. The women were working fewer hours in direct patient-care settings, and those women who were parents and under 35 years old spent fewer hours on patient care than did the men (from all age groups) who were parents. The authors discuss their findings in terms of the impacts of age and cohort effects and the possible lessening of gender-based differences in present-day physicians' practices.

Responses to non-emergency questions in rural medicine: their usefulness to practice decisions.

This study reports the nature of non-emergency, day-to-day practice-related questions which arose in rural practice and were phoned in to a medical information system (MIS). The usefulness of these questions, and their responses, to clinical decision-making is outlined. Sixty-seven practitioners from 10 rural communities enrolled in the project. In response to each inquiry two or three articles were sent to the practitioner and to a consultant for validation. At the conclusion of the study the questions posed, and their responses, were examined. Forty-six per cent of the questions received were categorized as diagnostic; 30% as management; and 24% as therapeutic. Questions were classified using the ICD.9.CM. Those most frequently posed were in the nervous system/sense organs (13%), injury/poisoning (9%), and genito-urinary (9%) categories. Interviews with doctors and consultants were conducted to assess the usefulness of the service. Study findings suggest that an MIS can provide helpful information for improving daily aspects of clinical care, doctor-patient communication, administrative decision-making, and physician education. Practitioners, consultants, and medical librarians reported benefits from this service.

Major changes in medical careers following medical school graduation: when, how often, and why.

Knowledge of the timing of, reasons for, and frequency of major medical-career changes of medical school graduates is useful in considering physician manpower needs. This study reports aspects of the medical-career changes made by a cohort of Alberta medical school graduates who graduated from 1973-1985. Of the 603 (81%) who participated, 160 (27%) reported major medical career changes. Significantly more specialists (35%) than family physicians (18%) made major changes. Forty-two percent made changes during the first year of residency, 21% later in residency, and 29% after entering practice. Reasons cited included general dissatisfaction (47%), lifestyle compatibility (24%), and training and practice experiences (19%). This study indicates that while personal needs and preferences influence changes during residency, practice experience is also important to career choices.