Controversies in acute stroke treatment.

The evidence base supporting the management of patients with acute stroke is evolving at a rapid rate, as new methods that aim to reduce disability and death from stroke are explored. Intravenous tissue plasminogen activator remains the only treatment shown in numerous studies to reduce disability 3 months after stroke with no increase in the risk of death and a relatively minor rate of symptomatic intracerebral hemorrhage complications. Despite these findings, health care providers have been slow to adopt this evidence-based treatment, which results in many patients experiencing disability caused by stroke. Numerous controversies exist related to the management of patients with acute stroke, including the use of tissue plasminogen activator, positioning and early mobility, blood pressure lowering in acute intracerebral hemorrhage, and even the use of innovative advanced practice nurse-led stroke treatment teams, with varying amounts of evidence available to provide direction. This article explores controversies associated with both approved and evolving treatments for ischemic and hemorrhagic stroke and makes recommendations for practice on the basis of the body of existing evidence, with an aim to improve the delivery of acute stroke treatment.

Postgraduate fellowship education and training for nurses: the NET SMART experience.

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.