1
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Lim J, Aguirre AO, Rattani A, Baig AA, Monteiro A, Kuo CC, Siddiqi M, Im J, Housley SB, McPheeters MJ, Ciecierska SSK, Jaikumar V, Vakharia K, Davies JM, Snyder KV, Levy EI, Siddiqui AH. Thrombectomy outcomes for acute ischemic stroke in lower-middle income countries: A systematic review and analysis. World Neurosurg X 2024; 23:100317. [PMID: 38511159 PMCID: PMC10950731 DOI: 10.1016/j.wnsx.2024.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Alexander O. Aguirre
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Abbas Rattani
- Department of Radiation Oncology, Tufts University Medical Center, Boston, MA, USA
| | - Ammad A. Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Cathleen C. Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Manhal Siddiqi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Justin Im
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Steven B. Housley
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Matthew J. McPheeters
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | | | - Vinay Jaikumar
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Jason M. Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Kenneth V. Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Elad I. Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Adnan H. Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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2
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Sedzro MT, Murray L, Garnett A, Nouvet N, Kankam K, Fiadzomor P. Exploring the lived experiences of family caregivers of patients with stroke in Africa: a scoping review of qualitative evidence. Brain Inj 2024; 38:390-402. [PMID: 38317299 DOI: 10.1080/02699052.2024.2310798] [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: 04/19/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The burden of stroke is immense in African countries, with post-stroke care usually becoming the responsibility of family. This review sought to determine the current breadth and depth of qualitative evidence regarding the lived experiences of family caregivers of patients with stroke in Africa. METHODS Informed by Joanna Briggs Institute (JBI) methodology for scoping reviews, six databases were searched. Included articles were appraised for quality using the JBI checklist. A priori themes developed using the study objectives were used to synthesize study findings. RESULTS The review included 22 articles, which outlined key patterns in stroke outcomes with most articles focused on rehabilitation and the experiences, outcomes, burdens, and coping mechanisms of caregiving. The intersectionality of socio-economic status, socio-political structures, and religious or traditional beliefs, attitudes, and practices characterized etiology beliefs, treatment trajectories of stroke, and caregiving role assignment. Whereas burdens were driven by limited resources, adopted coping strategies involved spiritual or religious beliefs, optimism, resilience, and social support networks. CONCLUSIONS Family caregivers' values must be acknowledged, supported, and integrated into the traditional healthcare system to provide comprehensive stroke care. Caregivers' health and well-being should be given more attention given their necessary contribution to stroke survivorship in Africa.
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Affiliation(s)
- Mawukoenya Theresa Sedzro
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Department of Speech, Language & Hearing Sciences, School of Allied Health Sciences, University of Health & Allied Sciences, Ho, Volta Region, Ghana
| | - Laura Murray
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences & Disorders, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Nouvet Nouvet
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Keren Kankam
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Peace Fiadzomor
- Department of Speech, Language & Hearing Sciences, School of Allied Health Sciences, University of Health & Allied Sciences, Ho, Volta Region, Ghana
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3
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Siiba A, Kangmennaang J, Baatiema L, Luginaah I. The relationship between climate change, globalization and non-communicable diseases in Africa: A systematic review. PLoS One 2024; 19:e0297393. [PMID: 38394170 PMCID: PMC10889617 DOI: 10.1371/journal.pone.0297393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024] Open
Abstract
Climate change and non-communicable diseases (NCDs) are considered the 21st Century's major health and development challenges. Both pose a disproportionate burden on low- and middle-income countries that are unprepared to cope with their synergistic effects. These two challenges pose risks for achieving many of the sustainable development goals (SDGs) and are both impacted by globalization through different pathways. While there are important insights on how climate change and or globalization impact NCDs in the general literature, comprehensive research that explores the influence of climate change and or globalization on NCDs is limited, particularly in the context of Africa. This review documents the pathways through which climate change and or globalization influence NCDs in Africa. We conducted a comprehensive literature search in eight electronic databases-Web of Science, PubMed, Scopus, Global Health Library, Science Direct, Medline, ProQuest, and Google Scholar. A total of 13864 studies were identified. Studies that were identified from more than one of the databases were automatically removed as duplicates (n = 9649). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 27 studies were eventually included in the final review. We found that the impacts of climate change and or globalization on NCDs act through three potential pathways: reduction in food production and nutrition, urbanization and transformation of food systems. Our review contributes to the existing literature by providing insights into the impact of climate change and or globalization on human health. We believe that our findings will help enlighten policy makers working on these pathways to facilitate the development of effective policy and public health interventions to mitigate the effects of climate change and globalization on the rising burden of NCDs and goal 3 of the SDG, in particular.
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Affiliation(s)
- Alhassan Siiba
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Joseph Kangmennaang
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana Legon, Greater Accra Region, Ghana
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, Ontario, Canada
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4
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Shumba C, Mtaja A, Saylor D. Developing Systems for Cardiac and Stroke Care in Zambia. J Am Heart Assoc 2024; 13:e030151. [PMID: 38156470 PMCID: PMC10863803 DOI: 10.1161/jaha.123.030151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/08/2023] [Indexed: 12/30/2023]
Affiliation(s)
| | - Agnes Mtaja
- University Teaching Hospital, Children’s Hospital, University of ZambiaLusakaZambia
| | - Deanna Saylor
- Johns Hopkins University School of MedicineBaltimoreMD
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5
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Opare-Addo PA, Oppong C, Gyamfi RA, Aikins M, Nsohlebna Nsoh L, Asare-Bediako S, Attafuah E, Sarfo K, Sampah AK, Yiadom JB, Sarfo FS. Deciphering the contextual barriers to mainstreaming the implementation of stroke thrombolysis in a Ghanaian hospital: Findings from the activate mixed-methods study. J Stroke Cerebrovasc Dis 2023; 32:107394. [PMID: 37866294 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107394] [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: 07/30/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Each year, stroke-related death and disability claim over 143 million years of healthy life globally. Despite accounting for much of the global stroke burden, acute stroke care in Low-and-Middle-Income Countries remains suboptimal. Thrombolysis, an effective treatment option for stroke, is only received by a minority of stroke patients in these settings. AIM To determine the context-specific barriers and facilitators for the implementation of mainstream stroke thrombolysis in a Ghanaian hospital. METHODS We employed a mixed-methods approach involving key stakeholders (recipients, providers, and leaders) in the acute stroke care continuum. Surveys were administered to acute stroke patients, and in-depth key informant interviews were conducted with experts in stroke care, including a neurologist, medical director, neurology residents, a stroke nurse, emergency physicians, a radiologist, and a pharmacist. The data collected from these interviews were transcribed and analysed using content analysis with the CFIR (Consolidated Framework for Implementation Research) model as a guiding template. Two independent coders were involved in the analysis process to ensure reliability and accuracy. RESULTS The stroke thrombolysis rate over a 6-month period was 0.83% (2 out of 242), with an average door-to-needle time among thrombolyzed patients being 2 hours, 37 minutes. Only 12.8% of patients (31 out of 242) presented within 4.5 hours of stroke symptom onset. The most significant obstacle to the implementation of acute stroke thrombolysis was related to the characteristics of the individuals involved, notably delays in presenting to the hospital among stroke patients due to a lack of knowledge about stroke symptoms and cultural beliefs. Additionally, a significant bottleneck that contributed to the discrepancy between the number of patients who presented within the 4.5-6 hour window and the number of patients who actually received thrombolysis was the inability to pay for the cost of thrombolytic agents. This was followed by challenges in the implementation processes. CONCLUSIONS Addressing challenges related to stroke awareness, and financial constraints via multi-level stakeholder engagement, and enactment of stroke protocols are crucial steps in ensuring a successful implementation of a stroke thrombolysis program in a resource-limited setting.
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Affiliation(s)
| | - Chris Oppong
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | | | | | | | | | - Kofi Sarfo
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | - Fred Stephen Sarfo
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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6
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Tenkorang PO, Awuah WA, Ng JC, Kalmanovich J, Nazir A, Yarlagadda R, Abdul-Rahman T, Isik A. Letter: The State of Cerebrovascular Care in Africa. Neurosurgery 2023; 92:e72-e73. [PMID: 36700753 DOI: 10.1227/neu.0000000000002330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
| | | | - Jyi Cheng Ng
- Faculty of Medicine and Health Sciences, University of Putra Malaysia, Serdang, Malaysia
| | - Jacob Kalmanovich
- Faculty of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Abubakar Nazir
- Faculty of Medicine, King Edward Medical University, Pakistan
| | - Rohan Yarlagadda
- Faculty of Medicine, University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | | | - Arda Isik
- Istanbul Medeniyet University, Department of General Surgery, Istanbul, Turkey
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7
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Kayola G, Mataa MM, Asukile M, Chishimba L, Chomba M, Mortel D, Nutakki A, Zimba S, Saylor D. Stroke Rehabilitation in Low- and Middle-Income Countries: Challenges and Opportunities. Am J Phys Med Rehabil 2023; 102:S24-S32. [PMID: 36634327 PMCID: PMC9846582 DOI: 10.1097/phm.0000000000002128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Stroke remains the second leading cause of global disability with 87% of stroke-related disability occurring in low- and middle-income countries. In low- and middle-income countries, access to acute stroke interventions is often limited, making effective poststroke rehabilitation potentially the best available intervention to promote poststroke recovery. Here, we build on our experience as an illustrative example of barriers individuals with stroke face in accessing rehabilitation services and review the literature to summarize challenges to providing effective rehabilitation in low- and middle-income countries. First, we focus on barriers individuals with stroke face in accessing rehabilitation in low- and middle-income countries, including health system barriers, such as lack of national guidelines, low prioritization of rehabilitation services, and inadequate numbers of skilled rehabilitation specialists, as well as patient factors, including limited health literacy, financial constraints, and transportation limitations. Next, we highlight consequences of this lack of rehabilitation access, including higher mortality, poorer functional outcomes, financial burden, caregiver stress, and loss of gross domestic product at a national level. Finally, we review possible strategies that could improve access and quality of rehabilitation services in low- and middle-income countries, including creation of inpatient stroke units, increased training opportunities for rehabilitation specialists, task shifting to available healthcare workers or caregivers, telerehabilitation, and community-based rehabilitation services.
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Affiliation(s)
- Grace Kayola
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | - Melody Asukile
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Lorraine Chishimba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Mashina Chomba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Dominique Mortel
- Department of Neurology, Johns Hopkins University School of Medicine
| | | | - Stanley Zimba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
- Department of Neurology, Johns Hopkins University School of Medicine
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8
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Decompressive hemicraniectomy versus medical treatment for malignant middle cerebral artery infarction: Eleven years experience in a Tunisian center. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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9
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Uwishema O, Berjaoui C, Correia IFS, Anis H, Karabulut E, Essayli D, Mhanna M, Oluyemisi A. Current Management of Acute Ischemic Stroke in Africa: A Review of the Literature. Eur J Neurol 2022; 29:3460-3465. [PMID: 35837810 DOI: 10.1111/ene.15495] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute ischemic stroke is one of the leading causes of disability and mortality globally, with increasing incidence in Africa, as the continent is already burdened with infectious diseases. Rapid diagnosis and efficient treatment are crucial, as even a slight delay to reperfuse the brain significantly affects the recovery outcome. Neuroimaging is vital for optimal care and thrombolytic or endovascular therapy in specialised stroke care units. This review aims to discuss the burden of acute ischemic stroke in Africa and how healthcare systems have tried to reduce the incidence and improve outcomes for the disease. METHODOLOGY Data was collected from online databases and medical journal published on PubMed, Ovid MEDLINE, ScienceDirect and Embase bibliographical data. All articles related to acute ischemic stroke in Africa were considered. RESULTS The medical care for acute ischemic stroke in Africa is far from optimal with little adherence to recommended protocols. There is a lack of public awareness of the disease, imaging infrastructure, personnel, stroke care units and recovery facilities, due to poor funding. Poor knowledge of stroke signs and symptoms results in delay in treatment and poor prognosis. CONCLUSION We urge African leaders and private entities to invest in stroke care by building appropriate infrastructures, providing medical equipments, implementing guidelines, and sustainable follow-up systems. Telehealth is a suggested strategy to mitigate the scarcity of health personnel, and international and national efforts to increase treatment affordability should be doubled. Further extensive research on the impact of acute ischemic stroke on the African continent population is encouraged.
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Affiliation(s)
- Olivier Uwishema
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Clinton Global Initiative University, New York, New York, USA.,Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Christin Berjaoui
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Faculty of Medicine and Surgery, Beirut Arab University, Beirut, Lebanon
| | - Inês F Silva Correia
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,School of Medicine, Faculty of Health, Medicine, Education and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Heeba Anis
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Deccan College of Medical Sciences, Hyderabad, Telangana, India.,Medtech Innovator, Riga Technical University, Riga, Latvia
| | - Ece Karabulut
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Dina Essayli
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Melissa Mhanna
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Adekunbi Oluyemisi
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,School of Public and Allied Health, Babcock University, Ilishan-Remo, Ogun State, Nigeria
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10
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Cisse FA, Ligot N, Conde K, Barry DS, Toure LM, Konate M, Soumah MF, Diawara K, Traore M, Naeije G. Predictors of stroke favorable functional outcome in Guinea, results from the Conakry stroke registry. Sci Rep 2022; 12:1125. [PMID: 35064178 PMCID: PMC8782910 DOI: 10.1038/s41598-022-05057-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
Low- to middle-income countries (LMICs) now bear most of the stroke burden. In LMICs, stroke epidemiology and health care systems are different from HICs. Therefore, a high-income country (HIC)-based predictive model may not correspond to the LMIC stroke context. Identify the impact of modifiable variables in acute stroke management in Conakry, Guinea as potential predictors of favorable stroke outcome. Data were extracted from the Conakry stroke registry that includes 1018 patients. A logistic regression model was built to predict favorable stroke outcomes, defined as mRS 0–2. Age, admission NIHSS score, mean arterial blood pressure and capillary glycemia were chosen as covariates. Delay to brain CT imaging under 24 h from symptom onset, fever, presence of sores and abnormal lung auscultation were included as factors. NIHSS score on admission, age and ischemic stroke were included in the null model as nuisance parameters to determine the contribution of modifiable variables to predict stroke favorable outcome. Lower admission NIHSS, brain CT imaging within 24 h of symptoms onset and lower mean arterial blood pressure emerged as a significant positive predictors of favorable stroke outcome with respective odd ratios (OR) of 1.35 [1.28–1.43], 2.1 [1.16–3.8] and 1.01 [1.01–1.04]. The presence of fever or sores impacted negatively stroke favorable outcomes with OR of 0.3 [0.1–0.85] and 0.25 [0.14–0.45]. The area under receiver operating characteristic curves (AUC) of the model was 0.86. This model explained 44.5% of the variability of the favorable stroke outcome with 10.2% of the variability explained by the modifiable variables when admission NIHSS, and ischemic stroke were included in the null model as nuisance parameter. In the Conakry stroke registry, using a logistic regression to predict stroke favorable outcome, five variables that led to an AUC of 0.86: admission NIHSS, early brain CT imaging, fever, sores and mean blood pressure. This paves the way for future public health interventions to test whether modulating amendable variables leads to increased favorable stroke outcomes in LMICs.
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Affiliation(s)
- Fode Abass Cisse
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Noémie Ligot
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kaba Conde
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Djigué Souleymane Barry
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Lamine Mohamed Toure
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mamadi Konate
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mohamed Fode Soumah
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Karinka Diawara
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Mohamed Traore
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Gilles Naeije
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium. .,Laboratoire de Cartographie Fonctionnelle du Cerveau, ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), 808 Lennik Street, 1070, Brussels, Belgium.
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11
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Waweru P, Gatimu SM. Stroke Epidemiology, Care, and Outcomes in Kenya: A Scoping Review. Front Neurol 2021; 12:785607. [PMID: 34975737 PMCID: PMC8716633 DOI: 10.3389/fneur.2021.785607] [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: 10/07/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Stroke is a leading cause of death and disability in sub-Saharan Africa with increasing incidence. In Kenya, it is a neglected condition with a paucity of evidence despite its need for urgent care and hefty economic burden. Therefore, we reviewed studies on stroke epidemiology, care, and outcomes in Kenya to highlight existing evidence and gaps on stroke in Kenya. Methods: We reviewed all published studies on epidemiology, care, and outcomes of stroke in Kenya between 1 January 1990 to 31 December 2020 from PubMed, Web of Science, EBSCOhost, Scopus, and African journal online. We excluded case reports, reviews, and commentaries. We used the Newcastle-Ottawa scale adapted for cross-sectional studies to assess the quality of included studies. Results: Twelve articles were reviewed after excluding 111 duplicates and 94 articles that did not meet the inclusion criteria. Five studies were of low quality, two of medium quality, and five of high quality. All studies were hospital-based and conducted between 2003 and 2017. Of the included studies, six were prospective and five were single-center. Stroke patients in the studies were predominantly female, in their seventh decade with systemic hypertension. The mortality rate ranged from 5 to 27% in-hospital and 23.4 to 26.7% in 1 month. Conclusions: Our study highlights that stroke is a significant problem in Kenya, but current evidence is of low quality and limited in guiding policy development and improving stroke care. There is thus a need for increased investment in hospital- and community-based stroke care and research.
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Affiliation(s)
- Peter Waweru
- Department of Neurosurgery, Kenyatta University Teaching, Referral and Research Hospital, Nairobi, Kenya
- *Correspondence: Peter Waweru
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12
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Zhang T, Li X, Sun G, Wang J, Chen H. Establishment of emergency-nursing pathway of interventional thrombectomy in acute ischemic stroke. Am J Transl Res 2021; 13:11966-11973. [PMID: 34786129 PMCID: PMC8581842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To establish the emergency-nursing pathway of interventional thrombectomy on acute ischemic stroke (AIS). METHODS 113 AIS patients who received interventional thrombotomy in conventional emergency model from Aug. 2019 to Feb. 2020 were included as control-group, and 127 patients, who underwent interventional thrombotomy by pathway-based emergency nursing program from Mar. 2020 to Sep. 2020, were classified into observation-group. The time points from admission to recanalization of the two groups, the recanalization rate, and the changes in the neurological impairment scale (NIHSS) scores of the two groups in pre- and post-treatment were compared; Meanwhile, the therapeutic efficacy rate between the two groups was evaluated and compared by modified Rankin Score (mRS) 90 days after discharge. RESULTS The average time from hospital arrival to femoral artery puncture, the average time of successful femoral artery puncture, and the average time from admission to recanalization in observation-group were remarkably shorter than that of control-group (P<0.05). The recanalization rate of endovascular therapy in observation-group was 92.13%, which was higher than that in control-group (80.53%, P<0.05); The NIHSS score of observation-group after treatment was obviously lower than that of control-group (P<0.05); The curative rate in observation-group was 90.55%, which was higher than that of 79.65% in control group (P<0.05); The satisfaction of observation-group patients with nursing care was 90.55%, which was higher than that of 73.45% in control-group (P<0.05). CONCLUSION Establishment of emergency-nursing pathway can reduce the time-consuming from admission to vascular recanalization for AIS patients undergoing interventional thrombectomy, increase the recanalization rate, improve the patients' neurological function, and ameliorate the curative rate and nursing satisfaction.
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Affiliation(s)
- Ting Zhang
- Department of Thoracic Surgery, Tianjin First Central HospitalTianjin 300192, China
| | - Xiaolu Li
- Department of Encephalopathy, Shandong Qingdao Integrated Traditional Chinese and Western Medicine HospitalQingdao 266000, Shandong, China
| | - Guiguan Sun
- Department of Encephalopathy, Shandong Qingdao Integrated Traditional Chinese and Western Medicine HospitalQingdao 266000, Shandong, China
| | - Juan Wang
- Department of Thoracic Surgery, Tianjin First Central HospitalTianjin 300192, China
| | - Huimin Chen
- Department of Neurology, The No. 4 Hospital of Ji’nanJi’nan 250031, Shandong, China
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Yaria J, Gil A, Makanjuola A, Oguntoye R, Miranda JJ, Lazo-Porras M, Zhang P, Tao X, Ahlgren JÁ, Bernabe-Ortiz A, Moscoso-Porras M, Malaga G, Svyato I, Osundina M, Gianella C, Bello O, Lawal A, Temitope A, Adebayo O, Lakkhanaloet M, Brainin M, Johnson W, Thrift AG, Phromjai J, Mueller-Stierlin AS, Perone SA, Varghese C, Feigin V, Owolabi MO. Quality of stroke guidelines in low- and middle-income countries: a systematic review. Bull World Health Organ 2021; 99:640-652E. [PMID: 34475601 PMCID: PMC8381090 DOI: 10.2471/blt.21.285845] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. METHODS We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. FINDINGS We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. CONCLUSION Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
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Affiliation(s)
- Joseph Yaria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Artyom Gil
- Division of Country Health Programme, WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | | | - Richard Oguntoye
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - J Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Puhong Zhang
- The George Institute for Global Health, Beijing, China
| | - Xuanchen Tao
- The George Institute for Global Health, Beijing, China
| | | | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - German Malaga
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Irina Svyato
- Moscow School of Management SKOLKOVO, Moscow, Russia
| | - Morenike Osundina
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Camila Gianella
- Department of Psychology, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Olamide Bello
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Abisola Lawal
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ajagbe Temitope
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Michael Brainin
- Department of Neurosciences and Preventive Medicine, Danube University, Krems, Austria
| | - Walter Johnson
- Department of Neurosurgery, Loma Linda University, California, United States of America
| | - Amanda G Thrift
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | | | | | - Cherian Varghese
- Noncommunicable Disease Department, World Health Organization, Geneva, Switzerland
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Mayowa O Owolabi
- Department of Medicine, University College Hospital, 200001 Ibadan, Oyo State, Nigeria.Correspondence to Mayowa O Owolabi ()
| | - on behalf of the Stroke Experts Collaboration Group
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Division of Country Health Programme, WHO European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russia
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, Beijing, China
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Moscow School of Management SKOLKOVO, Moscow, Russia
- Department of Psychology, Pontificia Universidad Católica del Perú, Lima, Peru
- Thung Chang Hospital, Thung Chang District, Nan, Thailand
- Department of Neurosciences and Preventive Medicine, Danube University, Krems, Austria
- Department of Neurosurgery, Loma Linda University, California, United States of America
- School of Clinical Sciences, Monash University, Melbourne, Australia
- Health System Research Institute, Nonthaburi, Thailand
- Institute for Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Noncommunicable Disease Department, World Health Organization, Geneva, Switzerland
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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14
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Beyene N, Fanta K, Tatiparthi R. Pharmacotherapy Pattern and Treatment Outcomes of Stroke Patients Admitted to Jimma University Medical Center, Ethiopia. PATIENT-RELATED OUTCOME MEASURES 2021; 12:267-275. [PMID: 34393535 PMCID: PMC8357615 DOI: 10.2147/prom.s307291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022]
Abstract
Background Despite the fact that stroke has been reported as one of the top three leading causes of death and morbidity in Ethiopia, there are limited data regarding the management of stroke and clinical outcomes. Hence, the present study aimed to evaluate the pharmacotherapy of stroke and factors associated with poor treatment outcomes. Methods A retrospective cross-sectional study was conducted at Jimma University Medical Center (JUMC) among adult stroke patients managed from 2014 to 2017. Clinical characteristics, treatment, and outcomes data were analyzed by using SPSS version 21. Multivariable logistic regression was performed to identify the predictors of poor treatment outcomes. Two-sided P < 0.05 was accepted as statistically significant. Results A total of 153 illegible patient cases were included in this study. The majority, 111 (72.5%), were male and the mean age of the patients was 57±13.7 years. Among 153 stroke patients, 112 (73.2%) patients presented with ischemic stroke. Aspirin and statins (78.6%) were the most commonly used treatment among ischemic stroke patients, whereas enalapril was used in about (43%) of stroke patients to treat high blood pressure. About 61 (40%) stroke patients had poor treatment outcomes; of this, 36 (23.5%) died in hospital. Older age (AOR = 1.034; 95% CI: 1.003–1.069), history of heart failure (AOR = 4.26; 95% CI: 1.58–11.48), loss of consciousness diabetes (AOR = 3.05 95% CI: 1.25–7.44), and aspiration pneumonia (AOR = 5.94; 95% CI: 2.46–14.32) were significantly associated with poor treatment outcomes. Conclusion Overall, treatment of stroke patients was sub-optimal and almost half of the patients had poor treatment outcomes. Availing of thrombolytic therapy, devising appropriate preventive measures of risk factors (hypertension), and decreasing preventable complication such as aspiration pneumonia could improve patient outcomes.
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Affiliation(s)
- Nigatu Beyene
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Korinan Fanta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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15
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Naidoo D. Decompressive craniotomy for malignant middle cerebral artery infarction: The quest for an African perspective. Surg Neurol Int 2021; 12:200. [PMID: 34084627 PMCID: PMC8168709 DOI: 10.25259/sni_303_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/10/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Although associated with controversy, decompressive craniotomy (DC) for malignant middle cerebral artery infarction (MMCAI) is an unequivocally lifesaving intervention. DC for MMCAI is rarely performed in lower- to middle-income countries. Methods: A systemic review was performed in attempt to determine the rates of utilization and outcomes of DC on the African continent. Results: Only two African studies describing DC for MMCAI were found. Conclusion: DC for MMCAI is rarely performed and/or reported on the African continent. The African perspective for this needs to be urgently broadened.
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Affiliation(s)
- Dinesh Naidoo
- Department of Neurosciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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16
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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17
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Kroeber ES, Adam L, Addissie A, Bauer A, Frese T, Kantelhardt EJ, Unverzagt S. Protocol for a systematic review on tertiary prevention interventions for patients with stroke in African countries. BMJ Open 2020; 10:e038459. [PMID: 32928859 PMCID: PMC7488840 DOI: 10.1136/bmjopen-2020-038459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Stroke is one of the common causes of mortality, morbidity and years of life lost worldwide. Baseline research on stroke epidemiology, prevention, acute and rehabilitative interventions in Africa is necessary to approach specific contexts and regional circumstances. Most studies on stroke have been conducted in high-income countries. This protocol describes the methodology to summarise the best available evidence on tertiary preventive strategies like rehabilitation interventions for patients with stroke in African contexts. METHODS AND ANALYSIS We will include experimental studies and prospective cohort studies conducted in African countries. A protocol has been registered in PROSPERO. Systematic search will include eight electronic databases (MEDLINE, Embase, the Cochrane Library, CINAHL, Cab-Direct, Physiotherapy Evidence Database (PEDro), African Journals Online and African Index Medicus) and the International Clinical Trials Register Platform and base on predefined search terms. We will search from inception of each database and repeat this strategy 3 months prior to review submission. Details of all eligible studies will be extracted and risk of bias for outcomes on global disability or dependence in daily living will be assessed. Main aim of this systematic review is to provide a narrative description of evidence on tertiary prevention strategies (including rehabilitation) for stroke. This description will be visualised in structured tables to aid interpretation of study characteristics, intervention effects and certainty of the evidence. ETHICS AND DISSEMINATION No ethical approval is necessary. Results will be presented in national and international conferences and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020159125.
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Affiliation(s)
- Eric Sven Kroeber
- Center of Health Sciences, Institute of General Practice and Family Medicine, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Lucas Adam
- Center of Health Sciences, Institute of General Practice and Family Medicine, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Adamu Addissie
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Oromia, Ethiopia
| | - Alexander Bauer
- Center of Health Sciences, Institute of General Practice and Family Medicine, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Thomas Frese
- Center of Health Sciences, Institute of General Practice and Family Medicine, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Eva Johanna Kantelhardt
- Center of Health Sciences, Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
| | - Susanne Unverzagt
- Center of Health Sciences, Institute of General Practice and Family Medicine, Martin-Luther-Universitat Halle-Wittenberg, Halle, Sachsen-Anhalt, Germany
- Department of General Practice, Leipzig University, Leipzig, Sachsen, Germany
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18
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Baatiema L, Abimbola S, de-Graft Aikins A, Damasceno A, Kengne AP, Sarfo FS, Charway-Felli A, Somerset S. Towards evidence-based policies to strengthen acute stroke care in low-middle-income countries. J Neurol Sci 2020; 418:117117. [PMID: 32919367 DOI: 10.1016/j.jns.2020.117117] [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: 06/04/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022]
Abstract
Stroke is a major public health issue in many low- and middle-income countries (LMICs). Despite the emergence of new effective interventions for acute stroke care, uptake remains slow and largely inaccessible to patients in LMICs, where health systems response has been inadequate. In this paper, we propose a policy framework to optimise access to acute stroke care in LMICs. We draw on evidence from relevant primary studies, such as availability of evidence-based acute stroke care interventions, barriers to uptake of interventions for stroke care and insights on stroke mortality and morbidity burden in LMICs. Insights from review of secondary studies, principally systematic reviews on evidence-based acute stroke care; and the accounts and experiences of some regional experts on stroke and other NCDs have been taken into consideration. In LMICs, there is limited availability and access to emergency medical transport services, brain imaging services and best practice interventions for acute stroke care. Availability of specialist acute stroke workforce and low awareness of early stroke signs and symptoms are also major challenges impeding the delivery of quality stroke care services. As a result, stroke care in LMICs is patchy, fragmented and often results in poor patient outcomes. Reconfiguration of LMIC health systems is thus required to optimise access to quality acute stroke care. We therefore propose a ten-point framework to be adapted to country-specific health system capacity, needs and resources: Emergency medical transport and treatment services, scaling-up interventions and services for acute stroke care, clinical guidelines for acute stroke treatment and management, access to brain imaging services, human resource capacity development strategies, centralisation of stroke services, tele-stroke care, public awareness campaigns on early stroke symptoms, establish stroke registers and financing of stroke care in LMICs. While we recognise the challenges of implementing the recommendations in low resource settings, this list can provide a platform as well serve as the starting point for advocacy and prioritisation of interventions depending on context.
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Affiliation(s)
- Leonard Baatiema
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
| | - Seye Abimbola
- School of Public Health, University of Sydney, Australia.
| | | | | | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Department of Medicine, Kumasi, Ghana.
| | | | - Shawn Somerset
- Faculty of Health, University of Canberra, Canberra, Australia.
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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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20
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Baatiema L, de‐Graft Aikins A, Sarfo FS, Abimbola S, Ganle JK, Somerset S. Improving the quality of care for people who had a stroke in a low-/middle-income country: A qualitative analysis of health-care professionals' perspectives. Health Expect 2020; 23:450-460. [PMID: 31967387 PMCID: PMC7104640 DOI: 10.1111/hex.13027] [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] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Efforts to improve the adoption of evidence-based interventions for optimal patient outcomes in low-/middle-income countries (LMICs) are persistently hampered by a plethora of barriers. Yet, little is known about strategies to address such barriers to improve quality stroke care. This study seeks to explore health professionals' views on strategies to improve quality stroke care for people who had a stroke in a LMIC. METHODS A qualitative interview study design was adopted. A semi-structured interview guide was used to conduct in-depth interviews among forty stroke care providers in major referral centres in Ghana. Participants were from nursing, medical, specialist and allied health professional groups. A purposive sample was recruited to share their views on practical strategies to improve quality stroke care in clinical settings. A thematic analysis approach was utilized to inductively analyse the data. RESULTS A number of overarching themes of strategies to improve quality stroke care were identified: computerization and digitization of medical practice, allocation of adequate resources, increase the human resource capacity to deliver stroke care, development of clinical guideline/treatment protocols, institutionalization of multidisciplinary care and professional development opportunities. These strategies were however differentially prioritized among different categories of stroke care providers. CONCLUSION Closing the gap between existing knowledge on how to improve quality of stroke care in LMICs has the potential to be successful if unique and context-specific measures from the views of stroke care providers are considered in developing quality improvement strategies and health systems and policy reforms. However, for optimal outcomes, further research into the effectiveness and feasibility of the proposed strategies by stroke care providers is needed.
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Affiliation(s)
- Leonard Baatiema
- Noguchi Memorial Institute for Medical ResearchUniversity of GhanaLegonGhana
| | | | - Fred S. Sarfo
- Kwame Nkrumah University of Science & TechnologyKumasiGhana
- Department of MedicineKomfo Anokye Teaching HospitalKumasiGhana
| | - Seye Abimbola
- School of Public HealthUniversity of SydneySydneyNSWAustralia
| | - John K. Ganle
- School of Public HealthUniversity of GhanaLegonGhana
| | - Shawn Somerset
- Faculty of HealthUniversity of CanberraCanberraACTAustralia
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21
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Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective. Glob Heart 2020; 15:15. [PMID: 32489788 PMCID: PMC7218780 DOI: 10.5334/gh.403] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations.
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Gadama Y, Kamtchum-Tatuene J, Benjamin L, Phiri T, Mwandumba HC. The significant gap between international standards and stroke management practices at Queen Elizabeth Central Hospital (Malawi): An audit report. Malawi Med J 2019; 31:249-255. [PMID: 32128035 PMCID: PMC7036432 DOI: 10.4314/mmj.v31i4.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background The Queen Elizabeth Central Hospital (QECH) is preparing to set up the first stroke unit in Blantyre, Malawi. We conducted this audit to assess current stroke management practices and outcomes at QECH and identify priority areas for intervention. Methods From April to June 2018, we prospectively enrolled patients with acute stroke and collected data on clinical presentation, cardiovascular risk factors, investigations and interventions, in-hospital outcomes, and follow-up plans after discharge. The American Heart Association/American Stroke Association (AHA/ASA) guidelines were used as the standard of care for comparison. Results Fifty patients with acute stroke were enrolled (46% women, 54% men). The mean age was 63.1 years (95% CI: 59.7-66.6). The diagnosis of stroke was based on the World Health Organization criteria. The diagnosis was made within 24 hours of admission in 19 patients (38%). Acute revascularisation therapy was not available. Forty-eight patients (96%) had their vital signs checked at baseline and <10% had their vital signs checked more than three times within the first 24 hours. Essential blood tests including random blood sugar (RBS), full blood count (FBC), urea/creatinine, and lipid profiles were performed in 72%, 68%, 48%, and 4%, respectively. An electrocardiogram was performed on 34 patients (68%). Blood pressure on admission was >140/90 mmHg in 34 patients (68%), including 4 with values >220/120 mmHg. Nine patients had an RBS >10 mmol/L and four received insulin. Prophylaxis for deep venous thrombosis was offered to 12 patients (24%). Aspiration pneumonia was reported in 16 patients (32%) and was the most common hospital complication. The mean duration of hospitalisation was 10.4 days (95% CI: 5.6-15.2), and case fatality was 18%. The modified Rankin scale at discharge was ≤2 in 32% of patients. Only four patients (8%) were transferred to a rehabilitation centre. At the time of discharge, only 32% of patients received education on stroke. Conclusion Acute stroke care is less than optimal in this setting. Simple interventions such as reducing the delay in making a stroke diagnosis, early swallow assessments, and closer monitoring of vital signs could make a significant difference in stroke outcome. Furthermore, treating cardiovascular risk factors and setting up health education programmes to improve secondary prevention represent key priorities.
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Affiliation(s)
- Yohane Gadama
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
- Institute of Neurology, University College London, London, UK
| | - Joseph Kamtchum-Tatuene
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Laura Benjamin
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
- Institute of Neurology, University College London, London, UK
- Institute of Infection and Global Health, University of Liverpool, UK
| | - Tamara Phiri
- Department of Medicine, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi
| | - Henry C Mwandumba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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23
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Chimatiro GL, Rhoda AJ. Scoping review of acute stroke care management and rehabilitation in low and middle-income countries. BMC Health Serv Res 2019; 19:789. [PMID: 31684935 PMCID: PMC6829977 DOI: 10.1186/s12913-019-4654-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 10/17/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Stroke is a major public health concern, affecting millions of people worldwide. Care of the condition however, remain inconsistent in developing countries. The purpose of this scoping review was to document evidence of stroke care and service delivery in low and middle-income countries to better inform development of a context-fit stroke model of care. METHODS An interpretative scoping literature review based on Arksey and O'Malley's five-stage-process was executed. The following databases searched for literature published between 2010 and 2017; Cochrane Library, Credo Reference, Health Source: Nursing/Academic Edition, Science Direct, BioMed Central, Cumulative Index to Nursing and Allied Health Literature (CINNAHL), Academic Search Complete, and Google Scholar. Single combined search terms included acute stroke, stroke care, stroke rehabilitation, developing countries, low and middle-income countries. RESULTS A total of 177 references were identified. Twenty of them, published between 2010 and 2017, were included in the review. Applying the Donebedian Model of quality of care, seven dimensions of stroke-care structure, six dimensions of stroke care processes, and six dimensions of stroke care outcomes were identified. Structure of stroke care included availability of a stroke unit, an accident and emergency department, a multidisciplinary team, stroke specialists, neuroimaging, medication, and health care policies. Stroke care processes that emerged were assessment and diagnosis, referrals, intravenous thrombolysis, rehabilitation, and primary and secondary prevention strategies. Stroke-care outcomes included quality of stroke-care practice, functional independence level, length of stay, mortality, living at home, and institutionalization. CONCLUSIONS There is lack of uniformity in the way stroke care is advanced in low and middle-income countries. This is reflected in the unsatisfactory stroke care structure, processes, and outcomes. There is a need for stroke care settings to adopt quality improvement strategies. Health ministry and governments need to decisively face stroke burden by setting policies that advance improved care of patients with stroke. Stroke Units and Recombinant Tissue Plasminogen Activator (rtPA) administration could be considered as both a structural and process necessity towards improvement of outcomes of patients with stroke in the LMICs.
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Affiliation(s)
- George Lameck Chimatiro
- University of the Western Cape, Cape Town, South Africa
- Medical Rehabilitation College, Box 256, Blantyre, Malawi
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24
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Cisse FA, Damien C, Bah AK, Touré ML, Barry M, Djibo Hamani AB, Haba M, Soumah FM, Naeije G. Minimal Setting Stroke Unit in a Sub-Saharan African Public Hospital. Front Neurol 2019; 10:856. [PMID: 31447769 PMCID: PMC6692431 DOI: 10.3389/fneur.2019.00856] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Sub-Saharan Africa (SSA) has the highest stroke prevalence along with a case fatality that amounts to 40%. We aimed to assess the effect of a minimal setting stroke unit in SSA Public hospital on stroke mortality and main medical complications. Materials and Methods: The study was set in Conakry, Guinea, Ignace Deen public referral hospital. Clinical characteristics, hospital mortality and main medical stroke complications rates (pneumonia, urinary tract infections, sores and venous thromboembolism) of admitted stroke patients after the installation of a minimal stroke unit equipped with heart rate, blood pressure and blood oxygen saturation monitoring and portable oxygen concentrator (POST) were compared to a similar number of stroke patients admitted before the stroke unit creation (PRE). Results: PRE (n = 318) and POST (n = 361) stroke, patients were comparable in term of age (61 ± 14 vs. 60 ± 14.8 years, p = 0.24), sex (56 vs. 50% males, p = 0.09), High blood pressure rate (76.7 vs. 79%, p = 0.44), stroke subtype (ischemic in 72 vs. 78% of cases, p = 0.05) and NIHSS (11 ± 4 vs. 11 ± 4, p = 0.85). Diabetes was more frequent in the PRE group (19 vs. 9%, p < 0.001). Mortality was significantly lower in the POST group (7.2 vs. 22.3%, p < 0.0001) as well as medical complications (4.1 vs. 27.7%, p < 0.001) and lower pneumonia rate (3.3 vs. 14.5%, p < 0.001). Conclusions: Minimally equipped stroke units significantly reduce stroke mortality and main medical complications in SSA.
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Affiliation(s)
- Fode A Cisse
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Charlotte Damien
- Department of Neurology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Aissatou K Bah
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - M L Touré
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - M Barry
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - A B Djibo Hamani
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Michel Haba
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Fode M Soumah
- Department of Neurology, CHU Ignace Deen, Université Gamal Abdel Nasser Conakry (UGANC), Conakry, Guinea
| | - Gilles Naeije
- Department of Neurology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
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Losonczy LI, Williams S, Papali A, Costantino CA, Colas LN, Patel BM, Zimmer DF, Olwine SR, Davidson Z, Wilson JW, McCurdy MT, Augustin ME, Nielsen ND. Haiti Acute and Emergency Care Conference: descriptive analysis of an acute care continuing medical education program. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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26
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Chen Q, Cao C, Gong L, Zhang Y. Health related quality of life in stroke patients and risk factors associated with patients for return to work. Medicine (Baltimore) 2019; 98:e15130. [PMID: 31008934 PMCID: PMC6494282 DOI: 10.1097/md.0000000000015130] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
To clarify dynamic change of quality of life (QOL) in patients with stroke after treatment, and to explore the predictors associated with return to work (RTW) within 48 weeks.Patients diagnosed with stroke were enrolled. All patients enrolled were asked to fill in the Short Form 36 Health Survey. For patients with stroke, SF-36 questionnaires were measured repeatedly 4 weeks after treatment. We used phone call to find out if the patient was RTW. The investigation time was 48 weeks.Patients with stroke had lower scores in terms of physiological dimensions, such as physical functional, role limitations due to physical problems, and general health (P < .001). While patients with strokes scored significantly lower in all mental dimensions including vitality, social functioning, role limitations due to emotional problems, and mental health (P < .001). After 4-weeks treatment, we found that, except for bodily pain, scores in dimensions like physical functioning, role limitations due to physical problems, and general health had increased significantly (P < .001). Multivariate logistic regression analysis was conducted, and the result showed that older age (P = .04) and singleness (P = .03) were risk factors associated with QOL improvement in stroke patients after treatment. Outcomes of stroke patients within 48 weeks were explored. The results showed that 108 out of 136 patients RTW within 48 weeks. Average days it took for patients with cerebral infarction to return to work were 77 ± 79, significantly less than patients with cerebral hemorrhage (206 ± 159 days) and patients with subarachnoid hemorrhage (117 ± 113 days, P < .001). Multivariate analysis indicated that only QOL improvement (P = .04) and subtype of stroke (P = .01) were independent factors associated with RTW within 48 weeks.QOL of stroke patients was significantly reduced. After treatments, the physiological quality of stroke patients increased, but the psychological quality remained low. In addition, patients with cerebral hemorrhage and patients with no significant improvement in QOL are independent risk factors for RTW. Therefore, for this subgroup of the population, early diagnosis, close follow-up and monitor of the psychological state should be provided to avoid the occurrence of adverse events.
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Affiliation(s)
| | - Chunni Cao
- Department of Hyperbaric Oxygen, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong Province, China
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