1
|
Reimer J, Wang F, Ramiro J, Welch E, Christopher KM, Braun J. Evaluation of Post-thrombolytic Events to Determine Appropriate ICU Monitoring Duration for Patients with Ischemic Stroke. Neurocrit Care 2024; 41:598-607. [PMID: 38589692 DOI: 10.1007/s12028-024-01979-3] [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: 12/14/2023] [Accepted: 03/08/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Standard treatment for eligible patients presenting with acute ischemic stroke (AIS) is thrombolysis with tissue plasminogen activators alteplase or tenecteplase. Current guidelines recommend monitoring patients in an intensive care unit (ICU) for 24 h after thrombolytic therapy. However, recent studies have questioned the need for prolonged ICU monitoring. This retrospective cohort study aims to identify potential candidates for early transition to a lower level of care by assessing risk factors for neurological deterioration, symptomatic intracranial hemorrhage (sICH), or need for ICU intervention within 24 h post-thrombolysis. METHODS This retrospective cohort study included adult patients 18 years and older with AIS who received thrombolysis. Patients were excluded if they were transferred to another facility, if they were transitioned to comfort care or hospice care within 24 h, or if they lacked imaging and National Institutes of Health Stroke Scale (NIHSS) score data. The primary end point was incidence of sICH between 0-12 and 12-24 h. Secondary end points included the need for ICU intervention and rates of neurological deterioration. RESULTS The analysis included 204 patients who received the full dose of alteplase. Among them, ten patients (4.9%) developed sICH, with the majority (n = 7) occurring within 12 h post-thrombolysis. Sixty-two patients required ICU interventions within 12 h compared with four patients after 12 h. Twenty-four patients had neurological deterioration within 12 h, and seven patients had neurological deterioration after 12 h. Multivariable analysis identified mechanical thrombectomy and increased blood pressure at presentation as predictors of ICU need beyond 12 h post-thrombolysis. CONCLUSIONS Our study demonstrates that sICH, neurological deterioration, and need for ICU intervention rarely occur beyond 12 h after thrombolytic administration. Patients presenting with blood pressures < 140/90 mm Hg, NIHSS scores < 10, and not undergoing mechanical thrombectomy may be best candidates for early de-escalation. Larger prospective studies are needed to more fully evaluate the safety, feasibility, and financial impact of early transition out of the ICU.
Collapse
Affiliation(s)
- James Reimer
- Department of Pharmacy, Hospital Sisters Health System St. Elizabeth's Hospital, O' Fallon, IL, USA
| | - Fajun Wang
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Joanna Ramiro
- Department of Neurology, Mercy Hospital, St. Louis, MO, USA
| | - Emily Welch
- Department of Pharmacy, Barnes Jewish Hospital, St. Louis, MO, USA
| | - Kara M Christopher
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - James Braun
- Department of Pharmacy, Sisters of Saint Mary Health Saint Louis University Hospital, 1201 South Grand Blvd, St. Louis, MO, 63104, USA.
| |
Collapse
|
2
|
Eleftheriadis K, Madden AM. An exploration of the experiences and attitudes of healthcare professionals towards enteral tube feeding for adults living in the community following stroke. J Hum Nutr Diet 2024; 37:1050-1060. [PMID: 38778633 DOI: 10.1111/jhn.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Guidelines recommend enteral feeding via gastrostomy should be considered for adult survivors of stroke with dysphagia who cannot eat or drink sufficiently for >4 weeks. Many people continue long-term tube-feeding via this route in the community where healthcare professionals contribute to their care and nutritional management, although little is known about their experiences of or attitudes towards enteral feeding in this situation. The present study aimed to explore the experiences and attitudes of healthcare professionals working with this patient group. METHODS Healthcare professionals were invited to complete a questionnaire devised for the study which comprised closed and open questions about tube-feeding including their patients' participation in feeding processes and mealtimes and how these might be improved. Responses to closed questions were analysed descriptively and free-text responses analysed using thematic analysis. RESULTS Fifty-seven participants met the inclusion criteria. They identified patients' quality of life (77% of respondents) and nutritional support (75%) as the most important aspects of tube-feeding. Good communication and training with healthcare teams and carers were considered important. Their patients' participation in tube-feed administration and mealtime involvement were described as variable and potentially beneficial, but both were related to patients' choice and health impairment. Blended tube-feeding was considered an option by 89% provided practical and safety conditions were met. CONCLUSIONS Participants' experiences of and attitudes towards tube feeding in adults living with stroke in the community in the sample in the present study are varied and focussed on individual patients' needs, safety and professional standards.
Collapse
Affiliation(s)
- Konstantinos Eleftheriadis
- School of Life and Medical Sciences, University of Hertfordshire and Therapies Department, North Middlesex University Hospital Trust, Hatfield, Hertfordshire, UK
| | - Angela M Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| |
Collapse
|
3
|
Tapp A, Griswold D, Dray D, Landgraff N, Learman K. High-intensity locomotor training during inpatient rehabilitation improves the discharge ambulation function of patients with stroke. A systematic review with meta-analysis. Top Stroke Rehabil 2024; 31:431-445. [PMID: 38285888 DOI: 10.1080/10749357.2024.2304960] [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: 08/16/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To evaluate the evidence of high-intensity locomotor training on outcomes related to gait and balance for patients with stroke in inpatient rehabilitation. METHODS Four databases were searched (PubMed, CINAHL, Web of Science, and MedLINE) for articles published prior to 13 June 2023. Studies of adults (>18 years old) with a diagnosis of stroke who received a high-intensity locomotor intervention while admitted to an inpatient rehabilitation facility were included. A functional outcome in the domain of gait speed, gait endurance, or balance must have been reported. Following the screening of 1052 studies, 43 were selected for full-text review. Studies were assessed for risk of bias using the tool appropriate to the study type. Gait speed, gait endurance, and balance outcome data were extracted for further analysis. RESULTS Eight studies were selected with risk of bias ratings as moderate (4), high (2), and low (2). Six studies were analyzed in the meta-analysis (N = 635). A random-effects model analyzed between-group differences. Standard mean differences demonstrated that high-intensity locomotor training produces a moderate effect on gait endurance (0.50) and gait speed (0.41) and a negligible effect on balance (0.08) compared with usual care. CONCLUSIONS The meta-analysis supports the use of high-intensity locomotor training over usual care for improving gait speed and gait endurance during inpatient post-stroke. Future studies should investigate dose-response relationships of high-intensity locomotor training in this setting. PROSPERO REGISTRATION #CRD42022341329.
Collapse
Affiliation(s)
- Annie Tapp
- Graduate Studies in Health and Rehabilitation, Youngstown State University, Youngstown, OH, USA
| | - David Griswold
- Graduate Studies in Health and Rehabilitation, Youngstown State University, Youngstown, OH, USA
| | - Daniel Dray
- Graduate Studies in Health and Rehabilitation, Youngstown State University, Youngstown, OH, USA
| | - Nancy Landgraff
- Graduate Studies in Health and Rehabilitation, Youngstown State University, Youngstown, OH, USA
| | - Kenneth Learman
- Graduate Studies in Health and Rehabilitation, Youngstown State University, Youngstown, OH, USA
| |
Collapse
|
4
|
Lu M, Wieber M, Rho M, Jayabalan P. The impact of a novel musculoskeletal consult service in an inpatient rehabilitation facility: A descriptive analysis. PM R 2024; 16:707-714. [PMID: 38148275 DOI: 10.1002/pmrj.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/28/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Musculoskeletal (MSK) pathologies significantly affect the rehabilitation course for patients admitted to an inpatient rehabilitation facility (IRF). The impact of a specialized inpatient MSK consult service has not been previously evaluated. OBJECTIVE To assess the demographics, pathologies, and impact on pain scores of patients who were evaluated by a specialized MSK consult service. DESIGN Retrospective descriptive analysis of patients at an IRF who were evaluated by the MSK consult service. SETTING Academic IRF. PARTICIPANTS 230 patients evaluated by the MSK consult service over 4.5 years. INTERVENTIONS MSK consult service composed of sports medicine fellowship-trained physiatrists who use history, physical examination, point-of-care ultrasound, and specialized MSK knowledge to assess and address MSK barriers to functional improvement. MAIN OUTCOME MEASURES Primary rehabilitation diagnosis, length of stay, discharge destination, reason for consult, MSK diagnosis, need for injection, change in Numerical Pain Rating Scale (NPRS) pain scores, change in Functional Independence Measures (FIM). RESULTS A total of 230 consults met inclusion criteria for analysis. The most common symptoms were shoulder pain (47%), knee pain (30%), and hip/groin pain (10.4%). The MSK consult service made 82 different musculoskeletal and neuromuscular diagnoses. The most common primary rehabilitation diagnosis was stroke (28.3%). Injections were performed in 44.3% of consults, with an average reduction in NPRS pain score of 2.3 (SD 1.9) and a statistically significant reduction in average NPRS pain scores in patients who underwent injections compared to those who did not (p < .001). CONCLUSIONS This study is the first to examine the use of an innovative inpatient MSK physiatry consult service in an IRF. This promising consult service can play a pivotal role in patient care by reducing functionally limiting MSK pain to allow for better toleration of therapies and to optimize functional gains.
Collapse
Affiliation(s)
- Michael Lu
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Megan Wieber
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Monica Rho
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Prakash Jayabalan
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| |
Collapse
|
5
|
Che F, Wang A, Ju Y, Liu L, Ma N, Cheng Z, Duan H, Zhao X, Geng X. Prevalence and Impact of Medical Complications on Clinical Outcomes in Acute Ischemic Stroke Patients After Endovascular Therapy - Data From a Comprehensive Stroke Unit in China. World Neurosurg 2024; 182:e386-e399. [PMID: 38030069 DOI: 10.1016/j.wneu.2023.11.113] [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: 08/10/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE We aim to assess the incidence and impact of in-hospital medical complications (MCs) on clinical outcomes in acute ischemic stroke (AIS) patients after endovascular therapy (EVT). METHODS AIS patients who underwent EVT were consecutively recruited from January 2019 to July 2022. The primary outcome was a poor 3-month functional outcome, defined as a modified Rankin Scale score (mRS) of 3-6. The safety variables were symptomatic intracerebral hemorrhage and mortality at 7 and 30 days. RESULTS A total of 306 (50.1%) patients experienced at least one of the MCs. The most common MC was pneumonia (42.6%). Multivariate analysis revealed that the setting of MCs was an independent predictor of a poor 3-month functional outcome (adjusted odds ratio [aOR] 4.40, 95% confidence interval [CI] 3.01-6.42; P < 0.001). In the subgroup analysis, this trend was significant, especially in the patients aged 60-75 years (aOR 5.87, 95% CI 3.45-9.97; P < 0.001) or with baseline NIHSS (≤16) (aOR 5.05, 95% CI 2.84-9.01; P < 0.001). For individuals, cardiac events (aOR 8.56, 95% CI 4.05-18.09; P < 0.001), pneumonia (aOR 5.08, 95% CI 3.42-7.55; P < 0.001), and gastrointestinal bleeding (GIB) (aOR 6.12, 95% CI 3.40-11.01; P < 0.001) were independently associated with the poor 3-month outcome. The setting of MCs was independently associated with symptomatic intracerebral hemorrhage (aOR 2.11, 95% CI 1.22-3.64; P = 0.007) and mortality at 30 days (aOR 2.11, 95% CI 1.22-3.64; P = 0.007) after adjustment, but not with mortality at 7 days. CONCLUSIONS MCs in AIS patients after EVT have a high incidence, despite successful reperfusion, adversely affecting clinical outcomes and increasing short-term mortality.
Collapse
Affiliation(s)
- Fengli Che
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Tiantan Neuroimaging Center for Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhe Cheng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Honglian Duan
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Tiantan Neuroimaging Center for Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
6
|
McGlinchey MP, Faulkner-Gurstein R, Sackley CM, McKevitt C. Factors guiding therapist decision making in the rehabilitation of physical function after severely disabling stroke - an ethnographic study. Disabil Rehabil 2024; 46:672-684. [PMID: 36734838 DOI: 10.1080/09638288.2023.2172463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Whilst strong evidence supports rehabilitation to improve outcomes post-stroke, there is limited evidence to guide rehabilitation in the most severely disabled group. In an era of evidence-based practice, the aim of the study was to understand what factors guide physiotherapists (PTs) and occupational therapists (OTs) to select particular interventions in the rehabilitation of physical function after severely disabling stroke. MATERIAL AND METHODS An ethnographic study was undertaken over an 18-month period involving five London, UK stroke services. Seventy-nine primary participants (30 PTs, 22 OTs, and 27 stroke survivors) were recruited to the study. Over 400 h of observation, 52 semi-structured interviews were conducted. Study data were analysed through thematic analysis. RESULTS Key factors guiding therapist decision making were clinical expertise, professional role, stroke survivors' clinical presentation, therapist perspectives about stroke recovery, and clinical guidelines. Research evidence, stroke survivors' treatment preferences, organisational type, and pathway design were less influential factors. Therapy practice did not always address the physical needs of severely disabled stroke survivors. CONCLUSIONS Multiple factors guided therapist decision making after severely disabling stroke. Alternative ways of therapist working should be considered to address the physical needs of severely disabled stroke survivors more fully.Implications for rehabilitationMultiple factors guide therapist decision making after severely disabling stroke, some of which result in the use of interventions that do not fully address stroke survivors' clinical needs.Therapists should critically reflect upon their personal beliefs and attitudes about severely disabling stroke to reduce potential sources of bias on decision making.Therapists should consider the timing and intensity of therapy delivery as well as their treatment approach to optimise outcomes after severely disabling stroke.
Collapse
Affiliation(s)
- Mark P McGlinchey
- Neurorehabilitation Service, Integrated Local Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christopher McKevitt
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
7
|
Legasto-Mulvale JM, Inness EL, Thompson AN, Chandran N, Mathur S, Salbach NM. Adverse Events During Submaximal Aerobic Exercise Testing in People With Subacute Stroke: A Scoping Review. J Neurol Phys Ther 2024; 48:27-37. [PMID: 37184472 DOI: 10.1097/npt.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND PURPOSE Concern for adverse cardiovascular events and limited guidance regarding how to conduct aerobic exercise (AEx) testing for individuals poststroke are key barriers to implementation by physical therapists in stroke rehabilitation. This study aimed to describe the nature and safety of submaximal AEx testing protocols for people with subacute stroke (PwSS) and the nature of comorbidity of PwSS who underwent submaximal AEx testing. METHODS We conducted a scoping review and searched MEDLINE, EMBASE, PsycINFO, CINAHL, and SPORTDiscus from inception to October 29, 2020. Studies involving submaximal AEx testing with PwSS, reporting on participant comorbidity and on adverse events during testing, were eligible. Two reviewers independently conducted title and abstract and full-text screening. One reviewer extracted data; a second reviewer verified data. RESULTS Thirteen studies involving 452 participants and 19 submaximal AEx testing protocols (10 field test, 7 incremental, and 2 constant load) were included. Hypertension (41%), diabetes (31%), and dyslipidemia (27%) were the most common comorbidities reported. No protocols resulted in a serious adverse event. The most common test termination criterion was a heart rate (HR) limit (9 protocols); a limit of 85% age-predicted maximal HR (APM-HR) most frequently reported. Average APM-HR achieved, computed using mean age and mean peak HR, ranged from 59% to 88% across 13 protocols. DISCUSSION AND CONCLUSION Diverse submaximal AEx testing protocols with conservative test termination criteria can be safely implemented with PwSS. Results can inform clinical practice guidelines and address physical therapists' concerns with the occurrence of serious adverse events during submaximal AEx testing.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A430 ).
Collapse
Affiliation(s)
- Jean Michelle Legasto-Mulvale
- Rehabilitation Sciences Institute (J.M.L.M., E.L.I., A.N.T., N.C., S.M., N.M.S.) and Department of Physical Therapy (J.M.L.M., E.L.I., S.M., N.M.S), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The KITE Research Institute, Toronto Rehabilitation Institute (E.L.I., N.M.S), University Health Network, Toronto, Ontario, Canada; and School of Rehabilitation Therapy (S.M.), Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
8
|
Huang J, Liao F, Luo Y, Shu X. Neutrophil-to-lymphocyte ratio at admission is a risk factor for in-hospital gastrointestinal bleeding in acute ischemic stroke patients after dual antiplatelet therapy: A case control study. J Stroke Cerebrovasc Dis 2023; 32:107325. [PMID: 37660552 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Gastrointestinal bleeding is a clinically important complication in acute ischemic stroke patients after dual antiplatelet therapy. The present study was to explore the association between neutrophil-to-lymphocyte ratio (NLR) and in-hospital gastrointestinal bleeding in acute ischemic stroke (AIS) patients who had received dual antiplatelet therapy. METHODS This restrospective study enrolled AIS patients who had received dual antiplatelet therapy in our hospital from January 2019 to December 2021. Patients were divided into a bleeding group and a non-bleeding group according to whether they had in-hospital gastrointestinal bleeding. Propensity score matching was used to match the confounding variables between the two groups. Multivariate logistic regression was performed to evaluate the association between NLR and in-hospital gastrointestinal bleeding. Receiver operating characteristic (ROC) curve was used to test the prediction ability of NLR. RESULTS A total of 1130 patients were enrolled in this study. Before matching, there were 51 patients in the bleeding group, 1079 patients in the non-bleeding group. After matching, 49 pairs of patients were successfully matched. Multivariate regression revealed that NLR was an independent predictor of in-hospital gastrointestinal bleeding in AIS patients who had received dual antiplatelet therapy. The area under curve (AUC) of NLR in predicting in-hospital gastrointestinal bleeding was 0.908, the sensitivity and specificity were 0.878 and 0.857 respectively. CONCLUSIONS NLR at admission is a useful predictor of in-hospital gastrointestinal bleeding in acute ischemic stroke patients after dual antiplatelet therapy. Still, more prospective studies with larger sample size are needed to validate the result.
Collapse
Affiliation(s)
- Jiaming Huang
- Department of Gastroenterology, Nanchang University Affiliated Ganzhou Hospital, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, China.
| | - Foqiang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yeting Luo
- Department of Neurology, Nanchang University Affiliated Ganzhou Hospital, Ganzhou People's Hospital, Ganzhou, Jiangxi 341000, China
| | - Xu Shu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| |
Collapse
|
9
|
Hadianfar A, Sasannezhad P, Nazar E, Yousefi R, Shakeri M, Jafari Z, Hashtarkhani S. Predictors of in-hospital mortality among patients with symptoms of stroke, Mashhad, Iran: an application of auto-logistic regression model. Arch Public Health 2023; 81:73. [PMID: 37106443 PMCID: PMC10134659 DOI: 10.1186/s13690-023-01084-5] [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: 11/21/2022] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Stroke is the second leading cause of death in adults worldwide. There are remarkable geographical variations in the accessibility to emergency medical services (EMS). Moreover, transport delays have been documented to affect stroke outcomes. This study aimed to examine the spatial variations in in-hospital mortality among patients with symptoms of stroke transferred by EMS, and determine its related factors using the auto-logistic regression model. METHODS In this historical cohort study, we included patients with symptoms of stroke transferred to Ghaem Hospital of Mashhad, as the referral center for stroke patients, from April 2018 to March 2019. The auto-logistic regression model was applied to examine the possible geographical variations of in-hospital mortality and its related factors. All analysis was performed using the Statistical Package for the Social Sciences (SPSS, v. 16) and R 4.0.0 software at the significance level of 0.05. RESULTS In this study, a total of 1,170 patients with stroke symptoms were included. The overall mortality rate in the hospital was 14.2% and there was an uneven geographical distribution. The results of auto-logistic regression model showed that in-hospital stroke mortality was associated with age (OR = 1.03, 95% CI: 1.01-1.04), accessibility rate of ambulance vehicle (OR = 0.97, 95% CI: 0.94-0.99), final stroke diagnosis (OR = 1.60, 95% CI: 1.07-2.39), triage level (OR = 2.11, 95% CI: 1.31-3.54), and length of stay (LOS) in hospital (OR = 1.02, 95% CI: 1.01-1.04). CONCLUSION Our results showed considerable geographical variations in the odds of in-hospital stroke mortality in Mashhad neighborhoods. Also, the age- and sex-adjusted results highlighted the direct association between such variables as accessibility rate of an ambulance, screening time, and LOS in hospital with in-hospital stroke mortality. Thus, the prognosis of in-hospital stroke mortality could be improved by reducing delay time and increasing the EMS access rate.
Collapse
Affiliation(s)
- Ali Hadianfar
- Student Research Committee, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Payam Sasannezhad
- Department of Neurology, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Eisa Nazar
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Razieh Yousefi
- Student Research Committee, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Mohammadtaghi Shakeri
- Department of Biostatistics, School of Public Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran.
| | - Zahra Jafari
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Soheil Hashtarkhani
- Center for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, USA
| |
Collapse
|
10
|
Tani T, Imai S, Inoue N, Kanazawa N, Fushimi K. Association between volume of patients undergoing stroke rehabilitation at acute care hospitals and improvement in activities of daily living. J Stroke Cerebrovasc Dis 2023; 32:106872. [PMID: 36450184 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106872] [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: 06/03/2022] [Revised: 10/23/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aimed to determine the relationship between the annual volume of patients undergoing rehabilitation per hospital and the outcomes of patients admitted for acute stroke. METHODS This observational study used nationwide administrative data. Data on stroke patients aged ≥ 20 years who underwent rehabilitation were extracted from 1,182 acute care hospitals in Japan. The exclusion criteria were extended hospital stay exceeding 180 days and death during hospitalization. Hospital volumes were divided into four quartiles of total patients per hospital. The primary outcome was an improvement in activities of daily living from admission to discharge measured using the Barthel index. Poisson regression analysis of activities of daily living improvement was performed using inverse probability of treatment weighting. RESULTS High rehabilitation volume was significantly correlated with improvements in activities of daily living using the "very low group" as a reference (risk ratio [95% confidence interval]): 1.06 [1.05-1.08], P<0.001). Low volume was also significantly associated with activities of daily living improvement (risk ratio [95% confidence interval]: 1.04 [1.03-1.06], P<0.001). CONCLUSIONS The annual volume of stroke patients undergoing multidisciplinary rehabilitation at a specific hospital may be a factor in the degree of patient improvement in activities of daily living.
Collapse
Affiliation(s)
- Takuaki Tani
- Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan; Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan
| | - Shinobu Imai
- Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan; Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji-shi, Tokyo, 192-0392, Japan
| | - Norihiko Inoue
- Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan; Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan
| | - Natsuko Kanazawa
- Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan
| | - Kiyohide Fushimi
- Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan; Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan.
| |
Collapse
|
11
|
Hossain D, Scott SH, Cluff T, Dukelow SP. The use of machine learning and deep learning techniques to assess proprioceptive impairments of the upper limb after stroke. J Neuroeng Rehabil 2023; 20:15. [PMID: 36707846 PMCID: PMC9881388 DOI: 10.1186/s12984-023-01140-9] [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: 04/01/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Robots can generate rich kinematic datasets that have the potential to provide far more insight into impairments than standard clinical ordinal scales. Determining how to define the presence or absence of impairment in individuals using kinematic data, however, can be challenging. Machine learning techniques offer a potential solution to this problem. In the present manuscript we examine proprioception in stroke survivors using a robotic arm position matching task. Proprioception is impaired in 50-60% of stroke survivors and has been associated with poorer motor recovery and longer lengths of hospital stay. We present a simple cut-off score technique for individual kinematic parameters and an overall task score to determine impairment. We then compare the ability of different machine learning (ML) techniques and the above-mentioned task score to correctly classify individuals with or without stroke based on kinematic data. METHODS Participants performed an Arm Position Matching (APM) task in an exoskeleton robot. The task produced 12 kinematic parameters that quantify multiple attributes of position sense. We first quantified impairment in individual parameters and an overall task score by determining if participants with stroke fell outside of the 95% cut-off score of control (normative) values. Then, we applied five machine learning algorithms (i.e., Logistic Regression, Decision Tree, Random Forest, Random Forest with Hyperparameters Tuning, and Support Vector Machine), and a deep learning algorithm (i.e., Deep Neural Network) to classify individual participants as to whether or not they had a stroke based only on kinematic parameters using a tenfold cross-validation approach. RESULTS We recruited 429 participants with neuroimaging-confirmed stroke (< 35 days post-stroke) and 465 healthy controls. Depending on the APM parameter, we observed that 10.9-48.4% of stroke participants were impaired, while 44% were impaired based on their overall task score. The mean performance metrics of machine learning and deep learning models were: accuracy 82.4%, precision 85.6%, recall 76.5%, and F1 score 80.6%. All machine learning and deep learning models displayed similar classification accuracy; however, the Random Forest model had the highest numerical accuracy (83%). Our models showed higher sensitivity and specificity (AUC = 0.89) in classifying individual participants than the overall task score (AUC = 0.85) based on their performance in the APM task. We also found that variability was the most important feature in classifying performance in the APM task. CONCLUSION Our ML models displayed similar classification performance. ML models were able to integrate more kinematic information and relationships between variables into decision making and displayed better classification performance than the overall task score. ML may help to provide insight into individual kinematic features that have previously been overlooked with respect to clinical importance.
Collapse
Affiliation(s)
- Delowar Hossain
- grid.22072.350000 0004 1936 7697Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Stephen H. Scott
- grid.410356.50000 0004 1936 8331Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON Canada
| | - Tyler Cluff
- grid.22072.350000 0004 1936 7697Faculty of Kinesiology, University of Calgary, Calgary, AB Canada
| | - Sean P. Dukelow
- grid.22072.350000 0004 1936 7697Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| |
Collapse
|
12
|
Tsuda M, Fukawa T, Yamamoto Y, Daizumoto K, Sasaki Y, Ueno Y, Tomida R, Kusuhara Y, Yamaguchi K, Takahashi M, Kanayama HO. Impact of early urinary catheter removal on successful voiding and physical function in stroke patients. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:436-442. [PMID: 37940529 DOI: 10.2152/jmi.70.436] [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] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The aim of the present study was to identify factors related to the success of trial without catheter (TWOC) in patients with stroke and to examine the effect of the timing of urinary catheter removal on the course of stroke. METHODS Patients who were admitted to the Stroke Care Unit of our institution between March 2018 and October 2021 were included. To identify factors related to success of TWOC, a multivariate analysis was performed on the patient's condition at admission and catheter indwelling time. The patients were divided into two groups by the timing of catheter removal, and we assessed the relationship between the timing of catheter removal successful TWOC and recovery of physical function. RESULTS A total of 118 patients were included. The presence of comorbidities and scores of severity and function at admission were not predictors of successful voiding. The time to achieve voiding sussess was significantly shorter in the early catheter removal group than in the later group (p<0.005). Interestingly, the early group also showed better improvements in physical function. CONCLUSION Early removal of catheters may lead to early recovery of bladder function, improvement of physical function, and lower risk of complications in patients with stroke. J. Med. Invest. 70 : 436-442, August, 2023.
Collapse
Affiliation(s)
- Megumi Tsuda
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshiteru Ueno
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiro-Omi Kanayama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| |
Collapse
|
13
|
Lip GYH, Genaidy A, Estes C, McKay D, Falks T. Transient ischemic attack events and incident cardiovascular and non-cardiovascular complications: Observations from a large diversified multimorbid cohort. Eur Stroke J 2022; 8:334-343. [PMID: 37021195 PMCID: PMC10069223 DOI: 10.1177/23969873221146044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Transient ischemic attack (TIA) is a strong signal prompting the incidence of future cardiovascular and non-cardiovascular complications, in light of recent debate on the so-called “stroke-heart syndrome.” We aimed to investigate the relation of TIAs to incident clinical events. Methods: Patients were drawn from three health plans with a wide spectrum of age groups and a wide mix of socio-economic/disability status. Two TIA cohorts in a retrospective design were used to achieve the study specific aims: (i) to investigate the incidence of TIA and associated cardiovascular and non-cardiovascular complications within 30 and 90 days from the onset of incident TIA events; and (ii) to examine the potential risk factors for developing incident TIA events in the general population with/without a history of prior stroke. Results: The incident TIA cohort consisted of 53,716 patients with an average age of 64.2 years (SD 15.2) and 46.1% male. Following TIA, the incidence proportions of ischemic stroke within 30 and 90 days were 2.7% and 3.8%, respectively, and for incident acute coronary syndrome being 0.94 and 1.84, respectively. Ventricular arrhythmia had proportions of 1.2 and 2.14, respectively within 30 and 90 days, with acute heart failure having values of 0.49 and 0.923. About 45% or more of the cardiovascular and non-cardiovascular complications occurred in the first 30 days following the incident TIA cases. About one-third of the recurrent TIA cases followed the incident TIA cases within a span of 30 days. Amongst comorbidities with stroke in the comorbid history, prior stroke provided the strongest risk factor in terms of odds ratio (OR = 8.34, 95% CI 7.21–9.66) for incident TIA events. Age was strongly associated with incident TIA events. Without a prior history of stroke (ischemic stroke/transient ischemic attack/thrombo-embolic events), valvular disease was the strongest risk factor from among the comorbidities (OR-1.87, 95% CI 1.51–2.32). Age also provided strong associations with incident TIA events. Conclusions: Following a TIA, there was a high risk of stroke, acute coronary syndrome, ventricular arrhythmia, acute heart failure, and non-cardiovascular complications.
Collapse
Affiliation(s)
- Gregory YH Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | | | | | | | | |
Collapse
|
14
|
What are the Outcomes After Primary Total Hip and Knee Arthroplasty in Patients With Prior Cerebrovascular Accidents? J Arthroplasty 2022; 37:2347-2352. [PMID: 35803519 DOI: 10.1016/j.arth.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND For patients who have a history of cerebrovascular accident (CVA) with neurological sequelae undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA), we sought to determine mortality rate, implant survivorship, complications, and clinical outcomes. METHODS Our total joint registry identified CVA sequelae patients undergoing primary THA (n = 42 with 25 on affected hip) and TKA (n = 56 with 34 on affected knee). Patients were 1:2 matched based upon age, sex, body mass index, and surgical year to a non-CVA cohort. Mortality and implant survivorship were evaluated via Kaplan-Meier methods. Clinical outcomes were assessed via Harris Hip scores or Knee Society scores . Mean follow-up was 5 years (range, 2-12). RESULTS For CVA sequelae and non-CVA patients, respectively, the 5-year patient survivorship was 69 versus 89% after THA (HR = 2.5; P = .006) and 56 versus 90% after TKA (HR = 2.4, P = .003). No significant difference was noted between groups in implant survivorship free from any reoperation after THA (P > .2) and TKA (P > .6). Postoperative CVA occurred at an equal rate in CVA sequelae and non-CVA patients after TKA (1.8%); none after THA in either group. The magnitude of change in Harris Hip scores (P = .7) and Knee Society scores (P = .7) were similar for CVA sequelae and non-CVA patients. CONCLUSION Complications, including the risk of postoperative CVA, implant survivorship, and outcome score improvement are similar for CVA sequelae and non-CVA patients. A 2.5-fold increased risk of death at a mean of 5 years after primary THA or TKA exist for CVA sequelae patients.
Collapse
|
15
|
Ghuman AS, Mathura P, Yu JC. Stopping routine urine screening studies for stroke rehabilitation inpatient admissions. BMJ Open Qual 2022; 11:bmjoq-2022-002052. [DOI: 10.1136/bmjoq-2022-002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022] Open
Abstract
Urine testing on asymptomatic patients is not aligned with guidelines; however, stroke survivors have trouble communicating symptoms, and urinary tract infections (UTIs) are a recognised poststroke complication. All stroke inpatients at a tertiary rehabilitation hospital underwent urine testing on admission. We led a quality improvement (QI) project on one stroke rehabilitation unit aimed to reduce admission urine testing from 100% to 0%. Baseline audit representing 2 weeks of admissions identified 27 of 28 patients had urine tests; however, none required UTI treatment despite 3 positive culture results. Estimated cost of testing was $C675. QI tools identified that a standardised paper-based admission form facilitated automatic urine testing. Project intervention strategies included education, clinicians crossing off urine orders and unit clerks flagging unaddressed orders for reassessment. A chart audit after 4 weeks and prescriber survey after 6 months assessed impact. Postintervention audit (n=23) revealed 1 patient had admission urine tests, 22 orders were crossed out, 1 chart was flagged and estimated testing cost declined from $C675 to $C25. Six urine tests were completed after admission and two patients required UTI treatment. Post 6 months, unit clerks assumed the role to cross out the order on the standardised form, and no patient had routine admission urine testing. There was no clinical benefit in screening for UTIs prior to stroke rehabilitation. This project is a practical example of deadopting a practice promoted by standardised order forms.
Collapse
|
16
|
Tøndel BG, Morelli VM, Hansen J, Brækkan SK. Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review. J Thromb Haemost 2022; 20:2173-2186. [PMID: 35815351 PMCID: PMC9796787 DOI: 10.1111/jth.15813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/15/2022] [Accepted: 07/01/2022] [Indexed: 01/07/2023]
Abstract
Identification of individuals with ischemic stroke at particularly high risk of venous thromboembolism (VTE) is crucial for targeted thromboprophylaxis. To guide clinical decision-making and development of risk prediction models, increased knowledge on risk factors and biomarkers is needed. Therefore, we set out to identify risk factors and predictors for VTE in people with ischemic stroke by conducting a systematic review of the literature. Medline and Embase were searched from January 1990 and onwards. Studies investigating demographic, clinical, and/or laboratory factors for stroke-related VTE were considered. Two reviewers screened all retrieved records, independently and in duplicate. Risk of bias assessments were guided by a structured framework (PROSPERO-ID: CRD42020176361). Of 4674 identified records, 26 studies were included. Twenty-six demographic, clinical, and laboratory factors associated with increased risk of stroke-related VTE after multivariable adjustments were identified. The following factors were reported by ≥2 studies: prior VTE, cancer, prestroke disability, leg weakness, increasing lesion volume of the brain infarct, infection, low Barthel Index, increasing length of hospital stay, biochemical indices of dehydration, as well as elevated levels of D-dimer, C-reactive protein, and homocysteine. The majority of the studies were of poor quality with moderate or high risk of bias. In conclusion, this systematic review informs on several potential risk factors and predictors for VTE in people with ischemic stroke. To improve risk stratification and guide development of risk prediction models, further confirmation is needed because there were few high-quality studies on each factor.
Collapse
Affiliation(s)
- Birgitte G. Tøndel
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
| | - Vânia M. Morelli
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - John‐Bjarne Hansen
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Sigrid K. Brækkan
- Thrombosis Research Center (TREC), Department of Clinical MedicineUiT – the Arctic University of NorwayTromsøNorway
- Division of Internal MedicineUniversity Hospital of North NorwayTromsøNorway
| |
Collapse
|
17
|
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 PMCID: PMC9376805 DOI: 10.3310/eftv1270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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.
Collapse
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
| | | | | |
Collapse
|
18
|
Yu Y, Xia T, Tan Z, Xia H, He S, Sun H, Wang X, Song H, Chen W. A2DS2 Score Combined With Clinical and Neuroimaging Factors Better Predicts Stroke-Associated Pneumonia in Hyperacute Cerebral Infarction. Front Neurol 2022; 13:800614. [PMID: 35185764 PMCID: PMC8855060 DOI: 10.3389/fneur.2022.800614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/04/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the predictors of stroke-associated pneumonia (SAP) and poor functional outcome in patients with hyperacute cerebral infarction (HCI) by combining clinical factors, laboratory tests and neuroimaging features. Methods We included 205 patients with HCI from November 2018 to December 2019. The diagnostic criterion for SAP was occurrence within 7 days of the onset of stroke. Poor outcome was defined as a functional outcome based on a 3-months MRS score >3. The relationship of demographic, laboratory and neuroimaging variables with SAP and poor outcome was investigated using univariate and multivariate analyses. Results Fifty seven (27.8%) patients were diagnosed with SAP and 40 (19.5%) developed poor outcomes. A2DS2 score (OR = 1.284; 95% CI: 1.048–1.574; P = 0.016), previous stroke (OR = 2.630; 95% CI: 1.122–6.163; P = 0.026), consciousness (OR = 2.945; 95% CI: 1.514–5.729; P < 0.001), brain atrophy (OR = 1.427; 95% CI: 1.040–1.959; P = 0.028), and core infarct volume (OR = 1.715; 95% CI: 1.163–2.528; P = 0.006) were independently associated with the occurrence of SAP. Therefore, we combined these variables into a new SAP prediction model with the C-statistic of 0.84 (95% CI: 0.78–0.90). Fasting plasma glucose (OR = 1.404; 95% CI: 1.202–1.640; P < 0.001), NIHSS score (OR = 1.088; 95% CI: 1.010–1.172; P = 0.026), previous stroke (OR = 4.333; 95% CI: 1.645–11.418; P = 0.003), SAP (OR = 3.420; 95% CI: 1.332–8.787; P = 0.011), basal ganglia-dilated perivascular spaces (BG-dPVS) (OR = 2.124; 95% CI: 1.313–3.436; P = 0.002), and core infarct volume (OR = 1.680; 95% CI: 1.166–2.420; P = 0.005) were independently associated with poor outcome. The C-statistic of the outcome model was 0.87 (95% CI: 0.81–0.94). Furthermore, the SAP model significantly improved discrimination and net benefit more than the A2DS2 scale, with a C-statistic of 0.76 (95% CI: 0.69–0.83). Conclusions After the addition of neuroimaging features, the models exhibit good differentiation and calibration for the prediction of the occurrence of SAP and the development of poor outcomes in HCI patients. The SAP model could better predict the SAP, representing a helpful and valid tool to obtain a net benefit compared with the A2DS2 scale.
Collapse
Affiliation(s)
- Yaoyao Yu
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tianyi Xia
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Zhouli Tan
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huwei Xia
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shenping He
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Han Sun
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xifan Wang
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haolan Song
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weijian Chen
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Weijian Chen
| |
Collapse
|
19
|
Tatlisumak T, Putaala J. General Stroke Management and Stroke Units. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
20
|
Li J, Zhang P, Liu Y, Chen W, Yi X, Wang C. Stroke Lateralization in Large Hemisphere Infarctions: Characteristics, Stroke-Related Complications, and Outcomes. Front Neurol 2021; 12:774247. [PMID: 34956055 PMCID: PMC8702425 DOI: 10.3389/fneur.2021.774247] [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: 09/11/2021] [Accepted: 11/05/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives: To assess the hemispheric differences in characteristics, stroke-related complications, and outcomes of patients with large hemisphere infarctions (LHI). Methods: We enrolled consecutive patients admitted within 24 h after the diagnosis of LHI (defined as an ischemic stroke involving more than 50% of the territory of the middle cerebral artery in computed tomography and/or magnetic resonance imaging). Univariate and multivariate analysis were performed to explore the association between lateralization and stroke-related complications and clinical outcomes. Results: A total of 314 patients with LHI were enrolled, with 171 (54.5%) having right hemispheric involvement. Right-sided patients with LHI had lower baseline National Institutes of Health Stroke Scale (NIHSS) score (18 vs. 22, p < 0.001), higher frequency of atrial fibrillation (69.0 vs. 52.4%, p = 0.003), and higher proportion of cardio-embolism (73.1 vs. 56.6%, p = 0.013) than the left. Right-sided LHI had higher incidence rates of malignant brain edema (MBE) (48.5 vs. 30.8%, p = 0.001) and a composite of cardiovascular events (29.8 vs. 17.5%, p = 0.011) during hospitalization. The incidence rate of 1-month mortality (34.5 vs. 23.8%, p = 0.036) was higher in right-sided patients with LHI, but there were no hemispheric differences in the incidence rates of 3-month mortality and unfavorable outcome (both p > 0.05). Multivariate analyses suggested right hemisphere involvement was independently associated with increased risk of MBE (adjusted OR 2.37, 95% CI 1.26–4.43, p = 0.007) and composite of cardiovascular events (adjusted OR 2.04, 95% CI 1.12–3.72, p = 0.020). However, it was not independently associated with 1-month death, 3-month mortality, and 3-month unfavorable outcome (all p > 0.05). Conclusions: Right-sided patients with LHI had higher frequency of atrial fibrillation and cardio-embolism than the left-sided patients. Right hemisphere involvement was independently associated with increased risk of MBE and composite of cardiovascular events during hospitalization, whereas stroke lateralization was not an independent predictor of mortality and unfavorable outcome in patients with LHI.
Collapse
Affiliation(s)
- Jie Li
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Ping Zhang
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Yingying Liu
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Wanli Chen
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Xingyang Yi
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| | - Chun Wang
- Department of Neurology, People's Hospital of Deyang, Deyang, China
| |
Collapse
|
21
|
Liaw MY, Lin MC, Leong CP, Wang LY, Pong YP, Yang TH, Huang YC. Electromyographic study assessing swallowing function in subacute stroke patients with respiratory muscle weakness. Medicine (Baltimore) 2021; 100:e27780. [PMID: 35049172 PMCID: PMC9191609 DOI: 10.1097/md.0000000000027780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dysphagia has been reported to be associated with the descent of the hyolaryngeal complex. Further, suprahyoid muscles play a greater role than infrahyoid muscles in elevation of the hyolarngeal complex. Respiratory muscle training (RMT) can improve lung function, and expiratory muscle strength training can facilitate elevation of the hyoid bone and increase the motor unit recruitment of submental muscles during normal swallowing. This study aimed to investigate the surface electromyography (sEMG) of the swallowing muscles, bilaterally, and the effect of RMT on swallowing muscles in stroke patients with respiratory muscle weakness. METHODS Forty patients with first episode of unilateral stroke were included in this retrospective controlled trial. After exclusion of 11 patients with respiratory muscle strength stronger than 70% of the predicted value, 15 were allocated to the RMT group and 14 to the control group. However, eventually, 11 patients in RMT group and 11 patients in control group completed the study. The sEMG of the orbicularis oris, masseter, submental, and infrahyoid muscles were recorded during dry swallowing, water swallowing (2 mL), and forced exhalation against a threshold breathing trainer set at different intensities, at baseline and after 6-week RMT. RESULTS Regarding the sEMG of submental muscles, there were significant between-group differences on the latency of the unaffected side (P = .048), significant change from baseline force on the unaffected side (P = .035), and significant between-side difference (P = .011) in the RMT group during dry swallowing. Significant change in the duration from baseline was observed on the affected side of the RMT group when blowing was set at 50% maximal expiratory pressure (MEP; P = .015), and on the unaffected side of the control group when blowing set at 15% MEP (P = .005). Significant difference was observed in the duration between 50% MEP and 15% MEP after 6-week program in the control group (P = .049). CONCLUSIONS A 6-week RMT can improve the electric signal of the affected swallowing muscles with more effect on the unaffected side than on the affected side during dry swallowing. Furthermore, RMT with 50% MEP rather than 15% MEP can facilitate greater submental muscle activity on the affected side in stroke patients with respiratory muscle weakness.
Collapse
Affiliation(s)
- Mei-Yun Liaw
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
- Chang Gung Respirology Center of Excellence, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Department of Respiratory Therapy, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
- Chang Gung Respirology Center of Excellence, Taiwan
| | - Chau-Peng Leong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
| | - Ya-Ping Pong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
| | - Tsung-Hsun Yang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
- Chang Gung Respirology Center of Excellence, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
| |
Collapse
|
22
|
Zhu Y, Gu L. Noninvasive Brain Stimulation for Poststroke Dysphagia: A Meta-Analysis for Randomized Controlled Trials. Eur Neurol 2021; 85:31-38. [PMID: 34702793 DOI: 10.1159/000518211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Past research has indicated that repetitive transcranial magnetic stimulation (rTMS) on the pharyngeal motor cortex may be beneficial to poststroke dysphagic patients. In addition, some studies have supported that transcranial direct current stimulation (tDCS) over the pharyngeal motor cortex can improve swallowing function in poststroke dysphagia. However, some studies showed that rTMS and tDCS show no effect on poststroke dysphagia. This study aims to make a meta-analysis to investigate the therapy effect of rTMS and tDCS on poststroke dysphagia in randomized controlled trials (RCTs). METHODS We searched for studies published before March 2021 in databases (PubMed, Web of Science, MEDLINE, EMBASE, and Google Scholar). Meta-analysis was made to compute the results of included studies using STATA 12.0 software. RESULTS The present study shows a significant increase in the swallowing function in poststroke dysphagia given rTMS compared to those given sham rTMS (standardized mean difference [SMD] = 1.08, 95% confidence interval [CI] = 0.37-1.80, I2 = 81.2%, p < 0.001). In addition, the study shows a significant increase in the swallowing function in poststroke dysphagia given tDCS (combined or not combined with conventional swallowing therapy), compared to those given sham tDCS (combined or not combined with conventional swallowing therapy) (SMD = 1.43, 95% CI = 0.73-2.13, I2 = 77.6%, p < 0.001). CONCLUSIONS The study demonstrates that rTMS and tDCS over the pharyngeal motor cortex show therapy effects on poststroke dysphagia. Many more large-scale, blinded RCTs are essential to investigate the effect of rTMS and tDCS on poststroke dysphagia.
Collapse
Affiliation(s)
- Yixin Zhu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Research Institution of Neuropsychiatry, Southeast University, Nanjing, China
| | - Lihua Gu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Research Institution of Neuropsychiatry, Southeast University, Nanjing, China
| |
Collapse
|
23
|
Bhakta A, Roy I, Huang K, Spangenberg J, Jayabalan P. Factors associated with unplanned transfers among cancer patients at a freestanding acute rehabilitation facility. PM R 2021; 14:1037-1043. [PMID: 34296529 DOI: 10.1002/pmrj.12681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cancer patients undergoing inpatient rehabilitation often have high risk of complications leading to unplanned transfer to acute care. Prior studies have identified factors associated with these transfers but have been limited to examining factors that pertain to initial admission to rehabilitation and were not conducted in a freestanding inpatient rehabilitation facility. OBJECTIVE The study aimed to include these prerehabilitation factors in addition to factors upon initial assessment in rehabilitation. It was hypothesized that specific factors from each of these periods would be associated with unplanned transfer to acute care. DESIGN Retrospective cohort study. SETTING Freestanding academic inpatient rehabilitation facility affiliated with an academic tertiary care facility with a comprehensive cancer center. PATIENTS Retrospective review of 330 specific encounters unique to 250 patients from March 2017 to September 2018. MAIN OUTCOME MEASURES The outcome measure was unplanned transfer to acute care. A binary logistic regression model was used to examine the relationship between factors from oncologic history, acute care course, and factors upon admission to rehabilitation to unplanned transfer to acute care. RESULTS From 330 encounters, there were 111 unplanned transfers (34%). Unplanned transfer to acute care was independently associated with gastrointestinal malignancy (odds ratio [OR] 4.4, p = .01), 6-minute walk test less than 90 m (OR 4.6, p = .003), and prior unplanned transfer (OR 3.5, p = .007). CONCLUSIONS The study suggests that oncologic and functional prerehabilitation markers are associated with an increased likelihood of unplanned transfer during inpatient cancer rehabilitation. These findings will provide a framework for creating predictive tools for unplanned transfers in cancer rehabilitation patients.
Collapse
Affiliation(s)
- Akash Bhakta
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Huntington Hospital, Pasadena, California, USA
| | - Ishan Roy
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin Huang
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jacqueline Spangenberg
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Prakash Jayabalan
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
24
|
McGlinchey MP, McKevitt C, Faulkner-Gurstein R, Sackley CM. The rehabilitation of physical function after severely disabling stroke: a survey of UK therapist practice. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Individuals who are severely disabled from stroke (survivors of severely disabling stroke) experience poorer outcomes compared to those who are less disabled from stroke. However, there is a paucity of evidence describing current therapy practice in the management of severely disabling stroke. The aim of the study was to describe intervention and outcome measure use by physiotherapists and occupational therapists in the rehabilitation of physical function of survivors of severely disabling stroke. Methods A mixed-methods survey was conducted, involving an online questionnaire and follow-up interviews. Survey participants were UK-based physiotherapists and occupational therapists with experience treating stroke. Questionnaire data were analysed with descriptive and inferential statistics. Interview data were analysed using content analysis. Results A total of 452 therapists (59% physiotherapists) responded to the questionnaire. Out of the respondents, 18 self-selected therapists participated in follow-up interviews to explain questionnaire data. Whole body positioning, training of upper limb handling and positioning, and sitting balance practice were the most frequently used interventions. Inpatient-based therapists performed more active rehabilitation interventions, whereas community-based therapists performed more training and education. The Barthel Index, Modified Rankin Scale and National Institutes for Health Stroke Scale were the most frequently used outcome measures. Outcome measure use was generally low and was more likely to be completed when it was part of a national audit. Reasons for low outcome measure use were perceived lack of time and insensitivity to detect clinical change. Conclusions A variety of interventions and outcome measures are used in the rehabilitation of survivors of severely disabling stroke. There is a need to evaluate the effectiveness of frequently used interventions and identify outcome measures that are sensitive to the needs of survivors of severely disabling stroke.
Collapse
Affiliation(s)
- Mark P McGlinchey
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Physiotherapy Department, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Faulkner-Gurstein
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catherine M Sackley
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
25
|
Khazaal W, Taliani M, Boutros C, Abou-Abbas L, Hosseini H, Salameh P, Sadier NS. Psychological Complications at 3 Months Following Stroke: Prevalence and Correlates Among Stroke Survivors in Lebanon. Front Psychol 2021; 12:663267. [PMID: 34177717 PMCID: PMC8222528 DOI: 10.3389/fpsyg.2021.663267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction: Stroke continues to be a common and debilitating medical condition which has a significant effect on public health as the second primary source of mortality and the third major root of disability worldwide. A wide range of complications affecting the survivor's life and interfering with the recovery process usually follows stroke; anxiety and depression are considered one of the major complications post-stroke. This study sought to investigate the short-term psychological consequences of stroke among Lebanese survivors and to identify their correlates. Methods: This study is a prospective observational epidemiological study. 143 stroke patients admitted to hospitals in Mount Lebanon and Beirut between February and May 2018.were included in this study. Assessments of complications were carried out at 3 months post-stroke by completing a 30-min face-to-face interview questionnaire. The survey included the socio-demographic -characteristics of the patients, their lifestyle, health indicators, the severity of stroke, and the post-stroke consequences disturbing their quality of life. Results: Complications were recorded for 117 stroke survivors (mean age, 72.46 years; 60.7% male). The analysis of results 3 months post stroke showed that 29 survivors suffered from neuropathic pain (24.8%), 110 (94%) suffered from fatigue, and 81 (69.2%) from cognitive impairment. High rates of anxiety (51.3%), and depression (76.1%) were recorded as well. Multivariate logistic regression confirmed that there is a significant association between depression and the following variables: anxiety (OR = 4.814, p-value = 0.017), pain (OR = 6.868, p-value = 0.002), and physical activity, which acts as a protective factor against depression (OR = 0.261; p-value = 0.029). However, the results of the multivariate logistic regression analysis for anxiety indicated that immobility-related complications increase the risk of anxiety by 8.457 in sedentary duration longer than 12 h (ORa = 8.457, p-value = 0.01). Furthermore, patients with neuropathic pain (24.8%) are 3.858 times more likely to have anxiety compared to patients without neuropathic pain (ORa = 3.858, p-value = 0.019). Conclusion: Using a patient-centered structure more interventions should take place to evaluate stroke survivors' outcomes, and organize rehabilitation services that deal with stroke consequences, particularly high anxiety and depression levels, which are prevalent and persistent among the Lebanese stroke survivors.
Collapse
Affiliation(s)
- Walaa Khazaal
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Maram Taliani
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Celina Boutros
- Institut Mondor de Recherche Biomedicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est, Creteil, Paris, France
| | - Linda Abou-Abbas
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Hassan Hosseini
- Institut Mondor de Recherche Biomedicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est, Creteil, Paris, France
| | - Pascale Salameh
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon.,Institut National de Sante Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon.,University of Nicosia Medical school, Nicosia, Cyprus
| | - Najwane Said Sadier
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.,College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| |
Collapse
|
26
|
Oyanagi K, Kitai T, Yoshimura Y, Yokoi Y, Ohara N, Kohara N, Sakai N, Honda A, Onishi H, Iwata K. Effect of early intensive rehabilitation on the clinical outcomes of patients with acute stroke. Geriatr Gerontol Int 2021; 21:623-628. [PMID: 34101957 DOI: 10.1111/ggi.14202] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/18/2021] [Accepted: 05/12/2021] [Indexed: 12/01/2022]
Abstract
AIM Intensive rehabilitation effectively improves physical functions in patients with acute stroke, but the frequency of intervention and its cost-effectiveness are poorly studied. This study aimed to examine the effect of early high-frequency rehabilitation intervention on inpatient outcomes and medical expenses of patients with stroke. METHODS The study retrospectively included 1759 patients with acute stroke admitted to the Kobe City Medical Center General Hospital between 2013 and 2016. Patients with a transient ischemic attack, subarachnoid hemorrhage, and those who underwent urgent surgery were excluded. Patients were divided into two groups according to the frequency of rehabilitation intervention: the high-frequency intervention group (>2 times/day, n = 1105) and normal-frequency intervention group (<2 times/day, n = 654). A modified Rankin scale score ≤2 at discharge, immobility-related complications and medical expenses were compared between the groups. RESULTS The high-frequency intervention group had a significantly shorter time to first rehabilitation (median [interquartile range], 19.0 h [13.1-38.4] vs. 24.7 h [16.1-49.4], P < 0.001) and time to first mobilization (23.3 h [8.7-47.2] vs. 22.8 h [5.7-62.3], P = 0.65) than the normal-frequency intervention group. Despite higher disease severity, the high-frequency intervention group exhibited favorable outcomes at discharge (modified Rankin scale, ≤2; adjusted odds ratio, 1.89; 95% confidence interval, 1.25-2.85; P = 0.002). No significant differences were observed between the two groups concerning the rate of immobility-related complications and total medical expenses during hospitalization. CONCLUSIONS High-frequency intervention was associated with improved outcomes and decreased medical expenses in patients with stroke. Our results may contribute to reducing medical expenses by increasing the efficiency of care delivery. Geriatr Gerontol Int 2021; 21: 623-628.
Collapse
Affiliation(s)
- Keiichi Oyanagi
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Kitai
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiro Yoshimura
- Center for Sarcopenia and Malnutrition Research, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Yuki Yokoi
- Department of Rehabilitation, Nishi-Kobe Medical Center, Kobe, Japan
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Akihiro Honda
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hideaki Onishi
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| |
Collapse
|
27
|
Complications During the Inpatient Rehabilitation Period in Neurological Subjects. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Norouzi S, Jafarabadi MA, Shamshirgaran SM, Farzipoor F, Fallah R. Modeling Survival in Patients With Brain Stroke in the Presence of Competing Risks. J Prev Med Public Health 2021; 54:55-62. [PMID: 33618500 PMCID: PMC7939750 DOI: 10.3961/jpmph.20.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives After heart disease, brain stroke (BS) is the second most common cause of death worldwide, underscoring the importance of understanding preventable and treatable risk factors for the outcomes of BS. This study aimed to model the survival of patients with BS in the presence of competing risks. Methods This longitudinal study was conducted on 332 patients with a definitive diagnosis of BS. Demographic characteristics and risk factors were collected by a validated checklist. Patients’ mortality status was investigated by telephone follow-up to identify deaths that may be have been caused by stroke or other factors (heart disease, diabetes, high cholesterol, etc.). Data were analyzed by the Lunn-McNeil approach at alpha=0.1. Results Older age at diagnosis (59–68 years: adjusted hazard ratio [aHR], 2.19; 90% confidence interval [CI], 1.38 to 3.48; 69–75 years: aHR, 5.04; 90% CI, 3.25 to 7.80; ≥76 years: aHR, 5.30; 90% CI, 3.40 to 8.44), having heart disease (aHR, 1.65; 90% CI, 1.23 to 2.23), oral contraceptive pill use (women only) (aHR, 0.44; 90% CI, 0.24 to 0.78) and ischemic stroke (aHR, 0.52; 90% CI, 0.36 to 0.74) were directly related to death from BS. Older age at diagnosis (59–68 years: aHR, 21.42; 90% CI, 3.52 to 130.39; 75–69 years: aHR, 16.48; 90% CI, 2.75 to 98.69; ≥76 years: aHR, 26.03; 90% CI, 4.06 to 166.93) and rural residence (aHR, 2.30; 90% CI, 1.15 to 4.60) were directly related to death from other causes. Significant risk factors were found for both causes of death. Conclusions BS-specific and non-BS-specific mortality had different risk factors. These findings could be utilized to prescribe optimal and specific treatment.
Collapse
Affiliation(s)
- Solmaz Norouzi
- Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology and Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Morteza Shamshirgaran
- Department of Statistics and Epidemiology, Faculty of Health Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Farshid Farzipoor
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramazan Fallah
- Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
29
|
Pongratanakul R, Thitisakulchai P, Kuptniratsaikul V. Factors related to interrupted inpatient stroke rehabilitation due to acute care transfer or death. NeuroRehabilitation 2021; 47:171-179. [PMID: 32716330 DOI: 10.3233/nre-203187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify factors that are independently related to interrupted stroke rehabilitation due to acute care transfer or death. METHODS Medical records of stroke inpatients admitted from 2012 to 2017 were reviewed. Stroke inpatients with interrupted stroke rehabilitation due to acute care transfer or death were enrolled into the case group. Those without interruption admitted in the same month were randomly selected into the control group (case to control ratio of 1 : 5). Ten clinical factors were studied. RESULTS Among stroke inpatients, 3.2% were transferred to acute care facilities and 0.2% died. The most common causes of acute care transfer were respiratory tract infection, intracranial hemorrhage, recurrent ischemic stroke, ischemic heart disease, and seizure. Three factors were found to be significantly associated with interrupted stroke rehabilitation, i.e. presence of feeding tube, presence of anemia and age. Our results also revealed significant association between presence of feeding tube and respiratory tract infection (p = 0.005). CONCLUSION Feeding tube, anemia and old age were identified as independent predictors of interrupted stroke rehabilitation due to acute care transfer or death. Interventions to reduce severe complications should be implemented in order to prevent interruption of rehabilitation process and to reduce the patient transfer rate.
Collapse
Affiliation(s)
- Rinlada Pongratanakul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Poungkaew Thitisakulchai
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vilai Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
30
|
Tian L, Nie ST, Lou TX, Chen H, Yuan GH. Clinical observation on acupoint massage plus Vitalstim electrical stimulation for deglutition disorder after stroke. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2020. [PMCID: PMC7751743 DOI: 10.1007/s11726-020-1212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective Methods Results Conclusion
Collapse
Affiliation(s)
- Li Tian
- Changsha Social Work College, Changsha, 410000 China
| | - Shao-tong Nie
- Hunan Traditional Chinese Medical College, Zhuzhou, 412000 China
| | - Tian-xiao Lou
- Hunan Traditional Chinese Medical College, Zhuzhou, 412000 China
| | - Huan Chen
- Zhuzhou Central Hospital, Hunan Province, Zhuzhou, 412000 China
| | - Guang-hui Yuan
- Zhuzhou Central Hospital, Hunan Province, Zhuzhou, 412000 China
| |
Collapse
|
31
|
Li J, Zhang P, Wu S, Yuan R, Liu J, Tao W, Wang D, Liu M. Impaired consciousness at stroke onset in large hemisphere infarction: incidence, risk factors and outcome. Sci Rep 2020; 10:13170. [PMID: 32759986 PMCID: PMC7406648 DOI: 10.1038/s41598-020-70172-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/23/2020] [Indexed: 02/05/2023] Open
Abstract
Impaired consciousness (IC) at stroke onset in large hemispheric infarctions (LHI) patients is common in clinical practice. However, little is known about the incidence and risk factors of IC at stroke onset in LHI. Besides, stroke-related complications and clinical outcomes in relation to the development of IC has not been systematically examined. Data of 256 consecutive patients with LHI were collected. IC at stroke onset was retrospectively collected from the initial emergency department and/or admission records. Of the 256 LHI patients enrolled, 93 (36.3%) had IC at stroke onset. LHI patients with IC at stroke onset were older (median age 66 vs. 61, p = 0.041), had shorter prehospital delay (24 vs. 26 h, p < 0.001and higher baseline National Institutes of Health Stroke Scale (NIHSS) score (19 vs. 12, p < 0.001). Independent risk factors of IC at stroke onset were high NIHSS score (odds ratio, OR 1.17, 95% confidence interval [CI] 1.12 to 1.23) and atrial fibrillation (OR 1.93, 95% CI 1.07 to 3.47). Dyslipidemia appeared to protect against IC at stroke onset (adjusted OR 0.416, 95% CI 0.175 to 0.988). IC at stroke onset was associated with higher frequency of stroke-related complications (90.32% vs. 67.48%, p < 0.001), especially brain edema (45.16% vs. 23.31%, p < 0.001) and pneumonia (63.44% vs. 47.82%, p = 0.019). The IC group had higher rates of in-hospital death (23.66% vs. 11.66%, p = 0.012), 3-month mortality (49.46% vs. 24.87%, p = 0.002), and 3-month unfavorable outcome (64.51% vs. 49.07%, p = 0.017). However, after adjusting for age, baseline NIHSS score and other confounders, IC at stroke onset was not an independent predictor of in-hospital death (adjusted OR 0.56, 95% CI 0.22 to 1.47), 3-month mortality (adjusted OR 0.54, 95% CI 0.25 to 1.14) and 3-month unfavorable outcome (adjusted OR 0.64, 95% CI 0.31 to 1.33) in LHI patients (all p > 0.05). Our results suggested that IC occur in 1 out of every 3 LHI patients at stroke onset and was associated with initial stroke severity and atrial fibrillation. LHI patients with IC at stroke onset more frequently had stroke-related complications, 3-month mortality and unfavorable outcome, whereas IC was not an independent predictor of poor outcomes.
Collapse
Affiliation(s)
- Jie Li
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China. .,Department of Neurology, People's Hospital of Deyang City, No. 173, North Taishan Road, Deyang, 618000, Sichuan Province, People's Republic of China.
| | - Ping Zhang
- Department of Neurology, People's Hospital of Deyang City, No. 173, North Taishan Road, Deyang, 618000, Sichuan Province, People's Republic of China
| | - Simiao Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Ruozhen Yuan
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Junfeng Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Wendan Tao
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Deren Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China.
| |
Collapse
|
32
|
McKechnie D, Fisher MJ, Pryor J, Mckechnie R. An examination of the nature and characteristics of patients readmitted to acute care from inpatient brain injury rehabilitation. J Adv Nurs 2020; 76:2586-2596. [PMID: 32748979 DOI: 10.1111/jan.14475] [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: 11/28/2019] [Revised: 05/21/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
AIM To describe the nature of readmission to acute care and identify patient characteristics associated with avoidable readmission to acute care from inpatient brain injury rehabilitation. DESIGN A retrospective cohort design. METHODS Data prospectively documented between 1 January 2012 -31 December 2018 in local clinical and administrative database were used. Patient medical records were accessed when missing data were identified. Descriptive statistics were used to describe the nature of readmission episodes and univariate and multivariable logistic regression were used to identify patient characteristics associated with readmission to acute care. RESULTS Of the 383 patients admitted for rehabilitation, 83 (22%) experienced readmission to acute care for a total of 171 episodes. Thirty-seven percent of readmission episodes were due to hospital acquired complications and therefore potentially avoidable. Infection accounted for 63% of hospital acquired complications. Patients with an avoidable readmission episode (N = 38) were more likely to have a significantly lower Functional Independence Measure score, be incontinent, have a tracheostomy, require a mobility aid, and be prescribed a dysphagia diet on rehabilitation admission. Patients with a tracheostomy on rehabilitation admission had a 56% probability for an avoidable readmission to acute care. CONCLUSION Brain injury rehabilitation patients with an avoidable readmission to acute care were more likely to have a higher burden of care on rehabilitation admission and infection was the leading cause of avoidable readmission episodes. IMPACT Research into readmission to acute care in the mixed brain injury inpatient rehabilitation population is limited. In this patient population, readmission to acute care is a contemporary issue that can occur at any time during a patient's rehabilitation admission. This study provides valuable information informing practice change for preventing avoidable readmission episodes. Locally developed policy aimed at preventing readmission episodes should include proactive prevention, early recognition of complications and discrete escalation care pathways.
Collapse
Affiliation(s)
| | - Murray J Fisher
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Ryde, NSW, Australia
| | - Julie Pryor
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Ryde, NSW, Australia
| | | |
Collapse
|
33
|
Na Y, Htwe M, Rehman CA, Palmer T, Munshi S. Sexual dysfunction after stroke-A biopsychosocial perspective. Int J Clin Pract 2020; 74:e13496. [PMID: 32100415 DOI: 10.1111/ijcp.13496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Poststroke sexual dysfunction (PSSD) is widespread and underrecognised, affecting over half of stroke patients with significant effects on a patients' quality of life. We reviewed the postulated factors contributing to PSSD and explore the underrecognition by presenting a questionnaire study as well as examining existing literature. METHODS A literature search between January 1980 and December 2019 in electronic databases such as EMBASE, MEDLINE and PubMed was conducted. The questionnaire study involved all adult stroke patients attending the outpatient clinic over a 6-month period, containing multiple choice and open questions relating to prevalence, impact and provision provided for patients with PSSD. FINDINGS Poststroke sexual dysfunction is unlikely attributed solely to the physical effects of stroke. We present a biopsychosocial model summarising the wide range of factors which can contribute to PSSD. Less than 10% of patients receive any advice despite 90% of patients hoping for advice relating to sexual dysfunction in stroke. INTERPRETATION AND IMPLICATIONS A multidisciplinary, proactive involvement in screening and managing PSSD is required to successfully manage a commonly forgotten complication of stroke. As part of the wider theme of managing lifestyle factors poststroke (eg, smoking, driving advice, dietary advice, alcohol), the 'sexual function aspect' of patients' lives must not be ignored.
Collapse
Affiliation(s)
- Yuuki Na
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - May Htwe
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Chaudhury Abdul Rehman
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Tracy Palmer
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Sunil Munshi
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| |
Collapse
|
34
|
Liu L, Chen W, Zhou H, Duan W, Li S, Huo X, Xu W, Huang L, Zheng H, Liu J, Liu H, Wei Y, Xu J, Wang Y. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases. Stroke Vasc Neurol 2020; 5:159-176. [PMID: 32561535 PMCID: PMC7337371 DOI: 10.1136/svn-2020-000378] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
Aim Stroke is the leading cause of disability and death in China. Ischaemic stroke accounts for about 60%–80% of all strokes. It is of considerable significance to carry out multidimensional management of ischaemic cerebrovascular diseases. This evidence-based guideline aims to provide the latest detailed and comprehensive recommendations on the diagnosis, treatment and secondary prevention of ischaemic cerebrovascular diseases. Methods We had performed comprehensive searches of MEDLINE (via PubMed) (before 30 June 2019), and integrated the relevant information into charts and distributed to the writing group. Writing group members discussed and determined the recommendations through teleconference. We used the level of evidence grading algorithm of Chinese Stroke Association to grade each recommendation. The draft was reviewed by the Guideline Writing Committee of Chinese Stroke Association Stroke and finalised. This guideline is fully updated every 3 years. Results This evidence-based guideline is based on the treatment, care and prevention of ischaemic cerebrovascular diseases, which emphasises on pathogenesis evaluation, intravenous thrombolysis, endovascular therapy, antiplatelet therapy, prevention and treatment of complications, and risk factor management. Conclusions This updated guideline presents a framework for the management of ischaemic cerebrovascular diseases. Timely first-aid measures, professional care in the acute stage, and proactive secondary prevention will be helpful to patients.
Collapse
Affiliation(s)
- Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongyu Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wanying Duan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shujuan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Huo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weihai Xu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Li'an Huang
- Department of Neurology, Guangzhou Overseas Chinese Hospital, The First Affiliated Hospital of JINAN University, Guangzhou, China
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jingyi Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Liu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yufei Wei
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | |
Collapse
|
35
|
Keller K, Hobohm L, Wenzel P, Münzel T, Espinola-Klein C, Ostad MA. Impact of atrial fibrillation/flutter on the in-hospital mortality of ischemic stroke patients. Heart Rhythm 2020; 17:383-390. [DOI: 10.1016/j.hrthm.2019.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Indexed: 10/25/2022]
|
36
|
Assessment of the Implementation of Critical Pathway in Stroke Patients: A 10-Year Follow-Up Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3265950. [PMID: 32190659 PMCID: PMC7063219 DOI: 10.1155/2020/3265950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/28/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022]
Abstract
Background The complications after stroke inhibit functional recovery and worsen the prognosis of patients. The implementation of a critical pathway (CP) can facilitate functional recovery after stroke by enabling comprehensive and systematic structured rehabilitation. Objective To evaluate the effects of the implementation of CP in stroke patients for 10 years. Methods The data were collected from 960 patients who were diagnosed with a stroke at the university hospital emergency room, who were transferred to the rehabilitation center after the acute phase, and who were discharged after undergoing comprehensive rehabilitation. Based on data collected over a period of 10 years, changes in demographic and stroke characteristics, preexisting medical conditions, poststroke complications, and functional states, as well as length of stay (LOS), were evaluated before and after CP implementation. The modified Rankin Scale (mRS) and the Korean version of the Modified Barthel Index (K-MBI) were used to evaluate functional states. Results There were no significant differences in demographic and stroke characteristics before and after CP implementation. For those with preexisting medical conditions, there was no significant difference between before and after CP implementation. The majority of the complications were significantly decreased after the implementation of CP. Except for hemorrhagic stroke patients, the Brunnstrom stage in the ischemic and total stroke patients after CP implementation was significantly increased in the upper and lower extremities. The total hospitalization LOS and rehabilitation center hospitalization times were significantly reduced in ischemic and total stroke patients. There was no statistically significant difference in the functional gain of K-MBI and the efficiency of rehabilitation between before and after CP implementation. Conclusion The implementation of CP allows for better application of evidence- and guideline-based key interventions and helps to provide early, comprehensive, organized, and more specialized care to stroke patients. Despite limited evidence, CP is still recommended as a means of promoting best practices in hospital care for stroke patients.
Collapse
|
37
|
Wang Y, Gao Y, Lu M, Liu Y. Long-term functional prognosis of patients with aneurysmal subarachnoid hemorrhage treated with rehabilitation combined with hyperbaric oxygen: Case-series study. Medicine (Baltimore) 2020; 99:e18748. [PMID: 32011457 PMCID: PMC7220398 DOI: 10.1097/md.0000000000018748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The long-term prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) has received increasing attention in recent years. Hyperbaric oxygen and rehabilitation are already used in clinical treatment of patients with aSAH, but it is unclear whether it can improve the long-term prognosis of patients postoperation. The purpose of this study was to evaluate the long-term prognosis and prognostic factors associated with combined rehabilitation and hyperbaric oxygen therapy for patients with aSAH.Information were retrospectively collected from patients with aSAH treated from October 2014 to July 2017, including demographics, history of hypertension, Hunt-Hess Grade at the time of onset, location of aneurysm, surgical treatment, status of delayed cerebral ischemia and tracheotomy, level of consciousness impairment (Glasgow Coma scale [GCS], neurologic function damage (National Institutes of Health Stroke Scale [NIHSS]), status of hydrocephalus, time of initial hyperbaric oxygen and rehabilitation therapy, as well as duration and frequency of hyperbaric oxygen therapy, and so on. Long-term functional prognosis was measured by modified Rankin scale (mRS), and mRS ≤3 was defined as good prognosis. Univariate and multivariate logistic regression were used to analyze predictors associated with poor prognosis.A total of 44 patients with aSAH were enrolled, and 25 patients (56.8%) had a good functional prognosis 6 months after disease onset. Univariate analysis showed age (P = .028), hyperbaric oxygen and rehabilitation start time (P = .039), NIHSS (P = .000), hydrocephalus (P = .024), frequency of hyperbaric oxygen therapy (P = .016), GCS ≤8 points (P = .000), and tracheotomy (P = .007) were associated with prognosis. Multivariate logistic regression analysis showed that only a higher NIHSS score was an independent predictor of poor prognosis (odds ratio = 1.59; 95% confidence interval, 1.10-2.30).More than 50% of patients with aSAH can achieve a good functional prognosis after combined rehabilitation and hyperbaric oxygen therapy. The severity of neurological impairment before treatment is closely related to poor prognosis.
Collapse
|
38
|
McKechnie D, Fisher MJ, Pryor J, McKechnie R. Predictors of unplanned readmission to acute care from inpatient brain injury rehabilitation. J Clin Nurs 2019; 29:593-601. [PMID: 31769573 DOI: 10.1111/jocn.15118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify the predictors of unplanned readmission to acute care (RTAC) from inpatient brain injury rehabilitation and to develop a risk prediction model. BACKGROUND RTAC from inpatient rehabilitation is not uncommon. Individual rehabilitation patient populations require their own body of evidence regarding predictors of RTAC. DESIGN Retrospective cohort study. METHODS Adult patients with new onset acquired brain injury admitted to a stand-alone rehabilitation facility between 1 January 2012-31 December 2018 were included in the study. The main measures were RTAC, sensitivity, specificity, the C-statistic and Youden's index. This paper is reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS Of 383 patients admitted for rehabilitation, 83 (22%) experienced a RTAC; 69 (18%) patients had at least one unplanned RTAC episode. Patients requiring unplanned RTAC were more likely to have lower Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM) scores on rehabilitation admission, a higher burden of care on rehabilitation discharge and be discharged to a nonhome residence. Rehabilitation admission GCS and motor FIM were identified as the independent RTAC predictors in multivariate regression modelling. The combined C-statistic was 0.86. A GCS cut-off score of ≤14 and motor FIM cut-off score of ≤40 were identified as optimal, yielding a combined Youden's index of 0.56 (sensitivity = 0.72; specificity = 0.83). CONCLUSION Patients requiring an unplanned RTAC had a lower functional status on rehabilitation admission. A prediction model for unplanned RTAC has been developed using validated and readily available clinical measures. RELEVANCE TO CLINICAL PRACTICE The developed RTAC risk prediction model is the first step in preventing unplanned RTAC from inpatient brain injury rehabilitation. Future research should focus on discrete interventions for preventing unplanned RTAC from inpatient brain injury rehabilitation.
Collapse
Affiliation(s)
| | - Murray J Fisher
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Sydney, NSW, Australia
| | - Julie Pryor
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Sydney, NSW, Australia
| | | |
Collapse
|
39
|
Zhang Y, Wang Z, Wang L, Yao S, Jiang X, Lu L, Xu N. A protocol for developing a clinical practice guideline for treating dysphagia after stroke using acupuncture. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.100947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Li J, Zhang P, Wu S, Wang Y, Zhou J, Yi X, Wang C. Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome. Ther Adv Neurol Disord 2019; 12:1756286419873264. [PMID: 31516557 PMCID: PMC6719470 DOI: 10.1177/1756286419873264] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/11/2019] [Indexed: 02/05/2023] Open
Abstract
Objective: Neurological and medical complications are major causes of morbidity and mortality after ischemic stroke. This study aimed to identify the incidence of stroke-related complications following large hemisphere infarction (LHI) and to explore their influence on unfavorable outcome in LHI patients. Methods: We prospectively enrolled consecutive patients with LHI. The unfavorable outcome was defined as an modified Rankin Scale (mRS) score of 4–6 at 3 months. Multivariate logistic regression analysis was employed to identify the stroke-related complications associated with unfavorable outcome. Results: Of the 256 cases with LHI included, 41 (16.0%) died during hospitalization, 94 (36.7%) died and 140 (55.3%) patients had unfavorable outcome at 3 months. A total of 194 (75.8%) had at least one complication. The three most common medical complications were pneumonia (53.5%), electrolyte disorder (30.9%), and urinary incontinence (18.4%), and the three most common neurological complications were malignant brain edema (31.2%), hemorrhagic transformation (27.7%), and poststroke seizures (7.0%). Overall, LHI patients with unfavorable outcome had more frequent stroke-related complications (91.4% versus 55.8%, p < 0.001) than patients with favorable outcome. After adjusting for age, baseline National Institutes of Health Stroke Scale score, and other confounders, only malignant brain edema [odds ratios (OR) 19.76, 95% confidence interval (CI) 4.73–82.45] and pneumonia (OR 2.45, 95% CI 1.11–5.40) were independently associated with 3-month unfavorable outcome in patients with LHI. Conclusions: More than three-quarters of LHI patients have at least one stroke-related complication. LHI patients with the unfavorable outcome had stroke-related complications more frequently, whereas only malignant brain edema and pneumonia are independently associated with 3-month unfavorable outcome.
Collapse
Affiliation(s)
- Jie Li
- Department of Neurology, People's Hospital of Deyang City, Deyang, PR China
| | - Ping Zhang
- Department of Neurology, People's Hospital of Deyang City, Deyang, PR China
| | - Simiao Wu
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yanfen Wang
- Department of Neurology, People's Hospital of Deyang City, Deyang, PR China
| | - Ju Zhou
- Department of Neurology, People's Hospital of Deyang City, Deyang, PR China
| | - Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang, PR China
| | - Chun Wang
- Department of Neurology, People's Hospital of Deyang City, No.173, North Taishan Road, Deyang 618000, Sichuan Province, PR China
| |
Collapse
|
41
|
Remote Postischemic Conditioning Promotes Stroke Recovery by Shifting Circulating Monocytes to CCR2 + Proinflammatory Subset. J Neurosci 2019; 39:7778-7789. [PMID: 31427395 DOI: 10.1523/jneurosci.2699-18.2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 06/17/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Brain injury from stroke is typically considered an event exclusive to the CNS, but injury progression and repair processes are profoundly influenced by peripheral immunity. Stroke stimulates an acute inflammatory response that results in a massive infiltration of peripheral immune cells into the ischemic area. While these cells contribute to the development of brain injury, their recruitment has been considered as a key step for tissue repair. The paradoxical role of inflammatory monocytes in stroke raises the possibility that the manipulation of peripheral immune cells before infiltration into the brain could influence stroke outcome. One such manipulation is remote ischemic limb conditioning (RLC), which triggers an endogenous tolerance mechanism. We observed that mice subjected to poststroke RLC shifted circulating monocytes to a CCR2+ proinflammatory monocyte subset and had reduced acute brain injury, swelling, and improved motor/gait function in chronic stroke. The RLC benefits were observed regardless of injury severity, with a greater shift to a CCR2+ subset in severe stroke. Adoptive transfer of CCR2-deficient monocytes abolished RLC-mediated protection. The study demonstrates the importance of RLC-induced shift of monocytes to a CCR2+ proinflammatory subset in attenuating acute injury and promoting functional recovery in chronic stroke. The defined immune-mediated mechanism underlying RLC benefits allows for an evidence-based framework for the development of immune-based therapeutic strategies for stroke patients.SIGNIFICANCE STATEMENT Stroke is the leading cause of physical disability worldwide but has few treatment options for patients. Because remote ischemic limb conditioning (RLC) elicits endogenous tolerance in neither an organ- nor a tissue-specific manner, the immune system has been considered a mediator for an RLC-related benefit. Application of RLC after stroke increased a proinflammatory CCR2+ monocyte subset in the blood and the brain. RLC reduced acute stroke injury and promoted motor/gait function during the recovery phase. The RLC benefits were absent in mice that received CCR2-deficient monocytes. This preclinical study shows the importance of CCR2+ proinflammatory monocytes in RLC benefits in stroke and provides a therapeutic RLC platform as a novel immune strategy to improve outcomes in stroke patients.
Collapse
|
42
|
Kotb HG, Ibrahim AH, Mohamed EF, Ali OM, Hassanein N, Badawy D, Abdelatty Aly E. The expression of microRNA 146a in patients with ischemic stroke: an observational study. Int J Gen Med 2019; 12:273-278. [PMID: 31496785 PMCID: PMC6691961 DOI: 10.2147/ijgm.s213535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/18/2019] [Indexed: 12/17/2022] Open
Abstract
Aim We conducted the present prospective study to assess the level of microRNA (miRNA) 146a in patients with ischemic stroke and its correlation with patients' characteristics. Methods We conducted an observational study that included adult patients (≥18 years old) who presented within 24 hrs after the onset of the symptoms of acute ischemic stroke. In addition, age- and sex-matched healthy volunteers were included as control group. The primary outcome in the present study was the difference in miRNA 146a expression between patients with ischemic stroke and control group participants. The expression of miRNA 146a was measured using quantitative real-time PCR. Quantitative real-time PCR amplification and analysis were performed using Rotor-Gene Q thermal cycler. Results The present study included 44 patients with ischemic stroke and 22 matched controls. Regarding the primary outcome of the present study, the median expression of miRNA 146a in patients with ischemic stroke was -1.98 fold (IQR -27.1-3.9) compared to 1.75 fold (IQR -2.25-5.27) in control group (P<0.001). However, the subgroup analysis showed that the expression of miRNA 146a was significantly downregulated in comatosed patients only (P<0.001). The expression of miRNA 146a correlated negatively with Glasgow Coma Scale score in comatose patients (r=-0.352, P=0.022). Conclusion In conclusion, the expression of miRNA 146a is significantly downregulated in ischemic stroke patients. Further studies are needed to assess its diagnostic utility and therapeutic potentials.
Collapse
Affiliation(s)
- Hend G Kotb
- Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Amal H Ibrahim
- Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Eman F Mohamed
- Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Omaima M Ali
- Department of Internal Medicine, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Nagwa Hassanein
- Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Dina Badawy
- Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Ehab Abdelatty Aly
- Health Radiation Research Department, National Center of Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo, Egypt
| |
Collapse
|
43
|
McKechnie D, Pryor J, McKechnie R, Fisher MJ. Predictors of Readmission to Acute Care from Inpatient Rehabilitation: An Integrative Review. PM R 2019; 11:1335-1345. [PMID: 31041836 DOI: 10.1002/pmrj.12179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/23/2019] [Indexed: 11/09/2022]
Abstract
Readmission to acute care (RTAC) from inpatient rehabilitation can have negative consequences for individuals and associated financial costs are increasing. Consequently, preventing avoidable RTAC represents a target for improvement in quality of care. The aim of this integrative review was to identify predictors of RTAC from inpatient rehabilitation. A systematic search of MEDLINE, EMBASE, ProQuest, and CINAHL databases was used. Thematic analysis was used to examine extracted data. Strong evidence indicating that the principal predictors of RTAC are lower functional status on admission to rehabilitation, a more severe injury and a higher number of comorbidities was identified in this review. This is despite the heterogeneous nature of impairment groups and factors/measures examined. However, the relevance of some predictors of RTAC (such as patient demographics, invasive devices and primary diagnoses) may be dependent on rehabilitation setting, impairment group or time between rehabilitation admission and RTAC (eg, below 3 vs 30 days). Consequently, findings of this integrative review highlight that RTAC is a complex, multifactorial patient issue with a complex interplay between the predictors and reasons for RTAC. LEVEL OF EVIDENCE: IV.
Collapse
Affiliation(s)
| | - Julie Pryor
- Royal Rehab, Sydney, Australia.,Sydney Nursing School, The University of Sydney, Sydney, Australia
| | | | - Murray J Fisher
- Royal Rehab, Sydney, Australia.,Sydney Nursing School, The University of Sydney, Sydney, Australia
| |
Collapse
|
44
|
Abstract
Gastrointestinal bleeding (GIB) is a common complication that occurs after stroke, and GIB may negatively affect patient prognosis. In this study, we aimed to examine:(1) the risk factors of GIB in acute cerebral infarction patients;(2) association between GIB and 1-year mortality in patients with acute cerebral infarction.Patients with acute cerebral infarction were divided into 2 groups based on the occurrence of GIB during acute stroke stage. Patient characteristics, clinical presentation, stroke risk factors, comorbidities, laboratory data, medication, and outcomes were investigated to analyze the associations between the variables and the probability of having GIB. In addition, patients in the study were matched individually by age, gender. A 1:1 matched case-control method and conditional logistic regression models for single and multiple factors were used to assess the risk factors of GIB in acute cerebral infarction patients.Clinical data of patients with acute cerebral infarction were reviewed and analyzed during the years 2015 and 2016. Finally, 1662 patients with acute cerebral infarction were included in this study, of whom 139 (8.5%) patients had GIB at admission. Multivariate logistic regression analysis revealed that the independent risk factors for GIB in patients with acute cerebral infarction were advanced age (OR = 1.030, P = .009), low Glasgow Coma Scale (GSC) score (OR = 0.850, P = .014), infection (OR = 4.693, P < .001), high NIHSS score (OR = 1.114, P = .001), and posterior circulation infarction (OR = 4.981, P = .010). The case-control study ultimately included 136 case-control pairs. Stepwise conditional regression analyses revealed that the independent risk factors for GIB in patients with acute cerebral infarction were low Glasgow Coma Scale (GSC) score (RR = 0.645, P = .011), infection (RR = 15.326, P = .001), and posterior circulation infarction (RR = 6.129, P = .045). The group with GIB had a higher rate of mortality and disability level (mRS grade ≥ 4) than the group without GIB (P < .001) within 1 year after stroke. In addition, independent risk factors of death within 1 year after stroke in patients were GIB (OR = 6.096, P < .001), infection (OR = 4.493, P < .001), mRS grade ≥ 4 (OR = 4.129, P < .001), and coronary heart disease (OR = 3.718, P = .001).GIB is a common complication after ischemic stroke. These identified factors may help clinicians identify risks of GIB before it develops. GIB is associated with increased risk of 1-year mortality and poor functional outcome in acute cerebral infarction patients.
Collapse
|
45
|
Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices and Subsequent Stroke. Am J Phys Med Rehabil 2019; 98:800-805. [PMID: 30998523 DOI: 10.1097/phm.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to examine the functional outcomes and medical complications of patients with left ventricular assist device implantation and subsequent stroke during comprehensive inpatient rehabilitation. DESIGN Retrospective cohort study of 21 patients admitted to an inpatient rehabilitation facility between 2009 and 2015. Main outcome measurements include admission and discharge Functional Independence Measure, length of stay, and Functional Independence Measure efficiency. RESULTS The study included 17 male and 4 female patients aged 32-75 yrs. Eleven patients (52%) required transfer to an acute care hospital for evaluation. Fifteen patients completed inpatient rehabilitation with median [interquartile range] length of stay 26 [13.5-34] days (range = 7-59 days), median [interquartile range] Functional Independence Measure gain of 18 [12.5-32], and median [interquartile range] Functional Independence Measure efficiency of 1.0 [0.6-1.44]. Patients who required transfer to acute care during their course but ultimately completed inpatient rehabilitation (n = 5) demonstrated larger median [interquartile range] Functional Independence Measure gain (40 [23-42]) and longer median [interquartile range] length of stay (35 [35-42]) compared with patients who completed inpatient rehabilitation without transfer (Functional Independence Measure gain = 15 [9.25-26.5]; length of stay = 14.5 [11.5-26.25]). CONCLUSIONS Patients with left ventricular assist device implantation and subsequent stroke demonstrate functional gains during acute inpatient rehabilitation programs. A large percent of patients required transfer to acute care.
Collapse
|
46
|
Zhou Y, Xu W, Wang W, Yao S, Xiao B, Wang Y, Chen B. Gastrointestinal Hemorrhage is Associated with Mortality after Acute Ischemic Stroke. Curr Neurovasc Res 2019; 16:135-141. [PMID: 30977448 DOI: 10.2174/1567202616666190412160451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Gastrointestinal (GI) hemorrhage is serious during the acute phase and is reported to be related to an increased risk of death during the acute phase of acute ischemic stroke in particular. Our study was designed to investigate the relationship between GI hemorrhage and the mortality of acute ischemic stroke, assessing the influence of cerebrovascular risk factors, brain herniation and oral anticoagulation on the onset of GI hemorrhage. The identified risk factors for the occurrence of GI hemorrhage help to elucidate their respective roles in the mortality of acute ischemic stroke. METHODS A total of 15993 consecutive patients with acute ischemic stroke, including 216 cases and 15777 controls, were enrolled in the study from October 2010 to December 2018. Basic clinical and examination data were collected at the time of study enrollment. GI hemorrhage was diagnosed according to the presence of clinical features and endoscopy. Chi-square test and multiple logistic regressions were conducted to explore the associations between the GI hemorrhage occurrence and known risk factors. Kaplan-Meier was used to assess the influence of GI hemorrhage on the age of mortality of acute ischemic stroke. RESULTS GI hemorrhage cases among patients with acute ischemic stroke accounted for 1.35%. Male patients with ischemic stroke were more likely to have GI hemorrhage than their female counterparts (odds ratio (OR): 1.79; P = 0.000). Patients with atrial fibrillation (AF) had a higher incidence of GI hemorrhage than their counterparts without AF (3.03% vs. 1.20%; P < 0.05). Use of oral anticoagulants was related to increased risk for GI hemorrhage (OR: 1.96; P = 0.00). After adjusting for age and sex, both AF and oral anticoagulant use maintained associations with increased risk for GI hemorrhage (2.59-times and 2.02-times risk respectively; P = 0.00). Patients with hyperlipidemia had a lower incidence of GI hemorrhage than their counterparts without hyperlipidemia (0.62% vs. 1.60%; P < 0.05). Hyperlipidemia was associated with a reduced risk of GI hemorrhage (OR: 0.38, 95% confidence interval (CI): 0.25-0.58; P = 0.00), even after adjusting for age and sex (OR: 0.41; P = 0.00). Patients with brain herniation had a 6.54-times increased risk for GI hemorrhage (P = 0.00). GI hemorrhage was associated with 10.98-fold risk for mortality of acute ischemic stroke (P = 0.00). There was an interaction between GI hemorrhage and brain herniation and increased 26.91-fold risk for the mortality after acute ischemic stroke (P = 0.00). CONCLUSION AF, oral anticoagulant use, brain herniation and male sex increase GI hemorrhage risk, while hyperlipidemia reduces risk. GI hemorrhage itself increases the risk for mortality of acute ischemic stroke. The interaction between GI hemorrhage and brain herniation increased the risk for the mortality after acute ischemic stroke.
Collapse
Affiliation(s)
- Yongtao Zhou
- The Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing, China
| | - Weihua Xu
- Gastroenterology Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Wei Wang
- Gastroenterology Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Shukun Yao
- Gastroenterology Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing, China.,The Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Bei Xiao
- The Department of Medical Record Room, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yuping Wang
- The Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Biao Chen
- The Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China.,Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing, China
| |
Collapse
|
47
|
Epidemiological Features of Ischemic Brain Stroke; a Cross-Sectional Hospital-Based Study. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.74362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
48
|
Chiang CF, Lin MT, Hsiao MY, Yeh YC, Liang YC, Wang TG. Comparative Efficacy of Noninvasive Neurostimulation Therapies for Acute and Subacute Poststroke Dysphagia: A Systematic Review and Network Meta-analysis. Arch Phys Med Rehabil 2019; 100:739-750.e4. [DOI: 10.1016/j.apmr.2018.09.117] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/29/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
|
49
|
Low FZ, Lim JH, Kapur J, Yeow RCH. Effect of a Soft Robotic Sock Device on Lower Extremity Rehabilitation Following Stroke: A Preliminary Clinical Study With Focus on Deep Vein Thrombosis Prevention. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2019; 7:4100106. [PMID: 31065466 PMCID: PMC6500781 DOI: 10.1109/jtehm.2019.2894753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/13/2018] [Accepted: 12/06/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Immobility of the lower extremity due to medical conditions such as stroke can lead to medical complications such as deep vein thrombosis or ankle contracture, and thereafter prolonged recovery process of the patients. In this preliminary clinical study, we aimed to examine the effect of a novel soft robotic sock device, capable of providing assisted ankle exercise, in improving blood flow in the lower limb to prevent the complication of strokes such as deep vein thrombosis and joint contracture. METHODS Stroke patients were recruited (n = 17) to compare patients using the conventional pneumatic compression device with our robotic sock device on separate days. The primary outcome was to compare the venous flow profile of the superficial femoral vein in terms of the time average mean velocity and volumetric flow. The secondary outcome was to identify the ankle joint range of motion with the assistance of the device. RESULTS We noted improvements in the venous profile at the early phase of the device use, though its efficacy seemed to drop with time, as compared to the IPC device, where there was a significant improvement in the venous profile. The ankle joint dorsiflexion-plantarflexion range of motion assisted by the device was 11.5±6.3°. Conclusion and clinical impact: The current version of our sock device appears to be capable of improving venous blood flow in the early phase of device use and assisting with ankle joint exercise. The insights from this preliminary clinical study will serve as the basis for further improvement of the device and subsequent conduct of a longitudinal clinical trial. FUNDING National Health Innovation Centre Singapore (NHIC) grant, R-172-000-391-511, MOE AcRF Tier 1 R-397-000-301-114.
Collapse
Affiliation(s)
- Fan-Zhe Low
- Department of Biomedical EngineeringNational University of SingaporeSingapore119077
| | - Jeong Hoon Lim
- Department of MedicineNational University of SingaporeSingapore119077
| | - Jeevesh Kapur
- Department of MedicineNational University of SingaporeSingapore119077
| | - Raye Chen-Hua Yeow
- Department of Biomedical EngineeringNational University of SingaporeSingapore119077.,Singapore Institute for Neurotechnology, National University of SingaporeSingapore119077.,Advanced Robotics CenterNational University of SingaporeSingapore119077
| |
Collapse
|
50
|
Abstract
Stroke is a leading cause of death and adult disability in the UK. A stroke can have significant negative effects on the lives of patients and their families and carers. While improved stroke management has contributed to a reduction in mortality and improved outcomes following rehabilitation, the incidence of stroke continues to rise in the UK, partly because of the ageing population. Stroke rehabilitation involves a multidisciplinary approach, with nurses performing a central role. This article describes the risk factors and types of stroke, the main areas of stroke rehabilitation and the role of the nurse. It emphasises that providing support to families and carers is a particularly important element of caring for people who have experienced a stroke.
Collapse
|