A stroke care management system prevents outcome differences related to time of stroke unit admission

Implementation of the stroke code registry in the emergency department of a regional hospital

Stroke is a cerebrovascular disease caused by a decrease or abrupt obstruction of blood flow to the brain. Nerve cells do not receive oxygen and there is a transient or permanent alteration of the function of a certain region of the brain. It causes high morbidity and mortality resulting in disabilities with a large economic cost to society. The Stroke Code was established at the Mollet Hospital in 2015. A protocol, action guideline and registry were created. The Mollet Hospital does not have a specialist unit so people who suffer thrombolysis and / or who require specific care are transferred to the referral centre. This registry is organized in several parts: demographic and clinical data, A-B-C-D assessment, procedures, National Institute of Health Stroke Scale (NIHSS) and Rankin scale, and nursing diagnoses: Impaired verbal communication, Impaired physical mobility, Acute pain, Anxiety and Risk for aspiration. This paper aims to describe the implementation of the Stroke Code registry and the level of completion in the emergency department of the Mollet hospital, revealing care times and transfers to other centres; NIHSS and Ranking scales completion and the activation of nursing diagnoses. An analysis of the Stroke Code registry provides data about healthcare services and detects weak points to improve to establish new action plans, standardise and promote continuity of care and avoid possible errors.

Reframing the Biological Basis of Neuroprotection Using Functional Genomics: Differentially Weighted, Time-Dependent Multifactor Pathogenesis of Human Ischemic Brain Damage

Background: Neuroprotection studies are generally unable to demonstrate efficacy in humans. Our specific hypothesis is that multiple pathophysiologic pathways, of variable importance, contribute to ischemic brain damage. As a corollary to this, we discuss the broad hypothesis that a multifaceted approach will improve the probability of efficacious neuroprotection. But to properly test this hypothesis the nature and importance of the multiple contributing pathways needs elucidation. Our aim is to demonstrate, using functional genomics, in human cardiac surgery procedures associated with cerebral ischemia, that the pathogenesis of perioperative human ischemic brain damage involves the function of multiple variably weighted proteins involving several pathways. We then use these data and literature to develop a proposal for rational design of human neuroprotection protocols.

Methods: Ninety-four patients undergoing deep hypothermic circulatory arrest (DHCA) and/or aortic valve replacement surgery had brain damage biomarkers, S100β and neurofilament H (NFH), assessed at baseline, 1 and 24 h post-cardiopulmonary bypass (CPB) with analysis for association with 92 single nucleotide polymorphisms (SNPs) (selected by co-author WAK) related to important proteins involved in pathogenesis of cerebral ischemia.

Results: At the nominal significance level of 0.05, changes in S100β and in NFH at 1 and 24 h post-CPB were associated with multiple SNPs involving several prospectively determined pathophysiologic pathways, but were not individually significant after multiple comparison adjustments. Variable weights for the several evaluated SNPs are apparent on regression analysis and, notably, are dissimilar related to the two biomarkers and over time post CPB. Based on our step-wise regression model, at 1 h post-CPB, SOD2, SUMO4, and GP6 are related to relative change of NFH while TNF, CAPN10, NPPB, and SERPINE1 are related to the relative change of S100B. At 24 h post-CPB, ADRA2A, SELE, and BAX are related to the relative change of NFH while SLC4A7, HSPA1B, and FGA are related to S100B.

Conclusions: In support of the proposed hypothesis, association SNP data suggest function of specific disparate proteins, as reflected by genetic variation, may be more important than others with variation at different post-insult times after human brain ischemia. Such information may support rational design of post-insult time-sensitive multifaceted neuroprotective therapies.