Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Conference Proceedings”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,585 records · Page 88Linked to original sources
PubMed2005

Breast carcinogenesis: can the examination of ductal fluid enhance our understanding?

PURPOSE/OBJECTIVES: To explore current breast carcinogenesis theories and the possibility of examining breast epithelial cells to confirm steps in the carcinogenic process and the relationship between intraductal sampling techniques and their role in enhanced risk prediction. DATA SOURCES: Published articles, textbooks, and conference proceedings. DATA SYNTHESIS: Examining breast epithelial cells may provide insight into the carcinogenic process while it is occurring. Methods of extracting breast epithelial cells include nipple aspiration, ductal lavage, and periareolar fine-needle aspiration. CONCLUSIONS: Nipple aspiration, ductal lavage, and periareolar fine-needle aspiration are viable means of examining possible precursors to breast tumors. Differentiating between true precursors and benign changes is an important step in breast cancer risk assessment. IMPLICATIONS FOR NURSING: Nipple aspiration and ductal lavage may be performed in an outpatient setting. RNs and advanced practice nurses may perform these procedures and discuss results with patients.

Biopsy, Needle↗
PubMed2005

Strengths and limitations of breast cancer risk assessment.

PURPOSE/OBJECTIVES: To evaluate current definitions of breast cancer risk and breast cancer risk assessment models, including the Gail, Claus, and BRCAPRO models, and discuss potential markers to enhance and standardize individual risk assessment. DATA SOURCES: Published articles, conference proceedings, and textbooks. DATA SYNTHESIS: Defining high risk for breast cancer development is explored, and options for high-risk women are discussed. The risk factors frequently used for risk evaluation, including age, age at menarche, age at first live birth, past history of breast biopsy, family history of breast cancer, and the presence of atypical hyperplasia, are reviewed. CONCLUSIONS: Current models of breast cancer risk assessment are limited. Exploring the progression from healthy tissue to malignancy through techniques such as fine needle aspiration, ductal lavage, and nipple aspiration may lead to more precise individualized risk prediction. IMPLICATIONS FOR NURSING: More accurate information regarding personal breast cancer risk is necessary. Oncology nurses may facilitate the use of appropriate tools that provide the most individualized risk assessment.

Adult↗
PubMed2005

Sleep wake disturbances in people with cancer and their caregivers: state of the science.

PURPOSE/OBJECTIVES: To review the state of the science on sleep/wake disturbances in people with cancer and their caregivers. DATA SOURCES: Published articles, books and book chapters, conference proceedings, and MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Library computerized databases. DATA SYNTHESIS: Scientists have initiated studies on the prevalence of sleep/wake disturbances and the etiology of sleep disturbances specific to cancer. Measurement has been limited by lack of clear definitions of sleep/wake variables, use of a variety of instruments, and inconsistent reporting of sleep parameters. Findings related to use of nonpharmacologic interventions were limited to 20 studies, and the quality of the evidence remains poor. Few pharmacologic approaches have been studied, and evidence for use of herbal and complementary supplements is almost nonexistent. CONCLUSIONS: Current knowledge indicates that sleep/wake disturbances are prevalent in cancer populations. Few instruments have been validated in this population. Nonpharmacologic interventions show positive outcomes, but design issues and small samples limit generalizability. Little is known regarding use of pharmacologic and herbal and complementary supplements and potential adverse outcomes or interactions with cancer therapies. IMPLICATIONS FOR NURSING: All patients and caregivers need initial and ongoing screening for sleep/wake disturbances. When disturbed sleep/wakefulness is evident, further assessment and treatment are warranted. Nursing educational programs should include content regarding healthy and disrupted sleep/wake patterns. Research on sleep/wake disturbances in people with cancer should have high priority.

Antidepressive Agents↗
PubMed2006

Measurement issues in quality-of-life assessments.

PURPOSE/OBJECTIVES: To describe issues to be considered when measuring the quality of life (QOL) of patients with cancer. DATA SOURCES: Published articles and books, conference proceedings, and abstracts. DATA SYNTHESIS: A review of the existing literature reveals an emerging field of research and considerable discussion of measurement issues. Consensus is growing about measurement approaches to this subjective concept; however, agreement differs regarding specific aspects of measurement approaches and interpretation of data. CONCLUSIONS: The purpose of the QOL assessment and how the data will be analyzed are the main determinants of the choice of assessment and measurement approaches. Differences regarding how QOL is measured may be encountered based on a clinical or research purpose. IMPLICATIONS FOR NURSING: QOL assessments may be used as part of data collection to address a specific research question or may be used to guide clinical practice. Research findings used to guide clinical practice should be evaluated for validity, reliability, and fit of the sample before being incorporated into clinical practice. QOL assessment in clinical practice may be used as an exploratory tool to identify potential problems or may be used to evaluate the effectiveness of a targeted intervention.

Data Interpretation, Statistical↗
PubMed2002

Speech and language therapy for dysarthria due to nonprogressive brain damage: a systematic Cochrane review.

BACKGROUND: Dysarthria is a common sequel of nonprogressive brain damage (typically stroke and traumatic brain damage). Impairment-based therapy and a wide variety of compensatory management strategies are undertaken by speech and language therapists with this patient population. OBJECTIVE: To determine the efficacy of speech and language therapy interventions for adults with dysarthria following nonprogressive brain damage. DESIGN: Systematic review. SEARCH STRATEGY: This review has drawn on the search strategies developed for the following Cochrane Groups as a whole: Stroke, Injuries, and Infectious Diseases. Relevant trials were identified in the Specialised Registers of Controlled Trials. We also searched the trials register of the Cochrane Rehabilitation and Related Therapies Field. The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PsycLIT, and Linguistics and Language Behavior Abstracts were electronically searched. Hand-searching of the International Journal of Language and Communication Disorders and of reference lists from relevant articles and conference proceedings was also undertaken. Colleagues were approached to identify other possible published and unpublished studies. SELECTION CRITERIA: Unconfounded randomized controlled trials. DATA COLLECTION AND ANALYSIS: One reviewer assessed trial quality. Two co-reviewers were available to examine any potential trials for possible inclusion in the review. MAIN RESULTS: No trials of the required standard were identified. REVIEWERS' CONCLUSIONS: There is no evidence of the quality required by this review to support or refute the effectiveness of speech and language therapy interventions for dysarthria following nonprogressive brain damage. There is an urgent need for good quality research in this area.

Adult↗
PubMed2004

Lessons for cluster randomized trials in the twenty-first century: a systematic review of trials in primary care.

BACKGROUND: Evidence suggests that cluster randomized trials are often poorly designed and analysed. There is little recent research on the methodologic quality of cluster randomized trials and none focuses on primary health care where these trials are increasingly common. METHODS: We conducted a systematic review of recent cluster randomized trials in primary health care, searching the Cochrane Controlled Trials Register. We also searched for unpublished trials in conference proceedings, and the UK National Research Register. We assess methodologic quality using a checklist, articulate problems facing investigators conducting these trials, and examine the extent to which carrying out a cluster randomized trial (as opposed to an individually randomized trial) in primary care may reduce power. RESULTS: We found 367 trial reports. Many trials were reported more than once. We characterize 152 independent cluster randomized trials in primary health care published between 1997 and 2000, and briefly describe 47 trials unpublished at December 2000. The quality of design and analysis was variable. Of published trials reporting sample size calculations 20% accounted for clustering in these calculations, 59% of published trials accounted for clustering in analyses. Unpublished trials were more recent and of higher quality. Reporting quality was better in journals reporting more cluster randomized trials. Many trial investigators reported problems with adherence to protocol, recruitment and type of intervention. CONCLUSIONS: Methodologic quality of cluster randomized trials in primary health care is variable and reporting needs improvement. The use of cluster randomization should be indicated in the title or abstract so these kinds of trials are easier to identify. Communicating appropriate methodology to health care researchers continues to be a challenge. Cluster randomized trials should always be piloted and information from pilots and unsuccessful trials shared more widely.

Cluster Analysis↗
PubMed2005

Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomized trials.

OBJECTIVES: To determine the effectiveness of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in traumatic corneal abrasions. METHODS: This was a systematic literature review and meta-analysis of randomized clinical trials (RCTs). The following databases were searched: MEDLINE (1966-2004), EMBASE (1980-2004), and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews (first quarter 2004). The structured search strategy included a RCT filter and the terms "cornea," "wounds and injuries," "trauma," "corneal diseases," "eye injuries," "anti-inflammatory agents, nonsteroidal" and specific trade names of topical NSAIDs. In addition, four journals in ophthalmology and emergency medicine were hand searched. Two authors independently reviewed citations from the literature searches. To be included, studies had to be RCTs evaluating topical NSAIDs in traumatic corneal abrasions. Trials were included regardless of language or whether they were unpublished or published. Exclusion criteria were corneal ulcers, nonrandomized studies, animal studies, or perioperative setting. Outcomes were pain scale scores at 24 hours and adverse effects. Two independent reviewers assessed four trial quality components: randomization, double blinding, reporting of withdrawals, and concealment of allocation. Weighted mean difference, using a random effects model, was calculated. RESULTS: Of the 200 citations identified, 11 RCTs met inclusion criteria. Eight trials were identified from the MEDLINE search, two from the EMBASE search, and one from conference proceedings. Seven trials enrolled fewer than 100 patients, and more than half of the studies were conducted in Europe. Five trials reported suitable data for analysis. The overall weighted mean difference for 459 patients was a reduction in pain by 1.30 points (95% confidence interval = -1.56 to -1.03) on the pain scale. Five of the trials met criteria for good quality. Transient stinging was a commonly noted adverse effect. CONCLUSIONS: Topical NSAIDs are effective analgesics for traumatic corneal abrasions.

Administration, Topical↗
PubMed2004

What is the impact of commercial test preparation courses on medical examination performance?

BACKGROUND: Commercial test preparation courses are part of the fabric of U.S. medical education. They are also big business with 2,000 sales for 1 firm listed at nearly $250 million. This article systematically reviews and evaluates research published in peer-reviewed journals and in the "grey literature" that addresses the impact of commercial test preparation courses on standardized, undergraduate medical examinations. SUMMARY: Thirteen computerized English language databases were searched using 29 search terms and search concepts from their onset to October 1, 2002. Also manually searched was medical education conference proceedings and publications after the end date; and medical education journal editors were contacted about articles accepted for publication, but not yet in print, that were deemed pertinent to this review. Studies that met three criteria were selected: (a) a commercial test preparation course or service was an educational intervention, (b) the outcome variable was one of several standardized medical examinations, and (c) results are published in a peer-reviewed journal or another outlet that insures scholarly scrutiny. The criteria were applied and data extracted by consensus of 2 reviewers. The search identified 11 empirical studies, of which 10 (8 journal articles, 2 unpublished reports) are included in this review. Qualitative data synthesis and tabular presentation of research methods and outcomes are used. CONCLUSION: The articles and unpublished reports reveal that current research lacks control and rigor; the incremental validity of the commercial courses on medical examination performance, if any, is extremely small; and evidence in support of the courses is weak or nonexistent; almost no details are given about the form and conduct of the commercial test preparation courses; studies are confined to courses in preparation for the Medical College Admission Test, the former National Board of Medical Examiners Part 1, and the United States Medical Licensing Examination Step 1, not tests of clinical science; and that cost-benefit analyses of the test preparation courses have not been done. It is concluded that the utility and value of commercial test preparation courses in medicine have not been demonstrated, and that evaluation apprehension in the medical profession and aggressive marketing practices are most likely responsible for commercial course prosperity.

Advertising↗
PubMed2002

Homocysteine, MTHFR 677C-->T polymorphism, and risk of ischemic stroke: results of a meta-analysis.

BACKGROUND: Data are conflicting concerning risk for ischemic stroke associated with hyperhomocyst(e)inemia (hyper-Hcy) and a common polymorphism in the gene encoding 5,10-methylenetetrahydrofolate reductase (MTHFR 677C-->T), which predisposes to hyper-Hcy in vivo. METHODS: Search of MEDLINE, Science Citation Index, and abstracts of conference proceedings revealed relevant articles. Exposure was defined as follows: 1) prevalence of hyper-Hcy; 2) absolute difference in the mean Hcy concentration between subjects with and without ischemic stroke; and 3) the MTHFR TT genotype frequency. Outcome was defined as ischemic stroke with or without neuroimaging. Inclusion criteria were retrospective and prospective studies with reported odds ratios (OR) or hazard ratios (HR) or arithmetic mean Hcy levels. Exclusion criteria were absence of OR or HR, outcome defined as carotid atherosclerosis or intima-media thickening, stroke in patients younger than 18 years old, and studies in languages other than English. Statistical analyses for between-study heterogeneity and pooled risk estimates were performed using Stata software (Stata Corporation, College Station, TX). RESULTS: Among 16 studies (1,487 stroke and 2,554 nonstroke cases), the pooled mean Hcy level in patients with ischemic stoke was 2.32 micromol/L (95% CI, 1.6 to 3.04; p < 0.001) greater than that in those without ischemic stroke. Among 14 included studies (1,769 stroke and 7,400 nonstroke cases), the pooled OR estimate of ischemic stroke associated with hyper-Hcy was 1.79 (95% CI, 1.61 to 2.0; p < 0.001). Among 19 included studies (2,788 stroke and 3,962 nonstroke cases), the OR associated with the TT genotype was 1.23 (95% CI, 0.96 to 1.58; p = 0.1). CONCLUSION: These data support an association between mild-to-moderate hyper-Hcy and ischemic stoke. The MTHFR TT genotype may have a small influence in determining susceptibility to ischemic stoke.

Brain Ischemia↗
PubMed1980

Institutional vs. noninstitutional care for the elderly.

The question of institutionalization vs. home care of the aged in need of medical care has been debated extensively. The arguments for deinstitutionalization have stressed the issue of cost. Home care is felt to be more cost efficient than institutional care. In this paper, both sides of the issue are investigated in detail by drawing on published conference proceedings and empirical studies reported in the literature.

Aged↗
PubMed1993

Review article: angiogenesis, neovascular proliferation and vascular pathophysiology as targets for cancer therapy.

A body of evidence that vascular-mediated damage occurs in murine tumours after many existing forms of anti-tumour therapy is rapidly accumulating (see Gray Conference Proceedings edited by Moore & West, 1991). Rapid conventional screens of cells in vitro or using leukaemias of lymphomas will not detect this mode of action and such screens will therefore miss effective agents. A change in the approach to experimental cancer therapy is needed to ensure that this important new avenue is fully investigated. Solid tumours will need to be studied and the importance of specific tumour cell biochemistry (e.g. on tissue factor procoagulant activity), of endothelial status and the immunocompetence of the host are all likely to be important. It is a subject of considerable debate at present whether transplanted subcutaneous mouse tumours are adequate models and whether they will reflect the response of spontaneous tumours, or even of transplants into other sites. Xenografts are not likely to be appropriate if the immuno-suppressed hosts lack the cells needed for the cytokine component of the pathway. The strategy of design and screening of new agents, for scheduling of existing agents and particularly the sequencing of adjunctive therapies are likely to be completely different for the "direct" tumor cell or "indirect" vascular-mediated approaches. It may eventually be appropriate to combine vascular manipulation with direct cytotoxicity aimed at malignant cells but the two mechanisms must be recognized as distinct entities and considered separately before attempting to coordinate them. It is important therefore to identify the "hallmarks" of vascular mediated injury and the means by which this can be distinguished from direct cell kill. These may be detectable in the tumour response but clues can also be gained from the side effects that are seen in normal tissues both with existing and with novel therapies (Figure 7). The appeal of vascular-mediated ischaemic therapy is that it is systemic and will have the potential of being effective on any tumour with a newly evoked vascular network, i.e. of about 1 mm in diameter, but it will be even more effective on large tumours than on small. Thus it should affect both large primary tumours and disseminated small metastases. The studies with many different anti-cancer agents have illustrated the potential complexity of responses that can appear to cause tumour cell death by collapse or occlusion of the blood supply. They have also focused attention on features of disparate agents, e.g. TNF, FAA, PDT, which may share similar pathways. No single feature of neovasculature can be highlighted as the sole route by which such antivascular therapy should be targeted. Rapid proliferation of the endothelial cells may prove to be a target, but it also influences differentiation characteristics, so that the immature cells will function abnormally. The permeability of these poorly formed vessels may lead to extravasation of proteins leading to increase interstitial pressures and by this means to an imbalance between intravascular and extravascular pressures and hence to collapse of the thin-walled vessels. Changes in systemic blood pressure, cardiac output, viscosity or coagulation and especially a redistribution of regional perfusion would all have differential effects in tumours and normal vessels. Clearly both vascular patho-physiology and the complexity of endothelial cell function and its imbalance in neovasculature will be important in understanding the mechanism of action of antivascular strategies. This very challenging boundary between oncology and a number of other medical and biological fields promises to lead to altered attitudes to existing therapies and the discovery of completely new classes of anti-cancer agents. The next decade should translate into clinical benefit for patients if the progress in this field continues to be as rapid as it has been in the late eighties. We must now determine what characteristics make one tumour more sensitive than another to agents such as heat, PDT, cytokines and FAA, and learn how to extrapolate from those rodent tumours to the human.

Animals↗
PubMed2005

Incidental lesions found on CT colonography: their nature and frequency.

CT colonography has been used to detect colonic polyps and cancers, but its effect in practice will also be influenced by the frequency with which extracolonic lesions of various types are detected. We performed a systematic review of the types of incidental lesions found on CT colonography. This is necessary to model the benefits and harms of detecting extracolonic lesions. Primary clinical studies of extracolonic findings on CT colonography were identified from electronic databases, scanning reference lists and hand searches of relevant journals and conference proceedings. A data collection proforma was used to collect information on extracolonic findings. 17 discreet studies were identified, involving 3488 patients. In total 40% of patients were recorded to have abnormalities and many had more than one abnormality. Nearly 14% of patients had further investigations and 0.8% were given immediate treatment. Extracolonic cancers were detected in 2.7% (0.9% had N0M0 cancers) and 0.9% had an aortic aneurysm. The number of extracolonic findings was high in all studies. While only a small population were judged "important", the prevalence of serious lesions outside the colon was nevertheless higher than in many other screening programs.

Adult↗
PubMed2003

Environmental threats to children's health in Southeast Asia and the Western Pacific.

The Southeast Asia and Western Pacific regions contain half of the world's children and are among the most rapidly industrializing regions of the globe. Environmental threats to children's health are widespread and are multiplying as nations in the area undergo industrial development and pass through the epidemiologic transition. These environmental hazards range from traditional threats such as bacterial contamination of drinking water and wood smoke in poorly ventilated dwellings to more recently introduced chemical threats such as asbestos construction materials; arsenic in groundwater; methyl isocyanate in Bhopal, India; untreated manufacturing wastes released to landfills; chlorinated hydrocarbon and organophosphorous pesticides; and atmospheric lead emissions from the combustion of leaded gasoline. To address these problems, pediatricians, environmental health scientists, and public health workers throughout Southeast Asia and the Western Pacific have begun to build local and national research and prevention programs in children's environmental health. Successes have been achieved as a result of these efforts: A cost-effective system for producing safe drinking water at the village level has been devised in India; many nations have launched aggressive antismoking campaigns; and Thailand, the Philippines, India, and Pakistan have all begun to reduce their use of lead in gasoline, with resultant declines in children's blood lead levels. The International Conference on Environmental Threats to the Health of Children, held in Bangkok, Thailand, in March 2002, brought together more than 300 representatives from 35 countries and organizations to increase awareness on environmental health hazards affecting children in these regions and throughout the world. The conference, a direct result of the Environmental Threats to the Health of Children meeting held in Manila in April 2000, provided participants with the latest scientific data on children's vulnerability to environmental hazards and models for future policy and public health discussions on ways to improve children's health. The Bangkok Statement, a pledge resulting from the conference proceedings, is an important first step in creating a global alliance committed to developing active and innovative national and international networks to promote and protect children's environmental health.

Asia, Southeastern↗
PubMed1999

A systematic review of laser therapy for venous leg ulcers.

A systematic review of randomised controlled trials (RCTs) was conducted to establish the effectiveness of low-level laser therapy as a treatment for venous leg ulcers. Wound-care journals, conference proceedings and electronic databases (including Medline and Cinahl) were searched up to October 1997 for RCTs comparing low-level laser therapy with sham laser, no laser, or non-coherent light of other wavelengths. In addition, companies who manufacture or distribute therapeutic lasers were contacted for any unpublished or ongoing studies. Results from searches were scrutinised by one reviewer to identify possible RCTs and full reports of these were obtained. Details of eligible studies were extracted and summarised using a data extraction sheet. Data extraction was checked by a second reviewer. Meta-analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar. A total of four eligible RCTs were identified. Two compared treatment with laser therapy to sham or placebo laser treatment. One study compared laser therapy with ultraviolet therapy. The fourth was a three-armed study which compared the effects of laser therapy alone, laser therapy plus infrared light, and non-coherent unpolarised red light. The comparisons of laser therapy with placebo, and laser therapy with ultraviolet therapy, showed no significant difference between treatments with regard to ulcer healing rates. The comparison of laser with red light showed a significant increase in complete healing at nine months for the combination of laser and infrared light compared to non-coherent unpolarised red light. We have not found any evidence of the benefit of low-level laser therapy per se on venous leg ulcer healing. It appears that a combination of HeNe laser and infrared light may promote the healing of venous ulcers, however more research is needed.

Evidence-Based Medicine↗
PubMed2000

Through the looking glass: finding Internet sites to mirror your collection.

Many libraries are grappling with the new freedom to link to the Internet directly from a Web-based catalog. A conservative approach that locates only Web sites replicating a library's print holdings is described. Methods for locating URLs include reviewing front matter in reference materials, scouring the Internet for material produced both in print and full text on the Web, electronic mailing lists, publishers' promotional materials, conferences, and journal articles. Readers are encouraged to make links from the catalog to any original material produced in Web-readable form by the university, including dissertations and conference proceedings.

Catalogs, Library↗
PubMed2001

Pneumococcal resistance: the treatment challenge.

OBJECTIVE: To review in vitro and in vivo information dealing with pneumococcal antibiotic resistance and provide a review of the incidence, mechanisms, and controversies surrounding this growing problem. The review is also intended to provide clinicians with relevant recommendations on treatment and prevention of this organism. DATA SOURCES AND SELECTION: Primary and review articles were identified by MEDLINE search (1966-August 2000) and through secondary resources such as conference proceedings. All of the articles identified from the data sources were evaluated, and all information deemed relevant was included in this review. DATA SYNTHESIS: The growing incidence and reporting of pneumococcal isolates that are resistant to one or more classes of antibiotics have become a troubling trend that has resulted in significant shifts in treatment. Although clinicians have shifted to a new generation or class of antibiotics when faced with a resistance trend, data with resistant pneumococci show that this may not be necessary. By incorporating the pharmacokinetic and pharmacodynamic data of antimicrobials into the decision-making process, many of the drugs that we have become hesitant to use due to this resistance may still be appropriate if used correctly. CONCLUSIONS: Appropriate dosing of antimicrobials, combined with optimal use of pneumococcal vaccines, will not only prolong the longevity of some agents, but also hopefully slow resistance development.

Animals↗
PubMed2001

Fibrinolytic therapy in intraventricular hemorrhage.

OBJECTIVE: To review the literature concerning intraventricular administration of fibrinolytic agents to treat patients with intraventricular hemorrhage (IVH). DATA SOURCES: An extensive literature search (MEDLINE, EMBASE, Conference Proceedings) was conducted to identify articles in English published between 1966 and May 2000 pertaining to the pathophysiology of IVH and its treatment by intraventricular administration of recombinant tissue plasminogen activator (alteplase) or urokinase (u-PA). The bibliographies of selected identified articles were also screened for publications not found in the computerized search. STUDY SELECTION: All pertinent publications were reviewed and considered. Those describing the intraventricular administration of fibrinolytic agents to patients with IVH were included. DATA SYNTHESIS: IVH has a poor prognosis, partly due to the mass effect of blood clots on the ventricular walls. The cerebrospinal fluid has a limited fibrinolytic system. Therefore, clots may remain in the ventricles for months after a hemorrhage. The management of IVH is primarily directed at controlling intracranial pressure through an external ventricular drain, but this catheter often becomes occluded by coagulated blood. To overcome this problem, and to dissolve the residual blood clot, investigators have administered alteplase or u-PA directly into the ventricles of patients with IVH. Complications of this therapy include infection and possible rebleeding. Clinical studies of fibrinolytic therapy for IVH have found a 30-35% reduction in mortality with treatment, but to date, have not clearly documented improved neurologic outcome of the survivors. CONCLUSIONS: Fibrinolytic therapy with alteplase or u-PA may be life-saving in severe cases of IVH. Yet many technical issues remain to be resolved, such as the optimal dose, frequency, method, timing, and duration of administration of the agent. Additional randomized, double-blind, placebo-controlled studies need to be performed so that the true value of this therapy can be assessed.

Cerebral Hemorrhage↗