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A closed-door round table discussion was held to address the need for improving stroke prehospital care globally. The discussion focused on key expert opinions and agreements, including the importance of rapid recognition and transfer to a hospital, the cost-effectiveness of improving prehospital care, the sharing of best practices, the development of specific guidelines for prehospital stroke care, the focus on onset to door time as a quality evaluation indicator, the need for prehospital stroke care research, the importance of funding and innovation, sustained collaboration, and the expansion of taskforces. The discussion also highlighted the need for prompt hospital transfer for patients ineligible for thrombolysis or thrombectomy and the management of minor strokes and transient ischemic attacks. The round table discussion provided valuable perspectives to inform future strategies for optimizing stroke prehospital care delivery and improving patient outcomes globally, with a particular emphasis on addressing the stroke burden in low- and middle-income countries. [Extracted from the article]

The goal is to improve stroke prehospital care, which includes stroke awareness, optimizing processes, developing novel tools, advocating policy, and optimizing transition from prehospital care to in-hospital care. Slurred speech occurs in >70% of stroke patients.[3] Dr. Lei Wang, a postdoc student in West Virginia, contacted us early this year and authorized us to share his stroke story for educational purposes. Julie Chin, a news anchor in Oklahoma, had a possible stroke during her live TV broadcast. [Extracted from the article]

Keywords: emergency; FAST; ischemic; prehospital delay; stroke; stroke 911 EN emergency FAST ischemic prehospital delay stroke stroke 911 1473 1475 3 09/05/22 20221001 NES 221001 INTRODUCTION In 2020, stroke ranked as the third cause of death from non-communicable diseases (except injury) in the United States.1 World Health Organization data from 2019 indicated that stroke is the number two cause of death worldwide. Therefore, it is reasonable to first target the Chinese community using the Chinese language and a culture-adapted approach to improve stroke awareness and promote the immediate action of calling 911 to reduce stroke-related mortality and morbidity. [Extracted from the article]

Background. Data on potential variations in delivery of appropriate stroke care over time are scarce. We investigated temporal changes in the quality of acute hospital stroke care across five national audits in Europe over a period of six years. Methods. Data were derived from national stroke audits in Germany, Poland, Scotland, Sweden, and England/Wales/Northern Ireland participating within the European Implementation Score (EIS) collaboration. Temporal changes in predefined quality indicators with comparable information between the audits were investigated. Multivariable logistic regression analyses were performed to estimate adherence to quality indicators over time. Results. Between 2004 and 2009, individual data from 542,112 patients treated in 538 centers participating continuously over the study period were included. In most audits, the proportions of patients who were treated on a SU, were screened for dysphagia, and received thrombolytic treatment increased over time and ranged from 2-fold to almost 4-fold increase in patients receiving thrombolytic therapy in 2009 compared to 2004. Conclusions. A general trend towards a better quality of stroke care defined by standardized quality indicators was observed over time. The association between introducing a specific measure and higher adherence over time might indicate that monitoring of stroke care performance contributes to improving quality of care. [ABSTRACT FROM AUTHOR]

The article analyzes the arguments on the notion of narrative of Alasdair MacIntyre, Paul Ricoeur, and Charles Taylor as having a central role to play in a person thinking about personal identity and ethics. It notes that an individual's sense of self is bound with his capacity to tell a coherent story about himself. However, the mainstream analytic debate on personal identity resulted in an impossible situation for progress because its parties abstract the person's notion from the narratives, in which persons figure as characters. It also examines the recent works of Peter Lamarque, John Christman, and Galen Strawson, which exemplified the narrative theories.

This paper examines Kierkegaard's discussion of patience in some of his Upbuilding Discourses, and its connection with his understanding of the nature of selfhood as it appears both in the Discourses and in The Sickness unto Death. That understanding stresses that selfhood is not simply given, but is a task to be achieved—although a task that can only be achieved by the self that is formed in the process of undertaking it. For Kierkegaard, an account of the self that recognizes its essential temporality must give a crucial role to patience as a virtue necessary for the formation and maintenance of personal identity. However, although the self is essentially temporal for Kierkegaard, it is also essentially such as to participate in eternity, and this complexity and tension in his concept of the self gives his understanding of patience a particular character—one that presents an important challenge to some of the dominant assumptions of recent and contemporary philosophy in both the analytic and the continental traditions. [ABSTRACT FROM AUTHOR]

Many philosophers now argue that the doubts of the philosophical sceptic are unnatural ones, in that they are not forced on us by considerations that any reasonable person would have to accept as compelling but only arise if one has already accepted certain controversial theoretical commitments. In this article I defend the naturalness of philosophical scepticism against such criticisms. After defining “global ontological scepticism,” I examine the work of a number of anti-sceptical philosophers—Michael Huemer, Michael Williams, and John McDowell. Although McDowell does move the debate to a deeper level by interpreting scepticism as a challenge to the very possibility of the mind's apprehending reality by being in a rational rather than a merely causal relation to it, none of them succeeds in showing that global ontological scepticism is, in the relevant sense, unnatural. This is not to say that the sceptic is correct; simply that it has not been shown that we can reasonably dismiss the sceptical questions and thereby evade the need to engage seriously with the sceptical arguments. [ABSTRACT FROM AUTHOR]

We describe two rare cases of alien limb syndrome following right posterior cerebral artery (PCA) stroke. Both patients present with left hemianopia, visual neglect and proprioceptive loss in addition to their alien limb symptoms. Lesion subtraction from seven control PCA patients revealed that medial parietal-occipital and thalamic areas were selectively damaged in the alien limb patients. We propose that loss of the sense of motor intention and internal model of the current state of the arm, combined with deficient proprioceptive and visual feedback of the moving limb, are critical for genesis of posterior alien limb and discuss how affected regions normally function to ensure awareness of self-generated motor activity. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To identify factors that were associated with cognitive impairment 3 months after stroke, and to examine the associations of cognitive impairment with stroke outcomes up to 4 years after stroke. DESIGN: Observational study. SETTING: Population-based stroke register. PARTICIPANTS: Six hundred forty-five subjects with first-ever stroke, identified from the register. MEASUREMENTS: Subjects were assessed for cognition using the Mini-Mental State Examination (MMSE) 3 months after stroke. Cognitively impaired subjects (MMSE <24, n = 248 (38%)) were compared with cognitively intact subjects (MMSE 24–30, n = 397) in terms of demographic details, stroke risk factors, laterality of stroke, and initial poststroke impairments. Outcome data collected at 1, 3, and 4 years poststroke included disability assessed by the Barthel Index (BI) and the Frenchay Activity Index, case fatality, and institutionalization. RESULTS: Two hundred forty-eight (38%) of 645 subjects were cognitively impaired 3 months after stroke. Using multivariate analyses, cognitive impairment was associated with age of 75 and older (odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.5–4.2), ethnicity (Caribbean/African (OR = 1.9, 95% CI = 1.2–3.2) and Asian (OR = 3.4, 95% CI = 1.1–10.2), lower socioeconomic class (OR = 2.1, 95% CI = 1.3–3.3), left hemispheric lesion (OR = 1.6, 95% CI = 1.01–2.4), visual field defect (OR = 2.0, 95% CI = 1.2–3.2), and urinary incontinence (OR = 4.8, 95% CI = 3.1–7.3). Using multivariate analyses, cognitive impairment was associated with death or disability (BI <15) at 4 years after stroke (OR = 2.2, 95% CI = 1.1–4.5). In univariate analyses, it was also associated with higher institutionalization 4 years after stroke (P = .001). CONCLUSIONS: Cognitive impairment is common 3 months after stroke and is independently associated with older age, ethnicity, lower social class, left hemispheric stroke,... [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine factors associated with recovery from poststroke urinary incontinence and to estimate the impact of this recovery on stroke outcome at 3 months. DESIGN: Prospective, observational study. SETTING: Population-based stroke register. PARTICIPANTS: Three hundred twenty-four incident cases of stroke with incontinence 1 week poststroke were identified from the register between January 1, 1995, and December 31, 1998. MEASUREMENTS: At 3 months, 105 patients were dead and 12 were lost to follow-up. The remaining patients were classified by continence status; those who had regained continence (n = 127) were compared with those who remained incontinent (n = 80) in terms of demographic details, stroke risk factors, premorbid disability, neurological impairments, and Oxfordshire Community Stroke Project stroke subtypes. Data at 3 months included disability using the modified Barthel Index (BI) (without its urinary continence component) and the Frenchay Activity Index (FAI), and institutionalization. RESULTS: Multivariate analysis showed being age 75 and older (odds ratio (OR) = 0.38; 95% confidence interval (CI) = 0.17–0.83) was associated with poor recovery from incontinence. Compared with subjects with total anterior circulatory infarctions, those with lacunar infarctions were more likely to regain continence (OR = 3.66; 95% CI =1.10–12.2), and compared with subjects with a BI between 0 and 14, those with a BI between 15 and 18 were also more likely to regain continence (OR = 21.8; 95% CI = 5.95–79.7). At 3 months, the incontinent group had greater institutionalization rates (27 (34%) vs 9 (7%), P < .001) and worse disability, measured with BI and FAI (BI: P < .001, FAI: P = .002). CONCLUSIONS: Age 75 and older is independently associated with poor recovery from poststroke urinary incontinence. Further clinical trials are required to explore underlying mechanisms and efficacy of possible interventions for this group of stroke... [ABSTRACT FROM AUTHOR]

It is widely thought that sceptical arguments, if correct, would show that everyday empirical knowledge-claims are false. Against this, I argue that the very generality of traditional sceptical arguments means that there is no direct incompatibility between everyday empirical claims and sceptical scenarios. Scepticism calls into doubt, not ordinary empirical beliefs, but philosophical attempts to give a deep ontological explanation of such beliefs. G. E. Moore's attempt to refute scepticism (and idealism) was unsuccessful, because it failed to recognise that philosophical scepticism operates on a different level from that on which we make - or doubt - particular empirical claims. And, as I argue with specific reference to work by Nozick and Fogelin, Moore's basic confusion is still widely shared in contemporary discussions of scepticism. [ABSTRACT FROM AUTHOR]

The article discusses a randomized trial, conducted by the authors, using primary care electronic health records (EHRs) collected from Great Britain Clinical Practice Research Datalink which revealed oral anticoagulant prescription after haemorrhagic stroke. stroke secondary prevention. Patients with prevalent stroke who were treated with warfarin were included in the trial. The study concludes that there may be a significant number of stroke patients who were treated with oral anticoagulants.

The article lists the names of the contributors of the periodical "Journal of Religious Ethics" including Elizabeth M. Bucar, G. Scott Davis and Christopher J. Insole.

Background: Delayed presentation to hospital after an acute stroke is a major explanation given for low thrombolysis rates. This study aimed to investigate the factors associated with delays in presentation after an acute stroke and changes after a mass media campaign., Methods and Results: Data were from a population-based study involving 1392 patients with first-ever strokes between 2002 and 2010 in a multiethnic South London population. Associations were determined between prehospital delay (≥3 hours) and variables of interest, including ethnicity, by using multivariate logistic regression analyses. Differences in prehospital delay and thrombolysis rates were determined for the period immediately before and after the FAST mass media campaign (2007/2008 versus 2009/2010). The median (Q(1) to Q(3)) time to presentation was 4.73 (1.55 to 12.70) hours, and 550 (39.5%) presented within 3 hours of symptom onset. In multivariate analysis, patients of black ethnicity had increased odds of delay (odds ratio: 1.63; 95% confidence interval, 1.11 to 2.38), whereas those with more severe strokes characterized by a higher National Institutes of Health Stroke Scale score (odds ratio: 0.35; 95% confidence interval, 0.20 to 0.61) had reduced odds of delay. There was no difference in the proportion of patients who arrived within 3 hours (P=0.30) in the period immediately before and after the FAST campaign (40.7% in 2007/2008 versus 44.9% in 2009/2010). Among patients with ischemic stroke, 119 (11.0%) received thrombolysis between 2002 and 2010, with no difference observed between the pre- and postcampaign periods (16.9% versus 16.4%)., Conclusion: Significant delays in seeking care after stroke still occur in this population despite efforts to increase public awareness. Future educational programs must identify and specifically address factors that influence behavior and should target those at higher risk of delay. (J Am Heart Assoc. 2012;1:e001685 doi: 10.1161/JAHA.112.001685.).