The input and variety of clinical knowledge for stroke rehabilitation shared at #QSUL11 is top-notch !! Thank you @dr_nickward and @NeurorehabUCLP for making it happen.

 You'll notice the unrealistic hope in one of the slides. That is complete proof that the stroke medical world is relying on the tyranny of low expectations instead of providing 100% recovery.  Unless the stroke medical world prioritizes 100% recovery research that tsunami of stroke survivors will overwhelm the stroke medical 'professionals'. They are not professionals unless they actually start working on 100% recovery! The last slide should have been: 'Upper limb recovery; HOW TO DO IT!'

The input and variety of clinical knowledge for stroke rehabilitation shared at #QSUL11 is top-notch !! Thank you

@dr_nickward

and

@NeurorehabUCLP

for making it happen.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stroke rate ‘tsunami’ will result in 12,000 new cases a year in Ireland

And because we have fucking failures of stroke associations  we have NO STRATEGY AND NO LEADERSHIP to solve stroke. This failure goes back decades and will continue until we get survivors in charge. Your children and grandchildren will be screwed if they have a stroke.

Stroke rate ‘tsunami’ will result in 12,000 new cases a year in Ireland

 

The results have prompted a demand by the Irish Heart Foundation for urgent investment in stroke services.(Services just provide the status quo which is a complete fucking failure.)

(PA)

By Cate McCurry, PA

November 09 2020 12:39 PM

---

Ireland is facing a “tsunami” of stroke cases in the next 10 years after research warned that the stroke rate will soar to almost 12,000 new incidences a year.

According to the Stroke Alliance for Europe (Safe), this represents a 58% increase.

The results have prompted a demand by the Irish Heart Foundation for urgent investment in stroke services.

The increase, predicted to be among the highest in Europe, will see the cost of stroke rise by nearly 40% over the almost 500 million euro the research estimates is already spent annually in Ireland to treat the disease.

This research shows the tsunami of new strokes we are facing in Ireland is due mainly to our ageing population. Chris Macey

Approximately 7,500 people in Ireland are currently hospitalised due to stroke each year, according to the HSE’s National Stroke Programme.

Ireland’s stroke rate could increase 59% by 2035

I see nothing here that they are working on the appalling 10% full recovery rate or the 88% failure rate of tPA to full recovery. Nothing on the 5 causes of the neuronal cascade of death in the first week. Rather they are going down the failed assumption that they just need more therapists, that €15 million a year could solve a lot of stroke problems. Without working on solving any of these problems stroke survivors will be screwed forever.
Others have referred to this as the upcoming tsunami of stroke.  
http://www.irishtimes.com/news/health/ireland-s-stroke-rate-could-increase-59-by-2035-1.3080300

Irish Heart Foundation says acute services already less effective and more expensive

about 20 hours ago

Aine McMahon

Chris Macey from the Irish Heart Foundation said: “We have to act now or the surging stroke rate will not just overwhelm our stroke units.”

 

The Irish Heart Foundation called for an urgent overhaul of how stroke services are resourced after a European study showed the death rate from stroke in Ireland will increase by 84 per cent in less than 20 years.

The Burden of Stroke in Europe report launched in the European Parliament in Brussels on Thursday by the Stroke Alliance for Europe also predicts the incidence of stroke in Ireland will increase by 59 per cent by 2035.

Irish Heart Foundation head of advocacy Chris Macey said acute stroke services were already becoming less effective and more expensive because stroke units could not cope with the number of strokes Irish people were having.

“We have to act now or the surging stroke rate will not just overwhelm our stroke units, there will also be a huge spill over into all acute services that will affect all patients using emergency services,” said Mr Macey.

“We don’t need extra money to fix things – we just need to invest in treatment and care that has been proved to save lives and money so we don’t have to send so many patients unnecessarily to expensive nursing home care.”

The latest statistics show that long-term care costs rose by €17.3 million in 2015 due to an increase in nursing home discharges – which could have paid for up to 1.6 million hours of homecare.

“If the HSE spent €15 million a year on providing the 200 extra therapists required to staff stroke units properly, these cost reductions would be restored and stroke services could gear up to deal with the accelerating upsurge of strokes facing our hospital system,” he said.

Clot retrieval

Other measures proven to be cost effective include the development of clot retrieval thrombectomyservices, which have been deemed cost effective in a Hiqa health technology assessment; the roll out of early supported discharge programmes whereby stroke patients receive vital therapy at home rather than in hospital; and increasing access to homecare for stroke survivors.

“These measures are largely deliverable within the funding restrictions imposed on the health services. Many are considered to be basic standards of care in other countries. Together they can significantly reduce preventable death and disability without any increase in overall costs,” said Mr Macey.

Three out of four of the country’s rehabilitation hospitals said they were unable to provide stroke patients with the recommended level of therapy they need, according to a HSE audit carried out last year.

Just one in four has a dedicated stroke unit and 60 per cent lack a stroke specialist to oversee rehabilitation. Less than one in three units has access to psychological services.

In addition, the vast majority of the 26 hospitals that took part in the study have no access to community rehabilitation teams to continue therapy that is essential to assist recovery for patients after they are discharged home.

Report predicts growth in stroke rates for UK

I see nothing here that they are working on the appalling 10% full recovery rate or the 88% failure rate of tPA to full recovery. Nothing on the 5 causes of the neuronal cascade of death in the first week. Without working on solving any of these problems stroke survivors will be screwed forever.
Others have referred to this as the upcoming tsunami of stroke. 
https://medicalxpress.com/news/2017-05-growth-uk.html

The number of strokes across the UK is likely to rise by almost half (44 per cent) in the next 20 years, according to a new report by researchers from King's College London.
The Burden of Stroke in Europe report is a comprehensive analysis of 35 European countries, published by the Stroke Alliance for Europe (SAFE) and the Stroke Association to mark European Stroke Awareness Day and the UK's national awareness month.
The report warns that throughout Europe the number of strokes could rise by 2035 due to our ageing population.
The report findings predict that by 2035:

• the number of new strokes across Europe is likely to increase by a third (34 per cent), and in the UK, this figure could jump by nearly half (44 per cent)
• the number of stroke survivors living in the UK is expected to rise by a third (32 per cent).

The report's authors caution that accurate comparisons between countries are extremely difficult, and advise that their predictions for the future have a significant level of uncertainty.
Professor Christopher McKevitt, an author of the report from the Division of Health and Social Care Research at King's College London, said: 'Our report shows that your chances of getting the best quality care when you first have a stroke vary widely across Europe, and within individual European states. It also shows that we know very little about what care stroke survivors get after discharge from hospital.
'As the population ages, more people will have a stroke, and more will survive with long-term disabilities. We need to ensure better access to the best acute stroke care for all; and we need to focus efforts on improving support for stroke survivors in the months and years after they are sent home from hospital.'
Juliet Bouverie, Chief Executive of the Stroke Association, said: 'The number of stroke survivors is set to rise by almost one million people, and that number in the UK is expected to increase by over 30%: that is one of the largest increases in Europe. These are shocking figures, and if they are borne out, health services will face a formidable challenge in tackling a stroke epidemic.
'There are alarming variations in delivering even the basic levels of treatment and care for stroke patients, such as access to stroke units and thrombolysis, not just across Europe, but across the UK. Without reorganisation, stroke patients are less likely to receive the treatment and care which will save their lives and reduce disability. This could ultimately lead to greater costs on their Governments and economies.'
As part of its recommendations, SAFE is calling for each EU member state to have a national stroke strategy, actively supported and sponsored by Government that covers the whole stroke pathway. This should include awareness, prevention, treatment and long-term support.
Ms Bouverie continued: 'While it is good news that many more people are now surviving a stroke, we also know that their needs are not currently being met after they've received initial life-saving treatment.'

Explore further: Caregivers of black stroke survivors spend more time, but report more positive outlook

More information: The Burden of Stroke in Europe: www.stroke.org.uk/sites/default/files/the_burden_of_stroke_in_europe_-_challenges_for_policy_makers.pdf

Provided by: King's College London

Call for Navigation: Charting a Course for Stroke Survivors

This Stroke Navigator Program is just rearranging the deck chairs on the Titanic. If you are going to address the upcoming tsunami of stroke you need to solve all the problems in stroke. This is just a fucking bandaid on a gaping hole in the brain.
http://www.cardiovascularbusiness.com/topics/practice-management/call-navigation-charting-course-stroke-survivors?page=0%2C0

Approximately 130,000 Americans will die from stroke this year. Another 795,000 people will suffer a stroke and live to join the 6.5 million stroke survivors in the United States today. Many will struggle with long-term disability, isolation and confusion. Nearly two-thirds of Medicare beneficiaries discharged after an ischemic stroke die or are rehospitalized within one year (Stroke 2011;42[1]:159-66). In the United States, the cost of stroke—including healthcare services, medications and lost productivity—totals $34 billion annually (Circulation 2015;131:e29-e322). 
Today’s stroke statistics are a drop in the bucket compared with the “stroke tsunami” that the National Stroke Association (NSA) says will accompany the aging of the baby boomers. By 2030, the prevalence of stroke will increase by 3.4 million people relative to 2012 and direct medical stroke-related costs will triple, according to American Heart Association/American Stroke Association projections (Stroke 2013;44:2361-2375). Improving how stroke survivors reintegrate into their communities and access resources needs to be a priority, says Amy Nieberlein, MSN, ACNP-BC, FNP-C, CEN. She talked with Cardiovascular Business about the NSA Stroke Recovery Navigator Program she’s helping to pilot at Swedish Medical Center in Denver.

What is the goal of the Stroke Recovery Navigator Program?

Put simply, the goal is make sure patients are equipped to handle life as stroke survivors. That means helping patients and their caregivers access resources that will improve their health outcomes and quality of life after they leave the hospital.

How did the pilot program work at your hospital?

During rounds, the other nurses and I told the patients about the program. The patients who agreed to participate were assigned to an NSA navigator who performed an initial needs assessment for each participant and identified community resources that matched his or her needs. The navigator worked with them for up to six months after hospital discharge.

What did the navigators do?

The navigators mostly provided telephone support to the stroke patients and their caregivers. Depending on the resources available and each patient’s needs, they might help with medication questions, address transportation barriers, make connections with stroke support groups and help them tackle the challenges associated with returning to work or activities of daily living. They also reinforced the education that we convey to all stroke patients when they’re discharged, including risk factor management and why it’s critical to seek immediate medical attention for stroke symptoms.

How was success measured?

The NSA set goals for several metrics for success, such as better than the national average for rehospitalization and improved scores on indexes for normal living reintegration (for patients) and reduced burden (for caregivers). For the most part, the program exceeded NSA’s goals for phase 1 (see Figure).
As a pilot site, we didn’t get to see the metrics for our group of patients specifically—we will in phase 2, which will be helpful—but I feel sure our patient satisfaction metrics would be up for the patients in this program, because it makes them feel empowered.

Based on your experience with patient care, what is the key to success for transition-to-home programs like this one?

The navigators start where the patient is. Where the process begins and how it moves forward are both highly individualized. There’s no way our hospital, which is a telemedicine hub serving eight states, could provide that kind of service to all of our patients, but trained navigators can get to know the patients and the resources their communities offer, and then match them. 

How did participating in the program affect your daily work?

Swedish Medical Center was one of three hospitals that participated in phase 1 of the pilot. Before patients were discharged from the acute care setting, we invited them to join the program. If they were interested, we sent their information to the NSA navigator assigned to our hospital. It didn’t add much work for us, and there were no costs for us to participate.

Based on your experience, which patients would you expect to benefit from a navigator program like this one?

You get to know your patients and get a sense for which ones will be engaged in their care. Patients with engaged family members seemed more likely to join the program, but I actually think the program would be even more valuable

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Stroke falls one place to fifth leading cause of death in US

And if we would ever figure out how to stop the neuronal cascade of death this could probably be lowered much further.
All this is going to do is allow the existing stroke associations to assert that their focus on prevention is what caused the decline and not focus on solving all the existing problems in stroke.
Damn will they be lazy? Or not?  The tsunami of stroke is coming and nobody is prepared.
http://www.medicalnewstoday.com/articles/287530.php

Stroke success in Canada could be strained

Of course it will be strained if you stay with the status quo failures of tPA, and nothing for the neuronal cascade of death.  All you have to do is read some research and push your hospitals to implement new techniques that may not be fully clinical trial approved. What is the downside? I will be screaming at my doctor for these 31 hyperacute possibilities I'm going to insist my doctor give me the first week. 
This tsunami of stroke was written about way back in 2006.

Estol CJ. The tsunami and stroke; two killer waves. International Journal of Stroke. 2006; 1: 40.

CrossRef

That's been plenty of time for some intelligent planning to be done. But of course nothing has been done except issue f*cking press releases.

http://www.cbc.ca/news/health/stroke-success-in-canada-could-be-strained-1.2665259

Stroke death rates have improved in Canada but an aging population and sicker patients could threaten the gains.
Thursday’s annual report from the Heart and Stroke Foundation says an estimated 50,000 strokes occur in Canada every year, or one every 10 minutes. About 315,000 Canadians are living with its effects.
"As our population gets older there will be more strokes and more patients to treat; many of these patients will be sicker, so there will be a bigger burden on the health-care system, on society and on families," Dr. Michael Hill, director of the stroke unit at the Calgary Stroke Program, said in the report.
Compared with five years ago, more hospitals are administering clot-busting drugs that can reduce damage to the brain if given within hours of a stroke. There is room to improve — less than one-third of hospitals that provide stroke services offer the clot-buster.
About two-thirds of stroke patients have a combination of illnesses such as chronic conditions that can make their care more complex, the group said.
In the past decade, strokes among people in their 50s have increased by 24 per cent.
The foundation estimates up to 80 per cent of premature heart disease and stroke can be prevented. Some healthy behaviours to adopt are to eat a nutritious diet, get enough physical activity, not smoke, control blood pressure, manage diabetes, limit alcohol intake and manage stress.
Stroke survival rates vary across Canada with the best chances in Quebec and Alberta. Atlantic Canadians are at greater risk of dying from a stroke, the report suggests. Reasons for the differences include:

• Urban or rural locations.
• Coordination of stroke services.
• Availability of services.

Only 60 per cent of stroke patients who leave hospital return home and of those 11 per cent have home support services in place.
Better access to care and rehabilitation could speed up and improve recovery, the group said. It pointed to how 16 per cent of all stroke patients go to in-patient rehabilitation, despite evidence that suggests the number should be closer to 40 per cent.
Telemedicine also has potential to expand for stroke care.

May is National Stroke Awareness Month. For 25 years, the National Stroke Association (NSA) has been raising awareness about the causes and results of stroke through this annual campaign.

You notice that there are no action verbs there.
Solving the 10% full recovery failure.
Solving spasticity.
Solving fatigue.
Stopping the neuronal cascade of death. 
Creating an objective, fast, easy diagnosis for stroke.
Preventing stroke with specific actionable activities.
Renaming stroke to 'brain attack'.
Researching anything about stroke.
Creating and updating textbooks on stroke for stroke-related medical students.
GAH!!!!! 25 years of failure in my opinion. Nothing being done here will solve the upcoming tsunami of stroke.
And is the board of directors ok with that?

Stroke: Improving stroke care in the ER

This is so f*cking bad. Everyone is just trying to improve the status quo. tPA at 12% efficacy is a failure. Nothing on  these 31 hyperacute possibilities I'm going to insist my doctor give me the first week. 
Can't anyone rub two neurons together and maybe get a spark of intelligence? 
If this is a sign of improvement any future strokies will truly be victims.
These idiots are living under rocks and are not looking at the failures in the existing stroke world. Nothing they talk about will solve the tsunami of stroke coming. 

Video here:
http://www.medpagetoday.com/HOTTOPICSNeurology/Neurology-Videos/447
What can be done to improve stroke care in emergency departments with existing drugs and technologies? That's the question we put to three stroke neurologists -- Natalia Rost, MD, MPH, of Massachusetts General Hospital in Boston; M. Shazam Hussain, MD, of the Cleveland Clinic in Cleveland; and Jeffrey Saver, MD, of the UCLA David Geffen School of Medicine in Los Angeles -- whose answers included cutting door-to-needle times and regular meetings to review procedures.

Tsunami of stroke

Its coming and no one is prepared. The existing number of neurologists and therapists will not be able to handle the workload coming. Two possibilities;
1. We just discharge them to home and instruct the caretakers like India is testing right now.
2. We revamp everything because we have figured out how to stop the neuronal cascade of death, that results in vastly less disability and the existing stroke infrastructure can handle that.
Anyone having a stroke in future years is totally screwed. Tell your parents right now to prepare to die or be disabled if they have a stroke because there is no planning or strategy  for stroke.
Tsunami statement came from  
The tsunami and stroke; two killer waves.

International Journal of Stroke

 February 2006

So 8 years and I bet nothing has been done. An example of nothing is the 

World Stroke Organization Synergium in 2010.

Hot Topics: Advances in Stroke

If these three guys are supposed to be experts, we are totally screwed. Not one of them mentioned any of the prevention ideas I've written about and whats worse is no mention of the neuronal cascade of death. All it was about is status quo stuff. That is nowhere close to being able to handle the upcoming tsunami of stroke. They should be hanging their heads in shame. If I was a real bastard I'd be writing to their institutions demanding to know when someone intelligent and innovative takes over.
Only 3min 13 seconds of blah.
http://www.medpagetoday.com/HOTTOPICSWhatWorksWhatDoesnt/special-reports/SpecialReports-Videos/408
What works and what doesn't work in stroke? We asked three experts in the field for their take: Joseph Broderick, MD, director of the UC Neuroscience Institute at the University of Cincinnati and UC Health, James C. Grotta, MD, director of stroke research in the Center for Innovation & Research at Memorial Hermann-Texas Medical Center, and Thomas G. Brott, MD, of the Mayo Clinic in Jacksonville, Fla. In this video, they discuss stents, tPA, and artery bypass. What's not working includes clot removal and some recent devices.
F*CK it all - There is absolutely nothing working in stroke. If you don't know that get the hell out and let some intelligent people solve the stroke problems.

"prisoners of the past" and "pioneers of the future." - Stroke

This comes from Newt Gingrichs' new book "Breakout,".
the divide between those who think the party needs no new ideas, no positive message, and no fundamental change on the one hand, and those who want to be aggressive about breaking out to a better future on the other.
I'll apply it to the stroke world.
Most of the stroke world is still enamored of tPA and the F.A.S.T. campaign.
tPA was approved in 1996 and has an appalling 12% efficacy.
F.A.S.T.  assumes that getting to the hospital fast will save the brain. This is an incorrect assumption due to tPA failures and no protocol to stop the neuronal cascade of death.  The pushers of F.A.S.T., all the stroke associations, are rooted in the past and can't get rid of the blinders they have put on themselves. No new ideas.

ASA - Dr. Sacco,

NSA - Mr. Baranski, 

WSO - Dr. Stephen Davis

are all prisoners of the past, none have reached out to stroke survivors and are just working on tweaking the status quo.
I don't see how the boards of directors can justify such failure of leadership.

The WSO has come up with the pathetic 2010 Stroke: working toward a prioritized world agenda

The status quo will not be enough for the coming tsunami of stroke.

 

Stroke Numbers Up Worldwide

You can read all the depressing statistics at the article. The existing stroke world is totally unprepared for the coming tsunami of strokes.
A couple of select paragraphs.
http://www.medpagetoday.com/Cardiology/Strokes/42451
In 2010, there were 16.9 million people who had a first stroke, 33 million stroke survivors, and 5.9 million people who died from a stroke -- increases of 68%, 84%, and 26% respectively since 1990, according to Valery Feigin, MD, of the Auckland University of Technology in New Zealand, and colleagues.
If those trends continue, there will be an estimated 12 million stroke deaths, 70 million stroke survivors, and more than 200 million DALYs lost globally each year by 2030, with low- and middle-income countries bearing the brunt of the problem, they noted.
Another analysis by Feigin's group published in The Lancet Global Health showed that hemorrhagic -- and not ischemic -- stroke accounted for the majority of the worldwide burden of deaths and disability-adjusted life years lost due to stroke.
 This will mean that objective diagnosis will become even more important and research into bleeders will need to speed up.

Sprinting towards a cliff of stroke

My regular readers  know this but the stroke medical world doesn't or their head is in the sand. The stroke medical teams are sprinting towards a cliff of vastly increased stroke patients. They don't have a low altitude parachute or a wingsuit and don't even know if there is water at the bottom. They must expect to build a glider of 100% effective stroke rehab with no preparation. We as patients will surely die or be severely disabled in the attempt.  Unless we start screaming about preparations nothing will get done. They have already proven in the last 20 years that the stroke medical world doesn't plan for the future.

That tsunami of stroke is coming and it's going to disable millions of survivors because the existing stroke protocols only have 10% fully recover. And that has nothing to do with the medical care received, just luck that those were small strokes.

European Society of Cardiology kicked off its 5-day meeting

And with 32,000 attendees and all that supposed brainpower I bet they have no stroke survivor talking to them, telling them they know jackshit about where stroke research and rehab should be going. No planning/no strategy means absolutely no progress being made. That coming tsunami of strokes will roll right over them, killing them and us in the process.
http://spo.escardio.org/default.aspx?eevtid=60

Stroke systems of care essential to reducing deaths, disabilities

And once again our stroke associations prove they are only press release orgs. You will notice nothing in here that is concrete and actionable. Not like my 30 actions in the immediate aftermath of my next stroke. Once again proving their incompentency. Nothing in here will prepare for the coming tsunami of stroke.
http://newsroom.heart.org/news/stroke-systems-of-care-essential-to-reducing-deaths-disabilities?preview=52bb
Statement Highlights:

• The American Heart Association/American Stroke Association has identified several key elements needed for systems of care to effectively reduce stroke-related deaths and disability.
• The systems should quickly and appropriately address patients’ needs from when stroke symptoms appear and EMS is called, during transport to and treatment in the hospital and through rehabilitation.

Embargoed for release at 3 p.m. CT/4 p.m. ET, Thursday, Aug. 29, 2013
DALLAS, Aug. 29, 2013 — Several key elements in systems of care can reduce stroke deaths and disabilities, according to a new American Heart Association/American Stroke Association policy statement published in its journal Stroke.
Stroke is the number four cause of death and a leading cause of adult disability in the United States. On average, every 4 minutes someone dies of a stroke.
The  policy statement addresses patients’ care from the time stroke symptoms are identified, to the emergency medical services’ (EMS) response, to the transport and treatment in the hospital and rehabilitation.
Recommendations include:

• Develop public education programs to improve awareness of stroke symptoms and the need to call 9-1-1 to get to the hospital quickly for treatment.(But tPA only gives you a 30% better chance at a better recovery. Who is coming up with something better?)
• Ensure EMS personnel can quickly assess stroke patients and get them to the hospital with appropriate care within 15-20 minutes.
• Establish protocols to optimize the transfer of patients between hospitals offering different levels of care and within the different departments of a hospital.
• Support the certification of stroke centers that follow treatment guidelines designed to improve patient care and outcomes. (Why? those guidelines need updating)
• Use telemedicine, especially in rural areas, to ensure patients have 24/7 access to consultation and care.

The association also calls for patients to have access to post-stroke care, including rehabilitation and nursing services, regardless of their financial status or socio-economic background.
Authors of the statement also address issues related to adequate reimbursement for stroke treatment and care and the need for quality improvement and public reporting initiatives.
The American Heart Association/American Stroke Association has long supported and helped  develop stroke systems of care. Public awareness and patient resources include the F.A.S.T. campaign and the Together to End Stroke program. The association certifies stroke centers and provides many quality improvement tools for healthcare providers and resources to help people learn more about stroke hospitals in their communities.
Information on the statement authors and disclosures are on the manuscript.
For the latest heart and stroke news, follow @HeartNews on Twitter.
For stroke science, follow Stroke at @StrokeAHA_ASA.

10% full recovery for stroke

A one slide presentation you can give to any medical stroke group.
10% is the only thing on the slide, you can create your own examples and make it into an hour-long presentation. They will remember it as the most powerful presentation they have ever seen/heard. Hopefully it will spur them to action.  Leave them with, 'What medical procedure would you undertake with only a 10% chance of success? Success is 100% recovery, nothing less!
First, according to Steve Jobs, you have to explain the problem.
Only 10% of stroke survivors fully recover. From 10% full recovery for stroke.
5 Powerful Ways to Open a Presentation
Is a 10% rate acceptable in any endeavor?
Use professional baseball hitting average,
Shaquille O'Neal free throw percentage,
Quarterback passing percentage,
Or any other percent that can show how stupid 10% is, you will need to beat them over the head with it.
Would you have a surgery that only had a 10% chance of succeeding?
Do not allow any excuses to be presented, like 'All strokes are different, all stroke recoveries are different'
You then ask for their solutions to bring that to 100%.
F.A.S.T. is not allowed, prevention is not allowed.
You then start at the beginning.
Diagnosis - objective - 17 possibilities; Which one are they researching/using?
How about these 11 risk reduction ideas,
Never mind hypothermia - these 16 possibilities. Reduces the damage occurring. It doesn't seem to work.
Reduce the neuronal cascade of death - maybe these 177 possibilities. If your doctor isn't using any of these, they are a major part of the problem - Fire them.
96
inShare
5 Powerful Ways to Close a Presentation
I know you don't feel this is your responsibility but everyone in the stroke world is sitting on their asses doing very little that is useful. This is not
There is no coordinated strategy or plan on how to address the coming tsunami of stroke. And I want 200% better service that I received last time. That is actually meaningless since I received no service at all from my doctor and 200% time zero is still zero.

Stroke - Somebody Else's Problem   Its your problem because you are the only one who cares.

Where are the stroke leaders?

You can easily substitute  stroke in here everyplace. We have no stroke leaders, everyone is hunkered down, pushing the status quo. The coming tsunami of stroke is not unexpected but we are unprepared. Change that!


Remember Lee Iacocca, the man who rescued Chrysler Corporation from
it's death throes? He's now 82 years old and has a new book, and here are some excerpts.

Lee Iacocca Says:

"Am I the only guy in this country who's fed up with what's happening?
Where the hell is our outrage? We should be screaming bloody murder.
We've got a gang of clueless bozos steering our ship of state right
over a cliff, we've got corporate gangsters stealing us blind, and we
can't even clean up after a hurricane much less build a hybrid car.
But instead of getting mad, everyone sits around and nods their heads
when the politicians say, "Stay the course"

Stay the course? You've got to be kidding. This is America , not the
damned "Titanic". I'll give you a sound bite: "Throw all the bums out!"

You might think I'm getting senile, that I've gone off my rocker, and
maybe I have. But someone has to speak up. I hardly recognize this
country anymore.

The most famous business leaders are not the innovators but the guys in
handcuffs. While we're fiddling in Iraq , the Middle East is burning
and nobody seems to know what to do. And the press is waving 'pom
-poms' instead of asking hard questions. That's not the promise of the
" America " my parents and yours traveled across the ocean for.
I've had enough. How about you?

I'll go a step further. You can't call yourself a patriot if you're
not outraged. This is a fight I'm ready and willing to have.
The Biggest "C" is Crisis ! (Iacocca elaborates on nine Cs of leadership, crisis being the fir st.)

Leaders are made, not born. Leadership is forged in times of crisis.
It's easy to sit there with your feet up on the desk and talk theory.
Or send someone else's kids off to war when you've never seen a
battlefield yourself. It's another thing to lead when your world comes
tumbling down.

On September 11, 2001, we needed a strong leader more than any other
time in our history. We needed a steady hand to guide us out of the
ashes. A Hell of a Mess So here's where we stand. We're immersed in a
bloody war with no plan for winning and no plan for leaving. We're
running the biggest deficit in the history of the country. We're
losing the manufacturing edge to Asia , while our once-great companies
are getting slaughtered by health care costs. Gas prices are s kyrocketing,
and nobody in power has a coherent energy policy. Our schools are in
trouble. Our borders are like sieves. The middle class is being squeezed
every which way These are times that cry out for leadership.

But when you look around, you've got to ask:"Where have all the leaders
gone?" Where are the curious, creative communicators? Where are the
people of character, courage, conviction, omnipotence, and common sense?
I may be a sucker for alliteration, but I think you get the point.

Name me a leader who has a better idea for homeland security than making
us take off our shoes in airp orts and throw away our shampoo? We've spent
billions of dollars building a huge new bureaucracy, and all we know how to
do is react to things that have already happened.

Name me one leader who emerged from the crisis of Hurricane Katrina.
Congress has yet to spend a single day evaluating the response to the hurricane,
or demanding accountability for the decisions that were made in the crucial
hours after the storm.

Everyone's hunkering down, fingers crossed, hoping it doesn't happen again.
Now, that's just crazy. Storms happen. Deal with it. Make a plan. Figure out
what you're going to do the next time.

Name me an industry leader who is thinking creatively about how we can restore
our competitive edge in manufacturing. Who would have believed that there
could ever be a time when "The Big Three" referred to Japanese car companies?
How did this happen, and more important, what are we going to do about it?

Name me a government leader who can articulate a plan for paying down the
debit, or solving the energy crisis, or managing the health c are problem.The silence
is deafening. But these are the crises that are eating away at our country and milking the middle class dry.

I have news for the gang in Congress. We didn't elect you to sit on your asses and
do nothing and remain silent while our democracy is being hijacked and our greatness is being replaced with mediocrity.What is everybody so afraid of? That some
bonehead on Fox News will call them a name? Give me a break.
Why don't you guys show some spine for a change?

Had Enough?
Hey, I'm not trying to be the voice of gloom and doom here. I'm trying to light a fire. I'm speaking out because I have hope I believe in America . In my lifetime I've had the privilege of living through some of America 's greatest moments. I've also
experienced some of our worst crises: the "Great Depression", "World War II", the "Korean War", the "Kennedy Assassination", the "Vietnam War", the 1970s oil crisis, and the struggles of recent years culminating with 9/11. If I've learned
one thing, it's this:
"You don't get anywhere by standing on the sidelines waiting for somebody else to take action. Whether it's building a better car or building a better future for our
children, we all have a role to play. That's the challenge I'm raising in this book. It's a call to "Action" for people who, like me, believe in America . It's not too late, but it's getting pretty close. So let's shake off the crap a nd go to work. Let's tell 'em all we've had "enough."

Make your own contribution by sending this to everyone you know and
care about. It's our country, folks; and it's our future. Our future is at stake!

Its definitely not any of these guys 

ASA - Dr. Sacco, 

NSA - Mr. Baranski, 

WSO - Dr. Stephen Davis

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

I know these persons think this is great, but this is just rearranging deck chairs on the Titantic.  Members of the oversight committee really need to get out and talk to survivors. There is nothing here that will prepare for the tsunami of strokes that are going to occur as the last of the baby boomer bulge reach 65. This has been known for 40 years and no one thought far enough ahead to figure out how to stop stroke damage. Other than the lazy F.A.S.T. news releases. 
http://stroke.ahajournals.org/content/early/2013/01/31/STR.0b013e318284056a.full
Analysis on this here:
Stroke: Time Is Still Brain

From various news reports
From Greensburg Daily News

American Stroke Association: Quick action key to stroke treatment

New guidelines recommend therapy within 60 minutes of hospital arrival

Hell, I got tPA within 60 minutes of arrival, 90 minutes total and still look at the massive damage I have. I believe most of that is from the neuronal cascade of death.

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http://mcalesternews.com/features/x503839726/American-Stroke-Association-Quick-action-key-to-stroke-treatment 

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http://www.clarksvilleonline.com/2013/02/03/new-american-stroke-association-guidelines-people-having-stroke-should-get-therapy-within-60-minutes-of-hospital-arrival/ 
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http://niagara-gazette.com/webextra/x964893854/American-Stroke-Association-Quick-action-key-to-stroke-treatment 

Stroke—A Primer from the Dana Foundation

A good explanation but they missed connecting the dots of the Ischemic Cascade to no therapies that stop that cascade. They repeat the simplistic prevention strategy and don't acknowledge that saving neurons is the goal, which is a total failure right now.   
http://www.dana.org/media/detail.aspx?id=37992
I was hoping for some more analysis/strategy on where to go from here before the tsunami of strokes starts hitting the baby boomers. 
Isn't that what the Dana Foundation should be doing?