A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction

Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.

An Exploratory Investigation of Difficulties in Applying Functional Behavior Assessment and Implementing Behavioral Intervention Plans in ADHD Programs in Saudi Arabia

Functional behavior assessment(FBA)and behavioral intervention plans(BIPs)can be effective for students with attention deficit hyperactivity disorder(ADHD);however,teachers may face difficulties when implementing FBA procedures and,in turn,BIPs because of lack of time,insufficient training,and multiplicity of beliefs.Thus,it is important to identify the difficulties teachers may face and the obstacles that can deter them from implementing intervention plans.This is a worthwhile endeavor because nearly all classrooms will have students with behavioral problems who will benefit from specifically designed educational interventions.This study aimed to identify the difficulties in applying FBA and the barriers in implementing BIPs among Saudi teachers in specialized ADHD programs.Using the descriptive-analytical approach,a questionnaire targeting difficulties and barriers was admi-nistered to 209 public school teachers from specialized ADHD programs in Saudi Arabia.The results revealed that the difficulty level of applying FBA in ADHD programs was high.The level of barriers in implementing BIPs was moderate.Finally,the study indicated that barriers in implementing BIPs could be predicted by the difficulties of applying FBA.The results suggest the importance offinding better practices,restructuring the provision of ADHD programs,training teachers,improving assessment tool availability,and ensuring cooperation between school administrators and teachers.