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Wennman I, Carlström E, Fridlund B, Wijk H. Actions taken affecting lead time in the care pathway for low-priority patients with a suspected stroke: A critical incident study. Int Emerg Nurs 2021; 60:101105. [PMID: 34864324 DOI: 10.1016/j.ienj.2021.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/23/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The time delay from alerted ambulance to arrival at the stroke unit is crucial for patients suffering a suspected stroke. This is a recognized problem why additional explorative knowledge regarding actions taken are needed. AIM To explore actions taken by nurses that affect lead times in the care pathway from the alerted ambulance to the stroke unit, for low-priority patients suffering a suspected stroke. METHOD The design of the study was explorative and descriptive and used a qualitative approach based on Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care pathway at an university hospital in western Sweden were interviewed about their actions that affected the lead time. RESULTS Actions undertaken affected lead time in the stroke care pathway for low-priority patients related to "promoting the care chain process" and "taking control of the situation". CONCLUSIONS The staff within all parts of the care pathway affected the lead time, individually as well as via interaction between departments. This calls for the need of further collaboration and consensus concerning how to facilitate a smooth care pathway.
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Affiliation(s)
- Ingela Wennman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Quality Strategies, Sahlgrenska University Hospital, Gothenburg, Sweden; Gothenburg Emergency Medicine Research Group, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Quality Strategies, Sahlgrenska University Hospital, Gothenburg, Sweden; Gothenburg Emergency Medicine Research Group, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Business, History, and Social Sciences, School of Business, University of South-Eastern Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Centre for Inter-Professional Collaboration within Emergency Care, Linnaeus University, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Quality Strategies, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
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Cioni G, Canini J. The side effects of the COVID-19 pandemic on key public health elements - How the global emergency has changed the acute management of myocardial infarction and stroke, the network of cancer care, and assistance to frail individuals. ITALIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4081/itjm.2021.1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a primary health problem globally. In particular, it has caused troubles even to the advanced health systems of Western countrieswho attempted to limit the spread of the infection and manage patients with severe respiratory distress. However, this sudden contingency has had a much higher cost if we also consider the cost of suspending ordinary clinical care or delays in the emergency pathways of non-COVID-19 patients. Furthermore, the policies applied to contain the contagion have exacerbated the socio-economic disparities of the population and isolated fragile patients, making them subject to clinical relapses or aggravation of chronic diseases. For this reason, the various specialist centers have equipped themselves to guarantee an effective therapeutic path. In this brief review, we have outlined some consequent repercussions on the management of acute and chronic cardiovascular and neurovascular diseases and on oncological treatment. In particular, we have described the effects of the current health reorganization on some acute and time-dependent diseases, such as stroke and acute coronary syndromes, in which therapeutic delay is potentially disabling or fatal. Furthermore, we have focused on cancer treatments, whose essential cornerstones are early screening and follow-up. Finally, the suffering of the local health network has led to a lack of continuity of care in fragile patients, such as psychiatric, marginalized, or multiple comorbid patients.
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Wennman I, Carlström E, Fridlund B, Wijk H. Experienced critical incidents affecting lead-times in the stroke care chain for low-priority patients - A qualitative study with critical incident technique. Int Emerg Nurs 2021; 58:101040. [PMID: 34329825 DOI: 10.1016/j.ienj.2021.101040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 04/30/2021] [Accepted: 06/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The time elapsing from the alarm being raised to arrival at the stroke unit is crucial for patients suffering a conceivable stroke. More knowledge is needed about critical incidents-both favourable and unfavourable-affecting the lead time in the care chain. AIM To explore favourable and unfavourable critical incidents (CIs), affecting lead times in the care chain from the alerted ambulance to the stroke unit, as experienced by nurses, for low-priority patients suffering a conceivable acute stroke. METHOD The study had an explorative descriptive design using a qualitative approach of Flanagan's Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care chain at a hospital in western Sweden were interviewed about their experiences regarding CIs influencing the lead time for low-priority patients. RESULTS There were 363 CIs identified related to human interactions and organizational structures. The types of CIs varied depending on where in the care chain they were experienced. Both favourable and unfavourable factors had an impact on the length of the lead time from alerted ambulance to stroke unit for lowpriority patients. Furthermore, CIs occurring both early and later in the care chain affected the whole process. CONCLUSIONS There is a need for greater understanding within each interrelated department in the care chain about how CIs at one part of the care chain have an impact on another.
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Affiliation(s)
- Ingela Wennman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden; Gothenburg Emergency Medicine Research Group, Sahlgrenska University Hospital, Sweden.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden; Gothenburg Emergency Medicine Research Group, Sahlgrenska University Hospital, Sweden; Department of Business, History, and Social Sciences, School of Business, University of South-Eastern Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Centre for Inter-Professional Collaboration within Emergency Care, Linnaeus University, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden; Chalmers University of Technology, Gothenburg, Sweden
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Gu S, Dai Z, Shen H, Bai Y, Zhang X, Liu X, Xu G. Delayed Stroke Treatment during COVID-19 Pandemic in China. Cerebrovasc Dis 2021; 50:715-721. [PMID: 34247153 PMCID: PMC8339026 DOI: 10.1159/000517075] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Social distance, quarantine, pathogen testing, and other preventive strategies implemented during CO-VID-19 pandemic may negatively influence the management of acute ischemic stroke (AIS). OBJECTIVE The current study aimed to evaluate the impacts of COVID-19 pandemic on treatment delay of AIS in China. METHODS This study included patients with AIS admitted in 2 hospitals in Jiangsu, China. Patients admitted before and after the COVID-19 pandemic outbreak (January 31, 2020, as officially announced by the Chinese government) were screened to collect sociodemographic data, medical history information, and symptom onset status from clinical medical records and compared for pre- (measured as onset-to-door time [ODT]) and posthospital delay (measured as door-to-needle time [DNT]). The influencing factors for delayed treatment (indicated as onset-to-needle time >4.5 h) were analyzed with multivariate logistic regression analysis. RESULTS A total of 252 patients were included, of which 153 (60.7%) were enrolled before and 99 (39.3%) after the COVID-19 pandemic. ODT increased from 202 min (interquartile range [IQR] 65-492) before to 317 min (IQR 75-790) after the COVID-19 pandemic (p = 0.001). DNT increased from 50 min (IQR 40-75) before to 65 min (IQR 48-84) after the COVID-19 pandemic (p = 0.048). The proportion of patients with intravenous thrombolysis in those with AIS was decreased significantly after the pandemic (15.4% vs. 20.1%; p = 0.030). Multivariate logistic regression analysis indicated that patients after COVID-19 pandemic, lower educational level, rural residency, mild symptoms, small artery occlusion, and transported by other means than ambulance were associated with delayed treatment. CONCLUSIONS COVID-19 pandemic has remarkable impacts on the management of AIS. Both pre- and posthospital delays were prolonged significantly, and proportion of patients arrived within the 4.5-h time window for intravenous thrombolysis treatment was decreased. Given that anti-COVID-19 measures are becoming medical routines, efforts are warranted to shorten the delay so that the outcomes of stroke could be improved.
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Affiliation(s)
- Shiyuan Gu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Affiliated Yixing Hospital of Jiangsu University, Yixing, China
| | - Zhengze Dai
- Department of Neurology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing Pukou Hospital, Nanjing, China
| | - Huachao Shen
- Department of Neurology, BenQ Medical Center, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Yongjie Bai
- Department of Neurology, First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gelin Xu
- Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, China
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Schott AM, Termoz A, Viprey M, Tazarourte K, Vecchia CD, Bravant E, Perreton N, Nighoghossian N, Cakmak S, Meyran S, Ducreux B, Pidoux C, Bony T, Douplat M, Potinet V, Sigal A, Xue Y, Derex L, Haesebaert J. Short and long-term impact of four sets of actions on acute ischemic stroke management in Rhône County, a population based before-and-after prospective study. BMC Health Serv Res 2021; 21:12. [PMID: 33397363 PMCID: PMC7783982 DOI: 10.1186/s12913-020-05982-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Optimizing access to recanalization therapies in acute ischemic stroke patients is crucial. Our aim was to measure the short and long term effectiveness, at the acute phase and 1 year after stroke, of four sets of actions implemented in the Rhône County. METHODS The four multilevel actions were 1) increase in stroke units bed capacity and development of endovascular therapy; 2) improvement in knowledge and skills of healthcare providers involved in acute stroke management using a bottom-up approach; 3) development and implementation of new organizations (transportation routes, pre-notification, coordination by the emergency call center physician dispatcher); and 4) launch of regional public awareness campaigns in addition to national campaigns. A before-and-after study was conducted with two identical population-based cohort studies in 2006-7 and 2015-16 in all adult ischemic stroke patients admitted to any emergency department or stroke unit of the Rhône County. The primary outcome criterion was in-hospital management times, and the main secondary outcome criteria were access to reperfusion therapy (either intravenous thrombolysis or endovascular treatment) and pre-hospital management times in the short term, and 12-month prognosis measured by the modified Rankin Scale (mRS) in the long term. RESULTS Between 2015-16 and 2006-7 periods ischemic stroke patients increased from 696 to 717, access to reperfusion therapy increased from 9 to 23% (p < 0.0001), calls to emergency call-center from 40 to 68% (p < 0.0001), first admission in stroke unit from 8 to 30% (p < 0.0001), and MRI within 24 h from 18 to 42% (p < 0.0001). Onset-to-reperfusion time significantly decreased from 3h16mn [2 h54-4 h05] to 2h35mn [2 h05-3 h19] (p < 0.0001), mainly related to a decrease in delay from admission to imaging. A significant decrease of disability was observed, as patients with mild disability (mRS [0-2]) at 12 months increased from 48 to 61% (p < 0.0001). Pre-hospital times, however, did not change significantly. CONCLUSIONS We observed significant improvement in access to reperfusion therapy, mainly through a strong decrease of in-hospital management times, and in 12-month disability after the implementation of four sets of actions between 2006 and 2016 in the Rhône County. Reducing pre-hospital times remains a challenge.
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Affiliation(s)
- A M Schott
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France.
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France.
| | - A Termoz
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - M Viprey
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - K Tazarourte
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
- Emergency Department - HEH, Hospices Civils de Lyon, Lyon, France
| | - C Della Vecchia
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
| | - E Bravant
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - N Perreton
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - N Nighoghossian
- Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - S Cakmak
- Hôpital Nord Ouest, Primary Stroke Center, Villefranche-sur-Saône, France
| | - S Meyran
- Emergency Department, Hôpital St Joseph St Luc, Lyon, France
| | - B Ducreux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - C Pidoux
- Emergency Department, Hôpital Nord Ouest, Villefranche-sur-Saône, France
| | - T Bony
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - M Douplat
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - V Potinet
- Emergency Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Bénite, France
| | - A Sigal
- Emergency Department, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - Y Xue
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - L Derex
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
- Hospices Civils de Lyon, Comprehensive Stroke Center, Hôpital Pierre Wertheimer, Bron, France
| | - J Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, 8 Avenue Rockefeller, 69008, Lyon, France
- Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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Kristoffersen ES, Jahr SH, Thommessen B, Rønning OM. Effect of COVID-19 pandemic on stroke admission rates in a Norwegian population. Acta Neurol Scand 2020; 142:632-636. [PMID: 32620027 PMCID: PMC7361547 DOI: 10.1111/ane.13307] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 11/25/2022]
Abstract
Objectives There are concerns that public anxiety around COVID‐19 discourages patients from seeking medical help. The aim of this study was to see how lockdown due to the pandemic affected the number of admissions of acute stroke. Methods All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke were identified by hospital chart review. January 3 to March 12 was defined as before, and March 13 to April 30 as during lockdown. Results There were 21.8 admissions/week before and 15.0 admissions/week during the lockdown (P < .01). Patients had on average higher NIHSS during the lockdown than before (5.9 vs. 4.2, P = .041). In the multivariable logistic regression model for ischemic stroke (adjusted for sex, age, living alone and NIHSS ≤ 5), there was an increased OR of 2.05 (95% CI 1.10‐3.83, P = .024) for not reaching hospital within 4.5 hours during the lockdown as compared to the period before the lockdown. Conclusion There was a significant reduction in number of admissions for stroke and TIAs during the lockdown due to the COVID‐19 pandemic in Norway.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of Neurology Akershus University Hospital Lørenskog Norway
- Department of General Practice University of Oslo Oslo Norway
| | - Silje Holt Jahr
- Department of Neurology Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Bente Thommessen
- Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Ole Morten Rønning
- Department of Neurology Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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Haesebaert J, Laude C, Termoz A, Bravant E, Perreton N, Bony T, Trehard H, Porthault S, Derex L, Nighoghossian N, Schott AM. Impact of a theory-informed and user-centered stroke information campaign on the public's behaviors, attitudes, and knowledge when facing acute stroke: a controlled before-and-after study. BMC Public Health 2020; 20:1712. [PMID: 33198689 PMCID: PMC7667807 DOI: 10.1186/s12889-020-09795-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background Public awareness of stroke symptoms is a key factor to ensure access to reperfusion strategies in due time. We designed and launched a regional theory-informed and user-centered information campaign and assessed its impact on emergency medical services (EMS) calls for stroke suspicion, time-to-call, and public attitudes and awareness concerning stroke. Methods A controlled before-and-after study was conducted during 3 sequential time-periods in 2 separate counties. Key messages of the campaign were underpinned by stroke representations and the theory of planned behavior, and focused on recognition of stroke warning signs and the need to call EMS urgently. The campaign included posters, leaflets, adverts and films displayed in bus and subway stations, internet, social networks, and local radio. Outcome measures on behavior, attitudes, and knowledge were assessed before the launch of the campaign, at 3 months, and 12 months. Results The number of EMS calls for stroke suspicion increased by 21% at 12 months in the intervention county and this change was significantly different to that observed in the control county (p = 0.02). No significant changes were observed regarding self-reported attitudes in case of stroke. An 8% significant increase in recognizing at least 2 stroke warning signs was observed in the intervention county (p = 0.04) at 3 months, while it did not change significantly in the control county (p = 0.6). However, there was no significant difference in warning sign recognition between both counties (p = 0.16). Conclusion The campaign significantly improved public’s behavior of calling EMS, although stroke knowledge was not improved as much as expected. Repeating these campaigns over time might further help improve timeliness and access to reperfusion strategies. Trial registration Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02846363. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09795-y.
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Affiliation(s)
- Julie Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France. .,Hospices Civils de Lyon, Pôle Santé Publique, F-69003, Lyon, France.
| | - Caroline Laude
- Hospices Civils de Lyon, Hôpital Edouard Herriot, PAM Urgences Réanimation Médicales, Lyon, France
| | - Anne Termoz
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle Santé Publique, F-69003, Lyon, France
| | - Estelle Bravant
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle Santé Publique, F-69003, Lyon, France
| | | | - Thomas Bony
- Hospices Civils de Lyon, Hôpital Edouard Herriot, PAM Urgences Réanimation Médicales, Lyon, France
| | - Hélène Trehard
- Hospices Civils de Lyon, Pôle Santé Publique, F-69003, Lyon, France
| | - Sylvie Porthault
- Hospices Civils de Lyon, Hôpital Edouard Herriot, PAM Urgences Réanimation Médicales, Lyon, France
| | - Laurent Derex
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Stroke Center, Lyon, France
| | | | - Anne-Marie Schott
- Université de Lyon, Université Claude Bernard Lyon 1 - HESPER EA 7425, Lyon, France.,Hospices Civils de Lyon, Pôle Santé Publique, F-69003, Lyon, France
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Hansson P, Andersson Hagiwara M, Herlitz J, Brink P, Wireklint Sundström B. Prehospital assessment of suspected stroke and TIA: An observational study. Acta Neurol Scand 2019; 140:93-99. [PMID: 31009075 DOI: 10.1111/ane.13107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/06/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Symptoms related to stroke diverge and may mimic many other conditions. AIMS To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA). METHODS An observational multicenter study includes nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the emergency medical service clinician before hospital admission during a four-month period were included. RESULTS Of 1081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, P = 0.007, a history of myocardial infarction (OR: 1.77, P = 0.01), facial droop (OR: 2.81, P < 0.0001), arm weakness (OR: 2.61, P < 0.0001), speech disturbance (OR: 1.92, P < 0.0001), and high systolic blood pressure (OR: 1.50, P = 0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, P = 0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up. CONCLUSIONS Seven factors including the three symptoms included in the Face Arm Speech Test were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke.
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Affiliation(s)
- Per‐Olof Hansson
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Peter Brink
- Intensive Care Unit NU‐Hospital Trollhättan Sweden
| | - Birgitta Wireklint Sundström
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
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Debussche X, Balcou-Debussche M. [Health literacy profiles in type 2 diabetes: The ERMIES-Ethnosocio study]. SANTE PUBLIQUE 2019; 30:145-156. [PMID: 30547481 DOI: 10.3917/spub.184.0145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Health literacy refers to the competences and resources required by individuals to meet the complex demands of health in modern society. This paper describes and analyses the health literacy profiles of type 2 diabetic patients included in a 2-year long self-management education programme. METHODS Nested in the ERMIES randomized controlled trial conducted in Reunion island, the ERMIES Ethnosocio study explored health literacy by means of two complementary approaches: description of health literacy profiles via the French version of the multidimensional "Health Literacy Questionnaire", and a socio-anthropological perspective based on 40 semi-structured interviews carried out in 2012 and then in 2015. RESULTS The results highlight the existence of 8 constitutive variables in the management of type 2 diabetes in an ordinary context: diet, physical activity, treatment and monitoring of disease (disease management), access to knowledge and skills (health knowledge), relationships with health professionals and social support (expertise, support and social network). They also emphasize the differentiated relationships of individuals to each of these variables, ranging from functional to interactive or critical "levels". DISCUSSION Considering the development of health literacy with patients and health professionals, and by questioning educational and therapeutic interventions as differentiating processes, this research opens up new perspectives for the approach to social inequalities in health. The combination of social sciences, medical sciences and public health is proving fruitful and potentially operative, provided that the definitions, methods, and strengths and limitations of selected prospects are clearly defined.
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Debussche X, Lenclume V, Balcou-Debussche M, Alakian D, Sokolowsky C, Ballet D, Elsworth GR, Osborne RH, Huiart L. Characterisation of health literacy strengths and weaknesses among people at metabolic and cardiovascular risk: Validity testing of the Health Literacy Questionnaire. SAGE Open Med 2018; 6:2050312118801250. [PMID: 30319778 PMCID: PMC6154264 DOI: 10.1177/2050312118801250] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/26/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives: Health literacy refers to the ability of individuals to gain access to, use,
and understand health information and services in order to maintain a good
health. The assessment of health literacy profiles in a population is
potentially crucial to respond to health needs. The Health Literacy
Questionnaire explores nine dimensions of health literacy and has been shown
to display robust psychometric properties. The aim was to test the validity
of the multidimensional Health Literacy Questionnaire and to describe the
health literacy profiles in a French population at risk of cardiovascular
disease. Methods: Data were collected using self-administered questionnaires from 175
participants attending health education and support programmes in local
associations of patients in Paris. Analysis included scale reliability,
confirmatory factor analysis, and health literacy profiles via descriptive
statistics. Results: In confirmatory factor analysis, the nine-factor structure was close to the
original Health Literacy Questionnaire. A nine-factor confirmatory factor
analysis model was fitted to the 44 items with no cross-loadings or
correlated residuals allowed. Given the restricted nature of the model, the
fit was satisfactory: χ2WLSMV(866 df) = 1383.81,
p = 0.0000, comparative fit index = 0.925, Tucker–Lewis index = 0.918, root
mean square error of approximation = 0.058, weighted root mean square
residual = 1.175. Composite reliability ranged from 0.77 to 0.91. Among the
9 scales of the Health Literacy Questionnaire, the highest scores were found
for scale 1 ‘Feeling understood and supported by healthcare professionals’
and scale 9 ‘Understand health information enough to know what to do’ and
the lowest for scale 2 ‘Having sufficient information to manage my health’
and scale 7 ‘Navigating the healthcare system’. Conclusion: The French version of the Health Literacy Questionnaire was shown to be
psychometrically robust with good reliability. In the context of France, the
9 scales of Health Literacy Questionnaire allow a thorough assessment of
health literacy strengths and weaknesses to respond to health literacy needs
and improve the accessibility of health information and services.
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Affiliation(s)
- Xavier Debussche
- Service d’Endocrinologie Diabétologie
Nutrition, CHU Felix Guyon, Saint-Denis, Réunion, France
- Centre d’Investigations Cliniques 1410
INSERM, Reunion University Hospital, Saint-Pierre, Réunion, France
- Xavier Debussche, Service d’Endocrinologie
Diabétologie Nutrition, CHU Felix Guyon, Allée des topazes CS11021, 97400
Saint-Denis, La Réunion, France.
| | - Victorine Lenclume
- Centre d’Investigations Cliniques 1410
INSERM, Reunion University Hospital, Saint-Pierre, Réunion, France
| | - Maryvette Balcou-Debussche
- EA7389 Institut Coopératif Austral pour
la Recherche en Education, University of Reunion, Saint-Denis, France
| | - Danielle Alakian
- Maison du Diabète Obésité risque
Cardiovasculaire (M’DOC), Paris, France
| | - Claude Sokolowsky
- Maison du Diabète Obésité risque
Cardiovasculaire (M’DOC), Paris, France
| | - Delphine Ballet
- EA7389 Institut Coopératif Austral pour
la Recherche en Education, University of Reunion, Saint-Denis, France
| | - Gerald R Elsworth
- Health Systems Improvement Unit, Centre
for Population Health Research, School of Health and Social Development, Deakin
University, Geelong, VIC, Australia
| | - Richard H Osborne
- Health Systems Improvement Unit, Centre
for Population Health Research, School of Health and Social Development, Deakin
University, Geelong, VIC, Australia
- Department of Public Health, University
of Copenhagen, Copenhagen, Denmark
| | - Laetitia Huiart
- Centre d’Investigations Cliniques 1410
INSERM, Reunion University Hospital, Saint-Pierre, Réunion, France
- Sciences Économiques et Sociales de la
Santé et Traitement de l’Information Médicale, Unité Mixte de Recherche 912
INSERM-IRD, Marseille, France
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11
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Hansson PO, Andersson Hagiwara M, Brink P, Herlitz J, Wireklint Sundström B. Prehospital identification of factors associated with death during one-year follow-up after acute stroke. Brain Behav 2018; 8:e00987. [PMID: 29770601 PMCID: PMC5991565 DOI: 10.1002/brb3.987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/11/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In acute stroke, the risk of death and neurological sequelae are obvious threats. The aim of the study was to evaluate the association between various clinical factors identified by the emergency medical service (EMS) system before arriving at hospital and the risk of death during the subsequent year among patients with a confirmed stroke. MATERIAL AND METHODS All patients with a diagnosis of stroke as the primary diagnosis admitted to a hospital in western Sweden (1.6 million inhabitants) during a four-month period were included. There were no exclusion criteria. RESULTS In all, 1,028 patients with a confirmed diagnosis of stroke who used the EMS were included in the analyses. Among these patients, 360 (35%) died during the following year. Factors that were independently associated with an increased risk of death were as follows: (1) high age, per year OR 1.07; 95% CI 1.05-1.09; (2) a history of heart failure, OR 2.08; 95% CI 1.26-3.42; (3) an oxygen saturation of <90%, OR 8.05; 95% CI 3.33-22.64; and (4) a decreased level of consciousness, OR 2.19; 95% CI 1.61-3.03. CONCLUSIONS Among patients with a stroke, four factors identified before arrival at hospital were associated with a risk of death during the following year. They were reflected in the patients' age, previous clinical history, respiratory function, and the function of the central nervous system.
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Affiliation(s)
- Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life and Social Welfare, Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Peter Brink
- Department of Health Sciences, Section for nursing - undergraduate level, University West, Trollhättan, Sweden
| | - Johan Herlitz
- Faculty of Caring Science, Work Life and Social Welfare, Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Birgitta Wireklint Sundström
- Faculty of Caring Science, Work Life and Social Welfare, Centre for Prehospital Research, University of Borås, Borås, Sweden
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