Management Of Stroke Research Articles

Adaptive Platform Trials in Stroke.

Clinical trials of treatments for stroke have generally utilized 2-arm, randomized designs to evaluate a single intervention against a control. Running separate clinical trials, with each addressing a single therapeutic question, is resource intensive and slows evidence generation, especially in a field with rapidly expanding treatment options and evolving practices. Platform trials-randomized clinical trials designed to evaluate multiple interventions that may enter and exit the ongoing platform based on a master protocol-accelerate the investigation of multiple therapeutic options within a single infrastructure. This in turn has the potential to accelerate access to new interventions for patients with stroke that can save lives and improve outcomes. In the context of acute ischemic stroke, 2 new platform trials have been established, the STEP trial (StrokeNet Thrombectomy Endovascular Platform) and ACT-GLOBAL (A Multi-Factorial, Multi-Arm, Multi-Stage, Randomised, Global Adaptive Platform Trial for Stroke), to address multiple therapeutic questions simultaneously using a multifactorial design including Bayesian modeling and other adaptive features. These trials are designed to maximize the information obtained from each participant, to align clinical research more closely with the complexities of clinical care, and to accelerate the identification of effective therapies. This article explores conceptual, practical, and statistical considerations in the design and implementation of adaptive platform trials and highlights their potential to accelerate the identification of new therapies, management, and rehabilitation in stroke.

Neurological management of ischemic stroke in sickle cell disease- a case report with an updated review of the literature.

In children and adults with sickle-cell disease (SCD), acute ischemic stroke (AIS) associated with a vaso-occlusive crisis is a leading cause of physical and cognitive disability and death. However, neurological guidelines for acute management of AIS fail to directly address this issue. We here report a case of a man with severe cerebrovascular complications and illustrate the current evidence on the management of SCD-related AIS. A 46-year-old man suffering from SCD and poorly controlled diabetes was admitted to the emergency room complaining of the onset, more than 10h before, of headache, paresthesia, and right hemianopia. The brain Angio-CT study revealed bilateral occlusion of the internal carotids and the posterior cerebral arteries, with remarkable compensatory hypertrophy of other vessels. The laboratory exams confirmed severe anemia with high hemoglobin-S levels (50%) and severe dehydration. IV hydration was prompted, along with erythrocyte apheresis and antiplatelet therapy. The patient successfully underwent these treatments, and the neurological deficits significantly improved. Nonetheless, due to the time window, he could not be treated with intravenous thrombolysis (IVT). AIS is a time-sensitive condition. In SCD, vaso-occlusive phenomena are the leading cause of AIS, but "classical" vascular risk factors can also play a role. Since current guidelines on the acute management of SCD complications are mainly focused on the hematological- rather than neurological- aspects, it is not clear whether these patients should undergo IVT before or after fluid resuscitation and erythrocyte apheresis. Furthermore, the principles of secondary prophylaxis are still controversial and require further investigation.

Implementation and sustainment of virtual reality stroke workflow training for physician trainees at comprehensive stroke centres: a quantitative and qualitative study

BackgroundVariation in stroke treatment metrics highlight a need for approaches to improve clinical processes. Training interventions can improve outcomes, but Australian physician trainees do not currently receive formal process-directed stroke training. Virtual reality (VR) stroke workflow training has proven acceptable, usable, useful and feasible in trial contexts, but how to integrate VR training into physician training remains unclear. The current study sought to document stroke staff perceptions of existing training and assess implementation of routine VR training at comprehensive stroke centres, outside of a trial context.MethodsTraining was delivered to physician trainees via individual sessions or facilitated group workshops depending on the hospital site. VR usage data was captured automatically via Wi-Fi. Survey responses from both trainees and training staff were collected, with statistical comparisons performed for matching questions in pre- and post-training surveys. Themes identified in open-ended survey responses were enumerated and reported.ResultsForty-two TACTICS VR training sessions were logged at 2 hospitals between May 2022 and October 2023. Trainees reported receiving low amounts of prior formal stroke training; both trainees and training staff identified unmet needs and barriers to existing training. VR users (n = 30) provided positive feedback on VR hardware, software design, user experience, content, educational value and delivery approach (mean scores 3.9 to 4.7; 1 = strongly disagree, 5 = strongly agree). VR training improved confidence in: knowledge of acute stroke assessment / treatment (post-training vs. pre-training = 4.0±0.7 vs. 2.9±1.0; P < .0001), ability to effectively assess / treat stroke (4.0±0.6 vs. 3.1±1.0; P < .0001), ability to optimally communicate with colleagues (4.1±0.6 vs. 3.3±1.0; P < .001), understanding of workflow practices (4.3±0.6 vs. 3.2±1.2; P < .0001), ability to make improvements (4.1±0.8 vs. 3.0±1.2; P < .0001) and awareness of local stroke management criteria / processes (4.1±0.8 vs. 3.6±1.1; P < .01). Respondents suggested enhancements in funding, access, awareness, training populations and delivery modality to improve training sustainment.ConclusionsVR stroke workflow training was perceived by trainees and training staff as feasible, acceptable, usable, useful and positively impacted stroke training. Respondents endorsed future use of VR training to support training at comprehensive stroke centres and identified aspects for improved future integration.

Adopting information and communications technology in the control, prevention, and management of stroke: perspectives from patients and providers in Uganda

ObjectiveThe stroke burden in Uganda ranks ninth among the ten causes of death, a major cause of chronic illnesses, accounting for the top ten causes of hospitalization. This baseline study examined how mobile phones can improve the prevention, management, and treatment of stroke in rural Uganda.MethodsIt was a cross-sectional study that utilized a mixture of methods. Quantitative data was collected from the districts' health information management system while qualitative data were from healthcare providers and patients/caregivers/survivors using a semi-structured guide. Quantitative data was analyzed descriptively while qualitative data was inductively analyzed through creating themes.ResultsAll participants supported the use of mobile phone interventions and suggested three major types of information to be included in this intervention: warning signs and indicators, underlying causes of stroke, and prevention measures. The challenges that might be faced in implementing this intervention are contextual, health system, and economic related.ConclusionThese baseline findings support the possibility of mobile phone intervention as an important instrument to improve stroke prevention, management, and treatment in rural Uganda. Challenges that might accompany the use of ICT have to be addressed as the intervention is designed.

Inhibition of Pyroptosis by Hydroxychloroquine as a Neuroprotective Strategy in Ischemic Stroke.

Hydroxychloroquine (HCQ), a well-known antimalarial and anti-inflammatory drug, has demonstrated potential neuroprotective effects in ischemic stroke by inhibiting pyroptosis, a programmed cell death associated with inflammation. This study investigates the impact of HCQ on ischemic stroke pathology using both in vivo and in vitro models. In vivo, C57BL/6 mice subjected to middle cerebral artery occlusion (MCAO) were treated with HCQ. Neurological deficits, infarct volume, and the expression of pyroptosis markers were evaluated. The results demonstrated that HCQ significantly improved motor function and reduced infarct volume in the MCAO mouse model. In vitro, BV2 microglial cells exposed to lipopolysaccharide (LPS) and oxygen-glucose deprivation (OGD) were treated with HCQ. Western blot and immunofluorescence analyses revealed that HCQ effectively suppressed the expression of pyroptosis markers GSDMD and NLRP3 in both in vivo and in vitro models. These findings suggest that HCQ mitigates ischemic stroke damage by inhibiting pyroptosis, highlighting its potential as a therapeutic agent for ischemic stroke. This study provides novel insights into the molecular mechanisms by which HCQ exerts its neuroprotective effects, offering a promising new avenue for developing safe, cost-effective, and widely applicable stroke treatments. The potential of HCQ to modulate neuroinflammatory pathways presents a significant advancement in ischemic stroke therapy, emphasizing the importance of targeting pyroptosis in stroke management and the broader implications for treating neuroinflammatory conditions.Significance Statement Ischemic stroke remains a leading cause of disability and death globally, with limited effective treatments. This study reveals that HCQ significantly mitigates ischemic stroke damage by inhibiting pyroptosis, a form of programmed cell death. Using in vivo and in vitro models, HCQ was shown to improve motor function and reduce infarct volume, highlighting its potential as a neuroprotective agent. These findings offer a promising new therapeutic approach for ischemic stroke, emphasizing the importance of targeting pyroptosis in stroke treatment.

Transcranial Direct Current Stimulation to Provide Neuroprotection and Enhance Cerebral Blood Flow in Stroke: A Comprehensive Review

Stroke remains a leading cause of global disability and mortality despite advancements in acute interventions. Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has primarily been studied for its effects on cortical excitability, with limited exploration of its neuroprotective and hemodynamic benefits. This review examines the role of tDCS in stroke, with a focus on neuroprotection in acute settings and cerebral blood flow (CBF) modulation in both acute and chronic phases. tDCS offers rapid, localized delivery to salvageable ischemic tissue, exerting pleiotropic effects that address a broader spectrum of pathological processes compared to pharmacological agents. Cathodal tDCS shows promise in acute ischemic stroke for neuroprotection in small-scale clinical studies, enhancing CBF and promoting vessel recanalization, while anodal tDCS demonstrates stronger effects on CBF, particularly in chronic stroke and hypoperfusion cases. Bihemispheric stimulation may offer additional benefits, with evidence suggesting a dose-dependent relationship between stimulation parameters and therapeutic outcomes. Further research is warranted to optimize stimulation protocols, evaluate safety and feasibility, and explore the potential of tDCS to promote neuroplasticity and functional recovery across different stroke populations and stages. By addressing these gaps, tDCS could emerge as a valuable adjunctive therapy in stroke management, complementing current interventions and expanding therapeutic windows.

Efficacy and safety outcomes of endovascular versus best medical treatment in posterior cerebral artery occlusion stroke

BackgroundThe management of acute ischemic stroke due to isolated posterior cerebral artery occlusion (iPCAO) remains a topic of debate. This study investigates the efficacy and safety of endovascular treatment (EVT)...

Clinical characteristics and quality care indicators of pediatric stroke in a referral center of Colombia: eleven-year experience (pediastroke).

This study aims to describe clinical variables and quality care indicators in pediatric stroke management at a high-complexity pediatric care center in Latin America. Retrospective study of patients with stroke, aged 2-18 years from 2011 to 2021. The principal outcomes were the mRs and mortality. Differences between groups were assessed using Fisher's exact test and the Mann-Whitney U test. We used logistic regression to explore the association between characteristics reported as relevant in literature and mortality. One hundred thirty six patients included, with a median age of 11 years, 54% were male. 47% were hemorrhagic strokes, followed by ischemic strokes at 39%. One-third of the cases presented in hospital. 51% of the patients had no prior medical history. The most common symptoms were altered consciousness, headache, and hemiparesis. The median door-to-image time was 123 min. The most frequent etiologies in ischemic stroke were arteriopathies and cardiac pathology, while vascular malformation and coagulopathies were predominant in hemorrhagic stroke. No patient received reperfusion therapy. At discharge, 48% of patients had a favorable mRs. The mortality rate was 21%. Patients with in-hospital stroke have approximately 7.37 times the odds of dying compared to those with out-of-hospital stroke. Patients with hemorrhagic stroke have approximately 7.46 times the odds of dying compared to those with ischemic stroke. Significant gaps exist in the epidemiology and quality indicators of pediatric stroke care compared to adult protocols. Implementing a "Pediatric code stroke" protocol and conducting prospective studies are crucial for improving pediatric stroke care and outcomes.

Deep learning biomarker of chronometric and biological ischemic stroke lesion age from unenhanced CT

Estimating progression of acute ischemic brain lesions – or biological lesion age - holds huge practical importance for hyperacute stroke management. The current best method for determining lesion age from non-contrast computerised tomography (NCCT), measures Relative Intensity (RI), termed Net Water Uptake (NWU). We optimised lesion age estimation from NCCT using a convolutional neural network – radiomics (CNN-R) model trained upon chronometric lesion age (Onset Time to Scan: OTS), while validating against chronometric and biological lesion age in external datasets (N = 1945). Coefficients of determination (R2) for OTS prediction, using CNN-R, and RI models were 0.58 and 0.32 respectively; while CNN-R estimated OTS showed stronger associations with ischemic core:penumbra ratio, than RI and chronometric, OTS (ρ2 = 0.37, 0.19, 0.11); and with early lesion expansion (regression coefficients >2x for CNN-R versus others) (all comparisons: p < 0.05). Concluding, deep-learning analytics of NCCT lesions is approximately twice as accurate as NWU for estimating chronometric and biological lesion ages.

Gut-Brain Axis Microbiota in Stroke Pathogenesis

Stroke is the second cause of death globally and the third cause of global disability, causing substantial health and socioeconomic problems. Clinically, Stroke is defined as brain tissue injury caused by a lack of blood supply to a particular area, resulting in permanent nerve damage or death. Stroke is also frequently associated with metabolic causes, including insulin resistance, obesity, hypertension, and type 2 diabetes mellitus (T2DM), significantly influencing the composition and abundance of the gut microbiota. Therefore, identifying potential risk factors influencing stroke prognosis and underlying pathogenic mechanisms is essential for better management and treatment of Stroke. Several studies show the existence of two-way communication between the gut and the brain through the gut microbiota. Intimate two-way interactions between the gut and the brain occur via neural (central, autonomic, and enteric nervous systems), hormonal (endocrine system), and immunological (innate and acquired immune systems) pathways, commonly referred to as the gut-microbiota axis. Brain or gut-brain axis (Gut-Brain Axis/GBA). Gut microbiota and derived metabolites play an important role in brain function by regulating GBA signaling. Recent evidence also suggests that GBA is critical in regulating immune function post-stroke. Intestinal dysbiosis provides a chronic peripheral and central inflammatory response that accelerates stroke pathology. Gut microbial dysbiosis is a significant risk factor positively correlated with poor post-stroke outcomes. This literature review summarizes the pathogenesis of ischemic Stroke, the description of the gut microbiota, and preclinical and clinical evidence indicating the pathogenic influence of gut dysbiosis in cerebral ischemic Stroke. Keywords: Stroke, Gut-brain axis, dysbiosis

DSA-based perfusion parameters versus TICI score after mechanical thrombectomy in acute ischaemic stroke patients: a congruence analysis

BackgroundSeveral factors are frequently considered for outcome prediction rin stroke patients. We assessed the value of digital subtraction angiography (DSA)-based brain perfusion measurements after mechanical thrombectomy (MT) for outcome prediction in acute ischaemic stroke.MethodsFrom DSA image data (n = 90; 38 females; age 73.3 ± 13.1 years [mean ± standard deviation]), time-contrast agent (CA) concentration curves were acquired, and maximum slope (MS), time to peak (TTP), and maximum CA concentration (CAmax) were calculated using an arterial input function. This data was used to predict neurological deficits at 24 h and upon discharge by using multiple regression analysis; the predictive capability was compared with the predictive power of the “Thrombolysis in cerebral infarction” (TICI) score. Intraclass correlation coefficients (ICC) of the NIHSS values were analysed.ResultsThe comparison of means revealed a linear trend after stratification into TICI classes for CAmax (TICI 0: 0.07 ± 0.02 a.u. to TICI 3: 0.22 ± 0.07 a.u.; p < 0.001), and for MS (TICI 0: 0.04 ± 0.01 a.u./s to TICI 3: 0.12 ± 0.0 a.u./s; p < 0.001). Regression analyses demonstrated equivalent capabilities for estimating neurological deficits after 24 h and at discharge using both the TICI score and DSA-based perfusion parameters (ΔR² ~ 0.03). Compared to the actual NIHSS, the ICC ranged from 0.55 to 0.84 for DSA-based models and from 0.6 to 0.82 for TICI-based models.ConclusionSemi-quantitative evaluation of DSA-based perfusion parameters prior to and after MT is feasible and could enhance the objectivity and comparability of MT outcome prediction. This technique may offer novel approaches in acute ischaemic stroke management and data comparability.Relevance statementDSA-based brain perfusion measurements following interventional stroke therapy could allow for an experience-independent assessment of reperfusion success. It demonstrates predictive power at least equivalent to the established methods. This could support a future automated DSA-based brain perfusion measurement method.Key PointsCurrently, the evaluation of stroke therapy success is based on the treating physician’s experience.The present study introduces an objective semi-quantitative evaluation method.In predicting clinical outcomes, the traditional expert-based and semi-quantitative methods are equivalent.Graphical

Addressing Systemic Complications of Acute Stroke: A Scientific Statement From the American Heart Association.

Systemic, nonneurological complications are common after ischemic and hemorrhagic strokes, affect different organ systems, and have a major impact on patient outcomes. Despite their obvious implications, this area in stroke management remains inadequately researched, and current literature offers fragmentary guidance for care. The purpose of this scientific statement is to elucidate the major systemic complications of strokes that occur during hospitalization, to synthesize evidence from current literature and existing guidelines, to address gaps in knowledge, and to provide a coherent set of suggestions for clinical care based on interpretation of existing evidence and expert opinion. This document advocates for improved interdisciplinary collaboration, team effort, and effective implementation strategies to reduce the burden of these events in clinical practice. It also calls for further research on strategies for preventing and managing systemic complications after stroke that improve outcomes in stroke survivors.

Recent advances in portable, low-field magnetic resonance imaging in cerebrovascular disease.

This review aims to describe recent advances in low-field (0.064 T) magnetic resonance imaging (LF-MRI) of cerebrovascular disease, including ischemic and hemorrhagic stroke and white matter hyperintensities. Since 2023, several studies have highlighted the rapidly changing landscape of portable, low-field MRI (LF-MRI) and its applications in stroke and cerebrovascular disease. The advantages of using LF-MRI in these settings are multifold: cheaper and dynamic imaging of this patient population confers closer observation during the acute and chronic stages of cerebrovascular disease. Initial deployments of the device span a variety of acute and emergency settings, including imaging around thrombolytic administration, endovascular reperfusion, intracerebral hemorrhage management, and cardiovascular intensive care. LF-MRI also has an important role in cerebrovascular disease monitoring and prevention, namely white matter hyperintensity (WMH) progression and vascular and Alzheimer's dementia. Early studies suggest reliable sensitivity and specificity for these pathologies. With further improvements to LF-MRI hardware, software and postprocessing on the horizon, we anticipate the device's ability to provide inexpensive and flexible neuroimaging to a wide array of healthcare settings that treat, prevent, and manage cerebrovascular disease. Recent studies indicate that LF-MRI promotes rapid, cost-effective, and clinically useful neuroimaging at various clinical timepoints throughout stroke and cerebrovascular disease progression and management.

A Prospective Multicenter Analysis of Mobile Stroke Unit Cost-Effectiveness.

Given the high disease and cost burden of ischemic stroke, evaluating the clinical efficacy and cost-effectiveness of new approaches to prevent and treat ischemic stroke is critical. Effective ischemic stroke management depends on timely administration of thrombolytics after stroke onset. This study evaluates the cost-effectiveness associated with the use of mobile stroke units (MSUs) to expedite tissue plasminogen activator (tPA) administration, as compared with standard management through emergency medical services (EMS). This study is a prospective, multicenter, alternating-week, cluster-controlled trial of MSU versus EMS. One-year and life-time cost-effectiveness analyses, using the incremental cost-effectiveness ratio (ICER) method, were performed from the perspective of CMS's Medicare. Quality-adjusted life years (QALYs) estimated using patient-reported EQ-5D-5L data were used as the effectiveness measure. Health care utilizations were converted to costs using average national Medicare reimbursements. ICERs excluding patients with pre-existing disability, and limited to stroke-related costs were also calculated. The first-year ICER for all tPA-eligible patients using total cost differences between MSU and EMS groups was $238,873/QALY; for patients without pre-existing disability was $61,199/QALY. The lifetime ICERs for all tPA-eligible patients and for those without pre-existing disability were $94,710 and $31,259/QALY, respectively. All ICERs were lower when restricted to stroke-related costs and were highly dependent on the number of patients treated per year in an MSU. MSUs' cost-effectiveness is borderline if we consider total first-year costs and outcomes in all tPA-eligible patients. MSUs are cost-effective to highly cost-effective when calculations are based on patients without pre-existing disability, patients' lifetime horizon, stroke-related costs, and more patients treated per year in an MSU. ANN NEUROL 2024.

Improving Knowledge About Stroke Using Simulation Training.

Background Stroke is a medical emergency that is risk-stratified using a national scoring system called the National Institute of Health Stroke Scale (NIHSS). The management of an acute stroke necessitates prompt management and swift decision-making. Human factors were identified in the literature as the main rate-limiting step to improving door-to-needle (DTN) time. We felt it would be prudent to design a local stroke course implemented at Great Western Hospital Swindon that incorporates both traditional and simulation-based elements to improve theoretical knowledge and emulate real-life scenarios. The objective of this course was to improve practical application in the efficient assessment and management of stroke patients, as this is critical to delivering timely treatment with thrombolysis or thrombectomy. Methods Twenty-four medical professionals (medical students and resident doctors) participated in our course between November 2022 and July 2023. The domains assessed includedunderstanding thrombolysis, understanding thrombectomy, confidence in performing NIHSS, and confidence in the assessment of stroke patients. The effectiveness of the stroke simulation course was assessed both quantitatively and qualitatively with pre- and post-course questionnaires. Results There was a significant improvement (p<0.05) in all four assessed domains. There was a significant increase (p=0.0003) in the mean difference of score 3.75 (95% CI: 2.43-5.07) in understanding thrombolysis. Similarly,understanding of thrombectomy was significantly improved (p=0.0002) with a mean difference in score of 3.4 (95% CI: 2.28-4.46). There was also a significant increase (p<0.0001) in confidence in completing NIHSS scoring by a mean of 4.33 (95% CI: 3.55-5.12). Lastly, there was a significant increase (p=0.0012) in the mean by 2.75 (95% CI: 1.51-3.99) in confidence in the assessment of stroke. Overall, 95.8% of the participants found the course at least good, if not very good or excellent, and 91.7% would recommend this course to others. Conclusion We found traditional and simulation-based training to be effective in improving understanding of thrombolysis, understanding of thrombectomy,confidence in NIHSS scoring, andconfidence in the assessment of stroke patients. This study validates theeffectiveness of our course in improving assessment and management in acute stroke patients. We infer that improvements in these domains coupled with simulation training focused on human factors (e.g., fatigue affecting decision-making or logistical issues such as delays in neuroimaging due to scanner availability) would achieve better DTN time in the participants of our course.

Advancing personalised care in atrial fibrillation and stroke: The potential impact of AI from prevention to rehabilitation.

Atrial fibrillation (AF) is a complex condition caused by various underlying pathophysiological disorders and is the most common heart arrhythmia worldwide, affecting 2 % of the European population. This prevalence increases with age, imposing significant financial, economic, and human burdens. In Europe, stroke is the second leading cause of death and the primary cause of disability, with numbers expected to rise due to ageing and improved survival rates. Functional recovery from AF-related stroke is often unsatisfactory, leading to prolonged hospital stays, severe disability, and high mortality. Despite advances in AF and stroke research, the full pathophysiological and management issues between AF and stroke increasingly need innovative approaches such as artificial intelligence (AI) and machine learning (ML). Current risk assessment tools focus on static risk factors, neglecting the dynamic nature of risk influenced by acute illness, ageing, and comorbidities. Incorporating biomarkers and automated ECG analysis could enhance pathophysiological understanding. This paper highlights the need for personalised, integrative approaches in AF and stroke management, emphasising the potential of AI and ML to improve risk prediction, treatment personalisation, and rehabilitation outcomes. Further research is essential to optimise care and reduce the burden of AF and stroke on patients and healthcare systems.

Reliability and Validity of the Turkish Version of the Acute Stroke Management Questionnaire.

The current research was carried out to test the validity and reliability of the Turkish version of the Acute Stroke Management Questionnaire (ASMaQ), developed to determine the acute stroke management awareness of health-care professionals. This methodological study was performed in a training and research hospital. Data were collected using the "Participant Interview Form" and the Acute Stroke Management Questionnaire. The Content Validity Index (CVI) of the Acute Stroke Management Questionnaire was found to be 0.91. As a result of exploratory factor analysis (EFA), it was revealed that the scale, which was adapted to Turkish, consisted of 3-factor and 29 items, as in its original form. Confirmatory factor analysis confirmed the 3-factor structure of the scale.The ASMaQ exhibited strong internal consistency (Cronbach's alpha 0.96) and test-retest reliability (0.879). The 29-item and three-dimensional structure of the Acute Stroke Management Questionnaire was revealed to be a valid and reliable measurement tool that could be utilized in evaluating the acute stroke management awareness of health-care professionals in the Turkish language and culture.

What Are the Predictors of Acute Care Nurses' Stroke Knowledge?: Empirical Research Quantitative.

To examine the predictability of categorical and quantitative study variables on acute stroke knowledge amongst study participants. Non-experimental, descriptive correlational. A convenience sample of registered nurses caring for adult, hospitalized patients recruited from the urban Southeast. A three-part survey was emailed to the nurses: demographics, stroke education and experience, and the Acute Stroke Management Questionnaire. Intensive Care Unit and Emergency Department nurses had the highest level of stroke knowledge. Nurses reporting three or more post-licensure education modalities had higher stroke knowledge scores than those reporting two or less. Practice setting, self-perception of stroke knowledge, self-identified knowledge of acute stroke management and three items related to code stroke were significantly correlated with stroke knowledge. Various methods of training and reinforcement of learning using varying teaching styles are effective in increasing nurses' stroke knowledge. Further stroke education is needed for nurses across the acute care setting. Future studies should explore lived experiences of nurses to gain understanding of nonquantifiable factors that nurses feel have strengthened their stroke knowledge. What Problem Did the Study Address? ○ Addressing the gap in the knowledge of predictors of nurse stroke knowledge. MAIN FINDINGS?: Practice setting, post-licensure stroke education, code stroke familiarity, confidence and understanding were all predictive of the overall stroke knowledge. WHOM WILL THE RESEARCH HAVE AN IMPACT?: Nurses, nurse educators, patients experiencing and at risk for stroke. The STROBE checklist was used to strengthen the reporting of the results. Nurses voluntarily participated in this study by completing the online questionnaire. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Provides predictors of stroke knowledge for nurse leaders to have a better understanding of nurses' educational needs. Provides evidence of a quick, effective measure of nurses' stroke knowledge.

Algae-based flexible localized oxygen control around Cells: An approach leading to more Biomimetic microphysiological systems

Oxygen levels are crucial in the cellular microenvironment, affecting cellular function. Controlling pericellular oxygen is essential for understanding cell-oxygen interactions, disease mechanisms, and developing therapies. In this study, an algae strain was engineered as a biological oxygen-control material, integrated with a light-controlled microphysiological system to regulate pericellular oxygen. This technique could provide different oxygen levels and varying profiles for different locations within one microphysiological system. Additionally, the pericellular oxygen dynamics were faster than those achieved by other methods. By utilizing this algae-integrated microfluidic chip, mesenchymal stem cells differentiated into adipocytes with improved phenotypic characteristics, including increased numbers and sizes of lipid droplets, under 21-day stage-specific oxygen concentrations. Furthermore, this technique effectively mitigated the need to vent significant amounts of oxygen or nitrogen into the laboratory during long-term or virus-infested experiments, thereby enhancing both safety and practicality. The algae-integrated microfluidic chip also served as a platform for constructing a stroke-related vascular-on-chip model, enabling the evaluation of the protective effects of oxygen therapy on endothelial injury induced by oxygen-glucose deprivation/reperfusion (OGD/R). The results indicated that waving hyperoxic dynamics were most effective in safeguarding vascular tissue against OGD/R compared to other hyperoxic dynamics. This finding can guide the clinical oxygen inhalation mode during stroke management. All the aforementioned results demonstrated that the algae-light microphysiological system offered a technical platform capable of precise, dynamic pericellular oxygen control across the disciplines of biology and pharmaceutics. Moreover, The cost-effective cultivation of algae on a large scale made this method suitable for wider use.

Exploring strategies for management of in-hospital stroke in Sweden: A qualitative study.

Patients with in-hospital stroke (IHS) are discovered and treated with delays compared to community-onset stroke. This qualitative study explores current routines and clinical practices for IHS in Sweden, aiming to uncover factors influencing management and propose areas for future research and development. Six physicians in charge of stroke alerts at Swedish hospitals were individually interviewed in video calls. Informants were selected from The Swedish Stroke Register, based on the hospital-specific median processing time for delivering thrombolysis or thrombectomy to IHS patients, stratified by hospital size. Transcribed interviews were analysed using reflexive thematic analysis. Three main themes were developed. The first emphasized the crucial step of discovering IHS and outlined possible workflow pathways, including defining the "key player" with stroke expertise and mandate to proceed with the stroke alert to immediate radiology. Subsequent themes addressed obstacles to optimal practice and suggested clear guidelines for contacting the "key player" to reduce delays, as well as offering IHS education to hospital staff. This study identified differences in workflows for IHS management across the six included sites. A "key player" emerged as a common denominator, who was called as the initiation of the stroke alert and had mandate to proceed with the alert to immediate radiology. Clear guidelines for contacting the "key player" and increased education about IHS were suggested as possible ways to mitigate delays to activate the stroke alert.