NOT GOOD ENOUGH! Why are you accepting failure to 100% recover as a success? That to me is complete failure and survivors would agree. No excuses allowed. Don't cry to me that brain research is hard. Recovery is way harder than that.
Hope you are OK with failure to recover when you are the 1 in 4 per WHO that has a stroke.
Mobile Stroke Units Improve Outcomes, Data Show
By Thomas R. Collins
March 19, 2021
Stroke patients treated by mobile stroke units received faster treatment and had better outcomes (Whoopee! NOT 100% RECOVERY.)compared to patients who arrived in the standard way to emergency departments (EDs), according to results presented at the International Stroke Conference 2021.
James C. Grotta, MD,
FAAN, director of stroke research at the Memorial Hermann-Texas Medical
Center and the primary author of the study, said the findings
demonstrate the benefits of mobile stroke units, adding to the evidence
base that could lead to reimbursement to make their use more widespread.
“A mobile stroke unit is a primary stroke center, basically," Dr. Grotta told Neurology Today At the Meetings. “We get everything done that needs to be done at a primary stroke center."
Mobile
units are ambulances equipped to treat patients on board with tissue
plasminogen activator (tPA), with a vascular neurologist on board and
the ability to do a CT scan and CT angiogram.
In the BEST-MSU
study, mobile stroke units were deployed to 911 stroke calls for one
week, and patients were treated on board or via telemedicine if they
were deemed tPA-eligible. On alternating weeks, the units were not
deployed, but staff met the EMS squad and determined whether the patient
was tPA-eligible when they arrived on scene, so that the two arms
included the same kinds of patients.
In the mobile stroke
units, 33 percent of patients were treated during the first 60
minutes—the so-called “golden hour"—compared with just 3 percent of
patients treated the standard way; in addition, 97.1 percent of those
who were tPA-eligible received tPA in the mobile stroke unit group,
compared to 79.1 percent of those in the standard treatment group. Most
of that difference, Dr. Grotta said, was probably due to a greater
inclination and willingness to use tPA by the mobile stroke unit
vascular neurologist, compared to physicians in the ED.
Researchers
used a utility-weighted modified Rankin score (uw-mRS), which takes
into account patient perceptions about the levels of disability on the
scale. For instance, an improvement from four to three—going from being
unable to walk to being able to walk—is considered more significant than
one to zero—non-significant symptoms versus no symptoms at all. At
three months, there was a 0.07 difference in uw-mRS in favor of the
mobile stroke unit group (p=0.002).
Based on these
results, for every 100 patients treated with a mobile unit rather than
standard management, 27 would have less final disability and 11 more
will be disability-free, he said.
In the study, the units were
used in fairly metropolitan areas, such as Los Angeles and Memphis, Dr.
Grotta said, adding the value in rural areas remains to be seen.
Researchers
will continue to assess health care utilization related to mobile
stroke units for a year. But he said that if a mobile unit is active
about half the time it treats 100 patients a year, resulting in 10 more
patients completely recovering, that would likely more than cover the
cost of the operating units.
“Even with a back-of-the-envelope
calculation, I would predict that it's cost-effective to the health
care system," he continued.
Commenting on the study, Robert J.
Adams, MD, professor of neurology at the Medical University of South
Carolina, said the data from this and other studies signal support for
more frequent use of mobile stroke units.
“The data are consistent that earlier treatment leads to better outcomes, unless there are more hemorrhages," Dr. Adams told Neurology Today
At the Meetings. “This study shows earlier treatment and a qualitative
benefit, which is the ability for us to get experience in the 'golden
hour.' We have very little data in that time domain. In my mind, these
data—and I have been doing this since before there were stroke systems
of care, prior to tPA and prior to the stroke certification
effort—clearly provide a 'go' signal. These units should be part of the
stroke treatment ecosystem."
Using the mobile stroke unit as a
primary stroke center “surrogate" in an area with a high stroke rate
but no hospital might be a way to increase its value, he said.
“The
unit could be placed there more of the time and defer the community
cost of building a facility primarily to treat stroke, for example," Dr.
Adams said. “Another way to look at this would be for there to be a
hefty surcharge to insurance carriers when the unit is used, to increase
its ability to generate funds to defer its cost."
Dr. Grotta
disclosed receiving a grant for research from Frazer Ltd and Genentech.
Dr. Adams disclosed receiving consulting fees from Global Blood
Products, a company that makes treatment for sickle cell disease. He has
also received travel expenses from Zeriscope, Inc., a company that make
mobile telemedicine platforms.
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