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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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Noch EK, Pham D, Kitago T, Wuennemann M, Wortman-Jutt S, Falo MC. Qualitative feasibility study of the mobile app Destroke for clinical stroke monitoring based on the NIH stroke scale. Heliyon 2023; 9:e18393. [PMID: 37560705 PMCID: PMC10407036 DOI: 10.1016/j.heliyon.2023.e18393] [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: 02/21/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Stroke is a leading cause of severe disability in the United States, but there is no effective method for patients to accurately detect the signs of stroke at home. We developed a mobile app, Destroke, that allows remote performance of a modified NIH stroke scale (NIHSS) by patients. AIMS To assess the feasibility of a mobile app for stroke monitoring and education by patients with a history of stroke. MATERIALS AND METHODS We enrolled 25 patients with a history of stroke in a prospective open-label study to evaluate the feasibility of the Destroke app in patients with stroke. Nineteen patients completed all study assessments, with a median time from stroke onset to enrollment of 5.6 years (range 0.1-12 years). We designed a modified NIHSS that assessed 12 out of 16 tasks on the NIHSS. Patients completed this test eight times over a 28-day period. We conducted pre-study surveys that assessed demographic information, stroke and cardiovascular history, baseline NIHSS, and experience using mobile technologies, and mid- and post-study surveys that assessed patient satisfaction on app usage and confidence in stroke detection. RESULTS Ten men and nine women participated in this study (median age of 64 (33-76)), representing ten US states and Washington D.C. Median baseline NIHSS was 0 (0-4). 15 patients reported using health apps. On a 5-point Likert scale, patients rated the app as 4.2 on being able to understand and use the app and 4.3 on using the app when instructed by their doctor. For eight patients with poor confidence in detecting the signs of a stroke before the study, six showed higher confidence after the study. CONCLUSIONS The use of an at-home stroke monitoring app is feasible by patients with a history of stroke and improves confidence in detecting the signs of stroke.
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Affiliation(s)
- Evan K. Noch
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
- Destroke, Inc., USA
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Brissette V, Rioux B, Choisi T, Poppe AY. Impact of bilingual face, arm, speech, time (FAST) public awareness campaigns on emergency medical services (EMS) activation in a large Canadian metropolitan area. CAN J EMERG MED 2023; 25:403-410. [PMID: 37010730 DOI: 10.1007/s43678-023-00482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/23/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND AND AIMS Face, arm, speech, time (FAST) public awareness campaigns improve stroke recognition in the general population. Whether this translates into improved emergency medical services (EMS) activation remains unclear. We assessed the association of five consecutive FAST campaigns with EMS calls for suspected strokes in a large urban area of Quebec, Canada. METHODS We conducted an observational study to assess data collected between June 2015 and December 2019 by the public EMS agency covering the cities of Laval and Montreal (Quebec, Canada). Five FAST campaigns were held over this period (mean duration: 9 weeks). We compared daily EMS calls before and after all FAST campaigns (2015 vs 2019) with t tests and Mann-Whitney U tests. We used single-group, univariate interrupted time series to measure changes in daily EMS calls for suspected strokes following each FAST campaign (stroke categories: any, symptom onset < 5 h, Cincinnati Prehospital Stroke Scale [CPSS] 3/3). Calls for headache served as negative control. RESULTS After five FAST campaigns, mean daily EMS calls increased by 28% (p < 0.001) for any suspected stroke and by 61% (p < 0.001) for stroke with symptom onset < 5 h, compared to 10.1% for headache (p = 0.012). Significant increases in daily EMS calls were observed after three campaigns (highest OR = 1.26; 95% CI 1.11, 1.43; p < 0.001). There were no significant changes in calls after individual campaigns for suspected stroke with symptom onset < 5 h, or suspected stroke with CPSS 3/3. CONCLUSIONS We observed an inconsistent impact of individual FAST campaigns on EMS calls for any suspected stroke, and did not observe significant EMS call changes after individual campaigns for acute (< 5 h) and severe (CPSS 3/3) strokes. These results may help stakeholders identify potential benefits and limitations of public awareness campaigns using the FAST acronym.
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Affiliation(s)
- Vincent Brissette
- Department of Medicine (Neurology), Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Bastien Rioux
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Alexandre Y Poppe
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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Mavragani A, Ancer Leal A, Montiel TC, Wynne KJ, Edquilang G, Vu KYT, Vahidy F, Savitz SI, Beauchamp JE, Sharrief A. An Intervention Mapping Approach to Developing a Stroke Literacy Video for Recent Stroke Survivors: Development and Usability Study. JMIR Form Res 2023; 7:e31903. [PMID: 35972729 PMCID: PMC9850284 DOI: 10.2196/31903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy-an understanding of stroke symptoms, risk factors, and treatment-likely contributes to vascular risk factor control and in turn stroke recurrence risk. Stroke literacy is the lowest among adults belonging to racial and ethnic minority populations in the United States. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce the risk of stroke recurrence. However, the failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. Intervention mapping (IM) provides a framework for use in the development, implementation, and evaluation of evidence-informed, health-related interventions. OBJECTIVE We aimed to develop a video-based educational intervention to improve stroke literacy in hospitalized patients with acute stroke. METHODS The 6-step iterative process of IM was used to develop a video-based educational intervention and related implementation and evaluation plans. The six steps included a needs assessment, the identification of outcomes and change objectives, the selection of theory- and video-based intervention methods and practical applications, the development of a video-based stroke educational intervention, plans for implementation, and evaluation strategies. RESULTS A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. A planned approach to video adoption, implementation, and evaluation was also developed. CONCLUSIONS An IM approach guided the development of a 5-minute video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support widespread access and participation in video-based health literacy interventions for populations with acute and chronic stroke. Studies are needed to assess the impact of video-based educational interventions that are paired with stroke systems of care optimization to reduce the risk of stroke recurrence. Furthermore, studies on culturally and linguistically sensitive video-based stroke literacy interventions are needed to address known racial and ethnic disparities in stroke literacy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1371/journal.pone.0171952.
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Affiliation(s)
| | - Andrea Ancer Leal
- Department of Research, Cizik School of Nursing at UTHealth, Houston, TX, United States
| | | | - Keona J Wynne
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | | | - Kim Yen Thi Vu
- Memorial Hermann - Texas Medical Center, Houston, TX, United States
| | - Farhaan Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX, United States.,Department of Population Health Sciences, Weill Cornell Medical School, New York, NY, United States.,Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States
| | - Sean I Savitz
- Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
| | - Jennifer Es Beauchamp
- Department of Research, Cizik School of Nursing at UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
| | - Anjail Sharrief
- Department of Neurology, McGovern Medical School, UTHealth, Houston, TX, United States.,UTHealth Institute for Stroke and Cerebrovascular Disease, Houston, TX, United States
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Austin EE, Lanos N, Hutchinson K, Barnes S, Fajardo Pulido D, Ruane C, Clay-Williams R. Groundhog Day in the emergency department: A systematic review of 20 years of news coverage in Australia. PLoS One 2023; 18:e0285207. [PMID: 37130103 PMCID: PMC10153716 DOI: 10.1371/journal.pone.0285207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023] Open
Abstract
This study examined how the Australian news media have portrayed public hospital Emergency Departments (EDs) over the last two decades. A systematic review and media frame analysis, searching Factiva and Australia and New Zealand News Stream for digital and print news articles published between January 2000 and January 2020. Eligibility criteria were (1) discussed EDs in public hospitals; (2) the primary focus of the article was the ED; (3) focused on the Australian context; (4) were published by one of the Australian state-based news outlets (e.g., The Sydney Morning Herald, Herald Sun). A pair of reviewers independently screened 242 articles for inclusion according to the pre-established criteria. Discrepancies were resolved via discussion. 126 articles met the inclusion criteria. Pairs of independent reviewers identified frames in 20% of the articles using an inductive approach to develop a framework for coding the remaining articles. News media rely heavily on reporting problems within and with the ED, while also proposing a cause. Praise for EDs was minimal. Opinions were primarily from government spokespeople, professional associations, and doctors. ED performance was often reported as fact, with no reference to the source of the information. Rhetorical framing devices, such as hyperbole and imagery, were used to emphasise dominant themes. The negative bias inherent in news media reporting of EDs could potentially damage public awareness of ED functioning, with implications for the likelihood of the public's accessing ED services. Like in the film Groundhog Day, news media reporting is stuck in a loop reporting the same narrative over and over again.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nadia Lanos
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Susan Barnes
- School of Social Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Colum Ruane
- General Education Department, City University of Macau, Macau, China
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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6
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The PRESTO study: awareness of stroke symptoms and time from onset to intervention. Neurol Sci 2023; 44:229-236. [PMID: 36190685 DOI: 10.1007/s10072-022-06399-9] [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: 04/06/2022] [Accepted: 08/11/2022] [Indexed: 11/05/2022]
Abstract
Timely access to medical assistance is the first crucial step to improving clinical outcomes of stroke patients. Many educational campaigns have been organized with the purpose of making people aware of what a stroke is and what is necessary to do after its clinical onset. The PRESTO campaign was organized in Genoa (Italy) to spread easy messages regarding the management of the acute phase of stroke. Educational material was disseminated to educate people to call the emergency medical services as soon as symptoms appear. Data collected were analyzed in three different phases of the campaign: before the beginning, during, and after the end. We enrolled 1,132 patients with ischemic stroke admitted to hospital within 24 hours of symptoms onset. Our data showed a mild reduction in onset-to-door time (24 minutes) during the months following the end of the campaign and a slight increase in number of patients who arrived at hospitals, in particular with milder symptoms and transient ischemic attack, as opposed to the same period before the campaign. Interestingly, in the months after the end of the campaign, we observed a slight reduction of the percentage of patients who accessed hospitals after 4.5 hours from symptoms onset. In conclusion, our results may suggest that an informative campaign can be successful in making people rapidly aware of stroke onset, with the consequent rapid access to hospitals. Considering the changing of way of access to information, we think that an extensive multimedia campaign should be evaluated in the next future.
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7
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Walter S, Phillips D, Wells B, Moon R, Bertsch T, Grunwald IQ, Fassbender K. Detection to Hospital Door: Gender Differences of Patients With Acute Stroke Symptoms. Front Neurol 2022; 13:833933. [PMID: 35463123 PMCID: PMC9021751 DOI: 10.3389/fneur.2022.833933] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/09/2022] [Indexed: 12/02/2022] Open
Abstract
Although prehospital stroke management is challenging, it is a crucial part of the acute stroke chain to enable equal access to highly specialised stroke care. It involves a critical understanding of players usually not specialized in acute stroke treatments. There is contradictory information about gender inequity in prehospital stroke detection, dispatch, and delivery to hospital stroke centers. The aim of this narrative review is to summarize the knowledge of gender differences in the first three stages of acute stroke management. Information on the detection of acute stroke symptoms by patients, their relatives, and bystanders is discussed. Women seem to have a better overall knowledge about stroke, although general understanding needs to be improved. However, older age and different social situations of women could be identified as reasons for reduced and delayed help-seeking. Dispatch and delivery lie within the responsibility of the emergency medical service. Differences in clinical presentation with symptoms mainly affecting general conditions could be identified as a crucial challenge leading to gender inequity in these stages. Improvement of stroke education has to be applied to tackle this inequal management. However, specifically designed projects and analyses are needed to understand more details of sex differences in prehospital stroke management, which is a necessary first step for the potential development of substantially improving strategies.
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Affiliation(s)
- Silke Walter
- Neurology, Saarland University, Homburg, Germany
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
- *Correspondence: Silke Walter
| | - Daniel Phillips
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
| | - Brittany Wells
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
| | - Robert Moon
- East of England Ambulance Service NHS Trust, Melbourn, United Kingdom
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Iris Q. Grunwald
- Division of Imaging Science and Technology, School of Medicine, University of Dundee, Dundee, United Kingdom
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8
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Stroke education focusing on recognition and response to decrease pre-hospital delay in India: Need of the hour to save hours. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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9
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Effect of Community Education Program on Stroke Symptoms and Treatment on School and College Students from South India: A Longitudinal Observational Study. Healthcare (Basel) 2021; 9:healthcare9121637. [PMID: 34946363 PMCID: PMC8702212 DOI: 10.3390/healthcare9121637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
Community awareness regarding stroke signs, risk factors, and actions that help reduce the risk and complications of stroke is poorly addressed, as it is thought to be the best approach to control and prevent stroke. Aim: To establish the awareness of stroke and its management among high school and college students using an educational intervention. A questionnaire was administered to students from five high schools and four colleges with different areas of focus, (arts, science and commerce), types (public, semi-public and private), and economic locations before and after an educational lecture on stroke. The lecture covered the following elements: stroke definition, signs, risk factors, actions, time window for thrombolytic therapy, and types of rehabilitation interventions. This study included 1036 participants, of whom 36.3% were male and 56.4% were high school students, and the mean age was 17.15 ± 1.29 (15-22) years. Before the lecture, 147 participants were unaware of a single sign of stroke, and 124 did not know the risk factors. After the intervention, 439 participants knew four signs of stroke, and 196 knew 12 risk factors. Female students had better knowledge about stroke signs (odds ratio (OR), 3.08; 95% confidence interval (95% CI), 2.15-4.43). Hypertension (52.7%) and weakness (59.85%) were the most known signs and risk factors. The proportion of students who selected traditional medicine as the mode of treatment decreased from 34.75% to 8.59% after the lecture. Other rehabilitation methods (e.g., physical therapy, occupational therapy, speech therapy and counseling) were chosen by more than 80% of the students. The results of the current study showed that the awareness on stroke risk factors and management among the school and college students can be significantly improved with regular educational interventions, and therefore stroke can be prevented to some extent.
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10
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The Impact of Stroke Public Awareness Campaigns Differs Between Sociodemographic Groups. Can J Neurol Sci 2021; 49:231-238. [PMID: 33875043 DOI: 10.1017/cjn.2021.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prehospital delays are a major obstacle to timely reperfusion therapy in acute ischemic stroke. Stroke sign recognition, however, remains poor in the community. We present an analysis of repeated surveys to assess the impact of Face, Arm, Speech, Time (FAST) public awareness campaigns on stroke knowledge. METHODS Four cross-sectional surveys were conducted between July 2016 and January 2019 in the province of Quebec, Canada (n = 2,451). Knowledge of FAST stroke signs (face drooping, arm weakness and speech difficulties) was assessed with open-ended questions. A bilingual English/French FAST public awareness campaign preceded survey waves 1-3 and two campaigns preceded wave 4. We used multivariable ordinal regression models weighted for age and sex to assess FAST stroke sign knowledge. RESULTS We observed an overall significant improvement of 26% in FAST stroke sign knowledge between survey waves 1 and 4 (odds ratio [OR] = 1.26; 95% CI: 1.02, 1.55; p = 0.035). After the last campaign, however, 30.5% (95% CI: 27.5, 33.6) of people were still unable to name a single FAST sign. Factors associated with worse performance were male sex (OR = 0.68; 95% CI: 0.53, 0.86; p = 0.002) and retirement (OR = 0.54; 95% CI: 0.35, 0.83; p = 0.005). People with lower household income and education had a tendency towards worse stroke sign knowledge and were significantly less aware of the FAST campaigns. CONCLUSIONS Knowledge of FAST stroke signs in the general population improved after multiple public awareness campaigns, although it remained low overall. Future FAST campaigns should especially target men, retired people and individuals with a lower socioeconomic status.
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11
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Grech P, Grech R. The role of health promotion theories in Stroke Awareness and Education. Appl Nurs Res 2021; 58:151415. [PMID: 33745555 DOI: 10.1016/j.apnr.2021.151415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
The aim of this paper is to provide an overview of health promotion theories and their application to Stroke Awareness and Education. Stroke stands as one of the leading causes of mortality and morbidity even though treatment is readily available. One of the major challenges in this area is that the effectiveness of treatment depends heavily on timely presentation to healthcare services. Unfortunately, many individuals do not seek help whilst experiencing symptoms or only do so after a significant delay. This paper explores the main health promotion theories related to this problematic health behaviour in relation to stroke.
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Affiliation(s)
- Paulann Grech
- Department of Mental Health, Faculty of Health Sciences, University of Malta, Malta.
| | - Reuben Grech
- Medical Imaging Department, Mater Dei Hospital, Malta
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12
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Yafasova A, Fosbøl EL, Johnsen SP, Kruuse C, Petersen JK, Alhakak A, Vinding NE, Torp-Pedersen C, Gislason GH, Køber L, Butt JH. Time to Thrombolysis and Long-Term Outcomes in Patients With Acute Ischemic Stroke: A Nationwide Study. Stroke 2021; 52:1724-1732. [PMID: 33657854 DOI: 10.1161/strokeaha.120.032837] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Adelina Yafasova
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (A.Y., E.L.F., J.K.P., A.A., N.E.V., L.K., J.H.B.)
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (A.Y., E.L.F., J.K.P., A.A., N.E.V., L.K., J.H.B.)
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark (S.P.J.)
| | - Christina Kruuse
- Department of Neurology, Herlev and Gentofte University Hospital, Denmark (C.K.).,University of Copenhagen, Institute of Clinical Medicine, Denmark (C.K.)
| | - Jeppe Kofoed Petersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (A.Y., E.L.F., J.K.P., A.A., N.E.V., L.K., J.H.B.)
| | - Amna Alhakak
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (A.Y., E.L.F., J.K.P., A.A., N.E.V., L.K., J.H.B.)
| | - Naja Emborg Vinding
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (A.Y., E.L.F., J.K.P., A.A., N.E.V., L.K., J.H.B.)
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark (C.T.-P.).,Department of Cardiology, Aalborg University Hospital, Denmark (C.T.-P.)
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark (G.H.G.).,The Danish Heart Foundation, Copenhagen, Denmark (G.H.G.).,The National Institute of Public Health, University of Southern Denmark, Odense, Denmark (G.H.G.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (A.Y., E.L.F., J.K.P., A.A., N.E.V., L.K., J.H.B.)
| | - Jawad Haider Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (A.Y., E.L.F., J.K.P., A.A., N.E.V., L.K., J.H.B.)
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13
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Prabhakaran S, Richards CT, Kwon S, Wymore E, Song S, Eisenstein A, Brown J, Kandula NR, Mason M, Beckstrom H, Washington KV, Aggarwal NT. A Community-Engaged Stroke Preparedness Intervention in Chicago. J Am Heart Assoc 2020; 9:e016344. [PMID: 32893720 PMCID: PMC7726971 DOI: 10.1161/jaha.120.016344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background We evaluated a community‐engaged stroke preparedness intervention that aimed to increase early hospital arrival and emergency medical services (EMS) utilization among patients with stroke in the South Side of Chicago, Illinois. Methods and Results We compared change in early hospital arrival (<3 hours from symptom onset) and EMS utilization before and after our intervention among patients with confirmed ischemic stroke at an intervention hospital on the South Side of Chicago with concurrent data from 6 hospitals in nonintervention communities on the North Side of Chicago and 17 hospitals in St Louis, Missouri. We assessed EMS utilization for suspected stroke secondarily, using geospatial information systems analysis of Chicago ambulance transports before and after our intervention. Among 21 497 patients with confirmed ischemic stroke across all sites, early arrival rates at the intervention hospital increased by 0.5% per month (95% CI, −0.2% to 1.2%) after intervention compared with the preintervention period but were not different from North Side Chicago hospitals (difference of −0.3% per month [95% CI, −0.12% to 0.06%]) or St Louis hospitals (difference of 0.7% per month [95% CI, −0.1% to 1.4%]). EMS utilization at the intervention hospital decreased by 0.8% per month (95% CI, −1.7% to 0.2%) but was not different from North Side Chicago hospitals (difference of 0.004% per month [95% CI, −1.1% to 1.1%]) or St Louis hospitals (difference of −0.7% per month [95% CI, −1.7% to 0.3%]). EMS utilization for suspected stroke increased in the areas surrounding the intervention hospital (odds ratio [OR], 1.4; 95% CI, 1.2–1.6) and in the South Side (OR, 1.2; 95% CI, 1.1–1.3), but not in the North Side (OR, 1.0; 95% CI, 0.9–1.1). Conclusions Following a community stroke preparedness intervention, early hospital arrival and EMS utilization for confirmed ischemic stroke did not increase. However, ambulance transports for suspected stroke increased in the intervention community compared with other regions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02301299.
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Affiliation(s)
| | | | - Soyang Kwon
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | - Erin Wymore
- Northwestern University, Feinberg School of Medicine Chicago IL
| | - Sarah Song
- Rush University Medical Center Chicago IL
| | | | - Jen Brown
- Northwestern University, Feinberg School of Medicine Chicago IL
| | | | - Maryann Mason
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | | | | | - Neelum T Aggarwal
- The Retirement Research Foundation Chicago IL.,Rush Alzheimer's Disease Center Chicago IL
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14
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Bridgwood BM, Wilson A, Clarke D, Eborall H. Understanding TIA: an ethnographic study of TIA consultations. Fam Pract 2020; 37:530-534. [PMID: 32016372 DOI: 10.1093/fampra/cmaa004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transient ischaemic attack (TIA) is a transient episode of neurological dysfunction. Rapid access TIA clinics have been set up as integrated 'one-stop' clinics that aim to investigate, diagnose, educate and implement treatment to reduce the risk of further TIA/stroke. OBJECTIVE This study aimed to examine how TIA consultations were conducted by observing the consultations and then interviewing patients. METHODS This ethnographic study observed fifteen patient-clinician consultations where a diagnosis of TIA was made within three different TIA outpatient clinics in the East Midlands. All fifteen patients, their accompanying family-members/carers and three stroke clinicians were interviewed. Data analysis was informed by the constant comparative approach. RESULTS There was considerable variation in the conduct of these consultations across sites and clinicians. This resulted in variation in patient experience and knowledge after the consultation including the ability to recognize TIA-associated risk factors and their management. As TIA symptoms resolve, patients may reduce their need to seek health care services in addition to demonstrating reduced concordance with secondary stroke prevention. Health professionals recognize that this single appointment provides patients with a large amount of information which may be difficult to process. Importantly, there was little discussion about future symptoms and how to respond. A management plan, which considered a patient's health belief, knowledge and encouraged the involvement of family members, improved information recall. CONCLUSIONS TIA is a complex medical diagnosis with multiple risk factors that may make the management complex and hence difficult for patients to undertake. Our findings found variability in the conduct, provision of information and patient understanding. Guidance on nationally agreed consultation framework may prove useful. Improved patient education may include individualized/sustained education utilizing multidisciplinary team members across family/primary and secondary care, video or greater online education and improved general public education.
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Affiliation(s)
| | - Andrew Wilson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David Clarke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
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15
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Knowledge on Signs and Risk Factors in Stroke Patients. J Clin Med 2020; 9:jcm9082557. [PMID: 32784554 PMCID: PMC7463706 DOI: 10.3390/jcm9082557] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/26/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022] Open
Abstract
Background: There is a pressing need to contribute evidence to the improvement in the early identification of signs and symptoms associated with strokes, and address the treatment-seeking delays. The objective of this study is to describe the knowledge regarding the warning signs and risk factors (RFs) among stroke patients, as well as of their attitudes toward a suspected event, and the analysis of its possible relationship with the socio-demographic and clinical characteristics of these patients. Method: A cross-sectional study was designed, in which all stroke patients admitted consecutively to the Burgos University Hospital (Spain) were included. The principal outcomes were the patient’s ability to identify two RFs and two warning signs and the patient’s hypothetical response to a possible stroke event. The possible factors associated with the knowledge of warning signs, RFs, and the correct response to a new event were studied using univariate and multivariate regression analysis. Results: A total of 529 patients were included. Having a higher education level or a history of prior stroke were associated with a greater degree of knowledge of warning signs (odds ratio (OR) 3.19, 95% confidence interval (CI) 1.70–5.74, p = 0.003; OR 3.54, 95%CI 2.09–5.99, p ≤ 0.001, respectively), RFs (OR 3.15, 95%CI 1.75–5.67, p = 0.008; OR 4.08, 95%CI 2.41–6.91, p = 0.002, respectively), and the correct response to a possible stroke (OR 1.82, 95%CI 1.16–2.86; p = 0.030; OR 2.11, 95%CI 1.29–3.46, p = 0.022, respectively). Conclusion: Knowledge of warning signs or stroke RFs is low in the hospitalized patients. A previous stroke or secondary/higher education levels are the predictor factors that increase the probability of knowledge of warning signs, RFs, or reaction to possible event.
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16
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Call 911: Lower Ambulance Utilization Among Young Adults, Especially Women, with Stroke. Can J Neurol Sci 2020; 47:764-769. [PMID: 32507117 DOI: 10.1017/cjn.2020.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Delayed presentation to the emergency department influences acute stroke care and can result in worse outcomes. Despite public health messaging, many young adults consider stroke as a disease of older people. We determined the differences in ambulance utilization and delays to hospital presentation between women and men as well as younger (18-44 years) versus older (≥45 years) patients with stroke. METHODS We conducted a population-based retrospective study using national administrative health data from the Canadian Institute of Health Information databases and examined data between 2003 and 2016 to compare ambulance utilization and time to hospital presentation across sex and age. RESULTS Young adults account for 3.9% of 463,310 stroke/transient ischemic attack/hemorrhage admissions. They have a higher proportion of hemorrhage (37% vs. 15%) and fewer ischemic events (50% vs. 68%) compared with older patients. Younger patients are less likely to arrive by ambulance (62% vs. 66%, p < 0.001), with younger women least likely to use ambulance services (61%) and older women most likely (68%). Median stroke onset to hospital arrival times were 7 h for older patients and younger men, but 9 h in younger women. There has been no improvement among young women in ambulance utilization since 2003, whereas ambulance use increased in all other groups. CONCLUSIONS Younger adults, especially younger women, are less likely to use ambulance services, take longer to get to hospital, and have not improved in utilization of emergency services for stroke over 13 years. Targeted public health messaging is required to ensure younger adults seek emergency stroke care.
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17
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Novikova LB, Akopyan AP, Sharapova KM, Kolchina EM. Reperfusion therapy in ischemic stroke. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-1-11-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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18
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Novikova LB, Akopyan AP, Sharapova KM, Kolchina EM. Reperfusion therapy of ischemic stroke. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2019-2192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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19
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Bowden A, Burford JH, Brennan ML, England GCW, Freeman SL. Horse owners' knowledge, and opinions on recognising colic in the horse. Equine Vet J 2020; 52:262-267. [PMID: 31461570 PMCID: PMC7027804 DOI: 10.1111/evj.13173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/15/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Colic is the most common emergency problem in the horse. An owner's ability to recognise colic and seek assistance is a critical first step in determining case outcome. OBJECTIVES The aim of this study was to assess horse owners' knowledge and opinions on recognising colic. STUDY DESIGN Cross-sectional study. METHODS An online questionnaire was distributed to horse owners with open and closed questions on their knowledge of normal clinical parameters in the horse, confidence and approach to recognising colic (including assessment through case scenarios), and their demographics. Descriptive and chi squared statistical analyses were performed. RESULTS There were 1564 participants. Many respondents either did not know or provided incorrect estimates for their horse's normal clinical parameters: only 45% (n = 693/1540) gave correct normal values for heart rate, 45% (n = 694/1541) for respiratory rate and 67% (n = 1028/1534) for rectal temperature. Knowledge of normal values was statistically associated with participants' educational qualifications (P<0.01). Owners said if they suspected their horse had colic they would assess faecal output (76%; n = 1131/1486), gastrointestinal sounds (75%; n = 1113/1486), respiratory rate (65%; n = 967/1486) and heart rate (54%; n = 797/1486). There was a lack of consensus on whether to call a vet for behavioural signs of colic, unless the signs were severe or persistent. The majority of participants (61%) were confident that they could recognise most types of colic. In the case scenarios, 49% were confident deciding that a surgical case had colic, but 9% were confident deciding an impaction case had colic. MAIN LIMITATIONS Most respondents were UK based; risk of self-selection bias for owners with previous experience of colic. CONCLUSIONS There was marked variation in horse owners' recognition and responses to colic, and significant gaps in knowledge. This highlights the need for the development of accessible educational resources to support owners' decision-making.
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Affiliation(s)
- A. Bowden
- School of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - J. H. Burford
- School of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - M. L. Brennan
- School of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - G. C. W. England
- School of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - S. L. Freeman
- School of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
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20
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Fladt J, Meier N, Thilemann S, Polymeris A, Traenka C, Seiffge DJ, Sutter R, Peters N, Gensicke H, Flückiger B, de Hoogh K, Künzli N, Bringolf-Isler B, Bonati LH, Engelter ST, Lyrer PA, De Marchis GM. Reasons for Prehospital Delay in Acute Ischemic Stroke. J Am Heart Assoc 2019; 8:e013101. [PMID: 31576773 PMCID: PMC6818040 DOI: 10.1161/jaha.119.013101] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Prehospital delay reduces the proportion of patients with stroke treated with recanalization therapies. We aimed to identify novel and modifiable risk factors for prehospital delay. Methods and Results We included patients with an ischemic stroke confirmed by diffusion-weighted magnetic resonance imaging, symptom onset within 24 hours and hospitalized in the Stroke Center of the University Hospital Basel, Switzerland. Trained study nurses interviewed patients and proxies along a standardized questionnaire. Prehospital delay was defined as >4.5 hours between stroke onset-or time point of wake-up-and admission. Overall, 336 patients were enrolled. Prehospital delay was observed in 140 patients (42%). The first healthcare professionals to be alarmed were family doctors for 29% of patients (97/336), and a quarter of these patients had a baseline National Institute of Health Stroke Scale score of 4 or higher. The main modifiable risk factor for prehospital delay was a face-to-face visit to the family doctor (adjusted odds ratio, 4.19; 95% CI, 1.85-9.46). Despite transport by emergency medical services being associated with less prehospital delay (adjusted odds ratio, 0.41; 95% CI, 0.24-0.71), a minority of patients (39%) who first called their family doctor were transported by emergency medical services to the hospital. The second risk factor was lack of awareness of stroke symptoms (adjusted odds ratio, 4.14; 95% CI, 2.36-7.24). Conclusions Almost 1 in 3 patients with a diffusion-weighted magnetic resonance imaging-confirmed ischemic stroke first called the family doctor practice. Face-to-face visits to the family doctor quadrupled the odds of prehospital delay. Efforts to reduce prehospital delay should address family doctors and their staffs as important partners in the prehospital pathway. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02798770.
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Affiliation(s)
- Joachim Fladt
- Department of Neurology University Hospital Basel Basel Switzerland
| | | | | | | | - Christopher Traenka
- Department of Neurology University Hospital Basel Basel Switzerland.,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation Felix Platter Hospital Basel Switzerland
| | - David J Seiffge
- Department of Neurology University Hospital Basel Basel Switzerland
| | - Raoul Sutter
- Department of Neurology University Hospital Basel Basel Switzerland.,Department of Intensive Care Medicine University Hospital Basel Basel Switzerland.,University of Basel Switzerland
| | - Nils Peters
- Department of Neurology University Hospital Basel Basel Switzerland.,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation Felix Platter Hospital Basel Switzerland.,University of Basel Switzerland
| | - Henrik Gensicke
- Department of Neurology University Hospital Basel Basel Switzerland.,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation Felix Platter Hospital Basel Switzerland.,University of Basel Switzerland
| | - Benjamin Flückiger
- Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Switzerland
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Switzerland
| | - Nino Künzli
- Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Switzerland
| | - Bettina Bringolf-Isler
- Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Switzerland
| | - Leo H Bonati
- Department of Neurology University Hospital Basel Basel Switzerland.,University of Basel Switzerland
| | - Stefan T Engelter
- Department of Neurology University Hospital Basel Basel Switzerland.,Neurorehabilitation Unit University of Basel and University Center for Medicine of Aging and Rehabilitation Felix Platter Hospital Basel Switzerland.,University of Basel Switzerland
| | - Philippe A Lyrer
- Department of Neurology University Hospital Basel Basel Switzerland.,University of Basel Switzerland
| | - Gian Marco De Marchis
- Department of Neurology University Hospital Basel Basel Switzerland.,University of Basel Switzerland
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21
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Martinez-Gutierrez JC, Chandra RV, Hirsch JA, Leslie-Mazwi T. Technological innovation for prehospital stroke triage: ripe for disruption. J Neurointerv Surg 2019; 11:1085-1090. [DOI: 10.1136/neurintsurg-2019-014902] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/19/2022]
Abstract
BackgroundWith the benefit of mechanical thrombectomy firmly established, the focus has shifted to improved delivery of care. Reducing time from symptom onset to reperfusion is a primary goal. Technology promises tremendous opportunities in the prehospital space to achieve this goal.MethodsThis review explores existing, fledgling, and potential future technologies for application in the prehospital space.ResultsThe opportunity for technology to improve stroke care resides in the detection, evaluation, triage, and transport of patients to an appropriate healthcare facility. Most prehospital technology remains in the early stages of design and implementation.ConclusionThe major challenges to tackle for future improvement in prehospital stroke care are that of public awareness, emergency medical service detection, and triage, and improved systems of stroke care. Thoughtfully applied technology will transform all these areas.
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23
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Farquharson B, Abhyankar P, Smith K, Dombrowski SU, Treweek S, Dougall N, Williams B, Johnston M. Reducing delay in patients with acute coronary syndrome and other time-critical conditions: a systematic review to identify the behaviour change techniques associated with effective interventions. Open Heart 2019; 6:e000975. [PMID: 30997136 PMCID: PMC6443141 DOI: 10.1136/openhrt-2018-000975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Background Time to treatment in many conditions, particularly acute coronary syndrome, is critical to reducing mortality. Delay between onset of symptoms and treatment remains a worldwide problem. Reducing patient delay has been particularly challenging. Embedding behaviour change techniques (BCTs) within interventions might lead to shorter delay. Objective To identify which BCTs are associated with reductions in patient delay among people with symptoms or conditions where time to treatment is critical. Methods The data sources were Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Study eligibility criteria include intervention evaluations (randomised controlled trials, controlled clinical trials and cohort studies) involving adults (aged >18 years) and including an outcome measure of patient delay up to August 2016. Study appraisal and synthesis methods include screening potential studies using a transparent, replicable process. Study characteristics, outcomes and BCTs were extracted from eligible studies. Results From 39 studies (200 538 participants), just over half (n=20) reported a significant reduction in delay. 19 BCTs were identified, plus 5 additional techniques, with a mean of 2 (SD=2.3) BCTs and 2 (SD=0.7) per intervention. No clear pattern between BCTs and effectiveness was found. In studies examining patient delay specifically, three of four studies that included two or more BCTs, in addition to the two most commonly used additional techniques, reported a significant reduction in delay. Conclusions Around half of the interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time. It is not clear what differentiates effective from non-effective interventions, although in relation to patient delay particularly additional use of BCTs might be helpful. Trial registration number CRD42014013106.
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Affiliation(s)
| | - Purva Abhyankar
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Karen Smith
- NHS Tayside School of Nursing & Midwifery, University of Dundee, Dundee, UK
| | | | - Shaun Treweek
- Health Sciences Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Brian Williams
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Kushwaha S, Talwar P, Chandel N, Anthony A, Maheshwari S, Khurana S. Saving the brain initiative - Developing an effective hub-and-spoke model to improve the acute stroke management pathways in urban India. J Neurol Sci 2018; 393:83-87. [PMID: 30125806 DOI: 10.1016/j.jns.2018.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We aimed to develop and evaluate a hub-and-spoke model in the East Delhi by assessing knowledge and creating awareness through sensitization programs in target communities and among general physicians (GPs) along with implementation of a standard stroke management protocol (SMP) at our institute in order to extend the benefit of thrombolytic therapy. METHODS We carried out a prospective interventional study using sensitization program comprising 1046 community participants and 101 GPs under "Saving the Brain Initiative" project. Network included one hub and six nearby spoke hospitals. The pre-awareness and post-awareness data along with clinical outcome of thrombolysis collected over 2012-2017 was analyzed. RESULTS We observed lack of awareness in communities and among GPs regarding stroke symptomatology and treatment options. There was 17.3% increase in patients with stroke post-awareness programs. Door-to-door time improved as 49.3% of patients reached hospital within <2 h of onset as compared to 32.2% in pre-awareness period. 89.4% patients had good outcome and were discharged with improved NIHSS. In the post-awareness period, the rate of thrombolysis increased by 4.0%. CONCLUSIONS Sensitization of primary physicians, paramedical and medical staff along with community dwellers and implementation of SMP through hub-and-stroke model is instrumental in improving the rate of thrombolysis and its outcome.
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Affiliation(s)
- Suman Kushwaha
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India.
| | - Puneet Talwar
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India.
| | - Niketa Chandel
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India
| | - Aldrin Anthony
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India
| | - Siddharth Maheshwari
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India
| | - Sarbjeet Khurana
- Department of Epidemiology, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, Delhi 110 095, India
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Huang Q, Zhang JZ, Xu WD, Wu J. Generalization of the right acute stroke promotive strategies in reducing delays of intravenous thrombolysis for acute ischemic stroke: A meta-analysis. Medicine (Baltimore) 2018; 97:e11205. [PMID: 29924046 PMCID: PMC6024468 DOI: 10.1097/md.0000000000011205] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The generalization of successful efforts for reducing time delays in intravenous thrombolysis (IVT) could help facilitate its utility and benefits in acute ischemic stroke (AIS) patients.We searched the PubMed and Embase databases for articles reporting interventions to reduce time delays in IVT, published between January 1995 and September 2017. The IVT rate was chosen as the primary outcome, while the compliance rates of onset-to-door time (prehospital delay) and door-to-needle time (in-hospital delay) within the targeted time frame were the secondary outcomes. Interventions designed to reduce prehospital, in-hospital, or total time delays were quantitatively described in meta-analyses. The efficacy of postintervention improvement was illustrated as odds ratios (ORs) and 95% confidence intervals (95% CIs).In total, 86 papers (17 on prehospital, 56 on in-hospital, and 13 on total delay) encompassing 17,665 IVT cases were enrolled, including 28 American, 23 Asian, 30 European, and 5 Australian studies. The meta-analysis revealed statistically significant improvement in promoting IVT delivery after prehospital improvement interventions with an OR of 1.45 (95% CI, 1.23-1.71) for the new transportation protocol, 1.38 (95% CI, 1.11-1.73) for educational and training programs, and 1.83 (95% CI, 1.44-2.32) for comprehensive prehospital stroke code. The benefits of reducing in-hospital delay were much greater in developed western countries than in Asian countries, with ORs of 2.90 (95% CI, 2.51-3.34), 2.17 (95% CI, 1.95-2.41), and 1.89 (95% CI, 1.74-2.04) in American, European, and Asian countries, respectively. And telemedicine (OR, 2.26; 95% CI, 2.08-2.46) seemed to work better than pre-notification alone (OR, 1.94; 95% CI, 1.74-2.17) and in-hospital organizational improvement programs (OR, 2.10; 95% CI, 1.97-2.23). Mobile stroke treatment unit and use of a comprehensive stroke pathway in the pre- and in-hospital settings significantly increased IVT rates by reducing total time delay, with ORs of 2.01 (95% CI, 1.60-2.51) and 1.77 (95% CI, 1.55-2.03), respectively.Optimization of the work flow with organizational improvement or novel technology could dramatically reduce pre- and in-hospital time delays of IVT in AIS. This study provided detailed information on the net and quantitative benefits of various programs for reducing time delays to facilitate the generalization of appropriate AIS management.
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Affiliation(s)
- Qiang Huang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Jing-ze Zhang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Wen-deng Xu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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26
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Vondráčková L, Mikulík R. Public stroke education: Current status worldwide and projects to increase awareness in the Czech Republic. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Effects of educational television commercial on pre-hospital delay in patients with ischemic stroke wore off after the end of the campaign. J Neurol Sci 2017; 381:117-118. [PMID: 28991660 DOI: 10.1016/j.jns.2017.08.3236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/30/2017] [Accepted: 08/21/2017] [Indexed: 11/22/2022]
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Nordanstig A, Asplund K, Norrving B, Wahlgren N, Wester P, Rosengren L. Impact of the Swedish National Stroke Campaign on stroke awareness. Acta Neurol Scand 2017; 136:345-351. [PMID: 28560735 DOI: 10.1111/ane.12777] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Time delay from stroke onset to arrival in hospital is an important obstacle to widespread reperfusion therapy. To increase knowledge about stroke, and potentially decrease this delay, a 27-month national public information campaign was carried out in Sweden. AIMS To assess the effects of a national stroke campaign in Sweden. METHODS The variables used to measure campaign effects were knowledge of the AKUT test [a Swedish equivalent of the FAST (Face-Arm-Speech-Time)] test and intent to call 112 (emergency telephone number) . Telephone interviews were carried out with 1500 randomly selected people in Sweden at eight points in time: before, three times during, immediately after, and nine, 13 and 21 months after the campaign. RESULTS Before the campaign, 4% could recall the meaning of some or all keywords in the AKUT test, compared with 23% during and directly after the campaign, and 14% 21 months later. Corresponding figures were 15%, 51%, and 50% for those remembering the term AKUT and 65%, 76%, and 73% for intent to call 112 when observing or experiencing stroke symptoms. During the course of the campaign, improvement of stroke knowledge was similar among men and women, but the absolute level of knowledge for both items was higher for women at all time points. CONCLUSION The nationwide campaign substantially increased knowledge about the AKUT test and intention to call 112 when experiencing or observing stroke symptoms, but knowledge declined post-intervention. Repeated public information therefore appears essential to sustain knowledge gains.
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Affiliation(s)
- A. Nordanstig
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - K. Asplund
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - B. Norrving
- Department of Clinical Sciences; Section of Neurology; Lund University, Skåne University Hospital; Lund Sweden
| | - N. Wahlgren
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - P. Wester
- Department of Clinical Science; Danderyds Hospital; Karolinska Institutet; Stockholm Sweden
| | - L. Rosengren
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
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Can Children Reduce Delayed Hospital Arrival for Ischemic Stroke?: A Systematic Review of School-Based Stroke Education. J Neurosci Nurs 2017; 48:E2-E13. [PMID: 27045288 DOI: 10.1097/jnn.0000000000000202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delayed hospital arrival after onset of ischemic stroke reduces the number of patients eligible for tissue plasminogen activator, which must be given soon after stroke onset. There are conflicting results about the impact of mass media stroke education on timing of hospital arrival and tissue plasminogen activator administration rates. School-based programs are a new way to communicate stroke information. METHODS A search of MEDLINE, CINAHL, PsycINFO, and ERIC databases from 1995 to 2014 identified school-based stroke education interventions. Twelve studies involving 3,312 children and 612 parents met criteria for review. RESULTS School-based stroke education interventions were effective to improve knowledge of stroke symptoms among children in kindergarten through junior high. Improvement for stroke risk factors was less robust. Interventions were effective regardless of format, length, or who delivered the information. Despite low parental response rates in some studies, there was evidence that children transmitted stroke information to parents. CONCLUSIONS School-based stroke education programs appear effective to improve knowledge of stroke symptoms. Research is needed to determine if children who participate are able to recognize stroke and respond appropriately by calling 911 in the real world. More study is needed about transfer of stroke knowledge from child to parent. Strategies to improve parent participation are needed.
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Baatiema L, de-Graft Aikins A, Sav A, Mnatzaganian G, Chan CKY, Somerset S. Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals. BMJ Open 2017; 7:e015385. [PMID: 28450468 PMCID: PMC5719663 DOI: 10.1136/bmjopen-2016-015385] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals' views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. DESIGN A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. SETTING A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. PARTICIPANTS A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. RESULTS Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. CONCLUSION Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.
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Affiliation(s)
- Leonard Baatiema
- Regional Institute for Population Studies, University of Ghana, Accra, Legon, Ghana
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Legon, Ghana
| | - Adem Sav
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Melbourne, Australia
| | - Carina K Y Chan
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Shawn Somerset
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
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Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers. Qual Life Res 2017; 26:2153-2160. [DOI: 10.1007/s11136-017-1550-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
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Metias MM, Eisenberg N, Clemente MD, Wooster EM, Dueck AD, Wooster DL, Roche-Nagle G. Public health campaigns and their effect on stroke knowledge in a high-risk urban population: A five-year study. Vascular 2017; 25:497-503. [PMID: 28264181 DOI: 10.1177/1708538117691879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The level of knowledge of stroke risk factors and stroke symptoms within a population may determine their ability to recognize and ultimately react to a stroke. Independent agencies have addressed this through extensive awareness campaigns. The aim of this study was to determine the change in baseline knowledge of stroke risk factors, symptoms, and source of stroke knowledge in a high-risk Toronto population between 2010 and 2015. Methods Questionnaires were distributed to adults presenting to cardiovascular clinics at the University of Toronto in Toronto, Canada. In 2010 and 2015, a total of 207 and 818 individuals, respectively, participated in the study. Participants were identified as stroke literate if they identified (1) at least one stroke risk factor and (2) at least one stroke symptom. Results A total of 198 (95.6%) and 791 (96.7%) participants, respectively, completed the questionnaire in 2010 and 2015. The most frequently identified risk factors for stroke in 2010 and 2015 were, respectively, smoking (58.1%) and hypertension (49.0%). The most common stroke symptom identified was trouble speaking (56.6%) in 2010 and weakness, numbness or paralysis (67.1%) in 2015. Approximately equal percentages of respondents were able to identify ≥1 risk factor (80.3% vs. 83.1%, p = 0.34) and ≥1 symptom (90.9% vs. 88.7%, p = 0.38). Overall, the proportion of respondents who were able to correctly list ≥1 stroke risk factors and stroke symptoms was similar in both groups.(76.8% vs. 75.5%, p = 0.70). The most commonly reported stroke information resource was television (61.1% vs. 67.6%, p = 0.09). Conclusion Stroke literacy has remained stable in this selected high-risk population despite large investments in public campaigns over recent years. However, the baseline remains high over the study period. Evaluation of previous campaigns and development of targeted advertisements using more commonly used media sources offer opportunities to enhance education.
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Affiliation(s)
| | - Naomi Eisenberg
- 2 Division of Vascular Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Canada
| | | | | | - Andrew D Dueck
- 2 Division of Vascular Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Canada
| | - Douglas L Wooster
- 2 Division of Vascular Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Canada
| | - Graham Roche-Nagle
- 2 Division of Vascular Surgery, Department of Surgery, Toronto General Hospital and University of Toronto, Toronto, Canada
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Puolakka T, Strbian D, Harve H, Kuisma M, Lindsberg PJ. Prehospital Phase of the Stroke Chain of Survival: A Prospective Observational Study. J Am Heart Assoc 2016; 5:e002808. [PMID: 27139735 PMCID: PMC4889170 DOI: 10.1161/jaha.115.002808] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/03/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few studies have discussed the emergency call and prehospital care as a continuous process to decrease the prehospital and in-hospital delays for acute stroke. To identify features associated with early hospital arrival (<90 minutes) and treatment (<120 minutes), we analyzed the operation of current dispatch protocol and emergency medical services and compared stroke recognition by dispatchers and ambulance crews. METHODS AND RESULTS This was a 2-year prospective observational study. All stroke patients who were transported to the hospital by emergency medical services and received recanalization therapy were recruited for the study. For a sample of 308 patients, the stroke code was activated in 206 (67%) and high priority was used in 258 (84%) of the emergency calls. Emergency medical services transported 285 (93%) of the patients using the stroke code and 269 (87%) using high priority. In the univariate analysis, the most dominant predictors of early hospital arrival were transport using stroke code (P=0.001) and high priority (P=0.002) and onset-to-call (P<0.0001) and on-scene times (P=0.052). In the regression analysis, the influences of high-priority transport (P<0.01) and onset-to-call time (P<0.001) prevailed as significant in both dichotomies of early arrival and treatment. The on-scene time was found to be surprisingly long (>23.5 minutes) for both early and late-arriving patients. CONCLUSIONS Fast emergency medical services activation and ambulance transport promoted early hospital arrival and treatment. Although patient-dependent delays still dominate the prehospital process, it should be ensured that the minutes on the scene are well spent.
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Affiliation(s)
- Tuukka Puolakka
- Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology and Clinical Neurosciences, Helsinki University Hospital, Helsinki, Finland
| | - Heini Harve
- Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland
| | - Markku Kuisma
- Emergency Medical Services, Helsinki University Hospital, Helsinki, Finland
| | - Perttu J Lindsberg
- Department of Neurology and Clinical Neurosciences, Helsinki University Hospital, Helsinki, Finland Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, University of Helsinki, Finland
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Redjaline A, Perrillat Y, Marrone G, Ballereau F, Martinez M, Borsier A, Garnier P, Viallon A. Délais d’admission et profil des patients présentant un accident vasculaire cérébral admis aux urgences d’hôpitaux ne disposant pas d’une unité neurovasculaire. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0576-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nishikawa T, Okamura T, Nakayama H, Miyamatsu N, Morimoto A, Toyoda K, Suzuki K, Toyota A, Hata T, Yamaguchi T. Effects of a Public Education Campaign on the Association Between Knowledge of Early Stroke Symptoms and Intention to Call an Ambulance at Stroke Onset: The Acquisition of Stroke Knowledge (ASK) Study. J Epidemiol 2015; 26:115-22. [PMID: 26441211 PMCID: PMC4773487 DOI: 10.2188/jea.je20150040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background An immediate ambulance call offers the greatest opportunity for acute stroke therapy. Effectively using ambulance services requires strengthening the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke onset, and encouraging the public to use ambulance services. Methods The present study utilized data from the Acquisition of Stroke Knowledge (ASK) study, which administered multiple-choice, mail-in surveys regarding awareness of early stroke symptoms and response to a stroke attack before and after a 2-year stroke education campaign in two areas subject to intensive and moderate intervention, as well as in a control area, in Japan. In these three areas, 3833 individuals (1680, 1088 and 1065 participants in intensive intervention, moderate intervention, and control areas, respectively), aged 40 to 74 years, who responded appropriately to each survey were included in the present study. Results After the intervention, the number of correctly identified symptoms significantly associated with intention to call an ambulance (P < 0.05) increased (eg, from 4 to 5 correctly identified symptoms), without increasing choice of decoy symptoms in the intensive intervention area. Meanwhile, in other areas, rate of identification of not only correct symptoms but also decoy symptoms associated with intention to call an ambulance increased. Furthermore, the association between improvement in the knowledge of stroke symptoms and intention to call an ambulance was observed only in the intensive intervention area (P = 0.009). Conclusions Our results indicate that intensive interventions are useful for strengthening the association between correct knowledge of early stroke symptoms and intention to call an ambulance, without strengthening the association between incorrect knowledge and intention to call an ambulance.
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Dombrowski SU, White M, Mackintosh JE, Gellert P, Araujo-Soares V, Thomson RG, Rodgers H, Ford GA, Sniehotta FF. The stroke 'Act FAST' campaign: remembered but not understood? Int J Stroke 2015; 10:324-30. [PMID: 25130981 DOI: 10.1111/ijs.12353] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/12/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The stroke awareness raising campaign 'Act FAST' (Face, Arms, Speech: Time to call Emergency Medical Services) has been rolled out in multiple waves in England, but impact on stroke recognition and response remains unclear. PURPOSE The purpose of this study was to test whether providing knowledge of the FAST acronym through a standard Act FAST campaign leaflet increases accurate recognition and response in stroke-based scenario measures. METHODS This is a population-based, cross-sectional survey of adults in Newcastle upon Tyne, UK, sampled using the electoral register, with individuals randomized to receive a questionnaire and Act FAST leaflet (n = 2500) or a questionnaire only (n = 2500) in 2012. Campaign message retention, stroke recognition, and response measured through 16 scenario-based vignettes were assessed. Data were analyzed in 2013. RESULTS Questionnaire return rate was 32.3% (n = 1615). No differences were found between the leaflet and no-leaflet groups in return rate or demographics. Participants who received a leaflet showed better campaign recall (75.7% vs. 68.2%, P = 0.003) and recalled more FAST mnemonic elements (66.1% vs. 45.3% elements named correctly, P < 0.001). However, there were no between-group differences for stroke recognition and response to stroke-based scenarios (P > 0.05). CONCLUSIONS Despite greater levels of recall of specific 'Act FAST' elements among those receiving the Act FAST leaflet, there was no impact on stroke recognition and response measures.
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Affiliation(s)
- Stephan U Dombrowski
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK; School of Natural Sciences, University of Stirling, Stirling, UK
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Mellon L, Doyle F, Rohde D, Williams D, Hickey A. Stroke warning campaigns: delivering better patient outcomes? A systematic review. PATIENT-RELATED OUTCOME MEASURES 2015; 6:61-73. [PMID: 25750550 PMCID: PMC4348144 DOI: 10.2147/prom.s54087] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Patient delay in presenting to hospital with stroke symptoms remains one of the major barriers to thrombolysis treatment, leading to its suboptimal use internationally. Educational interventions such as mass media campaigns and community initiatives aim to reduce patient delays by promoting the signs and symptoms of a stroke, but no consistent evidence exists to show that such interventions result in appropriate behavioral responses to stroke symptoms. Methods A systematic literature search and narrative synthesis were conducted to examine whether public educational interventions were successful in the reduction of patient delay to hospital presentation with stroke symptoms. Three databases, MEDLINE, CINAHL, and PsycINFO, were searched to identify quantitative studies with measurable behavioral end points, including time to hospital presentation, thrombolysis rates, ambulance use, and emergency department (ED) presentations with stroke. Results Fifteen studies met the inclusion criteria: one randomized controlled trial, two time series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies. Studies were heterogeneous in quality; thus, meta-analysis was not feasible. Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect. Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance transports following the intervention. Three studies examining ED presentations reported significantly increased ED presentations following intervention. Public educational interventions varied widely on type, duration, and content, with description of intervention development largely absent from studies, limiting the potential replication of successful interventions. Conclusions Positive intervention effects were reported in the majority of studies; however, methodological weaknesses evident in a number of studies limited the generalizability of the observed effects. Reporting of specific intervention design was suboptimal and impeded the identification of key intervention components for reducing patient delay. The parallel delivery of public and professional interventions further limited the identification of successful intervention components. A lack of studies of sound methodological quality using, at a minimum, a controlled before and after design was identified in this review, and thus studies incorporating a rigorous study design are required to strengthen the evidence for public interventions to reduce patient delay in stroke. The potential clinical benefits of public interventions are far-reaching, and the challenge remains in translating knowledge improvements and correct behavioral intentions to appropriate behavior when stroke occurs.
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Affiliation(s)
- Lisa Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hartigan I, O’Connell E, O'Brien S, Weathers E, Cornally N, Kilonzo B, McCarthy G. The Irish national stroke awareness campaign: a stroke of success? Appl Nurs Res 2014; 27:e13-9. [DOI: 10.1016/j.apnr.2014.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 12/26/2022]
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Haass A, Walter S, Ragoschke-Schumm A, Grunwald IQ, Lesmeister M, Khaw AV, Fassbender K. ["Time is brain". Optimizing prehospital stroke management]. DER NERVENARZT 2014; 85:189-94. [PMID: 24276091 DOI: 10.1007/s00115-013-3952-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Acute stroke is one of the main causes of death and chronic disability. Thrombolysis, achieved by administering recombinant tissue plasminogen activator within 4.5 h, is an effective therapeutic option for ischemic stroke. However, less than 2-12 % of patients receive this treatment and a major reason is that most patients reach the hospital too late. Several time-saving measures should be implemented. Firstly, optimized and continual public awareness campaigns for patients should be initiated to reduce delays in notifying the emergency medical service. Secondly, emergency medical service personnel should develop protocols for prenotification of the receiving hospital. Other suggested measures involve educating emergency medical service personnel to systematically use scales for recognizing the symptoms of stroke and to triage patients to experienced stroke centers. In the future, administering treatment at the emergency site (mobile stroke unit concept) may allow more than a small minority of patients to benefit from available recanalization treatment options.
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Affiliation(s)
- A Haass
- Neurologische Klinik, Universität des Saarlandes, Kirrberger Str., 66424, Homburg, Deutschland
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Kawano H, Yokota C, Yamamoto F, Mori Y, Mihara Y, Ando Y, Minematsu K. Stroke education for multidisciplinary medical personnel in a rural area of Japan for promotion of hospital visit of acute stroke patients. J Stroke Cerebrovasc Dis 2014; 23:2372-7. [PMID: 25194740 DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/02/2014] [Accepted: 05/13/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There are few studies of stroke education suitable for multidisciplinary medical personnel. A reorganization of the management of acute stroke and stroke education for multidisciplinary medical personnel started since 2013 in our hospital located in a rural area of Japan. This study aimed to examine the effect of our stroke education on changing the number of visits of acute stroke patients to our hospital and to test the stroke knowledge of medical personnel. METHODS The stroke education, composed of a 20-minute lecture, was given by a stroke neurologist to 217 medical personnel (age, 49 ± 10 years; male, 70%). Posters printed with the FAST message were given to the participants at the end of the lesson: F, facial drooping; A, arm numbness or weakness; S, slurred speech or difficulty speaking or understanding; T, a time to call an ambulance. Participants completed questionnaires on stroke knowledge at baseline and 3 months after the lesson. RESULTS The number of participants who remembered correctly the FAST mnemonic at 3 months was significantly higher than at baseline (78 vs. 90%, P = .006). The correct answer rate for stroke symptoms other than FAST such as vision loss was approximately 50% at 3 months. The number of visits of acute stroke patients to our hospital, particularly patients with transient ischemic attack, increased significantly compared with that before the stroke education. CONCLUSIONS Our stroke education method using the FAST mnemonic designed for multidisciplinary medical personnel improved their stroke knowledge. Reorganization of the management of acute stroke and greater stroke knowledge for medical staff are necessary to increase the visits of acute stroke patients in the rural areas.
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Affiliation(s)
- Hiroyuki Kawano
- Department of Neurology, Minamata City General Hospital and Medical Center, Minamata, Kumamoto, Japan
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Fumio Yamamoto
- Department of Neurology, Minamata City General Hospital and Medical Center, Minamata, Kumamoto, Japan
| | - Yoshiteru Mori
- Department of Nursing, Minamata City General Hospital and Medical Center, Minamata, Kumamoto, Japan
| | - Yosuke Mihara
- Department of Neurosurgery, Minamata City General Hospital and Medical Center, Minamata, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Flynn D, Ford GA, Rodgers H, Price C, Steen N, Thomson RG. A time series evaluation of the FAST National Stroke Awareness Campaign in England. PLoS One 2014; 9:e104289. [PMID: 25119714 PMCID: PMC4131890 DOI: 10.1371/journal.pone.0104289] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/10/2014] [Indexed: 12/01/2022] Open
Abstract
Objective In February 2009, the Department of Health in England launched the Face, Arm, Speech, and Time (FAST) mass media campaign, to raise public awareness of stroke symptoms and the need for an emergency response. We aimed to evaluate the impact of three consecutive phases of FAST using population-level measures of behaviour in England. Methods Interrupted time series (May 2007 to February 2011) assessed the impact of the campaign on: access to a national stroke charity's information resources (Stroke Association [SA]); emergency hospital admissions with a primary diagnosis of stroke (Hospital Episode Statistics for England); and thrombolysis activity from centres in England contributing data to the Safe Implementation of Thrombolysis in Stroke UK database. Results Before the campaign, emergency admissions (and patients admitted via accident and emergency [A&E]) and thrombolysis activity was increasing significantly over time, whereas emergency admissions via general practitioners (GPs) were decreasing significantly. SA webpage views, calls to their helpline and information materials dispatched increased significantly after phase one. Website hits/views, and information materials dispatched decreased after phase one; these outcomes increased significantly during phases two and three. After phase one there were significant increases in overall emergency admissions (505, 95% CI = 75 to 935) and patients admitted via A&E (451, 95% CI = 26 to 875). Significantly fewer monthly emergency admissions via GPs were reported after phase three (−19, 95% CI = −29 to −9). Thrombolysis activity per month significantly increased after phases one (3, 95% CI = 1 to 6), and three (3, 95% CI = 1 to 4). Conclusions Phase one had a statistically significant impact on information seeking behaviour and emergency admissions, with additional impact that may be attributable to subsequent phases on information seeking behaviour, emergency admissions via GPs, and thrombolysis activity. Future campaigns should be a0ccompanied by evaluation of impact on clinical outcomes such as reduced stroke-related morbidity and mortality.
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Affiliation(s)
- Darren Flynn
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Gary A. Ford
- Institute for Ageing and Health (Stroke Research Group), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen Rodgers
- Institute for Ageing and Health (Stroke Research Group), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher Price
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington, United Kingdom
| | - Nick Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard G. Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Yperzeele L, Van Hooff RJ, De Smedt A, Valenzuela Espinoza A, Van de Casseye R, Hubloue I, De Keyser J, Brouns R. Prehospital stroke care: limitations of current interventions and focus on new developments. Cerebrovasc Dis 2014; 38:1-9. [PMID: 25116305 DOI: 10.1159/000363617] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/15/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The global burden of stroke is immense, both in medical and economic terms. With the aging population and the ongoing industrialization of the third world, stroke prevalence is expected to increase and will have a major effect on national health expenditures. Currently, the medical treatment for acute ischemic stroke is limited to intravenous recombinant tissue plasminogen activator (IV r-tPA), but its time dependency leads to low utilization rates in routine clinical practice. Prehospital delay contributes significantly to delayed or missed treatment opportunities in acute stroke. State-of-the-art acute stroke care, starting in the prehospital phase, could thereby reduce the disease burden and its enormous financial costs. SUMMARY The first part of this review focuses on current education measures for the general public, the emergency medical services (EMS) dispatchers and paramedics. Although much has been expected of these measures to improve stroke care, no major effects on prehospital delay or missed treatment opportunities have been demonstrated over the years. Most interventional studies showed little or no effect on the onset-to-door time, IV r-tPA utilization rates or outcome, except for prenotification of the receiving hospital by the EMS. No data are currently available on the cost-effectiveness of these commonly used measures. In the second part, we discuss new developments for the improvement of prehospital stroke diagnosis and treatment which could open new perspectives in the nearby future. These include the implementation of prehospital telestroke and the deployment of mobile stroke units. These approaches may improve patient care and could serve as a platform for prehospital clinical trials. Other opportunities include the implementation of noninvasive diagnostics (like transcranial ultrasound and blood-borne biomarkers) and the reevaluation of neuroprotective strategies in the prehospital phase. Key Messages: Timely initiation of treatment can effectively reduce the medical and economic burden of stroke and should begin with optimal prehospital stroke care. For this, prehospital telemedicine is a particularly attractive approach because it is a scalable solution that has the potential to rapidly optimize acute stroke care at limited cost.
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Affiliation(s)
- Laetitia Yperzeele
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Sundseth A, Faiz KW, Rønning OM, Thommessen B. Factors related to knowledge of stroke symptoms and risk factors in a norwegian stroke population. J Stroke Cerebrovasc Dis 2014; 23:1849-55. [PMID: 24809671 DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Previous studies have identified insufficient knowledge of stroke symptoms and risk factors both among survivors of stroke and in the general population. The purpose of this study was to investigate knowledge of stroke symptoms and risk factors in a Norwegian stroke population and to identify factors associated with good knowledge. METHODS This prospective study included patients with acute transient ischemic attack, ischemic stroke, and intracerebral hemorrhage. Knowledge of stroke symptoms and risk factors was explored by asking open-ended questions. Bivariate and multivariate regression analyses were performed to identify factors related to good knowledge. RESULTS In total, 287 patients (mean age ± standard deviation, 70.0 ± 12.9 years) answered the open-ended questionnaire of which 71% knew at least 1 symptom of stroke whereas 43% knew at least 1 risk factor. Knowledge of both numbness/weakness and speech difficulties as symptoms of stroke (43% of the patients) was associated with lower age (odds ratio [OR], .96; 95% confidence interval [CI], .94-.99), higher education (OR, 2.25; 95% CI, 1.17-4.30), and having previously received information regarding stroke (OR, 7.74; 95% CI, 3.82-15.67). Knowing at least 2 of the 3 risk factors of stroke "smoking", "hypertension", and "diabetes" (14% of the patients) was associated with lower age (OR, .94; 95% CI, .92-.97). CONCLUSIONS Knowledge of stroke symptoms and risk factors in patients with acute cerebrovascular disease seems to be insufficient. Further educational efforts are needed, as better knowledge may improve prevention of stroke and increase the number of patients who can receive thrombolysis.
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Affiliation(s)
- Antje Sundseth
- Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Kashif Waqar Faiz
- Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Morten Rønning
- Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bente Thommessen
- Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway
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Sakamoto Y, Yokota C, Miyashita F, Amano T, Shigehatake Y, Oyama S, Itagaki N, Okumura K, Toyoda K, Minematsu K. Effects of stroke education using an animated cartoon and a manga on elementary school children. J Stroke Cerebrovasc Dis 2014; 23:1877-81. [PMID: 24794944 DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/21/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Stroke education for the youth is expected to reduce prehospital delay by informing the bystander of appropriate action to take and providing knowledge to prevent onset of stroke in future. Previously, we developed effective teaching materials consisting of an animated cartoon and a Manga for junior high school students. The aim of this study was to evaluate the feasibility and effectiveness of our educational materials for stroke education taught by schoolteachers to elementary school children. METHODS Using our teaching materials, a 30-minute lesson was given by trained general schoolteachers. Questionnaires on stroke knowledge (symptoms and risk factors) and action to take on identification of suspected stroke symptoms were filled out by school children before, immediately after, and at 3 months after completion of the lesson. RESULTS A total of 219 children (aged 10 or 11 years) received the stroke lesson. Stroke knowledge significantly increased immediately after the lesson compared with before (symptoms, P < .001; risk factors, P < .001); however, correct answer rates decreased at 3 months immediately after completion of the lesson (symptoms, P = .002; risk factors, P = .045). The proportion of the number of children calling emergency medical service on identifying stroke symptoms was higher immediately after the lesson than baseline (P = .007) but returned to the baseline at 3 months after the lesson. CONCLUSIONS Stroke lesson by schoolteachers using our teaching materials consisting of an animated cartoon and a Manga that was previously used for junior high school students was feasible for elementary school children. However, revision of the materials is required for better retention of stroke knowledge for children.
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Affiliation(s)
- Yuki Sakamoto
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Fumio Miyashita
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tatsuo Amano
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuya Shigehatake
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Oyama
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naruhiko Itagaki
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kosuke Okumura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Sobotková P, Goldemund D, Reif M, Mikulík R. Predictors of noticing stroke educational campaign. J Stroke Cerebrovasc Dis 2014; 23:1662-8. [PMID: 24725812 DOI: 10.1016/j.jstrokecerebrovasdis.2014.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/08/2014] [Accepted: 01/15/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Long-term campaigns to improve stroke awareness, such as the campaign conducted in the Czech Republic since 2006, have not been effective. However, the small subpopulation that noticed the campaign had better stroke awareness than the population that did not. To better understand this awareness campaign responsiveness and to design more successful future campaigns, predictors of noticing campaigns were identified. MATERIALS AND METHODS This study is a secondary analysis of cross-sectional nationwide survey data of the Czech population older than 40 years, collected in 2009. The survey used a 3-stage random sampling method (area, household, and household member) and personal semistructured interview questionnaires concerning participants' stroke knowledge, demographic characteristics, medical history, and stroke information sources. To identify the association between these variables and whether the campaign was noticed (the primary outcome of the study), multivariate binary logistic regression analysis was used. RESULTS A total of 601 participants were surveyed (90% response rate), 19% of them stated that they noticed the stroke awareness campaign. Primary independent predictors of campaign efficiency were heart disease (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0-3.2), obesity (OR, 2.4; 95% CI, 1.3-4.7), and current smoking (OR, .4; 95% CI, .3-.7). CONCLUSIONS Tobacco smokers in particular should be targeted by stroke awareness campaigns, for example, through health warning labels on cigarette packs. People with some stroke risk factors, such as heart disease and obesity, are responsive to information about stroke. Therefore, educational campaigns should target the groups with increased risk of stroke.
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Affiliation(s)
- Petra Sobotková
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - David Goldemund
- Department of Neurology, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Michal Reif
- Department of Neurology, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Robert Mikulík
- Department of Neurology, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
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Shigehatake Y, Yokota C, Amano T, Tomii Y, Inoue Y, Hagihara T, Toyoda K, Minematsu K. Stroke education using an animated cartoon and a manga for junior high school students. J Stroke Cerebrovasc Dis 2014; 23:1623-7. [PMID: 24680086 DOI: 10.1016/j.jstrokecerebrovasdis.2014.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND We investigated whether junior high school students could be educated regarding stroke with an animated cartoon and a Manga that we produced for the purpose of dissemination of this knowledge. METHODS We produced a 10-minute animated cartoon and a Manga that provided information regarding stroke risk factors, stroke signs and symptoms, and awareness to immediately contact emergent medical service (EMS) on identification of stroke signs and symptoms. From December 2011 to March 2012, 493 students in 15 classes of the first grade (age 12-13 years) of 3 junior high schools were enrolled in the study. Each subject watched the animated cartoon and read the Manga; this was referred to as "training." Lessons about stroke were not given. Questionnaires on stroke knowledge were evaluated at baseline, immediately after the training, and 3 months after the training. RESULTS The proportion of correct answers given immediately after the training was higher for all questions, except those related to arrhythmia, compared with baseline. Percentage of correct answers given at 3 months was higher than that at baseline in questions related to facial palsy (75% versus 33%), speech disturbance (91% versus 60%), hemiplegia (79% versus 52%), numbness of 1 side (58% versus 51%), calling for EMS (90% versus 85%), alcohol intake (96% versus 72%), and smoking (69% versus 54%). At 3 months after the training, 56% of students answered the FAST (facial droop, arm weakness, speech disturbance, time to call for EMS) mnemonic correctly. CONCLUSIONS Stroke education using these teaching aids of the animated cartoon and the Manga improved stroke knowledge in junior high school students.
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Affiliation(s)
- Yuya Shigehatake
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Tatsuo Amano
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuhiro Tomii
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuteru Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takaaki Hagihara
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Ragoschke-Schumm A, Walter S, Haass A, Balucani C, Lesmeister M, Nasreldein A, Sarlon L, Bachhuber A, Licina T, Grunwald IQ, Fassbender K. Translation of the 'time is brain' concept into clinical practice: focus on prehospital stroke management. Int J Stroke 2014; 9:333-40. [PMID: 24593156 PMCID: PMC4374710 DOI: 10.1111/ijs.12252] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/04/2013] [Indexed: 11/28/2022]
Abstract
Acute stroke is one of the main causes of death and chronic disability. Thrombolysis with recombinant tissue plasminogen activator within the first hours after onset of symptoms is an effective therapeutic option for ischemic stroke. However, fewer than 2% to 7% of patients receive this treatment, primarily because most patients reach the hospital too late for the initiation of successful therapy. Several measures can reduce detrimental delay until treatment. It is of importance to use continual public awareness campaigns to reduce delays in patients' alarm of emergency medical services. Further relevant measures are repetitive education of emergency medical services teams to ensure the systematic use of scales designed for recognition of stroke symptoms and the proper triage of patients to stroke centers. A most important time-saving measure is prenotification of the receiving hospital by the emergency medical services team. In the future, treatment already at the emergency site may allow more than a small minority of patients to benefit from available treatment.
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Affiliation(s)
- A Ragoschke-Schumm
- Department of Neurology, University Hospital of the Saarland, Homburg, Germany
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Factors Related to Decision Delay in Acute Stroke. J Stroke Cerebrovasc Dis 2014; 23:534-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.05.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 11/18/2022] Open
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Australian Public’s Awareness of Stroke Warning Signs Improves After National Multimedia Campaigns. Stroke 2013; 44:3540-3. [DOI: 10.1161/strokeaha.113.002987] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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