引言血管性认知损害（vascular cognitive impairment,VCI）诊断共识的缺乏（体现为多种不同评估方案的使用）,妨碍了对其理解和治疗的推进.多个国家的大量临床医生和研究人员参与了2个阶段血管性认知损害分类共识研究（Vascular Impair...引言血管性认知损害（vascular cognitive impairment,VCI）诊断共识的缺乏（体现为多种不同评估方案的使用）,妨碍了对其理解和治疗的推进.多个国家的大量临床医生和研究人员参与了2个阶段血管性认知损害分类共识研究（Vascular Impairment of Cognition Classification Consensus Study,VICCCS）,旨在就VCI的诊断原则（VICCCS-1）和诊断方案（VICCCS-2）达成一致意见.本文提供了VICCCS-2的相关内容.方法使用VICCCS-1达成的原则和已发表的诊断指南作为在线德尔菲（Delphi）调查的参考基点,以期对VCI的临床诊断达成共识.结果共进行了6轮调查,每轮有65～79名专家参与,他们就VICCCS修订的轻度和重度VCI的诊断指南达成共识,并肯定了美国国立神经疾病与卒中研究所-加拿大卒中网（National Institute of Neurological Disorders and Stroke–Canadian Stroke Network,NINDS-CSN）发布的神经心理学评估方案和对影像学检查的推荐意见.讨论VICCCS-2建议规范化应用NINDS-CSN推荐的神经心理学和影像学评估方案诊断VCI,以促进研究协作.展开更多
Background and purpose:Providing participants with evidence-based care for secondary prevention is an ethical and scientific priority for trials in stroke therapy.The optimal strategy,however,is uncertain.We report th...Background and purpose:Providing participants with evidence-based care for secondary prevention is an ethical and scientific priority for trials in stroke therapy.The optimal strategy,however,is uncertain.We report the performance of a new approach for delivering preventive care to trial participants.Methods:Participants were enrolled in the Insulin Resistance Intervention after Stroke trial,which examined the insulin sensitiser,pioglitazone versus placebo for prevention of stroke and myocardial infarction after ischaemic stroke or transient ischaemic attack.Preventive care was the responsibility of the participants’personal healthcare providers,but investigators monitored care and provided feedback annually.We studied achievement of 8 prevention goals at baseline and 3 annual visits,with a focus on 3 priority goals:blood pressure<140/90 mm Hg,lowdensity lipoprotein(LDL)cholesterol<2.59 mmol/L and antithrombotic therapy.Results:The proportion of participants achieving the priority goals was highest for antithrombotic use(96–99%in each year)and similar for blood pressure(66–72%in each year)and LDL(68–70%in each year).All 3 priority goals were achieved by 47–52%of participants in any given year.However,only 22%of participants achieved all 3 goals in each year.Conclusions:A strategy of monitoring care and providing feedback was associated with high average yearly achievement of 3 priority secondary prevention goals,but the majority of trial participants did not persist in being at goal over time.Trial registration number:NCT00091949.展开更多
文摘引言血管性认知损害（vascular cognitive impairment,VCI）诊断共识的缺乏（体现为多种不同评估方案的使用）,妨碍了对其理解和治疗的推进.多个国家的大量临床医生和研究人员参与了2个阶段血管性认知损害分类共识研究（Vascular Impairment of Cognition Classification Consensus Study,VICCCS）,旨在就VCI的诊断原则（VICCCS-1）和诊断方案（VICCCS-2）达成一致意见.本文提供了VICCCS-2的相关内容.方法使用VICCCS-1达成的原则和已发表的诊断指南作为在线德尔菲（Delphi）调查的参考基点,以期对VCI的临床诊断达成共识.结果共进行了6轮调查,每轮有65～79名专家参与,他们就VICCCS修订的轻度和重度VCI的诊断指南达成共识,并肯定了美国国立神经疾病与卒中研究所-加拿大卒中网（National Institute of Neurological Disorders and Stroke–Canadian Stroke Network,NINDS-CSN）发布的神经心理学评估方案和对影像学检查的推荐意见.讨论VICCCS-2建议规范化应用NINDS-CSN推荐的神经心理学和影像学评估方案诊断VCI,以促进研究协作.
基金The IRIS trial was funded by a research grant(U01NS044876)from the US National Institute of Neurological Disorders and Stroke.Pioglitazone and placebo were provided by Takeda Pharmaceuticals International.GAF is supported by an NIHR Senior Investigator Award.
文摘Background and purpose:Providing participants with evidence-based care for secondary prevention is an ethical and scientific priority for trials in stroke therapy.The optimal strategy,however,is uncertain.We report the performance of a new approach for delivering preventive care to trial participants.Methods:Participants were enrolled in the Insulin Resistance Intervention after Stroke trial,which examined the insulin sensitiser,pioglitazone versus placebo for prevention of stroke and myocardial infarction after ischaemic stroke or transient ischaemic attack.Preventive care was the responsibility of the participants’personal healthcare providers,but investigators monitored care and provided feedback annually.We studied achievement of 8 prevention goals at baseline and 3 annual visits,with a focus on 3 priority goals:blood pressure<140/90 mm Hg,lowdensity lipoprotein(LDL)cholesterol<2.59 mmol/L and antithrombotic therapy.Results:The proportion of participants achieving the priority goals was highest for antithrombotic use(96–99%in each year)and similar for blood pressure(66–72%in each year)and LDL(68–70%in each year).All 3 priority goals were achieved by 47–52%of participants in any given year.However,only 22%of participants achieved all 3 goals in each year.Conclusions:A strategy of monitoring care and providing feedback was associated with high average yearly achievement of 3 priority secondary prevention goals,but the majority of trial participants did not persist in being at goal over time.Trial registration number:NCT00091949.
