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Pre hospital management of stroke

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https://www.readbyqxmd.com/read/29218822/european-academy-of-neurology-european-stroke-organisation-consensus-statement-and-practical-guidance-for-pre-hospital-management-of-stroke
#1
A Kobayashi, A Czlonkowska, G A Ford, A C Fonseca, G J Luijckx, J Korv, N Pérez de la Ossa, C Price, D Russell, A Tsiskaridze, M Messmer-Wullen, J De Keyser
Reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving chances of a favorable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations...
December 7, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29183926/protocol-for-a-feasibility-randomised-controlled-trial-of-screening-and-enhanced-risk-management-for-vascular-event-related-decline-in-memory-served-memory
#2
Phyo Kyaw Myint, Yoon K Loke, William Davison, Katharina Mattishent, George Christopher Fox, Robert Fleetcroft, David Turner, Lee Shepstone, John F Potter
INTRODUCTION: Stroke is a leading cause of death and disability. The development of dementia after stroke is common. Vascular risk factors (VRF) which contribute to stroke risk can also contribute to cognitive decline, especially in vascular dementia (VaD). There is no established treatment for VaD, therefore strategies for prevention could have major health resource implications. This study was designed to assess whether patients with early cognitive decline after stroke/transient ischaemic attack (TIA) can be easily identified and whether target-driven VRF management can prevent progression to dementia...
November 28, 2017: BMJ Open
https://www.readbyqxmd.com/read/29181841/epidural-therapy-for-the-treatment-of-severe-pre-eclampsia-in-non-labouring-women
#3
REVIEW
Amita Ray, Sujoy Ray
BACKGROUND: Pre-eclampsia is a pregnancy-specific multi-organ disorder, which is characterised by hypertension and multisystem organ involvement and which has significant maternal and fetal morbidity and mortality. Failure of the placental vascular remodelling and reduced uteroplacental flow form the etiopathological basis of pre-eclampsia. There are several established therapies for pre-eclampsia including antihypertensives and anticonvulsants. Most of these therapies aim at controlling the blood pressure or preventing complications of elevated blood pressure, or both...
November 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29181655/the-organisation-of-the-acute-ischemic-stroke-management-key-notes-of-the-italian-neurological-society-and-of-the-italian-stroke-organization
#4
E Agostoni, A Carolei, G Micieli, L Provinciali, D Toni, Simone Vidale
The main aim of acute ischemic stroke treatment is the as much possible prompt, safe and effective arterial recanalisation, in order to restore reperfusion into the ischemic brain area. The procedures obtaining this result are rapidly evolving and in the last years, we observed new evidences that affirmed the therapeutical benefit of the concomitant treatment using endovenous thrombolysis and mechanical thrombectomy in selected patients with ischemic stroke. However, all treatments are time-sensitive and the main limitation for their application is represented by the time...
November 27, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/29158105/the-effect-and-associated-factors-of-dispatcher-recognition-of-stroke-a-retrospective-observational-study
#5
Ming-Ju Hsieh, Kuo-Liong Chien, Jen-Tang Sun, Sung-Chun Tang, Li-Kai Tsai, Wen-Chu Chiang, Yu-Chun Chien, Jiann-Shing Jeng, Matthew Huei-Ming Ma
BACKGROUND/PURPOSE: Details of the communication between the caller and dispatcher have not been reported previously in Taiwan. This study aimed to: (1) understand the details of the communication between the caller and dispatcher among the calls for stroke patients, (2) identify factors associated with stroke recognition by dispatchers, and (3) evaluate the association between stroke recognition by dispatchers and stroke management. METHODS: We conducted a retrospective observational study involving patients with stroke or transient ischemic stroke transported by the emergency medical service, and arriving at 9 hospitals in Taipei within 3 h of symptom onset from January 1, 2013 to February 28, 2014...
November 17, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/29153847/effect-of-incentive-payments-on-chronic-disease-management-and-health-services-use-in-british-columbia-canada-interrupted-time-series-analysis
#6
M Ruth Lavergne, Michael R Law, Sandra Peterson, Scott Garrison, Jeremiah Hurley, Lucy Cheng, Kimberlyn McGrail
We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total h ealth care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods...
November 10, 2017: Health Policy
https://www.readbyqxmd.com/read/29123562/the-role-of-occupational-and-physiotherapy-in-multi-modal-approach-to-tackling-delirium-in-the-intensive-care
#7
REVIEW
Jenny Rains, Nigel Chee
The presence of delirium within critical care remains a long-standing challenge for patients and clinicians alike. A myriad of pre-disposing and precipitating factors lead to this patient cohort being high risk for developing delirium during their critical care stay. Until now, non-pharmacological management of these patients usually encompasses a 'bundle' of principles to reduce delirium days. These bundles have limited focus on the entire multi-disciplinary team (including occupational therapists and physiotherapists) who could assist with the reduction of delirium...
November 2017: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29053908/no-time-to-hesitate-in-acute-in-hospital-stroke
#8
EDITORIAL
Annette Fromm
The treatment options for acute ischemic stroke are rapidly improving, and there is high awareness for community-onset stroke, pre-hospital pathways and streamline in-hospital management. However, the management of in-hospital stroke is often less well established, and stringent procedures are frequently missing. Higher rates of in-hospital complications and in-hospital mortality were suggested among in-hospital stroke patients who had been treated with i.v. thrombolysis. This issue is addressed in a new propensity-matched analysis from the SITS-EAST registry...
October 20, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28959873/prognostic-factors-in-chronic-subdural-hematoma-results-from-a-monocentric-consecutive-surgical-series-of-605-patients
#9
Susanna Bacigaluppi, Fedra Guastalli, Nicola L Bragazzi, Alberto Balestrino, Paolo Bruzzi, Gianluigi Zona
BACKGROUND: The study of age-related diseases like chronic subdural hematoma (CSDH) is of high interest, considered the general ageing of the population. This investigation aimed to identify the main clinical characteristics of CSDH patients, to evaluate the impact of the disease on quality of life, its treatment and co-morbidities/complications and to compare our data with other surgical series published over the past 5 years. METHODS: A retrospective cohort study including all consecutive patients operated for CSDH between January 1st 2006 and December 31st 2013 at the Unit of Neurosurgery of our hospital was carried out...
September 28, 2017: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/28927193/timing-of-percutaneous-coronary-intervention-in-patients-with-non-st-elevation-myocardial-infarction-a-swedeheart-study
#10
Daniel Lindholm, Joakim Alfredsson, Oskar Angerås, Felix Böhm, Fredrik Calais, Sasha Koul, Bo Lagerqvist, Henrik Renlund, Giovanna Sarno, Christoph Varenhorst
Aims: Although routine invasive management is recommended in NSTEMI patients, the optimal timing of the procedure is not defined. The aim of this study was to assess outcomes in relation to timing of PCI in NSTEMI patients. Methods and results: This was an observational, prospective, multicentre cohort study from the SWEDEHEART registry including all Swedish PCI centres. We included 40 494 consecutive PCI-treated patients who were admitted to any coronary care unit from 2006 to 2013...
January 1, 2017: European Heart Journal. Quality of Care & Clinical Outcomes
https://www.readbyqxmd.com/read/28892278/reflection-on-stroke-deaths-and-end-of-life-stroke-care
#11
Syed Zujajuddin Quadri, Thang Huynh, Cecilia Cappelen-Smith, Nirupama Wijesuriya, Abul Mamun, Roy Beran, Alan Mcdougall, Dennis Cordato
BACKGROUND: The benefit of palliative care referral for severe stroke patients on end-of-life care pathways (EOLCP) is increasingly recognised. Palliative care provides assistance with symptom management and transition to end-of-life care. Advance care planning (ACP) may help accommodate patient/family expectations and guide management. METHOD: Retrospective study of all stroke deaths (2014-2015) at Liverpool Hospital, Sydney, Australia. Data examined included age, co-morbidities, living arrangements, pre-existing ACP, palliative care referral rates and 'survival time'...
September 11, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28872449/the-pre-hospital-stroke-treatment-organization
#12
Heinrich Audebert, Klaus Fassbender, M Shazam Hussain, Martin Ebinger, Guillaume Turc, Ken Uchino, Stephen Davis, Anne Alexandrov, James Grotta
Background The PRE-hospital Stroke Treatment Organization was formed in 2016 as an international consortium of medical practitioners involved in pre-hospital treatment of patients with acute stroke. Aims PRE-hospital Stroke Treatment Organization's mission is to improve stroke outcomes by supporting research and advocacy for pre-hospital stroke treatment in Mobile Stroke Units. PRE-hospital Stroke Treatment Organization will provide a platform to enhance collaborative research across the spectrum of acute stroke management in the pre-hospital setting...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28800605/stroke-survivors-with-severe-mental-illness-are-they-at-risk-for-increased-non-psychiatric-hospitalizations
#13
Flavius Robert Lilly, Joel Culpepper, Mary Stuart, Donald Steinwachs
BACKGROUND: This study examined outcomes for two groups of stroke survivors treated in Veteran Health Administration (VHA) hospitals, those with a severe mental illness (SMI) and those without prior psychiatric diagnoses, to examine risk of non-psychiatric medical hospitalizations over five years after initial stroke. METHODS: This retrospective cohort study included 523 veterans who survived an initial stroke hospitalization in a VHA medical center during fiscal year 2003...
2017: PloS One
https://www.readbyqxmd.com/read/28729311/a-review-of-rate-control-in-atrial-fibrillation-and-the-rationale-and-protocol-for-the-rate-af-trial
#14
Dipak Kotecha, Melanie Calvert, Jonathan J Deeks, Michael Griffith, Paulus Kirchhof, Gregory Yh Lip, Samir Mehta, Gemma Slinn, Mary Stanbury, Richard P Steeds, Jonathan N Townend
BACKGROUND AND OBJECTIVE: Atrial fibrillation (AF) is common and causes impaired quality of life, an increased risk of stroke and death as well as frequent hospital admissions. The majority of patients with AF require control of heart rate. In this article , we summarise the limited evidence from clinical trials that guides prescription, and present the rationale and protocol for a new randomised trial. As rate control has not yet been shown to reduce mortality, there is a clear need to compare the impact of therapy on quality of life, cardiac function and exercise capacity...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28726651/factors-associated-with-post-stroke-fatigue-within-the-first-3-month-after-stroke
#15
I Delva, N Lytvynenko, M Delva
Aim - identify socio-demographic, personal and psychological factors associated with certain post-stroke fatigue (PSF) domains within first 3 months after stroke. There were examined patients consequently in definite time points after ischemic or hemorrhagic strokes: at hospital stay (234 patients), in 1 month (203 patients) and in 3 months (176 patients). Global PSF and certain PSF domains were measured by multidimensional fatigue inventory-20 (MFI-20) scale. In multivariate logistic regression analysis the majority of variables (gender, marital status, education level, smoking status, level of alcohol consumption, apathetic impairments, arterial hypertension, atrial fibrillation, ischemic heart disease, diabetes mellitus, body mass index, waist circumference) were not significantly associated with any PSF domain risk at any time point after stroke...
June 2017: Georgian Medical News
https://www.readbyqxmd.com/read/28716014/the-comprehensive-post-acute-stroke-services-compass-study-design-and-methods-for-a-cluster-randomized-pragmatic-trial
#16
Pamela W Duncan, Cheryl D Bushnell, Wayne D Rosamond, Sara B Jones Berkeley, Sabina B Gesell, Ralph B D'Agostino, Walter T Ambrosius, Blair Barton-Percival, Janet Prvu Bettger, Sylvia W Coleman, Doyle M Cummings, Janet K Freburger, Jacqueline Halladay, Anna M Johnson, Anna M Kucharska-Newton, Gladys Lundy-Lamm, Barbara J Lutz, Laurie H Mettam, Amy M Pastva, Mysha E Sissine, Betsy Vetter
BACKGROUND: Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes...
July 17, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28706862/flexible-band-versus-rigid-ring-annuloplasty-for-tricuspid-regurgitation-a-systematic-review-and-meta-analysis
#17
REVIEW
Nelson Wang, Steven Phan, David H Tian, Tristan D Yan, Kevin Phan
BACKGROUND: Up to 20% of patients have pre-discharge residual moderate to severe tricuspid regurgitation (TR) after tricuspid repair. Reoperations for recurrent TR carry high mortality rates, which emphasizes the importance of identifying the optimal technique for the surgical management of TR. The present study is a systematic review and meta-analysis that aims to compare short and long term survival and freedom from TR of flexible band ring versus rigid ring for annuloplasty of TR. METHODS: We conducted a systematic review and meta-analysis of comparative studies to evaluate these procedures...
May 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28703300/a-point-based-prediction-model-for-cardiovascular-risk-in-orthotopic-liver-transplantation-the-car-olt-score
#18
Lisa B VanWagner, Hongyan Ning, Maureen Whitsett, Josh Levitsky, Sarah Uttal, John T Wilkins, Michael M Abecassis, Daniela P Ladner, Anton I Skaro, Donald M Lloyd-Jones
Cardiovascular disease (CVD) complications are important causes of morbidity and mortality after orthotopic liver transplantation (OLT). There is currently no preoperative risk-assessment tool that allows physicians to estimate the risk for CVD events following OLT. We sought to develop a point-based prediction model (risk score) for CVD complications after OLT, the Cardiovascular Risk in Orthotopic Liver Transplantation risk score, among a cohort of 1,024 consecutive patients aged 18-75 years who underwent first OLT in a tertiary-care teaching hospital (2002-2011)...
December 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28683821/stroke-awareness-among-dubai-emergency-medical-service-staff-and-impact-of-an-educational-intervention
#19
Fatima Shire, Zahra Kasim, Suhail Alrukn, Maria Khan
BACKGROUND: Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patients. The objective of our study was to assess the level of awareness regarding pre-hospital identification and management of acute stroke among EMS Staff in Dubai and to evaluate the impact of an educational lecture on their knowledge. METHODS: Ours was a cross-sectional study with a pre-test and post-test design. The intervention was an educational lecture, based on the updated guidelines in pre-hospital care of acute stroke...
July 6, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28667222/promoting-optimal-physical-exercise-for-life-propel-aerobic-exercise-and-self-management-early-after-stroke-to-increase-daily-physical-activity-study-protocol-for-a-stepped-wedge-randomised-trial
#20
Avril Mansfield, Dina Brooks, Ada Tang, Denise Taylor, Elizabeth L Inness, Alex Kiss, Laura Middleton, Louis Biasin, Rebecca Fleck, Esmé French, Kathryn LeBlanc, Anthony Aqui, Cynthia Danells
INTRODUCTION: Physical exercise after stroke is essential for improving recovery and general health, and reducing future stroke risk. However, people with stroke are not sufficiently active on return to the community after rehabilitation. We developed the Promoting Optimal Physical Exercise for Life (PROPEL) programme, which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation. This study aims to evaluate the effect of PROPEL on long-term participation in exercise after discharge from stroke rehabilitation...
June 30, 2017: BMJ Open
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