Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Thursday, October 27, 2016

This green wine is actually made out of marijuana—and it's available in the US

The best of two worlds for stroke rehabilitation. But you better live in California and have a medical marijuana license. One more reason we need to legalize marijuana. Regulation via state legislatures of medical marijuana is a fucking sick joke.

My 13 reasons for marijuana use post-stroke.  

Alcohol for these 12 reasons.

Do not follow any of my suggestions, I'm not medically trained
eople have been sipping different types of wine for thousands of years. Red, white, Rosé, and even blue are being enjoyed by the multitudes. But have you ever heard of green? Green wine aka Cannabis Wine has probably been around since the creation of weed and wine. Who knew?

What is it?

This so-called Canna Vine is a high-end marijuana product that combines organically grown marijuana and farmed grapes.
Due to the lower fermentation temperatures, you still feel the therapeutic effects of marijuana without the high levels of THC, the primary psychoactive compound found in the drug.
The result is a mellow, physical “body high” rather than a more disorienting mental high (which is unique among common ingestible forms of marijuana).

How is it made?

The creators are experimenting with two new weed types, sativa and indica, to find an equal balance of “uplifting and relaxing sensations."
To start the process, about a pound of cured marijuana is wrapped in cheesecloth and added to a wine barrel, where it will ferment, then repose, for a year or more.
The final product is described as "subtle with a little flush after the first sip, but then the effect is really cheery, and at the end of the night you sleep really well. It really is the best of both worlds; you get delicious wines with medicinal benefits.”

What can we expect next?

As of now, Canna Vine is only available and legal in California with a medical marijuana license. However, even if you are in California and have a marijuana license, you’ll also need to dish out $120 to $400 dollars for half a bottle.
Currently Molyneux and Lindquist, the founders, are continuing to work on their products. Lindquist states that “Cannabis wine has been so effective as a stress reliever, as a mood elevator, and as a medicine. I have no idea what the market will be like for it, but whatever I make I want to be safe, made from pure ingredients and, hopefully, delicious.” 
Read the original article on Spoon University. Copyright 2016. Follow Spoon University on Twitter.

More evidence on exercise delaying later life dementia

This is very important to me. I was in great shape 10 years ago. Will that carry over long enough until I get old? Or do I need to really get exercising again?
This is where we need a publicly distributed and available protocol. Our fucking failures of stroke associations will fail once again at this task
Analysis of this here:

More evidence on exercise delaying later life dementia

Actual research here:

Therapeutically relevant structural and functional mechanisms triggered by physical and cognitive exercise

Patients With Haemorrhagic Stroke Fare Better if They Tolerate Full Course of Nimodipine

I'm sure your doctor has warned you about nimodipine side effects.
  • mild dizziness;
  • flushing (redness, warmth, or tingling feeling);
  • headache;
  • nausea, constipation; or.
  • sweating.
Patients hospitalised with aneurysmal subarachnoid haemorrhage who can tolerate 90% of their scheduled doses of nimodipine have a better chance of being discharged home than patients who have lower compliance with the agent, according to results of a retrospective study presented at the 141st Annual Meeting of the American Neurological Association (ANA).
“Nimodipine compliance of 90.1% or higher was most predictive of a good outcome, while multivariate logistic regression reveals that older age, World Federation of Neurological Surgeons (WFNS) grade 3 or greater, and missing 1 or more nimodipine doses are associated with worse clinical outcomes,” reported lead author Aaron Wessell, MD, University of Maryland School of Medicine, Baltimore, Maryland, speaking at a poster presentation here on October 16.
Dr. Wessell and colleagues analysed the records of 118 consecutive patients with aneurysmal subarachnoid haemorrhage, all of whom were treated with the Maryland Low-Dose IV Heparin Infusion Protocol between July 2008 and July 2015. In all, 53 patients were discharged home -- and 83% of those received at least 90% of the scheduled nimodipine doses. On the other hand, 31 of 65 patients (48%) were discharged to rehabilitation facilities or died in hospital (P < .001).
High compliance was reported among 75 patients; low compliance was reported in 43 patients. Patients who had lower compliance were about 6 years older on average: 53.56 years compared with 59.60 years (P = .011). Those with a higher-grade haemorrhage also were more likely to have low compliance -- with an average of WFNS grade 2 for those who were compliant compared with grade 4 for patients who were unable to receive the full dosing (P < .001).
Halving the dose of nimodipine and administering it at 30 mg every 2 hours did not appear to have a negative effect on outcome. Patients were treated with nimodipine for as long as 21 days.
Dr. Wessell noted that nimodipine is the only pharmacological agent that has shown consistency in randomised, placebo-controlled trials to improve outcomes in aneurysmal subarachnoid haemorrhage. “Unfortunately, a significant percentage of patients admitted with aneurysmal subarachnoid haemorrhage demonstrate sensitivity to nimodipine’s hypotensive effect,” he noted.
The average age of patients in this study was 55.76 years; about 65% of the patients were female. In all, about 62% of patients had been diagnosed with hypertension; 54% had a history of tobacco use; and 74% were diagnosed with symptomatic hydrocephalus.
[Presentation title: High Compliance with Scheduled Nimodipine Is Associated with Better Outcome in Aneurysmal Subarachnoid Hemorrhage Patients Co-Treated with Heparin Infusion. Abstract 218]

Abstracts for the 10th World Stroke Congress, 2016

49 references to protocol in the 285 pages. None of which seem to refer to anything about stroke rehab. TL:DR(Too long; didn't read)  This is what our fucking failures of stroke associations should be summarizing for what could be useful for stroke survivors. But that will never occur with those lazy bastards.
This just completely proves that the World Stroke Congress has no interest in helping stroke survivors. You are on your own. Deal with it.

Wednesday, October 26, 2016

Betrayal of stroke patients: Sufferers are forced to wait months for NHS rehab

The real betrayal is that only 10% of stroke survivors get to almost full recovery. Where is the hue and cry about that? 

  • Stroke victims are having to wait more than four months for physiotherapy
  • Delays in their treatment have a 'devastatingimpact on overall recovery 
  • Each year 150,000 UK adults suffer stroke and many must regain mobility

Stroke victims are having to wait more than four months for physiotherapy after leaving hospital, according to a report.
The delays have a ‘devastating’ impact on patients’ recovery and undo previous painstaking hard work, experts say.
Around 152,000 UK adults suffer a stroke each year and some are left paralysed on one side of the body or very weak in their limbs.

They have to relearn basic movements through physiotherapy sessions involving repetitive exercises.
Research by the Chartered Society of Physiotherapy found 85 per cent of health trusts do not offer stroke victims physiotherapy within two weeks of leaving hospital. A fifth make them wait at least 13 weeks and 4 per cent cannot offer sessions until after 18 weeks.
The society’s Catherine Pope said: ‘The results of this audit are a stark reminder that too many patients are being let down once they leave hospital.
‘Effective rehabilitation gives people back their independence, allowing them to return to work or simply to resume everyday activities.’
She added: ‘It is crucial that it is regular and timely in those early days, and then on an ongoing, longer-term basis, it is important that patients can access that expert advice and support to help them manage their condition.
‘The consequences of missing out on care can be devastating so it is essential that greater attention is paid to ensuring the excellence seen in some areas is available to all.’

Dominic Brand, of the Stroke Association, has called the NHS figures 'extremely concerning'
The research involved Freedom of Information requests to all 209 clinical commissioning groups in England, of which 135 replied.
Dominic Brand, a spokesman for the Stroke Association, described the findings as ‘extremely concerning’.
‘Major strides have been made in the way stroke is treated in hospital(not really, you are doing nothing about the neuronal cascade of death); however, it is clear that far too many stroke survivors are going without the right support,’ he said.
‘Stroke survivors regularly tell us they have had to wait weeks – and in some cases months – for the support and therapy they need to rebuild their lives.
‘For too many people, their support comes too late, it stops too soon, or they don’t have access to all types of therapy they need.’

Statistical analysis plan for the family-led rehabilitation after stroke in India (ATTEND) trial: A multicenter randomized controlled trial of a new model of stroke rehabilitation compared to usual care

Will be useless unless we finally get a database of stroke rehab protocols with efficacy ratings.
  1. Laurent Billot1,2
  2. Richard I Lindley1,2
  3. Lisa A Harvey2
  4. Pallab K Maulik3,4
  5. Maree L Hackett1,5
  6. Gudlavalleti VS Murthy6,7
  7. Craig S Anderson1,2
  8. Bindiganavale R Shamanna8
  9. Stephen Jan1
  10. Marion Walker9
  11. Anne Forster10
  12. Peter Langhorne11
  13. Shweta J Verma12
  14. Cynthia Felix3
  15. Mohammed Alim3
  16. Dorcas BC Gandhi12
  17. Jeyaraj Durai Pandian12
  1. 1The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
  2. 2Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  3. 3Research and Development, George Institute for Global Health India, Hyderabad, Telangana, India
  4. 4The George Institute for Global Health, Oxford University, Oxford, UK
  5. 5College of Health and Wellbeing, University of Central Lancashire, Preston, UK
  6. 6Indian Institute of Public Health, Hyderabad, India
  7. 7Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
  8. 8School of Medical Sciences, University of Hyderabad, Hyderabad, Telangana, India
  9. 9School of Medicine, University of Nottingham, Nottingham, UK
  10. 10Academic Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Foundation Trust, University of Leeds, Leeds, UK
  11. 11Academic Section of Geriatric Medicine, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
  12. 12Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
  1. Richard I Lindley, The George Institute for Global Health, University of Sydney, Level 3, 50 Bridge St., Sydney, NSW 2000, Australia. Email:


Background In low- and middle-income countries, few patients receive organized rehabilitation after stroke, yet the burden of chronic diseases such as stroke is increasing in these countries. Affordable models of effective rehabilitation could have a major impact. The ATTEND trial is evaluating a family-led caregiver delivered rehabilitation program after stroke.
Objective To publish the detailed statistical analysis plan for the ATTEND trial prior to trial unblinding.
Methods Based upon the published registration and protocol, the blinded steering committee and management team, led by the trial statistician, have developed a statistical analysis plan. The plan has been informed by the chosen outcome measures, the data collection forms and knowledge of key baseline data.
Results The resulting statistical analysis plan is consistent with best practice and will allow open and transparent reporting.
Conclusions Publication of the trial statistical analysis plan reduces potential bias in trial reporting, and clearly outlines pre-specified analyses.
Clinical Trial Registrations India CTRI/2013/04/003557; Australian New Zealand Clinical Trials Registry ACTRN1261000078752; Universal Trial Number U1111-1138-6707.

How even our brains get ‘slacker’ as we age

Is your doctor blaming your stroke rather than this slacking for your cognitive problems?  Occams razor?

Losing the youthful firmness and elasticity in our skin is one of the first outward signs of ageing.  Now it seems it’s not just our skin that starts to sag - but our brains too.
New research from Newcastle University, UK, in collaboration with the Federal University of Rio de Janeiro, investigated the way the human brain folds and how this ‘cortical folding’ changes with age.
Linking the change in brain folding to the tension on the cerebral cortex - the outer layer of neural tissue in our brains - the team found that as we age, the tension on the cortex appears to decrease.  This effect was more pronounced in individuals with Alzheimer’s disease.
Publishing their findings today in the academic journal PNAS, the team say this new research sheds light on the underlying mechanisms which affect brain folding and could be used in the future to help diagnose brain diseases.
Lead author Dr Yujiang Wang, of Newcastle University, explains:
“One of the key features of a mammalian brain is the grooves and folds all over the surface – a bit like a walnut - but until now no-one has been able to measure this folding in a consistent way.
“By mapping the brain folding of over 1,000 people, we have shown that our brains fold according to a simple universal law. We also show that a parameter of the law, which is interpreted as the tension on the inside of the cortex, decreases with age.
“In Alzheimer’s disease, this effect is observed at an earlier age and is more pronounced. The next step will be to see if there is a way to use the changes in folding as an early indicator of disease.”
Common in all mammals
The expansion of the cerebral cortex is the most obvious feature of mammalian brain evolution and is generally accompanied by increasing degrees of folding of the cortical surface.
In the average adult brain, for example, if the cortex of one side – or hemisphere – was unfolded and flattened out it would have a surface area of about 100,000 mm2, roughly one and a half times the size of a piece of A4 paper.
Previous research has shown that folding of the cortex across mammalian species follows a universal law – that is, regardless of size and shape, they all fold in the same way.
However, until now there has been no systematic study demonstrating that the same law holds within a species.
Tension slackens with age
“Our study has shown that we can use this same law to study changes in the human brain,” explains Dr Wang, based in Newcastle University’s world-leading School of Computing Science.
“From this, we identified a parameter that decreases with age, which we interpret as changing the tension on the cortical surface.  It would be similar to the skin.  As we age, the tension drops and the skin starts to slacken.
“It has long been known that the size and thickness of the cortex changes with age but the existence of a general law for folding shows us how to combine these quantities into a single measure of folding that can then be compared between genders, age groups and disease states.”
Women’s brains less folded
The team also found that male and female brains differ in size, surface area, and the degree of folding. Indeed, female brains tend to be slightly less folded than male brains of the same age. Despite this, male and female brains are shown to follow exactly the same law.
“This indicates that for the first time, we have a consistent way of quantifying cortical folding in humans,” says Dr Wang.
Throughout the lifespan of healthy individuals, cortical folding changes in the same way in both men and women but in those with Alzheimer’s disease the change in the brain folding was significantly different.
She adds: “More work is needed in this area but it does suggest that the effect Alzheimer’s disease has on the folding of the brain is akin to premature ageing of the cortex.”

Attached files

  • New research from Newcastle University, UK, in collaboration with the Federal University of Rio de Janeiro, investigated the way the human brain folds and how this ‘cortical folding’ changes with age. Linking the change in brain folding to the tension on the cerebral cortex - the outer layer of neural tissue in our brains - the team found that as we age, the tension on the cortex appears to decrease. This effect was more pronounced in individuals with Alzheimer’s disease. Pictured is lead author of the study, Dr Yujiang Wang, Newcastle University, UK. Credit: Newcastle University

Study provides insight into available treatments for stroke prevention in atrial fibrillation patients

So you can intelligently discuss your options with your doctor.
A recent study from University of Alabama at Birmingham researchers published in PLOS ONE compares different available treatments for stroke prevention in patients with non-valvular atrial fibrillation.
The group identified six clinical trials with 59,627 patients comparing six different FDA-approved treatment alternatives. The study combined all phase-three randomized controlled clinical trials comparing different novel oral blood thinners, left atrial appendage closure devices, known as WATCHMAN devices, and Coumadin (warfarin) for stroke prevention in patients with non-valvular atrial fibrillation. Investigators reported data on ischemic stroke, major bleeding and primary safety endpoint from these clinical trials.
WATCHMAN left atrial appendage devices are used as an alternative to long-term warfarin therapy for stroke risk-reduction patients with non-valvular atrial fibrillation.
UAB doctors say too many options may not be a good thing.
"The occurrence of multiple treatment pathways has presented dilemmas for the clinicians," said Navkaranbir S. Bajaj, M.D., the first author of the PLOS ONE study who designed and conducted the analyses for the study.
"We exploited the fact that no direct comparisons from trials were available between WATCHMAN and novel oral anti-coagulants," said Bajaj, instructor fellow in the division of cardiovascular disease.
The study explains that, while direct evidence from randomized controlled trials is lacking, indirect comparisons using systematic network meta-analyses can provide useful complementary information that may be less biased than the direct evidence.
Researchers have found that all treatments had comparable efficacy in reducing stroke rates. However, Apixaban, one of the novel oral blood thinners, was a clear winner in terms of safety profile, and the WATCHMAN device was ranked last due to a higher number of procedural adverse events.
"In an era of precision medicine, we need to individualize treatment for our patients," said senior author Pankaj Arora, M.D., assistant professor in the Division of Cardiovascular Disease. "Our current analysis gives insight into how one can do that to prevent stroke in patients with atrial fibrillation."
Arora says one size does not fit all, and his clinical translational research group is actively working to apply this order to all cardiovascular diseases. The authors concluded that the trade-off between safety and efficacy should be the driving force, and the hierarchical ranking presented in this paper can serve as a clinical tool to guide selection of therapy in patients with atrial fibrillation.
University of Alabama at Birmingham

Novel approach to analyzing brain structures may help predict progression of Alzheimer's disease

With any forward thinking at all this could be used to analyze survivors brains
Use of a novel approach to analyzing brain structure that focuses on the shape rather than the size of particular features may allow identification of individuals in early presymptomatic stages of Alzheimer's disease. A team of Massachusetts General Hospital (MGH) investigators using advanced computational tools to analyze data from standard MRI scans report that individuals with Alzheimer's disease, including those diagnosed partway through a multi-year study, had greater levels of asymmetry - differences in shape between the left and right sides of the brain - of key brain structures. Their study has been published online in the journal Brain.
"Our results show for the first time that asymmetry of the hippocampus and amygdala increases with disease severity, above and beyond age-associated effects," says Christian Wachinger, PhD, formerly with the Martinos Center for Biomedical Imaging at MGH, the lead author of the report. "By studying the progression of asymmetry from mild cognitive impairment to dementia, we demonstrated that greater asymmetry in those and a few other structures can predict disease progression and could be a biomarker allowing early detection of dementia."
Wachinger is part of a team led by Martin Reuter, PhD, of the Martinos Center, that developed BrainPrint, a computer-aided system for representing the whole brain based on the shapes rather than the size or volume of structures. Originally described in a 2015 article in NeuroImage, BrainPrint appears to be as accurate as a fingerprint in distinguishing among individuals. In a recent paper in the same journal, Wachinger and Reuter demonstrated the use of BrainPrint for automated diagnosis of Alzheimer's disease.
The current study used BrainPrint to analyze structural asymmetries in a series of MR images of almost 700 participants in the National Institute of Health-sponsored Alzheimer's Disease Neuroimaging Initiative (ADNI). Participation in that study involves MR brain imaging taken upon enrollment and repeated every 6 to 12 months, along with cognitive and genetic testing; and the MGH study analyzed data from ADNI participants with at least three MRI scans. Participants were divided into four groups: those diagnosed with probable Alzheimer's when entering the study, healthy controls with no sign of dementia, individuals with mild cognitive impairment that remained stable over the two to three years for which scans were available, and those with mild cognitive impairment that progressed to Alzheimer's disease during the study.
BrainPrint analysis of the data revealed that initial, between-hemisphere differences in the shapes of the hippocampus and amygdala - structures known to be sites of neurodegeneration in Alzheimer's disease - were highest in individuals with dementia and lowest in healthy controls. Among those originally classified with mild cognitive impairment, baseline asymmetry was higher in those that progressed to Alzheimer's dementia and became even greater as symptoms developed. Increased asymmetry was also associated with poorer cognitive test scores and with increased cortical atrophy.
The senior author of the Brain paper, Reuter explains, "Several studies have indicated that Alzheimer's has different effects in different sub-structures of the hippocampus and amygdala. Since the shape descriptors of BrainPrint are more sensitive to subtle changes within a structure than are standard volume-based measures, they are better suited to quantify early disease effects and predict future progression, which opens up new research directions into the mechanisms that cause these asymmetries. For example, in addition to asymmetric distribution of amyloid beta, which has been reported, the differences could reflect disease subtypes that affect hemispheres differently."
Now a professor of Neurobiological Research in the Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy at Ludwig Maximilian University of Munich, Wachinger adds, "In collaboration with colleagues at the Martinos Center, we are planning further exploration of the relationship between shape asymmetries and established Alzheimer's disease biomarkers to better understand the underlying biological mechanisms. Differentiating between those with stable mild cognitive impairment and those who will progress to Alzheimer's is of great clinical relevance, as it could help select individuals appropriate for clinical trials of disease-modifying therapies."
Massachusetts General Hospital

MACRA: Down the Rabbit Hole The regulation is a disaster, says Caroline Poplin, MD, JD

I'm sorry but I look forward to this to force stroke hospitals to actually improve recovery results of stroke survivors. Money is probably the only way stroke hospitals will improve stroke results. Nothing else seems to have worked in the past 50 years.
MACRA -- the Medicare Access and Chip Reauthorization Act of 2015 -- is a disaster.
It will take the joy out of practicing medicine without significantly improving patient outcomes (except in a circular way) or reducing cost, by moving medical decisions from the bedside to the C-suite. It benefits primarily the health policy community -- consultants, academics, executives -- who designed it. Ironically, MACRA was one of the few major pieces of legislation in the last few years to pass Congress with bipartisan support.
It pains me to say this. I am a New Deal Democrat like my parents -- I believe government exists to do good things, in particular to protect ordinary workers, consumers, small investors, from the unconstrained power of large corporations, and to make markets work efficiently and fairly.
The ostensible purpose of MACRA is to reduce U.S. healthcare costs -- a worthy objective. However, regulating medical practice in exquisite, deadening detail is surely not the answer. The fact that the proposed regulation implementing MACRA was 962 pages tells you all you need to know. (The final rule, which the Centers for Medicare & Medicaid Services (CMS) issued on October 19th -- was more than 2,100 pages, mainly because it includes comments on the rule and the agency's responses.)
High-Cost, Fragmented Care
There are two serious problems with American healthcare: first, it is the most expensive in the world, by a lot -- whether one measures it per capita, as a fraction of gross domestic product (GDP), whatever. The second is fragmentation of care, due in part to the exponential expansion of medical knowledge in the last 25 years. By comparison, most people believe that the quality of medicine in the U.S. is good, often excellent, if you can get it.
It would seem that the reason healthcare costs more in the U.S. than anywhere else is that we pay higher prices than anywhere else. But members of the health policy community that developed MACRA has a different theory. They believe that, because we pay doctors a fee for every service with a CPT code that they provide (there are many important services that have no CPT code and are therefore not reimbursed), doctors purposely perform and charge for many services of little or no value to anyone: that is, they provide "volume," not "value," despite years of training about appropriate care. The purpose of MACRA is to fix that.
So who, then, determines the value of a service? Normally, in a consumer society like ours, consumers determine value. Indeed, we expect different people to have different values; a free market allows consumers to decide what they value most, and that is what I think most patients do, especially in a system that continually proclaims itself "patient-centered." It is a reckless doctor who talks a patient into a drug or procedure with potentially serious side effects that the patient really doesn't want -- that is a setup for a lawsuit.
However, the authors of MACRA believe in economics. In economic theory, one determines a product's value by how much a consumer is willing to pay for it. Since healthcare consumers rarely pay the full freight (because of insurance), the law discounts their choice. Instead of doctors and patients, MACRA has experts decide what services are most valuable.
Points Mean Bonuses, Penalties
MACRA creates a program called MIPS (Merit-based Incentive Payment System) under which most physicians (and other providers) will continue to be paid fee-for-service (FFS), but their income will be adjusted by bonuses and penalties based on how they score on a 100-point scale. In 2017, points will be awarded as follows:
  • 60 points will be available for successful performance on quality measures (the regulations apparently give us a list of measures to choose from)
  • 25 points will be available for "advancing care information" -- that is, for using your electronic health record (EHR) -- instead of a means, it has become an end in itself
  • 15 points will be available for "clinical improvement activities"
  • 0 points will be available for resource use, that is, keeping costs down. (Points for cost control will go up starting in 2018; quality points will go down.)
This system is supposed to go into effect for 85% of FFS Medicare by the end of 2016. The bonuses and penalties for 2017 will be implemented in 2019 -- up to 4% in bonuses for top performers, and 4% in penalties for the bottom 25%. These bonuses/penalties will increase to 9% by 2022. Congress required MACRA to be budget-neutral, so the bonuses will be paid out of the penalties -- my success requires that you fail. Hardly the best incentive for cooperation and teamwork.
Providers can only receive points for activities that are carefully, correctly measured and documented as structured data in the EHR. The things patients, especially sick patients, want and need most -- empathy, time, concern for their well-being -- count for nothing.
So to be blunt, from now on we are paid only for treating the numbers.
Primary Care Under Fire
All this is aimed particularly at primary care providers, those who are already the most poorly paid, the most hassled group, and yet are considered the linchpin of a high-performing medical system. We can expect the flight of young doctors to procedural subspecialties to continue. And the cost of implementing this extremely complex system will surely offset any cost reduction achieved.
But for the health policy community, MIPS is just a transition to the ideal system, the Advanced Alternative Payment Model (APM), where patients are cared for inside a vertically integrated healthcare delivery system managed by highly-paid corporate executives, reimbursed by capitation, at financial risk for profit and loss: an Accountable Care Organization (ACO) accountable to payers, not patients.
For each patient, the ACO receives a fixed (hopefully risk-adjusted) fee. If the ACO can care for the patient for less, it makes a profit. If he or she requires more care, the ACO takes a loss. If fees are ratcheted down, by definition the payer lowers its cost. But what of the patient?
In every group, a small fraction of patients are responsible for a large fraction of the cost of care. What if there is not enough money to care for everyone? Some patients will have to do without. Who will decide, and how?
To me, this is sub silentio rationing. To others, perhaps death panels.
Instead, we should control prices of drugs and medical supplies, like the rest of the developed world. Respect doctors and patients: they are not economic ciphers. Pay doctors the right fees for the right services -- more for coordination of care (currently unreimbursed), less for ineffective procedures. Reduce fragmented care by requiring all EHRs to be completely interoperable. Let us practice medicine the way we were taught: "To cure sometimes, to relieve often, to comfort always."
It's faster, easier, cheaper, and far less fraught.

HSE audit finds lack of rehabilitation services for stroke patients

It is even much worse than that. They don't measure any results so they can't even tell you how badly the existing stroke rehab services are getting survivors to recovery.
Three out of four of the country’s rehabilitation hospitals admit they are unable to provide stroke patients with the recommended level of therapy they need, according to a HSE audit.
Just one in four has a dedicated stroke unit and 60 per cent lack a stroke specialist to oversee rehabilitation. Less than one in three units has access to psychological services.
In addition, the vast majority of the 26 hospitals that took part in the study have no access to community rehabilitation teams to continue therapy that is essential to assist recovery for patients after they are discharged home.
The study by the Irish Heart Foundation (IHF) and the HSE’s national stroke programme is the first to examine post-stroke care in Ireland and follows on a national audit of stroke care published earlier this year. This showed a 25 per cent reduction in deaths from the condition in seven years but also pointed to deficits in staffing.
“The incidence of stroke in Ireland is rising by about 350 extra cases every year, but we still have a severe shortage of stroke unit beds to accommodate patients, or the specialist nursing, therapy and medical staff we need to care for them,” said the HSE’s national clinical lead for stroke, Prof Joe Harbison.
“We have only about half the acute stroke unit beds we need to meet international standards, and this audit shows an even lower proportion of specialist rehabilitation beds.”
He said: “Deficits in allied health professionals range from 40 per cent to 80 per cent in acute hospitals and are at least a third lower in most therapy areas in our rehabilitation hospitals compared to the UK.”


As a result, stroke outcomes, apart from the death rate, deteriorated last year, for the first time since the national stroke programme was created.
“This is not unexpected in view of the current level of fixed and insufficient resources and an increasing number of patients,” said Prof Harbison.
Despite a recent increase in strokes affecting people of working age, the audit found only 27 per cent of hospitals provided any assistance to patients in returning to work and just half provided training for managing the consequences of stroke after discharge.
It also showed major organisational deficits across the rehabilitation hospital network. For example, half of the hospitals could not provide accurate information on the numbers of stroke patients they admitted or discharged in the previous year, while bed access was restricted based on age in 12 of the 26 hospitals audited.
IHF head of advocacy Chris Macey said the audit confirmed the grim reality of rehabilitation services for stroke patients in Ireland .
“Whilst more people than ever are surviving stroke, they are being denied the opportunity to make the best recovery possible by a chronic dearth of vital therapy services.”
Case study: ‘After that initial burst, the help you get is watered down’
The first indication that Jillian O’Boyle was suffering a stroke came when her knee suddenly gave way at work.
It was a busy Friday in November, 2010, and O’Boyle, who lived in Athboy, Co Meath and was 32 at the time, thought little of it.
Within days, however, she had lost the feeling in her lower legs and found herself in intensive care in hospital. Due to an autoimmune disorder that caused the stroke, she was unable to speak, suffered from facial paralysis and had difficulty moving on her right side.
She was transferred from her local hospital to Beaumont, where she spent two months. This was followed by three months in the National Rehabilitation Hospital in Dún Laoghaire.
Stroke happens in an instant but recovery, where possible, is a lifelong process. O’Boyle says the first year was “brilliant” in terms of the rehabilitation services she got. Months of intensive physiotherapy, speech and language therapy and occupational therapy helped her relearn how to speak and move.
The first words took weeks to come out. Then she learned to walk again, at least as far as the distance between the wheelchair and the car. Within two years, with the help and support of her husband Fergus, she had realised her goal of completing the mini-marathon.
“But after that initial burst, the help you get is watered down. They want to discharge you as soon as possible. The minute you go out of the system, you’re down at the back of the queue.”
Although she has suffered further strokes since, which undid much of the progress made, Ms O’Boyle started from scratch again and has continued her recovery. “They wanted me to go to rehab but I said no. I’m very headstrong. I knew what I wanted to do for myself.”
Today, her speech is clear and she can walk slowly, though her movement on the right side remains problematic.
“I’m a fighter, so I am. You have to be,” she says. A major problem is the lack of support services for stroke survivors in the community. She hasn’t seen an occupational therapist in several years, largely because cover is not being provided when staff go on maternity leave, she says.
She says her biggest wish is for more stroke beds to be provided across the regions, and for more rehabilitation services, delivered to patients in their homes.

Almost three quarters of hospitals don't have adequate rehab facilities for stroke patients

It is even much worse than that. They don't measure any results so they can't even tell you how badly the existing stroke rehab services are getting survivors to recovery.
Almost three quarters of hospitals don't have adequate rehab facilities for stroke patients.
An audit led by the HSE and the Irish Heart Foundation found that 73% of facilities can't provide the correct services.
Furthermore the audit found there are major shortages in nursing, medical and therapy staff numbers.
Due to an ageing population, stroke is rising by 350 cases a year.

The audit which was carried out on 26 out of 29 facilities found deficiencies in vital recovery services for stroke patients.
Almost two thirds of those facilities surveyed, 60%, did not have a stroke specialist.
77% of hospitals had no dedicated stroke unit compared to just a quarter in the UK while 61% had no access to a Community Rehabilitation team.
The audit team recommended investment to provide more beds, more staff and community teams to deal with the problems highlighted in the report.
HSE's Professor Joe Harbison said there is a need for around 250 extra therapists to tackle the problems.
Professor Harbison said: “The incidence of stroke in Ireland is rising by about 350 extra cases every year, but we still have a severe shortage of stroke unit beds to accommodate patients, or the specialist nursing, therapy and medical staff we need to care for them,” said the HSE’s National Clinical Lead for Stroke, Professor Joe Harbison.
“We have only about half the acute stroke unit beds we need to meet international standards, and this audit shows an even lower proportion of specialist rehabilitation beds."
Dr Paul McElwaine, Stroke Research Fellow, National Clinical Programme for Stroke added:“It makes no sense at all that we have significant investment of expertise and resources to save patients’ lives after a stroke, but then fail to follow through with basic therapy services that will help them recover.
“Ireland is at the cutting edge of developing lifesaving treatments such as thrombectomy and thrombolysis to treat stroke.
"But we waste much of the benefit of these innovations by failing to provide the therapy that doesn’t just promote recovery and a better quality of life for patients, but also reduces overall health service costs by keeping patients out of nursing homes.”

The Responsiveness of the Lucerne ICF-Based Multidisciplinary Observation Scale: A Comparison with the Functional Independence Measure and the Barthel Index

No fucking clue what use this is. No measurement of actual changes in the brain, just secondary changes.which are not objective.
imageTim Vanbellingen1,2*, imageBeatrice Ottiger1, imageTobias Pflugshaupt1, imageJan Mehrholz3, imageStephan Bohlhalter1, imageTobias Nef2,4 and imageThomas Nyffeler1,2
  • 1Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
  • 2Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
  • 3Wissenschaftliches Institut, Klinik Bavaria in Kreischa GmbH, Kreischa, Germany
  • 4ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
Background: Good responsive functional outcome measures are important to measure change in stroke patients. The aim of study was to compare the internal and external responsiveness, floor and ceiling effects of the motor, cognition, and communication subscales of the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) with the motor and cognition subscales of the Functional Independence Measure (FIM), and the Barthel Index (BI), in a large cohort of stroke patients.
Methods: One hundred eighteen stroke patients participated in this study. Admission and discharge score distributions of the LIMOS motor, LIMOS cognition and communication, FIM motor and FIM cognition, and BI were analyzed based on skewness and kurtosis. Floor and ceiling effects of the scales were determined. Internal responsiveness was assessed with t-tests, effect sizes (ESs), and standardized response means (SRMs). External responsiveness was investigated with linear regression analyses.
Results: The LIMOS motor and LIMOS cognition and communication subscales were more responsive, expressed by higher ESs (ES = 0.65, SRM = 1.17 and ES = 0.52, SRM = 1.17, respectively) as compared with FIM motor (ES = 0.54, SRM = 0.96) and FIM cognition (ES = 0.41, SRM = 0.88) and the BI (ES = 0.41, SRM = 0.65). The LIMOS subscales showed neither floor nor ceiling effects at admission and discharge (all <15%). In contrast, ceiling effects were found for the FIM motor (16%), FIM cognition (15%) at discharge and the BI at admission (22%) and discharge (43%). LIMOS motor and LIMOS cognition and communication subscales significantly correlated (p < 0.0001) with a change in the FIM motor and FIM cognition subscales, suggesting good external responsiveness.
Conclusion: We found that the LIMOS motor and LIMOS cognition and communication, which are ICF-based multidisciplinary standardized observation scales, might have the potential to better detect changes in functional outcome of stroke patients, compared with the FIM motor and FIM cognition and the BI.


Several measures for activities of daily living (ADL) have been published for patients with stroke. Among those, the Barthel index (BI) (1) and the functional independence measure (FIM) (2) are most widely used (35). The FIM covers two main aspects of functional outcome, by including a motor and cognitive subscale, while the BI includes motor items only. Previous studies have explored floor and ceiling effects, and responsiveness of both FIM subscales, often comparing the FIM motor subscale with the BI. No clear advantage of the FIM motor subscale over the BI has been found (6, 7). In addition, floor and ceiling effects have been suggested for both FIM motor subscale (79) and BI (10, 11). An attempt to overcome ceiling effects and to extend the range of the FIM has been the adding of 12 additional items of the functional assessment measure (FAM) to the FIM, so-called FIM + FAM (12). However, the added value of the FAM can be questioned, since ceiling effects still remained (12, 13). Consequently, the FIM is still most commonly used as a reference functional outcome measurement and this, in particular, in stroke rehabilitation centers (5).
Recently, the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) has been developed (14). In this study, it was found that the scale covers four components, which can be defined as LIMOS motor, LIMOS cognition, LIMOS communication, and LIMOS domestic life subscales. These LIMOS subscales have several advantages. First, the composition and rating of the scales are based on the International Classification of Functioning, Disability, and Health (ICF) (1518). In fact, the selection of the items of the LIMOS is based on the comprehensive ICF core sets for stroke (17). Second, the scales are used by a multidisciplinary team (nurses, physical and occupational therapists, speech therapists, neurologists). Finally, with respect to the LIMOS motor and LIMOS cognition, for example, these include detailed motor items, such as carrying objects (d430), and cognitive items, such as focusing attention (d160). Therefore, the more comprehensive LIMOS subscales are expected to be more sensitive to change over time than the other measures.
The test–retest, inter-rater reliability and construct validity of the total LIMOS and its subscales has been previously confirmed (14). However, the internal and external responsiveness, which are important psychometric properties, still remains to be established. The internal responsiveness is defined as the ability of a measure to change over a specific time frame, and the external responsiveness is reflected by the extent to which changes in a measure relate to corresponding changes in a reference measure (19). The advantage of having more sensitive measures is that even subtle changes can be measured in stroke patients with already good sensory–motor functions. These patients may still have impaired cognitive functions associated with difficulties in extended ADL tasks (e.g., cooking, using public transport services).
The aim of this single center, prospective cohort study was to explore the internal and external responsiveness, floor and ceiling effects, of the LIMOS motor, and LIMOS cognition and communication subscales – relative to the widely used FIM motor and FIM cognition subscales and the BI – in a large cohort of inpatients with stroke, who received multidisciplinary neurorehabilitation.
More at link.

Never Be Ashamed of a Scar: 4 Lessons on Self-Acceptance & Resilience

You have to believe in yourself. I have an obvious walking problem, I stride ahead anyway, staring and daring people to comment on my disability. No one ever does. I can't walk thru crowds without grabbing my left arm close to my body. It is my one concession to trying to hide my disabilities.

Neuroscience Says Listening to This 1 Song Reduces Anxiety by up to 65 Percent

So the massive amount of anxiety you have because your doctor has no clue how to get you recovered or anything at all about stroke should be resolvable because your doctor is up-to-date on this anxiety reducer. Sorry about putting this conundrum on you because your doctor will never do this for you. You are on your own with this dangerous idea.
About one-third of stroke survivors experience depression, anxiety or apathy

Neuroscience Says Listening to This 1 Song Reduces Anxiety by up to 65 Percent

Everyone knows they need to manage their stress. When things get difficult at work, school, or in your personal life, you can use as many tips, tricks, and techniques as you can get to calm your nerves.
So here's a science-backed one: make a playlist of the 10 songs found to be the most relaxing on earth.
Sound therapies have long been popular as a way of relaxing and restoring one's health. For centuries, indigenous cultures have used music to help enhance well-being and improve health conditions.
Now, neuroscientists out of the UK have specified which tunes give you the most bang for your musical buck.
The study was conducted on participants who attempted to solve difficult puzzles as quickly as possible while connected to sensors. The puzzles induced a certain level of stress, and participants listened to different songs while researchers measured brain activity as well as physiological states that included heart rate, blood pressure, and rate of breathing.
According to Dr. David Lewis-Hodgson of Mindlab International, which conducted the research, the top song produced a greater state of relaxation than any other music tested to date.
In fact, listening to that one song -- Weightless -- resulted in a striking 65 percent reduction in participants' overall anxiety, and a 35 percent reduction in their usual physiological resting rates.
That is remarkable.
Equally remarkable is the fact that the song was actually constructed to do so. The group that created Weightless, Marconi Union, did so in collaboration with sound therapists. Its carefully arranged harmonies, rhythms and bass lines help slow a listener's heart rate, reduce blood pressure and lower levels of the stress hormone cortisol.
When it comes to lowering anxiety, the stakes couldn't be higher. Stress either exacerbates or increases the risk of health issues like heart disease, obesity, depression, gastrointestinal problems, asthma, and more. More troubling still, a recent paper out of Harvard and Stanford found that health issues from job stress alone cause more deaths than diabetes, Alzheimer's, or influenza.
In this age of constant bombardment, the science is clear: if you want your mind and body to last, you've got to prioritize giving them a rest. Music is an easy way to take some of the pressure off of all the pings, dings, apps, tags, texts, emails, appointments, meetings, and deadlines that can easily spike your stress level and leave you feeling drained and anxious.
Of the top track, Dr. David Lewis-Hodgson said, "Weightless was so effective, many women became drowsy and I would advise against driving while listening to the song because it could be dangerous."
So don't drive while listening to these, but do take advantage of the
10. We Can Fly, by Rue du Soleil (Café Del Mar)
9. Canzonetta Sull'aria, by Mozart
8. Someone Like You, by Adele
7. Pure Shores, by All Saints
6. Please Don't Go, by Barcelona
5. Strawberry Swing, by Coldplay
4. Watermark, by Enya
3. Mellomaniac (Chill Out Mix), by DJ Shah
2. Electra, by Airstream
1. Weightless, by Marconi Union
I made a public playlist of all of them on Spotify that runs about 50 minutes (it's also downloadable).
There's also a free 10-hour version of Weightless available if you want a longer listening experience.

Why dietary supplements are suspect - Harvard Health Publications

Be careful out there, you have no clue what is in those supplements you take. And if our fuckingly stupid federal legislators hadn't passed the Dietary Supplement Health and Education Act of 1994 (DSHEA): (DSHEA) defined dietary supplements as a category of food, which put them under different regulations than drugs. They are considered safe until proven otherwise. Caveat Emptor.

Dietary supplements—including herbs, vitamins, minerals, and other products—are a $37-billion industry in the United States, and 60% of women are taking them regularly. At the same time, mounting research is suggesting that supplements—even mainstays like calcium—may be harmful at high doses.
The use of supplements and other alternatives to standard treatments is centuries old, but Dr. David Eisenberg, adjunct associate professor at the Harvard T.H. Chan School of Public Health, was the first to document the widespread use of alternative therapies in the United States. In a 1993 article in The New England Journal of Medicine, Dr. Eisenberg and colleagues reported that more than a third of Americans were using unconventional therapies, largely for chronic conditions, and most were doing so without letting their clinicians know. That report covered acupuncture, spinal manipulation, massage, and yoga, but it also focused public attention on all unconventional treatments, including the growing use of herbal remedies and other dietary supplements. In 1998, the Office of Alternative Medicine in the National Institutes of Health (NIH) was revamped as the National Center for Complementary and Alternative Medicine and charged with funding rigorous studies into the safety and effectiveness of alternative physical treatments as well as popular dietary supplements and herbs.

The evidence for herbs

The traditional practice of herbal medicine involves combining different herbs and using them in a variety of preparations. Herbal remedies marketed today are usually powders or extracts derived from plant leaves, stems, or roots. Several studies, largely NIH-funded, have put some remedies often recommended for women to the test. The results are summarized below.
Black cohosh. A plant long used as a home remedy for arthritis, black cohosh has been recommended for hot flashes, night sweats, vaginal dryness, and other menopausal symptoms. Studies of its effectiveness have had mixed results. However, there are more than 50 reports of liver damage in people taking it, although it is unknown whether black cohosh or another substance in the preparation triggered the reactions.
Chamomile. This herb appears to be effective in relieving anxiety. Although less potent than prescription drugs, a cup of chamomile tea may soothe your nerves. Because chamomile is related to ragweed, marigolds, chrysanthemums, and daisies, it may trigger an allergic reaction if you have asthma or are allergic to these plants.
Echinacea. There is no conclusive evidence that echinacea either prevents colds or reduces cold symptoms. It may trigger reactions in people who are allergic to ragweed, marigolds, chrysanthemums, or daisies.
Ginseng. Although ginseng has been touted as a remedy for everything from colds to fatigue to forgetfulness, there isn't strong evidence from clinical trials that it has any of those properties. Ginseng may also interact with aspirin and the anti-clotting agent warfarin (Coumadin).
Ginkgo biloba. Extracts from the leaves of the ginkgo tree are promoted for improving memory and preventing and treating dementia. However, in the Ginkgo Evaluation of Memory study of 3,000 men and women over age 75, ginkgo didn't slow cognitive decline or reduce the incidence of dementia over a six-year period. Ginkgo may also increase bleeding risk.
Milk thistle. Laboratory studies indicated that this herb, also known as silymarin, had a protective effect on liver cells, but clinical trials haven't validated any benefit. Don't count on milk thistle to compensate for the effects of a few extra glasses of wine.
St. John's wort. A few early studies indicated that St. John's wort might alleviate depression, but larger trials failed to confirm those results. St. John's wort also interacts with a large number of prescription medications.

What's up with supplements?

Vitamins, minerals, amino acids, and other compounds that are essential for good health have been marketed as supplements for decades. However, relatively few have been tested in clinical trials. Those that have been or are being subjected to scientific scrutiny include the following:
Calcium. Research has indicated that high doses of calcium from supplements don't have much of an effect on bone density and increase the risk of heart disease and kidney stones. If you aren't getting at least 500 to 700 milligrams (mg) of calcium in your daily diet, you may need a supplement, but it's a good idea to limit your supplement intake to 600 mg a day.
Glucosamine and chondroitin. These substances, both components of cartilage, are used to prevent arthritis and relieve joint pain. Clinical trials have shown that they have little effect.
Melatonin. A synthetic copy of a natural hormone, melatonin is used for jet lag, sleep disturbances, and insomnia. Research has determined that it can be effective at doses as low as 0.5 mg. If you're considering it, talk to your doctor about dosage and timing.
Vitamin D. Because most people who live in northern latitudes don't make enough vitamin D from sun exposure, a supplement may be necessary to fill the daily requirement of 800 international units (IUs). Whether higher, 2,000-IU doses reduce the risk of heart attack, stroke, or cancer will be determined by the 25,000-person Vitamin D and Omega-3 Trial (the VITAL study), whose results will be announced in 2017.
Omega-3 fatty acids. Although studies have linked consuming foods high in omega-3s to a reduced risk of heart disease and inflammation, it's questionable whether omega-3 supplements—available primarily in fish oil capsules—have the same effect. The VITAL study will help to answer that question, too.
Supplements for other purposes. The shelves of supplement stores abound with products that promise to make exercise easier and promote weight loss. These, too, are unproven, and some may contain stimulants that are harmful when used for extended periods.

The bottom line

The value of most herbs and supplements has been discounted or remains unproven. Few are worth the money spent on them. Moreover, there is no guarantee that the pills, capsules, or tablets contain all—or even any—of the ingredients listed on the packaging.
Most important, taking supplements can be risky. A study published in October 2015 in The New England Journal of Medicine found that the adverse effects of supplements were responsible for an average of 23,000 emergency department visits per year.
If you are concerned that your diet isn't providing all the nutrients you need, don't shop for supplements before talking to your doctor. If you truly need a vitamin or other dietary supplement, your clinician can suggest an appropriate product and dose. If you're currently talking a vitamin or other supplement, let your health care team know.

Serious issues with supplements

"Some non-vitamin supplements are marketed heavily in the absence of reliable evidence of efficacy or safety and may interact with prescription drugs. Moreover, some people may delay beginning proven therapies because they are relying on supplements. And some of these products are costly," says Dr. David Eisenberg, adjunct associate professor at the Harvard T.H. Chan School of Public Health.
The supplements used in government-funded clinical studies are analyzed for purity and standardized for dose. Supplement manufacturers are required to perform such analyses and to supply the results to the FDA. Yet, according to a report aired in January 2016 by PBS's investigative series Frontline, few of the thousands of supplement manufacturers do so, and the FDA lacks the staff and resources to analyze supplements or to compel manufacturers to comply.
As a result, the contents of a supplement capsule may not be what's described on the label. Canadian researchers who analyzed a random sample of 44 products from 12 manufacturers reported in 2013 that 60% of the products contained substances not listed on the labels, some of which were potentially harmful contaminants. And a 2015 investigation by the New York attorney general determined that only 21% of random samples of popular house-brands supplements purchased from GNC, Target, Walgreens, and Walmart contained the ingredients in the concentrations listed on the labels. Some contained no trace of the advertised active ingredient, and others consisted primarily of "fillers," including wheat and soy, which may trigger allergic reactions in some people. Other investigations have uncovered supplements adulterated with steroid hormones. When it comes to dietary supplements, the ancient warning "buyer beware!" is more relevant than ever.

Study finds increased risk of pregnancy-associated stroke among young women

Be careful out there.
Pregnancy was not found to raise the risk of stroke in older women, according to a study from Columbia University Medical Center and NewYork-Presbyterian. In younger women, however, the risk of stroke was significantly higher for those who were pregnant.
The researchers published their findings today in JAMA Neurology.
Pregnancy-associated stroke occurs in an estimated 34 out of 100,000 women. Previous studies suggested that the risk of pregnancy-associated stroke is higher in older women than in younger women.
"The incidence of pregnancy-associated strokes is rising, and that could be explained by the fact that more women are delaying childbearing until they are older, when the overall risk of stroke is higher," said Joshua Z. Willey, MD, assistant professor of neurology at CUMC, assistant attending neurologist on the stroke service at NewYork-Presbyterian/Columbia, and a senior author on the paper. "However, very few studies have compared the incidence of stroke in pregnant and non-pregnant women who are the same age."
In this study, the researchers examined data collected on every woman hospitalized for stroke in New York State between 2003 and 2012. Of these 19,146 women, age 12 to 55 years, 797 (4.2 percent) were pregnant or had just given birth.
The researchers found that the overall incidence of stroke during or soon after pregnancy increased with age (46.9 per 100,000 in women age 45 to 55 vs 14 per 100,000 in women age 12 to 24).
However, pregnant and postpartum women in the youngest group (age 12 to 24) had more than double the risk of stroke than non-pregnant women in the same age group (14 per 100,000 in pregnant women vs 6.4 in non-pregnant women).
For women age 25 to 34, pregnancy increased the risk 1.6 times. Stroke risk was similar in pregnant and non-pregnant women in the older age groups.
"We have been warning older women that pregnancy may increase their risk of stroke, but this study shows that their stroke risk appears similar to women of the same age who are not pregnant," said Eliza C. Miller, MD, a vascular neurology fellow in the Department of Neurology at CUMC and NewYork-Presbyterian and lead author of the study. "But in women under 35, pregnancy significantly increased the risk of stroke. In fact, 1 in 5 strokes in women from that age group were related to pregnancy. We need more research to better understand the causes of pregnancy-associated stroke, so that we can identify young women at the highest risk and prevent these devastating events."
Columbia University Medical Center