Stroke; a journal of cerebral circulation
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National Institutes of Health Stroke Scale certification is required for participation in modern stroke clinical trials and as part of good clinical care in stroke centers. A new training and demonstration DVD was produced to replace existing training and certification videotapes. Previously, this DVD, with 18 patients representing all possible scores on 15 scale items, was shown to be reliable among expert users. The DVD is now the standard for National Institutes of Health Stroke Scale training, but the videos have not been validated among general (ie, nonexpert) users. ⋯ The data suggest that certification using the National Institute of Neurological Disorders and Stroke DVDs is robust and surprisingly reliable for National Institutes of Health Stroke Scale certification across multiple venues.
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Clinical trials for prevention of vasospasm after aneurysmal subarachnoid hemorrhage (SAH) seldom have improved overall outcome; one reason may be inadequate sample size. We used data from the tirilizad trials and the Columbia University subarachnoid hemorrhage outcomes project to estimate sample sizes for clinical trials for reduction of vasospasm after SAH, assuming trials must show effect on 90-day patient-centered outcome. ⋯ Clinical trials targeting vasospasm and using traditional patient-centered outcome require very high sample sizes and will therefore be costly, time-consuming, and impractical. This will hinder development of new treatment strategies.
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Comparative Study
Influence of weekend hospital admission on short-term mortality after intracerebral hemorrhage.
There is expanding literature to show that certain patients admitted during the weekend have worse outcomes than similar patients admitted during the week. Although many clinicians have hypothesized the presence of this "weekend effect" with patients with intracerebral hemorrhage, there is a paucity of studies validating this conjecture. ⋯ Weekend admission for intracerebral hemorrhage was associated with increased risk-adjusted mortality when compared with admission during the remainder of the week.
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Antiplatelet medication use and reduced platelet activity may be associated with mortality after intracerebral hemorrhage (ICH). We tested the hypothesis that reduced platelet activity is associated with early ICH clot growth and worse outcomes. ⋯ Reduced platelet activity was associated with early ICH volume growth and worse functional outcome. Because platelet activity can be increased with platelet transfusion, increasing platelet activity is a potential method to reduce ICH volume growth and improve functional outcomes.
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A major limitation of tissue plasminogen activator (tPA) thrombolysis for ischemic stroke is the narrow time window for safe and effective therapy. Delayed tPA thrombolysis increases the risk of cerebral hemorrhage and mortality, which, in part, is related to neurovascular proteolysis mediated by matrix metalloproteinases (MMPs). We recently showed that normobaric hyperoxia treatment reduces MMP-9 expression and blood-brain barrier disruption in the ischemic brain. Therefore, we hypothesized that normobaric hyperoxia could increase the safety of delayed tPA thrombolysis in stroke. ⋯ Our results suggest that early normobaric hyperoxia treatment may represent an important strategy to increase the safety of delayed tPA thrombolysis in ischemic stroke.