Stroke; a journal of cerebral circulation
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Organized stroke systems of care include Primary Stroke Center (PSC) certification and preferential emergency medical services (EMS) routing of suspected patients with stroke to designated PSCs. Stroke EMS routing is not nationally governed; in California, routing is determined by county. EMS routing policies might provide an incentive for PSC accreditation. We evaluated the relationship between independent adoption of EMS routing protocols and PSC designation acquisition in California. ⋯ Implementation of EMS routing policies may be an important factor driving PSC certification. National adoption of stroke routing policies may lead to more PSCs, positively impacting patient care.
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The Centers for Medicare and Medicaid Services proposes to use 30-day hospital readmissions after ischemic stroke as part of the Hospital Inpatient Quality Reporting Program for payment determination beginning in 2016. The proportion of poststroke readmissions that is potentially preventable is unknown. ⋯ On the basis of Agency for Healthcare Research and Quality Prevention Quality Indicators, we found that a small proportion of readmissions after ischemic stroke were classified as preventable. Although other causes of readmissions not reflected in the Agency for Healthcare Research and Quality measures could also be avoidable, hospital-level programs intended to reduce all-cause readmissions and costs should target high-risk patients.
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The Combined Lysis of Thrombus in Brain Ischemia With Transcranial Ultrasound and Systemic T-PA-Hands-Free (CLOTBUST-HF) study is a first-in-human, National Institutes of Health-sponsored, multicenter, open-label, pilot safety trial of tissue-type plasminogen activator (tPA) plus a novel operator-independent ultrasound device in patients with ischemic stroke caused by proximal intracranial occlusion. ⋯ http://www.clinicaltrials.gov. Unique identifier: CLOTBUST-HF NCT01240356.
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Randomized Controlled Trial
Intraoperative magnesium administration does not improve neurocognitive function after cardiac surgery.
Neurocognitive decline occurs frequently after cardiac surgery and persists in a significant number of patients. Magnesium is thought to provide neuroprotection by preservation of cellular energy metabolism, blockade of the N-methyl-D-aspartate receptor, diminution of the inflammatory response, and inhibition of platelet activation. We therefore hypothesized that intraoperative magnesium administration would decrease postoperative cognitive impairment. ⋯ http://www.clinicaltrials.gov. Unique identifier: NCT00041392.