Background and Purpose-Multiple approaches are being studied to enhance the rate of thrombolysis for acute ischemic stroke. Treatment of myocardial infarction with a combination of a reduced-dose fibrinolytic agent and a glycoprotein (GP) IIb/IIIa receptor antagonist has been shown to improve the rate of recanalization versus fibrinolysis alone. The combined approach to lysis utilizing eptifibatide and recombinant tissue-type plasminogen activator (rt-PA) (CLEAR) stroke trial assessed the safety of treating acute ischemic stroke patients within 3 hours of symptom onset with this combination. Methods-The CLEAR trial was a National Institutes of Health/National Institute of Neurological Disorders and Stroke-funded multicenter, double-blind, randomized, dose-escalation and safety study. Patients were randomized 3:1 to either low-dose rt-PA (tier 1ϭ0.3 mg/kg, tier 2ϭ0.45 mg/kg) plus eptifibatide (75 g/kg bolus followed by 0.75 g/kg per min infusion for 2 hours) or standard-dose rt-PA (0.9 mg/kg). The primary safety end point was the incidence of symptomatic intracerebral hemorrhage within 36 hours. Secondary analyses were performed regarding clinical efficacy. Results-Ninety-four patients (40 in tier 1 and 54 in tier 2) were enrolled. The combination group of the 2 dose tiers (nϭ69) had a median age of 71 years and a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 14, and the standard-dose rt-PA group (nϭ25) had a median age of 61 years and a median baseline NIHSS score of 10 (Pϭ0.01 for NIHSS score). Fifty-two (75%) of the combination treatment group and 24 (96%) of the standard treatment group had a baseline modified Rankin scale score of 0 (Pϭ0.04). There was 1 (1.4%; 95% CI, 0% to 4.3%) symptomatic intracranial hemorrhage in the combination group and 2 (8.0%; 95% CI, 0% to 19.2%) in the rt-PA-only arm (Pϭ0.17). During randomization in tier 2, a review by the independent data safety monitoring board demonstrated that the safety profile of combination therapy at the tier 2 doses was such that further enrollment was statistically unlikely to indicate inadequate safety for the combination treatment group, the ultimate outcome of the study. Thus, the study was halted. There was a trend toward increased clinical efficacy of standard-dose rt-PA compared with the combination treatment group. Conclusions-The safety of the combination of reduced-dose rt-PA plus eptifibatide justifies further dose-ranging trials in acute ischemic stroke. (Stroke. 2008;39:3268-3276.)
Objectives: The authors hypothesized that unethical recruiting practices and illegal questioning occur during emergency medicine (EM) resident recruitment. The objectives were to estimate the prevalence of specific unethical recruiting practices and illegal questioning by EM programs based on the perceptions of residency applicants and to measure the effect of these perceptions on applicant appraisal of programs. Methods: This was a cross-sectional survey of all applicants who matched to U.S. EM programs in 2005 and 2006. The survey questionnaire was developed by the study authors and was validated by pretesting on a small group representative of the study population. The survey addressed specific questions regarding program recruiting behaviors and interview questioning. The hyperlink to the secure anonymous online survey questionnaire was distributed to all EM program directors, asking them in turn to forward the hyperlink to their newly matched incoming residency class. All data were calculated with Score method with continuity correction and reported in proportions with 95% confidence intervals (CIs). Results: The authors received 671 survey responses. Among respondents, 56 (8.3%, 95% CI = 6.4% to 10.7%) stated that they were specifically asked to disclose at least one program's position on their rank list by a program representative, and 44 (6.6%, 95% CI = 4.9% to 8.9%) reported that they matched at a program residing lower on their rank list than at least one other program that had informed the applicant they were ranked to match. Furthermore, 201 respondents (30.0%, 95% CI = 26.5% to 33.7%) believed that they were asked at least one illegal question during their interviews, the most common of which was inquiry into their marital status (189 respondents: 28.2%, 95% CI = 24.8% to 31.9%). Respondents were 11 times more likely to move a program to a lower position of preference on their rank order list (12.2%, 95% CI = 9.8% to 15.0%) rather than a higher position (1.1%, 95% CI = 0.5% to 2.3%) as a result of perceiving unethical recruiting behaviors or illegal questioning. Conclusions: These results demonstrate that among survey respondents, some perceived unethical recruiting behaviors and illegal questioning in the 2005 and 2006 Match. Perceptions of such behaviors appeared to have a negative impact on applicant appraisal of EM residency programs. ACADEMIC EMERGENCY MEDICINE 2009; 16:550-557 ª
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.