Abstract-Thishours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD 2 score Ն3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis. Key Words: AHA Scientific Statements Ⅲ brain Ⅲ brain ischemia Ⅲ cerebral ischemia Ⅲ ischemia Ⅲ stroke Ⅲ transient ischemic attack Ⅲ acute stroke syndromes Ⅲ acute cerebrovascular syndromes R ecent scientific studies have revised our understanding of 3 key aspects of transient ischemic attack (TIA): how it is best defined, what the early risk of stroke and other vascular outcomes is, and how it is best evaluated. This statement reviews and synthesizes recent scientific advances regarding the definition, urgency, and evaluation of TIA and is designed to aid the clinician in the short-and long-term management of patients with TIA. DefinitionTIAs are brief episodes of neurological dysfunction resulting from focal cerebral ischemia not associated withThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on January 16, 2009. A copy of the statement is available at http://www.americanheart.org/presenter.jhtml?identifierϭ3003999 by selecting either the "topic list" link or the "chronological list" link (No. LS-2037). To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, visit http://www.americanheart.org/presenter.jhtml?identifierϭ3023366.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml?identifierϭ4431. A link to the "Permission Request Form" appears on the right side of the page.© 2009 American Heart Association, Inc. UrgencyLarge cohort and population-based studies reported in the last 5 years have demonstrated a higher risk ...

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Supportive-expressive therapy, with its emphasis on providing support and helping patients face and deal with their disease-related stress, can help reduce distress in patients with metastatic breast cancer.

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S troke is one of the leading causes of severe, long-term disability, 1 with a majority of stroke survivors requiring the assistance of a family caregiver.2 A family caregiver is defined in this context as a relative, partner, personal friend, or neighbor who provides assistance to an adult with a chronic or disabling condition such as stroke.3 Although family members may not consider themselves caregivers, this term is commonly used in the literature to represent family or informal (unpaid) caregivers.Family caregiver stress is commonly associated with longterm institutionalization of stroke survivors, resulting in significant costs to the healthcare system. [4][5][6][7][8] Family caregiver stress can also result in other negative outcomes for both survivors and their caregivers. 7 For example, caregiver stress has been shown to interfere with rehabilitation of the survivor 7 and can result in social isolation, declining health, and increased risk of mortality for the caregivers. 9,10 Depression is especially prevalent in stroke family caregivers, 7,11,12 with some studies reporting higher depression rates in the caregivers than in the survivors for whom they provide care. 11,13 Miller and colleagues 14 made recommendations for family caregiver education and support across inpatient, outpatient, and chronic care settings based on clinical practice guidelines and existing research. These recommendations involved (1) caregivers serving as integral members of interdisciplinary teams, (2) assessment of caregiver needs and concerns, (3) follow-up contacts and referrals, (4) counseling focused on problem solving and social support, (5) provision of strokerelated information, and (6) attention to the emotional and Abstract-Stroke is a leading cause of severe, long-term disability. Most stroke survivors are cared for in the home by a family caregiver. Caregiver stress is a leading cause of stroke survivor institutionalization, which results in significant costs to the healthcare system. Stroke family caregiver and dyad intervention studies have reported a variety of outcomes. A critical analysis of 17 caregiver intervention studies and 15 caregiver/stroke survivor dyad intervention studies was conducted to provide evidence-based recommendations for the implementation and future design of stroke family caregiver and dyad interventions. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on March 26, 2014. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or ...

BACKGROUND. This study was designed to replicate our earlier finding that intensive group therapy extended survival time of women with metastatic breast cancer. Subsequent findings concerning the question of whether such psychosocial support affects survival have been mixed. METHODS. One hundred twenty‐five women with confirmed metastatic (n = 122) or locally recurrent (n = 3) breast cancer were randomly assigned either to the supportive‐expressive group therapy condition (n = 64), where they received educational materials plus weekly supportive‐expressive group therapy, or to the control condition (n = 61), where they received only educational materials for a minimum of 1 year. The treatment, 90 minutes once a week, was designed to build new bonds of social support, encourage expression of emotion, deal with fears of dying and death, help restructure life priorities, improve communication with family members and healthcare professionals, and enhance control of pain and anxiety. RESULTS. Overall mortality after 14 years was 86%; median survival time was 32.8 months. No overall statistically significant effect of treatment on survival was found for treatment (median, 30.7 months) compared with control (median, 33.3 months) patients, but there was a statistically significant intervention site‐by‐condition interaction. Exploratory moderator analysis to explain that interaction revealed a significant overall interaction between estrogen‐receptor (ER) status and treatment condition (P = .002) such that among the 25 ER‐negative participants, those randomized to treatment survived longer (median, 29.8 months) than ER‐negative controls (median, 9.3 months), whereas the ER‐positive participants showed no treatment effect. CONCLUSIONS. The earlier finding that longer survival was associated with supportive‐expressive group therapy was not replicated. Although it is possible that psychosocial effects on survival are relevant to a small subsample of women who are more refractory to current hormonal treatments, further research is required to investigate subgroup differences. Cancer 2007. © 2007 American Cancer Society.

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T o work toward the goal of building healthier lives, free of cardiovascular diseases and stroke, the American Heart Association (AHA) and American Stroke Association (ASA) have developed a multifaceted strategy for improving the quality of care for stroke. A key feature of this strategy is the development of professional guidelines for evidence-based stroke care. Recommendations are provided for acute management, primary and secondary prevention, rehabilitation, stroke systems of care, and other domains of stroke care. 1-4The strength of the evidence supporting these recommendations is given, according to a specified grading system. For many aspects of care, there is widespread consensus that the intervention is beneficial, usually supported by strong scientific evidence including randomized controlled trials.Professional guidelines improve the delivery of evidencebased care; however, despite these guidelines, gaps between best evidence-based practice and actual practice persist.5 To close these gaps in quality of care, several organizations have developed systems to allow practitioners and healthcare organizations such as hospitals to quantify the quality of their care through performance measures. A performance measure is defined by the Agency for Healthcare Research and Quality as a "mechanism for assessing the degree to which a provider competently and safely delivers the appropriate clinical services to the patient within the optimal time period." 6 The AHA and American College of Cardiology Foundation have additionally suggested that performance measures should be based on the highest level of supportive evidence and have the greatest impact on health outcomes.7 Performance measures, in addition to supporting quality improvement activities, are specifically suitable for public reporting, external comparisons, and possibly pay-for-performance programs.As steward of the professional guidelines for stroke care, with a large group of volunteer expert clinicians with expertise in guideline creation and performance measurement, the AHA/ASA is uniquely positioned to develop high-quality performance measures based on the guidelines. Accordingly, in 2011 the AHA/ASA formed the Stroke Performance Oversight Committee to oversee development of stroke performance measures and quality metrics. Writing committees were commissioned for different domains of stroke care based on the care setting and type of cerebrovascular disease (eg, ischemic stroke versus intracerebral hemorrhage), roughly corresponding to the topics of the highest-impact professional guideline statements.8 This document provides the results of the writing committee on acute inpatient management of ischemic stroke.The primary intended purpose of these performance measures is to facilitate improved adherence to guideline-recommended care. The writing committee hopes that healthcare providers, healthcare organizations, and payers, such as the Centers for Medicare and Medicaid Services (CMS), may find these measures useful to measure and improve their qual...