European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre-hospital management of stroke

Background and purposeThe reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving the chances of a favourable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting. MethodsThe GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations. ResultsDespite very low quality of evidence educational campaigns to increase the awareness of immediately calling emergency medical services are strongly recommended. Moderate quality evidence was found to support strong recommendations for the training of emergency medical personnel in recognizing the symptoms of a stroke and in implementation of a pre-hospital code stroke' including highest priority dispatch, pre-hospital notification and rapid transfer to the closest stroke-ready' centre. Insufficient evidence was found to recommend a pre-hospital stroke scale to predict large vessel occlusion. Despite the very low quality of evidence, restoring normoxia in patients with hypoxia is recommended, and blood pressure lowering drugs and treating hyperglycaemia with insulin should be avoided. There is insufficient evidence to recommend the routine use of mobile stroke units delivering intravenous thrombolysis at the scene. Because only feasibility studies have been reported, no recommendations can be provided for pre-hospital telemedicine during ambulance transport. ConclusionsThese guidelines inform on the contemporary approach to patients with suspected stroke in the pre-hospital setting. Further studies, preferably randomized controlled trials, are required to examine the impact of particular interventions on quality parameters and outcome. Click for the corresponding questions to this CME article

Description of the intermediate length scale structural motifs in sodium vanado-phosphate glasses by magnetic resonance spectroscopies

For the first time, the local and medium range orders in sodium vanado-phosphate glasses have been investigated by advanced magnetic resonance spectroscopy methods. One- and two-dimensional 31P/51V magic angle spinning nuclear magnetic resonance techniques (31P(51V) REAPDOR and 51V(31P) D-HMQC) have been used to monitor the formation of P-O-V5+ bonds and to provide the first accurate description of the intermediate length scale structural motifs in these glasses. The structural model has been completed by the investigation of the chemical environment of the V4+ ions (produced through the partial reduction of V5+ during the melting stage of the glass preparation) using standard continuous wave and advanced pulsed electron paramagnetic resonance techniques (HYSCORE). Finally, the combination of both sets of data leads to the first complete and precise structural model of the alkali vanado-phosphate glass system