1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Sim J, Shin C. Two stroke education programs designed for older adults. Geriatr Nurs 2024; 55:105-111. [PMID: 37979469 DOI: 10.1016/j.gerinurse.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/20/2023]
Abstract
Stroke is an important public health problem worldwide and in Korea causing death and serious long-term disability. This study tested the feasibility, acceptability, and preliminary efficacy of two stroke education programs. The pictogram-based education program was administered to 118 participants, and the PowerPoint-based education program was administered to 108 participants. Stroke knowledge (stroke definition, risk factors, warning signs) and first action knowledge in the event of stroke were assessed among all participants prior to and following completion of their respective programs. Both stroke education programs showed similar, significant improvements in stroke knowledge and first action knowledge from baseline to posttest. Also, feasibility (81-88 % participation and 96 % completion) and acceptability (86-97 % satisfaction) of both stroke education programs were supported. These findings indicate that healthcare professionals can use either of the education programs to improve stroke knowledge and first action knowledge among older adults who are at high risk for stroke.
Collapse
Affiliation(s)
- Jeongha Sim
- Department of Nursing, Jeonju University, Jeonju, Republic of Korea
| | - Chanam Shin
- College of Nursing, Texas Woman's University, Denton, TX, USA.
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Kamal H, Assaf S, Kabalan M, El Maissi R, Salhab D, Rahme D, Lahoud N. Evaluation of stroke pre-hospital management in Lebanon from symptoms onset to hospital arrival and impact on patients' status at discharge: a pilot study. BMC Neurol 2022; 22:494. [PMID: 36539720 PMCID: PMC9764570 DOI: 10.1186/s12883-022-03018-0] [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: 09/05/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hospital arrival time after acute ischemic stroke onset is the major factor limiting the eligibility of patients to receive intravenous thrombolysis. Shortening the prehospital delay is crucial to reducing morbidity and mortality for stroke patients. The study was conducted to investigate the factors that influence hospital arrival time after acute stroke onset in the Lebanese population and to assess the effect of the prehospital phase on patients' prognosis at discharge. METHOD A prospective cross-sectional study was performed in eleven hospitals from April to July 2021 including 100 patients having stroke symptoms or transient ischemic attack (TIA). Two questionnaires were used to collect data addressing patient management in the pre-hospital phase and the in-hospital phase. Descriptive and bivariate analyses were done to evaluate the potential associations between prognosis, pre-hospital characteristics, and other factors. RESULTS The patients' mean age was 70.36 ± 12.25 years, 43 (53.8%) of them were females, and 79 (85%) arrived within 3 hours after symptoms onset. Diabetic patients had a significant delay in hospital arrival compared with non-diabetics (27.0%vs.7.1%, p-value = 0.009). Moreover, 37 (75.5%) of school-level education patients arrived early at the hospital compared to 7 (100%) of university-level education (p-value = 0.009). The modified Rankin Scale (mRS) at discharge in patients with hemorrhagic stroke (10 (90%)) was worse than that in patients with ischemic stroke (38 (80%)) or TIA (3 (15%)) (p-value< 0.001). CONCLUSION The study findings make it imperative to raise awareness about stroke symptoms among the Lebanese population. Emergency Medical Services should be utilized appropriately in the transportation of stroke patients to achieve optimal patient outcomes.
Collapse
Affiliation(s)
- Hiba Kamal
- grid.411324.10000 0001 2324 3572Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Sara Assaf
- grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Mayssan Kabalan
- grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Raneem El Maissi
- grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Dima Salhab
- grid.411324.10000 0001 2324 3572Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Deema Rahme
- grid.18112.3b0000 0000 9884 2169Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Nathalie Lahoud
- grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Kuang J, Zhu X, Yang L, Gao Z, Wei X, Zhou K, Xu M. Factors influencing alertness to premonitory symptoms in stroke patients with pre-hospital delay. Public Health Nurs 2022; 39:1204-1212. [PMID: 35714655 DOI: 10.1111/phn.13108] [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: 10/18/2021] [Revised: 05/01/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose was to explore the alertness of premonitory symptoms in stroke patients with prehospital delay, and to analyze the influencing factors. DESIGN AND SAMPLE A cross-sectional study using the convenience sampling method was conducted in the neurology department of a general hospital between November 2018 and July 2019. A total of 352 stroke patients were participated in the survey. MEASURES A hierarchical multiple regression was performed to analyze the factors related to the alertness of premonitory symptoms (0-9 scores) in stroke patients with prehospital delay. RESULTS The alertness score was 6.53 ± 2.377. The lowest score of 0.55 ± 0.498 was for "Continuous yawning occurs continuously despite no tiredness or lack of sleep is okay, and need not be treated." The hierarchical regression results revealed that symptom onset, symptom change before admission, knowledge, social support were the influencing factors delaying the alertness of premonitory symptoms. Knowledge and support from friends could improve the alertness, while support from family and other support had a notable negative impact. CONCLUSIONS Stroke patients need to be more alert toward premonitory symptoms. This alertness is related to stroke knowledge and social support. Nurses should formulate interventions and advise stroke patients to improve their stroke knowledge and expand their social network.
Collapse
Affiliation(s)
- Jinke Kuang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xuemei Zhu
- School of Nursing, Harbin Medical University/The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Li Yang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Zihan Gao
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xiao Wei
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Kexin Zhou
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Mengfan Xu
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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.
Collapse
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.
| | | |
Collapse
|
9
|
Hu HJ, Song M. Disrupted Ionic Homeostasis in Ischemic Stroke and New Therapeutic Targets. J Stroke Cerebrovasc Dis 2017; 26:2706-2719. [PMID: 29054733 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/30/2017] [Accepted: 09/06/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of long-term disability. All neuroprotectants targeting excitotoxicity have failed to become stroke medications. In order to explore and identify new therapeutic targets for stroke, we here reviewed present studies of ionic transporters and channels that are involved in ischemic brain damage. METHOD We surveyed recent literature from animal experiments and clinical reports in the databases of PubMed and Elsevier ScienceDirect to analyze ionic mechanisms underlying ischemic cell damage and suggest promising ideas for stroke therapy. RESULTS Dysfunction of ionic transporters and disrupted ionic homeostasis are most early changes that underlie ischemic brain injury, thus receiving sustained attention in translational stroke research. The Na+/K+-ATPase, Na+/Ca2+ Exchanger, ionotropic glutamate receptor, acid-sensing ion channels (ASICs), sulfonylurea receptor isoform 1 (SUR1)-regulated NCCa-ATP channels, and transient receptor potential (TRP) channels are critically involved in ischemia-induced cellular degenerating processes such as cytotoxic edema, excitotoxicity, necrosis, apoptosis, and autophagic cell death. Some ionic transporters/channels also act as signalosomes to regulate cell death signaling. For acute stroke treatment, glutamate-mediated excitotoxicity must be interfered within 2 hours after stroke. The SUR1-regulated NCCa-ATP channels, Na+/K+-ATPase, ASICs, and TRP channels have a much longer therapeutic window, providing new therapeutic targets for developing feasible pharmacological treatments toward acute ischemic stroke. CONCLUSION The next generation of stroke therapy can apply a polypharmacology strategy for which drugs are designed to target multiple ion transporters/channels or their interaction with neurotoxic signaling pathways. But a successful translation of neuroprotectants relies on in-depth analyses of cell death mechanisms and suitable animal models resembling human stroke.
Collapse
Affiliation(s)
- Hui-Jie Hu
- Department of Pharmacology, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingke Song
- Department of Pharmacology, Institute of Medical Sciences, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
10
|
Shin CN, An K, Sim J. Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey. Int J Nurs Sci 2017; 4:52-57. [PMID: 31406718 PMCID: PMC6626084 DOI: 10.1016/j.ijnss.2016.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/16/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea. METHODS This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records. Among 233 acute ischemic stroke patients enrolled in a large-scale study, 160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis. RESULTS Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs. 625 min., p = 0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs. 31.5%, p = 0.013). For those who first contacted emergency medical service, the facilitators of emergency medical service use were the presence of hemiparesis (p = 0.003), bilateral paralysis (p = 0.040), and loss of balance (p = 0.021). The predominant barrier was the failure to recognize the urgency of symptoms (p = 0.006). CONCLUSIONS The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.
Collapse
Affiliation(s)
- Cha-Nam Shin
- College of Nursing and Health Innovation, Arizona State University, 500 N. Third St., Phoenix, AZ 85004, United States
| | - Kyungeh An
- College of Nursing, Virginia Commonwealth University, 1100 E. Leigh St., Richmond, VA, United States
| | - Jeongha Sim
- Department of Nursing, Jeonju University, 303 Cheonjam-ro, Wansan-gu, Jeonju, 560-759, South Korea
| |
Collapse
|