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 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.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Sunday, August 26, 2018

To Treat or Not to Treat? Exploring Factors Influencing r-tPA (Recombinant Tissue-Type Plasminogen Activator) Treatment Decisions for Minor Stroke

Every single stroke coming into your stroke hospital should have a protocol to follow. There is never a stroke that is too good to treat. You never magically recover from a stroke. Your doctor should never have to make a subjective decision. You have an objective damage diagnosis(The NIH Stroke Scale is not objective so we have a problem right from the start.). What should follow directly from that is a stroke protocol to remove the clot or stop the bleeding and then a protocol to stop the neuronal cascade of death or the hemorrhage cascade of death.  This is so fucking simple, why can't it be done?  Laziness? Incompetence? Or just don't care? No leadership? No strategy? Not my job?
https://www.ahajournals.org/doi/10.1161/STROKEAHA.118.022538?platform=hootsuite
The authors undertook this multicenter United States-based survey to explore factors that influence intravenous thrombolysis decisions patients with minor stroke, who constitute a controversial category of acute ischemic stroke. One hundred ninety-four physicians were across the United States with 150 vignettes using a variation of the following 7 factors that were agreed on by an expert panel as most likely to influence tPA (tissue-type plasminogen activator) administration: National Institutes of Health Stroke Scale (NIHSS) score(The NIH Stroke Scale is not objective so we have a problem right from the start.), NIHSS area of deficit with emphasis on 3 levels (visual/language/weakness), baseline functional status, previous ischemic stroke, previous intracerebral hemorrhage, recent use of anticoagulation, and temporal pattern of symptoms in first hour of emergency department care. One hundred fifty-six physicians returned complete vignettes and were included in the final analysis, 80% neurologists and 20% emergency department physicians; nearly 2/3 practiced in academic institutions and comprehensive stroke centers. On the 2 extremes of the spectrum, physicians were most likely to treat patients with higher NIHSS, stable course, and no prior hemorrhage or ischemic stroke and least likely to consider treatment in those with low NIHSS, preexisting disability, and recent stroke or hemorrhage. Overall, 4 of the 7 factors weighed heavily in physician decisions, in descending order: previous intracerebral hemorrhage, anticoagulation use, NIHSS score, and previous recent ischemic stroke. However, in a conjoint model, only 25% of the variability in decision-making was accounted for. The authors also explored the effect of individual physician characteristics, such as age, years of practice, sex, and area of training; they found no significant impact on the probability to use thrombolysis. Overall, a substantial proportion of the variability in decision-making in minor stroke remains currently unexplained. See p 1933.

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