NHRMC receives comprehensive stroke center certification - WILMINGTON, N.C

So fucking what? 'Care' and treatment, NOT RESULTS. 

NHRMC receives comprehensive stroke center certification - WILMINGTON, N.C

WILMINGTON, N.C. (WECT) - New Hanover Regional Medical Center's Stroke Center has received special certification that sets it apart from every other hospital in the state.

NHRMC is now a comprehensive stroke center after receiving the DNV GL Healthcare certification, which reflects the highest level of competence for treatment of serious stroke events. New Hanover is the only DNV-certified comprehensive stroke center in North Carolina, according to a news release.

“Comprehensive stroke center designation represents a milestone in NHRMC’s commitment to providing the best care for our community,” said James S. McKinney, MD, medical director of the NHRMC Stroke Center. “The NHRMC Stroke Center has become a referral destination for patients across southeastern North Carolina needing the most advanced care for strokes and aneurysms.”

NHRMC is the only hospital in southeastern North Carolina to offer 24/7 neuro-interventional coverage to treat patients suffering cerebrovascular emergencies, including stroke and aneurysms.

The DNV GL Healthcare certification is based on standards set by the Brain Attack Coalition and the American Stroke Association. It affirms the medical center addressed the full spectrum of stroke care — diagnosis, treatment, rehabilitation and education — and establishes clear metrics to evaluate outcomes.

“There was a time when stroke patients in the southeastern region of North Carolina had to seek care elsewhere," said Jeffrey Beecher, DO, director of cerebrovascular and endovascular neurosurgery. "That time has come and gone.”

For more information on NHRMC neuroscience, click here.

Copyright 2019 WECT. All rights reserved.

Dawdling Diminishes Reperfusion in Stroke Thrombectomy

Good to know that blaming the patient is the height of stroke treatment. Rather than the total fucking crapola that stroke doctors do that only gets 10% fully recovered. 'You didn't have the exact make and model of stroke that matches what we can treat, and not very successful treatment at that.'

Dawdling Diminishes Reperfusion in Stroke Thrombectomy

Door-to-puncture delays still no good, despite DAWN, DEFUSE 3

• by Nicole Lou, Reporter, MedPage Today/CRTonline.org January 23, 2019

Reperfusion success after mechanical thrombectomy for a large vessel occlusion dimmed with every passing hour from stroke endovascular center arrival to groin puncture, according to the HERMES group.
The odds dropped the longer to groin puncture from admission (OR 0.78 per hour, 95% CI 0.64-0.95) or first imaging (OR 0.74 per hour, 95% CI 0.59-0.93), according to Romain Bourcier, MD, PhD, of the University Hospital of Nantes, France, and collaborators.
Their meta-analysis of pooled patient-level data from the thrombectomy arms of seven randomized trials (n=728) was published online in JAMA Neurology.
"Our results could be confusing compared with the results of the late time studies [DAWN and DEFUSE 3]. Importantly, even if the reperfusion rate declines as time elapses, patients recanalized in later times continue to have better clinical outcome compared with those without reperfusion," the investigators emphasized.
In 2018, based on DAWN and DEFUSE 3 data showing benefits to late thrombectomy, U.S. guidelines expanded the window for endovascular stroke therapy from 6 hours to 24 hours after the patient was last known to be well.
"The bottom line is that time is brain -- still. All the publicity around longer time windows may have sent the wrong message to the troops out there. Yes, we can treat some patients late and get success. But for the majority of patients, early is better, and the best chance for success is with early, timely intervention," commented Patrick Lyden, MD, of Cedars-Sinai Medical Center in Los Angeles, who was not part of the research group.
Cutting down modifiable in-hospital delays is still crucial, the investigators said, though they said they couldn't tell from their data if it was best to start by optimizing patient transfer, imaging, or procedural factors.
The HERMES participants included in the meta-analysis were patients with M1/M2 or intracranial carotid artery occlusions. The group was age 65.4 years on average and 47.4% women. Successful reperfusion was defined as an adjusted mTICI score of 2b/3 at the end of thrombectomy.
"While the probability of successful reperfusion decreased in our study with all intervals, the association was much more pronounced when arrival at the emergency department or imaging to groin puncture were considered compared with onset to groin puncture," Bourcier's group noted.
In fact, the study population showed no relationship between time from stroke onset to arterial access and successful reperfusion. The authors said this was "possibly because several of the trials used imaging selection criteria to choose patients (thereby selecting those more likely to be slow progressors), and one trial examined an extended 12-hour eligibility window from stroke onset."
They acknowledged that the trials they pooled differed in study entry criteria and imaging modalities used. Moreover, they lacked any information on thrombectomy procedural details, such as device selection.
“Patients with favorable imaging profiles had very good reperfusion rates in DEFUSE 3 and DAWN indicating that extended time is not a barrier to high repulsion rates in well-selected patients,” according to Gregory Albers, MD, of California’s Stanford University. “Of course, sooner is always better, but when the patient does not arrive early we need imaging to determine if they are still a good candidate for thrombectomy.”

The HERMES Collaboration was funded by a grant from Medtronic to the University of Calgary.
Bourcier disclosed no conflicts of interest.
Study co-authors reported numerous ties to industry.

last updated 01.23.2019

• Primary Source

  JAMA Neurology

  Source Reference: Bourcier R, et al "Association of time from stroke onset to groin puncture with quality of reperfusion after mechanical thrombectomy: a meta-analysis of individual patient data from 7 randomized clinical trials" JAMA Neurol 2019; DOI: 10.1001/jamaneurol.2018.4510.

A Sea Change in Treating Heart Attacks

I wonder what this would be for stroke. I know stroke dropped from 3rd leading cause of death to 5th but I bet no one has analyzed the disability leftover from strokes. We may be saving lives from stroke but I bet we have barely moved the disability interventions. So go ask your hospital how good they are in preventing disability from stroke.
http://www.nytimes.com/2015/06/21/health/saving-heart-attack-victims-stat.html?_r=0
The death rate from coronary heart disease has dropped
38 percent in a decade. One reason is that hospitals
rich and poor have streamlined emergency treatment.

Stroke survivors unaware of therapy options for spastic muscles, survey finds

Well maybe they aren't aware because there are no solutions, botox and phenol do not treat the spasticity, they only treat the superficial symptoms.  Talking to your therapist won't do a damn bit of good, your PMR doctor and neurologist know nothing either. But there is always marijuana which no one will tell you about.
http://www.mcknights.com/stroke-survivors-unaware-of-therapy-options-for-spastic-muscles-survey-finds/article/320063/

The right treatment is necessary to overcome a stroke

I wish I knew who was feeding this reporter this information because that person seems to know more than anyone else in the world.
http://www.whptv.com/news/local/story/The-right-treatment-is-necessary-to-overcome-a/nmS02wzwBEWt17rF8tG9tQ.cspx
a stroke can be detrimental to your health and can have lasting affects if you don't get the right treatment.  So what is the right treatment?

Treatment Options in Acute Ischemic Stroke - Cleveland Clinic

Another Online health chat with them.
Don't be polite, the world was not changed by polite people. Bring your questions on hyperacute treatments(I have 160 posts on them if you need inspiration) and hypothermia and cascade of death.  It should be easy to  overwhelm him with questions. Questions open on May 20 so you can submit them ahead of time. Be prepared with your questions when you register. I think I once had to register under 2 email ids to get all the questions in.
http://www.clevelandclinic.org/health/chatreg/ChatPage.aspx?ChatId=1367

Treatment Options in Acute Ischemic Stroke
Monday, May 21, 2012 - 12 Noon (Eastern Time)

M. Shazam Hussain

• Neurological Institute
• Cerebrovascular Center
• Cleveland Clinic

Each year, more than half a million Americans suffer from strokes. A stroke, or “brain attack,” occurs when the blood supply is cut off from part of the brain. When this happens, the blood-deprived brain loses its supply of oxygen and nutrients. When the brain is deprived of blood for even a few minutes, it begins to die.

There are two types of stroke-ischemic and hemorrhagic. In ischemic strokes, brain arteries become blocked and prevent blood from nourishing the brain. In hemorrhagic strokes, brain arteries rupture from damage caused by high blood pressure and other risk factors or an aneurysm (an abnormal out pouching of a blood vessel) and cause blood to flood the brain, creating pressure that leads to brain-cell death.

There are many risk factors that increase the risk of stroke. Some factors can be controlled, while others cannot. Some of these factors include: high blood pressure, high cholesterol, heart disease, being overweight, heavy, drinking, smoking, diabetics and a family history of strokes.

Ways to reduce these risks include: not smoking, limiting alcohol intake, control your weight and blood pressure, finding out if you have an irregular heartbeat or a diseased carotid artery.

Immediate treatment of a stroke may limit or prevent brain damage. A thrombolytic agent or “clot buster” medication may be given within the first 4.5 hours of the onset stroke symptoms, and patients may also qualify for emergent endovascular therapy to try to open blocked blood vessels. It is critical to call 911 and get to the hospital quickly if you experience stroke symptoms.  Show him all the untested possibilities

1.  (What is the success rate of tPA? full recovery) Is Draculin available for use?
2. Edaravone is used in Japan, why isn't it available here?
3. Should anti-depressants be prescribed for all survivors to enhance rehabilitation? 
4. Should  Tenecteplase be used in combination with tPA during ER treatment? 
5.  There have been over 1000 treatments that worked in mice or rats that failed in humans, Why didn't we see more successes?
6. Would it be possible to use magnetic nanoparticles to deliver tPA directly to the clot? Reducing the amount needed and the risk of bleeds.
7. How long does the neuronal cascade of death continue in ischemic stroke? 
8. Should hypothermia become the standard treatment in the ambulance?
9. Which body cooling device do you think has the best chance of  becoming standard in the ambulance? core body cooler, drug cooler , brain helmet, nasal cooler , neck cooler?
10. Is Enzogenol a possibility?
11. What is the outlook for microrobots to travel in the bloodstream and remove clots? 

Take advantage of this chat to speak to a specialist about techniques, medications and treatment options after a stroke occurs from M. Shazam Hussain, M.D, who is involved in both medical and endovascular treatment of acute stroke patients.

The Cerebrovascular Center at Cleveland Clinic’s Neurological Institute integrates a multidisciplinary team of neurologists, neurosurgeons, neuroradiologists, neurointensivists and rehabilitation specialists who provide expert diagnosis and medical, endovascular and surgical management of all cerebrovascular conditions. Cleveland Clinic is a designated Primary Stroke Center.

A Primary Stroke Center is usually housed in a hospital where a group of medical professionals who specialize in stroke, work together to diagnose, treat, and provide early rehabilitation to stroke patients. The Joint Commission’s Certificate of Distinction for Primary Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. The Cleveland Clinic Primary Stroke Center provides services that have critical elements to achieve long term success in improving outcomes. We provide quality care and effectively manage the unique and specialized needs of stroke patients.

M. Shazam Hussain, M.D, is the designated stroke center director and staff physician in the Cerebrovascular Center at Cleveland Clinic. He received his medical degree from University of Saskatchewan College of Medicine in Canada, and then went on to complete a residency and fellowship at University of Alberta Hospital Canada in neurology and vascular neurology. Dr. Hussain joined Cleveland Clinic for his final fellowship in endovascular surgical neuroradiology. His specialty interests include acute stroke therapy, cerebrovascular diseases and neuroimaging.

To make an appointment with Dr. Hussain or any other of the specialists in our Neurological Institute at Cleveland Clinic, please call 216.636.5860 or call toll-free at 866.588.2264. You can also visit us online at clevelandclinic.org/cerebrovascular.

This Health Chat will open on Sunday, May 20, 2012 to allow you to submit questions. We will try to answer as many questions as possible during the chat. Please create an account to attend the chat and submit your questions.