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Pre hospital management of stroke

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https://www.readbyqxmd.com/read/27873224/therapeutic-potential-of-transdermal-glyceryl-trinitrate-in-the-management-of-acute-stroke
#1
Jason P Appleton, Nikola Sprigg, Philip M Bath
The nitric oxide donor, glyceryl trinitrate (GTN), is a candidate treatment for the management of acute stroke with haemodynamic and potential reperfusion and neuroprotective effects. When administered as a transdermal patch during the acute and subacute phases after stroke, GTN was safe, lowered blood pressure, maintained cerebral blood flow, and did not induce cerebral steal or alter functional outcome. However, when given within 6 h of stroke onset, GTN reduced death and dependency (odds ratio 0.52; 95% confidence interval 0...
November 21, 2016: CNS Drugs
https://www.readbyqxmd.com/read/27846459/simplifying-electrocardiographic-assessment-in-stemi-reperfusion-management-pros-and-cons
#2
REVIEW
Cheuk-Kit Wong
Current guidelines on STEMI reperfusion management do not incorporate further electrocardiographic details over the presence of significant ST elevation. Fibrinolysis is considered an alternative therapy to primary PCI if there is a long PCI-related delay, but the 2 therapies should not be combined. Meanwhile, reperfusion for ischemic stroke has evolved on mechanistic understanding - reperfusion benefit being greatest in the patient with small "core" infarct and large ischemic "penumbra". Fibrinolysis is not regarded as an alternative to mechanical thrombectomy, and the 2 therapies can be combined...
November 11, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27823684/impact-of-the-2013-american-college-of-cardiology-american-heart-association-cholesterol-guidelines-on-the-prescription-of-high-intensity-statins-in-patients-hospitalized-for-acute-coronary-syndrome-or-stroke
#3
Michael Valentino, Jad Al Danaf, Andrew Panakos, Loheetha Ragupathi, Danielle Duffy, David Whellan
BACKGROUND: The 2013 American College of Cardiology/American Heart Association cholesterol management guidelines represented a paradigm shift from the National Cholesterol Education Program Adult Treatment Panel III guidelines, replacing low-density lipoprotein cholesterol targets with a risk assessment model to guide statin therapy. Our objectives are to compare provider prescription of high-intensity statin therapy in patients hospitalized with acute coronary syndrome (ACS) or cerebrovascular accident (CVA) before and after the publication of the 2013 cholesterol guidelines, determine potential predictors of high-intensity statin utilization, and identify targets for improvement in cardiovascular risk reduction among these high-risk populations...
November 2016: American Heart Journal
https://www.readbyqxmd.com/read/27822599/prehospital-and-intra-hospital-time-delays-in-posterior-circulation-stroke-results-from-the-austrian-stroke-unit-registry
#4
Peter Sommer, Leonhard Seyfang, Alexandra Posekany, Julia Ferrari, Wilfried Lang, Elisabeth Fertl, Wolfgang Serles, Thomas Töll, Stefan Kiechl, Stefan Greisenegger
Therapeutic effect of recombinant tissue-plasminogen activator (rt-PA) is time dependent. There is limited evidence whether localization of stroke within the posterior circulation (PCS) is associated with a treatment delay. We aimed to analyze within a nationwide multicenter cohort whether duration of pre- and intra-hospital patient management differs between patients with PCS and anterior circulation strokes (ACS). We studied onset-to-door-times (ODT) and door-to-needle-times (DNT) of all patients with acute ischemic stroke (IS) enrolled in the Austrian Stroke Unit Registry according to infarct localization...
November 7, 2016: Journal of Neurology
https://www.readbyqxmd.com/read/27699002/the-impact-of-temporal-artery-biopsy-on-surgical-practice
#5
Adam Thomas Cristaudo, Ryo Mizumoto, Rasika Hendahewa
BACKGROUND: Giant cell arteritis (GCA) has the potential to cause irreversible blindness and stroke in affected patients [1-4]. Temporal artery biopsy (TAB) remains the gold standard test for GCA [6-8]. Recent literature suggests that TAB does not change management of patients with suspected GCA and that ultrasound scan (USS) may be sufficient enough alone to confirm the diagnosis [9-11,13]. The aim of this study is to therefore determine the impact of TAB on current surgical practice and emergency theatre services...
November 2016: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/27686633/management-of-swallowing-in-thrombolysed-stroke-patients-implementation-of-a-new-protocol
#6
Maria Schwarz, Anne Coccetti, Elizabeth Cardell, Allison Murdoch, Jennifer Davis
PURPOSE: There is a paucity of evidence regarding dysphagia management post-thrombolysis. The aim of this case-control study was to evaluate the impact of a dysphagia management protocol on patient outcomes. Thrombolysis has been completed at our metropolitan hospital since 2011 and a dysphagia management protocol was developed in 2012. METHOD: Chart auditing was completed for 83 participants in three groups: pre-protocol (n = 12) (2011), post-protocol (n = 28) (2012-2014), and non-thrombolysed stroke patients (n = 43)...
September 29, 2016: International Journal of Speech-language Pathology
https://www.readbyqxmd.com/read/27668914/evaluation-and-management-of-acute-onset-hemiparesis-in-an-adolescent-with-leukemia
#7
Krishnan N Subrahmanian, Young H Shim, Mona D Shah, Brandon H Tran, Alexandra M Stevens, Andrea T Cruz
Emergency departments (EDs) are alert to the possibility of stroke and the need for early interventions to improve long-term clinical outcomes. However, new-onset hemiparesis in pediatric patients with leukemia may be due to a number of different etiologies, including most common side effects from chemotherapeutic agents. We present a case of a 15-year-old boy with pre-B acute lymphoblastic leukemia on chemotherapy, having recently received a high-dose methotrexate infusion in addition to intrathecal methotrexate therapy, who presented to our ED with acute right-sided hemiparesis...
September 23, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27580820/effects-of-a-health-promotion-program-on-medication-adherence-to-antiplatelet-therapy-among-ischemic-stroke-patients-in-hainan-province-china
#8
Qingjie Su, Chaoyun Li, Faqing Long, Bin Chen, Zhongqin Wan, Yingman Wu, Mingming Dai, Desheng Wang, Yuhui Zhang, Bufei Wang
Survivors of ischemic stroke are still at a significant risk for recurrence. Antiplatelet agents are the treatment of first choice for long-term secondary prevention of vascular events. This study aims to assess a health promotion program on medication adherence to antiplatelet therapy among ischemic stroke patients in Hainan province, China. In five hospitals from the intervention group, four highly experienced physicians trained 62 neurologists, who in turn trained 613 stroke patients to improve their awareness and adherence to antiplatelet therapy...
August 31, 2016: Vascular
https://www.readbyqxmd.com/read/27555053/multidisciplinary-assessment-in-optimising-results-of-percutaneous-patent-foramen-ovale-closure
#9
Allan Davies, Avedis Ekmejian, Nicholas Collins, Rohan Bhagwandeen
BACKGROUND: Percutaneous patent foramen ovale (PFO) closure is a therapeutic option to prevent recurrent cerebral ischaemia in patients with cryptogenic stroke and transient cerebral ischaemia (TIA). The apparent lack of benefit seen in previous randomised trials has, in part, reflected inclusion of patients with alternate mechanisms of stroke. The role of formal neurology involvement in accurately delineating the likely aetiology of stroke or TIA is crucial in appropriate identification of patients for device closure...
August 5, 2016: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/27554105/study-to-improve-cardiovascular-outcomes-in-high-risk-older-patients-icon1-with-acute-coronary-syndrome-study-design-and-protocol-of-a-prospective-observational-study
#10
Vijay Kunadian, R Dermot G Neely, Hannah Sinclair, Jonathan A Batty, Murugapathy Veerasamy, Gary A Ford, Weiliang Qiu
INTRODUCTION: The ICON1 study (a study to Improve Cardiovascular Outcomes in high-risk older patieNts with acute coronary syndrome) is a prospective observational study of older patients (≥75 years old) with non-ST-elevation acute coronary syndrome managed by contemporary treatment (pharmacological and invasive). The aim of the study was to determine the predictors of poor cardiovascular outcomes in this age group and to generate a risk prediction tool. METHODS AND ANALYSIS: Participants are recruited from 2 tertiary hospitals in the UK...
August 23, 2016: BMJ Open
https://www.readbyqxmd.com/read/27487190/quality-improvement-in-acute-ischemic-stroke-care-in-taiwan-the-breakthrough-collaborative-in-stroke
#11
Fang-I Hsieh, Jiann-Shing Jeng, Chang-Ming Chern, Tsong-Hai Lee, Sung-Chun Tang, Li-Kai Tsai, Hsun-Hsiang Liao, Hang Chang, Kenneth A LaBresh, Hung-Jung Lin, Hung-Yi Chiou, Hou-Chang Chiu, Li-Ming Lien
In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011...
2016: PloS One
https://www.readbyqxmd.com/read/27470878/sodium-glucose-cotransporter-2-inhibitors-in-the-treatment-of-diabetes-mellitus-cardiovascular-and-kidney-effects-potential-mechanisms-and-clinical-applications
#12
Hiddo J L Heerspink, Bruce A Perkins, David H Fitchett, Mansoor Husain, David Z I Cherney
Sodium-glucose cotransporter-2 (SGLT2) inhibitors, including empagliflozin, dapagliflozin, and canagliflozin, are now widely approved antihyperglycemic therapies. Because of their unique glycosuric mechanism, SGLT2 inhibitors also reduce weight. Perhaps more important are the osmotic diuretic and natriuretic effects contributing to plasma volume contraction, and decreases in systolic and diastolic blood pressures by 4 to 6 and 1 to 2 mm Hg, respectively, which may underlie cardiovascular and kidney benefits...
September 6, 2016: Circulation
https://www.readbyqxmd.com/read/27439484/-sex-differences-in-the-integrated-stroke-management-in-a-rural-healthcare-area-in-asturias
#13
T Lopez-Martinez, J Bernardo-Cofino, E Garcia-Prieto, M Feito-Alvarez, R de Dios-Del Valle, S Calleja-Puerta
INTRODUCTION: Sex differences and the (rural or urban) nature of populations largely determine the integrated management of time-dependent pathologies such as strokes, which is the main cause of female hospitalisation and mortality in our setting. AIM: To determine whether any differential characteristics can be observed between male and female stroke patients in a rural healthcare area in the Principality of Asturias. PATIENTS AND METHODS: A descriptive retrospective study was conducted at the Jarrio Hospital...
August 16, 2016: Revista de Neurologia
https://www.readbyqxmd.com/read/27424326/the-effect-of-peer-review-on-mortality-rates
#14
W Krahwinkel, E Schuler, M Liebetrau, A Meier-Hellmann, J Zacher, R Kuhlen
OBJECTIVE: Lowering of mortality rates in hospitals with mortality rates higher than accepted reference values for acute myocardial infarction (AMI), congestive heart failure (CHF), pneumonia, stroke, mechanical ventilation (MV) and colorectal surgery by using an external peer review process that identifies areas requiring rectification and implements protocols directed at improving these areas. DESIGN: Retrospective, observational, quality management study using administrative data to compare in-hospital mortality rates (pre and post an external peer review process that included adoption of improvement protocols) with reference values...
July 15, 2016: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/27359109/targeting-transradial-approach-an-updated-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#15
Francesca Del Furia, Gennaro Giustino, Alaide Chieffo
BACKGROUND: Transradial access (TRA) emerged in the last two decades as a valid alternative to the standard transfemoral access (TFA) for cardiac catheterization and percutaneous coronary intervention (PCI). Due to contrasting results, the penetration and uptake of TRA in real-world clinical practice has been slow and still limited to high experienced center. METHODS: We performed an updated systematic review and study-level meta-analysis of randomized controlled trials (RCTs) that investigated the efficacy and safety of TRA versus TFA for PCI in patients with ACS...
June 30, 2016: Panminerva Medica
https://www.readbyqxmd.com/read/27355167/pharmacological-therapy-following-acute-coronary-syndromes-in-patients-with-atrial-fibrillation-how-do-we-balance-ischaemic-risk-with-bleeding-risk
#16
Aimee L Fake, Scott A Harding, Philip P Matsis, Peter D Larsen
BACKGROUND: Dual anti-platelet therapy (DAPT) with aspirin and a P2Y12receptor antagonist is standard of care following an acute coronary syndrome (ACS), as it has been shown to reduce recurrent myocardial infarction (MI) and death. In atrial fibrillation (AF) patients, the use of oral anticoagulants (OACs) is the standard of care as these agents have been shown to reduce the risk of stroke and death. Current guidelines suggest that decisions around antithrombotic therapy should be made by assessing ischaemic and bleeding risks...
2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27304197/first-automated-stroke-imaging-evaluation-via-electronic-alberta-stroke-program-early-ct-score-in-a-mobile-stroke-unit
#17
Iris Quasar Grunwald, Andreas Ragoschke-Schumm, Michael Kettner, Lenka Schwindling, Safwan Roumia, Stefan Helwig, Matthias Manitz, Silke Walter, Umut Yilmaz, Eric Greveson, Martin Lesmeister, Wolfgang Reith, Klaus Fassbender
BACKGROUND: Recently, a mobile stroke unit (MSU) was shown to facilitate acute stroke treatment directly at the emergency site. The neuroradiological expertise of the MSU is improved by its ability to detect early ischemic damage via automatic electronic (e) evaluation of CT scans using a novel software program that calculates the electronic Alberta Stroke Program Early CT Score (e-ASPECTS). METHODS: The feasibility of integrating e-ASPECTS into an ambulance was examined, and the clinical integration and utility of the software in 15 consecutive cases evaluated...
2016: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/27256836/recent-endovascular-stroke-trials-and-their-impact-on-stroke-systems-of-care
#18
REVIEW
Maxim Mokin, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy, L Nelson Hopkins
Five recently published randomized trials of endovascular therapy versus medical management, including intravenous thrombolysis, demonstrated strong positive data in support of intra-arterial thrombectomy procedures. The American Heart Association/American Stroke Association released a focused update of the 2013 guidelines on the early management of acute ischemic strokes to specifically incorporate the findings of the 5 "positive" trials. In this review, we examine the key results of those trials and the principal changes in the updated guidelines...
June 7, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27207814/increased-risk-of-stroke-and-mortality-following-new-onset-atrial-fibrillation-during-hospitalization
#19
Daniele Massera, Dan Wang, David A Vorchheimer, Abdissa Negassa, Mario J Garcia
AIMS: The outcome of patients who develop new-onset atrial fibrillation (AF) during hospitalization is unknown, and the management of this patient population is not specifically addressed by current guidelines. We investigated the incidence of death and inhospital stroke among a large cohort of hospitalized inpatients who developed new-onset AF. METHODS AND RESULTS: All patients ≥50 years of age admitted to a tertiary academic medical centre (20 April 2005 to 31 December 2011; n = 84 919) were studied...
May 20, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27194487/telemedicine-for-the-acute-management-of-stroke-in-burgundy-france-an-evaluation-of-effectiveness-and-safety
#20
N Legris, M Hervieu-Bègue, B Daubail, A Daumas, B Delpont, G-V Osseby, O Rouaud, M Giroud, Y Béjot
BACKGROUND: In the context of the development of telemedicine in France to address low thrombolysis rates and limited stroke infrastructures, a star-shaped telestroke network was implemented in Burgundy (1.6 million inhabitants). We evaluated the safety and effectiveness of this network for thrombolysis in acute ischemic stroke patients. METHODS: One hundred and thirty-two consecutive patients who received intravenous thrombolysis during a telemedicine procedure (2012-2014) and 222 consecutive patients who were treated at the stroke center of Dijon University Hospital, France (2011-2012) were included...
September 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
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