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61. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke (Full text)

d) Recent acute myocardial infarction (within previous 3 mo) Notes The checklist includes some FDA-approved indications and contraindications for administration of intravenous rtPA for acute ischemic stroke. Recent guideline revisions have modified the original FDA-approved indications. A physician with expertise in acute stroke care may modify this list. Onset time is defined as either the witnessed onset of symptoms or the time last known normal if symptom onset was not witnessed. In patients (...) only if it appears >6 h after stroke <6 6 Total 5834 … Placebo … 1711 (29.3) … … … … ATLANTIS indicates Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke; ECASS II, European Cooperative Acute Stroke Study II; IST-3, Third International Stroke Trial; MCA, middle cerebral artery; NINDS, National Institute of Neurological Diseases and Stroke; and tPA, tissue-type plasminogen activator. * Only the first 276 patients received placebo; open control thereafter. Overall, 1711

2015 American Heart Association PubMed abstract

62. Guidelines for the Prevention of Stroke in Women

regularly, as they were for prenatal care. Postpartum preeclampsia is associated with a high risk for stroke and may be the underlying cause of severe postpartum headaches. 152 Transient elevations in BP are common post partum because of volume redistribution, iatro- genic administration of fluid, alterations in vascular tone, and use of nonsteroidal anti-inflammatory drugs, 153–155 but persis- tently elevated BP should be categorized and treated accord- ing to the adult guidelines. 140 A 2010 Cochrane (...) risk for preeclampsia, 158 but there are insufficient data to support a recommendation. Treatment of Elevated BP During Pregnancy, Including Preeclampsia The central autoregulatory plateau in pregnancy is estimated at 120 mm Hg, and women with moderate to severe high BP in pregnancy, especially those with preeclampsia, are at risk for loss of central cerebral vascular autoregulation. The association between high BP and stroke risk in women with preeclampsia is not linear, such that stroke can occur

2014 Congress of Neurological Surgeons

63. Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke

imaging and highly trained multidisciplinary hospital teams rapidly responding to emergency activation. Despite the previous acceptance of intravenous ?brinolysis for acute ischemic stroke and the development of designated stroke centers (1), ischemic stroke remains a leading cause of adult death and disability (2). Many patients are not can- didates for ?brinolysis, and intravenous therapy is relatively ineffective for severe strokes as a result of large cerebral artery occlusions. Moreover (...) in Acute Ischemic Stroke (THRACE) (8) trials reported 38% and 53% rates of mRS score 0–2 at 90 days, respectively, and, in the per- protocol population of the Pragmatic Ischaemic Thrombectomy Evalua- tion (PISTE) trial (129), 57% of the endovascular group reached an mRS score of 0–2 at 90 days. The major trials focused on stroke patients with large artery occlu- sions, speci?cally internal carotid terminus or proximal middle cerebral (ie, M1) arteries. However, some patients with severe stroke have

2018 Society of Interventional Radiology

64. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association (Full text)

14) • When considered separately from other CVDs, stroke ranks No. 5 among all causes of death, behind dis- eases of the heart, cancer, chronic lower respiratory disease, and unintentional injuries/accidents. • Globally, in 2013 there were 6.5 million stroke deaths, making stroke the second-leading cause of death behind ischemic heart disease. • Approximately 795 000 strokes occur in the United States each year. On average, every 40 seconds, someone in the United States has a stroke (...) . . . . . . . . . . . . . . . . . e295 11. Metabolic Syndrome . . . . . . . . . . . . . . . e313 12. Chronic Kidney Disease . . . . . . . . . . . . . e336 Cardiovascular Conditions/Diseases 13. Total Cardiovascular Diseases . . . . . . . . . . e349 14. Stroke (Cerebrovascular Disease). . . . . . . . . e374 15. Global CVD and Stroke . . . . . . . . . . . . . . e414 16. Congenital Cardiovascular Defects and Kawasaki Disease . . . . . . . . . . . . . . . . e423 17. Disorders of Heart Rhythm . . . . . . . . . . . . e440 18. Sudden

2017 American Heart Association PubMed abstract

65. Telemedicine quality and outcomes in stroke

benchmarked telestroke consultations as they related to time performance and reviewed the clinical data from 8 stroke centers that provided 235 telestroke consults over a 7-month period. Of the 203 consults that met their study criteria, 60 of 203 or ≈ 30% carried a diagnosis of stroke or transient ischemic attack, and 13 of 60 stroke cases (21.7%) were recommended for intravenous tPA. Although the mean response time (time from arrival to physician log-on) was 76 minutes, the percent of patients eligible (...) , that are used as guides in the endorsement process. Prior Experience With the Use of Quality Measures in Stroke Since 2001, more than a dozen performance measure guidelines have been published and sponsored or cosponsored by the American Heart Association/American Stroke Association. These include guidelines for the treatment of chronic heart failure, myocardial infarction, coronary artery disease and hypertension, and acute ischemic stroke. In acute stroke, implementation of quality improvement initiatives

2016 American Academy of Neurology

66. Stroke Assessment Across the Continuum of Care

on the entire family , and nurses have a role to play in the assessment of the family and family caregivers. However, the focus of this document is on the screening and/or assessment of the adult stroke survivor. This is not meant to exclude the pediatric client, but children have unique assessment needs related to developmental stages that are beyond the scope of this guideline. For the purpose of this guideline, types of stroke include transient ischemic attacks (TIAs), ischemic and hemorrhagic stroke (...) hemorrhage. The remaining half are due to subarachnoid hemorrhage (SAH) or bleeding from an arteriovenous malformation (StopSTROKE, 2004; The Internet Stroke Center, 2004). Transient Ischemic Attack (TIA): Ischemic stroke may be preceded by one or more transient ischemic attacks (The Internet Stroke Center, 2004), the sudden occurrence of a focal neurologic deficit that disappears completely within 24 hours. Symptoms of most TIAs, however, usually resolve within minutes to approximately an hour

2005 Registered Nurses' Association of Ontario

67. Management of patients with stroke: Identification and management of dysphagia

. The guideline complements SIGN 118 Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning. 20 and SIGN 108 Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention. 21 1.2.2 TARGET USERS OF THE GUIDELINE The guideline is relevant to all personnel in contact with stroke patients throughout the care pathway from initial primary care response, through hospital admission, on to continuing (...) DEFINITIONS The World Health Organisation defines stroke as a clinical syndrome of rapidly developed clinical signs of focal or global disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than vascular origin. 22 Dysphagia, a difficulty in swallowing, can be caused by many pathologies including stroke. In patients with stroke, it is characterised by difficulty in safely moving food or liquids from the mouth to the stomach without aspiration. It may

2010 SIGN

68. Canadian best practice recommendations for stroke care

ESO European Stroke Organization: Guidelines for the management of ischaemic stroke and transient ischaemic attack 26 EXPRESS Early use of Existing Preventive Strategies for Stroke 47 HSFO Heart and Stroke Foundation of Ontario: Consensus Panel on the Stroke Rehabilitation System 48 MATCH Management of Atherothrombosis with Clopidogrel in High-risk patients with recent TIA or ischemic stroke 49 NAEMSP National Association of EMS Physicians 50 NICE National Institute for Health and Clinical (...) : • emergency medical services care of stroke patients before hospital arrival or during transport between hospitals • acute management of transient ischemic attack and minor stroke, especially for patients managed in the community or discharged home from the emergency department • components of acute stroke management, to minimize the risk of complications • vascular cognitive impairment and dementia as manifesta- tions of stroke, to emphasize that those symptoms of vas- cular cognitive impairment should

2009 CPG Infobase

69. Canadian best practice recommendations for stroke care

be managed with lifestyle modi?cation, dietary guidelines, and medication recommendations. (CSQCS, Australian, VA/DOD; Evidence Level A) • Statin agents should be prescribed for all patients who have had an ischemic stroke/TIA event (Australian, VA/DOD; evidence level A), in order to achieve a target goal of an LDL-C of 3.4 to simvastatin or placebo for a mean duration of 5 years; inclusion criteria were any of the following: coronary artery disease, cerebrovascular disease, peripheral vascular disease (...) , diabetes, or patients over 65 years with hypertension. The Heart Protection Study showed that simvastatin 40 mg once daily rapidly produced a de?nite and substantial reduction in ischaemic stroke, irrespective of the patient’s age, gender, or blood lipid concentrations when treatment was initiated. It also demonstrated that statin therapy reduced the risk of major vascular events among people who have previously had a stroke or other cerebrovascular event, even if they did not already have manifest

2008 CPG Infobase

70. Covid-19: Clinical guide for the management of stroke patients during the coronavirus pandemic

to hospital for patients with a stroke mimic or transient ischaemic attack (TIA) – this may include the rapid introduction of pre- hospital tele medicine, eg via apps such as GoodSam/Facetime. Work on the direct to CT pathway for patients with clear stroke symptoms and an onset time that makes them amenable to recanalisation therapy. Maintaining high standards of stroke care across the pathway Many facets of the stroke pathway are deemed important, but during this time of considerable pressure some (...) /Facetime/WhatsApp video call) mobile apps with established virtual assessments should be considered for extension to settings such as multidisciplinary teams (MDTs), pre-hospital, virtual ward rounds and rehabilitation. There are pre-existing GDPR clauses offering flexibility in times of crisis, as laid out by NHSX, and we would encourage use of facilitative technologies during this time. Consider enhanced pre hospital communication with senior stroke decision maker to reduce unnecessary conveyance

2020 Covid-19 Ad hoc guidelines

71. Canadian Stroke Best Practice recommendations, seventh edition: acetylsalicylic acid for prevention of vascular events

on antiplatelet and anticoagulant use, 9 and Thrombosis Canada clinical guides. 8GUIDELINE E304 CMAJ | MARCH 23, 2020 | VOLUME 192 | ISSUE 12 of placebo reduced the number of serious vascular events by 36 (standard error [SE] 5) per 1000 per year in patients with a previ- ous myocardial infarction and also by 36 (SE 6) per 1000 per year in patients with a previous history of stroke or transient ischemic attack. In patients with peripheral arterial disease, treatment with ASA instead of placebo reduced (...) outcome were 0.96 (95% confidence interval [CI] 0.81–1.13) and 0.95 (95% CI 0.83–1.08), respectively. In the ASCEND trial, 4 the risk of the primary outcome (first serious vascular event [myocardial infarction, stroke, transient ischemic attack or cardiovascular death]) was significantly lower in the ASA group (8.5% v. 9.6%; relative risk [RR] 0.88, 95% CI 0.79–0.97). The results of these 3 trials were incorporated into 2 system- atic reviews, the results of which conflicted. 5,6 The use of ASA did

2020 CPG Infobase

72. Covid-19: Stroke

, stroke patients are advised to protect themselves from contagion, given they are at increased risk for complications if they get COVID-19. Moreover, based on current information, it appears that elderly people with coronary heart disease or hypertension are more likely to present with more severe symptoms. People affected by infectious diseases as COVID-19 are also at increased risk of ischaemic and haemorrhagic cerebrovascular complications. For this reason, an increased number of strokes could (...) be forecast. However, an unexpected reduction of stroke patients in the emergency room throughout Europe has been observed. It is reasonable to assume that patients with acute mild stroke or TIA remain at home, because they are asked to stay at home, limit emergency room visits, and minimise travel. The patients may be prioritising avoiding contagion. Another issue is that stroke care organization and pathways within hospitals are currently adapted to cover the requirements of dealing with COVID-19

2020 European Academy of Neurology

73. Guidelines for Psychological Practice With Older Adults

, family, geropsy- chology, health, industrial/organizational, neuropsychol- ogy, rehabilitation, and others. The 2008 APA Survey of Psychology Health Service Providers found that 4.2% of respondents viewed older adults as their primary focus and 39% reported that they provided some type of psy- chological services to older adults (APA, Center for Workforce Studies, 2008). Relatively few psychologists, however, have received formal training in the psychol- ogy of aging. Fewer than one third of APA (...) the views that (a) with age inevitably comes demen- tia; (b) older adults have high rates of mental illness, particularly depression; (c) older adults are inef?cient in the workplace; (d) most older adults are frail and ill; (e) older adults are socially isolated; (f) older adults have no interest in sex or intimacy; and (g) older adults are in?ex- ible and stubborn (Edelstein & Kalish, 1999). These ste- reotypes are not accurate, since research has found that the vast majority of older adults

2014 American Psychological Association

74. Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change

are not intended to be mandatory or exhaustive and may not be applicable to every professional situation. They are not de?nitive, and they are not intended to take precedence over the judgment of psychologists. Guidelines on this topic were originally developed by an APA Presidential Task Force, approved as policy of APA by the APA Council of Representatives, and pub- lished in 1998 (APA Presidential Task Force on the As- sessment of Age-Consistent Memory Decline and Demen- tia, 1998). Consistent with APA (...) . The Diagnostic and Statistical Manual of Mental Dis- orders (4th ed.; DSM–IV; American Psychiatric Associa- tion, 2000) outlines diagnostic criteria for the clinical syn- drome of dementia and additional criteria for diagnosing dementia of the Alzheimer type and vascular dementia, as well as briefer guidelines for diagnosing less common causes of dementia, such as head trauma, Parkinson’s dis- ease, and general medical disorders. Diagnostic guidelines for AD have also been provided by the National Institute

2012 American Psychological Association

76. 2016 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult

-HDL-C or apoB in the future. Anderson et al. 1267 2016 CCS Dyslipidemia Guidelinesintervention or coronary artery bypass graft surgery), other arterial revascularization procedures, angina pectoris, cerebro- vascular disease including transient ischemic attack, or pe- ripheral arterial disease (claudication and/or ankle-brachial index 3.0 cm diameter); (3) diabetes mellitus (DM) with age 40 years,> 15-year duration for age 30 years (type 1 diabetes mellitus [DM]), or with the presence (...) , nonfatal myocardial infarction (MI), ischemic stroke, revascularization, and acute coronary syndromes hospitalizations. Number needed to treat (NNT): NNT to prevent 1 CVD event for 5 years of treatment per 1 mmol/L reduction in LDL-C. NNT of 20%).Despitethecontroversy,wecontinuetoadvocateforlow- density lipoprotein cholesterol targets for subjects who start therapy. Detailed recommendations are also presented for health behaviour modi?cation that is indicated in all subjects. Finally, recommendation

2016 CPG Infobase

77. The Canadian Cardiovascular Society heart failure companion: bridging guidelines to your practice

of MRA for patients who have had an increased NP level. (5) Correction of any condition, such as systemic hyperten- sion, valvular heart disease, cardiac ischemia, or tachy- cardia and/or atrial ?brillation that might have aggravated or precipitated HF. (6) Treatment of concomitant comorbid conditions. (7) Use of minimal doses of diuretics necessary to maintain euvolemia. (8) Access to HF clinics, cardiac rehabilitation, and self-care management as per any other patient with HF. How Should I Manage (...) - ci?c forms of HF, many of which are outlined in Table 5. 38 Second, withdrawal of chronic ACEi/b-blocker therapy for patients with dilated cardiomyopathy (ischemic or non- ischemic) whose LVEF improved with triple therapy will result in a 60%-80% likelihood of recurrence of low LVEF, usually with symptoms. 39 As such, withdrawal of these medications should only be considered after consultation with a physician experienced and competent in the treatment of HF. Finally, reassessment of LVEF should

2016 CPG Infobase

78. Management of chronic heart failure

and a checklist of information for patients. The management of specific aetiologies of HF such as inherited (genetic) cardiac conditions, has not been covered in this guideline. Other relevant SIGN guidelines on the management of acute coronary syndrome, arrhythmias and stable angina, primary prevention of coronary heart disease and cardiac rehabilitation are available from 1.2.2 DEFINITIONS Heart failure is a clinical syndrome of symptoms (eg breathlessness, fatigue) and signs (eg oedema (...) account for breathlessness. An electrocardiogram is also indicated as it may demonstrate an underlying aetiology such as prior myocardial infarction or identify other important diagnoses such as atrial fibrillation. A health technology appraisal (HT A) concluded that a scoring system can be used to determine who should be referred directly for echocardiography and who should have a natriuretic peptide test. 10 The scoring system included three items; the presence of any one of which should direct

2016 SIGN

80. Acute coronary syndrome

, and hypertension with or without left ventricular hypertrophy (LVH). Type 3: Myocardial infarction resulting in death when biomarker values are unavailable Cardiac death with symptoms suggestive of myocardial ischaemia and presumed new ischaemic electrocardiograph (ECG) changes or new left bundle branch block (LBBB), but death occurring before blood samples could be obtained, before cardiac biomarker could rise, or in rare cases cardiac biomarkers were not collected. Type 4a: Myocardial infarction related (...) to percutaneous coronary intervention Myocardial infarction associated with percutaneous coronary intervention (PCI) is arbitrarily defined by elevation of cardiac troponin values >5 x 99 th percentile upper reference limit (URL) in patients with normal baseline values (=99 th percentile URL) or a rise of cardiac troponin values >20% if the baseline values are elevated and are stable or falling. In addition, either (i) symptoms suggestive of myocardial ischaemia, or (ii) new ischaemic ECG changes or new LBBB

2016 SIGN


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