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Zhao S, Sun T, Zhang M, Yan M, Wang K, Li L, Liu J. Efficacy and safety of Shenmai injection for acute ischemic stroke: a systematic review and meta-analysis. Front Pharmacol 2024; 15:1394936. [PMID: 38895632 PMCID: PMC11184089 DOI: 10.3389/fphar.2024.1394936] [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: 03/02/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
Background Ischemic stroke is a serious and sudden cerebrovascular condition that significantly affects individual's health and imposes a substantial economic burden on medical management. Despite its widespread use in China, there is still a lack of reliable evidence regarding the efficacy of Shenmai injection (SMI) in acute ischemic stroke (AIS). We aimed to comprehensively assess the effectiveness and safety of SMI in treating AIS through a systematic review and meta-analysis. Methods Randomized controlled studies (RCTs) investigating the efficacy of SMI in treating AIS were searched for in eight databases from the inception of each database till January 2024. We utilized the ROB 2.0 to assess the risk of bias. A meta-analysis was conducted using Review Manager 5.4, while sensitivity analyses and publication bias assessments were conducted using Stata 16.1. Results A total of 17 studies involving 1,603 AIS patients were included in our meta-analysis. Our results showed that SMI plus conventional treatments (CTs) was more effective than CTs alone in improving the total effective rate (RR 1.22, 95% CI: 1.14 to 1.30, p < 0.00001), the Barthel index (BI) (MD 12.18, 95% CI: 10.30 to 14.06, p < 0.00001), and reducing the National Institute of Health Stroke Scale Score (NIHSS) score (MD -3.05, 95% CI: 3.85 to -2.24, p < 0.00001) and Modified Rankin Scale (mRS) (MD -0.68, 95% CI: 0.86 to-0.49, p < 0.00001). In addition, SMI combination therapy was better than CTs alone in decreasing the levels of IL-6, IL-18, and hs-CRP. SMI therapy also enhanced the cerebral hemorheology of patients by reducing levels of fibrinogen and plasma viscosity. However, there was no significant difference in the incidence of adverse events, including elevated transaminase, rash, nausea, bleeding, urticaria, headache, vomiting, chest tightness, and facial flushes. Moreover, no serious adverse effects or life-threatening events were reported. Conclusion Our study shows that combining SMI with CTs effectively enhances the neurological function of patients with acute cerebral infarction. However, our findings should be interpreted considering the significant heterogeneity and suboptimal quality of the analyzed trials. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024504675, Identifier PROSPERO, CRD42024504675.
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Affiliation(s)
- Shuai Zhao
- Beijing University of Chinese Medicine, Beijing, China
| | - Tianye Sun
- Beijing University of Chinese Medicine, Beijing, China
| | - Mi Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Mingyuan Yan
- Beijing University of Chinese Medicine, Beijing, China
| | - Kaiyue Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Lili Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Jinmin Liu
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Tworek K, Tomaszewska A, Owecka B, Fryska Z, Marcinkowski JT, Owecki M. Non-compliance with medical recommendations results in delayed hospitalization and poorer prognosis in patients with cerebral ischemic stroke in Poland: Non-compliance effects on post-ischemic stroke prognosis. J Stroke Cerebrovasc Dis 2024; 33:107465. [PMID: 37949030 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107465] [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: 08/02/2023] [Revised: 10/06/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES This study aimed to reveal and analyze the causes of delays in reaching the hospital of patients with cerebral ischemic stroke and to assess their clinical picture. MATERIAL AND METHODS The study group included 161 patients with stroke, who reported to the hospital beyond the thrombolytic treatment therapeutic window. The control group consisted of 85 patients recruited consecutively with stroke who received thrombolytic treatment per eligibility criteria. Laboratory and medical imaging tests essential for neurological condition assessment were conducted in the study group. Control group research was based on retrospective analysis of medical records. RESULTS The rate of deaths during hospitalization was lower in the control group (4.7%) compared to the study group (14.9%). In the study group, more patients (16.8%) admitted to non-compliance with medical recommendations than in the control group (5.9%). There were no statistically significant differences in nicotinism and alcohol dependence syndrome frequency between both groups. CONCLUSIONS Based on each group inclusion criteria, a lower mortality rate in the control group indicates a crucial role of the therapeutic window in cerebral stroke treatment. Analysis of reasons for delay points out that efficient prophylaxis is the education of patients with stroke risk factors and their families.
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Affiliation(s)
- Karolina Tworek
- Department of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Agata Tomaszewska
- Students Research Circle of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Barbara Owecka
- Students Research Circle of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Zuzanna Fryska
- Students Research Circle of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Jerzy T Marcinkowski
- Department of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland
| | - Maciej Owecki
- Department of Public Health, Poznań University of Medical Sciences (PUMS), Rokietnicka 4, 60-806 Poznań, Poland.
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Chiangkhong A, Suwanwong C, Wongrostrai Y. Lifestyle, clinical, and occupational risk factors of recurrent stroke among the working-age group: A systematic review and meta-analysis. Heliyon 2023; 9:e13949. [PMID: 36915512 PMCID: PMC10006477 DOI: 10.1016/j.heliyon.2023.e13949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Background Stroke recurrence is increasing in the working-age population. This study aimed to summarize and evaluate the risk factors for recurrent stroke among the working-age population. Methods Relevant studies were extracted from several databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Fixed- or random-effects estimates of the pooled odds ratio (OR) and 95% confidence interval (CI) of risk factors for recurrent stroke were generated based on heterogeneity. Subgroup and publication bias analyses were also performed. Results Seventeen studies were included in the meta-analysis. Pooled effects results revealed that the risk of recurrent stroke in the working-age group was as follows: Diabetes (OR = 1.85, 95% CI: 1.47, 2.32), hypertension (OR = 1.27, 95% CI: 1.12, 1.44), smoking (OR = 1.52, 95% CI: 1.27, 1.81), history of cardiac disease (OR = 2.86, 95% CI: 2.22, 3.67), history of stroke (OR = 2.45, 95% CI: 1.81, 3.31), and National Institutes of Health stroke severity score (OR = 1.09, 95% CI: 1.03, 1.15). Conclusion These findings suggest that several factors, such as diabetes, hypertension, smoking, history of cardiac disease and stroke, and severity of a stroke, are potential risk factors for recurrent stroke in the working-age group. Therefore, strategies to reduce those risk factors should be adopted and attention paid to prevent recurrent stroke among working-age populations.
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Affiliation(s)
- Araya Chiangkhong
- Kuakarun Faculty of Nursing, Navamindradhiraj University, Bangkok, Thailand
| | - Charin Suwanwong
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| | - Yupha Wongrostrai
- Kuakarun Faculty of Nursing, Navamindradhiraj University, Bangkok, Thailand
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Getu RA, Aga F, Badada T, Workie SG, Belew MA, MekonnenRN K. Knowledge of stroke risk factors and warning symptoms among adults with type 2 diabetes in Addis Ababa, Ethiopia, 2021: an institution-Based cross-sectional study. BMC Cardiovasc Disord 2023; 23:21. [PMID: 36646999 PMCID: PMC9841697 DOI: 10.1186/s12872-022-03031-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 12/26/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Stroke is a global public health concern with type 2 diabetes being one of the common risk factors. Knowledge of stroke risk factors and warning symptoms among type 2 diabetes patients is largely unknown in developing countries like Ethiopia. The inability to recognize stroke warning symptoms accurately is an important cause of delay in seeking medical attention. We investigated knowledge of stroke risk factors and warning symptoms among adults with type 2 diabetes and the factors associated with these variables. METHODS This was an institution-based cross-sectional study. We enrolled 470 adult type 2 diabetes patients using a systematic random sampling method from four government-managed hospitals in Addis Ababa from 1 to 30 February 2021. The Stroke Recognition Questionnaire was adapted to measure the knowledge of stroke risk factors and warning symptoms. Sociodemographic characteristics, source of information, and reaction to stroke were also measured. Data were analyzed using SPSS version 25 and linear regression analysis was used to determine factors independently associated with knowledge of stroke risk factors and warning symptoms. RESULT The mean age of the participants was 50.6 ± 12.9 years. The mean score of knowledge of stroke risk factors and warning symptoms was 67.2% and 63.9%, respectively. Higher educational level (B = 2.007, 95% CI = 1.101, 2.914, P < 0.001), knowing someone diagnosed with stroke (B = 3.328, 95% CI = 2.734, 3.922, P < 0.001), and living with others (B = 2.28, 95% CI = 1.606, 2.954, P < 0.001) were independently associated with knowledge of stroke risk factors. Younger age (B = - 0.021, 95% CI= -0.038, 0.005, P = 0.01), higher educational level (B = 1.873, 95% CI = 1.017, 2.730, P < 0.001), and knowing someone diagnosed with stroke (B = 3.64, 95% CI = 3.079, 4.200, P < 0.001) were independently associated with knowledge of warning symptoms of stroke. CONCLUSION The mean score of knowledge of stroke risk factors and warning symptoms was 67.2% and 63.9%, respectively. Younger age, higher educational level, and living with other people are predictors of better knowledge of stroke risk factors and warning symptoms in this study. Future educational interventions should target type 2 diabetes adults with advancing age and the involvement of their family members.
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Affiliation(s)
- Rediet Akele Getu
- grid.464565.00000 0004 0455 7818Department of Nursing, School of Nursing and Midwifery, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Fekadu Aga
- grid.7123.70000 0001 1250 5688School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tadesse Badada
- grid.7123.70000 0001 1250 5688School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sewnet Getaye Workie
- grid.464565.00000 0004 0455 7818Department of Public Health, School of Public Health, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Makda Abate Belew
- grid.464565.00000 0004 0455 7818Department of Nursing, School of Nursing and Midwifery, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Kalkidan MekonnenRN
- grid.464565.00000 0004 0455 7818Department of Nursing, School of Nursing and Midwifery, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
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Syed W, Qadhi OA, Barasheed A, AlZahrani E, Basil A. Al-Rawi M. Evaluation of knowledge of risk factors and warning signs of stroke - An observational study among future health care professionals. Front Public Health 2023; 11:1131110. [PMID: 36969679 PMCID: PMC10031120 DOI: 10.3389/fpubh.2023.1131110] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/31/2023] [Indexed: 03/29/2023] Open
Abstract
Background and objective The role of healthcare professionals in society is unique since they are providers of health information and medication counseling to patients. Hence, this study aimed to evaluate Knowledge of Risk Factors and Warning Signs of Stroke among undergraduate health care Students (UHCS) at King Saud University (KSU), Riyadh, Saudi Arabia. Methodology An online cross-sectional study was conducted among UHCS at KSU, Riyadh, Saudi Arabia from September to November 2022, using self-administered 34-item questionnaires divided into five sections to assess participants' knowledge of stroke risk factors, warning signs, and management and source of information about the stroke. The Statistical Package for the Social Sciences version 26 was used to analyze the data (SPSS). Results Of the 300 questionnaires distributed, 205 students completed the questionnaires, giving a response rate of 68.3%. Of whom 63 (30.7%) were pharmacy, 81 (39.5%) were nursing and 61 (29.8%) were emergency medical services (EMS) Students. One hundred and eighty-two (88.8%) of the students agreed that stroke affects bodily movement. With regards to risk factors, students identified high blood pressure 182 (88.8%), followed by heart disease 175 (85.4%), advanced age 164 (80%), previous Stroke history 158(77.1%), and lack of physical activity 156 (76.1%). Difficulty in speaking or slurred speech 164 (80%), dizziness, and loss of balance 163 (79.5%) were identified as the warning signs of stroke. In this study, 41.3 % of the pharmacy students reported a good level of knowledge than nursing and EMS students. However, 32.2% (N = 66) of the healthcare undergraduates reported good knowledge. The knowledge score was significantly associated with the year of study, and educational degree (p = 0.0001). Furthermore, there were no differences between parents working in healthcare settings (p = 0.99). Conclusion In conclusion, the knowledge of stroke among healthcare students at King Saud University varied. The reported knowledge gap mostly relates to stroke risk factors and warning signs. Therefore, increasing public awareness of potential risk factors and stroke warning signs needs to receive more attention.
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Affiliation(s)
- Wajid Syed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Wajid Syed
| | - Omaimah A. Qadhi
- Medical-Surgical Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Amal Barasheed
- Medical-Surgical Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Ebtesam AlZahrani
- Medical-Surgical Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Mahmood Basil A. Al-Rawi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Nindrea RD, Hasanuddin A. Non-modifiable and modifiable factors contributing to recurrent stroke: A systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Bhagavathy MG, Anniyappa S, Thankappan R, Bharathi B. Lived experiences of stroke survivors in India: A phenomenological study. BELITUNG NURSING JOURNAL 2022; 8:405-413. [PMID: 37554493 PMCID: PMC10405661 DOI: 10.33546/bnj.2161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/29/2022] [Accepted: 09/19/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Stroke is a major cause of long-term disability and has a potentially enormous emotional and socio-economic impact on patients, their families, and health services. Perceptions of patients with stroke have already been studied worldwide, which are unique in terms of their cultural background. However, in India, there is a lack of studies about the experience of the disease by stroke survivors and their perspectives of understanding the situation. OBJECTIVE This study aimed to explore lived experience of stroke survivors in India. METHODS A phenomenological study design was used. In-depth interviews were conducted with a purposive sample of ten stroke survivors who had experienced post-stroke deficits three months to one year after stroke. Data were analyzed using Diekelmann's hermeneutical approach to identify underlying themes. RESULTS Two main themes emerged: (1) emergence of stroke (actual occurrence, mental perception, and recognition of illness) and (2) therapeutic concerns (enhanced and weakened recovery). CONCLUSION Recognizing how patients experience the illness is crucial in planning care for stroke survivors. Strengthening factors enhancing recovery and limiting the hindering factors through effective therapeutic management is a necessity. The findings might also contribute to refining existing interventions and designing holistic multi-component rehabilitation programs that facilitate easy recovery. The study also highlights the need for providing information to general public on recognizing warning signs of stroke.
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Affiliation(s)
- Manjula G Bhagavathy
- Department of Medical-Surgical Nursing, College of Nursing, King Khalid University, Khamis Mushait, Saudi Arabia
| | - Saravana Anniyappa
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Bindu Bharathi
- Department of Public Health Nursing, College of Nursing, Northern Border University, Arar, Saudi Arabia
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Admas M, Teshome M, Petrucka P, Telayneh AT, Alamirew NM. In-hospital mortality and its predictors among adult stroke patients admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. SAGE Open Med 2022; 10:20503121221122465. [PMID: 36093420 PMCID: PMC9459489 DOI: 10.1177/20503121221122465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Stroke is the second-leading global cause of death next to ischemic heart disease. The burden of stroke mortality, morbidity, and disability is increasing across the world. In Ethiopia, evidence on the survival status of adult stroke patients is insufficient. The purpose of this study is to estimate in-hospital mortality and its predictors among adult stroke patients. Methods Institution-based retrospective follow-up study was conducted on adult stroke patients who were admitted to Debre Markos Comprehensive Specialized Hospital from 1 November 2015 to 31 October 2020. Through simple random sampling, 382 patient charts were selected from 1125 stroke patients for 5 years follow-up period. Data were entered using EpiData™ version 4.1 and exported to Stata/SE™ version 14 for cleaning, coding, categorizing, and analysis. Predictor variables were selected using 95% confidence interval with a corresponding adjusted hazard ratio. Results In this study, 219 (57.33%) males and the mean (standard deviation) age of 57.65 ± 14.3 years. The in-hospital mortality rate of stroke was 12.8%; the median (interquartile range) time to mortality and Glasgow Coma Scale were 7 (4-13) days and 14 (11-15), respectively. The incidence of in-hospital mortality was 29/1000, 11/1000, 8/1000, and 13.6/1000 person-days in the first, second, third, and end of follow-up weeks, respectively. Pneumonia (adjusted hazard ratio = 3.51 (95% confidence interval = 1.86, 6.61)), hemorrhagic stroke (adjusted hazard ratio = 2.03 (95% confidence interval = 1.03, 3.99)), moderate impairment Glasgow Coma Scale (9-12) (adjusted hazard ratio = 2.16 (95% confidence interval = 1.08, 4.29)), severe impairment Glasgow Coma Scale (3-8) (adjusted hazard ratio = 2.38 (95% confidence interval = 1.01, 5.67)), history of hypertension (adjusted hazard ratio = 2.01 (95% confidence interval = 1.08, 3.74)), and increased intracranial pressure (adjusted hazard ratio = 2.12 (95% confidence interval = 1.10, 4.07)) were statistically significant predictors for in-hospital mortality. Conclusion In-hospital mortality of stroke was relatively high, and the median time to mortality was 8 days. Pneumonia, hemorrhagic stroke, Glasgow Coma Scale, history of hypertension, and increased intracranial pressure were identified predictors.
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Affiliation(s)
- Maru Admas
- Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia
| | - Muluken Teshome
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Animut Takele Telayneh
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nakachew Mekonnen Alamirew
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Saade S, Hallit S, Salameh P, Hosseini H. Knowledge and Response to Stroke Among Lebanese Adults: A Population-Based Survey. Front Public Health 2022; 10:891073. [PMID: 35719671 PMCID: PMC9203897 DOI: 10.3389/fpubh.2022.891073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To date, research on public awareness of stroke warning symptoms, risk factors and practice in the general adult population in Lebanon is scarce. The aim of our study is to identify the level of stroke awareness in order to develop and implement preventive measures particularly in relationship to primary stroke prevention. Methods It is a cross-sectional study conducted among 410 adult participants from the five main governorates of Lebanon. Stroke knowledge and practice were assessed using two validated questionnaires namely the Stroke Knowledge Test (SKT) and the Stroke Action Test (STAT). Multivariable linear regression models were conducted to examine socio-demographic, social habits, and clinical factors independently associated with the SKT and the STAT scores. Results The mean SKT score of the participants was 9.16. 48.5% showed a poor stroke-related knowledge level and 51.5% a good knowledge level. Living in Mount Lebanon and occasional smokers showed statistically significant lower mean SKT scores; whereas, university degree and suffering from diabetes mellitus were associated with higher mean SKT scores. The mean overall STAT score was 41.3%. For 36.8% of the stroke symptoms, respondents selected call 112. The mean STAT scores of participants who get their information from the internet was statistically significantly lower. However, no association was found between the SKT score and the STAT score. Conclusion Knowledge of stroke risk factors was low, as was awareness of the need to call 112 in response to stroke symptoms. Hence, it is essential to develop health education programs in order to decrease stroke morbidity and mortality.
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Affiliation(s)
- Sylvia Saade
- Life Sciences and Health Department, Paris-Est University, Paris, France
- Health and Sciences Department, American University of Health and Sciences, Beirut, Lebanon
- *Correspondence: Sylvia Saade
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Psychology Department, College of Humanities, Effat University, Jeddah, Saudi Arabia
- Research Department, Psychiatric Hospital of the Cross, Jal El Dib, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, University of Nicosia, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Hassan Hosseini
- Life Sciences and Health Department, Paris-Est University, Paris, France
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Thagizadeh A, Ghahramanian A, Zamanzadeh V, Aslanabadi N, Onyeka TC, Ramazanzadeh N. Illness perception and cardiovascular risk factors in patients with myocardial infarction undergoing percutaneous coronary intervention in Iran. BMC Cardiovasc Disord 2022; 22:245. [PMID: 35655125 PMCID: PMC9161526 DOI: 10.1186/s12872-022-02684-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Knowing of perception of the illness, and cardiovascular risk factors in patients with myocardial infarction is crucial in engaging in effective secondary prevention. This study aimed to examine illness perception and cardiovascular risk factors in patients with myocardial infarction undergoing percutaneous coronary intervention. Methods The participants comprised 131 patients undergoing a first-time percutaneous coronary intervention at a metropolitan, tertiary referral hospital in Tabriz, Iran. The convenience sampling method was employed to select the research sample within a six-month period. The instruments used were as follows: (1) Demographic and health information form, (2) The Brief Illness Perception Questionnaire (3) The Health Risk Assessment framework developed by the Centers for Disease Control and Prevention. The design of the study was descriptive, cross sectional. The continuous variables were analyzed using Independent t-test and analysis of variance (ANOVA); and categorical variables were compared using the chi-square test. Results Most participants had a positive family history of cardiovascular disease (54.2%), with 66.4% of participants having at least one cardiovascular risk factor such as diabetes (36.6%) hypertension (32.8%) and dyslipidemia (16%). Most participants were physically inactive (78.6%), about 48.9% were overweight, 34.4% suffered from obesity and 26% were smokers. Illness perception in this study was seen to be high (6.21), with highest scores occurring in the illness control dimension (6.83) and lowest scores occurring in the understanding dimension (3.77). There was a significant relationship between illness perception and physical activity, nutrition, sleep and general health. Direct significant relationships between biometric values (cholesterol, glucose, blood pressure); psychological factors (depression, anxiety and stress) and illness perception were also found to exist. Conclusions Low scores in two dimensions of illness perception may lead to psychological consequences such as stress, anxiety, and depression. The relationship between illness perception and some risk factors of cardiovascular disease such as physical activity, diet and biometric values, reveal the need for more attention to patient education and counselling.
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Lin SY, Law KM, Yeh YC, Wu KC, Lai JH, Lin CH, Hsu WH, Lin CC, Kao CH. Applying Machine Learning to Carotid Sonographic Features for Recurrent Stroke in Patients With Acute Stroke. Front Cardiovasc Med 2022; 9:804410. [PMID: 35155629 PMCID: PMC8833232 DOI: 10.3389/fcvm.2022.804410] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although carotid sonographic features have been used as predictors of recurrent stroke, few large-scale studies have explored the use of machine learning analysis of carotid sonographic features for the prediction of recurrent stroke. METHODS We retrospectively collected electronic medical records of enrolled patients from the data warehouse of China Medical University Hospital, a tertiary medical center in central Taiwan, from January 2012 to November 2018. We included patients who underwent a documented carotid ultrasound within 30 days of experiencing an acute first stroke during the study period. We classified these participants into two groups: those with non-recurrent stroke (those who has not been diagnosed with acute stroke again during the study period) and those with recurrent stoke (those who has been diagnosed with acute stroke during the study period). A total of 1,235 carotid sonographic parameters were analyzed. Data on the patients' demographic characteristics and comorbidities were also collected. Python 3.7 was used as the programming language, and the scikit-learn toolkit was used to complete the derivation and verification of the machine learning methods. RESULTS In total, 2,411 patients were enrolled in this study, of whom 1,896 and 515 had non-recurrent and recurrent stroke, respectively. After extraction, 43 features of carotid sonography (36 carotid sonographic parameters and seven transcranial color Doppler sonographic parameter) were analyzed. For predicting recurrent stroke, CatBoost achieved the highest area under the curve (0.844, CIs 95% 0.824-0.868), followed by the Light Gradient Boosting Machine (0.832, CIs 95% 0.813-0.851), random forest (0.819, CIs 95% 0.802-0.846), support-vector machine (0.759, CIs 95% 0.739-0.781), logistic regression (0.781, CIs 95% 0.764-0.800), and decision tree (0.735, CIs 95% 0.717-0.755) models. CONCLUSION When using the CatBoost model, the top three features for predicting recurrent stroke were determined to be the use of anticoagulation medications, the use of NSAID medications, and the resistive index of the left subclavian artery. The CatBoost model demonstrated efficiency and achieved optimal performance in the predictive classification of non-recurrent and recurrent stroke.
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Kin-Man Law
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
- Department of Computer Science and Engineering, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Chun Yeh
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
| | - Kuo-Chen Wu
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Jhih-Han Lai
- Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
- Department of Nuclear Medicine and Positron Emission Tomography Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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12
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Chakrabarty J, Cutinho M, Menon G. Knowledge on risk factors and warning signs of stroke in Udupi. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2022. [DOI: 10.4103/mjmsr.mjmsr_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Singer T, Ding S, Ding S. Astroglia Abnormalities in Post-stroke Mood Disorders. ADVANCES IN NEUROBIOLOGY 2021; 26:115-138. [PMID: 34888833 DOI: 10.1007/978-3-030-77375-5_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Stroke is the leading cause of human death and disability. After a stroke, many patients may have some physical disability, including difficulties in moving, speaking, and seeing, but patients may also exhibit changes in mood manifested by depression, anxiety, and cognitive changes which we call post-stroke mood disorders (PSMDs). Astrocytes are the most diverse and numerous glial cell type in the central nervous system (CNS). They provide structural, nutritional, and metabolic support to neurons and regulate synaptic activity under normal conditions. Astrocytes are also critically involved in focal ischemic stroke (FIS). They undergo many changes after FIS. These changes may affect acute neuronal death and brain damage as well as brain recovery and PSMD in the chronic phase after FIS. Studies using postmortem brain specimens and animal models of FIS suggest that astrocytes/reactive astrocytes are involved in PSMD. This chapter provides an overview of recent advances in the molecular base of astrocyte in PSMD. As astrocytes exhibit high plasticity after FIS, we suggest that targeting local astrocytes may be a promising strategy for PSMD therapy.
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Affiliation(s)
- Tracey Singer
- Dalton Cardiovascular Research Center, Columbia, MO, USA
| | - Sarah Ding
- Dalton Cardiovascular Research Center, Columbia, MO, USA
| | - Shinghua Ding
- Dalton Cardiovascular Research Center, Columbia, MO, USA.
- Department of Biomedical, Biological and Chemical Engineering, University of Missouri, Columbia, MO, USA.
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Lin B, Zhang Z, Thrift AG, Wang W, Mei Y, Guo Y, Liu L, Liu F, Xue L. Qualitative study of Stroke Survivors' Perceptions of Secondary Prevention. J Adv Nurs 2021; 78:1377-1388. [PMID: 34636437 DOI: 10.1111/jan.15079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/05/2021] [Accepted: 09/26/2021] [Indexed: 11/28/2022]
Abstract
AIMS To understand how survivors of stroke perceive secondary prevention and explore their perceived barriers and facilitators using the Theoretical Domains Framework. DESIGN A qualitative descriptive study. METHODS Nineteen survivors of stroke from three hospitals were recruited and interviewed from April 2019 to April 2020. The data were analysed deductively and inductively by content analysis strategies. RESULTS Three main themes of perception of secondary prevention were identified, these being active treatment-seeking, attention to taking medications and negative attitude towards lifestyle changes. Using deductive analysis, eight domains of the Theoretical Domains Framework were reported to be relevant in the secondary prevention behaviour of survivors of stroke that mapped to five 'barrier' domains (i.e. knowledge, physical skills, beliefs about capability, beliefs about consequences and optimism) as well as six 'facilitator' domains (i.e. knowledge, interpersonal skills, beliefs about capability, intention, emotion and social influences). Using inductive analysis we identified two additional important factors not falling in the domains of the Theoretical Domains Framework. These comprised female spouses' support and patients' economic autonomy, both of which could be classified as a facilitator or barrier. CONCLUSION Survivors of stroke perceive seeking treatment and using preventive medication as more important than modifying lifestyle behaviours. Knowledge and insight into the barriers and facilitators of secondary prevention in this specific context provides a theoretical and practical basis for the design of future secondary prevention interventions. IMPACT Stroke survivors' perceptions of secondary prevention, barriers and facilitators were explored in the context of a developing country. These findings highlight the need to better communicate the importance of improving lifestyle modification and medication adherence, and provide evidence for designing relevant interventions for stroke management in the community.
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Affiliation(s)
- Beilei Lin
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, PR China.,Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhenxiang Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Amanda G Thrift
- Stroke and Aging Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Wenna Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yongxia Mei
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yunfei Guo
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Lamei Liu
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Fang Liu
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Lihong Xue
- The Huaxian People's Hospital, Anyang, Henan, PR China
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15
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Kharbach A, Obtel M, Achbani A, Aasfara J, Hassouni K, Lahlou L, Razine R. Ischemic stroke in Morocco: Prehospital delay and associated factors. Rev Epidemiol Sante Publique 2021; 69:345-359. [PMID: 34148762 DOI: 10.1016/j.respe.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco. PATIENTS AND METHODS An observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department. RESULTS A total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6hours (IQR, 4-16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40-437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57-80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01-0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00-0.36), and direct admission without reference (OR 0.005; CI95%: 0.00-0.07), were independently associated with late arrival (>4.5hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37-138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03-0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00-0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03-0.80), distance between 50 and 100km (OR 10.16; CI95%: 1.16-89.33), and direct admission without reference (OR 0.03; CI95%: 0.00-0.14), were independently associated with late arrival (>6hours) of patients with acute ischemic stroke. CONCLUSION Patient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.
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Affiliation(s)
- A Kharbach
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - M Obtel
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
| | - A Achbani
- Laboratory of Cell Biology and Molecular Genetics (LBCGM), Department of Biology, Faculty of Sciences, University Ibn Zohr Agadir, Rabat, Morocco.
| | - J Aasfara
- Department of Neurology, International Cheikh Khalifa University Hospital, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - K Hassouni
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS) Casablanca, Rabat, Morocco.
| | - L Lahlou
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr, Agadir, Morocco.
| | - R Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco; Laboratory of Social Medicine (Public Health, Hygiene and Preventive Medicine), Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.
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16
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Alnaami I, Alhazzani A, Alburaidi I, Alkhayri M, Dibssan H, Alqahtani MS, Alqahtani M, Alqahtani S, Shehata SF, Gaber A, Alqahtani SA. Demographic characteristics and types of stroke in Southwestern Saudi Arabia, and the potential demand of neuro endovascular specialists. ACTA ACUST UNITED AC 2021; 26:62-68. [PMID: 33530045 PMCID: PMC8015492 DOI: 10.17712/nsj.2021.1.20200104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/10/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify demographic characteristics, and types of stroke in Southwestern (Aseer) Region, Saudi Arabia. METHODS This study is a retrospective and hospital-based. The data of all stroke patients (n=562) admitted to the tertiary care hospital in the province, Aseer Central Hospital (ACH) within the period from January 2016 until December 2017 are included. RESULTS The mean ± SD of stoke patients' age was 62.6 ± 17.0 years. Male patients were more than female patients (62.6% and 37.4%, respectively). The majority (93.2%) were Saudi, while 91.5% had below university education and 6.4% were smokers. Interestingly, only 2% of patients had a family history of stroke, while 68.1% were diabetic, 80.4% were hypertensive, 91.6% had high serum cholesterol level, and 10.7% had history of transient ischemic attacks (TIA). Despite the lack of awareness, and leading to delay in reaching health care facility, 58.1% of stroke patients, were arriving to emergency department (ED) in less than 24 hours (potential endovascular therapeutic window). CONCLUSIONS In Aseer Region, Saudi Arabia, stroke affects mainly those who are older, less educated, diabetic, hypertensive, with hypercholesterolemia and previous history of TIA. Associated factors for stroke differ significantly according to their nationality.
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Affiliation(s)
- Ibrahim Alnaami
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Adel Alhazzani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Ibrahim Alburaidi
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Mona Alkhayri
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Hani Dibssan
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Mohammed S Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Mohammed Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Saleh Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Shehata F Shehata
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Ashraf Gaber
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
| | - Saeed A Alqahtani
- From the Division of Neurosurgery (Alnaami, Alburaidi, Alkhayri, Dibssan, Alqahtani S, Alqahtani M), Department of Surgery, from the Department of Family and Community Medicine (Shehata), from the Division of Neurology (Alqahtani S), Department of Medicine, College of Medicine, King Khalid University, from the Department of Radiology (Gaber), Aseer Central Hospital, Abha; from the Division of Neurology (Alhazzani), Department of Medicine, College of Medicine, King Saud University, Riyadh, from the Division of Neurology (Alqahtani MS), Armed forces Hospital-Southern Region, Aseer, Kingdom of Saudi Arabia, and from the High Institute of Public Health (Shehata), Alexandria, Egypt
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Workina A, Kebede S, Fekadu C, Wubetie Snr A. Knowledge of Risk Factors and Warning Signs of Stroke Among Patients with Heart Disease at Tikur Anbessa Specialized Hospital. Open Access Emerg Med 2021; 13:57-66. [PMID: 33623445 PMCID: PMC7896790 DOI: 10.2147/oaem.s291648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are extensive. The inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention and which leads to secondary complications. PURPOSE To identify cardiac patients' knowledge of stroke risk factors and warning signs. PATIENTS AND METHODS The institutional based cross-sectional study design was employed. Participants were selected using systematic random sampling. Close-ended questionnaires were pre-tested and validated for consistency before data collection. Then after data collection, data were checked and entered into Epi-data 4.6. Finally, the cleaned data were exported to SPSS version 25 for analysis. Statistical analysis using binary logistic regression was done and Predictors with a p-value of <0.05 were considered statistically significant. RESULTS A total of 227 patients were included in the study, of which 140 (61.7%) of them identified physical inactivity, followed by hypertension126 (55.5%) as stroke risk factor while 15.4% of them did not know any risk factor of stroke. Amongst the study participants, 45.81% of them had adequate knowledge of stroke risk factors. Regarding stroke warning signs the most identified sign was sudden unilateral weakness 142 (62.6%) while 46 (20.26%) of them did not know at least one warning sign of a stroke. Based on multivariable logistic regression analysis, higher education level AOR 3.05 (95% CI 1.62-5.74) and Urban residence area AOR 2.07 (95% CI 1.05-4.1) were significantly associated with knowledge of stroke risk factors with p-value<0.05. CONCLUSION Study participants had inadequate knowledge of stroke risk factors and warning signs. Educational status and information about stroke are significantly associated with adequate knowledge of stroke risk factors, raising stroke awareness is the mainstay to reduce stroke burden.
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Affiliation(s)
- Abdata Workina
- School of Nursing, Jimma University, Jimma, Oromia, Ethiopia
| | - Sofia Kebede
- Department of Emergency Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Chala Fekadu
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Lobo EH, Frølich A, Kensing F, Rasmussen LJ, Livingston PM, Grundy J, Abdelrazek M. mHealth applications to support caregiver needs and engagement during stroke recovery: A content review. Res Nurs Health 2020; 44:213-225. [PMID: 33341958 DOI: 10.1002/nur.22096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Caregiving in stroke results in severe physical, psychological, and social impacts on the caregiver. Over the past few years, researchers have explored the use of mHealth technologies to support healthcare-related activities due to their ability to provide real-time care at any given place or time. The purpose of this content review is to investigate mHealth apps in supporting stroke caregiving engagement based on three aspects: motivation, value, and satisfaction. We searched app stores and repositories for apps related to stroke caregiving published up to September 2020. Extracted apps were reviewed and filtered using inclusion criteria, and then downloaded onto compatible devices to determine eligibility. Results were compared with evidence-based frameworks to identify the ability of these apps in engaging and supporting the caregiver. Forty-seven apps were included in this review that enabled caregivers to support their needs, such as adjustment to new roles and relationships, involvement in care and caring for oneself using several different functionalities. These functionalities include information resources, risk assessment, remote monitoring, data sharing, reminders and so on. However, no single app was identified that focuses on all aspects of stroke caregiving. We also identified several challenges faced by users through their reviews and the factors associated with value and satisfaction. Our findings can add to the knowledge of existing mHealth technologies and their functionalities to support stroke caregiving needs, and the importance of considering user engagement in the design. They can be used by developers and researchers looking to design better mHealth apps for stroke caregiving.
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Affiliation(s)
- Elton H Lobo
- Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - John Grundy
- Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia
| | - Mohamed Abdelrazek
- Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia
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Bhat V, Gs T, Kasthuri A. Stroke Awareness among Elderly Hypertensives in a Rural Area of Bangalore District, India. J Stroke Cerebrovasc Dis 2020; 30:105467. [PMID: 33207300 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES India faces a high and growing burden of hypertension, which is an important cerebrovascular risk factor, especially in elderly persons. Poor awareness contributes to delays in seeking health care, which is undesirable given the emergent nature of stroke. Literature regarding awareness in this subgroup of the population is scarce. Our objective was to assess awareness regarding cerebrovascular disease among elderly persons with hypertension residing in a rural area of Bangalore district, and estimate their individual risk of stroke. MATERIAL & METHODS We randomly selected 144 elderly hypertensives residing in a rural area in Bangalore district from a list of known hypertensives maintained as part of a population-based senior citizen health service. We developed an open-ended, face-validated questionnaire, which was administered following informed consent, to assess stroke awareness. We defined good awareness as knowing at least one risk factor, one warning sign, and having the knowledge that stroke requires immediate treatment. Univariate and multivariate analyses were performed to assess factors associated with good or poor awareness. RESULTS 40% of the study population had not heard of the term 'stroke'. Only 22% could identify the brain as the organ affected. 51% could name at least one symptom. 45% of males and 24% of females believed that their hypertension predisposed them to stroke. 56% could not name a single risk factor. Only 37% of the males and 18% of the females had good overall awareness. Female gender and low literacy were associated with poor overall awareness, while being gainfully employed, a history of alcohol use and doing higher levels of exercise were associated with greater awareness on univariate analysis. None of these factors were statistically significantly related to stroke awareness on multivariate analysis. CONCLUSIONS Awareness of different aspects of stroke was very poor, highlighting the need for stroke education at all levels of care.
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Affiliation(s)
- Vivek Bhat
- St. John's Medical College, Bangalore, India
| | - Thanmayi Gs
- St. John's Medical College, Bangalore, India
| | - Arvind Kasthuri
- Department of Community Medicine, St. John's Medical College, Sarjapur Main Road, Bangalore 560034, India.
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Mohammed OAA, Ahmed FAAO, Koko AEA, Khalifa SEO, Abdelaziz HAM, Mohamed MEA, Harrington F, Abdelaziz SI, Abdalrahman IB. Awareness about stroke among high and low risk individuals in Khartoum, Sudan: a cross-sectional study. Pan Afr Med J 2020; 36:318. [PMID: 33193972 PMCID: PMC7603826 DOI: 10.11604/pamj.2020.36.318.23107] [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: 04/26/2020] [Accepted: 05/04/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction stroke causes 10.17% of all deaths in Sudan. Levels of stroke awareness amongst patients in Sudan are unknown. The aim of this study is to assess the level of awareness of stroke risk factors, symptoms and immediate management amongst high and low risk patients. Methods using descriptive cross-sectional study, participants of high and low risk groups were recruited from the referral clinics of three tertiary hospitals in Khartoum. Data was collected through interviews using structured questionnaire. Knowledge score was devised to assess the awareness about stroke symptoms, risk factors, and management. Results of the 286 participants, 150 were females. The mean age was 44.66 years. About 79.4% reported that stroke is preventable. Hypertension was the most identified risk factor (71.6%) while genetics (0.2%) and alcohol (0.2%) were the least identified risk factors. Twenty-seven percent (27.6%) did not know any stroke risk factors, while 32.9% did not know any warning symptoms. Paralysis of one side of the body was the most identified warning symptom (30.7%). The mean awareness score was 21.9 ± 3.4 among the high risk group vs. 22.1 ± 3.6 among the low risk group with no statistically significant difference between the two groups (p = .717). The mean awareness score was statistically associated with the level of education (p < 0.001). Conclusion the awareness level was relatively low and not statistically different between high and low risk groups. We recommend the development of an effective educational program for the whole community.
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Widjaja KK, Chulavatnatol S, Suansanae T, Wibowo YI, Sani AF, Islamiyah WR, Nathisuwan S. Knowledge of stroke and medication adherence among patients with recurrent stroke or transient ischemic attack in Indonesia: a multi-center, cross-sectional study. Int J Clin Pharm 2020; 43:666-672. [PMID: 33124676 DOI: 10.1007/s11096-020-01178-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BackgroundThere is a limited data in Indonesia regarding the stroke knowledge and medication adherence among stroke survivors.ObjectiveTo assess the level of stroke knowledge and medication adherence along with their relationship among stroke survivors.SettingTwo tertiary-care hospitals in Surabaya, East Java, Indonesia.MethodsA prospective, cross-sectional study was conducted among 215 stroke survivors. Stroke Knowledge Test and the Morisky Green Levine Adherence Scale questionnaires were used to evaluate stroke knowledge and medication adherence, respectively. Binary logistic regression was performed to assess the rela tionship between stroke knowledge and medication adherence. Main outcome measuresRelationship between stroke knowledge and medication adherence.ResultsA total of 215 patients with mean age of 56.34 ± 8.69 years were recruited into this study. Mean Stroke Knowledge Test score was 7.89 ± 3.38 with 76.7% had low level of stroke knowledge. Mean Morisky Green Levine Adherence Scale was 3.05 ± 1.11 with 52.1% had low to medium medication adherence. Education and duration of stroke correlated with stroke knowledge level (Spearman's correlation coefficient: 0.307, p = 0.001 and 0.128, p = 0.041, respectively). Age and disability correlated with medication adherence (Spearman's correlation coefficient: 0.169; p = 0.013 and 0.171; p = 0.012), respectively. After adjustment for covariates, stroke knowledge level was independently associated with medication adherence (adjusted OR: 4.37, 95% CI 2.00-9.53; p < 0.001).ConclusionStroke knowledge was low among Indonesian stroke survivors and independently related to medication adherence. Attempts should be made to increase stroke knowledge which may improve medication adherence among stroke survivors.
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Affiliation(s)
- Karina Kumaladewi Widjaja
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suvatna Chulavatnatol
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Thanarat Suansanae
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Yosi Irawati Wibowo
- Centre for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
| | - Achmad Firdaus Sani
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand.
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Intamas U, Rawiworrakul T, Amnatsatsue K, Nanthamongkolchai S, Palmer MH. Care of stroke survivors in community: a case study of rural Thai community. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-07-2019-0172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThis study aims to describe survivors of stroke circumstances, issues with providing care for survivors of stroke and services expected by caregivers and survivors of stroke.Design/methodology/approachA qualitative research design was conducted in Singburi Province. Data collection methods included in-depth interviews, focus groups and participatory observations. Semi-structured in-depth interview guides, quality-of-life scale and depression scale were used to collect data from survivors of stroke, their caregivers, health personnel, local governors and village health volunteers. Naturalistic research tradition was used for qualitative data analysis and descriptive statistics for quantitative data analysis.FindingsThe majority of survivors of stroke had hemiplegic limb and severe deficits in their activities of daily living. Caregivers were family members, and they often developed depression. Issues with providing care to stroke survivors included lack of knowledge about stroke and home care, inadequacy and discontinuity of care and the shortage of stroke care personnel in the community. A stakeholder's expected stroke services included the provision of effective continuing care, community participation in care and enhancing the village health volunteer's capacity.Originality/valueThis study illustrated the stroke service systems in rural Thai communities. The study's findings could be applied when planning future research using community participation to test a model of care for stroke survivors to promote better outcomes and be responsive to the needs of stroke survivors, especially those who are disabled.
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Knowledge on Signs and Risk Factors in Stroke Patients. J Clin Med 2020; 9:jcm9082557. [PMID: 32784554 PMCID: PMC7463706 DOI: 10.3390/jcm9082557] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/26/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022] Open
Abstract
Background: There is a pressing need to contribute evidence to the improvement in the early identification of signs and symptoms associated with strokes, and address the treatment-seeking delays. The objective of this study is to describe the knowledge regarding the warning signs and risk factors (RFs) among stroke patients, as well as of their attitudes toward a suspected event, and the analysis of its possible relationship with the socio-demographic and clinical characteristics of these patients. Method: A cross-sectional study was designed, in which all stroke patients admitted consecutively to the Burgos University Hospital (Spain) were included. The principal outcomes were the patient’s ability to identify two RFs and two warning signs and the patient’s hypothetical response to a possible stroke event. The possible factors associated with the knowledge of warning signs, RFs, and the correct response to a new event were studied using univariate and multivariate regression analysis. Results: A total of 529 patients were included. Having a higher education level or a history of prior stroke were associated with a greater degree of knowledge of warning signs (odds ratio (OR) 3.19, 95% confidence interval (CI) 1.70–5.74, p = 0.003; OR 3.54, 95%CI 2.09–5.99, p ≤ 0.001, respectively), RFs (OR 3.15, 95%CI 1.75–5.67, p = 0.008; OR 4.08, 95%CI 2.41–6.91, p = 0.002, respectively), and the correct response to a possible stroke (OR 1.82, 95%CI 1.16–2.86; p = 0.030; OR 2.11, 95%CI 1.29–3.46, p = 0.022, respectively). Conclusion: Knowledge of warning signs or stroke RFs is low in the hospitalized patients. A previous stroke or secondary/higher education levels are the predictor factors that increase the probability of knowledge of warning signs, RFs, or reaction to possible event.
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Saengsuwan J, Suangpho P. Self-perceived and Actual Risk of Further Stroke in Patients with Recurrent Stroke or Recurrent Transient Ischemic Attack in Thailand. J Stroke Cerebrovasc Dis 2019; 28:632-639. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/29/2018] [Accepted: 11/03/2018] [Indexed: 01/30/2023] Open
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Sananmuang T, Dejsiripongsa T, Keandoungchun J, Apirakkan M. Reliability of ABC/2 Method in Measuring of Infarct Volume in Magnetic Resonance Diffusion-Weighted Image. Asian J Neurosurg 2019; 14:801-807. [PMID: 31497105 PMCID: PMC6703032 DOI: 10.4103/ajns.ajns_68_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims Manual planimetry is the current method defining infarct volume on magnetic resonance (MR) diffusion-weighted image. ABC/2 method is an ellipsoid geometric formula with advantage estimation of intraparenchymal hemorrhage volume. Our study aimed to find the reliability and reproducibility of ABC/2 method compared to manual planimetric segmentation method. Settings and Design This was a cross-sectional analytical study with retrospective and prospective data collection. Subjects and Methods A total of 109 patients with acute ischemic stroke and underwent MR images at Ramathibodi Hospital were retrospectively reviewed. Relationship between manual planimetric segmentation and ABC/2 methods (nonadjusted ABC/2 method and adjusted ABC*/2 method) was determined using Wilcoxon signed-rank test, linear regression analysis, and Bland-Altman plot. Subgroup analysis by location, onset, shape, and size of infarct volume was performed. Interobserver reliability was established using intraclass correlation coefficient and Bland-Altman plot. Statistical Analysis Used Wilcoxon signed-rank test, linear regression analysis, and Bland-Altman plot were used for statistical analysis. Results Infarct volume measured with nonadjusted ABC/2 method (23.56, 48.81, 4.25, 0.11, 318.94) (mean, standard deviation, median, minimum, maximum) and adjusted ABC*/2 method (13.37, 28.3, 2.08, 0.06, 170.10) was smaller than manual planimetric method (28.50, 58.64, 5.56, 0.27, 335.49) (P < 0.001). Linear regression's slope confirmed underestimation of volume infarct. In round-to-ellipsoid shape and white matter group, the differences found between nonadjusted ABC/2 and manual planimetric methods are not statistically significant. Conclusions ABC/2 method is a simple, rapid, and reproducible method with an excellent positive correlation of both adjusted and nonadjusted ABC/2 methods to manual planimetric segmentation method but tendency to underestimated infarct volume. High interobserver reliability and good agreement between two observers have been established. The utilization of nonadjusted ABC/2 method should be used with caution due to its tendency to underestimate the infarct volume.
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Affiliation(s)
- Thiparom Sananmuang
- Division of Diagnostic Neuroradiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanya Dejsiripongsa
- Division of Diagnostic Neuroradiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jesada Keandoungchun
- Division of Neurology, Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mungkorn Apirakkan
- Division of Diagnostic Neuroradiology, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Arulprakash N, Umaiorubahan M. Causes of delayed arrival with acute ischemic stroke beyond the window period of thrombolysis. J Family Med Prim Care 2018; 7:1248-1252. [PMID: 30613505 PMCID: PMC6293923 DOI: 10.4103/jfmpc.jfmpc_122_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Context: Early thrombolytic therapy in acute ischemic stroke has proven to reduce the associated morbidity. Many factors are in play, delaying the arrival of patients. Aim: To ascertain the factors causing delay in patients with acute ischemic stroke presenting beyond the window period of thrombolysis in and around Chennai, Tamil Nadu, India. Subjects and Methods: An observational cross-sectional study involving 200 patients with acute ischemic stroke at Sri Ramachandra Medical College, Chennai, India between June 2015 and July 2016 was conducted. The data was collected by direct interview using a questionnaire designed to study factors such as age, family structure, residence, distance from the hospital, education status, wake-up stroke, transport, symptoms, knowledge about symptoms, seriousness of symptoms, waiting on symptoms, insurance and point of admission. Data was analyzed for means, frequencies, percentages and multiple linear regression analysis was performed to identify factors independently influencing delayed arrival. Results: Mean age of the cohort was 58.08 years: 142 men and 58 women. Mean time of delayed arrival was 13.6 hours. Multiple linear regression analysis revealed that seriousness of symptoms (P = 0.001), residence (P = 0.001), point of admission (P = 0.033) and wake-up stroke (P = 0.005) were statistically significant predictors of delayed arrival. Conclusion: Patients not perceiving their symptoms to be serious, residing in a rural area, not arriving to the emergency, and having a stroke while awake were all the significant predictors of pre-hospital delay in our study. Awareness among the masses about symptom recognition and early arrival to a tertiary care center will reduce the delay and associated morbidity. Primary care physicians notably play a significant role in educating patients at risk, identifying the symptoms of stroke and referring them for thrombolysis.
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Affiliation(s)
- Narenraj Arulprakash
- Department of Neurology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India
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