scholarly journals Effect of multi-level stroke education on treatment and prognosis of acute ischemic stroke

2020 ◽  
Author(s):  
Xiaoman Zhang ◽  
Yinfang Liu ◽  
Xinhui Cao ◽  
Xiaoyu Xu ◽  
Yatao Zhu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multi Level ◽  
Stroke Education

Abstract T P251: Factors for Delayed Medical Care Seeking among Elderly Stroke Patients in Korea

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jeongha sim ◽  
Dongchoon Ahn ◽  
cha-nam shin
Keyword(s):  
Ischemic Stroke ◽  
Medical Care ◽  
Acute Ischemic Stroke ◽  
Statistical Significance ◽  
Care Seeking ◽  
Stroke Patients ◽  
Convenience Sample ◽  
Hospital Arrival ◽  
Stroke Education ◽  
Korean Elderly

Background: Stroke is the second leading cause of death in Korea and the prevalence of acute ischemic stroke among older adults continues to grow, which is known to be related to delayed hospital arrival after the onset of symptoms. Thus, decreasing the incidence of elderly stroke is a major health promotion objective in Korea, yet little is reported about the factors associated with the delayed medical care seeking behavior among elderly stroke patients in Korea. Purpose: The purpose of this study was to understand factors of delayed medical care seeking among elderly stroke patients in order to develop intervention strategies to improve the health of this population. Methods: A cross-sectional, descriptive study was conducted in a convenience sample of 233 hospitalized elderly patients with acute ischemic stroke using a self-administered survey. Descriptive statistics and chi-square test were used for data analysis. Results: More than half of them were male (60.5%) with age of 61 and older (76.9%), and relied on the opinion of their children or friends when deciding medical care for stroke (58.3%). Regarding the reasons of seeking medical care, there was no statistical significance between individuals who arrived at a hospital within three hours of the onset of symptoms and who arrived after three hours. Reasons for delayed hospital arrival were significantly different between groups (individuals of hospital arrival within three hours vs. individuals with hospital arrival after three hours), which include lack of knowledge about the severity of stroke and unawareness of symptoms (χ2 = 24.1), or inconvenience of a hospital visit, waiting for the effects of alternative medications, and stroke during sleep (χ2 = 55.1) with p <0.001. Conclusions: In conclusion, this study helped identify factors delaying hospital arrival after the onset of symptoms among Korean elderly stroke patients. Interventions should include stroke education focusing on the severity of stroke and related symptoms. The stroke education should target not only elderly stroke patients but their family members and friends. It may result in overall national health by decreasing prevalence of stroke among Korean elderly population.

Abstract 17: Hospital Variation in Thrombolysis Times in Acute Ischemic Stroke Patients: the Contributions of Door-to-Imaging Time and Imaging-to-Needle Time

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Kori Sauser ◽  
Deborah A Levine ◽  
Adrienne V Nickles ◽  
Mathew J Reeves
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cohort Analysis ◽  
Random Effect ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Patient Factors ◽  
Hospital Variation ◽  
Imaging Time ◽  
Multi Level

Background: Given the limited time window available for treatment with tPA in acute ischemic stroke patients, guidelines recommend door-to-imaging time within 25 minutes of hospital arrival and a door-to-needle time (DTN) within 60 minutes. Despite temporal improvements in door-to-image and DTN, tPA treatment times remain suboptimal. Objectives: To examine the contributions of door-to-image and imaging-to-needle times to delays in timely delivery of tPA to ischemic stroke patients, and to examine between-hospital variation in DTN. Methods: A cohort analysis of 1,193 ischemic stroke patients treated with intravenous tPA from 2009-2012 at 25 Michigan hospitals participating in the Paul Coverdell National Acute Stroke Registry. The primary outcome was DTN (time in minutes from emergency department arrival to tPA delivery). Multi-level linear regression models included hospital-specific random effects. Results: Mean patient age was 68 years, median NIHSS score was 11 (IQR 6-17), 51% were female, and 37% were nonwhite. Mean DTN was 82.9 ±35.4 minutes, mean door-to-imaging time was 22.8 ±15.9 minutes and mean imaging-to-needle time was 60.1 ±32.3 minutes. A majority of patients had door-to-imaging within 25 minutes (68.4%) but only a minority had DTN within 60 minutes (28.7%). At the patient level door-to-imaging time was only modestly correlated with DTN (r= 0.41), conversely image-to-needle time was strongly correlated with DTN (r= 0.89) (figure). In the multi-level model the hospital random effect accounted for only 12.7% of variability in door-to-needle time. Neither annual stroke volume nor primary stroke center designation was a significant predictor of better DTN. Patient factors (age, race, sex, arrival mode, onset-to-arrival time, and stroke severity) explained 15.4% of the between-hospital variation in DTN. After adjustment for patient factors, door-to-imaging time explained only 10.8% of the variation in hospital risk-adjusted DTN, while imaging-to-needle time explained 64.6%. Conclusion: Compared to door-to-imaging time, imaging-to-needle time was more closely correlated with DTN and a much greater contributor to variability in hospital door-to-needle times. More attention to systems changes that can decrease imaging-to-needle time for acute ischemic stroke patients is now needed.

Abstract NS5: Improvement of Follow-up Rate After Discharge of Acute Ischemic Stroke Patients by the Man-to-man Education for Stroke During Admission

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hee Sun Yu ◽  
Na Young Yun ◽  
Jong Wook Shin ◽  
Hye Seon Jeong ◽  
Sangeun Yoo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Education Program ◽  
Drug Information ◽  
Warning Signs ◽  
Stroke Patients ◽  
Nutrition Behavior ◽  
Number Of Patients ◽  
Stroke Education

Background: We have executed a man-to-man stroke education program for acute ischemic stroke patients during admission since 2012. The contents of the man-to-man stroke education includes warning signs of stroke, guidance for prompt actions after symptom onset, drug information, and exercise and nutrition behavior after discharge. We evaluated whether the man-to-man education given during admission is effective to improve follow-up rates after discharge for acute ischemic stroke patients. Methods: We compared clinical data including modified Rankin Scale (mRS) at discharge and length of stay and follow-up data after discharge of 697 acute ischemic stroke patients (Male:Female=283:414, mean age±SD, 69.0±12.1 years) admitted in 2013, who received the man-to-man education during admission, with the data of 602 patients (M:F=254:348, 67.1±12.2 years) admitted in 2008, who did not receive the active education during admission. To evaluate follow-up rates, we first checked the follow-up status of all included patients within 1, 4, 8, 12, 16 months after discharge. Then, follow-up rates at each time point were calculated as the ratio of the number of patients followed at the point to the all patients discharged in 2008 or 2013. Differences of the follow-up rates between 2008 and 2013 were compared at individual follow-up time points using one-sided x2-test. Results: Even though the favorable outcome defined as 0-3 of mRS at discharge was similar between 2008 and 2013 (2008 vs. 2013, 88.3 vs. 87.4%, p=0.342), length of admission was significantly shorter in 2013 than 2008 (2008 vs. 2013, 10.2 vs. 6.6 days, p<0.001). On follow-up rates evaluations, follow-up at 1 month was significantly higher in 2013 (89.8%) than 2008 patients (83.7%) (p=0.001). The follow-up rates subsequently decreased at 4months (2008 vs. 2013, 77.3 vs. 81.5%, p=0.040), 8 months (70.1 vs. 74.3%, p=0.051), 12 months (63.1vs. 67.6%, p=0.052), and 16 months (57.6 vs. 63.0%, p=0.028). However, the follow-up rates of 2013 patients was consistently higher than 2008 ones. Conclusion: The present data suggested that active education program for acute ischemic stroke patients could improve to follow-up rates of the patients after discharge.

Predictive value of the ankle brachial index in patients with acute ischemic stroke

VASA ◽  
2014 ◽  
Vol 43 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Vasilios Giampatzis ◽  
Stella Bouziana ◽  
Athinodoros Pavlidis ◽  
Marianna Spanou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
National Institutes Of Health ◽  
Limited Data ◽  
Severe Stroke ◽  
Hospital Outcome ◽  
Peripheral Arterial

Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

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