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https://www.readbyqxmd.com/read/28153014/towards-best-practice-in-acute-stroke-care-in-ghana-a-survey-of-hospital-services
#1
Leonard Baatiema, Michael Otim, George Mnatzaganian, Ama De-Graft Aikins, Judith Coombes, Shawn Somerset
BACKGROUND: Stroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice...
February 2, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28144702/endovascular-thrombectomy-in-acute-ischemic-stroke-outcome-in-referred-versus-directly-admitted-patients
#2
Philipp Bücke, Marta Aguilar Pérez, Elisabeth Schmid, Christian H Nolte, Hansjörg Bäzner, Hans Henkes
PURPOSE: Endovascular mechanical thrombectomy (mTE) in acute ischemic stroke due to large cerebral artery occlusion is effective and safe. The procedure is currently offered by specialized hospitals. Physicians from smaller hospitals need to refer patients to stroke centers. Secondary referrals involve delays for transportation. Little is known about effects of distant referrals on outcome and complications as compared to direct admittance. METHODS: To evaluate the effects of referral patterns on outcome and safety, we analyzed 941 patients with anterior circulation stroke receiving mTE between January 2010 and December 2015...
January 31, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28110987/outcomes-for-emergency-department-patients-with-recent-onset-atrial-fibrillation-and-flutter-treated-in-canadian-hospitals
#3
Ian G Stiell, Catherine M Clement, Brian H Rowe, Robert J Brison, D George Wyse, David Birnie, Paul Dorian, Eddy Lang, Jeffrey J Perry, Bjug Borgundvaag, Debra Eagles, Damian Redfearn, Jennifer Brinkhurst, George A Wells
STUDY OBJECTIVE: Recent-onset atrial fibrillation and flutter are the most common arrhythmias managed in the emergency department (ED). We evaluate the management and 30-day outcomes for recent-onset atrial fibrillation and flutter patients in Canadian EDs, where cardioversion is commonly practiced. METHODS: We conducted a prospective cohort study in 6 academic hospital EDs and enrolled patients who had atrial fibrillation and flutter onset within 48 hours. Patients were followed for 30 days by health records review and telephone...
January 19, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28056095/ischemic-bowel-syndrome-in-patients-with-spinal-cord-injury-a-nationwide-study
#4
Chih-Wei Tseng, Cheng-Li Lin, Yu-Tso Chen, Long-Bin Jeng
PURPOSE: The aim of this study was to determine whether spinal cord injuries (SCI) is associated with increased risk of ischemic bowel syndrome (IBS) in an Asian population by analyzing data from the National Health Insurance Research Database (NHIRD) in Taiwan. METHODS: Patients aged ≥20 years in the inpatient database with newly identified SCI from 2000 to 2011 were selected as the SCI cohort. For the non-SCI cohort, patients were selected based on a 1:4 risk-set sampling...
2017: PloS One
https://www.readbyqxmd.com/read/28039855/use-of-oral-anticoagulant-therapy-in-older-adults-with-atrial-fibrillation-after-acute-ischemic-stroke
#5
Emer R McGrath, Alan S Go, Yuchiao Chang, Leila H Borowsky, Margaret C Fang, Kristi Reynolds, Daniel E Singer
OBJECTIVES: To explore barriers to anticoagulation in older adults with atrial fibrillation (AF) at high risk of stroke and to identify opportunities for interventions that might increase use of oral anticoagulants (OACs). DESIGN: Retrospective cohort study. SETTING: Two large community-based AF cohorts. PARTICIPANTS: Individuals with ischemic stroke surviving hospitalization (N = 1,405, mean age 79). MEASUREMENTS: Using structured chart review, reasons for nonuse of OAC were identified, and 1-year poststroke survival was assessed...
February 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27895242/availability-of-endovascular-therapies-for-cerebrovascular-disease-at-primary-stroke-centers
#6
Mark J Alberts, Jean Range, William Spencer, Vicki Cantwell, M J Hampel
BACKGROUND: Endovascular therapies (EVTs) are useful for treating cerebrovascular disease. There are few data about the availability of such services at primary stroke centers (PSCs). Our hypothesis was that some of these services may be available at some PSCs. METHODS: We conducted an internet-based survey of hospitals certified as PSCs by the Joint Commission. The survey inquired about EVTs such as intra-arterial (IA) lytics, IA mechanical clot removal, coiling of aneurysms, and cervical arterial stenting, physician training, coverage models, hospital type, and outcomes...
November 28, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27871433/regional-variation-in-acute-stroke-care-organisation
#7
Paula Muñoz Venturelli, Thompson Robinson, Pablo M Lavados, Verónica V Olavarría, Hisatomi Arima, Laurent Billot, Maree L Hackett, Joyce Y Lim, Sandy Middleton, Octavio Pontes-Neto, Bin Peng, Liying Cui, Lily Song, Gillian Mead, Caroline Watkins, Ruey-Tay Lin, Tsong-Hai Lee, Jeyaraj Pandian, H Asita de Silva, Craig S Anderson
BACKGROUND: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). METHODS: HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke...
December 15, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27768752/use-of-a-diagnostic-score-to-prioritize-computed-tomographic-ct-imaging-for-patients-suspected-of-ischemic-stroke-who-may-benefit-from-thrombolytic-therapy
#8
Wen Yea Hwong, Michiel L Bots, Sharmini Selvarajah, L Jaap Kappelle, Zariah Abdul Aziz, Norsima Nazifah Sidek, Ilonca Vaartjes
BACKGROUND: A shortage of computed tomographic (CT) machines in low and middle income countries often results in delayed CT imaging for patients suspected of a stroke. Yet, time constraint is one of the most important aspects for patients with an ischemic stroke to benefit from thrombolytic therapy. We set out to assess whether application of the Siriraj Stroke Score is able to assist physicians in prioritizing patients with a high probability of having an ischemic stroke for urgent CT imaging...
2016: PloS One
https://www.readbyqxmd.com/read/27760870/increasing-comorbidity-and-health-services-utilization-in-older-adults-with-prior-stroke
#9
Andrea Gruneir, Lauren E Griffith, Kathryn Fisher, Dilzayn Panjwani, Sima Gandhi, Li Sheng, Chris Patterson, Amiram Gafni, Jenny Ploeg, Maureen Markle-Reid
OBJECTIVE: To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. METHODS: This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions...
November 15, 2016: Neurology
https://www.readbyqxmd.com/read/27750249/how-reliable-are-administrative-data-for-capturing-stroke-patients-and-their-care
#10
Joan Porter, Luke Mondor, Moira K Kapral, Jiming Fang, Ruth E Hall
BACKGROUND/AIMS: The reliability of diagnostic coding of acute stroke and transient ischemic attack (TIA) in administrative data is uncertain. The purpose of this study is to determine the agreement between administrative data sources and chart audit for the identification of stroke type, stroke risk factors, and the use of hospital-based diagnostic procedures in patients with stroke or TIA. METHODS: Medical charts for a population-based sample of patients (n = 14,508) with ischemic stroke, intracerebral hemorrhage (ICH), or TIA discharged from inpatient and emergency departments (ED) in Ontario, Canada, between April 1, 2012 and March 31, 2013, were audited by trained abstractors...
October 18, 2016: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/27698281/why-do-transient-ischemic-attack-patients-have-higher-early-stroke-recurrence-risk-than-those-with-ischemic-stroke-influence-of-patient-behavior-and-other-risk-factors-in-the-north-dublin-population-stroke-study
#11
Layan Akijian, Danielle Ní Chróinín, Elizabeth Callaly, Niamh Hannon, Michael Marnane, Áine Merwick, Órla Sheehan, Derek Hayden, Gillian Horgan, Joseph Duggan, Lorraine Kyne, Killian O'Rourke, Sean Murphy, Eamon Dolan, David Williams, Peter J Kelly
Background Few studies have directly compared stroke recurrence rates after stroke and transient ischemic attack, and the risk factors underlying early recurrence are poorly understood. We aimed to investigate risk factors for recurrent stroke after first stroke and transient ischemic attack in a population-based study. Methods The North Dublin Population Stroke Study applied multiple overlapping hot and cold pursuit methods, to ascertain hospital- and community-treated stroke and transient ischemic attack patients over a 12-month period...
January 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27678127/the-influence-of-emergency-department-crowding-on-the-efficiency-of-care-for-acute-stroke-patients
#12
Ming-Ta Tsai, Yung-Lin Yen, Chih-Min Su, Chih-Wei Hung, Chia-Te Kung, Kuan-Han Wu, Hsien-Hung Cheng
OBJECTIVE: To investigate the impact of emergency department (ED) crowding (number of ED patients) and number of ED staff on the efficiency of the ED care process for acute stroke patients. DESIGN: Retrospective cohort study conducted from 1 May 2008 to 31 December 2013. SETTING: Largest primary stroke center (3000-bed tertiary academic hospital) in southern Taiwan. PARTICIPANTS: Patients aged 18-80 years presenting to the ED with acute stroke symptoms ≤3 h from symptom onset (n = 1142)...
September 27, 2016: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/27580820/effects-of-a-health-promotion-program-on-medication-adherence-to-antiplatelet-therapy-among-ischemic-stroke-patients-in-hainan-province-china
#13
Qingjie Su, Chaoyun Li, Faqing Long, Bin Chen, Zhongqin Wan, Yingman Wu, Mingming Dai, Desheng Wang, Yuhui Zhang, Bufei Wang
Survivors of ischemic stroke are still at a significant risk for recurrence. Antiplatelet agents are the treatment of first choice for long-term secondary prevention of vascular events. This study aims to assess a health promotion program on medication adherence to antiplatelet therapy among ischemic stroke patients in Hainan province, China. In five hospitals from the intervention group, four highly experienced physicians trained 62 neurologists, who in turn trained 613 stroke patients to improve their awareness and adherence to antiplatelet therapy...
August 31, 2016: Vascular
https://www.readbyqxmd.com/read/27579967/collaborative-care-on-the-stroke-unit-a-cross-sectional-outcomes-study
#14
Janet G Wood
OBJECTIVE: The aim of this study was to evaluate the economic and quality outcomes associated with a collaborative advanced practice nurse and hospitalist physician model of care on the inpatient stroke unit as compared with usual hospitalist physician-led care. BACKGROUND: High functioning collaborative teams are anticipated to be essential under value-based reimbursement. METHODS: Hospitalist nurse practitioners were assigned to the stroke unit in collaboration with hospitalist physicians to implement daily hospital management for patients with stroke and transient ischemic attack...
October 2016: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/27566677/an-investigation-of-the-use-of-acupuncture-in-stroke-patients-in-taiwan-a-national-cohort-study
#15
Shu-Wen Weng, Ta-Liang Chen, Chun-Chieh Yeh, Chien-Chang Liao, Hsin-Long Lane, Jaung-Geng Lin, Chun-Chuan Shih
BACKGROUND: Acupuncture is considered a complementary and alternative medicine in many countries. The purpose of this study was to report the pattern of acupuncture use and associated factors in patients with stroke. METHODS: We used claims data from Taiwan's National Health Insurance Research Database and identified 285001 new-onset stroke patients in 2000-2008 from 23 million people allover Taiwan. The use of acupuncture treatment after stroke within one year was identified...
August 26, 2016: BMC Complementary and Alternative Medicine
https://www.readbyqxmd.com/read/27545856/ischemic-stroke-after-wasp-sting
#16
Ashish Kulhari, Ashley Rogers, Han Wang, Vishakhadatta Mathur Kumaraswamy, Wei Xiong, Michael DeGeorgia
BACKGROUND: Despite the common occurrence of hymenopteran stings worldwide, primary neurologic manifestations including stroke are rare. We report a case of a healthy male who developed a right middle cerebral artery (MCA) territory ischemic stroke after getting stung by a wasp. CASE REPORT: A 44-year-old man with hypertension presented to the hospital with sudden-onset left hemiparesis, left facial weakness, and dysarthria after being stung by a wasp. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) scans of the brain revealed a right MCA territory infarct and a lack of flow in the distal right internal carotid artery and MCA...
October 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27435204/medicare-claims-indicators-of-healthcare-utilization-differences-after-hospitalization-for-ischemic-stroke-race-gender-and-caregiving-effects
#17
David L Roth, Orla C Sheehan, Jin Huang, James D Rhodes, Suzanne E Judd, Meredith Kilgore, Brett Kissela, Janet Prvu Bettger, William E Haley
Background Differences in healthcare utilization after stroke may partly explain race or gender differences in stroke outcomes and identify factors that might reduce post-acute stroke care costs. Aim To examine systematic differences in Medicare claims for healthcare utilization after hospitalization for ischemic stroke in a US population-based sample. Methods Claims were examined over a six-month period after hospitalization for 279 ischemic stroke survivors 65 years or older from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study...
October 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27419905/low-density-lipoprotein-cholesterol-levels-and-lipid-modifying-therapy-prescription-patterns-in-the-real-world-an-analysis-of-more-than-33-000-high-cardiovascular-risk-patients-in-japan
#18
Tamio Teramoto, Kiyoko Uno, Izuru Miyoshi, Irfan Khan, Katherine Gorcyca, Robert J Sanchez, Shigeto Yoshida, Kazuhiro Mawatari, Tomoya Masaki, Hidenori Arai, Shizuya Yamashita
BACKGROUND AND AIMS: Low-density lipoprotein cholesterol (LDL-C) is a key modifiable risk factor in the development of cardiovascular (CV) disease. In 2012, the Japan Atherosclerosis Society (JAS) issued guidelines recommending statins as first-line pharmacotherapy for lowering LDL-C in patients at high risk for CV events. This study assessed achievement of recommended LDL-C goals and lipid-modifying therapy (LMT) use in a high CV risk population in Japan. METHODS: Patients from the Medical Data Vision (MDV) database, an electronic hospital-based claims database in Japan, who met the following inclusion criteria were included in this study: LDL-C measurement in 2013; ≥20 years of age; ≥2 years representation in the database; and a high CV risk condition (recent acute coronary syndrome (ACS), other coronary heart disease (CHD), ischemic stroke, peripheral arterial disease (PAD) or diabetes)...
August 2016: Atherosclerosis
https://www.readbyqxmd.com/read/27336904/-weekend-effect-on-stroke-mortality-revisited-application-of-a-claims-based-stroke-severity-index-in-a-population-based-cohort-study
#19
Cheng-Yang Hsieh, Huey-Juan Lin, Chih-Hung Chen, Chung-Yi Li, Meng-Jun Chiu, Sheng-Feng Sung
Previous studies have yielded inconsistent results on whether weekend admission is associated with increased mortality after stroke, partly because of differences in case mix. Claims-based studies generally lack sufficient information on disease severity and, thus, suffer from inadequate case-mix adjustment. In this study, we examined the effect of weekend admission on 30-day mortality in patients with ischemic stroke by using a claims-based stroke severity index.This was an observational study using a representative sample of the National Health Insurance claims data linked to the National Death Registry...
June 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27333939/drip-and-ship-thrombolytic-therapy-supported-by-the-telestroke-system-for-acute-ischemic-stroke-patients-living-in-medically-under-served-areas
#20
Teruyoshi Kageji, Fumiaki Obata, Hirofumi Oka, Yasuhisa Kanematsu, Ryo Tabata, Kenji Tani, Hiroyasu Bando, Shinji Nagahiro
There are a few stroke specialists in medically under-served areas in Japan. Consequently, in remote area patients may not receive thrombolysis with intravenous recombinant tissue plasminogen activator (iv rt-PA), the standard treatment for acute ischemic stroke. Using a mobile telestroke support system (TSS) that accesses the internet via a smart phone, we implemented iv rt-PA infusion therapy under a drip-and-ship protocol to treat the stroke patients in medically under-served areas. The physicians at the Tokushima Prefectural Kaifu Hospital (TPKH), located in rural Japan, can relay CT or MRI scans and other patient data via their smart phone to off-site stroke specialists...
December 15, 2016: Neurologia Medico-chirurgica
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