Implementation of multimodal computed tomography in a telestroke network : five-year experience

Aims: Penumbral selection is best-evidence practice for thrombectomy in the 6-24 hour window. Moreover, it helps to identify the best responders to thrombolysis. Multimodal computed tomography (mCT) at the primary centre—including noncontrast CT, CT perfusion, and CT angiography—may enhance reperfusion therapy decision-making. We developed a network with five spoke primary stroke sites and assessed safety, feasibility, and influence of mCT in rural hospitals on decision-making for thrombolysis. Methods: Consecutive patients assessed via telemedicine from April 2013 to June 2018. Clinical outcomes were measured, and decision-making compared using theoretical models for reperfusion therapy applied without mCT guidance. Symptomatic intracranial hemorrhage (sICH) was assessed according to Safe Implementation of Treatments in Stroke Thrombolysis Registry criteria. Results: A total of 334 patients were assessed, 240 received mCT, 58 were thrombolysed (24.2%). The mean age of thrombolysed patients was 70 years, median baseline National Institutes of Health Stroke Scale was 10 (IQR 7-18) and 23 (39.7%) had a large vessel occlusion. 1.7% had sICH and 3.5% parenchymal hematoma. Three months poststroke, 55% were independent, compared with 70% in the non-thrombolysed group. Conclusion: Implementation of CTP in rural centers was feasible and led to high thrombolysis rates with low rates of sICH. © 2019 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd

The GP's role in acute stroke management

An acute stroke is a medical emergency and a potentially devastating event. Although GPs frequently deal with patients experiencing health sequelae of stroke, acute presentations to the GP of patients with acute stroke are relatively uncommon

Mappable regions

Contains 'ZeaV4.map35.plus20.bed', a conservative mappability bed file described in the supplemental methods

Custom scripts

Contains custom scripts with functions described in the supplemental methods. Refer the commented header lines of each for details of usage

mapDamage results

Complete mapDamage output files for nine newly sequenced ancient maize genomes

Maize SNP calls

Binary plink-formatted files containing the complete set of SNP calls before processing for linkage

Un outil conceptuel pour apprendre le raisonnement éthique aux soignants

L’éthique clinique nécessite la mise en œuvre d’un double mouvement : celui d’une sensibilité à autrui d’une part, celui de la capacité à répondre de ses décisions devant autrui d’autre part. Pour développer cette dernière, des médecins et des soignants se sont réunis dans le cadre d’une collaboration interprofessionnelle, afin de créer un outil qui permette de structurer un raisonnement éthique et de dégager des pistes d’actions en situation complexe

GERP scores and neutral model

- GERP; mutation load analysis. - chr10.4degen.tre; newick-format neutral model tree generated from fourfold-degenerate sites of plant genomes aligned to chromosome 10 of maize. - Zea_mays.allChr.rates.gz; gerpcol output (expected substitutions and RS scores) used for analysis across the maize genome

Implementation of multimodal computed tomography in a telestroke network: Five-year experience

AIMS: Penumbral selection is best-evidence practice for thrombectomy in the 6-24 hour window. Moreover, it helps to identify the best responders to thrombolysis. Multimodal computed tomography (mCT) at the primary centre-including noncontrast CT, CT perfusion, and CT angiography-may enhance reperfusion therapy decision-making. We developed a network with five spoke primary stroke sites and assessed safety, feasibility, and influence of mCT in rural hospitals on decision-making for thrombolysis. METHODS: Consecutive patients assessed via telemedicine from April 2013 to June 2018. Clinical outcomes were measured, and decision-making compared using theoretical models for reperfusion therapy applied without mCT guidance. Symptomatic intracranial hemorrhage (sICH) was assessed according to Safe Implementation of Treatments in Stroke Thrombolysis Registry criteria. RESULTS: A total of 334 patients were assessed, 240 received mCT, 58 were thrombolysed (24.2%). The mean age of thrombolysed patients was 70 years, median baseline National Institutes of Health Stroke Scale was 10 (IQR 7-18) and 23 (39.7%) had a large vessel occlusion. 1.7% had sICH and 3.5% parenchymal hematoma. Three months poststroke, 55% were independent, compared with 70% in the non-thrombolysed group. CONCLUSION: Implementation of CTP in rural centers was feasible and led to high thrombolysis rates with low rates of sICH.status: publishe