International journal of stroke : official journal of the International Stroke Society
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Randomized Controlled Trial
Reperfusion after 4.5 hours reduces infarct growth and improves clinical outcomes.
The currently proven time window for thrombolysis in ischemic stroke is 4.5 h. Beyond this, the risks and benefits of thrombolysis are uncertain. ⋯ Thrombolysis 4.5-6 h after stroke onset reduced infarct growth and increased the rate of reperfusion, which was associated with good neurological and functional outcome.
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Research resources should address the issues that are most important to people affected by a particular healthcare problem. Systematic identification of stroke survivor, caregiver, and health professional priorities would ensure that scarce research resources are directed to areas that matter most to people affected by stroke. ⋯ The top 10 research priorities relating to life after stroke have been identified using a rigorous and person-centered approach. These should be used to inform the prioritization and funding of future research relating to life after stroke.
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In Germany, the financing of stroke unit care was implemented into the hospital reimbursement system in 2006. Since then, many acute care hospitals newly implemented stroke units. Simultaneous, in-hospital mortality for stroke declined. ⋯ The earlier stroke unit implementations might represent rather 'formal' inceptions in experienced hospitals with preexisting appropriate stroke care, whereas late implementations seem to have caused extra improvements. Overall, stroke patients are more likely to survive when admitted to an stroke unit-providing hospital. A more stringent assignment of acute stroke patients to stroke unit-providing hospitals could possibly further reduce stroke mortality in Germany.
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Intravenous tissue plasminogen activator is the most effective treatment for acute ischemic stroke, and its use may therefore serve as an indicator of the available level of acute stroke care. The greatest burden of stroke is in low- and middle-income countries, but the extent to which intravenous tissue plasminogen activator is used in these countries is unreported. ⋯ By reported use, intravenous tissue plasminogen activator for acute ischemic stroke is available to some patients in approximately one-third of countries. Access to advanced acute stroke care is most limited where the greatest burden of cerebrovascular disease is reported.
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Randomized Controlled Trial
The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial protocol: a randomized, blinded, efficacy trial of standard vs. intensive hyperglycemia management in acute stroke.
Patients with acute ischemic stroke and hyperglycemia have worse outcomes than those without hyperglycemia. Intensive glucose control during acute stroke is feasible and can be accomplished safely but has not been fully assessed for efficacy. ⋯ This trial will provide important novel information about preferred management of acute ischemic stroke patients with hyperglycemia. It will determine the potential benefits and risks of intensive glucose control during acute stroke.