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Bersch-Ferreira AC, Machado RHV, de Oliveira JS, Santos RHN, da Silva LR, Mota LGS, Pagano R, Sady ERR, Miyada DHK, Valeis N, Martins PN, de Almeida JC, Marchioni DML, Lara EMS, Gherardi-Donato ECS, Quinhoneiro D, Carvalho APPF, Machado MMA, Gedda LPF, Ferro CMB, Carvalho ACMS, Feoli AMP, Walker MS, Pinto SL, Silva KC, Bruscato NM, Moriguchi EH, Penafort AM, Santiago RA, Osório DRD, Rower HB, Barbosa MR, da Silva JGST, Weber B, Cavalcanti AB, Marcadenti A. Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial. J Hypertens 2024; 42:1173-1183. [PMID: 38690885 DOI: 10.1097/hjh.0000000000003703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of a nutritional strategy based on two components and adapted for the public health system on blood pressure, cardiometabolic features, self-care, qualify of life and diet quality in individuals with hypertension. METHODS NUPRESS was an open-label, parallel-group, superiority randomized controlled clinical trial in which participants at least 21 years with hypertension and poorly controlled blood pressure were randomly assigned (1 : 1 allocation ratio) to either an individualized dietary prescription according to nutritional guidelines (control group, n = 205); or a two-component nutrition strategy, including a goal-directed nutritional counseling and mindfulness techniques (NUPRESS [intervention] group, n = 205). Primary outcomes were SBP (mmHg) after 24 weeks of follow up and blood pressure control, defined as either having SBP more than 140 mmHg at baseline and achieving 140 mmHg or less after follow-up or having SBP 140 mmHg or less at baseline and reducing the frequency of antihypertensive drugs in use after follow-up. RESULTS In total, 410 participants were randomized and submitted to an intention-to-treat analysis regarding primary outcomes. Both groups decreased blood pressure, but after adjusting for baseline values, there was no significant difference between them on SBP [intervention-control difference: -0.03 (-3.01; 2.94); P = 0.98] nor blood pressure control [odds ratio 1.27 (0.82; 1.97); P = 0.28]. No differences between groups were also detected regarding secondary and tertiary outcomes. CONCLUSION There was no difference between a two-component nutritional strategy and an established dietary intervention on blood pressure in participants with hypertension.
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Affiliation(s)
- Angela C Bersch-Ferreira
- Hcor Teaching Institute, São Paulo
- Department of Research, BP - A Beneficência Portuguesa de São Paulo, São Paulo
| | | | | | | | | | | | - Raira Pagano
- Department of Research, BP - A Beneficência Portuguesa de São Paulo, São Paulo
| | | | | | | | - Pedro N Martins
- School of Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora
| | - Jussara C de Almeida
- Department of Nutrition, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul
- Division of Nutrition and Dietetics, Hospital de Clínicas de Porto Alegre, Porto Alegre
| | - Dirce M L Marchioni
- Department of Nutrition, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo
| | | | | | - Driele Quinhoneiro
- Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão Preto
| | - Ana Paula P F Carvalho
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Malaine M A Machado
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Lana P F Gedda
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Camila M B Ferro
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Ana Clara M S Carvalho
- Research Improvement Group in Health and Nutrition, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia
| | - Ana Maria P Feoli
- Postgraduate Program in Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre
| | - Marthina S Walker
- Postgraduate Program in Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre
| | - Sônia L Pinto
- Nutrition Course, Universidade Federal do Tocantins, Palmas
| | - Kellen C Silva
- Nutrition Course, Universidade Federal do Tocantins, Palmas
| | | | - Emilio H Moriguchi
- Instituto Moriguchi, Veranópolis
- Internal Medicine Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre
| | | | | | - Denise R D Osório
- Multiprofessional Outpatient Systemic Arterial Hypertension, Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre
| | - Helena B Rower
- Multiprofessional Outpatient Systemic Arterial Hypertension, Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre
| | - Marina R Barbosa
- Nutrition Course, School of Medicine, Universidade Federal de Uberlândia, Uberlândia
| | | | - Bernardete Weber
- Department of Research, BP - A Beneficência Portuguesa de São Paulo, São Paulo
| | | | - Aline Marcadenti
- Hcor Research Institute, São Paulo
- Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
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Ogedegbe G, Teresi JA, Williams SK, Ogunlade A, Izeogu C, Eimicke JP, Kong J, Silver SA, Williams O, Valsamis H, Law S, Levine SR, Waddy SP, Spruill TM. Home Blood Pressure Telemonitoring and Nurse Case Management in Black and Hispanic Patients With Stroke: A Randomized Clinical Trial. JAMA 2024:2819467. [PMID: 38842799 PMCID: PMC11157441 DOI: 10.1001/jama.2024.6609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/29/2024] [Indexed: 06/07/2024]
Abstract
Importance Black and Hispanic patients have high rates of recurrent stroke and uncontrolled hypertension in the US. The effectiveness of home blood pressure telemonitoring (HBPTM) and telephonic nurse case management (NCM) among low-income Black and Hispanic patients with stroke is unknown. Objective To determine whether NCM plus HBPTM results in greater systolic blood pressure (SBP) reduction at 12 months and lower rate of stroke recurrence at 24 months than HBPTM alone among Black and Hispanic stroke survivors with uncontrolled hypertension. Design, Setting, and Participants Practice-based, multicenter, randomized clinical trial in 8 stroke centers and ambulatory practices in New York City. Black and Hispanic study participants were enrolled between April 18, 2014, and December 19, 2017, with a final follow-up visit on December 31, 2019. Interventions Participants were randomly assigned to receive either HBPTM alone (12 home BP measurements/week for 12 months, with results transmitted to a clinician; n = 226) or NCM plus HBPTM (20 counseling calls over 12 months; n = 224). Main Outcomes and Measures Primary outcomes were change in SBP at 12 months and rate of recurrent stroke at 24 months. Final statistical analyses were completed March 14, 2024. Results Among 450 participants who were enrolled and randomized (mean [SD] age, 61.7 [11.0] years; 51% were Black [n = 231]; 44% were women [n = 200]; 31% had ≥3 comorbid conditions [n = 137]; 72% had household income <$25 000/y [n = 234/324]), 358 (80%) completed the trial. Those in the NCM plus HBPTM group had a significantly greater SBP reduction than those in the HBPTM alone group at 12 months (-15.1 mm Hg [95% CI, -17.2 to -13.0] vs -5.8 mm Hg [95% CI, -7.9 to -3.7], respectively; P < .001). The between-group difference in SBP reduction at 12 months, adjusted for primary care physician clustering, was -8.1 mm Hg (95% CI, -11.2 to -5.0; P < .001) at 12 months. The rate of recurrent stroke was similar between both groups at 24 months (4.0% in the NCM plus HBPTM group vs 4.0% in the HBPTM alone group, P > .99). Conclusions and Relevance Among predominantly low-income Black and Hispanic stroke survivors with uncontrolled hypertension, addition of NCM to HBPTM led to greater SBP reduction than HBPTM alone. Additional studies are needed to understand the long-term clinical outcomes, cost-effectiveness, and generalizability of NCM-enhanced telehealth programs among low-income Black and Hispanic stroke survivors with significant comorbidity. Trial Registration Clinical Trials.gov Identifier: NCT02011685.
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Affiliation(s)
- Gbenga Ogedegbe
- Institute for Excellence in Health Equity, NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Jeanne A. Teresi
- Division of General Medicine, Columbia University, New York, New York
- Columbia University Stroud Center and New York State Psychiatric Institute, New York
| | - Stephen K. Williams
- Institute for Excellence in Health Equity, NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Adebayo Ogunlade
- Institute for Excellence in Health Equity, NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Chigozirim Izeogu
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Joseph P. Eimicke
- Division of General Medicine, Columbia University, New York, New York
| | - Jian Kong
- Division of General Medicine, Columbia University, New York, New York
| | | | - Olajide Williams
- Department of Neurology, Columbia University Medical School, New York, New York
| | - Helen Valsamis
- Department of Neurology, NYC Health and Hospitals/Kings County, New York, New York
| | - Susan Law
- Department of Neurology, NYC Health and Hospitals/Kings County, New York, New York
| | - Steven R. Levine
- Department of Neurology, NYC Health and Hospitals/Kings County, New York, New York
- Departments of Neurology and Emergency Medicine and Stroke Center, SUNY Downstate Health Sciences University, New York, New York
| | - Salina P. Waddy
- Division of Clinical Innovation, National Center for Advancing Translational Sciences, Bethesda, Maryland
| | - Tanya M. Spruill
- Institute for Excellence in Health Equity, NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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3
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Bushnell C. Achieving Blood Pressure Goals and Addressing Inequities in Blood Pressure Management After Stroke. J Am Heart Assoc 2024; 13:e031307. [PMID: 38529654 DOI: 10.1161/jaha.123.031307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Cheryl Bushnell
- Department of Neurology Wake Forest University School of Medicine Winston-Salem NC USA
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Towfighi A, Ovbiagele B. Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving 2023 Update. J Am Heart Assoc 2024; 13:e031306. [PMID: 38529646 DOI: 10.1161/jaha.124.031306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Amytis Towfighi
- University of Southern California Los Angeles CA USA
- Los Angeles County Department of Health Services Los Angeles CA USA
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Leinberger-Jabari A, Golob MM, Lindson N, Hartmann-Boyce J. Effectiveness of culturally tailoring smoking cessation interventions for reducing or quitting combustible tobacco: A systematic review and meta-analyses. Addiction 2024; 119:629-648. [PMID: 38105395 DOI: 10.1111/add.16400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/24/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND AIMS Standard approaches to smoking cessation may not be as effective for certain populations, and tailoring on cultural factors could improve their effectiveness. This systematic review measured the effectiveness of culturally tailoring smoking cessation interventions on quitting or reducing smoking combustible tobacco. METHOD We searched MEDLINE, PsychInfo, Embase and Cochrane Central Register from inception to 21 June 2023 for randomized controlled trials (RCTs) of community-based, primary care or web-based interventions for smoking cessation in adults who smoked tobacco, with measurement of smoking abstinence or reduction at least 3 months following baseline. We examined comparisons between either an intensity-matched culturally tailored intervention and a non-tailored intervention or a standard non-tailored intervention and the same intervention plus a culturally tailored adjunct. We sub-grouped studies according to the level of tailoring and performed subgroup analyses where appropriate. We assessed risk of bias and certainty of evidence. RESULTS We identified 43 studies, 33 of which were meta-analyzed (n = 12 346 participants). We found moderate certainty evidence, limited by heterogeneity, that intensity-matched culturally tailored cessation interventions increased quit success when compared with non-tailored interventions at 3-month follow-up or longer (n = 5602, risk ratio [RR] = 1.29 95% confidence interval [CI] 1.10, 1.51, I2 = 47%, 14 studies). We found a positive effect of adding a culturally tailored component to a standard intervention compared with the standard intervention alone (n = 6674, RR = 1.47, 95% CI 1.10, 1.95, I2 = 74%, 18 studies), but our certainty in this effect was low due to imprecision and substantial statistical heterogeneity. CONCLUSION Culturally tailored smoking cessation interventions may help more people to quit smoking than a non-tailored intervention. Adapting or adding cultural components to smoking cessation interventions originally developed for majority populations could improve cessation rates in populations who do not fully identify with majority cultural norms.
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Affiliation(s)
- Andrea Leinberger-Jabari
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Melanie M Golob
- Department of Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Nicola Lindson
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
- Department of Health Policy and Promotion, University of Massachusetts Amherst, Amherst, United States
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Duckie CL, Boston KA, Champagne B, Thompson J, Halpern DJ, Granger BB. Improving Hypertension Control in the Black Patient Population: A Quality Improvement Study of Workflow Redesign Using the Electronic Health Record to Integrate Self-Monitoring, Education, and Reporting. J Nurs Care Qual 2024; 39:175-182. [PMID: 37782914 DOI: 10.1097/ncq.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Nearly half of American adults have hypertension (HTN), and non-Hispanic Black patients are diagnosed at a higher rate than others. LOCAL PROBLEM Our local clinic population reflected disproportionate rates of uncontrolled HTN among Black patients. METHODS A quality improvement pre-/postintervention design was used to evaluate an educational intervention to reduce blood pressure (BP) and improve self-monitoring of BP in Black patients using the Chronic Care Model. INTERVENTIONS A team-based approach was used to redesign clinic workflows and patient education, prescribe self-paced videos from an electronic health record (EHR) patient portal, and provide home BP cuffs. RESULTS Black participants (n = 79) improved viewing of prescribed videos (7.9% to 68.5%), knowledge scores (67.9 to 75.2), and mean systolic BP (-20.3 mm Hg; P > .001). CONCLUSIONS This team-based approach enhanced patient engagement, self-monitoring skills, EHR-reported BP, and overall BP control for a cohort of Black patients with uncontrolled BP.
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Affiliation(s)
- Charmaine L Duckie
- Author Affiliations: Duke Primary Care Riverview, Durham, North Carolina (Drs Duckie, Champagne, Boston, and Halpern); Duke Primary Care Croasdaile and Riverview, Duke Population Health Management Office, Durham, North Carolina (Dr Champagne); Duke University School of Nursing, Durham, North Carolina (Drs Thompson and Granger); Quality & Population Health, Duke Primary Care, Durham, North Carolina (Dr Halpern); and Duke Heart Center Nursing Research Program, Durham, North Carolina (Dr Granger)
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Woo BFY, Ng WM, Tan IF, Zhou W. Practice patterns, role and impact of advanced practice nurses in stroke care: A mixed-methods systematic review. J Clin Nurs 2024; 33:1306-1319. [PMID: 38131430 DOI: 10.1111/jocn.16970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/02/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
AIM(S) To undertake a systematic review of the practice patterns and roles of advanced practice nurses (APNs) in inpatient and outpatient stroke-care services; and to evaluate the impact of APN-led inpatient and outpatient stroke-care services on clinical and patient-reported outcomes. DESIGN A mixed-methods systematic review. METHODS A systematic search was conducted across six electronic databases for primary studies. Data were synthesised using a convergent integrated approach. DATA SOURCES (INCLUDE SEARCH DATES) *FOR REVIEWS ONLY: A systematic search was conducted across PubMed, CINAHL, Cochrane Library, Embase, PsycInfo and ProQuest Dissertations & Theses Global, for primary studies published between the inception of the databases and 3 November 2022. RESULTS Findings based on the 18 included primary studies indicate that the APNs' roles have been implemented across the continuum of stroke care, including pre-intervention care, inpatient care and post-discharge care. Practicing at an advanced level, the APNs engaged in clinical, operational and educational undertakings across services and disciplines. Positive clinical and patient-reported outcomes have been attributed to their practice. CONCLUSION The review highlights the critical role of APNs in improving stroke care, especially in the pre-intervention phase. Their clinical expertise, patient-centered approach and collaboration can transform stroke care. Integrating APNs into stroke care teams is essential for better management and outcomes in light of the increasing stroke burden. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Healthcare institutions should integrate APNs to enhance pre-intervention stroke care, improve diagnostic accuracy and expedite treatment. APNs can prioritise patient-centric care, including assessments, coordination and education. Medication reconciliation, timely rehabilitation referrals and lifestyle modifications for secondary stroke prevention are crucial. Implementing advanced practice nursing frameworks ensures successful APN integration, leading to improved stroke care and better patient outcomes in response to the growing stroke burden. IMPACT (ADDRESSING) What problem did the study address? Poor clarity of the role of advanced practice nurses among patients, physicians, healthcare professionals, health policymakers and nurses. What were the main findings? Advanced practice nurses practise across the continuum of stroke care, mainly in pre-intervention care which takes place before initiating treatment, inpatient care and post-discharge care. The implementation of the advanced practice nurse role in stroke care has contributed positively to clinical and patient-reported outcomes. Where and on whom will the research have an impact? Insights from the review are envisioned to inform healthcare policymakers and leaders in the implementation and evaluation of the APN role in stroke care. REPORTING METHOD Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: https://figshare.com/ndownloader/files/41606781; Registered on Open Science Framework osf.io/dav8j.
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Affiliation(s)
- Brigitte Fong Yeong Woo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wai May Ng
- National Neuroscience Institute, Singapore, Singapore
| | - Il Fan Tan
- National Neuroscience Institute, Singapore, Singapore
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National Neuroscience Institute, Singapore, Singapore
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Bulto LN, Roseleur J, Noonan S, Pinero de Plaza MA, Champion S, Dafny HA, Pearson V, Nesbitt K, Gebremichael LG, Beleigoli A, Gulyani A, Schultz T, Hines S, Clark RA, Hendriks JM. Effectiveness of nurse-led interventions versus usual care to manage hypertension and lifestyle behaviour: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2024; 23:21-32. [PMID: 37130339 DOI: 10.1093/eurjcn/zvad040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/04/2023]
Abstract
AIMS This review aimed to investigate the effectiveness of nurse-led interventions vs. usual care on hypertension management, lifestyle behaviour, and patients' knowledge of hypertension and associated risk factors. METHODS A systematic review with meta-analysis was conducted following Joanna Briggs Institute (JBI) guidelines. MEDLINE (Ovid), EmCare (Ovid), CINAHL (EBSCO), Cochrane library, and ProQuest (Ovid) were searched from inception to 15 February 2022. Randomized controlled trials (RCTs) examining the effect of nurse-led interventions on hypertension management were identified. Title and abstract, full text screening, assessment of methodological quality, and data extraction were conducted by two independent reviewers using JBI tools. A statistical meta-analysis was conducted using STATA version 17.0. RESULTS A total of 37 RCTs and 9731 participants were included. The overall pooled data demonstrated that nurse-led interventions may reduce systolic blood pressure (mean difference -4.66; 95% CI -6.69, -2.64; I2 = 83.32; 31 RCTs; low certainty evidence) and diastolic blood pressure (mean difference -1.91; 95% CI -3.06, -0.76; I2 = 79.35; 29 RCTs; low certainty evidence) compared with usual care. The duration of interventions contributed to the magnitude of blood pressure reduction. Nurse-led interventions had a positive impact on lifestyle behaviour and effectively modified diet and physical activity, but the effect on smoking and alcohol consumption was inconsistent. CONCLUSION This review revealed the beneficial effects of nurse-led interventions in hypertension management compared with usual care. Integration of nurse-led interventions in routine hypertension treatment and prevention services could play an important role in alleviating the rising global burden of hypertension. REGISTRATION PROSPERO: CRD42021274900.
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Affiliation(s)
- Lemma N Bulto
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Jacqueline Roseleur
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Sara Noonan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Maria Alejandra Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
- National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, 5005, SA, Australia
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Hila Ariela Dafny
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Vincent Pearson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Katie Nesbitt
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Lemlem G Gebremichael
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Alline Beleigoli
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Aarti Gulyani
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Timothy Schultz
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, 5005, SA, Australia
| | - Sonia Hines
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
- Flinders Rural and Remote Health, NT. College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Robyn A Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, 5001, SA, Australia
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Voura EB, Abdul-Malak Y, Jorgensen TM, Abdul-Malak S. A retrospective analysis of the social determinants of health affecting stroke outcomes in a small hospital situated in a health professional shortage area (HPSA). PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001933. [PMID: 38190408 PMCID: PMC10773951 DOI: 10.1371/journal.pgph.0001933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
Where someone lives is a major determinant of population health. In the United States, people who live in Health Professional Shortage Areas are considered medically underserved and have a higher propensity for conditions such as stroke, hypertension, and diabetes. Our goal was to better understand the diverse needs of patients presenting to the Crouse Hospital emergency department with stroke symptoms. Crouse Hospital is a small community hospital located in a shortage area serving both urban and rural populations in and around Syracuse, New York. Despite its small size, Crouse Hospital quickly became a major comprehensive stroke center in Central New York. With this study we assessed the social factors affecting the stroke patient population in the community and compared these characteristics between those living in served and underserved areas. Informed by the social determinants of health framework, we analyzed 1731 incidents of stroke that occurred between January 2019 and January 2021, and observed that the circumstances associated with stroke varied by service category and race, with White patients and those from served areas having better stroke outcomes compared to those residing in underserved areas and those that were not White. Our analyses help us to understand the underlying factors influencing the observed disparities and allow us to move forward by implementing informed community-based interventions to decrease stroke incidence and improve post-stroke care. Using our example other small hospitals can enact similar strategies to address the social determinants affecting their patients to improve stroke outcomes in their region.
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Affiliation(s)
- Evelyn B. Voura
- Crouse Neuroscience Institute, Crouse Health at Crouse Hospital, Crouse Medical Practice, Syracuse, New York, United States of America
- Department of Neuroscience and Physiology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, United States of America
| | - Ynesse Abdul-Malak
- Department of Sociology and Anthropology, Colgate University, Hamilton, New York, United States of America
| | - Tabatha M. Jorgensen
- Crouse Neuroscience Institute, Crouse Health at Crouse Hospital, Crouse Medical Practice, Syracuse, New York, United States of America
| | - Sami Abdul-Malak
- Crouse Neuroscience Institute, Crouse Health at Crouse Hospital, Crouse Medical Practice, Syracuse, New York, United States of America
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Sur NB, Kozberg M, Desvigne-Nickens P, Silversides C, Bushnell C. Improving Stroke Risk Factor Management Focusing on Health Disparities and Knowledge Gaps. Stroke 2024; 55:248-258. [PMID: 38134258 DOI: 10.1161/strokeaha.122.040449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Stroke is a leading cause of death and disability in the United States and worldwide, necessitating comprehensive efforts to optimize stroke risk factor management. Health disparities in stroke incidence, prevalence, and risk factor management persist among various race/ethnic, geographic, and socioeconomic populations and negatively impact stroke outcomes. This review highlights existing literature and guidelines for stroke risk factor management, emphasizing health disparities among certain populations. Moreover, stroke risk factors for special groups, including the young, the very elderly, and pregnant/peripartum women are outlined. Strategies for stroke risk factor improvement at every level of the health care system are discussed, from the individual patient to providers, health care systems, and policymakers. Improving stroke risk factor management in the context of the social determinants of health, and with the goal of eliminating inequities and disparities in stroke prevention strategies, are critical steps to reducing the burden of stroke and equitably improving public health.
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Affiliation(s)
- Nicole B Sur
- Department of Neurology, University of Miami Miller School of Medicine, FL (N.B.S.)
| | - Mariel Kozberg
- Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston (M.K.)
| | | | | | - Cheryl Bushnell
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC (C.B.)
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Lu L, Wei S, Huang Q, Chen Y, Huang F, Ma X, Huang C. Effect of "Internet + tertiary hospital-primary hospital-family linkage home care" model on self-care ability and quality of life of discharged stroke patients. Am J Transl Res 2023; 15:6727-6739. [PMID: 38186986 PMCID: PMC10767543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To investigate the intervention effect of an "Internet + tertiary hospital-primary hospital-family linkage home care" model on the quality of life and self-care abilities of discharged stroke patients. METHODS The clinical data of 90 patients with stroke who were hospitalized and discharged from the Department of Neurology of the Affiliated Hospital of Youjiang Medical College for Nationalities from October 2020 to September 2021 were retrospectively analyzed. They were split into a control group (41 cases) and an intervention group (40 cases) based on different care modes. The intervention group was given the "Internet + tertiary hospital-primary hospital-family connection home care" paradigm, while the control group received normal nursing interventions. The degree of nerve defect, quality of life, anxiety and depression, self-care ability and exercise ability of the patients were evaluated by National Institutes of Health Stroke Scale (NIHSS), Stroke Specific Quality of Life Scale (SS-QOL), General Hospital Anxiety and Depression Scale (HADS), Self-care Ability Scale (ESCA), and Fugl-Meyer Motor Function Assessment (FMA) before discharge and at 3rd, 6th and 12th month after discharge, respectively. The re-hospitalization rate, treatment compliance and exercise ability of the two groups were compared within a year after discharge. RESULTS The scores of SS-QOL, ESCA and FMA in the intervention group increased with time, and the scores of SS-QOL, ESCA and FMA at 3rd, 6th and 12th month after discharge were higher than those in the control group (all P<0.05). The NIHSS and HADS scores decreased over time, and the NIHSS and HADS scores were lower than the control group at 12th month after discharge (P<0.05). Within a year of discharge, the intervention group had a lower rehospitalization rate than the control group (P<0.05), and the treatment compliance score was higher in the intervention group than that in the control group (P<0.05). CONCLUSION The "Internet + tertiary hospital-primary hospital-family nursing" model can improve self-care ability and treatment compliance of patients, improve their nerve defects and psychological status as well as quality of life, and reduce rehospitalization rate.
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Affiliation(s)
- Liuxue Lu
- Department of Nursing, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Suyu Wei
- “Internet Nursing Service” Office, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Quyun Huang
- Department of Neurology, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Yuke Chen
- Department of Pediatrics, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Fengxing Huang
- Department of Nursing, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Xiaoan Ma
- Department of Infectious Diseases, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
| | - Caimei Huang
- Respiratory Intensive Care Unit, Affiliated Hospital of Youjiang Medical University for NationalitiesBaise 533000, Guangxi, China
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12
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Singh SD, Oreskovic T, Carr S, Papier K, Conroy M, Senff JR, Chemali Z, Gutierrez-Martinez L, Parodi L, Mayerhofer E, Marini S, Nunley C, Newhouse A, Ouyang A, Brouwers HB, Westover B, Rivier C, Falcone G, Howard V, Howard G, Pikula A, Ibrahim S, Sheth KN, Yechoor N, Lazar RM, Anderson CD, Tanzi RE, Fricchione G, Littlejohns T, Rosand J. The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort. Front Neurol 2023; 14:1291020. [PMID: 38107629 PMCID: PMC10725202 DOI: 10.3389/fneur.2023.1291020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction The 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke. Methods The BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40-69 years, recruited between 2006-2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline. Results The BCS (median: 12; IQR:11-14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (95%CI: 40-72%) lower risk of dementia among participants aged <50. Among those aged 50-59, the figure was 32% (95%CI: 20-42%) and 8% (95%CI: 2-14%) for those aged >59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged <50, 52% (95%CI, 47-56%) among those aged 50-59, and 33% (95%CI, 29-37%) among those aged >59. Discussion The BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide.
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Affiliation(s)
- Sanjula D. Singh
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Tin Oreskovic
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Keren Papier
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Megan Conroy
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jasper R. Senff
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Zeina Chemali
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Division of Neuropsychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Leidys Gutierrez-Martinez
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Livia Parodi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ernst Mayerhofer
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Sandro Marini
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Courtney Nunley
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Amy Newhouse
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Division of Neuropsychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - An Ouyang
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - H. Bart Brouwers
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Brandon Westover
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Cyprien Rivier
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Guido Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Virginia Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Aleksandra Pikula
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sarah Ibrahim
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Nirupama Yechoor
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ronald M. Lazar
- McKnight Brain Institute, Department of Neurology, School of Medicine, University of Alabama School of Medicine, Birmingham, AL, United States
| | - Christopher D. Anderson
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Rudolph E. Tanzi
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Gregory Fricchione
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Thomas Littlejohns
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Broad Institute of MIT and Harvard, Cambridge, MA, United States
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
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13
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Peek ME, Gottlieb LM, Doubeni CA, Viswanathan M, Cartier Y, Aceves B, Fichtenberg C, Cené CW. Advancing health equity through social care interventions. Health Serv Res 2023; 58 Suppl 3:318-326. [PMID: 38015863 PMCID: PMC10684037 DOI: 10.1111/1475-6773.14244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To use evidence on addressing racism in social care intervention research to create a framework for advancing health equity for all populations with marginalized social identities (e.g., race, gender, and sexual orientation). Such groups have disproportionate social needs (e.g., food insecurity) and negative social determinants of health (SDOH; e.g., poverty). We recommend how the Agency for Healthcare Research and Quality (AHRQ) could advance health equity for marginalized populations through social care research and care delivery. DATA SOURCES AND STUDY SETTING This commentary is informed by a literature review of social care interventions that were affiliated with healthcare systems; input from health equity researchers, policymakers, and community leaders attending the AHRQ Health Equity Summit; and consensus of the authors. PRINCIPAL FINDINGS We recommend that AHRQ: (1) create an ecosystem that values research on SDOH and the effectiveness and implementation of social care interventions in the healthcare sector; (2) work with other federal agencies to (a) develop position statements with actionable recommendations about racism and other systems that perpetuate marginalization based on social identity and (b) develop aligned, complementary approaches to research and care delivery that address social marginalization; (3) advance both inclusive care delivery and inclusive research teams; (4) advance understanding of racism as a social determinant of health and effective strategies to mitigate its adverse impact on health; (5) advance the creation and scaling of effective strategies for addressing SDOH in healthcare systems, particularly in co-creation with community partners; and (6) require social care intervention researchers to use methods that advance our understanding of social health equity. CONCLUSIONS AHRQ, as a federal agency, could help advance health equity using a range of strategies, including using the agency's levers to ensure AHRQ stakeholders examine and address the unique experiences of socially marginalized populations in SDOH and social care intervention research.
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Affiliation(s)
- Monica E. Peek
- Section of General Internal Medicine, Chicago Center for Diabetes Translation Research, MacLean Center for Clinical Medical Ethics, Center for the Study of Race, Politics and CultureThe University of ChicagoChicagoIllinoisUSA
| | - Laura M. Gottlieb
- Social Interventions Research and Evaluation Network (SIREN), Center for Health and CommunityUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Chyke A. Doubeni
- The Ohio State University Wexner Medical Center, Family and Community MedicineThe Ohio State University College of MedicineColumbusOhioUSA
| | | | - Yuri Cartier
- Social Interventions Research and Evaluation Network (SIREN), Center for Health and CommunityUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Benjamin Aceves
- School of Public HealthSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Caroline Fichtenberg
- Department of Family and Community Medicine, Social Interventions Research and Evaluation Network (SIREN), Center for Health and Community ResearcherUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Crystal W. Cené
- Section of General Internal MedicineUniversity of CaliforniaSan DiegoCaliforniaUSA
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14
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Sharrief A. Achieving Equity in Stroke Care and Outcomes: A Comment on an AHA Scientific Statement. Stroke 2023; 54:2958-2960. [PMID: 37753650 DOI: 10.1161/strokeaha.123.043542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Racial disparities in stroke outcomes have been described for over a century. Racial and ethnic inequities in care and disparities in outcomes exist across the continuum of stroke care. In this commentary, I discuss several themes that emerged from the recent article, Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control: A Scientific Statement From the American Heart Association. This statement provides a comprehensive overview of interventions aimed at reducing racial and ethnic disparities and highlights gaps in knowledge and research priorities.
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Affiliation(s)
- Anjail Sharrief
- Department of Neurology, McGovern Medical School at the University of Texas Health Sciences Center, Houston
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15
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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Li Z, Li J, Yang L, Tan J, Zhu F, Wan LH. Effects of a digital learning platform on health behaviours in stroke patients from baseline to 6 months after discharge: a randomized controlled trial. Eur J Cardiovasc Nurs 2023; 22:575-585. [PMID: 36790874 DOI: 10.1093/eurjcn/zvad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 01/17/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
AIMS Improving the health behaviour can help prevent stroke recurrence. The existing health education interventions require more human resource. There is a lack of constructing a low-cost, highly universal, and easy-to-use stroke secondary prevention platform based on the existing medical resources. METHODS AND RESULTS This was a randomized controlled trial to test the effects of a digital learning platform on the health knowledge, beliefs, and behaviours of stroke patients from baseline to 6 months after discharge. The control group received routine health education while the intervention group received health belief education during hospitalization and used a digital learning platform for 6 months after discharge. The health knowledge was assessed by The Stroke Health Knowledge Questionnaire, health beliefs by The Short Form Health Belief Model Scale for Stroke Patients, and health behaviours by the Stroke Health Behavior Scale. A total of 90 patients were included: 45 each in the intervention group and the control group, of whom 38 and 37 completed the study, respectively. At 6 months after discharge, (1) the health knowledge score of the intervention group was insignificantly higher than that of the control group, (2) the health belief score of the intervention group was significantly higher than that of the control group, and (3) the intervention group had higher health behaviour scores especially in physical activity than that of the control group. Other health behaviour dimensions have time effect, but not significant. CONCLUSIONS The digital learning platform can improve health behaviours of stroke patients 6 months after discharge, especially in physical activity. REGISTRATION ChiCTR1800019936.
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Affiliation(s)
- Zhuoran Li
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Rd. 2, Guangzhou 510089, China
| | - Jingjing Li
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Rd. 2, Guangzhou 510089, China
| | - Lijun Yang
- Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Rd., Guangzhou 510120, China
| | - Juxiang Tan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, 2693 Kaichuang Road, Guangzhou 510013, China
| | - Fenyan Zhu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, 2693 Kaichuang Road, Guangzhou 510013, China
| | - Li-Hong Wan
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Rd. 2, Guangzhou 510089, China
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Johnson KH, Gardener H, Gutierrez C, Marulanda E, Campo-Bustillo I, Gordon Perue G, Hlaing W, Sacco R, Romano JG, Rundek T. Disparities in transitions of acute stroke care: The transitions of care stroke disparities study methodological report. J Stroke Cerebrovasc Dis 2023; 32:107251. [PMID: 37441890 PMCID: PMC10529930 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE The Transitions of Stroke Care Disparities Study (TCSD-S) is an observational study designed to determine race-ethnic and sex disparities in post-hospital discharge transitions of stroke care and stroke outcomes and to develop hospital-level initiatives to reduce these disparities to improve stroke outcomes. MATERIALS AND METHODS Here, we present the study rationale, describe the methodology, report preliminary outcomes, and discuss a critical need for the development, implementation, and dissemination of interventions for successful post-hospital transition of stroke care. The preliminary outcomes describe the demographic, stroke risk factor, socioeconomic, and acute care characteristics of eligible participants by race-ethnicity and sex. We also report on all-cause and vascular-related death, readmissions, and hospital/emergency room representations at 30- and 90-days after hospital discharge. RESULTS The preliminary sample included data from 1048 ischemic stroke and intracerebral hemorrhage discharged from 10 comprehensive stroke centers across the state of Florida. The overall sample was 45% female, 22% Non-Hispanic Black and 21% Hispanic participants, with an average age of 64 ± 14 years. All cause death, readmissions, or hospital/emergency room representations are 10% and 19% at 30 and 90 days, respectively. One in 5 outcomes was vascular-related. CONCLUSIONS This study highlights the transition from stroke hospitalization as an area in need for considerable improvement in systems of care for stroke patients discharged from hospital. Results from our preliminary analysis highlight the importance of investigating race-ethnic and sex differences in post-stroke outcomes.
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Affiliation(s)
- Karlon H Johnson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA.
| | - Hannah Gardener
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Carolina Gutierrez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Erika Marulanda
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Iszet Campo-Bustillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Gillian Gordon Perue
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - WayWay Hlaing
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Ralph Sacco
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Jose G Romano
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
| | - Tatjana Rundek
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 919, Miami, Florida 33136, USA
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Boden-Albala B, Rebello V, Drum E, Gutierrez D, Smith WR, Whitmer RA, Griffith DM. Use of Community-Engaged Research Approaches in Clinical Interventions for Neurologic Disorders in the United States: A Scoping Review and Future Directions for Improving Health Equity Research. Neurology 2023; 101:S27-S46. [PMID: 37580148 DOI: 10.1212/wnl.0000000000207563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence suggests a significant prevalence of race and ethnic disparities in the United States among people with neurologic conditions including stroke, Alzheimer disease and related dementia (ADRD), Parkinson disease (PD), epilepsy, spinal cord injury (SCI), and traumatic brain injury (TBI). Recent neurologic research has begun the paradigm shift from observational health disparities research to intervention research in an effort to narrow the disparities gap. There is an evidence base that suggests that community engagement is a necessary component of health equity. While the increase in disparities focused neurologic interventions is encouraging, it remains unclear whether and how community-engaged practices are integrated into intervention design and implementation. The purpose of this scoping review was to identify and synthesize intervention studies that have actively engaged with the community in the design and implementation of interventions to reduce disparities in neurologic conditions and to describe the common community engagement processes used. METHODS Two databases, PubMed and CINAHL, were searched to identify eligible empirical studies within the United States whose focus was on neurologic interventions addressing disparities and using community engagement practices. RESULTS We identified 392 disparity-focused interventions in stroke, ADRD, PD, epilepsy, SCI, and TBI, of which 53 studies incorporated community engagement practices: 32 stroke studies, 15 ADRD, 2 epilepsy studies, 2 PD studies, 1 SCI study, and 1 TBI study. Most of the interventions were designed as randomized controlled trials and were programmatic in nature. The interventions used a variety of community engagement practices: community partners (42%), culturally tailored materials and mobile health (40%), community health workers (32%), faith-based organizations and local businesses (28%), focus groups/health need assessments (25%), community advisory boards (19%), personnel recruited from the community/champions (19%), and caregiver/social support (15%). DISCUSSION Our scoping review reports that the proportion of neurologic intervention studies incorporating community engagement practices is limited and that the practices used within those studies are varied. The major practices used included collaboration with community partners and utilization of culturally tailored materials. We also found inconsistent reporting and dissemination of results from studies that implemented community engagement measures in their interventions. Future directions include involving the community in research early and continuously, building curricula that address challenges to community engagement, prioritizing the inclusion of community engagement reporting in peer-reviewed journals, and prioritizing and incentivizing research of subpopulations that experience disparities in neurologic conditions.
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Affiliation(s)
- Bernadette Boden-Albala
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC.
| | - Vida Rebello
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Emily Drum
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Desiree Gutierrez
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Wally R Smith
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Rachel A Whitmer
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Derek M Griffith
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
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19
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Rossi LP, Granger BB, Bruckel JT, Crabbe DL, Graven LJ, Newlin KS, Streur MM, Vadiveloo MK, Walton-Moss BJ, Warden BA, Volgman AS, Lydston M. Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association. Circulation 2023; 148:512-542. [PMID: 37427418 DOI: 10.1161/cir.0000000000001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.
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20
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Askim T, Hokstad A, Bergh E, Døhl Ø, Ellekjær H, Ihle-Hansen H, Indredavik B, Leer ASM, Lydersen S, Saltvedt I, Seljeseth Y, Thommessen B. Multimodal individualised intervention to prevent functional decline after stroke: protocol of a randomised controlled trial on long-term follow-up after stroke (LAST-long). BMJ Open 2023; 13:e069656. [PMID: 37164457 PMCID: PMC10173970 DOI: 10.1136/bmjopen-2022-069656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Multimodal interventions have emerged as new approaches to provide more targeted intervention to reduce functional decline after stroke. Still, the evidence is contradictory. The main objective of the Life After Stroke (LAST)-long trial is to investigate if monthly meetings with a stroke coordinator who offers a multimodal approach to long-term follow-up can prevent functional decline after stroke. METHODS AND ANALYSIS LAST-long is a pragmatic single-blinded, parallel-group randomised controlled trial recruiting participants living in six different municipalities, admitted to four hospitals in Norway. The patients are screened for inclusion and recruited into the trial 3 months after stroke. A total of 300 patients fulfilling the inclusion criteria will be randomised to an intervention group receiving monthly follow-up by a community-based stroke coordinator who identifies the participants' individual risk profile and sets up an action plan based on individual goals, or to a control group receiving standard care. All participants undergo blinded assessments at 6-month, 12-month and 18-month follow-up. Modified Rankin Scale at 18 months is primary outcome. Secondary outcomes are results of blood tests, blood pressure, adherence to secondary prophylaxis, measures of activities of daily living, cognitive function, physical function, physical activity, patient reported outcome measures, caregiver's burden, the use and costs of health services, safety measures and measures of adherence to the intervention. Mixed models will be used to evaluate differences between the intervention and control group for all endpoints across the four time points, with treatment group, time as categorical covariates and their interaction as fixed effects, and patient as random effect. ETHICS AND DISSEMINATION This trial was approved by the Regional Committee of Medical and Health Research Ethics, REC no. 2018/1809. The main results will be published in international peer-reviewed open access scientific journals and to policy-makers and end users in relevant channels. TRIAL REGISTRATION NUMBER ClincalTrials.gov Identifier: NCT03859063, registered on 1 March 2019.
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Affiliation(s)
- Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Hokstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Elin Bergh
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Øystein Døhl
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Finance, Trondheim Municipality, Trondheim, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Stroke, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Bent Indredavik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Stroke, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Silja Mäkitalo Leer
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health and Social Services, Trondheim Municipality, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatric Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Yngve Seljeseth
- Department of Medicine, Ålesund Hospital, Helse More og Romsdal HF, Ålesund, Norway
| | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
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21
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Amin HP, Madsen TE, Bravata DM, Wira CR, Johnston SC, Ashcraft S, Burrus TM, Panagos PD, Wintermark M, Esenwa C. Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association. Stroke 2023; 54:e109-e121. [PMID: 36655570 DOI: 10.1161/str.0000000000000418] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
At least 240 000 individuals experience a transient ischemic attack each year in the United States. Transient ischemic attack is a strong predictor of subsequent stroke. The 90-day stroke risk after transient ischemic attack can be as high as 17.8%, with almost half occurring within 2 days of the index event. Diagnosing transient ischemic attack can also be challenging given the transitory nature of symptoms, often reassuring neurological examination at the time of evaluation, and lack of confirmatory testing. Limited resources, such as imaging availability and access to specialists, can further exacerbate this challenge. This scientific statement focuses on the correct clinical diagnosis, risk assessment, and management decisions of patients with suspected transient ischemic attack. Identification of high-risk patients can be achieved through use of comprehensive protocols incorporating acute phase imaging of both the brain and cerebral vasculature, thoughtful use of risk stratification scales, and ancillary testing with the ultimate goal of determining who can be safely discharged home from the emergency department versus admitted to the hospital. We discuss various methods for rapid yet comprehensive evaluations, keeping resource-limited sites in mind. In addition, we discuss strategies for secondary prevention of future cerebrovascular events using maximal medical therapy and patient education.
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22
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Reeves MJ, Boden-Albala B, Cadilhac DA. Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations. Stroke 2023; 54:386-395. [PMID: 36689590 DOI: 10.1161/strokeaha.122.039565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2023]
Abstract
In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person's recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.
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Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Bernadette Boden-Albala
- Department of Health Society and Behavior, Department of Epidemiology and Biostatistics, Program in Public Health, Department of Neurology, School of Medicine, University of California (B.B.-A.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (D.A.C.)
- Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (D.A.C.)
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23
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Li M, Tang H, Liu X. Primary care team and its association with quality of care for people with multimorbidity: a systematic review. BMC PRIMARY CARE 2023; 24:20. [PMID: 36653754 PMCID: PMC9850572 DOI: 10.1186/s12875-023-01968-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multimorbidity is posing an enormous burden to health systems, especially for primary healthcare system. While primary care teams (PCTs) are believed to have potentials to improve quality of primary health care (PHC), less is known about their impact on the quality of care for people with multimorbidity. We assessed the characteristics of PCTs and their impact on the quality of care for people with multimorbidity and the mechanisms. METHODS: We searched PubMed, MEDLINE, EMBASE, ProQuest for published studies from January 2000 to October 2021 for studies in English. Following through PRISMA guidelines, two reviewers independently abstracted data and reconciled by consensus with a third reviewer. Titles, abstracts, and full texts were evaluated to identify relevant studies. Studies were categorized by types of interventions, the impact of interventions on outcome measures, and mechanisms of interventions. RESULTS: Seventeen studies (13 RCT, 3 cohort studies, and 1 non-randomized trial) were identified. PCTs were summarized into three types-upward PCTs, downward PCTs and traditional PCTs according to the skill mix. The upward PCTs included primary care workers and specialists from upper-level hospitals, downward PCTs involving primary care workers and lay health workers, and traditional PCTs involving physicians and care managers. PCTs improved patients' mental and psychological health outcomes greatly, and also improved patients' perceptions towards care including satisfaction with care, sense of improvement, and patient-centeredness. PCTs also improved the process of care and changed providers' behaviors. However, PCTs showed mixed effects on clinical outcome measures. CONCLUSIONS PCTs have improved mental and psychological health outcomes, the process of care, patients' care experiences, and satisfaction towards care for patients with multimorbidity. The effect of PCTs on clinical outcomes and changes in patient behaviors need to be further explored.
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Affiliation(s)
- Mingyue Li
- grid.11135.370000 0001 2256 9319Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China ,grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Beijing, 100191 China
| | - Haoqing Tang
- grid.11135.370000 0001 2256 9319Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China ,grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Beijing, 100191 China
| | - Xiaoyun Liu
- grid.11135.370000 0001 2256 9319China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Beijing, 100191 China
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24
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Cené CW, Viswanathan M, Fichtenberg CM, Sathe NA, Kennedy SM, Gottlieb LM, Cartier Y, Peek ME. Racial Health Equity and Social Needs Interventions: A Review of a Scoping Review. JAMA Netw Open 2023; 6:e2250654. [PMID: 36656582 PMCID: PMC9857687 DOI: 10.1001/jamanetworkopen.2022.50654] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Social needs interventions aim to improve health outcomes and mitigate inequities by addressing health-related social needs, such as lack of transportation or food insecurity. However, it is not clear whether these studies are reducing racial or ethnic inequities. OBJECTIVE To understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity. EVIDENCE REVIEW Sources included a scoping review of systematic searches of PubMed and the Cochrane Library from January 1, 1995, through November 29, 2021, expert suggestions, and hand searches of key citations. Eligible studies evaluated interventions addressing social needs; reported behavioral, health, or utilization outcomes or harms; and were conducted in multiracial or multiethnic populations. Two reviewers independently assessed titles, abstracts, and full text for inclusion. The team developed a framework to assess whether the study was "conceptually thoughtful" for understanding root causes of racial health inequities (ie, noted that race or ethnicity are markers of exposure to racism) and whether analyses were "analytically informative" for advancing racial health equity research (ie, examined differential intervention impacts by race or ethnicity). FINDINGS Of 152 studies conducted in multiracial or multiethnic populations, 44 studies included race or ethnicity in their analyses; of these, only 4 (9%) were conceptually thoughtful. Twenty-one studies (14%) were analytically informative. Seven of 21 analytically informative studies reported differences in outcomes by race or ethnicity, whereas 14 found no differences. Among the 7 that found differential outcomes, 4 found the interventions were associated with improved outcomes for minoritized racial or ethnic populations or reduced inequities between minoritized and White populations. No studies were powered to detect differences. CONCLUSIONS AND RELEVANCE In this review of a scoping review, studies of social needs interventions in multiracial or multiethnic populations were rarely conceptually thoughtful for understanding root causes of racial health inequities and infrequently conducted informative analyses on intervention effectiveness by race or ethnicity. Future work should use a theoretically sound conceptualization of how race (as a proxy for racism) affects social drivers of health and use this understanding to ensure social needs interventions benefit minoritized racial and ethnic groups facing social and structural barriers to health.
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Affiliation(s)
- Crystal W. Cené
- Department of Medicine, University of California, San Diego Health, San Diego
- School of Medicine, University of California, San Diego
| | - Meera Viswanathan
- RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, RTI International, Research Triangle Park
| | - Caroline M. Fichtenberg
- University of California, San Francisco Social Intervention Research and Evaluation Network, San Francisco
- School of Medicine, Department of Family and Community Medicine, Center for Health and Community, University of California, San Francisco
| | - Nila A. Sathe
- RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, RTI International, Research Triangle Park
| | - Sara M. Kennedy
- RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center, RTI International, Research Triangle Park
| | - Laura M. Gottlieb
- School of Medicine, Department of Family and Community Medicine, Center for Health and Community, University of California, San Francisco
| | - Yuri Cartier
- University of California, San Francisco Social Intervention Research and Evaluation Network, San Francisco
| | - Monica E. Peek
- Section of General Internal Medicine, MacLean Center for Clinical Medical Ethics, Center for the Study of Race, Politics and Culture, The University of Chicago, Chicago, Illinois
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25
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Cadel L, Cimino SR, Bradley-Ridout G, Hitzig SL, Patel T, Ho CH, Packer TL, Lofters AK, Hahn-Goldberg S, McCarthy LM, Guilcher SJT. Medication self-management interventions for persons with stroke: A scoping review. PLoS One 2023; 18:e0285483. [PMID: 37200316 DOI: 10.1371/journal.pone.0285483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
The use of multiple medications is common following a stroke for secondary prevention and management of co-occurring chronic conditions. Given the use of multiple medications post-stroke, optimizing medication self-management for this population is important. The objective of this scoping review was to identify and summarize what has been reported in the literature on interventions related to medication self-management for adults (aged 18+) with stroke. Electronic databases (Ovid Medline, Ovid Embase, EBSCO CINAHL, Ovid PsycINFO, Web of Science) and grey literature were searched to identify relevant articles. For inclusion, articles were required to include an adult population with stroke undergoing an intervention aimed at modifying or improving medication management that incorporated a component of self-management. Two independent reviewers screened the articles for inclusion. Data were extracted and summarized using descriptive content analysis. Of the 56 articles that met the inclusion criteria, the focus of most interventions was on improvement of secondary stroke prevention through risk factor management and lifestyle modifications. The majority of studies included medication self-management as a component of a broader intervention. Most interventions used both face-to-face interactions and technology for delivery. Behavioural outcomes, specifically medication adherence, were the most commonly targeted outcomes across the interventions. However, the majority of interventions did not specifically or holistically target medication self-management. There is an opportunity to better support medication self-management post-stroke by ensuring interventions are delivered across sectors or in the community, developing an understanding of the optimal frequency and duration of delivery, and qualitatively exploring experiences with the interventions to ensure ongoing improvement.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tejal Patel
- University of Waterloo School of Pharmacy, Kitchener, ON, Canada
- Schlegel-University of Waterloo Research Institute of Aging, Waterloo, ON, Canada
| | - Chester H Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tanya L Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- OpenLab, University Health Network, Toronto, ON, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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26
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Myserlis EP, Mayerhofer E, Abramson JR, Teo KC, Montgomery BE, Sugita L, Warren AD, Goldstein JN, Gurol ME, Viswanathan A, Greenberg SM, Biffi A, Anderson CD, Rosand J. Lobar intracerebral hemorrhage and risk of subsequent uncontrolled blood pressure. Eur Stroke J 2022; 7:280-288. [PMID: 36082262 PMCID: PMC9446337 DOI: 10.1177/23969873221094412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Uncontrolled blood pressure (BP) in intracerebral hemorrhage (ICH) survivors is common and associated with adverse clinical outcomes. We investigated whether characteristics of the ICH itself were associated with uncontrolled BP at follow-up. METHODS Subjects were consecutive patients aged ⩾18 years with primary ICH enrolled in the prospective longitudinal ICH study at Massachusetts General Hospital between 1994 and 2015. We assessed the prevalence of uncontrolled BP (mean BP ⩾140/90 mmHg) 6 months after index event. We used multivariable logistic regression models to assess the effect of hematoma location, volume, and event year on uncontrolled BP. RESULTS Among 1492 survivors, ICH was lobar in 624 (42%), deep in 749 (50%), cerebellar in 119 (8%). Lobar ICH location was associated with increased risk for uncontrolled BP after 6 months (OR 1.35; 95% CI [1.08-1.69]). On average, lobar ICH survivors were treated with fewer antihypertensive drugs compared to the rest of the cohort: 2.1 ± 1.1 vs 2.5 ± 1.2 (p < 0.001) at baseline and 1.8 ± 1.2 vs. 2.4 ± 1.2 (p < 0.001) after 6 months follow-up. After adjustment for the number of antihypertensive drugs prescribed, the association of lobar ICH location with risk of uncontrolled BP was eliminated. CONCLUSIONS ICH survivors with lobar hemorrhage were more likely to have uncontrolled BP after 6 months follow-up. This appears to be a result of being prescribed fewer antihypertensive medications. Future treatment strategies should focus on aggressive BP control after ICH independent of hemorrhage location.
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Affiliation(s)
- Evangelos Pavlos Myserlis
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Ernst Mayerhofer
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica R Abramson
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Kay-Cheong Teo
- Department of Medicine, Queen Mary
Hospital, LKS Faculty of Medicine, The University of Hong Kong, HK, China SAR
| | - Bailey E. Montgomery
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Lansing Sugita
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew D Warren
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine,
Massachusetts General Hospital, Boston, MA, USA
| | - Mahmut Edip Gurol
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher D Anderson
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Center for Genomic Medicine,
Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population
Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Henry and Allison McCance Center for
Brain Health, Massachusetts General Hospital, Boston, MA, USA
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Li H, Xu D, Xu Y, Wei L. Impact of Medical Community Model on Intravenous Alteplase Door-to-Needle Times and Prognosis of Patients With Acute Ischemic Stroke. Front Surg 2022; 9:888015. [PMID: 35574548 PMCID: PMC9091958 DOI: 10.3389/fsurg.2022.888015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
Abstract
Objective In this study, we retrospectively analyzed 795 AIS patients who received intravenous alteplase for thrombolytic therapy in one third-class hospital or three second-class hospitals in Dongyang City and sought to evaluate the effects of the medical community model on intravenous alteplase door-to-needle time (DNT) and prognosis of patients with acute ischemic stroke. Methods According to whether the medical community model is established or not, 303 AIS patients (204 cases from the third-class hospital and 99 cases from three second-class hospitals) were assigned to control group unavailable to the medical community model and 492 AIS patients (297 cases from the third-class hospital, and 195 cases from three second-class hospitals) into observational group available to the medical community model. Results A higher thrombolysis rate, a shorter DNT, more patients with DNT ≤ 60 min and DNT ≤ 45 min, a shorter ONT, lower National Institutes of Health Stroke Scale (NIHSS) scores at 24 h, 7 d, 14 d, and modified Rankin scale (mRS) scores at 3 months after thrombolytic therapy, a shorter length of hospital stay, and less hospitalization expense were found in the observational group than the control group. Subgroup analysis based on different-class hospitals revealed that the medical community model could reduce the DNT and ONT to increase the thrombolysis rate of AIS patients, especially in low-class hospitals. After the establishment of the medical community model, the AIS patients whether from the third-class hospital or three second-class hospitals exhibited lower NIHSS scores at 24 h, 7 d, 14 d after thrombolytic therapy (p < 0.05). After a 90-day follow-up for mRS scores, a significant difference was only noted in the mRS scores of AIS patients from the third-class hospital after establishing the medical community model (p < 0.05). It was also found that the medical community model led to reduced length of hospital stay and hospitalization expenses for AIS patients, especially for the second-class hospitals. Conclusion The data suggest that the medical community model could significantly reduce intravenous alteplase DNT and improve the prognosis of patients with AIS.
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Khalesi S, Williams E, Irwin C, Johnson DW, Webster J, McCartney D, Jamshidi A, Vandelanotte C. Reducing salt intake: a systematic review and meta-analysis of behavior change interventions in adults. Nutr Rev 2021; 80:723-740. [PMID: 34921314 PMCID: PMC8907486 DOI: 10.1093/nutrit/nuab110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Prolonged high salt (sodium) intake can increase the risk of hypertension and cardiovascular disease. Behavioral interventions may help reduce sodium intake at the population level. OBJECTIVE The effectiveness of behavior change interventions to reduce sodium intake in adults was investigated in this systematic review and meta-analysis. DATA SOURCE The PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and EMBASE databases were searched. DATA EXTRACTION Narrative synthesis and random-effects meta-analyses were used to determine intervention efficacy. A total of 61 trials (46 controlled trials and 15 quasi-experimental studies) were included. RESULTS Behavior change interventions resulted in significant improvements in salt consumption behavior (eg, decrease in purchase of salty foods; increase in use of salt substitutes), leading to reductions in sodium intake as measured by urinary sodium in 32 trials (N = 7840 participants; mean difference, -486.19 mg/d [95%CI, -669.44 to -302.95]; P < 0.001; I2 = 92%) and dietary sodium in 19 trials (N = 3750 participants; mean difference -399.86 mg/d [95%CI, -581.51 to -218.20]; P < 0.001; I2 = 96%), equivalent to a reduction of >1 g of salt intake daily. Effects were not significantly different based on baseline sodium intakes, blood pressure status, disease status, the use of behavior change theories, or the main method of intervention delivery (ie, online vs face-to-face). CONCLUSION Behavior change interventions are effective at improving salt consumption practices and appear to reduce salt intake by >1 g/d. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020185639.
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Affiliation(s)
- Saman Khalesi
- Appelton Institute & School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton & Brisbane, Queensland, Australia
| | - Edwina Williams
- Appelton Institute & School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton & Brisbane, Queensland, Australia
| | - Christopher Irwin
- Menzies Health Institute Queensland and School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia. D.W Johnson is with the Metro South Integrated Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Danielle McCartney
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | | | - Corneel Vandelanotte
- Appelton Institute & School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton & Brisbane, Queensland, Australia
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Michalski D, Prost A, Handel T, Schreiber M, Tylcz JB, Geisler D, Urban D, Schramm S, Lippmann S, Gullnick J, Neumuth T, Classen J, Ivanova G. The PostStroke-Manager - combining mobile, digital and sensor-based technology with personal assistance: protocol of the feasibility study. Neurol Res Pract 2021; 3:53. [PMID: 34503568 PMCID: PMC8426588 DOI: 10.1186/s42466-021-00137-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/08/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Post stroke management has moved into the focus as it represents the only way to secure acute treatment effects in the long term. Due to individual courses, post stroke management appears rather challenging and is hindered by existing barriers between treatment sectors. As a novel concept, the PostStroke-Manager combines digital and sensor-based technology with personal assistance to enable intersectoral cooperation, best possible reduction of stroke-related disability, optimal secondary prevention, and detection of physical and psychological comorbidities. METHODS This prospective single-center observational study aims to investigate the feasibility of the PostStroke-Manager concept in an outpatient setting. Ninety patients who have suffered an ischemic or hemorrhagic stroke or transient ischemic attack will be equipped with a tablet and mobile devices recording physical activity, blood pressure, and electrocardiographic signals. Through a server-based platform, patients will be connected with the primary care physician, a stroke pilot and, if necessary, other specialists who will use web-based platforms. Via the tablet, patients will have access to an application with 10 newly designed components including, for instance, a communication tool, medication schedule, medical records platform, and psychometric screenings (e.g., depression, anxiety symptoms, quality of life, adherence, cognitive impairment). During the 1-year follow-up period, clinical visits are scheduled at three-month intervals. In the interim, communication will be secured by an appropriate tool that includes text messenger, audio, and video telephony. As the primary endpoint, feasibility will be measured by a 14-item questionnaire that addresses digital components, technical support, and personal assistance. The PostStroke-Manager will be judged feasible if at least 50% of these aspects are rated positively by at least 75% of patients. Secondary endpoints include feedback from professionals and longitudinal analyses on clinical and psychometric parameters. PERSPECTIVE This study will answer the question of whether combined digital and personal support is a feasible approach to post stroke management. Furthermore, the patient perspective gained regarding digital support may help to specify future applications. This study will also provide information regarding the potential use of remote therapies and mobile devices in situations with limited face-to-face contacts. TRIAL REGISTRATION German Register for Clinical Trials ( DRKS00023213 .), registered 27 April 2021.
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Affiliation(s)
- Dominik Michalski
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Alexander Prost
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Till Handel
- Innovation Center Computer Assisted Surgery, University of Leipzig, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Max Schreiber
- Innovation Center Computer Assisted Surgery, University of Leipzig, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Jean-Baptiste Tylcz
- Innovation Center Computer Assisted Surgery, University of Leipzig, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Daniela Geisler
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Daniela Urban
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Stephanie Schramm
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Stefan Lippmann
- Department of Primary Care, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Jenny Gullnick
- Department of Primary Care, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery, University of Leipzig, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Joseph Classen
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Galina Ivanova
- Innovation Center Computer Assisted Surgery, University of Leipzig, Semmelweisstr. 14, 04103, Leipzig, Germany
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