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Deitelzweig S, Terasawa E, Atreja N, Kang A, Hines DM, Dhamane AD, Hagan M, Noman A, Luo X. Payer formulary tier increases of apixaban: how patients respond and potential implications. Curr Med Res Opin 2023; 39:1093-1101. [PMID: 37519272 DOI: 10.1080/03007995.2023.2232636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To assess potential impacts of formulary tier increases of apixaban-an efficacious oral anticoagulant (OAC) for preventing stroke in patients with atrial fibrillation (AF)-on patients' prescription drug plan (PDP) switching and OAC treatment patterns. METHODS Nationwide claims data for Medicare beneficiaries with Parts A, B, and D (100% sample) were used to assess apixaban-treated AF patients who faced a formulary tier increase for apixaban in 2017 by their Part D PDP. Patients' out-of-pocket (OOP) costs for apixaban were described, along with PDP switching and OAC treatment patterns. RESULTS Among 1845 included patients, 97.7% had apixaban on tier 3 of their plan's formulary in 2016 and faced its increase to tier 4 for 2017. Approximately 4% (N = 81) of patients pre-emptively switched to a different PDP for 2017 with almost all switching to plans with apixaban on a lower formulary tier and 85.2% continuing apixaban treatment. Among the 96% (N = 1764) of patients who remained on the same PDP for 2017, over half (57.5%) continued apixaban treatment, despite increased OOP costs ($54 vs. $135 for a 30-day supply in 2016 vs. 2017). Only 12.4% of those who remained on the same plan for 2017 switched to another OAC, while as much as 30.1% discontinued OACs. These discontinuers exhibited higher comorbidity burdens than patients continuing on any OAC. CONCLUSION The majority of patients continued on apixaban despite higher OOP cost, suggesting patients' reluctance to change treatment for non-medical reasons; however, 30% of patients discontinued OAC treatment after higher apixaban tier placement.
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Affiliation(s)
- Steven Deitelzweig
- Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | | | - Nipun Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
| | - Amiee Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
| | | | | | - Melissa Hagan
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
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2
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Yang CC, Bamodu OA, Chan L, Chen JH, Hong CT, Huang YT, Chung CC. Risk factor identification and prediction models for prolonged length of stay in hospital after acute ischemic stroke using artificial neural networks. Front Neurol 2023; 14:1085178. [PMID: 36846116 PMCID: PMC9947790 DOI: 10.3389/fneur.2023.1085178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Background Accurate estimation of prolonged length of hospital stay after acute ischemic stroke provides crucial information on medical expenditure and subsequent disposition. This study used artificial neural networks to identify risk factors and build prediction models for a prolonged length of stay based on parameters at the time of hospitalization. Methods We retrieved the medical records of patients who received acute ischemic stroke diagnoses and were treated at a stroke center between January 2016 and June 2020, and a retrospective analysis of these data was performed. Prolonged length of stay was defined as a hospital stay longer than the median number of days. We applied artificial neural networks to derive prediction models using parameters associated with the length of stay that was collected at admission, and a sensitivity analysis was performed to assess the effect of each predictor. We applied 5-fold cross-validation and used the validation set to evaluate the classification performance of the artificial neural network models. Results Overall, 2,240 patients were enrolled in this study. The median length of hospital stay was 9 days. A total of 1,101 patients (49.2%) had a prolonged hospital stay. A prolonged length of stay is associated with worse neurological outcomes at discharge. Univariate analysis identified 14 baseline parameters associated with prolonged length of stay, and with these parameters as input, the artificial neural network model achieved training and validation areas under the curve of 0.808 and 0.788, respectively. The mean accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of prediction models were 74.5, 74.9, 74.2, 75.2, and 73.9%, respectively. The key factors associated with prolonged length of stay were National Institutes of Health Stroke Scale scores at admission, atrial fibrillation, receiving thrombolytic therapy, history of hypertension, diabetes, and previous stroke. Conclusion The artificial neural network model achieved adequate discriminative power for predicting prolonged length of stay after acute ischemic stroke and identified crucial factors associated with a prolonged hospital stay. The proposed model can assist in clinically assessing the risk of prolonged hospitalization, informing decision-making, and developing individualized medical care plans for patients with acute ischemic stroke.
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Affiliation(s)
- Cheng-Chang Yang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Research Center for Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Oluwaseun Adebayo Bamodu
- Department of Medical Research and Education, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Hematology and Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jia-Hung Chen
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Ting Huang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Nursing, School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Chih Chung
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,*Correspondence: Chen-Chih Chung ✉
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Inui Y, Tanaka Y, Ogawa T, Hayashida K, Morioka S. Relationship between exercise motivation and social support in a support facility for persons with disabilities in Japan. Ann Med 2022; 54:820-829. [PMID: 35285358 PMCID: PMC8928799 DOI: 10.1080/07853890.2022.2049860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
PURPOSE Exercise motivation (EM) is related to individual capabilities and social support. However, in support facilities for people with disabilities, it is susceptible to a lack of social support. In this study, we classified EM into Autonomous Motivation (AM) and controlled motivation (CM) and then examined the influence of social support. METHOD Thirty-three residents from a support facility for people with disabilities in Japan participated in this study. We conducted a hierarchical multiple regression analysis in which age, gender and time since admission were entered in Step 1, mobility and self-efficacy as individual capabilities in Step 2, and family support, facility support and peer support as social support in Step 3. RESULT A significant increase in variance from Step 2 to Step 3 was found for both AM (ΔR2 = 0.504, ΔF = 12.18, p < .001) and CM (ΔR2 = 0.269, ΔF = 3.491, p = .031). The results also showed that AM was higher among those with high family and facility support, and CM was higher among those with low family and high peer support. CONCLUSIONS Social support was a more significant predictor of EM among participants than individual capabilities.KEY MESSAGESAmong residents of support facilities for people with disabilities, assessing not only individual capabilities but also social support status can lead to better understandings of exercise motivation (EM).To enhance facility residents' autonomous motivation (AM), it is necessary to intervene after evaluating family and facility support.When family support is not readily available among facility residents, efforts should be made to encourage residents to interact with each other to increase peer support.
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Affiliation(s)
- Yasuhiro Inui
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan.,Nara Prefecture General Support Center for Persons with Disabilities, Nara, Japan.,Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, Nara, Japan
| | - Yoichi Tanaka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan.,Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, Nara, Japan
| | - Tatsuya Ogawa
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan.,Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Kazuki Hayashida
- Department of Rehabilitation, Fujiikai Rehabilitation Hospital, Osaka, Japan.,Neuro rehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan.,Neuro rehabilitation Research Center, Kio University, Nara, Japan
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Stevens E, Clarke SG, Harrington J, Manthorpe J, Martin FC, Sackley C, McKevitt C, Marshall IJ, Wyatt D, Wolfe C. The provision of person-centred care for care home residents with stroke: An ethnographic study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5186-e5195. [PMID: 35869786 PMCID: PMC10084099 DOI: 10.1111/hsc.13936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/31/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Care home residents with stroke have higher levels of disability and poorer access to health services than those living in their own homes. We undertook observations and semi-structured interviews (n = 28 participants) with managers, staff, residents who had experienced a stroke and their relatives in four homes in London, England, in 2018/2019. Thematic analysis revealed that residents' needs regarding valued activity and stroke-specific care and rehabilitation were not always being met. This resulted from an interplay of factors: staff's lack of recognition of stroke and its effects; gaps in skills; time pressures; and the prioritisation of residents' safety. To improve residential care provision and residents' quality of life, care commissioners, regulators and providers may need to re-examine how care homes balance safety and limits on staff time against residents' valued activity, alongside improving access to specialist healthcare treatment and support.
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Affiliation(s)
- Eleanor Stevens
- School of Life Course & Population SciencesKing's College LondonLondonUK
| | - Stephanie G. Clarke
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustLondonUK
- University Hospitals BirminghamDepartment of PhysiotherapyBirminghamUK
| | - Jean Harrington
- School of Life Course & Population SciencesKing's College LondonLondonUK
| | - Jill Manthorpe
- National Institute for Health and Care Research (NIHR) Policy Research Unit in Health & Social Care Workforce, King's College LondonLondonUK
| | - Finbarr C. Martin
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Catherine Sackley
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Faculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK
| | - Christopher McKevitt
- School of Life Course & Population SciencesKing's College LondonLondonUK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South LondonLondonUK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC)Guy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | - Iain J. Marshall
- School of Life Course & Population SciencesKing's College LondonLondonUK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South LondonLondonUK
| | - David Wyatt
- School of Life Course & Population SciencesKing's College LondonLondonUK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC)Guy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK
| | - Charles Wolfe
- School of Life Course & Population SciencesKing's College LondonLondonUK
- Guy's and St Thomas' NHS Foundation TrustLondonUK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South LondonLondonUK
- National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC)Guy's and St Thomas' NHS Foundation Trust and King's College LondonLondonUK
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Zhou J, He B, He Y, Zhu H, Zhang M, Huang W, Wang Y. The effectiveness of psychoeducational interventions on family function among families after stroke: A meta-analysis. Int J Nurs Pract 2022; 28:e13081. [PMID: 35855498 DOI: 10.1111/ijn.13081] [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: 09/27/2020] [Revised: 11/18/2021] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
AIMS This meta-analysis aimed to synthesize the available evidence on the effectiveness of psychoeducational interventions on family function among families after stroke. BACKGROUND Family function may be improved by psychoeducational intervention, but findings about the effect of psychoeducation on family function among families after stroke have been mixed. METHODS This was a meta-analysis carried out by searching five international electronic databases, including Cochrane Library, PubMed, EMBASE, Web of Science and CINAHL, as well as four national electronic databases, including Chinese Biological Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP and Wanfang. Two groups of researchers screened the studies independently, assessed the quality of the studies and extracted data. Meta-analysis was performed by using the RevMan 5.3 software. RESULTS Five studies on psychoeducational interventions were included. Pooled analysis of these studies showed a small effect of the interventions on improving family function (WMD: -0.13, 95% CI: -0.24 to -0.01, P < 0.05). Subgroup analysis showed significant differences between the psychoeducation and control groups at 1 month postintervention (WMD: -0.12, 95% CI: -0.18 to -0.05, P < 0.05) and more than 6 months postintervention (WMD: -0.14, 95% CI: -0.24 to -0.04, P < 0.05). The psychoeducational interventions also had positive effect on improving the problem solving (WMD: -0.22, 95% CI: -0.14 to -0.03, P < 0.05) and communication (WMD: -0.23, 95% CI: -0.41 to -0.05, P < 0.05) functions of the family. There were significant differences in the group of dyad intervention (WMD: -0.14, 95% CI: -0.25 to -0.02, P < 0.05) and the group using face to face method (WMD: -0.58, 95% CI: -0.84 to -0.32, P < 0.05). CONCLUSIONS Synthesized results demonstrated the favourable effect of psychoeducational interventions on the improvement of the family function among families after stroke, especially in terms of family problem solving and family communication. Future psychoeducational intervention research design should consider the combination of multiple intervention methods and the applicable population of intervention.
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Affiliation(s)
- Jia Zhou
- Shihezi University School of Medicine, Xinjiang, China
| | - Bin He
- The People's Hospital of Shihezi City, Xinjiang, China
| | - Yaoyu He
- Liaoning He University, Liaoning, China
| | - Hongxu Zhu
- Shihezi University School of Medicine, Xinjiang, China
| | | | - Wei Huang
- The Shaanxi Provincial People's Hospital, Shaanxi, China
| | - Yuhuan Wang
- Shihezi University School of Medicine, Xinjiang, China
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Kjörk EK, Gustavsson M, El-Manzalawy N, Sunnerhagen KS. Stroke-related health problems and associated actions identified with the post-stroke checklist among nursing home residents. BMC Cardiovasc Disord 2022; 22:50. [PMID: 35164696 PMCID: PMC8842537 DOI: 10.1186/s12872-022-02466-3] [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: 02/11/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the needs of permanent nursing home residents after a stroke; comprehensive descriptions of needs are rare. The Post-Stroke Checklist facilitates the identification of health problems. The study aimed to use the Post-Stroke Checklist to identify the extent of health problems, and how they were addressed, in nursing home residents that experienced strokes in Sweden. We also investigated the feasibility of the Checklist in a nursing home context. Methods This is a cross-sectional explorative study. Twenty nursing homes in two regions of Sweden participated. We included residents that had experienced a stroke within approximately 3 years and the responsible staff members were approached. Questionnaires were completed during face-to-face meetings with staff members (n = 45) knowledgeable about the residents. Data collection included the Post-Stroke Checklist, Barthel Index, modified Rankin Scale, resident and staff characteristics, and a satisfaction-questionnaire completed by staff. Results At the included nursing homes 1061 residents, 22% (n = 239) had a history of stroke, and 6% (n = 65) had experienced strokes during the last 3.5 years. Forty-nine residents were included (41% men, median age, 86 years, range 59–97). Among the health problems identified with the Checklist, activities of daily living (82%) were most common, and spasticity (41%) and pain (29%) were least common. Residents had extensive care needs, with a median of six health problems per resident. The total number of health problems addressed by previous actions i.e., referrals, as suggested in the Checklist, was 124, when recalled by staff. The median Barthel index score was 35. Lack of follow-up after stroke (e.g., by using a checklist) was reported in 17/20 nursing homes. The staff were satisfied with the Post-Stroke Checklist. Conclusions We found that more than 1/5 of residents had experienced a stroke; thus, the Post-Stroke Checklist was a useful tool in nursing homes. Half of the residents had more than six health problems, identified with the Post-Stroke Checklist. Extensive needs, combined with a lack of follow-up, indicated a risk of insufficient care. These findings suggested that nursing home routines could be improved with the Post-Stroke Checklist. Trial registration The project is registered in Research web, project number: 256021.
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Affiliation(s)
- Emma K Kjörk
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy at University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.
| | - Martha Gustavsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy at University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden
| | - Nohad El-Manzalawy
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy at University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy at University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden
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Fisher RJ, Riley-Bennett F, Russell L, Lee C, Sturt R, Walker M, Sackley C. Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability. BMJ Open 2021; 11:e052593. [PMID: 34857570 PMCID: PMC8640659 DOI: 10.1136/bmjopen-2021-052593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
UNLABELLED In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge. OBJECTIVES To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus. SETTING Virtual nominal group technique (vNGT) across the UK. PARTICIPANTS Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience. METHODS Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique's five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements. RESULTS A combined total of 421 statements achieved positive consensus (>75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required. CONCLUSION The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.
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Affiliation(s)
| | | | - Lal Russell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Claire Lee
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Ruth Sturt
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Marion Walker
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Cath Sackley
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Predicting Independence 6 and 18 Months after Ischemic Stroke Considering Differences in 12 Countries: A Secondary Analysis of the IST-3 Trial. Stroke Res Treat 2021; 2021:5627868. [PMID: 34373778 PMCID: PMC8349276 DOI: 10.1155/2021/5627868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This study is aimed at identifying the best clinical model to predict poststroke independence at 6 and 18 months, considering sociodemographic and clinical characteristics, and then identifying differences between countries. Methods Data was retrieved from the International Stroke Trial 3 study. Nine clinical variables (age, gender, severity, rt-PA, living alone, atrial fibrillation, history of transient ischemic attack/stroke, and abilities to lift arms and walk) were measured immediately after the stroke and considered to predict independence at 6 and 18 months poststroke. Independence was measured using the Oxford Handicap Scale. The adequacy, predictive capacity, and discriminative capacity of the models were checked. Countries were added to the final models. Results At 6 months poststroke, 35.8% (n = 1088) of participants were independent, and at 18 months, this proportion decreased to 29.9% (n = 747). Both 6 and 18 months poststroke predictive models obtained fair discriminatory capacities. Gender, living alone, and rt-PA only reached predictive significance at 18 months. Poststroke patients from Poland and Sweden showed greater chances to achieve independence at 6 months compared to the UK. Poland also achieved greater chances at 18 months. Italy had worse chances than the UK at both follow-ups. Discussion. Six and eight variables predicted poststroke independence at 6 and 18 months, respectively. Some variables only reached significance at 18 months, suggesting a late influence in stroke patients' rehabilitation. Differences found between countries in achieving independence may be related to healthcare system organization or cultural characteristics, a hypothesis that must be addressed in future studies. These results can allow the development of tailored interventions to improve the outcomes.
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Harpaz D, Seet RCS, Marks RS, Tok AIY. B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor. BIOSENSORS 2020; 10:E107. [PMID: 32859068 PMCID: PMC7559708 DOI: 10.3390/bios10090107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 05/12/2023]
Abstract
Stroke is a widespread condition that causes 7 million deaths globally. Survivors suffer from a range of disabilities that affect their everyday life. It is a complex condition and there is a need to monitor the different signals that are associated with it. Stroke patients need to be rapidly diagnosed in the emergency department in order to allow the admission of the time-limited treatment of tissue plasminogen activator (tPA). Stroke diagnostics show the use of sophisticated technologies; however, they still contain limitations. The hidden information and technological advancements behind the utilization of biomarkers for stroke triaging are significant. Stroke biomarkers can revolutionize the way stroke patients are diagnosed, monitored, and how they recover. Different biomarkers indicate different cascades and exhibit unique expression patterns which are connected to certain pathologies in the human body. Over the past decades, B-type natriuretic peptide (BNP) and its derivative N-terminal fragment (NT-proBNP) have been increasingly investigated and highlighted as significant cardiovascular biomarkers. This work reviews the recent studies that have reported on the usefulness of BNP and NT-proBNP for stroke triaging. Their classification association is also presented, with increased mortality in stroke, correlation with cardioembolic stroke, and an indication of a second stroke recurrence. Moreover, recent scientific efforts conducted for the technological advancement of a bedside point-of-care (POC) device for BNP and NT-proBNP measurements are discussed. The conclusions presented in this review may hopefully assist in the major efforts that are currently being conducted in order to improve the care of stroke patients.
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Affiliation(s)
- Dorin Harpaz
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore;
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
| | - Raymond C. S. Seet
- Division of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore;
| | - Robert S. Marks
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
| | - Alfred I. Y. Tok
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore;
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Patchwood E, Woodward-Nutt K, Rothwell K, Perry C, Tyrrell P, Bowen A. Six-month reviews for stroke survivors: a study of the modified Greater Manchester Stroke Assessment Tool with care home residents. Clin Rehabil 2020; 34:677-687. [PMID: 32202130 PMCID: PMC7227127 DOI: 10.1177/0269215520912515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objectives: To explore the feasibility of using a stroke-specific toolkit for six-month post-stroke reviews in care homes to identify unmet needs and actions. Design: An observational study including qualitative interviews to explore the process and outcome of reviews. Setting: UK care homes. Participants: Stroke survivors, family members, care home staff (review participants) and external staff involved in conducting reviews (assessors). Interventions: Modified Greater Manchester Stroke Assessment Tool (GM-SAT). Results: The observational study provided data on 74 stroke survivors across 51 care homes. In total, out of 74, 45 (61%) had unmet needs identified. Common unmet needs related to blood pressure, mobility, medicine management and mood. We conducted 25 qualitative interviews, including 13 review participants and 12 assessors. Three overarching qualitative themes covered acceptability of conducting reviews in care homes, process and outcomes of reviews, and acceptability of modified GM-SAT review toolkit. The modified GM-SAT review was positively valued, but stroke survivors had poor recall of the review event including the actions agreed. Care home staff sometimes assisted with reviews and highlighted their need for training to support day-to-day needs of stroke survivors. Assessors highlighted a need for clearer guidance on the use of the toolkit and suggested further modifications to enhance it. They also identified organizational barriers and facilitators to implementing reviews and communicating planned actions to GPs and other agencies. Conclusion: The modified GM-SAT provides a feasible means of conducting six-month reviews for stroke survivors in care homes and helps identify important needs. Further modifications have enhanced acceptability. Full implementation into practice requires staff training and organizational changes.
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Affiliation(s)
- Emma Patchwood
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
| | | | | | - Catherine Perry
- Applied Research Collaboration for Greater Manchester and Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Pippa Tyrrell
- Stroke Medicine, University of Manchester, UK (Honorary Professor)
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, UK
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11
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Chiu SC, Yang RS, Yang RJ, Chang SF. Effects of resistance training on body composition and functional capacity among sarcopenic obese residents in long-term care facilities: a preliminary study. BMC Geriatr 2018; 18:21. [PMID: 29357826 PMCID: PMC5778732 DOI: 10.1186/s12877-018-0714-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/11/2018] [Indexed: 01/01/2023] Open
Abstract
Background Aging-related loss of muscle and strength with increased adiposity is prevalent among older people in long-term care (LTC) facilities. Studies have shown that people with sarcopenic obesity (SO) are at high risk of declining physical performance. At present, no interventional studies on residents with SO in nursing homes have been conducted in the literature. The objectives of this study include appraising the changes in body composition and physical performance following resistance training among residents with SO in LTC facilities. Methods This study used a quasiexperimental research design. Residents who are 60 years of age or above and have been living a sedentary lifestyle in LTC facilities for the past 3 months will be eligible for inclusion. The intervention group engaged in chair muscle strength training twice a week for 12 weeks, whereas the control group underwent the usual care. The main variables were physical parameters of being lean and fat, the strength of grip and pinch, and a functional independence measure using descriptive analysis, chi-squared test, t-test, and generalized estimating equation for statistical analysis through SPSS. Results A total of 64 respondents with SO completed the study. After training, total grip strength (p = 0.001) and total pinch strength (p = 0.014) of the intervention group differed significantly from those of the control group. The right grip strength of the intervention group increased by 1.71 kg (p = 0.003) and the left grip strength improved by 1.35 kg (p = 0.028) compared with baseline values. The self-care scores of the intervention group increased by 2.76 points over baseline scores, particularly for the action of dressing oneself. Although grip strength and self-care scores improved more among those in the intervention group, body fat and skeletal muscle percentages did not differ significantly between the groups after training (p > 0.05). Conclusions Resistance exercises for elderly residents in LTC facilities may play an important role in helping them maintain physical well-being and improve muscle strength. Trial registration Clinicaltrials.gov, number NCT02912338. Retrospectively registered on 09/21/2016.
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Affiliation(s)
- Shu-Ching Chiu
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Rong-Sen Yang
- Department of Orthopaedics, National Taiwan University & Hospital, No. 7, Chung-Shan S. Rd, Taipei, Taiwan, Republic of China
| | - Rea-Jeng Yang
- Department of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Pei-Tou, Taipei, 112, Taiwan, Republic of China
| | - Shu-Fang Chang
- Department of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, 365 Ming Te Road, Pei-Tou, Taipei, 112, Taiwan, Republic of China.
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Harpaz D, Eltzov E, Seet RCS, Marks RS, Tok AIY. Point-of-Care-Testing in Acute Stroke Management: An Unmet Need Ripe for Technological Harvest. BIOSENSORS 2017; 7:E30. [PMID: 28771209 PMCID: PMC5618036 DOI: 10.3390/bios7030030] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 12/20/2022]
Abstract
Stroke, the second highest leading cause of death, is caused by an abrupt interruption of blood to the brain. Supply of blood needs to be promptly restored to salvage brain tissues from irreversible neuronal death. Existing assessment of stroke patients is based largely on detailed clinical evaluation that is complemented by neuroimaging methods. However, emerging data point to the potential use of blood-derived biomarkers in aiding clinical decision-making especially in the diagnosis of ischemic stroke, triaging patients for acute reperfusion therapies, and in informing stroke mechanisms and prognosis. The demand for newer techniques to deliver individualized information on-site for incorporation into a time-sensitive work-flow has become greater. In this review, we examine the roles of a portable and easy to use point-of-care-test (POCT) in shortening the time-to-treatment, classifying stroke subtypes and improving patient's outcome. We first examine the conventional stroke management workflow, then highlight situations where a bedside biomarker assessment might aid clinical decision-making. A novel stroke POCT approach is presented, which combines the use of quantitative and multiplex POCT platforms for the detection of specific stroke biomarkers, as well as data-mining tools to drive analytical processes. Further work is needed in the development of POCTs to fulfill an unmet need in acute stroke management.
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Affiliation(s)
- Dorin Harpaz
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
- Institute for Sports Research (ISR), Nanyang Technology University and Loughborough University, Nanyang Avenue, Singapore 639798, Singapore.
| | - Evgeni Eltzov
- Agriculture Research Organization (ARO), Volcani Centre, Rishon LeTsiyon 15159, Israel.
| | - Raymond C S Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore.
| | - Robert S Marks
- Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
- The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
- The Ilse Katz Centre for Meso and Nanoscale Science and Technology, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
| | - Alfred I Y Tok
- School of Material Science & Engineering, Nanyang Technology University, 50 Nanyang Avenue, Singapore 639798, Singapore.
- Institute for Sports Research (ISR), Nanyang Technology University and Loughborough University, Nanyang Avenue, Singapore 639798, Singapore.
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Lee K, Cho E. Activities of daily living and rehabilitation needs for older adults with a stroke: A comparison of home care and nursing home care. Jpn J Nurs Sci 2016; 14:103-111. [PMID: 27390250 DOI: 10.1111/jjns.12139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 04/14/2016] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
Abstract
AIM To compare the changes in benefit levels of activities of daily living (ADLs), rehabilitation, and long-term care services (LTCS) in older adults with a stroke in different modalities of LTCS, which include home care and nursing home care. METHODS This study analyzed national data regarding LTCS from 2008 to 2009 in South Korea. The data about 7668 older adults with a stroke were extracted from a pool of 182,535 total beneficiaries. In order to control for the baseline differences between older adults who received home care and those who received nursing home care, propensity score matching (PSM) was carried out and there were 1099 matched pairs of participants ( n = 2198). After the PSM, the changes in ADLs and rehabilitation between the two groups were analyzed by using a paired t-test and the changes in LTCS benefit levels were compared by using the χ2 -test. RESULTS The ADLs and rehabilitation needs of the older adults who received home care improved, while the older adults who received nursing home care experienced deterioration. After 1 year, the LTCS benefit levels were significantly different between the home care and the nursing home care groups CONCLUSION: All of the ADLs, rehabilitation needs, and LTCS benefit levels for 1 year had improved in the home care patients, while they worsened in those who received nursing home care. This finding provides evidence to direct the policy of LTCS and offers information to guide older adults with a stroke and their family when deciding between the modalities of LTCS.
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Affiliation(s)
- Kyongeun Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Eunhee Cho
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
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