The Experts below are selected from a list of 142464 Experts worldwide ranked by ideXlab platform
Lauri Bishop - One of the best experts on this subject based on the ideXlab platform.
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sexuality after Stroke Patient counseling preferences
Disability and Rehabilitation, 2013Co-Authors: Joel Stein, Marni Hillinger, Cait Clancy, Lauri BishopAbstract:AbstractPurpose: Sexual dysfunction is common after Stroke, but is frequently not addressed by healthcare providers. The aim of this study was to examine Patient preferences for counseling related to sexuality post-Stroke. Method: Two hundred and sixty-eight Patients from a Stroke registry were provided an anonymous paper or online survey. Thirty-eight Patients responded and completed the survey. The survey included demographic information, and scales of sexual dysfunction, fatigue, depression and functional independence. In addition, we queried subjects about Stroke-related sexual dysfunction and their preferences for counseling and education materials. Results: Most respondents (71%) identified sexuality as a moderately to very important issue in their post-Stroke rehabilitation. Sexual dysfunction was common, with 47% of respondents indicating that their sexual function had declined since the Stroke. Eighty-one percent reported receiving insufficient information about sexuality post-Stroke, and the maj...
Gilberto R Gonzalez - One of the best experts on this subject based on the ideXlab platform.
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low signal high noise and large uncertainty make ct perfusion unsuitable for acute ischemic Stroke Patient selection for endovascular therapy
Journal of NeuroInterventional Surgery, 2012Co-Authors: Gilberto R GonzalezAbstract:Neurointerventionists are on the cusp of revolutionizing the care of the acute ischemic Stroke Patient. The stage is set for a major advance after 2 decades of experience and the development of extraordinarily effective endovascular devices. This advance depends on a clear demonstration of improved Patient outcomes, but the evidence for improved outcomes after endovascular therapy is weak. This was most dramatically demonstrated by the halting of the IMS III trial (ClinicalTrials.gov Identifier: NCT00359424). There is an emerging consensus that the proper selection of Patients for endovascular treatment has been lacking. Patient selection using neuroimaging has not been successful, most likely because ineffective neuroimaging methods have been employed. I have been a strong advocate of using neuroimaging, especially CT perfusion (CTP), for Patient selection. CTP is particularly attractive because it can be obtained immediately after non-contrast CT and C without moving the Patient. But I was wrong. There is now strong evidence that some neuroimaging methods are effective but others are not. I have learned that the evidence is especially strong for the reliability of diffusion MRI and the unreliability of CTP for measuring the size of the infarct core in the individual Patient. In this essay, I review the evidence that led to my current view on the best practices for imaging the Stroke Patient. My hope is that my education may help neurointerventionists maximally benefit their Patients. The greatest opportunity to improve overall outcomes in ischemic Stroke is the successful treatment of Patients with occlusion of major cerebral arteries. The vast majority of these Patients involve occlusion of the proximal middle cerebral artery (MCA), and this condition will be the focus of this essay. Figure 1 illustrates the altered physiology produced by a right MCA occlusion. With occlusion, there is an immediate alteration in cerebral hemodynamics that is simultaneously …
Eric E Smith - One of the best experts on this subject based on the ideXlab platform.
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abstract 12 national surveillance of Stroke quality of care and outcomes using post stratification survey weights on the get with the guidelines Stroke Patient registry
Circulation-cardiovascular Quality and Outcomes, 2020Co-Authors: Boback Ziaeian, Haolin Xu, Roland A Matsouaka, Ying Xian, Yosef Khan, Lee H Schwamm, Gregg C Fonarow, Eric E SmithAbstract:Background: The U.S. lacks an appropriate Stroke surveillance system. This study developed and validated post-stratification weights for an existing Stroke Patient registry to represent the entire ...
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patterns predictors variations and temporal trends in emergency medical service hospital prenotification for acute ischemic Stroke
Journal of the American Heart Association, 2012Co-Authors: Cheryl B Lin, Ying Xian, Eric E Smith, Jeffrey L Saver, Eric D Peterson, Li Liang, Daiwai M Olson, Bimal R Shah, Adrian F Hernandez, Lee H SchwammAbstract:BackgroundEmergency medical services (EMS) hospital prenotification of an incoming Stroke Patient is guideline recommended as a means of increasing the timeliness with which Stroke Patients are eva...
Raf Brouns - One of the best experts on this subject based on the ideXlab platform.
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intravenous thrombolysis with recombinant tissue plasminogen activator in a Stroke Patient treated with dabigatran
Cerebrovascular Diseases, 2010Co-Authors: Ann De Smedt, Sylvie De Raedt, Koenraad Nieboer, Jacques De Keyser, Raf BrounsAbstract:Apixaban is increasingly used in clinical practice (1), but data on the bleeding risk in Patients treated with recombinant tissue plasminogen activator (rt-PA) while taking apixaban are nonexistent. A 74-year-old right-handed man presented with abrupt onset of global aphasia. He was known with a partial right hemianopsia secondary to a left occipital intracerebral hemorrhage five-years earlier and with paroxysmal nonvalvular atrial fibrillation treated with apixaban 5 mg bid. The National Institutes of Health Stroke Scale (NIHSS) score was 8. Noncontrast computed tomography (CT) of the brain showed no signs of acute intracranial pathology. Perfusion-CT revealed hypoperfusion in the territory of the left middle cerebral artery (Fig. 1a). An ostial stenosis of the left internal carotid artery was diagnosed on CT angiography (Fig. 1b). After informed consent by proxy, i.v. rt-PA therapy (0·9 mg/kg; total dose 81 mg) was administered at 4·5 h after symptom onset and 8·5 h after apixaban intake. Platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen levels were normal, as was creatinine clearance. The Patient experienced an excellent recovery (NIHSS score 1) without signs of new infarction or intracranial hemorrhage on repeat CT. As apixaban is commonly used in Patients with elevated Stroke risk (1), therapeutic decision-making with regard to thrombolytic therapy may not uncommonly pose problems in the near future. Our case report illustrates that further study on the safety of rt-PA in this Patient population is justified. Ann De Smedt*, Melissa Cambron, Koenraad Nieboer, Maarten Moens, Robbert-Jan Van Hooff, Laetitia Yperzeele, Kristin Jochmans, Jacques De Keyser, and Raf Brouns
Jeffrey L Saver - One of the best experts on this subject based on the ideXlab platform.
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patterns predictors variations and temporal trends in emergency medical service hospital prenotification for acute ischemic Stroke
Journal of the American Heart Association, 2012Co-Authors: Cheryl B Lin, Ying Xian, Eric E Smith, Jeffrey L Saver, Eric D Peterson, Li Liang, Daiwai M Olson, Bimal R Shah, Adrian F Hernandez, Lee H SchwammAbstract:BackgroundEmergency medical services (EMS) hospital prenotification of an incoming Stroke Patient is guideline recommended as a means of increasing the timeliness with which Stroke Patients are eva...
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comprehensive overview of nursing and interdisciplinary care of the acute ischemic Stroke Patient a scientific statement from the american heart association
Stroke, 2009Co-Authors: Debbie Summers, Anne Leonard, Deidre Wentworth, Jeffrey L Saver, Jo Simpson, Judith Spilker, Nanette Hock, Elaine T Miller, Pamela H MitchellAbstract:Ischemic Stroke represents 87% of all Strokes.1 As worldwide initiatives move forward with Stroke care, healthcare providers and institutions will be called on to deliver the most current evidence-based care. The American Heart Association/American Stroke Association (AHA/ASA) charged a panel of healthcare professionals from several disciplines with developing a practical, comprehensive overview of care for the Patient with acute ischemic Stroke (AIS). This article focuses on educating nursing and allied healthcare professionals about the roles and responsibilities of those who care for Patients with AIS. Nurses play a pivotal role in all phases of care of the Stroke Patient. For the purposes of this article, the writing panel has defined 2 phases of Stroke care: (1) The emergency or hyperacute care phase,2,3 which includes the prehospital setting and the emergency department (ED), and (2) the acute care phase, which includes critical care units, intermediate care units, Stroke units, and general medical units. Stroke is a complex disease that requires the efforts and skills of all members of the multidisciplinary team. Nurses are often responsible for the coordination of care throughout the continuum.4–9 Coordinated care of the AIS Patient results in improved outcomes, decreased lengths of stay, and decreased costs.10 In developing this comprehensive overview, the writing panel applied the rules of evidence and formulation of strength of evidence (recommendations) used by other AHA writing groups11 (Table 1). We also cross-reference other AHA guidelines as appropriate. Table 1. Applying Classification of Recommendations and Levels of Evidence *Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as gender, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. …
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Prehospital care of the acute Stroke Patient.
Techniques in vascular and interventional radiology, 2005Co-Authors: Venkatakrishna Rajajee, Jeffrey L SaverAbstract:Emergency medical services (EMS) is the first medical contact for most acute Stroke Patients, thereby playing a pivotal role in the identification and treatment of acute cerebrovascular brain injury. The benefit of thrombolysis and interventional therapies for acute ischemic Stroke is highly time dependent, making rapid and effective EMS response of critical importance. In addition, the general public has suboptimal knowledge about Stroke warning signs and the importance of activating the EMS system. In the past, the ability of EMS dispatchers to recognize Stroke calls has been documented to be poor. Reliable Stroke identification in the field enables appropriate treatment to be initiated in the field and potentially inappropriate treatment avoided; the receiving hospital to be prenotified of a Stroke Patient's imminent arrival, rapid transport to be initiated; and Stroke Patients to be diverted to Stroke-capable receiving hospitals. In this article we discuss research studies and educational programs aimed at improving Stroke recognition by EMS dispatchers, prehospital personnel, and emergency department (ED) physicians and how this has impacted Stroke treatment. In addition public educational programs and importance of community awareness of Stroke symptoms will be discussed. For example, general public's utilization of 911 system for Stroke victims has been limited in the past. However, it has been repeatedly shown that utilization of the 911 system is associated with accelerated arrival times to the ED, crucial to timely treatment of Stroke Patients. Finally, improved Stroke recognition in the field has led investigators to study in the field treatment of Stroke Patients with neuroprotective agents. The potential impact of this on future of Stroke treatment will be discussed.
