Welcome to StrokeFM Episode 27: In this exciting episode, we're taking you behind the scenes of our simulation session, where we grappled with angioedema in a code stroke. Explore with us as we delve into the intricacies of diagnosing and managing this life-threatening condition, learn from our successes and challenges, and gain insights from our team of expert cohosts. Whether you're a seasoned medical professional or starting your journey in health, you will want to experience this engaging journey into the heart of medical simulation training. This is a part of our ongoing efforts in a joint collaborative effort between Stroke and Emergency medicine. With that said, there is no duty of care. This is purely an educational podcast.
In this exciting episode, join our expert panel @MirandaLambRN, @LowylNotario, @emeduc, @neuroccm; we delve into the critical topic of Crisis Resource Management (CRM) in acute stroke care. In our podcast, we will apply these principles to a real-world scenario: managing a stroke emergency in the case of angioedema. The aim is to highlight the practical application of these CRM principles and discuss how they can facilitate consistent, safe, and efficacious care, helping to alleviate human factors and support high-performing teams. To make the transition from simulation to actual patient care as seamless as possible, thereby reducing stress, promoting certainty, and enhancing patient outcomes. So don't miss out. Tune in to our discussion to learn more about the transformative power of CRM in acute stroke care!
StrokeFM is the Official Podcast of the CSC (Canadian Stroke Consortium), Founder and Producer Dr. Houman Khosravani @neuroccm; Producer and Audio Engineer Dr. Jaime Cazes @JaimeCazes.
The music for this educational podcast is graciously provided by the musician breakmastercylinder @BrkmstrCylinder
As always, you abide by our Disclaimer statement by listening to this podcast.
#CrisisResourceManagement, #HighPerformingTeam
Read our CRM manuscript.
In this episode, we interview Dr. Bijoy Menon (PI) and Dr. Rick Swartz (Co-PI), and we delve into the AcT trial, a study conducted to evaluate the efficacy of tenecteplase compared to alteplase for treating acute ischemic stroke. The trial involved 1,600 participants, with a median follow-up duration of 97 days.
The participants, who were all 18 years or older and had suffered an acute ischemic stroke within 4.5 hours of symptom onset, were randomly divided into two groups. Group one (816 patients) received intravenous tenecteplase (0.25 mg/kg, maximum of 25 mg), and group two (784 patients) received intravenous alteplase (0.09 mg/kg bolus, followed by a 60-minute infusion of the remaining 0.81 mg/kg).
The primary outcome measured was the modified Rankin Scale score of 0 or 1, which indicates no significant disability. This was achieved by 36.9% of patients in the tenecteplase group compared to 34.8% in the alteplase group, establishing tenecteplase's noninferiority (p for superiority = 0.19).
Secondary outcomes, such as intracerebral hemorrhage, were similar in both groups, with 3.4% in the tenecteplase group and 3.2% in the alteplase group.
The conclusion drawn from the AcT trial is that tenecteplase was noninferior to alteplase in preserving neurological function in patients with acute ischemic stroke. Due to its ease of administration, tenecteplase may become a preferred treatment option.
This episode is based on the study "Intravenous tenecteplase compared with alteplase for acute ischemic stroke in Canada (AcT): a pragmatic, multicenter, open-label, registry-linked, randomized, controlled, non-inferiority trial" published in Lancet in 2022.
Disclaimer - StrokeFM is an Educational Podcast, by listening you understand that there is no duty of care, please read the full disclaimer.
StrokeFM is the Official Podcast of the CSC (Canadian Stroke Consortium), Founder and Executive Producer Dr. Houman Khosravani @neuroccm; Audio Engineer and Producer Dr. Jaime Cazes @JaimeCazes.
The music for this educational podcast is graciously provided by the musician breakmastercylinder @BrkmstrCylinder
Welcome to StrokeFM Episode 25: ThromboNeurology - Bridging Stroke and Thrombosis Services for Enhanced Patient Care. In this episode, we explore the importance of fostering close collaboration between Stroke, Thrombosis, and Vascular Medicine disciplines. With overlapping diagnostic and treatment considerations and common underlying disorders and pathophysiology, there is immense potential for synergy and improved patient care through integrating these services.
Listen in on insights provided by Stephanie Carlin (Thrombodsis Pharmacist, Hamilton) on the benefits of cross-pollination and training between thrombosis and stroke fellowship programs, share their experiences in leveraging existing expertise in vascular medicine, and provide insights into how centers in Canada/US, and other parts of the world can benefit by working closer together in collaboration between stroke and thrombosis programs.
In addition to the insightful conversation, we have created a website and reference list strokeandthrombosis.org for background reading and resources to help you delve deeper into the topic. So, tune in to StrokeFM Episode 25: ThromboNeurology and join us on this journey towards a more collaborative and integrated approach to stroke and thrombosis care!
StrokeFM is the Official Podcast of the CSC (Canadian Stroke Consortium), Founder and Executive Producer Dr. Houman Khosravani @neuroccm; Audio Engineer and Producer Dr. Jaime Cazes @JaimeCazes.
The music for this educational podcast is graciously provided by the musician breakmastercylinder @BrkmstrCylinder
Welcome to Season 3 of Stroke FM, where we continue our mission to bring you the best in stroke education. We are beyond excited to dive into a world where technology and stroke care intersect, exploring the fascinating realm of technology, Artificial Intelligence and its potential impact on stroke treatment and management.
As always, our team is committed to delivering a series of captivating episodes that cover pragmatic topics across the spectrum. We'll discuss the latest breakthroughs, innovative approaches, and the most pressing challenges that professionals and patients face in stroke care.
But that's not all! This season, we're also bringing together a stellar lineup of experts, thought leaders and industry insiders to share their insights and experiences. They'll provide you with invaluable knowledge and guidance and a glimpse into what the future holds for stroke care and technology.
So, join us on this thrilling journey, and buckle up as we delve deeper into the captivating world of stroke education, technology, and care. Together, we'll uncover new ways to improve the lives of those affected by stroke and revolutionize how we approach stroke treatment.
Ready to get started? Tune in to Stroke FM Season 3.
StrokeFM is the Official Podcast of the CSC (Canadian Stroke Consortium), Founder and Executive Producer Dr. Houman Khosravani @neuroccm; Audio Engineer and Producer Dr. Jaime Cazes @JaimeCazes.
The music for this educational podcast is graciously provided by the musician breakmastercylinder @BrkmstrCylinder
The Society of Vascular and Interventional Neurology (SVIN) held its first Hybrid Annual Meeting November 17-20, 2021, virtually and on-site in Phoenix, AZ. It provided an opportunity for top-of-the-line education, networking opportunities, and discussions. Please visit their website: https://svin2021.com for further details and access to the conference. Become a member of SVIN and the CSC. In this episode, our host @neuroccm joins SVIN's new President Dr. Ameer Hassan @AmeerEHassan to discuss meeting highlights, and some key take-home messages from some of the great science presented at the meeting.
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This is an official Canadian Stroke Consortium (CSC) - StrokeFM Podcast episode:
Neuroprotection and stroke care
What does the future hold? Where are we coming from and where are we going? These and other exciting topics of discussion in conversation with Dr. Michael Hill (Calgary Stroke Program) as we chat about ESCAPE NA1 and ESCAPE NEXT. ESCAPE-NEXT is a multi-centre, randomized, double-blinded, placebo-controlled, parallel Group, single-dose trial designed to determine the efficacy and safety of Nerinetide in participants with acute ischemic stroke undergoing endovascular thrombectomy excluding thrombolysis. This is an official CSC Podcast episode (Season 2, Episode 8). As usual, see our Disclaimer about this educational podcast.
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In this episode we get together with Dr. Tess Fitzpatrick @TessFitzNeuro (first author on a recent paper on this topic: Quality of anticoagulation using intravenous unfractionated heparin for cerebrovascular indications) and Dr. Katherine Sawicka @KatherineSawic1 (our resident guru in Clinical Epidemiology and lover of all things research methods) to discuss challenges with anticoagulation using unfractionated heparin infusions. This is not to be confused with the fact that this agent provides a very good modality to providing anticoagulation and has very specific uses, but in the real world setting, IV infusion of this agent causes issues with the quality of anticoagulation achieved. We discuss how there may be better alternatives specifically low molecular weight heparin (LMWH) when it comes to use cases in stroke. Anticoagulating a patient with acute stroke is always a challenging topic, and there are nuances to be considered, to reduce the risk of hemorrhage, and therefore we looked back at the use of unfractionated heparin infusion in stroke and talk about how some considerations are very important to keep in mind. As usual - please note our disclaimer.
On this inaugural joint CSC (Canadian Stroke Consortium) Stroke FM episode, two colleagues from Calgary's Stroke program Bijoy Menon @bijoymenon and Andrew Demchuk discuss nuances of the soon-to-be-published MR CLEAN-NO IV trial (direct to EVT vs. bridging therapy) after the trial's results were showcased at ISC 2021. We look forward to future episodes as the joint CSC-Stroke FM collaboration unfolds on this podcast. We aim to highligh new and exciting scientific breakthroughs, educational topics, and all things part of the chain of survival for stroke care.
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AHA International Stroke Conference 2021
Featured Studies:
ANGIO-CAT Study
"Nonetheless this represents an extremely exciting time, and the message should not be lost that patients with large vessel occlusions can be screened to some degree of reliance clinically and imaged using a flat panel CT with what appears to be a safe modality, and then be taken to thrombectomy and not be denied thrombolysis if needed. This study shows a major speed-up effect in workflow processes. It is quite possible that future studies with higher number of patients, in a multicenter setting, could tease out outcome differences as well. Therefore overall, this is an incredibly positive step forward - Our tools are only as good as the people able to deliver them, and this workflow improvement study certainly opens the door to further optimization of hyperacute stroke care." excerpt from a news piece by @neuroccm for Neurodiem.
BEST-MSU Study
"Taken together, 17% more patients were treated with TPA, the full 30% or more in the golden hour, with significantly improved patient-centered outcomes. There were 10% more patients with a modified Rankin score of 0 or 1 at 90 days. Overall, this is an important step forward in pushing the boundaries of bringing the treatment to the patient, and if this is ultimately found to be cost effective this represents yet another hyperacute innovation in acute stroke treatment. This may have specific relevance to both large, populated centers that are spread apart geographically, and certainly more austere environments as well." excerpt from a news piece by @neuroccm for Neurodiem.
MR CLEAN-NO-IV Study
Direct to EVT (early window) vs. Thrombolysis + EVT - designed as a superiority study. "They did not show superiorly nor non-inferiority of direct to EVT vs. combination treatment. There were no differences in symptomatic intracranial hemorrhage which is a particularly important finding, given that one could expect a higher rate with the TPA group. Dr. Yvo Roos, in a post-presentation interview with the AHA, suggest that hemorrhage rates may be more related to either delayed recanalization or simply that reperfusion itself is the main culprit for hemorrhage rather than onboard thrombolytic. This is provocative and needs further study and further details need to be reviewed. Certainly, there is biological plausibility and that patients are heterogeneous enough in their physiology and baseline neurovascular characteristics that reperfusion as a physiologic insult can result in such findings.
The important takeaway message here is that for patients that are eligible to receive thrombolysis – that thrombolysis should not be withheld in the era of thrombectomy, and thrombolysis should be delivered in a timely manner.
Taken together, there appears to be more science and understanding of criteria that are still necessary to be discovered with regards to which patient should go a stroke center capable of delivering thrombolysis versus directly to center that can provide comprehensive care with both modalities." excerpt from a news piece by @neuroccm for Neurodiem.
In this episode, two keen Resident MDs Drs. Ryan Muir (PGY4) and Jaime Cazes (PGY1) join us for an in-depth at how things are going! A recent look back from within the 2'nd wave of COVID (in Canada), which thankfully is subsiding. They provide insight into how COVID has impacted their residency training, what our program has done, and how new learning opportunities have manifested in the form of Virtual Care. #TakeCare Everyone and keep looking out for your #Wellness as we look forward to better days!
Did you ask about thrombolysis? We are here to deliver anxiolysis! In this second of a two-part episode of 2021, we discuss "crisis resource management" (CRM) in acute stroke - a cognitive, mindfulness, and non-technical framework for optimizing clinical performance and working in high-performing teams. CRM is a tool to master four operational domains: that of the self, teamwork, our working environment, and of course, (care for) our patient. Using CRM principles helps make us better clinicians, work more effectively in teams, and maintain a calm sense of vigilance. We re-introduce the concept of a "zero point survey" (Reid et al. 2018) as a starting point before coming on-call for a code stroke and as a tool for better self-awareness and performance. High-performing teams support good clinical outcomes at the resuscitation phase and apply to all subsequent patient care settings. Central to a high-performing team are principles of CRM and their timely application to stroke care. We review our paper in Neurocritical Care titled: "Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care" with three of the authors: Rajendram, Notario, Khosravani - In this episode we conclude this talk on "how to be a bad-a$$ stroke" resus doc!
Did you ask about thrombolysis? We are here to deliver anxiolysis! In this first of a two-part episode of 2021, we discuss "crisis resource management" (CRM) in acute stroke - a cognitive, mindfulness, and non-technical framework for optimizing clinical performance and working in high-performing teams. CRM is a tool to master four operational domains: that of the self, teamwork, our working environment, and of course, (care for) our patient. Using CRM principles helps make us better clinicians, work more effectively in teams, and maintain a calm sense of vigilance. We re-introduce the concept of a "zero point survey" (Reid et al. 2018) as a starting point before coming on-call for a code stroke and as a tool for better self-awareness and performance. High-performing teams support good clinical outcomes at the resuscitation phase and apply to all subsequent patient care settings. Central to a high-performing team are principles of CRM and their timely application to stroke care. We review our paper in Neurocritical Care titled: "Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care" with three of the authors: Rajendram, Notario, Khosravani
Greetings Stroke FM listeners. We are back in 2021 with an exciting series of Podcasts, follow-up episodes, clinical and non-technical discussions and new future partnerships. Looking forward to releasing episodes as we record them this year and moving onwards! Take care + stay safe!
Key Terms: Thrombolysis, endovascular therapy,
Hosts: Ryan Muir, Houman Khosravani
Summary:
In this episode the hosts discuss the future of stroke by exploring and proposing novel applied modern concepts of endovascular and thrombolytic therapies to innovative and creative ideas for the future.
Key Terms: Transition to residency, Work-life balance, Mentorship, Surviving PGY1
Hosts: Sydney Lee, Jaime Cazes and Houman Khosravani
Summary:
Key Terms: COVID-19, Stroke Orientation, NVU
Hosts: Jane Liao, Houman Khosravani
Summary:
Key Terms: Protected Code Stroke, COVID-19, Personal Protective Equipment
Hosts: Phavalan Rajendram, Jaime Cazes, Houman Khosravani
Summary:
Key Terms: COVID-19, PPE, Pandemic, medical education
Hosts: Jaime Cazes, Houman Khosravani
Summary:
Key Terms: ICH, blood pressure control, spot sign
Hosts: Phavalan Rajendram, Neha Patel, Houman Khosravani
Summary:
Key terms: DAPT, Minor stroke, TIA
Hosts: Tess Fitzpatrick, Katherine Sawicka, and Houman Khosravani
Summary:
