Brain computerized tomography reading in suspected acute ischemic stroke patients: what are essentials for medical students?

Abstract Background Few systematic methods prioritize the image education in medical students (MS). We hope to develop a checklist of brain computerized tomography (CT) reading in patients with suspected acute ischemic stroke (AIS) for MS and primary care (PC) physicians. Methods Our pilot group generated the items indicating specific structures or signs for the checklist of brain CT reading in suspected AIS patients for MS and PC physicians. These items were used in a modified web-based Delphi process using the online software “SurveyMonkey”. In total 15 panelists including neurologists, neurosurgeons, neuroradiologists, and emergency department physicians participated in the modified Delphi process. Each panelist was encouraged to express feedback, agreement or disagreement on the inclusion of each item using a 9-point Likert scale. Items with median scores of 7–9 were included in our final checklist. Results Fifty-two items were initially provided for the first round of the Delphi process. Of these, 35 achieved general agreement of being an essential item for the MS and PC physicians. The other 17 of the 52 items in this round and another two added items suggested by the panelists were further rated in the next round. Finally, 38 items were included in the essential checklist items of brain CT reading in suspected AIS patients for MS and PC physicians. Conclusions We established a reference regarding the essential items of brain CT reading in suspected AIS patients. We hope this helps to minimize malpractice and a delayed diagnosis, and to improve competency-based medical education for MS and PC physicians.

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Interobserver and intraobserver reliabilities of multislice electrocardiogram-gated spiral computerized tomography in evaluating aortic atheroma in patients with acute ischemic stroke

Clinical Imaging ◽

10.1016/j.clinimag.2007.10.001 ◽

2008 ◽

Vol 32 (2) ◽

pp. 109-113 ◽

Cited By ~ 5

Author(s):

Dhruvil J. Pandya ◽

Robert C. Gilkeson ◽

Jose I. Suarez ◽

Robert Tarr ◽

Mark Schluchter ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Computerized Tomography ◽

Aortic Atheroma ◽

Spiral Computerized Tomography

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Whole-brain CT perfusion: reliability and reproducibility of volumetric perfusion deficit assessment in patients with acute ischemic stroke

Neuroradiology ◽

10.1007/s00234-013-1179-0 ◽

2013 ◽

Vol 55 (7) ◽

pp. 827-835 ◽

Cited By ~ 49

Author(s):

Kolja M. Thierfelder ◽

Wieland H. Sommer ◽

Alena B. Baumann ◽

Ernst Klotz ◽

Felix G. Meinel ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Ct Perfusion ◽

Perfusion Deficit ◽

Whole Brain ◽

Brain Ct

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Variability of optic nerve sheath diameter in acute ischemic stroke

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919842982 ◽

2019 ◽

Vol 27 (4) ◽

pp. 223-228 ◽

Cited By ~ 1

Author(s):

Nalan Kozaci ◽

Mustafa Avci ◽

Gulsum Caliskan ◽

Serkan Yuksel

Keyword(s):

Ischemic Stroke ◽

Optic Nerve ◽

Acute Ischemic Stroke ◽

Computerized Tomography ◽

Diffusion Weighted Imaging ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Nerve Sheath ◽

Diffusion Weighted ◽

And Diffusion

Background: Stroke is the third leading cause of death and the first cause of disability in the world. It holds an important place in hospital admissions and health expenses in the industrialized world. Objective: The aim of the study was to evaluate the relationship between optic nerve sheath diameter and the findings of brain computerized tomography scans and brain diffusion-weighted imaging and investigate the variability of optic nerve sheath diameter measured by ultrasonography in acute ischemic stroke. Methods: Patients who had acute ischemic stroke were included in Group A. Healthy adults were included in Group B as the control group. In addition, according to computerized tomography scans and diffusion-weighted imaging findings, Group A was divided into three subgroups. Patients with normal computerized tomography and diffusion-weighted imaging were included in Group 1, patients with normal computerized tomography and ischemic area on diffusion-weighted imaging were included in Group 2, and patients with ischemic area on computerized tomography and diffusion-weighted imaging were included in Group 3. Results: A total of 100 patients were included in Group A and 100 healthy adults included in Group B. The optic nerve sheath diameter values of Groups A and B were 5.4 ± 0.6 and 4.2 ± 0.4 mm (p < 0.001), respectively. The optic nerve sheath diameter cutoff value for detection of acute ischemic stroke was determined as 4.7 mm. The sensitivity and specificity at this cutoff value were determined as 89% and 90%, respectively. According to computerized tomography scans and diffusion-weighted imaging findings, there were 18 patients in Group 1, 56 patients in Group 2, and 26 patients in Group 3. Time from onset of symptoms to presentation to emergency department was shortest in Group 1 (3.0 ± 1.8 h). The widest optic nerve sheath diameter was calculated in Group 3 (optic nerve sheath diameter: 5.7 ± 0.6 mm). Conclusion: This study demonstrates that the optic nerve sheath diameter increases in acute ischemic stroke and it increases earlier than computerized tomography and diffusion-weighted imaging alteration occur. Therefore, optic nerve sheath diameter can be applied to assist the diagnosis of acute ischemic stroke with other imaging techniques with equivocal/negative results and determination of appropriate treatment, especially in cases with normal computerized tomography scan and diffusion-weighted imaging.

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Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20160174 ◽

2017 ◽

Vol 75 (1) ◽

pp. 50-56 ◽

Cited By ~ 8

Author(s):

Octávio Marques Pontes-Neto ◽

Pedro Cougo ◽

Sheila Cristina Ouriques Martins ◽

Daniel G. Abud ◽

Raul G. Nogueira ◽

...

Keyword(s):

Health Care ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Health Care Providers ◽

Cerebrovascular Diseases ◽

Discussion Forums ◽

Care Providers ◽

Web Based ◽

Health Authorities ◽

Public Health Authorities

ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.

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The correlation between brain CT scan and the oxfordshire community stroke project (OCSP) classification in acute ischemic stroke

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/s1052-3057(97)80163-2 ◽

1997 ◽

Vol 6 (6) ◽

pp. 466

Author(s):

Amira R Al-Buhairi ◽

Stephen Phillips ◽

Grant Llewellyn ◽

Mohammed MS Jan

Keyword(s):

Ischemic Stroke ◽

Ct Scan ◽

Acute Ischemic Stroke ◽

Brain Ct ◽

Oxfordshire Community Stroke Project ◽

Brain Ct Scan

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Clinical Significance of Hyperdense Lesions on Non-enhanced Brain CT Obtained Immediately after Arterial Revascularization in Acute Ischemic Stroke Patients

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/1562502 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Changbin Wang ◽

Zudong Yin ◽

Xinyi Zhang ◽

Xiumin Zhao

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Significance ◽

Type I ◽

Type Ii ◽

Contrast Extravasation ◽

Arterial Revascularization ◽

Brain Ct ◽

Type Iii

Purpose. To analyze the characteristics of hyperdense lesions on brain CT conducted immediately after arterial revascularization (AR) in patients with acute ischemic stroke (AIS), track the outcome of those lesions and investigate their clinical significance. Materials and Methods. 97 AIS patients were enrolled in our study. Among them, 52 patients showed hyperdense lesions and were divided into three categories: type I, type II and type III according to the morphologic characteristics of hyperdense lesions. All patients underwent several follow-up CT/MR examinations to visualize the outcomes of the lesions. Results. Among the 52 patients, 22 showed contrast extravasation, 23 displayed contrast extravasation combined with hemorrhagic transformation (HT) and 7 confirmed symptomatic intracranial hemorrhage (SICH) in follow-up CT/MR. Among the without hyperdense lesions group, only 7 converted to hemorrhage, and no SICH occurred. All type I lesions showed contrast extravasation; 23 type II lesions turned to hemorrhage, 2 revealed SICH and 6 were pure contrast extravasation; all of the type III developed into SICH. Conclusion. Hyperdense lesions on non-enhanced brain CT obtained immediately after arterial revascularization (AR) exhibited varying features. Type I indicated a pure contrast extravasation. Type II and type III hyperdense lesions suggested higher incidence of HT, the presence of type III lesions indicated an ominous outcome.

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Development and Validation of a Competency-Based Education Model Suitable for Undergraduate Human Nutrition and Dietetics Training in Uganda: A Modified Delphi Process

10.21203/rs.3.rs-1048815/v1 ◽

2021 ◽

Author(s):

Peterson Kato Kikomeko ◽

Sophie Ochola ◽

Archileo N. Kaaya ◽

Irene Ogada ◽

Tracy Lukiya Birungi ◽

...

Keyword(s):

Focus Group ◽

Needs Assessment ◽

Delphi Process ◽

Human Nutrition ◽

Competency Based Education ◽

Modified Delphi ◽

Competency Based ◽

Nutrition And Dietetics ◽

Competency Domains ◽

The Given

Abstract Background: Competency-based education (CBE) equips health professionals with the requisite competencies for health systems performance. This study aimed to develop and validate a CBE model suitable for teaching Human Nutrition/Human Nutrition and Dietetics (HN/HND) at the undergraduate level in Uganda. Methods: The study was undertaken in two main phases, (1) competency needs assessment and (2) model development and content validation. The later had three iterative stages: a needs assessment results validation workshop; an expert focus group discussion to develop a draft CBE model framework; and consensus development-itself undertaken in two modified Delphi rounds to ascertain participant consensus on the relevance and suitability of the competency domains, subdomains, and statements comprised in the developed draft CBE framework for undergraduate HN/HND training in Uganda. In the modified Delphi process, participants indicated the degree to which they agreed or disagreed with each of the given statements on five-point Likert-type items of strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree as well as the level of training they recommended the given competency statement to be learned. The workshop had 31 participants, the focus group eight, while the first and second Delphi rounds had 70 and 55 participants respectively. Results: In total, seven competency domains, 24 subdomains, and 190 competency statements were developed. Content analysis and analysis of percentage responses for each competency statement were done with participant consensus set at ≥80%. All the seven domains (100%); 22 (91.7%) of the 24 subdomains; and 153 (87.9%) of the 174 analysed competency statements were evaluated as both relevant and suitable for undergraduate HN/HND training and hence included in the validated CBE model. Conclusion: This study evaluated the relevancy and suitability of seven competency domains prevention and management of malnutrition; nutrition in the lifecycle; food security, food safety, agriculture, and livelihoods promotion; ethics and professionalism in nutrition and dietetics; research and data analysis; policy, advocacy, and social and behaviour change communication; and nutrition leadership and management for undergraduate HN/HND training in Uganda. The study recommends translating the developed CBE model into a standard curriculum that can be taught and evaluated.

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