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Panda BK, Suryawanshi VR, Attarde G, Borkar N, Iyer S, Shah J. Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study. Indian J Crit Care Med 2023; 27:806-815. [PMID: 37936803 PMCID: PMC10626231 DOI: 10.5005/jp-journals-10071-24566] [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: 08/09/2023] [Accepted: 09/25/2023] [Indexed: 11/09/2023] Open
Abstract
Aim To characterize the impact of adherence to quality metrics of stroke care on the clinical outcomes of ischemic stroke (IS) and intracerebral hemorrhage (ICH) admissions. Methods Consecutive patients with acute stroke were prospectively followed up for their demographic and clinical characteristics, acute stroke management, and associated clinical outcomes at discharge. Stroke quality metrics [adopted from the American Heart Association (AHA)/American Stroke Association's Get with The Guidelines (GWTG)] with a specific interest in an association between acute reperfusion therapies and functional recovery in stroke patients are analyzed and presented. A composite measure of care was considered "0 (non-adherence) to 1 (adherence)." An all-or-none measure of care was calculated to check whether eligible patients received all the quality-of-care interventions. Multivariate Cox regression models were used to study an association between optimal adherence and clinical outcomes. Results During the study period, of the total 256 stroke admissions, 200 (78.1%) patients had IS, and the remaining 56 (21.9%) patients had ICH. The median [interquartile range (IQR)] age of total stroke admissions was 57 (36-78) years. Male preponderance was observed (IS: 80% and ICH: 67.9%). The conformity of performance metrics in IS patients was from 69.1% [95% confidence interval (CI), 68.5-69.6] for the use of deep vein thrombosis prophylaxis (DVTp) to 97.8% (95% CI, 96.2-98.6) for the use of statins. In ICH patients, it ranged from 61.7% (95% CI, 60.4-62.5) for the use of DVTp to 89.9% (95% CI, 88.6-89.7) for stroke rehabilitation. The unadjusted odds ratio (OR) of mortality (in-hospital plus the 28th-day postdischarge) was higher in ICH patients vs IS patients (4.42, p = 0.005). Optimal adherence with intravenous recombinant tissue plasminogen activator (IV-rtPA) therapy [hazards ratio (HR) = 0.23], in-hospital acute measures [IS (HR = 0.41) and ICH (HR = 0.63)], and discharge measures [IS (HR = 0.35) and ICH (HR = 0.45)] were associated with reduced hazards of the 28th-day mortality in both cohorts. Compared to ICH, IS patients had significantly improved neurofunctional recovery [modified Rankin score (mRS) ≤ 2, p < 0.01]. Conclusion Adherence to quality metrics and performance measures was associated with low mortality and favorable clinical outcomes. Also, DVTp as an in-hospital (acute) measure of stroke care needs attention in both cerebrovascular events. How to cite this article Panda BK, Suryawanshi VR, Attarde G, Borkar N, Iyer S, Shah J. Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study. Indian J Crit Care Med 2023;27(11):806-815.
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Affiliation(s)
- Bijoy Kumar Panda
- Department of Pharmacy Practice, Krishna Institute of Pharmacy, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, India
| | - Vaibhav R Suryawanshi
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Gargi Attarde
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Nilima Borkar
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Shivakumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
| | - Jignesh Shah
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
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Dos Santos RB, Fiedler A, Badwal A, Legasto-Mulvale JM, Sibley KM, Olaleye OA, Diermayr G, Salbach NM. Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1084085. [PMID: 36896249 PMCID: PMC9989207 DOI: 10.3389/fresc.2023.1084085] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Background Use of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown. Purpose To identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke. Methods A scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool. Results Of the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle- and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country. Conclusion CPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke. Systematic Review Registration https://osf.io/, identifier: 10.17605/OSF.IO/6RBDV.
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Affiliation(s)
- Renato B Dos Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo - UNICID, Sao Paulo, Brazil.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Annabelle Fiedler
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Anchal Badwal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jean Michelle Legasto-Mulvale
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gudrun Diermayr
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, University Health Network, Toronto, ON, Canada
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3
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Dhurjati R, Sagar V, Kanukula R, Rehana N, Mohanan PP, Huffman MD, Bhaumik S, Salam A. Quality of the Indian clinical practice guidelines for the management of cardiovascular conditions. JRSM Open 2022; 13:20542704221127178. [PMID: 36506268 PMCID: PMC9730011 DOI: 10.1177/20542704221127178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To assess the quality of Indian clinical practice guidelines (CPG)s for the management of cardiovascular conditions, MEDLINE, Embase, Google Scholar and websites of relevant medical associations and government organisations were searched, from inception until August 2020, to identify Indian CPGs for the management of cardiovascular disease (CVD) conditions, produced in or between 2010 and 2019. Excluded were CPGs that were not specific to India, focused on alternative systems of medicine, of non-CVD conditions (even if they included a component of CVD), and those related to the electronic devices, cardiac biomarkers, or diagnostic procedures. Quality of the each included CPG was assessed using the AGREE II tool by four reviewers in duplicate, independently. Each AGREE II domain score and overall quality score was considered low (≤40%), moderate (40.1%-59.9%), and high (≥60%). Of the 23 CPGs included, six (26%) were reported to be adapted from other CPGs. Fourteen (61%) CPGs were produced by medical associations, six (26%) by individual authors and three (13%) by government agencies. Based on the AGREE II overall quality score, two (9%) CPGs were of high quality, four (17%) and seventeen (74%) CPGs were of moderate and low quality, respectively. Except for scope and purpose, and clarity of presentation all other domains were rated low. The quality of most Indian CPGs for managing CVD conditions assessed using the AGREE II tool was moderate-to-low. Combined efforts from different stakeholders are needed to develop, disseminate and implement high-quality CPGs while identifying and addressing barriers to their uptake to optimize patient care and improve outcomes.
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Affiliation(s)
| | - Vidya Sagar
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Raju Kanukula
- The George Institute for Global Health, New Delhi, Delhi, India
| | - Nusrath Rehana
- The George Institute for Global Health, New Delhi, Delhi, India
| | | | - Mark D. Huffman
- Washington University in St. Louis, St Louis, MO, USA,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Soumyadeep Bhaumik
- The George Institute for Global Health, New Delhi, Delhi, India,Meta-research & Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, Delhi, India
| | - Abdul Salam
- The George Institute for Global Health, New Delhi, Delhi, India,Manipal Academy of Higher Education, Manipal, Karnataka, India,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia,Abdul Salam.
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Harjpal P, Qureshi MI, Kovela RK, Jain M. Bilateral Lower Limb Training for Post-stroke Survivors: A Bibliometric Analysis. Cureus 2022; 14:e29615. [PMID: 36321041 PMCID: PMC9603067 DOI: 10.7759/cureus.29615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022] Open
Abstract
Stroke is one of the most disabling conditions affecting the middle-aged population all around the world. This study aims to explore the rehabilitation of stroke patients using bibliometric analysis, which includes statistical analysis of recent articles, books, and other kinds of publications, to assess scientific output and determine the significance of scientific investigations in terms of both quality and quantity. In this study, an analysis of global trends in research in bilateral lower limb training for training balance and walking for patients in the subacute stage post-stroke between 1988 and 2021 was done. All the articles were obtained from PubMed databases. CiteSpace software was used to analyze the relationship between publications and country, journals, institutions, authors, references, and the keywords used. A total of 160 publications were included in the analysis. There was a tremendous increase in the research of physiotherapy intervention in patients who had residual disability post-stroke with a publication rate of 7.1 articles per year of publications. The use of the sophisticated PubMed database to extract articles allowed for a thorough and powerful bibliometric analysis of stroke rehabilitation research published between 1988 and 2020. In general, the number of studies on bilateral training has increased in recent decades. This historical overview of rehabilitation for post-stroke survivors will serve as a valuable starting point for future study into possible collaborators, focus issues, and trends. This bibliometric analysis highlights the potential value of exercise therapy for stroke survivors in creating more effective hemiplegia rehabilitation programs. This research may encourage the use of strengthening in the therapeutic therapy of hemiplegia balance. The groundwork will be laid for future research on strengthening stroke to be organized and given top priority.
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Ye Z, Busse JW, Hill MD, Lindsay MP, Guyatt GH, Prasad K, Agarwal A, Beattie C, Beattie J, Dodd C, Heran MKS, Narayan S, Chartúir NN, O'Donnell M, Resmini I, Sacco S, Sylaja PN, Volders D, Wang X, Xie F, Zachrison KS, Zhang L, Zhong H, An Z, Smith EE. Endovascular thrombectomy and intravenous alteplase in patients with acute ischemic stroke due to large vessel occlusion: A clinical practice guideline. J Evid Based Med 2022; 15:263-271. [PMID: 36123777 DOI: 10.1111/jebm.12493] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
AIM Whether or not use of intravenous alteplase in combination with endovascular thrombectomy (EVT) improves outcomes versus EVT alone, for acute stroke patients with large vessel occlusion presenting directly to a comprehensive stroke center, is uncertain. METHODS Six randomized trials exploring this issue were published, and we synthesized this evidence to inform a rapid guideline based on the Guidelines International Network principles and guided by the GRADE approach. RESULTS We enlisted an international panel that included 4 patient partners and 1 caregiver, individuals from 6 countries. The panel considered low certainty evidence that EVT alone, relative to EVT with intravenous alteplase, possibly results in a small decrease in the proportion of patients that achieve functional independence and possibly a small increase in mortality. Both effect estimates were downgraded twice due to very serious imprecision. The panel also considered moderate certainty evidence that EVT alone probably decreases symptomatic intracranial hemorrhage, versus EVT with alteplase, and combination therapy was more costly than EVT alone. As a result of the low certainty for improved recovery without impairment and mortality for combination therapy versus EVT alone, and moderate certainty for increased harm with combination therapy, the panel made a weak recommendation in favor of EVT alone for stroke patients eligible for both treatments, and initially presenting directly to a comprehensive stroke center that provides both treatments. CONCLUSIONS Consistent with this weak recommendation, optimal patient management will likely often include co-treatment with intravenous alteplase, depending on local circumstances and patient presentation.
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Affiliation(s)
- Zhikang Ye
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Departments of Medicine, Community Health Sciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Kameshwar Prasad
- Department of Neurology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Arnav Agarwal
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Manraj K S Heran
- Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sunil Narayan
- Comprehensive Stroke Care Centre, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Norita Ní Chartúir
- Lecturing Media/Communications, National University of Ireland, Galway, Ireland
| | - Martin O'Donnell
- Department of Medicine, HRB-Clinical Research Facility, National University of Ireland, Galway, Ireland
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
| | - David Volders
- Department of Diagnostic Imaging, Dalhousie University, Halifax, Canada
| | - Xin Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lingli Zhang
- West China Second University Hospital/Chinese Evidence-based Medicine Center, Sichuan University, Sichuan, China
- The Evidence-Based Pharmacy Committee, the Chinese Pharmaceutical Society, Beijing, China
| | - Hongliang Zhong
- Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhuoling An
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Eric E Smith
- Department of Clinical Neurosciences and Calgary Stroke Program, University of Calgary, Calgary, Canada
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6
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Lynch EA, Connell LA, Carvalho LB, Bird ML. Do clinical guidelines guide clinical practice in stroke rehabilitation? An international survey of health professionals. Disabil Rehabil 2021; 44:4118-4125. [PMID: 33651965 DOI: 10.1080/09638288.2021.1891304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify health professionals awareness of stroke rehabilitation guidelines, and factors perceived to influence guideline use internationally. METHODS Online survey study. Open-ended responses were thematically analysed, guided by the Consolidated Framework for Implementation Research. RESULTS Data from 833 respondents from 30 countries were included. Locally developed guidelines were available in 22 countries represented in the sample. Respondents from high-income countries were more aware of local guidelines compared with respondents from low- and middle-income countries.Local contextual factors such as management support and a culture of valuing evidence-based practice were reported to positively influence guideline use, whereas inadequate time and shortages of skilled staff inhibited the delivery of guideline-recommended care. Processes reported to improve guideline use included education, training, formation of workgroups, and audit-feedback cycles. Broader contextual factors included accountability (or lack thereof) of health professionals to deliver rehabilitation consistent with guideline recommendations. CONCLUSION While many health professionals were aware of clinical guidelines, they identified multiple barriers to their implementation. Efforts should be made to raise awareness of local guidelines in low- and middle-income countries. More attention should be paid to addressing local contextual factors to improve guideline use internationally, going beyond traditional strategies focused on individual health professionals.IMPLICATIONS FOR REHABILITATIONSystems are required so people and organisations are held accountable to deliver evidence-based care in stroke rehabilitation.Locally developed stroke rehabilitation guidelines should be promoted to boost awareness of these guidelines in low- and middle-income countries.In all regions, strategies to influence or adapt to the local setting, are required to optimise guideline use.
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Affiliation(s)
- Elizabeth A Lynch
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,Adelaide Nursing School, University of Adelaide, Adelaide, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, Australia
| | - Louise A Connell
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom.,East Lancashire Hospitals NHS Trust, Burnley General Teaching Hospital, Burnley, United Kingdom
| | - Lilian B Carvalho
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,College of Health and Medicine, University of Tasmania, Launceston, Australia
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John L, William A, Dawar D, Khatter H, Singh P, Andrias A, Mochahari C, Langhorne P, Pandian J. Implementation of a Physician-Based Stroke Unit in a Remote Hospital of North-East India-Tezpur Model. J Neurosci Rural Pract 2021; 12:356-361. [PMID: 33927525 PMCID: PMC8064833 DOI: 10.1055/s-0041-1723099] [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] [Indexed: 11/23/2022] Open
Abstract
Objective
The study aims to determine the effects of implementing stroke unit (SU) care in a remote hospital in North-East India.
Materials and Methods
This before-and-after implementation study was performed at the Baptist Christian Mission Hospital, Tezpur, Assam between January 2015 and December 2017. Before the implementation of stroke unit care (pre-SU), we collected information on usual stroke care and 1-month outcome of 125 consecutive stroke admissions. Staff was then trained in the delivery of SU care for 1 month, and the same information was collected in a second (post-SU) cohort of 125 patients.
Statistical Analysis
Chi-square and Mann–Whitney U test were used to compare group differences. The loss to follow-up was imputed by using multiple imputations using the Markov Chain Monto Carlo method. The sensitivity analysis was also performed by using propensity score matching of the groups for baseline stroke severity (National Institute of Health Stroke Scale) using the nearest neighbor approach to control for confounding, and missing values were imputed by using multiple imputations. The adjusted odds ratio was calculated in univariate and multivariate regression analysis after adjusting for baseline variables. All the analysis was done by using SPSS, version 21.0., IBM Corp and R version 4.0.0., Armonk, New York, United States.
Results
The pre-SU and post-SU groups were age and gender matched. The post-SU group showed higher rates of swallow assessment (36.8 vs. 0%,
p
< 0.001), mobility assessment, and re-education (100 vs. 91.5%,
p
= 0.037). The post-SU group also showed reduced complications (28 vs. 45%,
p
= 0.006) and a shorter length of hospital stay (4 ± 2.16 vs. 5 ± 2.68 days,
p
= 0.026). The functional outcome (modified ranking scale) at 1-month showed no difference between the groups, good outcome in post-SU (39.6%) versus pre-SU (35.7%),
p
= 0.552.
Conclusion
The implementation of this physician-based SU care model in a remote hospital in India shows improvements in quality measures, complications, and possibly patient outcomes.
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Affiliation(s)
- Lydia John
- Department of Medicine, Baptist Christian Hospital, Tezpur, Assam, India
| | - Akanksha William
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Dimple Dawar
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Himani Khatter
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Pratibha Singh
- Department of Medicine, Baptist Christian Hospital, Tezpur, Assam, India
| | - Anjana Andrias
- Department of Medicine, Baptist Christian Hospital, Tezpur, Assam, India
| | | | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, Royal Infirmary Hospital, Glasgow, United Kingdom
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
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Ouyang M, Zhang Y, Wang X, Song L, Billot L, Robinson T, Lavados PM, Arima H, Hackett ML, Olavarría VV, Muñoz-Venturelli P, Middleton S, Watkins CL, Pontes-Neto OM, Lee TH, Brunser AM, Anderson CS. Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study. J Neurol Sci 2020; 419:117187. [DOI: 10.1016/j.jns.2020.117187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/22/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
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Srivastava MP, Bhatia R, Vishnu VY, Goyal M. Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India. Stroke 2020; 51:1969-1977. [DOI: 10.1161/strokeaha.119.026733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M.V. Padma Srivastava
- Head of Department (Neurology), All India Institute of Medical Sciences (AIIMS), New Delhi (M.V.P.S.)
| | | | | | - Mayank Goyal
- Department of Radiology, Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Canada (M.G.)
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Yang W, Yang J, Xiong X, Weng X, Wu W. Effect of Statins on Patients with Acute Ischemic Stroke Infection based on Intelligent Data Acquisition of Computed Tomography Image information (Preprint). JMIR Med Inform 2020. [DOI: 10.2196/18571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kate MP, Arora D, Verma SJ, Sylaja PN, Renjith V, Sharma M, Pandian JD. Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) study protocol. Int J Stroke 2020; 15:109-115. [PMID: 31852411 DOI: 10.1177/1747493019895653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
RATIONALE Recurrent stroke, cardiovascular morbidity, and mortality are important causes of poor outcome in patients with index stroke. Despite the availability of best medical management recurrent stroke occur in up to 15-20% of patients with stroke in India. Education for stroke prevention could be a strategy to prevent recurrent strokes. HYPOTHESIS We hypothesize that a structured semi-interactive stroke prevention package can reduce the risk of recurrent strokes, acute coronary artery syndrome, and death in patients with sub-acute stroke at the end of one year. DESIGN Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in INDIA (SPRINT INDIA) is a multi-center stroke trial involving 25 centers under the Indian Stroke Clinical Trial Network. Patients with first ever sub-acute stroke within two days to three months of onset, age 18-85 years, mRS <5, showing recent stroke in imaging are included. Participants or caregivers able to read and complete tasks suggested in a stroke prevention workbook and have a cellular device for receiving short message service and watching videos. A total of 5830 stroke patients speaking 11 different languages are being randomized to intervention or control arm. Patients in the intervention arm are receiving a stroke prevention workbook, regular educational short messages, and videos. All patients in the control arm are receiving standard of care management. SUMMARY Structured semi-interactive stroke prevention package may reduce the risk of recurrent strokes, acute coronary artery syndrome, and death in patients with sub-acute stroke. TRIAL REGISTRATION This trial is registered with clinicaltrials.gov (NCT03228979) and CTRI (Clinical Trial Registry India; CTRI/2017/09/009600).
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Affiliation(s)
| | - Deepti Arora
- Department of Neurology, Christian Medical College, Ludhiana, India
| | | | - P N Sylaja
- Department of Neurology, Sri Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
| | - Vishnu Renjith
- Department of Neurology, Sri Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
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