scholarly journals Building a Mobile Stroke Unit Based on 5G Technology – A Study Protocol

2021 ◽  
Vol 12 ◽  
Author(s):  
Gangfeng Gu ◽  
Junyao Jiang ◽  
Bo Zheng ◽  
Xiao Du ◽  
Ke Huang ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mobile Networks ◽  
Stroke Unit ◽  
Controlled Trial ◽  
Treatment Decision ◽  
Decision Time ◽  
Clinical Trial Registration ◽  
Regular Care ◽  
Mobile Stroke Unit

Background: In-time treatment of acute stroke is critical to saving people’s lives and improving the quality of post-stroke life. A mobile stroke unit (MSU) with fifth-generation (5G) mobile networks strengthens the interaction of patient information and healthcare resources, thereby reducing response times and improving thrombolysis results. However, clinical evidence of better outcomes compared to regular care is still lacking.Method and Design: In this randomized controlled trial, 484 patients with acute stroke are allocated into the MSU and regular care groups. We establish medical records for each patient and conduct a follow-up of 90 days. The primary outcomes are functional results as defined by utility-weighted modified Rankin Scale (uw-mRS) 90 days after the incidence occurred, whereas secondary outcomes include the alarm to CT scan completed time, the alarm to treatment decision time, the alarm to thrombolytic time, quality of life, and symptomatic intracranial hemorrhage combined with NIHSS score as well as cost-effectiveness.Discussion: This study establishes an innovative MSU (based on 5G) to manage acute stroke, comparing its clinical and economic outcomes to regular care and informing decision-makers of the effectiveness of the stroke emergency system.Clinical Trial Registration: [http://www.chictr.org.cn/showproj.aspx?proj=63874], identifier [ChiCTR2000039695].

Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 116-123
Author(s):  
Mathew Cherian ◽  
Pankaj Mehta ◽  
Shriram Varadharajan ◽  
Santosh Poyyamozhi ◽  
Elango Swamiappan ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Retrospective Review ◽  
Stroke Unit ◽  
Care Pathway ◽  
Clinical Care ◽  
Stroke Care ◽  
First Year ◽  
Proof Of Concept ◽  
Mobile Stroke Unit ◽  
Clinical Care Pathway

Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.

scholarly journals The mobile stroke unit and management of acute stroke in rural settings

2018 ◽  
Vol 190 (28) ◽  
pp. E855-E858 ◽  
Author(s):  
Ashfaq Shuaib ◽  
Thomas Jeerakathil
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Mobile Stroke Unit ◽  
Rural Settings

scholarly journals Mobile Stroke Unit in the UK Healthcare System: Avoidance of Unnecessary Accident and Emergency Admissions

2020 ◽  
Vol 49 (4) ◽  
pp. 388-395
Author(s):  
Iris Q. Grunwald ◽  
Daniel J. Phillips ◽  
David Sexby ◽  
Viola Wagner ◽  
Martin Lesmeister ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Hospital Admissions ◽  
Hospital Treatment ◽  
Stroke Patients ◽  
Transient Ischaemic Attacks ◽  
Accident And Emergency ◽  
Mobile Stroke Unit ◽  
The Uk

Background: Acute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay. Objective: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward, and stroke management metrics were assessed. Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40–60). Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.

scholarly journals THE EFFECT OF CAREGIVER EDUCATION PROGRAM ON FUNCTIONAL INDEPENDENCE AND MORTALITY IN FIRST-EVER STROKE

2018 ◽  
Vol 2 (2) ◽  
pp. 57-67
Author(s):  
S.Airiza Ahmad ◽  
Iman Supandiman ◽  
Soemarmo Markam ◽  
Riwanti Estiasari ◽  
Graeme Hankey
Keyword(s):  
Quality Of Life ◽  
Education Program ◽  
Stroke Unit ◽  
Controlled Trial ◽  
Stroke Survivor ◽  
Functional Independence ◽  
Control Group ◽  
Invasive Treatment ◽  
Caregiver Education

Background: At present, the management of stroke focuses not only on the acute stage of saving the penumbra but also on the secondary prevention of managing the potential sequel following stroke, preventing the occurrence of another attack, and improving the quality of life. Continuous role of caregivers in supporting stroke survivor after passing the acute phase is therefore invaluable. Caregiver education program (CEP) was routinely used as a part of discharge plan on acute stroke patients in stroke unit in Indonesia. This study aims to evaluate the effect of CEP as one of stroke rehabilitation modalities using a historical data that still correlated to the practice in stroke unit nowadays. Methods: A single-blinded randomized controlled trial was performed on 172 subjects of first-ever stroke with no other comorbidities and not having invasive treatment on the recruitment time. The subjects were randomly allocated into two groups: a group receiving CEP (n=88) as the experiment group and a control group (n=84). A four-session CEP, held since the second week of admission by interactive discussion using overhead projector and poster, was performed by a neurologist to the caregiver member of experiment group stroke survivor. The outcome of functional independence and mortality on the third month post-onset was assessed using Barthel activity daily living (ADL) index and the mortality report, respectively. Results: No statistical difference was found on the baseline of the two groups. CEP significantly increased the functional independence (RR=1.30, 95% CI 1.03-1.63) of stroke survivor. Despite the insignificant effect on three-month survival, the group receiving CEP had less mortality rate over time. Conclusion: Caregiver education program had a positive outcome on the patient’s functional independence. Thus, it improves the quality of life.

Abstract TP282: Prehospital Acute Stroke Treatment by Critical Care Physicians in a Mobile Stroke Unit

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Karianne Larsen ◽  
Lars H Tveit ◽  
Henriette S Jæger ◽  
Maren R Hov ◽  
Jo Røislien ◽  
...  
Keyword(s):  
Critical Care ◽  
Acute Stroke ◽  
Stroke Unit ◽  
Stroke Treatment ◽  
Mobile Stroke Unit ◽  
Acute Stroke Treatment

Rest or 30-Min Walk as Exercise Intervention (RESTOREX) in Myasthenia Gravis: A Randomized Controlled Trial

2021 ◽  
pp. 1-7
Author(s):  
Usha K. Misra ◽  
Jayantee Kalita ◽  
Varun K. Singh ◽  
Aditya Kapoor ◽  
Abhilasha Tripathi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Randomized Controlled Trial ◽  
Myasthenia Gravis ◽  
Controlled Trial ◽  
Trial Registration ◽  
Clinical Trial Registration ◽  
Randomized Controlled ◽  
Secondary Endpoints

<b><i>Introduction:</i></b> There is a lack of evidence about the usefulness of exercise or rest in myasthenia gravis (MG). This study is aimed to evaluate the efficacy and safety of exercise or rest in MG. <b><i>Methods:</i></b> In a single-center open-labeled randomized controlled trial, the patients with mild to moderate MG were randomized to 30-min walk or rest in addition to the standard treatment. The primary endpoint was 50% improvement in the MG Quality of Life (MG-QOL15), and secondary endpoints were change in the Myasthenic Muscle Score (MMS), MG Activities of Daily Living (MGADL), grip strength, dose of acetylcholine esterase inhibitor and prednisone, 6-min walk test (6MWT), decrement in trapezius on the low-rate repetitive nerve stimulation test, and adverse events. The outcomes were defined at 3 months, by &#x3e;50% improvement in these outcome parameters. <b><i>Results:</i></b> Forty patients with MG were randomized to the exercise or rest arm. The 2 arms were matched for demographic and clinical parameters. The patients in the exercise arm had significantly better QOL evidenced by MG-QOL15 (<i>p =</i> 0.02). The secondary endpoints, distance covered in 6MWT (<i>p =</i> 0.007), were also better in the exercise arm without any adverse event. <b><i>Conclusion:</i></b> Regular exercise for 30 min in mild and moderate MG improves quality of life and walking distance compared to rest and is safe. <b><i>Clinical Trial Registration:</i></b> The clinical trial registration number is CTRI/2019/11/021869.

scholarly journals Variation in quality of acute stroke care by day and time of admission: prospective cohort study of weekday and weekend centralised hyperacute stroke unit care and non-centralised services

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e025366 ◽  
Author(s):  
Mariya Melnychuk ◽  
Stephen Morris ◽  
Georgia Black ◽  
Angus I G Ramsay ◽  
Jeannie Eng ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Performance Standards ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
P Values ◽  
Stroke Units ◽  
Hyperacute Stroke ◽  
Time Of Admission

ObjectiveTo investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units compared with the rest of England.DesignProspective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme.SettingAcute stroke services in London hyperacute stroke units and the rest of England.Participants68 239 patients with a primary diagnosis of stroke admitted between January and December 2014.InterventionsHub-and-spoke model for care of suspected acute stroke patients in London with performance standards designed to deliver uniform access to high-quality hyperacute stroke unit care across the week.Main outcome measures16 indicators of quality of acute stroke care, mortality at 3 days after admission to the hospital, disability at the end of the inpatient spell, length of stay.ResultsThere was no variation in quality of care by day and time of admission to the hospital across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor was there variation in 3-day mortality or disability at hospital discharge (all p values>0.05). Other quality of care measures significantly varied by day and time of admission across the week in London (all p values<0.01). In the rest of England there was variation in all measures by day and time of admission across the week (all p values<0.01), except for mortality at 3 days (p value>0.05).ConclusionsThe London hyperacute stroke unit model achieved performance standards for ‘front door’ stroke care across the week. The same benefits were not achieved by other models of care in the rest of England. There was no weekend effect for mortality in London or the rest of the England. Other aspects of care were not constant across the week in London hyperacute stroke units, indicating some performance standards were perceived to be more important than others.

scholarly journals Early mobilization and quality of life after stroke

Neurology ◽  
2019 ◽  
Vol 93 (7) ◽  
pp. e717-e728
Author(s):  
Toby B. Cumming ◽  
Leonid Churilov ◽  
Janice Collier ◽  
Geoffrey Donnan ◽  
Fiona Ellery ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Usual Care ◽  
Recurrent Stroke ◽  
Controlled Trial ◽  
Early Mobilization ◽  
Care Quality ◽  
Secondary Outcome ◽  
Clinical Trial Registration ◽  
Significant Difference

ObjectiveTo determine whether early and more frequent mobilization after stroke affects health-related quality of life.MethodsA Very Early Rehabilitation Trial (AVERT) was an international, multicenter (56 sites), phase 3 randomized controlled trial, spanning 2006–2015. People were included if they were aged ≥18 years, presented within 24 hours of a first or recurrent stroke (ischemic or hemorrhagic), and satisfied preordained physiologic criteria. Participants were randomized to usual care alone or very early and more frequent mobilization in addition to usual care. Quality of life at 12 months was a prespecified secondary outcome, evaluated using the Assessment of Quality of Life 4D (AQoL-4D). This utility-weighted scale has scores ranging from −0.04 (worse than death) to 1 (perfect health). Participants who died were assigned an AQoL-4D score of 0.ResultsNo significant difference in quality of life at 12 months between intervention (median 0.47, interquartile range [IQR] 0.07–0.81) and usual care (median 0.49, IQR 0.08–0.81) groups was identified (p = 0.86), nor were there any group differences across the 4 AQoL-4D domains. The same lack of group difference in quality of life was observed at 3 months. When cohort data were analyzed (both groups together), quality of life was strongly associated with acute length of stay, independence in activities of daily living, cognitive function, depressive symptoms, and anxiety symptoms (all p < 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age.ConclusionsEarlier and more frequent mobilization after stroke did not influence quality of life.Clinical trial registrationanzctr.org.au; ACTRN12606000185561Classification of evidenceThis study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.

Sign in / Sign up

Export Citation Format

Share Document