Endovascular thrombectomy - Undergoing procedural sedation vs general anesthesia in acute stroke patients: A systematic review of the literature and single- centre retrospective study

AbstractBackground:Pharmacists have become an integral member of the multidisciplinary team providing clinical patient care in various healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well-established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes.Methods: Study abstracts and full-text articles evaluating the impact of a pharmacist intervention on outcomes in patients with an acute stroke/transient ischemic attack (TIA) or a history of an acute stroke/TIA were identified and a qualitative analysis performed.Results: A total of 20 abstracts and full-text studies were included. The included studies provided evidence supporting pharmacist interventions in multiple settings, including emergency departments, inpatient, outpatient, and community pharmacy settings. In a significant proportion of the studies, pharmacist care was collaborative with other healthcare professionals. Some of the pharmacist interventions included participation in a stroke response team, assessment for thrombolytic use, medication reconciliation, participation in patient rounds, identification and resolution of drug therapy problems, risk-factor reduction, and patient education. Pharmacist involvement was associated with increased use of evidence-based therapies, medication adherence, risk-factor target achievement, and maintenance of health-related quality of life.Conclusions: Available evidence suggests that a variety of pharmacist interventions can have a positive impact on stroke patient outcomes. Pharmacists should be considered an integral member of the stroke patient care team.

Download Full-text

Dysphagia screening tools for acute stroke patients available for nurses: A systematic review

Nursing Practice Today ◽

10.18502/npt.v6i3.1253 ◽

2019 ◽

Author(s):

Isabel de Jesus Oliveira ◽

Liliana Andreia Neves Da Mota ◽

Susana Vaz Freitas ◽

Pedro Lopes Ferreira

Keyword(s):

Systematic Review ◽

Acute Stroke ◽

Methodological Quality ◽

Selection Index ◽

Significant Proportion ◽

Screening Tools ◽

Quality Analysis ◽

Diagnostic Process ◽

Index Test ◽

Stroke Patients

Background & Aim: There is a high incidence of dysphagia after stroke that, depending on the assessment, methodology and time elapsed, can range from 8.1% to 80%. Early and systemic dysphagia screening is associated with a decreased risk of aspiration pneumonia and prevents inadequate hydration/nutrition. The purpose of this systematic review was to identify dysphagia screening tools for acute stroke patients available for nurses validated against reference test. The research question was: which dysphagia screening tools for acute stroke patients available for nurses? Methods & Materials: Three electronic databases were searched from January 2007 to November 2017: on PubMed, Scielo and CINAHL Plus. Two independent reviewers screened all titles and abstracts, assessed methodological quality and extracted data. The methodological quality analysis and evaluation was guided according to four domains: patient selection, index test, reference standard and flow and timing. Divergences between reviewers in data extraction were consensualized through discussion. Results: From the 377 articles retrieved, only three articles met criteria for review: Barnes-Jewish Hospital-Stroke Dysphagia Screen; the Gugging Swallowing Screen and, The Toronto Bedside Swallowing Screening Test. None of the screening tools complies with all psychometric properties, which means that a still significant proportion of patients will be kept nil by mouth without being necessary or that some patients will “fall through the cracks” interrupting the diagnostic process. The tools identified are different from each other, making their comparison impracticable. Conclusion: Due to psychometric proprieties and dietary recommendations adjusted to dysphagia severity, of all available tools, GUSS is a suitable screening tool for nurses in clinical practice.

Download Full-text

Urban-rural differences in the care and outcomes of acute stroke patients: Systematic review

Journal of the Neurological Sciences ◽

10.1016/j.jns.2018.12.021 ◽

2019 ◽

Vol 397 ◽

pp. 63-74 ◽

Cited By ~ 8

Author(s):

Mitchell Dwyer ◽

Sabah Rehman ◽

Thomas Ottavi ◽

Jim Stankovich ◽

Seana Gall ◽

...

Keyword(s):

Systematic Review ◽

Acute Stroke ◽

Stroke Patients ◽

Urban Rural

Download Full-text

Toward a more inclusive paradigm: thrombectomy for stroke patients with pre-existing disabilities

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016783 ◽

2020 ◽

pp. neurintsurg-2020-016783 ◽

Cited By ~ 1

Author(s):

Robert W Regenhardt ◽

Michael J Young ◽

Mark R Etherton ◽

Alvin S Das ◽

Christopher J Stapleton ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Infarct Size ◽

Acute Stroke ◽

Medical History ◽

Coronary Disease ◽

Vulnerable Population ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Endovascular Thrombectomy ◽

Final Infarct Size

BackgroundPersons with pre-existing disabilities represent over one-third of acute stroke presentations, but account for a far smaller proportion of those receiving endovascular thrombectomy (EVT) and thrombolysis. This is despite existing ethical, economic, legal, and social directives to maximize equity for this vulnerable population. We sought to determine associations between baseline modified Rankin Scale (mRS) and outcomes after EVT.MethodsIndividuals who underwent EVT were identified from a prospectively maintained database. Demographics, medical history, presentations, treatments, and outcomes were recorded. Baseline disability was defined as baseline mRS≥2. Accumulated disability was defined as the delta between baseline mRS and absolute 90-day mRS.ResultsOf 381 individuals, 49 had baseline disability (five with mRS=4, 23 mRS=3, 21 mRS=2). Those with baseline disability were older (81 vs 68 years, P<0.0001), more likely female (65% vs 49%, P=0.032), had more coronary disease (39% vs 20%, P=0.006), stroke/TIA history (35% vs 15%, P=0.002), and higher NIH Stroke Scale (19 vs 16, P=0.001). Baseline mRS was associated with absolute 90-day mRS ≤2 (OR=0.509, 95%CI=0.370–0.700). However, baseline mRS bore no association with accumulated disability by delta mRS ≤0 (ie, return to baseline, OR=1.247, 95%CI=0.943–1.648), delta mRS ≤1 (OR=1.149, 95%CI=0.906–1.458), delta mRS ≤2 (OR 1.097, 95% CI 0.869–1.386), TICI 2b–3 reperfusion (OR=0.914, 95%CI=0.712–1.173), final infarct size (P=0.853, β=−0.014), or intracerebral hemorrhage (OR=0.521, 95%CI=0.244–1.112).ConclusionsWhile baseline mRS was associated with absolute 90-day disability, there was no association with accumulated disability or other outcomes. Patients with baseline disability should not be routinely excluded from EVT based on baseline mRS alone.

Download Full-text

Outcome of treatment of Mycobacterium bovis versus Mycobacterium tuberculosis: a retrospective study in Northern Italy and a systematic review of the literature

10.26226/morressier.56d6be70d462b80296c96f1a ◽

2016 ◽

Author(s):

Giorgia Sulis

Keyword(s):

Systematic Review ◽

Mycobacterium Tuberculosis ◽

Retrospective Study ◽

Mycobacterium Bovis ◽

Northern Italy ◽

Review Of The Literature

Download Full-text

Faculty Opinions recommendation of Association of General Anesthesia vs Procedural Sedation With Functional Outcome Among Patients With Acute Ischemic Stroke Undergoing Thrombectomy: A Systematic Review and Meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736694085.793568038 ◽

2019 ◽

Author(s):

Mark Nunnally

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Meta Analysis ◽

Procedural Sedation

Download Full-text

Abstract 2395: Respiratory Muscle Weakness in Acute Stroke Patients

Stroke ◽

10.1161/str.43.suppl_1.a2395 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Ross Pollock ◽

Ged Rafferty ◽

John Moxham ◽

Lalit Kalra

Keyword(s):

Systematic Review ◽

Muscle Strength ◽

Acute Stroke ◽

Muscle Weakness ◽

Respiratory Muscle ◽

Mean Difference ◽

Respiratory Muscle Strength ◽

Inclusion Criteria ◽

Stroke Patients ◽

Respiratory Muscle Weakness

Background: Increased frequency of chest infections in acute stroke patients may be the result of respiratory muscle weakness contributing to a weak cough and poor airway clearance. We undertook a systematic review of studies comparing respiratory muscle strength in acute stroke patients with age-matched controls. Method: A systematic review of literature was performed using the electronic databases Medline, EMBASE, ISI web of knowledge and the Scopus. The key words searched were stroke or cerebrovascular accident in combination with cough, inspiratory, expiratory or respiratory and strength or weakness. Studies were included if they compared stroke patients with age matched controls and measured maximum inspiratory or expiratory mouth pressure (PImax and PEmax) for inspiratory and expiratory muscle strength respectively. Results: The initial search identified 136 articles, 14 of which remained after screening for pre-defined inclusion criteria and removal of duplicates. Eleven were excluded after reviewing abstracts (5 did not assess muscle strength, 5 did not include healthy control group, 1 absolute values could not be obtained). A further study was identified from the reference lists of screened articles. The 4 studies that met inclusion criteria included 121 subjects. Mean PImax ranged from 75-99 cmH 2 O in controls and 37-74 cmH 2 O in stroke patients. (mean difference 41 cmH 2 O, 95% CI 54 to 29 cm H 2 O; P<0.0001). Mean PEmax ranged from 52-89 cm H 2 O in stroke patients and was also reduced compared with age matched controls (mean difference 55 cmH 2 O, 95% CI 61 to 48 cmH 2 O; P<0.0001). ( Fig 1 ). Conclusion: Individual studies and pooled data suggest that respiratory muscle strength is impaired in acute stroke patients. However, these studies are limited by small samples and design heterogeneity. Larger studies are needed to assess the relationship of respiratory muscle weakness with chest infections and clinical outcomes in the acute phase.

Download Full-text