Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, May 4, 2012

Hospitals need to scan stroke patients faster

This article and the original one in Stroke magazine are a great example of not looking at the complete picture. They are looking at improving the process not what is the best outcome for the patient.They are assuming that application of tPA is the answer to correcting a stroke in progress. tPA has a poor success rate - I've seen from 30-32%, No one seems to want to publish the actual rate. With no hyperacute therapies that stop the neuronal cascade of death Time may be Brain but there is nothing out there for saving those neurons.
 They don't even talk about the too good to treat cases
Article in futurity.org here;

http://www.futurity.org/health-medicine/hospitals-need-to-scan-stroke-patients-faster/
Only 41.7 percent of stroke patients undergo brain imaging within the recommended 25 minutes of their arrival at a hospital, according to a new study.

The mantra in stroke care is “time is brain.” With each passing minute more brain cells are irretrievably lost and, because of this, timely diagnosis and treatment is essential to increase the chances for recovery.

Straight from the Source

DOI: 10.1161/STROKEAHA.111.626374
The study, published this month in the journal Stroke, also finds that certain individuals, including people with diabetes, those over 75 years of age, women, those that did not arrive by ambulance, non-whites, and those with certain cardiac conditions are less likely to receive a timely brain scan. These delays mean that treatment often comes either too late or not at all.
‘We were struck by the fact that less than half of patients with acute stroke symptoms did not receive a brain scan within recommended guidelines,” says University of Rochester Medical Center neurologist Adam Kelly, lead author of the study.
“This was the performance of hospitals who are actively participating in a national quality improvement program, so rates in non-participating hospitals may be even worse.”
Imaging the brain is an essential tool in the diagnosis of a stroke and determines which treatment option physicians will pursue. Strokes caused by a blockage in one of the arteries that serve the brain—called ischemic strokes—are candidates for the clot-busting drug tissue plasminogen activator (tPA), which can restore blood flow and improve clinical outcomes.
However, this drug cannot be used when the symptoms are instead caused by a ruptured blood vessel in the brain. Furthermore, in order for tPA to be most effective it must be administered as soon as possible and within three hours of the onset of symptoms. It is therefore essential that physicians are able to “see” what is occurring in the brain, and quickly.
Several national organizations, including the American Heart Association (AHA), have created guidelines for emergency stroke care. An AHA quality improvement program, called Get with the Guidelines, is used to evaluate and recognize hospitals for their quality of stroke care. The program collects data and quality measures—such as the amount of time to complete an MRI or CT scan of a suspected stroke patient’s brain—from each enrolled hospital. At the time of the study, 1,199 hospitals across the nation were participating in the Get with the Guidelines program.
The study’s authors used the AHA data collected by the program to analyze the imaging times for 40,777 stroke patients who were candidates for tPA—had an ischemic stroke, arrived at the hospital within the three hour window, and did not have other conditions that precluded the use of tPA.
In addition to low overall compliance with the brain imaging guidelines, the authors also found that individuals were less likely to receive timely brain scans if they:
  • Did not arrive at the hospital by ambulance (47 percent less likely)
  • Were of non-white race, even though blacks and certain other ethnic/racial groups have a higher incidence of stroke
  • Had certain known risk factors for stroke such as diabetes, a prior history of stroke, over 75 years old, and peripheral vascular disease.
In terms of clinical outcomes, the study showed that delays in diagnostic imaging can translate into missed or delayed treatment as well. Patients who received brain imaging within the recommended 25-minute period were much more likely to receive tPA (63 percent) compared to those not meeting this recommendation (38 percent).
Furthermore, when tPA was administered, it was given earlier in patients who were imaged quickly. Earlier treatment with tPA is associated with improved functional outcomes in patients with ischemic stroke.
“Despite the strides that have been made in stroke care, it is clear that there is significant room for improvement in the evaluation of patients suspected of stroke,”says Kelly. “Time is too precious and hospitals cannot be the reason for delay.”
Additional authors at the Duke Clinical Research Institute, the University of Calgary, and Massachusetts General Hospital contributed to the study, which was supported by a grant from AHA.

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