1
|
Joundi RA, Yu AYX, Smith EE, Zerna C, Penn AM, Balshaw RF, Votova K, Bibok MB, Penn M, Saly V, Hegedus J, Coutts SB, Yu AYX, Penn AM, Trivedi A, Cook J, Morrison J, Blackwood K, Richards K, Votova K, Nealis M, Bibok MB, Penn M, Beattyova P, Rosenberg P, Frost S, Grant C, Hedgedus J, Grant S, Watson T, Saly V, Sedgwick C, Lesperance ML, Croteau NS, Appireddy R, Balshaw RF, Field TS, Dubuc V, Demchuk AM, Jambula A, Le A, Menon BK, Calvert C, Kenney C, Zerna C, Nikneshan D, Smith EE, Klourfeld E, Wagner G, Klein G, Aram H, Desai J, Ryckborst K, Bilston L, Hill MD, Almekhlafi M, Godfrey N, Imoukheude O, Stys P, Barber PA, Couillard P, Eswaradas P, Rhandawa P, Coutts SB, Bal S, Peters S, Save S, Subramaniam S, Musuka T, Stewart T, Hong ZM. Association Between Duration of Transient Neurological Events and Diffusion-Weighted Brain Lesions. J Am Heart Assoc 2023; 12:e027861. [PMID: 36695298 PMCID: PMC9973650 DOI: 10.1161/jaha.122.027861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background The relationship between duration of transient neurological events and presence of diffusion-weighted lesions by symptom type is unclear. Methods and Results This was a substudy of SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment), a multicenter prospective cohort of patients with minor ischemic cerebrovascular events or stroke mimics at academic emergency departments in Canada. For this study we included patients with resolved symptoms and determined the presence of diffusion-weighted imaging (DWI) lesion on magnetic resonance imaging within 7 days. Using logistic regression, we evaluated the association between symptom duration and DWI lesion, assessing for interaction with symptom type (focal only versus nonfocal/mixed), and adjusting for age, sex, education, comorbidities, and systolic blood pressure. Of 658 patients included, a DWI lesion was present in 232 (35.1%). There was a significant interaction between symptom duration and symptom type. For those with focal-only symptoms, there was a continuous increase in DWI probability up to 24 hours in duration (ranging from ≈40% to 80% probability). In stratified analyses, the increase in probability of DWI lesion with increased duration of focal symptoms was seen in women but not men. For those with nonfocal or mixed symptoms, predicted probability of DWI lesion was ≈35% and was greater in men, but did not increase with longer duration. Conclusions Increased duration of neurological deficits is associated with greater probability of DWI lesion in those with focal symptoms only. For individuals with nonfocal or mixed symptoms, about one-third had DWI lesions, but the probability did not increase with duration. These results may be important to improve risk stratification of transient neurological events.
Collapse
Affiliation(s)
- Raed A. Joundi
- Division of Neurology, Hamilton Health SciencesMcMaster University & Population Health Research InstituteHamiltonOntarioCanada
| | - Amy Y. X. Yu
- Division of Neurology, Department of MedicineUniversity of Toronto, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Eric E. Smith
- Departments of Clinical Neurosciences and Community Health SciencesUniversity of CalgaryAlbertaCanada
| | - Charlotte Zerna
- Department of Clinical Neurosciences and Diagnostic ImagingUniversity of Calgary Cumming School of MedicineCalgaryAlbertaCanada
| | - Andrew M. Penn
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Robert F. Balshaw
- George & Fay Yee Centre for Healthcare InnovationUniversity of ManitobaWinnipegManitobaCanada
| | - Kristine Votova
- Island Health Regional Health Authority, Division of Medical SciencesUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | - Maximilian B. Bibok
- Department of Research and Capacity Building, Island HealthVictoriaBritish ColumbiaCanada
| | - Melanie Penn
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Viera Saly
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Janka Hegedus
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Shelagh B. Coutts
- Departments of Clinical Neurosciences and Community Health SciencesUniversity of CalgaryAlbertaCanada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Wong CHY, Jenne CN, Tam PP, Léger C, Venegas A, Ryckborst K, Hill MD, Kubes P. Prolonged Activation of Invariant Natural Killer T Cells and T H2-Skewed Immunity in Stroke Patients. Front Neurol 2017; 8:6. [PMID: 28154551 PMCID: PMC5244395 DOI: 10.3389/fneur.2017.00006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/05/2017] [Indexed: 01/09/2023] Open
Abstract
Background Infection is highly prevalent and contribute significantly to mortality of stroke patients. In addition to the well described robust systemic lymphocytopenia and skewed T helper 2 (TH2)-immunity after stroke, emerging experimental evidence demonstrate that the development of infection poststroke is attributed by the activation of invariant natural killer T (iNKT) cells. In this prospective study, we examined the levels of a broad spectrum of inflammatory mediators, the activation status of iNKT cell in the blood of patients with various degree of stroke severity, and investigate whether these parameters differ in patients who later develop poststroke infections. Methods and results We obtained blood from stroke patients and matching controls to perform flow cytometry and multiplex measurement of inflammatory mediators. Our data suggest a pronounced activation of iNKT cells in stroke patients as compared with matched Healthy and Hospital control patients. The magnitude of iNKT activation is positively correlated with the severity of stroke, supporting the hypothesis that iNKT cells may contribute in the modulation of the host immune response after stroke-associated brain injury. In addition, stroke severity is closely correlated with decreased TH1/TH2 ratio, increased production of interleukin (IL)-10, with infected stroke patients showing exacerbated production of IL-10. Conclusion Stroke triggers a robust and sustained shift in systemic immunity in patients, including specific lymphopenia, robust activation of iNKT cells, systemic production of IL-10, and a prolonged TH2-skewed immunity, all are potential contributors to severe immune suppression seen in patients after stroke. Future studies with large sample size will provide potential causality relationship insights.
Collapse
Affiliation(s)
- Connie H Y Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Science, Monash University, Melbourne, VIC, Australia; Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - Craig N Jenne
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada; Department of Critical Care, Snyder Institute for Critical Care, University of Calgary, Calgary, AB, Canada
| | - Patrick P Tam
- Department of Critical Care, Snyder Institute for Critical Care, University of Calgary , Calgary, AB , Canada
| | - Caroline Léger
- Department of Critical Care, Snyder Institute for Critical Care, University of Calgary , Calgary, AB , Canada
| | - Andres Venegas
- Stroke Unit, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary , Calgary, AB , Canada
| | - Karla Ryckborst
- Stroke Unit, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary , Calgary, AB , Canada
| | - Michael D Hill
- Stroke Unit, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary , Calgary, AB , Canada
| | - Paul Kubes
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada; Department of Critical Care, Snyder Institute for Critical Care, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
3
|
Gladstone DJ, Dorian P, Spring M, Panzov V, Mamdani M, Healey JS, Thorpe KE, Aviv R, Boyle K, Blakely J, Cote R, Hall J, Kapral M, Kozlowski N, Laupacis A, O’Donnell M, Sabihuddin K, Sharma M, Shuaib A, Vaid H, Pinter A, Abootalebi S, Chan R, Crann S, Fleming L, Frank C, Hachinski V, Hesser K, Kumar B, Soros P, Wright M, Basile V, Boyle K, Hopyan J, Rajmohan Y, Swartz R, Vaid H, Valencia G, Ween J, Aram H, Barber P, Coutts S, Demchuk A, Fischer K, Hill M, Klein G, Kenney C, Menon B, McClelland M, Russell A, Ryckborst K, Stys P, Smith E, Watson T, Chacko S, Sahlas D, Sancan J, Côté R, Durcan L, Ehrensperger E, Minuk J, Wein T, Wadup L, Asdaghi N, Beckman J, Esplana N, Masigan P, Murphy C, Tang E, Teal P, Villaluna K, Woolfenden A, Yip S, Bussière M, Dowlatshahi D, Sharma M, Stotts G, Robert S, Ford K, Hackam D, Miners L, Mabb T, Spence JD, Buck B, Griffin-Stead T, Jassal R, Siddiqui M, Hache A, Lessard C, Lebel F, Mackey A, Verreault S, Astorga C, Casaubon LK, del Campo M, Jaigobin C, Kalman L, Silver FL, Atkins L, Coles K, Penn A, Sargent R, Walter C, Gable Y, Kadribasic N, Schwindt B, Shuaib A, Kostyrko P, Selchen D, Saposnik G, Christie P, Jin A, Hicklin D, Howse D, Edwards E, Jaspers S, Sher F, Stoger S, Crisp D, Dhanani A, John V, Levitan M, Mehdiratta M, Wong D. Atrial Premature Beats Predict Atrial Fibrillation in Cryptogenic Stroke. Stroke 2015; 46:936-41. [DOI: 10.1161/strokeaha.115.008714] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- David J. Gladstone
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Paul Dorian
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Melanie Spring
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Val Panzov
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Muhammad Mamdani
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Jeff S. Healey
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | - Kevin E. Thorpe
- From the Division of Neurology (D.J.G.), Department of Medicine (D.J.G., P.D., M.S., M.M.), and Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Ontario, Canada; University of Toronto Stroke Program, Toronto, Ontario, Canada (D.J.G.); Division of Neurology, Department of Medicine, and the Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada (D.J.G.); Heart and Stroke Foundation Canadian Partnership for
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - R. Chan
- London Health Sciences Centre; London, Ontario
| | - S. Crann
- London Health Sciences Centre; London, Ontario
| | - L. Fleming
- London Health Sciences Centre; London, Ontario
| | - C. Frank
- London Health Sciences Centre; London, Ontario
| | | | - K. Hesser
- London Health Sciences Centre; London, Ontario
| | - B.S. Kumar
- London Health Sciences Centre; London, Ontario
| | - P. Soros
- London Health Sciences Centre; London, Ontario
| | - M. Wright
- London Health Sciences Centre; London, Ontario
| | - V. Basile
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - K. Boyle
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - J. Hopyan
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - Y. Rajmohan
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - R. Swartz
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - H. Vaid
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - G. Valencia
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - J. Ween
- Sunnybrook Health Sciences Centre; Toronto, Ontario
| | - H. Aram
- Foothills Hospital; Calgary, Alberta
| | | | - S. Coutts
- Foothills Hospital; Calgary, Alberta
| | | | | | - M.D. Hill
- Foothills Hospital; Calgary, Alberta
| | - G. Klein
- Foothills Hospital; Calgary, Alberta
| | - C. Kenney
- Foothills Hospital; Calgary, Alberta
| | - B. Menon
- Foothills Hospital; Calgary, Alberta
| | | | | | | | - P. Stys
- Foothills Hospital; Calgary, Alberta
| | | | | | - S. Chacko
- Hamilton Health Sciences Centre; Hamilton, Ontario
| | - D. Sahlas
- Hamilton Health Sciences Centre; Hamilton, Ontario
| | - J. Sancan
- Hamilton Health Sciences Centre; Hamilton, Ontario
| | - R. Côté
- Montreal General Hospital; Montreal, Québec
| | - L. Durcan
- Montreal General Hospital; Montreal, Québec
| | | | - J. Minuk
- Montreal General Hospital; Montreal, Québec
| | - T. Wein
- Montreal General Hospital; Montreal, Québec
| | - L. Wadup
- Montreal General Hospital; Montreal, Québec
| | - N. Asdaghi
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - J. Beckman
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - N. Esplana
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - P. Masigan
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - C. Murphy
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - E. Tang
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - P. Teal
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - K. Villaluna
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - A. Woolfenden
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | - S. Yip
- Vancouver Hospital and Health Sciences Centre; Vancouver, British Columbia
| | | | | | - M. Sharma
- The Ottawa Hospital; Ottawa, Ontario
| | - G. Stotts
- The Ottawa Hospital; Ottawa, Ontario
| | - S. Robert
- The Ottawa Hospital; Ottawa, Ontario
| | - K. Ford
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - D. Hackam
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - L. Miners
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - T. Mabb
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - J. D. Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute; London, Ontario
| | - B. Buck
- Grey Nuns Hospital; Edmonton Alberta
| | | | - R. Jassal
- Grey Nuns Hospital; Edmonton Alberta
| | | | - A. Hache
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - C. Lessard
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - F. Lebel
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - A. Mackey
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - S. Verreault
- Centre Hospitalier Affilié Universitaire de Québec: Hôpital de l’Enfant-Jesus; Québec, Québec
| | - C. Astorga
- University Health Network; Toronto, Ontario
| | | | | | | | - L. Kalman
- University Health Network; Toronto, Ontario
| | - FL Silver
- University Health Network; Toronto, Ontario
| | - L. Atkins
- Vancouver Island Health Authority; Victoria, British Columbia
| | - K. Coles
- Vancouver Island Health Authority; Victoria, British Columbia
| | - A. Penn
- Vancouver Island Health Authority; Victoria, British Columbia
| | - R. Sargent
- Vancouver Island Health Authority; Victoria, British Columbia
| | - C. Walter
- Vancouver Island Health Authority; Victoria, British Columbia
| | - Y. Gable
- Mackenzie Health Sciences Centre; Edmonton, Alberta
| | | | - B. Schwindt
- Mackenzie Health Sciences Centre; Edmonton, Alberta
| | - A. Shuaib
- Mackenzie Health Sciences Centre; Edmonton, Alberta
| | | | - D. Selchen
- St. Michael’s Hospital; Toronto, Ontario
| | | | - P. Christie
- Kingston General Hospital; Kingston, Ontario
| | - A. Jin
- Kingston General Hospital; Kingston, Ontario
| | - D. Hicklin
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - D. Howse
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - E. Edwards
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - S. Jaspers
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - F. Sher
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | - S. Stoger
- Thunder Bay Regional Health Sciences Centre; Thunder Bay, Ontario
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Green T, Gandhi S, Kleissen T, Simon J, Raffin-Bouchal S, Ryckborst K. Advance care planning in stroke: influence of time on engagement in the process. Patient Prefer Adherence 2014; 8:119-26. [PMID: 24493922 PMCID: PMC3908836 DOI: 10.2147/ppa.s54822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Individuals who experience stroke have a higher likelihood of subsequent stroke events, making it imperative to plan for future medical care. In the event of a further serious health event, engaging in the process of advanced care planning (ACP) can help family members and health care professionals (HCPs) make medical decisions for individuals who have lost the capacity to do so. Few studies have explored the views and experiences of patients with stroke about discussing their wishes and preferences for future medical events, and the extent to which stroke HCPs engage in conversations around planning for such events. In this study, we sought to understand how the process of ACP unfolded between HCPs and patients post-stroke. PATIENTS AND METHODS Using grounded theory (GT) methodology, we engaged in direct observation of HCP and patient interactions on an acute stroke unit and two stroke rehabilitation units. Using semi-structured interviews, 14 patients and four HCPs were interviewed directly about the ACP process. RESULTS We found that open and continual ACP conversations were not taking place, patients experienced an apparent lack of urgency to engage in ACP, and HCPs were uncomfortable initiating ACP conversations due to the sensitive nature of the topic. CONCLUSION In this study, we identified lack of engagement in ACP post-stroke, attributable to patient and HCP factors. This encourages us to look further into the process of ACP in order to develop open communication between the patient with stroke, their families, and stroke HCPs.
Collapse
Affiliation(s)
- Theresa Green
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Correspondence: Theresa Green, University of Calgary, Professional Faculties Building, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada, Tel +1 403 220 2464, Fax +1 403 210 9838, Email
| | - Shreyas Gandhi
- Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Tessa Kleissen
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Jessica Simon
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Karla Ryckborst
- Calgary Stroke Program, Alberta Health Services, Calgary, AB, Canada
| |
Collapse
|