1. Patient Recruitment Patient Recruitment Thomas Devlin, MD PhD Erlanger Southeast Regional Stroke Center

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4. Figure 3. Erlanger Total Stroke Volume 2004 - 2010 1357 1118 1271

6. t-PA NINDS: 3 Hour Window Benefit Vs Harm For every 8 patients treated, 1 benefits. For every 8 patients treated, 1 benefits. For every 16 treated, 1 is harmed by ICH. For every 16 treated, 1 is harmed by ICH. For every 34 treated, 1 dies of ICH. For every 34 treated, 1 dies of ICH. Thus for every 4 pts who benefit 1 pt dies. Thus for every 4 pts who benefit 1 pt dies. ECASS 3: 3 - 4.5 hours: good outcome in only 7% (52% vs. 45%)

8. Know What to Say Sad Reality of Current Stroke Treatment: 3 - 5% of Acute Strokes receive IV t-PA Most stroke patients present past 3 hours. The # of Interventional Centers limited. No substitute for revascularization. Desperately need a lytic, longer window, which can be given anywhere, with placebo data. THE MOST IMPORTANT STROKE STUDY

9. Public Awareness: GET OUT OF THE HOSPITAL - Publicize the extended time windows. - Health Screenings - Health Fairs - Media is Free Advertisement 1 Major Story per Month Synergy between trials. Stop Stroke Saturday- Patient stories. Rotary Club. Engage Community Leaders.

10. Pre Hospital - EMS Frequent EMS Meetings – Onsite & Webinars (60% pts from EMS directly)Frequent EMS Meetings – Onsite & Webinars (60% pts from EMS directly) Clinical trial training – PR talk.Clinical trial training – PR talk. Monthly Newsletters – get emailsMonthly Newsletters – get emails Hold them in the ER – give pt f/u.Hold them in the ER – give pt f/u. Know all Air Medical CompaniesKnow all Air Medical Companies

11. Transfer Center – OneCall System 8100 call - > Neuro phone consult Stat.8100 call - > Neuro phone consult Stat. – No Divert – Auto Launch– No Divert – Auto Launch Affable and AvailableAffable and Available ? IV tPA? IV tPA ? Neurointervention? Neurointervention ? Clinical Trial? Clinical Trial EVERY CALL IS A MARKETING OPPORTUNITY!!!!!!EVERY CALL IS A MARKETING OPPORTUNITY!!!!!! Get email address for monthly newsletterGet email address for monthly newsletter F/U with Patient Outcomes/ get cell phonesF/U with Patient Outcomes/ get cell phones

12. Network Hospitals 55 hospitals of various Levels of sophistication Form a Strategic Plan to visit hospitals PAX Network Monthly Newsletters Share Protocols Affiliation Agreements Telemedicine

13. Organizing the Emergency Department and Imaging Services Summary Trial List on Wall. Stoke Alert Pager (alerts all support staff) ER MD: MUST Do NIHSS and Read CTA-P Physician Stroke Pager (call before CT) Residents not involved in key decisions Treatment Pathways Very Complicated.

14. Enrollment Aids Yahoo Web site – Powerpoint Summary of I/E IPHONE Pics of All I/E Criteria for each trial PhotoFolders Enrollment books and labeled central lab tubes in ER with clear instructions. Have all STAT phone number on your phone. Treat Coordinators like GODS!

15. Patient Throughput Determine roadblocks for enrollment (? $) CT issues (who reads and when). Repeat CT scans (1 hr plain, 2 hrs CTA) Remember the DOC PUSHES THE DRUG! Teach the lab staff what you expect. Talk to the ICU RN – clear order sets. Dont use the tube system for ICU blood. Make your PI practice the entire study himself.

16. BEWARE FDA - Clinical Trial Work is Serious Business Knowledge is Power – Get certified! DIAS 4 needs Clean Data – Lives and $$$ are at stake.

17. STROKE Research Takes Commitment!

18. As a Team We Can Make History