Mobile Stroke Units - Cost-Effective or Just an Expensive Hype?

AbstractPurpose of ReviewAcute stroke is a treatable disease. Nevertheless, only a minority of patients obtain guideline-adjusted therapy. One major reason is the small time window in which therapies have to be administered in order to reverse or mitigate brain injury and prevent disability. The Mobile Stroke Unit (MSU) concept, available for a decade now, is spreading worldwide, comprising ambulances, fully equipped with computed tomography, laboratory unit and telemedicine connection to the stroke centre and staffed with a specialised stroke team. Besides its benefits, this concept adds a relevant amount of costs to health services.Recent FindingsThe feasibility of the MSU and its impact on reducing treatment times have been proven by several research trials. In addition, pre-hospital stroke diagnosis including computed tomographic angiography analysis facilitates correct triage of patients, needing mechanical recanalization, thereby reducing the number of secondary or inter-hospital transfers. Even so, the concept is not yet fully implemented on a broad scale. One reason is the still open question of cost-effectiveness. There are assumptions based on the randomised trials of MSUs hinting towards an acceptable amount of money per quality-adjusted life years and overall cost-effectiveness. Up to now, neither a prospective analysis nor a consideration of secondary transfer avoidance is available.SummaryThe MSU concept is an innovative and impactful strategy to improve stroke ...
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research

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Conclusion: This network meta-analysis provides supporting evidence to the idea that DWI has a higher diagnostic value regarding ischemic stroke among MRI methods, and CTP has a poor diagnostic value among CT methods, which provide therapeutic considerations for Ischemic stroke intervention.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
Authors: Campbell BC Abstract In recent years, reperfusion therapies such as intravenous thrombolysis and endovascular thrombectomy for ischaemic stroke have dramatically reduced disability and revolutionised stroke management. Thrombolysis with alteplase is effective when administered to patients with potentially disabling stroke, who are not at high risk of bleeding, within 4.5 hours of the time the patient was last known to be well. Emerging evidence suggests that other thrombolytics such as tenecteplase may be even more effective. Treatment may be possible beyond 4.5 hours in patients selected using brain imagi...
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research
Geng-Hong Xia1†, Chao You1,2†, Xu-Xuan Gao1, Xiu-Li Zeng1, Jia-Jia Zhu1, Kai-Yu Xu3, Chu-Hong Tan1, Ruo-Ting Xu1, Qi-Heng Wu1, Hong-Wei Zhou3, Yan He4*‡ and Jia Yin1*‡ 1Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China 2Department of Neurology, The First People's Hospital of Zunyi, Zunyi, China 3State Key Laboratory of Organ Failure Research, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China 4Microbiome Medicine Center, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical Univ...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
This article presents an overview on recent advances in optical non-invasive diagnostics of the peripheral hemodynamics of the upper and lower limbs in rheumatological and endocrinological profile patients. Among these are laser Doppler flowmetry (LDF), tissue reflectance oximetry (TRO), pulse oximetry (PO) and fluorescent spectroscopy (FS). The laser Doppler flowmetry method allows for investigating the blood flow in the microcirculatory bed in vivo. The method is based on probing the tissue with laser radiation and analyzing back reflected from the tissue radiation partially scattered from moving red blood cells (Bonner...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
AbstractPurpose of ReviewAcute stroke is a treatable disease. Nevertheless, only a minority of patients obtain guideline-adjusted therapy. One major reason is the small time window in which therapies have to be administered in order to reverse or mitigate brain injury and prevent disability. The Mobile Stroke Unit (MSU) concept, available for a decade now, is spreading worldwide, comprising ambulances, fully equipped with computed tomography, laboratory unit and telemedicine connection to the stroke centre and staffed with a specialised stroke team. Besides its benefits, this concept adds a relevant amount of costs to heal...
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research
Conclusions—A single, high-quality computed tomography angiography is the preferred diagnostic strategy. Short-term complications are rare and often transient. Long-term outcome is excellent with respect to disability and death, but high-quality studies focused at neuropsychological sequelae are needed.
Source: Stroke - Category: Neurology Authors: Tags: Epidemiology, Risk Factors, Cerebrovascular Disease/Stroke Original Contributions Source Type: research
CONCLUSION: Onset of neurologic symptoms can be immediate or delayed in patients undergoing venous foam sclerotherapy. Early recognition of neurologic deficits resulting from paradoxical gas embolism and its treatment with hyperbaric oxygen can prevent permanent disability. PMID: 29677415 [PubMed - in process]
Source: WMJ - Category: General Medicine Authors: Tags: WMJ Source Type: research
The following are key points to remember from the American Heart Association (AHA)/American Stroke Association (ASA) 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke:These 2018 guidelines are an update to the 2013 guidelines, which were published prior to the six positive “early window” mechanical thrombectomy trials that emerged in 2015 and 2016 showed a clear benefit of“extended window” mechanical thrombectomy for certain patients with large vessel occlusion who could be treated out to 16-24 hours IV tPA should be administered to all eligible acute stroke patien...
Source: Sumer's Radiology Site - Category: Radiology Authors: Source Type: blogs
Abstract Vascular injuries represent a significant burden of mortality and disability. Blunt injuries to the neck vessels can present with signs of stroke either immediately or in a delayed fashion. Most injuries are detected with computed tomography angiography and managed with either antiplatelet medications or anticoagulation. In contrast, patients with penetrating injuries to the neck vessels require airway management, hemorrhage control, and damage control resuscitation before surgical repair. The keys to diagnosis and management of peripheral vascular injury include early recognition of the injury; hemorrhag...
Source: The Medical Clinics of North America - Category: General Medicine Authors: Tags: Emerg Med Clin North Am Source Type: research
Vascular injuries represent a significant burden of mortality and disability. Blunt injuries to the neck vessels can present with signs of stroke either immediately or in a delayed fashion. Most injuries are detected with computed tomography angiography and managed with either antiplatelet medications or anticoagulation. In contrast, patients with penetrating injuries to the neck vessels require airway management, hemorrhage control, and damage control resuscitation before surgical repair. The keys to diagnosis and management of peripheral vascular injury include early recognition of the injury; hemorrhage control with dir...
Source: Emergency Medicine Clinics of North America - Category: Emergency Medicine Authors: Source Type: research
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