Clinical retrospective

Horan RF, Austen KF Systemic mastocytosis retrospective review of a decade s clinical experience at the Brigham and Womens Hospital. J Invest Dermatol 1991 96 5S-13S. 

A variety of data sources are available to inform interactive programs, including prospective data sets, retrospective databases, expert opinion, and unpub-lished/published literature. Time horizon, that is, the length of time into the future considered in the analysis over which costs and outcomes are projected, is very important here [26]. For example, if a clinical trial or the published literature only report short-term results for a chronic condition, the outcomes may come into question. This is where decision-analytic models may come... 

No direct comparison trials have been reported between the different thrombolytic agents in acute ischemic stroke. In a retrospective review of the results for acute stroke lAT performed at our center, we have found significantly higher rates of recanalization and good clinical outcome in the era in which lA UK was used versus the era in which UK was not available and lAT with rt-PA was the primary treatment. Conversely, in another retrospective study, Eckert et al. found no major difference between the recanalization rates of UK and rt-PA. 

In rodent stroke models, statin pretreatment has been shown to reduce infarct volumes and improve outcomes. Similarly, several clinical studies have shown that prior statin use reduced the severity of acute ischemic stroke and myocardial infarction. Recent studies indicate that beneftt can be achieved even when treatment is initiated after the onset of symptoms. In rodents, atorvastatin and simvastatin have been shown to reduce the growth of ischemic lesions, enhance functional outcome, and induce brain plasticity when administered after stroke onset. A retrospective analysis of the population-based Northern Manhattan Stroke Study (NOMASS) showed that patients using lipid-lowering agents at the time of ischemic stroke have a lower incidence of in-hospital stroke progression and reduced 90-day mortality rates. Retrospective analysis of data of the phase III citicoline trial showed... 

Qureshi et al." evaluated the timing of deterioration in patients with massive MCA strokes in a multicenter retrospective chart review. They found that 68% of patients manifested clinical deterioration by 48 hours, and nearly another 20% did so by 72 hours. Thus, the first 3-5 days appears to be the most crucial time for detecting patients at high risk for deterioration, although there was a small minority of patients who had deterioration at greater than 5 days from symptom onset. Early impairment in consciousness was also found to be predictive of mortality in one cohort of patients within a randomized chnical trial." One postmortem study of 192 patients found features in 45 patients that they postulate led to mahgnant ... 

Warfarin has not been adequately studied in non-cardioembolic stroke, but it is often recommended in patients after antiplatelet agents fail. One small retrospective study suggests that warfarin is better than aspirin.30 More recent clinical trials have not found oral anticoagulation in those patients without atrial fibrillation or carotid stenosis to be better than antiplatelet therapy. In the majority of patients without atrial fibrillation, antiplatelet therapy is recommended over warfarin. In patients with atrial fibrillation, long-term anticoagulation with warfarin is recommended and is effective in both primary and secondary prevention of stroke.12 The goal International Normalized Ratio (INR) for this indication is 2 to 3. 

Major drawback Dose, indication, timing may not be standardized and therefore could confound associations if prospective, then same drawback as clinical trial if retrospective, same drawback as case-control Prospective study requiring follow-up time until endpoints develop to measure response... 

This hypothesis was investigated in a retrospective analysis of the response to an ALOX5 inhibitor, ABT-761, which is clinically similar to zileuton. In 221 patients with asthma who received either high-dose ABT-761 (n= 114) or placebo (n= 107] treatment, approximately 6% of asthmatic patients had no wild-type allele... 

Clinical trials serve to assess the safety and efficacy of any potential new therapeutic intervention in its intended target species. In our context, an intervention represents the use of a new biopharmaceutical. Examples of other interventions could be, for example, a new surgical procedure or a novel medical device. Veterinary clinical trials are based upon the same principles, but this discussion is restricted to investigations in humans. Clinical trials are also prospective rather than retrospective in nature, i.e. participants receiving the intervention are followed forward with time. 

Diagnosis Clinical diagnosis. Physical findings are usually non-specific. Chest X-ray may reveal a pneumonic process, mediastinal lymphadenopathy or plural effusion. Routine culture is possible but difficult. The diagnosis can be established retrospectively by serology. As for treatment, administration of antibiotics such as streptomycin or gentamicin with early treatment can be very effective. 

Prospectively and retrospectively evaluate, explain and extrapolate from the relationships between nonclinical trial findings and adverse clinical trial... 

In the broadest sense, genotyping can also be used in proof-of-principle trials and for individualization and modification of dose based on genotype. Associations between genotypes and clinical outcomes can also be explored retrospectively, as was the case for abacavir,20 21 but these are mainly exploratory and would need confirmation in a clinical trial prospectively. An important distinction was made between two types of genome-based enrichment the first type (preferred) is when there is a well-understood, genome-based pathophysiological ability to select responders and nonresponders, and the second type is when genomic-based predictions of differences in response are... 

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