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Acute Stroke Treatment: Addressing Missed Opportunities

A Grand Rounds Program

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This activity is jointly sponsored by Medical Education Resources and National Stroke Association.

Program Overview
Stroke is one of the leading causes of long-term adult disability, affecting approximately 795,000 people each year in the U.S. Many studies have identified patient failure to arrive at the hospital in time for treatment following the stroke symptom onset as the key barrier to increasing rates of thrombolytic treatment. Stroke center personnel agree that public lack of knowledge about the appropriate response to stroke symptoms is a key barrier to stroke treatment—a barrier that has proven intransigent to many and diverse interventions.

The Acute Stroke Treatment: Addressing Missed Opportunities grand rounds program will provide a succinct update on key new evidence about acute stroke care, especially care in the emergency department, where the speed and accuracy of diagnosis and treatment can have profound long-term impacts on patient quality of life.

Purpose Statement
To educate learners on the most common missed opportunities in acute ischemic stroke in an effort to increase diagnosis and treatment to improve patient outcomes.

Proposed Agenda

  • Time is brain–every second counts: A rationale for early treatment
  • Improving rates of treatment
    • Stroke mimics and atypical presentations
    • Reconsidering exclusion criteria for IV tPA
    • The expanding treatment window
  • Strategies to decrease door-to-needle time

Goals and Learning Objectives
The goal of the Acute Stroke Treatment: Addressing Missed Opportunities grand rounds activity is to promote the reduction in time to treat and facilitate increased treatment rates for acute ischemic stroke. Through participation in these activities, learners will be able to:

  • Discuss the rationale for earliest possible treatment
  • Identify potential targets for improving times to treat in the emergency department
  • Describe characteristics that can lead to delayed or missed diagnosis and/or treatment
  • Discuss the rationale for evolving and modifying exclusion criteria, based on evidence

Target Audience
The target audience for the Acute Stroke Treatment: Addressing Missed Opportunities grand rounds activity includes emergency medicine physicians and nurses, neurologists and neuroscience nurses. Because in-hospital strokes account for approximately 15 percent of all strokes, the program also will target ICU and other nurses, hospitalists and other hospital-based professionals who care for stroke patients.

Physician Credit
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Medical Education Resources (MER) and National Stroke Association. MER is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Medical Education Resources designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Credit 
Medical Education Resources is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This CE activity provides 1 contact hour of continuing nursing education.

Medical Education Resources is a provider of continuing nursing education by the California Board of Registered Nursing, Provider #CEP 12299, for 1 contact hour.

For questions regarding this activity, please contact Medical Education Resources at info@cmepartner.org or National Stroke Association at vsiebert-thomas@stroke.org.

Authoring Faculty
Edward Jauch, MD, MS
Professor, Interim Chief, Division of Emergency Medicine
Associate Vice Chair, Research, Department of Medicine
Professor, Department of Neurosciences
Medical University of South Carolina
Charleston, S.C.

David Liebeskind, MD, FAHA, FAAN
Professor of Neurology
Neurology Director, Stroke Imaging
Co-medical and Co-technical Director, UCLA
Cerebral Blood Flow Laboratory
Program Director, Stroke and Vascular Neurology
Associate Neurology Director, UCLA Stroke Center
Los Angeles, Calif.

Kimberly Bova, BSN, RN, CCRN, CEN
Emergency Department RN III
Medical University of South Carolina
Charleston, S.C.


Disclosure of Conflicts of Interest
MER ensures balance, independence, objectivity and scientific rigor in all its educational programs. In accordance with this policy, MER identifies conflicts of interest with its instructors, content managers and other individuals who are in a position to control the content of an activity. Conflicts are resolved by MER to ensure that all scientific research referred to, reported or used in a CME activity conforms to the generally accepted standards of experimental design, data collection and analysis. MER is committed to providing its learners with high-quality CME activities that promote improvements or quality in healthcare and not the business interest of a commercial interest.

The Acute Stroke Treatment: Addressing Missed Opportunities grand rounds activity is supported by an educational grant from Genentech, Inc.

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