Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 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:

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's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Wednesday, January 18, 2017

New knowledge, technologies yield drastic changes in cardiology over 20 years

I would have to say that for stroke the last 20 years were not very good. tPA was introduced in 1996 and was immediately a failure with only a 12% full recovery rate. We have never addressed that failure, just kept pushing for faster ways to deliver that failure and expand the timeframe that failure can be delivered in. Complete failure in action and NOONE is acknowledging that failure. 'Happy talk' abounds, and if you listen to that there is absolutely nothing wrong with stroke.
Since Cardiology Today was launched 20 years ago in 1997, not only has the prognosis for patients with heart disease vastly changed, but so has the practice of cardiology.

Back then, cardiologist involvement occurred mainly when patients were seriously ill, often if they needed CABG or other heart surgery, if they needed PCI with or without bare-metal stenting, or if they had MI, or cardiac arrest. Another difference between then and now was that stroke was often the focus of only neurologists. The prognosis for most patients with HF was grim. Fewer people visited cardiologists for diagnostic testing or preventive strategies.
“The focus in the late ’90s when we launched the Cardiology Today print publication was totally dominated by acute MI, principally STEMI,” Cardiology Today Chief Medical Editor Carl J. Pepine, MD, MACC, eminent scholar emeritus and professor in the division of cardiovascular medicine at University of Florida, Gainesville, said in an interview. “Now, due to advances, patients with STEMI are in a far minority, and I would say that the field is dominated by HF. I like to think that’s a result of our success: We have kept people from dying of heart disease, so now they’re living with heart disease.”
Over the course of 20 years, CVD and CV mortality rates have declined in the United States and many other countries, minimally invasive technologies have enabled more patients to be treated for heart problems successfully, new drugs and better understanding of old drugs have enabled patients to live longer before an intervention is required, and physicians and patients have a stronger knowledge of what it means to be heart-healthy.

A common thread among all the changes is “an increasing reliance on doing something rather than watchful waiting,” Eduardo Marbán, MD, PhD, director of the Cedars-Sinai Heart Institute, told Cardiology Today.

The landscape in 1997

One major difference between then and now, Pepine said, is that cardiology did not have nearly as many subspecialties. One could specialize in electrophysiology/arrhythmias or intervention, but many of today’s other subspecialties within cardiology were embryonic or nonexistent.
“Back then, I was an interventionalist and we were concerned mostly with ... diagnostics and early intervention: plain old balloon angioplasty and BMS,” Pepine said. “By the late ’90s and early 2000s, that all changed. We didn’t have a HF subspecialty at the time, but we’ve since had an explosion of HF specialists and an American Board of Internal Medicine certification in advanced HF and transplant cardiology. Now there are specialists with focus in topics such as cardio-oncology, cardiometabolic and cardio-renal.”
The catheter laboratory then doubled as the physiology laboratory, but that is no longer the case, as the latter has generally shifted to the echocardiography, MR and nuclear labs, he said.
For diagnostics, “we had conventional stress testing, such as echocardiography and nuclear testing, and invasive angiography,” Pamela S. Douglas, MD, who holds the Ursula Geller professorship for research in cardiovascular diseases at Duke Clinical Research Institute, Duke University School of Medicine, told Cardiology Today. “We had no noninvasive angiography or calcium scoring. CT was nonexistent as a cardiac test.”

Moreover, there was not nearly the intensity of focus on evidence-based medicine that is seen today, Nanette K. Wenger, MD, FAHA, MACC, emeritus professor of medicine in the division of cardiology at Emory University School of Medicine, consultant at Emory Heart and Vascular Center, and director of the Cardiac Clinics at Grady Memorial Hospital, Atlanta, said in an interview.
“In general, there was more consensus and less evidence base,” Wenger, a member of the Cardiology Today Editorial Board, said. “We were just beginning to get into the very careful exploration of evidence, at a point of transition between consensus — people sitting around a table and making recommendations — and a very precise exploration of the data.”

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