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Lessons for major system change: centralization of stroke services in two metropolitan areas of England
Conclusions
A combination of system (top-down) and distributed (bottom-up) leadership is important in enabling change. System leadership provides the political authority required to coordinate stakeholders and to capitalize on clinical leadership by aligning it with transformation goals. Policy makers should examine how the structures of system authority, with performance management and financial levers, can be employed to coordinate transformation by aligning the disparate interests of providers and commissioners.
Source: Journal of Health Services Research and Policy - June 5, 2016 Category: Health Management Authors: Turner, S., Ramsay, A., Perry, C., Boaden, R., McKevitt, C., Morris, S., Pursani, N., Rudd, A., Tyrrell, P., Wolfe, C., Fulop, N. Tags: Original Research Source Type: research
A tennis lesson: sharp practice in the science behind the Sharapova case
Maria Sharapova (and hundreds of other elite athletes) took meldonium, a drug developed at the time of the USSR for the treatment of heart attack and stroke, though it has never been approved for use anywhere outside of the former Soviet Union. Meldonium is an inhibitor of -butyrobetaine hydroxylase, an enzyme involved in the carnitine biosynthetic pathway.1 Intake results in a reduction of tissue carnitine content, including the heart and skeletal muscles. Carnitine plays a critical role in transferring long-chain fatty acids across mitochondrial inner membrane into the mitochondrial matrix, to enable entry of the fatty a...
Source: Postgraduate Medical Journal - July 25, 2016 Category: Journals (General) Authors: Arduini, A., Zammit, V. A. Tags: Cardiomyopathy, Open access, Drugs: infectious diseases, Drugs: cardiovascular system, Epilepsy and seizures, Stroke, Interventional cardiology, Ischaemic heart disease, Diabetes, Metabolic disorders, Occupational and environmental medicine Editorials Source Type: research
A pilot study evaluating the use of ABCD2 score in pre-hospital assessment of patients with suspected transient ischaemic attack: experience and lessons learned
ConclusionsIt is possible to identify, recruit and follow up patients with suspected TIA in the EMS setting. Training large numbers of EMS staff is required as exposure to TIA patients is infrequent. Significant insight was gained into the complexity of NHS research governance mechanisms in the UK. This knowledge will facilitate the planning of a future adequately powered study to validate the ABCD2 tool in a pre-hospital setting.
Source: Experimental and Translational Stroke Medicine - August 19, 2016 Category: Neurology Source Type: research
Late emergence of macular sparing in a stroke patient: Clinical Case Report
We report a case of HH with a dramatic improvement in central vision several days after an occipital infarction. To our knowledge, this is the first case to show macular sparing developing after several days.
Source: Medicine - July 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Recovery of an injured corticobulbar tract in a patient with stroke: A case report
Rationale: The corticobulbar tract (CBT) is known to be involved in the motor function of the non-oculomotor cranial nuclei and controls the muscles of the face, head, and neck. Several studies have reported injury of the CBT in patients with brain injury, however, little is known about recovery of the injured CBT.
Patient concerns: A 59-year-old right-handed male underwent decompressive craniectomy for management of brain swelling and intracerebral hemorrhage following an infarction in the left middle cerebral artery territory. Initially, the patient had showed severe dysphagia and had to be fed using a Levin tube. Five ...
Source: Medicine - September 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Gait recovery by activation of the unaffected corticoreticulospinal tract in a stroke patient: A case report
Rationale:
A 50-year-old man presented with complete paralysis at the onset of a putaminal hemorrhage.
Patient concerns:
The patient presented with complete paralysis of the left upper and lower extremities (Medical Research Council:0/5).
Diagnoses:
Spontaneous intra crebral hemorrhage on putamen.
Intervention:
He underwent comprehensive rehabilitative therapy from 3 weeks after onset. At 3weeks after onset, he presented with severe weakness of the left extremities. The weakness of his left extremities had recovered as follows at 3 months after onset. Consequently, he was able to walk independently on an even fl...
Source: Medicine - December 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
From stroke to neurodegenerative diseases: The multi-target neuroprotective effects of 3-n-butylphthalide and its derivatives
Publication date: Available online 11 August 2018Source: Pharmacological ResearchAuthor(s): Longjian Huang, Shan Wang, Fei Ma, Yong Zhang, Yuchen Peng, Changhong Xing, Yipu Feng, Xiaoliang Wang, Ying PengAbstractDiscovering effective agents to slow or stop neurodegeneration is a challenging task. Over decades, only a few drugs were approved by Food and Drug Administration (FDA) and most ended in failure. The lessons learned have switched the strategy of drug discovery from designing highly selective ligands to a network pharmacology approach. This enables many natural products like butylphthalide (NBP) once again to be reg...
Source: Pharmacological Research - August 11, 2018 Category: Drugs & Pharmacology Source Type: research
Acute diffuse and transient thyroid swelling after intravenous thrombolysis for acute ischemic stroke: A case report
Rationale:
Intravenous thrombolysis is the primary therapy for acute ischemic stroke (AIS), but it has some complications, including symptomatic intracranial hemorrhage, orolingual angioedema, and extracranial bleeding. However, thyroid disorders associated with thrombolysis are very rare.
Patient concerns:
A 56-year-old man developed acute pain and neck swelling after thrombolysis with recombinant tissue plasminogen activator.
Diagnoses:
Ultrasound revealed a diffusely enlarged thyroid with linear hypoechoic areas throughout the entire gland, resembling a “cracked” appearance.
Interventions:
The patient was...
Source: Medicine - September 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
A pilot study evaluating the use of ABCD2 score in pre-hospital assessment of patients with suspected transient ischaemic attack: experience and lessons learned
ConclusionsIt is possible to identify, recruit and follow up patients with suspected TIA in the EMS setting. Training large numbers of EMS staff is required as exposure to TIA patients is infrequent. Significant insight was gained into the complexity of NHS research governance mechanisms in the UK. This knowledge will facilitate the planning of a future adequately powered study to validate the ABCD2 tool in a pre-hospital setting.
Source: Experimental and Translational Stroke Medicine - August 20, 2016 Category: Neurology Source Type: research
Early ST-segment elevation acute myocardial infarction after thrombolytic therapy for acute ischemic stroke: A case report
We report a case of STEMI occurring 40 minutes after thrombolytic therapy for AIS and discuss the possible mechanisms and therapeutic approaches.
Patient concerns:
A 87-year-old woman with a history of arterial hypertension was admitted for acute onset of right-sided limb weakness 2 hours before arrival at the emergency department. Forty minutes after intravenous recombinant tissue plasminogen activator (i.v. rtPA) administration for AIS, STEMI occurred (signaled by a third-degree atrioventricular block).
Diagnoses:
The diagnoses were AIS and STEMI. Coronary angiography confirmed right coronary artery occlusion.
...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Discrepancy between perfusion- and diffusion-weighted images in ischemic stroke: A case report
Rationale:
With the development of multi-slice computed tomography (CT) technology, perfusion CT angiography (p-CTA) is now widely used for the diagnosis of acute cerebral infarction. Although p-CTA has the advantage of distinguishing between an ischemic penumbra and an infarct core, more research is needed with respect to its clinical use.
Patient concerns:
A healthy 36-year-old man experienced sudden dizziness while swimming. His dizziness persisted irrespective of the change in position, and then improved during transport. He had no neurological abnormality when he arrived at the emergency room.
Diagnoses:
CT pe...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Decreasing Stroke Alerts in the Emergency Department: A Lesson in Resource Utilization
Source: Western Journal of Emergency Medicine - July 31, 2019 Category: Emergency Medicine Source Type: research
Successful dabigatran reversal after subdural hemorrhage using idarucizumab in a mobile stroke unit: A case report
Rationale:
Idarucizumab is a specific reversal agent for patients with bleeding related to the anticoagulant dabigatran. There are no prior descriptions of Idarucizumab administration in the prehospital setting for intracranial hemorrhage.
Patient concerns:
An 82-year-old woman treated with dabigatran for atrial fibrillation developed acute focal weakness. This led to activation of emergency medical services and assessment in the mobile stroke unit (MSU).
Diagnosis:
Computed tomography of the brain performed in the MSU revealed an acute subdural hematoma.
Interventions:
The patient was treated with Idarucizumab ...
Source: Medicine - May 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Mitochondrial DNA 10158T>C mutation in a patient with mitochondrial encephalomyopathy with lactic acidosis, and stroke-like episodes syndrome: A case-report and literature review (CARE-complaint)
Rationale:
Mitochondrial encephalomyopathy with lactic acidosis and stroke- like episodes (MELAS) syndrome is caused by mitochondrial respiratory chain dysfunction and oxidative phosphorylation disorder. It is a rare clinical metabolic disease involved with multiple systems.
Patient concerns:
A 22-year-old patient presented with limb convulsion accompanied by loss of consciousness, headache, partial blindness, blurred vision, and so on.
Diagnoses:
Brain magnetic resonance imaging showed a high-intensity area in bilateral occipital cortex, left parietal lobe and cerebellum on diffusion-weighted imaging. These focus ...
Source: Medicine - June 12, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Recovery of an injured arcuate fasciculus via transcallosal fiber in a stroke patient: A case report
We report on a patient whose arcuate fasciculus (AF) and corticobulbar tract (CBT) recovered following an infarct in the middle cerebral artery (MCA) territory, demonstrated on serial diffusion tensor tractography (DTT).
Patient concerns:
The patient showed moderate conduction aphasia on the Western Aphasia Battery with an aphasia quotient of 46.5‰ (spontaneous speech: 35.0‰, auditory comprehension: 36.0‰, and naming: 53.1‰) at 1 month after onset. His aphasia improved with an aphasia quotient of 49‰ (spontaneous speech: 71.0‰, auditory comprehension: 52.0‰, and naming: 59.0‰) at 10 months after onse...
Source: Medicine - August 6, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
