The American Stroke Association (ASA) assembled a multidisciplinary group of experts to develop recommendations regarding the potential effectiveness of establishing an identification program for ...stroke centers and systems. "Identification" refers to the full spectrum of models for assessing and recognizing standards of quality care (self-assessment, verification, certification, and accreditation). A primary consideration is whether stroke center identification might improve patient outcomes.
In February 2001, ASA, with the support of the Stroke Council's Executive Committee, decided to embark on an evaluation of the potential impact of stroke center identification. HealthPolicy R&D was selected to prepare a comprehensive report. The investigators reported on models outside the area of stroke, ongoing initiatives within the stroke community (such as Operation Stroke), and state and federal activities designed to improve care for stroke patients. The investigators also conducted interviews with thought leaders in the stroke community, representing a diverse sampling of specialties and affiliations. In October 2001, the Advisory Working Group on Stroke Center Identification developed its consensus recommendations. This group included recognized experts in neurology, emergency medicine, emergency medical services, neurological surgery, neurointensive care, vascular disease, and stroke program planning.
There are a variety of existing identification programs, generally falling within 1 of 4 categories (self-assessment, verification, certification, and accreditation) along a continuum with respect to intensity and scope of review and consumption of resources. Ten programs were evaluated, including Peer Review Organizations, trauma centers, and new efforts by the National Committee on Quality Assurance and the Joint Commission on the Accreditation of Healthcare Organizations to identify providers and disease management programs. The largest body of literature on clinical outcomes associated with identification programs involves trauma centers. Most studies support that trauma centers and systems lead to improved mortality rates and patient outcomes. The Advisory Working Group felt that comparison to the trauma model was most relevant given the need for urgent evaluation and treatment of stroke. The literature in other areas generally supports the positive impact of identification programs, although patient outcomes data have less often been published. In the leadership interviews, participants generally expressed strong support for pursuing some form of voluntary identification program, although concerns were raised that this effort could meet with some resistance.
Identification of stroke centers and stroke systems competencies is in the best interest of stroke patients in the United States, and ASA should support the development and implementation of such processes. The purpose of a stroke center/systems identification program is to increase the capacity for all hospitals to treat stroke patients according to standards of care, recognizing that levels of involvement will vary according to the resources of hospitals and systems.
This article presents information about the American Board of Psychiatry and Neurology's new subspecialty certificate in vascular neurology, including the requirements for board certification. ...Practicing neurologists and child neurologists who have a major focus in vascular neurology can apply for the new certificate. In addition, the Accreditation Council for Graduate Medical Education has approved fellowship training in the subspecialty, and it is likely that residents who wish to pursue a career in vascular neurology will select this training option.
This study followed the progress of a cohort of child neurology and neurology graduates who sought certification by the American Board of Psychiatry and Neurology (ABPN). The 211 candidates were ...recent graduates when they initiated the certification process in October 1994, and 92% of them have achieved certification. First-attempt performances on the Part I and Part II examinations were related; 62% of those certified passed both on their first attempts. Of those who were certified, 24% also achieved certification in at least one additional ABPN specialty (psychiatry) or subspecialty (clinical neurophysiology, neurodevelopmental disabilities, and pain medicine). Overall, it was estimated that 82% of the 1994 child neurology and neurology graduates sought ABPN certification, and of these, 82% were successful. (J Child Neurol 2005;20:25—27).
There remains nearly a twofold increase in blacks compared with whites for stroke mortality. The death rate from cerebral hemorrhage in blacks approximates twice that of whites. Subarachnoid ...hemorrhage is a frequent cause of mortality and morbidity in stroke and is also about twice as frequent in blacks. Lacunar strokes occur more in blacks reflecting increased incidence of hypertension and are leading causes of multi-infarct encephalopathy and dementia. Therefore, the concomitant occurrence of hypertension and stroke is most common in African Americans and requires diagnosis of the type of stroke, which then defines the rationale of blood pressure control. Cerebral vascular changes associated with acute, chronic, and reactive hypertension are operative. When to treat, when not to treat, and the appropriateness of specific antihypertensive agents in acute stroke are relevant. A common misconception is that the increased blood pressure is the cause of the stroke when it is likely the result of the stroke. Lowering the blood pressure in all acute stroke patients with elevated blood pressure may worsen the neurologic deficit. Thus, the judicious control of blood pressure is to be stressed in the concomitant occurrence of hypertension and stroke.
Two patients with chronic bilateral subdural hematomas developed symmetrical generalized choreiform movements. In one patient the chorea disappeared after evacuation of the hematomas, and in the ...other the movement improved. The latter patient has a family history of Huntington's disease.
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