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The APC already discusses the expected funding mechanisms for decisions made that affect secondary care -- this will be either via the tariff uplift items within the healthcare resource group ; or via the high cost drug exclusion mechanism. Though at an early stage we plan to use the APC as a place to discuss and agree additions of new drugs to the PbR exclusion list the Annex B agents such as cytokine inhibitors ; . It will allow us to consider broader indications of drugs on the list and new agents where they become available. The latter is provided for in the technical guidance under paragraph 34 ; . The agreed approach may well be taken as advice to commissioning bodies rather than a final decision, but it seems a good way to ensure expert advice on the subject. What works well is that discussion helps to clarify for PCT and Trust members the funding consequences of decisions, but it is too early to be sure this will works satisfactorily. What isn't so good is that these mechanisms are not straightforward and are evolving, it is hard for members of the APC to understand the detail on this. For further details contact: Martin Stephens, Director of Clinical Effectiveness, Southampton University Hospitals NHS Trust Email: martin ephens suht.swest.nhs, because ibuprofen. Hypothermia has been shown to provide profound neuroprotection in a variety of experimental and clinical settings. Unfortunately, implementation of hypothermia clinically has been hampered by slow and inexact delivery techniques. Recently, we have developed a novel intravascular hypothermia catheter INNERCOOL therapies, San Diego, CA ; that can produce rapid, controlled cooling of the body. The purpose of the study was to examine the safety and efficacy of delayed hypothermia in a primate stroke model using the cooling catheter. Methods: Eight baboons 20 25 kg ; were enrolled in the hypothermia arm of the study and compared to eight control animals that underwent stroke without placement of the catheter. Hemispheric stroke was created by transorbital occlusion of the left internal carotid and bilateral anterior communicating arteries for one hour. The uniformity and adequacy of the ischemic insult was confirmed with intraoperative motor evoked potentials. Ninety minutes after the clips were removed 150 minutes after the onset of ischemia ; , the cooling catheter 10 french ; was placed into the inferior vena cava via the femoral vein. Hypothermia to 32 C was then induced and 484 maintained for 6 hours. Infarct volume on 72h T2-MRI, survival self-sufficiency, and neurologic Effective treatment windows for hyperbaric oxygen in transient and score at days 3 and 9 were evaluated. Animals that were not self-sufficient were sacrificed on permanent focal cerebral ischemia day 3. Results: Cooling from 37 C to was rapid and uniform 6.3 0.8 C h ; with animals reaching the target temperature on average 3h after the onset of ischemia. Re-warming was Robert Silbergleit, Wen Ye also easily controlled with animals reaching 36 C within 6: 30h 30 min, without notable rises in ICP as measured by fiberoptic intraparenchymal probe. Hypothermic animals showed a 47% Objective: Hyperbaric oxygen HBO ; reduces brain infarct volume in animal models of stroke reduction in infarct volume, a 87% increase in self-sufficiency hypothermia: 6 7 vs. when treatment is begun soon after the onset of ischemia and when duration of ischemia is normothermia: 3 9 ; , and 45% and 58% improvements in neurologic score at days 3 and 9 short. We studied the effect of longer, clinically relevant treatment intervals with HBO in p NS for all comparisons ; . There was no evidence of pulmonary embolus, DVT, infection, transient ischemia of varying duration and in permanent focal ischemia. Methods: Permanent bleeding, hemorrhagic transformation, or other adverse events attributed to the catheter. middle cerebral artery occlusion p-MCAO ; or temporary middle cerebral artery occlusion Conclusions: Together, these preliminary data suggest that perhaps mild core hypothermia may t-MCAO ; of 2, 3, 4, or 5 hours duration was performed in 105 rats by intraluminal suture be protective in the setting of reperfused stroke even at clinically relevant time points and that technique. A sudden drop in cortical cerebral blood flow CBF ; , measured by continuous laser an intravenous cooling catheter provides a safe, rapid and exquisitely reproducible way in Doppler flowmetry, confirmed MCAO during suture Downloaded from stroke.ahajournals by induce both hypothermia 2007 as subsequent normothermia. insertion. Animals were treated with air at which to on September 21, as well.

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