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management of stroke

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https://www.readbyqxmd.com/read/28230899/shared-care-across-the-interface-between-primary-and-specialty-care-in-management-of-long-term-conditions
#1
REVIEW
Susan M Smith, Gráinne Cousins, Barbara Clyne, Shane Allwright, Tom O'Dowd
BACKGROUND: Shared care has been used in the management of many chronic conditions with the assumption that it delivers better care than primary or specialty care alone; however, little is known about the effectiveness of shared care. OBJECTIVES: To determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review...
February 23, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28229894/mobile-stroke-units-for-prehospital-thrombolysis-triage-and-beyond-benefits-and-challenges
#2
REVIEW
Klaus Fassbender, James C Grotta, Silke Walter, Iris Q Grunwald, Andreas Ragoschke-Schumm, Jeffrey L Saver
In acute stroke management, time is brain. Bringing swift treatment to the patient, instead of the conventional approach of awaiting the patient's arrival at the hospital for treatment, is a potential strategy to improve clinical outcomes after stroke. This strategy is based on the use of an ambulance (mobile stroke unit) equipped with an imaging system, a point-of-care laboratory, a telemedicine connection to the hospital, and appropriate medication. Studies of prehospital stroke treatment consistently report a reduction in delays before thrombolysis and cause-based triage in regard to the appropriate target hospital (eg, primary vs comprehensive stroke centre)...
March 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28229841/-neuroimaging-and-blood-biomarkers-in-functional-prognosis-after-stroke
#3
REVIEW
João Paulo Branco, Joana Santos Costa, João Sargento-Freitas, Sandra Oliveira, Bruno Mendes, Jorge Laíns, João Pinheiro
INTRODUCTION: Stroke remains one of the leading causes of morbidity and mortality around the world and it is associated with an important long-term functional disability. Some neuroimaging resources and certain peripheral blood or cerebrospinal fluid proteins can give important information about etiology, therapeutic approach, follow-up and functional prognosis in acute ischemic stroke patients. However, among the scientific community, there is currently more interest in the stroke vital prognosis over the functional prognosis...
November 2016: Acta Médica Portuguesa
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
#4
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/28228467/gender-differences-in-clinical-presentation-and-1-year-outcomes-in-atrial-fibrillation
#5
Renate B Schnabel, Ladislav Pecen, Francisco M Ojeda, Markus Lucerna, Nargiz Rzayeva, Stefan Blankenberg, Harald Darius, Dipak Kotecha, Raffaele De Caterina, Paulus Kirchhof
OBJECTIVES: Our objective was to examine gender differences in clinical presentation, management and prognosis of atrial fibrillation (AF) in a contemporary cohort. METHODS: In 6412 patients, 39.7% women, of the PREvention oF thromboembolic events - European Registry in Atrial Fibrillation, we examined gender differences in symptoms, risk factors, therapies and 1-year incidence of adverse outcomes. RESULTS: Men with AF were on average younger than women (mean±SD: 70...
February 22, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28228305/clinical-presentation-management-and-outcomes-in-the-indian-heart-rhythm-society-atrial-fibrillation-ihrs-af-registry
#6
A Vora, A Kapoor, M Nair, Y Lokhandwala, C Narsimhan, A G Ravikishore, S K Dwivedi, N Namboodiri, R Hygriv, A Saxena, A Nabar, S Garg, N Bardoloi, R Yadav, A Nambiar, U Pandurangi, D Jhala, A Naik, Nagmallesh, S Rajagopal, R Selvaraj, V Arora, A Thachil, J Thomas, G Panicker
AIM: A national atrial fibrillation (AF) registry was conducted under the aegis of the Indian Heart Rhythm Society (IHRS), to capture epidemiological data-type of AF, clinical presentation and comorbidities, current treatment practices, and 1-year follow-up outcomes. METHODS: A total of 1537 patients were enrolled from 24 sites in India in the IHRS-AF registry from July 2011 to August 2012. Their baseline characteristics and follow-up data were recorded in case report forms and subsequently analyzed...
January 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/28228074/lenticulostriate-artery-and-lenticulostriate-artery-neural-complex-new-concept-for-intracerebral-hemorrhage
#7
Rong Hu, Hua Feng
BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is the poorest prognosis of all stroke subtypes with a high mortality and morbidity. Although considerable progress has been made, no intervention is currently available to alter the outcome of patients with ICH, suggesting a new concept directing ICH study is urgently needed. METHODS: Most ICH occurs in the deep area of the brain, the basal ganglion, whose blood supply is mainly from lenticulostriate arteries (LSAs)...
February 20, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28227048/anticoagulation-manager-development-of-a-clinical-decision-support-mobile-application-for-management-of-anticoagulants
#8
Chih-Wen Cheng, Hang Wu, Pamela J Thompson, Julie R Taylor, Barbara A Zehnbauer, Karlyn K Wilson, May D Wang, Chih-Wen Cheng, Hang Wu, Pamela J Thompson, Julie R Taylor, Barbara A Zehnbauer, Karlyn K Wilson, May D Wang, Karlyn K Wilson, Pamela J Thompson, Barbara A Zehnbauer, Hang Wu, Julie R Taylor, Chih-Wen Cheng, May D Wang
Patients with certain clotting disorders or conditions have a greater risk of developing arterial or venous clots and downstream embolisms, strokes, and arterial insufficiency. These patients need prescription anticoagulant drugs to reduce the possibility of clot formation. However, historically, the clinical decision making workflow in determining the correct type and dosage of anticoagulant(s) is part science and part art. To address this problem, we developed Anticoagulation Manager, an intelligent clinical decision workflow management system on iOS-based mobile devices to help clinicians effectively choose the most appropriate and helpful follow-up clotting tests for patients with a common clotting profile...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28226082/stroke-occurring-in-patients-with-cognitive-impairment-or-dementia
#9
Solène Moulin, Didier Leys
Objective: To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods: Literature search. Results: (i) A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii) Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii) Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv) Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others...
February 2017: Arquivos de Neuro-psiquiatria
https://www.readbyqxmd.com/read/28225376/a-qualitative-analysis-of-general-emergency-medicine-providers-perceptions-on-pediatric-emergency-telemedicine
#10
Ji Won Kim, Gunjan Tiyyagura, Melissa Langhan
OBJECTIVE: Most children in the United States are evaluated in general emergency departments (ED), which are staffed by practitioners who care for both adults and children and may have limited pediatric resources. The application of telemedicine in pediatrics is growing and has been shown to be effective in outpatient as well as critical care settings. Telemedicine has the potential to address disparities in access to pediatric emergency care. The objective of this study was to explore experiences of general ED providers with telemedicine and their perception about a potential video telemedicine program with pediatric ED providers...
February 21, 2017: Pediatric Emergency Care
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
#11
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/28224105/nutrient-stimulation-of-mesenteric-blood-flow-implications-for-older-critically-ill-patients
#12
REVIEW
Thu An Nguyen, Yasmine Ali Abdelhamid, Liza K Phillips, Leeanne S Chapple, Michael Horowitz, Karen L Jones, Adam M Deane
Nutrient ingestion induces a substantial increase in mesenteric blood flow. In older persons (aged ≥ 65 years), particularly those with chronic medical conditions, the cardiovascular compensatory response may be inadequate to maintain systemic blood pressure during mesenteric blood pooling, leading to postprandial hypotension. In older ambulatory persons, postprandial hypotension is an important pathophysiological condition associated with an increased propensity for syncope, falls, coronary vascular events, stroke and death...
February 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28222715/the-characteristics-of-stroke-units-in-ontario-a-pan-provincial-survey
#13
Valeria E Rac, Yeva Sahakyan, Iris Fan, Luciano Ieraci, Ruth Hall, Linda Kelloway, Gabrielle van der Velde, Moira K Kapral, Mark Bayley, Murray Krahn
BACKGROUND: Previous studies have demonstrated that organized, multidisciplinary care is the cornerstone of current strategies to reduce the death and disability caused by stroke. Identification of stroke units and an understanding of their composition and operation would provide insight for the further actions required to improve stroke care. The objective of this study was to identify and survey stroke units in Canada's largest province, Ontario (population of 13 million) in order to describe availability, structure, staffing, processes of care, and type of population stroke units serve...
February 21, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28222473/telemedizin-%C3%A2-tempis%C3%A2-netzwerk-f%C3%A3-r-schlaganfallbehandlung-in-der-regelversorgung
#14
Nicolas Völkel, Gordian J Hubert, Roman L Haberl
Despite all efforts that have been made stroke is a burden and remains one of the most devastating neurological diseases. Treatment of patients on a Stroke Unit improves stroke prognosis and is recommended for all patients with acute stroke. In rural areas population-wide implementation of Stroke Units is extremely challenging. Therefore the Telemedical Project for integrated Stroke Care (TEMPiS) was established in 2003 as a TeleStroke network to overcome this barrier in Southeast Bavaria/Germany. TEMPiS was one of the very early telemedical stroke networks worldwide and was evaluated intensively during its implementation phase between February 2003 and December 2005...
February 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28221268/moyamoya-syndrome-associated-with-hereditary-spherocytosis-an-emerging-clinical-entity
#15
Eleanor Gait-Carr, Daniel J A Connolly, David King
Moyamoya syndrome is an unusual cerebrovascular disorder, which has rarely been reported in association with hereditary spherocytosis. We present the case of a 6-year-old boy with hereditary spherocytosis who was diagnosed with Moyamoya syndrome following a stroke. We discuss why these conditions may coexist and briefly outline the management of such children.
February 17, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/28220472/renal-denervation-for-resistant-hypertension
#16
REVIEW
Giuseppe Coppolino, Anna Pisano, Laura Rivoli, Davide Bolignano
BACKGROUND: Resistant hypertension is highly prevalent among the general hypertensive population and the clinical management of this condition remains problematic. Different approaches, including a more intensified antihypertensive therapy, lifestyle modifications, or both, have largely failed to improve patients' outcomes and to reduce cardiovascular and renal risk. As renal sympathetic hyperactivity is a major driver of resistant hypertension, renal sympathetic ablation (renal denervation) has been recently proposed as a possible therapeutic alternative to treat this condition...
February 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28220330/synchronous-cardiocerebral-infarction-in-the-era-of-endovascular-therapy-which-to-treat-first
#17
Leonard L L Yeo, Tommy Andersson, Kong Wan Yee, Benjamin Y Q Tan, Prakash Paliwal, Anil Gopinathan, Mahendran Nadarajah, Eric Ting, Hock L Teoh, Robin Cherian, Erik Lundström, Edgar L W Tay, Vijay K Sharma
A cardiocerebral ischemic attack (CCI) or a concurrent acute ischemic stroke (AIS) and myocardial infarction (AMI) is a severe event with no clear recommendations for ideal management because of the rarity of the scenario. The narrow time window for treatment and complexity of the treatment decision puts immense pressure on the treating physician. We evaluated this challenging situation at our tertiary center. Using our prospective stroke database out of a total of 555 patients with acute ischemic stroke between 2009 and 2014, we identified five consecutive cases with CCI (incidence 0...
February 20, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28219685/development-of-a-chronic-disease-management-program-for-stroke-survivors-using-intervention-mapping-the-stroke-coach
#18
Brodie M Sakakibara, Scott A Lear, Susan I Barr, Oscar Benavente, Charlie H Goldsmith, Noah D Silverberg, Jennifer Yao, Janice J Eng
OBJECTIVE: To describe the systematic development of the Stroke Coach, a theory- and evidence-based intervention to improve control of lifestyle behaviour risk factors in stroke patients. DESIGN: Intervention development. SETTING: Community. PARTICIPANTS: Individuals who have had a stroke. INTERVENTION: We used Intervention Mapping to guide the development of the Stroke Coach. Intervention Mapping is a systematic process used for intervention development and comprised of steps that progress from the integration of theory and evidence to the organization of realistic strategies to facilitate the development of a practical intervention supported by empirical evidence...
February 17, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28217390/management-of-aneurysmal-subarachnoid-hemorrhage-state-of-the-art-and-future-perspectives
#19
REVIEW
Giovanni Grasso, Concetta Alafaci, R Loch Macdonald
BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) accounts for 5% of strokes and carries a poor prognosis. It affects around 6 cases per 100,000 patient years occurring at a relatively young age. METHODS: Common risk factors are the same as for stroke, and only in a minority of the cases, genetic factors can be found. The overall mortality ranges from 32% to 67%, with 10-20% of patients with long-term dependence due to brain damage. An explosive headache is the most common reported symptom, although a wide spectrum of clinical disturbances can be the presenting symptoms...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28216353/left-subclavian-artery-revascularization-in-zone-2-thoracic-endovascular-aortic-repair-is-associated-with-lower-stroke-risk-across-all-aortic-diseases
#20
Rhiannon J Bradshaw, S Sadie Ahanchi, Obie Powell, Sebastian Larion, Colin Brandt, Michael C Soult, Jean M Panneton
BACKGROUND: The best management strategy for the left subclavian artery (LSA) in pathologic processes of the aorta requiring zone 2 thoracic endovascular aortic repair (TEVAR) remains controversial. We compared LSA coverage with or without revascularization as well as the different means of LSA revascularization. METHODS: A retrospective chart review was conducted of patients with any aortic diseases who underwent zone 2 TEVAR deployment from 2007 to 2014. Primary end points included 30-day stroke and 30-day spinal cord injury (SCI)...
February 16, 2017: Journal of Vascular Surgery
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