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Connor AO, Hobson H, Ryan D, Collins R. 238 THE IMPACT OF COVID-19 ON ACUTE STROKE TREATMENT. Age Ageing 2022. [PMCID: PMC9620361 DOI: 10.1093/ageing/afac218.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Acute stroke management is time critical. Treatment options are dictated by time of symptom onset. 2019 Irish National Audit of Stroke (INAS) showed less than 50% stroke cases arrived in hospital within three hours of symptoms and national average rate of thrombolysis was 11%. The median time Door-To-Needle time (DTN) was 56 minutes, and to thrombectomy 93 and 240 minutes ‘direct to mothership’ / ‘drip and ship’ transfer to thrombectomy centre respectively. Methods Retrospective review of all stroke FAST calls on our acute stroke database in TUH from July 2019 -2021. Data was analysed pre (up until March 2020) and during COVID-19 pandemic. Results FAST protocol imaging was obtained in 78% of cases (464/594). Documented time of symptom onset to CT was 1:50:00 pre-Covid-19 and 2:26:00 during Covid (p<0.001). ED registration to CT was 28mins pre-Covid-19 and 30mins during Covid (p<0.001). The median DTN time was 41mins pre-Covid-19 (n=21), and 54mins during Covid-19 (n=37). Conclusion In contrast to INAS COVID-19 report, median DTN times and thrombolysis rates dis-improved at TUH. Trends observed probably reflect multiple factors; patient hesitation to attend ED; patient isolation from family; busier ambulance service; Infection control protocols. We observed small but significant change in door-to-CT time but a more significant increase in DTN. This may reflect time taken donning Personal Protective Equipment (PPE) or general increased ED activity. Understanding the impact of COVID-19 on acute stroke treatment metrics in addition to differences at sites may identify targets for national quality improvement in service delivery.
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Affiliation(s)
- AO Connor
- Tallaght University Hospital , Dublin, Ireland
| | - H Hobson
- Tallaght University Hospital , Dublin, Ireland
| | - D Ryan
- Tallaght University Hospital , Dublin, Ireland
| | - R Collins
- Tallaght University Hospital , Dublin, Ireland
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O’Connor A, Hobson H, Collins R. 1083 A REVIEW OF FAST DATA IN TALLAGHT UNIVERSITY HOSPITAL, AND THE IMPACT OF COVID ON TREATMENT. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Stroke is a leading cause of morbidity. Current guidelines advise maximum of 4.5 hours post symptom onset for thrombolysis, and 24 hours for thrombectomy. (1) Delay between symptom onset and treatment is associated with an inferior outcome. Thrombolysis is available in 27 Irish centers. Average rate of thrombolysis is 11%. (3) Fewer than half of stroke patients arrived in hospital within three hours of symptom onset in 2019. (4) Median door-to-needle time is 48 minutes.
Method
FAST calls in Tallaght University Hospital, from 2/7/19–1/7/21, were included in this analysis (n = 594).
Results
160 FAST calls took place pre-Covid (20/month), and 434 post-Covid (27.12/month). Time of symptom onset was recorded in 390 cases. Time patients last seen well was known in 185 cases, unknown time of onset in 19. After review by the stroke clinician, FAST imaging was obtained in 78% of cases (n = 464). Of these, 34 cases of FAST imaging were performed for inpatients. Average time from registration to CT was 35:24 minutes pre covid, and 45:52 minutes post. 9.7% of patients were thrombolysed. The median door-to-needle time was 41 minutes pre-Covid(n = 21, 2.625/month), and 54 minutes after (n = 37, 2.3/month). Thrombectomy was performed in 46 cases. 222 patients were diagnosed with an ischaemic stroke, 50 had TIA and 48 had haemorrhagic strokes. Other diagnoses included migraine (6.7%, n = 40), seizures (6.7%, n = 40) and Bells Palsy (3.7%, n = 22). 55% (n = 330) of cases were registered to ED with FAST call between the hours of 9 am-5 pm. 27% (n = 161) of cases occurred during the night shift.
Conclusion
The median door-to-needle times were below national median pre-Covid, and longer post-pandemic, with an increase in the rate of presentation in the same time-frame. This report highlights the effect of the pandemic on time-critical patient interventions in stroke and the need to stratify services to respond to structural challenges.
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McGarvey C, Hobson H, Greene S, Cogan N, McCabe D, McCarthy A, Murphy S, O'Dowd S, Walsh R, Coughlan T, O'Neill D, Kennelly S, Mello S, Coveney S, Ryan D, Collins R. 209 NEURO-MEDICAL COMPLICATIONS OF STROKE—TRENDS OVER THE DECADES IN AN ACUTE STROKE UNIT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Neuro-medical complications post-stroke are common and often serious [1]. We first described complications in our stroke cohort in 1998 and sought to assess whether the severity and the nature of neuro-medical complications may have changed over time due to changes in presentation and the processes of care [2].
Methods
Analysis of stroke service database, which captures all neuro-medical complications as part of its portal for the Irish National Audit of Stroke (INAS), was completed. The frequency of each of the 19 complications was expressed as the percentage of patients that developed each complication over a certain year and over 5 years. Historical comparison was made with dataset from 1998, which captured six complications.
Results
Data on 1,283 patients presenting over 5 years between 2015–2019 was collected. The median age of all patients was 71 years (Range 21–101). In all, 19 different post-stroke complications were recorded; 48% (n = 622) had post-stroke pain, while 23.85% (n = 306) had cognitive decline. Data on 100 patients from 1998 was compared for a number of common metrics including; 21.82% (n = 275) of patients developed an LRTI in the 2015–2019 cohort compared with 14%(n = 14) in the 1998 cohort (p = 0.09) while 16.29% (n = 209) of patients developed a swallow disorder compared to 21% (n = 21) in 1998 (p = 0.22).
Conclusion
There are high levels of neuro-medical complications in stroke patients. Twenty years has seen extensive investment in hyperacute stroke care yet post-acute care complications did not appear to reduce significantly between this time, albeit with low numbers. Direction of future funding may consider the full spectrum of stroke care.
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Affiliation(s)
- C McGarvey
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - H Hobson
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - S Greene
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - N Cogan
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - D McCabe
- Department of Neurology, Tallaght University Hospital , Dublin, Ireland
| | - A McCarthy
- Department of Neurology, Tallaght University Hospital , Dublin, Ireland
| | - S Murphy
- Department of Neurology, Tallaght University Hospital , Dublin, Ireland
| | - S O'Dowd
- Department of Neurology, Tallaght University Hospital , Dublin, Ireland
| | - R Walsh
- Department of Neurology, Tallaght University Hospital , Dublin, Ireland
| | - T Coughlan
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - D O'Neill
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - S Kennelly
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - S Mello
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - S Coveney
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - D Ryan
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
| | - R Collins
- Department of Age-Related Health Care/Stroke Service and School of Gerontology Trinity College Dublin , Dublin, Ireland
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Burden N, Creton S, Weltje L, Maynard S, Hobson H, Wheeler J. An evidence base to support the one concentration approach in fish bioconcentration studies for plant protection products and general chemicals. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Compounds previously identified as 5-HT1A antagonists have subsequently been demonstrated to possess partial agonistic properties in models assessing somatodendritic autoreceptor function. This study examined the influences of (+)-WAY-100135, claimed to be the first selective 5-HT1A antagonist, on offensive behaviour in male mice. Employing a resident-intruder paradigm, administration of (+)-WAY-100135 (1.0-10.0 mg/kg s.c.) enhanced elements of resident offensive behaviour at 2.5 and 5.0 mg/kg but reduced such behaviour at 10.0 mg/kg. In comparison, resident defensive postures remained unchanged except for a significant increase in defensive sideways behaviour at 10.0 mg/kg. These effects were accompanied by reduced rearing behaviour across the dose range tested. Attend/approach behaviour was significantly reduced at the lowest, but increased at the highest, doses tested. Such results may reflect response competition rather than concomitant motor impairment. Given the dynamic behavioural interactions occurring in this paradigm, the increased offensive behaviour of the resident mice leads to enhanced defence and counter-attack by the intruder conspecifics. The results are discussed with reference to the current literature concerning the behavioural effects of other 5-HT1A antagonists.
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Affiliation(s)
- R Bell
- School of Psychology, Queen's University of Belfast, Ireland
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Abstract
Investigations examining the influence of 5-HT1A receptors in murine agonistic and social behavior have reported either specific or nonspecific attenuation of offensive behavior. To clarify this situation, the effects of three 5-HT1A agonists were examined on isolation-induced aggression and social behavior in male mice. 8-OH-DPAT (0.025-1.25 mg/kg) increased social behavior, rearing, and digging. Offensive behavior was reduced, without concomitant sedation. Ipsapirone (0.1-10.0 mg/kg) reduced naso-nasal behavior, whilst enhancing stretched-attend behavior, cage-exploration, and rearing. Offensive and defensive behaviors were attenuated, without reductions in activity. MDL 73005 EF (0.25-8.0 mg/kg) reduced social behaviors, cage-exploration and rearing while maintenance behavior was increased. Offensive and defensive behaviors showed attenuation. Current results corroborate previous findings with respect to 5-HT1A receptor involvement in murine agonistic behavior and anxiety. Data also connote that the behavioral specificity of 5-HT1A ligands should be interpreted in terms of response competition rather than solely concomitant sedation.
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Affiliation(s)
- R Bell
- School of Psychology, Queen's University of Belfast
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Abstract
In view of conflicting results reported for 5-HT1A receptor involvement in murine social conflict, this study examined the effect of two compounds, SDZ 216-525 and (-)-pindolol, on agonistic and social behavior in male mice. In a resident-intruder paradigm, (-)-pindolol (1.0-20.0 mg/kg), a beta-adrenergic 5-HT1A/1B antagonist, significantly attenuated all agonistic behaviors across the dose range employed. Social behaviors showed significant decreases, while nonsocial cage exploration showed significant increases at all doses. Defensive evade was significantly attenuated at 20.0 mg/kg. SDZ 216-525 (0.025-1.0 mg/kg), a selective 5-HT1A antagonist, significantly attenuated offensive posturing and bite-attacks at 1.0 mg/kg, and all offensive behaviors nonsignificantly at the smaller doses tested. Rearing was significantly attenuated at 1.0 mg/kg, while cage exploration increased at this dose. Defensive and social behaviors remained largely unchanged. These results show that both compounds tested produced significant reductions in offensive behavior, with concomitant changes in defensive, social, and nonsocial behaviors. Results are discussed in relation to SDZ 216-525 and (-)-pindolol potential for the control of anxiety and agonistic behavior.
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Affiliation(s)
- R Bell
- School of Psychology, Queen's University of Belfast, Northern Ireland
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Bell R, Hobson H. Effects of pindobind 5-hydroxytryptamine1A (5-HT1A), a novel and potent 5-HT1A antagonist, on social and agonistic behaviour in male albino mice. Pharmacol Biochem Behav 1993; 46:67-72. [PMID: 8255924 DOI: 10.1016/0091-3057(93)90318-n] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In view of inconsistent results reported for 5-hydroxytryptamine1A (5-HT1A) receptor involvement in murine social conflict, this study examined the effects of N1-(bromoacetyl)-N8-[3-(4-indolyloxy)-2- hydroxypropyl]-(Z)-1,8-diamino-p-menthane (pindobind) 5-HT1A, a novel 5-HT1A antagonist, on agonistic and social behaviour in mice. Employing a resident-intruder paradigm, administration of pindobind 5-HT1A (0.5-10 mg/kg) to resident animals produced a reduction in offensive sideways and chasing behaviour. Defensive postures were unchanged except for evasion, which was reduced. Within social behaviour, nonspecific social behaviour and following behaviour were reduced while stretch/attend behaviour was enhanced. Nonsocial behavioural changes included an increase in resident cage exploration and rearing. Intruder data indicated no significant change in offensive behaviours, an attenuation of defensive sideways posturing and evasion, decreases in attend behaviour, and increases in cage exploration, rearing, and digging. Results are discussed in relation to the effects of 5-HT1A receptor (ant)agonism on murine offensive behaviour.
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Affiliation(s)
- R Bell
- School of Psychology, Queen's University of Belfast, UK
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