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Hollick RJ, James WRG, Nicoll A, Locock L, Black C, Dhaun N, Egan AC, Fluck N, Laidlaw L, Lanyon PC, Little MA, Luqmani RA, Moir L, McBain M, Basu N. Identifying key health system components associated with improved outcomes to inform the re-configuration of services for adults with rare autoimmune rheumatic diseases: a mixed-methods study. THE LANCET. RHEUMATOLOGY 2024; 6:e361-e373. [PMID: 38782514 DOI: 10.1016/s2665-9913(24)00082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Adults with rare autoimmune rheumatic diseases face unique challenges and struggles to navigate health-care systems designed to manage common conditions. Evidence to inform an optimal service framework for their care is scarce. Using systemic vasculitis as an exemplar, we aimed to identify and explain the key service components underpinning effective care for rare diseases. METHODS In this mixed-methods study, data were collected as part of a survey of vasculitis service providers across the UK and Ireland, interviews with patients, and from organisational case studies to identify key service components that enable good care. The association between these components and patient outcomes (eg, serious infections, mortality) and provider outcomes (eg, emergency hospital admissions) were examined in a population-based data linkage study using routine health-care data obtained from patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis from national health datasets in Scotland. We did univariable and multivariable analyses using Bayesian poisson and negative binomial regression to estimate incident rate ratios (IRRs), and Cox proportional hazards models to estimate hazard ratios (HRs). People with lived experiences were involved in the research and writing process. FINDINGS Good care was characterised by service components that supported timely access to services, integrated care, and expertise. In 1420 patients with ANCA-associated vasculitis identified from national health datasets, service-reported average waiting times for new patients of less than 1 week were associated with fewer serious infections (IRR 0·70 [95% credibility interval 0·55-0·88]) and fewer emergency hospital admissions (0·78 [0·68-0·92]). Nurse-led advice lines were associated with fewer serious infections (0·76 [0·58-0·93]) and fewer emergency hospital admissions (0·85 [0·74-0·96]). Average waiting times for new patients of less than 1 week were also associated with reduced mortality (HR 0·59 [95% credibility interval 0·37-0·93]). Cohorted clinics, nurse-led clinics, and specialist vasculitis multi-disciplinary team meetings were associated with fewer serious infections (IRR 0·75 [0·59-0·96] for cohorted clinics; 0·65 [0·39-0·84] for nurse-led clinics; 0·72 [0·57-0·90] for specialist vasculitis multi-disciplinary team meetings) and emergency hospital admissions (0·81 [0·71-0·91]; 0·75 [0·65-0·94]; 0·86 [0·75-0·96]). Key components were characterised by their ability to overcome professional tensions between specialties. INTERPRETATION Key service components associated with important health outcomes and underpinning factors were identified to inform initiatives to improve the design, delivery, and effectiveness of health-care models for rare autoimmune rheumatic diseases. FUNDING Versus Arthritis.
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Affiliation(s)
- Rosemary J Hollick
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK.
| | - Warren R G James
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Avril Nicoll
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Corri Black
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK; NHS Grampian, Foresterhill, Aberdeen, UK
| | - Neeraj Dhaun
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Allyson C Egan
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, Ireland
| | | | - Lynn Laidlaw
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Peter C Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK; Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mark A Little
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Laura Moir
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Maureen McBain
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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Chen Y, Lei Q, Li J, Li J, He Y, Li J, Xing S, Fan Y, Zeng J. Certification of stroke centers at primary hospitals and the improvement of thrombolysis n South China during 2020-2022. Eur Stroke J 2024; 9:477-485. [PMID: 38189301 DOI: 10.1177/23969873231223062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION IVT use declined globally in 2020 due to the Corona Virus Disease 2019 (COVID-19) pandemic, but it increased in South China. This study was conducted to evaluate the association of establishing Stroke Prevention Centers (SPCs) at primary hospitals with IVT increase in South China. MATERIALS AND METHODS We conducted a longitudinal observational study across 336 hospitals in 114 areas in South China during 2020-2022. Data regarding certified stroke centers, IVT volumes, and IVT rates were collected. Correlations between IVT rates and the number or density of stroke centers were accessed. IVT use was compared among areas with different levels of stroke centers or on different certification process. RESULTS During 2020-2022, there were 83, 125, and 152 stroke centers, with 26, 65, and 92 SPCs, respectively. IVT therapies were 12,795, 17,266, and 20,411, representing a 29.8% increase/year (all p < 0.001). IVT rates increased from 7.2% in 2020 to 8.8% and 10.4% in 2021 and 2022, demonstrating a 22.2% increase/year (all p < 0.001). IVT rates correlated with the number and density of SPCs (all p < 0.05). IVT rates were higher in areas equipped with SPCs than in those without stroke centers (all p < 0.05). IVT rates consistently increased during the SPC certification process from 1 year before through the certification and subsequent maintenance (both p < 0.05). DISCUSSION AND CONCLUSION Well-organised SPCs and IVT therapy demonstrated substantial increase during the 3-year period. Certification of SPCs at primary hospitals is associated with improved IVT therapy in South China even with city lockdown during COVID-19 pandemic.
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Affiliation(s)
- Yicong Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Qingfeng Lei
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
- Department of Neurology, The Sixth Affiliated Hospital, Sun Yat-sen University, Yuancun, Guangzhou, China
| | - Jiaoxing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jianle Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yinxin He
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jingjing Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Shihui Xing
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yuhua Fan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases; National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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Prust ML, Forman R, Ovbiagele B. Addressing disparities in the global epidemiology of stroke. Nat Rev Neurol 2024; 20:207-221. [PMID: 38228908 DOI: 10.1038/s41582-023-00921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.
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Affiliation(s)
- Morgan L Prust
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Rachel Forman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, CA, USA
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Shrestha GS, Nepal G, Prust ML. Developing Systems of Emergency and Inpatient Neurologic Care in Resource-Limited Settings. Semin Neurol 2024; 44:105-118. [PMID: 38485125 DOI: 10.1055/s-0043-1778638] [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: 04/19/2024]
Abstract
Neurologic diseases represent a significant global health challenge, leading to disability and mortality worldwide. Healthcare systems in low- and middle-income countries are disproportionally affected. In these resource-limited settings, numerous barriers hinder the effective delivery of emergency and inpatient neurologic care, including shortages of trained personnel, limited access to diagnostics and essential medications, inadequate facilities, and absence of rehabilitation services. Disparities in the neurology workforce, limited access to neuroimaging, and availability of acute interventions further exacerbate the problem. This article explores strategies to enhance global capacity for inpatient neurologic care, emphasizing the importance of workforce development, context-specific protocols, telehealth solutions, advocacy efforts, and collaborations.
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Affiliation(s)
- Gentle Sunder Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Gaurav Nepal
- Department of General Medicine, Rani Primary Healthcare Centre, Rani, Biratnagar, Nepal
| | - Morgan Lippitt Prust
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
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Silva GS, Rocha E. Developing Systems of Care for Stroke in Resource-limited Settings. Semin Neurol 2024; 44:119-129. [PMID: 38513704 DOI: 10.1055/s-0044-1782617] [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: 03/23/2024]
Abstract
Although stroke prevention and treatment strategies have significantly advanced in recent years, implementation of these care elements in resource-limited settings can be challenging, since the burden of stroke is higher and access to stroke care is lower. Barriers to stroke care in resource-limited settings include insufficient prevention, reduced awareness of stroke symptoms, limited prehospital care and lack of triage systems, limited access to comprehensive stroke centers, inadequate personnel education, lack of staff and resources, as well as limited access to neuroimaging, thrombolytics, mechanical thrombectomy, neurosurgical care, and rehabilitation. Here, we suggest strategies to improve stroke care in these settings, including public health campaigns, protocols for prehospital notification, organized flow to specialized stroke centers, development of dedicated stroke units, and utilization of telemedicine and telerehabilitation. We also highlight the role of international organizations and governments in reducing the global burden of stroke.
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Affiliation(s)
- Gisele Sampaio Silva
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Neurology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eva Rocha
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
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Thiengtham S, Chiang-Hanisko L, D'Avolio D, Sritanyarat W. Experience of Transitional Care Among Thai-Isan Older Stroke Survivors and Their Family Caregivers. QUALITATIVE HEALTH RESEARCH 2024:10497323241232937. [PMID: 38482851 DOI: 10.1177/10497323241232937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The transitional care model for people who have suffered brain injuries is a relatively recent addition to the Thai healthcare system. The aim of this study was to explore experience of Thai Isan older stroke survivors and their family caregivers across different points of transition from hospital to home. Fifteen dyads of older stroke survivors and their family caregivers were recruited following the inclusion and exclusion criteria. Data were collected through participant observations and semi-structured interviews. Forty-seven participation observation field notes and twenty-four interview transcriptions were analyzed using the Four Phases of the Data Analysis Enabler and the Leininger-Templin-Thompson Ethnoscript Coding Enabler. Three themes emerged: I feel lost with managing care at home; it has been challenging for our family to maintain continuity of care; and it is a matter of who fits in and is convenient for family care responsibilities. The findings of this study have highlighted the dispersion of care among Thai-Isan people during the patient's transition to home. Therefore, a transitional care plan should be developed that specifies who is responsible for monitoring and supporting patients and families throughout this period.
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Affiliation(s)
- Supavadee Thiengtham
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Lenny Chiang-Hanisko
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Deborah D'Avolio
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Wanapa Sritanyarat
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
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Xue X, Zhang L, Zhen J, Zeng X. Effects of evidence-based nursing in patients with stroke: A systematic review and meta-analysis. Nurse Educ Pract 2024; 76:103921. [PMID: 38395003 DOI: 10.1016/j.nepr.2024.103921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
AIM The aim of this study was to evaluate the efficacy of evidence-based nursing (EBN) in patients with confirmed stroke. BACKGROUND After acute hospital treatment, stroke patients often return home for rehabilitation. Stroke ward nursing, demonstrates improved disability-free survival rates. EBN as a new nursing paradigm, rooted in authentic scientific evidence, will transform traditional nursing models. The goal is to advance nursing science, enhance practices and optimize patient outcomes. DESIGN AND METHODS PubMed, Embase, Cochrane Library and Web of Science were comprehensively searched from the inception to July 2nd, 2023. 13015 patients with confirmed stroke were included, of which 3351 patients were in EBN group, 9664 patients were in the control group. Odd ratio (OR) and standardized mean difference (SMD) and the 95% confidence intervals (CIs) were calculated. RESULTS Twelve studies were included in this study. The risk of bias in included studies was assessed as low. The OR for cumulative death was 1.61 (95% CI: 0.68, 3.85; z = 1.08, P = 0.2811). The pooled SMD for SF-36 physical component scores was -0.06 (95% CI: -1.15, 0.04; z = -1.11, P = 0.2688). The SMD for SF-36 mental health scores was -0.01 (95% CI: -0.10, 0.09; z = -0.10, P = 0.9207). The SMD for WHOQOL-BREF mentality scores was -0.06 (95% CI: -0.21, 0.10; z = -0.71, P = 0.4754). The SMD for WHOQOL-BREF physiology scores was 1.13 (95% CI: -1.13, 3.39; z = 0.98, P = 0.3283). CONCLUSIONS EBN is effective in improving psychological status, physical functions and quality of life in patients with stroke in individual studies, efficacy of EBN was not observed in pooled analyses, more evidence-based information is needed to comprehensively assess the efficacy of EBN in stroke patients.
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Affiliation(s)
- Xiaolu Xue
- Department of Neurology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi 030024, China.
| | - Lifang Zhang
- Department of Nursing, Shanxi Coal Central Hospital, Taiyuan, Shanxi 030006, China
| | - Jiao Zhen
- Department of Neurology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Xiaoxia Zeng
- Department of Nursing, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi 030024, China
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Sadiq E, von Klemperer A, Woodiwiss A, Norton G, Modi G. Stroke as the index presentation of traditional cardiovascular risk factors and Human Immunodeficiency Virus in a South African population. J Stroke Cerebrovasc Dis 2024; 33:107529. [PMID: 38103446 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES We sought to identify what proportion of each cardiovascular risk factor and Human Immunodeficiency Virus (HIV) was first diagnosed at the time of stroke, compared to those that were diagnosed prior to the event, and to explore if this had any impact on the severity of stroke. METHODS Adult patients presenting with a new stroke to a quaternary hospital in Johannesburg between 2014 and 2017 were prospectively recruited. Patients were investigated for undiagnosed traditional cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidaemia, atrial fibrillation, obesity and smoking), as well as HIV infection. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). RESULTS 346 patients were included. Stroke was the index presentation for at least one risk factor in 199 (57.5 %) patients. Dyslipidaemia was newly diagnosed in 76.0 % of all dyslipidaemics (95 out of 125). Newly-diagnosed dyslipidaemia was associated with a more severe neurological deficit (Median NIHSS of 12 (8-16) vs 7 (4-12), p=0.0007) and younger age on presentation (53 (44-63) years vs 62 (51-71) years, p=0.02) as compared to previously-diagnosed dyslipidaemia. CONCLUSIONS More than half of patients had previously undiagnosed modifiable risk factors at the time of their stroke. Dyslipidaemia was undiagnosed in a very high proportion, and this was associated with a higher stroke severity and younger age of presentation.
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Affiliation(s)
- Eitzaz Sadiq
- Division of Neurology, Department of Neurosciences, School of Clinical Medicine and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa.
| | - Alexander von Klemperer
- Division of Neurology, Department of Neurosciences, School of Clinical Medicine and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
| | - Angela Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Girish Modi
- Division of Neurology, Department of Neurosciences, School of Clinical Medicine and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
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Tan E, Gao L, Tran HN, Cadilhac D, Bladin C, Moodie M. Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost-utility analysis for a middle income country. J Telemed Telecare 2024; 30:18-30. [PMID: 34292801 DOI: 10.1177/1357633x211032407] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Telemedicine can alleviate the problems faced in rural settings in providing access to specialist stroke care. The evidence of the cost-effectiveness of this model of care outside high-income countries is limited. This study aimed to conduct: (a) a systematic review of economic evaluations of telestroke and (b) a cost-utility analysis of telestroke, using China as a case study. METHODS We systematically searched Embase, Medline Complete and Cochrane databases. Inclusion criteria: full economic evaluations of telemedicine/telestroke networks examining the use of thrombolysis in patients with acute ischaemic stroke, published in English. A cost-utility analysis was undertaken using a Markov model incorporating a decision tree to simulate the delivery of telestroke for acute ischaemic stroke in rural China, compared to no telestroke from a societal and healthcare perspective. One-way deterministic sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of results. RESULTS Of 559 publications found, eight met the eligibility criteria and were included in the systematic review (two cost-effectiveness analyses and six cost-utility analyses, all performed in high-income countries). Telestroke was a cost-saving/cost-effective intervention in five out of the eight studies. In our modelled analysis for rural China, telestroke was the dominant strategy, with estimated cost savings of Chinese yuan 4,328 (US$627) and additional 0.0925 quality-adjusted life years per patient. Sensitivity analyses confirmed the base case results. DISCUSSION Consistent with published economic evaluations of telestroke in other jurisdictions, telestroke represents a cost-effective solution to enhance stroke care in rural China.
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Affiliation(s)
- Elise Tan
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Huong Nq Tran
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Dominique Cadilhac
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
| | - Chris Bladin
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia
- Public Health and Health Services Research, The Florey Institute Neuroscience and Mental Health, University of Melbourne, Australia
- Ambulance Victoria, Australia
- Eastern Health Clinical School, Monash University, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Australia
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Jia DT, Carcamo PM, Diaz MM. Ongoing Healthcare Disparities in neuroHIV: Addressing Gaps in the Care Continuum. Curr HIV/AIDS Rep 2023; 20:368-378. [PMID: 37999827 DOI: 10.1007/s11904-023-00683-9] [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] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW We aim to review the neurological complications of HIV and the social, cultural, and economic inequalities that contribute to disparities in neuroHIV care. RECENT FINDINGS Disparities in diagnostics and care of patients with neurological infections and non-infectious conditions associated with HIV in both high-income and low-to-middle-income countries (LMIC) are common. The COVID-19 pandemic has exacerbated these disparities. Factors, such as HIV-related stigma, may deter people from accessing HIV treatment. First-line recommended treatments for neurological infections are not available in many LMICs, leading to inadequate treatment and exposure to agents with more harmful side effect profiles. Access-related factors, such as lack of transportation, lack of health insurance, and inadequate telehealth access, may increase the risk of HIV-related neurological complications. Further research is needed to increase awareness of neurological complications among providers and PWH, and regional guidelines should be considered to better address these complications.
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Affiliation(s)
- Dan Tong Jia
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Paloma M Carcamo
- Laboratory of Epidemiology and Public Health, Yale School of Public Health, New Haven, CT, USA
- Health Innovation Laboratory, Alexander Von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Monica M Diaz
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
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Akemokwe FM, Adejumo OA, Odiase FE, Okaka EI, Imarhiagbe FA, Ogunrin OA. Relationship between Kidney Dysfunction, Stroke Severity, and Outcomes in a Nigerian Tertiary Hospital: A Prospective Study. Niger J Clin Pract 2023; 26:1742-1749. [PMID: 38044782 DOI: 10.4103/njcp.njcp_369_23] [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: 05/13/2023] [Accepted: 07/06/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Stroke is a common neurologic disease associated with fatal outcomes. Kidney dysfunction may be an important predictor of stroke severity and outcome. AIM To determine the relationship between kidney dysfunction at admission and stroke severity and 30-day outcome. MATERIALS AND METHODS This was a prospective study that involved 150 stroke patients. Stroke severity at admission was assessed using the National Institutes of Health Stroke Scale (NIHSS). Renal dysfunction was assessed by the presence of albuminuria and or reduced glomerular filtration rate (GFR) at admission. Neurological outcome was assessed using mortality, modified Rankin Scale (mRS), and Glasgow Outcome Scale (GCS). RESULTS The mean age of the study participants was 61.0 ± 13.2 years. Renal dysfunction was present in 66% of the participants while the case fatality rate of stroke was 26%. Poor neurological outcome at 30 days was found in 44.1% of survivors. Those with albuminuria had lower GCS (P = 0.041), lower GFR (P = 0.004), higher mRS score on day 14 (P = 0.041) and day 30 (P = 0.032), and higher NIHSS score (P = 0.034). Independent predictors of 30-day mortality were albuminuria (Adjusted Odd Ratio (AOR) 3.60, 95%CI: 1.07-12.17) and increasing NIHSS score (AOR = 1.15, 95%CI: 1.04-1.28). Lower GCS (P < 0.001), elevated white blood cells (P = 0.003), serum creatinine (P = 0.048), and NIHSS score (P < 0.001) were associated with poor neurological outcome. NIHSS score was the only significant predictor of neurologic outcome (AOR: 1.25; CI: 1.11-1.41; P ≤ 0.001). CONCLUSIONS Kidney dysfunction was associated with stroke severity and mortality. However, it was not an independent predictor of neurological outcome.
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Affiliation(s)
- F M Akemokwe
- Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - O A Adejumo
- Department of Internal Medicine, University of Medical Sciences, Ondo City, Ondo State, Nigeria
| | - F E Odiase
- Department of Internal Medicine, University of Benin, Benin City, Edo State, Nigeria
| | - E I Okaka
- Department of Internal Medicine, University of Benin, Benin City, Edo State, Nigeria
| | - F A Imarhiagbe
- Department of Internal Medicine, University of Benin, Benin City, Edo State, Nigeria
| | - O A Ogunrin
- Neurology Department, Neuroscience Directorate, Royal Stoke University Hospital, University Hospital of North Midlands NHS Trust, Stoke on Trent, UK
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Xavier D, Murphy R, Pais P, Pandian J, Gosala S, Mathur N, Khurana D, Sundararajan R, Gupta R, Joshi R, Vanchilingam S, Venkatarathanamma PN, Desai S, Reddin C, O'Donnell M, Yusuf S. Characteristics, clinical practice patterns, and outcomes of strokes in India: INSPIRE-A multicentre prospective study. Int J Stroke 2023; 18:965-975. [PMID: 37114983 DOI: 10.1177/17474930231175584] [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: 04/29/2023]
Abstract
BACKGROUND India has a high burden of stroke, but there are limited data available on the characteristics of patients presenting with stroke in India. AIMS We aimed to document the clinical characteristics, practice patterns, and outcomes of patients presenting with acute stroke to Indian hospitals. METHODS A prospective registry study of patients admitted with acute clinical stroke was conducted in 62 centers across different regions in India between 2009 and 2013. RESULTS Of the 10,329 patients included in the prescribed registry, 71.4% had ischemic stroke, 25.2% had intracerebral hemorrhage (ICH), and 3.4% had an undetermined stroke subtype. Mean age was 60 years (SD = 14) with 19.9% younger than 50 years; 65% were male. A severe stroke at admission (modified-Rankin score 4-5) was seen in 62%, with 38.4% of patients having severe disability at discharge or dying during hospitalization. Cumulative mortality was 25% at 6 months. Neuroimaging was completed in 98%, 76% received physiotherapy, 17% speech and language therapy (SLT), 7.6% occupational therapy (OT), with variability among sites; 3.7% of ischemic stroke patients received thrombolysis. Receipt of physiotherapy (odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.33-0.52) and SLT (OR = 0.45, 95% CI: 0.32-0.65) was associated with lower mortality, while a history of atrial fibrillation (OR = 2.22, 95% CI: 1.37-3.58) and ICH (OR = 2.00, 95% CI: 1.66-2.40) were associated with higher mortality. CONCLUSION In the INSPIRE (In Hospital Prospective Stroke Registry) study, one-in-five patients with acute stroke was under 50 years of age, and one-quarter of stroke was ICH. There was a low provision of thrombolysis and poor access to multidisciplinary rehabilitation highlighting how improvements are needed to reduce morbidity and mortality from stroke in India.
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Affiliation(s)
| | - Robert Murphy
- HRB Clinical Research Facility, University of Galway, Galway, Ireland
| | - Prem Pais
- St. John's Research Institute, Bangalore, India
| | | | | | | | - Dheeraj Khurana
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | | | | | | | | | - Catriona Reddin
- HRB Clinical Research Facility, University of Galway, Galway, Ireland
| | - Martin O'Donnell
- HRB Clinical Research Facility, University of Galway, Galway, Ireland
- PHRI, McMasters University, Hamilton, ON, Canada
| | - Salim Yusuf
- PHRI, McMasters University, Hamilton, ON, Canada
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13
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Gerstl JVE, Blitz SE, Qu QR, Yearley AG, Lassarén P, Lindberg R, Gupta S, Kappel AD, Vicenty-Padilla JC, Gaude E, Atchaneeyasakul KC, Desai SM, Yavagal DR, Peruzzotti-Jametti L, Patel NJ, Aziz-Sultan MA, Du R, Smith TR, Bernstock JD. Global, Regional, and National Economic Consequences of Stroke. Stroke 2023; 54:2380-2389. [PMID: 37497672 PMCID: PMC7614992 DOI: 10.1161/strokeaha.123.043131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND An understanding of global, regional, and national macroeconomic losses caused by stroke is important for allocation of clinical and research resources. The authors investigated the macroeconomic consequences of stroke disease burden in the year 2019 in 173 countries. METHODS Disability-adjusted life year data for overall stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) were collected from the GBD study (Global Burden of Disease) 2019 database. Gross domestic product (GDP, adjusted for purchasing power parity [PPP]) data were collected from the World Bank; GDP and disability-adjusted life year data were combined to estimate macroeconomic losses using a value of lost welfare (VLW) approach. All results are presented in 2017 international US dollars adjusted for PPP. RESULTS Globally, in 2019, VLW due to stroke was $2059.67 billion or 1.66% of the global GDP. Global VLW/GDP for stroke subtypes was 0.78% (VLW=$964.51 billion) for ischemic stroke, 0.71% (VLW=$882.81 billion) for intracerebral hemorrhage, and 0.17% (VLW=$212.36 billion) for subarachnoid hemorrhage. The Central European, Eastern European, and Central Asian GBD super-region reported the highest VLW/GDP for stroke overall (3.01%), ischemic stroke (1.86%), and for subarachnoid hemorrhage (0.26%). The Southeast Asian, East Asian, and Oceanian GBD super-region reported the highest VLW/GDP for intracerebral hemorrhage (1.48%). CONCLUSIONS The global macroeconomic consequences related to stroke are vast even when considering stroke subtypes. The present quantification may be leveraged to help justify increased spending of finite resources on stroke in an effort to improve outcomes for patients with stroke globally.
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Affiliation(s)
- Jakob V. E. Gerstl
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Sarah E. Blitz
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Harvard Medical School, Boston, MA
| | - Qing Rui Qu
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
| | - Alexander G. Yearley
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Harvard Medical School, Boston, MA
| | - Philipp Lassarén
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Rebecca Lindberg
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Ari D. Kappel
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | - Dileep R. Yavagal
- Department of Neurology, University of Miami & Jackson Memorial Hospitals, FL
| | - Luca Peruzzotti-Jametti
- Department of Clinical Neurosciences and NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London
| | - Nirav J. Patel
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Mohammed A. Aziz-Sultan
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA
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14
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Zhang W, Jiao Y, Zhang T, Liu X, Ye J, Zhang Y, Yang B, Dai M, Shi X, Fu F, Wang L, Xu C. Early detection of acute ischemic stroke using Contrast-enhanced electrical impedance tomography perfusion. Neuroimage Clin 2023; 39:103456. [PMID: 37379734 PMCID: PMC10318520 DOI: 10.1016/j.nicl.2023.103456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
A cerebral contrast-enhanced electrical impedance tomography perfusion method is developed for acute ischemic stroke during intravenous thrombolytic therapy. Several clinical contrast agents with stable impedance characteristics and high-conductivity contrast were screened experimentally as electrical impedance contrast agent candidates. The electrical impedance tomography perfusion method was tested on rabbits with focal cerebral infarction, and its capability for early detection was verified based on perfusion images. The experimental results showed that ioversol 350 performed significantly better as an electrical impedance contrast agent than other contrast agents (p < 0.01). Additionally, perfusion images of focal cerebral infarction in rabbits confirmed that the electrical impedance tomography perfusion method could accurately detect the location and area of different cerebral infarction lesions (p < 0.001). Therefore, the cerebral contrast-enhanced electrical impedance tomography perfusion method proposed herein combines traditional, dynamic continuous imaging with rapid detection and could be applied as an early, rapid-detection, auxiliary, bedside imaging method for patients after a suspected ischemic stroke in both prehospital and in-hospital settings.
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Affiliation(s)
- Weirui Zhang
- Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan 430074, People's Republic of China; Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China
| | - Yang Jiao
- Department of Neurosurgery, Tangdu Hospital of Fourth Military Medical University, Xi'an 710032, People's Republic of China
| | - Tao Zhang
- Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China; Drug and Instrument Supervision and Inspection Station, Xining Joint Logistics Support Center, Lanzhou 730050, People's Republic of China
| | - Xuechao Liu
- Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China
| | - Jianan Ye
- Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China
| | - Yuyan Zhang
- Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China
| | - Bin Yang
- Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China
| | - Meng Dai
- Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China
| | - Xuetao Shi
- Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China
| | - Feng Fu
- Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China
| | - Liang Wang
- Department of Neurosurgery, Tangdu Hospital of Fourth Military Medical University, Xi'an 710032, People's Republic of China
| | - Canhua Xu
- Department of Biomedical Engineering, the Fourth Military Medical University, Xi'an 710032, People's Republic of China; Shaanxi Key Laboratory for Bioelectromagnetic Detection and Intelligent Perception, Xi'an 710032, People's Republic of China.
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15
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Sarfo FS, Akpa OM, Ovbiagele B, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Ogbole G, Fakunle A, Okekunle AP, Asowata OJ, Calys-Tagoe B, Uvere EO, Sanni T, Olowookere S, Ibinaiye P, Akinyemi JO, Arulogun O, Jenkins C, Lackland DT, Tiwari HK, Isah SY, Abubakar SA, Oladimeji A, Adebayo P, Akpalu J, Onyeonoro U, Ogunmodede JA, Akisanya C, Mensah Y, Oyinloye OI, Appiah L, Agunloye AM, Osaigbovo GO, Adeoye AM, Adeleye OO, Laryea RY, Olunuga T, Ogah OS, Oguike W, Ogunronbi M, Adeniyi W, Olugbo OY, Bello AH, Ogunjimi L, Diala S, Dambatta HA, Singh A, Adamu S, Obese V, Adusei N, Owusu D, Ampofo M, Tagge R, Fawale B, Yaria J, Akinyemi RO, Owolabi MO. Patient-level and system-level determinants of stroke fatality across 16 large hospitals in Ghana and Nigeria: a prospective cohort study. Lancet Glob Health 2023; 11:e575-e585. [PMID: 36805867 PMCID: PMC10080070 DOI: 10.1016/s2214-109x(23)00038-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria. METHODS The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeria. Cases include adults (aged ≥18 years) with clinical and radiological evidence of an acute stroke. Data on stroke services and resources available at each study site were collected and analysed as system-level factors. A host of demographic and clinical variables of cases were analysed as patient-level factors. A mixed effect log-binomial model including both patient-level and system-level covariates was fitted. Results are presented as adjusted risk ratios (aRRs) with respective 95% CIs. FINDINGS Overall, 814 (21·8%) of the 3739 patients admitted with stroke died as inpatients: 476 (18·1%) of 2635 with ischaemic stroke and 338 (30·6%) of 1104 with intracerebral haemorrhage. The variability in the odds of stroke fatality that could be attributed to the system-level factors across study sites assessed using model intracluster correlation coefficient was substantial at 7·3% (above a 5% threshold). Stroke units were available at only five of 16 centres. The aRRs of six patient-level factors associated with stroke fatality were: low vegetable consumption, 1·19 (95% CI 1·07-1·33); systolic blood pressure, 1·02 (1·01-1·04) for each 10 mm Hg rise; stroke lesion volume more than 30 cm3, 1·48 (1·22-1·79); National Institutes of Health Stroke Scale (NIHSS) score, 1·20 (1·13-1·26) for each 5-unit rise; elevated intracranial pressure, 1·75 (1·31-2·33); and aspiration pneumonia, 1·79 (1·16-2·77). INTERPRETATION Studies are needed to assess the efficacy of interventions targeting patient-level factors such as aspiration pneumonia in reducing acute stroke fatality in this region. Policy directives to improve stroke unit access are warranted. FUNDING US National Institutes of Health. TRANSLATIONS For the Twi, Yoruba and Hausa translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Onoja M Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria; Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
| | - Adekunle Fakunle
- Department of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Public Health, Osun State University, Osogbo, Nigeria
| | - Akinkunmi Paul Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, South Korea
| | - Osahon J Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ezinne O Uvere
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Taofeek Sanni
- Federal Teaching Hospital, Ido-Ekiti Ado-Ekiti, Nigeria
| | - Samuel Olowookere
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | - Suleiman Y Isah
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sani A Abubakar
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Josephine Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - James A Ogunmodede
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Yaw Mensah
- Korle Bu Teaching Hospital, Accra, Ghana
| | - Olalekan I Oyinloye
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Atinuke M Agunloye
- Department of Radiology, University of Ibadan, Ibadan, Nigeria; College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Abiodun M Adeoye
- Department of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria
| | | | - Ruth Y Laryea
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Obiabo Y Olugbo
- Delta State University/Delta State University Teaching Hospital, Oghara, Nigeria
| | - Abiodun H Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Luqman Ogunjimi
- Department of Pharmacology and Therapeutics, Olabisi Onabanjo University, Abeokuta, Nigeria
| | - Samuel Diala
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Vida Obese
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Nathaniel Adusei
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dorcas Owusu
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Raelle Tagge
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Joseph Yaria
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rufus O Akinyemi
- University College Hospital, Ibadan, Nigeria; Federal Medical Centre, Abeokuta, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa O Owolabi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Lebanese American University, Beirut, Lebanon; Blossom Center for Neurorehabilitation, Ibadan, Nigeria.
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16
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Socioeconomic inequities in mortality and functional outcome after stroke in Zanzibar: A prospective cohort study. J Stroke Cerebrovasc Dis 2023; 32:107081. [PMID: 36931091 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES To characterise mortality and functional outcome and their relationships with socioeconomic deprivation for women and men in Zanzibar. MATERIALS AND METHODS Participants in ZanStroke, a prospective observational study of patients admitted to hospital with a diagnosis of acute stroke, were followed up until one year after the stroke. The modified National Institute of Health Stroke Scale was used to assess initial stroke severity, while modified Rankin Scale (mRS) was used to assess disability at 12 months post-stroke. A multidimensional poverty index was created using individual-level data. Kaplan-Meier analysis and Cox regression model were used to examine associations of socioeconomic deprivation and death at 28 days and 12 months after stroke onset, while logistic regression analysis was used to examine associations between deprivation and functional outcome. RESULTS Overall mortality rate was 38.2% (CI 34.8-41.9) at 28 days, rising to 59.0% (CI 55.2-62.8) at 12 months. When adjusted for other variables, survival was higher among the least deprived (HR 0.60 CI 0.45-0.80), an association that was strongly significant for women (HR 0.46 CI 0.29-0.74). Among 12-month survivors 45.1% (n = 122) had no/low level of disability (mRS 0-2), while 22.9% (n = 62) were unable to walk independently or at all. No difference between socioeconomic deprivation and outcome was seen at one year. CONCLUSION Case-fatality rates were high, and socioeconomic disparities were evident even during the acute stroke phase. Policies are needed to reduce significant health disparities, adapt evidence-based interventions, and promote equitable access to stroke care and rehabilitation.
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Scheffler E, Mash R. A stroke rehabilitation training program for community-based primary health care, South Africa. Afr J Disabil 2023; 12:1135. [PMID: 37065935 PMCID: PMC10091063 DOI: 10.4102/ajod.v12i0.1135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/09/2022] [Indexed: 03/05/2023] Open
Abstract
Background With an increasing burden of stroke and a lack of access to rehabilitation services in rural South African settings, stroke survivors rely on untrained family caregivers for support and care. Community health workers (CHWs) support these families but have no stroke-specific training. Objectives To describe the development of a contextually appropriate stroke training program for CHWs in the Cape Winelands District, South Africa. Method Twenty-six health professionals and CHWs from the local primary healthcare services participated in action research over a 15-month period from September 2014 to December 2015. The groups participated in two parallel cooperative inquiry (CI) groups. The inquiry followed the cyclical steps of planning, action, observation and reflection. In this article, the planning step and how the CI groups used the first three steps of the analyse, design, develop, implement, evaluate (ADDIE) instructional design model are described. Results The CHWs' scope of practice, learning needs, competencies and characteristics, as well as the needs of the caregivers and stroke survivors, were identified in the analysis step. The program design consisted of 16 sessions to be delivered over 20 h. Program resources were developed with appropriate technology, language and instructional methodology. Conclusion The program aims to equip CHWs to support family caregivers and stroke survivors in their homes as part of their generalist scope of practice. The implementation and initial evaluation will be described in a future article. Contribution The study developed a unique training program for CHWs to support caregivers and stroke survivors in a resource-constrained, rural, middle-income country setting.
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Affiliation(s)
- Elsje Scheffler
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Disability and Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robert Mash
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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18
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Langhorne P, Ricci S. Unmet needs in acute stroke medicine. Neurol Sci 2023; 44:1127-1129. [PMID: 36602632 DOI: 10.1007/s10072-022-06595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Peter Langhorne
- University of Glasgow, Institure of Cardiovascular and Medical Sciences, Academic Section of Geriatric Medicine, Scotland, UK
| | - Stefano Ricci
- Coordinatore Comitato Scientifico, Italian Stroke Association, Perugia, Italy.
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A nomogram predictive model for long-term survival in spontaneous intracerebral hemorrhage patients without cerebral herniation at admission. Sci Rep 2023; 13:3126. [PMID: 36813798 PMCID: PMC9946945 DOI: 10.1038/s41598-022-26176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/12/2022] [Indexed: 02/24/2023] Open
Abstract
Stratification of spontaneous intracerebral hemorrhage (sICH) patients without cerebral herniation at admission, to determine the subgroups may be suffered from poor outcomes or benefit from surgery, is important for following treatment decision. The aim of this study was to establish and verify a de novo nomogram predictive model for long-term survival in sICH patients without cerebral herniation at admission. This study recruited sICH patients from our prospectively maintained ICH patient database (RIS-MIS-ICH, ClinicalTrials.gov Identifier: NCT03862729) between January 2015 and October 2019. All eligible patients were randomly classified into a training cohort and a validation cohort according to the ratio of 7:3. The baseline variables and long-term survival outcomes were collected. And the long-term survival information of all the enrolled sICH patients, including the occurrence of death and overall survival. Follow-up time was defined as the time from the onset to death of the patient or the last clinical visit. The nomogram predictive model was established based on the independent risk factors at admission for long-term survival after hemorrhage. The concordance index (C-index) and ROC curve were used to evaluate the accuracy of the predictive model. Discrimination and calibration were used to validate the nomogram in both the training cohort and the validation cohort. A total of 692 eligible sICH patients were enrolled. During the average follow-up time of 41.77 ± 0.85 months, a total of 178 (25.7%) patients died. The Cox Proportional Hazard Models showed that age (HR 1.055, 95% CI 1.038-1.071, P < 0.001), Glasgow Coma Scale (GCS) at admission (HR 2.496, 95% CI 2.014-3.093, P < 0.001) and hydrocephalus caused by intraventricular hemorrhage (IVH) (HR 1.955, 95% CI 1.362-2.806, P < 0.001) were independent risk factors. The C index of the admission model was 0.76 and 0.78 in the training cohort and validation cohort, respectively. In the ROC analysis, the AUC was 0.80 (95% CI 0.75-0.85) in the training cohort and was 0.80 (95% CI 0.72-0.88) in the validation cohort. SICH patients with admission nomogram scores greater than 87.75 were at high risk of short survival time. For sICH patients without cerebral herniation at admission, our de novo nomogram model based on age, GCS and hydrocephalus on CT may be useful to stratify the long-term survival outcomes and provide suggestions for treatment decision-making.
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Zeng X, Balikuddembe JK, Liang P. Impact of community-based rehabilitation on the physical functioning and activity of daily living of stroke patients: a systematic review and meta-analysis. Disabil Rehabil 2023; 45:403-414. [PMID: 35200068 DOI: 10.1080/09638288.2022.2037755] [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: 01/19/2023]
Abstract
PURPOSE This study aimed at establishing the impact of community-based rehabilitation (CBR) on the physical functioning and activity of daily living (ADL) of patients with stroke (PWS). MATERIALS AND METHODS Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic search was conducted in five databases, including PubMed, OVID Embase, OVID Medline, Cochrane Library, and Web of Science between May 2010 and 2020. Meta-analysis was performed using the Comprehensive Meta-Analysis Version 2 software to establish whether the studies were sufficiently homogenous. RESULTS Twenty studies out of 828 publications were included in the present systematic review. A significant difference between CBR intervention and control groups was identified about the physical functional capacity in mobility, 6-metre walk test (6MWT) (g = 0.351, 95% CI (0.110, 0.592)), community walking test (g= -0.473, 95% CI (-0.926, -0.020)) and on the other hand a significant improvement in ADL was found (g = 0.138, 95% CI(0.051, 0.224)). CONCLUSIONS CBR is revealed to be effective in improving the physical functioning and ADL for PWS and is drawn based on eligible studies which were conducted in high-income countries (HICs). This highlights a gap between developed and less-resourced countries as far as CBR for PWS is concerned and calls for a further study. Protocol Registration: CRD42020159683Implication for rehabilitationCommunity-based rehabilitation (CBR) is recommended as one of the best programme for treating stroke patients with stroke (PWS) after they are discharged from hospitals.CBR is effective in improving the physical functioning and activity of daily living of PWS.Further research should be carried out to compare between CBR and institution-based rehabilitation for PWS, especially the less-resourced settings which are grappling with a challenge of limited skilled rehabilitation professionals.
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Affiliation(s)
- Xinglin Zeng
- Rehabilitation Department, West China Medical School, Sichuan University, Chengdu, PR China
| | - Joseph K Balikuddembe
- Institute for Disaster Management and Reconstruction, Sichuan University and Hong-Kong Polytechnic University, Chengdu, PR China
| | - Ping Liang
- Cardiac Rehabilitation Center, Fuwai Hospital, Beijing, China
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21
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Kayola G, Mataa MM, Asukile M, Chishimba L, Chomba M, Mortel D, Nutakki A, Zimba S, Saylor D. Stroke Rehabilitation in Low- and Middle-Income Countries: Challenges and Opportunities. Am J Phys Med Rehabil 2023; 102:S24-S32. [PMID: 36634327 PMCID: PMC9846582 DOI: 10.1097/phm.0000000000002128] [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: 01/14/2023]
Abstract
ABSTRACT Stroke remains the second leading cause of global disability with 87% of stroke-related disability occurring in low- and middle-income countries. In low- and middle-income countries, access to acute stroke interventions is often limited, making effective poststroke rehabilitation potentially the best available intervention to promote poststroke recovery. Here, we build on our experience as an illustrative example of barriers individuals with stroke face in accessing rehabilitation services and review the literature to summarize challenges to providing effective rehabilitation in low- and middle-income countries. First, we focus on barriers individuals with stroke face in accessing rehabilitation in low- and middle-income countries, including health system barriers, such as lack of national guidelines, low prioritization of rehabilitation services, and inadequate numbers of skilled rehabilitation specialists, as well as patient factors, including limited health literacy, financial constraints, and transportation limitations. Next, we highlight consequences of this lack of rehabilitation access, including higher mortality, poorer functional outcomes, financial burden, caregiver stress, and loss of gross domestic product at a national level. Finally, we review possible strategies that could improve access and quality of rehabilitation services in low- and middle-income countries, including creation of inpatient stroke units, increased training opportunities for rehabilitation specialists, task shifting to available healthcare workers or caregivers, telerehabilitation, and community-based rehabilitation services.
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Affiliation(s)
- Grace Kayola
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | - Melody Asukile
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Lorraine Chishimba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Mashina Chomba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Dominique Mortel
- Department of Neurology, Johns Hopkins University School of Medicine
| | | | - Stanley Zimba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
- Department of Neurology, Johns Hopkins University School of Medicine
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22
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The Burden and In-Hospital Mortality of Stroke Admissions at a Tertiary Level Hospital in Namibia: A Retrospective Cohort Study. Stroke Res Treat 2023; 2023:1978536. [PMID: 36777446 PMCID: PMC9908341 DOI: 10.1155/2023/1978536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/25/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Background Despite stroke being a leading cause of morbidity and mortality globally, there is a dearth of information on the burden and outcomes of stroke in sub-Saharan Africa and Namibia in particular. Methods A hospital-based, retrospective cohort study was conducted to analyse non-electronic medical records of all consecutive stroke patients who were admitted to one of the highest tertiary-level hospitals in Namibia for 12 months (2019-2020). The primary outcome of the study was to establish the in-hospital mortality, stroke subtypes, and associated complications. Results In total, 220 patients were included in the study, their mean age was 53 (SD13.8) years, and 55.5% were males. 61.0% had an ischaemic stroke (IS), and 39.0% had a haemorrhagic stroke (HS). The mean age was significantly lower in patients with HS vs. IS (48.2 ± 12.2 vs. 56.1 ± 13.3, p < 0.001). Of the IS patients, the majority (29.0%) had total anterior circulation infarct (TACI), while in the HS group, 34.0% had basal ganglia haemorrhage with or without intraventricular extension. Hypertension (p = 0.015), dyslipidaemia (p = 0.001), alcohol consumption (p = 0.022), and other cardiovascular diseases (p = 0.007) were more prevalent in patients with IS compared to those with HS. The prevalence rate of intravenous thrombolysis was 2.2% in IS and use of intravenous antihypertensives in 25.9% of patients with HS than IS. The in-hospital mortality was 26.4% with complications such as raised ICP, aspiration pneumonia, hydrocephalus, and sepsis significantly high in those that died. Aspiration pneumonia (OR 2.79, 95% CI 1.63-4.76, p < 0.001) and increased ICP (OR 0.30, 95% CI 0.16-057, p < 0.001) were independent predictors of in-hospital mortality on the multivariate analysis. Conclusion Our findings showed a younger mean age for stroke and mortality rate comparable to other low- to middle-income countries (LMICs). Hypertension and alcohol consumption were the main risk factors for both stroke subtypes, while aspiration pneumonia and raised intracranial pressure predicted in-hospital mortality.
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23
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Moody KA, Maillie L, Dhamoon MS. National Patterns and Outcomes of Neurologist Care in Acute Ischemic Stroke. Neurohospitalist 2023; 13:13-21. [PMID: 36531857 PMCID: PMC9755618 DOI: 10.1177/19418744221129428] [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: 01/03/2024] Open
Abstract
Background & Purpose Specialist care of acute ischemic stroke patients has been associated with improved outcomes but is not well-characterized. We sought to elucidate the involvement and influence of neurologists on acute ischemic stroke care. Methods Using 100% Medicare datasets, index acute ischemic stroke admissions from 2016-2018 were identified with International Classification of Diseases, 10th Revision codes. Neurologists were identified by NPI code. Neurologist involvement in care was defined as: "neurologist involved in care"; "hospital with a neurologist"; and "percent of acute ischemic stroke treated by neurologist." Adjusted logistic regression models summarized exposure to neurologists and their association with outcomes (inpatient mortality, good outcome, and 30-day readmission). Results Among 647838 index AIS admissions from 2016-2018, 15.6% included a neurologist involved in care, associated with receiving intravenous thrombolysis (19.1% vs 6.5%), endovascular thrombectomy (13.2% vs 1.4%), treatment at a teaching hospital (87.7% vs 55.5%), and treatment at a hospital in the highest volume quartile (95.3% vs 75.6%). Of 4797 hospitals, 36.1% had a neurologist, among which the mean percent of admissions treated by a neurologist was 14.7% (SD 24.4). Neurologist involvement was associated with increased inpatient mortality (OR 1.81; 95% CI 1.75-1.86), decreased odds of a good outcome (OR .92; 95% CI .90-.93), and increased 30-day readmission (OR 1.04; 95% C: 1.01-1.06). Conclusions The minority of acute ischemic stroke admissions among the elderly in the US are treated by neurologists. Neurologist involvement in care is associated with worse outcomes, possibly from the allocation of severe cases to neurologists.
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Affiliation(s)
- Kate A. Moody
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luke Maillie
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandip S. Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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24
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Dos Santos RB, Fiedler A, Badwal A, Legasto-Mulvale JM, Sibley KM, Olaleye OA, Diermayr G, Salbach NM. Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1084085. [PMID: 36896249 PMCID: PMC9989207 DOI: 10.3389/fresc.2023.1084085] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Background Use of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown. Purpose To identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke. Methods A scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool. Results Of the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle- and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country. Conclusion CPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke. Systematic Review Registration https://osf.io/, identifier: 10.17605/OSF.IO/6RBDV.
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Affiliation(s)
- Renato B Dos Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo - UNICID, Sao Paulo, Brazil.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Annabelle Fiedler
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Anchal Badwal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jean Michelle Legasto-Mulvale
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gudrun Diermayr
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, University Health Network, Toronto, ON, Canada
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25
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Malgaonkar N, Ramachandran M, Patel SD, Dsouza SA. Occupational Therapists' Perceptions of Home Program Provision for Stroke Survivors in a Lower- and Middle-Income Country: An Exploratory Study. Occup Ther Health Care 2023; 37:54-74. [PMID: 34253118 DOI: 10.1080/07380577.2021.1930326] [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: 01/05/2023]
Abstract
This qualitative study aimed to understand occupational therapists' experiences of providing home programs to stroke survivors in India. Using an interpretative phenomenological approach, eight practicing occupational therapists were interviewed in depth about home programs for individuals recovering from stroke. Two broad themes with subthemes emerged describing the organizational factors, sociocultural and economic influences on home program provision as well as describing how the occupational therapists addressed the challenges to facilitate home program provision and adherence. The findings can inform occupational therapy practice in lower- and middle-income countries like India and other countries where existing practice recommendations for stroke rehabilitation and core professional tenets may be challenged.
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Affiliation(s)
- Neha Malgaonkar
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Physical Medicine and Rehabilitation Department, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, India
| | - Meena Ramachandran
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Bridgepoint Collaboratory for Research and Innovation, Sinai Health, Toronto, Canada
| | - Sefali Dushyant Patel
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Catholic Relief Services, Hanoi, Vietnam
| | - Sebestina Anita Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Centre for Studies on Healthy Aging, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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26
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De Bartolo D, D’amico I, Iosa M, Aloise F, Morone G, Marinozzi F, Bini F, Paolucci S, Spadini E. Validation of SuPerSense, a Sensorized Surface for the Evaluation of Posture Perception in Supine Position. SENSORS (BASEL, SWITZERLAND) 2022; 23:424. [PMID: 36617020 PMCID: PMC9823460 DOI: 10.3390/s23010424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to validate a sensorized version of a perceptive surface that may be used for the early assessment of misperception of body midline representation in subjects with right stroke, even when they are not yet able to stand in an upright posture. This device, called SuPerSense, allows testing of the load distribution of the body weight on the back in a supine position. The device was tested in 15 patients with stroke, 15 age-matched healthy subjects, and 15 young healthy adults, assessing three parameters analogous to those conventionally extracted by a baropodometric platform in a standing posture. Subjects were hence tested on SuPerSense in a supine position and on a baropodometric platform in an upright posture in two different conditions: with open eyes and with closed eyes. Significant correlations were found between the lengths of the center of pressure path with the two devices in the open-eyes condition (R = 0.44, p = 0.002). The parameters extracted by SuPerSense were significantly different among groups only when patients were divided into those with right versus left brain damage. This last result is conceivably related to the role of the right hemisphere of the brain in the analysis of spatial information.
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Affiliation(s)
- Daniela De Bartolo
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Ilaria D’amico
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Via Eudossiana 18, 00184 Rome, Italy
| | - Marco Iosa
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
- Department of Psychology, Sapienza University of Rome, Via Dei Marsi 78, 00185 Rome, Italy
| | - Fabio Aloise
- Alfameg s.r.l., Via Giacomo Favretto 9, 00147 Rome, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Via Eudossiana 18, 00184 Rome, Italy
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Via Eudossiana 18, 00184 Rome, Italy
| | - Stefano Paolucci
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Ennio Spadini
- Perceptive Lab s.r.l., Via Sebastiano Veniero 22, 00192 Rome, Italy
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27
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Kumluang S, Geue C, Langhorne P, Wu O. Availability of stroke services and hospital facilities at different hospital levels in Thailand: a cross-sectional survey study. BMC Health Serv Res 2022; 22:1558. [PMID: 36539806 PMCID: PMC9764597 DOI: 10.1186/s12913-022-08922-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Stroke has one of the biggest burden of disease in Thailand and all health regions have been tasked to develop their service delivery to achieve the national key performance indicators set out by the Thai service plan strategy 2018-2022. Our aim was to characterise stroke services and hospital facilities by investigating differences in facilities across different hospital levels in Thailand. METHODS Self-complete questionnaires were distributed to 119 hospitals in 12 health regions between November-December 2019. Participants were health professionals whose main responsibilities are related to stroke service provision in their hospital. Descriptive statistics were used to report differences of stroke service provision between advanced-level, standard-level and mid-level referral hospitals. RESULTS Thirty-eight (32% response rate) completed questionnaires were returned. All advanced-level, standard-level (100%) and 55% of mid-level referral hospitals provided stroke units. Neurologists were available in advanced-level (100%) and standard-level referral hospitals (50%). Standard-level and mid-level referral hospitals only had a quarter of rehabilitation physicians compared to advanced-level referral hospital. Home-based rehabilitation was provided at 100% in mid-level but only at 16% and 50% in advanced-level and standard-level referral hospitals. CONCLUSIONS Setting up a stroke unit, as a national goal that was set out in the service plan strategy 2018-2022, was achieved fully (100%) in advanced-level and standard-level referral hospitals including key essential supportive components. However, capacity in hospitals was found to be limited and stroke service delivery needs to be improved especially at mid-level referral hospitals. This should include regular organisational surveys and the use of electronic records to facilitate monitoring of clinical/health outcomes of patients.
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Affiliation(s)
- Suthasinee Kumluang
- grid.8756.c0000 0001 2193 314XHealth Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia Geue
- grid.8756.c0000 0001 2193 314XHealth Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Langhorne
- grid.8756.c0000 0001 2193 314XSchool of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- grid.8756.c0000 0001 2193 314XHealth Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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28
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Cacho RDO, Moro CHC, Bazan R, Guarda SNFD, Pinto EB, Andrade SMMDS, Valler L, Almeida KJ, Ribeiro TS, Jucá RVBDM, Minelli C, Piemonte MEP, Paschoal EHA, Pedatella MTA, Pontes-Neto OM, Fontana AP, Pagnussat ADS, Conforto AB. Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1067-1074. [PMID: 36535291 PMCID: PMC9770079 DOI: 10.1055/s-0042-1758558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most of the Brazilian population relies on public healthcare and stroke is a major cause of disability in this country of continental dimensions. There is limited information about access to rehabilitation after stroke in Brazil. OBJECTIVE To provide comprehensive information about Access to Rehabilitation After discharge from public hospitals in Brazil (AReA study), up to 6 months after stroke. METHODS The present study intends to collect information from 17 public health centers in 16 Brazilian cities in the 5 macroregions of the country. Each center will include 36 participants (n = 612). The inclusion criteria are: age ≥ 18 years old; ischemic or hemorrhagic stroke, from 6 months to 1 year prior to the interview; admission to a public hospital in the acute phase after stroke; any neurological impairment poststroke; patient or caregiver able to provide informed consent and answer the survey. Patients can only be recruited in public neurology or internal medicine outpatient clinics. Outcomes will be assessed by a standard questionnaire about rehabilitation referrals, the rehabilitation program (current status, duration in months, number of sessions per week) and instructions received. In addition, patients will be asked about preferences for locations of rehabilitation (hospitals, clinics, or at home). TRIAL STATUS The study is ongoing. Recruitment started on January 31st, 2020 and is planned to continue until June 2022. CONCLUSION The AReA study will fill a gap in knowledge about access to stroke rehabilitation in the public health system in different Brazilian regions.
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Affiliation(s)
- Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil.,Address for correspondence Roberta de Oliveira Cacho
| | | | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, São Paulo SP, Brazil.
| | | | - Elen Beatriz Pinto
- Escola Bahiana de Medicina e Saúde Pública, Fundação para o Desenvolvimento das Ciências, Salvador BA, Brazil.
| | | | - Lenise Valler
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas SP, Brazil.
| | - Kelson James Almeida
- Universidade Federal do Piauí, Centro Universitário UniFacid, Departamento de Medicina Especializada em Neurologia, Teresina PI, Brazil.
| | - Tatiana Souza Ribeiro
- Universidade Federal do Rio Grande do Norte, Departamento de Fisioterapia, Natal RN, Brazil.
| | | | - Cesar Minelli
- Hospital Carlos Fernando Malzoni, Instituto “Você sem AVC”, Matão SP, Brazil.,Universidade de São Paulo, Departamento de Neurociências e Ciências Comportamentais, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil.
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.
| | | | | | | | - Ana Paula Fontana
- Universidade Federal do Rio de Janeiro, Faculdade de Fisioterapia, Laboratório Pesquisa em Recuperação Funcional Após AVC, Rio de Janeiro RJ, Brazil.
| | - Aline de Souza Pagnussat
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Fisioterapia, Porto Alegre RS, Brazil.
| | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital de Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
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29
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dos Santos E, Wollmann GM, Nagel V, Ponte HMS, Furtado LETA, Martins-Filho RKV, Weiss G, Martins SCO, Ferreira LE, de França PHC, Cabral NL. Incidence, lethality, and post-stroke functional status in different Brazilian macro-regions: The SAMBA study (analysis of stroke in multiple Brazilian areas). Front Neurol 2022; 13:966785. [PMID: 36188387 PMCID: PMC9520622 DOI: 10.3389/fneur.2022.966785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/12/2022] [Indexed: 11/14/2022] Open
Abstract
Background Stroke is the second leading cause of death in Brazil. The social and financial burden of stroke is remarkable; however, the epidemiological profile remains poorly understood. Objective The aim of this study was to report the incidence, lethality, and functional status at 30 and 90 days post-stroke in the cities of different Brazilian macro-regions. Methods This is an observational, prospective, and population-based study, led in Canoas (South), Joinville (South, reference center), Sertãozinho (Southeast), and Sobral (Northeast) in Brazil. It was developed according to the three-step criteria recommended by the World Health Organization to conduct population-based studies on stroke. Using different sources, all hospitalized and ambulatory patients with stroke were identified and the same criteria were kept in all cities. All first events were included, regardless of sex, age, or type of stroke. Demographic and risk factor data were collected, followed by biochemical, electrocardiographic, and radiological test results. Functional status and lethality were obtained using the mRankin scale through telephonic interview (validated Brazilian version). Results In 1 year, 932 stroke cases were registered (784 ischemic stroke, 105 hemorrhagic stroke, and 43 subarachnoid hemorrhage). The incidence rates per 100,000 inhabitants, adjusted for the world population, were 63 in Canoas, 106 in Joinville, 72 in Sertãozinho, and 96 in Sobral. The majority (70.8%) were followed for 90 days. Kaplan-Meier curves showed that 90-day survival was different among cities. Sobral, which has the lowest socioeconomic indexes, revealed the worst results in terms of lethality and functional status. Conclusion This study expands the knowledge of stroke epidemiology in Brazil, a middle-income country with enormous socioeconomic and cultural diversity. The discrepancy observed regarding the impact of stroke in patients from Joinville and Sobral highlights the need to improve the strategic allocation of resources to meet the health priorities in each location.
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Affiliation(s)
- Emily dos Santos
- Postgraduate Program on Health and Environment, University of the Region of Joinville–Univille, Joinville, Brazil
| | - Giulia M. Wollmann
- Department of Medicine, University of the Region of Joinville–Univille, Joinville, Brazil
| | - Vivian Nagel
- Joinville Stroke Registry, Hospital Municipal São José, Joinville, Brazil
| | | | | | - Rui K. V. Martins-Filho
- Hospital das Clínicas de Ribeirão Preto, University of São Paulo–USP, Ribeirão Preto, Brazil
| | - Gustavo Weiss
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Sheila C. O. Martins
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Leslie E. Ferreira
- Postgraduate Program on Health and Environment, University of the Region of Joinville–Univille, Joinville, Brazil
- Department of Medicine, University of the Region of Joinville–Univille, Joinville, Brazil
| | - Paulo H. C. de França
- Postgraduate Program on Health and Environment, University of the Region of Joinville–Univille, Joinville, Brazil
- Department of Medicine, University of the Region of Joinville–Univille, Joinville, Brazil
| | - Norberto L. Cabral
- Postgraduate Program on Health and Environment, University of the Region of Joinville–Univille, Joinville, Brazil
- Department of Medicine, University of the Region of Joinville–Univille, Joinville, Brazil
- Joinville Stroke Registry, Hospital Municipal São José, Joinville, Brazil
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30
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Motamed-Gorji N, Hariri S, Masoudi S, Sharafkhah M, Nalini M, Oveisgharan S, Khoshnia M, Motamed-Gorji N, Gharavi A, Etemadi A, Poustchi H, Zand R, Malekzadeh R. Incidence, early case fatality and determinants of stroke in Iran: Golestan Cohort Study. J Stroke Cerebrovasc Dis 2022; 31:106658. [PMID: 35973398 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES While few studies investigated the incidence of stroke in Iran, no Iranian cohort has estimated the standardized-incidence rate and early fatality of first-ever-stroke subtypes along with associated factors. METHODS Golestan Cohort Study is a prospective study launched in northeastern Iran in 2004, including 50,045 individuals aged 40-75 at baseline. Age-standardized incidence rate of first-ever-stroke was calculated per 100,000 person-years, according to World Standard Population. The 28-day case fatality was calculated by dividing the number of fatal first-ever-stroke during the first 28 days by total events. Cox proportional hazard models were conducted to assess incidence and fatality risk factors. We used Population Attributable Fractions to estimate the incidence and early fatality proportions reduced by ideal risk factor control. RESULTS 1,135 first-ever-strokes were observed during 8.6 (median) years follow-up. First-ever-stroke standardized incidence rate was estimated 185.2 (95% CI: 173.2-197.2) per 100,000 person-years. The 28-day case fatality was 44.1% (95% CI: 40.4-48.2). Hypertension and pre-stroke physical activity were the strongest risk factors associated with first-ever-stroke incidence (Hazard ratio: 2.83; 2.47-3.23) and 28-day case fatality (Hazard ratio: 0.59; 0.44-0.78), respectively. Remarkably, opium consumption was strongly associated with hemorrhagic stroke incidence (Hazard ratio: 1.52; 1.04-2.23) and ischemic stroke fatality (Hazard ratio: 1.44; 1.01-2.09). Overall, modifiable risk factors contributed to 83% and 61% of first-ever-stroke incidence and early fatality, respectively. CONCLUSION Efficient risk factor control can considerably reduce stroke occurrence and fatality in our study. Establishing awareness campaigns and 24-hour stroke units seem necessary for improving the stroke management in this area.
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Affiliation(s)
- Nazgol Motamed-Gorji
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanam Hariri
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Masoudi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sharafkhah
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Nalini
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahram Oveisgharan
- Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, IL, USA
| | - Masoud Khoshnia
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Abdolsamad Gharavi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Zand
- Neuroscience Institute, Penn State University, Hershey, PA, USA; Neuroscience Institute, Geisinger, Danville, PA, USA.
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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31
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Xie Q, Wu Y, Pei J, Gao Q, Guo Q, Wang X, Zhong J, Su Y, Zhao J, Zhang L, Dou X. Prevalence and risk factors of ischemic stroke-related headache in China: a systematic review and meta-analysis. BMC Public Health 2022; 22:1533. [PMID: 35953857 PMCID: PMC9367127 DOI: 10.1186/s12889-022-13917-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/31/2022] [Indexed: 12/05/2022] Open
Abstract
Background Headache accompanying ischemic stroke is considered an independent predictor of neurological deterioration. This meta-analysis aims to estimate the prevalence of ischemic stroke-related headaches and identify its risk factors in China. Methods PubMed, Embase, Cochrane Library database, Web of Science, PsycINFO, and four Chinese databases for the related publications were searched. Two researchers independently selected the literature, extracted the relevant data, and assessed its methodological quality. The meta-analysis applied a random-effects model with R software to calculate the pooled prevalence of ischemic stroke-related headaches in Chinese patients, and to merge the odds ratio (OR) of risk factors. Subgroup analysis, sensitivity analysis, and meta-regression analysis were conducted. Publication bias was assessed by a funnel plot and Egger test. Results Ninety-eight studies were eligible for inclusion. The overall pooled prevalence of ischemic stroke-related headache was 18.9%. Subgroup analysis showed that the prevalence of ischemic stroke related-headaches was higher among studies using self-report to diagnosis headache (18.9%; 95%CI, 8.9% to 40.2%), and those focused on age ≥ 55 years (19.7%; 95%CI, 14.9% to 25.9%), rural settings (24.9%; 95%CI, 19.7% to 31.6%). There were no significant differences in the headache prevalence between studies in the south and north, and inland and coastal studies. The prevalence of pre onset headache (13.9%) and tension-type headache (15.5%) and was higher compared with other types. History of headache (OR = 3.24; 95%CI, 2.26 to 4.65.), female gender (OR = 2.06; 95%CI, 1.44 to 2.96.), midbrain lesions (OR = 3.56; 95%CI, 1.86 to 6.83.), and posterior circulation stroke (OR = 2.13; 95%CI, 1.14 to 4.32) were major risk factors. Conclusion The prevalence of ischemic stroke-associated headache is high in China. In addition, women, presence of midbrain lesions, posterior circulation stroke and a history of migraine were high-risk factors for ischemic stroke-related headaches. Designing effective interventions to prevent or alleviated headaches is necessary to promote patients’ neurological recovery and quality of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13917-z.
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Affiliation(s)
- Qi Xie
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yinping Wu
- The Medical Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Juhong Pei
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Qianqian Gao
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Qiang Guo
- The Department of Tuberculosis Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou, Gansu, China
| | - Xinglei Wang
- Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Juanping Zhong
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China.,The Medical Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Yujie Su
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Junqiang Zhao
- School of Nursing University of Ottawa, Ottawa, Canada
| | - Lanfang Zhang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Xinman Dou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China. .,Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
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32
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Perrier J, Olié V, Gabet A, Tzourio C, Bezin J. Antihypertensive and lipid‐lowering drugs usage after primary stroke in a large representative sample of the French population. Fundam Clin Pharmacol 2022; 36:742-749. [DOI: 10.1111/fcp.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/09/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Perrier
- Inserm, Bordeaux Population Health Research Center U1219 University of Bordeaux Bordeaux France
| | - Valérie Olié
- Santé Publique France, The French Public Health Agency Paris France
| | - Amélie Gabet
- Santé Publique France, The French Public Health Agency Paris France
| | - Christophe Tzourio
- Inserm, Bordeaux Population Health Research Center U1219 University of Bordeaux Bordeaux France
| | - Julien Bezin
- Inserm, Bordeaux Population Health Research Center U1219 University of Bordeaux Bordeaux France
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33
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Providing Neurocritical Care in Resource-Limited Settings: Challenges and Opportunities. Neurocrit Care 2022; 37:583-592. [PMID: 35840824 DOI: 10.1007/s12028-022-01568-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
Acute neurologic illnesses (ANI) contribute significantly to the global burden of disease and cause disproportionate death and disability in low-income and middle-income countries (LMICs) where neurocritical care resources and expertise are limited. Shifting epidemiologic trends in recent decades have increased the worldwide burden of noncommunicable diseases, including cerebrovascular disease and traumatic brain injury, which coexist in many LMICs with a persistently high burden of central nervous system infections such as tuberculosis, neurocysticercosis, and HIV-related opportunistic infections and complications. In the face of this heavy disease burden, many resource-limited countries lack the infrastructure to provide adequate care for patients with ANI. Major gaps exist between wealthy and poor countries in access to essential resources such as intensive care unit beds, neuroimaging, clinical laboratories, neurosurgical capacity, and medications for managing complex neurologic emergencies. Moreover, many resource-limited countries face critical shortages in health care workers trained to manage neurologic emergencies, with subspecialized neurocritical care expertise largely absent outside of high-income countries. Numerous opportunities exist to overcome these challenges through capacity-building efforts that improve outcomes for patients with ANI in resource-limited countries. These include research on needs and best practices for ANI management in LMICs, developing systems for effective triage, education and training to expand the neurology workforce, and supporting increased collaboration and data sharing among LMIC health care workers and systems. The success of these efforts in curbing the disproportionate and rising impact of ANI in LMICs will depend on the coordinated engagement of the global neurocritical care community.
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34
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Hughes CML, Tran B, Modan A, Zhang X. Accuracy and Validity of a Single Inertial Measurement Unit-Based System to Determine Upper Limb Kinematics for Medically Underserved Populations. Front Bioeng Biotechnol 2022; 10:918617. [PMID: 35832406 PMCID: PMC9271671 DOI: 10.3389/fbioe.2022.918617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke is one of the leading causes of death and disability worldwide, with a disproportionate burden represented by low- and middle-income countries (LMICs). To improve post-stroke outcomes in LMICs, researchers have sought to leverage emerging technologies that overcome traditional barriers associated with stroke management. One such technology, inertial measurement units (IMUs), exhibit great potential as a low-cost, portable means to evaluate and monitor patient progress during decentralized rehabilitation protocols. As such, the aim of the present study was to determine the ability of a low-cost single IMU sensor-based wearable system (named the T’ena sensor) to reliably and accurately assess movement quality and efficiency in physically and neurologically healthy adults. Upper limb movement kinematics measured by the T’ena sensor were compared to the gold standard reference system during three functional tasks, and root mean square errors, Pearson’s correlation coefficients, intraclass correlation coefficients, and the Bland Altman method were used to compare kinematic variables of interest between the two systems for absolute accuracy and equivalency. The T’ena sensor and the gold standard reference system were significantly correlated for all tasks and measures (r range = 0.648—0.947), although less so for the Finger to Nose task (r range = 0.648—0.894). Results demonstrate that single IMU systems are a valid, reliable, and objective method by which to measure movement kinematics during functional tasks. Context-appropriate enabling technologies specifically designed to address barriers to quality health services in LMICs can accelerate progress towards the United Nations Sustainable Development Goal 3.
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Affiliation(s)
- Charmayne Mary Lee Hughes
- NeuroTech Lab, Health Equity Institute, San Francisco State University, San Francisco, CA, United States
- Department of Kinesiology, San Francisco State University, San Francisco, CA, United States
- *Correspondence: Charmayne Mary Lee Hughes,
| | - Bao Tran
- School of Engineering, San Francisco State University, San Francisco, CA, United States
| | - Amir Modan
- School of Engineering, San Francisco State University, San Francisco, CA, United States
| | - Xiaorong Zhang
- School of Engineering, San Francisco State University, San Francisco, CA, United States
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35
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Shlobin NA, Clark JR, Campbell JM, Bernstein M, Jahromi BS, Potts MB. Ethical Considerations in Surgical Decompression for Stroke. Stroke 2022; 53:2673-2682. [PMID: 35703095 DOI: 10.1161/strokeaha.121.038493] [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: 11/16/2022]
Abstract
Stroke is a major cause of morbidity and mortality. Neurosurgical decompression is often considered for the treatment of malignant infarcts and intraparenchymal hemorrhages, but this treatment can be frought with ethical dilemmas. In this article, the authors outline the primary principles of bioethics and their application to stroke care, provide an overview of key ethical issues and special situations in the neurosurgical management of stroke, and highlight methods to improve ethical decision-making for patients with stroke. Understanding these ethical principles is essential for stroke care teams to deliver appropriate, timely, and ethical care to patients with stroke.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. (N.A.S., J.R.C., B.S.J., M.B.P.)
| | - Jeffrey R Clark
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. (N.A.S., J.R.C., B.S.J., M.B.P.)
| | | | - Mark Bernstein
- Division of Neurosurgery, Department of Surgery, University of Toronto, University Health Network, Ontario, Canada (M.B.)
| | - Babak S Jahromi
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. (N.A.S., J.R.C., B.S.J., M.B.P.).,Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL. (B.S.J., M.B.P.).,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL. (B.S.J., M.B.P.)
| | - Matthew B Potts
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. (N.A.S., J.R.C., B.S.J., M.B.P.).,Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL. (B.S.J., M.B.P.).,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL. (B.S.J., M.B.P.)
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36
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Magnitude and Predictors of In-Hospital Stroke Mortality in Ethiopia: A Systematic Review and Meta-Analysis. Stroke Res Treat 2022; 2022:7202657. [PMID: 35656388 PMCID: PMC9155958 DOI: 10.1155/2022/7202657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/02/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Stroke is the second leading cause of mortality worldwide, accounting for approximately 5.5 million deaths each year. Due to demographic and health changes, the epidemiology of stroke is shifting from industrialized to low- and middle-income nations. Ethiopia is a developing country with a population that reflects this shift. Therefore, this systematic review and meta-analysis are aimed at evaluating the extent of in-hospital mortality of both ischemic and hemorrhagic stroke in Ethiopia and determining relevant factors associated with the mortality. Methods Observational studies published as of July 15, 2020, that reported the magnitude, predictors, and causes of in-hospital mortality of stroke were systematically and comprehensively retrieved using the PRISMA 2020 criteria from databases such as PubMed/MEDLINE, Science Direct, and Google Scholar. The review papers were chosen based on the study methodology (facility-based observational), the study area (Ethiopia), the study population (adult patients with stroke), the outcome (in-hospital mortality), and the fact that they were published in English. Result A total of 3709 patients with stroke were included in this systematic review and meta-analysis, which included 19 publications. In-hospital mortality was 14.03 percent on average in the studies, with reports ranging from 6.04 percent to 37.37 percent. Patients with hemorrhagic type stroke, admission Glasgow Coma Scale less than or equal to 12, impaired mental status, National Institutes of Health Stroke Scale stroke level greater than 13, prolonged hospital stay, any incontinence, pneumonia, and/or swallowing trouble had an increased risk of death after stroke. Conclusion The magnitude of in-hospital mortality of patients with stroke in Ethiopia is high. The assessment of the level of consciousness is vital for clinical management and as an indicator of prognosis. Patients with unfavorable prognostic signs, such as entry Glasgow Coma Scale, National Institutes of Health Stroke Scale stroke level > 13, hemorrhagic stroke, pneumonia, incontinence, and dysphagia, should be given priority.
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37
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Ye Q, Zhai F, Chao B, Cao L, Xu Y, Zhang P, Han H, Wang L, Xu B, Chen W, Wen C, Wang S, Wang R, Zhang L, Jiao L, Liu S, Zhu YC, Wang LD. Rates of intravenous thrombolysis and endovascular therapy for acute ischaemic stroke in China between 2019 and 2020. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 21:100406. [PMID: 35243459 PMCID: PMC8873940 DOI: 10.1016/j.lanwpc.2022.100406] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND In recent years, a series of initiatives have been launched to promote intravenous thrombolysis (IVT) and endovascular therapy (EVT) for acute ischaemic stroke (AIS) in China. We aimed to update the rates of IVT and EVT in China between 2019 and 2020 and to evaluate the current IVT and EVT according to hospital grades. METHODS Cross-sectional data on patients receiving IVT/EVT were derived from the Bigdata Observatory platform for Stroke of China (BOSC). The monthly number of discharged patients with a principal diagnosis of AIS was derived from the first pages of medical records of each hospital. The rates and information of IVT and EVT were analysed according to hospital grades. FINDINGS During this period, 938 tertiary hospitals and 786 secondary hospitals from 31 provinces continuously reported data to the BOSC. The overall IVT rate for AIS was 5·64%, and the EVT rate was 1·45%. The IVT rate in secondary hospitals was higher than that in tertiary hospitals (6·39% vs. 5·39%, P < 0·001), whereas the EVT rate in secondary hospitals was much lower than that in tertiary hospitals (0·29% vs. 1·84%, P < 0·001). Significant differences in demographic and clinical characteristics of patients receiving IVT/EVT were also shown between tertiary and secondary hospitals. INTERPRETATION The rates of IVT and EVT for AIS have greatly increased in China, but there is still a large gap compared with developed countries. Hospital inhomogeneity in IVT and EVT suggests the importance of developing a region-specific network for stroke treatment. FUNDING None.
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Affiliation(s)
- Qing Ye
- Department of Neurology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Feifei Zhai
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Baohua Chao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Lei Cao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Yun Xu
- Department of Neurology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Peilan Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Hongxing Han
- Department of Neurology, Linyi People's Hospital, Shandong, China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Bing Xu
- Department of Neurology and Neuroscience, Shenyang First People's Hospital, Liaoning, China
| | - Wenhuo Chen
- Department of Neurointervention, Zhangzhou affiliated Hospital of Fujian Medical University, Fujian, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Shouchun Wang
- Department of Neurology, The First Hospital of Jilin University, Jilin, China
| | - Runqing Wang
- Department of Neurology, Zhengzhou Central Hospital, Zhengzhou, China
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Shandong, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Long-De Wang
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
- School of Public Health, Peking University, Beijing, China
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38
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Prust M, Saylor D, Zimba S, Sarfo FS, Shrestha GS, Berkowitz A, Vora N. Inpatient Management of Acute Stroke of Unknown Type in Resource-Limited Settings. Stroke 2022; 53:e108-e117. [PMID: 35045720 PMCID: PMC8885836 DOI: 10.1161/strokeaha.121.037297] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is the second leading cause of death and disability worldwide, with a disproportionate burden on low- and middle-income countries. Critical elements of guideline-based stroke care developed in high-income countries are not applicable to resource-limited settings, where lack of access to neuroimaging prevents clinicians from distinguishing between ischemic stroke and intracranial hemorrhage, requiring challenging clinical decision-making, particularly in the acute setting. We discuss strategies for acute inpatient management of stroke of unknown type with a focus on blood pressure management and antiplatelet therapy when neuroimaging is unavailable, and review some of the challenges and strategies for successfully implementing stroke unit care in resource-limited health care settings.
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Affiliation(s)
| | - Deanna Saylor
- Johns Hopkins University Hospital, Baltimore, MD, USA,University Teaching Hospital, Lusaka, Zambia
| | | | | | | | - Aaron Berkowitz
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Nirali Vora
- Stanford University Medical Center, Stanford, CA, USA
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39
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Rahbar MH, Medrano M, Diaz-Garelli F, Gonzalez Villaman C, Saroukhani S, Kim S, Tahanan A, Franco Y, Castro-Tejada G, Diaz SA, Hessabi M, Savitz SI. Younger age of stroke in low-middle income countries is related to healthcare access and quality. Ann Clin Transl Neurol 2022; 9:415-427. [PMID: 35142101 PMCID: PMC8935275 DOI: 10.1002/acn3.51507] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Stroke is the second leading cause of mortality globally with higher burden and younger age in low‐middle income countries (LMICs) than high‐income countries (HICs). However, it is unclear to what extent differences in healthcare access and quality (HAQ) and prevalence of risk factors between LMICs and HICs contribute to younger age of stroke in LMICs. In this systematic review, we conducted meta‐analysis of 67 articles and compared the mean age of stroke between LMICs and HICs, before and after adjusting for HAQ index. We also compared the prevalence of main stroke risk factors between HICs and LMICs. The unadjusted mean age of stroke in LMICs was significantly lower than HICs (63.1 vs. 68.6), regardless of gender (63.9 vs. 66.6 among men, and 65.6 vs. 70.7 among women) and whether data were collected in population‐ (64.7 vs. 69.5) or hospital‐based (62.6 vs. 65.9) studies (all p < 0.01). However, after adjusting for HAQ index, the difference in the mean age of stroke between LMICs and HICs was not significant (p ≥ 0.10), except among women (p = 0.048). In addition, while the median prevalence of hypertension in LMICs was 23.4% higher than HICs, the prevalence of all other risk factors was lower in LMICs than HICs. Our findings suggest a much larger contribution of HAQ to the younger mean age of stroke in LMICs, as compared with other potential factors. Additional studies on stroke care quality and accessibility are needed in LMICs.
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Affiliation(s)
- Mohammad H Rahbar
- Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Martin Medrano
- Department of Medicine, School of Medicine, Pontificia Universidad Catalica Madre and Maestra (PUCMM), Santiago, Dominican Republic
| | - Franck Diaz-Garelli
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | | | - Sepideh Saroukhani
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sori Kim
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Biostatistics & Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amirali Tahanan
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Yahaira Franco
- Department of Neurology, Clínica Corominas, Santiago, Dominican Republic
| | - Gelanys Castro-Tejada
- Department of Medicine, School of Medicine, Pontificia Universidad Catalica Madre and Maestra (PUCMM), Santiago, Dominican Republic
| | - Sarah A Diaz
- Department of Medicine, School of Medicine, Pontificia Universidad Catalica Madre and Maestra (PUCMM), Santiago, Dominican Republic
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences (CCTS), The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, Houston, Texas, USA.,Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Jacob MA, Ekker MS, Allach Y, Cai M, Aarnio K, Arauz A, Arnold M, Bae HJ, Bandeo L, Barboza MA, Bolognese M, Bonardo P, Brouns R, Chuluun B, Chuluunbatar E, Cordonnier C, Dagvajantsan B, Debette S, Don A, Enzinger C, Ekizoglu E, Fandler-Höfler S, Fazekas F, Fromm A, Gattringer T, Hora TF, Jern C, Jood K, Kim YS, Kittner S, Kleinig T, Klijn CJ, Kõrv J, Kumar V, Lee KJ, Lee TH, Maaijwee NA, Martinez-Majander N, Marto JP, Mehndiratta MM, Mifsud V, Montanaro V, Pacio G, Patel VB, Phillips MC, Piechowski-Jozwiak B, Pikula A, Ruiz-Sandoval J, von Sarnowski B, Swartz RH, Tan KS, Tanne D, Tatlisumak T, Thijs V, Viana-Baptista M, Vibo R, Wu TY, Yesilot N, Waje-Andreassen U, Pezzini A, Putaala J, Tuladhar AM, de Leeuw FE. Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults-A Worldwide Meta-analysis: The GOAL Initiative. Neurology 2022; 98:e573-e588. [PMID: 34906974 PMCID: PMC8829964 DOI: 10.1212/wnl.0000000000013195] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional health care services. We studied the global distribution of risk factors, causes, and 3-month mortality of young patients with ischemic stroke, by performing a patient data meta-analysis from different cohorts worldwide. METHODS We performed a pooled analysis of individual patient data from cohort studies that included consecutive patients with ischemic stroke aged 18-50 years. We studied differences in prevalence of risk factors and causes of ischemic stroke between different ethnic and racial groups, geographic regions, and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression. RESULTS We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Black (hypertension, 52.1%; diabetes, 20.7%) and Asian patients (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often the cause of stroke in high-income countries (HICs; both p < 0.001), whereas "other determined stroke" and "undetermined stroke" were higher in low and middle-income countries (LMICs; both p < 0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (odds ratio 2.49; 95% confidence interval 1.42-4.36). DISCUSSION Ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial and regional differences in incidence of ischemic stroke. Our results also highlight the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve health care facilities in LMICs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Keon-Joo Lee
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
| | - Tsong-Hai Lee
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Frank-Erik de Leeuw
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
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Chong MR, Narula S, Morton R, Judge C, Akhabir L, Cawte N, Pathan N, Lali R, Mohammadi-Shemirani P, Shoamanesh A, O'Donnell M, Yusuf S, Langhorne P, Paré G. Mitochondrial DNA Copy Number as a Marker and Mediator of Stroke Prognosis: Observational and Mendelian Randomization Analyses. Neurology 2022; 98:e470-e482. [PMID: 34880091 PMCID: PMC8826461 DOI: 10.1212/wnl.0000000000013165] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/24/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Low buffy coat mitochondrial DNA copy number (mtDNA-CN) is associated with incident risk of stroke and poststroke mortality; however, its prognostic utility has not been extensively explored. Our goal was to investigate whether low buffy coat mtDNA-CN is a marker and causal determinant of poststroke outcomes using epidemiologic and genetic studies. METHODS First, we performed association testing between baseline buffy coat mtDNA-CN measurements and 1-month poststroke outcomes in 3,498 cases of acute, first stroke from 25 countries from the international, multicenter case-control study Importance of Conventional and Emerging Risk Factors of Stroke in Different Regions and Ethnic Groups of the World (INTERSTROKE). Then, we performed 2-sample mendelian randomization analyses to evaluate potential causative effects of low mtDNA-CN on 3-month modified Rankin Scale (mRS) score. Genetic variants associated with mtDNA-CN levels were derived from the UK Biobank study (N = 383,476), and corresponding effects on 3-month mRS score were ascertained from the Genetics of Ischemic Stroke Functional Outcome (GISCOME; N = 6,021) study. RESULTS A 1-SD lower mtDNA-CN at baseline was associated with stroke severity (baseline mRS score: odds ratio [OR] 1.27, 95% confidence interval [CI] 1.19-1.36; p = 4.7 × 10-12). Independently of baseline stroke severity, lower mtDNA-CN was associated with increased odds of greater 1-month disability (ordinal mRS score: OR 1.16, 95% CI 1.08-1.24; p = 4.4 × 10-5), poor functional outcome status (mRS score 3-6 vs 0-2: OR 1.21, 95% CI 1.08-1.34; p = 6.9 × 10-4), and mortality (OR 1.35, 95% CI 1.14-1.59; p = 3.9 × 10-4). Subgroup analyses demonstrated consistent effects across stroke type, sex, age, country income level, and education level. In addition, mtDNA-CN significantly improved reclassification of poor functional outcome status (net reclassification index [NRI] score 0.16, 95% CI 0.08-0.23; p = 3.6 × 10-5) and mortality (NRI score 0.31, 95% CI 0.19-0.43; p = 1.7 × 10-7) beyond known prognosticators. With the use of independent datasets, mendelian randomization revealed that a 1-SD decrease in genetically determined mtDNA-CN was associated with increased odds of greater 3-month disability quantified by ordinal mRS score (OR 2.35, 95% CI 1.13-4.90; p = 0.02) and poor functional outcome status (OR 2.68, 95% CI 1.05-6.86; p = 0.04). DISCUSSION Buffy coat mtDNA-CN is a novel and robust marker of poststroke prognosis that may also be a causal determinant of poststroke outcomes. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that low buffy coat mtDNA-CN (>1 SD) was associated with worse baseline severity and 1-month outcomes in patients with ischemic or hemorrhagic stroke.
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Affiliation(s)
- Michael Robert Chong
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Sukrit Narula
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Robert Morton
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Conor Judge
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Loubna Akhabir
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Nathan Cawte
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Nazia Pathan
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Ricky Lali
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Pedrum Mohammadi-Shemirani
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Ashkan Shoamanesh
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Martin O'Donnell
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Salim Yusuf
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Peter Langhorne
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK
| | - Guillaume Paré
- From the Population Health Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., A.S., M.O., S.Y., G.P.), David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences; Thrombosis and Atherosclerosis Research Institute (M.R.C., S.N., R.M., C.J., L.A., N.C., N.P., R.L., P.M.-S., S.Y., G.P.); Department of Biochemistry and Biomedical Sciences (M.R.C., G.P.), Departments of Pathology and Molecular Medicine (M.R.C., R.M., P.M.-S., G.P.) and Medicine (L.A., A.S., S.Y., G.P.), Michael G. DeGroote School of Medicine, and Department of Health Research Methods, Evidence, and Impact (S.N., R.L., S.Y., G.P.), McMaster University, Hamilton, Ontario, Canada; National University of Ireland Galway (C.J., M.O.); and Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK.
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Li X, Jia Z, Yan Y. Ticagrelor for prevention of stroke and cognitive impairment in patients with vascular high-risk factors: A meta-analysis of randomized controlled trials. Int J Cardiol 2022; 353:96-102. [PMID: 35114201 DOI: 10.1016/j.ijcard.2022.01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND In recent randomized controlled studies, the prevention of stroke and cognitive function of ticagrelor has been controversial. We conducted a meta-analysis to compare ticagrelor with other antiplatelet treatment in patients with vascular high-risk factors disease, defined as acute coronary syndrome, stroke or transient ischemic attack, coronary artery disease or peripheral artery disease. METHODS We searched the PubMed, Embase, and Cochrane libraries for published randomized controlled trials and additional available data from ClinicalTrials.gov. The primary outcome was related adverse stroke events and the secondary outcome was cognitive function related adverse events. The outcomes were statistically analyzed using Peto odds ratio. RESULTS 12 RCTs with 105,654 patients were included in meta-analysis. Primary outcomes: all stroke (OR 0.84, 95%CI 0.78-0.90, P < 0.001); Secondary outcomes: ischemic stroke (OR 0.83, 95%CI 0.77-0.90, P < 0.001), transient ischemic attack (OR 0.78, 95%CI 0.62-0.97, P = 0.029), intracranial hemorrhage (OR 1.33, 95%CI 1.09-1.61, P = 0.005), Parkinson's disease (OR 0.30, 95%CI 0.12-0.72, P = 0.007), dementia (OR 0.31, 95%CI 0.13-0.77, P = 0.012), dizziness (OR: 1.39, 95%CI 1.03-1.87, P = 0.032), insomnia (OR 1.45, 95%CI 1.05-2.00, P = 0.026). CONCLUSIONS Ticagrelor may provide more favorable outcomes for all stroke, ischemic stroke, and transient ischemic attack prevention in patients with vascular high-risk factors. However, this benefit may come with the cost of intracranial hemorrhage, dizziness and insomnia. Ticagrelor may reduce the risk of dementia and Parkinson's disease, although available data are limited.
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Affiliation(s)
- Xiaohui Li
- School of Life Science and Enginering, Handan University, People's Republic of China
| | - Zetian Jia
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, People's Republic of China
| | - Yaqi Yan
- Department of Cardiology, The First Hospital of Handan of Hebei Province, Handan 056000, People's Republic of China.
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Cisse FA, Ligot N, Conde K, Barry DS, Toure LM, Konate M, Soumah MF, Diawara K, Traore M, Naeije G. Predictors of stroke favorable functional outcome in Guinea, results from the Conakry stroke registry. Sci Rep 2022; 12:1125. [PMID: 35064178 PMCID: PMC8782910 DOI: 10.1038/s41598-022-05057-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Low- to middle-income countries (LMICs) now bear most of the stroke burden. In LMICs, stroke epidemiology and health care systems are different from HICs. Therefore, a high-income country (HIC)-based predictive model may not correspond to the LMIC stroke context. Identify the impact of modifiable variables in acute stroke management in Conakry, Guinea as potential predictors of favorable stroke outcome. Data were extracted from the Conakry stroke registry that includes 1018 patients. A logistic regression model was built to predict favorable stroke outcomes, defined as mRS 0–2. Age, admission NIHSS score, mean arterial blood pressure and capillary glycemia were chosen as covariates. Delay to brain CT imaging under 24 h from symptom onset, fever, presence of sores and abnormal lung auscultation were included as factors. NIHSS score on admission, age and ischemic stroke were included in the null model as nuisance parameters to determine the contribution of modifiable variables to predict stroke favorable outcome. Lower admission NIHSS, brain CT imaging within 24 h of symptoms onset and lower mean arterial blood pressure emerged as a significant positive predictors of favorable stroke outcome with respective odd ratios (OR) of 1.35 [1.28–1.43], 2.1 [1.16–3.8] and 1.01 [1.01–1.04]. The presence of fever or sores impacted negatively stroke favorable outcomes with OR of 0.3 [0.1–0.85] and 0.25 [0.14–0.45]. The area under receiver operating characteristic curves (AUC) of the model was 0.86. This model explained 44.5% of the variability of the favorable stroke outcome with 10.2% of the variability explained by the modifiable variables when admission NIHSS, and ischemic stroke were included in the null model as nuisance parameter. In the Conakry stroke registry, using a logistic regression to predict stroke favorable outcome, five variables that led to an AUC of 0.86: admission NIHSS, early brain CT imaging, fever, sores and mean blood pressure. This paves the way for future public health interventions to test whether modulating amendable variables leads to increased favorable stroke outcomes in LMICs.
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Affiliation(s)
- Fode Abass Cisse
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Noémie Ligot
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kaba Conde
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Djigué Souleymane Barry
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Lamine Mohamed Toure
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mamadi Konate
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mohamed Fode Soumah
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Karinka Diawara
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mohamed Traore
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Gilles Naeije
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium. .,Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), 808 Lennik Street, 1070, Brussels, Belgium.
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44
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OUP accepted manuscript. Eur Heart J 2022; 43:2224-2234. [DOI: 10.1093/eurheartj/ehac103] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/13/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
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45
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Xie YJ, Wei QC, Chen Y, Liao LY, Li BJ, Tan HX, Jiang HH, Guo QF, Gao Q. Cerebellar Theta Burst Stimulation on Walking Function in Stroke Patients: A Randomized Clinical Trial. Front Neurosci 2021; 15:688569. [PMID: 34764848 PMCID: PMC8576464 DOI: 10.3389/fnins.2021.688569] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/05/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: The objective of this study was to explore the efficacy of cerebellar intermittent theta burst stimulation (iTBS) on the walking function of stroke patients. Methods: Stroke patients with walking dysfunction aged 25–80 years who had suffered their first unilateral stroke were included. A total of 36 patients [mean (SD) age, 53 (7.93) years; 10 women (28%)] were enrolled in the study. All participants received the same conventional physical therapy, including transfer, balance, and ambulation training, during admission for 50 min per day during 2 weeks (10 sessions). Every session was preceded by 3 min procedure of cerebellar iTBS applyed over the contralesional cerebellum in the intervention group or by a similar sham iTBS in control group. The groups were formed randomly and the baseline characteristics showed no significant difference. The primary outcome measure was Fugl–Meyer Assessment–Lower Extremity scores. Secondary outcomes included walking performance and corticospinal excitability. Measures were performed before the intervention beginning (T0), after the first (T1) and the second (T2) weeks. Results: The Fugl–Meyer Assessment for lower extremity scores slightly improved with time in both groups with no significant difference between the groups and over the time. The walking performance significantly improved with time and between group. Two-way mixed measures ANOVA showed that there was significant interaction between time and group in comfortable walking time (F2,68 = 6.5242, P = 0.0080, η2partial = 0.276, ε = 0.641), between-group comparisons revealed significant differences at T1 (P = 0.0072) and T2 (P = 0.0133). The statistical analysis of maximum walking time showed that there was significant interaction between time and groups (F2,68 = 5.4354, P = 0.0115, η2partial = 0.198, ε = 0.734). Compared with T0, the differences of maximum walking time between the two groups at T1 (P = 0.0227) and T2 (P = 0.0127) were statistically significant. However, both the Timed up and go test and functional ambulation category scale did not yield significant differences between groups (P > 0.05). Conclusion: Our results revealed that applying iTBS over the contralesional cerebellum paired with physical therapy could improve walking performance in patients after stroke, implying that cerebellar iTBS intervention may be a noninvasive strategy to promote walking function in these patients. This study was registered at ChiCTR, number ChiCTR1900026450.
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Affiliation(s)
- Yun-Juan Xie
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qing-Chuan Wei
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Chen
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Ling-Yi Liao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.,Daping Hospital, Third Military Medical University, Chongqing, China
| | - Bao-Jin Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Xin Tan
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Han-Hong Jiang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qi-Fan Guo
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Gao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
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Herath HMMTB, Rodrigo C, Alahakoon AMBD, Ambawatte SB, Senanayake S, Senanayake B, Fernando A. Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country. BMC Neurol 2021; 21:434. [PMID: 34753432 PMCID: PMC8576930 DOI: 10.1186/s12883-021-02475-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/29/2021] [Indexed: 11/12/2022] Open
Abstract
Background Stroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis. There is also limited evidence on post-thrombolysis outcomes of patients from Asian countries in these income bands. Methods This is a single center prospective observational study of a patient cohort with acute ischaemic stroke, undergoing thrombolysis with alteplase (low and standard dose), over a 24-month period in 2019/2020. Modified Rankin scale (mRS) for dependency at 3 months (primary outcome), duration of hospital stay, incidence of symptomatic intracranial haemorrhages and all-cause mortality at 3 months (secondary outcomes) were recorded. Demographic, clinical and treatment related factors associated with these outcomes were explored. Results Eighty-nine patients (males – 61, 69%, mean age: 60 years ±12.18) were recruited. Time from symptom onset to reperfusion was 174 min ± 56.50. Fifty-one patients were independent according to mRS, 11 (12.4%) patients died, and 11 (12.5%) developed symptomatic intracranial haemorrhages by 3 months. Functional independence at 3 months was independently associated with National Institutes of Health Stroke Scale (NIHSS) on admission (p < 0.05). Thrombolysis with low dose alteplase did not lead to better or worse outcomes compared to standard dose. Conclusions On admission NIHSS is predictive of functional independence at 3 months post-thrombolysis. Low dose alteplase may be as efficacious as standard dose alteplase with associated cost savings, but this needs to be confirmed by a prospective clinical trial for the Sri Lankan population. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02475-3.
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Affiliation(s)
- H M M T B Herath
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
| | - A M B D Alahakoon
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | | | - Bimsara Senanayake
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Arjuna Fernando
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Emerging immune and cell death mechanisms in stroke: Saponins as therapeutic candidates. Brain Behav Immun Health 2021; 9:100152. [PMID: 34589895 PMCID: PMC8474497 DOI: 10.1016/j.bbih.2020.100152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 12/15/2022] Open
Abstract
The complexity of the ischemic cascade is based on the integrated crosstalk of every cell type in the neurovascular unit. Depending on the features of the ischemic insult, several cell death mechanisms are triggered, such as apoptosis, necroptosis, ferroptosis/oxytosis, ETosis or pyroptosis, leading to reactive astrogliosis. However, emerging evidence demonstrates a dual role for the immune system in stroke pathophysiology, where it exerts both detrimental and also beneficial functions. In this review, we discuss the relevance of several cell death modalities and the dual role of the immune system in stroke pathophysiology. We also provide an overview of some emerging immunomodulatory therapeutic strategies, amongst which saponins, which are promising candidates that exert multiple pharmacological effects. Several cell death mechanisms coexist in stroke pathophysiology. Neurons are more vulnerable to necroptosis than glial cells. Inhibitors of receptor-interacting protein kinases and of ferroptosis induce neuroprotection. Saponins exert modulatory effects on inflammation and neuronal cell death in stroke.
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48
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Youkee D, Deen G, Barrett E, Fox-Rushby J, Johnson I, Langhorne P, Leather A, Marshall IJ, O'Hara J, Rudd A, Sama A, Scott C, Thompson M, Wafa H, Wall J, Wang Y, Watkins C, Wolfe C, Lisk DR, Sackley CM. A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes. Front Neurol 2021; 12:712060. [PMID: 34557147 PMCID: PMC8453059 DOI: 10.3389/fneur.2021.712060] [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: 05/19/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone. Methods: A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals. Results: Three hundred eighty-five strokes were registered, and 315 (81.8%) were first-in-a-lifetime events. Mean age was 59.2 (SD 13.8), and 187 (48.6%) were male. Of the strokes, 327 (84.9%) were confirmed by CT scan. Two hundred thirty-one (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median National Institutes of Health Stroke Scale on presentation was 17 [interquartile range (IQR) 9-25]. Haemorrhagic strokes compared with ischaemic strokes were more severe, 20 (IQR 12-26) vs. 13 (IQR 7-22) (p < 0.001), and occurred in a younger population, mean age 52.3 (SD 12.0) vs. 61.6 (SD 13.8) (p < 0.001), with a lower level of educational attainment of 28.2 vs. 40.7% (p = 0.04). The median time from stroke onset to arrival at the principal referral hospital was 25 hours (IQR 6-73). Half of the patients (50.4%) sought care at another health provider prior to arrival. One hundred fifty-one patients died in the hospital (39.5%). Forty-three deaths occurred within 48 hours of arriving at the hospital, with median time to death of 4 days (IQR 0-7 days). Of the patients, 49.6% had ≥1 complication, 98 (25.5%) pneumonia and 33 (8.6%) urinary tract infection. Male gender (OR 3.33, 1.65-6.75), pneumonia (OR 3.75, 1.82-7.76), subarachnoid haemorrhage (OR 43.1, 6.70-277.4) and undetermined stroke types (OR 6.35, 2.17-18.60) were associated with higher risk of in-hospital death. Discussion: We observed severe strokes occurring in a young population with high in-hospital mortality. Further work to deliver evidence-based stroke care is essential to reduce stroke mortality in Sierra Leone.
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Affiliation(s)
- Daniel Youkee
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,*Correspondence: Daniel Youkee
| | - Gibrilla Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Edward Barrett
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Julia Fox-Rushby
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Israel Johnson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Iain J. Marshall
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Jessica O'Hara
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Anthony Rudd
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Albert Sama
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Christella Scott
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Melvina Thompson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Hatem Wafa
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Jurate Wall
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Yanzhong Wang
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom,NIHR Applied Research Collaboration South London, London, United Kingdom
| | - Caroline Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, United Kingdom
| | - Charles Wolfe
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom,NIHR Applied Research Collaboration South London, London, United Kingdom
| | - Durodami Radcliffe Lisk
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Catherine Mary Sackley
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,Division of Stroke Medicine, University of Nottingham, Nottingham, United Kingdom
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Novarro-Escudero N, Moon YJ, Olmedo A, Ferguson T, Caballero I, Onodera E, Effio E, Klein LM, Zink EK, Johnson B, Urrutia VC. Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries. Front Neurol 2021; 12:684775. [PMID: 34484099 PMCID: PMC8415350 DOI: 10.3389/fneur.2021.684775] [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: 03/24/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke is the second leading cause of death and disability worldwide. Stroke centers have become a central component of modern stroke services in many high-income countries, but their feasibility and efficacy in low, middle, and emerging high-income countries are less clear. Also, despite the availability of international guidelines, many hospitals worldwide do not have organized clinical stroke care. We present a methodology to help hospitals develop stroke centers and review quality data after implementation. Objectives: To describe and compare demographics, performance, and clinical outcomes of the Pacífica Salud, Hospital Punta Pacífica (PSHPP) stroke center during its first 3 years 2017–2019. Methods: Pacífica Salud, Hospital Punta Pacífica was organized to implement protocols of care based on the best practices by international guidelines and a quality improvement process. The methodology for implementation adapts a model for translating evidence into practice for implementation of evidence-based practices in medicine. This is a retrospective study of prospectively collected quality data between March of 2017 to December of 2019 for patients admitted to PSHPP with primary diagnosis stroke. Data collected include demographics, clinical data organized per the Joint Commission's STK Performance Measures, door to needle, door to groin puncture, 90 day modified Rankin Score, and hemorrhagic complications from IV thrombolysis and mechanical thrombectomy (MT). Primary outcome: year over year proficiency in documenting performance measures. Secondary outcome: year over year improvement. Results: A total of 143 patients were admitted for acute ischemic stroke, TIA, or hemorrhagic stroke. Of these, 36 were admitted in 2017, 50 in 2018, and 57 in 2019. Performance measure proficiency increased in the year-over-year analysis as did the total number of patients and the number of patients treated with IV thrombolysis and MT. Conclusions: We present the methodology and results of a stroke program implementation in Panamá. This program is the first in the country and in Central America to achieve Joint Commission International (JCI) certification as a Primary Stroke Center (PSC). We postulate that the dissemination of management guidelines is not sufficient to encourage the development of stroke centers. The application of a methodology for translation of evidence into practice with mentorship facilitated the success of this program.
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Affiliation(s)
| | - Yoon Ji Moon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Argelis Olmedo
- Department of Nursing and Quality, Pacífica Salud, Hospital Punta Pacífica, Panamá, Panama
| | - Teresa Ferguson
- Primary Stroke Center, Pacífica Salud, Hospital Punta Pacífica, Panamá, Panama
| | - Ileana Caballero
- Department of Emergency Medicine, Pacífica Salud, Hospital Punta Pacífica, Panamá, Panama
| | - Eduardo Onodera
- Department of Radiology, Pacífica Salud, Hospital Punta Pacífica, Panamá, Panama
| | - Euclides Effio
- Department of Neurosurgery, Pacífica Salud, Hospital Punta Pacífica, Panamá, Panama
| | - Lisa M Klein
- Department of Neurosciences, The Johns Hopkins Hospital Comprehensive Stroke Center, Baltimore, MD, United States
| | - Elizabeth K Zink
- Department of Neurosciences, The Johns Hopkins Hospital Comprehensive Stroke Center, Baltimore, MD, United States
| | - Brenda Johnson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurosciences, The Johns Hopkins Hospital Comprehensive Stroke Center, Baltimore, MD, United States
| | - Victor C Urrutia
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neurosciences, The Johns Hopkins Hospital Comprehensive Stroke Center, Baltimore, MD, United States
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50
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Predicting Independence 6 and 18 Months after Ischemic Stroke Considering Differences in 12 Countries: A Secondary Analysis of the IST-3 Trial. Stroke Res Treat 2021; 2021:5627868. [PMID: 34373778 PMCID: PMC8349276 DOI: 10.1155/2021/5627868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This study is aimed at identifying the best clinical model to predict poststroke independence at 6 and 18 months, considering sociodemographic and clinical characteristics, and then identifying differences between countries. Methods Data was retrieved from the International Stroke Trial 3 study. Nine clinical variables (age, gender, severity, rt-PA, living alone, atrial fibrillation, history of transient ischemic attack/stroke, and abilities to lift arms and walk) were measured immediately after the stroke and considered to predict independence at 6 and 18 months poststroke. Independence was measured using the Oxford Handicap Scale. The adequacy, predictive capacity, and discriminative capacity of the models were checked. Countries were added to the final models. Results At 6 months poststroke, 35.8% (n = 1088) of participants were independent, and at 18 months, this proportion decreased to 29.9% (n = 747). Both 6 and 18 months poststroke predictive models obtained fair discriminatory capacities. Gender, living alone, and rt-PA only reached predictive significance at 18 months. Poststroke patients from Poland and Sweden showed greater chances to achieve independence at 6 months compared to the UK. Poland also achieved greater chances at 18 months. Italy had worse chances than the UK at both follow-ups. Discussion. Six and eight variables predicted poststroke independence at 6 and 18 months, respectively. Some variables only reached significance at 18 months, suggesting a late influence in stroke patients' rehabilitation. Differences found between countries in achieving independence may be related to healthcare system organization or cultural characteristics, a hypothesis that must be addressed in future studies. These results can allow the development of tailored interventions to improve the outcomes.
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