Exploration on training advanced physicians in cerebrovascular intervention
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Abstract:
The application of cerebrovascular intervention brings the diagnosis and treatment of cerebrovascular disease into a brand-new domain. Many neurological physicians have become physicians of cerebrovascular intervention by training. In the big teaching hospitals carrying out cerebrovascular intervention, advanced physicians are the hard strength in the lot of cerebrovascular intervention. The training aiming at cerebrovascular intervention and comprehensive abilities affects both the training results and the therapeutic results of cerebrovascular intervention. Therefore, it is an important issue to explore how to consummate and standard the training methods of advanced physicians studying cerebrovascular intervention.
Key words:
Cerebrovascular disease; Intervention; Advanced physician; TrainingOn the basis of the results of pathophysiological and controlled clinical studies, cardiac rehabilitation is now recognized as an effective therapeutic intervention in patients with chronic heart failure (CHF). Achieving clinical stability, optimizing medical therapy, education and counseling regarding lifestyle changes, implementing an exercise training programme, and ensuring an adequate follow-up are the core components of cardiac rehabilitation in CHF. Cardiologists, nurses, physiotherapists, psychologists, and dietitians, all aim at the achievement of such objectives. Education and counseling of patients with CHF are essential aspects of patient care as they can improve the clinical and functional outcome of such patients. In this setting, specially trained nurses may play a pivotal role. An organized plan of patient education and counseling should include explanation of the disease and dietary and exercise regimen recommendations; in addition, the patients should be taught the name of each drug and its purpose, dosage, frequency, and significant side effects.
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Patient Education
Disease management
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Stroke
General hospital
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Patient Education
Disease management
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Disease management
Health coaching
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Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
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Position paper
Secondary Prevention
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Neurointensive care
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Stroke
Clinical Practice
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Increasing awareness of the importance of cardiovascular prevention is not yet matched by the resources and actions within health care systems. Recent publication of the European Commission's European Heart Health Charter in 2008 prompts a review of the role of cardiac rehabilitation (CR) to cardiovascular health outcomes. Secondary prevention through exercise-based CR is the intervention with the best scientific evidence to contribute to decrease morbidity and mortality in coronary artery disease, in particular after myocardial infarction but also incorporating cardiac interventions and chronic stable heart failure. The present position paper aims to provide the practical recommendations on the core components and goals of CR intervention in different cardiovascular conditions, to assist in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and consumers in the recognition of the comprehensive nature of CR. Those charged with responsibility for secondary prevention of cardiovascular disease, whether at European, national or individual centre level, need to consider where and how structured programmes of CR can be delivered to all patients eligible. Thus a novel, disease-oriented document has been generated, where all components of CR for cardiovascular conditions have been revised, presenting both well-established and controversial aspects. A general table applicable to all cardiovascular conditions and specific tables for each clinical disease have been created and commented.
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Introduction: Given the narrow time window, high acuity, and growing complexity, medical student experience with early management of acute stroke (EMAS) is often limited. However, all medical students need experience recognizing and treating acute stroke regardless of their eventual specialty. Simulation-based education has been demonstrated to improve knowledge acquisition without compromising patient safety. We utilized simulation as part of an educational quality improvement initiative to address a gap in medical student experience and comfort in EMAS. Methods: In the 2017-2018 academic year, 104 third year medical students participated in stroke code simulation during the neurology clerkship. Stroke fellows led groups of ten students through two cases: right M1 occlusion requiring intravenous alteplase (IV tPA) and mechanical thrombectomy (MT) and left thalamic intracerebral hemorrhage complicated by status epilepticus. In each case, students identified and triaged stroke syndromes, performed the NIH Stroke Scale, interpreted CT and CTA images, and formulated treatment plans utilizing IV tPA and MT as well as blood pressure and antiepileptic medications. All participants completed pre- and post-simulation tests targeting clinical knowledge of EMAS (score range 0-7). Additionally, 45 students completed an anonymous post-simulation survey on subjective feelings of confidence managing acute stroke and seizure (Likert scale of 1-5). Results: Mean EMAS test score improved from 4.85 (SEM 0.089) pre-simulation to 5.25 (SEM 0.101) post-simulation (p<0.01). Students demonstrated significant improvement on questions assessing the role of supplemental oxygen in EMAS (p<0.01) and lacunar stroke syndromes (p<0.05). Subjectively, 77.8% of participants reported that simulation was the best form of acute stroke instruction they received, and 73.4% agreed or strongly agreed that the simulation improved their level of comfort with EMAS. Conclusion: Simulation improved medical student knowledge and level of comfort with EMAS. All medical school graduates should be trained to recognize signs and initiate management of acute stroke.
Stroke
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Acute stroke
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Physical rehabilitation is an important component of cardiorehabilitation and secondary prophylaxis programs for patients with coronary heart disease (CHD) especially after endovascular interventions. Of special importance among a variety of rehabilitative technologies under current conditions of financial crisis are those ensuring high-quality and cost-effective medical aid The clinico-economic analysis of the programs of long-term physical training is presented with reference to their application for rehabilitation of patients with CHD after endovascular intervention. The use of this approach on an individual basis is believed to promote the introduction of physical training methods into clinical practice, rational planning of secondary prophylaxis programs and reduction of financial burden on public health services.
Secondary prophylaxis
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