Target Audience

This continuing medical education activity is intended for physicians, nurses and other allied health professionals.

Learning Objectives

After attending this program, participants will be able to:

• Review medical management for asymptomatic carotid disease 
• Describe Transcarotid Arterial Revascularization treatment option for symptomatic carotid disease 
• Discuss early diagnosis and treatment of post revascularization hyperperfusion    
• Verbalize monitoring protocol for post carotid procedure patients 
• Identify red flag headaches, distinguish between a migraine vs stroke    
• Review therapeutic options in the management of acute vascular headaches including migraine   
• Describe non pharmaceutical pain management strategies for headaches
• Describe urinary problems associated with neurologic diseases
• Share nursing performance improvement project to decrease Foley usage and CAUTI rate   
• Review urological interventions in the outpatient setting
• Review the clinical manifestations of Fibromuscular Dysplasia (FMD) and the relationship between FMD and stroke and other vascular complications
• Summarize nursing interventions for patients with FMD
• Recognize the Fibromuscular Dysplasia Society of America as a public health charity working towards better diagnosis and treatment of Fibromuscular Dysplasia
• Describe palliative care services for the neuroscience patient 
• Discuss how nursing can facilitate crucial conversations and support patients and families with palliative care 
• Review cognitive and behavioral effects on the post stroke patient  
• Discuss cognitive rehabilitation strategies for the stroke patient         
• Describe post stroke depression and management 
• Recognize the current recommended options for Mechanical thrombectomy for patients with acute ischemic stroke.   
• Review roles of emergency department caregivers   

Media

Recorded slides and audio presentation. Power point slides with videos.

Planning Committee

Cathy Sila MD, FAHA

Mary Beemiller BSN, RN

Melissa Brately BSN, RN, CNRN  

Kim Findura RN

Julie Fussner BSN, RN, CPHQ, SCRN

Kelly Montgomery BSN, RN, SCRN

Danielle Sindelar MSN, RN, CMSRN

Natalie Smith BSN, CMSRN, SCRN

Erin Supan MSN, RN, APRN-CNS, CNRN  

Chase Vlad BSN, RN, CCRN

No Planning Committee member indicated a financial interest relevant to this activity.

Accreditation Statement

Case Western Reserve University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Case Western Reserve University School of Medicine designates this enduring material for a maximum of 7.0 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure Statement

The policy of Case Western Reserve University School of Medicine CME Program (CWRU CME) requires that the Activity Director, planning committee members and all activity faculty (that is, anyone in a position to control the content of the educational activity) disclose to the activity participants all relevant financial relationships with commercial interests. Where disclosures have been made, conflicts of interest, real or apparent, must be resolved. Disclosure will be made to activity participants prior to the commencement of the activity. CWRU CME also requires that faculty make clinical recommendations based on the best available scientific evidence and that faculty identify any discussion of “off-label” or investigational use of pharmaceutical products or medical devices.

Acknowledgments

This activity was supported by a grant from Cerenovus.

Instructions

To receive statements of credit for up to 7.0 AMA PRA Category 1 Credits^TM you must:

1. Review and reflect on the full content of the recorded session.
2. Successfully complete the post-test. A score of 75% is required for passage.
3. Complete the evaluation.

Your credits will be recorded by the CWRU CME Program and made a part of your cumulative transcript.

Estimated Time to Complete this Educational Activity

Including review of any resource material and completion of the post-test, this activity is expected to take 7.0 hours to complete all modules.

Fee

There is no fee for this program.

To contact the CME Provider: Email CWRU CME at medcme@case.edu

Resources

1. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Endorsed by the Society for Academic Emergency Medicine and The Neurocritical Care Society William J. Powers, MD, FAHA, Chair; and et al; on behalf of the American Heart Association Stroke Council Stroke. 2019;50:e???–e???. doi: 10.1161/STR.000000000000021
2. Early Outcomes in the ROADSTER 2 Study of Transcarotid Artery Revascularization in Patients With Significant Carotid Artery Disease Vikram S. Kashyap, MD and et al; Originally published19 Aug 2020 https://doi.org/10.1161/STROKEAHA.120.030550 Stroke. 2020;51:2620–2629
3. Chou D.E. Secondary Headache Syndromes. Continuum. 2018 Aug;24(4, Headache):1179-1191.
4. Chaibi, Aleksander, Peter J. Tuchin, and Michael Bjorn Russell. Manual therapies for migraine; a systematic review. The Journal of headache and pain 12.2 (2011): 127-133. 
5.  Panfili Z, Metcalf M, Griebling TL. Contemporary Evaluation and Treatment of Poststroke Lower Urinary Tract Dysfunction. Urol Clin North Am. 2017:44(3):403-414
6. Holroyd S. Urinary incontinence after stroke. BR J Community Nurs. 2019;24(12):590-594
7. Gornik HL, Persu A, Adlam D, etal. on behalf of the Working Group ‘Hypertension and the Kidney’ of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM) First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med 2019 [Epub 16 January 2019]. DOI: 10.1177/1358863X18821816
8. Gornik HL, Persu AP, et al. Vascular Medicine. 2019;24:164.
9. Baker, JM Palliative Neurology July 2020: 57-60
10. T. Quill & A. Abernethy. NEJM 2013; 368;13:1173-1174
11. Wilson BA, Gracey F, Evans JJ, & Bateman A. 2009. Neuropsychological Rehabilitation: Theory, Models, Therapy and Outcome. Cambridge University Press.
12. Das, J., & G.K., R. (2018). Post stroke depression: The sequelae of cerebral stroke. Neuroscience & Biobehavioral Reviews, 90, 104–114. https://doi.org/10.1016/j.neubiorev.2018.04.005
13. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct R.G Nogueira, MD and et al: Orignially published 17 Nov 2017. DOI: 10.1056/NEJMoal 706442
14. Predicting a Large Vessel Occlusion Neurology 1999; 53: 126, Stroke 2007; 38: 414, Cerebrovasc Dis 2002;13:225