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Hagberg G, Ihle-Hansen H, Abzhandadze T, Reinholdsson M, Viktorisson A, Ihle-Hansen H, Stibrant Sunnerhagen K. The precision by the Face Arm Speech Time (FAST) algorithm in stroke capture, sex and age differences: a stroke registry study. BMJ Neurol Open 2024; 6:e000574. [PMID: 38646506 PMCID: PMC11029396 DOI: 10.1136/bmjno-2023-000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/01/2024] [Indexed: 04/23/2024] Open
Abstract
Background The shift towards milder strokes and studies suggesting that stroke symptoms vary by age and sex may challenge the Face-Arm-Speech Time (FAST) coverage. We aimed to study the proportion of stroke cases admitted with FAST symptoms, sex and age differences in FAST presentation and explore any additional advantage of including new item(s) from the National Institute of Health Stroke Scale (NIHSS) to the FAST algorithm. Methods This registry-based study included patients admitted with acute stroke to Sahlgrenska University Hospital (November 2014 to June 2019) with NIHSS items at admission. FAST symptoms were extracted from the NIHSS at admission, and sex and age differences were explored using descriptive statistics. Results Of 5022 patients, 46% were women. Median NIHSS at admission for women was (2 (8-0) and for men 2 (7-0)). In total, 2972 (59%) had at least one FAST symptom, with no sex difference (p=0.22). No sex or age differences were found in FAST coverage when stratifying for stroke severity. 52% suffered mild strokes, whereas 30% had FAST symptoms. The most frequent focal NIHSS items not included in FAST were sensory (29%) and visual field (25%) and adding these or both in modified FAST algorithms led to a slight increase in strokes captured by the algorithms (59%-67%), without providing enhanced prognostic information. Conclusions 60% had at least one FAST symptom at admission, only 30% in mild strokes, with no sex or age difference. Adding new items from the NIHSS to the FAST algorithm led only to a slight increase in strokes captured.
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Affiliation(s)
- Guri Hagberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Oslo Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Tamar Abzhandadze
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Malin Reinholdsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Adam Viktorisson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Hege Ihle-Hansen
- Department of Medicine, Vestre Viken Hospital Trust, Drammen, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Katharina Stibrant Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Neurocare, Sahlgrenska University Hospital, Goteborg, Sweden
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Alsheikh S, Altoijry A, Alokayli S, Alkhalife SI, Alsahil SJ, AlGhofili H. Exploring Understanding of Peripheral Artery Disease among Patients at High-Risk in Saudi Arabia: Results from an Interview-Based Study. Clin Pract 2023; 14:13-23. [PMID: 38391398 PMCID: PMC10887943 DOI: 10.3390/clinpract14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The level of awareness of peripheral artery disease (PAD) in Saudi Arabia, especially among populations at high risk, is not currently well known. Therefore, our objective was to assess the existing level of awareness among patients who are at high risk of PAD, as well as their comprehension of the disease. METHOD An interview-based cross-sectional study included 1035 participants with risk factors for PAD and collected data on demographics and knowledge domains related to PAD. RESULTS The statistical analysis was performed using t-tests and ANOVA. Overall, participants exhibited poor knowledge, with a mean score of 5.7 out of 26. The highest scores were observed in the risk factor and preventive measure domains, with means of 1.8 out of 7 and 1.8 out of 6, respectively. The factors associated with higher knowledge scores included older age, male gender, higher education, healthcare profession, interviews in vascular settings, previous awareness of PAD, and prior cardio-cerebrovascular interventions. CONCLUSION This study underscores the inadequate knowledge of PAD among high-risk individuals. Targeted educational initiatives are essential to bridge this knowledge gap, potentially reducing the burden of PAD-related complications and improving patient outcomes. Efforts should focus on raising awareness about PAD, particularly among high-risk populations.
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Affiliation(s)
- Sultan Alsheikh
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Shirin Alokayli
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Sarah Ibrahim Alkhalife
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Shahad Jamal Alsahil
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Hesham AlGhofili
- Vascular Surgery Department, King Salman Heart Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
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Liu Y, Wang D, Chu M, Yang Z, Luo Y, Wang D, Zhao J. Value of the stroke 1-2-0 prehospital stroke education system: the experience of a general practitioner team. BMC Neurol 2023; 23:431. [PMID: 38062426 PMCID: PMC10770900 DOI: 10.1186/s12883-023-03476-0] [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] [Received: 03/18/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Stroke is one of the leading causes of death worldwide, especially in developing countries. In China, there is an urgent need to educate people about stroke awareness and the importance of using emergency medical services (EMS) quickly after a stroke has occurred. OBJECTIVE We sought to explore the effects of the Stroke 1-2-0 Prehospital Stroke Education System based on the experience of a general practitioner team. METHOD We prospectively enrolled 119 community general practitioners to be trained in the procedures advocated by the Stroke 1-2-0 Prehospital Stroke Education System. The training content included early detection of ischemic stroke, first aid for stroke, and intravenous thrombolysis; The effects of the training were later evaluated via a before-and-after comparison. The 119 enrolled physicians formed a Stroke 1-2-0 lecturer group and taught stroke knowledge to community residents. The group remained active for 6 months, during which the medical treatment data of stroke patients (i.e., stroke onset time, prehospital delay, whether an ambulance was called, and whether thrombolytic therapy was performed) in each of 5 jurisdictions were recorded for the month before (January 2021) and that after (August 2021) the 6-month community education program. Finally, the effects of the community education program were evaluated. RESULTS The participants' understanding of intravenous thrombolysis in the treatment of acute ischemic stroke improved significantly after the training as compared with their earlier understanding (96% vs. 78.99%; P < .001), and their understanding of the time window for intravenous thrombolysis increased from 26.05% before to 72% (P < .001) after the training. Most of the participants (90% vs. 67.23%; P < .001) said that they would immediately call the 120 emergency number of China's emergency phone system if they encountered individuals who appeared to be victims of acute stroke. A total of 82 stroke patients were seen before and 67 after the community education program. As for the use of the emergency call system, more patients with stroke activated that system after the program versus before (21.95% vs. 37.31%; P = .04). The 3-hour arrival rate after the program was nearly three times higher than that before the program (62.69% vs. 19.51%; P < .001). Also, regarding receiving thrombolysis after the occurrence of a stroke, the program triggered a substantial increase compared with the total earlier (19.4% vs. 6.1%; P = .013). CONCLUSION We found that the Stroke 1-2-0 Prehospital Stroke Education System significantly improved community residents' knowledge regarding stroke.
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Affiliation(s)
- Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Daosheng Wang
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Min Chu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Zhenzhen Yang
- Department of General Medicine, Xinzhuang Community Health Service Center, Shanghai, China
| | - Yunhe Luo
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Delong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China.
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Desmeules F, Mercier É, Blanchard PG, Emond M. Do we call FAST enough when it matters the most? CAN J EMERG MED 2023; 25:361-362. [PMID: 37142855 DOI: 10.1007/s43678-023-00510-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Francis Desmeules
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université Laval, 1050, Avenue de la Médecine, Local 4617, Québec, QC, G1V 0A6, Canada.
| | - Éric Mercier
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université Laval, 1050, Avenue de la Médecine, Local 4617, Québec, QC, G1V 0A6, Canada
- VITAM - Centre de recherche en santé durable, Québec, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- CHU de Québec - Hôpital de L'Enfant-Jésus, H-608, 1401 18e rue, Québec, G1J 1Z4, Canada
| | - Pierre-Gilles Blanchard
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université Laval, 1050, Avenue de la Médecine, Local 4617, Québec, QC, G1V 0A6, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- CHU de Québec - Hôpital de L'Enfant-Jésus, H-608, 1401 18e rue, Québec, G1J 1Z4, Canada
| | - Marcel Emond
- Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université Laval, 1050, Avenue de la Médecine, Local 4617, Québec, QC, G1V 0A6, Canada
- VITAM - Centre de recherche en santé durable, Québec, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- CHU de Québec - Hôpital de L'Enfant-Jésus, H-608, 1401 18e rue, Québec, G1J 1Z4, Canada
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Shah R, Gilbert A, Melles R, Patel A, Do T, Wolek M, Vora RA. Central Retinal Artery Occlusion: Time to Presentation and Diagnosis. Ophthalmol Retina 2023:S2468-6530(23)00005-2. [PMID: 36639057 DOI: 10.1016/j.oret.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the presentation patterns of patients diagnosed with central retinal artery occlusion (CRAO) from 2011 to 2020. DESIGN Retrospective cohort study SUBJECTS: The present study was conducted in 484 patients presenting within 30 days of symptom onset with accurate documentation of time of symptom onset, time of presentation to the health care system, and time of presentation to an ophthalmologist. METHODS An independent chart review of patients with CRAO was conducted. MAIN OUTCOME MEASURES Demographic information including age, sex, and race were collected. Presentation patterns such as time of first symptoms, time of first contact with the health care system, and time of evaluation by an ophthalmologist were analyzed. Additionally, information regarding the medical venue or specialty of initial patient contact was collected. RESULTS A total of 247 (51%) patients contacted the health care system within 4.5 hours of system onset, whereas 86 (17.8%) patients waited over 24 hours. Only 81 (32.8%) of the 247 patients who presented within 4.5 hours saw an ophthalmologist within that time frame, whereas 172 (35.5%) of the entire cohort of 484 did not present to an ophthalmologist within 24 hours of vision loss. There was significant variability with regards to medical specialty of initial patient contact, with 292 (60.3%) patients first presenting to an emergency department and 133 (27.5%) patients first presenting to an ophthalmologist. Black and Hispanic patients presented later than patients of White, Asian, or other racial backgrounds (40.4 ± 10.2 hours versus 23.0 ± 3.4 hours, P = 0.05). CONCLUSIONS Although no level 1 evidence-based treatment is currently available for CRAO, thrombolytic therapy may be promising. Even though over half of patients with CRAO within our institution connected with the health care system within a potential window for thrombolytic therapy, most did not receive a definitive ophthalmic diagnosis within that time frame. Public health educational campaigns and infrastructure optimization must speed up presentation times, decrease the time to ophthalmic diagnosis, and target vulnerable populations to offer and research timely administration of thrombolytic therapy. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ronak Shah
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Aubrey Gilbert
- Kaiser Permanente Northern California, Vallejo, California
| | - Ronald Melles
- Kaiser Permanente Northern California, Oakland, California
| | - Amar Patel
- Kaiser Permanente Northern California, Oakland, California
| | - Timothy Do
- University of California Davis School of Medicine, Sacramento, California
| | - Michael Wolek
- University Hospitals at Case Western Reserve University, Cleveland, Ohio
| | - Robin A Vora
- Kaiser Permanente Northern California, Oakland, California.
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Parsons Leigh J, Brundin-Mather R, Moss SJ, Nickel A, Parolini A, Walsh D, Bigham BL, Carter AJE, Fox-Robichaud A, Fiest KM. Public awareness and knowledge of sepsis: a cross-sectional survey of adults in Canada. Crit Care 2022; 26:337. [PMID: 36329489 PMCID: PMC9632573 DOI: 10.1186/s13054-022-04215-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Sepsis is a life-threatening complication of the body’s response to infection. The financial, medical, and psychological costs of sepsis to individuals and to the healthcare system are high. Most sepsis cases originate in the community, making public awareness of sepsis essential to early diagnosis and treatment. There has been no comprehensive examination of adult’s sepsis knowledge in Canada. Methods We administered an online structured survey to English- or French-literate adults in Canada. The questionnaire comprised 28 questions in three domains: awareness, knowledge, and information access. Sampling was stratified by age, sex, and geography and weighted to 2016 census data. We used descriptive statistics to summarize responses; demographic differences were tested using the Rao–Scott correction for weighted chi-squared tests and associations using multiple variable regression. Results Sixty-one percent of 3200 adults sampled had heard of sepsis. Awareness differed by respondent’s residential region, sex, education, and ethnic group (p < 0.001, all). The odds of having heard of sepsis were higher for females, older adults, respondents with some or completed college/university education, and respondents who self-identified as Black, White, or of mixed ethnicity (p < 0.01, all). Respondent’s knowledge of sepsis definitions, symptoms, risk factors, and prevention measures was generally low (53.0%, 31.5%, 16.5%, and 36.3%, respectively). Only 25% of respondents recognized vaccination as a preventive strategy. The strongest predictors of sepsis knowledge were previous exposure to sepsis, healthcare employment, female sex, and a college/university education (p < 0.001, all). Respondents most frequently reported hearing about sepsis through television (27.7%) and preferred to learn about sepsis from healthcare providers (53.1%). Conclusions Sepsis can quickly cause life-altering physical and psychological effects and 39% of adults sampled in Canada have not heard of it. Critically, a minority (32%) knew about signs, risk factors, and strategies to lower risk. Education initiatives should focus messaging on infection prevention, employ broad media strategies, and use primary healthcare providers to disseminate evidence-based information. Future work could explore whether efforts to raise public awareness of sepsis might be bolstered or hindered by current discourse around COVID-19, particularly those centered on vaccination. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04215-6.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada. .,Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada.
| | | | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.,Department of Critical Care, CRISMA Center, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Angie Nickel
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Ariana Parolini
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Deirdre Walsh
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Blair L Bigham
- Division of Critical Care, Department of Anesthesia, Stanford University, Stanford, CA, USA
| | - Alix J E Carter
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Emergency Health Services Nova Scotia, Halifax, NS, Canada
| | - Alison Fox-Robichaud
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Surgical implementation gap: an interrupted time series analysis with interviews examining the impact of surgical trials on surgical practice in England. BMJ Qual Saf 2022; 32:341-356. [DOI: 10.1136/bmjqs-2022-015077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/03/2022] [Indexed: 11/03/2022]
Abstract
ObjectivesLandmark studies published near the turn of the 21st century found an implementation gap concerning the effect of evidenced-based findings on clinical practice. The current study examines the uptake of six trials that produced actionable findings to describe the effects of evidence on practice and the reasons for those effects.DesignA sequential, explanatory mixed methods study was conducted. First, a quantitative study assessed whether actionable findings from large, publicly funded elective surgical trials influenced practice. Subsequently, qualitative interviews were conducted to explain the quantitative findings.SettingChanges in NHS-funded practice were tracked across hospitals in England. Interviews were conducted online.Data and participantsThe six surgical trials were funded and published by England’s National Institute for Health Research’s Health Technology Assessment programme between 2006 and 2015. Quantitative time series analyses used data about the frequencies or proportions of relevant surgical procedures conducted in England between 2001 and 2020. Subsequently, qualitative interviews were conducted with 25 participants including study authors, surgeons and other healthcare staff in the supply chain. Transcripts were coded to identify major temporal events and Consolidated Framework for Implementation Research (CFIR) domains/constructs that could influence implementation. Findings were synthesised by clinical area.ResultsThe quantitative analyses reveal that practice changed in accordance with findings for three trials. In one trial (percutaneous vs nasogastric tube feed after stroke), the change took a decade to occur. In another (patella resurfacing), change anticipated the trial findings. In the third (abdominal aortic aneurysm repair), changes tracked the evolving evidence base. In the remaining trials (two about varicose veins and one about gastric reflux), practice did not change in line with findings. For varicose veins, the results were superseded by a further trial. For gastric reflux, surgical referrals declined as medical treatment increased. The exploratory qualitative analysis informed by CFIR found that evidence from sources apart from the trial in question was mentioned as a reason for non-adoption in the three trials where evidence did not affect practice and in the trial where uptake was delayed. There were no other consistent patterns in the qualitative data.ConclusionWhile practice does not always change in the direction indicated by clinical trials, our results suggest that individuals, official committees and professional societies do assimilate trial evidence. Decision-makers seem to respond to the totality of evidence such that there are often plausible reasons for not adopting the evidence of any one trial in isolation.
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Abstract
The care pathway for patients with atrial fibrillation (AF) is variable and this variability is explored in a patient pathway review. This review describes events that may take place for a patient with AF considering the "ideal" and the "real-world" pathway and attempts to rationalize them by considering the patient, clinician, health service, and societal perspective. In the "ideal" pathway, AF in a patient is either identify before or after stroke. The "real-world" pathway introduces the concepts that symptoms may influence patient decision-making to seek help, AF may be identified incidentally, and healthcare professionals may fail to identify AF. The management of AF includes no treatment or treatment such as stroke prevention, rate or rhythm control, and comorbidity management. The overall outcomes for patient depend on the presence of symptoms and response to therapies. The two major priorities for patients are symptomatic relief and avoidance of stroke. While most clinicians will find that initial AF management is not challenging but there may be incidental opportunities for earlier identification. From the healthcare service perspective, noncardiologists and cardiologists care for patients with AF, which results in much heterogeneity management. From the societal perspective, the burden of AF is significant resulting in substantial cost from hospitalizations and treatments. People with AF can take on different paths, which depend on factors related to the patient's decision-making, clinical decision-making, and patient's response to the treatment. A streamlined approach to a holistic and integrated care pathway approach to AF management is needed.
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Affiliation(s)
- Chun Shing Kwok
- From the Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK; and the
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, Liverpool, UK
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Yuan J, Li M, Liu Y, Xiong X, Zhu Z, Liu F, Wang Y, Hu W, Lu ZK, Liu R, Zhao J. Analysis of Time to the Hospital and Ambulance Use Following a Stroke Community Education Intervention in China. JAMA Netw Open 2022; 5:e2212674. [PMID: 35579896 PMCID: PMC9115614 DOI: 10.1001/jamanetworkopen.2022.12674] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/29/2022] [Indexed: 12/03/2022] Open
Abstract
Importance Prehospital delay (time from symptom onset of stroke to the door of a hospital) in patients with stroke is long in China. With the goal of improving public awareness and knowledge of stroke recognition, Stroke 1-2-0 was developed in China as an education program to prompt rapid response to the onset of stroke based on clinical practice in China, and examination of its outcomes is needed. Objective To investigate the association of the Stroke 1-2-0 educational campaign with prehospital delay for patients with ischemic stroke. Design, Setting, and Participants In a population-based cross-sectional study, all patients with ischemic stroke events were admitted to the Minhang Hospital, which is the only tertiary care hospital with a stroke center that provides acute stroke care in Xinzhuang county, Shanghai, China. The study period was from January 1, 2016, to December 31, 2019, and data analysis was performed from January 1 to July 31, 2021. Exposures A multifaceted Stroke 1-2-0 educational campaign comprising slides, videos, brochures, and posters distributed in the community. Main Outcomes and Measures Proportion of patients with hospital arrival within 3 hours and use of an ambulance to seek medical care, as well as the odds of seeking medical attention within 3 hours after the stroke before vs after initiation of the multifaceted educational campaign. Results A total of 2857 patients (1774 men [62.1%]; mean [SD] age, 69.83 [12.66] years) with stroke were identified, including 503 in the precampaign period and 2354 in the postcampaign period. Following the multifaceted campaign, the median (IQR) prehospital delay time decreased from 18.72 (7.44-27.84) hours to 6.00 (2.00-16.35) hours (P < .001). After the implementation of the Stroke 1-2-0 campaign, the proportion of patients with hospital arrival time within 3 hours increased from 5.8% to 33.4% (P < .001) and use of an ambulance increased from 3.2% to 30.6% (P < .001). In an interrupted time series analysis, the initiation of the Stroke 1-2-0 campaign was associated with significantly increased odds of arriving at the hospital within 3 hours (odds ratio, 8.01; 95% CI, 7.17-8.95; P < .001) and use of an ambulance (odds ratio, 9.41; 95% CI, 8.24-10.74; P < .001). Conclusions and Relevance The persistent multifaceted campaign using the Stroke 1-2-0 program was associated with reduced prehospital delay and improved timely arrival rate and ambulance arrival rate for patients with stroke. These findings suggest that Stroke 1-2-0 can be adopted in other regions of China to possibly improve health outcomes and reduce clinical burdens for all patients with stroke.
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Affiliation(s)
- Jing Yuan
- Department of Clinical Pharmacy, School of Pharmacy, Fudan University, Shanghai, China
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Xiaomo Xiong
- Clinical Pharmacy and Outcomes Sciences Department, University of South Carolina, Columbia
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Fangyu Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Wei Hu
- Department of Cardiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Z. Kevin Lu
- Clinical Pharmacy and Outcomes Sciences Department, University of South Carolina, Columbia
| | - Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
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10
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Patient, Public, and Healthcare Professional's Sepsis Awareness, Knowledge, and Information Seeking Behaviors: A Scoping Review. Crit Care Med 2022; 50:1187-1197. [PMID: 35481953 PMCID: PMC9275848 DOI: 10.1097/ccm.0000000000005564] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sepsis awareness and understanding are important aspects of prevention, recognition, and clinical management of sepsis. We conducted a scoping review to identify and map the literature related to sepsis awareness, general knowledge, and information-seeking behaviors with a goal to inform future sepsis research and knowledge translation campaigns.
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11
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Kumi F, Bugri AA, Adjei S, Duorinaa E, Aidoo M. Quality of acute ischemic stroke care at a tertiary Hospital in Ghana. BMC Neurol 2022; 22:28. [PMID: 35039001 PMCID: PMC8762857 DOI: 10.1186/s12883-021-02542-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Information on the quality of acute ischemic stroke care provided in lower-to-middle income countries is limited. Objective This study was undertaken to examine the quality of acute ischemic stroke care provided at Tamale Teaching Hospital in Ghana. Methods The medical records of patients admitted into the medical ward of the hospital between January to October 2021 were reviewed retrospectively. Extent of compliance to 15 stroke performance indicators were determined. Results Under the study period, 105 patients were admitted at the hospital with acute ischemic stroke. The mean (±SD) age was 65 ± 12 years; 38.1% were males; 65.7% had National Health Insurance Scheme coverage. Glasgow Coma Scale was the only functional stroke rating scale used by physicians to rate stroke severity. About a quarter of the patients had CT scan performed within 24 h of admission. Less than a quarter of the patients had a last known well time documented. Rate of thrombolytic administration was 0%. Less than a quarter of the patients were prescribed venous thromboembolism prophylaxis on the day of admission or day after. Only 13.8% of patients had documented reasons for not being prescribed venous thromboembolism prophylaxis. Antiplatelet therapy was prescribed to 33.3% of the patients by the end of day 2 of admission. Anticoagulation was prescribed to all patients who had comorbid condition of atrial fibrillation as part of the discharge medications. More than half of the patients were discharged to go home with statin medications. Documented stroke education was provided to 31.4% caretakers or patients. Slightly less than half of the patients were assessed for or received rehabilitation. Less than a quarter had documented dysphagia screening within 24 h of admission. None of the patient had their stroke severity rated with National Institutes of Health Stroke Scale on arrival. No patient obtained carotid imaging assessment by end of day 2. Conclusion There were several gaps in the quality of acute ischemic stroke care provided to patients at the Tamale Teaching Hospital. With the exception of discharging patients on statin medications, there was poor adherence to all other stroke performance indicators.
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Affiliation(s)
- Frank Kumi
- Pharmacy Unit, King's Medical Center, Tamale, Ghana.
| | - Amos A Bugri
- Pharmacy Directorate, Tamale Teaching Hospital, Tamale, Ghana
| | - Stephen Adjei
- Pharmacy Directorate, Tamale Teaching Hospital, Tamale, Ghana
| | - Elvis Duorinaa
- Pharmacy Directorate, Tamale Teaching Hospital, Tamale, Ghana
| | - Matthew Aidoo
- Department of Pharmacology, University for Development Studies, Tamale, Ghana
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12
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Springer MV, Bi R, Skolarus LE, Lin CC, Burke JF. Community Intent to Activate Emergency Medical Services May Be Associated with Regional tPA Treatment. Cerebrovasc Dis 2022; 51:207-213. [PMID: 34515063 PMCID: PMC8898989 DOI: 10.1159/000518729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Acute stroke treatments are underutilized in the USA. Enhancing stroke preparedness, the recognition of stroke symptoms, and intent to call emergency medical services (EMS) could reduce delay in hospital arrival thereby increasing eligibility for time-sensitive stroke treatments. Whether higher stroke preparedness is associated with higher tissue plasminogen activator (tPA) treatment rates is however uncertain. We therefore set out to determine the contribution of stroke preparedness to regional variation in tPA treatment. METHODS The region was defined by hospital service area (HSA). Stroke preparedness was determined by using Behavioral Risk Factor Surveillance System survey questions assessing stroke symptom recognition and intent to call 911 in response to a stroke. We used Medicare data to determine the percentage of tPA-treated hospitalized stroke patients in 2007, 2009, and 2011, adjusting for number of stroke hospitalizations in each HSA (primary outcome). We performed multivariate linear regression to estimate the association of regional stroke preparedness on log-transformed tPA treatment rates controlling for demographic, EMS, and hospital characteristics. RESULTS The adjusted percentage of stroke patients receiving tPA ranged from 1.4% (MIN) to 11.3% (MAX) of stroke/TIA hospitalizations. Across HSAs, a median (IQR) of 86% (81-90%) of responses to a witnessed stroke indicated intent to call 911, and a median (IQR) of 4.4 (4.2-4.6) out of 6 stroke symptoms was recognized. Every 1% increase in an HSA's intent to call 911 was associated with a 0.44% increase in adjusted tPA treatment rate (p = 0.05). Lower accuracy of recognition of stroke symptoms was associated with higher adjusted tPA treatment rates (p = 0.05). CONCLUSIONS There was little regional variation in intent to call EMS and stroke symptom recognition. Intent to call EMS and stroke symptom recognition are modest contributors to regional variation in tPA treatment.
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Affiliation(s)
| | - Ran Bi
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lesli E. Skolarus
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chun Chieh Lin
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - James F. Burke
- Stroke Program, University of Michigan Medical School, Ann Arbor, Michigan, USA
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13
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Bull Iversen A, Paaske Johnsen S, Christensen B, Bondo Christensen M, Andersen G. The impact of a Danish stroke campaign: A cross-sectional study. Acta Neurol Scand 2022; 145:102-110. [PMID: 34523120 DOI: 10.1111/ane.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the impact of the Danish stroke campaign, 1 year after initiation. MATERIALS & METHODS The campaign ran in various media during 2019-2020. We performed a two-centre, repeated cross-sectional study in 2018 (before campaign) and again in 2020 based on data from structured interviews of patients and bystanders, medical records and the Danish Stroke Registry. Primary outcomes were patient delay and system delay. Patient delay is defined as the time from symptom onset until the first contact to a healthcare professional, whereas system delay is the time from this contact until arrival at the stroke centre. Secondary outcomes were primary emergency medical services (EMS) contact, arrival at a stroke centre within 3 h of symptom onset, initiation of reperfusion therapy and knowledge of ≥2 core symptoms of stroke. RESULTS We included 852 patients with stroke or transient ischemic attack. Patient delay and system delay were a median of 166 min and 96 min before the campaign and were non-significantly reduced by 16 min (95% CI -128 to 97) and 7 min (95% CI -21 to 6) in the second period. We found no significant differences in the clinical outcomes. The knowledge of ≥2 core symptoms increased from 22% to 30% (OR 1.63; 95% CI 1.15 to 2.30) in patients and from 53% to 65% (OR 1.81; 95% CI 1.24 to 2.64) in bystanders. CONCLUSION Patient delay, system delay and clinical outcomes remained relatively unchanged. However, the knowledge of core symptoms had improved 1 year after campaign initiation.
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Affiliation(s)
- Ane Bull Iversen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research Department of Clinical Medicine Aalborg University and Aalborg University Hospital Aalborg Denmark
| | - Bo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Grethe Andersen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
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14
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Flowers AM, Chan W, Meyer BI, Bruce BB, Newman NJ, Biousse V. Referral Patterns of Central Retinal Artery Occlusion to an Academic Center Affiliated With a Stroke Center. J Neuroophthalmol 2021; 41:480-487. [PMID: 34788238 PMCID: PMC9546636 DOI: 10.1097/wno.0000000000001409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Central retinal artery occlusion (CRAO) is a medical emergency, and patients who present acutely should be immediately referred to the nearest stroke center. We evaluated practice patterns for CRAO management at one academic center over the last decade. METHODS This was a retrospective study on all adult patients diagnosed with a CRAO seen at one tertiary hospital and outpatient clinic affiliated with a comprehensive stroke center ("our institution") from 2010 to 2020. Our electronic medical records were searched for CRAO diagnoses, and patient medical records were reviewed. The exclusion criteria were incorrect diagnosis, unclear diagnosis, historical CRAO, or satellite clinic location. Demographics, distance and time to presentation to our institution, number and type of prior providers seen, diagnostic tests performed, and treatments provided were collected. Summary statistics of median, mean, and frequency were calculated and reported with measures of variance (interquartile range [IQR], ranges). F, Tukey, and Fisher exact tests were used for comparisons. RESULTS We included 181 patients with a diagnosis of CRAO (80 [44.2%] women; median age 69 years [range 20-101]). The median distance from patient's home to our institution was 27.8 miles (IQR 15.5-57.4; range 2.4-930). The median time from visual loss to presentation at our institution was 144 hours (IQR 23-442 hours, range 0.5-2,920) from 2010 to 2013, 72 hours (IQR 10.5-372 hours, range 0-13,140) from 2014 to 2016, and 48 hours (IQR 7-180 hours, range 0-8,030) from 2017 to 2020 (P = 0.07). 91/181 (50%) patients presented to an outpatient provider. 73/181 (40%) presented to an emergency department. Eighty-six percent presented within 1 week of visual loss onset, and rates of comprehensive inpatient evaluation for acute CRAO improved from 44% in 2010-2013 to 82% in 2017-2020 (P < 0.01). CONCLUSIONS Patients with CRAO often present late and only after evaluation by multiple outpatient providers. Improvement has occurred over the past decade, but delays underscore the barriers to performing clinical trials evaluating very acute treatments for CRAO. Educational interventions for healthcare providers and patients are necessary.
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Affiliation(s)
- Alexis M Flowers
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
| | - Wesley Chan
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
| | | | - Beau B. Bruce
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
- Department of Neurology, Emory University, Atlanta, GA 30322
- Department of Epidemiology, Emory University, Atlanta, GA 30322
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
- Department of Neurology, Emory University, Atlanta, GA 30322
- Department of Neurological Surgery, Emory University, Atlanta, GA 30322
| | - Valérie Biousse
- Department of Ophthalmology, Emory University, Atlanta, GA 30322
- Department of Neurology, Emory University, Atlanta, GA 30322
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15
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Katsarava Z, Akhvlediani T, Janelidze T, Gudadze T, Todua M, Akhvlediani K, Khinikadze M, Egutidze G, Margania T, Tsiskaridze A. Establishing Stroke Services in the Republic of Georgia. Eur Neurol 2021; 85:56-64. [PMID: 34569481 DOI: 10.1159/000518845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This article summarizes the medical experience in establishing stroke units and systemic thrombolysis in Georgia, which, like many other post-Soviet countries, still faces problems in organizing stroke care even after 30 years of independence. PATIENTS AND METHODS We created an example of treating acute stroke with systemic thrombolysis and introduced stroke units in several hospitals in the country, including standardization of the diagnostic and treatment process, consistent evaluation, and monthly feedback to the stroke unit staff. RESULTS Systemic thrombolysis has become a clinical routine in some large hospitals and is meanwhile reimbursed by the state insurance. The data of consecutive 1,707 stroke patients in 4 major cities demonstrated significant time lost at the prehospital level, due to failure in identifying stroke symptoms, delay in notification, or transportation. The consequent quality reports resulted in a dramatic increase in adherence to the European and national guidelines. A mandatory dysphagia screening and subsequent treatment led to a decrease in pneumonia rates. DISCUSSION We discuss our experience and suggestions on how to overcome clinical, financial, and ethical problems in establishing a stroke services in a developing country. CONCLUSION The Georgian example might be useful for doctors in other post-Soviet countries or other parts of the world.
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Affiliation(s)
- Zaza Katsarava
- Evex Medical Corporation, Tbilisi, Georgia.,Evangelical Hospital Unna, Unna, Germany.,Department of Neurology, University of Duisburg-Essen, Essen, Germany.,I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Tamar Akhvlediani
- American MD Program, Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia
| | | | | | | | | | - Mirza Khinikadze
- Evex Medical Corporation, Tbilisi, Georgia.,Pineo Medical Ecosystem, Tbilisi, Georgia.,Tbilisi Institute of Medicine, Tbilisi, Georgia.,New Vision University, Tbilisi, Georgia
| | | | | | - Alexander Tsiskaridze
- Pineo Medical Ecosystem, Tbilisi, Georgia.,Tbilisi Institute of Medicine, Tbilisi, Georgia.,Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia.,Georgian Stroke Association, Tbilisi, Georgia
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16
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Phan TG, Beare R, Srikanth V, Ma H. Sentiments expressed in YouTube public awareness campaigns: stroke. Intern Med J 2021; 51:971-974. [PMID: 34155771 DOI: 10.1111/imj.15367] [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] [Received: 11/20/2020] [Revised: 09/13/2020] [Accepted: 03/05/2020] [Indexed: 11/27/2022]
Abstract
Social media (YouTube) has been used to educate the public on stroke signs and the need to contact emergency hotline. We perform sentiment analysis to explore the emotional response to the 2006 North American and contrast this with the five Australian campaigns (2009-2015). The positive sentiment in the North American campaign provides insights for developing material for public health campaigns.
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Affiliation(s)
- Thanh G Phan
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia.,Stroke and Aging Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Richard Beare
- Stroke and Aging Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Developmental Imaging, Murdoch Children Research Institute, Melbourne, Victoria, Australia
| | - Velandai Srikanth
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia.,Stroke and Aging Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Henry Ma
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia.,Stroke and Aging Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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17
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Newberry Le Vay J, Fraser A, Byass P, Tollman S, Kahn K, D'Ambruoso L, Davies JI. Mortality trends and access to care for cardiovascular diseases in Agincourt, rural South Africa: a mixed-methods analysis of verbal autopsy data. BMJ Open 2021; 11:e048592. [PMID: 34172550 PMCID: PMC8237742 DOI: 10.1136/bmjopen-2020-048592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Cardiovascular diseases are the second leading cause of mortality behind HIV/AIDS in South Africa. This study investigates cardiovascular disease mortality trends in rural South Africa over 20+ years and the associated barriers to accessing care, using verbal autopsy data. DESIGN A mixed-methods approach was used, combining descriptive analysis of mortality rates over time, by condition, sex and age group, quantitative analysis of circumstances of mortality (CoM) indicators and free text narratives of the final illness, and qualitative analysis of free texts. SETTING This study was done using verbal autopsy data from the Health and Socio-Demographic Surveillance System site in Agincourt, rural South Africa. PARTICIPANTS Deaths attributable to cardiovascular diseases (acute cardiac disease, stroke, renal failure and other unspecified cardiac disease) from 1993 to 2015 were extracted from verbal autopsy data. RESULTS Between 1993 and 2015, of 15 305 registered deaths over 1 851 449 person-years of follow-up, 1434 (9.4%) were attributable to cardiovascular disease, corresponding to a crude mortality rate of 0.77 per 1000 person-years. Cardiovascular disease mortality rate increased from 0.34 to 1.12 between 1993 and 2015. Stroke was the dominant cause of death, responsible for 41.0% (588/1434) of all cardiovascular deaths across all years. Cardiovascular disease mortality rate was significantly higher in women and increased with age. The main delays in access to care during the final illness were in seeking and receiving care. Qualitative free-text analysis highlighted delays not captured in the CoM, principally communication between the clinician and patient or family. Half of cases initially sought care outside a hospital setting (50.9%, 199/391). CONCLUSIONS The temporal increase in deaths due to cardiovascular disease highlights the need for greater prevention and management strategies for these conditions, particularly for the women. Strategies to improve seeking and receiving care during the final illness are needed.
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Affiliation(s)
| | - Andrew Fraser
- Education Centre, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, UK
| | - Peter Byass
- Department of Epidemiology & Global Health, Umea Universitet, Umeå, Sweden
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Lucia D'Ambruoso
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Justine I Davies
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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18
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The Impact of Stroke Public Awareness Campaigns Differs Between Sociodemographic Groups. Can J Neurol Sci 2021; 49:231-238. [PMID: 33875043 DOI: 10.1017/cjn.2021.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prehospital delays are a major obstacle to timely reperfusion therapy in acute ischemic stroke. Stroke sign recognition, however, remains poor in the community. We present an analysis of repeated surveys to assess the impact of Face, Arm, Speech, Time (FAST) public awareness campaigns on stroke knowledge. METHODS Four cross-sectional surveys were conducted between July 2016 and January 2019 in the province of Quebec, Canada (n = 2,451). Knowledge of FAST stroke signs (face drooping, arm weakness and speech difficulties) was assessed with open-ended questions. A bilingual English/French FAST public awareness campaign preceded survey waves 1-3 and two campaigns preceded wave 4. We used multivariable ordinal regression models weighted for age and sex to assess FAST stroke sign knowledge. RESULTS We observed an overall significant improvement of 26% in FAST stroke sign knowledge between survey waves 1 and 4 (odds ratio [OR] = 1.26; 95% CI: 1.02, 1.55; p = 0.035). After the last campaign, however, 30.5% (95% CI: 27.5, 33.6) of people were still unable to name a single FAST sign. Factors associated with worse performance were male sex (OR = 0.68; 95% CI: 0.53, 0.86; p = 0.002) and retirement (OR = 0.54; 95% CI: 0.35, 0.83; p = 0.005). People with lower household income and education had a tendency towards worse stroke sign knowledge and were significantly less aware of the FAST campaigns. CONCLUSIONS Knowledge of FAST stroke signs in the general population improved after multiple public awareness campaigns, although it remained low overall. Future FAST campaigns should especially target men, retired people and individuals with a lower socioeconomic status.
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19
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Lavorgna L, Brigo F, Esposito S, Abbadessa G, Sparaco M, Lanzillo R, Moccia M, Inglese M, Bonfanti L, Trojsi F, Spina E, Russo A, De Micco P, Clerico M, Tedeschi G, Bonavita S. Public Engagement and Neurology: An Update. Brain Sci 2021; 11:429. [PMID: 33800571 PMCID: PMC8065487 DOI: 10.3390/brainsci11040429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Public engagement (PE) is defined as the involvement of "specialists who listen, develop their understanding, and interact with non-specialists in non-profit activities of educational, cultural, and social nature to engage the public in science-related matters". The public health relevance of PE consists in building up a scientifically literate society, able to participate in and support scientific and technological developments and their implications for educational settings. Neurological disorders account for 35% of all diseases. PE could have a positive impact on the lives of people affected by neurological diseases. METHOD This review evaluates the role of PE in dementia, stroke, epilepsy, multiple sclerosis, Parkinson's disease, migraine, neurogenetics, and amyotrophic lateral sclerosis. RESULTS AND CONCLUSIONS PE can provide accessible information, support research activities and prevention through appropriate lifestyles, and increase knowledge and awareness of neurological disorders, improving their diagnosis and treatment.
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Affiliation(s)
- Luigi Lavorgna
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), 39012 Merano, Italy;
| | - Sabrina Esposito
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Gianmarco Abbadessa
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Maddalena Sparaco
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Matilde Inglese
- Italy—OSPEDALE San Martino, IRCCS, University of Genova, 16132 Genoa, Italy;
| | - Luca Bonfanti
- Neuroscience Institute Cavalieri Ottolenghi (NICO), 10043 Orbassano, Italy;
- Department of Veterinary Sciences, University of Turin, 10095 Torino, Italy
| | - Francesca Trojsi
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Emanuele Spina
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Antonio Russo
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | | | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Torino, 10124 Turin, Italy;
| | - Gioacchino Tedeschi
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Simona Bonavita
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
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20
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Comparison of FAST and Stroke-112: A randomized study in Taiwan. J Formos Med Assoc 2021; 121:187-192. [PMID: 33736903 DOI: 10.1016/j.jfma.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/PURPOSE FAST and Stroke-112 are two campaigns to reduce the emergency room arrival time of stroke patients. No study has compared the effectiveness of these campaigns. This study aimed to compare recalling capacity of people in these two campaigns. METHODS A prospective, open-label randomized study was conducted in 2019. Recall ability for the items of the two campaigns on the 5th and 30th days post-education was compared using non-parametric methods. Subject characteristics including age, education level, presence of stroke in co-residents, and habitual language were evaluated using multiple ordered logistic regression. RESULTS There were 202 participants in FAST group and 193 participants in Stroke-112 group who completed the study. No differences were observed between the two groups in recall ability, either on day 5 or day 30 after receiving education. For both campaigns, recall ability was better for signs in the face (FAST: 87.1%, Stroke-112: 86.5%) and the arm (FAST: 87.1%, Stroke-112: 88.1%) than for abnormality in speech (FAST: 78.7%, Stroke-112: 76.7%) on day 5. Recall ability on day 30 remained the same only for the arm item (FAST: 86.1%, Stroke-112: 88.6%). The recall ability was correlated to education level equal or more than 7 years in FAST group, and was inversely correlated to age and being a stroke patient in Stroke-112 group. CONCLUSION We found no difference in recall ability between the 2 campaigns. Education level was associated with recallability of FAST, and age and stroke history were associated with recallability of Stroke-112.
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21
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Barnett C, Mitchell C, Tyson S. The management of patients with functional stroke: speech and language therapists’ views and experiences. Disabil Rehabil 2021; 44:3547-3558. [DOI: 10.1080/09638288.2020.1867910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Caroline Barnett
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claire Mitchell
- Division of Human Communication, Development & Hearing, University of Manchester, Manchester, UK
| | - Sarah Tyson
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
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Jones A, O'Connell N, David AS, Chalder T. Functional Stroke Symptoms: A Narrative Review and Conceptual Model. J Neuropsychiatry Clin Neurosci 2020; 32:14-23. [PMID: 31726918 DOI: 10.1176/appi.neuropsych.19030075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Stroke services have been reconfigured in recent years to facilitate early intervention. Throughout stroke settings, some patients present with functional symptoms that cannot be attributed to a structural cause. Emphasis on fast diagnosis and treatment means that a proportion of patients entering the care pathway present with functional symptoms that mimic stroke or have functional symptoms in addition to vascular stroke. There is limited understanding of mechanisms underlying functional stroke symptoms, how the treatment of such patients should be managed, and no referral pathway or treatment. Predisposing factors vary between individuals, and symptoms are heterogeneous: onset can be acute or insidious, and duration can be short-lived or chronic in the context of new or recurrent illness cognitions and behaviors. This article proposes a conceptual model of functional symptoms identified in stroke services and some hypotheses based on a narrative review of the functional neurological disorder literature. Predisposing factors may include illness experiences, stressors, and chronic autonomic nervous system arousal. Following the onset of distressing symptoms, perpetuating factors may include implicit cognitive processes, classical and operant conditioning, illness beliefs, and behavioral responses, which could form the basis of treatment targets. The proposed model will inform the development of theory-based interventions as well as a functional stroke care pathway.
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Affiliation(s)
- Abbeygail Jones
- The Department of Psychological Medicine, King's College London (Jones, Chalder); the Institute of Population Health, Trinity College Dublin (O'Connell); and the Institute of Mental Health, University College London (David)
| | - Nicola O'Connell
- The Department of Psychological Medicine, King's College London (Jones, Chalder); the Institute of Population Health, Trinity College Dublin (O'Connell); and the Institute of Mental Health, University College London (David)
| | - Anthony S David
- The Department of Psychological Medicine, King's College London (Jones, Chalder); the Institute of Population Health, Trinity College Dublin (O'Connell); and the Institute of Mental Health, University College London (David)
| | - Trudie Chalder
- The Department of Psychological Medicine, King's College London (Jones, Chalder); the Institute of Population Health, Trinity College Dublin (O'Connell); and the Institute of Mental Health, University College London (David)
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23
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Prabhakaran S, Richards CT, Kwon S, Wymore E, Song S, Eisenstein A, Brown J, Kandula NR, Mason M, Beckstrom H, Washington KV, Aggarwal NT. A Community-Engaged Stroke Preparedness Intervention in Chicago. J Am Heart Assoc 2020; 9:e016344. [PMID: 32893720 PMCID: PMC7726971 DOI: 10.1161/jaha.120.016344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background We evaluated a community‐engaged stroke preparedness intervention that aimed to increase early hospital arrival and emergency medical services (EMS) utilization among patients with stroke in the South Side of Chicago, Illinois. Methods and Results We compared change in early hospital arrival (<3 hours from symptom onset) and EMS utilization before and after our intervention among patients with confirmed ischemic stroke at an intervention hospital on the South Side of Chicago with concurrent data from 6 hospitals in nonintervention communities on the North Side of Chicago and 17 hospitals in St Louis, Missouri. We assessed EMS utilization for suspected stroke secondarily, using geospatial information systems analysis of Chicago ambulance transports before and after our intervention. Among 21 497 patients with confirmed ischemic stroke across all sites, early arrival rates at the intervention hospital increased by 0.5% per month (95% CI, −0.2% to 1.2%) after intervention compared with the preintervention period but were not different from North Side Chicago hospitals (difference of −0.3% per month [95% CI, −0.12% to 0.06%]) or St Louis hospitals (difference of 0.7% per month [95% CI, −0.1% to 1.4%]). EMS utilization at the intervention hospital decreased by 0.8% per month (95% CI, −1.7% to 0.2%) but was not different from North Side Chicago hospitals (difference of 0.004% per month [95% CI, −1.1% to 1.1%]) or St Louis hospitals (difference of −0.7% per month [95% CI, −1.7% to 0.3%]). EMS utilization for suspected stroke increased in the areas surrounding the intervention hospital (odds ratio [OR], 1.4; 95% CI, 1.2–1.6) and in the South Side (OR, 1.2; 95% CI, 1.1–1.3), but not in the North Side (OR, 1.0; 95% CI, 0.9–1.1). Conclusions Following a community stroke preparedness intervention, early hospital arrival and EMS utilization for confirmed ischemic stroke did not increase. However, ambulance transports for suspected stroke increased in the intervention community compared with other regions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02301299.
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Affiliation(s)
| | | | - Soyang Kwon
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | - Erin Wymore
- Northwestern University, Feinberg School of Medicine Chicago IL
| | - Sarah Song
- Rush University Medical Center Chicago IL
| | | | - Jen Brown
- Northwestern University, Feinberg School of Medicine Chicago IL
| | | | - Maryann Mason
- Northwestern University, Feinberg School of Medicine Chicago IL.,Lurie Children's Hospital of Chicago
| | | | | | - Neelum T Aggarwal
- The Retirement Research Foundation Chicago IL.,Rush Alzheimer's Disease Center Chicago IL
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24
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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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25
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Gocan S, Bourgoin A, Shamloul R, Sivakumar B, Dowlatshahi D, Stotts G. Early vascular imaging and key system strategies expedite carotid revascularization after transient ischemic attack and stroke. J Vasc Surg 2020; 72:1728-1734. [PMID: 32273220 DOI: 10.1016/j.jvs.2020.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND International guidelines recommend carotid revascularization within 14 days for patients with a symptomatic transient ischemic attack (TIA) or stroke event. However, significant delays in care persist, with only 9% of outpatients and 36% of inpatients in Ontario meeting this target. The study objective was to explore the influence of health system factors on carotid revascularization timelines. METHODS We conducted a retrospective chart review of all symptomatic TIA/stroke patients undergoing carotid endarterectomy or stenting at The Ottawa Hospital (2015-2016). The primary outcome was time from TIA/stroke to carotid revascularization. Health system variables of interest included location and timing of patient presentation, timelines to vascular imaging, and same-day collaboration between key services such as emergency, neurology, and surgery. Descriptive statistics and univariate analysis were used to determine statistically significant differences between groups. RESULTS A total of 228 records met the inclusion criteria. The median time from TIA/stroke to carotid revascularization was 10 days, with 58% of patients meeting the 14-day guideline. Prompt patient presentation to emergency demonstrated significantly shorter timelines to surgery (7 days; P < .001). Early vascular imaging was strongly correlated with early revascularization (4-5 days; P < .001). In addition, collaboration from two or more care services enhanced timelines to surgery ranging from 2.0 to 6.5 days (P < .001-.008). CONCLUSIONS Early/emergency response to stroke symptoms was pivotal in achieving best practice recommendations for rapid carotid revascularization, emphasizing the need for ongoing public awareness. Emergency and ambulatory strategies to facilitate urgent vascular imaging, as well as mechanisms for same-day communication between teams require optimization to promote early revascularization.
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Affiliation(s)
- Sophia Gocan
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Neuroscience, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Aline Bourgoin
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Neuroscience, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rany Shamloul
- Division of Neuroscience, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brammiya Sivakumar
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Neuroscience, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dar Dowlatshahi
- Division of Neuroscience, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Grant Stotts
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Neuroscience, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
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26
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Alkhalil M. A promising tool to tackle the risk of cerebral vascular disease, the emergence of novel carotid wall imaging. Brain Circ 2020; 6:81-86. [PMID: 33033777 PMCID: PMC7511918 DOI: 10.4103/bc.bc_65_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/24/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
Stroke is a heterogeneous vascular disease. Carotid artery atherosclerosis is associated with almost one-quarter of ischemic strokes. Moreover, a large percentage of preventable strokes are currently attributed to carotid atherosclerosis. Over the past three decades, the management of carotid artery disease has evolved. The benefits of carotid revascularization alongside medical therapy have early been recognized. Nonetheless, the debate regarding the optimal strategy is still ongoing, particularly in patients with asymptomatic carotid artery disease. One of the challenges is the use of luminal stenosis to quantify the severity of the carotid artery disease and to guide decision-making regarding invasive revascularization. Characterizing carotid atherosclerotic plaque is a promising tool to identify vulnerable plaque. Certain features such as large lipid core have already been linked to acute vascular events, not only at the plaque level but also to predict systemic cardiovascular events. Recently, a quantitative T2 mapping magnetic resonance imaging technique was developed and validated against histology. The ability to accurately quantify plaque lipid content using this technique opens several new opportunities. In this review articles, we will discuss the current challenges in the management of carotid artery disease and the future roles of T2 mapping to aid therapeutic options. These roles may include how to determine the mode of invasive carotid revascularization in symptomatic patients. Moreover, there may be a rational to use T2 mapping as a risk stratification tool in asymptomatic patients with carotid artery stenosis. It may also provide an opportunity to stage atherosclerosis and identify patients with coronary atherosclerosis who may benefit maximally from intensive lipid interventions.
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Affiliation(s)
- Mohammad Alkhalil
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK
- Department of Cardiology, Toronto General Hospital, Toronto, Canada
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27
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Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature. J Neurol 2020; 268:2723-2734. [PMID: 32206899 DOI: 10.1007/s00415-020-09803-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIMS This review examined factors that delay thrombolysis and what management strategies are currently employed to minimise this delay, with the aim of suggesting future directions to overcome bottlenecks in treatment delivery. METHODS A systematic review was performed according to PRISMA guidelines. The search strategy included a combination of synonyms and controlled vocabularies from Medical Subject Headings (MeSH) and EmTree covering brain ischemia, cerebrovascular accident, fibrinolytic therapy and Alteplase. The search was conducted using Medline (OVID), Embase (OVID), PubMed and Cochrane Library databases using truncations and Boolean operators. The literature search excluded review articles, trial protocols, opinion pieces and case reports. Inclusion criteria were: (1) The article directly related to thrombolysis in ischaemic stroke, and (2) The article examined at least one factor contributing to delay in thrombolytic therapy. RESULTS One hundred and fifty-two studies were included. Pre-hospital factors resulted in the greatest delay to thrombolysis administration. In-hospital factors relating to assessment, imaging and thrombolysis administration also contributed. Long onset-to-needle times were more common in those with atypical, or less severe, symptoms, the elderly, patients from lower socioeconomic backgrounds, and those living alone. Various strategies currently exist to reduce delays. Processes which have achieved the greatest improvements in time to thrombolysis are those which integrate out-of-hospital and in-hospital processes, such as the Helsinki model. CONCLUSION Further integrated processes are required to maximise patient benefit from thrombolysis. Expansion of community education to incorporate less common symptoms and provision of alert pagers for patients may provide further reduction in thrombolysis times.
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28
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Wafa HA, Wolfe CDA, Bhalla A, Wang Y. Long-term trends in death and dependence after ischaemic strokes: A retrospective cohort study using the South London Stroke Register (SLSR). PLoS Med 2020; 17:e1003048. [PMID: 32163411 PMCID: PMC7067375 DOI: 10.1371/journal.pmed.1003048] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There have been reductions in stroke mortality over recent decades, but estimates by aetiological subtypes are limited. This study estimates time trends in mortality and functional dependence by ischaemic stroke (IS) aetiological subtype over a 16-year period. METHODS AND FINDINGS The study population was 357,308 in 2011; 50.4% were males, 56% were white, and 25% were of black ethnic backgrounds. Population-based case ascertainment of stroke was conducted, and all participants who had their first-ever IS between 2000 and 2015 were identified. Further classification was concluded according to the underlying mechanism into large-artery atherosclerosis (LAA), cardio-embolism (CE), small-vessel occlusion (SVO), other determined aetiologies (OTH), and undetermined aetiologies (UND). Temporal trends in survival rates were examined using proportional-hazards survival modelling, adjusted for demography, prestroke risk factors, case mix variables, and processes of care. We carried out additional regression analyses to explore patterns in case-fatality rates (CFRs) at 30 days and 1 year and to explore whether these trends occurred at the expense of greater functional dependence (Barthel Index [BI] < 15) among survivors. A total of 3,128 patients with first-ever ISs were registered. The median age was 70.7 years; 50.9% were males; and 66.2% were white, 25.5% were black, and 8.3% were of other ethnic groups. Between 2000-2003 and 2012-2015, the adjusted overall mortality decreased by 24% (hazard ratio [HR] per year 0.976; 95% confidence interval [CI] 0.959-0.993). Mortality reductions were equally noted in both sexes and in the white and black populations but were only significant in CE strokes (HR per year 0.972; 95% CI 0.945‒0.998) and in patients aged ≥55 years (HR per year 0.975; 95% CI 0.959‒0.992). CFRs within 30 days and 1 year after an IS declined by 38% (rate ratio [RR] per year 0.962; 95% CI 0.941‒0.984) and 37% (RR per year 0.963; 95% CI 0.949‒0.976), respectively. Recent IS was independently associated with a 23% reduced risk of functional dependence at 3 months after onset (RR per year 0.983; 95% CI 0.968-0.998; p = 0.002 for trend). The study is limited by small number of events in certain subgroups (e.g., LAA), which could have led to insufficient power to detect significant trends. CONCLUSIONS Both mortality and 3-month functional dependence after IS decreased by an annual average of around 2.4% and 1.7%, respectively, during 2000‒2015. Such reductions were particularly evident in strokes of CE origins and in those aged ≥55 years.
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Affiliation(s)
- Hatem A. Wafa
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, United Kingdom
- * E-mail:
| | - Charles D. A. Wolfe
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, United Kingdom
| | - Ajay Bhalla
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Yanzhong Wang
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, United Kingdom
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29
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Wilhelm LO, Gellert P, White M, Araujo-Soares V, Ford GA, Mackintosh JE, Rodgers H, Sniehotta FF, Thomson RG, Dombrowski SU. The Recognition-Response Gap in Acute Stroke: Examining the Relationship between Stroke Recognition and Response in a General Population Survey. J Stroke Cerebrovasc Dis 2020; 29:104499. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/15/2022] Open
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30
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Jones AT, O'Connell NK, David AS. Epidemiology of functional stroke mimic patients: a systematic review and meta‐analysis. Eur J Neurol 2019; 27:18-26. [DOI: 10.1111/ene.14069] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A. T. Jones
- Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - N. K. O'Connell
- Department of Public Health and Primary Care Institute of Population Health Trinity College Dublin Dublin Ireland
| | - A. S. David
- Institute of Mental Health University College London London UK
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31
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Morrow A, Miller CB, Dombrowski SU. Can people apply 'FAST' when it really matters? A qualitative study guided by the common sense self-regulation model. BMC Public Health 2019; 19:643. [PMID: 31138193 PMCID: PMC6537353 DOI: 10.1186/s12889-019-7032-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/22/2019] [Indexed: 11/11/2022] Open
Abstract
Background Early identification of stroke symptoms and rapid access to the emergency services increases an individual’s chance of receiving thrombolytic therapy and reduces the likelihood of infirmity. The UK’s national stroke campaign ‘Act FAST’ was developed to increase public awareness of stroke symptoms and highlighted the importance of rapid response by contacting emergency services. No study to date has assessed if and how people who experienced or witnessed stroke in line with the campaigns’ symptoms of the FAST acronym (i.e., facial weakness, arm weakness, slurred speech, and time) may use this FAST in their response. Methods Semi-structured interviews with 13 stroke patients and witnesses were conducted. Interviews were theory-guided based on the Common Sense Self-Regulation Model, to understand the appraisal process of the onset of stroke symptoms and how this impacted on participants’ ability to apply their knowledge of the FAST campaign. Results The majority of patients (n = 8/13) failed to correctly identify stroke and reported no impact of the campaign on their stroke recognition and response. Inability to identify stroke, perceiving symptoms to lack severity and lack of control contributed to a delay in seeking medical attention. Conclusion Stroke witnesses and patients predominantly fail to identify stroke which suggest a lack of FAST application when it matters. Inaccurate risk perceptions and lack of physical control both play central roles in influencing the formation of illness representation not associated with an appropriate emergency response.
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Affiliation(s)
- Alison Morrow
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Christopher B Miller
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Stephan U Dombrowski
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK.,Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
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32
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Meredith G, Rudd A. Reducing the severity of stroke. Postgrad Med J 2019; 95:271-278. [DOI: 10.1136/postgradmedj-2018-136157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 11/04/2022]
Abstract
Stroke remains one of the most important causes of death and disability worldwide. Effective prevention could reduce the burden of stroke dramatically. The management of stroke has undergone a revolution over the last few decades, particularly with the development of techniques for revascularisation of patients with ischaemic stroke. Advanced imaging able to identify potentially salvageable brain is further increasing the potential for effective acute treatment. However, the majority of stroke patients won’t benefit from these treatments and will need effective specialist stroke care and ongoing rehabilitation to overcome impairments and adapt to living with a disability. There are still many unanswered questions about the most effective way of delivering rehabilitation. Likewise, research into how to manage primary intracerebral haemorrhage has yet to transform care.
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33
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Dolmans LS, Kappelle LJ, Bartelink MLE, Hoes AW, Rutten FH. Delay in patients suspected of transient ischaemic attack: a cross-sectional study. BMJ Open 2019; 9:e027161. [PMID: 30819716 PMCID: PMC6398704 DOI: 10.1136/bmjopen-2018-027161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Suspected transient ischaemic attack (TIA) necessitates an urgent neurological consultation and a rapid start of antiplatelet therapy to reduce the risk of early ischaemic stroke following a TIA. Guidelines for general practitioners (GPs) emphasise the urgency to install preventive treatment as soon as possible. We aimed to give a contemporary overview of both patient and physician delay. METHODS A survey at two rapid-access TIA outpatient clinics in Utrecht, the Netherlands. All patients suspected of TIA were interviewed to assess time delay to diagnosis and treatment, including the time from symptom onset to (1) the first contact with a medical service (patient delay), (2) consultation of the GP and (3) assessment at the TIA outpatient clinic. We used the diagnosis of the consulting neurologist as reference. RESULTS Of 93 included patients, 43 (46.2%) received a definite, 13 (14.0%) a probable, 11 (11.8%) a possible and 26 (28.0%) no diagnosis of TIA. The median time from symptom onset to the visit to the TIA service was 114.5 (IQR 44.0-316.6) hours. Median patient delay was 17.5 (IQR 0.8-66.4) hours, with a delay of more than 24 hours in 36 (38.7%) patients. The GP was first contacted in 76 (81.7%) patients, and median time from first contact with the GP practice to the actual GP consultation was 2.8 (0.5-18.5) hours. Median time from GP consultation to TIA service visit was 40.8 (IQR 23.1-140.7) hours. Of the 62 patients naïve to antithrombotic medication who consulted their GP, 27 (43.5%) received antiplatelet therapy. CONCLUSIONS There is substantial patient and physician delay in the process of getting a confirmed TIA diagnosis, resulting in suboptimal prevention of an early ischaemic stroke.
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Affiliation(s)
- L Servaas Dolmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie-Louise El Bartelink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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34
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Turner SL, Karahalios A, Forbes AB, Taljaard M, Grimshaw JM, Cheng AC, Bero L, McKenzie JE. Design characteristics and statistical methods used in interrupted time series studies evaluating public health interventions: protocol for a review. BMJ Open 2019; 9:e024096. [PMID: 30696676 PMCID: PMC6352832 DOI: 10.1136/bmjopen-2018-024096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION An interrupted time series (ITS) design is an important observational design used to examine the effects of an intervention or exposure. This design has particular utility in public health where it may be impracticable or infeasible to use a randomised trial to evaluate health system-wide policies, or examine the impact of exposures (such as earthquakes). There have been relatively few studies examining the design characteristics and statistical methods used to analyse ITS designs. Further, there is a lack of guidance to inform the design and analysis of ITS studies.This is the first study in a larger project that aims to provide tools and guidance for researchers in the design and analysis of ITS studies. The objectives of this study are to (1) examine and report the design characteristics and statistical methods used in a random sample of contemporary ITS studies examining public health interventions or exposures that impact on health-related outcomes, and (2) create a repository of time series data extracted from ITS studies. Results from this study will inform the remainder of the project which will investigate the performance of a range of commonly used statistical methods, and create a repository of input parameters required for sample size calculation. METHODS AND ANALYSIS We will collate 200 ITS studies evaluating public health interventions or the impact of exposures. ITS studies will be identified from a search of the bibliometric database PubMed between the years 2013 and 2017, combined with stratified random sampling. From eligible studies, we will extract study characteristics, details of the statistical models and estimation methods, effect metrics and parameter estimates. Further, we will extract the time series data when available. We will use systematic review methods in the screening, application of inclusion and exclusion criteria, and extraction of data. Descriptive statistics will be used to summarise the data. ETHICS AND DISSEMINATION Ethics approval is not required since information will only be extracted from published studies. Dissemination of the results will be through peer-reviewed publications and presentations at conferences. A repository of data extracted from the published ITS studies will be made publicly available.
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Affiliation(s)
- Simon L Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Amalia Karahalios
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew B Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Lisa Bero
- Faculty of Pharmacy and Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Bray JE, Finn J, Cameron P, Smith K, Straney L, Cartledge S, Nehme Z, Lim M, Bladin C. Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns. Stroke 2018; 49:3078-3080. [PMID: 30571429 DOI: 10.1161/strokeaha.118.023263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The Australian Stroke Foundation ran annual paid advertising between 2004 and 2014, using the FAST (Face, Arm, Speech, Time) campaign from 2006 and adding the message to call emergency medical services in 2007. In this study, we examined temporal trends in emergency medical services use and referrals from general practitioners in the Australian state of Victoria to evaluate the impact of these campaigns. Methods- Using data from 33 public emergency departments, contributing to the Victorian Emergency Minimum Dataset, we examined trends in emergency department presentations for 118 000 adults with an emergency diagnosis of stroke or transient ischemic attack between 2003 and 2015. Annual trends were examined using logistic regression using a precampaign period (January 2003 to August 2004) as reference and adjusting for demographic variables. Results- Compared with the precampaign period, significant increases in emergency medical services use were seen annually between 2008 and 2015 (all P<0.001, eg, 2015; adjusted odds ratio, 1.16; 95% CI, 1.10-1.23). In contrast, a decrease was seen in patients presenting via general practitioners across all campaign years (all P<0.001, eg, 2015; adjusted odds ratio, 0.48; 95% CI, 0.44-0.53). Conclusions- Since the Stroke Foundation campaigns began, a greater proportion of stroke and transient ischemic attack patients are presenting to hospital by emergency medical services and appear to be bypassing their general practitioners.
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Affiliation(s)
- Janet E Bray
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.).,Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., P.C., M.L.)
| | - Judith Finn
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.)
| | - Peter Cameron
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., P.C., M.L.)
| | - Karen Smith
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia (K.S., Z.N., C.B.)
| | - Lahn Straney
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia
| | - Susie Cartledge
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Department of Community Emergency Health and Paramedic Practice (K.S., Z.N.), Monash University, Melbourne, Victoria, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia (S.C.)
| | - Ziad Nehme
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Department of Community Emergency Health and Paramedic Practice (K.S., Z.N.), Monash University, Melbourne, Victoria, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia (K.S., Z.N., C.B.)
| | - Michael Lim
- Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., P.C., M.L.)
| | - Christopher Bladin
- Eastern Health Clinical School (C.B.), Monash University, Melbourne, Victoria, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia (K.S., Z.N., C.B.).,Florey Institute, Melbourne, Victoria, Australia (C.B.)
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Wolters FJ, Li L, Gutnikov SA, Mehta Z, Rothwell PM. Medical Attention Seeking After Transient Ischemic Attack and Minor Stroke Before and After the UK Face, Arm, Speech, Time (FAST) Public Education Campaign: Results From the Oxford Vascular Study. JAMA Neurol 2018; 75:1225-1233. [PMID: 29971433 PMCID: PMC6233848 DOI: 10.1001/jamaneurol.2018.1603] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/04/2018] [Indexed: 01/13/2023]
Abstract
Importance Risk of major stroke is high during the hours and days after transient ischemic attack (TIA) and minor stroke but is substantially reduced by urgent medical treatment. Public education campaigns have improved the response after major stroke, but their association with behavior after TIA and minor stroke is uncertain. The number of potentially preventable early recurrent strokes in patients who delay or fail to seek medical attention is unknown. Objective To investigate the association of public education with delays and failure in seeking medical attention after TIA and minor stroke. Design, Setting, and Participants Prospective population-based study of all patients with TIA or stroke who sought medical attention between April 1, 2002, and March 31, 2014, registered at 9 general practices in Oxfordshire, United Kingdom. Data analysis took place from July 1, 2013, to March 2, 2015. Exposures Face, Arm, Speech, Time (FAST) public education campaign in the United Kingdom. Main Outcomes and Measures Number of early recurrent strokes in patients who delayed or failed to seek medical attention, as well as the odds of seeking urgent attention after TIA and minor stroke before vs after initiation of the public education campaign. Results Among 2243 consecutive patients with first TIA or stroke (mean [SD] age, 73.6 [13.4] years; 1126 [50.2%] female; 96.3% of white race/ethnicity), 1656 (73.8%) had a minor stroke or TIA. After the FAST campaign, patients with major stroke more often sought medical attention within 3 hours (odds ratio [OR], 2.56; 95% CI, 1.11-5.90; P = .03). For TIA and minor stroke, there was no improvement in use of emergency medical services (OR, 0.79; 95% CI, 0.50-1.23; P for interaction = .03 vs major stroke) or time to first seeking medical attention within 24 hours (OR, 0.75; 95% CI, 0.48-1.19; P for interaction = .006 vs major stroke). Patient perception of symptoms after TIA and minor stroke was associated with more urgent behavior, but correct perception declined after the FAST campaign (from 37.3% [289 of 774] to 27.6% [178 of 645]; OR, 0.64; 95% CI, 0.51-0.80; P < .001). One hundred eighty-eight patients had a stroke within 90 days of their initial TIA or stroke, of whom 93 (49.5%) followed unheeded TIAs for which no medical attention was sought, similar before and after the FAST campaign (43 of 538 [8.0%] before vs 50 of 615 [8.1%] after, P = .93). Conclusions and Relevance This study suggests that in contrast to major stroke, extensive FAST-based public education has not improved the response to TIA and minor stroke in the United Kingdom, emphasizing the need for campaigns that are tailored to transient and less severe symptoms.
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Affiliation(s)
- Frank J. Wolters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
| | - Linxin Li
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
| | - Sergei A. Gutnikov
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
| | - Ziyah Mehta
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
| | - Peter M. Rothwell
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Headington, Oxford, United Kingdom
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Dolmans LS, Hoes AW, Bartelink MLEL, Koenen NCT, Kappelle LJ, Rutten FH. Patient delay in TIA: a systematic review. J Neurol 2018; 266:1051-1058. [PMID: 30027321 PMCID: PMC6469675 DOI: 10.1007/s00415-018-8977-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/27/2018] [Accepted: 07/14/2018] [Indexed: 11/29/2022]
Abstract
Background Patients who suffer a transient ischemic attack (TIA) have a high short-term risk of developing ischemic stroke, notably within the first 48 h. Timely diagnosis and urgent preventive treatment substantially reduce this risk. We conducted a systemic review to quantify patient delay in patients with (suspected) TIA, and assess determinants related to such delay. Methods A systematic review using MEDLINE and EMBASE databases up to March 2017 to identify studies reporting the time from onset of TIA symptoms to seeking medical help. Results We identified nine studies providing data on patient delay, published between 2006 and 2016, with 7/9 studies originating from the United Kingdom (UK). In total 1103 time-defined TIA patients (no remaining symptoms > 24 h), and 896 patients with a minor stroke (i.e., mild remaining symptoms > 24 h) were included (49.1% men, mean age 72.2 years). Patient’s delay of more than 24 h was reported in 33.1–44.4% of TIA patients, with comparable proportions for minor stroke patients. Delays were on average shorter in patients interviewed at the emergency department than among patients seen at TIA outpatient clinics. Univariably associated with a shorter delay were (1) a longer duration of symptoms, (2) motor symptoms, (3) a higher ABCD2 score, and (4) correct patient’s recognition as possible ischemic cerebrovascular event. Conclusions More than a third of patients experiencing a TIA delays medical attention for more than a day, thus critically extending the initiation of stroke preventive treatment. There still seems to be insufficient awareness among lay people that symptoms suggestive of TIA should be considered as an emergency. Additional data and multivariable analyses are needed to define main determinants of patient delay.
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Affiliation(s)
- L Servaas Dolmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marie-Louise E L Bartelink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niels C T Koenen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Tsivgoulis G, Kargiotis O, Rudolf J, Komnos A, Tavernarakis A, Karapanayiotides T, Ellul J, Katsanos AH, Giannopoulos S, Gryllia M, Safouris A, Papamichalis P, Vadikolias K, Mitsias P, Hadjigeorgiou G. Intravenous thrombolysis for acute ischemic stroke in Greece: the Safe Implementation of Thrombolysis in Stroke registry 15-year experience. Ther Adv Neurol Disord 2018; 11:1756286418783578. [PMID: 30034535 PMCID: PMC6048606 DOI: 10.1177/1756286418783578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background: Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion
treatment for acute ischemic stroke (AIS), however there are scarce data
regarding outcomes and complications of IVT in Greece. We evaluated safety
and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation
of Thrombolysis in Stroke: International Stroke Thrombolysis Register
(SITS-ISTR) dataset. Methods: All AIS patients treated with IVT in Greece between December 2002 and July
2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk
factors, baseline stroke severity [defined using National Institutes of
Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were
recorded. Safety outcomes included symptomatic intracranial hemorrhage
(sICH) and 3-month mortality rates. The efficacy outcomes evaluated a
reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month
favorable functional outcome [FFO; modified Rankin scale (mRS) scores of
0–1] and 3-month functional independence (FI; mRS-scores of 0–2). The safety
and efficacy outcomes were assessed comparatively with previously published
data from SITS national and international registries. Results: A total of 523 AIS patients were treated with IVT in 12 Greek centers
participating in the SITS-ISTR during the study period (mean age 62.4 ±
12.7; 34.6% women; median baseline NIHSS score: 11 points; median OTT: 150
min). The rates of sICH were 1.4%, 2.3%, and 3.8% according to the
SIST-MOST, ECASS II, and NINDS criteria respectively. The median reduction
in NIHSS score at 2 and 24 h was 3 [interquartile range (IQR): 1–5] and 5
(IQR: 2–8) points respectively. The 3-month FI, FFO and mortality were
66.5%, 55.6% and 7.9%. All safety and efficacy outcomes were comparable with
available data from SITS-ISTR in other European countries. Conclusions: Our study underscores the safety and efficacy of IVT for AIS in Greece.
Additional action is necessary in order to increase the availability of IVT
in the Greek population and to include more centers in the SITS-ISTR.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Jobst Rudolf
- Department of Neurology, Papageorgiou Hospital, Thessaloniki, Greece
| | | | | | - Theodoros Karapanayiotides
- Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - John Ellul
- Department of Neurology, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece
| | - Aristeidis H Katsanos
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sotirios Giannopoulos
- Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Maria Gryllia
- Department of Neurology, Athens General Hospital G. Gennimatas, Athens, Greece
| | - Apostolos Safouris
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | | | - Konstantinos Vadikolias
- Department of Neurology, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece
| | - Panayiotis Mitsias
- Department of Neurology Medical School, University of Crete, Heraklion, Crete, Greece
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Meira F, Magalhães D, da Silva LS, Mendonça E Silva AC, Silva GS. Knowledge about Stroke in Belo Horizonte, Brazil: A Community-Based Study Using an Innovative Video Approach. Cerebrovasc Dis Extra 2018; 8:60-69. [PMID: 29788007 PMCID: PMC6006611 DOI: 10.1159/000488400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 03/13/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND PURPOSE Stroke is a leading cause of death in Brazil. Knowledge about the clinical manifestations of stroke as well as its risk factors and its management is still poor in the country. We intended to assess the stroke knowledge of an urban population in Belo Ho-rizonte, Brazil. METHODS Individuals assisted by a basic health unit were interviewed between February and August 2014. After demographic data collection, the participants were asked to watch a video that consisted of a person presenting stroke signals and they were asked to answer questions about the condition shown on the video. Afterwards, they answered a semi-structured questionnaire to evaluate their stroke knowledge. RESULTS A total of 703 people were interviewed (62.1% female, mean age 46.7 years). Recognition of a person having a stroke on the presented video was achieved by 56.1% of the subjects. Female sex (p = 0.029) and contact with someone who had had a stroke (family member [p < 0.01], neighbor [p < 0.05]) increased the odds of correctly identifying the condition showed on the video. The most commonly mentioned clinical manifestations of stroke were weakness (34.7%) and speech disturbance (31.6%). Stroke risk factors that were most named were "unbalanced diet" (42.3%) and hypertension (33.7%). Most participants (66.8%) said they would call the emergency medical services, while 17.8% would go directly to a hospital. Only 17 subjects knew thrombolytic therapy for acute stroke. CONCLUSION Female sex and a family history of stroke increased the odds of recognizing the signs of stroke. Knowledge about the clinical manifestations, risk factors, and management of stroke was low in the studied population.
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Affiliation(s)
- Fidel Meira
- Stroke Unit, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
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Hickey A, Mellon L, Williams D, Shelley E, Conroy RM. Does stroke health promotion increase awareness of appropriate behavioural response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response. Eur Stroke J 2018; 3:117-125. [PMID: 31008344 DOI: 10.1177/2396987317753453] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/02/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction Inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention. We report on post-campaign findings (wave 2) of national surveys to estimate changes in population knowledge following a media-based Face, Arm, Speech, Time stroke awareness campaign, comparing findings to those of a pre-campaign population survey (wave 1).Participants and methods: One thousand and ten randomly selected adults (18+) completed the Stroke Awareness Questionnaire on knowledge of warning signs, risk factors and response to stroke at wave 2 and findings were compared to wave 1 survey results. Logistic regression was used to examine the association between demographic characteristics and self-reported risk factors with knowledge of stroke and emergency response. Results No significant differences existed in the ability of respondents to define stroke or to identify two or more stroke risk factors between waves 1 and 2 surveys (71% and 70%, respectively). Respondents to the wave 2 survey were five times more likely (odds ratio 4.9, p < .001) than those responding at wave 1 to know at least two warning signs of stroke (67% vs. 31%, respectively), specifically those targeted by the Face, Arm, Speech, Time campaign. While significant improvement in intention to call an ambulance was noted (odds ratio 1.5, p < .001, 57% at wave 2 compared to 47% at wave 1), for almost half of respondents (43%) this would not have been their first response to stroke. Less than 5% of respondents to both surveys identified thrombolysis as an emergency treatment for stroke (3.9% at wave 2 compared to 1.8% at wave 1). Discussion Although significant improvements were made in several areas of stroke knowledge and intended response, awareness of acute stroke interventions was poor and intended behavioural response was suboptimal. Conclusion Findings from this study indicate need for targeted campaigns to improve population understanding of the reasons underlying the importance of rapid emergency response to stroke.
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Affiliation(s)
- Anne Hickey
- 1Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Lisa Mellon
- 1Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - David Williams
- 2Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Emer Shelley
- 3Department of Epidemiology & Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ronan M Conroy
- 3Department of Epidemiology & Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Bonfert MV, Badura K, Gerstl J, Borggraefe I, Heinen F, Schroeder S, Olivieri M, Weinberger R, Landgraf MN, Vill K, Tacke M, Berweck S, Reiter K, Hoffmann F, Nicolai T, Gerstl L. Childhood Stroke: Awareness, Interest, and Knowledge Among the Pediatric Community. Front Pediatr 2018; 6:182. [PMID: 29988546 PMCID: PMC6026646 DOI: 10.3389/fped.2018.00182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/04/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: Acute childhood stroke is an emergency requiring a high level of awareness among first-line healthcare providers. This survey serves as an indicator of the awareness of, the interest in, and knowledge of childhood stroke of German pediatricians. Methods: Thousand six hundred and ninety-seven physicians of pediatric in- and outpatient facilities in Bavaria, Germany, were invited via email to an online-survey about childhood stroke. Results: The overall participation rate was 14%. Forty-six percent of participants considered a diagnosis of childhood stroke at least once during the past year, and 47% provide care for patients who have suffered childhood stroke. The acronym FAST (Face-Arm-Speech-Time-Test) was correctly cited in 27% of the questionnaires. Most commonly quoted symptoms of childhood stroke were hemiparesis (90%), speech disorder (58%), seizure (44%), headache (40%), and impaired consciousness (33%). Migraine (63%), seizure (39%), and infections of the brain (31%) were most frequently named as stroke mimics. Main diagnostic measures indicated were magnetic resonance imaging (MRI) (96%) and computer tomography (CT) (55%). Main therapeutic strategies were thrombolysis (80%), anticoagulation (41%), neuroprotective measures, and thrombectomies (15% each). Thirty-nine percent of participants had taken part in training sessions, 61% studied literature, 37% discussed with colleagues, and 25% performed internet research on childhood stroke. Ninety-three percent of participants approve skill enhancement, favoring training sessions (80%), publications (43%), and web based offers (35%). Consent for offering a flyer on the topic to caregivers in facilities was given in 49%. Conclusion: Childhood stroke constitutes a topic of clinical importance to pediatricians. Participants demonstrate a considerable level of comprehension concerning the subject, but room for improvement remains. A multi-modal approach encompassing an elaborate training program, regular educational publications in professional journals, and web based offers could reach a broad range of health care providers. Paired with a public adult and childhood stroke awareness campaign, these efforts could contribute to optimize the care for children suffering from stroke.
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Affiliation(s)
- Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Katharina Badura
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Schön Klinik Vogtareuth, Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany
| | - Julia Gerstl
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Department of Pediatrics, Facharztzentrum Hauzenberg, Hauzenberg, Germany
| | - Ingo Borggraefe
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Sebastian Schroeder
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Martin Olivieri
- Department of Pediatric Hemostaseology, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Raphael Weinberger
- Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Moritz Tacke
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Steffen Berweck
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Schön Klinik Vogtareuth, Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany
| | - Karl Reiter
- Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Florian Hoffmann
- Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Thomas Nicolai
- Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
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Kelly KM, Holt KT, Neshewat GM, Skolarus LE. Community Interventions to Increase Stroke Preparedness and Acute Stroke Treatment Rates. Curr Atheroscler Rep 2017; 19:64. [PMID: 29147858 DOI: 10.1007/s11883-017-0695-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Acute stroke treatments reduce the risk of post-stroke disability. These treatments, tissue plasminogen activator (tPA) and intra-arterial treatment, are highly time-dependent; thus, one of the main barriers to treatment is pre-hospital delay. Stroke preparedness is defined as the ability to recognize stroke symptoms and the intent to activate emergency medical services (EMS). This review describes types of acute stroke treatment and preparedness interventions, including recent mass media interventions to increase acute stroke treatment rates, and adult and youth community interventions to increase stroke preparedness. RECENT FINDINGS The mass media campaigns show mixed results regarding acute stroke treatment rates, possibly attributed to the various media platforms utilized and resources available. The adult and youth community interventions reveal an overall increase in stroke symptom recognition and behavioral intent to call EMS. However, most of these community interventions were not grounded in health behavior theory, and they were tested in single group, pre-post test study designs that assessed behavioral rather than clinical outcomes. The delivery of stroke preparedness information by youth to adults, for example via home assignments, is a promising and innovative approach to stroke preparedness. Mass media and community interventions show promise to increase stroke preparedness and acute stroke treatment rates. The development of health behavior theory-based interventions that are tested via scientifically rigorous study designs are needed to prioritize which interventions should be disseminated to culturally and socially similar communities.
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Affiliation(s)
- Kathleen M Kelly
- Stroke Program, Department of Neurology, University of Michigan, 1500 East Medical Center Drive SPC#5855, Ann Arbor, MI, 48109-5855, USA
| | - Kathryn T Holt
- Stroke Program, Department of Neurology, University of Michigan, 1500 East Medical Center Drive SPC#5855, Ann Arbor, MI, 48109-5855, USA
| | - Gina M Neshewat
- Stroke Program, Department of Neurology, University of Michigan, 1500 East Medical Center Drive SPC#5855, Ann Arbor, MI, 48109-5855, USA
| | - Lesli E Skolarus
- Stroke Program, Department of Neurology, University of Michigan, 1500 East Medical Center Drive SPC#5855, Ann Arbor, MI, 48109-5855, USA.
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Can Children Reduce Delayed Hospital Arrival for Ischemic Stroke?: A Systematic Review of School-Based Stroke Education. J Neurosci Nurs 2017; 48:E2-E13. [PMID: 27045288 DOI: 10.1097/jnn.0000000000000202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delayed hospital arrival after onset of ischemic stroke reduces the number of patients eligible for tissue plasminogen activator, which must be given soon after stroke onset. There are conflicting results about the impact of mass media stroke education on timing of hospital arrival and tissue plasminogen activator administration rates. School-based programs are a new way to communicate stroke information. METHODS A search of MEDLINE, CINAHL, PsycINFO, and ERIC databases from 1995 to 2014 identified school-based stroke education interventions. Twelve studies involving 3,312 children and 612 parents met criteria for review. RESULTS School-based stroke education interventions were effective to improve knowledge of stroke symptoms among children in kindergarten through junior high. Improvement for stroke risk factors was less robust. Interventions were effective regardless of format, length, or who delivered the information. Despite low parental response rates in some studies, there was evidence that children transmitted stroke information to parents. CONCLUSIONS School-based stroke education programs appear effective to improve knowledge of stroke symptoms. Research is needed to determine if children who participate are able to recognize stroke and respond appropriately by calling 911 in the real world. More study is needed about transfer of stroke knowledge from child to parent. Strategies to improve parent participation are needed.
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A high-urgency stroke code reduces in-hospital delays in acute ischemic stroke: a single-centre experience. Neurol Sci 2017; 38:1671-1676. [DOI: 10.1007/s10072-017-3046-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/21/2017] [Indexed: 12/29/2022]
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Caminiti C, Schulz P, Marcomini B, Iezzi E, Riva S, Scoditti U, Zini A, Malferrari G, Zedde ML, Guidetti D, Montanari E, Baratti M, Denti L. Development of an education campaign to reduce delays in pre-hospital response to stroke. BMC Emerg Med 2017. [PMID: 28646851 PMCID: PMC5483310 DOI: 10.1186/s12873-017-0130-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Systematic reviews call for well-designed trials with clearly described intervention components to support the effectiveness of educational campaigns to reduce patient delay in stroke presentation. We herein describe the systematic development process of a campaign aimed to increase stroke awareness and preparedness. Methods Campaign development followed Intervention Mapping (IM), a theory- and evidence-based tool, and was articulated in two phases: needs assessment and intervention development. In phase 1, two cross-sectional surveys were performed, one aiming to measure stroke awareness in the target population and the other to analyze the behavioral determinants of prehospital delay. In phase 2, a matrix of proximal program objectives was developed, theory-based intervention methods and practical strategies were selected and program components and materials produced. Results In phase 1, the survey on 202 citizens highlighted underestimation of symptom severity, as in only 44% of stroke situations respondents would choose to call the emergency service (EMS). In the survey on 393 consecutive patients, 55% presented over 2 hours after symptom onset; major determinants were deciding to call the general practitioner first and the reaction of the first person the patient called. In phase 2, adult individuals were identified as the target of the intervention, both as potential “patients” and witnesses of stroke. The low educational level found in the patient survey called for a narrative approach in cartoon form. The family setting was chosen for the message because 42% of patients who presented within 2 hours had been advised by a family member to call EMS. To act on people’s tendency to view stroke as an untreatable disease, it was decided to avoid fear-arousal appeals and use a positive message providing instructions and hope. Focus groups were used to test educational products and identify the most suitable sites for message dissemination. Conclusions The IM approach allowed to develop a stroke campaign integrating theories, scientific evidence and information collected from the target population, and enabled to provide clear explanations for the reasons behind key decisions during the intervention development process. Trial registration NCT01881152. Retrospectively registered June 7 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12873-017-0130-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Peter Schulz
- Institute of Communication and Health, Università della Svizzera italiana, Via Buffi 6, CH 6900, Lugano, Switzerland
| | - Barbara Marcomini
- Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Elisa Iezzi
- Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Silvia Riva
- Department of Oncology and Hematology, University of Milan, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Umberto Scoditti
- Stroke Care Program, Neurology Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Andrea Zini
- Stroke Unit, Nuovo Ospedale Civile S Agostino Estense, Via Pietro Giardini 1355, 41126, Baggiovara, Modena, Italy
| | - Giovanni Malferrari
- Department of Neuromotor Physiol, Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Umberto I 50, 42123, Reggio Emilia, Italy
| | - Maria Luisa Zedde
- Department of Neuromotor Physiol, Stroke Unit, Neurology Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Umberto I 50, 42123, Reggio Emilia, Italy
| | - Donata Guidetti
- Department of Neurology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29100, Piacenza, Italy
| | - Enrico Montanari
- Neurology Unit, Vaio Fidenza Hospital, Via Don Tincati 5, 43036, Fidenza, Parma, Italy
| | - Mario Baratti
- Division of Neurology, B Ramazzini Hospital, Via Guido Molinari 2, 41012, Carpi, Modena, Italy
| | - Licia Denti
- Clinical Geriatrics Unit, University Hospital of Parma, Via Gramsci 14, 43126, Parma, Italy
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Baatiema L, de-Graft Aikins A, Sav A, Mnatzaganian G, Chan CKY, Somerset S. Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals. BMJ Open 2017; 7:e015385. [PMID: 28450468 PMCID: PMC5719663 DOI: 10.1136/bmjopen-2016-015385] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals' views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. DESIGN A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. SETTING A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. PARTICIPANTS A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. RESULTS Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. CONCLUSION Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.
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Affiliation(s)
- Leonard Baatiema
- Regional Institute for Population Studies, University of Ghana, Accra, Legon, Ghana
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Legon, Ghana
| | - Adem Sav
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Melbourne, Australia
| | - Carina K Y Chan
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Shawn Somerset
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
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Hurst K, Lee R, Sideso E, Giles M, Handa A. Delays in the presentation to stroke services of patients with transient ischaemic attack and minor stroke. Br J Surg 2016; 103:1462-6. [PMID: 27529453 DOI: 10.1002/bjs.10199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/20/2016] [Accepted: 03/10/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The UK National Institute for Health and Care Excellence (NICE) guidelines state that carotid endarterectomy should be scheduled within 2 weeks of symptoms. The recent National Stroke Strategy has reduced the time interval to 48 h. This study aimed to review the possible delays. METHODS This study analysed patients with confirmed transient ischaemic attack (TIA) or minor stroke, referred to a single tertiary centre clinic and followed up 1 month after the event. A questionnaire was used to collect data on the rapid-access clinic pathway, and details of previous medication and treatment. RESULTS Some 150 patients presented with a confirmed TIA or minor stroke during a 5-month interval (June to October 2014). Fifty-one (34·0 per cent) had a history of TIA or stroke and 35 (23·3 per cent) had undergone an 'index' event in the 5 days before presentation. Forty-five patients (30·0 per cent) experienced a reduction or loss of vision. Of this group, 32 had a deficit in vision only, none of whom attributed these symptoms to a cerebrovascular event. Overall 92 (61·3 per cent) of the 150 patients had a delay in presentation to medical services. Forty-seven (31·3 per cent) had residual symptoms at the clinic appointment. Eighty-eight patients (58·7 per cent) did not think they were having a stroke and 54 (36·0 per cent) were unaware of the National Stroke Strategy (FAST campaign - Face, Arm, Speech, Time). CONCLUSION Two-thirds of patients were not aware they were having a stroke, one-third were unaware of the FAST campaign and nearly one-third presented with eye symptoms. Inclusion of eye symptoms and reaffirmation of the need to react might avoid unnecessary delays in the presentation of patients with TIA and minor stroke.
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Affiliation(s)
- K Hurst
- Nuffield Departments of Surgical Sciences, John Radcliffe Hospital, Oxford, UK
| | - R Lee
- Nuffield Departments of Surgical Sciences, John Radcliffe Hospital, Oxford, UK
| | - E Sideso
- Nuffield Departments of Surgical Sciences, John Radcliffe Hospital, Oxford, UK
| | - M Giles
- Departments of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - A Handa
- Nuffield Departments of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.
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Rothwell PM, Algra A, Chen Z, Diener HC, Norrving B, Mehta Z. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet 2016; 388:365-375. [PMID: 27209146 PMCID: PMC5321490 DOI: 10.1016/s0140-6736(16)30468-8] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Aspirin is recommended for secondary prevention after transient ischaemic attack (TIA) or ischaemic stroke on the basis of trials showing a 13% reduction in long-term risk of recurrent stroke. However, the risk of major stroke is very high for only the first few days after TIA and minor ischaemic stroke, and observational studies show substantially greater benefits of early medical treatment in the acute phase than do longer-term trials. We hypothesised that the short-term benefits of early aspirin have been underestimated. METHODS Pooling the individual patient data from all randomised trials of aspirin versus control in secondary prevention after TIA or ischaemic stroke, we studied the effects of aspirin on the risk and severity of recurrent stroke, stratified by the following time periods: less than 6 weeks, 6-12 weeks, and more than 12 weeks after randomisation. We compared the severity of early recurrent strokes between treatment groups with shift analysis of modified Rankin Scale (mRS) score. To understand possible mechanisms of action, we also studied the time course of the interaction between effects of aspirin and dipyridamole in secondary prevention of stroke. In a further analysis we pooled data from trials of aspirin versus control in which patients were randomised less than 48 h after major acute stroke, stratified by severity of baseline neurological deficit, to establish the very early time course of the effect of aspirin on risk of recurrent ischaemic stroke and how this differs by severity at baseline. FINDINGS We pooled data for 15,778 participants from 12 trials of aspirin versus control in secondary prevention. Aspirin reduced the 6 week risk of recurrent ischaemic stroke by about 60% (84 of 8452 participants in the aspirin group had an ischaemic stroke vs 175 of 7326; hazard ratio [HR] 0·42, 95% CI 0·32-0·55, p<0·0001) and disabling or fatal ischaemic stroke by about 70% (36 of 8452 vs 110 of 7326; 0·29, 0·20-0·42, p<0·0001), with greatest benefit noted in patients presenting with TIA or minor stroke (at 0-2 weeks, two of 6691 participants in the aspirin group with TIA or minor stroke had a disabling or fatal ischaemic stroke vs 23 of 5726 in the control group, HR 0·07, 95% CI 0·02-0·31, p=0·0004; at 0-6 weeks, 14 vs 60 participants, 0·19, 0·11-0·34, p<0·0001). The effect of aspirin on early recurrent ischaemic stroke was due partly to a substantial reduction in severity (mRS shift analysis odds ratio [OR] 0·42, 0·26-0·70, p=0·0007). These effects were independent of dose, patient characteristics, or aetiology of TIA or stroke. Some further reduction in risk of ischaemic stroke accrued for aspirin only versus control from 6-12 weeks, but there was no benefit after 12 weeks (stroke risk OR 0·97, 0·84-1·12, p=0·67; severity mRS shift OR 1·00, 0·77-1·29, p=0·97). By contrast, dipyridamole plus aspirin versus aspirin alone had no effect on risk or severity of recurrent ischaemic stroke within 12 weeks (OR 0·90, 95% CI 0·65-1·25, p=0·53; mRS shift OR 0·90, 0·37-1·72, p=0·99), but dipyridamole did reduce risk thereafter (0·76, 0·63-0·92, p=0·005), particularly of disabling or fatal ischaemic stroke (0·64, 0·49-0·84, p=0·0010). We pooled data for 40,531 participants from three trials of aspirin versus control in major acute stroke. The reduction in risk of recurrent ischaemic stroke at 14 days was most evident in patients with less severe baseline deficits, and was substantial by the second day after starting treatment (2-3 day HR 0·37, 95% CI 0·25-0·57, p<0·0001). INTERPRETATION Our findings confirm that medical treatment substantially reduces the risk of early recurrent stroke after TIA and minor stroke and identify aspirin as the key intervention. The considerable early benefit from aspirin warrants public education about self-administration after possible TIA. The previously unrecognised effect of aspirin on severity of early recurrent stroke, the diminishing benefit with longer-term use, and the contrasting time course of effects of dipyridamole have implications for understanding mechanisms of action. FUNDING Wellcome Trust, the National Institute of Health Research (NIHR) Biomedical Research Centre, Oxford.
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Affiliation(s)
- Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Ale Algra
- Department of Neurology, Rudolph Magnus Institute for Neuroscience, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Zhengming Chen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Sweden
| | - Ziyah Mehta
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Why Patients Delay Their First Contact with Health Services After Stroke? A Qualitative Focus Group-Based Study. PLoS One 2016; 11:e0156933. [PMID: 27275948 PMCID: PMC4898830 DOI: 10.1371/journal.pone.0156933] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/20/2016] [Indexed: 11/29/2022] Open
Abstract
Background Despite national and local French information campaigns, when acute stroke occurs, waiting times before calling mobile emergency medical services (EMS) to receive appropriate treatment (i.e. thrombolysis) and decrease the risk of physical disability, remain long. We aimed to identify the representations of stroke in the general population and to determine barriers to and facilitators for rapidly contacting EMS. Method We conducted a qualitative study among the general population with 10 focus groups, 5 comprising employed people (N = 29) and 5 comprising retirees (N = 32). The themes discussed were general knowledge about stroke and its risk factors, symptoms, appropriate management and the awareness that stroke is an emergency issue. Results In addition to a lack of knowledge about stroke, other barriers to rapidly contacting the EMS were difficulties in recognizing symptoms and understanding that these symptoms constitute an emergency. Furthermore, when faced with stroke, a feeling of inevitability and fatalism about the consequences of a stroke was highlighted. Participants were unaware of the existence of an effective treatment and they mistrusted medical competences. Finally, we found a strong presence and participant appreciation of common knowledge, resulting in the sharing of experiences of stroke. This could partly compensate for the lack of specific knowledge about symptom recognition and appropriate action. Conclusion Information campaigns should not only inform the public about stroke symptoms in order to ensure people act appropriately, but should also focus on increasing public awareness about the fact that an effective treatment exists.
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Advani R, Naess H, Kurz M. Mass Media Intervention in Western Norway Aimed at Improving Public Recognition of Stroke, Emergency Response, and Acute Treatment. J Stroke Cerebrovasc Dis 2016; 25:1467-72. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/01/2016] [Accepted: 02/19/2016] [Indexed: 11/29/2022] Open
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