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Pre hospital management of stroke

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https://www.readbyqxmd.com/read/29844031/impact-of-transcranial-doppler-ultrasound-on-logistics-and-outcomes-in-stroke-thrombolysis-results-from-the-sits-istr
#1
Michael V Mazya, Niaz Ahmed, Elsa Azevedo, Antoni Davalos, Laura Dorado, Michal Karlinski, Svetlana Lorenzano, Jiří Neumann, Danilo Toni, Tiago P Moreira
BACKGROUND AND PURPOSE: Diagnostic transcranial Doppler ultrasound (TCD) is commonly used in patients with acute stroke before or during treatment with intravenous thrombolysis (IVT). We aimed to assess how much TCD delays IVT initiation and whether TCD influences outcomes. METHODS: We analyzed data from the SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register) collected from December 2002 to December 2011. Outcomes were door-to-needle time, symptomatic intracerebral hemorrhage, functional outcome per the modified Rankin Scale, and mortality at 3 months...
May 29, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29720045/protocol-for-a-prospective-collaborative-systematic-review-and-meta-analysis-of-individual-patient-data-from-randomized-controlled-trials-of-vasoactive-drugs-in-acute-stroke-the-blood-pressure-in-acute-stroke-collaboration-stage-3
#2
Else Charlotte Sandset, Nerses Sanossian, Lisa J Woodhouse, Craig Anderson, Eivind Berge, Kennedy R Lees, John F Potter, Thompson G Robinson, Nikola Sprigg, Joanna M Wardlaw, Philip M Bath
Rationale Despite several large clinical trials assessing blood pressure lowering in acute stroke, equipoise remains particularly for ischemic stroke. The "Blood pressure in Acute Stroke Collaboration" commenced in the mid-1990s focussing on systematic reviews and meta-analysis of blood pressure lowering in acute stroke. From the start, Blood pressure in Acute Stroke Collaboration planned to assess safety and efficacy of blood pressure lowering in acute stroke using individual patient data. Aims To determine the optimal management of blood pressure in patients with acute stroke, including both intracerebral hemorrhage and ischemic stroke...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29663986/-interpretation-of-2018-guidelines-for-the-early-management-of-patients-with-acute-ischemic-stroke
#3
Gang Wang, Bangjiang Fang, Xuezhong Yu, Zhijun Li
In 2018, the American Heart Association/American Stroke Association (AHA/ASA) has developed the latest 2018 guidelines for the early management of patients with acute ischemic stroke (AIS), based on the latest evidences. The 2018 guidelines including recommendations on pre-hospital and in-hospital management treatment, has revised and add new recommendations from 2013 guideline. The major changes in 2018 guideline involve applications of brain imaging in early stage, intravenous thrombolysis and mechanical thrombectomy, et al...
April 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29657369/factors-affecting-the-effective-management-of-acute-stroke-a-prospective-observational-study
#4
C V Nagendra, T S Srinath Kumar, Vikram Bohra, Viju Wilben, Vivek Karan, Vikram Huded
Background: Stroke, characterized by sudden loss of cerebral function, is among one of the leading cause of death and disability world over. The newer treatment modalities have changed the landscape of stroke treatment but are very much time bound. Aim: To characterize pre-hospital and in-hospital factors affecting acute stroke management thus defining lacunae in stroke management. Subjects and Methods: A prospective observational study, conducted at the emergency department of a tertiary care center in southern India from August 2015 to July 2016...
March 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29627355/atrial-fibrillation-in-the-icu
#5
REVIEW
Nicholas A Bosch, Jonathan Cimini, Allan J Walkey
Atrial fibrillation (AF) is the most common arrhythmia encountered in the ICU. Preexisting AF is highly prevalent among older patients with chronic conditions who are at risk for critical illness, whereas new-onset AF can be triggered by accelerated atrial remodeling and arrhythmogenic triggers encountered during critical illness. The acute loss of atrial systole and onset of rapid ventricular rates that characterize new-onset AF often lead to decreased cardiac output and hemodynamic compromise. Thus, new-onset AF is both a marker of disease severity as well as a likely contributor to poor outcomes, similar to other manifestations of organ dysfunction during critical illness...
April 6, 2018: Chest
https://www.readbyqxmd.com/read/29603057/the-dysphagia-in-stroke-protocol-reduces-aspiration-pneumonia-in-patients-with-dysphagia-following-acute-stroke-a-clinical-audit
#6
Sarah E Perry, Anna Miles, John N Fink, Maggie-Lee Huckabee
Cough reflex testing has been evaluated as a component of the clinical swallowing assessment as a means of identifying patients at risk of aspiration during swallowing. A previous study by our research group found good sensitivity and specificity of the cough reflex test for identifying patients at risk of aspiration post-stroke, yet its use did not decrease pneumonia rates, contrary to previous reports. The aim of this study was to expand on our earlier work by implementing a clinical management protocol incorporating cough reflex testing within the same healthcare setting and compare patient outcomes to those from the original study and to evaluate clinical outcomes in patients with acute stroke who were managed using the Dysphagia in Stroke Protocol (DiSP)...
March 30, 2018: Translational Stroke Research
https://www.readbyqxmd.com/read/29401054/impact-of-standardizing-management-of-atrial-fibrillation-with-rapid-heart-rate-in-the-emergency-department
#7
Ernesto De Leon, Lewei Duan, Ellen Rippenberger, Adam L Sharp
CONTEXT: There is substantial variation in the emergency treatment of atrial fibrillation with tachycardia. A standardized treatment approach at an academic center decreased admissions without adverse outcomes, but this approach has not been evaluated in a community Emergency Department (ED). OBJECTIVE: To evaluate the implementation of a standardized treatment guideline for patients with atrial fibrillation and a rapid heart rate in a community ED. DESIGN: An observational pre-/postimplementation (August 2013 to July 2014 and August 2014 to July 2015, respectively) study at a community ED...
2018: Permanente Journal
https://www.readbyqxmd.com/read/29362251/evaluation-and-management-of-patients-with-acute-chest-pain-in-china-empact-protocol-for-a-prospective-multicentre-registry-study
#8
Wen Zheng, Jiali Wang, Feng Xu, Jiaqi Zheng, He Zhang, Jingjing Ma, Guangmei Wang, Hao Wang, Derek P Chew, Yuguo Chen
INTRODUCTION: Acute chest pain represents a major healthcare burden in emergency departments (ED) throughout the world. Among these patients, rapidly determining whether an acute coronary syndrome (ACS) is evolving remains difficult. In China, there are limited data correlating the baseline characteristics, evaluation and management of ED patients with acute chest pain and ACS-related symptoms with clinical outcomes. Nor has there been an evaluation of outcomes at different levels of hospitals...
January 23, 2018: BMJ Open
https://www.readbyqxmd.com/read/29291175/factors-delaying-management-of-acute-stroke-an-indian-scenario
#9
Siju V Abraham, S Vimal Krishnan, Fazil Thaha, Jayaraj Mymbilly Balakrishnan, Tom Thomas, Babu Urumese Palatty
Background and Purpose: The purpose of this study was to assess factors causing delay in treatment of acute stroke in a tertiary care institute in South India. Methods: All clinically suspected cases of acute stroke presenting to the emergency department over a period of 1 year were prospectively followed up and data collected as per a preset pro forma. The various time intervals from stroke onset to definitive management and other pertinent data were collected...
October 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/29279254/factors-related-to-immediate-response-to-symptoms-in-patients-with-stroke-or-transient-ischaemic-attack
#10
R García Ruiz, J Silva Fernández, R M García Ruiz, M Recio Bermejo, Á Arias Arias, A Santos Pinto, A Lomas Meneses, E Botía Paniagua, J Abellán Alemán
INTRODUCTION: Despite recent advances in the management of acute stroke, fewer than 10% of patients receive reperfusion therapy. One of the main reasons for such a low rate of administration is the delay on the part of patients and their families in seeking medical attention. This study aimed to analyse this delay. METHODS: A prospective observational study was conducted on consecutive stroke or transient ischaemic attack. Data on sociodemographic and clinical parameters, decision delay, pre-hospital delay, and first medical contact were collected...
December 23, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/29249376/public-stroke-knowledge-awareness-and-response-to-acute-stroke-multi-center-study-from-4-egyptian-governorates
#11
Mohammad A Farrag, Mohammed I Oraby, Azza A Ghali, Osama A Ragab, Ahmed Nasreldein, Ghaydaa A Shehata, Eman Elfar, Foad Abd-Allah
BACKGROUND AND PURPOSE: Acute stroke treatment has significantly improved over the years in Egypt. However, there is often notable delay in pre-hospital and in-hospital management of acute stroke patients. The delay may be largely attributed to poor stroke knowledge and awareness of the general public and this study was aimed at the evaluation of the abovementioned factors. METHODS: Descriptive cross-sectional study involving 1154 participants from 4 governorates using a questionnaire in Arabic, collecting sociodemographic data, participants' risk factors, and knowledge and stroke awareness (risk factors, symptoms, prevention, treatment and prognosis, action in response to acute stroke)...
January 15, 2018: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29247142/novel-telestroke-program-improves-thrombolysis-for-acute-stroke-across-21-hospitals-of-an-integrated-healthcare-system
#12
MULTICENTER STUDY
Mai N Nguyen-Huynh, Jeffrey G Klingman, Andrew L Avins, Vivek A Rao, Abigail Eaton, Sunil Bhopale, Anne C Kim, John W Morehouse, Alexander C Flint
BACKGROUND AND PURPOSE: Faster treatment with intravenous alteplase in acute ischemic stroke is associated with better outcomes. Starting in 2015, Kaiser Permanente Northern California redesigned its acute stroke workflow across all 21 Kaiser Permanente Northern California stroke centers to (1) follow a single standardized version of a modified Helsinki model and (2) have all emergency stroke cases managed by a dedicated telestroke neurologist. We examined the effect of Kaiser Permanente Northern California's Stroke EXpediting the PRrocess of Evaluating and Stopping Stroke program on door-to-needle (DTN) time, alteplase use, and symptomatic intracranial hemorrhage rates...
January 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29218822/european-academy-of-neurology-and-european-stroke-organization-consensus-statement-and-practical-guidance-for-pre-hospital-management-of-stroke
#13
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
BACKGROUND AND PURPOSE: The reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving the chances of a favourable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting. METHODS: The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions...
March 2018: 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
#14
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
#15
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
#16
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...
March 2018: Neurological Sciences
https://www.readbyqxmd.com/read/29158105/the-effect-and-associated-factors-of-dispatcher-recognition-of-stroke-a-retrospective-observational-study
#17
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
#18
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...
February 2018: 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
#19
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
#20
EDITORIAL
A Fromm
No abstract text is available yet for this article.
February 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
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