Glucagon-Like Receptor-1 Agonists and Stroke: a Systematic Review and Meta-Analysis of Cardiovascular Outcome Trials

 Gee, if you'd write them up as protocols, they'd become standard of care and survivors would benefit. Doesn't anyone in stroke have two functioning neurons to rub together for a spark of intelligence? Since we have NO leadership in stroke you can't hand this off to someone else to accomplish

Glucagon-Like Receptor-1 Agonists and Stroke: a Systematic Review and Meta-Analysis of Cardiovascular Outcome Trials

Anastasia Adamou https://orcid.org/0000-0003-4701-0858 anaadamou@uth.gr, Fotios Barkas, MD https://orcid.org/0000-0002-5940-6895, […], and George Ntaios https://orcid.org/0000-0002-0629-9248+1View all authors and affiliations

Accepted Manuscripts

https://doi.org/10.1177/17474930241253988

• 
  

• • Abstract
• Get access
• • Cite article
  • Share options
  • Information, rights and permissions
  • Metrics and citations

Abstract

Background:

In stroke survivors, approximately 15% and 60% exhibit concurrent diabetes mellitus and overweight/obesity, respectively, necessitating heightened secondary prevention efforts. Despite Glucagon-like receptor-1 agonists (GLP-1 RAs) demonstrating improved outcomes for those with diabetes mellitus or obesity, their underutilization persists among eligible individuals. This systematic review and meta-analysis investigated the impact of GLP-1 RAs on stroke risk. The findings aim to optimize the implementation(Well, then write up and distribute a protocol on this. Writing this research article does nothing! Its been proven stroke hospitals don't keep up-to-date on research!) of this therapeutic strategy in stroke survivors with diabetes mellitus or obesity.

Methods:

Following PRISMA guidelines, we systematically reviewed MEDLINE and Scopus until 15/11/2023. Eligible studies included randomized cardiovascular outcome trials (CVOTs) with individuals, with or without type 2 diabetes, randomized to either GLP-1 RA or placebo. The outcomes were total strokes, non-fatal strokes, and fatal strokes. Analyses were conducted using RevMan 5.4.1.

Results:

Among 1,369 screened studies, 11 were eligible, encompassing 82,140 participants (34.6% women) with a cumulative follow-up of 247,596 person-years. In the GLP-1 RAs group, the stroke rate was significantly lower compared to placebo (RR: 0.85, 95% CI: 0.77-0.93; NNT: 200), showing no heterogeneity or interaction with administration frequency (daily vs. weekly). Additionally, the GLP-1 RAs group exhibited a significantly lower rate of non-fatal strokes compared to placebo (RR: 0.87, 95% CI: 0.79-0.95; NNT: 250), with no heterogeneity or interaction based on administration frequency, route (oral vs subcutaneous), or diabetes presence.

Conclusion:

In this meta-analysis of 11 CVOTs with 82,140 participants, GLP-1 RAs demonstrated a 16% relative reduction in stroke risk compared to placebo. This finding may increase implementation of GLP-1 RAs by stroke specialists in individuals with stroke and comorbid diabetes mellitus or obesity.

Get full access to this article

Editorial: Mechanical thrombectomy and development of new devices: emerging trends in rescue strategies for failed mechanical thrombectomy

All stroke survivors would consider mechanical thrombectomy a failure if they don't get to 100% recovery! Survivors don't believe in the tyranny of low expectations the stroke medical world considers OK.

Editorial: Mechanical thrombectomy and development of new devices: emerging trends in rescue strategies for failed mechanical thrombectomy

Ichiro Yuki^1* Juyu Chueh²

• ¹University of California (UC) Irvine Medical Center, Irvine, CA, United States
• ²School of Medicine, Tufts University, Boston, MA, United States

Editorial on the Research Topic
Mechanical thrombectomy and development of thrombectomy devices

In 2015, a series of randomized trials led to the widespread acceptance of mechanical thrombectomy (MT) as a treatment for patients with acute ischemic stroke. Particularly, MT for large vessel occlusion (LVO) under specific pre-treatment conditions is now considered the standard of care (1).(That standard of care is still a complete failure, not 100% recovery! The operative word there is 'care'; NOT RESULTS OR RECOVERY!)

Meanwhile, clinical investigations have shifted their focus toward expanding treatment indications by exploring the effectiveness of MT in cases with longer treatment time windows, lower pre-treatment ASPECT scores, distal branch occlusions, and posterior circulations. LVO associated with intracranial atherosclerotic disease (ICAD) is one of the actively discussed conditions. Reports indicate that ICAD accounts for 6% (2) to 29.6% (3) of ischemic strokes, with varying prevalence among ethnic backgrounds, being more common in Asian, African-American, and Hispanic populations.

The challenges in treating ICAD-related LVO are 2-fold. Firstly, diagnosing ICAD based on the initial imaging is often technically impossible due to the lack of contrast filling in the target lesion. As a result, interventionalists need to make a decision once partial recanalization of the target lesion is achieved although differentiating between ICAD-related occlusion and occlusion caused by hard clot or arterial dissection can also be challenging. Secondly, ICAD-related occlusions are known to be associated with a higher rate of post-treatment re-occlusion (4). Therefore, the selection of rescue therapies such as Percutaneous Transluminal Angioplasty (PTA), PTA with stenting (PTAS), and/or antiplatelet therapy (Glycoprotein IIB/IIIA inhibitor) plays a crucial role in maximizing treatment efficacy while minimizing post-procedure complications such as symptomatic intracerebral hemorrhage (sICH).

Numerous non-controlled studies have been conducted to address these issues; however, the optimal timing to shift from MT to PTA/PTAS during the procedure remains unclear. The number of thrombectomy attempts made can provide more convincing evidence of unsuccessful reperfusion/underlying ICAD, but it also raises concerns about intimal damage due to endothelial denudation, vessel perforations or stretching/torsions.

In this Research Topic of Frontiers of Neurology, Deng et al. conducted a retrospective subgroup analysis of the Angel-ACT registry to evaluate the efficacy and safety of PTAS for ICAD-related acute LVO. Of the 1,793 patients enrolled in the Angel-ACT group, 475 patients who met the inclusion criteria were included in the study. The patients were divided into three groups based on treatment methods: (1) Early Rescue Therapy Group: Patients underwent PTA/PTAS after one or no MT attempt, (2) No Rescue Therapy Group: Patients treated only with MT, and (3) Late Rescue Therapy Group: Patients underwent PTA/PTAS after two or more MT attempts.

After propensity score matching, the Early Rescue Therapy group showed better functional outcomes (mRS 0–1) at 90 days compared to the No Rescue Therapy group [adjusted odds ratio (aOR), 0.55, p = 0.01] or Late Rescue Therapy group (aOR 0.39, p = 0.01). There was no difference in the risk of symptomatic intracranial hemorrhage between the groups.

The authors concluded that once ICAD-related LVO is suspected, early decision-making to perform rescue therapy improves the efficacy of treatment without increasing the risk of post-procedural complications. The relatively poor clinical outcome in the Late Rescue Therapy group, which underwent MT attempts of twice or greater before transitioning to PTA/PTAS, was accounted for by (1) the lower reperfusion rate that can lead to prolonged procedure time and (2) more intimal damage causing vasospasm and intraluminal thrombosis.

This article provides a valuable contribution to the field of neuro-interventional practice by addressing another predicament that interventionalists have to face from time to time. The study provided another evidence that early decision making of shifting the procedure from simple MT to the rescue therapy improves the treatment outcomes of patient with ICAD-related-LVO.

The results above is also consistent with a recently performed large-scale study, the SAINT (Stenting and Angioplasty in Neurothrombectomy) study, which is a multicenter retrospective study evaluating the efficacy of rescue intracranial stenting for failed thrombectomy (2).

In our Research Topic, there is another article that delves into the same subject. Authored by Cai et al., the article is titled “Rescue intracranial stenting for acute ischemic stroke after mechanical thrombectomy failure: a systematic review, meta-analysis, and trial sequential analysis.” The authors conducted a meta-analysis and trial sequential analysis of 15 clinical studies (1,595 patients) evaluating the efficacy and safety of rescue stenting for the failed MT. Compared to non-stenting approaches, rescue stenting was associated with better modified Rankin Scale (mRS) scores (0–2), a lower 90-day mortality rate, without increasing the risk of symptomatic intracranial hemorrhage. The trial sequential analysis also confirmed sufficient sample size and statistical power of the meta-analysis concerning mRS scores. Authors concluded that the study supported the use of rescue stenting as an effective and safe treatment for patients with acute ischemic stroke after a failed MT.

As we witness the growing body of positive clinical data regarding the effectiveness of rescue therapy for IACD-related-LVO, it is logical to consider a randomized clinical trial (RCT) as the subsequent phase to gain more clarity on the treatment's clinical advantages. Nevertheless, it is important to exercise caution due to the historical track record of PTA/PTAS for “symptomatic ICAD”, which has been discouraging (5, 6). Recently, another RCT, the CASSIS trial, also failed to show the benefit of PTAS for the treatment of symptomatic severe ICAD (7). Needless to say the “ICAD-related-LVO” and “symptomatic ICAD” are totally different condition. Nevertheless, the occurrence of post-treatment stroke events or deaths within a 1-year timeframe, which range from 8.5 to 19.7% (5, 8), cannot be ignored, and it emphasizes the urgent requirement for new technological advancements or peri-procedural therapies to enhance the safety of the procedure.

The overall efficacy of rescue therapy for failed thrombectomy cases has been improving over the past several years, partially due to the improvement of the peri-procedural antiplatelet therapy. For instance, an increasing number of studies have reported the benefits of utilizing intra-arterial (IA) injection of short-acting IIb/IIIa inhibitors, such as Tirofiban, as a rescue treatment for failed thrombectomy (9). Furthermore, post treatment protocols of antiplatelet therapy have been changing. Interventionalists are now screening patients more frequently using CYP2C19 genetic testing or platelet aggregometry to rule out potential clopidogrel non-responders and proactively using the new-generation antiplatelet agents, such as ticagrelor or prasugrel, which are fast-acting agents with more consistent efficacy compared to the first-generation thienopyridine, clopidogrel. Given that the majority of RCTs in the past were designed to use clopidogrel for post-dual antiplatelet therapy, there is hope that future RCTs may be expected to have better efficacy and safety in the treated arm.

Currently, there are ongoing developments for the ICAD treatment with the introduction of new-generation endovascular stents specifically designed for this condition, including drug-eluting stent systems. Encouraging results have emerged from several clinical studies conducted in China (10). On the other hand, the lack of an appropriate animal model that accurately simulates ICAD poses challenges in conducting preclinical evaluations for these innovative devices. Therefore, there is a pressing need to establish ICAD animal models that effectively replicate post-treatment thromboembolism and in-stent stenosis. By doing so, we can expedite the progress of new device development aimed at treating patients with treatment resistant LVO.

Study of Rivaroxaban for Cerebral Venous Thrombosis: A Randomized Controlled Feasibility Trial Comparing Anticoagulation With Rivaroxaban to Standard-of-Care in Symptomatic Cerebral Venous Thrombosis

Who the fuck are the blithering idiots that are worried about standard of 'care'? Survivors want to know about standard of RESULTS  you fucking idiots! 

When you realize the absolute idiocy in stroke you legitimately get mad. Tell me exactly why I shouldn't be mad!

Study of Rivaroxaban for Cerebral Venous Thrombosis: A Randomized Controlled Feasibility Trial Comparing Anticoagulation With Rivaroxaban to Standard-of-Care in Symptomatic Cerebral Venous Thrombosis

Thalia S. Field,

Vanessa Dizonno,

Mohammed A. Almekhlafi,

Fouzi Bala,

Ibrahim Alhabli,

Hubert Wong,

Monica Norena,

Maria Karina Villaluna,

Princess King-Azote,

Namali Ratnaweera,

… See all authors

and on behalf of the SECRET Investigators

Originally published7 Sep 2023https://doi.org/10.1161/STROKEAHA.123.044113Stroke. 2023;0

Abstract

Background:

Emerging data suggest that direct oral anticoagulants may be a suitable choice for anticoagulation for cerebral venous thrombosis (CVT). However, conducting high-quality trials in CVT is challenging as it is a rare disease with low rates of adverse outcomes such as major bleeding and functional dependence. To facilitate the design of future CVT trials, SECRET (Study of Rivaroxaban for Cerebral Venous Thrombosis) assessed (1) the feasibility of recruitment, (2) the safety of rivaroxaban compared with standard-of-care anticoagulation, and (3) patient-centered functional outcomes.

Methods:

This was a phase II, prospective, open-label blinded-end point 1:1 randomized trial conducted at 12 Canadian centers. Participants were aged ≥18 years, within 14 days of a new diagnosis of symptomatic CVT, and suitable for oral anticoagulation; they were randomized to receive rivaroxaban 20 mg daily, or standard-of-care anticoagulation (warfarin, target international normalized ratio, 2.0–3.0, or low-molecular-weight heparin) for 180 days, with optional extension up to 365 days. Primary outcomes were annual rate of recruitment (feasibility); and a composite of symptomatic intracranial hemorrhage, major extracranial hemorrhage, or mortality at 180 days (safety). Secondary outcomes included recurrent venous thromboembolism, recanalization, clinically relevant nonmajor bleeding, and functional and patient-reported outcomes (modified Rankin Scale, quality of life, headache, mood, fatigue, and cognition) at days 180 and 365.

Results:

Fifty-five participants were randomized. The rate of recruitment was 21.3 participants/year; 57% of eligible candidates consented. Median age was 48.0 years (interquartile range, 38.5–73.2); 66% were female. There was 1 primary event (symptomatic intracranial hemorrhage), 2 clinically relevant nonmajor bleeding events, and 1 recurrent CVT by day 180, all in the rivaroxaban group. All participants in both arms had at least partial recanalization by day 180. At enrollment, both groups on average reported reduced quality of life, low mood, fatigue, and headache with impaired cognitive performance. All metrics improved markedly by day 180.

Conclusions:

Recruitment targets were reached, but many eligible participants declined randomization. There were numerically more bleeding events in patients taking rivaroxaban compared with control, but rates of bleeding and recurrent venous thromboembolism were low overall and in keeping with previous studies. Participants had symptoms affecting their well-being at enrollment but improved over time.

REGISTRATION:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03178864.

• Download figure
• Download PowerPoint

tPA for Acute Ischemic Stroke and Its Controversies: A Review

Do you know that the standard of care using tPA is a complete failure? They define it differently than I do but at an 88% failure rate to get to full recovery sounds like complete failure to me.  The tyranny of low expectations in full display regarding tPA usage. I am a prime example of that failure, I got it in 90 minutes and in total lost 5.5 billion neurons. Under no circumstances can that be called a success of tPA. 

tPA for Acute Ischemic Stroke and Its Controversies: A Review

Brian Dewar MLIS, Michel Shamy, MD, MA, FRCPC

First Published April 14, 2019 Research Article

https://doi.org/10.1177/1941874419838961

Article information

Abstract

Background and Purpose:

Although neurologists consider intravenous tissue plasminogen activator (tPA) to be standard of care in the treatment of patients with acute ischemic stroke, its use remains contentious within the broader medical community, and particularly among emergency physicians. Why might this be? We provide a historical context to this ongoing controversy by reviewing how neurologists have conceptualized the acute stroke and its treatment, with the aim of bridging this gap.

Methods:

Based on historical sources in the Mackie Family History of Neuroscience Collection at the University of Calgary, as well as online resources, we trace the evolution of the concept of the “acute stroke,” which has come to mean a stroke that is potentially treatable with tPA. We frame this conceptualization in relation to historical “building blocks” in anatomy, pathology, and physiology. We then use these building blocks to explain why neurologists understand tPA to be effective and why emergency physicians often do not.

Results and Conclusions:

Arguments against the use of tPA reiterate 20-year-old concerns about its efficacy and safety. We believe these persistent concerns can be framed as a lack of understanding of the “building blocks” upon which neurologists’ conception of tPA is built. Our view suggests that the way forward to bridge the gap between neurology and other disciplines is not to conduct more trials but to offer a shared conceptualization of the trials already completed and of the intellectual tradition from which they emerged.

Keywords stroke, cerebrovascular disorders, education, techniques, epidemiology, techniques, outcomes, techniques

Access Options

tPA for Acute Ischemic Stroke and Its Controversies: A Review

They don't bother telling you that the standard of care of using tPA is a failure to get to complete recovery 88% of the time.  THAT IS COMPLETELY APPALLING.  So they are pushing a failure stroke intervention.  I know they consider reperfusion from tPA a success but I consider that only as the first step.

tPA for Acute Ischemic Stroke and Its Controversies: A Review 

Brian Dewar MLIS, Michel Shamy, MD, MA, FRCPC

First Published April 14, 2019 Research Article

https://doi.org/10.1177/1941874419838961

Article information

Abstract

Background and Purpose:

Although neurologists consider intravenous tissue plasminogen activator (tPA) to be standard of care in the treatment of patients with acute ischemic stroke, its use remains contentious within the broader medical community, and particularly among emergency physicians. Why might this be? We provide a historical context to this ongoing controversy by reviewing how neurologists have conceptualized the acute stroke and its treatment, with the aim of bridging this gap.

Methods:

Based on historical sources in the Mackie Family History of Neuroscience Collection at the University of Calgary, as well as online resources, we trace the evolution of the concept of the “acute stroke,” which has come to mean a stroke that is potentially treatable with tPA. We frame this conceptualization in relation to historical “building blocks” in anatomy, pathology, and physiology. We then use these building blocks to explain why neurologists understand tPA to be effective and why emergency physicians often do not.

Results and Conclusions:

Arguments against the use of tPA reiterate 20-year-old concerns about its efficacy and safety. We believe these persistent concerns can be framed as a lack of understanding of the “building blocks” upon which neurologists’ conception of tPA is built. Our view suggests that the way forward to bridge the gap between neurology and other disciplines is not to conduct more trials but to offer a shared conceptualization of the trials already completed and of the intellectual tradition from which they emerged.

Keywords stroke, cerebrovascular disorders, education, techniques, epidemiology, techniques, outcomes, techniques

View access options

Government and NHS England end of 2007 National Stroke Strategy.

It is quite simple. You write your own stroke strategy based upon solving all these problems in stroke. You want results not processes, or guidelines or standard of care. Hand that strategy to your government and get it implemented. Waiting for the government to do something is fucking useless. You are on your own, solve it yourself. 

Government and NHS England end of 2007 National Stroke Strategy.

An observational study on usual physiotherapy care in a stroke rehabilitation unit

Totally the wrong aim of the study. It should have been what are the results of  usual physiotherapy care. Without knowing that your stroke hospital has no fucking clue what problems need to be corrected.  But it makes their job so much easier if nothing needs to change because they are following the 'standard of care' that is really a total failure. But I'm not medically trained so obviously I'm totally missing the boat about the incompetence in your stroke hospital. Good luck recovering in such an environment. And biased beside by using high functioning patients.
http://www.magonlinelibrary.com/doi/abs/10.12968/ijtr.2016.23.Sup11.S549

Genevieve HendreySenior physiotherapist, Caulfield Hospital and LaTrobe University, Melbourne, Australia Gavin WilliamsSpecialist neurological physiotherapist and research fellow, Epworth Hospital, Australia Ross ClarkSchool of Health and Sports Science, University of the Sunshine Coast, Sippy Downs, Queensland, Australia Anne E HollandClinical chair, physiotherapy, La Trobe University and Alfred Health, Melbourne, Australia

DOI: http://dx.doi.org/10.12968/ijtr.2016.23.Sup11.S549

Published Online: November 09, 2016

• Abstract
• Full Text
• References
• PDF
• PDF Plus

Aim:

To document the range of physiotherapy interventions undertaken by stroke patients with mobility deficits during ‘usual care’ in inpatient rehabilitation.

Methods:

Twenty consecutively admitted adults were approached to participate if they met the inclusion criteria: diagnosis of first stroke with leg weakness; functional ambulation category score ≥3; able to mobilise ≥14 metres on level ground(I couldn't do that for months); and able to provide consent. All individual physiotherapy sessions for each participant were observed for one day. The duration of each therapy session was recorded, as well as the duration and type of specific physiotherapy interventions.

Findings:

Twenty participants (12 males, 8 females; mean ± SD age: 69 ± 20 years) were observed. All participants attended at least one individual session of physiotherapy on the day this study was conducted. Physiotherapy sessions lasted 47.8 ± 7.6 minutes, with an average of 17.9 ± 6.9 minutes spent resting. The most frequently provided therapies were: gait training (10.8 ± 4.7 minutes per session); strength training (8.5 ± 7.0 minutes per session); and balance training (6.2 ± 3.6 minutes per session).

Conclusions:

In this sample of ambulant patients following stroke, inpatient physiotherapy rehabilitation focused on gait training, lower limb strengthening and balance training. Active therapy time was low and long rest periods with no prescribed activity were evident, which suggests therapy time is not optimally utilised in this population.

Physician: Doctors, patients shortchanged by emphasis on population-based standards of care

This standard of care thinking is a main reason why stroke survivors are still screwed by their lack of recovery. That thinking gave us Get With the Guidelines and Joint Commission certification. Neither of which does anything to improve stroke recovery on a continuing basis. Get with the results would be able to rachet up the  solutions by adjusting the results percentage. Since todays tPA full recovery is only 12%, we could increase that goal to 15% in one year and continually increase the goal annually. Actually even that is the wrong goal because it assumes a solution rather than stating what the real requirement is. The real requirement should be: Full recovery from stroke by interventions in the ambulance/emergency room. That way tPA is not assumed to be in the mix. 

Physician: Doctors, patients shortchanged by emphasis on population-based standards of care

In his recent book, “The Finest Traditions of My Calling,” Dr. Abraham Nussbaum, 41, makes the case that doctors and patients alike are being shortchanged by current medical practices that emphasize population-based standards of care rather than individual patient needs and experiences.
Nussbaum, a psychiatrist, is the chief education officer at Denver Health Medical Center and practices on the adult inpatient psychiatric unit there. I recently spoke with him and this is an edited transcript of our conversation.

Q&A at the link.

Acute stroke intervention: a systematic review

If intravenous rtPA remains the standard of care, then most stroke patients getting this are still screwed since it only fully works 12% of the time.

http://www.ncbi.nlm.nih.gov/pubmed/25871671

Prabhakaran S¹, Ruff I¹, Bernstein RA¹.

Author information

Abstract

IMPORTANCE:

Acute ischemic stroke is a major cause of mortality and morbidity in the United States. We review the latest data and evidence supporting catheter-directed treatment for proximal artery occlusion as an adjunct to intravenous thrombolysis in patients with acute stroke.

OBJECTIVE:

To review the pathophysiology of acute brain ischemia and infarction and the evidence supporting various stroke reperfusion treatments.

EVIDENCE REVIEW:

Systematic literature search of MEDLINE databases published between January 1, 1990, and February 11, 2015, was performed to identify studies addressing the role of thrombolysis and mechanical thrombectomy in acute stroke management. Studies included randomized clinical trials, observational studies, guideline statements, and review articles. Sixty-eight articles (N = 108,082 patients) were selected for review.

FINDINGS:

Intravenous thrombolysis is the mainstay of acute ischemic stroke management for any patient with disabling deficits presenting within 4.5 hours from symptom onset. Randomized trials have demonstrated that more patients return to having good function (defined by being independent and having slight disability or less) when treated within 4.5 hours after symptom onset with intravenous recombinant tissue plasminogen activator (IV rtPA) therapy. Mechanical thrombectomy in select patients with acute ischemic stroke and proximal artery occlusions has demonstrated substantial rates of partial or complete arterial recanalization and improved outcomes compared with IV rtPA or best medical treatment alone in multiple randomized clinical trials. Regardless of mode of reperfusion, earlier reperfusion is associated with better clinical outcomes.

CONCLUSIONS AND RELEVANCE:

Intravenous rtPA remains the standard of care for patients with moderate to severe neurological deficits who present within 4.5 hours of symptom onset. Outcomes for some patients with acute ischemic stroke and moderate to severe neurological deficits due to proximal artery occlusion are improved with endovascular reperfusion therapy. Efforts to hasten reperfusion therapy, regardless of the mode, should be undertaken within organized stroke systems of care.

You are going to have to DEMAND the reasons for the 'A' rating. I'm willing to guarantee that it is not based upon objective RESULTS. 30day deaths, tPA full efficacy, 100% recovery. It's up to you to pay it forward and challenge this puffery. With no drilling down into why they are rated this way they will never make it better for the next stroke patients. I'm saying they are basically not measuring the correct results and thus we have absolutely no idea how good they are. Lying by omission of the pertinent facts. 
HAVE THEM PROVE IT WITH RESULTS!
http://www.burytimes.co.uk/news/13875283.Stroke_unit_at_Fairfield_General_Hospital_is_best_performing_in_the_UK/ 

 

Stroke unit at Fairfield General Hospital is best performing in the UK

FAIRFIELD Hospital’s specialist stroke unit has been classed as the best performing in the country.
According to Sentinel Stroke National Audit Programme (SSNAP) data for April to June, gathered by the Royal College of Physicians, the unit achieved an "A" rating for nearly all measures, culminating in a total team rating of "A".
Staff at the hospital’s hyper-acute stroke centre say this result coincides with Pennine Acute Hospitals NHS Trust launching a seven-day stroke service at Fairfield in April as part of the new Greater Manchester model of stroke care.
Dr Khalil Kawafi, consultant physician at the trust said: “The reconfiguration and centralisation of stroke services at the trust has allowed us to simplify the pathway for stroke patients, ensuring that everyone in the north east sector of Greater Manchester gets access to the hyper-acute stroke centre.
"We are proud of our door-to-needle time of 30 to 35 minutes which is a marker of good quality stroke care.(This is called not setting your goal correctly, the bar is set way too low; the goal should be delivery of tPA in the ambulance) I don't give a shit how hard that goal is, that should be the goal.
"Stroke centralisation has ensured that we can deliver the necessary staffing for seven-day care. Having all stroke patients on one site has also reduced the burden of repatriation and freed up valuable ambulance resources.

“This achievement would not have been possible without the support and co-operation of our own radiology and A&E departments at Fairfield Hospital. Now that we have shown we can be one of the best, the challenge is to maintain this standard of care (NOT RESULTS?)for our stroke patients.”

Share article

As part of the new Greater Manchester stroke model, Fairfield provides a dedicated hyper-acute stroke unit together with two, 20-bed dedicated acute/stroke rehabilitation units comprising a full multi-disciplinary team.
The SSNAP clinical audit results are based on 20,049 patients admitted to hospital and 19,754 patients discharged from hospital between April 1 and June 30.

Survey: Patient harm tops hospital’s concern, but most lack proper data to fix it

You could easily prove patient harm to every single stroke patient  by doing MRI scans on a daily basis post-stroke and seeing the progression of the dead area. But your hospital doesn't even know about this problem unless YOU tell them about it. And some typeA personality will eventually sue a stroke hospital for that reason. Standard of care will be unlikely to be a valid defense. 

Survey: Patient harm tops hospital’s concern, but most lack proper data to fix it 

The financial burden of patient harm at the hands of hospitals is likely more than $100 billion annually, but if those same hospitals had access to reliable, real-time data it would go a long way in curbing both harm and costs, according to a new survey.

Pascal Metrics, a Washington, D.C.-based patient safety organization, recently unveiled a white paper detailing the latest obstacles and efforts surrounding patient harm, which could be anything from patient death on the extreme end to an allergic reaction to medications.

Despite the industry-wide shift toward electronic medical records and the promise of making the health system more connected, scores of health systems across the U.S lack the technological know-how to best address patient harm, though many would like to, according to Dr. David Classen, chief medical information officer for Pascal Metrics.“For all the money we spent on technology, patient safety is still a huge problem in hospitals as well as ambulatory care in general,” he said, citing a 2011 study by the Institute of Medicine that spurred Pascal to take on the issue. “After all this investment, we still have all this patient harm that is occurring.”

To that end, more than $30 billion has been directed toward electronic health record adoption since 2009, but it’s been a patchwork of systems with varying degrees of success, Dr. Classen said.

Ninety percent of responding hospitals and health systems noted that patient harm is commonly discussed in their healthcare system, yet only 24 percent said they felt their current technologies show detailed harm rates and patterns in their units. That raises the question: Is there enough data to turn conversations into actionable practices that cut down on patient harm?

“Most hospital discussions about patient safety are informed by retrospective data that is reported voluntarily and only detects less than 10 percent of all harm,” said Dr. Classen. “Reducing patient harm must start with clinically reliable data that’s available in real or near-real time, so you can do something about it.”

Can ecstasy treat the agony of PTSD?

If we can't even get marijuana off the Schedule I drug list because our legislators are stupid we'll never get this approved.

And since stroke can cause PTSD(23% chance) your doctor will never stick their head out for a non standard of care to help any stroke patient.

Cannabis Effects on PTSD: Can Smoking Medical Marijuana Reduce Symptoms

The latest here:

Can ecstasy treat the agony of PTSD?

1. Kai Kupferschmidt

For almost 30 years, Rick Doblin has pushed the idea of using the drug MDMA, better known as ecstasy, in psychotherapy. The Multidisciplinary Association for Psychedelic Studies, which he founded, has funded two phase II trials of MDMA to treat post-traumatic stress disorder (PTSD), one with encouraging results, and is supporting several others. Doblin and some other scientists believe the drug may help PTSD patients relive their traumas with a therapist in a safe atmosphere without overwhelming emotions. Swiss neurobiologist Franz Vollenweider says Doblin has a political agenda and lacks the expertise or the money to organize a phase III study.

Read the Full Text

How an iPod Can Fight Alzheimer’s and Dementia

I didn't see any research links documenting this. But so what, what is the dowside or negative side effects? Why isn't your hospital doing this for all stroke patients? Too expensive? Not in the standard of care? It changes the status quo? Your hospital can't figure out a way to charge daily for listening to music?
http://www.thedailybeast.com/articles/2014/07/20/how-an-ipod-can-fight-alzheimer-s-and-dementia.html?

Traumatic Brain Injury in Veterans May Increase Risk of Dementia

With this and your 33% dementia chance post-stroke from an Australian study.  Your doctors should have a defined protocol to prevent that dementia as part of their standard of care.
Good luck finding any doctor who can do something other than the generic crap like;
The generic crap from Harvard 
Or pretty much the same crap from Mayo clinic


http://dgnews.docguide.com/traumatic-brain-injury-veterans-may-increase-risk-dementia?

My suggestions are here:
Dementia prevention 19 ways

Predictors of 30-Day Hospital Readmission Following Ischemic and Hemorrhagic Stroke

And if our doctors would stop all the death and damage going on the first week because of the neuronal cascade of death I bet this factor would be significantly reduced for stroke. But I can guarantee that nothing will be done, we seem to have no one willing to try anything outside the current failure of standard of care. F*cking hey.
http://ajm.sagepub.com/content/early/2014/06/10/1062860614535838.abstract

1. Roy E. Strowd, MD1
2. Starla M. Wise, DO1
3. U. Natalie Umesi, BS1
4. Laura Bishop, DO1
5. Jeffrey Craig, MD2
6. David Lefkowitz, MD1
7. Patrick S. Reynolds, MD1
8. Charles Tegeler, MD1
9. Martinson Arnan, MD1
10. Pamela W. Duncan, PhD1
11. Cheryl D. Bushnell, MD, MHS1

1. ¹Wake Forest School of Medicine, Winston Salem, NC
2. ²Mercy Hospital, Oklahoma City, OK

1. Cheryl D. Bushnell, MD, MHS, Wake Forest Baptist Stroke Center, Department of Neurology, Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, NC 27157. Email: cbushnel@wakehealth.edu

Abstract

Stroke patients have a high rate of 30-day readmission. Understanding the characteristics of patients at high risk of readmission is critical. A retrospective case-control study was designed to determine factors associated with 30-day readmission after stroke. A total of 79 cases with acute ischemic or hemorrhagic strokes readmitted to the same hospital within 30 days were compared with 86 frequency-matched controls. Readmitted patients were more likely to have had ≥2 hospitalizations in the year prior to stroke (21.5% vs 2.3% in controls, P < .001), and in the multivariate model, admission National Institutes of Health Stroke Score (NIHSS; odds ratio [OR] = 1.072; 95% confidence interval [CI] = 1.021-1.126 per 1 point increase; P = .005), prior hospitalizations (OR = 2.205; 95% CI = 1.426-3.412 per admission; P < .001), and absence of hyperlipidemia (OR = 0.444; 95% CI = 0.221-0.894; P = .023) were independently associated with readmission. The research team concludes that admission NIHSS and frequent prior hospitalizations are associated with 30-day readmission after stroke. If validated, these characteristics identify high-risk patients and focus efforts to reduce readmission.

Standardization of Interdisciplinary Clinical Practice and Assessment in Stroke Rehabilitation

Holy shit. You mean we've been complete guinea pigs since forever? Why are our doctors and therapists even asking us to pay them? They are still in  by guess and by golly mode.
http://www.omicsonline.org/standardization-of-interdisciplinary-clinical-practice-and-assessment-in-2329-9096.1000166.pdf
Your medical team can read the complete 7 pages.

Carolyn L Kinney, Megan C Eikenberry, Stephen F Noll, James Tompkins and Joseph Verheijde*

Department of Physical Medicine and Rehabilitation, Mayo Clinic, 13400 E Shea Boulevard, Scottsdale, AZ, 85259, USA

*Corresponding author:

Joseph Verheijde, Department of Physical Medicine and

Rehabilitation, Mayo Clinic, 13400 E Shea Boulevard, Scottsdale, AZ, 85259, USA

Abstract

Medical practice has increasingly focused on providing evidence-based interventions. We describe a process to

standardize the interdisciplinary assessment of patients presenting for rehabilitation after stroke in a single academic

medical center. Multiple assessment tools and outcome measures were reviewed for validity, specificity for stroke

population, ease of administration, and utility in research. Interdisciplinary participation in the review process facilitated

compliance with new documentation requirements. Measurements were incorporated into the electronic medical

record from which an interdisciplinary database was developed for research applications. Clinically, the electronic

medical record documentation is accessible to all healthcare providers in our medical system. Objective data from the

use of quantifiable outcome measures facilitates clinical decision-making, more appropriate goal setting, and provides

opportunities to optimize the value of the care delivered. It creates opportunities for best practices in the rehabilitation

of patients with stroke and contributes to the provision of cost-effective patient care. Quantifiable measures also result

in improved patient and caregiver understanding of patient impairment and progress, and as we observed, increased

patient motivation in therapies. From a research perspective, having an interdisciplinary database in place enhances

opportunities for future collaborative and integrated clinical studies. We posit that broad implementation of the care

strategy outlined, and the database resulting from it, will also facilitate multicenter clinical research opportunities which

will ultimately benefit patients with stroke.