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Thrombectomy in stroke of unknown onset, wake up stroke and late presentations: Australian experience from 2 comprehensive stroke centres
This study shows good ‘real world’ outcomes, comparable to published RCTs, in patients with unknown-onset, or late presentation, stroke treated with EVT more than 6 h from stroke onset.
Source: Journal of Clinical Neuroscience - November 8, 2018 Category: Neuroscience Source Type: research

Advances in stroke medicine.
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 - May 6, 2019 Category: General Medicine Tags: Med J Aust Source Type: research

Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: the role of perfusion flow and pressure.
CONCLUSIONS: Neither low perfusion pressure nor low perfusion flow during cardiopulmonary bypass were predictive of postoperative acute kidney injury, stroke or death. PMID: 32515271 [PubMed - as supplied by publisher]
Source: Perfusion - June 8, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Turner L, Hardikar A, Jose MD, Bhattarai K, Fenton C, Sharma R, Kirkland G, Jeffs L, Breslin M, Silva Ragaini B, Newland RF Tags: Perfusion Source Type: research

TACTICS - Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship: evaluating the effectiveness of an 'implementation intervention' in providing better patient access to reperfusion therapies: protocol for a non-randomised controlled stepped wedge cluster trial in acute stroke
BMJ Open. 2022 Feb 11;12(2):e055461. doi: 10.1136/bmjopen-2021-055461.ABSTRACTINTRODUCTION: Stroke reperfusion therapies, comprising intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT), are best practice treatments for eligible acute ischemic stroke patients. In Australia, EVT is provided at few, mainly metropolitan, comprehensive stroke centres (CSC). There are significant challenges for Australia's rural and remote populations in accessing EVT, but improved access can be facilitated by a 'drip and ship' approach. TACTICS (Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship) aim...
Source: Rural Remote Health - February 12, 2022 Category: Rural Health Authors: Annika Ryan Christine L Paul Martine Cox Olivia Whalen Andrew Bivard John Attia Christopher Bladin Stephen M Davis Bruce C V Campbell Mark Parsons Rohan S Grimley Craig Anderson Geoffrey A Donnan Christopher Oldmeadow Sarah Kuhle Frederick R Walker Rebecc Source Type: research

TACTICS - Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship: evaluating the effectiveness of an 'implementation intervention in providing better patient access to reperfusion therapies: protocol for a non-randomised controlled stepped wedge cluster trial in acute stroke
Introduction Stroke reperfusion therapies, comprising intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT), are best practice treatments for eligible acute ischemic stroke patients. In Australia, EVT is provided at few, mainly metropolitan, comprehensive stroke centres (CSC). There are significant challenges for Australia’s rural and remote populations in accessing EVT, but improved access can be facilitated by a ‘drip and ship’ approach. TACTICS (Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship) aims to test whether a multicomponent, multidisciplinary impleme...
Source: BMJ Open - February 11, 2022 Category: General Medicine Authors: Ryan, A., Paul, C. L., Cox, M., Whalen, O., Bivard, A., Attia, J., Bladin, C., Davis, S. M., Campbell, B. C. V., Parsons, M., Grimley, R. S., Anderson, C., Donnan, G. A., Oldmeadow, C., Kuhle, S., Walker, F. R., Hood, R. J., Maltby, S., Keynes, A., Delcou Tags: Open access, Health services research Source Type: research

Telestroke Assessment With Perfusion CT Improves the Diagnostic Accuracy of Stroke vs. Mimic
Conclusions: In the telehealth setting, the absence of an ischaemic lesion on CTP adds to the diagnostic accuracy in distinguishing mimic from stroke, above that from clinical features.
Source: Frontiers in Neurology - December 3, 2021 Category: Neurology Source Type: research

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke
Conclusions: Treating patients not meeting the DAWN or DEFUSE 3 clinical trial criteria in the extended time window for EVT was associated with less gain in QALYs and higher cost. Caution should be exercised when considering this procedure for patients not satisfying the trial perfusion imaging criteria for EVT.
Source: Frontiers in Neurology - December 14, 2021 Category: Neurology Source Type: research

Stenosis Length and Degree Interact With the Risk of Cerebrovascular Events Related to Internal Carotid Artery Stenosis
Conclusion: We found a statistically insignificant tendency for the ultrasound-measured length of sICAS<70% to be longer than that of sICAS≥70%. Moreover, the ultrasound-measured length of sICAS<90% was significantly longer than that of sICAS 90%. Among patients with sICAS≥70%, the degree and length of stenosis were inversely correlated. Larger studies are needed before a clinical implication can be drawn from these results. Introduction Internal carotid artery stenosis (ICAS) causes around one-fifth of ischemic cerebrovascular stroke and has the highest risk of early stroke recurrence...
Source: Frontiers in Neurology - April 8, 2019 Category: Neurology Source Type: research

Reduced Impact of Endovascular Thrombectomy on Disability in Real-World Practice, Relative to Randomized Controlled Trial Evidence in Australia
Conclusions: EVT for the treatment of LVO in a registry of routine care was associated with significantly lower DALYs lost than medical care alone, but the saved DALYs are less than those reported in clinical trials, as there were major differences in the baseline characteristics of the patients.
Source: Frontiers in Neurology - December 8, 2020 Category: Neurology Source Type: research

An Evaluation of Personal Cooling Systems for Reducing Thermal Strain Whilst Working in Chemical/Biological Protective Clothing
Conclusion: The IV, PCM, and SLIV produced lower heart rate, mean skin, rectal and mean body temperatures in addition to improved work times compared to control. The WS did not improve work times possibly as a result of the cooling capacity of the suit abating, and magnifying thermal insulation. Considering the added time and resources required to implement combination cooling in the form of ice slurry and ice vest (SLIV), there was no significant additive effect for perception, cardiovascular strain, rectal temperature and total trial time relative to the phase change vest or ice vest alone. This may be a product of a &#x...
Source: Frontiers in Physiology - April 11, 2019 Category: Physiology Source Type: research

Does the Addition of Non-Approved Inclusion and Exclusion Criteria for rtPA Impact Treatment Rates? Findings in Australia, the UK, and the USA
Conclusions: Non-standard criteria for rtPA eligibility were evident in all three countries and could, in part, explain comparably low use of rtPA. Differences in the use of standard criteria may signify practitioner intolerance for those derived from original efficacy studies that are no longer relevant.Intervent Neurol 2019;8:1 –12
Source: Interventional Neurology - October 5, 2018 Category: Neurology Source Type: research

Cardiovascular Programming During and After Diabetic Pregnancy: Role of Placental Dysfunction and IUGR
This study demonstrated that the incidence of ischemic heart disease and death were three times higher among men with low birth weight compared to men with high birth weight (5). Epidemiological investigations of adults born at the time of the Dutch famine between 1944 and 1945 revealed an association between maternal starvation and a low infant birth weight with a high incidence of hypertension and coronary heart disease in these adults (23). Furthermore, Painter et al. reported the incidence of early onset coronary heart disease among persons conceived during the Dutch famine (24). In that regard, Barker's findin...
Source: Frontiers in Endocrinology - April 8, 2019 Category: Endocrinology Source Type: research

Does respiratory variation of inferior vena cava diameter predict fluid responsiveness in spontaneously ventilating children with sepsis
ConclusionsIVC collapsibility has poor test characteristics for predicting fluid responsiveness in spontaneously ventilating children with sepsis.
Source: Emergency Medicine Australasia - February 1, 2018 Category: Emergency Medicine Authors: Elliot Long, Trevor Duke, Ed Oakley, Adam O'Brien, Bennett Sheridan, Franz E Babl, Tags: Paediatric Emergency Medicine Source Type: research

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