• 제목/요약/키워드: Stroke team

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Clinical features and risk factors for missed stroke team activation in cases of acute ischemic stroke in the emergency department

  • ;;;;정시경
    • 대한응급의학회지
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    • 제29권5호
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    • pp.437-448
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    • 2018
  • Objective: Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis. Methods: We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated. Results: The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness. Conclusion: A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.

급성기 뇌졸중 환자에서 Stroke Rehabilitation Assessment of Movement와 Berg Balance Scale, Modified Barthel Index와의 상관관계 (Correlations of the Stroke Rehabilitation Assessment of Movement, Berg Balance Scale, and Modified Barthel Index in Patients With Acute Stroke)

  • 정유회;송은지;이강노;안준수;성준혁;송문성
    • 한국전문물리치료학회지
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    • 제18권2호
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    • pp.52-59
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    • 2011
  • The purpose of this study was to examine the relationship of the Stroke Rehabilitation Assessment of Movement (STREAM), the Berg Balance Scale (BBS), and the Modified Barthel Index (MBI) in the acute stroke care setting. Twenty patients with their first stroke were evaluated using STREAM, BBS, and MBI initially and at 4 weeks. The data was analyzed using the independent t-test, paired t-test, and the Pearson product moment correlation analysis. The scores on the STREAM were strongly associated with the scores on both the BBS and MBI (with Pearson correlation coefficients ranging from .88 to .95), and there was significant improvement between the initial scores and those obtained four weeks later for STREAM, BBS, and MBI (p=.001, p=.001, p<.001). The results suggest that STREAM may be able to reflect functional recovery and to assess voluntary movement in patients who have suffered an acute stroke.

Acute Ischemic Stroke: Current Management and Role of the Nurse Practitioner

  • Kang, Ji-Yeon;Coleman, Patricia;Kim, Keum-Soon;Yi, Young-Hee;Choi, Eun-Jung
    • 중환자간호학회지
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    • 제2권1호
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    • pp.26-35
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    • 2009
  • Purpose: This paper reviews current diagnostic evaluation, treatment, nursing considerations, and the nurse practitioner’s (NP) role in acute ischemic stroke care. Methods: National guidelines and extensive literature on acute stroke care were reviewed and a relevant clinical case was introduced. Results: Computerized tomography (CT) of the head without contrast is the initial brain imaging procedure for patients with an acute stroke. Magnetic resonance imaging (MRI) can be an alternative test. Restoration of cerebral perfusion to the affected area is a key therapeutic strategy for ischemic stroke. A number of treatment strategies such as thrombolysis, anticoagulation, antiplatelet, and surgical treatment can be selected to improve blood flow to the ischemic region. The NP on the stroke team is involved with immediate stroke management including neurological assessment, ensuring adequate oxygenation, blood pressure management, activity, and diet. Discharge planning with the patient, family teaching and coordination of follow up care should also be implemented early in the hospitalization. Conclusion: The nurse practitioner is one of the cardinal members on the stroke team, and must be updated with current treatment and management guidelines.

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Identifying Atrial Fibrillation With Sinus Rhythm Electrocardiogram in Embolic Stroke of Undetermined Source: A Validation Study With Insertable Cardiac Monitors

  • Ki-Hyun Jeon;Jong-Hwan Jang;Sora Kang;Hak Seung Lee;Min Sung Lee;Jeong Min Son;Yong-Yeon Jo;Tae Jun Park;Il-Young Oh;Joon-myoung Kwon;Ji Hyun Lee
    • Korean Circulation Journal
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    • 제53권11호
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    • pp.758-771
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    • 2023
  • Background and Objectives: Paroxysmal atrial fibrillation (AF) is a major potential cause of embolic stroke of undetermined source (ESUS). However, identifying AF remains challenging because it occurs sporadically. Deep learning could be used to identify hidden AF based on the sinus rhythm (SR) electrocardiogram (ECG). We combined known AF risk factors and developed a deep learning algorithm (DLA) for predicting AF to optimize diagnostic performance in ESUS patients. Methods: A DLA was developed to identify AF using SR 12-lead ECG with the database consisting of AF patients and non-AF patients. The accuracy of the DLA was validated in 221 ESUS patients who underwent insertable cardiac monitor (ICM) insertion to identify AF. Results: A total of 44,085 ECGs from 12,666 patient were used for developing the DLA. The internal validation of the DLA revealed 0.862 (95% confidence interval, 0.850-0.873) area under the curve (AUC) in the receiver operating curve analysis. In external validation data from 221 ESUS patients, the diagnostic accuracy of DLA and AUC were 0.811 and 0.827, respectively, and DLA outperformed conventional predictive models, including CHARGE-AF, C2HEST, and HATCH. The combined model, comprising atrial ectopic burden, left atrial diameter and the DLA, showed excellent performance in AF prediction with AUC of 0.906. Conclusions: The DLA accurately identified paroxysmal AF using 12-lead SR ECG in patients with ESUS and outperformed the conventional models. The DLA model along with the traditional AF risk factors could be a useful tool to identify paroxysmal AF in ESUS patients.

뇌졸중 환자를 위한 팀접근 재활프로그램의 효과 (The Effect of a Multidisciplinary Team Approach on the Rehabilitation of Stroke Survivors)

  • 조복희
    • 재활간호학회지
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    • 제6권2호
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    • pp.137-151
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    • 2003
  • The purpose of this study was to develop a multidisciplinary team approach program for stroke survivors, and to identify its effects on their rehabilitation. The team was composed of 7 members: a rehabilitation nurse, a physician, a physical therapist, an occupational therapist, a therapeutic recreational therapist, a nutritionist, and a researcher. A quasi-experimental study was performed with 36 subjects: 18 in the experimental group and 18 in the control group, using a noneqivalent control group pretest-posttest design. The experimental group participated 4 times in rehabilitation programsfocused on information and emotional support provided by the rehabilation team-and received telephone counseling from the researcher. The control group did not receive any treatment. The selection criteria for the subjects in this study were: (a) patients who were diagnosed as having had an ischemic stroke within the last year, (b) patients free of any communication disorder, (c) and those having a primary caregiver who could assist in filling out the form assessing the level of ADL. The data were collected from patients who had been discharged from a tertiary hospital, between October 1st, 1999 and September 30th, 2000. The data were analysed by $X^2$ test, Fisher's exact test, ANCOVA, Wilcoxon's rank sum test, and Wilcoxon's signed rank test using an SAS program. The results were as follows: 1. In terms of physical variables (blood pressure, grasp power, and ADL) 1) There was a significant difference in blood pressure between the two groups (systolic pressure P= .012, diastolic pressure P= .050). 2) There was also a significant difference in grasp power between the two groups (affected side : P= .012, unaffected side : P= .010). 3) There was no significant change in the level of ADL between the two groups. 2. In terms of psychosocial variables (depression, self-efficacy, self-esteem, and social activities) 1) There were no significant differences between the two groups. However, all four psychosocial variables showed a tendency to improve in the experimental group, while only two variables (depression and self-efficacy) showed a simalar tendency in the control group. 2) The level of social activities in the control group decreased significantly after a month (P= .050). 3. The level of life satisfaction improved in both groups, but no significant difference was found. Stroke has high recurrence rate and requires considerable follow-up care. The program used in this study was developed and designed for stimulting the rehabilitation process of stroke survivors. Through the program period of one month (meetings were held weekly), a positive effect was detected in physical variables, although the psychosocial variables did not improve significantly. In retrospect, a one month period may not be an adequate length of time to improve the psychosocial variables, as the stroke survivors were complicated cases, and most of them were elderly. Further research is therefore recommended by increasing the length of program, so that its effect can be more noticeable.

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선박 추진용 2행정 저속엔진의 고장모드 데이터 개발 및 LSTM 알고리즘을 활용한 특성인자 신뢰성 검증연구 (The Study of Failure Mode Data Development and Feature Parameter's Reliability Verification Using LSTM Algorithm for 2-Stroke Low Speed Engine for Ship's Propulsion)

  • 박재철;권혁찬;김철환;장화섭
    • 대한조선학회논문집
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    • 제60권2호
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    • pp.95-109
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    • 2023
  • In the 4th industrial revolution, changes in the technological paradigm have had a direct impact on the maintenance system of ships. The 2-stroke low speed engine system integrates with the core equipment required for propulsive power. The Condition Based Management (CBM) is defined as a technology that predictive maintenance methods in existing calender-based or running time based maintenance systems by monitoring the condition of machinery and diagnosis/prognosis failures. In this study, we have established a framework for CBM technology development on our own, and are engaged in engineering-based failure analysis, data development and management, data feature analysis and pre-processing, and verified the reliability of failure mode DB using LSTM algorithms. We developed various simulated failure mode scenarios for 2-stroke low speed engine and researched to produce data on onshore basis test_beds. The analysis and pre-processing of normal and abnormal status data acquired through failure mode simulation experiment used various Exploratory Data Analysis (EDA) techniques to feature extract not only data on the performance and efficiency of 2-stroke low speed engine but also key feature data using multivariate statistical analysis. In addition, by developing an LSTM classification algorithm, we tried to verify the reliability of various failure mode data with time-series characteristics.

균형능력 운동치료 시스템을 이용한 치료가 급성기 뇌졸중 환자의 균형과 이동능력에 미치는 영향 (The Effects of Treatment With a TETRAX on Balance and Mobility in Acute Stroke Patients)

  • 이남현;이진;이강노
    • 한국전문물리치료학회지
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    • 제17권3호
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    • pp.11-19
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    • 2010
  • The purpose of the study was to determine the effects of balance training with 'TETRAX' system, a balance training and assessment tool, on balance and mobility in acute hemiplegic patients. Nineteen matched subjects were assigned randomly into either an experimental group or a control group. An experimental group with 10 subjects received balance training with 'TETRAX' exercise program and conventional physical therapy interventions 5 times per week during 4 weeks. A control group with 9 subjects received conventional physical therapy interventions 5 times per week during 4 weeks. Outcome measures were taken before and after 4 weeks of interventions using the Stroke Rehabilitation Assessment of Movement (STREAM), the Berg Balance Scale (BBS), gait speed, and the fall down index. Results indicated that both exercise groups improved significantly in STREAM, BBS, and gait speed (p<.05). The experimental group had a little improvement than the control group. Both exercise groups did not show statistical significance in fall down index (p<.05). Following 4 weeks of intervention, except gait speed there was no statistically significant difference between two groups. However, these findings suggest that conventional physical therapy interventions with visual feedback training could be effective on improving balance and mobility than conventional physical therapy alone in acute hemiplegic patients.

급성 뇌졸중 의심 환자의 병원 전 지연 원인 분석 (An analysis of the causes of prehospital delays in patients with suspected acute stroke)

  • 이남진;문준동
    • 한국응급구조학회지
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    • 제24권2호
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    • pp.27-38
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    • 2020
  • Purpose: Stroke is a time-sensitive disease that could have reduced complications and mortality with timely diagnosis and treatment. This study aimed to analyze the causes of delay in detecting the clinical signs and symptoms of stroke. Methods: This retrospective observational study analyzed the emergency medical services reports of suspected stroke patients with positive predictive values on the Cincinnati Prehospital Stroke Scale. The study was conducted in Daejeon, Republic of Korea from January 1, 2016 through December 31, 2017. Results: Prolonged prehospital time was associated with high blood pressure, history of cerebrovascular disease, and incidences during daily activities, and sleep. High blood pressure and complications from a previous stroke strongly associated with the prolonged stroke-detection phase (p<.05). Total prehospital time was shortened when patients had evident stroke symptoms, such as decreased level of consciousness, dysarthria, and hemiplegia (p<.05). There was no significant difference in gender or age as a factor that delayed the total prehospital time of the suspected stroke patients. Conclusion: Many patients did not recognize the early clinical symptoms and signs of a stroke. Furthermore, risk factors, such as high blood pressure and history of stroke, prolonged the total prehospital time. Therefore, we need targeted interventions that educate about warning symptoms of stroke, along with emphasis on the importance of emergency calls to substantially reduce the prehospital delays.

중풍환자에 대한 일차 한의임상진료 가이드라인 (Clinical Practice Guideline of Korean Medicine for Stroke : Preliminary Guideline and Recommendation)

  • 한창호
    • 대한한방내과학회지
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    • 제33권4호
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    • pp.347-366
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    • 2012
  • The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on stroke management for clinical practitioners. Many countries are already well engaged in developing and releasing their own clinical practice guidelines, whereas Korean Medicine (KM) is still beginning. It will take time and effort to develop evidence-based guidelines and recommendations of KM or other traditional medicine because they are weak in the area of scientific evidence. The clinical practice guideline of Korean medicine for stroke was formulated through extensive review of published literature and consensus meeting of Korean medicine specialists. This project was supported by a grant of the Oriental Medicine R&D Project, the Ministry of Health and Welfare. Referring to guidelines developed in other countries, the experts in the subject tried to organize and develop guidelines and recommendations adequate for domestic medical circumstances. In December, 2008, a multi-disciplinary team called the Evidence Based Clinical Practice Guidelines Development Group (EBCPGsDG) for Stroke was organized. The writing committee was comprised of experts in internal medicine, acupuncture, rehabilitation, and Sasang constitution. Outside specialists and associated panels were invited for consultation. The scope of the guideline encompasses acupuncture, moxibustion and herbal medicine (including Korean medicine, traditional Chinese medicine, Kampo medicine) as interventions for stroke patients. It includes statements about ischemic stroke (I63), stroke not specified as hemorrhage or infarction (I64), and sequelae of cerebrovascular disease (I69) according to the International Classification of Disease (ICD). The committee subdivided the description of herbal medications into acute stroke management, subacute stroke management, post-stroke management, and secondary prevention of stroke. Guidelines on the practice of acupuncture and moxibustion were described in order for acute stroke management, subacute stroke management, chronic stroke management, and post-stroke rehabilitation. Clinicians who are working in the field of stroke care can adopt this guideline for their practice.

소형 2행정 엔진의 전송 포트 형상에 따른 소기 성능에 대한 수치 해석적 연구 (Numerical Study on Transfer Port Design for Scavenging Performance in Small Two-stroke Engines)

  • 김청환;박성호;김명규;안은수
    • 한국추진공학회지
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    • 제24권6호
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    • pp.28-44
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    • 2020
  • 본 연구에서는 무인 항공기용 소형 2행정 엔진의 성능 개선을 위해 다양한 전송 포트 형상의 가스교환 성능을 평가하였다. 성능 평가를 위해 네 가지 전송 포트 형상에 따른 3차원 전산 유체 해석을 진행하였으며, 가스 교환 성능의 정량적 평가를 위해 이상적 소기 모델인 완전 대체 소기 모델과 완전 혼합 소기 모델을 바탕으로 새로운 3단계 소기 모델을 개발하여 해석 결과에 적용하였다. 2행정 엔진의 전송 포트 형상 변경을 통해 흡기의 단락 현상을 효과적으로 줄였으며 가스 교환 과정 동안의 실린더 내 난류 에너지 또한 크게 개선되었다. 또한, 전송 포트 형상 별 3단계 소기 모델의 적용을 통해 가스 교환 성능을 정량적으로 평가할 수 있었으며, 포트 형상 별 소기 양상의 차이를 확인할 수 있었다.