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Geerts JA, Pieterse ME, Laverman GD, Waanders F, Oosterom N, Slegten JT, Salemink E, Bode C. Cognitive Bias Modification Training Targeting Fatigue in Kidney Patients: Usability study (Preprint). JMIR Form Res 2022; 7:e43636. [DOI: 10.2196/43636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
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Alonso de Leciñana M, Morales A, Martínez-Zabaleta M, Ayo-Martín Ó, Lizán L, Castellanos M. Characteristics of stroke units and stroke teams in Spain in 2018. Pre2Ictus project. NEUROLOGÍA (ENGLISH EDITION) 2022; 38:173-180. [PMID: 35780047 DOI: 10.1016/j.nrleng.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain. METHODS We performed a cross-sectional study based on an ad-hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year. RESULTS The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. A mean (standard deviation) of 4 (3) neurologists were assigned to each stroke unit/team; 98% of stroke units (and 38% of stroke teams) have an on-call neurologist available 24 hours a day, 98% of units (79% of stroke teams) included specialised nurses, 86% of units (71% of stroke teams) included a social worker, and 81% of units (71% of stroke teams) included a rehabilitation physician. Most stroke units (80%) had 4--6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds was 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring was 3 (1) days. All stroke units and 86% of stroke teams had intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams were able to perform mechanical thrombectomy, whereas the remaining centres had referral pathways in place. Telestroke systems were in place at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases. CONCLUSIONS Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.
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Affiliation(s)
- M Alonso de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Ó Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - L Lizán
- Outcomes'10 SLU, Castellón, Spain; Departamento de Medicina, Universitat Jaume I, Castellón, Spain
| | - M Castellanos
- Servicio de Neurología, Hospital Universitario e Instituto de Investigación Biomédica, La Coruña, Spain
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Alonso de Leciñana M, Morales A, Martínez-Zabaleta M, Ayo-Martín Ó, Lizán L, Castellanos M. Characteristics of stroke units and stroke teams in Spain in 2018. Pre2Ictus project. Neurologia 2020; 38:S0213-4853(20)30222-X. [PMID: 32917435 DOI: 10.1016/j.nrl.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/18/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The aim of this work is to describe the characteristics of stroke units and stroke teams in Spain. METHOD We performed a cross-sectional study based on an ad hoc questionnaire designed by 5 experts and addressed to neurologists leading stroke units/teams that had been operational for ≥ 1 year. RESULTS The survey was completed by 43 stroke units (61% of units in Spain) and 14 stroke teams. The mean (SD) number of neurologists assigned to each unit/team is 4±3. 98% of stroke units (and 38% of stroke teams) have a neurologist on-call available 24hours, 365 days. 98% of stroke units (79% of stroke teams) have specialised nurse, 95% of units (71% of stroke teams) auxiliary personnel, 86% of units (71% of stroke teams) social worker, 81% of stroke units (71% of stroke teams) have a rehabilitation physician and 81% of stroke units (86% of stroke teams) a physiotherapist. Most stroke units (80%) have 4-6 beds with continuous non-invasive monitoring. The mean number of unmonitored beds is 14 (8) for stroke units and 12 (7) for stroke teams. The mean duration of non-invasive monitoring is 3 (1) days. All stroke units and 86% of stroke teams have intravenous thrombolysis available, and 81% of stroke units and 21% of stroke teams are able to perform mechanical thrombectomy, whereas the remaining centres have referral pathways in place. Telestroke systems are available at 44% of stroke units, providing support to a mean of 4 (3) centres. Activity is recorded in clinical registries by 77% of stroke units and 50% of stroke teams, but less than 75% of data is completed in 25% of cases. CONCLUSIONS Most stroke units/teams comply with the current recommendations. The systematic use of clinical registries should be improved to further improve patient care.
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Affiliation(s)
- M Alonso de Leciñana
- Servicio de Neurología, Centro de Ictus, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, España.
| | - A Morales
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - M Martínez-Zabaleta
- Servicio de Neurología, Hospital Universitario de Donostia, San Sebastián, España
| | - Ó Ayo-Martín
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - L Lizán
- Outcomes'10 SLU, Castellón, España; Departamento de Medicina, Universitat Jaume I, Castellón, España
| | - M Castellanos
- Servicio de Neurología, Hospital Universitario e Instituto de Investigación Biomédica, La Coruña, España
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Analysis of cerebrovascular disease mortality trends in Andalusia (1980–2014). NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Li C, Xu X, Zhou G, He K, Qi T, Zhang W, Tian F, Zheng Q, Hu J. Implementation of National Health Informatization in China: Survey About the Status Quo. JMIR Med Inform 2019; 7:e12238. [PMID: 30789350 PMCID: PMC6403529 DOI: 10.2196/12238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/06/2018] [Accepted: 12/09/2018] [Indexed: 01/25/2023] Open
Abstract
Background The National Health and Family Planning Commission (NHFPC) in China organized a nationwide survey to investigate the informatization in hospitals and regional Health and Family Planning Commissions (HFPCs) in 2017. The survey obtained valid results from 79.69% (2021/2536) of major hospitals and 81% (26/32) of provincial and 73.1% (307/420) of municipal HFPCs. The investigated topics covered hardware infrastructure, information resources, applications, systems, and organizations in health informatics. Objective This study aimed to provide evidence collected from the survey regarding China’s health informatization and assist policy making regarding health informatics in the 13th Five-Year Plan of China. Methods Based on the survey, the paper presented the status quo of China’s health informatization and analyzed the progress and potential problems in terms of the country’s health information development policies. Results Related policies have helped to construct 4-level information platforms and start converging the regional data to the 3 centralized databases. The principle of informatics has been transiting from finance-centered to people-centered. Alternatively, the quality, usability, and interoperability of the data still need to be improved. Conclusions The nationwide survey shows that China’s health informatization is rapidly developing. Current information platforms and databases technically support data exchanging between all provinces and cities. As China is continuing to improve the infrastructure, more advanced applications are being developed upon it.
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Affiliation(s)
- Chen Li
- School of Electronic and Information Engineering, Xi'an Jiaotong University, Xi'an, China.,Shanxi Province Key Laboratory of Satellite and Terrestrial Network Technology Research and Development, Xi'an Jiaotong University, Xi'an, China
| | - Xiangdong Xu
- Department of Information Technology, Center of Statistics and Health Informatics, National Health Commission of People's Republic of China, Beijing, China
| | - Guanghua Zhou
- Department of Information Technology, Center of Statistics and Health Informatics, National Health Commission of People's Republic of China, Beijing, China
| | - Kai He
- School of Electronic and Information Engineering, Xi'an Jiaotong University, Xi'an, China.,Shanxi Province Key Laboratory of Satellite and Terrestrial Network Technology Research and Development, Xi'an Jiaotong University, Xi'an, China
| | - Tianliang Qi
- School of Electronic and Information Engineering, Xi'an Jiaotong University, Xi'an, China.,Shanxi Province Key Laboratory of Satellite and Terrestrial Network Technology Research and Development, Xi'an Jiaotong University, Xi'an, China
| | - Wei Zhang
- College of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Tian
- School of Electronic and Information Engineering, Xi'an Jiaotong University, Xi'an, China.,Shanxi Province Key Laboratory of Satellite and Terrestrial Network Technology Research and Development, Xi'an Jiaotong University, Xi'an, China
| | - Qinghua Zheng
- School of Electronic and Information Engineering, Xi'an Jiaotong University, Xi'an, China.,Shanxi Province Key Laboratory of Satellite and Terrestrial Network Technology Research and Development, Xi'an Jiaotong University, Xi'an, China
| | - Jianping Hu
- Department of Information Technology, Center of Statistics and Health Informatics, National Health Commission of People's Republic of China, Beijing, China
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Cayuela A, Cayuela L, Rodríguez-Domínguez S, González A, Moniche F. Analysis of cerebrovascular disease mortality trends in Andalusia (1980-2014). Neurologia 2017; 34:309-317. [PMID: 28318728 DOI: 10.1016/j.nrl.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/14/2016] [Accepted: 12/23/2016] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION In recent decades, mortality rates for cerebrovascular diseases (CVD) have decreased significantly in many countries. This study analyses recent tendencies in CVD mortality rates in Andalusia (1980-2014) to identify any changes in previously observed sex and age trends. PATIENTS AND METHODS CVD mortality and population data were obtained from Spain's National Statistics Institute database. We calculated age-specific and age-standardised mortality rates using the direct method (European standard population). Joinpoint regression analysis was used to estimate the annual percentage change in rates and identify significant changes in mortality trends. We also estimated rate ratios between Andalusia and Spain. RESULTS Standardised rates for both males and females showed 3 periods in joinpoint regression analysis: an initial period of significant decline (1980-1997), a period of rate stabilisation (1997-2003), and another period of significant decline (2003-2014). CONCLUSIONS Between 1997 and 2003, age-standardised rates stabilised in Andalusia but continued to decrease in Spain as a whole. This increased in the gap between CVD mortality rates in Andalusia and Spain for both sexes and most age groups.
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Affiliation(s)
- A Cayuela
- Unidad de Gestión Clínica de Salud Pública, Prevención y Promoción de la Salud, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, España.
| | - L Cayuela
- Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - S Rodríguez-Domínguez
- Unidad de Gestión Clínica Pino Montano A, Distrito Sanitario Sevilla, Sevilla, España
| | - A González
- Servicio de Neurorradiología Intervencionista, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F Moniche
- Unidad de Ictus, Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Análisis de recursos asistenciales para el ictus en España en 2012: ¿beneficios de la Estrategia del Ictus del Sistema Nacional de Salud? Neurologia 2014; 29:387-96. [DOI: 10.1016/j.nrl.2013.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/10/2013] [Accepted: 06/17/2013] [Indexed: 11/22/2022] Open
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9
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Analysis of stroke care resources in Spain in 2012: Have we benefitted from the Spanish Health System's stroke care strategy? NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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de Andrés-Nogales F, Vivancos Mora J, Barriga Hernández FJ, Díaz Otero F, Izquierdo Esteban L, Ortega-Casarrubios MÁ, Castillo Moreno L, Ximénez-Carrillo Rico Á, Martín Torres MP, Gómez-Escalonilla Escobar CI, Torres González C, de Salas-Cansado M, Casado Gómez MÁ, Soto Álvarez J, Gil-Núñez A. Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study. Neurologia 2014; 30:536-44. [PMID: 25066492 DOI: 10.1016/j.nrl.2014.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/21/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. METHODS A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. RESULTS During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. CONCLUSIONS Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation.
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Affiliation(s)
- F de Andrés-Nogales
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España.
| | - J Vivancos Mora
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, España
| | | | - F Díaz Otero
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Izquierdo Esteban
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | | | | | - Á Ximénez-Carrillo Rico
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, España
| | | | | | - C Torres González
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - M de Salas-Cansado
- Departamento de Investigación de Resultados en Salud y Farmacoeconomía, Pfizer S. L. U., Alcobendas, Madrid, España
| | - M Á Casado Gómez
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - J Soto Álvarez
- Departamento de Investigación de Resultados en Salud y Farmacoeconomía, Pfizer S. L. U., Alcobendas, Madrid, España
| | - A Gil-Núñez
- Hospital General Universitario Gregorio Marañón, Madrid, España
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Portilla-Cuenca J, Ramírez-Moreno J, López-Espuela F, Romero-Sevilla R, Jiménez-Caballero P, Fermín-Marrero J, Falcón-García A, Gámez-Leyva G, Castellano-Fernández F, Calle-Escobar M, Gavilán-Iglesias T, Gómez-Gutiérrez M, Serrano-Cabrera A, Casado-Naranjo I. Functional outcome of stroke and the cumulative experience of a stroke unit. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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12
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Rodríguez Cruz P, Pérez Sánchez J, Cuello J, Sobrino García P, Vicente Peracho G, García Arratibel A, Sánchez Guzmán D, Bravo Quelle N, Gutiérrez Ruano B, Alarcón Morcillo C, Cordido Henríquez F, Romero Delgado F, Muñoz González A, Domínguez Rubio R, Iglesias Mohedano A, Martín Barriga M, de la Casa Fages B, Díaz Otero F, Ezpeleta D, García Pastor A, Gil Núñez A. Workload of on-call emergency room neurologists in a Spanish tertiary care centre. A one-year prospective study. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Portilla-Cuenca JC, Ramírez-Moreno JM, López-Espuela F, Romero-Sevilla RM, Jiménez-Caballero PE, Fermín-Marrero JA, Falcón-García A, Gámez-Leyva G, Castellano-Fernández F, Calle-Escobar ML, Gavilán-Iglesias T, Gómez-Gutiérrez M, Serrano-Cabrera A, Casado-Naranjo I. Functional outcome of stroke and the cumulative experience of a stroke unit. Neurologia 2013; 29:271-9. [PMID: 24139388 DOI: 10.1016/j.nrl.2013.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Patients with acute stroke are more likely to survive and achieve independence if they are treated in a stroke unit. Available information in our setting is scarce. We analyse the outcomes of our patients on the basis of cumulative experience in a stroke unit. PATIENTS AND METHODS A retrospective cohort study of patients admitted to a stroke unit. We differentiate between two groups according to the year of admission: group A (July 2007-December 2009) and group B (January 2010-December 2011), analysing early outcome based on the score on the National Institute of Health stroke scale and mortality at discharge, and medium-term outcome in terms of mortality and functional status according to the modified Rankin scale at three months. RESULTS A total 1070 patients were included. There were no differences between groups with respect to favourable outcome (68.3% vs 63.9), hospital mortality (5.1% vs 6.6%), or 90-day mortality (12.8% vs 13.1%). The percentage of patients who were independent at 90 days was greater in group B (56.3% vs 65.5%, P=.03). In the multivariate analysis adjusted for stroke subtype and fibrinolytic therapy, the association between patient independence and admission period remained present. CONCLUSIONS The probability of functional independence in our patients increased alongside accumulated experience in our stroke unit with no differences in mortality.
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Affiliation(s)
- J C Portilla-Cuenca
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - J M Ramírez-Moreno
- Equipo de Ictus, Sección de Neurología, Hospital Universitario Infanta Cristina, Badajoz, España
| | - F López-Espuela
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - R M Romero-Sevilla
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - P E Jiménez-Caballero
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - J A Fermín-Marrero
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - A Falcón-García
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - G Gámez-Leyva
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | | | - M L Calle-Escobar
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - T Gavilán-Iglesias
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - M Gómez-Gutiérrez
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - A Serrano-Cabrera
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España
| | - I Casado-Naranjo
- Unidad de Ictus, Sección de Neurología, Hospital San Pedro de Alcántara, Cáceres, España.
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Workload of on-call emergency room neurologists in a Spanish tertiary care centre. A one-year prospective study. Neurologia 2013; 29:193-9. [PMID: 23969294 DOI: 10.1016/j.nrl.2013.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/25/2013] [Accepted: 04/10/2013] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Population ageing, the rising demand for healthcare, and the establishment of acute stroke treatment programs have given rise to increases in the number and complexity of neurological emergency cases. Nevertheless, many centres in Spain still lack on-call emergency neurologists. METHODS We conducted a retrospective study to describe the role of on-call neurologists at Hospital General Universitario Gregorio Marañón, a tertiary care centre in Madrid, Spain. Sociodemographic characteristics, most common pathologies, diagnostic tests, and destination of the patients attended were recorded daily using a computer database. Results were compared with the general care data from the emergency department. RESULTS The team attended 3234 patients (3.48% of the emergency department total). The mean number of patients seen per day was 11.15. The most frequent pathologies were stroke (34%), epilepsy (16%) and headache (8%). The mean stay in the emergency department was 7.17 hours. Hospital admission rate was 40% (7.38% of emergency hospital admissions). The main destinations for admitted patients were the stroke unit (39.5%) and the neurology department (33%). Endovascular or thrombolytic therapies were performed on 76 occasions. Doctors attended 70% of the patients during on-call hours. CONCLUSIONS Emergency neurological care is varied, complex, and frequently necessary. Neurological cases account for a sizeable percentage of both patient visits to the emergency room and the total number of emergency admissions. The current data confirm that on-call neurologists available on a 24-hour basis are needed in emergency departments.
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Félix-Redondo F, Consuegra-Sánchez L, Ramírez-Moreno J, Lozano L, Escudero V, Fernández-Bergés D. Ischemic stroke mortality tendency (2000–2009) and prognostic factors. ICTUS Study-Extremadura (Spain). Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Félix-Redondo F, Consuegra-Sánchez L, Ramírez-Moreno J, Lozano L, Escudero V, Fernández-Bergés D. Tendencia de la mortalidad por ictus isquémico (2000-2009) y factores pronósticos. Estudio ICTUS-Extremadura. Rev Clin Esp 2013; 213:177-85. [DOI: 10.1016/j.rce.2013.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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17
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Impact of introducing neurology into a local hospital in Andalusia. Neurologia 2012; 27:400-6. [PMID: 22326997 DOI: 10.1016/j.nrl.2011.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/09/2011] [Accepted: 12/17/2011] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION The stroke mortality rate in Andalusia is twice that of other autonomous communities. This could be associated with the absence of neurologists in most local hospitals in this community, unlike in the rest of Spain. The objective of this study was to evaluate the impact of incorporating a neurologist to evaluate and monitor stroke patients in a local hospital in Andalusia. METHODS An observational study was conducted on stroke cases admitted in the first quarter of 2006. Quality indicators, mortality rates, and incapacity rates at follow-up were analysed, comparing groups with and without neurological care. RESULTS A total of 116 stroke patients were admitted. There were significant differences in tests performed to diagnose patients (Doppler and echocardiography). The mean hospital stay was significantly lower with neurology care. There was a 39.1% absolute decrease in mortality and a 35.7% absolute increase in capacity for daily life activities was also observed. Neurological care and a lower incapacity level at admission were the only two factors independently associated with a decrease in length of hospital stay and mortality CONCLUSION Specialised care by a neurologist is effective in reducing length of hospital stay, mortality and incapacity. The incorporation of neurologists in local hospitals in Andalusia should be a priority to guarantee equal care in all autonomous communities in Spain. This objective should be included in the Plan Andaluz de Atención al Ictus as a first step in forming a network of stroke units and teams.
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Impact of introducing neurology into a local hospital in Andalusia. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2012.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Serna-Candel C, Matías-Guiu J. From the evidence to the organisation of stroke care. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/j.nrleng.2011.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Stroke care in Spain. What do we have? What do we need? NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/j.nrleng.2011.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Díez-Tejedor E, Fuentes B. Situación asistencial del ictus en España. ¿Qué tenemos? ¿Qué nos falta? Neurologia 2011; 26:445-8. [DOI: 10.1016/j.nrl.2011.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 01/10/2011] [Indexed: 10/17/2022] Open
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Serna-Candel C, Matías-Guiu J. [From the evidence to the organisation of stroke care]. Neurologia 2011; 26:507-9. [PMID: 21549455 DOI: 10.1016/j.nrl.2011.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 01/07/2011] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION Acute stroke care in stroke units (SU) compared to care in general medicine wards provides benefits to the patient. DEVELOPMENT Acute stroke care in an SU has shown benefits in reducing mortality, institutionalisation, dependency and costs compared to care in internal medicine wards, and even a lower risk of recurrence in the long term. The benefits are associated with specific treatments developed in the SU, such as thrombolytic therapy, development of clinical pathways, standardised procedures, and training and experience of professionals in the SU. This evidence should lead to the proper organisation of hospitals to ensure that all acute stroke patients may benefit from care in an SU. The introduction of SUs is a priority in Europe, although the number of stroke patients admitted to SUs is still low. CONCLUSIONS Based on current evidence, acute stroke patients should be cared for in an SU due to the associated clinical benefits and hospitals should organise to provide this care to patients.
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