Tag Archives: medical

In-custody 16-year-old escapes from Dell Children’s Medical Center

16-year-old escapes from Dell Children's Medical Center

AUSTIN (KXAN) — The Texas Juvenile Justice Department is looking for a 16-year-old boy who escaped custody Monday while undergoing treatment at Dell Children’s Medical Center, according to a release from the department.

Erik Robinson, from Corpus Christi, escaped custody around 6:40 p.m. while he was outside for supervised recreation at the hospital at 4900 Mueller Boulevard, the release says.

Robinson is described by authorities as a white male with blond hair and blue eyes. He is 5’8″ and weighs approximately 150 pounds. He has scars on his right wrist, his left hand, both knees, and his back. He was last seen wearing a gray Adidas sweat shirt and gray sweat pants, the release says.

Residents in the area near Dell Children’s Medical Center and in Corpus Christi should be aware of their surroundings. If you see Robinson, authorities ask that you call 911, but not engage him.

TJJD says it typically does not reveal the identities of youth, but in situations such as an escape the agency does so to help ensure public safety and the safety of the youth.

Author: KXAN Staff
This post originally appeared on KXAN Austin

Dartmouth Medical School Drops Cheating Charges

Dartmouth’s medical school is dropping charges against students whom they accused of cheating by looking up course materials online during closed-book remote exams, according to The New York Times.

In March, Dartmouth’s Geisel School of Medicine charged 17 students on the basis of a review of online activity on Canvas, a popular online course management system. Outside technology experts conducted a software review that found that the students’ devices could automatically generate activity on Canvas, even when no one was using them, The New York Times reported.

The school dropped seven cases after students argued that administrators mistook automated activity for cheating. Now the school is dropping the remaining 10 cases, which could have led to expulsion, suspension, course failure, or misconduct marks for some students.

“I have decided to dismiss all the honor code charges,” Duane Compton, the medical school dean, wrote in an email to the Geisel community on Wednesday.

Compton said the students’ academic records won’t be affected, the newspaper reported.

“I have apologized to the students for what they have been through and believe dismissal of the charges is the best path forward,” he wrote.

Compton said the reversal came “upon further review and based on new information received from our learning management system provider,” according to the Associated Press (AP). A Dartmouth spokesman told The New York Times that the school couldn’t comment on the decision to drop the charges. The agreements between the school and the students aren’t yet final, the newspaper reported. The students didn’t respond to requests for comment.

In a virtual town hall meeting in April, Compton said the investigation began after a witness reported that students appeared to be using Canvas during exams, the AP reported. In Wednesday’s email, Compton said the medical school will review a proposal for open-book exams in preclinical courses, hold in-person exams for all students during the next academic year, and improve communication between the administration and students.

The investigation at Dartmouth drew widespread attention, spurring conversation among educational experts and technology specialists. Although universities use special software to lock down devices during remote exams, Geisel also used Canvas to track student activity, The New York Times reported. Technology experts said the software isn’t designed to work in a forensic way and to distinguish between automated and human activity.

The post-accusation procedures also drew criticism, The New York Times reported. Some of the students said they had less than 48 hours to respond to charges, that they did not receive complete data logs of their activity, and that they were advised to plead guilty. Compton denied these claims during an interview with the newspaper in April. In this week’s email to the Geisel community, he took a more conciliatory tone.

“As we look to the future, we must ensure fairness in our honor code review process, especially in an academic environment that includes more remote learning,” he wrote. “We will learn from this and we will do better.”

Carolyn Crist is a Georgia-based journalist specializing in health, medicine, business, and education.

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This post originally appeared on Medscape Medical News Headlines

The NHS says you should allow it to share your medical records next month, here's why

NHS Data Share How To Opt Out Medical Records UK Database Database

NHS has confirmed why it thinks patients should allow it to share their medical records (Image: GETTY • NHS)

If you didn’t know, the NHS is planning to make the medical records of some 55 million people available to academic and commercial partners later this month, unless the patients themselves decide to opt-out before the deadline. The change, which will see records brought together in a centralised database, only applies to people living in England and registered with a GP surgery.

While there’s still time to opt-out of the data-sharing, which kickstarts on June 23, 2021. Ahead of the upcoming deadline, NHS Digital is making the case for its new policy, which it says will be used “for research that results in better treatments, and to save lives”.

According to NHS Digital, which runs the country’s healthcare IT systems, a new centralised database is needed because the current system used by GP surgeries, known as General Practice Extraction, is over a decade old. While sensitive information, including mental and sexual health data, criminal records, full postcode and date of birth, is included in the database. NHS Digital says that anything that could be used to identify you from your records will be pseudonymised before it’s uploaded from your local GP practice.

“This means that this data is replaced with unique codes so patients cannot be directly identified in the data which is shared with us. The data is also securely encrypted,” NHS Digital explains.

However, the code to unscramble the anonymised data will be held by the NHS. This is different from the approach taken by some tech companies, including Apple and WhatsApp, which do not store the digital keys that could unscramble the anonymised data. That’s why Apple refused to help FBI investigators who hoped to unlock an iPhone owned by one of the terrorist suspects.

NHS Data Share How To Opt Out Medical Records UK Database Database

The software to store GP records is over a decade old, so NHS Digital is centralising everything (Image: GETTY )

According to Apple CEO Tim Cook, “In today’s digital world, the ‘key’ to an encrypted system is a piece of information that unlocks the data, and it is only as secure as the protections around it. Once the information is known, or a way to bypass the code is revealed, the encryption can be defeated by anyone with that knowledge. In the physical world, it would be the equivalent of a master key, capable of opening hundreds of millions of locks – from restaurants and banks to stores and homes. No reasonable person would find that acceptable.”

NHS Digital will hold the keys to unlock its anonymised data, but says it will “only ever re-identify the data if there was a lawful reason to do so and it would need to be compliant with data protection law”. In an example scenario of why medical records would be un-scrambled to reveal the identity of the patient, NHS Digital adds: “a patient may have agreed to take part in a research project or clinical trial and has already provided consent to their data being shared with the researchers for this purpose.”

NHS Digital publishes a list of who it shares its database of anonymised records with, which is updated each month, however, privacy campaigners say it can be extremely difficult to find out who sees the data due to the NHS’ “opaque” commercial relationships. For its part, the NHS says that patient data is never used for insurance or marketing purposes, promoting or selling products or services, market research, or advertising.

How to stop NHS Digital collecting your records for its database

The NHS wants to make medical records of roughly 55 million people available to academic and commercial partners from July 1, 2021. Unless you decide to opt-out before the deadline, records from your GP surgery will be brought together in a centralised database. It’s worth noting the change only applies to those living in England.

The deadline to opt-out of the data-grab is June 23, 2021. Ahead of the upcoming deadline, NHS Digital is making the case for its new policy, which it says will be used “for research that results in better treatments, and to save lives”.

However, if you decide to remove yourself from the database, you’ll need to fill out a form and submit it to your GP.

If you don’t do this before the deadline, your medical records will become a permanent feature of the NHS Digital database. Opting out after June 23 will still work, but will only apply to future data – any historic data will still be available to researchers, academic and commercial partners of the NHS. You can find the form required to opt out here.

If you’re not comfortable with the upcoming changes, there is still time to opt-out.

However, NHS Digital says that – should too many people decide to keep their medical records under lock and key – it could have serious consequences for research and cutting-edge new treatments in England.

“If a large number of people choose to opt out then the data becomes less useful for planning services and conducting research,” NHS Digital warns in a FAQ on its website about the incoming policy. “This is a particular problem if people from certain areas or groups are more likely to opt out. If that happens then services may not reflect the needs of those groups or areas and research may reach misleading conclusions.”

Of course, the final concern that most patients will have about the data-sharing is whether the NHS stands to make money from your private healthcare records. According to NHS Digital, that’s not going to happen.

“NHS Digital does not sell data,” it states in the FAQ, “It does however charge those who want to access its data for the costs of making the data available to them. This is because we are not funded centrally to do this. Charges only cover the cost of running the service and means that those organisations who need access to the data bear the costs of this, rather than NHS Digital. We do not make profits from the service.”

NHS Digital outlines how patient data is used

Digital rights campaigners Foxglove have questioned the legality of the upcoming change in a letter sent to the Department of Health and Social Care. According to Solicitor Rosa Curling, the public have not been given enough time to learn about the changes and decide whether to opt-out. Writing in a letter to the Government department, Curling states: “Very few members of the public will be aware that the new processing is imminent, directly affecting their personal medical data.”

To remove yourself from the database, you’ll need to fill out a form and submit it to your GP. If you don’t do this before the deadline, your medical records will become a permanent feature of the NHS Digital database. Opting out after June 23 will still work, but will only apply to future data – any historic data will still be available to researchers, academic and commercial partners of the NHS. You can find the form required to opt out here.

Advocacy group MedConfidential, a privacy-focused group that has been pivotal in raising the alarm about the impending deadline, told the Financial Times: “They’re trying to sneak it out, they are giving you six weeks nominally and if you do not act based on web pages on the NHS digital site and some YouTube videos and a few tweets, your entire GP history could have been scraped, never to be deleted.”

Author:
This post originally appeared on Daily Express :: Tech Feed

Ridges in nails – should you be worried? Signs you need to seek medical attention

Ridges on the finger nails can merely be a sign of ageing, a vitamin deficiency or dehydration, or as a result of a skin condition such as dry skin or eczema. But in some cases, ridges can signal something more serious. According to Dr Ross Perry of skin clinic chain Cosmedics, slight ridges are normal and can develop during the ageing process as when cell growth slows and lessens, so as you age it may not be unusual to see this happen.

He continued: “Nutritional factors such as deficiencies in vitamins such as Vitamin A, or if your body is low in protein or calcium then you may notice ridges.

“Severe iron deficiencies could also create ridges and other changes to the nails.”

But he warned, if ridges are accompanied with discolouring it may be caused by a medical condition and you may need to seek medical advice.

Dr Perry also advised: “Severe, deep ridges albeit rare could be a symptom of a more serious medical condition such as kidney disease and would need medical tests to determine the cause.

READ MORE: Vitamin B12 supplement: Two indications on your feet that you’re deficient in the nutrient

“Diabetes could also be the underlying health reason for this.”

Trauma to the nails can also cause defects such as ridges, so the advice is to never pick your nails.

But Dr Perry recommends: “If you experience any sudden changes to your fingernails it is always advised to seek medical attention.”

So what’s the difference between vertical and horizontal ridges on the nails?

Dr Anita Takwale, consultant dermatologist and specialist in hair and nail disorders at Stratum Clinics, goes into detail about vertical ridges.

DON’T MISS

She explained: “Longitudinal ridges on the nails if occurring on thumbs could be due to trauma inflicted on the nail folds like habit-tic which is the most common problem.

“The other causes associated with skin changes either along the finger pulps or the rest of the skin could be secondary to inflammatory disorders like eczema or psoriasis or infections like paronychia which may produce transverse ridges.”

Horizontal ridges on the nails are sometimes referred to as Beau’s lines.

The condition was named by a French physician, Joseph Honore Simon Beau, who first described it in 1846.

Mayo Clinic says: “Beau’s lines are indentations that run across the nails.

“The indentations can appear when growth at the area under the cuticle is interrupted by injury or severe illness.

“Conditions associated with Beau’s lines include uncontrolled diabetes and peripheral vascular disease, as well as illnesses associated with a high fever, such as scarlet fever, measles, mumps and pneumonia.

“Beau’s lines can also be a sign of zinc deficiency.”

Parallel white lines that run all the way across the nail could be a sign of low levels of protein in the blood, according to Roxane Bakker, Registered Dietitian and Head of Nutrition at www.vitl.com.

She said: “If you notice these, contact your GP as soon as possible and monitor your protein intake.”

She added: “White spots on your fingernails are actually rather common and there can be a number of reasons why they might appear.

“Most white spots on your nails are harmless and shouldn’t be a cause for concern.”

Author:
This post originally appeared on Daily Express :: Health Feed
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GPs are fighting NHS plans to share your medical records with private companies next month

As it stands, all 36 GP surgeries in the London Borough of Tower Hamlets have agreed to withhold the data when collection begins July 1, 2021. An email calling on colleagues to mirror the protest has now been circulated to some 270 practices in England, The Guardian has reported.

Doctors believe the automatic siphoning of NHS medical records, including details on mental and sexual health data, criminal records, and more, will undermine trust between patients and their GP, Dr Ameen Kamlana, who is based in Tower Hamlets and taking part in the protest, has claimed.

“There’s an immense amount of good that can come from responsible and secure use of public data, public health records,” Dr Kamlana told The Guardian. “However, our issue here with this particular proposal is that it’s been rushed through. There has been no public information campaign to inform the public about the plans, and in order to allow them to decide for themselves whether they are happy about it.

“Essentially what’s being asked for here is people’s entire health record, so everything that we’ve coded in people’s records from the time of their birth to the time of their death, including their physical, mental and sexual health, including their health-related concerns with family and work and including their drug and alcohol history. Essentially all your most intimate private details of your life is being asked to be handed over and we were concerned that the public aren’t aware of what’s being done.”

Not included in NHS Digital’s upcoming database will be patient’s full addresses, any images or videos taken during private consultations, or legally restricted data, such as IVF treatment or gender reassignment.

NHS Digital says that anything in your records that could be used to directly identify you will be scrambled before it’s uploaded from your local GP practice. However, the organisation admits this process is completely reversible – NHS Digital will hold onto the code that unscrambles the data to its original state.

It claims that it will only ever reverse the anonymised data to reveal the identity of the patient “if there was a lawful reason to do so and it would need to be compliant with data protection law”. However, privacy campaigners have criticised the plans as “legally problematic”.

The records of 55 million patients in England compiled next month will then be made available to academics and commercial third parties, privacy campaigners have claimed. These records will be used for research and planning, with NHS Digital claiming that records “decide what new health and care services are required in a local area, informs clinical guidance and policy, and supports researching and developing cures for serious illnesses, such as heart disease, diabetes, and cancer.”

If you’d like to be omitted from the database, there is still time to remove your NHS records. To be exempt from the data-grab, you’ll need to fill out a form and submit it to your GP.

If you don’t do this before the deadline, which is June 23, 2021, your medical records will become a permanent feature of the NHS Digital database. Opting out after June 23 will still work, but will only apply to future data – any historic data will still be available to researchers, academic and commercial partners of the NHS. You can find the form required to opt out here.

Advocacy group MedConfidential, a privacy-focused group that has been pivotal in raising the alarm, told the Financial Times: “They’re trying to sneak it out, they are giving you six weeks nominally and if you do not act based on web pages on the NHS digital site and some YouTube videos and a few tweets, your entire GP history could have been scraped, never to be deleted.”

Speaking to Express.co.uk, a spokesperson for NHS Digital spokesperson said: “Patient data is already used every day to plan and improve healthcare services, for research that results in better treatments, and to save lives. During the pandemic, data from GPs has been used to benefit millions of us: helping to identify and protect those most vulnerable, roll out our world-leading vaccine programme, and identify hospital treatments, which have prevented people dying from covid.

“We have engaged with doctors, patients, data, privacy and ethics experts to design and build a better system for collecting this data. The data will only be used for health and care planning and research purposes, by organisations that can show they have an appropriate legal basis and a legitimate need to use it. We take our responsibility to safeguard patient data extremely seriously.”

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This post originally appeared on Daily Express :: Tech Feed

Janssen vaccine side effects: Three signs you should get medical attention immediately

The Covid vaccine, developed by Johnson & Johnson’s pharmaceutical arm Janssen, has been shown to be 67 percent effective overall at preventing moderate to severe COVID-19. Some studies have also said it offers complete protection from admission to hospital and death. But like all vaccines, the Janssen vaccine can cause side effects, although it should be noted not everybody gets them.
You should also get urgent medical attention if you get symptoms of a severe allergic reaction.

With a severe allergic reaction a combination of the following symptoms may occur:

  • feeling faint or light-headed
  • changes in your heartbeat
  • shortness of breath
  • wheezing
  • swelling of your lips, face, or throat
  • hives or rash
  • nausea or vomiting
  • stomach pain.

“Very common” side effects, that affect more than one in 10 people, include:

  • headache
  • nausea
  • muscle aches
  • pain where the injection is given
  • feeling very tired

DON’T MISS

“Common” side effects include:

  • redness where the injection is given
  • swelling where the injection is given
  • chills
  • joint pain
  • cough
  • fever

“Uncommon” side effects, that may affect up to one in 100 people, include:

  • rash
  • muscle weakness
  • arm or leg pain
  • feeling weak
  • feeling generally unwell
  • sneezing
  • sore throat
  • back pain
  • tremor
  • excessive sweating
Allergic reactions and hives are classed as “rare” side effects.

At its meeting on April 20, 2021, the European Medicines Agency’s (EMA) safety committee (PRAC) concluded a warning about unusual blood clots with low blood platelets should be added to the product information for the Janssen vaccine.

But PRAC also concluded these events should be listed as very rare side effects of the vaccine.

The Belgium government announced on Wednesday it was suspending vaccination with the Janssen vaccine for people under the age of 41 following the death of a woman who suffered severe side effects after having the jab.

The woman – who was under the age of 40 – died on May 21, after being admitted to hospital with severe thrombosis and platelet deficiency, a statement by the Belgian health ministers said.

She was vaccinated through her employer and outside of the official Belgian vaccination campaign.

If you get any side effects you should talk to your doctor, pharmacist or nurse, even if it’s not listed above.

If you’re concerned about a side effect it can be reported directly via the Coronavirus Yellow Card reporting site or search for MHRA Yellow Card in the Google Play or Apple App Store and include batch/Lot number if available.

Author:
This post originally appeared on Daily Express :: Health Feed
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Teeth health: How to avoid medical emergencies at home – expert weighs in

It was recently reported that more people in Britain stopped visiting the dentist during the pandemic than in any other country in Europe. In fact, research from GSK Consumer Healthcare revealed that 43 percent of Brits visited a dentist less often since the onset of the pandemic. Medical professionals are noticing the impact of this as they see a rise in patients coming in with severe dental and oral problems. Dr Richard Marques spoke exclusively with Expres.co.uk to discuss this concerning issue and offers his top tips for reducing your risk of medical emergencies regarding teeth health.

Dr Marques said: “The Covid-19 pandemic has had long lasting effects in terms of delaying dental services.

“Clinics were closed for varying amounts of time during the initial lockdown, however, outside of the pandemic, the dentistry industry requires meaningful investment to reduce waiting lists in general. Dental health will suffer if this is not prioritised.

“This is very serious for the overall dental health of the nation.

“Dental check-ups are so important. Problems such as cavities can be spotted early and prevented from worsening / leading to bigger problems like root canals or tooth extractions.”

Dr Marques added: “Gum problems should be treated before they progress.

“Bleeding and inflamed gums can ultimately result in wobbly teeth and tooth loss.

“Hygienist appointments are also important to prevent this.

“Finally, and most worrying is the diagnosis of oral cancers which can starts as ulcers and progress from there, although this is very rare.

“To sum up – regular dental visits are vital for maintaining good dental and gum health which can impact overall health as well.”

For at-home tips to help reduce medical emergencies, Dr Marques offers his top tips which include:

  • If your teeth is knocked out, place it in a glass of milk until it can be treated (the milk helps keep an acid-alkali ratio meaning the tooth won’t swell)
  • Take paracetamol (or if safe to do so, ibuprofen) to help reduce the immediate pain
  • Hold an ice pack (or a pack of frozen veg) on areas of swelling
  • Dissolve salt in warm water and swish around the mouth for 60 seconds to help remove bacteria and clear infection
  • Dab a small amount of clove oil on the affected area to help reduce pain 

Author:
This post originally appeared on Daily Express :: Health Feed
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Austin police asking for help finding missing 85-year-old man with medical condition

(KTLA) – Huntington Beach police arrested 149 people after a massive crowd descended on the California beach Saturday for a party promoted in a TikTok video. The crowd grew “unruly,” police said, prompting them to declare an unlawful assembly.

The young party-goers were invited to the event dubbed “Adrian’s kickback” in a viral video, which garnered over 3 million views and caught the attention of local police, who worked with agencies in neighboring cities to prepare for the mass gathering.

Author: Chelsea Moreno
This post originally appeared on KXAN Austin

Similar Outcome With EVT and Medical Tx in Basilar Artery Stroke

New data fail to support an advantage of endovascular therapy (EVT) over standard medical therapy among patients with basilar-artery-occlusion stroke.

In the trial, the likelihood of a favorable outcome was similar between patients randomly assigned to EVT (44.2%) and those who received medical treatment (37.7%). Further, researchers observed a trend toward higher risk for symptomatic intracranial hemorrhage among patients who received EVT vs medical treatment.

Dr Wouter Schonewille

Still, the researchers say they can’t rule out a benefit. “Our results suggest that EVT may be effective in basilar-artery occlusion, but less effective than it is in anterior-circulation stroke,” Wouter J. Schonewille, MD, PhD, a neurologist at St. Antonius Hospital in Nieuwegein, the Netherlands, told Medscape Medical News. “A larger trial might have shown a significant treatment effect.”

The data, from the Basilar Artery International Cooperation Study (BASICS), were published online May 20 in The New England Journal of Medicine.

Stroke resulting from occlusion of the basilar artery is associated with high rates of morbidity and mortality. Beginning in 2015, several studies showed a benefit of EVT for patients with ischemic stroke, but few patients with basilar-artery occlusion have been included in trials of EVT.

Stroke resulting from basilar-artery occlusion is different enough from stroke in the anterior cerebral circulation that trials of EVT among patients with basilar-artery stroke are justified, the researchers suggest.

Revision of Inclusion Criteria

In a prospective trial at 23 international centers, patients with stroke resulting from basilar-artery occlusion were randomly assigned to receive either EVT within 6 hours of stroke onset or medical therapy, which could include intravenous (IV) thrombolysis. Eligible patients were younger than 85 years and had a National Institutes of Health Stroke Scale (NIHSS) score of 10 or greater.

Enrollment was slow, and some enrolling physicians appeared to be unsure about the best treatment approach for particular subgroups of patients. For these reasons, the investigators revised the eligibility criteria 4 years after the trial had begun. They started to allow patients who were aged 85 years or older, those who had an NIHSS score lower than 10, and those with contraindications to IV thrombolysis.

The investigators chose favorable functional outcome, defined as a Modified Rankin Scale (mRS) score of 0 to 3, at 90 days as their primary endpoint. Primary safety endpoints were symptomatic intracranial hemorrhage (ICH) within 3 days of treatment and mortality at 90 days.

The researchers also examined secondary outcomes, including excellent clinical outcome (defined as an mRS score of 0 to 2), and NIHSS score at 24 hours.

During the study period, the investigators identified 424 eligible patients and randomly assigned 300 of them to treatment. The groups that were and that were not assigned to treatment were similar in age (mean, 66.8 years) and sex (38% women).

The researchers assigned 154 patients to EVT and 146 to medical treatment. Three patients in the EVT group and seven patients in the medical group crossed over into the opposite group.

The First Completed Trial

There was no significant difference between the two groups on the primary outcomes.

The rate of favorable functional outcome was 44.2% in the EVT arm and 37.7% in the medical arm (risk ratio, 1.18; 95% CI, 0.92 – 1.50; P = .19).

Within 3 days of treatment, the risk for symptomatic ICH was higher in the EVT arm (4.5%) than in the medical arm (0.7%), but this difference was not statistically significant.

The rate of mortality at 90 days was 38.3% in the EVT group and 43.2% in the medical group (risk ratio, 0.87; 95% CI, 0.68 – 1.12; P = .29).

The rate of excellent outcome was 35.1% in the EVT arm and 30.1% in the medical arm (risk ratio, 1.17; 95% CI, 0.87 – 1.57). NIHSS score at 24 hours was 11.0 in the EVT group and 15.0 in the medical group.

EVT was effective at opening the basilar artery. About 72% of patients in the EVT group achieved successful reperfusion. The rate of basilar-artery patency at 24 hours was 84.5% in the EVT group and 56.3% in the medical group.

“Ours is the first completed trial in patients with basilar-artery occlusion,” said Schonewille. “Other trials, such as AUST and BEST, have been halted prematurely due to a loss of perceived equipoise among investigators.”

In the setting of clinical research, equipoise refers to uncertainty over whether a treatment will provide benefit. The loss of equipoise among stroke centers around the world made it difficult to find centers willing to participate in this study as well as to recruit patients, said Schonewille.

Had the researchers used advanced imaging in patient selection, it could have affected the results as it did in trials of patients with anterior-circulation stroke, said Schonewille. “Including patients with a minor deficit certainly played a role, as these patients did better with standard therapy,” he said.

Thrombolysis might be more effective in basilar-artery occlusion than in anterior-circulation vessel occlusion, he suggested. Because collateral flow is greater in the posterior circulation than in the anterior circulation, basilar-artery occlusion may entail a lower degree of hypoperfusion. This factor could enable a longer time window for recanalization therapy, thus favoring EVT, and create a lower risk for hemorrhage after EVT, said Schonewille.

Absence of Equipoise

These results raise the question of why EVT is beneficial for large-vessel occlusion in the anterior circulation but is not clearly better than medical treatment for stroke resulting from basilar-artery occlusion, writes Marc Fisher, MD, a neurologist at Beth Israel Deaconess Medical Center, in Boston, Massachusetts, in an accompanying editorial. Patient selection may explain this discrepancy, he said.

Advanced imaging was used to select patients in all but one of the trials of EVT in patients with large-vessel occlusion in the anterior circulation, but it was not used in the current study. Similarly, the investigators did not examine the extent of collateral circulation and thrombus when selecting patients. In addition, the mRS is an insufficiently sensitive instrument in this context, Fisher concludes.

“It is very difficult to conduct randomized trials of stroke due to basilar artery occlusion, especially after the 2015 trials,” said Tudor G. Jovin, MD, director of Cooper Neurological Institute, in Camden, New Jersey, who commented on the findings for Medscape Medical News. “The authors should be congratulated for their persistence and perseverance.”

But the study’s main weakness is the fundamental problem facing randomized trials in basilar large-vessel-occlusion stroke, which is the absence of perfect equipoise, said Jovin. “That’s evident from the fact that it took them so long to enroll so few patients,” he said.

Subgroup analysis showed little difference in outcome between patients assigned to treatment before 2017 and those assigned afterward. This finding is dubious, said Jovin, because registry data suggest that outcomes of EVT have improved with improvements in the devices and in systems of care. The outcomes of medical care have not changed.

“In my mind, this is not about what is better, medical therapy versus EVT,” said Jovin. “The fundamental question is what is better, leaving a vessel occluded versus not occluded?” More than half of patients who received medical treatment were successfully recanalized. But the study does not address the question of how to treat patients in whom IV thrombolysis does not work, said Jovin.

In addition, the results do not show that EVT in addition to medical therapy does not work. Rather, they fail to show that EVT works, said Jovin. The authors acknowledge the possibility that EVT is effective in this patient population. “To me, this was an underpowered trial,” said Jovin. “I don’t think it has necessarily answered the question.”

To reach the sample size that they finally achieved, the investigators had to change the study’s inclusion criteria. “This underscores the challenges that we have with this disease,” said Jovin. If the researchers had maintained their original inclusion criteria, the results might well have shown a benefit of EVT, he added.

“My hope is that a meta-analysis will shed some more light into the benefit of this procedure, because I think that it’s going to be very challenging in the future to randomize patients,” said Jovin.

“Cherry Picking” of Patients?

The main contribution of the BASICS trial is that it provides crucial information about the relatively high efficacy of IV thrombolysis in basilar-artery occlusion, said Raul Nogueira, MD, professor of neurology, neurosurgery, and radiology at Emory University School of Medicine, in Atlanta, Georgia, who commented on the findings for Medscape Medical News.

The investigators also provided important data about the use of IV thrombolysis on the basis of the estimated time of basilar-artery occlusion, rather than time from symptom onset. This decision allowed for IV tPA treatment in an additional 10% of the patients, said Nogueira. “While the study was underpowered and had many limitations, it still provides the largest number of randomized patients treated with EVT thus far,” he noted.

The slow pace of recruitment and low number of participants may reflect selection bias, said Nogueira. There seems to have been “cherry picking of the patients that were less likely to benefit from EVT, as many of those who were more likely to benefit were then treated outside the trial,” he added. The participation of many centers with low clinical volumes, and consequently more limited endovascular expertise, also may explain the pace of recruitment.

“It is important to acknowledge the Herculean effort of the BASICS investigators, which clearly represents one of the best studies about basilar-artery occlusion,” said Nogueira. Nevertheless, the reason few high-volume centers participated in the trial, and why many qualifying patients were excluded from it was “poor equipoise, which is critical to the successful completion of any clinical trial.”

The protocol modifications that the investigators made were not enacted to improve the trial, but to ensure that it could be completed. But these modifications were made at the cost of assumptions that had been based on the investigators’ own preliminary findings, said Nogueira. They had the paradoxical result of diluting the treatment effect and increasing the expected effect size.

“I do not believe BASICS should raise any questions about the efficacy of EVT in basilar-artery occlusion patients of moderate to severe clinical severity—even more so in those who are not candidates for IV thrombolysis—as these patients are well known to have a dismal prognosis in the absence of reperfusion,” said Nogueira. The pooled analysis of data from the BASICS and BEST trials that he presented at the International Stroke Conference 2021 indicated a significant benefit of EVT in patients presenting with an NIHSS score of 10 or greater.

“The BASICS trial elegantly highlights how efficacious IV thrombolysis can be for basilar-artery occlusion patients and calls for new studies aimed to expand the time window for IV thrombolysis in this patient population,” Nogueira concluded.

The study was supported by the Dutch Heart Foundation, the Swiss Heart Foundation, the São Paulo Research Foundation, the National Council for Scientific and Technological Development in Brazil, the University Medical Center Utrecht, and St. Antonius Hospital Nieuwegein. Schonewille has disclosed no relevant financial relationships. Fisher has received personal fees from AstraZeneca, Simere USA, Lumosa, and ALLM for unrelated work. Jovin was a principal investigator of a previous randomized trial of EVT in basilar-artery occlusion. Nogueira had no disclosures that were directly related to the BASICS trial.

N Engl J Med. 2021;384:1910-1920. Abstract, Editorial

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Maradona medical team ‘deficient and reckless’ before football icon’s death, investigators say

Author: RT
This post originally appeared on RT Sport News

A medical board investigating the death of Diego Maradona has concluded that the team treating the Argentine football icon before his passing had acted “inappropriately,” according to reports.

Maradona died of heart failure aged 60 last November, a loss which sent his nation and the wider sporting world into deep mourning.

Recriminations have raged on regarding the treatment that the World Cup winner was receiving around the time of his death, which came just weeks after he had undergone brain surgery.

A medical board set up in Argentina to probe the death has now concluded that Maradona’s medical team were “reckless” in their care of the former Napoli and Boca Juniors icon.  

“The action of the health team in charge of treating DAM (Diego Armando Maradona) was inadequate, deficient and reckless,” said a report shared with Reuters by a source close to the investigation.

The report added that Maradona had become seriously ill around 12 hours before his death, and that “he presented unequivocal signs of a prolonged agonizing period, so we conclude that the patient was not properly monitored from 00:30 on 11/25/2020.”

Maradona’s private doctor, Leopoldo Luque, was targeted by investigators after the star’s passing, with his home and offices being raided last year as part of a probe into potential involuntary manslaughter.

Luque has denied any wrongdoing and was not charged. 

Also on rt.com Diego Maradona doctor ‘investigated for manslaughter’ as Argentine police raid home and clinic

Maradona’s family have been vocal in their calls for the circumstances of his death to be clarified, while in March, Argentines took to the streets to call for “justice for Diego” as they demanded answers as to whether negligence had been a factor.

Maradona’s ex-wife, Claudia Villafane, and two of his daughters, Dalma and Gianinna, were part of the protest.

The football star famously fought addiction to drink and drugs throughout his playing days and post-career life, although an autopsy in December revealed no traces of alcohol or narcotics in his body at the time of death – but did confirm the presence of psychotropic drugs used to treat anxiety and depression.

Maradona passed away while he was recuperating in Tigre, just outside Buenos Aires. A World Cup winner, he provided some of the most iconic moments in football history – including his famous ‘Hand of God’ and solo goals against England in their quarter-final in Mexico in 1986.

Also on rt.com Maradona daughter rages at ‘sons of b*tches’ as autopsy finds NO alcohol or narcotics in Argentine icon’s body at time of death

Monuments and memorials to the late star include Italian club Napoli remaining their stadium in his honor. Maradona enjoyed the best days of his club career in southern Italy, guided the team of gritty underdogs to a first ever Serie A in 1987 – a title they won again in 1990. Led by Maradona, the Italians also lifted the UEFA Cup in 1989.     

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