AHA Journals, Author Interviews, Cost of Health Care, Stroke / 24.10.2014

A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, AustraliaMedicalResearch.com Interview with: A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, Australia Medical Research: What are the main findings of the study? Dr. Cadilhac: Our results provide important information for health policy and planning, by providing a better understanding of the long-term costs of ischemic stroke (IS) and intracerebral hemorrhage stroke (ICH). 243 patients who experienced an ischemic stroke– the most common type of stroke, and 43 patients with intracerebral hemorrhage stroke who went on to survive for 10 years or more were interviewed to calculate annual costs as part of the North East Melbourne Stroke Incidence Study. Average annual healthcare costs 10 years after an ischemic stroke were $5,418 (AUD) – broadly similar to costs estimated between 3 and 5 years ($5,545). Whereas previous estimates for annual healthcare costs for intracerebral hemorrhage stroke ten years after stroke onset were $6,101, Professor Cadilhac’s team found the true cost was $9,032 far higher than costs calculated at 3 to 5 years ($6,101) because of a greater need for aged care facilities 10 years on. The high lifetime costs per stroke for both subtypes for first-ever events emphasize the significant economic implications of stroke (ischemic stroke AUD103,566 [USD 68,769] and intracerebral hemorrhage stroke AUD82,764 [USD54,956]). The study also provides evidence of the importance of updating cost estimates when population demography patterns change or if new information on incidence rates, or case-fatality rates, are available. We found a much larger number of intracerebral hemorrhage stroke would be expected than from earlier estimates because a) there are a larger number of people in the age groups 45 to 84 years living in Australia in 2010; and b) we applied new information on incidence rates from a larger geographical region than what was found from using the original NEMESIS pilot study region. In the online supplement we also provide an estimate of health loss reported as quality adjusted Life years (QALYs) lost to highlight how many years of healthy life is lost from a first-ever stroke event. (more…)
AHA Journals, Author Interviews, Clots - Coagulation, Erasmus, Stroke / 17.10.2014

MedicalResearch.com: Interview Invitation S. Akoudad, MD Msc PhD candidate Dep. Epidemiology, Radiology, Neurology Erasmus MC, Rotterdam , the Netherlands Medical Research: What are the main findings of the study? Dr.  Vernooij: We found that compared to never users, coumarin users had a higher prevalence of deep or infratentorial microbleeds and probably also a higher incidence of any microbleeds. A higher maximum international normalized ratio (INR) was associated with deep or infratentorial microbleeds, and among coumarin users, a greater variability in INR was associated with a higher prevalence of microbleeds. (more…)
Stroke / 07.10.2014

dr_john-falconerMedicalResearch.com Interview with: John Falconer MD FRCPC Neurologist, Kelowna General Hospital; Clinical Associate Professor of Neurology, University of British Columbia Medical Research: What are the main findings of this study? Dr. Falconer: This study set out to investigate the possible benefits of having a physician with a proprietorial interest (Pro-MD) in a stroke unit, tightly combined with a multidisciplinary inter-professional team, and including the family and the patient in as essential members for the management of a stroke patient. This also involved the introduction of a geographic located Acute Stroke Unit. We compared Acute Bed Days used by patients from the five months before to five months after this system was put in place. Our main end point was number of days in acute hospital care before and after, but we also informally tracked patient and caregiver satisfaction and staff morale. The Proprietary Physician, or Pro-M Drefers to a physician who has a “proprietorial” interest in a hospital unit or ward. In other words, I was working at this unit in a wholistic sense, trying not only to manage patients as best they can, but also interested in the patient flow and family-patient communications. We found that patient bed days were reduced by approximately 25% overall, while at the same time, patient and family satisfaction was improved, and staff morale increased. Initially, we had supposed that patients and their family would be more satisfied, but we were surprised at the reduction in Acute Bed Days that resulted. (more…)
AHA Journals, Author Interviews, Stroke / 07.10.2014

Vijaya Sundararajan, MD, MPH, FACP Associate Professor Head, Health Outcomes Group, Head, Biostatistics Hub Research Advisor, Centre for Palliative Care Department of Medicine Eastern Hill Academic Centre Melbourne Medical School Faculty of Medicine, Dentistry and Health Sciences University of MelbourneMedicalResearch.com Interview with: Vijaya Sundararajan, MD, MPH, FACP Associate Professor Head, Health Outcomes Group, Head, Biostatistics Hub Research Advisor, Centre for Palliative Care Department of Medicine Eastern Hill Academic Centre Melbourne Medical School Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Medical Research: What are the main findings of this study? Dr. Sundararajan: The main findings of the study are that over the last 10 years, there has been a measurable decline in people having a stroke 3 months after a new mini stroke (TIA); a mini stroke is also known as a ‘warning sign for stroke’. There has also been an overall decline in of the proportion of people having these mini strokes in the Australian State of Victoria (population 5.6million). These trends probably reflect improved primary and secondary prevention efforts for the last decade. These improvements are likely to include increased use of preventive medications and surgery for carotid artery narrowing in people identified as being at high risk of having a stroke, as well as improved behaviors (e.g. reducing smoking, improving diets, uptake of physical activity, among others). The most important aspect of our results is many fewer strokes occur when people with a TIA are managed in a hospital with a stroke unit (up to 6%).  Even when the patient’s TIA is managed in an Emergency Department and the patient released without admission, if the hospital has a stroke unit, these patients appear to have better outcomes. This likely reflects the cohesion and organization of the stroke unit in implementing the necessary tests and treatments promptly, and setting up the infrastructure to follow patients up. (more…)
Author Interviews, Radiology, Stroke / 17.09.2014

Ankur Pandya, PhD Assistant Professor of Healthcare Policy and Research Departments of Healthcare Policy and Research Weill Cornell Medical College New York, NY 10065.MedicalResearch.com Interview with: Ankur Pandya, PhD Assistant Professor of Healthcare Policy and Research Departments of Healthcare Policy and Research Weill Cornell Medical College New York, NY 10065. Medical Research: What are the main findings of the study? Dr. Pandya: Asymptomatic carotid stenosis is a highly prevalent condition that can lead to ischemic stroke, which is a leading cause of death and healthcare costs in the U.S. Revascularization procedures are often performed on asymptomatic carotid stenosis patients, but experts have questioned whether the stroke prevention benefits outweigh the risks and costs of revascularization in these patients. Imaging-based stroke risk assessment has traditionally focused on the degree of artery narrowing, but there has been growing interest in using cerebrovascular reserve (CVR) assessment to stratify these patients into those that are more likely to have a stroke, and thus better candidates for revascularization, and those that would be better off with less invasive management strategies (such as medical therapy). We therefore developed a simulation model to evaluate whether the CVR-based decision rule could be used efficiently select the right patients for revascularization. We found that the CVR-based strategy represented the best value for money compared to immediate revascularizations or medical therapy-based treatment for all patients. (more…)
Author Interviews, JAMA, Stroke / 16.09.2014

Silvia Koton, PhD, MOccH, RN Chair, Department of Nursing The Stanley Steyer School of Health Professions Tel Aviv University Tel Aviv, IsraelMedicalResearch.com Interview with: Silvia Koton, PhD, MOccH, RN Chair, Department of Nursing The Stanley Steyer School of Health Professions Tel Aviv University Tel Aviv, Israel Medical Research: What are the main findings of the study? Dr. Koton: Based on data on 14,357 participants in the Atherosclerosis Risk in Communities (ARIC) study who were free of stroke when the study began in 1987 and followed until the end of 2011, we found a 24 percent overall decline in first-time strokes in each of the last two decades and a 20 percent overall drop per decade in deaths after stroke. The results were similar across race and gender, but varied by age: the decline in stroke risk was concentrated mainly in the over-65 set, while the decrease in stroke-related deaths was primarily found among those under age 65. (more…)
AHA Journals, Author Interviews, Stroke / 27.08.2014

dr_opeolu_adeoyeMedicalResearch.com Interview with: Opeolu Adeoye, MD MS FACEP FAHA Associate Professor, Emergency Medicine and Neurosurgery Division of Neurocritical Care University of Cincinnati Cincinnati, OH 45267 Medical Research: What are the main findings of the study? Dr. Adeoye : Despite adequate access of the US population to hospitals that can deliver acute stroke care, only 4% of stroke patients in the US received tPA, the only approved medication for treating acute ischemic stroke. (more…)
Author Interviews, Diabetes, Kidney Disease, Neurology, Stroke / 21.08.2014

MedicalResearch.com Interview with: Prof. Chia-Huang Kao From the Graduate Institute of Clinical Medical Science Department of Radiation Oncology and Nuclear Medicine and PET Center Graduate Institute of Clinical Medical Science China Medical University Hospital, Taichung, Taiwan. Medical Research: What are the main findings of the study? Prof. Kao: Patients with chronic kidney disease (CKD) are at high risk for hypoglycemia; several factors are reported to contribute to hypoglycemia in these patients. However, most previous studies were limited by the relatively small number of patients with CKD included in the study by the exclusion of cases with CKD. In the present study, the incidence rate of hypoglycemia in patients with CKD was 4.5%, which is approximately twice the value noted in previous reports and multivariate analysis revealed a 2.53-fold increase in the risk of death for CKD patients with hypoglycemia after adjusting for related confounding factors including hypertension, hyperlipidemia, diabetes, and antidiabetic drugs. (more…)
Author Interviews, Stem Cells, Stroke / 11.08.2014

MedicalResearch.com Interview with: Dr Soma Banerjee M.D. Department of Stroke Medicine Imperial College Healthcare National Health Services Trust St. Mary’s Hospital Campus, Praed Street, London Medical Research: What are the main findings of the study? Dr. Banerjee: This stem cell trial is the first of its kind in humans to show that selected bone marrow stem cells (CD34+ cells) from the patients' own bone marrow, can be administered to patients with severe strokes, within an early timescale after their stroke. This pilot study of 5 patients showed that it was both safe and feasible to administer these cells to patients within a week of the event. This was primarily a safety study, but clinical measures of recovery were also assessed, and these showed improvements in disability scores and scores of neurological impairment, in all 5 patients. (more…)
AHA Journals, Author Interviews, Cognitive Issues, Stroke / 09.08.2014

Kumar Bharat Rajan, PhD Assistant Professor Department of Internal Medicine Section of Population Sciences Chicago IL 60612MedicalResearch.com Interview with: Kumar Bharat Rajan, PhD Assistant Professor Department of Internal Medicine Section of Population Sciences Chicago IL 60612 Medical Research: What are the main findings of the paper? Dr. Rajan: Lower levels of cognitive functioning was associated with incident stroke and the change in cognitive functioning was increased after incident stroke. Cognitive functioning was an independent marker of mortality even after accounting for incident stroke. (more…)
Alzheimer's - Dementia, Author Interviews, JAMA, Neurological Disorders, Stroke / 23.07.2014

MedicalResearch.com Interview with: Agustin Ibanez, PhD Laboratory of Experimental Psychology and Neuroscience Institute of Cognitive Neurology and the National Scientific and Technical Research Council and Sandra Baez, MS; Institute of Cognitive Neurology and Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina Medical Research: What are the main findings of the study? Answer: Both patients with the behavioral variant of frontotemporal dementia (bvFTD) and patients with frontal strokes presented moral judgment abnormalities. Their deficits were related to impairments in the integration of intentions and outcomes. Specifically, both patient groups judged moral scenarios by focusing on the actions' outcomes instead of the protagonists' intentions. (more…)
Author Interviews, Neurology, Stroke / 20.07.2014

Sang-Beom Jeon, MD, PhD From the Department of Neurology Asan Medical Center University of Ulsan College of Medicine Seoul, Republic of Korea.MedicalResearch.com Interview with: Sang-Beom Jeon, MD, PhD From the Department of Neurology Asan Medical Center University of Ulsan College of Medicine Seoul, Republic of Korea. Medical Research: What are the main findings of the study? Dr. Sang-Beom Jeon: In this MRI study of 825 stroke patients, we demonstrated that high plasma concentrations of homocysteine, also known as hyperhomocysteinemia, were associated with small-vessel disease (lacunar infarcts and leukoaraiosis) and large-vessel atherosclerosis of cerebral arteries. (more…)
Author Interviews, JAMA, Stroke, Surgical Research / 17.07.2014

Mads E. Jørgensen, M.B. University of Copenhagen, DenmarkMedicalResearch.com Interview with: Mads E. Jørgensen, M.B. University of Copenhagen, Denmark Medical Research: What are the main findings of the study? Answer: We included all patients undergoing non-cardiac surgery in 2005-2011, which were then categorized by time elapsed between stroke and surgery. Patients with a very recent stroke, i.e. less than 3 months prior to surgery, had a significant 14 times higher relative risk of 30-day MACE following surgery, compared with patients without prior stroke. Patients with a more distant stroke had a 2-5 fold higher risk of MACE following surgery, and still significantly higher than risks in patients without prior stroke. An additional model including time between stroke and surgery as a continuous measure showed a steep decrease in risks of perioperative MACE during the first 9 months. After 9 months, an increase in time between stroke and surgery did not further reduce the risks. The results for 30-day all-cause mortality showed similar patterns, although estimates were not as dramatic as for 30-day MACE. When analyzing the MACE components individually, we found that recurrent strokes were the main contributor to the high risk of MACE. A history of stroke any time prior to surgery was associated with a 16 fold increased relative risk of recurrent stroke, compared with patients without prior stroke. We also performed analyses stratified by surgery risk as low- (OR for stroke anytime, 3.97; 95% CI, 2.79-5.66), intermediate- (OR for stroke anytime, 4.46; 95% CI, 2.87-5.13) and high-risk (OR for stroke anytime, 1.98; 95% CI, 1.20-3.27), which were somewhat challenged in power. However, results indicated that stroke associated relative risk was at least as high in low and intermediate-risk surgery as in high risk surgery. (more…)
AHA Journals, Author Interviews, Stroke / 15.07.2014

Iftikhar J. Kullo, MD Division of Cardiovascular Diseases Mayo Clinic Rochester, MNMedicalResearch.com Interview with: Iftikhar J. Kullo, MD Division of Cardiovascular Diseases Mayo Clinic Rochester, MN   Medical Research: What are the main findings of the study? Dr. Kullo: The main findings of the study are: 1) Family history of stroke or heart attack is associated with presence of significant narrowing (greater than 70%) of the carotid arteries. These are the arteries that supply blood to the brain and narrowing or blockage of these arteries is associated with increased risk of stroke; 2) Having a sibling history of stroke or heart attack was more strongly associated with narrowing of the carotid artery than having a parent with such history; 3) The greater number of relatives with history of stroke or heart attack, the greater the odds of having narrowing in one of the carotid arteries. (more…)
AHA Journals, Author Interviews, Electronic Records, Medicare, Stroke / 04.07.2014

MedicalResearch.com Interview with Hiraku Kumamar, MD, MPH Department of Epidemiology Harvard School of Public Health, Boston, MA and Soko Setoguchi-Iwata, M.D. Duke Clinical Research Institute Durham, NC 27715 Medical Research: What are the main findings of the study? Answer: We evaluated the accuracy of discharge diagnosis of stroke in the Medicare claims database by linking it to a nationwide epidemiological study cohort with 30239 participants called REasons for Geographic And Racial Differences in Stroke (REGARDS). We found that among the 282 events captured using a strict claims definition of stroke, 91% were true events.  We also found that 12% of the overall strokes had been identified only by Medicare claims, strongly supporting the use of these readily available data for event follow-up in cohort studies. (more…)
Author Interviews, Heart Disease, NEJM, Stroke / 01.07.2014

MedicalResearch.com Interview with: Dr. Tommaso Sanna MD Institute of Cardiology Catholic University of the Sacred Heart Rome, Italy MedicalResearch: What are the main findings of the study? Dr. Sanna: In patients with cryptogenic stroke, continuous ECG monitoring with an implantable device, called the Reveal XT Insertable Cardiac Monitor (ICM), discovered Atrial Fibrillation in 6.4 times more patients than conventional diagnostic strategies at six months, 7.3 times more patients at 12 months, and 8.8 times more patients at 36 months. In more detail, after 36 months of follow-up, 30% of patients with cryptogenic stroke had at least one episode of atrial fibrillation. (more…)
AHA Journals, Author Interviews, Race/Ethnic Diversity, Stroke / 25.06.2014

Wuwei (Wayne) Feng MD MS FANA Assistant Professor, Department of Neuroscience Department of Health Science & Research Medical University of South Carolina Stroke Center The Center of Rehabilitation Research in Neurological ConditionsMedicalResearch.com Interview with: Wuwei (Wayne) Feng MD MS FANA Assistant Professor, Department of Neuroscience Department of Health Science & Research Medical University of South Carolina Stroke Center The Center of Rehabilitation Research in Neurological Conditions MedicalResearch: What are the main findings of the study? Dr. Feng: Stroke hospitalization rate is decreasing in the elderly, but increasing in the young/middle aged population, but this increase is mainly driven by the increase in blacks (not in whites) which incurred persistent racial disparity in stroke. It has tremendous economic impact as outlined in the paper. Of hospital charges totaling $2.8 billion over 10-year period, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients <65 years). By way of background: 84,179 stroke hospitalizations occurred in South Carolina from 2001 to 2010. Blacks accounted for 29,846 (35.5%) and whites accounted for 54,333 (64.5%) of the strokes. Among blacks, 50.4% were <65 years of age compared to 29.6% among whites. The overall stroke hospitalization rate decreased over the 10-year period. There was a significant reduction in stroke hospitalization rate in the older (≥65 years old) populations, for both blacks and whites. Whereas, in the younger populations (<65 years old), the overall rate of stroke hospitalizations actually increased significantly; however this increase was only associated with black patients. For example, the hospitalization rate per 100,000 for young blacks was 121 in 2001, 139 in 2005 and 142 in 2010 (a 17.3% increase from 2001). This racial disparity was more severe in the younger group with the highest disparity seen in the 45-54 year age groups for both ischemic strokes (having a clot) and intra-cerebral hemorrhagic strokes. (more…)
Author Interviews, Stroke, Wake Forest / 22.06.2014

Cheryl Bushnell, MD, MHS Associate Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist School of Medicine Winston Salem, NC 27157MedicalResearch.com Interview with: Cheryl Bushnell, MD, MHS Associate Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist School of Medicine Winston Salem, NC  27157 MedicalResearch: What are the main findings of the study? Dr. Bushnell: We found that readmitted patients were significantly more likely to have more severe strokes, and to have been hospitalized two or more times during the year prior to the initial stroke admission, independent of other clinical factors, such as congestive heart failure, heart disease, or stroke complications (pneumonia, acute renal failure). (more…)
Author Interviews, BMJ, Stroke / 26.05.2014

Michael T. C. Poon, MBChB, BMedSci (Hons) Junior Doctor, Wycombe General Hospital Buckinghamshire Healthcare NHS Trust, UKMedicalResearch.com Interview with: Michael T. C. Poon, MBChB, BMedSci (Hons) Junior Doctor, Wycombe General Hospital Buckinghamshire Healthcare NHS Trust, UK   MedicalResearch: What are the main findings of the study? Dr. Poon: At present, we know that the incidence and one-month case fatality of intracerebral haemorrhage (ICH) have remained static for the past two decades. However, any trend in long-term survival after ICH is less clear. Survivors face the risks of recurrent ICH as well as ischaemic events in the future. The balance between these risks has particular clinical implication on the decision about restarting antiplatelet/anticoagulant therapy after ICH. To address these questions, we undertook a systematic review and meta-analysis to determine whether long-term survival after intracerebral haemorrhage has changed over time, and to re-assess the balance between the risks of recurrent ICH and ischaemic events in studies quantifying both of these risks in the same population. The survival rates after ICH at 1 year and 5 years do not appear to have changed over time – 1 year survival was 46% and 5 year survival was 29%. The risk of recurrent ICH may be influenced by the ICH location, with lobar ICH having a higher rate of recurrence. In contrast to the previous systematic review, we found the risk of ischaemic stroke to be at least as high as the risk of recurrent ICH over 3 years after ICH. This reinforces the difficulty that clinicians and patients have in deciding about antithrombotic treatment after ICH. (more…)
AHA Journals, Author Interviews, Pain Research, Stroke / 15.05.2014

MedicalResearch Interview with: Dr. Teshamae Monteith MD Assistant professor of Neurology Chief of the Headache Division University of Miami Miller School of Medicine. MedicalResearch: What are the main findings of the study? Dr. Monteith:   
  • A doubling of silent brain infarctions in those with migraine even after adjusting for other stroke risk factors;
  • No increase in the volume of white-matter hyperintensities (small blood vessel abnormalities) that have been associated with migraine in other studies;
  • Migraines with aura — changes in vision or other senses preceding the headache — wasn’t common in participants and wasn’t necessary for the association with silent cerebral infarctions.
  • High blood pressure, another important stroke risk factor, was more common in those with migraine. But the association between migraine and silent brain infarction was also found in participants with normal blood pressure.
(more…)
AHA Journals, Author Interviews, Nutrition, Stroke / 14.05.2014

MedicalResearch Interview with: Dr. Yan Qu Qingdao Municipal hospital Fruits and Vegetables Consumption and Risk of Stroke A Meta-Analysis of Prospective Cohort Studies MedicalResearch: What are the main findings of the study? Reply: First, both fruits and vegetables were found inversely associated with risk of stroke, and the relationships might be linear. Second, the inverse association of fruits and vegetables consumption with risk of stroke is consistent across subgroup analysis by outcome (stroke incidence and stroke mortality), location where the study was conducted (USA, Europe and Asia), sex (male and female), and stroke subtypes (ischemic and hemorrhagic). Third, citrus fruits, leafy vegetables and apples/pears were found inversely associated with risk of stroke. Fourth, very similar results were found in the subgroup analysis by status [yes: 0.78 (0.71-0.86) or no: 0.79 (0.74-0.85)] of adjusting for 6 or more of the 7 covariates (smoking, alcohol, blood pressure/hypertension, serum cholesterol, physical activity, body mass index, ≥3 dietary variables). These findings generally indicated that the association of fruits and vegetables consumption with the reduced risk of stroke may not be the result of confounding by the known factors. (more…)
Cannabis, Neurology, Stroke / 09.05.2014

MedicalResearch.com Interview with: Tara Dutta M.D. Vascular Neurology Fellow University of Maryland Medical Center MedicalResearch: What are the main findings of the study? Dr. Dutta: We analyzed data from the Stroke Prevention in Young Adults Study in order to evaluate for an association between self-reported marijuana use and ischemic stroke.   1,101 cases and 1,154 age, gender, and race-matched controls, aged 15-49 years old, were recruited from the greater Baltimore-Washington area between 1992 and 2008. Interviews were conducted to assess for various potential stroke risk factors, including illicit drug, alcohol, and tobacco use. Individuals reporting use of vasoactive illicit drugs, including cocaine and amphetamines, were excluded, yielding 751 cases and 813 controls. Logistic regression analysis was used to determine the association between marijuana use and ischemic stroke, adjusting for age, gender, race, current tobacco use, current alcohol use, hypertension, and diabetes. We did not find a positive association between marijuana use and ischemic stroke risk in our population of young-onset stroke patients compared to matched controls, even after controlling for current tobacco and alcohol use, hypertension, and diabetes.   A statistically significant inverse relationship was observed between remote use (defined as any use over one year ago) and stroke risk (adjusted OR 0.77, CI 0.61-0.98, p = 0.03). We also looked to see whether recent use (in the past 30 days), and particularly recent heavy use, was associated with ischemic stroke risk as has been suggested in the medical literature. Though our data did not show this association, the number of patients reporting recent use in our study was very small­­­­­­­. (more…)
Author Interviews, Mayo Clinic, Neurology, Stroke / 06.05.2014

Kejal Kantarci, M.D. M.S. Professor of Radiology Division of Neuroradiology Mayo Clinic, Rochester, MN 55905 MedicalResearch.com Interview with: Kejal Kantarci, M.D. M.S. Professor of Radiology Division of Neuroradiology Mayo Clinic, Rochester, MN 55905 MedicalResearch: What are the main findings of the study? Dr. Kantarci: Microinfarcts are one of the most common pathologies identified in the brains of older individuals and they impact cognition. However they are invisible lesions on MRI. We demonstrated that presence of microinfarcts in autopsied individuals are associated with the macroinfarcts identified on their MRI scans than they were alive. We also demonstrated that the presence of these invisible lesions are related to greater brain atrophy rates that are localized to watershed zones. (more…)
Author Interviews, Infections, Stroke / 01.05.2014

Professor Stuart Allan Faculty of Life Sciences, AV Hill Building The University of Manchester Manchester, M13 9PTMedicalResearch.com Interview with: Professor Stuart Allan Faculty of Life Sciences, AV Hill Building The University of Manchester Manchester, M13 9PT MedicalResearch.com: What are the main findings of the study? Dr. Allan: Using an experimental model of stroke it was found that animals with preceding Streptococcus pneumoniae infection had a worse outcome than uninfected animals. This confirms and extends previous data, both clinical and preclinical, that systemic inflammation is a key contributor to stroke outcome. Importantly, effects of infection were also demonstrated in animals with co-morbidities associated with stroke (atherosclerosis and age), with outcomes worse than observed in healthy young subjects. Exacerbating effects of infection on stroke are mediated via the pro-inflammatory cytokine, interleukin-1 (IL-1), shown by reversal of the increased ischaemic brain damage and functional impairments by treatment with the IL-1 receptor antagonist (IL-1Ra). Infection also leads to increased platelet activation and microvascular coagulation after stroke, which contributes to the increased injury. Collectively, these data are the first to show, how systemic inflammatory mechanisms induced by one of the most common non-invasive, human S.pneumoniae isolates, lead to critical illness after stroke in different rodent species and strains, and how common stroke comorbidities interact with infection to worsen outcome after stroke. (more…)
Author Interviews, Erasmus, Neurology, Stroke / 25.04.2014

M. Arfan Ikram, MD, PhD Assistant professor in Neuroepidemiology Erasmus Medical Center Rotterdam, the NetherlandsMedicalResearch.com Interview with: M. Arfan Ikram, MD, PhD Assistant professor in Neuroepidemiology Erasmus Medical Center Rotterdam, the Netherlands MedicalResearch.com: What are the main findings of this study? Dr. Ikram: We show that the risk of stroke might be increased due to an increased risk of ischemic stroke or increased risk of hemorrhagic stroke. Because these subtypes of stroke require different -often opposite- clinical management, currently available prediction rules for any stroke are insufficient. We propose a novel prediction rule that provides separate risks for ischemic stroke and hemorrhagic stroke. (more…)
Author Interviews, JAMA, Stroke, UCLA / 24.04.2014

Dr. Gregg C. Fonarow MD Director, Ahmanson-UCLA Cardiomyopathy Center UCLA CHAMP - Cholesterol, Hypertension, and Atherosclerosis Management Program Professor, Department of Medicine Associate Chief, Cardiology David Geffen School of Medicine Los Angeles, CAMedicalResearch.com Interview with: Dr. Gregg C. Fonarow MD Director, Ahmanson-UCLA Cardiomyopathy Center Professor, Department of Medicine Associate Chief, Cardiology David Geffen School of Medicine Los Angeles, CA MedicalResearch.com: What are the main findings of the study? Dr. Fonarow: This study examined data from hospitals that have adopted the American Heart Association/ American Stroke Association’s national quality initiative, Target: Stroke, which aims to increase the number of stroke patients treated with clot-busting drugs for ischemic stroke within 60 minutes or less after hospital arrival.  Initiated nationwide in 2010, Target: Stroke provided 10 key strategies as well as tools to facilitate timely tPA administration, as well as additional approaches to improve stroke care and outcome. Data from 71,169 tPA-treated stroke patients at 1,030 hospitals participating in Target: Stroke were analyzed to compared the time to treatment and incidence of complications before implementation, from 2003 to 2009, to the post-implementation years, from 2010 to 2013. This study found that the percentage of patients treated within the recommended timeframe increased from less than one-third before Target: Stroke to more than half afterwards. The Target: Stroke program goal of 50 percent or more of patients having door-to-needle times within 60 minutes was successfully achieved. In addition, the average time to treatment dropped by 15 minutes, from 74 to 59 minutes. Faster treatment was associated with lower rates of complications, including death. Before Target: Stroke, 9.9% of stroke patients died in the hospital, compared to 8.3% of patients treated after the initiative started, a difference which was statistically significant. In addition, patients treated by Target: Stroke strategies were less likely to develop the complication of symptomatic intracranial hemorrhage. (more…)
Author Interviews, JAMA, Outcomes & Safety, Stroke / 22.04.2014

Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger Oberarzt der Klinik und Hochschulambulanz für Neurologie am Campus Charité Mitte Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin | CCM Charitéplatz 1 | 10117 Berlin | GermanyMedicalResearch.com Interview with: Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger Oberarzt der Klinik und Hochschulambulanz für Neurologie am Campus Charité Mitte Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin | CCM Charitéplatz 1 | 10117 Berlin | Germany MedicalResearch.com: What are the main findings of the study? Dr. Ebinger: The main findings of our study was a significant time reduction during randomized weeks with prehospital thrombolysis compared to control weeks with regular care. (more…)
Author Interviews, Blood Pressure - Hypertension, CMAJ, McGill, Stroke / 14.04.2014

Finlay A McAlister MD Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit Epidemiology Coordinating and Research (EPICORE) Centre McGill University, Montréal, QuebecMedicalResearch.com Interview with: Finlay A McAlister MD University of Alberta, Edmonton, Canada MedicalResearch.com: What are the main findings of the study? Dr. McAlister: We tested 2 systems of case management on top of usual care (note that at baseline more than 3/4 of our study patients were already taking medications to lower blood pressure (BP) and/or cholesterol but none were at guideline-recommended targets). The first (our "control" group) was a nurse seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians with advice to patients who had blood pressure or cholesterol above guideline-recommended targets to see their primary care physician. The second (our "intervention" group) was a pharmacist seeing patients monthly x 6 months, measuring their blood pressure and LDL cholesterol, counseling them about risk factor reduction strategies (including lifestyle and medication adherence), and faxing results of BP/cholesterol to their primary care physicians.  However, if patients had blood pressure or cholesterol above guideline-recommended targets instead of just recommending that the patient see their primary care physician the pharmacist provided them with a prescription for medication (or up-titration of their current medications) to address the uncontrolled risk factor. Both groups improved substantially over usual care, but the intervention group improved even more (13% absolute improvement in control of BP/cholesterol levels compared to the nurse-led control arm) . (more…)