Journal ArticleDOI
Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial
Silke Walter,Panagiotis Kostopoulos,Anton Haass,Isabel Keller,Martin Lesmeister,Thomas Schlechtriemen,Christian L. Roth,Panagiotis Papanagiotou,Iris Q. Grunwald,Helmut Schumacher,Stephan Helwig,Julio Viera,Heiko Körner,Maria Alexandrou,Umut Yilmaz,Karin Ziegler,K.I. Schmidt,Rainer Dabew,Darius Kubulus,Yang Liu,Thomas Volk,Kai Kronfeld,Christian Ruckes,Thomas Bertsch,Wolfgang Reith,Klaus Fassbender +25 more
TLDR
For patients with suspected stroke, treatment by the mobile stroke unit substantially reduced median time from alarm to therapy decision, and the MSU strategy offers a potential solution to the medical problem of the arrival of most stroke patients at the hospital too late for treatment.Abstract:
Summary Background Only 2–5% of patients who have a stroke receive thrombolytic treatment, mainly because of delay in reaching the hospital. We aimed to assess the efficacy of a new approach of diagnosis and treatment starting at the emergency site, rather than after hospital arrival, in reducing delay in stroke therapy. Methods We did a randomised single-centre controlled trial to compare the time from alarm (emergency call) to therapy decision between mobile stroke unit (MSU) and hospital intervention. For inclusion in our study patients needed to be aged 18–80 years and have one or more stroke symptoms that started within the previous 2·5 h. In accordance with our week-wise randomisation plan, patients received either prehospital stroke treatment in a specialised ambulance (equipped with a CT scanner, point-of-care laboratory, and telemedicine connection) or optimised conventional hospital-based stroke treatment (control group) with a 7 day follow-up. Allocation was not masked from patients and investigators. Our primary endpoint was time from alarm to therapy decision, which was analysed with the Mann-Whitney U test. Our secondary endpoints included times from alarm to end of CT and to end of laboratory analysis, number of patients receiving intravenous thrombolysis, time from alarm to intravenous thrombolysis, and neurological outcome. We also assessed safety endpoints. This study is registered with ClinicalTrials.gov, number NCT00792220. Findings We stopped the trial after our planned interim analysis at 100 of 200 planned patients (53 in the prehospital stroke treatment group, 47 in the control group), because we had met our prespecified criteria for study termination. Prehospital stroke treatment reduced the median time from alarm to therapy decision substantially: 35 min (IQR 31–39) versus 76 min (63–94), p Interpretation For patients with suspected stroke, treatment by the MSU substantially reduced median time from alarm to therapy decision. The MSU strategy offers a potential solution to the medical problem of the arrival of most stroke patients at the hospital too late for treatment. Funding Ministry of Health of the Saarland, Germany, the Werner-Jackstadt Foundation, the Else-Kroner-Fresenius Foundation, and the Rettungsstiftung Saar.read more
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National Institute of Neurological Disorders and Stroke
Milton Budoff,Tamara J. Martin +1 more
TL;DR: Marmosets are poised to be a central player to advance the core mission of the NINDS, as their brains retain the typical anatomical and functional organization of the primate brain and the species exhibits the breadth of cognitive sophistication that distinguishes primates from other taxonomic groups.
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Interactive telemedicine: effects on professional practice and health care outcomes
TL;DR: The effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care compared with usual care alone are assessed to improve patient health outcomes, access to health care and reduce healthcare costs.
Journal ArticleDOI
Effect of the Use of Ambulance-Based Thrombolysis on Time to Thrombolysis in Acute Ischemic Stroke: A Randomized Clinical Trial
Martin Ebinger,Benjamin Winter,Matthias Wendt,Joachim E. Weber,Carolin Waldschmidt,Michal Rozanski,Alexander Kunz,Peter M. Koch,Philipp A. Kellner,Daniel Gierhake,Kersten Villringer,Jochen B. Fiebach,Ulrike Grittner,Andreas Hartmann,Bruno-Marcel Mackert,Matthias Endres,Heinrich J. Audebert +16 more
TL;DR: Compared with usual care, the use of ambulance-based thrombolysis resulted in decreased time to treatment without an increase in adverse events.
Journal ArticleDOI
Microwave-Based Stroke Diagnosis Making Global Prehospital Thrombolytic Treatment Possible
Mikael Persson,Andreas Fhager,Hana Dobsicek Trefna,Yinan Yu,Tomas McKelvey,Göran Pegenius,Jan-Erik Karlsson,Mikael Elam +7 more
TL;DR: Two different brain diagnostic devices based on microwave technology and the associated two first proof-of-principle measurements that show that the systems can differentiate hemorrhagic from ischemic stroke in acute stroke patients, as well as differentiate hemoragic patients from healthy volunteers are presented.
Journal ArticleDOI
Stroke Thrombolysis Save a Minute, Save a Day
Atte Meretoja,Mahsa Keshtkaran,Jeffrey L. Saver,Turgut Tatlisumak,Mark W Parsons,Markku Kaste,Stephen M. Davis,Geoffrey A. Donnan,Leonid Churilov +8 more
TL;DR: Realistically achievable small reductions in stroke thrombolysis delays would result in significant and robust average health benefits over patients’ lifetimes, and the awareness of concrete importance of speed could promote practice change.
References
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Journal ArticleDOI
Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.
James C. Grotta,M Kothari,K.M.A. Welch,Joseph P. Broderick,Barbara C. Tilley,Thomas G. Brott,Marler,Patrick D. Lyden,Paul M. O'Byrne +8 more
Journal ArticleDOI
Thrombolysis with Alteplase 3 to 4.5 Hours After Acute Ischemic Stroke
Werner Hacke,Markku Kaste,Erich Bluhmki,Miroslav Brozman,Antoni Dávalos,Donata Guidetti,Vincent Larrue,Kennedy R. Lees,Zakaria Medeghri,Thomas Machnig,Dietmar Schneider,Rüdiger von Kummer,Nils Wahlgren,Danilo Toni +13 more
TL;DR: As compared with placebo, intravenous alteplase administered between 3 and 4.5 hours after the onset of symptoms significantly improved clinical outcomes in patients with acute ischemic stroke; altePlase was more frequently associated with symptomatic intracranial hemorrhage.
Journal ArticleDOI
A multiple testing procedure for clinical trials.
TL;DR: The overall size of the procedure is shown to be controlled with virtually the same accuracy as the single sample chi-square test based on N(m1 + m2) observations and the power is found to bevirtually the same.
Journal ArticleDOI
Thresholds in cerebral ischemia - the ischemic penumbra.
TL;DR: Recent evidence indicates that immediate failure of basic functions such as synaptic transmission, ion pumping and energy metabolism in the ischemic brain, is critically dependent on residual blood flow, and that these functions fail at certain critical flow thresholds.
Journal Article
Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology
Harold P. Adams,Gregory J. del Zoppo,Mark J. Alberts,Deepak L. Bhatt,Lawrence F. Brass,Anthony J. Furlan,Robert L. Grubb,Randall T. Higashida,Edward C. Jauch,Chelsea S. Kidwell,Patrick D. Lyden,Lewis B. Morgenstern,Adnan I Qureshi,Robert H. Rosenwasser,Phillip A. Scott,Eelco F. M. Wijdicks +15 more
TL;DR: The goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke.
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