Efficacy of Tenecteplase in Large Vessel Occlusion Stroke Within 24 Hours of Symptom Onset: The ETERNAL-LVO Randomized Controlled Trial.

Background: To assess the efficacy and safety of tenecteplase in patients presenting within 24 hours of symptom onset with a large vessel occlusion and target mismatch on perfusion computed tomography.

Methods: ETERNAL-LVO was a prospective, randomized, open-label, blinded end point, phase 3, superiority trial where adult participants with a large vessel occlusion, presenting within 24 hours of onset with salvageable tissue on computed tomography perfusion, were randomized to tenecteplase 0.25 mg/kg or standard care across 11 primary and comprehensive stroke centers in Australia.

Anticoagulation in the context of post-intracerebral haemorrhage: A narrative review.

Background: Recommencement of oral anticoagulation (OAC) for patients post-intracerebral haemorrhage (ICH) remains a challenging decision for clinicians. High-quality evidence to assist with this decision is lacking and current guidelines primarily focus on balancing thromboembolic and bleeding risk.

Objective: This study evaluated the literature and current guidelines for recommencement of OAC in patients who have experienced an incident ICH.

Management and Outcomes of Pulmonary Embolism in the Oldest-Old.

Background: Treatment for pulmonary embolism has expanded to include Direct Oral Anticoagulants (DOACs). The incidence of pulmonary-embolism (PE) in "oldest-old" age group (≥85 years) is rapidly increasing, but there is limited research on its management and clinical outcomes.

Aim: To examine the differences in management and outcomes in those aged ≥85 years compared to other age groups.

Health service management study for stroke: a randomized controlled trial to evaluate two models of stroke care.

Background: The most effective and efficient model for providing organized stroke care remains uncertain. This study aimed to compare the effect of two models in a randomized controlled trial.

Methods: Patients with acute stroke were randomized on day one of admission to combined, co-located acute/rehabilitation stroke care or traditionally separated acute/rehabilitation stroke care.

Preferences, barriers and facilitators for establishing comprehensive stroke units: a multidisciplinary survey.

Objectives: To determine the preferences of multidisciplinary stroke clinicians for models of inpatient stroke unit care and perceived barriers to establishing a comprehensive stroke unit (CSU) model (acute and rehabilitation care in the same ward).

Methods: Written questionnaires distributed and completed at multidisciplinary stroke unit case conferences in NSW, Australia.

Results: Twenty hospitals with 22 stroke units were surveyed, 13 acute stroke units, 7 rehabilitation stroke units, 2 CSUs.

Venous thromboembolism in psychogeriatric in-patients--a study of risk assessment, incidence, and current prophylaxis prescribing.

Background: While venous thromboembolism (VTE) risk assessment and prophylaxis is well established for medical and surgical in-patients, there is a paucity of evidence, and therefore guidelines, in this area for psychogeriatric in-patients. We wished to determine VTE incidence, risk, and use of prophylaxis, in a psychogeriatric in-patient population.

Methods: Retrospective audit of consecutive psychogeriatric patients aged 65 years and over admitted to Bankstown Hospital over a 3-year period, 2007-2009.

Comprehensive stroke units: a review of comparative evidence and experience.

Background: Stroke unit care offers significant benefits in survival and dependency when compared to general medical ward. Most stroke units are either acute or rehabilitation, but comprehensive (combined acute and rehabilitation) model (comprehensive stroke unit) is less common.

Aim: To examine different levels of evidence of comprehensive stroke unit compared to other organized inpatient stroke care and share local experience of comprehensive stroke units.

A prospective review of hip fracture subtypes, surgical procedure, cognitive status, and analgesia use across 4 Australian hospitals.

Objectives: To correlate analgesia use among patients with hip fracture requiring surgery with hip fracture subtype, cognitive status, and type of surgery in the postacute period.

Design And Participants: Prospective review of patients with hip fractures requiring surgical intervention. A total of 415 patients (mean age: 81.

Management and outcomes of delirious patients with hyperactive symptoms in a secured behavioral unit jointly used by geriatricians and pyschogeriatricians.

To compare the clinical outcomes and length of stay (LOS) between delirious patients with hyperactive symptoms admitted directly and those admitted indirectly from Emergency Department into a secured, behavioral unit jointly used by geriatricians and pyschogeriatricians (the Unit). A retrospective study analyzing data from the medical records of 122 patients with an admission diagnosis of delirium with hyperactive symptoms and subsequently discharged from the Unit, including restraint, one-to-one nursing care, falls, absconding, duration of delirium, recovery from delirium, destination and LOS. Significantly fewer patients with direct admission (n=68) required physical restraint or chemical restraint compared with those transferred (n=54).

Management for motor and non-motor complications in late Parkinson's disease.

The prevalence of neurodegenerative diseases such as Parkinson's disease (PD) increases with age. In an aging population, an understanding of the management of late complications of PD is becoming ever more important. Drug treatment for Parkinson's disease is largely symptomatic and relies primarily on levodopa (L-dopa) and adjuvant therapies including dopamine agonists and catechol-O-methyltransferase (COMT) inhibitors.

Dysphagia: causes, assessment, treatment, and management.

Dysphagia, or difficulty in swallowing, is a condition with a strong age-related bias. Rates of dysphagia vary due to differences in method between studies; eg, clinical history of "swallowing difficulty," evidence of aspiration, or dysphagia confirmed by swallowing investigations. In general, the rate is lower in the community than in nursing home facilities.

Localised herpes zoster infection and SIADH.

Localised herpes zoster infection ('shingles') in older patients is a common presentation to primary, and sometimes secondary, care physicians. However, symptoms of hyponatraemia, caused by the rare complication of 'syndrome of inappropriate antidiuretic hormone secretion' (SIADH), may be mistaken for constitutional symptoms of the infection itself. Such patients may require closer monitoring or hospitalisation.

Current and future concepts in stroke prevention.

Stroke is a major cause of morbidity and mortality in an aging population. The current understanding of the pathophysiology of atherosclerotic diseases, the most common cause of stroke, and the evidence for existing therapeutic interventions for the prevention of stroke are presented. Specifically, we review the evidence for antiplatelet agents, anticoagulants, antihypertensive medications, lipid-lowering agents and carotid endarterectomy for stroke prevention.

Atrial myxoma as a cause of stroke: case report and discussion.

Cardiac myxoma is a source of emboli to the central nervous system and elsewhere in the vascular tree. However, nonspecific systemic symptoms and minor embolic phenomena may be overlooked in the absence of any history of cardiac problems. In this situation, cardiac investigations may not be performed, and diagnosis of this rare condition may be delayed until the onset of more significant embolic disease, such as stroke with functional impairment, as in the case reported here.