The overall goal of stroke care is to minimize brain injury and optimize the individual’s recovery. Preferential transport to stroke-capable centers has been shown to improve outcomes. Stroke centers are equipped with resources often not available at smaller community hospitals. The presence of specialists, including neurologists and stroke care specialists, multidisciplinary teams experienced in stroke care, advanced imaging modalities, and other therapeutic options make transport to stroke centers the most suitable option. The goal of the stroke team, emergency physician, or other experts should be to assess the individual with suspected stroke within ten minutes.

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Disposition: Disposition is the last link in the chain of survival. This step in stroke care focuses on the continuing care of the stroke patient. It is recommended that patients be admitted to an intensive care unit or stroke unit within three hours of arrival in the ED. Continued monitoring of a stroke patient includes frequent assessment of neurological status and monitoring of glucose levels and vitals, as well as prevention of complications. Determining the cause of the stroke is also part of disposition.
Ischemic strokes are the most common. They occur when an artery is blocked and blood flow to the brain is stopped. Caused by build-ups of fatty deposits on the inside of an artery wall which then becomes completely clogged. Ischemic strokes account for eighty percent of all strokes suffered. Some ischemic strokes are preceded by stroke-like symptoms called transient ischemic attacks (TIAs). These may occur months before the stroke. The loss of vision in a TIA may be described as a feeling that a shade is being pulled down over your eyes. The symptoms are usually temporary and improve within 10 to 20 minutes.
Intravenous injection of tissue plasminogen activator (tPA). This injection of recombinant tissue plasminogen activator (tPA), also called alteplase, is considered the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm. This potent clot-busting drug ideally is given within three hours. In some instances, tPA can be given up to 4.5 hours after stroke symptoms begin.
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Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.

However, elderly care is focused on satisfying the expectations of two tiers of customers: the resident customer and the purchasing customer, who are often not identical, since relatives or public authorities, rather than the resident, may be providing the cost of care. If residents are confused or have communication difficulties, it may be very difficult for relatives or other concerned parties to be sure of the standard of care being given, and the possibility of elder abuse is a continuing source of concern. The Adult Protective Services Agency, a component of the human service agency in most states, is typically responsible for investigating reports of domestic elder abuse and providing families with help and guidance. Other professionals who may be able to help include doctors or nurses, police officers, lawyers, and social workers.[41]
NYU Langone’s Comprehensive Stroke Care Center is a leading center of its type in our region and offers a sophisticated rehabilitation program that includes care from a rehabilitation physician (known as a physiatrist), physical therapist, occupational therapist, specialized nurses, speech-language pathologists and psychologists. Other facilities like nursing homes may provide adequate rehabilitation services, but the point here is to maximize recovery.
Having all this expertise in a single place, focused on you, means that you're not just getting one opinion. Your care is discussed among the team, your test results are available quickly, appointments are scheduled in coordination, and the most highly specialized stroke experts in the world are all working together for you. What might take months to accomplish elsewhere can typically be done in a matter of days at Mayo Clinic.
Information about long-term care options in the United States can be found by contacting the local Area Agency on Aging[20] or elder referral agencies such as Silver Living or A Place for Mom. Furthermore, the U.S. government recommends evaluation of health care facilities through websites using data collected from sources such as Medicare records.[21]
Nurse Next Door’s around-the-clock care gives you on-going companionship and support every day and every evening. Whether it’s 3 in the afternoon, or 3 in the middle of the night, our comprehensive health services program will support you with compassionate and attentive assistance any time you need it. From providing medication in the evening, to assisting you with getting dressed in the morning, we will ensure you have around-the-clock home care for situations that may require close monitoring. Rest easy knowing you will always have someone by your side to attend to your needs if and when necessary.
The best post rehabilitation center I have seen in the country is center for Neuro Recovery. My father went there completely enfeeble and in a wheelchair when he started and left walking after nine months of strengthening and functional movement exercises. I have never seen such a state of the art facility and knowledge-based staff. If this was going to happen to another family member again, I know I would go back to this amazing facility.
Another top facility that you may want to consider is the University of Washington Stroke Center, which deals with diagnosis and post-stroke patient care. Certified by The Joint Commission as a primary stroke center, this facility is involved in innovative research of new medications as well as various procedures or surgeries that can help prevent or treat stroke. The medical services offered by the UW Medicine Stroke Center include emergency services, acute stroke teams, and neuroimaging, neurosurgical, and neuroradiology services. Health care professionals are continually upgrading their education so they can provide the best support and care. These medical services are available at any time of the day, ensuring that stroke victims are stabilized and can begin recovery as soon as possible after a stroke.
Delivery:  Delivery is the prompt transport of the patient to a hospital, preferably a stroke center. Emergency medical personnel should be trained in performing a rapid assessment of the patient’s condition. If a stroke is suspected, the patient should be transported to an appropriate receiving hospital as soon as possible. A medical history and baseline mental status should be documented. The time since onset of symptoms should also be noted and is referred to as ‘time zero’, or the last time the patient was seen to be normal. Emergency medical workers need to provide pre-arrival information to the receiving facility so that the ED can prepare for the arrival of a potential stroke patient.
Staff is awake and available 24 hours a day so if any emergencies occur no matter the time, there will be someone ready to help. Making sure residents with diabetes monitor their insulin levels is clearly an important task and Best Personal Care Facility can help with that task. If a resident needs assistance moving from a bed to a wheelchair, this facility has staff who can help.
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Endovascular procedures. Endovascular procedures may be used to treat certain hemorrhagic strokes. The doctor inserts a long tube through a major artery in the leg or arm and then guides the tube to the site of the weak spot or break in a blood vessel. The tube is then used to install a device, such as a coil, to repair the damage or prevent bleeding.

Therapy designed to improve mobility in elderly patients is usually built around diagnosing and treating specific impairments, such as reduced strength or poor balance. It is appropriate to compare older adults seeking to improve their mobility to athletes seeking to improve their split times. People in both groups perform best when they measure their progress and work toward specific goals related to strength, aerobic capacity, and other physical qualities. Someone attempting to improve an older adult’s mobility must decide what impairments to focus on, and in many cases, there is little scientific evidence to justify any of the options. Today, many caregivers choose to focus on leg strength and balance. New research suggests that limb velocity and core strength may also be important factors in mobility.[44] Assistive technology and advancements in the field are further giving elders greater freedom and mobility.[45] Several platforms use Artificial Intelligence to now suggest assistive devices to the elder for a better match[46].


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Stroke patients at any hospital within the Forrest Health network now have immediate access to highly specialized neurologists as the result of a partnership between Forrest Health and Ochsner Clinic Foundation in New Orleans. Through the Telestroke network, emergency department physicians have the ability to consult immediately with Ochsner neurologists 24 hours a day, 7 days a week, 365 days a year using telemedicine equipment to determine the best treatment options for stroke patients.  
Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography).

Expertise and experience. Mayo Clinic's campuses in Florida and Minnesota are certified as comprehensive stroke centers by The Joint Commission, a national organization that evaluates and accredits hospitals and staff. Mayo Clinic's campus in Arizona, and the Mayo Clinic Health System sites in Eau Claire, Wisconsin, La Crosse, Wisconsin, and Mankato, Minnesota, are certified as primary stroke centers by The Joint Commission.
Physician assistants (PA) typically obtain medical histories, perform examinations and procedures, order treatments, diagnose diseases, prescribe medication, order and interpret diagnostic tests, refer patients to specialists as required, and first or second-assist in surgery. Their education includes a bachelor’s degree, extensive clinical training from an accredited PA program and they must obtain a license to practice as a physician assistant.
Senior Care a été créé par Céline BOUCHER-MARTIN en 2010 dans  l'intention de mettre en place un travail en amont de la personne âgée, en dispensant des formations de qualité par des formateurs de terrain auprès de tous les professionnels de santé  dans les domaines public, Privé ou associatif (Direction, Médecin, Infirmière, Aide-soignante, Psychologue, Psychomotricien, ASV, ASH, AVF, Secrétaire, …) formations orientées dans un but commun: "Améliorer la qualité de vie et le prendre soin de la personne âgée en perfectionnant les pratiques professionnelles". Senior care fonctionne avec 3 salariés et une quinzaine d’intervenants extérieurs. Nos formations se font sur site  sur l’ensemble de la France et en Corse et dans nos deux antennes de formations sur Mouans-Sartoux et Cannes.
All patients exhibiting symptoms of stroke are triaged as a patient for Stroke Alert. When this determination is made, numerous things will begin to happen quickly. The team of nurses, emergency physicians, neurologists, radiologists, critical care doctors, surgeons and others can make treatment determinations within 60 minutes of symptom presentation.
This app is an easy-to-use voice-activated assistant that offers many of the same features listed in the apps above. Lyra offers the added feature of continuing the same conversation across multiple devices like smartphones, tablets, and computers by logging in to keep everything connected. Its creator claims you can speak to Lyra in any dialect, as it is “capable of understanding multiple languages, context, and intent.” Lyra is available on Google Play and the iTunes app store.  
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One relatively new service in the United States that can help keep older people in their homes longer is respite care.[18] This type of care allows caregivers the opportunity to go on vacation or a business trip and know that their family member has good quality temporary care, for without this help the elder might have to move permanently to an outside facility. Another unique type of care cropping in U.S. hospitals is called acute care of elder units, or ACE units, which provide "a homelike setting" within a medical center specifically for older adults.[19]
Personal assistants can change your life, but they can be pricey. If you’re working for yourself or for a small company, or if you’re just feeling overwhelmed in your everyday life, hiring a personal assistant might sound like a pipe dream. But for a quick fix, many effective personal assistant apps can be downloaded completely free of cost on your mobile device. Some mobile devices even come standard equipped with virtual assistants, such as Apple’s Siri, Cortana, or Google Assistant—one study found that 42 percent of smart phone users, or 71 million people, used an artificial-intelligence-based personal assistant app. 
The Hound app claims to be the “best way to search using your natural voice.” It uses familiar sites like NPR, Accuweather, Yelp, Uber, Sportradar, and Expedia to complete common tasks and to give you the most up-to-date information. If you’re looking for a new car, consider a Hyundai, which in 2019 is launching a voice-enabled, AI-equipped car powered by Houndify. Hound is available on Google Play and the iTunes app store.
“We are thrilled to support the University of Louisville Hospital – Comprehensive Stroke Center’s U Care program with our RN-led clinical AfterCare model. Patients and their caregivers need more resources and ongoing support when managing the transition from a hospitalization to another setting or home. We look forward to implementing this model and future programs to help UofL Hospital provide a differentiated patient experience for the communities it serves,” said Dr. Brian Holzer, CEO of Lacuna Health.
Physician assistants (PA) typically obtain medical histories, perform examinations and procedures, order treatments, diagnose diseases, prescribe medication, order and interpret diagnostic tests, refer patients to specialists as required, and first or second-assist in surgery. Their education includes a bachelor’s degree, extensive clinical training from an accredited PA program and they must obtain a license to practice as a physician assistant.
Before the inspection, we reviewed the information we held about the service. This included the previous inspection report and notifications since the last inspection. Notifications are changes, events and incidents that the service must inform us about. We used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
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