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Timsit S, Bailly P, Nowak E, Merrien FM, Hervé D, Viakhireva-Dovganyuk I, Jourdain A, Thomas E, Goas P, Rouhart F. Cryptogenic mechanism in ischaemic stroke patients is a predictor of 5-year survival: A population-based study. Eur Stroke J 2016; 1:279-287. [PMID: 31008289 DOI: 10.1177/2396987316669216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/30/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction The present study sought to identify factors affecting mortality beyond 28 days in ischaemic stroke patients with whatever ischaemic mechanism. Patients and methods A prospective population-based registry was set up in Brest County, Brittany, France. Demographic data, clinical presentation, vascular risk factors and mortality were collected from January 2008 to December 2012. At "home without help" was used as a surrogate marker for low Rankin (0-1) at discharge from the hospital. IS was classified on the TOAST classification. Overall mortality was calculated using the Kaplan-Meier method. Multivariate analysis of mortality beyond 28 days was implemented, using a Cox model, on significant risk factors identified on univariate analysis. Results About 3024 IS cases were followed up beyond 28 days. Overall mortality beyond 28 days was 38.49% at 60 months. On multivariate analysis, age (10 years: HR = 1.84; [1.66-2.02]), coronary artery disease (HR = 1.28; [1.05-1.56]), cardiac arrhythmia (HR = 1.36; [1.11-1.67]), peripheral artery disease (HR = 1.66 [1.29-2.13]) and incomplete assessment (HR = 1.39; [1.12-1.74]) were associated with higher mortality risk, whereas female gender (HR = 0.80; [0.68-0.94]), high Glasgow Coma Scale score (GCS > 12) (HR = 0.58; [0.45-0.76]), lacunar syndrome (HR = 0.82; [0.68-0.99], being 'at home without help' (HR = 0.50; [0.41-0.59]) and negative assessment (HR = 0.75; [0.58-0.97], compared to cardioembolism) were associated with better survival probability. Discussion Initial clinical status, prior cardiovascular diseases and age was associated with more risk of death: an increment of 10 years almost doubled mortality. Women had more survival probability than men, controlling for age. Ischaemic stroke mechanisms were predictors of late 5-year mortality. Conclusion Patients with negative assessment, i.e. representing truly cryptogenic ischaemic stroke, had the best survival probability probably due to fewer atherosclerotic markers.
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Affiliation(s)
- S Timsit
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - P Bailly
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - E Nowak
- Centre d'Investigation Clinique-INSERM CIC 1412, CHRU, Brest, France
| | - F M Merrien
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - D Hervé
- Centre d'Investigation Clinique-INSERM CIC 1412, CHRU, Brest, France
| | | | - A Jourdain
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - E Thomas
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - P Goas
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
| | - F Rouhart
- Service de Neurologie et Unité Neuro-Vasculaire, CHRU, Brest, France
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Abstract
Despite major improvements in primary prevention and acute treatment over the last decades, stroke is still a devastating disease. At the beginning of the 21st century, the age-standardized incidence of stroke in Europe ranged from 95 to 290/100,000 per year, with one-month case-fatality rates ranging from 13 to 35%. Approximately 1.1 million inhabitants of Europe suffered a stroke each year, and ischemic stroke accounted for approximately 80% of cases. Although global stroke incidence is declining, rates observed in young adults are on the rise, thus suggesting a need for strategies to improve prevention. In addition, because of the ageing population, the absolute number of stroke is expected to dramatically increase in coming years: by 2025, 1.5 million European people will suffer a stroke each year. Beyond vital prognosis, stroke patients are also at increased risk of poor outcome within the first year of the event including re-hospitalisation (33%), recurrent event (7 to 13%), dementia (7 to 23%) mild cognitive disorder (35 to 47%), depression (30 to 50%), and fatigue (35% to 92%), all of them contributing to affect health related quality of life. Given these observations, an urgent development of acute care provision, as well as resources for post-stroke therapeutic strategies, is needed.
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Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, Norrving B, Donnan GA, Cadilhac DA. Global stroke statistics. Int J Stroke 2016; 12:13-32. [PMID: 27794138 DOI: 10.1177/1747493016676285] [Citation(s) in RCA: 281] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Up to date data on incidence, mortality, and case-fatality for stroke are important for setting the agenda for prevention and healthcare. Aims and/or hypothesis We aim to update the most current incidence and mortality data on stroke available by country, and to expand the scope to case-fatality and explore how registry data might be complementary. Methods Data were compiled using two approaches: (1) an updated literature review building from our previous review and (2) direct acquisition and analysis of stroke events in the World Health Organization (WHO) mortality database for each country providing these data. To assess new and/or updated data on incidence, we searched multiple databases to identify new original papers and review articles that met ideal criteria for stroke incidence studies and were published between 15 May 2013 and 31 May 2016. For data on case-fatality, we searched between 1980 and 31 May 2016. We further screened reference lists and citation history of papers to identify other studies not obtained from these sources. Mortality codes for ICD-8, ICD-9, and ICD-10 were extracted. Using population denominators provided for each country, we calculated both the crude mortality from stroke and mortality adjusted to the WHO world population. We used only the most recent year reported to the WHO for which both population and mortality data were available. Results Fifty-one countries had data on stroke incidence, some with data over many time periods, and some with data in more than one region. Since our last review, there were new incidence studies from 12 countries, with four meeting pre-determined quality criteria. In these four studies, the incidence of stroke, adjusted to the WHO World standard population, ranged from 76 per 100,000 population per year in Australia (2009-10) up to 119 per 100,000 population per year in New Zealand (2011-12), with the latter being in those aged at least 15 years. Only in Martinique (2011-12) was the incidence of stroke greater in women than men. In countries either lacking or with old data on stroke incidence, eight had national clinical registries of hospital based data. Of the 128 countries reporting mortality data to the WHO, crude mortality was greatest in Kazhakstan (in 2003), Bulgaria, and Greece. Crude mortality and crude incidence of stroke were both positively correlated with the proportion of the population aged ≥ 65 years, but not with time. Data on case-fatality were available in 42 studies in 22 countries, with large variations between regions. Conclusions In this updated review, we describe the current data on stroke incidence, case-fatality and mortality in different countries, and highlight the growing trend for national clinical registries to provide estimates in lieu of community-based incidence studies.
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Affiliation(s)
- Amanda G Thrift
- 1 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Tharshanah Thayabaranathan
- 1 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - George Howard
- 2 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Virginia J Howard
- 3 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Peter M Rothwell
- 4 Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (Clinical Neurology), University of Oxford, Oxford, UK
| | - Valery L Feigin
- 5 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- 6 Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - Geoffrey A Donnan
- 7 Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.,8 Neurology Department, The University of Melbourne, Melbourne, Australia
| | - Dominique A Cadilhac
- 1 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,7 Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Satue E, Vila-Corcoles A, Ochoa-Gondar O, de Diego C, Forcadell MJ, Rodriguez-Blanco T, Barnes L, Jariod M. Incidence and risk conditions of ischemic stroke in older adults. Acta Neurol Scand 2016; 134:250-7. [PMID: 26592375 DOI: 10.1111/ane.12535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to investigate incidence and mortality from ischemic stroke in older adults with specific underlying chronic conditions, evaluating the influence of these conditions in developing stroke. MATERIALS & METHODS Population-based cohort study involving 27,204 individuals ≥60 years old in Southern Catalonia, Spain. All cases of hospitalization from ischemic stroke (confirmed by neuro-imaging) were collected from 01/12/2008 until 30/11/2011. Incidence rates and 30-day mortality were estimated according to age, sex, chronic illnesses, and underlying conditions. Multivariable Cox regression analysis was used to calculate Hazards Ratio (HR) and estimate the association between baseline conditions and risk of developing stroke. RESULTS Mean incidence rate reached 453 cases per 100,000 person-years. Maximum rates appeared among individuals with history of prior stroke (2926 per 100,000), atrial fibrillation (1815 per 100,000), coronary artery disease (1104 per 100,000), nursing-home residence (1014 per 100,000), and advanced age ≥80 years (1006 per 100,000). Thirty-day mortality was 13% overall, reaching 21% among patients over 80 years. Age [HR: 1.06; 95% confidence interval (CI): 1.04-1.07], history of prior stroke (HR: 5.08; 95% CI: 3.96-6.51), history of coronary artery disease (HR: 1.65; 95% CI: 1.21-2.25), atrial fibrillation (HR: 2.96; 95% CI: 2.30-3.81), diabetes mellitus (HR: 1.55; 95% CI: 1.23-1.95), and smoking (HR: 1.64; 95% CI: 1.15-2.34) emerged independently associated with an increased risk of ischemic stroke. CONCLUSION Incidence and mortality from ischemic stroke remains considerable. Apart from age and history of atherosclerosis (prior stroke or coronary artery disease), atrial fibrillation, diabetes, and smoking were the underlying conditions most strongly associated with an increased risk.
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Affiliation(s)
- E. Satue
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | - A. Vila-Corcoles
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | - O. Ochoa-Gondar
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | - C. de Diego
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | - M. J. Forcadell
- Primary Care Service ‘Camp de Tarragona’; Institut Catala de la Salut; Tarragona Spain
| | | | - L. Barnes
- Sant Pau i Santa Tecla Hospital; Tarragona Spain
| | - M. Jariod
- Joan XXIII Hospital; Tarragona Spain
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55
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Pascoe MC, Linden T. Folate and MMA predict cognitive impairment in elderly stroke survivors: A cross sectional study. Psychiatry Res 2016; 243:49-52. [PMID: 27367490 DOI: 10.1016/j.psychres.2016.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022]
Abstract
Elderly stroke survivors are at risk of malnutrition and long-term cognitive impairment. Vitamin B-related metabolites, folate and methylmalonic acid, have been implicated in cognitive function. We conducted a study exploring the relationship between blood folate, methylmalonic acid and post-stroke cognitive impairment. This is a cross sectional study of elderly Swedish patients (n=149) 20 months post-stroke, assessed using the Mini Mental State Examination, serum blood levels of methylmalonic acid and red blood cell levels of folate. Linear modeling indicated that low levels of blood folate and elevated methylmalonic acid significantly contributed to cognitive impairment in stroke survivors. Half of the stroke survivors were shown to have folate deficiency at 20 months after stroke. Folate deficiency is common long term after stroke and both low folate and elevated methylmalonic acid appear to be associated with long term cognitive impairment, in elderly Swedish stroke survivors.
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Affiliation(s)
- Michaela C Pascoe
- Centre for the Heart and Mind, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC 3000, Australia; Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, Australia.
| | - Thomas Linden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
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56
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Extracorporeal Shock Wave Stimulation as Alternative Treatment Modality for Wrist and Fingers Spasticity in Poststroke Patients: A Prospective, Open-Label, Preliminary Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:4648101. [PMID: 27504139 PMCID: PMC4967701 DOI: 10.1155/2016/4648101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/13/2016] [Accepted: 06/08/2016] [Indexed: 12/18/2022]
Abstract
Objective. To evaluate the effectiveness of radial shock waves (rESW) for wrist and fingers flexors spasticity in stroke patients. Methods. Twenty patients with upper limb muscle spasticity were enrolled in the study and treated with a single session of rESW. The spasticity level of the radio carpal (RC) and finger (FF) joints was assessed using Modified Ashworth Scale (MAS). The resting bioelectrical activity of the flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU) was examined using surface electromyography (sEMG). Trophic conditions were measured using infrared thermal (IRT) imaging. All measurements were conducted at baseline (t0), immediately after rESW (t1), and 1 (t2) and 24 (t3) hours following rESW. Results. Significant reduction in MAS was observed for the RC joint in t1, as well as for the FF joints in t1, t2, and t3. A significant decrease in sEMG was shown for the FCR muscle in t1 and t2, as well as for the FCU muscle in t1 and t3. Also, a significant increase in IRT value was observed in t3 only. Conclusions. A single session of rESW could be an effective alternative treatment for reduction of limb spasticity and could lead to improvement of trophic conditions of the spastic muscles.
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57
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Comprehensive imaging of stroke – Looking for the gold standard. Neurol Neurochir Pol 2016; 50:241-50. [DOI: 10.1016/j.pjnns.2016.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 11/20/2022]
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58
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Herrington W, Lacey B, Sherliker P, Armitage J, Lewington S. Epidemiology of Atherosclerosis and the Potential to Reduce the Global Burden of Atherothrombotic Disease. Circ Res 2016; 118:535-46. [PMID: 26892956 DOI: 10.1161/circresaha.115.307611] [Citation(s) in RCA: 901] [Impact Index Per Article: 112.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atherosclerosis is a leading cause of vascular disease worldwide. Its major clinical manifestations include ischemic heart disease, ischemic stroke, and peripheral arterial disease. In high-income countries, there have been dramatic declines in the incidence and mortality from ischemic heart disease and ischemic stroke since the middle of the 20th century. For example, in the United Kingdom, the probability of death from vascular disease in middle-aged men (35-69 years) has decreased from 22% in 1950 to 6% in 2010. Most low- and middle-income countries have also reported declines in mortality from stroke over the last few decades, but mortality trends from ischemic heart disease have been more varied, with some countries reporting declines and others reporting increases (particularly those in Eastern Europe and Asia). Many major modifiable risk factors for atherosclerosis have been identified, and the causal relevance of several risk factors is now well established (including, but not limited to, smoking, adiposity, blood pressure, blood cholesterol, and diabetes mellitus). Widespread changes in health behaviors and use of treatments for these risk factors are responsible for some of the dramatic declines in vascular mortality in high-income countries. In order that these declines continue and are mirrored in less wealthy nations, increased efforts are needed to tackle these major risk factors, particularly smoking and the emerging obesity epidemic.
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Affiliation(s)
- William Herrington
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Oxford OX3 7LF, UK
| | - Ben Lacey
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Oxford OX3 7LF, UK
| | - Paul Sherliker
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Oxford OX3 7LF, UK
| | - Jane Armitage
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Oxford OX3 7LF, UK.
| | - Sarah Lewington
- From the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Oxford OX3 7LF, UK
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Nacu A, Fromm A, Sand KM, Waje‐Andreassen U, Thomassen L, Naess H. Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study. Acta Neurol Scand 2016; 133:202-7. [PMID: 26032994 PMCID: PMC4744685 DOI: 10.1111/ane.12446] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Age dependency of acute ischaemic stroke aetiology and vascular risk factors have not been adequately evaluated in stroke patients in Norway. Aims of this study were to evaluate how stroke subtypes and vascular risk factors vary with age in a western Norway stroke population. MATERIALS AND METHODS Patients aged 15-100 years consecutively admitted to our neurovascular centre with acute ischaemic stroke between 2006 and 2012 were included. The study population was categorized as young (15-49 years), middle-aged (50-74 years) or elderly (≥ 75 years). Stroke aetiology was defined by TOAST criteria. Risk factors and history of cardiovascular disease were recorded. RESULTS In total, 2484 patients with acute cerebral infarction were included: 1418 were males (57.3%). Mean age was 70.8 years (SD ± 14.9), 228 patients were young, 1126 middle-aged, and 1130 were elderly. The proportion of large-artery atherosclerosis and of small-vessel occlusion was highest among middle-aged patients. The proportion of cardioembolism was high at all ages, especially among the elderly. The proportion of stroke of other determined cause was highest among young patients. Some risk factors (diabetes mellitus, active smoking, angina pectoris, prior stroke and peripheral artery disease) decreased among the elderly. The proportions of several potential causes increased with age. CONCLUSION The proportion of stroke subtypes and vascular risk factors are age dependent. Age 50-74 years constitutes the period in life where cardiovascular risk factors become manifest and stroke subtypes change.
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Affiliation(s)
- A. Nacu
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - A. Fromm
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - K. M. Sand
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - U. Waje‐Andreassen
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
| | - L. Thomassen
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - H. Naess
- Centre for Neurovascular Diseases Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
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Lopes JM, Sanchis GJB, Medeiros JLAD, Dantas FG. Hospitalização por acidente vascular encefálico isquêmico no Brasil: estudo ecológico sobre possível impacto do Hiperdia. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 19:122-34. [DOI: 10.1590/1980-5497201600010011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: O estudo avaliou a tendência de hospitalização por acidente vascular encefálico isquêmico (HAVEI) e a sua mortalidade hospitalar no Brasil nos últimos 15 anos, assim como o impacto do programa Hiperdia nesse cenário. Métodos: Delineou-se um estudo ecológico com abordagem analítica e dados coletados no Sistema de Internação Hospitalar sobre episódios de AVEI, referentes aos anos de 1998 a 2012. Todos os dados foram estratificados por sexo e faixa etária, criando-se um indicador para HAVEI e proporção de mortalidade hospitalar. A fim de estimar a tendência dos dados criou-se uma curva polinomial de melhor aderência e para a averiguar o impacto do Hiperdia aplicou-se o Modelo Linear Generalizado tomados como desfecho a HAVEI e a mortalidade hospitalar. Adotou-se um nível de significância de 5% para minimizar um erro tipo I. Resultados: Foi evidenciada redução das HAVEI de 37,57/105 habitantes em 1998 a 2001 para 10,33/105 habitantes em 2002 a 2005, declinando 73,64%. A redução aconteceu em ambos os sexos, assim como para todas as faixas etárias. A mortalidade hospitalar por AVEI também declinou no Brasil a partir de 2002, tanto em homens como em mulheres, porém em menos de 3% e apenas nas faixas entre 0 e 14 anos e acima de 80 anos não detectamos tendência. Conclusão: Portanto, o declínio das HAVEI coincidiu temporalmente com a implementação do Hiperdia no ano de 2002 e essa tendência se mantém até hoje.
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61
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Kase CS, Shoamanesh A, Greenberg SM, Caplan LR. Intracerebral Hemorrhage. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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62
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Paiva S, Magalhães R, Alves J, Sampaio A. Efficacy of cognitive intervention in stroke: A long road ahead. Restor Neurol Neurosci 2015; 34:139-52. [PMID: 26684266 DOI: 10.3233/rnn-150590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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63
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Hayden DT, Hannon N, Callaly E, Ní Chróinín D, Horgan G, Kyne L, Duggan J, Dolan E, O’Rourke K, Williams D, Murphy S, Kelly PJ. Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation–Related Stroke. Stroke 2015; 46:3488-93. [DOI: 10.1161/strokeaha.115.011139] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/10/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Demographic trends in atrial fibrillation (AF) incidence may yield a substantial rise in the societal burden of AF-related stroke (AF-stroke). Accurate population-wide outcome data are essential to inform health service planning to improve AF-stroke prevention, and provision of rehabilitation, nursing home, and community supports for AF-stroke survivors.
Methods—
We investigated rates and determinants of 5-year fatality, stroke recurrence, functional outcomes, and prescribing of secondary prevention medications in AF-stroke in the North Dublin Population Stroke Study. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using lifetables and Kaplan–Meier survival curves, and Cox proportional hazard modeling was performed to identify predictors of death and recurrent stroke.
Results—
Five hundred sixty-eight patients with new stroke were identified, including 177 (31.2%) AF-stroke. At 5 years, 39.2% (confidence interval, 31.5–46.8) of ischemic AF-stroke patients were alive. Congestive heart failure, hypertension, age <65, 65–74 years, and ≥75 years, diabetes mellitus, prior stroke, transient ischemic attack or thromboembolism, vascular disease and female sex (CHA
2
DS
2
-VASc) score (hazard ratio [HR], 1.34;
P
<0.001), CHADS
2
score (HR 1.42,
P
=0.004), National Institute of Health Stroke Scale (HR, 1.09;
P
<0.0001), and subtherapeutic international normalized ratio (<2.0) at stroke onset (HR, 3.29;
P
=0.003) were independently associated with 5-year fatality, whereas warfarin (HR, 0.40;
P
=0.001) and statin use after index stroke (HR, 0.52;
P
=0.005) were associated with improved survival. The 5-year recurrence rate after ischemic AF-stroke was 21.5% (confidence interval, 14.5–31.3). Trends toward greater risk of recurrence were observed for persistent AF (HR, 3.09;
P
=0.07) and CHA
2
DS
2
-VASc score (HR, 1.34;
P
=0.07). Nursing home care was needed for 25.9% of patients.
Conclusions—
AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed.
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Affiliation(s)
- Derek T. Hayden
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Niamh Hannon
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Elizabeth Callaly
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Danielle Ní Chróinín
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Gillian Horgan
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Lorraine Kyne
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Joseph Duggan
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Eamon Dolan
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Killian O’Rourke
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - David Williams
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Sean Murphy
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
| | - Peter J. Kelly
- From the Stroke Department (D.T.H., E.C., D.N.C., G.H., K.O., S.M., P.J.K.), and Geriatrics Department (L.K., J.D.), Neurovascular Unit for Applied Translational Research and Therapeutics, University College Dublin/Dublin Academic Medical Centre, Mater University Hospital, Dublin, Ireland; Stroke Department, Beaumont University Hospital, Dublin, Ireland (D.W.); Stroke Department, Connolly Hospital Blanchardstown, Dublin, Ireland (E.C., E.D.); Department of Neurosciences, Addenbrookes Hospital,
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Konieczny MJ, Ri SJ, Georgiadis JR. Omental Approach to Functional Recovery After Cerebrovascular Disease. World Neurosurg 2015; 87:406-16. [PMID: 26493716 DOI: 10.1016/j.wneu.2015.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To review and synthesize the clinical literature regarding risks and benefits of omentum transplantation and transposition surgery in patients with ischemic stroke of other etiology (non-MMD) and Moyamoya disease (MMD), and to evaluate the evidence for biological underpinnings of the presumed physiologic effects of omentum transplantation and transposition on vascularization of brain parenchyma. METHODS Articles were searched on scientific databases using predefined key terms. Data abstraction was based on the clinical course as reported in the articles. For further analysis, patients were divided into groups according to their diagnosis (MMD or non-MMD). Descriptive statistics were computed for better integration of the results. RESULTS The final literature review contained 15 articles (11 case series, 4 single case studies) with data on 93 patients (29 non-MMD, 64 MMD). At post-assessment 56% of patients showed substantial gains in functional domains (24% in the non-MMD group, 71% in the MMD group) and 92% demonstrated improvements of cerebral vascularization (55% in the non-MMD group, 98% in the MMD group). Differences in improvement became apparent with regard to the initial symptomatology wherein transient ischemic attacks were related to superior recovery rates and language pathologies showed least improvement. CONCLUSIONS Surgical revascularization using omental tissue has shown good success rates, particularly for recurrent transient ischemic attacks and prevention of further strokes and should be considered as treatment option for selected patients. Experimental data on the physiologic basis for postoperative improvement delivered convincing evidence for its arteriogenic potential and recent developments in omental stem cell research suggest a role in recovery from long-standing neurological deficits.
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Affiliation(s)
- Marek J Konieczny
- Department of Molecular Neurobiology, Graduate School of Behavioural and Cognitive Neurosciences, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands; Charite-Universitätsmedizin Berlin, Department of Experimental Neurology, Campus Benjamin Franklin, Berlin, Germany.
| | - Song-Jin Ri
- Charite-Universitätsmedizin Berlin, Department of Experimental Neurology, Campus Benjamin Franklin, Berlin, Germany
| | - Janniko R Georgiadis
- Department of Neuroscience, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
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Jolink WM, Klijn CJ, Brouwers PJ, Kappelle LJ, Vaartjes I. Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage. Neurology 2015; 85:1318-24. [DOI: 10.1212/wnl.0000000000002015] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 06/16/2015] [Indexed: 11/15/2022] Open
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Readiness Visual Analog Scale: A Simple Way to Predict Post-Stroke Smoking Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9536-41. [PMID: 26287221 PMCID: PMC4555296 DOI: 10.3390/ijerph120809536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/21/2015] [Accepted: 08/05/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the present study was to assess a relationship between readiness to quit and post-stroke smoking behavior. METHODS Eighty-six active smokers with first-ever ischemic stroke were recruited in a tertiary-care stroke unit. The question "Are you ready to quit smoking within the next month?" with yes/no responses and the 10-cm readiness visual analog scale (VAS) was administered during the anti-smoking intervention. Smoking status was verified at the 3- and 12-month follow-up. RESULTS The readiness VAS score at hospitalization was significantly lower in patients classified as smokers as compared to patients classified as non-smokers. The readiness score <5 cm was a significant predictor of smoking at the 3-month (OR, 7.3) and 12-month follow-up (OR, 4.9). CONCLUSIONS The present results suggest that the readiness VAS can be used as a simple and inexpensive instrument for early identification of patients who continue to smoke after stroke.
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Shin JY, Choi NK, Lee J, Park MJ, Lee SH, Park BJ. A comparison of risperidone and haloperidol for the risk of ischemic stroke in the elderly: a propensity score-matched cohort analysis. J Psychopharmacol 2015; 29:903-9. [PMID: 25827642 DOI: 10.1177/0269881115578162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE With an increase in antipsychotic use in the elderly, the safety profile of antipsychotics has been emphasized. Strong concerns have been raised about whether the risk of ischemic stroke differs between risperidone and haloperidol. This study compared the risk of ischemic stroke between elderly patients taking risperidone and haloperidol. METHOD We conducted a retrospective cohort study using the Korea Health Insurance Review and Assessment Service database, applying a propensity-matched analysis. The cohort consisted of elderly patients who were newly prescribed haloperidol or risperidone between January 1, 2006 and December 31, 2009. Patients with prior cerebrovascular diseases (ICD-10, I60-I69), transient ischemic attack (ICD-10, G45), or cerebral tumors (ICD-10, C31) during 365 days prior to the initiation date were excluded. The study subjects were selected by propensity score matching. The outcome was defined as the first hospitalization for ischemic stroke (ICD-10, I63). Cox regression models were used to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for ischemic stroke with haloperidol compared with risperidone use. RESULTS A total of 14,103 patients were included in the propensity-matched cohort for each drug. Overall, the incidence rate was higher for haloperidol users compared to the risperidone users (6.43 per 1000 person-years vs. 2.88 per 1000 person-years). A substantially increased risk was observed in haloperidol users (adjusted HR = 2.02, 95% CI, 1.12-3.62). CONCLUSIONS The evidence showed that haloperidol should be prescribed in the elderly with caution.
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Affiliation(s)
- Ju-Young Shin
- Office of Drug Utilization Review, Korea Institute of Drug Safety and Risk Management, Anyang-si, Gyeonggi-do, Korea
| | - Nam-Kyong Choi
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Mi-Ju Park
- Office of Drug Utilization Review, Korea Institute of Drug Safety and Risk Management, Anyang-si, Gyeonggi-do, Korea
| | - Shin Haeng Lee
- Office of Drug Utilization Review, Korea Institute of Drug Safety and Risk Management, Anyang-si, Gyeonggi-do, Korea
| | - Byung-Joo Park
- Office of Drug Utilization Review, Korea Institute of Drug Safety and Risk Management, Anyang-si, Gyeonggi-do, Korea Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
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Sedova P, Brown RD, Zvolsky M, Kadlecova P, Bryndziar T, Volny O, Weiss V, Bednarik J, Mikulik R. Validation of Stroke Diagnosis in the National Registry of Hospitalized Patients in the Czech Republic. J Stroke Cerebrovasc Dis 2015; 24:2032-8. [PMID: 26139454 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/18/2015] [Accepted: 04/12/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Stroke is a common cause of mortality and morbidity in Eastern Europe. However, detailed epidemiological data are not available. The National Registry of Hospitalized Patients (NRHOSP) is a nationwide registry of prospectively collected data regarding each hospitalization in the Czech Republic since 1998. As a first step in the evaluation of stroke epidemiology in the Czech Republic, we validated stroke cases in NRHOSP. METHODS Any hospital in the Czech Republic with a sufficient number of cases was included. We randomly selected 10 of all 72 hospitals and then 50 patients from each hospital in 2011 stratified according to stroke diagnosis (International Classification of Diseases Tenth Revision [ICD-10] cerebrovascular codes I60, I61, I63, I64, and G45). Discharge summaries from hospitalization were reviewed independently by 2 reviewers and compared with NRHOSP for accuracy of discharge diagnosis. Any disagreements were adjudicated by a third reviewer. RESULTS Of 500 requested discharge summaries, 484 (97%) were available. Validators confirmed diagnosis in NRHOSP as follows: transient ischemic attack (TIA) or any stroke type in 82% (95% confidence interval [CI], 79-86), any stroke type in 85% (95% CI, 81-88), I63/cerebral infarction in 82% (95% CI, 74-89), I60/subarachnoid hemorrhage in 91% (95% CI, 85-97), I61/intracerebral hemorrhage in 91% (95% CI, 85-96), and G45/TIA in 49% (95% CI, 39-58). The most important reason for disagreement was use of I64/stroke, not specified for patients with I63. CONCLUSIONS The accuracy of coding of the stroke ICD-10 codes for subarachnoid hemorrhage (I60) and intracerebral hemorrhage (I61) included in a Czech Republic national registry was high. The accuracy of coding for I63/cerebral infarction was somewhat lower than for ICH and SAH.
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Affiliation(s)
- Petra Sedova
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic; Department of Neurology, Mayo Clinic, Rochester, MN
| | | | - Miroslav Zvolsky
- Institute for Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Pavla Kadlecova
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Tomas Bryndziar
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Ondrej Volny
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Viktor Weiss
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Robert Mikulik
- Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic; International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
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Di Carlo A, Pezzella FR, Fraser A, Bovis F, Baeza J, McKevitt C, Boaz A, Heuschmann P, Wolfe CDA, Inzitari D. Methods of Implementation of Evidence-Based Stroke Care in Europe: European Implementation Score Collaboration. Stroke 2015; 46:2252-9. [PMID: 26111887 DOI: 10.1161/strokeaha.115.009299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Differences in stroke care and outcomes reported in Europe may reflect different degrees of implementation of evidence-based interventions. We evaluated strategies for implementing research evidence into stroke care in 10 European countries. METHODS A questionnaire was developed and administered through face-to-face interviews with key informants. Implementation strategies were investigated considering 3 levels (macro, meso, and micro, eg, policy, organization, patients/professionals) identified by the framing analysis, and different settings (primary, hospital, and specialist) of stroke care. Similarities and differences among countries were evaluated using the categorical principal components analysis. RESULTS Implementation methods reported by ≥7 countries included nonmandatory policies, public financial incentives, continuing professional education, distribution of educational material, educational meetings and campaigns, guidelines, opinion leaders', and stroke patients associations' activities. Audits were present in 6 countries at national level; national and regional regulations in 4 countries. Private financial incentives, reminders, and educational outreach visits were reported only in 2 countries. At national level, the first principal component of categorical principal components analysis separated England, France, Scotland, and Sweden, all with positive object scores, from the other countries. Belgium and Lithuania obtained the lowest scores. At regional level, England, France, Germany, Italy, and Sweden had positive scores in the first principal component, whereas Belgium, Lithuania, Poland, and Scotland showed negative scores. Spain was in an intermediate position. CONCLUSIONS We developed a novel method to assess different domains of implementation in stroke care. Clear variations were observed among European countries. The new tool may be used elsewhere for future contributions.
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Affiliation(s)
- Antonio Di Carlo
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.).
| | - Francesca Romana Pezzella
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.)
| | - Alec Fraser
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.)
| | - Francesca Bovis
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.)
| | - Juan Baeza
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.)
| | - Chris McKevitt
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.)
| | - Annette Boaz
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.)
| | - Peter Heuschmann
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.)
| | - Charles D A Wolfe
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.)
| | - Domenico Inzitari
- From the Institute of Neuroscience, Italian National Research Council, Florence, Italy (A.D.C., D.I.); Department of Emergency, San Camillo-Forlanini Hospital, Rome, Italy (F.R.P.); Department of Management, School of Social Science and Public Policy (A.F., J.B.) and Division of Health and Social Care Research (C.M.K.), King's College, London, United Kingdom; Department of Neurofarba, Neuroscience Section, University of Florence, Italy (F.B., D.I.); Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, London, United Kingdom (A.B.); Institute of Clinical Epidemiology and Biometry (P.H.) and Comprehensive Heart Failure Center (P.H.), University of Würzburg, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany (P.H.); and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College, London, United Kingdom (C.D.A.W.)
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Ayis S, Wellwood I, Rudd AG, McKevitt C, Parkin D, Wolfe CDA. Variations in Health-Related Quality of Life (HRQoL) and survival 1 year after stroke: five European population-based registers. BMJ Open 2015; 5:e007101. [PMID: 26038354 PMCID: PMC4458636 DOI: 10.1136/bmjopen-2014-007101] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE There were two main objectives: to describe and compare clinical outcomes and Patient-Reported Outcome Measures (PROMs) collected using standardised procedures across the European Registers of Stroke (EROS) at 3 and 12 months after stroke; and to examine the relationship between patients' Health-Related Quality of Life (HRQoL) at 3 months after stroke and survival up to 1 year across the 5 populations. DESIGN Analysis of data from population-based stroke registers. SETTING European populations in Dijon (France); Kaunas (Lithuania); London (UK); Warsaw (Poland) and Sesto Fiorentino (Italy). PARTICIPANTS Patients with ischaemic or intracerebral haemorrhage (ICH) stroke, registered between 2004 and 2006. OUTCOME MEASURES (1) HRQoL, assessed by the physical component summary (PCS) and mental component summary (MCS) of the Short-Form Health Survey (SF-12), mapped into the EQ-5D to estimate responses on 5 dimensions (mobility, activity, pain, anxiety and depression, and self-care) and utility scores. (2) Mortality within 3 months and within 1 year of stroke. RESULTS Of 1848 patients, 325 were lost to follow-up and 500 died within a year of stroke. Significant differences in mortality, HRQoL and utility scores were found, and remained after adjustments. Kaunas had an increased risk of death; OR 2.34, 95% CI (1.32 to 4.14) at 3 months after stroke in Kaunas, compared with London. Sesto Fiorentino had the highest adjusted PCS: 43.54 (SD=0.96), and Dijon had the lowest adjusted MCS 38.67 (SD=0.67). There are strong associations between levels of the EQ-5D at 3 months and survival within the year. The trend across levels suggests a dose-response relationship. CONCLUSIONS The study demonstrated significant variations in survival, HRQoL and utilities across populations that could not be explained by stroke severity and sociodemographic factors. Strong associations between HRQoL at 3 months and survival to 1 year after stroke were identified.
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Affiliation(s)
- Salma Ayis
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
| | - Ian Wellwood
- Division of Health and Social Care Research, King's College London, London, UK
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anthony G Rudd
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
| | - Christopher McKevitt
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
| | - David Parkin
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
| | - Charles D A Wolfe
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
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Mehndiratta P, Wasay M, Mehndiratta MM. Implications of female sex on stroke risk factors, care, outcome and rehabilitation: an Asian perspective. Cerebrovasc Dis 2015; 39:302-8. [PMID: 25925617 DOI: 10.1159/000381832] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke affects 16.9 million people annually and the greatest burden of stroke is in low- and middle-income countries, where 69% of all strokes occur. Stroke risk factors, mortality and outcomes differ in developing countries as compared to the developed world. We performed a literature review of 28 articles pertaining to epidemiology of stroke in Asian women, stroke risk factors, gender-related differences, and stroke outcomes. SUMMARY Asian women differ from women worldwide due to differences in stroke awareness, risk factor profile, stroke subtypes, and social issues that impact stroke care. While Asian men have a higher incidence of stroke as compared to women overall, the long- and short-term outcomes in Asian women tend to be poorer. Both conventional and gender-specific risk factors contribute to stroke risk. Oral contraceptive use and addictions such as tobacco and alcohol are less prevalent among Asian women due to socio cultural differences. There is however, a much higher preponderance of pregnancy-related stroke and cardio-embolic stroke secondary to rheumatic heart disease and heavy use of chewing tobacco. The overall outcome is poor due to poor access to health care and lack of resources. Key Messages: Our review exposed the gaps in our knowledge about stroke risk factors and differences in stroke care provided to Asian women. While there are sociocultural barriers that impede the provision of immediate care to these stroke patients, much needs to be done by way of prevention of recurrent stroke and treatment of risk factors.
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Affiliation(s)
- Prachi Mehndiratta
- Vascular Neurology Fellow, McKim Hall, University of Virginia, Charlottesville, Va., USA
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Słomka A, Świtońska M, Żekanowska E. Hepcidin Levels Are Increased in Patients with Acute Ischemic Stroke: Preliminary Report. J Stroke Cerebrovasc Dis 2015; 24:1570-6. [PMID: 25881778 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/14/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Our current understanding of iron balance in acute ischemic stroke (AIS) is still limited. The objective of this study was to evaluate levels of iron homeostasis proteins-hepcidin (25-amino acid form) and soluble hemojuvelin (sHJV) together with hepcidin/sHJV ratio (Hepc/sHJV) and soluble transferrin receptor (sTfR) in patients with AIS. In addition, the effect of timing of blood collection, type of stroke treatment, and scores on the National Institutes of Health Stroke Scale were investigated. METHODS Participants comprised 31 patients diagnosed with AIS and 20 matched healthy controls. Venous blood samples were drawn on the first day and on the seventh day after stroke onset. Individuals who had experienced a stroke were subdivided according to type of treatment (thrombolysis group, n = 12 versus nonthrombolysis group, n = 19). Plasma hepcidin, sHJV, and sTfR levels were determined by the enzyme-linked immunosorbent assay method. RESULTS We found that plasma hepcidin levels were significantly higher in ischemic stroke patients compared with the control group (median, 19.82 versus 12.62 ng/mL, P = .04). Furthermore, levels of hepcidin on the seventh day (1 week after diagnosis) were significantly higher in patients treated with thrombolysis than in patients not treated with thrombolysis (median, 22.16 versus 16.21 ng/mL, P = .04). CONCLUSIONS The study provides evidence that AIS is associated with increased hepcidin levels. Stroke treatment may have an influence on hepcidin synthesis.
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Affiliation(s)
- Artur Słomka
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland.
| | - Milena Świtońska
- Neurology and Stroke Care Unit, Jan Biziel University Hospital No 2, Bydgoszcz, Poland
| | - Ewa Żekanowska
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Poland
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Ponfick M, Wiederer R, Nowak DA. Outcome of Intensive Care Unit-Dependent, Tracheotomized Patients with Cerebrovascular Diseases. J Stroke Cerebrovasc Dis 2015; 24:1527-31. [PMID: 25881771 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/03/2014] [Accepted: 03/14/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Outcome studies in intensive care unit -dependent, tracheotomized, and mechanical ventilated patients with cerebrovascular disease (CVD) are scarce. METHODS In a retrospective approach, we analyzed the outcome of 143 patients with ischemic stroke (IS), primary intracerebral hemorrhage (PICH), and subarachnoid hemorrhage (SAH). To measure the potential benefit of in-patient rehabilitation, we used the Functional Independence Measure (FIM). In addition, weaning and rehabilitation duration, duration of mechanical ventilation (MV) in the acute care hospital (preweaning), and mortality rates were assessed. RESULTS Approximately 50% of all patients were transferred home. These patients were fully independent or under nursing support. We found no differences regarding weaning and rehabilitation durations, or FIM scores in between each entity. Log-regression analyses showed that every day on MV generates a 3.2% reduction of the possibility to achieve a beneficial outcome (FIM ≥ 50 points [only moderate assistance necessary]), whereas every day in-patient rehabilitation without MV increases the chance for favorable outcome by 1.9%. Mortality rates were 5% for IS and 10% for PICH and SAH, respectively. CONCLUSIONS This study shows that even severely affected, tracheotomized patients with CVD benefit from early in-patient rehabilitation, irrespective of the etiology of vascular brain injury. Mortality rates of early rehabilitation in CVD are low. Until no validated outcome predictors are available, all efforts should be undertaken to enable in-patient rehabilitation, even in severe cases of CVD to improve outcome and to prevent accommodation in long-time-care facilities.
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Affiliation(s)
- Matthias Ponfick
- Helios Klinik Kipfenberg, Kipfenberg, Germany; Neurologische Universitätsklinik Marburg, Philipps-Universität Marburg, Marburg, Germany.
| | | | - Dennis A Nowak
- Helios Klinik Kipfenberg, Kipfenberg, Germany; Neurologische Universitätsklinik Marburg, Philipps-Universität Marburg, Marburg, Germany
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Tulla H, Hippeläinen M, Turpeinen A, Pitkänen O, Hartikainen J. New-onset atrial fibrillation at discharge in patients after coronary artery bypass surgery: short- and long-term morbidity and mortality. Eur J Cardiothorac Surg 2015; 48:747-52. [DOI: 10.1093/ejcts/ezu526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/03/2014] [Indexed: 11/12/2022] Open
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Tucker MR, Olivier J, Pagel A, Bleuler H, Bouri M, Lambercy O, Millán JDR, Riener R, Vallery H, Gassert R. Control strategies for active lower extremity prosthetics and orthotics: a review. J Neuroeng Rehabil 2015; 12:1. [PMID: 25557982 PMCID: PMC4326520 DOI: 10.1186/1743-0003-12-1] [Citation(s) in RCA: 353] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/05/2014] [Indexed: 12/11/2022] Open
Abstract
: Technological advancements have led to the development of numerous wearable robotic devices for the physical assistance and restoration of human locomotion. While many challenges remain with respect to the mechanical design of such devices, it is at least equally challenging and important to develop strategies to control them in concert with the intentions of the user.This work reviews the state-of-the-art techniques for controlling portable active lower limb prosthetic and orthotic (P/O) devices in the context of locomotive activities of daily living (ADL), and considers how these can be interfaced with the user's sensory-motor control system. This review underscores the practical challenges and opportunities associated with P/O control, which can be used to accelerate future developments in this field. Furthermore, this work provides a classification scheme for the comparison of the various control strategies.As a novel contribution, a general framework for the control of portable gait-assistance devices is proposed. This framework accounts for the physical and informatic interactions between the controller, the user, the environment, and the mechanical device itself. Such a treatment of P/Os--not as independent devices, but as actors within an ecosystem--is suggested to be necessary to structure the next generation of intelligent and multifunctional controllers.Each element of the proposed framework is discussed with respect to the role that it plays in the assistance of locomotion, along with how its states can be sensed as inputs to the controller. The reviewed controllers are shown to fit within different levels of a hierarchical scheme, which loosely resembles the structure and functionality of the nominal human central nervous system (CNS). Active and passive safety mechanisms are considered to be central aspects underlying all of P/O design and control, and are shown to be critical for regulatory approval of such devices for real-world use.The works discussed herein provide evidence that, while we are getting ever closer, significant challenges still exist for the development of controllers for portable powered P/O devices that can seamlessly integrate with the user's neuromusculoskeletal system and are practical for use in locomotive ADL.
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Affiliation(s)
- Michael R Tucker
- />Rehabilitation Engineering Lab, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Jeremy Olivier
- />Robotic Systems Laboratory, Institute for Microengineering, EPFL, Lausanne, Switzerland
| | - Anna Pagel
- />Sensory Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Hannes Bleuler
- />Robotic Systems Laboratory, Institute for Microengineering, EPFL, Lausanne, Switzerland
| | - Mohamed Bouri
- />Robotic Systems Laboratory, Institute for Microengineering, EPFL, Lausanne, Switzerland
| | - Olivier Lambercy
- />Rehabilitation Engineering Lab, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - José del R Millán
- />Defitech Chair in Non-Invasive Brain-Machine Interface, Center for Neuroprosthetics, Institute of Bioengineering, EPFL, Lausanne, Switzerland
| | - Robert Riener
- />Sensory Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
- />Faculty of Medicine, Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Heike Vallery
- />Sensory Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
- />Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Roger Gassert
- />Rehabilitation Engineering Lab, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
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Benito García M, Atín Arratibel MÁ, Terradillos Azpiroz ME. The Bobath Concept in Walking Activity in Chronic Stroke Measured Through the International Classification of Functioning, Disability and Health. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2014; 20:242-50. [DOI: 10.1002/pri.1614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 05/21/2014] [Accepted: 08/21/2014] [Indexed: 11/06/2022]
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Rozec B, Cinotti R, Le Teurnier Y, Marret E, Lejus C, Asehnoune K, Blanloeil Y. [Epidemiology of cerebral perioperative vascular accidents]. ACTA ACUST UNITED AC 2014; 33:677-89. [PMID: 25447778 DOI: 10.1016/j.annfar.2014.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Stroke is a well-described postoperative complication, after carotid and cardiac surgery. On the contrary, few studies are available concerning postoperative stroke in general non-cardiac non-carotid surgery. The high morbid-mortality of stroke justifies an extended analysis of recent literature. ARTICLE TYPE Systematic review. DATA SOURCES Firstly, Medline and Ovid databases using combination of stroke, cardiac surgery, carotid surgery, general non-cardiac non-carotid surgery as keywords; secondly, national and European epidemiologic databases; thirdly, expert and French health agency recommendations; lastly, reference book chapters. RESULTS In cardiac surgery, with an incidence varying from 1.2 to 10% according to procedure complexity, stroke occurs peroperatively in 50% of cases and during the first 48 postoperative hours for the others. The incidence of stroke after carotid surgery is 1 to 20% according to the technique used as well as operator skills. Postoperative stroke is a rare (0.15% as mean, extremes around 0.02 to 1%) complication in general surgery, it occurs generally after the 24-48th postoperative hours, exceptional peroperatively, and 40% of them occurring in the first postoperative week. It concerned mainly aged patient in high-risk surgeries (hip fracture, vascular surgery). Postoperative stroke was associated to an increase in perioperative mortality in comparison to non-postoperative stroke operated patients. CONCLUSION Postoperative stroke is a quality marker of the surgical teams' skill and has specific onset time and induces an increase of postoperative mortality.
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Affiliation(s)
- B Rozec
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
| | - R Cinotti
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - Y Le Teurnier
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - E Marret
- Département d'anesthésie-réanimation, institut hospitalier franco-britannique, 4, rue Kléber, 92300 Levallois-Perret, France
| | - C Lejus
- Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 1, France
| | - K Asehnoune
- Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu, CHU de Nantes, 44093 Nantes cedex 1, France
| | - Y Blanloeil
- Service d'anesthésie et de réanimation chirurgicale, hôpital G.-et-R.-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
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Jové M, Mauri-Capdevila G, Suárez I, Cambray S, Sanahuja J, Quílez A, Farré J, Benabdelhak I, Pamplona R, Portero-Otín M, Purroy F. Metabolomics predicts stroke recurrence after transient ischemic attack. Neurology 2014; 84:36-45. [PMID: 25471397 DOI: 10.1212/wnl.0000000000001093] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To discover, by using metabolomics, novel candidate biomarkers for stroke recurrence (SR) with a higher prediction power than present ones. METHODS Metabolomic analysis was performed by liquid chromatography coupled to mass spectrometry in plasma samples from an initial cohort of 131 TIA patients recruited <24 hours after the onset of symptoms. Pattern analysis and metabolomic profiling, performed by multivariate statistics, disclosed specific SR and large-artery atherosclerosis (LAA) biomarkers. The use of these methods in an independent cohort (162 subjects) confirmed the results obtained in the first cohort. RESULTS Metabolomics analyses could predict SR using pattern recognition methods. Low concentrations of a specific lysophosphatidylcholine (LysoPC[16:0]) were significantly associated with SR. Moreover, LysoPC(20:4) also arose as a potential SR biomarker, increasing the prediction power of age, blood pressure, clinical features, duration of symptoms, and diabetes scale (ABCD2) and LAA. Individuals who present early (<3 months) recurrence have a specific metabolomic pattern, differing from non-SR and late SR subjects. Finally, a potential LAA biomarker, LysoPC(22:6), was also described. CONCLUSIONS The use of metabolomics in SR biomarker research improves the predictive power of conventional predictors such as ABCD2 and LAA. Moreover, pattern recognition methods allow us to discriminate not only SR patients but also early and late SR cases.
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Affiliation(s)
- Mariona Jové
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Gerard Mauri-Capdevila
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Idalmis Suárez
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Serafi Cambray
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Jordi Sanahuja
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Alejandro Quílez
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Joan Farré
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Ikram Benabdelhak
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Reinald Pamplona
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Manuel Portero-Otín
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Francisco Purroy
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain.
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Bustamante A, Garcia-Berrocoso T, Llombart V, Simats A, Giralt D, Montaner J. Neuroendocrine hormones as prognostic biomarkers in the setting of acute stroke: overcoming the major hurdles. Expert Rev Neurother 2014; 14:1391-403. [PMID: 25418815 DOI: 10.1586/14737175.2014.977867] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke represents one of the major causes of disability and mortality worldwide and prediction of outcome represents a challenge for both clinicians and researchers. In the past years, many blood markers have been associated with stroke outcome but despite this evidence, no biomarker is routinely used in stroke management. In this review, we focus on markers of the neuroendocrine system, which represent potential candidates to be implemented in clinical practice. Moreover, we present a systematic review and literature-based meta-analysis for copeptin, a new biomarker of the hypothalamo-pituitary-adrenal axis that has shown additional predictive value over clinical information in a large prospective study. The meta-analysis of the included 7 studies, with more than 2000 patients, reinforced its association with poor outcome (pooled odds ratio: 2.474 [1.678-3.268]) and mortality (pooled OR: 2.569 [1.642-3.495]). We further review the current situation of the topic and next steps to implement these tools by clinicians.
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Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institut of Research, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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Barbosa D, Santos CP, Martins M. The application of cycling and cycling combined with feedback in the rehabilitation of stroke patients: a review. J Stroke Cerebrovasc Dis 2014; 24:253-73. [PMID: 25444025 DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/29/2014] [Accepted: 09/06/2014] [Indexed: 01/27/2023] Open
Abstract
Stroke is a leading cause of long-term disabilities, such as hemiparesis, inability to walk without assistance, and dependence of others in the activities of daily living. Motor function rehabilitation after stroke demands for methods oriented to the recovery of the walking capacity. Because of the similarities with walking, cycling leg exercise may present a solution to this problem. The aim of this article is to review the state of the art applications of cycling leg exercise as a (1) motor function rehabilitation method and an (2) aerobic training method for stroke patients as well as the commonly used (3) assessment tools. The cycling characteristics and applications, the applied test protocols as well as the tools used to assess the state and the recovery of patients and types of cycling devices are presented. In addition, the potential benefits of the use of other therapies, like feedback, together with cycling are explored. The application of cycling leg exercise alone and combined with feedback in stroke rehabilitation approaches has shown promising results. Positive effects on motor abilities were found in subacute and chronic patients. However, larger and normalized studies and assessments are needed because there is a high heterogeneity in the patients' characteristics, protocols and metrics. This wil allow the comparison between different studies related with cycling.
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Affiliation(s)
- David Barbosa
- Department of Industrial Electronics, University of Minho, Azurém, Guimarães, Portugal
| | - Cristina P Santos
- Department of Industrial Electronics, University of Minho, Azurém, Guimarães, Portugal.
| | - Maria Martins
- Department of Industrial Electronics, University of Minho, Azurém, Guimarães, Portugal
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81
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Stranjalis G, Kalamatianos T, Gatzonis S, Loufardaki M, Tzavara C, Sakas DE. The incidence of the first-ever stroke in a Mediterranean island population: the isle of Lesvos stroke study. Neuroepidemiology 2014; 43:206-12. [PMID: 25402469 DOI: 10.1159/000365849] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/02/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is a paucity of research on the incidence and distribution of stroke types in Greece. This is the first study investigating stroke incidence in a Greek island, the Northern Aegean island of Lesvos (Eastern Mediterranean Sea). METHODS A multisource, prospective population-based register was established and subjects with first-ever stroke (FES) between June 1st 2010 and May 31st 2011 were identified. RESULTS 197 FES subjects registered, 112 males and 85 females (mean age ± SD = 75 ± 12 years). Cerebral infarction was diagnosed in 77.7%, intracerebral hemorrhage in 12.7%, subarachnoid hemorrhage in 2.5%; undetermined stroke accounted for 7.1%. The crude annual incidence rates of FES were 227.9 (95% CI 196-260) per 100,000. Following age- and gender-standardization to the 'European' population, FES incidence rates were 117 (95% CI 99-136). Early case fatality was 20.81% (95% CI 16-27%). CONCLUSIONS The present findings indicate that the incidence of FES in the studied Mediterranean population is at the low end of the range of estimates established by recent European registers. The results of the present study extend the limited epidemiological data on stroke in Greece and can help guide future monitoring, prevention and treatment strategies.
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Affiliation(s)
- George Stranjalis
- Department of Neurosurgery, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
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82
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Świtońska M, Słomka A, Sinkiewicz W, Żekanowska E. Tissue-factor-bearing microparticles (MPs-TF) in patients with acute ischaemic stroke: the influence of stroke treatment on MPs-TF generation. Eur J Neurol 2014; 22:395-401, e28-9. [PMID: 25370815 DOI: 10.1111/ene.12591] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/10/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Stroke is an important cause of death and disability throughout the world. Microparticles play a cardinal role in vascular hemostasis. The primary aim of this study was to evaluate the procoagulant activity of microparticles and levels of tissue-factor-bearing microparticles (MPs-TF), tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in patients with acute ischaemic stroke. METHODS Seventy-three patients with a diagnosis of acute ischaemic stroke were included. Venous blood samples were drawn on the first day and the seventh day after stroke onset. Plasma microparticles, MPs-TF, TF and TFPI were determined by enzyme-linked immunosorbent assay. Assessment variables were timing of blood collection, type of stroke treatment, presence or absence of diabetes mellitus and hypertension, and scores on the National Institutes of Health Stroke Scale together with scores on the modified Rankin Scale. RESULTS Whilst MPs-TF and TFPI levels of stroke subjects were significantly higher (median, 1.63 vs. 0.73 pg/ml; median, 114.26 vs. 78.60 ng/ml, respectively), TF levels in the plasma of stroke patients were significantly lower (median, 82.27 vs. 97.80 pg/ml) than those of healthy individuals. Lower levels of TF were detected in patients with severe stroke in comparison with patients with mild stroke. Moreover, the data also showed that in stroke patients not treated with alteplase the activity of microparticles was significantly higher 1 week after diagnosis in comparison with the activity at the time of diagnosis. CONCLUSION Our findings suggest that patients with acute ischaemic stroke have increased generation of MPs-TF. Nevertheless, further studies are needed in order to confirm such inference.
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Affiliation(s)
- M Świtońska
- Neurology and Stroke Care Unit, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland
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83
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Galanth S, Tressieres B, Lannuzel A, Foucan P, Alecu C. Factors Influencing Prognosis and Functional Outcome One Year After a First-Time Stroke in a Caribbean Population. Arch Phys Med Rehabil 2014; 95:2134-9. [DOI: 10.1016/j.apmr.2014.07.394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 07/07/2014] [Accepted: 07/12/2014] [Indexed: 11/29/2022]
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84
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Mo D, Hardin DS, Erfurth EM, Melmed S. Adult mortality or morbidity is not increased in childhood-onset growth hormone deficient patients who received pediatric GH treatment: an analysis of the Hypopituitary Control and Complications Study (HypoCCS). Pituitary 2014; 17:477-85. [PMID: 24122237 PMCID: PMC4159575 DOI: 10.1007/s11102-013-0529-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The French Safety and Appropriateness of Growth Hormone treatments in Europe (SAGhE) cohort has raised concern of increased mortality risk during follow-up into adulthood in certain patients who had received growth hormone (GH) treatment during childhood. The Hypopituitary Control and Complications Study monitored mortality and morbidity of adult GH-deficient patients including those with childhood-onset GH deficiency (COGHD) who received GH treatment as children. PURPOSE Evaluate risk of mortality, cancer, myocardial infarction (MI) and stroke in a prospective observational study. METHODS COGHD patients [n = 1,204, including 389 diagnosed with idiopathic COGHD (ICOGHD)] had received pediatric GH treatment. Standardized mortality ratios (SMRs), and cancer standardized incidence ratios (SIRs) in patients without a prior cancer were estimated relative to reference populations. Crude incidence rates were estimated for MI and stroke. RESULTS No increased mortality or cancer incidence was observed, as compared with reference populations, during a follow-up of 3.7 ± 3.3 years (mean ± SD). The overall SMR for COGHD was 1.14 [95 % confidence interval (CI) 0.55-2.10], and for ICOGHD, 0.33 (0.01-1.84). The overall cancer SIR for COGHD was 0.27 (0.01-1.50), and for ICOGHD, 0.00 (0.00-2.45). No incident case of MI was reported. The crude stroke incidence rate [181.3 per 100,000 person-years] in COGHD patients was consistent with the rates reported in reference populations. No incident case of stroke was identified in ICOGHD patients who are presumed to have no increased stroke risk factors. CONCLUSIONS The results indicate no increased risk of mortality or incidence of cancer, stroke, or MI in adult GH-deficient patients who had previously received pediatric GH treatment.
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Affiliation(s)
- Daojun Mo
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Dana Sue Hardin
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285 USA
| | - Eva Marie Erfurth
- Department of Endocrinology, Skånes University Hospital, Lund, Sweden
| | - Shlomo Melmed
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA USA
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85
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Pucciarelli G, Savini S, Byun E, Simeone S, Barbaranelli C, Vela RJ, Alvaro R, Vellone E. Psychometric properties of the Caregiver Preparedness Scale in caregivers of stroke survivors. Heart Lung 2014; 43:555-60. [PMID: 25239706 DOI: 10.1016/j.hrtlng.2014.08.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the psychometric characteristics of the Caregiver Preparedness Scale (CPS) in caregivers of stroke survivors. BACKGROUND Caregiver preparedness can have an important impact on both the caregiver and the stroke survivor. The validity and reliability of the CPS has not been tested for the stroke-caregiver population. METHODS We used a cross-sectional design to study a sample of 156 caregivers of stroke survivors. Construct validity of the CPS was evaluated by confirmatory factor analysis (CFA). Internal consistency and test-retest reliability were also evaluated. RESULTS Caregivers were, on average, 54 year old (SD = 13.2) and most were women (64.7%). CFA supported the unidimensionality of the scale (comparative fit index = 0.98). Reliability was also supported: item-reliability index and item-total correlations above 0.30; composite reliability index = 0.93; Cronbach's alpha = 0.94; factor score determinacy = 0.97; and test-retest reliability = 0.92. CONCLUSION The CPS is valid and reliable in caregivers of stroke survivors. Scores on this scale may assist health-care providers in identifying caregivers with less preparedness to provide specific interventions.
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Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Serenella Savini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Eeeseung Byun
- Department of Family Health Care Nursing, University of California San Francisco School of Nursing, San Francisco, CA, USA
| | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | | | - Raúl Juárez Vela
- Faculty of Health Sciences, University San Jorge, Zaragoza, Spain
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
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86
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Malmivaara A, Meretoja A, Peltola M, Numerato D, Heijink R, Engelfriet P, Wild SH, Belicza É, Bereczki D, Medin E, Goude F, Boncoraglio G, Tatlisumak T, Seppälä T, Häkkinen U. Comparing ischaemic stroke in six European countries. The EuroHOPE register study. Eur J Neurol 2014; 22:284-91, e25-6. [PMID: 25196190 DOI: 10.1111/ene.12560] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 07/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of hospitalizations, treatment and case fatality of ischaemic stroke were assessed utilizing a comprehensive multinational database to attempt to compare the healthcare systems in six European countries, aiming also to identify the limitations and make suggestions for future improvements in the between-country comparisons. METHODS National registers of hospital discharges for ischaemic stroke identified by International Classification of Diseases codes 433-434 (ICD-9) and code I63 (ICD-10), medication purchases and mortality were linked at the patient level in each of the participating countries and regions: Finland, Hungary, Italy, the Netherlands, Scotland and Sweden. Patients with an index admission in 2007 were followed for 1 year. RESULTS In all, 64,170 patients with a disease code for ischaemic stroke were identified. The number of patients registered per 100,000 European standard population ranged from 77 in Scotland to 407 in Hungary. Large differences were observed in medication use. The age- and sex-adjusted all-cause case fatality amongst hospitalized patients at 1 year from stroke was highest in Hungary at 31.0% (95% confidence interval 30.5-31.5). Regional differences in age- and sex-adjusted 1-year case fatality within countries were largest in Hungary (range 23.6%-37.6%) and smallest in the Netherlands (20.5%-27.3%). CONCLUSIONS It is feasible to link population-wide register data amongst European countries to describe incidence of hospitalizations, treatment patterns and case fatality of ischaemic stroke on a national level. However, the coverage and validity of administrative register data for ischaemic stroke should be developed further, and population-based and clinical stroke registers should be created to allow better control of case mix.
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Affiliation(s)
- A Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
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87
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Savini S, Buck HG, Dickson VV, Simeone S, Pucciarelli G, Fida R, Matarese M, Alvaro R, Vellone E. Quality of life in stroke survivor-caregiver dyads: a new conceptual framework and longitudinal study protocol. J Adv Nurs 2014; 71:676-87. [PMID: 25186274 DOI: 10.1111/jan.12524] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2014] [Indexed: 11/30/2022]
Abstract
AIM To describe a new conceptual framework and the research protocol of a study designed to examine the quality of life in stroke survivor-caregiver dyads. BACKGROUND Stroke has a significant impact on the patient-caregiver dyad. Few studies have been guided by a specific conceptual framework which considers the interactions among pre-existing situations prior to stroke, the new situation caused by the stroke and the moderating effects of environmental and caregiver-related variables. DESIGN Longitudinal study. METHODS A sample of stroke survivor-caregiver dyads will be enrolled at patient discharge from rehabilitation hospitals and will be surveyed every 3 months for 1-year. Hypotheses generated from the conceptual framework will test predictors, mediators and moderators of stroke survivor and caregiver quality of life from the pre-existing situation prior to the stroke, the new situation mediation poststroke and situation moderators. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, December 2013. DISCUSSION This study seeks to identify variables in the pre-existing situation prior to the stroke (e.g. living condition), the new situation mediation poststroke (e.g. type of stroke and caregiver burden) as well as situation moderators (e.g. social support) that influence stroke survivor-caregiver dyad's quality of life across the stroke trajectory. Also, the study will inform clinical practice and research by identifying variables that are potentially modifiable and therefore amenable to intervention. The proposed framework will also be helpful for future research focused on stroke survivor-caregiver dyads.
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88
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Thrift AG, Cadilhac DA, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Donnan GA. Global stroke statistics. Int J Stroke 2014; 9:6-18. [PMID: 24350870 DOI: 10.1111/ijs.12245] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In many countries, stroke is a lower priority than other diseases despite its public health impact. One issue is a lack of readily accessible comparative data to help make the case for the development of national stroke strategies. To assist in this process, we need to have a common repository of the latest published information on the impact of stroke worldwide. We aim to provide a repository of the most current incidence and mortality data on stroke available by country and illustrate the gaps in these data. We plan to update this repository annually and expand the scope to address other aspects of the burden of stroke. Data were compiled using two approaches: (1) an extensive literature review with a major focus on published systematic reviews on stroke incidence (between 1980 and May 14, 2013); and (2) direct acquisition and collation of data from the World Health Organization to present the most current estimates of stroke mortality for each country recognized by the World Health Organization. For mortality, ICD8, ICD9, and ICD10 mortality codes were extracted. Using population denominators crude stroke mortality was calculated, as well as adjusting for the World Health Organization world population. We used only the most recent year reported to the World Health Organization. Incidence rates for stroke were available for 52 countries, with some countries having incidence studies undertaken in more than one region. When adjusted to the World Health Organization world standard population, incidence rates for stroke ranged from 41 per 100 000 population per year in Nigeria (1971-74) to 316/ 100 000/year in urban Dar-es-Salaam (Tanzania). Some regions had three to fivefold greater incidence than other countries. Of the 123 countries reporting mortality data, crude mortality was greatest in Kazhakstan (in 2003). In many regions data were very old or nonexistent. Such country-level data are important for citizens, clinicians, and policy makers so that local and global strategies to reduce the overall burden of stroke can be implemented. Through this first annual review of country-specific stroke epidemiology, we hope to promote discussion and provide insights into the worldwide burden of stroke.
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Affiliation(s)
- Amanda G Thrift
- Department of Medicine, Stroke and Ageing Research Centre, Southern Clinical School, Monash University, Clayton, Vic., Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia
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89
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Basteris A, Nijenhuis SM, Stienen AHA, Buurke JH, Prange GB, Amirabdollahian F. Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review. J Neuroeng Rehabil 2014; 11:111. [PMID: 25012864 PMCID: PMC4108977 DOI: 10.1186/1743-0003-11-111] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 06/23/2014] [Indexed: 01/19/2023] Open
Abstract
Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.
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Affiliation(s)
- Angelo Basteris
- Adaptive Systems Research Group, School of Computer Science, University of Hertfordshire, College Lane, AL95HX Hatfield, United Kingdom.
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90
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Vivancos J, Gilo F, Frutos R, Maestre J, García-Pastor A, Quintana F, Roda J, Ximénez-Carrillo A, Díez Tejedor E, Fuentes B, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Castellanos M, Castillo J, Dávalos A, Díaz-Otero F, Egido J, Fernández J, Freijo M, Gállego J, Gil-Núñez A, Irimia P, Lago A, Masjuan J, Martí-Fábregas J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Nombela F, Purroy F, Ribó M, Rodríguez-Yañez M, Roquer J, Rubio F, Segura T, Serena J, Simal P, Tejada J. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2012.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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91
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Alexandrino GM, Damásio J, Canhão P, Geraldes R, Melo TP, Correia C, Ferro JM. Stroke in sports: a case series. J Neurol 2014; 261:1570-4. [PMID: 24888314 DOI: 10.1007/s00415-014-7383-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/14/2014] [Accepted: 05/14/2014] [Indexed: 11/25/2022]
Abstract
Regular physical activity decreases vascular risk. However, vascular events, including stroke, can occur while practicing physical activities. Stroke associated with sports is a rare clinical entity, whose risk factors and mechanisms are not fully understood. We report a case series of sports-related stroke, from tertiary care institutions. From the stroke registries of two University Neurology services and Stroke Units we retrieved all cases of stroke which occurred in temporal association with the practice of sports. Investigators had to fill a simple case report form, describing the demographic, clinical characteristics of the patients and the sport associated with the stroke. We included ten patients aged between 27 and 65 years, 8 being male. Only three subjects had vascular risk factors. Trauma to the head and/or neck was reported in two patients only. Cervicocerebral arterial dissection was the main cause of stroke, occurring in six of the ten cases. No patient died, but three were left disabled (modified Rankin Scale 3-5). This case series confirms that stroke associated with sport is very rare. The majority of the victims did not have vascular risk factors. Dissection was the most common cause of sport-associated stroke. Strokes were often disabling.
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Affiliation(s)
- Gonçalo M Alexandrino
- Serviço de Neurologia, Department of Neurosciences, Hospital de Santa Maria, Universidade de Lisboa, Lisbon, Portugal
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92
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Quality indicators in acute stroke care: a prospective observational survey in 13 Italian regions. Aging Clin Exp Res 2014; 26:279-86. [PMID: 24293350 DOI: 10.1007/s40520-013-0171-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Quality monitoring has great relevance in stroke care. The Project "How to guarantee adherence to effective interventions in stroke care" aimed to estimate adherence to acute-phase guidelines in stroke care in Italy. METHODS A prospective observational study was performed in 27 hospitals of 13 Italian Regions. Adherence to 15 process indicators was evaluated, comparing also stroke units (SU) with conventional wards. An overall score of care, defined as the sum of achieved indicators, was calculated. A multilevel hierarchical model described performance at patient, hospital and regional level. RESULTS Overall, 484 consecutive stroke patients (mean age, 73.4 years; 52.7 % males) were included. Total score ranged from 2 to 15 (mean 8.5 ± 2.4). SU patients were more often evaluated with the National Institutes of Health Stroke Scale (NIHSS) within 24 h, had more frequently an assessment of pre- and post-stroke disability, and a CT scan the same or the day after admission. Regional-hospital- and patient-level variability explained, respectively, 25, 34, and 41 % of total score variance. In multivariate models, patients >80 years vs. younger showed a change in total score of -0.45 (95 % CI -0.79 to -0.12), and those with NIHSS ≥14 vs. ≤5 of -0.92 (95 % CI -1.53 to -0.30). A negative change means a worse adjusted average adherence to process indicators. SU admission increased total score of 1.55 (95 % CI 0.52-2.58). CONCLUSIONS Our data confirm the need of quality monitoring in stroke care. Although SU patients showed a better adherence to quality indicators, overall compliance was unsatisfactory.
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93
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Iannopollo G, Camporotondo R, De Ferrari GM, Leonardi S. Efficacy versus safety: the dilemma of using novel platelet inhibitors for the treatment of patients with ischemic stroke and coronary artery disease. Ther Clin Risk Manag 2014; 10:321-9. [PMID: 24851050 PMCID: PMC4018317 DOI: 10.2147/tcrm.s39216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Coronary and cerebrovascular atherothrombosis are the leading cause of mortality and morbidity worldwide. Novel antiplatelet agents have been established for the management of patients with clinically evident coronary atherothrombosis and are increasingly used in these patients. These agents, however, have shown limited efficacy in the prevention of cerebrovascular events and potential harm in patients with history of stroke or transient ischemic attack. Herein, the efficacy and safety of two established antiplatelet agents in patients with stroke – aspirin and clopidogrel – are reviewed with a focus on the use and challenges related to novel antiplatelet agents – prasugrel, ticagrelor, and vorapaxar – in patients at risk for and with a history of stroke or transient ischemic attack.
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94
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Vila-Corcoles A, Ochoa-Gondar O, Rodriguez-Blanco T, de Diego-Cabanes C, Satue-Gracia E, Vila-Rovira A, Torrente Fraga C. Evaluating clinical effectiveness of pneumococcal vaccination in preventing stroke: the CAPAMIS Study, 3-year follow-up. J Stroke Cerebrovasc Dis 2014; 23:1577-84. [PMID: 24656243 DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/04/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cerebrovascular benefits using the 23-valent pneumococcal polysaccharide vaccine (PPV23) are controversial. This study assessed clinical effectiveness of PPV23 in preventing ischemic stroke in people older than 60 years. METHODS We conducted a population-based cohort study involving 27,204 individuals of 60 years or older in Tarragona, Spain, who were prospectively followed from December 01, 2008, until November 30, 2011. Outcomes were neuroimaging-confirmed ischemic stroke, 30-day mortality from stroke, and all-cause death. Pneumococcal vaccination effectiveness was evaluated by Cox regression analyses, estimating hazard ratios (HRs) adjusted for age, sex, comorbidities, and influenza vaccine status. RESULTS Cohort members were followed for a total of 76,033 person-years, of which 29,065 were for vaccinated subjects. Overall, 343 cases of stroke, 45 deaths from stroke, and 2465 all-cause deaths were observed. Pneumococcal vaccination did not alter the risk of stroke (multivariable HR: 1.04; 95% confidence interval [CI]: .83-1.30; P=.752), death from stroke (HR: 1.14; 95% CI: .61-2.13; P=.686), and all-cause death (HR: .97; 95% CI: .89-1.05; P=.448). In analyses focused on people with and without a history of cerebrovascular disease, the PPV23 did not emerge effective in preventing any analyzed event, but influenza vaccine emerged independently associated with a reduced risk of death from stroke (HR: .51; 95% CI: .28-.93; P=.029) and all-cause death (HR: .73; 95% CI: .67-.81; P<.001). CONCLUSIONS Our data support that the PPV23 does not provide benefit against ischemic stroke, but it also supports a beneficial effect of influenza vaccine in reducing specific- and all-cause mortality risk in the general population older than 60 years.
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Affiliation(s)
- Angel Vila-Corcoles
- Primary Care Service "Camp de Tarragona", Institut Catala de la Salut, Tarragona, Spain
| | - Olga Ochoa-Gondar
- Primary Care Service "Camp de Tarragona", Institut Catala de la Salut, Tarragona, Spain.
| | - Teresa Rodriguez-Blanco
- Primary Care Research Institute, Institut d'Investigacio en Atencio Primaria Jordi Gol, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Eva Satue-Gracia
- Primary Care Service "Camp de Tarragona", Institut Catala de la Salut, Tarragona, Spain
| | - Angel Vila-Rovira
- Research Assistance on Mortality Data, Institut d'Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
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95
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Flöel A, Werner C, Grittner U, Hesse S, Jöbges M, Knauss J, Seifert M, Steinhagen-Thiessen E, Gövercin M, Dohle C, Fischer W, Schlieder R, Nave AH, Meisel A, Ebinger M, Wellwood I. Physical fitness training in Subacute Stroke (PHYS-STROKE)--study protocol for a randomised controlled trial. Trials 2014; 15:45. [PMID: 24491065 PMCID: PMC3922602 DOI: 10.1186/1745-6215-15-45] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/21/2014] [Indexed: 12/02/2022] Open
Abstract
Background Given the rising number of strokes worldwide, and the large number of individuals left with disabilities after stroke, novel strategies to reduce disability, increase functions in the motor and the cognitive domains, and improve quality of life are of major importance. Physical activity is a promising intervention to address these challenges but, as yet, there is no study demonstrating definite outcomes. Our objective is to assess whether additional treatment in the form of physical fitness-based training for patients early after stroke will provide benefits in terms of functional outcomes, in particular gait speed and the Barthel Index (co-primary outcome measures) reflecting activities of daily living (ADL). We will gather secondary functional outcomes as well as mechanistic parameters in an exploratory approach. Methods/Design Our phase III randomised controlled trial will recruit 215 adults with moderate to severe limitations of walking and ADL 5 to 45 days after stroke onset. Participants will be stratified for the prognostic variables of “centre”, “age”, and “stroke severity”, and randomly assigned to one of two groups. The interventional group receives physical fitness training delivered as supported or unsupported treadmill training (cardiovascular active aerobic training; five times per week, over 4 weeks; each session 50 minutes; total of 20 additional physical fitness training sessions) in addition to standard rehabilitation treatment. The control intervention consists of relaxation sessions (non-cardiovascular active; five times per week week, over 4 weeks; each session 50 minutes) in addition to standard rehabilitation treatment. Co-primary efficacy endpoints will be gait speed (in m/s, 10 m walk) and the Barthel Index (100 points total) at 3 months post-stroke, compared to baseline measurements. Secondary outcomes include standard measures of quality of life, sleep and mood, cognition, arm function, maximal oxygen uptake, and cardiovascular risk factors including blood pressure, pulse, waist-to-hip ratio, markers of inflammation, immunity and the insulin-glucose pathway, lipid profile, and others. Discussion The goal of this endpoint-blinded, phase III randomised controlled trial is to provide evidence to guide post-stroke physical fitness-based rehabilitation programmes, and to elucidate the mechanisms underlying this intervention. Trial registration Registered in ClinicalTrials.gov with the Identifier NCT01953549.
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Affiliation(s)
- Agnes Flöel
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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96
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Simeone S, Savini S, Cohen MZ, Alvaro R, Vellone E. The experience of stroke survivors three months after being discharged home: A phenomenological investigation. Eur J Cardiovasc Nurs 2014; 14:162-9. [PMID: 24491347 DOI: 10.1177/1474515114522886] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke is the leading cause of disability in adults, and has a significant impact on individuals, families, and society. Returning home after a stroke represents a challenging experience for patients who struggle to adapt to their new life conditions. Although many studies have been conducted on stroke survivors, few studies have focused on the lived experience of patients at three months after they came home after rehabilitation. AIMS The aim of this study was to describe the experience of stroke survivors three months after being discharged home from rehabilitation hospitals. METHOD A phenomenological methodology was used to conduct the study. Participants were enrolled from rehabilitation hospitals in the cities of Rome and Naples. Interviews were conducted at the patients' house and data were analysed with a phenomenological approach FINDINGS Fifteen stroke survivors were interviewed (mean age 70 years; 12 males). Five themes emerged from the phenomenological analysis of the interviews and the field notes: deeply changed life, vivid memory of the acute phase of the stroke, slowed lives, relief after recovering from stroke, being a burden for family members. CONCLUSIONS The results of this study give an overview of the experience of stroke survivors three months after being discharged home. From a clinical perspective, health care providers need to provide more interventions to help survivors to cope better with life changes and encourage them to adapt to daily life limitations caused by stroke. Also, health care providers should improve support provided to family members of stroke patients.
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97
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Bokhari FAS, Wellwood I, Rudd AG, Langhorne P, Dennis MS, Wolfe CDA. Selective admission into stroke unit and patient outcomes: a tale of four cities. HEALTH ECONOMICS REVIEW 2014; 4:1. [PMID: 24405520 PMCID: PMC3892120 DOI: 10.1186/2191-1991-4-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/17/2013] [Indexed: 06/03/2023]
Abstract
: Care of stroke patients costs considerably more in specialized stroke units (SU) compared to care in general medical wards (GMW) but the technology may be cost effective if it leads to significantly improved outcomes. While randomized control trials show better outcomes for stroke patients admitted to SU, observational studies report mixed findings. In this paper we use individual level data from first-ever stroke patients in four European cities and find evidence of selection by the initial severity of stroke into SU in some cities. In these cases, the impact of admission to SU on outcomes is overestimated by multivariate logit models even after controlling for case-mix. However, when the imbalance in patient characteristics and severity of stroke by admission to SU and GMW is adjusted using propensity score methods, the differences in outcomes are no longer statistically significant in most cases. Our analysis explains why earlier studies using observational data have found mixed results on the benefits of admission to SU.
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Affiliation(s)
- Farasat AS Bokhari
- School of Economics and ESRC Centre for Competition Policy, University of East Anglia, Norwich, UK
| | - Ian Wellwood
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, London, UK and NIHR Biomedical Research Centre, Guy’s & St Thomas’ NHS Foundation Trust, King’s College London, London, UK
| | - Anthony G Rudd
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, London, UK and NIHR Biomedical Research Centre, Guy’s & St Thomas’ NHS Foundation Trust, King’s College London, London, UK
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK
| | - Martin S Dennis
- Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Charles DA Wolfe
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King’s College London, London, UK and NIHR Biomedical Research Centre, Guy’s & St Thomas’ NHS Foundation Trust, King’s College London, London, UK
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98
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Kotlęga D, Białecka M, Kurzawski M, Droździk M, Ciećwież S, Gołąb-Janowska M, Nowacki P. Risk factors of stroke and −717A>G (rs2794521) CRP gene polymorphism among stroke patients in West Pomerania province of Poland. Neurol Neurochir Pol 2014; 48:30-4. [DOI: 10.1016/j.pjnns.2013.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 12/23/2013] [Indexed: 11/26/2022]
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99
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Carod-Artal FJ, Casanova Lanchipa JO, Cruz Ramírez LM, Pérez NS, Siacara Aguayo FM, Moreno IG, Romero LG, Coral LF, Trizotto DS, Moreira CM. Stroke Subtypes and Comorbidity among Ischemic Stroke Patients in Brasilia and Cuenca: A Brazilian–Spanish Cross-cultural Study. J Stroke Cerebrovasc Dis 2014; 23:140-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/20/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022] Open
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100
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Scherbakov N, von Haehling S, Anker SD, Dirnagl U, Doehner W. Stroke induced Sarcopenia: Muscle wasting and disability after stroke. Int J Cardiol 2013; 170:89-94. [DOI: 10.1016/j.ijcard.2013.10.031] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 12/25/2022]
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