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:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Tuesday, February 28, 2017

Workflow in Acute Stroke: What Is the 90th Percentile?

If you were told that tPA administration gives you a 31-54% better chance of recovery vs. that tPA fails to get you fully recovered 88% of the time, which one makes you feel better since both are true? This is where the stroke medical world is lying by omission and thus not truly showing how bad the problems in stroke are. All 'happy talk' means there is no reason to solve any of the fucking problems in stroke.
http://stroke.ahajournals.org/content/48/3/808?etoc=
Jessalyn K. Holodinsky, Noreen Kamal, Alexis T. Wilson, Michael D. Hill, Mayank Goyal

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Introduction

The manner in which information is presented can profoundly affect the interpretation of that information and, consequently, any action taken. As an illustrative example, let us assume that swimming pools across the country have to report the time it takes to rescue a child who is drowning. As a parent, would you be satisfied if the median time to rescue a drowning child was 30 seconds? Knowing that a lifeguard could reach your child in only half a minute may be comforting. However, this comfort likely would not last if you were then informed that the 90th percentile is 6 minutes, a time which is likely life-threatening. We argue here that acute ischemic stroke treatment faces a similar reporting issue and that we should be doing more to acknowledge and improve the 90th percentile for stroke patients.
We recommend that investigators report interval times with the 90th percentile, in addition to median and interquartile range, in their primary results on paper and at presentation. In the long run, this change would allow us to focus on ensuring that the majority of patients are treated within an acceptable time frame, rather than only 50% of patients. Additionally, efforts tailored to improving the 90th percentile would result in improved systems of care and stroke outcomes.
Based on data from recent endovascular trials, it is absolutely clear that when it comes to stroke treatment, time is brain.15 The longer the time from onset to reperfusion, the lower the likelihood of good outcome.6 The effect of time delay is even more pronounced when one considers onset to randomization times in endovascular trials.15 This is not because of physiological factors; rather, it is the result of these trials overtly selecting patients based on favorable imaging.(cherry picking) In all of …
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