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Improving care after stroke Dr Nick Losseff Consultant Neurologist - - PowerPoint PPT Presentation
Improving care after stroke Dr Nick Losseff Consultant Neurologist - - PowerPoint PPT Presentation
Improving care after stroke Dr Nick Losseff Consultant Neurologist What is a stroke ? Recognising a stroke What is the treatment ? Time is brain Preventing brain damage Accurate diagnosis Respiratory care Hydration Hypertension
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Recognising a stroke
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What is the treatment ?
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Time is brain
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Preventing brain damage
Accurate diagnosis Respiratory care Hydration Hypertension Hyperglycaemia Pyrexia TPA Drugs (ASA)
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Outcome after stroke
- Casemix adjusted outcome in Europe
– 4534 patients (Wolfe et al – Stroke 1999)
- 42% dead at 3 months - U.K.
- 19% dead - France
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Recent UCLH developments
- 2007: Started the first 24 /7 “clot busting
treatment” service for stroke in North London
– Accessible to anyone coming to UCH A+E – Delivered excellent results (numbers treated / survival)
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London Stroke Strategy
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Critical Mass
- Clinical expertise
- Volume facilitate multidisciplinary teams
- Research facilitated
- Junior Staffing optimised
- Efficiency
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Decision to change
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Hyperacute Stroke Units
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SU and TIA services
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UCLH Hyperacute Stroke Unit
- Far greater number of people being treated
- High thrombolysis rates - 18% - extended to sector (i.e.
thrombolysis rate doubled in sector by centralisation)
- All in license thrombolysis achieved in target < 1 hr
- Survey of mortality shows UCLH low mortality extending
to all HASU treated pts (6% - follow up in local unit)
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Success !
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Partnership
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Exemplar of change
- Clear demonstration where concentration
- f expertise and partnerships between
health service providers delivers real benefits for people
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Conclusion
- Radical and bold
- Should strive to
improve our services
- Nihilism
- Population based