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Liu J, Wang Y, Li J, Zhang S, Wu Q, Wei C, Cui T, Wu B, Willey JZ, Liu M. Treatment and Outcomes of Thrombolysis Related Hemorrhagic Transformation: A Multi-Center Study in China. Front Aging Neurosci 2022; 14:847648. [PMID: 35462687 PMCID: PMC9021791 DOI: 10.3389/fnagi.2022.847648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To investigate the current management of thrombolysis related hemorrhagic transformation (HT) in real-world practice, and whether these treatments would reduce the risk of 3-month death and hematoma expansion after HT. Methods A multicenter retrospective study was performed in three comprehensive stroke centers in China (West China Hospital, The First People’s Hospital of Ziyang, and Mianyang Central Hospital) between January 1st 2012 and December 31th 2020. Participants were patients diagnosed with HT after intravenous thrombolytics on brain computed tomography (CT) within 36 h after stroke onset. The treatment after thrombolysis related HT included aggressive therapy (procoagulant, neurosurgical treatment) and dehydration therapy (mannitol or glycerin and fructose). The primary clinical outcome was 3-month death. The primary radiographic outcome was hematoma expansion, defined as a 33% increase in the hematoma volume using the (A × B × C)/2 method on follow-up imaging. Results Of 538 patients with ischemic stroke receiving thrombolysis included during the study period, 94 patients (17.4%) were diagnosed with HT, 50% (47/94) of whom were symptomatic HT. The 3-month death was 31.5% (29/92), with two patients having been lost to follow up. A total of 68 patients (72.3%) had follow-up brain CT scans after HT detection for evaluating hematoma expansion, of whom 14.7% (10/68) had hematoma expansion. Among the 10 patients with hematoma expansion, 7 patients were from symptomatic HT group, and 3 patients were from the asymptomatic hematoma group. In regard to escalation in therapy, six patients received neurosurgical treatment and three patients had a fresh frozen plasma infusion. In addition, dehydration therapy was the most common management after HT diagnosis [87.2% (82 of 94)]. In the multivariable models, refusing any treatment after HT diagnosis was the sole factor associated with increased 3-month death (odds ratio, 13.6; 95% CI, 3.98–56.9) and hematoma expansion risk (odds ratio, 8.54; 95% CI, 1.33–70.1). In regard to the effects of aggressive therapy, a non-significant association of receiving hemostatic/neurosurgery therapy with a lower 3-month death and hematoma expansion risk was observed (all P > 0.05). Conclusion Refusing any treatment after HT detection had a significant trend of increasing 3-month death and hematoma expansion risk after HT. Our finding of hematoma expansion among patients with asymptomatic HT in non-western populations suggests an opportunity for intervention. Very few patients after thrombolysis related HT diagnosis received procoagulant or neurosurgical therapies. Large multicenter studies enrolling diverse populations are needed to examine the efficacy of these therapies on different HT subtypes.
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Affiliation(s)
- Junfeng Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Yanan Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Department of Neurology, The First People’s Hospital of Ziyang, Ziyang, China
| | - Shanshan Zhang
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
| | - Qian Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Chenchen Wei
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ting Cui
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Joshua Z. Willey
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ming Liu,
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Chantakeeree C, Sormunen M, Estola M, Jullamate P, Turunen H. Factors Affecting Quality of Life among Older Adults with Hypertension in Urban and Rural Areas in Thailand: A Cross-Sectional Study. Int J Aging Hum Dev 2021; 95:222-244. [PMID: 34931879 PMCID: PMC9316351 DOI: 10.1177/00914150211050880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study explored factors affecting quality of life in older adults with
hypertension by comparing those living in urban and rural areas. A
cross-sectional study was conducted on 420 older adults living in urban and
rural areas in Thailand. Data were collected using the WHOQOL-OLD and
Health-Promoting Lifestyle Profile-II tools, which measured quality of life and
health-promoting behaviors among the participants. Older adults in urban areas
had higher quality of life scores than those in rural locations.
Health-promoting behaviors significantly predicted higher quality of life for
all residents. A high perceived health status predicted increase of quality of
life in urban residents, whereas the presence of comorbidity effects decreased
quality of life. A longer hypertension duration predicted higher quality of life
in rural residents. These findings suggest that healthy behaviors and
self-management interventions are critical to improve quality of life in older
Thai adults with hypertension.
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Affiliation(s)
- Chonticha Chantakeeree
- Department of Nursing Science, Faculty of Health Sciences, 101232University of Eastern Finland, Box 1627, 70211, Kuopio, Finland.,Gerontological Nursing Division, Faculty of Nursing, 37688Burapha University, 169 Long-Hard Bangsaen Road, Tambon Saensook, Amphur Muang, Chonburi, 20131, Thailand
| | - Marjorita Sormunen
- Institute of Public Health and Clinical Nutrition, Department of Medicine, Faculty of Health Sciences, 205537University of Eastern Finland, Box 1627, 70211, Kuopio, Finland
| | - Matti Estola
- Faculty of Social Sciences (Joensuu Campus), 122208University of Eastern Finland, Box 111, 80101, Joensuu, Finland
| | - Pornchai Jullamate
- Gerontological Nursing Division, Faculty of Nursing, 37688Burapha University, 169 Long-Hard Bangsaen Road, Tambon Saensook, Amphur Muang, Chonburi, 20131, Thailand
| | - Hannele Turunen
- Department of Nursing Science, Faculty of Health Sciences, 101232University of Eastern Finland, Box 1627, 70211, Kuopio, Finland.,60650Kuopio University Hospital, Box 100, 70029 KYS
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Lin Y, Long-Sutehall T, Myall M. Transferring home to die from critical care units: A scoping review of international practices. J Crit Care 2021; 65:205-215. [PMID: 34243069 DOI: 10.1016/j.jcrc.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify and characterise the international practices of transferring a dying patient home to die from critical care units. MATERIALS AND METHODS A systematic scoping review following the Joanne Briggs Institute methodology was applied searching fifteen data sources to identify papers published in English and Chinese from 1970 to 2019. RESULTS Of the 28 papers meeting eligibility criteria 19 were published in the West and seven in China. The number of patients being transferred home to die was larger in China (74/184-96/159) than in the West (1-7). Clinical characteristics of patients transferred included: consciousness, with or without intubation and ventilation, and clinical stability. Reported key barriers to transfer included: Lack of evidence guiding transfer practice, the CCU environment and culture, Practical and logistical factors and Family members expectations and reactions. Key facilitators of transfer were reported as: Engagement with the multidisciplinary team and Personal patient and family wishes. CONCLUSIONS Transferring patients home to die from critical care is a complex practice varying significantly across countries. Further research to address current knowledge gaps is important to inform policy and practice.
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Affiliation(s)
- Yanxia Lin
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
| | - Tracy Long-Sutehall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - Michelle Myall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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