Global prevention of stroke and dementia: the WSO Declaration.

 Useless, NO abstract provided and NO details. This is what the WSO thinks of laypersons. ABSOLUTELY NOTHING! I look forward to being contacted by the president of the WSO and being told EXACTLY where I am wrong.

Global prevention of stroke and dementia: the WSO Declaration.

 

Epigenetic clock could shed light on brain ageing's link to dementia

But I don't think I'm going to provide a brain sample to test if I'm getting dementia. Doing that would prove I have it. 

Epigenetic clock could shed light on brain ageing's link to dementia

Scientists have developed a clock that could provide insights into how accelerated ageing in the brain might be associated with Alzheimer's disease and other forms of dementia.

While the circadian body clock dictates our preferred rhythm of sleep or wakefulness, the epigenetic clock could shed light on how swiftly people age, and how prone they are to diseases of old age, researchers say.

As a result of using human brain tissue samples, it is far more accurate than previous versions that were based on blood samples or other tissues, according to University of Exeter scientists.

Professor Jonathan Mill, of the University of Exeter - who led the research team, said: "The research area of epigenetic clocks is really exciting, and has the potential to help us understand the mechanisms involved in ageing.

"Our new clock will help us explore accelerated ageing in the human brain.

"As we're using brain samples, this clearly isn't a model that can be used in living people to tell how fast they'll age.

"However, we can apply it to donated brain tissue to help us learn more about the factors involved in brain diseases such as dementia."

The team analysed an epigenetic marker - which tells genes to switch on or off - known as DNA methylation in the human cortex, a brain region involved in cognition and implicated in diseases such as Alzheimer's disease.

They identified 347 DNA methylation sites that optimally predict age in the human cortex, when analysed in combination.

Researchers then tested their model in a separate collection of 1,221 human brain samples from the Brains for Dementia Research (BDR) cohort, which is funded by the Alzheimer's Society and Alzheimer's Research UK, and in a dataset of 1,175 blood samples.

Methylation data has been used to develop biomarkers of ageing, referred to as epigenetic clocks.

These have been widely used to identify differences between chronological age and biological age in health and disease, including neurodegeneration, dementia and other brain phenotypes, the researchers say.

Gemma Shireby, who was first author of the research as part of her PhD at the University of Exeter, said: "Our new epigenetic body clock dramatically outperformed previous models in predicting biological age in the human brain.

"Our study highlights the importance of using tissue that is relevant to the mechanism you want to explore when developing epigenetic clock models.

"In this case, using brain tissue ensures the epigenetic clock is properly calibrated to investigate dementia."

The research is published in the journal Brain, and funded by Alzheimer's Society

Gandhi and Professor Peters

 When a friend sent me this I knew I had to post it because of calling select persons blithering idiots.

(This one was found on the internet. We cannot corroborate its accuracy, but it is an amusing story...)

When Gandhi was studying law at the University College of London, there was a professor, whose last name was Peters, who felt animosity for Gandhi, and because Gandhi never lowered his head towards him, their "arguments" were very common.

One day, Mr. Peters was having lunch at the dining room of the University and Gandhi came along with his tray and sat next to the professor. The professor, in his arrogance, said, "Mr Gandhi: you do not understand... a pig and a bird do not sit together to eat," to which Gandhi replies, "You do not worry professor, I'll fly away, " and he went and sat at another table.

Mr. Peters, green of rage, decides to take revenge on the next test, but Gandhi responds brilliantly to all questions. Then, Mr. Peters asked him the following question, "Mr Gandhi, if you are walking down the street and find a package, and within it there is a bag of wisdom and another bag with a lot of money; which one will you take?"

Without hesitating, Gandhi responded, "the one with the money, of course."

Mr. Peters, smiling, said, "I, in your place, would have taken the wisdom, don't you think?"

"Each one takes what one doesn't have," responded Gandhi indifferently.

Mr. Peters, already hysteric, writes on the exam sheet the word "idiot" and gives it to Gandhi. Gandhi takes the exam sheet and sits down. A few minutes later, Gandhi goes to the professor and says, "Mr. Peters, you signed the sheet, but you did not give me the grade."

Eating and drinking failures duing COVID-19

 It is bad enough trying to get a face mask on one handed, but trying to eat food or drink just by lifting your mask is a complete failure. So I don't go out unless social distancing is enforced. Here in Florida it is a total crapshoot.

This is an impossibility for me

Priorities and Needs Regarding Sexual Rehabilitation for Individuals in the Subacute Phase Post-stroke

Ask your doctor for the EXACT SPECIFIC STROKE PROTOCOLS TO GET YOU FUCKING AGAIN. 

All this is why you need to be doing lots of sex, why the hell can't your doctor get you fucking again?

Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better

 

Sex after stroke

 

Sex linked to better brain power in older age

Sex: The Ultimate Full Body Workout

 

Better Memory From This Extremely Pleasurable Activity - Sex

 

WHY SEX IS BETTER FOR YOUR BRAIN THAN SUDOKU 

 

Sex linked to better brain power in older age

 

Good News About Sex- It Doesn't Cause a Stroke

 

Sex Does Not Increase Heart Attack Risk - What about stroke?

 

Frequent orgasms may protect against heart attacks

 

An orgasm a day keeps the doctor away!

In case you don't have a partner she could prescribe this.

Electrosex

And the benefits of marijuana for sex here:

Sex, Marijuana and Baby Booms

The latest here:

 

Priorities and Needs Regarding Sexual Rehabilitation for Individuals in the Subacute Phase Post-stroke

• Louis-Pierre Auger,
• Evelina Pituch,
• Johanne Filiatrault,
• Frédérique Courtois &
• Annie Rochette 

Sexuality and Disability (2020)Cite this article

• 3 Accesses

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Abstract

It is recommended that sexuality be addressed at all transition points along the continuum in stroke rehabilitation. However, little is known about needs specific to the subacute phase. (1) Explore priorities and needs of individuals who have had a stroke regarding sexuality in the subacute phase of stroke rehabilitation, according to both clients and clinicians; (2) Explore clinicians’ perceptions of their professional roles with regard to sexuality rehabilitation after stroke. This qualitative study involved a convenience sample composed of five clients and 15 clinicians. Clinicians were asked to implement an interview guide to assess their clients’ need to address sexuality during rehabilitation. Following implementation, data was collected through individual interviews (n = 6) and focus groups (n = 3). Verbatim were partially co-coded (15%) and analyzed by two independent assessors through a thematic analyzis. The mean age of the five clients (3 female, 2 male) was 67.0 years-old (S.D. 4.6) and clinicians included a psychologist and occupational, physical and speech language therapists. Three themes emerged: (1) Sexuality: a secondary priority, (2) Clients’ needs: just talk about it!, and (3) professional roles. Clients and clinicians considered sexuality as important, but a secondary priority to be addressed after more basic activities of daily living. Needs varied among clients regarding sexuality and clinicians shared their respective contribution to the issue while emphasizing interdisciplinarity. This study is among the first to identify priorities and needs related to sexuality for clients in subacute phase of stroke rehabilitation and their clinicians.

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Unravelling perceived fatigue and activity pacing in maintaining a physically active lifestyle after stroke rehabilitation: a longitudinal cohort study

YOU FUCKING BLITHERING IDIOTS. 'Perceived'. Talk to survivors sometime, there is nothing perceived about post stroke fatigue. THIS is why we need survivors in charge, we wouldn't allow stupid assumptions like this to be researched.

 Unravelling perceived fatigue and activity pacing in maintaining a physically active lifestyle after stroke rehabilitation: a longitudinal cohort study

 

Abstract

To identify fatigue trajectories during/after stroke rehabilitation, to determine characteristics associated with trajectory membership before discharge and to investigate how these trajectories and activity pacing are associated with sustained physical activity after rehabilitation.People after stroke (n = 206) were followed from 3–6 weeks before discharge (T0) to 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation in the ReSpAct study. Latent Class analysis was used to identify trajectories of perceived fatigue. Binomial multivariable logistic regression analyses were performed to determine characteristics associated with trajectory membership (T0). Multilevel regression analyses were used to investigate how perceived fatigue and activity pacing were associated with self-reported physical activity (T0–T3).

Three fatigue trajectories were identified: high (n = 163), low (n = 41) and recovery (n = 2). Compared with the high fatigue trajectory, people in the low fatigue trajectory were more likely to report higher levels of health-related quality of life (HR-QoL) (OR = 3.07, 95%CI = 1.51–6.26) and physical activity (OR = 1.93, 95%CI = 1.07–3.47). Sustained high levels of physical activity after rehabilitation were significantly associated with low perceived fatigue and high perceived risk of overactivity.

Three fatigue trajectories after stroke rehabilitation were identified. High levels of HR-QoL and physical activity before discharge identified people in the low fatigue trajectory. A physically active lifestyle after rehabilitation was associated with low perceived fatigue and perceived risk of overactivity.

• IMPLICATIONS FOR REHABILITATION

• Since almost 80% of people after stroke in this study perceived severe fatigue up to 1 year after stroke rehabilitation, activities focusing on the management of fatigue symptoms should be integrated in general stroke rehabilitation.

• In clinical practice, low levels of health-related quality of life and low levels of self-reported physical activity before discharge from stroke rehabilitation should be considered by rehabilitation professionals (e.g., physicians, physiotherapists, and physical activity counsellors) since these characteristics can predict chronic perceived fatigue up to 1 year after stroke rehabilitation.

• A physical activity counselling programme delivered during and after stroke rehabilitation may be improved by incorporating tailored advice regarding the management of fatigue.(NOT CURE!)
  

Investigating the optimum size of nanoparticles for their delivery into the brain assisted by focused ultrasound-induced blood–brain barrier opening

 For when our researchers find a drug they need to get across the blood brain barrier. Assuming that our fucking failures of stroke associations  can remember this when researchers need it.

Investigating the optimum size of nanoparticles for their delivery into the brain assisted by focused ultrasound-induced blood–brain barrier opening

• Seiichi Ohta,
• Emi Kikuchi,
• Ayumu Ishijima,
• Takashi Azuma,
• Ichiro Sakuma &
• Taichi Ito 

Scientific Reports volume 10, Article number: 18220 (2020) Cite this article

• 102 Accesses

• 2 Altmetric

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Abstract

The blood–brain barrier (BBB) has hampered the efficiency of nanoparticle delivery into the brain via conventional strategies. The widening of BBB tight junctions via focused ultrasound (FUS) offers a promising approach for enhancing the delivery of nanoparticles into the brain. However, there is currently an insufficient understanding of how nanoparticles pass through the opened BBB gaps. Here we investigated the size-dependence of nanoparticle delivery into the brain assisted by FUS-induced BBB opening, using gold nanoparticles (AuNPs) of 3, 15, and 120 nm diameter. For 3- and 15-nm AuNPs, FUS exposure significantly increased permeation across an in vitro BBB model by up to 9.5 times, and the permeability was higher with smaller diameter. However, in vivo transcranial FUS exposure in mice demonstrated that smaller particles were not necessarily better for delivery into the brain. Medium-sized (15 nm) AuNPs showed the highest delivery efficiency (0.22% ID), compared with 3- and 120-nm particles. A computational model suggested that this optimum size was determined by the competition between their permeation through opened BBB gaps and their excretion from blood. Our results would greatly contribute to designing nanoparticles for their delivery into the brain for the treatment of central nervous system diseases.

Introduction

Nanoparticles have attracted global attention in the biomedical field. It has been revealed that their interaction with cells and/or tissues can be tailored through nanoparticle design, such as their size, shape, and surface chemistry¹. Combined with the advances in nanoparticle functionalization methods, this has opened the way for various biomedical applications of nanoparticles, including drug delivery, imaging, and therapies^2,3. However, despite the promise of nanoparticle-based systems, their translation to clinical use remains a challenge, mainly due to the low efficiency of their delivery to target sites^4,5. Various factors have been proposed as hampering nanoparticle delivery, including uptake by the reticuloendothelial system (RES), restricted diffusion in dense extracellular matrix (ECM), resistance by interstitial pressure, and clearance via the renal system^6,7,8.

The brain is one of the most difficult target organs to deliver nanoparticles to because of the existence of the blood–brain barrier (BBB). The BBB is composed of brain endothelial cells attached to a continuous basement membrane and linked together by tight junctions that prevents foreign substances from entering into the brain⁹. Even small molecular drugs can barely cross the BBB, which is a major limitation for the treatment of central nervous system (CNS) diseases, such as Alzheimer’s disease and Parkinson’s disease; diseases whose prevalence is rapidly increasing as societies around the world are aging. In the case of nanoparticles, the restriction of their permeation across the BBB is even more pronounced because of their relatively large size. Although various delivery methods have been attempted, e.g., using receptor-mediated endocytosis^10,11,12, transcytosis^13,14, or transporters^15,16, the efficiency of delivering nanoparticles into the brain is insufficient to fully exploit their therapeutic and diagnostic potential. For example, using transferrin receptor-targeted nanoparticles is one of the most widely used strategies to get nanoparticles across the BBB, but it typically results in < 0.1% delivery efficiency to the brain¹⁰.

Focused ultrasound (FUS) in combination with the administration of microbubbles (MBs) is an emerging technique being investigated to enhance the permeation of therapeutics across the BBB in a noninvasive, localized, and transient manner¹⁷. FUS induces inertial or stable cavitation with MBs that exerts a mechanical force onto capillary walls, leading to a temporary opening of the BBB via the widening of tight junctions^17,18,19. The enhanced delivery of small molecular drugs^20,21, oligonucleotides^22,23, and antibodies^24,25,26 into the brain via FUS-induced BBB opening has been demonstrated in vivo. In addition, clinical trials are now being conducted into the FUS-assisted delivery of small molecular drugs into gliomas^27,28. This technology could provide a promising strategy for improving the efficiency of nanoparticle delivery to the brain, although there are still only a limited number of reports on its application for nanoparticles^{29,30,31,32,33,34}.

To employ FUS-induced BBB opening for nanoparticle delivery, a question that must be addressed is how the size of nanoparticles can affect the enhanced permeation through opened BBB gaps. It is expected that the optimum nanoparticle design for this delivery mechanism would be different from that usually employed for enhanced permeation and retention (EPR)-based delivery strategies for tumors, in which nanoparticles are extravasated from naturally leaky blood vessels¹. However, although some previous studies investigated the effect of the size of nanoparticles, such as liposomes, on this strategy³⁴, the mechanism still needs to be clarified, especially in single to sub-hundred nanometer range. Here, we explored the effect of nanoparticle size on their delivery into the brain assisted by FUS-induced BBB opening, using polyethylene glycol (PEG)-coated gold nanoparticles (AuNPs) of different sizes, 3 to 120 nm, as a model (Fig. 1). An in vitro BBB model capable of FUS exposure was developed to examine the size-dependent permeation behavior of these particles. The size-dependent delivery of AuNPs into the brain was further investigated in vivo via transcranial FUS exposure in mice. Based on the obtained results, a kinetic model was proposed to estimate the optimum nanoparticle size for delivery into the brain assisted by FUS-induced BBB opening.

 

 

Noyes Health(Dansville, NY) recognized 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:

 

 Noyes Health(Dansville, NY) recognized for stroke care

 Can't copy so you'll have to read at link.

Wearable hip-assist robot modulates cortical activation during gait in stroke patients: a functional near-infrared spectroscopy study

OH man, useless, not measuring objective results.

Wearable hip-assist robot modulates cortical activation during gait in stroke patients: a functional near-infrared spectroscopy study

• Su-Hyun Lee,
• Hwang-Jae Lee,
• Youngbo Shim,
• Won Hyuk Chang,
• Byung-Ok Choi,
• Gyu-Ha Ryu &
• Yun-Hee Kim 

Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 145 (2020) Cite this article

• Metrics details

Abstract

Background

Gait dysfunction is common in post-stroke patients as a result of impairment in cerebral gait mechanism. Powered robotic exoskeletons are promising tools to maximize neural recovery by delivering repetitive walking practice.

Objectives

The purpose of this study was to investigate the modulating effect of the Gait Enhancing and Motivating System-Hip (GEMS-H) on cortical activation during gait in patients with chronic stroke. Methods. Twenty chronic stroke patients performed treadmill walking at a self-selected speed either with assistance of GEMS-H (GEMS-H) or without assistance of GEMS-H (NoGEMS-H). Changes in oxygenated hemoglobin (oxyHb) concentration in the bilateral primary sensorimotor cortex (SMC), premotor cortices (PMC), supplemental motor areas (SMA), and prefrontal cortices (PFC) were recorded using functional near infrared spectroscopy.

Results

Walking with the GEMS-H promoted symmetrical SMC activation, with more activation in the affected hemisphere than in NoGEMS-H conditions. GEMS-H also decreased oxyHb concentration in the late phase over the ipsilesional SMC and bilateral SMA (P < 0.05).

Conclusions

The results of the present study reveal that the GEMS-H promoted more SMC activation and a balanced activation pattern that helped to restore gait function. Less activation in the late phase over SMC and SMA during gait with GEMS-H indicates that GEMS-H reduces the cortical participation of stroke gait by producing rhythmic hip flexion and extension movement and allows a more coordinate and efficient gait patterns.

Trial registration NCT03048968. Registered 06 Feb 2017

Background

Stroke survivors can suffer several neurological impairments or deficits, such as hemiparesis, sensory and motor skills disorder, cognitive deficits, or disorders in communication and visuo-spatial perception. Hemiplegia is one of the most common impairments after stroke and significantly reduces walking ability. Poststroke hemiplegic gait is typically characterized by a reduced gait velocity and asymmetry of bilateral kinetic, kinematic and spatiotemporal parameters [1,2,3]. Gait function is an important factor in determining the ability to independently perform activities of daily living. Therefore, regaining gait ability is a primary goal in the rehabilitation program for stroke patients.

Robot-assisted therapy for gait rehabilitation after stroke is a potential and novel approach for facilitating the restoration of function and enhancing the neural recovery process after stroke. Advanced and intelligent robotic devices are able to provide high-intensity, high-dosage, and consistent training, while potentially reducing strain on therapists [4,5,6]. The relative merits of wearable versus stationary robots include potability and the ability to shift the location of treatment into a more real-world environment, including the home, community, and society. The Gait Enhancing and Motivating System-Hip (GEMS-H), developed by Samsung Electronics Co., Ltd. (Suwon, Republic of Korea), is a hip-type robotic exoskeleton. Our previous studies showed that GEMS-H improved gait function, muscle efficiency, and cardiopulmonary metabolic efficiency [7,8,9,10]. However, it is not yet known how GEMS-H assisted gait training modulates cortical activity of stroke patients.

Gait is mediated through complex neuronal networks in the central nervous system involving cortical, subcortical, and spinal regions [11]. Repetitive gait training may modify these networks and induce physiological plasticity to improve ambulation [12]. Assessment of cortical activation while the subject is moving is a key factor in promoting a better understanding of neural motor control. Currently, limited information is available on the cerebral mechanisms underlying locomotor recovery after stroke because of technical limitations in assessing cerebral activation during execution of motor tasks. To date, various non-invasive methods have been used to acquire brain signals, including functional magnetic resonance imaging (fMRI), electroencephalography (EEG), positron emission tomography (PET), and functional near-infrared spectroscopy (fNIRS). fNIRS is a relatively new optical neuroimaging technique that enables visualization of cortical activation during human gait [13]. Although fNIRS has limited depth sensitivity that restricts the measurements of brain activity to cortical layers [14], this technique allows the noninvasive measurement of cortical activity with relatively good spatial and temporal resolution [15]. Compared to other neuroimaging devices, its advantages such as less sensitive to motion artifacts, cheap, portable, safe, and silent, [16] make it the choice for comprehensive and promising results in examination of stroke patients during rehabilitation [13, 17,18,19,20].

In this study, we aimed to identify how the wearable hip-assist robot modulates cortical activation during gait in patients with stroke. We hypothesized that GEMS-H-assisted walking would induce better automatic control of gait compared with walking without assistance of GEMS-H (NoGEMS-H), expressed as a reduction in cortical activation compared with the NoGEMS-H conditions. We also speculated that assistance with GEMS-H would lead to a more symmetrical cortical activation compared with NoGEMS-H conditions.

 

Predictive criteria identifies patients at risk for cytokine storm in COVID-19

This helps not one bit. we need to know EXACTLY what needs to be done to prevent this cytokine storm. I want to know what to tell my doctor to do. First off I'm doing aspirin and then heparin. What is next?

I'm not medically trained so I know nothing, don't listen to me.

The latest here:

Predictive criteria identifies patients at risk for cytokine storm in COVID-19 

New criteria comprising inflammation, cell death and tissue damage, and prerenal electrolyte imbalance may predict cytokine storm in COVID-19 at an early stage, according to findings published in the Annals of the Rheumatic Diseases.

“A significant number of patients hospitalized with COVID-19 infection develop an hyperinflammatory response called cytokine storm,” Roberto Caricchio, MD, FACR, of the Temple University School of Medicine, in Philadelphia, told Healio Rheumatology. “These patients tend to have longer length of hospital stay and importantly are at greater risk of complications and death. There are no criteria to identify these patients.”

“The ability to predict early on during the hospitalization which patient develops the cytokine storm could help initiate early treatment, shorten hospitalization and improve clinical outcome,” Roberto Caricchio, MD, FACR, told Healio Rheumatology. Source: Adobe Stock

To develop criteria to predict cytokine storm associated with COVID-19, Caricchio studied 513 patients with a confirmed diagnosis of COVID-19 admitted to Temple University Hospital from March 10 to April 17. All included patients had been hospitalized for up to 1 week prior to enrollment and demonstrated ground-glass opacity by high-resolution computerized tomography of the chest as per radiology reading, as well as a reverse transcriptase PCR for COVID-19 RNA.

The researchers analyzed laboratory results for the first 7 days of hospitalization for each patient and used logistic regression and principal component analysis to determine the predictive criteria. They then used a “genetic algorithm” to find the cutoffs for each laboratory result. The researchers validated the criteria with a second cohort of 258 patients.

Roberto Caricchio

According to the researchers, the criteria for macrophage activation syndrome, hemophagocytic lymphohistiocytosis and the HScore failed to identify cytokine storm associated with COVID-19. Instead, Caricchio and colleagues used new criteria that included three clusters of laboratory results. These involved inflammation, cell death and tissue damage, and prerenal electrolyte imbalance. These criteria demonstrated a sensitivity of 0.85 and a specificity of 0.8. In addition, they were able to identify patients with longer hospitalization and increased mortality.

The results underscore the importance of hyperinflammation and tissue damage in cytokine storm associated with COVID-19, the researchers wrote.

“Interestingly the criteria could be grouped in three major pathological aspect of COVID-19 disease: inflammation, cell death and tissue damage and prerenal electrolyte imbalance,” Caricchio said. “The patients who met the criteria had three times longer length of hospitalization and six times higher mortality. Importantly the vast majority of patients who met the criteria, did so within the first 7 days and half of them at the time of admission. Therefore, the criteria are able to identify the cytokine storm very early during hospitalization.”

“The ability to predict early on during the hospitalization which patient develops the cytokine storm could help initiate early treatment, shorten hospitalization and improve clinical outcome,” he added. “Importantly these criteria are based on available routine laboratory tests accessible to most hospitals and could be readily used in clinical practice.”

 

Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults

Even if you are aware of stroke symptoms and head to a hospital immediately YOU ARE STILL FUCKING SCREWED. 

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults

Reed Mszar

,

Shiwani Mahajan

,

Javier Valero-Elizondo

,

Tamer Yahya

,

Richa Sharma

,

Gowtham R. Grandhi

,

Rohan Khera

,

Salim S. Virani

,

Judith Lichtman

,

Safi U. Khan

, … See all authors

Originally published26 Oct 2020https://doi.org/10.1161/STROKEAHA.120.031137Stroke. ;0

Abstract

Background and Purpose:

Despite declining stroke rates in the general population, stroke incidence and hospitalizations are rising among younger individuals. Awareness of and prompt response to stroke symptoms are crucial components of a timely diagnosis and disease management. We assessed awareness of stroke symptoms and response to a perceived stroke among young adults in the United States.

Methods:

Using data from the 2017 National Health Interview Survey, we assessed awareness of 5 common stroke symptoms and the knowledge of planned response (ie, calling emergency medical services) among young adults (<45 years) across diverse sociodemographic groups. Common stroke symptoms included: (1) numbness of face/arm/leg, (2) confusion/trouble speaking, (3) difficulty walking/dizziness/loss of balance, (4) trouble seeing in one/both eyes, and (5) severe headache.

Results:

Our study population included 24 769 adults, of which 9844 (39.7%) were young adults who were included in our primary analysis, and represented 107.2 million US young adults (mean age 31.3 [±7.5] years, 50.6% women, and 62.2% non-Hispanic White). Overall, 2718 young adults (28.9%) were not aware of all 5 stroke symptoms, whereas 242 individuals (2.7%; representing 2.9 million young adults in the United States) were not aware of a single symptom. After adjusting for confounders, Hispanic ethnicity (odds ratio, 1.96 [95% CI, 1.17–3.28]), non-US born immigration status (odds ratio, 2.02 [95% CI, 1.31–3.11]), and lower education level (odds ratio, 2.77 [95% CI, 1.76–4.35]), were significantly associated with lack of symptom awareness. Individuals with 5 high-risk characteristics (non-White, non-US born, low income, uninsured, and high school educated or lower) had nearly a 4-fold higher odds of not being aware of all symptoms (odds ratio, 3.70 [95% CI, 2.43–5.62]).

Conclusions:

Based on data from the National Health Interview Survey, a large proportion of young adults may not be aware of stroke symptoms. Certain sociodemographic subgroups with decreased awareness may benefit from focused public health interventions.

 

Palm Beach Gardens(FL) Medical Center Receives Get With The Guidelines- Stroke Gold Plus with Target: Stroke Honor Roll Elite 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:

 

Palm Beach Gardens(FL) Medical Center Receives Get With The Guidelines- Stroke Gold Plus with Target: Stroke Honor Roll Elite Achievement Award

October 27 2020 - Palm Beach Gardens Medical Center receives the American Heart Association/American Stroke Association’s Get With The Guidelines- Stroke Gold Plus with Target: Stroke Honor Roll Elite Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke/brain attack patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

 

Palm Beach Gardens Medical Center meets specific quality achievement measures for the diagnosis and treatment of stroke/brain attack 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. In order to safely transition to discharge; patients receive brain attack education with an emphasis on recognizing stroke symptoms, the importance of calling 911 and managing controllable risk factors to prevent future brain attacks. Patients are encouraged to set goals based on their individual risk factors so they can actively manage their health on the journey toward recovery. 

“Palm Beach Gardens Medical Center 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 Teresa Urquhart, chief executive officer at Palm Beach Gardens Medical Center. “The tools and resources provided help us track and measure our success in meeting evidenced-based clinical guidelines developed to improve patient outcomes.” 

 

Palm Beach Gardens Medical Center additionally received the Association’s Target: StrokeSM Honor Roll Elite Gold Plus 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.  

 

According to the American Heart Association/American Stroke Association, stroke/brain attack 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.

 

It is important to recognize brain attack symptoms and to immediately call to 911 so patients are emergently transported to the hospital for examination and treatment.

 

Predicting length of stay in patients admitted to stroke rehabilitation with severe and moderate levels of functional impairments

WHAT ABSOLUTE FUCKING STUPIDITY. 

Length of stay NOT recovery results! Will you please talk to survivors sometime soon, they don't care about length of stay, they care about RECOVERY YOU BLITHERING IDIOTS.

Predicting length of stay in patients admitted to stroke rehabilitation with severe and moderate levels of functional impairments

García-Rudolph, Alejandro PhD^a,b,c,∗; Cegarra, Blanca MSc^a,b,c,d; Opisso, Eloy PhD^a,b,c; Tormos, Josep María PhD^a,b,c; Bernabeu, Montserrat MD^a,b,c; Saurí, Joan PhD^a,b,c

Editor(s): Khasawneh., Fadi T.

Author Information

Medicine: October 23, 2020 - Volume 99 - Issue 43 - p e22423

doi: 10.1097/MD.0000000000022423

• Open
• SDC

Abstract

Severe stroke patients are known to be associated with larger rehabilitation length of stay (LOS) but other factors besides severity may be contributing. We aim to identify LOS predictors within a population of mostly severe patients and analyze the impact of socioeconomic situation in functionality at admission.

A retrospective observational cohort study was conducted including 172 inpatients admitted to a rehabilitation center between 2007 and 2019. Associations with LOS were examined among 30 potential predictor variables using bivariate correlations. Significantly correlated (P < .002, Bonferroni adjustment) variables were entered into 9 different multiple linear regression models.

No mild participants were included, 63.37% severe and 36.63% moderate. Most significant LOS determinants were: 1) total functional independence measure (FIM) (P < .001) and hemiparesis (P = .0108) (adjusted R² = 0.24), 2) cognitive FIM (P = .002) and severity (P = .001) (adjusted R² = 0.22), and 3) home accessibility (P = .043) and hemiparesis (P = 0.032) (adjusted R² = 0.19).

Known LOS predictors (e.g., depression, ataxia) within the full stroke severities were not found significant in our dataset.

Socioeconomic situation was found moderately correlated with total FIM (r = −0.32, P < .0001).

When stratifying the patients’ socioeconomic situation into mild, important, and severe social risk, their respective median total FIM at admission were 61.5, 50, and 41, with significant differences between the mild and important group (P < .001); also significant differences were found between mild and severe groups (P < .001).

A few of the variables identified in the literature as significant predictors of LOS within the full stroke population were also significant for our dataset (National Institutes of Health Stroke Scale, FIM, home accessibility) explaining less than 25% of the LOS variance. Most of the 30 analyzed known predictors were not significant (e.g., depression, age, recurrent stroke, ataxia, orientation, verbal communication, etc) suggesting that factors outside functional, socioeconomic, medical, and demographics not included in this study (e.g., rehabilitation sessions intensity) have important influences on LOS for severe patients.

Patients at mild social risk obtained significantly higher total FIM at admission than patients at important and severe social risk. The importance of socioeconomic situation has been scarcely studied in the literature in relation to functionality at admission; our results suggest that it requires to be considered.

1 Introduction

Stroke rehabilitation length of stay (LOS) is one of the most relevant quantitative indexes that measure health service utilization within a hospital. LOS is the principal predictive factor of medical expenses among variables that affect the total costs during hospitalization.^[1] The ability to accurately predict which stroke patients are likely to require longer inpatient care is desirable for both budgetary planning and healthcare providers’ considerations as well as to manage emotional expectations when communicating with patients and families.^[2]

Many factors have been shown to influence subacute rehabilitation LOS, including stroke severity measured with the National institute of Health Stroke Scale (NIHSS),^[3] ability to perform activities of daily living,^[4] or admission Functional Independence Measure (FIM) score.^[5] The presence of ataxia may increase LOS,^[6] dysphagia,^[7] as well as aphasia,^[8] diabetes,^[9] obesity,^[10] and hypertension.^[11] Besides, recurrent stroke patients have been previously reported requiring longer LOS.^[12]

Furthermore, there is evidence that motor^[13] and cognitive^[14] rehabilitation after stroke should be started as early as possible. Nevertheless, time since stroke onset to rehabilitation admission has been scarcely included as covariate in LOS predictive models.

Falls are common post-stroke (12%–47%) and may extend inpatient stroke rehabilitation LOS^[15] as well as depression.^[16] In terms of social factors, there are conflicting reports about whether living alone predicts LOS, for example, Tan et al (longer LOS),^[17] Saxena et al (shorter LOS).^[18] Besides, inadequate family support^[19] and environmental factors (e.g., home modifications) may delay LOS.^[20]

A 2015 Lancet review^[21] reports that socioeconomic status (SES) is reflected in short-term and long-term outcomes after stroke. Studies have demonstrated an association between lower SES and having more severe deficits after stroke assessed by NIHSS at admission.^[22] To our best knowledge there is a lack of similar studies addressing associations between functional independence, for example, total FIM(T-FIM), motor FIM (M-FIM), and cognitive FIM (C-FIM) at admission and SES.

Although several researchers have previously examined the prediction of LOS within the full spectrum of stroke rehabilitation patients (mild, moderate, and severe), different variables may have different impact in LOS when excluding the population with mild functional impairments. For example, while age has previously been identified as a significant contributor of LOS, this variable may not have the same impact for severe and milder patients as the latter group tends to be younger.^[5] To classify stroke severity at admission as mild, moderate, or severe, in this work, we apply the RPG benchmark (Rehabilitation Patient Groups), as in similar previous research.^[23]

The objectives of the present study are to analyze the associations between functional independence (T-FIM, M-FIM, and C-FIM) at admission and SES within a population of ischemic and hemorrhagic (moderate-RPG and severe-RPG) stroke patients admitted to an inpatient rehabilitation hospital and predict their LOS from a wide range of potential predictors, including the aforementioned demographics, clinical, and social state-of-the-art variables.

It is hypothesized that M-FIM, C-FIM, and T-FIM at admission will have a stronger association (negative correlation) with SES than NIHSS.

It is also hypothesized that, while some of the same variables that have been identified as significant predictors of LOS within the full stroke population will also emerge for this sample, a different composite of predictors will best account for the variance associated with LOS for patients admitted to stroke rehabilitation with severe and moderate functional impairments.