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Fan D, Miao R, Huang H, Wang X, Li S, Huang Q, Yang S, Deng R. Multimodal ischemic stroke recurrence prediction model based on the capsule neural network and support vector machine. Medicine (Baltimore) 2024; 103:e39217. [PMID: 39213233 PMCID: PMC11365640 DOI: 10.1097/md.0000000000039217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/06/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024] Open
Abstract
Ischemic stroke (IS) has a high recurrence rate. Machine learning (ML) models have been developed based on single-modal biochemical tests, and imaging data have been used to predict stroke recurrence. However, the prediction accuracy of these models is not sufficiently high. Therefore, this study aimed to collect biochemical detection and magnetic resonance imaging (MRI) data to establish a dataset and propose a high-performance heterogeneous multimodal IS recurrence prediction model based on deep learning. This is a retrospective cohort study. Data were retrospectively collected from 634 IS patients in Zhuhai, China, a 12-month follow-up was conducted to determine stroke recurrence. We propose the ischemic stroke multi-group learning (ISGL) model, an integrated model for predicting the recurrence risk of multimodal IS in patients, based on a capsule neural network and a linear support vector machine (SVM). Two capsule neural network prediction models based on T1 and T2 signals in the MRI data and a SVM prediction model based on biochemical test data were established. Finally, a vote was conducted on the final judgment of the integrated model. The ISGL model was compared with 6 classical ML and deep learning models: k-nearest neighbors, SVM, logistic regression, random forest, eXtreme Gradient Boosting, and visual geometry group. The results revealed that the accuracy, specificity, sensitivity and the area under the curve of the ISGL model were 95%, 96%, 94%, and 95%, respectively. Among the comparison models, the visual geometry group method exhibited the best performance, but it much lower than those of the ISGL model. Analysis of the importance of biochemical test data revealed that low-density lipoprotein, smoking, and heart disease history were the positively correlated factors, and total cholesterol, high-density lipoprotein, and diabetes were and the negatively correlated factors. This study proposes the ISGL model can be used simultaneously with MRI and biochemical data to predict IS recurrence. This combination resulted in higher rate of performance than that of the other ML models. Additionally, this study found related risk factors affected recurrence, which can be used to intervene in high-risk patients' recurrence as early as possible and promote the development of secondary prevention of stroke.
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Affiliation(s)
- Daying Fan
- Nursing Department, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Rui Miao
- Basic Teaching Department, Zhuhai Campus of Zunyi Medical University, Zhu Hai, China
| | - Hao Huang
- Neurological Department, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xianlin Wang
- Nursing Department, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Siyuan Li
- Nursing Department, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qinghua Huang
- Basic Teaching Department, Zhuhai Campus of Zunyi Medical University, Zhu Hai, China
| | - Shan Yang
- Nursing Department, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Renli Deng
- Nursing Department, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Dong J, Ma Y, Chen Y, Guo J, Zhang T, Yang T, Zhang H, Yan F, Han L. Prevalence and influencing factors of patient delay in stroke patients: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:202. [PMID: 38700541 DOI: 10.1007/s10143-024-02436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 03/03/2024] [Accepted: 04/27/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Determine the prevalence and influencing factors of patient delay in stroke patients and explore variation in prevalence by country and delayed time. METHODS PubMed, The Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), Weipu database, and Wanfang database were comprehensively searched for observational studies from inception to April, 2023. The pooled prevalence, odds ratio (OR), and 95% confidence intervals (CI) were calculated with Stata 16.0 software. RESULTS In total, 2721 articles were screened and data from 70 studies involving 85,468 subjects were used in meta-analysis. The pooled prevalence of patient delay in stroke patients was 59% (95% CI, 0.54-0.64). The estimates of pooled prevalence calculated for African, Asian, and European patient delay in stroke patients were 55% (0.29-0.81), 61% (0.56-0.66), and 49% (0.34-0.64).According to the patient delay time, the prevalence of 6 h, 5 h, 4.5 h, 3.5 h, 3 h and 2 h were 54% (0.47-0.61), 73% (0.61-0.86), 60% (0.49-0.71), 81% (0.68-0.93), 52% (0.42-0.62), 63% (0.19-1.07). Distance from the place of onset to the hospital > 10 km [OR=2.49, 95%CI (1.92, 3.24)], having medical insurance [OR = 0.45, 95%CI (0.26,0.80)], lack of stroke-related knowledge [OR = 1.56, 95%CI (1.08,2.26)], education level below junior high school [OR = 1.69, 95%CI (1.22,2.36)], non-emergency medical services (Non-EMS) [OR = 2.10, 95%CI (1.49,2.97)], living in rural areas [OR = 1.54, 95%CI (1.15,2.07)], disturbance of consciousness [OR = 0.60, 95%CI (0.39,0.93)], history of atrial fibrillation [OR = 0.53, 95%CI (0.47,0.59)], age ≥ 65 years [OR = 1.18, 95%CI (1.02,1.37)], National institutes of health stroke scale (NIHSS) ≤ 4 points [OR= 2.26, 95%CI (1.06,4.79)]were factors for patient delay in stroke patients. CONCLUSIONS The prevalence of patient delay in stroke patients is high, we should pay attention to the influencing factors of patient delay in stroke patients and provide a theoretical basis for shortening the treatment time of stroke patients.
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Affiliation(s)
- Jianhui Dong
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China.
- School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, 730000, China.
| | - Yanru Chen
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Jiali Guo
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Tong Zhang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Tingting Yang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, 730030, China
| | - Fanghong Yan
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China.
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, 730030, China.
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Sirousinejad ZS, Dianati M, Kheiran M, Sooki Z. Delays in receiving Alteplase and related factors in patients with stroke referred to Shahid Beheshti Hospital in Kashan-Iran in 2020-2021. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:147. [PMID: 38784291 PMCID: PMC11114574 DOI: 10.4103/jehp.jehp_1685_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/27/2023] [Indexed: 05/25/2024]
Abstract
BACKGROUND The benefits of using Alteplase are time-dependent. This study aimed to evaluate delays between the onset of symptoms and the administration of Alteplase and related factors in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS In this cross-sectional study, 60 AIS patients receiving Alteplase were selected by census sampling from July 2020 to July 2021 from the eligible patients referred to Shahid Beheshti Hospital in Kashan, Iran. The data collection tool was a researcher-made questionnaire containing demographic information, time periods from the onset of symptoms to the injection of Alteplase, and associated factors. The required information was collected from the patients, their relatives, their health records, and Kashan Emergency Medical Service (EMS) information system. Data were analyzed in SPSS-16. RESULTS Eighty-five percent of the 60 patients participating in the study were transferred to the hospital by EMS ambulances. The mean time intervals between different phases were as follows: Onset-To-Door (OTD) time 81.35 ± 33.76 minutes; Door-To-CT (DTC) scan time 16.12 ± 17.46 minutes; Door-To-Needle (DNT) time 51.30 ± 26.14 minutes; and the overall Onset-To-Needle (ONT) time 133.75 ± 39.17 minutes. Also, the mean ONT in people transferred by EMS was about 129 minutes, and the longest prehospital delay in these patients was related to the time between the arrival of the EMS ambulance to the hospital. Marital status and geographical location where the stroke had occurred showed a significant relationship with prehospital delay and pre-hospital notification (PHN) by EMS But there was no relationship between underlying diseases or economic status and prehospital delays; also, the patient's diastolic blood pressure at the time of receiving Alteplase showed a significant relationship with in-hospital delay. CONCLUSION The findings of the study showed that the majority of people trust and use EMS ambulances to transfer to the hospital and the time spent in different stages, from the onset of symptoms to the injection of the thrombolytic drug, was in an acceptable range in the patients.
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Affiliation(s)
- Zahra Sadat Sirousinejad
- Department of Nursing, Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Mansour Dianati
- Department of Nursing, Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahdi Kheiran
- Department of Neurology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Sooki
- Department of Midwifery, Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
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KAZADI KABANDA I, KIANGEBENI NGONZO C, EMEKA BOWAMOU CK, DIVENGI NZAMBI JP, KIATOKO PONTE N, TUYINAMA MADODA O, NKODILA NATUHOYILA A, M’BUYAMBA-KABANGU JR, LONGO-MBENZA B, BANZULU BOMBA D, KIANU PHANZU B. Stroke signs knowledge and factors associated with a delayed hospital arrival of patients with acute stroke in Kinshasa. Heliyon 2024; 10:e28311. [PMID: 38571603 PMCID: PMC10988012 DOI: 10.1016/j.heliyon.2024.e28311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Background Rapid recognition and early medical intervention are essential to reduce stroke-related mortality and long-term disability. This study aimed to evaluate awareness of stroke symptoms/signs and determine factors delaying the hospital arrival of patients with acute stroke in Kinshasa. Methods Patients with stroke and/or accompanying family members were interviewed using a standard questionnaire, and their medical records were reviewed. Factors independently associated with a late arrival (≥4.5 h) to the hospital were identified using the logistic regression test in forward multivariate analysis. Results Overall, 202 patients with an average age of 57.9 ± 13.1 years were included. Only 27 (13.4%) patients immediately associated the initial symptoms with a stroke episode. Delayed hospital arrival was observed in 180 (89.1%) patients. Unmarried status (adjusted odds ratio [aOR], 2.29; 95% confidence interval [CI], 1.17-4.88; p = 0.007), low education level (aOR, 2.29; 95% CI, (1.12-5.10; p = 0,014), absence of impaired consciousness (aOR, 3.12; 95% CI, 1.52-4.43; p = 0.005), absence of a history of hypertention (aOR, 1.85; 95% CI, 1.18-3.78; p = 0.041), absence of a history of diabetes (aOR, 1.93; 95% CI, 1.15-4.58; p = 0.013), heavy alcohol consumption (aOR, 1.83; 95% CI, 1.12-2.83; p = 0.045), absence of a severe to very severe stroke (aOR, 4.93; 95% CI, 0.82-1.01; p = 0.002), and presence of ischemic stroke (aOR, 2.93; 95% CI, 1.54-4.59; p = 0.001) were identified as independent determinants of delayed hospital arrival. Conclusions This study depicted a low stroke awareness rate and a much longer prehospital delay than evidence-based guidelines recommend and identified eight factors that public health actions could target to promote the earliest management of stroke.
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Affiliation(s)
- Igor KAZADI KABANDA
- Faculty of Medicine, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | | | | | - Jean-Paul DIVENGI NZAMBI
- Department of Internal Medicine, Reference General Hospital, Kinshasa, the Democratic Republic of the Congo
| | - Nono KIATOKO PONTE
- Unit of Neurology, Centre Hospitalier Initiative Plus de Kinkole, Kinshasa, the Democratic Republic of the Congo
| | - Olivier TUYINAMA MADODA
- Emergency Unit, University Hospital of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Aliocha NKODILA NATUHOYILA
- Department of Biostatistics, Public Health School of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | | | - Benjamin LONGO-MBENZA
- Cardiology Unit, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Degani BANZULU BOMBA
- Department of Neuropsychiatry, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Bernard KIANU PHANZU
- Cardiology Unit, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
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Jiang Y, Xiong Y, Chi Y, Lin F, Zhao Q, Li Y. Healthcare-Seeking Delays in Acute Ischemic Stroke Patients: The Influence of Gender, Immigrant Status, and Educational Background. Risk Manag Healthc Policy 2024; 17:191-204. [PMID: 38264584 PMCID: PMC10803282 DOI: 10.2147/rmhp.s445001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024] Open
Abstract
Purpose Timely medical attention is crucial for patients with Acute Ischemic Stroke (AIS), as delays can significantly impact therapeutic outcomes. These delays are influenced by a combination of socio-cultural, educational, and clinical factors. Patients and Methods An in-depth analysis was conducted to assess the prevalence and median duration of healthcare-seeking delays in AIS patients. The study specifically investigated the independent impacts of sociocultural and clinical determinants on these delays, with a focus on immigrant status, gender disparities, and educational levels. Multivariate regression analysis was employed to identify these independent effects while controlling for potential confounding factors. Results Among 1419 AIS patients, 82.52% (n = 1171) experienced delays exceeding 2 hours from symptom onset of symptoms to hospital arrival. The median delay was 12.3 hours. Immigrant populations encountering longer delays compared to native groups. Younger males (<45 years) and elderly females were more prone to delay in healthcare-seeking. Identified independent risk factors for delay included male gender (OR = 1.65 [95% CI:1.14-2.48]), self-acknowledged diabetes (OR = 2.50 [95% CI:1.21-5.17]), small vessel (OR = 2.07 [95% CI:1.27-3.36]), and wake stroke (OR = 7.04 [95% CI:3.69-13.44]). Educational background (high school and above), GCS score with 3-8 points (OR = 0.52 [95% CI:0.09-0.69]), understanding stroke-related knowledge (OR = 0.26 [95% CI:0.09-0.44]), conscious disturbance (OR = 0.25 [95% CI:0.10-0.62]) and limb weakness (OR=0.21[95% CI:0.21-0.49]) are protective factors for timely treatment. Conclusion Immigrant populations experienced longer delays from symptom onset to hospital arrival. The crucial roles of education and knowledge about stroke underscore the need for enhanced health literacy campaigns and public awareness, with a targeted focus on younger males and elderly females.
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Affiliation(s)
- Youli Jiang
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Yao Xiong
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Yue Chi
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Fu Lin
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Qingshi Zhao
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
| | - Yanfeng Li
- Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of China
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Liu QH, Tan JX, Hu CX, Zhang XP, Liu SY, Wan LH. Relationship of family function and pre-hospital delay among Chinese patients with recurrent ischaemic stroke and the mediation effect of stigma. Eur J Cardiovasc Nurs 2023; 22:586-593. [PMID: 36611018 DOI: 10.1093/eurjcn/zvad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/24/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
AIMS Pre-hospital delay refers to the time span from the onset of symptoms to arrival at a hospital ≥ 3 h and is the main limitation of stroke reperfusion therapies. Family factors and stroke-related stigma may influence pre-hospital delay. However, few studies have confirmed the influence of stigma on pre-hospital delay or explored the relationships between family function, stigma, and pre-hospital delay among patients with recurrent stroke. This study aimed to explore the relationship between family function and pre-hospital delay among patients with recurrent stroke and examine the mediation role of stigma in this relationship. METHODS AND RESULTS A cross-sectional study was performed at the neurology departments of two hospitals in Guangzhou, China between July 2021 and April 2022. A total of 115 patients with recurrent stroke completed questionnaires and were included in the analysis. Data were collected using the Short Form Family Assessment Device, the Stroke Stigma Scale, and the Stroke Knowledge Questionnaire. Spearman's correlation and a structural equation model were used for data analysis. Family function directly influenced pre-hospital delay [β=0.27, P = 0.033, 95%CI = (0.02-0.51)] and indirectly influenced pre-hospital delay [β=0.17, P = 0.038, 95%CI = (0.02-0.34)] through stigma. Moreover, stigma partially mediated the effect of family function on pre-hospital delay. CONCLUSION Family function and stigma directly and indirectly influenced pre-hospital delay among patients with recurrent stroke. Future health education and interventions need to focus on strengthening and improving emotional support from family members to improve family function and reduce stigma, thereby reducing pre-hospital delay among patients with recurrent stroke.
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Affiliation(s)
- Qun-Hong Liu
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Rd. 2, Guangzhou 510089, China
| | - Ju-Xiang Tan
- Department of Neurology and Stroke Center, The Third Affiliated Hospital, Sun Yat-sen University, 2693 Kaichuang Avenue, Guangzhou 510700, China
| | - Cai-Xia Hu
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, 111 Dade Rd., Guangzhou 510120, China
| | - Xiao-Pei Zhang
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, 111 Dade Rd., Guangzhou 510120, China
| | - Shu-Ying Liu
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, 111 Dade Rd., Guangzhou 510120, China
| | - Li-Hong Wan
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Rd. 2, Guangzhou 510089, China
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Zeng X, Balikuddembe JK, Liang P. Impact of community-based rehabilitation on the physical functioning and activity of daily living of stroke patients: a systematic review and meta-analysis. Disabil Rehabil 2023; 45:403-414. [PMID: 35200068 DOI: 10.1080/09638288.2022.2037755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed at establishing the impact of community-based rehabilitation (CBR) on the physical functioning and activity of daily living (ADL) of patients with stroke (PWS). MATERIALS AND METHODS Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic search was conducted in five databases, including PubMed, OVID Embase, OVID Medline, Cochrane Library, and Web of Science between May 2010 and 2020. Meta-analysis was performed using the Comprehensive Meta-Analysis Version 2 software to establish whether the studies were sufficiently homogenous. RESULTS Twenty studies out of 828 publications were included in the present systematic review. A significant difference between CBR intervention and control groups was identified about the physical functional capacity in mobility, 6-metre walk test (6MWT) (g = 0.351, 95% CI (0.110, 0.592)), community walking test (g= -0.473, 95% CI (-0.926, -0.020)) and on the other hand a significant improvement in ADL was found (g = 0.138, 95% CI(0.051, 0.224)). CONCLUSIONS CBR is revealed to be effective in improving the physical functioning and ADL for PWS and is drawn based on eligible studies which were conducted in high-income countries (HICs). This highlights a gap between developed and less-resourced countries as far as CBR for PWS is concerned and calls for a further study. Protocol Registration: CRD42020159683Implication for rehabilitationCommunity-based rehabilitation (CBR) is recommended as one of the best programme for treating stroke patients with stroke (PWS) after they are discharged from hospitals.CBR is effective in improving the physical functioning and activity of daily living of PWS.Further research should be carried out to compare between CBR and institution-based rehabilitation for PWS, especially the less-resourced settings which are grappling with a challenge of limited skilled rehabilitation professionals.
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Affiliation(s)
- Xinglin Zeng
- Rehabilitation Department, West China Medical School, Sichuan University, Chengdu, PR China
| | - Joseph K Balikuddembe
- Institute for Disaster Management and Reconstruction, Sichuan University and Hong-Kong Polytechnic University, Chengdu, PR China
| | - Ping Liang
- Cardiac Rehabilitation Center, Fuwai Hospital, Beijing, China
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Potisopha W, Vuckovic KM, DeVon HA, Park CG, Phutthikhamin N, Hershberger PE. Decision Delay Is a Significant Contributor to Prehospital Delay for Stroke Symptoms. West J Nurs Res 2023; 45:55-66. [PMID: 35711105 DOI: 10.1177/01939459221105827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prehospital delay after stroke symptom onset is a primary barrier to eligibility for reperfusion therapies. Decision delay is an understudied contributor to prehospital delay. We aimed to explore decision delay as a component of prehospital delay. For this correlational study, 170 Thai acute stroke patients were interviewed to explore their treatment-seeking decision factors: prior stroke knowledge, onset context, and cognitive, emotional, and behavioral factors. Participants' mean age was 61.2 years, and 46% were women. Median decision delay and prehospital delay times were 120 and 372 minutes. Decision delay represented 49% of prehospital delays. Factors shortening decision delay were atrial fibrillation, prior stroke knowledge, perceived cause of symptoms as stroke, perceived severity of symptoms, and advice from bystanders to seek treatment. In contrast, seeking support from others and self-treatment affected prolonged decision delay. Shortening decision delay, often under the patient or bystander control, can reduce overall prehospital delay.
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Affiliation(s)
- Wiphawadee Potisopha
- Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Karen M Vuckovic
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA.,College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Holli A DeVon
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Chang G Park
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - Patricia E Hershberger
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA.,College of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Botelho A, Rios J, Fidalgo AP, Ferreira E, Nzwalo H. Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316357. [PMID: 36498429 PMCID: PMC9735885 DOI: 10.3390/ijerph192316357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. METHODOLOGY Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. RESULTS A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. CONCLUSIONS Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.
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Affiliation(s)
- Ana Botelho
- Faculty of Economy, University of Algarve, 8005-139 Faro, Portugal
- Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
- Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
| | - Jonathan Rios
- Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
| | - Ana Paula Fidalgo
- Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
| | - Eugénia Ferreira
- Faculty of Economy, University of Algarve, 8005-139 Faro, Portugal
| | - Hipólito Nzwalo
- Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal
- Algarve Biomedical Research Institute, 8005-139 Faro, Portugal
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Gao Z, Liu Q, Yang L, Zhu X. Identification of high-risk factors for prehospital delay for patients with stroke using the risk matrix methods. Front Public Health 2022; 10:858926. [PMID: 36438229 PMCID: PMC9691690 DOI: 10.3389/fpubh.2022.858926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stroke has become a leading cause of mortality and adult disability in China. The key to treating acute ischemic stroke (AIS) is to open the obstructed blood vessels as soon as possible and save the ischemic penumbra. However, the thrombolytic rate in China is only 2.5%. Research has been devoted to investigating the causes of prehospital delay, but the exact controllable risk factors for prehospital delay remain uncertain, and a consensus is lacking. We aimed to develop a risk assessment tool to identify the most critical risk factors for prehospital delay for AIS patients. Methods From November 2018 to July 2019, 450 patients with AIS were recruited. Both qualitative and quantitative data were collected. The Delphi technique was used to obtain expert opinions about the importance of the risk indices in two rounds of Delphi consultation. Then, we used the risk matrix to identify high-risk factors for prehospital delay for AIS patients. Results The risk matrix identified the following five critical risk factors that account for prehospital delay after AIS: living in a rural area; no bystanders when stroke occurs; patients and their families lacking an understanding of the urgency of stroke treatment; patients and their families not knowing that stroke requires thrombolysis or that there is a thrombolysis time window; and the patient self-medicating, unaware of the seriousness of the symptoms, and waiting for spontaneous remission. Conclusions The risk analysis tool used during this study may help prevent prehospital delays for patients with AIS.
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Affiliation(s)
- Zihan Gao
- School of Nursing, Qingdao University, Qingdao, China
| | - Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Li Yang
- School of Nursing, Qingdao University, Qingdao, China,*Correspondence: Li Yang
| | - Xuemei Zhu
- School of Nursing, Harbin Medical University, Heilongjiang, China
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11
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Identification and analysis of key risk factors for prehospital delay in patients with stroke. Int Emerg Nurs 2022; 62:101156. [DOI: 10.1016/j.ienj.2022.101156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/27/2022] [Accepted: 02/11/2022] [Indexed: 01/18/2023]
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Kharbach A, Obtel M, Achbani A, Aasfara J, Hassouni K, Lahlou L, Razine R. Ischemic stroke in Morocco: Prehospital delay and associated factors. Rev Epidemiol Sante Publique 2021; 69:345-359. [PMID: 34148762 DOI: 10.1016/j.respe.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco. PATIENTS AND METHODS An observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department. RESULTS A total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6hours (IQR, 4-16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40-437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57-80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01-0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00-0.36), and direct admission without reference (OR 0.005; CI95%: 0.00-0.07), were independently associated with late arrival (>4.5hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37-138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03-0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00-0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03-0.80), distance between 50 and 100km (OR 10.16; CI95%: 1.16-89.33), and direct admission without reference (OR 0.03; CI95%: 0.00-0.14), were independently associated with late arrival (>6hours) of patients with acute ischemic stroke. CONCLUSION Patient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.
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Affiliation(s)
- A Kharbach
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - M Obtel
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - A Achbani
- Laboratory of Cell Biology and Molecular Genetics (LBCGM), Department of Biology, Faculty of Sciences, University Ibn Zohr Agadir, Rabat, Morocco.
| | - J Aasfara
- Department of Neurology, International Cheikh Khalifa University Hospital, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - K Hassouni
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - L Lahlou
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Agadir, Morocco.
| | - R Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
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Wang R, Wang Z, Yang D, Wang J, Gou C, Zhang Y, Xian L, Wang Q. Early Hospital Arrival After Acute Ischemic Stroke Is Associated With Family Members' Knowledge About Stroke. Front Neurol 2021; 12:652321. [PMID: 34122301 PMCID: PMC8187751 DOI: 10.3389/fneur.2021.652321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: Prehospital delay is the major factor limiting intravenous thrombolysis and mechanical thrombectomy in acute ischemic stroke (AIS). This study aimed to: (1) identify factors related to prehospital delay and (2) determine the impact of recognition and behavior of family members on patient delay. Methods: A cross-sectional, multicenter study was conducted at six teaching hospitals in China between December 1, 2018 and November 30, 2019. Patients who experienced AIS within 7 days of onset were interviewed. Results: Of 1,782 consecutive patients (male, 57.97%; mean age, 66.3 ± 9.65 years) who had an AIS, 267 (14.98%) patients arrived within 4.5 h and 722 (40.52%) patients arrived within 6 h of stroke onset. Among patients who arrived within 4.5 h, 103 (38.6%) received thrombolysis. Age over 65 years (OR, 2.009; 95% CI, 1.014-3.982), prior stroke (OR, 3.478; 95% CI, 1.311-9.229), blurred vision (OR, 3.95; 95% CI, 1.71-9.123), and patients deciding to seek medical help (OR, 3.097; 95% CI, 1.417-6.769) were independently associated with late arrival. In contrast, sudden onset of symptoms (OR, 0.075; 95% CI, 0.028-0.196), the National Institutes of Health Stroke Scale 7-15 (OR, 0.093; 95% CI, 0.035-0.251), consciousness disturbance (OR, 0.258; 95% CI, 0.091-0.734), weakness (OR, 0.265; 95% CI, 0.09-0.784), arrival by ambulance (OR, 0.102; 95% CI, 0.049-0.211), decision time <30 min (OR, 0.008; 95% CI, 0.003-0.018), and family member understanding stroke requires early treatment (OR, 0.224; 95% CI, 0.109-0.462) were independently associated with early arrival. Conclusions: The prehospital delay in China lags behind Western countries. Recognition and behavior of stroke patients' family members may play a key role in early arrival.
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Affiliation(s)
- Rongyu Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhiqiang Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jian Wang
- Department of Neurology, Yaan People's Hospital, Yaan, China
| | - Chongji Gou
- Department of Neurology, Pengzhou People's Hospital, Pengzhou, China
| | - Yaodan Zhang
- Department of Neurology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Liulin Xian
- Department of Neurology, Nanbu Traditional Chinese Medicine, Nanbu, China
| | - Qingsong Wang
- Department of Neurology, The General Hospital of Western Theater Command, Chengdu, China
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Wang Y, Liu Y, Liu R, Zhao J. Cluster-randomised controlled trial of Stroke 1-2-0 education programme to reduce stroke prehospital delay in China: a study protocol. BMJ Open 2021; 11:e048064. [PMID: 34035108 PMCID: PMC8154964 DOI: 10.1136/bmjopen-2020-048064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Stroke is the leading cause of death and disability in China. The median time of stroke pre-hospital delay is more than 15 hours, mainly due to the lack of awareness on stroke symptoms and calling emergency services. We developed Stroke 1-2-0 recognition tool in China, by adapting Face, Arm, Speech and Time. Our preliminary findings suggested that Stroke 1-2-0 can improve public's knowledge of the stroke symptoms, but its impact on the prehospital delay is still unclear. Furthermore, these findings were mainly obtained from Shanghai, one of the largest metropolises in China. However, more than half of population in China lives in the rural area. Given the striking disparities in socioeconomic status and quality of stroke care across the nation, a multicentre trial is warranted. METHODS AND ANALYSIS Stroke 1-2-0 education programme will adopt a multicentre, cluster-randomised controlled design. We aimed to recruit 32 communities from 16 counties across China. Each county includes two communities having more than 100 000 residents. The two communities sampled in the same county will be randomly assigned to receive either Stroke 1-2-0 education programme or usual care. The primary objective of this study is to evaluate the impact of Stroke 1-2-0 public education programme in reducing stroke prehospital delay among adults residing in the community, compared with the usual care. The intervention will be implemented for 1 year. The primary outcomes are the symptom onset to hospital arrival time ('onset-to-door time', ODT) and 3-hour hospital arriving rate. We will use an intention-to-treat approach. A linear mixed model will be used to control for potential cluster effects. ETHICS AND DISSEMINATION This study is approved by the Shanghai Minhang District Central Hospital Institutional Review Board (Shanghai, China). The findings will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2000040782.
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Affiliation(s)
- Yong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
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Exosomes Derived from CXCR4-Overexpressing BMSC Promoted Activation of Microvascular Endothelial Cells in Cerebral Ischemia/Reperfusion Injury. Neural Plast 2021; 2020:8814239. [PMID: 33381162 PMCID: PMC7762674 DOI: 10.1155/2020/8814239] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/27/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Ischemic stroke is a severe acute cerebrovascular disease which can be improved with neuroprotective therapies at an early stage. However, due to the lack of effective neuroprotective drugs, most stroke patients have varying degrees of long-term disability. In the present study, we investigated the role of exosomes derived from CXCR4-overexpressing BMSCs in restoring vascular function and neural repair after ischemic cerebral infarction. Methods BMSCs were transfected with lentivirus encoded by CXCR4 (BMSCCXCR4). Exosomes derived from BMSCCXCR4 (ExoCXCR4) were isolated and characterized by transmission electron microscopy and dynamic light scattering. Western blot and qPCR were used to analyze the expression of CXCR4 in BMSCs and exosomes. The acute middle cerebral artery occlusion (MCAO) model was prepared, ExoCXCR4 were injected into the rats, and behavioral changes were analyzed. The role of ExoCXCR4 in promoting the proliferation and tube formation for angiogenesis and protecting brain endothelial cells was determined in vitro. Results Compared with the control groups, the ExoCXCR4 group showed a significantly lower mNSS score at 7 d, 14 d, and 21 d after ischemia/reperfusion (P < 0.05). The bEnd.3 cells in the ExoCXCR4 group have stronger proliferation ability than other groups (P < 0.05), while the CXCR4 inhibitor can reduce this effect. Exosomes control (ExoCon) can significantly promote the migration of bEnd.3 cells (P < 0.05), while there was no significant difference between the ExoCXCR4 and ExoCon groups (P > 0.05). ExoCXCR4 can further promote the proliferation and tube formation for the angiogenesis of the endothelium compared with ExoCon group (P < 0.05). In addition, cobalt chloride (COCl2) can increase the expression of β-catenin and Wnt-3, while ExoCon can reduce the expression of these proteins (P < 0.05). ExoCXCR4 can further attenuate the activation of Wnt-3a/β-catenin pathway (P < 0.05). Conclusions In ischemia/reperfusion injury, ExoCXCR4 promoted the proliferation and tube formation of microvascular endothelial cells and play an antiapoptotic role via the Wnt-3a/β-catenin pathway.
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Yang L, Liu Q, Zhao Q, Zhu X, Wang L. Machine learning is a valid method for predicting prehospital delay after acute ischemic stroke. Brain Behav 2020; 10:e01794. [PMID: 32812396 PMCID: PMC7559608 DOI: 10.1002/brb3.1794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study aimed to identify the influencing factors associated with long onset-to-door time and establish predictive models that could help to assess the probability of prehospital delay in populations with a high risk for stroke. MATERIALS AND METHODS Patients who were diagnosed with acute ischemic stroke (AIS) and hospitalized between 1 November 2018 and 31 July 2019 were interviewed, and their medical records were extracted for data analysis. Two machine learning algorithms (support vector machine and Bayesian network) were applied in this study, and their predictive performance was compared with that of the classical logistic regression models after using several variable selection methods. Timely admission (onset-to-door time < 3 hr) and prehospital delay (onset-to-door time ≥ 3 hr) were the outcome variables. We computed the area under curve (AUC) and the difference in the mean AUC values between the models. RESULTS A total of 450 patients with AIS were enrolled; 57 (12.7%) with timely admission and 393 (87.3%) patients with prehospital delay. All models, both those constructed by logistic regression and those by machine learning, performed well in predicting prehospital delay (range mean AUC: 0.800-0.846). The difference in the mean AUC values between the best performing machine learning model and the best performing logistic regression model was negligible (0.014; 95% CI: 0.013-0.015). CONCLUSIONS Machine learning algorithms were not inferior to logistic regression models for prediction of prehospital delay after stroke. All models provided good discrimination, thereby creating valuable diagnostic programs for prehospital delay prediction.
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Affiliation(s)
- Li Yang
- School of Nursing, Qingdao University, Qingdao, China
| | - Qinqin Liu
- School of Nursing, The second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Qiuli Zhao
- School of Nursing, The second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Xuemei Zhu
- School of Nursing, The second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Ling Wang
- School of Nursing, The second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
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Jiang YJ, Wang ZM, Wang ZY, Wei CJ. Association between serum lipoprotein levels and neurological function in patients with acute ischemic stroke: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20258. [PMID: 32443365 PMCID: PMC7253775 DOI: 10.1097/md.0000000000020258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The target of this study is to summarize the association between the serum lipoprotein levels and neurological function in patients with acute ischemic stroke. METHODS A comprehensive search of Cochrane Library, PUBMED, EMBASE, Web of Science, and Chinese Biomedical Literature Database, China National Knowledge Infrastructure from inception to the February 29, 2020 without language and publication date restrictions. All searched studies will be selected by 2 authors independently against the eligibility criteria. Included studies will be critically appraised, and essential data will be extracted by 2 independent authors. If necessary, meta-analysis will be utilized to synthesize the outcome data from included articles. If it is not possible, a narrative synthesis will be undertaken. RESULTS This study will summarize the up-to-date evidence to investigate the association between serum lipoprotein levels and neurological function in patients with acute ischemic stroke. CONCLUSION Its results may present beneficial evidence and guidance for the clinical practice and further studies. STUDY REGISTRATION NUMBER INPLASY202040043.
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Alharbi FA, Maghfuri NM, Abdu DM, Redine MY. Saudi neurology residents' knowledge and attitudes toward intravenous thrombolysis in patients with acute ischemic stroke. J Family Med Prim Care 2020; 9:192-196. [PMID: 32110589 PMCID: PMC7014870 DOI: 10.4103/jfmpc.jfmpc_924_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 01/01/2023] Open
Abstract
Background Although intravenous (IV) thrombolysis is an effective treatment for patients with acute ischemic stroke (AIS), it remains underused by neurologists worldwide. This study assessed the knowledge and attitudes toward IV thrombolysis in patients with AIS among neurology residents in Saudi Arabia. Materials and Methods An online survey was conducted using a sample of 81 neurology residents in and around Saudi Arabia. Statistical analysis included descriptive studies and Chi-square or Fisher's exact test. Results Of the 81 respondents, 50 (61.7%) were males and 31 (38.3%) females. Regarding IV thrombolysis use in AIS patients; 61.7% thought that they would consider it, a vast majority about 72.8% showed positive attitudes toward performing IV thrombolysis for AIS patients, 69.1% thought that IV thrombolysis is safe, 79.0% did not think that they have good knowledge about IV thrombolysis, and 53.1% felt not confident about their ability to employ IV thrombolysis. Confidence with knowledge was associated with the residency stage (P = 0.000). Attitudes toward IV thrombolysis was found associated with sex (P = 0.044) and residency stage (P = 0.002). Residents from the central region were more likely to have positive attitudes (P = 0.043). Conclusion The surveyed neurology residents showed a positive attitude towards the safety and use of IV thrombolysis for AIS patients. However, knowledge and confidence along with knowledge about the treatment are lacking. Therefore, theoretical and practical training is warranted to improve knowledge about IV thrombolysis.
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Affiliation(s)
- Fatimah Ali Alharbi
- Medical Intern, College of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Nadia Magbul Maghfuri
- Medical Intern, College of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Dalia Mohammed Abdu
- Medical Intern, College of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Misoon Yahya Redine
- Medical Intern, College of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
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Soto-Cámara R, González-Santos J, González-Bernal J, Martín-Santidrian A, Cubo E, Trejo-Gabriel-Galán JM. Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke. J Clin Med 2019; 8:E1712. [PMID: 31627368 PMCID: PMC6832968 DOI: 10.3390/jcm8101712] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Despite recent advances in acute stroke care, only 1-8% of patients can receive reperfusion therapies, mainly because of prehospital delay (PHD). OBJECTIVE This study aimed to identify factors associated with PHD from the onset of acute stroke symptoms until arrival at the hospital. METHODS A cross-sectional study was conducted including all patients consecutively admitted with stroke symptoms to Burgos University Hospital (Burgos, Spain). Socio-demographic, clinical, behavioral, cognitive, and contextualized characteristics were recorded, and their possible associations with PHD were studied using univariate and multivariable regression analyses. RESULTS The median PHD of 322 patients was 138.50 min. The following factors decreased the PHD and time until reperfusion treatment where applicable: asking for help immediately after the onset of symptoms (OR 10.36; 95% confidence interval (CI) 4.47-23.99), onset of stroke during the daytime (OR 7.73; 95% CI 3.09-19.34) and the weekend (OR 2.64; 95% CI 1.19-5.85), occurrence of stroke outside the home (OR 7.09; 95% CI 1.97-25.55), using a prenotification system (OR 6.46; 95% CI 1.71-8.39), patient's perception of being unable to control symptoms without assistance (OR 5.14; 95% CI 2.60-10.16), previous knowledge of stroke as a medical emergency (OR 3.20; 95% CI 1.38-7.40), call to emergency medical services as the first medical contact (OR 2.77; 95% CI 1.32-5.88), speech/language difficulties experienced by the patient (OR 2.21; 95% CI 1.16-4.36), and the identification of stroke symptoms by the patient (OR 1.98; 95% CI 1.03-3.82). CONCLUSIONS The interval between the onset of symptoms and arrival at the hospital depends on certain contextual, cognitive, and behavioral factors, all of which should be considered when planning future public awareness campaigns.
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Affiliation(s)
- Raúl Soto-Cámara
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain.
- Emergency Medical Service, 09200 Burgos, Spain.
| | | | | | | | - Esther Cubo
- Neurology Department, University Hospital of Burgos, 09006 Burgos, Spain.
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Zhou Y, Yan S, Song X, Gong Y, Li W, Wang M, Yin X, Hu B, Lu Z. Intravenous thrombolytic therapy for acute ischemic stroke in Hubei, China: a survey of thrombolysis rate and barriers. BMC Neurol 2019; 19:202. [PMID: 31438899 PMCID: PMC6704516 DOI: 10.1186/s12883-019-1418-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of thrombolysis in most countries are well below best practice benchmarks. We aimed to investigate thrombolysis utilization and its associated factors in acute ischemic stroke (AIS) patients in Hubei province, China, to assess neurologists' experiences of the treatment, and to identify barriers against the treatment from perspective of AIS patients and neurologists. METHODS Survey of 2096 AIS patients and 709 neurologists from 66 hospitals was conducted in Hubei province between 2014 and 2015. A multivariable logistic regression model was utilized to identify the factors associated with thrombolysis utilization and neurologists' experiences with thrombolysis. RESULTS Of the 2096 AIS patients, only 3.8% received thrombolysis. Of the 709 neurologists, 66.0% reported using thrombolysis for AIS patients. The main reasons for not using thrombolysis were late arrival of patients, fear of the risk of complications of thrombolysis, and light or quickly recovered stroke symptoms. The behavior and clinical characteristics of patients, including early admission to hospital (odds ratio [OR] = 5.81, 95% confidence intervals [CI] 3.31-10.20), using emergency medical services to be hospitalized (OR = 3.36, 95% CI 2.00-5.62), stroke history (OR = 0.53, 95% CI 0.28-0.99), and National Institute of Health Stroke Scale score < 4 (OR = 0.46, 95% CI 0.27-0.77) were shown to significantly affect the thrombolysis utilization in the multivariate model. In addition, hospital grade (OR = 2.84, 95% CI 1.84-4.37), education level (OR = 2.49, 95% CI 1.09-5.73), and working years (OR = 1.88, 95% CI 1.18-3.00) were strongly associated with neurologists' experiences of thrombolysis. CONCLUSIONS A very low proportion of AIS patients received thrombolysis in Hubei province, China. Considerable education programs and interventions were required regarding knowledge of stroke treatment for clinicians and proper behavior after stroke for AIS patients and their families.
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Affiliation(s)
- Yanfeng Zhou
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Shijiao Yan
- School of Public Health, Hainan Medical University, Haikou, 571199, People's Republic of China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, 571199, People's Republic of China
| | - Xingyue Song
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Mengdie Wang
- Department of Neurology, Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Bo Hu
- Department of Neurology, Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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Late Hospital Arrival for Thrombolysis after Stroke in Southern Portugal: Who Is at Risk? J Stroke Cerebrovasc Dis 2019; 28:900-905. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/09/2018] [Accepted: 12/08/2018] [Indexed: 11/23/2022] Open
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Gebreyohannes EA, Bhagavathula AS, Abebe TB, Seid MA, Haile KT. In-Hospital Mortality among Ischemic Stroke Patients in Gondar University Hospital: A Retrospective Cohort Study. Stroke Res Treat 2019; 2019:7275063. [PMID: 30693082 PMCID: PMC6332873 DOI: 10.1155/2019/7275063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/23/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Ischemic stroke is the third leading cause of mortality in low-income countries and the sixth in Ethiopia. The aim of this study was to determine the rate and predictors of in-hospital mortality due to ischemic stroke in Gondar University Hospital. METHODS The study was conducted from April 1, 2017, to May 15, 2017, at Gondar University Hospital. A census using retrospective cohort study design was conducted on medical records of adult patients with the diagnosis of ischemic stroke attending the medical inpatient ward of Gondar University Hospital between November 2012 and September 2016. Cox hazard regression was used to determine the predictors of in-hospital mortality. A two-sided statistical test at 5% level of significance was used. RESULTS The mean (±SD) duration of hospital stay was 11.55 (10.040) days. Of the total 208 patients, 26 (12.5%) patients died in the hospital. Cox regression revealed that only a decrease in renal function, particularly elevated serum creatinine (AHR=8.848, 95% CI: 1.616-67.437), was associated with a statistically significant increase of in-hospital mortality. The symptom onset-to-admission time varied greatly among patients and ranged from 1 hour to 168 hours. CONCLUSION The in-hospital mortality associated with ischemic stroke was found to be high. Mainly, elevation in serum creatinine was highly associated with poorer outcomes in terms of in-hospital mortality. Much work should be done on improving the knowledge and awareness of the community regarding ischemic stroke and stroke in general to encourage early medical seeking behavior and reduce mortality and long-term disability.
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Affiliation(s)
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, University of Gondar, Gondar, Ethiopia
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE Univerisity, Abu Dhabi, UAE
| | - Tamrat Befekadu Abebe
- Department of Clinical Pharmacy, University of Gondar, Gondar, Ethiopia
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Solna, Sweden
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Wang MD, Yin XX, Yang TT, Wang Y, Zhu YY, Zhou YF, Lu ZX, Hu B. Chinese neurologists' perspective on intravenous thrombolysis for acute ischemic stroke. Brain Behav 2018; 8:e00882. [PMID: 29568683 PMCID: PMC5853636 DOI: 10.1002/brb3.882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/01/2017] [Accepted: 10/22/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study examined the neurologists' perspective toward intravenous thrombolysis for the treatment of acute ischemic stroke and the influencing factors in a Chinese Province. METHODS A cross-sectional study was conducted from 1 October 2014 to 31 January 2015. A total of 719 neurologists from 66 hospitals in Hubei Province were included. A questionnaire was designed, and multivariable logistic regression models were used to identify the factors associated with the neurologists' perspective toward intravenous thrombolysis. RESULTS Among the responding neurologists, 67.3% reported using intravenous thrombolysis and 32.9% believed the treatment was unsafe. Approximately 51.4% reported deficits in their knowledge of intravenous thrombolysis and 45.8% felt unconfident about their ability to employ the treatment. The majority (90.1%) supported hospitals in performing intravenous thrombolysis for eligible patients. Their safety concern was associated with hospital grade (odds ratio[OR] = 2.3; 95% confidence interval [CI], 1.4-3.7) and previous experiences with thrombolysis (OR = 3.1; 95% CI, 2.1-4.6). Their confidence was associated with their educational background (OR = 2.5; 95% CI, 1.3-4.5), knowledge mastery (OR = 10.4; 95% CI, 6.6-16.3), and previous experiences with thrombolysis (OR = 3.3; 95% CI, 2.1-5.3). Their attitudes were associated with gender (OR = 0.6; 95% CI, 0.3-1.0) and previous experiences with thrombolysis (OR = 4.9; 95% CI, 2.5-9.4). CONCLUSIONS Most neurologists in Hubei Province, China, identified with intravenous thrombolysis for the treatment of acute ischemic stroke. However, they were weak in knowledge and lack confidence. Therefore, training, especially practical training, is needed to promote the use of thrombolysis in the region.
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Affiliation(s)
- Meng-Die Wang
- Department of Neurology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Xiao-Xv Yin
- School of Public Health Tongji Medical College Huazhong University of Science and Technolog yWuhan China
| | - Ting-Ting Yang
- School of Public Health Tongji Medical College Huazhong University of Science and Technolog yWuhan China
| | - Yong Wang
- Department of Neurology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Yi-Yi Zhu
- Department of Neurology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Yan-Feng Zhou
- School of Public Health Tongji Medical College Huazhong University of Science and Technolog yWuhan China
| | - Zu-Xun Lu
- School of Public Health Tongji Medical College Huazhong University of Science and Technolog yWuhan China
| | - Bo Hu
- Department of Neurology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China.,The Stroke Quality Control Center of Hubei Province Wuhan Hubei China.,Key Laboratory of Neurological Disease Ministry of Education Tongji Medical College Huazhong University of Science and Technology Wuhan China
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