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Iskandar K, Rahme D, Salameh P, Haddad C, Sacre H, Bahlol M, Darwish RM, El Khatib S, Safwan J, Sakr F, Rahhal M, Hosseini H, Cherfane M. Evaluating the influence of a 3-min online video on the community knowledge of stroke in four Arab countries. Front Public Health 2024; 12:1342490. [PMID: 38841682 PMCID: PMC11151891 DOI: 10.3389/fpubh.2024.1342490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Studies from developed and developing countries showed that the knowledge levels of stroke need improvement. Educational campaigns varied and were of limited influence predominantly because of their short duration and the need for financial support. The study aims to test the impact of a 3-min online video on the knowledge of stroke and factors influencing the knowledge score in four Arab countries. Methods A cross-sectional web-based pre-post study was conducted in Egypt, Jordan, Lebanon, and the United Arab Emirates. The data were collected using the snowball technique. Participants were adults aged 18 years and above. The questionnaire sequence was conducting a pretest, followed by the educational video explaining stroke occurrence, types, risks, warning signs, preventive measures, and treatment, and finally, a posttest to evaluate the differences in knowledge from baseline. Statistical analysis included paired t-tests comparing pre-post-education stroke knowledge scores, while repeated measures ANOVA, adjusting for covariates, assessed mean changes. Results The total number of participants was 2,721, mainly younger than 55 years. The majority had a university degree and were not healthcare professionals. A significant improvement was noted in the total knowledge score in all countries from a mean average (Mpretest = 21.11; Mposttest = 23.70) with p < 0.001. Identification of the stroke risks (Mpretest = 7.40; Mposttest = 8.75) and warning signs (Mpretest = 4.19; Mposttest = 4.94), understanding the preventive measures (Mpretest = 5.27; Mposttest = 5.39) and the importance of acting fast (Mpretest = 0.82; Mposttest = 0.85) improved from baseline with (p < 0.001) for all score components. Conclusion The educational tool successfully enhanced public understanding of stroke risks, the identification of stroke signs, and the critical need for emergency action. The advantages of this video include its short length, free online access, use of evidence-based content in lay language, and reflective images. The ultimate goal remains the long-term improvement of sustainability by mandating full-scale trials.
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Affiliation(s)
- Katia Iskandar
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Health and Social Work, School of Public Health, Lebanese University, Fanar, Lebanon
- Higher Institute of Public Health (ISSP), Saint Joseph University of Beirut, Beirut, Lebanon
| | - Deema Rahme
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Pharmacy Practice, School of Pharmacy, Beirut Arab University, Beirut, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Egypt
- Department of Pharmaceutical management and economics, Department Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Egyptian Russian University, Badr city, Cairo governorate, Egypt
| | - Mohamed Bahlol
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rula M. Darwish
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
| | - Sarah El Khatib
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Health and Social Work, School of Public Health, Lebanese University, Fanar, Lebanon
| | - Jihan Safwan
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
- UMR U955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, Paris, France
| | - Mohamad Rahhal
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Hassan Hosseini
- INSERM U955-E01, IMRB, Henri Mondor Hospital, Créteil, France
- Department of Neurology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Michelle Cherfane
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Environmental and Public Health Department, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
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Du Y, Xue N, Liang J, Deng Y. Knowledge, Attitude, Skill, and Practice of Emergency Nurses Regarding the Early Management of Patients With Acute Ischemic Stroke in Beijing. J Emerg Nurs 2024; 50:95-105. [PMID: 37831051 DOI: 10.1016/j.jen.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Emergency nurses play an important role in the early management of acute ischemic stroke. The purpose of this study was to evaluate the knowledge, attitudes, skills, and practice of emergency nurses in Beijing regarding the early management of acute ischemic stroke. METHODS This cross-sectional study enrolled emergency nurses in 26 hospitals in Beijing between August and November 2022. Correlations among knowledge, attitude, and skill/practice were evaluated by Pearson correlation analysis. RESULTS This study included 564 nurses (82.98% were female). The average knowledge, attitude, and skill/practice scores were 15.48 ± 2.39 (possible range, 0-22), 39.84 ± 4.89 (possible range, 9-45), and 40.59 ± 5.21 (possible range, 13-52). The knowledge was significantly positively correlated with attitude and skill/practice (all P< .001). There was also a positive correlation between attitude and skill/practice (P< .001). DISCUSSION These findings may facilitate the implementation of education/training programs to improve the early management of acute ischemic stroke by nurses in emergency departments.
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Spina E, Candelaresi P, Volpe G, D'Onofrio F, Spitaleri D, Martusciello G, Piccirillo G, Briganti F, Muto M, Feleppa M, Sparaco M, Manto A, Cuomo T, Ascione S, Ripa P, Romano DG, Andreone V, Manganelli F, Napoletano R. Trends of recanalization therapies and state of art for ischemic stroke treatment in Campania region, Italy. Neurol Sci 2022; 43:6865-6870. [PMID: 36074192 PMCID: PMC9663370 DOI: 10.1007/s10072-022-06321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/31/2022] [Indexed: 12/02/2022]
Abstract
Background
According to the last Italian report by the Ministry of Health in 2018, the estimated number of acute ischemic strokes (AIS) in Campania is 10,000/year, with an expected number of 1390 intravenous thrombolysis (IVT) and 694 mechanical thrombectomies (MT). In 2017, only 1.5% of expected patients received IVT and 0.2% MT. This study analyzed the trend of IVT and MT in 2019–2020 and depicted the state of art of Stroke Care in Campania. Methods From the regional health task force, we obtained the hospital discharge forms from all private and public hospitals in Campania; we selected patients with a principal diagnosis of AIS and measured the rate of patients admitted to neurology units and the rate of IVT, MT, and IVT + MT for both 2019 and 2020. Results In 2019, we observed 4817 admissions for AIS; 2858/4817 (59.3%) patients were admitted to neurology units. Out of 4817 patients, 192 received IVT, 165 MT, and 131 IVT + MT (488 treated patients; 10.1%). In 2020, we observed 4129 admissions for AIS; 2502/4129 (62.7%) patients were admitted to neurology units. Out of 4129 patients, 198 received IVT, 250 MT, and 180 IVT + MT (628 treated patients; 15.2%). These results showed that despite a reduction of AIS admissions in 2020, the relative and absolute rate of recanalization treatments increased. However, the number of patients who were not admitted to neurology units nor received acute treatments remained dramatically high. Conclusion Despite the development of acute treatments, the Campania Stroke Network still needs significative efforts to improve.
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Affiliation(s)
- Emanuele Spina
- Department of Neurosciences, Reproductive and Odontostomatology, University of Naples "Federico II", Via Pansini, 5, Naples, Italy.
- Neurology Unit, P.O. "San Leonardo", Castellammare Di Stabia, Italy.
| | | | - Giampiero Volpe
- Neurology and Stroke Unit, AOU "San Giovanni Di Dio Ruggi d'Aragona", Salerno, Italy
| | | | - Daniele Spitaleri
- Neurology and Stroke Unit, AORN "San Giuseppe Moscati", Avellino, Italy
| | | | - Giovanni Piccirillo
- Neurology and Stroke Unit, AORN "Sant'Anna E San Sebastiano", Caserta, Italy
| | - Francesco Briganti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Mario Muto
- Diagnostic and Interventional Neuroradiology, AORN Antonio Cardarelli, Naples, Italy
| | | | - Marco Sparaco
- Neurology and Stroke Unit, AORN "San Pio", Benevento, Italy
| | - Andrea Manto
- Neuroradiology Unit, P.O. "Umberto I", Nocera Inferiore, Italy
| | - Teresa Cuomo
- Neurology and Stroke Unit, P.O. "Umberto I", Nocera Inferiore, Italy
| | | | - Patrizia Ripa
- Neurology and Stroke Unit, P.O. "Ospedale del Mare", Naples, Italy
| | - Daniele Giuseppe Romano
- Department of Diagnostic and Interventional Neuroradiology, University Hospital "San Giovanni Di Dio E Ruggi d'Aragona", Salerno, Italy
| | | | - Fiore Manganelli
- Department of Neurosciences, Reproductive and Odontostomatology, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Rosa Napoletano
- Neurology and Stroke Unit, AOU "San Giovanni Di Dio Ruggi d'Aragona", Salerno, Italy
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Turner AC, Etherton MR. Utilization of Telestroke Prior to and Following the COVID-19 Pandemic. Semin Neurol 2022; 42:3-11. [PMID: 35576926 DOI: 10.1055/s-0041-1742181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For over two decades, telestroke has been utilized as a means for improving acute access to a stroke specialist when this expertise is otherwise unavailable. During this time, telestroke use has increased and improvements in care metrics have been widely reported. Several telestroke model variations are utilized; each has different workflow implications. A successful telestroke system should include adequate protocols and training, equipment, documentation system, and tracking of quality metrics. Upfront costs of needed technology and devices, credentialing hurdles, and limited reimbursement are all reported barriers to the utilization of telestroke. Emphasis on safety measures during the COVID-19 pandemic resulted in the dramatic upscaling of telehealth utilization, although overall stroke volumes declined in many areas in the early phases of the pandemic. Going forward, continued reduction in cost of required devices and broadband connections, increased use of automated and advanced analytical software, and a universal licensing and credentialing system are needed to continue the expansion of telestroke use.
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Affiliation(s)
- Ashby C Turner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark R Etherton
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Tsakpounidou K, van der Merwe J, Klinke ME, Webb C, Ouriques Martins SC, Proios H. FAST Heroes: Results of Cross-Country Implementation of a Global School-Based Stroke Education Campaign. Front Public Health 2022; 10:849023. [PMID: 35509512 PMCID: PMC9058110 DOI: 10.3389/fpubh.2022.849023] [Citation(s) in RCA: 2] [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: 01/05/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEducating the at-risk population about stroke symptoms and requirement of calling an ambulance when stroke strikes is challenging. This exploratory cross-country study provides insights to the FAST Heroes educational campaign and outcomes hitherto achieved.AimsThe primary aim of the study was to measure the transfer of stroke-related knowledge to parents after a global school-based FAST Heroes educational campaign for 5- to 9-year-old children in 14 different countries. The secondary aim was to evaluate parents and teachers' acceptability toward the program.MethodsThe duration of the program was 5 h; 1 h per week, joining face-to-face educational sessions with workbooks, cartoons, web-based learning, and other fun activities. Outcomes were measured before implementation (t1), after implementation (t2), and at 6-month follow-up (t3). Program acceptability and stroke knowledge were evaluated by feedback surveys for teachers and parents.ResultsWorldwide, 4,202 parents completed the program with their children and answered surveys at t1 and t2. They increased their knowledge of three stroke symptoms from 48 to 83% (p < 0.001). All three surveys were completed by 86 parents, who improved their knowledge of stroke symptoms, 55% (t1), 79% (t2), and 94% (t3) (p < 0.001). Overall, the educational messages were successfully passed onward.ConclusionsFindings confirm the primary aim of the study that is knowledge about stroke transfer well from children to their families through the FAST Heroes program. Second, parents and teachers globally consider the program feasible and worthwhile. The results will inform further rollout of the campaign.
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Affiliation(s)
- Kalliopi Tsakpounidou
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
- *Correspondence: Kalliopi Tsakpounidou
| | - Jan van der Merwe
- Boehringer Ingelheim International Gesellschaft mit Beschränkter Haftung (GmbH), Healthcare Affairs and Patient Engagement, Ingelheim am Rhein, Germany
| | | | | | - Sheila Cristina Ouriques Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento, Neurology, Porto Alegre, Brazil
| | - Hariklia Proios
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
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Wang R, Wang Z, Yang D, Wang J, Gou C, Zhang Y, Xian L, Wang Q. Early Hospital Arrival After Acute Ischemic Stroke Is Associated With Family Members' Knowledge About Stroke. Front Neurol 2021; 12:652321. [PMID: 34122301 PMCID: PMC8187751 DOI: 10.3389/fneur.2021.652321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: Prehospital delay is the major factor limiting intravenous thrombolysis and mechanical thrombectomy in acute ischemic stroke (AIS). This study aimed to: (1) identify factors related to prehospital delay and (2) determine the impact of recognition and behavior of family members on patient delay. Methods: A cross-sectional, multicenter study was conducted at six teaching hospitals in China between December 1, 2018 and November 30, 2019. Patients who experienced AIS within 7 days of onset were interviewed. Results: Of 1,782 consecutive patients (male, 57.97%; mean age, 66.3 ± 9.65 years) who had an AIS, 267 (14.98%) patients arrived within 4.5 h and 722 (40.52%) patients arrived within 6 h of stroke onset. Among patients who arrived within 4.5 h, 103 (38.6%) received thrombolysis. Age over 65 years (OR, 2.009; 95% CI, 1.014-3.982), prior stroke (OR, 3.478; 95% CI, 1.311-9.229), blurred vision (OR, 3.95; 95% CI, 1.71-9.123), and patients deciding to seek medical help (OR, 3.097; 95% CI, 1.417-6.769) were independently associated with late arrival. In contrast, sudden onset of symptoms (OR, 0.075; 95% CI, 0.028-0.196), the National Institutes of Health Stroke Scale 7-15 (OR, 0.093; 95% CI, 0.035-0.251), consciousness disturbance (OR, 0.258; 95% CI, 0.091-0.734), weakness (OR, 0.265; 95% CI, 0.09-0.784), arrival by ambulance (OR, 0.102; 95% CI, 0.049-0.211), decision time <30 min (OR, 0.008; 95% CI, 0.003-0.018), and family member understanding stroke requires early treatment (OR, 0.224; 95% CI, 0.109-0.462) were independently associated with early arrival. Conclusions: The prehospital delay in China lags behind Western countries. Recognition and behavior of stroke patients' family members may play a key role in early arrival.
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Affiliation(s)
- Rongyu Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhiqiang Wang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jian Wang
- Department of Neurology, Yaan People's Hospital, Yaan, China
| | - Chongji Gou
- Department of Neurology, Pengzhou People's Hospital, Pengzhou, China
| | - Yaodan Zhang
- Department of Neurology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Liulin Xian
- Department of Neurology, Nanbu Traditional Chinese Medicine, Nanbu, China
| | - Qingsong Wang
- Department of Neurology, The General Hospital of Western Theater Command, Chengdu, China
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Rababah JA, Al-Hammouri MM, AlNsour E. Effectiveness of an educational program on improving healthcare providers' knowledge of acute stroke: A randomized block design study. World J Emerg Med 2021; 12:93-98. [PMID: 33728000 DOI: 10.5847/wjem.j.1920-8642.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Stroke is a time-sensitive neurological disease and a life-threatening medical condition. Providing timely management for stroke patients is a crucial issue in healthcare settings. The primary objective of this study is to evaluate the effectiveness of an evidence-based educational program on healthcare providers' (HCPs) overall knowledge of stroke. METHODS A randomized block design with post-test only was used. A total of 189 HCPs (physicians, registered nurses, and paramedics) involved with treating stroke patients in the emergency were recruited. Participants were randomly assigned to either the intervention or waiting list control group. A one-session, stroke educational program was offered to the HCPs followed by a post-test designed to assess knowledge about stroke. RESULTS A significant main effect on the profession type was found, with physicians having higher mean scores of stroke knowledge compared with nurses and paramedics (F [2, 183]=48.55, P<0.001). The implemented educational program had a positive effect on increasing the level of stroke knowledge among HCPs (F [1, 183]=43.31, P<0.001). The utilization of any evidence-based assessment tools for patients with suspected stroke was denied by 36% of the total sample. CONCLUSIONS The implemented intervention can increase HCP's knowledge regarding stroke. Stroke education should be considered as one of the essential requirements for professional development for all HCPs in the emergency.
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Affiliation(s)
- Jehad A Rababah
- Jordan University of Science and Technology, Faculty of Nursing, Irbid 22110, Jordan
| | | | - Esra'a AlNsour
- Prince Al Hussein Bin Abdullah II Academy for Civil Protection, Amman 11511, Jordan
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Knowledge on Signs and Risk Factors in Stroke Patients. J Clin Med 2020; 9:jcm9082557. [PMID: 32784554 PMCID: PMC7463706 DOI: 10.3390/jcm9082557] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/26/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022] Open
Abstract
Background: There is a pressing need to contribute evidence to the improvement in the early identification of signs and symptoms associated with strokes, and address the treatment-seeking delays. The objective of this study is to describe the knowledge regarding the warning signs and risk factors (RFs) among stroke patients, as well as of their attitudes toward a suspected event, and the analysis of its possible relationship with the socio-demographic and clinical characteristics of these patients. Method: A cross-sectional study was designed, in which all stroke patients admitted consecutively to the Burgos University Hospital (Spain) were included. The principal outcomes were the patient’s ability to identify two RFs and two warning signs and the patient’s hypothetical response to a possible stroke event. The possible factors associated with the knowledge of warning signs, RFs, and the correct response to a new event were studied using univariate and multivariate regression analysis. Results: A total of 529 patients were included. Having a higher education level or a history of prior stroke were associated with a greater degree of knowledge of warning signs (odds ratio (OR) 3.19, 95% confidence interval (CI) 1.70–5.74, p = 0.003; OR 3.54, 95%CI 2.09–5.99, p ≤ 0.001, respectively), RFs (OR 3.15, 95%CI 1.75–5.67, p = 0.008; OR 4.08, 95%CI 2.41–6.91, p = 0.002, respectively), and the correct response to a possible stroke (OR 1.82, 95%CI 1.16–2.86; p = 0.030; OR 2.11, 95%CI 1.29–3.46, p = 0.022, respectively). Conclusion: Knowledge of warning signs or stroke RFs is low in the hospitalized patients. A previous stroke or secondary/higher education levels are the predictor factors that increase the probability of knowledge of warning signs, RFs, or reaction to possible event.
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Edo-Izquierdo S, Martínez-Blanquet LJ, Rovira T. Hierarchy of the main factors predicting the decision to go to the doctor in a general population sample: A factorial survey design. PATIENT EDUCATION AND COUNSELING 2020; 103:1407-1414. [PMID: 32044189 DOI: 10.1016/j.pec.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 01/16/2020] [Accepted: 02/03/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To obtain a hierarchy of the main factors that predict the decision to go to the doctor when symptoms are not yet linked to a specific disease. METHOD 64 representative vignettes, combinations of nine factors, were presented to 168 adults between 28-60 years of age. RESULTS Multilevel multiple regression models were used to rank the main factors predicting urgency to see a doctor in order of importance: the interference of symptoms in daily activities (B = -1.29; p < .001), fear (B = -0.96; p < .001), pain (B = -0.90; p < .001), access to medical care (B = -0.64; p < .001) and confidence in the doctor (B = -0.27; <.05). Moreover, gender (B = 0.56; p < .05) and educational level (B =-0.31; p < .05) explained part of the interindividual variation in the daily symptoms' interference. CONCLUSION When a specific disease has not yet been diagnosed, daily symptoms' interference is the factor that most strongly increases the urgency to visit a doctor, especially among men and among people with a higher level of education. PRACTICE IMPLICATIONS To reduce delay, generic health prevention campaigns should place more emphasis on possible interference in daily activities than on the meaning of symptoms for health.
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Affiliation(s)
| | | | - Tatiana Rovira
- Department of Basic Psychology, Autonomous University of Barcelona, Spain.
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Factors Associated with Pre-Hospital Delay and Intravenous Thrombolysis in China. J Stroke Cerebrovasc Dis 2020; 29:104897. [PMID: 32430238 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104897] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/18/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pre-hospital delay was a critical factor affecting stroke patients receiving intravenous thrombolytic therapy. The aim of this study was to explore the factors associated with pre-hospital delay and thrombolysis in China. METHODS Patient data were obtained from emergency department (ED), and the factors of patient pre-hospital delay were recorded through a well-designed form. RESULTS A total of 630 patients were eventually included in the study. 317 patients were admitted to the ED during the thrombolysis time window, and only 105 patients received intravenous thrombolytic therapy. In the univariate analysis, transportation (OR: 0.15; 95% CI: 0.44 - 0.518; p = 0.001), atrial fibrillation (OR: 0.555; 95% CI: 0.372-0.828; p = 0.004) and response of symptoms (OR: 0.002; 95% CI: 0.000-0.013; p = 0.000) were associated with early arrival. Speech disturbances (OR: 2.095; 95% CI: 1.294-3.391; p = 0.002), smoking (OR: 2.563; 95% CI: 1.527-4.304; p = 0.000), alcohol consumption (OR: 2.155; 95% CI: 1.159-4.005; p = 0.014) and referral presentation (OR: 2.837; 95% CI: 1.584-5.082; p = 0.000) were associated with thrombolysis. In the logistic regression analysis, direct visiting to the hospital after onset and rushing to emergency after onset were independent predictor of early arrival of AIS and intravenous thrombolytic. CONCLUSIONS The pre-hospital delay of acute ischemic stroke in China was still serious. Strengthening the ability to identify stroke-related symptoms and establishing a mutual referral medical support service model between lower and upper hospitals may effectively shorten the pre-hospital delay of stroke patients.
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Silva GS, Maldonado NJ, Mejia-Mantilla JH, Ortega-Gutierrez S, Claassen J, Varelas P, Suarez JI. Neuroemergencies in South America: How to Fill in the Gaps? Neurocrit Care 2020; 31:573-582. [PMID: 31342447 DOI: 10.1007/s12028-019-00775-8] [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: 10/26/2022]
Abstract
South America is a subcontinent with 393 million inhabitants with widely distinct countries and diverse ethnicities, cultures, political and societal organizations. The epidemiological transition that accompanied the technological and demographic evolution is happening in South America and leading to a rise in the incidence of neurodegenerative and cardiovascular diseases that now coexist with the still high burden of infectious diseases. South America is also quite heterogeneous regarding the existence of systems of care for the various neurological emergencies, with some countries having well-organized systems for some diseases, while others have no plan of action for the care of patients with acute neurological symptoms. In this article, we discuss the existing systems of care in different countries of South America for the treatment of neurological emergencies, mainly stroke, status epilepticus, and traumatic brain injury. We also will address existing gaps between the current systems and recommendations from the literature to improve the management of such emergencies, as well as strategies on how to solve these disparities.
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Affiliation(s)
- Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP) and Albert Einstein Hospital, Albert Einstein Street, 627, Suite 218, São Paulo, SP, 05652-900, Brazil.
| | | | | | | | | | | | - Jose I Suarez
- Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Turner AC, Schwamm LH, Etherton MR. Acute ischemic stroke: improving access to intravenous tissue plasminogen activator. Expert Rev Cardiovasc Ther 2020; 18:277-287. [PMID: 32323590 DOI: 10.1080/14779072.2020.1759422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Since approval by the United States Food and Drug Administration in 1996, alteplase utilization rates for acute ischemic stroke have increased. Despite its efficacy for improving stroke outcomes, however, the majority of ischemic stroke patients still do not receive alteplase. To address this issue, different methods for improving access to alteplase have been tested with varying degrees of success. AREAS COVERED This article gives an overview of the recent approaches pursued to improve access to alteplase for acute ischemic stroke patients. Utilization of stroke systems of care, quality metrics, and quality-improvement initiatives to improve alteplase treatment rates are discussed. The implementation of Telestroke networks to improve access and timely evaluation by a stroke specialist are also reviewed. Lastly, this review discusses the use of neuroimaging techniques to identify alteplase candidates in stroke of unknown symptom onset or beyond the 4.5-h treatment window. EXPERT COMMENTARY Expanding access to alteplase therapy for acute ischemic stroke is a multi-faceted approach. Specific considerations based on region, population, and health-care resources should be considered for each strategy. Neuroimaging approaches to identify alteplase-eligible patients beyond the 4.5-h treatment window are a recent development in acute stroke care that holds promise for increasing alteplase treatment rates.
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Affiliation(s)
- Ashby C Turner
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA
| | - Mark R Etherton
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA
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Falkenberg HK, Mathisen TS, Ormstad H, Eilertsen G. "Invisible" visual impairments. A qualitative study of stroke survivors` experience of vision symptoms, health services and impact of visual impairments. BMC Health Serv Res 2020; 20:302. [PMID: 32293430 PMCID: PMC7158142 DOI: 10.1186/s12913-020-05176-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Visual impairments (VIs) have a negative impact on life and affect up to 60% of stroke survivors. Despite this, VIs are often overlooked. This paper explores how persons with VIs experience vision care within stroke health services and how VIs impact everyday life the first 3 months post stroke. METHODS Individual semi-structured interviews were conducted with 10 stroke survivors 3 months post stroke, and analyzed using qualitative content analysis. RESULTS The main theme, "Invisible" visual impairments, represents how participants experience VIs as an unknown and difficult symptom of stroke and that the lack of attention and appropriate visual care leads to uncertainty about the future. VIs were highlighted as a main factor hindering the participants living life as before. The lack of acknowledgement, information, and systematic vision rehabilitation leads to feelings of being unsupported in the process of coping with VIs. CONCLUSION VIs are unknown symptoms pre stroke and sequelas after stroke that significantly affect everyday life. VIs and vision rehabilitation needs more attention through all phases of stroke health services. We request a greater awareness of VIs as a presenting symptom of stroke, and that visual symptoms should be included in stroke awareness campaigns. Further, we suggest increased competence and standardized evidence-based clinical pathways for VIs to advance all stroke health services including rehabilitation in order to improve outcomes and adaptation to future life for stroke survivors with VIs.
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Affiliation(s)
- Helle K Falkenberg
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway. .,USN Research Group of Older Peoples` Health, University of South-Eastern Norway, Drammen, Norway.
| | - Torgeir S Mathisen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Hasbergs vei 36, 3616, Kongsberg, Norway.,USN Research Group of Older Peoples` Health, University of South-Eastern Norway, Drammen, Norway
| | - Heidi Ormstad
- Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Grethe Eilertsen
- USN Research Group of Older Peoples` Health, University of South-Eastern Norway, Drammen, Norway.,Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Gandolfo C, Alberti F, Del Sette M, Gagliano A, Reale N. Results of an educational campaign on stroke awareness in the 2032 Rotary District in Northern-Western Italy. Neurol Sci 2020; 41:411-416. [DOI: 10.1007/s10072-019-04126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
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Lahr MMH, van der Zee DJ, Luijckx GJ, Buskens E. Optimising acute stroke care organisation: a simulation study to assess the potential to increase intravenous thrombolysis rates and patient gains. BMJ Open 2020; 10:e032780. [PMID: 31964668 PMCID: PMC7045180 DOI: 10.1136/bmjopen-2019-032780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To assess potential increases in intravenous thrombolysis (IVT) rates given particular interventions in the stroke care pathway. DESIGN Simulation modelling was used to compare the performance of the current pathway, best practices based on literature review and an optimised model. SETTING Four hospitals located in the North of the Netherlands, as part of a centralised organisational model. PARTICIPANTS Ischaemic stroke patients prospectively ascertained from February to August 2010. INTERVENTION The interventions investigated included efforts aimed at patient response and mode of referral, prehospital triage and intrahospital delays. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was thrombolysis utilisation. Secondary measures were onset-treatment time (OTT) and the proportion of patients with excellent functional outcome (modified Rankin scale (mRS) 0-1) at 90 days. RESULTS Of 280 patients with ischaemic stroke, 125 (44.6%) arrived at the hospital within 4.5 hours, and 61 (21.8%) received IVT. The largest improvements in IVT treatment rates, OTT and the proportion of patients with mRS scores of 0-1 can be expected when patient response is limited to 15 min (IVT rate +5.8%; OTT -6 min; excellent mRS scores +0.2%), door-to-needle time to 20 min (IVT rate +4.8%; OTT -28 min; excellent mRS scores+3.2%) and 911 calls are increased to 60% (IVT rate +2.9%; OTT -2 min; excellent mRS scores+0.2%). The combined implementation of all potential best practices could increase IVT rates by 19.7% and reduce OTT by 56 min. CONCLUSIONS Improving IVT rates to well above 30% appears possible if all known best practices are implemented.
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Affiliation(s)
- Maarten M H Lahr
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Durk-Jouke van der Zee
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Gert-Jan Luijckx
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Giorli E, Schirinzi E, Baldi R, Mannironi A, Raggio E, Reale N, Gandolfo C, Del Sette M. Planning a campaign to fight stroke: an educational pilot project in La Spezia, Italy. Neurol Sci 2019; 40:2133-2140. [PMID: 31183674 DOI: 10.1007/s10072-019-03963-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/03/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Best medical treatments of ischemic stroke are admission to stroke unit, intravenous thrombolysis and, in selected cases, thrombectomy. Time from symptom onset to interventions is the best predictor of clinical outcome. In order to verify the effectiveness of an active education programme of awareness on the knowledge of stroke, we performed a local campaign "on the field". SUBJECTS AND METHODS We selected 101 subjects from the general population who took part in the "stroke awareness campaign" organised by the Italian Association for the fight against stroke (A.L.I.Ce). Mean age was 59 years (50% female; 50% male); 55% of the sample reported a high level of education (> 8 years: high school or university degree). After a short multiple-choice questionnaire, we administered a face-to-face standard educational protocol (15 min). The efficacy of that educational intervention was then verified after a period of 12 months, by telephone interview. RESULTS There was improvement both in the definition of stroke (66% vs. 92%, p < .001) and in recognizing symptoms and signs (19% vs. 72%, p < .001). Knowledge of the importance of stroke unit in the acute treatment of stroke did not improve, as it was already high on baseline (92% vs. 97%, p: n.s.). The improvement was evident in particular in younger and higher educated people, without difference in gender. There was no difference based on risk factor profiles of participants. CONCLUSIONS Our results suggest that a personalised education can improve knowledge on stroke symptoms and signs, independently of gender and personal risk factors. The results should be verified in larger and less selection population.
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Affiliation(s)
- Elisa Giorli
- Unit of Neurology, St. Andrea Hospital, La Spezia, Italy.
- A.L.I.Ce. Liguria, Associazione Lotta all'Ictus Cerebrale, Genoa, Italy.
| | - E Schirinzi
- A.L.I.Ce. Liguria, Associazione Lotta all'Ictus Cerebrale, Genoa, Italy
- Unit of Neurology, E.O. Ospedali Galliera, Genoa, Italy
| | - R Baldi
- S.S.D. Epidemiology, St. Andrea Hospital, La Spezia, Italy
| | - A Mannironi
- Unit of Neurology, St. Andrea Hospital, La Spezia, Italy
- A.L.I.Ce. Liguria, Associazione Lotta all'Ictus Cerebrale, Genoa, Italy
| | - E Raggio
- S.S.D. Epidemiology, St. Andrea Hospital, La Spezia, Italy
| | - N Reale
- A.L.I.Ce. Liguria, Associazione Lotta all'Ictus Cerebrale, Genoa, Italy
| | - C Gandolfo
- A.L.I.Ce. Liguria, Associazione Lotta all'Ictus Cerebrale, Genoa, Italy
- Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
| | - M Del Sette
- A.L.I.Ce. Liguria, Associazione Lotta all'Ictus Cerebrale, Genoa, Italy
- Unit of Neurology, E.O. Ospedali Galliera, Genoa, Italy
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Abstract
Primary aldosteronism (PA), the most common form of secondary hypertension, can be either surgically cured or treated with targeted pharmacotherapy. PA is frequently undiagnosed and untreated, leading to aldosterone-specific cardiovascular morbidity and nephrotoxicity. Thus, clinicians should perform case detection testing for PA at least once in all patients with hypertension. Confirmatory testing is indicated in most patients with positive case detection testing results. The next step is to determine whether patients with confirmed PA have a disease that can be cured with surgery or whether it should be treated medically; this step is guided by computed tomography scan of the adrenal glands and adrenal venous sampling. With appropriate surgical expertise, laparoscopic unilateral adrenalectomy is safe, efficient and curative in patients with unilateral adrenal disease. In patients who have bilateral aldosterone hypersecretion, the optimal management is a low-sodium diet and lifelong treatment with a mineralocorticoid receptor antagonist administered at a dosage to maintain a high-normal serum potassium concentration without the aid of oral potassium supplements.
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Affiliation(s)
- W F Young
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
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Majid U, Kim C, Cako A, Gagliardi AR. Engaging stakeholders in the co-development of programs or interventions using Intervention Mapping: A scoping review. PLoS One 2018; 13:e0209826. [PMID: 30586425 PMCID: PMC6306258 DOI: 10.1371/journal.pone.0209826] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Health care innovations tailored to stakeholder context are more readily adopted. This study aimed to describe how Intervention Mapping (IM) was used to design health care innovations and how stakeholders were involved. METHODS A scoping review was conducted. MEDLINE, EMBASE, Cochrane Library, Scopus and Science Citation Index were searched from 2008 to November 2017. English language studies that used or cited Intervention Mapping were eligible. Screening and data extraction were done in triplicate. Summary statistics were used to describe study characteristics, IM steps employed, and stakeholder involvement. RESULTS A total of 852 studies were identified, 449 were unique, and 333 were excluded based on title and abstracts, 116 full-text articles were considered and 61 articles representing 60 studies from 13 countries for a variety of clinical issues were included. The number of studies published per year increased since 2008 and doubled in 2016 and 2017. The majority of studies employed multiple research methods (76.7%) and all 6 IM steps (73.3%). Resulting programs/interventions were single (55.4%) or multifaceted (46.4%), and 60.7% were pilot-tested. Programs or interventions were largely educational material or meetings, and were targeted to patients (70.2%), clinicians (14.0%) or both (15.8%). Studies provided few details about current or planned evaluation. Of the 4 (9.3%) studies that reported impact or outcomes, 3 achieved positive improvements in patient or professional behaviour or patient outcomes. Many studies (28.3%) did not involve stakeholders. Those that did (71.7%) often involved a combination of patients, clinicians, and community organizations. However, less than half (48.8%) described how they were engaged. Most often stakeholders were committee members and provide feedback on program or intervention content or format. CONCLUSIONS It is unclear if use of IM or stakeholder engagement in IM consistently results in effective programs or interventions. Those employing IM should report how stakeholders were involved in each IM step and how involvement influenced program or intervention design. They should also report the details or absence of planned evaluation. Future research should investigate how to optimize stakeholder engagement in IM, and whether use of IM itself or stakeholder engagement in IM are positively associated with effective programs or interventions.
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Affiliation(s)
- Umair Majid
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Claire Kim
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Albina Cako
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anna R. Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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Denti L, Schulz PJ. Response by Denti and Schulz to Letter Regarding Article, “Impact on Prehospital Delay of a Stroke Preparedness Campaign: A SW-RCT (Stepped-Wedge Cluster Randomized Controlled Trial)”. Stroke 2018; 49:e166. [DOI: 10.1161/strokeaha.118.020413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Licia Denti
- Geriatrics Ward-Stroke Care Section, University Hospital of Parma, Italy
| | - Peter J. Schulz
- Institute of Communication and Health, University of Svizzera Italiana, Lugano, Switzerland
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Arulprakash N, Umaiorubahan M. Causes of delayed arrival with acute ischemic stroke beyond the window period of thrombolysis. J Family Med Prim Care 2018; 7:1248-1252. [PMID: 30613505 PMCID: PMC6293923 DOI: 10.4103/jfmpc.jfmpc_122_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Context: Early thrombolytic therapy in acute ischemic stroke has proven to reduce the associated morbidity. Many factors are in play, delaying the arrival of patients. Aim: To ascertain the factors causing delay in patients with acute ischemic stroke presenting beyond the window period of thrombolysis in and around Chennai, Tamil Nadu, India. Subjects and Methods: An observational cross-sectional study involving 200 patients with acute ischemic stroke at Sri Ramachandra Medical College, Chennai, India between June 2015 and July 2016 was conducted. The data was collected by direct interview using a questionnaire designed to study factors such as age, family structure, residence, distance from the hospital, education status, wake-up stroke, transport, symptoms, knowledge about symptoms, seriousness of symptoms, waiting on symptoms, insurance and point of admission. Data was analyzed for means, frequencies, percentages and multiple linear regression analysis was performed to identify factors independently influencing delayed arrival. Results: Mean age of the cohort was 58.08 years: 142 men and 58 women. Mean time of delayed arrival was 13.6 hours. Multiple linear regression analysis revealed that seriousness of symptoms (P = 0.001), residence (P = 0.001), point of admission (P = 0.033) and wake-up stroke (P = 0.005) were statistically significant predictors of delayed arrival. Conclusion: Patients not perceiving their symptoms to be serious, residing in a rural area, not arriving to the emergency, and having a stroke while awake were all the significant predictors of pre-hospital delay in our study. Awareness among the masses about symptom recognition and early arrival to a tertiary care center will reduce the delay and associated morbidity. Primary care physicians notably play a significant role in educating patients at risk, identifying the symptoms of stroke and referring them for thrombolysis.
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Affiliation(s)
- Narenraj Arulprakash
- Department of Neurology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India
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