Deans' stroke musings: Stroke Care in Mexico: A Pilot Study of a Multidisciplinary Stroke Care Network

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, August 31, 2022

Stroke Care in Mexico: A Pilot Study of a Multidisciplinary Stroke Care Network

It is immediately obvious what is wrong here. Survivors don't give a fuck about 'care'. They want to know recovery results. GET THERE! Until we get survivors in charge stroke will never have the correct research to solve stroke.

Stroke Care in Mexico: A Pilot Study of a Multidisciplinary Stroke Care Network

Dulce Bonifacio-Delgadillo MD.¹, Julita Orozco-Vázquez MD.², Pablo Cordoba-Santos ³, Angel Solis-Buenfil ⁴, Oscar Hernández-Hernández ⁵, Leonardo Morales-Jaramillo MD.¹, David Timaran-Montenegro MD.¹, Daniela Fuentes-Badillo¹ & Lilia Nuñez-Orozco.¹

¹ Interventional Neuroradiology, Centro Médico Nacional 20 de Noviembre, Mexico City ISSSTE

²Radiology Centro Médico Nacional 20 de Noviembre Mexico City ISSSTE

³ ISSSTE, Emergency Department Hospital Columbia Rivera Osorio Pachuca, Hidalgo, MX

⁴ ISSSTE, Emergency Department Hospital Regional Merida, MX

⁵ ISSSTE, Emergency Department Hospital Dario Fernandez Fierro Mexico City MX

Eight public medical institutions were selected across Mexico city and two small cities to become stroke care facilities (Figure 1). As part of the network, each centre implemented stroke specialist care and a formal stroke pathway for the treatment and follow up of patients.

Two years on, Dr. Dulce Bonifacio, a doctor at one of the chosen centres (Centro Médico Nacional 20 de Noviembre), and team have set out to investigate care quality at each centre. “We wanted to look at how ResISSSTE Cerebro was working at each public medical centre” explained Dr. Dulce Bonifacio. “To do this, we looked at the critical time periods and frequency of reperfusion therapy at each of the eight sites”.

The team prospectively recorded demographics, door-to-imaging, time to neurological assessment, alteplase initiation time and mortality and analysed the data; assessing a total of 118 patients with confirmed stroke who were admitted to the hospital over a period of 26 months

“Patients had a mean age of 68.2 years and just over half were male (53%), with 112 of 118 the confirmed stroke cases ischaemic” explained Dr. Bonifacio. The team found that the median door-to-imaging time was 50 minutes, and for neurological assessment 138 minutes after symptom onset. The overall 30-day mortality rate was 10%. “We also saw that in the 39% of patients treated with alteplase, the median time to thrombolysis after onset of symptoms was 167 minutes” explained said Dr. Dulce Bonifacio.

The team also considered how stroke care differed at each type of institute “Acute Stroke Ready Hospitals had shorter times to neurological assessment and shorter door-to-imaging times, but time-to-thrombolysis was broadly similar across each type of stroke centre” said Dr. Dulce Bonifacio. “Compared to previous research, the current figures suggest that the centres in ResISSSTE Cerebro are doing well in: increasing thrombolysis rates, reducing times to neurological assessment and reducing mortality from stroke”.