RESUMO
Management of acute ischemic stroke patients is organized around several priorities aimed at ensuring optimal patient outcomes, the first of which is reperfusion therapy, followed by determination of pathogenic mechanism by provision of a comprehensive workup to determine probable cause of the ischemic stroke or transient ischemic attack, for the purpose of providing appropriate prophylaxis for subsequent events. Provision of secondary prevention measures along with therapies that prevent complications associated with neurologic disability, and evaluation for the most appropriate level of rehabilitation services are the final priorities during acute hospitalization. This article provides an overview of reperfusion therapies and emerging hemodynamic treatments for hyperacute ischemic strokes. Gaps in the scientific evidence that are driving current blood flow augmentation research are identified.
Assuntos
Isquemia Encefálica/complicações , Reperfusão/métodos , Acidente Vascular Cerebral/terapia , Doença Aguda , Algoritmos , Causalidade , Contrapulsação , Cuidados Críticos/métodos , Serviços Médicos de Emergência/métodos , Enfermagem em Emergência/métodos , Tratamento de Emergência/métodos , Fibrinolíticos/uso terapêutico , Hidratação , Humanos , Guias de Prática Clínica como Assunto , Reperfusão/enfermagem , Reperfusão/tendências , Prevenção Secundária/métodos , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Terapia Trombolítica , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêuticoRESUMO
The Neurovascular Education and Training in Stroke Management and Acute Reperfusion Therapy (NET SMART) program for advanced practice nursing (APN) offers a first-of-its-kind, academic, postgraduate, fellowship program for APNs that is modeled after physician academic fellowship programs but supported by a flexible Internet-based platform. This article details the rationale, methods, and preliminary results of the NET SMART APN experience, which serves as a unique template for the development of academic postgraduate nursing fellowship programs across a variety of specialty practices.
Assuntos
Prática Avançada de Enfermagem/educação , Educação de Pós-Graduação em Enfermagem/organização & administração , Bolsas de Estudo/organização & administração , Neurociências/educação , Acidente Vascular Cerebral/terapia , Doença Aguda , Prática Avançada de Enfermagem/organização & administração , Certificação , Cuidados Críticos/organização & administração , Currículo , Humanos , Internet , Modelos Educacionais , Modelos de Enfermagem , Neurociências/organização & administração , Enfermeiros Clínicos/educação , Enfermeiros Clínicos/organização & administração , Profissionais de Enfermagem/educação , Profissionais de Enfermagem/organização & administração , Pesquisa em Educação em Enfermagem , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Reperfusão/métodos , Reperfusão/enfermagem , Acidente Vascular Cerebral/diagnósticoRESUMO
Stroke is the third leading cause of death in the United States and the leading cause of adult disability, consistently ranking in the top 10 of leading diagnostic categories encountered by practitioners in emergency and critical care settings. Despite its prevalence and clinical significance, only tissue plasminogen activator for ischemic stroke has been shown to reduce 3-month mortality and disability in phase III clinical trials, whereas for hemorrhagic stroke, no medicinal treatment has yet to demonstrate a similar reduction in mortality or disability. This article describes challenges inherent in the design and conduct of hyperacute stroke trials. Sample heterogeneity associated with pathophysiologic stroke mechanisms, the neurovascular territory implicated, systemic and intracranial hemodynamics, risk factor profiles, and patient access to requisite healthcare services are reviewed as contributors challenging enrollment into well-designed studies. Current controversies associated with designation of endpoints are presented and strategies to enhance trial design, and subsequent enrollment, are discussed. Recommendations are made for future clinical research into phenomena associated with hyperacute stroke.