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Gorgui J, Gorshkov M, Khan N, Daskalopoulou SS. Hypertension as a Risk Factor for Ischemic Stroke in Women. Can J Cardiol 2014; 30:774-82. [DOI: 10.1016/j.cjca.2014.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/12/2014] [Accepted: 01/13/2014] [Indexed: 12/24/2022] Open
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2
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Zahuranec DB, Lisabeth LD, Sánchez BN, Smith MA, Brown DL, Garcia NM, Skolarus LE, Meurer WJ, Burke JF, Adelman EE, Morgenstern LB. Intracerebral hemorrhage mortality is not changing despite declining incidence. Neurology 2014; 82:2180-6. [PMID: 24838789 DOI: 10.1212/wnl.0000000000000519] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study. METHODS We identified all cases of spontaneous ICH in a South Texas community from 2000 to 2010 using rigorous case ascertainment methods within the Brain Attack Surveillance in Corpus Christi Project. Yearly population counts were determined from the US Census, and deaths were determined from state and national databases. Age-, sex-, and ethnicity-adjusted incidence was estimated for each year with Poisson regression, and a linear trend over time was investigated. Trends in 30-day case fatality and long-term mortality (censored at 3 years) were estimated with log-binomial or Cox proportional hazards models adjusted for demographics, stroke severity, and comorbid disease. RESULTS A total of 734 cases of ICH were included. The age-, sex-, and ethnicity-adjusted ICH annual incidence rate was 5.21 per 10,000 (95% confidence interval [CI] 4.36, 6.24) in 2000 and 4.30 per 10,000 (95% CI 3.21, 5.76) in 2010. The estimated 10-year change in demographic-adjusted ICH annual incidence rate was -31% (95% CI -47%, -11%). Yearly demographic-adjusted 30-day case fatality ranged from 28.3% (95% CI 19.9%, 40.3%) in 2006 to 46.5% (95% CI 35.5, 60.8) in 2008. There was no change in ICH case fatality or long-term mortality over time. CONCLUSIONS ICH incidence decreased over the past decade, but case fatality and long-term mortality were unchanged. This suggests that primary prevention efforts may be improving over time, but more work is needed to improve ICH treatment and reduce the risk of death.
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Affiliation(s)
- Darin B Zahuranec
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor.
| | - Lynda D Lisabeth
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Brisa N Sánchez
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Melinda A Smith
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Devin L Brown
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Nelda M Garcia
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Lesli E Skolarus
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - William J Meurer
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - James F Burke
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Eric E Adelman
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
| | - Lewis B Morgenstern
- From the Stroke Program, Department of Neurology (D.B.Z., L.D.L., B.N.S., M.A.S., D.L.B., N.M.G., L.E.S., W.J.M., J.F.B., E.E.A., L.B.M.), and Department of Emergency Medicine (W.J.M., L.B.M.), University of Michigan Medical School; and the Departments of Epidemiology (L.D.L., L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor
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Abstract
Diabetes is a condition of accelerated vascular aging. Patients with diabetes have approximately twice the risk of stroke compared to nondiabetics. Hyperglycemia is a strong risk factor for poor outcome after stroke, but it may be simply a marker of poor outcome rather than a cause. Glucose lowering has not been shown to be associated with improved prognosis. Similarly, long-term prevention of stroke risk among diabetic patients is not improved with glucose-lowering therapies. Stroke prevention and treatment remains generic among diabetic patients. The future, however, may be brighter, with multiple new agents recently available. We await the outcome of these agents on macrovascular complications such as stroke.
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Affiliation(s)
- Michael D Hill
- Stroke Unit, Foothills Hospital, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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4
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Doonan RJ, Dawson AJ, Kyriacou E, Nicolaides AN, Corriveau MM, Steinmetz OK, Mackenzie KS, Obrand DI, Daskalopoulos ME, Daskalopoulou SS. Association of ultrasonic texture and echodensity features between sides in patients with bilateral carotid atherosclerosis. Eur J Vasc Endovasc Surg 2013; 46:299-305. [PMID: 23849798 DOI: 10.1016/j.ejvs.2013.05.024] [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: 12/27/2012] [Accepted: 05/20/2013] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Our objective was to estimate the correlation of echodensity and textural features, using ultrasound and digital image analysis, between plaques in patients with bilateral carotid stenosis. DESIGN Cross-sectional observational study. METHODS Patients undergoing carotid endarterectomy were recruited from Vascular Surgery at the Royal Victoria and Jewish General hospitals in Montreal, Canada. Bilateral pre-operative carotid ultrasound and digital image analysis was performed to extract echodensity and textural features using a commercially available Plaque Texture Analysis software (LifeQMedical Ltd). Principal component analysis (PCA) was performed. Partial correlation coefficients for PCA and individual imaging variables between surgical and contralateral plaques were calculated with adjustment for age, sex, contralateral stenosis, and statin use. RESULTS In the whole group (n = 104), the six identified PCA variables and 42/50 individual imaging variables were moderately correlated (r = .211-.641). Correlations between sides were increased in patients with ≥50% contralateral stenosis and symptomatic patients. CONCLUSION Textural and echodensity features of carotid plaques were similar between two sides in patients with bilateral stenosis, supporting the notion that plaque instability is determined by systemic factors. Patients with unstable features of one plaque should perhaps be monitored more closely or treated more aggressively for their contralateral stenosis, particularly if this is hemodynamically significant.
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Affiliation(s)
- R J Doonan
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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5
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Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJB, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:870-947. [PMID: 23370205 DOI: 10.1161/str.0b013e318284056a] [Citation(s) in RCA: 3227] [Impact Index Per Article: 293.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. METHODS Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. RESULTS The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. CONCLUSIONS Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.
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6
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Smolderen KG, Bell A, Lei Y, Cohen EA, Steg PG, Bhatt DL, Mahoney EM. One-year costs associated with cardiovascular disease in Canada: Insights from the REduction of Atherothrombosis for Continued Health (REACH) registry. Can J Cardiol 2010; 26:297-305. [PMID: 20931098 PMCID: PMC2954538 DOI: 10.1016/s0828-282x(10)70437-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 04/11/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To provide a contemporary estimate of the economic burden of atherothrombosis in Canada, annual cardiovascular-related hospitalizations, medication use and associated costs across the entire spectrum of atherothrombotic disease were examined. METHODS The REduction of Atherothrombosis for Continued Health (REACH) registry enrolled 1964 Canadian outpatients with coronary artery disease, cerebrovascular disease or peripheral arterial disease (PAD), or three or more cardiovascular risk factors. Baseline data on cardiovascular risk factors and associated medication use, and one-year follow-up data on cardiovascular events, hospitalizations, procedures and medication use were collected. Annual hospitalization and medication costs (Canadian dollars) were derived and compared among patients according to the presence of established atherothrombotic disease at baseline, specific arterial beds affected and the number of affected arterial beds. RESULTS Average annualized medication costs were $1,683, $1,523 and $1,776 for patients with zero, one, and two or three symptomatic arterial beds, respectively. Average annual hospitalization costs increased significantly with the number of beds affected ($380, $1,403 and $3,465, respectively; P<0.0001 for overall linear trend). Mean hospitalization costs for patients with any coronary artery disease, any cerebrovascular disease and any PAD were $1,743, $1,823 and $4,677, respectively. After adjusting for other clinical factors, PAD at baseline was independently associated with a significant increase in hospitalization costs. CONCLUSION Costs associated with vascular-related hospitalizations and interventions for Canadian patients increased with the number of affected arterial beds, and were particularly high for patients with PAD and⁄or polyvascular disease. These contemporary data provide insight into the economic burden associated with atherothrombotic disease in Canada, and highlight the need for increased preventive strategies to lessen the burden for patients and society.
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Affiliation(s)
- Kim G Smolderen
- Mid America Heart Institute of Saint Luke’s Hospital, Kansas City, Missouri, USA
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
| | | | - Yang Lei
- Mid America Heart Institute of Saint Luke’s Hospital, Kansas City, Missouri, USA
| | - Eric A Cohen
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | | | - Deepak L Bhatt
- VA Boston Healthcare System and Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Elizabeth M Mahoney
- Mid America Heart Institute of Saint Luke’s Hospital, Kansas City, Missouri, USA
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7
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Coelho FMS, Santos BFCD, Cendoroglo Neto M, Lisboa LF, Cypriano AS, Lopes TO, Miranda MJD, Avila AMH, Alonso JB, Pinto HS. Temperature variation in the 24 hours before the initial symptoms of stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:242-5. [PMID: 20464293 DOI: 10.1590/s0004-282x2010000200017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 11/03/2009] [Indexed: 11/22/2022]
Abstract
UNLABELLED A few studies have performed to evaluate the temperature variation influences over on the stroke rates in Brazil. METHOD 176 medical records of inpatients were analyzed after having had a stroke between 2004 and 2006 at Hospital Israelita Albert Einstein. The temperature preceding the occurrence of the symptoms was recorded, as well as the temperature 6, 12 and 24 hours before the symptoms in 6 different weather substations, closest to their houses in São Paulo. RESULTS Strokes occurred more frequently after a variation of 3 C between 6 and 24 hours before the symptoms. There were most hospitalizations between 23-24 C. CONCLUSION Incidence of stroke on these patients was increased after a variation of 3 masculine Celsius within 24 hours before the ictus. The temperature variations could be an important factor in the occurrence of strokes in this population.
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Summers D, Leonard A, Wentworth D, Saver JL, Simpson J, Spilker JA, Hock N, Miller E, Mitchell PH. Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient. Stroke 2009; 40:2911-44. [DOI: 10.1161/strokeaha.109.192362] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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9
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van der Velde G, Hogg-Johnson S, Bayoumi AM, Cassidy JD, Côté P, Boyle E, Llewellyn-Thomas H, Chan S, Subrata P, Hoving JL, Hurwitz E, Bombardier C, Krahn M. Identifying the best treatment among common nonsurgical neck pain treatments: a decision analysis. J Manipulative Physiol Ther 2009; 32:S209-18. [PMID: 19251067 DOI: 10.1016/j.jmpt.2008.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
STUDY DESIGN Decision analysis. OBJECTIVE To identify the best treatment for nonspecific neck pain. SUMMARY OF BACKGROUND DATA In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects. METHODS (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decisionanalytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial. RESULTS There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days. CONCLUSION When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.
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10
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Zhu HF, Newcommon NN, Cooper ME, Green TL, Seal B, Klein G, Weir NU, Coutts SB, Watson T, Barber PA, Demchuk AM, Hill MD. Impact of a Stroke Unit on Length of Hospital Stay and In-Hospital Case Fatality. Stroke 2009; 40:18-23. [DOI: 10.1161/strokeaha.108.527606] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hai Feng Zhu
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Nancy N. Newcommon
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Mary Elizabeth Cooper
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Teri L. Green
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Barbara Seal
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Gary Klein
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Nicolas U. Weir
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Shelagh B. Coutts
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Tim Watson
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Philip A. Barber
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Andrew M. Demchuk
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
| | - Michael D. Hill
- From Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. All authors are affiliated with the Calgary Stroke Program, a partnership between the Department of Clinical Neurosciences, Calgary Health Region and the Hotchkiss Brain Institute, University of Calgary
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Lindsay P, Bayley M, McDonald A, Graham ID, Warner G, Phillips S. Toward a more effective approach to stroke: Canadian Best Practice Recommendations for Stroke Care. CMAJ 2008; 178:1418-25. [PMID: 18490636 DOI: 10.1503/cmaj.071253] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Each year more than 50,000 Canadians experience a stroke and more than 300,000 currently live with its effects. Despite the evidence supporting best practices in stroke care, significant gaps in translating this knowledge into action remains in Canada. An interdisciplinary working group of the Canadian Stroke Strategy was formed to develop best-practice recommendations relevant to Canadian health care. The working group used a rigorous process to develop the guidelines, which included reviewing existing stroke recommendations and research literature, and consulting a national interprofessional consensus panel. The Canadian Best Practice Recommendations for Stroke Care consist of 24 recommendations based on the strongest evidence and address topics that span the full continuum of stroke care. Implementation and dissemination of these recommendations is in progress. Bringing about change will require political will and collaboration throughout the health care system.
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12
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van der Velde G, Hogg-Johnson S, Bayoumi AM, Cassidy JD, Côté P, Boyle E, Llewellyn-Thomas H, Chan S, Subrata P, Hoving JL, Hurwitz E, Bombardier C, Krahn M. Identifying the Best Treatment Among Common Nonsurgical Neck Pain Treatments. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008. [DOI: 10.1007/s00586-008-0635-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Identifying the best treatment among common nonsurgical neck pain treatments: a decision analysis. Spine (Phila Pa 1976) 2008; 33:S184-91. [PMID: 18204391 DOI: 10.1097/brs.0b013e31816454f8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Decision analysis. OBJECTIVE To identify the best treatment for nonspecific neck pain. SUMMARY OF BACKGROUND DATA In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects. METHODS (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decision-analytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial. RESULTS There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days. CONCLUSION When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.
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Fang J, Alderman MH, Keenan NL, Croft JB. Declining US Stroke Hospitalization since 1997: National Hospital Discharge Survey, 1988–2004. Neuroepidemiology 2008; 29:243-9. [DOI: 10.1159/000112857] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EFM. Guidelines for the Early Management of Adults With Ischemic Stroke. Circulation 2007; 115:e478-534. [PMID: 17515473 DOI: 10.1161/circulationaha.107.181486] [Citation(s) in RCA: 657] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose—
Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included.
Methods—
Members of the panel were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council’s Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years.
Results—
Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.
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Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EFM. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007; 38:1655-711. [PMID: 17431204 DOI: 10.1161/strokeaha.107.181486] [Citation(s) in RCA: 1513] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. METHODS Members of the panel were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council's Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years. RESULTS Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.
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Laupland KB, Gregson DB, Flemons WW, Hawkins D, Ross T, Church DL. Burden of community-onset bloodstream infection: a population-based assessment. Epidemiol Infect 2006; 135:1037-42. [PMID: 17156500 PMCID: PMC2870648 DOI: 10.1017/s0950268806007631] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although community-onset bloodstream infection (BSI) is recognized to be a major cause of morbidity and mortality, there is a paucity of population-based studies defining its overall burden. We conducted population-based laboratory surveillance for all community-onset BSI in the Calgary Health Region during 2000-2004. A total of 4467 episodes of community-onset BSI were identified for an overall annual incidence of 81.6/100,000. The three species, Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae were responsible for the majority of community-onset BSI; they occurred at annual rates of 25.8, 13.5, and 10.1/100,000, respectively. Overall 3445/4467 (77%) episodes resulted in hospital admission representing 0.7% of all admissions to major acute care hospitals. The subsequent hospital length of stay was a median of 9 (interquartile range, 5-15) days; the total days of acute hospitalization attributable to community-onset BSI was 51,146 days or 934 days/100,000 annually. Four hundred and sixty patients died in hospital for a case-fatality rate of 13%. Community-onset BSI is common and has a major patient and societal impact. These data support further efforts to reduce the burden of community-onset BSI.
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Affiliation(s)
- K B Laupland
- Department of Medicine, University of Calgary, and Calgary Health Region, Alberta, Canada.
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Yang Q, Botto LD, Erickson JD, Berry RJ, Sambell C, Johansen H, Friedman JM. Improvement in stroke mortality in Canada and the United States, 1990 to 2002. Circulation 2006; 113:1335-43. [PMID: 16534029 DOI: 10.1161/circulationaha.105.570846] [Citation(s) in RCA: 246] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In the United States and Canada, folic acid fortification of enriched grain products was fully implemented by 1998. The resulting population-wide reduction in blood homocysteine concentrations might be expected to reduce stroke mortality if high homocysteine levels are an independent risk factor for stroke. METHODS AND RESULTS In this population-based cohort study with quasi-experimental intervention, we used segmented log-linear regression to evaluate trends in stroke-related mortality before and after folic acid fortification in the United States and Canada and, as a comparison, during the same period in England and Wales, where fortification is not required. Average blood folate concentrations increased and homocysteine concentrations decreased in the United States after fortification. The ongoing decline in stroke mortality observed in the United States between 1990 and 1997 accelerated in 1998 to 2002 in nearly all population strata, with an overall change from -0.3% (95% CI, -0.7 to 0.08) to -2.9 (95% CI, -3.5 to -2.3) per year (P=0.0005). Sensitivity analyses indicate that changes in other major recognized risk factors are unlikely to account for the reduced number of stroke-related deaths in the United States. The fall in stroke mortality in Canada averaged -1.0% (95% CI, -1.4 to -0.6) per year from 1990 to 1997 and accelerated to -5.4% (95% CI, -6.0 to -4.7) per year in 1998 to 2002 (P< or =0.0001). In contrast, the decline in stroke mortality in England and Wales did not change significantly between 1990 and 2002. CONCLUSIONS The improvement in stroke mortality observed after folic acid fortification in the United States and Canada but not in England and Wales is consistent with the hypothesis that folic acid fortification helps to reduce deaths from stroke.
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Affiliation(s)
- Quanhe Yang
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Kokotailo RA, Hill MD. Coding of stroke and stroke risk factors using international classification of diseases, revisions 9 and 10. Stroke 2005; 36:1776-81. [PMID: 16020772 DOI: 10.1161/01.str.0000174293.17959.a1] [Citation(s) in RCA: 555] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Surveillance is necessary to understand and meet the future demands stroke will place on health care. Administrative data are the most accessible data source for stroke surveillance in Canada. The International Classification of Diseases, 10th revision (ICD-10) coding system has potential improvements over ICD-9 for stroke classification. Our purpose was to compare hospital discharge abstract coding using ICD-9 and ICD-10 for stroke and its risk factors. METHODS We took advantage of a switch in coding systems from ICD-9 to ICD-10 to independently review stroke patient charts. From time periods April 2000 to March 2001, 717 charts, and from April 2002 to March 2003, 249 charts were randomly selected for review. Using a before-and-after time period design, the accuracy of hospital coding of stroke (part I) and stroke risk factors (part II) using ICD-9 and ICD-10 was compared. We used careful definitions of stroke and its types based on ICD-9 using the fourth and fifth digit modifier codes. RESULTS Stroke coding was equally good with ICD-9 (90% [CI95 86 to 93] correct) and ICD-10 [92% (CI95 88 to 95 correct) with ICD-10. There were some differences in coding by stroke type, notably with transient ischemic attack, but these differences were not statistically significant. Atrial fibrillation, coronary artery disease/ischemic heart disease, diabetes mellitus, and hypertension were coded with high sensitivity (81% to 91%) and specificity (83% to 100%). ICD-10 was as good as ICD-9 for stroke risk factor coding. CONCLUSIONS Passive surveillance using administrative data are a useful tool for identifying stroke and its risk factors using both ICD-9 and ICD-10.
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Affiliation(s)
- Rae A Kokotailo
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Alberta, Canada
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Hill MD, Buchan AM. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ 2005; 172:1307-12. [PMID: 15883405 PMCID: PMC557101 DOI: 10.1503/cmaj.1041561] [Citation(s) in RCA: 320] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Thrombolysis for acute ischemic stroke has remained controversial. The Canadian Alteplase for Stroke Effectiveness Study, a national prospective cohort study, was conducted to assess the effectiveness of alteplase therapy for ischemic stroke in actual practice. METHODS The study was mandated by the federal government as a condition of licensure of alteplase for the treatment of stroke in Canada. A registry was established to collect data over 2.5 years for stroke patients receiving such treatment from Feb. 17, 1999, through June 30, 2001. All centres capable of administering thrombolysis therapy according to Canadian guidelines were eligible to submit patient data to the registry. Data collection was prospective, and follow-up was completed at 90 days after stroke. Copies of head CT scans obtained at baseline and at 24-48 hours after the start of treatment were submitted to a central panel for review. RESULTS A total of 1135 patients were enrolled at 60 centres in all major hospitals across Canada. The registry collected data for an estimated 84% of all treated ischemic stroke patients in the country. An excellent clinical outcome was observed in 37% of the patients. Symptomatic intracranial hemorrhage occurred in only 4.6% of the patients (95% confidence interval [CI] 3.4%-6.0%); however, 75% of these patients died in hospital. An additional 1.3% (95% CI 0.7%-2.2%) of patients had hemiorolingual angioedema. CONCLUSIONS The outcomes of stroke patients undergoing thrombolysis in Canada are commensurate with the results of clinical trials. The rate of symptomatic intracranial hemorrhage was low. Stroke thrombolysis is a safe and effective therapy in actual practice.
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Affiliation(s)
- Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alta
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