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Friday, December 21, 2012 - Medical Journal Publishes State Stroke Research Trial

Medical Journal Publishes State Stroke Research Trial
Munson Medical Center mentioned as part of state’s INSTINCT study

The British medical journal “The Lancet-Neurology” today published research about collaborative efforts to improve stroke care at Munson Medical Center and 21 other hospitals around the state through a stroke study from 2008 - 2010.

Munson and the other hospitals participated in the INSTINCT study. INSTINCT stands for Increasing Stroke Treatment through Interventional Change Tactics. The goal of the study was to increase the number of appropriate stroke patients who received tPA, a clot-busting medication approved by the FDA in 1996 to reduce the effects of acute ischemic stroke.

The study was supported by the National Institutes of Health and led by Phillip Scott, M.D., associate professor of emergency medicine at the University of Michigan. Each hospital, including Munson, had physicians called “principal investigators” leading the local portion of the study.

All hospitals were in the Lower Peninsula and were chosen at random from among hospitals with at least 100 stroke discharges per year. All hospitals that participated stayed in the trial until data collection ended in 2010.

“We essentially saw a doubling of tPA usage, using standard technologies for education and support. Importantly, the increase was achieved safely,” Scott said. “This shows that we can translate the knowledge of effective stroke treatment into a community setting.”

At Munson, Internist and Medical Department Chairman Don Caraccio, M.D., and Neurologist and Stroke Medical Director Kersti Bruining, M.D., both credited the interdisciplinary team effort that has improved care of stroke patients in northern Michigan.

“We had many champions and leaders for the stroke study such as stroke care coordinator Kathleen Glaza, M.S.N., R.N., ACNS, BC; hospitalist Kenneth Friar, M.D.; and William Chung, M.D., in the Emergency Department,” Dr. Caraccio said. “The list of folks who were and have been involved is innumerable. All have made a difference in the care of stroke patients and made Munson a center of excellence for stroke care.”

Munson also was recently designated a Primary Stroke Center by The Joint Commission, and earlier this year was recognized by the Michigan Stroke Registry Quality Improvement Program for its efforts on stroke care.

“Northern Michigan residents should feel confident about the stroke care that is available at Munson Medical Center,” Dr. Bruining said. “Having the INSTINCT study shared in ‘The Lancet-Neurology’ journal speaks to the quality of evidence-based medicine that is being practiced in the region.”

In order to be eligible to receive tPA, patients need to seek treatment within three hours of their stroke. Munson implemented a team approach to stroke care that involved EMS, ER and other nurses, pharmacists, and physicians working with Munson neurologists.

“This study helped open up the eyes and minds of everyone to the benefit of tPA and patients continue to benefit from that understanding today,” Glaza said. “We have had people brought to our emergency department paralyzed on one side. They later left the hospital with hardly any signs of the stroke’s impact.”

Glaza said becoming familiar with stroke symptoms is important in order for a stroke patient to receive timely treatment. The F.A.S.T. acronym is an easy way to remember when to act:
Face – Ask the person to smile. Does one side of the face droop?
Arms – Ask the person to raise both arms. Does one arm drift downward?
Speech – Ask the person to repeat a simple phrase. Is their speech slurred or strange?
Time – If you observe any of these signs, call 9-1-1 immediately.

“The Lancet-Neurology” journal is one of the leading scientific journals dealing with clinical neurology in the world.