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Soulleihet V, Nicoli F, Trouve J, Girard N, Jacquin L. Optimized acute stroke pathway using medical advanced regulation for stroke and repeated public awareness campaigns. Am J Emerg Med 2013; 32:225-32. [PMID: 24361139 DOI: 10.1016/j.ajem.2013.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the efficiency of a specific organizational model for early stroke management associated with repeated public awareness campaigns on stroke warning signs. METHOD Our model is based on initial telephone triage of potential candidates for an intravenous thrombolysis by an emergency physician before a 3-party conference including basic life support team on scene and a stroke neurologist. We performed a time series analysis for a period of 5 years and a half, comparing the number of emergency telephone calls with that of intravenous thrombolysis treatment realized. RESULTS In our organizational model, repeated awareness public campaigns increased both the number of emergency calls for suspected stroke and the selection of potential candidates for intravenous thrombolysis. Results from the time series analysis suggest that educational campaigns are a major factor influencing our emergency medical service activity. This result is correlated with the number of performed intravenous thrombolyses by the stroke center especially within a 3-hour delay (Spearman ρ, P = .621, P = .000 and P = .439, P = .000, respectively). CONCLUSION Educational programs repeated each year are useful to the population for learning how to recognize stroke symptoms and send straight away an emergency call. Combining the emergency action with an early remote evaluation by the stroke center team and a direct admission in imaging department shortens the time-to-treatment delay. This model is reproducible in different health care systems.
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Affiliation(s)
- Valéry Soulleihet
- Assistance Publique-Hôpitaux de Marseille, CHU Timone, SAMU 13, 13005 Marseille, France
| | - François Nicoli
- OLEA Medical, 13600 La Ciotat, France; Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service d'urgences neurovasculaires, 13005 Marseille, France
| | - Jacques Trouve
- Centre Hospitalier Henri Duffaut, SAMU 84, 84903 Avignon cedex 09, France
| | - Nadine Girard
- Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service de Neuroradiologie, 13005 Marseille, France
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences Médicales, 69003 Lyon, France.
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Te Ao B, Brown P, Fink J, Vivian M, Feigin V. Potential gains and costs from increasing access to thrombolysis for acute ischemic stroke patients in New Zealand hospitals. Int J Stroke 2013; 10:903-10. [PMID: 24206567 DOI: 10.1111/ijs.12152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Treatment of ischemic stroke patients with tissue-type plasminogen activator (tPA) is known to be effective and cost-effective, yet the percentage of patients treated with thrombolysis in hospitals remains low. The purpose of this study is to examine whether providing thrombolysis in New Zealand hospitals is currently cost-effective and to estimate the amount that might be spent on campaigns aimed at increasing thrombolysis receipt rates. METHODS A decision-analytic model was developed and populated using health services data from the literature and the Auckland Regional Community Stroke Outcome Study. The cost-utilities of providing thrombolysis over one-year and patient lifetime were estimated. Using a threshold of NZ$20 000 (US$15 337) per quality-adjusted life year, the analysis identified the maximum amount that might be spent on campaigns aiming to increase rates of receipt of thrombolysis above their current levels. Monte Carlo simulations and probabilistic sensitivity analysis explored the robustness of the findings. RESULTS Providing thrombolysis was cost-effective, especially when long-term costs and effects were considered (NZ$6641 or US$5093 per quality-adjusted life year). The results suggest that better management within hospitals would be more effective in increasing thrombolysis receipt rates (up to 17%) than campaigns aiming at higher awareness of stroke symptoms in the community. The amount that might be spent on a national campaign to increase rate of receipt of thrombolysis from its current level (3% of eligible patients) depended upon the effectiveness of the campaign, ranging from under NZ$6 million for New Zealand for an increase in rate to 30% to over $9 million for an increase in rate to 50%. CONCLUSION While thrombolysis is a cost-effective treatment in New Zealand, resources should be devoted to campaigns, both within hospitals and in the community, to increase coverage.
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Affiliation(s)
- Braden Te Ao
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Paul Brown
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,School of Social Science, Humanities and Arts, University of California, Merced, CA, USA
| | - John Fink
- Department of Neurology, Canterbury District Health Board, Christchurch, New Zealand
| | - Mark Vivian
- New Zealand Stroke Foundation, Wellington, New Zealand
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Dombrowski SU, Mackintosh JE, Sniehotta FF, Araujo-Soares V, Rodgers H, Thomson RG, Murtagh MJ, Ford GA, Eccles MP, White M. The impact of the UK 'Act FAST' stroke awareness campaign: content analysis of patients, witness and primary care clinicians' perceptions. BMC Public Health 2013; 13:915. [PMID: 24088381 PMCID: PMC3850704 DOI: 10.1186/1471-2458-13-915] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 09/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background The English mass media campaign ‘Act FAST’ aimed to raise stroke awareness and the need to call emergency services at the onset of suspected stroke. We examined the perceived impact and views of the campaign in target populations to identify potential ways to optimise mass-media interventions for stroke. Methods Analysis of semi-structured interviews conducted as part of two qualitative studies, which examined factors influencing patient/witness response to acute stroke symptoms (n = 19 stroke patients, n = 26 stroke witnesses) and perceptions about raising stroke awareness in primary care (n = 30 clinicians). Both studies included questions about the ‘Act FAST’ campaign. Interviews were content analysed to determine campaign awareness, perceived impact on decisions and response to stroke, and views of the campaign. Results Most participants were aware of the Act FAST campaign. Some patients and witnesses reported that the campaign impacted upon their stroke recognition and response, but the majority reported no impact. Clinicians often perceived campaign success in raising stroke awareness, but few thought it would change response behaviours. Some patients and witnesses, and most primary care clinicians expressed positive views towards the campaign. Some more critical participant comments included perceptions of dramatic, irrelevant, and potentially confusing content, such as a prominent ‘fire in the brain’ analogy. Conclusions Act FAST has had some perceived impact on stroke recognition and response in some stroke patients and witnesses, but the majority reported no campaign impact. Primary care clinicians were positive about the campaign, and believed it had impacted on stroke awareness and recognition but doubted impact on response behaviour. Potential avenues for optimising and complementing mass media campaigns such as ‘Act FAST’ were identified.
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Affiliation(s)
- Stephan U Dombrowski
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK.
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Morimoto A, Miyamatsu N, Okamura T, Nakayama H, Toyoda K, Suzuki K, Toyota A, Hata T, Yamaguchi T. Effects of Intensive and Moderate Public Education on Knowledge of Early Stroke Symptoms Among a Japanese Population. Stroke 2013; 44:2829-34. [DOI: 10.1161/strokeaha.113.001537] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
To assess the effects of intensive and moderate public education on knowledge of early stroke symptoms among a general Japanese population.
Methods—
Information on early stroke symptoms was distributed by leaflet 12× and by booklet twice in an intensive intervention area >22 months, and by leaflet and booklet once each in a moderate intervention area. No distribution occurred in the control area. Before and after the intervention, a mailed survey was conducted in the 3 areas. A total of 2734 individuals, aged 40 to 74 years, who did not select all 5 correct symptoms of stroke in the preintervention survey were eligible for our analysis.
Results—
The numbers of correct answers selected about stroke symptoms did not differ significantly among the 3 areas in the preintervention survey (
P
=0.156). In the postintervention survey, the proportions of participants who selected sudden 1-sided numbness or weakness (94.2% in the intensive intervention area, 88.3% in the moderate intervention area, and 89.2% in the control area;
P
<0.001) and sudden severe headache (76.8%, 70.1%, and 70.4%, respectively;
P
<0.001) differed significantly among the 3 areas. After adjustment for confounding factors, the multivariable-adjusted odds ratios (95% confidence intervals) for correctly choosing all 5 symptoms were 1.35 (1.07–1.71) in the intensive intervention area and 0.96 (0.74–1.24) in the moderate intervention area compared with the control area.
Conclusions—
Our findings suggest that frequent distribution of leaflets and booklets significantly improved the short-term knowledge of community residents about early symptoms of stroke.
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Affiliation(s)
- Akiko Morimoto
- From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital,
| | - Naomi Miyamatsu
- From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital,
| | - Tomonori Okamura
- From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital,
| | - Hirofumi Nakayama
- From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital,
| | - Kazunori Toyoda
- From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital,
| | - Kazuo Suzuki
- From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital,
| | - Akihiro Toyota
- From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital,
| | - Takashi Hata
- From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital,
| | - Takenori Yamaguchi
- From the Department of Clinical Nursing, Shiga University of Medical Science, Shiga, Japan (A.M., N.M.); Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan (T.O.); Japan Stroke Association, Osaka, Japan (H.N., T.Y.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.T.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); Rehabilitation Center, Chugoku Rosai Hospital,
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55
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Higashida R, Alberts MJ, Alexander DN, Crocco TJ, Demaerschalk BM, Derdeyn CP, Goldstein LB, Jauch EC, Mayer SA, Meltzer NM, Peterson ED, Rosenwasser RH, Saver JL, Schwamm L, Summers D, Wechsler L, Wood JP. Interactions Within Stroke Systems of Care. Stroke 2013; 44:2961-84. [DOI: 10.1161/str.0b013e3182a6d2b2] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Rasura M, Baldereschi M, Di Carlo A, Di Lisi F, Patella R, Piccardi B, Polizzi B, Inzitari D. Effectiveness of public stroke educational interventions: a review. Eur J Neurol 2013; 21:11-20. [DOI: 10.1111/ene.12266] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- M. Rasura
- UOS Stroke Unit; Azienda-Ospedaliera Sant'Andrea; Sapienza; University of Rome; Rome Italy
| | - M. Baldereschi
- Italian National Research Council; Neurosciences Institute; Florence Italy
| | - A. Di Carlo
- Italian National Research Council; Neurosciences Institute; Florence Italy
| | - F. Di Lisi
- UOS Stroke Unit; Azienda-Ospedaliera Sant'Andrea; Sapienza; University of Rome; Rome Italy
| | - R. Patella
- UOS Stroke Unit; Azienda-Ospedaliera Sant'Andrea; Sapienza; University of Rome; Rome Italy
| | - B. Piccardi
- Department of Neurosciences and Pharmacology; University of Florence; Florence Italy
| | - B. Polizzi
- Center of Disease Control; Health Ministry; Rome Italy
| | - D. Inzitari
- Department of Neurosciences and Pharmacology; University of Florence; Florence Italy
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57
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Audebert HJ, Saver JL, Starkman S, Lees KR, Endres M. Prehospital stroke care: new prospects for treatment and clinical research. Neurology 2013; 81:501-8. [PMID: 23897876 PMCID: PMC3776535 DOI: 10.1212/wnl.0b013e31829e0fdd] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/16/2013] [Indexed: 01/03/2023] Open
Abstract
Brain cells die rapidly after stroke and any effective treatment must start as early as possible. In clinical routine, the tight time-outcome relationship continues to be the major limitation of therapeutic approaches: thrombolysis rates remain low across many countries, with most patients being treated at the late end of the therapeutic window. In addition, there is no neuroprotective therapy available, but some maintain that this concept may be valid if administered very early after stroke. Recent innovations have opened new perspectives for stroke diagnosis and treatment before the patient arrives at the hospital. These include stroke recognition by dispatchers and paramedics, mobile telemedicine for remote clinical examination and imaging, and integration of CT scanners and point-of-care laboratories in ambulances. Several clinical trials are now being performed in the prehospital setting testing prehospital delivery of neuroprotective, antihypertensive, and thrombolytic therapy. We hypothesize that these new approaches in prehospital stroke care will not only shorten time to treatment and improve outcome but will also facilitate hyperacute stroke research by increasing the number of study participants within an ultra-early time window. The potentials, pitfalls, and promises of advanced prehospital stroke care and research are discussed in this review.
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Affiliation(s)
- Heinrich J Audebert
- Department of Neurology, Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.
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58
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Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol 2013; 12:585-96. [DOI: 10.1016/s1474-4422(13)70100-5] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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59
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Oliveira-Filho J, Martins SCO, Pontes-Neto OM, Longo A, Evaristo EF, Carvalho JJFD, Fernandes JG, Zétola VF, Gagliardi RJ, Vedolin L, Freitas GRD. Guidelines for acute ischemic stroke treatment: part I. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 70:621-9. [PMID: 22899035 DOI: 10.1590/s0004-282x2012000800012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jamary Oliveira-Filho
- Rua Reitor Miguel Calmon s/n; Instituto de Ciências da Saúde / sala 455; 40110-100 Salvador BA - Brasil
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60
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Riesch SK, Ngui EM, Ehlert C, Miller MK, Cronk CA, Leuthner S, Strehlow M, Hewitt JB, Durkin MS. Community outreach and engagement strategies from the Wisconsin Study Center of the National Children's Study. Public Health Nurs 2013; 30:254-65. [PMID: 23586770 DOI: 10.1111/phn.12018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this methods article was to describe and evaluate outreach and engagement strategies designed to initially build county-wide awareness and support for the National Children's Study (NCS or the study) and subsequently to target the segment communities where recruitment for the study occurred. Selected principles from community outreach, social marketing, and health care system and personal referral formed the foundation for the strategies. The strategies included a celebration event, community advisory board, community needs assessment, building relationships with health care providers and systems, eliciting a network of study supporters, newsletters, appearances at local young family-oriented events (health fairs, parades), presentations to local community leaders, community forums, "branding" with assistance from a women-owned local marketing firm, and mailings including an oversized, second-touch postcard. Six months after study launch, approximately 4,600 study-eligible women were asked in a door-to-door survey if and how they became aware of the study. On average, 40% of eligible women reported being aware of the study. The most frequently cited strategy to cultivate their awareness was study-specific mailings. Awareness of the NCS increased by 7.5% among those receiving a second-touch postcard relative to controls (95% CIs [4.9, 10.7] z = 5.347, p < 0.0000, d = 0.16). Community outreach and engagement strategies, in particular the oversized postcard as a second-touch effort, may be used effectively by researchers for participant recruitment and by public health nurses for delivery of important population-focused messages.
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Affiliation(s)
- Susan K Riesch
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin 53792, USA.
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61
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Bethune R, Marshall MJ, Mitchell SJ, Oppong C, Cartmel MT, Arumugam PJ, Gee AS, Daniels IR. Did the 'Be Clear on Bowel Cancer' public awareness campaign pilot result in a higher rate of cancer detection? Postgrad Med J 2013; 89:390-3. [PMID: 23572594 DOI: 10.1136/postgradmedj-2012-131014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To assess the impact of a 7-week public bowel cancer awareness campaign pilot by reviewing the number of 2-week referrals from general practitioners (GPs) to hospital, endoscopic procedures and new cancers diagnosed throughout the five acute hospitals in The Peninsular Cancer Network, UK. DESIGN A retrospective before and after study. SETTING The Peninsula Cancer Network in the South West of England, UK. MAIN OUTCOME MEASURES For the period July 2010-July 2011, data were collected on the number of 2-week referrals, number of endoscopic procedures performed and number of new cancers diagnosed. The average for the 6 months before the campaign was compared with the immediate 3 months and then the fourth to sixth months following the campaign. Student's t test was used to compare the means of the three groups. RESULTS There was a statistically significant increase in the number of 2-week referrals from GPs to hospital in the 3 months following the campaign but this effect disappeared after that. There was no statistical increase in the number of endoscopic procedures or new cancers diagnosed following the awareness campaign. CONCLUSIONS The pilot 'Be Clear on Cancer' awareness campaign had a significant effect on the number of patients being referred from GPs to hospital; however, the effect was short lived and had returned to baseline by 3 months. The campaign had no effect on the number of new cancers diagnosed, which was the stated underlying aim of the pilot.
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Affiliation(s)
- Rob Bethune
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
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62
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Abstract
BACKGROUND No commonly agreed definition exists for 'stroke symptom knowledge' among members of the general public. Recalling at least one correct stroke symptom has been used in the past. However, this criterion was not associated with rapid presentation to hospital. Rapid presentation is vital in order to provide effective acute stroke treatment. AIMS AND/OR HYPOTHESIS We sought to identify a base level of community stroke symptom knowledge associated with stroke recognition when symptoms occur, an immediate ambulance call, and 'stroke recognition and immediately calling an ambulance' as a single sequence of events. METHODS For six-months in 2004-2005, we identified all patients with stroke living in a defined region of Melbourne and who were transported by ambulance to one of the three hospitals. The person who called the ambulance (caller) was interviewed. RESULTS One hundred ninety-eight patients were identified and 150 callers interviewed. Symptoms reported most frequently were limb weakness (67%), speech problems (57%), and facial weakness (24%). Reporting at least two of the symptoms - facial weakness, limb weakness, or speech problems (62% of callers) - was associated with stroke recognition (P = 0·004), immediately calling an ambulance (P = 0·065), and both 'stroke recognition and immediately calling an ambulance' (P = 0·053). CONCLUSIONS Knowing at least two of the symptoms - facial weakness, limb weakness, and speech problems - appears to be an appropriate indicator of stroke symptom knowledge as it is associated with stroke recognition and appropriate action. Recognizing stroke symptoms and immediately calling an ambulance increase the potential to reduce prehospital time delays and improve eligibility of acute stroke patients for rapid treatment.
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Affiliation(s)
- Ian Mosley
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic., Australia
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Miyamatsu N, Okamura T, Nakayama H, Toyoda K, Suzuki K, Toyota A, Hata T, Hozawa A, Nishikawa T, Morimoto A, Ogita M, Morino A, Yamaguchi T. Public Awareness of Early Symptoms of Stroke and Information Sources about Stroke among the General Japanese Population: The Acquisition of Stroke Knowledge Study. Cerebrovasc Dis 2013; 35:241-9. [DOI: 10.1159/000347066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/01/2013] [Indexed: 11/19/2022] Open
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O'Callaghan G, Murphy S, Loane D, Farrelly E, Horgan F. Stroke Knowledge in an Irish Semi-Rural Community-Dwelling Cohort and Impact of a Brief Education Session. J Stroke Cerebrovasc Dis 2012; 21:629-35; quiz 636-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 02/15/2011] [Indexed: 11/16/2022] Open
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65
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Trobbiani K, Freeman K, Arango M, Lalor E, Jenkinson D, Thrift AG. Comparison of Stroke Warning Sign Campaigns in Australia, England, and Canada. Int J Stroke 2012; 8 Suppl A100:28-31. [DOI: 10.1111/j.1747-4949.2012.00917.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Public awareness of the signs of stroke is essential to ensure that those affected by stroke arrive at the hospital in time for lifesaving therapies. It is unclear how well stroke awareness campaigns improve awareness of stroke signs and whether people translate this into action. Methods We evaluated stroke awareness campaigns conducted in England, Australia, and Canada using pre- and post-campaign surveys. We assessed the proportion of people who could name the main signs of stroke, and compared the proportion naming these correctly between locations. We also assessed whether people would call emergency services in the event of a stroke. Proportion responding correctly was compared using chi-square analysis. Results The amount spent on the campaigns was different in each country. The post-campaign survey was conducted among 400 people in Australia, 1921 in England, and 2703 in Canada. Sixty-eight per cent of people in Australia and 57% in Canada could name two or more signs of stroke ( P < 0·001). After the campaign, knowledge of each of the elements of the campaign (face, arm, speech, time) was significantly greater in England than in Australia ( P < 0·001 for each item). A high proportion of participants reported that they would call emergency services in the event of a stroke (97% in England, 90% in Australia, and 67% in Canada). Conclusion Knowledge of stroke signs and the action to be taken can be improved with awareness campaigns. The effectiveness of these campaigns may be enhanced by spend on media, media mix, and key messages. It is critical to ensure that campaigns provide the clear and bold message that prompt action is an essential ingredient to reduce death and disability following stroke.
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Affiliation(s)
- Kym Trobbiani
- National Stroke Foundation, Melbourne, Vic., Australia
| | | | - Manuel Arango
- Heart and Stroke Foundation of Canada, Ottawa, Canada
| | - Erin Lalor
- National Stroke Foundation, Melbourne, Vic., Australia
| | | | - Amanda G. Thrift
- Department of Medicine, Monash Medical Centre, Monash University, Melbourne, Vic., Australia
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66
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Abstract
This brief review examines certain strategies for increasing community awareness and recognition of the warning signs and symptoms of stroke. Attention should be given to the intended audience, especially at-risk groups. To enhance stroke literacy, a complete message should include the following 4 aspects: (1) a stroke is a serious medical problem that involves the blood supply to the brain, (2) all 5 approved warning signs and symptoms, (3) the many risk factors involved in stroke, and (4) the need to promptly call 911 for emergency services and treatment. Such knowledge could lead to improvement in the rapid arrival to an emergency room and promote optimal and timely medical treatment. With several educational paradigms and strategies in existence, we propose that more rigorous study of their comparative performance and utility is needed. In a preliminary survey, our own program, called "KNOW FIVE - STAY ALIVE," provided greater posttest knowledge compared with the "FAST" program and a National Institutes of Health brochure called "Know Stroke. Know the signs, Act in time."
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67
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Affiliation(s)
- Vítor Tedim Cruz
- From the Neurology Department (V.T.C., I.A., I.Alves, A.M., P.C.), Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal; Health Sciences Department (SACS) (V.T.C., I.A., I.Alves,, A.M.), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal; UnIGENe (P.C.), Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal
| | - Isabel Araújo
- From the Neurology Department (V.T.C., I.A., I.Alves, A.M., P.C.), Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal; Health Sciences Department (SACS) (V.T.C., I.A., I.Alves,, A.M.), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal; UnIGENe (P.C.), Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal
| | - Ivânia Alves
- From the Neurology Department (V.T.C., I.A., I.Alves, A.M., P.C.), Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal; Health Sciences Department (SACS) (V.T.C., I.A., I.Alves,, A.M.), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal; UnIGENe (P.C.), Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal
| | - Aldiro Magano
- From the Neurology Department (V.T.C., I.A., I.Alves, A.M., P.C.), Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal; Health Sciences Department (SACS) (V.T.C., I.A., I.Alves,, A.M.), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal; UnIGENe (P.C.), Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal
| | - Paula Coutinho
- From the Neurology Department (V.T.C., I.A., I.Alves, A.M., P.C.), Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal; Health Sciences Department (SACS) (V.T.C., I.A., I.Alves,, A.M.), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal; UnIGENe (P.C.), Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal
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Robinson TG, Reid A, Haunton VJ, Wilson A, Naylor AR. The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? Emerg Med J 2012; 30:467-71. [DOI: 10.1136/emermed-2012-201471] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tong D, Reeves MJ, Hernandez AF, Zhao X, Olson DM, Fonarow GC, Schwamm LH, Smith EE. Times From Symptom Onset to Hospital Arrival in the Get With The Guidelines–Stroke Program 2002 to 2009. Stroke 2012; 43:1912-7. [DOI: 10.1161/strokeaha.111.644963] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Time from symptom onset to hospital arrival is the most important factor in determining eligibility for intravenous tissue-type plasminogen activator. We used data from a large contemporary nationwide study to determine temporal trends in the proportions of patients arriving within time windows for potential acute ischemic stroke therapies.
Methods—
Trends in symptom onset to hospital arrival time (“onset-to-door time”) for patients with acute ischemic stroke in the Get With The Guidelines–Stroke (GWTG-Stroke) program were analyzed between 2003 and 2009. Factors associated with early onset-to-door time (≤2 hours) were also examined.
Results—
Between April 2003 and March 2009, 1287 hospitals submitted data on 413 147 patients with acute ischemic stroke of whom 194 352 (47.0%) had a specific onset time documented. Among all 413 147 patients, onset-to-door time was documented as ≤2 hours in 20.6%, ≤3 hours in 25.1%, ≤3.5 hours in 26.8%, and ≤8 hours in 35.8%. Early arrival within 2 hours was significantly associated with emergency medical services transport (
P
<0.0001). There was no substantial change in onset-to-door time over the 6-year study period. Expansion of the tissue-type plasminogen activator treatment window from 3 to 4.5 hours (allowing 60 minutes for provision of tissue-type plasminogen activator) increases the pool of potentially eligible patients by 6.3% (30.1% relative increase).
Conclusions—
More than one fourth of patients with ischemic stroke arrive within the time window for tissue-type plasminogen activator therapy; however, this percentage has remained unchanged over recent years. Further efforts are needed to increase the portion of patients with acute ischemic stroke presenting within the time window for acute interventions.
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Affiliation(s)
- David Tong
- From the California Pacific Medical Center (CPMC) Comprehensive Stroke Care Center (D.T.), CPMC Center for Stroke Research (D.T.), CPMC Department of Neurosciences, and the Department of Epidemiology (M.J.R.), Michigan State University, East Landing, MI; Duke Clinical Research Institute, Durham, NC (A.F.H., X.Z., D.M.O.); the Ronald Reagan UCLA Medical Center (G.C.F.), University of California at Los Angeles, Los Angeles, CA; Massachusetts General Hospital (L.H.S.), Boston, MA; and the Department of
| | - Mathew J. Reeves
- From the California Pacific Medical Center (CPMC) Comprehensive Stroke Care Center (D.T.), CPMC Center for Stroke Research (D.T.), CPMC Department of Neurosciences, and the Department of Epidemiology (M.J.R.), Michigan State University, East Landing, MI; Duke Clinical Research Institute, Durham, NC (A.F.H., X.Z., D.M.O.); the Ronald Reagan UCLA Medical Center (G.C.F.), University of California at Los Angeles, Los Angeles, CA; Massachusetts General Hospital (L.H.S.), Boston, MA; and the Department of
| | - Adrian F. Hernandez
- From the California Pacific Medical Center (CPMC) Comprehensive Stroke Care Center (D.T.), CPMC Center for Stroke Research (D.T.), CPMC Department of Neurosciences, and the Department of Epidemiology (M.J.R.), Michigan State University, East Landing, MI; Duke Clinical Research Institute, Durham, NC (A.F.H., X.Z., D.M.O.); the Ronald Reagan UCLA Medical Center (G.C.F.), University of California at Los Angeles, Los Angeles, CA; Massachusetts General Hospital (L.H.S.), Boston, MA; and the Department of
| | - Xin Zhao
- From the California Pacific Medical Center (CPMC) Comprehensive Stroke Care Center (D.T.), CPMC Center for Stroke Research (D.T.), CPMC Department of Neurosciences, and the Department of Epidemiology (M.J.R.), Michigan State University, East Landing, MI; Duke Clinical Research Institute, Durham, NC (A.F.H., X.Z., D.M.O.); the Ronald Reagan UCLA Medical Center (G.C.F.), University of California at Los Angeles, Los Angeles, CA; Massachusetts General Hospital (L.H.S.), Boston, MA; and the Department of
| | - DaiWai M. Olson
- From the California Pacific Medical Center (CPMC) Comprehensive Stroke Care Center (D.T.), CPMC Center for Stroke Research (D.T.), CPMC Department of Neurosciences, and the Department of Epidemiology (M.J.R.), Michigan State University, East Landing, MI; Duke Clinical Research Institute, Durham, NC (A.F.H., X.Z., D.M.O.); the Ronald Reagan UCLA Medical Center (G.C.F.), University of California at Los Angeles, Los Angeles, CA; Massachusetts General Hospital (L.H.S.), Boston, MA; and the Department of
| | - Gregg C. Fonarow
- From the California Pacific Medical Center (CPMC) Comprehensive Stroke Care Center (D.T.), CPMC Center for Stroke Research (D.T.), CPMC Department of Neurosciences, and the Department of Epidemiology (M.J.R.), Michigan State University, East Landing, MI; Duke Clinical Research Institute, Durham, NC (A.F.H., X.Z., D.M.O.); the Ronald Reagan UCLA Medical Center (G.C.F.), University of California at Los Angeles, Los Angeles, CA; Massachusetts General Hospital (L.H.S.), Boston, MA; and the Department of
| | - Lee H. Schwamm
- From the California Pacific Medical Center (CPMC) Comprehensive Stroke Care Center (D.T.), CPMC Center for Stroke Research (D.T.), CPMC Department of Neurosciences, and the Department of Epidemiology (M.J.R.), Michigan State University, East Landing, MI; Duke Clinical Research Institute, Durham, NC (A.F.H., X.Z., D.M.O.); the Ronald Reagan UCLA Medical Center (G.C.F.), University of California at Los Angeles, Los Angeles, CA; Massachusetts General Hospital (L.H.S.), Boston, MA; and the Department of
| | - Eric E. Smith
- From the California Pacific Medical Center (CPMC) Comprehensive Stroke Care Center (D.T.), CPMC Center for Stroke Research (D.T.), CPMC Department of Neurosciences, and the Department of Epidemiology (M.J.R.), Michigan State University, East Landing, MI; Duke Clinical Research Institute, Durham, NC (A.F.H., X.Z., D.M.O.); the Ronald Reagan UCLA Medical Center (G.C.F.), University of California at Los Angeles, Los Angeles, CA; Massachusetts General Hospital (L.H.S.), Boston, MA; and the Department of
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Worthmann H, Schwartz A, Heidenreich F, Sindern E, Lorenz R, Adams HA, Flemming A, Luettje K, Walter U, Haertle B, Dengler R. Educational Campaign on Stroke in an Urban Population in Northern Germany: Influence on Public Stroke Awareness and Knowledge. Int J Stroke 2012; 8:286-92. [DOI: 10.1111/j.1747-4949.2012.00809.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Public stroke awareness and knowledge may be supportive for stroke prevention and emergency care-seeking behavior after the acute event, which is highly important for early treatment onset. Aims In an urban population in Northern Germany (Hannover), a six-month stroke educational campaign was conducted. We expected an increase in stroke knowledge and awareness thereafter. Methods Computer-assisted telephone interviews were randomly conducted among 1004 representative participants before and 1010 immediately after the educational multimedia campaign. The computer-assisted telephone interviews focused on questions about stroke knowledge and interventions remembered. Results Knowledge of stroke risk factors increased during the campaign for overweight, physical inactivity, old age, and stroke in family ( P < 0·05). The knowledge of stroke warning signs was low, although it significantly increased during the campaign ( P < 0·001) as paresis/weakness (46%) and speech problems (31%) were most frequently named. The majority of respondents indicated that the first action after suffering from stroke should be calling emergency care (74% before vs. 84% after campaign, P < 0·001). Conclusions Our data indicate that stroke knowledge and awareness, which could provide earlier presentation to the emergency unit for timely treatment onset, are still low in urban Northern Germany but may decisively be increased by educational campaigns.
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Affiliation(s)
- Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Fedor Heidenreich
- Department of Neurology, Diakoniekrankenhaus Henriettenstiftung, Hannover, Germany
| | - Eckhart Sindern
- Department of Neurology, Diakoniekrankenhaus Friederikenstift gGmbH, Hannover, Germany
| | - Reinhard Lorenz
- Department of Neurology, Klinikum Agnes Karll Laatzen, Laatzen, Germany
| | - Hans-Anton Adams
- Stabsstelle für Interdisziplinäre Notfall- und Katastrophenmedizin, Hannover Medical School, Hannover, Germany
| | - Andreas Flemming
- Stabsstelle für Interdisziplinäre Notfall- und Katastrophenmedizin, Hannover Medical School, Hannover, Germany
| | | | - Ulla Walter
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Birgit Haertle
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School, Hannover, Germany
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Eissa A, Krass I, Bajorek BV. Barriers to the utilization of thrombolysis for acute ischaemic stroke. J Clin Pharm Ther 2012; 37:399-409. [PMID: 22384796 DOI: 10.1111/j.1365-2710.2011.01329.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Thrombolysis is currently the only evidence-based pharmacological treatment available for acute ischaemic stroke (AIS); however, its current utilization is suboptimal (administered to <3% of AIS patients). The aim of this article was to identify the potential barriers to the use of thrombolysis via a review of the available literature. METHODS Medline, Embase, International Pharmaceutical Abstracts and Google Scholar were searched to identify relevant original articles, review papers and other literature published in the period 1995-2011. RESULTS AND DISCUSSION Several barriers to the utilization of thrombolysis in stroke have been identified in the literature and can be broadly classified as 'preadmission' barriers and 'post-admission' barriers. Preadmission barriers include patient and paramedic-related factors leading to late patient presentation for treatment (i.e. outside the therapeutic time window for the administration of thrombolysis). Post-admission barriers include in-hospital factors, such as suboptimal triage of stroke patients and inefficient in-hospital acute stroke care systems, a lack of appropriate infrastructure and expertise to administer thrombolysis, physician uncertainty in prescribing thrombolysis and difficulty in obtaining informed consent for thrombolysis. Suggested strategies to overcome these barriers include public awareness campaigns, prehospital triage by paramedics, hospital bypass protocols and prenotification systems, urgent stroke-unit admission, on-call multidisciplinary acute stroke teams, urgent neuroimaging protocols, telestroke interventions and risk-assessment tools to aid physicians when considering thrombolysis. Additionally, greater pharmacists' engagement is warranted to help identify the people at risk of stroke and support preventative strategies, and provide the public with information regarding the recognition of stroke, as well as facilitate the access and use of thrombolysis. WHAT IS NEW AND CONCLUSION The most effective interventions appear to be those comprising several strategies and those that target more than one barrier simultaneously. Therefore, optimal utilization of thrombolysis requires a systematic, integrated multidisciplinary approach across the continuum of acute care.
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Affiliation(s)
- A Eissa
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia.
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March EG. Towards Prevention and Early Recognition of Stroke: The Australian Context. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.12.3.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractStroke is a preventable disease leading to physical, cognitive and emotional disability. Its high prevalence and poor outcome shifts this disease from the clinical, medical realm to a significant public health problem. This article provides an overview of the problem, and the status of stroke prevention in the Australian context. To achieve this, it first examines the recent Australian surveillance data on stroke, identifying the at-risk groups. It then argues for targeted stroke prevention, assesses relevant policies and programs in the international and Australian contexts, and briefly reviews approaches for increased awareness and recognition of stroke symptoms. The article concludes by emphasising the need to account for the at-risk-groups when developing targeted health promotion campaigns for effective prevention of stroke in Australia.
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Miyamatsu N, Kimura K, Okamura T, Iguchi Y, Nakayama H, Toyota A, Watanabe M, Morimoto A, Morinaga M, Yamaguchi T. Effects of Public Education by Television on Knowledge of Early Stroke Symptoms Among a Japanese Population Aged 40 to 74 Years. Stroke 2012; 43:545-9. [DOI: 10.1161/strokeaha.111.634196] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
An educational campaign by mass media has been associated with great increases in the knowledge about early symptoms of stroke. However, few studies were conducted with a controlled community intervention study.
Methods—
To clarify the effects of a 1-year television campaign for the whole population on improvement of knowledge about stroke symptoms in 2 cities, a campaign area and a control area in Japan were selected. Before and after the campaign, 1960 randomly selected residents aged 40 to 74 years answered a telephone survey regarding knowledge of early stroke symptoms. We calculated the percentage and 95% CIs of participants who correctly chose all 5 early symptoms of stroke in each area and in each year.
Results—
Before the campaign, 53% of participants (95% CI, 50%–55%) in the campaign area and 46% (95% CI, 44%–49%) in the control area correctly chose 5 early symptoms. After the 1-year television campaign, knowledge was significantly improved only in the campaign area (campaign area, 63%; 95% CI, 60%–66%; control area, 51%; 95% CI, 48%–54%). After sex stratification, only women showed improved knowledge of early symptoms. The audience rate for the campaign television programs was found to be higher in women than in men.
Conclusions–
A 1-year stroke educational television campaign effectively improved knowledge about early stroke symptoms among Japanese women aged 40 to 74 years. No impact was found among men in this age group. Future studies should examine the impact of this approach on stroke knowledge among younger individuals and whether there are any behavioral changes that contribute to earlier presentation for treatment.
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Affiliation(s)
- Naomi Miyamatsu
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
| | - Kazumi Kimura
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
| | - Tomonori Okamura
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
| | - Yasuyuki Iguchi
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
| | - Hirofumi Nakayama
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
| | - Akihiro Toyota
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
| | - Makoto Watanabe
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
| | - Akiko Morimoto
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
| | - Miho Morinaga
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
| | - Takenori Yamaguchi
- From the Department of Clinical Nursing (N.M., A.M., M.M.), Shiga University of Medical Science, Shiga, Japan; the Department of Stroke Medicine (K.K., Y.I.), Kawasaki Medical School, Japan; the Department of Preventive Medicine and Public Health (T.O.), Keio University, Japan; the Japan Stroke Association (H.N., T.Y.), Japan; the Rehabilitation Centre (A.T.), Chugoku Rosai Hospital, Japan; the National Cerebral and Cardiovascular Center (M.W., T.Y.), Japan; and the Department of Mathematical Health
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Sheppard JP, Mellor RM, Bailey SM, Barton P, Boyal A, Greenfield S, Jowett S, Mant J, Quinn T, Singh S, McManus RJ. Protocol for an observation and implementation study investigating optimisation of the management of stroke and transient ischaemic attack (TIA). BMJ Open 2012; 2:bmjopen-2012-001430. [PMID: 22734121 PMCID: PMC3383985 DOI: 10.1136/bmjopen-2012-001430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patients benefit from early and intensive treatment in both acute ischaemic stroke and transient ischaemic attack. Recent audits of acute stroke/transient ischaemic attack care suggest that although standards have improved, current services still fall short of optimal care. The aim of this study is to establish a database of patients accessing stroke services. Data will be collected and analysed to provide individualised feedback to healthcare professionals who can then use these findings to develop strategies for service improvement. METHODS AND ANALYSIS This longitudinal observational study will evolve with the ongoing findings from the research output. The project will consist of three phases: assessment of current practice, feedback of findings and evaluation of service change. Consecutive patients will be recruited from participating hospitals, and identifiable data will be collected to link records from the Primary Care, Secondary Care and Emergency Services. As this study focuses on observation of current practice, a sample size calculation is not deemed appropriate. Patients will be sent follow-up questionnaires examining quality of life at 3 and 12 months post-event. Qualitative interviews will examine the care pathway through the experiences of patients, their carers, healthcare personnel and commissioners. Collected data will be used in economic analyses, which will evaluate the impact of current care and service redesign on the NHS costs and patient outcomes (death and quality of life). ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the National Research Ethics Committee (reference; 09/H0716/71), and site-specific R&D approval has been acquired from the relevant NHS trusts. All findings will be presented at relevant healthcare/academic conferences and written up for publication in peer-reviewed journals. Results will be fed back to patients and participating trusts through a series of reports and presentations. These will be used to facilitate discussions about service redesign and implementation.
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Affiliation(s)
- James Peter Sheppard
- Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Ruth Mary Mellor
- Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Sheila Marie Bailey
- Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Pelham Barton
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Amunpreet Boyal
- Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Sheila Greenfield
- Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Sue Jowett
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tom Quinn
- Faculty of Health and Medical Sciences, School of Health and Social Care, University of Surrey, Guildford, UK
| | - Satinder Singh
- Department of Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Richard J McManus
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Chichester M, Ciranni P. Approaching menopause (but not there yet!): caring for women in midlife. Nurs Womens Health 2011; 15:320-4. [PMID: 21884497 DOI: 10.1111/j.1751-486x.2011.01652.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mosley I, Nicol M, Donnan G, Dewey H. Family physician decisions following stroke symptom onset and delay times to ambulance call. BMC FAMILY PRACTICE 2011; 12:82. [PMID: 21813024 PMCID: PMC3170189 DOI: 10.1186/1471-2296-12-82] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 08/04/2011] [Indexed: 11/22/2022]
Abstract
Background For stroke patients, calling an ambulance has been shown to be associated with faster times to hospital than contacting a family physician. However little is known about the impact of decisions made by family physicians on delay times for stroke patients once they have been called. We aimed to test the hypotheses that among ambulance transported stroke patients: • Factors associated with first calling a family physician, could be identified. • Time to ambulance call will be longer when a family physician is first contacted. • Medical examination prior to the ambulance call will be associated with longer delay times. Methods For 6 months in 2004, all ambulance-transported stroke patients who presented from a defined region in Melbourne, Australia to one of three hospitals were assessed. Ambulance and hospital records were analysed. The patient and the person who called the ambulance were interviewed to obtain their description of the stroke event. Results 198 patients were included in the study. In 32% of cases an ambulance was first called. No demographic or situational factors were associated with first calling a doctor. Patients with a history of stroke or TIA were less likely to call a doctor following symptom onset (p = 0.01). Patients with a severe stroke (Glasgow Coma Scale < 9) never called a doctor first. When a family physician was contacted (22% of cases), the time to ambulance call was significantly longer than when an ambulance was first called (p = 0.0018) (median 143 and 44 minutes, respectively). In 36% of calls to a family physician, the doctor elected to first examine the patient. Time to ambulance call was shorter when the doctor vetted the call and advised the caller to immediately call an ambulance (45%) (median 412 and 92 minutes respectively: p = 0.06). Conclusion Time delays to ambulance call were significantly longer for stroke patients when a family physician was first contacted. Further extensive delays were experienced by patients when the family physician elected to examine the patient. Family physicians and their staff have an important role to play in averting potential delays for stroke patients by screening calls and providing immediate advice to "call an ambulance".
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Affiliation(s)
- Ian Mosley
- National Stroke Research Institute, Melbourne, Australia.
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Barger SD. Perceived Emotional Support and Frequent Social Contacts Are Associated with Greater Knowledge of Stroke Warning Signs: Evidence from Two Cross-sectional US Population Surveys. J Health Psychol 2011; 17:169-78. [DOI: 10.1177/1359105311412837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Public knowledge of acute stroke symptoms is a goal of public health policy. Similarly, general health knowledge is a hypothesized pathway for the salutary effects of social ties. This study examined the association of stroke warning sign knowledge with the quantity (number of recent social contacts) and/or quality (perceived emotional support) of social ties in two population-based cross-sectional surveys ( Ns = 33,326 and 80,454). Both higher levels of emotional support and more frequent social contacts were independently associated with greater stroke warning sign knowledge. Social isolation is a novel marker of poor knowledge of stroke warning signs.
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Bray JE, Mosley I, Bailey M, Barger B, Bladin C. Stroke public awareness campaigns have increased ambulance dispatches for stroke in Melbourne, Australia. Stroke 2011; 42:2154-7. [PMID: 21757668 DOI: 10.1161/strokeaha.110.612036] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Launch of the National Stroke Foundation stroke awareness campaigns has occurred annually during Stroke Week (September) since 2004. From 2006, the campaign used FAST (Face, Arm, Speech, Time) with calling an ambulance added in 2007. The aim of this study was to explore the impact of these campaigns on ambulance dispatches for stroke (Medical Priority Dispatch Card 28) in Melbourne, Australia. METHODS A cross-sectional study examining the monthly proportions of ambulance dispatches for stroke between August 1999 and 2010 was conducted. The proportions of dispatches for stroke were used due to increases in the population and in ambulance dispatches over the study period. These proportions were statistically compared for the month before Stroke Week (August) and the month after Stroke Week (October) for each year and seasonal variation was examined. RESULTS Between 1999 and 2009, the annual proportion of dispatches for stroke increased from 2.1% (n=4327) to 2.95% (n=9918). When stroke dispatches in August were compared with those in October, a significant increase in October was only detected since the call an ambulance message was added to FAST: 2007 (2.62% to 3.00%, P=0.006), 2008 (2.62% to 3.05%, P=0.003), and 2009 (2.70% to 3.09%, P=0.007). From 2005, the peak season for stroke dispatches shifted from winter to spring. CONCLUSIONS Ambulance dispatches for stroke significantly increased after the National Stroke Foundation campaigns began, particularly in years receiving greater funding and featuring the FAST symptoms and the message to call an ambulance. Monitoring ambulance use appears to be an effective measure of campaign penetration.
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Affiliation(s)
- Janet E Bray
- Ambulance Victoria, Doncaster, Victoria, 3618, Australia.
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79
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Lowthian JA, Cameron PA, Stoelwinder JU, Curtis A, Currell A, Cooke MW, McNeil JJ. Increasing utilisation of emergency ambulances. AUST HEALTH REV 2011; 35:63-9. [PMID: 21367333 DOI: 10.1071/ah09866] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 05/18/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Increased ambulance utilisation is closely linked with Emergency Department (ED) attendances. Pressures on hospital systems are widely acknowledged with ED overcrowding reported regularly in the media and peer-reviewed literature. Strains on ambulance services are less well-documented or studied. AIMS To review the literature to determine the trends in utilisation of emergency ambulances throughout the developed world and to discuss the major underlying drivers perceived as contributing to this increase. METHOD A search of online databases, search engines, peer-reviewed journals and audit reports was undertaken. FINDINGS Ambulance utilisation has increased in many developed countries over the past 20 years. Annual growth rates throughout Australia and the United Kingdom are similar. Population ageing, changes in social support, accessibility and pricing, and increasing community health awareness have been proposed as associated factors. As the extent of their contribution has not yet been established these factors were reviewed. CONCLUSION The continued rise in utilisation of emergency ambulances is placing increasing demands on ambulance services and the wider health system, potentially compromising access, quality, safety and outcomes. A variety of factors may contribute to this increase and targeted strategies to reduce utilisation will require an accurate identification of the major drivers of demand.
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Affiliation(s)
- Judy A Lowthian
- Ambulance Victoria, 375 Manningham Road, Doncaster, VIC 3108, Australia.
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80
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Maasland L, Brouwer-Goossensen D, den Hertog HM, Koudstaal PJ, Dippel DWJ. Health education in patients with a recent stroke or transient ischaemic attack: a comprehensive review. Int J Stroke 2011; 6:67-74. [PMID: 21205243 DOI: 10.1111/j.1747-4949.2010.00541.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health education aims at the acquisition of skills and attitudes to modify behaviour that influences health, leads to a modification of risk factors and ultimately to a decrease in disability and case fatality from stroke. Health education is an underdeveloped but important aspect of stroke care. Health education could promote compliance and healthy behaviour, improve patients' understanding of their health status and treatment options and facilitate communication. We reviewed the effect of health education in stroke and transient ischaemic attack patients, aiming at feasibility, effectiveness at the level of knowledge, attitude and skills, health behaviour changes and stroke outcome. We also describe the current status of health education for patients with recent coronary artery disease and public health education in stroke. Basic knowledge of stroke and transient ischaemic attack patients of their disease and associated risk factors is not sufficient. This is also observed in patients with coronary artery disease and in the general population. A beneficial effect of health education in stroke and transient ischaemic attack patients on health behaviour, risk reduction or stroke outcome has not been proven. Trials in patients with coronary artery disease, however, have shown that health education could result in a change of lifestyle. No specific method is superior, although the individualised, repetitive and active methods appear more successful. More intervention studies of health education in stroke and transient ischaemic attack patients are needed. Future trials should be large, have a long follow-up, should use an intensive and repetitive approach and involve patients' relatives to induce and maintain a healthy lifestyle.
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Affiliation(s)
- Lisette Maasland
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
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81
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Lowthian JA, Cameron PA. Emergency demand access block and patient safety: a call for national leadership. Emerg Med Australas 2011; 21:435-9. [PMID: 20002712 DOI: 10.1111/j.1742-6723.2009.01226.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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82
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Stroke thrombolysis: Barriers to implementation. Int Emerg Nurs 2011; 19:53-7. [DOI: 10.1016/j.ienj.2010.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 02/18/2010] [Accepted: 02/19/2010] [Indexed: 11/17/2022]
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83
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Lecouturier J, Rodgers H, Murtagh MJ, White M, Ford GA, Thomson RG. Systematic review of mass media interventions designed to improve public recognition of stroke symptoms, emergency response and early treatment. BMC Public Health 2010; 10:784. [PMID: 21182777 PMCID: PMC3022856 DOI: 10.1186/1471-2458-10-784] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 12/23/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mass media interventions have been implemented to improve emergency response to stroke given the emergence of effective acute treatments, but their impact is unclear. METHODS Systematic review of mass media interventions aimed at improving emergency response to stroke, with narrative synthesis and review of intervention development. RESULTS Ten studies were included (six targeted the public, four both public and professionals) published between 1992 and 2010. Only three were controlled before and after studies, and only one had reported how the intervention was developed. Campaigns aimed only at the public reported significant increase in awareness of symptoms/signs, but little impact on awareness of need for emergency response. Of the two controlled before and after studies, one reported no impact on those over 65 years, the age group at increased risk of stroke and most likely to witness a stroke, and the other found a significant increase in awareness of two or more warning signs of stroke in the same group post-intervention. One campaign targeted at public and professionals did not reduce time to presentation at hospital to within two hours, but increased and sustained thrombolysis rates. This suggests the campaign had a primary impact on professionals and improved the way that services for stroke were organised. CONCLUSIONS Campaigns aimed at the public may raise awareness of symptoms/signs of stroke, but have limited impact on behaviour. Campaigns aimed at both public and professionals may have more impact on professionals than the public. New campaigns should follow the principles of good design and be robustly evaluated.
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Affiliation(s)
- Jan Lecouturier
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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84
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Teuschl Y, Brainin M. Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledge. Int J Stroke 2010; 5:187-208. [PMID: 20536616 DOI: 10.1111/j.1747-4949.2010.00428.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Time is essential for the treatment of acute stroke. Much time is lost outside the hospital, either due to failure in identifying stroke symptoms or due to a delay in notification or transport. We review studies reporting factors associated with better stroke knowledge and shorter time delays. We summarise the evidences for the effect of stroke knowledge and education on people's reaction in the acute situation of stroke. METHODS We searched MEDLINE for studies reporting factors associated with prehospital time of stroke patients, or knowledge of stroke symptoms. Further, we searched for studies reporting educational interventions aimed at increasing stroke symptom knowledge in the population. FINDINGS We included a total of 182 studies. Surprisingly, those factors associated with better stroke knowledge such as education and sociodemographic variables were not related to shorter time delays. Few studies report shorter time delays or better stroke knowledge in persons having suffered a previous stroke. Factors associated with shorter time delays were more severe stroke and symptoms regarded as serious, but not better knowledge about the most frequent symptoms such as hemiparesis or disorders of speech. Only 25-56% of patients recognised their own symptoms as stroke. While stroke education increases the knowledge of warning signs, a few population studies measured the impact of education on time delays; in such studies, time delays decreased after education. This may partly be mediated by better organisation of EMS and hospitals. INTERPRETATION There is a discrepancy between theoretical stroke knowledge and the reaction in an acute situation. Help-seeking behaviour is more dependent on the perceived severity of symptoms than on symptom knowledge. Bystanders play an important role in the decision to call for help and should be included in stroke education. Education is effective and should be culturally adapted and presented in a social context. It is unclear which educational concept is best suited to enhance symptom recognition in the acute situation of stroke, especially in view of discrepancies between knowledge and action.
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Affiliation(s)
- Yvonne Teuschl
- Department of Clinical Medicine and Preventive Medicine, Danube University, Krems, Austria
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85
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Fussman C, Rafferty AP, Lyon-Callo S, Morgenstern LB, Reeves MJ. Lack of Association Between Stroke Symptom Knowledge and Intent to Call 911. Stroke 2010; 41:1501-7. [DOI: 10.1161/strokeaha.110.578195] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chris Fussman
- From the Michigan Department of Community Health (C.F., A.P.R., S.L.-C.), Lansing, Mich; the Stroke Program (L.B.M.), University of Michigan Medical School and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Mich; and the Department of Epidemiology (M.J.R.), College of Human Medicine, Michigan State University, East Lansing, Mich
| | - Ann P. Rafferty
- From the Michigan Department of Community Health (C.F., A.P.R., S.L.-C.), Lansing, Mich; the Stroke Program (L.B.M.), University of Michigan Medical School and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Mich; and the Department of Epidemiology (M.J.R.), College of Human Medicine, Michigan State University, East Lansing, Mich
| | - Sarah Lyon-Callo
- From the Michigan Department of Community Health (C.F., A.P.R., S.L.-C.), Lansing, Mich; the Stroke Program (L.B.M.), University of Michigan Medical School and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Mich; and the Department of Epidemiology (M.J.R.), College of Human Medicine, Michigan State University, East Lansing, Mich
| | - Lewis B. Morgenstern
- From the Michigan Department of Community Health (C.F., A.P.R., S.L.-C.), Lansing, Mich; the Stroke Program (L.B.M.), University of Michigan Medical School and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Mich; and the Department of Epidemiology (M.J.R.), College of Human Medicine, Michigan State University, East Lansing, Mich
| | - Mathew J. Reeves
- From the Michigan Department of Community Health (C.F., A.P.R., S.L.-C.), Lansing, Mich; the Stroke Program (L.B.M.), University of Michigan Medical School and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Mich; and the Department of Epidemiology (M.J.R.), College of Human Medicine, Michigan State University, East Lansing, Mich
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86
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Fogle CC, Oser CS, McNamara MJ, Helgerson SD, Gohdes D, Harwell TS. Impact of media on community awareness of stroke warning signs: a comparison study. J Stroke Cerebrovasc Dis 2010; 19:370-5. [PMID: 20472468 DOI: 10.1016/j.jstrokecerebrovasdis.2009.06.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 05/19/2009] [Accepted: 06/01/2009] [Indexed: 11/26/2022] Open
Abstract
Prompt identification of the warning signs of ischemic stroke is critical to ensure appropriate and timely treatment. We implemented a 20-week public education campaign in one media market to increase community awareness of warning signs for stroke and the need to call 911. Telephone surveys were conducted in adults aged 45 years and older in the intervention county and a comparison county before and after the campaign to evaluate its impact. There was a significant increase in awareness of two or more warning signs for stroke from baseline to follow-up in the intervention county (73%-82%) but not in the comparison county (68%-69%). Respondent awareness of stroke warning signs increased significantly in the intervention county among men (68%-79%) and women (76%-84%) and among respondents aged 45 to 64 years (77%-85%) and respondents aged 65 years and older (67%-78%). There was no significant change in the proportion of respondents indicating they would call 911 if they witnessed someone having a stroke in the intervention county (81%-84%). However, after the campaign, an increased proportion of respondents in the intervention county indicated they would call 911 if they experienced sudden numbness or loss of sensation (50%-56%). Our findings suggest that a high-intensity public education campaign can increase community awareness of the warning signs for stroke and the need to call 911 for specific symptoms.
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Affiliation(s)
- Crystelle C Fogle
- Chronic Disease Prevention and Health Promotion Bureau, Montana Department of Public Health and Human Services, Helena, Montana 59620-2951, USA
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87
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Abstract
Scand J Caring Sci; 2010; 24; 307-311 Stroke patients' delay of emergency treatment Treatment of stroke victims with fibrinolysis should take place within a time limit of 3 hours. In spite of comprehensive endeavours to reduce hospital arrival time, too many patients still delay arrival beyond this time limit. This qualitative case study explored the meaning of acute stroke and treatment to four patients with more than 24-hour delayed arrival. The setting of the study was the catchment area of a university hospital. Semi-structured interviews were analysed through the empirical psychological, phenomenological method. An essence was found which was constituted by four themes. The essence of stroke symptoms and treatment was: 'Threatened control of bodily function, autonomy and integrity'. When the patients fell ill they acted as if nothing had happened. They treated their body like a defective device. In encounters with physicians they demanded to be met as a person by a person; otherwise they rejected both the physician and her or his prescriptions. They did not involve their near ones in decision-making. The conclusions were the following: Health care information about how to act in cases of early stroke symptoms may need to imbue people with an understanding of how early treatment of neurological symptoms and preserved control of life are intimately connected. Furthermore emergency care of acute stroke patients might need to take place in an organisation where patients are sure to be met by physicians as a person by a person.
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Affiliation(s)
- Finn Hjelmblink
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
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88
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Abstract
PURPOSE OF REVIEW Tissue-type plasminogen activator is the only pharmacological treatment approved for acute ischemic strokes but is administered to less than 5% of the patients. Excessive prehospital and in-hospital delays and lack of stroke center coverage are major issues that negatively impact stroke care. New strategies are being developed and evaluated to increase the number of tissue-type plasminogen activator-treated patients. RECENT FINDINGS Factors that limit rapid access to acute stroke care are discussed, including those influencing time intervals from stroke onset to hospital admission. We also describe strategies that hold promise to reduce prehospital delays and increase access to acute stroke treatment. SUMMARY The shortening of prehospital delays requires education of patients and health professionals and optimization of transport strategies. Future developments may include video conferencing offering telestroke expertise, strategies (i.e. therapeutic interventions) that might help to treat acute stroke patients with tissue-type plasminogen activator, and prehospital selection of candidates for endovascular therapies.
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89
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Jones SP, Jenkinson AJ, Leathley MJ, Watkins CL. Stroke knowledge and awareness: an integrative review of the evidence. Age Ageing 2010; 39:11-22. [PMID: 19897540 DOI: 10.1093/ageing/afp196] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND the recognition of stroke symptoms by the public and activation of the emergency medical services (EMS) are the most important factors in instigating pre-hospital stroke care. Studies have suggested that poor recognition of the warning signs of stroke is the main cause of delay in accessing the EMS. METHODS an integrative review of published studies about stroke knowledge and awareness was performed by searching online bibliographic databases, using keywords, from 1966 to 2008. Studies were included in the review if they focussed on risk factors, signs and symptoms, action and information. Each study was reviewed by two researchers (SJ and MJ). RESULTS we identified 169 studies of which 39 were included in the review. The ability to name one risk factor for stroke varied between studies, ranging from 18% to 94% when asked open-ended questions and from 42% to 97% when asked closed questions. The ability to name one symptom ranged from 25% to 72% when asked open-ended questions and from 95% to 100% when asked closed questions. When asked what action people would take if they thought they were having a stroke, between 53% and 98% replied that they would call the EMS. People generally obtained information about stroke from family and friends. Older members of the population, ethnic minority groups and those with lower levels of education had consistently poor levels of stroke knowledge. CONCLUSIONS generally, levels of knowledge about recognising and preventing stroke were poor. Nevertheless, most participants stated they would contact the EMS at the onset of stroke symptoms.
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90
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Gladstone DJ, Rodan LH, Sahlas DJ, Lee L, Murray BJ, Ween JE, Perry JR, Chenkin J, Morrison LJ, Beck S, Black SE. A Citywide Prehospital Protocol Increases Access to Stroke Thrombolysis in Toronto. Stroke 2009; 40:3841-4. [DOI: 10.1161/strokeaha.108.540377] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Intravenous tissue plasminogen activator for ischemic stroke is approved for eligible patients who can be treated within a 3-hour window, but treatment rates remain disappointingly low, often <5%. To improve rapid access to stroke thrombolysis in Toronto, Canada, a citywide prehospital acute stroke activation protocol was implemented by the provincial government to transport acute stroke patients directly to one of 3 regional stroke centers, bypassing local hospitals. This comprised a paramedic screening tool, ambulance destination decision rule, and formal memorandum of understanding of system stakeholders. This report describes the initial impact of the activation protocol at our regional stroke center.
Methods—
We compared consecutive patients with stroke arriving to our stroke center during the first 4 months of this new triage protocol (February 14 to June 14, 2005) versus the same 4-month period in 2004.
Results—
The protocol resulted in an immediate doubling in the number of patients with acute stroke arriving to our regional stroke center within 2.5 hours of symptom onset. We observed a 4-fold increase in patients who were eligible for and treated with tissue plasminogen activator. The tissue plasminogen activator treatment rate for ischemic stroke patients increased from 9.5% to 23.4% (
P
=0.01), and one in 2 patients with ischemic stroke arriving within 2.5 hours received thrombolysis during this period (one in 5 of patients with ischemic stroke overall). The median onset-to-needle time for tissue plasminogen activator-treated patients was significantly reduced. Many implementation challenges were identified and addressed.
Conclusions—
This prehospital triage was immediately successful in improving tissue plasminogen activator access for patients with ischemic stroke, enabling our center to achieve one of the highest tissue plasminogen activator treatment rates in North America and underscoring the need for coordinated systems of acute stroke care. Sustainability of such an initiative will be dependent on interdisciplinary teamwork, ongoing paramedic training, adequate hospital staffing, bed availability, and repatriation agreements with community hospitals.
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Affiliation(s)
- David J. Gladstone
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lance H. Rodan
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Demetrios J. Sahlas
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Liesly Lee
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian J. Murray
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jon E. Ween
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - James R. Perry
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jordan Chenkin
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laurie J. Morrison
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shann Beck
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sandra E. Black
- From the North and East GTA-Ontario Regional Stroke Centre and Division of Neurology, Department of Medicine, and Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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91
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Davis SM, Martinelli D, Braxton B, Kutrovac K, Crocco T. The Impact of the Extended Parallel Process Model on Stroke Awareness. Stroke 2009; 40:3857-63. [PMID: 19797185 DOI: 10.1161/strokeaha.109.559427] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen M. Davis
- From the Department of Emergency Medicine (S.M.D., B.B., K.K., T.C.), West Virginia University, Morgantown, WVa; and the P.I. Reed School of Journalism (D.M.), West Virginia University, Morgantown, WVa
| | - Diana Martinelli
- From the Department of Emergency Medicine (S.M.D., B.B., K.K., T.C.), West Virginia University, Morgantown, WVa; and the P.I. Reed School of Journalism (D.M.), West Virginia University, Morgantown, WVa
| | - Brian Braxton
- From the Department of Emergency Medicine (S.M.D., B.B., K.K., T.C.), West Virginia University, Morgantown, WVa; and the P.I. Reed School of Journalism (D.M.), West Virginia University, Morgantown, WVa
| | - Kyle Kutrovac
- From the Department of Emergency Medicine (S.M.D., B.B., K.K., T.C.), West Virginia University, Morgantown, WVa; and the P.I. Reed School of Journalism (D.M.), West Virginia University, Morgantown, WVa
| | - Todd Crocco
- From the Department of Emergency Medicine (S.M.D., B.B., K.K., T.C.), West Virginia University, Morgantown, WVa; and the P.I. Reed School of Journalism (D.M.), West Virginia University, Morgantown, WVa
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92
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Slot KB, Murray V, Boysen G, Berge E. Thrombolytic treatment for stroke in the Scandinavian countries. Acta Neurol Scand 2009; 120:270-6. [PMID: 19456310 DOI: 10.1111/j.1600-0404.2009.01162.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We wanted to describe the use of thrombolytic treatment for stroke in Scandinavia, to assess stroke doctors' opinions on this treatment, to identify barriers against treatment, and to suggest improvements to overcome these barriers. METHODS We sent questionnaires to 493 Scandinavian doctors, who were involved in acute stroke care. RESULTS We received 453 (92%) completed questionnaires. Overall, 1.9% (range per hospital 0-13.9%) of patients received thrombolytic treatment. A majority (94%) of the respondents was convinced of the beneficial effects of thrombolytic treatment and many (85%) felt that its risks were acceptable. Main barriers were: unawareness of stroke symptoms among patients (82%) and their failure to respond adequately (54%); ambulance services not triaging acute stroke as urgent (23%); and insufficient in-hospital routines (15%). The respondents suggested that the following measures should be prioritized to increase the treatment's use: educational programmes to improve public awareness on stroke and how to respond (96%); education of in-hospital (88%) and prehospital (76%) medical staff. CONCLUSIONS A large majority of Scandinavian doctors regard thrombolytic treatment for stroke as beneficial, yet its implementation in clinical practice has so far been poor. Our survey identified important barriers and potential measures that could increase its future use.
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Affiliation(s)
- K Bruins Slot
- Department of Internal Medicine, Ullevaal University Hospital, Oslo, Norway.
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93
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Nelson MJ, DeIorio NM, Schmidt T, Griffiths D, Daya M, Haywood L, Zive D, Newgard CD. Local media influence on opting out from an exception from informed consent trial. Ann Emerg Med 2009; 55:1-8. [PMID: 19682770 DOI: 10.1016/j.annemergmed.2009.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 04/15/2009] [Accepted: 05/27/2009] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE News media are used for community education and notification in exception from informed consent clinical trials, yet their effectiveness as an added safeguard in such research remains unknown. We assessed the number of callers requesting opt-out bracelets after each local media report and described the errors and content within each media report. METHODS We undertook a descriptive analysis of local media trial coverage (newspaper, television, radio, and Web log) and opt-out requests during a 41-month period at a single site participating in an exception from informed consent out-of-hospital trial. Two nontrial investigators independently assessed 41 content-based media variables (including background, trial information, graphics, errors, publication information, and assessment) with a standardized, semiqualitative data collection tool. Major errors were considered serious misrepresentation of the trial purpose or protocol, whereas minor errors included misinformation unlikely to mislead the lay reader about the trial. We plotted the temporal relationship between opt-out bracelet requests and media reports. Descriptive information about the news sources and the trial coverage are presented. RESULTS We collected 39 trial-related media reports (33 newspaper, 1 television, 1 radio, and 4 blogs). There were 13 errors in 9 (23%) publications, 7 of which were major and 6 minor. Of 384 requests for 710 bracelets, 310 requests (80%) occurred within 4 days after trial media coverage. Graphic timeline representation of the data suggested a close association between media reports about the trial and requests for opt-out bracelets. CONCLUSION According to results from a single site, local media coverage for an exception from informed consent clinical trial had a substantial portion of errors and appeared closely associated with opt-out requests.
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Affiliation(s)
- Maria J Nelson
- Oregon Health and Science University School of Medicine, Portland, OR 97239-3098, USA
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94
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Abstract
Despite the proven benefits of thrombolysis for patients presenting with acute ischemic stroke, only a limited number of patients receive thrombolytic therapy. The reason for the low treatment rate is that thrombolysis is only effective a few hours after the onset of ischemic stroke, so delays in patients being admitted to hospital and being diagnosed mean that the therapeutic window is often missed. Major factors that lead to prehospital delay include the general public's lack of knowledge of stroke symptoms and their poor understanding of the appropriate course of action following a stroke. Indeed, the patients who arrive early in hospital tend to be those who recognize the symptoms of stroke and take them seriously. Deficiencies in the identification of stroke by emergency medical services and general practitioners also contribute to prehospital delay. Aggressive, combined educational programs aimed at the general public, general practitioners, and medical and paramedical hospital staff can lead to increased stroke treatment rates. In this Review, we explore the extent of prehospital delay in stroke, identify the factors that affect the time taken for patients to reach hospital, and describe strategies designed to reduce the delay.
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Affiliation(s)
- Miriam Bouckaert
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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95
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Hickey A, O'Hanlon A, McGee H, Donnellan C, Shelley E, Horgan F, O'Neill D. Stroke awareness in the general population: knowledge of stroke risk factors and warning signs in older adults. BMC Geriatr 2009; 9:35. [PMID: 19656359 PMCID: PMC2734750 DOI: 10.1186/1471-2318-9-35] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 08/05/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of death and functional impairment. While older people are particularly vulnerable to stroke, research suggests that they have the poorest awareness of stroke warning signs and risk factors. This study examined knowledge of stroke warning signs and risk factors among community-dwelling older adults. METHODS Randomly selected community-dwelling older people (aged 65+) in Ireland (n = 2,033; 68% response rate). Participants completed home interviews. Questions assessed knowledge of stroke warning signs and risk factors, and personal risk factors for stroke. RESULTS Of the overall sample, 6% had previously experienced a stroke or transient ischaemic attack. When asked to identify stroke risk factors from a provided list, less than half of the overall sample identified established risk factors (e.g., smoking, hypercholesterolaemia), hypertension being the only exception (identified by 74%). Similarly, less than half identified established warning signs (e.g., weakness, headache), with slurred speech (54%) as the exception. Overall, there were considerable gaps in awareness with poorest levels evident in those with primary level education only and in those living in Northern Ireland (compared with Republic of Ireland). CONCLUSION Knowledge deficits in this study suggest that most of the common early symptoms or signs of stroke were recognized as such by less than half of the older adults surveyed. As such, many older adults may not recognise early symptoms of stroke in themselves or others. Thus, they may lose vital time in presenting for medical attention. Lack of public awareness about stroke warning signs and risk factors must be addressed as one important contribution to reducing mortality and morbidity from stroke.
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Affiliation(s)
- Anne Hickey
- Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ann O'Hanlon
- Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hannah McGee
- Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire Donnellan
- Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - Emer Shelley
- Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Desmond O'Neill
- Department of Medical Gerontology, Trinity College, Dublin, Ireland
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96
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Anderson BE, Rafferty AP, Lyon-Callo S, Fussman C, Reeves MJ. Knowledge of Tissue Plasminogen Activator for Acute Stroke Among Michigan Adults. Stroke 2009; 40:2564-7. [DOI: 10.1161/strokeaha.108.545988] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although tissue plasminogen activator (tPA) is an effective therapy for acute ischemic stroke, treatment rates remain low. Efforts to address the underuse of tPA include public education to increase the recognition of stroke symptoms and the awareness of tPA treatment. Our objective was to determine the level of knowledge about tPA treatment for acute stroke among a representative sample of Michigan adults.
Methods—
The Michigan Behavioral Risk Factor Survey (BRFS) is a random-digit-dial telephone survey of adults conducted annually as part of the national BRFS. Questions regarding tPA treatment for acute stroke were included in the 2004 Michigan BRFS. We examined the prevalence of awareness using χ
2
tests and generated multivariable logistic regression models.
Results—
Among 4724 respondents, only 32.2% (95% CI=30.8 to 33.8%) were aware of the existence of tPA treatment for acute stroke, of whom 52.7% (50.0 to 55.4%) knew that it needed to be administered within 3 hours of symptom onset. Awareness of tPA was higher among middle aged adults, females, whites, and those with higher education and income. Awareness of the time window for tPA was higher among middle aged adults and whites.
Conclusions—
In this population-based survey only a third of the public were aware of tPA as a treatment for stroke, and only 1 in 6 were aware that the treatment exists and needs to be given within 3 hours of symptom onset. Continuing efforts are necessary to increase public knowledge about tPA treatment for acute stroke.
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Affiliation(s)
- Beth E. Anderson
- From the Michigan Department of Community Health (B.E.A., A.P.R., S.L.C., C.F.), Lansing; and the Department of Epidemiology (M.J.R.), Michigan State University, East Lansing
| | - Ann P. Rafferty
- From the Michigan Department of Community Health (B.E.A., A.P.R., S.L.C., C.F.), Lansing; and the Department of Epidemiology (M.J.R.), Michigan State University, East Lansing
| | - Sarah Lyon-Callo
- From the Michigan Department of Community Health (B.E.A., A.P.R., S.L.C., C.F.), Lansing; and the Department of Epidemiology (M.J.R.), Michigan State University, East Lansing
| | - Chris Fussman
- From the Michigan Department of Community Health (B.E.A., A.P.R., S.L.C., C.F.), Lansing; and the Department of Epidemiology (M.J.R.), Michigan State University, East Lansing
| | - Mathew J. Reeves
- From the Michigan Department of Community Health (B.E.A., A.P.R., S.L.C., C.F.), Lansing; and the Department of Epidemiology (M.J.R.), Michigan State University, East Lansing
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97
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Stroke and newspapers: inattention or neglect? J Stroke Cerebrovasc Dis 2009; 18:259-61. [PMID: 19560678 DOI: 10.1016/j.jstrokecerebrovasdis.2008.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 11/10/2008] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Services for stroke are poorly developed in Europe, and research into stroke is underfunded compared with heart disease or cancer. This may arise from the low profile of stroke within the public domain. Our aim was to assess the coverage of stroke compared with heart disease in a popular form of mass media, newspapers in the United Kingdom and Ireland. METHODS We searched the online databases of 4 major newspapers in the United Kingdom and Ireland using the terms "stroke" and "heart" during a 1-year period from May 1, 2006, to May 1, 2007. The resulting articles were then classified by two clinicians and those relating to the clinical conditions of stroke and heart disease were selected. RESULTS The searches were refined by hand and those articles relating to stroke were: 105 in the Irish Times, 223 in the Daily Telegraph, 22 in The Observer, and 149 in The Guardian. The number of articles relating to heart disease was: 443 in the Irish Times, 653 in the Daily Telegraph, 81 in The Observer, and 688 in The Guardian. CONCLUSIONS Newspaper coverage of stroke is underreported when compared with heart disease, despite the clinical and financial burden of this condition. Professional and advocacy organizations for those with stroke need to develop strategies to increase the profile of stroke in the public domain.
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98
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Fang MC, Panguluri P, Machtinger EL, Schillinger D. Language, literacy, and characterization of stroke among patients taking warfarin for stroke prevention: Implications for health communication. PATIENT EDUCATION AND COUNSELING 2009; 75:403-410. [PMID: 19171448 PMCID: PMC2740646 DOI: 10.1016/j.pec.2008.12.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 12/04/2008] [Accepted: 12/05/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Warfarin is a medication commonly prescribed to prevent strokes associated with certain medical conditions such as atrial fibrillation; however, little is known about how people taking warfarin perceive the goal of therapy and how they describe strokes. We assessed the stroke-related health literacy of anticoagulated patients to inform ways in which to improve health communication among people taking warfarin. METHODS We conducted a mixed-methods study of an ethnically and linguistically diverse sample of people taking warfarin to prevent stroke (N=183) and measured literacy using the short-form Test of Functional Health Literacy in Adults. We asked participants to (1) describe their indication for warfarin, and (2) describe a stroke. Transcribed answers were coded as concordant or discordant with established indications for warfarin and definitions of stroke. RESULTS Forty-three percent of participants provided a discordant response when describing their indication for warfarin. Only 9.3% reported that the purpose of taking warfarin was to prevent stroke. Not speaking English [OR=2.4 (1.1-5.6)] and less than a college education [OR=3.3 (1.4-7.3)] were independently associated with discordant answers about warfarin. Nearly 40% of subjects had inaccurate perceptions of stroke, and only one-third of subjects described a symptom or sign of stroke. Among English and Spanish-speaking participants, inadequate literacy was strongly associated with discordant responses about stroke [OR=5.8 (2.1-15.6)]. CONCLUSION Among high-risk people taking warfarin to prevent stroke, significant gaps in stroke-related health literacy exist. These gaps likely represent mismatches in the ways clinicians teach and patients learn. PRACTICE IMPLICATIONS Since stroke risk awareness and early recognition of the signs and symptoms of stroke are critical aspects of stroke prevention and treatment, clinicians should more strongly link warfarin therapy to stroke prevention and ensure that patients know the presenting symptoms and signs of stroke. Public health communication strategies regarding stroke prevention need to target individuals with limited literacy and limited English proficiency.
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Affiliation(s)
- Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, CA 94143, United States.
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99
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Tadros A, Crocco T, Davis SM, Newman J, Mullen J, Best R, Teets A, Maxwell C, Slaughter B, Teter S. Emergency Medical Services-Based Community Stroke Education. Stroke 2009; 40:2134-42. [PMID: 19359622 DOI: 10.1161/strokeaha.108.532762] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although previous studies using mass media have demonstrated successful public stroke awareness campaigns, they may have been too costly for smaller communities to implement. The goal of this study was to investigate if a novel emergency medical services (EMS) -sponsored community awareness campaign could increase public stroke awareness.
Methods—
This was a pre- and postintervention study with 2 phases conducted between August 2005 and July 2007. During Phase I, strategic placement of stroke education media by EMS personnel was implemented in one county over a 2-year period. Five random-digit, standardized phone surveys measuring stroke awareness were conducted with county residents to assess the campaign’s impact. In Phase II, EMS interventions and random-digit measurements were conducted in 4 additional counties with 4 counties randomly selected as controls.
Results—
A pattern of increasing stroke knowledge after exposure to the EMS intervention followed by declines in the absence of the intervention was observed during Phase I. EMS interventions also demonstrated a positive effect on the stroke knowledge of residents who lived in counties exposed to the intervention during Phase II with a statistically significant (
P
<0.05) increase observed in the proportion of respondents that named 2 stroke risk factors and 3 symptoms in comparison to either no changes or declines in the control counties. No evidence of a positive impact on knowledge of calling 911 for stroke was observed.
Conclusion—
Results of this study suggest that the public’s knowledge of stroke signs and symptoms was increased using communitywide EMS-based programs. Additional studies are needed to determine optimal methods for educating the public regarding the need to call 911 for stroke and to confirm these results in other locales.
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Affiliation(s)
- Allison Tadros
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
| | - Todd Crocco
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
| | - Stephen M. Davis
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
| | - Jeremy Newman
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
| | - Jeffrey Mullen
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
| | - Ronald Best
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
| | - Anthony Teets
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
| | - Charles Maxwell
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
| | - Barbara Slaughter
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
| | - Stellman Teter
- From the Department of Emergency Medicine (A. Tadros, T.C., S.M.D., J.N., J.M., R.B.), West Virginia University School of Medicine, Morgantown, WVa; and Monongalia County Emergency Medical Services (A. Teets, C.M., B.S., S.T.), Morgantown, WVa
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100
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Evenson KR, Foraker RE, Morris DL, Rosamond WD. A comprehensive review of prehospital and in-hospital delay times in acute stroke care. Int J Stroke 2009; 4:187-99. [PMID: 19659821 PMCID: PMC2825147 DOI: 10.1111/j.1747-4949.2009.00276.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to systematically review and summarize prehospital and in-hospital stroke evaluation and treatment delay times. We identified 123 unique peer-reviewed studies published from 1981 to 2007 of prehospital and in-hospital delay time for evaluation and treatment of patients with stroke, transient ischemic attack, or stroke-like symptoms. Based on studies of 65 different population groups, the weighted Poisson regression indicated a 6.0% annual decline (P<0.001) in hours/year for prehospital delay, defined from symptom onset to emergency department arrival. For in-hospital delay, the weighted Poisson regression models indicated no meaningful changes in delay time from emergency department arrival to emergency department evaluation (3.1%, P=0.49 based on 12 population groups). There was a 10.2% annual decline in hours/year from emergency department arrival to neurology evaluation or notification (P=0.23 based on 16 population groups) and a 10.7% annual decline in hours/year for delay time from emergency department arrival to initiation of computed tomography (P=0.11 based on 23 population groups). Only one study reported on times from arrival to computed tomography scan interpretation, two studies on arrival to drug administration, and no studies on arrival to transfer to an in-patient setting, precluding generalizations. Prehospital delay continues to contribute the largest proportion of delay time. The next decade provides opportunities to establish more effective community-based interventions worldwide. It will be crucial to have effective stroke surveillance systems in place to better understand and improve both prehospital and in-hospital delays for acute stroke care.
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Affiliation(s)
- K R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514, USA.
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