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From the Editor
Despite this gigantic problem, there is a relative shortage of neurologists, especially those with advanced training in stroke, as well as a poor distribution of expertise, especially in rural areas where the incidence of stroke may be highest. To address these challenges, the Joint Commission on Accreditation of Health Organizations (JCAHO) has offered a program to certify centers of excellence for treatment of stroke. In her chapter entitled, Systematic Quality Improvement in Stroke Care, Christy Casper, NP, outlines the criteria for certification as a stroke center under this program. Swedish Medical Center, in collaboration with CNI, has become the first certified center, not only in Colorado, but for the entire Rocky Mountain region. This is a monumental accomplishment, especially considering that Swedish Medical Center is a community hospital and that the CNI follows a private practice model of comprehensive neurological care. Dr. Don Smith, creator and director of the center, as well as his colleagues in neurology, nursing, administration, social service and rehabilitation deserve much praise and admiration for the commitment and cooperation necessary to bring his dream to fruition. In this CNI REVIEW we are brought up to date on new approaches to early detection (Telemedicine, etc., Dr. Fanale), intervention (Endovascular Management, Dr. Huddle), ICU Monitoring (Dr. Greer), and rehabilitation (CNI NeuroHealth Center, Roz Davis and Carol Greenwald, MD). Having completed a reading of the Review, I’m sure that you, like myself, will be excited about the great progress that has been made and will continue to be made toward the goal of reducing the incidence, morbidity, and mortality associated with stroke. I am also certain that you will feel the same sense of pride that I feel to be associated with an Institute that has developed what must be called a model program and invaluable regional resource for people with neurovascular disease. Stroke sets a standard for all the other CNI Programs to emulate. Edward B. Arenson, MD From the Guest Editor Technological advances in the diagnosis and treatment of stroke have been stunning. Yet, stroke remains common, costly and tragic. How can this be? We do not make good use of the tools at our disposal. For example, only a small minority of stroke patients — perhaps 3% — receive the urgent treatment that may reverse the effects of a stroke. Why do we fail so badly in living up to our potential? Our failure, it seems, is not technological but sociological. It lies largely with our system of care. Stroke care is necessarily a group effort. Effective care requires that a complex set of actions be tightly coordinated among many individuals. Closing the gap between our capabilities and our accomplishments requires nothing less than re-engineering of our system of care. This reengineering is well underway at CNI and Swedish Medical Center. We are pleased that our program was the first in Colorado (and among the first in the country) to be designated a Primary Stroke Center. We are honored by this mark of distinction, but we realize that a Stroke Center is not defined by a certificate that hangs on the wall. Rather, it is defined by an ongoing commitment to creating and maintaining a continuously improving process. This involves adapting to changing “best practices” that are derived from evidence-based medicine. It involves participation in clinical research to discover better ways of preventing, treating, and recovering from stroke. It involves monitoring and analysis of our own experience. It involves communication and collaboration. In this edition of the CNI REVIEW, we offer a sampling from some of the people, programs and practices that make CNI and Swedish Medical Center the stroke-leader in Colorado. I am deeply grateful to be a part of this program. Don B. Smith, MD To view the articles: This issue of the CNI REVIEW is provided in Adobe Acrobat PDF format. You can right-click to download the PDF file to your computer, or click to open and read online. Or click on each title below to open a smaller PDF file containing only the article's pages.
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CNI REVIEW Library · CNI PublicationsColorado Neurological Institute (CNI),
701 East Hampden Ave.,
Suite 330,
Englewood, CO 80113
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The current issue of the CNI REVIEW addresses the monumental health
problem of stroke including aspects of prevention, early detection and
response, acute treatment, and long-term rehabilitation.
Stroke is a massive problem. It is the leading cause of disability and
the third most common cause of death after heart disease and cancer in
this country. American Stroke Association data reveals that in 2006
approximately 57.9 billion dollars will be spent on the care and rehabilitation
of stroke patients.
This figure does not include the huge loss of income, productivity and
quality of life associated
with this potentially preventable and, finally, treatable disease. 
Stroke
imperils life, mobility, communication, employment,
relationships, and one’s own sense of self. Few stroke survivors
escape
without lasting scars. It has been a problem since antiquity, but it
isn’t a
problem that can’t be solved. There are few areas in medicine where
the
opportunity for progress is so great.
The cause of stroke is understood. Effective treatments are
available. Risk factors are well known. Altering risks can prevent strokes.
In short, stroke is
treatable, modifiable, and preventable. 
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