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Sample records for stroke hospitalization rates

  1. Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR).

    Science.gov (United States)

    Cadilhac, Dominique A; Kilkenny, Monique F; Levi, Christopher R; Lannin, Natasha A; Thrift, Amanda G; Kim, Joosup; Grabsch, Brenda; Churilov, Leonid; Dewey, Helen M; Hill, Kelvin; Faux, Steven G; Grimley, Rohan; Castley, Helen; Hand, Peter J; Wong, Andrew; Herkes, Geoffrey K; Gill, Melissa; Crompton, Douglas; Middleton, Sandy; Donnan, Geoffrey A; Anderson, Craig S

    2017-05-01

    Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate. Cohort design linking Australian Stroke Clinical Registry data with national death registrations. Multivariable models using recommended statistical methods for calculating 30-day RAMRs for hospitals, adjusted for demographic factors, ability to walk on admission, stroke type, and stroke recurrence. Australian hospitals providing at least 200 episodes of acute stroke care, 2009-2014. Hospital RAMRs estimated by different models. Changes in hospital rank order and funnel plots were used to explore variation in hospital-specific 30-day RAMRs; that is, RAMRs more than three standard deviations from the mean. In the 28 hospitals reporting at least 200 episodes of care, there were 16 218 episodes (15 951 patients; median age, 77 years; women, 46%; ischaemic strokes, 79%). RAMRs from models not including stroke severity as a variable ranged between 8% and 20%; RAMRs from models with the best fit, which included ability to walk and stroke recurrence as variables, ranged between 9% and 21%. The rank order of hospitals changed according to the covariates included in the models, particularly for those hospitals with the highest RAMRs. Funnel plots identified significant deviation from the mean overall RAMR for two hospitals, including one with borderline excess mortality. Hospital stroke mortality rates and hospital performance ranking may vary widely according to the covariates included in the statistical analysis.

  2. Impact of stroke unit in a public hospital on length of hospitalization and rate of early mortality of ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Maria Sheila G. Rocha

    2013-10-01

    Full Text Available We ascertained whether a public health stroke unit reduces the length of hospitalization, the rate of inpatient fatality, and the mortality rate 30 days after the stroke. Methods We compared a cohort of stroke patients managed on a general neurology/medical ward with a similar cohort of stroke patients managed in a str oke unit. The in-patient fatality rates and 30-day mortality rates were analyzed. Results 729 patients were managed in the general ward and 344 were treated at a comprehensive stroke unit. The in-patient fatality rates were 14.7% for the general ward group and 6.9% for the stroke unit group (p<0.001. The overall mortality rate 30 days after stroke was 20.9% for general ward patients and 14.2% for stroke unit patients (p=0.005. Conclusions We observed reduced in-patient fatalities and 30-day mortality rates in patients managed in the stroke unit. There was no impact on the length of hospitalization.

  3. Characterization of Hospitalized Ischemic Stroke Patients in Palestine

    African Journals Online (AJOL)

    Objective: Stroke is a major health problem, yet no studies on stroke have been reported from Palestine. This one-year, hospital-based study was conducted to determine the prevalence of risk factors and the in-hospital mortality rate in patients with ischemic stroke. Method: All patients admitted to Al-Watani government ...

  4. National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014.

    Science.gov (United States)

    Lecoffre, Camille; de Peretti, Christine; Gabet, Amélie; Grimaud, Olivier; Woimant, France; Giroud, Maurice; Béjot, Yannick; Olié, Valérie

    2017-11-01

    Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management. © 2017 American Heart Association, Inc.

  5. The PRE-hospital Stroke Treatment Organization.

    Science.gov (United States)

    Audebert, Heinrich; Fassbender, Klaus; Hussain, M Shazam; Ebinger, Martin; Turc, Guillaume; Uchino, Ken; Davis, Stephen; Alexandrov, Anne; Grotta, James

    2017-12-01

    Background The PRE-hospital Stroke Treatment Organization was formed in 2016 as an international consortium of medical practitioners involved in pre-hospital treatment of patients with acute stroke. Aims PRE-hospital Stroke Treatment Organization's mission is to improve stroke outcomes by supporting research and advocacy for pre-hospital stroke treatment in Mobile Stroke Units. PRE-hospital Stroke Treatment Organization will provide a platform to enhance collaborative research across the spectrum of acute stroke management in the pre-hospital setting. PRE-hospital Stroke Treatment Organization will also facilitate the appropriate proliferation and distribution of Mobile Stroke Units by providing a forum for professional communication, resource for public education, and stimulus for government, industry, and philanthropic support. Summary of review In this "white paper", we describe the evidence supporting pre-hospital stroke treatment, progress to date, practical issues such as application in various environments and staffing, planned research initiatives, and organizational structure. Conclusions PRE-hospital Stroke Treatment Organization is not-for-profit, with membership open to anyone involved (or hoping to become involved) in pre-hospital stroke care. PRE-hospital Stroke Treatment Organization has a Steering Committee comprised of members from Europe, U.S., Canada, Australia, and other regions having a Mobile Stroke Unit in operation. PRE-hospital Stroke Treatment Organization convenes satellite meetings for membership at the International Stroke Conference and European Stroke Congress each year to address the PRE-hospital Stroke Treatment Organization mission. The first research collaborations agreed upon are to: (1) develop a list of common data elements to be collected by all Mobile Stroke Unit programs and entered into a common research database, and (2) develop a protocol for investigating the natural history of hyper-acute Intracerebral Hemorrhage.

  6. Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization.

    Science.gov (United States)

    Schwartz, Jennifer; Wang, Yongfei; Qin, Li; Schwamm, Lee H; Fonarow, Gregg C; Cormier, Nicole; Dorsey, Karen; McNamara, Robert L; Suter, Lisa G; Krumholz, Harlan M; Bernheim, Susannah M

    2017-11-01

    The Centers for Medicare & Medicaid Services publicly reports a hospital-level stroke mortality measure that lacks stroke severity risk adjustment. Our objective was to describe novel measures of stroke mortality suitable for public reporting that incorporate stroke severity into risk adjustment. We linked data from the American Heart Association/American Stroke Association Get With The Guidelines-Stroke registry with Medicare fee-for-service claims data to develop the measures. We used logistic regression for variable selection in risk model development. We developed 3 risk-standardized mortality models for patients with acute ischemic stroke, all of which include the National Institutes of Health Stroke Scale score: one that includes other risk variables derived only from claims data (claims model); one that includes other risk variables derived from claims and clinical variables that could be obtained from electronic health record data (hybrid model); and one that includes other risk variables that could be derived only from electronic health record data (electronic health record model). The cohort used to develop and validate the risk models consisted of 188 975 hospital admissions at 1511 hospitals. The claims, hybrid, and electronic health record risk models included 20, 21, and 9 risk-adjustment variables, respectively; the C statistics were 0.81, 0.82, and 0.79, respectively (as compared with the current publicly reported model C statistic of 0.75); the risk-standardized mortality rates ranged from 10.7% to 19.0%, 10.7% to 19.1%, and 10.8% to 20.3%, respectively; the median risk-standardized mortality rate was 14.5% for all measures; and the odds of mortality for a high-mortality hospital (+1 SD) were 1.51, 1.52, and 1.52 times those for a low-mortality hospital (-1 SD), respectively. We developed 3 quality measures that demonstrate better discrimination than the Centers for Medicare & Medicaid Services' existing stroke mortality measure, adjust for

  7. In-hospital stroke recurrence and stroke after transient ischemic attack: frequency and risk factors.

    Science.gov (United States)

    Erdur, Hebun; Scheitz, Jan F; Ebinger, Martin; Rocco, Andrea; Grittner, Ulrike; Meisel, Andreas; Rothwell, Peter M; Endres, Matthias; Nolte, Christian H

    2015-04-01

    We aimed to assess the risk of recurrent ischemic events during hospitalization for stroke or transient ischemic attack (TIA) with optimal current management and to identify associated risk factors. We performed a retrospective analysis of all patients treated for acute ischemic stroke or TIA in 3 stroke units between 2010 and 2013. Recurrent stroke was defined as new persisting (≥24 hours) neurological deficit occurring >24 hours after the index event and not attributable to other causes of neurological deterioration. Cox proportional hazard regression identified risk factors associated with recurrent stroke. The study included 5106 patients. During a median length of stay of 5 days (interquartile range, 4-8), stroke recurrence (or stroke after TIA) occurred in 40 patients (0.8%) and was independently associated with history of TIA, symptomatic carotid stenosis (≥70%), or other determined etiology. Patients with recurrent stroke and other determined etiology had cervical arterial dissection (n=2), primary angiitis of the central nervous system (n=1), giant cell arteritis (n=1), and lung cancer with nonbacterial thrombotic endocarditis (n=1). In patients with initial TIA or minor stroke (National Institutes of Health Stroke Scale ≤5) recurrence was associated additionally with pneumonia after the inciting ischemic event but before stroke recurrence. Patients with initial stroke and aphasia had a lower stroke recurrence rate and there were no recurrences in patients with lacunar stroke. Recurrence was associated with significantly higher in-hospital mortality (17.5% versus 3.1%; Pstroke recurrence was low with optimal current management. Patients with a history of TIA, severe symptomatic carotid stenosis, or uncommon causes of stroke were at higher risk. Pneumonia was associated with a higher risk of stroke recurrence in patients with initial TIA or minor stroke but not in the overall population studied. Aphasia may bias the detection rate by concealing new

  8. Stroke treatment outcomes in hospitals with and without Stroke Units.

    Science.gov (United States)

    Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

    2017-10-23

    Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Rural versus urban academic hospital mortality following stroke in Canada.

    Science.gov (United States)

    Fleet, Richard; Bussières, Sylvain; Tounkara, Fatoumata Korika; Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M; Dupuis, Gilles

    2018-01-01

    Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.

  10. In-hospital stroke: characteristics and outcomes.

    LENUS (Irish Health Repository)

    Briggs, R

    2015-01-01

    In-hospital stroke (IS) made up 6.5% of strokes recorded in the Irish National Stroke Register in 2012. International research has demonstrated poorer outcomes post IS compared to out of hospital stroke (OS). We aimed to profile all IS and OS over a 22 month period and compare the two groups by gathering data from the HIPE portal stroke register. The study site is a primary stroke centre. IS represented 11% (50\\/458) of total strokes with over half (27\\/50, 54%) admitted initially with medical complaints. IS patients had a significantly longer length of stay (79.2 +\\/- 87.4 days vs. 21.9 +\\/- 45.9 days, p < 0.01) and higher mortality (13\\/50 vs. 39\\/408, p < 0.01). Patients in the IS group were also less likely to receive stroke unit care (1\\/50 vs. 136\\/408, p < 0.01). This study demonstrates the significant morbidity and mortality associated with IS and highlights the need for efforts to be made to optimize identification and management of acute stroke in this cohort.

  11. Hospital arrival time after onset of stroke.

    Science.gov (United States)

    Kay, R; Woo, J; Poon, W S

    1992-01-01

    To estimate the proportion of patients with stroke likely to be eligible for a trial of anticoagulant treatment for acute ischaemic stroke, the interval between onset of symptoms and arrival at hospital was analysed prospectively. Of 773 patients with stroke admitted in one year, 63% arrived at hospital within 12 hours, 76% within 24 hours, and 85% within 48 hours of ictus. The arrival time varied significantly with stroke subtype. Patients with intracerebral haemorrhage tended to arrive earlier than those with cerebral infarct, who arrived sooner than those with lacunar infarct. The results suggest that about half of all patients with ischaemic stroke in Hong Kong would present within 12 hours of ictus, in time for inclusion in a therapeutic trial. PMID:1431964

  12. Model of hospital-supported discharge after stroke

    DEFF Research Database (Denmark)

    Torp, Claus Rydahl; Vinkler, Sonja; Pedersen, Kirsten Damgaard

    2006-01-01

    BACKGROUND AND PURPOSE: Readmission rate within 6 months after a stroke is 40% to 50%. The purpose of the project was to evaluate whether an interdisciplinary stroke team could reduce length of hospital stay, readmission rate, increase patient satisfaction and reduce dependency of help. METHODS......: One hundred and ninety-eight patients with acute stroke were randomized into 103 patients whose discharge was supported by an interdisciplinary stroke team and 95 control patients who received standard aftercare. Baseline characteristics were comparable in the 2 groups. The patients were evaluated...... services. Furthermore, there was no significant difference in functional scores or patient satisfaction. CONCLUSIONS: In this setting we could not show benefit of an interdisciplinary stroke team supporting patients at discharge perhaps because standard aftercare was very efficient already....

  13. The King's College Hospital Acute Stroke Unit.

    Science.gov (United States)

    Bath, P; Butterworth, R J; Soo, J; Kerr, J E

    1996-01-01

    The King's College Hospital (KCH) Acute Stroke Unit (ASU) was set up in January 1994 in order to provide acute management for patients admitted with stroke and to undertake biomedical research. Of 206 patients admitted to KCH with a stroke or suffering an in-hospital stroke, 141 (68%) patients were admitted to the ASU over its first 6 months of operation: 120 (85%) were from the Accident and Emergency Department and 21 (15%) from other wards. Management included resuscitation and medical stabilisation, investigation, prevention of stroke complications (including aspiration, venous thrombosis, and pressure sores), rehabilitation (physiotherapy, occupational therapy, speech and language therapy), nutrition (dietetics) and initiation of secondary prevention measures (aspirin or anticoagulation, blood pressure and lipid lowering, and carotid endarterectomy). All aspects of management are driven by agreed guidelines. Patients remain under the care of the admitting physician but specific stroke management and guidance is provided by two research doctors and the unit's nurses, therapists and dietician. The unit also facilitates research into stroke pathophysiology and acute therapeutic interventions. Our experience suggests that an ASU is relatively easy to set up and may contribute to improved care. Whether ASUs improve patient survival and functional outcome, and are cost-effective, requires further study.

  14. Delay in presentation after acute ischemic stroke: the Careggi Hospital Stroke Registry.

    Science.gov (United States)

    Eleonora, Innocenti; Patrizia, Nencini; Ilaria, Romani; Alessandra, Del Bene; Francesco, Arba; Benedetta, Piccardi; Giovanni, Pracucci

    2014-01-01

    Intravenous thrombolysis with recombinant tissue-type plasminogen activator is the approved treatment for acute ischemic stroke within 4.5 h from symptoms onset. Evidence suggests the earlier treatment was given, the greater the chance of a favorable outcome. We investigated if the delay in hospital presentation has been modified in the past 8 years. Acute ischemic strokes admitted to the Emergency Department of the Careggi Hospital, Florence from March 2004 to December 2012 were prospectively collected in the Careggi Hospital Stroke Registry. Proportion of patients presenting ≤ 2 h, 2-3.5, 3.5-6, and >6 h from symptom onset or with awakening stroke were compared. From March 2004 to December 2012, 3,856 patients with acute ischemic stroke arrived to the Careggi Emergency Department. During the period, 28.3 % of patients arrived ≤ 2 h from symptoms onset and 9.8 % between 2 and 3.5 h. The proportion of time-eligible patients is steady in the first years with a slight increase in 2011 and 2012. Early presentation is significantly associated with younger age, intracerebral hemorrhage, and stroke severity. In this study, about one-third of acute ischemic strokes arrived at the Emergency Department within the therapeutic time-window for intravenous thrombolysis. There is only a slight increase in early presentation through the period, mainly in the last 2 years. Additional efforts are required to impact deeply on the rates of time-eligible patients.

  15. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.

    2013-07-01

    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  16. Pattern of hospitalized-stroke patients in ASEAN countries an ASNA stroke epidemiological study

    Directory of Open Access Journals (Sweden)

    Jusuf Misbach

    2001-03-01

    discharged from the hospital were alive improved (57% and mean death rate was 22%, highest in Thailand (45% and lowest in Brunei (8%. This hospital based stroke data showed the recent characteristics of stroke pattern in seven ASEAN member countries and it will be very important data for health policy maker in these countries and for further cooperative researches in the future. (Med J Indones 2001; 10: 48-56Keywords: Stroke, clinical pattern, risk factor

  17. Stroke in a resource-constrained hospital in Madagascar

    OpenAIRE

    Stenumg?rd, P?l Sigurd; Rakotondranaivo, Miadana Joshua; Sletvold, Olav; Follestad, Turid; Ellekj?r, Hanne

    2017-01-01

    Background Stroke is reported as the most frequent cause of in-hospital death in Madagascar. However, no descriptive data on hospitalized stroke patients in the country have been published. In the present study, we sought to investigate the feasibility of collecting data on stroke patients in a resource-constrained hospital in Madagascar. We also aimed to characterize patients hospitalized with stroke. Methods We registered socio-demographics, clinical characteristics, and early out...

  18. Stroke Risk Factors among Patients in a Nigerian Teaching Hospital ...

    African Journals Online (AJOL)

    ... aim of this study was to describe the risk factors in stroke patients admitted in a Nigerian teaching hospital. Methods: This is a prospective study carried out in the Jos University Teaching Hospital in Nigeria. The participants were 120 patients admitted into the hospital with stroke. Stroke was defined by the WHO definition.

  19. Stroke mortality and its predictors in a Nigerian teaching hospital

    African Journals Online (AJOL)

    Abstract. Background: Stroke is the third leading cause of death worldwide. Stroke mortality has been noted to be higher in blacks in biracial studies. There have been few studies on stroke mortality and its predictors in Nigeria. This study examines mortality of stroke and its predictors in a Northern Nigerian teaching hospital.

  20. Stroke mortality and its predictors in a Nigerian teaching hospital ...

    African Journals Online (AJOL)

    Background: Stroke is the third leading cause of death worldwide. Stroke mortality has been noted to be higher in blacks in biracial studies. There have been few studies on stroke mortality and its predictors in Nigeria. This study examines mortality of stroke and its predictors in a Northern Nigerian teaching hospital.

  1. Risk factors for falls of hospitalized stroke patients

    NARCIS (Netherlands)

    Tutuarima, J. A.; van der Meulen, J. H.; de Haan, R. J.; van Straten, A.; Limburg, M.

    1997-01-01

    Patients with stroke are at a high risk for falling. We assessed the fall incidence and risk factors for patients hospitalized as the result of an acute stroke. We studied a cohort of 720 stroke patients from 23 hospitals in The Netherlands. The data were abstracted from the medical and nursing

  2. Stroke-related mortality in a tertiary care hospital in Andalusia: Analysis and reflections.

    Science.gov (United States)

    Maestre-Moreno, J F; Fernández-Pérez, M D; Triguero-Cueva, L; Gutiérrez-Zúñiga, R; Herrera-García, J D; Espigares-Molero, A; Mínguez-Castellanos, A

    Stroke is a very common cause of death, especially in southern Spain. The present study analyses in-hospital mortality associated with stroke in an Andalusian tertiary care hospital. We gathered the files of all patients who had died at Hospital Universitario Virgen de las Nieves in Granada in 2013 and whose death certificates indicated stroke as the cause of death. We also gathered stroke patients discharge data and compared them to that of patients with acute coronary syndrome (ACS). A total of 825 patients had a diagnosis of stroke (96 deaths, 11.6%); of these, 562 had ischaemic stroke (44 deaths, 7.8%) and 263 haemorrhagic stroke (52 deaths, 19.7%). Patients with haemorrhagic stroke therefore showed greater mortality rate (OR=2.9). Patients in this group died after a shorter time in hospital (median, 4 vs 7 days; mean, 6 days). However, patients with ischaemic stroke were older and presented with more comorbidities. On the other hand, 617 patients had a diagnosis of ACS (36 deaths, 5.8%). The mortality odds ratio (MOR) was 2.1 (stroke/SCA). Around 23% of the patients who died from stroke were taking anticoagulants. 60% of the deceased patients with ischaemic stroke and 20% of those with haemorrhagic stroke had atrial fibrillation (AF); 35% of the patients with ischaemic stroke and AF were taking anticoagulants. Stroke is associated with higher admission and in-hospital mortality rates than SCA. Likewise, patients with haemorrhagic stroke showed higher mortality rates than those with ischaemic stroke. Patients with fatal stroke usually had a history of long-term treatment with anticoagulants; 2 thirds of the patients with fatal ischaemic stroke and atrial fibrillation were not receiving anticoagulants. According to our results, optimising prevention in patients with AF may have a positive impact on stroke-related in-hospital mortality. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Characteristics of stroke in tibet autonomous region in china: a hospital-based study of acute stroke.

    Science.gov (United States)

    Fang, Jiajia; Zhuo-Ga, Cidan; Zhao, Yuhua; Kong, Fanyi; Si, Yang; Liu, Ming; Zhou, Dong

    2011-01-01

    We know little of the current status of stroke in Tibet Autonomous Region in China. This study was designed to investigate the characteristics of acute stroke in Tibet. We conducted a hospital-based study on acute first-ever stroke in the People's Hospital of Tibet Autonomous Region (PHOTAR), and then compared the data collected to that from West China Hospital (WCH). The study included 301 inpatients from PHOTAR and 3,334 from WCH. The peak age group in PHOTAR was one decade younger than in WCH. Intracerebral hemorrhage (ICH) was the main stroke subtype in PHOTAR (74.1%). The prevalence of hypertension and heavy alcohol consumption prior to stroke were the most important vascular risk factors. Treatments for stroke in PHOTAR lacked standardization and in-hospital mortality was higher for each subtype. ICH is the dominant stroke subtype in Tibet Autonomous Region, and can be attributed to high rates of hypertension and heavy alcohol consumption. Greater public awareness of stroke and effective management of risk factors should be implemented immediately in Tibet. Copyright © 2011 S. Karger AG, Basel.

  4. Young ischaemic stroke in South Auckland: a hospital-based study.

    Science.gov (United States)

    Wu, Teddy Y; Kumar, Ajay; Wong, Edward H

    2012-10-26

    To analyse the risk factors, trends in incidence and aetiology of stroke in young adults in a hospital-based population in South Auckland, New Zealand. A retrospective review of patients aged 15 years to 45 years with a discharge diagnosis of ischaemic stroke (ICD 10 Codes I63 - I65, G46, I672, I675-I679, I694- I694) from June 1 2004 to December 31, 2009. Vascular risk factors, demographic factors, stroke severity, stroke subtype, results of investigations and stroke outcome were determined from review of the hospital record (paper copy and electronic record). A total of 131 patients were identified, representing 4.6% of all stroke discharges. Over one-half of the patients were of "underdetermined cause" (Trial of Org 10172 in Acute Stroke Treatment [TOAST] criteria), (1) mainly due to incomplete investigation. Cardioembolism (16%) was the second most common cause of stroke, followed by small vessel disease and stroke of other determined aetiology (both 12.2%). Confirmed large vessel atherosclerosis (6.1%) was the least common cause of stroke in this study population. The most common risk factors were hyperlipidaemia (45.8%), hypertension (42.7%), current tobacco smoking (42.7%) and obesity (36.6%). The indigenous Maori and Pacific Island people had a higher rate of stroke, at least double of other ethnicities. The in-hospital fatality rate was 3.1%. All surviving patients were discharged home. Eighty-six percent of the survivors were independent. Our study demonstrates strokes of undetermined aetiology and cardioembolism were the most common cause of stroke in young people in South Auckland, and that Māori and Pacific Island people have a higher rate of stroke.

  5. Stroke in a resource-constrained hospital in Madagascar.

    Science.gov (United States)

    Stenumgård, Pål Sigurd; Rakotondranaivo, Miadana Joshua; Sletvold, Olav; Follestad, Turid; Ellekjær, Hanne

    2017-07-24

    Stroke is reported as the most frequent cause of in-hospital death in Madagascar. However, no descriptive data on hospitalized stroke patients in the country have been published. In the present study, we sought to investigate the feasibility of collecting data on stroke patients in a resource-constrained hospital in Madagascar. We also aimed to characterize patients hospitalized with stroke. We registered socio-demographics, clinical characteristics, and early outcomes of patients admitted for stroke between 23 September 2014 and 3 December 2014. We used several validated scales for the evaluation. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS), disability by the modified Rankin Scale (mRS), and function by the Barthel Index (BI). We studied 30 patients. Sixteen were males. The median age was 62.5 years (IQR 58-67). The NIHSS and mRS were completed for all of the patients, and BI was used for the survivors. Three patients received a computed tomography (CT) brain scan. The access to laboratory investigations was limited. Electrocardiographs (ECGs) were not performed. The median NIHSS score was 16.5 (IQR 10-35). The in-hospital stroke mortality was 30%. At discharge, the median mRS score was 5 (IQR 4-6), and the median BI score was 45 (IQR 0-72.5). Although the access to brain imaging and supporting investigations was deficient, this small-scale study suggests that it is feasible to collect essential data on stroke patients in a resource-constrained hospital in Madagascar. Such data should be useful for improving stroke services and planning further research. The hospitalized stroke patients had severe symptoms. The in-hospital stroke mortality was high. At discharge, the disability category was high, and functional status low.

  6. Frequency and predictors of stroke after acute myocardial infarction: specific aspects of in-hospital and postdischarge events.

    Science.gov (United States)

    Hachet, Olivier; Guenancia, Charles; Stamboul, Karim; Daubail, Benoit; Richard, Carole; Béjot, Yannick; Yameogo, Valentin; Gudjoncik, Aurélie; Cottin, Yves; Giroud, Maurice; Lorgis, Luc

    2014-12-01

    Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up. One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced in-hospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification showed that only 2 types of stroke were identified more frequently. As expected, the leading subtype of in-hospital ischemic stroke was cardioembolic stroke (n=64, 60%), the second was stroke of undetermined pathogenesis (n=38, 36%). After multivariable backward regression analysis, female sex, previous transient ischemic attack (TIA)/stroke, new-onset atrial fibrillation, left ventricular ejection fraction (odds ratio per point of left ventricular ejection fraction), and C-reactive protein were independently associated with in-hospital ischemic stroke. When antiplatelet and anticoagulation therapy within the first 48 hours was introduced into the multivariable model, we found that implementing these treatments (≥1) was an independent protective factor of in-hospital stroke. In-hospital hemorrhagic stroke was dramatically increased (5-fold) when thrombolysis was prescribed as the reperfusion treatment. However, the different parenteral anticoagulants were not predictors of risk in univariable analysis

  7. Stroke Among Young Adults at the LAUTECH Teaching Hospital ...

    African Journals Online (AJOL)

    Stroke Among Young Adults at the LAUTECH Teaching Hospital, Osogbo, Nigeria. AF Mustapha, EO Sanya, TO Bello. Abstract. Background: Stroke in young adults is relatively rare and there are very few hospital reports about it in Nigeria. The aetiologic mechanisms of stoke among young adults are quite distinct from ...

  8. Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II.

    Science.gov (United States)

    Bettger, Janet Prvu; Li, Zixiao; Xian, Ying; Liu, Liping; Zhao, Xingquan; Li, Hao; Wang, Chunxue; Wang, Chunjuan; Meng, Xia; Wang, Anxin; Pan, Yuesong; Peterson, Eric D; Wang, Yilong; Wang, Yongjun

    2017-04-01

    Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

  9. Diagnostic accuracy of guys Hospital stroke score (allen score) in acute supratentorial thrombotic/haemorrhagic stroke

    International Nuclear Information System (INIS)

    Zulfiqar, A.; Toori, K. U.; Khan, S. S.; Hamza, M. I. M.; Zaman, S. U.

    2006-01-01

    A consecutive series of 103 patients, 58% male with mean age of 62 year (range 40-75 years), admitted with supratentorial stroke in our teaching hospital were studied. All patients had Computer Tomography scan brain done after clinical evaluation and application of Allen stroke score. Computer Tomography Scan confirmed thrombotic stroke in 55 (53%) patients and haemorrhagic stroke in 48 (47%) patients. Out of the 55 patients with definitive thrombotic stroke on Computer Tomography Scan, Allen stroke score suggested infarction in 67%, haemorrhage in 6% and remained inconclusive in 27% of cases. In 48 patients with definitive haemorrhagic stroke on Computer Tomography Scan, Allen stroke score suggested haemorrhage in 60%, infarction in 11% and remained inconclusive in 29% of cases. The overall accuracy of Allen stroke score was 66%. (author)

  10. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  11. Comparison of tissue plasminogen activator administration management between Telestroke Network hospitals and academic stroke centers: the Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany.

    Science.gov (United States)

    Audebert, Heinrich J; Kukla, Christian; Vatankhah, Bijan; Gotzler, Berthold; Schenkel, Johannes; Hofer, Stephan; Fürst, Andrea; Haberl, Roman L

    2006-07-01

    Systemic thrombolysis is the only therapy proven to be effective for ischemic stroke. Telemedicine may help to extend its use. However, concerns remain whether management and safety of tissue plasminogen activator (tPA) administration after telemedical consultation are equivalent in less experienced hospitals compared with tPA administration in academic stroke centers. During the second year of the ongoing Telemedical Pilot Project for Integrative Stroke Care, all systemic thrombolyses in stroke patients of the 12 regional clinics and the 2 stroke centers were recorded prospectively. Patients' demographics, stroke severity (National Institutes of Health Stroke Scale), frequency of administration, time management, protocol violations, and safety were included in the analysis. In 2004, 115 of 4727 stroke or transient ischemic attack patients (2.4%) in the community hospitals and 110 of 1889 patients in the stroke centers (5.8%) received systemic thrombolysis. Prehospital latencies were shorter in the regional hospitals despite longer distances. Door to needle times were shorter in the stroke centers. Although blood pressure was controlled more strictly in community hospitals, symptomatic intracerebral hemorrhage rate (7.8%) was higher (P=0.14) than in stroke centers (2.7%) but still within the range of the National Institute of Neurological Disorders and Stroke trial. In-hospital mortality rate was low in community hospitals (3.5%) and in stroke centers (4.5%). Although with a lower rate of systemic thrombolysis, there was no evidence of lower treatment quality in the remote hospitals. With increasing numbers of tPA administration and growing training effects, the telestroke concept promises better coverage of systemic thrombolysis in nonurban areas.

  12. Development of smartphone application that aids stroke screening and identifying nearby acute stroke care hospitals.

    Science.gov (United States)

    Nam, Hyo Suk; Heo, JoonNyung; Kim, Jinkwon; Kim, Young Dae; Song, Tae Jin; Park, Eunjeong; Heo, Ji Hoe

    2014-01-01

    The benefits of thrombolytic treatment are time-dependent. We developed a smartphone application that aids stroke patient self-screening and hospital selection, and may also decrease hospital arrival time. The application was developed for iPhone and Android smartphones. Map data for the application were adopted from the open map. For hospital registration, a web page (http://stroke119.org) was developed using PHP and MySQL. The Stroke 119 application includes a stroke screening tool and real-time information on nearby hospitals that provide thrombolytic treatment. It also provides information on stroke symptoms, thrombolytic treatment, and prescribed actions when stroke is suspected. The stroke screening tool was adopted from the Cincinnati Prehospital Stroke Scale and is displayed in a cartoon format. If the user taps a cartoon image that represents abnormal findings, a pop-up window shows that the user may be having a stroke, informs the user what to do, and directs the user to call emergency services. Information on nearby hospitals is provided in map and list views, incorporating proximity to the user's location using a Global Positioning System (a built-in function of smartphones). Users can search for a hospital according to specialty and treatment levels. We also developed a web page for hospitals to register in the system. Neurology training hospitals and hospitals that provide acute stroke care in Korea were invited to register. Seventy-seven hospitals had completed registration. This application may be useful for reducing hospital arrival times for thrombolytic candidates.

  13. Facilities available in European hospitals treating stroke patients.

    Science.gov (United States)

    Leys, Didier; Ringelstein, E Bernd; Kaste, Markku; Hacke, Werner

    2007-11-01

    Stroke units decrease mortality and need for institutional care, but they are not widely available. The objective of the study was to determine, among European hospitals admitting acute stroke patients, how many are able to provide an appropriate level of care. Method- We randomly selected 886 hospitals in 25 countries. We used definitions derived from a European expert survey for comprehensive stroke centers (CSC), primary stroke centers (PSC), and minimum level required for any hospital ward (AHW) admitting stroke patients. We determined the proportion of hospitals meeting criteria for each category, and which facilities were not available. Participating hospitals treated approximately one-third of all strokes supposed to have occurred in these countries in 2005. Forty-three (4.9%) met criteria for CSC, 32 (3.6%) for PSC, 356 (40.2%) for AHW, and 455 (51.4%) provided a lower level of care. In 2005, hospitals meeting criteria for CSC, PSC, AHW, and none of them admitted 27 644 (8.3%), 17 365 (5.2%), 146 175 (44.1%), and 140 306 (42.3%) patients. There was no 24-hour availability for brain CT scan in 25% of hospitals not meeting criteria for AHW. Of 448 hospitals admitting at least 1 stroke per day, 51 (11.4%) met criteria for PSC or CSC, and 227 (50.7%) for AHW. Less than 10% of European hospitals admitting acute stroke patients have optimal facilities, and in 40% even the minimum level is not available. Because the availability of facilities does not grant their use, our study suggests that only few acute stroke patients are treated in appropriate centers in Europe.

  14. Stroke Admission to Tikur Anbassa Teaching Hospital: With ...

    African Journals Online (AJOL)

    Background: Although the burden of cerebrovascular accident is not known in Africa, including Ethiopia, it s a frequent cause of mortality and morbidity in hospital practice. Stroke in the young is associated with different spectrum of risk factors and treatment outcome as compared to stroke in the older age group. Method: To ...

  15. Hospital: With Emphasis on Stroke in the Young

    African Journals Online (AJOL)

    Results: Two hundred and fifty nine patients satisfying the definition of stroke were admitted to. Tikur Anbassa Teaching Hospital. Stroke in the young accounted for 28% (73 patients). Hypertension was the commonest risk factor among both age groups. Rheumatic heart diseases. (RHD) was the second commonest risk ...

  16. Length of hospital stay and discharge delays in stroke patients

    NARCIS (Netherlands)

    van Straten, A.; van der Meulen, J. H.; van den Bos, G. A.; Limburg, M.

    1997-01-01

    In The Netherlands, many stroke patients stay in the hospital for some time merely waiting for discharge placement. This indicates an inefficient use of hospital resources, as well as a possible deficiency in the quality of care, because hospitals are not adequately equipped to care for these

  17. Stroke subtypes, risk factors and mortality rate in northwest of Iran

    DEFF Research Database (Denmark)

    Farhoudi, Mehdi; Mehrvar, Kaveh; Sadeghi-Bazargani, Homayoun

    2017-01-01

    data, risk factors, types and mortality. Methods: A retrospective study was done in two university tertiary referral hospitals in Tabriz, northwest of Iran, from March 2008 to April 2013. Patients diagnosed with stroke were enrolled in the study. Demographic data, stroke subtypes, duration...... of hospitalization, stroke risk factors and hospital mortality rate were recorded for all the patients. Results: A total number of 5355 patients were evaluated in the present study. Mean age of the patients was 67.5 ± 13.8 years, and 50.6% were men. Final diagnosis of ischemic stroke was made in 76.......5% of the patients, intra-cerebral hemorrhage (ICH) with or without intra-ventricular hemorrhage (IVH) in 14.3% and subarachnoid hemorrhage (SAH) in 9.2%. Stroke risk factors among the patients were hypertension in 68.8% of the patients, diabetes mellitus (DM) in 23.9%, smoking in 12.6% and ischemic heart diseases...

  18. Nutritional Status of Hospitalized Stroke Patients: Assessment by Body Mass Index and Subjective Global Assessment Method

    Directory of Open Access Journals (Sweden)

    Gloria Kartika

    2017-06-01

    Full Text Available Background: Stroke is a disease with a high mortality rate and common cause of disability. Nutritional factors are strongly associated with this disease. Malnutrition in hospitalized patients increases the incidence of complications, prolonged the length of stay and also the cost of hospitalization. Furthermore, nutritional status of stroke patients can deteriorate during hospitalization. The prevalence of malnutrition in hospitalized stroke patients is about 6% to 62%. The objective of this study was to identify  the nutritional status of hospitalized stroke patient. Methods: This was a descriptive cross-sectional study. Population of the study was hospitalized stroke patients at Neurology Ward, Kemuning Building Dr. Hasan Sadikin General Hospital Bandung, Indonesia from August until October 2014 who meet the inclusion criteria. Nutritional status was measured objectively using Body Mass Index (BMI and subjectively using Subjective Global Assessment (SGA method. The collected data were processed using  frequency tabulation and percentage. Results: Twenty six hospitalized stroke patients were included in this study. The hospitalized patients with normal BMI were about 12 people (46.15%, 8 people were overweight (30.77%, 4 people were undernourished (15.39% and 2 people (7.69% were obese. According to SGA measurement, approximately 18 people (69.22% were moderately malnourished, and as much as 4 people (15.39% were in good nutrition, whereas 4 people (15.39% were severely malnourished. Conclusions: Majority of the hospitalized stroke patients has normal BMI and moderately malnourished based on SGA.   DOI: 10.15850/amj.v4n2.1090

  19. Velocity, stroke rate, and distance per stroke during elite swimming competition.

    Science.gov (United States)

    Craig, A B; Skehan, P L; Pawelczyk, J A; Boomer, W L

    1985-12-01

    The mean velocity of 9 out of 10 women's events during the U.S. Olympic Swimming Trials was greater in 1984 as compared to 1976. Three of the 10 men's events showed improvement. In 9 out of these 12 events, the increased velocity was accounted for by increased distance per stroke (range, -3 to -13%). In the women's 100-m butterfly and 100-m backstroke, increased velocity was due solely to faster stroke rates. The finalists in each event were compared to those whose velocities were 3-7% slower. In almost all events and stroke styles, the finalists achieved greater distances per stroke than did the slower group. In the men's events increased distance per stroke was associated with decreased stroke rate, except in the backstroke, in which both were increased for the finalists. Although the faster women swimmers generally had greater distances per stroke, they were more dependent than men on faster stroke rates to achieve superiority. The profile of velocity for races of 200 m and longer indicated that as fatigue developed the distance per stroke decreased. The faster swimmers compensated for this change by maintaining or increasing stroke rate more than did their slower competitors. This study indicates that improvements and superiority in stroke mechanics are reflected in the stroke rate and distance per stroke used to swim a race.

  20. Designated Stroke Center Status and Hospital Characteristics as Predictors of In-Hospital Mortality among Hemorrhagic Stroke Patients in New York, 2008-2012.

    Science.gov (United States)

    Gatollari, Hajere J; Colello, Anna; Eisenberg, Bonnie; Brissette, Ian; Luna, Jorge; Elkind, Mitchell S V; Willey, Joshua Z

    2017-01-01

    Although designated stroke centers (DSCs) improve the quality of care and clinical outcomes for ischemic stroke patients, less is known about the benefits of DSCs for patients with intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Compared to non-DSCs, hospitals with the DSC status have lower in-hospital mortality rates for hemorrhagic stroke patients. We believed these effects would sustain over a period of time after adjusting for hospital-level characteristics, including hospital size, urban location, and teaching status. We evaluated ICH (International Classification of Diseases, Ninth Revision; ICD-9: 431) and SAH (ICD-9: 430) hospitalizations documented in the 2008-2012 New York State Department of Health Statewide Planning and Research Cooperative System inpatient sample database. Generalized estimating equation logistic regression was used to evaluate the association between DSC status and in-hospital mortality. We calculated ORs and 95% CIs adjusted for clustering of patients within facilities, other hospital characteristics, and individual level characteristics. Planned secondary analyses explored other hospital characteristics associated with in-hospital mortality. In 6,352 ICH and 3,369 SAH patients in the study sample, in-hospital mortality was higher among those with ICH compared to SAH (23.7 vs. 18.5%). Unadjusted analyses revealed that DSC status was related with reduced mortality for both ICH (OR 0.7, 95% CI 0.5-0.8) and SAH patients (OR 0.4, 95% CI 0.3-0.7). DSC remained a significant predictor of lower in-hospital mortality for SAH patients (OR 0.6, 95% CI 0.3-0.9) but not for ICH patients (OR 0.8, 95% CI 0.6-1.0) after adjusting for patient demographic characteristics, comorbidities, hospital size, teaching status and location. Admission to a DSC was independently associated with reduced in-hospital mortality for SAH patients but not for those with ICH. Other patient and hospital characteristics may explain the benefits of DSC

  1. Processes of early stroke care and hospital costs

    DEFF Research Database (Denmark)

    Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H

    2014-01-01

    Background: The relationship between processes of early stroke care and hospital costs remains unclear. Aims: We therefore examined the association in a population-based cohort study. Methods: We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005...... of hospitalization were $23352 (standard deviation 27827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose-response relationship. The adjusted costs were $24566 (95% confidence interval 19364-29769) lower for patients who received 75......-100% of the relevant processes of care compared with patients receiving 0-24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Conclusions: Early care in agreement with key guidelines recommendations for the management...

  2. Thrombolytic utilization for ischemic stroke in US hospitals with neurology residency program.

    Science.gov (United States)

    Moradiya, Yogesh; Crystal, Howard; Valsamis, Helen; Levine, Steven R

    2013-12-03

    We aimed to compare the rates of thrombolysis utilization for acute ischemic stroke in hospitals with neurology residency (NR) to those of other teaching (OT) and nonteaching (NT) hospitals. A retrospective serial cross-sectional cohort study of a nationally representative sample of stroke patients was conducted. Accreditation Council for Graduate Medical Education-accredited NR program-affiliated hospitals in the United States were cross-matched to the hospitals in the Nationwide Inpatient Sample from 2000 to 2010. ICD-9-CM codes were used for case ascertainment. A total of 712,433 adult ischemic stroke patients from 6,839 hospital samples were included, of whom 10.1%, 29.1%, and 60.8% were treated in NR, OT, and NT hospitals, respectively. Stroke patients in NR received thrombolysis more frequently (3.74% ± 0.24% [standard error]) than in OT (2.28% ± 0.11%, p < 0.001) and NT hospitals (1.44% ± 0.06%, p < 0.001). The adjusted odds ratios (ORs) of thrombolysis rates in NR vs OT and NR vs NT increased with each decade increment in age. In multivariate analysis, NR was independently predictive of higher thrombolysis rate (adjusted OR 1.51; 95% confidence interval [CI] 1.44-1.59 [NR vs OT], and adjusted OR 1.82; 95% CI 1.73-1.91 [NR vs NT]). Acute stroke care in NR hospitals is associated with an increased thrombolytic utilization. The disparities between the thrombolysis rate in NR and that in OT and NT hospitals are greater among elderly patients.

  3. The time course of subsequent hospitalizations and associated costs in survivors of an ischemic stroke in Canada

    Directory of Open Access Journals (Sweden)

    Ishak Khajak J

    2006-08-01

    Full Text Available Abstract Background Documentation of the hospitalizations rates following a stroke provides the inputs required for planning health services and to evaluate the economic efficiency of any new therapies. Methods Hospitalization rates by cause were examined using administrative data on 18,695 patients diagnosed with ischemic stroke (first or subsequent, excluding transient ischemic attack in Saskatchewan, Canada between 1990 and 1995. Medical history was available retrospectively to January 1980 and follow-up was complete to March 2000. Analyses evaluated the rate and timing of all-cause and cardiovascular hospitalizations within discrete periods in the five years following the index stroke. Cardiovascular hospitalizations included patients with a primary diagnosis of ischemic stroke, transient ischemic attack, myocardial infarction, stable or unstable angina, heart failure or peripheral arterial disease. Results One-third (36% of patients were identified by a hospitalized stroke. Mean age was 70.5 years, 48.0% were male, half had a history of stroke or a transient ischemic attack at the time of their index stroke. Three-quarters of the patients (72.7% were hospitalized at least once during a mean follow-up of 4.6 years, accruing CAD $24 million in the first year alone. Of all hospitalizations, 20.4% were related to cardiovascular disease and 1.6% to bleeds. In the month following index stroke, 12.5% were admitted, an average of 1.04 times per patient hospitalized. Strokes accounted for 33% of all hospitalizations in the first month. The rate diminished steadily throughout the year and stabilized in the second year when approximately one-third of patients required hospitalization, at a rate of about one hospitalization for every two patient-years. Mean lengths of stay ranged from nine days to nearly 40 days. Close-fitting Weibull functions allow highly specific probability estimates. Other cardiovascular risk factors significantly increased

  4. The time course of subsequent hospitalizations and associated costs in survivors of an ischemic stroke in Canada.

    Science.gov (United States)

    Caro, J Jaime; Migliaccio-Walle, Kristen; Ishak, Khajak J; Proskorovsky, Irina; O'Brien, Judith A

    2006-08-14

    Documentation of the hospitalizations rates following a stroke provides the inputs required for planning health services and to evaluate the economic efficiency of any new therapies. Hospitalization rates by cause were examined using administrative data on 18,695 patients diagnosed with ischemic stroke (first or subsequent, excluding transient ischemic attack) in Saskatchewan, Canada between 1990 and 1995. Medical history was available retrospectively to January 1980 and follow-up was complete to March 2000. Analyses evaluated the rate and timing of all-cause and cardiovascular hospitalizations within discrete periods in the five years following the index stroke. Cardiovascular hospitalizations included patients with a primary diagnosis of ischemic stroke, transient ischemic attack, myocardial infarction, stable or unstable angina, heart failure or peripheral arterial disease. One-third (36%) of patients were identified by a hospitalized stroke. Mean age was 70.5 years, 48.0% were male, half had a history of stroke or a transient ischemic attack at the time of their index stroke. Three-quarters of the patients (72.7%) were hospitalized at least once during a mean follow-up of 4.6 years, accruing CAD $24 million in the first year alone. Of all hospitalizations, 20.4% were related to cardiovascular disease and 1.6% to bleeds. In the month following index stroke, 12.5% were admitted, an average of 1.04 times per patient hospitalized. Strokes accounted for 33% of all hospitalizations in the first month. The rate diminished steadily throughout the year and stabilized in the second year when approximately one-third of patients required hospitalization, at a rate of about one hospitalization for every two patient-years. Mean lengths of stay ranged from nine days to nearly 40 days. Close-fitting Weibull functions allow highly specific probability estimates. Other cardiovascular risk factors significantly increased hospitalization rates. After stroke, there are frequent

  5. Hospital-based stroke care in Ireland: results from one regional register.

    LENUS (Irish Health Repository)

    Fan, C W

    2000-01-01

    Most patients with acute stroke are admitted to hospital. If stroke services in this country are to be improved, we need accurate and reliable information about the types of stroke patients being admitted, their present management and outcome.

  6. Formation and function of acute stroke-ready hospitals within a stroke system of care recommendations from the brain attack coalition.

    Science.gov (United States)

    Alberts, Mark J; Wechsler, Lawrence R; Jensen, Mary E Lee; Latchaw, Richard E; Crocco, Todd J; George, Mary G; Baranski, James; Bass, Robert R; Ruff, Robert L; Huang, Judy; Mancini, Barbara; Gregory, Tammy; Gress, Daryl; Emr, Marian; Warren, Margo; Walker, Michael D

    2013-12-01

    Many patients with an acute stroke live in areas without ready access to a Primary or Comprehensive Stroke Center. The formation of care facilities that meet the needs of these patients might improve their care and outcomes and guide them and emergency responders to such centers within a stroke system of care. The Brain Attack Coalition conducted an electronic search of the English medical literature from January 2000 to December 2012 to identify care elements and processes shown to be beneficial for acute stroke care. We used evidence grading and consensus paradigms to synthesize recommendations for Acute Stroke-Ready Hospitals (ASRHs). Several key elements for an ASRH were identified, including acute stroke teams, written care protocols, involvement of emergency medical services and emergency department, and rapid laboratory and neuroimaging testing. Unique aspects include the use of telemedicine, hospital transfer protocols, and drip and ship therapies. Emergent therapies include the use of intravenous tissue-type plasminogen activator and the reversal of coagulopathies. Although many of the care elements are similar to those of a Primary Stroke Center, compliance rates of ≥67% are suggested in recognition of the staffing, logistical, and financial challenges faced by rural facilities. ASRHs will form the foundation for acute stroke care in many settings. Recommended elements of an ASRH build on those proven to improve care and outcomes at Primary Stroke Centers. The ASRH will be a key component for patient care within an evolving stroke system of care.

  7. The time course of subsequent hospitalizations and associated costs in survivors of an ischemic stroke in Canada

    OpenAIRE

    Ishak Khajak J; Migliaccio-Walle Kristen; Caro J Jaime; Proskorovsky Irina; O'Brien Judith A

    2006-01-01

    Abstract Background Documentation of the hospitalizations rates following a stroke provides the inputs required for planning health services and to evaluate the economic efficiency of any new therapies. Methods Hospitalization rates by cause were examined using administrative data on 18,695 patients diagnosed with ischemic stroke (first or subsequent, excluding transient ischemic attack) in Saskatchewan, Canada between 1990 and 1995. Medical history was available retrospectively to January 19...

  8. Acute Stroke Through the Perspective of a County Hospital: Problems and Opportunities

    Directory of Open Access Journals (Sweden)

    Atay Vural

    2016-04-01

    Full Text Available Objective: Stroke is one of the most important public health issues worldwide, and ranks as the second highest cause of mortality in our country. Regular follow-up of stroke statistics and taking necessary precautions upon determining deficits by countries themselves constitute the most important way of improving prognosis and survival after stroke incidents. To achieve this goal, statistical studies should be performed at various levels of healthcare services. Tertiary care hospitals are the most suitable centers to perform these studies. However, the majority of the population receives service at secondary care centers where the actual statistics remain unknown. The objective of this study was to examine all patients with acute stroke who presented to a county hospital over a one-year period and obtain related data, discuss deficits, and provide solutionbased recommendations. Materials and Methods: All patients diagnosed as having acute stroke between July 2013-July 2014 were included in the study. Demographic, clinical, and radiologic data, in addition to the timing of presentation and baseline National Institutes of Health Stroke Scale (NIHSS scores were recorded retrospectively, and patients were classified by the type of stroke. All patients were followed up for at least one year after the stroke incident and cumulative survival scores were calculated using Kaplan-Meier analysis. Results: Hemorrhagic stroke was determined in four out of 49 patients with acute stroke; the 45 patients diagnosed as having ischemic stroke were included in the study. Among these, 44.4% (n=20 of the patients presented within the first three hours of onset of clinical symptoms, 4.4% (n=2 presented at 3.-4.5 hours. Baseline NIHSS was 1-4 (mild stroke in 50% (n=10 of patients who presented in the first three hours, and >5 (moderate or severe stroke in 50% (n=10 of the remaining patients. The etiologic cause was embolic in 37.1% (n=13, large artery atherosclerosis

  9. Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors.

    Science.gov (United States)

    Zhou, Yanfeng; Yang, Tingting; Gong, Yanhong; Li, Wenzhen; Chen, Yawen; Li, Jing; Wang, Mengdie; Yin, Xiaoxv; Hu, Bo; Lu, Zuxun

    2017-05-01

    Timely thrombolytic treatment is paramount after acute ischemic stroke (AIS); however, a large proportion of patients experience substantial delays in presentation to hospital. This study evaluates the prevalence and risk factors in pre-hospital delays after AIS in central urban China. AIS patients from 66 hospitals in 13 major cities across Hubei Province, between October 1, 2014 and January 31, 2015 were interviewed and their medical records were reviewed to identify those who suffered pre-hospital delays. Bivariate and multivariate analyses were undertaken to determine the prevalence rates and the risk factors associated with pre-hospital delays. A total of 1835 patients were included in the analysis, with 69.3 % patients reportedly arrived at hospital 3 or more hours after onset and 55.3 % patients arrived 6 or more hours after onset. Factors associated with increased pre-hospital delays for 3 or more hours were as follows: patient had a history of stroke (odds ratio (OR), 1.319, P = 0.028), onset location was at home (OR, 1.573, P = 0.002), and patients rather than someone else noticed the symptom onset first (OR, 1.711; P pre-hospital delays. These findings indicate that pre-hospital delays after AIS are common in urban central China, and future intervention programs should be focused on public awareness of stroke and appropriate response.

  10. Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.

    Directory of Open Access Journals (Sweden)

    Sven Streit

    Full Text Available Transient ischemic attacks (TIA are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs and hospital physicians (HPs knew about stroke risk after TIA, and to measure their referral rates.We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients.Of the 1545 physicians, 40% (614 returned the survey. Of these, 75% (457 overestimated stroke risk within 24 hours, and 40% (245 overestimated risk within 3 months after TIA. Only 9% (53 underestimated stroke risk within 24 hours and 26% (158 underestimated risk within 3 months; 78% (473 of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543 would rigorously investigate the cause of a TIA, but only 38% (229 would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care.Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

  11. Curitiba acute ischemic stroke protocol: a university hospital and EMS initiative in a large Brazilian city

    Directory of Open Access Journals (Sweden)

    Marcos Christiano Lange

    2011-06-01

    Full Text Available Few healthcare centers in Brazil perform thrombolytic therapy for acute ischemic stroke (AIS patients. OBJECTIVE: The aim of this study was to describe an interinstitutional protocol for the rapid identification and thrombolytic treatment of AIS patients at a public health hospital in a large Brazilian city. METHOD: Emergency medical services (EMS personnel evaluated 433 patients with possible stroke during a six-month period. After a standard checklist, patients with suspected AIS and symptoms onset of less than two hours were evaluated at our University Hospital (UH. RESULTS: Sixty-five (15% patients met the checklist criteria and had a symptom onset of less than two hours, but only 50 (11% patients were evaluated at the UH. Among them, 35 (70% patients had ischemic stroke, 10 (20% had hemorrhagic stroke, and 5 (10% had other diagnoses. Of the 35 ischemic stroke patients, 15 (43% underwent IV thrombolysis. CONCLUSION: The present study demonstrated that trained EMS workers could help to improve the rate of thrombolytic treatment in large Brazilian cities. Permanent training programs for EMS and hospital staff, with quality control and correct identification of AIS patients, should be implemented to increase appropriate thrombolytic therapy rates in Brazil.

  12. Beyond Volume: Hospital-Based Healthcare Technology for Better Outcomes in Cerebrovascular Surgical Patients Diagnosed With Ischemic Stroke

    OpenAIRE

    Kim, Jae-Hyun; Park, Eun-Cheol; Lee, Sang Gyu; Lee, Tae-Hyun; Jang, Sung-In

    2016-01-01

    Abstract We examined whether the level of hospital-based healthcare technology was related to the 30-day postoperative mortality rates, after adjusting for hospital volume, of ischemic stroke patients who underwent a cerebrovascular surgical procedure. Using the National Health Insurance Service-Cohort Sample Database, we reviewed records from 2002 to 2013 for data on patients with ischemic stroke who underwent cerebrovascular surgical procedures. Statistical analysis was performed using Cox ...

  13. Epidemiology and in-hospital outcome of stroke in South Ethiopia.

    Science.gov (United States)

    Deresse, Birrie; Shaweno, Debebe

    2015-08-15

    Although the burden of stroke in Sub-Saharan Africa, including Ethiopia, is increasing, there are few available data on stroke in Ethiopia. To describe the magnitude of risk factors, sub-types and in-hospital outcome of stroke at Hawassa University Referral Hospital, Ethiopia. A prospective hospital-based study was conducted with all adult patients admitted to Hawassa University Referral Hospital with stroke diagnosis between May 2013 and April 2014. Computerized tomography scan was performed in all patients to confirm the type of stroke. Stroke severity at admission was assessed by the National Institute of Health Stroke Scale. Stroke outcome at discharge was measured using the modified Rankin stroke scale. A total of 163 stroke patients were recruited during the study period, of which 82 (50.3%) patients had ischemic stroke while 81 (49.7%) had hemorrhagic stroke. Stroke risk factors included hypertension (50.9%), cardiac diseases (16.6%), diabetes mellitus (7.4%), alcohol (10.4%), cigarette smoking (4.9%) and tuberculous meningitis (3.1%). In-hospital stroke mortality was 14.7%. The main predictors of in-hospital stroke mortality were stroke severity at admission, hemorrhagic stroke, decreased level of consciousness and seizure. The proportion of hemorrhagic stroke is higher than in Western countries. Hypertension is the most common risk factor for stroke. More than half of the patients were discharged with severe disability. We recommend establishing stroke units in resource limited countries like Ethiopia in order to reduce stroke mortality and post stroke disability. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Increasing Incidence of Hospitalization for Stroke and Transient Ischemic Attack in Young Adults: A Registry-Based Study.

    Science.gov (United States)

    Tibæk, Maiken; Dehlendorff, Christian; Jørgensen, Henrik S; Forchhammer, Hysse B; Johnsen, Søren P; Kammersgaard, Lars P

    2016-05-11

    Studies have reported increasing incidence of ischemic stroke in adults younger than 50 to 55 years. Information on temporal trends of other stroke subtypes and transient ischemic attack (TIA) is sparse. The aim of this study was to investigate temporal trends of the incidence of hospitalizations for TIA and stroke including sex- and subtype-specific trends in young adults aged 15 to 30 years. From the Danish National Patient Register, we identified all cases of first-ever stroke and TIA (age 15-30 years) in Denmark, who were hospitalized during the study period of 1994 to 2012. Incidence rates and estimated annual percentage changes (EAPCs) were estimated by using Poisson regression. During the study period, 4156 cases of first-ever hospitalization for stroke/TIA were identified. The age-standardized incidence rates of hospitalizations for stroke increased significantly (EAPC 1.83% [95% CI 1.11-2.55%]) from 11.97/100 000 person-years (PY) in 1994 to 16.77/100 000 PY in 2012. TIA hospitalizations increased from 1.93/100 000 PY in 1994 to 5.81/100 000 PY in 2012 and after 2006 more markedly in men than in women (EAPC 16.61% [95% CI 10.45-23.12%]). The incidence of hospitalizations for ischemic stroke was markedly lower among men, but increased significantly from 2006 (EAPC 14.60% [95% CI 6.22-23.63%]). The incidences of hospitalizations for intracerebral hemorrhage and subarachnoid hemorrhage remained stable during the study period. The incidence rates of first-time hospitalizations for ischemic stroke and TIA in young Danish adults have increased substantially since the mid 1990s. The increase was particularly prominent in the most recent years. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  15. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals.

    Science.gov (United States)

    Dimitrov, Nikolay; Koenig, William; Bosson, Nichole; Song, Sarah; Saver, Jeffrey L; Mack, William J; Sanossian, Nerses

    2015-09-01

    Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Each county's local emergency medical services agency (LEMSA) was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45%) had stroke routing protocols, covering 23 counties (40%) and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile). In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.

  16. Trends in in-hospital mortality among patients with stroke in China.

    Directory of Open Access Journals (Sweden)

    Qian He

    Full Text Available BACKGROUND: The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China. METHODS: 109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression. RESULTS: Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001. The percentage of severe patients increased while odds of mortality (2010 versus 2007 decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987, intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708, and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649. In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality. CONCLUSIONS: The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.

  17. Characteristics and outcome of stroke patients with cerebrovascular accident at the intensive care unit of a tertiary hospital in Nigeria.

    Science.gov (United States)

    Tobi, Ku; Okojie, Nq

    2013-01-01

    Patients with severe stroke defined as NIHSS score >17 constituting about 15-20% of cerebrovascular accident require admission into the Intensive Care Unit (ICU). However the benefit of ICU admission for stroke patients remains controversial. Aim & Objectives: To determine the characteristics and outcome of patients with cerebrovascular accident managed at the Intensive Care Unit of University of Benin Teaching Hospital. Demographic characteristics, clinical features and course, treatment options and outcome of all stroke patients admitted in ICU from January 2002 to January 2012 were retrieved from the hospital records and analyzed. A patient before and after each stroke patient were selected as controls for the study. Primary outcome variable was ICU mortality, type of stroke whether ischemic or haemorrhagic, duration of stay, whether patients were transferred from the medical/stroke ward or from the accident and emergency department of the hospital. A total of thirty six (36) stroke patients were admitted into the ICU within the study period accounting for 5.6% of the total ICU admissions. The male: female ratio is 2:1 and patients aged >60 years accounted for 55.6%. Stroke patients admitted into ICU had a mortality rate of 77.8%. Patients with severe stroke admitted into the ICU were 4 times more likely to die compared to non-stroke patients in the ICU (p=0.002, OR=4.472). However, severe stroke had no significant impact on duration of ICU stay (p=0.454, OR=1.464). Stroke patients have a high mortality in the intensive care unit that is independent on the type and route of admission. Provision of the support equipment and instruments required for high dependency service in the intensive care unit and early admission should improve the outcome.

  18. The quality of prehospital ischemic stroke care: compliance with guidelines and impact on in-hospital stroke response.

    Science.gov (United States)

    Oostema, John Adam; Nasiri, Mojdeh; Chassee, Todd; Reeves, Mathew J

    2014-01-01

    A number of emergency medical services (EMSs) performance measures for stroke have been proposed to promote early stroke recognition and rapid transportation to definitive care. This study examined performance measure compliance among EMS-transported stroke patients and the relationship between compliance and in-hospital stroke response. Eight quality indicators were derived from American Stroke Association guidelines. A prospective cohort of consecutive, EMS-transported patients discharged from 2 large Midwestern stroke centers with a diagnosis of acute ischemic stroke was identified. Data were abstracted from hospital and EMS records. Compliance with 8 prehospital quality indicators was calculated. Univariate and multivariable logistic regression analysis were performed to measure the association between prehospital compliance and a binary outcome of door-to-computed tomography (CT) time less than or equal to 25 minutes. Over the 12 month study period, 186 EMS-transported ischemic stroke patients were identified. Compliance was highest for prehospital documentation of a glucose level (86.0%) and stroke screen (78.5%) and lowest for on-scene time less than or equal to 15 minutes (46.8%), hospital prenotification (56.5%), and transportation at highest priority (55.4%). After adjustment for age, time from symptom onset, and stroke severity, transportation at highest priority (odds ratio [OR], 13.45) and hospital prenotification (OR, 3.75) were both associated with significantly faster door-to-CT time. No prehospital quality metric was associated with tissue-plasminogen activator delivery. EMS transportation at highest priority and hospital prenotification were associated with faster in-hospital stroke response and represent logical targets for EMS quality improvement efforts. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Quality of Care and Ischemic Stroke Risk After Hospitalization for Transient Ischemic Attack: Findings From Get With The Guidelines-Stroke.

    Science.gov (United States)

    O'Brien, Emily C; Zhao, Xin; Fonarow, Gregg C; Schulte, Phillip J; Dai, David; Smith, Eric E; Schwamm, Lee H; Bhatt, Deepak L; Xian, Ying; Saver, Jeffrey L; Reeves, Mathew J; Peterson, Eric D; Hernandez, Adrian F

    2015-10-01

    Patients with transient ischemic attack (TIA) are at increased risk for ischemic stroke. We derived a prediction rule for 1-year ischemic stroke risk post-TIA, examining estimated risk, receipt of inpatient quality of care measures for TIA, and the presence or absence of stroke at 1 year post discharge. We linked 67 892 TIA Get With The Guidelines-Stroke patients >65 years (2003-2008) to Medicare inpatient claims to obtain longitudinal outcomes. Using Cox proportional hazards modeling in a split sample, we identified baseline demographics and clinical characteristics associated with ischemic stroke admission during the year post-TIA, and developed a Get With The Guidelines Ischemic Stroke after TIA Risk Score; performance was examined in the validation sample. Quality of care was estimated by a global defect-free care measure, and individual performance measures within estimated risk score quintiles. The overall hospital admission rate for ischemic stroke during the year post-TIA was 5.7%. Patients with ischemic stroke were more likely to be older, black, and have higher rates of smoking, previous stroke, diabetes mellitus, previous myocardial infarction, heart failure, and atrial fibrillation. The Risk Score showed moderate discriminative performance (c-statistic=0.606); highest quintile patients were less likely to receive statins, smoking cessation counseling, and defect-free care. Although not associated with 1-year ischemic stroke, DCF was associated with a significantly lower risk of all-cause mortality. TIA patients with high estimated ischemic stroke risk are less likely to receive defect-free care than low-risk patients. Standardized risk assessment and delivery of optimal inpatient care are needed to reduce this risk-treatment mismatch. © 2015 American Heart Association, Inc.

  20. Stroke incidence rates among black residents of Harare - a ...

    African Journals Online (AJOL)

    general practitioners or the city health clinics directly to one of the four general hospitals. The city health clinics do not have beds for acute medical cases and the general practitioners do not visit patients in their homes, and cannot refer cases of stroke to nursing homes before acute treatment and evaluation by physicians in ...

  1. What happens to stroke patients after hospital discharge?

    LENUS (Irish Health Repository)

    Noone, I

    2001-05-01

    Of 231 stroke patients discharged from hospital, 34 patients (14.7%) had died when reviewed 6 months later. Of 195 survivors, 115 (58%) were independent and living in the community. The remaining 80 (42%) patients were dependent. The majority of dependent patients were in institutional care but 29 (36%) were residing in the community of whom a substantial number were not receiving physiotherapy, occupational therapy or day care. Patients who were dependent in nursing homes were less likely to have received physiotherapy (48% versus 70%) or occupational therapy (28% versus 60%) compared to disabled patients in hospital based extended nursing care. 45 patients (24%) had been re-admitted to hospital although only 48% of patients had been reviewed in hospital outpatients since discharge. 64% of patients were on anti-thrombotic treatment. This survey suggests that 6 months after hospital discharge, most stroke patients are still alive and living in the community. Many of the dependent survivors have ongoing unmet medical and rehabilitation needs.

  2. Association of Indoor Smoke-Free Air Laws with Hospital Admissions for Acute Myocardial Infarction and Stroke in Three States

    Directory of Open Access Journals (Sweden)

    Brett R. Loomis

    2012-01-01

    Full Text Available Objective. To examine whether comprehensive smoke-free air laws enacted in Florida, New York, and Oregon are associated with reductions in hospital admissions for acute myocardial infarction (AMI and stroke. Methods. Analyzed trends in county-level, age-adjusted, hospital admission rates for AMI and stroke from 1990 to 2006 (quarterly for Florida, 1995 to 2006 (monthly for New York, and 1998 to 2006 (monthly for Oregon to identify any association between admission rates and passage of comprehensive smoke-free air laws. Interrupted time series analysis was used to adjust for the effects of preexisting moderate local-level laws, seasonal variation in hospital admissions, differences across counties, and a secular time trend. Results. More than 3 years after passage of statewide comprehensive smoke-free air laws, rates of hospitalization for AMI were reduced by 18.4% (95% CI: 8.8–28.0% in Florida and 15.5% (95% CI: 11.0–20.1% in New York. Rates of hospitalization for stroke were reduced by 18.1% (95% CI: 9.3–30.0% in Florida. The few local comprehensive laws in Oregon were not associated with reductions in AMI or stroke statewide. Conclusion. Comprehensive smoke-free air laws are an effective policy tool for reducing the burden of AMI and stroke.

  3. Generalization of the Right Acute Stroke Prevention Strategies in Reducing in-Hospital Delays.

    Directory of Open Access Journals (Sweden)

    Qiang Huang

    Full Text Available The aim of this study was to reduce the door-to-needle (DTN time of intravenous thrombolysis (IVT in acute ischemic stroke (AIS through a comprehensive, hospital-based implementation strategy. The intervention involved a systemic literature review, identifying barriers to rapid IVT treatment at our hospital, setting target DTN time intervals, and building an evolving model for IVT candidate selection. The rate of non-in-hospital delay (DTN time ≤ 60 min was set as the primary endpoint. A total of 348 IVT cases were enrolled in the study (202 and 146 in the pre- and post-intervention group, respectively. The median age was 61 years in both groups; 25.2% and 26.7% of patients in the pre- and post-intervention groups, respectively, were female. The post-intervention group had higher rates of dyslipidemia and minor stroke [defined as National Institutes of Health Stroke Scale (NIHSS ≤ 3]; less frequent atrial fibrillation; higher numbers of current smokers, heavy drinkers, referrals, and multi-model head imaging cases; and lower NIHSS scores and blood sugar level (all P 0.05. These findings indicate that it is possible to achieve a DTN time ≤ 60 min for up to 60% of hospitals in the current Chinese system, and that this logistical change can yield a notable improvement in the outcome of IVT patients.

  4. Pre-hospital Delay as Determinant of Ischemic Stroke Outcome in an Italian Cohort of Patients Not Receiving Thrombolysis.

    Science.gov (United States)

    Denti, Licia; Artoni, Andrea; Scoditti, Umberto; Gatti, Elisa; Bussolati, Chiara; Ceda, Gian Paolo

    2016-06-01

    Pre-hospital delay in acute stroke is critical to the administration of thrombolysis and affects patients' clinical outcome. In this study, the impact of pre-hospital delay on the outcome of ischemic stroke was investigated in an Italian cohort of patients who did not receive thrombolysis. Data from a cohort of 1847 patients, suffering from first-ever ischemic stroke and referred to an in-hospital clinical pathway were analyzed retrospectively. The relationship between pre-hospital delay and 1-month mortality was assessed with adjustment for demographics, premorbid disability, and stroke severity, which was graded according to the Scandinavian Stroke Scale, with higher scores indicating less severity. Five hundred and twelve patients (27.7%) arrived at hospital within 2 hours of symptom onset. A significant correlation was found between early arrival and a reduced risk of 1-month mortality (hazard ratio .65; 95% confidence interval .48-.89; P = .02). There was a significant interaction (P = .01) between pre-hospital delay and the neurological score on mortality in the multivariate model, and the survival advantage of early admission was significant only for patients with scores on the Scandinavian Stroke Scale less than 18 (hazard ratio .54; 95% confidence interval .34-.85; P = .008). Our study suggests that reducing pre-hospital delay can increase the probability of survival in patients with ischemic stroke, especially those who are most severely affected. Even if the patients cannot benefit from thrombolysis, survival rates can be increased provided that they are managed according to standardized care processes. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Validation of the Caregivers' Satisfaction with Stroke Care Questionnaire: C-SASC hospital scale

    NARCIS (Netherlands)

    J.M. Cramm (Jane); M.M.H. Strating (Mathilde); A.P. Nieboer (Anna)

    2011-01-01

    textabstractTo date, researchers have lacked a validated instrument to measure stroke caregivers' satisfaction with hospital care. We adjusted a validated patient version of satisfaction with hospital care for stroke caregivers and tested the 11-item caregivers' satisfaction with hospital care

  6. Improved prehospital triage of patients with stroke in a specialized stroke ambulance: results of the pre-hospital acute neurological therapy and optimization of medical care in stroke study.

    Science.gov (United States)

    Wendt, Matthias; Ebinger, Martin; Kunz, Alexander; Rozanski, Michal; Waldschmidt, Carolin; Weber, Joachim E; Winter, Benjamin; Koch, Peter M; Freitag, Erik; Reich, Jenrik; Schremmer, Daniel; Audebert, Heinrich J

    2015-03-01

    Specialized management of patients with stroke is not available in all hospitals. We evaluated whether prehospital management in the Stroke Emergency Mobile (STEMO) improves the triage of patients with stroke. STEMO is an ambulance staffed with a specialized stroke team and equipped with a computed tomographic scanner and point-of-care laboratory. We compared the prehospital triage of patients with suspected stroke at dispatcher level who either received STEMO care or conventional care. We assessed transport destination in patients with different diagnoses. Status at hospital discharge was used as short-term outcome. From May 2011 to January 2013, 1804 of 6182 (29%) patients received STEMO care and 4378 of 6182 (71%) patients conventional care. Two hundred forty-five of 2110 (11.6%) patients with cerebrovascular events were sent to hospitals without Stroke Unit in conventional care when compared with 48 of 866 (5.5%; Pstroke, STEMO care reduced transport to hospitals without Stroke Unit from 10.1% (151 of 1497) to 3.9% (24 of 610; P<0.01). The delivery rate of patients with intracranial hemorrhage to hospitals without neurosurgery department was 43.0% (65 of 151) in conventional care and 11.3% (7 of 62) in STEMO care (P<0.01). There was a slight trend toward higher rates of patients discharged home in neurological patients when cared by STEMO (63.5% versus 60.8%; P=0.096). The triage of patients with cerebrovascular events to specialized hospitals can be improved by STEMO ambulances. http://www.clinicaltrials.gov. Unique identifier: NCT01382862. © 2015 American Heart Association, Inc.

  7. Registry of patients with stroke stated in a public hospital of Peru, 2000-2009

    OpenAIRE

    Castañeda-Guarderas, Ana; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Cirujano.; Beltrán-Ale, Guillermo; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Cirujano.; Casma-Bustamante, Renzo; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Cirujano.; Ruíz-Grosso, Paulo; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Grupo de Trabajo en Salud Mental, Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Cirujano.; Málaga, Germán; Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia. Lima, Perú. Centro de Excelencia en Enfermedades Crónicas (CRONICAS), Universidad Peruana Cayetano Heredia. Lima, Perú. Departamento de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú. Médico Internista, Magíster en Medicina.

    2014-01-01

    We performed a descriptive study taking on account the characteristics of the registries of the patients hospitalized at the Hospital Nacional Cayetano Heredia between the years 2000 and 2009 with stroke as hospitalization diagnosis. 2225 records were obtained from patients older than 18, with stroke. According to ICD-10, 1071 had diagnosis of ischemic stroke, 554 were hemorrhagic, 183 were subarachnoid hemorrhage, 49 were ischemic plus hemorrhagic, 10 were transient ischemic attack (TIA)...

  8. Erythrocyte sedimentation rate: Can be a prognostic marker in acute ischemic stroke?

    Directory of Open Access Journals (Sweden)

    Selim Selçuk Çomoğlu

    2013-01-01

    Full Text Available OBJECTIVE: The aim of this study is to investigate the relationship between the erythrocyte sedimentation rate (ESR values and the severity of neurological findings on admission, short- term prognosis, risk factors and etiology of the patients with acute ischemic stroke. MATERIAL and METHODS: One hundred and fifty-eight consecutive patients who admitted to the hospital within 24 hours of stroke onset were retrospectively analyzed. National Institutes of Health Stroke Scale (NIHSS and modified Rankin Scale (mRS scores on admission and mRS scores at discharge, brain imaging findings, stroke etiology and risk factors of the patients were recorded. Patients were classified into three groups according to ESR values on admission and compared in terms of severity of clinical symptoms on admission, short-term prognosis, risk factors and etiology of stroke. RESULTS: A total 158 patients with acute ischemic stroke including 89 women and 69 men were enrolled in the study. Patients with ESR≤10 mm/h were included in group 1 (n=49, ESR levels between 11-25 mm/h were included in group 2 (n=69 and ESR≥26 mm/h were included in group 3 (n=40. No significant difference was determined between the groups in terms of NIHSS and mRS scores on admission and mRS scores at discharge and etiology of stroke. While coronary artery disease was found more frequently in group 1 and 2 than group 3 (p=0.018, valvular heart disease was more frequently in group 2 than group 1 (p=0.037. CONCLUSION: The results of our study revealed that ESR levels on admission do not reflect the severity of stroke and can not be accepted as a useful predictor of short-term prognosis in patients with acute ischemic stroke.

  9. The influence of the day of the week of hospital admission on the prognosis of stroke patients.

    Science.gov (United States)

    Barros, Juliana B; Goulart, Alessandra Carvalho; Alencar, Airlane P; Lotufo, Paulo A; Bensenor, Isabela M

    2013-04-01

    This study aimed to evaluate the weekday and weekend distribution of stroke case hospital admissions and their respective prognosis based on a sample from the Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral (EMMA), a cohort of stroke patients admitted to a community hospital in the city of São Paulo, Brazil. We ascertained all consecutive cases of first-time strokes between April 2006 and December 2008 and performed a subsequent one-year follow-up. No association was found between frequency of hospital admissions due to ischemic and hemorrhagic strokes and the specific day of the week on which the admission occurred. However, ten-day and twelve-month case-fatality was higher in hemorrhagic stroke patients admitted at the weekend. We also found that intracerebral hemorrhage patients admitted on weekends had a worse survival rate (50%) compared with those admitted during weekdays (25.6%, P log-rank = 0.03). We found a multivariate hazard ratio of 2.49 (95%CI: 1.10-5.81, P trend = 0.03) for risk of death at the weekend compared to weekdays for intracerebral hemorrhage cases. No difference in survival was observed with respect to the overall sample of stroke or ischemic stroke patients.

  10. Diurnal Variation of Intravenous Thrombolysis Rates for Acute Ischemic Stroke and Associated Quality Performance Parameters

    Directory of Open Access Journals (Sweden)

    Björn Reuter

    2017-07-01

    Full Text Available IntroductionBased on data from the Baden-Wuerttemberg stroke registry, we aimed to explore the diurnal variation of acute ischemic stroke (IS care delivery.Materials and methods92,530 IS patients were included, of whom 37,471 (40% presented within an onset-to-door time ≤4.5 h. Daytime was stratified in 3-h time intervals and working vs. non-working hours. Stroke onset and hospital admission time, rate of door-to-neurological examination time ≤30 min, onset-/door-to-imaging time IV thrombolysis (IVT rates, and onset-/door-to-needle time were determined. Multivariable regression models were used stratified by stroke onset and hospital admission time to assess the relationship between IVT rates, quality performance parameters, and daytime. The time interval 0:00 h to 3:00 h and working hours, respectively, were taken as reference.ResultsThe IVT rate of the whole study population was strongly associated with the sleep–wake cycle. In patients presenting within the 4.5-h time window and potentially eligible for IVT stratification by hospital admission time identified two time intervals with lower IVT rates. First, between 3:01 h and 6:00 h (IVT rate 18% and likely attributed to in-hospital delays with the lowest diurnal rate of door-to-neurological examination time ≤30 min and the longest door-to-needle time Second, between 6:01 h and 15:00 h (IVT rate 23–25% compared to the late afternoon and evening hours (IVT rate 27–29% due to a longer onset-to-imaging time and door-to-imaging time. No evidence for a compromised stroke service during non-working hours was observed.ConclusionThe analysis provides evidence that acute IS care is subject to diurnal variation which may affect stroke outcome. An optimization of IS care aiming at constantly high IVT rates over the course of the day therefore appears desirable.

  11. Ethnicity and thrombolysis in ischemic stroke: a hospital based study in Amsterdam

    Directory of Open Access Journals (Sweden)

    Stam Jan

    2011-06-01

    Full Text Available Abstract Background Ethnic differences have been reported with regard to several medical therapies. The aim of this study was to investigate the relation between ethnicity and thrombolysis in stroke patients. Methods Retrospective single-centre study. Patients admitted with an ischemic stroke between 2003 and 2008 were included. Ethnicity was determined by self-identification and stratified into white and non-white (all other ethnicities. The main outcome measure was the difference in thrombolysis rate between white and non-white patients. Logistic regression analysis was used to identify potential confounders of the relation between ethnicity and thrombolysis. Results 510 patients were included, 392 (77% white and 118 (23% non-white. Non-white patients were younger (median 69 vs. 60 years, p Conclusions Non-white stroke patients less often received thrombolysis than white patients, partly as a result of a delay in presentation. In this single centre study, potential bias due to hospital differences or insurance status could be ruled out as a cause. The magnitude of the difference is worrisome and requires further investigation. Modifiable causes, such as patient delay, awareness of stroke symptoms, language barriers and treatment of cardiovascular risk factors, should be addressed specifically in these ethnic groups in future stroke campaigns.

  12. Risk of stroke in patients hospitalized for isolated vertigo: a four-year follow-up study.

    Science.gov (United States)

    Lee, Ching-Chih; Su, Yu-Chieh; Ho, Hsu-Chieh; Hung, Shih-Kai; Lee, Moon-Sing; Chou, Pesus; Huang, Yung-Sung

    2011-01-01

    vertigo is a common presenting symptom in ambulatory care settings, and stroke is its leading and most challenging concern. This study aimed to determine the risk of stroke in vertigo patients in a 4-year follow-up after hospitalization for acute isolated vertigo. the study cohorts consisted of all patients hospitalized with a principal diagnosis of vertigo (n=3021), whereas patients hospitalized for an appendectomy in 2004 (n=3021) comprised the control group and surrogate for the general population. Cox proportional hazard model was performed as a means of comparing the 4-year stroke-free survival rate between the 2 cohorts after adjusting for possible confounding and risk factors. Among vertigo patients, there was further stratification for risk factors to identify the group at high risk for stroke. of the 243 stroke patients, 185 (6.1%) were from the study cohort and 58 (1.9%) were from the control group. Comparing the 2 groups, patients with vertigo symptoms had a 3.01-times (95% CI, 2.20-4.11; Pstroke after adjusting for patient characteristics, comorbidities, geographic region, urbanization level of residence, and socioeconomic status. Vertigo patients with ≥ 3 risk factors had a 5.51-fold higher risk for stroke (95% CI, 3.10-9.79; Pstroke than the general population. They should have a comprehensive neurological examination, vascular risk factors survey, and regular follow-up for several years after hospital discharge after treatment of isolated vertigo.

  13. European Academy of Neurology and European Stroke Organization consensus statement and practical guidance for pre-hospital management of stroke.

    Science.gov (United States)

    Kobayashi, A; Czlonkowska, A; Ford, G A; Fonseca, A C; Luijckx, G J; Korv, J; de la Ossa, N Pérez; Price, C; Russell, D; Tsiskaridze, A; Messmer-Wullen, M; De Keyser, J

    2018-03-01

    The reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving the chances of a favourable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations. Despite very low quality of evidence educational campaigns to increase the awareness of immediately calling emergency medical services are strongly recommended. Moderate quality evidence was found to support strong recommendations for the training of emergency medical personnel in recognizing the symptoms of a stroke and in implementation of a pre-hospital 'code stroke' including highest priority dispatch, pre-hospital notification and rapid transfer to the closest 'stroke-ready' centre. Insufficient evidence was found to recommend a pre-hospital stroke scale to predict large vessel occlusion. Despite the very low quality of evidence, restoring normoxia in patients with hypoxia is recommended, and blood pressure lowering drugs and treating hyperglycaemia with insulin should be avoided. There is insufficient evidence to recommend the routine use of mobile stroke units delivering intravenous thrombolysis at the scene. Because only feasibility studies have been reported, no recommendations can be provided for pre-hospital telemedicine during ambulance transport. These guidelines inform on the contemporary approach to patients with suspected stroke in the pre-hospital setting. Further studies, preferably randomized controlled trials, are required to examine the impact of particular interventions on quality parameters and outcome. © 2017 EAN.

  14. Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment

    DEFF Research Database (Denmark)

    Simonsen, Sofie; Andresen, Morten; Michelsen, Lene

    2014-01-01

    BackgroundEffective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during...

  15. Epidemiology of stroke patients in Tikur Anbessa Specialized Hospital

    African Journals Online (AJOL)

    unhcc

    2013-09-20

    Sep 20, 2013 ... stroke are not well identified in Ethiopia. Methods: A retrospective chart review of all stroke patients who presented from December 2010 to December ... In developed nations, ischemic stroke accounts for 85. % of the stroke types (1,5-6), but in ..... Emphasis on Stroke in the Young. EthiopJHealth. Dev. 2002 ...

  16. Critical stroke rate as a parameter for evaluation in swimming

    Directory of Open Access Journals (Sweden)

    Marcos Franken

    2013-12-01

    Full Text Available The purpose of this study was to investigate the critical stroke rate (CSR compared to the average stroke rate (SR when swimming at the critical speed (CS. Ten competitive swimmers performed five 200 m trials at different velocities relative to their CS (90, 95, 100, 103 and 105% in front crawl. The CSR was significantly higher than the SR at 90% of the CS and lower at 105% of the CS. Stroke length (SL at 103 and 105% of the CS were lower than the SL at 90, 95, and 100% of the CS. The combination of the CS and CSR concepts can be useful for improving both aerobic capacity/power and technique. CS and CSR could be used to reduce the SR and increase the SL, when swimming at the CS pace, or to increase the swimming speed when swimming at the CSR.

  17. Nursing magnet hospitals have better CMS hospital compare ratings

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-11-01

    Full Text Available Background: There has been conflicting data on whether Nursing Magnet Hospitals (NMH provide better care. Methods: NMH in the Southwest USA (Arizona, California, Colorado, Hawaii, Nevada, and New Mexico were compared to hospitals not designated as NMH using the Centers for Medicare and Medicaid (CMS hospital compare star designation. Results: NMH had higher star ratings than non-NMH hospitals (3.34 + 0.78 vs. 2.86 + 0.83, p<0.001. The hospitals were mostly large, urban non-critical access hospitals. Academic medical centers made up a disproportionately large portion of the NMH. Conclusions: Although NMH had higher hospital ratings, the data may favor non-critical access academic medical centers which are known to have better outcomes.

  18. Epidemiology of Stroke in Costa Rica: A 7-Year Hospital-Based Acute Stroke Registry of 1319 Consecutive Patients.

    Science.gov (United States)

    Torrealba-Acosta, Gabriel; Carazo-Céspedes, Kenneth; Chiou, Sy Han; O'Brien, Anthony Terrence; Fernández-Morales, Huberth

    2017-12-25

    Limited data on stroke exist for Costa Rica. Therefore, we created a stroke registry out of patients with stroke seen in the Acute Stroke Unit of the Hospital Calderon Guardia. We analyzed 1319 patients enrolled over a 7-year period, which incorporated demographic, clinical, laboratory, and neuroimaging data. The mean age of patients with stroke was 68.0 ± 15.5 years. Seven hundred twenty-five were men and the age range was 13-104 years. The most prevalent risk factors were hypertension (78.8%), dyslipidemia (36.3%), and diabetes (31.9%). Fifteen percent had atrial fibrillation and 24.7% had a previous stroke or transient ischemic attack. Prevalence of hypertension and atrial fibrillation increased with age; however, younger patients were more associated with thrombophilia. We documented 962 (72.9%) ischemic and 270 (20.5%) hemorrhagic strokes. Of the ischemic strokes, 174 (18.1%) were considered secondary to large-artery atherothrombosis, 175 (18.2%) were due to cardiac embolism, 19 (2.0%) were due to lacunar infarcts, and 25 (2.6%) were due to other determined causes. Five hundred sixty-nine (59.1%) remained undetermined. Atherothrombotic strokes were mostly associated with dyslipidemia, diabetes, metabolic syndrome, and obesity, whereas lacunar infarcts were associated with hypertension, smoking, sedentary lifestyle, and previous stroke or transient ischemic attack. Of our patients, 69.9% scored between 0 and 9 in the initial National Institutes of Health Stroke Scale (NIHSS). We found differences in sociodemographic features, risk factors, and stroke severity among stroke subtypes. Risk factor prevalence was similar to other registries involving Hispanic populations. Copyright © 2017 National Stroke Association. All rights reserved.

  19. Population-Based Incidence Rates of First-Ever Stroke in Central Vietnam.

    Science.gov (United States)

    Yamanashi, Hirotomo; Ngoc, Mai Quang; Huy, Tran Van; Suzuki, Motoi; Tsujino, Akira; Toizumi, Michiko; Takahashi, Kensuke; Thiem, Vu Dinh; Anh, Dang Duc; Anh, Nguyen Thi Hien; Tho, Le Huu; Maeda, Takahiro; Cox, Sharon E; Yoshida, Lay-Myint; Ariyoshi, Koya

    2016-01-01

    Stroke incidence data with methodologically acceptable design in Southeast Asia countries is limited. This study aimed to determine incidence of age-, sex- and subtype-specific first-ever stroke (FES) in Vietnam. We conducted a hospital-based retrospective study, targeting all stroke cases hospitalized at a solo-provider hospital in our study site of Nha Trang from January 2009 to December 2011 with International Classification of Diseases, 10th revision (ICD-10) codes I60-69. We calculated positive predictive values (PPVs) of each ICD-10-coded stroke by conducting a detailed case review of 190 randomly selected admissions with ICD-10 codes of I60-I69. These PPVs were then used to estimate annual incident stroke cases from the computerized database. National census data in 2009 was used as a denominator. 2,693 eligible admissions were recorded during the study period. The crude annual incidence rate of total FES was 90.2 per 100,000 population (95% CI 81.1-100.2). The age-adjusted incidence of FES was 115.7 (95% CI 95.9-139.1) when adjusted to the WHO world populations. Importantly, age-adjusted intracerebral hemorrhage was as much as one third of total FES: 36.9 (95% CI 26.1-51.0). We found a considerable proportion of FES in Vietnam to be attributable to intracerebral hemorrhage, which is as high or exceeding levels seen in high-income countries. A high prevalence of improperly treated hypertension in Vietnam may underlie the high prevalence of intracerebral hemorrhagic stroke in this population.

  20. Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients: A Clinical Intervention Study.

    Science.gov (United States)

    Palli, Christoph; Fandler, Simon; Doppelhofer, Kathrin; Niederkorn, Kurt; Enzinger, Christian; Vetta, Christian; Trampusch, Esther; Schmidt, Reinhold; Fazekas, Franz; Gattringer, Thomas

    2017-09-01

    Dysphagia is a common stroke symptom and leads to serious complications such as aspiration and pneumonia. Early dysphagia screening can reduce these complications. In many hospitals, dysphagia screening is performed by speech-language therapists who are often not available on weekends/holidays, which results in delayed dysphagia assessment. We trained the nurses of our neurological department to perform formal dysphagia screening in every acute stroke patient by using the Gugging Swallowing Screen. The impact of a 24/7 dysphagia screening (intervention) over swallowing assessment by speech-language therapists during regular working hours only was compared in two 5-month periods with time to dysphagia screening, pneumonia rate, and length of hospitalization as outcome variables. Overall, 384 patients (mean age, 72.3±13.7 years; median National Institutes of Health Stroke Scale score of 3) were included in the study. Both groups (pre-intervention, n=198 versus post-intervention, n=186) were comparable regarding age, sex, and stroke severity. Time to dysphagia screening was significantly reduced in the intervention group (median, 7 hours; range, 1-69 hours) compared with the control group (median, 20 hours; range, 1-183; P =0.001). Patients in the intervention group had a lower rate of pneumonia (3.8% versus 11.6%; P =0.004) and also a reduced length of hospital stay (median, 8 days; range, 2-40 versus median, 9 days; range, 1-61 days; P =0.033). 24/7 dysphagia screening can be effectively performed by nurses and leads to reduced pneumonia rates. Therefore, empowering nurses to do a formal bedside screening for swallowing dysfunction in stroke patients timely after admission is warranted whenever speech-language therapists are not available. © 2017 American Heart Association, Inc.

  1. CORRELATION OF INPATIENT AND OUTPATIENT MEASURES OF STROKE CARE QUALITY WITHIN VETERANS HEALTH ADMINISTRATION HOSPITALS

    Science.gov (United States)

    Ross, Joseph S.; Arling, Greg; Ofner, Susan; Roumie, Christianne L.; Keyhani, Salomeh; Williams, Linda S.; Ordin, Diana L.; Bravata, Dawn M.

    2011-01-01

    Background Quality of care delivered in the inpatient and ambulatory settings may be correlated within an integrated health system such as the Veterans Health Administration (VHA). We examined the correlation between stroke care quality at hospital discharge and within 6 months post-discharge. Methods Cross-sectional hospital-level correlation analyses of chart-abstracted data for 3467 veterans discharged alive after an acute ischemic stroke from 108 VHA medical centers and 2380 veterans with post-discharge follow-up within 6 months, in fiscal year 2007. Four risk-standardized processes of care represented discharge care quality: prescription of anti-thrombotic and anti-lipidemic therapy, anti-coagulation for atrial fibrillation, and tobacco cessation counseling, along with a composite measure of defect-free care. Five risk-standardized intermediate outcomes represented post-discharge care quality: achievement of blood pressure, low-density lipoprotein (LDL), international normalized ratio (INR), and glycosylated hemoglobin target levels, and delivery of appropriate treatment for post-stroke depression, along with a composite measure of achieved outcomes. Results Median risk-standardized composite rate of defect-free care at discharge was 79%. Median risk-standardized post-discharge rates of achieving goal were 56% for blood pressure, 36% for LDL, 41% for INR, 40% for glycosylated hemoglobin, and 39% for depression management and the median risk-standardized composite six-month outcome rate was 44%. The hospital composite rate of defect-free care at discharge was correlated with meeting the LDL goal (r=0.31; p=0.007) and depression management (r=0.27; p=0.03) goal, but was not correlated with blood pressure, INR, or glycosylated hemoglobin goals, nor with the composite measure of achieved post-discharge outcomes (p-values >0.15). Conclusions Hospital discharge care quality was not consistently correlated with ambulatory care quality. PMID:21719771

  2. Timing of hospital arrival in stroke patients in Benin City Nigeria ...

    African Journals Online (AJOL)

    Introduction: The aim of this study was to observe the time of arrival to hospital of stroke patients in Benin City, Edo state and to present the predictors of delayed presentation after acute stroke. Method: This is an observational cross sectional study which was carried out in the medical wards of Central Hospital, Benin City ...

  3. Factors associated with hospital arrival time after the onset of stroke ...

    African Journals Online (AJOL)

    Background: Late presentation to hospital after onset of stroke affects management and outcomes of the patients. This study aimed to determine the factors associated with time taken to present to hospital after the onset of acute stroke symptoms. Methods: A descriptive cross sectional study was conducted at two teaching ...

  4. Stroke Patients Communicating Their Healthcare Needs in Hospital: A Study within the ICF Framework

    Science.gov (United States)

    O'Halloran, Robyn; Worrall, Linda; Hickson, Louise

    2012-01-01

    Background: Previous research has identified that many patients admitted into acute hospital stroke units have communication-related impairments such as hearing, vision, speech, language and/or cognitive communicative impairment. However, no research has identified how many patients in acute hospital stroke units have difficulty actually…

  5. The Stroke unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study

    NARCIS (Netherlands)

    Meijer, R.; van Limbeek, J.; Peusens, G.; Rulkens, M.; Dankoor, K.; Vermeulen, M.; de Haan, R. J.

    2005-01-01

    Objective: To investigate which factors during the subacute phase post stroke have predictive value for the discharge outcome from the hospital stroke unit. Methods: In a prospective cohort of 338 patients admitted to a hospital stroke unit 26 potentially prognostic factors, arranged in clinical and

  6. Frequency Of Hyperthermia In Acute Ischemic Stroke Patients Visiting A Tertiary Care Hospital

    International Nuclear Information System (INIS)

    Maheshwari, A. K.; Kumar, P.; Alam, M. T.; Aurangzeb, M.; Imran, K.; Masroor, M.; Parkash, J.

    2016-01-01

    Objective: To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country. Study Design: Cross-sectional, observational study. Place and Duration of Study: Medical Wards of Civil Hospital, Karachi, from January to June 2013. Methodology: Patients aged = 18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 (SPSS Inc., IL, Chicago, USA). Result: A total of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 ±9.5 years. Among these, 61 (57.5 percentage) were males and 45 (42.5 percentage) females. Among all patients, 51.9 percentage presented with loss of consciousness, 30.2 percentage with slurred speech, 77.4 percentage with limb weakness, and 9.4 percentage with decrease vision. A total of 17 (16 percentage) patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of < 60 years of age, 26 percentage developed hyperthermia compared to 7.1 percentage in patients of = 60 years of age (p=0.008). On gender stratification, among male patients, 14.8 percentage developed hyperthermia compared to 17.8 percentage in female patients (p=0.43). Conclusion: It is concluded from this study that the frequency of hyperthermia in ischemic stroke was 16 percentage and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia. (author)

  7. Facilities available in French hospitals treating acute stroke patients: comparison with 24 other European countries.

    Science.gov (United States)

    Leys, D; Cordonnier, C; Debette, S; Hacke, W; Ringelstein, E B; Giroud, M; Mas, J L; Kaste, M

    2009-06-01

    The purpose of this study was to compare the proportion of French hospitals meeting criteria for primary (PSC) or comprehensive (CSC) stroke centres, with that of 24 other European countries. We surveyed 121 randomly selected hospitals admitting stroke patients routinely in France and 765 in other European countries. We determined the proportion of hospitals meeting criteria for CSC and PSC according to the EUSI experts definition. The 121 selected hospitals had treated 37,778 patients in 2005 (mean 312), i.e. approximately 25% of all strokes supposed to have occurred in France. Eleven hospitals had an acute stroke care unit, versus 448 of 765 other Hospitals (OR 0.07; 95% CI, OR 0.04-0.13). rt-PA was given to 622 patients (2.2% of ischaemic strokes, versus 3.3% for the other countries). No hospital met criteria for CSC, and only 2 (1.7%) met criteria for PSC. Many facilities considered as necessary by experts were less available, especially personnel, brain CT-scan, ECG monitoring and rt-PA protocols. However, CT angiography 24 h/24, and air ambulance were more often available. Only a few French hospitals offer an optimal level of care for stroke patients. This result contrasts with the high cost of stroke care in France, suggesting an inappropriate use of resources. Conclusions useful for health administrators are: (i) to offer more facilities in reasonably equipped hospitals; (ii) to prevent admission of stroke patients in small under-equipped hospitals; (iii) to promote specific stroke nurse instruction; and (iv) to promote a better organisation of stroke care over the territory.

  8. A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass.

    Science.gov (United States)

    Asimos, Andrew W; Ward, Shana; Brice, Jane H; Enright, Dianne; Rosamond, Wayne D; Goldstein, Larry B; Studnek, Jonathan

    2014-01-01

    Our goal was to determine if a statewide Emergency Medical Services (EMSs) Stroke Triage and Destination Plan (STDP), specifying bypass of hospitals unable to routinely treat stroke patients with thrombolytics (community hospitals), changed bypass frequency of those hospitals. Using a statewide EMS database, we identified stroke patients eligible for community hospital bypass and compared bypass frequency 1-year before and after STDP implementation. Symptom onset time was missing for 48% of pre-STDP (n = 2385) and 29% of post-STDP (n = 1612) cases. Of the remaining cases with geocodable scene addresses, 58% (1301) in the pre-STDP group and 61% (2,078) in the post-STDP group were ineligible for bypass, because a community hospital was not the closest hospital to the stroke event location. Because of missing data records for some EMS agencies in 1 or both study periods, we included EMS agencies from only 49 of 100 North Carolina counties in our analysis. Additionally, we found conflicting hospital classifications by different EMS agencies for 35% of all hospitals (n = 38 of 108). Given these limitations, we found similar community hospital bypass rates before and after STDP implementation (64%, n = 332 of 520 vs. 63%, n = 345 of 552; P = .65). Missing symptom duration time and data records in our state's EMS data system, along with conflicting hospital classifications between EMS agencies limit the ability to study statewide stroke routing protocols. Bypass policies may apply to a minority of patients because a community hospital is not the closest hospital to most stroke events. Given these limitations, we found no difference in community hospital bypass rates after implementation of the STDP. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Ethnicity and thrombolysis in ischemic stroke: a hospital based study in Amsterdam.

    Science.gov (United States)

    Coutinho, Jonathan M; Klaver, Eva C; Roos, Yvo B; Stam, Jan; Nederkoorn, Paul J

    2011-06-30

    Ethnic differences have been reported with regard to several medical therapies. The aim of this study was to investigate the relation between ethnicity and thrombolysis in stroke patients. Retrospective single-centre study. Patients admitted with an ischemic stroke between 2003 and 2008 were included. Ethnicity was determined by self-identification and stratified into white and non-white (all other ethnicities). The main outcome measure was the difference in thrombolysis rate between white and non-white patients. Logistic regression analysis was used to identify potential confounders of the relation between ethnicity and thrombolysis. 510 patients were included, 392 (77%) white and 118 (23%) non-white. Non-white patients were younger (median 69 vs. 60 years, ppresentation. In this single centre study, potential bias due to hospital differences or insurance status could be ruled out as a cause. The magnitude of the difference is worrisome and requires further investigation. Modifiable causes, such as patient delay, awareness of stroke symptoms, language barriers and treatment of cardiovascular risk factors, should be addressed specifically in these ethnic groups in future stroke campaigns. © 2011 Coutinho et al; licensee BioMed Central Ltd.

  10. Changes of deceleration and acceleration capacity of heart rate in patients with acute hemispheric ischemic stroke

    Directory of Open Access Journals (Sweden)

    Xu YH

    2016-03-01

    Full Text Available Yan-Hong Xu,1 Xing-De Wang,2 Jia-Jun Yang,1 Li Zhou,2 Yong-Chao Pan1 1Department of Neurology, 2Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China Background and purpose: Autonomic dysfunction is common after stroke, which is correlated with unfavorable outcome. Phase-rectified signal averaging is a newly developed technique for assessing cardiac autonomic function, by detecting sympathetic and vagal nerve activity separately through calculating acceleration capacity (AC and deceleration capacity (DC of heart rate. In this study, we used this technique for the first time to investigate the cardiac autonomic function of patients with acute hemispheric ischemic stroke. Methods: A 24-hour Holter monitoring was performed in 63 patients with first-ever acute ischemic stroke in hemisphere and sinus rhythm, as well as in 50 controls with high risk of stroke. DC, AC, heart rate variability parameters, standard deviation of all normal-to-normal intervals (SDNN, and square root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals (RMSSD were calculated. The National Institutes of Health Stroke Scale (NIHSS was used to assess the severity of stroke. We analyzed the changes of DC, AC, SDNN, and RMSSD and also studied the correlations between these parameters and NIHSS scores. Results: The R–R (R wave to R wave on electrocardiogram intervals, DC, AC, and SDNN in the cerebral infarction group were lower than those in controls (P=0.003, P=0.002, P=0.006, and P=0.043, but the difference of RMSSD and the D-value and ratio between absolute value of AC (|AC| and DC were not statistically significant compared with those in controls. The DC of the infarction group was significantly correlated with |AC|, SDNN, and RMSSD (r=0.857, r=0.619, and r=0.358; P=0.000, P=0.000, and P=0.004. Correlation analysis also showed that DC, |AC|, and SDNN

  11. estimated glomerular filtration rate and risk of survival in acute stroke

    African Journals Online (AJOL)

    2014-03-03

    Mar 3, 2014 ... independence and the common odds ratio with stroke severity as a layering variable. Results: No significant ... Conclusion: Independent of stroke severity, GFR is a surrogate in the assessment of the risk of survival in acute ..... outcome of acute stroke in the University College. Hospital Ibadan, Nigeria.

  12. Motor deficit outcome in patients with stroke in the neurology unit of the Befelatanana University Hospital in Antananarivo.

    Science.gov (United States)

    Razafindrasata, R S; Rasaholiarison, N F; Razafimahefa, J; Tehindrazanarivelo, A D

    2017-11-01

    A stroke is the sudden onset of focal neurological deficits presumed to have mecanism vascular and is the leading cause of acquired motor disability in adults. To improve stroke management, we examined the motor disability of patients presenting with stroke, their course, and its determinant factors. This retrospective descriptive study reviewed case records from the neurology unit of the Befelatanana University Hospital from january to december 2015. We included all patients who had a stroke with motor impairment of any upper or lower limbs, with or without computed tomography of the brain, that is, 227 (36.50 %) of the 622 patients admitted to the neurology unit. The mean age of onset was 55.41 years with a sex-ratio 1.16. Predominantly, we found perforating artery strokes (51.54 %), ischemic strokes (36.12 %), and right limb location deficits (50.22 %). Stroke patients were managed with physical therapy from the beginning of the acute stage, that is, from the admission (77.53 %). Two third of the motor deficits were steady (67.84 %), with a median NIHSS=8 and MRS=4 at hospital discharge. The mortality rate was 8.37 % (6.60 % during the first week and 1.77 % after that). We found no significant determinant factors. Hospital mortality decreased during the study. The lack of overcoming of motor disability was due to the short follow-up period, which included only the acute stage. These findings point out the utility of a neurovascular unit (UNV) for reducing disabilities and developing a network for stroke management during the acute stage in Madagascar.

  13. Mortality and Incidence of Hospital Admissions for Stroke among Brazilians Aged 15 to 49 Years between 2008 and 2012.

    Directory of Open Access Journals (Sweden)

    Fernando Adami

    Full Text Available The objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012.Secondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60-I64. Crude and standardized mortality (WHO reference and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0.There were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15-49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54 in 2008 to 6.32 (95% CI 6.31; 6.32 in 2012 (β = -0.27, p = 0.013, r2 = 0.90. During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67 in 2008 and 25.11 (95% CI 25.10; 25.11 in 2012 (β = 0.09, p = 0.692, r2 = 0.05. There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group.We observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults.

  14. Mortality and Incidence of Hospital Admissions for Stroke among Brazilians Aged 15 to 49 Years between 2008 and 2012

    Science.gov (United States)

    Adami, Fernando; Figueiredo, Francisco Winter dos Santos; Paiva, Laércio da Silva; de Sá, Thiago Hérick; Santos, Edige Felipe de Sousa; Martins, Bruno Luis; Valenti, Vitor Engrácia; de Abreu, Luiz Carlos

    2016-01-01

    Introduction The objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012. Methods Secondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60–I64). Crude and standardized mortality (WHO reference) and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0. Results There were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15–49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54) in 2008 to 6.32 (95% CI 6.31; 6.32) in 2012 (β = -0.27, p = 0.013, r2 = 0.90). During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67) in 2008 and 25.11 (95% CI 25.10; 25.11) in 2012 (β = 0.09, p = 0.692, r2 = 0.05). There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group. Conclusion We observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults. PMID:27332892

  15. Implementation of a stroke registry is associated with an improvement in stroke performance measures in a tertiary hospital in Mexico.

    Science.gov (United States)

    Herrera, Ana Lucia; Góngora-Rivera, Fernando; Muruet, Walter; Villarreal, Héctor Jorge; Gutiérrez-Herrera, Mildred; Huerta, Lena; Carrasco, Diana; Soto-García, Anally; Espinosa-Ortega, Meztli

    2015-04-01

    Stroke registries provide a simple way for improving patient care, and its use has been associated with a better adherence to the published guidelines. Few Latin American countries had established stroke registries. Our study is the first in Mexico to report the effects of implementing a stroke registry. To determine if the implementation of a systematized registry is associated with an improved adherence to the performance measures. We compared prospective data (August 2008-November 2010) against historical controls (February 2005-July 2008). Our stroke registry (i-Registro Neurovascular) consists of a standardized clinical form that includes demographic and clinical variables (risk factors, medications, neuroimaging, etiology, acute and outpatient treatments, and neurologic scores [National Institutes of Health Stroke Scale and modified Rankin Scale]). We evaluated 9 performance measures suggested by the American Heart Association and the Joint Commission. We analyzed the data from 574 patients, 260 from the prospective phase and 314 from historical controls. No significant statistical differences in demographic characteristics or stroke risk factors were found. The implementation of the stroke registry was associated with a statistically significant (P cost and readily achievable and a viable option for encouraging an increased report of guidelines adherence of other hospitals in Latin America. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Determinants in Adolescence of Stroke-Related Hospital Stay Duration in Men: A National Cohort Study.

    Science.gov (United States)

    Bergh, Cecilia; Udumyan, Ruzan; Appelros, Peter; Fall, Katja; Montgomery, Scott

    2016-09-01

    Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke. Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using information from population-based national registers. Stress resilience, body mass index, cognitive function, physical fitness, and blood pressure were measured at compulsory military conscription examinations in late adolescence. Joint Cox proportional hazards models estimated the associations of these characteristics with long compared with short duration of stroke-related hospital stay and with second stroke compared with first. Some 3000 men were diagnosed with nonfatal stroke between ages 31 and 58 years. Low stress resilience, underweight, and higher systolic blood pressure (per 1-mm Hg increase) during adolescence were associated with longer hospital stay (compared with shorter) in ischemic stroke, with adjusted relative hazard ratios (and 95% confidence intervals) of 1.46 (1.08-1.89), 1.41 (1.04-1.91), and 1.01 (1.00-1.02), respectively. Elevated systolic and diastolic blood pressures during adolescence were associated with longer hospital stay in men with intracerebral hemorrhage: 1.01 (1.00-1.03) and 1.02 (1.00-1.04), respectively. Among both stroke types, obesity in adolescence conferred an increased risk of second stroke: 2.06 (1.21-3.45). Some characteristics relevant to length of stroke-related hospital stay and risk of second stroke are already present in adolescence. Early lifestyle influences are of importance not only to stroke risk by middle age but also to recurrence and use of healthcare resources among stroke survivors. © 2016 American Heart Association, Inc.

  17. Early Mortality and Associated Factors among Patients with Stroke Admitted to a Large Teaching Hospital in Tanzania.

    Science.gov (United States)

    Okeng'o, Kigocha; Chillo, Pilly; Gray, William K; Walker, Richard W; Matuja, William

    2017-04-01

    Stroke is a major cause of death worldwide and 85.5% of stroke deaths occur in low- and middle-income countries due to stroke. The aim of this study was to investigate correlates and predictors of 30-day mortality in stroke patients in urban Tanzania. A prospective 30-day follow-up study was conducted at the Muhimbili National Hospital, Dar es Salaam, Tanzania. We recruited all patients with stroke seen at the Emergency Medicine Department and medical wards. Patients underwent medical history and physical examination including full neurological examination. For those who met the criteria for the diagnosis of stroke according to the World Health Organization, further data were collected, including cholesterol, creatinine, fasting blood glucose, full blood picture, human immunodeficiency virus serology, and electrocardiogram. Patients were followed up at 30 days from the date of stroke onset. The date and the cause of death of those participants who died within 30 days of stroke onset were recorded. A total of 224 patients were recruited into the study, with follow-up data available on 186 (83.0%). At 30 days post stroke, 124 patients (66.7%) were still alive. Mortality was significantly higher among stroke patients who were over 65 years of age. Of the 62 who died, 54% died of aspiration pneumonia and 21% of septicemia. Patients with infection were 4.4 times more likely to die than thosewithout (P = .001). Poststroke mortality rates were high. Many deaths were potentially preventable. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  18. Pattern of complementary and alternative medicine use among Malaysian stroke survivors: A hospital-based prospective study

    Directory of Open Access Journals (Sweden)

    Azidah Abdul Kadir

    2015-07-01

    Full Text Available Complementary and alternative medicine (CAM; 補充與替代醫學 bǔ chōng yǔ tì dài yī xué is widely practiced among stroke patients globally. We conducted a study to determine the pattern of CAM use and its associated factors in stroke survivors attending a tertiary hospital in Malaysia within 6 months after the stroke. This was a prospective cohort study that included all stroke patients who were admitted to a tertiary center in Malaysia from December 2009 to December 2010. Patients were interviewed and examined within 72 hours of admission. The sociodemographic data and medical history were collected. Clinical examinations were done to assess the stroke severity using the Scandinavian Stroke Scale and functional status based on modified Barthel index (MBI. Patients were reassessed at 6 months after the stroke on the CAM use and functional status (MBI. The response rate was 92%. The study population consisted of 52 men and 41 women with a mean age of 63.7 ± 10.3 years. Sixty-seven percent practiced CAM. Massage was the most frequently used method (63.4%, followed by vitamins (7.5%. In multiple logistic regression analysis, functional status (MBI score on discharge (p = 0.004, odds ratio 1.034, 95% confidence interval 1.01–1.06 and Scandinavian Stroke Scale score (p = 0.045, odds ratio 1.87, 95% confidence interval 1.01–3.43 were significant predictors for use of CAM. In conclusion, the use of CAM among stroke survivors is high. Patients who have better functional status on discharge and less severe stroke are more likely to use CAM.

  19. Benefits of clinical facilitators on improving stroke care in acute hospitals: a new programme for Australia.

    Science.gov (United States)

    Purvis, Tara; Moss, Karen; Francis, Linda; Borschmann, Karen; Kilkenny, Monique F; Denisenko, Sonia; Bladin, Christopher F; Cadilhac, Dominique A

    2017-07-01

    Care gaps for stroke lead to preventable disability and deaths. The Victorian State Government implemented a programme of employing clinical Facilitators on a fixed-term basis for up to 3 years (2008-2011) in eight hospitals to improve stroke care. The Facilitators were to establish stroke units where absent, implement evidence-based management protocols and provide staff education within an agreed work plan. To determine if the Facilitator role was associated with improved stroke care and to describe factors supporting or mitigating enhancements to care. A mixed methods design was employed with historical control using patient-level audit data (pre-Facilitator: n = 600; post-Facilitator: n = 387) and qualitative data from independently conducted semistructured interviews with hospital staff, including clinicians, executives and facilitators (n = 10 focus groups; 75 respondents). Stroke units, clinical pathways and outpatient clinics for managing transient ischaemic attacks (TIA) were established. Compared with the pre-Facilitator period, significant increases in patient access to stroke unit care (53% vs 86%, P team motivation and cohesiveness and increasing interest in stroke care. Ongoing barriers included limited resources to operate TIA clinics effectively, staff turnover requiring ongoing education, inconsistency in compliance with protocols and, in some hospitals, the need for formalised medical leadership. Fixed-term employment of Facilitators was effective in positively influencing stroke care in hospitals through a range of change management strategies where stroke-specific expertise had been previously limited. © 2017 Royal Australasian College of Physicians.

  20. Processes and outcomes of ischemic stroke care: the influence of hospital level of care.

    Science.gov (United States)

    Tung, Yu-Chi; Jeng, Jiann-Shing; Chang, Guann-Ming; Chung, Kuo-Piao

    2015-08-01

    Processes of stroke care play an increasingly important role in comparing hospital performance. The relationship between processes of care and outcomes for stroke is unclear. Moreover, in terms of stroke care regionalization, little information is available with regard to the relationships among hospital level of care, processes and outcomes of stroke care. We used nationwide population-based data to examine the relationship between processes of care and mortality and the relationships among hospital level of care, processes and mortality for ischemic stroke. Cross-sectional study. General acute care hospitals throughout Taiwan. A total of 31 274 ischemic stroke patients admitted in 2010 through Taiwan's National Health Insurance Research Database. Processes of care and 30-day mortality. Multilevel models were used after adjustment for patient and hospital characteristics to test the relationship between processes of care and 30-day mortality and the relationships among hospital level of care, processes and 30-day mortality. The use of thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment was associated with lower mortality. Hospital level of care was associated with the use of thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment, and mortality. These processes of care were mediators of the relationship between hospital level of care and mortality. Outcomes among patients with ischemic stroke can be improved by thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment. Among patients with ischemic stroke, admission to designated stroke center hospitals may be associated with lower mortality through better processes of care. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  1. Hospital acquired pneumonia is linked to right hemispheric peri-insular stroke.

    Directory of Open Access Journals (Sweden)

    André Kemmling

    Full Text Available Hospital acquired pneumonia (HAP is a major complication of stroke. We sought to determine associations between infarction of specific brain regions and HAP.215 consecutive acute stroke patients with HAP (2003-2009 were carefully matched with 215 non-pneumonia controls by gender, then NIHSS, then age. Admission imaging and binary masks of infarction were registered to MNI-152 space. Regional atlas and voxel-based log-odds were calculated to assess the relationship between infarct location and the likelihood of HAP. An independently validated penalized conditional logistic regression model was used to identify HAP associated imaging regions.The HAP and control patients were well matched by gender (100%, age (95% within 5-years, NIHSS (98% within 1-point, infarct size, dysphagia, and six other clinical variables. Right hemispheric infarcts were more frequent in patients with HAP versus controls (43.3% vs. 34.0%, p = 0.054, whereas left hemispheric infarcts were more frequent in controls (56.7% vs. 44.7%, p = 0.012; there was no significant difference between groups in the rate of brainstem strokes (p = 1.0. Of the 10 most infarcted regions, only right insular cortex volume was different in HAP versus controls (20 vs. 12 ml, p = 0.02. In univariate analyses, the highest log-odds regions for pneumonia were right hemisphere, cerebellum, and brainstem. The best performing multivariate model selected 7 brain regions of infarction and 2 infarct volume-based variables independently associated with HAP.HAP is associated with right hemispheric peri-insular stroke. These associations may be related to autonomic modulation of immune mechanisms, supporting recent hypotheses of stroke mediated immune suppression.

  2. Thrombolysis in acute ischemic stroke is associated with lower long-term hospital bed day use

    DEFF Research Database (Denmark)

    Terkelsen, Thorkild; Schmitz, Marie Louise; Simonsen, Claus Z

    2016-01-01

    Background  Thrombolysis with intravenous recombinant tissue-type plasminogen activator improves functional outcome in acute ischemic stroke. Few studies have investigated the effects of thrombolysis in a real-world setting. We evaluated the impact of thrombolysis on long-term hospital bed day use...... patients admitted to stroke centers not yet offering thrombolysis in 2004-2006. The outcomes were length of the stroke admission, total all-cause hospital bed day use during the first year after the stroke, and the long-term risk of readmissions. Thrombolysed and non-thrombolysed patients were compared...... in the overall risk of readmission (adjusted hazard ratio, 0.91; 95% CI: 0.79-1.04); however, thrombolysis was associated with reduced risk of pneumonia (adjusted hazard ratio, 0.59; 95% CI: 0.35-0.97).  Conclusions  Thrombolysis in ischemic stroke was associated with lower long-term hospital bed day use...

  3. Analysis of Hospital Charges of Inpatients with Acute Ischemic Stroke in Beijing, China, 2012-2015.

    Science.gov (United States)

    Kong, Dehui; Liu, Xiaole; Lian, Hui; Zhao, Xiaoyi; Zhao, Yakun; Xu, Qun; Peng, Bin; Wang, Haitao; Fang, Quan; Zhang, Shuyang; Cheng, Kangan; Jin, Xiaofeng; Fan, Zhongjie

    2018-02-08

    The study aimed to analyze the hospital charges of the inpatients with acute ischemic stroke in Beijing and determine the factors associated with hospital costs. Medical records of hospitalized patients with a primary diagnosis of ischemic stroke according to International Classification of Diseases 10th Revision codes were collected from 121 hospitals in Beijing from March 1, 2012, to February 28, 2015. Distribution characteristics of hospital charges for different hospital levels (level 2 hospitals and level 3 hospitals) and types (Western medicine hospitals and Chinese medicine hospitals) were studied. Linear regression analysis was used to examine the association among hospital costs and factors that influenced total hospital charges. There were 158,781 admissions for ischemic stroke, 63.1% of the patients were male and their mean age was 67.7 ± 12.4 years, the median length of hospital stay (LOHS) was 13.5 days (interquartile range 9.9-18.1 days). The median hospital charge was 2,112 (1,436-3,147) US dollars. Of these, 46.7% were for medicine, 21.1% for laboratory and examination, and 16.3% for therapy. LOHS, hospital level, and pulmonary infection were key determinants of the hospital charges. The proportion of medicine fees for the ischemic stroke inpatients showed a downward trend during the period from 2012 to 2015, but medicine fees still accounted for the largest percentage of hospital charges in China. LOHS emerged to be the main determinant of the cost. Decreasing medicine fees and LOHS might be strategies to decrease hospital charges and reduce economic burden of stroke in China. © 2018 S. Karger AG, Basel.

  4. [Acupuncture treatment programs for post-stroke motor rehabilitation in community hospitals: study protocol of a multicenter, randomized, controlled trial].

    Science.gov (United States)

    Fu, Qin-hui; Pei, Jian; Jia, Qi; Song, Yi; Gu, Yue-hua; You, Xiao-xin

    2012-05-01

    Stroke is responsible for increasingly high rates of mortality and disability worldwide. Approximately two million people suffer from stroke for the first time in China each year. The high incidence (50%) of post-stroke disability brings a heavy burden to patients and their caregivers. Acupuncture has been widely used in the communities for post-stroke rehabilitation in China. The objective of this trial is to apply our acupuncture research achievement to treatment and evaluation of post-stroke hemiplegic patients in community. A multicenter, randomized, controlled trial will be performed in Longhua Hospital and a number of community health service centers in Shanghai. A total of 124 patients (estimated sample size) with post-stroke hemiplegia will be randomly divided into an acupuncture group and a control group. The patients undergoing randomization should be stratified according to National Institutes of Health Stroke Scale score at baseline. Within the acupuncture group, different acupuncture protocols are administered to patients with flaccid paralysis or spastic paralysis based on the Ashworth Scale. Patients in the acupuncture group will also be treated with comprehensive rehabilitation therapy. The control group will be treated with comprehensive rehabilitation therapy only. The primary outcome measures are the Simplified Fugl-Meyer Motor Scale, the Modified Barthel Index, and the Burden of Stroke Scale. Secondary outcome measures are the modified Rankin Scale, the modified Ashworth Scale and the Stroke Scale of Traditional Chinese Medicine. Outcome measures will be performed after 4 and 8 weeks of treatment. The patients will be followed up after 6 months. The results of this study are expected to demonstrate that our standardized acupuncture protocol for treating and evaluating post-stroke hemiplegic patients will improve motor function and lessen the burden of post-stroke patients within the communities. This will provide the evidence to support

  5. Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.

    LENUS (Irish Health Repository)

    Hannon, Niamh

    2014-10-30

    No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.

  6. Predictors of in-hospital mortality among stroke patients in Uyo ...

    African Journals Online (AJOL)

    Background: Stroke is the third leading cause of death in most industrialized countries. Several reports indicate that it is also becoming a major cause of morbidity and mortality in Nigeria and other developing countries. Aim: To identify risk factors and predictors of in-hospital mortality among patients admitted for stroke in a ...

  7. Decreased nighttime heart rate variability is associated with increased stroke risk

    DEFF Research Database (Denmark)

    Binici, Zeynep; Mouridsen, Mette Rauhe; Køber, Lars

    2011-01-01

    Prediction of stroke in healthy individuals is challenging and there is a diurnal variation of stroke onset. We hypothesized that heart rate variability with a focus on nighttime heart rate variability will predict the risk of stroke in apparently healthy middle-age and elderly subjects....

  8. [The Determinants of Dysphagia in Patients With Stroke During Hospitalized Rehabilitation].

    Science.gov (United States)

    Szu, Li-Yun; Hsieh, Suh-Ing; Tseng, Su-Mei; Huang, Tzu-Hsin

    2017-06-01

    Stroke was the third leading cause of death in Taiwan in 2014. A study found that 53.61% of stroke patients suffered from dysphagia disorder during the rehabilitation phase, which may result in lung aspiration and death. The determinants of dysphagia among nationally hospitalized-rehabilitation stroke patients have not been explored comprehensively. To explore the incidence of dysphagia among hospitalized-rehabilitation stroke patients and the related determinants of dysphagia. This descriptive and correlational research design employed a convenience sample of 130 hospitalized stroke patients from rehabilitation wards at a northern regional hospital in Taiwan. A questionnaire and functional assessment were used to collect data. Instruments used included personal and clinical characteristics data questionnaire, the National Institute of Health Stroke Scale (NIHSS), Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Standardization Swallowing Assessment (SSA), and Acute Stroke Dysphagia Screening (ASDS). Data analyses contained descriptive statistics and logistic regression. The incidence of stroke dysphagia was 63.8% (SSA) and 64.6% (ASDS), respectively. Age, marital status, stroke site, stroke severity (NIHSS), and cognitive status (MMSE) were identified as significant determinants of dysphagia in bivariate logistic regression, whereas stroke severity and cognitive status were identified as significant independent determinants of dysphagia in multivariate logistic regression. Two-thirds of the participant sample were affected by dysphagia, for which NIHSS and cognitive status were identified as significant determinants. Thus, nurses may conduct early screening for high risk populations based on patients' clinical characteristics in order to reduce aspiration pneumonia problems and to improve the quality of clinical care for dysphagia patients.

  9. Variations and determinants of hospital costs for acute stroke in China.

    Directory of Open Access Journals (Sweden)

    Jade W Wei

    Full Text Available BACKGROUND: The burden of stroke is high and increasing in China. We modelled variations in, and predictors of, the costs of hospital care for patients with acute stroke in China. METHODS AND FINDINGS: Baseline characteristics and hospital costs for 5,255 patients were collected using the prospective register-based ChinaQUEST study, conducted in 48 Level 3 and 14 Level 2 hospitals in China during 2006-2007. Ordinary least squares estimation was used to determine factors associated with hospital costs. Overall mean cost of hospitalisation was 11,216 Chinese Yuan Renminbi (CNY (≈US$1,602 per patient, which equates to more than half the average annual wage in China. Variations in cost were largely attributable to stroke severity and length of hospital stay (LOS. Model forecasts showed that reducing LOS from the mean of 20 days for Level 3 and 18 days for Level 2 hospitals to a duration of 1 week, which is common among Western countries, afforded cost reductions of 49% and 19%, respectively. Other lesser determinants varied by hospital level: in Level 3 hospitals, health insurance and the occurrence of in-hospital complications were each associated with 10% and 18% increases in cost, respectively, whilst treatment in a teaching hospital was associated with approximately 39% decrease in cost on average. For Level 2 hospitals, stroke due to intracerebral haemorrhage was associated with a 19% greater cost than for ischaemic stroke. CONCLUSIONS: Changes to hospital policies to standardise resource use and reduce the variation in LOS could attenuate costs and improve efficiencies for acute stroke management in China. The success of these strategies will be enhanced by broader policy initiatives currently underway to reform hospital reimbursement systems.

  10. Variations and determinants of hospital costs for acute stroke in China.

    Science.gov (United States)

    Wei, Jade W; Heeley, Emma L; Jan, Stephen; Huang, Yining; Huang, Qifang; Wang, Ji-Guang; Cheng, Yan; Xu, En; Yang, Qidong; Anderson, Craig S

    2010-09-28

    The burden of stroke is high and increasing in China. We modelled variations in, and predictors of, the costs of hospital care for patients with acute stroke in China. Baseline characteristics and hospital costs for 5,255 patients were collected using the prospective register-based ChinaQUEST study, conducted in 48 Level 3 and 14 Level 2 hospitals in China during 2006-2007. Ordinary least squares estimation was used to determine factors associated with hospital costs. Overall mean cost of hospitalisation was 11,216 Chinese Yuan Renminbi (CNY) (≈US$1,602) per patient, which equates to more than half the average annual wage in China. Variations in cost were largely attributable to stroke severity and length of hospital stay (LOS). Model forecasts showed that reducing LOS from the mean of 20 days for Level 3 and 18 days for Level 2 hospitals to a duration of 1 week, which is common among Western countries, afforded cost reductions of 49% and 19%, respectively. Other lesser determinants varied by hospital level: in Level 3 hospitals, health insurance and the occurrence of in-hospital complications were each associated with 10% and 18% increases in cost, respectively, whilst treatment in a teaching hospital was associated with approximately 39% decrease in cost on average. For Level 2 hospitals, stroke due to intracerebral haemorrhage was associated with a 19% greater cost than for ischaemic stroke. Changes to hospital policies to standardise resource use and reduce the variation in LOS could attenuate costs and improve efficiencies for acute stroke management in China. The success of these strategies will be enhanced by broader policy initiatives currently underway to reform hospital reimbursement systems.

  11. Mortality in Dutch hospitals: trends in time, place and cause of death after admission for myocardial infarction and stroke. An observational study

    NARCIS (Netherlands)

    Slobbe, Laurentius C. J.; Arah, Onyebuchi A.; de Bruin, Agnes; Westert, Gert P.

    2008-01-01

    BACKGROUND: Patterns in time, place and cause of death can have an important impact on calculated hospital mortality rates. Objective is to quantify these patterns following myocardial infarction and stroke admissions in Dutch hospitals during the period 1996-2003, and to compare trends in the

  12. Winter excess in hospital admissions, in-patient mortality and length of acute hospital stay in stroke: a hospital database study over six seasonal years in Norfolk, UK.

    Science.gov (United States)

    Myint, Phyo K; Vowler, Sarah L; Woodhouse, Peter R; Redmayne, Oliver; Fulcher, Robert A

    2007-01-01

    Several studies have examined the incidence and mortality of stroke in relation to season. However, the evidence is conflicting partly due to variation in the populations (community vs. hospital-based), and in climatic conditions between studies. Moreover, they may not have been able to take into account the age, sex and stroke type of the study population. We hypothesized that the age, sex and type of stroke are major determinants of the presence or absence of winter excess in morbidity and mortality associated with stroke. We analyzed a hospital-based stroke register from Norfolk, UK to examine our prior hypothesis. Using Curwen's method, we performed stratified sex-specific analyses by (1) seasonal year and (2) quartiles of patients' age and stroke subtype and calculated the winter excess for the number of admissions, in-patient deaths and length of acute hospital stay. There were 5,481 patients (men=45%). Their ages ranged from 17 to 105 years (median=78 years). There appeared to be winter excess in hospital admissions, deaths and length of acute hospital stay overall accounting for 3/100,000 extra admissions (winter excess index of 3.4% in men and 7.6% in women) and 1/100,000 deaths (winter excess index of 4.7 and 8.6% in women) due to stroke in winter compared to non-winter periods. Older patients with non-haemorrhagic stroke mainly contribute to this excess. If our findings are replicated throughout England and Wales, it is estimated that there are 1,700 excess admissions, 600 excess in-patient deaths and 24,500 extra acute hospital bed days each winter, related to stroke within the current population of approximately 60 million. Further research should be focused on the determinants of winter excess in morbidity and mortality associated with stroke. This may subsequently reduce the morbidity and mortality by providing effective preventive strategies in future. (c) 2007 S. Karger AG, Basel.

  13. Heart rate as a predictor of stroke in high-risk, hypertensive patients with previous stroke or transient ischemic attack.

    Science.gov (United States)

    Sandset, Else Charlotte; Berge, Eivind; Kjeldsen, Sverre E; Julius, Stevo; Holzhauer, Björn; Krarup, Lars-Henrik; Hua, Tsushung A

    2014-01-01

    Risk factors for first stroke are well established, but less is known about risk factors for recurrent stroke. In the present analysis, we aimed to assess the effect of heart rate and other possible predictors of stroke in a hypertensive population with previous stroke or transient ischemic attack (TIA). The Valsartan Antihypertensive Long-Term Use Evaluation trial was a multicentre, double-masked, randomized controlled, parallel group trial comparing the effects of an angiotensin receptor blocker (valsartan) and a calcium channel blocker (amlodipine) in patients with hypertension and high cardiovascular risk. We used Cox proportional hazard models to investigate the effect of baseline variables on the risk of stroke. Quadratic terms of the continuous variables were entered in the models to test for linearity. Of 15,245 patients included in the trial, 3014 had a previous stroke or TIA at baseline and were included in the present analysis. Stroke recurrence occurred in 239 patients (7.9%) during a median of 4.5 years of follow-up. Resting heart rate (per 10 beats per minute; hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.18-6.58) and diabetes mellitus at baseline (HR, 1.47; 95% CI, 1.03-2.10) were significantly associated with an increased risk of stroke recurrence in the multivariable analysis. In high-risk, hypertensive patients with previous stroke or TIA, resting heart rate was the strongest predictor of recurrent stroke. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Hospitalization rates among economic immigrants to Canada.

    Science.gov (United States)

    Ng, Edward; Sanmartin, Claudia; Manuel, Douglas G

    2017-07-19

    Economic immigrants generally, and economic class principal applicants (ECPAs) specifically, tend to have better health than other immigrants. However, health outcomes vary among subcategories within this group, especially by sex. This study examines hospitalization rates among ECPAs aged 25 to 74 who arrived in Canada between 1980 and 2006 as skilled workers, business immigrants, or live-in caregivers. The analysis used two linked databases to estimate age-standardized hospitalization rates (ASHRs) overall and for leading causes by sex. ASHRs of ECPA subcategories were compared with each other and with those of the Canadian-born population. Logistic regression was used to derive odds ratios for hospitalization among ECPAs, by sex. Male and female ECPAs aged 25 to 74 had significantly lower all-cause ASHRs than did the Canadian-born population in the same age range. This pattern prevailed for each ECPA subcategory and for each disease examined. Compared with skilled workers, business immigrants had lower odds of hospitalization; live-in caregivers who arrived after 1992 had higher odds. Adjustment for education, official language proficiency, and world region reduced the strength of or eliminated these associations. Compared with the Canadian-born population, ECPAs generally had low hospitalization rates. Differences were apparent among ECPA subcategories.

  15. Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke.

    Directory of Open Access Journals (Sweden)

    Lisa A Simpson

    Full Text Available BACKGROUND: The literature suggests that stroke is a major risk factor for falls, but there is a lack of prospective, controlled studies which quantify fall-risk after stroke. The purpose of this study was to compare the rates, location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls. METHODOLOGY/PRINCIPAL FINDINGS: A sample of 80 people with stroke and 90 controls received baseline assessments of balance, mobility and balance confidence. Falls were recorded prospectively over 13 months for both groups. Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression. Fall location was compared between groups using χ(2 statistics. The rate of falls for individuals with stroke was 1.77 times the rate for the control group. People with stroke were more likely to fall at home. Poorer balance (Berg Balance Scale was associated with greater falls for both stroke and control groups (incidence rate ratio [IRR]: 0.908 and IRR: 0.877 respectively. A faster Timed Up and Go Test was associated with greater falls for the stroke group (IRR: 0.955 while better walking endurance (Six Minute Walk Test was associated with greater falls for the controls (IRR: 1.004. Balance confidence was not an independent predictor in either group. CONCLUSIONS: Individuals recently discharged home are at greater risk of falling than individuals without stroke. Attention to home environment is warranted. Balance function can predict falls for both people with stroke and age and sex matched controls. Increased mobility may increase exposure to fall opportunities.

  16. Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke.

    Science.gov (United States)

    Simpson, Lisa A; Miller, William C; Eng, Janice J

    2011-04-29

    The literature suggests that stroke is a major risk factor for falls, but there is a lack of prospective, controlled studies which quantify fall-risk after stroke. The purpose of this study was to compare the rates, location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls. A sample of 80 people with stroke and 90 controls received baseline assessments of balance, mobility and balance confidence. Falls were recorded prospectively over 13 months for both groups. Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression. Fall location was compared between groups using χ(2) statistics. The rate of falls for individuals with stroke was 1.77 times the rate for the control group. People with stroke were more likely to fall at home. Poorer balance (Berg Balance Scale) was associated with greater falls for both stroke and control groups (incidence rate ratio [IRR]: 0.908 and IRR: 0.877 respectively). A faster Timed Up and Go Test was associated with greater falls for the stroke group (IRR: 0.955) while better walking endurance (Six Minute Walk Test) was associated with greater falls for the controls (IRR: 1.004). Balance confidence was not an independent predictor in either group. Individuals recently discharged home are at greater risk of falling than individuals without stroke. Attention to home environment is warranted. Balance function can predict falls for both people with stroke and age and sex matched controls. Increased mobility may increase exposure to fall opportunities.

  17. Bringing the hospital to the patient: first treatment of stroke patients at the emergency site.

    Directory of Open Access Journals (Sweden)

    Silke Walter

    2010-10-01

    Full Text Available Early treatment with rt-PA is critical for favorable outcome of acute stroke. However, only a very small proportion of stroke patients receive this treatment, as most arrive at hospital too late to be eligible for rt-PA therapy.We developed a "Mobile Stroke Unit", consisting of an ambulance equipped with computed tomography, a point-of-care laboratory system for complete stroke laboratory work-up, and telemedicine capabilities for contact with hospital experts, to achieve delivery of etiology-specific and guideline-adherent stroke treatment at the site of the emergency, well before arrival at the hospital. In a departure from current practice, stroke patients could be differentially treated according to their ischemic or hemorrhagic etiology even in the prehospital phase of stroke management. Immediate diagnosis of cerebral ischemia and exclusion of thrombolysis contraindications enabled us to perform prehospital rt-PA thrombolysis as bridging to later intra-arterial recanalization in one patient. In a complementary patient with cerebral hemorrhage, prehospital diagnosis allowed immediate initiation of hemorrhage-specific blood pressure management and telemedicine consultation regarding surgery. Call-to-therapy-decision times were 35 minutes.This preliminary study proves the feasibility of guideline-adherent, etiology-specific and causal treatment of acute stroke directly at the emergency site.

  18. Computed tomography stroke findings and population demographics at Pelonomi Hospital, Bloemfontein

    Directory of Open Access Journals (Sweden)

    Kevin Daffue

    2016-09-01

    Full Text Available Background: Stroke remains the highest cause of death in patients more than 50 years old in South Africa, and the fourth highest cause of death overall. There is a paucity of information regarding this disease in the Free State Province. Objectives: To assess the stroke profile of patients referred for computed tomography (CT imaging to our institution along with evaluating factors that could improve stroke management. Method: The demographic information, stroke risk factors, stroke types and time to imaging were evaluated for all patients who presented for CT stroke imaging from July 2014 until July 2015. Information was gathered prospectively from the hospital and radiology information systems. Results: The study included 174 patients (53.5% female, 46.5% male. Their mean age was 59 years (standard deviation (SD 14.6. The most prevalent risk factors were hypertension (83.7%, smoking (20.5% and diabetes (15.0%. The population group consisted of 67.8% ischaemic (n = 118 and 32.2% (n = 56 haemorrhagic strokes. The majority of patients with a known time of symptom onset (n = 102 presented after 8 hours (82.4%. The median order to report time (ORT was 61 min (range 18 min–1361 min. The median arrival to report time (ART was 32 min (range 4 min–893 min. Conclusion: Our stroke population did not differ significantly from others in South Africa and Africa overall. Pre- and in-hospital delays significantly influenced patient numbers qualifying for thrombolysis.

  19. Heart rate variability and baroreceptor sensitivity in acute stroke: a systematic review.

    Science.gov (United States)

    Yperzeele, Laetitia; van Hooff, Robbert-Jan; Nagels, Guy; De Smedt, Ann; De Keyser, Jacques; Brouns, Raf

    2015-08-01

    Autonomic nervous system dysfunction is common after acute stroke and is associated with elevated risk of cardiac arrhythmia and mortality. Heart rate variability and baroreceptor sensitivity have been investigated as parameters of autonomic nervous system dysfunction for the prediction of stroke outcome. We performed a systematic literature review on heart rate variability and baroreceptor sensitivity as parameters for autonomic nervous function in acute stroke. Twenty-two studies were included. Associations between heart rate variability or baroreceptor sensitivity and stroke severity, early and late complications, dependency and mortality were reported. However, interpretability of most studies and extrapolation to general stroke population are limited due to many confounding factors such as varying methodology, small sample sizes, survival selection, and exclusion of patients with frequently occurring comorbidities in stroke. Key issues, such as the effect of thrombolytic therapy on autonomic function, autonomic nervous system dysfunction in the hyperacute phase of stroke, and correlation with the risk of recurrent stroke have not been investigated. Also, nonlinear techniques have remained largely unexplored in this domain, in spite of their advantage to provide more solid evaluation in the occurrence of arrhythmia. Cardiac autonomic dysfunction, represented by reduced heart rate variability or impaired baroreceptor sensitivity, is associated with stroke severity, early and late complications, dependency, and mortality. Large-scale prospective studies applying internationally accepted standards of measures for analysis of heart rate variability and baroreceptor sensitivity are needed in patients with acute stroke. © 2015 World Stroke Organization.

  20. Increasing Incidence of Hospitalization for Stroke and Transient Ischemic Attack in Young Adults

    DEFF Research Database (Denmark)

    Tibæk, Maiken; Dehlendorff, Christian; Jørgensen, Henrik S

    2016-01-01

    BACKGROUND: Studies have reported increasing incidence of ischemic stroke in adults younger than 50 to 55 years. Information on temporal trends of other stroke subtypes and transient ischemic attack (TIA) is sparse. The aim of this study was to investigate temporal trends of the incidence of hosp......-time hospitalizations for ischemic stroke and TIA in young Danish adults have increased substantially since the mid 1990s. The increase was particularly prominent in the most recent years.......BACKGROUND: Studies have reported increasing incidence of ischemic stroke in adults younger than 50 to 55 years. Information on temporal trends of other stroke subtypes and transient ischemic attack (TIA) is sparse. The aim of this study was to investigate temporal trends of the incidence...... of hospitalizations for TIA and stroke including sex- and subtype-specific trends in young adults aged 15 to 30 years. METHODS AND RESULTS: From the Danish National Patient Register, we identified all cases of first-ever stroke and TIA (age 15-30 years) in Denmark, who were hospitalized during the study period...

  1. Pharmacotherapy prior to and in acute ischaemic stroke. The use of pharmacotherapy and drug-associated outcomes in real world practice - findings from the Polish Hospital Stroke Registry.

    Science.gov (United States)

    Niewada, Maciej; Sarzyńska-Długosz, Iwona Marta; Skowrońska, Marta; Kamiński, Bogumił; Kobayashi, Adam; Członkowska, Anna

    2013-01-01

    Stroke is a preventable disease and acute ischaemic stroke can be effectively treated. Specific pharmacotherapy is recommended in either prevention or acute ischemic stroke treatment. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute ischaemic stroke in a real world practice. Ischaemic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, web-based questionnaire with authorized access. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute ischaemic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency - modified Rankin Scale  3) at hospital discharge, while late outcomes covered one-year survival. A total number of 26 153 ischaemic stroke patients (mean age: 71.8 years; females: 51.6%) was reported. The ana-lysis of pharmacotherapy showed that preventive use of hypo-tensive agents, anticoagulants in atrial fibrillation, antiplatelets and statins is inadequate. Regression models confirmed some expected drug benefits and additionally revealed that antihypertensive drugs or aspirin used prior to stroke and oral anticoagulants or statins used in hospital were associated with better stroke outcome. The prevention of ischaemic stroke needs to be monitored and improved. Evidence-based treatment of acute ischaemic stroke requires further promotion. The benefits of acute ischaemic stroke treatment with statins require to be confirmed in randomized controlled settings.

  2. Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.

    Science.gov (United States)

    Xian, Ying; Thomas, Laine; Liang, Li; Federspiel, Jerome J; Webb, Laura E; Bushnell, Cheryl D; Duncan, Pamela W; Schwamm, Lee H; Stein, Joel; Fonarow, Gregg C; Hoenig, Helen; Montalvo, Cris; George, Mary G; Lutz, Barbara J; Peterson, Eric D; Bettger, Janet Prvu

    2017-10-01

    Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. URL: https://clinicaltrials.gov. Unique identifier: NCT02284165. © 2017 American Heart Association, Inc.

  3. Stroke among young adults at the LAUTECH Teaching Hospital, Osogbo, Nigeria.

    Science.gov (United States)

    Mustapha, A F; Sanya, E O; Bello, T O

    2012-01-01

    Stroke in young adults is relatively rare and there are very few hospital reports about it in Nigeria. The aetiologic mechanisms of stoke among young adults are quite distinct from those of the adults' populations. The purpose of this retrospective study was to determine the frequency, aetiologic mechanisms and prognosis of stroke among young adults at the LAUTECH Teaching Hospital Osogbo Nigeria. The study was both retrospective and descriptive. Case notes of stroke patients aged 16-45 years managed at the LAUTECH Teaching Hospital Osogbo from June 2005 till February 2008 were retrieved. Demographic data, clinical profile of stroke, laboratory investigation results and treatment outcomes were collated. Clinical diagnosis and classification of stroke was mainly clinical using the WHO clinical criteria. Only 3 patients had cranial CT scan. Out of the total number of 208 stroke patients managed during this period, 27(12.9%) were aged 45 years and below. This comprised of 17 males and 10 females. The age range was between 23-45 years. Using the WHO clinical criteria, there were 14 cases of heamorrhagic CVD and 13 cases of ischaemic CVD. The three cranial CT scan that were done revealed cerebral infarction which was consistent with the clinical diagnosis. Severe hypertension was found in 16 (59.2%) patients on admission. 3 patients had clinical and electrocardiographic evidence of rheumatic heart disease with infective endocarditis. Other risk factors included Sickle cell disease, cardiac arrhythmias etc. 8 out of the 27 patients died giving a percentage mortality of 29.6% and 7 patients were discharged against medical advice. Heamorrhagic stroke was slightly more frequent than ischaemic CVD. Systemic hypertension was also found to be prevalent among these young Nigerian adults with stroke. However, it was difficult to unravel the aetiologic mechanisms of stroke in this study because of paucity of investigations.

  4. Dignity realization of patients with stroke in hospital care: A grounded theory.

    Science.gov (United States)

    Rannikko, Sunna; Stolt, Minna; Suhonen, Riitta; Leino-Kilpi, Helena

    2017-01-01

    Dignity is seen as an important but complex concept in the healthcare context. In this context, the discussion of dignity includes concepts of other ethical principles such as autonomy and privacy. Patients consider dignity to cover individuality, patient's feelings, communication, and the behavior of healthcare personnel. However, there is a lack of knowledge concerning the realization of patients' dignity in hospital care and the focus of the study is therefore on the realization of dignity of the vulnerable group of patients with stroke. The aim of the study was to create a theoretical construct to describe the dignity realization of patients with stroke in hospital care. Research design and participants: Patients with stroke (n = 16) were interviewed in 2015 using a semi-structured interview containing open questions concerning dignity. The data were analyzed using constant comparison of Grounded Theory. Ethical considerations: Ethical approval for the research was obtained from the Ethics Committee of the University. The permission for the research was given by the hospital. Informed consent was obtained from participants. The "Theory of Dignity Realization of Patients with Stroke in Hospital Care" consists of a core category including generic elements of the new situation and dignity realization types. The core category was identified as "Dignity in a new situation" and the generic elements as health history, life history, individuality and stroke. Dignity of patients with stroke is realized through specific types of realization: person-related dignity type, control-related dignity type, independence-related dignity type, social-related dignity type, and care-related dignity type. The theory has similar elements with the previous literature but the whole construct is new. The theory reveals possible special characteristics in dignity realization of patients with stroke. For healthcare personnel, the theory provides a frame for a better understanding and

  5. Etiology of strokes and hemiplegia in children presenting at Ayub Teaching Hospital, Abbottabad.

    Science.gov (United States)

    Siddiqui, Tahir Saeed; Rehman, Anis ur; Ahmed, Basharat

    2006-01-01

    Strokes in pediatric age group are not common. However diagnosing the cause of stroke will help in providing preventive and curative treatment. Present study was conducted to find etiology of strokes/hemiplegia in children. This study was conducted in Department of Pediatrics, Ayub Teaching Hospital Abbottabad from December 2002 to December 2005. All children from two months to fifteen years of age were included in the study. Children with weakness due to acute poliomyelitis and Guillan barre syndrome were excluded. Investigations were based on findings on history and clinical examination and included full blood count, PT, APTT, Platelets count, ECG, Echocardiography, hematocrit, lumber puncture with CSF analysis and culture and CT-scan skull. Data of all the patients presenting with strokes/hemiplegia was entered on prepared proforma. The main etiology of strokes was intracranial infection causing strokes in 23(56.09%)children and majority of children (78.26%) in this group were below five years. Etiology was un-known in 7(17.07%) children after necessary available investigations. Intracranial infection Infections that is meningitis and encephalitis are commonest etiology of strokes and hemiplegia in paediatrics patients presenting at Ayub Teaching Hospital, Abbottabad.

  6. Prehospital and hospital delays after stroke onset--United States, 2005-2006.

    Science.gov (United States)

    2007-05-18

    Each year approximately 700,000 persons in the United States have a new or recurrent stroke; of these persons, 15%-30% become permanently disabled, and 20% require institutionalization during the first 3 months after the stroke. The severity of stroke-related disability can be reduced if timely and appropriate treatment is received. Patients with ischemic stroke may be eligible for treatment with intravenous thrombolytic (i.e., tissue plasminogen activator [t-PA]) therapy within 3 hours of symptom onset. Receipt of this treatment usually requires patients to recognize stroke symptoms and receive prompt transport to a hospital emergency department (ED), where timely evaluation and brain imaging (i.e., computed tomography or magnetic resonance imaging) can take place. For patients eligible for t-PA, evidence suggests that the earlier patients are treated after the onset of symptoms the greater the likelihood of a more favorable outcome. In 2001, Congress established the Paul Coverdell National Acute Stroke Registry to measure and track the quality of care provided to acute stroke patients. To assess prehospital delays from onset of stroke symptoms to ED arrival and hospital delays from ED arrival to receipt of brain imaging, CDC analyzed data from the four states participating in the national stroke registry. The results of that analysis indicated that fewer than half (48.0%) of stroke patients for whom onset data were available arrived at the ED within 2 hours of symptom onset, and prehospital delays were shorter for persons transported to the ED by ambulance (i.e., emergency medical services) than for persons who did not receive ambulance transport. The interval between ED arrival and brain imaging also was significantly reduced for those arriving by ambulance. More extensive public education is needed regarding early recognition of stroke and the urgency of telephoning 9-1-1 to receive ambulance transport. Shortening prehospital and hospital delays will increase

  7. Accuracy of Physical Therapists' Early Predictions of Upper-Limb Function in Hospital Stroke Units: The EPOS Study

    NARCIS (Netherlands)

    Nijland, R.H.M.; van Wegen, E.E.H.; Harmeling-van Wel, B.; Kwakkel, G.

    2013-01-01

    Background. Early prediction of outcome after stroke is becoming increasingly important, as most patients are discharged from hospital stroke units within several days after stroke. Objectives. The primary purposes of this study were: (1) to determine the accuracy of physical therapists' predictions

  8. Predictors of In-Hospital Mortality for Stroke in Douala, Cameroon

    Directory of Open Access Journals (Sweden)

    N. Y. Mapoure

    2014-01-01

    Full Text Available Background. The objective of this study was to describe complications in hospitalized patients for stroke and to determine the predictive factors of intrahospital mortality from stroke at the Douala General Hospital (DGH in Cameroon. Patients and Methods. A prospective cross-sectional study was carried out from January 1, 2010 to December 31, 2012, at the DGH. All the patients who were aged more than 15 years with established diagnosis of stroke were included. A univariate analysis was done to look for factors associated with the risk of death, whilst the predictive factors of death were determined in a multivariate analysis following Cox regression model. Results. Of the 325 patients included patients, 68.1% were males and the mean age was 58.66 ± 13.6 years. Ischaemic stroke accounted for 52% of the cases. Sepsis was the leading complications present in 99 (30.12% cases. Independent predicting factors of in-hospital mortality were Glasgow Coma Scale lower than 8 (HR = 2.17 95% CI 4.86–36.8; P=0.0001, hyperglycaemia at admission (HR = 3.61 95% CI 1.38–9.44; P=0.009, and hemorrhagic stroke (HR = 5.65 95% CI 1.77–18; P=0.003. Conclusion. The clinician should systematically diagnose and treat infectious states and hyperglycaemia in stroke.

  9. [Application of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction].

    Science.gov (United States)

    Wang, Zhi-min; Wang, Peng; Chen, Jie; Luo, Dan-hong; Shen, Wang-ming

    2008-07-01

    To evaluate the efficacy of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction. 77 acute cerebral infarction patients were randomly assigned to stroke rehabilitation unit group and 73 to ordinary group. The NIH stroke scale (NIHSS), activities of daily living (ADL) Barthel index and average hospitalized time were compared in two groups before and after the treatment. The average NIHSS in two groups before treatment were 9.26 and 9.12 respectively (P > 0.05) but became 2.62 and 7.64 after treatment (P 0.05) but 87.26 and 64.20 after the treatment (P rehabilitation unit being applied in the acute phase of cerebral infarction, it showed positive results in the following aspects as: improving the neurological function, capabilities of managing daily life, and also shortening the days of hospitalization.

  10. Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study.

    Science.gov (United States)

    Chen, Chien-Min; Yang, Yao-Hsu; Chang, Chia-Hao; Chen, Pau-Chung

    2017-12-01

    To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. Retrospective cohort study. Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. None. Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI scorestroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Stroke mortality and its predictors in a Nigerian teaching hospital

    African Journals Online (AJOL)

    mias, cardiac disorders, vasculitis, heavy alcohol con- sumption and cigarette smoking4. Additional well recognized risk factors are Sickle cell disease, oral contraceptives, vasculitic lesions and hy- percoagulable states4. More recently, HIV and hyper- homocysteinaemia have been noted as novel risk fac- tors for stroke5.

  12. Association of dialysis with in-hospital disability progression and mortality in community-onset stroke.

    Science.gov (United States)

    Usui, Tomoko; Hanafusa, Norio; Yasunaga, Hideo; Nangaku, Masaomi

    2018-02-22

    End-stage renal disease is associated with increased risk of cerebrovascular disease, but the effect on post-stroke clinical outcomes has not been thoroughly investigated. Using the Japanese Diagnosis Procedure Combination database, which includes administrative claims and discharge abstract data, we examined the association between risk factors including dialysis therapy and in-hospital disability progression or mortality in patients with community-onset stroke. We extracted data of patients aged ≥20 years old who were admitted to the hospital within 3 days after onset of stroke between July 2010 and March 2013. The disability level was divided into modified Rankin Scale (mRS) 0-1, 2-3, 4-5, and 6 (death). Disability progression was defined as an increase in disability level. Odds ratios for in-hospital disability progression and mortality were calculated using logistic regression models. Of 435,403 patients, 7,562 (1.7%) received dialysis therapy. The median length of stay was 21 and 20 days for patients with and without dialysis, respectively. During the hospital stay, disability progressed in 100,402 (23.1%) patients and 45,919 (10.5%) died. Patients on dialysis had a higher prevalence of disability progression (26.8%) and mortality (13.1%) compared to those without dialysis (23.0% and 10.5%, respectively). Dialysis was associated with an increased risk of in-hospital disability progression (odds ratio, 1.56; 95% confidence interval, 1.47-1.66) and mortality (odds ratio 1.70; 95% confidence interval, 1.57-1.84). These risks were comparable among subtypes of stroke. Dialysis was associated with an increased risk of in-hospital disability progression and mortality among patients with community-onset stroke, regardless of stroke subtype. This article is protected by copyright. All rights reserved.

  13. Variable lengths of stay among ischemic stroke subtypes in Chinese general teaching hospitals.

    Directory of Open Access Journals (Sweden)

    Yi Li

    Full Text Available BACKGROUND: Length of stay (LOS is one of the most important quantitative indexes that measures health service utilization within a hospital. Many studies have examined the association of three major stroke categories with LOS. Our aim is to investigate the differences of LOS among ischemic stroke subtypes, results from which are helpful to healthcare providers and government agencies to improve health care delivery efficiency. METHODOLOGY/PRINCIPAL FINDINGS: Using the Beijing Municipal Health Bureau's hospitalization summary reports, we performed a retrospective study among first-ever in-hospital patients with ischemic stroke (ICD-10 I63 in three general teaching hospitals in Beijing, China, from 2006 to 2010 with generalized linear model. In our study, 5,559 patients (female, 36.0%; age, 64.4 ± 12.9 years were included. The estimated mean LOS of ischemic stroke was 17.4 ± 1.8 days. After adjusting for confounders, LOS of lacunar infarction (14.7 days; p<0.001 and LOS of small cerebral infarction (17.0 days; p=0.393 were shorter than that of single cerebral infarction (17.9 days, p<0.001. LOS of multi-infarct (19.0 days; p=0.028, brainstem infarction (19.3 days; p=0.045, basal ganglia infarction (18.5 days; p=0.452 and other subtypes of ischemic stroke (18.9 days; p=0.327 were longer than that of single cerebral infarction. CONCLUSIONS: LOS of ischemic stroke patient differes across single cerebral infarction, lacunar infarction, multi-infarct and brainstem infarction patients. The ascending order of LOS was lacunar infarction, small cerebral infarction, single cerebral infarction, basal ganglia infarction, other subtypes of ischemic stroke, multi-infarct and brainstem infarction.

  14. Hospital treatment costs and length of stay associated with hypertension and multimorbidity after hemorrhagic stroke.

    Science.gov (United States)

    Specogna, Adrian V; Turin, Tanvir C; Patten, Scott B; Hill, Michael D

    2017-08-10

    Previous studies have identified various treatment and patient characteristics that may be associated with higher hospital cost after spontaneous intracerebral hemorrhage (ICH); a devastating type of stroke. Patient morbidity is perhaps the least understood of these cost-driving factors. We describe how hypertension and other patient morbidities affect length of stay, and hospital treatment costs after ICH using primary and simulated data. We also describe the relationship between cost and length of stay within these patients. We used a cohort design; evaluating 987 consecutive ICH patients across one decade in a Canadian center. Economic, treatment, and patient data were obtained from clinical and administrative sources. Multimorbidity was defined as the presence of one or more diagnoses at hospital admission in addition to a primary diagnosis of ICH. Hypertension was the most frequent (67%) morbidity within these patients, as well as the strongest predictor of longer stay (adjusted RR for >7 days: 1.31, 95% CI: 1.07-1.60), and was significantly associated with higher cost per visit when accounting for other morbidities (adjusted cost increase for hypertension $8123.51, 95% CI: $4088.47 to $12,856.72 USD). A Monte Carlo simulation drawing one million samples of patients estimated for a generation (100 years) assuming 0.94% population growth per year, and a hospitalization rate of 12 per 100,000 inhabitants, supported these findings (p = 0.516 for the difference in unadjusted cost: simulated vs primary). Using a restricted cubic spline, we observed that the rate of change in overall cost for all patients was greatest for the first 3 weeks (p < 0.001) compared to subsequent weeks. Patient multimorbidity, specifically hypertension, is a strong predictor of longer stay and cost after ICH. The non-linear relationship between cost and time should also be considered when forecasting healthcare spending in these patients.

  15. Effects of Speech Therapy in Hospitalized Patients with Post-Stroke Dysphagia: A Systematic Review of Observational Studies

    Directory of Open Access Journals (Sweden)

    Joice Santos Andrade

    2017-12-01

    Conclusion: Speech therapy in hospital bed in post-stroke hospitalized patients with dysphagia seems to bring satisfactory results in the short-term, revealing the importance of diagnosis and early intervention in these cases.

  16. Hospital arrival time and functional outcome after acute ischaemic stroke: results from the PREMIER study.

    Science.gov (United States)

    León-Jiménez, C; Ruiz-Sandoval, J L; Chiquete, E; Vega-Arroyo, M; Arauz, A; Murillo-Bonilla, L M; Ochoa-Guzmán, A; Carrillo-Loza, K; Ramos-Moreno, A; Barinagarrementeria, F; Cantú-Brito, C

    2014-05-01

    Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations is available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 hour) arrival were family history of ischemic heart disease and personal history of migraines; in <3 hours: age 40-69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  17. Trends in stroke admissions to a Tanzanian hospital over four decades: a retrospective audit.

    Science.gov (United States)

    Walker, Richard W; Viney, Rachel; Green, Laura; Mawanswila, Manasseh; Maro, Venance P; Gjertsen, Charlotte; Godfrey, Hannah; Smailes, Rosanna; Gray, William K

    2015-10-01

    The aim of this study was to record stroke admissions to a tertiary referral hospital in Tanzania over four decades. We audited the medical records held at a large teaching and tertiary referral hospital in northern Tanzania over four decades. We collected records for the years 1974-1976, 1984-1986, 1994-1995 and 2008. All patients admitted as inpatients with a primary diagnosis of stroke were included in the study. Data collected included age, sex, stroke subtype, predominant side of symptoms and survival to discharge. The number of stroke admissions rose from just four in the three-year period 1974-1976 (mean 1.3 cases annually) to 153 cases annually in 2008. The mean age of those admitted rose steadily during this period, as did the proportion of females admitted. The burden of stroke on health services in Tanzania appears to have increased rapidly. If this increase is to be slowed, then sustainable primary preventative measures to target known stroke risk factors will be required. © 2015 John Wiley & Sons Ltd.

  18. Analysis of the new code stroke protocol in Asturias after one year. Experience at one hospital.

    Science.gov (United States)

    García-Cabo, C; Benavente, L; Martínez-Ramos, J; Pérez-Álvarez, Á; Trigo, A; Calleja, S

    2018-03-01

    Prehospital code stroke (CS) systems have been proved effective for improving access to specialised medical care in acute stroke cases. They also improve the prognosis of this disease, which is one of the leading causes of death and disability in our setting. The aim of this study is to analyse results one year after implementation of the new code stroke protocol at one hospital in Asturias. We prospectively included patients who were admitted to our tertiary care centre as per the code stroke protocol for the period of one year. We analysed 363 patients. Mean age was 69 years and 54% of the cases were men. During the same period in the previous year, there were 236 non-hospital CS activations. One hundred forty-seven recanalisation treatments were performed (66 fibrinolysis and 81 mechanical thrombectomies or combined treatments), representing a 25% increase with regard to the previous year. Recent advances in the management of acute stroke call for coordinated code stroke protocols that are adapted to the needs of each specific region. This may result in an increased number of patients receiving early care, as well as revascularisation treatments. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Nurses Knowledge Regarding Risk Factors And Management Of Stroke At Rajshahi Medical College Hospital Bangladesh

    Directory of Open Access Journals (Sweden)

    Nahid Uz Zaman

    2015-08-01

    Full Text Available The study was carried out with a view to assess the nurses knowledge regarding the risk factors and management of stroke following a cross type descriptive study. Nurses having academic qualification were S.S.C 32 and H.S.C 68. Nurses having professional qualification were Diploma in Nursing amp Midwifery 50 because this degree was compulsory and basic for all. During the data collection there were also 42 B.Sc. in Nursing and 8 MPHM.Sc. among those respondents. Length of Service of the respondents nurses were 6 1 to 10 years followed by 24 58 amp 12 were in the 11 to 20 years 21 to 30 years and 31 to 40 years. The Nurses were given correct answer about 74 knowledge regarding stroke 50 types of stroke 82 controllable risk factor of stroke 76 uncontrollable risk factor of stroke 85 positioning needed for patients and 86 management of stroke. Considering the above discussion it was obviously clear that the Senior Staff Nurses SSN were much conscious regarding the risk factors and management of stroke working at Rajshahi Medical College Hospital RMCH.

  20. Orodental status and medical problems of stroke inpatients undergoing rehabilitation at a rehabilitation hospital in Japan.

    Science.gov (United States)

    Asahi, Yoshinao; Omichi, Shiro; Ono, Takahiro

    2015-09-01

    Many stroke patients may have oral problems and systemic diseases, but clinical information on treatment provided to stroke patients for dental problems during inpatient rehabilitation is rare. The objective of this study was to research stroke inpatients' requirements for dental treatment and the accompanying risks. We included 165 stroke patients undergoing inpatient rehabilitation at Morinomiya Hospital during the year 2010 and researched the causes of stroke and the patients' orodental status, underlying diseases, antithrombotic drugs prescribed and special considerations or difficulties in the treatment. Cerebral infarction was the most common causes of stroke. Many patients had hypertension, heart disease or diabetes mellitus, and 54.5% had been prescribed antithrombotic drugs. Dentists diagnosed 57.0% patients with untreated dental cavities. Approximately 30% did not use dentures despite having a requirement. In total, 142 patients underwent dental treatment including periodontal treatment, prosthetic treatment and tooth extraction under management of circulation and haemostasis such as monitoring vital signs and surgical splints in cases of the difficult extraction. The current study revealed a high requirement for dental treatment among stroke patients and demonstrated the effectiveness of performing dental treatment during inpatient rehabilitation of these patients. © 2014 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

  1. Ischaemic stroke management by emergency care physicians at public sector hospitals of Karachi, Pakistan

    International Nuclear Information System (INIS)

    Luni, F.K.; Hamid, S.A.; Mamji, S.; Baig, S.M.

    2011-01-01

    To assess the clinicians management of patients presenting with acute ischaemic stroke in the emergency departments of two large state run hospitals in Karachi, Pakistan. A questionnaire was filled by 59 registered medical practitioners working at these two government hospitals who would be managing stroke patients presenting in the emergency. It was a descriptive cross sectional study designed to assess the methods used by the doctors for diagnosing and treating stroke patients. The data was collected from October to November 2007 and entered using Epi Data Entry and analyzed by SPSS 13.0. Results: The preferred overall investigation for a suspected stroke patient in an emergency ward was an ECG (98%). 51% of the respondents would prescribe aspirin to most patients (300 mg by 40% respondents). Intravenous tissue plasminogen activator was thought to be beneficial by 43% of doctors, low molecular weight heparin by 91%, subcutaneous heparin by 86.5%, intravenous Vitamin B complex by 20% and steroids by 39% of respondents. Regarding elevated blood pressure, 60% answered that they would manage the blood pressure according to the type of stroke and 73% responded that they would lower blood pressure when it reached greater than 150/80. 88% of the doctors answered that they would use cholesterol lowering drugs in the management of stroke patients in an emergency. 97% of the doctors recommended rehabilitation and 88% of the respondents believed that there should be separate stroke units. Conclusion: The development of a standardized protocol and stroke team is recommended which should speed the clinical assessment, decisions for early management and also increase the performance of diagnostic studies. (author)

  2. The role of clinical pathway on the outcomes of ischemic stroke patients at Bethesda Hospital Yogyakarta

    Directory of Open Access Journals (Sweden)

    Francisca Diana Alexandra, Iwan Dwiprahasto, Rizaldy Pinzon

    2014-04-01

    Full Text Available Stroke becomes world health problem all over the world because it is the causal factor of high mortality and disability. Good and well-organized process of healthcare service will improve the outcome of the patients with stroke. Clinical pathway may be used as clear standard to help reduce unnecessary variations of medical treatment and measure. The study aimed at finding out the correlation between the use of clinical pathway and the outcome of the patients with ischemic stroke in Bethesda Hospital Yogyakarta. It was an observational and analytic study with cohort restorative study design. The author compared the outcomes of acute ischemic stroke between the group with clinical pathway and the group without the clinical pathway. Data was collected using consecutive sampling from the electronic registry and medical record data of the patients from January 1st, 2011 to December 31st, 2011. It was conducted to 124 patients with ischemic stroke assigned to two groups (the first groups of 62 patients with clinical pathway and the second groups of 62 patients without clinical pathway. The basic characteristics of the two groups were the same. The results of the analysis showed that there was a significant decrease in the incidence of complication and a significant increase in the use of antiplatelete drugs, antidiabetic drugs and statin as secondary preventive measure of the recurrent stroke. There was not any significant difference in the duration of the hospitalized healthcare, the financing and the mortality between the two observation groups. The study indicated that the use of the clinical pathway in the stroke treatment improved the outcome of the patients with stroke. It was necessary to conduct further study to evaluate the effectiveness of the clinical pathway in improving the outcome of the patients with bigger number of the subjects and the longer period of time.

  3. Supplement Consumption among Post stroke Patients in Dr. Hasan Sadikin General Hospital Bandung

    Directory of Open Access Journals (Sweden)

    Annisa Rahayu

    2016-09-01

    Full Text Available Background: Stroke is one of the leading causes of global disability. Post stroke rehabilitation program becomes the key to gain functional recovery. Thus it minimizes disabilities. Multiple studies have been carried out to gain greater functional outcomes for post stroke patients, including medical therapy such as supplements. However, supplement effectiveness in providing stroke recovery or prevention is still debatable. There is no data of supplement consumption among post stroke patients; therefore, the aim of this study was to determine the supplement consumption among post stroke patients. Methods: This study was a cross sectional descriptive study using primary data with a consecutive sampling method. Minimum samples for this study were 42 post stroke respondents who followed rehabilitation program. This study was conducted at Physical Medicine and Rehabilitation Clinic of Dr. Hasan Sadikin General Hospital Bandung from June until November 2013. The interviews were done after written informed consent was obtained. Descriptive statistics such as frequency distributin and proportion were used to analyze the data. Results: From 42 respondents, 23 (55% respondents consumed the supplement. From 34 supplements recorded, 56% were herbs supplements; followed by multivitamin (29%, mineral (6%, multivitamin and mineral (6%, and other supplement (3%. The most frequent ingredients composed in the supplements were B1, B6 and B12 vitamin (7%. Conclusions: More than a half of post stroke patients at Physical Medicine and Rehabilitation Clinic Dr. Hasan Sadikin General Hospital are supplement users, with herbal supplements as the majority. The most frequent ingredients used are B1, B6 and B12 vitamin.

  4. [Intravenous thrombolysis for acute ischemic stroke. A four years’ experience in a Chilean public hospital].

    Science.gov (United States)

    Soto V, Álvaro; Morales I, Gladys; Grandjean B, Marcela; Pollak W, Débora; Del Castillo C, Carolina; García F, Pía; Von Johnn A, Alexis; Riquelme G, Alfonso

    2017-04-01

    Intravenous thrombolysis (IVT) with alteplase (tissue plasminogen activator) is the standard pharmacological treatment in acute ischemic stroke (AIS), reducing disability in patients. To report the results a thrombolysis protocol during four years in a regional public hospital. Data from 106 consecutive patients aged 68 ± 13 years (57% men) who were treated with IVT, from May 2012 until April 2016, was analyzed. The median door-to-needle time was 80 minutes (interquartile range = 57-113). The median National Institute of Health Stroke Scale (NIHSS) scores on admission and at discharge were was 11.5 and 5 points respectively. At discharge, 27% of hospitalized patients had a favorable outcome (n = 99), defined as having 0 to 1 points in the modified Rankin scale. Symptomatic intracerebral hemorrhage and mortality rates were 5.7 and 13.1%, respectively. The thrombolysis rate rose from 0.7% in 2012 to 6% in 2016. The implementation of 24/7 neurology shifts in the Emergency Department allowed us to increase the amount and quality of IVT in our hospital, as measured by the rate of thrombolysis and by process indicators such as door-to-needle time.

  5. SURVIVAL RATE PENYANDANG HIPERTENSI DENGAN KONSUMSI NATRIUM RENDAH TERHADAP KEJADIAN STROKE

    Directory of Open Access Journals (Sweden)

    Ekowati Rahajeng

    2017-01-01

    Full Text Available Stroke is the leading cause of death and disability in the world. Several studies have shown that stroke can be prevented through modifiable risk factors. The adequate treatment of hypertension may reduce the risk of stroke. Lifestyle modification such as reducing salt intake in hypertension management have demonstrated lowering blood pressure, enhancing the effectiveness of antihypertension drugs and also reducing stroke risk. This study aims to verify the survival rate of hypertension with lower sodium intake (<2000 mg per day on the incidence of stroke. The study was conducted through a prospective cohort study (4 years of follow-up in 1082 people with confirmed hypertension. Stroke were confirmed by neurologist. The consumption of sodium, sugar and fat were collected through 24-hour dietary recall. Hypertension survival rate was calculated using Life Table Survival analysis. This study has demonstrated evidence of the higher survival rate of hypertension with low sodium intake on the incidence of stroke, with the difference 2-year survival rate is 3 percent higher and 4-year survival rate is 5 percent higher. Sodium consumption of <2000 mg per day in people with hypertension has prevented a 78 percent incidence of stroke. Therefore, the intervention programs to reduce of the consumption of salt or sodium in Indonesia should be prioritized.

  6. A study of factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with Stroke: A developing state scenario

    Directory of Open Access Journals (Sweden)

    Vinayak Nagaraja

    2010-10-01

    Full Text Available Background: Thrombolytic therapy for acute ischemic stroke has recently become available in India but its success depends on initiating the treatment in the narrow therapeutic time window. There is commonly a delay of several hours before patients with acute stroke seek medical attention. Materials and Methods: A prospective study was conducted to assess the factors influencing this delay in admission of acute stroke cases. 134cases (101 males, 33 females of acute stroke that arrived within 72 hours at our hospital casualty were recruited. A standardized structured questionnaire was given to patients or their attendants. Results: The median time to casualty arrival was 9 hours with 13.4% cases arriving within 3 hours and 36.5 % cases within 6 hours. Distances from hospital, referral, belief in myths and alternate medicine and low threat perception of symptoms of stroke were independent factors associated with delay in arrival. Living in city, day time onset, urgency shown by attendant, availability of transport and presence of family history were associated with early arrival. There was no correlation with patients' or attendants' sex, educational status, history of previous stroke or transient ischemic attack, subtype or severity of stroke, time of stroke and availability of transport. 134 patients (65.7% were from rural population, 55.22%-smokers, 46.76%-alcoholics with mean (SD age of 53.83+/-18.02years [significantly lower in females (mean difference=9.73years p=0.002], were admitted and diagnosed to have stroke. 87.3% had first episode of stroke and 12.7 had more than one episode of stroke. ICF rate was 26.1%. ICF rate has no relation with age (p=0.516, sex (p=0.460, number of episodes (0.795, underlying hypertension (p=0.905. Odds of diabetics dying were 12 times higher than non-diabetics. Inpatient mortality was also significantly higher in smokers compared with non-smokers (p=0.004, in patients with right-sided compared with left

  7. estimated glomerular filtration rate and risk of survival in acute stroke

    African Journals Online (AJOL)

    2014-03-03

    Mar 3, 2014 ... the risk of survival in acute stroke. INTRODUCTION. Stroke is independently associated with impairment in the structure and function of the glomerulus. (1). Estimated Glomerular Filtration Rate (GFR) as determined by the four-item Modification of diet in renal disease (MDRD) equation is a fairly reliable.

  8. Stroke rehabilitation: assistive technology devices and environmental modifications following primary rehabilitation in hospital--a therapeutic perspective

    DEFF Research Database (Denmark)

    Sørensen, Hanne Vinkel; Lendal, Susie; Schultz-Larsen, Kirsten

    2003-01-01

    The aim of this article is to describe the need for assistive devices and environmental modifications among long-living stroke survivors and to investigate if the need is continued and growing over time. The study sample of 155 consecutive stroke patients with stroke-related impairment, discharged...... home from three hospitals in Copenhagen from 1996 through 1998, constituted 20% of the total population of stroke survivors in this area. The results showed that 75% of these patients were provided with assistive devices and/or environmental modifications at discharge. Six months after discharge...... be required in order to target stroke survivors' changing needs for assistive devices and environmental modifications....

  9. Economic Evaluation of a Pre-Hospital Protocol for Patients with Suspected Acute Stroke.

    Science.gov (United States)

    Lahiry, Suman; Levi, Christopher; Kim, Joosup; Cadilhac, Dominique A; Searles, Andrew

    2018-01-01

    In regional and rural Australia, patients experiencing ischemic stroke do not have equitable access to an intravenous recombinant tissue plasminogen activator (tPA). Although thrombolysis with tPA is a clinically proven and cost-effective treatment for eligible stroke patients, there are few economic evaluations on pre-hospital triage interventions to improve access to tPA. To describe the potential cost-effectiveness of the pre-hospital acute stroke triage (PAST) protocol implemented to provide priority transfer of appropriate patients from smaller hospitals to a primary stroke center (PSC) in regional New South Wales, Australia. The PAST protocol was evaluated using a prospective and historical control design. Using aggregated administrative data, a decision analytic model was used to simulate costs and patient outcomes. During the implementation of the PAST protocol (intervention), patient data were collected prospectively at the PSC. Control patients included two groups (i) patients arriving at the PSC in the 12 months before the implementation of the PAST protocol and, (ii) patients from the geographical catchment area of the smaller regional hospitals that were previously not bypassed during the control period. Control data were collected retrospectively. The primary outcome of the economic evaluation was the additional cost per disability adjusted life years (DALYs) averted in the intervention period compared to the control period. The intervention was associated with a 17 times greater odds of eligible patients receiving tPA (adjusted odds ratio, 95% CI 9.42-31.2, p  pre-hospital triage intervention was a potentially cost-effective strategy for improving access to tPA therapy for patients with ischemic stroke in regional Australia.

  10. Serum Alkaline Phosphatase, Phosphate, and In-Hospital Mortality in Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Zhong, Chongke; You, Shoujiang; Chen, Juping; Zhai, Guojie; Du, Huaping; Luo, Yi; Dong, Xiaofeng; Cao, Yongjun; Liu, Chun-Feng; Zhang, Yonghong

    2018-01-01

    The clinical impacts of serum alkaline phosphatase (ALP) and phosphate on early death are not fully understood in patients with acute ischemic stroke. We examined the associations between serum ALP, phosphate, and in-hospital mortality after ischemic stroke. Serum ALP and phosphate were measured in 2944 ischemic stroke patients from 22 hospitals in Suzhou City from December 2013 to May 2014. Cox proportional hazard models and restricted cubic splines were used to estimate the relationships between serum ALP and phosphate (both as categorical and continuous variables) and risk of in-hospital mortality. During hospitalization, 111 patients (3.7%) died from all causes. After multivariable adjustment, the hazard ratio (HR) of the highest quartile compared with the lowest quartile of ALP was 2.19 (95% confidence interval [CI], 1.20-4.00) for early death. Restricted cubic spline analysis indicated a significant linear association between ALP and death (P-linearity = .017). A U-shaped association of phosphate with in-hospital mortality was observed (P-nonlinearity = .011). Compared with the third quartile of phosphate (1.08-1.21 mmol/L), HRs of the lowest and highest quartiles for early death were 2.17 (1.15-4.08) and 1.70 (.88-3.30), respectively. Sensitivity analyses further confirmed our findings. We observed a graded relationship between serum ALP levels and risk of early death in patients with acute ischemic stroke. There was a U-shaped association between phosphate and all-cause mortality with significantly increased risk among patients with lower phosphate levels. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Reporting time of ischemic stroke patients within the time window for thrombolysis in a tertiary care hospital at rawalpindi

    International Nuclear Information System (INIS)

    Tariq, M.; Ishtiaq, S.; Anwar, S.O.

    2014-01-01

    To determine the reporting time of ischemic stroke patients within the time window for thrombolysis at Military Hospital (MH) Rawalpindi. Design: A descriptive study. Place and duration of Study: Military Hospital Rawalpindi over a period of four months from Dec 2013 to Mar 2014. Patients and Methods: Patients admitted to MH Rawalpindi with symptoms suggestive of stroke and having objective focal neurologic deficits consistent with stroke were included in the study. A CT scan of brain was carried out immediately to rule out intracranial bleed. The CT scan of brain was either normal or revealed radiological findings suggestive of an infarct. Results: A total of 86 patients met the inclusion criteria of the study. Only 19 (22%) patients with ischemic stroke presented to the hospital within 4.5 hours after onset of their symptoms. Conclusion: Only a small number of ischemic stroke patients report to the hospital within the therapeutic window for thrombolytic therapy. (author)

  12. Rates and Determinants of 5-Year Outcomes After Atrial Fibrillation-Related Stroke: A Population Study.

    Science.gov (United States)

    Hayden, Derek T; Hannon, Niamh; Callaly, Elizabeth; Ní Chróinín, Danielle; Horgan, Gillian; Kyne, Lorraine; Duggan, Joseph; Dolan, Eamon; O'Rourke, Killian; Williams, David; Murphy, Sean; Kelly, Peter J

    2015-12-01

    Demographic trends in atrial fibrillation (AF) incidence may yield a substantial rise in the societal burden of AF-related stroke (AF-stroke). Accurate population-wide outcome data are essential to inform health service planning to improve AF-stroke prevention, and provision of rehabilitation, nursing home, and community supports for AF-stroke survivors. We investigated rates and determinants of 5-year fatality, stroke recurrence, functional outcomes, and prescribing of secondary prevention medications in AF-stroke in the North Dublin Population Stroke Study. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using lifetables and Kaplan-Meier survival curves, and Cox proportional hazard modeling was performed to identify predictors of death and recurrent stroke. Five hundred sixty-eight patients with new stroke were identified, including 177 (31.2%) AF-stroke. At 5 years, 39.2% (confidence interval, 31.5-46.8) of ischemic AF-stroke patients were alive. Congestive heart failure, hypertension, age stroke, transient ischemic attack or thromboembolism, vascular disease and female sex (CHA2DS2-VASc) score (hazard ratio [HR], 1.34; PStroke Scale (HR, 1.09; Pstroke onset (HR, 3.29; P=0.003) were independently associated with 5-year fatality, whereas warfarin (HR, 0.40; P=0.001) and statin use after index stroke (HR, 0.52; P=0.005) were associated with improved survival. The 5-year recurrence rate after ischemic AF-stroke was 21.5% (confidence interval, 14.5-31.3). Trends toward greater risk of recurrence were observed for persistent AF (HR, 3.09; P=0.07) and CHA2DS2-VASc score (HR, 1.34; P=0.07). Nursing home care was needed for 25.9% of patients. AF-stroke is associated with considerable long-term morbidity, fatality, stroke recurrence, and nursing home requirement. Adequately resourced national AF strategies to improve AF detection and prevention are needed. © 2015 American Heart Association, Inc.

  13. Does HIPE data capture the complexity of stroke patients in an acute hospital setting?

    LENUS (Irish Health Repository)

    Clarke, B

    2010-01-01

    The Hospital Inpatient Enquiry (HIPE) system is currently used as a principle source of national data on discharges from acute hospitals. The Casemix Programme is used to calculate funding for patient care (HIPE activity and Specialty Costs Returns). Th coding is usually undertaken by clerical personnel. We were concerned that the medical complexity of our stroke patients was not captured by the process. The aims of this study were to compare activity coded by HIPE coding staff and medical staff in consecutive stroke patients discharged from the hospital. One hundred consecutive discharged patients with stroke as primary diagnosis were coded by clerical staff [usual practice] and by medical staff. We compared the coding and any differences. We calculated the financial comparison of subsequent differences in Diagnostic Related Groups (DRGs) and Relative Values (RVs). Clinician coded DRGs resulted in a higher assigned RV in 45 cases. The total RV value for HIPE using clerical coding was 595,268.94 euros and using medical coding was 725,252.16 euros. We conclude that medical input is useful in detailing the complications arising in stroke patients. We suggest that physicians should assist in the HIPE coding process in order to capture clinical complexity, so that funding can be appropriately assigned to manage these complex patients.

  14. Beyond Volume: Hospital-Based Healthcare Technology for Better Outcomes in Cerebrovascular Surgical Patients Diagnosed With Ischemic Stroke: A Population-Based Nationwide Cohort Study From 2002 to 2013.

    Science.gov (United States)

    Kim, Jae-Hyun; Park, Eun-Cheol; Lee, Sang Gyu; Lee, Tae-Hyun; Jang, Sung-In

    2016-03-01

    We examined whether the level of hospital-based healthcare technology was related to the 30-day postoperative mortality rates, after adjusting for hospital volume, of ischemic stroke patients who underwent a cerebrovascular surgical procedure. Using the National Health Insurance Service-Cohort Sample Database, we reviewed records from 2002 to 2013 for data on patients with ischemic stroke who underwent cerebrovascular surgical procedures. Statistical analysis was performed using Cox proportional hazard models to test our hypothesis. A total of 798 subjects were included in our study. After adjusting for hospital volume of cerebrovascular surgical procedures as well as all for other potential confounders, the hazard ratio (HR) of 30-day mortality in low healthcare technology hospitals as compared to high healthcare technology hospitals was 2.583 (P technology hospitals with high volume as compared to high healthcare technology hospitals with high volume was the highest (10.014, P technology hospitals had the highest 30-day mortality rate, irrespective of hospital volume. Although results of our study provide scientific evidence for a hospital volume/30-day mortality rate relationship in ischemic stroke patients who underwent cerebrovascular surgical procedures, our results also suggest that the level of hospital-based healthcare technology is associated with mortality rates independent of hospital volume. Given these results, further research into what components of hospital-based healthcare technology significantly impact mortality is warranted.

  15. Mexican-National Institute of Neurology and Neurosurgery-Stroke Registry: Results of a 25-Year Hospital-Based Study

    Directory of Open Access Journals (Sweden)

    Antonio Arauz

    2018-04-01

    Full Text Available Background and purposeStroke has been scarcely studied in Latin America (LA. The Mexican Institute of Neurology Stroke Registry was established in 1990 as a prospective computer-based database to register data obtained from patients admitted with stroke. Using this data, we attempted to define the profile of risk factors and outcomes.MethodsThe demographic data, stroke description, ancillary tests, vascular risk factors, and modified Rankin scale (mRs were registered. Ischemic stroke subtyping was based on the Trial of Org 10,172 of the Acute Stroke Treatment classification. We followed-up patients using multiple overlapping methods. Primary outcomes included mRs, recurrence, and death at 30 days and at the end of follow-up.ResultsWe included 4,481 patients with a median follow-up of 27 months, (17,281 person-years follow-up. The mean age was 52.8 ± 18 years. There were 2,229 males (50% included in the study. CI was present in 64.9%, intracerebral hemorrhage (ICH in 25.6%, and cerebral venous thrombosis (CVT in 6.3%. Hypertension was the major risk factor (46.5%. The most common cause of CI was atherosclerosis (27%. ICH was mainly hypertensive (58%, and 60% of CVT were puerperal. Overall, the mortality rate was 24.5%. The recurrence rate was 16.9%. Poor outcome (mRs ≥ 3 was found in 56.2% of patients. The best outcomes were observed in CVT patients (74.5% mRs ≤ 2, whereas 72.1% ICH patients had mRs ≥3.ConclusionThis is one of the largest hospital-based registries in LA and shows significant differences with other previously published registries, including a younger age, relatively less hypertension, and larger proportion of CVT. Poor functional outcome was common. This study adds to the understanding of geographic differences in stroke characteristics and outcomes.

  16. Stroke survivors with severe mental illness: Are they at-risk for increased non-psychiatric hospitalizations?

    Directory of Open Access Journals (Sweden)

    Flavius Robert Lilly

    Full Text Available This study examined outcomes for two groups of stroke survivors treated in Veteran Health Administration (VHA hospitals, those with a severe mental illness (SMI and those without prior psychiatric diagnoses, to examine risk of non-psychiatric medical hospitalizations over five years after initial stroke.This retrospective cohort study included 523 veterans who survived an initial stroke hospitalization in a VHA medical center during fiscal year 2003. The survivors were followed using administrative data documenting inpatient stroke treatment, patient demographics, disease comorbidities, and VHA hospital admissions. Multivariate Poisson regression was used to examine the relationship between patients with and without SMI diagnosis preceding the stroke and their experience with non-psychiatric medical hospitalizations after the stroke.The study included 100 patients with SMI and 423 without SMI. Unadjusted means for pre-stroke non-psychiatric hospitalizations were higher (p = 0.0004 among SMI patients (1.47 ± 0.51 compared to those without SMI (1.00 ± 1.33, a difference which persisted through the first year post-stroke (SMI: 2.33 ± 2.46; No SMI: 1.74 ± 1.86; p = 0.0004. Number of non-psychiatric hospitalizations were not significantly different between the two groups after adjustment for patient sociodemographic, comorbidity, length of stay and inpatient stroke treatment characteristics. Antithrombotic medications significantly lowered risk (OR = 0.61; 95% CI: 0.49-0.73 for stroke-related readmission within 30 days of discharge.No significant differences in medical hospitalizations were present after adjusting for comorbid and sociodemographic characteristics between SMI and non-SMI stroke patients in the five-year follow-up. However, unadjusted results continue to draw attention to disparities, with SMI patients experiencing more non-psychiatric hospitalizations both prior to and up to one year after their initial stroke. Additionally

  17. Use of outcome measures in stroke rehabilitation in the transition from hospital to home-based rehabilitation

    DEFF Research Database (Denmark)

    Maribo, Thomas; Nielsen, Claus Vinther

    Relevance: Stroke is one of the major chronic diseases leading to long-term disability. Stroke treatment has improved and in-hospital stays have been reduced, leading to increasing emphasis on home-based rehabilitation. The transition from hospital to home-based rehabilitation is critical, as vital...... are vague. Purpose: The purpose was to examine the use of outcome measures used in clinical practice in the transition from hospital to home-based rehabilitation. Methods/Analysis: A questionnaire were sent to the heads of 26 hospitals discharging patients with stroke and 52 municipalities' health services...... rehabilitation, especially in the transition between hospital and home-based rehabilitation. A nationwide, interprofessional and intersectional group is currently discussing recommendations for the use of outcome measures in stroke rehabilitation. Results from this group will be presented at the conference...

  18. Rasch analysis in the development of a rating scale for assessment of mobility after stroke

    DEFF Research Database (Denmark)

    Engberg, A; Garde, B; Kreiner, S

    1995-01-01

    The study describes the development of a rating scale for assessment of mobility after stroke. It was based on 74 first-stroke patients, 40 men and 34 women, each assessed three times during rehabilitation. Their median age was 69 years, and they represented all degrees of severity of paresis....... Content, construct, criterion and convergent validity were examined, as well as the inter-rater reliability. The final rating scale has three special characteristics: 1) it reflects the regularity in the recovery of mobility after stroke; 2) the sum of item scores comprises the information contained...

  19. [Frequency and characteristics of strokes involving the perforating arteries in the Department of Neurology at the Befelatanana General Hospital, Antananarivo].

    Science.gov (United States)

    Rasaholiarison, Nomena Finiavana; Randrianasolo, Rahamefy Odilon; Rajaonarison, Lala Andriamasinavalona; Rakotomanana, Jenny Larissa; Razafimahefa, Julien; Tehindrazanarivelo, Alain Djacoba

    2017-01-01

    Strokes of the perforating arteries are mainly arteriolopathies. They result in dementia and stroke recurrence. This study aimed to evaluate the frequency and characteristics of these strokes to better prevent these complications. We conducted a descriptive, retrospective study in the department of neurology at the Befelatanana general hospital, Antananarivo over the period 01 March-25 September 2015. All patients with abrupt neurological deficit and deep brain involvement on brain scanner were included in the study. The features of strokes involving the perforating arteries were collected. Data were processed with SPSS 20 software. Out of 172 patients with a stroke, 83(48.25%) had stroke involving the perforating arteries. Stroke involving the perforating arteries affected young people (65.06%) aged less than 65 years and preferentially the male population (61.44%). Haemorrhagic forms accounted for 67.46%. Thirty-one patients (37.34%) had stroke recurrences and, among them, almost a quarter had 2 recurrences (38.70%) in less than a year. All patients with recurrence had dysexecutive disorder (p < 0.0001) and poor antihypertensive medication adherence. Mortality accounted for only 6.02% in patients with onset of these strokes during hospitalization. Specific neurologic follow-up is necessary after a first stroke involving perforating arteries in order to make an early diagnosis of dementia and to prevent recurrences.

  20. Feeding practice in acute stroke patients in a tertiary care hospital.

    Science.gov (United States)

    Miah, Md Titu; Al-Amin, Mohammad; Khan, Mohammad Ashik Imran; Ayaz, K F M; Zakaria, M H; Ahmed, Srijoni; Ahasan, H A M Nazmul

    2010-12-01

    Feeding is a basic component of care and it is the most common and difficult management issue for stroke patients. Objective of this study was to know the practice of feeding (oral & nasogastric tube feeding), different types of food used and their caloric value in stroke patients. This direct observational study was done from June 2010 to November 2010, in different medicine wards of Dhaka Medical College Hospital, and included 100 acute stroke patients confirmed by CT scan or MRI of brain and duration of hospital stay for at least 24 hours. Out of 100 cases, 22% took their feeding orally and 78% cases through nasogastric tube. Artificial milk powder 66% cases (NG tube vs. Orally, 58% vs. 8%), juice 18% (NG tube 13% vs. orally 5%), horlicks & juice & soup 10% (NG tube vs. Orally, 7% vs. 3%), khichury 2% orally, bread & egg & shuji 4% cases orally. In 100 cases studied, none of them fulfilled the calorie requirement up to the standard level according to the guideline of Nutrition & Food Science Institute, of Dhaka University, Bangladesh. Though this study was small scale but the magnitude of under nutrition among stroke patients revealed is alarming and needs urgent attention.

  1. Stroke

    Science.gov (United States)

    ... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...

  2. Impairment in glomerular filtration rate or glomerular filtration barrier and occurrence of stroke.

    Science.gov (United States)

    Ovbiagele, Bruce

    2008-07-01

    Chronic kidney disease (CKD) is associated with substantial burden and is a strong risk factor for cardiovascular disease. However, data on the relationship between CKD and stroke are few and are limited by unreliable or inadequate assessment of renal function. To properly assess the relationship between renal insufficiency and stroke in stroke survivors in the United States by simultaneously examining the effect of guideline-recommended indices of renal disease that measure glomerular filtration rate (creatinine clearance) and glomerular filtration barrier (proteinuria). Cross sectional. Nationally representative survey of the United States. Participants aged 55 or older who participated in the National Health and Nutrition Examination Survey from 1999 to 2004. Indices of renal disease that measure glomerular filtration rate (creatinine clearance) and glomerular filtration barrier (microalbuminuria). Of 6382 adults who met inclusion criteria, 5624 (88%) had full and complete data, of which 414 (6%) reported having had a stroke. Stroke survivors were older and more likely to have CKD, diabetes, hypertension, coronary artery disease, elevated blood pressure, increased glycohemoglobin concentration, and lower hematocrit compared with respondents who did not report stroke. Multivariate models showed that microalbuminuria (odds ratio, 1.51; 95% confidence interval, 1.02-2.24), decreased glomerular filtration rate (odds ratio, 1.93; 95% confidence interval, 1.28-2.91), and stage 3 CKD (odds ratio, 2.09; 95% confidence interval, 1.38-3.16) were significantly associated with stroke. Stroke is independently associated with impairment in structure and function of the glomerulus, which supports the need to consider screening patients with stroke for CKD and to simultaneously assess for both indices of renal disease.

  3. Comorbid Psychiatric Disease Is Associated With Lower Rates of Thrombolysis in Ischemic Stroke.

    Science.gov (United States)

    Bongiorno, Diana M; Daumit, Gail L; Gottesman, Rebecca F; Faigle, Roland

    2018-03-01

    Intravenous thrombolysis (IVT) improves outcomes after acute ischemic stroke but is underused in certain patient populations. Mental illness is pervasive in the United States, and patients with comorbid psychiatric disease experience inequities in treatment for a range of conditions. We aimed to determine whether comorbid psychiatric disease is associated with differences in IVT use in acute ischemic stroke. Acute ischemic stroke admissions between 2007 and 2011 were identified in the Nationwide Inpatient Sample. Psychiatric disease was defined by International Classification of Diseases , Ninth Revision, Clinical Modification codes for secondary diagnoses of schizophrenia or other psychoses, bipolar disorder, depression, or anxiety. Using logistic regression, we tested the association between IVT and psychiatric disease, controlling for demographic, clinical, and hospital factors. Of the 325 009 ischemic stroke cases meeting inclusion criteria, 12.8% had any of the specified psychiatric comorbidities. IVT was used in 3.6% of those with, and 4.4% of those without, psychiatric disease ( P disease was associated with lower odds of receiving IVT (adjusted odds ratio, 0.80; 95% confidence interval, 0.76-0.85). When psychiatric diagnoses were analyzed separately individuals with schizophrenia or other psychoses, anxiety, or depression each had significantly lower odds of IVT compared to individuals without psychiatric disease. Acute ischemic stroke patients with comorbid psychiatric disease have significantly lower odds of IVT. Understanding barriers to IVT use in such patients may help in developing interventions to increase access to evidence-based stroke care. © 2018 American Heart Association, Inc.

  4. The Relationship between Self-rated Health and Hospital Records

    DEFF Research Database (Denmark)

    Nielsen, Torben Heien

    2016-01-01

    This paper investigates whether self-rated health (SRH) covaries with individual hospital records. By linking the Danish Longitudinal Survey on Ageing with individual hospital records covering all hospital admissions from 1995 to 2006, I show that SRH is correlated to historical, current, and fut...

  5. The relation between knowledge about hypertension and education in hospitalized patients with stroke in Vienna.

    Science.gov (United States)

    Samal, Doris; Greisenegger, Stefan; Auff, Eduard; Lang, Wilfried; Lalouschek, Wolfgang

    2007-04-01

    Knowledge about hypertension and its control influences blood pressure control in patients with hypertension. We assessed these parameters in a large cohort of patients with ischemic stroke or transient ischemic attack and analyzed their association with educational attainment. Five hundred ninety-one consecutive patients with stroke with a medical history of hypertension were interviewed about knowledge concerning hypertension within a multicenter hospital-based stroke registry. We analyzed answers in relation to educational level with multivariate logistic regression adjusted for age and sex. Seventy-seven percent of the patients stated to have known about hypertension being a risk factor for stroke, but only 30% felt at increased risk of stroke. Less than half (47%) could identify 140 mm Hg or less as the maximum tolerated systolic blood pressure, and 53% had their blood pressure only controlled monthly or less often. Knowledge of possible consequences of myocardial infarction, nephropathy, peripheral vascular disease, and retinopathy was 64%, 20%, 11%, and 16%, respectively. Approximately half of patients were acquainted with the nonpharmacologic treatment options of physical activity (49%), reduction of salt intake (54%), and reduction of caloric intake (48%), whereas relaxation techniques were only known to 17%. Adherence to those treatment options ranged from 42% to 67%. Educational level was significantly associated with knowledge of increased risk, possible consequences of hypertension, and knowledge about nonmedication treatment options. Knowledge in our population was insufficient and partly associated with educational level, leaving much room for improvement by educational campaigns. Furthermore, we found a gap between knowledge of the increased risk for stroke in patients with hypertension and awareness of their own risk.

  6. External Counterpulsation Increases Beat-to-Beat Heart Rate Variability in Patients with Ischemic Stroke.

    Science.gov (United States)

    Xiong, Li; Tian, Ge; Wang, Li; Lin, Wenhua; Chen, Xiangyan; Leung, Thomas Wai Hong; Soo, Yannie Oi Yan; Wong, Lawrence Ka Sing

    2017-07-01

    External counterpulsation (ECP) is a noninvasive method used to augment cerebral perfusion in ischemic stroke. However, the response of beat-to-beat heart rate variability (HRV) in patients with ischemic stroke during ECP remains unknown. Forty-eight patients with unilateral ischemic stroke at the subacute stage and 14 healthy controls were recruited. Beat-to-beat heart rate before, during, and after ECP was monitored. The frequency components of HRV were calculated using power spectral analysis. Very low frequency (VLF; <.04 Hz), low frequency (LF; .04-.15 Hz), high frequency (HF; .15-.40 Hz), total power spectral density (TP; <.40 Hz), and LF/HF ratio were calculated. In stroke patients, although there were no statistical differences in all of the HRV components, the HRV at VLF showed a trend of increase during ECP compared with baseline in the left-sided stroke patients (P = .083). After ECP, the HRV at LF and TP remained higher than baseline in the right-sided stroke patients (LF, 209.4 versus 117.9, P = .050; TP, 1275.6 versus 390.2, P = .017, respectively). Besides, the HRV at TP also increased after ECP compared with baseline in the left-sided stroke patients (563.0 versus 298.3, P = .029). Irrespective of the side of the ischemia, patients showed an increased beat-to-beat HRV after ECP. Additionally, sympathetic and parasympathetic cardiac modulations were increased after ECP in patients after right-sided subacute stroke. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Public and Private Hospital Care Disparities of Ischemic Stroke in Mexico: Results from the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) Study.

    Science.gov (United States)

    Ruiz-Sandoval, José Luis; Briseño-Godínez, María Eugenia; Chiquete-Anaya, Erwin; Arauz-Góngora, Antonio; Troyo-Sanromán, Rogelio; Parada-Garza, Juan Didier; Ramos-Moreno, Alma; Barinagarrementería, Fernando; Murillo-Bonilla, Luis Manuel; Cantú-Brito, Carlos

    2018-02-01

    Mortality and bad outcome by stroke are higher in developing countries than in industrialized countries. Health-care system efficiency could explain these disparities. Our objective was to identify the impact on short- and middle-term outcomes of patients with acute ischemic stroke (AIS) among public and private Mexican medical care. We analyzed data from patients with AIS included in the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) study. Transient ischemic attacks (TIAs) and ambulatory patients were excluded. Mortality and good outcome were assessed by the modified Rankin Scale (mRS) and analyzed at 1, 3, and 12 months of follow-up. From 1246 patients with AIS included in the registry, 1123 were hospitalized, either in public (n = 881) or in private (n = 242) hospitals. There were no significant differences regarding age and gender. In private settings, patients had a higher educational level, a major frequency of dyslipidemia, a previous stroke and TIA, less overweight and obesity, a sedentary lifestyle, and diabetes; stroke severity, the rate of systemic complications, the length of stay, and in-hospital mortality were also lower; a major frequency of thrombolysis was observed when compared with public hospitals. Our study showed a better outcome (mRS score ≤2) in private scenarios and a higher mortality in patients treated in public hospitals at short- and middle-term follow-ups. A polarized medical practice was observed in the AIS care in this large multicenter cohort of Mexico. There is evidence of an advantage for private scenarios, possibly related with an optimal infrastructure or with a strong patient's economic status. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  8. Acute Stroke at The University College Hospital Ibadan, Nigeria ...

    African Journals Online (AJOL)

    The over-all mortality was 15.5% and was closely related to the NIHSS score, level of consciousness (GCS) and associated complications such as raised intracranial pressure and aspiration pneumonia. NIHSS score > 20 was the only significant independent predictor of thirty days mortality in this study. The case fatality rate ...

  9. Economic Evaluation of a Pre-Hospital Protocol for Patients with Suspected Acute Stroke

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    Suman Lahiry

    2018-03-01

    Full Text Available BackgroundIn regional and rural Australia, patients experiencing ischemic stroke do not have equitable access to an intravenous recombinant tissue plasminogen activator (tPA. Although thrombolysis with tPA is a clinically proven and cost-effective treatment for eligible stroke patients, there are few economic evaluations on pre-hospital triage interventions to improve access to tPA.AimTo describe the potential cost-effectiveness of the pre-hospital acute stroke triage (PAST protocol implemented to provide priority transfer of appropriate patients from smaller hospitals to a primary stroke center (PSC in regional New South Wales, Australia.Materials and methodsThe PAST protocol was evaluated using a prospective and historical control design. Using aggregated administrative data, a decision analytic model was used to simulate costs and patient outcomes. During the implementation of the PAST protocol (intervention, patient data were collected prospectively at the PSC. Control patients included two groups (i patients arriving at the PSC in the 12 months before the implementation of the PAST protocol and, (ii patients from the geographical catchment area of the smaller regional hospitals that were previously not bypassed during the control period. Control data were collected retrospectively. The primary outcome of the economic evaluation was the additional cost per disability adjusted life years (DALYs averted in the intervention period compared to the control period.ResultsThe intervention was associated with a 17 times greater odds of eligible patients receiving tPA (adjusted odds ratio, 95% CI 9.42–31.2, p < 0.05 and the majority of the associated costs were incurred during acute care and rehabilitation. Overall, the intervention was associated with an estimated net avoidance of 93.3 DALYs. The estimated average cost per DALY averted per patient in the intervention group compared to the control group was $10,921.ConclusionBased on our

  10. Stroke patients communicating their healthcare needs in hospital: a study within the ICF framework.

    Science.gov (United States)

    O'Halloran, Robyn; Worrall, Linda; Hickson, Louise

    2012-01-01

    Previous research has identified that many patients admitted into acute hospital stroke units have communication-related impairments such as hearing, vision, speech, language and/or cognitive communicative impairment. However, no research has identified how many patients in acute hospital stroke units have difficulty actually communicating their healthcare needs. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) conceptualizes difficulty communicating about healthcare needs as a type of activity limitation, within the Activity and Participation component. The ICF proposes that activity limitation can be measured in four different ways. The first aim of this research was to measure a patient's difficulty communicating his or her healthcare needs, that is, activity limitation, in two of the four ways suggested by the ICF when interacting with healthcare providers. The second aim was to investigate whether communication-related impairments in hearing, vision, speech, language and/or cognitive communicative impairment predict difficulty communicating healthcare needs, measured in these ways. A total of 65 patients consecutively admitted into two acute hospital stroke units in Melbourne, Australia, who consented to this research participated in this study. Early in their admission participants were screened for hearing, vision, speech, language and cognitive communicative impairment. Participants were also assessed for difficulty communicating about healthcare needs in two ways proposed by the ICF: 'capacity with assistance' and 'performance'. Relationships between communication-related impairment and both capacity with assistance and performance were explored through Spearman's correlations and binary logistic regression. A total of 87% of patients had one or more communication-related impairments. Half of the patients (51%) had difficulty communicating their healthcare needs when assessed in terms of capacity with

  11. Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad, India

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    Lalitha Pidaparthi

    2016-01-01

    Full Text Available Background: It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy. Objective: The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them. Materials and Methods: Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed. Results: Out of 2,593 stroke patients, only 145 (5.6% patients presented within 6 h of stroke onset and among them 118 (81.4% patients had ischemic stroke and 27 (18.6% patients had hemorrhagic stroke. A total of 89/118 (75.4% patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4, hemorrhagic infarct (N = 1, gastrointestinal bleed (N = 1, oral anticoagulant usage with prolonged international normalized ratio (INR (N = 1, and recent cataract surgery (N = 1]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7, fear of bleed (N = 4, rapidly improving symptoms (N = 4, mild stroke (N = 2, delayed neurologist referral within the hospital (N = 2, and logistic difficulty in organizing endovascular treatment (N = 2. Conclusion: One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions.

  12. FASTER (Face, Arm, Speech, Time, Emergency Response): experience of Central Coast Stroke Services implementation of a pre-hospital notification system for expedient management of acute stroke.

    Science.gov (United States)

    O'Brien, W; Crimmins, D; Donaldson, W; Risti, R; Clarke, T A; Whyte, S; Sturm, J

    2012-02-01

    Despite benefit in acute ischaemic stroke, less than 3% of patients receive tissue plasminogen activator (tPA) in Australia. The FASTER (Face, Arm, Speech, Time, Emergency Response) protocol was constructed to reduce pre-hospital and Emergency Department (ED) delays and improve access to thrombolysis. This study aimed to determine if introduction of the FASTER protocol increases use of tPA using a prospective pre- and post-intervention cohort design in a metropolitan hospital. A pre-hospital assessment tool was used by ambulance services to screen potential tPA candidates. The acute stroke team was contacted, hospital bypass allowed, triage and CT radiology alerted, and the patient rapidly assessed on arrival to ED. Data were collected prospectively during the first 6 months of the new pathway and compared to a 6-month period 12 months prior to protocol initiation. In the 6 months following protocol introduction, 115 patients presented within 24 hours of onset of an ischaemic stroke: 22 (19%) received thrombolysis, significantly greater than five (7%) of 67 patients over the control period, p=0.03. Overall, 42 patients were referred via the FASTER pathway, with 21 of these receiving tPA (50%). One inpatient stroke was also treated. Only two referrals (patients involving the ambulance services and streamlined hospital assessment is effective and efficient in improving patient access to thrombolysis. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  13. Follow-up services for stroke survivors after hospital discharge--a randomized control study

    DEFF Research Database (Denmark)

    Andersen, Hanne Elkjaer; Eriksen, Karen; Brown, Anne

    2002-01-01

    OBJECTIVE: To evaluate whether follow-up services for stroke survivors could improve functional outcome and reduce readmission rate. In this paper results of functional outcome are reported. DESIGN: Randomized controlled trial allocating patients to one of three different types of aftercare: (1......) follow-up home visits by a physician, (2) physiotherapist instruction in the patient's home, or (3) standard aftercare. SUBJECTS: Stroke patients with persisting impairment and disability who, after completing inpatient rehabilitation, were discharged to their homes. OUTCOME MEASURES: Six months after...... discharge, functional outcome was assessed with Functional Quality of Movement, Barthel Index, Frenchay Activity Index and Index of Extended Activites of Daily Living. RESULTS: One-hundred and fifty-five stroke patients were included in the study. Fifty-four received follow-up home visits by a physician, 53...

  14. Simple In-Hospital Interventions to Reduce Door-to-CT Time in Acute Stroke

    Directory of Open Access Journals (Sweden)

    Elyar Sadeghi-Hokmabadi

    2016-01-01

    Full Text Available Background. Intravenous tissue plasminogen activator, a time dependent therapy, can reduce the morbidity and mortality of acute ischemic stroke. This study was designed to assess the effect of simple in-hospital interventions on reducing door-to-CT (DTC time and reaching door-to-needle (DTN time of less than 60 minutes. Methods. Before any intervention, DTC time was recorded for 213 patients over a one-year period at our center. Five simple quality-improvement interventions were implemented, namely, call notification, prioritizing patients for CT scan, prioritizing patients for lab analysis, specifying a bed for acute stroke patients, and staff education. After intervention, over a course of 44 months, DTC time was recorded for 276 patients with the stroke code. Furthermore DTN time was recorded for 106 patients who were treated with IV thrombolytic therapy. Results. The median DTC time significantly decreased in the postintervention period comparing to the preintervention period [median (IQR; 20 (12–30 versus 75 (52.5–105, P<0.001]. At the postintervention period, the median (IQR DTN time was 55 (40–73 minutes and proportion of patients with DTN time less than 60 minutes was 62.4% (P<0.001. Conclusion. Our interventions significantly reduced DTC time and resulted in an acceptable DTN time. These interventions are feasible in most hospitals and should be considered.

  15. Identifying factors associated with hospital readmissions among stroke patients in Taipei.

    Science.gov (United States)

    Chuang, Kun-Yang; Wu, Shwu-Chong; Ma, Ai-Hsuan Sandra; Chen, Yu-Hui; Wu, Chen-Long

    2005-06-01

    Hospital readmissions contribute significantly to the cost of medical care, and may reflect unresolved problems at discharge or a lack of resources in post-hospital care. The purpose of this paper is to assess the effects of patient characteristics at discharge, the need for nursing care, discharge planning program, post-hospital care arrangements, and caregiver characteristics on readmissions of stroke patients. Patients discharged from neurological wards in seven hospitals in the Taipei area were recruited into the study. Surveys were conducted before their discharge, and at one month after discharge. Of the 489 patients included in the study, 24.3% were readmitted. After controlling for other variables, factors associated with readmissions were number of limitations in activities of daily living (ADL), first incidence of stroke, the need for wound nursing care, the adoption of a care plan, and the discharge locations. Contrary to expectation, age, length of stay, counseling before discharge, and caregiver burden were not associated with readmissions. The findings of this study indicate that ADL limitation is an effective predictor of readmissions. Increasing home nursing resources to meet the demand for wound nursing care may also be effective in reducing readmissions. Discharging patients into institutions for a short period of time may also prove to be more economically viable due to the reduction in readmissions.

  16. Addition of 24 hour heart rate variability parameters to the cardiovascular health study stroke risk score and prediction of incident stroke : The cardiovascular health study

    NARCIS (Netherlands)

    Bodapati, R.K.; Kizer, J.R.; Kop, W.J.; Stein, P.K.

    2017-01-01

    Background Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24‐hour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHS‐SCORE), previously developed at the baseline

  17. Out-of-hospital stroke screen accuracy in a state with an emergency medical services protocol for routing patients to acute stroke centers.

    Science.gov (United States)

    Asimos, Andrew W; Ward, Shana; Brice, Jane H; Rosamond, Wayne D; Goldstein, Larry B; Studnek, Jonathan

    2014-11-01

    Emergency medical services (EMS) protocols, which route patients with suspected stroke to stroke centers, rely on the use of accurate stroke screening criteria. Our goal is to conduct a statewide EMS agency evaluation of the accuracies of the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS) for identifying acute stroke patients. We conducted a retrospective study in North Carolina by linking a statewide EMS database to a hospital database, using validated deterministic matching. We compared EMS CPSS or LAPSS results (positive or negative) to the emergency department diagnosis International Classification of Diseases, Ninth Revision codes. We calculated sensitivity, specificity, and positive and negative likelihood ratios for the EMS diagnosis of stroke, using each screening tool. We included 1,217 CPSS patients and 1,225 LAPSS patients evaluated by 117 EMS agencies from 94 North Carolina counties. Most EMS agencies contributing data had high annual patient volumes and were governmental agencies with nonvolunteer, emergency medical technician-paramedic service level providers. The CPSS had a sensitivity of 80% (95% confidence interval [CI] 77% to 83%) versus 74% (95% CI 71% to 77%) for the LAPSS. Each had a specificity of 48% (CPSS 95% CI 44% to 52%; LAPSS 95% CI 43% to 53%). The CPSS and LAPSS had similar test characteristics, with each having only limited specificity. Development of stroke screening scales that optimize both sensitivity and specificity is required if these are to be used to determine transport diversion to acute stroke centers. Copyright © 2014. Published by Elsevier Inc.

  18. Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital

    Science.gov (United States)

    Luvizutto, Gustavo José; Gameiro, Mônica de Oliveira Orsi; Schelp, Arthur Oscar; Braga, Gabriel Pereira; Ribeiro, Priscila Watson; Bazan, Rodrigo

    2015-01-01

    [Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, localization, treatment received, ictus onset, hospitalization time, discharge date, and date of first evaluation at the rehabilitation center. The Modified Rankin Scale in 90 days after ictus was utilized to measure functional incapacity with the individuals divided into two groups, before and after acute stroke unit implementation (2010). Functional incapacity was compared between before and after acute stroke unit implementation by the Mann-Whitney test, χ2 test and Fisher’s exact test. [Results] The medical records of 170 patients were evaluated. In the group evaluated after 2010, the patients were significantly older and presented a shorter time between hospitalization and discharge, shorter time until the first evaluation in rehabilitation, and increased percentage of mild incapacity (Modified Rankin Scale = 0 to 2). [Conclusion] After acute stroke unit implementation, the patients treated in the rehabilitation section presented a shorter hospitalization time and rehabilitation delay and less functional incapacity. PMID:26355915

  19. Patient with stroke: hospital discharge planning, functionality and quality of life

    Directory of Open Access Journals (Sweden)

    Henrique José Mendes Nunes

    Full Text Available ABSTRACT Stroke still causes high levels of human inability and suffering, and it is one of the main causes of death in developed countries, including Portugal. Objective: analyze the strategies of hospital discharge planning for these patients, increasing the knowledge related to hospitalhome transition, discharge planning processes and the main impact on the quality of life and functionality. Method: integrative literature review using the PICOD criteria, with database research. Results: 19 articles were obtained, using several approaches and contexts. For quality of life, the factors related to the patient satisfaction with care and the psychoemotional aspects linked with functionality are the most significant. Conclusion: during the hospitalization period, a careful hospital discharge planning and comprehensive care to patients and caregivers - in particular the functional and psychoemotional aspects - tend to have an impact on the quality of life of patients.

  20. Informed Consent: the Rate-Limiting Step in Acute Stroke Trials

    Directory of Open Access Journals (Sweden)

    David Z Rose

    2011-10-01

    Full Text Available Successful implementation of a randomized clinical trial (RCT for neuro-vascular emergencies such as cerebral infarction, intracerebral hemorrhage (ICH, or subarachnoid hemorrhage (SAH is difficult. Besides establishing an accurate, hyper-expedited diagnosis among many mimics in a person with acute neurological deficits, informed consent must be obtained from this vulnerable group of patients who may be unable to convey their own wishes, grasp the gravity of their situation, or give a complete history or examination. We review the influences, barriers, and factors investigators encounter when providing established and putative stroke therapies, and focus on informed consent, the most important research protector of human subjects, as the rate-limiting step for enrollment into acute stroke RCTs. The informed consent process has received relatively little attention in the stroke literature, but is especially important for stroke victims with acute cognitive, aural, lingual, motor, or visual impairments. Consent by a surrogate may not accurately reflect the patient’s wishes. Further, confusion about trial methodology, negative opinions of placebo-controlled studies, and therapeutic misconception by patients or surrogates may impede trial enrollment and requires further study. Exception From Informed Consent (EFIC offers an opportunity that is rarely if ever utilized for stroke RCTs. Ultimately, advancing the knowledge base and treatment paradigms for acute stroke is essential but autonomy, beneficence (non-malfeasance, and justice must also be carefully interwoven into any well-designed RCT.

  1. Improving treatment times for patients with in-hospital stroke using a standardized protocol.

    Science.gov (United States)

    Koge, Junpei; Matsumoto, Shoji; Nakahara, Ichiro; Ishii, Akira; Hatano, Taketo; Sadamasa, Nobutake; Kai, Yasutoshi; Ando, Mitsushige; Saka, Makoto; Chihara, Hideo; Takita, Wataru; Tokunaga, Keisuke; Kamata, Takahiko; Nishi, Hidehisa; Hashimoto, Tetsuya; Tsujimoto, Atsushi; Kira, Jun-Ichi; Nagata, Izumi

    2017-10-15

    Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol. Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008-March 2014) and after implementation (April 2014-December 2016). Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5min, pvs. 26.5min, pvs. 16min, p=0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53min, p=0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0-2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods. Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Cognition and Comorbidity Behavior in Hospitalized Patients Suffering from Stroke. Seychelles 2010-2011

    Directory of Open Access Journals (Sweden)

    Armando Carlos Roca Socarras

    2012-10-01

    Full Text Available Background: cognitive impairment and high comorbidity are common health problems in patients with cerebrovascular disease. Objective: to describe the behavior of cognitive impairment and comorbidity in hospitalized patients suffering from stroke. Method: descriptive study of 77 patients with ischemic stroke admitted from April 2010 to December 2011, in Seychelles General Hospital. The behavior of this disease in relation to variables such as age, presence of chronic noncommunicable diseases, cognitive impairment, educational level, affected cerebral hemisphere and time of evolution was analyzed. Results: 68,9 % of patients presented cognitive impairment, their average age was 74,2 (± 9,19 years old compared to 62,4 (± 14,2 years old for those with no cognitive impairment. We found a higher frequency of chronic noncommunicable diseases in cognitively impaired patients with a Charlson comorbidity index of 2,11 (± 0,97. 18 patients with cognitive impairment and 23 patients with no cognitive impairment were diagnosed with depression. Conclusions: more than half of hospitalized patients experienced cognitive impairment and in most cases previous to cerebrovascular disease. Male patients predominated. There was an increase in age, severity of depression, as well as in the frequency of chronic noncommunicable diseases, and myocardial infarction of considerable size, in respect to patients with no cognitive impairment.

  3. Stroke prevention in hospitalized patients with atrial fibrillation: a population-based study.

    Science.gov (United States)

    Nagpal, Seema; Anderson, David; Putnam, Wayne; Flowerdew, Gordon; Gardner, Martin; Cox, Jafna

    2003-01-01

    Oral anticoagulants reduce the incidence of stroke by 68%, yet suboptimal use has been documented in surveys of patients with atrial fibrillation. The present study examined current patterns of anticoagulant use for patients hospitalized with atrial fibrillation across an entire health care system. Improving Cardiovascular Outcomes in Nova Scotia (ICONS) is a prospective cohort study involving all patients hospitalized in Nova Scotia with atrial fibrillation, among other conditions. Consecutive inpatients with atrial fibrillation from October 15, 1997 to October 14, 1998 were studied. Detailed demographic and clinical data were collected and the proportion of patients using antithrombotic therapy was tabulated by risk category. Multivariate logistic regression was used to assess the relationship of various demographic and clinical factors with the use of antithrombotic agents. There were 2202 patients hospitalized with atrial fibrillation; 644 admitted specifically for this condition. Only 21% of patients admitted with atrial fibrillation were on warfarin sodium at admission and this increased by time of discharge. Diabetes was negatively correlated with warfarin sodium use. Histories of prosthetic valve replacement, stroke/transient ischemic attack, and heart failure were positively associated with anticoagulant use on admission. Patients with prosthetic valve replacement, heart failure, or hyperlipidemia were most likely to receive anticoagulants at discharge. Antithrombotic agents remain underused by patients with atrial fibrillation. While higher risk patients are generally targeted, this is not invariably the case; thus, diabetics remain under treated. Further work is needed to explain such anomalous practice and promote optimal antithrombotic therapy use.

  4. Treatment of ischemic stroke with r-tPA: implementation challenges in a tertiary hospital in Brazil

    Directory of Open Access Journals (Sweden)

    Elza Dias Tosta

    2014-05-01

    Full Text Available Purpose: This paper presents the initial experience with thrombolysis for acute ischaemic stroke at Hospital de Base do Distrito Federal (HBDF, Brazil, and the difficulties associated with the implementation of this treatment. Method: A retrospective study was performed using the medical records of all patients with acute stroke who were treated with intravenous alteplase in our department, between May 2011 and April 2012. Results: The thrombolytic therapy was administered to 32 patients. The mean time between the ictus and the start of stroke therapy start was 195 (60-270 minutes. Sixteen patients demonstrated a significant clinical improvement (decrease in National Institute Health Stroke Scale [NIHSS] score≥4 points in 24 hours; 6 patients were discharged with an NIHSS score of 0 and 2 demonstrated haemorrhagic transformation. Conclusions: The results of our study are similar to those reported in the literature, although we have been dealing with difficulties, such as the lack of a stroke unit.

  5. The Direct Referral to Endovascular Center criteria: a proposal for pre-hospital evaluation of acute stroke in the Madrid Stroke Network.

    Science.gov (United States)

    Rodríguez-Pardo, J; Fuentes, B; Alonso de Leciñana, M; Ximénez-Carrillo, Á; Zapata-Wainberg, G; Álvarez-Fraga, J; Barriga, F J; Castillo, L; Carneado-Ruiz, J; Díaz-Guzman, J; Egido-Herrero, J; de Felipe, A; Fernández-Ferro, J; Frade-Pardo, L; García-Gallardo, Á; García-Pastor, A; Gil-Núñez, A; Gómez-Escalonilla, C; Guillán, M; Herrero-Infante, Y; Masjuan-Vallejo, J; Ortega-Casarrubios, M Á; Vivancos-Mora, J; Díez-Tejedor, E

    2017-03-01

    For patients with acute ischaemic stroke due to large-vessel occlusion, it has recently been shown that mechanical thrombectomy (MT) with stent retrievers is better than medical treatment alone. However, few hospitals can provide MT 24 h/day 365 days/year, and it remains unclear whether selected patients with acute stroke should be directly transferred to the nearest MT-providing hospital to prevent treatment delays. Clinical scales such as Rapid Arterial Occlusion Evaluation (RACE) have been developed to predict large-vessel occlusion at a pre-hospital level, but their predictive value for MT is low. We propose new criteria to identify patients eligible for MT, with higher accuracy. The Direct Referral to Endovascular Center criteria were defined based on a retrospective cohort of 317 patients admitted to a stroke center. The association of age, sex, RACE scale score and blood pressure with the likelihood of receiving MT were analyzed. Cut-off points with the highest association were thereafter evaluated in a prospective cohort of 153 patients from nine stroke units comprising the Madrid Stroke Network. Patients with a RACE scale score ≥ 5, systolic blood pressure <190 mmHg and age <81 years showed a significantly higher probability of undergoing MT (odds ratio, 33.38; 95% confidence interval, 12-92.9). This outcome was confirmed in the prospective cohort, with 68% sensitivity, 84% specificity, 42% positive and 94% negative predictive values for MT, ruling out 83% of hemorrhagic strokes. The Direct Referral to Endovascular Center criteria could be useful for identifying patients suitable for MT. © 2017 EAN.

  6. Association between ambient air pollution and hospitalization for ischemic and hemorrhagic stroke in China: A multicity case-crossover study.

    Science.gov (United States)

    Liu, Hui; Tian, Yaohua; Xu, Yan; Huang, Zhe; Huang, Chao; Hu, Yonghua; Zhang, Jun

    2017-11-01

    There is growing interest in the association between ambient air pollution and stroke, but few studies have investigated the association in developing countries. The primary objective of this study was to examine the association between levels of ambient air pollutants and hospital admission for stroke in China. A time-stratified case-crossover analysis was conducted between 2014 and 2015 in 14 large Chinese cities among 200,958 ischemic stroke and 41,746 hemorrhagic stroke hospitalizations. We used conditional logistic regression to estimate the percentage changes in stroke admissions in relation to interquartile range increases in air pollutants. Air pollution was positively associated with ischemic stroke. A difference of an interquartile range of the 6-day average for particulate matter less than 10 μm in aerodynamic diameter, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone corresponded to 0.7% (95% CI: 0%, 1.4%), 1.6% (95% CI: 1.0%, 2.3%), 2.6% (95% CI: 1.8%, 3.5%), 0.5% (95% CI: -0.2%, 1.1%), and 1.3% (95% CI: 0.3%, 2.3%) increases in ischemic stroke admissions, respectively. For hemorrhagic stroke, we observed the only significant association in relation to nitrogen dioxide on the current day (percentage change: 1.6%; 95% CI: 0.3%, 2.9%). Our findings contribute to the limited scientific literature concerning the effect of ambient air pollution on stroke in developing countries. Our findings may have significant public health implications for primary prevention of stroke in China. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. The Disability Rate of 5-Year Post-Stroke and Its Correlation Factors: A National Survey in China.

    Science.gov (United States)

    Yang, Yang; Shi, Yu-Zhi; Zhang, Ning; Wang, Shuo; Ungvari, Gabor S; Ng, Chee H; Wang, Yi-Long; Zhao, Xing-Quan; Wang, Yong-Jun; Wang, Chun-Xue; Xiang, Yu-Tao

    2016-01-01

    Few studies on long-term functional outcome have been conducted in post-stroke patients in China. The objective of this study was to conduct a nationwide survey in China to investigate the 5-year prevalence of post-stroke disability and its correlation factors. A total of 893 patients with ischemic stroke were included. Demographic, clinical and neuro-imaging information were collected with standardized instruments that assessed stroke severity, depression, cognitive impairment, stroke recurrence and physical disability. Disability was assessed with the modified Ranking Score (mRS), of which a cutoff score ≥2 indicates disability. Statistical analysis included chi-square tests, two independent samples t-tests, Mann-Whitney U test and multiple logistic regression analysis. The frequency of disability in this study population was 45%. Multivariate analyses revealed that older age, lower education level, previous history of stroke, stroke severity at admission, depression, cognitive impairment at 3 months, and stroke recurrence within 5 years follow up were all significantly associated with post-stroke disability. The disability rate in 5-year post-stroke was high in Chinese patients. Treatment of depression, secondary prevention of stroke and rehabilitation may benefit disabled patients with stroke in China.

  8. Rates and correlates of suicidal ideation among stroke survivors: a meta-analysis.

    Science.gov (United States)

    Bartoli, Francesco; Pompili, Maurizio; Lillia, Nicoletta; Crocamo, Cristina; Salemi, Giuseppe; Clerici, Massimo; Carrà, Giuseppe

    2017-06-01

    A better understanding of the epidemiological impact of suicidal ideation after stroke is required to identify subjects needing personalised interventions. The aim of this meta-analysis was to estimate rates and correlates of suicidal ideation among stroke survivors. We searched via Ovid, Medline, Embase and PsycInfo from database inception until August 2016. Predefined outcomes were (1) rates of suicidal ideation based on random-effects pooled proportion and (2) relevant sociodemographic and clinical correlates, using random-effects odds ratio (OR) or standardised mean difference (SMD) for categorical and continuous variables, respectively. Fifteen studies and 13 independent samples, accounting for 10 400 subjects, were included in meta-analyses. The pooled proportion of suicidal ideation among stroke survivors was 11.8% (7.4% to 16.2%), with high heterogeneity across studies (I 2 =97.3%). Current (OR=11.50; psuicidal ideation. Moreover, suicidal ideation was less likely in stroke survivors who were married (OR=0.63; psuicidal ideation. Thus, there is enough evidence to support the use of routine screening and early interventions to prevent and treat suicidal ideation after stroke, especially among subjects carrying specific correlates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Muscle energy stores and stroke rates of emperor penguins: implications for muscle metabolism and dive performance.

    Science.gov (United States)

    Williams, Cassondra L; Sato, Katsufumi; Shiomi, Kozue; Ponganis, Paul J

    2012-01-01

    In diving birds and mammals, bradycardia and peripheral vasoconstriction potentially isolate muscle from the circulation. During complete ischemia, ATP production is dependent on the size of the myoglobin oxygen (O(2)) store and the concentrations of phosphocreatine (PCr) and glycogen (Gly). Therefore, we measured PCr and Gly concentrations in the primary underwater locomotory muscle of emperor penguin and modeled the depletion of muscle O(2) and those energy stores under conditions of complete ischemia and a previously determined muscle metabolic rate. We also analyzed stroke rate to assess muscle workload variation during dives and evaluate potential limitations on the model. Measured PCr and Gly concentrations, 20.8 and 54.6 mmol kg(-1), respectively, were similar to published values for nondiving animals. The model demonstrated that PCr and Gly provide a large anaerobic energy store, even for dives longer than 20 min. Stroke rate varied throughout the dive profile, indicating muscle workload was not constant during dives as was assumed in the model. The stroke rate during the first 30 s of dives increased with increased dive depth. In extremely long dives, lower overall stroke rates were observed. Although O(2) consumption and energy store depletion may vary during dives, the model demonstrated that PCr and Gly, even at concentrations typical of terrestrial birds and mammals, are a significant anaerobic energy store and can play an important role in the emperor penguin's ability to perform long dives.

  10. Socioeconomic position and incidence of ischemic stroke in denmark 2003-2012. A nationwide hospital-based study

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Steding-Jessen, Marianne; Dalton, Susanne Oksbjerg

    2014-01-01

    of working age (smoking, and high alcohol consumption in particular and, to a lesser extent, previous myocardial infarction or intermittent arterial claudication were significantly overrepresented among stroke...... patients with lower socioeconomic position. Atrial fibrillation and hypertension were not. CONCLUSIONS: In Denmark, there is a strong relation between low socioeconomic position and risk for hospitalization for stroke. Lifestyle, as indicated by smoking, obesity, and alcohol consumption, and diabetes...

  11. Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers.

    Science.gov (United States)

    Yang, Li; Zhao, Qiuli; Zhu, Xuemei; Shen, Xiaoying; Zhu, Yulan; Yang, Liu; Gao, Wei; Li, Minghui

    2017-08-01

    Many factors influence pre-hospital delays in the event of stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015, and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. There were significant differences between before and after intervention (P pre-hospital delays.

  12. Do more hospital beds lead to higher hospitalization rates? a spatial examination of Roemer's Law.

    Directory of Open Access Journals (Sweden)

    Paul L Delamater

    Full Text Available BACKGROUND: Roemer's Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer's Law. We pose the question, "Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?" METHODS: We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. RESULTS: We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. CONCLUSIONS: This study provides evidence for the effects of Roemer's Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings

  13. Gender differences and woman-specific trends in acute stroke: results from a hospital-based registry (1986-2009).

    Science.gov (United States)

    Arboix, Adrià; Cartanyà, Anna; Lowak, Michael; García-Eroles, Luís; Parra, Olga; Oliveres, Montserrat; Massons, Joan

    2014-12-01

    We assessed gender differences and women-specific secular trends in stroke. Data from 2318 women and 2274 men with first-ever stroke collected from the Sagrat Cor Hospital Stroke Registry of Barcelona between 1986 and 2009 were analyzed. Patient's age increased significantly from a mean of 74.5 years in 1986-1992 to 81.2 years in 2004-2009 (P 12 days) from 59.7% to 33.7% (P = 0.0001). Lacunar infarction was more frequent in men (21.5% vs. 16.2%, P = 0.0003) and cardioembolic infarction in women (26% vs. 15.6%, P = 0.0001). Acute stroke in women continues to be a severe disease with high risk of death in the immediate post-stroke phase (13.5%) and low probability of early full neurological recovery (13.9% vs. 11.8%, P = 0.029). Women differ from men in the distribution of risk factors and stroke subtype, stroke severity, and outcome. An increase in the patient's age, hypertension, atrial fibrillation and cardioembolic infarction, as well as a decrease mortality and length of hospitalization over a 24-year period was recorded. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. A STUDY ON THE CLINICAL CORRELATION OF THE GLYCAEMIC STATUS AND STROKE EVENTS AMONG STROKE PATIENTS ADMITTED IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    K. Ghanachandra Singh

    2016-09-01

    Full Text Available BACKGROUND AND OBJECTIVES Stroke is a common cause of chronic debilitating disease as a result of the vascular related effect of certain part of the brain. Also the mortality due to the nature of stroke either Intracerebral Haemorrhage (ICH or Cerebral Infarction (Ischaemic stroke vary, the earlier causing more fatality. The risk factors of the ICH or the Ischaemic stroke vary to certain degree. Glycaemic state of stroke patients affects the outcome of them. It is of importance to establish clinical correlation of the glycaemic status of the stroke patients with the type and extent of the lesion documented by Computerised Tomography (CT scan of brain for development of preventive measures and clinical management of such patients for better outcome. Hence, this study was conducted among stroke patients who were admitted in Medicine wards, Jawaharlal Nehru Institute of Medical Sciences (JNIMS, Porompat, Manipur. DATA AND METHODS A study of stroke cases was undertaken in patients who were admitted to Medicine wards, Jawaharlal Nehru Institute of Medical Sciences (JNIMS, Porompat, Manipur from January 2011 till December 2014. All the patients were investigated with CT scan brain, Blood sugar along with Glycosylated Haemoglobin (HbA1C besides other routine tests and recorded. RESULT Out of the 200 stroke patients registered in 48 months, 120 patients were having hyperglycaemia. All the patients with stress hyperglycaemia were haemorrhagic. 85.71% of the cases among known diabetes were also haemorrhagic. CONCLUSION Glycaemic state of patients presented in stroke gives a picture of clinical difference. The size of the lesion measured by CT scan of brain also varies among different types of hyperglycaemia and the prognosis of the patients and showed that those patients with higher glucose level had haemorrhagic lesions with bigger size and had higher mortality rate. The deteriorating glucose tolerance with age also contributes to the increased incidence

  15. Modeling of in hospital mortality determinants in myocardial infarction patients, with and without stroke: A national study in Iran

    Directory of Open Access Journals (Sweden)

    Ali Ahmadi

    2016-01-01

    Full Text Available Background: The data and determinants of mortality due to stroke in myocardial infarction (MI patients are unknown. This study was conducted to evaluate the differences in risk factors for hospital mortality among MI patients with and without stroke history. Materials and Methods: This study was a retrospective, cohort study; 20,750 new patients with MI from April, 2012 to March, 2013 were followed up and their data were analyzed according to having or not having the stroke history. Stroke and MI were defined based on the World Health Organization′s definition. The data were analyzed by logistic regression in STATA software. Results: Of the 20,750 studied patients, 4293 had stroke history. The prevalence of stroke in the studied population was derived 20.96% (confidence interval [CI] 95%: 20.13-21.24. Of the patients, 2537 (59.1% had ST-elevation MI (STEMI. Mortality ratio in patients with and without stroke was obtained 18.8% and 10.3%, respectively. The prevalence of risk factors in MI patients with and without a stroke is various. The adjusted odds ratio of mortality in patients with stroke history was derived 7.02 (95% CI: 5.42-9 for chest pain resistant to treatment, 2.39 (95% CI: 1.97-2.9 for STEMI, 3.02 (95% CI: 2.5-3.64 for lack of thrombolytic therapy, 2.2 (95% CI: 1.66-2.91 for heart failure, and 2.17 (95% CI: 1.6-2.9 for ventricular tachycardia. Conclusion: With regards to the factors associated with mortality in this study, it is particularly necessary to control the mortality in MI patients with stroke history. More emphasis should be placed on the MI patients with the previous stroke over those without in the interventions developed for prevention and treatment, and for the prevention of avoidable mortalities.

  16. The study of diagnosis status and, transfer time of stroke patients transferred by pre-hospital emergency medical system (EMS to Vali-Asr hospital in Arak City

    Directory of Open Access Journals (Sweden)

    Saiedeh Bahrampouri

    2013-08-01

    Full Text Available Introduction: Stroke is main cause of death and disability in worldwide and emergency care can decrease complications. Emergency Medical System transferred half of stroke patients to hospital, so improve accuracy of diagnosis may accelerated treatment. This study aimed to determine diagnosis status and, transfer time of stroke patients transferred by prehospital Emergency Medical System to hospital in Arak City. Methods: This study was descriptive -analytic study and all 43 patient’s records with a diagnosis of stroke that transferred by Emergency Medical System to hospital in Arak City was selected. The study Checklist was contained information about age, sex, type of accident prehospital, response time, scene time, transfer time and total time from inpatients records and Emergency Center statistics .Regarding data analysis,SPSS19 software and descriptive statistical tests were used. Results: Mean (SD of age all patients were 73/7±3/8 and 51/2% were women. Ambulance paramedics' stroke diagnosis was correct in 15 (34/9%,20(46/5%of false and 8(18/6% not diagnosed for stroke patients who initially presented to them. The most common non stroke conditions were confusion. Mean response time and scene time, transfer time and total time were 6/9,16/9,9/1 and 35/3 minutes, respectively. In patients with correct diagnose stroke, mean response, scene, transfer and total time were 7,17/1,3/9 and 35/7 minutes. The people with the wrong diagnosis or no diagnosis of stroke by emergency medical personnel were taken to hospital, Mean response, scene, transfer and total time were 6/9, 16/8,9/7 and 33/5 minutes. Conclusions: The results of this study showed that, the correct diagnosis by EMS personnel could be resulted faster transferring patient to definite treatment center.It is recommended to develop prehospital diagnosis tool of stroke, which is contextually adapted and appropriate to facilitate diagnose of strokes and improve the quality of care.

  17. Assessing quality of life after stroke. The value and limitations of proxy ratings

    NARCIS (Netherlands)

    Sneeuw, K. C.; Aaronson, N. K.; de Haan, R. J.; Limburg, M.

    1997-01-01

    Because many stroke survivors have cognitive and communication disorders, self-reported information on a patient's quality of life (QL) cannot always be obtained. Proxy ratings may be used to prevent exclusion of this highly relevant subgroup of patients from QL studies. The purpose of this study

  18. The Relationship between Self-rated Health and Hospital Records

    DEFF Research Database (Denmark)

    Nielsen, Torben Heien

    This paper investigates whether self-rated health (SRH) co-varies with individual hospital records. By linking the Danish Longitudinal Survey on Aging with individual hospital records covering all hospital admissions from 1995-2006, I show that SRH is correlated to historical, current, and future...... hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result, that SRH is a stronger predictor of mortality than objective health measures. The addition of future...... hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that SRH is able to capture diseases at prodromal stages and that with a sufficiently long time series of individual records, objective health measures can predict mortality...

  19. The Relationship between Self-Rated Health and Hospital Records

    DEFF Research Database (Denmark)

    Nielsen, Torben Heien

    2013-01-01

    This paper investigates whether self-rated health (SRH) co-varies with individual hospital records. By linking the Danish Longitudinal Survey on Aging with individual hospital records covering all hospital admissions from 1995-2006, I show that SRH is correlated to historical, current, and future...... hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result, that SRH is a stronger predictor of mortality than objective health measures. The addition of future...... hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that SRH is able to capture diseases at prodromal stages and that with a sufficiently long time series ofindividual records, objective health measures can predict mortality...

  20. Validation of the Los Angeles pre-hospital stroke screen (LAPSS in a Chinese urban emergency medical service population.

    Directory of Open Access Journals (Sweden)

    Shengyun Chen

    Full Text Available BACKGROUND AND PURPOSE: Early and accurate diagnosis of stroke by emergency medical service (EMS paramedics is critical for reducing pre-hospital delays. The Los Angeles pre-hospital stroke screen (LAPSS has been widely used as a validated screening tool for early identifying stroke patients by EMS paramedics. However, validation of LAPSS has never been performed in Chinese stroke population. This study is aimed to verify the LAPSS for early identifying stroke patients in a Chinese urban EMS. METHODS: 76 paramedics of five urban first aid stations attached to Beijing 120 EMS were involved. The paramedics were trained by professionals to quickly screen patients based on LAPSS. Potential "target stroke" individuals who met the base LAPSS screen criteria were identified. Sensitivity and specificity analyses of the LAPSS were calculated. RESULTS: From June 10, 2009 to June 10, 2010, paramedics transported a total of 50,220 patients. 1550 patients who met the baseline screen criteria were identified as the potential "target stroke" population. 1130 patients had the completed LAPSS information datasheet and 997 patients were clinically diagnosed with stroke. The average time of completing the LAPSS was 4.3±3.0 minutes (median, 5 minutes. The sensitivity and specificity of the LAPSS in this study was 78.44% and 90.22%, respectively. After adjusting for age factor by excluding patients of >45 years old, the sensitivity was significantly increased to 82.95% with specificity unchanged. CONCLUSION: The paramedics of Beijing 120 EMS could efficiently use LAPSS as a screening tool for early identifying stroke patients. While the sensitivity of LAPSS in Chinese urban patient population was lower than those reported in previous LAPSS validation studies, the specificity was consistent with these studies. After excluded the item of "Age>45 years", the sensitivity was improved.

  1. Validation of the Los Angeles pre-hospital stroke screen (LAPSS) in a Chinese urban emergency medical service population.

    Science.gov (United States)

    Chen, Shengyun; Sun, Haixin; Lei, Yanni; Gao, Ding; Wang, Yan; Wang, Yilong; Zhou, Yong; Wang, Anxin; Wang, Wenzhi; Zhao, Xingquan

    2013-01-01

    Early and accurate diagnosis of stroke by emergency medical service (EMS) paramedics is critical for reducing pre-hospital delays. The Los Angeles pre-hospital stroke screen (LAPSS) has been widely used as a validated screening tool for early identifying stroke patients by EMS paramedics. However, validation of LAPSS has never been performed in Chinese stroke population. This study is aimed to verify the LAPSS for early identifying stroke patients in a Chinese urban EMS. 76 paramedics of five urban first aid stations attached to Beijing 120 EMS were involved. The paramedics were trained by professionals to quickly screen patients based on LAPSS. Potential "target stroke" individuals who met the base LAPSS screen criteria were identified. Sensitivity and specificity analyses of the LAPSS were calculated. From June 10, 2009 to June 10, 2010, paramedics transported a total of 50,220 patients. 1550 patients who met the baseline screen criteria were identified as the potential "target stroke" population. 1130 patients had the completed LAPSS information datasheet and 997 patients were clinically diagnosed with stroke. The average time of completing the LAPSS was 4.3±3.0 minutes (median, 5 minutes). The sensitivity and specificity of the LAPSS in this study was 78.44% and 90.22%, respectively. After adjusting for age factor by excluding patients of >45 years old, the sensitivity was significantly increased to 82.95% with specificity unchanged. The paramedics of Beijing 120 EMS could efficiently use LAPSS as a screening tool for early identifying stroke patients. While the sensitivity of LAPSS in Chinese urban patient population was lower than those reported in previous LAPSS validation studies, the specificity was consistent with these studies. After excluded the item of "Age>45 years", the sensitivity was improved.

  2. Risk adjustment for inter-hospital comparisons of caesarean section rates in Taipei municipal hospitals.

    Science.gov (United States)

    Hsu, Chun-Chyang; Shieh, Guahn-Ren; Wu, Chuan-Song; Shen, Hsi-Che; Tang, Chao-Hsiun

    2006-08-01

    This study sets out to determine whether adjustments for specific patient caesarean delivery risk factors have an affect on the assessment of performance rates among the municipal hospitals of Taipei City. Analysis of National Health Insurance (NHI) claims data, linked with birth certificate data, was undertaken on a cohort of 27,693 live births in the six general hospitals of the Taipei Medical Hospital System (TMHS) between 1999 and 2001. Using multivariable logistic regression modeling of the risk factors independently associated with caesarean deliveries, an expected caesarean delivery rate was constructed for each of the hospitals. By contrasting observed rates with expected rates to quantify the magnitude of the deviation from average practice, a measurement similar to relative risk (RR) was also constructed for each hospital. The observed rates for two of the six hospitals examined fell within the expected 95% confidence interval (CI), two were above the expected upper limit, and two were below the expected lower limit. The RR ranking of Hospitals A (RR=1.08, CI=1.01-1.15) and C (RR=1.01, CI=1.00-1.03) improved from first to second, and third to fourth, whilst the RR of Hospitals B (RR=1.09, CI=1.05-1.14) and D (RR=1.02, CI=0.99-1.06) worsened from second to first, and fourth to third, respectively. The RR rankings of Hospitals E (RR=0.92, CI=0.88-0.96) and F (RR=0.80, CI=0.77-0.84) were the same as the observed rates. Caesarean delivery rate profiles, or hospital comparisons without risk adjustment, may be methodologically biased and may lead to unfair judgments by healthcare purchasers.

  3. Relationship between hemorrhagic stroke hospitalization and exposure to fine particulate air pollution in Taipei, Taiwan.

    Science.gov (United States)

    Chiu, Hui-Fen; Chang, Chih-Ching; Yang, Chun-Yuh

    2014-01-01

    This study was undertaken to determine whether there was a correlation between fine particle (PM2.5) levels and hospital admissions for hemorrhagic stroke (HS) in Taipei, Taiwan. Hospital admissions for HS and ambient air pollution data for Taipei were obtained for the period 2006-2010. The relative risk of hospital admissions was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased HS admissions were significantly associated with PM2.5 levels both on warm days (>23°C) and cool days (<23°C), with an interquartile range rise associated with a 12% (95% CI = 7-18%) and 4% (95% CI = 0-8%) elevation in admissions for HS, respectively. In the two-pollutant models, PM2.5 remained significantly high after inclusion of SO2 or O3 on both warm and cool days. This study provides evidence that higher levels of PM2.5 increase the risk of hospital admissions for HS.

  4. Hospital employee assault rates before and after enactment of the california hospital safety and security act.

    Science.gov (United States)

    Casteel, Carri; Peek-Asa, Corinne; Nocera, Maryalice; Smith, Jamie B; Blando, James; Goldmacher, Suzi; O'Hagan, Emily; Valiante, David; Harrison, Robert

    2009-02-01

    This study examines changes in violent event rates to hospital employees before and after enactment of the California Hospital Safety and Security Act in 1995. We compared pre- and post-initiative employee assault rates in California (n = 116) emergency departments and psychiatric units with those in New Jersey (n = 50), where statewide workplace violence initiatives do not exist. Poisson regression with generalized estimating equations was used to compare assault rates between a 3-year pre-enactment period (1993-1995) and a 6-year post-enactment period (1996-2001) using New Jersey hospitals as a temporal control. Assault rates among emergency department employees decreased 48% in California post-enactment, compared with emergency department employee assault rates in New Jersey (rate ratio [RR] = 0.52, 95% confidence interval [CI]: 0.31, 0.90). Emergency department employee assault rates decreased in smaller facilities (RR = 0.46, 95% CI: 0.21, 0.96) and for-profit-controlled hospitals (RR = 0.39, 95% CI: 0.19, 0.79) post-enactment. Among psychiatric units, for-profit-controlled hospitals (RR = 0.41, 95% CI: 0.19, 0.85) and hospitals located in smaller communities (RR = 0.44, 95% CI: 0.21, 0.92) experienced decreased assault rates post-enactment. Policy may be an effective method to increase safety to health care workers.

  5. Variation in the rates of adverse events between hospitals and hospital departments.

    NARCIS (Netherlands)

    Zegers, M.; Bruijne, M.C. de; Spreeuwenberg, P.; Wagner, C.; Wal, G. van der; Groenewegen, P.P.

    2011-01-01

    Objective: The objective of this study was to analyze the variation in the rates of adverse events (AEs), and preventable AEs, between hospitals and hospital departments in order to investigate the room for improvement in reducing AEs at both levels. In addition, we explored the extent to which

  6. Variation in rates of adverse events between hospitals and hospital departments

    NARCIS (Netherlands)

    Zegers, M.; Bruijne, M.C. de; Spreeuwenberg, P.; Wagner, C.; van der Wal, G.; Groenewegen, P.P.

    2011-01-01

    Objective. The objective of this study was to analyze the variation in the rates of adverse events (AEs), and preventable AEs, between hospitals and hospital departments in order to investigate the room for improvement in reducing AEs at both levels. In addition, we explored the extent to which

  7. Comparison of Risk Factors of Stroke and Myocardial Infarction in Patients 15 to 45 Years in Affiliated Hospitals of Babol University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Alijan Ahmadi Ahangar

    2016-12-01

    Full Text Available Background Myocardial infarction (MI and stroke are the second and third leading causes of death in the world. By identifying the risk factors we can take the necessary measures to prevent the occurrence of these diseases. Methods In this retrospective study, 90 MI patients and 90 stroke patients 15 - 45 year admitted to hospitals of Babol University of Medical Sciences that randomly arranged by the time of hospitalization conducted. Demographics, laboratory test and risk factors were collected using check list. The data analyzed with McNemar and Npar tests by using SPSS 21 version software. Results The most common risk factor in young patient was a history of cerebrovascular disease that in stroke was 31 cases (34% And in MI was 33 cases (37%. History of cerebrovascular disease with MI was significant 33 (37%, 57(63%, P = 0.047. A history of cardiovascular disease with stroke was significant (20 (22%, 70 (68, P = 0.001. A history of addiction with MI was significant (23 (26%, 67 (74%, P < 0.001. In stroke patients 52 cases (% 57 low-density lipoprotein (LDL was high and in 66 cases (73.1% high-density lipoprotein (HDL was low. In patients with MI in 46 patients (51% LDL was high and the 66 patients (73% HDL was low. Conclusions Young peoples with a history of cerebrovascular, cardiovascular disease and addictions should be considering as target society. Primary health care system must identify high-risk individuals, and policy barriers that prevent implementation of programs to lower death rate.

  8. A review of stroke admissions at a tertiary hospital in rural ...

    African Journals Online (AJOL)

    2011-06-15

    Jun 15, 2011 ... Ischemic stroke was 64.4%; hemorrhagic stroke, 34.7%; .... from the sixth decade, although young patients are not exempted.[2] People of .... ischemic stroke. Of the 31 patients that had <2 risk factors, seven (25.0%) died within 30 days compared with 17 (24.3%) of 70 patients with ≥2 risk factor for stroke.

  9. Strategies of Daily Living Rehabilitative Activities for Post Stroke Patients at Minia University Hospital

    Science.gov (United States)

    Zaky, Hend Elham Mohamed; EL-Lateef Mohammad, Zienab Abd; EL-Labban, Abdou Saad Taha; Ahmed, Gahen

    2015-01-01

    Background: Stroke is a leading cause of disability. Rehabilitation aims to hasten and maximize recovery from stroke by treating the disabilities caused by the stroke. Therefore, the aim of this study determine the post stroke patients' knowledge and practices in relation to disease and activities of daily living before the implementation of…

  10. Impact of naturalistic lighting on hospitalized stroke patients in a rehabilitation unit

    DEFF Research Database (Denmark)

    West, Anders; Jennum, Poul; Simonsen, Sofie Amalie

    2017-01-01

    regulator, the suprachiasmatic nucleus, is mainly controlled by natural daylight, and the blue spectrum is considered the most powerful. During stroke rehabilitation, patients typically are mostly indoors and therefore not exposed to the natural daytime variation in light intensity. Furthermore, several...... rehabilitation hospitals may be exposed to powerful light in the blue spectrum, but at a time that is adversely related to their endogenous circadian phase, for example in the late evening instead of the daytime. Hypothesis: Naturalistic light that mimics the natural daytime spectrum variation will have...... a positive impact on the health of poststroke patients admitted to rehabilitation. We test specifically for improved sleep and less fatigue (questionnaires, polysomnography, Actiwatch), improved well-being (questionnaires), lessen anxiety and depression (questionnaires), improved cognition (tests...

  11. Combined effects of family history of CVD and heart rate on ischemic stroke incidence among Inner Mongolians in China.

    Science.gov (United States)

    Zhou, Yipeng; Tian, Yunfan; Zhong, Chongke; Batu, Buren; Xu, Tian; Li, Hongmei; Zhang, Mingzhi; Wang, Aili; Zhang, Yonghong

    2016-05-01

    This study aimed to evaluate the combined effects of family history of cardiovascular diseases (FHCVD) and heart rate on ischemic stroke incidence among Inner Mongolians in China. A prospective cohort study was conducted among 2589 participants aged 20 years and older from Inner Mongolia, China. The participants were divided into four groups according to status of FHCVD and heart rate and followed up from June 2002 to July 2012. Cox proportional hazards models were used to evaluate the combined effects of FHCVD and heart rate on the incidence of ischemic stroke. A total of 76 ischemic stroke occurred during the follow-up period. The observed ischemic stroke cases tended to be older and male, and had higher prevalence of smoking, drinking, hypertension and FHCVD as well as higher systolic and diastolic blood pressures at baseline compared with those who did not experience ischemic stroke. Age- and gender-adjusted hazard ratio (95% confidence interval) of ischemic stroke in the participants with both FHCVD and heart rate ≥ 80 were 2.89 (1.51-5.53), compared with those without FHCVD and heart rate < 80. After multiple adjustment, the association between ischemic stroke risk and both FHCVD and heart rate ≥ 80 remained statistically significant (hazard ratio, 2.47; 95% confidence interval: 1.22-5.01). Our main finding that participants with both FHCVD and faster heart rate have the highest risk of ischemic stroke suggests that faster heart rate may increase the risk of ischemic stroke among people with FHCVD.

  12. The current status of prevention and treatment of exertional heat stroke at home and abroad: from the scene to the hospital

    Directory of Open Access Journals (Sweden)

    De-qiang LUO

    2017-10-01

    Full Text Available Exertional heat stroke (EHS is an emergency with a high mortality rate, characterized by acute onset and identification difficulties. EHS prevention focuses on evaluating the environment by professionals, making preventive measures in advance, identifying internal and external risk factors for the onset of disease, carrying out prior heat adaptation and endurance training, monitoring the status of high risk persons in real time. After occurrence of EHS, the key to success treatment is on-site accurate identification and diagnosis and rapid implementation of effective cooling measures, thus winning time of EHS patients transferred to the hospital for the treatment. This article reviews the current status of EHS prevention and treatment in domestic and foreign from the scene to the hospital. Summarizing the recognition, diagnosis, cooling measures, treatment concepts and principles of EHS, we hope to provide a reference for the rescue of EHS in hospital and outside. DOI: 10.11855/j.issn.0577-7402.2017.08.15

  13. A case-control study of medium-term exposure to ambient nitrogen dioxide pollution and hospitalization for stroke.

    Science.gov (United States)

    Johnson, Julie Y M; Rowe, Brian H; Allen, Ryan W; Peters, Paul A; Villeneuve, Paul J

    2013-04-19

    There are several plausible mechanisms whereby either short or long term exposure to pollution can increase the risk of stroke. Over the last decade, several studies have reported associations between short-term (day-to-day) increases in ambient air pollution and stroke. The findings from a smaller number of studies that have looked at long-term exposure to air pollution and stroke have been mixed. Most of these epidemiological studies have assigned exposure to air pollution based on place of residence, but these assignments are typically based on relatively coarse spatial resolutions. To date, few studies have evaluated medium-term exposures (i.e, exposures over the past season or year). To address this research gap, we evaluated associations between highly spatially resolved estimates of ambient nitrogen dioxide (NO2), a marker of traffic pollution, and emergency department visits for stroke in Edmonton, Canada. This was a case-control study with cases defined as those who presented to an Edmonton area hospital emergency department between 2007 and 2009 with an acute ischemic stroke, hemorrhagic stroke, or transient ischemic attack. Controls were patients who presented to the same emergency departments for lacerations, sprains, or strains. A land-use regression model provided estimates of NO2 that were assigned to the place of residence. Logistic regression methods were used to estimate odds ratios for stroke in relation to an increase in the interquartile range of NO2 (5 ppb), adjusted for age, sex, meteorological variables, and neighborhood effects. The study included 4,696 stroke (cases) and 37,723 injury patients (controls). For all strokes combined, there was no association with NO2. Namely, the odds ratio associated with an interquartile increase in NO2 was 1.01 (95% confidence interval {CI}: 0.94-1.08). No associations were evident for any of the stroke subtypes examined. When combined with our earlier work in Edmonton, our findings suggest that day

  14. Frequency of risk factors of cerebral infarction in stroke patients. a study of 100 cases in naseer teaching hospital, peshawar

    International Nuclear Information System (INIS)

    Safeer, M.; Tariq, M.; Rehman, U.U.

    2008-01-01

    To study the risk factors of cerebral infarction in stroke patients. It is a descriptive hospital based study conducted at the Department of Medicine, Naseer Teaching Hospital, Peshawar from January 2005 to December 2005. One hundred patients of stroke with cerebral infarction confirmed on C.T. scan brain and more than twenty years of age were included. Risk factors for cerebral infarction were defined in terms of hypertension, diabetes mellitus, ischemic heart disease, smoking, dyslipidaemia, TIAs (transient ischemic attacks), carotid artery stenosis and family history of stroke. Data of 100 cases with cerebral infarction was recorded. Most of the patients had more than one risk factors for cerebral infarction. hypertension was commonest risk factor (55%), smoking (30%), ischemic heart disease (34%), diabetes mellitus) (26%), hyperlipedaemia (30%), atrial fibrillation (25%), carotid artery stenosis (27%), obesity (15%) and family history of stroke (12%). 39% of patients had physical inactivity. Males were slightly predominant than females (51% vs 49%) and mean age was 50 years. females were rather older with mean age of 53 years. Cerebral infarction accounts for 80% to 85% of cases of stroke, which is a common neurological disorder. It increases a burden of disability and misery for patients and their families. Most of the risk factors of cerebral infarction are modifiable, its prevention should be the main cause of concern for the community. (author)

  15. Assessment of utility of Siriraj Stroke Score (SSS in stroke patients of Pt. BD Sharma PGIMS hospital, Rohtak, India

    Directory of Open Access Journals (Sweden)

    H. Singh

    2001-09-01

    Full Text Available India has predominantly poor rural population where brain CT scan, most often advised investigation in patients of stroke, may not always be available, hence Indian physician in such setting base his diagnosis on bed side sign evaluation for which Siriraj Stroke Score (SSS could be helpful. Objective of study: to assess the utility of SSS in patients of stroke. Methodology: sixty subjects of stroke were evaluated on SSS and 'probable' diagnosis so made was compared with CT scan's (brain 'certain' diagnosis. Main findings: by using SSS, the probable bedside diagnosis was cerebral infarct (score < -1 in 32 subjects and cerebral haemorrhage (score > +1 in 24 subjects while 4 subjects had indeterminant score (-1 to +1. Fifty subjects had their probable diagnosis matched with brain CT scan certain diagnosis. The above findings showed that SSS had 93.7% sensitivity, 76.6% specificity, 81.2% positive predictive value, 92% negative predictive value with an overall accuracy as 93.7% for diagnosis of cerebral infarction. For patients of cerebral haemorrhage the sensitivity was 83.3%, specificity was 92.5%, positive predictive value was 86.9%, negative predictive values was 92.5% with overall accuracy as 83.3%. Principal conclusion: physicians in the rural settings may find SSS to be quite useful in the management of stroke especially where more sophisticated radiological investigations may not be available for confirmation of diagnosis due to high cost or attended due to transportation risk. (Med J Indones 2007; 10: 164-8Keywords: stroke, cerebrovascular accident, infarction, haemorrhage

  16. Characterizing and predicting rates of delirium across general hospital settings.

    Science.gov (United States)

    McCoy, Thomas H; Hart, Kamber L; Perlis, Roy H

    2017-05-01

    To better understand variation in reported rates of delirium, this study characterized delirium occurrence rate by department of service and primary admitting diagnosis. Nine consecutive years (2005-2013) of general hospital admissions (N=831,348) were identified across two academic medical centers using electronic health records. The primary admitting diagnosis and the treating clinical department were used to calculate occurrence rates of a previously published delirium definition composed of billing codes and natural language processing of discharge summaries. Delirium rates varied significantly across both admitting diagnosis group (X 2 10 =12786, pdelirium (86/109764; 0.08%) and neurological admissions the greatest (2851/25450; 11.2%). Although the rate of delirium varied across the two hospitals the relative rates within departments (r=0.96, pdelirium varies significantly across admitting diagnosis and hospital department. Both admitting diagnosis and department of care are even stronger predictors of risk than age; as such, simple risk stratification may offer avenues for targeted prevention and treatment efforts. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Assessment of the needs of caregivers of stroke patients at state-owned acute-care hospitals in southern Vietnam, 2011.

    Science.gov (United States)

    Hayashi, Yumiko; Hai, Hoang Hoa; Tai, Nguyen Anh

    2013-08-22

    Care for stroke patients has improved steadily in southern Vietnam. Medical treatments such as thrombolytic therapy have been implemented at several hospitals, and stroke-care units composed of a team of various health professionals have been created. However, little attention has been focused on providing support to caregivers of stroke patients. This study aimed to characterize the caregivers of stroke patients who were treated in state-owned acute-care hospitals and to learn about their needs when patients are discharged. Such information can be used to enhance the caregiver's support system. We used questionnaires to conduct a descriptive study in 2011 at a state-owned acute-care hospital in southern Vietnam. We recruited study participants from among caregivers of stroke patients who had been informed of their hospital discharge date. We assessed 8 caregiver characteristics, and caregiver participants selected their needs from the survey's list of 15 possible needs. We analyzed the data by using the independent sample t test and logistic regression. Of the 93 caregivers who consented to participate, 86 (92.5%) completed the survey and indicated their concerns at discharge. The most frequently cited need was information on how to prevent stroke recurrence (72, 83.7%), followed by which drugs are most effective in preventing a relapse (62, 72.1%), how long recovery would take (61, 70.9%), and availability of hospitals in the patient's hometown (60, 69.8%). A little over half of caregivers indicated financial concerns. A caregiver's need for information on diet for a stroke survivor increased with the caregiver's education level. This study revealed several needs among caregivers of stroke survivors in southern Vietnam that are similar to those found by studies of caregivers of stroke survivors in high-income countries. Our findings suggest that comprehensive stroke care that includes caregiver education about healthful diets and prevention of stroke recurrence

  18. The Correlation Between Rates of Falling, Balance, Quality of Life and Fear of Falling in Patients With Chronic Stroke

    Directory of Open Access Journals (Sweden)

    Hamid Azadeh

    2018-04-01

    Conclusion The findings of the present study demonstrated the correlation between balance, physical dimensions of quality of life and fear of falling in patients with stroke; however, the rate of falling has no association with fear of falling.

  19. Hospital revisit rate after a diagnosis of conversion disorder.

    Science.gov (United States)

    Merkler, Alexander E; Parikh, Neal S; Chaudhry, Simriti; Chait, Alanna; Allen, Nicole C; Navi, Babak B; Kamel, Hooman

    2016-04-01

    To estimate the hospital revisit rate of patients diagnosed with conversion disorder (CD). Using administrative data, we identified all patients discharged from California, Florida and New York emergency departments (EDs) and acute care hospitals between 2005 and 2011 with a primary discharge diagnosis of CD. Patients discharged with a primary diagnosis of seizure or transient global amnesia (TGA) served as control groups. Our primary outcome was the rate of repeat ED visits and hospital admissions after initial presentation. Poisson regression was used to compare rates between diagnosis groups while adjusting for demographic characteristics. We identified 7946 patients discharged with a primary diagnosis of CD. During a mean follow-up of 3.0 (±1.6) years, patients with CD had a median of three (IQR, 1-9) ED or inpatient revisits, compared with 0 (IQR, 0-2) in patients with TGA and 3 (IQR, 1-7) in those with seizures. Revisit rates were 18.25 (95% CI, 18.10 to 18.40) visits per 100 patients per month in those with CD, 3.90 (95% CI, 3.84 to 3.95) in those with TGA and 17.78 (95% CI, 17.75 to 17.81) in those with seizures. As compared to CD, the incidence rate ratio for repeat ED visits or hospitalisations was 0.89 (95% CI, 0.86 to 0.93) for seizure disorder and 0.32 (95% CI 0.31 to 0.34) for TGA. CD is associated with a substantial hospital revisit rate. Our findings suggest that CD is not an acute, time-limited response to stress, but rather that CD is a manifestation of a broader pattern of chronic neuropsychiatric disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Healthy Living after Stroke

    Science.gov (United States)

    ... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... the hospital. Thank goodness, she did. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...

  1. Ocular disorders in stroke patients in a tertiary hospital in Nigeria ...

    African Journals Online (AJOL)

    Visual complaints following stroke were documented in 9.6% of the patients. Conclusion: Ocular abnormalities are present in patients with stroke, mostly due to predisposing risk factors for stroke, and age‑related changes. Routine ophthalmic evaluation is suggested in the management of patients with cerebrovascular ...

  2. A Review of Stroke Cases in a Military Hospital in Nigeria

    African Journals Online (AJOL)

    Am J Epidemiology, 1984; 120:236-43. 12. Walker RW, Mclarry DG. Hypertension and stroke in developing countries. Lancet, 1995; 346:778. 13. Joubert J. The MEDUNS. A Stroke between 1986 and 1987. South Africa Med J, 1991; 80:567-570. 14. Bonita R, Stewart AW, Beaglehole R. International trends in stroke motality, ...

  3. Stroke awareness among inpatient nursing staff at an academic medical center.

    Science.gov (United States)

    Adelman, Eric E; Meurer, William J; Nance, Dorinda K; Kocan, Mary Jo; Maddox, Kate E; Morgenstern, Lewis B; Skolarus, Lesli E

    2014-01-01

    Because 10% of strokes occur in hospitalized patients, we sought to evaluate stroke knowledge and predictors of stroke knowledge among inpatient and emergency department nursing staff. Nursing staff completed an online stroke survey. The survey queried outcome expectations (the importance of rapid stroke identification), self-efficacy in recognizing stroke, and stroke knowledge (to name 3 stroke warning signs or symptoms). Adequate stroke knowledge was defined as the ability to name ≥2 stroke warning signs. Logistic regression was used to identify the association between stroke symptom knowledge and staff characteristics (education, clinical experience, and nursing unit), stroke self-efficacy, and outcome expectations. A total of 875 respondents (84% response rate) completed the survey and most of the respondents were nurses. More than 85% of respondents correctly reported ≥2 stroke warning signs or symptoms. Greater self-efficacy in identifying stroke symptoms (odds ratio, 1.13; 95% confidence interval, 1.01-1.27) and higher ratings for the importance of rapid identification of stroke symptoms (odds ratio, 1.23; 95% confidence interval, 1.002-1.51) were associated with stroke knowledge. Clinical experience, educational experience, nursing unit, and personal knowledge of a stroke patient were not associated with stroke knowledge. Stroke outcome expectations and self-efficacy are associated with stroke knowledge and should be included in nursing education about stroke.

  4. Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke. Care needs and involvement

    DEFF Research Database (Denmark)

    Aadal, Lena; Angel, Sanne; Langhorn, Leanne

    2017-01-01

    and the relatives and support the interaction between the patient and the relatives. Four themes occurred: the changed lives of relatives; shared life after stroke; noncooperating relatives; time for the relatives. CONCLUSION: Nurses experience their roles and functions addressing relatives after stroke as crucial...... to the patient. Caregivers require nurse assistance, support and to be seen as an essential partner in the care giving process. However, the nurses do not perceive that teaching of relatives is a task they should routinely undertake. This might indicate an ambiguity between the relatives' expectations...... and the actual contribution from nurses. AIM: This study describes nurses' experienced roles and functions addressing the relatives of patients with stroke during in-hospital rehabilitation. METHODOLOGICAL DESIGN: A phenomenological hermeneutic approach influenced by Paul Ricoeur. In a secondary analysis focus...

  5. Forecasting Advancement Rates to Petty Officer Third Class for U.S. Navy Hospital Corpsmen

    Science.gov (United States)

    2014-06-01

    Lemeshow HM hospital corpsman HM1 hospital corpsman first class HM2 hospital corpsman second class HM3 hospital corpsman third class HMC chief...hospital corpsman HMCM master chief hospital corpsman HMCS senior chief hospital corpsman HN hospitalman HR hospitalman recruit HYT high year tenure...between the rates of seaman (E-3; HN) and chief petty officer (E-7; HMC ) in the Hospital Corpsman (HM) rating, this thesis seeks to develop advancement

  6. Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings.

    Science.gov (United States)

    Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael

    2016-01-01

    Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.

  7. The cost effectiveness of an early transition from hospital to nursing home for stroke patients: design of a comparative study.

    Science.gov (United States)

    Heijnen, Ron W H; Evers, Silvia M A A; van der Weijden, Trudy D E M; Limburg, Martien; Schols, Jos M G A

    2010-05-26

    As the incidence of stroke has increased, its impact on society has increased accordingly, while it continues to have a major impact on the individual. New strategies to further improve the quality, efficiency and logistics of stroke services are necessary. Early discharge from hospital to a nursing home with an adequate rehabilitation programme could help to optimise integrated care for stroke patients.The objective is to describe the design of a non-randomised comparative study evaluating early admission to a nursing home, with multidisciplinary assessment, for stroke patients. The study is comprised of an effect evaluation, an economic evaluation and a process evaluation. The design involves a non-randomised comparative trial for two groups. Participants are followed for 6 months from the time of stroke. The intervention consists of a redesigned care pathway for stroke patients. In this care pathway, patients are discharged from hospital to a nursing home within 5 days, in comparison with 12 days in the usual situation. In the nursing home a structured assessment takes place, aimed at planning adequate rehabilitation. People in the control group receive the usual care. The main outcome measures of the effect evaluation are quality of life and daily functioning. In addition, an economic evaluation will be performed from a societal perspective. A process evaluation will be carried out to evaluate the feasibility of the intervention as well as the experiences and opinions of patients and professionals. The results of this study will provide information about the cost effectiveness of the intervention and its effects on clinical outcomes and quality of life. Relevant strengths and weaknesses of the study are addressed in this article. Current Controlled Trails ISRCTN58135104.

  8. Acute-phase predictors of 6-month functional outcome in Italian stroke patients eligible for In-Hospital Rehabilitation.

    Science.gov (United States)

    Franceschini, Marco; Fugazzaro, Stefania; Agosti, Maurizio; Sola, Carlotta; Di Carlo, Antonio; Cecconi, Lorenzo; Ferro, Salvatore

    2018-01-23

    to assess early post-stroke prognostic factors in patients admitted for post-acute phase rehabilitation. a one-year multicenter prospective project was conducted in four Italian regions on 352 patients who were hospitalized after a first stroke and were eligible for post-acute rehabilitation. Clinical data were collected in the Stroke or Acute Care Units (acute phase), then in Rehabilitation Units (post-acute phase) and, subsequently, after a 6-month post-stroke period (follow-up). Clinical outcome measures were represented using the Barthel Index (BI) and the modified Rankin Scale (mRS). Univariate and multivariate analyses were performed to identify the most important prognostic index. mRS score, minor neurologic impairment and early out-of-bed mobilization (within 2 days after the stroke) proved to be important factors related to a better recovery according to BI (power of prediction = 37%). Similarly, age, pre-morbid mRS score and early out-of-bed mobilization were seen to be significant factors in achieving better overall participation and activity according to the mRS (power of prediction = 48%). BI at admission and certain comorbidities were also significant prognostic factors correlated with a better outcome. according to the BI and mRS, early mobilization is an early predictor of favorable outcome.

  9. Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population.

    Science.gov (United States)

    Mavaddat, Nahal; van der Linde, Rianne; Parker, Richard; Savva, George; Kinmonth, Ann Louise; Brayne, Carol; Mant, Jonathan

    2016-01-01

    Poor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its' relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke. MRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years. 11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1-1.9)), but not stroke mortality (OR 1.2 (0.8-1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9-1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6-1.4)), stroke mortality (OR 1.1(0.5-2.5)), or survival (OR 1.1(0.6-2.1)). Poor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.

  10. Blood transfusion and 30-day readmission rate in adult patients hospitalized with sickle cell disease crisis.

    Science.gov (United States)

    Nouraie, Mehdi; Gordeuk, Victor R

    2015-10-01

    Sickle cell disease (SCD) patients hospitalized with vasoocclusive pain crisis tend to have prolonged length of stay (LOS) and high 30-day readmission rates. We investigated the associations of demographic characteristics, comorbidities, and blood transfusion during hospitalization with these outcomes. Repeated regression analysis was used to analyze 39,324 admissions of 4348 adults with sickle cell crisis from 2007 to 2012 in the Truven Health MarketScan Medicaid Databases. The mean (95% range) LOS was 5.9 (1.0-19.0) days and the 30-day readmission rate was 39.6% (95% confidence interval [CI], 39.1%-40.0%). Older age; chronic cardiopulmonary, renal, or liver disease; and sepsis were associated with both longer LOS and greater 30-day readmission rate. Female sex, iron overload, acute chest syndrome, acute renal failure, and stroke were additional predictors of longer LOS. Simple red blood cell transfusion was administered in 31.8% of the admissions, and these patients tended to have more severe disease (chronic cardiopulmonary or kidney disease, acute chest syndrome, acute kidney or liver failure, sepsis). Nevertheless, transfusion was associated with a reduced estimated odds ratio (OR) of inpatient mortality of 0.75 (95% CI, 0.57-0.99) and a decreased OR of 30-day readmission of 0.78 (95% CI, 0.73-0.83). Our findings point to blood transfusion as a potential means to reduce the 30-day readmission rate among Medicaid patients hospitalized with sickle cell crisis. There is a need for a prospective study to examine the potential benefit and safety of simple blood transfusion for this purpose. © 2015 AABB.

  11. British Association of Stroke Physicians: benchmarking survey of stroke services.

    Science.gov (United States)

    Rodgers, Helen; Dennis, Martin; Cohen, David; Rudd, Anthony

    2003-03-01

    the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. to describe the organisation and staffing of specialist hospital-based stroke services in the UK. a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.

  12. Stroke rates and diving air volumes of emperor penguins: implications for dive performance.

    Science.gov (United States)

    Sato, Katsufumi; Shiomi, Kozue; Marshall, Greg; Kooyman, Gerald L; Ponganis, Paul J

    2011-09-01

    Emperor penguins (Aptenodytes forsteri), both at sea and at an experimental dive hole, often have minimal surface periods even after performance of dives far beyond their measured 5.6 min aerobic dive limit (ADL: dive duration associated with the onset of post-dive blood lactate accumulation). Accelerometer-based data loggers were attached to emperor penguins diving in these two different situations to further evaluate the capacity of these birds to perform such dives without any apparent prolonged recovery periods. Minimum surface intervals for dives as long as 10 min were less than 1 min at both sites. Stroke rates for dives at sea were significantly greater than those for dives at the isolated dive hole. Calculated diving air volumes at sea were variable, increased with maximum depth of dive to a depth of 250 m, and decreased for deeper dives. It is hypothesized that lower air volumes for the deepest dives are the result of exhalation of air underwater. Mean maximal air volumes for deep dives at sea were approximately 83% greater than those during shallow (emperor penguins, (b) stroke rate at sea is greater than at the isolated dive hole and, therefore, a reduction in muscle stroke rate does not extend the duration of aerobic metabolism during dives at sea, and (c) a larger diving air volume facilitates performance of deep dives by increasing the total body O(2) store to 68 ml O(2) kg(-1). Although increased O(2) storage and cardiovascular adjustments presumably optimize aerobic metabolism during dives, enhanced anaerobic capacity and hypoxemic tolerance are also essential for longer dives. This was exemplified by a 27.6 min dive, after which the bird required 6 min before it stood up from a prone position, another 20 min before it began to walk, and 8.4 h before it dived again.

  13. Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: a randomized single-center clinical trial.

    Science.gov (United States)

    Kim, Eun-Kyong; Park, Eun Young; Sa Gong, Jung-Whan; Jang, Sung-Ho; Choi, Youn-Hee; Lee, Hee-Kyung

    2017-11-01

    Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge. In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period. After OHCP, oral hygiene status including the plaque index, calculus index, and O'Leary plaque index improved significantly in the intervention group, compared to the control group (p oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital. Implications for Rehabilitation Initial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center. An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status and plaque control performance among stroke patients at three months after discharge. Repeated tooth brushing education and professional tooth cleaning were necessary to improve plaque control performance of stroke patients.

  14. Expert versus proxy rating of verbal communicative ability of people with aphasia after stroke.

    Science.gov (United States)

    de Jong-Hagelstein, Marjolein; Kros, Lieke; Lingsma, Hester F; Dippel, Diederik W J; Koudstaal, Peter J; Visch-Brink, Evy G

    2012-11-01

    In randomized clinical trials of aphasia treatment, a functional outcome measure like the Amsterdam-Nijmegen Everyday Language Test (ANELT), administered by speech-language therapists, is often used. However, the agreement between this expert rating and the judgment of the proxy about the quality of the daily life communication of the person with aphasia is largely unknown. We examined the association between ANELT scores by speech-language therapists and proxy judgments on the Partner Communication Questionnaire both at 3 and 6 months in 39 people with aphasia after stroke. We also determined which factors affected the level of agreement between expert and proxy judgment of the communicative ability at 6 months in 53 people with aphasia. We found moderate agreement (at 3 months r = .662; p = aphasia, measured with the Aphasia Severity Rating Scale, was associated with better agreement. In conclusion, although proxies were slightly more positive than experts, we found moderate agreement between expert and proxy rating of verbal communicative ability of people with aphasia after stroke, especially in milder cases.

  15. Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke. Care needs and involvement.

    Science.gov (United States)

    Aadal, Lena; Angel, Sanne; Langhorn, Leanne; Pedersen, Birgitte Blicher; Dreyer, Pia

    2017-09-04

    In the last decades, length of stay of in-hospital rehabilitation of patients with stroke has been significantly reduced. Health authorities expect relatives to be at disposal to convey the knowledge of everyday life and to provide emotional as well as practical support in relation to the patient. Caregivers require nurse assistance, support and to be seen as an essential partner in the care giving process. However, the nurses do not perceive that teaching of relatives is a task they should routinely undertake. This might indicate an ambiguity between the relatives' expectations and the actual contribution from nurses. This study describes nurses' experienced roles and functions addressing the relatives of patients with stroke during in-hospital rehabilitation. A phenomenological hermeneutic approach influenced by Paul Ricoeur. In a secondary analysis focus group, interviews of 19 randomly selected nurses from three different hospital settings were interpreted in three levels. The study was conducted in accordance with the ethical guidelines for nursing research in the Nordic countries. The nurses expressed that they address the patient and the relatives and support the interaction between the patient and the relatives. Four themes occurred: the changed lives of relatives; shared life after stroke; noncooperating relatives; time for the relatives. Nurses experience their roles and functions addressing relatives after stroke as crucial, challenging and multifaceted. They acknowledged care needs of the relatives in their own right by addressing the relatives' vulnerability during in-hospital rehabilitation characterised by an existential threat to the physical as well as the shared life. The focus on the needs of relatives considering their expected future role was experienced as conflicting with restricting time frames and a healthcare system focusing on the individual patient. © 2017 Nordic College of Caring Science.

  16. A lower baseline glomerular filtration rate predicts high mortality and newly cerebrovascular accidents in acute ischemic stroke patients.

    Science.gov (United States)

    Dong, Kai; Huang, Xiaoqin; Zhang, Qian; Yu, Zhipeng; Ding, Jianping; Song, Haiqing

    2017-02-01

    Chronic kidney disease (CKD) is gradually recognized as an independent risk factor for cardiovascular and cardio-/cerebrovascular disease. This study aimed to examine the association of the estimated glomerular filtration rate (eGFR) and clinical outcomes at 3 months after the onset of ischemic stroke in a hospitalized Chinese population.Totally, 972 patients with acute ischemic stroke were enrolled into this study. Modified of Diet in Renal Disease (MDRD) equations were used to calculate eGFR and define CKD. The site and degree of the stenosis were examined. Patients were followed-up for 3 months. Endpoint events included all-cause death and newly ischemic events. The multivariate logistic model was used to determine the association between renal dysfunction and patients' outcomes.Of all patients, 130 patients (13.4%) had reduced eGFR (<60 mL/min/1.73 m), and 556 patients had a normal eGFR (≥90 mL/min/1.73 m). A total of 694 patients suffered from cerebral artery stenosis, in which 293 patients only had intracranial artery stenosis (ICAS), 110 only with extracranial carotid atherosclerotic stenosis (ECAS), and 301 with both ICAS and ECAS. The patients with eGFR <60 mL/min/1.73m had a higher proportion of death and newly ischemic events compared with those with a relatively normal eGFR. Multivariate analysis revealed that a baseline eGFR <60 mL/min/1.73 m increased the risk of mortality by 3.089-fold and newly ischemic events by 4.067-fold. In further analysis, a reduced eGFR was associated with increased rates of mortality and newly events both in ICAS patients and ECAS patients. However, only an increased risk of newly events was found as the degree of renal function deteriorated in ICAS patients (odds ratio = 8.169, 95% confidence interval = 2.445-14.127).A low baseline eGFR predicted a high mortality and newly ischemic events at 3 months in ischemic stroke patients. A low baseline eGFR was also a strong independent predictor for newly

  17. Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study.

    Science.gov (United States)

    Jensen, Magnus T; Pereira, Marta; Araujo, Carla; Malmivaara, Anti; Ferrieres, Jean; Degano, Irene R; Kirchberger, Inge; Farmakis, Dimitrios; Garel, Pascal; Torre, Marina; Marrugat, Jaume; Azevedo, Ana

    2018-03-01

    The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Consecutive ACS patients admitted in 2008-2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70-79 bpm in STEMI and 60-69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

  18. Preadmission oral anticoagulant treatment and clinical outcome among patients hospitalized with acute stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Svendsen, Marie Louise; Hansen, Morten Lock

    2014-01-01

    Preadmission oral anticoagulant treatment (OAT) has been linked with less severe stroke and a better outcome in patients with atrial fibrillation. However, the existing studies have methodological limitations and have, with one exception, not included hemorrhagic strokes. We performed a nationwide...... historic follow-up study using data from population-based healthcare registries to assess the effect of preadmission OAT on stroke outcomes further....

  19. Relationship between Kidney Dysfunction and Ischemic Stroke Outcomes: Albuminuria, but Not Estimated Glomerular Filtration Rate, Is Associated with the Risk of Further Vascular Events and Mortality after Stroke.

    Science.gov (United States)

    Lee, Seung-Jae; Lee, Dong-Geun

    2016-01-01

    Estimated glomerular filtration rate (eGFR) and albuminuria are known to be associated with ischemic stroke outcomes. In this study, we investigated the longitudinal relationships of the two markers with mortality, vascular events and functional outcomes in a stroke cohort. A total of 295 patients with acute ischemic stroke were prospectively recruited in a single center between May 2012 and February 2015. Renal dysfunction was defined as a decreased eGFR (albuminuria (urine albumin-to-creatinine ratio ≥ 30 mg/g). Good functional outcome at 6 months was defined as a modified Rankin scale score ≤ 2, and the occurrence of major vascular events (stroke, acute coronary syndrome or peripheral artery occlusion) or death was monitored. The associations between renal dysfunction and mortality, major vascular events, and 6-month functional outcome were evaluated by the Cox proportional hazards model and logistic regression analysis. Unadjusted and adjusted hazards ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were obtained. A Kaplan-Meier survival curve for composite adverse events (major vascular events or death) was also computed according to the presence or absence of albuminuria. Albuminuria, not eGFR, was significantly associated with mortality (P = 0.028; HR 2.15; 95% CI 1.09-4.25) and major vascular events (P = 0.044; HR 2.24; 95% CI 1.02-4.94) in the multivariate Cox proportional hazards models adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history, initial National Institutes of Health Stroke Scale (NIHSS) score and eGFR. In addition, albuminuria was negatively associated with 6-month functional outcome in the multivariate logistic regression analysis adjusting for age, sex, diabetes, hypertension, current smoking, atrial fibrillation, previous stroke, alcohol history and eGFR (P = 0.001; OR 0.36; 95% CI 0.20-0.65), but the association disappeared when NIHSS score was

  20. Reducing hospital readmission rates: current strategies and future directions.

    Science.gov (United States)

    Kripalani, Sunil; Theobald, Cecelia N; Anctil, Beth; Vasilevskis, Eduard E

    2014-01-01

    New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

  1. Fight like a ferret: a novel approach of using art therapy to reduce anxiety in stroke patients undergoing hospital rehabilitation.

    Science.gov (United States)

    Ali, Khalid; Gammidge, Tony; Waller, Diane

    2014-06-01

    The holistic aspect of stroke rehabilitation to include psychological well-being is currently neglected, with more emphasis placed on physical recovery despite anxiety and depression being common poststroke. From the limited amount of current literature, it seems that creative strategies such as art therapy (AT) can be beneficial in reducing isolation and anxiety among stroke patients. Stroke patients (able to consent) in a hospital rehabilitation unit were invited to participate in two weekly AT sessions for 6 weeks, facilitated by an art psychotherapist using paints, crayons, clay, a camera and an iPad. Hospital anxiety and depression scales (HAD) and therapy outcome measures (TOM) were measured at the beginning and end of the study. Six male patients were recruited, average age 69 years (38-85). Group discussions allowed patients to express openly feelings of frustration as well as hope for physical and emotional recovery: 'fight like a ferret', an expression used by a group member. The group produced several art objects and photographic images that were collated using stop-frame animation to produce a 10 min film. Median HAD score for the group was eight points upon entering the study and six points on finishing the study. There is little attention to the emotional needs of stroke patients in rehabilitation. Properly designed research studies exploring the role of AT in addressing anxiety and depression poststroke are needed. Our study showed that AT was a feasible intervention that helped patients explore the sequel of stroke in an open supportive environment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. 42 CFR 412.331 - Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution.

    Science.gov (United States)

    2010-10-01

    ..., after a new hospital accepts its first patient but before the end of its base year, it merges with one... hospital-specific rate and payment determination for the merged entity are determined as follows— (1) Post... campus in accordance with § 412.328, and then determines a revised hospital-specific rate for the merged...

  3. Evaluation of the Hospital Anxiety and Depression Scale (HADS) in screening stroke patients for symptoms: Item Response Theory (IRT) analysis.

    Science.gov (United States)

    Ayis, Salma A; Ayerbe, Luis; Ashworth, Mark; DA Wolfe, Charles

    2018-03-01

    Variations have been reported in the number of underlying constructs and choice of thresholds that determine caseness of anxiety and /or depression using the Hospital Anxiety and Depression scale (HADS). This study examined the properties of each item of HADS as perceived by stroke patients, and assessed the information these items convey about anxiety and depression between 3 months to 5 years after stroke. The study included 1443 stroke patients from the South London Stroke Register (SLSR). The dimensionality of HADS was examined using factor analysis methods, and items' properties up to 5 years after stroke were tested using Item Response Theory (IRT) methods, including graded response models (GRMs). The presence of two dimensions of HADS (anxiety and depression) for stroke patients was confirmed. Items that accurately inferred about the severity of anxiety and depression, and offered good discrimination of caseness were identified as "I can laugh and see the funny side of things" (Q4) and "I get sudden feelings of panic" (Q13), discrimination 2.44 (se = 0.26), and 3.34 (se = 0.35), respectively. Items that shared properties, hence replicate inference were: "I get a sort of frightened feeling as if something awful is about to happen" (Q3), "I get a sort of frightened feeling like butterflies in my stomach" (Q6), and "Worrying thoughts go through my mind" (Q9). Item properties were maintained over time. Approximately 20% of patients were lost to follow up. A more concise selection of items based on their properties, would provide a precise approach for screening patients and for an optimal allocation of patients into clinical trials. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Validity and reliability of critical speed, critical stroke rate, and anaerobic capacity in relation to front crawl swimming performances.

    Science.gov (United States)

    Dekerle, J; Sidney, M; Hespel, J M; Pelayo, P

    2002-02-01

    The purpose of this investigation was to determine whether the concepts of critical swimming speed, critical stroke rate and anaerobic swimming capacity could be used by coaches as a reliable index in order to monitor endurance performances in competitive swimmers. The results of this study conducted with well-trained swimmers showed that the 30-min test velocity (V30) is not different from the critical swimming speed determined from 200- and 400-m tests but is overestimated by 3.2 %. Furthermore, a regression analysis of the number of stroke cycles on time calculated for each swimmer showed a linear relationship (r(2) greater than 0.99 and p less than 0.01). The 30-min stroke rate test (SR30) was not different from the critical stroke rate determined from 200- and 400-m tests after a correction of minus 3.9 %. These data suggest that the slope of this regression line represents the critical stroke rate defined as the maximal stroke rate value, which can theoretically be maintained continuously without exhaustion. Coaches could easily use critical swimming speed combined with critical stroke rate in order not only to set aerobic training loads but also to control the swimming technique during training. Besides, anaerobic swimming capacity (ASC) values defined as the y-intercept of the regression line between distance and time were not correlated (p > 0.05) with the determined distance over which a significant drop in the maximal speed could be noticed on a 25-m test. Thus, ASC does not provide a reliable estimation of the anaerobic capacity.

  5. A temible complication of ischemic stroke: pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Linda Iurato

    2015-12-01

    Pulmonary embolism is a major contributor to in-hospital death after stroke. Although the rate of clinically overt pulmonary embolism after stroke has been estimated to be less than 1%, pulmonary emboli account for up to 50% of early deaths after stroke. In daily practice, the clinical burden of pulmonary embolism in patient with stroke is, however, underestimated since the clinical symptoms of stroke may obscure the recognition of this complication. The aim of this article is to describe the clinical and therapeutic aspects of pulmonary embolism as complication after stroke.

  6. Thirty-Day Case Fatality of Stroke at the Lagos University Teaching ...

    African Journals Online (AJOL)

    Background: There is some evidence that the case fatality rate of stroke has declined in recent years, although it is not certain that this reduction has been caused by changes in stroke management. There has been no recent review of the case fatality rate of stroke at the Lagos University Teaching Hospital [LUTH].

  7. Prospective assessment of patients with stroke in Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia

    Directory of Open Access Journals (Sweden)

    Ayalew Zewdie

    2018-03-01

    Discussion: Our study identified hypertension to be the most common risk factor for stroke. The predominant aetiology type in this cohort is haemorrhagic stroke. Lastly, the median arrival time to an emergency centre was 24 h after symptom onset.

  8. Ethnicity and thrombolysis in ischemic stroke: a hospital based study in Amsterdam

    NARCIS (Netherlands)

    Coutinho, Jonathan M.; Klaver, Eva C.; Roos, Yvo B.; Stam, Jan; Nederkoorn, Paul J.

    2011-01-01

    Ethnic differences have been reported with regard to several medical therapies. The aim of this study was to investigate the relation between ethnicity and thrombolysis in stroke patients. Retrospective single-centre study. Patients admitted with an ischemic stroke between 2003 and 2008 were

  9. Ocular disorders in stroke patients in a tertiary hospital in Nigeria

    African Journals Online (AJOL)

    2015-08-06

    Aug 6, 2015 ... in 71.8% eyes and optic nerve head changes in 48.8% eyes which includes temporal disc pallor and glaucomatous optic neuropathy ... Conclusion: Ocular abnormalities are present in patients with stroke, mostly due to predisposing risk factors for stroke ... ages of 41 and 70 years which form the bulk of the.

  10. A review of stroke admissions at a tertiary hospital in rural ...

    African Journals Online (AJOL)

    Background: Stroke is a common neurological disorder and is the third leading cause of death and a major cause of long-term disability. The disease is expected to increase in low- and middle-income countries like Nigeria. There is no information on stroke in rural Nigeria. Objectives: To review the clinical patterns, ...

  11. Impact of heart rate on admission on mortality and morbidity in acute ischaemic stroke patients - results from VISTA.

    Science.gov (United States)

    Nolte, C H; Erdur, H; Grittner, U; Schneider, A; Piper, S K; Scheitz, J F; Wellwood, I; Bath, P M W; Diener, H-C; Lees, K R; Endres, M

    2016-12-01

    Elevated heart rate (HR) is associated with worse outcomes in patients with cardiovascular disease. Its predictive value in acute stroke patients is less well established. We investigated the effects of HR on admission in acute ischaemic stroke patients. Using the Virtual International Stroke Trials Archive (VISTA) database, the association between HR in acute stroke patients without atrial fibrillation and the pre-defined composite end-point of (recurrent) ischaemic stroke, transient ischaemic attack (TIA), myocardial infarction (MI) and vascular death within 90 days was analysed. Pre-defined secondary outcomes were the composite end-point components and any death, decompensated heart failure and degree of functional dependence according to the modified Rankin Scale after 90 days. HR was analysed as a categorical variable (quartiles). In all, 5606 patients were available for analysis (mean National Institutes of Health Stroke Scale 13; mean age 67 years; mean HR 77 bpm; 44% female) amongst whom the composite end-point occurred in 620 patients (11.1%). Higher HR was not associated with the composite end-point. The frequencies of secondary outcomes were 3.2% recurrent stroke (n = 179), 0.6% TIA (n = 35), 1.8% MI (n = 100), 6.8% vascular death (n = 384), 15.0% any death (n = 841) and 2.2% decompensated heart failure (n = 124). Patients in the highest quartile (HR> 86 bpm) were at increased risk for any death [adjusted hazard ratio (95% confidence interval) 1.40 (1.11-1.75)], decompensated heart failure [adjusted hazard ratio 2.20 (1.11-4.37)] and worse modified Rankin Scale [adjusted odds ratio 1.29 (1.14-1.52)]. In acute stroke patients, higher HR (>86 bpm) is linked to mortality, heart failure and higher degree of dependence after 90 days but not to recurrent stroke, TIA or MI. © 2016 EAN.

  12. Readmission rates in not-for-profit vs. proprietary hospitals before and after the hospital readmission reduction program implementation.

    Science.gov (United States)

    Birmingham, Lauren E; Oglesby, Willie H

    2018-01-19

    The Patient Protection and Affordable Care Act established the Hospital Readmission Reduction Program (HRRP) to penalize hospitals with excessive 30-day hospital readmissions of Medicare enrollees for specific conditions. This policy was aimed at increasing the quality of care delivered to patients and decreasing the amount of money paid for potentially preventable hospital readmissions. While it has been established that the number of 30-day hospital readmissions decreased after program implementation, it is unknown whether this effect occurred equally between not-for-profit and proprietary hospitals. The aim of this study was to determine whether or not the HRRP decreased readmission rates equally between not-for-profit and proprietary hospitals between 2010 and 2012. Data on readmissions came from the Dartmouth Atlas and hospital ownership data came from the Centers for Medicare and Medicaid Services. Data were joined using the Medicare provider number. Using a difference-in-differences approach, bivariate and regression analyses were conducted to compare readmission rates between not-for-profit and proprietary hospitals between 2010 and 2012 and were adjusted for hospital characteristics. In 2010, prior to program implementation, unadjusted readmission rates for proprietary and not-for-profit hospitals were 16.16% and 15.78%, respectively. In 2012, following program implementation, 30-day readmission rates dropped to 15.76% and 15.29% for proprietary and not-for-profit hospitals. The data suggest that the implementation of the Hospital Readmission Reduction Program had similar effects on not-for-profit and proprietary hospitals with respect to readmission rates, even after adjusting for confounders. Although not-for-profit hospitals had lower 30-day readmission rates than proprietary hospitals in both 2010 and 2012, they both decreased after the implementation of the HRRP and the decreases were not statistically significantly different. Thus, this study

  13. Factors affecting poor attendance for outpatient physiotherapy by patients discharged from Mthatha General Hospital with a stroke

    Directory of Open Access Journals (Sweden)

    N.P. Ntamo

    2013-12-01

    Full Text Available Background: Stroke is a major cause of disability inthe world and its long term effects require adherence to physiotherapyprotocols for optimal rehabilitation. Clinical impression of data fromMthatha General Hospital (MGH Physiotherapy Department revealedthat there was poor attendance of outpatient physiotherapy by strokepatients discharged from MGH and this had negative effects on outcomesand health care costs.Objective: To determine the extent and the socio-demographic reasonsfor poor attendance for outpatient physiotherapy by stroke patients.Methods: An observational descriptive study was conducted using arandomly selected sample of 103 stroke patients from a population of 139who attended physiotherapy in MGH in 2007. Structured interviews wereconducted and SPSS was used for data analysis.Results: The majority (86% of patients did not attend physiotherapy until discharge from the Physiotherapy Department. Themajor reasons for poor attendance were lack of finances (95%, migration to other areas (36%, and living a long distance fromMGH (38%.Conclusion: Almost 9 out of 10 stroke patients fail to attend for outpatient physiotherapy because of lack of finances.Recommendation: Development of a Provincial Rehabilitation Policy with specific reference to decentralization of rehabilitationservices to address unavailability of physiotherapy services at clinics and health care centers which are proximal to the patients’residential areas is recommended.

  14. Risk Factors, Subtypes, and Outcome of Ischemic Stroke in Kuwait: A National Study.

    Science.gov (United States)

    Al-Hashel, Jasem Y; Al-Sabah, Al-Alya; Ahmed, Samar F; Al-Enezi, Maha; Al-Tawheid, Nour; Al Mesailekh, Zainab; Eliwa, Jasmine; Alroughani, Raed

    2016-09-01

    Epidemiological studies of stroke burden in Kuwait are scarce. We aimed to identify the risk factors, subtypes, and outcome of ischemic stroke in the 6 major hospitals in Kuwait between 2008 and 2013. A cross-sectional survey was carried out using randomly selected ischemic stroke patients. It included data of sociodemographic status, stroke risk factors, stroke subtypes, treatment, and outcomes. A total of 1257 ischemic stroke patients (811 men and 446 women; mean age 60.2 ± 13.1) were included. Small-artery ischemic stroke was the most common stroke subgroup (69.8%) whereas hypertension was the most prevalent risk factor (80.9%). History of heart disease was significantly associated (P strokes (58.3%) compared to large-artery stroke (37.5%) and small-artery stroke (32.5%). Atrial fibrillation was significantly prevalent (P stroke (54.2%) compared to large-artery stroke (13%) and small-artery stroke (7.6%). Presentation at ages less than 45 years was significantly (P stroke was significantly associated with higher mortality rates (25% versus 12.4% and 6.8%; P strokes, respectively. Small-artery ischemic stroke was the most common stroke subgroup, and hypertension was the most common risk factor. The outcome was better in younger patients. Cardioembolic stroke was associated with worse outcome. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Association between polyvascular atherosclerosis and estimated glomerular filtration rate in patients with ischaemic stroke: data analysis of the patients in the Chinese National Stroke Registry.

    Science.gov (United States)

    Meng, Xia; Chen, Yu; Jing, Jing; Zhao, Xingquan; Wang, Chunxue; Liu, Liping; Wang, Anxin; Pan, Yuesong; Li, Chao; Wang, Yilong

    2015-05-01

    This study evaluated the prevalence of chronic kidney disease (CKD) in ischemic stroke (IS) patients with polyvascular disease (PolyVD) and analysed the relationship between PolyVD and estimated glomerular filtration rate (eGFR) in IS patients. Data from 9152 consecutive IS patients from the China National Stroke Registry were analysed. PolyVD was defined as patients with IS and coronary artery disease (CAD) and/or peripheral arterial disease (PAD). Chronic kidney disease was defined as eGFR stroke, and National Institutes of Health Stroke Scale scores. PolyVD was observed in 1387 of 9152 patients (15.16%). Among these patients, 1351 (14.76%) had CAD, 56 (0.61%) had PAD, and 20 (0.22%) had CAD and PAD in addition to IS. The prevalence of CKD in IS patients with PolyVD and IS alone was 29.56 and 16.28%, respectively (P < 0.0001). The PolyVD group had a significantly higher risk of lower eGFR (OR: 1.414, 95% CI: 1.202-1.665, P < 0.0001) compared with patients with IS alone. IS patients with PolyVD had a high prevalence of CKD, and PolyVD was independently associated with a low eGFR.

  16. Changes and predictors of psychological stress among elderly stroke survivors 6 months after hospital discharge.

    Science.gov (United States)

    Dos Santos, Emanuella Barros; Rodrigues, Rosalina Aparecida Partezani; Fhon, Jack Roberto Silva; Haas, Vanderlei José

    2017-12-21

    The aim of this study was to analyse the changes in psychological stress and identify its basal predictors among elderly stroke survivors after 6 months following discharge from hospital to home directly, rather than to a rehabilitation facility. The sample comprised 50 elderly stroke survivors. Data were collected at 2 weeks (T1), at 3 months (T2), and at 6 months (T3) after hospital discharge. The following instruments were applied: Perceived Stress Scale-10 items (PSS-10), National Institute of Health Stroke Scale, Functional Independence Measure, and Geriatric Depression Scale-15 items. Study records indicated that the age of the study participants ranged from 60 to 87 years old (mean = 70.3; standard deviation = 7.6). The number of male and female participants was similar. The PSS-10 score decreased almost 6 points between T1 (mean = 15.1) and T3 (mean = 9.7; p psychological stress at 6 months following discharge. Copyright © 2017 John Wiley & Sons, Ltd.

  17. The effect of a smoking ban on hospitalization rates for cardiovascular and respiratory conditions in Prince Edward Island, Canada.

    Directory of Open Access Journals (Sweden)

    Katherine Gaudreau

    Full Text Available This is the first study to have examined the effect of smoking bans on hospitalizations in the Atlantic Canadian socio-economic, cultural and climatic context. On June 1, 2003 Prince Edward Island (PEI enacted a province-wide smoking ban in public places and workplaces. Changes in hospital admission rates for cardiovascular (acute myocardial infarction, angina, and stroke and respiratory (chronic obstructive pulmonary disease and asthma conditions were examined before and after the smoking ban.Crude annual and monthly admission rates for the above conditions were calculated from April 1, 1995 to December 31, 2008 in all PEI acute care hospitals. Autoregressive Integrated Moving Average time series models were used to test for changes in mean and trend of monthly admission rates for study conditions, control conditions and a control province after the comprehensive smoking ban. Age- and sex-based analyses were completed.The mean rate of acute myocardial infarctions was reduced by 5.92 cases per 100,000 person-months (P = 0.04 immediately after the smoking ban. The trend of monthly angina admissions in men was reduced by -0.44 cases per 100,000 person-months (P = 0.01 in the 67 months after the smoking ban. All other cardiovascular and respiratory admission changes were non-significant.A comprehensive smoking ban in PEI reduced the overall mean number of acute myocardial infarction admissions and the trend of angina hospital admissions.

  18. Post Stroke Fatigue; Point Prevalence, Characterization, Associations and Radiological Correlation in a Rehabilitation Hospital

    LENUS (Irish Health Repository)

    Khan, A

    2017-11-01

    Post stroke fatigue (PSF) is a frequently reported symptom by stroke survivors undergoing rehabilitation. This cross sectional observational study was undertaken in a rehabilitation facility to look at its prevalence and relationship with various variables like personal factors, type of stroke, social context, hemispheric involvement on CT scan and mobility status. The results showed that PSF was present in 83% (25 out of 30) of the patients included in the study. No clear association could be established between PSF, social, radiological and functional characteristics.

  19. Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers.

    Science.gov (United States)

    Glover, McKinley; Khalilzadeh, Omid; Choy, Garry; Prabhakar, Anand M; Pandharipande, Pari V; Gazelle, G Scott

    2015-10-01

    An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality. The purpose of this study was to examine the extent to which hospitals utilize social media and whether user-generated metrics on Facebook(®) correlate with a Hospital Compare(®) metric, specifically 30-day all cause unplanned hospital readmission rates. This was a retrospective cross-sectional study conducted among all U.S. hospitals performing outside the confidence interval for the national average on 30-day hospital readmission rates as reported on Hospital Compare. Participants were 315 hospitals performing better than U.S. national rate on 30-day readmissions and 364 hospitals performing worse than the U.S. national rate. The study analyzed ratings of hospitals on Facebook's five-star rating scale, 30-day readmission rates, and hospital characteristics including beds, teaching status, urban vs. rural location, and ownership type. Hospitals performing better than the national average on 30-day readmissions were more likely to use Facebook than lower-performing hospitals (93.3 % vs. 83.5 %; p Facebook rating was associated with increased odds of the hospital belonging to the low readmission rate group by a factor of 5.0 (CI: 2.6-10.3, p Facebook-related variables. Hospitals with lower rates of 30-day hospital-wide unplanned readmissions have higher ratings on Facebook than hospitals with higher readmission rates. These findings add strength to the concept that aggregate measures of patient satisfaction on social media correlate with more traditionally accepted measures of hospital quality.

  20. Event rates, hospital utilization, and costs associated with major complications of diabetes: a multicountry comparative analysis.

    Directory of Open Access Journals (Sweden)

    Philip M Clarke

    2010-02-01

    Full Text Available Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries.Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE study (mean age at entry 66 y. The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$, which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions and lowest for nephropathy (15%-26%. The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across

  1. Addition of 24-Hour Heart Rate Variability Parameters to the Cardiovascular Health Study Stroke Risk Score and Prediction of Incident Stroke: The Cardiovascular Health Study

    Science.gov (United States)

    Bodapati, Rohan K.; Kizer, Jorge R.; Kop, Willem J.; Kamel, Hooman; Stein, Phyllis K.

    2018-01-01

    Background Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24-hour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHS-SCORE), previously developed at the baseline examination. Methods and Results N=884 stroke-free CHS participants (age 75.3 ± 4.6), with 24-hour Holters adequate for HRV analysis at the 1994–1995 examination, had 68 strokes over ≤8 year follow-up (median 7.3 [interquartile range 7.1–7.6] years). The value of adding HRV to the CHS-SCORE was assessed with stepwise Cox regression analysis. The CHS-SCORE predicted incident stroke (HR=1.06 per unit increment, P=0.005). Two HRV parameters, decreased coefficient of variance of NN intervals (CV%, P=0.031) and decreased power law slope (SLOPE, P=0.033) also entered the model, but these did not significantly improve the c-statistic (P=0.47). In a secondary analysis, dichotomization of CV% (LOWCV% ≤12.8%) was found to maximally stratify higher-risk participants after adjustment for CHS-SCORE. Similarly, dichotomizing SLOPE (LOWSLOPE <− 1.4) maximally stratified higher-risk participants. When these HRV categories were combined (eg, HIGHCV% with HIGHSLOPE), the c-statistic for the model with the CHS-SCORE and combined HRV categories was 0.68, significantly higher than 0.61 for the CHS-SCORE alone (P=0.02). Conclusions In this sample of older adults, 2 HRV parameters, CV% and power law slope, emerged as significantly associated with incident stroke when added to a validated clinical risk score. After each parameter was dichotomized based on its optimal cut point in this sample, their composite significantly improved prediction of incident stroke during ≤8-year follow-up. These findings will require validation in separate, larger cohorts. PMID:28396041

  2. Does cultural and linguistic diversity affect health-related outcomes for people with stroke at discharge from hospital?

    Science.gov (United States)

    Davies, Sarah E; Dodd, Karen J; Hill, Keith D

    2017-04-01

    Primary purpose to determine if cultural and linguistic diversity affects health-related outcomes in people with stroke at discharge from hospital and secondary purpose to explore whether interpreter use alters these outcomes. Systematic search of: Cochrane, PEDro, CINAHL, Medline, Pubmed, Embase, PsycINFO and Ageline databases. Publications were classified into whether they examined the impact of diversity in culture, or language or culture and language combined. Quality of evidence available was summarized using Best Evidence Synthesis. Eleven studies met inclusion criteria and were reviewed. Best Evidence Synthesis indicated conflicting evidence about the impact of culture alone and language barriers alone on health-related outcomes. There was strong evidence that hospital length of stay does not differ between groups when the combined impact of culture and language was investigated. Conflicting evidence was found for other outcomes including admission, discharge and change in FIM scores, and post-hospital discharge living arrangements. It is unknown if interpreter use alters health-related outcomes, because this was infrequently reported. The current limited research suggests that cultural and linguistic diversity does not appear to impact on health-related outcomes at discharge from hospital for people who have had a stroke, however further research is needed to address identified gaps. Implications for Rehabilitation The different language, culture and beliefs about health demonstrated by patients with stroke from minority groups in North America do not appear to significantly impact on their health-related outcomes during their admission to hospital. It is not known whether interpreter use influences outcomes in stroke rehabilitation because there is insufficient high quality research in this area. Clinicians in countries with different health systems and different cultural and linguistic groups within their communities need to view the results with caution

  3. Regulatory, policy and quality update for venous thromboembolism and stroke in United States hospitals.

    Science.gov (United States)

    Mahan, Charles E

    2012-10-01

    Stroke and venous thromboembolism (VTE) have a large impact on the United States (US) healthcare system. It is estimated that up to 1.7million new and recurrent stroke and VTE events are occurring in the US on an annual basis with the combined cost approaching over $200billion per year. A significant amount of stroke and VTE are preventable from appropriate antithrombotic use in at-risk patients and the Center for Medicaid and Medicare Services, the Joint Commission, the National Quality Forum and other key quality and regulatory entities have prioritized minimizing the impact of morbidity, mortality and avoidable costs related to these diseases. This review provides a brief history, overview, and update for the development of quality measures, quality systems, and regulatory and policy changes as related to stroke and VTE within the US healthcare system. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Predicting Risk Factors of Working Aged Hemorrhagic Stroke Patients in a Tertiary Teaching Hospital in Chiang Mai

    Directory of Open Access Journals (Sweden)

    Suphannee Triamvisit

    2018-02-01

    Full Text Available Stroke is the third leading cause of morbidity and mortality in Thailand accounting for a significant and increasing share of hospital costs. The purpose of this project is to study the epidemiology of the prevalence and its predicting factors of working aged hemorrhagic stroke (HS patients admitted at a tertiary teaching hospital in Chiang Mai, Thailand. We conducted a five-year retrospective descriptive study. The subjects in this study were patients diagnosed with HS, between 15-59 years of age, and admitted to a tertiary teaching hospital in Chiang Mai, Thailand from January 2009 to December 2013. A total of 404 working aged adults who had HS were admitted to the hospital during this review period; 60.9% males and 39.1% females. Nearly 70% of patients were between 46-59 years of age (M = 47.5, SD = 9.8. Of the patients admitted to the hospital, 76.7% were transferred there from other hospitals. Intracerebral hemorrhage was present in 59.7% of patients. Severe HS occurred in 35.9% of the patients with a Glasgow Coma Score from 3-8. Approximately 69% of the working aged HS patients required surgery. The top five identified risk factors for HS were hypertension (83.4%, hyperlipidemia (38.9%, alcohol consumption (21.5%, smoking (15.3 %, and drug non-adherence (14.9%. We found significantly associated risk factors in working-aged HS by multivariate analysis among male gender (p < .001, drug non-adherence (p = .047, and hypertension (p = .048. Raising awareness to reduce risk behavior and health promotion in the community are the keynotes for health care providers in working-aged HS prevention.

  5. Factors Associated with Delay in Presentation to the Hospital for Young Adults with Ischemic Stroke.

    Science.gov (United States)

    Leung, Lester Y; Caplan, Louis R

    2016-01-01

    Young adults with ischemic stroke may present late to medical care, but the reasons for these delays are unknown. We sought to identify factors that predict delay in presentation. We performed a retrospective cohort study of adults aged 18-50 admitted to a single academic medical center between 2007 and 2012. Eighty six of 141 (61%) young adults with ischemic stroke presented at the health center more than 4.5 h after stroke onset. Diabetes was associated with delays in presentation (p = 0.033, relative risk (RR) 1.4 (95% CI 1.1-1.8)), whereas systemic cancer was associated with early presentations (p = 0.033, RR 0.26 (95% CI 0.044-1.6)). Individuals who were single were more likely to present late than those who were married or living with a partner (p = 0.0045, RR 1.7 (95% CI 1.3-2.2)). Individuals who were unemployed were more likely to present late than those who were employed or in school (p = 0.020, RR 1.4 (95% CI 1.1-1.8)). Age (dichotomized as 18-35 and 36-50), race, home medications, other medical conditions (including common stroke mimics in young adults), and stroke subtype were not determinants of delay in presentation, although there was a trend toward delayed presentations in women (p = 0.076) and with low stroke severity (dichotomized as National Institutes of Health Stroke Scale (NIHSS) ≤5 and NIHSS >5, p = 0.061). A majority of young adults with ischemic stroke presented outside the time window for intravenous fibrinolysis. Diabetes, single status, and unemployed status were associated with delayed presentation. © 2016 S. Karger AG, Basel.

  6. Impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital.

    Science.gov (United States)

    Vianna, Pedro G; Dale, Charles R; Simmons, Sarah; Stibich, Mark; Licitra, Carmelo M

    2016-03-01

    The role of contaminated environments in the spread of hospital-associated infections has been well documented. This study reports the impact of a pulsed xenon ultraviolet no-touch disinfection system on infection rates in a community care facility. This study was conducted in a community hospital in Southern Florida. Beginning November 2012, a pulsed xenon ultraviolet disinfection system was implemented as an adjunct to traditional cleaning methods on discharge of select rooms. The technology uses a xenon flashlamp to generate germicidal light that damages the DNA of organisms in the hospital environment. The device was implemented in the intensive care unit (ICU), with a goal of using the pulsed xenon ultraviolet system for disinfecting all discharges and transfers after standard cleaning and prior to occupation of the room by the next patient. For all non-ICU discharges and transfers, the pulsed xenon ultraviolet system was only used for Clostridium difficile rooms. Infection data were collected for methicillin-resistant Staphylococcus aureus, C difficile, and vancomycin-resistant Enterococci (VRE). The intervention period was compared with baseline using a 2-sample Wilcoxon rank-sum test. In non-ICU areas, a significant reduction was found for C difficile. There was a nonsignificant decrease in VRE and a significant increase in methicillin-resistant S aureus. In the ICU, all infections were reduced, but only VRE was significant. This may be because of the increased role that environment plays in the transmission of this pathogen. Overall, there were 36 fewer infections in the whole facility and 16 fewer infections in the ICU during the intervention period than would have been expected based on baseline data. Implementation of pulsed xenon ultraviolet disinfection is associated with significant decreases in facility-wide and ICU infection rates. These outcomes suggest that enhanced environmental disinfection plays a role in the risk mitigation of hospital

  7. Comparison of costs and discharge outcomes for patients hospitalized for ischemic or hemorrhagic stroke with or without atrial fibrillation in the United States.

    Science.gov (United States)

    Pan, Xianying; Simon, Teresa A; Hamilton, Melissa; Kuznik, Andreas

    2015-05-01

    This retrospective analysis investigated the impact of baseline clinical characteristics, including atrial fibrillation (AF), on hospital discharge status (to home or continuing care), mortality, length of hospital stay, and treatment costs in patients hospitalized for stroke. The analysis included adult patients hospitalized with a primary diagnosis of ischemic or hemorrhagic stroke between January 2006 and June 2011 from the premier alliance database, a large nationally representative database of inpatient health records. Patients included in the analysis were categorized as with or without AF, based on the presence or absence of a secondary listed diagnosis of AF. Irrespective of stroke type (ischemic or hemorrhagic), AF was associated with an increased risk of mortality during the index hospitalization event, as well as a higher probability of discharge to a continuing care facility, longer duration of stay, and higher treatment costs. In patients hospitalized for a stroke event, AF appears to be an independent risk factor of in-hospital mortality, discharge to continuing care, length of hospital stay, and increased treatment costs.

  8. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

    Science.gov (United States)

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

    2012-01-01

    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  9. Early management and outcome of acute stroke in Auckland

    International Nuclear Information System (INIS)

    Anderson, N.E.; Bonita, R.; Broad, J.B.

    1997-01-01

    Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. The aims of this study was to compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of the 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in-hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. It was concluded that in Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT. (authors)

  10. The modifying role of caregiver burden on predictors of quality of life of caregivers of hospitalized chronic stroke patients.

    Science.gov (United States)

    Jeong, Yeon-Gyu; Myong, Jun-Pyo; Koo, Jung-Wan

    2015-10-01

    Caregiver burden is an important predictor of quality of life (QoL) among caregivers of stroke patients. While caregiver burden and QoL might be closely related, caregiver burden seems also to be a potential modifier of the associations between patients' and caregivers' characteristics and caregivers' QoL. The purpose of this study was to investigate the effect of caregiver burden in caregivers of hospitalized chronic stroke patients and the predictors of caregivers' QoL by level of caregiver burden. A total of 238 patients and their caregivers were interviewed using questionnaires consisting of the Zarit Burden Interview and the Korean-version of the World Health Organization Quality of Life-BREF. Multiple hierarchical regression analyses were performed to determine the predictors of caregivers' QoL among caregivers stratified by median caregiver burden score (high/low). Caregiver burden had a modifying effect on caregivers' QoL. In caregivers with high burden, the patient characteristics of being unemployed and the caregiver characteristics of poor health status, lower income, and being a spouse were negative predictors of caregivers' QoL. In caregivers with low burden, the patient characteristics of being hospitalized for a longer duration and the caregiver characteristics of poor health status were negative predictors of caregivers' QoL (all ps < 0.05). This study found that in South Korea, more attention should be paid to spouses who are caring for hospitalized chronic stroke patients, particularly with regard to their health status and financial problems. Further studies are needed to examine the impact of factors not examined in the Korean cultural context. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Teleneurology to improve stroke care in rural areas: The Telemedicine in Stroke in Swabia (TESS) Project.

    Science.gov (United States)

    Wiborg, Andreas; Widder, Bernhard

    2003-12-01

    Assessing both stroke patients and their CT scans by using a conventional videoconference system offers an interesting opportunity to improve stroke care in rural areas. However, until now there have been no studies to suggest whether this method is feasible in routine stroke management. Seven rural hospitals in the southern part of Germany in Swabia were connected to the stroke unit of Günzburg with the use of a videoconference link (Telemedicine in Stroke in Swabia [TESS] Project). The local physicians are free to present every admitted stroke patient to the Günzburg stroke expert, who can assess the clinical status and CT images, thereafter giving therapeutic recommendations. All teleconsultations are rated concerning transmission quality and relevance of telemedicine for stroke management. A total of 153 stroke patients were examined by teleconsultation. Mean age was 67.5 years. Eighty-seven patients had suffered an ischemic stroke, 9 had an intracerebral hemorrhage, and 17 suffered a transient ischemic attack. Forty patients were revealed to have a diagnosis other than stroke. Duration of teleconsultation was 15 minutes on average. User satisfaction was good concerning imaging and audio quality, and patient satisfaction was very good or good in all cases. Relevant contributions could be made in >75% of the cases concerning diagnostic workup, CT assessment, and therapeutic recommendations. Teleconsultation using a videoconference system seems to be a feasible and promising method to improve stroke care in rural areas where management in a stroke unit is hindered by long transportation distances.

  12. Cognition, continence and transfer status at the time of discharge from an acute hospital setting and their associations with an unfavourable discharge outcome after stroke.

    Science.gov (United States)

    Myint, Phyo K; Vowler, Sarah L; Redmayne, Oliver; Fulcher, Robert A

    2008-01-01

    Current demographic trends pose a major societal challenge due to the rising number of older people with chronic conditions such as stroke. The relative impact of various disabilities at the time of discharge from an acute unit on discharge outcome is poorly understood. To examine the association between cognition, continence and transfer status at the time of discharge from the acute stroke unit and discharge destination. A retrospective stroke register database study was conducted in an acute stroke unit in a UK hospital with a catchment population of 568,000. Consecutive acute stroke admissions between 1997 and 2003 who were discharged alive were identified and the likelihood of adverse discharge outcomes defined as institutionalization or a requirement for longer-term rehabilitation was estimated. A total of 2,521 discharges were analyzed (median length of hospital stay 8 days). The presence of confusion, urinary incontinence or the need for help with transfers at the time of discharge predicted a higher likelihood of an adverse outcome even after controlling for age, stroke subtype, premorbid Rankin score and length of hospital stay. The need for help with transfers appeared to be the most consistent and significant factor associated with an adverse outcome regardless of age, sex or stroke subtype across the sample distribution. The ability to transfer has a pivotal role in the clinical decision making of discharge destination after stroke. Understanding of the factors which may increase the potential for improving this ability after acute stroke could have an impact on clinical outcome. Copyright 2008 S. Karger AG, Basel.

  13. Challenges in building interpersonal care in organized hospital stroke units: The perspectives of stroke survivors, family caregivers and the multidisciplinary team.

    Science.gov (United States)

    Ryan, Tony; Harrison, Madeleine; Gardiner, Clare; Jones, Amanda

    2017-10-01

    To explore the organized stroke unit experience from the multiple perspectives of stroke survivor, family carer and the multi-disciplinary team. Organized stroke unit care reduces morbidity, mortality and institutionalization and is promoted globally as the most effective form of acute and postacute provision. Little research has focused on how care is experienced in this setting from the perspectives of those who receive and provide care. This study used a qualitative approach, employing Framework Analysis. This methodology allows for a flexible approach to data collection and a comprehensive and systematic method of analysis. Semi-structured interviews were undertaken during 2011 and 2012 with former stroke unit stroke survivors, family carers and senior stroke physicians. In addition, eight focus groups were conducted with members of the multi-disciplinary team. One hundred and twenty-five participants were recruited. Three key themes were identified across all data sets. First, two important processes are described: responses to the impact of stroke and seeking information and stroke-specific knowledge. These are underpinned by a third theme: the challenge in building relationships in organized stroke unit care. Stroke unit care provides satisfaction for stroke survivors, particularly in relation to highly specialized medical and nursing care and therapy. It is proposed that moves towards organized stroke unit care, particularly with the emphasis on reduction of length of stay and a focus on hyper-acute models, have implications for interpersonal care practices and the sharing of stroke-specific knowledge. © 2017 John Wiley & Sons Ltd.

  14. First-Ever Stroke and Transient Ischemic Attack Incidence and 30-Day Case-Fatality Rates in a Population-Based Study in Argentina

    DEFF Research Database (Denmark)

    Bahit, M Cecilia; Coppola, Mariano L; Riccio, Patricia M

    2016-01-01

    BACKGROUND AND PURPOSE: Epidemiological data about stroke are scarce in low- and middle-income Latin-American countries. We investigated annual incidence of first-ever stroke and transient ischemic attack (TIA) and 30-day case-fatality rates in a population-based setting in Tandil, Argentina....... METHODS: We prospectively identified all first-ever stroke and TIA cases from overlapping sources between January 5, 2013, and April 30, 2015, in Tandil, Argentina. We calculated crude and standardized incidence rates. We estimated 30-day case-fatality rates. RESULTS: We identified 334 first-ever strokes.......1% (95% CI, 14.2-36.6) for intracerebral hemorrhage, and 1.9% (95% CI, 0.4-5.8) for TIA. CONCLUSIONS: This study provides the first prospective population-based stroke and TIA incidence and case-fatality estimate in Argentina. First-ever stroke incidence was lower than that reported in previous Latin...

  15. Preventing Stroke Deaths

    Science.gov (United States)

    ... die within minutes. Strokes happen more in some populations and geographic areas. Stroke death declines have stalled in 3 out of every 4 states. Blacks have the highest stroke death rates among all ...

  16. Cohort-specific trends in stroke mortality in seven European countries were related to infant mortality rates

    NARCIS (Netherlands)

    Amiri, M.; Kunst, A. E.; Janssen, F.; Mackenbach, J. P.

    2006-01-01

    Objectives: To assess, in a population-based study, whether secular trends in cardiovascular disease mortality in seven European countries were correlated with past trends in infant mortality rate (IMR) in these countries. Study Design and Setting: Data on ischemic heart disease (IHD) and stroke

  17. Half of the adults who present to hospital with stroke develop at least one contracture within six months: an observational study.

    Science.gov (United States)

    Kwah, Li Khim; Harvey, Lisa A; Diong, Joanna H L; Herbert, Robert D

    2012-01-01

    What is the incidence of contractures six months after stroke? Can factors measured within four weeks of stroke predict the development of elbow, wrist, and ankle contractures six months later? Prospective cohort study. Consecutive sample of 200 adults with stroke admitted to a Sydney hospital. Loss of range of motion in major joints of the body was measured using a 4-point ordinal contracture scale. In addition, elbow extension, wrist extension, and ankle dorsiflexion range of motion were measured using torque-controlled procedures. Potential predictors of contracture were age, pre-morbid function, severity of stroke, muscle strength, spasticity, motor function, and pain. Measurements were obtained within four weeks of stroke and at six months after stroke. 52% of participants developed at least one contracture. Incidence of contracture varied across joints from 12% to 28%; shoulders and hips were most commonly affected. Muscle strength was a significant predictor of elbow, wrist, and ankle joint range. Prediction models explained only 6% to 20% of variance in elbow, wrist, and ankle joint range. About half of all patients with stroke develop at least one contracture within six months of stroke. Incidence of contractures across all joints ranged from 12% to 28%. Muscle strength is a significant predictor of elbow, wrist, and ankle contractures but cannot be used to accurately predict contractures in these joints. Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.

  18. Hospital characteristics associated with increased conversion rates among organ donors in New England.

    Science.gov (United States)

    Rios-Diaz, Arturo J; Olufajo, Olubode A; Stinebring, Jill; Endicott, Samantha; McKown, Brandon T; Metcalfe, David; Zogg, Cheryl K; Salim, Ali

    2017-10-01

    It is unknown whether hospital characteristics affect institutional performance with regard to organ donation. We sought to determine which hospital- and patient-level characteristics are associated with high organ donor conversion rates after brain death (DBD). Data were extracted from the regional Organ Procurement Organization (2011-2014) and other sources. Hospitals were stratified into high-conversion hospitals (HCH; upper-tertile) and low-conversion hospitals (LCH; lower-tertile) according to conversion rates. Hospital- and patient-characteristics were compared between groups. There were 564 potential DBD donors in 27 hospitals. Conversion rates differed between hospitals in different states (p donors differed between HCH and LCH in race (p organ donor conversion rates. This suggests that there is a pool of potential donors in large specialized hospitals that are not successfully converted to DBD. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke.

    Science.gov (United States)

    Zhao, Lu; Wang, Ruihao; Song, Bo; Tan, Song; Gao, Yuan; Fang, Hui; Lu, Jie; Xu, Yuming

    2015-07-01

    The association between atherogenic dyslipidemia and stroke recurrence remains unclear, and may be influenced by different subtypes of ischemic stroke. We aimed to investigate whether atherogenic dyslipidemia contributed to stroke recurrence in ischemic stroke patients and in those with certain subtypes of ischemic stroke. We conducted a prospective hospital-based study enrolling patients with acute ischemic stroke. Atherogenic dyslipidemia was defined as high-density lipoprotein cholesterol dyslipidemia and stroke recurrence was analyzed by using multivariable Cox regression model. In the 510 ischemic stroke patients, 64 patients (12·5%) had atherogenic dyslipidemia, and 66 patients (12·9%) experienced stroke recurrence events within 24 months. Kaplan-Meier analysis revealed that stroke recurrence rate was significantly higher in patients with atherogenic dyslipidemia than those without in all the stroke patients (20·3% vs. 11·9%; P = 0·048), and more evident in those of large-artery atherosclerosis subtype (31·0% vs. 14·1%; P = 0·014), but not in the other subtypes. Multivariable Cox regression analysis revealed that atherogenic dyslipidemia was associated with higher stroke recurrence risk among stroke patients of large-artery atherosclerosis subtype (hazard ratio, 2·79; 95% confidence interval, 1·24-6·28), but not significant in all the stroke patients (hazard ratio, 1·69; 95% confidence interval, 0·85-3·37). Atherogenic dyslipidemia is associated with higher risk of stroke recurrence in ischemic stroke patients. Such association might be more pronounced in large-artery atherosclerosis subtype and needs further investigation to establish such relationship. © 2015 World Stroke Organization.

  20. Changes in risk factor profile after ischemic stroke

    DEFF Research Database (Denmark)

    Hornnes, Nete

    Background and aims. Adherence to preventive medication and to a healthy life style reduces stroke survivors’ risk of recurrent stroke. We investigated risk factor management in patients admitted to 3 Copenhagen hospitals with ischemic stroke (IS) Methods. 320 patients with acute IS were followed...... up 1 year after stroke. We constructed a baseline risk factor profile (RFP) of 6 variables: smoking, excessive drinking, physical inactivity, untreated hypertension, no cholesterol-lowering, and no antithrombotic treatment/warfarin at discharge from hospital. Each item was rated 0 or 1 giving......-fatal recurrent stroke or myocardial infarction Conclusions. We suggest the organisation of secondary prevention clinics within the stroke units for life style modification and treatment to target of risk factors immediately after discharge, thus extending the success of TIA clinics to all stroke survivors...

  1. A Review of Stroke Cases in a Military Hospital in Nigeria | Ukoha ...

    African Journals Online (AJOL)

    BACKGROUND: CVA (Stroke) remains one of the most common neurological illnesses in the country, accounting for a greater percentage of morbidity and morality. Its increasing prevalence is a source of worry to most health personnel. OBJECTIVES: The aim of the study is to review the patient characteristic, risk factors, ...

  2. Laboratory-confirmed respiratory infections as predictors of hospital admission for myocardial infarction and stroke: time-series analysis of English data for 2004-2015.

    Science.gov (United States)

    Blackburn, R M; Zhao, H; Pebody, R; Hayward, A C; Warren-Gash, C

    2018-01-06

    Acute respiratory infections are associated with increased risk of myocardial infarction (MI) and stroke, however, the role of different organisms is poorly characterised. We undertook a time-series analysis of English hospital admissions for MI and stroke (age-stratified: 45-64, 65-74, 75+ years), laboratory-confirmed viral respiratory infections and environmental data for 2004-2015. Weekly counts of admissions were modelled using multivariable Poisson regression with weekly counts of respiratory viruses (influenza, parainfluenza, rhinovirus, respiratory syncytial virus (RSV), adenovirus or human meta-pneumovirus (HMPV)) investigated as predictors. We controlled for seasonality, long-term trends and environmental factors. Weekly hospital admissions in adults aged 45+ years averaged 1347 (IQR 1217-1541) for MI and 1175 (IQR 1023-1395) for stroke. Median numbers of respiratory infections ranged from 11 cases per week (IQR 5-53) for influenza to 55 (IQR 7-127) for rhinovirus. In the adjusted models, all viruses except parainfluenza were significantly associated with MI and ischaemic stroke admissions in those aged 75+. Among 65-74 year olds, adenovirus, rhinovirus and RSV were associated with MI but not ischaemic stroke admissions. Respiratory infections were not associated with MI or ischaemic stroke in people aged 45-64, nor with haemorrhagic stroke in any age group. An estimated 0.4-5.7% of MI and ischaemic stroke admissions may be attributable to respiratory infection, with greater excess burden during weeks with high circulating virus levels. We identified small but strongly significant associations in the timing of respiratory infection (with HMPV, RSV, influenza, rhinovirus and adenovirus) and MI or ischaemic stroke hospitalisations in the elderly. NCT02984280.

  3. Self-rated health, symptoms of depression and general symptoms at 3 and 12 months after a first-ever stroke: a municipality-based study in Sweden

    Directory of Open Access Journals (Sweden)

    Hassler Ejda

    2007-10-01

    Full Text Available Abstract Background Self-rated health is an important indicator of quality of life as well as a good predictor of future health. The purpose of the study was to follow up the self-rated health and the prevalence of symptoms of depression and general symptoms in a population of first-ever stroke patients 3 and 12 months after stroke. Methods All patients surviving their first-ever stroke and residing in Nacka municipality in Stockholm County Council were included using a multiple overlapping search strategy during an 18-month period (n = 187. Our study group comprised the 145 patients who survived the first 3 months after stroke. Three and 12 months after their stroke, the patients were assessed regarding self-rated health and general symptoms using parts of the Göteborg Quality of Life Instrument (GQLI, and regarding symptoms of depression using the Montgomery Asberg Depression Scale (MADRS-S. Results Self-rated health was rated as very good or rather good by 62% at 3 months after stroke and by 78% at 12 months after stroke. More than half of the patients suffered from symptoms of depression, with no significant improvement at 12 months. The most common general symptoms at 3 months after stroke were fatigue, sadness, pain in the legs, dizziness and irritability. Fatigue and sadness were still common at 12 months. Twelve months after stroke the prevalences of crying easily, irritability, impaired concentration, nausea and loss of weight were significantly lower. Conclusion The majority of patients rated their health as rather good or very good at 3 and 12 months after stroke. However, the majority suffered from fatigue and from symptoms of depression after both 3 and 12 months. In continued care of stroke survivors, it is important to consider the fact that many patients who rate their health as good may nevertheless have symptoms of depression, and some of them may benefit from anti-depressive treatment.

  4. Clinical predictive value of the ABCD2 score for early risk of stroke in patients who have had transient ischaemic attack and who present to an Australian tertiary hospital.

    Science.gov (United States)

    Sanders, Lauren M; Srikanth, Velandai K; Psihogios, Helen; Wong, Kitty K; Ramsay, David; Phan, Thanh G

    2011-02-07

    To determine the predictive value of the ABCD(2) score for early risk of stroke in Australian patients who have had transient ischaemic attack (TIA). Cohort study of 512 consecutive patients with suspected TIA referred by the emergency department to the acute stroke unit (in accordance with the TIA pathway) of an urban tertiary hospital in Melbourne, Victoria, between 1 June 2004 and 30 November 2007. Overall accuracy, estimated by the area under the curve (AUC) of receiver operating characteristic plots (of true positive rate v false positive rate), and sensitivity, specificity, predictive values and likelihood ratios at prespecified cut-off ABCD(2) scores for stroke within 2, 7 and 90 days. 24 patients were excluded because their symptoms lasted more than 24 hours. All included patients were reviewed by a stroke physician; TIA was confirmed in 301/488 (61.7%). Most (289/301; 96.0%) had complete follow-up. Stroke occurred in 4/292 patients (1.37%; 95% CI, 0.37%-3.47%) within 2 days and 7/289 (2.42%; 95% CI, 0.98%-4.93%) within 90 days; no patient had a stroke between 2 and 7 days. The AUCs for stroke in patients with confirmed TIA were 0.80 (95% CI, 0.68-0.91) and 0.62 (95% CI, 0.40-0.83) for stroke within 2 days and 90 days, respectively. At a cut-off of ≥ 5, the ABCD(2) score had modest specificity for stroke within 2 days (0.58) and 90 days (0.58), but positive predictive values (2 days, 0.03; 90 days, 0.04) and positive likelihood ratios (2 days, 2.40; 90 days, 1.71) were both poor. The score performed similarly poorly at other prespecified cut-off scores. Given its poor predictive value, the use of the ABCD(2) score alone may not be dependable for guiding clinical treatment decisions or service organisation in an Australian tertiary setting. Validation in other Australian settings is recommended before it can be applied with confidence.

  5. Stroke in Trinidad and Tobago: burden of illness and risk factors

    Directory of Open Access Journals (Sweden)

    Mahabir Deepak

    1998-01-01

    Full Text Available This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1 105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9 478 bed days per annum. The hospital admission fatality rate was 29%. Among surviving patients, 437 (56% were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35_64 years were 114 (95%CI: 83 to 145 per 100 000 in Afro-Trinidadian men and 144 (109 to 179 in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146 and 152 (118 to 186. Among patients with first strokes, 348/531 (66% reported physician-diagnosed hypertension, but only 226 (65% of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies.

  6. Stroke in Trinidad and Tobago: burden of illness and risk factors

    Directory of Open Access Journals (Sweden)

    Deepak Mahabir

    1998-10-01

    Full Text Available This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1 105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9 478 bed days per annum. The hospital admission fatality rate was 29%. Among surviving patients, 437 (56% were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35_64 years were 114 (95%CI: 83 to 145 per 100 000 in Afro-Trinidadian men and 144 (109 to 179 in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146 and 152 (118 to 186. Among patients with first strokes, 348/531 (66% reported physician-diagnosed hypertension, but only 226 (65% of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies.

  7. Low hospital admission rates for respiratory diseases in children

    NARCIS (Netherlands)

    J.H.J.M. Uijen (Hans); F.G. Schellevis (François); P.J.E. Bindels (Patrick); S.P. Willemsen (Sten); J.C. van der Wouden (Hans)

    2010-01-01

    markdownabstractBACKGROUND: Population-based data on hospital admissions for children aged 0-17 years concerning all respiratory diseases are scarce. This study examined hospital admissions in relation to the preceding consultations in general practice in this age group. METHODS: Data on

  8. Utilisation of diagnostic computerised tomography imaging and immediate clinical outcomes in older people with stroke before and after introduction of the National Service Framework for older people. A comparative study of hospital-based stroke registry data (1997-2003): Norfolk experience.

    Science.gov (United States)

    Myint, Phyo K; Vowler, Sarah L; Redmayne, Oliver; Fulcher, Robert A

    2006-07-01

    how the National Service Framework (NSF) for older people in England might be associated with changes in clinically relevant stroke outcome has not been investigated. We looked for changes in computerised tomography (CT) scan rate, inpatient case-fatality rate (CFR), length of acute hospital stay and discharge destination for older people with stroke, compared with their younger counterparts, for a period before, and after, the introduction of the NSF. two periods, 4 years before and 2 years after the publication of the NSF, were selected to compare the above outcomes between three age categories: or = 85 years of age. Annual summary data for these periods were compared for the magnitude of changes in all age categories for all outcomes measured between pre- and post-NSF periods. n = 5,219. Utilisation of CT imaging had increased in all age groups post-NSF, with the most significant improvement in the oldest group. This change was associated with a greater proportion of people who had CT in this age group being discharged home in the post-NSF period. There was no change in the mortality from stroke in any age group during the study. Although the length of acute hospital stay increased, this was associated with a higher percentage of home discharges particularly in > 65-year olds, suggesting better clinical outcome in those who survived. in this single-centre analysis, the post-NSF period appeared to be associated with improvement in outcome in older people with stroke. Continual monitoring using stroke registry data may help to assess whether these effects are sustained in the longer term.

  9. Impact of proteinuria and glomerular filtration rate on risk of ischaemic and intracerebral hemorrhagic stroke: a result from the Kailuan study.

    Science.gov (United States)

    Li, Z; Wang, A; Cai, J; Gao, X; Zhou, Y; Luo, Y; Wu, S; Zhao, X

    2015-02-01

    Persons with chronic kidney disease, defined by a reduced estimated glomerular filtration rate and proteinuria, have an increased risk of cardiovascular disease including stroke. However, data from developing countries are limited. Our aim was to assess the relationship between chronic kidney disease and risk of stroke and its subtypes in a community-based population in China. The study was based on 92,013 participants (18-98 years old; 73,248 men and 18,765 women) of the Kailuan study who at baseline were free from stroke and myocardial infarction and had undergone tests for serum creatinine or proteinuria. Glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration formula and proteinuria by the urine dipstick result in laboratory databases. The primary outcome was the first occurrence of stroke. Data were analyzed using Cox proportional hazards models adjusted for relevant confounders and results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). During a follow-up of 4 years, 1575 stroke events (1128 ischaemic, 406 intracerebral hemorrhagic and 41 subarachnoid hemorrhagic strokes) occurred. After adjustment for variable confounders, patients with proteinuria were found to have increased HRs for the total and subtypes of stroke events (HR 1.61; 95% CI 1.35-1.92 for total stroke; HR 1.53; 95% CI 1.24-1.89 for ischaemic stroke; and HR 1.90; 95% CI 1.35-2.67 for hemorrhagic stroke). However, estimated glomerular filtration rate was not associated with incident stroke after adjustment for established cardiovascular risk factors. Proteinuria increased the risk of stroke in a general Chinese population. © 2014 EAN.

  10. Identification of stroke mimics among clinically diagnosed acute strokes.

    Science.gov (United States)

    Tuntiyatorn, Lojana; Saksornchai, Pichaya; Tunlayadechanont, Supoch

    2013-09-01

    Stroke is a clinically syndrome of a sudden onset of neurological deficit in a vascular cause. Stroke mimics is the non-vascular disorders with stroke-like clinical symptoms. It is important to distinguish true stroke from mimics since treatment plan may differ To determine the incidence of the stroke mimics and identify their etiologies. All non-contrast head CT of the patients with clinically diagnosed stroke who immediately received imaging upon arrival at the emergency department of the university hospital were retrospectively reviewed in 12-month period between January 1 and December 31, 2008. Medical records, laboratory results, MRI, and 6-month clinical follow-up records were reviewed for final diagnosis. Seven hundred four patients were included in this study, including 363 (51.5%) men and 341 (48.5%) women with range in age from 24 to 108 years. Amongst those, 417 (59.2%) were ischemic stroke, 80 (11.40%) were hemorrhagic stroke, 186 (26.4%) were stroke-mimics, and 21 (3%) were inconclusive. The etiologies among stroke-mimics were metabolic/intoxication (35, 18.8%), sepsis (28, 15.0%), seizure (21, 11.3%), syncope (20, 10.8%), subdural hemorrhage (14, 7.5%), vertigo (11, 6.0%), brain tumor (10, 5.30%), central nervous system infection (5, 2.7%), others (26, 14.0%), and unspecified (16, 8.6%). Incidence rates and etiologies of the stroke mimics were similar to the western reports. However the frequency of each mimic was not.

  11. Preliminary evaluations related to the ranges of hematological and biochemical variables in hospitalized patients with stroke

    Directory of Open Access Journals (Sweden)

    Ahmad Chitsaz

    2013-01-01

    Conclusions: Any considerable alter in patients′ biochemical and hematological figures (BS, Hgb, Plt and Lymph may necessitate further attention related to inter- and intra-individual variability in clinical supervision and drug′s assortment. Therefore, success in treatment could be achieved by the close management of clinical, biochemical, hematological, and pharmacological manifestation. To reduce disability, mortality, and morbidity in Iranian stroke population further clinical studies are needed to correlate drugs and laboratory markers to associated clinical events in order.

  12. Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital

    OpenAIRE

    Luvizutto, Gustavo José; Gameiro, Mônica de Oliveira Orsi; Schelp, Arthur Oscar; Braga, Gabriel Pereira; Ribeiro, Priscila Watson; Bazan, Rodrigo

    2015-01-01

    [Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, ...

  13. The association of admission heart rate and in-hospital cardiovascular events in patients with non-ST-segment elevation acute coronary syndromes: results from 135 164 patients in the CRUSADE quality improvement initiative.

    Science.gov (United States)

    Bangalore, Sripal; Messerli, Franz H; Ou, Fang-Shu; Tamis-Holland, Jacqueline; Palazzo, Angela; Roe, Matthew T; Hong, Mun K; Peterson, Eric D

    2010-03-01

    To evaluate the relationship between presenting heart rate (HR) and in-hospital events in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). We evaluated 139 194 patients with NSTE-ACS in the CRUSADE quality improvement initiative. The presenting HR was summarized as 10 beat increments. Patients with systolic BP HR of 60-69 b.p.m. after controlling for baseline variables. Primary outcome was a composite of in-hospital events all-cause mortality, non-fatal re-infarction, and stroke. Secondary outcomes were each of these considered separately. From the cohort of 135 164 patients, 8819 (6.52%) patients had a primary outcome (death/re-infarction or stroke) of which 5271 (3.90%) patients died, 3578 (2.65%) patients had re-infarction, and 1038 (0.77%) patients had a stroke during hospitalization. The relationship between presenting HR and primary outcome, all-cause mortality, and stroke followed a 'J-shaped' curve with an increased event rate at very low and high HR even after controlling for baseline variables. However, there was no relationship between presenting HR and risk of re-infarction. In contrast to patients with stable CAD, in the acute setting, the relationship between presenting HR and in-hospital cardiovascular outcomes has a 'J-shaped' curve (higher event rates at very low and high HRs). These associations should be considered in ACS prognostic models.

  14. Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals

    Directory of Open Access Journals (Sweden)

    Stephen Trzeciak MD, MPH

    2016-03-01

    Full Text Available Objective: In 2015, the Centers for Medicare and Medicaid Services (CMS released new summary star ratings for US hospitals based on patient experience. We aimed to test the association between CMS patient experience star ratings and clinical outcomes. Methods: We analyzed risk-adjusted data for more than 3000 US hospitals from CMS Hospital Compare using linear regression. Results: We found that better patient experience was associated with favorable clinical outcomes. Specifically, a higher number of stars for patient experience had a statistically significant association with lower rates of many in-hospital complications. A higher patient experience star rating also had a statistically significant association with lower rates of unplanned readmissions to the hospital within 30 days. Conclusion: Better patient experience according to the CMS star ratings is associated with favorable clinical outcomes. These results support the inclusion of patient experience data in the framework of how hospitals are paid for services.

  15. Declining stroke and vascular event recurrence rates in secondary prevention trials over the past 50 years and consequences for current trial design.

    Science.gov (United States)

    Hong, Keun-Sik; Yegiaian, Sharon; Lee, Meng; Lee, Juneyoung; Saver, Jeffrey L

    2011-05-17

    It is widely supposed, but not well-demonstrated, that cumulative advances in standard care have reduced recurrent stroke and cardiovascular events in secondary prevention trials. Systematic search identified all randomized, controlled trials of medical secondary stroke prevention therapies published from 1960 to 2009. Randomized, controlled trials narrowly focused on single stroke mechanisms, including atrial fibrillation, cervical carotid stenosis, and intracranial stenosis, were excluded. From control arms of individual trials, we extracted data for baseline characteristics and annual event rates for recurrent stroke, fatal stroke, and major vascular events and analyzed trends over time. Fifty-nine randomized controlled trials were identified, enrolling 66 157 patients in control arms. Over the 5 decade periods, annual event rates declined, per decade, for recurrent stroke by 0.996% (P=0.001), fatal stroke by 0.282% (P=0.003), and major vascular events by 1.331% (P=0.001). Multiple regression analyses identified increasing antithrombotic use and lower blood pressures as major contributors to the decline in recurrent stroke. For recurrent stroke, annual rates fell from 8.71% in trials launched in the 1960s to 6.10% in the 1970s, 5.41% in the 1980s, 4.04% in the 1990s, and 4.98% in the 2000s. The sample size required for a trial to have adequate power to detect a 20% reduction in recurrent stroke increased 2.2-fold during this period. Recurrent stroke and vascular event rates have declined substantially over the last 5 decades, with improved blood pressure control and more frequent use of antiplatelet therapy as the leading causes. Considerably larger sample sizes are now needed to demonstrate incremental improvements in medical secondary prevention.

  16. Reliability assessment of a hospital quality measure based on rates of adverse outcomes on nursing units.

    Science.gov (United States)

    Staggs, Vincent S

    2017-12-01

    The purpose of this study was to develop methods for assessing the reliability of scores on a widely disseminated hospital quality measure based on nursing unit fall rates. Poisson regression interactive multilevel modeling was adapted to account for clustering of units within hospitals. Three signal-noise reliability measures were computed. Squared correlations between the hospital score and true hospital fall rate averaged 0.52 ± 0.18 for total falls (0.68 ± 0.18 for injurious falls). Reliabilities on the other two measures averaged at least 0.70 but varied widely across hospitals. Parametric bootstrap data reflecting within-unit noise in falls were generated to evaluate percentile-ranked hospital scores as estimators of true hospital fall rate ranks. Spearman correlations between bootstrap hospital scores and true fall rates averaged 0.81 ± 0.01 (0.79 ± 0.01). Bias was negligible, but ranked hospital scores were imprecise, varying across bootstrap samples with average SD 11.8 (14.9) percentiles. Across bootstrap samples, hospital-measure scores fell in the same decile as the true fall rate in about 30% of cases. Findings underscore the importance of thoroughly assessing reliability of quality measurements before deciding how they will be used. Both the hospital measure and the reliability methods described can be adapted to other contexts involving clustered rates of adverse patient outcomes.

  17. Recreational marijuana use and acute ischemic stroke: A population-based analysis of hospitalized patients in the United States.

    Science.gov (United States)

    Rumalla, Kavelin; Reddy, Adithi Y; Mittal, Manoj K

    2016-05-15

    Recreational marijuana use is considered to have few adverse effects. However, recent evidence has suggested that it precipitates cardiovascular and cerebrovascular events. Here, we investigated the relationship between marijuana use and hospitalization for acute ischemic stroke (AIS) using data from the largest inpatient database in the United States. The Nationwide Inpatient Sample was queried from 2004 to 2011 for all patients (age 15-54) with a primary diagnosis of AIS. The incidence of AIS hospitalization in marijuana users and non-marijuana users was determined. We utilized multivariable logistic regression analyses to study the independent association between marijuana use and AIS. Overall, the incidence of AIS was significantly greater among marijuana users compared to non-users (Relative Risk [RR]: 1.13, 95% CI: 1.11-1.15, PMarijuana use was more prevalent among younger patients, males, African Americans, and Medicaid enrollees (PMarijuana users were more likely to use other illicit substances but had less overall medical comorbidity. In multivariable analysis, adjusted for potential confounders, marijuana (Odds Ratio [OR]: 1.17, 95% CI: 1.15-1.20), tobacco (OR: 1.76, 95% CI: 1.74-1.77), cocaine (OR: 1.32, 95% CI: 1.30-1.34), and amphetamine (OR: 2.21, 95% CI: 2.12-2.30) usage were found to increase the likelihood of AIS (all Precreational marijuana use is independently associated with 17% increased likelihood of AIS hospitalization. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics.

    Science.gov (United States)

    Everhart, Damian; Schumacher, Jessica R; Duncan, R Paul; Hall, Allyson G; Neff, Donna F; Shorr, Ronald I

    2014-01-01

    Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group. Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able

  19. Relevance of prehospital stroke code activation for acute treatment measures in stroke care: a review.

    Science.gov (United States)

    Baldereschi, Marzia; Piccardi, Benedetta; Di Carlo, Antonio; Lucente, Giuseppe; Guidetti, Donata; Consoli, Domenico; Provinciali, Leandro; Toni, Danilo; Sacchetti, Maria Luisa; Polizzi, Bianca Maria; Inzitari, Domenico

    2012-01-01

    The use of emergency services with prehospital stroke assessment and early notification to the treatment hospital (stroke code) is a crucial determinant of delay time for acute stroke treatment. We reviewed and summarized the literature on prehospital stroke code system implementation. Two databases were explored (last update June 20, 2011) with 3 key words (stroke code, stroke prehospital management and stroke prehospital services). Inclusion criteria were: randomized and quasirandomized controlled trials, cohort and case-control studies, and hospital- and emergency-based registers, with no year or language restrictions. We examined the reference lists of all included articles. All potentially relevant reports and abstracts were transcribed into a specifically designed data abstraction form. Only 19 of the 680 studies which were initially retrieved, published from 1999 to 2011, fulfilled our inclusion criteria. One clinical trial was identified. Large differences in stroke code procedures and study designs within and across countries prohibited the pooling of the data. Most studies were carried out in urban areas. Assuming the rate of tissue-plasminogen activator treatment as the performance measure, most studies report a significant increase in the rate of treatment (increase between 3.2 and 16%) with only 1 study not reporting any increase. Despite its limitations, this review suggests that the use of prehospital stroke code is an important intervention to improve the accessibility of the benefits of thrombolysis, especially when implemented together with educational campaigns to optimize the awareness and behavior of patients and bystanders. Copyright © 2012 S. Karger AG, Basel.

  20. Does a pre-hospital emergency pathway improve early diagnosis and referral in suspected stroke patients? – Study protocol of a cluster randomised trial [ISRCTN41456865

    Directory of Open Access Journals (Sweden)

    Lori Giuliano

    2005-10-01

    Full Text Available Abstract Background Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the organizational standards required to grant appropriate care. We performed a systematic search for studies evaluating the effect of pre-hospital and emergency interventions for suspected stroke patients and we found that there seems to be only a few studies on the emergency field and none about implementation of clinical pathways. We will test the hypothesis that the adoption of emergency clinical pathway improves early diagnosis and referral in suspected stroke patients. We designed a cluster randomised controlled trial (C-RCT, the most powerful study design to assess the impact of complex interventions. The study was registered in the Current Controlled Trials Register: ISRCTN41456865 – Implementation of pre-hospital emergency pathway for stroke – a cluster randomised trial. Methods/design Two-arm cluster-randomised trial (C-RCT. 16 emergency services and 14 emergency rooms were randomised either to arm 1 (comprising a training module and administration of the guideline, or to arm 2 (no intervention, current practice. Arm 1 participants (152 physicians, 280 nurses, 50 drivers attended an interactive two sessions course with continuous medical education CME credits on the contents of the clinical pathway. We estimated that around 750 patients will be met by the services in the 6 months of observation. This duration allows recruiting a sample of patients sufficient to observe a 30% improvement in the proportion of appropriate diagnoses. Data collection will be performed using current information systems. Process outcomes will be measured at the cluster level six months after the

  1. Factors Associated with In-Hospital Delay in Intravenous Thrombolysis for Acute Ischemic Stroke: Lessons from China.

    Directory of Open Access Journals (Sweden)

    Qiang Huang

    Full Text Available In-hospital delay reduces the benefit of intravenous thrombolysis (IVT in acute ischemic stroke (AIS, while factors affecting in-hospital delay are less well known in Chinese. We are aiming at determining the specific factors associated with in-hospital delay through a hospital based cohort. In-hospital delay was defined as door-to-needle time (DTN ≥60 min (standard delay criteria or ≥75% percentile of all DTNs (severe delay criteria. Demographic data, time intervals [onset-to-door time (OTD, DTN, door-to-examination time (DTE, door-to-imaging time (DTI, door-to-laboratory time (DTL and final-test-to-needle time (FTN, the time interval between the time obtaining the result of the last screening test and the needle time], medical history and additional variables were calculated using Mann-Whitney U or Pearson Chi-Square tests for group comparison, and multivariate linear regression analysis was performed to identify independent variables of in-hospital delay. A total of 202 IVT cases were enrolled. The median age was 61 years and 25.2% were female. The cutoff points for the upper quartile of DTN (severe delay criteria was 135 min.When compared with the reference group without in-hospital delay, older age, shorter OTD and less referral were found in the standard delay group and male sex, presence with transient ischemic attacks or rapidly improving symptom, and with multi-model CT imaging were more frequent in the severe delay group. In the multivariate linear regression analysis, FTN (P<0.001 and DTL (P = 0.002 were significantly associated with standard delay; while DTE (P = 0.005, DTI (P = 0.033, DTL (P<0.001, and FTN (P<0.001 were positively associated with severe delay. There was not a significant change in the trend of DTNs during the study period (P = 0.054. In-hospital delay was due to multifactors in China, in which time delays of decision-making process and laboratory tests contributed the most. Efforts aiming at reducing the delay

  2. Assessment of awareness of post-hospital rehabilitation need in patients after acute coronary syndrome and after stroke.

    Science.gov (United States)

    Szalewska, Dominika; Dudaniec-Tarkowska, Agnieszka; Zieliński, Piotr

    2017-09-21

    Acute coronary syndrome (ACS) and stroke are the leading causes of mortality and long-term morbidity across the world. Post-hospital rehabilitation (PHR) is strongly recommended in both groups. The purpose was assessment of awareness of the PHR need in patients after ACS and after ischaemic stroke (IS). The study included 60 patients (17 F, 43 M), 62 ± 13.6 years of age, admitted to hospital due to ACS (n=30 pts) or IS (n=30 pts). A cross-sectional survey was carried out in order to evaluate awareness of the PHR need through a questionnaire composed of 14 one-choice answer questions. There was no significant correlation between place of residence and willingness to participate in the PHR programme: 69.2% (n=9) of the pts living in rural areas and 80.9% (n=38) living in the city declared their willingness to partcipate. The majority of patients declared that PHR is needed (87.5% of pts with basic educational level, 63.2% with vocational education, 61.1% with technical education, 80% with university education level). 43.3% (n=13) of pts after ACS and 66.7% (n=20) pts after IS declared they had been informed about the possibility of PHR. Altogether, 46.7% (n=14) of pts after ACS and 33.3% (n=10) after stroke understood it to be a stay in a spa; only 10% (n=3) of pts after ACS and 33.3% (n=10) after IS understood it correctly. 30% (n=9) pts after ACS and 13.3% (n=4) after IS saw it as a change in lifestyle and 13.3% (n=4) pts after ACS and 20% (n=6) after IS declared they did not know what PHR was. Type of place of residence and educational level had no association with the PHR need. Patients after IS were more aware than those after ACS. Increased independence was the main expectation in both groups. The majority of patients perceived PHR to consist of treatment in a spa. Too few patients were informed about the possibility of PHR.

  3. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability.

    Science.gov (United States)

    Guan, Ling; Collet, Jean-Paul; Mazowita, Garey; Claydon, Victoria E

    2018-01-01

    Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye's fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or "stressors," respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke.

  4. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability

    Science.gov (United States)

    Guan, Ling; Collet, Jean-Paul; Mazowita, Garey; Claydon, Victoria E.

    2018-01-01

    Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye’s fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or “stressors,” respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke. PMID:29556209

  5. The impact of HMO penetration on the rate of hospital cost inflation, 1985-1993.

    Science.gov (United States)

    Gaskin, D J; Hadley, J

    1997-01-01

    This paper provides evidence that growth in health maintenance organization (HMO) enrollment slows hospital cost inflation. During the period 1985-1993, hospitals in areas with high rates of HMO penetration and growth had a slower rate of growth in expenses (8.3%) than hospitals in low penetration areas (11.2%). From 1992-1993, HMO growth lowered the rate of hospital cost inflation by .34 to 3.40 percentage points, depending on the base-year level and the annual change in HMO penetration. Declines in Medicare Prospective Payment System (PPS) margins also lowered hospital cost inflation; over the time period, annual hospital cost inflation was reduced by .38 percentage points. The estimates imply that the cumulative effect of HMO growth on hospital costs has been a $56.2 billion reduction (in 1993 dollars).

  6. [Stroke and transient ischemic attack-mimicking conditions: a prospective analysis of risk factors and clinical profiles at a general hospital].

    Science.gov (United States)

    García-Moncó, J C; Marrodán, A; Foncea Beti, N; Gómez Beldarrain, M

    2002-01-01

    Nonvascular structural entities can simulate stroke and transient ischemic attacks (TIA) in a variable percentage, but this issue has not been properly addressed in our environment. Their differentiation is important, since the management of patients with a true cerebrovascular accident differs considerably from that of mimicking conditions. To analyze prospectively those structural disorders that mimic stroke and TIA in the department of neurology of a general hospital and to determine if there are any distinctive risk factors and/or clinical presentations that would allow for their separation from true stroke and TIA. All patients admitted to our Department of Neurology with stroke or TIA were evaluated prospectively for a 4-year period. Those in whom a mimicking condition was disclosed were the subjects of this study. Their clinical features and vascular risk factors were compared with a sample of randomly selected patients with true stroke or TIA admitted during the same period. A total of 28 patients comprised the stroke-TIA mimicking group, 21 of them had a stroke-like syndrome and 7 a TIA-like syndrome. The mimicking group represented a 1.9% (2% of strokes and 1.6% of TIA) of all the patients with true cerebrovascular disorders admitted during the same period. Cancer, either primary or metastatic, was the single most frequent mimicking condition, accounting for two-thirds of the cases. Risk factors for stroke and TIA were significantly more frequent in the true stroke-TIA group without differences in age or sex, while the opposite is true in terms of prior or concurrent cancer. No single clinical profile allowed for a distinction between the two groups, although vertebrobasilar dysfunction suggested true ischemia, and vomiting, isolated dysarthria and dysarthria-clumsy hand occurred only in the true stroke-TIA group. Nonvascular conditions can cause signs and symptoms indistinguishable from true stroke and TIA, representing about 2% of the patients admitted

  7. The knowledge and attitudes of occupational therapy, physiotherapy and speech-language therapy students, regarding the speech-language therapist's role in the hospital stroke rehabilitation team.

    Science.gov (United States)

    Felsher, L; Ross, E

    1994-01-01

    The purpose of the present study was to survey and compare the knowledge and attitudes of final year occupational therapy, physiotherapy and speech-language therapy students, concerning the role of the speech-language therapist as a member of the stroke rehabilitation team in the hospital setting. In order to achieve this aim, a questionnaire was administered to final year students in these three disciplines, and included questions on most areas of stroke rehabilitation with which the speech-language therapist might be involved, as well as the concepts of rehabilitation and teamwork in relation to stroke rehabilitation. Results suggested a fairly good understanding of the concepts of rehabilitation and teamwork. Students appeared to have a greater understanding of those disorders following a stroke, with which the speech-language therapist is commonly involved, such as Aphasia, Dysarthria, Verbal Apraxia and Dysphagia. However, students appeared to show less understanding of those disorders post-stroke, for which the speech-language therapist's role is less well defined, such as Agraphia, Alexia and Amnesia. In addition, a high percentage of role duplication/overlapping in several aspects of stroke rehabilitation, such as family and social support, was found. Several implications for facilitating communication, collaboration and understanding between paramedical professions, as well as for further research are also provided.

  8. The Relationship between Place of Residence and Hospitalization Rate in the Biggest Referral Hospital of the Northwest according to Hospitalization Wards

    Directory of Open Access Journals (Sweden)

    Amin Talebpour

    2016-06-01

    Full Text Available ​ Background and objectives: In accordance with the global pattern, the urban population in Iran is higher than the rural population. But, are the statistics of using hospitalization services in public hospitals in these two categories similar to this pattern? This study seeks to determine the effect of place of residence on hospitalization rate by examining annual hospitalization statistics of the country’s biggest referral hospital in the northwest. Material and Methods: The method used in this study is cross-sectional and all cases of hospitalization in Imam Reza Hospital as the northwest’s biggest referral hospital were picked by available sampling method. The cases of 30260 hospitalized patients were examined through direct observation and items extracted from their files were recorded in the checklist. In order to determine the relations between the variables, K2 test was applied and the P-value was considered less than 0.05 The obtained data were analyzed by SPSS.16 software. Results: Results indicated that the frequency distribution of patients in terms of their urban or rural residence did not yield any significant difference (P>0/05. Results also showed that the highest hospitalization rate for urban patients was 16.1% (3305 individuals in surgery ward while it was 14.2% (1384 individuals for rural patients in orthopedic ward. The least significant statistical difference between urban and rural hospitalization rates was observed in renal ward with 72.9% (1162 individual urban patients and 27.1% (432 individuals rural patients of total patients hospitalized in this ward. The most significant statistical difference between urban and rural hospitalization rates was observed in ICU with 44.9% (297 individuals urban patients and 55.1% (365 individuals rural patients of the total patients hospitalized in this ward. Conclusion: A relative comparison among illnesses in urban and rural populations, aside from illnesses caused by trauma

  9. Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis.

    Science.gov (United States)

    Zhang, Dongfeng; Wang, Weijing; Li, Fang

    2016-10-18

    Resting heart rate is linked to risk of coronary artery disease, stroke, sudden death and noncardiovascular diseases. We conducted a meta-analysis to assess these associations in general populations and in populations of patients with hypertension or diabetes mellitus. We searched PubMed, Embase and MEDLINE from inception to Mar. 5, 2016. We used a random-effects model to combine study-specific relative risks (RRs). We used restricted cubic splines to assess the dose-response relation. We included 45 nonrandomized prospective cohort studies in the meta-analysis. The multivariable adjusted RR with an increment of 10 beats/min in resting heart rate was 1.12 (95% confidence interval [CI] 1.09-1.14) for coronary artery disease, 1.05 (95% CI 1.01-1.08) for stroke, 1.12 (95% CI 1.02-1.24) for sudden death, 1.16 (95% CI 1.12-1.21) for noncardiovascular diseases, 1.09 (95% CI 1.06-1.12) for all types of cancer and 1.25 (95% CI 1.17-1.34) for noncardiovascular diseases excluding cancer. All of these relations were linear. In an analysis by category of resting heart rate ( 80 beats/min), the RRs were 0.99 (95% CI 0.93-1.04), 1.08 (95% CI 1.01-1.16) and 1.30 (95% CI 1.19-1.43), respectively, for coronary artery disease; 1.08 (95% CI 0.98-1.19), 1.11 (95% CI 0.98-1.25) and 1.08 (95% CI 0.93-1.25), respectively, for stroke; and 1.17 (95% CI 0.94-1.46), 1.31 (95% CI 1.12-1.54) and 1.57 (95% CI 1.39-1.77), respectively, for noncardiovascular diseases. After excluding studies involving patients with hypertension or diabetes, we obtained similar results for coronary artery disease, stroke and noncardiovascular diseases, but found no association with sudden death. Resting heart rate was an independent predictor of coronary artery disease, stroke, sudden death and noncardiovascular diseases over all of the studies combined. When the analysis included only studies concerning general populations, resting heart rate was not associated with sudden death. © 2016 Canadian Medical

  10. Assessment of healthcare personnel knowledge of stroke care at a large referral hospital in sub-Saharan Africa - A survey based approach.

    Science.gov (United States)

    Lin, Chen; Vakani, Ravi; Kussin, Peter; Guhwe, Mary; Farjat, Alfredo E; Choudhury, Kingshuk; Renner, David; Oduor, Chrispine; Graffagnino, Carmelo

    2017-08-01

    There is no published literature regarding sub-Saharan health-care providers' understanding of stroke management patterns. Understanding current stroke management knowledge is important in formulating future education opportunities for providers to optimize patient outcomes. A cross-sectional survey of acute stroke diagnosis, hospital management, and secondary prevention questions was administered to health-care providers working in one large Kenyan acute referral hospital. Due to the prevalence of medical students (61.8%), an experienced-focused analysis contrasted students with more experienced providers. Providers (n=199) anonymously responded to the surveys. Among the acute diagnosis most respondents stated that stroke scales should always used (58.3% of respondents), 3h was the time period for alteplase (t-PA) (53.8% of respondents), and CT scan should be always be obtained prior to administration of anticoagulant therapy (61.3% of respondents). Neither VTE prophylaxis nor dysphagia/swallowing screening were considered to be done a majority of time. Secondary prevention results were variable. The respondent's level of clinical experience made the most difference in correctly answering the most appropriate IV Fluid to use in stroke patients (adjusted p=0.003) and the ideal initiation time for antithrombotic therapy (adjusted p=0.0017). Healthcare providers demonstrated a wide variability in their responses. Future efforts to improve stroke care in sub-Saharan Africa should include education and process improvement initiatives to focus on more specific aspects of stroke management based on the results from this survey. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. The analysis of hyper-homocysteine incidence rate and multi-risk factors in 200 patients with cerebral stroke

    International Nuclear Information System (INIS)

    Ding Xiudong; Yang Jianghui; Huo Aimei; Wang Yan; Chu Yanchuang; Dong Mei

    2009-01-01

    To investigate the hyperhomocysteine incidence rate and clinical significance in 200 patients with cerebral stroke, the serum homocysteine, fibrinogen, C-reaction protein, cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol levels in 200 patients with cerebral stroke and 100 normal healthy controls were detected. The results showed that both serum homocysteine and plasma FIB levels in patients with cerebral infarction and intracerebral hemorrhage were significantly higher than those in controls (P 0.05). The hyper-homocysteinemia is an independent risk factor for cerebral stoke, and hyperhomocysteine may lead to the increase of Fibrinogen level, which is one of the important reasons for the high blood viscosity in the cerebral infarction patients. (authors)

  12. Protein consumptions in stroke patients

    Directory of Open Access Journals (Sweden)

    Zahra Maghsoudi

    2013-01-01

    Full Text Available Background : Stroke is one of the most common causes of disabilities and death all over the world. The mortality rate of stroke is predicted to be doubled by 2030 in the Middle East countries. Nutrition is an effective strategy in prevention and management of stroke. This study assessed the relationship between various protein types and stroke risk. Materials and Methods: This hospital-based case-control study was performed in a University hospital. The data regarding consumption of usual food intake of 69 cases (46 men and 23 women and 60 controls (30 men and 30 women was collected with a food frequency questionnaire (FFQ. The mean consumption of red and white meat and vegetable and processed proteins consumption were compared between two groups. Results: The percent of total of daily protein intake were lower in patients with stroke in both sexes (25.92% vs 30.55% in men and 30.7% vs 31.14% in women. Conclusion: Lower protein consumption may be observed in patients with stroke patients in both sex.

  13. Hospital-Nursing Home Transfer Patterns and Influence on Nursing Home Clostridium difficile Infection Rates

    Science.gov (United States)

    Campbell, Lauren; Bush, Kristen; Dumyati, Ghinwa

    2017-01-01

    Abstract Background Little is known as to how hospital C. difficile infection (CDI) may impact nursing home (NH) CDI, or how patient transfers may modify this relationship. This study aims to examine a possible association between hospital and NH CDI rates, and whether NH CDI rates are influenced by patient transfers from hospital to NH. Methods Patient transfers among the 5 hospitals and 34 NHs in Monroe County, NY were identified from the Minimum Data Set (MDS) 3.0 and Medicare Provider Analysis and Review files for 2011–13, and aggregated to the NH level. NH and hospital CDI rates were obtained from Emerging Infections Program CDI population surveillance and National Healthcare Safety Network data, respectively. Multivariate negative binomial regression modeled the association between hospital CDI rate (weighted by hospital-to-NH transfers/overall transfers among hospitals and NHs) and NH CDI rate, controlling for NH covariates from NH Compare and the Online Survey, Certification, and Reporting files. Patient transfer networks between hospitals and NHs were constructed, and basic network analysis of transfer patterns was conducted to confirm contributing factors to NH CDI rates from the multivariate model. Results When weighted hospital CDI rate increased by 1%, NH CDI rate increased by 18% (P = 0.016). Antibiotic and feeding tube prevalence were associated with a 4% and 8% increase in NH CDI rate, respectively (P≤0.014). Network analysis confirmed multivariate results and detected hospital-NH pairs with high edge weights (number of transfers) where NHs receiving patients from hospitals with high CDI rates had higher CDI rates. Network clustering methods were used to identify 2 sub-networks within overall annual networks and clusters of hospital-NH pairs for targeted intervention. Conclusion Hospital CDI rate, adjusting for patient transfers, is associated with higher NH CDI rates in multivariate and network analyses, suggesting that NHs with a large inflow

  14. Similar Secondary Stroke Prevention and Medication Persistence Rates among Rural and Urban Patients

    Science.gov (United States)

    Rodriguez, Daniel; Cox, Margueritte; Zimmer, Louise O.; Olson, DaiWai M.; Goldstein, Larry B.; Drew, Laura; Peterson, Eric D.; Bushnell, Cheryl D.

    2011-01-01

    Purpose: Rural residents are less likely to obtain optimal care for many serious conditions and have poorer health outcomes than those residing in more urban areas. We determined whether rural vs urban residence affected postdischarge medication persistence and 1 year outcomes after stroke. Methods: The Adherence eValuation After Ischemic…

  15. Increasing rate of atrial fibrillation from 2003 to 2011 in patients with ischaemic stroke

    DEFF Research Database (Denmark)

    Jespersen, S F; Christensen, L. M.; Christensen, A

    2015-01-01

    identified. Frequency analysis and linear regression were used to assess trends in atrial fibrillation diagnosis and oral anticoagulation therapy prescription. RESULTS: A total of 17.1% (n = 9482) of ischaemic stroke patients had atrial fibrillation. The relative frequency of atrial fibrillation increased...

  16. CHARACTERISTICS AND OUTCOME OF STROKE PATIENTS WITH CEREBROVASCULAR ACCIDENT AT THE INTENSIVE CARE UNIT OF A TERTIARY HOSPITAL IN NIGERIA

    OpenAIRE

    Tobi, KU; Okojie, NQ

    2013-01-01

    Background: Patients with severe stroke defined as NIHSS score >17 constituting about 15-20% of cerebrovascular accident require admission into the Intensive Care Unit (ICU). However the benefit of ICU admission for stroke patients remains controversial.

  17. A review of post-stroke urinary incontinence.

    Science.gov (United States)

    Tuong, Nicole E; Klausner, Adam P; Hampton, Lance J

    2016-06-01

    Cerebrovascular accidents, or strokes, are a common cause of morbidity and mortality in the United States. Urinary incontinence is a prevalent morbidity experienced by post-stroke patients that is associated with long term disability and institutionalization effects on these patients. An extensive literature review was conducted using multiple academic search engines using the keywords: 'stroke,' 'CVA,' 'urinary incontinence,' 'urodynamics,' 'pharmacologic treatments,' and 'conservative treatments.' Articles were reviewed and summarized to explain incidence, assessment, and treatments of urinary incontinence in post-stroke individuals. Twenty-eight percent to seventy-nine percent of stroke survivors experience urinary incontinence with detrusor overactivity being the most common type of incontinence assessed by urodynamic studies. There continues to be insufficient data studying the effects and benefits of non-pharmacologic and pharmacologic treatments in post-stroke patients. Similarly, urinary incontinence remains an indicator of increased morbidity, disability, and institutionalization rates in the post-stroke patient. Stroke is a debilitating disease which causes urinary incontinence in many patients. As a result, patients have increased rates of hospitalization and disability compared to post-stroke patients without urinary incontinence. The history and physical exam are key in diagnosing the type of urinary incontinence with urodynamic studies being an adjunctive study. Non-pharmacologic treatment, such as behavioral therapy, and pharmacologic agents including antimuscarinics and beta adrenergic medications, are not well studied in the post-stroke patient. Urinary incontinence in stroke patients needs to be further studied to help decrease morbidity and mortality rates within this population.

  18. Unplanned 3-day re-attendance rate at Emergency Department (ED) and hospital's bed occupancy rate (BOR).

    Science.gov (United States)

    Sun, Yan; Heng, Bee Hoon; Tay, Seow Yian; Tan, Kelvin Brian

    2015-12-01

    Unplanned re-attendance at the Emergency Department (ED) is often monitored as a quality indicator of the care accorded to patients during their index ED visit. High bed occupancy rate (BOR) has been considered as a matter of reduced patient comfort and privacy. Most hospitals in Singapore operate under BORs above 85 %. This study aims to explore factors associated with the unplanned 3-day ED re-attendance rate and, in particular, if higher BOR is associated with higher 3-day unplanned ED re-attendance rate. This was a multicenter retrospective study using time series data. Three acute tertiary hospitals were selected from all six adult public hospitals in Singapore based on data availability. Daily data from year 2008 to 2013 were collected from the study hospitals' information systems. These included: ED visit date, day of week, month, year, public holiday, daily hospital BOR, daily bed waiting time (BWT) at ED (both median and 95th percentile), daily ED admission rate, and 3-day ED re-attendance rate. The primary outcome of the study was unplanned 3-day ED re-attendance rate from all reasons. Both univariate analysis and generalized linear regression were respectively applied to study the crude and adjusted association between the unplanned 3-day ED re-attendance rate and its potential associated factors. All analyses were conducted using SPSS 18 (PASW 18, IBM). The average age of patients who visited ED was 35 years old (SD = 2), 37 years old (SD = 2), and 40 years old (SD = 2) in hospitals A, B, and C respectively. The average 3-day unplanned ED re-attendance rate was 4.9 % (SE = 0.47 %) in hospital A, 3.9 % (SE = 0.35 %) in hospital B, and 4.4 % (SE = 0.30 %) in hospital C. After controlling for other covariates, the unplanned 3-day ED re-attendance rates were significantly associated with hospital, time trend, day of week, daily average BOR, and ED admission rate. Strong day-of-week effect on early ED re-attendance rate was

  19. National trends in heart failure hospitalization rates in Slovenia 2004-2012.

    Science.gov (United States)

    Omersa, Daniel; Farkas, Jerneja; Erzen, Ivan; Lainscak, Mitja

    2016-11-01

    Heart failure (HF) hospitalization rates are decreasing in western Europe, but little is known about trends in central and east European countries. We analysed the Slovenian national hospitalization database to determine the burden of HF hospitalization. The Slovenian National Hospital Discharge Registry was searched for HF hospitalizations between 2004 and 2012 in patients aged ≥20 years. A total of 55 531 main HF hospitalizations (43 636 first HF hospitalizations) in 34 406 patients (median age 78 years, 55% female) were recorded. The most common co-morbidities were arterial hypertension (54.3%), atrial fibrillation (40.6%), diabetes mellitus (24.5%), and ischaemic heart disease (21.9%). The number of age-standardized main and first HF hospitalizations per 100 000 population decreased from 249 to 232 (7.1%, P = 0.002) and from 467 to 435 (6.8%, P = 0.074), respectively. Crude main and first HF hospitalization rates increased from 249 to 298 (19.8%, P Slovenia, standardized HF hospitalization rates have decreased but the crude HF hospitalization burden has increased. Readmissions were associated with established cardiovascular risk factors. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  20. Risk of subsequent ischemic and hemorrhagic stroke in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden

    Directory of Open Access Journals (Sweden)

    Zöller Bengt

    2012-06-01

    Full Text Available Abstract Background Certain immune-mediated diseases (IMDs have been associated with increased risk for cardiovascular disorders. The aim of the present study was to examine whether there is an association between 32 different IMDs and first hospitalization for ischemic or hemorrhagic stroke. Methods All individuals in Sweden hospitalized with a main diagnosis of IMD (without previous or coexisting stroke, between January 1, 1987 and December 31, 2008 (n = 216,291, were followed for first hospitalization for ischemic or hemorrhagic stroke. The reference population was the total population of Sweden. Adjusted standardized incidence ratios (SIRs for ischemic and hemorrhagic stroke were calculated. Results Totally 20 and 15 of the 32 IMDs studied, respectively, were associated with an increased risk of ischemic and hemorrhagic stroke during the follow-up. The overall risks of ischemic and hemorrhagic stroke during the first year after hospitalization for IMD were 2.02 (95% CI 1.90–2.14 and 2.65 (95% CI 2.27–3.08, respectively. The overall risk of ischemic or hemorrhagic stroke decreased over time, to 1.50 (95% CI 1.46–1.55 and 1.83 (95% CI 1.69–1.98, respectively, after 1–5 years, and 1.29 (95% CI 1.23–1.35 and 1.47 (95% CI 1.31–1.65, respectively, after 10+ years. The risk of hemorrhagic stroke was ≥2 during the first year after hospitalization for seven IMDs: ankylosing spondylitis (SIR = 8.11, immune thrombocytopenic purpura (SIR = 8.60, polymyalgia rheumatica (SIR = 2.06, psoriasis (SIR = 2.88, rheumatoid arthritis (SIR = 3.27, systemic lupus erythematosus (SIR = 8.65, and Wegener´s granulomatosis (SIR = 5.83. The risk of ischemic stroke was ≥2 during the first year after hospitalization for twelve IMDs: Addison’s disease (SIR = 2.71, Crohn´s disease (SIR = 2.15, Grave´s disease (SIR = 2.15, Hashimoto´s thyroiditis (SIR = 2.99, immune thrombocytopenic purpura (SIR = 2

  1. Burden and outcome of prevalent ischemic brain disease in a national acute stroke registry.

    Science.gov (United States)

    Koton, Silvia; Tsabari, Rakefet; Molshazki, Noa; Kushnir, Moshe; Shaien, Radi; Eilam, Anda; Tanne, David

    2013-12-01

    Previous overt stroke and subclinical stroke are frequent in patients with stroke; yet, their clinical significance and effects on stroke outcome are not clear. We studied the burden and outcome after acute ischemic stroke by prevalent ischemic brain disease in a national registry of hospitalized patients with acute stroke. Patients with ischemic stroke in the National Acute Stroke Israeli prospective hospital-based registry (February to March 2004, March to April 2007, and April to May 2010) with information on previous overt stroke and subclinical stroke per computed tomography/MRI (n=3757) were included. Of them, a subsample (n=787) was followed up at 3 months. Logistic regression models were computed for outcomes in patients with prior overt stroke or subclinical stroke, compared with patients with first stroke, adjusting for age, sex, vascular risk factors, stroke severity, and clinical classification. Two-thirds of patients had a prior overt stroke or subclinical stroke. Death rates were similar for patients with and without prior stroke. Adjusted odds ratios (OR; 95% confidence interval [CI]) for disability were increased for patients with prior overt stroke (OR, 1.31; 95% CI, 1.03-1.66) and subclinical stroke (OR, 1.45; 95% CI, 1.16-1.82). Relative odds of Barthel Index≤60 for patients with prior overt stroke (OR, 2.04; 95% CI, 1.14-3.68) and with prior subclinical stroke (OR, 2.04; 95% CI, 1.15-3.64) were twice higher than for patients with a first stroke. ORs for dependency were significantly increased for patients with prior overt stroke (OR, 1.95; 95% CI, 1.19-3.20) but not for those with subclinical stroke (OR, 1.36; 95% CI, 0.84-2.19). In our national cohort of patients with acute ischemic stroke, nearly two thirds had a prior overt stroke or subclinical stroke. Risk of poor functional outcomes was increased for patients with prior stroke, both overt and subclinical.

  2. National data on stroke outcomes in Thailand.

    Science.gov (United States)

    Kongbunkiat, Kannikar; Kasemsap, Narongrit; Thepsuthammarat, Kaewjai; Tiamkao, Somsak; Sawanyawisuth, Kittisak

    2015-03-01

    Stroke is a major public health problem worldwide. There are limited data on national stroke prevalence and outcomes after the beginning of the thrombolytic therapy era in Thailand. This study aimed to investigate the prevalence and factors associated with mortality in stroke patients in Thailand using the national reimbursement databases. Clinical data retrieved included individuals under the universal coverage, social security, and civil servant benefit systems between 1 October 2009 and 30 September 2010. The stroke diagnosis code was based on the International Classification of Diseases 10th revision system including G45 (transient cerebral ischemic attacks and related syndromes), I61 (intracerebral hemorrhage), and I63 (cerebral infarction). The prevalence and stroke outcomes were calculated from these coded data. Factors associated with death were evaluated by multivariable logistic regression analysis. We found that the most frequent stroke subtype was cerebral infarction with a prevalence of 122 patients per 100,000 of population, an average length of hospital stay of 6.8 days, an average hospital charge of 20,740 baht (∼$USD 691), a mortality rate of 7%, and thrombolytic prescriptions of 1%. The significant factors associated with stroke mortality were septicemia, pulmonary embolism, pneumonia, myocardial infarction, status epilepticus, and heart failure. In conclusion, the prevalence and outcomes of stroke in Thailand were comparable with other countries. The era of thrombolytic therapy has just begun in Thailand. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Correlation between critical force and critical velocity and their respective stroke rates

    Directory of Open Access Journals (Sweden)

    Eduardo Kokubun

    2006-12-01

    Full Text Available The critical power model has been utilized to estimate the anaerobic and aerobic capacities in swimming. There are studies which evidence the applicability of swimming velocity, force during tethered swimming and stroke rate data to the critical power model. However, the relationship among these estimates derived from freestyle and tethered swimming needs to be established. Therefore, the aim of this study was to evaluate the relationship between critical force (FCRIT obtained from tethered swimming and critical velocity (VCRIT during freestyle swimming (VCRIT, and their respective critical stroke rates (FBrCRIT. Eleven swimmers of both sexes (16.6 ± 1.3 years, 60 ± 10 kg, 172 ± 8 cm underwent maximal tests to exhaustion in the tethered system and to as fast as possible trials during 200 and 400 m freestyle swimming. There were estimates of: 1 FCRIT and CIAnaer fi tting the three known equations derived from the critical power model (hyperbolic forcetime F-t, linear force-1/time F-1/t, linear impulse-time I-t; 2 VCRIT and CNAnaer during the freestyle tests using the linear distance-time relationship (d-t and; 3 FBrCRIT and CBrAnaer during both kinds of tests (tethered and freestyle. The tethered performance data presented a good fi tting to the critical power model: FCRIT (R2 of 0.98, 0.97 and 0.99 and FBrCRIT-TETHERED (R2 of 0.96, 0.90 and 0.99. There was a high correlation between VCRIT and FCRIT (r= 0.89-0.91. Nevertheless, there was no signifi cant correlation among the estimates of FBrCRIT-TETHERED and FBrCRIT-FREESTYLE, neither among the anaerobic variables. These results indicate that FCRIT can be considered a reliable aerobic capacity index. However, the FBrCRIT-TETHERED did not approach this capacity, despite the good fi tting to the critical power model. RESUMO O modelo da potência crítica tem sido utilizado para estimar a capacidade anaeróbia e aeróbia na natação. Há estudos demonstrando que a velocidade de nado livre, for

  4. Analysis of hospitalization rates by electoral ward: relationship to accessibility and deprivation data.

    Science.gov (United States)

    Slack, R; Ferguson, B; Ryder, S

    1997-02-01

    The objective of this paper is to investigate the relevance of access to hospital services in explaining utilization rates at a District Health Authority level in the UK. In order to test the hypothesis that access is important, it is necessary to develop a means of scoring access factors and then combining these scores with other more recognized influences on hospitalization rates e.g. deprivation measures. Acknowledging that hospitalization rates are not merely products of a population's socio-economic characteristics, the effect of accessibility to hospital services for the resident population is investigated through the derivation of an access score using both private and public transport from electoral ward of residence. Deprivation and accessibility to services were both found to be significant factors in determining hospitalization rates at electoral ward level. The chosen supply variable--number of GPs--was not found to be significant in any of the models developed using linear regression techniques. To conclude, it appears that access plays an important role in determining hospitalization rates within a given population. If high hospitalization rates are accepted as an indicator of effectively met demand then policy makers may have to consider increasing the accessibility of hospital services.

  5. Racial Differences by Ischemic Stroke Subtype: A Comprehensive Diagnostic Approach

    Directory of Open Access Journals (Sweden)

    Sarah Song

    2012-01-01

    Full Text Available Background. Previous studies have suggested that black populations have more small-vessel and fewer cardioembolic strokes. We sought to analyze racial differences in ischemic stroke subtype employing a comprehensive diagnostic workup with magnetic resonance-imaging-(MRI- based evaluation including diffusion-weighted imaging (DWI. Methods. 350 acute ischemic stroke patients admitted to an urban hospital with standardized comprehensive diagnostic evaluations were retrospectively analyzed. Ischemic stroke subtype was determined by three Trial of Org 10172 in Acute Stroke Treatment (TOAST classification systems. Results. We found similar proportions of cardioembolic and lacunar strokes in the black and white cohort. The only subtype category with a significant difference by race was “stroke of other etiology,” more common in whites. Black stroke patients were more likely to have an incomplete evaluation, but this did not reach significance. Conclusions. We found similar proportions by race of cardioembolic and lacunar strokes when employing a full diagnostic evaluation including DWI MRI. The relatively high rate of cardioembolism may have been underappreciated in black stroke patients when employing a CT approach to stroke subtype diagnosis. Further research is required to better understand the racial differences in frequency of “stroke of other etiology” and explore disparities in the extent of diagnostic evaluations.

  6. High Survival Rates and Associated Factors Among Ebola Virus Disease Patients Hospitalized at Donka National Hospital, Conakry, Guinea

    Science.gov (United States)

    Qureshi, Adnan I.; Chughtai, Morad; Bah, Elhadj Ibrahima; Barry, Moumié; Béavogui, Kézély; Loua, Tokpagnan Oscar; Malik, Ahmed A.

    2015-01-01

    Background Anecdotal reports suggesting that survival rates among hospitalized patients with Ebola virus disease in Guinea are higher than the 29.2% rate observed in the current epidemic in West Africa. Methods Survival after symptom onset was determined using Kaplan Meier survival methods among patients with confirmed Ebola virus disease treated in Conakry, Guinea from March 25, 2014, to August 5, 2014. We analyzed the relationship between survival and patient factors, including demographics and clinical features. Results Of the 70 patients analyzed [mean age ± standard deviation (SD), 34 ± 14.1; 44 were men], 42 were discharged alive with a survival rate among hospitalized patients of 60% (95% confidence interval, 41.5–78.5%). The survival rate was 28 (71.8%) among 39 patients under 34 years of age, and 14 (46.7%) among 30 patients aged 35 years or greater (p = 0.034). The rates of myalgia (3 of 42 versus 7 of 28, p = 0.036) and hiccups (1 of 42 versus 5 of 28, p = 0.023) were significantly lower among patients who survived. Conclusions Our results provide insights into a cohort of hospitalized patients with Ebola virus disease in whom survival is prominently higher than seen in other cohorts of hospitalized patients. PMID:25992182

  7. Reducing recurrent stroke: methodology of the motivational interviewing in stroke (MIST) randomized clinical trial.

    Science.gov (United States)

    Krishnamurthi, Rita; Witt, Emma; Barker-Collo, Suzanne; McPherson, Kathryn; Davis-Martin, Kelly; Bennett, Derrick; Rush, Elaine; Suh, Flora; Starkey, Nicola; Parag, Varsha; Rathnasabapathy, Yogini; Jones, Amy; Brown, Paul; Te Ao, Braden; Feigin, Valery L

    2014-01-01

    Recurrent stroke is prevalent in both developed and developing countries, contributing significantly to disability and death. Recurrent stroke rates can be reduced by adequate risk factor management. However, adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor, leading to a large number of preventable recurrent strokes. Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke. The overall aim of the study is to determine the effectiveness of motivational interviewing in improving adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months poststroke to reduce risk factors for recurrent stroke. Recruitment of 430 first-ever stroke participants will occur in the Auckland and Waikato regions. Randomization will be to intervention or usual care groups. Participants randomized to intervention will receive four motivational interviews and five follow-up assessments over 12 months. Nonintervention participants will be assessed at the same time points. Primary outcome measures are changes in systolic blood pressure and low-density lipoprotein levels 12 months poststroke. Secondary outcomes include self-reported adherence and barriers to prescribed medications, new cardiovascular events (including stroke), changes in quality of life, and mood. The results of the motivational interviewing in stroke trial will add to our understanding of whether motivational interviewing may be potentially beneficial in the management of stroke and other diseases where similar lifestyle factors or medication adherence are relevant. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  8. Spatial analysis of drug-related hospital admissions: an auto-Gaussian model to estimate the hospitalization rates in Italy

    Directory of Open Access Journals (Sweden)

    Emanuela Colasante

    2008-12-01

    Full Text Available

    Introduction: The aim of this study is to evaluate, even if partially, how much the drug use phenomenon impacts on the Italian National Heatlh System throughout the estimation at local level (Local Health Unit of the hospitalization rate caused by substance use and abuse such as opiates, barbiturates-sedativeshypnotics, cocaine and cannabis, and keeping in mind the phenomenon distribution in the space and so the fact that what happens in a specific area depends on what is happening in the neighbourhoods close to it (spatial autocorrelation.

    Methods: Data from hospital discharge database were provided by the Ministry of Health and an auto- Gaussian model was fitted. The spatial trend can be a function of other explanatory variables or can simply be modeled as a function of spatial location. Both models were fitted and compared using the number of subjects kept in charge by Drug Addiction Services and the number of beds held by hospitals as covariates.

    Results: Concerning opiates use related hospitalizations, results show areas where the phenomenon was less prominent in 2001 (Lombardy, part of Liguria, Umbria, part of Latium, Campania, Apulia and Sicily. In the following years, the hospitalization rates increased in some areas, such as the north of Apulia, part of Campania and Latium. A dependence of the opiates related hospitalization rates on the rate of subjects kept in charge by the Drug Addiction Services is highlighted. Concerning barbiturates-sedatives-hypnotics consumption, the best model is the one without covariates and estimated hospitalization rates are lower then 3 per thousand. The model with only the covariate “rate of subjects kept in charge by Drug Addiction Services” has been used both for cocaine and cannabis. In these two cases, more than a half of the Local Health Units report hospitalization rates lower than 0.5 per thousand

  9. Impact of Discharge Components on Readmission Rates for Children Hospitalized with Asthma.

    Science.gov (United States)

    Parikh, Kavita; Hall, Matt; Kenyon, Chén C; Teufel, Ronald J; Mussman, Grant M; Montalbano, Amanda; Gold, Jessica; Antoon, James W; Subramony, Anupama; Mittal, Vineeta; Morse, Rustin B; Wilson, Karen M; Shah, Samir S

    2018-01-29

    To describe hospital-based asthma-specific discharge components at children's hospitals and determine the association of these discharge components with pediatric asthma readmission rates. This is a multicenter retrospective cohort study of pediatric asthma hospitalizations in 2015 at children's hospitals participating in the Pediatric Health Information System. Children ages 5 to 17 years were included. An electronic survey assessing 13 asthma-specific discharge components was sent to quality leaders at all 49 hospitals. Correlations of combinations of asthma-specific discharge components and adjusted readmission rates were calculated. The survey response rate was 92% (45 of 49 hospitals). Thirty-day and 3-month adjusted readmission rates varied across hospitals, ranging from 1.9% to 3.9% for 30-day readmissions and 5.7% to 9.1% for 3-month readmissions. No individual or combination discharge components were associated with lower 30-day adjusted readmission rates. The only single-component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education (P components in bundles was associated with reduced adjusted 3-month readmission rates, but this did not reach statistical significance. This was seen in a 2-discharge component bundle including content of education and communication with the primary medical doctor, as well as a 3-discharge component bundle, which included content of education, medications in-hand, and home-based environmental mitigation. Children's hospitals demonstrate a range of asthma-specific discharge components. Although we found no significant associations for specific hospital-level discharge components and asthma readmission rates at 30 days, certain combinations of discharge components may support hospitals to reduce healthcare utilization at 3 months. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Variations in hospitalization rates among nursing home residents: the role of facility and market attributes.

    Science.gov (United States)

    Carter, Mary W; Porell, Frank W

    2003-04-01

    This study examined the contribution of facility-level and area market-level attributes to variations in hospitalization rates among nursing home residents. Three years (1991-1994) of state quarterly Medicaid case-mix reimbursement data from 527 nursing homes (NH) in Massachusetts were linked with Medicare Provider Analysis and Review hospital claims and nursing facility attribute data to produce a longitudinal, analytical file containing 72,319 person-quarter observations. Logistic regression models were used to estimate the influence of facility-level and market-level factors on hospital use, after controlling for individual-level resident attributes, including: NH diagnoses, resident-level quality of care indicators, and diagnostic cost grouping classification from previous hospital stays. Multivariate findings suggest that resident heterogeneity alone does not account for the wide variations in hospitalization rates across nursing homes. Instead, facility characteristics such as profit status, nurse staffing patterns, NH size, chain affiliation, and percentage of Medicaid and Medicare reimbursed days significantly influence NH residents' risk of hospitalization. Broader area market factors also appear to contribute to variations in hospitalization rates. Variations in hospitalization rates may reflect underutilization, as well as overutilization. Continued efforts toward identifying medically necessary hospitalizations are needed.

  11. Changing trends in hospitalization rates associated with psychosis: Spain, 1980-2009.

    Science.gov (United States)

    Medel-Herrero, Alvaro; Amate, J M; Saz-Parkinson, Z; Gómez-Beneyto, M

    2015-12-01

    To analyze the prevalence of hospitalization attributable to psychosis in Spain over the last three decades. Longitudinal analysis (1980-2009) of age-adjusted hospital discharges rates associated with psychosis (ICD9 290-8) in all Spanish hospitals. Spanish Hospital Morbidity Survey. The hospitalization rate associated with psychotic episodes had been gradually increasing since 1980 until 2004; an abrupt turnaround observed in 2004 marks the beginning of a steady decline in the rate. The turning point described is not observed for each of the psychotic diagnoses separately analyzed. However, it is clearly seen when data are grouped in diagnosis-related groups (organic-psychosis, functional psychosis and substance-induced psychosis) since the time course of the diseases within the major diagnostic groups are interrelated as evidenced by shared turning points which collectively display a common time course pattern. Main hospital indicators and antipsychotic drug prescriptions were analyzed for any possible turning point in mid-2000s. Psychiatric hospital beds and length of stays remained stable by 2004; the hospitalizations associated with non-psychotic psychiatric pathologies show no turning point in 2004. However, an abrupt change on antipsychotic drug prescriptions is precisely observed in 2004. After decades of linear growth, hospitalizations for psychotic patients begin to decline in 2004, coinciding with the start of last generation atypical antipsychotic drug consumption in Spain. Some of the psychotic diagnostic rates evolve in an interrelated manner which calls into question the diagnosis and nosological boundaries between some of these pathologies.

  12. Endoscopic Perforation Rates at a Canadian University Teaching Hospital

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    Tarun Misra

    2004-01-01

    Full Text Available BACKGROUND: Despite advances in training, operative techniques and endoscopic technology, upper and lower endoscopic procedures continue to have potential for intestinal perforation. Perforation rates provided to patients at the time of consent have frequently been derived from historical cohorts and survey datasets.

  13. The influence of teamwork culture on physician and nurse resignation rates in hospitals.

    Science.gov (United States)

    Mohr, David C; Burgess, James F; Young, Gary J

    2008-02-01

    Employee turnover is a critical concern, particularly for hospitals, because they face a very tight labour market for hiring replacements, and high turnover itself may have substantial negative effects on the continuity and quality of patient care. Hospitals with a stronger teamwork culture may experience lower turnover but this has not been formally studied. Research on determinants of employee turnover has not separated out resignations from the larger, more inclusive definition of turnover that includes retirement. This study investigated the relationship between the teamwork culture of hospitals and physician and nurse resignation rates. The study setting was the Veterans Health Administration (VHA). Each hospital was assessed on teamwork culture based on a survey of current employees. Hospital-level resignation rates were obtained for physicians and nurses. Separate multivariate regression models on physicians and nurses were employed. The models included hospital-level characteristics and labour market variables. Analysis of covariance was also performed to attempt to further reveal effects in high versus low teamwork culture hospitals. Teamwork culture was negatively associated with nurse and physician resignation rates, but was statistically significant in the nurse resignation model only. Additional analyses indicated a 0.47 standard deviation (SD) difference in nurse resignation rates and a 0.40 SD difference in physician resignation rates between hospitals in the top and bottom quartiles of the distribution for teamwork culture. In conclusion, these results suggest that developing and emphasizing a teamwork culture may facilitate greater retention of health-care employees, especially nurses.

  14. [Characterization of stroke patients attended at IMSS hospitals in Mexico City].

    Science.gov (United States)

    Torres-Arreola, Laura Del Pilar; Valenzuela-Flores, Adriana Abigail; Villa-Barragán, Juan Pablo

    2018-01-01

    Cerebrovascular disease (CD) is considered a problem of huge social, economic and public health implications worldwide in adults and elderly. In Mexico, the information concerning the provision of services to people and their characteristics is limited. The objective is to describe the characteristics of patients with CV who attended the hospitals of the Instituto Mexicano del Seguro Social (IMSS) in Mexico City. It was carried out a cohort study of patients with ischemic or hemorrhagic CD who arrived to IMSS. Patients were recruited from seven IMSS general hospitals in Mexico City from June, 2013, to October, 2014. We assigned 430 subjects with CD (78.14% had ischemic CD). There were no statistical differences regarding gender. The median age of patients was 74 years. During their first 72 hours of hospital stay, it was assessed language proficiency in 90%, the ability to walk in 16.3% and the ability to move extremities in 94%. The main risk factors were hypertension, 84%; diabetes mellitus, 46.3%; history of CD, 25.1%; smoking history, 13.7%. 80% of patients reported that their health was regular or poor. General characteristics of patients and vascular risk factors are similar to those reported by other studies. Secondary prevention strategies are performed in less time than that recommended by international standards. It is urgent to design strategies to build better ways of care during the acute phase of patients with CD.

  15. Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes in a U.S. Nationwide Analysis of 3,998,667 Hospitalizations.

    Science.gov (United States)

    Rumalla, Kavelin; Kumar, Ashwath S; Mittal, Manoj K

    2017-10-01

    The prognosis from acute ischemic stroke (AIS) is worsened by poststroke medical complications. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS are not known. We queried the Nationwide Inpatient Sample (2002-2011) to identify all patients with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariable analysis was utilized to identify risk factors for GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes. We identified 16,987 patients with GIBO (.43%) among 3,988,667 AIS hospitalizations and 4.2% of these patients underwent surgery. In multivariable analysis, patients with 75+ years of age were two times as likely to suffer GIBO compared to younger patients (P Stroke patients with pre-existing comorbidities (coagulopathy, cancer, blood loss anemia, and fluid/electrolyte disorder) were more likely to experience GIBO (all P risk factors identified in this study aim to encourage the monitoring of patients at highest risk for GIBO. The predominant form of stroke-related GIBO is nonmechanical obstruction, although the causative relationship remains unknown. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  16. Demographic Characteristics of Strokes Types in Sanliurfa

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    Yusuf Ižnanc

    2016-01-01

    Full Text Available Aim: Sanliurfa training and research hospital for diagnosis and treatment of patients with stroke admitted demographic features planned. We aimed to study demographic feature of stroke patient who admitted to Sanliurfa training and research hospital for diagnosis and treatment. Material and Method: 01/10/2011 and 01/9/2012, ischemic and hemorrhagic brain training and research hospital in Sanliurfa vascular disease diagnosis and treatment without any exclusion criteria, patient sequential 454 retrospectively.Results: 366%u2019si 88 were ischemic, hemorrhagic stroke. 54.6% by sex male,% 45.4 were women. Average age: 67.86 di.56.3% radiologically roaming the front circulation infarct brain infarct% found the rear 23.2. Hospital stay duration: 9.27 day.. Hemorrhagic stroke was longer this Sura in the group. Mortality rate 4.6% in all in packaging (21 patients, ischemic in boots in 1.9% (7 patients, hemorrhagic of boots were found at 15.9% (14 patients.Discussion: our study of Sanliurfa province stroke data in terms of the region together, although a portion of their valuable results. In the summer, the ischemic stroke incidence is higher.

  17. Hospitalization Rate and Population-Based Incidence of Hospitalization for Community-Acquired Pneumonia Among Children in Suzhou, China.

    Science.gov (United States)

    Shan, Wei; Shi, Ting; Zhang, Xiyan; Xue, Jian; Wang, Yin; Yu, Jia; Huang, Yukai; Lin, Sheng; Zhao, Genming; Tian, Jianmei; Zhang, Tao

    2018-03-22

    Data on hospitalization burden of CAP in children is very limited in China. This study aimed to estimate the hospitalization rate and population-based incidence of hospitalization of CAP for children <15 years of age in Suzhou, China. This was a retrospective study of children hospitalized in Soochow University Affiliated Children's Hospital (SCH) from January 2010 to December 2014. Children who were residents of downtown Suzhou, 29 days to <15 years of age, with discharge diagnosis codes (ICD-10) including J09 to J18 and J20 to J22 were included. All-cause clinical community-acquired pneumonia (CCAP) and radiographically confirmed pneumonia (RCAP) were identified based on individual medical chart review. The hospitalization rate (HR) and population-based cumulative incidence of hospitalization (HI) were calculated. Among 184,734 children <15 years old admitted to SCH during the study period, 31,302 children were identified as having CCAP, and 24,218 (77.4%) children confirmed as having RCAP. CCAP hospitalization occurred year round and peaked during winter and early spring. The overall HRs for CCAP and RCAP were 189.0 (95%CI, 187.1-190.9) and 146.2 (95%CI, 144-148) per 1,000 hospitalizations respectively, and the HIs per 100,000 children annually were CCAP, 3,235.8 (95%CI, 3207.3-3264.2) and RCAP, 2,503.5 (95%CI, 2,478.3-2,528.6). For children <5 years old, the HR for CCAP was 248.4 (95%CI, 245.9-250.9) and RCAP 194.0 (95%CI, 191.4-196.3) per 1,000 hospitalizations; the HI for CCAP was 6,956.2 (95%CI: 6,892.8-7,019.6) and 5,431.9 (95%CI: 5,375.4-5,488.4) per 100,000 children for RCAP. The highest HR and HI were observed in children 29 days to <6 months old: HR for CCAP was 407.4 (95%CI: 400.9-413.9) per 1,000 hospitalizations and HI for CCAP was 11,203.7 (95%CI: 11,026.8-11,380.6) per 100,000 children annually. There is a considerable burden of CAP among children <15 years of age in Suzhou, particularly among children 29 days to <6 months of age and during winter

  18. Estimation of Sparkover Rate of Medium-Voltage Line due to Direct Lightning Hit Taking Account of Statistics on Observed Return-Stroke Current

    Science.gov (United States)

    Hongo, Yasuji; Michishita, Koji

    The overvoltage associated with direct lightning hits has been the important factor for the insulation design of a distribution line. In this paper, the sparkover rate of a medium-voltage line associated with direct lightning hits is investigated based on numerical calculations obtained by using EMTP and statistical analysis by taking account of the correlation between the peak value and the front duration of return-stroke current waveform. When the line is equipped with surge arresters at the interval of 100m in addition to the overhead ground wire, the sparkover rate associated with subsequent strokes is higher than that associated with first strokes. This demonstrates the importance of the study of current parameters for subsequent strokes.

  19. Ventilatory Threshold may be a More Specific Measure of Aerobic Capacity than Peak Oxygen Consumption Rate in Persons with Stroke

    Science.gov (United States)

    Boyne, Pierce; Reisman, Darcy; Brian, Michael; Barney, Brian; Franke, Ava; Carl, Daniel; Khoury, Jane; Dunning, Kari

    2017-01-01

    Background After stroke, aerobic deconditioning can have a profound impact on daily activities. This is usually measured by the peak oxygen consumption rate achieved during exercise testing (VO2-peak). However, VO2-peak may be distorted by motor function. The oxygen uptake efficiency slope (OUES) and VO2 at the ventilatory threshold (VO2-VT) could more specifically assess aerobic capacity after stroke, but this has not been tested. Objectives To assess the differential influence of motor function on three measures of aerobic capacity (VO2-peak, OUES and VO2-VT) and to evaluate the inter-rater reliability of VO2-VT determination post-stroke. Methods Among 59 persons with chronic stroke, cross-sectional correlations with motor function (comfortable gait speed [CGS] and lower extremity Fugl-Meyer [LEFM]) were compared between the different aerobic capacity measures, after adjustment for covariates, in order to isolate any distorting effect of motor function. Reliability of VO2-VT determination between 3 raters was assessed with intra-class correlation (ICC). Results CGS was moderately correlated with VO2-peak (r=0.52, p<0.0001) and weakly correlated with OUES (r=0.41, p=0.002) and VO2-VT (r=0.37, p=0.01). LEFM was weakly correlated with VO2-peak (r=0.26, p=0.055) and very weakly correlated with OUES (r=0.19, p=0.17) and VO2-VT (r=0.14, p=0.31). Compared to VO2-peak, VO2-VT was significantly less correlated with CGS (r difference = -0.16, p=0.02). Inter-rater reliability of VO2-VT determination was high (ICC: 0.93, 95%CI: 0.89 to 0.96). Conclusions Motor dysfunction appears to artificially lower measured aerobic capacity. VO2-VT seemed to be less distorted than VO2-peak and had good inter-rater reliability, so it may provide more specific assessment of aerobic capacity post-stroke. PMID:27454553

  20. Wide variation in hospital and physician payment rates evidence of provider market power.

    Science.gov (United States)

    Ginsburg, Paul B

    2010-11-01

    Wide variation in private insurer payment rates to hospitals and physicians across and within local markets suggests that some providers, particularly hospitals, have significant market power to negotiate higher-than-competitive prices, according to a new study by the Center for Studying Health System Change (HSC). Looking across eight health care markets--Cleveland; Indianapolis; Los Angeles; Miami; Milwaukee; Richmond, Va.; San Francisco; and rural Wisconsin--average inpatient hospital payment rates of four large national insurers ranged from 147 percent of Medicare in Miami to 210 percent in San Francisco. In extreme cases, some hospitals command almost five times what Medicare pays for inpatient services and more than seven times what Medicare pays for outpatient care. Variation within markets was just as dramatic. For example, the hospital with prices at the 25th percentile of Los Angeles hospitals received 84 percent of Medicare rates for inpatient care, while the hospital with prices at the 75th percentile received 184 percent of Medicare rates. The highest-priced Los Angeles hospital with substantial inpatient claims volume received 418 percent of Medicare. While not as pronounced, significant variation in physician payment rates also exists across and within markets and by specialty. Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market. Purchasers and public policy makers can address provider market power, or the ability to negotiate higher-than-competitive prices, through two distinct approaches. One is to pursue market approaches to strengthen competitive forces, while the other is to constrain payment rates through regulation.

  1. Accounting For Patients' Socioeconomic Status Does Not Change Hospital Readmission Rates.

    Science.gov (United States)

    Bernheim, Susannah M; Parzynski, Craig S; Horwitz, Leora; Lin, Zhenqiu; Araas, Michael J; Ross, Joseph S; Drye, Elizabeth E; Suter, Lisa G; Normand, Sharon-Lise T; Krumholz, Harlan M

    2016-08-01

    There is an active public debate about whether patients' socioeconomic status should be included in the readmission measures used to determine penalties in Medicare's Hospital Readmissions Reduction Program (HRRP). Using the current Centers for Medicare and Medicaid Services methodology, we compared risk-standardized readmission rates for hospitals caring for high and low proportions of patients of low socioeconomic status (as defined by their Medicaid status or neighborhood income). We then calculated risk-standardized readmission rates after additionally adjusting for patients' socioeconomic status. Our results demonstrate that hospitals caring for large proportions of patients of low socioeconomic status have readmission rates similar to those of other hospitals. Moreover, readmission rates calculated with and without adjustment for patients' socioeconomic status are highly correlated. Readmission rates of hospitals caring for patients of low socioeconomic status changed by approximately 0.1 percent with adjustment for patients' socioeconomic status, and only 3-4 percent fewer such hospitals reached the threshold for payment penalty in Medicare's HRRP. Overall, adjustment for socioeconomic status does not change hospital results in meaningful ways. Project HOPE—The People-to-People Health Foundation, Inc.

  2. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths - United States, 2001 – 2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — In general, total combined rates for traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations and deaths have increased over the past...

  3. Adult stroke registry in West Africa: Profile of 334 in-patients in the University of Benin Teaching Hospital, Benin City, Nigeria

    Directory of Open Access Journals (Sweden)

    Frank Aiwansoba Imarhiagbe

    2016-01-01

    Full Text Available Background: Profiling of stroke types in sub-Saharan Africa until recently has been done in part with the clinical diagnosis, where neuroimaging is not affordable or accessible. Objective: To profile all first-ever stroke using cranial computed tomography (CT scan. Methods: Three hundred and thirty-four first-ever stroke had demographic data as well as the duration of admission or time to event (outcome, stroke type and severity, volume of hemorrhage in cases of parenchymal hemorrhage captured from the stroke unit register. Operationally outcome was defined as discharge to follow-up or discharge against medical advice (DAMA or all-cause in-hospital mortality, stroke type was defined by cranial CT as cerebral infarct or intracerebral hemorrhage (ICH or subarachnoid hemorrhage. Stroke severity was defined by the Canadian Neurological Scale (CNS and the National Institutes of Health Stroke Score (NIHSS. Data were analyzed as appropriate. Results: Mean age was 62.63 ± 14.90 years, comprising 190 (56.9% males and 144 (43.1% females. Mean duration of admission was 12.91 ± 11.38 days. Totally, 251 had cerebral infarct (75.15%, 81 (24.25% had ICH, 2 (0.60% had subarachnoid hemorrhage. A total of 177 (51.19% were discharged to follow-up, 15 (4.50% were DAMA with acute case fatality of 148 (44.31%. Mean CNS score was 2.85 ± 2.57 and mean NIHSS was 17.29 ± 5.15. Age, time to outcome and NIHSS were the predictors of outcome (survival or discharged to follow-up and all-cause mortality (odds ratio [OR] =1.043, P = 0.016, OR = 0.923, P = 0.001, OR = 2.467, P < 0.001 respectively and NIHSS was the only predictor of survival (hazard ratio = 0.872, P < 0.001. Conclusion: This neuroimaging profiling of acute stroke type and outcome is expected to be an improvement over reviews based largely on the presumptive diagnosis.

  4. Ideal timing to transfer from an acute care hospital to an interdisciplinary inpatient rehabilitation program following a stroke: an exploratory study

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    Nadeau Sylvie

    2006-11-01

    Full Text Available Abstract Background Timely accessibility to organized inpatient stroke rehabilitation services may become compromised since the demand for rehabilitation services following stroke is rapidly growing with no promise of additional resources. This often leads to prolonged lengths of stays in acute care facilities for individuals surviving a stroke. It is believed that this delay spent in acute care facilities may inhibit the crucial motor recovery process taking place shortly after a stroke. It is important to document the ideal timing to initiate intensive inpatient stroke rehabilitation after the neurological event. Therefore, the objective of this study was to examine the specific influence of short, moderate and long onset-admission intervals (OAI on rehabilitation outcomes across homogeneous subgroups of patients who were admitted to a standardized interdisciplinary inpatient stroke rehabilitation program. Methods A total of 418 patients discharged from the inpatient neurological rehabilitation program at the Montreal Rehabilitation Hospital Network after a first stroke (79% of all cases reviewed were included in this retrospective study. After conducting a matching procedure across these patients based on the degree of disability, gender, and age, a total of 40 homogeneous triads (n = 120 were formed according to the three OAI subgroups: short (less than 20 days, moderate (between 20 and 40 days or long (over 40 days; maximum of 70 days OAI subgroups. The rehabilitation outcomes (admission and discharge Functional Independence Measure scores (FIM, absolute and relative FIM gain scores, rehabilitation length of stay, efficiency scores were evaluated to test for differences between the three OAI subgroups. Results Analysis revealed that the three OAI subgroups were comparable for all rehabilitation outcomes studied. No statistical difference was found for admission (P = 0.305–0.972 and discharge (P = 0.083–0.367 FIM scores, absolute (P = 0

  5. 30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012: A Multi-Ethnic Population-Based Series of Studies.

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    Valery L Feigin

    Full Text Available Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ over 30-years.Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard annual incidence and mortality with corresponding 95% confidence intervals (CI were calculated per 100,000 people, assuming a Poisson distribution.5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31% and 62% (95% CI 36%-86%, respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively compared with NZ/Europeans (mean age 75 years. There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17% across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in

  6. 30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies.

    Science.gov (United States)

    Feigin, Valery L; Krishnamurthi, Rita V; Barker-Collo, Suzanne; McPherson, Kathryn M; Barber, P Alan; Parag, Varsha; Arroll, Bruce; Bennett, Derrick A; Tobias, Martin; Jones, Amy; Witt, Emma; Brown, Paul; Abbott, Max; Bhattacharjee, Rohit; Rush, Elaine; Suh, Flora Minsun; Theadom, Alice; Rathnasabapathy, Yogini; Te Ao, Braden; Parmar, Priya G; Anderson, Craig; Bonita, Ruth

    2015-01-01

    Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years. Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years) of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution. 5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency

  7. Airplane stroke syndrome.

    Science.gov (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

    2016-07-01

    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic

    Directory of Open Access Journals (Sweden)

    Aznida Firzah Abdul Aziz

    2013-01-01

    Full Text Available Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s control, depression according to Patient Health Questionnaire (PHQ9, and level of independence using Barthel Index (BI. Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05. Results: Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD 10.9] years, mean stroke episodes were 1.30 (SD 0.5. The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0 months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007, while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06. Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2−100 to 90.5 (range: 27−100 (Z = 2.34, P = 0.01. Median PHQ9 scores decreased from 4.0 (range: 0−22 to 3.0 (range: 0−19 though the change was not significant (Z= −0.744, P = 0.457. Conclusions: Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level.

  9. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2014-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  10. Hospital waste: Generation rates in Bogotá, 2012-2015

    Directory of Open Access Journals (Sweden)

    Juan Pablo Rodríguez-Miranda

    2016-10-01

    Full Text Available Introduction: The generation of waste by hospital activities in large urban areas requires comprehensive management, which involves knowing its production characteristics. Objective: To establish performance indicators for the management of hospital waste based on generation rates and hospital waste classification in Bogotá D.C. in the period 2012 - 2015. Materials and methods: Qualitative descriptive-prospective study, with cross-sectional design performed based on secondary information obtained from hospitals in Colombia. Results: According to the information analyzed, between 2012 and 2015 2 727 947 tons of hospital waste were generated in Bogotá D.C; 45% of waste corresponded to non-hazardous waste (recyclable and ordinary and 55% to hazardous waste (infectious, chemical and dangerous administrative waste. Conclusions: The waste generation rates observed exceed by 40% the calculation presented by the Ministry of Environment and other sources reporting a percentage of 10-15% for hazardous waste.

  11. Can use of an administrative database improve accuracy of hospital-reported readmission rates?

    Science.gov (United States)

    Edgerton, James R; Herbert, Morley A; Hamman, Baron L; Ring, W Steves

    2017-12-05

    Readmission rates after cardiac surgery are being used as a quality indicator; they are also being collected by Medicare and are tied to reimbursement. Accurate knowledge of readmission rates may be difficult to achieve because patients may be readmitted to different hospitals. In our area, 81 hospitals share administrative claims data; 28 of these hospitals (from 5 different hospital systems) do cardiac surgery and share Society of Thoracic Surgeons (STS) clinical data. We used these 2 sources to compare the readmissions data for accuracy. A total of 45,539 STS records from January 2008 to December 2016 were matched with the hospital billing data records. Using the index visit as the start date, the billing records were queried for any subsequent in-patient visits for that patient. The billing records included date of readmission and hospital of readmission data and were compared with the data captured in the STS record. We found 1153 (2.5%) patients who had STS records that were marked "No" or "missing," but there were billing records that showed a readmission. The reported STS readmission rate of 4796 (10.5%) underreported the readmission rate by 2.5 actual percentage points. The true rate should have been 13.0%. Actual readmission rate was 23.8% higher than reported by the clinical database. Approximately 36% of readmissions were to a hospital that was a part of a different hospital system. It is important to know accurate readmission rates for quality improvement processes and institutional financial planning. Matching patient records to an administrative database showed that the clinical database may fail to capture many readmissions. Combining data with an administrative database can enhance accuracy of reporting. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  12. Right ventricular stroke work index as a negative predictor of mortality and initial hospital stay after lung transplantation.

    Science.gov (United States)

    Armstrong, Hilary F; Schulze, P Christian; Kato, Tomoko S; Bacchetta, Matthew; Thirapatarapong, Wilawan; Bartels, Matthew N

    2013-06-01

    Studies have shown that patients with poor pre-lung transplant (LTx) right ventricular (RV) function have prolonged post-operative ventilation time and intensive care stay as well as a higher risk of in-hospital death. RV stroke work index (RVSWI) calculates RV workload and contractility. We hypothesized that patients with higher RV workload capacity, indicated by higher RVSWI, would have better outcomes after LTx. A retrospective record review was performed on all LTx patients between 2005 and 2011 who had right heart catheterizations (RHC) 1-year before LTx. In addition, results for echocardiograms and cardiopulmonary exercise testing within 1-year of RHCs were gathered. Mean RVSWI was 9.36 ± 3.59 for 115 patients. There was a significant relation between mean pulmonary artery pressure (mPAP), RVSWI, RV end-diastolic diameter (RVEDd), left atrial dimension (LAD), peak and resting pressure of end-tidal carbon dioxide, minute ventilation /volume of carbon dioxide production, and 1-year mortality after LTx. Contrary to our hypothesis, those who survived had lower RVSWI than those who died within 1 year (8.99 ± 3.38 vs 11.6 ± 4.1, p = 0.026). Hospital length of stay significantly correlated with mPAP, RVSWI, left ventricular ejection fraction, percentage of fractional shortening, RVEDd, RV fractional area change, LAD, and RV wall thickness in diastole. Intensive care length of stay also significantly correlated with these variables and with body mass index. RVSWI was significantly different between groups of different RV function, indicating that increased RVSWI is associated with impairment of RV structure and function in patients undergoing LTx evaluation. This study demonstrates an association between 1-year mortality, initial hospital and intensive care length of stay, and pre-LTx RVSWI. Increased mPAP is a known risk for outcomes in LTx patients. Our findings support this fact and also show increased mortality with elevation of RVSWI, demonstrating the value

  13. Poor Self-Rated Health Influences Hospital Service Use in Hospitalized Inpatients With Chronic Conditions in Taiwan.

    Science.gov (United States)

    Isaac, Vivian; McLachlan, Craig S; Baune, Bernhard T; Huang, Chun-Ta; Wu, Chia-Yi

    2015-09-01

    Our aim was to investigate the association between self-rated health (SRH) and use of hospital services (ie, medical outpatient department, emergency department, and general ward. admissions). Cross-sectional study data were collected from 230 consecutive patients admitted to medical departments of a 2000-bed academic medical center in Taiwan using standardized operating procedures for data collection of SRH (ie, a single-item question inquiring overall perceived health status), medical disorders, depressive symptoms, and combined service utilization over a 1-year period (ie, number of visits to outpatient department, number of visits to emergency department, and number of hospitalizations). Electronic medical records were retrieved, with self-reported external medical visits added to in-hospital frequencies of service use to provide better estimation of health service utilization. Fifty-two percent of study patients rated their health as poor or very poor. Poor SRH was associated with more visits to medical outpatient department, emergency department, and hospital admission. Multivariate logistic regression demonstrated an independent association between poor SRH and services utilization after adjustment for age, gender, hypertension, diabetes, metastatic cancer, number of chronic illness, life-threatening event, life-time suicidal ideation, and depression. SRH may be a useful research tool to model medical service use for inpatients with chronic conditions.

  14. Ischemic Stroke in Young Adults: Profile of SARAH Hospital Brasília From 2008 to 2012.

    Science.gov (United States)

    Montanaro, Vinícius V A; Freitas, Denise D S; Ruiz, Miguel C M; Cavalcanti, Eduardo B U; Marinho, Patricia B C; Freitas, Maria C D N B; Oliveira, Eleonora M J D

    2017-03-01

    The societal and economic impact of ischemic stroke in young adults is considerable. The etiological investigation of ischemic stroke in this population is also challenging. To describe the characteristics of young patients with ischemic stroke admitted to a neurological rehabilitation program in Brazil. This transversal retrospective study analyzed data from the electronic health records of 134 patients aged 18 to 45 years with ischemic stroke admitted from 2008 to 2012. The average patient age at the time of ictus was 33 years; 56% of the subjects were female, and 29.3% had undetermined etiologies of stroke, on the basis of both TOAST and SSS TOAST criteria. Further, 48.7% of the subjects had a known vascular risk factor, which was arterial hypertension in most cases. The results of thrombophilia testing were positive in 13.7% of patients, but in only 3.7% of patients, thrombophilia was determined to be the causal mechanism of the stroke. There was a significant association between thrombophilia and patent foramen ovale, but no significant association was found between thrombophilia and arterial dissection. Among the patients with artery dissections, 46% had a history of trauma, which was statistically significant. Etiological diagnosis of stroke in the young is challenging for clinicians. Hence, a more effective classification scheme, better investigative mechanisms, and correct determination of causal associations in ischemic stroke are needed. Thrombophilia screening should be performed in the presence of relevant clinical signs and/or family history.

  15. Cigarette smoking is an independent risk factor for post-stroke delirium.

    Science.gov (United States)

    Lim, Tae Sung; Lee, Jin Soo; Yoon, Jung Han; Moon, So Young; Joo, In Soo; Huh, Kyoon; Hong, Ji Man

    2017-03-23

    Post-stroke delirium is a common problem in the care of stroke patients, and is associated with longer hospitalization, high short-term mortality, and an increased need for long-term care. Although post-stroke delirium occurs in approximately 10 ~ 30% of patients, little is known about the risk factors for post-stroke delirium in patients who experience acute stroke. A total of 576 consecutive patients who experienced ischemic stroke (mean age, 65.2 years; range, 23-93 years) were screened for delirium over a 2-year period in an acute stroke care unit of a tertiary referral hospital. We screened for delirium using the Confusion Assessment Method. Once delirium was suspected, we evaluated the symptoms using the Korean Version of the Delirium Rating Scale-Revised-98. Neurological deficits were assessed using the National Institutes of Health Stroke Scale at admission and discharge, and functional ability was assessed using the Barthel Index and modified Rankin Scale at discharge and 3 months after discharge. Thirty-eight (6.7%) patients with stroke developed delirium during admission to the acute stroke care unit. Patients with delirium were significantly older (70.6 vs. 64.9 years of age, P = .001) and smoked cigarettes more frequently (40% vs. 24%, P = .033) than patients without delirium. In terms of clinical features, the delirium group experienced a significantly higher rate of major hemispheric stroke (55% vs. 26%, P delirium were older age, history of cigarette smoking, and major hemispheric stroke. Abrupt cessation of cigarette smoking may be a risk factor for post-stroke delirium in ischemic stroke patients. The development of delirium after stroke is associated with worse outcome and longer hospitalization.

  16. Complications and 30-day hospital readmission rates of patients undergoing tracheostomy: A prospective analysis.

    Science.gov (United States)

    Spataro, Emily; Durakovic, Nedim; Kallogjeri, Dorina; Nussenbaum, Brian

    2017-12-01

    To determine inpatient and outpatient tracheostomy complication rates and 30-day hospital readmission rates, and to assess patient and procedural risk factors associated with complications and readmissions. Prospective cohort study. Adult patients undergoing tracheostomy at a single academic hospital performed by any service, for any indication, were enrolled in this study over the course of 1 year. All patients had complete 30-day follow-up after discharge to determine complication and hospital readmission rates. Logistic regression was used to assess patient and procedural risk factors associated with these events. One hundred patients were enrolled in this study from June 1, 2015, to June 1, 2016. The overall inpatient tracheostomy complication rate was 47% (95% confidence interval [CI], 37%-57%). Inpatient complications were associated with location in the medical intensive care unit and increased length of hospitalization. The outpatient tracheostomy complication rate was 15% (95% CI, 8%-22%). Outpatient complications were associated with having a previous tracheostomy or an awake tracheostomy under local anesthesia. The all-cause 30-day hospital readmission rate was 33% (95% CI, 24%-42%), and the tracheostomy-specific readmission rate was 13% (95% CI, 6%-20%). All-cause readmissions were associated with diabetes, length of hospitalization after tracheostomy, and outpatient complications. The overall mortality rate during the study period was 11% (95% CI, 5%-17%), with one tracheostomy-related death. Patients undergoing tracheostomies are at high risk for both inpatient and outpatient complications, as well for 30-day hospital readmission. Understanding patient and procedural risk factors associated with these events will help guide interventions for quality improvement. 2b. Laryngoscope, 127:2746-2753, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Stroke care: Experiences and clinical research in stroke units in Chennai

    Directory of Open Access Journals (Sweden)

    Gobindram Arjundas

    2006-01-01

    Full Text Available Background: S troke is the second commonest cause of death in India with crude overall prevalence rate of 220 per 100,000. With an increasing aging population at risk, the stroke burden in India can be expected to reach epidemic proportions. Materials and Methods: The first protocol-based prospective studies, funded by private agencies was conducted in Madras Institute of Neurology in 1984-86. The results led to establishment of the first stroke unit in Tamil Nadu state, in the institute. The first all-India hospital-based studies in acute stroke was completed as INDIAN COOPERATIVE ACUTE STROKE STUDIES (ICASS I and ICASS II with WHO STEP ONE by members of the Indian Stroke Association between 2000-2005. This has generated very useful data for our country. Results: Mortality in 1984-86 was 40%. Stroke unit in the institute dropped it to 12%. About 10 years later, ICASS studies showed a further fall of mortality to 8%, which is the current international figure in the west. Morbidity pattern showed about half return to their original activities. But about one third are left totally disabled needing prolonged care, for which fiscal, social and rehab provisions have to be done on a national basis. Conclusions: The progress and success of care of Stroke in the last three decades, from treatment in medical and neurology wards to specialized stroke units is presented. The main risk factors are hypertension, diabetes and ischemic heart disease across the country. Hypertension alone or with the other two diseases was present in 72% of cases. Prevention and treatment of these factors will reduce the stroke burden, mortality and morbidity of strokes. The Stroke-team concept can be extended to the smallest hospitals in our country.

  18. Proteinuria and clinical outcomes after ischemic stroke.

    Science.gov (United States)

    Kumai, Y; Kamouchi, M; Hata, J; Ago, T; Kitayama, J; Nakane, H; Sugimori, H; Kitazono, T

    2012-06-12

    The impact of chronic kidney disease (CKD) on clinical outcomes after acute ischemic stroke is still not fully understood. The aim of the present study was to elucidate how CKD and its components, proteinuria and low estimated glomerular filtration rate (eGFR), affect the clinical outcomes after ischemic stroke. The study subjects consisted of 3,778 patients with first-ever ischemic stroke within 24 hours of onset from the Fukuoka Stroke Registry. CKD was defined as proteinuria or low eGFR (Stroke Scale during hospitalization), in-hospital mortality, and poor functional outcome (modified Rankin Scale score at discharge of 2 to 6). The effects of CKD, proteinuria, and eGFR on these outcomes were evaluated using a multiple logistic regression analysis. CKD was diagnosed in 1,320 patients (34.9%). In the multivariate analyses after adjusting for confounding factors, patients with CKD had significantly higher risks of neurologic deterioration, in-hospital mortality, and poor functional outcome (p relationship between the eGFR level and each outcome was found. CKD is an important predictor of poor clinical outcomes after acute ischemic stroke. Proteinuria independently contributes to the increased risks of neurologic deterioration, mortality, and poor functional outcome, but the eGFR may not be relevant to these outcomes.

  19. Impact of Discharge Timings of Healthy Newborns on the Rates and Etiology of Neonatal Hospital Readmissions

    International Nuclear Information System (INIS)

    Habib, H.S.

    2013-01-01

    Objective: To evaluate the effect of early hospital discharge after initial birth hospitalization on the rate and etiology of hospital readmissions during the neonatal period. Study Design: Cross-sectional analytical study. Place and Duration of Study: King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from October 2008 to September 2011. Methodology: Full-term normal newborns were included in this study, and all infants showing any features that would increase the chances of readmission were excluded. Initial birth hospitalization and readmission in the neonatal period were analyzed. Data was collected from the Discharge Abstract Database. Results: Overall, 12,728 normal newborns were delivered during the study period. Vaginally delivered infants were discharged early (within 48 hours), while those delivered via caesarean section had longer hospital stays (mean length of stay: 1.1 and 2.8 days, respectively). There were 166 readmissions, wherein the leading cause was neonatal sepsis (37.3%) followed by neonatal jaundice (26.5%). The readmission rate in early discharged (142 out of 9927) was significantly higher (p = 0.017) as compared to newborns who were discharged late after birth (24 out of 2801). Etiology of readmissions was not affected by discharge timings. Conclusion: Hospital discharge of neonates within 48 hours after delivery is counterproductive and significantly increases the risk for hospital readmission during the neonatal period. The pre-dominance of sepsis-related cases observed here indicates the need to explore its causes and determine an optimal prevention and management strategy. (author)

  20. The association between patient-reported incidents in hospitals and estimated rates of patient harm.

    Science.gov (United States)

    Bjertnaes, Oyvind; Deilkås, Ellen Tveter; Skudal, Kjersti Eeg; Iversen, Hilde Hestad; Bjerkan, Anne Mette

    2015-02-01

    The aim of this study was to test the association between the rates of patient-reported incidents and patient harm documented in the patient record. The study was a secondary analysis of two national hospital assessments conducted in 2011. Hospital services in Norway. The patient survey was a standard national patient-experience survey conducted at the hospital level for all 63 hospitals in Norway. The medical record review was performed by 47 Global Trigger Tools (GTTs) in all 19 hospital trusts and 4 private hospitals. The two data sets were matched at the unit level, yielding comparable patient experiences and GTT data for 7 departments, 16 hospitals and 11 hospital trusts. No intervention. The correlation at the unit level between the patient-reported incident in hospital instrument (PRIH-I) and estimated rates of patient harm from the GTT. The PRIH-I index was significantly correlated with all patient-reported experience indicators at the individual level, with estimates for all patient harm events (Categories E-I) at the unit level (r = 0.62, P < 0.01), and with estimates of more serious harm events in Categories F-I (r = 0.42, P < 0.05). Patient-reported incidents in hospitals, as measured by the PRIH-I, are strongly correlated with patient harm rates based on the GTT. This indicates that patient-reported incidents are related to patient safety, but more research is needed to confirm the usefulness of patient reporting in the evaluation of patient safety. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  1. Plastic surgeons' self-reported operative infection rates at a Canadian academic hospital.

    Science.gov (United States)

    Ng, Wendy Ky; Kaur, Manraj Nirmal; Thoma, Achilleas

    2014-01-01

    Surgical site infection rates are of great interest to patients, surgeons, hospitals and third-party payers. While previous studies have reported hospital-acquired infection rates that are nonspecific to all surgical services, there remain no overall reported infection rates focusing specifically on plastic surgery in the literature. To estimate the reported surgical site infection rate in plastic surgery procedures over a 10-year period at an academic hospital in Canada. A review was conducted on reported plastic surgery surgical site infection rates from 2003 to 2013, based on procedures performed in the main operating room. For comparison, prospective infection surveillance data over an eight-year period (2005 to 2013) for nonplastic surgery procedures were reviewed to estimate the overall operative surgical site infection rates. A total of 12,183 plastic surgery operations were performed from 2003 to 2013, with 96 surgical site infections reported, corresponding to a net operative infection rate of 0.79%. There was a 0.49% surgeon-reported infection rate for implant-based procedures. For non-plastic surgery procedures, surgical site infection rates ranged from 0.04% for cataract surgery to 13.36% for high-risk abdominal hysterectomies. The plastic surgery infection rate at the study institution was found to be site infection rates. However, these results do not report patterns of infection rates germane to procedures, season, age groups or sex. To provide more in-depth knowledge of this topic, multicentre studies should be conducted.

  2. Stroke mimic diagnoses presenting to a hyperacute stroke unit.

    Science.gov (United States)

    Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J

    2016-10-01

    Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.

  3. Stroke awareness decreases prehospital delay after acute ischemic stroke in korea

    Directory of Open Access Journals (Sweden)

    Lee Su-Ho

    2011-01-01

    Full Text Available Abstract Background Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea. Methods A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay. Results Among the 500 patients (median 67 years, 62% men, the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313. Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381, knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633 and use of ambulance (OR 1.961, 95% CI 1.176-3.270 were significantly associated with early arrival. Conclusions In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.

  4. The bacterial contamination rate of glucose meter test strips in the hospital setting

    Science.gov (United States)

    Al-Rubeaan, Khalid A.; Saeb, Amr T. M.; AlNaqeb, Dhekra M.; AlQumaidi, Hamed M.; AlMogbel, Turki A.

    2016-01-01

    Objectives: To assess the rate of bacterial contamination of the multi-use vial and single-use packed glucose meter strips, and to identify the type and frequency of various bacterial contamination in different hospital wards. Methods: This prospective observational study was conducted by a team from the Strategic Center for Diabetes Research in 7 general hospitals in the Central region of Saudi Arabia during the period from August to September 2014 to assess the bacterial contamination rate of the unused strips. A total of 10,447 strips were cultured using proper agar media and incubated both aerobically and anaerobically. Results: The total bacterial contamination rate for the multi-use vials glucose strips was 31.7%, while single-use packed strips were not contaminated at all. Ministry of Health hospitals had the highest contamination rates compared with other hospitals. Critical, obstetric, and surgical wards had the highest bacterial isolates number, where most were in the risk group 3 according to the National Institute of Health guidelines. Staphylococcus species were the most common bacteria found. Conclusion: Glucose meter strips should be recognized as a source of bacterial contamination that could be behind serious hospital acquired infections. The hospital infection control team should adopt proper measures to implement protocols for glucose meter cleaning and glucose strips handling. PMID:27570855

  5. Determination of Rate and Causes of Wastage of Blood and Blood Products in Iranian Hospitals

    Directory of Open Access Journals (Sweden)

    Rafat Mohebbi Far

    2014-06-01

    Full Text Available OBJECTIVE: The purpose of this study was to determine the rate and causes of wastage of blood and blood products (packed red cells, plasma, platelets, and cryoprecipitate in Qazvin hospitals. METHODS: The study was conducted in all hospitals in Qazvin, including 5 teaching hospitals, 2 social welfare hospitals, 3 private hospitals, 1 charity hospital, and 1 military hospital. This descriptive study was based on available data from hospital blood banks in the province of Qazvin. The research instrument was a 2-part questionnaire. The first part was related to demographic characteristics of hospitals and the second part elicited information about blood and blood component wastage. The collected data were then analyzed using descriptive statistic methods and SPSS 11.5. RESULTS: Blood wastage may occur for a number of reasons, including time expiry, wasted imports, blood medically or surgically ordered but not used, stock time expired, hemolysis, or miscellaneous reasons. Data indicated that approximately 77.9% of wasted pack cell units were wasted for the reason of time expiry. Pack cell wastage in hospitals is reported to range from 1.93% to 30.7%. Wastage at all hospitals averaged 9.8% among 30.913 issued blood products. Overall blood and blood product (packed red cells, plasma, platelets, and cryoprecipitate wastage was 3048 units and average total wastage per participant hospital for all blood groups was 254 units per year. CONCLUSION: Blood transfusion is an essential part of patient care. The blood transfusion system has made significant advancements in areas such as donor management, storage of blood, cross-matching, rational use of blood, and distribution. In order to improve the standards of blood banks and the blood transfusion services in Iran, comprehensive standards have been formulated to ensure better quality control in collection, storage, testing, and distribution of blood and its components for the identified major factors

  6. Stroke Treatments

    Science.gov (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...

  7. Anemia Rate Assessment in Hospitalized Patients with Acute Bacterial Infection in Qom Hospitals, Qom, Iran, 2007-2008

    Directory of Open Access Journals (Sweden)

    A.H. Ghanuni

    2009-06-01

    Full Text Available Background and ObjectivesImmunosuppression is regarded among the risk factors for bacterial infection. But in recent studies, anemia was considered a predisposing factor for bacterial infections. The main goals of this study was to assess the rate of anemia in hospitalized patients with acute bacterial infection and to determine the relationship between anemia and bacterial infection as a predisposing factor.Methods 311 hospitalized patients whose bacterial infection was well documented based on the files present in Kamkar, Arabnia, Fatemi, and Sahamieh hospitals in Qom, Iran, were selected for the present study. They were categorized into various age groups from newborns to the elderly. The data included, age, sex, Hb of the patients the first, third and discharge day, HCT in the first, third and discharge day, MCV, MCH, MCHC, WBC in the first, third, fourth day, Diff in the first and fourth days, ESR, CRP, maximum of fever and disease, chronic disease, smoking. A P<0.05 was considered as being significant.Results On the basis of hemoglobin rate, 43.9 % of patients had anemia as a co-disease. There was no anemia among newborns, but 57% of infants had it. Patients who had pyorrheal lymphadenitis had maximum rate of anemia among other patients. ConclusionOn the average, the rate of anemia in this study was 2.1 times more than that of general population in Qom, as well as in any of the age groups. This difference indicates that anemia rate in patients with acute bacterial infections is more common than general population. However, more studies are needed for the assessment of the relationship between anemia and bacterial infection as a predisposing factor. But it seems that the hemoglobin level and severity of disease have direct effects on each other. Keywords: Anemia; Bacterial Infections; Patients; Qom, Iran.

  8. Variations in 30-day hospital readmission rates across primary care clinics within a tertiary referral center.

    Science.gov (United States)

    Tang, Ning; Maselli, Judith H; Gonzales, Ralph

    2014-11-01

    Reducing hospital readmissions is a national healthcare priority. Little is known about how readmission rates vary across unique primary care practices. To calculate all-cause 30-day hospital readmission rates at the level of individual primary care practices and identify factors associated with variations in these rates. Retrospective analysis Seven primary care clinics affiliated with the University of California, San Francisco (UCSF). Adults ≥18 years old with a primary care provider (PCP) at UCSF MEASUREMENTS: All-cause 30-day readmission rates were calculated for primary care clinics for discharges between July 1, 2009 and June 30, 2012. We built a model to identify demographic, clinical, and hospital factors associated with variation in rates. There were 12,564 discharges for patients belonging to the 7 clinics, with 8685 index discharges and 1032 readmissions. Readmission rates varied across practices, from 14.9% in Human Immunodeficiency Virus primary care and 7.7% in women's health. In multivariable analyses, factors associated with variation in readmission rates included: male gender (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.05-1.40), Medicare insurance (OR: 1.31, 95% CI: 1.05, 1.64; Ref = private), Medicare-Medicaid dual eligible (OR: 1.26, 95% CI: 1.01-1.56), multiple comorbidities, and admitting services. Patients with a departed PCP awaiting transfer assignment to a new PCP had an OR of 1.59 (95% CI: 1.16-2.17) compared with having a current faculty PCP. Primary care practices are important partners in improving care transitions and reducing hospital readmissions, and this study introduces a new way to view readmission rates. PCP turnover may be an important risk factor for hospital readmissions. © 2014 Society of Hospital Medicine.

  9. Stroke rehabilitation: assistive technology devices and environmental modifications following primary rehabilitation in hospital--a therapeutic perspective

    DEFF Research Database (Denmark)

    Sørensen, Hanne Vinkel; Lendal, Susie; Schultz-Larsen, Kirsten

    2003-01-01

    The aim of this article is to describe the need for assistive devices and environmental modifications among long-living stroke survivors and to investigate if the need is continued and growing over time. The study sample of 155 consecutive stroke patients with stroke-related impairment, discharged...... the proportion was 81%. The aids most frequently prescribed were bath seats, aids for mobility, grab bars, and removal of door thresholds. At follow-up 3-5 years later, 74% of the survivors were seen (76 patients). Almost all of the survivors were dependent on assistive devices and/or environmental modifications...

  10. New onset of insomnia in hospitalized patients in general medical wards: incidence, causes, and resolution rate

    OpenAIRE

    Ho, An; Raja, Bronson; Waldhorn, Richard; Baez, Valentina; Mohammed, Idiris

    2017-01-01

    ABSTRACT Background: Insomnia is common in hospitalized patients. However, no study has examined new onset of insomnia in patients without a prior history of insomnia. Objectives: Incidence of new onset of insomnia in inpatients, associated factors and resolution rate after 2 weeks. Method: This is a prospective observational study conducted at a community hospital. We used the Insomnia Severity Index questionnaire to screen for insomnia in all patients located in the general medical floors f...

  11. Development of a behaviour rating system for rural/remote pre-hospital settings.

    Science.gov (United States)

    Holly, Deirdre; Swanson, Vivien; Cachia, Philip; Beasant, Beverley; Laird, Colville

    2017-01-01

    Remote and Rural pre-hospital care practitioners manage serious illness and injury on an unplanned basis, necessitating technical and non-technical skills (NTS). However, no behaviour rating systems currently address NTS within these settings. Informed by health psychology theory, a NTS-specific behaviour rating system was developed for use within pre-hospital care training for remote and rural practitioners. The Immediate Medical Care Behaviour Rating System (IMCBRS), was informed by literature, expert advice and review and observation of an Immediate Medical Care (IMC) course. Once developed, the usability and appropriateness of the rating system was tested through observation of candidates' behaviour at IMC courses during simulated scenarios and rating their use of NTS using the IMCBRS. Observation of training confirmed rating system items were demonstrated in 28-62% of scenarios, depending on context. The IMCBRS may thus be a useful addition to training for rural and practitioners. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Recanalization and Mortality Rates of Thrombectomy With Stent-Retrievers in Octogenarian Patients with Acute Ischemic Stroke

    International Nuclear Information System (INIS)

    Parrilla, G.; Carreón, E.; Zamarro, J.; Espinosa de Rueda, M.; García-Villalba, B.; Marín, F.; Hernández-Fernández, F.; Morales, A.; Fernández-Vivas, M.; Núñez, R.; Moreno, A.

    2015-01-01

    BackgroundOur objective was to evaluate the effect of treatment with stent-retrievers in octogenarians suffering an acute ischemic stroke.MethodsA total of 150 consecutive patients with acute stroke who were treated with stent-retrievers between April 2010 and June 2012 were retrospectively reviewed. Patients were divided into those <80 years old (n = 116) and those ≥80 (n = 34). Baseline characteristics, procedure data, and endpoints (postprocedural NIHSS, death, and mRS at 3 months) were compared.ResultsHigh blood pressure, atrial fibrillation, and anticoagulation were more frequent in octogenarians (p = 0.01, 0.003, and 0.04 respectively). There were no differences between both groups regarding previous intravenous thrombolysis (32.4 vs. 48.3 %, p = 0.1), preprocedural NIHSS (18.1 vs. 16.8, p = 0.3), procedure time (74.5 (40–114) min vs. 63 (38–92) min, p = 0.2), revascularization time (380.5 (298–526.3) min vs. 350 (296.3–452.8), p = 0.3), TICI ≥ 2B (88.2 vs. 93.9 %, p = 0.1), and symptomatic haemorrhage (5.9 vs. 2.6 %, p = 0.3). Discharge NIHSS was higher in octogenarians (9.7 vs. 6.5, p = 0.03). Death and 3-month mRS ≥3 were more frequent in octogenarians (35.3 vs. 17.2 %, p = 0.02 and 73.5 vs. 37.1 %, p = 0.02). ICA-involvement and prolonged revascularization involved higher mortality (66.7 vs. 27.6 %, p = 0.03) and worse mRS (50 vs. 24.4 %, p = 0.06) in octogenarians.ConclusionsIn our series, treatment with stent-retrievers in octogenarians with acute ischemic stroke achieved good rates of recanalization but with a high mortality rate. ICA involvement and revascularization times beyond 6 hours associated to a worse prognosis. These data might be of value in the design of prospective studies evaluating the clinical efficacy of the endovascular treatments in octogenarians

  13. Recanalization and Mortality Rates of Thrombectomy With Stent-Retrievers in Octogenarian Patients with Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Parrilla, G., E-mail: gpr1972@gmail.com [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain); Carreón, E. [Service of Neurology Hospital Clínico Universitario Virgen de la Arrixaca (Spain); Zamarro, J.; Espinosa de Rueda, M.; García-Villalba, B. [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain); Marín, F. [Hospital Clínico Universitario Virgen de la Arrixaca, Department of Cardiology (Spain); Hernández-Fernández, F. [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain); Morales, A. [Service of Neurology Hospital Clínico Universitario Virgen de la Arrixaca (Spain); Fernández-Vivas, M.; Núñez, R. [Hospital Clínico Universitario Virgen de la Arrixaca, Intensive Care Unit (Spain); Moreno, A. [Hospital Clínico Universitario Virgen de la Arrixaca, Service of Interventional Neuroradiology (Spain)

    2015-04-15

    BackgroundOur objective was to evaluate the effect of treatment with stent-retrievers in octogenarians suffering an acute ischemic stroke.MethodsA total of 150 consecutive patients with acute stroke who were treated with stent-retrievers between April 2010 and June 2012 were retrospectively reviewed. Patients were divided into those <80 years old (n = 116) and those ≥80 (n = 34). Baseline characteristics, procedure data, and endpoints (postprocedural NIHSS, death, and mRS at 3 months) were compared.ResultsHigh blood pressure, atrial fibrillation, and anticoagulation were more frequent in octogenarians (p = 0.01, 0.003, and 0.04 respectively). There were no differences between both groups regarding previous intravenous thrombolysis (32.4 vs. 48.3 %, p = 0.1), preprocedural NIHSS (18.1 vs. 16.8, p = 0.3), procedure time (74.5 (40–114) min vs. 63 (38–92) min, p = 0.2), revascularization time (380.5 (298–526.3) min vs. 350 (296.3–452.8), p = 0.3), TICI ≥ 2B (88.2 vs. 93.9 %, p = 0.1), and symptomatic haemorrhage (5.9 vs. 2.6 %, p = 0.3). Discharge NIHSS was higher in octogenarians (9.7 vs. 6.5, p = 0.03). Death and 3-month mRS ≥3 were more frequent in octogenarians (35.3 vs. 17.2 %, p = 0.02 and 73.5 vs. 37.1 %, p = 0.02). ICA-involvement and prolonged revascularization involved higher mortality (66.7 vs. 27.6 %, p = 0.03) and worse mRS (50 vs. 24.4 %, p = 0.06) in octogenarians.ConclusionsIn our series, treatment with stent-retrievers in octogenarians with acute ischemic stroke achieved good rates of recanalization but with a high mortality rate. ICA involvement and revascularization times beyond 6 hours associated to a worse prognosis. These data might be of value in the design of prospective studies evaluating the clinical efficacy of the endovascular treatments in octogenarians.

  14. Cognitive aging and rate of hospitalization in an urban population of older people.

    Science.gov (United States)

    Wilson, Robert S; Rajan, Kumar B; Barnes, Lisa L; Hebert, Liesi E; Mendes de Leon, Carlos F; Evans, Denis A

    2014-04-01

    The association of age-related cognitive change with hospitalization is not well understood. At 3-year intervals for a mean of 8.7 years, 2,273 older residents of a geographically defined urban community underwent cognitive testing from which a global measure was derived. Hospitalization data were obtained from Part A Medicare beneficiary records. The association of level of cognitive function and rate of cognitive decline in each 3-year interval with subsequent rate of hospitalization was assessed using mixed-effects count regression models. There were 9,091 hospitalizations involving 1,810 of the 2,273 individuals in the cohort (79.6%). Rate of hospitalization increased by 9.7% (95% confidence interval [CI]: 7.2, 12.3) with each additional study year; by 32.7% (95% CI: 26.8, 38.0) for each 1 point lower on the global cognitive measure at the beginning of an observation interval; and by 24.3% (95% CI: 16.6, 32.6) for each 1-point decrease in the global cognitive measure during the previous observation period. These associations persisted after adjustment for comorbidities and exclusion of those with a Mini-Mental State Examination score less than 26. Individual differences in trajectories of cognitive aging are associated with subsequent risk of hospitalization.

  15. The impact of varicella vaccination on varicella-related hospitalization rates: global data review

    Directory of Open Access Journals (Sweden)

    Maki Hirose

    Full Text Available Abstract Objective: To describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. Data source: We identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or "hospitalization". Publications in English published between January 1995 and May 2015 were included. Data synthesis: 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4%–99.2% reduction in hospitalization rates in children younger than four years, 6–14 years after the onset of universal vaccination (1995, with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1–4 years in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1–4 years in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1–4 years in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1–4 years in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years in four years, coverage of 77.2% and Italy 69.7%–73.8% decrease (general population, coverage of 60%–95%. Conclusions: The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between

  16. The impact of varicella vaccination on varicella-related hospitalization rates: global data review.

    Science.gov (United States)

    Hirose, Maki; Gilio, Alfredo Elias; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta

    2016-09-01

    to describe the impact of varicella vaccination on varicella-related hospitalization rates in countries that implemented universal vaccination against the disease. we identified countries that implemented universal vaccination against varicella at the http://apps.who.int/immunization_monitoring/globalsummary/schedules site of the World Health Organization and selected articles in Pubmed describing the changes (pre/post-vaccination) in the varicella-related hospitalization rates in these countries, using the Keywords "varicella", "vaccination/vaccine" and "children" (or) "hospitalization". Publications in English published between January 1995 and May 2015 were included. 24 countries with universal vaccination against varicella and 28 articles describing the impact of the vaccine on varicella-associated hospitalizations rates in seven countries were identified. The US had 81.4% -99.2% reduction in hospitalization rates in children younger than four years after 6-14 years after the onset of universal vaccination (1995), with vaccination coverage of 90%; Uruguay: 94% decrease (children aged 1-4 years) in six years, vaccination coverage of 90%; Canada: 93% decrease (age 1-4 years) in 10 years, coverage of 93%; Germany: 62.4% decrease (age 1-4 years) in 8 years, coverage of 78.2%; Australia: 76.8% decrease (age 1-4 years) in 5 years, coverage of 90%; Spain: 83.5% decrease (age <5 years) in four years, coverage of 77.2% and Italy 69.7% -73.8% decrease (general population), coverage of 60%-95%. The publications showed variations in the percentage of decrease in varicella-related hospitalization rates after universal vaccination in the assessed countries; the results probably depend on the time since the implementation of universal vaccination, differences in the studied age group, hospital admission criteria, vaccination coverage and strategy, which does not allow direct comparison between data. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por

  17. Higher Calorie Diets Increase Rate of Weight Gain and Shorten Hospital Stay in Hospitalized Adolescents With Anorexia Nervosa

    Science.gov (United States)

    Garber, Andrea K.; Mauldin, Kasuen; Michihata, Nobuaki; Buckelew, Sara M.; Shafer, Mary-Ann; Moscicki, Anna-Barbara

    2015-01-01

    Purpose Current recommendations for refeeding in anorexia nervosa (AN) are conservative, beginning around 1,200 calories to avoid refeeding syndrome. We previously showed poor weight gain and long hospital stay using this approach and hypothesized that a higher calorie approach would improve outcomes. Methods Adolescents hospitalized for malnutrition due to AN were included in this quasi-experimental study comparing lower and higher calories during refeeding. Participants enrolled between 2002 and 2012; higher calories were prescribed starting around 2008. Daily prospective measures included weight, heart rate, temperature, hydration markers and serum phosphorus. Participants received formula only to replace refused food. Percent Median Body Mass Index (% MBMI) was calculated using 50th percentile body mass index for age and sex. Unpaired t-tests compared two groups split at 1,200 calories. Results Fifty-six adolescents with mean (±SEM) age 16.2 (±.3) years and admit %MBMI 79.2% (±1.5%) were hospitalized for 14.9 (±.9) days. The only significant difference between groups (N = 28 each) at baseline was starting calories (1,764 [±60] vs. 1,093 [±28], p calories had faster weight gain (.46 [±.04] vs. .26 [±.03] %MBMI/day, p calorie advances (122 [±8] vs. 98 [±6], p = .024), shorter hospital stay (11.9 [±1.0] vs. 17.6 [±1.2] days, p calorie diets produced faster weight gain in hospitalized adolescents with AN as compared with the currently recommended lower calorie diets. No cases of the refeeding syndrome were seen using phosphate supplementation. These findings lend further support to the move toward more aggressive refeeding in AN. PMID:24054812

  18. Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues

    Science.gov (United States)

    Kozhimannil, Katy Backes; Law, Michael R.; Virnig, Beth A.

    2013-01-01

    Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordination of maternity care, more data collection and measurement, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting. PMID:23459732

  19. Trends in Hospitalization and Mortality Rates Due to Acute Cardiovascular Disease in Castile and León, 2001 to 2015.

    Science.gov (United States)

    López-Messa, Juan B; Andrés-de Llano, Jesús M; López-Fernández, Laura; García-Cruces, Jesús; García-Crespo, Julio; Prieto González, Miryam

    2018-02-01

    To analyze hospitalization and mortality rates due to acute cardiovascular disease (ACVD). We conducted a cross-sectional study of the hospital discharge database of Castile and León from 2001 to 2015, selecting patients with a principal discharge diagnosis of acute myocardial infarction (AMI), unstable angina, heart failure, or acute ischemic stroke (AIS). Trends in the rates of hospitalization/100 000 inhabitants/y and hospital mortality/1000 hospitalizations/y, overall and by sex, were studied by joinpoint regression analysis. A total of 239 586 ACVD cases (AMI 55 004; unstable angina 15 406; heart failure 111 647; AIS 57 529) were studied. The following statistically significant trends were observed: hospitalization: ACVD, upward from 2001 to 2007 (5.14; 95%CI, 3.5-6.8; P < .005), downward from 2011 to 2015 (3.7; 95%CI, 1.0-6.4; P < .05); unstable angina, downward from 2001 to 2010 (-12.73; 95%CI, -14.8 to -10.6; P < .05); AMI, upward from 2001 to 2003 (15.6; 95%CI, 3.8-28.9; P < .05), downward from 2003 to 2015 (-1.20; 95%CI, -1.8 to -0.6; P < .05); heart failure, upward from 2001 to 2007 (10.70; 95%CI, 8.7-12.8; P < .05), upward from 2007 to 2015 (1.10; 95%CI, 0.1-2.1; P < .05); AIS, upward from 2001 to 2007 (4.44; 95%CI, 2.9-6.0; P < .05). Mortality rates: downward from 2001 to 2015 in ACVD (-1.16; 95%CI, -2.1 to -0.2; P < .05), AMI (-3.37, 95%CI, -4.4 to -2, 3, P < .05), heart failure (-1.25; 95%CI, -2.3 to -0.1; P < .05) and AIS (-1.78; 95%CI, -2.9 to -0.6; P < .05); unstable angina, upward from 2001 to 2007 (24.73; 95%CI, 14.2-36.2; P < .05). The ACVD analyzed showed a rising trend in hospitalization rates from 2001 to 2015, which was especially marked for heart failure, and a decreasing trend in hospital mortality rates, which were similar in men and women. These data point to a stabilization and a decline in hospital mortality, attributable to established prevention measures. Copyright © 2017 Sociedad Española de Cardiología. Published by

  20. Do Avoidable Hospitalization Rates among Older Adults Differ by Geographic Access to Primary Care Physicians?

    Science.gov (United States)

    Daly, Michael R; Mellor, Jennifer M; Millones, Marco

    2017-06-28

    To investigate the association between older adults' potentially avoidable hospitalization rates and both a geographic measure of primary care physician (PCP) access and a standard bounded-area measure of PCP access. State physician licensure data from the Virginia Board of Medicine. Patient-level hospital discharge data from Virginia Health Information. Area-level data from the American Community Survey and the Area Health Resources Files. Virginia Information Technologies Agency road network data. US Census Bureau TIGER/Line boundary files. We use enhanced two-step floating catchment area methods to calculate geographic PCP accessibility for each ZIP Code Tabulation Area in Virginia. We use spatial regression techniques to model potentially avoidable hospitalization rates. Geographic accessibility was calculated using ArcGIS. Physician locations were geocoded using TAMU GeoServices and ArcGIS. Increased geographic access to PCPs is associated with lower rates of potentially avoidable hospitalization among older adults. This association is robust, allowing for spatial spillovers in spatial lag models. Compared to bounded-area density measures, unbounded geographic accessibility measures provide more robust evidence that avoidable hospitalization rates are lower in areas with more PCPs per person. Results from our spatial lag models reveal the presence of positive spatial spillovers. © Health Research and Educational Trust.

  1. Thrombolysis in Postoperative Stroke.

    Science.gov (United States)

    Voelkel, Nicolas; Hubert, Nikolai Dominik; Backhaus, Roland; Haberl, Roman Ludwig; Hubert, Gordian Jan

    2017-11-01

    Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery. Patients were included if surgery was performed within the last 90 days before stroke. The primary outcome was defined as surgical site hemorrhage. Subgroups with major/minor surgery and recent/nonrecent surgery (within 10 days before IVT) were analyzed separately. One hundred thirty-four patients underwent surgical intervention before IVT. Surgery had been performed recently (days 1-10) in 49 (37%) and nonrecently (days 11-90) in 85 patients (63%). In 86 patients (64%), surgery was classified as major, and in 48 (36%) as minor. Nine patients (7%) developed surgical site hemorrhage after IVT, of whom 4 (3%) were serious, but none was fatal. One fatal bleeding occurred remotely from surgical area. Rate of surgical site hemorrhage was significantly higher in recent than in nonrecent surgery (14.3% versus 2.4%, respectively, odds ratio adjusted 10.73; 95% confidence interval, 1.88-61.27). Difference between patients with major and minor surgeries was less distinct (8.1% and 4.2%, respectively; odds ratio adjusted 4.03; 95% confidence interval, 0.65-25.04). Overall in-hospital mortality was 8.2%. Intracranial hemorrhage occurred in 9.7% and was asymptomatic in all cases. IVT may be administered safely in postoperative patients as off-label use after appropriate risk-benefit assessment. However, bleeding risk in surgical area should be taken into account particularly in patients who have undergone surgery shortly before stroke onset. © 2017 American Heart Association, Inc.

  2. Single motor unit firing rate after stroke is higher on the less-affected side during stable low-level voluntary contractions

    Directory of Open Access Journals (Sweden)

    Penelope A Mcnulty

    2014-07-01

    Full Text Available Muscle weakness is the most common outcome after stroke and a leading cause of adult-acquired motor disability. Single motor unit properties provide insight into the mechanisms of post-stroke motor impairment. Motor units on the more-affected side are reported to have lower peak firing rates, reduced discharge variability and a more compressed dynamic range than healthy subjects. The activity of 169 motor units was discriminated from surface EMG in 28 stroke patients during sustained voluntary contractions 10% of maximal and compared to 110 units recorded from 16 healthy subjects. Motor units were recorded in three series: ankle dorsiflexion, wrist flexion and elbow flexion. Mean firing rates after stroke were significantly lower on the more-affected than the less-affected side (p< 0.001 with no between-side differences for controls. When data were combined, firing rates on the less-affected side were significantly higher than those either on the more-affected side or healthy subjects (p< 0.001. Motor unit mean firing rate was higher in the upper-limb than the lower-limb (p< 0.05. The coefficient of variation of motor unit discharge rate was lower for motor units after stroke compared to controls for wrist flexion (p< 0.05 but not ankle dorsiflexion. However, the dynamic range of motor units was compressed only for motor units on the more-affected side during wrist flexion. Our results show that the pathological change in motor unit firing rate occurs on the less-affected side after stroke and not the more-affected side as previously reported, and suggest that motor unit behavior recorded in a single muscle after stroke cannot be generalized to muscles acting on other joints even within the same limb. These data emphasize that the less-affected side does not provide a valid control for physiological studies on the more-affected side after stroke and that both sides should be compared to data from age- and sex-matched healthy subjects.

  3. Predictors of Stroke After Transient Ischemic Attack in Children.

    Science.gov (United States)

    Lehman, Laura L; Watson, Christopher G; Kapur, Kush; Danehy, Amy R; Rivkin, Michael J

    2016-01-01

    Transient ischemic attack (TIA) in children has received far less attention compared with TIA in adults. The risk factors of stroke after TIA in children are relatively unknown. We aimed to determine the percentage of children who have stroke after TIA and the risk factors associated with stroke after TIA. We searched the medical records at Boston Children's Hospital for the year 2010 to find children who were evaluated for TIA to determine associated risk factors of stroke after TIA. We included children who were evaluated in 2009 through 2010 for TIA and had magnetic resonance imaging. We examined follow-up imaging through August 2014 for subsequent stroke. Logistic regression was used to calculate odds ratios for factors in our cohort who are associated with stroke after presentation with TIA. We identified 63 children who experienced a TIA. The mean time of imaging follow-up was 4.5 years after TIA presentation. Of the 63 children, 10 (16%) developed radiological evidence of ischemic cerebral injury within the follow-up period. Four of the 10 (6%) demonstrated diffusion abnormalities on magnetic resonance imaging at TIA presentation, whereas 8 (13%) had a stroke after their TIA. Arteriopathy, female sex, and autoimmune disorders were significantly associated with stroke after TIA. In our cohort of children, stroke occurred after TIA at a rate similar to that seen in adults, but the risk factors for stroke after TIA in children are different. © 2015 American Heart Association, Inc.

  4. User fee exemption does not affect lower rates of hospital admission of girls in Vietnam.

    Science.gov (United States)

    Schmidt, Wolf-Peter; Suzuki, Motoi; Thiem, Vu Dinh; Yoshida, Lay-Myint; Matsubayashi, Toru; Yanai, Hideki; Tho, Le Huu; Anh, Dang Duc; Ariyoshi, Koya

    2012-10-01

    In many countries, girls have been reported to be less often admitted to hospital than boys. We studied the influence of socio-economic factors, education and access to health care on girls' and boys' admission rates for pneumonia, diarrhoea and dengue fever in south-central Vietnam. We explored whether the user fee exemption for children under 6 years introduced in 2005 had an impact on girls' admission rates. In a cohort analysis, we used data from a large census in Khanh Hoa Province conducted in 2006, linked to hospital admission records at individual level. We further analysed a cross-sectional health care utilization survey in a sample of children reported ill at the census. There were 38 731 children under 6 years among a total census population of 353 891. Overall, girls under the age of 6 years were 29% less likely to be admitted to hospital than boys. The gender differences in admission rates in children under 6 years were similar for diarrhoea, pneumonia and dengue. None of the socio-economic and educational factors appeared to affect the gender difference. The user fee exemption starting from October 2005 had no impact on the girls/boys rate ratio of admission. In conclusion, the higher hospital admission rates of boys compared with girls in Vietnam are independent of socio-economic factors and user fees. Higher susceptibility of boys to severe disease could explain part of the gender gap, but profound cultural norms and beliefs may also have contributed to the findings.

  5. Preventable Hospitalization Rates and Neighborhood Poverty among New York City Residents, 2008-2013.

    Science.gov (United States)

    Bocour, Angelica; Tria, Maryellen

    2016-12-01

    Knowing which demographic groups have higher rates of preventable hospitalizations can help identify geographic areas where improvements in primary care access and quality can be made. This study assessed whether preventable hospitalization rates by neighborhood poverty decreased from 2008 to 2013 and whether the gap between very high and low poverty neighborhoods changed. We examined trends in age-adjusted preventable hospitalization rates and rate ratios by neighborhood poverty overall and by sex using JoinPoint regression. Prevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality were applied to inpatient hospitalization data from the New York State Department of Health's Statewide Planning and Research Cooperative System. PQIs were classified into composites. From 2008 to 2013, preventable hospitalization rates per 100,000 adults across each poverty group decreased. For very high poverty neighborhoods (ZIP codes with ≥30 % of persons living below the federal poverty level (FPL)), there were significant decreases overall (3430.56 to 2543.10, annual percent change [APC] = -5.91 %), for diabetes (676.15 to 500.83, APC = -5.75 %), respiratory (830.78 to 660.29, APC = -4.85 %), circulatory (995.69 to 701.81, APC = -7.24 %), and acute composites (928.18 to 680.17, APC = -5.62 %). The rate ratios also decreased over time; however, in 2013, the rates for very high poverty neighborhoods were two to four times higher than low poverty neighborhoods (ZIP codes with still exist. These findings underscore the need to ensure adequate access to quality and timely primary care among individuals living in high poverty neighborhoods.

  6. The Danish Stroke Registry

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...

  7. Trends in neurosurgical complication rates at teaching vs nonteaching hospitals following duty-hour restrictions.

    Science.gov (United States)

    Dumont, Travis M; Tranmer, Bruce I; Horgan, Michael A; Rughani, Anand I

    2012-11-01

    In 2003 the Accreditation Council for Graduate Medical Education implemented duty-hour restrictions for residents, with an unclear impact on patient care. The authors hypothesize that implementation of duty-hour restrictions is not associated with decreased morbidity for neurosurgical patients. This hypothesis was tested with the Nationwide Inpatient Sample to examine inpatient complications associated with a common elective procedure, craniotomy for meningioma. The Nationwide Inpatient Sample was queried for all patients admitted for elective craniotomy for meningioma from 1998 to 2008, excluding the year 2003. Each case was queried for common in-hospital postoperative complications. The complication rate was compared for 5-year epochs at teaching and nonteaching hospitals before (1998-2002) and after (2004-2008) the adoption of the Accreditation Council for Graduate Medical Education work-hour restriction. Multivariate analysis was performed to control for the effects of age and medical comorbidities. We identified 21177 patients who met inclusion criteria. We identified an effect of age, preexisting medical comorbidity, and timing of surgery on postoperative complication rates. At teaching hospitals, the complication rate increased from 14% to 16% (P < .001). In contrast, this increase was not mirrored at nonteaching hospitals, which saw a nearly constant postoperative complication rate of 15% from 1998 to 2002 and 15% for the years 2004 to 2008 (P = .979). This effect remained significant in a multivariate analysis including age and existing comorbidities as covariates (P = .016). In patients undergoing craniotomy for meningioma, postoperative complication rates increased at teaching hospitals, but not at nonteaching hospitals over the 5-year epochs before and after 2003.

  8. Low stroke rate and few thrombo-embolic events after HeartMate II implantation under mild anticoagulation.

    Science.gov (United States)

    Menon, Ares K; Götzenich, Andreas; Sassmannshausen, Helena; Haushofer, Marcus; Autschbach, Rüdiger; Spillner, Jan W

    2012-08-01

    Bleeding and thrombo-embolism are two of the most threatening adverse events associated with the use of continuous flow left ventricular assist devices (LVADs) in the treatment of severe heart failure. We analysed our LVAD patients treated with the HeartMate II (HM II) device by following a low anticoagulation regimen. Between 2008 and February 2011, we implanted 40 HM II LVADs in our institution. Intention to treat was bridge to transplant in 25, destination therapy in 9, bridge to candidacy in 5 cases and bridge to recovery in 1 case. Heparin was started only after 24 h postoperatively, and Phenprocumon (Phen) was started after removal of all chest drains. International normalized ratio (INR) target in the years 2008-2009 was 2.5, and 2.0-2.5 since 2010. Acetyl salicylic acid (ASA) was prescribed 50-100 mg/day only in patients <55 years or in case of severe atherosclerotic disease of the right coronary artery. All data were analysed consecutively concerning thrombo-embolic and bleeding events. Fifty-two percent of the patients were in INTERMACS level 1 or 2 at the time of implantation. The mean age was 58 ± 11 years, and the mean days under LVAD was 241 days (maximum: 1052 days). The survival rate was 87.5% after 30 years and 75% in the long term. Early postoperatively, no strokes or thrombo-embolic events occurred. In the long term, two patients suffered from ischaemic strokes, but recovered well. In both of these index events, the INR was lasting below 1.4. One of these two patients developed pump thrombosis additionally. Only three patients (ASA + Phen) developed gastrointestinal bleeding (7.5%). Two patients were withdrawn from Phen + ASA because of multiple angiodysplasia. Compared with the literature, even a mild anticoagulation protocol does not increase the risk of thrombotic events, but reduces bleeding events in the use of an HM II LVAD.

  9. Examining vertebrobasilar artery stroke in two Canadian provinces.

    Science.gov (United States)

    Boyle, Eleanor; Côté, Pierre; Grier, Alexander R; Cassidy, J David

    2009-02-01

    Ecological study. To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization. Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level. All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates. The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period. In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

  10. Rates of Hospitalization for Dehydration Following Hurricane Sandy in New Jersey.

    Science.gov (United States)

    Swerdel, Joel N; Rhoads, George G; Cosgrove, Nora M; Kostis, John B

    2016-04-01

    Hurricane Sandy, one of the most destructive natural disasters in New Jersey history, made landfall on October 29, 2012. Prolonged loss of electrical power and extensive infrastructure damage restricted access for many to food and water. We examined the rate of dehydration in New Jersey residents after Hurricane Sandy. We obtained data from 2008 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records from nonfederal New Jersey hospitals (N=517,355). Patients with dehydration had ICD-9-CM discharge diagnosis codes for dehydration, volume depletion, and/or hypovolemia. We used log-linear modeling to estimate the change in in-patient hospitalizations for dehydration comparing 2 weeks after Sandy with the same period in the previous 4 years (2008-2011). In-patient hospitalizations for dehydration were 66% higher after Sandy than in 2008-2011 (rate ratio [RR]: 1.66; 95% confidence interval [CI]: 1.50, 1.84). Hospitalizations for dehydration in patients over 65 years of age increased by nearly 80% after Sandy compared with 2008-2011 (RR: 1.79; 95% CI: 1.58, 2.02). Sandy was associated with a marked increase in hospitalizations for dehydration. Reducing the rate of dehydration following extreme weather events is an important public health concern that needs to be addressed, especially in those over 65 years of age.

  11. Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry.

    Science.gov (United States)

    Cocho, D; Sagales, M; Cobo, M; Homs, I; Serra, J; Pou, M; Perez, G; Pujol, G; Tantinya, S; Bao, P; Aloy, A; Sabater, R; Gendre, J; Otermin, P

    During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. We examined 418 patients with acute stroke (G0=275, G1=143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P=.005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P=.003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P=.4), lower mortality (1.7% in G0 vs. 0.7% in G1, P=.3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P=.05). Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Chest compression rates and survival following out-of-hospital cardiac arrest.

    Science.gov (United States)

    Idris, Ahamed H; Guffey, Danielle; Pepe, Paul E; Brown, Siobhan P; Brooks, Steven C; Callaway, Clifton W; Christenson, Jim; Davis, Daniel P; Daya, Mohamud R; Gray, Randal; Kudenchuk, Peter J; Larsen, Jonathan; Lin, Steve; Menegazzi, James J; Sheehan, Kellie; Sopko, George; Stiell, Ian; Nichol, Graham; Aufderheide, Tom P

    2015-04-01

    Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined. Prospective, observational study. Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial. Adults with out-of-hospital cardiac arrest treated by emergency medical service providers. None. Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean±SD) was 67±16 years. Chest compression rate was 111±19 per minute, compression fraction was 0.70±0.17, and compression depth was 42±12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n=10,371), a global test found no significant relationship between compression rate and survival (p=0.19). However, after adjustment for covariates including chest compression depth and fraction (n=6,399), the global test found a significant relationship between compression rate and survival (p=0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival. After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.

  13. Annual changes in rotavirus hospitalization rates before and after rotavirus vaccine implementation in the United States.

    Science.gov (United States)

    Shah, Minesh P; Dahl, Rebecca M; Parashar, Umesh D; Lopman, Benjamin A

    2018-01-01

    Hospitalizations for rotavirus and acute gastroenteritis (AGE) have declined in the US with rotavirus vaccination, though biennial peaks in incidence in children aged less than 5 years occur. This pattern may be explained by lower rotavirus vaccination coverage in US children (59% to 73% from 2010-2015), resulting in accumulation of susceptible children over two successive birth cohorts. Retrospective cohort analysis of claims data of commercially insured US children aged rotavirus and for AGE from the 2002-2015 rotavirus seasons were examined. Median age and rotavirus vaccination coverage for biennial rotavirus seasons during pre-vaccine (2002-2005), early post-vaccine (2008-2011) and late post-vaccine (2012-2015) years. Age-stratified hospitalization rates decreased from pre-vaccine to early post-vaccine and then to late post-vaccine years. The clearest biennial pattern in hospitalization rates is the early post-vaccine period, with higher rates in 2009 and 2011 than in 2008 and 2010. The pattern diminishes in the late post-vaccine period. For rotavirus hospitalizations, the median age and the difference in age between biennial seasons was highest during the early post-vaccine period; these differences were not observed for AGE hospitalizations. There was no significant difference in vaccination coverage between biennial seasons. These observations provide conflicting evidence that incomplete vaccine coverage drove the biennial pattern in rotavirus hospitalizations that has emerged with rotavirus vaccination in the US. As this pattern is diminishing with higher vaccine coverage in recent years, further increases in vaccine coverage may reach a threshold that eliminates peak seasons in hospitalizations.

  14. Predictors of stroke - associated mortality in Africans.

    Science.gov (United States)

    Longo-Mbenza, B; Tonduangu, K; Muyeno, K; Phanzu, M; Kebolo Baku, A; Muvova, D; Lelo, T; Odio, W; Lukoki, L; Bikangi Nkiabungu, F; Kilembe, M; Tshiamala, P; Katalay, L; Mwema, M; Muyembe, T

    2000-01-01

    The objective of the study was to examine the association of the stroke-related mortality with gender, age, ethnicity, social class, blood pressure, fibrinogen, selected clinical data and meteorologic parameters in hospitalized Africans. A series of 1032 consecutively hospitalized incident cases of acute stroke between 1987 and 1991 was studied. Univariate and multivariate analyses were used to estimate the risk (odds ratio=OR) of stroke mortality for meteorologic parameters on the month before the accident onset and selected sociodemophysiological variables on the day of admission. The variables significantly associated with stroke mortality in multivariate analysis were male sex (OR= 2.3 [1.3 - 4.1]), low social class (OR= 2.0 [1.2 - 4.0]), migrant tribes (OR= 1.7 [1.5 - 1.8]), ischemic stroke (OR= 1.4 [1.2 - 1.6]), heart rate >=100 bpm (OR= 1.1 [1.0 - 1.2]), age > or =60 years (OR= 1.03 [1.01 - 1.06]), systolic blood pressure> 160 mmHg (OR= 1. 02 [1.01 - 1.03]), and fibrinogen > or =400 mg/dl (OR= 1.01 [1.002 - 1. 02]). However, diastolic blood pressure > 90 mmHg and global radiation< 340 Cal/cm(2)/day were significantly (p< 0.05) and inversely associated with stroke mortality. Our results indicate that male sex, older age, low social class, migration, ischemic stroke and higher baseline levels of heart rate, systolic blood pressure and fibrinogen are significant predictors of stroke mortality, but lower global radiation and higher diastolic blood pressure are inversely linked.

  15. Trends in Stroke Incidence and 28-Day Case Fatality in a Nationwide Stroke Registry of a Multiethnic Asian Population.

    Science.gov (United States)

    Tan, Chuen Seng; Müller-Riemenschneider, Falk; Ng, Sheryl Hui Xian; Tan, Pei Zheng; Chan, Bernard P L; Tang, Kok-Foo; Ahmad, Aftab; Kong, Keng He; Chang, Hui Meng; Chow, Khuan Yew; Koh, Gerald Choon-Huat; Venketasubramanian, Narayanaswamy

    2015-10-01

    This study investigated trends in stroke incidence and case fatality overall and according to sex, age, ethnicity, and stroke subtype in a multiethnic Asian population. The Singapore Stroke Registry identifies all stroke cases in all public hospitals using medical claims, hospital discharge summaries, and death registry data. Age-standardized incidence rates and 28-day case-fatality rates were calculated for individuals aged ≥15 years between 2006 and 2012. To estimate the annual percentage change of the rates, a linear regression model was fitted to the log rates, and a Wald test was performed to test for trend. P values Chinese (-2.64; 95% CI, -3.15 to -2.13), Indians (-3.78; 95% CI, -5.93 to -1.58), and others (-12.73; 95% CI, -18.93 to -6.06) compared with Malays (2.58; 95% CI, 1.17 to 4.02); and in ischemic stroke subtype (ischemic: -2.43; 95% CI, -3.13 to -1.73; hemorrhagic: -1.02; 95% CI, -2.04 to 0.01). Subgroup-specific findings for case fatality were similar. This is the first countrywide hospital-based registry study in a multiethnic Asian population, and it revealed marked overall reductions in stroke incidence and case fatality. However, it also identified important population groups with less favorable trends, especially younger adults and those of Malay ethnicity. © 2015 American Heart Association, Inc.

  16. Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis.

    Science.gov (United States)

    Oliver, Matthew J; Al-Jaishi, Ahmed A; Dixon, Stephanie N; Perl, Jeffrey; Jain, Arsh K; Lavoie, Susan D; Nash, Danielle M; Paterson, J Michael; Lok, Charmaine E; Quinn, Robert R

    2016-09-07

    Assisted peritoneal dialysis is a treatment option for individuals with barriers to self-care who wish to receive home dialysis, but previous research suggests that this treatment modality is associated with a higher rate of hospitalization. The objective of our study was to determine whether assisted peritoneal dialysis has a different rate of hospital days compared to in-center hemodialysis. We conducted a multicenter, retrospective cohort study by linking a quality assurance dataset to administrative health data in Ontario, Canada. Subjects were accrued between January 1, 2004 and July 9, 2013. Individuals were grouped into assisted peritoneal dialysis (family or home care assisted) or in-center hemodialysis on the basis of their first outpatient dialysis modality. Inverse probability of treatment weighting using a propensity score was used to create a sample in which the baseline covariates were well balanced. The study included 872 patients in the in-center hemodialysis group and 203 patients in the assisted peritoneal dialysis group. Using an intention to treat approach, patients on assisted peritoneal dialysis had a similar hospitalization rate of 11.1 d/yr (95% confidence interval, 9.4 to 13.0) compared with 12.9 d/yr (95% confidence interval, 10.3 to 16.1) in the hemodialysis group (P=0.19). Patients on assisted peritoneal dialysis were more likely to be hospitalized for dialysis-related reasons (admitted for 2.4 d/yr [95% confidence interval, 1.8 to 3.2] compared with 1.6 d/yr [95% confidence interval, 1.1 to 2.3] in the hemodialysis group; P=0.04). This difference was partly explained by more hospital days because of peritonitis. Modality switching was associated with high rates of hospital days per year. Assisted peritoneal dialysis was associated with similar rates of all-cause hospitalization compared with in-center hemodialysis. Patients on assisted peritoneal dialysis who experienced peritonitis and technique failure had high rates of

  17. Family History in Young Patients With Stroke.

    Science.gov (United States)

    Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt

    2015-07-01

    Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.

  18. Registro de pacientes con accidente cerebro vascular en un hospital público del Perú, 2000-2009 Registry of patients with stroke stated in a public hospital of Peru, 2000-2009

    Directory of Open Access Journals (Sweden)

    Ana Castañeda-Guarderas

    2011-12-01

    Full Text Available Estudio que describe las características de los registros de pacientes con accidente cerebro vascular (ACV, como diagnóstico causante de hospitalización en el Hospital Nacional Cayetano Heredia entre los años 2000 - 2009. Se obtuvieron 2225 registros de pacientes mayores de 18 años, con ACV. De acuerdo con la CIE-10, 1071 tenían el diagnóstico de ACV isquémico, 554 ACV hemorrágico, 183 hemorragia subaracnoidea, 49 isquémico hemorrágico, 10 crisis isquémica transitorias y en 358 no fue posible especificar el tipo. Se registraron 352 muertes (19,6 %, la mayoría en los primeros tres días. La razón hombre/mujer fue 1,09; la edad promedio 64,1 ± 17,2 años y la mediana del tiempo de hospitalización fue de nueve días. Las condiciones asociadas más frecuentes fueron hipertensión arterial, fibrilación auricular y diabetes mellitus tipo 2. La mortalidad descrita es la más alta informada en nuestro medio, es constante en todos los grupos de edad y mayor en mujeres.We performed a descriptive study taking on account the characteristics of the registries of the patients hospitalized at the Hospital Nacional Cayetano Heredia between the years 2000 and 2009 with stroke as hospitalization diagnosis. 2225 records were obtained from patients older than 18, with stroke. According to ICD-10, 1071 had diagnosis of ischemic stroke, 554 were hemorrhagic, 183 were subarachnoid hemorrhage, 49 were ischemic plus hemorrhagic, 10 were transient ischemic attack (TIA and in 358 we were unable to specify the type of stroke. 352 deaths were recorded (19.6 %, most of them during the first 3 days. The male / female ratio was 1.09, the mean age 64.1 ± 17.2 years and the median length of hospital stay was 9 days. The most common associated conditions were high blood pressure, atrial fibrillation and type 2 diabetes mellitus. The mortality found is the highest reported in our country, constant in all age groups and higher in women.

  19. The U.S. Twin Delivery Volume and Association with Cesarean Delivery Rates: A Hospital-Level Analysis.

    Science.gov (United States)

    Easter, Sarah Rae; Robinson, Julian N; Carusi, Daniela; Little, Sarah E

    2018-03-01

     The objective of this study was to test whether hospitals experienced in twin delivery have lower rates of cesarean delivery for twins.  We divided obstetric hospitals in the 2011 National Inpatient Sample by quartile of annual twin deliveries and compared twin cesarean delivery rates between hospitals with weighted linear regression. We used Pearson's coefficients to correlate a hospital's twin cesarean delivery rate to its overall cesarean delivery and vaginal birth after cesarean (VBAC) rates.  Annual twin delivery volume ranged from 1 to 506 across the 547 analyzed hospitals with a median of 10 and mode of 3. Adjusted rates of cesarean delivery were independent of delivery volume with a rate of 75.5 versus 74.8% in the lowest and highest volume hospitals ( p  = 0.09 across quartiles). A hospital's cesarean delivery rate for twins moderately correlated with the overall cesarean rate ( r  = 0.52, p  cesarean delivery rates at higher volume hospitals. Twin cesarean delivery rates correlate with other obstetric parameters such as singleton cesarean delivery and VBAC rates suggesting twin cesarean delivery rate is more closely related to a hospital's general obstetric practice than its twin delivery volume. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  20. Explaining failure through success: a critical analysis of reduction in road and stroke deaths as an explanation for Australia's low deceased organ donation rates.

    Science.gov (United States)

    Bendorf, A; Kerridge, I H; Kelly, P J; Pussell, B; Guasch, X

    2012-08-01

    During the past two decades, Australian federal and state governments have funded many initiatives to bolster organ donation. Despite large investments of time, effort and money, Australia's deceased donation rate is in the bottom half of the Organisation for Economic Co-operation and Development countries and has only marginally increased from 11.9 donors per million people (pmp) in 1990 to 14.9 donors pmp in 2011. An often-cited explanation for this situation is that Australia's success in increasing levels of public health and safety through reduced traffic and stroke fatalities has reduced its number of potential deceased organ donors. We refer to this as the 'Failure Because of Success' hypothesis. Although commonly accepted, this hypothesis is largely untested. By analysing data from international donation and transplantation organisations and international public health and safety organisations, we compared historical deceased organ donation rates with traffic and stroke fatality rates in Australia and the seven countries with the world's highest deceased organ donation rates (Spain, Portugal, France, USA, Belgium, Austria and Italy). Traffic fatality rates across all countries in the study have fallen dramatically during the time period, with Spain having the lowest traffic fatality rates. Stroke fatality rates demonstrate similar reductions, with France showing the lowest cerebral vascular accident mortality rates. When compared with countries with the world's highest deceased donation rates, Australia's improvements to public health and safety through reductions in traffic and stroke fatalities were neither unique nor exemplary and do not provide an adequate explanation for its low organ donor rates. © 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

  1. Acute ischemic stroke--from symptom recognition to thrombolysis.

    Science.gov (United States)

    Kurz, M W; Kurz, K D; Farbu, E

    2013-01-01

    The understanding of stroke has changed in the recent years from rehabilitation to an emergency approach. We review existing data from symptom recognition to thrombolysis and identify challenges in the different phases of patient treatment. Implementation of treatment in dedicated stroke units with a multidisciplinary team exclusively treating stroke patients has led to significant reduction of stroke morbidity and mortality. Yet, first the introduction of treatment with intravenous rtPA (IVT) has led to the 'time is brain' concept where stroke is conceived as an emergency. As neuronal death in stroke is time dependent, all effort should be laid on immediate symptom recognition, rapid transport to the nearest hospital with a stroke treatment facility and diagnosis and treatment as soon as possible. The main cause of prehospital delay is that patients do not recognize that they suffered a stroke or out of other reasons do not call the Emergency Medical Services immediately. Educational stroke awareness campaigns may have an impact in increasing the number of patients eligible for rtPA treatment and can decrease the prehospital times if they are directed both to the public and to the medical divisions treating stroke. Stroke transport times can be shortened by the use of helicopter and a stroke mobile--an ambulance equipped with a CT scanner--may be helpful to decrease time from onset to treatment start in the future. Yet, IVT has several limitations such as a narrow time window and a weak effect in ischemic strokes caused by large vessel occlusions. In these cases, interventional procedures and the concept of bridging therapy, a combined approach of IVT and intraarterial thrombolysis or mechanical thrombectomy, might improve recanalization rates and patient outcome. As neuronal death in stroke patients occurs in a time-dependent fashion, all effort should be made to decrease time from symptom onset to treatment start with rtPA: major challenges are stroke

  2. Determination of the CKM matrix element vertical stroke V{sub cb} vertical stroke, the B {yields} X{sub s}{gamma} decay rate, and the b-quark mass

    Energy Technology Data Exchange (ETDEWEB)

    Bernlochner, Florian Urs

    2011-09-15

    vertical stroke V{sub cb} vertical stroke. The b-quark mass is determined by analyzing measured B {yields} X{sub s}{gamma} photon energy spectra from BABAR and Belle. Due to the sizeable background contributions from other processes which produce high energetic photons, the B {yields} X{sub s}{gamma} decay rate is best measured near the kinematic limit where the photon recoils against a light jet-like hadronic state. Unfortunately, the heavy quark expansion breaks down in this kinematic limit and non-perturbative corrections arise. This behaviour in the theory can be remedied by summing the most divergent contributions of the heavy quark expansion into a single function, the shape function. At the time being, the shape function cannot be determined by first principles. This work includes the first direct measurement of the shape function with absorbed 1/m{sub b} corrections, and uses the applied framework for a precision test of the Standard Model prediction for the B {yields} X{sub s}{gamma} decay by determining the absolute value of the leading Wilson coefficient C{sup incl.}{sub 7}. The b-quark mass is related to the first, second, and third moment of the shape function. For vertical stroke C{sup incl.}{sub 7} vertical stroke and the b-quark mass we find, vertical stroke C{sup incl.}{sub 7} V{sub tb} V*{sub ts} vertical stroke x 10{sup 3} = 15.003{+-}0.537{sub exp.}{+-}0.303{sub theo.}, m{sup 1S}{sub b} = 4.764{+-}0.027{sub exp.}{+-}0.016{sub theo.} GeV/c{sup 2}, where the uncertainties are experimental, and theoretical, respectively. The extracted value of vertical stroke C{sup incl.}{sub 7} vertical stroke is in excellent agreement with the Standard Model expectation and the precision on the b quark mass in the 1S scheme, m{sup 1S}{sub b}, is of the same order as the uncertainties on m{sup 1S}{sub b} from global B {yields} X{sub c}l{nu}{sub l} moment fits.

  3. Access to expert stroke care with telemedicine: REACH MUSC

    Directory of Open Access Journals (Sweden)

    Abby Swanson Kazley

    2012-03-01

    Full Text Available Stroke is a leading cause of death and disability, and rtPA can significantly reduce the long-term impact of acute ischemic stroke (AIS if given within 3 hours of symptom onset. South Carolina is located in the stroke belt and has a high rate of stroke and stroke mortality. Many small rural SC hospitals do not maintain the expertise needed to treat AIS patients with rtPA. MUSC is an academic medical center using REACH MUSC telemedicine to deliver stroke care to 15 hospitals in the state, increasing the likelihood of timely treatment with rtPA. The purpose of this study is to determine the increase in access to rtPA through the use of telemedicine for AIS in the general population and in specific segments of the population based on age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality.We used a retrospective cross-sectional design examining Census data from 2000 and Geographic Information Systems (GIS analysis to identify South Carolina residents that live within 30 or 60 minutes of a Primary Stroke Center (PSC or a REACH MUSC site. We include all South Carolina citizens in our analysis and specifically examine the population’s age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality. Our sample includes 4,012,012 South Carolinians. The main measure is access to expert stroke care at a Primary Stroke Center (PSC or a REACH MUSC hospital within 30 or 60 minutes. We find that without REACH MUSC, only 38% of the population has potential access to expert stroke care in SC within sixty minutes given that most PSCs will maintain expert stroke coverage. REACH MUSC allows 76% of the population to be within sixty minutes of expert stroke care, and 43% of the population to be within 30 minute drive time of expert stroke care. These increases in access are especially significant for groups that have faced disparities in care and high rates of AIS. The use of telemedicine can

  4. The relationship between stroke survivors' perceived identity and mood, self-esteem and quality of life.

    Science.gov (United States)

    Lapadatu, Irina; Morris, Reg

    2017-01-11

    To examine change in identity after stroke and to elucidate its relationship with mood and quality of life. To test Higgins' theory of the impact of identity (self-discrepancy) on anxiety and depression. To examine the role of self-esteem in mediating the relationship between identity and outcomes. Sixty-five community-living first-time stroke survivors, mean age 61.58 and time since stroke 5.60 years, were recruited from stroke charities. A cross-sectional study used the Head Injury Semantic Differential Scale, the Hospital Anxiety and Depression Scale, the Rosenberg Self-Esteem Scale, the Stroke-Specific Quality of Life Questionnaire (adapted) and the Barthel Index. Identity was rated more negatively after stroke than before (t(64) = 6.46, p self-esteem (r = -.48, p self-esteem (β = .30, p self-esteem are associated with important outcomes for stroke survivors.

  5. Work support for working age persons who have experienced a stroke in Japan: cooperation between hospitals and work support agencies.

    Science.gov (United States)

    Saito, Yoko; Mineo, Mai; Yaeda, Jun

    2013-01-01

    The number of Japanese working age persons who have experienced a stroke is significantly increasing. In such cases work support is an urgent issue. Although an active cooperation between medical institutions and work support agencies is critical, it has been insufficient, due to an absence of key coordinators with sufficient knowledge in both occupational therapy and work support or vocational rehabilitation. The present paper introduced two case studies to illustrate the importance of the cooperation between medical institutions and work support agencies and discussed reasons why medical institutions have difficulties in supporting persons who have experienced a stroke in their return to work.

  6. Age and Sex Differences in Rates of Influenza-Associated Hospitalizations in Hong Kong.

    Science.gov (United States)

    Wang, Xi-Ling; Yang, Lin; Chan, Kwok-Hung; Chan, King-Pan; Cao, Pei-Hua; Lau, Eric Ho-Yin; Peiris, J S Malik; Wong, Chit-Ming

    2015-08-15

    Few studies have explored age and sex differences in the disease burden of influenza, although men and women probably differ in their susceptibility to influenza infections. In this study, quasi-Poisson regression models were applied to weekly age- and sex-specific hospitalization numbers of pneumonia and influenza cases in the Hong Kong SAR, People's Republic of China, from 2004 to 2010. Age and sex differences were assessed by age- and sex-specific rates of excess hospitalization for influenza A subtypes A(H1N1), A(H3N2), and A(H1N1)pdm09 and influenza B, respectively. We found that, in children younger than 18 years, boys had a higher excess hospitalization rate than girls, with the male-to-female ratio of excess rate (MFR) ranging from 1.1 to 2.4. MFRs of hospitalization associated with different types/subtypes were less than 1.0 for adults younger than 40 years except for A(H3N2) (MFR = 1.6), while all the MFRs were equal to or higher than 1.0 in adults aged 40 years or more except for A(H1N1)pdm09 in elderly persons aged 65 years or more (MFR = 0.9). No MFR was found to be statistically significant (P < 0.05) for hospitalizations associated with influenza type/subtype. There is some limited evidence on age and sex differences in hospitalization associated with influenza in the subtropical city of Hong Kong. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Predicting Fluctuating Rates of Hospitalizations in Relation to Influenza Epidemics and Meteorological Factors.

    Directory of Open Access Journals (Sweden)

    Radia Spiga

    Full Text Available In France, rates of hospital admissions increase at the peaks of influenza epidemics. Predicting influenza-associated hospitalizations could help to anticipate increased hospital activity. The purpose of this study is to identify predictors of influenza epidemics through the analysis of meteorological data, and medical data provided by general practitioners.Historical data were collected from Meteo France, the Sentinelles network and hospitals' information systems for a period of 8 years (2007-2015. First, connections between meteorological and medical data were estimated with the Pearson correlation coefficient, Principal component analysis and classification methods (Ward and k-means. Epidemic states of tested weeks were then predicted for each week during a one-year period using linear discriminant analysis. Finally, transition probabilities between epidemic states were calculated with the Markov Chain method.High correlations were found between influenza-associated hospitalizations and the variables: Sentinelles and emergency department admissions, and anti-correlations were found between hospitalizations and each of meteorological factors applying a time lag of: -13, -12 and -32 days respectively for temperature, absolute humidity and solar radiation. Epidemic weeks were predicted accurately with the linear discriminant analysis method; however there were many misclassifications about intermediate and non-epidemic weeks. Transition probability to an epidemic state was 100% when meteorological variables were below: 2°C, 4 g/m3 and 32 W/m2, respectively for temperature, absolute humidity and solar radiation. This probability was 0% when meteorological variables were above: 6°C, 5.8g/m3 and 74W/m2.These results confirm a good correlation between influenza-associated hospitalizations, meteorological factors and general practitioner's activity, the latter being the strongest predictor of hospital activity.

  8. Stroke in Commercial Flights.

    Science.gov (United States)

    Álvarez-Velasco, Rodrigo; Masjuan, Jaime; DeFelipe, Alicia; Corral, Iñigo; Estévez-Fraga, Carlos; Crespo, Leticia; Alonso-Cánovas, Araceli

    2016-04-01

    Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis. © 2016 American Heart Association, Inc.

  9. Breastfeeding rates and hospital breastfeeding practices in Canada: a national survey of women.

    Science.gov (United States)

    Chalmers, Beverley; Levitt, Cheryl; Heaman, Maureen; O'Brien, Beverley; Sauve, Reg; Kaczorowski, Janusz

    2009-06-01

    The Baby-Friendly Hospital Initiative was launched by the World Health Organization and UNICEF in 1989 to promote, protect, and support breastfeeding worldwide. The objective of this study was to report breastfeeding rates and adherence to the Baby Friendly Hospital Initiative of the World Health Organization and UNICEF in Canada, as reported by participants in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Eligible women (n = 8,244) were identified from a randomly selected sample of infants born 3 months before the May 2006 Canadian Census, and stratified by province or territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer-assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews took approximately 45 minutes and were completed when infants were between 5 and 10 months old (between 9 and 14 months in the territories). Completed responses were obtained from 6,421 women (78% response rate). Nineteen of 309 questions concerned early mother-infant contact and breastfeeding practices. Breastfeeding intention (90.0%) and initiation (90.3%) rates were high, although exclusive breastfeeding rates at 6 months after birth (14.4%) were lower than desirable. The findings suggested a low adherence to several best practices advocated by the Baby-Friendly Hospital Initiative. Although breastfeeding initiation rates were relatively high in Canada, exclusive breastfeeding duration fell short of globally recommended standards.

  10. Study of Survival Rate After Cardiopulmonary Resuscitation (CPR) in Hospitals of Kermanshah in 2013

    Science.gov (United States)

    Goodarzi, Afshin; Jalali, Amir; Almasi, Afshin; Naderipour, Arsalan; Kalhori, Reza Pourmirza; Khodadadi, Amineh

    2015-01-01

    Background: After CPR, the follow-up of survival rate and caused complications are the most important practices of the medical group. This study was performed aimed at determining the follow-up results after CPR in patients of university hospitals in Kermanshah in 2014. Methods: In this prospective study, 320 samples were examined. A purposive sampling method was used, and data was collected using a researcher-made information form with content and face validity and reliability of r= 0.79. Data was analyzed with STATA9 software and statistical tests, including calculation of the success rate, relative risk (RR), chi-square and Fisher at significance level of P < 0.05. Results: The initial success rate of cardiopulmonary resuscitation was equal to 15.3%, while the ultimate success rate (discharged alive from the hospital) was as 10.6%. The six-month success rate after resuscitation was 8.78% than those who were discharged alive. There were no significant statistical differences between different age groups regarding the initial success rate of resuscitation (P = 0.14), and the initial resuscitation success rate was higher in patients in morning shift (P = 0.02). Conclusion: By the results of study, it is recommended to increase the medical - nursing knowledge and techniques for personnel in the evening and night shifts. Also, an appropriate dissemination of health care staff in working shifts should be done to increase the success rate of CPR procedure. PMID:25560341

  11. [Optimized logistics in the prehospital management of acute stroke].

    Science.gov (United States)

    Luiz, T; Moosmann, A; Koch, C; Behrens, S; Daffertshofer, M; Ellinger, K

    2001-12-01

    Current management of acute stroke is characterised by an aggressive approach including specific therapy i. e. reperfusion therapy. However currently stroke patients often arrive too late in hospitals offering adequate treatment. Therefore optimized logistics play a predominant role in modern stroke management. 1. Does teaching of EMS staff and the public result in reduced prehospital latencies 2. Will EMS personnel be able to effectively screen patients potentially suitable for thrombolysis? During a six week-period all EMS patients presenting with possible signs of an acute stroke were prospectively registered (period 1). Data of interest were age, mode of primary contact, prehospital latencies, mode of transportation, destination and final diagnosis. Next an algorithm was established allowing EMS personnel to transfer patients with an assumed stroke to the best suitable hospital. Teaching comprised clinical signs, indication of CT scanning, pathophysiology, specific therapeutic options (thrombolysis), and criteria to identify patients suitable for thrombolysis. In a second step the public was continuously taught about stroke symptoms and the necessity to instantly seek EMS assistance. After 12 months data were compared to baseline (period 2). (period 2 vs. Period 1): Rate of patients transferred to a stroke center: 60 % vs. 54 %; rate of those transported to hospitals not offering CT scans: 17 % vs. 26 % (p < 0.05). Percentage of patients primarily contacting the EMS system: 33 % vs. 24 %. Median interval between onset of symptoms and emergency call: 54 vs. 263 minutes Median interval between the emergency call and arrival at the emergency department: 44 vs. 58 minutes (p < 0.01). Rate of patients admitted with a diagnosis other than stroke: 18 % vs. 25 % (n. s.). Median interval between onset of symptoms and hospital admission: 140 vs. 368 minutes (p < 0.001). Median age: 69 vs. 75 years (p < 0.01). This study demonstrates the efficacy of educational efforts in

  12. Assessing the nosocomial infections' rate and the antibiotic resistance pattern among the patient hospitalized in beheshti hospital during 2013

    Directory of Open Access Journals (Sweden)

    Manijeh Kadkhodaei

    2018-01-01

    Full Text Available Aims: Nosocomial infection is associated with increased mortality, morbidity, and length of stay. Detection of infection, identify the etiology of bacterial antibiotic resistance pattern, is necessary given the widespread use of antibiotics and antibiotic-resistant organisms. Materials and Methods: This cross-sectional study was done on 288 patients admitted to the Beheshti Hospitals in Kashan based on NNIS definitions according to the state of Health and Medical education. In this study infections and antibiotic resistance symptoms were found. Data analyses were performed with Chi-square test. Results: Among the 288 patients studied, with mean out of hospital infection was 0.80%. Most cases of infection associated were pneumonia. The highest rates of infection were in the Intensive Care Unit (ICU with 51.7%. Nosocomial infection in ICU wards was associated with increased mortality and morbidity. The most common types were ventilator-associated pneumonia. Among the microorganisms, negative Gram was seen more. The common pathogens were including Acinetobacter, Escherichia coli, and Klebsiella. Antimicrobial resistance was generally increasing and had emerged from selective pressure from antibiotic use and transmission through health staff. Conclusion: This study showed a correlation between antibiotic use and resistance of microorganisms is significant. Hence, it seems that reducing aggressive acts and conduct hygiene education and monitoring act of antibiotics is necessary to prevent antibiotic resistance.

  13. Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

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    Atci Ibrahim Burak

    2017-12-01

    Full Text Available Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU, length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36% patients, 9-13 in 23 (46% patients and 3-8 in 9 (18% patients. The reasons for emergency department admissions were fall from high in 29 (58% patients, assault in 11 (22% patients and motor vehicle accident in 10 (20% patients. The average cost per ICU stay was 2838 $ (range=343-20571 $. The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients. Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.

  14. Neural Network for Determining Risk Rate of Post-Heart Stroke Patients

    Directory of Open Access Journals (Sweden)

    Oldřich Trenz

    2014-01-01

    Full Text Available The ischemic heart disease presents an important health problem that affects a great part of the population and is the cause of one third of all deaths in the Czech Republic. The availability of data describing the patients’ prognosis enables their further analysis, with the aim of lowering the patients’ risk, by proposing optimum treatment. The main reason for creating the neural network model is not only to automate the process of establishing the risk rate of patients suffering from ischemic heart disease, but also to adapt it for practical use in clinical conditions. Our aim is to identify especially the specific group of risk-rate patients whose well-timed preventive care can improve the quality and prolong the length of their lives.The aim of the paper is to propose a patient-parameter structure, using which we could create a suitable model based on a self-taught neural network. The emphasis is placed on identifying key descriptive parameters (in the form of a reduction of the available descriptive parameters that are crucial for identifying the required patients, and simultaneously to achieve a portability of the model among individual clinical workplaces (availability of parameters.

  15. Association between Search Behaviors and Disease Prevalence Rates at 18 U.S. Children's Hospitals.

    Science.gov (United States)

    Daniel, Dennis; Wolbrink, Traci; Logvinenko, Tanya; Harper, Marvin; Burns, Jeffrey

    2017-10-01

    Background Usage of online resources by clinicians in training and practice can provide insight into knowledge gaps and inform development of decision support tools. Although online information seeking is often driven by encountered patient problems, the relationship between disease prevalence and search rate has not been previously characterized. Objective This article aimed to (1) identify topics frequently searched by pediatric clinicians using UpToDate (http://www.uptodate.com) and (2) explore the association between disease prevalence rate and search rate using data from the Pediatric Health Information System. Methods We identified the most common search queries and resources most frequently accessed on UpToDate for a cohort of 18 children's hospitals during calendar year 2012. We selected 64 of the most frequently searched diseases and matched ICD-9 data from the PHIS database during the same time period. Using linear regression, we explored the relationship between clinician query rate and disease prevalence rate. Results The hospital cohort submitted 1,228,138 search queries across 592,454 sessions. The majority of search sessions focused on a single search topic. We identified no consistent overall association between disease prevalence and search rates. Diseases where search rate was substantially higher than prevalence rate were often infectious or immune/rheumatologic conditions, involved potentially complex diagnosis or management, and carried risk of significant morbidity or mortality. None of the examined diseases showed a decrease in search rate associated with increased disease prevalence rates. Conclusion This is one of the first medical learning needs assessments to use large-scale, multisite data to identify topics of interest to pediatric clinicians, and to examine the relationship between disease prevalence and search rate for a set of pediatric diseases. Overall, disease search rate did not appear to be associated with hospital

  16. [Who is rehospitalized in a psychiatric hospital? Psychiatric hospitalization rates and social indicators in the Zurich canton (Switzerland)].

    Science.gov (United States)

    Rüesch, P; Meyer, P C; Hell, D

    2000-03-01

    There are two approaches in the research on the relation between social conditions and mental disorder: The ecological approach is concerned with characteristics of the social composition of a certain geographical area and their relation to the frequency of disorders, whereas for the individualistic view variables of the psychosocial background of the individual are of interest. This study is on the risk for psychiatric admission (first and re-admission). While considering variables of the social context of the community as well as of the background of the individual, it tries to take into account both the ecological and the individualistic view of the relationship between social conditions and (treated) mental disorder. The sample of the study includes data of 4021 psychiatric inpatients treated in 1997 in one of the seven psychiatric hospitals of the Swiss canton of Zurich as well as data of social context of the 171 communities of the canton of Zurich. The psychiatric first and re-admission rates of the community can be predicted by the following variables of its social context: 1. pro portion of foreigners, 2. urban character of the living area, 3. population density. Two other variables are of relevance only for the prediction of first admissions: 4. proportion of one-person households and 5. local tax rate. However, further results of the study show that correlations between variables of the social context and psychiatric admission rate of the community cannot be interpreted as risks for the individual.

  17. MEMORY SONGS DECREASE DEPRESSION FOR STROKE PATIENTS

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    Harmayetty Harmayetty

    2017-07-01

    Full Text Available Introduction: Biological, physical and phsycosocial changes in stroke patient could be a stressor that induced a depression state. There would be an emotional disturbance in stroke patient and stroke attack would be recurrent, if it was not treated. One of the alternative techniques to reduce depression is musical therapy especially memory songs. Method: This study was used a quasy experimental pre-post test purposive sampling design. The population was stroke patients who treated in Neurological Ward A and Stroke Unit Dr Soetomo Hospital Surabaya. There were 12 respondents divided into 6 respondents for treatment group and 6 respondents for control group. The independent variable was music (memory song and dependent variable was depression. Data were collected by using questionnaire which adapted from Hamilton Depression Rating Scale and Geriatric Depression Rating Scale, then analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level α≤0.05. Result: The result showed that there was a difference between pre test and post test in depression (p=0.0196 and there was a difference in the depression between treatment group and control group (p=0.002. Discussion: It can be concluded that music (memory songs has an effect to the depression of stroke patient. Further studies are needed to concerning other factors that may affect the relaxation technique especially in listening music.

  18. Improved meal presentation increases food intake and decreases readmission rate in hospitalized patients.

    Science.gov (United States)

    Navarro, Daniela Abigail; Boaz, Mona; Krause, Ilan; Elis, Avishay; Chernov, Karina; Giabra, Mursi; Levy, Miriam; Giboreau, Agnes; Kosak, Sigrid; Mouhieddine, Mohamed; Singer, Pierre

    2016-10-01

    Reduced food intake is a frequent problem at a hospital setting, being a cause and/or consequence of malnutrition. Food presentation can affect food intake and induce nutritional benefit. To investigate the effect of improved meal presentation supported by gastronomy expertise on the food intake in adults hospitalized in internal medicine departments. Controlled before and after study. Two hundred and six newly hospitalized patients in internal medicine departments were included and divided in two groups, a) control: receiving the standard lunch from the hospital and b) experimental: receiving a lunch improved in terms of presentation by the advices received by the Institut Paul Bocuse, Ecully, Lyon, France together with the hospital kitchen of the Beilinson Hospital, without change in the composition of the meal. The amount of food left at the participants' plates was estimated using the Digital Imaging Method, which consisted in photographing the plates immediately to previous tray collection by the researcher. In addition, the nutritionDay questionnaire was used to measure other variables concerned to their food intake during hospitalization. Charlson Comorbidity Index was calculated. There was no significant difference between the groups regarding demography or Charlson Comorbidity Index. Patients who received the meal with the improved presentation showed significantly higher food intake than those who received the standard meal, despite reported loss in appetite. Participants from the experimental group left on their plate less starch (0.19 ± 0.30 vs. 0.52 + 0.41) (p  0.05). Both of the groups were asked how hungry they were before the meal and no significance was shown. More participants from the experimental group reported their meal to be tasty in comparison to those in the control group (49.5% vs. 33.7% p < 0.005). Length of stay was not different but readmission rate decreased significantly in the study group (p < 0.02) from 31.2% to 13

  19. Early infection and prognosis after acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Reith, J

    2001-01-01

    Infection is a frequent complication in the early course of acute stroke and may adversely affect stroke outcome. In the present study, we investigate early infection developing in patients within 3 days of admission to the hospital and its independent relation to recovery and stroke outcome....... In addition, we identify predictors for early infections, infection subtypes, and their relation to initial stroke severity....

  20. The High Prevalence of Anxiety Disorders After Stroke.

    Science.gov (United States)

    Cumming, Toby B; Blomstrand, Christian; Skoog, Ingmar; Linden, Thomas

    2016-02-01

    Previous studies indicate that post-stroke anxiety is common and persistent. We aimed to determine whether point prevalence of anxiety after stroke is higher than in the population at large, and whether the profile of anxiety symptoms is different. This case-control study was conducted in Göteborg, Sweden, with stroke patients recruited from the Sahlgrenska University Hospital and a comparison group selected from local population health studies. We included 149 stroke survivors (assessed at 20 months post-stroke) and 745 participants from the general population matched for age and sex. A comprehensive psychiatric interview was conducted, with anxiety and depressive disorders diagnosed according to DSM-III-R criteria. Those in the stroke group were significantly more likely than those in the comparison group to have generalized anxiety disorder (GAD) (27% versus 8%), phobic disorder (24% versus 8%) and obsessive-compulsive disorder (9% versus 2%). Multivariate regression indicated that being in the stroke group, female sex, and having depression were all significant independent associates of having an anxiety disorder. In terms of symptom profile, stroke survivors with GAD were significantly more likely to report vegetative disturbance than those in the comparison group with GAD but less likely to have observable muscle tension or reduced sleep. Point prevalence of anxiety disorders is markedly higher after stroke than in the general population, and this cannot be attributed to higher rates of comorbid depression. Copyright © 2016. Published by Elsevier Inc.

  1. Effect of the racket mass and the rate of strokes on kinematics and kinetics in the table tennis topspin backhand.

    Science.gov (United States)

    Iino, Yoichi; Kojima, Takeji

    2016-01-01

    The purpose of this study was to investigate the effect of the racket mass and the rate of strokes on the kinematics and kinetics of the trunk and the racket arm in the table tennis topspin backhand. Eight male Division I collegiate table tennis players hit topspin backhands against topspin balls projected at 75 balls · min(-1) and 35 balls · min(-1) using three rackets varying in mass of 153.5, 176 and 201.5 g. A motion capture system was used to obtain trunk and racket arm motion data. The joint torques of the racket arm were determined using inverse dynamics. The racket mass did not significantly affect all the trunk and racket arm kinematics and kinetics examined except for the wrist dorsiflexion torque, which was significantly larger for the large mass racket than for the small mass racket. The racket speed at impact was significantly lower for the high ball frequency than for the low ball frequency. This was probably because pelvis and upper trunk axial rotations tended to be more restricted for the high ball frequency. The result highlights one of the advantages of playing close to the table and making the rally speed fast.

  2. Ecological investigation, density, infestation rate and control strategy of German cockroach, Blattella germanica (L. in two hospitals in Ismailia, Egypt

    Directory of Open Access Journals (Sweden)

    M.F. Mahmoud

    2013-12-01

    Full Text Available A study was conducted to investigate the ecological situation, density, infestation rate and control strategy of German cockroach, Blattella germanica indoors in two hospitals in Ismailia Governorate, Egypt. The sticky traps method was used for 12 months in 2012. The cockroach index, sanitation and ventilation rate tables were tools to investigate the effectiveness of sanitation and related factors on B. germanica in Ismailia. Results showed that the population density of B. germanica increased gradually from January to July, and then decreased gradually till December of 2012 in both hospitals. The population density of B. germanica captured from hospital 1 (urban was higher than hospital 2 (rural in all months. Moreover, the number of German cockroach caught from different apartments in both hospitals was very significant different. Among these apartments, kitchen had the highest number of German cockroach, density, infestation rate and percent of nymphs. The highest population density was in kitchen (298.44, followed by dry food store (69.99, furniture room (25.91 and patient room (8.94, for hospital 1. However, the population was low in all apartments in hospital 2. Although several stages of B. germanica were caught from two hospitals, nymphs showed the higher infestation rate in all apartments surveyed in both hospitals. The infestation rate of nymphs was 92.5% in hospital 1 and 63.06% in hospital 2. In addition, temperature and humidity were measured in hospitals to study the relationship between population density of B. germanica and these parameters. There was a positive correlation between temperature and the population density for hospital 1 and for hospital 2. The correlation was negative between humidity and population density in both hospitals. In conclusion, integrated control measures should be taken according to the seasonal fluctuation, population density in hospitals in Ismailia. It should put the emphasis on environmental

  3. Emergency Medical Services Support for Acute Ischemic Stroke Patients Receiving Thrombolysis at a Primary Stroke Center

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    Byron R. Spencer

    2009-01-01

    Full Text Available Background Emergency Medical Services (EMS is a vital link in the overall chain of stroke survival. A Primary Stroke Center (PSC relies heavily on the 9-1-1 response system along with the ability of EMS personnel to accurately diagnose acute stroke. Other critical elements include identifying time of symptom onset, providing pre-hospital care, selecting a destination PSC, and communicating estimated time of arrival (ETA. Purpose Our purpose was to evaluate the EMS component of thrombolysed acute ischemic stroke patient care at our PSC. Methods In a retrospective manner we retrieved electronic copies of the EMS incident reports for every thrombolysed ischemic stroke patient treated at our PSC from September 2001 to August 2005. The following data elements were extracted: location of victim, EMS agency, times of dispatch, scene, departure, emergency department (ED arrival, recordings of time of stroke onset, blood pressure (BP, heart rate (HR, cardiac rhythm, blood glucose (BG, Glasgow Coma Scale (GCS, Cincinnati Stroke Scale (CSS elements, emergency medical personnel field assessment, and transport decision making. Results Eighty acute ischemic