1
|
Parsons Leigh J, Brundin-Mather R, Moss SJ, Nickel A, Parolini A, Walsh D, Bigham BL, Carter AJE, Fox-Robichaud A, Fiest KM. Public awareness and knowledge of sepsis: a cross-sectional survey of adults in Canada. Crit Care 2022; 26:337. [PMID: 36329489 PMCID: PMC9632573 DOI: 10.1186/s13054-022-04215-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Sepsis is a life-threatening complication of the body’s response to infection. The financial, medical, and psychological costs of sepsis to individuals and to the healthcare system are high. Most sepsis cases originate in the community, making public awareness of sepsis essential to early diagnosis and treatment. There has been no comprehensive examination of adult’s sepsis knowledge in Canada. Methods We administered an online structured survey to English- or French-literate adults in Canada. The questionnaire comprised 28 questions in three domains: awareness, knowledge, and information access. Sampling was stratified by age, sex, and geography and weighted to 2016 census data. We used descriptive statistics to summarize responses; demographic differences were tested using the Rao–Scott correction for weighted chi-squared tests and associations using multiple variable regression. Results Sixty-one percent of 3200 adults sampled had heard of sepsis. Awareness differed by respondent’s residential region, sex, education, and ethnic group (p < 0.001, all). The odds of having heard of sepsis were higher for females, older adults, respondents with some or completed college/university education, and respondents who self-identified as Black, White, or of mixed ethnicity (p < 0.01, all). Respondent’s knowledge of sepsis definitions, symptoms, risk factors, and prevention measures was generally low (53.0%, 31.5%, 16.5%, and 36.3%, respectively). Only 25% of respondents recognized vaccination as a preventive strategy. The strongest predictors of sepsis knowledge were previous exposure to sepsis, healthcare employment, female sex, and a college/university education (p < 0.001, all). Respondents most frequently reported hearing about sepsis through television (27.7%) and preferred to learn about sepsis from healthcare providers (53.1%). Conclusions Sepsis can quickly cause life-altering physical and psychological effects and 39% of adults sampled in Canada have not heard of it. Critically, a minority (32%) knew about signs, risk factors, and strategies to lower risk. Education initiatives should focus messaging on infection prevention, employ broad media strategies, and use primary healthcare providers to disseminate evidence-based information. Future work could explore whether efforts to raise public awareness of sepsis might be bolstered or hindered by current discourse around COVID-19, particularly those centered on vaccination. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04215-6.
Collapse
Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada. .,Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada.
| | | | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.,Department of Critical Care, CRISMA Center, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Angie Nickel
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Ariana Parolini
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Deirdre Walsh
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Blair L Bigham
- Division of Critical Care, Department of Anesthesia, Stanford University, Stanford, CA, USA
| | - Alix J E Carter
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Emergency Health Services Nova Scotia, Halifax, NS, Canada
| | - Alison Fox-Robichaud
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
2
|
Patient, Public, and Healthcare Professional's Sepsis Awareness, Knowledge, and Information Seeking Behaviors: A Scoping Review. Crit Care Med 2022; 50:1187-1197. [PMID: 35481953 PMCID: PMC9275848 DOI: 10.1097/ccm.0000000000005564] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sepsis awareness and understanding are important aspects of prevention, recognition, and clinical management of sepsis. We conducted a scoping review to identify and map the literature related to sepsis awareness, general knowledge, and information-seeking behaviors with a goal to inform future sepsis research and knowledge translation campaigns.
Collapse
|
3
|
Flowers AM, Chan W, Meyer BI, Bruce BB, Newman NJ, Biousse V. Referral Patterns of Central Retinal Artery Occlusion to an Academic Center Affiliated With a Stroke Center. J Neuroophthalmol 2021; 41:480-487. [PMID: 34788238 PMCID: PMC9546636 DOI: 10.1097/wno.0000000000001409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Central retinal artery occlusion (CRAO) is a medical emergency, and patients who present acutely should be immediately referred to the nearest stroke center. We evaluated practice patterns for CRAO management at one academic center over the last decade. METHODS This was a retrospective study on all adult patients diagnosed with a CRAO seen at one tertiary hospital and outpatient clinic affiliated with a comprehensive stroke center ("our institution") from 2010 to 2020. Our electronic medical records were searched for CRAO diagnoses, and patient medical records were reviewed. The exclusion criteria were incorrect diagnosis, unclear diagnosis, historical CRAO, or satellite clinic location. Demographics, distance and time to presentation to our institution, number and type of prior providers seen, diagnostic tests performed, and treatments provided were collected. Summary statistics of median, mean, and frequency were calculated and reported with measures of variance (interquartile range [IQR], ranges). F, Tukey, and Fisher exact tests were used for comparisons. RESULTS We included 181 patients with a diagnosis of CRAO (80 [44.2%] women; median age 69 years [range 20-101]). The median distance from patient's home to our institution was 27.8 miles (IQR 15.5-57.4; range 2.4-930). The median time from visual loss to presentation at our institution was 144 hours (IQR 23-442 hours, range 0.5-2,920) from 2010 to 2013, 72 hours (IQR 10.5-372 hours, range 0-13,140) from 2014 to 2016, and 48 hours (IQR 7-180 hours, range 0-8,030) from 2017 to 2020 (P = 0.07). 91/181 (50%) patients presented to an outpatient provider. 73/181 (40%) presented to an emergency department. Eighty-six percent presented within 1 week of visual loss onset, and rates of comprehensive inpatient evaluation for acute CRAO improved from 44% in 2010-2013 to 82% in 2017-2020 (P < 0.01). CONCLUSIONS Patients with CRAO often present late and only after evaluation by multiple outpatient providers. Improvement has occurred over the past decade, but delays underscore the barriers to performing clinical trials evaluating very acute treatments for CRAO. Educational interventions for healthcare providers and patients are necessary.
Collapse
Affiliation(s)
- Alexis M Flowers
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
| | - Wesley Chan
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
| | | | - Beau B. Bruce
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
- Department of Neurology, Emory University, Atlanta, GA 30322
- Department of Epidemiology, Emory University, Atlanta, GA 30322
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
- Department of Neurology, Emory University, Atlanta, GA 30322
- Department of Neurological Surgery, Emory University, Atlanta, GA 30322
| | - Valérie Biousse
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
- Department of Neurology, Emory University, Atlanta, GA 30322
| |
Collapse
|
4
|
Volevach E, Maršálková H, Bobek J, Svobodová V, Mikulik R. Educational Program Improved Senior Preparedness to Call 911 as a Response to Stroke. J Stroke Cerebrovasc Dis 2021; 30:106047. [PMID: 34450477 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106047] [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: 04/16/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Stroke predominantly affects the elderly. Universities of the Third Age (U3A) are presented with an opportunity to target them. The goal of our study was to improve older adults' preparedness to call 911 as a response to symptoms of stroke. MATERIALS AND METHODS Participants were recruited from U3A in Brno, Czech Republic in year 2018. The program included an educational movie about stroke and testing with pretest posttest design. Stroke awareness was measured by Stroke Action Test and video-clips portraying stroke and stroke mimicking symptoms. Respondents had to answer close-ended questions. Composite scores were compared using paired t-test. RESULTS Data were obtained from 206 attendees of the program, that is 2% of all students, from 4 of 5 U3A in Brno. The mean test score improved from 80% to 87% (paired p < 0.001). Participants with a lower baseline knowledge improved by 12% (95% CI 9% to 16%) and with a higher baseline knowledge by 0% (95% CI 3% to 4%). The score for calling 911 for stroke mimicking symptoms improved from 29% to 20% (paired p < 0.001). CONCLUSIONS Video-based educational program improved senior preparedness to call 911 as a response to stroke. The improvement was mild, which is at least partly due to a high baseline level of preparedness of seniors active in U3A. A lower baseline knowledge was however associated with a bigger improvement, which might be important for use in a less active/educated population. Educational intervention also decreased intention to call 911 for stroke mimicking symptoms, which could have important implications for decreasing unnecessary activation of pre-hospital services.
Collapse
Affiliation(s)
- Ekaterina Volevach
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
| | - Hana Maršálková
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Jan Bobek
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Veronika Svobodová
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Robert Mikulik
- 1st Department of Neurology and International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic,; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| |
Collapse
|
5
|
The Impact of Stroke Public Awareness Campaigns Differs Between Sociodemographic Groups. Can J Neurol Sci 2021; 49:231-238. [PMID: 33875043 DOI: 10.1017/cjn.2021.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prehospital delays are a major obstacle to timely reperfusion therapy in acute ischemic stroke. Stroke sign recognition, however, remains poor in the community. We present an analysis of repeated surveys to assess the impact of Face, Arm, Speech, Time (FAST) public awareness campaigns on stroke knowledge. METHODS Four cross-sectional surveys were conducted between July 2016 and January 2019 in the province of Quebec, Canada (n = 2,451). Knowledge of FAST stroke signs (face drooping, arm weakness and speech difficulties) was assessed with open-ended questions. A bilingual English/French FAST public awareness campaign preceded survey waves 1-3 and two campaigns preceded wave 4. We used multivariable ordinal regression models weighted for age and sex to assess FAST stroke sign knowledge. RESULTS We observed an overall significant improvement of 26% in FAST stroke sign knowledge between survey waves 1 and 4 (odds ratio [OR] = 1.26; 95% CI: 1.02, 1.55; p = 0.035). After the last campaign, however, 30.5% (95% CI: 27.5, 33.6) of people were still unable to name a single FAST sign. Factors associated with worse performance were male sex (OR = 0.68; 95% CI: 0.53, 0.86; p = 0.002) and retirement (OR = 0.54; 95% CI: 0.35, 0.83; p = 0.005). People with lower household income and education had a tendency towards worse stroke sign knowledge and were significantly less aware of the FAST campaigns. CONCLUSIONS Knowledge of FAST stroke signs in the general population improved after multiple public awareness campaigns, although it remained low overall. Future FAST campaigns should especially target men, retired people and individuals with a lower socioeconomic status.
Collapse
|
6
|
Grech P, Grech R. The role of health promotion theories in Stroke Awareness and Education. Appl Nurs Res 2021; 58:151415. [PMID: 33745555 DOI: 10.1016/j.apnr.2021.151415] [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: 12/29/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
The aim of this paper is to provide an overview of health promotion theories and their application to Stroke Awareness and Education. Stroke stands as one of the leading causes of mortality and morbidity even though treatment is readily available. One of the major challenges in this area is that the effectiveness of treatment depends heavily on timely presentation to healthcare services. Unfortunately, many individuals do not seek help whilst experiencing symptoms or only do so after a significant delay. This paper explores the main health promotion theories related to this problematic health behaviour in relation to stroke.
Collapse
Affiliation(s)
- Paulann Grech
- Department of Mental Health, Faculty of Health Sciences, University of Malta, Malta.
| | - Reuben Grech
- Medical Imaging Department, Mater Dei Hospital, Malta
| |
Collapse
|
7
|
Perceptions of Signs of Addiction Among Opioid Naive Patients Prescribed Opioids in the Emergency Department. J Addict Med 2021; 15:491-497. [PMID: 33560692 DOI: 10.1097/adm.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient knowledge deficits related to opioid risks, including lack of knowledge regarding addiction, are well documented. Our objective was to characterize patients' perceptions of signs of addiction. METHODS This study utilized data obtained as part of a larger interventional trial. Consecutively discharged English-speaking patients, age >17 years, at an urban academic emergency department, with a new opioid prescription were enrolled from July 2015 to August 2017. During a follow-up phone interview 7 to 14 days after discharge, participants were asked a single question, "What are the signs of addiction to pain medicine?" Verbatim transcribed answers were analyzed using a directed content analysis approach and double coding. These codes were then grouped into themes. RESULTS There were 325 respondents, 57% female, mean age 43.8 years, 70.1% privately insured. Ten de novo codes were added to the 11 DSM-V criteria codes. Six themes were identified: (1) effort spent acquiring opioids, (2) emotional and physical changes related to opioid use, (3) opioid use that is "not needed, (4) increasing opioid use, (5) an emotional relationship with opioids, and (6) the inability to stop opioid use. CONCLUSIONS Signs of addiction identified by opioid naive patients were similar to concepts identified in medical definitions. However, participants' understanding also included misconceptions, omissions, and conflated misuse behaviors with signs of addiction. Identifying these differences will help inform patient-provider risk communication, providing an opportunity for counseling and prevention.
Collapse
|
8
|
Tanislav C, Jacob L, Kostev K. Consultations Decline for Stroke, Transient Ischemic Attack, and Myocardial Infarction during the COVID-19 Pandemic in Germany. Neuroepidemiology 2021; 55:1-8. [PMID: 33530092 PMCID: PMC7900477 DOI: 10.1159/000513812] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic raises the concern that other non-COVID conditions will be affected by a decline in care. Therefore, we aimed to investigate the decline in ambulatory presentations for vascular events (stroke, transient ischemic attack [TIA], and myocardial infarction [MI]) during the COVID-19 pandemic. METHODS Patients with a diagnosis of ischemic stroke, TIA, or MI documented anonymously in 1,262 general practices in Germany were included. We studied the differences between 2019 and 2020 (between April and June) in terms of rates and baseline characteristics by comparing monthly absolute frequencies. RESULTS A total of 3,496 patients with stroke (mean age: 72.2 years), 1,608 patients with TIA (mean age: 71.5 years), and 2,385 patients with MI (mean age: 66.8 years) were identified between April and June 2020, indicating a decrease of 10% (stroke), 16% (TIA), and 9% (MI) compared to 2019. For patients with stroke, the decrease in men was 13% (women: -6%) but reached 17% in the age category 51-60 years. For MI, the decrease was only obvious in males (14%). The largest decrease in stroke (-17%) and MI (-19%) was noted in April, while that for TIA occurred in May (-22%). In June for all 3 conditions, the previous year's level was achieved. Only in TIA, the age differs between 2019 and 2020 (mean age: 69.9 vs. 71.5 years; p < 0.05). In patients with stroke and MI, the proportions of men were lower in 2019 than in 2020 (stroke: 54.8-50.5%, p < 0.05 and MI: 64-60.2%, p < 0.05). CONCLUSION Although the decline in the number of patients presenting with stroke, TIA, and MI was not as noticeable in the ambulatory sector as it was in the area of emergency hospital-based care, our data indicate that the COVID-19 pandemic affected all sectors within the medical care system.
Collapse
Affiliation(s)
- Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, Siegen, Germany,
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | | |
Collapse
|
9
|
Impact of a Pre-Discharge Education Session on Stroke Knowledge: a Randomized Trial. J Stroke Cerebrovasc Dis 2020; 29:105272. [PMID: 32992206 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/22/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND PURPOSES Stroke knowledge, awareness of risk factors and stroke warning symptoms is very poor among stroke survivors. We investigated whether a pre-discharge education intervention in the stroke unit could improve stroke knowledge in patients with TIA or minor stroke. METHODS We performed a prospective single-center, randomized controlled trial (2013-2016) in patients with TIA or minor stroke. The intervention consisted in an interactive group session focused on stroke education, within the stroke unit before hospital discharge. Primary outcome was the 3-month change in stroke knowledge score (SKS) from randomization. Secondary outcomes were the 12-month change in SKS, the number of risk factors and warning signs named, control of risk factors and self-reported adherence. RESULTS A total of 199 patients (mean [SD] age, 63.5 [12.4] years; 67 [33.7%] women) were randomized (99 in stroke education session). Intervention was associated with a greater improvement in SKS than in the control group (baseline-adjusted mean between-group difference, 1.6 point [95%CI, 1.4 to 1.9]; p=0.001). This difference was significantly maintained at 12 months. The number of risk factors and warning signs named were significantly increased in the intervention group at 3 months. Control of risk factors and self-reported adherence did not differ significantly between the two groups. CONCLUSIONS An interactive education session in the stroke unit significantly improved stroke knowledge at 3 months and 12 months in patients with TIA or minor stroke.
Collapse
|
10
|
Wilhelm LO, Gellert P, White M, Araujo-Soares V, Ford GA, Mackintosh JE, Rodgers H, Sniehotta FF, Thomson RG, Dombrowski SU. The Recognition-Response Gap in Acute Stroke: Examining the Relationship between Stroke Recognition and Response in a General Population Survey. J Stroke Cerebrovasc Dis 2020; 29:104499. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/15/2022] Open
|
11
|
Stevens ER, Roberts E, Kuczynski HC, Boden-Albala B. Stroke Warning Information and Faster Treatment (SWIFT): Cost-Effectiveness of a Stroke Preparedness Intervention. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1240-1247. [PMID: 31708060 PMCID: PMC6857539 DOI: 10.1016/j.jval.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/09/2019] [Accepted: 06/10/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Less than 25% of stroke patients arrive to an emergency department within the 3-hour treatment window. OBJECTIVE We evaluated the cost-effectiveness of a stroke preparedness behavioral intervention study (Stroke Warning Information and Faster Treatment [SWIFT]), a stroke intervention demonstrating capacity to decrease race-ethnic disparities in ED arrival times. METHODS Using the literature and SWIFT outcomes for 2 interventions, enhanced educational (EE) materials, and interactive intervention (II), we assess the cost-effectiveness of SWIFT in 2 ways: (1) Markov model, and (2) cost-to-outcome ratio. The Markov model primary outcome was the cost per quality-adjusted life-year (QALY) gained using the cost-effectiveness threshold of $100 000/QALY. The primary cost-to-outcome endpoint was cost per additional patient with ED arrival <3 hours, stroke knowledge, and preparedness capacity. We assessed the ICER of II and EE versus standard care (SC) from a health sector and societal perspective using 2015 USD, a time horizon of 5 years, and a discount rate of 3%. RESULTS The cost-effectiveness of the II and EE programs was, respectively, $227.35 and $74.63 per additional arrival <3 hours, $440.72 and $334.09 per additional person with stroke knowledge proficiency, and $655.70 and $811.77 per additional person with preparedness capacity. Using a societal perspective, the ICER for EE versus SC was $84 643 per QALY gained and the ICER for II versus EE was $59 058 per QALY gained. Incorporating fixed costs, EE and II would need to administered to 507 and 1693 or more patients, respectively, to achieve an ICER of $100 000/QALY. CONCLUSION II was a cost-effective strategy compared with both EE and SC. Nevertheless, high initial fixed costs associated with II may limit its cost-effectiveness in settings with smaller patient populations.
Collapse
Affiliation(s)
- Elizabeth R Stevens
- Department of Epidemiology, New York University College of Global Public Health, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA.
| | - Eric Roberts
- Department of Epidemiology, New York University College of Global Public Health, New York, NY, USA
| | - Heather Carman Kuczynski
- Department of Epidemiology, New York University College of Global Public Health, New York, NY, USA
| | - Bernadette Boden-Albala
- Department of Epidemiology, New York University College of Global Public Health, New York, NY, USA
| |
Collapse
|
12
|
Mackay MT, Lee M, Yock-Corrales A, Churilov L, Donnan GA, Monagle P, Babl FE. Differentiating arterial ischaemic stroke from migraine in the paediatric emergency department. Dev Med Child Neurol 2018; 60:1117-1122. [PMID: 29655223 DOI: 10.1111/dmcn.13772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 01/03/2023]
Abstract
AIM To estimate the strengths of association between clinical features and migraine or arterial ischaemic stroke (AIS) in children presenting to the emergency department. METHOD Eighty-four children with migraine, prospectively recruited from 2009 to 2010, were compared with 55 children with AIS, prospectively/retrospectively recruited from 2003 to 2010. Odds ratios were calculated via logistic regression to measure associations between clinical features and process-of-care factors, and migraine and AIS. RESULTS Median age was 13 years 5 months (interquartile range 12y 11mo-13y 10mo) for migraine and 5 years (interquartile range 3y 7mo-8y) for patients with AIS. All cases of AIS and 30% of migraine cases underwent neuroimaging. Over 40% of children with migraine had vomiting, numbness, or visual disturbance; other symptoms were uncommon. Fifty-five per cent had no signs on physician assessment. Weakness or speech disturbance were common in patients with AIS. Significant clinical features associated with increased odds of AIS included sudden symptom onset, weakness, seizures, speech disturbance, and ataxia, and signs of face, arm, or leg weakness, inability to walk, dysarthria, dysphasia, and altered consciousness (p<0.05). Significant features associated with decreased odds of AIS included older age, vomiting, visual, sensory, other symptoms, and absent focal signs on assessment (p<0.05). INTERPRETATION Presenting features can discriminate childhood AIS from migraine. These differences inform decisions about urgency and type of neuroimaging in children presenting to the emergency department with brain attack symptoms. WHAT THE PAPER ADDS Weakness, seizures, ataxia, speech, or walking difficulties are more frequent in arterial ischaemic stroke (AIS). Vomiting, visual, or sensory disturbance and absent focal signs are more frequent in migraine. Identifying features of AIS and migraine guides neuroimaging in children with brain attack symptoms.
Collapse
Affiliation(s)
- Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Parkville, Vic., Australia.,Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Vic., Australia
| | - Michelle Lee
- Emergency Department, Royal Children's Hospital Melbourne, Parkville, Vic., Australia
| | | | - Leonid Churilov
- University of Melbourne, Parkville, Vic., Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Vic., Australia
| | - Geoffrey A Donnan
- University of Melbourne, Parkville, Vic., Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Vic., Australia
| | - Paul Monagle
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,Department of Haematology, Royal Children's Hospital, Parkville, Vic., Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Vic., Australia
| |
Collapse
|
13
|
Wolters FJ, Li L, Gutnikov SA, Mehta Z, Rothwell PM. Medical Attention Seeking After Transient Ischemic Attack and Minor Stroke Before and After the UK Face, Arm, Speech, Time (FAST) Public Education Campaign: Results From the Oxford Vascular Study. JAMA Neurol 2018; 75:1225-1233. [PMID: 29971433 PMCID: PMC6233848 DOI: 10.1001/jamaneurol.2018.1603] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/04/2018] [Indexed: 01/13/2023]
Abstract
Importance Risk of major stroke is high during the hours and days after transient ischemic attack (TIA) and minor stroke but is substantially reduced by urgent medical treatment. Public education campaigns have improved the response after major stroke, but their association with behavior after TIA and minor stroke is uncertain. The number of potentially preventable early recurrent strokes in patients who delay or fail to seek medical attention is unknown. Objective To investigate the association of public education with delays and failure in seeking medical attention after TIA and minor stroke. Design, Setting, and Participants Prospective population-based study of all patients with TIA or stroke who sought medical attention between April 1, 2002, and March 31, 2014, registered at 9 general practices in Oxfordshire, United Kingdom. Data analysis took place from July 1, 2013, to March 2, 2015. Exposures Face, Arm, Speech, Time (FAST) public education campaign in the United Kingdom. Main Outcomes and Measures Number of early recurrent strokes in patients who delayed or failed to seek medical attention, as well as the odds of seeking urgent attention after TIA and minor stroke before vs after initiation of the public education campaign. Results Among 2243 consecutive patients with first TIA or stroke (mean [SD] age, 73.6 [13.4] years; 1126 [50.2%] female; 96.3% of white race/ethnicity), 1656 (73.8%) had a minor stroke or TIA. After the FAST campaign, patients with major stroke more often sought medical attention within 3 hours (odds ratio [OR], 2.56; 95% CI, 1.11-5.90; P = .03). For TIA and minor stroke, there was no improvement in use of emergency medical services (OR, 0.79; 95% CI, 0.50-1.23; P for interaction = .03 vs major stroke) or time to first seeking medical attention within 24 hours (OR, 0.75; 95% CI, 0.48-1.19; P for interaction = .006 vs major stroke). Patient perception of symptoms after TIA and minor stroke was associated with more urgent behavior, but correct perception declined after the FAST campaign (from 37.3% [289 of 774] to 27.6% [178 of 645]; OR, 0.64; 95% CI, 0.51-0.80; P < .001). One hundred eighty-eight patients had a stroke within 90 days of their initial TIA or stroke, of whom 93 (49.5%) followed unheeded TIAs for which no medical attention was sought, similar before and after the FAST campaign (43 of 538 [8.0%] before vs 50 of 615 [8.1%] after, P = .93). Conclusions and Relevance This study suggests that in contrast to major stroke, extensive FAST-based public education has not improved the response to TIA and minor stroke in the United Kingdom, emphasizing the need for campaigns that are tailored to transient and less severe symptoms.
Collapse
Affiliation(s)
- Frank J. Wolters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
| | - Linxin Li
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
| | - Sergei A. Gutnikov
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
| | - Ziyah Mehta
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
| | - Peter M. Rothwell
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
| |
Collapse
|
14
|
Hickey A, Mellon L, Williams D, Shelley E, Conroy RM. Does stroke health promotion increase awareness of appropriate behavioural response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response. Eur Stroke J 2018; 3:117-125. [PMID: 31008344 PMCID: PMC6460411 DOI: 10.1177/2396987317753453] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/02/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention. We report on post-campaign findings (wave 2) of national surveys to estimate changes in population knowledge following a media-based Face, Arm, Speech, Time stroke awareness campaign, comparing findings to those of a pre-campaign population survey (wave 1).Participants and methods: One thousand and ten randomly selected adults (18+) completed the Stroke Awareness Questionnaire on knowledge of warning signs, risk factors and response to stroke at wave 2 and findings were compared to wave 1 survey results. Logistic regression was used to examine the association between demographic characteristics and self-reported risk factors with knowledge of stroke and emergency response. RESULTS No significant differences existed in the ability of respondents to define stroke or to identify two or more stroke risk factors between waves 1 and 2 surveys (71% and 70%, respectively). Respondents to the wave 2 survey were five times more likely (odds ratio 4.9, p < .001) than those responding at wave 1 to know at least two warning signs of stroke (67% vs. 31%, respectively), specifically those targeted by the Face, Arm, Speech, Time campaign. While significant improvement in intention to call an ambulance was noted (odds ratio 1.5, p < .001, 57% at wave 2 compared to 47% at wave 1), for almost half of respondents (43%) this would not have been their first response to stroke. Less than 5% of respondents to both surveys identified thrombolysis as an emergency treatment for stroke (3.9% at wave 2 compared to 1.8% at wave 1). DISCUSSION Although significant improvements were made in several areas of stroke knowledge and intended response, awareness of acute stroke interventions was poor and intended behavioural response was suboptimal. CONCLUSION Findings from this study indicate need for targeted campaigns to improve population understanding of the reasons underlying the importance of rapid emergency response to stroke.
Collapse
Affiliation(s)
- Anne Hickey
- Department of Psychology, Division of Population Health
Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Lisa Mellon
- Department of Psychology, Division of Population Health
Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in
Ireland and Beaumont Hospital, Dublin, Ireland
| | - Emer Shelley
- Department of Epidemiology & Public Health Medicine,
Division of Population Health Sciences, Royal College of Surgeons in
Ireland, Dublin 2, Ireland
| | - Ronan M Conroy
- Department of Epidemiology & Public Health Medicine,
Division of Population Health Sciences, Royal College of Surgeons in
Ireland, Dublin 2, Ireland
| |
Collapse
|
15
|
Folyovich A, Biczó D, Béres-Molnár KA, Toldi G. Assessment of the Efficiency of Stroke Awareness Campaigns in Hungary. J Stroke Cerebrovasc Dis 2018; 27:1770-1774. [PMID: 29503169 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/12/2018] [Accepted: 02/04/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The critical period of stroke management lies between the disease onset and the time of the emergency call, relying on stroke-related knowledge of the population. Public campaigns play a role in spreading relevant health information. Due to the substantial expenses of these campaigns, the assessment of their efficiency is reasonable. METHODS We assessed the number of thrombolytic treatments performed in Hungary, subjected to national media coverage and in particular in Budapest, being the location of the Stroke Day campaign, in the period between 2008 and 2015. We compared the change in the daily mean number of thrombolytic treatments performed during the preceding and following day, week, and month. Data were also compared with annual means. RESULTS No meaningful changes can be seen in the number of thrombolytic treatments on the days immediately following Stroke Days, and casual differences can be seen in the following week. The comparison of the numbers of thrombolytic treatments performed in the postcampaign months with the monthly means in the corresponding years revealed a positive effect in each year except for 2012, 2014, and 2015. Regarding the whole examined period, however, the effect is not statistically significant, neither for data obtained from Hungary nor from Budapest. CONCLUSIONS Better outcomes were observed 1 month after a campaign than more immediately. This can be partly explained by ongoing media coverage in a given period rather than exposure of the public on a single Stroke Day.
Collapse
Affiliation(s)
- András Folyovich
- Department of Neurology and Stroke Center, Szent János Hospital, Budapest, Hungary
| | - Dávid Biczó
- DRK Hospital Neuwied, University of Bonn, Bonn, Germany
| | | | - Gergely Toldi
- First Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
16
|
Vondráčková L, Mikulík R. Public stroke education: Current status worldwide and projects to increase awareness in the Czech Republic. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
17
|
Impact of the Act FAST stroke campaign delivered by student pharmacists on the primary prevention of stroke. J Am Pharm Assoc (2003) 2017; 57:326-332.e6. [PMID: 28411014 DOI: 10.1016/j.japh.2017.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/18/2017] [Accepted: 02/07/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the impact of an Act FAST educational intervention performed by student pharmacists on knowledge of stroke recognition and management. DESIGN Stroke preparedness and knowledge of primary prevention were assessed with the use of pre- and post-intervention surveys targeting community members at health fairs. The intervention was an Act FAST educational session with blood pressure and blood glucose screenings provided by student pharmacists. Act FAST is a quick tool to help recognize and respond to a stroke. The acronym FAST stands for Face, Arms, Speech, and Time. SETTING Community health fairs in Vallejo, CA. PARTICIPANTS Community members 18 years of age and older. INTERVENTION Act FAST educational session delivered by student pharmacists. MAIN OUTCOME MEASURES Knowledge of signs, symptoms, management, and risk factors of strokes as defined by the American Heart Association. RESULTS Following the Act FAST educational intervention, total knowledge of signs, symptoms, and management of stroke significantly increased from moderate to high (n = 112; 95% confidence interval [CI] 1.419-2.188; P <0.0001). Total knowledge of risk factors of stroke also significantly increased following the educational intervention (n = 88; 95% CI 0.6496-1.746; P <0.0001). CONCLUSION The Act FAST educational intervention delivered by student pharmacists increased knowledge of signs, symptoms, immediate management, and modifiable risk factors of stroke. This suggests that student pharmacists may have a positive impact on community members' preparedness and knowledge of primary prevention of stroke. The Act FAST campaign may be a useful tool for all training health care professionals.
Collapse
|
18
|
Advani R, Naess H, Kurz M. Mass Media Intervention in Western Norway Aimed at Improving Public Recognition of Stroke, Emergency Response, and Acute Treatment. J Stroke Cerebrovasc Dis 2016; 25:1467-72. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/01/2016] [Accepted: 02/19/2016] [Indexed: 11/29/2022] Open
|
19
|
Brown RA, Shantsila E, Varma C, Lip GYH. Symptom-to-door times in patients presenting with ST elevation myocardial infarction--do ethnic or gender differences exist? QJM 2016; 109:175-80. [PMID: 26025691 DOI: 10.1093/qjmed/hcv112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies have shown higher in-hospital mortality for female patients and ethnic minorities admitted to hospital with acute ST elevation myocardial infarction (STEMI). Pre-hospital delay is thought to be associated with increased in-hospital mortality. AIM To assess the impact of gender and ethnicity on symptom-to-door time (STDT) in patients presenting with STEMI. DESIGN Retrospective survey of consecutive patients receiving primary percutaneous coronary intervention between January 2008 and January 2013. A multivariate model was used to adjust for confounders. MAIN OUTCOME MEASURE Influence of gender and ethnicity on STDT. RESULTS We analysed 1020 patients (75% male, 263 South Asians, 38 Afro Caribbeans and 719 White Europeans.) There was a trend towards longer unadjusted median STDT in women compared with men (132 min vs. 113 min P = 0.07) which disappeared after correction for age and ethnicity (P = 0.15). There was no gender difference in hospital mortality after correction for age (odds ratio 0.69, 95% confidence interval 0.40-1.18, P = 0.17). On linear regression analysis South Asians showed a trend towards longer STDT than other ethnic groups (P = 0.08) however after adjustment for diabetes there was no association between South Asian ethnicity and hospital mortality. CONCLUSIONS Neither female gender nor ethnicity were shown to be associated with significant pre-hospital delay.
Collapse
Affiliation(s)
- Richard A Brown
- From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK and
| | - Eduard Shantsila
- From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK and Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, UK
| | - Chetan Varma
- Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, UK
| | - Gregory Y H Lip
- From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK and Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, UK
| |
Collapse
|
20
|
Marto JP, Borbinha C, Filipe R, Calado S, Viana-Baptista M. Impact of stroke education on middle school students and their parents: A cluster randomized trial. Int J Stroke 2016; 12:401-411. [PMID: 27799456 DOI: 10.1177/1747493016677980] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background School students are an attractive target for stroke education due to the potential impact on stroke prevention and recognition. Additionally, these students can drive behavioral changes in their families. Aim To evaluate the impact of stroke education on school students, in terms of students' and parents' acquired stroke knowledge. Methods A structured questionnaire on knowledge of stroke was filled out by eighth-grade students and one of their parents in seven public schools. In four of these schools, students attended a stroke lecture; educational flyers and magnetic posters were distributed and parent education was encouraged. Students and parents of the other three schools were included in a control group. Students and parents, of both intervention and control groups, were resubmitted to the initial structured questionnaire within one week of the stroke lecture and three months later. Results We included 764 students and 344 parents, 383 (50.1%) and 210 (61.0%) in the intervention group. Correct test scores for students before, within one week, and three months after the intervention were 54.49% versus 55.03% (p = 0.418), 98.69% versus 60.89% (p < 0.001), and 95.58% versus 75.7% (p < 0.001) in the intervention and control groups, respectively. Correct test scores for parents at the same time points were 68.78% versus 64.47% (p = 0.107), 96.89% versus 71.42% (p < 0.001), and 94.58% versus 76.54% (p < 0.001) in the intervention and control groups, respectively. Conclusions School-based interventions may improve stroke knowledge in middle school students and their parents.
Collapse
Affiliation(s)
- João Pedro Marto
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Cláudia Borbinha
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Rita Filipe
- 2 Public Health Unit, Agrupamento de Centros de Saúde (ACES), Lisboa Ocidental e Oeiras, Lisbon, Portugal
| | - Sofia Calado
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,3 Chronic Diseases Research Centre (CEDOC)-Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Miguel Viana-Baptista
- 1 Department of Neurology, Egas Moniz Hospital, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,3 Chronic Diseases Research Centre (CEDOC)-Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
21
|
Dombrowski SU, Ford GA, Morgenstern LB, White M, Sniehotta FF, Mackintosh JE, Gellert P, Skolarus LE. Differences Between US and UK Adults in Stroke Preparedness: Evidence From Parallel Population-Based Community Surveys. Stroke 2015; 46:3220-5. [PMID: 26419968 PMCID: PMC4617289 DOI: 10.1161/strokeaha.115.009997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Although time-dependent treatment is available, most people delay contacting emergency medical services for stroke. Given differences in the healthcare system and public health campaigns, exploring between-country differences in stroke preparedness may identify novel ways to increase acute stroke treatment. METHODS A survey was mailed to population-based samples in Ingham County, Michigan, US (n=2500), and Newcastle upon Tyne, UK (n=2500). Surveys included stroke perceptions and stroke/nonstroke scenarios to assess recognition and response to stroke. Between-country differences and associations with stroke preparedness were examined using t tests and linear mixed models. RESULTS Overall response rate was 27.4%. The mean age of participants was 55 years, and 58% were female. US participants were better in recognizing stroke (70% versus 63%, d=0.27) and were more likely to call emergency medical services (55% versus 52%, d=0.11). After controlling for demographics and comorbidities, US participants remained more likely to recognize stroke but were not more likely to respond appropriately. A greater belief that medical treatment can help with stroke and understanding of stroke was associated with improved stroke recognition and response. CONCLUSIONS Overall, stroke recognition and response were moderate. US participants were modestly better at recognizing stroke, although there was little difference in response to stroke. Future stroke awareness interventions could focus more on stroke outcome expectations and developing a greater understanding of stroke among the public.
Collapse
Affiliation(s)
- Stephan U Dombrowski
- From the Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK (S.U.D.); Institute for Ageing & Health (G.A.F.) and Institute of Health & Society (M.W., F.F.S., J.E.M.), Newcastle University, Newcastle upon Tyne, UK; Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK (G.A.F.); Stroke Program, Department of Neurology, University of Michigan (L.B.M., L.E.S.); Centre for Diet & Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, UK (M.W.); Fuse, UKCRC Centre for Translation Research in Public Health, Newcastle University, Newcastle upon Tyne, UK (F.F.S.); and Institute of Medical Sociology, Charité-Universitätsmedizin Berlin, Berlin, Germany (P.G.).
| | - Gary A Ford
- From the Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK (S.U.D.); Institute for Ageing & Health (G.A.F.) and Institute of Health & Society (M.W., F.F.S., J.E.M.), Newcastle University, Newcastle upon Tyne, UK; Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK (G.A.F.); Stroke Program, Department of Neurology, University of Michigan (L.B.M., L.E.S.); Centre for Diet & Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, UK (M.W.); Fuse, UKCRC Centre for Translation Research in Public Health, Newcastle University, Newcastle upon Tyne, UK (F.F.S.); and Institute of Medical Sociology, Charité-Universitätsmedizin Berlin, Berlin, Germany (P.G.)
| | - Lewis B Morgenstern
- From the Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK (S.U.D.); Institute for Ageing & Health (G.A.F.) and Institute of Health & Society (M.W., F.F.S., J.E.M.), Newcastle University, Newcastle upon Tyne, UK; Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK (G.A.F.); Stroke Program, Department of Neurology, University of Michigan (L.B.M., L.E.S.); Centre for Diet & Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, UK (M.W.); Fuse, UKCRC Centre for Translation Research in Public Health, Newcastle University, Newcastle upon Tyne, UK (F.F.S.); and Institute of Medical Sociology, Charité-Universitätsmedizin Berlin, Berlin, Germany (P.G.)
| | - Martin White
- From the Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK (S.U.D.); Institute for Ageing & Health (G.A.F.) and Institute of Health & Society (M.W., F.F.S., J.E.M.), Newcastle University, Newcastle upon Tyne, UK; Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK (G.A.F.); Stroke Program, Department of Neurology, University of Michigan (L.B.M., L.E.S.); Centre for Diet & Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, UK (M.W.); Fuse, UKCRC Centre for Translation Research in Public Health, Newcastle University, Newcastle upon Tyne, UK (F.F.S.); and Institute of Medical Sociology, Charité-Universitätsmedizin Berlin, Berlin, Germany (P.G.)
| | - Falko F Sniehotta
- From the Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK (S.U.D.); Institute for Ageing & Health (G.A.F.) and Institute of Health & Society (M.W., F.F.S., J.E.M.), Newcastle University, Newcastle upon Tyne, UK; Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK (G.A.F.); Stroke Program, Department of Neurology, University of Michigan (L.B.M., L.E.S.); Centre for Diet & Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, UK (M.W.); Fuse, UKCRC Centre for Translation Research in Public Health, Newcastle University, Newcastle upon Tyne, UK (F.F.S.); and Institute of Medical Sociology, Charité-Universitätsmedizin Berlin, Berlin, Germany (P.G.)
| | - Joan E Mackintosh
- From the Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK (S.U.D.); Institute for Ageing & Health (G.A.F.) and Institute of Health & Society (M.W., F.F.S., J.E.M.), Newcastle University, Newcastle upon Tyne, UK; Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK (G.A.F.); Stroke Program, Department of Neurology, University of Michigan (L.B.M., L.E.S.); Centre for Diet & Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, UK (M.W.); Fuse, UKCRC Centre for Translation Research in Public Health, Newcastle University, Newcastle upon Tyne, UK (F.F.S.); and Institute of Medical Sociology, Charité-Universitätsmedizin Berlin, Berlin, Germany (P.G.)
| | - Paul Gellert
- From the Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK (S.U.D.); Institute for Ageing & Health (G.A.F.) and Institute of Health & Society (M.W., F.F.S., J.E.M.), Newcastle University, Newcastle upon Tyne, UK; Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK (G.A.F.); Stroke Program, Department of Neurology, University of Michigan (L.B.M., L.E.S.); Centre for Diet & Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, UK (M.W.); Fuse, UKCRC Centre for Translation Research in Public Health, Newcastle University, Newcastle upon Tyne, UK (F.F.S.); and Institute of Medical Sociology, Charité-Universitätsmedizin Berlin, Berlin, Germany (P.G.)
| | - Lesli E Skolarus
- From the Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK (S.U.D.); Institute for Ageing & Health (G.A.F.) and Institute of Health & Society (M.W., F.F.S., J.E.M.), Newcastle University, Newcastle upon Tyne, UK; Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK (G.A.F.); Stroke Program, Department of Neurology, University of Michigan (L.B.M., L.E.S.); Centre for Diet & Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, UK (M.W.); Fuse, UKCRC Centre for Translation Research in Public Health, Newcastle University, Newcastle upon Tyne, UK (F.F.S.); and Institute of Medical Sociology, Charité-Universitätsmedizin Berlin, Berlin, Germany (P.G.)
| |
Collapse
|
22
|
Clarke DJ, Forster A. Improving post-stroke recovery: the role of the multidisciplinary health care team. J Multidiscip Healthc 2015; 8:433-42. [PMID: 26445548 PMCID: PMC4590569 DOI: 10.2147/jmdh.s68764] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.
Collapse
Affiliation(s)
- David J Clarke
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| |
Collapse
|
23
|
Boden-Albala B, Stillman J, Roberts ET, Quarles LW, Glymour MM, Chong J, Moats H, Torrico V, Parides MC. Comparison of Acute Stroke Preparedness Strategies to Decrease Emergency Department Arrival Time in a Multiethnic Cohort. Stroke 2015; 46:1806-12. [DOI: 10.1161/strokeaha.114.008502] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/21/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Less than 25% of stroke patients arrive to an emergency department within the 3-hour treatment window. Stroke Warning Information and Faster Treatment (SWIFT) compared an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times in a prospective cohort of multiethnic stroke/transient ischemic attack survivors.
Methods—
A single-center randomized controlled trial (2005–2011) randomized participants to EE (bilingual stroke preparedness materials) or II (EE plus in-hospital sessions). We assessed differences by randomization in the proportion arriving to emergency department <3 hours, prepost intervention arrival <3 hours, incidence rate ratio for total events, and stroke knowledge and preparedness capacity.
Results—
SWIFT randomized 1193 participants (592 EE, 601 II): mean age 63 years; 50% female, 17% black, 51% Hispanic, 26% white. At baseline, 28% arrived to emergency department <3 hours. Over 5 years, first recurrent stroke (n=133), transient ischemic attacks (n=54), or stroke mimics (n=37) were documented in 224 participants. Incidence rate ratio=1.31 (95% confidence interval=1.05–1.63; II to EE). Among II, 40% arrived <3 hours versus 46% EE (
P
=0.33). In prepost analysis, there was a 49% increase in the proportion arriving <3 hours (
P
=0.001), greatest among Hispanics (63%,
P
<0.003). II had greater stroke knowledge at 1 month (odds ratio=1.63; 1.23–2.15). II had higher preparedness capacity at 1 month (odds ratio=3.36; 1.86, 6.10) and 12 months (odds ratio=7.64; 2.49, 23.49).
Conclusions—
There was no difference in arrival <3 hours overall between II and EE; the proportion arriving <3 hours increased in both groups and in race-ethnic minorities.
Clinical Trial Registration—
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415389.
Collapse
Affiliation(s)
- Bernadette Boden-Albala
- From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department
| | - Joshua Stillman
- From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department
| | - Eric T. Roberts
- From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department
| | - Leigh W. Quarles
- From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department
| | - M. Maria Glymour
- From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department
| | - Ji Chong
- From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department
| | - Harmon Moats
- From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department
| | - Veronica Torrico
- From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department
| | - Michael C. Parides
- From the Division of Social Epidemiology, Global Institute of Public Health (B.B.-A., E.T.R., L.W.Q., V.T.), Department of Neurology, Langone Medical Center (B.B.-A.), and Department of Epidemiology, College of Dentistry (B.B.-A.), New York University, NY; Department of Emergency Medicine (J.S.), and Department of Neurology (H.M.), Columbia University, New York, NY; Department of Epidemiology and Biostatistics, University of California at San Francisco (M.M.G.); Center for Biostatistics, Department
| |
Collapse
|