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Jiang Y, Zhao Q, Guan J, Wang Y, Chen J, Li Y. Analyzing prehospital delays in recurrent acute ischemic stroke: Insights from interpretable machine learning. PATIENT EDUCATION AND COUNSELING 2024; 123:108228. [PMID: 38458092 DOI: 10.1016/j.pec.2024.108228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE This study investigates prehospital delays in recurrent Acute Ischemic Stroke (AIS) patients, aiming to identify key factors contributing to these delays to inform effective interventions. METHODS A retrospective cohort analysis of 1419 AIS patients in Shenzhen from December 2021 to August 2023 was performed. The study applied the Extreme Gradient Boosting (XGBoost) algorithm and SHapley Additive exPlanations (SHAP) for identifying determinants of delay. RESULTS Living with others and lack of stroke knowledge emerged as significant risk factors for delayed hospital presentation in recurrent AIS patients. Key features impacting delay times included residential status, awareness of stroke symptoms, presence of conscious disturbance, diabetes mellitus awareness, physical weakness, mode of hospital presentation, type of stroke, and presence of coronary artery disease. CONCLUSION Prehospital delays are similarly prevalent among both recurrent and first-time AIS patients, highlighting a pronounced knowledge gap in the former group. This discovery underscores the urgent need for enhanced stroke education and management. PRACTICE IMPLICATION The similarity in prehospital delay patterns between recurrent and first-time AIS patients emphasizes the necessity for public health initiatives and tailored educational programs. These strategies aim to improve stroke response times and outcomes for all patients.
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Affiliation(s)
- Youli Jiang
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Qingshi Zhao
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Jincheng Guan
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Yuying Wang
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China
| | - Jingfang Chen
- The Third People's Hospital of Shenzhen, Shenzhen 518112, China; National Clinical Research Center for Infectious Diseases, 29 Bulan Road, Longgang District, Shenzhen 518112, China.
| | - Yanfeng Li
- Department of Neurology, People's Hospital of Longhua, 38 Jinglong Jianshe Road, Longhua District, Shenzhen 518109, China.
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Chavez AA, Simmonds KP, Venkatachalam AM, Ifejika NL. Health Care Disparities in Stroke Rehabilitation. Phys Med Rehabil Clin N Am 2024; 35:293-303. [PMID: 38514219 DOI: 10.1016/j.pmr.2023.06.030] [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: 03/23/2024]
Abstract
Stroke outcomes are influenced by factors such as education, lifestyle, and access to care, which determine the extent of functional recovery. Disparities in stroke rehabilitation research have traditionally included age, race/ethnicity, and sex, but other areas make up a gap in the literature. This article conducted a literature review of original research articles published between 2008 and 2022. The article also expands on research that highlights stroke disparities in risk factors, rehabilitative stroke care, language barriers, outcomes for stroke survivors, and interventions focused on rehabilitative stroke disparities.
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Affiliation(s)
- Audrie A Chavez
- Brain Injury Medicine Fellow, Spaulding Rehabilitation, Harvard University, Cambridge, MA, USA
| | - Kent P Simmonds
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Nneka L Ifejika
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA; Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Stop 9055, Dallas, TX 75390-9055, USA.
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3
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Denny MC, Rosendale N, Gonzales NR, Leslie-Mazwi TM, Middleton S. Addressing Disparities in Acute Stroke Management and Prognosis. J Am Heart Assoc 2024; 13:e031313. [PMID: 38529656 DOI: 10.1161/jaha.123.031313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/03/2024] [Indexed: 03/27/2024]
Abstract
There are now abundant data demonstrating disparities in acute stroke management and prognosis; however, interventions to reduce these disparities remain limited. This special report aims to provide a critical review of the current landscape of disparities in acute stroke care and highlight opportunities to use implementation science to reduce disparities throughout the early care continuum. In the prehospital setting, stroke symptom recognition campaigns that have been successful in reducing prehospital delays used a multilevel approach to education, including mass media, culturally tailored community education, and professional education. The mobile stroke unit is an organizational intervention that has the potential to provide more equitable access to timely thrombolysis and thrombectomy treatments. In the hospital setting, interventions to address implicit biases among health care providers in acute stroke care decision-making are urgently needed as part of a multifaceted approach to advance stroke equity. Implementing stroke systems of care interventions, such as evidence-based stroke care protocols at designated stroke centers, can have a broader public health impact and may help reduce geographic, racial, and ethnic disparities in stroke care, although further research is needed. The long-term impact of disparities in acute stroke care cannot be underestimated. The consistent trend of longer time to treatment for Black and Hispanic people experiencing stroke has direct implications on long-term disability and independence after stroke. A learning health system model may help expedite the translation of evidence-based interventions into clinical practice to reduce disparities in stroke care.
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Affiliation(s)
- M Carter Denny
- Department of Neurology Georgetown University School of Medicine Washington DC USA
- Department of Neurology, MedStar Health Washington DC USA
| | - Nicole Rosendale
- Department of Neurology University of California San Francisco San Francisco CA USA
- Weill Institute for Neurosciences, University of California San Francisco San Francisco CA USA
| | - Nicole R Gonzales
- Department of Neurology University of Colorado Anschutz Medical Campus Aurora CO USA
| | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University Darlinghurst Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University Darlinghurst Australia
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Towfighi A, Ovbiagele B. Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving 2023 Update. J Am Heart Assoc 2024; 13:e031306. [PMID: 38529646 DOI: 10.1161/jaha.124.031306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Amytis Towfighi
- University of Southern California Los Angeles CA USA
- Los Angeles County Department of Health Services Los Angeles CA USA
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5
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Hamilton RH. Building an ethnically and racially diverse neurology workforce. Nat Rev Neurol 2024; 20:222-231. [PMID: 38388568 DOI: 10.1038/s41582-024-00941-3] [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: 02/02/2024] [Indexed: 02/24/2024]
Abstract
As diversity among patient populations continues to grow, racial and ethnic diversity in the neurology workforce is increasingly essential to the delivery of culturally competent care and for enabling inclusive, generalizable clinical research. Unfortunately, diversity in the workforce is an area in which the field of neurology has historically lagged and faces formidable challenges, including an inadequate number of trainees entering the field, bias experienced by trainees and faculty from minoritized racial and ethnic backgrounds, and 'diversity tax', the disproportionate burden of service work placed on minoritized people in many professions. Although neurology departments, professional organizations and relevant industry partners have come to realize the importance of diversity to the field and have taken steps to promote careers in neurology for people from minoritized backgrounds, additional steps are needed. Such steps include the continued creation of diversity leadership roles in neurology departments and organizations, the creation of robust pipeline programmes, aggressive recruitment and retention efforts, the elevation of health equity research and engagement with minoritized communities. Overall, what is needed is a shift in culture in which diversity is adopted as a core value in the field.
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Affiliation(s)
- Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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6
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Sheth KN, Solomon N, Alhanti B, Messe SR, Xian Y, Bhatt DL, Hemphill JC, Frontera JA, Chang RC, Danelich IM, Huang J, Schwamm L, Smith EE, Goldstein JN, Mac Grory B, Fonarow GC, Saver JL. Time to Anticoagulation Reversal and Outcomes After Intracerebral Hemorrhage. JAMA Neurol 2024; 81:2815044. [PMID: 38335064 PMCID: PMC11002694 DOI: 10.1001/jamaneurol.2024.0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/19/2024] [Indexed: 02/12/2024]
Abstract
Importance Intracerebral hemorrhage (ICH) is the deadliest stroke subtype, and mortality rates are especially high in anticoagulation-associated ICH. Recently, specific anticoagulation reversal strategies have been developed, but it is not clear whether there is a time-dependent treatment effect for door-to-treatment (DTT) times in clinical practice. Objective To evaluate whether DTT time is associated with outcome among patients with anticoagulation-associated ICH treated with reversal interventions. Design, Setting, and Participants This cohort study used data from the American Heart Association Get With The Guidelines-Stroke quality improvement registry. Patients with ICH who presented within 24 hours of symptom onset across 465 US hospitals from 2015 to 2021 were included. Data were analyzed from January to September 2023. Exposures Anticoagulation-associated ICH. Main Outcomes and Measures DTT times and outcomes were analyzed using logistic regression modeling, adjusted for demographic, history, baseline, and hospital characteristics, with hospital-specific random intercepts to account for clustering by site. The primary outcome of interest was the composite inpatient mortality and discharge to hospice. Additional prespecified secondary outcomes, including functional outcome (discharge modified Rankin Scale score, ambulatory status, and discharge venue), were also examined. Results Of 9492 patients with anticoagulation-associated ICH and documented reversal intervention status, 4232 (44.6%) were female, and the median (IQR) age was 77 (68-84) years. A total of 7469 (78.7%) received reversal therapy, including 4616 of 5429 (85.0%) taking warfarin and 2856 of 4069 (70.2%) taking a non-vitamin K antagonist oral anticoagulant. For the 5224 patients taking a reversal intervention with documented workflow times, the median (IQR) onset-to-treatment time was 232 (142-482) minutes and the median (IQR) DTT time was 82 (58-117) minutes, with a DTT time of 60 minutes or less in 1449 (27.7%). A DTT time of 60 minutes or less was associated with decreased mortality and discharge to hospice (adjusted odds ratio, 0.82; 95% CI, 0.69-0.99) but no difference in functional outcome (ie, a modified Rankin Scale score of 0 to 3; adjusted odds ratio, 0.91; 95% CI, 0.67-1.24). Factors associated with a DTT time of 60 minutes or less included White race, higher systolic blood pressure, and lower stroke severity. Conclusions and Relevance In US hospitals participating in Get With The Guidelines-Stroke, earlier anticoagulation reversal was associated with improved survival for patients with ICH. These findings support intensive efforts to accelerate evaluation and treatment for patients with this devastating form of stroke.
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Affiliation(s)
- Kevin N. Sheth
- Yale Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole Solomon
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Steven R. Messe
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia
| | - Ying Xian
- Department of Neurology, University of Texas at Southwestern, Dallas
| | - Deepak L. Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | | | - Lee Schwamm
- Department of Biomedical Informatics and Data Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Eric E. Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Joshua N. Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Brian Mac Grory
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | - Gregg C. Fonarow
- Division of Cardiology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Jeffrey L. Saver
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, California
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7
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Amoah D, Prior S, Mather C, Schmidt M, Bird ML. Exploring the Unmet Needs of Young Adults with Stroke in Australia: Can Technology Help Meet Their Needs? A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6450. [PMID: 37568991 PMCID: PMC10418600 DOI: 10.3390/ijerph20156450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
The post-stroke needs of young adults with stroke are not being met, as most resources are tailored to older people with stroke. This includes technology-based applications, which are being used more frequently in stroke rehabilitation. There is limited data on technology usage to support the unique needs of young adults with stroke in Australia. This study aimed to explore the unmet needs of young adults aged 18-30 years with stroke and ascertain how technology can help meet those needs to improve quality of life and participation. Sixteen in-depth semi-structured interviews were conducted with young adults with stroke (n = 10), healthcare professionals (n = 3) and caregivers of young adults with stroke (n = 3). The interviews were transcribed verbatim and analyzed inductively. Five themes were generated: 'Support for recovery', 'Availability of specific resources', 'Continuity of care', 'Adjustment' and 'Knowledge'. This study revealed the unique needs of young adults under 30 years with stroke who requested more targeted post-stroke support, age-specific resources and improved awareness on young stroke, with technology playing a pivotal role in all these interventions. We suggest co-designing technology-based solutions with young people after stroke to maximize their effectiveness in improving quality of life and participation in this unique cohort.
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Affiliation(s)
- Dinah Amoah
- School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia
| | - Sarah Prior
- Tasmanian School of Medicine, University of Tasmania, Burnie, TAS 7320, Australia
| | - Carey Mather
- Australian Institute of Health Service Management, University of Tasmania, Hobart, TAS 7001, Australia
| | - Matthew Schmidt
- School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston, TAS 7250, Australia
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8
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Moreno AP, Camargo L, Gaitán G, Castillo EE, Pabón SA, Shelach S, Gargiulo P, Caldichoury N, López N. Effectiveness of a digital application to improve stroke knowledge for kids. Neurologia 2023; 38:278-283. [PMID: 37169470 DOI: 10.1016/j.nrleng.2021.10.006] [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: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Stroke is highly prevalent in Latin America and one of the leading causes of morbidity and mortality in the world. Educating children about stroke has been established as an effective method to detect symptoms early, reduce hospital visits, and raise awareness among adults. OBJECTIVE To analyze the effectiveness of a mobile application to improve knowledge and understanding of stroke among children. METHOD We conducted a focus group session including 12 children in order to analyze the behavior of 6 questions previously validated by expert neurologists. Subsequently, 105 primary school students between the ages of 7 and 12 completed a questionnaire on stroke symptoms and how to contact the emergency services before and after using an application on stroke symptoms. Qualitative analyses and the Student t test were used to verify the existence of differences between pre- and post-intervention test results. RESULTS After a single 40-min working session with the application, between 50% and 67% of the children were able to identify the signs of stroke, and 96.2% knew the national emergency services telephone number. Statistical analysis revealed statistically significant differences before and after the intervention with the digital application (t=19.54; p<0.001) and intragroup differences in the post-intervention test results (t=40.71; p<0.001). CONCLUSION Primary school children who used our digital application increased their knowledge, understanding, and learning of stroke symptoms.
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Affiliation(s)
- A P Moreno
- Residencia Neurología, Escuela de Medicina, Universidad del Sinú, Cartagena, Colombia
| | - L Camargo
- Profesorado Neurología, Universidad del Sinú y Universidad de Cartagena, Cartagena, Colombia.
| | - G Gaitán
- Residencia Neurología, Escuela de Medicina, Universidad del Sinú, Cartagena, Colombia
| | - E E Castillo
- Profesorado Neurología, Universidad del Sinú, Cartagena, Colombia
| | - S A Pabón
- Educación médica, Estrategia pedagógica en ACV, Colombia
| | - S Shelach
- Laboratorio de Neurociencias, Universidad Católica San Pablo, Arequipa, Perú
| | - P Gargiulo
- Laboratorio de Neurociencias y Psicología Experimental, Universidad Nacional de Cuyo, Mendoza, Argentina
| | | | - N López
- Departamento de Ciencias Sociales, Universidad de la Costa, Barranquilla, Colombia
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Faigle R. Racial and Ethnic Disparities in Stroke Reperfusion Therapy in the USA. Neurotherapeutics 2023; 20:624-632. [PMID: 37219714 PMCID: PMC10275817 DOI: 10.1007/s13311-023-01388-y] [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] [Accepted: 05/08/2023] [Indexed: 05/24/2023] Open
Abstract
Racial and ethnic inequities in stroke care are ubiquitous. Acute reperfusion therapies, i.e., IV thrombolysis (IVT) and mechanical thrombectomy (MT), are central to acute stroke care and are highly efficacious at preventing death and disability after stroke. Disparities in the use of IVT and MT in the USA are pervasive and contribute to worse outcomes among racial and ethnic minority individuals with ischemic stroke. A meticulous understanding of disparities and underlying root causes is necessary in order to develop targeted mitigation strategies with lasting effects. This review details racial and ethnic disparities in the use of IVT and MT after stroke and highlights inequities in the underlying process measures as well as the contributing root causes. Furthermore, this review spotlights the systemic and structural inequities that contribute to race-based differences in the use of IVT and MT, including geographic and regional differences and differences based on neighborhood, zip code, and hospital type. In addition, recent promising trends suggesting improvements in racial and ethnic IVT and MT disparities and potential approaches for future solutions to achieve equity in stroke care are briefly discussed.
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Affiliation(s)
- Roland Faigle
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 484, Baltimore, MD, 21287, USA.
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10
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Tekyol D, Altundağ İ, Efe Y, Kılıç M, Öncü T, Pul MF, Sayman C, Sayman ÖA. Investigation of an alternative education module in raising middle school student's awareness of acute stroke. Clin Neurol Neurosurg 2023; 225:107565. [PMID: 36608465 DOI: 10.1016/j.clineuro.2022.107565] [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: 09/03/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Public knowledge and recognition of stroke and prompt calls to ambulance services when stroke is suspected are vital to the survival of stroke patients and to minimize their disability. In this study, our aim was to investigate the effectiveness of an online education session to increase middle school (11-14-year-old) students' awareness of stroke. METHODS An interactive education session was organized for students using the online education portal of a local middle school. The effectiveness of this intervention was measured using knowledge measurement tests before, immediately after, and three months after the session. The compliance of the data with the normal distribution was checked with the Kolmogorov-Smirnov test. The McNemar chi-square analysis was used to compare the distribution of correct and incorrect answers among the tests, and one-way analysis of variance was conducted to compare the mean values of correct answers. RESULTS The students' stroke knowledge levels were found to be higher in both tests applied after the educational session and all the questions compared to the baseline evaluation. Stroke awareness was also determined to be higher among the students living with a family member aged over 65 years. CONCLUSIONS Online interactive education can increase students' awareness of stroke. Such programs can be included in the education curriculum of schools. Public awareness of vital diseases should continue even in extraordinary situations, such as pandemics.
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Affiliation(s)
- Davut Tekyol
- Department of Emergency Medicine, Health Science University, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey.
| | - İbrahim Altundağ
- Department of Emergency Medicine, Health Science University, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey.
| | - Yasin Efe
- Ataşehir Emlak Konut Secondary School, İstanbul, Turkey.
| | - Mazlum Kılıç
- Department of Emeregency, Fatih Sultan Mehmet Training and Research Hospital, Turkey.
| | - Tuğçe Öncü
- Department of Child and Adolescent Psychiatry, Burdur State Hospital, Turkey.
| | - Murat Fatih Pul
- Department of Neurology, Fatih Sultan Mehmet Training and research Hospital, İstanbul, Turkey.
| | - Ceyhun Sayman
- İstanbul University Health Science Institute Neurodevelopmental Translational Neuroscience Ph.D, Turkey.
| | - Özden Aksu Sayman
- Pediatrics Department, Alanya Alaeddin Keykubat University, Antalya, Turkey.
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11
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Mavragani A, Ancer Leal A, Montiel TC, Wynne KJ, Edquilang G, Vu KYT, Vahidy F, Savitz SI, Beauchamp JE, Sharrief A. An Intervention Mapping Approach to Developing a Stroke Literacy Video for Recent Stroke Survivors: Development and Usability Study. JMIR Form Res 2023; 7:e31903. [PMID: 35972729 PMCID: PMC9850284 DOI: 10.2196/31903] [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: 12/28/2021] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy-an understanding of stroke symptoms, risk factors, and treatment-likely contributes to vascular risk factor control and in turn stroke recurrence risk. Stroke literacy is the lowest among adults belonging to racial and ethnic minority populations in the United States. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce the risk of stroke recurrence. However, the failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. Intervention mapping (IM) provides a framework for use in the development, implementation, and evaluation of evidence-informed, health-related interventions. OBJECTIVE We aimed to develop a video-based educational intervention to improve stroke literacy in hospitalized patients with acute stroke. METHODS The 6-step iterative process of IM was used to develop a video-based educational intervention and related implementation and evaluation plans. The six steps included a needs assessment, the identification of outcomes and change objectives, the selection of theory- and video-based intervention methods and practical applications, the development of a video-based stroke educational intervention, plans for implementation, and evaluation strategies. RESULTS A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. A planned approach to video adoption, implementation, and evaluation was also developed. CONCLUSIONS An IM approach guided the development of a 5-minute video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support widespread access and participation in video-based health literacy interventions for populations with acute and chronic stroke. Studies are needed to assess the impact of video-based educational interventions that are paired with stroke systems of care optimization to reduce the risk of stroke recurrence. Furthermore, studies on culturally and linguistically sensitive video-based stroke literacy interventions are needed to address known racial and ethnic disparities in stroke literacy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1371/journal.pone.0171952.
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Affiliation(s)
| | - Andrea Ancer Leal
- Department of Research, Cizik School of Nursing at UTHealth, Houston, TX, United States
| | | | - Keona J Wynne
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | | | - Kim Yen Thi Vu
- Memorial Hermann - Texas Medical Center, Houston, TX, United States
| | - Farhaan Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Population Health Sciences, Weill Cornell Medical School, New York, NY, United States.,Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States
| | - Sean I Savitz
- Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
| | - Jennifer Es Beauchamp
- Department of Research, Cizik School of Nursing at UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
| | - Anjail Sharrief
- Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
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12
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Walter S, Phillips D, Wells B, Moon R, Bertsch T, Grunwald IQ, Fassbender K. Detection to Hospital Door: Gender Differences of Patients With Acute Stroke Symptoms. Front Neurol 2022; 13:833933. [PMID: 35463123 PMCID: PMC9021751 DOI: 10.3389/fneur.2022.833933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/09/2022] [Indexed: 12/02/2022] Open
Abstract
Although prehospital stroke management is challenging, it is a crucial part of the acute stroke chain to enable equal access to highly specialised stroke care. It involves a critical understanding of players usually not specialized in acute stroke treatments. There is contradictory information about gender inequity in prehospital stroke detection, dispatch, and delivery to hospital stroke centers. The aim of this narrative review is to summarize the knowledge of gender differences in the first three stages of acute stroke management. Information on the detection of acute stroke symptoms by patients, their relatives, and bystanders is discussed. Women seem to have a better overall knowledge about stroke, although general understanding needs to be improved. However, older age and different social situations of women could be identified as reasons for reduced and delayed help-seeking. Dispatch and delivery lie within the responsibility of the emergency medical service. Differences in clinical presentation with symptoms mainly affecting general conditions could be identified as a crucial challenge leading to gender inequity in these stages. Improvement of stroke education has to be applied to tackle this inequal management. However, specifically designed projects and analyses are needed to understand more details of sex differences in prehospital stroke management, which is a necessary first step for the potential development of substantially improving strategies.
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Affiliation(s)
- Silke Walter
- Neurology, Saarland University, Homburg, Germany
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
- *Correspondence: Silke Walter
| | - Daniel Phillips
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
| | - Brittany Wells
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
| | - Robert Moon
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Iris Q. Grunwald
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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13
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Sheriff F, Xu H, Maud A, Gupta V, Vellipuram A, Fonarow GC, Matsouaka RA, Xian Y, Reeves M, Smith EE, Saver J, Rodriguez G, Cruz-Flores S, Schwamm LH. Temporal Trends in Racial and Ethnic Disparities in Endovascular Therapy in Acute Ischemic Stroke. J Am Heart Assoc 2022; 11:e023212. [PMID: 35229659 PMCID: PMC9075329 DOI: 10.1161/jaha.121.023212] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Endovascular therapy (EVT) use increased following clinical trials publication in 2015, but limited data suggest there may be persistent race and ethnicity differences. Methods and Results We included all patients with acute ischemic stroke arriving within 6 hours of last known well and with National Institute of Health Stroke Scale (NIHSS) score ≥6 between April 2012 and June 2019 in the Get With The Guidelines‐Stroke database and evaluated the association between race and ethnicity and EVT use and outcomes, comparing the era before versus after 2015. Of 302 965 potentially eligible patients; 42 422 (14%) underwent EVT. Although EVT use increased over time in all racial and ethnic groups, Black patients had reduced odds of EVT use compared with non‐Hispanic White (NHW) patients (adjusted odds ratio [aOR] before 2015, 0.68 [0.58‒0.78]; aOR after 2015, 0.83 [0.76‒0.90]). In‐hospital mortality/discharge to hospice was less frequent in Black, Hispanic, and Asian patients compared with NHW. Conversely discharge home was more frequent in Hispanic (29.7%; aOR, 1.28 [1.16‒1.42]), Asian (28.2%; aOR, 1.23 [1.05‒1.44]), and Black (29.1%; aOR, 1.08 [1.00‒1.18]) patients compared with NHW (24%). However, at 3 months, functional independence (modified Rankin Scale, 0–2) occurred less frequently in Black (37.5%; aOR, 0.84 [0.75‒0.95]) and Asian (33%; aOR, 0.79 [0.65‒0.98]) patients compared with NHW patients (38.1%). Conclusions In a large cohort of patients treated with EVT, Black versus NHW patient disparities in EVT use have narrowed over time but still exist. Discharge related outcomes were slightly more favorable in racial and ethnic underrepresented groups; 3‐month functional outcomes were worse but improved across all groups with time.
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Affiliation(s)
| | - Haolin Xu
- Duke Clinical Res Inst Durham Durham NC
| | - Alberto Maud
- Texas Tech University Health Sciences Center El Paso TX
| | - Vikas Gupta
- Texas Tech University Health Sciences Center El Paso TX
| | | | - Gregg C Fonarow
- UCLA Division of CardiologyRonald Reagan-UCLA Medical Center Los Angeles CA
| | | | - Ying Xian
- University of Texas Southwestern Medical Center Dallas TX
| | - Mathew Reeves
- College of Human Medicine Michigan State University East Lansing MI
| | | | | | | | | | - Lee H Schwamm
- Mass General HospitalHarvard Medical School Boston MA
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14
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Effectiveness of a digital application to improve stroke knowledge for kids. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Willis A, Skolarus LE, Faigle R, Menon U, Redwine H, Brown AM, Felton E, Mendizabal A, Nath A, Jensen F, McArthur JC. Strengthened through Diversity: A Blueprint for Organizational Change. Ann Neurol 2021; 90:524-536. [PMID: 34236104 PMCID: PMC8478779 DOI: 10.1002/ana.26165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/06/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Allison Willis
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | | | - Roland Faigle
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Uma Menon
- Ochsner Neuroscience Institute, Covington, LA
| | - Hannah Redwine
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX
| | - Amanda M Brown
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | | | - Adys Mendizabal
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | | | - Frances Jensen
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
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16
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Nemade D, Beckett M, Nolte J, Shivkumar V. Make Kids Stroke-Smart: A Community Based Interventional Study. Cureus 2020; 12:e11884. [PMID: 33415037 PMCID: PMC7781778 DOI: 10.7759/cureus.11884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Stroke is the third leading cause of death and the major cause of long-term disability in the United States. Timely recognition of symptoms is critical. Family members are crucial in recognizing stroke symptoms since <5% patients can call Emergency Medical Services themselves due to inability to speak or dial the phone. This might be of significance, especially, in family units where children have frequent contact with multiple generations. This study was undertaken to assess and improve the knowledge about stroke amongst children. Methods: A community-based interventional study was conducted among 305 kids ranging from second to eighth grade. A pre-test questionnaire was administered and later health education regarding stroke was imparted using audiovisual aids. Post-test was done to assess the impact of stroke education. Components of education included were: 1) What is stroke? 2) FAST mnemonic. 3) Time sensitive treatment. 4) Risk factors for stroke 5) How can they help? 6) Whom to call and where to go? The data was compiled and analyzed using Chi square test. Results: There was a significant lack of knowledge in the pretest groups. The post-test showed statistically significant improvement in all the tested components irrespective of age or grade (p<0.001). Conclusion: Targeting the younger generation for stroke education is one way to improve community knowledge of stroke symptoms thus increasing the chances that the stroke patient may receive acute stroke therapy. Children can also be used as a conduit to transmit educational information to parents and other family members thus further raising awareness.
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Affiliation(s)
- Dipali Nemade
- Neurology, Marshall University School of Medicine, Huntington, USA
| | - Mitzi Beckett
- Neurology, Cabell Huntington Hospital, Huntington, USA
| | - Justin Nolte
- Neurology, Marshall University School of Medicine, Huntington, USA
| | - Vikram Shivkumar
- Neurology, Marshall University School of Medicine, Huntington, USA
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17
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Levine DA, Duncan PW, Nguyen-Huynh MN, Ogedegbe OG. Interventions Targeting Racial/Ethnic Disparities in Stroke Prevention and Treatment. Stroke 2020; 51:3425-3432. [PMID: 33104466 DOI: 10.1161/strokeaha.120.030427] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Systemic racism is a public health crisis. Systemic racism and racial/ethnic injustice produce racial/ethnic disparities in health care and health. Substantial racial/ethnic disparities in stroke care and health exist and result predominantly from unequal treatment. This special report aims to summarize selected interventions to reduce racial/ethnic disparities in stroke prevention and treatment. It reviews the social determinants of health and the determinants of racial/ethnic disparities in care. It provides a focused summary of selected interventions aimed at reducing stroke risk factors, increasing awareness of stroke symptoms, and improving access to care for stroke because these interventions hold the promise of reducing racial/ethnic disparities in stroke death rates. It also discusses knowledge gaps and future directions.
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Affiliation(s)
- Deborah A Levine
- Department of Internal Medicine and Cognitive Health Services Research Program (D.A.L.), University of Michigan, Ann Arbor
- Department of Neurology and Stroke Program (D.A.L.), University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation (D.A.L.), University of Michigan, Ann Arbor
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC (P.W.D.)
| | - Mai N Nguyen-Huynh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (M.N.N.-H.)
- Department of Neurology, Kaiser Permanente Walnut Creek Medical Center, CA (M.N.N.-H.)
| | - Olugbenga G Ogedegbe
- Department of Population Health and Department of Medicine, New York University Grossman School of Medicine, NY (O.G.O.)
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18
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Prabhakaran S, Richards CT, Kwon S, Wymore E, Song S, Eisenstein A, Brown J, Kandula NR, Mason M, Beckstrom H, Washington KV, Aggarwal NT. A Community-Engaged Stroke Preparedness Intervention in Chicago. J Am Heart Assoc 2020; 9:e016344. [PMID: 32893720 PMCID: PMC7726971 DOI: 10.1161/jaha.120.016344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background We evaluated a community‐engaged stroke preparedness intervention that aimed to increase early hospital arrival and emergency medical services (EMS) utilization among patients with stroke in the South Side of Chicago, Illinois. Methods and Results We compared change in early hospital arrival (<3 hours from symptom onset) and EMS utilization before and after our intervention among patients with confirmed ischemic stroke at an intervention hospital on the South Side of Chicago with concurrent data from 6 hospitals in nonintervention communities on the North Side of Chicago and 17 hospitals in St Louis, Missouri. We assessed EMS utilization for suspected stroke secondarily, using geospatial information systems analysis of Chicago ambulance transports before and after our intervention. Among 21 497 patients with confirmed ischemic stroke across all sites, early arrival rates at the intervention hospital increased by 0.5% per month (95% CI, −0.2% to 1.2%) after intervention compared with the preintervention period but were not different from North Side Chicago hospitals (difference of −0.3% per month [95% CI, −0.12% to 0.06%]) or St Louis hospitals (difference of 0.7% per month [95% CI, −0.1% to 1.4%]). EMS utilization at the intervention hospital decreased by 0.8% per month (95% CI, −1.7% to 0.2%) but was not different from North Side Chicago hospitals (difference of 0.004% per month [95% CI, −1.1% to 1.1%]) or St Louis hospitals (difference of −0.7% per month [95% CI, −1.7% to 0.3%]). EMS utilization for suspected stroke increased in the areas surrounding the intervention hospital (odds ratio [OR], 1.4; 95% CI, 1.2–1.6) and in the South Side (OR, 1.2; 95% CI, 1.1–1.3), but not in the North Side (OR, 1.0; 95% CI, 0.9–1.1). Conclusions Following a community stroke preparedness intervention, early hospital arrival and EMS utilization for confirmed ischemic stroke did not increase. However, ambulance transports for suspected stroke increased in the intervention community compared with other regions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02301299.
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Affiliation(s)
| | | | - Soyang Kwon
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | - Erin Wymore
- Northwestern University, Feinberg School of Medicine Chicago IL
| | - Sarah Song
- Rush University Medical Center Chicago IL
| | | | - Jen Brown
- Northwestern University, Feinberg School of Medicine Chicago IL
| | | | - Maryann Mason
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | | | | | - Neelum T Aggarwal
- The Retirement Research Foundation Chicago IL.,Rush Alzheimer's Disease Center Chicago IL
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19
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Komolafe MA, Olorunmoteni OE, Fehintola FO. Effect of Health Education on Level of Awareness and Knowledge of Nigerian In-School adolescents on Stroke and Its Risk Factors. J Stroke Cerebrovasc Dis 2020; 29:104757. [PMID: 32173228 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/29/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stroke education in adolescents has been established as an effective method of creating awareness about stroke, its warning signs and risk factors. It contributes to desired behavioural change in the adolescents as well as their parents. Thus, we aimed to determine the baseline knowledge of school attending adolescents about stroke and its risk factors as well as the effect of stroke education on their stroke awareness. METHODS This study employed a quasi-experimental study design and was conducted in secondary schools in Ile-Ife, Osun State, Nigeria. The schools were divided into intervention and control groups. We assessed the baseline knowledge of the students on stroke, its risk factors, warning signs, and ways of preventing it using a pre-tested structured questionnaire in both intervention and control groups. In the intervention group, health talks on stroke consisting of oral presentation and distribution of fliers were presented for 30 minutes in each selected school. Each school was visited 2 weeks after the health education intervention to assess their knowledge on stroke, its risk factors, and ways of preventing it. The control group was also visited after 2 weeks for a re-assessment of their stroke knowledge and the conduct of heath talk on other aspects of neurology such as sleep, epilepsy, etc. Results: A total of 1259 adolescents were studied with 661 in the intervention group and 598 in the control group. The mean age of the respondents was 13.56 ± 2.87 the intervention group and 13.38 ± 2.06 in the control group. There were higher mean scores on knowledge of stroke and its risk factors among the intervention group than seen in the control group after the stroke education. CONCLUSIONS Stroke education is an effective way of creating and maintaining stroke awareness among school-attending adolescents.
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Affiliation(s)
- Morenikeji A Komolafe
- Department of Internal Medicine, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - Oluwatosin E Olorunmoteni
- Department of Paediatrics and Child Health, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - Funmito O Fehintola
- Department of Community Health, Obafemi Awolowo University/Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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20
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Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019; 50:e344-e418. [PMID: 31662037 DOI: 10.1161/str.0000000000000211] [Citation(s) in RCA: 3131] [Impact Index Per Article: 626.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AIS Guidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting some recommendations, was published online by the AHA. The writing group was asked review the original document and revise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion of important newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers' comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationships with industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the American College of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format. Results- These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. Conclusions- These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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21
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Umar AB, Koehler TJ, Zhang R, Gilbert V, Farooq MU, Davis AT, Nyenhuis D, Gorelick PB. Stroke knowledge among middle and high school students. J Int Med Res 2019; 47:4230-4241. [PMID: 31307252 PMCID: PMC6753559 DOI: 10.1177/0300060519858887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective To determine the awareness of stroke symptoms and risk factors in middle and
high school students at a single institution. Methods An 11-question multiple-choice stroke awareness survey was administered to
students in grades 7 to 12 at City High Middle School in Grand Rapids,
Michigan, United States. Summary statistics were calculated. Results A total of 603/608 surveys were analyzed. Only 8% of respondents correctly
identified stroke as the fifth leading cause of death in the United States.
Half (50.1%) recognized that a stroke occurred in the brain. Sixty-seven
students (11.1%) correctly identified all 11 stroke risk factors. Only 5.1%
correctly selected all four correct stroke symptoms. Two-thirds (64.5%)
recognized stroke as an immediate medical emergency. Slightly more than half
(55.9%) knew the acronym FAST (face, arms, speech, time). Conclusions Most students in our study were unaware of all the risk factors and symptoms
related to stroke. Although this study was limited because data were
collected from only one school, the findings suggest a need to educate
middle and high school students about stroke risk factors, symptoms and
acute interventions.
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Affiliation(s)
| | - Tracy J Koehler
- Scholarly Activity Support, Spectrum Health, Grand Rapids, MI, United States
| | - Reian Zhang
- City High Middle School, Grand Rapids, MI, United States
| | | | - Muhammad U Farooq
- Mercy Health, Hauenstein Neurosciences, Grand Rapids, MI, United States
| | - Alan T Davis
- Scholarly Activity Support, Spectrum Health, Grand Rapids, MI, United States
| | - David Nyenhuis
- Mercy Health, Hauenstein Neurosciences, Grand Rapids, MI, United States
| | - Philip B Gorelick
- Mercy Health, Hauenstein Neurosciences, Grand Rapids, MI, United States and Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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22
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Williams O, Leighton-Herrmann Quinn E, Teresi J, Eimicke JP, Kong J, Ogedegbe G, Noble J. Improving Community Stroke Preparedness in the HHS (Hip-Hop Stroke) Randomized Clinical Trial. Stroke 2019; 49:972-979. [PMID: 29567762 DOI: 10.1161/strokeaha.117.019861] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/03/2018] [Accepted: 02/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Deficiencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among economically disadvantaged minorities. We evaluated the effectiveness of a stroke preparedness intervention delivered to preadolescent urban public school children on the stroke knowledge/preparedness of their parents. METHODS We recruited 3070 fourth through sixth graders and 1144 parents from 22 schools into a cluster randomized trial with schools randomized to the HHS (Hip-Hop Stroke) intervention or attentional control (nutrition classes). HHS is a 3-hour culturally tailored, theory-based, multimedia stroke literacy intervention targeting school children, which systematically empowers children to share stroke information with parents. Our main outcome measures were stroke knowledge/preparedness of children and parents using validated surrogates. RESULTS Among children, it was estimated that 1% (95% confidence interval [CI], 0%-1%) of controls and 2% (95% CI, 1%-4%; P=0.09) of the intervention group demonstrated optimal stroke preparedness (perfect scores on the knowledge/preparedness test) at baseline, increasing to 57% (95% CI, 44%-69%) immediately after the program in the intervention group compared with 1% (95% CI, 0%-1%; P<0.001) among controls. At 3-month follow-up, 24% (95% CI, 15%-33%) of the intervention group retained optimal preparedness, compared with 2% (95% CI, 0%-3%; P<0.001) of controls. Only 3% (95% CI, 2%-4%) of parents in the intervention group could identify all 4 letters of the stroke FAST (Facial droop, Arm weakness, Speech disturbance, Time to call 911) acronym at baseline, increasing to 20% at immediate post-test (95% CI, 16%-24%) and 17% at 3-month delayed post-test (95% CI, 13%-21%; P=0.0062), with no significant changes (3% identification) among controls. Four children, all in the intervention group, called 911 for real-life stroke symptoms, in 1 case overruling a parent's wait-and-see approach. CONCLUSIONS HHS is an effective, intergenerational model for increasing stroke preparedness among economically disadvantaged minorities. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT01497886.
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Affiliation(s)
- Olajide Williams
- From the Department of Neurology, Columbia University Medical Center, New York, NY (O.W., E.L.-H.Q., J.N.); Research Division, Hebrew Home at Riverdale, Bronx, NY (J.P.E., J.K., J.T.); Columbia University Stroud Center at New York State Psychiatric Institute (J.T.); and Department of Population Health, NYU School of Medicine (G.O.).
| | - Ellyn Leighton-Herrmann Quinn
- From the Department of Neurology, Columbia University Medical Center, New York, NY (O.W., E.L.-H.Q., J.N.); Research Division, Hebrew Home at Riverdale, Bronx, NY (J.P.E., J.K., J.T.); Columbia University Stroud Center at New York State Psychiatric Institute (J.T.); and Department of Population Health, NYU School of Medicine (G.O.)
| | - Jeanne Teresi
- From the Department of Neurology, Columbia University Medical Center, New York, NY (O.W., E.L.-H.Q., J.N.); Research Division, Hebrew Home at Riverdale, Bronx, NY (J.P.E., J.K., J.T.); Columbia University Stroud Center at New York State Psychiatric Institute (J.T.); and Department of Population Health, NYU School of Medicine (G.O.)
| | - Joseph P Eimicke
- From the Department of Neurology, Columbia University Medical Center, New York, NY (O.W., E.L.-H.Q., J.N.); Research Division, Hebrew Home at Riverdale, Bronx, NY (J.P.E., J.K., J.T.); Columbia University Stroud Center at New York State Psychiatric Institute (J.T.); and Department of Population Health, NYU School of Medicine (G.O.)
| | - Jian Kong
- From the Department of Neurology, Columbia University Medical Center, New York, NY (O.W., E.L.-H.Q., J.N.); Research Division, Hebrew Home at Riverdale, Bronx, NY (J.P.E., J.K., J.T.); Columbia University Stroud Center at New York State Psychiatric Institute (J.T.); and Department of Population Health, NYU School of Medicine (G.O.)
| | - Gbenga Ogedegbe
- From the Department of Neurology, Columbia University Medical Center, New York, NY (O.W., E.L.-H.Q., J.N.); Research Division, Hebrew Home at Riverdale, Bronx, NY (J.P.E., J.K., J.T.); Columbia University Stroud Center at New York State Psychiatric Institute (J.T.); and Department of Population Health, NYU School of Medicine (G.O.)
| | - James Noble
- From the Department of Neurology, Columbia University Medical Center, New York, NY (O.W., E.L.-H.Q., J.N.); Research Division, Hebrew Home at Riverdale, Bronx, NY (J.P.E., J.K., J.T.); Columbia University Stroud Center at New York State Psychiatric Institute (J.T.); and Department of Population Health, NYU School of Medicine (G.O.)
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Magnani JW, Mujahid MS, Aronow HD, Cené CW, Dickson VV, Havranek E, Morgenstern LB, Paasche-Orlow MK, Pollak A, Willey JZ. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e48-e74. [PMID: 29866648 PMCID: PMC6380187 DOI: 10.1161/cir.0000000000000579] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
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Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018; 49:e46-e110. [PMID: 29367334 DOI: 10.1161/str.0000000000000158] [Citation(s) in RCA: 3432] [Impact Index Per Article: 572.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. METHODS Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format. RESULTS These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. CONCLUSIONS These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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25
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Vondráčková L, Mikulík R. Public stroke education: Current status worldwide and projects to increase awareness in the Czech Republic. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mackay MT, Monagle P, Babl FE. Improving diagnosis of childhood arterial ischaemic stroke. Expert Rev Neurother 2017; 17:1157-1165. [DOI: 10.1080/14737175.2017.1395699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mark T. Mackay
- Department of Neurology, Royal Children’s Hospital, Parkville, Australia
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Florey Institute of Neurosciences and Mental Health, Parkville, Australia
| | - Paul Monagle
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Department of Haematology, Royal Children’s Hospital, Parkville, Australia
| | - Franz E. Babl
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
- Emergency Department, Royal Children’s Hospital Melbourne, Parkville, Australia
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Tomari S, Yokota C, Nishimura K, Hino T, Ohyama S, Arimizu T, Wada S, Ohnishi H, Toyoda K, Minematsu K. Effects of school-based intervention by emergency medical technicians on students and their parents: a community-based prospective study of the Akashi project. BMJ Open 2017; 7:e016780. [PMID: 29038179 PMCID: PMC5652533 DOI: 10.1136/bmjopen-2017-016780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Stroke lessons for youth provided by emergency medical technicians (EMTs) may be an effective strategy to facilitate early intervention for patients with stroke. The aim of this study was to examine how effective EMT-led lessons on stroke awareness for schoolchildren were at disseminating stroke information. SETTING, PARTICIPANTS AND OUTCOME MEASURES The study was performed in the city of Akashi, Hyogo, Japan (Akashi project). Children (aged 9-10 years old) at 11 public elementary schools and their parents were enrolled in this study. EMTs from the firefighting headquarters provided lessons on stroke to the children using our educational materials between September 2014 and October 2015. Each child was given our educational materials to take home and discuss stroke with their parents. The children and their parents answered questionnaires on stroke knowledge before, immediately and at 3 months after the lesson. RESULTS A total of 763 children and 489 parents were enrolled (ie, 64% of children). The scores of either stroke symptoms or risk factors were significantly higher immediately and at 3 months after the lesson, compared with before the lesson, both in children and the parents (p<0.01). Compared with the baseline in both groups (58% in children, 83% in parents), the meaning of the FAST mnemonic at 3 months (88%, 94%), as well as at immediately after the lesson (90%, 89%), was significantly higher (p<0.001). CONCLUSION Stroke education by EMTs was effective in increasing stroke awareness in elementary school children, as well as their parents.
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Affiliation(s)
- Shinya Tomari
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kunihiro Nishimura
- Department of Preventative Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tenyu Hino
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Ohyama
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takuro Arimizu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinichi Wada
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Can Children Reduce Delayed Hospital Arrival for Ischemic Stroke?: A Systematic Review of School-Based Stroke Education. J Neurosci Nurs 2017; 48:E2-E13. [PMID: 27045288 DOI: 10.1097/jnn.0000000000000202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delayed hospital arrival after onset of ischemic stroke reduces the number of patients eligible for tissue plasminogen activator, which must be given soon after stroke onset. There are conflicting results about the impact of mass media stroke education on timing of hospital arrival and tissue plasminogen activator administration rates. School-based programs are a new way to communicate stroke information. METHODS A search of MEDLINE, CINAHL, PsycINFO, and ERIC databases from 1995 to 2014 identified school-based stroke education interventions. Twelve studies involving 3,312 children and 612 parents met criteria for review. RESULTS School-based stroke education interventions were effective to improve knowledge of stroke symptoms among children in kindergarten through junior high. Improvement for stroke risk factors was less robust. Interventions were effective regardless of format, length, or who delivered the information. Despite low parental response rates in some studies, there was evidence that children transmitted stroke information to parents. CONCLUSIONS School-based stroke education programs appear effective to improve knowledge of stroke symptoms. Research is needed to determine if children who participate are able to recognize stroke and respond appropriately by calling 911 in the real world. More study is needed about transfer of stroke knowledge from child to parent. Strategies to improve parent participation are needed.
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Stroke awareness in Korean high school students. Acta Neurol Belg 2017; 117:455-459. [PMID: 28154990 DOI: 10.1007/s13760-017-0754-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
Public awareness is essential for the early diagnosis, treatment, and prevention of stroke. In particular, young adults represent an important avenue for increasing awareness and precluding the adoption of unhealthy, risk-increasing behaviors. This study was the first to investigate the basic knowledge of Korean adolescents about stroke and evaluate the improvement of this knowledge after an educational lecture. In total, 1269 high school students were instructed on the risk factors, symptoms, diagnosis, and management of stroke. Knowledge was evaluated before education (Pre-E), immediately after the lecture (Post-E1), and during a 2-week follow-up (Post-E2), using a questionnaire. Overall, we found that students' knowledge increased after the educational session. On the questionnaire section pertaining to stroke risk factors, out of nine possible points, the mean scores were 3.97, 5.28, and 5.10, on the Pre-E, Post-E1, and Post-E2 tests, respectively, indicating a significant improvement (p < 0.001). Additionally, students who reported that they paid attention during the lecture performed better, and scored 4.29, 6.32, and 6.40, on the Pre-E, Post-E1, and Post-E2 tests, respectively, again indicating a significant improvement (p < 0.001). Our findings indicate that incorporating a stroke education program into school curriculums will enhance the knowledge of Korean adolescents. Implementing this type of program is critical as it may reduce behavior associated with increased stroke risk, and more effort is needed to develop educational methods for engaging students and increasing their concentration during these programs.
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Skolarus LE, Mazor KM, Sánchez BN, Dome M, Biller J, Morgenstern LB. Development and Validation of a Bilingual Stroke Preparedness Assessment Instrument. Stroke 2017; 48:1020-1025. [PMID: 28250199 DOI: 10.1161/strokeaha.116.015107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke preparedness interventions are limited by the lack of psychometrically sound intermediate end points. We sought to develop and assess the reliability and validity of the video-Stroke Action Test (video-STAT) an English and a Spanish video-based test to assess people's ability to recognize and react to stroke signs. METHODS Video-STAT development and testing was divided into 4 phases: (1) video development and community-generated response options, (2) pilot testing in community health centers, (3) administration in a national sample, bilingual sample, and neurologist sample, and (4) administration before and after a stroke preparedness intervention. RESULTS The final version of the video-STAT included 8 videos: 4 acute stroke/emergency, 2 prior stroke/nonemergency, 1 nonstroke/emergency, and 1 nonstroke/nonemergency. Acute stroke recognition and action response were queried after each vignette. Video-STAT scoring was based on the acute stroke vignettes only (score range 0-12 best). The national sample consisted of 598 participants, 438 who took the video-STAT in English and 160 who took the video-STAT in Spanish. There was adequate internal consistency (Cronbach α=0.72). The average video-STAT score was 5.6 (SD=3.6), whereas the average neurologist score was 11.4 (SD=1.3). There was no difference in video-STAT scores between the 116 bilingual video-STAT participants who took the video-STAT in English or Spanish. Compared with baseline scores, the video-STAT scores increased after a stroke preparedness intervention (6.2 versus 8.9, P<0.01) among a sample of 101 black adults and youth. CONCLUSIONS The video-STAT yields reliable scores that seem to be valid measures of stroke preparedness.
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Affiliation(s)
- Lesli E Skolarus
- From the Stroke Program (L.E.S., M.D., L.B.M.) and Department of Biostatistics (B.N.S), University of Michigan, Ann Arbor; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester (K.M.M.); and Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL (J.B.).
| | - Kathleen M Mazor
- From the Stroke Program (L.E.S., M.D., L.B.M.) and Department of Biostatistics (B.N.S), University of Michigan, Ann Arbor; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester (K.M.M.); and Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL (J.B.)
| | - Brisa N Sánchez
- From the Stroke Program (L.E.S., M.D., L.B.M.) and Department of Biostatistics (B.N.S), University of Michigan, Ann Arbor; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester (K.M.M.); and Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL (J.B.)
| | - Mackenzie Dome
- From the Stroke Program (L.E.S., M.D., L.B.M.) and Department of Biostatistics (B.N.S), University of Michigan, Ann Arbor; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester (K.M.M.); and Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL (J.B.)
| | - José Biller
- From the Stroke Program (L.E.S., M.D., L.B.M.) and Department of Biostatistics (B.N.S), University of Michigan, Ann Arbor; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester (K.M.M.); and Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL (J.B.)
| | - Lewis B Morgenstern
- From the Stroke Program (L.E.S., M.D., L.B.M.) and Department of Biostatistics (B.N.S), University of Michigan, Ann Arbor; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester (K.M.M.); and Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL (J.B.)
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Mackay MT, Stojanovski B, Mosley I, Churilov L, Donnan GA, Monagle P. Parental Care-Seeking Behavior and Prehospital Timelines of Care in Childhood Arterial Ischemic Stroke. Stroke 2016; 47:2638-40. [PMID: 27608817 DOI: 10.1161/strokeaha.116.014728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Taking appropriate action in the prehospital setting is important for rapid stroke diagnosis in adults. Data are lacking for children. We aimed to describe parental care-seeking behavior and prehospital timelines of care in childhood arterial ischemic stroke. METHODS A structured questionnaire was developed, using value-focused event-driven conceptual modeling techniques, to interview parents of children presenting to the emergency department with arterial ischemic stroke from 2008 to 2014. RESULTS Twenty-five parents (median age 41 years, interquartile range 36-45) were interviewed. Twenty-four children were awake, and 1 child was asleep at stroke onset; 23 had sudden onset symptoms. Location at stroke onset included home (72%), school (8%), or other setting (20%). Carergivers present included parent (76%), another child (8%), teacher (4%), or alone (8%). Eighty-four percent of parents thought symptoms were serious, and 83% thought immediate action was required, but only 48% considered the possibility of stroke. Initial actions included calling an ambulance (36%), wait and see (24%), calling a general practitioner (16%) or family member (8%), and driving to the emergency department or family physician (both 8%). Median time from onset to emergency department arrival was 76 minutes (interquartile range 53-187), being shorter for ambulance-transported patients. CONCLUSIONS Stroke recognition and care-seeking behavior are suboptimal, with less than half the parents considering stroke or calling an ambulance. Initiatives are required to educate parents about appropriate actions to facilitate time-critical interventions.
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Affiliation(s)
- Mark T Mackay
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia.
| | - Belinda Stojanovski
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Ian Mosley
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Leonid Churilov
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Geoffrey A Donnan
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
| | - Paul Monagle
- From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia
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Skolarus LE, Zimmerman MA, Bailey S, Dome M, Murphy JB, Kobrossi C, Dombrowski SU, Burke JF, Morgenstern LB. Stroke Ready Intervention: Community Engagement to Decrease Prehospital Delay. J Am Heart Assoc 2016; 5:e003331. [PMID: 27208000 PMCID: PMC4889198 DOI: 10.1161/jaha.116.003331] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Time-limited acute stroke treatments are underused, primarily due to prehospital delay. One approach to decreasing prehospital delay is to increase stroke preparedness, the ability to recognize stroke, and the intention to immediately call emergency medical services, through community engagement with high-risk communities. METHODS AND RESULTS Our community-academic partnership developed and tested "Stroke Ready," a peer-led, workshop-based, health behavior intervention to increase stroke preparedness among African American youth and adults in Flint, Michigan. Outcomes were measured with a series of 9 stroke and nonstroke 1-minute video vignettes; after each video, participants selected their intended response (primary outcome) and symptom recognition (secondary outcome), receiving 1 point for each appropriate stroke response and recognition. We assessed differences between baseline and posttest appropriate stroke response, which was defined as intent to call 911 for stroke vignettes and not calling 911 for nonstroke, nonemergent vignettes and recognition of stroke. Outcomes assessments were performed before workshop 1 (baseline), at the conclusion of workshop 2 (immediate post-test), and 1 month later (delayed post-test). A total of 101 participants completed the baseline assessment (73 adults and 28 youths), 64 completed the immediate post-test, and 68 the delayed post-test. All participants were African American. The median age of adults was 56 (interquartile range 35-65) and of youth was 14 (interquartile range 11-16), 65% of adults were women, and 50% of youths were women. Compared to baseline, appropriate stroke response was improved in the immediate post-test (4.4 versus 5.2, P<0.01) and was sustained in the delayed post-test (4.4 versus 5.2, P<0.01). Stroke recognition did not change in the immediate post-test (5.9 versus 6.0, P=0.34), but increased in the delayed post-test (5.9 versus 6.2, P=0.04). CONCLUSIONS Stroke Ready increased stroke preparedness, a necessary step toward increasing acute stroke treatment rates. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01499173.
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Affiliation(s)
- Lesli E Skolarus
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI
| | - Marc A Zimmerman
- Department of Health Behavior of Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Mackenzie Dome
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI
| | - Jillian B Murphy
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI
| | | | | | - James F Burke
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI
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Sharkey S, Denke L, Herbert MA. Using Puppets to Teach Schoolchildren to Detect Stroke and Call 911. J Sch Nurs 2016; 32:228-33. [PMID: 27009590 DOI: 10.1177/1059840516636197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To overcome barriers to improved outcomes, we undertook an intervention to teach schoolchildren how to detect a stroke and call emergency medical services (EMS). We obtained permission from parents and guardians to use an 8-min puppet show to instruct the fourth, fifth, and sixth graders about stroke detection, symptomatology, and calling EMS. A pretest and three posttests-one immediately following the presentation, one at 3 months, and a third at 6 months-were administered. Responses from 282 students were evaluable. Significant improvements (p < .001) in knowledge were found through all posttests in identifying what parts of the body stroke affected and through the first two posttests in recognizing symptoms stroke victims experienced. Students demonstrated at pretest a high awareness of EMS and 911 (97.5%) and showed slight, but not significant, improvement over time.
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Affiliation(s)
- Sonya Sharkey
- Cardiology Department, Medical City Dallas Hospital, Dallas, TX, USA
| | - Linda Denke
- Organizational Development, Medical City Dallas Hospital, Dallas, TX, USA Houston J. and Florence A. Doswell College of Nursing, Texas Woman's University, Dallas, TX, USA
| | - Morley A Herbert
- Department of Clinical Research, Medical City Dallas Hospital, Dallas, TX, USA
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Marto JP, Borbinha C, Filipe R, Calado S, Viana-Baptista M. Impact of stroke education on middle school students and their parents: A cluster randomized trial. Int J Stroke 2016; 12:401-411. [PMID: 27799456 DOI: 10.1177/1747493016677980] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background School students are an attractive target for stroke education due to the potential impact on stroke prevention and recognition. Additionally, these students can drive behavioral changes in their families. Aim To evaluate the impact of stroke education on school students, in terms of students' and parents' acquired stroke knowledge. Methods A structured questionnaire on knowledge of stroke was filled out by eighth-grade students and one of their parents in seven public schools. In four of these schools, students attended a stroke lecture; educational flyers and magnetic posters were distributed and parent education was encouraged. Students and parents of the other three schools were included in a control group. Students and parents, of both intervention and control groups, were resubmitted to the initial structured questionnaire within one week of the stroke lecture and three months later. Results We included 764 students and 344 parents, 383 (50.1%) and 210 (61.0%) in the intervention group. Correct test scores for students before, within one week, and three months after the intervention were 54.49% versus 55.03% (p = 0.418), 98.69% versus 60.89% (p < 0.001), and 95.58% versus 75.7% (p < 0.001) in the intervention and control groups, respectively. Correct test scores for parents at the same time points were 68.78% versus 64.47% (p = 0.107), 96.89% versus 71.42% (p < 0.001), and 94.58% versus 76.54% (p < 0.001) in the intervention and control groups, respectively. Conclusions School-based interventions may improve stroke knowledge in middle school students and their parents.
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Affiliation(s)
- João Pedro Marto
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Cláudia Borbinha
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Rita Filipe
- 2 Public Health Unit, Agrupamento de Centros de Saúde (ACES), Lisboa Ocidental e Oeiras, Lisbon, Portugal
| | - Sofia Calado
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,3 Chronic Diseases Research Centre (CEDOC)-Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,3 Chronic Diseases Research Centre (CEDOC)-Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
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Morgenstern LB, Kissela BM. Stroke Disparities: Large Global Problem That Must Be Addressed. Stroke 2015; 46:3560-3. [PMID: 26470778 DOI: 10.1161/strokeaha.115.009533] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Lewis B Morgenstern
- From the Stroke Program, Departments of Neurology, Epidemiology, Emergency Medicine and Neurosurgery, The University of Michigan Medical School and School of Public Health, Ann Arbor, MI (L.B.M.); and Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, The University of Cincinnati, OH (B.M.K.).
| | - Brett M Kissela
- From the Stroke Program, Departments of Neurology, Epidemiology, Emergency Medicine and Neurosurgery, The University of Michigan Medical School and School of Public Health, Ann Arbor, MI (L.B.M.); and Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, The University of Cincinnati, OH (B.M.K.)
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Meurer WJ, Levine DA, Kerber KA, Zahuranec DB, Burke J, Baek J, Sánchez B, Smith MA, Morgenstern LB, Lisabeth LD. Neighborhood Influences on Emergency Medical Services Use for Acute Stroke: A Population-Based Cross-sectional Study. Ann Emerg Med 2015; 67:341-348.e4. [PMID: 26386884 DOI: 10.1016/j.annemergmed.2015.07.524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE Delay to hospital arrival limits acute stroke treatment. Use of emergency medical services (EMS) is key in ensuring timely stroke care. We aim to identify neighborhoods with low EMS use and to evaluate whether neighborhood-level factors are associated with EMS use. METHODS We conducted a secondary analysis of data from the Brain Attack Surveillance in Corpus Christi project, a population-based stroke surveillance study of ischemic stroke and intracerebral hemorrhage cases presenting to emergency departments in Nueces County, TX. The primary outcome was arrival by EMS. The primary exposures were neighborhood resident age, poverty, and violent crime. We estimated the association of neighborhood-level factors with EMS use, using hierarchic logistic regression, controlling for individual factors (stroke severity, ethnicity, and age). RESULTS During 2000 to 2009 there were 4,004 identified strokes, with EMS use data available for 3,474. Nearly half (49%) of stroke cases arrived by EMS. Adjusted stroke EMS use was lower in neighborhoods with higher family income (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.75 to 0.97) and a larger percentage of older adults (OR 0.70; 95% CI 0.56 to 0.89). Individual factors associated with stroke EMS use included white race (OR 1.41; 95% CI 1.13 to 1.76) and older age (OR 1.36 per 10-year age increment; 95% CI 1.27 to 1.46). The proportion of neighborhood stroke cases arriving by EMS ranged from 17% to 71%. The fully adjusted model explained only 0.3% (95% CI 0% to 1.1%) of neighborhood EMS stroke use variance, indicating that individual factors are more strongly associated with stroke EMS use than neighborhood factors. CONCLUSION Although some neighborhood-level factors were associated with EMS use, patient-level factors explained nearly all variability in stroke EMS use. In this community, strategies to increase EMS use should target individuals rather than specific neighborhoods.
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Affiliation(s)
- William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI; Department of Neurology, University of Michigan, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Stroke Program, University of Michigan, Ann Arbor, MI
| | - Deborah A Levine
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Stroke Program, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Kevin A Kerber
- Department of Neurology, University of Michigan, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Darin B Zahuranec
- Department of Neurology, University of Michigan, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Stroke Program, University of Michigan, Ann Arbor, MI
| | - James Burke
- Department of Neurology, University of Michigan, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Stroke Program, University of Michigan, Ann Arbor, MI
| | - Jonggyu Baek
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Brisa Sánchez
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Stroke Program, University of Michigan, Ann Arbor, MI; Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Melinda A Smith
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Lewis B Morgenstern
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI; Department of Neurology, University of Michigan, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Stroke Program, University of Michigan, Ann Arbor, MI; Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Lynda D Lisabeth
- Department of Neurology, University of Michigan, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Stroke Program, University of Michigan, Ann Arbor, MI; Department of Epidemiology, University of Michigan, Ann Arbor, MI.
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Ottawa C, Sposato LA, Nabbouh F, Saposnik G. Stroke preparedness in children: translating knowledge into behavioral intent: a systematic review and meta-analysis. Int J Stroke 2015; 10:1008-13. [PMID: 26352602 DOI: 10.1111/ijs.12628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/04/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND If translated into behavioral intent, improving stroke knowledge may potentially impact on better outcomes. Children are an attractive target population since they can drive familial behavioral changes. However, the impact of interventions on stroke knowledge among children is unclear. We performed a systematic review and meta-analysis to investigate whether educational interventions targeting children improve stroke knowledge and lead to behavioral changes. METHODS We searched Ovid, PubMed, and Embase between January 2000 and December 2014. We included studies written in English reporting the number of children aged 6-15 years undergoing educational interventions on stroke and providing the results for baseline and early and late postintervention tests. We compared the proportion of correct answers between baseline, early, and late responses for two endpoints: knowledge and behavioral intent. RESULTS Of the initial 58 articles found, we included nine that met the inclusion criteria. Compared with baseline tests (51·7%, 95% confidence interval 40·9-62·4), there was improvement in stroke knowledge in early (74·0%, 95% confidence interval 64·4-82·5, P = 0·002) and late (67·3%, 95% confidence interval 55·4-78·2, P = 0·027) responses. There was improvement in the early (92·1%, 95% confidence interval 86·0-96·6, P < 0·001) and late (83·9%, 95% confidence interval 73·5-92·1, P = 0·001) responses for behavioral intent compared with the baseline assessment (63·8%, 95% confidence interval 53·5-73·4). CONCLUSION Children are a potentially attractive target population for improvement in stroke knowledge and behavioral intent, both in the short and long term. Our findings may support the implementation of large-scale stroke educational initiatives targeting children.
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Affiliation(s)
- Cassandra Ottawa
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Fadl Nabbouh
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Ohyama S, Yokota C, Miyashita F, Amano T, Inoue Y, Shigehatake Y, Sakamoto Y, Toyoda K, Minematsu K. Effective Education Materials to Advance Stroke Awareness Without Teacher Participation in Junior High School Students. J Stroke Cerebrovasc Dis 2015; 24:2533-8. [PMID: 26227323 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/22/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Youth stroke education is promising for the spread of stroke awareness. The aim of this study was to examine whether our stroke awareness teaching materials without teacher's participation can increase student awareness to act fast on suspected stroke signs. METHODS We used the face, arm, speech, and time (FAST) mnemonic derived from the Cincinnati Prehospital Stroke Scale. Seventy-three students of the second grade and 72 students of the third grade (age range, 13-15 years) in a junior high school were enrolled in the study. The students were divided into 2 groups: students who received a teacher's lesson (group I) and those who did not receive a teacher's lesson (group II). Students in group II watched an animated cartoon and read a Manga comic in class. All students took the educational aids home, including the Manga comic and magnetic posters printed with the FAST message. Questionnaires on stroke knowledge were examined at baseline and immediately and 3 months after receiving the intervention. RESULTS At 3 months after the intervention, a significant improvement in understanding the FAST message was confirmed in both the groups (group I, 85%; group II, 94%). Significant increases in the knowledge of risk factors were not observed in each group. CONCLUSIONS Our education materials include a Manga comic, an animated cartoon, and a magnetic poster, without an accompanying teacher's lesson can increase stroke awareness, including the FAST message, in junior high school students.
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Affiliation(s)
- Satoshi Ohyama
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Fumio Miyashita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tatsuo Amano
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasuteru Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuya Shigehatake
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuki Sakamoto
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Madsen TE, Baird KA, Silver B, Gjelsvik A. Analysis of Gender Differences in Knowledge of Stroke Warning Signs. J Stroke Cerebrovasc Dis 2015; 24:1540-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/20/2015] [Accepted: 03/14/2015] [Indexed: 11/26/2022] Open
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Matsuzono K, Yokota C, Takekawa H, Okamura T, Miyamatsu N, Nakayama H, Nishimura K, Ohyama S, Ishigami A, Okumura K, Toyoda K, Miyamoto Y, Minematsu K, Sugiyama D, Nagao M, Morimoto A, Kadota A, Takizawa N, Ieiri K, Watanabe T. Effects of Stroke Education of Junior High School Students on Stroke Knowledge of Their Parents. Stroke 2015; 46:572-4. [DOI: 10.1161/strokeaha.114.007907] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and purpose—
Educating the youth about stroke is a promising approach for spreading stroke knowledge. The aim of this study was to verify communication of stroke knowledge to parents by educating junior high school students about stroke.
Methods—
We enrolled 1127 junior high school students (age, 13–15 years) and their parents in the Tochigi prefecture, Japan. All students received a stroke lesson, watched an animated cartoon, and read the related Manga comic as educational aids. The students took back home the Manga and discussed what they learned with their parents. Questionnaires on stroke knowledge were given to all at baseline and immediately after the lesson.
Results—
A total of 1125 students and 915 parents answered the questionnaires. In the students, the frequency of correct answers increased significantly for all questions on stroke symptoms except for headache, and for all questions on risk factors after the lesson. In the parents, the correct answer rates increased for stroke symptoms except for headache and numbness in one side of the body, and for all questions on risk factors except for hypertension. Ninety-one percent of students and 92.7% of parents correctly understood the Face, Arm, Speech, and Time (FAST) mnemonic after the lesson.
Conclusions—
Improvement of stroke knowledge immediately after the stroke lesson was observed in parents as well as their children, which indicated that our teaching materials using the Manga was effective in delivering the stroke knowledge to parents through their children.
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Affiliation(s)
- Kosuke Matsuzono
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Chiaki Yokota
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Hidehiro Takekawa
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Tomonori Okamura
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Naomi Miyamatsu
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Hirofumi Nakayama
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Kunihiro Nishimura
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Satoshi Ohyama
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Akiko Ishigami
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Kosuke Okumura
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Kazunori Toyoda
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Yoshihiro Miyamoto
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
| | - Kazuo Minematsu
- From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K. Matsuzono, C.Y., S.O., A.I., K.O., K.T., K. Minematsu); Department of Neurology, Dokkyo Medical University, Tochigi, Japan (H.T.); Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan (T.O.); Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (N.M.); Japan Stroke Association, Osaka, Japan (H.N.); and
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Skolarus LE, Murphy JB, Dome M, Zimmerman MA, Bailey S, Fowlkes S, Morgenstern LB. Creating a Novel Video Vignette Stroke Preparedness Outcome Measure Using a Community-Based Participatory Approach. Health Promot Pract 2014; 16:533-9. [PMID: 25367896 DOI: 10.1177/1524839914557032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evaluating the efficacy of behavioral interventions for rare outcomes is a challenge. One such topic is stroke preparedness, defined as inteventions to increase stroke symptom recognition and behavioral intent to call 911. Current stroke preparedness intermediate outcome measures are centered on written vignettes or open-ended questions and have been shown to poorly reflect actual behavior. Given that stroke identification and action requires aural and visual processing, video vignettes may improve on current measures. This article discusses an approach for creating a novel stroke preparedness video vignette intermediate outcome measure within a community-based participatory research partnership. A total of 20 video vignettes were filmed of which 13 were unambiguous (stroke or not stroke) as determined by stroke experts and had test discrimination among community participants. Acceptable reliability, high satisfaction, and cultural relevance were found among the 14 community respondents. A community-based participatory approach was effective in creating a video vignette intermediate outcome. Future projects should consider obtaining expert and community feedback prior to filming all the video vignettes to improve the proportion of vignettes that are usable. While content validity and preliminary reliability were established, future studies are needed to confirm the reliability and establish construct validity.
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Haass A, Walter S, Ragoschke-Schumm A, Grunwald IQ, Lesmeister M, Khaw AV, Fassbender K. ["Time is brain". Optimizing prehospital stroke management]. DER NERVENARZT 2014; 85:189-94. [PMID: 24276091 DOI: 10.1007/s00115-013-3952-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Acute stroke is one of the main causes of death and chronic disability. Thrombolysis, achieved by administering recombinant tissue plasminogen activator within 4.5 h, is an effective therapeutic option for ischemic stroke. However, less than 2-12 % of patients receive this treatment and a major reason is that most patients reach the hospital too late. Several time-saving measures should be implemented. Firstly, optimized and continual public awareness campaigns for patients should be initiated to reduce delays in notifying the emergency medical service. Secondly, emergency medical service personnel should develop protocols for prenotification of the receiving hospital. Other suggested measures involve educating emergency medical service personnel to systematically use scales for recognizing the symptoms of stroke and to triage patients to experienced stroke centers. In the future, administering treatment at the emergency site (mobile stroke unit concept) may allow more than a small minority of patients to benefit from available recanalization treatment options.
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Affiliation(s)
- A Haass
- Neurologische Klinik, Universität des Saarlandes, Kirrberger Str., 66424, Homburg, Deutschland
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46
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Kawano H, Yokota C, Yamamoto F, Mori Y, Mihara Y, Ando Y, Minematsu K. Stroke education for multidisciplinary medical personnel in a rural area of Japan for promotion of hospital visit of acute stroke patients. J Stroke Cerebrovasc Dis 2014; 23:2372-7. [PMID: 25194740 DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/02/2014] [Accepted: 05/13/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There are few studies of stroke education suitable for multidisciplinary medical personnel. A reorganization of the management of acute stroke and stroke education for multidisciplinary medical personnel started since 2013 in our hospital located in a rural area of Japan. This study aimed to examine the effect of our stroke education on changing the number of visits of acute stroke patients to our hospital and to test the stroke knowledge of medical personnel. METHODS The stroke education, composed of a 20-minute lecture, was given by a stroke neurologist to 217 medical personnel (age, 49 ± 10 years; male, 70%). Posters printed with the FAST message were given to the participants at the end of the lesson: F, facial drooping; A, arm numbness or weakness; S, slurred speech or difficulty speaking or understanding; T, a time to call an ambulance. Participants completed questionnaires on stroke knowledge at baseline and 3 months after the lesson. RESULTS The number of participants who remembered correctly the FAST mnemonic at 3 months was significantly higher than at baseline (78 vs. 90%, P = .006). The correct answer rate for stroke symptoms other than FAST such as vision loss was approximately 50% at 3 months. The number of visits of acute stroke patients to our hospital, particularly patients with transient ischemic attack, increased significantly compared with that before the stroke education. CONCLUSIONS Our stroke education method using the FAST mnemonic designed for multidisciplinary medical personnel improved their stroke knowledge. Reorganization of the management of acute stroke and greater stroke knowledge for medical staff are necessary to increase the visits of acute stroke patients in the rural areas.
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Affiliation(s)
- Hiroyuki Kawano
- Department of Neurology, Minamata City General Hospital and Medical Center, Minamata, Kumamoto, Japan
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Fumio Yamamoto
- Department of Neurology, Minamata City General Hospital and Medical Center, Minamata, Kumamoto, Japan
| | - Yoshiteru Mori
- Department of Nursing, Minamata City General Hospital and Medical Center, Minamata, Kumamoto, Japan
| | - Yosuke Mihara
- Department of Neurosurgery, Minamata City General Hospital and Medical Center, Minamata, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Boden-Albala B, Edwards DF, St Clair S, Wing JJ, Fernandez S, Gibbons MC, Hsia AW, Morgenstern LB, Kidwell CS. Methodology for a community-based stroke preparedness intervention: the Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities Study. Stroke 2014; 45:2047-52. [PMID: 24876243 DOI: 10.1161/strokeaha.113.003502] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Acute stroke education has focused on stroke symptom recognition. Lack of education about stroke preparedness and appropriate actions may prevent people from seeking immediate care. Few interventions have rigorously evaluated preparedness strategies in multiethnic community settings. METHODS The Acute Stroke Program of Interventions Addressing Racial and Ethnic Disparities (ASPIRE) project is a multilevel program using a community-engaged approach to stroke preparedness targeted to underserved black communities in the District of Columbia. This intervention aimed to decrease acute stroke presentation times and increase intravenous tissue-type plasminogen activator utilization for acute ischemic stroke. RESULTS Phase 1 included (1) enhancement of focus of emergency medical services on acute stroke; (2) hospital collaborations to implement and enrich acute stroke protocols and transition District of Columbia hospitals toward primary stroke center certification; and (3) preintervention acute stroke patient data collection in all 7 acute care District of Columbia hospitals. A community advisory committee, focus groups, and surveys identified perceptions of barriers to emergency stroke care. Phase 2 included a pilot intervention and subsequent citywide intervention rollout. A total of 531 community interventions were conducted, reaching >10,256 participants; 3289 intervention evaluations were performed, and 19,000 preparedness bracelets and 14,000 stroke warning magnets were distributed. Phase 3 included an evaluation of emergency medical services and hospital processes for acute stroke care and a year-long postintervention acute stroke data collection period to assess changes in intravenous tissue-type plasminogen utilization. CONCLUSIONS We report the methods, feasibility, and preintervention data collection efforts of the ASPIRE intervention. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00724555.
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Affiliation(s)
- Bernadette Boden-Albala
- From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.)
| | - Dorothy F Edwards
- From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.)
| | - Shauna St Clair
- From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.)
| | - Jeffrey J Wing
- From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.)
| | - Stephen Fernandez
- From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.)
| | - M Chris Gibbons
- From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.)
| | - Amie W Hsia
- From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.)
| | - Lewis B Morgenstern
- From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.)
| | - Chelsea S Kidwell
- From the Division of Social Epidemiology, Global Institute for Public Health (B.B.-A.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, New York; Departments of Kinesiology and Medicine, University of Wisconsin, Madison (D.F.E.); Department of Neurology and Georgetown Stroke Center, Georgetown University Medical Center, Washington, DC (S.S.C., A.W.H., C.S.K.); Department of Biostatistics (J.J.W.), and Departments of Epidemiology and Neurology Emergency Medicine and Neurosurgery (L.B.M.), University of Michigan, Ann Arbor; Medstar Health Research Institute, Hyattsville, MD (S.F.); Johns Hopkins Urban Health Institute, Baltimore, MD (M.C.G.); Stroke Center, Medstar Washington Hospital Center, DC (A.W.H.); and Departments of Neurology and Medical Imaging, University of Arizona College of Medicine, Tucson (C.S.K.)
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48
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Sakamoto Y, Yokota C, Miyashita F, Amano T, Shigehatake Y, Oyama S, Itagaki N, Okumura K, Toyoda K, Minematsu K. Effects of stroke education using an animated cartoon and a manga on elementary school children. J Stroke Cerebrovasc Dis 2014; 23:1877-81. [PMID: 24794944 DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/21/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Stroke education for the youth is expected to reduce prehospital delay by informing the bystander of appropriate action to take and providing knowledge to prevent onset of stroke in future. Previously, we developed effective teaching materials consisting of an animated cartoon and a Manga for junior high school students. The aim of this study was to evaluate the feasibility and effectiveness of our educational materials for stroke education taught by schoolteachers to elementary school children. METHODS Using our teaching materials, a 30-minute lesson was given by trained general schoolteachers. Questionnaires on stroke knowledge (symptoms and risk factors) and action to take on identification of suspected stroke symptoms were filled out by school children before, immediately after, and at 3 months after completion of the lesson. RESULTS A total of 219 children (aged 10 or 11 years) received the stroke lesson. Stroke knowledge significantly increased immediately after the lesson compared with before (symptoms, P < .001; risk factors, P < .001); however, correct answer rates decreased at 3 months immediately after completion of the lesson (symptoms, P = .002; risk factors, P = .045). The proportion of the number of children calling emergency medical service on identifying stroke symptoms was higher immediately after the lesson than baseline (P = .007) but returned to the baseline at 3 months after the lesson. CONCLUSIONS Stroke lesson by schoolteachers using our teaching materials consisting of an animated cartoon and a Manga that was previously used for junior high school students was feasible for elementary school children. However, revision of the materials is required for better retention of stroke knowledge for children.
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Affiliation(s)
- Yuki Sakamoto
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Fumio Miyashita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tatsuo Amano
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuya Shigehatake
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Oyama
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naruhiko Itagaki
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kosuke Okumura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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49
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Gardois P, Booth A, Goyder E, Ryan T. Health promotion interventions for increasing stroke awareness in ethnic minorities: a systematic review of the literature. BMC Public Health 2014; 14:409. [PMID: 24775404 PMCID: PMC4019964 DOI: 10.1186/1471-2458-14-409] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 04/14/2014] [Indexed: 11/28/2022] Open
Abstract
Background Stroke places a significant burden to all affected individuals, but it is perhaps more significant amongst members of black, minority and ethnic communities, who may experience poorer awareness of stroke symptoms than the general population. Recently, several initiatives tried to improve public awareness that symptoms of stroke need to be treated as a medical emergency. However, ethnic communities present cultural barriers, requiring tailored health promotion interventions, whose effectiveness remains uncertain. Our systematic review aimed to identify relevant published evidence, synthesize the main study components and identify evidence of the effectiveness of the interventions. Methods MEDLINE, EMBASE, CINAHL, and PsycInfo were searched for journal articles on health promotion interventions for increasing stroke awareness in ethnic minorities, published in English between 1995 and 2012. Search results were collaboratively assessed by the authors; included studies were analysed to identify their main characteristics, and a thematic analysis of their content was conducted. No meta-analysis was performed, due to the heterogeneity of results. Results Eighteen studies were included, reporting 15 interventions conducted in the US, for African-Americans or Hispanics; populations sizes differed between interventions. Interventions were mostly carried out in community settings with different educational techniques, focussing on experiential methods. Health professionals usually organized the programs, delivered by nurses, other health professionals or volunteers. The few theory-based interventions focussed on individual-level behavioural change. Practical cultural adaptation strategies were not linked to specific theoretical frameworks. Interventions widely differed as for target populations, settings, delivery methods, contents and professional roles involved. All study designs were quantitative, and the emerging evidence of effectiveness was inconclusive. Such interventions operate in very complex scenarios, and several variables may influence their effectiveness. Therefore, qualitative or mixed-methods study designs may shed light on barriers and facilitators, experiential education strategies and community involvement. Network- and community-level theories may help improving design and evaluation of interventions. Conclusions Eleven case reports and four RCTs provide evidence about stroke awareness interventions organized in the US. The studies provide only partial and inconclusive evidence about the effectiveness of the interventions. Hence, further research is needed on different countries and ethnic minorities.
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Affiliation(s)
- Paolo Gardois
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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50
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Shigehatake Y, Yokota C, Amano T, Tomii Y, Inoue Y, Hagihara T, Toyoda K, Minematsu K. Stroke education using an animated cartoon and a manga for junior high school students. J Stroke Cerebrovasc Dis 2014; 23:1623-7. [PMID: 24680086 DOI: 10.1016/j.jstrokecerebrovasdis.2014.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND We investigated whether junior high school students could be educated regarding stroke with an animated cartoon and a Manga that we produced for the purpose of dissemination of this knowledge. METHODS We produced a 10-minute animated cartoon and a Manga that provided information regarding stroke risk factors, stroke signs and symptoms, and awareness to immediately contact emergent medical service (EMS) on identification of stroke signs and symptoms. From December 2011 to March 2012, 493 students in 15 classes of the first grade (age 12-13 years) of 3 junior high schools were enrolled in the study. Each subject watched the animated cartoon and read the Manga; this was referred to as "training." Lessons about stroke were not given. Questionnaires on stroke knowledge were evaluated at baseline, immediately after the training, and 3 months after the training. RESULTS The proportion of correct answers given immediately after the training was higher for all questions, except those related to arrhythmia, compared with baseline. Percentage of correct answers given at 3 months was higher than that at baseline in questions related to facial palsy (75% versus 33%), speech disturbance (91% versus 60%), hemiplegia (79% versus 52%), numbness of 1 side (58% versus 51%), calling for EMS (90% versus 85%), alcohol intake (96% versus 72%), and smoking (69% versus 54%). At 3 months after the training, 56% of students answered the FAST (facial droop, arm weakness, speech disturbance, time to call for EMS) mnemonic correctly. CONCLUSIONS Stroke education using these teaching aids of the animated cartoon and the Manga improved stroke knowledge in junior high school students.
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Affiliation(s)
- Yuya Shigehatake
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Tatsuo Amano
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuhiro Tomii
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuteru Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takaaki Hagihara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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