Sunday, August 10, 2008

Studies Focus on Stroke Patients

After more than 15,000 stroke patients were studied, it was reported that only 23% arrived at the hospital within two hours after the onset of symptoms and received tPA. Also, Patients arriving by ambulance were more than twice as likely to receive timely CT scans as those patients that walked in on their own.

Recently, researchers analyzed data on patients from 46 hospitals enrolled in the North Carolina Stroke Registry (NCCSR) from January 2005 to April 2008 for a study. The NCCR is one of four registries originally funded by CDC with a mandate to measure, track, and improve the quality of acute stroke care.

NCCSR as part of a pilot program gathers data on each step of emergency and hospital care for stroke patients from the time of the emergency response to the patient’s discharge from a hospital. The NCCSR differs from most quality improvement efforts because it encourages the collection of patient data to be concurrent with care as opposed to latter collecting the data from medical records.

At the end of the three year pilot, the results showed that large gaps existed between generally recommended guidelines for treating stroke patients and actual hospital practices. Intensive quality improvement efforts are needed to close the gap.

Gathering data on stroke patients is vital in order to provide appropriate emergency treatment, but another study at the University of California San Diego Medical Center, reported that that the UCSD telemedicine program enables stroke specialists to play an important role in the treatment of stroke patients.

The team at UCSD uses the “Stroke Team Remote Evaluation Using a Digital Observation Camera” system referred to as “STRokE DOC”. The system connects stroke experts located at a hub site to the patient at a remote but connected spoke site via the internet. The audio/video teleconsultation system enables the stroke expert real-time visual and audio access not only to the patient, but also to the emergency medicine practitioner, to the medical team, nurses, attending physicians, and perhaps family members.

The researchers had initially planned for a four year study with 400 patients participating. However, the study’s steering committee halted the trial after an analysis clearly showed that one group was superior to the other based on the preliminary data for 222 patients. In the final analysis, the telemedicine group was found to be far superior for correct decision making. When adjusted for initial stroke severity, there was no difference in the number of cases resulting in brain hemorrhage, death, or long term outcomes between the telemedicine or telephone groups.

The researchers say that the next step is to do a study to evaluate the long term health outcomes of patients. However, this will require a bigger trial to determine if there are any differences in clinical outcomes for these patients.

Using robots may also prove to be beneficial in helping stroke patients. According to a study done by researchers at the Rochester Institute of Technology, Georgia Tech, and Georgetown University, robots may be the solution for people with disabilities to regain the use of their limbs. The study was funded through the National Science foundation Computer, Information Science and Engineering Directorate.

The study showed that bio-signals produced by the human body, can improve the performance of external assistive devices called orthoses. These devices could aid individuals with physical disabilities such as strokes or major spinal cord injuries. By using a robotic orthoses to work with an individual’s residual strength and any remaining physiological information or signals in their limbs produced by their muscles, may be a way to enable stroke patients to regain significant use of their limbs.