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Ang TE, Bivard A, Levi C, Ma H, Hsu CY, Campbell B, Donnan G, Davis SM, Parsons M. Multi-Modal CT in Acute Stroke: Wait for a Serum Creatinine before Giving Intravenous Contrast? No! Int J Stroke 2015; 10:1014-7. [DOI: 10.1111/ijs.12605] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
Background Multi-modal CT (MMCT) to guide decision making for reperfusion treatment is increasingly used, but there remains a perceived risk of contrast-induced nephropathy (CIN). At our center, MMCT is used empirically without waiting for serum-creatinine (sCR) or renal profiling. Aims To determine the incidence of CIN, examine the risk factors predisposing to its development, and investigate its effects on clinical outcome in the acute stroke population. Methods An institution-wide protocol was implemented for acute stroke presentations to have MMCT (100–150 ml nonionic tri-iodinated contrast, perfusion CT and CT angiography) without waiting for serum-creatinine to minimize delays. Intravenous saline is routinely infused (80–125 ml/h) for at least 24-h after MMCT. Serial creatinine levels were measured at baseline, risk period, and follow-up. Renal profiles and clinical progress were reviewed up to 90 days. Results We analyzed 735 consecutive patients who had MMCT for the evaluation of acute ischemic or hemorrhagic stroke during the last five-years. A total of 623 patients met the inclusion criteria for analysis: 16 cases (2·6%) biochemically qualified as CIN; however, the risk period serum-creatinine for 15 of these cases was confounded by dehydration, urinary tract infection, or medications. None of the group had progression to chronic kidney disease or required dialysis. Conclusions The incidence of CIN is low when MMCT is used routinely to assess acute stroke patients. In this population, CIN was a biochemical phenomenon that did not have clinical manifestations, cause chronic kidney disease, require dialysis, or negatively impact on 90-day mRS outcomes. Renal profiling and waiting for a baseline serum-creatinine are an unnecessary delay to emergency reperfusion treatment.
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Affiliation(s)
- Timothy E. Ang
- Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Andrew Bivard
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Christopher Levi
- Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Henry Ma
- Neurology, Monash Medical Centre, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Bruce Campbell
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Donnan
- University of Melbourne, Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Stephen M. Davis
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Parsons
- Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
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Ramirez L, Krug A, Nhoung H, Kazaryan S, Gasparian G, Perese J, Razmara A, Liebeskind DS, Majersik JJ, Sanossian N. Vascular Neurologists as Directors of Stroke Centers in the United States. Stroke 2015. [PMID: 26219648 DOI: 10.1161/strokeaha.115.009888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hospital certification as primary and comprehensive stroke center is associated with improvement in care. We aimed to characterize the leadership at stroke centers nationwide to determine the proportion led by vascular neurologists, a board-recognized subspecialty focusing on stroke care. METHODS We identified hospitals in the United States holding primary and comprehensive stroke center designation as of September 2013. We contacted each hospital to identify the medical director and used data from relevant medical boards to determine specialization. Sex and date of medical school graduation were obtained from an online physician database. RESULTS Of the 1167 primary and 50 comprehensive stroke center hospitals certified by the Joint Commission (n=1114), Det Norske Veritas (n=68), and Healthcare Facilities Accreditation Program (n=35), we identified the director in 940 (77%). Leadership was most often by a neurologist (n=745; 79%) followed by physicians in emergency medicine (n=58; 6%) and internal medicine (n=17; 2%). Vascular neurologists (n=319) led about one-third of stroke centers. Directors were mostly men (n=764; 81%), with a median number of years after medical school graduation of 25 (interquartile range, 18-34). Comprehensive stroke centers were more likely than primary stroke centers to have leadership by vascular neurologist (77%, n=37 versus 32%, n=282; P<0.001). CONCLUSIONS Vascular neurologist led about one-third of stroke centers. There is opportunity for vascular neurologists to increase their role in stroke center directorship.
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Affiliation(s)
- Lucas Ramirez
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.)
| | - Aaron Krug
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.)
| | - Heng Nhoung
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.)
| | - Suzie Kazaryan
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.)
| | - Gregory Gasparian
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.)
| | - Joshua Perese
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.)
| | - Ali Razmara
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.)
| | - David S Liebeskind
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.)
| | - Jennifer J Majersik
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.)
| | - Nerses Sanossian
- From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
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Affiliation(s)
- Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX2 6HE, UK.
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Hacke W, Diener HC. [Mechanical thrombectomy in acute ischemic stroke. What is the position after the latest study results?]. DER NERVENARZT 2015; 86:719-24. [PMID: 26013535 DOI: 10.1007/s00115-015-4319-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mechanical devices for the recanalization of vessel occlusions in severe acute ischemic stroke have been developed for more than a decade. Several devices have been approved for clinical use on the basis of uncontrolled case series. Many neurologists have asked for randomized clinical trials comparing the new devices with standard treatment, e.g. thrombolytic therapy within a 4.5 h time window. The first 3 investigator initiated randomized trials published in 2013 failed to show superiority of mechanical thrombectomy over standard treatment. In the aftermath of these negative results several new trials with changes in design (e.g. shorter time window and only proximal vessel occlusions) and the use of modern devices with proven higher recanalization rates, so called stent retrievers, have been launched. In October 2014 the first of these new trials was presented and showed a clear superiority of thrombectomy. Based on this result interim analyses of five other studies were performed and most were prematurely terminated because of overwhelming efficacy. Only one trial testing another type of recanalization device failed to reach a statistically significant result. Currently five studies have already been published and two more studies have been presented at scientific conferences. This article provides an overview of the study protocols and the results of the individual studies, their common features and the characteristics of patients who benefit from this treatment. Finally, the consequences that these results may have for the treatment of patients with severe stroke caused by proximal vessel occlusion are discussed.
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Affiliation(s)
- W Hacke
- Abteilung Neurologie und Poliklinik, Neurologische Klinik, Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland,
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Wessel MJ, Zimerman M, Hummel FC. Non-invasive brain stimulation: an interventional tool for enhancing behavioral training after stroke. Front Hum Neurosci 2015; 9:265. [PMID: 26029083 PMCID: PMC4432668 DOI: 10.3389/fnhum.2015.00265] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/23/2015] [Indexed: 01/20/2023] Open
Abstract
Stroke is the leading cause of disability among adults. Motor deficit is the most common impairment after stroke. Especially, deficits in fine motor skills impair numerous activities of daily life. Re-acquisition of motor skills resulting in improved or more accurate motor performance is paramount to regain function, and is the basis of behavioral motor therapy after stroke. Within the past years, there has been a rapid technological and methodological development in neuroimaging leading to a significant progress in the understanding of the neural substrates that underlie motor skill acquisition and functional recovery in stroke patients. Based on this and the development of novel non-invasive brain stimulation (NIBS) techniques, new adjuvant interventional approaches that augment the response to behavioral training have been proposed. Transcranial direct current, transcranial magnetic, and paired associative (PAS) stimulation are NIBS techniques that can modulate cortical excitability, neuronal plasticity and interact with learning and memory in both healthy individuals and stroke patients. These techniques can enhance the effect of practice and facilitate the retention of tasks that mimic daily life activities. The purpose of the present review is to provide a comprehensive overview of neuroplastic phenomena in the motor system during learning of a motor skill, recovery after brain injury, and of interventional strategies to enhance the beneficial effects of customarily used neurorehabilitation after stroke.
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Affiliation(s)
- Maximilian J Wessel
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Máximo Zimerman
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany ; Institute of Cognitive Neurology (INECO) , Buenos Aires , Argentina
| | - Friedhelm C Hummel
- Brain Imaging and Neurostimulation (BINS) Laboratory, Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany ; Favaloro University , Buenos Aires , Argentina
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Stason WB. Can Clinical Practice Guidelines Increase the Effectiveness and Cost-Effectiveness of Poststroke Rehabilitation? Top Stroke Rehabil 2015. [DOI: 10.1310/elyh-md3v-4ytt-ewmw] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Stig Jørgense H, Nakayama H, Otto Raaschou H, Møller Pedersen P, Houth J, Skyhøj Olsen T. Functional and Neurological Outcome of Stroke and the Relation to Stroke Severity and Type, Stroke Unit Treatment, Body Temperature, Age, and Other Risk Factors: The Copenhagen Stroke Study. Top Stroke Rehabil 2015. [DOI: 10.1310/bt7j-2n6u-vd53-e1qu] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Kyle S, Saha S. Nanotechnology for the detection and therapy of stroke. Adv Healthc Mater 2014; 3:1703-20. [PMID: 24692428 DOI: 10.1002/adhm.201400009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Indexed: 01/06/2023]
Abstract
Over the years, nanotechnology has greatly developed, moving from careful design strategies and synthesis of novel nanostructures to producing them for specific medical and biological applications. The use of nanotechnology in diagnostics, drug delivery, and tissue engineering holds great promise for the treatment of stroke in the future. Nanoparticles are employed to monitor grafted cells upon implantation, or to enhance the imagery of the tissue, which is coupled with a noninvasive imaging modality such as magnetic resonance imaging, computed axial tomography or positron emission tomography scan. Contrast imaging agents used can range from iron oxide, perfluorocarbon, cerium oxide or platinum nanoparticles to quantum dots. The use of nanomaterial scaffolds for neuroregeneration is another area of nanomedicine, which involves the creation of an extracellular matrix mimic that not only serves as a structural support but promotes neuronal growth, inhibits glial differentiation, and controls hemostasis. Promisingly, carbon nanotubes can act as scaffolds for stem cell therapy and functionalizing these scaffolds may enhance their therapeutic potential for treatment of stroke. This Progress Report highlights the recent developments in nanotechnology for the detection and therapy of stroke. Recent advances in the use of nanomaterials as tissue engineering scaffolds for neuroregeneration will also be discussed.
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Affiliation(s)
- Stuart Kyle
- School of Medicine; University of Leeds; Leeds LS2 9JT UK
| | - Sikha Saha
- Division of Cardiovascular and Diabetes Research; Leeds Institute of Genetics; Health and Therapeutics; University of Leeds; Leeds LS2 9JT UK
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Análisis de recursos asistenciales para el ictus en España en 2012: ¿beneficios de la Estrategia del Ictus del Sistema Nacional de Salud? Neurologia 2014; 29:387-96. [DOI: 10.1016/j.nrl.2013.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/10/2013] [Accepted: 06/17/2013] [Indexed: 11/22/2022] Open
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Analysis of stroke care resources in Spain in 2012: Have we benefitted from the Spanish Health System's stroke care strategy? NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Uehara T, Yasui N, Okada Y, Hasegawa Y, Nagatsuka K, Minematsu K. Which should be the essential components of stroke centers in Japan? A survey by questionnaires sent to the directors of facilities certified by the Japan stroke society. Cerebrovasc Dis 2014; 37:409-16. [PMID: 25011445 DOI: 10.1159/000362641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 04/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We conducted a survey by questionnaire to identify the essential components of stroke centers in Japan and compared our results with the European Expert Survey. METHODS In 2007, a questionnaire was mailed to the directors of 740 facilities certified by the Japan Stroke Society to ask their opinion on the essential components of comprehensive stroke centers (CSC), primary stroke centers (PSC) and any hospital ward (AHW) admitting acute stroke patients. The directors were asked to provide 1 of the following 6 possible answers regarding 112 components: 'irrelevant'; 'useful but not necessary'; 'desirable'; 'important but not absolutely necessary'; 'absolutely necessary', or 'question unclear or ambiguous'. The components considered 'absolutely necessary' by more than 75% of the respondents were compared between our survey and the European Expert Survey. In addition, we compared the rates of neurosurgeons and neurologists who answered 'absolutely necessary' with regard to each component. RESULTS Responses were obtained from 428 directors (57.8% response rate). Among these respondents, 298 (69.6%) were neurosurgeons. There was no component considered 'absolutely necessary' for AHW by more than 75% of the respondents, and this was similar to the results of the European Expert Survey. The following components were considered 'absolutely necessary' for PSC in our survey: brain CT scanning 24 h a day, 7 days a week (24/7); automated monitoring of the ECG, pulse oximetry, blood pressure and breathing, and respiratory support. In both our survey and the European Expert Survey, the essential components for CSC were as follows: physiotherapist; brain CT scanning 24/7; monitoring of the ECG, pulse oximetry and blood pressure; carotid surgery; angioplasty and stenting, and intravenous recombinant tissue plasminogen activator protocols. The components multidisciplinary stroke team, stroke-trained nurse, ultrasonography, collaboration with an outside rehabilitation center, stroke pathway and clinical research were deemed essential only in the European Expert Survey. However, MRI 24/7, MR angiography 24/7, conventional angiography 24/7, respiratory support as well as most neuroendovascular and neurosurgical treatments were considered necessary for CSC by more than 75% of the respondents in our survey. Analyzing the responses from only neurologists reduced the differences between our survey and the European Expert Survey. CONCLUSIONS The present study indicated the essential components expected for stroke centers in Japan. Our survey demonstrated that more emphasis was likely to be placed on installations than on a dedicated stroke team and the use of stroke care maps. In addition, the results of this study may reflect some characteristics of the stroke care environment in Japan, such as the predominance of neurosurgeons and widespread use of MRI.
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Affiliation(s)
- Toshiyuki Uehara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Cordonnier C, Leys D. Should INTERACT 2 results modify our management of acute spontaneous intra-cerebral haemorrhages? Rev Neurol (Paris) 2014; 169:835-7. [PMID: 24182888 DOI: 10.1016/j.neurol.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C Cordonnier
- EA 1046, Department of neurology, Stroke centre, Roger-Salengro hospital, Lille University Hospital, rue Émile-Laine, 59037 Lille, France
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Rate of intravenous thrombolysis for acute ischaemic stroke in the North-of-France region and evolution over time. J Neurol 2014; 261:1320-8. [DOI: 10.1007/s00415-014-7344-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 11/26/2022]
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Alonso de Leciñana M, Egido J, Casado I, Ribó M, Dávalos A, Masjuan J, Caniego J, Martínez Vila E, Díez Tejedor E, Fuentes (Secretaría) B, Álvarez-Sabin J, Arenillas J, Calleja S, Castellanos M, Castillo J, Díaz-Otero F, López-Fernández J, Freijo M, Gállego J, García-Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Martí-Fábregas J, Martínez-Sánchez P, Molina C, Morales A, Nombela F, Purroy F, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J, Vivancos J. Guidelines for the treatment of acute ischaemic stroke. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2011.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Abstract
BACKGROUND People with hyperglycaemia concomitant with an acute stroke have greater mortality, stroke severity, and functional impairment when compared with those with normoglycaemia at stroke presentation. This is an update of a Cochrane Review first published in 2011. OBJECTIVES To determine whether intensively monitoring insulin therapy aimed at maintaining serum glucose within a specific normal range (4 to 7.5 mmol/L) in the first 24 hours of acute ischaemic stroke influences outcome. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (September 2013), CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to September 2013), EMBASE (1980 to September 2013), CINAHL (1982 to September 2013), Science Citation Index (1900 to September 2013), and Web of Science (ISI Web of Knowledge) (1993 to September 2013). We also searched ongoing trials registers and SCOPUS. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing intensively monitored insulin therapy versus usual care in adults with acute ischaemic stroke. DATA COLLECTION AND ANALYSIS We obtained a total of 1565 titles through the literature search. Two review authors independently selected the included articles and extracted the study characteristics, study quality, and data to estimate the odds ratio (OR) and 95% confidence interval (CI), mean difference (MD) and standardised mean difference (SMD) of outcome measures. We resolved disagreements by discussion. MAIN RESULTS We included 11 RCTs involving 1583 participants (791 participants in the intervention group and 792 in the control group). We found that there was no difference between the treatment and control groups in the outcomes of death or dependency (OR 0.99, 95% CI 0.79 to 1.23) or final neurological deficit (SMD -0.09, 95% CI -0.19 to 0.01). The rate of symptomatic hypoglycaemia was higher in the intervention group (OR 14.6, 95% CI 6.6 to 32.2). In the subgroup analyses of diabetes mellitus (DM) versus non-DM, we found no difference for the outcomes of death and disability or neurological deficit. The number needed to treat was not significant for the outcomes of death and final neurological deficit. The number needed to harm was nine for symptomatic hypoglycaemia. AUTHORS' CONCLUSIONS After updating the results of our previous review, we found that the administration of intravenous insulin with the objective of maintaining serum glucose within a specific range in the first hours of acute ischaemic stroke does not provide benefit in terms of functional outcome, death, or improvement in final neurological deficit and significantly increased the number of hypoglycaemic episodes. Specifically, those people whose glucose levels were maintained within a tighter range with intravenous insulin experienced a greater risk of symptomatic and asymptomatic hypoglycaemia than those people in the control group.
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Affiliation(s)
- M Fernanda Bellolio
- Mayo ClinicDepartment of Emergency MedicineGenerose Building‐G410200 First Street SWRochesterMinnesotaUSA55905
| | - Rachel M Gilmore
- Mayo ClinicDepartment of Emergency MedicineGenerose Building‐G410200 First Street SWRochesterMinnesotaUSA55905
| | - Latha Ganti
- NFSG Veterans Affairs Medical Center1601 Archer RoadGainesvilleFloridaUSA32610
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Bokhari FAS, Wellwood I, Rudd AG, Langhorne P, Dennis MS, Wolfe CDA. Selective admission into stroke unit and patient outcomes: a tale of four cities. HEALTH ECONOMICS REVIEW 2014; 4:1. [PMID: 24405520 PMCID: PMC3892120 DOI: 10.1186/2191-1991-4-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/17/2013] [Indexed: 06/03/2023]
Abstract
: Care of stroke patients costs considerably more in specialized stroke units (SU) compared to care in general medical wards (GMW) but the technology may be cost effective if it leads to significantly improved outcomes. While randomized control trials show better outcomes for stroke patients admitted to SU, observational studies report mixed findings. In this paper we use individual level data from first-ever stroke patients in four European cities and find evidence of selection by the initial severity of stroke into SU in some cities. In these cases, the impact of admission to SU on outcomes is overestimated by multivariate logit models even after controlling for case-mix. However, when the imbalance in patient characteristics and severity of stroke by admission to SU and GMW is adjusted using propensity score methods, the differences in outcomes are no longer statistically significant in most cases. Our analysis explains why earlier studies using observational data have found mixed results on the benefits of admission to SU.
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Affiliation(s)
- Farasat AS Bokhari
- School of Economics and ESRC Centre for Competition Policy, University of East Anglia, Norwich, UK
| | - Ian Wellwood
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, London, UK and NIHR Biomedical Research Centre, Guy’s & St Thomas’ NHS Foundation Trust, King’s College London, London, UK
| | - Anthony G Rudd
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, London, UK and NIHR Biomedical Research Centre, Guy’s & St Thomas’ NHS Foundation Trust, King’s College London, London, UK
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK
| | - Martin S Dennis
- Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Charles DA Wolfe
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, London, UK and NIHR Biomedical Research Centre, Guy’s & St Thomas’ NHS Foundation Trust, King’s College London, London, UK
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Sheedy R, Bernhardt J, Levi CR, Longworth M, Churilov L, Kilkenny MF, Cadilhac DA. Are Patients with Intracerebral Haemorrhage Disadvantaged in Hospitals? Int J Stroke 2013; 9:437-42. [DOI: 10.1111/ijs.12223] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/09/2013] [Indexed: 11/30/2022]
Abstract
Background and Aims Providing evidence-based clinical care reduces disability and mortality rates following stroke. We examined if compliance with evidence-based processes of care were different for patients with intracerebral haemorrhage when compared with ischemic stroke and sought to describe differences in health outcomes during hospitalization and at time of discharge for these stroke subtypes. Methods The New South Wales acute stroke dataset was used. This included data from 50–100 consecutively admitted patients' medical records collected from 32 New South Wales hospitals between 2003 and 2010. Multivariable logistic regression analyses were conducted taking into account patient factors and clustering of patients by hospital. Results Ischemic stroke and intracerebral haemorrhage cases had similar demographic features (ischemic stroke n = 3467, mean age 74 years [standard deviation 13], 50% female; intracerebral haemorrhage n = 275, mean age 74 years [standard deviation 13], 48% female). Following multivariable analyses patients with intracerebral haemorrhage were less likely to be admitted to a stroke unit (adjusted odds ratio 0·65; 95% confidence interval 0·45–0·94) or receive an assessment from allied health (adjusted odds ratio 0·54; 95% confidence interval 0·33–0·89) than patients with ischemic stroke. Patients with intracerebral haemorrhage are also less likely to be independent (adjusted odds ratio 0·36; 95% confidence interval 0·3–0·5) at time of hospital discharge and had a greater odds of dying in hospital (adjusted odds ratio 2·1; 95% confidence interval 1·3–3·5). Patients that were admitted to a stroke unit had a greater odds of being independent (modified Rankin Score 0–2) at day 7–10 irrespective of stroke type or severity on admission (adjusted odds ratio 1·3; 95% confidence interval 1·01–1·66). Conclusions Following intracerebral haemorrhage, patients were less likely to be admitted to an acute stroke unit and receive allied health interventions. Admission to stroke units improved the likelihood of being independent at days 7–10 and, therefore, more should be done to encourage evidence-based care for intracerebral haemorrhage.
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Affiliation(s)
- Renee Sheedy
- Barwon Health, Geelong, VIC, Australia
- La Trobe University, Melbourne, VIC, Australia
| | - Julie Bernhardt
- La Trobe University, Melbourne, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Christopher R. Levi
- Center for Brain and Mental Health Research, Hunter Medical Research Institute, Hunter New England Area Health, Newcastle University, Newcastle, NSW, Australia
| | - Mark Longworth
- Statewide Stroke Services, NSW Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Monique F. Kilkenny
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Translational Public Health Unit, Stroke & Ageing Research, Southern Clinical School, Monash University, Melbourne, VIC, Australia
| | - Dominique A. Cadilhac
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Translational Public Health Unit, Stroke & Ageing Research, Southern Clinical School, Monash University, Melbourne, VIC, Australia
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Abstract
BACKGROUND Organised stroke unit care is provided by multidisciplinary teams that exclusively manage stroke patients in a ward dedicated to stroke patients, with a mobile stroke team or within a generic disability service (mixed rehabilitation ward). OBJECTIVES To assess the effect of stroke unit care compared with alternative forms of care for people following a stroke. SEARCH METHODS We searched the trials registers of the Cochrane Stroke Group (January 2013) and the Cochrane Effective Practice and Organisation of Care (EPOC) Group (January 2013), MEDLINE (2008 to September 2012), EMBASE (2008 to September 2012) and CINAHL (1982 to September 2012). In an effort to identify further published, unpublished and ongoing trials, we searched 17 trial registers (January 2013), performed citation tracking of included studies, checked reference lists of relevant articles and contacted trialists. SELECTION CRITERIA Randomised controlled clinical trials comparing organised inpatient stroke unit care with an alternative service. After formal risk of bias assessment, we have now excluded previously included quasi-randomised trials. DATA COLLECTION AND ANALYSIS Two review authors initially assessed eligibility and trial quality. We checked descriptive details and trial data with the co-ordinators of the original trials. MAIN RESULTS We included 28 trials, involving 5855 participants, comparing stroke unit care with an alternative service. More-organised care was consistently associated with improved outcomes. Twenty-one trials (3994 participants) compared stroke unit care with care provided in general wards. Stroke unit care showed reductions in the odds of death recorded at final (median one year) follow-up (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.69 to 0.94; P = 0.005), the odds of death or institutionalised care (OR 0.78, 95% CI 0.68 to 0.89; P = 0.0003) and the odds of death or dependency (OR 0.79, 95% CI 0.68 to 0.90; P = 0.0007). Sensitivity analyses indicated that the observed benefits remained when the analysis was restricted to securely randomised trials that used unequivocally blinded outcome assessment with a fixed period of follow-up. Outcomes were independent of patient age, sex, initial stroke severity or stroke type, and appeared to be better in stroke units based in a discrete ward. There was no indication that organised stroke unit care resulted in a longer hospital stay. AUTHORS' CONCLUSIONS Stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke. The benefits were most apparent in units based in a discrete ward. We observed no systematic increase in the length of inpatient stay.
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69
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de Weerd L, Groenhof F, Kollen BJ, van der Meer K. Survival of stroke patients after introduction of the 'Dutch Transmural Protocol TIA/CVA'. BMC FAMILY PRACTICE 2013; 14:74. [PMID: 23734793 PMCID: PMC3680245 DOI: 10.1186/1471-2296-14-74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 05/30/2013] [Indexed: 11/10/2022]
Abstract
Background Earlier research showed that healthcare in stroke could be better organized, aiming for improved survival and less comorbidity. Therefore, in 2004 the Dutch College of General Practitioners (NHG) and the Dutch Association of Neurology (NVN) introduced the ‘Dutch Transmural Protocol TIA/CVA’ (the LTA) to improve survival, minimize the risk of stroke recurrence, and increase quality of life after stroke. This study examines whether survival improved after implementation of the new protocol, and whether there was an increase in contacts with the general practitioner (GP)/nurse practitioner, registration of comorbidity and prescription of medication. Methods From the primary care database of the Registration Network Groningen (RNG) two cohorts were composed: one cohort compiled before and one after introduction of the LTA. Cohort 1 (n = 131, first stroke 2001–2002) was compared with cohort 2 (n = 132, first stroke 2005–2006) with regard to survival and the secondary outcomes. Results Comparison of the two cohorts showed no significant improvement in survival. In cohort 2, the number of contacts with the GP was significantly lower and with the nurse practitioner significantly higher, compared with cohort 1. All risk factors for stroke were more prevalent in cohort 2, but were only significant for hypercholesterolemia. In both cohorts more medication was prescribed after stroke, whereas ACE inhibitors were prescribed more frequently only in cohort 2. Conclusion No major changes in survival and secondary outcomes were apparent after introduction of the LTA. Although, there was a small improvement in secondary prevention, this study shows that optimal treatment after introduction of the LTA has not yet been achieved.
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Affiliation(s)
- Leonie de Weerd
- Department of General Practice, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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70
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Vaartjes I, O'Flaherty M, Capewell S, Kappelle J, Bots M. Remarkable decline in ischemic stroke mortality is not matched by changes in incidence. Stroke 2012; 44:591-7. [PMID: 23212165 DOI: 10.1161/strokeaha.112.677724] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In Western Europe, mortality from ischemic stroke (IS) has declined over several decades. Age-sex-specific IS mortality, IS incidence, 30-day case fatality, and 1-year mortality after hospital admission are essential for explaining recent trends in IS mortality in the new millennium. METHODS Data for all IS deaths (1980-2010) in the Netherlands were grouped by year, sex, and age. A joinpoint regression was fitted to detect points in time at which significant changes in the trends occur. By linking nationwide registers, a cohort of patients first admitted for IS between 1997 and 2005 was constructed and age-sex-specific 30-day case fatality and 1-year mortality were computed. IS incidence (admitted IS patients and out-of-hospital IS deaths) was computed by age and sex. Mann-Kendall tests were used for trend evaluation. RESULTS IS mortality declined continuously between 1980 and 2000 with an attenuation of decline in the 1990s in some of the age-sex groups. A remarkable decline in IS mortality after 2000 was observed in all age-sex groups, except for young men. An improved decline in 30-day case fatality and in 1-year mortality was also observed in almost all age-sex groups. In contrast, IS incidence remained stable between 1997 and 2005 or even increased slightly. CONCLUSIONS The recent remarkable decline in IS mortality was not matched by a decline in the number of incident nonfatal IS events. This is worrying, because IS is already a leading cause of adult disability, claiming a heavy human and economic burden. Prevention of IS is therefore now of the greatest importance.
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Affiliation(s)
- Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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71
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Albright KC, Savitz SI, Raman R, Martin-Schild S, Broderick J, Ernstrom K, Ford A, Khatri R, Kleindorfer D, Liebeskind D, Marshall R, Merino JG, Meyer DM, Rost N, Meyer BC. Comprehensive stroke centers and the 'weekend effect': the SPOTRIAS experience. Cerebrovasc Dis 2012. [PMID: 23207423 DOI: 10.1159/000345077] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous studies have found mortality among ischemic stroke patients to be higher on weekends. We sought to evaluate whether weekend admission was associated with worse outcomes in a large comprehensive stroke center (CSC) cohort. METHODS Consecutive ischemic stroke patients presenting within 6 h of symptom onset were identified using the 8 CSC SPOTRIAS (Specialized Programs of Translational Research in Acute Stroke) database. Patients who received intra-arterial therapy or who were enrolled in a nonobservational clinical trial were excluded. All patients meeting the inclusion criteria were then divided into two groups: weekday admissions or weekend admissions. Weekend admission was defined as Friday 17:01 to Monday 08:59. The remainder were classified as weekday admissions. Multivariate logistic regression was used, adjusting for age, stroke severity on admission [according to the National Institutes of Health Stroke Scale (NIHSS)] and admission glucose, in order to compare the outcomes of the weekend versus the weekday groups. RESULTS Eight thousand five hundred and eighty-one subjects from the combined SPOTRIAS database were screened from 2002 to 2009; 2,090 (24.4%) of these met the inclusion criteria. There was no significant difference in tissue plasminogen activator treatment rates between the weekday and weekend groups (58.5 vs. 60.4%, p = 0.397). Weekend admission was not a significant independent predictor of inhospital mortality (8.4 vs. 9.9%, p = 0.056), length of stay (4 vs. 5 days, p = 0.442), favorable discharge disposition (38.0 vs. 42.2%, p = 0.122), favorable functional outcome at discharge (41.6 vs. 43.4%, p = 0.805), favorable 90-day functional outcome (54.2 vs. 46.9%, p = 0.301), or 90-day mortality (18.2 vs. 19.8%, p = 0.680) when adjusting for age, NIHSS and admission glucose. CONCLUSIONS In this large cohort of ischemic stroke patients treated at CSCs, we did not observe the 'weekend effect.' This may be due to access to stroke specialists 24 h a day on 365 days a year, nurses with stroke experience and the organized system for delivering care that is available at CSCs. These results suggest that EMS protocol should be reexamined regarding the preferential delivery of weekend stroke victims to hospitals that provide all levels of reperfusion therapy. This further highlights the importance of organized stroke care.
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Affiliation(s)
- Karen C Albright
- Health Services and Center for Outcome and Effectiveness Research and Education, University of Alabama at Birmingham, Birmingham, AL 35249-3280, USA.
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Blicher JU, Stagg CJ, O'Shea J, Østergaard L, MacIntosh BJ, Johansen-Berg H, Jezzard P, Donahue MJ. Visualization of altered neurovascular coupling in chronic stroke patients using multimodal functional MRI. J Cereb Blood Flow Metab 2012; 32:2044-54. [PMID: 22828998 PMCID: PMC3493993 DOI: 10.1038/jcbfm.2012.105] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evaluation of cortical reorganization in chronic stroke patients requires methods to accurately localize regions of neuronal activity. Blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) is frequently employed; however, BOLD contrast depends on specific coupling relationships between the cerebral metabolic rate of oxygen (CMRO(2)), cerebral blood flow (CBF), and volume (CBV), which may not exist following stroke. The aim of this study was to understand whether CBF-weighted (CBFw) and CBV-weighted (CBVw) fMRI could be used in sequence with BOLD to characterize neurovascular coupling mechanisms poststroke. Chronic stroke patients (n=11) with motor impairment and age-matched controls (n=11) performed four sets of unilateral motor tasks (60 seconds/30 seconds off/on) during CBFw, CBVw, and BOLD fMRI acquisition. While control participants elicited mean BOLD, CBFw, and CBVw responses in motor cortex (P<0.01), patients showed only mean changes in CBF (P<0.01) and CBV (P<0.01), but absent mean BOLD responses (P=0.20). BOLD intersubject variability was consistent with differing coupling indices between CBF, CBV, and CMRO(2). Thus, CBFw and/or CBVw fMRI may provide crucial information not apparent from BOLD in these patients. A table is provided outlining distinct vascular and metabolic uncoupling possibilities that elicit different BOLD responses, and the strengths and limitations of the multimodal protocol are summarized.
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Affiliation(s)
- Jakob U Blicher
- Research Unit, Hammel Neurocentre, Aarhus University Hospital, Hammel, Denmark.
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73
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[Treatment of acute ischemic stroke]. Radiologe 2012; 52:375-83; quiz 384-5. [PMID: 22526117 DOI: 10.1007/s00117-012-2314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Ischemic stroke is a medical emergency requiring fast and effective collaboration of neurologists and radiologists. Currently there are promising new developments in the treatment of acute ischemic stroke with efforts being made to reduce the door-to-needle time and to improve recanalization of occluded vessels by new endovascular techniques. Clinical trials have also demonstrated the efficacy of thrombolysis up to 4.5 h and confirmed the importance of the time to treatment for positive outcome.
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74
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Byl NN. Mobility training using a bionic knee orthosis in patients in a post-stroke chronic state: a case series. J Med Case Rep 2012; 6:216. [PMID: 22823961 PMCID: PMC3411435 DOI: 10.1186/1752-1947-6-216] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 07/23/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION An emerging area of neurorehabilitation is the use of robotic devices to enhance the efficiency and effectiveness of lower extremity physical therapy post-stroke. Many of the robotic devices currently available rely on computer-driven locomotive algorithms combined with partial bodyweight-supported treadmill training that drive reflex stepping with minimal patient intention during therapy. In this case series, we examined the effect of task-oriented mobility training in patients in a post-stroke chronic state using a novel, wearable, mobile, intention-based robotic leg orthosis. CASE PRESENTATION Three individuals, all of whom had reached a plateau with conventional bodyweight-supported treadmill training, participated in task-oriented mobility therapy (1.5 hours, two to four times per week for four weeks) with a robotic leg orthosis under supervision by a physical therapist. Participant 1 was a 59-year-old Caucasian man, who had an ischemic left stroke six years previously with resultant right hemiparesis. Participant 2 was a 42-year-old Caucasian woman with left hemiparesis after a right stroke 15 months previously. Participant 3 was a 62-year-old Caucasian woman with a history of a right middle cerebral artery aneurysm with third degree sub-arachnoid hemorrhage 10 years ago.Immediately after training, all participants demonstrated improved gait speed (10 meter walk), stride length and walking endurance (6 minute walk) compared with baseline measurements. Improvements were maintained one month after training. Timed up and go and five times sit-to-stand were maintained for all three participants, with only one individual remaining outside the safety performance norm. CONCLUSIONS Lower extremity training integrating an intention-based robotic leg orthosis may improve gait speed, endurance and community levels of participation in select patients in a post-stroke chronic state after plateauing within a bodyweight-supported treadmill training program. The wearable, mobile assistive robotic device safely supplemented supervised physical therapy including mobility and balance skill training.
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Affiliation(s)
- Nancy N Byl
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of California San Francisco (UCSF), PT Health and Wellness Center, Bakar Community Center, 1675 Owens Street, Box 0736, San Francisco, 94158-2332, USA.
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75
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Affiliation(s)
- Iolo Doull
- Regional Cystic Fibrosis Centre, Department of Paediatric Respiratory Medicine, Children's Hospital for Wales, Cardiff, CF14 4XW, UK.
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76
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Moseley A, Sherrington C, Herbert R, Maher C. The Extent and Quality of Evidence in Neurological Physiotherapy: An Analysis of the Physiotherapy Evidence Database (PEDro). BRAIN IMPAIR 2012. [DOI: 10.1375/brim.1.2.130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractEvidence-based practice involves the use of evidence from systematic reviews and randomised controlled trials. The extent of this evidence in neurological physiotherapy has not previously been surveyed. The aim of this study was to describe the quantity and quality of randomised controlled trials, and the quantity and scope of systematic reviews relevant to neurological physiotherapy. PEDro (the Physiotherapy Evidence Database) was searched for trials and reviews relevant to neurological physiotherapy (adult and paediatric). The quality and quantity of trials were analysed, and the topics and conclusions of reviews were synthesised. The search revealed a total of 265 records, consisting of 238 randomised controlled trials and 27 systematic reviews. Since the first trial was published in 1958, the number of trials has expanded exponentially. Fifty-four percent of trials were categorised as being of moderate to high quality, rating five or more out of ten. The first review was published in 1991. Many of the reviews have been unable to reach firm conclusions due to the paucity of available trials. The results show that there is a substantial body of evidence relevant to neurological physiotherapy. However, there remains scope for improvements in the quality of the conduct and reporting of clinical trials. There is an urgent need for more randomised controlled trials and systematic reviews.
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77
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Guidelines for the treatment of acute ischaemic stroke. Neurologia 2011; 29:102-22. [PMID: 22152803 DOI: 10.1016/j.nrl.2011.09.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 09/11/2011] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. DEVELOPMENT Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 °C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. CONCLUSION Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated.
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Serna-Candel C, Matías-Guiu J. From the evidence to the organisation of stroke care. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/j.nrleng.2011.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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López Fernández J, Arenillas Lara J, Calleja Puerta S, Botia Paniagua E, Casado Naranjo I, Deyá Arbona E, Escribano Soriano B, Freijo Guerrero M, Geffners Sclarsky D, Gil Núñez A, Gil Peralta A, Gil Pujadas A, Gómez Escalonilla C, Lago Martin A, Larracoechea Jausoro J, Legarda Ramírez I, Maestre Moreno J, Manciñeiras Montero J, Mola Caballero De Rodas S, Moniche Álvarez F, Muñoz Arrondo R, Vidal Sánchez J, Purroy García F, Ramírez Moreno J, Rebollo Álvarez Amandi M, Rubio Borrego F, Segura Martin T, Tejada García J, Tejero Juste C, Masjuan Vallejo J. Recursos asistenciales en ictus en España 2010: análisis de una encuesta nacional del Grupo de Estudio de Enfermedades Cerebrovasculares. Neurologia 2011; 26:449-54. [DOI: 10.1016/j.nrl.2010.10.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 10/24/2010] [Indexed: 02/01/2023] Open
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López Fernández J, Arenillas Lara J, Calleja Puerta S, Botia Paniagua E, Casado Naranjo I, Deyá Arbona E, Escribano Soriano B, Freijo Guerrero M, Geffners Sclarsky D, Gil Núñez A, Gil Peralta A, Gil Pujadas A, Gómez Escalonilla C, Lago Martin A, Larracoechea Jausoro J, Legarda Ramírez I, Maestre Moreno J, Manciñeiras Montero J, Mola Caballero De Rodas S, Moniche Álvarez F, Muñoz Arrondo R, Vidal Sánchez J, Purroy García F, Ramírez Moreno J, Rebollo Álvarez Amandi M, Rubio Borrego F, Segura Martin T, Tejada García J, Tejero Juste C, Masjuan Vallejo J. Health care resources for stroke patients in Spain, 2010: Analysis of a national survey by the Cerebrovascular Diseases Study Group. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/j.nrleng.2010.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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81
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Abstract
BACKGROUND Patients with hyperglycaemia concomitant with an acute stroke have greater stroke severity and greater functional impairment when compared to those with normoglycaemia at stroke presentation. OBJECTIVES To determine whether maintaining serum glucose within a specific normal range (4 to 7.5 mmol/L) in the first 24 hours of acute ischaemic stroke influences outcome. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (June 2010), CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE (1950 to June 2010), EMBASE (1980 to June 2010), CINAHL (1982 to June 2010), Science Citation Index (1900 to June 2010), and Web of Science (ISI Web of Knowledge) (1993 to June 2010). In an effort to identify further published, unpublished and ongoing trials we searched ongoing trials registers and SCOPUS. SELECTION CRITERIA Eligible studies were randomised controlled trials comparing intensively monitored insulin therapy versus usual care in adult patients with acute ischaemic stroke. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the study characteristics, study quality, and data to estimate the odds ratio (OR) and 95% confidence interval (CI), mean difference (MD) and standardised mean difference (SMD) of outcome measures. MAIN RESULTS We included seven trials involving 1296 participants (639 participants in the intervention group and 657 in the control group). We found that there was no difference between treatment and control groups in the outcome of death or disability and dependence (OR 1.00, 95% CI 0.78 to 1.28) or final neurological deficit (SMD -0.12, 95% CI -0.23 to 0.00). The rate of symptomatic hypoglycaemia was higher in the intervention group (OR 25.9, 95% CI 9.2 to 72.7). In the subgroup analyses of diabetes mellitus (DM) versus non-DM, we found no difference for the outcomes of death and dependency or neurological deficit. AUTHORS' CONCLUSIONS With the current evidence, we found that the administration of intravenous insulin with the objective of maintaining serum glucose within a specific range in the first hours of acute ischaemic stroke does not provide benefit in terms of functional outcome, death, or improvement in final neurological deficit and significantly increased the number of hypoglycaemic episodes. Specifically, those who were maintained within a more tight range of glycaemia with intravenous insulin experienced a greater risk of symptomatic and asymptomatic hypoglycaemia than those individuals in the control group.
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Affiliation(s)
- M Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Genrose Building-G410, 200 First Street SW, Rochester, Minnesota, USA, 55905
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83
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Alberts MJ, Latchaw RE, Jagoda A, Wechsler LR, Crocco T, George MG, Connolly ES, Mancini B, Prudhomme S, Gress D, Jensen ME, Bass R, Ruff R, Foell K, Armonda RA, Emr M, Warren M, Baranski J, Walker MD. Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition. Stroke 2011; 42:2651-65. [PMID: 21868727 DOI: 10.1161/strokeaha.111.615336] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. METHODS We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. RESULTS Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. CONCLUSIONS Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center.
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Affiliation(s)
- Mark J Alberts
- Northwestern University, 710 N Lake Shore Drive, Chicago, IL 60611, USA.
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Tamura A, Ichihara T, Minagawa T, Kuwamura Y, Kondo H, Takata S, Yasui N, Nagahirois S. Exercise intervention soon after stroke onset to prevent muscle atrophy. ACTA ACUST UNITED AC 2011. [DOI: 10.12968/bjnn.2011.7.4.574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ayako Tamura
- Department of Nursing Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Takako Ichihara
- Department of Nursing, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Takako Minagawa
- Department of Nursing, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Yumi Kuwamura
- Department of Nursing, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Hiroko Kondo
- Department of Nursing, Hiroshima International University, Japan
| | - Shinjiro Takata
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Natuo Yasui
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
| | - Shinji Nagahirois
- Department of Neurosurgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Japan
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OKUBO N. Effectiveness of the “Elevated Position” Nursing Care Program in promoting the reconditioning of patients with acute cerebrovascular disease. Jpn J Nurs Sci 2011; 9:76-87. [DOI: 10.1111/j.1742-7924.2011.00188.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Meretoja A, Kaste M, Roine RO, Juntunen M, Linna M, Hillbom M, Marttila R, Erilä T, Rissanen A, Sivenius J, Häkkinen U. Trends in treatment and outcome of stroke patients in Finland from 1999 to 2007. PERFECT Stroke, a nationwide register study. Ann Med 2011; 43 Suppl 1:S22-30. [PMID: 21639714 DOI: 10.3109/07853890.2011.586361] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION This article in this supplement issue on the Performance, Effectiveness, and Costs of Treatment episodes (PERFECT) project describes trends in Finnish stroke treatment and outcome. MATERIAL AND METHODS The PERFECT Stroke study uses multiple national registry linkages at individual patient level to produce a national stroke database with comprehensive follow-up of all hospital-treated stroke patients in Finland. RESULTS There were 94,316 incident stroke patients treated in Finnish hospitals from 1999 to 2007. Lengths-of-stays decreased after ischemic stroke (IS), and increased after intracerebral (ICH) and subarachnoid (SAH) hemorrhage. Ten-year survival improved in IS (hazard ratio 0.75; 95% CI 0.71-0.79) and ICH patients (0.88; 0.79-0.97), increasing median survival by 2 and 1 life-years respectively. This has translated into more days spent home among IS patients, but not among ICH patients. Treatment by neurologists improved the survival of IS (odds ratio [OR] 1.77; 95% CI 1.70-1.84) and ICH patients (OR 1.55; 95% CI 1.40-1.69), and treatment by neurosurgeons of SAH patients (OR 2.66; 95% CI 2.25-3.16), the effects were further improved by care in specialized stroke centers. DISCUSSION The survival of Finnish IS and ICH patients has improved. Specialized acute care was associated with improved outcome.
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Affiliation(s)
- Atte Meretoja
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. atte.meretoja@fi mnet.fi
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Burstein DS, Jacobs JP, Li JS, Sheng S, O'Brien SM, Rossi AF, Checchia PA, Wernovsky G, Welke KF, Peterson ED, Jacobs ML, Pasquali SK. Care models and associated outcomes in congenital heart surgery. Pediatrics 2011; 127:e1482-9. [PMID: 21576309 PMCID: PMC3103274 DOI: 10.1542/peds.2010-2796] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Recently, there has been a shift toward care of children undergoing heart surgery in dedicated pediatric cardiac intensive care units (CICU). The impact of this trend on patient outcomes is unclear. We evaluated postoperative outcomes associated with a CICU versus other ICU models. PATIENTS AND METHODS Society of Thoracic Surgeons Congenital Heart Surgery Database participants (2007-2009) who completed an ICU survey were included. In multivariable analysis, we evaluated outcomes associated with a CICU versus other ICUs, adjusting for center volume, patient factors, and Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery surgical risk category. RESULTS A total of 20 922 patients (47 centers; 25 with a CICU) were included. Overall unadjusted mortality was 3.8%, median length of stay was 6 days (interquartile range: 4-13), and 21% had 1 or more complications. In multivariable analysis, there was no difference in mortality comparing CICUs versus other ICUs (odds ratio: 0.88 [95% confidence interval: 0.65-1.19]). In stratified analysis, CICUs were associated with lower mortality only among those in Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery category 3 (odds ratio: 0.47 [95% confidence interval: 0.25-0.86]), primarily related to atrioventricular canal repair and arterial switch operation. There was no difference in length of stay or complications overall or in stratified analysis. CONCLUSIONS We were not able to detect a difference in postoperative morbidity or mortality associated with the presence of a dedicated CICU for children undergoing heart surgery. There may be a survival benefit in certain subgroups .
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Affiliation(s)
| | - Jeffrey P. Jacobs
- Department of Cardiology, Division of Thoracic and Cardiovascular Surgery, The Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, St Petersburg and Tampa, Florida
| | - Jennifer S. Li
- Duke Clinical Research Institute and ,Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | | | - Anthony F. Rossi
- Congenital Heart Institute, Miami Children's Hospital, Miami, Florida
| | - Paul A. Checchia
- Divisions of Pediatric Critical Care and Cardiology, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri
| | - Gil Wernovsky
- Divisions of Pediatric Cardiology and Critical Care Medicine, The Cardiac Center at The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Karl F. Welke
- Mary Bridge Children's Hospital, Multicare Health System, Tacoma, Washington; and
| | | | - Marshall L. Jacobs
- Department of Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sara K. Pasquali
- Duke Clinical Research Institute and ,Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
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Serna-Candel C, Matías-Guiu J. [From the evidence to the organisation of stroke care]. Neurologia 2011; 26:507-9. [PMID: 21549455 DOI: 10.1016/j.nrl.2011.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/07/2011] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION Acute stroke care in stroke units (SU) compared to care in general medicine wards provides benefits to the patient. DEVELOPMENT Acute stroke care in an SU has shown benefits in reducing mortality, institutionalisation, dependency and costs compared to care in internal medicine wards, and even a lower risk of recurrence in the long term. The benefits are associated with specific treatments developed in the SU, such as thrombolytic therapy, development of clinical pathways, standardised procedures, and training and experience of professionals in the SU. This evidence should lead to the proper organisation of hospitals to ensure that all acute stroke patients may benefit from care in an SU. The introduction of SUs is a priority in Europe, although the number of stroke patients admitted to SUs is still low. CONCLUSIONS Based on current evidence, acute stroke patients should be cared for in an SU due to the associated clinical benefits and hospitals should organise to provide this care to patients.
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Bonaiuti D, Sioli P, Fumagalli L, Beghi E, Agostoni E. Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation. Neurol Sci 2011; 32:619-23. [PMID: 21533563 DOI: 10.1007/s10072-011-0588-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
Abstract
Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.
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Affiliation(s)
- Donatella Bonaiuti
- Physical Medicine and Rehabilitation Department, S. Gerardo Hospital, Monza, Italy
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López Espuela F, Jiménez Gracia MA, Luengo Morales E, Blanco Gazapo A, Márquez Caballero J, Bravo Fernández S, Portilla Cuenca JC. [A descriptive study of patients seen in a stroke unit in the Community of Extremadura]. ENFERMERIA INTENSIVA 2011; 22:138-43. [PMID: 21256062 DOI: 10.1016/j.enfi.2010.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the activity in the stroke unit (SU) of the Hospital de Caceres as well as the demographic characteristics and cardiovascular risk factors in our patients. To determine the patient's functional status at discharge. MATERIAL AND METHODS A descriptive study of 432 patients admitted consecutively in the SU of the Hospital de Caceres from October, 2008 to May, 2010 was carried out. The different study variables (demographic, risk factors, dependence) were determined and analyzed. RESULTS The patient prototype was a 71-year old-man from the rural environment, with hypertension, hyperlipidemia, diabetes, who had an ischemic stroke. On medical discharge from the stroke unit (SU), the patient had a mild functional dependence, after and average stay of 2.8 days in the SU. CONCLUSIONS All patients who suffers a stroke should be attended by and benefit from the care provided in a SU. These units are organizational models that improve patient care in the acute phase, this resulting in lower mortality and disability in these patients.
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Affiliation(s)
- F López Espuela
- Departamento de Neurología, Hospital San Pedro de Alcántara, Cáceres, Spain.
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Adoukonou TA, Vallat JM, Joubert J, Macian F, Kabore R, Magy L, Houinato D, Preux PM. [Management of stroke in sub-Saharan Africa: current issues]. Rev Neurol (Paris) 2011; 166:882-93. [PMID: 20800860 DOI: 10.1016/j.neurol.2010.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 04/25/2010] [Accepted: 06/21/2010] [Indexed: 01/04/2023]
Abstract
In sub-Saharan Africa, stroke is likely to present an increasingly important public health problem with a larger relative share of overall morbidity and mortality. Overall, sub-Saharan Health Care is characterized by a lack of human resources, lack of facilities for special investigations, and especially an absence of specific programs addressing the prevention of cardiovascular conditions. Current data on the epidemiology of stroke in sub-Saharan Africa, although sparse and fragmentary, indicate a comparatively high incidence of cerebral hemorrhage associated with high blood pressure, while ischemic stroke in black Africans still appears to be related primarily to small artery disease, HIV infection, and sickle cell disease. With urbanization, the role of large-vessel atherosclerosis is increasing. It is thus essential to coordinate government funding, health care professionals and development agencies to address this rising health problem. Access to health care needs to be better structured, and screening programs should be developed in order to identify and treat vascular risk factors. Improved training of health care professionals is also required in the areas of prevention, diagnosis and management of stroke. Implementation of best-practice recommendations for the management of stroke adapted to the specificities and resources of African countries would help rationalize the scarce resources currently available.
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Affiliation(s)
- T A Adoukonou
- Service de neurologie, CHU Dupuytren, EA 3174 neuroépidémiologie tropicale et comparée, université de Limoges, IFR 145 GEIST, institut de neuroépidémiologie et de neurologie tropicale, Limoges, France
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Kwakkel G, Veerbeek JM, van Wegen EE, Nijland R, Harmeling-van der Wel BC, Dippel DW. Predictive value of the NIHSS for ADL outcome after ischemic hemispheric stroke: Does timing of early assessment matter? J Neurol Sci 2010; 294:57-61. [DOI: 10.1016/j.jns.2010.04.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/07/2010] [Accepted: 04/07/2010] [Indexed: 11/26/2022]
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Abstract
Remarkable progress has occurred over the last two decades in stroke interventions. Many have been developed on the basis of their efficacy in other disorders. This "inheritance" approach should continue, but two areas where completely novel therapeutic targets might emerge are the stimulation of neuroplasticity and unraveling the genetic code of stroke heterogeneity (Table 2). For the former, the next steps are to identify small-molecule, nontoxic compounds that most effectively enhance plasticity in animal models, and then subject them to clinical trial in humans. For the latter, more and larger-scale cooperative GWASs in carefully phenotyped stroke populations are required to better understand the polygenic nature of cerebrovascular disease. Then, the physiological relevance of genetic abnormalities can be determined in in vitro and in vivo systems before candidate compounds are developed.
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The role of nursing in the rehabilitation of stroke survivors: an extended theoretical account. ANS Adv Nurs Sci 2010; 33:E27-40. [PMID: 20154522 DOI: 10.1097/ans.0b013e3181cd837f] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article provides a critique and theoretical extension of a work that sought to describe the contribution of nurses to stroke rehabilitation. At the time, the role of nursing was considered important but therapeutically nonspecific. Stroke nursing research has increased significantly and so has research focusing on the patient experiences of the adjustment and rehabilitation processes following a stroke. These developments provide significant new insights that may refine and extend the original understanding of the role of nursing in stroke rehabilitation. This article proposes an extended theoretical framework of the role of nursing in stroke recovery and rehabilitation.
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Banzi R, Moja L, Liberati A, Gensini GF, Gusinu R, Conti AA. Measuring the impact of evidence: the Cochrane systematic review of organised stroke care. Intern Emerg Med 2009; 4:507-10. [PMID: 19888638 DOI: 10.1007/s11739-009-0323-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rita Banzi
- Italian Cochrane Centre, Mario Negri Institute for Pharmacological Research, Via La Masa, 19, 20156, Milan, Italy
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Semi-intensive stroke unit versus conventional care in acute ischemic stroke or TIA — A prospective study in Germany. J Neurol Sci 2009; 287:131-7. [DOI: 10.1016/j.jns.2009.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 08/06/2009] [Accepted: 08/10/2009] [Indexed: 11/21/2022]
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Jerome D, Dehail P, Daviet JC, Lamothe G, De Sèze MP, Orgogozo JM, Mazaux JM. Stroke in the under-75S: Expectations, concerns and needs. Ann Phys Rehabil Med 2009; 52:525-37. [DOI: 10.1016/j.rehab.2009.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 06/08/2009] [Indexed: 11/26/2022]
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