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Neuroscience News

Advanced Neuroscience Network will be at the annual International Stroke Conference

Each year the the International Stroke Conference brings together people from all over the globe to provide clinical sessions, topic discussions regarding neurosciences and stroke, strategies to help with neurological care within the community, and presentations from key leaders within the field of neurosciences.

The Advanced Neurosciece Network is proud to be in attendance this year as not only an exhibitor, but also a contributor to the clinical education and presentations being provided at this years event.

Members of the Advanced Neuroscience Network will be in attendance for both poster presentations and an oral presentation.

Come see our poster presentations on Wednesday, January 24th :

  • 6:05 PM – Clinical Outcomes After Mechanical Thrombectomy in Acute Ischemic Stroke Patients Aged 65 Years and over: a Subgroup Analysis of the STRATIS Registry
  • 6:30 PM – The Impact of EMS Directly Transporting Patients With Suspected Acute Ischemic Stroke to Comprehensive Stroke Centers in South Florida

On Thursday January 25, at 4:09 PM, join us for a presentation by Dr. Nils H. Mueller-Kronast a: Bypass to an Endovascular-capable Center May Significantly Shorten Treatment Times Without Substantially Delaying Thrombolysis: An Analysis of the STRATIS Registry.

Come visit us at booth 312!

Gardens Medical Center adds Neuro Intensive Care Unit

Gardens Medical Center adds Neuro Intensive Care Unit

Palm Beach Gardens Medical Center now has a dedicated Neuro Intensive Care Unit (NICU) providing advanced, multidisciplinary, patient centered care for the most critically ill patients with neurosurgical and neurological life threatening illnesses, including stroke, brain hemorrhage and tumors.

As a primary stroke center, Palm Beach Gardens Medical Center is part of the Advanced Neuroscience Network, a broad team of hospitals and doctors in Florida who are focused on offering a full continuum of care throughout South Florida.

PALM BEACH READERS: Sign up for Florida Weekly's Palm Beach email edition here.

“The Neuro Intensive Care Unit is designed to address the clinical needs of our neurological and neurosurgical patients to improve their outcomes,” Dianne Goldenberg, chief executive officer of Palm Beach Gardens Medical Center, said in a statement. “Our Neuro ICU is equipped with advanced minimally invasive monitoring and treatment techniques-both mechanical and pharmacological therapies to give our patients some of the most advanced care.”

The Neuro Intensive Care Unit team is comprised of healthcare professionals who are trained and experienced in both the neurological and medical management of the patients.

Together, the Palm Beach Gardens medical team will provide continuous bedside care.

For more information, call 561-625- 5070 or visit www.pbgmc.com.

World Stroke Day – Dr. Paul Acevedo interview by ABC News Channel 25

Sunday October 29, 2017

“There are over 750,000 strokes a year in the United States which makes this a significant health problem”, says Dr. Acevedo, but there is hope. Dr. Acevedo goes on to discuss how it is an exciting time for hospitals and the community because many times strokes can be recognized and prevented. Many risk factors for strokes can be recognized and prevented.

With the significance of stroke it is very important to educate not just those who are at risk for stroke, but the community as a whole. Dr. Acevedo discusses the importance of time and how “time is brain” which is a phrase commonly used in stroke neurology because almost 2 million brain cells can die off each minute a patient is suffering from a stroke. “Similar to hurricane preparedness, we have a hurricane plan, we can also have a stroke plan” says Dr. Acevedo in planning for a stroke in the event this does occur.

Planning for a stroke begins with awareness and understanding the signs and symptoms of a stroke. The acronym F.A.S.T. (Face, Arms, Speech, Time is of the essence) is commonly used to educate and reinforce community awareness of what to look if a stroke is occurring. Dr. Acevodo shares that while awareness is importance, it is also important to understand the risk factors for stroke such as: smoking, age, alcohol, high blood pressure, diabetes and even the types of medications someone is one such as any form of blood thinners or anticoagulants that the patient may be on. Knowing these risk factors can be of great importance to help a patient manage them and reduce a risk of stroke.

When asked about new developments in stroke care, Dr. Acevedo went on to discuss new interventional processes and procedures to treat and help patients who has suffered a stroke. “We now have the capabilities to remove a clot from a patient’s brain within minutes of losing their speech and they are able to speak again shortly thereafter” says Dr. Acevedo with regards to the latest in technological advances in stroke over the past several years.

Regional Medical Director, Dr. Nils Mueller, recently published in EMS World Magazine

Members of the Florida Puerto Rico Stroke Registry were recently published in a series of stroke articles through the EMS World Magazine, including our very own Regional Medical Director, Dr. Nils Mueller. The article title “Stroke Care: It’s about time!” discusses stroke care and the importance of time with regards to stroke care. We have included his recently article below, but it can also be viewed directly on the EMS World Magazine website by clicking here.

By Peter Antevy, MD; Nils Mueller-Kronast, MD; Mark Ellis Sep 05, 2017

time clock non-digital

Stroke Care: It’s about time!

There is no better phrase that defines each and every step of the stroke chain of survival. The acronym FAST (face, arm, speech, time) has been ubiquitous for years in messaging to the lay public, thanks to the diligent promotion of the American Heart Association and American Stroke Association. Yet while time to stroke recognition is critical, of equal importance is the time to stroke quantification, time to the destination hospital, time to CT, time to IV tPA and time to mechanical thrombectomy (MT). The recognition that EMS is a key player in the chain of survival is critical to success. Not only does EMS set the dominoes in motion, but it can also help guarantee data loop closure from entry to postdischarge.

It’s time to widen the lens to get a clearer picture of how quality stroke care unfolds. It’s about time we begin to leverage the system to optimize stroke care locally, regionally and nationally. Simply said:

  • It’s about time to recognize the significant impact EMS has on the outcomes of stroke patients.
  • It’s about time EMS leadership joined forces with local neurointerventionalist physicians.
  • It’s about time EMS actively participated in tailoring the stroke response to local resource availability.
  • It’s about time time-dependent stroke processes were measured and transparently reported.
  • It’s about time EMS transport decisions for stroke patients hinged on outcome data.

The South Florida Dilemma

Like most urban regions of the country, stroke care in South Florida operated in silos for decades. A typical story read like this: The patient or family member dialed 9-1-1; EMS responded and transported to a local hospital; the hospital treated the patient; the patient was discharged.

This wouldn’t be a problem except that each of the steps has numerous variables to be considered. Is the EMS agency performing to a high standard? Is the hospital examining its processes and measuring its outcomes? Are patients achieving better outcomes at one hospital versus another? To complicate matters, follow-up on patients by EMS systems has typically occurred on an ad hoc basis and rarely led to constructive feedback for either party. Patients were sometimes held at primary stroke centers (PSCs) instead of being transferred to competitors with interventional capabilities, while some “comprehensive” stroke centers existed on paper yet cryptically performed at subpar levels. A system of care did not exist, and the data feedback loop was not driving quality in the region. Something had to be done.

The History of Stroke Care

Between IV tPA’s approval in 1995 and 2010, there was debate and only hesitant adoption of intravenous thrombolysis by many providers. This was in part driven by only modest evidence of IV tPA’s impact for the most severe stroke patients. Starting in 2011 the Target: Stroke initiative helped bring publicity to process quality and move the stroke community toward higher percentages of patients treated—and in parallel toward shorter door-to-needle times.1

In 2012 the first stent retriever was introduced, and stroke experts quickly realized its potential. Without robust data, treatment was offered in a nonsystematic approach, and despite clear anecdotal evidence of efficacy, patients arriving in PSCs were transferred for intervention on a case-by-case basis.2

After two years of grassroots lobbying, in 2012 half of Broward County’s EMS agencies started to quantify stroke severity using a prehospital tool to identify patients for bypass, in part to permit enrollment into randomized thrombectomy trials. Then in 2013 high-performing South Florida hospitals began posting their door-to-needle times for EMS agencies to review. As awareness and peer pressure increased, in just three years the mean door-to-needle time in Florida dropped from the high 70-minute range to the high 40s, as the system of care became increasingly better at, and passionate about, delivering IV tPA.

Since 2015, with the publication of six randomized trials documenting the dramatic superiority of mechanical thrombectomy as far as 24 hours out, the stroke system of care has needed to reinvent itself.3–7 Over and over paramedics found themselves being called back to the ED to retransport the same stroke patient with obvious symptoms from a PSC to a CSC 10 minutes down the road for MT.

Following the example of ST-elevation MI and its ECG-based field pre-alert approach (which has cut door-to-balloon times from 90 minutes to less than 60), EMS medical directors and stroke interventionalists in South Florida collaborated in a newly formed coalition, the Broward EMS Stroke Coalition (BESC). The group broke through a seemingly impenetrable wall by routing patients with a high probability of an emergent large-vessel occlusion (ELVO) directly to a CSC.

As the local stroke champions shared data from their high-performing centers, effectively creating a new local performance benchmark, EMS medical directors began to request, supported by the Florida EMS quality assurance statute, stroke process and outcome data from the other facilities that weren’t voluntarily disclosing their data. This process was cumbersome and inefficient at best, yet it set a standard that EMS was an active participant in the stroke chain of survival. While looking to enhance the overall system of care, BESC became the driving force between patients’ entry into the system and ultimate outcome.

EMS Agency, Meet Your Neurointerventionalist

Recognizing that the hospital side of the equation was of critical importance to the process, outstanding clinicians who understood the value of collaboration with EMS and other community partners made their presence felt by disrupting their hospitals’ stroke processes and personally reaching out to each and every EMS agency. This face-to-face engagement was something the prehospital community had never experienced—for years the groups had functioned in silos.

Once the forces joined, there was a palpable difference in the system’s quality of care, sense of community and sense that everyone mattered. The lesson learned was the critical importance of the EMS agency connection with the stroke neurointerventionalist—two parties who link at the beginning of the case and also at the end (during follow-up, feedback and survivor dinners).

By 2016 hospitals in Broward County had begun collecting stroke process data and sharing and benchmarking it through the AHA Get With The Guidelines–Stroke (GWTG-S) tool. Thanks to years of determination, data collection had become an accepted part of providing high-quality stroke care. What was missing was a mechanism to provide feedback to the hospitals and EMS agencies.

Supercharging Data Feedback 

Lightning struck again when EMS leaders in the region joined forces with the Florida Puerto Rico (FL-PR) Stroke Registry, a NIH-funded statewide quality improvement project led by Ralph Sacco, MD, to help identify and reduce disparities in stroke care.8 In 2016 the tool was reconfigured to look at prehospital and hospital data points to find best practices with a focus on outcomes.

After a concerted effort, by January 2017 all hospitals receiving stroke patients in Broward and Palm Beach counties agreed to join the GWTG-S registry and the FL-PR registry to participate in a countywide benchmarking dashboard. The registries function in parallel to provide quarterly hospital data dashboards structured to improve outcomes. Currently almost every hospital in the tricounty region (also including Miami-Dade) is participating with the process, and now, for the first time, hospitals have agreed to provide 90-day outcome data on patients receiving stroke treatment with IV tPA and MT.

The collaboration between EMS leaders and hospital stroke champions has led to a dramatic reduction of key time intervals. While robust data is still being gathered for publication, we can now say that only a fraction of patients arrive to PSCs in Broward County via EMS. With that, the percentage of the ischemic stroke population offered mechanical thrombectomy has more than tripled in the Southeast Florida counties that have adopted bypass and instituted EMS prenotifications based on a severity scale (RACE in Broward and Palm Beach) to the interventional teams.

Currently the two busiest centers achieve door-to-groin medians of 40 minutes or less, showing that by improving the system of care, simplifying identification of candidates and dropping complex imaging protocols, dramatic improvement beyond even the current national IV thrombolysis average is possible. Analysis of pooled randomized thrombectomy trials has cast doubt as to whether IV tPA even provides additional benefit in patients with ELVO. Randomized trials are ongoing in Europe on the impact of bypass with longer transport distances and whether forgoing IV tPA treatment in favor of direct mechanical thrombectomy will lead to similar clinical outcomes.

If these trials show that IV tPA treatment in the “drip and ship” model does not confer clinical benefit and that the delays associated with transfer outweigh the longer transport times of bypass, then even communities with a lesser density of CSCs than our tricounty region, and thus longer transport times, will have to think about bypass directly to CSCs for patients with suspected ELVO.

We are confident that local benchmarking through our registry-generated dashboards will further reduce variability and improve care for all stroke patients. The Florida legislature has recognized the importance of these quality improvement projects and approved legislation to create a statewide stroke registry.

It’s about time for EMS to rise to the occasion and participate in every step of the stroke process. It’s about time for collaboration to begin to bridge the gap between clinical silos. It’s about time to guarantee that every stroke victim receives the optimal treatment possible in their region. It’s about time that data collection be seamless and outcomes be used to drive process changes for entire systems.

We cannot improve what we don’t measure. It’s about time we get started.

References

  1. Fonarow GC, Zhao X, Smith EE, et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA, 2014 Apr 23–30; 311(16): 1,632–40.
  2. Zaidat OO, Castonguay AC, Gupta R, et al. North American Solitaire Stent Retriever Acute Stroke registry: post-marketing revascularization and clinical outcome results. J Neurointerv Surg, 2014 Oct; 6(8): 584–8.
  3. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med, 2015 Jan 1; 372(1): 11–20.
  4. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med, 2015 Jun 11; 372(24): 2,285–95.
  5. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med, 2015 Mar 12; 372(11): 1,019–30.
  6. Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med, 2015 Jun 11; 372(24): 2,296–306.
  7. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med, 2015 Mar 12; 372(11): 1,009–18.
  8. Sacco RL, Gardener H, Wang K, et al. Racial-ethnic disparities in acute stroke care in the Florida-Puerto Rico collaboration to reduce stroke disparities study. J Am Heart Assoc, 2017 Feb 14; 6(2).

Peter Antevy, MD, serves as the EMS medical director for the Coral Springs Fire Department, Davie Fire Rescue, Southwest Ranches Fire-Rescue, American Ambulance and Transitional Health Solutions in Florida. He is associate EMS medical director for Palm Beach County Fire Rescue and the Seminole Tribe of Florida’s Fire Rescue Department. Antevy serves as medical director at the Coral Springs Fire Academy and for Broward College’s EMS program and is a pediatric emergency medicine physician at Joe DiMaggio Children’s Hospital in Hollywood, Fla. He is founder and chief medical officer of Pediatric Emergency Standards, Inc. Reach him at Peter@Handtevy.com.

Nils Mueller-Kronast, MD, is board-certified in neurology, stroke neurology and neurocritical care. He has a long-standing interest in improving stroke systems of care, stroke research and endovascular stroke treatment. He has founded a regional telehealth stroke system in northeastern Indiana and participated in various stroke advocacy and leadership groups in southeast Florida, including the Florida Puerto Rico registry. He serves as director of the neurointerventional program at Delray Medical Center and regional neuroscience director for Tenet Florida. Reach him at muellerkronast@gmail.com. 

Mark Ellis is chief of Hallandale Beach Fire Rescue in Florida. He joined the department in 2012 as division chief of EMS. He holds an AS degree in emergency medical services from Broward College and a BA in organizational leadership and a master’s degree in executive management from St. Thomas University. He is a professor at St. Thomas and a paramedic clinical instructor with Broward College’s EMS Department. Reach him at mellis@hallandalebeachfl.gov

 

The Advanced Neuroscience Network is a proud member of the Florida Puerto Rico Stroke Registry. In partnership with the American Heart Association’s Get with the Guidelines-Stroke quality improvement (QI) initiative, the Florida Puerto Rico Stroke Registry aims to leverage self-reported data already collected throw the AHA’s GWTG stroke database to identify and address disparities in stroke care. Through the use of this data, education program can implemented and help to address the disparities within the community.

Latest News

Does a Miracle Cure Exist for Migraines?

Does a Miracle Cure Exist for Migraines?

There is a recent trend taking the internet by storm as the ABC Channel 25 news team reported which involves a cure for migraines. This miracle cure is a piercing that targets a specific acupressure point that many claim to help cure all symptoms of a migraine. While this “miracle cure” appears to be a rapidly growing trend, it is not recommended by medical professionals.

The news team interviewed various individuals who suffered from debilitating migraines and have decided to undergo receiving this new piercing in the hopes that it will help to cure their symptoms. According to the World Health Organization, over 60 million Americans battle headache disorders and two-thirds of them are women. The acupressure point that is targeted with the piercing is believed by many to cure or relieve symptoms of migraines.

The news team interviewed Acupuncturist Dr. Ken Grey who states that this type of piercing acts as a sort of Band-Aid and does not truly treat the migraines. Patients would come to him claiming that, “the results were not long lasting.”

The news team also interviewed Dr. Jennifer Buczyner, Neurologist with the Advanced Neuroscience Network who also does not recommend the piercing as those receiving it may cause them to experience the placebo effect. Dr. Buczyner went on to share with the news team that, “when an individual experiences a migraine, there are pathways that are activated, so from a neurologist standpoint putting something in the ear would in no way have any impact on something that happens deep inside the brain.” The pathways that Dr. Buczyner were referring to are 4 inches within the brain.

As always before choosing any treatment, it is important to consult a health professional to determine to the true cause of the problem and if there are any treatment methods available to assist with any pain or discomfort you are feeling.

Dr. Arif Dalvi interviewed during Fox 29 Morning Show

Dr. Arif Dalvi interviewed during Fox 29 Morning Show

Nick Buoniconti number 85 stands on the sidelines of a football fieldDr. Arif Dalvi, Medical Director for the Memory Center at St. Mary’s Medical Center, was recently a guest on the FOX 29 morning show to discuss the recent health issues of former Miami Dolphins linebacker Nick Buoniconti. In the interview the Fox 29 news team asks Dr. Dalvi to explain what exactly the symptoms are that the famed football player is experiencing, which appear to be affecting both his memory and ability to perform daily tasks such as using the restroom, or putting on a t-shirt. Dr. Dalvi explained that with, “Memory it affects in ways similar to Alzheimer’s disease, and movement similar Parkinson’s disease.”

During the interview Dr. Dalvi goes on to explain that this can happen in other sports beyond the NFL. These types of symptoms are a result from, “repeated hits to the brain without giving it time to heal in between.” These symptoms can be displayed in soccer players who repeatedly hit a soccer balls against their head during game play. This example was used when asking Dr. Dalvi if the severity of the hit to the brain made a difference. While a soccer ball is light, the “brain floats within fluid called CSF, and it is the knocking of the brain back and forth against the walls of the skull that cause the damage” as Dr. Dalvi explained.

Arif Dalvi, MDIn the case for Nick Buoniconti, it was not about the number of hits that he took while in the NFL, it really comes down to the lack of protocols that existed for players who experienced serious injury on the field. Dr. Dalvi went on to emphasize the importance of current protocols that require players to stop playing in between hits so that they can be evaluated to prevent future injury.

Is it possible for Nick Buoniconti and other football players exhibiting similar symptoms to find treatments to help reduce the symptoms? This question was asked of Dr. Dalvi who stated that, “by the time you take treatments, the damage is so severe to the brain so it is all about 

Latest News

Palmetto General Hospital reunites stroke survivors with first responders and hospital staff who saved them

Palmetto General Hospital reunites stroke survivors with first responders and hospital staff who saved them

Screen Shot 2017-05-23 at 1.55.50 PMIn August of 2016, Palmetto General Hospital, part of the Advanced Neuroscience Network (ANN), earned the recognition from The Joint Commission and the American Heart Association (AHA)/American Stroke Association (ASA) as meeting The Joint Commission’s standards for Comprehensive Stroke Center Certification. As one of only two comprehensive centers in South Florida and four in the state with this distinction, Palmetto General Hospital is part of an elite group of providers focused on provided complex and quality stroke care. Comprehensive Stroke Centers are recognized as industry leaders and are responsible for setting the national agenda in highly specialized stroke care.

Palmetto General Hospital’s commitment to quality stroke care goes beyond having the capabilities to perform advanced acute procedures to stroke patients, they are also actively informing and educating the community as to the importance of recognizing the signs and symptoms of a stroke. Most recently, the team at Palmetto General Hospital reunited stroke survivors with Emergency Medical Service teams and the Stroke and Neurointerventional Team that worked to save their lives.

The stroke survivor event was done to not only highlight the patients and their family members, but to serve as way to highlight the importance of knowing the signs and symptoms of a stroke and why time is brain. For every minute that a patient goes without receiving interventional care, they lose 1.9 million neurons. This event highlighted the significance that community awareness can bring as well as the importance of the relationship that Palmetto General Hospital has with EMS providers in educating them to recognize the signs and symptoms of a stroke and triage patients in the field.

Dr. Acevedo’s interview with Channel 12 News

Dr. Acevedo interviewed by News Channel 12 on stroke risk factors- and how to reduce them

Dr. Acevedo interviewed by News Channel 12 on stroke risk factors- and how to reduce them

Recently, Dr. Paul Acevedo was interviewed for Stroke Awareness Month by Channel 12 Dr. Acevedo's Profile PhotoNews. Every year approximately 800,000 people suffer from a stroke and of these strokes 80% are preventable. The news team inquired as to how exactly a person can prevent strokes. Dr. Acevedo started off by stating that, “stroke is the final event of a chronic condition of a lot of problems with blood vessels, blood sugar, and high blood pressure.” The Channel 12 news team further inquired about reducing risk factors of a stroke and Dr. Acevedo stated that, “diet can be changed, exercise, smoking and alcohol cessation can all lead to preventing stroke in our population.

As the interview carried on, the news team inquired about strokes occurring in the younger population two which Dr. Acevedo commented and stated that, “much of this is due to change in risk factors that lead to higher risk of stroke in population.” Of these risk factors some of those mentioned were:

  • Metabolic Disease
  • High Blood Pressure
  • Sedentary Lifestyle
  • Diabetes
  • Obesity

The news team then inquired specifically about how family history affects risk factors for a stroke and if there is a way for individuals who have a history of stroke in their family to reduce that risk. Dr. Acevedo went on to state that, “the chances are a little higher if you have had a family member who has suffered from a stroke, but the risks can be diminished and reduced.” Some of the ways to reduce this risk include:

  • Exercising and avoiding sedentary lifestyle
  • Going to doctor and having risk factors checked such as blood sugar, and blood pressure
  • Eliminating tobacco use
  • Reducing alcohol use

As the news team carried on they asked Dr. Acevedo about the acronym F.A.S.T. and what it means with regards to a stroke. “F.A.S.T. is a great way to get out and educate the community where the awareness has to be.

  • F – Face weakness
  • A – Arm weakness
  • S – Speech Changes
  • T – Time is of the essence

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