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2024 SEP 2 (NewsRx) -- By a News Reporter-Staff News Editor at Stem Cell Week -- Fresh data on stroke are presented in a new report. According to news reporting [...]

Objective. The aim of this systematic review was to determine what percentages of physical therapists provide interventions that are of high value, low value, or unknown value for cardiorespiratory conditions, neurological conditions, or conditions requiring acute hospital care. Whether an intervention was considered high or low value was determined by reference to guidelines or systematic reviews. Methods. Searches of numerous databases were performed by combining terms synonymous with 'practice patterns' and 'physical therapy' until April 2018. Studies that investigated what interventions physical therapists provide for any cardiorespiratory condition, neurological condition, or condition requiring acute hospital care through surveys and audits of clinical notes were included. Through the use of medians and interquartile ranges, the percentages of physical therapists who provided interventions that were of high value, low value, or unknown value were summarized. Results. Twenty-six studies were included. The median percentages of physical therapists who provided interventions of high, low, and unknown value for chronic obstructive pulmonary disease ranged from 78% to 96%, 67% to 100%, and 56% to 91%, respectively. These percentages ranged from 61% to 97%, 87% to 98%, and 83% to 98% for adults who were critically ill in intensive care units; 70% to 93%, 38% to 50%, and 8% to 95% before or after cardiac/thoracic surgery; 25% to 96%, 23% to 84%, and 96% for acute stroke; and 11% (high value) and 13% (unknown value) for Parkinson disease, respectively. Conclusions. This review found patterns of physical therapist practice for cardiorespiratory conditions, neurological conditions, and conditions requiring acute hospital care that were both evidence based and not evidence based. A concern is that a substantial percentage of physical therapists provided interventions that were of low or unknown value despite the availability of high-value interventions. Impact. This systematic review is the first, to our knowledge, to summarize the percentage of physical therapist treatment choices that were high versus low value for cardiorespiratory conditions, neurological conditions, and conditions requiring acute hospital care. The findings highlight areas of practice where low-value care could be replaced with high-value care--such as in the management of patients who have chronic obstructive pulmonary disease or who are in intensive care--and identify an urgent need to develop and test strategies to ensure that patients with these conditions receive the interventions most likely to improve their outcomes., High- and low-value health care is a concept receiving substantial attention in many fields of medicine. (1) High-value care refers to an intervention for which evidence suggests it provides a [...]

Background. A substantial number of patients with stroke never receive acute care therapy services, despite the fact that therapy after stroke reduces the odds of death and disability and improves patients' functioning. Objective. The aim of this study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke. Design. This was a single-center longitudinal observational study. Methods. Adults with a diagnosis of ischemic or hemorrhagic stroke (N = 1366) were enrolled during their hospitalization in an acute stroke center in a large metropolitan area. The main outcomes were receipt of therapist consultations, interventions, or both. Results. Participants with acute hemorrhagic stroke (intracerebral: odds ratio [OR] = 0.34 [95% CI = 0.19-0.60]; subarachnoid: OR = 0.52 [95% CI = 0.28-0.99]) and with greater stroke severity by National Institutes of Health Stroke Scale (NIHSS) score (NIHSS score of > 15: OR = 0.34 [95% CI = 0.23-0.51]) were less likely to receive therapist consultations. Participants with moderate stroke severity (NIHSS score of 6-15: OR = 1.43 [95% CI = 1.01-2.331) were more likely to receive therapy interventions. Those who were able to ambulate before admission were more than 5 times as likely to receive therapy interventions (OR = 5.08 [95% CI = 1.91-13.52]). Also, participants with longer lengths of stay (ie, more intensive care unit and non-intensive care unit days) were more likely to receive therapist consultations and interventions. Tests or procedures were the most common reasons for unsuccessful attempts to complete therapist consultations. Limitations. Lack of operational and qualitative data prohibited detailed explorations of barriers to delivery of therapist consultations and interventions. Conclusions. Approximately 1 in 4 participants with acute stroke received neither a consultation nor an intervention. Efforts to improve the delivery of acute care therapy services are needed to optimize care for these people., Advances in stroke management have significantly reduced mortality due to stroke. (1) Despite these advances, stroke remains a leading cause of long-term disability. (1,2) Therapy services, which include physical therapy, [...]

A 64-year-old woman with normal baseline functioning presented to hospital with an altered level of consciousness. She had a history of hypertension (perindopril 8 mg/d), gout (allopurinol 200 mg/d) and [...]

Background. Little is known about variation in use of rehabilitation services provided in acute care hospitals for people who have had a stroke. Objective. The objective was to examine patient and hospital sources of variation in acute care rehabilitation services provided for stroke. Design. This was a retrospective, cohort design. Methods. The sample consisted of Medicare fee-for-service beneficiaries with ischemic stroke admitted to acute care hospitals in 2010. Medicare claims data were linked to the Provider of Services file to gather information on hospital characteristics and the American Community Survey for sociodemographic data. Chi-square tests compared patient and hospital characteristics stratified by any rehabilitation use. We used multilevel, multivariable random effect models to identify patient and hospital characteristics associated with the likelihood of receiving any rehabilitation and with the amount of therapy received in minutes. Results. Among 104,295 patients, 85.2% received rehabilitation (61.5% both physical therapy and occupational therapy; 22.0% physical therapy only; and 1.7% occupational therapy only). Patients received 123 therapy minutes on average (median [SD] = 90.0 [99-2] minutes) during an average length of stay of 4.8 [3-5] days. In multivariable analyses, male sex, dual enrollment in Medicare and Medicaid, prior hospitalization, ICU stay, and feeding tube were associated with lower odds of receiving any rehabilitation services. These same variables were generally associated with fewer minutes of therapy. Patients treated by tissue plasminogen activator, in limited-teaching and nonteaching hospitals, and in hospitals with inpatient rehabilitation units, were more likely to receive more therapy minutes. Limitation. The findings are limited to patients with ischemic stroke. Conclusion. Only 61% of patients with ischemic stroke received both physical therapy and occupational therapy services in the acute setting. We identified considerable variation in the use of rehabilitation services in the acute care setting following a stroke., Stroke, a leading cause of hospitalization, is associated with high hospital readmission rates, postacute care use, and long-term disability.1'3 Early mobilization during the acute hospitalization following a stroke is recommended [...]

Cerebrovascular disease is not only the third largest cause of death in Canada, it is also associated with substantial functional morbidity after an event. In 2013, over 400 000 Canadians [...]

Objective: This review evaluates the use of virtual reality (VR) tools in cognitive rehabilitation of stroke-affected individuals. Methods: Studies performed between 2010 and 2017 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms 'VR,' 'rehabilitation,' and 'stroke.' Results: Stroke patients experienced significant improvement in many cognitive domains (such as executive and visual-spatial abilities and speech, attention, and memory skills) after the use of VR training. Conclusions: Rehabilitation using new VR tools could positively affect stroke patient cognitive outcomes by boosting motivation and participation. Keywords: cognitive rehabilitation, stroke, virtual reality training, Cognitive rehabilitation (CR) helps restore normal function or compensate cognitive deficits in brain-injured or cognitively impaired individuals. In current clinical practice, there are 2 basic types of CR: restorative and [...]

Treatment options for anticoagulated patients presenting with ischemic stroke are limited. Off-label use of idarucizumab to rapidly reverse the anticoagulant effect of dabigatran may ensure eligibility for thrombolytic therapy with alteplase. This case describes a 77-year-old white male who presented to the hospital 89 minutes after sudden onset of right-sided hemiparesis, dysarthria, and facial palsy. Significant history included atrial fibrillation and previous right-sided cortical stroke. Medication reconciliation revealed he was taking dabigatran 150 mg twice a day, with the last dose being 179 minutes before presentation. Neuroimaging revealed no new infarct or hemorrhage, and 60 minutes after arrival, a decision was made to give idarucizumab to reverse the anticoagulant effect of dabigatran. In the absence of any contraindication, he was then treated with intravenous alteplase and idarucizumab. No adverse outcomes were noted, and at discharge, his new stroke symptoms were completely resolved.Keywords: alteplase, dabigatran, idarucizumab, ischemic stroke, thrombolytic therapy, Approximately 87% of all strokes are ischemic, and between 17% and 30% are caused by cardiac emboli. (1-3) Cardioembolic strokes are more disabling because they usually occlude large cerebral blood [...]

Objective: To characterize the rate of guideline-concordant initiation of oral anticoagulation (OAC) among elderly Veterans with atrial fibrillation (AF) and high stroke risk.Data Sources/Study Setting: Veterans Health Administration (VHA) Corporate Data Warehouse (CDW) linked with Medicare claims 2011-2015.Study Design: We identified 6619 elderly, high stroke-risk patients with a new episode of AF initially diagnosed in the VHA during fiscal years 2012-2015. We used logistic regression to estimate marginal effects of associations between patient characteristics and OAC initiation within 90 days of the first AF episode.Data Extraction Methods: We identified OACs using generic drug names. We calculated comorbidities and risk scores using diagnosis codes from 1 year of baseline data.Principal Findings: Overall, 66.5% of Medicare-eligible Veterans with AF at high risk of stroke initiated an OAC within 90 days. We found lower initiation rates for patients enrolled in Medicare Part D and those ineligible for drug co-payment subsidies. OAC initiation rates increased during the study among VHA-reliant patients but not among dual VHA-Part D enrollees.Conclusions: One-third of elderly Veterans at risk of stroke are not receiving recommended therapy. Increased coordination between Medicare and VHA providers may lead to improvements in anticoagulation quality and stroke prevention.KEYWORDSchronic disease, medical decision-making, pharmaceuticals: prescribing/use/costs, VA Health Care System, 1 | BACKGROUNDAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia, estimated to affect 33.5 million globally. (1) Its prevalence in the United States is projected to increase from [...]

ABSTRACT Venous thromboembolism (VTE) is a frequent and potentially fatal complication of immobility caused by cerebrovascular disease. This review examines the efficiency of deep vein thrombosis (DVT) prophylaxis methods. Patients [...]

In patients with suspected acute stroke, immediate brain imaging, most frequently with computed tomography (CT), is essential to distinguish between an ischemic lesion and a hemorrhage. (1) In ischemic stroke, [...]

Background. The evidence base for stroke rehabilitation recommends intensive and repetitive task-specific practice, as well as aerobic exercise. However, translating these evidence-based interventions from research into clinical practice remains a major challenge. Objective. The objective of this study was to investigate factors influencing implementation of higher-intensity activity in stroke rehabilitation settings. Design. This qualitative study used a cross-sectional design. Methods. Semi-structured interviews were conducted with rehabilitation therapists from 4 sites across 2 Canadian provinces who had experience in delivering a higher-intensity intervention as part of a clinical trial (Determining Optimal post-Stroke Exercise [DOSE]). An interview guide was developed, and data were analyzed using implementation frameworks. Results. Fifteen therapists were interviewed before data saturation was reached. Therapists and patients generally had positive experiences regarding high-intensity interventions. However, therapists felt they would adapt the protocol to accommodate their beliefs about ensuring movement quality. The requirement for all patients to have a graded exercise test and the use of sensors (eg, heart rate monitors) gave therapists confidence to push patients harder than they normally would. Paradoxically, a system that enables routine graded exercise testing and the availability of staff and equipment contribute challenges for implementation in everyday practice. Conclusions. Even therapists involved in delivering a high-intensity intervention as part of a trial wanted to adapt it for clinical practice; therefore, it is imperative that researchers are explicit regarding key intervention components and what can be adapted to help ensure implementation fidelity. Changes in therapists' beliefs and system-level changes (staffing and resources) are likely necessary to facilitate higher-intensity rehabilitation in practice., In stroke rehabilitation, best evidence is for intensive repetitive task practice. (12) Intensity refers to the work rate, effort level, or metabolic demand of exercise. In stroke rehabilitation, key aspects [...]

An 81-year-old man presented to our hospital with signs and symptoms suggestive of a left middle cerebral artery stroke. The patient had a history of stable coronary artery disease, ischemic [...]

BACKGROUND: We previously derived the Ottawa Subarachnoid Hemorrhage Rule to identify subarachnoid hemorrhage (SAH) in patients with acute headache. Our objective was to validate the rule in a new cohort of consecutive patients who visited an emergency department. METHODS: We conducted a multicentre prospective cohort study at 6 university-affiliated tertiary-care hospital emergency departments in Canada from January 2010 to January 2014. We included alert, neurologically intact adult patients with a headache peaking within 1 hour of onset. Treating physicians in the emergency department explicitly scored the rule before investigations were started. We defined subarachnoid hemorrhage as detection of any of the following: subarachnoid blood visible upon computed tomography of the head (from the final report by the local radiologist); xanthochromia in the cerebrospinal fluid (by visual inspection); or the presence of erythrocytes (> 1 x [10.sup.6/L)] in the final tube of cerebrospinal fluid, with an aneurysm or arteriovenous malformation visible upon cerebral angiography. We calculated sensitivity and specificity of the Ottawa SAH Rule for detecting or ruling out subarachnoid hemorrhage. RESULTS: Treating physicians enrolled 1153 of 1743 (66.2%) potentially eligible patients, including 67 with subarachnoid hemorrhage. The Ottawa SAH Rule had 100% sensitivity (95% confidence interval [CI] 94.6%-100%) with a specificity of 13.6% (95% CI 13.1%-15.8%), whereas neuroimaging rates remained similar (about 87%). INTERPRETATION: We found that the Ottawa SAH Rule was sensitive for identifying subarachnoid hemorrhage in otherwise alert and neurologically intact patients. We believe that the Ottawa SAH Rule can be used to rule out this serious diagnosis, thereby decreasing the number of cases missed while constraining rates of neuroimaging., Subarachnoid hemorrhage is one of the most serious causes of sudden headache, yet it accounts for only 1%-3% of headaches. (1-4) Although the decision to order neuroimaging in a patient [...]

Background. Evidence-based guidelines are needed to inform rehabilitation practice, including the effect of number of exercise training sessions on recovery of walking ability after stroke. Objective. The objective of this study was to determine the response to increasing number of training sessions of 2 interventions--locomotor training and strength and balance exercises--on poststroke walking recovery. Design. This is a secondary analysis of the Locomotor Experience Applied Post-Stroke (LEAPS) randomized controlled trial. Setting. Six rehabilitation sites in California and Florida and participants' homes were used. Participants. Participants were adults who dwelled in the community (N=347), had had a stroke, were able to walk at least 3 m (10 ft) with assistance, and had completed the required number of intervention sessions. Intervention. Participants received 36 sessions (3 times per week for 12 weeks), 90 minutes in duration, of locomotor training (gait training on a treadmill with body-weight support and overground training) or strength and balance training. Measurements. Walking speed, as measured by the 10-Meter Walk Test, and 6-minute walking distance were assessed before training and following 12, 24, and 36 intervention sessions. Results. Participants at 2 and 6 months after stroke gained in gait speed and walking endurance after up to 36 sessions of treatment, but the rate of gain diminished steadily and, on average, was very low during the 25- to 36-session epoch, regardless of treatment type or severity of impairment. Limitations. Results may not generalize to people who are unable to initiate a step at 2 months after stroke or people with severe cardiac disease. Conclusions. In general, people who dwelled in the community showed improvements in gait speed and walking distance with up to 36 sessions of locomotor training or strength and balance exercises at both 2 and 6 months after stroke. However, gains beyond 24 sessions tended to be very modest. The tracking of individual response trajectories is imperative in planning treatment., Dose is a critical parameter contributing to the effectiveness of therapeutic interventions for motor and behavioral recovery after stroke. (1-4) Exercise parameters that contribute to a dose-response relationship in physical [...]

ABSTRACT This article describes the provision of stroke services in Greece and addresses the possible effects of the hospital rotation system. Unique to Greece is a centrally administered rotation system [...]

This quality improvement project focused on improving patient education and patient satisfaction, and reducing all-cause 30-day readmissions. A 72-hour discharge follow-up telephone call was completed in patients discharged home with diagnosis of stroke., The Hospital Readmissions Reduction and Hospital Value-Based Purchasing Programs are driven by mandates for improvement in standards of care and quality performance measures impacting reimbursement (Centers for Medicare & Medicaid [...]

2020 DEC 19 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on Central Nervous System Diseases and Conditions - Subarachnoid Hemorrhage [...]

2020 DEC 19 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Cardiovascular Diseases and Conditions - Vasculitis have been [...]

2020 DEC 19 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on Cerebrovascular Diseases and Conditions - Stroke is the subject [...]

2020 NOV 28 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Cerebrovascular Diseases and Conditions - Stroke is now [...]

2020 NOV 28 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators discuss new findings in Nutritional and Metabolic Diseases and Conditions - [...]

2020 NOV 28 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators discuss new findings in Cardiovascular Diseases and Conditions - Transient Ischemic [...]

2020 NOV 28 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New study results on stroke have been published. According to news reporting [...]

2020 NOV 28 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Cerebrovascular Diseases and Conditions - Stroke is now [...]

2020 NOV 28 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on Central Nervous System Diseases and Conditions - Subarachnoid Hemorrhage [...]

2020 NOV 14 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on stroke is the subject of a new report. According [...]

2020 NOV 14 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Data detailed on Cerebrovascular Diseases and Conditions - Stroke have been presented. [...]

2020 NOV 7 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Immune System Diseases and Conditions - HIV/AIDS. [...]

2020 NOV 7 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Cerebrovascular Diseases and Conditions - Stroke have been [...]

2020 OCT 31 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on Cerebrovascular Diseases and Conditions - Stroke is the subject [...]

2020 OCT 31 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Central Nervous System Diseases and Conditions - [...]

2020 OCT 31 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Cerebrovascular Diseases and Conditions - Stroke. According [...]

2020 OCT 31 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on Cerebrovascular Diseases and Conditions - Stroke is the subject [...]

2020 OCT 31 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Vascular Diseases and Conditions - Ischemia-Reperfusion Injury is [...]

Byline: Our Bureau On the occasion of World Stroke Day, Nanavati Super Specialty Hospital has unveiled one of the largest comparative study of neurological deficit, morbidity, mortality and overall clinical [...]

CytoDyn announced two patients have demonstrated noticeable signs of improvement following treatment with leronlimab in helping their recovery from stroke. The most recent stroke patient, a physician in Mississippi, requested [...]

2020 OCT 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on Cerebrovascular Diseases and Conditions - Stroke is the subject [...]

2020 OCT 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on Cerebrovascular Diseases and Conditions - Stroke are presented in [...]

2020 OCT 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on Cerebrovascular Diseases and Conditions - Stroke is the subject [...]

2020 OCT 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Cerebrovascular Diseases and Conditions - Stroke have been [...]

2020 OCT 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Kidney Diseases and Conditions - Chronic Kidney [...]

2020 OCT 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Cerebrovascular Diseases and Conditions - Stroke is now [...]

2020 OCT 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Cardiovascular Diseases and Conditions - Transient Ischemic [...]

2020 OCT 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on Digestive System Diseases and Conditions - Dysphagia is the [...]