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Survivor gives us a lens into regional systems of care for acute ischemic stroke in North Dakota
I just got back from the North Dakota Mission: Lifeline STEMI and Acute Stroke Conference in Bismark, ND. I had a great time and I learned a lot. I often get asked to speak in various venues about acute STEMI and 12-lead ECG interpretation, but for this conference they wanted me to talk mostly about stroke. That turned out to be a good thing because it forced me to read the 2013 AHA / ASA Guildelines for the Early Management of Patients With Acute Ischemic Stroke to make sure I was asking intelligent questions during the panel discussion (which I moderated) and also giving accurate information for the class I taught about ...
Source: EMS 12-Lead - May 31, 2013 Category: Cardiology Authors: Tom Bouthillet Tags: ems-topics patient-management North Dakota Mission Lifeline Stroke Source Type: research

Lori’s Stroke Required Help From Doctors An Hour Away. Telemedicine Provided It.
Editor’s note: Our previous stories this American Stroke Month featured warning signs heeded and missed. Today we shift gears to showcase a textbook response to a stroke, including the crucial role of telestroke, a way for experts at another facility to help care for a patient via a webcam-type connection. The CHRONIC Care Act, which includes a provision to require Medicare to cover telestroke, will be discussed Tuesday during a hearing of the Senate Finance Committee. Lori Hoopingarner savored her occasional weekend getaway. Between running her financial advising company, raising a 10-year-old daughter and 6-year-old s...
Source: Healthy Living - The Huffington Post - May 15, 2017 Category: Consumer Health News Source Type: news

Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study
This study is registered with ClinicalTrials.gov, number NCT02358772. Findings Between Feb 5, 2011, and March 5, 2015, 427 patients were treated within the STEMO vehicle and their data were entered into a pre-hospital registry. 505 patients received conventional care and their data were entered into an in-hospital thrombolysis registry. Of these, 305 patients in the STEMO group and 353 in the conventional care group met inclusion criteria and were included in the analysis. 161 (53%) patients in the STEMO group versus 166 (47%) in the conventional care group had an mRS score of 1 or lower (p=0·14). Compared with conventio...
Source: The Lancet Neurology - July 15, 2016 Category: Neurology Source Type: research

Effects of alteplase on survival after ischaemic stroke (IST-3): 3 year follow-up of a randomised, controlled, open-label trial
We report the effect of intravenous alteplase on long-term survival after ischaemic stroke of participants in the Third International Stroke Trial (IST-3). Methods In IST-3, done at 156 hospitals in 12 countries (Australia, Europe, and the UK), participants (aged >18 years) were randomly assigned with a telephone voice-activated or web-based system in a 1:1 ratio to treatment with intravenous 0·9 mg/kg alteplase plus standard care or standard care alone within 6 h of ischaemic stroke. We followed up participants in the UK and Scandinavia (Sweden and Norway) for survival up to 3 years after randomisation using data...
Source: The Lancet Neurology - July 19, 2016 Category: Neurology Source Type: research

Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa – A survey based approach
Publication date: August 2017 Source:Journal of Clinical Neuroscience, Volume 42 Author(s): Chen Lin, Ravi Vakani, Peter Kussin, Mary Guhwe, Alfredo E. Farjat, Kingshuk Choudhury, David Renner, Chrispine Oduor, Carmelo Graffagnino There is no published literature regarding sub-Saharan health-care providers’ understanding of stroke management patterns. Understanding current stroke management knowledge is important in formulating future education opportunities for providers to optimize patient outcomes. A cross-sectional survey of acute stroke diagnosis, hospital management, and secondary prevention questions was administ...
Source: Journal of Clinical Neuroscience - June 29, 2017 Category: Neuroscience Source Type: research

Optimizing Prehospital Triage for Patients With Stroke Involving Large Vessel Occlusion
The past 20 years have witnessed a revolution in the paradigm of acute ischemic stroke treatment. In 1996, intravenous alteplase was shown to improve outcomes among patients treated within 3 hours of stroke onset. This finding upended the historical therapeutic nihilism about stroke, and with it the leisurely armchair approach to stroke treatment. The concept of so-called acute ischemic stroke emerged. This changed the nature and practice of vascular neurology, created a vigorous and sometimes controversial debate between vascular neurologists and emergency physicians about the merits of alteplase, and paved the way for mo...
Source: JAMA Neurology - September 4, 2018 Category: Neurology Source Type: research

Review Streamlining of prehospital stroke management: the golden hour
Thrombolysis with alteplase administered within a narrow therapeutic window provides an effective therapy for acute ischaemic stroke. However, mainly because of prehospital delay, patients often arrive too late for treatment, and no more than 1–8% of patients with stroke obtain this treatment. We recommend that all links in the prehospital stroke rescue chain must be optimised so that in the future more than a small minority of patients can profit from time-sensitive acute stroke therapy. Measures for improvement include continuous public awareness campaigns, education of emergency medical service personnel, the use of s...
Source: Lancet Neurology - May 24, 2013 Category: Neurology Authors: Klaus Fassbender, Clotilde Balucani, Silke Walter, Steven R Levine, Anton Haass, James Grotta Tags: Review Source Type: research

Factors affecting in-hospital delay of intravenous thrombolysis for acute ischemic stroke: A retrospective cohort study
This study was designed to investigate the factors affecting the in-hospital delay of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Two hundred and forty-eight consecutive AIS patients treated with intravenous administration of alteplase in Gansu Provincial Hospital from December 2014 to August 2018 were enrolled retrospectively in this study. According to door-to-needle (DTN) time, the patients were divided into either a delay group (DTN time> 60 minutes; n = 184) or a non-delay group (DTN time ≤60 minutes; n = 64). The baseline data, laboratory tests, onset-to-door (OTD) time, door-to-acc...
Source: Medicine - May 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research