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Comment: Well-organized stroke service reduces the burden of stroke
The idea, presented here, that emergency medical services transporting acute stroke patients should bypass hospitals without stroke units (SUs) and experience in IV stroke thrombolysis (IVT) is not new, but now it is based on evidence.1 Hospitals without SU and experience in stroke IVT treated fewer potential thrombolysis candidates than experienced stroke centers (SCs). This was the case in patients over 80 years of age and those with preexisting disabilities, although patients treated at SCs with IVT had equally low mortality as the rest of the IVT-treated patients.1 The finding that patients treated off-label with IVT h...
Source: Neurology - May 22, 2016 Category: Neurology Authors: Kaste, M. Tags: All Cerebrovascular disease/Stroke ARTICLE Source Type: research
Cadagan: Humor and tenacity after a stroke
Most parents try to discourage their children from indulging in humor about bodily functions like burping. But for Daniel and Lori Hooley, a simple smirk in response to a belch was the sign they needed that their daughter, Cadagan, was going to be okay.
It was 2012 and 7-year-old Cadagan was asleep, tucked into bed for the night. Around 11 p.m., she suddenly awoke — but it wasn’t because of a nightmare or a late-night request for a glass of water. Instead, she seemed limp and couldn’t focus. Then she began throwing up. Born with an extremely rare genetic disorder called trisomy 12p, the little girl had already experi...
Source: Thrive, Children's Hospital Boston - November 20, 2017 Category: Pediatrics Authors: Jessica Cerretani Tags: Diseases & Conditions Our Patients’ Stories Dr. Cameron Trenor Dr. Laura Lehman Dr. Michael Rivkin stroke Stroke and Cerebrovascular Center vasculitis Source Type: news
Stroke Center Care and Outcome: Results from the CSPPC Stroke Program
AbstractThe aim of this study was to assess the association between admission to stroke centers for acute ischemic stroke and complications and mortality during hospitalization in a Chinese population by means of an observational study using data from the China Stroke Center Data-Sharing Platform. We compared in-hospital complications and mortality for patients admitted with acute ischemic stroke (N = 13,236) between November 1, 2018 and December 31, 2018 at stroke center (SH) and non-stroke center (CH) hospitals using distance to hospitals as an instrumental variable to adjust for potential prehospital selection bias....
Source: Translational Stroke Research - September 7, 2019 Category: Neurology Source Type: research
Validity of stroke severity assessment using medical records in a population-based cohort
Initial stroke severity is an important prognostic factor for outcome after acute stroke, in terms of functional dependency, post-stroke dementia, and mortality.1,2 Whilst the majority of stroke patients who are admitted to the hospital with stroke have substantial neurological deficits, over half of all strokes that occur in the population qualify as minor stroke,3 and are managed often in outpatient care.4 Given the important differences between minor and major stroke in prognosis and management, it is important to distinguish patients on the basis of stroke severity, but assessment outside of specialised stroke centres ...
Source: Journal of Stroke and Cerebrovascular Diseases - February 18, 2023 Category: Neurology Authors: Jacqueline J. Claus, Brian B.P. Berghout, M. Kamran Ikram, Frank J. Wolters Source Type: research
National Sentinel Stroke Audit 1998-2011.
This article describes the achievements of the NSSA and the -lessons learned.
PMID: 24115698 [PubMed - as supplied by publisher]
Source: Clinical Medicine - October 1, 2013 Category: Journals (General) Authors: Cloud G, Hoffman A, Anthony Rudd on behalf of the Intercollegiate Stroke Working Party Tags: Clin Med Source Type: research
Quality in Acute Stroke Care (QASC): process evaluation of an intervention to improve the management of fever, hyperglycemia, and swallowing dysfunction following acute stroke
BackgroundOur randomized controlled trial of a multifaceted evidence‐based intervention for improving the inpatient management of fever, hyperglycemia, and swallowing dysfunction in the first three‐days following stroke improved outcomes at 90 days by 15%. We designed a quantitative process evaluation to further explain and illuminate this finding.
MethodsBlinded retrospective medical record audits were undertaken for patients from 19 stroke units prior to and following the implementation of three multidisciplinary evidence‐based protocols (supported by team‐building workshops, and site‐based education and suppor...
Source: International Journal of Stroke - December 1, 2013 Category: Neurology Authors: Peta Drury, Christopher Levi, Catherine D'Este, Patrick McElduff, Elizabeth McInnes, Jennifer Hardy, Simeon Dale, N Wah Cheung, Jeremy M Grimshaw, Clare Quinn, Jeanette Ward, Malcolm Evans, Dominique Cadilhac, Rhonda Griffiths, Sandy Middleton Tags: Research Source Type: research
Burden of stroke in Egypt: current status and opportunities
Middle East and North Africa (MENA) countries have a diversity of populations with similar life style, dietary habits, and vascular risk factors that may influence stroke risk, prevalence, types, and disease burden. Egypt is the most populated nation in the Middle East with an estimated 85.5 million people. In Egypt, according to recent estimates, the overall prevalence rate of stroke is high with a crude prevalence rate of 963/100 000 inhabitants. In spite of disease burden, yet there is a huge evidence practice gap. The recommended treatments for ischemic stroke that are guideline include systematic supportive care in ...
Source: International Journal of Stroke - July 7, 2014 Category: Neurology Authors: Foad Abd‐Allah, Ramez Reda Moustafa Tags: Panorama Source Type: research
Episode-based payment for ischemic stroke care with implications for neurologists
Episode-based payment bundles a single lumped payment around a health care event, such as ischemic stroke. Hospitals are already experienced with a type of episode-based payment for stroke, the diagnosis-related group payment system. Ischemic stroke fits well into an episode-based system because (1) ischemic stroke is common, (2) an ischemic stroke care episode lasts for a definable period of time, and (3) ischemic stroke care costs are high and episode-based payment could provide savings. In an episode-based ischemic stroke care payment system built around cost savings, it is unclear whether neurologists would provide sav...
Source: Nature Clinical Practice - June 9, 2014 Category: Neurology Authors: Dobbs, M. R. Tags: All Cerebrovascular disease/Stroke, Models of care, Health care reform Eye on Practice Source Type: research
Cardiovascular Disease Is the Main Cause of Long-Term Excess Mortality After Ischemic Stroke in Young Adults Ischemic Stroke in Young Adults
Adults with stroke at a young age (18–50 years) remain at an increased risk of death for decades. It is unclear what cause underlies this long-term excess mortality and whether this is sex and time specific. Therefore, we investigated sex-specific temporal changes in cause of death after transient ischemic attack or ischemic stroke in young adults aged 18 to 50 years. We included all 845 consecutive 30-day survivors, of a first-ever transient ischemic attack (n=261) or ischemic stroke (n=584), admitted to our hospital between 1980 and 2010. Survival status was assessed at April 1, 2013. Observed cause-specific mortal...
Source: Hypertension - February 11, 2015 Category: Cardiology Authors: Rutten-Jacobs, L. C. A., Arntz, R. M., Maaijwee, N. A. M., Schoonderwaldt, H. C., Dorresteijn, L. D., van Dijk, E. J., de Leeuw, F.-E. Tags: Acute Cerebral Infarction Ischemic Stroke in Young Adults Source Type: research
Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue Following Stroke practice guidelines, update 2015
Every year, approximately 62 000 people with stroke and transient ischemic attack are treated in Canadian hospitals, and the evidence suggests one‐third or more will experience vascular‐cognitive impairment, and/or intractable fatigue, either alone or in combination. The 2015 update of the Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue Module guideline is a comprehensive summary of current evidence‐based recommendations for clinicians in a range of settings, who provide care to patients following stroke. The three consequences of stroke that are the focus of the this guideline (poststrok...
Source: International Journal of Stroke - June 29, 2015 Category: Neurology Authors: Gail A. Eskes, Krista L. Lanctôt, Nathan Herrmann, Patrice Lindsay, Mark Bayley, Laurie Bouvier, Deirdre Dawson, Sandra Egi, Elizabeth Gilchrist, Theresa Green, Gord Gubitz, Michael D. Hill, Tammy Hopper, Aisha Khan, Andrea King, Adam Kirton, Paige Moorh Tags: Guidelines Source Type: research
Association Between Dehydration and Short-Term Risk of Ischemic Stroke in Patients with Atrial Fibrillation
We examined whether dehydration increases the risk of ischemic stroke in patients with a recent hospitalization for atrial fibrillation (AF). Data was from 1994 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records New Jersey hospitals, for AF hospitalizations (n = 1,282,787). Estimates for the association between AF hospitalization with/without dehydration and ischemic stroke within 30 days post-AF discharge were determined using log-linear multivariable modeling adjusting for socio-demographic factors and comorbid conditions. Within 10 days of discharge for AF, p...
Source: Translational Stroke Research - May 22, 2016 Category: Neurology Source Type: research
Biomarkers of Acute Stroke Etiology (BASE) Study Methodology
AbstractAcute ischemic stroke affects over 800,000 US adults annually, with hundreds of thousands more experiencing a transient ischemic attack. Emergent evaluation, prompt acute treatment, and identification of stroke or TIA (transient ischemic attack) etiology for specific secondary prevention are critical for decreasing further morbidity and mortality of cerebrovascular disease. The Biomarkers of Acute Stroke Etiology (BASE) study is a multicenter observational study to identify serum markers defining the etiology of acute ischemic stroke. Observational trial of patients presenting to the hospital within 24 h of strok...
Source: Translational Stroke Research - May 5, 2017 Category: Neurology Source Type: research
Jacob ’s story: What it’s like to have a stroke as a kid
My name is Jacob and I’m 8 years old. Two years ago, I had a stroke. At first, I didn’t realize what that meant, and I didn’t understand why I couldn’t move the way I used to.
With time, I’ve been able to get most of my function back, but my right arm has something called dystonia. That means the muscles cramp up and sometimes my arm moves on its own or gets stiff. I can’t control it, and that makes life hard sometimes.
I come to Boston Children’s Hospital every few months to see Dr. Michael Rivkin at the Stroke and Cerebrovascular Center there. Nobody likes having to go to the doctor, but Dr. Rivkin is more...
Source: Thrive, Children's Hospital Boston - September 26, 2017 Category: Pediatrics Authors: Jacob Downing Tags: Diseases & Conditions Our Patients’ Stories Dr. Michael Rivkin stroke Stroke and Cerebrovascular Center Source Type: news
Striking a balance: Charlie ’s recovery from neonatal stroke
“Hey, Charlie,” says Dr. Michael Rivkin as he gently dangles a small rubber ducky in front of the little boy. “Would you like this?” A wide smile breaks out across the toddler’s face. Why yes, he certainly would like that duck. He reaches and grasps at it, closing his tiny fingers around the toy.
For Charlie Strzempek, it’s nothing more than a playful act. But for his parents, Kathleen and Tom, it’s a major accomplishment. Dr. Rivkin isn’t simply offering his patient a toy. He’s testing his ability to grab and hold an object in his right hand — the side of his body affected by a neonatal stroke.
A shin...
Source: Thrive, Children's Hospital Boston - December 27, 2017 Category: Pediatrics Authors: Jessica Cerretani Tags: Diseases & Conditions Our Patients’ Stories Dr. Michael Rivkin Julie Croteau occupational therapy stroke Stroke and Cerebrovascular Center Source Type: news
Very Low Frequency Heart Rate Variability Predicts the Development of Post-Stroke Infections
AbstractStroke-induced immunodepression is a major risk factor for severe infectious complications in the immediate post-stroke period. We investigated the predictive value of heart rate variability (HRV) to identify patients at risk of post-stroke infection, systemic inflammatory response syndrome, or severe sepsis during the post-acute interval from days 3 to 5 after stroke onset. A prospective, observational monocentric cohort study was conducted in a university hospital stroke unit of patients with ischemic infarction in the territory of the middle cerebral artery without an ongoing infection at admission. Standard HRV...
Source: Translational Stroke Research - January 7, 2019 Category: Neurology Source Type: research
