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Ghotme KA, Rosseau G, Blount J, Caceres A, Garcia RM, Qureshi M, Baticulon R, Shlobin NA, Park KB, Boop FA, Enam SA, Conteh F, Figaji A, Aldana PR, Barthélemy EJ, Moser R, Ocal E, Patissapu J, Johnson WD, Khan T. The Power of Advocacy in Global Neurosurgery. Neurosurgery 2024:00006123-990000000-01317. [PMID: 39185896 DOI: 10.1227/neu.0000000000003108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/19/2024] [Indexed: 08/27/2024] Open
Abstract
Advocacy, one of the five domains of global neurosurgery, represents a powerful avenue to influence public policy to expand access to safe, timely, and affordable neurosurgical care. In this manuscript, we characterize advocacy in global neurosurgery, describe specific neurosurgeon-led initiatives, and delineate how neurosurgeons can become involved in global neurosurgery advocacy efforts. Advocacy in global neurosurgery involves working together in organized neurosurgery with organizations focused on clinical provisions, training, and policy initiatives. Effective advocacy uses a data-driven approach with myriad facilitators, including collaboration and approach strategies for sharing information and a variety of contextual, ideological, and practical barriers. The main action fronts for global neurosurgery include identifying needs, broadening access, and assuring quality. Neurosurgery-led initiatives transforming public policy have occurred on regional and global scales and accelerated since 2019. Folate fortification of staple foods to prevent neural tube defects represents a recent and notably successful area of advocacy and remains in progress. Neurosurgeons who aspire to become involved in advocacy efforts must obtain competencies and skills distinct from, yet complementary to, the traditional neurosurgical training curriculum.
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Affiliation(s)
- Kemel A Ghotme
- Translational Neuroscience Research Lab, School of Medicine, Universidad de La Sabana, Campus Universitario Puente del Común, Chia, Colombia
- Neurosurgery Department, Fundacion Santa Fe De Bogota, Bogota, District of Columbia, Colombia
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Jeffrey Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adrian Caceres
- Servicio de Neurocirugía, Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, Costa Rica
| | - Roxanna M Garcia
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mahmood Qureshi
- Neurosurgery Section, Aga Khan University Hospital, Nairobi, Kenya
| | - Ronnie Baticulon
- Division of Neurosurgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kee B Park
- Harvard Initiative for Global Health: Harvard Global Health Institute, Boston, Massachusetts, USA
| | - Frederick A Boop
- Neurosurgery Division, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Syed Ather Enam
- Brain and Mind Institute, The Aga Khan University, Karachi, Pakistan
| | - Fatu Conteh
- University of Sierra Leone, Freetown, Sierra Leone
| | - Anthony Figaji
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Philip R Aldana
- Division of Pediatric Neurosurgery, University of Florida, Jacksonville, Florida, USA
| | - Ernest J Barthélemy
- Global Neurosurgery Laboratory, Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Richard Moser
- Department of Neurological Surgery, University of Massachusetts Chan Medical School, Boston, Massachusetts, USA
| | - Eylem Ocal
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jogi Patissapu
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Walter D Johnson
- School of Public Health, Loma Linda University School of Public Health, Loma Linda, California, USA
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Pakistan
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Sun J, Ma L, Miao X, Sun H, Zhu S, Zhang R, Fan L, Hu T. Current Status of Outcomes Reported by Patients With Stroke and an Analysis of Influencing Factors: Cross-Sectional Questionnaire Study. JMIR Form Res 2024; 8:e58330. [PMID: 39186763 PMCID: PMC11384171 DOI: 10.2196/58330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Stroke is the leading cause of acquired disability and the second leading cause of death worldwide. Its rate of incidence, disability, mortality, and recurrence is high, and the patients experience various symptoms of discomfort, which not only affect their rehabilitation function but also reduce their ability to perform daily activities and their quality of life. Nowadays, with the improvement of China's medical standards, patients are increasingly attentive to their quality of life and health status. However, diagnostic techniques and effective treatments for patients with stroke are still limited but urgently required. OBJECTIVE This study aimed to evaluate the quality of life during hospitalization using a stroke patient-reported outcomes (PROs) scale and additionally to recognize potential factors and risk indicators that may impact recurrent events, facilitating early intervention measures. METHODS This is a registry-based, retrospective observational cross-sectional study on patients with stroke. A convenient sampling method was used to select various indicators of patients. The Stroke-PRO scale was then used to assess patients' conditions across physical, psychological, social, and therapeutic domains. Multiple linear regression analysis was applied to identify factors influencing stroke PROs, while correlation analysis was conducted to explore the relationship between these outcomes and blood lipid levels. RESULTS The mean Stroke-PRO score in this study was 4.09 (SD 0.29) points. By multiple linear regression analysis, residence, occupation, physical exercise, Barthel index, Braden scale, National Institutes of Health Stroke Scale scores at admission, and stroke type were the risk factors for reported outcomes of patients with stroke (P<.05). Correlation analysis showed that serum triglyceride, total cholesterol, and low-density lipoprotein were negatively correlated with Stroke-PRO scores in patients with stroke (P<.05), while high-density lipoprotein was positively correlated with patients with stroke (P<.05). The 95% CI was -0.31 to -0.03 for triglyceride, 0.17-0.44 for high-density lipoprotein, -0.29 to -0.01 for cholesterol, -0.30 to -0.02 for low-density lipoprotein, and -0.12 to 0.16 for blood glucose. CONCLUSIONS Patients with stroke have a low level of health, and their reported outcomes need to be improved. Accordingly, nursing staff should pay attention to the quality of life and blood lipid indexes of patients with stroke, actively assess their actual health status, and take early intervention measures to promote their recovery.
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Affiliation(s)
- Jia Sun
- Nursing Department, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Liang Ma
- Nursing Department, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiao Miao
- Nursing Department, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Hui Sun
- Department of Medicine, Southeast University, Nanjing, China
| | - SuSu Zhu
- Nursing Department, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Ran Zhang
- Nursing Department, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - LeLe Fan
- Nursing Department, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - TingTing Hu
- Nursing Department, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
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Mishra SR, Wei K, O’Hagan E, Khanal V, Laaksonen MA, Lindley RI. Stroke Care in South Asia - Identifying Gaps for Future Action. Glob Heart 2024; 19:68. [PMID: 39185007 PMCID: PMC11342841 DOI: 10.5334/gh.1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024] Open
Abstract
Stroke causes around 730,000 deaths in South Asia, nearly half of stroke-related deaths in developing countries. This highlights the need to address health system responses, considering poverty, service quality, and availability. The article identifies four key challenges in stroke management and rehabilitation in South Asia, emphasizing long-term monitoring, risk factor control, and community surveillance, drawing on experiences from Nepal.
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Affiliation(s)
- Shiva Raj Mishra
- NHMRC Clinical Trials Centre, University of Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Australia
- Nepal Development Society, Bharatpur-6, Chitwan, Nepal
| | - Kanghui Wei
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Edel O’Hagan
- Westmead Applied Research Centre, University of Sydney, Australia
| | - Vishnu Khanal
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, Australia
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Li X, He Y, Wang D, Rezaei MJ. Stroke rehabilitation: from diagnosis to therapy. Front Neurol 2024; 15:1402729. [PMID: 39193145 PMCID: PMC11347453 DOI: 10.3389/fneur.2024.1402729] [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: 03/22/2024] [Accepted: 06/28/2024] [Indexed: 08/29/2024] Open
Abstract
Stroke remains a significant global health burden, necessitating comprehensive and innovative approaches in rehabilitation to optimize recovery outcomes. This paper provides a thorough exploration of rehabilitation strategies in stroke management, focusing on diagnostic methods, acute management, and diverse modalities encompassing physical, occupational, speech, and cognitive therapies. Emphasizing the importance of early identification of rehabilitation needs and leveraging technological advancements, including neurostimulation techniques and assistive technologies, this manuscript highlights the challenges and opportunities in stroke rehabilitation. Additionally, it discusses future directions, such as personalized rehabilitation approaches, neuroplasticity concepts, and advancements in assistive technologies, which hold promise in reshaping the landscape of stroke rehabilitation. By delineating these multifaceted aspects, this manuscript aims to provide insights and directions for optimizing stroke rehabilitation practices and enhancing the quality of life for stroke survivors.
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Affiliation(s)
- Xiaohong Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanjin He
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dawu Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Carbonera LA, Rivillas JA, Gordon Perue G, da Luz Dorneles L, Boiani M, de Souza AC, Sampaio Silva G, Dorn M, Martins SCO. The MAPSTROKE project: A computational strategy to improve access to acute stroke care. Int J Stroke 2024; 19:747-753. [PMID: 38346937 DOI: 10.1177/17474930241234528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Global access to acute stroke treatment is variable worldwide, with notable gaps in low and middle-income countries (LMIC), especially in rural areas. Ensuring a standardized method for pinpointing the existing regional coverage and proposing potential sites for new stroke centers is essential to change this scenario. AIMS To create and apply computational strategies (CSs) to determine optimal locations for new acute stroke centers (ASCs), with a pilot application in nine Latin American regions/countries. METHODS Hospitals treating acute ischemic stroke (AIS) with intravenous thrombolysis (IVT) and meeting the minimum infrastructure requirements per structured protocols were categorized as ASCs. Hospitals with emergency departments, noncontrast computed tomography (NCCT) scanners, and 24/7 laboratories were identified as potential acute stroke centers (PASCs). Hospital geolocation data were collected and mapped using the OpenStreetMap data set. A 45-min drive radius was considered the ideal coverage area for each hospital based on the drive speeds from the OpenRouteService database. Population data, including demographic density, were obtained from the Kontur Population data sets. The proposed CS assessed the population covered by ASCs and proposed new ASCs or artificial points (APs) settled in densely populated areas to achieve a target population coverage (TPC) of 95%. RESULTS The observed coverage in the region presented significant disparities, ranging from 0% in the Bahamas to 73.92% in Trinidad and Tobago. No country/region reached the 95% TPC using only its current ASCs or PASCs, leading to the proposal of APs. For example, in Rio Grande do Sul, Brazil, the introduction of 132 new centers was suggested. Furthermore, it was observed that most ASCs were in major urban hubs or university hospitals, leaving rural areas largely underserved. CONCLUSIONS The MAPSTROKE project has the potential to provide a systematic approach to identify areas with limited access to stroke centers and propose solutions for increasing access to AIS treatment. DATA ACCESS STATEMENT Data used for this publication are available from the authors upon reasonable request.
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Affiliation(s)
| | - Julián Alejandro Rivillas
- Department of Neurology, Fundación Valle del Lili Hospital Universitario, Cali, Colombia
- Public Health Department, Universidad Icesi, Cali, Colombia
| | - Gillian Gordon Perue
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Leonardo da Luz Dorneles
- Institute of Informatics and Center for Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Mateus Boiani
- Institute of Informatics and Center for Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Cláudia de Souza
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Gisele Sampaio Silva
- Department of Neurology, Universidade Federal de São Paulo (UNIFESP) and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcio Dorn
- Institute of Informatics and Center for Biotechnology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sheila Cristina Ouriques Martins
- Department of Neurology and Neurosurgery, Hospital Moinhos de Vento, Porto Alegre, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Isaev NK, Genrikhs EE, Stelmashook EV. Methylene blue and its potential in the treatment of traumatic brain injury, brain ischemia, and Alzheimer's disease. Rev Neurosci 2024; 35:585-595. [PMID: 38530227 DOI: 10.1515/revneuro-2024-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
Traumatic brain injury (TBI) and brain ischemia/reperfusion cause neurodegenerative processes that can continue after the acute stage with the development of severe brain atrophy with dementia. In this case, the long-term neurodegeneration of the brain is similar to the neurodegeneration characteristic of Alzheimer's disease (AD) and is associated with the accumulation of beta amyloid and tau protein. In the pathogenesis of AD as well as in the pathogenesis of cerebral ischemia and TBI oxidative stress, progressive inflammation, glial activation, blood-brain barrier dysfunction, and excessive activation of autophagy are involved, which implies the presence of many targets that can be affected by neuroprotectors. That is, multivariate cascades of nerve tissue damage represent many potential targets for therapeutic interventions. One of such substances that can be used in multi-purpose therapeutic strategies is methylene blue (MB). This drug can have an antiapoptotic and anti-inflammatory effect, activate autophagy, inhibit the aggregation of proteins with an irregular shape, inhibit NO synthase, and bypass impaired electron transfer in the respiratory chain of mitochondria. MB is a well-described treatment for methemoglobinemia, malaria, and encephalopathy caused by ifosfamide. In recent years, this drug has attracted great interest as a potential treatment for a number of neurodegenerative disorders, including the effects of TBI, ischemia, and AD.
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Affiliation(s)
- Nickolay K Isaev
- 64935 M.V. Lomonosov Moscow State University , 119991, Moscow, Russia
- Research Center of Neurology, 125367, Moscow, Russia
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Battaglini D, Kelly TL, Griffee M, Fanning J, Premraj L, Whitman G, Porto DB, Arora R, Thomson D, Pelosi P, White NM, Bassi GL, Suen J, Fraser JF, Robba C, Cho SM. Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries. Heart Lung 2024; 68:131-144. [PMID: 38968643 DOI: 10.1016/j.hrtlng.2024.06.015] [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: 04/24/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/07/2024]
Abstract
PURPOSE We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. METHODS International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. RESULTS 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4-44.9) LMICs and 17.6 (95 %CI = 15.8-19.7) HICs; ischemic 9.47 (95 %CI = 6.57-13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73-10.9) LMICs, and 2.52 (95 %CI = 2.00-3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75-17.3) LMICs, 8.99 (95 %CI = 7.70-10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31-2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29-2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19-1.72), p < 0.001)]. CONCLUSIONS Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. TRIAL REGISTRATION ACTRN12620000421932 registered on 30/03/2020.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
| | - Thu-Lan Kelly
- Queensland University of Technology, Brisbane, Australia
| | - Matthew Griffee
- Department of Anesthesiology and Perioperative Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jonathon Fanning
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Lavienraj Premraj
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Griffith University School of Medicine, Gold Coast, Australia
| | - Glenn Whitman
- Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diego Bastos Porto
- Faculty of Medicine, Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Rakesh Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - David Thomson
- Division of Critical Care, University of Cape Town, Cape Town, South Africa
| | - Paolo Pelosi
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Nicole M White
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gianluigi Li Bassi
- Queensland University of Technology, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain; University of Queensland, Brisbane, Australia; St Andrew's War Memorial Hospital, UnitingCare Hospitals, Brisbane Australia; Wesley Medical Research, Brisbane, Australia
| | - Jacky Suen
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - John F Fraser
- Queensland University of Technology, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; St Andrew's War Memorial Hospital, UnitingCare Hospitals, Brisbane Australia; Wesley Medical Research, Brisbane, Australia; School of Medicine, Griffith University, Brisbane, Australia
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mahajan C, Kapoor I, Prabhakar H. The Urban-Rural Divide in Neurocritical Care in Low-Income and Middle-Income Countries. Neurocrit Care 2024:10.1007/s12028-024-02040-z. [PMID: 38960992 DOI: 10.1007/s12028-024-02040-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
The term "urban-rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural-urban differences in terms of facilities related to neurocritical care (NCC) in LMICs. Issues related to common clinical conditions such as stroke, traumatic brain injury, myasthenia gravis, epilepsy, tubercular meningitis, and tracheostomy are also discussed. To facilitate delivery of NCC in resource-limited settings, proposed strategies include strengthening preventive measures, focusing on basics, having a multidisciplinary approach, promoting training and education, and conducting cost-effective research and collaborative efforts. The rural areas of LMICs bear the maximum impact because of their limited access to preventive health services, high incidence of acquired brain injury, inability to have timely management of neurological emergencies, and scarcity of specialist services in a resource-deprived health center. An increase in the health budget allocation for rural areas, NCC education and training of the workforce, and provision of telemedicine services for rapid diagnosis, management, and neurorehabilitation are some of the steps that can be quite helpful.
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Affiliation(s)
- Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Inoa V, Then R, Cancelliere NM, Spiegel GR, Fraser JF, Hepburn M, Martins SCO, Guff L, Strong M, Elijovich L, González F, Guerrero WR, Eusebio A, Gayle F, Manosalva Alzate HA, Villamán CG, Suazo L, de Souza R, Potter-Vig J, Hassan AE, Ortega-Gutierrez S, Yavagal DR, Gordon Perue GL. Mechanical Thrombectomy Workshops Improve Procedural Knowledge and Skills Among Neurointerventional Teams in Low- to Middle-Income Countries. Stroke 2024; 55:1886-1894. [PMID: 38913795 DOI: 10.1161/strokeaha.124.046516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/22/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND While mechanical thrombectomy (MT) is proven to be lifesaving and disability sparing, there remains a disparity in its access in low- to middle-income countries. We hypothesized that team-based MT workshops would improve MT knowledge and skills. METHODS We designed a 22-hour MT workshop, conducted as 2 identical events: in English (Jamaica, January 2022) and in Spanish (Dominican Republic, May 2022). The workshops included participating neurointerventional teams (practicing neurointerventionalists, neurointerventional nurses, and technicians) focused on acute stroke due to large vessel occlusion. The course faculty led didactic and hands-on components, covering topics from case selection and postoperative management to device technology and MT surgical techniques. Attendees were evaluated on stroke knowledge and MT skills before and after the course using a multiple choice exam and simulated procedures utilizing flow models under fluoroscopy, respectively. Press conferences for public education with invited government officials were included to raise stroke awareness. RESULTS Twenty-two physicians and their teams from 8 countries across the Caribbean completed the didactic and hands-on training. Overall test scores (n=18) improved from 67% to 85% (P<0.002). Precourse and postcourse hands-on assessments demonstrated reduced time to completion from 36.5 to 21.1 minutes (P<0.001). All teams showed an improvement in measures of good MT techniques, with 39% improvement in complete reperfusion. Eight teams achieved a Thrombolysis in Cerebral Infarction score of 3 on pre-course versus 15 of 18 teams on post-course. There was a significant reduction in total potentially dangerous maneuvers (70% pre versus 20% post; P<0.002). Universally, the workshop was rated as satisfactory and likely to change practice in 93% Dominican Republic and 75% Jamaica. CONCLUSIONS A team-based hands-on simulation approach to MT training is novel, feasible, and effective in improving procedural skills. Participants viewed these workshops as practice-changing and instrumental in creating a pathway for increasing access to MT in low- to middle-income countries.
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Affiliation(s)
- Violiza Inoa
- University of Tennessee Health Science Center, Memphis. Semmes-Murphey Clinic, Memphis, TN (V.I., G.R.S., L.E.)
| | - Ryna Then
- Cooper Medical School of Rowan University, Camden, NJ (R.T.)
- TeleSpecialists, LLC, Fort Myers, FL (R.T.)
| | | | - Gary R Spiegel
- University of Tennessee Health Science Center, Memphis. Semmes-Murphey Clinic, Memphis, TN (V.I., G.R.S., L.E.)
| | - Justin F Fraser
- Departments of Neurosurgery, Neurology, Radiology, Otolaryngology, and Neuroscience, University of Kentucky, Lexington (J.F.F.)
| | - Madihah Hepburn
- Summa Health Neurosciences and Stroke Center, Akron, OH (M.H.)
| | | | - Lauren Guff
- Baptist Memorial Healthcare, Memphis, TN (L.G.)
| | | | - Lucas Elijovich
- University of Tennessee Health Science Center, Memphis. Semmes-Murphey Clinic, Memphis, TN (V.I., G.R.S., L.E.)
| | | | - Waldo R Guerrero
- Department of Neurology and Brain Repair, University of South Florida, Tampa, FL (W.R.G.)
| | | | - Francene Gayle
- King Edward Memorial Hospital, Paget, Bermuda (F. Gayle)
| | | | - Cosme G Villamán
- Department Neurointervención Clínica Corominas y Corazones del Cibao, Dominican Republic (C.G.V.)
| | - Luis Suazo
- Centro de Medicina Avanzada y Telemedicina, Dominican Republic (L.S.)
| | | | | | - Ameer E Hassan
- Department of Neurology, Valley Baptist Medical Center, University of Texas Rio Grande Valley (A.E.H.)
| | | | - Dileep R Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, FL (D.R.Y., G.L.G.P.)
| | - Gillian L Gordon Perue
- Department of Neurology, University of Miami Miller School of Medicine, FL (D.R.Y., G.L.G.P.)
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Amoah D, Schmidt M, Mather C, Prior S, Herath MP, Bird ML. An international perspective on young stroke incidence and risk factors: a scoping review. BMC Public Health 2024; 24:1627. [PMID: 38890645 PMCID: PMC11186079 DOI: 10.1186/s12889-024-19134-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Stroke among younger age groups is increasing globally. While there is a focus on research conducted on people under 65 years who have had a stroke, there is a paucity of data on the incidence and risk factors of stroke among younger people (≤ 30 years). This scoping review examines evidence on incidence and risk factors for perinatal, paediatric and young adult stroke globally. METHODS The review was guided by the Joanna Briggs Institute's scoping review methodology. A systematic search was conducted on 23rd March 2022 across Medline Ovid, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The eligibility criteria included all study designs providing information on the incidence and risk factors of stroke among young people (≤ 30 years) in the last ten years. RESULTS A total of 5750 articles were identified. After screening, 471 articles (224 cohort studies (47.6%), 164 case studies/case series (34.8%), 35 reviews (7.4%), 30 case-control (6.4%) and 18 combinations of designs (3.8%) were included. There was data from 50 different countries, 199 studies were from high-income countries, upper and middle income (n = 38), lower middle-income (n = 39), low-income (n = 3) countries, international study (n = 7) and a further 185 articles did not state the country of research. Most of the studies (63%) focused on risk factors while incidence constituted 37%. Incidence data were reported heterogeneously across studies, leading to an inability to synthesise data. The three most frequently reported risk factors for perinatal stroke were infections, cardiac conditions, and intrapartum factors. Vasculopathies, infection and cardiac conditions accounted for most reported risk factors for paediatric stroke, while chronic conditions such as diabetes mellitus, vasculopathies and cardiac conditions accounted for the most reported risk factors among young adults. CONCLUSION This review has highlighted different stroke risk factors for each age cohort of people under 30 years. The low number of epidemiological studies suggests that further research of this type is needed to fully understand the incidence and risk factors in young stroke. A standardised reporting of age groupings of incidence data is imperative to enable the comparison of data from different geographical locations.
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Affiliation(s)
- Dinah Amoah
- School of Health Sciences, University of Tasmania, Launceston, Australia.
| | - Matthew Schmidt
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Carey Mather
- School of Nursing, University of Tasmania, Launceston, Australia
| | - Sarah Prior
- Tasmanian School of Medicine, University of Tasmania, Burnie, Australia
| | - Manoja P Herath
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston, Australia
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11
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Gandhi DBC, Baggio JAO, D'Souza JV, Urimubenshi G, Vijayanand PJ. Global Access to Stroke Rehabilitation: A Narrative Synthesis of Comparative Highlights. Stroke 2024; 55:e161-e164. [PMID: 38634278 DOI: 10.1161/strokeaha.123.045116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Dorcas B C Gandhi
- Department of Neurology and College of Physiotherapy (D.B.C.G.), Christian Medical College & Hospital, Ludhiana, Punjab, India
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Health Education, Karnataka, India (D.B.C.G.)
| | - Jussara A O Baggio
- Medical School of Federal University of Alagoas, Arapiraca, Brazil (J.A.O.B.)
| | - Jennifer V D'Souza
- Department of Physiotherapy, St. John's Medical College, Bengaluru, Karnataka, India (J.V.D.)
| | - Gerard Urimubenshi
- Department of Physiotherapy, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali (G.U.)
| | - Pranay J Vijayanand
- Department of Neurology (P.J.V.), Christian Medical College & Hospital, Ludhiana, Punjab, India
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12
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Zhang ZY, Huang L, Gao M, Zhang TQ, Zhang FY, Yi J, Liu ZL. Parallel-Forms Reliability and Minimal Detectable Change of the Four Telerehabilitation Version Mobility-Related Function Scales in Stroke Survivors. Arch Phys Med Rehabil 2024; 105:1124-1132. [PMID: 38307318 DOI: 10.1016/j.apmr.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/25/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To investigate the parallel-forms reliability, minimal detectable change with 95% confidence interval (MDC95), and feasibility of the 4 telerehabilitation version mobility-related function scales: Fugl-Meyer Assessment-lower extremity subscale (Tele-FMA-LE), Berg Balance Scale (Tele-BBS), Tinetti Performance Oriented Mobility Assessment-Gait subscale (Tele-POMA-G), and Rivermead Mobility Index (Tele-RMI). DESIGN Reliability and agreement study and cross-sectional study. SETTING Medical center. PARTICIPANTS Stroke survivors' ability to independently walk 3 meters with assistive devices, age of ≥18 years for participants and their partners, stable physical condition, and absence of cognitive impairment (N=60). INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Parallel-forms reliability and MDC95 of Tele-FMA-LE, Tele-BBS, Tele-POMA-G, and Tele-RMI. RESULTS No significant differences (P>.05) were observed among the mean scores of the telerehabilitation version and face-to-face version mobility-related function scales. Intraclass correlation coefficients (ICCs) indicated good reliability for most scales, with Tele-FMA-LE, Tele-BBS, and Tele-RMI scores achieving values of 0.81, 0.78, and 0.84. Tele-POMA-G scores demonstrated moderate reliability (ICC=0.72). Weighted kappa (κw) showed good-to-excellent reliability for most individual items (κw>0.60). The MDCs of the Tele-FMA-LE, Tele-BBS, Tele-POMA-G, and Tele-RMI were 5.84, 8.10, 2.74, and 1.31, respectively. Bland-Altman analysis showed adequate agreement between tele-assessment and face-to-face assessment for all scales. The 5 dimensions affirm the robust feasibility of tele-assessment: assessment time, subjective fatigue perception, overall preference, participant satisfaction, and system usability. CONCLUSIONS The study demonstrates good parallel-forms reliability, MDC, and promising feasibility of the 4 telerehabilitation version mobility-related function scales (Tele-FMA-LE, Tele-BBS, Tele-POMA-G, and Tele-RMI) in survivors of stroke.
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Affiliation(s)
- Zhi-Yuan Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Lu Huang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Min Gao
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Tian-Qi Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Feng-Yue Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Jiang Yi
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Zhong-Liang Liu
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China.
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13
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Iskandar K, Rahme D, Salameh P, Haddad C, Sacre H, Bahlol M, Darwish RM, El Khatib S, Safwan J, Sakr F, Rahhal M, Hosseini H, Cherfane M. Evaluating the influence of a 3-min online video on the community knowledge of stroke in four Arab countries. Front Public Health 2024; 12:1342490. [PMID: 38841682 PMCID: PMC11151891 DOI: 10.3389/fpubh.2024.1342490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Studies from developed and developing countries showed that the knowledge levels of stroke need improvement. Educational campaigns varied and were of limited influence predominantly because of their short duration and the need for financial support. The study aims to test the impact of a 3-min online video on the knowledge of stroke and factors influencing the knowledge score in four Arab countries. Methods A cross-sectional web-based pre-post study was conducted in Egypt, Jordan, Lebanon, and the United Arab Emirates. The data were collected using the snowball technique. Participants were adults aged 18 years and above. The questionnaire sequence was conducting a pretest, followed by the educational video explaining stroke occurrence, types, risks, warning signs, preventive measures, and treatment, and finally, a posttest to evaluate the differences in knowledge from baseline. Statistical analysis included paired t-tests comparing pre-post-education stroke knowledge scores, while repeated measures ANOVA, adjusting for covariates, assessed mean changes. Results The total number of participants was 2,721, mainly younger than 55 years. The majority had a university degree and were not healthcare professionals. A significant improvement was noted in the total knowledge score in all countries from a mean average (Mpretest = 21.11; Mposttest = 23.70) with p < 0.001. Identification of the stroke risks (Mpretest = 7.40; Mposttest = 8.75) and warning signs (Mpretest = 4.19; Mposttest = 4.94), understanding the preventive measures (Mpretest = 5.27; Mposttest = 5.39) and the importance of acting fast (Mpretest = 0.82; Mposttest = 0.85) improved from baseline with (p < 0.001) for all score components. Conclusion The educational tool successfully enhanced public understanding of stroke risks, the identification of stroke signs, and the critical need for emergency action. The advantages of this video include its short length, free online access, use of evidence-based content in lay language, and reflective images. The ultimate goal remains the long-term improvement of sustainability by mandating full-scale trials.
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Affiliation(s)
- Katia Iskandar
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Health and Social Work, School of Public Health, Lebanese University, Fanar, Lebanon
- Higher Institute of Public Health (ISSP), Saint Joseph University of Beirut, Beirut, Lebanon
| | - Deema Rahme
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Pharmacy Practice, School of Pharmacy, Beirut Arab University, Beirut, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Egypt
- Department of Pharmaceutical management and economics, Department Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Egyptian Russian University, Badr city, Cairo governorate, Egypt
| | - Mohamed Bahlol
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rula M. Darwish
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
| | - Sarah El Khatib
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Health and Social Work, School of Public Health, Lebanese University, Fanar, Lebanon
| | - Jihan Safwan
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
- UMR U955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, Paris, France
| | - Mohamad Rahhal
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Hassan Hosseini
- INSERM U955-E01, IMRB, Henri Mondor Hospital, Créteil, France
- Department of Neurology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Michelle Cherfane
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Environmental and Public Health Department, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
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Tan KS, Pandian JD, Liu L, Toyoda K, Leung TWH, Uchiyama S, Kuroda S, Suwanwela NC, Aaron S, Chang HM, Venketasubramanian N. Stroke in Asia. Cerebrovasc Dis Extra 2024; 14:58-75. [PMID: 38657577 PMCID: PMC11250668 DOI: 10.1159/000538928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is a significant burden of stroke in Asia. Asia has the largest population in the world in 2023, estimated at 4.7 billion. Approximately 9.5-10.6 million strokes will be anticipated annually in the backdrop of a diverse group of well-developed and less developed countries with large disparities in stroke care resources. In addition, Asian countries are in varying phases of epidemiological transition. SUMMARY In this review, we examined recent epidemiological features of ischaemic stroke and intracerebral haemorrhage in Asia with recent developments in hyperacute stroke reperfusion therapy and technical improvements in intracerebral haemorrhage. The article also discussed the spectrum of cerebrovascular diseases in Asia, which include intracranial atherosclerosis, intracerebral haemorrhage, infective aetiologies of stroke, moyamoya disease, vascular dissection, radiation vasculopathy, and cerebral venous thrombosis. KEY MESSAGES The review of selected literature and recent updates calls for attention to the different requirements for resources within Asia and highlights the breadth of cerebrovascular diseases still requiring further research and more effective therapies.
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Affiliation(s)
- Kay Sin Tan
- Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Thomas Wai Hon Leung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Shinichiro Uchiyama
- Centre for Brain and Cerebral Vessels, Sanno Medical Centre, International University of Health and Welfare, Tokyo, Japan
| | - Sathoshi Kuroda
- Department of Neurosurgery, Toyama University, Toyama, Japan
| | - Nijasri C. Suwanwela
- Chulalongkorn Stroke Centre, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sanjith Aaron
- Department of Medicine, Christian Medical College, Vellore, India
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, Singapore
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15
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Poll M, Martins RT, Anschau F, Jotz GP. Length of Hospitalization and Mortality among Stroke Patients before and after the Implementation of a Specialized Unit: A Retrospective Cohort Study Using Real-World Data from One Reference Hospital in Southern Brazil. Healthcare (Basel) 2024; 12:836. [PMID: 38667598 PMCID: PMC11050536 DOI: 10.3390/healthcare12080836] [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: 01/24/2024] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Stroke constitutes a significant global cause of mortality and disability. The implementation of stroke units influences hospital quality indicators, guiding care management. We aimed to compare hospital length of stay (LOS), in-hospital mortality, and post-discharge mortality between stroke patients admitted in the pre- and post-implementation periods of a stroke unit in a public hospital in southern Brazil. This retrospective cohort study used real-world data from one reference hospital, focusing on the intervention (stroke unit) and comparing it to the general ward (control). We analyzed the electronic medical records of 674 patients admitted from 2009 to 2012 in the general ward and 766 patients from 2013 to 2018 in the stroke unit. Admission to the stroke unit was associated with a 43% reduction in the likelihood of prolonged hospitalization. However, there was no significant difference in the risk of in-hospital mortality between the groups (Hazard ratio = 0.90; Interquartile range = 0.58 to 1.39). The incidence of death at three, six and twelve months post-discharge did not differ between the groups. Our study results indicate significant improvements in care processes for SU patients, including shorter LOS and better adherence to treatment protocols. However, our observations revealed no significant difference in mortality rates, either during hospitalization or after discharge, between the SU and GW groups. While SU implementation enhances efficiency in stroke care, further research is needed to explore long-term outcomes and optimize management strategies.
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Affiliation(s)
- Marcia Poll
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
| | - Rodrigo Targa Martins
- Stroke Unit Coordination, Conceição Hospital Group, Porto Alegre 91350-200, RS, Brazil
| | - Fernando Anschau
- Conceição Hospital Group, Department of Education and Research Coordination, Porto Alegre 91350-200, RS, Brazil
| | - Geraldo Pereira Jotz
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
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16
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Prust ML, Forman R, Ovbiagele B. Addressing disparities in the global epidemiology of stroke. Nat Rev Neurol 2024; 20:207-221. [PMID: 38228908 DOI: 10.1038/s41582-023-00921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.
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Affiliation(s)
- Morgan L Prust
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Rachel Forman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, CA, USA
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Shrestha GS, Nepal G, Prust ML. Developing Systems of Emergency and Inpatient Neurologic Care in Resource-Limited Settings. Semin Neurol 2024; 44:105-118. [PMID: 38485125 DOI: 10.1055/s-0043-1778638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Neurologic diseases represent a significant global health challenge, leading to disability and mortality worldwide. Healthcare systems in low- and middle-income countries are disproportionally affected. In these resource-limited settings, numerous barriers hinder the effective delivery of emergency and inpatient neurologic care, including shortages of trained personnel, limited access to diagnostics and essential medications, inadequate facilities, and absence of rehabilitation services. Disparities in the neurology workforce, limited access to neuroimaging, and availability of acute interventions further exacerbate the problem. This article explores strategies to enhance global capacity for inpatient neurologic care, emphasizing the importance of workforce development, context-specific protocols, telehealth solutions, advocacy efforts, and collaborations.
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Affiliation(s)
- Gentle Sunder Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Gaurav Nepal
- Department of General Medicine, Rani Primary Healthcare Centre, Rani, Biratnagar, Nepal
| | - Morgan Lippitt Prust
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
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18
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Silva GS, Rocha E. Developing Systems of Care for Stroke in Resource-limited Settings. Semin Neurol 2024; 44:119-129. [PMID: 38513704 DOI: 10.1055/s-0044-1782617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Although stroke prevention and treatment strategies have significantly advanced in recent years, implementation of these care elements in resource-limited settings can be challenging, since the burden of stroke is higher and access to stroke care is lower. Barriers to stroke care in resource-limited settings include insufficient prevention, reduced awareness of stroke symptoms, limited prehospital care and lack of triage systems, limited access to comprehensive stroke centers, inadequate personnel education, lack of staff and resources, as well as limited access to neuroimaging, thrombolytics, mechanical thrombectomy, neurosurgical care, and rehabilitation. Here, we suggest strategies to improve stroke care in these settings, including public health campaigns, protocols for prehospital notification, organized flow to specialized stroke centers, development of dedicated stroke units, and utilization of telemedicine and telerehabilitation. We also highlight the role of international organizations and governments in reducing the global burden of stroke.
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Affiliation(s)
- Gisele Sampaio Silva
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Neurology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eva Rocha
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
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Ademoyegun AB, Ogundiran O, Kayode AJ, Olaosun AO, Awotidebe TO, Mbada CE. Hearing loss, gait and balance impairments and falls among individuals with sub-acute stroke: A comparative cross-sectional study. Heliyon 2024; 10:e26880. [PMID: 38486770 PMCID: PMC10937590 DOI: 10.1016/j.heliyon.2024.e26880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
Background The impact of hearing loss in stroke is less explored. This study aimed to compare hearing loss in patients with sub-acute stroke with healthy controls and evaluate its association with gait and balance impairments and falls. Methods This study involved 78 ambulant sub-acute stroke patients and 78 age-sex-matched controls. Hearing loss was assessed with pure tone average, while gait and balance impairments were assessed with the Timed Up and Go test, Berg Balance Scale, Functional Gait Assessment and 10-m walk test (gait speed). Fall occurrence was evaluated by a self-report questionnaire. Results The prevalence of hearing loss (pure tone average of >25 dB) was higher in stroke patients than in controls (64.1% vs. 35.9%; p < 0.001). The mean pure tone average of stroke patients showed a significant positive correlation with Timed Up and Go test (r = 0.357; p = 0.001) and fall occurrence (r = 0.253; p = 0.025), and a significant negative correlation with Berg Balance Scale (r = -0.299; p = 0.008) and Functional Gait Assessment (r = -0.452; p < 0.001). There was a non-significant negative correlation with gait speed (r = -0.166; p = 0.147). Multiple regression showed that mean pure tone average was associated with Timed Up and Go test (B = 0.096; 95%CI: 0.010, 0.183) and Functional Gait Assessment (B = -0.087; 95%CI: -0.157, -0.017), but not with gait speed (B = -0.003; 95%CI: -0.007, 0.001) and Berg Balance Scale (B = -0.058; 95%CI: -0.165, 0.049). Conclusion Hearing loss is more prevalent among patients with sub-acute stroke compared with age-sex-matched controls. Hearing loss is also associated with gait and balance impairments and falls among sub-acute stroke patients. We recommend that hearing screening and rehabilitation be incorporated into post-stroke rehabilitation programmes as part of strategies to improve balance and gait and reduce or prevent falls.
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Affiliation(s)
- Adekola B. Ademoyegun
- Department of Physiotherapy, Osun State University Teaching Hospital, Osogbo, Nigeria
- Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olawale Ogundiran
- Department of Speech, Language and Hearing Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Adepoju J. Kayode
- Department of Ear, Nose and Throat, Osun State University Teaching Hospital, Osogbo, Nigeria
| | - Adedayo O. Olaosun
- Department of Otorhinolaryngology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Taofeek O. Awotidebe
- Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Chidozie E. Mbada
- Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, United Kingdom
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Wei L, Liu Y, Wang Y, Bian J, Song Z, Liu X, Wang S. The effects of Baduanjin on physical function, daily living activities and quality of life in patients with stroke: a systematic review and meta-analysis. Top Stroke Rehabil 2024; 31:178-198. [PMID: 37555455 DOI: 10.1080/10749357.2023.2238433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVES Baduanjin is a traditional Chinese exercise that combines respiration and movement. The study is designed to evaluate the effects of Baduanjin on physical function, daily living activities, and quality of life in stroke patients. METHODS Eleven databases were searched from inception through 16 September 2022. The methodological quality evaluation of the studies was evaluated with the Cochrane Handbook for Systematic Reviews of Interventions v5.1.0. The quality evaluation of the evidence was graded with the Guideline Development Tool . RESULTS A total of 24 studies were included. Three indicators with moderate quality evidence, six indicators with low quality evidence, and one indicator with very low quality evidence. Meta-analysis results suggest that Baduanjin group is better than the control group in increasing Berg balance scale [MD = 7.99, 95%CI (4.99, 10.99), P < 0.00001], Fugl- Meyer balance scale [MD = 5.26, 95%CI (0.12, 10.40), P = 0.04]; Total Fugl-Meyer assessment scale [MD = 7.17, 95%CI (3.13, 11.2), P = 0.0005], Fugl-Meyer assessment lower extremity scale[MD = 3.05, 95%CI(0.95, 5.15), P = 0.004], Fugl-Meyer assessment upper extremity scale[MD = 4.60, 95%CI (1.64,7.56), P = 0.002]; walking function scale[SMD = 0.69, 95%CI (0.14, 1.23), P = 0.01]; trunk function scale[MD = 2.46, 95%CI (1.75,3.17), P < 0.00001]; Barthel index[MD = 9.43, 95%CI (6.20,12.65), P < 0.00001] and quality of life score[SMD = 1.85, 95%CI (1.46, 2.23), P < 0.00001]. Meanwhile, Baduanjin reduced Neurological deficit scores SMD = -1.41, 95%CI (-1.83, -0.98), P < 0.00001]). CONCLUSIONS Baduanjin is probably an effective rehabilitation method to improve balance, motor, trunk, neurological functions, daily living activities, and quality of life in stroke patients. However, the result of Baduanjin in improving walking function is unstable, and further high-quality randomized controlled trials are needed to confirm the results.
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Affiliation(s)
- Lirong Wei
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin Key Laboratory of Cancer Prevention and Treatment, Tianjin Medical Research Center for Malignant Tumors
| | - Yun Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanan Wang
- Department of Preventive Health Care, Tianjin First Central Hospital, Tianjin, China
| | - Jiping Bian
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhengyang Song
- Department of Preventive Health Care, Tianjin First Central Hospital, Tianjin, China
| | - Xiaofeng Liu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shen Wang
- Department of Preventive Health Care, Tianjin First Central Hospital, Tianjin, China
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Markus HS. Reperfusion therapy for stroke: From improving global access, to thrombectomy beyond 24 hours. Int J Stroke 2024; 19:248-250. [PMID: 38420839 DOI: 10.1177/17474930241232131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
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22
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Zhu Y, Liu R, Zhao X, Kang C, Yang D, Ge G. VEGF overexpression in transplanted NSCs promote recovery of neurological function in rats with cerebral ischemia by modulating the Wnt signal transduction pathway. Neurosci Lett 2024; 824:137668. [PMID: 38331020 DOI: 10.1016/j.neulet.2024.137668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024]
Abstract
Neural stem cell transplantation is a good method to treat stroke, but the mechanism is still unclear. Therefore, this study aims to explore the regulatory mechanism of VEGF overexpression in transplanted NSCs to promote the recovery of neural function in ischemic rats by regulating Wnt signal transduction pathways. We amplified VEGF gene fragments by PCR and transfected them into NSCs with Ad5 adenovirus. Rat brain IRI model was established by MCAO method, and VEGF transfected NSCs (VEGF-NSCs) were transplanted 24 h after successful IRI model. One week after the transplant, cognitive function was assessed using a neurological deficit score; Brain injury was assessed by histopathology; Photochemical and ELISA methods were used to detect oxidative stress markers and inflammatory factors, respectively. Western blotting has been detected in molecules of the Wnt signaling pathway. The results showed that the transduced NSCs express VEGF at least for 14 days. VEGF-NSCs transplantation (VNT) improved spatial learning and memory in rats, and inhibited oxidative stress injury, inflammatory response, and histopathological injury. VNT also resulted in significant changes in the phosphorylation levels of β-catenin and GSK-3β proteins, ultimately triggering activation of the Wnt signal transduction pathway. These results suggest that the neuroprotective effects of VNT may be related to the regulation of the Wnt signal transduction pathway.
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Affiliation(s)
- Yizhen Zhu
- Class 3, Nursing, Grade 2023, Guizhou Medical University, Guizhou 551113, PR China.
| | - Ruojing Liu
- Department of Human Anatomy, Guizhou Medical University, Guizhou 561113, PR China.
| | - Xue Zhao
- Department of Human Anatomy, Guizhou Medical University, Guizhou 561113, PR China.
| | - Chaosheng Kang
- Department of Human Anatomy, Guizhou Medical University, Guizhou 561113, PR China.
| | - Dan Yang
- Department of Human Anatomy, Guizhou Medical University, Guizhou 561113, PR China.
| | - Guo Ge
- Department of Human Anatomy, Guizhou Medical University, Guizhou 561113, PR China.
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Liu C, Chen H, Tao X, Li C, Li A, Wu W. ALKBH5 protects against stroke by reducing endoplasmic reticulum stress-dependent inflammation injury via the STAT5/PERK/EIF2α/CHOP signaling pathway in an m 6A-YTHDF1-dependent manner. Exp Neurol 2024; 372:114629. [PMID: 38056583 DOI: 10.1016/j.expneurol.2023.114629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/31/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Endoplasmic reticulum (ER) stress causes neuroinflammation and neuronal apoptosis during ischemic stroke progression. This study has investigated the role of ALKBH5 in ER stress during ischemic stroke progression. METHODS In vivo and in vitro models of ischemic stroke were established by middle cerebral artery occlusion (MCAO) and OGD/R treatment, respectively. Cerebral infarct size was detected using triphenyltetrazolium chloride staining (TTC), and pathological changes were examined using histological staining. The levels of inflammatory factors were analyzed using Enzyme-linked immunosorbent assay. Cell counting kit-8 assay and flow cytometry were used to measure cell viability and apoptosis, respectively. The global m6A level was detected using the commercial kit, and STAT5 mRNA m6A level was determined using methylated RNA binding protein immunoprecipitation (Me-RIP). ALKBH5, YTHDF1, and STAT5 interactions were analyzed using RIP and RNA pull-down assays. RESULTS ALKBH5 was upregulated in MCAO animals and OGD/R cell models. ALKBH5 knockdown exacerbated ER stress, neuroinflammation, and neuronal apoptosis in brain tissues and neuronal cells. ALKBH5 inhibited STAT5 mRNA stability and expression in an m6A-YTHDF1-dependent manner. STAT5 promoted ER stress by activating the PERK/eIF2/CHOP signaling pathway. Furthermore, STAT5 knockdown reversed the effects of ALKBH5 knockdown on OGD/R-induced ER stress and neuroinflammation in HT22 cells. CONCLUSION ALKBH5 knockdown exacerbated ischemic stroke by increasing ER stress-dependent neuroinflammation and neuronal apoptosis via the STAT5/PERK/EIF2α/CHOP signaling pathway in an m6A-YTHDF1-dependent manner.
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Affiliation(s)
- Chujuan Liu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, PR China; Department of Rehabilitation, Hunan Provincial People's Hospital, The First Affifiliated Hospital of Hunan Normal University, Changsha 410006, Hunan Province, PR China
| | - Hui Chen
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, PR China
| | - Xi Tao
- Department of Rehabilitation, Hunan Provincial People's Hospital, The First Affifiliated Hospital of Hunan Normal University, Changsha 410006, Hunan Province, PR China
| | - Chen Li
- Department of Rehabilitation, Hunan Provincial People's Hospital, The First Affifiliated Hospital of Hunan Normal University, Changsha 410006, Hunan Province, PR China
| | - Aiping Li
- Department of Neurological Neurology, Hunan Provincial People's Hospital, The First Affifiliated Hospital of Hunan Normal University, Changsha 410006, Hunan Province, PR China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, PR China.
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Machado N, Williams G, Olver J, Johnson L. Is early initiated cardiorespiratory fitness training within a model of stroke-integrated cardiac rehabilitation safe and feasible? J Stroke Cerebrovasc Dis 2024; 33:107493. [PMID: 38061183 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/21/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE To investigate the safety and feasibility of an early initiated stroke-integrated Cardiac Rehabilitation program. METHODS People with acute first or recurrent ischaemic stroke, admitted to Epworth HealthCare were screened for eligibility and invited to participate. In addition to usual care neurorehabilitation, participants performed 1) cardiorespiratory fitness training 3-days/week during inpatient rehabilitation (Phase 1), and/or 2) 2-days/week centre-based cardiorespiratory fitness training plus education and 1-day/week home-based cardiorespiratory fitness training for 6-weeks during outpatient rehabilitation (Phase 2). Safety was determined by the number of adverse and serious adverse events. Feasibility was determined by participant recruitment, retention, and attendance rates, adherence to exercise recommendations, and participant satisfaction. RESULTS There were no study-related adverse or serious adverse events. Of 117 eligible stroke admissions, 62 (53%) were recruited, while 10 (16.1%) participants withdrew. Participants attended 189 of 201 (94%) scheduled cardiorespiratory fitness training sessions in Phase 1 and 341/381 (89.5%) scheduled sessions in Phase 2. Only 220/381 (58%) scheduled education sessions were attended. The minimum recommended cardiorespiratory fitness training intensity (40% heart rate reserve) and duration (20 minutes) was achieved by 57% and 55% of participants respectively during Phase 1, and 60% and 92% respectively during Phase 2. All respondents strongly agreed (69%) or agreed (31%) they would recommend the stroke-integrated Cardiac Rehabilitation program to other people with stroke. CONCLUSION Cardiorespiratory fitness training in line with multiple clinical practice guidelines included within a model of stroke-integrated Cardiac Rehabilitation appears to be safe and feasible in the early subacute phase post-stroke.
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Affiliation(s)
- Natasha Machado
- Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia.
| | - Gavin Williams
- Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia
| | - John Olver
- Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia
| | - Liam Johnson
- Rehabilitation, Epworth HealthCare, Victoria, Australia; Physiotherapy Department, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Victoria, Australia; Faculty of Health Sciences, School of Behavioural and Health Sciences, Australian Catholic University, Victoria, Australia
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Fasugba O, Sedani R, Mikulik R, Dale S, Vařecha M, Coughlan K, McElduff B, McInnes E, Hladíková S, Cadilhac DA, Middleton S. How registry data are used to inform activities for stroke care quality improvement across 55 countries: A cross-sectional survey of Registry of Stroke Care Quality (RES-Q) hospitals. Eur J Neurol 2024; 31:e16024. [PMID: 37540834 PMCID: PMC10952746 DOI: 10.1111/ene.16024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND AND PURPOSE The Registry of Stroke Care Quality (RES-Q) is a worldwide quality improvement data platform that captures performance and quality measures, enabling standardized comparisons of hospital care. The aim of this study was to determine if, and how, RES-Q data are used to influence stroke quality improvement and identify the support and educational needs of clinicians using RES-Q data to improve stroke care. METHODS A cross-sectional self-administered online survey was administered (October 2021-February 2022). Participants were RES-Q hospital local coordinators responsible for stroke data collection. Descriptive statistics are presented. RESULTS Surveys were sent to 1463 hospitals in 74 countries; responses were received from 358 hospitals in 55 countries (response rate 25%). RES-Q data were used "always" or "often" to: develop quality improvement initiatives (n = 213, 60%); track stroke care quality over time (n = 207, 58%); improve local practice (n = 191, 53%); and benchmark against evidence-based policies, procedures and/or guidelines to identify practice gaps (n = 179, 50%). Formal training in the use of RES-Q tools and data were the most frequent support needs identified by respondents (n = 165, 46%). Over half "strongly agreed" or "agreed" that to support clinical practice change, education is needed on: (i) using data to identify evidence-practice gaps (n = 259, 72%) and change clinical practice (n = 263, 74%), and (ii) quality improvement science and methods (n = 255, 71%). CONCLUSION RES-Q data are used for monitoring stroke care performance. However, to facilitate their optimal use, effective quality improvement methods are needed. Educating staff in quality improvement science may develop competency and improve use of data in practice.
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Affiliation(s)
- Oyebola Fasugba
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Rupal Sedani
- International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Robert Mikulik
- International Clinical Research Centre, Neurology DepartmentSt. Anne's University Hospital and Masaryk UniversityBrnoCzech Republic
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Miroslav Vařecha
- International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Kelly Coughlan
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Sabina Hladíková
- International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
- Stroke Theme, Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneHeidelbergVictoriaAustralia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
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26
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Goncalves S, Le Bourvellec M, Mandigout S, Duclos NC. Impact of Active Physiotherapy on Physical Activity Level in Stroke Survivors: A Systematic Review and Meta-Analysis. Stroke 2023; 54:3097-3106. [PMID: 37909205 DOI: 10.1161/strokeaha.123.043629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Stroke survivors are frequently physically inactive. However, evidence of the effectiveness of active physiotherapy on physical activity level in stroke survivors is scarce. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, covering electronic searches from inception to March 16, 2022. Participants: Stroke survivors living in the community. Intervention: Any active physiotherapy, that is, involving exercises that require voluntary effort. Outcome measure: Objective and subjective physical activity level. RESULTS Of 5590 identified references, 25 randomized controlled trials were eligible, and 21 had available data. The random-effects meta-analysis resulted in a small, significant effect size in favor of active physiotherapy measured using objective or subjective tools (21 studies, 1834 participants, standardized mean difference, 0.22 [95% CI, 0.04-0.40]; heterogeneity I2=65%), and a medium significant effect when objective tools were used (9 studies, 424 participants, standardized mean differences, 0.48 [95% CI, 0.03-0.92]; I2=73%). Meta-regression showed that 35% of the variance in trial outcome was explained by the measurement tool (objective or subjective) and 23% by age. None of the variances were associated with a specific dosage in terms of frequency, time, exercise duration, or the severity of the disability. CONCLUSIONS Active physiotherapy seems to increase objective physical activity in community-dwelling stroke survivors. However, the evidence is of very low certainty. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42022315639.
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Affiliation(s)
- Stéphanie Goncalves
- HAVAE, Limoges University, Department of Physical Activity and Sport Sciences, UR20217, F-87000, France (S.G., S.M.)
| | - Morgane Le Bourvellec
- MOVE, Poitiers University, Faculty of Sport Sciences, UR20296, F-86000, France (M.L.B.)
| | - Stéphane Mandigout
- HAVAE, Limoges University, Department of Physical Activity and Sport Sciences, UR20217, F-87000, France (S.G., S.M.)
- ILFOMER, Limoges University, F-87000, France (S.M.)
| | - Noémie C Duclos
- Bordeaux University, INSERM, BPH, U1219, Team ACTIVE, F-33000, France (N.C.D.)
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27
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Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol 2023; 22:1160-1206. [PMID: 37827183 PMCID: PMC10715732 DOI: 10.1016/s1474-4422(23)00277-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars. Disability-adjusted life-years (DALYs) The sum of the years of life lost as a result of premature mortality from a disease and the years lived with a disability associated with prevalent cases of the disease in a population. One DALY represents the loss of the equivalent of one year of full health On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases. Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Mayowa O Owolabi
- Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Centre, Ibadan, Nigeria.
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Opare-Addo PA, Oppong C, Gyamfi RA, Aikins M, Nsohlebna Nsoh L, Asare-Bediako S, Attafuah E, Sarfo K, Sampah AK, Yiadom JB, Sarfo FS. Deciphering the contextual barriers to mainstreaming the implementation of stroke thrombolysis in a Ghanaian hospital: Findings from the activate mixed-methods study. J Stroke Cerebrovasc Dis 2023; 32:107394. [PMID: 37866294 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Each year, stroke-related death and disability claim over 143 million years of healthy life globally. Despite accounting for much of the global stroke burden, acute stroke care in Low-and-Middle-Income Countries remains suboptimal. Thrombolysis, an effective treatment option for stroke, is only received by a minority of stroke patients in these settings. AIM To determine the context-specific barriers and facilitators for the implementation of mainstream stroke thrombolysis in a Ghanaian hospital. METHODS We employed a mixed-methods approach involving key stakeholders (recipients, providers, and leaders) in the acute stroke care continuum. Surveys were administered to acute stroke patients, and in-depth key informant interviews were conducted with experts in stroke care, including a neurologist, medical director, neurology residents, a stroke nurse, emergency physicians, a radiologist, and a pharmacist. The data collected from these interviews were transcribed and analysed using content analysis with the CFIR (Consolidated Framework for Implementation Research) model as a guiding template. Two independent coders were involved in the analysis process to ensure reliability and accuracy. RESULTS The stroke thrombolysis rate over a 6-month period was 0.83% (2 out of 242), with an average door-to-needle time among thrombolyzed patients being 2 hours, 37 minutes. Only 12.8% of patients (31 out of 242) presented within 4.5 hours of stroke symptom onset. The most significant obstacle to the implementation of acute stroke thrombolysis was related to the characteristics of the individuals involved, notably delays in presenting to the hospital among stroke patients due to a lack of knowledge about stroke symptoms and cultural beliefs. Additionally, a significant bottleneck that contributed to the discrepancy between the number of patients who presented within the 4.5-6 hour window and the number of patients who actually received thrombolysis was the inability to pay for the cost of thrombolytic agents. This was followed by challenges in the implementation processes. CONCLUSIONS Addressing challenges related to stroke awareness, and financial constraints via multi-level stakeholder engagement, and enactment of stroke protocols are crucial steps in ensuring a successful implementation of a stroke thrombolysis program in a resource-limited setting.
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Affiliation(s)
| | - Chris Oppong
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | | | | | | | | | - Kofi Sarfo
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | - Fred Stephen Sarfo
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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29
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Alrafiah AR. Expression of Tie2 (angiopoietin receptor) on the monocyte subpopulations from ischemic stroke patients: Histological and flowcytometric studies. Histol Histopathol 2023; 38:1257-1267. [PMID: 36876965 DOI: 10.14670/hh-18-601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Different subpopulations of monocytes play roles in phagocytosis, inflammation, and angiogenic processes e.g., Tie2-expressing monocytes (TEMs). The brain is flooded with macrophages that are derived from monocytes within 3-7 days after a stroke. This study aimed to determine the expression level of Tie2 (an angiopoietin receptor) on monocytes and their subpopulations in ischemic stroke patients using the histological and immunohistological study of bone marrow biopsies and blood flow cytometry examination. METHODS Ischemic stroke patients within two days were selected. Participants in the control group were healthy volunteers of matched age and gender. Sample collection was performed within 24 to 48 hours after medical consultants confirmed the stroke diagnosis. An iliac crest bone marrow biopsy was obtained and fixed for histological and immunohistological staining with antiCD14 and antiCD68. Flow cytometry was used to determine the total monocyte population, monocyte subpopulations, and TEMs after staining with monoclonal antibodies to CD45, CD14, CD16, and Tie2. RESULTS Post-stroke patients' bone marrow cells were hypercellular. There was an apparent increase in CD68 and CD14-positive cells. Ischemic stroke patients exhibited low percentages of nonclassical monocytes CD14lowCD16++, with an increase in intermediate monocytes CD14highCD16+. Moreover, ischemic stroke patients had significantly higher levels of TEMs than control group. CONCLUSIONS The results of this study demonstrate dysregulation of angiogenesis in monocyte subsets in ischemic stroke patients, which could be used as an early diagnostic marker of neurovascular damage and may need angiogenic therapy or improved medications to prevent further damage of blood vessels.
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Affiliation(s)
- Aziza R Alrafiah
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
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30
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Amanzonwé ER, Kossi O, Noukpo SI, Adoukonou T, Hansen D, Triccas LT, Feys P. Physiotherapy practices in acute and sub-acute stroke in a low resource country: A prospective observational study in Benin. J Stroke Cerebrovasc Dis 2023; 32:107353. [PMID: 37713747 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107353] [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: 04/04/2023] [Revised: 08/04/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Physiotherapy is highly recommended for early recovery from stroke. This study aimed to document physiotherapy practices for people with acute and early sub-acute stroke in Benin. METHODS In this prospective observational study, physiotherapists working with acute stroke people documented the content of their treatment from six hospitals in Benin during the first session, at 2-week, and 1-month post-stroke with a standardized physiotherapy documentation form. We used the motricity index (MI) and trunk control test (TCT) to assess impairments, and the 10-meter walk test (10mWT), functional independence measure (FIM), walking, stair climbing, and dressing upper body subscales were used for activity limitations. RESULTS Fifteen physiotherapists (60 % male, mean±SD age=31.3±5.8 years) recorded treatment sessions for 77 stroke participants (53.2 % male, mean±SD age=57.7±12.5 years). Physiotherapists focused on conventional physiotherapy approaches, including musculoskeletal (67 % of pre-functional activity time) and neuromuscular (53 % of sitting activity time) interventions. A significant difference was found between the therapy time delivered for people with mild, moderate, and severe stroke (p < 0.001). The MI (p= 0.033) and TCT (p= 0.002) measures showed significant improvement at 2-week and 1-month (p< 0.001) post-stroke, while 10mWT, FIM walking, stair climbing, and dressing upper body items significantly increased at 1-month (p< 0.001) but not at 2-week post-stroke. CONCLUSION Physiotherapists working with acute stroke patients in Benin mainly use conventional neuromuscular and musculoskeletal interventions. In contrast, aerobic exercises were rarely employed regardless of stroke severity. Furthermore, our findings showed that the volume of physiotherapy sessions varied by stroke severity.
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Affiliation(s)
- Elogni Renaud Amanzonwé
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium; Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
| | - Oyéné Kossi
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium; Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin; ENATSE, National School of Public Health and Epidemiology, Université de Parakou, Parakou, Benin.
| | - Sènadé Inès Noukpo
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium; Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
| | - Thierry Adoukonou
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin; ENATSE, National School of Public Health and Epidemiology, Université de Parakou, Parakou, Benin
| | - Dominique Hansen
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Lisa Tedesco Triccas
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
| | - Peter Feys
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
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Tunkl C, Paudel R, Bajaj S, Thapa L, Tunkl P, Chandra A, Shah B, Karmacharya B, Subedi A, Jalan P, Ghimire P, Ghimire MR, Dorje G, Begli NH, Golenia J, Gajurel BP, Shreyan S, Sharma N, Krauss A, Pandian J, Fischer T, van der Merwe J, Wick W, Hacke W, Gumbinger C. Implementing stroke care in a lower-middle-income country: results and recommendations based on an implementation study within the Nepal Stroke Project. Front Neurol 2023; 14:1272076. [PMID: 37941574 PMCID: PMC10628475 DOI: 10.3389/fneur.2023.1272076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023] Open
Abstract
Background Globally, the majority of strokes affect people residing in lower- and lower-middle-income countries (LMICs), but translating evidence-based knowledge into clinical practice in regions with limited healthcare resources remains challenging. As an LMIC in South Asia, stroke care has remained a healthcare problem previously unaddressed at a national scale in Nepal. The Nepal Stroke Project (NSP) aims to improve acute stroke care in the tertiary healthcare sector of Nepal. We hereby describe the methods applied and analyze the barriers and facilitators of the NSP after 18 months. Methods The NSP follows a four-tier strategy: (1) quality improvement by training healthcare professionals in tertiary care centers; (2) implementation of in-hospital stroke surveillance and quality monitoring system; (3) raising public awareness of strokes; and (4) collaborating with political stakeholders to facilitate public funding for stroke care. We performed a qualitative, iterative analysis of observational data to analyze the output indicators and identify best practices. Results Both offline and online initiatives were undertaken to address quality improvement and public awareness. More than 1,000 healthcare professionals across nine tertiary care hospitals attended 26 stroke-related workshops conducted by Nepalese and international stroke experts. Monthly webinars were organized, and chat groups were made for better networking and cross-institutional case sharing. Social media-based public awareness campaigns reached more than 3 million individuals. Moreover, live events and other mass media campaigns were instituted. For quality monitoring, the Registry of Stroke Care Quality (RES-Q) was introduced. Collaboration with stakeholders (both national and international) has been initiated. Discussion We identified six actions that may support the development of tertiary care centers into essential stroke centers in a resource-limited setting. We believe that our experiences will contribute to the body of knowledge on translating evidence into practice in LMICs, although the impact of our results must be verified with process indicators of stroke care.
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Affiliation(s)
- Christine Tunkl
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Raju Paudel
- Department of Neurology, Grande International Hospital, Kathmandu, Nepal
| | - Sunanjay Bajaj
- Department of Neurology, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, United States
| | - Lekhjung Thapa
- Department of Neurology, National Neuro Center, Kathmandu, Nepal
| | - Patrick Tunkl
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Avinash Chandra
- Department of Neurology, Annapurna Neurological Institute, Kathmandu, Nepal
| | - Bhupendra Shah
- Department of Neurology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Balgopal Karmacharya
- Department of Neurosurgery and Emergency Medicine, Manipal Teaching Hospital, Pokhara, Nepal
| | - Ashim Subedi
- Department of Neurosurgery and Emergency Medicine, Manipal Teaching Hospital, Pokhara, Nepal
| | - Pankaj Jalan
- Department of Neurology, Norvic International Hospital, Kathmandu, Nepal
| | | | - Mahesh Raj Ghimire
- Department of Neurology, National Neuro Center, Kathmandu, Nepal
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Nima Haji Begli
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jessica Golenia
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Nooma Sharma
- Department of Neurology, National Neuro Center, Kathmandu, Nepal
| | - Alexandra Krauss
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Thomas Fischer
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Werner Hacke
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Gumbinger
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
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Gunaratne PS, Jeevagan V, Bandusena S, Ziyad AIA, Wickramasinghe C, Arambepola C, Chang T. Characteristics, management and outcome of stroke: Observations from the Sri Lanka Stroke Clinical Registry. J Stroke Cerebrovasc Dis 2023; 32:107269. [PMID: 37579639 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/08/2023] [Accepted: 07/18/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Stroke registries are pivotal to the monitoring and improvement of the quality of stroke care. We report data from the initial phase of a nationally representative hospital-based stroke registry in Sri Lanka. METHODS Based on an observational cohort design, all consecutive patients aged ≥18 years with a diagnosis of stroke or transient ischemic attack (TIA) presenting to six tertiary-care hospitals in the Western, Eastern, Southern, Northern and Central provinces of Sri Lanka within 14 days of onset were recruited. RESULTS During a period of 14 months, 5893 patients with a stroke/TIA (58.8% men; mean age 65.22 years, SD=13.28) were entered into the database; 69.8% (n=4111) had an ischaemic stroke (IS); 20.9% (n=1233) had a haemorrhagic stroke (HS); 7.2% (424) had a TIA; and 2.1% (125) had a venous stroke. While IS were more common among women (71.7% vs 68.4%; p=0.006), HS were more common among men (22.3% vs 19.0%; p=0.003). Hemiparesis (86.2% vs 83.2%; p=0.011), headache (29% vs 11.6%; p<0.001), seizures (5.9% vs 4.2%; p=0.013), sphincter dysfunction (11.8% vs 7.7%; p<0.001) and hypertension (72% vs 67.3%, p=0.002) were more common in HS while dysphasia (63.2% vs 50.0%; p<0.001), ataxia (9.6% vs 7.3%; p=0.014), sensory disturbances (10.8% vs 6.0%; p<0.001) and diabetes mellitus (37.9% vs 28.1%; p<0.001) were more common in IS. Thrombolysis was administered in only 2.1% while only 14.6% had access to stroke units. The mean door-to-needle time was 100.2 (SD=46.0) minutes. The hospital mortality rate was 8.3%. Recurrent strokes within three months were more common in HS than IS (3.2% vs 1.6%; p=0.007). CONCLUSIONS While stroke characteristics in Sri Lanka are similar to that of other populations, the rate of thrombolysis and access to stroke units are inadequate. The stroke registry provides useful data for the appraisal and improvement of stroke services.
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Affiliation(s)
| | | | | | | | | | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine - University of Colombo, 25, Kynsey Road, Colombo 00800, Sri Lanka
| | - Thashi Chang
- National Hospital of Sri Lanka, Colombo 01000, Sri Lanka; Department of Clinical Medicine, Faculty of Medicine - University of Colombo, 25, Kynsey Road, Colombo 00800, Sri Lanka.
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Carmona C, Sullivan JE, Arceo R, Drogos J, Besser S, Gutierrez S, Jeteric Z, Wyman J, Yao J. Development and Preliminary Validity Study of a Modified Version of the Upper Extremity Fugl-Meyer Assessment for Use in Telerehabilitation. J Neurol Phys Ther 2023; 47:208-216. [PMID: 37314323 PMCID: PMC10487354 DOI: 10.1097/npt.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND/PURPOSE The Upper Extremity Fugl-Meyer Assessment (UEFMA, maximum 66) is widely used in clinics and research studies to examine poststroke upper extremity (UE) impairment. This study aimed to develop and provide pilot data to support the validity of a remote version of the UEFMA to examine UE impairment after stroke through telerehabilitation. METHODS Team members developed a remote version of the UEFMA for telerehabilitation (tUEFMA, maximum 44) using subscales II to IV and VII of the UEFMA. Twenty-two participants with moderate to severe arm impairment (UEFMA, median = 19) and chronic stroke (>1 year post) were evaluated using the UEFMA (face-to-face) and the tUEFMA (remotely). A prediction equation was used to identify the function to predict the UEFMA based on the tUEFMA. Intraclass correlation (ICC) was used to test the absolute agreement between the subscales included in the UEFMA and the tUEFMA, and between their 2 normalized total scores. RESULTS A strong and significant agreement was found between the total scores of the UEFMA and the projected value based on the tUEFMA (ICC = 0.79, P < 0.05). The ICC test also reported a good agreement in subscales II to IV and a poor agreement in subscale VII between the UEFMA and the tUEFMA using a real-time video link. DISCUSSION AND CONCLUSIONS The study findings suggest that the tUEFMA is a promising tool to remotely examine UE impairment in individuals with chronic stroke and moderate to severe arm impairment. Future research should evaluate additional psychometric properties and clinical utility of the tUEFMA across stroke participants with a broad range of arm impairments.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A441 ).
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Affiliation(s)
- Carolina Carmona
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Jane E. Sullivan
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Riegele Arceo
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Justin Drogos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Sofie Besser
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Susana Gutierrez
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Zineyra Jeteric
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - James Wyman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Jun Yao
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
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Caso V, Martins S, Mikulik R, Middleton S, Groppa S, Pandian JD, Thang NH, Danays T, van der Merwe J, Fischer T, Hacke W. Six years of the Angels Initiative: Aims, achievements, and future directions to improve stroke care worldwide. Int J Stroke 2023; 18:898-907. [PMID: 37226325 PMCID: PMC10507995 DOI: 10.1177/17474930231180067] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
The rate of stroke-related death and disability is four times higher in low- and middle-income countries (LMICs) than in high-income countries (HICs), yet stroke units exist in only 18% of LMICs, compared with 91% of HICs. In order to ensure universal and equitable access to timely, guideline-recommended stroke care, multidisciplinary stroke-ready hospitals with coordinated teams of healthcare professionals and appropriate facilities are essential.Established in 2016, the Angels Initiative is an international, not-for-profit, public-private partnership. It is run in collaboration with the World Stroke Organization, European Stroke Organisation, and regional and national stroke societies in over 50 countries. The Angels Initiative aims to increase the global number of stroke-ready hospitals and to optimize the quality of existing stroke units. It does this through the work of dedicated consultants, who help to standardize care procedures and build coordinated, informed communities of stroke professionals. Angels consultants also establish quality monitoring frameworks using online audit platforms such as the Registry of Stroke Care Quality (RES-Q), which forms the basis of the Angels award system (gold/platinum/diamond) for all stroke-ready hospitals across the world.The Angels Initiative has supported over 1700 hospitals (>1000 in LMICs) that did not previously treat stroke patients to become "stroke ready." Since its inception in 2016, the Angels Initiative has impacted the health outcomes of an estimated 7.46 million stroke patients globally (including an estimated 4.68 million patients in LMICs). The Angels Initiative has increased the number of stroke-ready hospitals in many countries (e.g. in South Africa: 5 stroke-ready hospitals in 2015 vs 185 in 2021), reduced "door to treatment time" (e.g. in Egypt: 50% reduction vs baseline), and increased quality monitoring substantially.The focus of the work of the Angels Initiative has now expanded from the hyperacute phase of stroke treatment to the pre-hospital setting, as well as to the early post-acute setting. A continued and coordinated global effort is needed to achieve the target of the Angels Initiative of >10,000 stroke-ready hospitals by 2030, and >7500 of these in LMICs.
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Affiliation(s)
| | - Sheila Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Robert Mikulik
- International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic
| | - Sandy Middleton
- Australian Catholic University and St. Vincent’s Health Network Sydney, Sydney, NSW, Australia
| | - Stanislav Groppa
- State University of Medicine and Pharmacy ‘Nicolae Testemitanu,’ Chisinau, Moldova
| | | | | | | | - Jan van der Merwe
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Thomas Fischer
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Werner Hacke
- Ruprecht-Karl-University Heidelberg, Heidelberg, Germany
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35
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Zhu D, Qi Z, Wang A, Zhang Y, Yu H. Emerging Validation for the Adapted Chinese Version of Quick Aphasia Battery. J Multidiscip Healthc 2023; 16:2557-2566. [PMID: 37667799 PMCID: PMC10475279 DOI: 10.2147/jmdh.s417810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/10/2023] [Indexed: 09/06/2023] Open
Abstract
Purpose The quick aphasia battery (QAB) was designed to evaluate language disorder from multi-dimension efficiently, which had been translated into several languages but lacked in Chinese. This study conducted cross-cultural adaption for the Chinese version and verified its psychometric properties. Material and Methods First, the Chinese Version of quick aphasia battery (CQAB) was adapted following WHO literature guidelines with steps of forward translation, expert panel, back-translation, pre-test, and interview, then develop the final version. Second, the psychometric properties tests were conducted in 128 post-stroke patients to identify if aphasia happens and verify the validity and reliability of CQAB. Results The Cronbach's alpha coefficient of the CQAB is 0.962, test-retest reliability 0.849, and inter-rater reliability 0.998. Content validity 0.917, KMO 0.861, exploratory factor analysis extracted 2 factors named "language understanding" and "language program", cumulative variance contribution rate is 91.588% >50%. Calibration association validity 0.977. Sensitivity 0.977, specificity 0.932, with the optimal cutoff point is 8.86. Conclusion The study supported CQAB, which adapted following standardized guidelines, is reliable and effective to assess language impairment in post-stroke patients.
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Affiliation(s)
- Dan Zhu
- School of Medicine, Tongji University, Shanghai, 200082, People’s Republic of China
- Department of Pediatric, Shanghai United Family Healthcare, Shanghai, 200050, People’s Republic of China
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Zhi Qi
- School of Medicine, Tongji University, Shanghai, 200082, People’s Republic of China
- Department of Neurology, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai, 200438, People’s Republic of China
| | - Aili Wang
- School of Medicine, Tongji University, Shanghai, 200082, People’s Republic of China
- Department of Pediatric, Shanghai United Family Healthcare, Shanghai, 200050, People’s Republic of China
| | - Yongqing Zhang
- School of Medicine, Tongji University, Shanghai, 200082, People’s Republic of China
| | - Haiping Yu
- Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
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Aref H, El Nahas N, Alrukn SA, Khan M, Kesraoui S, Alnidawi F, Hokmabadi ES, Farhoudi M, Fairooz M, Batayha W, Salmeen A, Abdulrahman H, Belahsen MF, Al Hashmi AM, Akhtar N, Al-Johani M, Seidi OA, Jouhar A, Mhiri C, Elbassiouny A, Shokri H, Roushdy T. Stroke services in MENA: What is there and what is needed. PLoS One 2023; 18:e0288030. [PMID: 37471350 PMCID: PMC10358887 DOI: 10.1371/journal.pone.0288030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Stroke represents a health care challenge to most parts of the world including the Middle East and North Africa (MENA) region. The MENA represents 6% of the world population with an age-standardized stroke rate of 87.7 (78.2-97.6) per 100,000 population. This number is subject to increase given that the cause of morbidity has recently shifted from infectious diseases to non-communicable diseases. Thus, in the coming years, treatment of stroke will pose a major burden on MENA countries which mostly lie in the low to middle income economies. Accordingly, we need to study the state of MENA stroke services in order to recognize and further inform policy makers about any gaps that need to be bridged in this domain. METHODS AND RESULTS Stroke specialists representing 16 countries filled an online survey that included: screening for risk factors, acute management, diagnostics, medications, post-discharge services, and stroke registries. Results showed that 11 countries screen for risk factors, 16 have neuroimaging studies, 15 provide intravenous thrombolysis (IVT), 13 mechanical thrombectomy (MT) while medications for secondary prevention are available in all countries. However, stroke units are not equally available and even absent in 4 countries, and despite the availability of IVT yet, the rate of administration is still low in 6 countries (<5%), and ranges from 5-20% in 7 countries. Stroke registries and training still need to be implemented in most countries. CONCLUSION Although imaging, revascularization therapies and medications for secondary prevention are available in most MENA countries, yet the rate of revascularization is low, so is the number of stroke units insufficient in some countries. Additionally, registries and structured training are still defective. Further field studies are required for more accurate determination of the status of stroke services in the MENA region.
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Affiliation(s)
- Hany Aref
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nevine El Nahas
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Maria Khan
- Neurology Department, Rashid Hospital, Dubai, United Arab Emirates
| | - Selma Kesraoui
- Neurology Department, Blida Hospital University, Blida, Algeria
| | - Firas Alnidawi
- Neurology Department, Salmaniyah Medical Complex, Manama, Bahrain
| | | | - Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Muataz Fairooz
- Neurology Department, Sa’ad Al-Witry Neurosciences Hospital, Baghdad, Iraq
| | - Waleed Batayha
- Neurology Department, Basma Teaching Hospital, Irbid, Jordan
| | - Athari Salmeen
- Neurology Department, Jaber AlAhmad Hospital, Kuwait, Kuwait
| | | | - Mohammed Faouzi Belahsen
- Neurology Department, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Amal M. Al Hashmi
- Central Stroke Unit, Neuroscience Directorate, Khoula Hospital, Muscat, Oman
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Al-Johani
- Neurology Department, King Salman ibn Abdulaziz Medical City, Madinah, Saudi Arabia
| | - Osheik Abu’Asha Seidi
- Neurology Department, Faculty of Medicine and Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Anas Jouhar
- Neurology and Neurophysiology Department, Damascus Hospital, Damascus, Syria
| | - Chokri Mhiri
- Department of Neurology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ahmed Elbassiouny
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam Shokri
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Roushdy
- Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Okekunle AP, Jones S, Adeniji O, Watkins C, Hackett M, Di Tanna GL, Owolabi M, Akinyemi R. Stroke in Africa: A systematic review and meta-analysis of the incidence and case-fatality rates. Int J Stroke 2023; 18:634-644. [PMID: 36503371 PMCID: PMC10313746 DOI: 10.1177/17474930221147164] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burden of stroke (a leading cause of disability and mortality) in Africa appears to be increasing, but a systematic review of the best available data to support or refute this observation is lacking. AIM To determine the incidence and 1-month case-fatality rates from high-quality studies of stroke epidemiology among Africans. SUMMARY OF REVIEW We searched and retrieved eligible articles on stroke epidemiology among indigenous Africans in bibliographic databases (MEDLINE, ScienceDirect, Google Scholar, and Cochrane library) using predefined search terms from the earliest records through January 2022. Methodological assessment of eligible studies was conducted using the Newcastle-Ottawa scale. Pooling of incidence and case-fatality rates was performed via generalized linear models (Poisson-Normal random-effects model). Of the 922 articles retrieved, 14 studies were eligible for inclusion. The total number of stroke cases was 2568, with a population denominator (total sample size included in population-based registries or those who agreed to participate in door-to-door community studies) of 3,384,102. The pooled crude incidence rate of stroke per 100,000 persons in Africa was 106.49 (95% confidence interval (CI) = 58.59-193.55), I2 = 99.6%. The point estimate of the crude incidence rate was higher among males, 111.33 (95% CI = 56.31-220.12), I2 = 99.2%, than females, 91.14 (95% CI = 47.09-176.37), I2 = 98.9%. One-month case-fatality rate was 24.45 (95% CI = 16.84-35.50), I2 = 96.8%, with lower estimates among males, 22.68 (95% CI = 18.62-27.63), I2 = 12.9%, than females, 27.57 (95% CI = 21.47-35.40), I2 = 51.6%. CONCLUSION The burden of stroke in Africa remains very high. However, little is known about the dynamics of stroke epidemiology among Africans due to the dearth of high-quality evidence. Further continent-wide rigorous epidemiological studies and surveillance programs using the World Health Organization STEPwise approach to Surveillance (WHO STEPS) framework are needed.
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Affiliation(s)
- Akinkunmi Paul Okekunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | | | - Olaleye Adeniji
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | | | - Maree Hackett
- University of Central Lancashire, Preston, UK
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Innovative Technologies, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rufus Akinyemi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Osei SKJ, Adomako-Bempah E, Yeboah AA, Owiredu LA, Ohene LA. Nurse-led telerehabilitation intervention to improve stroke efficacy: Protocol for a pilot randomized feasibility trial. PLoS One 2023; 18:e0280973. [PMID: 37267261 DOI: 10.1371/journal.pone.0280973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/10/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The prevalence of stroke continues to rise in low-middle income countries. The continual rise in stroke cases and increasing prevalence on post-acute needs represent a crucial call for increased accessibility and utilization of rehabilitation services. AIM The primary objective of the study is to test the feasibility of a nurse-led telerehabilitation intervention in improving self-efficacy among stroke survivors. The findings of the trial are intended for use in a future larger study. METHODS Participants would be recruited at the University of Ghana Hospital and randomized into an intervention group and a control group. Participants aged ≥ 18 years, diagnosed of stroke at most 12months prior the recruitment and requiring moderate level of assistance would be considered for eligibility. Participants in the intervention group will receive individualized and comprehensive nurse-led rehabilitation therapies in physical, emotional, cognitive and nursing education domains for 6 months, in addition to treatment as usual (TAU). The control group will only receive treatment as usual. Follow-up evaluations will occur immediately, 30 days and 90 days after the intervention. DISCUSSION Providing stroke rehabilitation services in low-resource settings presents a significant challenge due to limited infrastructure and a lack of trained healthcare professionals. The current study has the potential of contributing to the growing body of evidence on the impact of telerehabilitation services in mitigating these challenges in low-resource settings. TRIAL REGISTRATION PACTR202210685104862, Pan African Clinical Trial Registry.
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Owolabi MO, Leonardi M, Bassetti C, Jaarsma J, Hawrot T, Makanjuola AI, Dhamija RK, Feng W, Straub V, Camaradou J, Dodick DW, Sunna R, Menon B, Wright C, Lynch C, Chadha AS, Ferretti MT, Dé A, Catsman-Berrevoets CE, Gichu M, Tassorelli C, Oliver D, Paulus W, Mohammed RK, Charway-Felli A, Rostasy K, Feigin V, Craven A, Cunningham E, Galvin O, Perry AH, Fink EL, Baneke P, Helme A, Laurson-Doube J, Medina MT, Roa JD, Hogl B, O'Bryan A, Trenkwalder C, Wilmshurst J, Akinyemi RO, Yaria JO, Good DC, Hoemberg V, Boon P, Wiebe S, Cross JH, Haas M, Jabalpurwala I, Mojasevic M, DiLuca M, Barbarino P, Clarke S, Zuberi SM, Olowoyo P, Owolabi A, Oyesiku N, Maly-Sundgren PC, Norrving B, Soekadar SR, van Doorn PA, Lewis R, Solomon T, Servadei F. Global synergistic actions to improve brain health for human development. Nat Rev Neurol 2023; 19:371-383. [PMID: 37208496 PMCID: PMC10197060 DOI: 10.1038/s41582-023-00808-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/21/2023]
Abstract
The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.
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Affiliation(s)
- Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- African Stroke Organization, Ibadan, Nigeria.
- World Federation for Neurorehabilitation, North Shields, UK.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudio Bassetti
- Neurology Department Inselspital - University of Bern, Bern, Switzerland
- European Academy of Neurology, Vienna, Austria
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | - Tadeusz Hawrot
- European Federation of Neurological Associations, Brussels, Belgium
| | | | | | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Volker Straub
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle, UK
| | - Jennifer Camaradou
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- One Neurology Initiative, Brussels, Belgium
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
- Atria Academy of Science and Medicine, New York, NY, USA
- American Brain Foundation, Minneapolis, MN, USA
| | - Rosita Sunna
- Tics and Tourette Across the Globe, Hannover, Germany
- Australian Clinical Psychology Association, Sydney, New South Wales, Australia
| | - Bindu Menon
- Department of Neurology, Apollo Specialty Hospitals, Nellore, India
| | | | - Chris Lynch
- Alzheimer's Disease International, London, UK
| | | | | | - Anna Dé
- Women's Brain Project, Guntershausen, Switzerland
| | - Coriene E Catsman-Berrevoets
- Department of Paediatric Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- European Paediatric Neurology Society, Bolton, UK
| | - Muthoni Gichu
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Global Brain Health Institute, San Francisco, CA, USA
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences of the University of Pavia, Pavia, Italy
- IRCCS C. Mondino Foundation Neurological Institute, Pavia, Italy
- International Headache Society, London, UK
| | - David Oliver
- University of Kent, Canterbury, UK
- International Neuro-Palliative Care Society, Roseville, MN, USA
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians University Munich, Klinikum Großhadern, Munich, Germany
- International Federation of Clinical Neurophysiology, Milwaukee, WI, USA
| | - Ramla K Mohammed
- Amal Neuro Developmental Centres, Gudalur, India
- Al Ameen Educational Trust, Gudalur, India
| | | | - Kevin Rostasy
- European Paediatric Neurology Society, Bolton, UK
- Department of Paediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Witten, Germany
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Orla Galvin
- European Federation of Neurological Associations, Brussels, Belgium
| | | | - Ericka L Fink
- Department of Paediatric Neurology and Critical Care, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Peer Baneke
- Multiple Sclerosis International Federation, London, UK
| | - Anne Helme
- Multiple Sclerosis International Federation, London, UK
| | | | - Marco T Medina
- National Autonomous University of Honduras, Tegucigalpa, Honduras
- Pan-American Federation of Neurological Societies, Santiago de Chile, Chile
| | - Juan David Roa
- HOMI Fundacion Hospital Paediatrico la Misericordia, Bogota, Colombia
| | - Birgit Hogl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- World Sleep Society, Rochester, MN, USA
| | | | - Claudia Trenkwalder
- Paracelsus-Elena Hospital, Kassel, Department of Neurosurgery, University Medical Centre, Goettingen, Germany
| | - Jo Wilmshurst
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- International Child Neurology Association, London, UK
| | - Rufus O Akinyemi
- African Stroke Organization, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joseph O Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - David C Good
- World Federation for Neurorehabilitation, North Shields, UK
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Volker Hoemberg
- World Federation for Neurorehabilitation, North Shields, UK
- SRH Neurorehabilitation Hospital Bad Wimpfen, Bad Wimpfen, Germany
| | - Paul Boon
- European Academy of Neurology, Vienna, Austria
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- International League Against Epilepsy, Flower Mound, TX, USA
| | - J Helen Cross
- International League Against Epilepsy, Flower Mound, TX, USA
- Clinical Neurosciences Section, UCL Institute of Child Health, University College London, London, UK
| | - Magali Haas
- Cohen Veterans Bioscience, New York, NY, USA
| | | | | | - Monica DiLuca
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- European Brain Council, Brussels, Belgium
| | | | - Stephanie Clarke
- World Federation for Neurorehabilitation, North Shields, UK
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sameer M Zuberi
- European Paediatric Neurology Society, Bolton, UK
- Paediatric Neurosciences Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Olowoyo
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
- Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Nelson Oyesiku
- Department of Neurosurgery, University of North Carolina at Chapel Hill, North Carolina, NC, USA
- World Federation of Neurosurgical Societies, Prague, Czech Republic
| | - Pia C Maly-Sundgren
- Department of Clinical Sciences/Diagnostic Radiology, Lund University, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences/Neurology, Lund University, Lund, Sweden
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Peripheral Nerve Society, Roseville, MN, USA
| | - Richard Lewis
- Peripheral Nerve Society, Roseville, MN, USA
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Tom Solomon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Encephalitis Society, Malton, North Yorkshire, UK
| | - Franco Servadei
- World Federation of Neurosurgical Societies, Prague, Czech Republic
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Humanitas University, Milan, Italy
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Chen ZJ, He C, Xu J, Zheng CJ, Wu J, Xia N, Hua Q, Xia WG, Xiong CH, Huang XL. Exoskeleton-Assisted Anthropomorphic Movement Training for the Upper Limb After Stroke: The EAMT Randomized Trial. Stroke 2023; 54:1464-1473. [PMID: 37154059 DOI: 10.1161/strokeaha.122.041480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Robot-assisted arm training is generally delivered in the robot-like manner of planar or mechanical 3-dimensional movements. It remains unclear whether integrating upper extremity (UE) natural coordinated patterns into a robotic exoskeleton can improve outcomes. The study aimed to compare conventional therapist-mediated training to the practice of human-like gross movements derived from 5 typical UE functional activities managed with exoskeletal assistance as needed for patients after stroke. METHODS In this randomized, single-blind, noninferiority trial, patients with moderate-to-severe UE motor impairment due to subacute stroke were randomly assigned (1:1) to receive 20 sessions of 45-minute exoskeleton-assisted anthropomorphic movement training or conventional therapy. Treatment allocation was masked from independent assessors, but not from patients or investigators. The primary outcome was the change in the Fugl-Meyer Assessment for Upper Extremity from baseline to 4 weeks against a prespecified noninferiority margin of 4 points. Superiority would be tested if noninferiority was demonstrated. Post hoc subgroup analyses of baseline characteristics were performed for the primary outcome. RESULTS Between June 2020 and August 2021, totally 80 inpatients (67 [83.8%] males; age, 51.9±9.9 years; days since stroke onset, 54.6±38.0) were enrolled, randomly assigned to the intervention, and included in the intention-to-treat analysis. The mean Fugl-Meyer Assessment for Upper Extremity change in exoskeleton-assisted anthropomorphic movement training (14.73 points; [95% CI, 11.43-18.02]) was higher than that of conventional therapy (9.90 points; [95% CI, 8.15-11.65]) at 4 weeks (adjusted difference, 4.51 points [95% CI, 1.13-7.90]). Moreover, post hoc analysis favored the patient subgroup (Fugl-Meyer Assessment for Upper Extremity score, 23-38 points) with moderately severe motor impairment. CONCLUSIONS Exoskeleton-assisted anthropomorphic movement training appears to be effective for patients with subacute stroke through repetitive practice of human-like movements. Although the results indicate a positive sign for exoskeleton-assisted anthropomorphic movement training, further investigations into the long-term effects and paradigm optimization are warranted. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2100044078.
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Affiliation(s)
- Ze-Jian Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
- World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
| | - Chang He
- Institute of Medical Equipment Science and Engineering, Huazhong University of Science and Technology, Wuhan, China (C.H., C.-H.X.)
- State Key Laboratory of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China (C.H., C.-H.X.)
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
- World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
| | - Chan-Juan Zheng
- Department of Rehabilitation Medicine, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, China (C.-J.Z., J.W., Q.H.)
| | - Jing Wu
- Department of Rehabilitation Medicine, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, China (C.-J.Z., J.W., Q.H.)
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
- World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
| | - Qiang Hua
- Department of Rehabilitation Medicine, Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Wuhan, China (C.-J.Z., J.W., Q.H.)
| | - Wen-Guang Xia
- Hubei Rehabilitation Hospital, Wuhan, China (W.-G.X.)
| | - Cai-Hua Xiong
- Institute of Medical Equipment Science and Engineering, Huazhong University of Science and Technology, Wuhan, China (C.H., C.-H.X.)
- State Key Laboratory of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China (C.H., C.-H.X.)
| | - Xiao-Lin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
- World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China (Z.-J.C., J.X., N.X., X.-L.H.)
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Zheng Z, Song R, Zhao Y, Lv H, Wang Y, Yu C. An investigation of the level of stigma and the factors influencing it in the rehabilitation of young and middle-aged stroke patients-a cross-sectional study. BMC Neurol 2023; 23:139. [PMID: 37005567 PMCID: PMC10067210 DOI: 10.1186/s12883-023-03189-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND There are few reported studies on stigma in young and middle-aged stroke patients during the rehabilitation period, however, the rehabilitation period plays a key role in the patients' disease regression. Exploring the level of stigma and the influencing factors in young and middle-aged stroke patients during the rehabilitation period is crucial for determining how to reduce the level of stigma and improve the patients' motivation for rehabilitation treatment. Therefore, this study investigated the level of stigma in young and middle-aged stroke patients and analyzed the factors influencing stigma in order to provide a reference or basis for healthcare professionals to develop effective and targeted stigma intervention programs. METHODS Using a convenience sampling method, 285 young and middle-aged stroke patients admitted to the rehabilitation medicine department of a tertiary care hospital in Shenzhen, China, from November 2021 to September 2022 were selected and surveyed using a general information questionnaire, the Stroke Stigma Scale(SSS), the Barthel Index(BI), and the Positive and Negative Emotions Scale(PANAS), and multiple linear regression and smoothed curve fitting were used to analyze the factors influencing the stigma of young and middle-aged stroke patients during the rehabilitation period. RESULTS SSS score of 45.08 ± 11.06, univariate analysis of age, occupation, education level, pre-stroke monthly income, insurance type, comorbid chronic disease status, primary caregiver, BI, positive and negative emotion as factors influencing stigma. Multiple linear regression showed that age, pre-stroke monthly income, BI, positive and negative emotions were independent influences on stigma in young and middle-aged stroke patients, explaining 58.0% of the total variance in stigma. A smoothed curve fit revealed a curvilinear relationship between the above influences and stigma. CONCLUSION Young and middle-aged stroke patients have a moderate level of stigma. Medical staff should focus on young patients aged 18-44 years, those with high monthly income before the stroke, those with poor self-care ability, and those with low positive and high negative emotion scores, and conduct early assessments and adopt targeted intervention programs according to the influencing factors to reduce the stigma of young and middle-aged stroke patients, improve their motivation for rehabilitation, and help them return to their families and society as soon as possible. TRIAL REGISTRATION Registration number of China Clinical Trials Registration Center: 20,220,328,004-FS01.
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Affiliation(s)
- Zixiu Zheng
- Inner Mongolia Baogang Hospital, Baotou, China
- Henan University of Science and Technology, Luoyang, China
| | - Runluo Song
- Henan University of Science and Technology, Luoyang, China
| | - Yunxiao Zhao
- Department of Nursing, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hongxia Lv
- Inner Mongolia Baogang Hospital, Baotou, China
| | | | - Cong Yu
- Department of Nursing, Shenzhen Second People's Hospital, Shenzhen, China.
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Sarfo FS, Akpa OM, Ovbiagele B, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Ogbole G, Fakunle A, Okekunle AP, Asowata OJ, Calys-Tagoe B, Uvere EO, Sanni T, Olowookere S, Ibinaiye P, Akinyemi JO, Arulogun O, Jenkins C, Lackland DT, Tiwari HK, Isah SY, Abubakar SA, Oladimeji A, Adebayo P, Akpalu J, Onyeonoro U, Ogunmodede JA, Akisanya C, Mensah Y, Oyinloye OI, Appiah L, Agunloye AM, Osaigbovo GO, Adeoye AM, Adeleye OO, Laryea RY, Olunuga T, Ogah OS, Oguike W, Ogunronbi M, Adeniyi W, Olugbo OY, Bello AH, Ogunjimi L, Diala S, Dambatta HA, Singh A, Adamu S, Obese V, Adusei N, Owusu D, Ampofo M, Tagge R, Fawale B, Yaria J, Akinyemi RO, Owolabi MO. Patient-level and system-level determinants of stroke fatality across 16 large hospitals in Ghana and Nigeria: a prospective cohort study. Lancet Glob Health 2023; 11:e575-e585. [PMID: 36805867 PMCID: PMC10080070 DOI: 10.1016/s2214-109x(23)00038-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria. METHODS The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeria. Cases include adults (aged ≥18 years) with clinical and radiological evidence of an acute stroke. Data on stroke services and resources available at each study site were collected and analysed as system-level factors. A host of demographic and clinical variables of cases were analysed as patient-level factors. A mixed effect log-binomial model including both patient-level and system-level covariates was fitted. Results are presented as adjusted risk ratios (aRRs) with respective 95% CIs. FINDINGS Overall, 814 (21·8%) of the 3739 patients admitted with stroke died as inpatients: 476 (18·1%) of 2635 with ischaemic stroke and 338 (30·6%) of 1104 with intracerebral haemorrhage. The variability in the odds of stroke fatality that could be attributed to the system-level factors across study sites assessed using model intracluster correlation coefficient was substantial at 7·3% (above a 5% threshold). Stroke units were available at only five of 16 centres. The aRRs of six patient-level factors associated with stroke fatality were: low vegetable consumption, 1·19 (95% CI 1·07-1·33); systolic blood pressure, 1·02 (1·01-1·04) for each 10 mm Hg rise; stroke lesion volume more than 30 cm3, 1·48 (1·22-1·79); National Institutes of Health Stroke Scale (NIHSS) score, 1·20 (1·13-1·26) for each 5-unit rise; elevated intracranial pressure, 1·75 (1·31-2·33); and aspiration pneumonia, 1·79 (1·16-2·77). INTERPRETATION Studies are needed to assess the efficacy of interventions targeting patient-level factors such as aspiration pneumonia in reducing acute stroke fatality in this region. Policy directives to improve stroke unit access are warranted. FUNDING US National Institutes of Health. TRANSLATIONS For the Twi, Yoruba and Hausa translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Onoja M Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria; Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
| | - Adekunle Fakunle
- Department of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Public Health, Osun State University, Osogbo, Nigeria
| | - Akinkunmi Paul Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, South Korea
| | - Osahon J Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ezinne O Uvere
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Taofeek Sanni
- Federal Teaching Hospital, Ido-Ekiti Ado-Ekiti, Nigeria
| | - Samuel Olowookere
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | - Suleiman Y Isah
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sani A Abubakar
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Josephine Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - James A Ogunmodede
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Yaw Mensah
- Korle Bu Teaching Hospital, Accra, Ghana
| | - Olalekan I Oyinloye
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Atinuke M Agunloye
- Department of Radiology, University of Ibadan, Ibadan, Nigeria; College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Abiodun M Adeoye
- Department of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria
| | | | - Ruth Y Laryea
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Obiabo Y Olugbo
- Delta State University/Delta State University Teaching Hospital, Oghara, Nigeria
| | - Abiodun H Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Luqman Ogunjimi
- Department of Pharmacology and Therapeutics, Olabisi Onabanjo University, Abeokuta, Nigeria
| | - Samuel Diala
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Vida Obese
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Nathaniel Adusei
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dorcas Owusu
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Raelle Tagge
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Joseph Yaria
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rufus O Akinyemi
- University College Hospital, Ibadan, Nigeria; Federal Medical Centre, Abeokuta, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa O Owolabi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Lebanese American University, Beirut, Lebanon; Blossom Center for Neurorehabilitation, Ibadan, Nigeria.
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Effect of Butylphthalide Capsules on Smac and XIAP Expression in Rats after Ischemia Reperfusion. J Surg Res 2023; 283:1038-1046. [PMID: 36914994 DOI: 10.1016/j.jss.2022.11.055] [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: 01/27/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Little is known about the protective effects of butylphthalide on cerebral ischemia-reperfusion injury. This study aims to investigate the impact on the second mitochondrial-derived activator of Caspases (Smac) and X-linked inhibitor of apoptosis protein (XIAP) expression in the ischemic semidark area using a rat model of carotid artery stenosis. METHODS Thirty Sprague-Dawley rats were randomly divided into the sham-operated group, carotid stenosis model controls, low-dose (20 mg/kg), medium-dose (40 mg/kg), and high-dose (80 mg/kg) butylphthalide groups. The neurological function was scored by the balance beam test (BBT). The morphological changes of brain tissue were detected by Hematoxylin-eosin (HE) staining, with apoptosis detected by Terminal Deoxynucleotidyl Transferase mediated dUTP Nick-End Labeling (TUNEL) staining. Smac and XIAP protein expression were detected by immunohistochemistry (IHC). The expressions of Smac and XIAP mRNA were detected by real-time quantitative polymerase chain reaction (RT-qPCR). RESULTS HE showed that neuronal loss, nuclear consolidation, and vacuolar degeneration were significantly reduced in the medium and high-dose butylphthalide groups compared with the model controls. The BBT scores and apoptotic index were significantly lower in the medium and high doses of butylphthalide compared with the model controls. RT-qPCR and IHC showed that Smac, XIAP mRNA and protein expressions in the ischemic hemispheric region were significantly reduced in low, medium, and high doses of butylphthalide compared with the model controls (P < 0.05), showing some concentration effect. CONCLUSIONS Butylphthalide can significantly reduce Smac and XIAP mRNA and protein expression, inhibit neuronal apoptosis induced by ischemia-reperfusion injury in rats with carotid stenosis, and exert neuroprotective effects.
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Gordon Perue G, Then R, Gayle F, Galav S, Thotamalla Y, Hepburn M, Rowe D, Suazo L, Villamán C, Manosalva H, Ortega-Gutierrez S, Yavagal D, Inoa V. Mission thrombectomy 2020 (MT2020+) surveys of Caribbean stroke services: A call for action in our region. J Neurol Sci 2023; 449:120640. [PMID: 37060622 DOI: 10.1016/j.jns.2023.120640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Stroke is the leading cause of death and adult-onset disability in the Caribbean region. Despite the tremendous advances in acute stroke care in the past 25 years, treatment in the Caribbean lags stroke standards of care. Mission Thrombectomy 2020+ (MT2020+) is a metrics based global campaign focused on increasing access to organized stroke care and mechanical thrombectomy. We conducted two consecutive online surveys across the MT2020+ Caribbean Region assessing access to thrombolytics, mechanical thrombectomy and stroke centers. The first survey - Mechanical Thrombectomy Access-Caribbean sub-study, allowed a comparison between global services and those in the MT2020+ Caribbean region. This survey provided a snapshot of the current state of stroke centers worldwide and confirmed lower available stroke resources in the MT2020+ Caribbean Region which has one certified stroke center, and 9 mechanical thrombectomy capable centers. The second survey - MT2020+ Caribbean Region infrastructure survey - was designed to determine the availability of stroke resources that are key components of stroke care in participating hospitals. Key infrastructural components such as 24/7 computerized tomographic scanners, access to thrombolytic therapy and access to mechanical thrombectomy capable centers were scarce. There were low volumes of mechanical thrombectomy performed in the Caribbean compared to other countries around the world. Limited resources and inadequate stroke infrastructure remains a major challenge in the Caribbean. We advocate for governmental support and investment, public and private partnerships and legislation to increase access and availability to acute stroke treatments to allow for equal access to care for all Caribbean citizens.
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Affiliation(s)
- Gillian Gordon Perue
- Department of Neurology, University of Miami, Miami, FL, United States of America.
| | - Ryna Then
- Cooper Medical School of Rowan University, Camden, NJ, United States of America
| | | | | | | | - Madihah Hepburn
- Summa Health Neurosciences & Stroke Center, Akron, OH, United States of America
| | | | - Luis Suazo
- Centro de Medicina Avanzada y Telemedicina, Dominican Republic
| | - Cosme Villamán
- Dept. Neurointervención Clínica Corominas y Corazones del Cibao, Dominican Republic
| | | | | | - Dileep Yavagal
- Department of Neurology and Neurosurgery, University of Miami, United States of America
| | - Violiza Inoa
- Semmes-Murphey Clinic, Memphis, Tennessee, University of Tennessee Health Science Center, Memphis, TN, United States of America
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Kayola G, Mataa MM, Asukile M, Chishimba L, Chomba M, Mortel D, Nutakki A, Zimba S, Saylor D. Stroke Rehabilitation in Low- and Middle-Income Countries: Challenges and Opportunities. Am J Phys Med Rehabil 2023; 102:S24-S32. [PMID: 36634327 PMCID: PMC9846582 DOI: 10.1097/phm.0000000000002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Stroke remains the second leading cause of global disability with 87% of stroke-related disability occurring in low- and middle-income countries. In low- and middle-income countries, access to acute stroke interventions is often limited, making effective poststroke rehabilitation potentially the best available intervention to promote poststroke recovery. Here, we build on our experience as an illustrative example of barriers individuals with stroke face in accessing rehabilitation services and review the literature to summarize challenges to providing effective rehabilitation in low- and middle-income countries. First, we focus on barriers individuals with stroke face in accessing rehabilitation in low- and middle-income countries, including health system barriers, such as lack of national guidelines, low prioritization of rehabilitation services, and inadequate numbers of skilled rehabilitation specialists, as well as patient factors, including limited health literacy, financial constraints, and transportation limitations. Next, we highlight consequences of this lack of rehabilitation access, including higher mortality, poorer functional outcomes, financial burden, caregiver stress, and loss of gross domestic product at a national level. Finally, we review possible strategies that could improve access and quality of rehabilitation services in low- and middle-income countries, including creation of inpatient stroke units, increased training opportunities for rehabilitation specialists, task shifting to available healthcare workers or caregivers, telerehabilitation, and community-based rehabilitation services.
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Affiliation(s)
- Grace Kayola
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | - Melody Asukile
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Lorraine Chishimba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Mashina Chomba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Dominique Mortel
- Department of Neurology, Johns Hopkins University School of Medicine
| | | | - Stanley Zimba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
- Department of Neurology, Johns Hopkins University School of Medicine
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Platz T, Pedersen AL, Deutsch P, Umlauft AN, Bader S. Analysis of the therapeutic interaction provided by a humanoid robot serving stroke survivors as a therapeutic assistant for arm rehabilitation. Front Robot AI 2023; 10:1103017. [PMID: 36950283 PMCID: PMC10025290 DOI: 10.3389/frobt.2023.1103017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
Objective: To characterize a socially active humanoid robot's therapeutic interaction as a therapeutic assistant when providing arm rehabilitation (i.e., arm basis training (ABT) for moderate-to-severe arm paresis or arm ability training (AAT) for mild arm paresis) to stroke survivors when using the digital therapeutic system Evidence-Based Robot-Assistant in Neurorehabilitation (E-BRAiN) and to compare it to human therapists' interaction. Methods: Participants and therapy: Seventeen stroke survivors receiving arm rehabilitation (i.e., ABT [n = 9] or AAT [n = 8]) using E-BRAiN over a course of nine sessions and twenty-one other stroke survivors receiving arm rehabilitation sessions (i.e., ABT [n = 6] or AAT [n = 15]) in a conventional 1:1 therapist-patient setting. Analysis of therapeutic interaction: Therapy sessions were videotaped, and all therapeutic interactions (information provision, feedback, and bond-related interaction) were documented offline both in terms of their frequency of occurrence and time used for the respective type of interaction using the instrument THER-I-ACT. Statistical analyses: The therapeutic interaction of the humanoid robot, supervising staff/therapists, and helpers on day 1 is reported as mean across subjects for each type of therapy (i.e., ABT and AAT) as descriptive statistics. Effects of time (day 1 vs. day 9) on the humanoid robot interaction were analyzed by repeated-measures analysis of variance (rmANOVA) together with the between-subject factor type of therapy (ABT vs. AAT). The between-subject effect of the agent (humanoid robot vs. human therapist; day 1) was analyzed together with the factor therapy (ABT vs. AAT) by ANOVA. Main results and interpretation: The overall pattern of the therapeutic interaction by the humanoid robot was comprehensive and varied considerably with the type of therapy (as clinically indicated and intended), largely comparable to human therapists' interaction, and adapted according to needs for interaction over time. Even substantially long robot-assisted therapy sessions seemed acceptable to stroke survivors and promoted engaged patients' training behavior. Conclusion: Humanoid robot interaction as implemented in the digital system E-BRAiN matches the human therapeutic interaction and its modification across therapies well and promotes engaged training behavior by patients. These characteristics support its clinical use as a therapeutic assistant and, hence, its application to support specific and intensive restorative training for stroke survivors.
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Affiliation(s)
- Thomas Platz
- Neurorehabilitation research group, University Medical Centre, Greifswald, Germany
- BDH-Klinik Greifswald, Institute for Neurorehabilitation and Evidence-Based Practice, “An-Institut,” University of Greifswald, Greifswald, Germany
- *Correspondence: Thomas Platz,
| | - Ann Louise Pedersen
- Neurorehabilitation research group, University Medical Centre, Greifswald, Germany
| | - Philipp Deutsch
- Neurorehabilitation research group, University Medical Centre, Greifswald, Germany
| | | | - Sebastian Bader
- Department of Computer Science, University of Rostock, Rostock, Germany
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Guo J, Chen X, Lyu Z, Xiu H, Lin S, Liu F. Repetitive transcranial magnetic stimulation (rTMS) for post-stroke sleep disorders: a systematic review of randomized controlled trials. Neurol Sci 2022; 43:6783-6794. [PMID: 35980480 DOI: 10.1007/s10072-022-06349-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Survivors of stroke often experience post-stroke sleep disorders (PSSDs), but pharmacotherapy risks adverse side effects. Transcranial magnetic stimulation (TMS) is potentially a nonpharmacotherapeutic option. This meta-analysis investigated the effects of rTMS to treat PSSD. METHODS Databases were searched for randomized controlled trials (RCTs) of rTMS to treat PSSD, conducted in accordance with the PRISMA 2020 guidelines. Risk-of-bias assessments were performed using the Cochrane risk-of-bias tool. A meta-analysis of the following indexes was performed using RevMan 5.4 software: Pittsburgh sleep quality index; effective rate of sleep improvement; Hamilton Anxiety Rating Scale (for mood); and National Institute of Health Stroke Scale (NIHSS, stroke severity). Mean differences (MDs) and confidence intervals (CIs) were calculated. RESULTS The meta-analysis included 17 RCTs, with 1411 patients overall. The indexes indicated that rTMS could improve the sleep quality, mood, and stroke severity of patients with PSSD: Pittsburgh sleep quality index (12 studies; MD = - 2.51, 95% CI [- 3.24, - 1.79], P < 0.00001); effective rate of sleep improvement (7 studies; MD = 4.03, 95% CI [2.43, 6.68], P < 0.0001); Hamilton Anxiety Rating Scale (2 studies; MD = - 4.05, 95% CI [- 4.77, - 3.32], P < 0.00001); and NIHSS (2 studies; MD = -2.71, 95% CI [- 3.36, - 2.06], P < 0.00001). CONCLUSION The results suggest that rTMS may have positive effects on the sleep quality, mood, and stroke severity of patients with PSSD.
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Affiliation(s)
- Jiaying Guo
- Nursing College, Fujian University of Traditional Chinese Medicine, No. 1 Qiu Yang Road, Shangjie, Minhou, Fujian, 350122, Fuzhou, People's Republic of China
| | - Xin Chen
- Nursing College, Fujian University of Traditional Chinese Medicine, No. 1 Qiu Yang Road, Shangjie, Minhou, Fujian, 350122, Fuzhou, People's Republic of China
| | - Zecai Lyu
- Nursing College, Fujian University of Traditional Chinese Medicine, No. 1 Qiu Yang Road, Shangjie, Minhou, Fujian, 350122, Fuzhou, People's Republic of China
| | - Huoqin Xiu
- Nursing College, Fujian University of Traditional Chinese Medicine, No. 1 Qiu Yang Road, Shangjie, Minhou, Fujian, 350122, Fuzhou, People's Republic of China
| | - Shaohong Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, No. 1 Qiu Yang Road, Shangjie, Minhou, Fujian, 350122, Fuzhou, People's Republic of China
| | - Fang Liu
- Nursing College, Fujian University of Traditional Chinese Medicine, No. 1 Qiu Yang Road, Shangjie, Minhou, Fujian, 350122, Fuzhou, People's Republic of China.
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BLOJ FA, BUICU FC, FILEP CR, SUCIU BA, VUNVULEA V, MĂRGINEAN L. A cost effectiveness analysis of stroke management in Romania. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Al Hashmi AM, Shuaib A, Imam Y, Amr D, Humaidan H, Al Nidawi F, Sarhan A, Mustafa W, Khalefa W, Ramadan I, Usman FS, Hokmabadi ES, Ghorbani M, Nassir T, Aladham F, Salmeen A, Kikano R, Muda S, Jose S, Bulushi MA, Sajwani B, Wasay M, Bashir Q, Al Hazzani A, Khoja W, Alkadere R, Osman H, Hussein A, Churojana A, Hammami N, Ozdemir AO, Giray S, Gurkas E, Hussain SI, Sallam AR, Mansour OY. Stroke services in the Middle East and adjacent region: A survey of 34 hospital-based stroke services. Front Neurol 2022; 13:1016376. [PMID: 36408502 PMCID: PMC9667787 DOI: 10.3389/fneur.2022.1016376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Acute stroke care is complex and requires multidisciplinary networking. There are insufficient data on stroke care in the Middle East and adjacent regions in Asia and Africa. Objective Evaluate the state of readiness of stroke programs in the Middle East North Africa and surrounding regions (MENA+) to treat acute stroke. Method Online questionnaire survey on the evaluation of stroke care across hospitals of MENA+ region between April 2021 and January 2022. Results The survey was completed by 34/50 (68%) hospitals. The median population serviced by participating hospitals was 2 million. The median admission of patients with stroke/year was 600 (250–1,100). The median length of stay at the stroke units was 5 days. 34/34 (100%) of these hospitals have 24/7 CT head available. 17/34 (50%) have emergency guidelines for prehospital acute stroke care. Mechanical thrombectomy with/without IVT was available in 24/34 (70.6%). 51% was the median (IQR; 15–75%) of patients treated with IVT within 60 min from arrival. Thirty-five minutes were the median time to reverse warfarin-associated ICH. Conclusion This is the first large study on the availability of resources for the management of acute stroke in the MENA+ region. We noted the disparity in stroke care between high-income and low-income countries. Concerted efforts are required to improve stroke care in low-income countries. Accreditation of stroke programs in the region will be helpful.
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Affiliation(s)
- Amal. M. Al Hashmi
- Central Stroke Unit, Neuroscience Directorate, Khoula Hospital, MOH, Muscat, Oman
- *Correspondence: Amal. M. Al Hashmi
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Yahia Imam
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Dareen Amr
- Stroke and Neurointervention Unit, Alexandria University School of Medicine, Alexandria, Egypt
| | - Hani Humaidan
- Stroke Unit, Salmaniya Medical Complex, Al Manamah, Bahrain
| | | | | | - Wessam Mustafa
- Department of Neurology, Mansoura University Hospital, Mansoura, Egypt
| | - Wael Khalefa
- Department of Neurology, Maady Military Hospital, Cairo, Egypt
| | - Ismail Ramadan
- Department of Neurology, Semoha Emergency Hospital, Alexandria University, Alexandria, Egypt
| | | | | | - Mohammed Ghorbani
- Division of Vascular and Endovascular Neurosurgery Firoozgar Hospital, Tehran, Iran
| | - Temeem Nassir
- Department of Internal Medicine, Maysan Cardiac Center, MOH, Musan, Iraq
| | | | - Athari Salmeen
- Department of Neurology, Jaber Al Ahmad Hospital, Kuwait City, Kuwait
| | - Raghid Kikano
- Lebanese American University, Head of Interventional Radiology, Beirut, Lebanon
| | - Sobri Muda
- Department of Radiology, Pengajar Hospital UPM, FPSK, Universiti Putra Malaysia, Serdang, Malaysia
| | - Sachin Jose
- Statistical Specialist, Oman Medical Specialty Board (OMSB), Muscat, Oman
| | | | | | - Mohammad Wasay
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | - Qasim Bashir
- Department of Neurology, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Adel Al Hazzani
- Neuroscience Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed Khoja
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Haytham Osman
- Department of Neurology, National Ribat University, Khartoum, Sudan
| | - Abbashar Hussein
- Department of Neurology, El Shaab Teaching Hospital, Khartoum, Sudan
| | - Anchalee Churojana
- Department of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nadia Hammami
- National Institute Mongi Ben Hamida of Neurology, Tunis, Tunisia
| | - Atilla Ozcan Ozdemir
- Interventional Neurology and Neurocritical Care Program, Eskisehir Osmangazi University,, Eskişehir, Turkey
| | - Semih Giray
- Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Erdem Gurkas
- Stroke Center, Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Seyd Irteza Hussain
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Ossama Yassin Mansour
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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50
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Middleton S, Dale S, McElduff B, Coughlan K, McInnes E, Mikulik R, Fischer T, Van der Merwe J, Cadilhac D, D’Este C, Levi C, Grimshaw JM, Grecu A, Quinn C, Cheung NW, Koláčná T, Medukhanova S, Sanjuan Menendez E, Salselas S, Messchendorp G, Cassier-Woidasky AK, Skrzypek-Czerko M, Slavat-Plana M, Antonella U, Pfeilschifter W. Translation of nurse-initiated protocols to manage fever, hyperglycaemia and swallowing following stroke across Europe (QASC Europe): A pre-test/post-test implementation study. Eur Stroke J 2022; 8:132-147. [PMID: 37021183 PMCID: PMC10069193 DOI: 10.1177/23969873221126027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Poor adoption of stroke guidelines is a problem internationally. The Quality in Acute Stroke Care (QASC) trial demonstrated significant reduction in death and disability with facilitated implementation of nurse-initiated Methods: This was a multi-country, multi-centre, pre-test/post-test study (2017–2021) comparing post implementation data with historically collected pre-implementation data. Hospital clinical champions, supported by the Angels Initiative conducted multidisciplinary workshops discussing pre-implementation medical record audit results, barriers and facilitators to FeSS Protocol implementation, developed action plans and provided education, with ongoing support co-ordinated remotely from Australia. Prospective audits were conducted 3-month after FeSS Protocol introduction. Pre-to-post analysis and country income classification comparisons were adjusted for clustering by hospital and country controlling for age/sex/stroke severity. Results: Data from 64 hospitals in 17 countries (3464 patients pre-implementation and 3257 patients post-implementation) showed improvement pre-to-post implementation in measurement recording of all three FeSS components, all p < 0.0001: fever elements (pre: 17%, post: 51%; absolute difference 33%, 95% CI 30%, 37%); hyperglycaemia elements (pre: 18%, post: 52%; absolute difference 34%; 95% CI 31%, 36%); swallowing elements (pre: 39%, post: 67%; absolute difference 29%, 95% CI 26%, 31%) and thus in overall FeSS Protocol adherence (pre: 3.4%, post: 35%; absolute difference 33%, 95% CI 24%, 42%). In exploratory analysis of FeSS adherence by countries’ economic status, high-income versus middle-income countries improved to a comparable extent. Discussion and conclusion: Our collaboration resulted in successful rapid implementation and scale-up of FeSS Protocols into countries with vastly different healthcare systems.
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Affiliation(s)
- Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Kelly Coughlan
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Sydney, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Robert Mikulik
- International Clinical Research Centre, Neurology Department, St. Ann’s University Hospital and Masaryk University, Brno, Czech Republic
| | - Thomas Fischer
- Angels Initiative, Boehringer Ingelheim International GmbH, Hamburg, Germany
| | - Jan Van der Merwe
- Angels Initiative, Boehringer Ingelheim International GmbH, Hamburg, Germany
| | - Dominique Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australia
- Sax Institute, Sydney, Australia
| | - Christopher Levi
- John Hunter Health and Innovation Precinct, HNE LHD, New Lambton, NSW, Australia
- Department of Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Jeremy M Grimshaw
- University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Andreea Grecu
- International Clinical Research Centre, Neurology Department, St. Ann’s University Hospital and Masaryk University, Brno, Czech Republic
| | - Clare Quinn
- Prince of Wales Hospital, Randwick, Australia
| | - Ngai Wah Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | | | - Merce Slavat-Plana
- Health Department, Agency for Health Quality and Assessment (AQuAS), CIBER Epidemiología y Salud Pública, CIBERESP, Stroke Programme, Barcelona, Spain
| | - Urso Antonella
- Hospital Network Area-Regional Health Department, Regione Lazio, Rome, Italy
| | - Waltraud Pfeilschifter
- Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
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