***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Recent innovations such as CT installation in ambulances may lead to earlier start of stroke-specific treatments . However , such technically complex mobile facilities require effective methods of correctly identifying patients before deployment . We aim ed to develop and vali date a new dispatcher identification algorithm for stroke emergencies . Methods — Dispatcher identification algorithm for stroke emergencies was informed by systematic qualitative analysis of the content of emergency calls to ambulance dispatchers for patients with stroke or transient ischemic attack ( N=117 ) and other neurological ( N=39 ) and nonneurological ( N=51 ) diseases ( Part A ) . After training of dispatchers , sensitivity and predictive values were determined prospect ively in patients admitted to Charité hospitals by using the discharge diagnosis as reference st and ard ( Part B ) . Results — Part A : Dysphasic/dysarthric symptoms ( 33 % ) , unilateral symptoms ( 22 % ) and explicitly stated suspicion of stroke ( 47 % ) were typically identified in patients with stroke but infrequently in nonstroke cases ( all < 10 % ) . Convulsive symptoms ( 41 % ) were frequent in other neurological diseases but not strokes ( 3 % ) . Pain ( 26 % ) and breathlessness ( 31 % ) were often expressed in nonneurological emergencies ( 6 % and 7 % in strokes ) . Part B : Between October 15 and December 16 , 2010 , 5774 patients were admitted by ambulance with 246 coded with final stroke diagnoses . Sensitivity of dispatcher identification algorithm for stroke emergencies for detecting stroke was 53.3 % and positive predictive value was 47.8 % for stroke and 59.1 % for stroke and transient ischemic attack . Of all 275 patients with stroke dispatcher codes , 215 ( 78.5 % ) were confirmed with neurological diagnosis . Conclusions — Using dispatcher identification algorithm for stroke emergencies , more than half of all patients with stroke admitted by ambulance were correctly identified by dispatchers . Most false-positive stroke codes had other neurological diagnoses Purpose — The aim of this guideline is to provide a focused up date of the current recommendations for the  endovascular  treatment of  acute ischemic stroke . When there is overlap , the recommendations made here supersede those of previous guidelines . Methods — This focused up date analyzes results from 8 r and omized , clinical trials of endovascular treatment and other relevant data published since 2013 . It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations . Members of the writing committee were appointed by the American Heart Association/American Stroke Association Stroke Council ’s Scientific Statement Oversight Committee and the American Heart Association/American Stroke Association Manuscript Oversight Committee . Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process . Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence . Prerelease review of the draft guideline was performed by 6 expert peer review ers and by the members of the Stroke Council Scientific Statement Oversight Committee and Stroke Council Leadership Committee . Results — Evidence -based guidelines are presented for the selection of patients with acute ischemic stroke for endovascular treatment , for the endovascular procedure , and for systems of care to facilitate endovascular treatment . Conclusions — Certain endovascular procedures have been demonstrated to provide clinical benefit in selected patients with acute ischemic stroke . Systems of care should be organized to facilitate the delivery of this care Background and Purpose — Emergency medical dispatchers play an important role in optimizing stroke care if they are able to accurately identify calls regarding acute cerebrovascular disease . This study was undertaken to assess the diagnostic accuracy of the current national protocol guiding dispatcher question ing of 911 callers to identify stroke ( QA Guide version 11.1 of the National Academy Medical Priority Dispatch System ) . Methods — We identified all Los Angeles Fire Department paramedic transports of patients to University of California Los Angeles Medical Center during the 12-month period from January to December 2005 in a prospect ively maintained data base . Dispatcher-assigned Medical Priority Dispatch System codes for each of these patient transports were abstract ed from the paramedic run sheets and compared to final hospital discharge diagnosis . Results — Among 3474 transported patients , 96 ( 2.8 % ) had a final diagnosis of stroke or transient ischemic attack . Dispatchers assigned a code of potential stroke to 44.8 % of patients with a final discharge diagnosis of stroke or TIA . Dispatcher identification of stroke showed a sensitivity of 0.41 , specificity of 0.96 , positive predictive value of 0.45 , and negative predictive value of 0.95 . Conclusions — Dispatcher recognition of stroke calls using the widely employed Medical Priority Dispatch System algorithm is suboptimal , with failure to identify more than half of stroke patients as likely stroke . Revisions to the current national dispatcher structured interview and symptom identification algorithm for stroke may facilitate more accurate recognition of stroke by emergency medical dispatchers OBJECTIVE Early stroke recognition optimizes patients ' opportunities to benefit from therapeutic options . Prehospital stroke recognition is suboptimal . If 9 - 1 - 1 dispatchers used stroke- identification tools , prehospital stroke recognition might occur more rapidly and accurately . The Cincinnati Prehospital Stroke Scale ( CPSS ) is a brief , effective tool used by emergency medical services and hospital personnel to identify stroke . The study 's goal was to determine whether laypersons could be instructed to use the CPSS over the telephone . METHODS Adult visitors ( laypersons ) to a tertiary care emergency department were enrolled . Using a mock patient , laypersons were instructed to use the CPSS via telephone by an investigator simulating a 9 - 1 - 1 dispatcher . The patient r and omly portrayed clinical ly normal and abnormal patient types . The layperson 's ability to convey CPSS instructions to the patient and relay findings to the investigator was scored . RESULTS Seventy laypersons were enrolled ( 35 each for normal and abnormal patient types ) . Average age was 48 years , 63 % were female , and 40 % never attended college .  Facial droop and speech instructions were administered with 100 % accuracy . Arm drift instructions were administered with 99 % accuracy . Layperson accuracies for interpreting findings were 93 % for facial droop , 93 % for arm drift , and 97 % for speech . Overall , stroke symptoms were detected with 94 % sensitivity ( 95 % CI 87 , 100 ) and 83 % specificity ( 95 % CI 70 , 95 ) . CONCLUSION Laypersons correctly administered and interpreted the CPSS when directed to do so over the telephone by a trained investigator . These findings suggest that the CPSS may be a useful tool in early prehospital detection of stroke by dispatchers BACKGROUND A number of emergency medical services ( EMSs ) performance measures for stroke have been proposed to promote early stroke recognition and rapid transportation to definitive care . This study examined performance measure compliance among EMS-transported stroke patients and the relationship between compliance and in-hospital stroke response . METHODS Eight quality indicators were derived from American Stroke Association guidelines . A prospect i ve cohort of consecutive , EMS-transported patients discharged from 2 large Midwestern stroke centers with a diagnosis of acute ischemic stroke was identified . Data were abstract ed from hospital and EMS records . Compliance with 8 prehospital quality indicators was calculated . Univariate and multivariable logistic regression analysis were performed to measure the association between prehospital compliance and a binary outcome of door-to-computed tomography ( CT ) time less than or equal to 25 minutes . RESULTS Over the 12 month study period , 186 EMS-transported ischemic stroke patients were identified . Compliance was highest for prehospital documentation of a glucose level ( 86.0 % ) and stroke screen ( 78.5 % ) and lowest for on-scene time less than or equal to 15 minutes ( 46.8 % ) , hospital prenotification ( 56.5 % ) , and transportation at highest priority ( 55.4 % ) . After adjustment for age , time from symptom onset , and stroke severity , transportation at highest priority ( odds ratio [ OR ] , 13.45 ) and hospital prenotification ( OR , 3.75 ) were both associated with significantly faster door-to-CT time . No prehospital quality metric was associated with tissue-plasminogen activator delivery . CONCLUSIONS EMS transportation at highest priority and hospital prenotification were associated with faster in-hospital stroke response and represent logical targets for EMS quality improvement efforts 
    Output:
    
Conclusion : Even when utilizing a stroke screening tool , the accuracy of stroke recognition by emergency dispatchers was suboptimal .