scholarly journals Towards Personalized Web-based Cognitive Rehabilitation for Patients with Ischemic Stroke: An Elo Rating Approach (Preprint)

10.2196/28090 ◽  
2021 ◽  
Author(s):  
Alejandro Garcia-Rudolph ◽  
Jaume Lopez ◽  
Eloy Opisso ◽  
Josep Maria Tormos ◽  
Vince I. Madai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Rehabilitation ◽  
Web Based

Towards Personalized Web-based Cognitive Rehabilitation for Patients with Ischemic Stroke: An Elo Rating Approach (Preprint)

2021 ◽  
Author(s):  
Alejandro Garcia-Rudolph ◽  
Jaume Lopez ◽  
Eloy Opisso ◽  
Josep Maria Tormos ◽  
Vince I. Madai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Verbal Memory ◽  
Cognitive Rehabilitation ◽  
Treated Patient ◽  
Inpatient Rehabilitation ◽  
Operating Characteristics ◽  
Web Based ◽  
Rehabilitation Outcomes ◽  
Number Of Patients ◽  
The Impact

BACKGROUND Stroke is a worldwide cause of disability, 40% of stroke survivors sustain cognitive impairments, most of them follow inpatient rehabilitation at specialized clinical centers. Web-based cognitive rehabilitation tasks are already integrated into clinical settings. The impact of a task execution depends on the ratio between the skills of the treated patient and the challenges imposed by the task itself. Thus, treatments personalization requires a trade-off between patients’ skills and tasks difficulties, which is still an open issue. In this work we propose Elo ratings to support clinicians in representing patients’ skills and supporting tasks assignations to optimize rehabilitation outcomes. OBJECTIVE i) perform a stratification of patients with ischemic stroke at early stage of rehabilitation in three levels according to their Elo rating ii) show the relationships between the Elo rating levels, tasks difficulty levels and rehabilitation outcomes iii) determine if Elo rating obtained at early stages of rehabilitation is a significant predictor of rehabilitation outcomes. METHODS The PlayerRatings R library was used to obtain the Elo rating for each patient. Working memory was assessed using the DIGITS subtest of Test Barcelona and the Rey Auditory Verbal Memory Test (RAVLT) was used to assess verbal memory. The three subtests of RAVLT were used: RAVLT learning (RAVLT075), free-recall memory (RAVLT015) and recognition (RAVLT015R). Memory predictors were identified using forward stepwise selection to add covariates to the models which were evaluated by assessing discrimination using the area under the receiver operating characteristics curve (AUC) for logistic regressions and adjusted R2 for linear regressions. RESULTS Three Elo levels (Low, Mid and High) with the same number of patients (n=96) in each Elo group, were obtained using the 50 initial tasks executions (from a total of 38,177) for n=288 adult patients consecutively admitted for inpatient rehabilitation in a clinical setting. The highest proportion of patients that improved in all 4 memory items were from Mid Elo level: 56.7% of them improved in DIGITS, 67.1% in RAVLT075, 58.8% in RAVLT015 and 53.7% in RAVLT015R (p < 0.001). The proportion of patients from the Mid Elo level that performed tasks at difficulty levels #1, #2 and #3 were: 32.1%, 31.0% and 36.9% (p < 0.001) respectively, showing the highest match between skills (represented by Elo level) and tasks difficulties, considering the set of 38,177 tasks executions. Elo ratings were significant predictors in 3 of the 4 models and quasi-significant in the other. When predicting RAVLT075 and DIGITS at discharge we obtained R2=0.54 and R2=0.43 respectively, meanwhile in RAVLT075 and DIGITS improvement predictions we obtained AUC= 0.73, 95% CI(0.64-0.82) and AUC= 0.81 95%CI(0.72-0.89). CONCLUSIONS Elo ratings can support clinicians at early rehabilitation stages in identifying cognitive profiles that can be used to assign tasks’ difficulty levels.

Abstract 205: Etiologic Ischemic Stroke Phenotypes in the NINDS Stroke Genetics Network

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Hakan Ay ◽  
Ethem M Arsava ◽  
Robert D. Brown ◽  
Steven J Kittner ◽  
Jin-Moo Lee ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Geographic Location ◽  
Quality Data ◽  
High Quality ◽  
Good Reliability ◽  
Web Based ◽  
Stroke Subtypes ◽  
Phenotype Data ◽  
Epidemiological Characteristics

Background and Purpose: NINDS Stroke Genetics Network (SiGN) is an international consortium of ischemic stroke studies that aims to generate high quality phenotype data to identify the genetic basis of ischemic stroke subtypes. The goal of this analysis is to characterize the etiopathogenetic basis of ischemic stroke in the consortium. Methods: This analysis included 16,954 subjects with imaging-confirmed ischemic stroke from 12 US studies and 11 studies from 8 European countries. 52 trained and certified adjudicators used the web-based Causative Classification of Stroke System for etiologic stroke classification through chart reviews to determine both phenotypic (abnormal test findings categorized in major etiologic groups without weighting towards the most likely cause in the presence of multiple etiologies) and causative subtypes in each subject. Classification reliability was assessed with blinded re-adjudication of 1509 randomly selected cases. Findings: The figure shows the distribution of etiologic categories. Overall, only 40% to 54% of cases with a given major ischemic stroke etiology (phenotypic subtype) were classified into the same final causative category with high confidence. There was good agreement for both causative (kappa 0·72, 95%CI:0·69-0·75) and phenotypic classifications (kappa 0·73, 95%CI:0·70-0·75). Conclusions: This study provides high quality data on etiologic stroke subtypes and demonstrates that etiologic subtypes can be determined with good reliability in studies that include investigators with different expertise and background, institutions with different stroke evaluation protocols and geographic location, and patient populations with different epidemiological characteristics. The discordance between phenotypic and causative stroke subtypes suggests that the presence of an abnormality in a stroke patient does not necessarily mean that it is the cause of stroke.

scholarly journals Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

2017 ◽  
Vol 75 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Octávio Marques Pontes-Neto ◽  
Pedro Cougo ◽  
Sheila Cristina Ouriques Martins ◽  
Daniel G. Abud ◽  
Raul G. Nogueira ◽  
...  
Keyword(s):  
Health Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Health Care Providers ◽  
Cerebrovascular Diseases ◽  
Discussion Forums ◽  
Care Providers ◽  
Web Based ◽  
Health Authorities ◽  
Public Health Authorities

ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.

scholarly journals Personalized Web-Based Cognitive Rehabilitation Treatments for Patients with Traumatic Brain Injury: Cluster Analysis (Preprint)

2019 ◽  
Author(s):  
Alejandro Garcia-Rudolph ◽  
Alberto Garcia-Molina ◽  
Eloy Opisso ◽  
Jose Tormos Muñoz
Keyword(s):  
Cluster Analysis ◽  
Cognitive Rehabilitation ◽  
External Validation ◽  
Functional Independence ◽  
Cluster Validity ◽  
Web Based ◽  
Highly Educated ◽  
Cluster Validity Indices ◽  
Validity Indices ◽  
R Packages

BACKGROUND Traumatic brain injury (TBI) is a leading cause of disability worldwide. TBI is a highly heterogeneous disease, which makes it complex for effective therapeutic interventions. Cluster analysis has been extensively applied in previous research studies to identify homogeneous subgroups based on performance in neuropsychological baseline tests. Nevertheless, most analyzed samples are rarely larger than a size of 100, and different cluster analysis approaches and cluster validity indices have been scarcely compared or applied in web-based rehabilitation treatments. OBJECTIVE The aims of our study were as follows: (1) to apply state-of-the-art cluster validity indices to different cluster strategies: hierarchical, partitional, and model-based, (2) to apply combined strategies of dimensionality reduction by using principal component analysis and random forests and perform stability assessment of the final profiles, (3) to characterize the identified profiles by using demographic and clinically relevant variables, and (4) to study the external validity of the obtained clusters by considering 3 relevant aspects of TBI rehabilitation: Glasgow Coma Scale, functional independence measure, and execution of web-based cognitive tasks. METHODS This study was performed from August 2008 to July 2019. Different cluster strategies were executed with Mclust, factoextra, and cluster R packages. For combined strategies, we used the FactoMineR and random forest R packages. Stability analysis was performed with the fpc R package. Between-group comparisons for external validation were performed using 2-tailed t test, chi-square test, or Mann-Whitney U test, as appropriate. RESULTS We analyzed 574 adult patients with TBI (mostly severe) who were undergoing web-based rehabilitation. We identified and characterized 3 clusters with strong internal validation: (1) moderate attentional impairment and moderate dysexecutive syndrome with mild memory impairment and normal spatiotemporal perception, with almost 66% (111/170) of the patients being highly educated (<i>P</i>&lt;.05); (2) severe dysexecutive syndrome with severe attentional and memory impairments and normal spatiotemporal perception, with 49.2% (153/311) of the patients being highly educated (<i>P</i>&lt;.05); (3) very severe cognitive impairment, with 45.2% (42/93) of the patients being highly educated (<i>P</i>&lt;.05). We externally validated them with severity of injury (<i>P</i>=.006) and functional independence assessments: cognitive (<i>P</i>&lt;.001), motor (<i>P</i>&lt;.001), and total (<i>P</i>&lt;.001). We mapped 151,763 web-based cognitive rehabilitation tasks during the whole period to the 3 obtained clusters (<i>P</i>&lt;.001) and confirmed the identified patterns. Stability analysis indicated that clusters 1 and 2 were respectively rated as 0.60 and 0.75; therefore, they were measuring a pattern and cluster 3 was rated as highly stable. CONCLUSIONS Cluster analysis in web-based cognitive rehabilitation treatments enables the identification and characterization of strong response patterns to neuropsychological tests, external validation of the obtained clusters, tailoring of cognitive web-based tasks executed in the web platform to the identified profiles, thereby providing clinicians a tool for treatment personalization, and the extension of a similar approach to other medical conditions.

scholarly journals A Web-Based Clinical System for Cohort Surveillance of Specific Clinical Effectiveness and Safety Outcomes: A Cohort Study of Non–Vitamin K Antagonist Oral Anticoagulants and Warfarin

10.2196/13329 ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. e13329 ◽  
Author(s):  
Fong-Ci Lin ◽  
Shih-Tsung Huang ◽  
Rung Ji Shang ◽  
Chi-Chuan Wang ◽  
Fei-Yuan Hsiao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Surveillance System ◽  
Adverse Drug Events ◽  
Medical Center ◽  
Oral Anticoagulants ◽  
Critical Role ◽  
Clinical Effectiveness ◽  
University Hospital ◽  
Drug Surveillance ◽  
Web Based

Background Conventional systems of drug surveillance lack a seamless workflow, which makes it crucial to have an active drug surveillance system that proactively assesses adverse drug events. Objective The aim of this study was to develop a seamless, Web-based workflow for comparing the safety and effectiveness of drugs in a database of electronic medical records. Methods We proposed a comprehensive integration process for cohort surveillance using the National Taiwan University Hospital Clinical Surveillance System (NCSS). We studied a practical application of the NCSS that evaluates the drug safety and effectiveness of novel oral anticoagulants (NOACs) and warfarin by cohort tree analysis in an efficient and interoperable platform. Results We demonstrated a practical example of investigating the differences in effectiveness and safety between NOACs and warfarin in patients with nonvalvular atrial fibrillation (AF) using the NCSS. We efficiently identified 2357 patients with nonvalvular AF with newly prescribed oral anticoagulants between 2010 and 2015 and further developed 1 main cohort and 2 subcohorts for separately measuring ischemic stroke as the clinical effectiveness outcome and intracranial hemorrhage (ICH) as the safety outcome. In the subcohort of ischemic stroke, NOAC users exhibited a significantly lower risk of ischemic stroke than warfarin users after adjusting for age, sex, comorbidity, and comedication in an intention-to-treat (ITT) analysis (P=.01) but did not exhibit a significantly distinct risk in an as-treated (AT) analysis (P=.12) after the 2-year follow-up. In the subcohort of ICH, NOAC users did not exhibit a different risk of ICH both in ITT (P=.68) and AT analyses (P=.15). Conclusions With a seamless and Web-based workflow, the NCSS can serve the critical role of forming associations between evidence and the real world at a medical center in Taiwan.

Abstract 2597: Centralized and Study-specific Phenotyping in a Large-scale Stroke Genetics Study: An Analysis from the NINDS Stroke Genetics Network (SiGN)

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Bradford B Worrall ◽  
Alejandro Rabinstein ◽  
Dale M Gamble ◽  
Kevin M Barrett ◽  
Shaneela Malik ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Large Scale ◽  
Association Studies ◽  
Web Based ◽  
Stroke Treatment ◽  
Automated Algorithm ◽  
Genome Association ◽  
Whole Genome Association ◽  
Toast Classification ◽  
User Friendly

Background: The Stroke Genetics Network (SiGN) funded by the NINDS aims to identify genetic risk factors in ischemic stroke using whole-genome association studies (GWAS). High quality phenotyping is crucial to successful application of GWAS. As a heterogenous disorder, stroke poses specific challenges. The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification is a broadly used, but its validity is challenged especially when performed by multiple investigators with differing interpretations of the system. The Causative Classification System for Ischemic Stroke (CCS) system is a new, web-based, and computerized algorithm that integrates clinical, diagnostic, and etiologic stroke characteristics in an evidence-based manner ( ccs.mgh.harvard.edu ) to generate subtypes. Methods: In planning the SiGN proposal, a sample of 20 coded charts were collected from a subset of participating studies to assess feasibility of central adjudication and comparability to study-specific TOAST. Two central adjudicators reviewed all records and generated TOAST and CCS subtypes. These were compared to study-specific TOAST subtype and the CCS phenotype generated for SiGN by local trained adjudicators. CCS data is now available for 7134 included cases using both a 5 and a 7 category system as defined in the table . Results: All 4 phenotypes were available for 115 ischemic stroke cases from 6 studies in SiGN. Basic demographics were 54% women, 63% white, and median age between 65-74. Table 1 provides the agreement between the various subtypes. Table 2 describes the types of disagreement. Conclusions: Central adjudication with only two adjudicators and curated medical records yielded more consistent subtyping independent of phenotyping system. The agreement for TOAST was higher than published rates by independent groups (∼0.50). In contrast, the agreement for CCS was lower than previously published (0.85-0.95). Site adjudicators' familiarity with TOAST and inexperience with CCS may contribute. Although CCS is an automated algorithm and has a number of user friendly features, our findings suggest that formal training and certification process before starting to use CCS may be worthwhile to achieve optimal benefit from the system.

scholarly journals Design and rationale for examining neuroimaging genetics in ischemic stroke

2017 ◽  
Vol 3 (5) ◽  
pp. e180 ◽  
Author(s):  
Anne-Katrin Giese ◽  
Markus D. Schirmer ◽  
Kathleen L. Donahue ◽  
Lisa Cloonan ◽  
Robert Irie ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Care ◽  
Cerebrovascular Lesions ◽  
Web Based ◽  
Genome Wide ◽  
Clinical Phenotyping ◽  
Neuroimaging Genetics ◽  
Analysis Platform

Objective:To describe the design and rationale for the genetic analysis of acute and chronic cerebrovascular neuroimaging phenotypes detected on clinical MRI in patients with acute ischemic stroke (AIS) within the scope of the MRI–GENetics Interface Exploration (MRI-GENIE) study.Methods:MRI-GENIE capitalizes on the existing infrastructure of the Stroke Genetics Network (SiGN). In total, 12 international SiGN sites contributed MRIs of 3,301 patients with AIS. Detailed clinical phenotyping with the web-based Causative Classification of Stroke (CCS) system and genome-wide genotyping data were available for all participants. Neuroimaging analyses include the manual and automated assessments of established MRI markers. A high-throughput MRI analysis pipeline for the automated assessment of cerebrovascular lesions on clinical scans will be developed in a subset of scans for both acute and chronic lesions, validated against gold standard, and applied to all available scans. The extracted neuroimaging phenotypes will improve characterization of acute and chronic cerebrovascular lesions in ischemic stroke, including CCS subtypes, and their effect on functional outcomes after stroke. Moreover, genetic testing will uncover variants associated with acute and chronic MRI manifestations of cerebrovascular disease.Conclusions:The MRI-GENIE study aims to develop, validate, and distribute the MRI analysis platform for scans acquired as part of clinical care for patients with AIS, which will lead to (1) novel genetic discoveries in ischemic stroke, (2) strategies for personalized stroke risk assessment, and (3) personalized stroke outcome assessment.

scholarly journals Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Ali M. Al Khathaami ◽  
Haya Aloraini ◽  
S. Almudlej ◽  
Haifa Al Issa ◽  
Nourhan Elshammaa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Controlled Trial ◽  
Negative Attitude ◽  
Stroke Care ◽  
Emergency Physicians ◽  
Web Based ◽  
Inadequate Knowledge ◽  
Proven Efficacy ◽  
Knowledge And Attitude

Background and Objectives. Tissue plasminogen activator (t-PA) within 4.5 hours from onset improves outcome in patients with ischemic stroke and has been recommended by several international guidelines. Since its approval in 1996, the debate among emergency physicians continues particularly around the result interpretation of the first positive randomized controlled trial, the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial. This lack of consensus might negatively affect the delivery of effective stroke care. Here we aimed to assess the knowledge and attitude of Saudi emergency physicians toward t-PA use within 4.5 hours of onset in acute ischemic stroke. Methods. A web-based, self-administered, locally designed questionnaire was sent to all emergency physicians practicing in the city of Riyadh from January to September 2017. Results. Out of 450 emergency physicians, 122 from ten hospitals in Riyadh participated in the survey, with a 27% response rate. The majority of participants were men (78%), and their mean age was 40 ± 8 years. Half of the participants were board certified, and 36% were consultants. Half of the participants consider the evidence for t-PA use in stroke within 4.5 hours of stroke onset to be controversial, and 41% recommend against its use due to lack of proven efficacy (37%), the risk of hemorrhagic complications (35%), lack of stroke expertise (21%), and medicolegal liability (9%). Nearly half were willing to administer IV t-PA for ischemic stroke in collaboration with remote stroke neurology consultation if telestroke is implemented. Conclusion. Our study detected inadequate knowledge and a negative attitude among Saudi emergency physicians toward t-PA use in acute stroke. This might negatively impact patient outcome. Therefore, we recommend developing urgent strategies to improve emergency physicians’ knowledge, attitudes, and beliefs in the management of acute stroke.

A Web-based Telestroke System Facilitates Rapid Treatment of Acute Ischemic Stroke Patients in Rural Emergency Departments

2009 ◽  
Vol 36 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Jeffrey A. Switzer ◽  
Christiana Hall ◽  
Hartmut Gross ◽  
Jennifer Waller ◽  
Fenwick T. Nichols ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Departments ◽  
Stroke Patients ◽  
Web Based ◽  
Rapid Treatment
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