Navigation Links
Stroke treated significantly faster and just as safely by medical residents
Date:2/24/2009

St. Louis, February 24, 2009 Diagnosing acute stroke is a high-pressure decision. The speed with which treatment is delivered makes all the difference. Early treatment can stop brain damage, but if treatment is given inappropriately, it can dangerously increase the risk of bleeding in the brain.

Because of this risk, the final decision to administer stroke treatmenta clot-busting enzyme known as tissue plasminogen activator (tPA)is usually reserved for neurologists or, in some cases, other attending physicians. But now a study conducted by researchers at Washington University School of Medicine in St. Louis with neurology residents at Barnes-Jewish Hospital has shown that residents with appropriate training can safely make the call, ensuring that effective treatment is delivered faster.

"Door-to-needle" times, measured as the time between a patient's arrival and the administration of tPA, were reduced by 26%, from an average of 81 minutes to 60 minutes.

"What's critical here is ability to safely reduce 'door-to-needle' time without unnecessarily increasing the risk of a brain hemorrhage," says Jin-Moo Lee, M.D., Ph.D., director of the cerebrovascular section in Neurology at Washington University and Barnes-Jewish Hospital. "What we've shown is that with proper training, feedback and supervision, residents are more than capable of making this complex decision safely."

The study appears online in Stroke.

Although they have completed medical school and passed the license exams necessary to practice general medicine, residents are working in hospitals to undertake more advanced postgraduate training. A select group of critical life-and-death treatment decisions traditionally have been reserved only for physicians who have already completed their residencies.

Stroke treatment is one such decision. At academic and community medical centers, it is usually held for specialists in neurology, or, in some cases, emergency medicine. But while residents are almost always immediately available in the emergency room, neurologists may not be, and the time spent waiting for such a physician to be summoned can allow harm from the stroke to intensify and spread.

For the study, which began in 2004, neurology residents at Barnes-Jewish Hospital started taking an annual three- to four-hour mini-course on use of tPA. The course taught them how to appropriately choose candidates for tPA and how to administer it. After residents were given the authority to administer tPA, a committee of medical faculty and staff met monthly to review the case of every patient evaluated for stroke treatment, giving residents feedback on their decision-making.

Researchers assessed the results by comparing the outcomes and complications of stroke patients treated by residents from 2004 to 2007 against the same data for stroke patients treated by attendings and fellows from 1998 to 2002. There was no significant increase in negative outcomes, including bleeding in the brain, and door-to-needle times were notably shorter for patients treated by residents.

"It makes senseresidents are always in house, and if they can make a direct decision on treatment without waiting for an attending or a fellow to respond to a pager, then the treatment time is going to be shorter," says lead author Andria Ford, M.D., a Washington University neurologist at Barnes-Jewish Hospital.

Neurology residents at Barnes-Jewish Hospital continue to regularly train in tPA usage and to have the authority to administer tPA.

Given an academic medical center where the resources exist to expand resident training and provide regular feedback, Lee thinks the model can be applied "across the boardnot just to neurologists in training but to emergency department physicians in training, for example."

Lee characterizes the study as the culmination of two major branches of the work of senior author Abdullah Nassief, M.D., a stroke expert who died suddenly of coronary artery disease on Feb. 3.

"Dr. Nassief was both director of the neurology department's residency program and of the Clinical Stroke Center and acute rehabilitation program at Barnes-Jewish Hospital, so he was very interested in the residents and in stroke treatment," he says. "In this last paper, he let the resident physicians teach the attending physicians a lesson: that with the proper training, they can make these complex decisions as well as the attendings."


'/>"/>

Contact: Michael C. Purdy
purdym@wustl.edu
314-286-0122
Washington University School of Medicine
Source:Eurekalert

Related medicine news :

1. Laser Therapy Disappoints in Stroke Trial
2. Early Menopause Doubles Stroke Risk
3. New Advances May Treat Stroke Faster, Better
4. Coffee or Tea Consumption May Lower Stroke Risk
5. Few Stroke Patients Get Clot-Busting Drug
6. Know the Warning Signs of Stroke? Most Dont.
7. More Fast-Food Joints in Neighborhoods Mean More Strokes
8. CRESTOR Cuts Risk of Stroke by Nearly Half in JUPITER Study
9. B Vitamins Might Lower Stroke Risk
10. Women less likely to receive critical care after a stroke, MSU researchers find
11. Study shows ultrasound and tPA effective for stroke
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/11/2016)... ... February 11, 2016 , ... Dr. Sadati’s recent feature in ... Along with performing procedures, the magazine also highlights that Dr. Sadati has pioneered ... of the most common procedures he performs is his natural facelift. “As people ...
(Date:2/11/2016)... (PRWEB) , ... February 11, 2016 , ... The president ... DoD Military Health System but would shift more of the cost burden to military ... TRICARE-reform plan laid out in the defense budget as including limited quantifiable benefit fixes ...
(Date:2/11/2016)... ... February 11, 2016 , ... ... and women’s health, is pleased to announce the promotions of Allison Kelly to ... team, Steve Catone to executive vice president of North American capital sales, and ...
(Date:2/11/2016)... Laurel, NJ (PRWEB) , ... February 11, 2016 ... ... announces the call for nominations seeking candidates for the Board of Commissioners. Individuals ... with passion, skills and experience with diversity of clinical practice settings and across ...
(Date:2/11/2016)... , ... February 11, 2016 , ... ... of a master charity program created to assist the people of their local ... closely with nonprofit organizations and community leaders. Their hope is to bring awareness ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... SAN FRANCISCO , Feb. 11, 2016  Kindred ... focused on saving and improving the lives of pets, ... Technical Section of the New Animal Drug Application (NADA) ... the pivotal field study (KB0120) of Zimeta for the ... by the Company. --> ...
(Date:2/11/2016)... SAN FRANCISCO , Feb. 11, 2016   ... the advancement of new health technologies, announced today " ... outstanding achievements in health tech over the past ten ... For nearly a decade, Health 2.0 has served ... and showcased and connected with thousands of technologies, companies, ...
(Date:2/11/2016)... 11, 2016  MiMedx Group, Inc. (NASDAQ: MDXG ... membrane and other birth tissues, human skin and bone, ... market advanced products and therapies, announced today that it ... Healthcare Conference in New York , ... Michael J. Senken , Chief Financial Officer and ...
Breaking Medicine Technology: