Pub Date : 2024-07-25DOI: 10.3389/fstro.2024.1430935
Michelle L. A. Nelson, Evan MacEachern, Marianne Saragosa
Stroke systems of care are grappling with pressures to ensure high-quality, evidence-informed, person-centered services with an emphasis on safe and timely discharge to the person's home and community. The literature describing the need for robust stroke systems has focused on services within the healthcare system, which are predominantly hospital-based and guided by the Medical Model. However, given the long-term nature of stroke recovery and the importance of attending to the challenges of resuming a meaningful life post-stroke, the involvement of community organizations becomes paramount in providing longer term support. This perspective paper explores the engagement of “community” within the context of stroke systems of care. It proposes that the community is both a destination of the pathway and a partner that can help address the ongoing and often unmet needs experienced post-discharge. Through these partnerships and collaborations, we suggest that community organizations can fill service gaps; volunteers could be leveraged to expand the breadth and quality of health and social services to meet the needs of stroke survivors and their families.
{"title":"The important role of community organizations in stroke recovery and reintegration","authors":"Michelle L. A. Nelson, Evan MacEachern, Marianne Saragosa","doi":"10.3389/fstro.2024.1430935","DOIUrl":"https://doi.org/10.3389/fstro.2024.1430935","url":null,"abstract":"Stroke systems of care are grappling with pressures to ensure high-quality, evidence-informed, person-centered services with an emphasis on safe and timely discharge to the person's home and community. The literature describing the need for robust stroke systems has focused on services within the healthcare system, which are predominantly hospital-based and guided by the Medical Model. However, given the long-term nature of stroke recovery and the importance of attending to the challenges of resuming a meaningful life post-stroke, the involvement of community organizations becomes paramount in providing longer term support. This perspective paper explores the engagement of “community” within the context of stroke systems of care. It proposes that the community is both a destination of the pathway and a partner that can help address the ongoing and often unmet needs experienced post-discharge. Through these partnerships and collaborations, we suggest that community organizations can fill service gaps; volunteers could be leveraged to expand the breadth and quality of health and social services to meet the needs of stroke survivors and their families.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"104 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-17DOI: 10.3389/fstro.2024.1393676
M. Charalambous, Rafaella Tereza Symeou, Elena Theodorou, Maria Kambanaros
People with aphasia (PWA) face challenges in sharing personal stories due to communication difficulties. Discourse treatment in aphasia focusing on personal narrative macrostructure has yet to receive the attention this warrants of researchers and clinicians. Emerging person-centered approaches involve coproduction and codesign with PWA for meaningful discourse treatments. Few studies explore discourse treatment's impact on functional communication. This pilot study aims to explore whether the use of the coproduction approach in the development of a multilevel personal narrative intervention at the group level increased the production of macrostructure elements in trained and untrained narrative discourse contexts, improved aphasia severity and functional communication skills, and advanced quality of life of the participants with aphasia.An ABA design was followed featuring a pre-treatment baseline assessment phase, a treatment phase, and a post-treatment assessment phase immediately after treatment was completed. Three people with chronic stroke-induced aphasia, three communication partners, and a moderator took part in the study. All participants were members of a university-led community aphasia communication group. The research protocol consisted of eleven, two-hour, weekly sessions over an 11-week block. Nine treatment sessions were carried out following codesign and coproduction methods that focused on participants with aphasia producing words, sentences, and total communication strategies to express macrostructure elements in their personal stories. Assessment measures were collected at baseline and post-treatment to evaluate improvements in trained and untrained narrative abilities, aphasia severity, functional communication, and the impact of aphasia on quality of life.Multilevel personal narrative therapy improved the narrative skills of the participants with aphasia at the macrostructural level of narrative discourse. Improvements were also observed in functional communication and quality of life post-treatment.The involvement of participants with aphasia in the codesign and coproduction of the treatment content for the group intervention facilitated improvement in narrative skills, functional communication, and overall quality of life with aphasia. It is recommended that researchers and clinicians consider using content from the personal narratives of clients with aphasia to build discourse treatment and adopt codesign and coproduction approaches, when designing interventions for people with chronic aphasia, to improve communication outcomes in everyday life.
{"title":"The coproduction of a multilevel personal narrative intervention for people with aphasia in a community communication support group—A pilot study","authors":"M. Charalambous, Rafaella Tereza Symeou, Elena Theodorou, Maria Kambanaros","doi":"10.3389/fstro.2024.1393676","DOIUrl":"https://doi.org/10.3389/fstro.2024.1393676","url":null,"abstract":"People with aphasia (PWA) face challenges in sharing personal stories due to communication difficulties. Discourse treatment in aphasia focusing on personal narrative macrostructure has yet to receive the attention this warrants of researchers and clinicians. Emerging person-centered approaches involve coproduction and codesign with PWA for meaningful discourse treatments. Few studies explore discourse treatment's impact on functional communication. This pilot study aims to explore whether the use of the coproduction approach in the development of a multilevel personal narrative intervention at the group level increased the production of macrostructure elements in trained and untrained narrative discourse contexts, improved aphasia severity and functional communication skills, and advanced quality of life of the participants with aphasia.An ABA design was followed featuring a pre-treatment baseline assessment phase, a treatment phase, and a post-treatment assessment phase immediately after treatment was completed. Three people with chronic stroke-induced aphasia, three communication partners, and a moderator took part in the study. All participants were members of a university-led community aphasia communication group. The research protocol consisted of eleven, two-hour, weekly sessions over an 11-week block. Nine treatment sessions were carried out following codesign and coproduction methods that focused on participants with aphasia producing words, sentences, and total communication strategies to express macrostructure elements in their personal stories. Assessment measures were collected at baseline and post-treatment to evaluate improvements in trained and untrained narrative abilities, aphasia severity, functional communication, and the impact of aphasia on quality of life.Multilevel personal narrative therapy improved the narrative skills of the participants with aphasia at the macrostructural level of narrative discourse. Improvements were also observed in functional communication and quality of life post-treatment.The involvement of participants with aphasia in the codesign and coproduction of the treatment content for the group intervention facilitated improvement in narrative skills, functional communication, and overall quality of life with aphasia. It is recommended that researchers and clinicians consider using content from the personal narratives of clients with aphasia to build discourse treatment and adopt codesign and coproduction approaches, when designing interventions for people with chronic aphasia, to improve communication outcomes in everyday life.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":" 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141828662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.3389/fstro.2024.1430261
Halvor Naess
A pooled analysis of data from randomized controlled trials showed that thrombolysis is an effective treatment in patients older than 80 years of age with acute ischemic stroke. However, the outcomes in daily clinical practice may differ from those observed in randomized controlled trials. Thus, the present study aimed to compare the short-term outcomes of patients older than 80 years of age with ischemic stroke or transient ischemic attacks (TIA) admitted to Haukeland University Hospital in Norway, examining thrombolysis vs. non-thrombolysis treatment in patients.All patients with acute ischemic stroke or TIA who were older than 80 years of age and admitted to Haukeland University Hospital within the 4.5-h window after stroke onset between 2006 and 2020 were prospectively included in this observational study. Patients who received thrombolysis were compared to patients who did not receive thrombolysis. The endpoint was a modified Rankin Scale (mRS) score on day 7 or discharge if earlier. The National Institutes of Health Stroke Scale (NIHSS) scores were recorded repeatedly during their hospital stays.In total, 808 patients were included. Thrombolysis was given to 393 (49%) patients. In patients with an NIHSS score of <3 (minor ischemic stroke) at admission, thrombolysis was associated with worse short-term outcomes (β = 0.13, p = 0.03), whereas thrombolysis was associated with better short-term outcomes in patients with an NIHSS score of ≥3 (major ischemic stroke) at admission (β = 0.12, p = 0.003). Thrombolysis appeared to be associated with neurological worsening in patients with an NIHSS score of <3 at admission. Excluding patients who underwent a thrombectomy did not change the results.In elderly patients with major ischemic stroke, thrombolysis was associated with better short-term outcomes. However, in patients with minor ischemic stroke, thrombolysis was associated with worse short-term outcomes. Several reasons for this discrepancy are discussed.
{"title":"Is thrombolysis beneficial in elderly patients with minor ischemic stroke?","authors":"Halvor Naess","doi":"10.3389/fstro.2024.1430261","DOIUrl":"https://doi.org/10.3389/fstro.2024.1430261","url":null,"abstract":"A pooled analysis of data from randomized controlled trials showed that thrombolysis is an effective treatment in patients older than 80 years of age with acute ischemic stroke. However, the outcomes in daily clinical practice may differ from those observed in randomized controlled trials. Thus, the present study aimed to compare the short-term outcomes of patients older than 80 years of age with ischemic stroke or transient ischemic attacks (TIA) admitted to Haukeland University Hospital in Norway, examining thrombolysis vs. non-thrombolysis treatment in patients.All patients with acute ischemic stroke or TIA who were older than 80 years of age and admitted to Haukeland University Hospital within the 4.5-h window after stroke onset between 2006 and 2020 were prospectively included in this observational study. Patients who received thrombolysis were compared to patients who did not receive thrombolysis. The endpoint was a modified Rankin Scale (mRS) score on day 7 or discharge if earlier. The National Institutes of Health Stroke Scale (NIHSS) scores were recorded repeatedly during their hospital stays.In total, 808 patients were included. Thrombolysis was given to 393 (49%) patients. In patients with an NIHSS score of <3 (minor ischemic stroke) at admission, thrombolysis was associated with worse short-term outcomes (β = 0.13, p = 0.03), whereas thrombolysis was associated with better short-term outcomes in patients with an NIHSS score of ≥3 (major ischemic stroke) at admission (β = 0.12, p = 0.003). Thrombolysis appeared to be associated with neurological worsening in patients with an NIHSS score of <3 at admission. Excluding patients who underwent a thrombectomy did not change the results.In elderly patients with major ischemic stroke, thrombolysis was associated with better short-term outcomes. However, in patients with minor ischemic stroke, thrombolysis was associated with worse short-term outcomes. Several reasons for this discrepancy are discussed.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141681048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-02DOI: 10.3389/fstro.2024.1426084
Jacob S. Kazmi, J. O'Hara, Amir Gandomi, Jason J. Wang, Maria X. Sanmartin, Bo Yang, P. Sanelli, Jeffrey M. Katz
The management of patients with initially mild acute ischemic stroke (AIS), defined by the National Institutes of Health Stroke Scale (NIHSS) scores 0–5, remains ambiguous despite advances in stroke treatment. The early identification of patients likely to deteriorate is critical in preventing lasting disability.We investigated the frequency and early predictors of poor functional outcomes in AIS patients with large-vessel occlusion (LVO) and initial mild deficits.We performed a retrospective observational study of consecutive AIS patients admitted to a single comprehensive stroke center between 2018 and 2021. The inclusion criteria were a diagnosis of AIS, an arrival NIHSS score of 0–5, imaging-confirmed LVO, and arrival within 24 h of the last-known-well time. The primary outcome was the change in the discharge-modified Rankin Score (ΔmRS) from baseline, categorized as 0–1 (stable outcome) or >1 (poor outcome). Early neurological deterioration was defined as a mean NIHSS score increase of >1 in the first 24-h period. Univariate and multivariable regression analyses were performed. The mean daily NIHSS scores were compared between groups using an analysis of variance (ANOVA).Of 4,410 stroke admissions, 120 patients met the study inclusion criteria, with 71 (59.2%) patients having a ΔmRS of 0–1 and 49 (40.8%) patients having a ΔmRS of > 1. The mean arrival NIHSS score was similar between groups. However, the mean first-24-h NIHSS score was significantly higher in the poor outcome group vs. the stable outcome group (2.13 vs. 0.95, p < 0.001). A demographic-adjusted multivariable logistic regression revealed that a higher mean first-24-h NIHSS score was the sole early predictor of poor outcome (odds ratio [OR] of 1.65 and a 95% confidence interval [CI] of [1.18, 2.48]). The only association with early neurological deterioration was vertebral artery occlusion, with an OR of 0.35 and a 95% CI of [0.14, 0.81]. The trending mean daily NIHSS scores revealed that patients with poor outcomes deteriorate within 24 h, a significant difference from the stable group (p < 0.001).Poor outcomes occurred in a significant proportion of LVO patients with initial mild deficits. The only association was early neurological deterioration. To prevent poor outcomes, rapid identification of any clinical deterioration should prompt consideration of thrombectomy.
{"title":"Outcome in acute ischemic stroke patients with large-vessel occlusion and initial mild deficits","authors":"Jacob S. Kazmi, J. O'Hara, Amir Gandomi, Jason J. Wang, Maria X. Sanmartin, Bo Yang, P. Sanelli, Jeffrey M. Katz","doi":"10.3389/fstro.2024.1426084","DOIUrl":"https://doi.org/10.3389/fstro.2024.1426084","url":null,"abstract":"The management of patients with initially mild acute ischemic stroke (AIS), defined by the National Institutes of Health Stroke Scale (NIHSS) scores 0–5, remains ambiguous despite advances in stroke treatment. The early identification of patients likely to deteriorate is critical in preventing lasting disability.We investigated the frequency and early predictors of poor functional outcomes in AIS patients with large-vessel occlusion (LVO) and initial mild deficits.We performed a retrospective observational study of consecutive AIS patients admitted to a single comprehensive stroke center between 2018 and 2021. The inclusion criteria were a diagnosis of AIS, an arrival NIHSS score of 0–5, imaging-confirmed LVO, and arrival within 24 h of the last-known-well time. The primary outcome was the change in the discharge-modified Rankin Score (ΔmRS) from baseline, categorized as 0–1 (stable outcome) or >1 (poor outcome). Early neurological deterioration was defined as a mean NIHSS score increase of >1 in the first 24-h period. Univariate and multivariable regression analyses were performed. The mean daily NIHSS scores were compared between groups using an analysis of variance (ANOVA).Of 4,410 stroke admissions, 120 patients met the study inclusion criteria, with 71 (59.2%) patients having a ΔmRS of 0–1 and 49 (40.8%) patients having a ΔmRS of > 1. The mean arrival NIHSS score was similar between groups. However, the mean first-24-h NIHSS score was significantly higher in the poor outcome group vs. the stable outcome group (2.13 vs. 0.95, p < 0.001). A demographic-adjusted multivariable logistic regression revealed that a higher mean first-24-h NIHSS score was the sole early predictor of poor outcome (odds ratio [OR] of 1.65 and a 95% confidence interval [CI] of [1.18, 2.48]). The only association with early neurological deterioration was vertebral artery occlusion, with an OR of 0.35 and a 95% CI of [0.14, 0.81]. The trending mean daily NIHSS scores revealed that patients with poor outcomes deteriorate within 24 h, a significant difference from the stable group (p < 0.001).Poor outcomes occurred in a significant proportion of LVO patients with initial mild deficits. The only association was early neurological deterioration. To prevent poor outcomes, rapid identification of any clinical deterioration should prompt consideration of thrombectomy.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141687205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-14DOI: 10.3389/fstro.2024.1382379
S. Masenga, Annet Kirabo
Ischemic stroke is a more common type of stroke and a leading cause of physical disability, cognitive decline, and death worldwide. Events occurring after an ischemic stroke episode determine the severity and outcomes. The NLR family pyrin domain containing 3 (NLRP3) inflammasome has emerged as a major contributor to the pathogenesis of ischemic stroke. Understanding its role in propagating ischemic injury is cardinal for therapeutic interventional research. In this review we summarize the current understanding of the underlying role of the NLRP3 inflammasome as well as highlight the current strides made in targeting the inflammasome as a modality to attenuate the effects of ischemic injury on brain tissue after a stroke event. We found that ischemic stroke initiates a cascade of complex intracellular processes beginning with oxidative stress that activates the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) consequentially activating the NLRP3 inflammasome. The NLRP3 inflammasome initiates inflammatory responses that exacerbate ischemic stroke. We have also briefly summarized the role of genetic susceptibility in stroke and its potential usage in clinical settings. Briefly, genetic mutations encoding the NLRP3 inflammasome are linked to stroke prognosis. A combination of advanced genetic testing and risk stratification based on sociodemographic, dietary, and lifestyle factors is encouraged for stroke prevention. IL-1β and IL-18 antagonists have been shown to inhibit the NLRP3 inflammasome consequently attenuating the adverse effects of ischemic stroke.
{"title":"The NLRP3 inflammasome in ischemic stroke","authors":"S. Masenga, Annet Kirabo","doi":"10.3389/fstro.2024.1382379","DOIUrl":"https://doi.org/10.3389/fstro.2024.1382379","url":null,"abstract":"Ischemic stroke is a more common type of stroke and a leading cause of physical disability, cognitive decline, and death worldwide. Events occurring after an ischemic stroke episode determine the severity and outcomes. The NLR family pyrin domain containing 3 (NLRP3) inflammasome has emerged as a major contributor to the pathogenesis of ischemic stroke. Understanding its role in propagating ischemic injury is cardinal for therapeutic interventional research. In this review we summarize the current understanding of the underlying role of the NLRP3 inflammasome as well as highlight the current strides made in targeting the inflammasome as a modality to attenuate the effects of ischemic injury on brain tissue after a stroke event. We found that ischemic stroke initiates a cascade of complex intracellular processes beginning with oxidative stress that activates the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) consequentially activating the NLRP3 inflammasome. The NLRP3 inflammasome initiates inflammatory responses that exacerbate ischemic stroke. We have also briefly summarized the role of genetic susceptibility in stroke and its potential usage in clinical settings. Briefly, genetic mutations encoding the NLRP3 inflammasome are linked to stroke prognosis. A combination of advanced genetic testing and risk stratification based on sociodemographic, dietary, and lifestyle factors is encouraged for stroke prevention. IL-1β and IL-18 antagonists have been shown to inhibit the NLRP3 inflammasome consequently attenuating the adverse effects of ischemic stroke.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141344805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-06DOI: 10.3389/fstro.2024.1381930
Thomas Devlin, Lan Gao, Oleg Collins, Gregory W Heath, Morgan Figurelle, Amanda Avila, Caitlyn Boyd, Hira Ayub, Theresa Sevilis
Thousands of hospitals worldwide have adopted mobile artificial intelligence (AI)-based stroke care coordination platforms. Studies exploring the benefit of these platforms have been scrutinized due to small sample size, serial cohort design, and measurement of metrics with multiple determinants. In this large multi-center study, we evaluated the ability of an AI-based stroke care coordination platform to expedite contact with the interventionalist (NIR) for potential thrombectomy.Acute stroke consultations seen by TeleSpecialists, LLC physicians at 166 facilities (17 states) utilizing Viz.ai software (AI) vs. no AI software (non-AI) were extracted from the TeleCare by TeleSpecialists™ database from December 1, 2021, through March 31, 2022. The primary outcome was time from patient arrival to first contact with the interventionalist to discuss need for potential thrombectomy (Arrival-to-NIR notification).A total of 14,116 cases were analyzed. Compared to the non-AI cohort, Arrival-to-NIR notification in the AI cohort was: (1) 39.5 min faster (44.13% reduction, p < 0.001) in the overall analysis; (2) 33.0 min faster (34.0% reduction, p < 0.001) in the non-thrombectomy (non-TC) facility subgroup analysis; and (3) 34.0 min faster (43.59% reduction, p < 0.001) in the thrombectomy capable (TC) facility subgroup analysis. IQR range comparison demonstrated a significant improvement in uniformity of stroke workflow across all AI subgroups. Significant, albeit small, confounding biases were revealed in the data. The presence of AI within the non-TC subgroup correlated with a lower acceptance rate for thrombectomy by the NIR (delta = −10.79% absolute and 23.17% relative reduction, p < 0.0001).While this study was limited by our inability to capture detailed neuroimaging timelines and patient outcomes, it suggests a potential significant benefit of AI-based stroke care coordination platforms and underscores the critical need to development robust “big data” systems to study the effects of AI, and other emerging technologies, on stroke systems of care.
{"title":"VALIDATE—Utilization of the Viz.ai mobile stroke care coordination platform to limit delays in LVO stroke diagnosis and endovascular treatment","authors":"Thomas Devlin, Lan Gao, Oleg Collins, Gregory W Heath, Morgan Figurelle, Amanda Avila, Caitlyn Boyd, Hira Ayub, Theresa Sevilis","doi":"10.3389/fstro.2024.1381930","DOIUrl":"https://doi.org/10.3389/fstro.2024.1381930","url":null,"abstract":"Thousands of hospitals worldwide have adopted mobile artificial intelligence (AI)-based stroke care coordination platforms. Studies exploring the benefit of these platforms have been scrutinized due to small sample size, serial cohort design, and measurement of metrics with multiple determinants. In this large multi-center study, we evaluated the ability of an AI-based stroke care coordination platform to expedite contact with the interventionalist (NIR) for potential thrombectomy.Acute stroke consultations seen by TeleSpecialists, LLC physicians at 166 facilities (17 states) utilizing Viz.ai software (AI) vs. no AI software (non-AI) were extracted from the TeleCare by TeleSpecialists™ database from December 1, 2021, through March 31, 2022. The primary outcome was time from patient arrival to first contact with the interventionalist to discuss need for potential thrombectomy (Arrival-to-NIR notification).A total of 14,116 cases were analyzed. Compared to the non-AI cohort, Arrival-to-NIR notification in the AI cohort was: (1) 39.5 min faster (44.13% reduction, p < 0.001) in the overall analysis; (2) 33.0 min faster (34.0% reduction, p < 0.001) in the non-thrombectomy (non-TC) facility subgroup analysis; and (3) 34.0 min faster (43.59% reduction, p < 0.001) in the thrombectomy capable (TC) facility subgroup analysis. IQR range comparison demonstrated a significant improvement in uniformity of stroke workflow across all AI subgroups. Significant, albeit small, confounding biases were revealed in the data. The presence of AI within the non-TC subgroup correlated with a lower acceptance rate for thrombectomy by the NIR (delta = −10.79% absolute and 23.17% relative reduction, p < 0.0001).While this study was limited by our inability to capture detailed neuroimaging timelines and patient outcomes, it suggests a potential significant benefit of AI-based stroke care coordination platforms and underscores the critical need to development robust “big data” systems to study the effects of AI, and other emerging technologies, on stroke systems of care.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"13 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.3389/fstro.2024.1363140
Sherita N. Chapman, Theandra Madu, N. Dabhi, Jackson A Narrett, N. Roach, Haydon M. Pitchford, Marcus C. Divers, Andrew M. Southerland
Ambulance-based telemedicine is an innovative strategy through which transport time can be used to rapidly and accurately triage stroke patients (i.e., mobile telestroke). The acute phase of stroke is a time-sensitive emergency, and delays in care during this phase worsen outcomes. In this literature review, we analyzed studies that investigated the feasibility and reliability of ambulance based telestroke.We followed PRISMA guidelines to perform a keyword-based search of PubMed, Web of Science, CINHAL, and Academic Search Complete databases. We reviewed references of search-identified articles to screen for additional articles. Articles for inclusion were selected according to author consensus in consideration of the studies' investigation of feasibility, reliability, or validity of ambulance-based telestroke.We identified 67 articles for secondary screening from which 19 articles were selected for full text review. The selected studies reported diverse methods of development, implementation, and assessment of ambulance-based telestroke systems. Although the methods and results varied among these studies, most concluded that the implementation of ambulance based telestroke is feasible.This topical review suggests that ambulance based telestroke is a feasible method for enhanced prehospital stroke care in a variety of settings. Further prospective research is needed to assess the real-world challenges and to identify additional strategies that bolster rapid and accurate prehospital assessment of acute stroke patients.
{"title":"A topical review of the feasibility and reliability of ambulance-based telestroke","authors":"Sherita N. Chapman, Theandra Madu, N. Dabhi, Jackson A Narrett, N. Roach, Haydon M. Pitchford, Marcus C. Divers, Andrew M. Southerland","doi":"10.3389/fstro.2024.1363140","DOIUrl":"https://doi.org/10.3389/fstro.2024.1363140","url":null,"abstract":"Ambulance-based telemedicine is an innovative strategy through which transport time can be used to rapidly and accurately triage stroke patients (i.e., mobile telestroke). The acute phase of stroke is a time-sensitive emergency, and delays in care during this phase worsen outcomes. In this literature review, we analyzed studies that investigated the feasibility and reliability of ambulance based telestroke.We followed PRISMA guidelines to perform a keyword-based search of PubMed, Web of Science, CINHAL, and Academic Search Complete databases. We reviewed references of search-identified articles to screen for additional articles. Articles for inclusion were selected according to author consensus in consideration of the studies' investigation of feasibility, reliability, or validity of ambulance-based telestroke.We identified 67 articles for secondary screening from which 19 articles were selected for full text review. The selected studies reported diverse methods of development, implementation, and assessment of ambulance-based telestroke systems. Although the methods and results varied among these studies, most concluded that the implementation of ambulance based telestroke is feasible.This topical review suggests that ambulance based telestroke is a feasible method for enhanced prehospital stroke care in a variety of settings. Further prospective research is needed to assess the real-world challenges and to identify additional strategies that bolster rapid and accurate prehospital assessment of acute stroke patients.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"79 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140371094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-25DOI: 10.3389/fstro.2023.1282209
Daniel J. Ryan, Peter Mueller-Barna, Rascha von Martial, Francesco Corea, Bojana Zvan, Ž. Živanović, Jesicaa Barlinn, Milena Krasinska-Chavez, Andrey Alasheev
Telestroke care is likely not inferior to face-to-face care in acute stroke management while it also provides rural sites with access to specialist expertise. However, little is known about the distribution and activity of telestroke networks across Europe. Consequently, the European Stroke Organization (ESO) Telestroke Committee aimed to address this through an online questionnaire.The questionnaire was developed through an unstructured consensus process, ratified by the ESO Executive Committee, and emailed to ESO members.Of 2,147 ESO members contacted, complete data sets were submitted on 25 networks from 10 countries. Among the 25 networks, the mean number of hubs per network was 1.6 (SD 1.2), and the mean number of spokes was 9 (SD 6.7), with considerable variability observed (range 2–24 spokes/network). All sites used audiovisual communication. The mean telemedicine consultations per year per site was 197 (SD 164). The primary reason for consultation was “diagnostic and triage purposes” in all but one network. The median number of strokes per site was 175 (interquartile range 192), and the mean intervention rate was 12.3% (SD 10; thrombolysis or thrombectomy).At 25 networks, this survey probably underrepresents telestroke activity across Europe, yet it is still the first study to provide a continent-wide geographical footprint and report on activity within the networks. There was considerable variability in network size and activity. Spoke sites reported an acceptable intervention rate of 12.3%. This percentage compares favorably with national data from European countries and suggests telestroke care supports reasonable intervention rates.
{"title":"Telestroke activity across Europe; The results of a European Stroke Organization survey","authors":"Daniel J. Ryan, Peter Mueller-Barna, Rascha von Martial, Francesco Corea, Bojana Zvan, Ž. Živanović, Jesicaa Barlinn, Milena Krasinska-Chavez, Andrey Alasheev","doi":"10.3389/fstro.2023.1282209","DOIUrl":"https://doi.org/10.3389/fstro.2023.1282209","url":null,"abstract":"Telestroke care is likely not inferior to face-to-face care in acute stroke management while it also provides rural sites with access to specialist expertise. However, little is known about the distribution and activity of telestroke networks across Europe. Consequently, the European Stroke Organization (ESO) Telestroke Committee aimed to address this through an online questionnaire.The questionnaire was developed through an unstructured consensus process, ratified by the ESO Executive Committee, and emailed to ESO members.Of 2,147 ESO members contacted, complete data sets were submitted on 25 networks from 10 countries. Among the 25 networks, the mean number of hubs per network was 1.6 (SD 1.2), and the mean number of spokes was 9 (SD 6.7), with considerable variability observed (range 2–24 spokes/network). All sites used audiovisual communication. The mean telemedicine consultations per year per site was 197 (SD 164). The primary reason for consultation was “diagnostic and triage purposes” in all but one network. The median number of strokes per site was 175 (interquartile range 192), and the mean intervention rate was 12.3% (SD 10; thrombolysis or thrombectomy).At 25 networks, this survey probably underrepresents telestroke activity across Europe, yet it is still the first study to provide a continent-wide geographical footprint and report on activity within the networks. There was considerable variability in network size and activity. Spoke sites reported an acceptable intervention rate of 12.3%. This percentage compares favorably with national data from European countries and suggests telestroke care supports reasonable intervention rates.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":" 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140384869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.3389/fstro.2024.1366957
Beatriz Coto-Solano
Stroke is a major public health concern in developing countries, where the burden of the disease is high and resources for care are often limited. While progress has been made in improving stroke care, many barriers still exist in providing adequate rehabilitation care for stroke survivors. In this paper we study the case of Costa Rica and how stroke care has been addressed in recent years. It is important to consider the particularities of Costa Rica when working on stroke rehabilitation. The existence of a socialized healthcare system, along with the consolidation of acute stroke management protocols, allows for the adequate management of the early stages. In addition to this, families play a key role in rehabilitation, particularly for a country where there is a lack of medium stay and long-stay rehabilitation centers. Therefore, providing training and education for families is essential in stroke case management. Looking toward the future, there is still a pending need to generate homogeneous stroke rehabilitation protocols throughout the national healthcare system, to ensure equitable access to health care, and to consolidate multidisciplinary groups. At the same time, the implementation of technologies is urgent, particularly considering their potential to help reduce waiting lists. Another goal is enhancing coordination with other state entities and NGOs to advance community, labor or educational reintegration of stroke patients.
{"title":"Overcoming barriers in the implementation of stroke care rehabilitation in a public hospital in Costa Rica","authors":"Beatriz Coto-Solano","doi":"10.3389/fstro.2024.1366957","DOIUrl":"https://doi.org/10.3389/fstro.2024.1366957","url":null,"abstract":"Stroke is a major public health concern in developing countries, where the burden of the disease is high and resources for care are often limited. While progress has been made in improving stroke care, many barriers still exist in providing adequate rehabilitation care for stroke survivors. In this paper we study the case of Costa Rica and how stroke care has been addressed in recent years. It is important to consider the particularities of Costa Rica when working on stroke rehabilitation. The existence of a socialized healthcare system, along with the consolidation of acute stroke management protocols, allows for the adequate management of the early stages. In addition to this, families play a key role in rehabilitation, particularly for a country where there is a lack of medium stay and long-stay rehabilitation centers. Therefore, providing training and education for families is essential in stroke case management. Looking toward the future, there is still a pending need to generate homogeneous stroke rehabilitation protocols throughout the national healthcare system, to ensure equitable access to health care, and to consolidate multidisciplinary groups. At the same time, the implementation of technologies is urgent, particularly considering their potential to help reduce waiting lists. Another goal is enhancing coordination with other state entities and NGOs to advance community, labor or educational reintegration of stroke patients.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140213652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-19DOI: 10.3389/fstro.2024.1371140
W. Dodd, Devan Patel, D. Laurent, Brandon Lucke-Wold, K. Hosaka, Richard D. Johnson, Nohra Chalouhi, Andrew A. Butler, Eduardo Candelario-Jalil, B. Hoh
Subarachnoid hemorrhage (SAH) is a life-threatening vascular condition without satisfactory treatment options. The secreted peptide adropin is highly expressed in the human brain and has neuroprotective effects in brain injury models, including actions involving the cerebrovasculature. Here, we report an endothelial nitric oxide synthase (eNOS)-dependent effect of synthetic adropin treatment that reverses the deleterious effects of SAH.We tested the molecular, cellular, and physiological responses of cultured brain microvascular endothelial cells and two mouse models of SAH to treatment using synthetic adropin peptide or vehicle.SAH decreases adropin expression in cultured brain microvascular endothelial cells and in murine brain tissue. In two validated mouse SAH models, synthetic adropin reduced cerebral edema, preserved tight junction protein expression, and abolished microthrombosis at 1 day post-SAH. Adropin treatment also prevented delayed cerebral vasospasm, decreased neuronal apoptosis, and reduced sensorimotor deficits at seven days post-SAH. Delaying initial treatment of adropin until 24 h post-SAH preserved the beneficial effect of adropin in preventing vasospasm and sensorimotor deficits. Mechanistically, adropin treatment increased eNOS phosphorylation (Ser1179) at 1 & 7 days post-SAH. Treating eNOS−/− mice with adropin failed to prevent vasospasm or behavioral deficits, indicating a requirement of eNOS signaling.Adropin is an effective treatment for SAH, reducing cerebrovascular injury in both the acute (1 day) and delayed (7 days) phases. These findings establish the potential of adropin or adropin mimetics to improve outcomes following subarachnoid hemorrhage.
{"title":"Subarachnoid hemorrhage-associated brain injury and neurobehavioral deficits are reversed with synthetic adropin treatment through sustained Ser1179 phosphorylation of endothelial nitric oxide synthase","authors":"W. Dodd, Devan Patel, D. Laurent, Brandon Lucke-Wold, K. Hosaka, Richard D. Johnson, Nohra Chalouhi, Andrew A. Butler, Eduardo Candelario-Jalil, B. Hoh","doi":"10.3389/fstro.2024.1371140","DOIUrl":"https://doi.org/10.3389/fstro.2024.1371140","url":null,"abstract":"Subarachnoid hemorrhage (SAH) is a life-threatening vascular condition without satisfactory treatment options. The secreted peptide adropin is highly expressed in the human brain and has neuroprotective effects in brain injury models, including actions involving the cerebrovasculature. Here, we report an endothelial nitric oxide synthase (eNOS)-dependent effect of synthetic adropin treatment that reverses the deleterious effects of SAH.We tested the molecular, cellular, and physiological responses of cultured brain microvascular endothelial cells and two mouse models of SAH to treatment using synthetic adropin peptide or vehicle.SAH decreases adropin expression in cultured brain microvascular endothelial cells and in murine brain tissue. In two validated mouse SAH models, synthetic adropin reduced cerebral edema, preserved tight junction protein expression, and abolished microthrombosis at 1 day post-SAH. Adropin treatment also prevented delayed cerebral vasospasm, decreased neuronal apoptosis, and reduced sensorimotor deficits at seven days post-SAH. Delaying initial treatment of adropin until 24 h post-SAH preserved the beneficial effect of adropin in preventing vasospasm and sensorimotor deficits. Mechanistically, adropin treatment increased eNOS phosphorylation (Ser1179) at 1 & 7 days post-SAH. Treating eNOS−/− mice with adropin failed to prevent vasospasm or behavioral deficits, indicating a requirement of eNOS signaling.Adropin is an effective treatment for SAH, reducing cerebrovascular injury in both the acute (1 day) and delayed (7 days) phases. These findings establish the potential of adropin or adropin mimetics to improve outcomes following subarachnoid hemorrhage.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"30 1‐2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140228136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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