scholarly journals Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Ali M. Al Khathaami ◽  
Haya Aloraini ◽  
S. Almudlej ◽  
Haifa Al Issa ◽  
Nourhan Elshammaa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Controlled Trial ◽  
Negative Attitude ◽  
Stroke Care ◽  
Emergency Physicians ◽  
Web Based ◽  
Inadequate Knowledge ◽  
Proven Efficacy ◽  
Knowledge And Attitude

Background and Objectives. Tissue plasminogen activator (t-PA) within 4.5 hours from onset improves outcome in patients with ischemic stroke and has been recommended by several international guidelines. Since its approval in 1996, the debate among emergency physicians continues particularly around the result interpretation of the first positive randomized controlled trial, the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial. This lack of consensus might negatively affect the delivery of effective stroke care. Here we aimed to assess the knowledge and attitude of Saudi emergency physicians toward t-PA use within 4.5 hours of onset in acute ischemic stroke. Methods. A web-based, self-administered, locally designed questionnaire was sent to all emergency physicians practicing in the city of Riyadh from January to September 2017. Results. Out of 450 emergency physicians, 122 from ten hospitals in Riyadh participated in the survey, with a 27% response rate. The majority of participants were men (78%), and their mean age was 40 ± 8 years. Half of the participants were board certified, and 36% were consultants. Half of the participants consider the evidence for t-PA use in stroke within 4.5 hours of stroke onset to be controversial, and 41% recommend against its use due to lack of proven efficacy (37%), the risk of hemorrhagic complications (35%), lack of stroke expertise (21%), and medicolegal liability (9%). Nearly half were willing to administer IV t-PA for ischemic stroke in collaboration with remote stroke neurology consultation if telestroke is implemented. Conclusion. Our study detected inadequate knowledge and a negative attitude among Saudi emergency physicians toward t-PA use in acute stroke. This might negatively impact patient outcome. Therefore, we recommend developing urgent strategies to improve emergency physicians’ knowledge, attitudes, and beliefs in the management of acute stroke.

scholarly journals Expert opinion paper on cardiac imaging after ischemic stroke

2021 ◽  
Author(s):  
Renate B. Schnabel ◽  
Stephan Camen ◽  
Fabian Knebel ◽  
Andreas Hagendorff ◽  
Udo Bavendiek ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Expert Opinion ◽  
Cardiac Imaging ◽  
Controlled Trial ◽  
Case Series ◽  
Stroke Care ◽  
Imaging Method ◽  
Cardiac Evaluation ◽  
Magnetic Resonance Imaging Mri ◽  
Ischemic Attack

AbstractThis expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the “Heart and Brain” consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.

scholarly journals Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

2018 ◽  
Vol 13 (9) ◽  
pp. 949-984 ◽  
Author(s):  
JM Boulanger ◽  
MP Lindsay ◽  
G Gubitz ◽  
EE Smith ◽  
G Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Best Practice ◽  
Stroke Care ◽  
Stroke Management ◽  
Practice Recommendations ◽  
Prehospital Emergency ◽  
Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

scholarly journals Recent advances in the management of acute ischemic stroke

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 484 ◽  
Author(s):  
Philip Chang ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Endovascular Intervention ◽  
Anterior Circulation ◽  
Recent Advances ◽  
Select Group ◽  
Technological Advances

In recent years, several landmark trials have transformed acute ischemic stroke care. The most dramatic results from the field of acute endovascular intervention demonstrate unequivocal benefit for a select group of patients with moderate to severe deficits presenting within 7 hours from onset and with occlusions of proximal arteries in the anterior circulation. In addition, technological advances and workflow efficiencies have facilitated more rapid delivery of acute stroke interventions. This review provides an overview of recent advances in the management of acute ischemic stroke.

scholarly journals tPA for Acute Ischemic Stroke and Its Controversies: A Review

2019 ◽  
Vol 10 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Brian Dewar ◽  
Michel Shamy
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Historical Context ◽  
Building Blocks ◽  
Medical Community ◽  
Emergency Physicians ◽  
Historical Sources ◽  
Historical Building ◽  
Intravenous Tissue Plasminogen Activator

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.

scholarly journals Effectiveness of home rehabilitation for ischemic stroke

2009 ◽  
Vol 1 (1) ◽  
pp. 36 ◽  
Author(s):  
Pakaratee Chaiyawat ◽  
Kongkiat Kulkantrakorn ◽  
Paskorn Sritipsukho
Keyword(s):  
Ischemic Stroke ◽  
Controlled Trial ◽  
Intervention Group ◽  
Stroke Care ◽  
Rehabilitation Program ◽  
Outcome Data ◽  
Depression Score ◽  
Control Group ◽  
Acute Stroke Care ◽  
Middle Cerebral Artery Infarction

The objective of this study was to develop and examine the effectiveness of an individual home rehabilitation program for patients with ischemic stroke. This was a randomized controlled trial in 60 patients with recent middle cerebral artery infarction. After hospital discharge for acute stroke care, they were randomly assigned to receive either a home rehabilitation program for three months (intervention group) or usual care (control group). We collected outcome data over three months after their discharge from the hospital. The Barthel Index (BI), the Modified Rankin Scale (MRS), the health-related quality-of-life index (EQ-5D), the Hospital Anxiety and Depression score (HADs), and the Thai Mental State Examination (TMSE) were used to analyze the outcomes. In the intervention group, all outcomes were significantly better (p

Abstract MP22: Sex Differences in the Delivery of Acute Telestroke Care

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Johanna L Morton ◽  
Suraj Didwania ◽  
Eric Anderson ◽  
Jason Hallock
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Patient Population ◽  
Functional Outcomes ◽  
Stroke Care ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Presenting Symptoms ◽  
Suspected Stroke

Background: Sex differences are encountered in many aspects of ischemic stroke, including risk factors, presenting symptoms, stroke mechanism, acute interventions and functional outcomes. As telestroke services continue to expand, many patients utilize telestroke for the evaluation and treatment of suspected stroke symptoms. To date, the existence of such differences between sexes has not been identified in the patient population having utilized telestroke for acute stroke care. Methods: A retrospective observational study of the experience of a single teleneurology practice serving 340 hospitals from April 2018 to June 2020 was performed. Patients seen in the emergency department (ED) with a diagnosis of suspected stroke were included. Data from the acute stroke encounter was reported through the current medical record platform. Results: Within the queried period, there were 11,454 male and 11,794 female patients identified as having received ED telestroke evaluation for suspected acute stroke. Males were younger than females (67 vs 70, P <0.01). Males had higher rates of prior stroke, hypertension, diabetes, hyperlipidemia, and coronary disease than females ( P <0.01), while females had higher rates of atrial fibrillation ( P =0.03) and TIA ( P <0.01). Rates of antiplatelet and anticoagulants were higher in males ( P <0.01) than females. There were no differences in time to ED presentation, time to request consult or make a thrombolysis decision, or length of consult. Females had higher stroke severity ( P <0.01) and door-to-needle times ( P <0.01), but lower alteplase rates ( P =0.02) compared to males. Conclusion: This review of a national heterogeneous telestroke patient population is indicative of sex differences in multiple aspects of acute ischemic stroke, most notably in thrombolysis delivered via telestroke. Further investigation into the etiology of such differences is warranted, as well as a survey of functional outcomes. As telemedicine continues to expand in the era of the COVID-19 pandemic, it is imperative that the reasons behind this disparity are investigated.

scholarly journals Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 3147-3155 ◽  
Author(s):  
Mayank Goyal ◽  
Johanna M. Ospel ◽  
Bijoy Menon ◽  
Mohammed Almekhlafi ◽  
Mahesh Jayaraman ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Neuronal Loss ◽  
Treatment Decision ◽  
Stroke Care ◽  
Core Concept ◽  
Vessel Occlusion ◽  
Ischemic Core

Endovascular treatment is a highly effective therapy for acute ischemic stroke due to large vessel occlusion and has recently revolutionized stroke care. Oftentimes, ischemic core extent on baseline imaging is used to determine endovascular treatment-eligibility. There are, however, 3 fundamental issues with the core concept: First, computed tomography and magnetic resonance imaging, which are mostly used in the acute stroke setting, are not able to precisely determine whether and to what extent brain tissue is infarcted (core) or still viable, due to variability in tissue vulnerability, the phenomenon of selective neuronal loss and lack of a reliable gold standard. Second, treatment decision-making in acute stroke is multifactorial, and as such, the relative importance of single variables, including imaging factors, is reduced. Third, there are often discrepancies between core volume and clinical outcome. This review will address the uncertainty in terminology and proposes a direction towards more clarity. This theoretical exercise needs empirical data that clarify the definitions further and prove its value.

scholarly journals Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions

Neurology ◽  
2021 ◽  
Vol 97 (20 Supplement 2) ◽  
pp. S6-S16
Author(s):  
Vasu Saini ◽  
Luis Guada ◽  
Dileep R. Yavagal
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Time Window ◽  
Systems Of Care ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Global Epidemiology

Purpose of the ReviewTo provide an up-to-date review of the incidence of stroke and large vessel occlusion (LVO) around the globe, as well as the eligibility and access to IV thrombolysis (IVT) and mechanical thrombectomy (MT) worldwide.Recent FindingsRandomized clinical trials have established MT with or without IVT as the usual care for patients with LVO stroke for up to 24 hours from symptom onset. Eligibility for IVT has extended beyond 4.5 hours based on permissible imaging criteria. With these advances in the last 5 years, there has been a notable increase in the population of patients eligible for acute stroke interventions. However, access to acute stroke care and utilization of MT or IVT is lagging in these patients.SummaryStroke is the second leading cause of both disability and death worldwide, with the highest burden of the disease shared by low- and middle-income countries. In 2016, there were 13.7 million new incident strokes globally; ≈87% of these were ischemic strokes and by conservative estimation about 10%–20% of these account for LVO. Fewer than 5% of patients with acute ischemic stroke received IVT globally in the eligible therapeutic time window and fewer than 100,000 MTs were performed worldwide in 2016. This highlights the large gap among eligible patients and the low utilization rates of these advances across the globe. Multiple global initiatives are underway to investigate interventions to improve systems of care and bridge this gap.

scholarly journals A cross-sectional study of awareness regarding dog bite and its management in rural community of Maharashtra, India

2020 ◽  
Vol 7 (9) ◽  
pp. 1307
Author(s):  
Mohammed Alqwaifly
Keyword(s):  
Saudi Arabia ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Stroke Treatment

Background: Stroke is a major cause of morbidity and disability worldwide. However, its outcomes have improved in the last few years with advancement in acute stroke treatment, including the use of tissue plasminogen activator (t-PA) within 4.5 hours of onset, which led several international guidelines to adopt it as the standard of care. In this study, authors sought to assess the knowledge, practices, and attitudes of emergency and medicine staff in Qassim, Saudi Arabia toward acute ischemic stroke care.Methods: A quantitative observational cross-sectional study involving 148 physicians from emergency and medicine departments (only three neurologists) was conducted in three main hospitals of the Qassim region, Saudi Arabia. Information was obtained from a self-administered questionnaire. A logistic regression model was used to control for potential confounding factors.Results: Ninety-two percent of participants were aware of t-PA. Eighty-seven percent of participants thought that t-PA was an effective treatment for acute ischemic stroke. Only 20% of participants had given t-PA or participated in the use of t-PA in acute ischemic stroke. Moreover, 64% of participants believed that allowing blood pressure to remain high was the most appropriate action in the first 24 hours in acute ischemic stroke patients who presented outside the t-PA window.Conclusion: Most of the emergency and medicine staff are well informed about t-PA, but the majority of these physicians have never given t-PA or participated in the administration of t-PA to a stroke patient. The main finding here is the positive outlook among emergency and medicine physicians in Qassim toward training in acute stroke care and administering t-PA for stroke, which will positively impact patient outcomes.

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