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Treating stroke patients just 15 minutes earlier can save lives

The research also determined that busier hospitals — those that treat more than 450 people for stroke each year — have better outcomes than those that treat fewer than 400 stroke patients per year.

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Photo by Jesper Aggergaard from Unsplash.com

Initiating stroke treatment just 15 minutes faster can save lives and prevent disability, according to a new UCLA-led study, published today in JAMA. The research also determined that busier hospitals — those that treat more than 450 people for stroke each year — have better outcomes than those that treat fewer than 400 stroke patients per year.

Researchers at the David Geffen School of Medicine at UCLA and five other institutions in the U.S. and Canada, examined data for 6,756 people who experienced ischemic strokes. The patients’ median age was 71, and 51.2% were women.

The researchers looked at stroke patients’ treatment results in light of their “door-to-puncture” time — that is, the interval from their arrival at the hospital to the time their treatment began.

The data showed that for every 1,000 people whose door-to-puncture time was 15 minutes sooner, 15 fewer died or were discharged to hospice care, 17 more were able to walk out of the hospital without assistance and 22 more could care for themselves after being discharged from the hospital. Researchers found that patients’ median time from arriving at the hospital to the beginning of treatment was one hour, 27 minutes, and the median time from the onset of symptoms to treatment was three hours, 50 minutes.

All of the patients in the study were treated with endovascular reperfusion therapy, which is used to treat strokes caused by a blockage in one of the major arteries of the brain.

The study is one of the largest to quantify the number of patients per thousand that could be saved by earlier stroke treatment, and to do so using real-world data as opposed to a clinical trial, according to Dr. Reza Jahan, the study’s co-lead author and a professor of interventional neuroradiology at the Geffen School of Medicine.

About 795,000 people in the U.S. have strokes each year, and about 140,000 die as a result. Ischemic strokes, which occur when a vessel supplying blood to the brain is obstructed, account for 87% of all strokes. (Other types of strokes include hemorrhagic strokes and transient ischemic attacks, which are sometimes referred to as mini strokes.)

Based on the study’s results, shaving 15 minutes off of treatment time could potentially improve results for thousands of people each year.

The study found that hospitals that perform endovascular reperfusion therapy on more than 50 patients per year generally begin treatment faster than hospitals that perform fewer than 30; and that initial treatment tends to be delayed at hospitals that are not certified as comprehensive stroke centers or are located in the Northeast, as well as for people who have a stroke during hospital “off hours” — weekends, holidays, and before 7 a.m. and after 6 p.m. on weekdays.

“We’re trying to improve treatment with better staffing on off hours and getting doctors to the hospital quicker when they’re on call,” Jahan said. “Patients who arrive at the hospital at 2 a.m. should be treated no differently than people who arrive at 2 p.m.”

Treatment delays also are more likely for people who live alone or fail to recognize their own stroke symptoms.

Based on the study results, the American Heart Association has already published new goals regarding how fast patients should be treated at comprehensive stroke centers, Jahan said.

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The paper’s other UCLA authors are Dr. Jeffrey Saver, a professor of neurology and director of the Comprehensive Stroke and Vascular Neurology Program at the David Geffen School of Medicine at UCLA, co-lead author of the study, and Dr. Gregg Fonarow, the Eliot Corday Chair in Cardiovascular Medicine and Science and director of the Ahmanson-UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA.

The data reviewed in the study is from the from the American Heart Association’s Get With The Guidelines-Stroke database, and the research team analyzed results for people who were treated for stroke at 231 U.S. hospitals between January 2015 and December 2016.

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Fitness

Treatment options to help overcome knee pain for sports enthusiasts

“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

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Millions of people experience chronic pain, with knee pain among the most common. Athletes and active adults know the impact activities like running and skiing can have on their knees, but when chronic knee pain makes it difficult to do those activities, or even day-to-day tasks like walking up the stairs, people may often face challenges.

According to the journal “Cartilage,” unlike other tissues, cartilage does not repair itself and, without proper treatment, can worsen over time and become more difficult to treat. However, options like FDA-approved knee cartilage repair surgery MACI (autologous cultured chondrocytes on porcine collagen membrane) uses a patient’s cells to help repair cartilage defects and may help alleviate knee pain.

“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

Justin Keys, a former patient of Meininger and avid skier, knows that the long-term outcomes of knee cartilage surgery can be worth the short-term sacrifices. After several injuries, including an ACL injury, Keys struggled with most activities except walking on flat, paved surfaces. After consulting with Meininger, Keys chose knee cartilage repair to help get back to his active lifestyle.

Keys considered whether to manage the injury as-is or choose MACI and undergo rehabilitation to potentially get back to his favorite activities in the future. He knew he could no longer use short-term relief methods and had to address his pain with a treatment to help provide lasting relief.

For athletes like Keys who want to fix knee pain, it’s important to consider these steps:

Discuss Options with Your Doctor

Patients should talk to their doctors and undergo an MRI to help assess the internal structures of the knee. Meininger recommends patients and their doctors discuss options for long-term knee restoration health, preserving function for future decades and recognizing the short-term sacrifice.

Set Yourself Up for Success

Experts like Meininger suggest patients take steps ahead of surgery to help their recovery.

“The important thing is to be as fit as possible and use the preseason months to undergo surgery and rehab,” Meininger said.

Patients can take steps to prep their home for recovery, which may include:

  • Bringing necessities down from hard-to-reach shelves
  • Moving furniture to ensure clear pathways
  • Installing shower safety handles to minimize potential falls

The Road to Rehab and Recovery

Rehabilitation takes time and everyone’s experience is unique. It can be as much of a mental challenge as it is physical. Committing to a physical therapy regime, staying hydrated and eating well are important aspects to support recovery. Patients should talk to their doctors with questions and before starting any exercises.

IMPORTANT SAFETY INFORMATION

Do not use if you are allergic to antibiotics such as gentamicin or materials from cow or pig; have severe osteoarthritis of the knee, other severe inflammatory conditions, infections or inflammation in the bone joint and other surrounding tissue or blood clotting conditions; had knee surgery in the past 6 months, not including surgery for obtaining a cartilage biopsy or a surgical procedure to prepare your knee for a MACI implant; or cannot follow a rehabilitation program post-surgery.

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Fitness

6 Exercise safety tips

Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

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In the wake of the COVID-19 pandemic, many Americans are more aware of their health and wellness. Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

Sprains, strains and injuries can happen to even the most seasoned athletes. When you’re testing your limits, even a minor injury can alter your performance. Consider products and supports like these from the CURAD Performance Series product line, available at Walmart and Amazon, to help you get back in the game quickly and safely.

Find more resources to support your fitness journey at CURAD.com.

Keep Dirt and Germs Away

The more active you are, the harder it can be to find a bandage that stays with you all day or all game long.

Spray Away Sore Spots

Controlling mild pain can help keep you at the top of your game, and a topical analgesic works fast to heal common pain brought on by fitness and exercise, such as pain in knees, feet, shoulders and backs.

Put Pain in the Past

When recovery becomes the name of the game and pain relief is needed after daily workouts or bodily injuries. Cold packs work to heal bruises, reduce swelling and relieve headaches and general pain points while microwavable heat packs provide satisfying heat therapy to address sore and stiff joints, muscle cramps and tension.

Reduce Impact of Knee Strain

Weak, injured or arthritic knees can come from many sources, including tendonitis and a wide range of conditions that result in strain or overuse. An adjustable band can provide support for on-field sports and during workouts or everyday activities.

Manage Pain and Relieve Pressure

If you participate in endurance and strength exercises or certain sports, you may ask a lot of your joints. Kinesiology tape can be configured a multitude of ways to help reduce pain and improve blood circulation, as well as relieve tension and pressure.

Control Back Strain

When your back is strained, your body and performance can suffer. A mild or moderate sprain can benefit from strong support and compression.

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Fitness

Exercise can provide relief for dry, itchy eyes

A significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes.

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Photo by Quinten de Graaf from Unsplash.com

A team led by researchers from the University of Waterloo discovered that a significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes. 

Every time we blink, our eyes are covered in tear film—an essential protective coating necessary for maintaining healthy ocular function. Healthy tear film comprises three layers–oil, water, and mucin–that work together to hydrate the ocular surface and protect against infection-causing irritants like dust or dirt.

When any part of the tear film becomes unstable, the ocular surface can develop dry spots, causing eye symptoms like itchiness or stinging and burning sensations.

“With so much of our activity tied to screen usage, dry eye symptoms are becoming increasingly common,” said Heinz Otchere, a PhD candidate in vision science at Waterloo. “Instead of having to use eye drops or other alternative treatments, our study aimed to determine if remaining physically active can be an effective preventative measure against dryness.”

Fifty-two participants were divided into two groups—athlete and non-athlete—to participate in an exercise session. Participants in the athlete group exercised at least five times per week, while non-athlete participants exercised no more than once per week. Researchers, which included experts from the University of Cape Coast in Ghana, performed visual examinations before and five minutes after each exercise session, where tear secretion and tear break-up time were assessed.

While participants in the athlete group showed the largest increase, Otchere says all participants experienced a meaningful boost in tear quantity and tear film stability after the exercise session. 

“It can be challenging for people to regularly exercise when the demand is there to work increasingly longer hours in front of screens,” Otchere said. “However, our findings show physical activity can be really important for not just our overall well-being, but for our ocular health too.”

The study, Differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability in athletes and non-athletes, was co-authored by Otchere, the University of Cape Coast’s Samuel Abokyi, Sekyere Nyamaah, and Michael Ntodie, and Ghana’s Our Lady of Grace Hospital’s Yaw Osei Akoto. It was recently published in the Experimental Eye Research journal.

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