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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.
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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
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Yuan J, Li M, Liu Y, Xiong X, Zhu Z, Liu F, Wang Y, Hu W, Lu ZK, Liu R, Zhao J. Analysis of Time to the Hospital and Ambulance Use Following a Stroke Community Education Intervention in China. JAMA Netw Open 2022; 5:e2212674. [PMID: 35579896 PMCID: PMC9115614 DOI: 10.1001/jamanetworkopen.2022.12674] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/29/2022] [Indexed: 12/03/2022] Open
Abstract
Importance Prehospital delay (time from symptom onset of stroke to the door of a hospital) in patients with stroke is long in China. With the goal of improving public awareness and knowledge of stroke recognition, Stroke 1-2-0 was developed in China as an education program to prompt rapid response to the onset of stroke based on clinical practice in China, and examination of its outcomes is needed. Objective To investigate the association of the Stroke 1-2-0 educational campaign with prehospital delay for patients with ischemic stroke. Design, Setting, and Participants In a population-based cross-sectional study, all patients with ischemic stroke events were admitted to the Minhang Hospital, which is the only tertiary care hospital with a stroke center that provides acute stroke care in Xinzhuang county, Shanghai, China. The study period was from January 1, 2016, to December 31, 2019, and data analysis was performed from January 1 to July 31, 2021. Exposures A multifaceted Stroke 1-2-0 educational campaign comprising slides, videos, brochures, and posters distributed in the community. Main Outcomes and Measures Proportion of patients with hospital arrival within 3 hours and use of an ambulance to seek medical care, as well as the odds of seeking medical attention within 3 hours after the stroke before vs after initiation of the multifaceted educational campaign. Results A total of 2857 patients (1774 men [62.1%]; mean [SD] age, 69.83 [12.66] years) with stroke were identified, including 503 in the precampaign period and 2354 in the postcampaign period. Following the multifaceted campaign, the median (IQR) prehospital delay time decreased from 18.72 (7.44-27.84) hours to 6.00 (2.00-16.35) hours (P < .001). After the implementation of the Stroke 1-2-0 campaign, the proportion of patients with hospital arrival time within 3 hours increased from 5.8% to 33.4% (P < .001) and use of an ambulance increased from 3.2% to 30.6% (P < .001). In an interrupted time series analysis, the initiation of the Stroke 1-2-0 campaign was associated with significantly increased odds of arriving at the hospital within 3 hours (odds ratio, 8.01; 95% CI, 7.17-8.95; P < .001) and use of an ambulance (odds ratio, 9.41; 95% CI, 8.24-10.74; P < .001). Conclusions and Relevance The persistent multifaceted campaign using the Stroke 1-2-0 program was associated with reduced prehospital delay and improved timely arrival rate and ambulance arrival rate for patients with stroke. These findings suggest that Stroke 1-2-0 can be adopted in other regions of China to possibly improve health outcomes and reduce clinical burdens for all patients with stroke.
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Affiliation(s)
- Jing Yuan
- Department of Clinical Pharmacy, School of Pharmacy, Fudan University, Shanghai, China
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Xiaomo Xiong
- Clinical Pharmacy and Outcomes Sciences Department, University of South Carolina, Columbia
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Fangyu Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Wei Hu
- Department of Cardiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Z. Kevin Lu
- Clinical Pharmacy and Outcomes Sciences Department, University of South Carolina, Columbia
| | - Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
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3
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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.
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4
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Bull Iversen A, Paaske Johnsen S, Christensen B, Bondo Christensen M, Andersen G. The impact of a Danish stroke campaign: A cross-sectional study. Acta Neurol Scand 2022; 145:102-110. [PMID: 34523120 DOI: 10.1111/ane.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the impact of the Danish stroke campaign, 1 year after initiation. MATERIALS & METHODS The campaign ran in various media during 2019-2020. We performed a two-centre, repeated cross-sectional study in 2018 (before campaign) and again in 2020 based on data from structured interviews of patients and bystanders, medical records and the Danish Stroke Registry. Primary outcomes were patient delay and system delay. Patient delay is defined as the time from symptom onset until the first contact to a healthcare professional, whereas system delay is the time from this contact until arrival at the stroke centre. Secondary outcomes were primary emergency medical services (EMS) contact, arrival at a stroke centre within 3 h of symptom onset, initiation of reperfusion therapy and knowledge of ≥2 core symptoms of stroke. RESULTS We included 852 patients with stroke or transient ischemic attack. Patient delay and system delay were a median of 166 min and 96 min before the campaign and were non-significantly reduced by 16 min (95% CI -128 to 97) and 7 min (95% CI -21 to 6) in the second period. We found no significant differences in the clinical outcomes. The knowledge of ≥2 core symptoms increased from 22% to 30% (OR 1.63; 95% CI 1.15 to 2.30) in patients and from 53% to 65% (OR 1.81; 95% CI 1.24 to 2.64) in bystanders. CONCLUSION Patient delay, system delay and clinical outcomes remained relatively unchanged. However, the knowledge of core symptoms had improved 1 year after campaign initiation.
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Affiliation(s)
- Ane Bull Iversen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research Department of Clinical Medicine Aalborg University and Aalborg University Hospital Aalborg Denmark
| | - Bo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Grethe Andersen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
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Kharbach A, Obtel M, Achbani A, Aasfara J, Hassouni K, Lahlou L, Razine R. Ischemic stroke in Morocco: Prehospital delay and associated factors. Rev Epidemiol Sante Publique 2021; 69:345-359. [PMID: 34148762 DOI: 10.1016/j.respe.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco. PATIENTS AND METHODS An observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department. RESULTS A total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6hours (IQR, 4-16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40-437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57-80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01-0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00-0.36), and direct admission without reference (OR 0.005; CI95%: 0.00-0.07), were independently associated with late arrival (>4.5hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37-138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03-0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00-0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03-0.80), distance between 50 and 100km (OR 10.16; CI95%: 1.16-89.33), and direct admission without reference (OR 0.03; CI95%: 0.00-0.14), were independently associated with late arrival (>6hours) of patients with acute ischemic stroke. CONCLUSION Patient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.
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Affiliation(s)
- A Kharbach
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - M Obtel
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - A Achbani
- Laboratory of Cell Biology and Molecular Genetics (LBCGM), Department of Biology, Faculty of Sciences, University Ibn Zohr Agadir, Rabat, Morocco.
| | - J Aasfara
- Department of Neurology, International Cheikh Khalifa University Hospital, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - K Hassouni
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - L Lahlou
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Agadir, Morocco.
| | - R Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
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6
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Lavorgna L, Brigo F, Esposito S, Abbadessa G, Sparaco M, Lanzillo R, Moccia M, Inglese M, Bonfanti L, Trojsi F, Spina E, Russo A, De Micco P, Clerico M, Tedeschi G, Bonavita S. Public Engagement and Neurology: An Update. Brain Sci 2021; 11:429. [PMID: 33800571 PMCID: PMC8065487 DOI: 10.3390/brainsci11040429] [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: 01/28/2021] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Public engagement (PE) is defined as the involvement of "specialists who listen, develop their understanding, and interact with non-specialists in non-profit activities of educational, cultural, and social nature to engage the public in science-related matters". The public health relevance of PE consists in building up a scientifically literate society, able to participate in and support scientific and technological developments and their implications for educational settings. Neurological disorders account for 35% of all diseases. PE could have a positive impact on the lives of people affected by neurological diseases. METHOD This review evaluates the role of PE in dementia, stroke, epilepsy, multiple sclerosis, Parkinson's disease, migraine, neurogenetics, and amyotrophic lateral sclerosis. RESULTS AND CONCLUSIONS PE can provide accessible information, support research activities and prevention through appropriate lifestyles, and increase knowledge and awareness of neurological disorders, improving their diagnosis and treatment.
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Affiliation(s)
- Luigi Lavorgna
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), 39012 Merano, Italy;
| | - Sabrina Esposito
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Gianmarco Abbadessa
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Maddalena Sparaco
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Matilde Inglese
- Italy—OSPEDALE San Martino, IRCCS, University of Genova, 16132 Genoa, Italy;
| | - Luca Bonfanti
- Neuroscience Institute Cavalieri Ottolenghi (NICO), 10043 Orbassano, Italy;
- Department of Veterinary Sciences, University of Turin, 10095 Torino, Italy
| | - Francesca Trojsi
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Emanuele Spina
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Antonio Russo
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | | | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Torino, 10124 Turin, Italy;
| | - Gioacchino Tedeschi
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Simona Bonavita
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
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7
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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.
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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
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8
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Using Search Engine Data to Explore Interest in PrEP and HIV Testing in the United States. AIDS Behav 2021; 25:983-991. [PMID: 33033997 DOI: 10.1007/s10461-020-03057-z] [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] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
We used Google search data from January 1, 2014 to January 1, 2019 to explore public awareness of pre-exposure prophylaxis (PrEP) and HIV testing in the United States. Using two search strings, one for PrEP and one for HIV testing, we compared search volume to state HIV prevalence and new HIV diagnoses. We also used Google News to identify news events related to short-term spikes in search volume. Controlling for poverty, education, and internet access, a one-unit increase in a state's HIV prevalence rate was associated with a 3% increase in PrEP search volume (aPR = 1.03 [1.034, 1.037], P < 0.0001) and HIV testing search volume (aPR = 1.03 [1.030, 1.032], P < 0.0001). Short-term search volume spikes also coincided with celebrity news and pharmaceutical company advertising. We demonstrate that search engine data can be a powerful tool for understanding HIV knowledge-seeking and can provide key insight to the events that drive public interest about HIV online.
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9
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McCambridge J, Keane C, Walshe M, Campbell P, Heyes J, Kalra PR, Cowie MR, Riley JP, O'Hanlon R, Ledwidge M, Gallagher J, McDonald K. The prehospital patient pathway and experience of care with acute heart failure: a comparison of two health care systems. ESC Heart Fail 2020; 8:1076-1084. [PMID: 33369196 PMCID: PMC8006706 DOI: 10.1002/ehf2.13089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 01/12/2023] Open
Abstract
Aims This study aimed to analyse community management of patients during the symptomatic period prior to admission with acute decompensated heart failure (ADHF). Methods and results We conducted a prospective, two‐centre, two‐country observational study evaluating care pathways and patient experience in patients admitted to hospital with ADHF. Quantitative and qualitative data were gathered from patients, carers, and general practitioners (GPs). From the Irish centre, 114 patients enrolled, and from the English centre, 50 patients. Symptom duration longer than 72 h prior to hospitalization was noted among 70.4% (76) Irish and 80% (40) English patients, with no significant difference between those with a new diagnosis of HF [de novo HF (dnHF)] and those with known HF [established HF (eHF)] in either cohort. For the majority, dyspnoea was the dominant symptom; however, 63.3% (31) of these Irish patients and 47.2% (17) of these English patients did not recognize this as an HF symptom, with no significant difference between dnHF and eHF patients. Of the 46.5% (53) of Irish and 38% (19) of English patients reviewed exclusively by GPs before hospitalization, numbers prescribed diuretics were low (11.3%, six; and 15.8%, three, respectively); eHF patients were no more likely to receive diuretics than dnHF patients. Barriers to care highlighted by GPs included inadequate access to basic diagnostics, specialist support and up‐to‐date patient information, and lack of GP comfort in managing HF. Conclusion The aforementioned findings, consistent across both health care jurisdictions, show a clear potential to intervene earlier and more effectively in ADHF or to prevent the need for hospitalization.
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Affiliation(s)
- Joseph McCambridge
- Cardiology Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ciara Keane
- Cardiology Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Myra Walshe
- Cardiology Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Patricia Campbell
- Cardiology Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - James Heyes
- Portsmouth Hospital NHS Trust, Portsmouth, UK
| | | | - Martin R Cowie
- Imperial College London (Royal Brompton Hospital), London, UK
| | - Jillian P Riley
- Imperial College London (Royal Brompton Hospital), London, UK
| | - Rory O'Hanlon
- Cardiology Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Mark Ledwidge
- Cardiology Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Joseph Gallagher
- Cardiology Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Irish College of General Practitioners, Lincoln Place, Dublin 2, Ireland
| | - Kenneth McDonald
- Cardiology Department, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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10
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Towfighi A, Skolarus LE. Inequities in Stroke Preparedness in Young Adults. Stroke 2020; 51:3479-3481. [DOI: 10.1161/strokeaha.120.032612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amytis Towfighi
- Department of Neurology, University of Southern California, Los Angeles (A.T.)
- Los Angeles County Department of Health Services, CA (A.T.)
| | - Lesli E. Skolarus
- Stroke Program, Department of Neurology, University of Michigan, Ann Arbor (L.E.S.)
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11
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Robles MC, Springer MV, Corches CL, Burke JF, Lin CC, Oliver A, Skolarus LE. Stroke Ready Very Brief Intervention Improves Immediate Postintervention Stroke Preparedness. Circ Cardiovasc Qual Outcomes 2020; 13:e006643. [PMID: 33238728 DOI: 10.1161/circoutcomes.120.006643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Cielito Robles
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | - Mellanie V Springer
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | - Casey L Corches
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | - James F Burke
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | - Chun Chieh Lin
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
| | | | - Lesli E Skolarus
- Stroke Program, University of Michigan Medical School (M.C.R., M.V.S., C.L.C., J.F.B., C.C.L., L.E.S.)
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12
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Corches CL, McBride AC, Robles MC, Rehman N, Bailey S, Oliver A, Skolarus LE. Development, Adaptation and Scale-up of a Community-wide, Health Behavior Theory-based Stroke Preparedness Intervention. Am J Health Behav 2020; 44:744-755. [PMID: 33081873 DOI: 10.5993/ajhb.44.6.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: Acute stroke treatments reduce the likelihood of post-stroke disability, but are vastly underutilized. In this paper, we describe the development, adaptation, and scale-up of the Stroke Ready program - a health behavior theory-based stroke preparedness intervention that addresses underlying behavioral factors that contribute to acute stroke treatment underutilization. Methods: Through a community-based participatory research (CBPR) approach, we conducted needs and determinant assessments, which informed creation and pilot testing of Stroke Ready. Based on these results, we then scaled Stroke Ready to the entire community by greatly expanding the delivery system. Results: The scaled Stroke Ready program is a community-wide stroke preparedness education program consisting of peer-led workshops, print materials, and digital, social, and broadcast media campaigns. Whereas the Stroke Ready pilot workshop was delivered to 101 participants, 5945 participants have received the scaled Stroke Ready peer-led workshop to date. Additionally, we have sent mailers to over 44,000 households and reached approximately 35,000 people through our social media campaign. Conclusion: Strategies including an expanded community advisory board, adaptation of the intervention and community-engaged recruitment facilitated the scale-up of Stroke Ready, which may serve as a model to increase acute stroke treatment rates, particularly in majority African-American communities.
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Affiliation(s)
- Casey L. Corches
- Casey L. Corches, Project Manager, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States;,
| | - A. Camille McBride
- A. Camille McBride, Research Assistant, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Maria Cielito Robles
- Maria Cielito Robles, Research Area Specialist, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Narmeen Rehman
- Narmeen Rehman, Research Assistant, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Sarah Bailey
- Sarah Bailey, Bridges Into the Future, Flint, MI, United States
| | - Alina Oliver
- Alina Oliver, Bethlehem Temple Church, Flint, MI, United States
| | - Lesli E. Skolarus
- Lesli E. Skolarus, Associate Professor, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
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13
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Jones A, O'Connell N, David AS, Chalder T. Functional Stroke Symptoms: A Narrative Review and Conceptual Model. J Neuropsychiatry Clin Neurosci 2020; 32:14-23. [PMID: 31726918 DOI: 10.1176/appi.neuropsych.19030075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Stroke services have been reconfigured in recent years to facilitate early intervention. Throughout stroke settings, some patients present with functional symptoms that cannot be attributed to a structural cause. Emphasis on fast diagnosis and treatment means that a proportion of patients entering the care pathway present with functional symptoms that mimic stroke or have functional symptoms in addition to vascular stroke. There is limited understanding of mechanisms underlying functional stroke symptoms, how the treatment of such patients should be managed, and no referral pathway or treatment. Predisposing factors vary between individuals, and symptoms are heterogeneous: onset can be acute or insidious, and duration can be short-lived or chronic in the context of new or recurrent illness cognitions and behaviors. This article proposes a conceptual model of functional symptoms identified in stroke services and some hypotheses based on a narrative review of the functional neurological disorder literature. Predisposing factors may include illness experiences, stressors, and chronic autonomic nervous system arousal. Following the onset of distressing symptoms, perpetuating factors may include implicit cognitive processes, classical and operant conditioning, illness beliefs, and behavioral responses, which could form the basis of treatment targets. The proposed model will inform the development of theory-based interventions as well as a functional stroke care pathway.
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Affiliation(s)
- Abbeygail Jones
- The Department of Psychological Medicine, King's College London (Jones, Chalder); the Institute of Population Health, Trinity College Dublin (O'Connell); and the Institute of Mental Health, University College London (David)
| | - Nicola O'Connell
- The Department of Psychological Medicine, King's College London (Jones, Chalder); the Institute of Population Health, Trinity College Dublin (O'Connell); and the Institute of Mental Health, University College London (David)
| | - Anthony S David
- The Department of Psychological Medicine, King's College London (Jones, Chalder); the Institute of Population Health, Trinity College Dublin (O'Connell); and the Institute of Mental Health, University College London (David)
| | - Trudie Chalder
- The Department of Psychological Medicine, King's College London (Jones, Chalder); the Institute of Population Health, Trinity College Dublin (O'Connell); and the Institute of Mental Health, University College London (David)
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14
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Caceres BA, Turchioe MR, Pho A, Koleck TA, Creber RM, Bakken SB. Sexual Identity and Racial/Ethnic Differences in Awareness of Heart Attack and Stroke Symptoms: Findings From the National Health Interview Survey. Am J Health Promot 2020; 35:57-67. [PMID: 32551829 DOI: 10.1177/0890117120932471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Investigate sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms. DESIGN Cross-sectional. SETTING 2014 and 2017 National Health Interview Survey. SAMPLE 54 326 participants. MEASURES Exposure measures were sexual identity (heterosexual, gay/lesbian, bisexual, "something else") and race/ethnicity. Awareness of heart attack and stroke symptoms was assessed. ANALYSIS Sex-stratified logistic regression analyses to examine sexual identity and racial/ethnic differences in awareness of heart attack and stroke symptoms. RESULTS Gay men were more likely than heterosexual men to identify calling 911 as the correct action if someone is having a heart attack (adjusted odds ratio [AOR] = 2.16, 95% CI: 1.18-3.96). The majority of racial/ethnic minority heterosexuals reported lower rates of awareness of heart attack and stroke symptoms than White heterosexuals. Hispanic sexual minority women had lower awareness of heart attack symptoms than White heterosexual women (AOR = 0.43, 95% CI: 0.25-0.74), whereas Asian sexual minority women reported lower awareness of stroke symptoms (AOR = 0.25, 95% CI: 0.08-0.80). Hispanic (AOR = 0.52, 95% CI: 0.33-0.84) and Asian (AOR = 0.35, 95% CI: 0.14-0.84) sexual minority men reported lower awareness of stroke symptoms than White heterosexual men. CONCLUSION Hispanic and Asian sexual minorities had lower rates of awareness of heart attack and stroke symptoms. Health information technology may be a platform for delivering health education and targeted health promotion for sexual minorities of color.
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Affiliation(s)
- Billy A Caceres
- Program for the Study of LGBT Health, 5798Columbia University School of Nursing, New York, NY, USA
| | | | - Anthony Pho
- 5798Columbia University School of Nursing, New York, NY, USA
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15
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Incidence of Hospitalization for Stroke in Queensland, Australia: Younger Adults at Risk. J Stroke Cerebrovasc Dis 2020; 29:104797. [PMID: 32278533 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Trends in the incidence of stroke are important for health care planning. Information is particularly scarce in Australia, due to the paucity of studies with access to recent, large-scale, longitudinal datasets. In this paper we investigated the incidence of hospitalization for stroke by sex, age, and subtype in the whole State of Queensland (Australia). METHODS We obtained data of all hospital admissions for stroke in Queensland from 2002 to 2015. Age standardized hospitalization rates for first-ever stroke were calculated along with WHO adjusted rates. Poisson regression analyses were conducted to investigate the influence of time and gender on the incidence of subtypes of stroke as well as the total incidence. RESULTS Admissions for first-ever stroke were 57,597. Crude hospitalization incidence rose from 87 (95% confidence interval [CI], 84-90) to 108 (95%CI, 105-111) for both sexes. The highest increase was in the age bands 40-49 from 33 (95%CI, 26-40) to 54 (95%CI, 46-62; +62%) and 50-59 from 82 (95%CI, 70-93) to 127 (95%CI, 114-140; +56%) in men and in 60-69 from 118 (95%CI, 100-136) to 159 (95%CI, 143-175; +34%) in women. Ischemic subtype rates appeared to increase more than haemorrhagic rates. Age range, sex, and year reliably predicted incidence rates. CONCLUSIONS If these trends are maintained, the data predict further increases, especially in males aged 40-59. With people apparently stroking earlier and mortality rates dropping, the healthcare system in Australia is faced with a rapidly increasing care burden.
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Turner AC, Schwamm LH, Etherton MR. Acute ischemic stroke: improving access to intravenous tissue plasminogen activator. Expert Rev Cardiovasc Ther 2020; 18:277-287. [PMID: 32323590 DOI: 10.1080/14779072.2020.1759422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Since approval by the United States Food and Drug Administration in 1996, alteplase utilization rates for acute ischemic stroke have increased. Despite its efficacy for improving stroke outcomes, however, the majority of ischemic stroke patients still do not receive alteplase. To address this issue, different methods for improving access to alteplase have been tested with varying degrees of success. AREAS COVERED This article gives an overview of the recent approaches pursued to improve access to alteplase for acute ischemic stroke patients. Utilization of stroke systems of care, quality metrics, and quality-improvement initiatives to improve alteplase treatment rates are discussed. The implementation of Telestroke networks to improve access and timely evaluation by a stroke specialist are also reviewed. Lastly, this review discusses the use of neuroimaging techniques to identify alteplase candidates in stroke of unknown symptom onset or beyond the 4.5-h treatment window. EXPERT COMMENTARY Expanding access to alteplase therapy for acute ischemic stroke is a multi-faceted approach. Specific considerations based on region, population, and health-care resources should be considered for each strategy. Neuroimaging approaches to identify alteplase-eligible patients beyond the 4.5-h treatment window are a recent development in acute stroke care that holds promise for increasing alteplase treatment rates.
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Affiliation(s)
- Ashby C Turner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA
| | - Mark R Etherton
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA
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17
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Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature. J Neurol 2020; 268:2723-2734. [PMID: 32206899 DOI: 10.1007/s00415-020-09803-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIMS This review examined factors that delay thrombolysis and what management strategies are currently employed to minimise this delay, with the aim of suggesting future directions to overcome bottlenecks in treatment delivery. METHODS A systematic review was performed according to PRISMA guidelines. The search strategy included a combination of synonyms and controlled vocabularies from Medical Subject Headings (MeSH) and EmTree covering brain ischemia, cerebrovascular accident, fibrinolytic therapy and Alteplase. The search was conducted using Medline (OVID), Embase (OVID), PubMed and Cochrane Library databases using truncations and Boolean operators. The literature search excluded review articles, trial protocols, opinion pieces and case reports. Inclusion criteria were: (1) The article directly related to thrombolysis in ischaemic stroke, and (2) The article examined at least one factor contributing to delay in thrombolytic therapy. RESULTS One hundred and fifty-two studies were included. Pre-hospital factors resulted in the greatest delay to thrombolysis administration. In-hospital factors relating to assessment, imaging and thrombolysis administration also contributed. Long onset-to-needle times were more common in those with atypical, or less severe, symptoms, the elderly, patients from lower socioeconomic backgrounds, and those living alone. Various strategies currently exist to reduce delays. Processes which have achieved the greatest improvements in time to thrombolysis are those which integrate out-of-hospital and in-hospital processes, such as the Helsinki model. CONCLUSION Further integrated processes are required to maximise patient benefit from thrombolysis. Expansion of community education to incorporate less common symptoms and provision of alert pagers for patients may provide further reduction in thrombolysis times.
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18
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Adams NC, Griffin E, Motyer R, Farrell T, Carmody E, O'Shea A, Murphy B, O'Hare A, Looby S, Power S, Brennan P, Doyle KM, Thornton J. Review of external referrals to a regional stroke centre: it is not just about thrombectomy. Clin Radiol 2019; 74:950-955. [PMID: 31521325 DOI: 10.1016/j.crad.2019.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/26/2019] [Indexed: 02/02/2023]
Abstract
AIMS To determine the experience of a regional stroke referral centre of external referrals for endovascular thrombectomy (EVT) in patients with symptoms of acute ischaemic stroke (AIS) and large vessel occlusion (LVO). MATERIALS AND METHODS Data were collected prospectively over two 4-month periods (2017-2018) on consecutive external referrals for EVT. Baseline demographics, imaging findings, and key time parameters were recorded. Reasons for not transferring patients and for not performing EVT were recorded. Key time intervals were calculated and compared between the transferred and non-transferred group with and without intracranial occlusion and between the transferred patients who underwent thrombectomy and those who did not. RESULTS Two hundred and sixty-two patients were referred. Sixty-one percent (n=159) were accepted and transferred for treatment. Of those transferred, 86% (n=136) had EVT. Fourteen percent (n=23) were unsuitable for EVT on arrival due to no vessel occlusion (48% n=11), poor Alberta Stroke Program Early CT Score (ASPECTS)/established infarct (30%, n=7) haemorrhage (9%, n=2), and clinical recovery (13% n=3). One hundred and three patients (39%) were ineligible for EVT following phone discussion due to absence of intracranial occlusion (59%, n=61), low ASPECTS (22%, n=23), distal occlusion (4%, n=4), low/improving National Institutes of Health Stroke Scale (NIHSS; 10.7%, n=11), and poor modified Rankin Scale (mRS) at baseline (3%, n=3). Patients with LVO but not transferred had longer onset to hospital arrival time compared with those transferred 151.5 versus 91 minutes (p<0.005), with a trend also toward a longer door to CT/CTA 40 minutes versus 30 minutes (p=0.142). CONCLUSION These data provide valuable insights into the service provision of a comprehensive stroke network. The present rates of EVT and futile transfers are modest compared to published data. Access to neuroradiology and specialised stroke assessment is crucial to optimise time to treatment.
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Affiliation(s)
- N C Adams
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland.
| | - E Griffin
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - R Motyer
- Department of Radiology, Tallaght Hospital, Tallaght, Dublin 24, Ireland
| | - T Farrell
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - E Carmody
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - A O'Shea
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - B Murphy
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - A O'Hare
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - S Looby
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - S Power
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - P Brennan
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - K M Doyle
- Department of Physiology, School of Medicine, National University of Ireland, Galway, Ireland
| | - J Thornton
- Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland; Honorary Clinical Associate Professor, Royal College of Surgeons, 123 St Stephens Green, Dublin, Ireland
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Morrow A, Miller CB, Dombrowski SU. Can people apply 'FAST' when it really matters? A qualitative study guided by the common sense self-regulation model. BMC Public Health 2019; 19:643. [PMID: 31138193 PMCID: PMC6537353 DOI: 10.1186/s12889-019-7032-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/22/2019] [Indexed: 11/11/2022] Open
Abstract
Background Early identification of stroke symptoms and rapid access to the emergency services increases an individual’s chance of receiving thrombolytic therapy and reduces the likelihood of infirmity. The UK’s national stroke campaign ‘Act FAST’ was developed to increase public awareness of stroke symptoms and highlighted the importance of rapid response by contacting emergency services. No study to date has assessed if and how people who experienced or witnessed stroke in line with the campaigns’ symptoms of the FAST acronym (i.e., facial weakness, arm weakness, slurred speech, and time) may use this FAST in their response. Methods Semi-structured interviews with 13 stroke patients and witnesses were conducted. Interviews were theory-guided based on the Common Sense Self-Regulation Model, to understand the appraisal process of the onset of stroke symptoms and how this impacted on participants’ ability to apply their knowledge of the FAST campaign. Results The majority of patients (n = 8/13) failed to correctly identify stroke and reported no impact of the campaign on their stroke recognition and response. Inability to identify stroke, perceiving symptoms to lack severity and lack of control contributed to a delay in seeking medical attention. Conclusion Stroke witnesses and patients predominantly fail to identify stroke which suggest a lack of FAST application when it matters. Inaccurate risk perceptions and lack of physical control both play central roles in influencing the formation of illness representation not associated with an appropriate emergency response.
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Affiliation(s)
- Alison Morrow
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Christopher B Miller
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Stephan U Dombrowski
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK.,Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
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20
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Schewe JC, Kappler J, Dovermann K, Graeff I, Ehrentraut SF, Heister U, Hoeft A, Weber SU, Muenster S. Diagnostic accuracy of physician-staffed emergency medical teams: a retrospective observational cohort study of prehospital versus hospital diagnosis in a 10-year interval. Scand J Trauma Resusc Emerg Med 2019; 27:36. [PMID: 30940205 PMCID: PMC6446382 DOI: 10.1186/s13049-019-0617-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In Germany, emergency medical teams are staffed with physicians but evidence regarding their prehospital diagnostic accuracy remains poor. OBJECTIVE To evaluate the out-of-hospital diagnostic accuracy of physician-staffed emergency medical teams (PEMTs). METHODS A retrospective observational cohort study involving the Emergency Medical Service Bonn, Germany, from January to December 2004 and 2014 respectively. A total of 8346 patients underwent medical treatment by PEMTs, of which 1960 adult patients (inclusion criteria: ≥18 years of age, hospital diagnosis available) were included for further analysis. Reasons for non-inclusion: death on scene, outpatient, interhospital transfer, mental illness, false alarm, no hospital medical history available. The overall diagnostic accuracy (correct or false) of PEMTs was measured after matching the prehospital diagnosis with the corresponding diagnosis of the hospital. Secondary outcome measures were incidence of common PEMT diagnoses (acute coronary syndrome (ACS), dyspnea, stroke/intracerebral bleeding), recognition rate of a given disease by PEMTs, and prehospital diagnostic accuracy in elderly patients. RESULTS PEMT calls increased 2-fold over a decade (2004: n = 3151 vs. 2014: n = 5195). Overall diagnostic accuracy of PEMTs increased from 87.5% in 2004 to 92.6% in the year 2014. The incidence of common PEMT diagnoses such as ACS, dyspnea or stroke/intracerebral bleeding increased 2-fold from 2004 to 2014. The recognition rate of a given disease by the PEMT varied between 2004 and 2014: an increase was observed when a stroke/intracerebral bleeding was diagnosed (2004: 67% vs. 2014: 83%; p = 0.054), a decreased rate of recognition occurred when a syncope/collapse was diagnosed (2004: 81% vs. 2014: 56%; p = 0.007) and a sepsis appears to be a rare event for EMS personnel (2004: 0% vs. 2014: 23%). Linear regression analysis revealed that the prehospital diagnostic accuracy decreases in the elderly patient. CONCLUSIONS The overall prehospital diagnostic accuracy of PEMTs improved between the year 2004 and 2014 respectively. Our findings suggest that the incidence of common diseases (ACS, dyspnea stroke/intracerebral bleeding, sepsis) increased over a 10-year period. Diagnostic accuracy of different diseases varied but generally decreased in the elderly patient. Regular training of EMS personnel and public campaigns should be implemented to improve the diagnostic accuracy in the future.
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Affiliation(s)
- Jens-Christian Schewe
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Jochen Kappler
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Katharina Dovermann
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Ingo Graeff
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
- Department of Emergency Medicine, Bonn, University Hospital Bonn, Bonn, Germany
| | - Stefan Felix Ehrentraut
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Ulrich Heister
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
- Emergency Medical Service Bonn, Bonn, Germany
| | - Andreas Hoeft
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Stefan Ulrich Weber
- Department of Anesthesiology, Critical Care and Pain Medicine, Heilig Geist Krankenhaus, Cologne, Germany
| | - Stefan Muenster
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
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21
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Farquharson B, Abhyankar P, Smith K, Dombrowski SU, Treweek S, Dougall N, Williams B, Johnston M. Reducing delay in patients with acute coronary syndrome and other time-critical conditions: a systematic review to identify the behaviour change techniques associated with effective interventions. Open Heart 2019; 6:e000975. [PMID: 30997136 PMCID: PMC6443141 DOI: 10.1136/openhrt-2018-000975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Background Time to treatment in many conditions, particularly acute coronary syndrome, is critical to reducing mortality. Delay between onset of symptoms and treatment remains a worldwide problem. Reducing patient delay has been particularly challenging. Embedding behaviour change techniques (BCTs) within interventions might lead to shorter delay. Objective To identify which BCTs are associated with reductions in patient delay among people with symptoms or conditions where time to treatment is critical. Methods The data sources were Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Study eligibility criteria include intervention evaluations (randomised controlled trials, controlled clinical trials and cohort studies) involving adults (aged >18 years) and including an outcome measure of patient delay up to August 2016. Study appraisal and synthesis methods include screening potential studies using a transparent, replicable process. Study characteristics, outcomes and BCTs were extracted from eligible studies. Results From 39 studies (200 538 participants), just over half (n=20) reported a significant reduction in delay. 19 BCTs were identified, plus 5 additional techniques, with a mean of 2 (SD=2.3) BCTs and 2 (SD=0.7) per intervention. No clear pattern between BCTs and effectiveness was found. In studies examining patient delay specifically, three of four studies that included two or more BCTs, in addition to the two most commonly used additional techniques, reported a significant reduction in delay. Conclusions Around half of the interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time. It is not clear what differentiates effective from non-effective interventions, although in relation to patient delay particularly additional use of BCTs might be helpful. Trial registration number CRD42014013106.
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Affiliation(s)
| | - Purva Abhyankar
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Karen Smith
- NHS Tayside School of Nursing & Midwifery, University of Dundee, Dundee, UK
| | | | - Shaun Treweek
- Health Sciences Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Brian Williams
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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22
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Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, Kutluk K, Mikulik R, Wardlaw J, Richard E, Nabavi D, Molina C, Bath PM, Stibrant Sunnerhagen K, Rudd A, Drummond A, Planas A, Caso V. Action Plan for Stroke in Europe 2018-2030. Eur Stroke J 2018; 3:309-336. [PMID: 31236480 PMCID: PMC6571507 DOI: 10.1177/2396987318808719] [Citation(s) in RCA: 263] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Two previous pan-European consensus meetings, the 1995 and 2006 Helsingborg meetings, were convened to review the scientific evidence and the state of current services to identify priorities for research and development and to set targets for the development of stroke care for the decade to follow. Adhering to the same format, the European Stroke Organisation (ESO) prepared a European Stroke Action Plan (ESAP) for the years 2018 to 2030, in cooperation with the Stroke Alliance for Europe (SAFE). The ESAP included seven domains: primary prevention, organisation of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment and life after stroke. Research priorities for translational stroke research were also identified. Documents were prepared by a working group and were open to public comments. The final document was prepared after a workshop in Munich on 21-23 March 2018. Four overarching targets for 2030 were identified: (1) to reduce the absolute number of strokes in Europe by 10%, (2) to treat 90% or more of all patients with stroke in Europe in a dedicated stroke unit as the first level of care, (3) to have national plans for stroke encompassing the entire chain of care, (4) to fully implement national strategies for multisector public health interventions. Overall, 30 targets and 72 research priorities were identified for the seven domains. The ESAP provides a basic road map and sets targets for the implementation of evidence-based preventive actions and stroke services to 2030.
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Affiliation(s)
- Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Skåne
University Hospital, Lund University, Lund, Sweden
| | | | - Antoni Davalos
- Department of Neurosciences, Hospital Universitari Germans Trias
i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital,
Ludwig-Maximilians University, Munich, and Munich Cluster of Systems Neurology
(SyNergy), Munich, Germany
| | | | - Alla Guekht
- Clinical Center for Neuropsychiatry, Russian National Research
Medical University, Moscow, Russia
| | - Kursad Kutluk
- Department of Neurology, Stroke Unit, University of Dokuz Eylul,
Izmir, Turkey
| | - Robert Mikulik
- International Clinical Research Center and Neurology Department,
St Anne's University Hospital Brno and Masaryk University Brno, Czech
Republic
| | - Joanna Wardlaw
- Centre for Clinical Neurosciences, Edinburgh Imaging and UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Edo Richard
- Department of Neurology, Radboud University Medical Centre,
Nijmegen, and Department of Neurology, Academic Medical Centre, Amsterdam, the
Netherlands
| | - Darius Nabavi
- Department of Neurology with Stroke Unit, Vivantes Hospital
Neukölln, Berlin, Germany
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Hospital Vall d´Hebron
Barcelona, Spain
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience,
University of Nottingham, Nottingham, UK
| | | | - Anthony Rudd
- Guy's and St Thomas' NHS Foundation Trust, Stroke NHS England
and Royal College of Physicians, London, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham,
Nottingham, UK
| | - Anna Planas
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB),
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona,
Spain
| | - Valeria Caso
- Stroke Unit, Department of Medicine and Cardiovascular
Medicine, University of Perugia, Perugia, Italy
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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.
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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
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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.
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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
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25
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Differences in and Determinants of Prehospital Delay Times among Stroke Patients-1994 Versus 2012. J Stroke Cerebrovasc Dis 2018; 27:2398-2404. [PMID: 29759941 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/23/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Prehospital delay is a challenge for stroke treatment and the delivery of time-critical treatments. Few studies have examined secular trends in prehospital delay, and results vary. This study investigates how prehospital delay among Norwegian stroke patients has changed over the last 2 decades. METHODS We compared time from symptom onset to admission in 2 cohorts of stroke patients admitted to Akershus University Hospital, Norway, in 1994 (n = 550) and 2012 (n = 522), and constructed predictive models for arrival within 3 hours for each cohort. RESULTS More patients arrived within 3 hours of symptom onset in 2012 compared to 1994 (proportion, 47.1% versus 19.3%, P < .001), also after adjusting for age, sex, and baseline differences; odds ratio (OR) was 5.14 (95% confidence interval [CI] 3.69-7.15). Stroke severity was the only predictor examined that was independently associated with early arrival during both periods. For patients with moderate strokes the overall OR was 2.06 (95% CI 1.41-3.00) and for severe strokes 4.52 (95% CI 2.97-6.87), compared to those with mild strokes. In the 1994 cohort additional predictors of early arrival were living with others and not being admitted from nursing home. CONCLUSIONS Prehospital delay in Norway has decreased considerably over the last 2 decades and since the availability of time-critical treatments. However, there is still an urgent need to reduce the number of delayed admissions as a large proportion of patients continue to arrive too late to benefit from these treatments. Patients with severer strokes were predicted to have earlier arrival.
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26
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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]
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27
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Kelly KM, Holt KT, Neshewat GM, Skolarus LE. Community Interventions to Increase Stroke Preparedness and Acute Stroke Treatment Rates. Curr Atheroscler Rep 2017; 19:64. [PMID: 29147858 DOI: 10.1007/s11883-017-0695-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Acute stroke treatments reduce the risk of post-stroke disability. These treatments, tissue plasminogen activator (tPA) and intra-arterial treatment, are highly time-dependent; thus, one of the main barriers to treatment is pre-hospital delay. Stroke preparedness is defined as the ability to recognize stroke symptoms and the intent to activate emergency medical services (EMS). This review describes types of acute stroke treatment and preparedness interventions, including recent mass media interventions to increase acute stroke treatment rates, and adult and youth community interventions to increase stroke preparedness. RECENT FINDINGS The mass media campaigns show mixed results regarding acute stroke treatment rates, possibly attributed to the various media platforms utilized and resources available. The adult and youth community interventions reveal an overall increase in stroke symptom recognition and behavioral intent to call EMS. However, most of these community interventions were not grounded in health behavior theory, and they were tested in single group, pre-post test study designs that assessed behavioral rather than clinical outcomes. The delivery of stroke preparedness information by youth to adults, for example via home assignments, is a promising and innovative approach to stroke preparedness. Mass media and community interventions show promise to increase stroke preparedness and acute stroke treatment rates. The development of health behavior theory-based interventions that are tested via scientifically rigorous study designs are needed to prioritize which interventions should be disseminated to culturally and socially similar communities.
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Affiliation(s)
- Kathleen M Kelly
- Stroke Program, Department of Neurology, University of Michigan, 1500 East Medical Center Drive SPC#5855, Ann Arbor, MI, 48109-5855, USA
| | - Kathryn T Holt
- Stroke Program, Department of Neurology, University of Michigan, 1500 East Medical Center Drive SPC#5855, Ann Arbor, MI, 48109-5855, USA
| | - Gina M Neshewat
- Stroke Program, Department of Neurology, University of Michigan, 1500 East Medical Center Drive SPC#5855, Ann Arbor, MI, 48109-5855, USA
| | - Lesli E Skolarus
- Stroke Program, Department of Neurology, University of Michigan, 1500 East Medical Center Drive SPC#5855, Ann Arbor, MI, 48109-5855, USA.
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Response to Symptoms and Prehospital Delay in Stroke Patients. Is It Time to Reconsider Stroke Awareness Campaigns? J Stroke Cerebrovasc Dis 2017; 27:625-632. [PMID: 29108809 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/24/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite recent advances in acute stroke care, reperfusion therapies are given to only 1%-8% of patients. Previous studies have focused on prehospital or decision delay. We aim to give a more comprehensive view by addressing different time delays and decisions. METHODS A total of 382 patients with either acute stroke or transient ischemic attack were prospectively included. Sociodemographic and clinical parameters and data on decision delay, prehospital delay, and first medical contact were recorded. Multivariate logistic regression analyses were conducted to identify factors related to decision delay of 15 minutes or shorter, calling the Extrahospital Emergency Services, and prehospital delay of 60 minutes or shorter and 180 minutes or shorter. RESULTS Prehospital delay was 60 minutes or shorter in 11.3% of our patients and 180 minutes or shorter in 48.7%. Major vascular risk factors were present in 89.8% of patients. Severity was associated with decision delay of 15 minutes or shorter (odds ratio [OR] 1.08; confidence interval [CI] 1.04-1.13), calling the Extrahospital Emergency Services (OR 1.17; CI 1.12-1.23), and prehospital delay of 180 minutes or shorter (OR 1.08; CI 1.01-1.15). Adult children as witnesses favored a decision delay of 15 minutes or shorter (OR 3.44; CI 95% 1.88-6.27; P < .001) and calling the Extrahospital Emergency Services (OR 2.24; IC 95% 1.20-4.22; P = .012). Calling the Extrahospital Emergency Services favored prehospital delay of 60 minutes or shorter (OR 5.69; CI 95% 2.41-13.45; P < .001) and prehospital delay of 180 minutes or shorter (OR 3.86; CI 95% 1.47-10.11; P = .006). CONCLUSIONS Severity and the bystander play a critical role in the response to stroke. Calling the Extrahospital Emergency Services promotes shorter delays. Future interventions should encourage immediately calling the Extrahospital Emergency Services, but the target should be redirected to those with known risk factors and their caregivers.
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29
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Effects of educational television commercial on pre-hospital delay in patients with ischemic stroke wore off after the end of the campaign. J Neurol Sci 2017; 381:117-118. [PMID: 28991660 DOI: 10.1016/j.jns.2017.08.3236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 07/30/2017] [Accepted: 08/21/2017] [Indexed: 11/22/2022]
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30
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Hov MR, Zakariassen E, Lindner T, Nome T, Bache KG, Røislien J, Gleditsch J, Solyga V, Russell D, Lund CG. Interpretation of Brain CT Scans in the Field by Critical Care Physicians in a Mobile Stroke Unit. J Neuroimaging 2017; 28:106-111. [PMID: 28766306 PMCID: PMC5811888 DOI: 10.1111/jon.12458] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/23/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE In acute stroke, thromboembolism or spontaneous hemorrhage abruptly reduces blood flow to a part of the brain. To limit necrosis, rapid radiological identification of the pathological mechanism must be conducted to allow the initiation of targeted treatment. The aim of the Norwegian Acute Stroke Prehospital Project is to determine if anesthesiologists, trained in prehospital critical care, may accurately assess cerebral computed tomography (CT) scans in a mobile stroke unit (MSU). METHODS In this pilot study, 13 anesthesiologists assessed unselected acute stroke patients with a cerebral CT scan in an MSU. The scans were simultaneously available by teleradiology at the receiving hospital and the on‐call radiologist. CT scan interpretation was focused on the radiological diagnosis of acute stroke and contraindications for thrombolysis. The aim of this study was to find inter‐rater agreement between the pre‐ and in‐hospital radiological assessments. A neuroradiologist evaluated all CT scans retrospectively. Statistical analysis of inter‐rater agreement was analyzed with Cohen's kappa. RESULTS Fifty‐one cerebral CT scans from the MSU were included. Inter‐rater agreement between prehospital anesthesiologists and the in‐hospital on‐call radiologists was excellent in finding radiological selection for thrombolysis (kappa .87). Prehospital CT scans were conducted in median 10 minutes (7 and 14 minutes) in the MSU, and median 39 minutes (31 and 48 minutes) before arrival at the receiving hospital. CONCLUSION This pilot study shows that anesthesiologists trained in prehospital critical care may effectively assess cerebral CT scans in an MSU, and determine if there are radiological contraindications for thrombolysis.
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Affiliation(s)
- Maren Ranhoff Hov
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Zakariassen
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
| | - Thomas Lindner
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,The Regional Centre for Emergency Medical Research and Development, Stavanger, Norway
| | - Terje Nome
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Kristi G Bache
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Jo Røislien
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Volker Solyga
- Department of Neurology, Østfold Hospital, Kalnes, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christian G Lund
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | -
- Department of Research and Development, The Norwegian Air Ambulance Foundation, Drøbak, Norway
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31
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Caminiti C, Schulz P, Marcomini B, Iezzi E, Riva S, Scoditti U, Zini A, Malferrari G, Zedde ML, Guidetti D, Montanari E, Baratti M, Denti L. Development of an education campaign to reduce delays in pre-hospital response to stroke. BMC Emerg Med 2017. [PMID: 28646851 PMCID: PMC5483310 DOI: 10.1186/s12873-017-0130-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Systematic reviews call for well-designed trials with clearly described intervention components to support the effectiveness of educational campaigns to reduce patient delay in stroke presentation. We herein describe the systematic development process of a campaign aimed to increase stroke awareness and preparedness. Methods Campaign development followed Intervention Mapping (IM), a theory- and evidence-based tool, and was articulated in two phases: needs assessment and intervention development. In phase 1, two cross-sectional surveys were performed, one aiming to measure stroke awareness in the target population and the other to analyze the behavioral determinants of prehospital delay. In phase 2, a matrix of proximal program objectives was developed, theory-based intervention methods and practical strategies were selected and program components and materials produced. Results In phase 1, the survey on 202 citizens highlighted underestimation of symptom severity, as in only 44% of stroke situations respondents would choose to call the emergency service (EMS). In the survey on 393 consecutive patients, 55% presented over 2 hours after symptom onset; major determinants were deciding to call the general practitioner first and the reaction of the first person the patient called. In phase 2, adult individuals were identified as the target of the intervention, both as potential “patients” and witnesses of stroke. The low educational level found in the patient survey called for a narrative approach in cartoon form. The family setting was chosen for the message because 42% of patients who presented within 2 hours had been advised by a family member to call EMS. To act on people’s tendency to view stroke as an untreatable disease, it was decided to avoid fear-arousal appeals and use a positive message providing instructions and hope. Focus groups were used to test educational products and identify the most suitable sites for message dissemination. Conclusions The IM approach allowed to develop a stroke campaign integrating theories, scientific evidence and information collected from the target population, and enabled to provide clear explanations for the reasons behind key decisions during the intervention development process. Trial registration NCT01881152. Retrospectively registered June 7 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12873-017-0130-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Peter Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Via Buffi 6, CH 6900, Lugano, Switzerland
| | - Barbara Marcomini
- Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Elisa Iezzi
- Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Silvia Riva
- Department of Oncology and Hematology, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Umberto Scoditti
- Stroke Care Program, Neurology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Andrea Zini
- Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, Via Pietro Giardini 1355, 41126, Baggiovara, Modena, Italy
| | - Giovanni Malferrari
- Department of Neuromotor Physiol, Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Umberto I 50, 42123, Reggio Emilia, Italy
| | - Maria Luisa Zedde
- Department of Neuromotor Physiol, Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Umberto I 50, 42123, Reggio Emilia, Italy
| | - Donata Guidetti
- Department of Neurology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29100, Piacenza, Italy
| | - Enrico Montanari
- Neurology Unit, Vaio Fidenza Hospital, Via Don Tincati 5, 43036, Fidenza, Parma, Italy
| | - Mario Baratti
- Division of Neurology, B Ramazzini Hospital, Via Guido Molinari 2, 41012, Carpi, Modena, Italy
| | - Licia Denti
- Clinical Geriatrics Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
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32
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Baatiema L, Otim ME, Mnatzaganian G, de-Graft Aikins A, Coombes J, Somerset S. Health professionals' views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review. Implement Sci 2017; 12:74. [PMID: 28583164 PMCID: PMC5460544 DOI: 10.1186/s13012-017-0599-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 05/08/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adoption of contemporary evidence-based guidelines for acute stroke management is often delayed due to a range of key enablers and barriers. Recent reviews on such barriers focus mainly on specific acute stroke therapies or generalised stroke care guidelines. This review examined the overall barriers and enablers, as perceived by health professionals which affect how evidence-based practice guidelines (stroke unit care, thrombolysis administration, aspirin usage and decompressive surgery) for acute stroke care are adopted in hospital settings. METHODOLOGY A systematic search of databases was conducted using MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, Cochrane Library and AMED (Allied and Complementary Medicine Database from 1990 to 2016. The population of interest included health professionals working clinically or in roles responsible for acute stroke care. There were no restrictions to the study designs. A quality appraisal tool for qualitative studies by the Joanna Briggs Institute and another for quantitative studies by the Centre for Evidence-Based Management were used in the present study. A recent checklist to classify barriers and enablers to health professionals' adherence to evidence-based practice was also used. RESULTS Ten studies met the inclusion criteria out of a total of 9832 search results. The main barriers or enablers identified included poor organisational or institutional level support, health professionals' limited skills or competence to use a particular therapy, low level of awareness, familiarity or confidence in the effectiveness of a particular evidence-based therapy, limited medical facilities to support evidence uptake, inadequate peer support among health professionals', complex nature of some stroke care therapies or guidelines and patient level barriers. CONCLUSIONS Despite considerable evidence supporting various specific therapies for stroke care, uptake of these therapies is compromised by barriers across organisational, patients, guideline interventions and health professionals' domains. As a result, we recommend that future interventions and health policy directions should be informed by these findings in order to optimise uptake of best practice acute stroke care. Further studies from low- to middle-income countries are needed to understand the barriers and enablers in such settings. TRIAL REGISTRATION The review protocol was registered in the international prospective register of systematic reviews, PROSPERO 2015 (Registration Number: CRD42015023481 ).
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Affiliation(s)
- Leonard Baatiema
- Regional Institute for Population Studies, University of Ghana, P.O Box LG96, Legon-Accra, Ghana.
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia.
| | - Michael E Otim
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Melbourne, Australia
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, P.O Box LG96, Legon-Accra, Ghana
| | - Judith Coombes
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Shawn Somerset
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
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Zock E, Kerkhoff H, Kleyweg RP, van Bavel-Ta TBV, Scott S, Kruyt ND, Nederkoorn PJ, van de Beek D. Help seeking behavior and onset-to-alarm time in patients with acute stroke: sub-study of the preventive antibiotics in stroke study. BMC Neurol 2016; 16:241. [PMID: 27884126 PMCID: PMC5123223 DOI: 10.1186/s12883-016-0749-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with acute stroke often do not seek immediate medical help, which is assumed to be driven by lack of knowledge of stroke symptoms. We explored the process of help seeking behavior in patients with acute stroke, evaluating knowledge about stroke symptoms, socio-demographic and clinical characteristics, and onset-to-alarm time (OAT). METHODS In a sub-study of the Preventive Antibiotics in Stroke Study (PASS), 161 acute stroke patients were prospectively included in 3 Dutch hospitals. A semi-structured questionnaire was used to assess knowledge, recognition and interpretation of stroke symptoms. With in-depth interviews, response actions and reasons were explored. OAT was recorded and associations with socio-demographic, clinical parameters were assessed. RESULTS Knowledge about stroke symptoms does not always result in correct recognition of own stroke symptoms, neither into correct interpretation of the situation and subsequent action. In our study population of 161 patients with acute stroke, median OAT was 30 min (interquartile range [IQR] 10-150 min). Recognition of one-sided weakness and/or sensory loss (p = 0.046) and adequate interpretation of the stroke situation (p = 0.003), stroke at daytime (p = 0.002), severe stroke (p = 0.003), calling the emergency telephone number (p = 0.004), and transport by ambulance (p = 0.040) were associated with shorter OAT. CONCLUSION Help seeking behavior after acute stroke is a complex process. A shorter OAT after stroke is associated with correct recognition of one-sided weakness and/or sensory loss, adequate interpretation of the stroke situation by the patient and stroke characteristics and logistics of stroke care, but not by knowledge of stroke symptoms.
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Affiliation(s)
- E. Zock
- Department of Neurology, Albert Schweitzer Hospital Dordrecht, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
- Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - H. Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital Dordrecht, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - R. P. Kleyweg
- Department of Neurology, Albert Schweitzer Hospital Dordrecht, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | | | - S. Scott
- Department of Neurology, Slotervaart Hospital Amsterdam, Amsterdam, The Netherlands
| | - N. D. Kruyt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - P. J. Nederkoorn
- Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - D. van de Beek
- Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
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Zock E, Kerkhoff H, Kleyweg RP, van de Beek D. Intrinsic factors influencing help-seeking behaviour in an acute stroke situation. Acta Neurol Belg 2016; 116:295-301. [PMID: 26732617 PMCID: PMC4989004 DOI: 10.1007/s13760-015-0555-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/12/2015] [Indexed: 02/03/2023]
Abstract
The proportion of stroke patients eligible for intravenous or intra-arterial treatment is still limited because many patients do not seek medical help immediately after stroke onset. The aim of our study was to explore which intrinsic factors and considerations influence help-seeking behaviour of relatively healthy participants, confronted with stroke situations. Semi-structured interviews were conducted with 25 non-stroke participants aged 50 years or older. We presented 5 clinical stroke situations as if experienced by the participants themselves. Recognition and interpretation of symptoms were evaluated and various factors influencing help-seeking behaviour were explored in-depth. We used the thematic synthesis method for data analysis. Five themes influencing help-seeking behaviour in a stroke situation were identified: influence of knowledge, views about seriousness, ideas about illness and health, attitudes towards others and beliefs about the emergency medical system. A correct recognition of stroke symptoms or a correct interpretation of the stroke situations did not automatically result in seeking medical help. Interestingly, similar factors could lead to different types of actions between participants. Many intrinsic, as well as social and environmental factors are of influence on help-seeking behaviour in an acute stroke situation. All these factors seem to play a complex role in help-seeking behaviour with considerable inter-individual variations. Accomplishing more patients eligible for acute stroke treatment, future research should focus on better understanding of all factors at various levels grounded in a theory of help-seeking behaviour.
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Why Patients Delay Their First Contact with Health Services After Stroke? A Qualitative Focus Group-Based Study. PLoS One 2016; 11:e0156933. [PMID: 27275948 PMCID: PMC4898830 DOI: 10.1371/journal.pone.0156933] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/20/2016] [Indexed: 11/29/2022] Open
Abstract
Background Despite national and local French information campaigns, when acute stroke occurs, waiting times before calling mobile emergency medical services (EMS) to receive appropriate treatment (i.e. thrombolysis) and decrease the risk of physical disability, remain long. We aimed to identify the representations of stroke in the general population and to determine barriers to and facilitators for rapidly contacting EMS. Method We conducted a qualitative study among the general population with 10 focus groups, 5 comprising employed people (N = 29) and 5 comprising retirees (N = 32). The themes discussed were general knowledge about stroke and its risk factors, symptoms, appropriate management and the awareness that stroke is an emergency issue. Results In addition to a lack of knowledge about stroke, other barriers to rapidly contacting the EMS were difficulties in recognizing symptoms and understanding that these symptoms constitute an emergency. Furthermore, when faced with stroke, a feeling of inevitability and fatalism about the consequences of a stroke was highlighted. Participants were unaware of the existence of an effective treatment and they mistrusted medical competences. Finally, we found a strong presence and participant appreciation of common knowledge, resulting in the sharing of experiences of stroke. This could partly compensate for the lack of specific knowledge about symptom recognition and appropriate action. Conclusion Information campaigns should not only inform the public about stroke symptoms in order to ensure people act appropriately, but should also focus on increasing public awareness about the fact that an effective treatment exists.
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Williams DJP. The great ESCAPE - a clinical pharmacologist's journey in stroke research. Br J Clin Pharmacol 2016; 82:334-9. [PMID: 27062549 DOI: 10.1111/bcp.12966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- David J P Williams
- Royal College of Surgeons in Ireland (RCSI) and Beaumont Hospital Dublin, Dublin, Ireland
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Mellon L, Doyle F, Williams D, Brewer L, Hall P, Hickey A. Patient behaviour at the time of stroke onset: a cross-sectional survey of patient response to stroke symptoms. Emerg Med J 2016; 33:396-402. [PMID: 26781460 DOI: 10.1136/emermed-2015-204806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 12/22/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Revascularisation treatment with thrombolysis must be initiated within 4.5 h following ischaemic stroke symptom onset. Despite its proven benefits, thrombolysis therapy is underused, with patient delay in presenting to hospital with symptoms identified as the leading barrier. This study aimed to examine help-seeking behaviour at stroke onset, in order to understand delays in accessing acute medical care for stroke symptoms. METHODS 149 consecutive patients hospitalised with ischaemic stroke were interviewed at 72 h poststroke with the Stroke Awareness Questionnaire and the Response to Symptoms Questionnaire. RESULTS Sixty per cent of stroke cases presented to the ED within 3.5 h of stroke onset. Knowledge of stroke symptoms and risk factors was poor, with 40% unable to correctly define a stroke. Bystander recognition of symptoms (p=0.03) and bystander initiation of Emergency Medical Services was associated with ED presentation within 3.5 h (p=0.03). CONCLUSIONS This study provides insights into patient response when a stroke occurs, with the presence and action of others highlighted as critical in fast response to stroke symptoms. Knowledge of stroke warning signs and risk factors was low among stroke survivors. Findings highlight the complexity of changing help-seeking behaviour during stroke onset, and provide directions for public education efforts to reduce prehospital delay.
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Affiliation(s)
- L Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Brewer
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Hall
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Abstract
There has been a tremendous evolution in the stroke systems of care in the USA. Public awareness, prehospital care, and in-hospital protocols have never been so effectively connected. However, given the critical role of time to effective reperfusion in the setting of acute ischemic stroke, it is vital and timely to implement strategies to further streamline emergency stroke care. This article reviews the most current standards and guidelines related to the flow of stroke care in the prehospital and emergency settings.
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Affiliation(s)
- Keith G DeSousa
- Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th St, CRB 13th Floor, Miami, FL, 33136, USA,
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Bray JE, Straney L, Barger B, Finn J. Effect of Public Awareness Campaigns on Calls to Ambulance Across Australia. Stroke 2015; 46:1377-80. [DOI: 10.1161/strokeaha.114.008515] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/23/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The National Stroke Foundation of Australia has run 12 public awareness campaigns since 2004. Campaign exposure and funding has varied annually and regionally during this time. The aim of this study was to measure the effect of campaigns on calls to ambulance for stroke across Australia in exposed regions (paid or pro bono advertising).
Methods—
All ambulance services in Australia provided monthly ambulance dispatch data between January 2003 and June 2014. We performed multivariable regression to measure the effect of campaign exposure on the volume of stroke-related emergency calls, after controlling for confounders.
Results—
The final model indicated that 11 of the 12 National Stroke Foundation campaigns were associated with increases in the volume of stroke-related calls (varying between 1% and 9.9%) in regions with exposure to advertising. This increase lasted ≈3 months, with an additional 10.2% relative increase in the volume of the calls in regions with paid advertising. We found no significant additional effect of the campaigns on stroke calls where ambulance services are publicly funded.
Conclusions—
The National Stroke Foundation stroke awareness campaigns are associated with increases to calls to ambulance for stroke in regions receiving advertising and promotion. Research is now required to examine whether this increased use in ambulance is for appropriate emergencies.
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Affiliation(s)
- Janet E. Bray
- From the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., L.S., J.F.); Alfred Hospital, Melbourne, Victoria, Australia (J.E.B.); Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.); Ambulance Victoria, Melbourne, Victoria, Australia (B.B.); and St John Ambulance, Perth, Western Australia, Australia (J.F.)
| | - Lahn Straney
- From the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., L.S., J.F.); Alfred Hospital, Melbourne, Victoria, Australia (J.E.B.); Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.); Ambulance Victoria, Melbourne, Victoria, Australia (B.B.); and St John Ambulance, Perth, Western Australia, Australia (J.F.)
| | - Bill Barger
- From the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., L.S., J.F.); Alfred Hospital, Melbourne, Victoria, Australia (J.E.B.); Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.); Ambulance Victoria, Melbourne, Victoria, Australia (B.B.); and St John Ambulance, Perth, Western Australia, Australia (J.F.)
| | - Judith Finn
- From the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., L.S., J.F.); Alfred Hospital, Melbourne, Victoria, Australia (J.E.B.); Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.); Ambulance Victoria, Melbourne, Victoria, Australia (B.B.); and St John Ambulance, Perth, Western Australia, Australia (J.F.)
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Wolters FJ, Paul NLM, Li L, Rothwell PM. Sustained impact of UK FAST-test public education on response to stroke: a population-based time-series study. Int J Stroke 2015; 10:1108-14. [PMID: 25854424 PMCID: PMC4672715 DOI: 10.1111/ijs.12484] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/22/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Urgent assessment is essential after stroke. Several countries have had public education campaigns, based on the FAST (Face-Arm-Speech-Time) test to reduce delays in seeking attention. However, the impact of these campaigns on patient behavior is uncertain. METHODS We prospectively determined patient behavior after incident major stroke (NIHSS > 3) in a UK population based study (Oxford Vascular Study) before (2002-2008) and after (2009-2013) introduction of the FAST TV-campaign and assessed any sustained impact of campaign continuation. RESULTS Among 668 consecutive patients with major stroke, medical attention was sought by a bystander in 553 (89·6%). Patients were more likely to present directly to emergency services (OR = 2·18, 95%CI:1·54-3·09, P < 0·0001) after the campaign and to arrive at hospital within 3 h (OR = 2·18, 1·55-3·06, P < 0·0001). Median [IQR] time to seeking attention fell from 53 [15-265] to 31 [7-120] minutes (P = 0·005) and median time to hospital arrival from 185 [88-885] to 119 [78-256] minutes (P < 0·0001). On time-series analysis improvements in hospital arrival within 3 h and use of emergency medical services were significantly associated to initiation of the campaign (aOR = 3·11, 1·53-6·29, P = 0·002; and 2·22, 1·05-4·67, P = 0·036, respectively), independent of trend, age, sex, ethnicity, educational level, social class, prior stroke and stroke severity, and have been sustained to 2013. CONCLUSION Delays to seeking and receiving medical attention after major stroke in the UK. fell strikingly in 2009, coinciding with the start of the FAST TV campaign. That medical attention was sought by a bystander in nearly 90% of cases illustrates the importance of mass-media public education rather than focused programs in high-risk groups for major stroke.
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Affiliation(s)
- Frank J Wolters
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Nicola L M Paul
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Linxin Li
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Mellon L, Doyle F, Rohde D, Williams D, Hickey A. Stroke warning campaigns: delivering better patient outcomes? A systematic review. PATIENT-RELATED OUTCOME MEASURES 2015; 6:61-73. [PMID: 25750550 PMCID: PMC4348144 DOI: 10.2147/prom.s54087] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Patient delay in presenting to hospital with stroke symptoms remains one of the major barriers to thrombolysis treatment, leading to its suboptimal use internationally. Educational interventions such as mass media campaigns and community initiatives aim to reduce patient delays by promoting the signs and symptoms of a stroke, but no consistent evidence exists to show that such interventions result in appropriate behavioral responses to stroke symptoms. Methods A systematic literature search and narrative synthesis were conducted to examine whether public educational interventions were successful in the reduction of patient delay to hospital presentation with stroke symptoms. Three databases, MEDLINE, CINAHL, and PsycINFO, were searched to identify quantitative studies with measurable behavioral end points, including time to hospital presentation, thrombolysis rates, ambulance use, and emergency department (ED) presentations with stroke. Results Fifteen studies met the inclusion criteria: one randomized controlled trial, two time series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies. Studies were heterogeneous in quality; thus, meta-analysis was not feasible. Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect. Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance transports following the intervention. Three studies examining ED presentations reported significantly increased ED presentations following intervention. Public educational interventions varied widely on type, duration, and content, with description of intervention development largely absent from studies, limiting the potential replication of successful interventions. Conclusions Positive intervention effects were reported in the majority of studies; however, methodological weaknesses evident in a number of studies limited the generalizability of the observed effects. Reporting of specific intervention design was suboptimal and impeded the identification of key intervention components for reducing patient delay. The parallel delivery of public and professional interventions further limited the identification of successful intervention components. A lack of studies of sound methodological quality using, at a minimum, a controlled before and after design was identified in this review, and thus studies incorporating a rigorous study design are required to strengthen the evidence for public interventions to reduce patient delay in stroke. The potential clinical benefits of public interventions are far-reaching, and the challenge remains in translating knowledge improvements and correct behavioral intentions to appropriate behavior when stroke occurs.
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Affiliation(s)
- Lisa Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Caruso D, Perez Akly M, Costantini PD, Fridman S, Esnaola MM. Do elderly patients call 911 when presented with clinical scenarios suggestive of acute stroke? A cross-sectional study. Cerebrovasc Dis 2015; 39:87-93. [PMID: 25571931 DOI: 10.1159/000369962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Among patients with acute stroke symptoms, delay in hospital admission is the main obstacle for the use of thrombolytic therapy and other interventions associated with decreased mortality and disability. The primary aim of this study was to assess whether an elderly clinical population correctly endorsed the response to call for emergency services when presented with signs and symptoms of stroke using a standardized questionnaire. METHODS We performed a cross-sectional study among elderly out-patients (≥60 years) in Buenos Aires, Argentina randomly recruited from a government funded health clinic. The correct endorsement of intention to call 911 was assessed with the Stroke Action Test and the cut-off point was set at ≥75%. Knowledge of stroke and clinical and socio-demographic indicators were also collected and evaluated as predictors of correct endorsement using logistic regression. RESULTS Among 367 elderly adults, 14% correctly endorsed intention to call 911. Presented with the most typical signs and symptoms, only 65% reported that they would call an ambulance. Amaurosis Fugax was the symptom for which was called the least (15%). On average, the correct response was chosen only 37% of the time. Compared to lower levels of education, higher levels were associated to correctly endorsed intention to call 911 (secondary School adjusted OR 3.53, 95% CI 1.59-7.86 and Tertiary/University adjusted OR 3.04, 95% CI 1.12-8.21). CONCLUSIONS These results suggest the need to provide interventions that are specifically designed to increase awareness of potential stroke signs and symptoms and appropriate subsequent clinical actions.
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Affiliation(s)
- Diego Caruso
- Department of Internal Medicine, Hospital Dr. César Milstein associated with University of Buenos Aires, Buenos Aires, Argentina
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Park M, Kim K, Lee JH, Kang C, Jo YH, Kim DH, Kang KW, Lee SH, Park C, Kim J, Chung H, Park H, Jang S. Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke. Clin Exp Emerg Med 2014; 1:41-48. [PMID: 27752551 PMCID: PMC5052826 DOI: 10.15441/ceem.14.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/07/2014] [Accepted: 08/17/2014] [Indexed: 12/29/2022] Open
Abstract
Objective Patients with severe sepsis or septic shock require timely, aggressive management to improve their outcomes, and early presentation of patients to the hospital may also be important. Thus, public awareness about sepsis may be important for improved outcomes. However, there are no studies regarding the public awareness of sepsis in the general Korean population. Therefore, the objective of this survey was to gain insight into the public awareness of sepsis. Methods Prospective paper-based and web-based surveys were issued between May and June 2013 to adults aged ≥18 years. Results A total of 1,081 participants responded to the survey (394 paper-based and 687 web-based). Mean age was 38.7±11.4 years, and 541 participants (50%) were men. Of the 1,081 participants, 831 (76.9%) had heard of the term “sepsis.” Of these participants, only 295 (35%) responded correctly regarding the definition of sepsis. However, 1,019 participants (94.3%) had heard of acute myocardial infarction, and 817 of these (80%) correctly defined acute myocardial infarction. Regarding stroke, 1,047 (96.9%) had heard of stroke, and 975 of these responded (93.1%) correctly to the definition of stroke. Conclusion There is poor public awareness about sepsis compared with that of acute myocardial infarction and stroke. This may limit the timely management of severe sepsis and septic shock.
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Affiliation(s)
- Minji Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Hoon Kim
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Kyeong Won Kang
- Department of Emergency Medicine, Jeju National University Hospital, Jeju, Korea
| | - Soo Hoon Lee
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Chanjong Park
- Department of Emergency Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heajin Chung
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyunmi Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sujin Jang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Flynn D, Ford GA, Rodgers H, Price C, Steen N, Thomson RG. A time series evaluation of the FAST National Stroke Awareness Campaign in England. PLoS One 2014; 9:e104289. [PMID: 25119714 PMCID: PMC4131890 DOI: 10.1371/journal.pone.0104289] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/10/2014] [Indexed: 12/01/2022] Open
Abstract
Objective In February 2009, the Department of Health in England launched the Face, Arm, Speech, and Time (FAST) mass media campaign, to raise public awareness of stroke symptoms and the need for an emergency response. We aimed to evaluate the impact of three consecutive phases of FAST using population-level measures of behaviour in England. Methods Interrupted time series (May 2007 to February 2011) assessed the impact of the campaign on: access to a national stroke charity's information resources (Stroke Association [SA]); emergency hospital admissions with a primary diagnosis of stroke (Hospital Episode Statistics for England); and thrombolysis activity from centres in England contributing data to the Safe Implementation of Thrombolysis in Stroke UK database. Results Before the campaign, emergency admissions (and patients admitted via accident and emergency [A&E]) and thrombolysis activity was increasing significantly over time, whereas emergency admissions via general practitioners (GPs) were decreasing significantly. SA webpage views, calls to their helpline and information materials dispatched increased significantly after phase one. Website hits/views, and information materials dispatched decreased after phase one; these outcomes increased significantly during phases two and three. After phase one there were significant increases in overall emergency admissions (505, 95% CI = 75 to 935) and patients admitted via A&E (451, 95% CI = 26 to 875). Significantly fewer monthly emergency admissions via GPs were reported after phase three (−19, 95% CI = −29 to −9). Thrombolysis activity per month significantly increased after phases one (3, 95% CI = 1 to 6), and three (3, 95% CI = 1 to 4). Conclusions Phase one had a statistically significant impact on information seeking behaviour and emergency admissions, with additional impact that may be attributable to subsequent phases on information seeking behaviour, emergency admissions via GPs, and thrombolysis activity. Future campaigns should be a0ccompanied by evaluation of impact on clinical outcomes such as reduced stroke-related morbidity and mortality.
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Affiliation(s)
- Darren Flynn
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Gary A. Ford
- Institute for Ageing and Health (Stroke Research Group), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen Rodgers
- Institute for Ageing and Health (Stroke Research Group), Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher Price
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington, United Kingdom
| | - Nick Steen
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard G. Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Dombrowski SU, Mackintosh JE, Sniehotta FF, Araujo-Soares V, Rodgers H, Thomson RG, Murtagh MJ, Ford GA, Eccles MP, White M. The impact of the UK 'Act FAST' stroke awareness campaign: content analysis of patients, witness and primary care clinicians' perceptions. BMC Public Health 2013; 13:915. [PMID: 24088381 PMCID: PMC3850704 DOI: 10.1186/1471-2458-13-915] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 09/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background The English mass media campaign ‘Act FAST’ aimed to raise stroke awareness and the need to call emergency services at the onset of suspected stroke. We examined the perceived impact and views of the campaign in target populations to identify potential ways to optimise mass-media interventions for stroke. Methods Analysis of semi-structured interviews conducted as part of two qualitative studies, which examined factors influencing patient/witness response to acute stroke symptoms (n = 19 stroke patients, n = 26 stroke witnesses) and perceptions about raising stroke awareness in primary care (n = 30 clinicians). Both studies included questions about the ‘Act FAST’ campaign. Interviews were content analysed to determine campaign awareness, perceived impact on decisions and response to stroke, and views of the campaign. Results Most participants were aware of the Act FAST campaign. Some patients and witnesses reported that the campaign impacted upon their stroke recognition and response, but the majority reported no impact. Clinicians often perceived campaign success in raising stroke awareness, but few thought it would change response behaviours. Some patients and witnesses, and most primary care clinicians expressed positive views towards the campaign. Some more critical participant comments included perceptions of dramatic, irrelevant, and potentially confusing content, such as a prominent ‘fire in the brain’ analogy. Conclusions Act FAST has had some perceived impact on stroke recognition and response in some stroke patients and witnesses, but the majority reported no campaign impact. Primary care clinicians were positive about the campaign, and believed it had impacted on stroke awareness and recognition but doubted impact on response behaviour. Potential avenues for optimising and complementing mass media campaigns such as ‘Act FAST’ were identified.
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Affiliation(s)
- Stephan U Dombrowski
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK.
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