Expansion of the dimensions in the current management of acute ischemic stroke

Malik, Preeti; Anwar, Arsalan; Patel, Ruti; Patel, Urvish

doi:10.1007/s00415-020-09873-6

Cited by 27 publications

(20 citation statements)

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“…The fi ndings of the current study, consistent with the results of previous research, highlight the multifaceted nature of stroke HCPs' experiences. [4] Understanding and evaluating the educational needs of HCPs regarding stroke is essential to establish benefi cial interdisciplinary training. In addition, evaluating the standards and elements of stroke care, as carried out by HCPs in the emergency, facilitates achieving better health outcomes for stroke patients.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Regardless of major improvements in its management over the last few decades, stroke is still a deadly disease that is on the rise because of an aging population worldwide and the epidemiological transition in LMICs, and one of these countries is Jordan. [3,4] Approximately 12% of the total deaths in Jordan result from stroke, and it is the third leading cause of death in the country. [5] The burden of stroke is expected to continuously increase in the future in Jordan because of the expected demographic changes.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of an educational program on improving healthcare providers’ knowledge of acute stroke: A randomized block design study

Rababah¹,

Al‐Hammouri²,

AlNsour³

2021

World Journal of Emergency Medicine

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BACKGROUND: Stroke is a time-sensitive neurological disease and a life-threatening medical condition. Providing timely management for stroke patients is a crucial issue in healthcare settings. The primary objective of this study is to evaluate the eff ectiveness of an evidence-based educational program on healthcare providers' (HCPs) overall knowledge of stroke. METHODS: A randomized block design with post-test only was used. A total of 189 HCPs (physicians, registered nurses, and paramedics) involved with treating stroke patients in the emergency were recruited. Participants were randomly assigned to either the intervention or waiting list control group. A one-session, stroke educational program was off ered to the HCPs followed by a post-test designed to assess knowledge about stroke. RESULTS: A signifi cant main eff ect on the profession type was found, with physicians having higher mean scores of stroke knowledge compared with nurses and paramedics (F [2, 183]=48.55, P<0.001). The implemented educational program had a positive effect on increasing the level of stroke knowledge among HCPs (F [1, 183]=43.31, P<0.001). The utilization of any evidence-based assessment tools for patients with suspected stroke was denied by 36% of the total sample. CONCLUSIONS: The implemented intervention can increase HCP's knowledge regarding stroke. Stroke education should be considered as one of the essential requirements for professional development for all HCPs in the emergency.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness of an educational program on improving healthcare providers’ knowledge of acute stroke: A randomized block design study

Rababah¹,

Al‐Hammouri²,

AlNsour³

2021

World Journal of Emergency Medicine

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“…Tissue-plasminogen activator remains the only effective drug approved by the United States Food and Drug Administration for the treatment of strokes ( 4 , 5 ). Since tissue-plasminogen activator is recommended to be administered within 4.5 h due to the relatively short half-life (3–4.5 min) ( 6 , 7 ), many patients cannot receive timely and efficient treatment. Therefore, the prevention and treatment of stroke require further investigation.…”

Section: Introductionmentioning

confidence: 99%

Preconditioning With Intermittent Hypobaric Hypoxia Attenuates Stroke Damage and Modulates Endocytosis in Residual Neurons

Wan

Liu

et al. 2021

Front. Neurol.

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Background: Moderate hypobaric hypoxia induces cerebral ischemic tolerance. We investigated the optimal method for applying hypobaric hypoxia preconditioning at 5,000 m to ischemic brain tissue and combined it with proteomics to determine the mechanisms underlying this effect.Methods: Male SD rats were randomly grouped as S (sham, n = 20), M (middle cerebral artery occlusion [MCAO], n = 28), H2M (intermittent hypobaric hypoxia preconditioned MCAO group, 2 h/day, 10 days, n = 20), H6M (intermittent hypobaric hypoxia preconditioned MCAO group, 6 h/day, 10 days, n = 28), and HpM (persistent hypobaric hypoxia preconditioned MCAO group, 10 days, n = 28). The permanent MCAO model was established based on the Zea Longa method. Infarction was assessed with the modified neurological severity score (mNSS) and 2,3,5-triphenyl tetrazolium chloride staining. The total protein expression of the neuron-specific nuclear protein (NeuN), cysteinyl aspartate specific proteinase 3 (caspase-3), cleaved-caspase-3, and interleukin 6 (IL-6) was determined using western blotting. We assessed the peri-infarct cortex's ultrastructural changes. A label-free proteomic study and western blot verification were performed on the most effective preconditioned group.Results: The H6M group showed a lower infarct volume (p = 0.0005), lower mNSS score (p = 0.0009) than the M group. The H2M showed a lower level of IL-6 (p = 0.0213) than the M group. The caspase-3 level decreased in the H2M (p = 0.0002), H6M (p = 0.0025), and HpM groups (p = 0.0054) compared with that in the M group. Cleaved-caspase-3 expression decreased in the H2M (p = 0.0011), H6M (p < 0.0001), and HpM groups (p < 0.0001) compared with that in the M group. The neurons' ultrastructure and the blood-brain barrier in the peri-infarct tissue improved in the H2M and H6M groups. Immunofluorescence revealed increased NeuN-positive cells in the peri-infarct tissue in the H6M group (p = 0.0003, H6M vs. M). Protein expression of Chmp1a, Arpc5, and Hspa2 factors related to endocytosis were upregulated in the H6M compared with those of the M group (p < 0.05 for all) on western blot verification of label-free proteomics.Conclusions: Intermittent hypobaric hypoxia preconditioning exerts a neuroprotective effect in a rat stroke model. Persistent hypobaric hypoxia stimulation exhibited no significant neuroprotective effect. Intermittent hypoxic preconditioning for 6 h/day for 10 days upregulates key proteins in clathrin-dependent endocytosis of neurons in the cortex.

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“…In the wake of the first NMDA antagonist failures, academic and industry investigators met to devise guidelines for improving the testing of candidate neuroprotective treatments in animal models and human trials (Stroke Therapy Academic Industry Roundtable, 1999;Fisher et al, 2009). Vitally, in the interim stroke-is-untreatable nihilism has departed from medicine, as both medical (tissue plasminogen activator, tPA) thrombolysis and, more recently, endovascular thrombectomy improve outcomes in selected patients, even if the latter is delayed up to 24 h after stroke onset (Malik et al, 2020). Major hospitals now deploy specialized stroke teams, capable of completing brain imaging and delivering drugs within minutes of a patient's arrival, and emergency medical services are tuned to getting patients to stroke centers as quickly as possible.…”

Section: Blocking Excitotoxicity In the Ischemic Human Brainmentioning

confidence: 99%

Excitotoxicity: Still Hammering the Ischemic Brain in 2020

2020

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Interest in excitotoxicity expanded following its implication in the pathogenesis of ischemic brain injury in the 1980s, but waned subsequent to the failure of N-methyl-D-aspartate (NMDA) antagonists in high profile clinical stroke trials. Nonetheless there has been steady progress in elucidating underlying mechanisms. This review will outline the historical path to current understandings of excitotoxicity in the ischemic brain, and suggest that this knowledge should be leveraged now to develop neuroprotective treatments for stroke.

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Expansion of the dimensions in the current management of acute ischemic stroke

Cited by 27 publications

References 50 publications

Effectiveness of an educational program on improving healthcare providers’ knowledge of acute stroke: A randomized block design study

Effectiveness of an educational program on improving healthcare providers’ knowledge of acute stroke: A randomized block design study

Preconditioning With Intermittent Hypobaric Hypoxia Attenuates Stroke Damage and Modulates Endocytosis in Residual Neurons

Excitotoxicity: Still Hammering the Ischemic Brain in 2020

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