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Park D, Son KJ, Kim JH, Kim HS. Effect of the Frequency of Rehabilitation Treatments on the Long-Term Mortality of Stroke Survivors with Mild-to-Moderate Disabilities under the Korean National Health Insurance Service System. Healthcare (Basel) 2023; 11:healthcare11111587. [PMID: 37297727 DOI: 10.3390/healthcare11111587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Given the increase in stroke-related social costs, studies on survival and functional prognosis after stroke are urgently needed. Therefore, we investigated the relationship between the frequency of rehabilitation treatments in the acute and subacute phases of stroke and the long-term mortality of stroke survivors with mild-to-moderate disabilities. We performed a retrospective cohort study using data from the Korean National Health Insurance Service database. Our final cohort included 733 patients with national disability registration grades 4-6. The number of special rehabilitation treatment claim codes was used as a proxy for the frequency of rehabilitation treatments. Furthermore, we categorized the rehabilitation frequencies within 24 months of stroke onset as 1-50, 51-200, 201-400, and >400. The dependent variable was all-cause mortality, and it was evaluated from 24 to 84 months after stroke onset. Severe disability was associated with a lower long-term mortality rate in the chronic phase (p < 0.001). In the Cox regression analysis, severe disability, older age, male sex, and chronic kidney disease were independent risk factors for long-term mortality in patients with stroke and mild-to-moderate disabilities. However, the frequency of acute/subacute rehabilitation treatments did not significantly improve long-term mortality. Our results suggest that the association between rehabilitation frequency and lower long-term mortality for patients with mild-to-moderate stroke was inconclusive. Therefore, further study is needed to determine a better-customized rehabilitation treatment system for these patients.
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Affiliation(s)
- Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang 37659, Republic of Korea
- Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Kang Ju Son
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
| | - Jong Hun Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
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Yoo SH, Kim GG, Kim SR, Park MS, Kim JT, Choi KH, Park HY, Yi SH, Cha JK, Kim DH, Nah HW. Predictors of long-term medication adherence in stroke survivors: A multicentre, prospective, longitudinal study. J Clin Nurs 2023; 32:58-70. [PMID: 35922959 DOI: 10.1111/jocn.16472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/04/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the optimal use of prescribed medications for stroke survivors is critical for preventing secondary stroke, longitudinal observations of the natural course of medication persistence and adherence in Korean stroke survivors are rare. Furthermore, studies are needed to identify strong predictors influencing medication adherence and to determine whether these predictors change over time. AIMS AND OBJECTIVES To evaluate the longitudinal medication persistence and adherence at 3 months and 1 year after discharge in all stroke patients and to identify predictors of long-term medication adherence in patients who can self-medicate. DESIGN A multicentre, prospective, longitudinal descriptive study. METHODS A total of 600 consecutive ischaemic stroke patients were recruited from three stroke centres across Korea, from 1 September, 2017 to 28 February, 2019. Various factors related to medication adherence suggested by the World Health Organisation were investigated through face-to-face interviews at each centre during hospitalisation. Medication persistence and adherence were assessed at 3 months and 1 year after discharge using the eight-item Morisky Medication Adherence Scale through telephone interviews. RESULTS Of 537 survivors at 3 months, 526 (98.0%) were persistent and 472 (89.7%) were adherent. Of 493 survivors at 1 year, 477 (96.8%) were persistent and 392 (82.2%) were adherent. Medication belief, income and health literacy were statistically significant predictors of three-month medication adherence, which predicted one-year medication adherence with older age and low income. CONCLUSIONS Among Korean stroke survivors, three-month and one-year medication persistence and adherence were relatively good. Medication beliefs and three-month medication adherence were important and modifiable factors predicting three-month adherence and one-year adherence, respectively. RELEVANCE TO CLINICAL PRACTICE To increase long-term adherence to medication, various strategies are needed to improve beliefs about medication, taking into account the patient's age and level of knowledge. These interventions need to be initiated during hospitalisation to form early medication habits after discharge.
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Affiliation(s)
- Sung-Hee Yoo
- College of Nursing, Chonnam National University, Gwangju, Korea
| | - Gye-Gyoung Kim
- College of Nursing, Chonnam National University, Gwangju, Korea
| | | | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital Medical School, Gwangju, Korea
| | - Hyun-Young Park
- Department of Neurology, Wonkwang University Hospital, Iksan, Korea
| | - Sang-Hak Yi
- Department of Neurology, Wonkwang University Hospital, Iksan, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Hyun-Wook Nah
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, Korea
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Health-related quality of life using WHODAS 2.0 and associated factors 1 year after stroke in Korea: a multi-centre and cross-sectional study. BMC Neurol 2022; 22:501. [PMID: 36564762 PMCID: PMC9789571 DOI: 10.1186/s12883-022-03032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Little is known about the self-perceived level of disability of stroke survivors in the community. We aimed to characterise Health-related quality of life (HRQoL) 1 year after stroke and investigate how sociodemographic and stroke-related factors and medical adherence explain the self-perceived level of disability in a Korean stroke population. METHODS This was a multicentre cross-sectional study. A total of 382 ischaemic stroke survivors at 1 year after onset from 11 university hospitals underwent a one-session assessment, including socioeconomic variables, the modified Rankin Scale (mRS), various neurological sequelae, the Morisky, Green and Levin-Medication Adherence Questionnaire (MGL), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-items. The relationship between disability and different variables was analysed using ordinal logistic regression. RESULTS The prevalence of disability based on global WHODAS 2.0 was 62.6% (mild, 41.6%; moderate, 16.0%; severe, 5.0%). The prevalence of severe disability was higher in participation in society (16.8%) and getting around (11.8%) than in other domains. Low MGL- motivation was the only factor determining a significant association between all six domains of disability after adjustment. Different predictors for specific domains were age, mRS, dysarthria, trouble seeing, cognition problems, and MGL-motivation for understanding and communicating; age, recurrent stroke, mRS, hemiplegia, facial palsy, general weakness, and MGL-motivation for getting around; age, education, mRS, hemiplegia, and MGL-motivation for self-care; education, recurrent stroke, hemiplegia, dysarthria, and MGL-motivation for getting along with people; age, education, income, mRS, hemiplegia, dysarthria, MGL-knowledge, and MGL-motivation for life activities; living without a spouse, mRS, hemiplegia, dysarthria, trouble seeing, cognition problems, general weakness, and MGL-motivation for participation in society. CONCLUSIONS Self-perceived disability according to the WHODAS 2.0 at 1 year after stroke was highly prevalent. Each disability domain showed a different prevalence and associated factors. Interventions promoting medical adherence to motivation seemed to help achieve high HRQoL in all domains.
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Kim DH, Moon SJ, Lee J, Cha JK, Kim MH, Park JS, Ban B, Kang J, Kim BJ, Kim WS, Yoon CH, Lee H, Kim S, Kang EK, Her AY, Yoon CW, Rha JH, Woo SI, Lee WK, Jung HY, Lee JH, Park HS, Hwang YH, Kim K, Kim RB, Choi NC, Hwang J, Park HW, Park KS, Yi S, Cho JY, Kim NH, Choi KH, Kim J, Han JY, Choi JC, Kim SY, Choi JH, Kim J, Sohn MK, Choi SW, Shin DI, Lee SY, Bae JW, Lee KS, Bae HJ. Comparison of Factors Associated With Direct Versus Transferred-in Admission to Government-Designated Regional Centers Between Acute Ischemic Stroke and Myocardial Infarction in Korea. J Korean Med Sci 2022; 37:e305. [PMID: 36325609 PMCID: PMC9623032 DOI: 10.3346/jkms.2022.37.e305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. METHODS Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. RESULTS Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI; additionally, age (65-74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. CONCLUSIONS Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.
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Affiliation(s)
- Dae-Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Seok-Joo Moon
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jae-Kwan Cha
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Moo Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Jong-Sung Park
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Byeolnim Ban
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihoon Kang
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won-Seok Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang-Hwan Yoon
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heeyoung Lee
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seongheon Kim
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun Kyoung Kang
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ae-Young Her
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Cindy W Yoon
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Joung-Ho Rha
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Seong-Ill Woo
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Won Kyung Lee
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Han-Young Jung
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Jang Hoon Lee
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Hun Sik Park
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Yang-Ha Hwang
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Keonyeop Kim
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Rock Bum Kim
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nack-Cheon Choi
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jinyong Hwang
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun-Woong Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Soo Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - SangHak Yi
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Jae Young Cho
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Nam-Ho Kim
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Kang-Ho Choi
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Juhan Kim
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jae-Young Han
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jay Chol Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Song-Yi Kim
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Joon-Hyouk Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Jei Kim
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Min Kyun Sohn
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Si Wan Choi
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Dong-Ick Shin
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Sang Yeub Lee
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Jang-Whan Bae
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Hee-Joon Bae
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Kang SW, Lee SH, Lee YS, Kwon S, Bosch P, Lee YJ, Ha IH. Association between depression and quality of life in stroke patients: The Korea National Health and Nutrition Examination Survey (KNHANES) IV–VII (2008–2018). PLoS One 2022; 17:e0269010. [PMID: 35700184 PMCID: PMC9197050 DOI: 10.1371/journal.pone.0269010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Stroke and depression are common diseases that affect quality of life (QoL). Although some recent studies have investigated the association between the two diseases, studies that examined the association between stroke, depression, and QoL are rare, with large-scale national-level studies lacking. We aimed to investigate the association between depression and QoL in stroke patients. Methods Data from the Korea National Health and Nutrition Examination Survey (KNHANES) IV–VII conducted in 2008–2018 were used, and 45,741 adults who were aged >40 years and had no missing data for stroke and depression were included in the analysis. The participants were first grouped by prevalence of stroke, and further divided by prevalence of depression. Results The overall prevalence of stroke was 3.2%, and the incidence was 9% higher in men than in women. Multiple logistic regression was performed after adjusting for demographic factors, health-related factors, and disease-related factors. The results confirmed that the stroke group with depression had a lower overall health-related quality of life, measured using EQ-5D, score compared to the stroke group without depression (-0.15). Moreover, the concurrent stroke and depression treatment group had the highest OR of 7.28 (95% CI 3.28–16.2) for the anxiety/depression domain. Conclusion Depression was strongly associated with QoL in stroke patients. This association was more evident in stroke patients undergoing treatment for depression. Thus, clinical approaches that take QoL into consideration are needed for stroke patients with depression.
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Affiliation(s)
- Sun Woo Kang
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Ye-Seul Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Seungwon Kwon
- Department of Cardiology and Neurology, Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea
| | - Peggy Bosch
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Nijmegen, The Netherlands
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
- * E-mail:
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Yoon CW, Oh H, Lee J, Rha J, Woo S, Lee WK, Jung H, Ban B, Kang J, Kim BJ, Kim W, Yoon C, Lee H, Kim S, Kim SH, Kang EK, Her A, Cha J, Kim D, Kim M, Lee JH, Park HS, Kim K, Kim RB, Choi N, Hwang J, Park H, Park KS, Yi S, Cho JY, Kim N, Choi K, Kim Y, Kim J, Han J, Choi JC, Kim S, Choi J, Kim J, Jee SJ, Sohn MK, Choi SW, Shin D, Lee SY, Bae J, Lee K, Bae H. Comparisons of Prehospital Delay and Related Factors Between Acute Ischemic Stroke and Acute Myocardial Infarction. J Am Heart Assoc 2022; 11:e023214. [PMID: 35491981 PMCID: PMC9238627 DOI: 10.1161/jaha.121.023214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Prehospital delay is an important contributor to poor outcomes in both acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We aimed to compare the prehospital delay and related factors between AIS and AMI.
Methods and Results
We identified patients with AIS and AMI who were admitted to the 11 Korean Regional Cardiocerebrovascular Centers via the emergency room between July 2016 and December 2018. Delayed arrival was defined as a prehospital delay of >3 hours, and the generalized linear mixed‐effects model was applied to explore the effects of potential predictors on delayed arrival. This study included 17 895 and 8322 patients with AIS and AMI, respectively. The median value of prehospital delay was 6.05 hours in AIS and 3.00 hours in AMI. The use of emergency medical services was the key determinant of delayed arrival in both groups. Previous history, 1‐person household, weekday presentation, and interhospital transfer had higher odds of delayed arrival in both groups. Age and sex had no or minimal effects on delayed arrival in AIS; however, age and female sex were associated with higher odds of delayed arrival in AMI. More severe symptoms had lower odds of delayed arrival in AIS, whereas no significant effect was observed in AMI. Off‐hour presentation had higher and prehospital awareness had lower odds of delayed arrival; however, the magnitude of their effects differed quantitatively between AIS and AMI.
Conclusions
The effects of some nonmodifiable and modifiable factors on prehospital delay differed between AIS and AMI. A differentiated strategy might be required to reduce prehospital delay.
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Leigh JH, Kim WS, Sohn DG, Chang WK, Paik NJ. Transitional and Long-Term Rehabilitation Care System After Stroke in Korea. Front Neurol 2022; 13:786648. [PMID: 35432175 PMCID: PMC9008335 DOI: 10.3389/fneur.2022.786648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Stroke is one of the leading causes of mortality and disability in Korea. Patients who experience stroke require adequate management throughout the acute to subacute and chronic stages. Many patients with long-term functional issues require rehabilitative management even in the chronic stage. A comprehensive rehabilitation and care model for patients who experience stroke is necessary to effectively manage their needs during rehabilitation and allocate medical resources throughout the stages, thus ensuring reduced unmet needs and improved post-stroke quality of life. In Korea, the government and medical specialists are working on re-organizing the rehabilitation care model, including standardized triage and discharge planning after acute stroke treatment, and establishing systematic transitional and long-term rehabilitation care plans. This review briefly introduces the general rehabilitation triage after acute stroke and describes the current transitional and continuous care systems available for these patients in Korea. We also present the issues faced in transitional and long-term care plans of the current system and the efforts invested in resolving them and promoting long-term care in stroke cases.
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Affiliation(s)
- Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, Yangpyeong-gun, South Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Gyun Sohn
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Medical Rehabilitation Center, Korea Workers' Compensation Welfare Service Incheon Hospital, Incheon, South Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Sex and Economic Disparity Related to Reperfusion Therapies for Patients with Acute Ischemic Stroke in South Korea across a 10-Year Period: A Nationwide Population-Based Study Using the National Health Insurance Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053050. [PMID: 35270741 PMCID: PMC8910261 DOI: 10.3390/ijerph19053050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 12/10/2022]
Abstract
A complete enumeration study was conducted to evaluate trends related to reperfusion therapies (intravenous thrombolysis (IVT) and endovascular treatment (EVT)) in acute ischemic stroke (AIS) in South Korea, according to sex, economic status, and age, over a 10-year period retrospectively, using the National Health Information Database (NHIS-2020-1-481). This study included AIS patients aged ≥20 years who were hospitalized in a general hospital or tertiary hospital for ≥4 days and underwent brain imaging during the same period. Study participants were classified by sex, economic status (Medical Aid beneficiaries and National Health Insurance beneficiaries) and age (20-44, 45-64, 65-79, and ≥80 years). Women showed a significantly lower OR (Odds ratio) than men in IVT (OR: 0.75; 95% CI: 0.73-0.77), EVT (OR: 0.96; 95% CI: 0.93-0.99), and any therapy (OR: 0.82; 95% CI: 0.80-0.84). The Medical Aid beneficiaries showed significantly lower OR in IVT (OR 0.91, 95% CI 0.88-0.95), EVT (OR 0.93, 95% CI 0.89-0.98), and either therapy (OR 0.92, 95% CI 0.90-0.95) than the National Health Insurance beneficiaries. This study showed sex and economic disparity related to reperfusion therapies in patients with AIS in Korea.
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Czap AL, Harmel P, Audebert H, Grotta JC. Stroke Systems of Care and Impact on Acute Stroke Treatment. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Seo KD, Kang MJ, Lee JK, Suh SH, Lee KY. Mechanical thrombectomy reduces the gap in treatment outcomes of ischemic stroke between hospital levels of care: analysis of a Korean nationwide data. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1227. [PMID: 34532364 PMCID: PMC8421926 DOI: 10.21037/atm-21-2342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/25/2021] [Indexed: 11/06/2022]
Abstract
Background Mechanical thrombectomy (MT) of ischemic stroke was demonstrated to be effective in clinical trials and was reported to have favorable outcomes in real clinical settings since 2015. We aimed to determine the national trends of MT and compare the outcomes between the different levels of treating hospital. Methods We obtained data from the nationwide database from 2008 to 2017. Patients with ischemic stroke who received MT were identified using the International Classification of Disease Codes. Good outcome was defined as discharge to home, and a poor outcome was defined as cerebral hemorrhage, physical disability, or death. The study period was divided into three (off-label MT, transitional, MT period). Hospital groups where MT was performed were divided into tertiary and non-tertiary hospitals. Results In MT period, 47.0% of the MT procedures were performed in non-tertiary hospitals compared with 36.1% in off-label MT period. Comparison of the 3-month mortality between patients who were treated in tertiary vs. non-tertiary hospitals revealed significant lower mortality in tertiary hospital through all period. The incidence of cerebral hemorrhage and physical disability did not differ between hospital groups. However, the percentage of patients discharged home was 41.4% for tertiary hospitals and 42.4% for non-tertiary hospitals, which was not statistically different in MT period (P=0.4671). Conclusions Analysis of the nationwide data confirmed that the extent of increase in MT was higher in non-tertiary hospitals than tertiary hospitals. In addition, no significant difference was revealed in the number of favorable clinical outcome between the hospital groups during MT period.
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Affiliation(s)
- Kwon-Duk Seo
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Min Jin Kang
- Institute of Health Insurance and Clinical Research, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jae Kwang Lee
- Institute of Health Insurance and Clinical Research, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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11
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Huang Z, Zhai G, You S, Ou Z, Mao X, Cao Y, Xiao G, Liu CF. Drip-and-Ship Model for Thrombectomy in Stroke Patients with Large-Vessel Occlusion. Eur Neurol 2021; 84:103-109. [PMID: 33677433 DOI: 10.1159/000513853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have demonstrated the efficacy of the "drip-and-ship" model in acute ischemic stroke (AIS) patients treated with intravenous (IV) thrombolysis. We investigated and report the outcomes of the safety and efficacy of the "drip-and-ship" model in AIS patients with acute large-vessel occlusion (LVO) in the anterior circulation who underwent endovascular treatment. METHODS A total of 92 AIS patients with LVO who underwent endovascular treatment enrolled from April 2017 to July 2018 at a single academic comprehensive stroke center (CSC) were included. Patients were divided into 2 groups: a front-door group (directly admitted to the CSC) and a drip-and-ship group (transferred to the CSC from other hospital). Logistic regression model was used to evaluate the functional outcome, mortality, and symptomatic intracranial hemorrhage (sICH) at 90 days. RESULTS After adjusting for age, gender, occlusion site, National Institutes of Health Stroke Scale (NIHSS) score, and other potential covariates, we did not see difference in modified Rankin Scale (mRS) score between the 2 groups at 90 days. The rate of excellent functional outcome (defined as mRS 0-1) in the drip-and-ship group is lower than the front-door group (p = 0.017); however, functional outcomes (defined as mRS 0-2) have no difference (p = 0.117). There was no significant difference in sICH (p = 0.909) and mortality (p = 0.319) between the 2 groups. CONCLUSIONS The "drip-and-ship" model has the potential to be a feasible model for patients with LVO in the anterior circulation to undergo endovascular treatment. Further large-scale prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Zhichao Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guojie Zhai
- Department of Neurology, The Affiliated Wujiang Hospital of Nantong University, Suzhou, China
| | - Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhijie Ou
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xueyu Mao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guodong Xiao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China,
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
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12
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Dippel DWJ. Improving the Delivery of High-Quality Reperfusion Therapy in the United States. Stroke 2020; 51:3492-3494. [PMID: 33161847 DOI: 10.1161/strokeaha.120.032405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Diederik W J Dippel
- Department of Neurology, Erasmus University Medical Center, Stroke Center, Rotterdam, the Netherlands
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13
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Bahk J, Jung-Choi K. The Contribution of Avoidable Mortality to the Life Expectancy Gains in Korea between 1998 and 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186499. [PMID: 32906627 PMCID: PMC7558962 DOI: 10.3390/ijerph17186499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/30/2022]
Abstract
This study evaluated the contribution of avoidable causes of death to gains in life expectancy between 1998 and 2017 in Korea. This is a multi-year, cross-sectional study using national data. Death certificate data from 1998 to 2017 were obtained from Statistics Korea. The difference in life expectancy between 1998 and 2017 by age and cause of death were decomposed using Arriaga’s method. Life expectancy rose 7.73 years over 20 years in Korea, which was largely (more than 50%) due to changes in avoidable causes of death. As age increased, the contribution to changes in life expectancy increased, and the gain in life expectancy due to avoidable causes also tended to increase. The major factors that drove that gain in life expectancy were avoidable causes such as cerebrovascular diseases and traffic accidents. The gain in life expectancy from preventable diseases was greater in men than in women. The results of this study indicate that active public health programs have been effective in improving life expectancy in Korea. Moreover, avoidable mortality could be further improved with good public health policy. Health policy aimed at reducing amenable and preventable deaths should be further implemented to promote population health.
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Affiliation(s)
- Jinwook Bahk
- Department of Public Health, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea;
| | - Kyunghee Jung-Choi
- Department of Occupational and Environmental Medicine, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul 07804, Korea
- Correspondence:
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14
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Kim YD, Heo JH, Yoo J, Park H, Kim BM, Bang OY, Kim HC, Han E, Kim DJ, Heo J, Kim M, Choi JK, Lee KY, Lee HS, Shin DH, Choi HY, Sohn SI, Hong JH, Baek JH, Kim GS, Seo WK, Chung JW, Kim SH, Song TJ, Han SW, Park JH, Kim J, Jung YH, Cho HJ, Ahn SH, Lee SI, Seo KD, Nam HS. Improving the Clinical Outcome in Stroke Patients Receiving Thrombolytic or Endovascular Treatment in Korea: from the SECRET Study. J Clin Med 2020; 9:jcm9030717. [PMID: 32155841 PMCID: PMC7141338 DOI: 10.3390/jcm9030717] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 12/22/2022] Open
Abstract
We investigated whether there was an annual change in outcomes in patients who received the thrombolytic therapy or endovascular treatment (EVT) in Korea. This analysis was performed using data from a nationwide multicenter registry for exploring the selection criteria of patients who would benefit from reperfusion therapies in Korea. We compared the annual changes in the modified Rankin scale (mRS) at discharge and after 90 days and the achievement of successful recanalization from 2012 to 2017. We also investigated the determinants of favorable functional outcomes. Among 1230 included patients, the improvement of functional outcome at discharge after reperfusion therapy was noted as the calendar year increased (p < 0.001). The proportion of patients who were discharged to home significantly increased (from 45.6% in 2012 to 58.5% in 2017) (p < 0.001). The successful recanalization rate increased over time from 78.6% in 2012 to 85.1% in 2017 (p = 0.006). Time from door to initiation of reperfusion therapy decreased over the years (p < 0.05). These secular trends of improvements were also observed in 1203 patients with available mRS data at 90 days (p < 0.05). Functional outcome was associated with the calendar year, age, initial stroke severity, diabetes, preadmission disability, intervals from door to reperfusion therapy, and achievement of successful recanalization. This study demonstrated the secular trends of improvement in functional outcome and successful recanalization rate in patients who received reperfusion therapy in Korea.
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Affiliation(s)
- Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu 41931, Korea; (S.-I.S.); (J.-H.H.)
| | - Hyungjong Park
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu 41931, Korea; (S.-I.S.); (J.-H.H.)
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea; (B.M.K.); (D.J.K.)
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (O.Y.B.); (W.-K.S.); (J.-W.C.)
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Euna Han
- College of Pharmacy, Yonsei Institute for Pharmaceutical Research, Yonsei University, Incheon 21983, Korea;
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 03722, Korea; (B.M.K.); (D.J.K.)
| | - JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Minyoung Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Jin Kyo Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 06273, Korea; (K.-Y.L.); (J.K.)
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Dong Hoon Shin
- Department of Neurology, Gachon University Gil Medical Center, Incheon 21565, Korea;
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul 05278, Korea;
| | - Sung-Il Sohn
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu 41931, Korea; (S.-I.S.); (J.-H.H.)
| | - Jeong-Ho Hong
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu 41931, Korea; (S.-I.S.); (J.-H.H.)
| | - Jang-Hyun Baek
- Department of Neurology, National Medical Center, Seoul 04564, Korea;
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Gyu Sik Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Ilsan 10444, Korea; (G.S.K.); (K.-D.S.)
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (O.Y.B.); (W.-K.S.); (J.-W.C.)
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (O.Y.B.); (W.-K.S.); (J.-W.C.)
| | - Seo Hyun Kim
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul 07804, Korea;
| | - Sang Won Han
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea; (S.W.H.); (J.H.P.)
| | - Joong Hyun Park
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Korea; (S.W.H.); (J.H.P.)
| | - Jinkwon Kim
- Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul 06273, Korea; (K.-Y.L.); (J.K.)
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea
| | - Yo Han Jung
- Department of Neurology, Changwon Fatima Hospital, Changwon 51394, Korea;
| | - Han-Jin Cho
- Department of Neurology, Pusan National University School of Medicine, Busan 49241, Korea;
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University School of Medicine, Gwangju 61453, Korea;
| | - Sung Ik Lee
- Department of Neurology, Sanbon Hospital, Wonkwang University School of Medicine, Sanbon 15865, Korea;
| | - Kwon-Duk Seo
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Ilsan 10444, Korea; (G.S.K.); (K.-D.S.)
- Department of Neurology, Sanbon Hospital, Wonkwang University School of Medicine, Sanbon 15865, Korea;
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.D.K.); (J.H.H.); (J.Y.); (H.P.); (J.H.); (M.K.); (J.K.C.)
- Correspondence: ; Tel.: +82-2-2228-1617; Fax: +82-2-393-0705
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15
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Yang HW, Lee M, Shin JW, Jeong HS, Kim J, Kim JL. Outcome Differences by Delirium Motor Subtype in Patients with Ischemic Stroke. Psychiatry Investig 2019; 16:852-859. [PMID: 31648422 PMCID: PMC6877462 DOI: 10.30773/pi.2019.0120] [Citation(s) in RCA: 5] [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] [Received: 05/14/2019] [Accepted: 07/30/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study evaluated the outcomes of ischemic stroke patients according to delirium motor subtype. METHODS This study included patients who were admitted to the stroke unit between August 2017 and March 2019 and met the DSM-5 diagnostic criteria for delirium. Patients were assessed twice weekly throughout their delirium episodes using the Korean version of the Delirium Motor Subtype Scale (K-DMSS) and the Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98). The clinical characteristics and short-term outcomes of the patients were also assessed. RESULTS A total of 943 stroke patients were included; the rate of incident delirium was 10.18%. Of the 95 delirium patients, 34 were classified as the hyperactive subtype, 30 as the mixed subtype, 25 as the hypoactive and six as no subtype. Among the subtype groups, the hypoactive subtype had the highest initial scores on the National Institutes of Health Stroke Scale (NIHSS; 6.72±4.75, p=0.02) and the modified Rankin Scale (mRS; 3.96±1.24, p<0.01). Additionally, the mixed and hypoactive subtypes had longer durations (p<0.01) and more severe symptoms of delirium (p=0.03) than the other motor subtypes, and the hypoactive subtype group had a significantly longer hospital stay (36.88±27.71 days, p<0.01) than the other subtype groups. After adjusting for baseline covariates in a multiple linear regression analysis, these differences remained significant. CONCLUSION The present results suggest that the motor subtype of delirium is associated with different characteristics and outcomes in ischemic stroke patients.
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Affiliation(s)
- Hee Won Yang
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Miji Lee
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong Wook Shin
- Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hye Seon Jeong
- Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jei Kim
- Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea.,Department of Neurology, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jeong Lan Kim
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Republic of Korea.,Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
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Lee JJ, Bae SG. Implementation of a care coordination system for chronic diseases. Yeungnam Univ J Med 2019; 36:1-7. [PMID: 31620605 PMCID: PMC6784624 DOI: 10.12701/yujm.2019.00073] [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: 11/01/2018] [Revised: 12/08/2018] [Accepted: 12/18/2018] [Indexed: 11/24/2022] Open
Abstract
The number of people with chronic diseases has been increasing steadily but the indicators for the management of chronic diseases have not improved significantly. To improve the existing chronic disease management system, a new policy will be introduced, which includes the establishment of care plans for hypertension and diabetes patients by primary care physicians and the provision of care coordination services based on these plans. Care coordination refers to a series of activities to assist patients and their families and it has been known to be effective in reducing medical costs and avoiding the unnecessary use of the hospital system by individuals. To offer well-coordinated and high-quality care services, it is necessary to develop a service quality assurance plan, track and manage patients, provide patient support, agree on patient referral and transition, and develop an effective information system. Local governance should be established for chronic disease management, and long-term plans and continuous quality improvement are necessary.
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Affiliation(s)
- Jung Jeung Lee
- Department of Preventive Medicine & Public Health, Keimyung University School of Medicine, Daegu, Korea
| | - Sang Geun Bae
- Department of Preventive Medicine & Public Health, Keimyung University School of Medicine, Daegu, Korea
- Corresponding author: Sang Geun Bae, Department of Preventive Medicine & Public Health, Keimyung University School of Medicine, 1095, Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea Tel: +82-53-580-3894, Fax: +82-53-580-3799, E-mail:
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17
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Kim JY, Kang K, Kang J, Koo J, Kim DH, Kim BJ, Kim WJ, Kim EG, Kim JG, Kim JM, Kim JT, Kim C, Nah HW, Park KY, Park MS, Park JM, Park JH, Park TH, Park HK, Seo WK, Seo JH, Song TJ, Ahn SH, Oh MS, Oh HG, Yu S, Lee KJ, Lee KB, Lee K, Lee SH, Lee SJ, Jang MU, Chung JW, Cho YJ, Choi KH, Choi JC, Hong KS, Hwang YH, Kim SE, Lee JS, Choi J, Kim MS, Kim YJ, Seok J, Jang S, Han S, Han HW, Hong JH, Yun H, Lee J, Bae HJ. Executive Summary of Stroke Statistics in Korea 2018: A Report from the Epidemiology Research Council of the Korean Stroke Society. J Stroke 2018; 21:42-59. [PMID: 30558400 PMCID: PMC6372894 DOI: 10.5853/jos.2018.03125] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022] Open
Abstract
Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.
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Affiliation(s)
- Jun Yup Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jaseong Koo
- Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eung-Gyu Kim
- Department of Neurology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Chulho Kim
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyun-Wook Nah
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Moo-Seok Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hwa Seo
- Department of Neurology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Mi-Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyung Geun Oh
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kijeong Lee
- Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Min Uk Jang
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seong-Eun Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Jimi Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ye Jin Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jinmi Seok
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Sujung Jang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Seokwan Han
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee Won Han
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jin Hyuk Hong
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hyori Yun
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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18
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Lee KH, Sohn MK, Jeong HS, Song HJ, Kim J, Kwon HJ, Koh HS, Jee S. The Effect of Inter-Departmental Stroke Meetings on Rehabilitation in a Comprehensive Cerebrovascular Center. J Korean Med Sci 2018; 33:e85. [PMID: 29495135 PMCID: PMC5835584 DOI: 10.3346/jkms.2018.33.e85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/09/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stroke is the number one cause of adulthood disability in Korea. Rehabilitation after stroke can minimize functional disability, enhance recovery toward independence, and optimize community reintegration. The inter-departmental stroke meeting (IDSM) is a potential method to improve rehabilitation outcomes in patients with stroke. We aimed to analyze the effect of IDSM on rehabilitation after acute ischemic stroke management. METHODS Medical records of 753 patients with acute ischemic stroke admitted to the neurology department of our medical center between January and December 2014 were reviewed retrospectively. In May 2014, weekly IDSMs were initiated. All physicians responsible for the patient's care reviewed patient treatment, methods of secondary prevention, and future rehabilitation plans. RESULTS The transfer rate significantly increased after initiation of IDSM (phase 2, 3) and the length of stay (LOS) before transfer to the rehabilitation department decreased significantly from 9.68 ± 8.50 days to 5.75 ± 2.12 days. There was a reduction in the total LOS from 52 ± 28.57 days to 35 ± 27.21 days after IDSMs were introduced. In non-transferred patients also, the total LOS reduced significantly. The transfer rate increased significantly and the LOS before transfer to the rehabilitation department decreased significantly after implementation of IDSM in a subgroup of patients with moderate to severe stroke. CONCLUSION The introduction of IDSM was significantly correlated with improvements in transfer rates and reduction of LOS in hospital. This finding shows that IDSMs are an important intervention to improve therapeutic progress and outcomes for patients with stroke.
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Affiliation(s)
- Kyu Ho Lee
- Department of Rehabilitation Medicine, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Hye Seon Jeong
- Department of Neurology, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Hee Jung Song
- Department of Neurology, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Jei Kim
- Department of Neurology, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Hyon Jo Kwon
- Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Hyeon Song Koh
- Department of Neurosurgery, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Daejeon-Chungnam Regional Cerebrovascular Center, Chungnam National University Hospital, Daejeon, Korea.
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19
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Jeong HS, Shin JW, Kwon HJ, Koh HS, Nam HS, Yu HS, Yoon NY, Kim J. Cost benefits of rapid recanalization using intraarterial thrombectomy. Brain Behav 2017; 7:e00830. [PMID: 29075576 PMCID: PMC5651400 DOI: 10.1002/brb3.830] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/17/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Thrombolytic therapy is associated with favorable clinical outcomes after successful and rapid recanalization in patients with acute ischemic stroke. This study aimed to evaluate the cost benefits and clinical outcomes at 1 year after intraarterial thrombectomy (IAT) by the rapidity of the successful recanalization. MATERIALS & METHODS Clinical outcomes of and medical costs incurred by 230 patients with acute ischemic stroke who underwent IAT were compared by the rapidity from symptom onset to successful recanalization (2b/3 thrombolysis in cerebral infarction grade): ≤6-hr (n = 143), >6-hr (n = 31), and no-recanalization (n = 56). Clinical outcomes including functional independence (0-2 modified Rankin Score), mortality, and home-discharge checked at 1 year post-IAT were compared among the three groups. Cost utility was calculated using quality-adjusted life years (QALY) estimated using the EuroQol-5 dimensions-3 levels questionnaire and the fees paid for institutional rehabilitation during the year post-IAT, and, was compared among the groups. RESULTS Patients in the ≤6-hr group showed higher functional independence (≤6-hr, 70%; >6-hr, 40%; no-recanalization, 6%, p < .001) and home-discharge rate (73%, 52%, 21%, and respectively, p < .001), and lower mortality (10%, 16%, and 43%, respectively, p < .001) at 1 year after IAT than other two groups. The cost utility of the ≤6-hr group was $35,557/QALY higher than that of the >6-hr group, and $27.829/QALY higher than no-recanalization group. CONCLUSIONS Rapid and successful recanalization of the occluded intracranial vessels within 6 hr after the onset of symptoms resulted in markedly higher cost utility and functional independence at 1 year post-IAT.
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Affiliation(s)
- Hye Seon Jeong
- Daejeon-Chungnam Regional Cerebrovascular Center Hospital and School of Medicine Chungnam National University Daejeon Korea.,Department of Neurology Hospital and School of Medicine Chungnam National University Daejeon Korea
| | - Jong Wook Shin
- Daejeon-Chungnam Regional Cerebrovascular Center Hospital and School of Medicine Chungnam National University Daejeon Korea.,Department of Neurology Hospital and School of Medicine Chungnam National University Daejeon Korea
| | - Hyon-Jo Kwon
- Daejeon-Chungnam Regional Cerebrovascular Center Hospital and School of Medicine Chungnam National University Daejeon Korea.,Department of Neurosurgery Hospital and School of Medicine Chungnam National University Daejeon Korea
| | - Hyeon-Song Koh
- Daejeon-Chungnam Regional Cerebrovascular Center Hospital and School of Medicine Chungnam National University Daejeon Korea.,Department of Neurosurgery Hospital and School of Medicine Chungnam National University Daejeon Korea
| | - Hae-Sung Nam
- Department of Preventive Medicine School of Medicine Chungnam National University Daejeon Korea
| | - Hee Seon Yu
- Daejeon-Chungnam Regional Cerebrovascular Center Hospital and School of Medicine Chungnam National University Daejeon Korea
| | - Na Young Yoon
- Daejeon-Chungnam Regional Cerebrovascular Center Hospital and School of Medicine Chungnam National University Daejeon Korea
| | - Jei Kim
- Daejeon-Chungnam Regional Cerebrovascular Center Hospital and School of Medicine Chungnam National University Daejeon Korea.,Department of Neurology Hospital and School of Medicine Chungnam National University Daejeon Korea
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20
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Seon Jeong H, Kim J. Paradigm Shift for Thrombolysis for Patients with Acute Ischaemic Stroke, from Extension of the Time Window to the Rapid Recanalisation After Symptom Onset. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10313503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Intravenous thrombolysis (IVT) and intra-arterial thrombolysis (IAT) are useful therapeutic tools to improve functional outcomes after recanalisation of occluded vessels in patients with acute ischaemic stroke. IVT could be performed for more patients by extending the time interval to 4.5 hours from onset to IVT initiation; however, this does not significantly improve functional outcomes. Recent studies indicated that IAT, particularly intra-arterial thrombectomy (IA-thrombectomy), significantly improved functional outcomes after recanalisation of occluded vessels, particularly when the recanalisation was performed within 6 hours of symptom onset. The focus of thrombolysis for acute ischaemic stroke patients is changing from extending the time window for IVT to successfully achieving good functional outcomes with IA-thrombectomy, by performing it within the 6-hour time limit. In this review, we discuss the present status of and limitations of extending IA-thrombectomy for improved functional outcomes after thrombolysis.
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Affiliation(s)
- Hye Seon Jeong
- Department of Neurology and Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Jei Kim
- Department of Neurology and Daejeon-Chungnam Regional Cerebrovascular Center, Hospital and School of Medicine, Chungnam National University, Daejeon, South Korea
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21
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Kim JT, Fonarow GC, Smith EE, Reeves MJ, Navalkele DD, Grotta JC, Grau-Sepulveda MV, Hernandez AF, Peterson ED, Schwamm LH, Saver JL. Treatment With Tissue Plasminogen Activator in the Golden Hour and the Shape of the 4.5-Hour Time-Benefit Curve in the National United States Get With The Guidelines-Stroke Population. Circulation 2016; 135:128-139. [PMID: 27815374 DOI: 10.1161/circulationaha.116.023336] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Earlier tissue plasminogen activator treatment improves ischemic stroke outcome, but aspects of the time-benefit relationship still not well delineated are: (1) the degree of additional benefit accrued with treatment in the first 60 minutes after onset, and (2) the shape of the time-benefit curve through 4.5 hours. METHODS We analyzed patients who had acute ischemic stroke treated with intravenous tissue plasminogen activator within 4.5 hours of onset from the Get With The Guidelines-Stroke US national program. Onset-to-treatment time was analyzed as a continuous, potentially nonlinear variable and as a categorical variable comparing patients treated within 60 minutes of onset with later epochs. RESULTS Among 65 384 tissue plasminogen activator-treated patients, the median onset-to-treatment time was 141 minutes (interquartile range, 110-173) and 878 patients (1.3%) were treated within the first 60 minutes. Treatment within 60 minutes, compared with treatment within 61 to 270 minutes, was associated with increased odds of discharge to home (adjusted odds ratio, 1.25; 95% confidence interval, 1.07-1.45), independent ambulation at discharge (adjusted odds ratio, 1.22; 95% confidence interval, 1.03-1.45), and freedom from disability (modified Rankin Scale 0-1) at discharge (adjusted odds ratio, 1.72; 95% confidence interval, 1.21-2.46), without increased hemorrhagic complications or in-hospital mortality. The pace of decline in benefit of tissue plasminogen activator from onset-to-treatment times of 20 through 270 minutes was mildly nonlinear for discharge to home, with more rapid benefit loss in the first 170 minutes than later, and linear for independent ambulation and in-hospital mortality. CONCLUSIONS Thrombolysis started within the first 60 minutes after onset is associated with best outcomes for patients with acute ischemic stroke, and benefit declined more rapidly early after onset for the ability to be discharged home. These findings support intensive efforts to organize stroke systems of care to improve the timeliness of thrombolytic therapy in acute ischemic stroke.
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Affiliation(s)
- Joon-Tae Kim
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Gregg C Fonarow
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Eric E Smith
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Mathew J Reeves
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Digvijaya D Navalkele
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - James C Grotta
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Maria V Grau-Sepulveda
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Adrian F Hernandez
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Eric D Peterson
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Lee H Schwamm
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Jeffrey L Saver
- From Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Neurology, University of Texas Health Science Center, Houston (D.D.N.); Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX (J.C.G.); Outcome Research and Assessment Group, Duke Clinical Research Institute, Durham, NC (M.V.G.-S., A.F.H., E.D.P.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.).
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22
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Oh GJ, Moon J, Lee YM, Park HK, Park KS, Yun YW, Kang G, Kim BG, Seo JH, Lee H, Lee WK, Lee KS, Kim HS, Lee YH. Public Awareness of Stroke and Its Predicting Factors in Korea: a National Public Telephone Survey, 2012 and 2014. J Korean Med Sci 2016; 31:1703-1710. [PMID: 27709846 PMCID: PMC5056200 DOI: 10.3346/jkms.2016.31.11.1703] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/13/2016] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to investigate time trends in the public awareness of stroke and its predicting factors. The target population was 9,600 community-dwelling adults, aged 19-79 years, in 16 metropolitan cities and provinces in Korea. The survey samples in 2012 and 2014 were selected separately (entirely different sets of subjects) using a proportionate quota sampling method. Information concerning knowledge of stroke and demographics was collected by trained telephone interviewers using random digit dialing. After excluding subjects with a non-response or refusal to answer any question, the analyses included 8,191 subjects in 2012 and 8,127 subjects in 2014. Respondents' awareness of stroke warning signs (numbness or weakness, difficulty speaking or understanding speech, dizziness, visual impairment, and severe headache) was highest for difficulty speaking or understanding speech (80.9% in 2012 and 86.4% in 2014). There were significant increases in the proportion of respondents understanding the appropriate action (i.e., calling an ambulance) at the time of stroke occurrence (59.6% to 67.1%), and in the proportion aware of the general need for prompt treatment (86.7% to 89.8%). In multivariable logistic regression analysis, older age, higher education level, higher household income, current non-smoking, exposure to stroke-related public relations materials, and experience of stroke education were significantly associated with both high knowledge of stroke warning signs and awareness of the need for prompt treatment. Between 2012 and 2014, the public's awareness of stroke increased significantly. More specialized interventions, including public relations materials and education, should focus on subgroups who have lower stroke knowledge.
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Affiliation(s)
- Gyung Jae Oh
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Jiyoung Moon
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Yu Mi Lee
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Hyeung Keun Park
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Ki Soo Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Korea
| | - Yong Woon Yun
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Hospital, Gwangju, Korea
| | - Gilwon Kang
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University Hospital, Cheongju, Korea
| | - Byoung Gwon Kim
- Busan-Ulsan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Jae Hee Seo
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Chungnam National University Hospital, Daejeon, Korea
| | - Heeyoung Lee
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won Kyung Lee
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University Hospital, Incheon, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Hee Sook Kim
- Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Young Hoon Lee
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
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23
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Park MS, Yoon W, Kim JT, Choi KH, Kang SH, Kim BC, Lee SH, Choi SM, Kim MK, Lee JS, Lee EB, Cho KH. Drip, Ship, and On-Demand Endovascular Therapy for Acute Ischemic Stroke. PLoS One 2016; 11:e0150668. [PMID: 26938774 PMCID: PMC4777434 DOI: 10.1371/journal.pone.0150668] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/16/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The "drip and ship" approach can facilitate an early initiation of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) at community hospitals. New endovascular treatment modalities, such as stent retrieval, have further improved the rate of safe and successful recanalization. We assessed the clinical outcomes of on-demand endovascular therapy in patients with AIS who were transported to a comprehensive stroke center under the "drip and ship" paradigm. METHODS This retrospective study evaluated prospectively registered patients with acute large vessel occlusions in the anterior circulation who underwent endovascular recanalization after IVT at our regional comprehensive stroke center between January 2011 and April 2014. Clinical outcomes and neuroradiological findings were compared between patients who received IVT at the center (direct visit, DV) and at a community hospital (drip and ship, DS). RESULTS Baseline characteristics such as age, initial National Institutes of Health Stroke Scale (NIHSS) score, and risk factors for stroke were similar, and most patients underwent endovascular therapy with a Solitaire stent (81.9% vs. 89.3% for DV and DS, respectively, P = 0.55). The average initial NIHSS score was 12.15 ± 4.1 (12.06 vs. 12.39 for DV and DS, respectively, P = 0.719). The proportions of long-term favorable outcomes (modified Rankin Scale score ≤ 2 at 90 days) and successful recanalization (Thrombolysis in Cerebral Ischemia score ≥ 2b) were not significantly different (P = 0.828 and 0.158, respectively). The mortality rates and occurrences of symptomatic intracerebral hemorrhage were not significantly different (P = 0.999 and 0.267, respectively). CONCLUSIONS The "drip and ship" approach with subsequent endovascular therapy is a feasible treatment concept for patients with acute large vessel occlusion in the anterior circulation that could help improve clinical outcomes in patients with AIS.
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Affiliation(s)
- Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
- Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
- * E-mail:
| | - Woong Yoon
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
- Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
- Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
- Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Seung-Ho Kang
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
- Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - B. Chae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung-Han Lee
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Myeong-Kyu Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
- Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Ji-Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Eun-Bin Lee
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
- Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
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Jeong JH, Yang JY, Cha JK, Kim DH, Nah HW, Kang MJ, Choi JH, Huh JT. Feasibility of a Pre-Hospital Notification System Using Direct Calls from Paramedics of 119 EMS Ambulances for Acute Stroke Patients: Accuracy of Diagnosis and Efficacy of Shortening of Door-to-Imaging Time. JOURNAL OF NEUROCRITICAL CARE 2015. [DOI: 10.18700/jnc.2015.8.2.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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25
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de Havenon A, Sultan-Qurraie A, Hannon P, Tirschwell D. Development of regional stroke programs. Curr Neurol Neurosci Rep 2015; 15:544. [PMID: 25763758 DOI: 10.1007/s11910-015-0544-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The organization of stroke care has undergone a dramatic evolution in the USA over the last two decades. Beginning with the recommendation for Primary Stroke Centers (PSCs) in 1994, there has been a concerted effort by physicians, the American Heart Association/American Stroke Association (AHA/ASA), National Institutes of Health (NIH), and state legislatures to advance an evidence-based system of care with several tiers of stroke centers. At the apex of this structure are Regional Stroke Centers (RSCs), which do not have official recognition like PSCs and Comprehensive Stroke Centers (CSCs), but their existence as a hub for the many disparate spokes of stroke care in their region is increasingly necessary. Observational evidence suggests that this approach is improving the delivery of stroke care and reducing costs in the USA. Similar efforts are being made in Europe and Asia with encouraging results. The RSC model has the potential to lead to more uniform evidence-based stroke medicine, but many challenges exist.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, 175 N. Medical Dr, Salt Lake City, UT, 84132, USA,
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