Julian Maingard

Bio: Julian Maingard is an academic researcher from Deakin University. The author has contributed to research in topics: Medicine & Aneurysm. The author has an hindex of 14, co-authored 87 publications receiving 755 citations. Previous affiliations of Julian Maingard include Austin Hospital & Monash University, Clayton campus.

Optimizing Resources for Endovascular Clot Retrieval for Acute Ischemic Stroke, a Discrete Event Simulation.

Abstract: Objective: Endovascular clot retrieval (ECR) is the standard of care for acute ischemic stroke due to large vessel occlusion. Performing ECR is a time critical and complex process involving many specialized care providers and resources. Maximizing patient benefit while minimizing service cost requires optimization of human and physical assets. The aim of this study is to develop a general computational model of an ECR service, which can be used to optimize resource allocation. Methods: Using a discrete event simulation approach, we examined ECR performance under a range of possible scenarios and resource use configurations. Results: The model demonstrated the impact of competing emergency interventional cases upon ECR treatment times and time impact of allocating more physical (more angiographic suites) or staff resources (extending work hours). Conclusion: Our DES model can be used to optimize resources for interventional treatment of acute ischemic stroke and large vessel occlusion. This proof-of-concept study of computational simulation of resource allocation for ECR can be easily extended. For example, center-specific cost data may be incorporated to optimize resource allocation and overall health care value.

Vertebroplasty and kyphoplasty for osteoporotic vertebral fractures: What are the latest data?

Abstract: Osteoporotic vertebral compression fractures frequently result in significant morbidity and health care resource use. For patients with severe and disabling pain, vertebral augmentation (vertebroplasty and kyphoplasty) is often considered. Although vertebroplasty was introduced >30 years ago, there are conflicting opinions regarding the role of these procedures in the treatment of osteoporotic vertebral compression fractures. This review article updates clinicians on the published prospective randomized controlled data, including the most recent positive trials that followed initial negative trials in 2009. Analysis of multiple national claim datasets has also provided further insight into the utility of these procedures. Finally, we considered the recent recommendations of national organizations and medical societies that advise on the use of vertebral augmentation procedures for osteoporotic vertebral compression fractures.

Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.

Abstract: In this meta-analysis, vertebral augmentation (with either vertebroplasty and/or balloon kyphoplasty) provided a 22% reduction in mortality compared with nonsurgical management in the treatment of ...

Guidelines for Prevention, I

Abstract: Developing and implementing successful interventions often depend upon effectively addressing ethnicity and social class factors, as these influence sexual behavior and its risks. Sexual attitudes differ across cultures. In most cultures, there are strong standards regarding sexual behavior which differ for men and women. Cultural differences also affect the extent to which early sexual behavior is considered acceptable.

Epidemiology of osteoporotic fractures

Abstract: Patients with vertebral, hip, distal radius, and proximal humerus fractures are most common among the osteoporosis-related fractures. The incidences of these fractures increase with age, however, the increase patterns differ between the fracture sites. The prevalence of vertebral fracture for Japanese is similar or slightly higher and the incidences of osteoporosis-related limb fractures are lower than those for Caucacians. A decrease in prevalence of vertebral fractures and an increase in the incidence of limb fractures are the secular trend in Japan. Previous fractures are significant risk factor for both vertebral and hip fractures. Greater physical activity increases the risk of distal radius fractures, and decreases the risk of proximal humerus fractures.

Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial.

Abstract: Importance Whether intravenous thrombolysis is needed in combination with mechanical thrombectomy in patients with acute large vessel occlusion stroke is unclear. Objective To examine whether mechanical thrombectomy alone is noninferior to combined intravenous thrombolysis plus mechanical thrombectomy for favorable poststroke outcome. Design, Setting, and Participants Investigator-initiated, multicenter, randomized, open-label, noninferiority clinical trial in 204 patients with acute ischemic stroke due to large vessel occlusion enrolled at 23 hospital networks in Japan from January 1, 2017, to July 31, 2019, with final follow-up on October 31, 2019. Interventions Patients were randomly assigned to mechanical thrombectomy alone (n = 101) or combined intravenous thrombolysis (alteplase at a 0.6-mg/kg dose) plus mechanical thrombectomy (n = 103). Main Outcomes and Measures The primary efficacy end point was a favorable outcome defined as a modified Rankin Scale score (range, 0 [no symptoms] to 6 [death]) of 0 to 2 at 90 days, with a noninferiority margin odds ratio of 0.74, assessed using a 1-sided significance threshold of .025 (97.5% CI). There were 7 prespecified secondary efficacy end points, including mortality by day 90. There were 4 prespecified safety end points, including any intracerebral hemorrhage and symptomatic intracerebral hemorrhage within 36 hours. Results Among 204 patients (median age, 74 years; 62.7% men; median National Institutes of Health Stroke Scale score, 18), all patients completed the trial. Favorable outcome occurred in 60 patients (59.4%) in the mechanical thrombectomy alone group and 59 patients (57.3%) in the combined intravenous thrombolysis plus mechanical thrombectomy group, with no significant between-group difference (difference, 2.1% [1-sided 97.5% CI, −11.4% to ∞]; odds ratio, 1.09 [1-sided 97.5% CI, 0.63 to ∞];P = .18 for noninferiority). Among the 7 secondary efficacy end points and 4 safety end points, 10 were not significantly different, including mortality at 90 days (8 [7.9%] vs 9 [8.7%]; difference, –0.8% [95% CI, –9.5% to 7.8%]; odds ratio, 0.90 [95% CI, 0.33 to 2.43];P > .99). Any intracerebral hemorrhage was observed less frequently in the mechanical thrombectomy alone group than in the combined group (34 [33.7%] vs 52 [50.5%]; difference, –16.8% [95% CI, –32.1% to –1.6%]; odds ratio, 0.50 [95% CI, 0.28 to 0.88];P = .02). Symptomatic intracerebral hemorrhage was not significantly different between groups (6 [5.9%] vs 8 [7.7%]; difference, –1.8% [95% CI, –9.7% to 6.1%]; odds ratio, 0.75 [95% CI, 0.25 to 2.24];P = .78). Conclusions and Relevance Among patients with acute large vessel occlusion stroke, mechanical thrombectomy alone, compared with combined intravenous thrombolysis plus mechanical thrombectomy, failed to demonstrate noninferiority regarding favorable functional outcome. However, the wide confidence intervals around the effect estimate also did not allow a conclusion of inferiority. Trial Registration umin.ac.jp/ctr Identifier:UMIN000021488

Thrombectomy for Distal, Medium Vessel Occlusions: A Consensus Statement on Present Knowledge and Promising Directions.

Abstract: Endovascular thrombectomy (EVT) is well established as a highly effective treatment for acute ischemic stroke (AIS) due to proximal, large vessel occlusions (PLVOs). With iterative further advances...