Ovbiagele Bruce
Stroke Center, Department of Neurology, UCLA Medical Center, University of California-Los Angeles, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
Crit Pathw Cardiol. 2009 Dec;8(4):151-5. doi: 10.1097/HPC.0b013e3181bce3eb.
Patients hospitalized with recent symptomatic cerebral ischemia are at high early risk for subsequent cerebrovascular events. This notwithstanding, an unacceptably high proportion of these patients do not receive prompt and appropriate treatment with evidence-based, guideline-recommended, vascular risk-reduction therapies when exposed to conventional care. Studies of ischemic stroke and transient ischemic attack patients reveal that treatment guidelines are often not followed or variably applied, thereby impeding improvements in care quality and clinical outcomes. A likely contributor to this evidence-practice chasm has been the unavailability to care providers of user-friendly, broadly applicable tools/algorithms that could facilitate ready and uniform implementation of proven therapies.The Stroke PROTECT (Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment) program, was designed for inpatient, outpatient, and transitional care settings, and systematically implements evidence-based medication and behavioral secondary prevention measures following the occurrence of an ischemic stroke or transient ischemic attack. PROTECT program pathways and tools incorporate early recognition and prompt initiation of evidence-based, guideline-recommended care in eligible patients without contraindications. The program has been associated with significant increases in discharge treatment utilization, as well as better therapy adherence, target biomarker control and enhanced clinical outcomes in the postdischarge setting. By utilizing best-care practices, PROTECT aims to help practitioners caring for patients with established cerebrovascular disease, to improve the quality of in-hospital and postdischarge stroke care.
近期有症状性脑缺血住院的患者，随后发生脑血管事件的早期风险很高。尽管如此，在接受常规治疗时，这些患者中仍有高得令人无法接受的比例未接受基于证据、指南推荐的血管风险降低疗法的及时、恰当治疗。对缺血性中风和短暂性脑缺血发作患者的研究表明，治疗指南常常未得到遵循或应用不一，从而阻碍了护理质量和临床结局的改善。造成这种证据与实践脱节的一个可能原因是，护理人员无法获得方便用户使用、广泛适用的工具/算法，这些工具/算法有助于已证实疗法的便捷、统一实施。中风PROTECT（通过协调治疗预防血栓栓塞事件复发）项目专为住院、门诊和过渡护理环境设计，在缺血性中风或短暂性脑缺血发作发生后，系统地实施基于证据的药物和行为二级预防措施。PROTECT项目路径和工具包括对符合条件且无禁忌症的患者进行早期识别，并迅速启动基于证据、指南推荐的护理。该项目与出院治疗利用率显著提高相关，以及在出院后环境中更好的治疗依从性、目标生物标志物控制和改善的临床结局。通过采用最佳护理实践，PROTECT旨在帮助护理已确诊脑血管疾病患者的从业者提高住院和出院后中风护理的质量。
