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Challenges of stroke educational interventions
ABSTRACTS
381
Brain Attack Awareness - A Community Approach
Chellenges of Stroke Educational Interventions Elaine Tilka Miller, D.N.S., R.N. Judith SDilker. B~S.N.. R 2 { .
Stroke related educational interventions for clients and families presents special challenges. This paper provides a synthesis o f the literature regarding important factors that can influence the success o f stroke related educational interventions for clients and families. The presentation will focus on: (1) variables that m a y influence the learning process such as readiness to learn, age, cultural diversity, health status, functional status, and structure of the learning situation and (2) outcome measures to evaluate the learning that has occurred such as perceived quality &life, and behavioral change. Health care professionals can benefit from these prior "lessons learned" in diverse settings.
Lack of Prothrombin Gene Mutation in Young Stroke Patients
RA Egan, WM Clark, R Press, HL Lutsep
Introduction: There is an increased incidence of hematologic abnormalities in young stroke patients. The Prothrombin Gene G20210A Mutation (PGM) is a newly described risk factor found in association with clotting disorders. Currently an association of PGM with stroke has not been described. This series examines the frequency of PGM in a small consecutive series of young patients with arterial stroke. Methods: All stroke patients admitted between December 1, 1997 and May 1, 1998 less than 55 years of age at Oregon Health Sciences University were examined for the PGM. Plasma was analyzed at the Medical Genetics Center at Oregon Health Sciences University. Results: We identified 16 young stroke patients with a mean age of 43.4 (27-53); 50% were female. Stroke etiology in 2/16 (125%) was believed secondary to atherosclerosis, 1/16 (6.25%) was due to cardioembotism, 3/16 (18.75%) were lacunar, and 6/16 (37.5%) were idiopathic. No patient studied carried the PGM. Discussion: The defined frequency of PGM in our Lab in the healthy population is 2%. We found no association of PGM with stroke in 16 patients studied. PGM does not appear to be a risk factor for arterial stroke in this high risk population. However, the small sample size warrants further study.
L. Gansauer, RN, MSN S. Scott, RN, BSN (Spartanburg, SC, USA) Background: This is a poster showing a three year project to improve the number of patients presenting to our Emergency Department with I hour and 40 rain.. This goal was to allow more stroke victims the opportunity to receive interventional therapy (t-PA). A multidlscipline temn improving stroke care, identified through a retrospective chart review that we needed to do a massive community educational program. Methods: This goal is being accomplished by: Newspaper Ads [] TV paid spots cl Public Service Programs [] Radio Public Service Ads ~a Feature ta Article about victims [] Screening/educational events [] Parish Nurse Proglarn ta Brain Attack Workshops [] NSA posters in public areas in the community. Q Public speaking by the team member to various community groups [] Education of the Healtbeare team with article, posters, data, and educational sessions, ResuUs: This is an intensive campaign focusing on improving symptom recognition, event to door time, and knowledge of tisk factors. We are surveying 50 people from the community eaeh month, and tracking symptoms to door times in the Emergency Department. Conclusion: To impact population knowledge y~u need a long-term multi faceted educational
campaign. Two early to demonstrate change in population knowledge.
Intraopemtive Tmnscramal Doppler as an Early Predictor of Shunt Requirement During Carotid Endarterectomy
KM Cockrott, JA Lee, TE Bell, J Lopez, D Tong, GK Steinberg (Stanford, California)
Background In order to reduce tile risks of neurological compromise during carotid endarterectomy (CEA) and to aid in determining which patients will benefit from intra-operative shunting, we have employed TCD as well as EEG and SSEP monitoring. Methods TCD velocities of the ipsilateral MCA were monitored in conjunction with EEG and SSEP monitoring. 33 CEAs were performed using this technique. Results Average initial peak velocity in the MCA was 63 :t=4 era/see. All patients whose velocities dropped to zero (7 of 12 shunted eases) or whose velocities fell below 50% of baseline (2 of 12) after cross.clamping were shunted. The remainder (3) were shunted because of surgeons preference (2) or change in SSEP (1). In the majority of eases, TCD changes noted prior to shunting were either not accompanied by or preceded EEG or SSEP changes. In the 5 cases where neurophysiologie parameters changed, TCD changed first in 3. After shunting, MCA velocities returned to baseline. At closing, mean velocities remained at baseline in 22 cases (67%); 11 cases (33%) showed velocity increases of > 25%. No patients suffered intraoperative or immediate postoperative strokes or TIAs. At a mean follow-up of 4.2 :l=0.8 too, 97% (31 pts) were in good/excellent condition. One patient was in poor condition as a result of an ipsilateral hemorrhagic infarct sustained 7 days postoperatively. Conclusions These results suggest that TCD is a useful tool in the iutraoperative management of CEA patients. Its use may alert the surgeon to the potential need for shunt placement earlier titan neurophysiological monitoring alone.
381
Brain Attack Awareness - A Community Approach
Chellenges of Stroke Educational Interventions Elaine Tilka Miller, D.N.S., R.N. Judith SDilker. B~S.N.. R 2 { .
Stroke related educational interventions for clients and families presents special challenges. This paper provides a synthesis o f the literature regarding important factors that can influence the success o f stroke related educational interventions for clients and families. The presentation will focus on: (1) variables that m a y influence the learning process such as readiness to learn, age, cultural diversity, health status, functional status, and structure of the learning situation and (2) outcome measures to evaluate the learning that has occurred such as perceived quality &life, and behavioral change. Health care professionals can benefit from these prior "lessons learned" in diverse settings.
Lack of Prothrombin Gene Mutation in Young Stroke Patients
RA Egan, WM Clark, R Press, HL Lutsep
Introduction: There is an increased incidence of hematologic abnormalities in young stroke patients. The Prothrombin Gene G20210A Mutation (PGM) is a newly described risk factor found in association with clotting disorders. Currently an association of PGM with stroke has not been described. This series examines the frequency of PGM in a small consecutive series of young patients with arterial stroke. Methods: All stroke patients admitted between December 1, 1997 and May 1, 1998 less than 55 years of age at Oregon Health Sciences University were examined for the PGM. Plasma was analyzed at the Medical Genetics Center at Oregon Health Sciences University. Results: We identified 16 young stroke patients with a mean age of 43.4 (27-53); 50% were female. Stroke etiology in 2/16 (125%) was believed secondary to atherosclerosis, 1/16 (6.25%) was due to cardioembotism, 3/16 (18.75%) were lacunar, and 6/16 (37.5%) were idiopathic. No patient studied carried the PGM. Discussion: The defined frequency of PGM in our Lab in the healthy population is 2%. We found no association of PGM with stroke in 16 patients studied. PGM does not appear to be a risk factor for arterial stroke in this high risk population. However, the small sample size warrants further study.
L. Gansauer, RN, MSN S. Scott, RN, BSN (Spartanburg, SC, USA) Background: This is a poster showing a three year project to improve the number of patients presenting to our Emergency Department with I hour and 40 rain.. This goal was to allow more stroke victims the opportunity to receive interventional therapy (t-PA). A multidlscipline temn improving stroke care, identified through a retrospective chart review that we needed to do a massive community educational program. Methods: This goal is being accomplished by: Newspaper Ads [] TV paid spots cl Public Service Programs [] Radio Public Service Ads ~a Feature ta Article about victims [] Screening/educational events [] Parish Nurse Proglarn ta Brain Attack Workshops [] NSA posters in public areas in the community. Q Public speaking by the team member to various community groups [] Education of the Healtbeare team with article, posters, data, and educational sessions, ResuUs: This is an intensive campaign focusing on improving symptom recognition, event to door time, and knowledge of tisk factors. We are surveying 50 people from the community eaeh month, and tracking symptoms to door times in the Emergency Department. Conclusion: To impact population knowledge y~u need a long-term multi faceted educational
campaign. Two early to demonstrate change in population knowledge.
Intraopemtive Tmnscramal Doppler as an Early Predictor of Shunt Requirement During Carotid Endarterectomy
KM Cockrott, JA Lee, TE Bell, J Lopez, D Tong, GK Steinberg (Stanford, California)
Background In order to reduce tile risks of neurological compromise during carotid endarterectomy (CEA) and to aid in determining which patients will benefit from intra-operative shunting, we have employed TCD as well as EEG and SSEP monitoring. Methods TCD velocities of the ipsilateral MCA were monitored in conjunction with EEG and SSEP monitoring. 33 CEAs were performed using this technique. Results Average initial peak velocity in the MCA was 63 :t=4 era/see. All patients whose velocities dropped to zero (7 of 12 shunted eases) or whose velocities fell below 50% of baseline (2 of 12) after cross.clamping were shunted. The remainder (3) were shunted because of surgeons preference (2) or change in SSEP (1). In the majority of eases, TCD changes noted prior to shunting were either not accompanied by or preceded EEG or SSEP changes. In the 5 cases where neurophysiologie parameters changed, TCD changed first in 3. After shunting, MCA velocities returned to baseline. At closing, mean velocities remained at baseline in 22 cases (67%); 11 cases (33%) showed velocity increases of > 25%. No patients suffered intraoperative or immediate postoperative strokes or TIAs. At a mean follow-up of 4.2 :l=0.8 too, 97% (31 pts) were in good/excellent condition. One patient was in poor condition as a result of an ipsilateral hemorrhagic infarct sustained 7 days postoperatively. Conclusions These results suggest that TCD is a useful tool in the iutraoperative management of CEA patients. Its use may alert the surgeon to the potential need for shunt placement earlier titan neurophysiological monitoring alone.