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Stroke Care (stroke + care)
Kinds of Stroke Care Selected AbstractsAcute Stroke Care at Rural Hospitals in Idaho: Challenges in Expediting Stroke CareTHE JOURNAL OF RURAL HEALTH, Issue 1 2006James G. Gebhardt MD ABSTRACT:,Context: Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. Purpose: To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. Methods: Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. Findings: The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. Conclusions: Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays. [source] Acute Stroke Care: A M anual from the University of Texas-Houston Stroke Team (Cambridge Pocket Clinicians)ACADEMIC EMERGENCY MEDICINE, Issue 3 2009Eric C. Bruno MD No abstract is available for this article. [source] Increasing complexities of stroke careINTERNAL MEDICINE JOURNAL, Issue 5 2009B. Clissold No abstract is available for this article. [source] The implementation of intravenous tissue plasminogen activator in acute ischaemic stroke , a scientific position statement from the National Stroke Foundation and the Stroke Society of AustralasiaINTERNAL MEDICINE JOURNAL, Issue 5 2009Ad Hoc Committee representing the National Stroke Foundation, the Stroke Society of Australasia Abstract Intravenous tissue plasminogen activator (tPA) has been licensed in Australia for thrombolysis in selected patients with acute ischaemic stroke since 2003. The use of tPA is low but is increasing across Australia and national audits indicate efficacy and safety outcomes equivalent to international benchmarks. Implementing tPA therapy in clinical practice is, however, challenging and requires a coordinated multidisciplinary approach to acute stroke care across prehospital, emergency department and inpatient care sectors. Stroke care units are an essential ingredient underpinning safe implementation of stroke thrombolysis. Support systems such as care pathways, therapy delivery protocols, and thrombolysis-experienced multidisciplinary care teams are also important enablers. Where delivery of stroke thrombolysis is being planned, health systems need to be re-configured to provide these important elements. This consensus statement provides a review of the evidence for, and implementation of, tPA in acute ischaemic stroke with specific reference to the Australian health-care system. [source] Acute stroke and transient ischaemic attack management , time to act fastINTERNAL MEDICINE JOURNAL, Issue 5 2009D. S. Crimmins Abstract Stroke is Australia's second single greatest killer with 53 000 new events each year at a rate of 1 every 10 min. Stroke services should be organized to enable people to access proven therapies, such as stroke unit care and thrombolysis, to reduce the impact of stroke. Timely, efficient and coordinated care from ambulance services, emergency services and stroke services will maximize recovery and prevent costly complications and subsequent strokes. Efficient management of patients with transient ischaemic attack can produce significant reductions in subsequent stroke events and risk stratification using the ABCD2 tool can aid management decisions. Evidence for acute stroke care continues to evolve and it is crucial that health professionals are aware of, and implement, best practice clinical guidelines for stroke care. [source] The Virtual International Stroke Trials Archive (VISTA): results and impact on future stroke trials and management of stroke patientsINTERNATIONAL JOURNAL OF STROKE, Issue 2 2010C. Weimar Background The Virtual International Stroke Trials Archive was established to improve stroke care and trial design through the collation, categorization and potential access to data sets from clinical trials for the treatment of stroke. Methods Virtual International Stroke Trials Archive currently provides access to a combined data set of 29 anonymised acute stroke trials and one acute stroke registry with data on >27 500 patients aged between 18 and 103 (mean 71) years. Results Virtual International Stroke Trials Archive has facilitated research across a broad canvas. The prognosis was poor in patients with very high blood pressure at the time of admission or with a wide variability of systolic blood pressure during the acute phase. The late occurrence of hyperthermia following an ischaemic stroke worsens the prognosis. Stroke lateralisation is not an important predictor of cardiac adverse events or 90-day mortality. Haemorrhagic transformation is seen frequently in patients with cardio-embolic strokes and is associated with a poor prognosis when occurring after the acute phase. Virtual International Stroke Trials Archive has allowed various prognostic models for patients with ischaemic or haemorrhagic stroke to be established and validated. More direct outcomes such as lesion volume can be useful in phase II clinical trials for determining whether a phase III trial should be undertaken. New outcome measures such as ,home time' may also strengthen future trials. On a worldwide level, the prognosis of stroke patients differs considerably between various countries. Conclusion Virtual International Stroke Trials Archive provides an excellent opportunity for analysis of natural history data and prognosis. It has the potential to influence clinical trial design and implementation through exploratory data analyses. [source] The Obama presidency: implications for stroke careINTERNATIONAL JOURNAL OF STROKE, Issue 4 2009W. L. Wright No abstract is available for this article. [source] Stroke units: many questions, some answersINTERNATIONAL JOURNAL OF STROKE, Issue 1 2009Blanca Fuentes Background The development of specialized stroke units has been a landmark innovation in acute stroke care. However, the high scientific evidence level for the recommendation for stroke units to provide clinical attention for acute stroke patients does not correspond to the level of stroke unit implementation. A narrative, nonsystematic review on published studies on stroke units was conducted, with special emphasis on those demonstrating their efficacy and effectiveness. We also attempt to provide some answers to several open questions regarding practical issues of stroke units. Summary of review Stroke units represent the most efficacious model for care provision compared with general ward care and stroke teams. Every stroke patient can benefit from stroke unit care. These units are efficient, cost-effective and their benefits are consistent over time. Compared with other specific stroke therapies such as aspirin or intravenous thrombolytic agents, stroke units have a higher target population and higher benefit in terms of number of deaths and/or dependencies avoided. New approaches in stroke unit management such as the implementation of noninvasive monitoring or alternative clinical pathways could improve their benefit even further. Conclusion Stroke units are cost-effective and need to be considered as a priority in health-care provision for stroke patients. [source] Development of stroke care in Sri LankaINTERNATIONAL JOURNAL OF STROKE, Issue 1 2009Padma S. Gunaratne No abstract is available for this article. [source] Promoting acute thrombolysis for ischaemic stroke (PRACTISE)INTERNATIONAL JOURNAL OF STROKE, Issue 2 2007Protocol for a cluster randomised controlled trial to assess the effect of implementation strategies on the rate, effects of thrombolysis for acute ischaemic stroke (ISRCTN 20405426) Rationale Thrombolysis with intravenous rtPA is an effective treatment for patients with ischaemic stroke if given within 3 h from onset. Generally, more than 20% of stroke patients arrive in time to be treated with thrombolysis. Nevertheless, in most hospitals, only 1,8% of all stroke patients are actually treated. Interorganisational, intraorganisational, medical and psychological barriers are hampering broad implementation of thrombolysis for acute ischaemic stroke. Aims To evaluate the effect of a high-intensity implementation strategy for intravenous thrombolysis in acute ischaemic stroke, compared with regular implementation; to identify success factors and obstacles for implementation and to assess its cost-effectiveness, taking into account the costs of implementation. Design The PRACTISE study is a national cluster-randomised-controlled trial. Twelve hospitals have been assigned to the regular or high-intensity intervention by random allocation after pair-wise matching. The high-intensity implementation consists of training sessions in conformity with the Breakthrough model, and a tool kit. All patients who are admitted with acute stroke and onset of symptoms not longer than 24 h are registered. Study outcomes The primary outcome measure is treatment with thrombolysis. Secondary outcomes are admission within 4 h after onset of symptoms, death or disability at 3 months, the rate of haemorrhagic complications in patients treated with thrombolysis, and costs of implementation and stroke care in the acute setting. Tertiary outcomes are derived from detailed criteria for the organisational characteristics, such as door-to-needle time and protocol violations. These can be used to monitor the implementation process and study the effectiveness of specific interventions. Discussion This study will provide important information on the effectiveness and cost-effectiveness of actively implementing an established treatment for acute ischaemic stroke. The multifaceted aspect of the intervention will make it difficult to attribute a difference in the primary outcome measure to a specific aspect of the intervention. However, careful monitoring of intermediate parameters as well as monitoring of accomplished SMART tasks can be expected to provide useful insights into the nature and role of factors associated with implementation of thrombolysis for acute ischaemic stroke, and of effective acute interventions in general. [source] Understanding nursing on an acute stroke unit: perceptions of space, time and interprofessional practiceJOURNAL OF ADVANCED NURSING, Issue 9 2009Cydnee C. Seneviratne Abstract Title.,Understanding nursing on an acute stroke unit: perceptions of space, time and interprofessional practice. Aim. This paper is a report of a study conducted to uncover nurses' perceptions of the contexts of caring for acute stroke survivors. Background. Nurses coordinate and organize care and continue the rehabilitative role of physiotherapists, occupational therapists and social workers during evenings and at weekends. Healthcare professionals view the nursing role as essential, but are uncertain about its nature. Method. Ethnographic fieldwork was carried out in 2006 on a stroke unit in Canada. Interviews with nine healthcare professionals, including nurses, complemented observations of 20 healthcare professionals during patient care, team meetings and daily interactions. Analysis methods included ethnographic coding of field notes and interview transcripts. Findings. Three local domains frame how nurses understand challenges in organizing stroke care: 1) space, 2) time and 3) interprofessional practice. Structural factors force nurses to work in exceptionally close quarters. Time constraints compel them to find novel ways of providing care. Moreover, sharing of information with other members of the team enhances relationships and improves ,interprofessional collaboration'. The nurses believed that an interprofessional atmosphere is fundamental for collaborative stroke practice, despite working in a multiprofessional environment. Conclusion. Understanding how care providers conceive of and respond to space, time and interprofessionalism has the potential to improve acute stroke care. Future research focusing on nurses and other professionals as members of interprofessional teams could help inform stroke care to enhance poststroke outcomes. [source] Physiological monitoring in acute stroke: a literature reviewJOURNAL OF ADVANCED NURSING, Issue 6 2007Stephanie P. Jones Abstract Title.,Physiological monitoring in acute stroke: a literature review Aim., This paper is a report of a review of the literature that considers how physiological parameters may affect outcome after stroke and the implications of this evidence for monitoring. Background., Throughout the world, the incidence of first-ever stroke is approximately 200 per 100,000 people per year [Sudlow et al. (1997)Stroke28, 491]. Stroke is the third most common cause of mortality [Sarti et al. (2000) Stroke31, 1588] and causes 5·54 million deaths worldwide [Murray & Lopez (1997) Lancet349, 268]. Physiological monitoring is considered a fundamental component of acute stroke care. Currently, the strength of evidence to support its use and identify its components is unclear. Nurse-led physiological assessment and subsequent interventions in acute stroke may have the potential to improve survival and reduce disability. Data sources., Online bibliographic databases from 1966 to 2007, including MEDLINE, EMBASE, CINAHL, AMED, Cochrane and ZETOC, were searched systematically. We identified 475 published papers relating to blood pressure, oxygen saturation and positioning, blood glucose and body temperature. Review methods., Titles and abstracts were reviewed independently by two reviewers and 61 relevant studies were read in full. The quality of included studies was assessed and proformas were used to record detailed data. A narrative synthesis described how the evidence from the papers could inform our understanding of physiological parameters and their association with outcome. Results., Current evidence suggests that patient outcome is worse when physiological parameters deviate from ,normal' in the acute phase of stroke. Conclusions., The evidence supports the need for monitoring and recording of blood pressure, oxygen saturation (including consideration of positioning), blood glucose and body temperature in the acute phase of stroke. This review has reinforced the importance of monitoring physiological parameters in the acute phase of stroke and adds support to the recommendation that monitoring should play a key role within nursing care. [source] Improving clinical practice in stroke through audit: results of three rounds of National Stroke AuditJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2005P. Irwin BA RGN MSc Abstract Background, The results of three rounds of National Stroke Audit in England,, Wales and Northern, Ireland are, compared. Methods, Audit of the organization of stroke services and retrospective case-note audit of up to 40 consecutive cases admitted per hospital over a 3-month period was conducted in each of 1998, 1999 and 2001/02. The changes in the organizational, case-mix and process results of the hospitals that had participated in all three rounds were analysed. Results, 60% of all eligible trusts from England, Wales and Northern Ireland took part in all three audits in 1998, 1999 and 2001/02. Total numbers of cases were 4996, 4841 and 5152, respectively. Case-mix variables were similar over the three rounds. Mortality at 7 and 30 days fell by 3% and 5%, respectively. The proportion of hospitals with a stroke unit rose from 48% to 77%. The proportion of patients spending most of their stay in a stroke unit rose from 17% in 1998 to 26% in 1999 and 29% in 2001/02. Improvements achieved in process standards of care between 1998 and 1999 (median change was a gain of 9%) failed to improve further by 2001/02 (median change was 0%). In all three rounds process standards ,of ,care ,tended ,to ,be ,better ,in ,stroke units. Conclusions, Three rounds of national audit of stroke care have shown standards of care on stroke units were notably higher than on general wards. Slowing in the rise of the proportion managed on stroke units mirrors the slow down in improvement to overall national standards of care. To further improve outcomes and national standards of stroke care a much higher proportion of patients needs to be managed in stroke units. [source] Availability of Diagnostic and Treatment Services for Acute Stroke in Frontier Counties in Montana and Northern WyomingTHE JOURNAL OF RURAL HEALTH, Issue 3 2006Nicholas J. Okon DO ABSTRACT:,Context: Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke. Purpose: The aim of this study was to assess the availability of key diagnostic technology and programs for acute stroke evaluation and treatment in Montana and northern Wyoming. Methods: In 2004, hospital medical directors or their designees were mailed a survey about the availability of diagnostic technology, programs, and personnel for acute stroke care. Findings: Fifty-eight of 67 (87%) hospitals responded to the survey. Seventy-nine percent (46/58) of responding hospitals were located in frontier counties, with an average bed size of 18 (11 SD). Of the hospitals in frontier counties, 44% reported emergency medical services prehospital stroke identification programs, 39% had 24-hour computed tomography capability, 44% had an emergency department stroke protocol, and 61% had a recombinant tissue plasminogen activator protocol. Thirty percent of hospitals in frontier counties reported that they met 6-10 of the criteria established by the Brain Attack Coalition to improve acute stroke care compared to 67% of hospitals in the nonfrontier counties. Conclusion: A stroke network model could enhance care and improve outcomes for stroke victims in frontier counties. [source] Acute Stroke Care at Rural Hospitals in Idaho: Challenges in Expediting Stroke CareTHE JOURNAL OF RURAL HEALTH, Issue 1 2006James G. Gebhardt MD ABSTRACT:,Context: Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. Purpose: To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. Methods: Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. Findings: The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. Conclusions: Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays. [source] Imaging the future of stroke: I. Ischemia,ANNALS OF NEUROLOGY, Issue 5 2009David S. Liebeskind MD Envisioning the future of stroke appears daunting considering the milestones already achieved in stroke imaging. A historical perspective on the developments in stroke care provides a striking narrative of how imaging has transformed diagnosis, therapy, and prognosis of cerebrovascular disorders. Multimodal imaging techniques such as CT and MRI, incorporating parenchymal depictions, illustration of the vasculature, and perfusion data, can provide a wealth of information regarding ischemic pathophysiology. Key elements of ischemic pathophysiology depicted with imaging include vascular occlusion, compensatory collateral flow, resultant hemodynamic conditions that reflect these sources of blood flow, and the neurovascular injury that ensues. The mantra of "time is brain" has been perpetuated, but this does not provide an entirely accurate reflection of ischemic pathophysiology and imaging insight shows far more than time alone. Maximizing the potential of perfusion imaging will continue to expand the nascent concept that cerebral ischemia may be completely reversible in certain scenarios. Novel modalities provide a fertile ground for discovery of therapeutic targets and the potential to assess effects of promising strategies. Beyond clinical trials, imaging has become a requisite component of the neurological examination enabling tailored stroke therapy with the use of detailed neuroimaging modalities. In this first article on ischemia, the focus is on the most recent imaging advances and exploring aspects of cerebral ischemia where imaging may yield additional therapeutic strategies. A subsequent article will review recent and anticipated imaging advances in hemorrhage. These thematic overviews underscore that imaging will undoubtedly continue to dramatically shape the future of stroke. Ann Neurol 2009;66:574,590 [source] Organised stroke care for rural AustraliansAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2009Alistair Wright No abstract is available for this article. [source] A review on sex differences in stroke treatment and outcomeACTA NEUROLOGICA SCANDINAVICA, Issue 6 2010P. Appelros Appelros P, Stegmayr B, Terént A. A review on sex differences in stroke treatment and outcome. Acta Neurol Scand: 2010: 121: 359,369. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Background,,, Beyond epidemiological differences, it has been controversial whether any important sex differences exist in the treatment of stroke. In this review paper, the following areas are covered: thrombolysis, stroke unit care, secondary prevention, surgical treatment, and rehabilitation. Additionally, symptoms at stroke onset, as well as outcome measures, such as death, dependency, stroke recurrence, quality of life, and depression are reviewed. Methods,,, Search in PubMed, tables-of-contents, review articles, and reference lists after studies that include information about sex differences in stroke care. Results,,, Ninety papers are included in this review. Women suffer more from cortical and non-traditional symptoms. Men and women benefit equally from thrombolysis and stroke unit care. Women with cardioembolic strokes may benefit more from anticoagulant therapy. Most studies have not found any tendency towards sexism in the choice of treatment. Post-stroke depression and low quality-of-life seem to be more common among women. Mortality rates are higher among men in some studies, while long-term ADL-dependency seems to be more common among women. Conclusions,,, Sex differences in stroke treatment and outcome are small, with no unequivocal proof of sex discrimination. Women have less favourable functional outcome because of higher age at stroke onset and more severe strokes. [source] Thrombolytic treatment for stroke in the Scandinavian countriesACTA NEUROLOGICA SCANDINAVICA, Issue 4 2009K. Bruins Slot Objective,,, We wanted to describe the use of thrombolytic treatment for stroke in Scandinavia, to assess stroke doctors' opinions on this treatment, to identify barriers against treatment, and to suggest improvements to overcome these barriers. Methods,,, We sent questionnaires to 493 Scandinavian doctors, who were involved in acute stroke care. Results,,, We received 453 (92%) completed questionnaires. Overall, 1.9% (range per hospital 0,13.9%) of patients received thrombolytic treatment. A majority (94%) of the respondents was convinced of the beneficial effects of thrombolytic treatment and many (85%) felt that its risks were acceptable. Main barriers were: unawareness of stroke symptoms among patients (82%) and their failure to respond adequately (54%); ambulance services not triaging acute stroke as urgent (23%); and insufficient in-hospital routines (15%). The respondents suggested that the following measures should be prioritized to increase the treatment's use: educational programmes to improve public awareness on stroke and how to respond (96%); education of in-hospital (88%) and prehospital (76%) medical staff. Conclusions,,, A large majority of Scandinavian doctors regard thrombolytic treatment for stroke as beneficial, yet its implementation in clinical practice has so far been poor. Our survey identified important barriers and potential measures that could increase its future use. [source] Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patientsACTA NEUROLOGICA SCANDINAVICA, Issue 5 2006S. K. Saxena Background,,, Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. Aim,,, The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Methodology,,, Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. Results,,, The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index , 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01,12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32,14.98). Conclusion,,, Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed. [source] | ||||||||||||||||||||||