How do you thoroughly wash your hands one-handed to prevent coronavirus transmission?

There is no point in looking for your fucking failures of stroke associations to provide this. It is obvious the response is likely; 'Just fuck off and die'. Your doctor will be no help.  I need to know, going to Madagascar this week and Vienna and northern Italy in April if Italy borders aren't completely closed. We were planning on visiting Balzano, the area between the Lombardy and Veneto regions that are hard hit. I'm healthy and not concerned.

How to prevent coronavirus infection: Wash your hands - Vox

Mayo Clinic Minute: How to properly wash your hands

Damn, I had an excellent comment from Jo, but managed to delete it.  

A Thrombectomy Study With Predictive Analytics End Point

Does your definition of good clinical outcome correspond with your patients? Or are you just assuming that the tyranny of low expectations is good enough? Your patients have to assume that they should just accept your efforts or just fuck off and die?

A Thrombectomy Study With Predictive Analytics End Point

Jens Fiehler

,

Goetz Thomalla

,

Martina Bernhardt

,

Helge Kniep

,

Ansgar Berlis

,

Franziska Dorn

,

Bernd Eckert

,

Andre Kemmling

,

Soenke Langner

,

Luca Remonda

,

Wolfgang Reith

, … Show all Authors

Originally published9 Apr 2019https://doi.org/10.1161/STROKEAHA.119.024858Stroke. 2019;0

Abstract

Background and Purpose—

Using a novel study design with virtual comparators based on predictive modeling, we investigated whether next-generation mechanical thrombectomy devices improve outcomes in patients with ischemic stroke. We hypothesized that this new study design shows that a next-generation mechanical thrombectomy system is superior to intravenous tPA (tissue-type plasminogen activator) therapy (IVT) alone.

Methods—

ERASER (Eric Acute Stroke Recanalization) was an investigator-initiated, prospective, multicenter, single-arm (virtual 2-arm) study that evaluated the effectiveness of a new recanalization device together with a specific intermediate catheter (Embolus Retriever with Interlinked Cages/SOFIA, Microvention) in stroke patients with internal carotid artery or middle cerebral artery occlusions. The primary end point was the volume of saved tissue(Wrong endpoint, should be 100% recovery). Volume of saved tissue was defined as the difference of actual infarct volume and brain volume predicted to develop infarction using a machine learning model based on data from intravenous tPA therapy patients.

Results—

Eighty-one patients were enrolled. The median patient age was 71 years (interquartile range, 61–77). National Institutes of Health Stroke Scale score was 14 (interquartile range, 12–18). The actual infarct volume was smaller than predicted by the intravenous tPA therapy model, with a median volume of saved tissue of 50 mL (interquartile range, 19–103; P<0.0001). Good clinical outcome (modified Rankin Scale, 0–2 at 90 days) was observed in 48 out of 69 (70%). The recanalization rate (Thrombolysis in Cerebral Infarction 2b/3) was 95%.

Conclusions—

ERASER is the first mechanical thrombectomy study with a primary end point based on predictive analytics enabling intraindividual virtual comparisons. The next-generation mechanical thrombectomy method resulted in smaller infarcts than predicted after intravenous tPA therapy alone and showed a high rate of good clinical outcome. The novel study design with virtual comparisons is promising for further application and testing in the neurovascular arena.

Clinical Trial Registration—

URL: https://www.clinicaltrials.gov. Unique identifier: NCT02534701.

Stroke survivor felt ‘lost’ when sent home from hospital

This is a direct result of your doctor and therapists having no clue or protocols to get you 100% recovered. Your doctor needs to come up with solutions and not just tell you to fuck off.  Your doctor will never use those exact words but the result is the same when they have nothing to help you get better.

Stroke survivor felt ‘lost’ when sent home from hospital

Stroke survivor Rosemary Brown described the experience as her brain having the biggest shock of its life Photo: Stroke Association/PA

A stroke survivor has described how she felt lost when she was discharged from hospital.
Rosemary Brown suffered a stroke in 2017 and said while she was grateful for the great care she received in hospital, she felt lost when she was sent home.
She was speaking as the Stroke Association launched a new report at Stormont on Monday which finds stroke survivors in Northern Ireland are struggling to recover.
“My brain had just had the biggest shock of its life and I was feeling shell shocked,” she said.

Stroke survivor Rosemary Brown with her partner Martin Credit: Stroke Association/PA

“I didn’t know where to turn and felt a bit abandoned for a few weeks.
“When I was sent home from hospital I was given a few leaflets but I don’t think my brain could really process that information at the time. It was just all too much.”
The Stroke Association’s Struggling to Recover report finds that around half of all stroke survivors in Northern Ireland feel abandoned when they leave hospital.
It also found they are unable to make a full recovery due to a lack of rehabilitation and on-going support.

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No stroke survivor should be abandoned

Ursula Ferguson, Stroke Association

The report finds that stroke survivors in Northern Ireland receive approximately one third of the recommended 45 minutes of physiotherapy, occupational therapy and speech therapy per day.
Other findings include that 45% of stroke survivors feel abandoned when they leave hospital, 90% feel their emotional needs are not met, 78% feel the care and support they receive at home is poor or very poor and 98% of family carers say they sometimes find it difficult to cope.
Ms Brown added: “Stroke survivors need quick access to physiotherapy and speech therapy which can help them make the best recovery possible.
“Referring people from the health service to services that can help should be as seamless as possible. It should happen automatically so people can get the support they need, instead of waiting too long for help.”
Ahead of the upcoming public consultation on reforming hospital stroke services, the Stroke Association is calling for the creation of an appropriately funded regional stroke pathway to reduce the postcode lottery of stroke care and help all stroke survivors to make the best recovery they can.
Ursula Ferguson, head of stroke support at the Stroke Association, said rehabilitation and long term support for stroke survivors has “long been identified as the Cinderella of stroke services”.
“We cannot enter another decade of unmet need and chronic underfunding of community based stroke care. Everyone affected by stroke in Northern Ireland has the right to make the best possible recovery,” she said.
“No stroke survivor should be abandoned.”
Every year around 4,000 people in Northern Ireland have a stroke or TIA (mini-stroke) and there are around 1,000 stroke related deaths.
There are more than 37,000 stroke survivors in Northern Ireland.

Palliative Care for Hospitalized Patients With Stroke

So let's just give up on those difficult stroke patients. So fuck off and die already.  We already have excluded these difficult patients from clinical research trials because they are just too damned hard to help recover. So when your doctor says you won't recover you may as well prove her/him right and just die already.
http://stroke.ahajournals.org/content/48/9/2534?etoc=

Results From the 2010 to 2012 National Inpatient Sample

Tarvinder Singh, Steven R. Peters, David L. Tirschwell, Claire J. Creutzfeldt

Download PDF

https://doi.org/10.1161/STROKEAHA.117.016893

Stroke. 2017;48:2534-2540

Originally published August 17, 2017

• Article
• Figures & Tables
• Supplemental Materials
• Info & Metrics

Abstract

Background and Purpose—Substantial variability exists in the use of life-prolonging treatments for patients with stroke, especially near the end of life. This study explores patterns of palliative care utilization and death in hospitalized patients with stroke across the United States.

Methods—Using the 2010 to 2012 nationwide inpatient sample databases, we included all patients discharged with stroke identified by International Classification of Diseases-Ninth Revision codes. Strokes were subclassified as ischemic, intracerebral, and subarachnoid hemorrhage. We compared demographics, comorbidities, procedures, and outcomes between patients with and without a palliative care encounter (PCE) as defined by the International Classification of Diseases-Ninth Revision code V66.7. Pearson χ² test was used for categorical variables. Multivariate logistic regression was used to account for hospital, regional, payer, and medical severity factors to predict PCE use and death.

Results—Among 395 411 patients with stroke, PCE was used in 6.2% with an increasing trend over time (P<0.05). We found a wide range in PCE use with higher rates in patients with older age, hemorrhagic stroke types, women, and white race (all P<0.001). Smaller and for-profit hospitals saw lower rates. Overall, 9.2% of hospitalized patients with stroke died, and PCE was significantly associated with death. Length of stay in decedents was shorter for patients who received PCE.

Conclusions—Palliative care use is increasing nationally for patients with stroke, especially in larger hospitals. Persistent disparities in PCE use and mortality exist in regards to age, sex, race, region, and hospital characteristics. Given the variations in PCE use, especially at the end of life, the use of mortality rates as a hospital quality measure is questioned.

Anaemia Negatively Affects Recovery From Traumatic Brain Injuries

The same study should occur in stroke survivors but won't because we have NO stroke leadership or strategy to answer these simple questions. You're screwed and obviously no one cares enough to even attempt to solve all the problems in stroke.  It is pretty much; 'Fuck off and die'. 

Anaemia Negatively Affects Recovery From Traumatic Brain Injuries

 Anaemia can negatively influence the outcomes of patients with traumatic brain injuries, according to a study presented at the recent 84th Annual Meeting of the American Association of Neurological Surgeons (AANS) and published in the journal World Neurosurgery.
“More research is needed to develop treatment protocols for anaemic patients with traumatic brain injuries,” said lead author N. Scott Litofsky, MD, Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, Missouri. “Anaemia occurs when there is a shortage of red blood cells, which causes reduced oxygen flow to vital organs throughout the body. There has been a lack of consensus among physicians regarding the relationship of anaemia and traumatic brain injuries on a patient’s health. Because of this uncertainty, treatment protocols are unclear and inconsistent.”
“Our observational study found that a patient's outcome is worse when he or she is anaemic,” he said.
For the study, the researchers studied the outcomes of 939 patients with traumatic brain injuries with anaemia who were admitted to the Frank L. Mitchell Jr., MD Trauma Center -- a Level I trauma centre that is part of University of Missouri Health Care system. The researchers compared haemoglobin levels of these patients and their outcomes within 1 year of surgery.
Despite also having more severe head and systemic injuries, patients with lower levels of haemoglobin had poorer outcomes. For each increase in haemoglobin of 1 gram above 7 grams per decilitre of blood, the likelihood of a good outcome increased by 33%.
To restore a patient’s haemoglobin level, a patient can receive a blood transfusion, but stored blood may not perform as well as a patient's own blood, and patients may experience allergic reactions or viral infections as a result of the transfusion.
“The purpose of this study is not to propose transfusion guidelines, but rather to show that anaemia can be harmful to patients with traumatic brain injuries,” said Dr. Litofsky. “Now that we have shown that anaemia affects a patient’s recovery, further studies are needed to determine the best way to correct it. The ultimate goal of this research is to help patients recover more quickly from traumatic brain injuries.”
SOURCE: University of Missouri-Columbia

Better detection of concussion in young football players

This should be transferable to detection of TBI and stroke if we had any strategy for stroke or stroke leadership at all. But we don't, so just fuck off and die is the message we are getting from our stroke associations.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=158773&CultureCode=en
Researcher Christian Duval, PhD, and his team have developed a new, simple and non-invasive approach to create a biomechanical and cognitive profile of football players and more quickly and accurately detect concussions in these individuals. Christian Duval and his post-doctoral student Hung Nguyen, PhD, work at the Research Centre of the Institut universitaire de gériatrie de Montréal, which is affiliated with the University of Montreal. They presented their preliminary research findings at the International Congress on Sport Sciences Research and Technology Support, which was held in Lisbon from November 15 to 17.
For their study, Christian Duval's team performed a dual-task assessment using simultaneous biomechanical and cognitive tests to evaluate the players every week. Thanks to a markerless motion capture system, this approach let them establish a unique profile for each person in just seven minutes and detect signs of concussion in a player before the medical team could. Developing such a fast and effective test is critical, as repeated impact on the young brain over time leaves damage similar to that caused by dementia.
“We had the players walk while avoiding obstacles and while executing cognitive tasks. The combination of these two results established each individual's personal signature. Our measurements let us quickly detect concussion symptoms that could go unnoticed by health care professionals or by the young athletes themselves. The test we developed also simulates game situations, because in football, players are stimulated both physically and intellectually,” explained Christian Duval.
In a sport in which many concussions go undetected, this approach could help health care professionals to not only better detect these brain injuries but also systematically monitor all players during the season to detect or monitor those who sustain a concussion to determine when they are ready to get back out on the field.

• Full bibliographic informationLongitudinal Study on the Detection and Evaluation of Onset Mild Traumatic Brain Injury During Dual Motor and Cognitive Tasks, 3rd International Congress on Sport Sciences Research and Technology Support, At Lisbon Portugal, Duval, Christian et al. Nov 19, 2015.