AHA Journals, Author Interviews, Social Issues, Stroke / 25.03.2014

Jill Cameron, PhD M.Ed., B.Sc. O.T CIHR New Investigator, Associate Professor, Department of Occupational Science and Occupational Therapy Graduate Department of Rehabilitation Science Faculty of Medicine, University of Toronto Adjunct Scientist, UHN-Toronto Rehabilitation InstituteMedicalResearch.com Interview with: Jill Cameron, PhD CIHR New Investigator, Associate Professor, Department of Occupational Science and Occupational Therapy Graduate Department of Rehabilitation Science Faculty of Medicine, University of Toronto Adjunct Scientist, UHN-Toronto Rehabilitation Institute MedicalResearch.com: What are the main findings of the study? Dr. Cameron: In our study with 399 stroke survivor, caregiver dyads, caregivers reported more psychological wellbeing when they provided more assistance to stroke survivors who had fewer symptoms of depression, better cognitive functioning, and who had more severe strokes.  In addition, caregivers who maintained participation in valued activities, had more mastery, gained personally providing care, were in better physical health, and were older reported more psychological wellbeing. (more…)
AHA Journals, Author Interviews, Race/Ethnic Diversity, Stroke, University of Michigan / 14.03.2014

Lynda D. Lisabeth, PhD Interim Chair and Associate Professor Department of Epidemiology University of Michigan Ann Arbor, MichiganMedicalResearch.com Interview with: Lynda D. Lisabeth, PhD Interim Chair and Associate Professor Department of Epidemiology University of Michigan Ann Arbor, Michigan MedicalResearch.com: What are the main findings of the study? Dr. Lisabeth: The main findings were that Mexican Americans scored worse than non-Hispanic whites on all outcomes measured at 90 days following stroke, including neurologic, functional and cognitive outcomes, after adjustment for confounding factors. Further, we found that one-third of Mexican American stroke survivors have post-stroke dementia. Mexican Americans experienced more aphasia than non-Hispanic whites. Levels of functional impairment were substantial, with Mexican Americans on average experiencing moderate functional disability. Mexican Americans reported significantly greater difficulty than non-Hispanic whites with all activities of daily living (ADLs) and instrumental activities of daily living (IADLs) that were studied. (more…)
AHA Journals, Author Interviews, Stroke / 14.03.2014

Atte Meretoja, MD, PhD, MSc (Stroke Medicine) Associate Professor and Principal Fellow (Neurology), University of Melbourne The Royal Melbourne Hospital L4C, Grattan St, Parkville VIC 3050, Australia Associate Professor of Neurology, University of Helsinki Helsinki University Central Hospital, FinlandMedicalResearch.com Interview with: Atte Meretoja, MD, PhD, MSc (Stroke Medicine) Associate Professor and Principal Fellow (Neurology), University of Melbourne The Royal Melbourne Hospital Australia Associate Professor of Neurology, University of Helsinki Helsinki University Central Hospital, Finland MedicalResearch.com: What are the main findings of the study? Dr. Meretoja: We used observational prospective data of consecutive stroke patients (n=2258) treated with intravenous thrombolysis in Australian and Finnish centers and a pooled analysis of thrombolysis trials to model the shift in patient outcomes with reducing treatment delays. We found out that each minute the treatment can be delivered faster granted on average 1.8 days of extra healthy life (95% prediction interval 0.9 to 2.7). In practice, this means that each 15 minute decrease in treatment delays provides an average equivalent of one month of additional disability-free life. (more…)
Author Interviews, Blood Pressure - Hypertension, Stroke / 12.03.2014

MedicalResearch.com Interview with: Dingli Xu, MD From Department of Cardiology Nanfang Hospital, Southern Medical University, Guangzhou, China MedicalResearch.com:  What are the main findings of the study? Answer:Our study showed that after controlling for multiple cardiovascular risk factors, the blood pressure range at 120-139/80-89 mm Hg (defined as ‘prehypertension’ in JNC 7), is significant associated with long-term risk of stroke. The results were consistent across stroke type, stroke endpoint, age, study characteristics, follow-up duration, and ethnicity. More importantly, even low-range prehypertension (BP 120-129/80-84mmHg) increased the risk of stroke compared with optimal BP (<120/80 mm Hg), and the risk was higher in individuals with high-range prehypertension (BP 130-139/85-85mmHg). In particular, we found that compared with individuals with optimal blood pressure individuals with low-range prehypertension were 44% more likely to develop stroke, and this risk was even greater (95%) in individuals with high-range prehypertension. (more…)
Author Interviews, Diabetes, Diabetologia, Gender Differences, Stroke / 27.02.2014

MedicalResearch.com Interview with: Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director, Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health, LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, LouisianaGang Hu, MD, MPH, PhD, FAHA Assistant professor & Director Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, Louisiana MedicalResearch.com: What are the main findings of the study? Dr. Gang Hu:  Our study suggests a graded association between HbA1c and the risk of stroke among female patients with type 2 diabetes and poor control of blood sugar has a stronger effect in women older than 55 years. (more…)
AHA Journals, Author Interviews, Stroke / 26.02.2014

MedicalResearch.com Interview with: Daniel Strbian, MD, PhD, MSc (Stroke Med), FESO Neurologist, Associate Professor Department of Neurology Helsinki University Central Hospital MedicalResearch.com: What are the main findings of the study?  Dr. Strbian: That even if the SEDAN score had the best performance, none of the scores showed better than a moderate performance. (more…)
Clots - Coagulation, OBGYNE, Stroke / 20.02.2014

Dr.Hooman Kamel MD Department of Neurology and the Brain and Mind Research Institute Weill Cornell Medical College in New York City.MedicalResearch.com Interview with: Dr.Hooman Kamel MD Department of Neurology and the Brain and Mind Research Institute Weill Cornell Medical College in New York City. MedicalResearch.com: What are the main findings of the study? Dr. Kamel: The risk of thrombotic events remains higher than normal for twice as long after childbirth as previously thought. However, the absolute risk in any given patient is low, especially after the first 6 weeks. (more…)
Brigham & Women's - Harvard, Duke, Medical Research Centers, Stroke, UCLA / 18.02.2014

Gregg C Fonarow, UCLA Medical Ctr, Los Angeles, CA; Director, Ahmanson-UCLA Cardiomyopathy Center Professor, Department of Medicine Associate Chief, Cardiology David Geffen School of MedicineMedicalResearch.com Interview with: Gregg C Fonarow, UCLA Medical Ctr, Los Angeles, CA; Director, Ahmanson-UCLA Cardiomyopathy Center Professor, Department of Medicine Associate Chief, Cardiology David Geffen School of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Fonarow: The study examined data from hospitals that have adopted the American Heart Association/ American Stroke Association’s national quality initiative, Target: Stroke. The primary aim of Target: Stroke is to increase the number of stroke patients treated with tPA for acute ischemic stroke within 60 minutes or less after hospital arrival. The study demonstrated that patients received stroke therapy significantly faster in hospitals that participated in Target: Stroke. Between 2010 and 2013, the time between hospital arrival and use of tPA (door-to-needle time) dropped by 15 minutes, from 74 to 59 minutes, in hospitals that participated in Target: Stroke. 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. Faster treatment was associated with improved patient outcomes and fewer complications, including death. (more…)
Author Interviews, Erasmus, JAMA, Stroke / 18.02.2014

dr_Arfan_IkramMedicalResearch.com Interview with: M. Arfan Ikram, MD, PhD Departments of Radiology, Epidemiology, and Neurology Erasmus Medical Center, Rotterdam, the Netherlands MedicalResearch.com:  What are the main findings of the study? Dr. Ikram: The main finding of the study, carried out within the Rotterdam Study and led by drs. Daniel Bos and Arfan Ikram (both from the Erasmus Medical Center Rotterdam, the Netherlands), was that intracranial atherosclerosis is a major risk factor for stroke in the Western (white) population. Traditionally, intracranial atherosclerosis has not been considered of major importance to stroke risk in Western populations. In contrast, most research on intracranial atherosclerosis originates from Asian and African populations, where is was actually recognized as the most important risk factor of stroke. Our study demonstrates that also in the Western population intracranial atherosclerosis is a major risk factor for stroke and should get more focus in clinical practice. Moreover, our findings indicate that its contribution to the proportion of all strokes is greater than that of atherosclerosis in other vessel beds that are further away from the brain. (more…)
AHA Journals, Author Interviews, Cost of Health Care, Stroke / 08.01.2014

Dr. James Sheppard MRC Research Fellow Department of Primary Care Health Sciences University of OxfordMedicalResearch.com Interview with Dr. James Sheppard MRC Research Fellow Department of Primary Care Health Sciences University of Oxford MedicalResearch.com: What are the main findings of the study? Dr. Sheppard: The aim of our study was to develop a decision-tree model which estimates the cost-effectiveness and potential implementation costs of a series of interventions which increase thrombolysis rates in acute stroke. The model examined all possible acute stroke patient pathways and was based on real life patient data. We found all proposed interventions to be cost saving whilst increasing patient quality of life after stroke. We estimate that, assuming a "willingness-to-pay"  of USD $30,000 per quality adjusted life year gained, the potential budget available to deliver interventions which improve acute stroke care range from USD $50,000 to USD $144,000. (more…)
Author Interviews, Stroke / 23.11.2013

Andrew D. Barreto, M.D. Assistant Professor of Neurology University of Texas, HoustonMedicalResearch.com Interview with: Andrew D. Barreto, M.D. Assistant Professor of Neurology University of Texas, Houston   MedicalResearch.com: What are the main findings of the study? Dr. Barreto: Applying a novel, operator-independent device used to produce ultrasound energy through the skull of stroke patients receiving IV-tPA (intravenous clot-busting medication that is the standard treatment for stroke patients) was safe – no signal of increased risk of symptomatic intracerebral hemorrhage (brain bleeding). Rates of recanalization (clot dissolution) were consistent with prior work that suggest aiming transcranial Doppler ultrasound energy at the clot amplifies the clot-busting effect of tPA alone. (more…)
Addiction, Author Interviews, Cannabis, Stroke / 22.11.2013

W. Scott Burgin, MD Professor and Chief Cerebrovascular Division Director, Comprehensive Stroke Center Department of Neurology USF College of Medicine Tampa General Hospital Stroke CenterMedicalResearch.com Interview with: W. Scott Burgin, MD Professor and Chief, Cerebrovascular Division Director, Comprehensive Stroke Center Department of Neurology USF College of Medicine Tampa General Hospital Stroke Center. MedicalResearch.com What are the main findings of the study? Dr. Burgin: Two cases of stroke, of embolic appearance, shortly after smoking synthetic marijuana. (more…)
Author Interviews, Johns Hopkins, Stroke / 12.11.2013

Yogesh Moradiya MBBS From the Neurosciences Critical Care Division Johns Hopkins University, Baltimore, MD;MedicalResearch.com Interview with: Yogesh Moradiya MBBS From the Neurosciences Critical Care Division Johns Hopkins University, Baltimore, MD;   MedicalResearch.com: What are the main findings of the study? Answer: We studied 712,433 stroke cases in 6,839 hospital samples in United States over 11-year study period (2000-2010) and found that hospitals with neurology residency training program treated stroke patients with tissue plasminogen activator (tPA) more frequently than other teaching or non-teaching hospitals. The higher tPA utilization in hospitals with neurology residencies was independent of patient age, gender, ethnicity, insurance status, comorbidities, hospital geographic location, stroke case volume, calendar year and the Joint Commission Primary Stroke Center certification. (more…)
AHA Journals, Author Interviews, Lancet, Stroke / 07.11.2013

Dr. Colin Derdeyn Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery Washington University School of Medicine, St Louis, MO, USAMedicalResearch.com Interview with: Dr. Colin Derdeyn Mallinckrodt Institute of Radiology and the Departments of Neurology and Neurosurgery Washington University School of Medicine, St Louis, MO, USA MedicalResearch.com: What are the main findings of the study?  Dr. Derdeyn: The primary results indicate that medical management, consisting of dual antiplatelets for 3 months after a transient ischemic attack (TIA) or stroke, and rapid, effective control of blood pressure (systolic BP less than 140 mm Hg and 130 mm Hg if diabetic) and LDL-cholesterol (less than 70 mg/dl), in addition to management of other risk factors, is superior to angioplasty and stenting in addition to the same medical regimen for reducing the risk of future stroke in patients with severe atherosclerotic stenosis (>70%) of a major intracranial artery.    In addition, while there were subgroups at higher risk for stroke on medical treatment (older age, female gender, prior stroke in the territory),  none of these subgroups appeared to have a benefit from stenting (i.e. stroke rates in the stenting groups in these subgroups was higher too). (more…)
Author Interviews, Diabetes, Diabetes Care, Stroke / 23.10.2013

MedicalResearch.com Interview with: Stefanie Hägg, MB Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland MedicalResearch.com: What are the main findings of the study? Answer: We studied the incidence of stroke in a large cohort of patients with type 1 diabetes in Finland. During 36,680 person-years of follow-up, we found that the incidence of total stroke, and the subtypes cerebral infarction and cerebral hemorrhage was 406, 286, and 120 per 100,000 person-years, respectively, which is higher than in the Finnish general population, for whom the incidence of stroke varies between 135 and 236 per 100,000 person years. Furthermore, we studied the impact of two diabetic microvascular complications, diabetic nephropathy and severe diabetic retinopathy, on the risk of stroke, as well as for the subtypes of stroke. The incidence of stroke, cerebral infarction, and cerebral hemorrhage increased with both the presence of severe diabetic retinopathy and with advancing diabetic nephropathy. Furthermore, we found that both diabetic nephropathy and severe diabetic retinopathy increased the risk for all subtypes of stroke, independently of traditional risk factors. A novel finding was that already incipient diabetic nephropathy (microalbuminuria) increased the risk of stroke, cerebral infarction, and cerebral hemorrhage more than 3-fold, compared with patients free of renal disease. The highest risk of stroke was seen in patients with end-stage renal disease. (more…)
Author Interviews, Heart Disease, Mineral Metabolism, Stroke / 14.10.2013

Abhishek Sharma, M.B.B.S. Maimonides Medical Center in Brooklyn, N.Y.MedicalResearch.com Interview with: Abhishek Sharma, M.B.B.S. Maimonides Medical Center in Brooklyn, N.Y.   MedicalResearch.com: What are the main findings of the study? Answer:  Evidence from RCT's and observational studies suggests a significantly increased risk of atrial fibrillation (AF) requiring hospitalization, but no increase in risk of stroke or cardiovascular mortality with the use of bisphosphonate. (more…)
Author Interviews, CMAJ, MRI, Stroke / 17.09.2013

Tobias Saam, MD Institute of Clinical Radiology Ludwig-Maximilians-Univ Hosp Munich, GermanyMedicalResearch.com Interview with: Tobias Saam, MD Institute of Clinical Radiology Ludwig-Maximilians-Univ Hosp Munich, Germany MedicalResearch.com: What are the main findings of the study? Dr. Saam: The results of our meta-analysis suggest that despite a large degree of detected heterogeneity of the published studies, the presence of intraplaque hemorrhage by MRI in patients with carotid artery disease is associated with an approximately 5.6-fold higher risk for cerebrovascular events, such as TIA or stroke, as compared to subjects without intraplaque hemorrhage. (more…)
Author Interviews, Diabetes, MRI, Nature, Stroke / 13.09.2013

Fabian Bamberg, MD, MPH Department of Clinical Radiology Ludwig Maximilians University, Klinikum Grosshadern Marchioninistrasse 15, 81377 Munich, GermanyMedicalResearch.com Interview with: Fabian Bamberg, MD, MPH Department of Clinical Radiology Ludwig Maximilians University, Klinikum Grosshadern Marchioninistrasse 15, 81377 Munich, Germany  MedicalResearch.com: What are the main findings of the study?  Dr. Bamberg: Our study shows that there is a substantial and heterogenous degree of subclinical cardiovascular disease burden in patients with diabetes undergoing whole-body MRI. These whole-body MRI findings have significant prognostic relevance. For instance, our results show that patients without any pathologic findings experience no adverse cardiovascular event over a period of six years while the risk for a heart attack or stroke increases with the degree of disease burden. (more…)
Author Interviews, Heart Disease, Stroke / 13.09.2013

Dr. Eung Y. Kim Department of Radiology, Research Institute of Radiological Science, Department of Neurology, and Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea;MedicalResearch.com Interview with: Dr. Eung Y. Kim Department of Radiology Gachon University Medical Center Incheon, South Korea.   MedicalResearch.com: What are the main findings of the study? Answer: The extent of calcification involving intracranial artery significantly correlates with that of coronary artery in patients with ischemic stroke. The Agatston score measured in the intracranial arteries may be an independent predictor of asymptomatic coronary artery disease in patients with ischemic stroke. (more…)
AHA Journals, Author Interviews, Stroke / 11.09.2013

R. Gilberto González, MD, PhD Massachusetts General Hospital Department of Radiology, PO Box 9657 Boston, MAMedicalResearch.com Interview with: R. Gilberto González, MD, PhD Massachusetts General Hospital Department of Radiology, PO Box 9657 Boston, MA MedicalResearch.com: What are the main findings of the study? Dr. González: Administration of IV tPA to patients with a severe stroke syndrome caused by occlusion of the distal internal carotid artery and/or the proximal middle cerebral arteries results in good outcomes in 35% compared to 17% of similar patients who did not receive tPA. (more…)
Author Interviews, Diabetes, Kidney Disease, Stroke / 10.09.2013

MedicalResearch.com Interview with: Yongjun Wang, MD Department of Neurology, Beijing Tiantan Hospital Capital Medical University, Beijing, China MedicalResearch.com: What are the main findings of the study? Answer: Our study demonstrated that reduced eGFR was independently associated with all-cause mortality and other post-stroke outcomes in type 2 diabetic patients; stroke subtype analysis in our cohort showed that this association was only evident in ischemic stroke and TIA. We also observed a U-shaped relationship between variation of eGFR and post-stroke outcomes, that is, increased odds ratios were seen among those with low and high levels of eGFR. The cutoff points of eGFR associated with poor outcomes of stroke were eGFR<45 ml/min/1.73m2 and≥ 120 ml/min/1.73m2, respectively. (more…)
Author Interviews, Exercise - Fitness, Stroke / 26.07.2013

MedicalResearch.com Interview with: Michelle N. McDonnell, PhD Division of Health Sciences International Centre for Allied Health Evidence University of South Australia Adelaide, SA 5001 Australia.Michelle N. McDonnell, PhD Division of Health Sciences International Centre for Allied Health Evidence University of South Australia Adelaide, SA 5001 Australia. MedicalResearch.com: What are the main findings of the study? Dr. McDonnell: In this study, we asked people how many times a week they engaged in intense physical activity, enough to work up a sweat. People responded that they were physically active 0, 1-3 or 4 or more times a week. When we followed up these people for several years, those who did not do any vigorous exercise were 20% more likely to have a stroke, compared to those who exercised four or more times a week. However, when we adjusted these results for other risk factors, this attenuated the effect down to 14%  which was not statistically significant. We also noticed that people who exercised four or more times a week had less hypertension (high blood pressure), were less likely to be obese and less likely to have diabetes. Each of these things on their own reduces your risk of stroke, so when we adjust for that the association between physical activity and stroke is weaker (20% to 14%). So physical activity seems to have an effect on stroke risk by improving these other risk factors. (more…)
Author Interviews, Stroke / 22.06.2013

MedicalResearch.com Interview with: Saeid Shahidi, MD. Chief Consultant in supra-aortic surgery. Vascular Unit, Regional Hospital Slagelse, Region Zealand, Denmark. MedicalResearch.com: What is the background of your study? Answer: Our Prospective Population-based study showed, an expedited CEA can be performed in the subacute period ( >2 - <30 days) without significantly increasing the operative risk. The acute admission and urgent aggressive BMT with dual therapy in our cohort was associated with significant reduction P<0.00001 in the risk of early neurological recurrent (NR) in the CEA patient. It seems that in neurologically stable patients CEA can wait up to 30 days provided urgent BMT has been started in specialized stroke/ TIA clinics. Our study also adds to the data on the benefit of specialist TIA clinics. (more…)
Author Interviews, JAMA, Stroke / 22.05.2013

Dr. Rishi Gupta, MD Associate Professor of Neurology, Neurosurgery and Radiology Emory University School of Medicine Director, Vascular Neurology Fellowship Program Director, Multi-Hospital Acute Stroke Network Marcus Stroke and Neuroscience Center Grady Memorial Hospital MedicalResearch.com: What are the main findings of the study? Dr. Gupta: The main findings of this study are that patients with more proximal cerebral arterial occlusion involving the middle cerebral artery and internal carotid artery appear to be the targets for endovascular reperfusion therapy trials. Moreover, previous clinical trials have used a NIHSS > 8 or > 10 threshold to include patients into randomzed trials comparing endovascular therapy versus IV tPA. The threshold may need to be higher and in our analysis we found that threshold to be 14 or greater. (more…)
Author Interviews, Diabetes, Race/Ethnic Diversity, Stroke / 08.05.2013

MedicalResearch.com eInterview with Jane C Khoury, PhD

Associate Professor Division of Biostatistics and Epidemiology Cincinnati Children’s Hospital Medical Center MLC 5041, 3333 Burnet Avenue Cincinnati, Ohio 45229-3039 MedicalResearch.com: What are the main findings of the study? Dr. Khoury: Over all age groups, those with diagnosed diabetes have at least 3-fold increased risk of incident ischemic stroke compared to those without diabetes. This is even more pronounced in those less than 65 years of age, with 5-fold and 12-fold increase for those of black and white race respectively.  All rates are adjusted to the 2000 population. (more…)
Author Interviews, Emergency Care, Stroke / 03.05.2013

MedicalResearch.com eInterview with with Dr. O. James Ekundayo, MD, DrPH Assistant Professor Department of Family & Community Medicine Meharry Medical College 1005 Dr. D.B. Todd Jr. Blvd. Nashville, TN 37208 Written Interview conducted with author by Editor Marie Benz, MD MedicalResearch.com What are the main findings of the study? Answer: The key findings are: ·         One third of stroke patients did not activate Emergency Medical Services (EMS). ·         Subgroups of patients who were less likely to use EMS include younger patients, patients of minority race or ethnicity, and those living in rural communities. ·         Prior history of stroke /TIA does not confer greater likelihood of EMS activation during subsequent stroke. ·         Patients who used EMS had shorter pre-hospital and in-hospital delay. They arrived early, had prompter evaluation, and received more rapid treatment. ·         More patients, who were eligible for clot-busting drug, received them. These happened because EMS gives the receiving hospital pre-notification about the arrival of the patient and the ER staff is ready to act as soon as the patient arrives. (more…)
Author Interviews, Exercise - Fitness, JAMA, Stroke / 19.03.2013

MedicalResearch.com Interview with Carron D. Gordon, PhD Section of Physical Therapy, University of the West Indies, Mona, Box 126, Kingston 7, Jamaica, West Indies MedicalResearch.com:  What are the main findings of the study? Dr. Gordon: The walking group showed a 17.6% improvement in distance walked in six minutes (measure of endurance) compared to 4% in the control group and 16.7% improvement in SF36-Physical Component (health-related quality of life) compared to 2.6% in the control group. (more…)