Second Affiliated Hospital of Soochow University

While early National Institutes of Health Stroke Scale (NIHSS) scores are predictive of outcomes in patients with acute ischemic stroke (AIS), the prognostic value of the discharge NIHSS score after intravenous thrombolysis (IVT) remains unclear. We aimed to determine whether the discharge NIHSS score outperforms baseline, 24-hour, and early change indicators in predicting poor 3-month outcomes (modified Rankin scale [mRS] score of 3-6).

In this retrospective cohort study, we analyzed 554 AIS patients who received IVT at our stroke center from May 2022 to March 2024. NIHSS scores were assessed at baseline, 24 h, and discharge. Absolute (baseline minus discharge) and percentage (absolute change/baseline × 100%) NIHSS changes were calculated. Multivariable logistic regression analyses were used to assess the independent correlation between different NIHSS scores and poor outcomes. Predictive performance was evaluated using receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Discharge NIHSS scores demonstrated superior discriminative ability for poor outcomes (AUC 0.950, 95% CI 0.932-0.969) versus baseline (AUC 0.842), 24-hour (AUC 0.930), absolute change (AUC 0.689), and percentage change (AUC 0.885) (all p < 0.001). The optimal cutoff was 4.5 (sensitivity 90.5%, specificity 86.0%). Adding the discharge NIHSS score to the 24-hour NIHSS score significantly improved reclassification (NRI 123.4%, IDI 9.1%). The discharge NIHSS score consistently outperformed the 24-hour NIHSS score in predicting poor 3-month functional outcomes across all key patient subgroups.

This study revealed a notable association between the discharge NIHSS score and poor 3-month outcomes in thrombolysis-eligible patients with AIS, particularly in those with moderate stroke severity. These findings complement the established prognostic value of the 24-hour NIHSS score and may guide postacute care planning.

Introduction: Healthcare workers (HCWs) are routinely exposed to distressing and potentially traumatic events during frontline care, yet receive limited structure training to manage such exposure. Psychological first aid (PFA) training has been widely disseminated among emergency responders and is increasingly being adapted for HCWs; however, its acceptability, implementation, and use in routine care remain underexplored. This study aimed to explore how an adapted PFA training programme was perceived, implemented, and used by HCWs in routine care, and to identify the mechanisms and contextual factors that influenced its impact.Method: A qualitative process evaluation was conducted alongside the delivery of the READ-Y (Rapport, Evaluation, Aid, Disposition, Yourself) PFA training programme in a Chinese tertiary hospital. Data collection included 3 months of observations of training delivery and 19 semi-structured interviews with HCW trainees, ward managers, and trainers/facilitators. Data were analysed using framework analysis.Results: Training was logistically feasible, consistently delivered, and characterized by high engagement in simulation and debriefing. Key fidelity elements of PFA training were maintained. Five key themes emerged: (1) positive reception of the adapted, blended-format training; (2) PFA was viewed as a pragmatic, stepwise tool for strengthening basic psychosocial support in routine care; (3) reported improvement in empathy, communication, and normalization of self-care among staff; (4) targeted skills development and peer learning as key mechanisms of reported change, fostering a shared language and support; and (5) multi-level contextual enablers (e.g. leadership endorsement, protected time) were identified and structural barriers (e.g. workload, burnout) existed that may hinder uptake.Conclusion: The adapted PFA training programme was perceived as feasible, relevant, and acceptable for HCWs, facilitating the integration of psychosocial support into routine care while promoting their own well-being. System-level integration and longitudinal evaluation of PFA training are recommended to assess sustained impact on patient and staff outcomes.

Patients with mild acute ischemic stroke (AIS) (NIHSS score ≤5) remain at substantial risk for early neurological deterioration (END) and poor functional outcomes despite receiving standard dual antiplatelet therapy (DAPT). Tirofiban, a rapid-onset glycoprotein IIb/IIIa receptor inhibitor, may reduce this risk; however, evidence in patients with mild AIS is limited.

To determine whether administration of intravenous tirofiban for 48 h followed by DAPT improves the proportion of patients with excellent functional outcomes (modified Rankin Scale [mRS] score 0-1) at 90 days compared with administration of DAPT alone in patients with mild noncardioembolic AIS within 48 h of onset.

The TiMIS trial is a prospective, multicenter, open-label, blinded-endpoint (PROBE), randomized controlled study. A total of 688 patients aged 18-80 years with noncardioembolic acute mild ischemic stroke within 48 h of symptom onset will be enrolled across 20 centers in China. Participants are randomized 1:1 to intravenous tirofiban for 48 h sequentially followed by DAPT or DAPT alone. The primary outcome is the proportion of patients with excellent functional outcomes at 90 days. Secondary outcomes include END, changes in the NIHSS score, good functional outcome, mRS score shift, incidence of new ischemic stroke and composite cardiovascular events, and safety endpoints (symptomatic intracerebral hemorrhage, all-cause mortality and severe bleeding events).

This trial provides crucial evidence on whether early intravenous tirofiban with sequential DAPT offers superior benefits over standard care in patients with mild AIS, potentially guiding future antithrombotic strategies.

ClinicalTrials.gov (NCT07095790).