Hyperacute ischemic stroke management: reperfusion and evolving therapies.

Management of acute ischemic stroke patients is organized around several priorities aimed at ensuring optimal patient outcomes, the first of which is reperfusion therapy, followed by determination of pathogenic mechanism by provision of a comprehensive workup to determine probable cause of the ischemic stroke or transient ischemic attack, for the purpose of providing appropriate prophylaxis for subsequent events. Provision of secondary prevention measures along with therapies that prevent complications associated with neurologic disability, and evaluation for the most appropriate level of rehabilitation services are the final priorities during acute hospitalization. This article provides an overview of reperfusion therapies and emerging hemodynamic treatments for hyperacute ischemic strokes.

Postgraduate fellowship education and training for nurses: the NET SMART experience.

The Neurovascular Education and Training in Stroke Management and Acute Reperfusion Therapy (NET SMART) program for advanced practice nursing (APN) offers a first-of-its-kind, academic, postgraduate, fellowship program for APNs that is modeled after physician academic fellowship programs but supported by a flexible Internet-based platform. This article details the rationale, methods, and preliminary results of the NET SMART APN experience, which serves as a unique template for the development of academic postgraduate nursing fellowship programs across a variety of specialty practices.

Methodologic challenges in the design and conduct of hyperacute stroke research.

Stroke is the third leading cause of death in the United States and the leading cause of adult disability, consistently ranking in the top 10 of leading diagnostic categories encountered by practitioners in emergency and critical care settings. Despite its prevalence and clinical significance, only tissue plasminogen activator for ischemic stroke has been shown to reduce 3-month mortality and disability in phase III clinical trials, whereas for hemorrhagic stroke, no medicinal treatment has yet to demonstrate a similar reduction in mortality or disability. This article describes challenges inherent in the design and conduct of hyperacute stroke trials.

Events of hospitalization among children with sickle cell disease.

Previous research has identified vaso-occlusive pain crisis as the most common reason for hospitalization among pediatric patients with sickle cell disease. We sought to identify contributors to hospitalization and length of stay (LOS) for this patient population. A descriptive design was used to determine factors associated with hospitalization and LOS for patients with sickle cell disease at an urban tertiary care pediatric hospital in the Midwest.

Pilot study of the feasibility and effectiveness of a natural laxative mixture.

We sought to determine the effect of a natural laxative mixture compared with daily prescribed laxatives on bowel movement frequency in elderly long-term care residents. Secondary endpoints included ease of administration and costs of the natural laxative. A randomized controlled trial comparing the effect of the Beverley-Travis natural laxative mixture to prescribed laxatives was conducted over an 8-week period.

AACN Synergy Model's characteristics of patients: psychometric analyses in a tertiary care health system.

Background: Models for delivery of patient care that recognize the relationship between the characteristics of the patient and the competencies of the nurse are essential for high-quality outcomes.

Objectives: (1) To test application of a case report form used to assess patients' characteristics as defined by the American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care in a general population of pediatric and adult patients and (2) to evaluate the internal consistency reliability and construct validity of the patient characteristics measure found on the American Association of Critical-Care Nurses Web site.

Methods: A cross-sectional correlational study was conducted in 2 phases.

Telemedicine-guided carotid and transcranial ultrasound: a pilot feasibility study.

Background And Purpose: Transcranial Doppler (TCD) and carotid duplex (CD) provide rapid and safe screening for stroke patients but are highly operator dependent. We explored the feasibility of telemedicine (TM)-guided TCD/CD administered by a health care provider inexperienced with ultrasound.

Methods: Dual video screens transmitted real-time TCD/CD images and sound to a neurosonographer.

Houston paramedic and emergency stroke treatment and outcomes study (HoPSTO).

Background And Purpose: Establishment of stroke centers, combined with accurate paramedic diagnosis and rapid transport, is essential to deliver acute stroke therapy. We wanted to measure and improve paramedic and hospital performance through implementation of the Brain Attack Coalition and American Stroke Association guidelines.

Methods: Pre-intervention and active-intervention phases with parallel data measurement points were used.