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Article ; Online: The Sky's the Limit: Expanding Nursing's Contribution to Acute Stroke Science.

Alexandrov, Anne W

American journal of critical care : an official publication, American Association of Critical-Care Nurses

2022 Volume 31, Issue 4, Page(s) 266–274

Abstract: Stroke is the number one cause of preventable disability in adults in the United States. Significant advances have occurred in medications and technology supporting rapid stroke diagnosis and treatment during the past 30 years, along with blurring of the ...

Abstract	Stroke is the number one cause of preventable disability in adults in the United States. Significant advances have occurred in medications and technology supporting rapid stroke diagnosis and treatment during the past 30 years, along with blurring of the lines of what traditionally constituted nursing or medical research. Ischemic stroke is a disease of vascular insufficiency that mirrors myocardial infarction more than any other neurologic diagnosis. My primary program of research is focused on exploration of methods to improve intracranial blood flow in patients with hyperacute ischemic stroke who have viable, yet vulnerable, brain tissue to prevent worsening or enable improvement of stroke symptoms. I am also examining augmentation of recombinant tissue plasminogen activator treatment and stimulation of both arteriogenesis and angiogenesis with external counter-pulsation in patients with intracranial atherosclerosis. My secondary program of research focuses on methods to improve stroke systems of care, including improvement of advance practice providers' contributions to acute stroke care, use of innovative mobile stroke units, and improvement of quality core measure processes. Lessons learned along the way are highlighted, along with the value of interdisciplinary "team science" to build knowledge and enhance the care of highly vulnerable patients with acute stroke.
MeSH term(s)	Adult ; Brain Ischemia/complications ; Brain Ischemia/drug therapy ; Humans ; Ischemic Stroke ; Myocardial Infarction/complications ; Stroke/complications ; Stroke/therapy ; Tissue Plasminogen Activator/therapeutic use ; Treatment Outcome ; United States
Chemical Substances	Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2022-06-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1130987-8
ISSN	1937-710X ; 1062-3264
ISSN (online)	1937-710X
ISSN	1062-3264
DOI	10.4037/ajcc2022109
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Article ; Online: Innovations in Prehospital Stroke Management Utilizing Mobile Stroke Units.

Alexandrov, Anne W / Alexandrov, Andrei V

Continuum (Minneapolis, Minn.)

2020 Volume 26, Issue 2, Page(s) 506–512

Abstract: Using a representative case, this article discusses prehospital innovations for patients with acute large vessel occlusion ischemic stroke, including mobile stroke unit care supported by advanced field imaging. ...

Abstract	Using a representative case, this article discusses prehospital innovations for patients with acute large vessel occlusion ischemic stroke, including mobile stroke unit care supported by advanced field imaging.
MeSH term(s)	Aged ; Ambulances/organization & administration ; Combined Modality Therapy ; Female ; Fibrinolytic Agents/administration & dosage ; Humans ; Infarction, Middle Cerebral Artery/diagnosis ; Infarction, Middle Cerebral Artery/therapy ; Ischemic Stroke/diagnosis ; Ischemic Stroke/diagnostic imaging ; Ischemic Stroke/drug therapy ; Ischemic Stroke/therapy ; Nurse Practitioners ; Organizational Innovation ; Thrombectomy ; Time-to-Treatment/organization & administration ; Tissue Plasminogen Activator/administration & dosage
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2020-04-13
Publishing country	United States
Document type	Journal Article
ISSN	1538-6899
ISSN (online)	1538-6899
DOI	10.1212/CON.0000000000000850
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Article ; Online: Triage Based on Preclinical Scores-Low-Cost Strategy for Accelerating Time to Thrombectomy.

Alexandrov, Anne W / Fassbender, Klaus

JAMA neurology

2020 Volume 77, Issue 6, Page(s) 681–682

MeSH term(s)	Humans ; Remote Consultation ; Stroke/diagnostic imaging ; Stroke/surgery ; Thrombectomy ; Triage
Language	English
Publishing date	2020-04-06
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2702023-X
ISSN	2168-6157 ; 2168-6149
ISSN (online)	2168-6157
ISSN	2168-6149
DOI	10.1001/jamaneurol.2020.0113
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Article ; Online: Clinical Localization of Stroke.

Dusenbury, Wendy / Alexandrov, Anne W

Critical care nursing clinics of North America

2020 Volume 32, Issue 1, Page(s) 1–19

Abstract: Acute stroke assessment is classically supported by clinical localization whereby presenting disabilities are associated with key arterial territories in the brain. Clinical localization skills are rarely taught to nonneurologists; yet, these skills are ... ...

Abstract	Acute stroke assessment is classically supported by clinical localization whereby presenting disabilities are associated with key arterial territories in the brain. Clinical localization skills are rarely taught to nonneurologists; yet, these skills are essential to the provision of evidence-based nursing care of stroke, enabling rapid patient identification, diagnosis, and ultimately, the delivery of acute treatment. This article explores the process of clinical localization in relation to the physiology affected by stroke vascular insufficiency. Elements of the neurologic examination are described as they relate to discreet areas in the brain and the National Institutes of Health Stroke Scale.
MeSH term(s)	Brain/pathology ; Cerebral Arteries/pathology ; Dominance, Cerebral/physiology ; Hemianopsia ; Hemiplegia ; Humans ; Neurologic Examination ; Neuroscience Nursing ; Severity of Illness Index ; Stroke/diagnosis ; Stroke/nursing ; Stroke/therapy ; United States
Language	English
Publishing date	2020-02-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1313997-6
ISSN	1558-3481 ; 0899-5885
ISSN (online)	1558-3481
ISSN	0899-5885
DOI	10.1016/j.cnc.2019.10.001
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Article ; Online: A Conceptual Model of the Influence of Mindfulness-Based Interventions on Stress and Quality of Life in Patients With Chronic Conditions.

Prather, Jenifer G / Baughman, Brandon / Alexandrov, Anne W / Grimes Stanfill, Ansley

Holistic nursing practice

2022 Volume 36, Issue 2, Page(s) 67–75

Abstract: Individuals with chronic conditions are susceptible to stress-related health complications. Left unattended, chronic stress exacerbates inflammation, diminishes quality of life (QOL), and increases all-cause mortality. Here, we suggest a theoretical ... ...

Abstract	Individuals with chronic conditions are susceptible to stress-related health complications. Left unattended, chronic stress exacerbates inflammation, diminishes quality of life (QOL), and increases all-cause mortality. Here, we suggest a theoretical framework promoting the use of mindfulness-based interventions (MBIs) in patients with chronic conditions and a conceptual model of how MBIs may influence stress and QOL.
MeSH term(s)	Chronic Disease ; Humans ; Inflammation ; Mindfulness ; Quality of Life
Language	English
Publishing date	2022-02-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	639032-8
ISSN	1550-5138 ; 0887-9311
ISSN (online)	1550-5138
ISSN	0887-9311
DOI	10.1097/HNP.0000000000000500
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Article: Early Mobilization Post Acute Stroke Thrombolysis and/or Thrombectomy Survey.

Silver, Brian / Demers-Peel, Meaghan / Alexandrov, Anne W / Selim, Magdy H / Bernhardt, Julie

The Neurohospitalist

2022 Volume 13, Issue 2, Page(s) 159–163

Abstract: Background: We sought to determine mobilization practices following emergency stroke therapy in centers across the United States.: Methods: We surveyed hospitals in the NIH StrokeNet regarding mobilization practices following acute stroke ... ...

Abstract	Background: We sought to determine mobilization practices following emergency stroke therapy in centers across the United States. Methods: We surveyed hospitals in the NIH StrokeNet regarding mobilization practices following acute stroke thrombolysis and/or thrombectomy. An anonymous survey was sent out to all StrokeNet sites Survey questions included stroke center designation, location of admission, whether a formal bed rest protocol was in place, minimum bed rest period required, which person first mobilized the patient. Results: 48 centers responded to the survey including 45 Comprehensive Stroke Centers and 3 Primary Stroke Centers. Most patients were admitted to a neuro-intensive care unit (54%), others to a general medical/surgical ICU, stroke ward, or combination. 60% of respondents indicated that a formal bed rest policy was in place. Minimum bed rest requirements after thrombolysis alone ranged from 0 to 24 hours (35% with a 24-hour bed rest protocol, 19% with no minimum, 13% with a 12-hour minimum, 4% with an 8-hour minimum, 4% with a 6-hour minimum, and 6% with a variable rest period). Similar variations were reported in patients undergoing thrombectomy with ranges from 0 to 24 hours bed rest. First mobilization was by a nurse 52% of the time and by a physical therapist 48% of the time. Conclusions: Mobilization practices following emergency ischemic stroke reperfusion treatments vary significantly across stroke centers. Mobilization of patients is performed primarily by nurses and therapists. Further study regarding an optimal approach for mobilization following acute ischemic stroke thrombolysis and/or thrombectomy is warranted.
Language	English
Publishing date	2022-12-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2629083-2
ISSN	1941-8752 ; 1941-8744
ISSN (online)	1941-8752
ISSN	1941-8744
DOI	10.1177/19418744221138890
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Article ; Online: Mobile Stroke Units: Evidence, Gaps, and Next Steps.

Navi, Babak B / Audebert, Heinrich J / Alexandrov, Anne W / Cadilhac, Dominique A / Grotta, James C

Stroke

2022 Volume 53, Issue 6, Page(s) 2103–2113

Abstract: Mobile stroke units (MSUs) are specialized ambulances equipped with the personnel, equipment, and imaging capability to diagnose and treat acute stroke in the prehospital setting. Over the past decade, MSUs have proliferated throughout the world, ... ...

Abstract	Mobile stroke units (MSUs) are specialized ambulances equipped with the personnel, equipment, and imaging capability to diagnose and treat acute stroke in the prehospital setting. Over the past decade, MSUs have proliferated throughout the world, particularly in European and US cities, culminating in the formation of an international consortium. Randomized trials have demonstrated that MSUs increase stroke thrombolysis rates and reduce onset-to-treatment times but until recently it was uncertain if these advantages would translate into better patient outcomes. In 2021, 2 pivotal, large, controlled clinical trials, B_PROUD and BEST-MSU, demonstrated that as compared with conventional emergency care, treatment aboard MSUs was safe and led to improved functional outcomes in patients with stroke. Further, the observed benefit of MSUs appeared to be primarily driven by the higher frequency of ultra-early thrombolysis within the golden hour. Nevertheless, questions remain regarding the cost-effectiveness of MSUs, their utility in nonurban settings, and optimal infrastructure. In addition, in much of the world, MSUs are currently not reimbursed by insurers nor accepted as standard care by regulatory bodies. As MSUs are now established as one of the few proven acute stroke interventions with an effect size that is comparable to that of intravenous thrombolysis and stroke units, stroke leaders and organizations should work with emergency medical services, governments, and community stakeholders to determine how MSUs might benefit individual communities, and their optimal organization and financing. Future research to explore the effect of MSUs on intracranial hemorrhage and thrombectomy outcomes, cost-effectiveness, and novel models including the use of rendezvous transports, helicopters, and advanced neuroimaging is ongoing. Recommended next steps for MSUs include reimbursement by insurers, integration with ambulance networks, recognition by program accreditors, and inclusion in registries that monitor care quality.
MeSH term(s)	Ambulances ; Emergency Medical Services ; Humans ; Stroke/diagnostic imaging ; Stroke/therapy ; Thrombectomy ; Thrombolytic Therapy/methods
Language	English
Publishing date	2022-03-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.121.037376
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Article ; Online: Use of tissue plasminogen activator to treat acute ischemic stroke.

Alexandrov, Anne W

Critical care nurse

2010 Volume 30, Issue 5, Page(s) 77–78

MeSH term(s)	Contraindications ; Fibrinolytic Agents/therapeutic use ; Humans ; Practice Guidelines as Topic ; Stroke/drug therapy ; Stroke/nursing ; Tissue Plasminogen Activator/therapeutic use ; United States
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2010-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	632663-8
ISSN	1940-8250 ; 0279-5442
ISSN (online)	1940-8250
ISSN	0279-5442
DOI	10.4037/ccn2010378
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Article ; Online: Resolving Clinical Trial Subject Disengagement in Socioeconomically Disadvantaged Subjects.

Rhudy, James P / Lewis, Jonathan C / Alexandrov, Andrei V / Alexandrov, Anne W

The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses

2019 Volume 51, Issue 4, Page(s) 164–168

Abstract: Background: Clinical trialists may be reluctant to enroll socioeconomically disadvantaged participants because of concerns for subject disengagement leading to noncompliance with longitudinal measures and high lost to follow-up (LTFU) rates.: ... ...

Abstract	Background: Clinical trialists may be reluctant to enroll socioeconomically disadvantaged participants because of concerns for subject disengagement leading to noncompliance with longitudinal measures and high lost to follow-up (LTFU) rates. Objectives: We describe the LTFU problem associated with disadvantaged participants and propose strategies to reduce clinical trial disengagement. Methods: Difficulties encountered in recruiting and retaining socioeconomically disadvantaged participants along with antecedents of disengagement are discussed. Data in the public domain were used to derive, symbolize, and map engagement by census tract. Exemplars of engaged and disengaged clinical trial participants are shared, and geospatial distribution of socio-spatial disengagement risk is presented. Results: Subject disengagement can be visualized by geospatial informatics suggesting areas of low and high socio-spatial disengagement risk. By failing to enroll socioeconomically disadvantaged subjects, researchers may deliberately exclude those who may benefit the most because of significant health disparities. Discussion: We propose a study of realistic LTFU rates for disadvantaged participants. Realistic clinical trial end points and methods may reduce disengagement among disadvantaged participants.
MeSH term(s)	Adult ; Clinical Trials as Topic ; Female ; Humans ; Longitudinal Studies ; Male ; Patient Selection ; Poverty Areas ; Vulnerable Populations
Language	English
Publishing date	2019-06-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	632790-4
ISSN	1945-2810 ; 0888-0395
ISSN (online)	1945-2810
ISSN	0888-0395
DOI	10.1097/JNN.0000000000000449
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Article: International beliefs and head positioning practices in patients with spontaneous hyperacute intracerebral hemorrhage.

Dusenbury, Wendy / Malkoff, Marc D / Schellinger, Peter D / Köhrmann, Martin / Arthur, Adam S / Elijovich, Lucas / Alexandrov, Andrei V / Tsivgoulis, Georgios / Alexandrov, Anne W

Therapeutic advances in neurological disorders

2023 Volume 16, Page(s) 17562864231161162

Abstract: Background: Prior to the conduct of the Head Position in Stroke Trial (HeadPoST), an international survey (: Objectives: We aimed to determine whether equipoise exists for head position in spontaneous hyperacute intracerebral hemorrhage (ICH) ... ...

Abstract	Background: Prior to the conduct of the Head Position in Stroke Trial (HeadPoST), an international survey ( Objectives: We aimed to determine whether equipoise exists for head position in spontaneous hyperacute intracerebral hemorrhage (ICH) patients following HeadPoST. Design: This is an international, web-distributed survey focused on head positioning in hyperacute ICH patients. Methods: A survey was constructed to examine clinicians' beliefs and practices associated with head positioning of hyperacute ICH patients. Survey items were developed with content experts, piloted, and then refined before distributing through stroke listservs, social media, and purposive snowball sampling. Data were analyzed using descriptive statistics and χ Results: We received 181 responses representing 13 countries on four continents: 38% advanced practice providers, 32% bedside nurses, and 30% physicians; overall, participants had median 7 [interquartile range (IQR) = 3-12] years stroke experience with a median of 100 (IQR = 37.5-200) ICH admissions managed annually. Participants disagreed that HeadPoST provided 'definitive evidence' for head position in ICH and agreed that their 'written admission orders include 30-degree head positioning', with 54% citing hospital policies for this head position in hyperacute ICH. Participants were unsure whether head positioning alone could influence ICH longitudinal outcomes. Use of serial proximal clinical and technology measures during the head positioning intervention were identified by 82% as the most appropriate endpoints for future ICH head positioning trials. Conclusion: Interdisciplinary providers remain unconvinced by HeadPoST results that head position does not matter in hyperacute ICH. Future trials examining the proximal effects of head positioning on clinical stability in hyperacute ICH are warranted.
Language	English
Publishing date	2023-03-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2442245-9
ISSN	1756-2864 ; 1756-2856
ISSN (online)	1756-2864
ISSN	1756-2856
DOI	10.1177/17562864231161162
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