Research indicates there is not enough patient centricity and patient engagement in research protocols for kidney disease.

I haven't seen any calls for stroke survivor involvement in any stroke research. Until that occurs most stroke research is totally fucking useless. All primary measures should be set by survivors.
https://patientengagementhit.com/news/patient-engagement-low-in-patient-centered-research-protocol

Telemedicine decreases time to alteplase administration for stroke

What a pile of shit, totally wrong test for primary measure. It should have been 100% recovery after administration. This is why stroke never gets anywhere, we have no one that is even trying to actually solve the correct problem in stroke. You're screwed along with your children and grandchildren until we get stroke survivors running the stroke associations. 
https://www.healio.com/cardiology/stroke/news/online/%7B845cb641-2220-4017-9fa6-da6fe8d7c89e%7D/telemedicine-decreases-time-to-alteplase-administration-for-stroke?utm_source=selligent&utm_medium=email&utm_campaign=cardiology%20news&m_bt=592835816269

Nguyen-Huynh MN, et al. Stroke. 2017;doi:10.1161/STROKEAHA.117.018413.

December 28, 2017

A novel telemedicine program increased alteplase administration rates and shortened door-to-needle times without an increase in adverse outcomes, according to a study published in Stroke.
“When a stroke happens, minutes matter,” Mai Nguyen-Huynh, MD, MAS, vascular neurologist and research scientist in the division of research at Kaiser Permanente in Oakland, California, said in a press release. “Faster treatment with intravenous [alteplase], which dissolves the stroke-causing clot and restores blood flow to the brain, is strongly associated with better functional outcomes for stroke patients.”

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Researchers analyzed data from 310 patients (mean age, 71 years; 50% women) who received alteplase (Activase, Genentech) before the telemedicine program was implemented and 557 patients (mean age, 74 years; 53% women) who received it after the program was initiated in 21 Kaiser Permanente Northern California hospitals.
The telemedicine program included ambulance prenotification, neurological evaluation, medical history review from electronic medical records, notification of potential transfer for endovascular stroke treatment, alteplase administration in the CT suite and rapid transport to the suite. A teleneurologist was on-call to examine and monitor the patient.
The primary outcome was the door-to-needle time for the administration of alteplase. Secondary outcomes were symptomatic intracranial hemorrhage, rate of alteplase administrations per month and disposition at discharge.
Alteplase administrations increased from 34 per month before implementation to 62 per month once the program was in place (P < .001). Door-to-needle times decreased from 52 minutes to 34 minutes (P < .001).
Alteplase administration times of less than 60 minutes occurred in 87.1% of patients during the program vs. 61% before it was implemented (P < .001). Patients who were treated within 30 minutes increased from 4.2% before the program was initiated to 40.8% after the program started (P < .001).
The rate of symptomatic intracranial hemorrhage was similar before (2.2%) and after (3.8%) the program was in place (P = .29).
“Future studies are needed to better evaluate the long-term sustainability of the intervention and its effect on clinical outcomes, including mortality and long-term disability,” Nguyen-Huynh and colleagues wrote. – by Darlene Dobkowski
Disclosures: The study was funded by the Permanente Medical Group. Nguyen-Huynh reports she received funding from the Permanente Medical Group.

Study finds statins may not be as effective as we thought

Well DUH! Attacking a secondary problem rather that the primary problem - inflammation - is the height of stupidity. Notice that your doctor will key off the words, no history of heart disease, to keep you on statins. Followup study on stroke survivors needed, which will never occur. 

Study finds statins may not be as effective as we thought

Statins, the popular cholesterol-fighting medication, might not be as effective as previously believed in protecting seniors with no history of heart disease, according to a study published Monday. NYU Langone Medical Center researchers looked at 2,867 healthy older adults who were taking statins and found no evidence to suggest they were living any longer as a result, according to findings published in JAMA Internal Medicine. Statins are sold under the generic name Pravastatin and under brand names such as Lipitor, Crestor and Zocor. “Our study argues that the benefits of initiating statins in older patients, particularly those over 75, may not outweigh the risks,” said lead author Dr. Benjamin Han.

MAGIC Post-Stroke Project - Dublin City University

This seems to be a wonderful project, but it is not attacking the primary problem only the secondary problem of delivering support to survivors. If we had ANY stroke leadership at all we would tackle the primary problem; dead and dying neurons as a result of the stroke. Stopping the neuronal cascade of death would help survivors much more than this effort but isn't as photogenic or as easy.

MAGIC Post-Stroke Project - Dublin City University

DCU Business School academics, Professor Regina Connolly and Dr Paul Davis, have been successful in attracting large EU funding in relation to the MAGIC Post-Stroke Project. The project aims to enable significant change in the delivery of health and social care services for patients post stroke.
Over 508,000 EU citizens are in need of post stroke services every year. Due to demographic changes, the health and social care systems are failing to keep pace with demand. The MAGIC Post-Stroke Project has recognised this significant gap associated with the recovery and needs of people post stoke.
“Presently one third of all stroke patients are discharged from hospital with a significant change to life-style, well-being, health status and independence, yet community health and social care services don’t enable patients to make a sufficient recovery post stroke.” said Professor Regina Connolly.
There has been significant progress in developing state of the art technologies to assist patients. However, there has been no system to implement rehabilitative improvement at scale or integrate health and social care services. MAGIC will use pre-commercial procurement to engage industry providers who will be required to compete through several phases of solution development and testing.
Professor Connolly explained: “By working in new ways and by reengineering systems with novel, innovative technology and solutions, we can think differently about our approach to care and improve the well-being of patients, optimising the opportunity for recovery post stroke.”
Dr Paul Davis commented: “MAGIC is an essential and strategically critical programme to modernise health and social care systems to meet demand and to stimulate research, development and innovation which will ultimately help a care team optimise a patient’s recovery.  MAGIC will also stimulate European industry to become a global leader in this innovative field.”
The total cost of the project will be over €5.1 million Euro, with 70 per cent funded by H2020, the EU’s programme for research and innovation. The MAGIC project will run until 2019. Partners include the University of Ulster, the UK Regional Health and Social Care Board, Invest NI and partners in the Czech Republic, Denmark, Finland, Italy, Luxembourg and Spain.

New Alternatives to Statins Add to a Quandary on Cholesterol

A well thought out article on statins.  Except that they still are going after secondary problems rather than the primary one, stopping the inflammation in your arteries that collects cholesterol.
Stopping inflammation would make much more sense, but that won't occur now because statins are a huge profit center for the drug industry.
Video here:
Stopping the original inflammation that starts the process of plaque formation

New Alternatives to Statins Add to a Quandary on Cholesterol 

Well worth being one of the 10 free articles a month you get from the NYTimes.

Doctors have long faced a conundrum in prescribing statins to lower cholesterol and heart attack risk: The drugs are cheap and effective for most people, and large, rigorous clinical trials have found minimal side effects. But as many as 25 percent of those who try them complain of muscle pain. Others stop taking the drugs because, they say, they cause a hazy memory or sleep problems, among other side effects not documented in studies.

Now, with the approval on Thursday of the second in a powerful — and very expensive — new class of cholesterol-lowering drugs, the dilemma confronting doctors just got trickier. Should the people who need to lower their cholesterol, but say they cannot tolerate statins, be prescribed new drugs that cost more than $14,000 a year, potentially adding billions of dollars to the nation’s medical bill?

Doctors say their first responsibility is to patients, but it is hard for them or their patients to forget the price of drugs meant to be taken for a lifetime. The new drugs are approved for use by people with heart disease who cannot control their LDL, the dangerous cholesterol, by other means. Doctors say they try to work with patients to ensure that all who can safely take statins, many of which cost pennies a day, do so, but a substantial portion of patients insist the side effects are too severe.

Mre at link.

Million Hearts Cardiovascular Disease (CVD) Risk Reduction model

I would have to say that providing incentives to lower blood pressure or cholesterol may not really be the best way to lower CVD. That is a secondary measure, you really want a primary measure like heart attack deaths or 30-day stroke deaths.  It is way too easy to game the system this way. The VA hid bad news for years. 

Million Hearts Cardiovascular Disease (CVD) Risk Reduction model 

Medicare providers could could get a bump in their paychecks for keeping patients' heart attack and stroke risks in check, the Centers for Medicare and Medicaid Services announced.
Providers are already paid bonuses for assessing certain cardiovascular metrics, said Darshak Sanghavi, MD, director of the Preventive and Population Health Models Group at the Centers for Medicare and Medicaid Innovation (CMMI).

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"They get paid just a little bit extra if they get your blood pressure under a certain target," he said, and to tackle cholesterol as well as ask about smoking, he added.
While providers do a "relatively good job," with this, the Million Hearts Cardiovascular Disease (CVD) Risk Reduction model aims to reward providers for leveraging these metrics in a meaningful way to actually alter 10-year risk scores.
Sanghavi announced the new payment model during a panel on disease prevention at the Bipartisan Policy Center last week.
Each year, 610,000 people die of heart disease in the U.S. -- that's one in every four deaths -- totaling around $315.4 billion annually, according to the Centers for Disease Control and Prevention Services (CDC), noted the CMS press release.
Using data such as age, gender, ethnicity, smoking habits, cholesterol level, and blood pressure, providers can calculate a score that predicts the likelihood a patient will encounter cardiovascular issues. "In other words, we can see into the future right now and tell you in the next 10 years what is your risk of heart attack or stroke," Sanghavi said.

Medicare providers who participate in the Million Hearts CVD Risk Reduction model will design "modification plans" through mutually agreed upon goals set with their patients, noted the press release. After relaying to a patient his or her risk of cardiovascular diseases, providers suggest interventions such as taking daily medications, quitting smoking, or developing better eating habits and then explaining the pros and cons of each strategy, Sanghavi said.
Providers will be rewarded for the 10-year absolute risk reduction of their practice. The basic premise is to marry the incentives with long-term outcomes, Sanghavi said
The original Million Hearts initiative began under former Health and Human Services Secretary Kathleen Sebelius in 2011. The new model spans 5 years and uses a randomized, control design involving 300,000 Medicare beneficiaries from roughly 720 practices. The providers in the control group will also be paid a monthly per-beneficiary payment. The ultimate aim of the program is to stop 1 million heart attacks and strokes by 2017.