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Stroke Guideline

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https://www.readbyqxmd.com/read/28820652/decreasing-stroke-code-to-ct-time-in-patients-presenting-with-stroke-symptoms
#1
Aleksandrs Kalnins, L Jake Mickelsen, Daisha Marsh, Christoph Zorich, Stephanie Casal, Waimei Amy Tai, Nirali Vora, Gennette Olalia, Max Wintermark, David B Larson
Guided quality improvement (QI) programs present an effective means to streamline stroke code to computed tomography (CT) times in a comprehensive stroke center. Applying QI methods and a multidisciplinary team approach may decrease the stroke code to CT time in non-prenotified emergency department (ED) patients presenting with symptoms of stroke. The aim of this project was to decrease this time for non-prenotified stroke code patients from a baseline mean of 20 minutes to one less than 15 minutes during an 18-week period by applying QI methods in the context of a structured QI program...
August 18, 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/28820348/where-to-now-avert-answered-an-important-question-but-raised-many-more
#2
Mark T Bayley, Audrey Bowen, Coralie English, Robert Teasell, Janice J Eng
A Very Early Rehabilitation Trial (AVERT) was a Phase 3 randomized trial with over 2100 subjects post stroke that had unexpected results with better outcomes for usual care than those receiving very early mobilization. This review of published stroke clinical practice guidelines highlights that recommendations for mobilization have changed after publication of AVERT but also that developers have struggled to provide recommendations for appropriate dose, duration and intensity of mobilization in the acute post stroke period with available analyses from AVERT and other literature...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28815784/nursing-care-for-stroke-patients-a-survey-of-current-practice-in-eleven-european-countries
#3
Zeliha Tulek, Ingrid Poulsen, Katrin Gillis, Ann-Cathrin Jönsson
AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death and disability globally. Optimal organisation of interdisciplinary stroke care is expected to ameliorate outcome after stroke. Consequently, universal access to stroke care based on evidence-based guidelines is a priority...
August 17, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28813855/an-optimized-design-of-a-parallel-robot-for-gait-training
#4
Marco Maddalena, Mozafar Saadat, Alireza Rastegarpanah, Rui C V Loureiro
The guidelines for enhancing robot-assisted training for post-stroke survivors head towards increasing exercise realism and variability; in particular lower limb rehabilitation needs the patient to feel challenged to adapt his locomotion and dynamic balance capabilities to different virtual ground scenarios. This paper proposes a design for a robot whose end-effector acts as a footplate to be in permanent contact with the user's foot during practice: the structure is such that it enables the user's foot to rotate around three axis, differently from what is currently available in the research for gait training; the parallel kinematic structure and the dimensional synthesis allow a suitable range of motion and aim at limiting device mass, footprint and reaction forces on the actuators when rendering virtual ground...
July 2017: IEEE ... International Conference on Rehabilitation Robotics: [proceedings]
https://www.readbyqxmd.com/read/28813741/a-case-of-an-acute-myocardial-infarction-post-thrombolytic-treatment-of-ischemic-stroke-a-management-dilemma
#5
Kalyan Wagle, Jimmy Yee, Vishesh Kumar, Amornpol Anuwatworn, Tomasz Stys, Adam Stys, Christopher Stanton
Acute ischemic stroke and myocardial infarction are emergency clinical events that require prompt intervention. Concurrent occurrence of both events magnifies the complexity of the clinical management. We present a case of a patient who presented with acute ischemic stroke, complicated by acute myocardial infarction shortly after thrombolytic was administered. This case highlights the importance of individualization of management especially in complex cases where there are no clear specific guidelines to follow...
August 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28812226/in-light-of-recently-published-clinical-trials-and-their-implication-for-clinical-practice-does-a-large-catchment-area-acute-hospital-require-24%C3%A2-hour-ct-neck-and-head-angiography-and-or-neuro-interventional-services-in-the-setting-of-acute-ischaemic-stroke
#6
REVIEW
J Halpin, C Peters, J O'Brien, T Scanlon, M Shelly, N Cunningham, L Hickey
BACKGROUND: Recently published clinical trials have resulted in a significant change in the guidelines used to manage patients suffering an acute ischaemic stroke. New neuro-interventional techniques have revolutionised stroke outcomes. Currently, such services are only available in two specialist centres. AIMS: We attempted to evaluate the need for the provision of routine computed tomography (CT) angiography and neuro-interventional services at a university teaching hospital in Limerick...
August 15, 2017: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/28808918/idarucizumab-in-dabigatran-treated-patients-with-acute-ischemic-stroke-receiving-alteplase-a-systematic-review-of-the-available-evidence
#7
REVIEW
Slaven Pikija, Laszlo K Sztriha, J Sebastian Mutzenbach, Stefan M Golaszewski, Johann Sellner
BACKGROUND AND PURPOSE: Current guidelines do not recommend the use of intravenous recombinant tissue plasminogen activator in patients with acute ischemic stroke who receive direct oral anticoagulants. While the humanized monoclonal antibody idarucizumab can quickly reverse the anticoagulant effects of the thrombin inhibitor dabigatran, safety data for subsequent tissue plasminogen activator treatment are sparse. Here, we review current knowledge about dabigatran reversal prior to systemic reperfusion treatment in acute ischemic stroke...
August 14, 2017: CNS Drugs
https://www.readbyqxmd.com/read/28808795/cerebral-venous-thrombosis-continental-disparities
#8
Laith Maali, Sheema Khan, Fares Qeadan, Mahmoud Ismail, Davana Ramaswamy, Vishnumurthy S Hedna
Cerebral venous thrombosis (CVT) usually accounts for < 1% of all strokes. Global disparity and diversity in their demographics, etiology, clinical features, radiological presentation, and mortality have not been previously explored. A systematic search was performed for publications in PubMed using key words "cerebral venous thrombosis," "Cerebral vein thrombosis," and "Cortical vein Thrombosis." A total of 600 relevant studies were abstracted with strict selection criteria, and a total of 7048 patient's data were used for the final analysis...
August 14, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/28806209/refractory-intracranial-hypertension-the-role-of-decompressive-craniectomy
#9
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
August 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28803530/enhancing-the-alignment-of-the-preclinical-and-clinical-stroke-recovery-research-pipeline-consensus-based-core-recommendations-from-the-stroke-recovery-and-rehabilitation-roundtable-translational-working-group
#10
Dale Corbett, S Thomas Carmichael, Timothy H Murphy, Theresa A Jones, Martin E Schwab, Jukka Jolkkonen, Andrew N Clarkson, Numa Dancause, Tadeusz Weiloch, Heidi Johansen-Berg, Michael Nilsson, Louise D McCullough, Mary T Joy
Stroke recovery research involves distinct biological and clinical targets compared to the study of acute stroke. Guidelines are proposed for the pre-clinical modeling of stroke recovery and for the alignment of pre-clinical studies to clinical trials in stroke recovery.
August 2017: Neurorehabilitation and Neural Repair
https://www.readbyqxmd.com/read/28799998/use-of-direct-oral-anticoagulants-for-treatment-of-atrial-fibrillation-in-patients-with-hiv-a-review
#11
Timothy A West, Jacinta Perram, Cameron J Holloway
PURPOSE OF REVIEW: Atrial fibrillation is increasingly common in the ageing population. Patients with atrial fibrillation and HIV have a higher stroke risk, with guidelines recommending anticoagulation in the majority. Whilst anticoagulation options have diversified in the last decade for the general population, there is limited evidence for the safety and efficacy of these medications when used concurrently with antiretroviral therapy. We review the potential for patients with HIV on antiretroviral therapy to have direct-acting oral anticoagulations (DOACs)...
August 10, 2017: Current Opinion in HIV and AIDS
https://www.readbyqxmd.com/read/28798906/cerebral-sinovenous-thrombosis
#12
REVIEW
Rebecca Ichord
Cerebral sinovenous thrombosis (CSVT) is a rare but serious cerebrovascular disorder affecting children from the newborn period through childhood and adolescence. The incidence is estimated at 0.6/100,000/year, with 30-50% occurring in newborns. Causes are diverse and are highly age dependent. Acute systemic illness is the dominant risk factor among newborns. In childhood CSVT, acute infections of the head and neck such as mastoiditis are most common, followed by chronic underlying diseases such as nephrotic syndrome, cancer, and inflammatory bowel disease...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28798779/one-swallow-does-not-a-summer-make-but-many-swallows-do-accumulating-clinical-evidence-for-nearly-eliminated-peri-procedural-and-30-day-complications-with-mesh-covered-stents-transforms-the-carotid-revascularisation-field
#13
REVIEW
Piotr Musiałek, L Nelson Hopkins, Adnan H Siddiqui
Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay - but it does not abolish - CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28798017/regional-variation-in-30-day-ischemic-stroke-outcomes-for-medicare-beneficiaries-treated-in-get-with-the-guidelines-stroke-hospitals
#14
Michael P Thompson, Xin Zhao, Kimon Bekelis, Daniel J Gottlieb, Gregg C Fonarow, Phillip J Schulte, Ying Xian, Barbara L Lytle, Lee H Schwamm, Eric E Smith, Mathew J Reeves
BACKGROUND: We explored regional variation in 30-day ischemic stroke mortality and readmission rates and the extent to which regional differences in patients, hospitals, healthcare resources, and a quality of care composite care measure explain the observed variation. METHODS AND RESULTS: This ecological analysis aggregated patient and hospital characteristics from the Get With The Guidelines-Stroke registry (2007-2011), healthcare resource data from the Dartmouth Atlas of Health Care (2006), and Medicare fee-for-service data on 30-day mortality and readmissions (2007-2011) to the hospital referral region (HRR) level...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28797196/the-improve-guidelines-ischaemia-models-procedural-refinements-of-in-vivo-experiments
#15
Nathalie Percie du Sert, Alessio Alfieri, Stuart M Allan, Hilary Vo Carswell, Graeme A Deuchar, Tracy D Farr, Paul Flecknell, Lindsay Gallagher, Claire L Gibson, Michael J Haley, Malcolm R Macleod, Barry W McColl, Christopher McCabe, Anna Morancho, Lawrence Df Moon, Michael J O'Neill, Isabel Pérez de Puig, Anna Planas, C Ian Ragan, Anna Rosell, Lisa A Roy, Kathryn O Ryder, Alba Simats, Emily S Sena, Brad A Sutherland, Mark D Tricklebank, Rebecca C Trueman, Lucy Whitfield, Raymond Wong, I Mhairi Macrae
Most in vivo models of ischaemic stroke target the middle cerebral artery and a spectrum of stroke severities, from mild to substantial, can be achieved. This review describes opportunities to improve the in vivo modelling of ischaemic stroke and animal welfare. It provides a number of recommendations to minimise the level of severity in the most common rodent models of middle cerebral artery occlusion, while sustaining or improving the scientific outcomes. The recommendations cover basic requirements pre-surgery, selecting the most appropriate anaesthetic and analgesic regimen, as well as intraoperative and post-operative care...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28794825/interventional-radiology-treatment-for-pulmonary-embolism
#16
REVIEW
Miguel A De Gregorio, Jose A Guirola, Celia Lahuerta, Carolina Serrano, Ana L Figueredo, William T Kuo
Venous thromboembolism (VTE) is an illness that has a potentially life-threatening condition that affects a large percentage of the global population. VTE with pulmonary embolism (PE) is the third leading cause of death after myocardial infarction and stroke. In the first three months after an acute PE, there is an estimated 15% mortality among submassive PE, and 68% mortality in massive PE. Current guidelines suggest fibrinolytic therapy regarding the clinical severity, however some studies suggest a more aggressive treatment approach...
July 28, 2017: World Journal of Radiology
https://www.readbyqxmd.com/read/28793390/interventions-for-maintaining-nasogastric-feeding-after-stroke-an-integrative-review-of-effectiveness-and-acceptability
#17
REVIEW
Catherine Mahoney, Linda Veitch
AIMS AND OBJECTIVES: To investigate the effectiveness and acceptability of interventions for maintaining nasogastric tubes (NGT) in adult stroke patients. BACKGROUND: Internationally, incidence of Cerebral Vascular Disease (CVD) continues to increase and stroke is the largest cause of complex disability in adults. Dysphagia is common following a stroke which necessitates feeding via a NGT. NGT are not well tolerated by stroke patients and may be frequently dislodged...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28792455/cardio-metabolic-benefits-of-plant-based-diets
#18
REVIEW
Hana Kahleova, Susan Levin, Neal Barnard
Cardio-metabolic disease, namely ischemic heart disease, stroke, obesity, and type 2 diabetes, represent substantial health and economic burdens. Almost one half of cardio-metabolic deaths in the U.S. might be prevented through proper nutrition. Plant-based (vegetarian and vegan) diets are an effective strategy for improving nutrient intake. At the same time, they are associated with decreased all-cause mortality and decreased risk of obesity, type 2 diabetes, and coronary heart disease. Evidence suggests that plant-based diets may reduce the risk of coronary heart disease events by an estimated 40% and the risk of cerebral vascular disease events by 29%...
August 9, 2017: Nutrients
https://www.readbyqxmd.com/read/28789779/management-of-blunt-cerebrovascular-injury-bcvi-in-the-multisystem-injury-patient-with-contraindications-to-immediate-anti-thrombotic-therapy
#19
Michelle K McNutt, A Cozette Kale, Ryan S Kitagawa, Ali H Turkmani, David W Fields, Sarah Baraniuk, Brijesh S Gill, Bryan A Cotton, Laura J Moore, Charles E Wade, Arthur Day, John B Holcomb
INTRODUCTION: Practice management guidelines for screening and treatment of patients with blunt cerebrovascular injury (BCVI) have been associated with a decreased risk of ischemic stroke. TREATMENT: of patients with BCVI and multisystem injuries that delays immediate antithrombotic therapy remains controversial. The purpose of this study was to determine the timing of BCVI treatment initiation, the incidence of stroke, and bleeding complications as a result of antithrombotic therapy in patients with isolated BCVI in comparison to those with BCVI complicated by multisystem injuries...
July 31, 2017: Injury
https://www.readbyqxmd.com/read/28782109/low-vs-high-haemoglobin-trigger-for-transfusion-in-vascular-surgery-protocol-for-a-randomised-trial
#20
A Møller, H B Nielsen, J Wetterslev, O B Pedersen, D Hellemann, S Shahidi
BACKGROUND: In patients with cardiovascular disease, guidelines for administration of red blood cells (RBC) are mainly based on studies outside the vascular surgical setting with the recommendation to use a haemoglobin (hb) trigger-level lower than by guidelines from The European Society for Vascular Surgery. Restricting RBC transfusion may affect blood O2 transport with a risk for development of tissue ischaemia and postoperative complications. METHODS: In a single-centre, open-label, assessor blinded trial, 58 vascular surgical patients (> 40 years of age) awaiting open surgery of the infrarenal aorta or infrainguinal arterial bypass surgery undergo a web-based randomisation to one of two groups: perioperative RBC transfusion triggered by hb < 8 g/dl or hb < 9...
September 2017: Acta Anaesthesiologica Scandinavica
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