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Stańczak M, Wyszomirski A, Słonimska P, Kołodziej B, Jabłoński B, Stanisławska-Sachadyn A, Karaszewski B. Circulating miRNA profiles and the risk of hemorrhagic transformation after thrombolytic treatment of acute ischemic stroke: a pilot study. Front Neurol 2024; 15:1399345. [PMID: 38938784 PMCID: PMC11210454 DOI: 10.3389/fneur.2024.1399345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/21/2024] [Indexed: 06/29/2024] Open
Abstract
Background Hemorrhagic transformation (HT) in acute ischemic stroke is likely to occur in patients treated with intravenous thrombolysis (IVT) and may lead to neurological deterioration and symptomatic intracranial hemorrhage (sICH). Despite the complex inclusion and exclusion criteria for IVT and some useful tools to stratify HT risk, sICH still occurs in approximately 6% of patients because some of the risk factors for this complication remain unknown. Objective This study aimed to explore whether there are any differences in circulating microRNA (miRNA) profiles between patients who develop HT after thrombolysis and those who do not. Methods Using qPCR, we quantified the expression of 84 miRNAs in plasma samples collected prior to thrombolytic treatment from 10 individuals who eventually developed HT and 10 patients who did not. For miRNAs that were downregulated (fold change (FC) <0.67) or upregulated (FC >1.5) with p < 0.10, we investigated the tissue specificity and performed KEGG pathway annotation using bioinformatics tools. Owing to the small patient sample size, instead of multivariate analysis with all major known HT risk factors, we matched the results with the admission NIHSS scores only. Results We observed trends towards downregulation of miR-1-3p, miR-133a-3p, miR-133b and miR-376c-3p, and upregulation of miR-7-5p, miR-17-3p, and miR-296-5p. Previously, the upregulated miR-7-5p was found to be highly expressed in the brain, whereas miR-1, miR-133a-3p and miR-133b appeared to be specific to the muscles and myocardium. Conclusion miRNA profiles tend to differ between patients who develop HT and those who do not, suggesting that miRNA profiling, likely in association with other omics approaches, may increase the current power of tools predicting thrombolysis-associated sICH in acute ischemic stroke patients. This study represents a free hypothesis-approach pilot study as a continuation from our previous work. Herein, we showed that applying mathematical analyses to extract information from raw big data may result in the identification of new pathophysiological pathways and may complete standard design works.
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Affiliation(s)
- Marcin Stańczak
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
- Department of Adult Neurology, University Clinical Center, Gdańsk, Poland
| | - Adam Wyszomirski
- Brain Diseases Centre, Medical University of Gdańsk, Gdańsk, Poland
| | - Paulina Słonimska
- Laboratory for Regenerative Biotechnology, Department of Biotechnology and Microbiology, Gdańsk University of Technology, Gdańsk, Poland
| | | | - Bartosz Jabłoński
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
- Department of Adult Neurology, University Clinical Center, Gdańsk, Poland
| | - Anna Stanisławska-Sachadyn
- Department of Biotechnology and Microbiology, Gdańsk University of Technology, Gdańsk, Poland
- BioTechMed Center, Gdańsk University of Technology, Gdańsk, Poland
| | - Bartosz Karaszewski
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
- Department of Adult Neurology, University Clinical Center, Gdańsk, Poland
- Brain Diseases Centre, Medical University of Gdańsk, Gdańsk, Poland
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Abujaber AA, Albalkhi I, Imam Y, Nashwan AJ, Yaseen S, Akhtar N, Alkhawaldeh IM. Predicting 90-Day Prognosis in Ischemic Stroke Patients Post Thrombolysis Using Machine Learning. J Pers Med 2023; 13:1555. [PMID: 38003870 PMCID: PMC10672468 DOI: 10.3390/jpm13111555] [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: 09/07/2023] [Revised: 09/26/2023] [Accepted: 10/11/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Objective: This study aimed to construct a machine learning model for predicting the prognosis of ischemic stroke patients who underwent thrombolysis, assessed through the modified Rankin Scale (mRS) score 90 days after discharge. (2) Methods: Data were sourced from Qatar's stroke registry covering January 2014 to June 2022. A total of 723 patients with ischemic stroke who had received thrombolysis were included. Clinical variables were examined, encompassing demographics, stroke severity indices, comorbidities, laboratory results, admission vital signs, and hospital-acquired complications. The predictive capabilities of five distinct machine learning models were rigorously evaluated using a comprehensive set of metrics. The SHAP analysis was deployed to uncover the most influential predictors. (3) Results: The Support Vector Machine (SVM) model emerged as the standout performer, achieving an area under the curve (AUC) of 0.72. Key determinants of patient outcomes included stroke severity at admission; admission systolic and diastolic blood pressure; baseline comorbidities, notably hypertension (HTN) and coronary artery disease (CAD); stroke subtype, particularly strokes of undetermined origin (SUO); and hospital-acquired urinary tract infections (UTIs). (4) Conclusions: Machine learning can improve early prognosis prediction in ischemic stroke, especially after thrombolysis. The SVM model is a promising tool for empowering clinicians to create individualized treatment plans. Despite limitations, this study contributes to our knowledge and encourages future research to integrate more comprehensive data. Ultimately, it offers a pathway to improve personalized stroke care and enhance the quality of life for stroke survivors.
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Affiliation(s)
- Ahmad A. Abujaber
- Nursing Department, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St., London WC1N 3JH, UK
| | - Yahia Imam
- Neurology Section, Neuroscience Institute, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | | | - Said Yaseen
- School of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Naveed Akhtar
- Neurology Section, Neuroscience Institute, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
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Li J, Qiu Y, Zhang C, Wang H, Bi R, Wei Y, Li Y, Hu B. The role of protein glycosylation in the occurrence and outcome of acute ischemic stroke. Pharmacol Res 2023; 191:106726. [PMID: 36907285 DOI: 10.1016/j.phrs.2023.106726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023]
Abstract
Acute ischemic stroke (AIS) is a serious and life-threatening disease worldwide. Despite thrombolysis or endovascular thrombectomy, a sizeable fraction of patients with AIS have adverse clinical outcomes. In addition, existing secondary prevention strategies with antiplatelet and anticoagulant drugs therapy are not able to adequately decrease the risk of ischemic stroke recurrence. Thus, exploring novel mechanisms for doing so represents an urgent need for the prevention and treatment of AIS. Recent studies have discovered that protein glycosylation plays a critical role in the occurrence and outcome of AIS. As a common co- and post-translational modification, protein glycosylation participates in a wide variety of physiological and pathological processes by regulating the activity and function of proteins or enzymes. Protein glycosylation is involved in two causes of cerebral emboli in ischemic stroke: atherosclerosis and atrial fibrillation. Following ischemic stroke, the level of brain protein glycosylation becomes dynamically regulated, which significantly affects stroke outcome through influencing inflammatory response, excitotoxicity, neuronal apoptosis, and blood-brain barrier disruption. Drugs targeting glycosylation in the occurrence and progression of stroke may represent a novel therapeutic idea. In this review, we focus on possible perspectives about how glycosylation affects the occurrence and outcome of AIS. We then propose the potential of glycosylation as a therapeutic drug target and prognostic marker for AIS patients in the future.
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Affiliation(s)
- Jianzhuang Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanmei Qiu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunlin Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hailing Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rentang Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanhao Wei
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanan Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Elwan ME, Mansour OY, Lashin ME, Melake MS. Factors affecting mechanical thrombectomy outcome in acute ischemic stroke patients: an Egyptian sample. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00491-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Stroke constitutes a major health problem worldwide, nowadays endovascular treatment is considered to be a standard of care in acute ischemic stroke patients with large vessel occlusion, accurate prediction of outcome of thrombectomy is essential for health care providers, patients and families. We studied different clinical and radiological variables that could predict functional outcome in stroke patients after thrombectomy. Thirty-four consecutive ischemic stroke patients were included, received intravenous tissue plasminogen activator (iv-tpa), then mechanical thrombectomy was done. Patients were clinically assessed at admission with National Institute of Health Stroke Scale (NIHSS) then evaluated by the Alberta Stroke Program early computerized tomography (CT) score (ASPECTS), clot burden scale (CBS) and collateral score (CS) in multiphase computerized tomography angiography (CTA) then good and poor outcomes at 3 months were defined by Modified Rankin Scale (MRS) of 0–2 and 3–6 points, respectively.
Results
Factors associated with good outcome (MRS 0–2) were lower admission NIHSS score (p < 0.037), small infarct core aspects ≥ 6 (p < 0.001), low clot burden (CBS 7–10) (p = 0.046) good collaterals (2–3) (p = 0.038) and absence of post-procedure hemorrhage (p < 0.0005).
Conclusions
Low admission NIHSS score, absence of post-procedure hemorrhage, small infarct core, low clot burden and good collaterals are reliable factors for good clinical outcome.
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Handley SC, Passarella M, Martin AE, Lorch SA, Srinivas SK, Nembhard IM. Development and Testing of a Survey Measure of Organizational Perinatal
Patient‐Centered
Care Culture. Health Serv Res 2022; 57:806-819. [PMID: 35128641 PMCID: PMC9264452 DOI: 10.1111/1475-6773.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop and test a measure of patient-centered care (PCC) culture in hospital-based perinatal care. DATA SOURCES Data were obtained from US perinatal hospitals: one provided survey development data and 14 contributed data for survey testing. STUDY DESIGN We used qualitative and quantitative methods to develop the mother-infant centered care (MICC) culture survey. Qualitative methods included observation, focus group, interviews, and expert consultations to adapt items from other settings and create new items capturing dimensions of PCC articulated by The Commonwealth Fund. We quantitatively assessed survey psychometric properties using reliability (Cronbach's α and Pearson correlation coefficients) and validity (exploratory and confirmatory factor analysis [CFA]) statistics, and refined the survey. After confirming aggregation suitability (ICCs), we calculated "MICC culture scores" at the individual, unit, and hospital level and assessed associations between scores and survey-collected, staff-reported outcomes to evaluate concurrent validity. DATA COLLECTION Survey development included 12 site-visit observations, one semi-structured focus group (five participants), two semi-structured interviews, five cognitive interviews, and three expert consultations. Survey testing used online surveys administered to obstetric and neonatal unit staff (N = 316). PRINCIPAL FINDINGS Using responses from 10 hospitals with ≥4 responses from both units (n = 240), the 20-item MICC culture survey demonstrated reliability (Cronbach's α = 0.95) while capturing all PCC dimensions (subscale Cronbach's α = 0.72-0.87). CFA showed validity through goodness-of-fit (overall chi-square = 214 [p-value = 0.012], SRMR = 0.056, RMSEA = 0.041, CFI = 0.97, and TLI = 0.96). Aggregation statistics (ICCs < 0.05) justify unit- and hospital-level aggregation. Demonstrating preliminary validity, individual-, unit-, and hospital-level MICC culture scores were associated with all outcomes (satisfaction with care provided, within-unit team effectiveness, and relational coordination [RC] between units) (p-values < 0.05), except for neonatal unit scores and RC (p-value = 0.11). CONCLUSIONS The MICC culture survey is a psychometrically sound measure of PCC culture for hospital-based perinatal care. Survey scores are associated with staff-reported outcomes. Future studies with patient outcomes will aid identification of improvement opportunities in perinatal care.
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Affiliation(s)
- Sara C. Handley
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine‐University of Pennsylvania Philadelphia Pennsylvania
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Molly Passarella
- Department of Pediatrics Children’s Hospital of Philadelphia Philadelphia PA
| | - Ashley E. Martin
- Department of Pediatrics Children’s Hospital of Philadelphia Philadelphia PA
| | - Scott A. Lorch
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine‐University of Pennsylvania Philadelphia Pennsylvania
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Sindhu K. Srinivas
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
- Department of Obstetrics and Gynecology Perelman School of Medicine‐University of Pennsylvania Philadelphia Pennsylvania
| | - Ingrid M. Nembhard
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
- The Wharton School University of Pennsylvania Philadelphia PA
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Neuroprotective Effect of Alpha-asarone on the Rats Model of Cerebral Ischemia-Reperfusion Stroke via Ameliorating Glial Activation and Autophagy. Neuroscience 2021; 473:130-141. [PMID: 34416342 DOI: 10.1016/j.neuroscience.2021.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/11/2022]
Abstract
Alpha-asarone, a major active component isolated from Acorus gramineus, can affect brain functions and behaviors by multiple mechanisms. However, the effect of alpha-asarone on cerebral ischemia-reperfusion (CIR) stroke has not been reported. The present study aimed to investigate the neuroprotective effect of alpha-asarone and the involved mechanisms against CIR stroke. Rats were subjected to middle cerebral occlusion (MCAO) for 2 h. Then the drug or drug-free vehicle was intravenously injected to corresponding groups. After reperfusion for 24 h, the infarct volume was evaluated by Triphenyl Tetrazolium Chloride (TTC) staining. The neurofunctional recovery and post-stroke epilepsy were evaluated. Nissl and Hematoxylin-Eosin (H&E) staining were used for histological observation. We investigated the protective mechanism of alpha-asarone against the stroke. The results showed that alpha-asarone exhibited a desirable neuroprotective effect, manifested as reducing infarct volume and post-stroke epilepsy and improving neurological function. Histological and flow cytometry analysis revealed that alpha-asarone treatment alleviated cell injury and apoptosis in vivo and in vitro. Furthermore, alpha-asarone decreased GFAP, Iba-1, and LC3II/LC3I expression and increased the expression of p62. These results suggested that alpha-asarone attenuated the CIR stroke injury via ameliorating glial activation and autophagy.
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Advani R, Ajmi S, Kurz MW. Mechanical thrombectomy: Lessons to be learned from intravenous thrombolysis. Brain Behav 2020; 10:e01500. [PMID: 31837108 PMCID: PMC6955823 DOI: 10.1002/brb3.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/24/2019] [Accepted: 11/22/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rajiv Advani
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Soffien Ajmi
- Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway.,Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Martin W Kurz
- Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway.,Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway
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Skvortsova VI, Shetova IM, Kakorina EP, Kamkin EG, Boiko EL, Alekyan BG, Ivanova GE, Shamalov NA, Dashyan VG, Krylov VV. Reduction in stroke death rates through a package of measures to improve medical care for patients with vascular diseases in the Russian Federation. ACTA ACUST UNITED AC 2018. [DOI: 10.17116/profmed20182114-10] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Skvortsova VI, Shetova IM, Kakorina EP, Kamkin EG, Boiko EL, Alekyan BG, Ivanova GE, Shamalov NA, Dashyan VG, Krylov VV. Results of implementation of a 'Complex of measures to improve medical care for patients with stroke in the Russian Federation'. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:5-12. [DOI: 10.17116/jnevro2018118415-12] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Bradley EH, Brewster AL, Fosburgh H, Cherlin EJ, Curry LA. Development and Psychometric Properties of a Scale to Measure Hospital Organizational Culture for Cardiovascular Care. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003422. [PMID: 28302647 DOI: 10.1161/circoutcomes.116.003422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because organizational culture is increasingly understood as fundamental to achieving high performance in hospital and other healthcare settings, the ability to measure this nuanced concept empirically has gained importance. Aside from measures of patient safety culture, no measure of organizational culture has been widely endorsed in the medical literature, limiting replication of previous findings and broader use in interventional studies. METHODS AND RESULTS We sought to develop and assess the validity and reliability of a scale for assessing organizational culture in the context of hospitals' efforts to reducing 30-day risk-standardized mortality after acute myocardial infarction. The 31-item scale was completed by 147 individuals representing 10 hospitals during August and September 2014. The resulting organizational culture scale demonstrated high level of construct validity and internal consistency. Factor analyses indicated that the 31 items loaded well (loading values 0.48-0.90), supporting distinguishable domains of (1) learning environment, (2) psychological safety, (3) commitment to the organization, (4) senior management support, and (5) time for improvement efforts. Cronbach α coefficients were 0.94 for the scale and ranged from 0.77 to 0.88 for the subscales. The scale displayed reasonable convergent validity and statistically significant variability across hospitals, with hospital identity accounting for 11.3% of variance in culture scores across respondents. CONCLUSIONS We developed and validated a relatively easy-to-administer survey that was able to detect substantial variability in organizational culture across different hospitals and may be useful in measuring hospital culture and evaluating changes in culture over time as part performance improvement efforts.
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Affiliation(s)
- Elizabeth H Bradley
- From the Global Health Leadership Institute, Yale School of Public Health, New Haven, CT.
| | - Amanda L Brewster
- From the Global Health Leadership Institute, Yale School of Public Health, New Haven, CT
| | - Heather Fosburgh
- From the Global Health Leadership Institute, Yale School of Public Health, New Haven, CT
| | - Emily J Cherlin
- From the Global Health Leadership Institute, Yale School of Public Health, New Haven, CT
| | - Leslie A Curry
- From the Global Health Leadership Institute, Yale School of Public Health, New Haven, CT
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Purvis T, Moss K, Francis L, Borschmann K, Kilkenny MF, Denisenko S, Bladin CF, Cadilhac DA. Benefits of clinical facilitators on improving stroke care in acute hospitals: a new programme for Australia. Intern Med J 2017; 47:775-784. [DOI: 10.1111/imj.13458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/05/2017] [Accepted: 04/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Tara Purvis
- Department of Medicine, School of Clinical Sciences at Monash Health; Monash University; Melbourne Australia
| | - Karen Moss
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
| | - Linda Francis
- School of Population and Global Health, Centre for Health Policy; The University of Melbourne; Melbourne Australia
| | - Karen Borschmann
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
| | - Monique F. Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health; Monash University; Melbourne Australia
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
| | - Sonia Denisenko
- Department of Health and Human Services; Victorian Government; Melbourne Australia
| | - Christopher F. Bladin
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
- Eastern Health Clinical School; Monash University; Melbourne Australia
| | - Dominique A. Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health; Monash University; Melbourne Australia
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
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12
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Thomson RG, De Brún A, Flynn D, Ternent L, Price CI, Rodgers H, Ford GA, Rudd M, Lancsar E, Simpson S, Teah J. Factors that influence variation in clinical decision-making about thrombolysis in the treatment of acute ischaemic stroke: results of a discrete choice experiment. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BackgroundIntravenous thrombolysis for patients with acute ischaemic stroke is underused (only 80% of eligible patients receive it) and there is variation in its use across the UK. Previously, variation might have been explained by structural differences; however, continuing variation may reflect differences in clinical decision-making regarding the eligibility of patients for treatment. This variation in decision-making could lead to the underuse, or result in inappropriate use, of thrombolysis.ObjectivesTo identify the factors which contribute to variation in, and influence, clinicians’ decision-making about treating ischaemic stroke patients with intravenous thrombolysis.MethodsA discrete choice experiment (DCE) using hypothetical patient vignettes framed around areas of clinical uncertainty was conducted to better understand the influence of patient-related and clinician-related factors on clinical decision-making. An online DCE was developed following an iterative five-stage design process. UK-based clinicians involved in final decision-making about thrombolysis were invited to take part via national professional bodies of relevant medical specialties. Mixed-logit regression analyses were conducted.ResultsA total of 138 clinicians responded and opted to offer thrombolysis in 31.4% of cases. Seven patient factors were individually predictive of the increased likelihood of offering thrombolysis (compared with reference levels in brackets): stroke onset time of 2 hours 30 minutes (50 minutes); pre-stroke dependency modified Rankin Scale score (mRS) of 3 (mRS4); systolic blood pressure (SBP) of 185 mmHg (140 mmHg); stroke severity scores of National Institutes of Health Stroke Scale (NIHSS) 5 without aphasia, NIHSS 14 and NIHSS 23 (NIHSS 2 without aphasia); age 85 years (65 years); and Afro-Caribbean (white). Factors predictive of not offering thrombolysis were age 95 years; stroke onset time of 4 hours 15 minutes; severe dementia (no memory problems); and SBP of 200 mmHg. Three clinician-related factors were predictive of an increased likelihood of offering thrombolysis (perceived robustness of the evidence for thrombolysis; thrombolysing more patients in the past 12 months; and high discomfort with uncertainty) and one factor was predictive of a decreased likelihood of offering treatment (clinicians’ being comfortable treating patients outside the licensing criteria).LimitationsWe anticipated a sample size of 150–200. Nonetheless, the final sample of 138 is good considering that the total population of eligible UK clinicians is relatively small. Furthermore, data from the Royal College of Physicians suggest that our sample is representative of clinicians involved in decision-making about thrombolysis.ConclusionsThere was considerable heterogeneity among respondents in thrombolysis decision-making, indicating that clinicians differ in their thresholds for treatment across a number of patient-related factors. Respondents were significantly more likely to treat 85-year-old patients than patients aged 68 years and this probably reflects acceptance of data from Third International Stroke Trial that report benefit for patients aged > 80 years. That respondents were more likely to offer thrombolysis to patients with severe stroke than to patients with mild stroke may indicate uncertainty/concern about the risk/benefit balance in treatment of minor stroke. Findings will be disseminated via peer-review publication and presentation at national/international conferences, and will be linked to training/continuing professional development (CPD) programmes.Future workThe nature of DCE design means that only a subset of potentially influential factors could be explored. Factors not explored in this study warrant future research. Training/CPD should address the impact of non-medical influences on decision-making using evidence-based strategies.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Richard G Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Aoife De Brún
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Ternent
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher I Price
- Stroke Unit, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, UK
| | - Helen Rodgers
- Stroke Unit, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, UK
| | - Gary A Ford
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Matthew Rudd
- Stroke Unit, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, UK
| | - Emily Lancsar
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | | | - John Teah
- The Stroke Association, Gateshead, UK
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13
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Martynov MY, Gusev EI. Current knowledge on the neuroprotective and neuroregenerative properties of citicoline in acute ischemic stroke. J Exp Pharmacol 2015; 7:17-28. [PMID: 27186142 PMCID: PMC4863531 DOI: 10.2147/jep.s63544] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ischemic stroke is one of the leading causes of long-lasting disability and death. Two main strategies have been proposed for the treatment of ischemic stroke: restoration of blood flow by thrombolysis or mechanical thrombus extraction during the first few hours of ischemic stroke, which is one of the most effective treatments and leads to a better functional and clinical outcome. The other direction of treatment, which is potentially applicable to most of the patients with ischemic stroke, is neuroprotection. Initially, neuroprotection was mainly targeted at protecting gray matter, but during the past few years there has been a transition from a neuron-oriented approach toward salvaging the whole neurovascular unit using multimodal drugs. Citicoline is a multimodal drug that exhibits neuroprotective and neuroregenerative effects in a variety of experimental and clinical disorders of the central nervous system, including acute and chronic cerebral ischemia, intracerebral hemorrhage, and global cerebral hypoxia. Citicoline has a prolonged therapeutic window and is active at various temporal and biochemical stages of the ischemic cascade. In acute ischemic stroke, citicoline provides neuroprotection by attenuating glutamate exitotoxicity, oxidative stress, apoptosis, and blood–brain barrier dysfunction. In the subacute and chronic phases of ischemic stroke, citicoline exhibits neuroregenerative effects and activates neurogenesis, synaptogenesis, and angiogenesis and enhances neurotransmitter metabolism. Acute and long-term treatment with citicoline is safe and in most clinical studies is effective and improves functional outcome.
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Affiliation(s)
- Mikhail Yu Martynov
- Department of Neurology, Neurosurgery and Medical Genetics, Russian National Research Medical University, Moscow, Russia
| | - Eugeny I Gusev
- Department of Neurology, Neurosurgery and Medical Genetics, Russian National Research Medical University, Moscow, Russia
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Grady AM, Bryant J, Carey ML, Paul CL, Sanson-Fisher RW, Levi CR. Agreement with evidence for tissue Plasminogen Activator use among emergency physicians: a cross-sectional survey. BMC Res Notes 2015; 8:267. [PMID: 26111807 PMCID: PMC4482289 DOI: 10.1186/s13104-015-1242-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/17/2015] [Indexed: 11/21/2022] Open
Abstract
Background Emergency department staff play a crucial role in the triage of stroke patients and therefore the capacity to deliver time-dependent treatments such as tissue Plasminogen Activator. This study aimed to identify among emergency physicians, (1) rates of agreement with evidence supporting tissue Plasminogen Activator use in acute stroke care; and (2) individual and hospital factors associated with high agreement with evidence supporting tissue Plasminogen Activator use. Methods Australian fellows and trainees of the Australasian College for Emergency Medicine were invited to complete an online cross-sectional survey assessing perceptions of tissue Plasminogen Activator use in acute stroke. Demographic and hospital characteristics were also collected. Results 429 Australasian College for Emergency Medicine members responded (13% response rate). Almost half (47.2%) did not agree with any statements regarding the benefits of tissue Plasminogen Activator use for acute stroke. Perceived routine administration of tissue Plasminogen Activator by the head of respondents’ emergency department was significantly associated with high agreement with the evidence supporting tissue Plasminogen Activator use in acute stroke. Conclusions Agreement with evidence supporting tissue Plasminogen Activator use in acute stroke is not high among responding Australian emergency physicians. In order for tissue Plasminogen Activator treatment to become widely accepted and adopted in emergency settings, beliefs and attitudes towards treatment need to be in accordance with clinical practice guidelines. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1242-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alice M Grady
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Mariko L Carey
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Christine L Paul
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Rob W Sanson-Fisher
- Priority Research Centre for Health Behaviour, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Christopher R Levi
- Department of Neurology, John Hunter Hospital, New Lambton, NSW, 2305, Australia. .,Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
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Muengtaweepongsa S, Prapa-Anantachai P, Dharmasaroja PA, Rukkul P, Yodvisitsak P. External validation of the SEDAN score: The real world practice of a single center. Ann Indian Acad Neurol 2015; 18:181-6. [PMID: 26019416 PMCID: PMC4445194 DOI: 10.4103/0972-2327.150592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/05/2014] [Accepted: 11/20/2014] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose: Symptomatic intracranial hemorrhage (sICH) is the most serious adverse event in stroke patients who received i.v. rt-PA and is usually associated with poor outcomes. The SEDAN score is built up to predict sICH. We aim to externally validate the SEDAN score in Thai patients from single center in the real world practice. Materials and Methods: The SEDAN score of stroke patients treated with intravenous rt-PA at Thammasat University Hospital from January 2010 to June 2012 was calculated. Patients were divided into three groups including symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage (AsICH) and no intracerebral hemorrhage (NoICH). The primary outcome of analyses was sICH. Each parameter of the SEDAN score and correlation between score and sICH were analyzed with univariate and multivariate model. Results: 295 patients (18.6% of stroke admission) were treated with i.v. rt-PA. 13 patients (4.4%) had sICH and 31 patients (10.4%) had AsICH. Baseline blood sugar >12 mmol/l, early infarction, hyperdense cerebral artery, age >75 years-old and NIHSS ≥10(SEDAN) were associated with sICH by univariate analysis (P value = 0.018, <0.001, <0.001, 0.002 and 0.027 respectively). The rate of sICH occurrence was increased in accordance with the increasing of the SEDAN score. By multivariate analysis, odds ratio of baseline blood sugar >12 mmol/l, early infarction, hyperdense cerebral artery, age >75 years-old and NIHSS ≥10 were 1.248, 2.503, 1.107, 1.532 and 1.263 respectively. Conclusions: The SEDAN score was practical to use and predictive in Thai population. Each parameter of the SEDAN score was an independent risk factor for sICH after treatment with i.v. rt-PA.
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Affiliation(s)
| | | | | | - Pattarawit Rukkul
- Department of Surgery, Faculty of Surgery, Thammasat University, Pathum Thani, Thailand
| | - Pornchai Yodvisitsak
- Department of Surgery, Faculty of Surgery, Thammasat University, Pathum Thani, Thailand
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16
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Ukawa N, Tanaka M, Morishima T, Imanaka Y. Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use. Int J Qual Health Care 2014; 27:37-45. [DOI: 10.1093/intqhc/mzu091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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17
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Enablers of the implementation of tissue plasminogen activator in acute stroke care: a cross-sectional survey. PLoS One 2014; 9:e114778. [PMID: 25490546 PMCID: PMC4260942 DOI: 10.1371/journal.pone.0114778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/13/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess emergency physicians' perceptions of individual and system enablers to the use of tissue Plasminogen Activator in acute stroke. METHOD Australian fellows and trainees of Australasian College for Emergency Medicine completed a 57-item online survey assessing enablers to implementation of evidence-based practice across six domains: knowledge, skills, modelling, monitoring, feedback, and maintenance. Demographic and workplace characteristics were obtained. Descriptive statistics were calculated to describe demographic and workplace characteristics of responders, and survey responses. Each domain received an overall score (%) based on the number of responders agreeing with all items within the domain. RESULTS A total of 429 (13%) Australasian College for Emergency Medicine members responded. 17.7% of respondents reported they and/or their workplace met all knowledge-related enablers, however only 2.3% had all skill-related enablers in place. Of respondents who decide which patients receive tissue Plasminogen Activator treatment, 18.1% agreed that all maintenance-related enablers are in place at their hospital, compared to 6.6% for those who do not decide which patients receive tissue Plasminogen Activator treatment. None of the respondents had all items in place cross all domains. CONCLUSIONS Even when allowing for the low response rate, it seems likely there is a lack of individual and system enablers supporting the implementation of best-practice stroke care in a number of Australian hospitals. Quality improvement programs could target all domains, particularly the skills-training and feedback emergency physicians receive, to aid implementation of tissue Plasminogen Activator treatment for acute stroke.
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18
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Purvis T, Moss K, Denisenko S, Bladin C, Cadilhac DA. Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators. J Multidiscip Healthc 2014; 7:389-400. [PMID: 25246799 PMCID: PMC4168868 DOI: 10.2147/jmdh.s67348] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A stroke care strategy was developed in 2007 to improve stroke services in Victoria, Australia. Eight stroke network facilitators (SNFs) were appointed in selected hospitals to enable the establishment of stroke units, develop thrombolysis services, and implement protocols. We aimed to explain the main issues being faced by clinicians in providing evidence-based stroke care, and to determine if the appointment of an SNF was perceived as an acceptable strategy to improve stroke care. Face-to-face semistructured interviews were used in a qualitative research design. Interview transcripts were verified by respondents prior to coding. Two researchers conducted thematic analysis of major themes and subthemes. Overall, 84 hospital staff participated in 33 interviews during 2008. The common factors found to impact on stroke care included staff and equipment availability, location of care, inconsistent use of clinical pathways, and professional beliefs. Other barriers included limited access to specialist clinicians and workload demands. The establishment of dedicated stroke units was considered essential to improve the quality of care. The SNF role was valued for identifying gaps in care and providing capacity to change clinical processes. This is the first large, qualitative multicenter study to describe issues associated with delivering high-quality stroke care and the potential benefits of SNFs to facilitate these improvements.
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Affiliation(s)
- Tara Purvis
- Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Monash Medical Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia ; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
| | - Karen Moss
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
| | - Sonia Denisenko
- Commission for Hospital Improvement, Department of Health Victoria, VIC, Australia
| | - Chris Bladin
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia ; Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Dominique A Cadilhac
- Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Monash Medical Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia ; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia ; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
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Overgaard K. The effects of citicoline on acute ischemic stroke: a review. J Stroke Cerebrovasc Dis 2014; 23:1764-9. [PMID: 24739589 DOI: 10.1016/j.jstrokecerebrovasdis.2014.01.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/14/2014] [Accepted: 01/19/2014] [Indexed: 11/28/2022] Open
Abstract
Early reopening of the occluded artery is, thus, important in ischemic stroke, and it has been calculated that 2 million neurons die every minute in an ischemic stroke if no effective therapy is given; therefore, "Time is Brain." In massive hemispheric infarction and edema, surgical decompression lowers the risk of death or severe disability defined as a modified Rankin Scale score greater than 4 in selected patients. The majority, around 80%-85% of all ischemic stroke victims, does not fulfill the criteria for revascularization therapy, and also for these patients, there is no effective acute therapy. Also there is no established effective acute treatment of spontaneous intracerebral bleeding. Therefore, an effective therapy applicable to all stroke victims is needed. The neuroprotective drug citicoline has been extensively studied in clinical trials with volunteers and more than 11,000 patients with various neurologic disorders, including acute ischemic stroke (AIS). The conclusion is that citicoline is safe to use and may have a beneficial effect in AIS patients and most beneficial in less severe stroke in older patients not treated with recombinant tissue plasminogen activator. No other neuroprotective agent had any beneficial effect in confirmative clinical trials or had any positive effect in the subgroup analysis. Citicoline is the only drug that in a number of different clinical stroke trials continuously had some neuroprotective benefit.
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Affiliation(s)
- Karsten Overgaard
- Department of Neurology, University Hospital of Copenhagen, Herlev Hospital, Herlev, Denmark.
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20
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Chang DJ, Oh SH, Lee N, Choi C, Jeon I, Kim HS, Shin DA, Lee SE, Kim D, Song J. Contralaterally transplanted human embryonic stem cell-derived neural precursor cells (ENStem-A) migrate and improve brain functions in stroke-damaged rats. Exp Mol Med 2013; 45:e53. [PMID: 24232252 PMCID: PMC3849578 DOI: 10.1038/emm.2013.93] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 01/19/2023] Open
Abstract
The transplantation of neural precursor cells (NPCs) is known to be a promising approach to ameliorating behavioral deficits after stroke in a rodent model of middle cerebral artery occlusion (MCAo). Previous studies have shown that transplanted NPCs migrate toward the infarct region, survive and differentiate into mature neurons to some extent. However, the spatiotemporal dynamics of NPC migration following transplantation into stroke animals have yet to be elucidated. In this study, we investigated the fates of human embryonic stem cell (hESC)-derived NPCs (ENStem-A) for 8 weeks following transplantation into the side contralateral to the infarct region using 7.0T animal magnetic resonance imaging (MRI). T2- and T2*-weighted MRI analyses indicated that the migrating cells were clearly detectable at the infarct boundary zone by 1 week, and the intensity of the MRI signals robustly increased within 4 weeks after transplantation. Afterwards, the signals were slightly increased or unchanged. At 8 weeks, we performed Prussian blue staining and immunohistochemical staining using human-specific markers, and found that high percentages of transplanted cells migrated to the infarct boundary. Most of these cells were CXCR4-positive. We also observed that the migrating cells expressed markers for various stages of neural differentiation, including Nestin, Tuj1, NeuN, TH, DARPP-32 and SV38, indicating that the transplanted cells may partially contribute to the reconstruction of the damaged neural tissues after stroke. Interestingly, we found that the extent of gliosis (glial fibrillary acidic protein-positive cells) and apoptosis (TUNEL-positive cells) were significantly decreased in the cell-transplanted group, suggesting that hESC-NPCs have a positive role in reducing glia scar formation and cell death after stroke. No tumors formed in our study. We also performed various behavioral tests, including rotarod, stepping and modified neurological severity score tests, and found that the transplanted animals exhibited significant improvements in sensorimotor functions during the 8 weeks after transplantation. Taken together, these results strongly suggest that hESC-NPCs have the capacity to migrate to the infarct region, form neural tissues efficiently and contribute to behavioral recovery in a rodent model of ischemic stroke.
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Affiliation(s)
- Da-Jeong Chang
- Department of Biomedical Science, CHA Stem Cell Institute, CHA University, Seoul, Republic of Korea
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21
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Kruyt ND, Nederkoorn PJ, Dennis M, Leys D, Ringleb PA, Rudd AG, Vermeulen M, Stam J, Hacke W, Roos YB. Door-to-needle time and the proportion of patients receiving intravenous thrombolysis in acute ischemic stroke: uniform interpretation and reporting. Stroke 2013; 44:3249-53. [PMID: 24052509 DOI: 10.1161/strokeaha.113.001885] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nyika D Kruyt
- From the Department of Neurology, Slotervaart Hospital Amsterdam (N.D.K.), Department of Neurology, Academic Medical Centre Amsterdam (P.J.N., M.V., J.S., Y.B.R.), The Netherlands; Department of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, Scotland (M.D.); Department of Neurology, Lille University Hospital, Lille, France (D.L.); Department of Neurology, Universität Heidelberg, Heidelberg, Germany (P.A.R., W.H.); and Department of Stroke Medicine, Guy's & St Thomas' Foundation Trust, London, England (A.G.R.)
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22
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Couper K, Salman B, Soar J, Finn J, Perkins GD. Debriefing to improve outcomes from critical illness: a systematic review and meta-analysis. Intensive Care Med 2013; 39:1513-23. [DOI: 10.1007/s00134-013-2951-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/03/2013] [Indexed: 02/06/2023]
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23
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Smith S, Horgan F, Sexton E, Cowman S, Hickey A, Kelly P, McGee H, Murphy S, O'Neill D, Royston M, Shelley E, Wiley M. The future cost of stroke in Ireland: an analysis of the potential impact of demographic change and implementation of evidence-based therapies. Age Ageing 2013; 42:299-306. [PMID: 23302602 DOI: 10.1093/ageing/afs192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND PURPOSE this paper examines the impact of demographic change from 2007 to 2021 on the total cost of stroke in Ireland and analyses potential impacts of expanded access to stroke unit care and thrombolytic therapy on stroke outcomes and costs. METHODS total costs of stroke are estimated for the projected number of stroke cases in 2021 in Ireland. Analysis also estimates the potential number of deaths or institutionalised cases averted among incident stroke cases in Ireland in 2007 at different rates of access to stroke unit care and thrombolytic therapy. Drawing on these results, total stroke costs in Ireland in 2007 are recalculated on the basis of the revised numbers of incident stroke patients estimated to survive stroke, and of the numbers estimated to reside at home rather than in a nursing home in the context of expanded access to stroke units or thrombolytic therapy. RESULTS future costs of stroke in Ireland are estimated to increase by 52-57% between 2007 and 2021 on the basis of demographic change. The projected increase in aggregate stroke costs for all incident cases in 1 year in Ireland due to the delivery of stroke unit care and thrombolytic therapy can be offset to some extent by reductions in nursing home and other post-acute costs.
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Affiliation(s)
- Samantha Smith
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Ireland.
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Bing F, Jacquin G, Poppe A, Roy D, Raymond J, Weill A. The cost of materials for intra-arterial thrombectomy. Interv Neuroradiol 2013; 19:83-6. [PMID: 23472729 DOI: 10.1177/159101991301900113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 12/06/2012] [Indexed: 11/16/2022] Open
Abstract
This paper reports the cost of endovascular materials used for the treatment of large-vessel ischemic stroke in the anterior circulation according to the angiographic score and clinical results at three months. From November 2009 to July 2011, 57 ischemic patients (mean age, 64.6 ±13.8 years) with anterior large vessel occlusion were included. Mean National Institutes of Health Stroke Scale (NIHSS) on admission was 18.4 ± 4.9. Mean duration of symptoms until the arterial puncture was 207±67 minutes. Recanalization was assessed using the Thrombolysis In Myocardial Infarction (TIMI) score. Patient selection was performed on a non-enhanced CT scanner. According to the TIMI final angiographic score and the modified Rankin score (mRS) at three months, we determined the cost of the material used. Complete (n=12, TIMI grade 3) or partial perfusion (n=35, TIMI grade 2) was achieved in 47 (82.5%) lesions. At three months, 33.3% (n=19) had a mRS score ≤ 2. The mean cost of the material used in the operative room was 5018±2402 euro. Intra-arterial thrombolysis presents a substantial initial cost and the long-term economic impact has to be evaluated. Our health system has to take the price of these new technologies into account for future medical choices and urgently evaluate them in randomized controlled trials.
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Affiliation(s)
- F Bing
- Department of Interventional Radiology, University Hospital of Strasbourg, NHC, Strasbourg, France.
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25
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Affiliation(s)
- Maaike Dirks
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam 3000 CA, Netherlands
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Intravenous thrombolysis in acute ischemic stroke after POLKARD: one center analysis of program impact on clinical practice. Adv Med Sci 2012; 56:231-40. [PMID: 22112428 DOI: 10.2478/v10039-011-0045-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Intravenous thrombolysis in the acute ischemic stroke was initiated in Poland within the National Cardiovascular Disease Prevention and Treatment Program POLKARD in the years 2003-2008. Since 2009 the procedure has been reimbursed by the National Health Fund (Narodowy Fundusz Zdrowia - NFZ). The purpose of the presented study was to assess whether the change of financing institution was associated with the change in proportion of patients treated and with any of the clinical parameters or stroke outcomes. PATIENTS AND METHODS We reviewed the data of the 90 consecutive patients with acute ischemic stroke treated with intravenous thrombolysis within 3-hours from symptoms onset. The differences between the POLKARD period and the year 2009, regarding clinical parameters, time delays, death rates and functional outcomes on day 90 after the stroke were analyzed. The association of outcome measures with baseline characteristics of the patients was analyzed with binary logistic regression. RESULTS In 2009 there was a significant increase in the proportion of patients treated (7.6%, 95%CI 5.3-10.7%, vs. 4.3%, 95%CI 3.3-5.5% respectively, p=0.013). There were no differences in age, baseline neurological presentation, prevalence of stoke risk factors, treatment time delays or hemorrhagic complications. Higher, but not significantly, 90-day mortality was observed (32.1%, 95%CI 13.3-54.1% vs. 16.1%, 95%CI 6.4-29.7% respectively, p=0.101). Baseline neurological deficits and in-hospital treatment time delays were significant predictors of disability and death. CONCLUSIONS After the Polish Ministry of Health program POLKARD termination and elimination of the reimbursement limits, higher proportion of ischemic stroke patients could be treated with the intravenous thrombolysis.
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Park SY, Kim MH, Kim OJ, Ahn HJ, Song JY, Jeong JY, Oh SH. Plasma heart-type fatty acid binding protein level in acute ischemic stroke: comparative analysis with plasma S100B level for diagnosis of stroke and prediction of long-term clinical outcome. Clin Neurol Neurosurg 2012; 115:405-10. [PMID: 22766253 DOI: 10.1016/j.clineuro.2012.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 04/18/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Heart-type fatty acid binding protein (H-FABP) is enriched in neuronal cell body as well as myocardium, and is rapidly released from damaged neuron into circulation in cerebral ischemia. We performed a comparative analysis between plasma H-FABP and S100B levels in the acute phase of ischemic stroke. METHODS The present study included 111 consecutive patients with acute ischemic stroke and 127 control subjects. Measurement of plasma H-FABP and S100B levels was conducted during acute phase (<24 h) of stroke. Clinical severities were evaluated by the use of NIHSS scores at admission and mRS score at 3 months after symptom onset. RESULTS Both the plasma H-FABP and S100B levels were significantly higher in stroke group than control group. In multiple logistic regression analysis, statistical significance of both markers remained significant after adjusting the vascular risk factors. In the receiver operator characteristic (ROC) curve analysis, neither H-FABP (area under curve [AUC]=0.71, P<0.001, sensitivity: 59.5%, specificity: 79.5%) nor S100B (AUC=0.70, P<0.001, sensitivity: 54.0%, specificity: 83.5%) showed a favorable degree of diagnostic value to discriminate stroke from stroke mimic. Plasma H-FABP (r=0.46, P<0.01) and S100B (r=0.45, P<0.01) were correlated with initial NIHSS score, and both marker were significantly higher in patients with poor clinical outcome. CONCLUSION Although plasma H-FABP is elevated in the acute phase of ischemic stroke, the diagnostic accuracy of H-FABP as a sole marker is not sufficient to be applied in the clinical setting. Plasma H-FABP can be used as a potential marker for stroke prognosis.
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Affiliation(s)
- So-Young Park
- Department of Neurology, CHA University, Seongnam, Republic of Korea
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Fischer U, Mono ML, Zwahlen M, Nedeltchev K, Arnold M, Galimanis A, Bucher S, Findling O, Meier N, Brekenfeld C, Gralla J, Heller R, Tschannen B, Schaad H, Waldegg G, Zehnder T, Ronsdorf A, Oswald P, Brunner G, Schroth G, Mattle HP. Impact of Thrombolysis on Stroke Outcome at 12 Months in a Population. Stroke 2012; 43:1039-45. [DOI: 10.1161/strokeaha.111.630384] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Thrombolysis improves outcome of patients with acute ischemic stroke, but it is unknown whether thrombolysis has a measurable effect on long-term outcome in a defined population.
Methods—
We prospectively assessed demographic data, management, and outcome of acute ischemic stroke patients admitted within 48 hours to 18 primary care hospitals of the canton of Bern (969 299 inhabitants) during 12 months. Blinded follow-up was obtained at 3 and 12 months. Predictors of mortality and favorable outcome (modified Rankin Scale score ≤2) at 3 and 12 months using logistic regression were analyzed.
Results—
From December 2007 to December 2008, 807 patients (mean age, 72 years) were included. Median National Institutes of Health Stroke Scale score on admission was 5; 107 patients (13%) received intravenous, intra-arterial, or mechanical thrombolysis. Estimated cumulative mortality at 3 months was 20.6% and at 12 months 27.4%. Age 75 years or older, higher National Institutes of Health Stroke Scale scores, and higher Charlson comorbidity index were independent predictors of mortality at 3 and 12 months. Estimated favorable outcome at 3 months was 48.2% and at 12 months was 44.6%. Thrombolysis was the only modifiable independent predictor of favorable outcome at 3 (relative risk, 1.49; 95% CI, 1.18–1.89) and 12 months (relative risk, 1.59; 95% CI, 1.24–2.04), whereas age younger than 75 years, male gender, National Institutes of Health Stroke Scale score <4, and lower Charlson comorbidity index were nonmodifiable predictors.
Conclusions—
Thirteen percent of acute ischemic stroke patients admitted within 48 hours to Bernese hospitals underwent thrombolysis, which exerted a measurable effect on 3-month outcome in this population. This effect was sustained at 12 months. Age, stroke severity, Charlson comorbidity index, and male gender were independent nonmodifiable predictors of outcome.
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Affiliation(s)
- Urs Fischer
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Marie-Luise Mono
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Marcel Zwahlen
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Krassen Nedeltchev
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Marcel Arnold
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Aekatarini Galimanis
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Sabine Bucher
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Oliver Findling
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Niklaus Meier
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Caspar Brekenfeld
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Jan Gralla
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Regula Heller
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Beatrice Tschannen
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Heinz Schaad
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Gabriel Waldegg
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Thomas Zehnder
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Anke Ronsdorf
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Phillip Oswald
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Georg Brunner
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Gerhard Schroth
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Heinrich P. Mattle
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
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Chen R, Vendrell I, Chen CPC, Cash D, O'Toole KG, Williams SA, Jones C, Preston JE, Wheeler JX. Proteomic analysis of rat plasma following transient focal cerebral ischemia. Biomark Med 2012; 5:837-46. [PMID: 22103620 DOI: 10.2217/bmm.11.89] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This study aimed to identify plasma protein changes in a rat model of ischemic stroke using a proteomic approach. MATERIALS & METHODS Four male Sprague-Dawley rats (3-6 months old) were subjected to 90 min of left middle cerebral artery occlusion under anesthesia with 1.5% isoflurane in O(2)/air followed by 24-h reperfusion. Blood samples (~100 µl) were collected at baseline, at the end of 90-min middle cerebral artery occlusion and at 24-h postreperfusion. Brain injuries were assessed by MRI at 24-h postreperfusion. Quantitative comparison of global plasma protein expression was performed using 2D differential in-gel electrophoresis. Differentially expressed protein spots were identified using peptide sequencing tandem mass spectrometry. RESULTS These rats had clear brain infarction in the left hemisphere detected by MRI. Thirty-three protein spots of plasma samples were differentially expressed following focal cerebral ischemia/reperfusion. These protein spots belonged to eight proteins. Six of them (α2-macroglobulin, complement C3, inter-α- trypsin inhibitor heavy chain H3, serum albumin, haptoglobin and transthyretin), which are a class of acute-phase proteins, changed significantly. CONCLUSION This study describes the responses of young rats to focal cerebral ischemia and suggests that future studies should use aged animals to better mimic the clinical ischemic stroke setting.
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Affiliation(s)
- Ruoli Chen
- National Institute for Biological Standards & Control, Health Protection Agency, Blanche Lane, South Mimms, Potters Bar, Hertfordshire, UK.
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Dalloz M, Bottin L, Muresan I, Favrole P, Foulon S, Levy P, Drouet T, Marro B, Alamowitch S. Thrombolysis rate and impact of a stroke code: A French hospital experience and a systematic review. J Neurol Sci 2012; 314:120-5. [DOI: 10.1016/j.jns.2011.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/02/2011] [Accepted: 10/04/2011] [Indexed: 11/15/2022]
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Karlinski M, Kobayashi A, Mikulik R, Sanak D, Wahlgren N, Czlonkowska A. Intravenous Alteplase in Ischemic Stroke Patients not Fully Adhering to the Current Drug License in Central and Eastern Europe. Int J Stroke 2012; 7:615-22. [PMID: 22309238 DOI: 10.1111/j.1747-4949.2011.00733.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The current European license for alteplase in acute ischemic stroke excludes from treatment large groups of patients. Nevertheless, in everyday practice, many patients receive off-label thrombolysis at the physician's discretion. Aim Our aim was to evaluate safety and effectiveness of intravenous alteplase in patients not fully adhering to the drug license compared with those treated strictly according to the license in Central and Eastern Europe. Methods We analyzed the data contributed to Safe Implementation of Thrombolysis in Stroke registry from nine countries between February 2003 and February 2010. Statistical analysis included multivariate logistic regression. Results Of 5594 consecutive patients, 1919 patients (34·3%) not fully adhered to the license. The most frequent deviations were: time-to-treatment >3 h (13·1%), use of intravenous antihypertensives (8·3%), age >80 years (7·3%), oral anticoagulation (4·2%), a previous stroke with concomitant diabetes (3·9%), and previous stroke <three-months (2·7%). The off-label group showed a significantly higher rate of symptomatic intracranial haemorrhage, which was not confirmed in the multivariate analysis. License nonadherence significantly increased the risk of death or dependency (odds ratio 1·26; 95% confidence interval: 1·08–1·48), with a trend for increased mortality (odds ratio 1·17; 95% confidence interval: 0·97–1·42). Isolated time-to-treatment >3 h was an independent predictor of unfavorable outcome (odds ratio 1·32; 95% confidence interval: 1·01–1·71). Conclusion Our findings show that patients not fully adhering to the European license are not at increased risk of symptomatic intracranial haemorrhage but achieve less favorable outcome. Some contraindications appear more redundant than others. However, the final conclusions about safety and effectiveness should be based on the results of ongoing randomized trials.
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Affiliation(s)
- Michal Karlinski
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Adam Kobayashi
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Robert Mikulik
- Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Daniel Sanak
- Department of Neurology, University Hospital, Olomouc, Czech Republic
| | - Nils Wahlgren
- Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anna Czlonkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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Intravenous thrombolysis for acute ischaemic stroke in patients not fully adhering to the European licence in Poland. Neurol Neurochir Pol 2012; 46:3-14. [DOI: 10.5114/ninp.2012.27179] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Minnerup J, Wersching H, Ringelstein EB, Schilling M, Schäbitz WR, Wellmann J, Berger K. Impact of the Extended Thrombolysis Time Window on the Proportion of Recombinant Tissue-Type Plasminogen Activator-Treated Stroke Patients and on Door-to-Needle Time. Stroke 2011; 42:2838-43. [DOI: 10.1161/strokeaha.111.616565] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Jens Minnerup
- From the Department of Neurology (J.M., E.B.R., M.S.), University of Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany; the Institute of Epidemiology and Social Medicine (H.W., J.W., K.B.), University of Münster, Münster, Germany; and the Department of Neurology (W.-R.S.), EVK Bielefeld, Bielefeld, Germany
| | - Heike Wersching
- From the Department of Neurology (J.M., E.B.R., M.S.), University of Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany; the Institute of Epidemiology and Social Medicine (H.W., J.W., K.B.), University of Münster, Münster, Germany; and the Department of Neurology (W.-R.S.), EVK Bielefeld, Bielefeld, Germany
| | - E. Bernd Ringelstein
- From the Department of Neurology (J.M., E.B.R., M.S.), University of Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany; the Institute of Epidemiology and Social Medicine (H.W., J.W., K.B.), University of Münster, Münster, Germany; and the Department of Neurology (W.-R.S.), EVK Bielefeld, Bielefeld, Germany
| | - Matthias Schilling
- From the Department of Neurology (J.M., E.B.R., M.S.), University of Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany; the Institute of Epidemiology and Social Medicine (H.W., J.W., K.B.), University of Münster, Münster, Germany; and the Department of Neurology (W.-R.S.), EVK Bielefeld, Bielefeld, Germany
| | - Wolf-Rüdiger Schäbitz
- From the Department of Neurology (J.M., E.B.R., M.S.), University of Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany; the Institute of Epidemiology and Social Medicine (H.W., J.W., K.B.), University of Münster, Münster, Germany; and the Department of Neurology (W.-R.S.), EVK Bielefeld, Bielefeld, Germany
| | - Jürgen Wellmann
- From the Department of Neurology (J.M., E.B.R., M.S.), University of Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany; the Institute of Epidemiology and Social Medicine (H.W., J.W., K.B.), University of Münster, Münster, Germany; and the Department of Neurology (W.-R.S.), EVK Bielefeld, Bielefeld, Germany
| | - Klaus Berger
- From the Department of Neurology (J.M., E.B.R., M.S.), University of Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany; the Institute of Epidemiology and Social Medicine (H.W., J.W., K.B.), University of Münster, Münster, Germany; and the Department of Neurology (W.-R.S.), EVK Bielefeld, Bielefeld, Germany
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Abilleira S, Dávalos A, Chamorro A, Alvarez-Sabín J, Ribera A, Gallofré M. Outcomes of intravenous thrombolysis after dissemination of the stroke code and designation of new referral hospitals in Catalonia: the Catalan Stroke Code and Thrombolysis (Cat-SCT) Monitored Study. Stroke 2011; 42:2001-6. [PMID: 21566237 DOI: 10.1161/strokeaha.110.605030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE From 2006, the Stroke Code system operates throughout Catalonia with full coverage. The objective of this study was to determine safety and effectiveness of intravenous thrombolysis in routine practice through a monitored study (Catalan Stroke Code and Thrombolysis [Cat-SCT]) and to assess outcomes according to hospitals' previous experience. METHODS We conducted a prospective, multicenter, observational, monitored study of recombinant tissue plasminogen activator-treated patients declared to the Cat-SCT by all treating hospitals in Catalonia (n=13, of which 6 were newly designated) over a 12-month period. Consecutive recruitment and quality of data were assured through comprehensive quality control. We estimated rates of outcome measures for the potential final sample (after inclusion of undeclared cases) and compared them with those reported for the actual sample. Symptomatic intracranial hemorrhage, mortality, and favorable outcome (modified Rankin Scale score 0 to 1) at 3 months were also evaluated according to hospitals' previous experience using multilevel logistic regression. RESULTS We analyzed 488 patients with a median age of 72 years (interquartile range: 63, 77), 57.2% males, with a baseline National Institutes of Health Stroke Scale score of 13 (interquartile range: 8, 19), and stroke to treatment time of 150 minutes (interquartile range: 120, 180 minutes). Symptomatic intracranial hemorrhage (Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy definition) was observed in 3.3% patients. Ninety-day mortality was 16.6% and 38.5% showed a favorable outcome at 3 months. External monitoring set inclusion losses at <5%. A sensitivity analysis including undeclared cases did not show significant changes in main outcomes. Inexperienced hospitals achieved similar outcomes, except for a higher rate of favorable outcome at 3 months. CONCLUSIONS Health planning applied to acute stroke care and based on dissemination of the Stroke Code system and designation of new referral hospitals showed intravenous thrombolysis safe and effective in routine practice, even among inexperienced hospitals.
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Affiliation(s)
- Sònia Abilleira
- Stroke Programme, Catalan Agency for Health Information, Assessment and Quality, Roc Boronat 81-95, 2a planta, 08005 Barcelona, Spain.
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Statler KD, Dong L, Nielsen DM, Bratton SL. Pediatric stroke: clinical characteristics, acute care utilization patterns, and mortality. Childs Nerv Syst 2011; 27:565-73. [PMID: 20922396 DOI: 10.1007/s00381-010-1292-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 09/23/2010] [Indexed: 01/21/2023]
Abstract
PURPOSE Acute care utilization patterns are not well described but may help inform care coordination and treatment for pediatric stroke. The Kids Inpatient Database was queried to describe demographics and clinical characteristics of children with stroke, compare acute care utilization for hemorrhagic vs. ischemic stroke and Children's vs. non-Children's Hospitals, and identify factors associated with aggressive care and in-hospital mortality. METHODS Using a retrospective cohort of children hospitalized with stroke, demographics, predisposing conditions, and intensive (mechanical ventilation, advanced monitoring, and blood product administration) or aggressive (pharmacological therapy and/or invasive interventions) care were compared by stroke and hospital types. Factors associated with aggressive care or in-hospital mortality were explored using logistic regression. RESULTS Hemorrhagic stroke comprised 43% of stroke discharges, was more common in younger children, and carried greater mortality. Ischemic stroke was more common in older children and more frequently associated with a predisposing condition. Rates of intensive and aggressive care were low (30% and 15%), similar by stroke type, and greater at Children's Hospitals. Older age, hemorrhagic stroke, predisposing condition, and treatment at a Children's Hospital were associated with aggressive care. Hemorrhagic stroke and aggressive care were associated with in-hospital mortality. CONCLUSIONS Acute care utilization is similar by stroke type but both intensive and aggressive care are more common at Children's Hospitals. Mortality remains relatively high after pediatric stroke. Widespread implementation of treatment guidelines improved outcomes in adult stroke. Adoption of recently published treatment recommendations for pediatric stroke may help standardize care and improve outcomes.
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Affiliation(s)
- Kimberly D Statler
- Department of Pediatrics, University of Utah, PO Box 2581289, 295 Chipeta Way, Salt Lake City, UT 84158, USA.
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Macleod MR, Petersson J, Norrving B, Hacke W, Dirnagl U, Wagner M, Schwab S. Hypothermia for Stroke: call to action 2010. Int J Stroke 2011; 5:489-92. [PMID: 21086713 DOI: 10.1111/j.1747-4949.2010.00520.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The European Hypothermia Stroke Research Workshop was held in January 2010, in response to the alarming prospects of a significant increase of stroke expected in the coming years globally. Considering that a minority of patients (around 10%) are currently eligible for thrombolytic treatment, there is a need for an efficacious, cost-effective novel therapy that can be implemented broadly within European health care systems. Accordingly, the primary objective of the workshop was the definition of a research agenda aiming to assess the therapeutic benefits of hypothermia in patients with acute ischaemic stroke. The meeting was organised by the European Stroke Research Network for Hypothermia (EuroHyp) and attended by the representatives of World Stroke Organisation, European Stroke Organisation, Stroke Alliance for Europe, Society for Cryobiology and other organisations--specifically the European Space Agency, and small- and medium-sized enterprises based in EU member states. The participants adopted the 'Hypothermia for Stroke--Call to Action 2010', a declaration specifying the priorities for hypothermia research in acute ischaemic stroke. The research programme outlined--a clinical study programme designed to identify and validate therapeutic cooling as a novel treatment providing benefit to a large number of stroke patients--contains a well-integrated series of Phase II studies aiming to refine the intervention (depth, duration, and mode of cooling; antishivering strategy; patient selection) and a pivotal Phase III clinical trial. The proposed integrated Phase II and III clinical study programme would test the effectiveness of this optimised intervention, and would allow the development of evidence-based Clinical Practice Guidelines describing the optimal use of therapeutic hypothermia as a treatment strategy for stroke.
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Affiliation(s)
- Malcolm R Macleod
- Department of Clinical Neurosciences, University of Edinburgh,Western General Hospital, Edinburgh, UK
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Eriksson M, Jonsson F, Appelros P, Asberg KH, Norrving B, Stegmayr B, Terént A, Asplund K. Dissemination of thrombolysis for acute ischemic stroke across a nation: experiences from the Swedish stroke register, 2003 to 2008. Stroke 2010; 41:1115-22. [PMID: 20395610 DOI: 10.1161/strokeaha.109.577106] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We used Riks-Stroke, the Swedish Stroke Register, to explore how thrombolysis has been disseminated in Swedish hospitals since it was approved in 2003. METHODS All 78 hospitals in Sweden admitting patients with acute stroke participate in Riks-Stroke. Between 2003 and 2008, 72 033 adult patients were hospitalized for acute ischemic stroke. We analyzed thrombolysis use by region, patient characteristics, and stroke service settings. RESULTS Nationwide, the use of thrombolysis increased from 0.9% in 2003 to 6.6% in 2008. There were marked regional differences in the dissemination of thrombolysis, but these gaps narrowed over time. Nonuniversity hospitals reached treatment levels similar to university settings, although with a 2- to 3-year delay. Symptomatic intracranial hemorrhage remained at the 3% to 9% level without an apparent time trend during dissemination. Independent predictors of higher thrombolysis use included younger age, male sex, not living alone, and no history of stroke or diabetes. In 2008, patients admitted to a stroke unit were 5 times more likely to receive thrombolysis than those admitted to general wards. CONCLUSIONS Nationwide implementation of thrombolysis has been slow but has accelerated mainly due to increased access outside university hospitals. The increased use has been achieved safely, but access has been unequal.
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Affiliation(s)
- Marie Eriksson
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, 901 87 Umeå, Sweden.
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Affiliation(s)
- Linda S Williams
- Veterans Affairs HSR&D Stroke Quality Enhancement Research Initiative, Roudebush Veterans Affairs Medical Center, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
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