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https://www.readbyqxmd.com/read/28228574/delays-in-door-to-needle-times-and-their-impact-on-treatment-time-and-outcomes-in-get-with-the-guidelines-stroke
#1
Noreen Kamal, Shubin Sheng, Ying Xian, Roland Matsouaka, Michael D Hill, Deepak L Bhatt, Jeffrey L Saver, Mathew J Reeves, Gregg C Fonarow, Lee H Schwamm, Eric E Smith
BACKGROUND AND PURPOSE: Despite quality improvement programs such as the American Heart Association/American Stroke Association Target Stroke initiative, a substantial portion of acute ischemic stroke patients are still treated with tissue-type plasminogen activator (alteplase) later than 60 minutes from arrival. This study aims to describe the documented reasons for delays and the associations between reasons for delays and patient outcomes. METHODS: We analyzed the characteristics of 55 296 patients who received intravenous alteplase in 1422 hospitals participating in Get With The Guidelines-Stroke from October 2012 to April 2015, excluding transferred patients and inpatient strokes...
February 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28225988/estimation-of-cardiovascular-risk-and-detection-of-subclinical-carotid-atheromatosis-in-patients-with-diabetes-without-a-history-of-cardiovascular-disease
#2
Walter Masson, Salvador De Francesca, Micaela Molinero, Daniel Siniawski, Andrés Mulassi, Frank Espinoza Morales, Melina Huerin, Martín Lobo, Graciela Molinero
Objectives: Cardiovascular risk estimated by several scores in patients with diabetes mellitus without a cardiovascular disease history and the association with carotid atherosclerotic plaque (CAP) were the aims of this study. Materials and methods: Cardiovascular risk was calculate using United Kingdom Prospective Diabetes Study (UKPDS) risk engine, Framingham risk score for cardiovascular (FSCV) and coronary disease (FSCD), and the new score (NS) proposed by the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol...
February 13, 2017: Archives of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28224974/differences-in-outcomes-in-patients-with-stable-coronary-artery-disease-managed-by-cardiologists-versus-non-cardiologists-the-international-prospective-clarify-registry
#3
Zofia Parma, Philippe Gabriel Steg, Nicola Greenlaw, Roberto Ferrari, Ian Ford, Kim Fox, Jean-Claude Tardif, Joao Morais, Marco Alcocer Gamba, Stefan Kääb, Michał Tendera
INTRODUCTION    Clinical outcomes of patients with stable coronary artery disease (SCAD) may differ between those primarily managed by cardiologists versus non-cardiologists.  OBJECTIVES    Our main objective was to analyze the clinical outcomes of outpatients with SCAD in relation to the specialty of the managing physicians.  PATIENTS AND METHODS    We studied 32,468 outpatients with SCAD included in the CLARIFY registry, with up to 4 years follow-up data. Cardiologists provided medical care in 84...
January 20, 2017: Polskie Archiwum Medycyny Wewnętrznej
https://www.readbyqxmd.com/read/28220473/risk-of-stroke-after-bereavement-a-systematic-literature-review
#4
REVIEW
F S Aalbaek, S Graff, M Vestergaard
Several studies have suggested that psychological stress may increase the risk of stroke. However, this link remains a controversial issue because of conflicting findings. Bereavement, the loss of a close relative, is considered a severely stressful life event. Increased risk of stroke could thus be expected after bereavement if stress plays a causal role. We aimed to evaluate the association between bereavement and stroke by performing a systematic review of the existing literature. The literature search was conducted according to the PRISMA guidelines for systematic reviews...
February 20, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28218020/stroke-rehabilitation-evidence-and-comorbidity-a-systematic-scoping-review-of-randomized-controlled-trials
#5
Michelle L A Nelson, Kaileah A McKellar, Juliana Yi, Linda Kelloway, Sarah Munce, Cheryl Cott, Ruth Hall, Martin Fortin, Robert Teasell, Renee Lyons
BACKGROUND: Most strokes occur in the context of other medical diagnoses. Currently, stroke rehabilitation evidence reviews have not synthesized or presented evidence with a focus on comorbidities and correspondingly may not align with current patient population. The purpose of this review was to determine the extent and nature of randomized controlled trial stroke rehabilitation evidence that included patients with multimorbidity. METHODS: A systematic scoping review was conducted...
February 20, 2017: Topics in Stroke Rehabilitation
https://www.readbyqxmd.com/read/28216288/home-automated-office-and-conventional-office-blood-pressure-as-predictors-of-cardiovascular-risk
#6
Emmanuel A Andreadis, Vasilios Papademetriou, Charalampia V Geladari, George N Kolyvas, Epameinondas T Angelopoulos, Konstantinos N Aronis
Automated office blood pressure (AOBP) has recently been shown to closely predict cardiovascular (CV) events in the elderly. Home blood pressure (HBP) has also been accepted as a valuable method in the prediction of CV disease. This study aimed to compare conventional office BP (OBP), HBP, and AOBP in order to evaluate their value in predicting CV events and deaths in hypertensives. We assessed 236 initially treatment naïve hypertensives, examined between 2009 and 2013. The end points were any CV and non-CV event including mortality, myocardial infarction, coronary heart disease, hospitalization for heart failure, severe arrhythmia, stroke, and intermittent claudication...
February 3, 2017: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/28212133/potential-uselessness-and-futility-of-left-atrial-appendage-occlusion-and-patent-foramen-ovale-closure-in-cardioembolic-stroke
#7
Gian L Nicolosi
International guidelines indicate that interventional closure of left atrial appendage and patent foramen ovale may be considered in selected patients for stroke prevention. These procedures appear, however, from the published literature, at high risk of uselessness and futility in the single case, if not even capable to induce harm and adverse events. In fact, all reported systematic reviews and meta-analyses have not shown in a convincing manner the superiority of these procedures in stroke prevention, taking into account the occurrence of possible complications also, as compared with alternative medical treatment...
February 16, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28208200/massive-pulmonary-embolism-extracorporeal-membrane-oxygenation-and-surgical-pulmonary-embolectomy
#8
Aaron Weinberg, Victor F Tapson, Danny Ramzy
Massive pulmonary embolism (PE) refers to large emboli that cause hemodynamic instability, right ventricular failure, and circulatory collapse. According to the 2016 ACCP Antithrombotic Guidelines, therapy for massive PE should include systemic thrombolytic therapy in conjunction with anticoagulation and supportive care. However, in patients with a contraindication to systemic thrombolytics or in those who fail the above interventions, extracorporeal membrane oxygenation (ECMO) and/or surgical embolectomy may be used to improve oxygenation, achieve hemodynamic stability, and successfully treat massive PE...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28206819/norrisk-2-a-norwegian-risk-model-for-acute-cerebral-stroke-and-myocardial-infarction
#9
Randi Selmer, Jannicke Igland, Inger Ariansen, Aage Tverdal, Inger Njølstad, Kari Furu, Grethe S Tell, Tor Ole Klemsdal
Background Guidelines for the prevention of cardiovascular disease recommend the estimation of an individual's total risk. We have developed a new model for the prediction of the 10-year risk of incident acute myocardial infarction or cerebral stroke based on Norwegian data, NORRISK 2. Design The model was based on 10-year follow-up of a large population-based cohort (CONOR) through linkage to the CVDNOR project, a database of cardiovascular disease hospital discharge diagnoses and mortality in Norway in 1994-2009...
January 1, 2017: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/28198732/intensive-blood-pressure-lowering-in-chronic-kidney-disease-the-time-has-come
#10
Marcel Ruzicka, Swapnil Hiremath
PURPOSE OF REVIEW: Release of the findings from the Systolic Blood Pressure Intervention Trial has resulted in a renewed examination of intensive blood pressure (BP) lowering. Only a few national hypertension guidelines (Canada and Australia) have changed recommendations, but considerable heterogeneity still exists with respect to the patient population to whom intensive BP lowering may apply. RECENT FINDINGS: There is fairly robust evidence that lower BP targets in nondiabetic chronic kidney disease (CKD) results in a decrease in heart failure and mortality...
February 13, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28196814/racial-ethnic-disparities-in-acute-stroke-care-in-the-florida-puerto-rico-collaboration-to-reduce-stroke-disparities-study
#11
Ralph L Sacco, Hannah Gardener, Kefeng Wang, Chuanhui Dong, Maria A Ciliberti-Vargas, Carolina M Gutierrez, Negar Asdaghi, W Scott Burgin, Olveen Carrasquillo, Enid J Garcia-Rivera, Ulises Nobo, Sofia Oluwole, David Z Rose, Michael F Waters, Juan Carlos Zevallos, Mary Robichaux, Salina P Waddy, Jose G Romano, Tatjana Rundek
BACKGROUND: Racial-ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined race-ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines-Stroke hospitals. METHODS AND RESULTS: Seventy-five sites in the Florida Puerto Rico Stroke Registry (66 Florida and 9 Puerto Rico) recorded 58 864 ischemic stroke cases (2010-2014). Logistic regression models examined racial-ethnic differences in acute stroke performance measures and defect-free care (intravenous tissue plasminogen activator treatment, in-hospital antithrombotic therapy, deep vein thrombosis prophylaxis, discharge antithrombotic therapy, appropriate anticoagulation therapy, statin use, smoking cessation counseling) and temporal trends...
February 14, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28196453/near-infrared-spectroscopy-in-gait-disorders
#12
Vera Gramigna, Giovanni Pellegrino, Antonio Cerasa, Simone Cutini, Roberta Vasta, Giuseppe Olivadese, Iolanda Martino, Aldo Quattrone
Walking is a complex motor behavior with a special relevance in clinical neurology. Many neurological diseases, such as Parkinson's disease and stroke, are characterized by gait disorders whose neurofunctional correlates are poorly investigated. Indeed, the analysis of real walking with the standard neuroimaging techniques poses strong challenges, and only a few studies on motor imagery or walking observation have been performed so far. Functional near-infrared spectroscopy (fNIRS) is becoming an important research tool to assess functional activity in neurological populations or for special tasks, such as walking, because it allows investigating brain hemodynamic activity in an ecological setting, without strong immobility constraints...
January 1, 2017: Neurorehabilitation and Neural Repair
https://www.readbyqxmd.com/read/28187799/management-of-intracerebral-hemorrhage
#13
A M Thabet, M Kottapally, J Claude Hemphill
Intracerebral hemorrhage (ICH) is a potentially devastating neurologic injury representing 10-15% of stroke cases in the USA each year. Numerous risk factors, including age, hypertension, male gender, coagulopathy, genetic susceptibility, and ethnic descent, have been identified. Timely identification, workup, and management of this condition remain a challenge for clinicians as numerous factors can present obstacles to achieving good functional outcomes. Several large clinical trials have been conducted over the prior decade regarding medical and surgical interventions...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187730/adherence-to-treatment-guidelines-the-association-between-stroke-risk-stratified-comparing-chads2-and-cha2ds2-vasc-score-levels-and-warfarin-prescription-for-adult-patients-with-atrial-fibrillation
#14
Scott A Chapman, Catherine A St Hill, Meg M Little, Michael T Swanoski, Shellina R Scheiner, Kenric B Ware, M Nawal Lutfiyya
BACKGROUND: Ischemic stroke is a risk associated with atrial fibrillation (AF) and is estimated to occur five times more often in afflicted patients than in those without AF. Anti-thrombotic therapy is recommended for the prevention of ischemic stroke. Risk stratification tools, such as the CHADS2, and more recently the CHA2DS2-VASc, for predicting stroke in patients with AF have been developed to determine the level of stroke risk and assist clinicians in the selection of antithrombotic therapy...
February 11, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28187718/an-education-programme-influencing-health-professionals-to-recommend-exercise-to-their-type-2-diabetes-patients-understanding-the-processes-a-case-study-from-oxfordshire-uk
#15
Anne Matthews, Natasha Jones, Alastair Thomas, Perdy van den Berg, Charlie Foster
BACKGROUND: Increasing levels of physical activity decreases the risk of premature mortality associated with chronic diseases e.g., coronary heart disease, type 2 diabetes, stroke. Despite this, most adults in England do not meet physical activity guidelines. Physical activity advice and signposting offered to at-risk patients by primary care providers is recommended. However, exercise medicine education is sparse, leading to poor practitioner knowledge of the risk reduction evidence and strategies to implement effective patient behaviour change...
February 11, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28183857/coexistent-sickle-cell-disease-has-no-impact-on-the-safety-or-outcome-of-lytic-therapy-in-acute-ischemic-stroke-findings-from-get-with-the-guidelines-stroke
#16
Robert J Adams, Margueritte Cox, Shelly D Ozark, Julie Kanter, Phillip J Schulte, Ying Xian, Gregg C Fonarow, Eric E Smith, Lee H Schwamm
BACKGROUND AND PURPOSE: The recommended treatment for ischemic stroke is tPA (tissue-type plasminogen activator). Although sickle cell disease (SCD) represents no known contraindication to tPA, National Heart Lung and Blood Institute of the National Institutes of Health recommended acute exchange transfusion for stroke in SCD, not tPA. Data on safety and outcomes of tPA in patients are needed to guide tPA use in SCD. METHODS: We matched patients from the American Heart Association and American Stroke Association Get With The Guidelines-Stroke registry with SCD to patients without SCD and compared usage, complications, and discharge outcomes after tPA...
February 9, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28183175/carotid-endarterectomy-has-significantly-lower-risk-in-the-last-two-decades-should-the-guidelines-now-be-updated
#17
Djordje Radak, Djurre de Waard, Alison Halliday, Mihailo Neskovic, Slobodan Tanaskovic
Carotid endarterectomy (CEA) carries a significant risk of procedural stroke and death Guidelines recommend keeping this risk below 6% and below 3% for symptomatic and asymptomatic patients respectively. After analysing our Institute's CEA results during the past 25 years, we found the rate of postoperative complications was now well below Guideline thresholds. Accordingly, we studied temporal changes in procedural risks in randomized controlled trials (RCTs) and in large observational studies in order to compare these against Guidelines...
February 9, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28182166/reducing-the-risk-of-stroke-in-elderly-patients-with-non-valvular-atrial-fibrillation-a-practical-guide-for-clinicians
#18
REVIEW
Joanne M Foody
Non-valvular atrial fibrillation (NVAF) significantly contributes to the burden of stroke, particularly in elderly patients. The challenge of optimizing anticoagulation therapy is balancing efficacy and bleeding risk, especially as the same patients at high risk of stroke also tend to be at high risk of bleeding. Treating the elderly patient with NVAF presents special challenges because of their heightened risk for both stroke and bleeding. Despite clinical trial data and evidence-based guidelines, surveys indicate that physicians underuse anticoagulation in older patients for reasons that include overemphasis of bleeding risk, particularly with the increased risk of falling, at the cost of thromboembolic risk...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/28174820/effect-of-a-novel-clinical-decision-support-tool-on-the-efficiency-and-accuracy-of-treatment-recommendations-for-cholesterol-management
#19
Marianne R Scheitel, Maya E Kessler, Jane L Shellum, Steve G Peters, Dawn S Milliner, Hongfang Liu, Ravikumar Komandur Elayavilli, Karl A Poterack, Timothy A Miksch, Jennifer Boysen, Ron A Hankey, Rajeev Chaudhry
BACKGROUND: The 2013 American College of Cardiology / American Heart Association Guidelines for the Treatment of Blood Cholesterol emphasize treatment based on cardiovascular risk. But finding time in a primary care visit to manually calculate cardiovascular risk and prescribe treatment based on risk is challenging. We developed an informatics-based clinical decision support tool, MayoExpertAdvisor, to deliver automated cardiovascular risk scores and guideline-based treatment recommendations based on patient-specific data in the electronic heath record...
February 8, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28171741/effectiveness-of-technologies-in-the-treatment-of-post-stroke-anomia-a-systematic-review
#20
REVIEW
Monica Lavoie, Joël Macoir, Nathalie Bier
BACKGROUND: Technologies are becoming increasingly popular in the treatment of language disorders and offer numerous possibilities, but little is known about their effectiveness and limitations. AIM: The aim of this systematic review was to investigate the effectiveness of treatments delivered by technology in the management of post-stroke anomia. METHODS: As a guideline for conducting this review, we used the PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions...
January 27, 2017: Journal of Communication Disorders
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