Objective: The objective of this article is to increase awareness and provide information for providers to guide educational strategies about potential obstacles encountered while educating patients with neurological deficits. Background:Stroke is the third leading cause of death worldwide. Those who survive are often left with disabilities that decrease quality of life and increase a need for institutional care. One quarter of patients diagnosed with stroke annually have had a stroke previously. Identification of personal risk factors and learning methods for controlling them is the first steps in preventing recurrent stroke. Conclusion:Educating patients about personal risk factors is not only a quality indicator for Joint Commission accredited stroke programs, but also education is associated with decreased readmission rates. However, the variety of neurological deficits seen in the stroke population can present a significant educational barrier.Practice Implications: Understanding the complexity and impact of neurological deficits affecting patients who have suffered a stroke may provide improved secondary prevention efforts. Providers who are able to fully evaluate educational needs and use this knowledge to individualize stroke education are essential in improving stroke outcomes through risk factor management and early recognition of recurrent stroke.

Isaacs syndrome is a rare neuromuscular disorder characterized by chronic muscle stiffness, cramping, fasciculations, myokymia, and hyperhidrosis. Pathogenesis includes autoimmunity, paraneoplastic disorders, genetic predisposition, or toxin exposure. There is no known cure for Isaacs syndrome. This case report describes a patient who had been given the diagnosis of Isaacs syndrome and received osteopathic manipulative treatment to manage fascial and cranial dysfunctions and reduce nervous system hyperexcitability. Long-term decrease of myokymia and reduction of severity and frequency of exacerbations resulted.

Placement of central venous catheters by organ procurement coordinators to assist in obtaining blood samples or for measuring intravascular pressure is appropriate. Preparation for this role should include appropriate didactic instruction and supervised clinical experience. The organ procurement organization must ensure that such training occurs and must support a continuing quality assurance program for such providers. Policies and procedures must be provided to guide practitioners in site selection, timing of implementation, and titration of measurements obtained. Also, resources must be readily available to treat any complications. This discussion reviews methods for insertion of venous catheters placed in the femoral, internal jugular, or subclavian veins.

Insertion of pulmonary artery catheters by organ procurement coordinators may be incorporated into donor management to optimize organ perfusion. As invasive procedures are added to coordinator roles, the organ procurement organization must include didactic instruction and supervised clinical experience as part of any training program. Policies and procedures guiding the use of the pulmonary artery catheter and the measurements obtained must be provided by the organization to guide practitioners. This article focuses on methods for insertion and basic troubleshooting of a pulmonary artery catheter.

Introduction: While the goal of IV tissue plasminogen activator (TPA) is to prevent infarction, few data exist on averted stroke. Methods: Secondary analysis of a multicenter trial from 2014-2020 comparing outcomes between patients treated for stroke by mobile stroke unit (MSU) vs standard care (SC). The analytical cohort were patients with suspected stroke treated with IV TPA. The primary outcome was a time-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours. The secondary outcome was a tissue-defined averted stroke diagnosis, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours and no acute infarction/hemorrhage on imaging. We used multivariable logistic regression to evaluate associations between study exposures (demographics, comorbidities, stroke characteristics) and outcomes. Results: Among 1009 patients with a median last known well-to-TPA time of 87 minutes, 276 patients (27%) had a time-defined averted stroke (31% MSU, 21% SC) and 159 patients (16%) had a tissue-defined averted stroke (18% MSU, 11% SC). Factors independently associated with time-defined averted stroke were younger age (OR, 0.98; 95% CI, 0.96-0.99), female sex (0R, 0.51; 95% CI, 0.36-0.74), hyperlipidemia (OR, 1.81, 95% CI, 1.24-2.64), normal premorbid function (0R, 2.22; 95% CI, 1.37-3.67), lower glucose (OR, 0.996; 95% CI, 0.993-0.999), lower MAP (OR, 0.991; 95% CI, 0.983-0.998), MSU care (OR, 1.77; 95% CI, 1.21-2.62), lower NIH stroke scale (OR, 0.89; 95% CI, 0.86-0.93), and no large vessel occlusion (LVO) (OR, 0.52; 95% CI, 0.32-0.83). For tissue-based averted stroke, younger age, female sex, hyperlipidemia, lower MAP, MSU treatment, lower NIH stroke scale, and no LVO were significantly associated. Conclusion: In a modern acute stroke trial, one-in-four patients treated with TPA for stroke recovered within 24 hours and one-in-six had no demonstrable brain injury on imaging. Younger age, female sex, hyperlipidemia, lower MAP, MSU care, lower stroke severity, and no LVO may increase the odds of averting stroke.