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Garcia-Esperon C, Chew BLA, Minett F, Cheah J, Rutherford J, Wilsmore B, Parsons MW, Levi CR, Spratt NJ. Impact of an outpatient telestroke clinic on management of rural stroke patients. Aust J Rural Health 2022; 30:337-342. [PMID: 35412702 DOI: 10.1111/ajr.12849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Report on feasibility, use and effects on investigations and treatment of a neurologist-supported stroke clinic in rural Australia. DESIGN Data were collected prospectively for consecutive patients referred to atelehealth stroke clinic from November 2018 to August 2021. SETTINGS, PARTICIPANTS AND INTERVENTIONS Patients attended the local hospital, with a rural stroke care coordinator, and were assessed by stroke neurologist over videoconference. MAIN OUTCOME MEASURES The following feasibility outcomes on the first appointments were analysed: (1) utility (a) change in medication, (b) request of additional investigations, (c) enrolment/offering clinical trials or d) other; (2) acceptability (attendance rate); and (3) process of care (waiting time to first appointment, distance travelled). RESULTS During the study period, 173 appointments were made; 125 (73.5%) were first appointments. The median age was 70 [63-79] years, and 69 patients were male. A diagnosis of stroke or transient ischemic attack was made by the neurologist in 106 patients. A change in diagnosis was made in 23 (18.4%) patients. Of the first appointments, 102 (81.6%) resulted in at least one intervention: medication was changed in 67 (53.6%) patients, additional investigations requested in 72 (57.6%), 15 patients (12%) were referred to a clinical trial, and other interventions were made in 23 patients. The overall attendance rate of booked appointments was high. The median waiting time and distance travelled (round-trip) for a first appointment were 38 [24-53] days and 60.8 [25.6-76.6] km respectively. CONCLUSION The telestroke clinic was very well attended, and it led to high volume of interventions in rural stroke patients.
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Affiliation(s)
- Carlos Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Fiona Minett
- Department of Nursing Administration, Manning Base Hospital, Taree, New South Wales, Australia
| | - Joseph Cheah
- Department of Nursing Administration, Manning Base Hospital, Taree, New South Wales, Australia
| | - Jennifer Rutherford
- Hunter New England Information and Communications Technology, Telehealth, Newcastle, New South Wales, Australia
| | - Bradley Wilsmore
- Department of Cardiology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Mark W Parsons
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Department of Neurology, Ingham Institute for Applied Medical Research, Liverpool Hospital, University of New South Wales South Western Sydney Clinical School, Sydney, New South Wales, Australia
| | - Christopher R Levi
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Neil J Spratt
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Koye DN, Magliano DJ, Reid CM, Pavkov ME, Chadban SJ, McDonald SP, Polkinghorne KR, White S, Paul C, Shaw JE. Trends in Incidence of ESKD in People With Type 1 and Type 2 Diabetes in Australia, 2002-2013. Am J Kidney Dis 2018; 73:300-308. [PMID: 30579709 DOI: 10.1053/j.ajkd.2018.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/11/2018] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE The number of people with diabetes and end-stage kidney disease (ESKD) is increasing worldwide, but it is unknown whether this indicates an increasing risk for ESKD in people with diabetes. We examined temporal trends in the incidence of ESKD within the Australian population with diabetes from 2002 to 2013. STUDY DESIGN Follow-up study using a national health care services registry. SETTING & PARTICIPANTS Registrants with type 1 or type 2 diabetes in Australia's National Diabetes Services Scheme (NDSS). PREDICTORS Age, sex, indigenous status, diabetes type, and calendar year. OUTCOME Incidence of ESKD (dialysis or kidney transplantation) or death ascertained using the Australian and New Zealand Dialysis and Transplant Registry and the Australian national death index. ANALYTICAL APPROACH NDSS registrants were followed up from 2002 or date of registration until onset of ESKD, death, or December 31, 2013. The incidence of ESKD in type 1 diabetes was calculated only in those younger than 55 years. RESULTS Among 1,375,877 registrants between 2002 and 2013, a total of 9,977 experienced incident ESKD, representing an overall incidence of ESKD in people with diabetes of 10.0 (95% CI, 9.8-10.2) per 10,000 person-years. Among those with type 1 diabetes, the age-standardized annual incidence was stable during the study period. Among those with type 2 diabetes, the incidence increased in nonindigenous people (annual percentage change, 2.2%; 95% CI, 0.4%-4.1%) with the greatest increases in those younger than 50 and those older than 80 years. No significant change over time was observed in indigenous people, although the adjusted incident rate ratio for indigenous versus nonindigenous was 4.03 (95% CI, 3.68-4.41). LIMITATIONS Lack of covariates such as comorbid conditions, medication use, measures of quality of care, and baseline kidney function. CONCLUSIONS The age-standardized annual incidence of ESKD increased in Australia from 2002 to 2013 for nonindigenous people with type 2 diabetes but was stable for people with type 1 diabetes. Efforts to prevent the development of ESKD, especially among indigenous Australians and those with early-onset type 2 diabetes, are warranted.
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Affiliation(s)
- Digsu N Koye
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Dianna J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; School of Public Health, Curtin University, Perth, Australia
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Stephen P McDonald
- ANZDATA, Adelaide, Australia; University of Adelaide, Adelaide, Australia
| | - Kevan R Polkinghorne
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Australia
| | - Sarah White
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - Jonathan E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Yang Y, Gao L, Fu J, Zhang J, Li Y, Yin B, Chen W, Geng D. Apparent diffusion coefficient evaluation for secondary changes in the cerebellum of rats after middle cerebral artery occlusion. Neural Regen Res 2013; 8:2942-50. [PMID: 25206615 PMCID: PMC4146177 DOI: 10.3969/j.issn.1673-5374.2013.31.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 10/05/2013] [Indexed: 11/18/2022] Open
Abstract
Supratentorial cerebral infarction can cause functional inhibition of remote regions such as the cerebellum, which may be relevant to diaschisis. This phenomenon is often analyzed using positron emission tomography and single photon emission CT. However, these methods are expensive and radioactive. Thus, the present study quantified the changes of infarction core and remote regions after unilateral middle cerebral artery occlusion using apparent diffusion coefficient values. Diffusion-weighted imaging showed that the area of infarction core gradually increased to involve the cerebral cortex with increasing infarction time. Diffusion weighted imaging signals were initially increased and then stabilized by 24 hours. With increasing infarction time, the apparent diffusion coefficient value in the infarction core and remote bilateral cerebellum both gradually decreased, and then slightly increased 3–24 hours after infarction. Apparent diffusion coefficient values at remote regions (cerebellum) varied along with the change of supratentorial infarction core, suggesting that the phenomenon of diaschisis existed at the remote regions. Thus, apparent diffusion coefficient values and diffusion weighted imaging can be used to detect early diaschisis.
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Affiliation(s)
- Yunjun Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Lingyun Gao
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Jun Fu
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Weijian Chen
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China
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