This problem could be solved by directed use of tPA via magnetic nanoparticles carrying a much smaller bolus of drug because it would be delivered directly to the site. But we seem to have no one in the stroke world that publicly acknowledges the problems in stroke and is working on a strategy to solve those problems. This is so fucking easy. You specifically describe the problem, hire researchers to solve that problem. Write up a stroke protocol based on the research that addresses the problem in real time.We must have incredibly stupid people out there.
http://circoutcomes.ahajournals.org/content/8/6_suppl_3/S69.extract?etoc
- Lee H. Schwamm, MD
+ Author Affiliations
- Correspondence to Lee H. Schwamm, MD, Department of Neurology, ACC 720, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. E-mail Lschwamm@partners.org
- Editorials
- decision making
- health services research
- thrombolytic therapy
- tissue plasminogen activator
In this issue of Circulation: Cardiovascular Quality and Outcomes, Decker et al1
have described a qualitative study to better define the type of
information and the best methods of display to enable patients
to express their preferences toward emergency
treatment of stroke with intravenous tissue-type plasminogen activator
(tPA).
Ten focus group interviews were conducted among
stroke survivors, caregivers, emergency physicians, and nurses, and then
based
on their findings, the Rapid Evaluation for
Stroke Outcomes using Lytics in a Vascular Event (RESOLVE) decision aid
tool was
developed. This work is an extension of the
previous work by the authors in developing a similar tool for shared
decision
making in nonurgent percutaneous cardiac
interventions. They found that patients and caregivers want simple
graphs that show
the increased chance of recovering to
independence, not to perfection, in general and for their individual
circumstances,
while understanding the risks involved.(But are you going to tell them that tPA only fully works 12% of the time?)
Providers had concerns about the process itself and voiced skepticism
about the underlying
efficacy and safety data of tPA, particularly
the risk of hemorrhage and the ability to have meaningful discussions of
risk
and benefit in such an emergent setting. This
skepticism is echoed in the recent modification of the American College
of Emergency
Physicians statement downgrading the level of
evidence supporting the use intravenous tPA in stroke and calling for
shared
decision making, when feasible, between the
patient (and his or her surrogate) and a member of the healthcare team
that includes
a discussion of potential benefits and harms
before the decision …
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