Using artificial intelligence for improving stroke diagnosis in emergency departments: a practical framework

 This is so fucking simple, pick one of these much faster stroke diagnosis tools and get the subjective views of neurologists out of the picture. Reduce misdiagnosis substantially. Is your stroke hospital smart enough to do this? Or will incompetence reign once again? If so, the board of directors needs to be fired.  

• diagnosis failure (27) 

  • young adult strokes (54)

   

 

Maybe one of these much faster possibilities?

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds   February 2017

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds March 2017

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017

The latest here:

Using artificial intelligence for improving stroke diagnosis in emergency departments: a practical framework

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Vida Abedi, Ayesha Khan, Durgesh Chaudhary, ...

First Published August 25, 2020 Review Article 

https://doi.org/10.1177/1756286420938962

Article information

   

Abstract

Stroke is the fifth leading cause of death in the United States and a major cause of severe disability worldwide. Yet, recognizing the signs of stroke in an acute setting is still challenging and leads to loss of opportunity to intervene, given the narrow therapeutic window. A decision support system using artificial intelligence (AI) and clinical data from electronic health records combined with patients’ presenting symptoms can be designed to support emergency department providers in stroke diagnosis and subsequently reduce the treatment delay. In this article, we present a practical framework to develop a decision support system using AI by reflecting on the various stages, which could eventually improve patient care and outcome. We also discuss the technical, operational, and ethical challenges of the process.

Keywords acute stroke, artificial intelligence, cerebrovascular disease/stroke, computer aided diagnosis, ischemic stroke, machine learning, stroke diagnosis, stroke in emergency department

Introduction

Stroke is the fifth leading cause of death in the United States and a significant cause of severe disability in adults.¹ Each year, around 800,000 Americans experience a new or recurrent stroke.² Rapid diagnosis and treatment of stroke is crucial and leads to improved outcomes and prognosis among patients treated within the ‘Golden Hour’.^3,4

However, strokes, especially posterior circulation strokes, are associated with significant (>10%) diagnostic error.⁵ The latter could be due to (1) some patients with acute stroke present with non-focal symptoms such as dizziness, diplopia, dysarthria, or ataxia,⁶ which may not trigger a neurology consult or a need for a more detailed neurological examination; (2) stroke is commonly misdiagnosed in younger patients^7,8; and (3) the emergency department (ED) is a challenging environment for providers, especially with the multiplicity of care protocols, and the dynamic nature of patient care.^8,9 Triage, consultations, admissions, discharge, and other steps in emergency care are time-sensitive, complex, and always changing to further improve efficacy and quality of care. Therefore, identifying potential stroke symptoms can be challenging,^10–12 especially when the providers are in training.^13,14 Besides, the risk of misdiagnosis can be higher among walk-in patients,¹⁵ when the providers do not receive a pre-arrival notification from emergency medical services,¹⁶ or when a neurologist is not readily available for an urgent consultation.^17–19 Scoring systems for the diagnosis of stroke and recurrent stroke do not have a high sensitivity to diagnose the posterior circulation stroke.^20,21 Furthermore, these tools are also not automatic, and require that the physicians suspect stroke as a differential diagnosis to apply the scoring system.

Artificial intelligence (AI), a computational framework meaning to emulate human insight, is one of the most transformative technologies.^22,23 The era of augmented intelligence in healthcare is driven by the notion that intelligent algorithms can support providers in diagnosis, treatment, and outcome prediction, especially with growing digital and connected patient data and advances in computational abilities.^24–26 The augmented-diagnostic model for stroke may be particularly helpful in low volume or non-stroke centers’ ED, where emergency providers have limited daily exposure to stroke. An automated, computer-assisted screening tool that can be seamlessly integrated into clinical workflow to quickly analyze patient symptoms and clinical data and suggest a diagnosis of stroke (‘StrokeAlert’ pop-up) in an ED setting could be valuable. Such a system will also help bring access and timely diagnosis for patients who choose to self-present to an ED. In this paper, we present a practical framework and summarize the stages needed to create a machine learning (ML)-enabled clinical decision support system for the screening of stroke patients in ED using data from electronic health records (EHRs) combined with the patient’s presenting symptoms at the point of care. We have assembled a team of experts and are leading such effort at Geisinger. Figure 1 summarizes the key steps of such a system.

Figure1. Key steps for a stroke ML-enabled decision support system for EDs.

ED, emergency department; ML, machine learning.

 

Rudimentary Dexterity Corresponds With Reduced Ability to Move in Synergy After Stroke: Evidence of Competition Between Corticoreticulospinal and Corticospinal Tracts?

Whatever the hell this is.

Rudimentary Dexterity Corresponds With Reduced Ability to Move in Synergy After Stroke: Evidence of Competition Between Corticoreticulospinal and Corticospinal Tracts?

Merav R. Senesh, MSc, Karina Barragan, David J. Reinkensmeyer, PhD

First Published August 24, 2020 Research Article 

https://doi.org/10.1177/1545968320943582

Article information

 

Abstract

Objective

When a stroke damages the corticospinal tract (CST), it has been hypothesized that the motor system switches to using the corticoreticulospinal tract (CRST) resulting in abnormal arm synergies. Is use of these tracts mutually exclusive, or can the motor system spontaneously switch between them depending on the type of movement it wants to make? If the motor system can share control at will, then people with a rudimentary ability to make dexterous movements should be able to perform synergistic arm movements as well.

Methods

We analyzed clinical assessments of 319 persons’ abilities to perform “out-of-synergy” and “in-synergy” arm movements after chronic stroke using the Upper Extremity Fugl-Meyer (UEFM) scale.

Results

We identified a moderate range of arm impairment (UEFM = ~30-40) where subjects had a rudimentary ability to make out-of-synergy (~23%-50% on the out-of-synergy score) and dexterous hand movements (~3-10 blocks on Box and Blocks Test). Below this range persons could perform in-synergy but not out-of-synergy or dexterous movements. In the moderate range, however, scoring better on out-of-synergy movements correlated with scoring worse on in-synergy movements (P = .001, r ≈ −0.6).

Conclusion

Rudimentary dexterity corresponded with reduced ability to move the arm in-synergy. This finding supports the idea that CST and CRST compete and has implications for rehabilitation therapy.

Keywords stroke, arm movement, dexterity, motor control, synergies, corticospinal tract

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The Efficiency, Efficacy, and Retention of Task Practice in Chronic Stroke

Useless, All this blathering with NO PROTOCOL CREATED.

The Efficiency, Efficacy, and Retention of Task Practice in Chronic Stroke 

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Chunji Wang, PhD, Carolee Winstein, PhD, David Z. D’Argenio, PhD, ...

First Published August 24, 2020 Research Article 

https://doi.org/10.1177/1545968320948609

Article information

 

Abstract

In motor skill learning, larger doses of practice lead to greater efficacy of practice, lower efficiency of practice, and better long-term retention. Whether such learning principles apply to motor practice after stroke is unclear. Here, we developed novel mixed-effects models of the change in the perceived quality of arm movements during and following task practice. The models were fitted to data from a recent randomized controlled trial of the effect of dose of task practice in chronic stroke. Analysis of the models’ learning and retention rates demonstrated an increase in efficacy of practice with greater doses, a decrease in efficiency of practice with both additional dosages and additional bouts of training, and fast initial decay following practice. Two additional effects modulated retention: a positive “self-practice” effect, and a negative effect of dose. Our results further suggest that for patients with sufficient arm use post-practice, self-practice will further improve(NOT GOOD ENOUGH, 100% RECOVERY IS THE GOAL.) use.

Keywords chronic stroke, neurorehabilitation, motor learning, mixed effect models, dose, retention

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A Need to Activate Lasting Engagement

To me, this is a pretty useless activity until there are protocols that address curing spasticity. All my favorite activities require full and free range of movement of legs, arms and hands. I don't accept the tyranny of low expectations that therapists will push on me.

 A Need to Activate Lasting Engagement

 

Rachelle Brick; Kathleen Doyle Lyons; Juleen Rodakowski; Elizabeth Skidmore

Author Affiliations

American Journal of Occupational Therapy, July 2020, Vol. 74, 7405347010. https://doi.org/10.5014/ajot.2020.039339

Abstract

Occupational therapy practitioners provide interventions to promote activity engagement to multiple clinical populations. They help clients develop restorative, adaptive, and compensatory skills to improve their performance in daily activities. The issue addressed in this article is that current clinical frameworks lack translation of learned skills to consistent everyday performance. There is a gap between what clients can do and what clients actually do in everyday life. Behavioral activation provides an explicit, structured, and practical approach that can translate capacity into long-term engagement. This article presents behavioral activation as a transdiagnostic approach that targets populations experiencing chronic illness to bridge the gap between what the client can do in therapy and what the client could do in everyday life.

What This Article Adds: People with chronic illness have difficulty translating the skills learned in traditional practice settings to everyday life. Behavioral activation offers occupational therapy practitioners a practical structure to promote the translation of learned skills.

 

CHI Memorial(Chattanooga, TN) Receives "Get With The Guidelines-Stroke Gold Plus" Quality Achievement Award

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

 

CHI Memorial(Chattanooga, TN) Receives "Get With The Guidelines-Stroke Gold Plus" Quality Achievement Award

CHI Memorial has received the American Heart Association/American Stroke Association’s Get With The Guidelines - Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s "commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence."
 
CHI Memorial earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions.
 
“CHI Memorial is dedicated to improving the quality of care for our stroke patients by implementing the American Heart Association’s Get With The Guidelines-Stroke initiative,” said Roza Adamczyk, MD, CHI Memorial stroke program medical director. “The tools and resources provided help us track and measure our success in meeting evidenced-based clinical guidelines developed to improve patient outcomes.” 
 
CHI Memorial received two additional awards from the American Heart Association/American Stroke Association.  The Association’s Target: Stroke Elite Plus award recognizes hospitals that meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke.  
 
The Target: Type 2 Honor Roll award recognizes hospitals that meet certain metrics by engaging in advanced care for patients with heart failure and/or stroke, and type 2 diabetes. This award allows Get with the Guidelines participating hospitals to be acknowledged for their compliance with Get with the Guidelines measures tailored to patients with type 2 diabetes, ensuring they receive the most up-to-date, evidence-based care when hospitalized with cardiovascular disease and/or stroke.
      
“We are pleased to recognize CHI Memorial for its commitment to stroke care,” said Lee H. Schwamm, MD, national chairperson of the Quality Oversight Committee and executive vice chair of Neurology, director of Acute Stroke Services, Massachusetts General Hospital, Boston, Ma. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”
 
According to the American Heart Association/American Stroke Association, stroke is the number five cause of death and a leading cause of adult disability in the United States. On average, someone in the US suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year. 

Norton Healthcare’s(Louisville,KY) four adult-service hospitals receive national awards for stroke care

 

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

Norton Healthcare’s(Louisville,KY) four adult-service hospitals receive national awards for stroke care

Norton Healthcare’s four adult-service hospitals have been nationally recognized for their advanced stroke care.

The American Heart Association/American Stroke Association awarded Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital and Norton Women’s & Children’s Hospital with its Get with the Guidelines – Stroke designation. Norton Brownsboro received gold designation, while the others received silver designations.

“Stroke is one of the leading causes of death and disability in Kentucky, and we want to ensure our patients get the best and fastest care possible,” said David Sun, M.D., Ph.D., executive medical director of Norton Neuroscience Institute. “Our team has worked incredibly hard not only to be at the forefront of stroke treatment, but also to educate the community about recognizing and preventing future strokes.”

The hospitals earned the awards by meeting specific quality measures for diagnosing and treating stroke patients. These measures use the latest stroke guidelines with the goal of speeding recovery and reducing death and disability. Before leaving the hospital, patients also receive education on managing their health, get a follow-up visit scheduled and receive options for transitional care.

Norton Neuroscience Institute

Norton Healthcare operates the area’s largest stroke care system. At its core is Norton Brownsboro Hospital, which is certified as a Comprehensive Stroke Center by The Joint Commission and the American Heart Association/American Stroke Association.

Norton Audubon, Norton Brownsboro and Norton Hospital received additional recognition for their quick treatment of stroke patients. The hospitals met goals developed to reduce the time between the patient’s arrival at the hospital and treatment with a clot-destroyer called tissue plasminogen activator, or tPA. This medication literally can stop a stroke as it’s happening by breaking up the blockage and restoring blood flow to the brain.

“Time saved is brain saved,” Dr. Sun said. “We want to treat an active stroke as quickly as possible so the patient has the best possible outcome.”

Stroke is the No. 5 cause of death and a leading cause of disability among U.S. adults. On average, someone in the U.S. experiences a stroke every 40 seconds, and nearly 795,000 people have a new or recurrent stroke each year.

In addition to the stroke awards, the American Heart Association/American Stroke Association also recognized all four hospitals for their treatment of patients with Type 2 diabetes. Individuals with Type 2 diabetes have a higher risk of developing heart disease and stroke.

Learn how to identify signs of a stroke.

 

CHRISTUS St. Michael Hospital-Atlanta Receives 2020 Get With The Guidelines-Stroke Gold Plus Quality Achievement Award

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they 'care' about us multiple times but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

CHRISTUS St. Michael Hospital-Atlanta Receives 2020 Get With The Guidelines-Stroke Gold Plus Quality Achievement Award

 

 

CHRISTUS St. Michael Hospital – Atlanta has received the American Heart Association/American Stroke Association’s Get With The Guidelines® Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

CHRISTUS St. Michael Hospital – Atlanta earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients should also receive education on managing their health, obtaining a follow-up visit and other care transition interventions.

According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year.

“CHRISTUS St. Michael Hospital – Atlanta is dedicated to improving the quality of care for our stroke patients by implementing the American Heart Association’s Get With The Guidelines-Stroke initiative,” said Brett Kinman, Interim Administrator. “The tools and resources provided help us track and measure our success in meeting evidenced-based clinical guidelines developed to improve patient outcomes.”

CHRISTUS St. Michael Hospital – Atlanta additionally received the Association’s Honor Roll Elite and Target: Type 2 Diabetes Honor Roll award, according to Heather Biddy BSN, RN, VA-BC, RN Program Manager – Trauma/Stroke/Chest Pain. To qualify for this recognition, hospitals must meet quality measures developed with more than 90-percent of compliance for 12 consecutive months for the “Overall Diabetes Cardiovascular Initiative Composite Score.”

CHRISTUS St. Michael Hospital – Atlanta has also met specific scientific guidelines as a Primary Stroke Center or as a Comprehensive Stroke Center, featuring a comprehensive system for rapid diagnosis and treatment of stroke patients admitted to the emergency department.

 

“We are pleased to recognize CHRISTUS St. Michael Hospital – Atlanta for their commitment to stroke care,” said Lee H. Schwamm, M.D., national chairperson of the Quality Oversight Committee and Executive Vice Chair of Neurology, Director of Acute Stroke Services, Massachusetts General Hospital, Boston, Massachusetts. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

# # #

CHRISTUS St. Michael Hospital – Atlanta, located along U.S. Highway 77 and South William Street in Atlanta, Texas, provides general and medical care for inpatient, outpatient, and emergency department patients. The 43-bed hospital is accredited with The Joint Commission (TJC) Gold Seal of Approval™ – demonstrating compliance with TJC standards for health care quality and safety. In addition, CHRISTUS St. Michael Hospital – Atlanta is designated a Support Stroke Level III Facility, offering teleneurology and tPA (tissue plasminogen activator) for treatment of strokes. Along with inpatient care, the hospital provides emergency services staffed by physicians and specially trained registered nurses – several of whom have earned advanced certifications in strokes, emergency, and trauma care. The hospital operates as a Level IV Trauma Center, holds Chest Pain Accreditation from the American College of Cardiology (ACC) and offers pediatric emergency telemedicine.

Other services include: in-hospital pharmacy, radiology/imaging for inpatient and outpatient care, CAP-accredited clinical laboratory, outpatient rehabilitation, wound care, sleep disorders center, outpatient cardiac-pulmonary rehabilitation, comprehensive diabetes education, and a health and fitness center.

Cape Cod Hospital(Hyannis,MA) Recognized for Achievement in Stroke Care

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they do appropriate treatment but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

 

Cape Cod(Hyannis,MA) Hospital Recognized for Achievement in Stroke Care

HYANNIS – Cape Cod Hospital has been recognized for achievement in stroke care with awards from the Paul Coverdell National Acute Stroke Program, a division of the CDC and the American Heart Association/American Stroke Association.

Cape Cod Hospital was awarded the Coverdell Award for achieving “Door to CT within 25 mins from arrival for at least 75 percent of stroke patients,” as measured by the Coverdell Program and announced by the Massachusetts Department of Public Health.

To earn this recognition, which was offered for the first time in 2020, Cape Cod Hospital met the timing and percentage measures for all patients who were eligible for alteplase treatment and arrived at the hospital via EMS.

In addition to the measurements of the award, Cape Cod Hospital also achieved the additional recommendation to engage EMS agencies in quality improvement activities aimed at improving this measure.

To earn the Coverdell System of Care Partnership Award, Cape Cod Hospital established a formal partnership, including a memorandum of understanding with EMS and post-acute care facilities for quality standards of care.

Cape Cod Hospital also earned the American Heart Association/American Stroke Association’s Gold “Get With The Guidelines” Plus Quality Award, an advanced level of recognition for hospitals who meet quality measures for 24 consecutive months or more including dysphagia screening, stroke education, intensive statin therapy and time to IV thrombolytic therapy.

Cape Cod Hospital also was named to the Target Type 2 Diabetes Honor Roll for improving gaps in Type 2 Diabetes care by the American Heart Association/American Diabetes Association. 

“These recognition’s are a testament to our tireless commitment to care quality and safety,” said CEO Mike Lauf.

“Continuous improvement in stroke care and achieving the highest quality standards are among the many ways we demonstrate our commitment to providing exceptional patient care.”

 

Baptist Health(Paducah, KY) stroke program lauded

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they do appropriate treatment but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

 

  Baptist Health(Paducah, KY) stroke program lauded

10 Providence hospitals in Southern California recognized for excellence in stroke care

 

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they do 'care' about us but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

10 Providence hospitals in Southern California recognized for excellence in stroke care

All 10 Providence medical centers in Southern California were recognized this week for quality care in treating patients suffering strokes, standards measured by the American Heart Association’s/American Stroke Association’s Get With The Guidelines awards program.

The Gold Plus Quality Achievement Award is given to hospitals that have experienced two or more consecutive years with a minimum 85 percent adherence with AHA/ASA achievement measures, and 75 percent on additional quality measures.

“We are employing the latest procedures and technology in order to extend the revolution in stroke care, which in many cases not only halts the stroke, but reverses its effects and restores function,” said Santa Monica-based neurosurgeon Neil A. Martin, M.D., executive medical director of neurosciences for Providence Southern California. “Today, patients, who not long ago were destined for a lifetime of disability, now can be treated in minutes, recover in hours and walk out of the hospital in days.

“In many cases, paramedics bypass other hospitals to get to one of our Providence medical centers because of the expertise that has gained them recognition as elite award-winning destination stroke centers. Our stroke teams are focused on relentlessly pursuing improvements in care, so that ever more patients can be saved.”

In Los Angeles County, the AHA/ASA Gold-Plus recognition was awarded to Providence Saint Joseph Medical Center, Burbank; Providence Holy Cross Medical Center, Mission Hills; Providence Cedars-Sinai Tarzana Medical Center, Providence Saint John’s Health Center, Santa Monica; and Providence Little Company of Mary Medical Centers in San Pedro and Torrance.. This honor recognizes the hospitals’ commitment to and success in implementing a high standard of stroke care by ensuring stroke patients receive treatment that meets nationally accepted, evidence-based standards and recommendations.

Additionally, Saint John’s was named to the Advanced Therapy Honor Roll and along with Saint Joseph, Holy Cross, and the Torrance and San Pedro hospital were designated for diabetes care. Saint John’s and Saint Joseph earned other top honors, making the Elite Plus Honor Roll, while Little Company of Mary Torrance garnished Elite Honor Roll status.

The Elite Plus Honor Roll level is based on adherence to target measures, and for the Elite Honor Roll, the speed at which patients are treated, which can make a critical difference.

In Orange County, Mission Hospital, with campuses in Mission Viejo and Laguna Beach, and St. Jude Medical Center, Fullerton, earned the Gold Plus Achievement Award, were named to the Stroke Elite Plus Honor Roll and recognized for diabetes care. Mission also was recognized for advanced stroke therapy.

St. Jude Medical Center in Fullerton earned the Gold Achievement Award; while St. Joseph Hospital, Orange, earned the Silver Achievement Award.

A Heart Association study shows stroke patients treated at hospitals participating in the national Get With The Guidelines – Stroke program were more likely to be discharged and less likely to die after leaving the hospital than patients in non-participating hospitals.

The awards go to hospitals that adhere to Get with the Guidelines indicators consistently and succeed in complying with recommended measures in treating stroke.

 

Ocala Health(FL) honored with prestigious award for commitment to stroke care

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they do 'care' about us but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

 

Ocala Health(FL) honored with prestigious award for commitment to stroke care

Ocala Health has received a prestigious award in connection with heart and stroke care.

The healthcare agency was honored with the American Heart Association/American Stroke Association’s “Get With The Guidelines-Stroke Gold Quality Achievement Award.” The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines founded in the latest scientific evidence.

Ocala Health earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period.

These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines – with the goal of speeding recovery and reducing death and disability for stroke patients. Care transition interventions such as patient education before discharge and follow-up visit scheduling also are a part of the quality achievement measures the agency has implemented to ensure patients remain on the road to recovery.

“Ocala Health is dedicated to improving the quality of care for our stroke patients by implementing the American Heart Association’s ‘Get With The Guidelines-Stroke initiative,’” said Russ Harper, vice president of neurosciences. “The tools and resources provided help us track and measure our success in meeting evidenced-based clinical guidelines developed to improve patient outcomes.”

Ocala Health additionally received the Association’s Target: Stroke Elite award. To qualify for this recognition, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA – the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke.

Ocala Health additionally received the Association’s Target: Type 2 Honor Roll award. To qualify for this recognition, hospitals must meet quality measures developed with more than 90 percent of compliance for 12 consecutive months for the “Overall Diabetes Cardiovascular Initiative Composite Score.”

Ocala Regional Medical Center also has met specific scientific guidelines as a as a Comprehensive Stroke Center, featuring a comprehensive system for rapid diagnosis and treatment of stroke patients admitted to the emergency department.

“We are pleased to recognize Ocala Health for their commitment to stroke care,” said Dr. Lee H. Schwamm, national chairperson of the Quality Oversight Committee. “Research has shown that hospitals adhering to clinical measures through the ‘Get With The Guidelines’ quality improvement initiative can often see fewer readmissions and lower mortality rates.”

According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year.

UPMC Western MD earns multiple American Heart Association awards

 

Big fucking whoopee.

 

 But you tell us NOTHING ABOUT RESULTS. They remind us they do 'care' about us but never tell us how many 100% recovered.  You have to ask yourself why they are hiding their incompetency by not disclosing recovery results. ARE THEY THAT FUCKING BAD?

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?  I would start cleaning the hospital by firing the board of directors, you can't let incompetency continue for years at a time.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

You'll want to know results so call that hospital president(Whoever that is) RESULTS are; tPA efficacy, 30 day deaths, 100% recovery. Because there is no point in going to that hospital if they are not willing to publish results.

 The latest invalid chest thumping here:

UPMC Western MD earns multiple American Heart Association awards

For the second year in a row, UPMC Western Maryland has received both the Mission: Lifeline® NSTEMI Gold Quality Achievement Award and the Mission: Lifeline® Gold Receiving Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer severe heart attacks.

Every year, more than 250,000 people experience an ST elevation myocardial infarction (STEMI), the deadliest type of heart attack, caused by a blockage of blood flow to the heart that requires timely treatment. To prevent death, it’s critical to restore blood flow as quickly as possible, either by mechanically opening the blocked vessel or by providing clot-busting medication.

The American Heart Association’s Mission: Lifeline program’s goal is to reduce system barriers to prompt treatment for heart attacks, beginning with the 9-1-1 call, to EMS transport and continuing through hospital treatment and discharge. The initiative provides tools, training and other resources to support heart attack care following protocols from the most recent evidence-based treatment guidelines.

UPMC Western Maryland earned the NSTEMI Gold Quality Achievement award by meeting specific criteria and standards of performance for the quick and appropriate treatment of NSTEMI heart attack patients by providing emergency procedures to re-establish blood flow to blocked arteries when needed, and the Gold Receiving Achievement award by meeting specific criteria and standards of performance for quick and appropriate treatment through emergency procedures to re-establish blood flow to blocked arteries in heart attack patients coming into the hospital directly or by transfer from another facility.

“We are very proud to again be recognized by the American Heart Association for the excellent care we provide to our heart attack patients here at UPMC Western Maryland” said Christopher Haas, D.O., Chairman of Internal Medicine and Medical Director of Cardiology. “It truly is a team effort that requires excellence from multiple services, including our first responders, emergency department, nursing staff, hospitalist service, data collectors, administration, and, of course, the entire Cardiology Department. We review and discuss our processes for every emergency heart attack that comes through our door, and we fine tune even the smallest of details in order to ensure our patients receive top-notch care that meets or exceeds national standards. To receive this award multiple times from the American Heart Association is exceptional and is truly an honor shared by our entire team.”

“We commend UPMC Western Maryland for these awards in recognition for following evidence-based guidelines for timely heart attack treatment,” said Tim Henry, M.D., Chair of the Mission: Lifeline Acute Coronary Syndrome Subcommittee. “We applaud the significant institutional commitment to their critical role in the system of care for quickly and appropriately treating heart attack patients.”

UPMC Western Maryland also has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

UPMC Western Maryland earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period. These measures include evaluation of the proper use of medications and other stroke treatments aligned with the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. Before discharge, patients should also receive education on managing their health, get a follow-up visit scheduled, as well as other care transition interventions

“UPMC Western Maryland is dedicated to improving the quality of care for our stroke patients by implementing the American Heart Association’s Get With The Guidelines-Stroke initiative,” said Jennifer Suter, Clinical Coordinator, Rehabilitation and Stroke program. “The tools and resources provided help us track and measure our success in meeting evidenced-based clinical guidelines developed to improve patient outcomes.”

“We are pleased to recognize UPMC Western Maryland for their commitment to stroke care,” said Lee H. Schwamm, M.D., national chairperson of the Quality Oversight Committee and Executive Vice Chair of Neurology, Director of Acute Stroke Services, Massachusetts General Hospital, Boston, Massachusetts. “Research has shown that hospitals adhering to clinical measures through the Get With The Guidelines quality improvement initiative can often see fewer readmissions and lower mortality rates.”

According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year.

 

The first step in ensuring better outcomes from stroke is getting to hospital quickly, and that means recognising the F.A.S.T. signs and calling triple zero (000) straight away.

Really won't do a damn fucking bit of good. Your stroke hospital is so fucking incompetent they have done nothing since 1996, when tPA was approved, to have protocols that get survivors recovered created and implemented. Don't believe me, ask your hospital EXACTLY WHAT THEY HAVE DONE SINCE 1996 THAT GETS SURVIVORS ANYWHERE CLOSE TO 100% RECOVERY.  Excuses are not allowed and if they say; 'All strokes are different, all stroke recoveries are different.' , they need to be shot. 

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will ream me out for making them look bad by being truthful , I look forward to that day.

 

 The first step in ensuring better outcomes from stroke is getting to hospital quickly, and that means recognising the F.A.S.T. signs and calling triple zero (000) straight away.

 

WSO Stroke Prevention Strategy - Join the WSO webinar series in occasion of the launch of the World Stroke Campaign 2020!

 You have got to be fucking kidding me. THERE IS ABSOLUTELY NOTHING IN THE WSO FOR SURVIVOR RECOVERY. THEY ARE COMPLETELY USELESS; no survivor contact, no rehab protocols, no strategy to solve stroke; NOTHING! 

But lazy press release prevention crapola exists. WHOOPEE!

WSO Stroke Prevention Strategy - Join the WSO webinar series in occasion of the launch of the World Stroke Campaign 2020!

A wake up call for Global Stroke Prevention! 

-Welcome and overview of the WSO Prevention Strategy. - Prof Michael Brainin

- Why current approaches to stroke prevention need an overhaul: the case for population-based approaches. - Prof Valery Feigin

- Accelerating progress on prevention where it matters most: lessons from LMICs. - Prof Jeyaraj Pandian 

- Implementation of cut stroke in half in Brazil. - Prof Sheila Martins 

-Close of the session/World Stroke Campaign #1in4. - Prof Sheila Martins 

- Q&A session

Time and date: Tue, September 1, 7 AM Brazil/ 12 PM CET/ 3.30 PM India/ 10 PM New Zealand 

REGISTER HERE

 

Adverse effects of pre-existing cerebral small vessel disease on cognitive improvement after carotid endarterectomy

 

Don't listen to what I have to say, I'm not medically trained.

Instead of doing a carotid endarterectomy with its attendant risks, why not glue it up?

1. Verify that the Circle of Willis is complete. Mine obviously is since one carotid artery is completely blocked and I am having no cognitive issues(arrogance is not one of my issues).

2. Glue the offending artery shut, No risky surgery.

 I guess this is why gluing is not done for brain work:
FDA issues warning about Covidien brain device that has killed nine - Onyx glue

Talk to your doctor about the dangers of stroke due to the endarterectomy procedure and why you would want to put inflexible metal stents in flexible arteries. Don't listen to me, but ask your doctor plenty of questions.   Ask for a guarantee of no stroke due to any procedure.  

The latest here:

Adverse effects of pre-existing cerebral small vessel disease on cognitive improvement after carotid endarterectomy

Show all authors

Jun Yoshida, Fumio Yamashita, Makoto Sasaki, ...

First Published September 9, 2019 Research Article Find in PubMed 

https://doi.org/10.1177/1747493019874732

Article information

   

Abstract

Background

Although patients with improved cognition after carotid endarterectomy usually exhibit postoperative restoration of cerebral blood flow, less than half of patients with such cerebral blood flow change have postoperatively improved cognition. Cerebral small vessel disease on magnetic resonance imaging is associated with irreversible cognitive impairment.

Aims

The purpose of the present prospective study was to determine whether pre-existing cerebral small vessel disease affects cognitive improvement after carotid endarterectomy.

Methods

Brain MR imaging was performed preoperatively, and the number or grade of each cerebral small vessel disease was determined in 80 patients undergoing carotid endarterectomy for ipsilateral internal carotid artery stenosis (≥70%). The volume of white matter hyperintensities relative to the intracranial volume was also calculated. Brain perfusion single-photon emission computed tomography and neuropsychological testing were performed preoperatively and two months postoperatively. Based on these data, a postoperative increase in cerebral blood flow and postoperative improved cognition, respectively, were determined.

Results

Logistic regression analysis using the sequential backward elimination approach revealed that a postoperative increase in cerebral blood flow (95% confidence interval [CI], 10.74–3730.00; P = 0.0004) and the relative volume of white matter hyperintensities (95% CI, 0.01–0.63; P = 0.0314) were significantly associated with postoperative improved cognition. Although eight of nine patients with postoperative improved cognition exhibited both a relative volume of white matter hyperintensities <0.65% and a postoperative increase in cerebral blood flow, none of patients with a relative volume of white matter hyperintensities ≥0.65% had postoperative improved cognition regardless of any postoperative change in cerebral blood flow.

Conclusion

Pre-existing cerebral white matter hyperintensities on magnetic resonance imaging adversely affect cognitive improvement after carotid endarterectomy.

Keywords Carotid endarterectomy, cognition, cerebral small vessel disease, cerebral white matter hyperintensity, cerebral blood flow

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