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Hara K, Kanda M, Kuwabara H, Kobayashi Y, Inoue T. Association between the quantity of stroke care units and the complement of neurosurgical and neurology specialists in Japan: A retrospective study. J Stroke Cerebrovasc Dis 2024; 33:107734. [PMID: 38670322 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107734] [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: 10/03/2023] [Revised: 12/13/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Stroke care units provide advanced intensive care for unstable patients with acute stroke. We conducted a survey to clarify the differences in stroke care units between urban and regional cities and the relationship between the number of stroke care unit beds and neurologists. METHODS This retrospective observational study was conducted in 2,857 and 4,184 hospitals in urban and regional cities in 47 provinces of Japan, respectively, between January 2020 and August 2023. Tokyo and ordinance-designated cities in provinces were defined as urban cities, and those without such cities were defined as regional cities. The primary endpoint was the presence or absence of a stroke care unit. RESULTS Multiple linear regression analysis revealed that the presence of stroke care units was significantly associated with the number of neurosurgical specialists. Receiver operating characteristic curve analysis was performed to predict the number of personnel required for stroke care unit installation based on the number of neurosurgical specialists. The area under the receiver operating characteristic curve, Youden index, sensitivity, and specificity were 0.721, 0.483, 0.783, and 0.700, respectively. CONCLUSIONS Our study underscores the indispensability of SCUs in stroke treatment, advocating for a strategic allocation of medical resources, heightened accessibility to neurosurgical specialists, and a concerted effort to address geographic and resource imbalances. The identified cutoff value of 8.99 neurosurgical specialists per 100,000 population serves as a practical benchmark for optimizing SCU establishment, thereby potentially mitigating stroke-related mortality.
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Affiliation(s)
- Kentaro Hara
- Department of Operation Center, National Hospital Organization Nagasaki Medical Center, Nagasaki 856-8562, Japan; Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8523, Japan; Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Masato Kanda
- Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Hiroyo Kuwabara
- Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
| | - Takahiro Inoue
- Healthcare Management Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan.
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O'Halloran R, Renton J, Harvey S, McSween MP, Wallace SJ. Do social determinants influence post-stroke aphasia outcomes? A scoping review. Disabil Rehabil 2024; 46:1274-1287. [PMID: 37010112 DOI: 10.1080/09638288.2023.2193760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To conduct a scoping review on five individual social determinants of health (SDOHs): gender, education, ethnicity, socioeconomic status, and social support, in relation to post-stroke aphasia outcomes. MATERIALS AND METHODS A comprehensive search across five databases was conducted in 2020 and updated in 2022. Twenty-five studies (3363 participants) met the inclusion criteria. Data on SDOHs and aphasia outcomes were extracted and analysed descriptively. RESULTS Twenty studies provide information on SDOH and aphasia recovery outcomes. Five studies provide insights on SDOH and response to aphasia intervention. Research on SDOH and aphasia recovery has predominantly focussed solely on language outcomes (14 studies), with less research on the role of SDOH on activity, participation, and quality of life outcomes (6 studies). There is no evidence to support a role for gender or education on language outcomes in the first 3 months post stroke. SDOHs may influence aphasia outcomes at or beyond 12 months post onset. CONCLUSIONS Research on SDOHs and aphasia outcomes is in its infancy. Given SDOHs are modifiable and operate over a lifetime, and aphasia is a chronic condition, there is a pressing need to understand the role of SDOHs on aphasia outcomes in the long term.
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Affiliation(s)
- Robyn O'Halloran
- NHMRC Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Australia
| | - Joanne Renton
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sam Harvey
- NHMRC Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
| | - Marie-Pier McSween
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
| | - Sarah J Wallace
- NHMRC Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
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Neibling B, Hayward KS, Smith M, Chapman P, Barker RN. Perseverance with home-based upper limb practice after stroke: perspectives of stroke survivors and their significant others. Disabil Rehabil 2024; 46:1103-1111. [PMID: 37144251 DOI: 10.1080/09638288.2023.2191011] [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: 05/28/2022] [Accepted: 03/09/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The aim of this study was to explore factors that influence stroke survivors' ability to persevere with home-based upper limb practice. METHODS A qualitative descriptive study embedded within a theoretical framework was conducted. Data were collected through semi-structured focus group, dyadic, and individual interviews. The Theoretical Domains Framework and Capability, Opportunity, Motivation - Behaviour (COM-B) model guided data collection and directed content analysis. FINDINGS Participants were 31 adult stroke survivors with upper limb impairment, with 13 significant other/s, who were living at home in Queensland, Australia. Three central tenants aligned with the COM-B and six themes were identified. Stroke survivors' capability to persevere was influenced by being physically able to practice and being able to understand, monitor and modify practice, their opportunity to persevere was influenced by accessing therapy and equipment required for practice and fitting practice into everyday life, and their motivation to persevere was influenced by having goals and experiencing meaningful outcomes and having support and being accountable. CONCLUSION Persevering with practice is multifaceted for stroke survivors. All facets need to be addressed in the design of strategies to enhance stroke survivors' ability to persevere and in turn, enhance their potential for continued upper limb recovery.IMPLICATIONS FOR REHABILITATIONMany stroke survivors do not persevere with long-term home-based upper limb practice despite the belief that high dose practice will promote continued recovery.Therapists need to support stroke survivors to setup individualised goal-based home programs that they can complete independently, or with support, within their everyday life.Stroke survivors need coaching to monitor and modify their practice and map their progress, so that they can recognise and experience meaningful recovery.To optimise upper limb recovery after stroke, strategies to enhance stroke survivors' capability, opportunity, and motivation to persevere across the continuum of recovery, need to be co-designed by stroke survivors, therapists and researchers.
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Affiliation(s)
- Bridee Neibling
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Kathryn S Hayward
- College of Healthcare Sciences, James Cook University, Townsville, Australia
- Departments of Physiotherapy, Medicine and Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Moira Smith
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Paul Chapman
- Rehabilitation Unit, Townsville University Hospital, Townsville, Australia
| | - Ruth N Barker
- College of Healthcare Sciences, James Cook University, Cairns, Australia
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Chow JWY, Dyett JF, Hirth S, Hart J, Duke GJ. Regional access to a centralized extracorporeal membrane oxygenation (ECMO) service in Victoria, Australia. CRIT CARE RESUSC 2024; 26:47-53. [PMID: 38690191 PMCID: PMC11056431 DOI: 10.1016/j.ccrj.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 05/02/2024]
Abstract
Introduction Victoria, Australia provides a centralised state ECMO service, supported by ambulance retrieval. Equity of access to this service has not been previously described. Objective Describe the characteristics of ECMO recipients and quantify geographical and socioeconomic influence on access. Design Retrospective observational study with spatial mapping. Participants and setting Adult (≥18 years) ECMO recipients from July 2016-June 2022. Data from administrative Victorian Admissions Episodes Database analysed in conjunction with Australian Urban Research Infrastructure Network population data and choropleth mapping. Presumed ECMO modes were inferred from cardiopulmonary bypass and pre-hospital cardiac arrest codes. Spatial autoregressive models including Moran's test used for spatial lag testing. Outcomes Demographics and outcomes of ECMO recipients; ECMO incidence by patient residence (Statistical-Area Level 2, SA-2) and Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD); and ECMO utilisation adjusted for patient factors and linear distance from the central ECMO referral site. Results 631 adults received ECMO over 6 years, after exclusion of paediatric (n = 242), duplicate (n = 135), and interstate or incomplete (n = 72) records. Mean age was 51.8 years, and 68.8 % were male. Overall ECMO incidence was 3.00 ± 3.95 per 105 population. 135 (21.4 %) were presumed VA-ECMO, 59 (9.3 %) presumed ECPR, and 437 (69.3 %) presumed VV-ECMO. Spatial lag was non-significant after adjusting for patient characteristics. Distance from the central referral site (dy/dx = 0.19, 95% CI -0.41-0.04, p = 0.105) and IRSAD score (dy/dx = 0.17, 95% CI -0.19-0.53, p = 0.359) did not predict ECMO utilisation. Conclusion Victorian ECMO incidence rates were low. We did not find evidence of inequity of access to ECMO irrespective of regional area or socioeconomic status.
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Affiliation(s)
- Joanna WY. Chow
- Box Hill Hospital, Eastern Health, VIC, Australia
- Alfred Hospital, Alfred Health, VIC, Australia
| | - John F. Dyett
- Box Hill Hospital, Eastern Health, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, VIC, Australia
- Monash Eastern Clinical School, VIC, Australia
| | - Steve Hirth
- Box Hill Hospital, Eastern Health, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, VIC, Australia
| | - Julia Hart
- Box Hill Hospital, Eastern Health, VIC, Australia
| | - Graeme J. Duke
- Box Hill Hospital, Eastern Health, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, VIC, Australia
- Monash Eastern Clinical School, VIC, Australia
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Korompoki E, Ntaios G, Tountopoulou A, Mavraganis G, Tsampalas E, Kalliontzakis I, Vassilopoulou S, Manios E, Savopoulos C, Milionis H, Protogerou A, Kakaletsis N, Galanis P, Kaitelidou D, Siskou O, Vemmos K. Quality Indicators and Clinical Outcomes of Acute Stroke: Results from a Prospective Multicenter Registry in Greece (SUN4P). J Clin Med 2024; 13:917. [PMID: 38337611 PMCID: PMC10856279 DOI: 10.3390/jcm13030917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
AIM The Stroke Units Necessity for Patients (SUN4P) project aims to provide essential data on stroke healthcare in Greece. Herein, we present results on established quality indicators and outcomes after first-ever stroke occurrences. METHODS This prospective multicenter study included consecutive patients admitted to nine hospitals across Greece in 2019-2021. Descriptive statistics were used to present patients' characteristics, key performance measures and stroke outcomes. RESULTS Among 892 patients, 755 had ischemic stroke (IS) (mean age 75.6 ± 13.6, 48.7% males) and 137 had hemorrhagic stroke (HS) (mean age 75.8 ± 13.2, 57.7% males). Of those, 15.4% of IS and 8% of HS patients were treated in the acute stroke unit (ASU) and 20.7% and 33.8% were admitted to the intensive care unit (ICU) or high-dependency unit (HDU), respectively. A total of 35 (4.6%) out of 125 eligible patients received intravenous alteplase with a door-to needle time of 60 min (21-90). The time to first scan for IS patients was 60 min (31-105) with 53.2% undergoing a CT scan within 60 min post presentation. Furthermore, 94.4% were discharged on antiplatelets, 69.8% on lipid-lowering therapy and 61.6% on antihypertensives. Oral anticoagulants (OAC) were initiated in 73.2% of the 153 IS patients with atrial fibrillation (AF). Among the 687 IS patients who survived, 85.4% were discharged home, 12% were transferred to rehabilitation centers, 1.2% to nursing homes and 1.3% to another hospital. CONCLUSIONS The SUN4P Registry is the first study to provide data from a prospectively collected cohort of consecutive patients from nine representative national hospitals. It represents an important step in the evaluation and improvement of the quality of acute stroke care in Greece.
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Affiliation(s)
- Eleni Korompoki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece; (G.M.); (E.M.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece;
| | - Argyro Tountopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.T.); (S.V.)
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece; (G.M.); (E.M.)
| | | | | | - Sofia Vassilopoulou
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (A.T.); (S.V.)
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece; (G.M.); (E.M.)
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece;
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45500 Ioannina, Greece;
| | - Athanasios Protogerou
- Clinic-Laboratory of Pathophysiology, First Department of Propeadeutic Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Nikolaos Kakaletsis
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital of Thessaloniki, 54643 Thessaloniki, Greece;
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (D.K.); (O.S.)
| | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (D.K.); (O.S.)
| | - Olga Siskou
- Center for Health Services Management and Evaluation, Nursing Department, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.G.); (D.K.); (O.S.)
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece
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Firth N, Hayward KS, Bernhardt J, Ray R, Barker RN. Stroke survivors' perspectives on decision-making about rehabilitation and the prospect of taking recovery-promoting drugs: A qualitative study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100297. [PMID: 37448649 PMCID: PMC10338145 DOI: 10.1016/j.rcsop.2023.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives To investigate factors which influence stroke survivors' decision-making about their rehabilitation and the prospect of taking recovery-promoting drugs, to enhance their recovery. Methods Seventeen stroke survivors who had undertaken stroke rehabilitation, and three spouses, participated in focus groups and individual interviews in northern Queensland, Australia. Inductive thematic analysis of the interview data was conducted in accordance with Braun and Clarke's six-phase process. Results Two specific, pivotal decision points during participants' stroke recovery process were identified: 1) overall, when deciding what rehabilitation they would undertake and hypothetically what recovery-promoting drugs they would take, and 2) on a daily basis, when deciding whether to participate in rehabilitation and take recovery-promoting drugs on any given day. Six themes which described factors influencing their decision-making were: 'My options for rehabilitation and recovery-promoting drugs'; 'The costs of rehabilitation and recovery-promoting drugs'; 'My recovery goals'; 'What I can deal with today'; 'The people my rehabilitation and recovery-promoting drugs affect'; and 'Fitting rehabilitation and recovery-promoting drugs into my life.' These themes were applicable at either one or both of the identified decision points. Conclusion Factors that influence stroke survivors' decision-making, overall and on a day-to-day basis, need to be considered to ensure they can make the best decisions for themselves to achieve their full recovery potential. Understanding the conditions under which a stroke survivor would take a recovery-promoting drug will contribute to the development of dosing protocols to which stroke survivors could adhere.
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Affiliation(s)
- Nerida Firth
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Kathryn S. Hayward
- Departments of Physiotherapy and Medicine, University of Melbourne, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Robin Ray
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Ruth N. Barker
- College of Healthcare Sciences, James Cook University, Cairns, Australia
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Adenova G, Kausova G, Tazhiyeva A. Improving multidisciplinary hospital care for acute cerebral circulation disorders in Kazakhstan. Heliyon 2023; 9:e18435. [PMID: 37593645 PMCID: PMC10427984 DOI: 10.1016/j.heliyon.2023.e18435] [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: 02/09/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background According to the World Stroke Organization, there was a significant increase in stroke cases, stroke deaths, and the DALY rate in low- and middle-income countries in 2022. The number of stroke cases rose by 70.0%, stroke deaths reached 86.0%, and the DALY rate reached 89.0%. Among cerebrovascular diseases, ischemic stroke accounts for 62.0% of all strokes, with more than 7.6 million cases reported annually.Kazakhstan, with a population of 19,832,737, is the largest country in Central Asia in terms of territory. In Kazakhstan, the incidence of cerebrovascular disease has risen from 258.4 cases per 100,000 population in 2015 to 433.7 cases per 100,000 population in 2020. Official statistics indicate that the average inpatient mortality rate from stroke in the country is 16.2%, and the average time for patients to be delivered to the hospital after an ambulance call is 40 min (83.2%).Our study findings reveal that in the regions of Kazakhstan, the main contributors to the high morbidity and mortality rates in stroke are a shortage of doctors, inadequate primary healthcare, insufficient follow-up and treatment, and delayed hospitalization. Consequently, this study has helped fill knowledge gaps regarding the epidemiological situation in these regions and underscores the need for training doctors in managing high-risk patients, establishing multidisciplinary home visit teams, and establishing "Stroke Schools" to enhance public awareness of early stroke signs and the fundamentals of a healthy lifestyle. Future research endeavors should consider these study results as valuable contributions towards addressing the existing problems. Aim To study the prevalence and mortality of acute cerebral circulation impairment in the population within multidisciplinary hospitals in the cities of Nur-Sultan and Almaty, Republic of Kazakhstan, for the period of 2018-2020.This retrospective study was conducted in two stages. In the first stage, an analysis of morbidity, prevalence, and mortality was conducted for the population of Nur-Sultan and Almaty cities, as well as for the overall population of Kazakhstan. This analysis was based on data from the "Electronic Register of Discharged Patients" (IS ERDB) and the annual collection "Health of the Population of the Republic of Kazakhstan and the Activities of Health Organizations in 2015-2020". In the second stage, we examined the care provided to patients with acute impaired cerebral circulation in a multidisciplinary hospital in these two cities. The analysis was based on data regarding the sex and age composition of treated patients in hospitals across the Republic of Kazakhstan, categorized according to the ICD-10 code "Acute Impaired Cerebral Circulation" (I60-I64). We investigated the methods of patients' delivery to medical organizations, types of hospitalization, and outcomes of treated patients. The sample of patients was selected using data from the "Electronic Register of Dispensary Patients" of the Ministry of Health of the Republic of Kazakhstan, along with the statistical collection "Health of the Population of the Republic of Kazakhstan and the Activities of Healthcare Organizations". Between January 1, 2018, and December 31, 2020, a total of 5965 patients were diagnosed with a cerebrovascular event and admitted to a general hospital in Nur-Sultan city, while 13,498 patients were diagnosed and admitted in Almaty city.
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Affiliation(s)
| | - Galina Kausova
- Kazakhstan Medical University “KSPH”, Almaty, Kazakhstan
| | - Aigul Tazhiyeva
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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Kapral MK. Kenton Award Lecture-Stroke Disparities Research: Learning From the Past, Planning for the Future. Stroke 2023; 54:379-385. [PMID: 36689593 DOI: 10.1161/strokeaha.122.039562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/15/2022] [Indexed: 01/24/2023]
Abstract
Inequities in stroke care and outcomes have been documented both within and among countries based on factors, such as race, geography, and socioeconomic status. Research can help us to identify, understand, and address inequities, and this article offers considerations for scientists working in this area. These include designing research aimed at identifying the underlying causes of inequities, recognizing the importance of the social determinants of health, considering interventions that go beyond the individual patient and provider to include policies and systems, acknowledging the role of structural racism, performing community-engaged participatory research, considering intersecting social identities, learning from cross-national comparisons, maintaining the data sources needed for inequities research, using terminology that advances health equity, and improving diversity across the research enterprise.
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Affiliation(s)
- Moira K Kapral
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Canada (M.K.K.)
- ICES, Toronto, Canada (M.K.K.)
- Toronto General Hospital Research Institute, Canada (M.K.K.)
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Teow KH, Tan PS, Frost T, Dewey HM, Borosak M, Choi PMC. Trends in direct oral anticoagulant use in patients presenting with acute stroke. Intern Med J 2022; 52:1633-1637. [PMID: 36100570 PMCID: PMC9546077 DOI: 10.1111/imj.15903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/18/2022] [Indexed: 11/26/2022]
Abstract
Acute ischaemic strokes occur despite the use of direct oral anticoagulants (DOACs). A retrospective review was conducted at a high‐volume primary stroke centre over a 3‐year period to assess the acute management of stroke presentations in patients prescribed DOACs. During the time period of the study, 103 of 195 anticoagulated stroke patients presented within the timeframe for thrombolysis and only 15 patients had DOAC plasma level assays performed. Of these 103, 5 received thrombolysis; however, DOAC level was not a factor in these cases.
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Affiliation(s)
- Kang H Teow
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Peter S Tan
- Department of Neuroscience, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Tanya Frost
- Department of Neuroscience, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Helen M Dewey
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Neuroscience, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Marija Borosak
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Laboratory Haematology, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Philip M C Choi
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Neuroscience, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
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Thompson SG, Barber PA, Gommans JH, Cadilhac DA, Davis A, Fink JN, Harwood M, Levack W, McNaughton HK, Feigin VL, Abernethy V, Girvan J, Kim J, Denison H, Corbin M, Wilson A, Douwes J, Ranta A. Geographic Disparities in Stroke Outcomes and Service Access: A Prospective Observational Study. Neurology 2022; 99:e414-e426. [PMID: 35623890 PMCID: PMC9421775 DOI: 10.1212/wnl.0000000000200526] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES International evidence shows that patients treated at nonurban hospitals experience poorer access to key stroke interventions. Evidence for whether this results in poorer outcomes is conflicting and generally based on administrative or voluntary registry data. The aim of this study was to use prospective high-quality comprehensive nationwide patient-level data to investigate the association between hospital geography and outcomes of patients with stroke and access to best-practice stroke care in New Zealand. METHODS This is a prospective, multicenter, nationally representative observational study involving all 28 New Zealand acute stroke hospitals (18 nonurban) and affiliated rehabilitation and community services. Consecutive adults admitted to the hospital with acute stroke between May 1 and October 31, 2018, were captured. Outcomes included functional outcome (modified Rankin Scale [mRS] score shift analysis), functional independence (mRS score 0-2), quality of life (EuroQol 5-dimension, 3-level health-related quality of life questionnaire), stroke/vascular events, and death at 3, 6, and 12 months and proportion accessing thrombolysis, thrombectomy, stroke units, key investigations, secondary prevention, and inpatient/community rehabilitation. Results were adjusted for age, sex, ethnicity, stroke severity/type, comorbid conditions, baseline function, and differences in baseline characteristics. RESULTS Overall, 2,379 patients were eligible (mean [SD] age 75 [13.7] years; 51.2% male; 1,430 urban, 949 nonurban). Patients treated at nonurban hospitals were more likely to score in a higher mRS score category (greater disability) at 3 (adjusted odds ratio [aOR] 1.28, 95% CI 1.07-1.53), 6 (aOR 1.33, 95% CI 1.07-1.65), and 12 (aOR 1.31, 95% CI 1.06-1.62) months and were more likely to have died (aOR 1.57, 95% CI 1.17-2.12) or experienced recurrent stroke and vascular events at 12 months (aOR 1.94, 95% CI 1.14-3.29 and aOR 1.65, 95% CI 1.09-2.52). Fewer nonurban patients received recommended stroke interventions, including endovascular thrombectomy (aOR 0.25, 95% CI 0.13-0.49), acute stroke unit care (aOR 0.60, 95% CI 0.49-0.73), antiplatelet prescriptions (aOR 0.72, 95% CI 0.58-0.88), ≥60 minutes of daily physical therapy (aOR 0.55, 95% CI 0.40-0.77), and community rehabilitation (aOR 0.69, 95% CI 0.56-0.84). DISCUSSION Patients managed at nonurban hospitals experience poorer stroke outcomes and reduced access to key stroke interventions across the entire care continuum. Efforts to improve access to high quality stroke care in nonurban hospitals should be a priority.
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Affiliation(s)
- Stephanie G Thompson
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - P Alan Barber
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - John H Gommans
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Dominique A Cadilhac
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Alan Davis
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - John N Fink
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Matire Harwood
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - William Levack
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Harry K McNaughton
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Valery L Feigin
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Virginia Abernethy
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Jacqueline Girvan
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Joosup Kim
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Hayley Denison
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Marine Corbin
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Andrew Wilson
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Jeroen Douwes
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand
| | - Annemarei Ranta
- From the Department of Medicine (S.G.T., W.L., A.R.), University of Otago, Wellington; Departments of Medicine (P.A.B.) and General Practice (M.H.), Auckland University; Department of Medicine (J.H.G.), Hawke's Bay District Health Board, New Zealand; Department of Medicine (D.A.C., J.K.), School of Clinical Sciences, Monash University, Melbourne, Australia; Department of Medicine (A.D.), Whangarei Hospital; Department of Neurology (J.N.F.), Canterbury District Health Board, Christchurch; Medical Research Institute of New Zealand (H.K.M.), Wellington; Auckland University of Technology (V.L.F.); Stroke Foundation New Zealand (V.A.), Wellington; Consumer Advisor (J.G.); Centre for Public Health and Epidemiology (H.D., M.C., J.D.), Massey University, Wellington; Department of Medicine (A.W.), Wairau Hospital, Blenheim; and Department of Neurology (A.R.), Capital & Coast District Health Board, Wellington, New Zealand.
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11
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Wright K, Dehar A, Stott NS, Mackey A, Sorhage A, Tapera R, Williams SA. Prioritizing indigenous health equity in health registers: an environmental scan of strategies for equitable ascertainment and quality data. Glob Health Res Policy 2022; 7:24. [PMID: 35854338 PMCID: PMC9295285 DOI: 10.1186/s41256-022-00250-6] [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: 10/27/2021] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cerebral palsy (CP) registers serve as instrumental tools to support development of care pathways, preventative strategies, and health gains. Such health gains, however, are not always universal, with Indigenous health inequities common. To support Indigenous health, health registers need complete, consistent, and high-quality data. The aim of this study was to identify perceived barriers to the ascertainment of Indigenous peoples on health registers and to collate strategies supporting comprehensive ascertainment and achievement of high-quality Indigenous data. Methods Environmental scanning methods were utilized within a Kaupapa Māori theoretical framework, which aims to produce research that is transformational and supportive of Indigenous health gain. Knowledge and insights were obtained from CP registers in countries with Indigenous populations and complemented by information from health registers in Aotearoa New Zealand (NZ). Data collection methods included an online survey and scan of organizational websites. Data extraction focused on general information about the register, barriers to ascertainment, and strategies to support ascertainment and high data quality. Results 52 registers were identified, 20 completed the survey and 19 included in the study (CP registers, n = 10, NZ health registers, n = 9). Web scan data were included for the other 32 registers (CP registers, n = 21, NZ health registers, n = 11). Indigenous health equity was identified in the visions and aims of only two health registers. Ethnicity data collection was identified in nearly three quarters of survey respondents and a limited number of organizational websites. Over half of survey respondents described system, health provider/service, or workforce barriers to ascertainment. Strategies were categorized into collaboration, health provider/service, workforce, and systems-levels. Indigenous-specific strategies were limited and focused on personal behaviour and access to registration. Conclusions CP and other health registers can have a significant role in identifying and addressing Indigenous health inequities. However, this is not currently an overt priority for many registers in this study and few registers describe ascertainment and data quality strategies specific to Indigenous peoples. Significant opportunity exists for health registers to be accountable and to implement approaches to support Indigenous health equity, address structural determinants of inequities, and achieve health gain for all.
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Affiliation(s)
- Karen Wright
- Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori, Auckland, New Zealand.
| | - Aria Dehar
- Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori, Auckland, New Zealand
| | - N Susan Stott
- Department of Surgery, University of Auckland, Auckland, New Zealand.,New Zealand Cerebral Palsy Register, Starship Child Health, Auckland, New Zealand
| | - Anna Mackey
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland, New Zealand
| | - Alexandra Sorhage
- New Zealand Cerebral Palsy Register, Starship Child Health, Auckland, New Zealand
| | - Rachel Tapera
- Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori, Auckland, New Zealand
| | - Sîan A Williams
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Curtin School of Allied Health, Curtin University, Perth, Australia
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12
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Gao L, Tan E, Kim J, Bladin CF, Dewey HM, Bagot KL, Cadilhac DA, Moodie M. Telemedicine for Stroke: Quantifying the Long-Term National Costs and Health Benefits. Front Neurol 2022; 12:804355. [PMID: 35813183 PMCID: PMC9265143 DOI: 10.3389/fneur.2021.804355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveFew countries have established national programs to maximize access and reduce operational overheads. We aimed to use patient-level data up to 12 months to model the potential long-term costs and health benefits attributable to implementing such a program for Australia.MethodsA Markov model was created for Australia with an inception population of 10,000 people with stroke presenting to non–urban or suburban hospitals without stroke medical specialists that could receive stroke telemedicine under a national program. Seven Markov states represented the seven modified Rankin Scale (mRS) scores (0 no disability to 6 dead) plus an absorbing state for all other causes of death. The literature informed inputs for the model; for the telemedicine program (including program costs and effectiveness) and patients, these were extrapolated from the Victorian Stroke Telemedicine (VST) program with the initial status of patients being their health state at day 365 as determined by their mRS score. Costs (2018 Australian dollars, healthcare, non–medical, and nursing home) and benefits were reported for both the societal and healthcare perspectives for up to a 25 years (lifetime) time horizon.ResultsWe assumed 4,997 to 12,578 ischemic strokes would arrive within 4.5 h of symptom onset at regional hospitals in 2018. The average per person lifetime costs were $126,461 and $127,987 from a societal perspective or $76,680 and $75,901 from a healthcare system perspective and benefits were 4.43 quality-adjusted life years (QALYs) and 3.98 QALYs gained, respectively, for the stroke telemedicine program and practice without such program. The stroke telemedicine program was associated with a cost saving of $1,526 (from the societal perspective) or an additional $779 (from the healthcare system perspective) and an additional 0.45 QALY gained per patient over the lifetime. The incremental costs of the stroke telemedicine program ($2,959) and management poststroke ($813) were offset by cost savings from rehospitalization (–$552), nursing home care (–$2178), and non–medical resource use (–$128).ConclusionThe findings from this long-term model provide evidence to support ongoing funding for stroke telemedicine services in Australia. Our estimates are conservative since other benefits of the service outside the use of intravenous thrombolysis were not included.
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Affiliation(s)
- Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Elise Tan
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Joosup Kim
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Christopher F. Bladin
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Ambulance Victoria, Doncaster, VIC, Australia
| | - Helen M. Dewey
- Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Kathleen L. Bagot
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- *Correspondence: Dominique A. Cadilhac
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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13
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The Allure of Big Data to Improve Stroke Outcomes: Review of Current Literature. Curr Neurol Neurosci Rep 2022; 22:151-160. [PMID: 35274192 PMCID: PMC8913242 DOI: 10.1007/s11910-022-01180-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To critically appraise literature on recent advances and methods using "big data" to evaluate stroke outcomes and associated factors. RECENT FINDINGS Recent big data studies provided new evidence on the incidence of stroke outcomes, and important emerging predictors of these outcomes. Main highlights included the identification of COVID-19 infection and exposure to a low-dose particulate matter as emerging predictors of mortality post-stroke. Demographic (age, sex) and geographical (rural vs. urban) disparities in outcomes were also identified. There was a surge in methodological (e.g., machine learning and validation) studies aimed at maximizing the efficiency of big data for improving the prediction of stroke outcomes. However, considerable delays remain between data generation and publication. Big data are driving rapid innovations in research of stroke outcomes, generating novel evidence for bridging practice gaps. Opportunity exists to harness big data to drive real-time improvements in stroke outcomes.
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14
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Sharobeam A, Yan B. Advanced imaging in acute ischemic stroke: an updated guide to the hub-and-spoke hospitals. Curr Opin Neurol 2022; 35:24-30. [PMID: 34845146 DOI: 10.1097/wco.0000000000001020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the role of the hub-and-spoke system in acute stroke care, highlight the role of advanced imaging and discuss emerging concepts and trials relevant to the hub-and-spoke model. RECENT FINDINGS The advent of advanced stroke multimodal imaging has provided increased treatment options for patients, particularly in rural and regional areas. When used in the hub-and-spoke model, advanced imaging can help facilitate and triage transfers, appropriately select patients for acute therapy and treat patients who may otherwise be ineligible based on traditional time metrics.Recent, ongoing trials in this area may lead to an even greater range of patients being eligible for acute reperfusion therapy, including mild strokes and patients with large core infarct volumes. SUMMARY Integration of advanced imaging into a hub-and-spoke system, when complemented with other systems including telemedicine, improves access to acute stroke care for patients in regional and rural areas.
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Affiliation(s)
- Angelos Sharobeam
- Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Australia
- School of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville
- Victorian Stroke Telemedicine Service, Ambulance Victoria, Australia
| | - Bernard Yan
- Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Australia
- School of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville
- Neurointervention Service, The Royal Melbourne Hospital, Parkville, Australia
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15
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Lu Y, Sun W, Shen Z, Sun W, Liu R, Li F, Shu J, Tai L, Li G, Chen H, Zhang G, Zhang L, Sun X, Qiu J, Wei Y, Jin H, Huang Y. Regional Differences in Hospital Costs of Acute Ischemic Stroke in China: Analysis of Data From the Chinese Acute Ischemic Stroke Treatment Outcome Registry. Front Public Health 2021; 9:783242. [PMID: 34957035 PMCID: PMC8702643 DOI: 10.3389/fpubh.2021.783242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Studies on the regional differences in hospital costs of acute ischemic stroke (AIS) are scarce in China. We aimed to explore the regional differences in hospital costs and identify the determinants of hospital costs in each region. Methods: Data were collected from the Chinese Acute Ischemic Stroke Treatment Outcome Registry (CASTOR), a multicenter prospective study on patients diagnosed with AIS and hospitalized from 2015 to 2017. Univariate and multivariate analyses were undertaken to identify the determinants of hospital costs of AIS. Results: A total of 8,547 patients were included in the study, of whom 3,700 were from the eastern area, 2,534 were from the northeastern area, 1,819 were from the central area, and 494 were from the western area. The median hospital costs presented a significant difference among each region, which were 2175.9, 2175.1, 2477.7, and 2282.4 dollars in each area, respectively. Each region showed a similar hospital cost proportion size order of cost components, which was Western medicine costs, other costs, diagnostic costs, and traditional medicine costs, in descending order. Male sex, diabetes mellitus, severe stroke symptoms, longer length of stay, admission to the intensive care unit, in-hospital complications of hemorrhage, and thrombectomy were independently associated with hospital costs in most regions. Conclusion: Hospital costs in different regions showed a similar proportion size order of components in China. Each region had different determinants of hospital costs, which reflected its current medical conditions and provided potential determinants for increasing medical efficiency according to each region's situation.
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Affiliation(s)
- Yuxuan Lu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Weiping Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhiyuan Shen
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Ran Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Junlong Shu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Liwen Tai
- Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guozhong Li
- Department of Neurology, First Affiliated Hospital of Harbin Medical University, Neurology, Harbin, China
| | - Huisheng Chen
- Department of Neurology, The General Hospital of Shenyang Military Command, Shenyang, China
| | - Guiru Zhang
- Department of Neurology, Penglai People's Hospital, Penglai, China
| | - Lei Zhang
- Department of Neurology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xuwen Sun
- Department of Neurology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jinhua Qiu
- Department of Neurology, Huizhou First Hospital, Huizhou, China
| | - Yan Wei
- Department of Neurology, Harrison International Peace Hospital, Hengshui, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
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