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Sadeghi NS, Maleki M, Gorji HA, Vatankhah S, Mohaghegh B. Differences and their contexts between teaching and nonteaching hospitals in Iran with other countries: A concurrent mixed-methods study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:32. [PMID: 35281395 PMCID: PMC8893075 DOI: 10.4103/jehp.jehp_1431_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND In terms of missions, hospitals are divided into teaching and nonteaching. In addition, differences in health-care systems in countries will lead to differences in hospitals' operation. Iran, as a specific health-care system, is different from other countries. Hence, the present study investigated differences between teaching and nonteaching hospitals and their differences in Iran and the world. MATERIALS AND METHODS A concurrent mixed-methods study was conducted in two stages. The first stage was a narrative review of studies (2000-2020). Using narrative inquiry and reflective analysis, the content was analyzed and the categories were extracted. The second stage was a qualitative study conducted using semi-structured interviews with forty Iranian hospital managers and policymakers through a purposive sampling in 2020. Content analysis was made using deductive approach, and MAXQDA 12 was used for data analysis. RESULTS According to the first stage, categories were extracted as follows: service quality, type of cases, patient satisfaction, efficiency, performance indicators, patient safety, personnel, use of drugs, access to services, technologies, justice in the type of services received, using guidelines, processes, and number of services. In the second stage, 8 main categories, 17 categories, and 45 subcategories were extracted. The extracted main categories were as follows: mission and target, management and behavioral organizations, supply chain and chain of results, human resources, costs and budget, policy demands, clients' satisfaction and patients' right, and integration of medical education. CONCLUSION Unlike other countries, in Iran, the combination of missions and the complete dependence of teaching hospitals on the government has caused differences. Reducing the treatment mission of teaching hospitals; differences in the budget and development of its indicators; lower tariffs for teaching hospitals; developing a cost-income management model and supply chain; preventing uncertainty other than medical students except medicine; considering the clients' right to choose hospital; and organizing research missions in hospitals were the solutions for decrease differences.
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Affiliation(s)
- Niusha Shahidi Sadeghi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Vatankhah
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohaghegh
- Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran
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Ortega-Gutierrez S, Farooqui M, Zha A, Czap A, Sebaugh J, Desai S, Jadhav A, Vora N, Rai V, Jovin TG, Thon JM, Heslin M, Thau L, Zevallos C, Quispe-Orozco D, Jillella DV, Nahab F, Mohammaden MH, Nogueira RG, Haussen DC, Nguyen TN, Romero JR, Aparicio HJ, Osman M, Haq IU, Liebeskind D, Hassan AE, Zaidat O, Siegler JE. Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration. Clin Neurol Neurosurg 2021; 201:106436. [PMID: 33383463 PMCID: PMC7836428 DOI: 10.1016/j.clineuro.2020.106436] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND To evaluate overall ischemic stroke volumes and rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US. METHODS We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as; March-May 2020 (COVID-19 period) and March-May 2019 (seasonal pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0-7), moderate [8-14], and severe (>14). Secondary outcomes were volume of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and discharge disposition. RESULTS Of the 7969 patients diagnosed with acute ischemic stroke during the study period, 933 (12 %) presented in the COVID-19 period while 1319 (17 %) presented in the seasonal pre-COVID-19 period. Significant decline was observed in the mean weekly volumes of newly diagnosed ischemic strokes (98 ± 3 vs 50 ± 20,p = 0.003), LVOs (16.5 ± 3.8 vs 8.3 ± 5.9,p = 0.008), and IV-tPA (10.9 ± 3.4 vs 5.3 ± 2.9,p = 0.0047), whereas the mean weekly proportion of LVOs (18 % ±5 vs 16 % ±7,p = 0.24) and IV-tPA (10.4 % ±4.5 vs. 9.9 % ±2.4,p = 0.66) remained the same, when compared to the seasonal pre-COVID-19 period. Additionally, an increased proportion of patients presented with a severe disease (NIHSS > 14) during the COVID-19 period (29.7 % vs 24.5 %,p < 0.025). The odds of being discharged to home were 26 % greater in the COVID-19 period when compared to seasonal pre-COVID-19 period (OR:1.26, 95 % CI:1.07-1.49,p = 0.016). CONCLUSIONS During COVID-19 period there was a decrease in volume of newly diagnosed ischemic stroke cases and IV-tPA administration. Patients admitted to the hospital had severe neurological clinical presentation and were more likely to discharge home.
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Affiliation(s)
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Alicia Zha
- Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030, USA
| | - Alexandra Czap
- Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030, USA
| | - Jacob Sebaugh
- Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030, USA
| | - Shashvat Desai
- University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA, 15219, USA; University of Pittsburgh Medical Center Presbyterian Medical Center, Pittsburgh, PA, 15213, USA
| | - Ashutosh Jadhav
- University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA, 15219, USA; University of Pittsburgh Medical Center Presbyterian Medical Center, Pittsburgh, PA, 15213, USA
| | - Nirav Vora
- Ohio Health Neuroscience Center, Riverside Methodist Hospital, Columbus, OH, 43214, USA
| | - Vivek Rai
- Ohio Health Neuroscience Center, Riverside Methodist Hospital, Columbus, OH, 43214, USA
| | - Tudor G Jovin
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, 08103, USA
| | - Jesse M Thon
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, 08103, USA
| | - Mark Heslin
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, 08103, USA
| | - Lauren Thau
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Cynthia Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Darko Quispe-Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA
| | - Dinesh V Jillella
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, 30303, USA
| | - Fadi Nahab
- Department of Neurology & Pediatrics, Emory University, Atlanta, GA, 30319, USA
| | - Mahmoud H Mohammaden
- Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, 30303, USA
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, 30303, USA
| | - Diogo C Haussen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, 30303, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA, 02118, USA
| | - Jose Rafael Romero
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA, 02118, USA
| | - Hugo J Aparicio
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA, 02118, USA
| | - Mohamed Osman
- Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH, 43608, USA
| | - Israr Ul Haq
- Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH, 43608, USA
| | - David Liebeskind
- Department of Neurology, Ronald Reagan University of California at Los Angeles, Los Angeles, CA, 90095, USA
| | - Ameer E Hassan
- Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX, 78550, USA
| | - Osama Zaidat
- Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH, 43608, USA
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, 08103, USA
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Man S, Tang AS, Schold JD, Kolikonda MK, Uchino K. The Patterns and Outcomes of Inter-Hospital Transfer Among Medicare Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:105331. [PMID: 32992204 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/03/2020] [Accepted: 09/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Inter-hospital transfer for ischemic stroke is an essential part of stroke system of care. This study aimed to understand the national patterns and outcomes of ischemic stroke transfer. METHODS AND RESULTS This retrospective study examined Medicare beneficiaries aged ≥65 years undergoing inter-hospital transfer for ischemic stroke in 2012. Cox proportional hazards model was used to compare 30-day and one-year mortality between transferred patients and direct admissions from the emergency department (ED admissions). Among 312,367 ischemic stroke admissions, 5.7% underwent inter-hospital transfer. Using this value as cut-off, the hospitals were classified into receiving (n = 411), sending (n = 559), and low-transfer (n = 1863) hospitals. Receiving hospitals were larger than low-transfer and sending hospitals as demonstrated by the median bed number (371, 189, and 88, respectively, p < 0.001); more frequently to be certified stroke centers (75%, 47%, and 16%, respectively, p < 0.001); and less commonly located in the rural area (2%, 7%, and 24%, respectively, p < 0.001). For receiving hospitals, transfer-in patients and ED admissions had comparable mortality at 30 days (10% vs 10%; adjusted HR [aHR]=1.07; 95% CI, 0.99-1.14) and 1 year (23% vs 24%; aHR=1.03; 95% CI, 0.99-1.08). For sending hospitals, transfer-out patients, compared to ED admissions, had higher mortality at 30 days (14% vs 11%; aHR=1.63; 95% CI, 1.39-1.91) and 1 year (30% vs 27%; aHR=1.33; 95% CI, 1.20-1.48). For low-transfer hospitals, overall transfer-in and transfer-out patients, compared to ED admissions, had higher mortality at 30 days (13% vs 10%; aHR=1.46; 95% CI, 1.33-1.60) and 1 year (28% vs 25%; aHR=1.27; 95% CI, 1.19-1.36). CONCLUSIONS Hospitals in the US, based on their transfer patterns, could be classified into 3 groups that shared distinct characteristics including hospital size, rural vs urban location, and stroke certification. Transferred patients at sending and low-transfer hospitals had worse outcomes than their ED admission counterpart.
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Affiliation(s)
- Shumei Man
- Department of Neurology & Cerebrovascular Center, Neurological Institute, Cleveland Clinic, United States
| | - Anne S Tang
- Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, United States
| | - Jesse D Schold
- Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, United States
| | - Murali K Kolikonda
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue/S80, Cleveland, OH, United States
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue/S80, Cleveland, OH, United States.
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Chu SY, Cox M, Fonarow GC, Smith EE, Schwamm L, Bhatt DL, Matsouaka RA, Xian Y, Sheth KN. Temperature and Precipitation Associate With Ischemic Stroke Outcomes in the United States. J Am Heart Assoc 2019; 7:e010020. [PMID: 30571497 PMCID: PMC6404452 DOI: 10.1161/jaha.118.010020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background There is disagreement in the literature about the relationship between strokes and seasonal conditions. We sought to (1) describe seasonal patterns of stroke in the United States, and (2) determine the relationship between weather variables and stroke outcomes. Methods and Results We performed a cross‐sectional study using Get With The Guidelines‐Stroke data from 896 hospitals across the continental United States. We examined effects of season, climate region, and climate variables on stroke outcomes. We identified 457 638 patients admitted from 2011 to 2015 with ischemic stroke. There was a higher frequency of admissions in winter (116 862 in winter versus 113 689 in spring, 113 569 in summer, and 113 518 in fall; P<0.0001). Winter was associated with higher odds of in‐hospital mortality (odds ratio [OR] 1.08 relative to spring, confidence interval [CI] 1.04–1.13, P=0.0004) and lower odds of discharge home (OR 0.92, CI 0.91–0.94, P<0.0001) or independent ambulation at discharge (OR 0.96, CI 0.94–0.98, P=0.0006). These differences were attenuated after adjusting for climate region and case mix and became inconsistent after controlling for weather variables. Temperature and precipitation were independently associated with outcome after multivariable analysis, with increases in temperature and precipitation associated with lower odds of mortality (OR 0.95, CI 0.93–0.97, P<0.0001 and OR 0.95, CI 0.90–1.00, P=0.035, respectively). Conclusions Admissions for ischemic stroke were more frequent in the winter. Warmer and wetter weather conditions were independently associated with better outcomes. Further studies should aim to identify sensitive populations and inform public health measures aimed at resource allocation, readiness, and adaptive strategies.
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Affiliation(s)
- Stacy Y Chu
- 1 Department of Neurology Yale School of Medicine New Haven CT
| | - Margueritte Cox
- 2 Outcomes Research and Assessment Group Duke Clinical Research Institute Durham NC
| | - Gregg C Fonarow
- 3 Division of Cardiology Department of Medicine UCLA Health Los Angeles CA
| | - Eric E Smith
- 4 Department of Clinical Neurosciences Hotchkiss Brain Institute University of Calgary Alberta Canada
| | - Lee Schwamm
- 5 Division of Stroke Department of Neurology Massachusetts General Hospital Boston MA
| | - Deepak L Bhatt
- 6 Brigham and Women's Hospital Heart & Vascular Center Harvard Medical School Boston MA
| | - Roland A Matsouaka
- 2 Outcomes Research and Assessment Group Duke Clinical Research Institute Durham NC
| | - Ying Xian
- 2 Outcomes Research and Assessment Group Duke Clinical Research Institute Durham NC.,7 Department of Neurology Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Kevin N Sheth
- 8 Division of Neurocritical Care and Emergency Neurology Department of Neurology Yale School of Medicine New Haven CT
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Darehed D, Blom M, Glader EL, Niklasson J, Norrving B, Eriksson M. Time Trends and Monthly Variation in Swedish Acute Stroke Care. Front Neurol 2019; 10:1177. [PMID: 31787926 PMCID: PMC6854029 DOI: 10.3389/fneur.2019.01177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose: Studies of monthly variation in acute stroke care have led to conflicting results. Our objective was to study monthly variation and longitudinal trends in quality of care and patient survival following acute stroke. Methods: Our nationwide study included all adult patients (≥18 years) with acute stroke (ischemic or hemorrhagic), admitted to Swedish hospitals from 2011 to 2016, and that were registered in The Swedish Stroke Register (Riksstroke). We studied how month of admission and longitudinal trends affected acute stroke care and survival. We also studied resilience to this variation among hospitals with different levels of specialization. Results: We included 132,744 stroke admissions. The 90-day survival was highest in May and lowest in January (84.1 vs. 81.5%). Thrombolysis rates and door-to-needle time within 30 min increased from 2011 to 2016 (respectively, 7.3 vs. 12.8% and 7.7 vs. 28.7%). Admission to a stroke unit as first destination of hospital care was lowest in January and highest in June (78.3 vs. 80.5%). Stroke unit admission rates decreased in university hospitals from 2011 to 2016 (83.4 vs. 73.9%), while no such trend were observed in less specialized hospitals. All the differences above remained significant (p < 0.05) after adjustment for possible confounding factors. Conclusion: We found that month of admission and longitudinal trends both affect quality of care and survival of stroke patients in Sweden, and that the effects differ between hospital types. The observed variation suggests an opportunity to improve stroke care in Sweden. Future studies ought to focus on identifying the specific factors driving this variation, for subsequent targeting by quality improvement efforts.
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Affiliation(s)
- David Darehed
- Sunderby Research Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mathias Blom
- Department of Clinical Sciences Lund, Medicine, Lund University, Lund, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Johan Niklasson
- Sunderby Research Unit, Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Bo Norrving
- Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
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Strijbos D, Keszthelyi D, Gilissen LPL, Lacko M, Hoeijmakers JGJ, van der Leij C, de Ridder RJJ, de Haan MW, Masclee AAM. Percutaneous endoscopic versus radiologic gastrostomy for enteral feeding: a retrospective analysis on outcomes and complications. Endosc Int Open 2019; 7:E1487-E1495. [PMID: 31673622 PMCID: PMC6811353 DOI: 10.1055/a-0953-1524] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background and study aims Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are techniques used for long-term enteral feeding. Our primary aim was to analyze procedure-related and 30-day mortality and complications between PEG and PRG in relation to indications. Patients and methods A single-center retrospective analysis was performed thath included all adult patients receiving initial PEG (January 2008 until April 2016) and PRG (January 2010 until April 2016). Outcomes were mortality (procedure-related, 30-day), complications (early (≤ 30 days) and late) and success rates. Results A total of 760 procedures (469 PRG and 291 PEG) were analyzed. Most common indications were head and neck cancer (HNC), cerebrovascular accident (CVA) and amyotrophic lateral sclerosis (ALS). Success rates for placement were 91.2 % for PEG and 97.1 % for PRG ( P = 0.001). Procedure-related mortality was 1.7 % in PEG and 0.4 % in PRG ( P = 0.113). The 30-day mortality was 10.7 % in PEG and 5.1 % in PRG ( P = 0.481 after multivariate logistic regression) CVA was associated with higher 30-day mortality, whereas ALS, higher body weight, and prophylactic placements in HNC were associated with lower rates. Tube-related complications were less frequent in PEG, both early (2.7 % vs. 26.4 %, P ≤ 0.001) and late (8.6 % vs. 31.5 %, P ≤ 0.001). The percentage of major complications and infections did not differ. Conclusions With respect to procedure-related and 30-day mortality, PEG and PRG compare equally. PRG had a higher procedural success rate. Tube-related complications and pain are less frequent after PEG compared to PRG. The choice for either PEG or PRG therefore should primarily be based on local facilities and expertise.
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Affiliation(s)
- Denise Strijbos
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands,Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, The Netherlands,Corresponding author Denise Strijbos Maastricht University Medical CenterP. Debyelaan 25, 6229 HXMaastrichtthe Netherlands+31(0)402399751
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lennard P. L. Gilissen
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, The Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology/Head & Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Rogier J. J. de Ridder
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michiel W. de Haan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ad A. M. Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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Climate Change and Healthcare Sustainability in the Agincourt Sub-District, Kruger to Canyons Biosphere Region, South Africa. SUSTAINABILITY 2019. [DOI: 10.3390/su11020496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As low-income communities are most vulnerable to climate-associated health concerns, access to healthcare will increase in importance as a key priority in South Africa. This study explores healthcare sustainability in the Agincourt sub-district, Kruger to Canyons Biosphere Region in Mpumalanga, South Africa. A rapid assessment and response methodology (RAR) was implemented, which includes the examination of previous studies conducted in the sub-district, the mapping of healthcare facilities in the area, and the implementation of a facility infrastructure and workforce capacity investigation by means of key informant (KI) interviews at eight healthcare facilities. Findings indicate that the greatest need across the facilities relate to access to medical doctors and pharmacists. None of the facilities factored climate associations with health into their clinical care strategies. The necessity to train healthcare facility staff on aspects related to climate change, health, and sustainability is highlighted. Environmental health practitioners should also be incorporated in grassroots community climate adaptation strategies. Outcomes further indicate the need for the advancement of integrated healthcare and climate adaptation strategies that focus on strengthening healthcare systems, which may include novel technological approaches such as telemedicine. Policy makers need to be proactive and pre-emptive in finding and improving processes and models to render healthcare services prepared for climate change.
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Wyse CA, Celis Morales CA, Ward J, Lyall D, Smith DJ, Mackay D, Curtis AM, Bailey MES, Biello S, Gill JMR, Pell JP. Population-level seasonality in cardiovascular mortality, blood pressure, BMI and inflammatory cells in UK biobank. Ann Med 2018; 50:410-419. [PMID: 29724143 DOI: 10.1080/07853890.2018.1472389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The risk of mortality from cardiovascular disease (CVD) is higher in wintertime throughout the world, but it is not known if this reflects annual changes in diet or lifestyle, or an endogenous photoperiodic mechanism that is sensitive to changes in day length. METHODS Phenotypic data on cardiometabolic and lifestyle factors were collected throughout a 4 year time period from 502,642 middle-aged participants in UK Biobank. To assess the impact of seasonal environmental changes on cardiovascular risk factors, we linked these data to the outdoor temperature and day length at the time of assessment. Self-reported information on physical activity, diet and disease status were used to adjust for confounding factors related to health and lifestyle. RESULTS Mortality related to CVD was higher in winter, as were risk factors for this condition including blood pressure, markers of inflammation and body mass index (BMI). These seasonal rhythms were significantly related to day length after adjustment for other factors that might affect seasonality including physical activity, diet and outdoor temperature. CONCLUSIONS The risk of CVD may be modulated by day length at temperate latitudes, and the implications of seasonality should be considered in all studies of human cardiometabolic health. Key messages In this cross-sectional study in UK Biobank, we report annual variations in cardiovascular risk factors and mortality that were associated with day length independent of environmental and lifestyle factors. These seasonal changes in day length might contribute to annual patterns in cardiovascular disease and mortality.
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Affiliation(s)
- Cathy A Wyse
- a Department of Molecular and Cellular Therapeutics Department , Royal College of Surgeons in Ireland (RCSI) , Dublin , Ireland.,b Institute of Biodiversity, Animal Health and Comparative Medicine , University of Glasgow , Glasgow , UK
| | - Carlos A Celis Morales
- c Institute of Cardiovascular and Medical Sciences , University of Glasgow , Glasgow , UK
| | - Joey Ward
- d Institute of Health and Wellbeing , University of Glasgow , Glasgow , UK
| | - Donald Lyall
- d Institute of Health and Wellbeing , University of Glasgow , Glasgow , UK
| | - Daniel J Smith
- d Institute of Health and Wellbeing , University of Glasgow , Glasgow , UK
| | - Daniel Mackay
- d Institute of Health and Wellbeing , University of Glasgow , Glasgow , UK
| | - Annie M Curtis
- a Department of Molecular and Cellular Therapeutics Department , Royal College of Surgeons in Ireland (RCSI) , Dublin , Ireland
| | - Mark E S Bailey
- e School of Life Sciences , University of Glasgow , Glasgow , UK
| | - Stephany Biello
- f Institute of Neuroscience and Psychology , University of Glasgow , Glasgow , UK
| | - Jason M R Gill
- c Institute of Cardiovascular and Medical Sciences , University of Glasgow , Glasgow , UK
| | - J P Pell
- d Institute of Health and Wellbeing , University of Glasgow , Glasgow , UK
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Toyoda K, Koga M, Yamagami H, Yokota C, Sato S, Inoue M, Tanaka T, Endo K, Fujinami J, Ihara M, Nagatsuka K, Minematsu K. Seasonal Variations in Neurological Severity and Outcomes of Ischemic Stroke - 5-Year Single-Center Observational Study. Circ J 2018; 82:1443-1450. [PMID: 29607895 DOI: 10.1253/circj.cj-17-1310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Seasonal variations in the severity and outcomes of stroke remain unclarified.Methods and Results:A total of 2,965 acute ischemic stroke patients from a single-center prospective registry were studied. Among the total patients, stroke onset did not vary by season, though it varied with a peak in winter when limited to patients >75 years old (P=0.026), when limited to patients with moderate-to-severe initial neurological deficits (National Institutes of Health Stroke Scale Score ≥10, P=0.014), and when limited to those with cardioembolic stroke (n=1,031, P=0.010). In 1,934 patients with noncardioembolic stroke, stroke onset did not vary by season. After multivariable adjustment, moderate-to-severe neurological deficits were more common in winter (odds ratio 1.37, 95% confidence interval 1.10-1.72) and spring (1.27, 1.01-1.60), and death at 1 year was more common in summer than in fall (1.55, 1.03-2.36); death or dependency (modified Rankin Scale score 3-6) and death or bedridden (score of 5-6) were not differently common among the seasons. CONCLUSIONS Overall ischemic stroke showed a fairly even distribution among the 4 seasons. Cardioembolic stroke was more common in winter. Ischemic stroke patients had more moderate-to-severe initial neurological deficits in winter and spring. Poor clinical outcomes at 1 year were generally similar among the seasons. Ischemic stroke is not necessarily a winter-dominant disease.
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Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Yamagami
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center
| | - Chiaki Yokota
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shoichiro Sato
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Kaoru Endo
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Jun Fujinami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center
| | | | - Kazuo Minematsu
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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10
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Kork F, Spies C, Conrad T, Weiss B, Roenneberg T, Wernecke KD, Balzer F. Associations of postoperative mortality with the time of day, week and year. Anaesthesia 2018; 73:711-718. [DOI: 10.1111/anae.14228] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 12/22/2022]
Affiliation(s)
- F. Kork
- Department of Anaesthesiology; Medical Faculty; RWTH Aachen University; Aachen Germany
| | - C. Spies
- Department of Anaesthesiology and Operative Intensive Care Medicine; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - T. Conrad
- Department of Mathematics and Computer Science; Freie Universität Berlin; Berlin Germany
| | - B. Weiss
- Department of Anaesthesiology and Operative Intensive Care Medicine; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - T. Roenneberg
- Institute of Medical Psychology; Ludwig-Maximilians-Universität München; München Germany
| | - K.-D. Wernecke
- SoStAna GmbH and Charité - Universitätsmedizin Berlin; Berlin Germany
| | - F. Balzer
- Department of Anaesthesiology and Operative Intensive Care Medicine; Charité - Universitätsmedizin Berlin; Berlin Germany
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11
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Gonzalez-Castellon M, Ju C, Xian Y, Hernandez A, Fonarow GC, Schwamm L, Smith EE, Bhatt DL, Reeves M, Willey JZ. Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes. J Am Heart Assoc 2018; 7:JAHA.117.007685. [PMID: 29386207 PMCID: PMC5850252 DOI: 10.1161/jaha.117.007685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Lower care quality and an increase in adverse outcomes as a result of new medical trainees is a concept well rooted in popular belief, termed the “July phenomenon.” Whether this phenomenon occurs in acute ischemic stroke has not been well studied. Methods and Results We analyzed data from patients admitted with ischemic stroke in 1625 hospitals participating in the Get With The Guidelines–Stroke program for the 5‐year period between January 2009 and December 2013. We compared acute stroke treatment processes and in‐hospitals outcomes among the 4 quarters (first quarter: July–September, last quarter: April–June) of the academic year. Multivariable logistic regression models were used to evaluate the relationship between academic year transition and processes measures. A total of 967 891 patients were included in the study. There was a statistically significant, but modest (<4 minutes or 5 percentage points) difference in distribution of or quality and clinical metrics including door‐to‐computerized tomography time, door‐to‐needle time, the proportion of patients with symptomatic intracranial hemorrhage within 36 hours of admission, and the proportion of patients who received defect‐free care in stroke performance measures among academic year quarters (P<0.0001). In multivariable analyses, there was no evidence that quarter 1 of the academic year was associated with lower quality of care or worse in‐hospital outcomes in teaching and nonteaching hospitals. Conclusions We found no evidence of the “July phenomenon” in patients with acute ischemic stroke among hospitals participating in the Get With The Guidelines–Stroke program.
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Affiliation(s)
| | | | - Ying Xian
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adrian Hernandez
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | | | - Lee Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Deepak L Bhatt
- Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA
| | - Matthew Reeves
- Department of Epidemiology, Michigan State University, East Lansing, MI
| | - Joshua Z Willey
- Division of Stroke, Department of Neurology, Columbia University Medical Center, New York, NY
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Meadows KL, Silver GM. The Effects of Various Weather Conditions as a Potential Ischemic Stroke Trigger in Dogs. Vet Sci 2017; 4:vetsci4040056. [PMID: 29144407 PMCID: PMC5753636 DOI: 10.3390/vetsci4040056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 11/18/2022] Open
Abstract
Stroke is the fifth leading cause of death in the United States, and is the leading cause of serious, long-term disability worldwide. There are at least 795,000 new or recurrent strokes each year, and approximately 85% of all stroke occurrences are ischemic. Unfortunately, companion animals are also at risk for ischemic stroke. Although the exact incidence of ischemic stroke in companion animals is unknown, some studies, and the veterinary information network (VIN), report that approximately 3% of neurological case referrals are due to a stroke. There is a long list of predisposing factors associated with the risk of ischemic stroke in both humans and canines; however, these factors do not explain why a stroke happens at a particular time on a particular day. Our understanding of these potential stroke “triggers” is limited, and the effect of transient environmental exposures may be one such “trigger”. The present study investigated the extent to which the natural occurrence of canine ischemic stroke was related to the weather conditions in the time-period immediately preceding the onset of stroke. The results of the present study demonstrated that the change in weather conditions could be a potential stroke trigger, with the strokes evaluated occurring after periods of rapid, large fluctuations in weather conditions. There are currently no epidemiological data on the seasonal variability of ischemic stroke in dogs, and determining whether canine stroke parallels human stroke would further validate the use of companion dogs as an appropriate naturally occurring model.
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Affiliation(s)
- Kristy L Meadows
- Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Rd., Grafton, MA 01536, USA.
| | - Gena M Silver
- Massachusetts Veterinary Referral Hospital, 20 Cabot Rd., Woburn, MA 01801, USA.
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13
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Hospital-Based Study of the Frequency and Risk Factors of Stroke Recurrence in Two Years in China. J Stroke Cerebrovasc Dis 2017; 26:2494-2500. [PMID: 28939046 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/24/2017] [Accepted: 05/17/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Stroke causes death and disability throughout the world and recurrent stroke events are more likely to be disabling or fatal. We conducted a hospital-based study to investigate the frequency and influence factors of stroke recurrence in China. METHODS Data from patients hospitalized with stroke between January 2007 and December 2010 of 109 tertiary hospitals in China were used. Stroke recurrence and associated factors were ascertained. The zero-inflated model was used to evaluate the factors of recurrence. RESULTS Of 101,926 discharged patients, the cumulative 2-year stroke recurrence rate was 3.80% for subarachnoid hemorrhage (SAH), 5.31% for intracerebral hemorrhage (ICH), and 8.71% for ischemic stroke (IS), respectively. Among patients with stroke recurrence, 54.11% with SAH, 60.42% with ICH, and 92.92% with IS relapsed for the same type of the first-onset stroke. For discharged patients with SAH with middle cerebral artery aneurysm clipping or artery aneurysm embolization, it was less likely to stroke relapse, but the times of recurrence would increase if 1 recurrence appeared. Cerebral artery aneurysms and hypertension were risk factors for recurrence frequency. For ICH, protective factors for recurrence were trepanation and drainage of intracranial hematoma, cerebral angiography, puncture and drainage of intracranial hematoma, and length of stay (LOS). But rheumatic heart disease and atrial fibrillation would further the relapse frequency. For IS, age and LOS were protective factors, but recurrence frequency would increase if the first recurrence happened. Cervical spondylopathy, male gender, and diabetes were risk factors for frequency of relapse. CONCLUSIONS Associated factors were different for recurrence frequency among different stroke types.
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Bahonar A, Khosravi A, Khorvash F, Maracy M, Saadatnia M. Seasonal and Monthly variation in stroke and its subtypes-10 Year Hospital-Based Study. Mater Sociomed 2017; 29:119-123. [PMID: 28883775 PMCID: PMC5544452 DOI: 10.5455/msm.2017.29.119-123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives: There is no evidence of long-term studies of seasonal variations in stroke in Iran. Hence, the aim of this study was to determine the seasonal and monthly variation of 28-day mortality in Isfahan, Iran. Methods: From 2003 to 2013, In a Hospital-based retrospective study which was conducted by Isfahan Cardiovascular Research Center(ICRC), 24186 cases with first-ever stroke were recruited. Multinomial logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for seasonal and monthly 28-day mortality for stroke in general and three subtypes of stroke including intracranial hemorrhage (ICH), ischemic (IS) and subarachnoid hemorrhage (SAH). Results: In this study, unadjusted and adjusted odds ratios of seasonal 28-day mortality of stroke was highest in the winter and lowest in the summer. Although, differences were not statistically significant. For total and IS stroke, the unadjusted 28-day mortality ratio (UMR) was significant in February (1.19, 95% CI 1.00 -1.42, P= 0.04) as compared to March. Whereas after adjusted, for total stroke, 28-day mortality was significantly lowest in May (0.746, 95% CI 0.575-0.97, p=0.029), June (0.777, 95% CI 0.60-0.99, p=0.49) and July (0.771, 95% CI 0.59-0.99 p=0.049) as compared to March. The AMR between months were not significant in SAH and IS. Conclusion: Our findings demonstrate clear obvious monthly variation of 28-day mortality of stroke and its subtypes in Isfahan but no seasonal variations were observed.
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Affiliation(s)
- Ahmad Bahonar
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Maracy
- Department of epidemiology &Biostatistics, school of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Sung SF, Hsieh CY, Lin HJ, Chen YW, Chen CH, Kao Yang YH, Hu YH. Validity of a stroke severity index for administrative claims data research: a retrospective cohort study. BMC Health Serv Res 2016; 16:509. [PMID: 27660046 PMCID: PMC5034530 DOI: 10.1186/s12913-016-1769-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Ascertaining stroke severity in claims data-based studies is difficult because clinical information is unavailable. We assessed the predictive validity of a claims-based stroke severity index (SSI) and determined whether it improves case-mix adjustment. Methods We analyzed patients with acute ischemic stroke (AIS) from hospital-based stroke registries linked with a nationwide claims database. We estimated the SSI according to patient claims data. Actual stroke severity measured with the National Institutes of Health Stroke Scale (NIHSS) and functional outcomes measured with the modified Rankin Scale (mRS) were retrieved from stroke registries. Predictive validity was tested by correlating SSI with mRS. Logistic regression models were used to predict mortality. Results The SSI correlated with mRS at 3 months (Spearman rho = 0.578; 95 % confidence interval [CI], 0.556–0.600), 6 months (rho = 0.551; 95 % CI, 0.528–0.574), and 1 year (rho = 0.532; 95 % CI 0.504–0.560). Mortality models with the SSI demonstrated superior discrimination to those without. The AUCs of models including the SSI and models with the NIHSS did not differ significantly. Conclusions The SSI correlated with functional outcomes after AIS and improved the case-mix adjustment of mortality models. It can act as a valid proxy for stroke severity in claims data-based studies. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1769-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, 539 Zhongxiao Road, East District, Chiayi City, 60002, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, 57, Section 1, Dongmen Road, East District, Tainan, 70142, Taiwan
| | - Huey-Juan Lin
- Department of Neurology, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan
| | - Yu-Wei Chen
- Department of Neurology, Landseed Hospital, 77 Guangtai Road, Pingjhen District, Taoyuan, Taiwan.,Department of Neurology, National Taiwan University Hospital, 7 Zhongshan South Road, Zhongzheng District, Taipei, 10002, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan, 701, Taiwan
| | - Yea-Huei Kao Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan, 701, Taiwan
| | - Ya-Han Hu
- Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, 168 University Road, Min-Hsiung, Chiayi County, 62102, Taiwan.
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Sipilä J, Ruuskanen JO, Rautava P, Kytö V. Effect of the summer holiday season on ischaemic stroke care in Finland. J Neurol Sci 2016; 367:363-4. [PMID: 27423621 DOI: 10.1016/j.jns.2016.06.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jussi Sipilä
- North Karelia Central Hospital, Joensuu, Finland; Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland; Department of Neurology, University of Turku, Turku, Finland.
| | - Jori O Ruuskanen
- Turku University Hospital, Turku, Finland, and Department of Neurology, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, and Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland, and Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
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Purvis T, Hill K, Kilkenny M, Andrew N, Cadilhac D. Improved in-hospital outcomes and care for patients in stroke research: An observational study. Neurology 2016; 87:206-13. [PMID: 27306625 DOI: 10.1212/wnl.0000000000002834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/01/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe stroke research activity in Australian acute public hospitals and determine if participation in research provides better quality of care and outcomes for patients with stroke. METHODS This was an observational study using data from hospitals that participated in the National Stroke Foundation (Australia) acute services audit program in 2009, 2011, and 2013. This included self-reported organizational features and a retrospective clinical audit of up to 40 medical records of patients with stroke from each hospital. Multilevel random effects logistic regression with level defined as hospital and adjustments for hospital, demographic, clinical, and stroke severity factors were undertaken. RESULTS A total of 240 hospitals submitted organizational data. Hospitals with a stroke unit (70% vs 7%, p < 0.001) and >200 stroke admissions per year (80% vs 17%, p < 0.001) reported greater involvement in research studies. Of 9,537 patients audited at 129 hospitals, 469 (5%) consented to participate in research. Patients who participated in research compared to nonparticipants were likely to be younger (median age 73 years; 25th percentile [Q1]: 63, 75th percentile [Q3]: 80, vs median age 76 years Q1: 64, Q3: 83; p < 0.001) and receive important clinical practices such as a swallow screen/assessment prior to oral intake (62% vs 56%; p < 0.01). An independent association with reduced in-hospital mortality (adjusted odds ratio 0.30, 95% confidence interval 0.12, 0.76) was evident if participating in research regardless of access to stroke unit care. CONCLUSIONS Patients who participate in stroke research receive better in-hospital care and are more likely to survive compared to nonresearch participants. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that patients with stroke who participate in research receive better quality of care and have reduced in-hospital mortality.
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Affiliation(s)
- Tara Purvis
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia.
| | - Kelvin Hill
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
| | - Monique Kilkenny
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
| | - Nadine Andrew
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
| | - Dominique Cadilhac
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
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Average Temperature, Diurnal Temperature Variation, and Stroke Hospitalizations. J Stroke Cerebrovasc Dis 2016; 25:1489-94. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 11/17/2022] Open
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Hsieh CY, Lin HJ, Chen CH, Li CY, Chiu MJ, Sung SF. "Weekend effect" on stroke mortality revisited: Application of a claims-based stroke severity index in a population-based cohort study. Medicine (Baltimore) 2016; 95:e4046. [PMID: 27336904 PMCID: PMC4998342 DOI: 10.1097/md.0000000000004046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index.This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry. We identified patients hospitalized for ischemic stroke, and examined the effect of weekend admission on 30-day mortality with vs without adjustment for stroke severity by using multilevel logistic regression analysis adjusting for patient-, physician-, and hospital-related factors. We analyzed 46,007 ischemic stroke admissions, in which weekend admissions accounted for 23.0%. Patients admitted on weekends had significantly higher 30-day mortality (4.9% vs 4.0%, P < 0.001) and stroke severity index (7.8 vs 7.4, P < 0.001) than those admitted on weekdays. In multivariate analysis without adjustment for stroke severity, weekend admission was associated with increased 30-day mortality (odds ratio (OR), 1.20; 95% confidence interval [CI], 1.08-1.34). This association became null after adjustment for stroke severity (OR, 1.07; 95% CI, 0.95-1.20).The "weekend effect" on stroke mortality might be attributed to higher stroke severity in weekend patients. While claims data are useful for examining stroke outcomes, adequate adjustment for stroke severity is warranted.
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Affiliation(s)
| | | | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan
- Department of Public Health, China Medical University, Taichung
| | - Meng-Jun Chiu
- Department of Public Health, College of Medicine, Tainan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
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Nakibuuka J, Sajatovic M, Nankabirwa J, Ssendikadiwa C, Kalema N, Kwizera A, Byakika-Tusiime J, Furlan AJ, Kayima J, Ddumba E, Katabira E. Effect of a 72 Hour Stroke Care Bundle on Early Outcomes after Acute Stroke: A Non Randomised Controlled Study. PLoS One 2016; 11:e0154333. [PMID: 27145035 PMCID: PMC4856379 DOI: 10.1371/journal.pone.0154333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 04/11/2016] [Indexed: 12/31/2022] Open
Abstract
Background Integrated care pathways (ICP) in stroke management are increasingly being implemented to improve outcomes of acute stroke patients. We evaluated the effect of implementing a 72 hour stroke care bundle on early outcomes among patients admitted within seven days post stroke to the national referral hospital in Uganda. Methods In a one year non-randomised controlled study, 127 stroke patients who had ‘usual care’ (control group) were compared to 127 stroke patients who received selected elements from an ICP (intervention group). Patients were consecutively enrolled (controls first, intervention group second) into each group over 5 month periods and followed to 30-days post stroke. Incidence outcomes (mortality and functional ability) were compared using chi square test and adjusted for potential confounders. Kaplan Meier survival estimates and log rank test for comparison were used for time to death analysis for all strokes and by stroke severity categories. Secondary outcomes were in-hospital mortality, median survival time and median length of hospital stay. Results Mortality within 7 days was higher in the intervention group compared to controls (RR 13.1, 95% CI 3.3–52.9). There was no difference in 30-day mortality between the two groups (RR 1.2, 95% CI 0.5–2.6). There was better 30-day survival in patients with severe stroke in the intervention group compared to controls (P = 0.018). The median survival time was 30 days (IQR 29–30 days) in the control group and 30 days (IQR 7–30 days) in the intervention group. In the intervention group, 41patients (32.3%) died in hospital compared to 23 (18.1%) in controls (P < 0.001). The median length of hospital stay was 8 days (IQR 5–12 days) in the controls and 4 days (IQR 2–7 days) in the intervention group. There was no difference in functional outcomes between the groups (RR 0.9, 95% CI 0.4–2.2). Conclusions While implementing elements of a stroke-focused ICP in a Ugandan national referral hospital appeared to have little overall benefit in mortality and functioning, patients with severe stroke may benefit on selected outcomes. More research is needed to better understand how and when stroke protocols should be implemented in sub-Saharan African settings. Trial Registration Pan African Clinical Trials Registry PACTR201510001272347
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Affiliation(s)
- Jane Nakibuuka
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Medicine, Mulago National referral hospital, Kampala, Uganda
- * E-mail:
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - Joaniter Nankabirwa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Nelson Kalema
- Department of Medicine, Mulago National referral hospital, Kampala, Uganda
| | - Arthur Kwizera
- Department of Anaesthesia and critical care, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jayne Byakika-Tusiime
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anthony J. Furlan
- University Hospitals Case Medical Center, Neurological Institute, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - James Kayima
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edward Ddumba
- Department of Medicine, St Raphael of St Francis Nsambya Hospital, Nkozi University, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Kumar N, Venkatraman A, Garg N. Seasonality in acute ischemic stroke related hospitalizations and case fatality rate in the United States. Int J Cardiol 2015; 195:134-5. [DOI: 10.1016/j.ijcard.2015.05.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022]
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22
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Developing a stroke severity index based on administrative data was feasible using data mining techniques. J Clin Epidemiol 2015; 68:1292-300. [PMID: 25700940 DOI: 10.1016/j.jclinepi.2015.01.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/16/2014] [Accepted: 01/16/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Case-mix adjustment is difficult for stroke outcome studies using administrative data. However, relevant prescription, laboratory, procedure, and service claims might be surrogates for stroke severity. This study proposes a method for developing a stroke severity index (SSI) by using administrative data. STUDY DESIGN AND SETTING We identified 3,577 patients with acute ischemic stroke from a hospital-based registry and analyzed claims data with plenty of features. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). We used two data mining methods and conventional multiple linear regression (MLR) to develop prediction models, comparing the model performance according to the Pearson correlation coefficient between the SSI and the NIHSS. We validated these models in four independent cohorts by using hospital-based registry data linked to a nationwide administrative database. RESULTS We identified seven predictive features and developed three models. The k-nearest neighbor model (correlation coefficient, 0.743; 95% confidence interval: 0.737, 0.749) performed slightly better than the MLR model (0.742; 0.736, 0.747), followed by the regression tree model (0.737; 0.731, 0.742). In the validation cohorts, the correlation coefficients were between 0.677 and 0.725 for all three models. CONCLUSION The claims-based SSI enables adjusting for disease severity in stroke studies using administrative data.
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Saad A, Adil MM, Patel V, Owada K, Winningham MJ, Nahab F. Clinical Outcomes after Thrombectomy for Acute Ischemic Stroke on Weekends versus Weekdays. J Stroke Cerebrovasc Dis 2014; 23:2708-2713. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/07/2014] [Accepted: 06/15/2014] [Indexed: 10/24/2022] Open
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Raj K, Bhatia R, Prasad K, Srivastava MVP, Vishnubhatla S, Singh MB. Seasonal differences and circadian variation in stroke occurrence and stroke subtypes. J Stroke Cerebrovasc Dis 2014; 24:10-6. [PMID: 25284717 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/16/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND India is a subtropical country with clear seasonal variations in weather conditions. Seasonal and circadian variation in occurrence of subtypes of cerebrovascular disease has been of interest in several studies from different countries and climate zones, but discrepant results have made the conclusions unclear. The aim of the present study was to observe the seasonal and circadian variation in the occurrence of stroke and its subtypes among our population. METHODS This was a cross-sectional observational study based on new cases and past cases of stroke on follow-up, conducted between January 2011 and December 2012 in the Department of Neurology, at the All India Institute of Medical Sciences, New Delhi, India. The date and time of onset of the stroke was recorded. The categorization of months into season was in accordance with the Indian Meteorological Department guidelines. The time of onset was distributed into 6 hourly intervals. Statistical calculations were performed using Stata version 12.1 and SPSS version 20. RESULTS A total of 583 patients were included for the study. The rate of occurrence of stroke was highest in the late morning 0600-1159 hours (P value <.001) compared with other times of the day, regardless of gender or age for both ischemic and hemorrhagic strokes. It was lowest in late evening (1800-2359 hours) quadrant compared with other quadrants. Although there was no significant difference found by dichotomizing the groups into two 6-month periods, there was an increasing trend in number of patients with stroke during the months November-February. There was no difference in stroke occurrence between the types of stroke or within each type among different seasons with different temperatures. Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification of ischemic strokes also did not show any association with season or circadian rhythm. CONCLUSIONS There is a significant increase in occurrence of strokes between 0600 and 1159 hours and lowest between 1800-2359 hours. No significant variation in stroke occurrence or subtype for any of the seasons was observed.
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Affiliation(s)
- Kishan Raj
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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He Q, Wu C, Luo H, Wang ZY, Ma XQ, Zhao YF, Lu J, Xiang C, Qin YY, Wu SQ, Yu FF, He J. Trends in in-hospital mortality among patients with stroke in China. PLoS One 2014; 9:e92763. [PMID: 24651454 PMCID: PMC3961404 DOI: 10.1371/journal.pone.0092763] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 02/26/2014] [Indexed: 11/18/2022] Open
Abstract
Background The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China. Methods 109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression. Results Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001). The percentage of severe patients increased while odds of mortality (2010 versus 2007) decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987), intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708), and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649). In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality. Conclusions The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.
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Affiliation(s)
- Qian He
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Cheng Wu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Hong Luo
- Center of Educational Technology, Second Military Medical University, Shanghai, China
| | - Zhi-Yong Wang
- Department of Information, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiu-Qiang Ma
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yan-Fang Zhao
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Jian Lu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Chun Xiang
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Ying-Yi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Shun-Quan Wu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Fei-Fei Yu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China
- * E-mail:
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Hao L, Chen L, Sai X, Liu Z, Yang G, Yan R, Wang L, Fu C, Xu X, Cheng Z, Wu Q, Li S. Synergistic effects of elevated homocysteine level and abnormal blood lipids on the onset of stroke. Neural Regen Res 2013; 8:2923-31. [PMID: 25206613 PMCID: PMC4146172 DOI: 10.3969/j.issn.1673-5374.2013.31.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/17/2013] [Indexed: 11/05/2022] Open
Abstract
Hyperhomocysteinemia and abnormal blood lipids are independent risk factors for stroke. However, whether both factors exert a synergistic effect in the onset of stroke remains unclear. The present study is a retrospective analysis of 2 089 cases of stroke and 2 089 control cases of simple intervertebral disk protrusion using a paired multivariate logistic regression method. Adjusting for known confounding variables including the patients' age, gender, smoking status, alcohol consumption status, patient and family medical history, and clinical biochemical indices, elevated homocysteine level was related to the onset of stroke. Patients with elevated homocysteine levels and abnormal blood lipids showed a 40.9 % increase in the risk for stroke compared to patients with normal homocysteine levels and blood lipids (odds ratio 1.409; 95% confidence interval 1.127-1.761). These results indicate that elevated homocysteine and abnormal blood lipids exert synergistic effects in the onset of stroke. Patients with elevated homocysteine levels and abnormal blood lipids are predisposed to stroke.
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Affiliation(s)
- Lu Hao
- Chinese PLA General Hospital, Beijing 100853, China
| | - Liming Chen
- Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaoyong Sai
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing 100853, China,Beijing Key Laboratory of Geriatrics, Beijing 100853, China
| | - Zhefeng Liu
- Chinese PLA General Hospital, Beijing 100853, China
| | - Guang Yang
- Chinese PLA General Hospital, Beijing 100853, China
| | - Rongzeng Yan
- Chinese PLA General Hospital, Beijing 100853, China
| | - Lili Wang
- Chinese PLA General Hospital, Beijing 100853, China
| | - Caiyun Fu
- Chinese PLA General Hospital, Beijing 100853, China
| | - Xuan Xu
- Chinese PLA General Hospital, Beijing 100853, China
| | | | - Qiang Wu
- Chinese PLA General Hospital, Beijing 100853, China
| | - Shuzhang Li
- Chinese PLA General Hospital, Beijing 100853, China,
Corresponding author: Shuzhang Li, Chief physician, Chinese PLA General Hospital, Beijing 100853, China, . (N201303006)
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