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Koska IO, Selver MA, Gelal F, Uluc ME, Çetinoğlu YK, Yurttutan N, Serindere M, Dicle O. Voxel level dense prediction of acute stroke territory in DWI using deep learning segmentation models and image enhancement strategies. Jpn J Radiol 2024; 42:962-972. [PMID: 38727961 DOI: 10.1007/s11604-024-01582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/23/2024] [Indexed: 08/31/2024]
Abstract
PURPOSE To build a stroke territory classifier model in DWI by designing the problem as a multiclass segmentation task by defining each stroke territory as distinct segmentation targets and leveraging the guidance of voxel wise dense predictions. MATERIALS AND METHODS Retrospective analysis of DWI images of 218 consecutive acute anterior or posterior ischemic stroke patients examined between January 2017 to April 2020 in a single center was carried out. Each stroke area was defined as distinct segmentation target with different class labels. U-Net based network was trained followed by majority voting of the voxel wise predictions of the model to transform them into patient level stroke territory classes. Effects of bias field correction and registration to a common space were explored. RESULTS Of the 218 patients included in this study, 141 (65%) were anterior stroke, and 77 were posterior stroke (35%) whereas 117 (53%) were male and 101 (47%) were female. The model built with original images reached 0.77 accuracy, while the model built with N4 bias corrected images reached 0.80 and the model built with images which were N4 bias corrected and then registered into a common space reached 0.83 accuracy values. CONCLUSION Voxel wise dense prediction coupled with bias field correction to eliminate artificial signal increase and registration to a common space help models for better performance than using original images. Knowing the properties of target domain while designing deep learning models is important for the overall success of these models.
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Affiliation(s)
- Ilker Ozgur Koska
- Department of Radiology, Behçet Uz Children's Hospital, Izmir, Turkey.
- Dokuz Eylül University The Graduate School of Natural and Applied Sciences, Dokuz Eylül Universtiy, Izmir, Turkey.
| | - M Alper Selver
- Engineering Faculty, Department of Electrical and Electronics Engineering, Dokuz Eylül University, Izmir, 35390, Turkey
- İzmir Health Technologies Development and Accelerator (BioIzmir), Dokuz Eylül University, Izmir, Turkey
| | - Fazil Gelal
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi, Izmir, 35360, Turkey
| | - Muhsin Engin Uluc
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Basin Sitesi, Izmir, 35360, Turkey
| | | | - Nursel Yurttutan
- Department of Radiology, Kahramanmaraş Sütçü İmam University Hospital, Kahramanmaraş, Turkey
| | - Mehmet Serindere
- Department of Radiology, Hatay Training and Research Hospital, Güzelburç/Hatay, Turkey
| | - Oğuz Dicle
- Medicine Faculty, Department of Radiology, Dokuz Eylül University, 15 Temmuz Sağlık Sanat Yerleşkesi/İnciraltı, İzmir, 35340, Turkey
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Freitas TE, Costa AI, Neves L, Barros C, Martins M, Freitas P, Noronha D, Freitas P, Faria T, Borges S, Freitas S, Henriques E, Sousa AC. Neuron-specific enolase as a prognostic biomarker in acute ischemic stroke patients treated with reperfusion therapies. Front Neurol 2024; 15:1408111. [PMID: 39091979 PMCID: PMC11291469 DOI: 10.3389/fneur.2024.1408111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction Ischemic stroke is a significant global health concern, with reperfusion therapies playing a vital role in patient management. Neuron-specific enolase (NSE) has been suggested as a potential biomarker for assessing stroke severity and prognosis, however, the role of NSE in predicting long-term outcomes in patients undergoing reperfusion therapies is still scarce. Aim To investigate the association between serum NSE levels at admission and 48 h after reperfusion therapies, and functional outcomes at 90 days in ischemic stroke patients. Methods This study conducted a prospective cross-sectional analysis on consecutive acute ischemic stroke patients undergoing intravenous fibrinolysis and/or endovascular thrombectomy. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days post-stroke and two groups were defined according to having unfavorable (mRS3-6) or favorable (mRS0-2) outcome. Demographic, clinical, radiological, and laboratory data were collected, including NSE levels at admission and 48 h. Spearman's coefficient evaluated the correlation between analyzed variables. Logistic regression analysis was performed to verify which variables were independently associated with unfavorable outcome. Two ROC curves determined the cut-off points for NSE at admission and 48 h, being compared by Delong test. Results Analysis of 79 patients undergoing reperfusion treatment following acute stroke revealed that patients with mRS 3-6 had higher NIHSS at admission (p < 0.0001), higher NIHSS at 24 h (p < 0.0001), and higher NSE levels at 48 h (p = 0.008) when compared to those with mRS 0-2. Optimal cut-off values for NSE0 (>14.2 ng/mL) and NSE48h (>26.3 ng/mL) were identified, showing associations with worse clinical outcomes. Adjusted analyses demonstrated that patients with NSE48h > 26.3 ng/mL had a 13.5 times higher risk of unfavorable outcome, while each unit increase in NIHSS24h score was associated with a 22% increase in unfavorable outcome. Receiver operating characteristic analysis indicated similar predictive abilities of NSE levels at admission and 48 h (p = 0.298). Additionally, a strong positive correlation was observed between NSE48h levels and mRS at 90 days (r = 0.400 and p < 0.0001), suggesting that higher NSE levels indicate worse neurological disability post-stroke. Conclusion Serum NSE levels at 48 h post-reperfusion therapies are associated with functional outcomes in ischemic stroke patients, serving as potential tool for patient long-term prognosis.
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Affiliation(s)
| | - Ana Isabel Costa
- Internal Medicine Department, Hospital Dr. Nélio Mendonça, Funchal, Portugal
| | - Leonor Neves
- Internal Medicine Department II, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Carolina Barros
- Stroke Centre, Hospital Dr. Nélio Mendonça, Funchal, Portugal
| | - Mariana Martins
- Stroke Centre, Hospital Dr. Nélio Mendonça, Funchal, Portugal
| | - Pedro Freitas
- Stroke Centre, Hospital Dr. Nélio Mendonça, Funchal, Portugal
| | - Duarte Noronha
- Neurology Department, Hospital Dr. Nélio Mendonça, Funchal, Portugal
| | | | - Teresa Faria
- Internal Medicine Department, Hospital Dr. Nélio Mendonça, Funchal, Portugal
| | - Sofia Borges
- Centro de Investigação Clínica Dra. Maria Isabel Mendonça, Funchal, Portugal
| | - Sónia Freitas
- Centro de Investigação Clínica Dra. Maria Isabel Mendonça, Funchal, Portugal
| | - Eva Henriques
- Centro de Investigação Clínica Dra. Maria Isabel Mendonça, Funchal, Portugal
| | - Ana Célia Sousa
- Centro de Investigação Clínica Dra. Maria Isabel Mendonça, Funchal, Portugal
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Al-Amoodi A, Debicki D, Sefein O, Bainbridge D. Ischemic Stroke in the Cardiac Surgery Intensive Care Unit: A Quality Improvement Study. J Cardiothorac Vasc Anesth 2024; 38:1524-1530. [PMID: 38614942 DOI: 10.1053/j.jvca.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/09/2024] [Accepted: 03/08/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE To investigate the frequency of stroke and code stroke activation and the factors influencing code stroke management in postoperative cardiac surgical patients. DESIGN A retrospective quality improvement study was conducted between January 1, 2016, and December 31, 2021. SETTING The Cardiac Surgery Recovery Unit (CSRU) at London Health Sciences Centre in London, Ontario, Canada. PARTICIPANTS Postcardiac surgery patients aged 18 years or older who developed ischemic stroke during their admission to the CSRU. INTERVENTIONS No specific interventions were administered as part of this study. Code stroke activation mobilizes a specialized team. The objectives include assessment by a physician within 10 minutes, obtaining neuroimaging and interpretation within 45 minutes, and beginning treatment within 60 minutes. MEASUREMENTS AND MAIN RESULTS The incidence rate of stroke in the CSRU was 1.3%, and 34% of these patients had code stroke activated. The time since the last known well status was 11 ± 8 hours. The most common reasons for not activating code stroke were not meeting both timing and clinical criteria. The average time for computed tomography (CT) scan was 36 ± 22 minutes. Among patients who had code stroke activated, 24% had large- vessel occlusion (LVO), and 67% of those with LVO had an established stroke on their initial CT. CONCLUSION Code stroke was activated in only one-third of patients who experienced a stroke following cardiac surgery. Additionally, out of those who had code stroke activated, only one-fourth were diagnosed with LVO. Among those with LVO, two-thirds were found to have a well-established stroke on noncontrast CT scans and were deemed ineligible for intervention.
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Affiliation(s)
- Abobakr Al-Amoodi
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Derek Debicki
- Department of Neurosciences, Department of Neurology, Western University, London, ON, Canada
| | - Osama Sefein
- Department of Anesthesiology, Department of Medicine, Division of Critical Care, Western University, London, ON, Canada
| | - Daniel Bainbridge
- Department of Anesthesiology, Department of Medicine, Division of Critical Care, Western University, London, ON, Canada
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Lima Neto AC, Bittar RSM. Vascular vertigo and dizziness: managing and treating outpatients. Braz J Otorhinolaryngol 2024; 90:101453. [PMID: 38991403 PMCID: PMC11295563 DOI: 10.1016/j.bjorl.2024.101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/14/2024] [Accepted: 05/23/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVE Due the lack of data on the treatment of Vascular Vertigo and Dizziness, this study aimed to report how we managed and treated those outpatients according to the recently introduced American Heart Association and Stroke Association guidelines. METHODS We conducted a longitudinal case series from May 2022 to February 2023. We included patients who met the Bárány Society's Vascular Vertigo and Dizziness classification and were eligible for therapy in accordance with the American Heart Association and Stroke Association guidelines, featuring aspects of the stroke group and transient attack group. RESULTS Overall, 41 patients (51.2% female; median age 72 years) were enrolled; 10 (24.3%) had ischemic strokes, 30 (73.1%) had transient ischemic attack, and 1 (2.4%) had a probable isolated labyrinthine infarction. The patients received dual antiplatelet (48.7%), single antiplatelet therapy (48.7%), and anticoagulant therapy (2.4%). No new crises occurred in 95.2% of the patients, and the transient ischemic attack group showed a significant decrease in discomfort from imbalance on the visual analog scale. CONCLUSIONS Antiplatelets and anticoagulants are safe and effective in treating Vascular Vertigo and Dizziness as they prevent new ischemic events and increase the flow of the posterior circulation, reducing vertigo/dizziness attacks and imbalance complaints. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Arlindo Cardoso Lima Neto
- Setor de Otoneurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, Brazil.
| | - Roseli Saraiva Moreira Bittar
- Setor de Otoneurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, Brazil
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Abujaber AA, Imam Y, Albalkhi I, Yaseen S, Nashwan AJ, Akhtar N. Utilizing machine learning to facilitate the early diagnosis of posterior circulation stroke. BMC Neurol 2024; 24:156. [PMID: 38714968 PMCID: PMC11075305 DOI: 10.1186/s12883-024-03638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Posterior Circulation Syndrome (PCS) presents a diagnostic challenge characterized by its variable and nonspecific symptoms. Timely and accurate diagnosis is crucial for improving patient outcomes. This study aims to enhance the early diagnosis of PCS by employing clinical and demographic data and machine learning. This approach targets a significant research gap in the field of stroke diagnosis and management. METHODS We collected and analyzed data from a large national Stroke Registry spanning from January 2014 to July 2022. The dataset included 15,859 adult patients admitted with a primary diagnosis of stroke. Five machine learning models were trained: XGBoost, Random Forest, Support Vector Machine, Classification and Regression Trees, and Logistic Regression. Multiple performance metrics, such as accuracy, precision, recall, F1-score, AUC, Matthew's correlation coefficient, log loss, and Brier score, were utilized to evaluate model performance. RESULTS The XGBoost model emerged as the top performer with an AUC of 0.81, accuracy of 0.79, precision of 0.5, recall of 0.62, and F1-score of 0.55. SHAP (SHapley Additive exPlanations) analysis identified key variables associated with PCS, including Body Mass Index, Random Blood Sugar, ataxia, dysarthria, and diastolic blood pressure and body temperature. These variables played a significant role in facilitating the early diagnosis of PCS, emphasizing their diagnostic value. CONCLUSION This study pioneers the use of clinical data and machine learning models to facilitate the early diagnosis of PCS, filling a crucial gap in stroke research. Using simple clinical metrics such as BMI, RBS, ataxia, dysarthria, DBP, and body temperature will help clinicians diagnose PCS early. Despite limitations, such as data biases and regional specificity, our research contributes to advancing PCS understanding, potentially enhancing clinical decision-making and patient outcomes early in the patient's clinical journey. Further investigations are warranted to elucidate the underlying physiological mechanisms and validate these findings in broader populations and healthcare settings.
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Affiliation(s)
- Ahmad A Abujaber
- Nursing Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Yahia Imam
- Neurology Section, Neuroscience Institute, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Said Yaseen
- School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdulqadir J Nashwan
- Nursing Department, Hamad Medical Corporation (HMC), Doha, Qatar.
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
| | - Naveed Akhtar
- Neuroradiology Department, Neuroscience Institute, Hamad Medical Corporation (HMC), Doha, Qatar
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Guthrie B, Rogers G, Livingstone S, Morales DR, Donnan P, Davis S, Youn JH, Hainsworth R, Thompson A, Payne K. The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-275. [PMID: 38420962 DOI: 10.3310/kltr7714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background Clinical guidelines commonly recommend preventative treatments for people above a risk threshold. Therefore, decision-makers must have faith in risk prediction tools and model-based cost-effectiveness analyses for people at different levels of risk. Two problems that arise are inadequate handling of competing risks of death and failing to account for direct treatment disutility (i.e. the hassle of taking treatments). We explored these issues using two case studies: primary prevention of cardiovascular disease using statins and osteoporotic fracture using bisphosphonates. Objectives Externally validate three risk prediction tools [QRISK®3, QRISK®-Lifetime, QFracture-2012 (ClinRisk Ltd, Leeds, UK)]; derive and internally validate new risk prediction tools for cardiovascular disease [competing mortality risk model with Charlson Comorbidity Index (CRISK-CCI)] and fracture (CFracture), accounting for competing-cause death; quantify direct treatment disutility for statins and bisphosphonates; and examine the effect of competing risks and direct treatment disutility on the cost-effectiveness of preventative treatments. Design, participants, main outcome measures, data sources Discrimination and calibration of risk prediction models (Clinical Practice Research Datalink participants: aged 25-84 years for cardiovascular disease and aged 30-99 years for fractures); direct treatment disutility was elicited in online stated-preference surveys (people with/people without experience of statins/bisphosphonates); costs and quality-adjusted life-years were determined from decision-analytic modelling (updated models used in National Institute for Health and Care Excellence decision-making). Results CRISK-CCI has excellent discrimination, similar to that of QRISK3 (Harrell's c = 0.864 vs. 0.865, respectively, for women; and 0.819 vs. 0.834, respectively, for men). CRISK-CCI has systematically better calibration, although both models overpredict in high-risk subgroups. People recommended for treatment (10-year risk of ≥ 10%) are younger when using QRISK-Lifetime than when using QRISK3, and have fewer observed events in a 10-year follow-up (4.0% vs. 11.9%, respectively, for women; and 4.3% vs. 10.8%, respectively, for men). QFracture-2012 underpredicts fractures, owing to under-ascertainment of events in its derivation. However, there is major overprediction among people aged 85-99 years and/or with multiple long-term conditions. CFracture is better calibrated, although it also overpredicts among older people. In a time trade-off exercise (n = 879), statins exhibited direct treatment disutility of 0.034; for bisphosphonates, it was greater, at 0.067. Inconvenience also influenced preferences in best-worst scaling (n = 631). Updated cost-effectiveness analysis generates more quality-adjusted life-years among people with below-average cardiovascular risk and fewer among people with above-average risk. If people experience disutility when taking statins, the cardiovascular risk threshold at which benefits outweigh harms rises with age (≥ 8% 10-year risk at 40 years of age; ≥ 38% 10-year risk at 80 years of age). Assuming that everyone experiences population-average direct treatment disutility with oral bisphosphonates, treatment is net harmful at all levels of risk. Limitations Treating data as missing at random is a strong assumption in risk prediction model derivation. Disentangling the effect of statins from secular trends in cardiovascular disease in the previous two decades is challenging. Validating lifetime risk prediction is impossible without using very historical data. Respondents to our stated-preference survey may not be representative of the population. There is no consensus on which direct treatment disutilities should be used for cost-effectiveness analyses. Not all the inputs to the cost-effectiveness models could be updated. Conclusions Ignoring competing mortality in risk prediction overestimates the risk of cardiovascular events and fracture, especially among older people and those with multimorbidity. Adjustment for competing risk does not meaningfully alter cost-effectiveness of these preventative interventions, but direct treatment disutility is measurable and has the potential to alter the balance of benefits and harms. We argue that this is best addressed in individual-level shared decision-making. Study registration This study is registered as PROSPERO CRD42021249959. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/12/22) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 4. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Bruce Guthrie
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Shona Livingstone
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Daniel R Morales
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Peter Donnan
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Sarah Davis
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Rob Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Alexander Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Youkee D, Marshall IJ, Fox-Rushby J, Lisk DR, O’Hara J, Wang Y, Rudd A, Wolfe CDA, Deen GF, Sackley C. Cohort Profile: The Stroke in Sierra Leone (SISLE) Register. Int J Epidemiol 2023; 52:e308-e314. [PMID: 37555838 PMCID: PMC10749756 DOI: 10.1093/ije/dyad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Daniel Youkee
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Iain J Marshall
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Julia Fox-Rushby
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Durodami R Lisk
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jessica O’Hara
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Yanzhong Wang
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Anthony Rudd
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Charles D A Wolfe
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Catherine Sackley
- King’s School of Life Course and Population Sciences, King’s College London, London, UK
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Pinzon RT, Wijaya VO, Veronica V. The role of homocysteine levels as a risk factor of ischemic stroke events: a systematic review and meta-analysis. Front Neurol 2023; 14:1144584. [PMID: 37251231 PMCID: PMC10216881 DOI: 10.3389/fneur.2023.1144584] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/07/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Among numerous risk factors, homocysteine (Hcy) has been linked to cerebral infarction; however, results have been inconsistent. This review aimed to conduct a meta-analysis of published studies to investigate the relationship between plasma Hcy levels and the risk of ischemic stroke. Methods A systematic literature search was conducted until November 2022 to obtain articles reporting Hcy levels in ischemic stroke patients. Review Manager software was used to perform all statistical analyses (version 5.3). Results Initial investigation yielded 283 articles. The final evaluation included 21 articles, including two prospective studies, one retrospective cohort, and 18 case-control studies. These studies included 9888 participants, of which 5031 were admitted patients with ischemic stroke. An integrated analysis revealed that ischemic stroke patients had significantly higher levels of Hcy than controls (mean difference (MD) = +3.70, 95% confidence interval (CI) = 2.42-5.81, p < 0.001). Conclusion This meta-analysis and systematic review indicate that ischemic stroke patients have significantly higher homocysteine levels than controls. Detecting hyperhomocysteinemia and reducing homocysteine levels should be explored among individuals at increased risk for ischemic stroke.
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Affiliation(s)
- Rizaldy Taslim Pinzon
- Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
- Neurology Department, Bethesda Hospital, Yogyakarta, Indonesia
| | | | - Vanessa Veronica
- Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
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Serrano-Castro ML, Garro-Zúñiga M, Simon E, Tamayo A, Siepmann T. Clinical and Imaging Phenotypes and Outcomes in a Costa Rican Cohort of Acute Ischemic Stroke Survivors: A Retrospective Study. J Clin Med 2023; 12:1080. [PMID: 36769728 PMCID: PMC9917829 DOI: 10.3390/jcm12031080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We characterized clinical and imaging phenotypes and their association with clinical outcomes in acute ischemic stroke (AIS) survivors in the understudied region of Costa Rica. METHODS We conducted a retrospective cohort study in AIS patients treated at a tertiary stroke center in Costa Rica from 2011-2015. Participants underwent detailed phenotyping for cardiovascular risk factors and stroke etiology. We assessed the association of ischemic brain lesion features and clinical outcomes using the Oxfordshire Community Stroke Project (OCSP) classification. RESULTS We included 684 AIS survivors (60.2% males, aged 68.1 ± 13.6 years, mean ± SD). While the cardiovascular risk profiles and mortality rates of our patients were similar to populations in European and North American countries, only 20.2% of patients with atrial fibrillation (AF) received anticoagulation. On multivariable analysis, patients with total anterior circulation infarct (TACI) displayed an increased risk of complications (OR: 4.2; 95% CI: 2.2-7.8; p < 0.001), higher mortality (OR: 6.9; 95% CI: 2.9-16.1; p < 0.001) and lower chance of functional independence at discharge (OR: 8.9; 95% CI: 4.1-19; p < 0.001) compared to non-TACI. The comorbidity of bronchopneumonia increased the probability of death by 14.5 times. CONCLUSIONS Our observations in a Costa Rican cohort of AIS survivors might help improve local measures for preventing and managing AIS.
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Affiliation(s)
- María Lorena Serrano-Castro
- Department of Internal Medicine, Hospital Chacón Paut, Caja Costarricense de Seguro Social, San José 10101, Costa Rica
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
| | - Mónica Garro-Zúñiga
- Department of Neurology, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José 94088, Costa Rica
| | - Erik Simon
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01069 Dresden, Germany
| | - Arturo Tamayo
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
- Winnipeg Regional Health Authority (WRHA), Section of Neurology, Department of Medicine, The Max Rady Faculty of Health Sciences, Brandon Regional Health Centre, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01069 Dresden, Germany
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Zhang JJ, Sánchez Vidaña DI, Chan JNM, Hui ESK, Lau KK, Wang X, Lau BWM, Fong KNK. Biomarkers for prognostic functional recovery poststroke: A narrative review. Front Cell Dev Biol 2023; 10:1062807. [PMID: 36699006 PMCID: PMC9868572 DOI: 10.3389/fcell.2022.1062807] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background and objective: Prediction of poststroke recovery can be expressed by prognostic biomarkers that are related to the pathophysiology of stroke at the cellular and molecular level as well as to the brain structural and functional reserve after stroke at the systems neuroscience level. This study aimed to review potential biomarkers that can predict poststroke functional recovery. Methods: A narrative review was conducted to qualitatively summarize the current evidence on biomarkers used to predict poststroke functional recovery. Results: Neurophysiological measurements and neuroimaging of the brain and a wide diversity of molecules had been used as prognostic biomarkers to predict stroke recovery. Neurophysiological studies using resting-state electroencephalography (EEG) revealed an interhemispheric asymmetry, driven by an increase in low-frequency oscillation and a decrease in high-frequency oscillation in the ipsilesional hemisphere relative to the contralesional side, which was indicative of individual recovery potential. The magnitude of somatosensory evoked potentials and event-related desynchronization elicited by movement in task-related EEG was positively associated with the quantity of recovery. Besides, transcranial magnetic stimulation (TMS) studies revealed the potential values of using motor-evoked potentials (MEP) and TMS-evoked EEG potentials from the ipsilesional motor cortex as prognostic biomarkers. Brain structures measured using magnetic resonance imaging (MRI) have been implicated in stroke outcome prediction. Specifically, the damage to the corticospinal tract (CST) and anatomical motor connections disrupted by stroke lesion predicted motor recovery. In addition, a wide variety of molecular, genetic, and epigenetic biomarkers, including hemostasis, inflammation, tissue remodeling, apoptosis, oxidative stress, infection, metabolism, brain-derived, neuroendocrine, and cardiac biomarkers, etc., were associated with poor functional outcomes after stroke. However, challenges such as mixed evidence and analytical concerns such as specificity and sensitivity have to be addressed before including molecular biomarkers in routine clinical practice. Conclusion: Potential biomarkers with prognostic values for the prediction of functional recovery after stroke have been identified; however, a multimodal approach of biomarkers for prognostic prediction has rarely been studied in the literature. Future studies may incorporate a combination of multiple biomarkers from big data and develop algorithms using data mining methods to predict the recovery potential of patients after stroke in a more precise way.
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Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | | | - Jackie Ngai-Man Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Edward S. K. Hui
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Xin Wang
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Benson W. M. Lau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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11
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Malliarou M, Tsionara C, Patsopoulou A, Bouletis A, Tzenetidis V, Papathanasiou I, Kotrotsiou E, Gouva M, Nikolentzos A, Sarafis P. Investigation of Factors That Affect the Quality of Life After a Stroke. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:437-442. [PMID: 37581817 DOI: 10.1007/978-3-031-31986-0_42] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Stroke, as a disease, describes a group of disorders characterized by the presence of central nervous system symptoms either as a result of ischemia (ischemic stroke) or bleeding (hemorrhagic stroke). The appearance of a stroke results in a permanent physical or cognitive disability. The stroke incidence is the third cause of death after heart disease and cancer, and is the main cause of long-term disability.The effects of a stroke on a patient's daily life, and hence on his quality of life, are intense and long-lasting. These include memory problems, speech difficulty, depression, reduced vision loss, and decreased walking ability. This limitation of the patient's motor activity has a direct negative impact on the quality of his life.To investigate the degree of this impact, a research was carried out at a hospital of Central Greece. The total sample consisted of 90 patients and the responses showed that post-stroke symptoms are significant. Consequences and treatment control of the disease on the life of the sample were the questions with the highest score showing the significant effect that a stroke has on life the patients.More specifically, the sample showed through responses that the disease affects their lives to a great extent. The pre-stroke scores on the domains of the sample are clearly higher than post-stroke. The highest difference was found in the use of the upper extremities in self-care and family roles while the lowest was found in the domain of thinking. The most affected domains were as follows: thinking, vision, and language. Alternatively, the least affected domain was family roles.
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Affiliation(s)
- Maria Malliarou
- Laboratory of Education and Research of Trauma Care and patient safety, Nursing Department, University of Thessaly, Larissa, Greece.
| | - Christina Tsionara
- Post-Graduate Program Primary Health Care, University of Thessaly, Larissa, Greece
| | - Anna Patsopoulou
- Laboratory of Education and Research of Trauma Care and patient safety, Nursing Department, University of Thessaly, Larissa, Greece
| | | | - Vasileios Tzenetidis
- Laboratory of Education and Research of Trauma Care and patient safety, Nursing Department, University of Thessaly, Larissa, Greece
| | - Iokasti Papathanasiou
- Laboratory of Education and Research of Trauma Care and patient safety, Nursing Department, University of Thessaly, Larissa, Greece
| | | | - Mary Gouva
- Nursing Department, University of Ioannina, Ioannina, Greece
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12
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Dos Reis FI, de Magalhães PSC, Diegoli H, Longo AL, Moro CHC, Safanelli JA, Nagel V, Lange MC, Zétola VF. Stroke profile and care during the COVID-19 pandemic: What changed and what did not? A prospective cohort from Joinville, Brazil. Front Neurol 2023; 14:1122875. [PMID: 36873444 PMCID: PMC9977808 DOI: 10.3389/fneur.2023.1122875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction The COVID-19 pandemic has wrought negative consequences concerning quality of care for stroke patients since its onset. Prospective population-based data about stroke care in the pandemic are limited. This study aims to investigate the impact of COVID-19 pandemic on stroke profile and care in Joinville, Brazil. Methods A prospective population-based cohort enrolled the first-ever cerebrovascular events in Joinville, Brazil, and a comparative analyzes was conducted between the first 12 months following COVID-19 restrictions (starting March 2020) and the 12 months just before. Patients with transient ischemic attack (TIA) or stroke had their profiles, incidences, subtypes, severity, access to reperfusion therapy, in-hospital stay, complementary investigation, and mortality compared. Results The profiles of TIA/stroke patients in both periods were similar, with no differences in gender, age, severity, or comorbidities. There was a reduction in incidence of TIA (32.8%; p = 0.003). In both periods, intravenous thrombolysis (IV) and mechanical thrombectomy (MT) rates and intervals from door to IV/MT were similar. Patients with cardioembolic stroke and atrial fibrillation had their in-hospital stay abbreviated. The etiologic investigation was similar before and during the pandemic, but there were increases in cranial tomographies (p = 0.02), transthoracic echocardiograms (p = 0.001), chest X-rays (p < 0.001) and transcranial Doppler ultrasounds (p < 0.001). The number of cranial magnetic resonance imaging decreased in the pandemic. In-hospital mortality did not change. Discussion The COVID-19 pandemic is associated with a reduction in TIA, without any influence on stroke profile, the quality of stroke care, in-hospital investigation or mortality. Our findings show an effective response by the local stroke care system and offer convincing evidence that interdisciplinary efforts are the ideal approach to avoiding the COVID-19 pandemic's negative effects, even with scarce resources.
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Affiliation(s)
| | | | - Henrique Diegoli
- Division of Neurology, Hospital Municipal São José, Joinville, Santa Catarina, Brazil
| | - Alexandre Luiz Longo
- Division of Neurology, Hospital Municipal São José, Joinville, Santa Catarina, Brazil
| | | | | | - Vivian Nagel
- Hospital Municipal São José, Joinville Stroke Registry, Joinville, Santa Catarina, Brazil
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13
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Watkins C, Tishkovskaya S, Brown C, Sutton C, Garcia YS, Forshaw D, Prescott G, Thomas L, Roffe C, Booth J, Bennett K, Roe B, Hollingsworth B, Mateus C, Britt D, Panton C. Systematic voiding programme in adults with urinary incontinence following acute stroke: the ICONS-II RCT. Health Technol Assess 2022; 26:1-88. [PMID: 35881012 DOI: 10.3310/eftv1270] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Urinary incontinence affects around half of stroke survivors in the acute phase, and it often presents as a new problem after stroke or, if pre-existing, worsens significantly, adding to the disability and helplessness caused by neurological deficits. New management programmes after stroke are needed to address urinary incontinence early and effectively. OBJECTIVE The Identifying Continence OptioNs after Stroke (ICONS)-II trial aimed to evaluate the clinical effectiveness and cost-effectiveness of a systematic voiding programme for urinary incontinence after stroke in hospital. DESIGN This was a pragmatic, multicentre, individual-patient-randomised (1 : 1), parallel-group trial with an internal pilot. SETTING Eighteen NHS stroke services with stroke units took part. PARTICIPANTS Participants were adult men and women with acute stroke and urinary incontinence, including those with cognitive impairment. INTERVENTION Participants were randomised to the intervention, a systematic voiding programme, or to usual care. The systematic voiding programme comprised assessment, behavioural interventions (bladder training or prompted voiding) and review. The assessment included evaluation of the need for and possible removal of an indwelling urinary catheter. The intervention began within 24 hours of recruitment and continued until discharge from the stroke unit. MAIN OUTCOME MEASURES The primary outcome measure was severity of urinary incontinence (measured using the International Consultation on Incontinence Questionnaire) at 3 months post randomisation. Secondary outcome measures were taken at 3 and 6 months after randomisation and on discharge from the stroke unit. They included severity of urinary incontinence (at discharge and at 6 months), urinary symptoms, number of urinary tract infections, number of days indwelling urinary catheter was in situ, functional independence, quality of life, falls, mortality rate and costs. The trial statistician remained blinded until clinical effectiveness analysis was complete. RESULTS The planned sample size was 1024 participants, with 512 allocated to each of the intervention and the usual-care groups. The internal pilot did not meet the target for recruitment and was extended to March 2020, with changes made to address low recruitment. The trial was paused in March 2020 because of COVID-19, and was later stopped, at which point 157 participants had been randomised (intervention, n = 79; usual care, n = 78). There were major issues with attrition, with 45% of the primary outcome data missing: 56% of the intervention group data and 35% of the usual-care group data. In terms of the primary outcome, patients allocated to the intervention group had a lower score for severity of urinary incontinence (higher scores indicate greater severity in urinary incontinence) than those allocated to the usual-care group, with means (standard deviations) of 8.1 (7.4) and 9.1 (7.8), respectively. LIMITATIONS The trial was unable to recruit sufficient participants and had very high attrition, which resulted in seriously underpowered results. CONCLUSIONS The internal pilot did not meet its target for recruitment and, despite recruitment subsequently being more promising, it was concluded that the trial was not feasible owing to the combined problems of poor recruitment, poor retention and COVID-19. The intervention group had a slightly lower score for severity of urinary incontinence at 3 months post randomisation, but this result should be interpreted with caution. FUTURE WORK Further studies to assess the effectiveness of an intervention starting in or continuing into the community are required. TRIAL REGISTRATION This trial is registered as ISRCTN14005026. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 31. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Caroline Watkins
- Lancashire Clinical Trials Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK.,Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Svetlana Tishkovskaya
- Lancashire Clinical Trials Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Chris Brown
- Lancashire Clinical Trials Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Chris Sutton
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Yvonne Sylvestre Garcia
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Denise Forshaw
- Lancashire Clinical Trials Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Gordon Prescott
- Lancashire Clinical Trials Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Lois Thomas
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Christine Roffe
- Research Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK
| | - Joanne Booth
- Research Centre for Health, School of Health and Life Sciences, Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Kina Bennett
- Centre for Health Research and Innovation, NIHR Lancashire Clinical Research Facility, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Brenda Roe
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | | | - Ceu Mateus
- Division of Health Research, Lancaster University, Lancaster, UK
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14
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Brodtmann A, Werden E, Khlif MS, Bird LJ, Egorova N, Veldsman M, Pardoe H, Jackson G, Bradshaw J, Darby D, Cumming T, Churilov L, Donnan G. Neurodegeneration Over 3 Years Following Ischaemic Stroke: Findings From the Cognition and Neocortical Volume After Stroke Study. Front Neurol 2021; 12:754204. [PMID: 34744989 PMCID: PMC8570373 DOI: 10.3389/fneur.2021.754204] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Stroke survivors are at high risk of dementia, associated with increasing age and vascular burden and with pre-existing cognitive impairment, older age. Brain atrophy patterns are recognised as signatures of neurodegenerative conditions, but the natural history of brain atrophy after stroke remains poorly described. We sought to determine whether stroke survivors who were cognitively normal at time of stroke had greater total brain (TBV) and hippocampal volume (HV) loss over 3 years than controls. We examined whether stroke survivors who were cognitively impaired (CI) at 3 months following their stroke had greater brain volume loss than cognitively normal (CN) stroke participants over the next 3 years. Methods: Cognition And Neocortical Volume After Stroke (CANVAS) study is a multi-centre cohort study of first-ever or recurrent adult ischaemic stroke participants compared to age- and sex-matched community controls. Participants were followed with MRI and cognitive assessments over 3 years and were free of a history of cognitive impairment or decline at inclusion. Our primary outcome measure was TBV change between 3 months and 3 years; secondary outcomes were TBV and HV change comparing CI and CN participants. We investigated associations between group status and brain volume change using a baseline-volume adjusted linear regression model with robust standard error. Results: Ninety-three stroke (26 women, 66.7 ± 12 years) and 39 control participants (15 women, 68.7 ± 7 years) were available at 3 years. TBV loss in stroke patients was greater than controls: stroke mean (M) = 20.3 cm3 ± SD 14.8 cm3; controls M = 14.2 cm3 ± SD 13.2 cm3; [adjusted mean difference 7.88 95%CI (2.84, 12.91) p-value = 0.002]. TBV decline was greater in those stroke participants who were cognitively impaired (M = 30.7 cm3; SD = 14.2 cm3) at 3 months (M = 19.6 cm3; SD = 13.8 cm3); [adjusted mean difference 10.42; 95%CI (3.04, 17.80), p-value = 0.006]. No statistically significant differences in HV change were observed. Conclusions: Ischaemic stroke survivors exhibit greater neurodegeneration compared to stroke-free controls. Brain atrophy is greater in stroke participants who were cognitively impaired early after their stroke. Early cognitive impairment was associated greater subsequent atrophy, reflecting the combined impacts of stroke and vascular brain burden. Atrophy rates could serve as a useful biomarker for trials testing interventions to reduce post-stroke secondary neurodegeneration. Clinical Trail Registration:http://www.clinicaltrials.gov, identifier: NCT02205424.
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Affiliation(s)
- Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Dementia Research Centre, Florey Institute and University of Melbourne, Parkville, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Laura J Bird
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Dementia Research Centre, Florey Institute and University of Melbourne, Parkville, VIC, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michele Veldsman
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Heath Pardoe
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Bradshaw
- Department of Clinical Neuropsychology, Austin Health, Heidelberg, VIC, Australia
| | - David Darby
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Dementia Research Centre, Florey Institute and University of Melbourne, Parkville, VIC, Australia
| | - Toby Cumming
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Geoffrey Donnan
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
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15
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Ischemic Stroke in Patients with Cancer: a Retrospective Cross-Sectional Study. J Crit Care Med (Targu Mures) 2021; 7:54-61. [PMID: 34722904 PMCID: PMC8519371 DOI: 10.2478/jccm-2021-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction An increasing trend of cancer associated stroke has been noticed in the past decade. Objectives To evaluate the risk factors and the incidence of neoplasia in stroke patients. Material and Method A retrospective, observational study was undertaken on 249 patients with stroke and active cancer (SAC) and 1563 patients with stroke without cancer (SWC). The general cardiovascular risk factors, the site of cancer, and the general clinical data were registered and evaluated. According to the “Oxfordshire Community Stroke Project” (OCSP) classification, all patients were classified into the clinical subtypes of stroke. The aetiology of stroke was considered as large-artery atherosclerosis, small vessel disease, cardio-embolic, cryptogenic or other determined cause. Results The severity of neurological deficits at admission were significantly higher in the SAC group (p<0.01). The haemoglobin level was significantly lower, and platelet level and erythrocyte sedimentation rate were significantly higher in the SAC group. Glycaemia, cholesterol and triglycerides levels were significantly higher in the SWC group. The personal history of hypertension was more frequent in the SWC group. In the SAC group, 28.9% had a cryptogenic aetiology, compared to 9.1% in SWC group. Cardio-embolic strokes were more frequent in the SAC group (24%) than the SWC group (19.6%). In the SAC group, 15,6% were diagnosed with cancer during the stroke hospitalization, and 78% of the SAC patients were without metastasis. Conclusions The most frequent aetiologies of stroke in cancer patients were cryptogenic stroke, followed by large-artery atherosclerosis. SAC patients had more severe neurological deficits and worse clinical outcomes than SWC patients. Stroke in cancer patients appears to be more frequently cryptogenic, probably due to cancer associated thrombosis. The association between stroke and cancer is important, especially in stroke of cryptogenic mechanism, even in the presence of traditional cardiovascular risk factors.
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16
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Youkee D, Deen G, Barrett E, Fox-Rushby J, Johnson I, Langhorne P, Leather A, Marshall IJ, O'Hara J, Rudd A, Sama A, Scott C, Thompson M, Wafa H, Wall J, Wang Y, Watkins C, Wolfe C, Lisk DR, Sackley CM. A Prospective Stroke Register in Sierra Leone: Demographics, Stroke Type, Stroke Care and Hospital Outcomes. Front Neurol 2021; 12:712060. [PMID: 34557147 PMCID: PMC8453059 DOI: 10.3389/fneur.2021.712060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone. Methods: A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson's chi-squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression, to explain in-hospital death, was reported as odds ratios (ORs) and 95% confidence intervals. Results: Three hundred eighty-five strokes were registered, and 315 (81.8%) were first-in-a-lifetime events. Mean age was 59.2 (SD 13.8), and 187 (48.6%) were male. Of the strokes, 327 (84.9%) were confirmed by CT scan. Two hundred thirty-one (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median National Institutes of Health Stroke Scale on presentation was 17 [interquartile range (IQR) 9-25]. Haemorrhagic strokes compared with ischaemic strokes were more severe, 20 (IQR 12-26) vs. 13 (IQR 7-22) (p < 0.001), and occurred in a younger population, mean age 52.3 (SD 12.0) vs. 61.6 (SD 13.8) (p < 0.001), with a lower level of educational attainment of 28.2 vs. 40.7% (p = 0.04). The median time from stroke onset to arrival at the principal referral hospital was 25 hours (IQR 6-73). Half of the patients (50.4%) sought care at another health provider prior to arrival. One hundred fifty-one patients died in the hospital (39.5%). Forty-three deaths occurred within 48 hours of arriving at the hospital, with median time to death of 4 days (IQR 0-7 days). Of the patients, 49.6% had ≥1 complication, 98 (25.5%) pneumonia and 33 (8.6%) urinary tract infection. Male gender (OR 3.33, 1.65-6.75), pneumonia (OR 3.75, 1.82-7.76), subarachnoid haemorrhage (OR 43.1, 6.70-277.4) and undetermined stroke types (OR 6.35, 2.17-18.60) were associated with higher risk of in-hospital death. Discussion: We observed severe strokes occurring in a young population with high in-hospital mortality. Further work to deliver evidence-based stroke care is essential to reduce stroke mortality in Sierra Leone.
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Affiliation(s)
- Daniel Youkee
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,*Correspondence: Daniel Youkee
| | - Gibrilla Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Edward Barrett
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Julia Fox-Rushby
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Israel Johnson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Iain J. Marshall
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Jessica O'Hara
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Anthony Rudd
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Albert Sama
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Christella Scott
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Melvina Thompson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Hatem Wafa
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Jurate Wall
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Yanzhong Wang
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom,NIHR Applied Research Collaboration South London, London, United Kingdom
| | - Caroline Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, United Kingdom
| | - Charles Wolfe
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, Guy and ST Thomas' NHS Foundation Trust and King's College London, London, United Kingdom,NIHR Applied Research Collaboration South London, London, United Kingdom
| | - Durodami Radcliffe Lisk
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Catherine Mary Sackley
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom,Division of Stroke Medicine, University of Nottingham, Nottingham, United Kingdom
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17
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Hankey GJ. Evolution of Evidence-Based Medicine in Stroke. Cerebrovasc Dis 2021; 50:644-655. [PMID: 34315156 DOI: 10.1159/000517679] [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: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022] Open
Abstract
The introduction and evolution of evidence-based stroke medicine has realized major advances in our knowledge about stroke, methods of medical research, and patient outcomes that continue to complement traditional individual patient care. It is humbling to recall the state of knowledge and scientific endeavour of our forebears who were unaware of what we know now and yet pursued the highest standards for evaluating and delivering effective stroke care. The science of stroke medicine has evolved from pathophysiological theory to empirical testing. Progress has been steady, despite inevitable disappointments and cul-de-sacs, and has occasionally been punctuated by sensational breakthroughs, such as the advent of reperfusion therapies guided by imaging.
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Affiliation(s)
- Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Washington, Australia.,Department of Neurology, Sir Charles Gairdner Hospital, Perth, Washington, Australia
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18
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Zipser CM, Deuel JW, Held JPO, Ernst J, Schubert M, Weller M, Luft AR, von Känel R, Boettger S. Economic Impact of Poststroke Delirium and Associated Risk Factors: Findings From a Prospective Cohort Study. Stroke 2021; 52:3325-3334. [PMID: 34233463 DOI: 10.1161/strokeaha.120.033005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Delirium is a common severe complication of stroke. We aimed to determine the cost-of-illness and risk factors of poststroke delirium (PSD). METHODS This prospective single-center study included n=567 patients with acute stroke from a hospital-wide delirium cohort study and the Swiss Stroke Registry in 2014. Delirium was determined by Delirium Observation Screening Scale or Intensive Care Delirium Screening Checklist 3 times daily during the first 3 days of admission. Costs reflected the case-mix index and diagnosis-related groups from 2014 and were divided into nursing, physician, and total costs. Factors associated with PSD were assessed with multiple regression analysis. Partial correlations and quantile regression were performed to assess costs and other factors associated with PSD. RESULTS The incidence of PSD was 39.0% (221/567). Patients with delirium were older than non-PSD (median 76 versus 70 years; P<0.001), 52% male (115/221) versus 62% non-PSD (214/346) and hospitalized longer (mean 11.5 versus 9.3 days; P<0.001). Dementia was the most relevant predisposing factor for PSD (odds ratio, 16.02 [2.83-90.69], P=0.002). Moderate to severe stroke (National Institutes of Health Stroke Scale score 16-20) was the most relevant precipitating factor (odds ratio, 36.10 [8.15-159.79], P<0.001). PSD was a strong predictor for 3-month mortality (odds ratio, 15.11 [3.33-68.53], P<0.001). Nursing and total costs were nearly twice as high in PSD (P<0.001). There was a positive correlation between total costs and admission National Institutes of Health Stroke Scale (correlation coefficient, 0.491; P<0.001) and length of stay (correlation coefficient, 0.787; P<0.001) in all patients. Quantile regression revealed rising nursing and total costs associated with PSD, higher National Institutes of Health Stroke Scale, and longer hospital stay (all P<0.05). CONCLUSIONS PSD was associated with greater stroke severity, prolonged hospitalization, and increased nursing and total costs. In patients with severe stroke, dementia, or seizures, PSD is anticipated, and additional costs are associated with hospitalization.
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Affiliation(s)
- Carl Moritz Zipser
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Switzerland. (C.M.Z., R.v.K.).,Department of Neurology and Neurophysiology, University of Zurich, Balgrist University Hospital, Switzerland (C.M.Z.)
| | - Jeremy Werner Deuel
- Department of Haematology and MRC - Wellcome Stem Cell Institute, University of Cambridge, Jeffrey Cheah Biomedical Centre, United Kingdom (J.W.D.)
| | - Jeremia Philipp Oskar Held
- Department of Neurology, Vascular Neurology and Rehabilitation, University of Zurich, University Hospital Zurich, Switzerland. (J.P.O.H., M.W., A.R.L.)
| | - Jutta Ernst
- Center of Clinical Nursing Science, University of Zurich, University Hospital Zurich, Switzerland. (J.E.)
| | - Maria Schubert
- Zurich University of Applied Science, School of Health Professions, Winterthur, Switzerland (M.S.)
| | - Michael Weller
- Department of Neurology, Vascular Neurology and Rehabilitation, University of Zurich, University Hospital Zurich, Switzerland. (J.P.O.H., M.W., A.R.L.)
| | - Andreas Rüdiger Luft
- Department of Neurology, Vascular Neurology and Rehabilitation, University of Zurich, University Hospital Zurich, Switzerland. (J.P.O.H., M.W., A.R.L.).,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.R.L.)
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Switzerland. (C.M.Z., R.v.K.)
| | - Soenke Boettger
- University of Zurich, University Hospital Zurich, Switzerland (S.B.)
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19
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Li L, Zuurbier SM, Kuker W, Warlow CP, Rothwell PM. Blood Pressure Control and Recurrent Stroke After Intracerebral Hemorrhage in 2002 to 2018 Versus 1981 to 1986: Population-Based Study. Stroke 2021; 52:3243-3248. [PMID: 34233466 PMCID: PMC8478103 DOI: 10.1161/strokeaha.121.034432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. The PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study) conducted in the early 1990s showed that blood pressure (BP) lowering therapy reduced the risks of recurrent stroke by about 50% after spontaneous intracerebral hemorrhage (ICH). However, the ICH subgroup was a minority, and trial cohorts are invariably selective. Therefore, it is unclear whether the impact of BP control on risk of recurrent stroke in ICH observed in PROGRESS would be as great in real-world practice.
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Affiliation(s)
- Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, United Kingdom (L.L., S.M.Z., W.K., C.P.W., P.M.R.)
| | - Susanna M Zuurbier
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, United Kingdom (L.L., S.M.Z., W.K., C.P.W., P.M.R.)
| | - Wilhelm Kuker
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, United Kingdom (L.L., S.M.Z., W.K., C.P.W., P.M.R.)
| | - Charles P Warlow
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, United Kingdom (L.L., S.M.Z., W.K., C.P.W., P.M.R.).,Department of Clinical Neurosciences, University of Edinburgh, United Kingdom (C.P.W.)
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, United Kingdom (L.L., S.M.Z., W.K., C.P.W., P.M.R.)
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20
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Khlif MS, Bird LJ, Restrepo C, Khan W, Werden E, Egorova‐Brumley N, Brodtmann A. Hippocampal subfield volumes are associated with verbal memory after first-ever ischemic stroke. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12195. [PMID: 34136634 PMCID: PMC8197170 DOI: 10.1002/dad2.12195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Hippocampal subfield volumes are more closely associated with cognitive impairment than whole hippocampal volume in many diseases. Both memory and whole hippocampal volume decline after stroke. Understanding the subfields' temporal evolution could reveal valuable information about post-stroke memory. METHODS We sampled 120 participants (38 control, 82 stroke), with cognitive testing and 3T-MRI available at 3 months and 3 years, from the Cognition and Neocortical Volume after Stroke (CANVAS) study. Verbal memory was assessed using the Hopkins Verbal Learning Test-Revised. Subfields were delineated using FreeSurfer. We used partial Pearson's correlation to assess the associations between subfield volumes and verbal memory scores, adjusting for years of education, sex, and stroke side. RESULTS The left cornu ammonis areas 2/3 and hippocampal tail volumes were significantly associated with verbal memory 3-month post-stroke. At 3 years, the associations became stronger and involved more subfields. DISCUSSION Hippocampal subfield volumes may be a useful biomarker for post-stroke cognitive impairment.
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Affiliation(s)
- Mohamed Salah Khlif
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Laura J. Bird
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Carolina Restrepo
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Wasim Khan
- Department of NeuroscienceCentral Clinical SchoolMonash UniversityClaytonVictoriaAustralia
- Department of Neuroimaging Institute of PsychiatryPsychology, and Neuroscience (IoPPN), King's College LondonLondonUK
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Natalia Egorova‐Brumley
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
- Melbourne School of Psychological SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyAustin HealthHeidelbergVictoriaAustralia
- Eastern Cognitive Disorders ClinicBox Hill HospitalMonash UniversityBox HillVictoriaAustralia
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21
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Orrapin S, Benyakorn T, Howard DP, Siribumrungwong B, Rerkasem K. Patches of different types for carotid patch angioplasty. Cochrane Database Syst Rev 2021; 2:CD000071. [PMID: 33598915 PMCID: PMC8094514 DOI: 10.1002/14651858.cd000071.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Extracranial carotid artery stenosis is the major cause of stroke, which can lead to disability and mortality. Carotid endarterectomy (CEA) with carotid patch angioplasty is the most popular technique for reducing the risk of stroke. Patch material may be made from an autologous vein, bovine pericardium, or synthetic material including polytetrafluoroethylene (PTFE), Dacron, polyurethane, and polyester. This is an update of a review that was first published in 1996 and was last updated in 2010. OBJECTIVES To assess the safety and efficacy of different types of patch materials used in carotid patch angioplasty. The primary hypothesis was that a synthetic material was associated with lower risk of patch rupture versus venous patches, but that venous patches were associated with lower risk of perioperative stroke and early or late infection, or both. SEARCH METHODS We searched the Cochrane Stroke Group trials register (last searched 25 May 2020); the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 4), in the Cochrane Library; MEDLINE (1966 to 25 May 2020); Embase (1980 to 25 May 2020); the Index to Scientific and Technical Proceedings (1980 to 2019); the Web of Science Core Collection; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) portal. We handsearched relevant journals and conference proceedings, checked reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised and quasi-randomised trials (RCTs) comparing one type of carotid patch with another for CEA. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility, risk of bias, and trial quality; extracted data; and determined the quality of evidence using the GRADE approach. Outcomes, for example, perioperative ipsilateral stroke and long-term ipsilateral stroke (at least one year), were collected and analysed. MAIN RESULTS We included 14 trials involving a total of 2278 CEAs with patch closure operations: seven trials compared vein closure with PTFE closure, five compared Dacron grafts with other synthetic materials, and two compared bovine pericardium with other synthetic materials. In most trials, a patient could be randomised twice and could have each carotid artery randomised to different treatment groups. Synthetic patch compared with vein patch angioplasty Vein patch may have little to no difference in effect on perioperative ipsilateral stroke between synthetic versus vein materials, but the evidence is very uncertain (odds ratio (OR) 2.05, 95% confidence interval (CI) 0.66 to 6.38; 5 studies, 797 participants; very low-quality evidence). Vein patch may have little to no difference in effect on long-term ipsilateral stroke between synthetic versus vein materials, but the evidence is very uncertain (OR 1.45, 95% CI 0.69 to 3.07; P = 0.33; 4 studies, 776 participants; very low-quality evidence). Vein patch may increase pseudoaneurysm formation when compared with synthetic patch, but the evidence is very uncertain (OR 0.09, 95% CI 0.02 to 0.49; 4 studies, 776 participants; very low-quality evidence). However, the numbers involved were small. Dacron patch compared with other synthetic patch angioplasty Dacron versus PTFE patch materials PTFE patch may reduce the risk of perioperative ipsilateral stroke (OR 3.35, 95% CI 0.19 to 59.06; 2 studies, 400 participants; very low-quality evidence). PTFE patch may reduce the risk of long-term ipsilateral stroke (OR 1.52, 95% CI 0.25 to 9.27; 1 study, 200 participants; very low-quality evidence). Dacron may result in an increase in perioperative combined stroke and transient ischaemic attack (TIA) (OR 4.41 95% CI 1.20 to 16.14; 1 study, 200 participants; low-quality evidence) when compared with PTFE. Early arterial re-stenosis or occlusion (within 30 days) was also higher for Dacron patches. During follow-up for longer than one year, more 'any strokes' (OR 10.58, 95% CI 1.34 to 83.43; 2 studies, 304 participants; low-quality evidence) and stroke/death (OR 6.06, 95% CI 1.31 to 28.07; 1 study, 200 participants; low-quality evidence) were reported with Dacron patch closure, although numbers of outcome events were small. Dacron patch may increase the risk of re-stenosis when compared with other synthetic materials (especially with PTFE), but the evidence is very uncertain (OR 3.73, 95% CI 0.71 to 19.65; 3 studies, 490 participants; low-quality evidence). Bovine pericardium patch compared with other synthetic patch angioplasty Bovine pericardium versus PTFE patch materials Evidence suggests that bovine pericardium patch results in a reduction in long-term ipsilateral stroke (OR 4.17, 95% CI 0.46 to 38.02; 1 study, 195 participants; low-quality evidence). Bovine pericardial patch may reduce the risk of perioperative fatal stroke, death, and infection compared to synthetic material (OR 5.16, 95% CI 0.24 to 108.83; 2 studies, 290 participants; low-quality evidence for PTFE, and low-quality evidence for Dacron; OR 4.39, 95% CI 0.48 to 39.95; 2 studies, 290 participants; low-quality evidence for PTFE, and low-quality evidence for Dacron; OR 7.30, 95% CI 0.37 to 143.16; 1 study, 195 participants; low-quality evidence, respectively), but the numbers of outcomes were small. The evidence is very uncertain about effects of the patch on infection outcomes. AUTHORS' CONCLUSIONS The number of outcome events is too small to allow conclusions, and more trial data are required to establish whether any differences do exist. Nevertheless, there is little to no difference in effect on perioperative and long-term ipsilateral stroke between vein and any synthetic patch material. Some evidence indicates that other synthetic patches (e.g. PTFE) may be superior to Dacron grafts in terms of perioperative stroke and TIA rates, and both early and late arterial re-stenosis and occlusion. Pseudoaneurysm formation may be more common after use of a vein patch than after use of a synthetic patch. Bovine pericardial patch, which is an acellular xenograft material, may reduce the risk of perioperative fatal stroke, death, and infection compared to other synthetic patches. Further large RCTs are required before definitive conclusions can be reached.
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Affiliation(s)
- Saritphat Orrapin
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Pathum Thani, Thailand
| | - Thoetphum Benyakorn
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Pathum Thani, Thailand
| | - Dominic Pj Howard
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Boonying Siribumrungwong
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Pathum Thani, Thailand
| | - Kittipan Rerkasem
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
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22
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Anderson CS. Progress in Stroke: Marking the 30-Year Anniversary of Cerebrovascular Diseases. Cerebrovasc Dis 2021; 50:2-3. [PMID: 33486493 DOI: 10.1159/000514399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia,
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23
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Burgos PI, Lara O, Lavado A, Rojas-Sepúlveda I, Delgado C, Bravo E, Kamisato C, Torres J, Castañeda V, Cerda M. Exergames and Telerehabilitation on Smartphones to Improve Balance in Stroke Patients. Brain Sci 2020; 10:E773. [PMID: 33114245 PMCID: PMC7690853 DOI: 10.3390/brainsci10110773] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 12/02/2022] Open
Abstract
Stroke is currently the world's second cause of disability. It can cause deficits such as postural control, and telerehabilitation could improve the therapeutic dose as well as functional results. The aim of this work is to determine the effectiveness and usability of a low-cost telerehabilitation system in patients with stroke. We developed a telerehabilitation system based on exergames on smartphones, inertial sensors, and a cloud database. We trained the balance of six participants (three men and three women) in early subacute stroke (seven weeks of progress). In addition to their conventional treatment, these participants trained for a total of nine sessions of 30 min per week, for four weeks. The telerehabilitation group was compared with a control group of four clinically similar participants (three men and one woman). Clinical and usability measurements were made before and after the training. The results show a significant improvement of 11.3 ± 3.5 points in the Berg Balance Scale, 8.3 ± 3.01 points in the Mini-BESTest, and 17.5 ± 9.87 points in the Barthel scale for the telerehabilitation group. However, only the improvements of Berg and Barthel scales were statistically higher for the telerehabilitation group compared to the control group. The proposed system achieved excellent usability on the System Usability Scale (87.5 ± 11.61). Our results demonstrate that a complementary low-cost telemedicine approach is feasible, and that it can significantly improve the balance of stroke patients; therefore, the proposed clinical strategy could potentially improve dosage and overall treatment effectiveness.
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Affiliation(s)
- Pablo I. Burgos
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (P.I.B.); (O.L.); (I.R.-S.); (J.T.)
- Department of Neuroscience, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile;
| | - Oriana Lara
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (P.I.B.); (O.L.); (I.R.-S.); (J.T.)
| | - Alejandro Lavado
- Biomedical Neuroscience Institute, Independencia 1027, Santiago 8380453, Chile;
- Integrative Biology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago PO Box 70031, Chile
| | - Ignacia Rojas-Sepúlveda
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (P.I.B.); (O.L.); (I.R.-S.); (J.T.)
| | - Carolina Delgado
- Department of Neuroscience, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile;
- Department of Neurology and Neurosurgery, Hospital Clínico de la Universidad de Chile, Santiago 8380453, Chile
| | - Eusebio Bravo
- Geriatrics Acute Units, Physical Medicine and Rehabilitation Service, Hospital Clínico de la Universidad de Chile, Santiago 8380000, Chile; (E.B.); (C.K.)
| | - Cristian Kamisato
- Geriatrics Acute Units, Physical Medicine and Rehabilitation Service, Hospital Clínico de la Universidad de Chile, Santiago 8380000, Chile; (E.B.); (C.K.)
| | - Julio Torres
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (P.I.B.); (O.L.); (I.R.-S.); (J.T.)
- Department of Neuroscience, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile;
- Service of Physical Medicine and Rehabilitation, Clínica Dávila, Santiago 8431657, Chile
| | - Victor Castañeda
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile;
- Center for Medical Informatics and Telemedicine, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Mauricio Cerda
- Biomedical Neuroscience Institute, Independencia 1027, Santiago 8380453, Chile;
- Integrative Biology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago PO Box 70031, Chile
- Center for Medical Informatics and Telemedicine, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
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24
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Mani AM, Prabhakar AT, Mannam P, Benjamin RN, Ahmed Shaikh AI, Mathew D, Singh P, Nair A, Alexander PT, Vijayaraghavan A, Sivadasan A, Mani S, Mathew V, Aaron S, Alexander M. Clinical Spectrum and Outcome of Neurosarcoidosis: A Retrospective Cohort Study from a Teaching Hospital in India. Ann Indian Acad Neurol 2020; 23:528-535. [PMID: 33223672 PMCID: PMC7657274 DOI: 10.4103/aian.aian_638_19] [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: 12/02/2019] [Revised: 01/02/2020] [Accepted: 02/08/2020] [Indexed: 11/04/2022] Open
Abstract
Context: Neurosarcoidosis (NS) is a chronic disease with a diverse clinical spectrum, therapeutic response, and outcome. There is scarce literature from our country regarding the same. Aims: The aim of this study was to evaluate the clinical spectrum, therapeutic responses, and outcomes of NS in an Indian cohort. Settings and Design: In a cross-sectional study, we included all patients with NS treated at a quaternary care teaching hospital in India from January 2007 to October 2019. Subjects and Methods: Patients older than 18 years of age fulfilling the diagnostic criteria for NS from the Neurosarcoidosis Consortium Consensus Group were included in the study. The therapeutic response and the degree of disability at last follow-up were assessed. Results: We identified 48 patients, among them 3 were categorized as having definite NS, 30 probable NS, and 15 possible NS. Cranial neuropathy was the most common presentation (47.9%), followed by myelopathy (25%). Systemic involvement was identified in 95.83% and mediastinal lymph nodes were the most common site. Clinical improvement was seen in 65.8% and disease stabilized in 28.9%, while 5.26% deteriorated. Fifty percent recovered without any residual disability, while 26.3% had minor and 23.7% had major residual sequelae. Conclusions: NS is a diverse illness, with a heterogeneous spectrum of clinical presentation, treatment response, and outcome. Cranial neuropathy is the most common presenting feature and has a good prognosis while myelopathy has an unfavorable prognosis. Meningeal and brain parenchymal disease is difficult to diagnose accurately unless systemic involvement is present. The diagnosis of NS should be clinically suspected in the appropriate clinical setting, the presence of systemic involvement should be investigated, and histologic confirmation should be attempted.
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Affiliation(s)
- Arun Mathai Mani
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - A T Prabhakar
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pavithra Mannam
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rohit Ninan Benjamin
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Atif Iqbal Ahmed Shaikh
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Donna Mathew
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pankaj Singh
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aditya Nair
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - P T Alexander
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Asish Vijayaraghavan
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ajith Sivadasan
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunithi Mani
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vivek Mathew
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sanjith Aaron
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mathew Alexander
- Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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25
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Tomari S, Magin P, Lasserson D, Quain D, Valderas JM, Dewey HM, Barber PA, Spratt NJ, Cadilhac DA, Feigin VL, Rothwell PM, Zareie H, Garcia-Esperon C, Davey A, Najib N, Sales M, Levi CR. The Characteristics of Patients With Possible Transient Ischemic Attack and Minor Stroke in the Hunter and Manning Valley Regions, Australia (the INSIST Study). Front Neurol 2020; 11:383. [PMID: 32670173 PMCID: PMC7326044 DOI: 10.3389/fneur.2020.00383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Transient ischemic attack (TIA) and minor stroke (TIAMS) are risk factors for stroke recurrence. Some TIAMS may be preventable by appropriate primary prevention. We aimed to recruit "possible-TIAMS" patients in the INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study. Methods: A prospective inception cohort study performed across 16 Hunter-Manning region, Australia, general practices in the catchment of one secondary-care acute neurovascular clinic. Possible-TIAMS patients were recruited from August 2012 to August 2016. We describe the baseline demographics, risk factors and pre-event medications of participating patients. Results: There were 613 participants (mean age; 69 ± 12 years, 335 women), and 604 (99%) were Caucasian. Hypertension was the most common risk factor (69%) followed by hyperlipidemia (52%), diabetes mellitus (17%), atrial fibrillation (AF) (17%), prior TIA (13%) or stroke (10%). Eighty-nine (36%) of the 249 participants taking antiplatelet therapy had no known history of cardiovascular morbidity. Of 102 participants with known AF, 91 (89%) had a CHA2DS2-VASc score ≥ 2 but only 47 (46%) were taking anticoagulation therapy. Among 304 participants taking an antiplatelet or anticoagulant agent, 30 (10%) had stopped taking these in the month prior to the index event. Conclusion: This study provides the first contemporary data on TIAMS or TIAMS-mimics in Australia. Community and health provider education is required to address the under-use of anticoagulation therapy in patients with known AF, possibly inappropriate use of antiplatelet therapy and possibly inappropriate discontinuation of antiplatelet or anticoagulation therapy.
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Affiliation(s)
- Shinya Tomari
- Priority Research Centre for Stroke, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Parker Magin
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
| | - Daniel Lasserson
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Debbie Quain
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Jose M. Valderas
- Health Service & Policy Research Group, University of Exeter – Saint Lukes Campus, Exeter, United Kingdom
| | - Helen M. Dewey
- Faculty of Medicine, Nursing and Health Sciences, Box Hill Hospital, Monash University, Melbourne, VIC, Australia
| | - P. Alan Barber
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Neil J. Spratt
- Priority Research Centre for Stroke, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Dominique A. Cadilhac
- Stroke and Aging Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Valery L. Feigin
- AUT University, National Institute for Stroke & Applied Neurosciences, Auckland, New Zealand
| | - Peter M. Rothwell
- Nuffield Department of Clinical Neuroscience, Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, United Kingdom
| | - Hossein Zareie
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | | | - Andrew Davey
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
| | - Nashwa Najib
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
| | - Milton Sales
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
| | - Christopher R. Levi
- Priority Research Centre for Stroke, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
- The Ingham Institute, SPHERE, Sydney, NSW, Australia
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Li L, Scott CA, Rothwell PM. Trends in Stroke Incidence in High-Income Countries in the 21st Century: Population-Based Study and Systematic Review. Stroke 2020; 51:1372-1380. [PMID: 32208842 PMCID: PMC7185053 DOI: 10.1161/strokeaha.119.028484] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/03/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Abstract
Background and Purpose- Population-based studies provide the most reliable data on stroke incidence. A previous systematic review of population-based studies suggested that stroke incidence in high-income countries decreased by 42% between the 1970s and early 2000s. However, it is uncertain whether this trend of steady decline has been maintained in more recent periods. Methods- Data from OCSP (Oxfordshire Community Stroke Project; 1981-1986) and OXVASC (Oxford Vascular Study; 2002-2017) along with other published population-based stroke incidence studies that reported temporal trends of stroke incidence since 1990 in high-income countries were included. Age-standardized relative incidence rate ratios were calculated for each study and then pooled with inverse-variance weighted random-effects meta-analysis. Projection estimates were calculated for the number of incident stroke patients in the United Kingdom from year 2015 to 2045. Results- In Oxfordshire, stroke incidence fell by 32% from OCSP to OXVASC, with a similar trend before or after year 2000. With the projected aging population, if the age-specific stroke incidence continued to decrease at its current rate (6% every 5 years), there would still be a 13% increase of the number of first-ever strokes in the United Kingdom up to year 2045. Incorporating the Oxfordshire data with other 12 population-based studies, stroke incidence declined steadily between the 1990s and 2010s within each study, resulting in a 28% decline over an average period of 16.5 years (pooled incidence rate ratio, 0.72 [95% CI, 0.66-0.79]; P<0.0001). The trend was the same for men (0.69 [95% CI, 0.61-0.77]; P<0.0001) and women (0.66 [95% CI, 0.59-0.74]; P<0.0001) and remained consistent after year 2010 in OXVASC. Proportion of disabling or fatal stroke also decreased over time (early versus later period, 53.6% versus 46.1%; P=0.02). Conclusions- Stroke incidence is continuing to decline with steady rate in Oxfordshire and in other high-income settings. However, the absolute number of strokes occurring is not falling.
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Affiliation(s)
- Linxin Li
- From the Nuffield Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Catherine A. Scott
- From the Nuffield Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Peter M. Rothwell
- From the Nuffield Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
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Zhang T, Jiang Y, Zhang S, Tie T, Cheng Y, Su X, Man Z, Hou J, Sun L, Tian M, Zhang Y, Li J, Ma Y. The association between homocysteine and ischemic stroke subtypes in Chinese: A meta-analysis. Medicine (Baltimore) 2020; 99:e19467. [PMID: 32195946 PMCID: PMC7220264 DOI: 10.1097/md.0000000000019467] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The findings on the association between elevated plasma homocysteine levels and the risk of the trial of org 10172 in acute stroke treatment (TOAST) of ischemic stroke have been inconsistent in Chinese. So far, there is no meta-analysis about the association between Hcy and the TOAST subtypes of ischemic stroke in Chinese. This study; therefore, aimed to evaluate whether elevated homocysteine levels are associated with the TOAST subtypes of ischemic stroke using a meta-analysis. MATERIALS AND METHODS A systematic search of electronic databases were conducted for studies reporting homocysteine levels in ischemic stroke and the TOAST of ischemic stroke to April 18, 2018. The data were extracted after the application of inclusion and exclusion criteria. All the data were analyzed using Stata software version 9.0 (Stata Corp LP, College Station, TX). The standardized mean difference (SMD) and 95% confidence interval (CI) were used to compare continuous variables. RESULTS Thirteen studies comprising 3114 participants (2243 patients and 871controls) met the eligibility criteria and were included in the meta-analysis. The meta-analysis revealed that the ischemic stroke group had significantly higher levels of homocysteine than controls (SMD = 1.15, 95% CI = 0.85-1.45, P < .05). The subgroup analyses suggested that the groups of patients with large-artery atherosclerosis, small-vessel occlusion, cardioembolism, stroke of other determined etiology and stroke of undetermined etiology had significantly higher levels of homocysteine compared to those in the control group (large-artery atherosclerosis: SMD = 2.12, 95% CI = 1.40-2.84, P < .05; small-vessel occlusion: SMD = 1.10, 95% CI = 0.72-1.48, P < .05; CE: SMD = 1.17, 95% CI = 0.64-1.71, P < .05; stroke of other determined etiology: SMD = 0.88, 95% CI = 0.53-1.24, P < .05; stroke of undetermined etiology: SMD = 1.50, 95% CI = 0.66-2.33, P < .05, respectively). CONCLUSION This meta-analysis found that ischemic stroke patients and the TOAST of ischemic stroke patients in Chinese had significantly higher homocysteine levels than the controls, suggesting that serum homocysteine levels may be a risk factor for ischemic stroke and the TOAST subtypes of ischemic stroke in Chinese.
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Affiliation(s)
- Tao Zhang
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Yuan Jiang
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Shuhua Zhang
- Tengzhou Central People's Hospital, Zaozhuang, Shandong province, China
| | - Tingting Tie
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Yan Cheng
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Xiaoming Su
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Zhu Man
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Jing Hou
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Li Sun
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Meiyuan Tian
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Yaogang Zhang
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Jianhua Li
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
| | - Yanyan Ma
- Qinghai University Affiliated Hospital, Xining, Qinghai Province
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Sharma A, Sharma VK, Ahmad A, Gupta D, Khan K, Shuaib A, Alexandrov AV, Saqqur M. Effect of Age on Arterial Recanalization and Clinical Outcome in Thrombolyzed Acute Ischemic Stroke in CLOTBUST Cohort. Ann Indian Acad Neurol 2020; 23:189-194. [PMID: 32189860 PMCID: PMC7061505 DOI: 10.4103/aian.aian_434_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 12/03/2022] Open
Abstract
Background and Aims: Despite the evidence from randomized clinical trials, the effectiveness of intravenous tissue recombinant plasminogen activator (IV-tPA) for elderly patients (≥80 yrs) with acute ischemic stroke (AIS) is often an important consideration in clinical practice. We evaluated the effect of older age on arterial recanalization, timing of recanalization and outcome in thrombolysed AIS patients. Methods: Consecutive AIS patients treated with IV-tPA and transcranial Doppler (TCD) examination within 3 hours of symptom-onset were included. Thrombolysis in Brain Ischemia (TIBI) flow-grading system was used to interpret TCD findings of persistent occlusion, re-occlusion and complete recanalization within 2 hours of IV-tPA bolus. Poor functional outcome was defined by modified Rankin score of 3 or more. Univariate and multiple logistic regression analyses were performed to assess the effect of age on clinical and TCD outcome measures. Results: The study included 361 patients (elderly = 85, <80 yrs = 276). Median age was 68 years (range 18-91 years). Compared to the elderly, younger patients (<80 years) were more females (63.5% versus 41.3%), had higher baseline National Institute of Health Stroke Scale score (17.5 versus 16.0 points) and shorter time from symptom-onset to IV-tPA bolus (median 136.6 versus 139.7 minutes). No significant differences were noted between the site of arterial occlusion, TCD outcome measures or time of complete recanalization between the 2 groups. More patients aged < 80 years achieved good functional outcome (51.9% versus 31.8% in the older age group; P = 0.004). IV-tPA induced recanalization and symptomatic intracranial hemorrhage were similar in the 2 groups. Multivariate logistic regression showed elderly age as an independent predictor of poor outcome (adjusted OR 2.5, 95%CI 1.26-4.95; P = 0.008). Conclusion: Elderly AIS patients achieve relatively poor functional outcome after IV-tPA despite similar rates of arterial recanalization. However, there is no increase in the hemorrhagic risk. Perhaps, decision for IV thrombolysis in elderly patients should be made cautiously.
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Affiliation(s)
- Arvind Sharma
- Department of Neurology, Zydus Hospital and B J Medical College, Ahmedabad, Gujarat, India
| | - Vijay K Sharma
- Yong Loo Lin School of Medicine, National University of Singapore and Division of Neurology, National University Hospital, Singapore
| | - Aftab Ahmad
- Division of Neurology, Ng Teng Fong General Hospital, Singapore
| | - Deepak Gupta
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Khursheed Khan
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Ashfaq Shuaib
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Maher Saqqur
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada.,Department of Neurology, Hammad Medical Center, Doha, Qatar
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Chutinet A, Keosodsay S, Vorasayan P, Samajarn J, Akarathanawat W, Kijpaisalratana N, Norsakpeseuth N, Phetsiriseng K, Thongsna S, Vongvasinkul P, Suwanwela NC. The First 10 Thrombolysis for Acute Ischemic Stroke in Lao People's Democratic Republic under Teleconsultation from Thailand. J Stroke Cerebrovasc Dis 2019; 28:104327. [PMID: 31530479 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/21/2019] [Accepted: 07/28/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acute ischemic stroke patients in Lao People's Democratic Republic (Lao PDR) are unable to access the intravenous thrombolytic therapy using recombinant tissue plasminogen activator (rtPA) due to various reasons. AIMS This study aimed to evaluate the feasibility and safety of thrombolytic therapy administration at Mittaphab Hospital, Lao PDR under the international telestroke consultation system from King Chulalongkorn Memorial Hospital, Thailand. METHODS Acute ischemic stroke patients who presented at Mittaphab Hospital within 4.5 hours after the onset and received thrombolytic therapy between December 2016 and June 2017 were studied. An immediate real time teleconsultation with 24 hours availability between neurologists at Mittaphab hospital and the Chulalongkorn stroke team was performed in all cases for patient evaluation and decision for thrombolytic treatment. RESULTS There were 205 patients with acute stroke, 28 patients (14%) arrived at the hospital within 4.5 hours after the onset. Ten patients (5%) were eligible for intravenous rtPA. The mean duration from onset to hospital arrival was 122.50 minutes and the mean door to needle time was 108 minutes. The mean National Institute of Health stroke scale (NIHSS) before thrombolysis was 10. At 90 days, the mean NIHSS was 3 and the mean mRS was 2. Seventy percent of patients had good outcome (mRS ≤2). Only one patient developed massive cerebral infarction. None of the patient developed symptomatic intracerebral hemorrhage or major bleedings. CONCLUSIONS Telestroke consultation from Thailand can facilitate the thrombolytic therapy for acute ischemic stroke patients in Lao PDR.
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Affiliation(s)
- Aurauma Chutinet
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Pongpat Vorasayan
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Jitlada Samajarn
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Wasan Akarathanawat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Naruchorn Kijpaisalratana
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
| | | | | | | | - Pakkawan Vongvasinkul
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nijasri C Suwanwela
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Gc VS, Suhrcke M, Atkin AJ, van Sluijs E, Turner D. Cost-effectiveness of physical activity interventions in adolescents: model development and illustration using two exemplar interventions. BMJ Open 2019; 9:e027566. [PMID: 31427318 PMCID: PMC6701678 DOI: 10.1136/bmjopen-2018-027566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To develop a model to assess the long-term costs and health outcomes of physical activity interventions targeting adolescents. DESIGN A Markov cohort simulation model was constructed with the intention of being capable of estimating long-term costs and health impacts of changes in activity levels during adolescence. The model parameters were informed by published literature and the analysis took a National Health Service perspective over a lifetime horizon. Univariate and probabilistic sensitivity analyses were undertaken. SETTING School and community. PARTICIPANTS A hypothetical cohort of adolescents aged 16 years at baseline. INTERVENTIONS Two exemplar school-based: a comparatively simple, after-school intervention and a more complex multicomponent intervention compared with usual care. PRIMARY AND SECONDARY OUTCOME MEASURES Incremental cost-effectiveness ratio as measured by cost per quality-adjusted life year gained. RESULTS The model gave plausible estimates of the long-term effect of changes in physical activity. The use of two exemplar interventions suggests that the model could potentially be used to evaluate a number of different physical activity interventions in adolescents. The key model driver was the degree to which intervention effects were maintained over time. CONCLUSIONS The model developed here has the potential to assess long-term value for money of physical activity interventions in adolescents. The two applications of the model indicate that complex interventions may not necessarily be the ones considered the most cost-effective when longer-term costs and consequences are taken into account.
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Affiliation(s)
- Vijay S Gc
- Centre for Health Economics, University of York, York, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
- Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Andrew J Atkin
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
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Felgueiras R, Magalhães R, Silva MR, Silva MC, Correia M. Transient ischemic attack: Incidence and early risk of stroke in northern Portugal from 1998–2000 to 2009–2011. Int J Stroke 2019; 15:278-288. [DOI: 10.1177/1747493019830322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective A decline in TIA incidence would be expected mirroring stroke trends, but patient's awareness of symptoms/signs, improved diagnostic procedures and changes in severity of vascular disease may raise TIA incidence. We aimed to estimate changes in TIA incidence and 30-day stroke risk in Portugal. Methods Data from two prospective community-based registers of first-ever TIA in 104,700 (1998–2000) and 118,232 (2009–2011) persons were collected using comprehensive case ascertainment methods. Incidence and stroke risk from TIA onset were compared using different inception cohorts. ABCD2 was used to stratified stroke risk. Results Overall, 141 patients were included in 1998–2000 and 174 in 2009–2011. Crude annual incidence rate increased from 67 to 74/100,000 (IRR=1.12; 95% CI, 0.90–1.40), particularly in men under 65 years (IRR=1.79; 95% CI, 1.06–3.04). Male/female IRR increased from 1.20 (0.86–1.68) in 1998–2000 to 1.77 (1.31–2.39) in 2009–2011, after adjustment for age. Better control of vascular risk factors (VRFs) accounted for lower ABCD2 scores in 2009–2011. The 30-day stroke risk was similar in study periods (18.4% vs. 16.7%, p > 0.7), decreasing from 16.1% to 8.2% ( p < 0.042) excluding patients reporting TIA after stroke occurrence and from 12.2% to 4.0% ( p < 0.011) further excluding patients who had stroke in ambulance/hospital. ABCD2 discriminated stroke risk only in 1998–2000; stroke severity decreased while posterior circulation stroke was more common in 2009–2011. Conclusion Despite a stable TIA incidence across periods, the risk increased in men compared to women. Better control of VRF accounted for lower ABCD2 scores and secondary prevention reduced stroke risk. Men under 65 years emerge as a preferential target for primary and secondary prevention.
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Affiliation(s)
- Rui Felgueiras
- Serviço de Neurologia, Hospital Santo António–Centro Hospitalar do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Mário R Silva
- Serviço de Neurologia, Hospital São Pedro–Centro Hospitalar de Trás-os-Montes e Alto Douro, Real, Portugal
| | - Maria C Silva
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Manuel Correia
- Serviço de Neurologia, Hospital Santo António–Centro Hospitalar do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Levi CR, Lasserson D, Quain D, Valderas J, Dewey HM, Alan Barber P, Spratt N, Cadilhac DA, Feigin V, Zareie H, Garcia Esperon C, Davey A, Najib N, Magin P. The International comparison of Systems of care and patient outcomes In minor Stroke and Tia (InSIST) study: A community-based cohort study. Int J Stroke 2019; 14:186-190. [PMID: 30608031 DOI: 10.1177/1747493018799983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
RATIONALE Rapid response by health-care systems for transient ischemic attack and minor stroke (TIA/mS) is recommended to maximize the impact of secondary prevention strategies. The applicability of this evidence to Australian non-hospital-based TIA/mS management is uncertain. AIMS Within an Australian community setting we seek to document processes of care, establish determinants of access to care, establish attack rates and determinants of recurrent vascular events and other clinical outcomes, establish the performance of ABC2-risk stratification, and compare the processes of care and outcomes to those in the UK and New Zealand for TIA/mS. SAMPLE SIZE ESTIMATES Recruiting practices containing approximately 51 full-time-equivalent general practitioners to recruit 100 TIA/mS per year over a four-year study period will provide sufficient power for each of our outcomes. METHODS AND DESIGN An inception cohort study of patients with possible TIA/mS recruited from 16 general practices in the Newcastle-Hunter Valley-Manning Valley region of Australia. Potential TIA/mS will be ascertained by multiple overlapping methods at general practices, after-hours collaborative, and hospital in-patient and outpatient services. Participants' index and subsequent clinical events will be adjudicated as TIA/mS or mimics by an expert panel. STUDY OUTCOMES Process outcomes-whether the patient was referred for secondary care; time from event to first patient presentation to a health professional; time from event to specialist acute-access clinic appointment; time from event to brain and vascular imaging and relevant prescriptions. Clinical outcomes-recurrent stroke and major vascular events; and health-related quality of life. DISCUSSION Community management of TIA/mS will be informed by this study.
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Affiliation(s)
- Christopher R Levi
- 1 John Hunter Hospital, Hunter Medical Research Institute, Newcastle, Australia.,2 Department of Neurology, The University of Newcastle, Newcastle, Australia.,3 The Ingham Institute, SPHERE, Sydney, Australia
| | - Daniel Lasserson
- 4 Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,5 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Debbie Quain
- 6 Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | - Jose Valderas
- 7 Health Services & Policy Research, Academic Collaboration for Primary Care (APEx), NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, UK
| | - Helen M Dewey
- 8 Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia
| | - P Alan Barber
- 9 Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Neil Spratt
- 1 John Hunter Hospital, Hunter Medical Research Institute, Newcastle, Australia.,2 Department of Neurology, The University of Newcastle, Newcastle, Australia
| | - Dominique A Cadilhac
- 10 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Parkville, Australia.,11 Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Valery Feigin
- 12 National Institute for Stroke & Applied Neurosciences, AUT University, Auckland, New Zealand
| | - Hossein Zareie
- 6 Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | | | - Andrew Davey
- 13 Discipline of General Practice, University of Newcastle, Newcastle, Australia
| | - Nashwa Najib
- 13 Discipline of General Practice, University of Newcastle, Newcastle, Australia
| | - Parker Magin
- 13 Discipline of General Practice, University of Newcastle, Newcastle, Australia
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van Schoonhoven AV, van Asselt AD, Tomaszewski M, Patel P, Khunti K, Gupta P, Postma MJ. Cost-Utility of an Objective Biochemical Measure to Improve Adherence to Antihypertensive Treatment. Hypertension 2018; 72:1117-1124. [DOI: 10.1161/hypertensionaha.118.11227] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Alexander V. van Schoonhoven
- From the Unit of PharmacoTherapy, -Epidemiology, and -Economics, Department of Pharmacy, University of Groningen, The Netherlands (A.V.v.S., A.D.I.v.A., M.J.P.)
| | - Antoinette D.I. van Asselt
- From the Unit of PharmacoTherapy, -Epidemiology, and -Economics, Department of Pharmacy, University of Groningen, The Netherlands (A.V.v.S., A.D.I.v.A., M.J.P.)
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, The Netherlands (A.D.I.v.A., M.J.P.)
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (M.T., P.G.)
- Division of Medicine, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, United Kingdom (M.T.)
| | - Prashanth Patel
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, United Kingdom (P.P., P.G.)
- Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre, University of Leicester, United Kingdom (P.P., P.G.)
| | - Kamlesh Khunti
- Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre, University of Leicester, United Kingdom (P.P., P.G.)
| | - Pankaj Gupta
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, United Kingdom (M.T., P.G.)
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, United Kingdom (P.P., P.G.)
- Department of Cardiovascular Sciences, British Heart Foundation Cardiovascular Research Centre, University of Leicester, United Kingdom (P.P., P.G.)
| | - Maarten J. Postma
- From the Unit of PharmacoTherapy, -Epidemiology, and -Economics, Department of Pharmacy, University of Groningen, The Netherlands (A.V.v.S., A.D.I.v.A., M.J.P.)
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, The Netherlands (A.D.I.v.A., M.J.P.)
- Department of Health Sciences, University Medical Centre Groningen, University of Groningen, The Netherlands (M.J.P.)
- Department of Economics, Econometrics and Finance, University of Groningen, Faculty of Economics and Business, The Netherlands (M.J.P.)
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Abstract
Given the need for early restoration of blood flow and preservation of partially damaged brain cells after ischemic stroke, the noninterventional treatment of stroke relies heavily on the speedy recognition and classification of the clinical syndrome. Initiation of systemic thrombolysis with careful observation of contraindications within the 3.0 (4.5)-hour time window is the approved therapy of choice. Management of hemorrhagic complications and resumption of oral anticoagulation if indicated are also discussed in this article.
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Yeşilot N, Ekizoğlu E, Çoban O. Clinical Features of Cancer Associated Ischemic Stroke. ACTA ACUST UNITED AC 2018; 55:113-117. [PMID: 30057450 DOI: 10.29399/npa.22999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/10/2017] [Indexed: 01/02/2023]
Abstract
Introduction Cerebrovascular disease is the second most common cause of central nervous system involvement in cancer patients after metastases. Procoagulant substances secreted by tumour cells, cancer therapy, and embolus from tumour have been implicated in ischemic stroke (IS) in cancer patients. Methods Four thousand twenty patients with IS were prospectively recorded to the Istanbul Medical School Stroke Registry from August 1997 to May 2016. Ninety-two patients with IS and cancer and 3928 IS patients without cancer constituted the two groups. Results Hypertension, hyperlipidemia, and congestive heart failure were less commonly encountered in cancer stroke patients. Lacunar and posterior circulation syndromes were less common and total anterior circulation syndrome was more common in cancer patients (p<0.001). Multiple territory infarcts were more frequently seen in patients having overt or non-overt disseminated intravascular coagulopathy (DIC) compared to those without DIC. Median survival was significantly shorter in patients with cancer-related stroke. Conclusion Cancer associated stroke without other underlying etiology is a specific group of stroke patients presenting with multiple territorial infarcts, overt or non-overt disseminated intravascular coagulopathy, and poor prognosis.
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Affiliation(s)
- Nilüfer Yeşilot
- Department of Neurology, Istanbul Medical Faculty of Istanbul University, Istanbul, Turkey
| | - Esme Ekizoğlu
- Department of Neurology, Istanbul Medical Faculty of Istanbul University, Istanbul, Turkey
| | - Oğuzhan Çoban
- Department of Neurology, Istanbul Medical Faculty of Istanbul University, Istanbul, Turkey
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36
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The urgent neurological consultation in the population of the province of Ferrara, Italy. Neurol Sci 2018; 39:1253-1259. [DOI: 10.1007/s10072-018-3424-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/21/2018] [Indexed: 10/17/2022]
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Alexandrov AW, Tsivgoulis G, Hill MD, Liebeskind DS, Schellinger P, Ovbiagele B, Arthur AS, Caso V, Nogueira RG, Hemphill JC, Grotta JC, Hacke W, Alexandrov AV. HeadPoST. Neurology 2018; 90:885-889. [DOI: 10.1212/wnl.0000000000005481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/12/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo critique the Head Positioning in Stroke Trial (HeadPoST) study methods in relation to preceding research findings in an aim to clarify the potential efficacy of positioning interventions and direction for future research.MethodsHead positioning research prior to the conduct of HeadPoST was reviewed by a team of international stroke experts, and methods and findings were compared to HeadPoST.ResultsMethods used to select HeadPoST patients differ substantially from those used in original head positioning studies, in particular enrollment of all types of stroke. HeadPoST enrolled primarily minor strokes (median NIH Stroke Scale 4, interquartile range [IQR] 2–8) without vascular imaging confirmation of subtype; elapsed time from stroke symptom onset to the initiation of intervention was late (median 14 hours, IQR 5–35), and time from hospital admission to enrollment was delayed (median 7 hours, IQR 2–26). Intervention integrity was not reported, including ability to achieve/maintain 30° head elevation in beds lacking head elevation capabilities. Deterioration or improvement associated with the intervention is unknown as serial assessments were not completed, and the trial's 3-month outcome was powered using unrelated study data.ConclusionsThe design of HeadPoST was suboptimal to measure differences produced by the intervention. Future head positioning trials in discrete patient cohorts (in particular, large vessel occlusion) with endpoints supported by pilot work are required to understand the efficacy of this simple yet potentially important intervention.
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Zhang HW, Zheng R, Xu C, Lin ZX, Qin Y, Cai J, Yuan Q. Tai Chi for improving recovery after stroke. Hippokratia 2018. [DOI: 10.1002/14651858.cd010207.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hong Wei Zhang
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Rui Zheng
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Chuanshan Xu
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Zhi Xiu Lin
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Ying Qin
- The Chinese University of Hong Kong; Division of Epidemiology, School of Public Health and Primary Care; Hong Kong Hong Kong China KHSAR
| | - Jing Cai
- Fujian University of Traditional Chinese Medicine; College of Integrative Medicine; Fuzhou China
| | - Qiuju Yuan
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
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Liu J, Xu F, Mohammadtursun N, Lv Y, Tang Z, Dong J. The Analysis of Constitutions of Traditional Chinese Medicine in Relation to Cerebral Infarction in a Chinese Sample. J Altern Complement Med 2017; 24:458-462. [PMID: 28820606 DOI: 10.1089/acm.2017.0027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the relationships between the constitutions of Traditional Chinese Medicine (TCM) and patients with cerebral infarction (CI) in a Chinese sample. METHODS A total of 3748 participants with complete data were available for data analysis. All study subjects underwent complete clinical baseline characteristics' evaluation, including a physical examination and response to a structured, nurse-assisted, self-administrated questionnaire. A population of 2010 neutral participants were used as the control group. Multiple variable regression (MLR) were employed to estimate the relationship between constitutions of TCM and the outcome. DESIGN A cross-sectional study was conducted to evaluate the association of body constitution of TCM and CI. SETTINGS/LOCATION Communications and healthcare centers in Shanghai. SUBJECTS A total of 3748 participants with complete data were available for data analysis. OUTCOME MEASURES All study subjects underwent complete clinical baseline characteristics' evaluation, including a physical examination and response to a structured, nurse-assisted, self-administrated questionnaire. A population of 2010 neutral participants were used as the control group. MLR were employed to estimate the relationship between constitutions of TCM and the outcome. RESULT The prevalence of CI was 2.84% and 4.66% in neutral participants and yang-deficient participants (p = 0.012), respectively. Univariate analysis demonstrated a positive correlation between yang deficiency and CI. After adjustment for relevant potential confounding factors, the MLR detected significant associations between yang deficiency and CI (odds ratio = 1.44, p = 0.093). CONCLUSION A yang-deficient constitution was significantly and independently associated with CI. A higher prevalence of CI was found in yang-deficient participants as compared with neutral participants.
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Affiliation(s)
- Jiaqi Liu
- 1 Department of Integrative Medicine, Huashan Hospital, Fudan University , Shanghai, China .,2 The Institute of Integrative Medicine, Fudan University , Shanghai, China
| | - Fei Xu
- 1 Department of Integrative Medicine, Huashan Hospital, Fudan University , Shanghai, China .,2 The Institute of Integrative Medicine, Fudan University , Shanghai, China
| | - Nabijan Mohammadtursun
- 1 Department of Integrative Medicine, Huashan Hospital, Fudan University , Shanghai, China .,2 The Institute of Integrative Medicine, Fudan University , Shanghai, China .,3 College of Xinjiang Uyghur Medicine , Hotan, China
| | - Yubao Lv
- 1 Department of Integrative Medicine, Huashan Hospital, Fudan University , Shanghai, China .,2 The Institute of Integrative Medicine, Fudan University , Shanghai, China
| | - Zihui Tang
- 1 Department of Integrative Medicine, Huashan Hospital, Fudan University , Shanghai, China .,2 The Institute of Integrative Medicine, Fudan University , Shanghai, China
| | - Jingcheng Dong
- 1 Department of Integrative Medicine, Huashan Hospital, Fudan University , Shanghai, China .,2 The Institute of Integrative Medicine, Fudan University , Shanghai, China
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40
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Subic A, Cermakova P, Norrving B, Winblad B, von Euler M, Kramberger MG, Eriksdotter M, Garcia-Ptacek S. Management of acute ischaemic stroke in patients with dementia. J Intern Med 2017; 281:348-364. [PMID: 28150348 DOI: 10.1111/joim.12588] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
An estimated 10% of stroke patients have an underlying dementia. As a consequence, health professionals often face the challenge of managing patients with dementia presenting with an acute stroke. Patients with dementia are less likely to receive thrombolysis (0.56-10% vs. 1-16% thrombolysis rates in the general population), be admitted to a stroke unit or receive some types of care. Anticoagulation for secondary stroke prevention is sometimes withheld, despite dementia not being listed as an exclusion criterion in current guidelines. Studies in this population are scarce, and results have been contradictory. Three observational studies have examined intravenous thrombolysis for treatment of acute ischaemic stroke in patients with dementia. In the two largest matched case-control studies, there were no significant differences between patients with and without dementia in the risks of intracerebral haemorrhage or mortality. The risk of intracerebral haemorrhage ranged between 14% and 19% for patients with dementia. Studies of other interventions for stroke are lacking for this population. Patients with dementia are less likely to be discharged home compared with controls (19% vs. 41%) and more likely to be disabled (64% vs. 59%) or die during hospitalization (22% vs. 11%). The aim of this review was to summarize current knowledge about the management of ischaemic stroke in patients with pre-existing dementia, including organizational aspects of stroke care, intravenous thrombolysis, access to stroke unit care and use of supportive treatment. Evidence to support anticoagulation for secondary prevention of stroke in patients with atrial fibrillation and antiplatelet therapy in nonembolic stroke will be discussed, as well as rehabilitation and how these factors influence patient outcomes. Finally, ethical issues, knowledge gaps and pathways for future research will be considered.
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Affiliation(s)
- A Subic
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia
| | - P Cermakova
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - B Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - B Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - M von Euler
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Karolinska University Hospital, Department of Clinical Pharmacology, Stockholm, Sweden
| | - M G Kramberger
- Department of Neurology, University Medical Center, Ljubljana, Slovenia
| | - M Eriksdotter
- Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - S Garcia-Ptacek
- Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
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41
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Wei CY, Quek RGW, Villa G, Gandra SR, Forbes CA, Ryder S, Armstrong N, Deshpande S, Duffy S, Kleijnen J, Lindgren P. A Systematic Review of Cardiovascular Outcomes-Based Cost-Effectiveness Analyses of Lipid-Lowering Therapies. PHARMACOECONOMICS 2017; 35:297-318. [PMID: 27785772 DOI: 10.1007/s40273-016-0464-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Previous reviews have evaluated economic analyses of lipid-lowering therapies using lipid levels as surrogate markers for cardiovascular disease. However, drug approval and health technology assessment agencies have stressed that surrogates should only be used in the absence of clinical endpoints. OBJECTIVE The aim of this systematic review was to identify and summarise the methodologies, weaknesses and strengths of economic models based on atherosclerotic cardiovascular disease event rates. METHODS Cost-effectiveness evaluations of lipid-lowering therapies using cardiovascular event rates in adults with hyperlipidaemia were sought in Medline, Embase, Medline In-Process, PubMed and NHS EED and conference proceedings. Search results were independently screened, extracted and quality checked by two reviewers. RESULTS Searches until February 2016 retrieved 3443 records, from which 26 studies (29 publications) were selected. Twenty-two studies evaluated secondary prevention (four also assessed primary prevention), two considered only primary prevention and two included mixed primary and secondary prevention populations. Most studies (18) based treatment-effect estimates on single trials, although more recent evaluations deployed meta-analyses (5/10 over the last 10 years). Markov models (14 studies) were most commonly used and only one study employed discrete event simulation. Models varied particularly in terms of health states and treatment-effect duration. No studies used a systematic review to obtain utilities. Most studies took a healthcare perspective (21/26) and sourced resource use from key trials instead of local data. Overall, reporting quality was suboptimal. CONCLUSIONS This review reveals methodological changes over time, but reporting weaknesses remain, particularly with respect to transparency of model reporting.
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Affiliation(s)
- Ching-Yun Wei
- Kleijnen Systematic Reviews Ltd., Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK.
| | | | | | | | - Carol A Forbes
- Kleijnen Systematic Reviews Ltd., Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Steve Ryder
- Kleijnen Systematic Reviews Ltd., Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Nigel Armstrong
- Kleijnen Systematic Reviews Ltd., Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Sohan Deshpande
- Kleijnen Systematic Reviews Ltd., Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Steven Duffy
- Kleijnen Systematic Reviews Ltd., Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Jos Kleijnen
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Peter Lindgren
- IHE-Institutet för Hälso-och Sjukvårdsekonomi, Lund, Sweden
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42
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Xu C, Zhang HW, Leung AWN, Lin ZX, Qin Y. Tai Chi for improving recovery after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd010207.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chuanshan Xu
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Hong Wei Zhang
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Albert WN Leung
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Zhi Xiu Lin
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Ying Qin
- The Chinese University of Hong Kong; Division of Epidemiology, School of Public Health and Primary Care; Hong Kong Hong Kong China KHSAR
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43
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French B, Thomas LH, Harrison J, Burton CR, Forshaw D, Booth J, Britt D, Cheater FM, Roe B, Watkins CL. Implementing a Systematic Voiding Program for Patients With Urinary Incontinence After Stroke. QUALITATIVE HEALTH RESEARCH 2016; 26:1393-1408. [PMID: 26935722 DOI: 10.1177/1049732316630975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We explored health professionals' views of implementing a systematic voiding program (SVP) in a multi-site qualitative process evaluation in stroke services recruited to the intervention arms of a cluster randomized controlled feasibility trial during 2011-2013. We conducted semi-structured group or individual interviews with 38 purposively selected nursing, managerial, and care staff involved in delivering the SVP. Content analysis of transcripts used normalization process theory (NPT) as a pre-specified organization-level exploratory framework. Barriers to implementing the SVP included perceived lack of suitability for some patient groups, patient fear of extending hospital stay, and difficulties with SVP enactment, scheduling, timing, recording, and monitoring. Enablers included the guidance provided by the SVP, patient and relative involvement, extra staff, improved nursing skill and confidence, and experience of success. Three potential mechanisms of consistency, visibility, and individualization linked the SVP process with improvements in outcome, and should be emphasized in SVP implementation.
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Affiliation(s)
| | - Lois H Thomas
- University of Central Lancashire, Preston, United Kingdom
| | | | | | - Denise Forshaw
- University of Central Lancashire, Preston, United Kingdom
| | - Joanne Booth
- Glasgow Caledonian University, Glasgow, United Kingdom
| | - David Britt
- University of Liverpool, Liverpool, United Kingdom
| | | | - Brenda Roe
- Edge Hill University, Ormskirk, United Kingdom
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Abstract
At the present time 'better health care' is one of the two main government objectives for the National Health Service. Since this implies future improvement it is essential to be able to describe current practice. This article describes the outcome (current practice), principally in terms of Barthel score, for stroke patients receiving rehabilitation on a specialized ward and puts forward a suggestion for a minimum data set which could be used to describe current practice on all rehabilitation wards.
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Affiliation(s)
- Joanna ML Geddes
- Rheumatology and Rehabilitation Research Unit, University of Leeds — Research Fellow, Rheumatology and Rehabilitation Research Unit, University of Leeds, Leeds LS2 9NZ, UK
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45
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Pollock C, Freemantle N, Sheldon T, Song F, Mason JM. Methodological difificulties in rehabilitation research. Clin Rehabil 2016. [DOI: 10.1177/026921559300700109] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper presents an overview of some of the pitfalls and suggests ways of improving the quality of research into rehabilitation after stroke. The aims of rehabilitation are outlined and methodological problems inherent in this area discussed, including spontaneous recovery, multidimensional outcomes, definition of treatment and placebo effects. Major weaknesses found in the rehabilitation literature are identified and recommendations for improvement made, including the need for comparable controls, adequate numbers, appropriate outcome measures, clear definition of therapy, generalizability, and a concern for the cost-effectiveness of stroke rehabilitation packages. The field of rehabilitation is still relatively new and idiosyncratic in form and content. Thus it still provides opportunities for research into its relative effectiveness before current practices in rehabilitation become entrenched in medical practice and folklore. Adequate funding support for improved, multicentre clinical trials in rehabilitation is essential.
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Affiliation(s)
- C. Pollock
- School of Public Health, University of Leeds
| | | | - T. Sheldon
- School of Public Health, University of Leeds
| | - F. Song
- School of Public Health, University of Leeds
| | - JM Mason
- Centre for Health Economics, University of York
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Abstract
Scales that measure independence in the basic self-care activities of daily living (ADLs) suffer from ceiling effects when applied to an outpatient population. The instrumental activities of daily living (IADL) measures, which assess the performance of tasks required for independence at home are more appropriate. However, validity evaluation of IADL measures seldom goes beyond content validity and little is known about their sensitivity to change. The aim of this study was to evaluate the construct validity of the extended ADL scale (EADL) and to test its sensitivity to change. Three hundred and sixty-one consecutive acute stroke admissions were recruited and surveyed at one, six and 12 months after stroke, using the EADL. There were the expected correlations with the Barthel Index, Nottingham Health Profile, Geriatric Depression Score and the London Stroke Satisfaction Score. Logistic regression analysis showed that, although men were more mobile, they were less likely to carry out domestic and kitchen tasks. Also, nonwhites were more disabled, owner-occupiers had higher leisure scores and those living alone had higher kitchen scores. Analysis of effect sizes showed that the EADL is sensitive to the changes that occur after stroke and would be sensitive to the effect of an intervention that produced a change in independence of two or more ADLs. The EADL is a valid measure of the performance of instrumental ADLs and is sensitive to clinically important changes.
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Affiliation(s)
- Patrick Gompertz
- Department of Public Health and Primary Care, Royal Free Hopsital School of Medicine, London
| | - Pandora Pound
- Department of Public Health and Primary Care, Royal Free Hopsital School of Medicine, London
| | - Shah Ebrahim
- Department of Public Health and Primary Care, Royal Free Hopsital School of Medicine, London
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Back L, Nagaraja V, Kapur A, Eslick GD. Role of decompressive hemicraniectomy in extensive middle cerebral artery strokes: a meta-analysis of randomised trials. Intern Med J 2016; 45:711-7. [PMID: 25684396 DOI: 10.1111/imj.12724] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prognosis for patients with 'malignant' or space-occupying oedema post middle cerebral artery infarct remains poor despite maximal medical therapy delivered in the intensive care setting. AIM We performed a meta-analysis to evaluate the value of surgical decompression versus medical management alone in patients suffering from malignant middle cerebral artery infarct. METHODS A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct and Web of Science. Original data was abstracted from each study and used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI). RESULTS The overall OR for mRS 6 (death) at 6 months for decompressive surgery as compared with standard medical management revealed a statistically significant reduction with OR of 0.19 (95% CI: 0.10-0.37). The frequency of patients with mRS 2, 3 and 5 outcomes was higher in the decompressive surgery cohort; however, these outcomes did not reach statistical significance. On the other hand, the number of patients with a mRS score of 4 was significantly higher in the decompressive surgery cohort with an OR of 3.29 (95% CI: 1.76-6.13). The overall OR for mRS 6 (death) at 12 months for decompressive surgery as compared with standard medical management revealed a statistically significant reduction with OR of 0.17 (95% CI: 0.10-0.29). The frequency of patients with mRS 3 and 5 outcomes was higher in the decompressive surgery cohort; however, these outcomes did not reach statistical significance. On the other hand, the number of patients with a mRS score of 4 was significantly higher in the decompressive surgery cohort with an OR of 4.43 (95% CI: 2.27-8.66). In the long run it was also observed that the number of patients with a mRS score of 2 was significantly higher in the decompressive surgery cohort an OR of 4.51 (95% CI: 1.06-19.24). CONCLUSIONS Our results imply that surgical intervention decreased mortality of patients with fatal middle cerebral artery infarct at the expense of increasing the proportion suffering from substantial disability at the conclusion of follow up.
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Affiliation(s)
- L Back
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
| | - V Nagaraja
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
| | - A Kapur
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
| | - G D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
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Coffin ST, Haglund NA, Davis ME, Xu M, Dunlay SM, Cowger JA, Shah P, Aaronson KD, Pagani FD, Stulak JM, Maltais S. Adverse neurologic events in patients bridged with long-term mechanical circulatory support: A device-specific comparative analysis. J Heart Lung Transplant 2015; 34:1578-85. [DOI: 10.1016/j.healun.2015.08.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/23/2015] [Accepted: 08/31/2015] [Indexed: 11/26/2022] Open
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49
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Stroke Incidence and Case Fatality Rate in an Urban Population. J Stroke Cerebrovasc Dis 2015; 24:771-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/13/2014] [Accepted: 11/09/2014] [Indexed: 11/22/2022] Open
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50
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Wang C, Wu Z, Li N, Zhao Y, Tian F, Zhou X, Wang Z. Clinical curative effect of electric acupuncture on acute cerebral infarction: a randomized controlled multicenter trial. J TRADIT CHIN MED 2015; 34:635-40. [PMID: 25618965 DOI: 10.1016/s0254-6272(15)30075-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine whether electric acupuncture can improve the daily life of patients with ischemic cerebral apoplexy at acute stage. METHODS A stratified-block randomized controlled multicenter trial was designed for this study. Totally 340 patients with acute ischemic cerebral apoplexy were randomly divided into an electric acupuncture group and a control group. In the electric acupuncture group, 170 patients were treated with electric acupuncture and routine therapy, and 170 patients in the control group with routine therapy alone. Major indexes for judging curative effect were Barthel index at 3- and 6- months follow-up visits and number of re-hospitalized patients. Minor indexes for judging curative effect were change in the score for nervous dysfunction at 4 and 12 weeks follow-up visits and number of patients persisting in rehabilitation treatment with acupuncture during follow-up visit. RESULTS Baseline data at the time of case selection between the two groups were similar. The odds ratio (OR) was 0.92, and the 95% confidence interval (CI) was 0.49-1.73 in disabled rate and 0.73 and 0.51-1.05 in the number of re-hospitalized patients in the electric acupuncture group at 6-month follow up visit compared with the control group. There was no difference in the score for nervous dysfunction at the end of 12-week follow-up visit between the two groups. The score for nervous dysfunction at the end of 4-week treatment in the electric acupuncture group was significantly higher than that in the control group (P < 0.05). The number of patients discharged from hospital who persisted in rehabilitation treatment with acupuncture in the acupuncture group was significantly higher than that in the control group. CONCLUSION Using electric acupuncture to treat patients with acute ischemic cerebral apoplexy can effectively improve the nervous dysfunction scores after 4-week treatment and their ability to deal with daily life after 6-month follow-up visit. Systematic treatment with acupuncture may also reduce the number of patients with secondary apoplexy.
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