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The DAWN Trial and how it could affect stroke care at your facility.

By: | Tags: , , , , , | July 4th, 2018

The Background:

The DAWN(DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo), was created to measure the effects of stroke treatment in the timeframe outside the AHA and ESO guidelines of 6 hours. Funded by Stryker Neurovascular, Dr. Nogueira and Tudor Jovin, MD were named Coprincipal Investigators and led the DAWN Trial.

A 2016 analysis suggested that the benefit of thrombectomy rapidly decays over time and may no longer exist beyond 7.3 hours from stroke onset (or TLSW). (Saver et al, JAMA. 2016). The results of the DAWN are particularly beneficial for patients with wake-up strokes, strokes with an unclear onset time or witnessed late presenting strokes, which represent a large portion (around 40%) of LVO (Large Vessel Occlusion) Stroke, which previously had no proven treatment options.

The Study:

A total of 206 patients were enrolled in the study and randomly assigned a group based on factors such as site of the stroke occlusion and the time-from-last-seen-well; 107 in the thrombectomy group and 99 to the control group. Patients were randomly assigned to thrombectomy (using theTrevodevice) plus standard medical care (the thrombectomy group) or to standard medical care alone (the control group). The median time of patients having received treatment in the DAWN trials was 12.2 hours and 13.2 for the control group. Patients were then followed for 90 days for results.

The Conclusion:

The study concluded that across all factors, treating stroke with endovascular thrombectomy in DAWN-eligible patients from 6 to 24 hours of symptom onset showed considerable improvement in functional independence and wellness at 90 days, versus standard care alone. Stroke can be tricky to identify but thanks to the DAWN trials, we now know that there is a larger window to treating stroke than once thought.

Tudor Jovin, MD,University of Pittsburgh School of Medicine, Pennsylvania, the study’s lead investigator, summarized: These results greatly expand the population of patients who can benefit from mechanical thrombectomy for stroke, to significantly reduce functional impairment in the mostly severely affected patients, he added. Time is still obviously very important and the earlier the treatment is given the better the results, but we have shown in this trial that it shouldn’t be the only factor that determines whether we consider endovascular therapy.

How will this impact facilities that have the capability to treat stroke patients? Patients that typically would have fallen outside of the treatment window now may benefit from thrombectomy and standard care. Any medical facility that could receive a stroke patient should review protocols to transfer patients to an EVT (Endovascular Treatment) facility as more patients can benefit from EVT. While this is certainly a pathway to a wider treatment window, time is brain still applies and each acute stroke case should still be treated as quickly as possible.

With the opening of this window of EVT treatment, more neurologists may be needed to assess and treat the influx of patients that now qualify in the 6-24 hour timeframe, instead of sending them straight to standard care. TeleSpecialists can implement a turnkey TeleStroke program, proving Board-certified neurologists via cart (licensed in your state and credentialed in your facility), fill any gaps in neurologist scheduling, assist your facility in stroke certification, and lower transfers of stroke patients to other facilities.

For more information on how TeleSpecialists can assist in building your TeleStroke program, contact us.

Nattasha Acevedo, MD

Dr. Acevedo received her medical degree from the Ponce School of Medicine in Puerto Rico and did her neurology residency at Montefiore Medical Center in New York. She went on to do a clinical neurophysiology fellowship at Emory School of Medicine in Atla nta, Georgia and then joined private practice in Fort Myers, Florida. She currently resides in San Juan, Puerto Rico. She likes running, paddle boarding and spending time with family.
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Bernadette Borte, MD

Dr. Borte received her medical degree from St. Matthew’s University School of Medicine in Grand Cayman. She completed her neurology residency at the University of Iowa Hospitals and Clinics in Iowa City, Iowa. Her areas of interest include inpatient neurology and acute stroke. When not working, she enjoys spending time outdoors with her family. Dr. Borte joined the TeleSpecialist family in March of 2019.
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Mazen Almidani, MD

Dr. Almidani is board certified in pediatrics by the American Board of Pediatrics and board certified in epilepsy, as well as neurology with special  qualification in child neurology by the American Board of Psychiatry and Neurology.  Dr. Almidani is happily married with 4 children. His oldest son has autism and his daughter has complicated seizures; both were a drive for him to become a neurologist. Dr. Almidani enjoys soccer, running and spending time with his family. He is very involved with his sons’ therapy and helping with daily challenges. He is double board certified in Pediatric and Adult Neurology and Epilepsy. He sees children and adults. He also participates in charities for children in Syria who may be underprivileged and/or affected by the war. Dr. Almidani joined TeleSpecialists in August 2020.
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Amanda Cheshire, MD

Dr. Cheshire received her medical degree from the University of Louisville School of Medicine in Louisville, Kentucky. She completed her neurology residency at the University of Cincinnati Medical Center in Cincinnati, Ohio. She did a fellowship in neurophysiology at the University of Michigan Medical School in Ann Arbor, Michigan. Dr. Cheshire is double board certified in neurology and clinical neurophysiology. She enjoys traveling, reading and music. She currently resides in Viera, Florida.  Dr. Cheshire joined TeleSpecialists in June 2019.
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Jessica Floyd, MD

Dr. Floyd completed her neurology residency at Mayo Clinic in Jacksonville, Florida followed by fellowship training in clinical neurophysiology with focus in EEG and epilepsy at the Medical University of South Carolina in Charleston, South Carolina. She has particular interest in hospital neurology and patient education as well as the blossoming specialty of lifestyle medicine. She strives to take advantage of every encounter with patients and medical staff to empower them to do their own research into how daily thoughts, choices, and habits can add up to create greater and longer-lasting brain and neurologic health for ourselves and our loved ones. She lives in Florence, South Carolina with her awesome husband of 13 plus years and three beautiful children. She is an avid yogi, astrologer, and lover of food and all things neurology! Dr. Floyd joined the TeleSpecialist family in July 2017.
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Nancy Futrell, MD

Dr. Futrell received her medical degree from the University of Utah in Salt Lake City, Utah. She also did her neurology residency at the University of Utah as well as a research fellowship in cerebral vascular disease at Jackson Memorial Hospital in Miami, Florida. She currently resides in Salt Lake City, Utah. She has authored 2 books and 50 peer reviewed papers. 
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Rebecca Jimenez-Sanders, MD

Dr. Jimenez Sanders received her undergraduate degree from Emory University, and her medical degree from the San Juan Bautista School of Medicine in Puerto Rico. She completed her neurology residency at the University of South Florida in Tampa, Florida, where she also did a specialized headache medicine and facial pain fellowship. She currently resides in Tampa, Florida with her husband and her two daughters. She is also fluent in Spanish and Italian languages, and enjoys photography, baking, boating, and biking.
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Cory Lamar, MD

Dr. Lamar received his medical degree from Meharry Medical College in Nashville, Tennessee. He completed his internship and residency at Wake Forest Baptist Health in Winston Salem, North Carolina. Following residency, he completed a clinical fellowship in neurophysiology, with a concentration in epilepsy. He currently resides in Florida and enjoys outdoor activities.
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Clifford Meyers, MD

Dr. Meyers received his medical degree from Brown University in Providence, Rhode Island and his MBA from the Simon School of Business at the University of Rochester in Rochester, New York. He completed his neurology residency at the University of Rochester, where he also did a neurophysiology fellowship. Dr. Meyers resides in Webster, New York with his wife and daughter. When not doing teleneurology, he enjoys playing sports with his wife and daughter.
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Tao Tong, MD

Dr. Tong received her medical degree from the University of Miami School of Medicine in Miami, Florida. She completed her neurology residency at Jackson Memorial Hospital in Miami, Florida, where she also did a neuromuscular/EMG fellowship.  She currently resides in College Station, Texas. Dr. Tong is married with two boys. She enjoys spending time with her family, traveling and reading.
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Shubhangi Chumble, MD

Dr. Chumble attended BJ Medical School. She is a board certified neurologist with a subspeciality interest in sleep medicine. Dr. Chumble did her residency at Howard University in Washington DC and has practiced neurology since 2001 in private and corporate settings. She lives in Melbourne, Florida and loves the sunshine state. Her hobbies include yoga, meditation, cooking , traveling and meeting new people. She also loves to do stained glass, pottery and painting. She joined TeleSpecialists in June 2019.
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