Etiologic workup in cases of cryptogenic stroke: protocol for a systematic review and comparison of international clinical practice guidelines

Bray, Emma P; McMahon, Naoimh E.; Bangee, Munirah; Al-Khalidi, A. Hakam; Benedetto, Valerio; Chauhan, Umesh; Clegg, Andrew; Georgiou, Rachel; Gibson, Josephine; Lane, Deirdre A.; Lip, Gregory Y.H.; Lightbody, Catherine Elizabeth; Sekhar, Alakendu; Chatterjee, Kausik; Watkins, Caroline L

doi:10.1186/s13643-019-1247-6

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…Domain scores were calculated by summing the scores of the individual items in a domain and by scaling the total as a percentage of the maximum possible score for that domain. In accordance with the AGREE II User Guide [ 15 ], the study team prioritized the rigor of development domain; documents scoring ≥60% were considered to have appropriately addressed this domain [ 16 , 17 ].…”

Section: Methodsmentioning

confidence: 99%

Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations

et al. 2021

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Background Sedation is commonly used in gastrointestinal endoscopy; however, considerable variability in sedation practices has been reported. The objective of this review was to identify and synthesize existing recommendations on sedation practices for routine gastrointestinal endoscopy procedures. Methods We systematically reviewed guidelines and position statements identified through a search of PubMed, guidelines databases, and websites of relevant professional associations from January 1, 2005 to May 10, 2019. We included English-language guidelines/position statements with recommendations relating to sedation for adults undergoing routine gastrointestinal endoscopy. Documents with guidance only for complex endoscopic procedures were excluded. We extracted and synthesized recommendations relating to: 1) choice of sedatives, 2) sedation administration, 3) personnel responsible for monitoring sedated patients, 4) skills and training of individuals involved in sedation, and 5) equipment required for monitoring sedated patients. We assessed the quality of included documents using the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool. Results We identified 19 guidelines and 7 position statements meeting inclusion criteria. Documents generally agreed that a single, trained registered nurse can administer moderate sedation, monitor the patient, and assist with brief, interruptible tasks. Documents also agreed on the routine use of pulse oximetry and blood pressure monitoring during endoscopy. However, recommendations relating to the drugs to be used for sedation, the healthcare personnel capable of administering propofol and monitoring patients sedated with propofol, and the need for capnography when monitoring sedated patients varied. Only 9 documents provided a grade or level of evidence in support of their recommendations. Conclusions Recommendations for sedation practices in routine gastrointestinal endoscopy differ across guidelines/position statements and often lack supporting evidence with potential implications for patient safety and procedural efficiency.

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Section: Methodsmentioning

confidence: 99%

Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations

et al. 2021

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“…Its application to detect the cause of stroke is therefore promising, especially in cryptogenic stroke, for which no cause of stroke has been detected. Indeed, in at least 30% of cases, the exact etiology of stroke cannot be determined using existing investigative protocols (48). Adding VW-MRI may therefore help to detect etiologies that cannot be diagnosed using only luminal angiograms.…”

Section: In Adultsmentioning

confidence: 99%

Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies

Edjlali¹,

Qiao²,

Boulouis³

et al. 2020

Cardiovasc Diagn Ther

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Intracranial vasculopathies are routinely investigated by lumen-based modalities such as magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA). These techniques are useful to analyze the vessel lumen, allowing to detect vessel stenosis or occlusion. However, the primum movins of the disease, i.e., an abnormal thickening of the vessel wall, remains within the arterial wall. The vasculopathy can moreover be present without always narrowing the lumen or modifying its regularity. Hence, there is a need to detect directly and analyze vessel wall abnormalities. Development of 3D high-resolution black blood sequences for intracranial vessel wall MR imaging (VW-MRI) enabled routine clinical applications not only vasculitis, but also of intracranial atherosclerotic disease (ICAD), intracranial dissections, reversible intracranial dissections, reversible cerebral vasoconstriction syndrome (RCVS), Moyamoya disease, and intracranial aneurysms. This highresolution intracranial VW-MRI approach is increasingly used on a clinical basis at many centers to solve diagnostic problems, especially in patients with ischemic stroke or intracranial hemorrhage. An expert consensus Guideline from the American Society of Neuroradiology provides recommendations for clinical implementation of intracranial vessel wall MRI. There are several technical aspects needed to be considered when implementing VW-MRI in intracranial vessels, including flow suppression, both in blood and cerebrospinal fluid (CSF), spatial resolution and signal-to-noise ratio (SNR). In this article, we review the technical aspects of VW-MRI, and recommend applications for vascular diseases including non-occlusive intracranial vasculopathies, Moyamoya disease, and identifying culprit plaques. We also give a focus on the utility of VW-MRI for determining stroke etiology in adults and in children and young adults.

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Etiologic workup in cases of cryptogenic stroke: protocol for a systematic review and comparison of international clinical practice guidelines

Cited by 2 publications

References 23 publications

Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations

Sedation practices for routine gastrointestinal endoscopy: a systematic review of recommendations

Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies

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