stroke Tag
17 Jan ICD-9 Codes Do Not Identify All Strokes in Atrial Fibrillation Patients
MedicalResearch.com Interview with:
Jonathan Thigpen, PharmD
Assistant Professor
Clinical and Administrative Sciences
Notre Dame of Maryland University School of Pharmacy
Medical Research: What is the background for this study? What are the main findings?
Dr. Thigpen: This effort assessed the accuracy of International Classification of Disease 9th Edition (ICD-9) stroke codes in identifying valid stroke events in a cohort of atrial fibrillation (AF) patients. The initial electronic search yielded 1,812 events across three stroke centers (Boston Medical Center, Geisinger Health System, and University of Alabama). All ICD-9 identified stroke events were vetted through manual chart review with final adjudication by a stroke neurologist. Atrial fibrillation was verified by evidence via electrocardiogram at stroke admission, 6 months prior to, or 90 days after stroke admission.
In addition to assessing the accuracy of the stroke codes alone, we also assessed the accuracy of stroke and Atrial fibrillation codes combined as well as the accuracy of stroke codes when seeking for stroke associated with Atrial fibrillation. These additional steps give readers insight as to the accuracy and reliability of using ICD-9 codes alone to create a stroke plus AF cohort. We feel that this effort is extremely important given the increasing reliance on ICD-9 codes as a means of identifying stroke events and covariates in research, especially research using administrative data.
The positive predictive value (PPV) of stroke codes alone was 94.2%. PPVs did not differ across clinical site or by type of event (ischemic vs. intracranial hemorrhage). PPV of stroke codes did differ by event coding position (primary vs. other; 97.2% vs. 83.7%) and by ischemic stroke code (433 vs. 434; 85.2% vs. 94.4%). When combined with validation of Atrial fibrillation codes, the PPV of stroke codes decreased to 82.2%. After excluding ischemic stroke due to a different mechanism (eg, vascular procedure, tumor, sepsis) the PPV dropped further to 72.8%. As a separate exercise, manual review confirmed 33 (7.2%) ischemic strokes in 458 events coded as "without infarction".
02 Jan Time Means Brain! Fast Treatment for Acute Ischemic Stroke Improves Recovery
MedicalResearch.com Interview with:
Diederik Dippel MD, PhD
Senior Consultant in Neurology
Erasmus MC University Medical Center
Rotterdam The Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Dippel: MR CLEAN is the first randomized clinical trial to show that intra-arterial treatment of ischemic stroke to get the clot out, really works. It leads to more recovery and less handicap. Previous studies had shown that intra-arterial treatment leads to recanalization, but the final proof that the treatment leads to recovery more often than standard treatment was lacking.
With standard treatment, less than 1 out of 5 recovers without handicap, but with this new treatment, this will be 1 out of 3. The treatment did not lead to more complications than standard treatment. The rate of symptomatic intracranial hemorrhage was similar in both arms.
Our study differs from previous, neutral trials.
- First, we required patients to have an intracranial arterial occlusion confirmed by neuro-imaging.
- Second, we used third generation thrombectomy devices, such as retrievable stents in most of the cases.
- Third, our trial was conducted in a country with a very good infrastructure, which allowed rapid transfer to intervention centers, which are spread throughout the country. Our rate of iv tPA in Dutch hospitals is over 11% on average.
- Last, all intervention centers participated, and almost no patients were treated outside the trial. Moreover, reimbursement of the treatment was conditional on participation in the trial.
28 Dec Stroke Risk Lower For Women With Heart Failure
MedicalResearch.com Interview with: Torben Bjerregaard Larsen Associate professor, MD, PhD, FESC Aalborg University Hospital Department of Cardiology Aalborg Thrombosis Research Unit Denmark Medical Research: What is the background for this study? What are the main findings? Dr. Larsen: Heart failure is a major public health issue with an increasing prevalence. Heart failure is associated with an increased risk of stroke, also in patients without concomitant atrial fibrillation. However, recent prospective randomized controlled trials investigating the effect of antithrombotic therapy in heart failure patients in sinus rhythm revealed that the benefit of warfarin in reducing stroke was counterbalanced by an increased risk of bleeding. Whether subgroups within the heart failure population would benefit from antithrombotic therapy is currently unknown. Therefore, possible subgroups with a higher risk of stroke within the heart failure population must be identified. We investigated whether female sex was associated with a higher risk of stroke, since female sex has been associated with an increased stroke risk among patients with atrial fibrillation. In our study, we found an association between female sex and decreased stroke risk in heart failure patients in sinus rhythm which persisted after adjustment for concomitant cardiovascular risk factors. This association was attenuated with increasing age which could possibly be due to competing risks of death, since competing risk of death was substantial among males in the older age groups.26 Dec July Effect of Medical Residents’ Care: No Adverse Stroke Outcomes
MedicalResearch.com Interview with:
Gustavo Saposnik, MD, MSc., FAHA, FRCPC
Director, Stroke Outcomes Research Center
Co-Director, Stroke Program - Research & Innovation
Associate Professor & Clinician Scientist
Departments of Medicine (Neurology) and
Health Policy, Management and Evaluation (HPME)
St. Michael’s Hospital University of Toronto
Medical Research: What is the background for this study? What are the main findings?
Dr. Saposnik: There is some controversy around worse outcomes at the beginning of academic year. Physicians recently graduated from medical schools begin their training and assume responsibilities for patient care in teaching hospitals, usually bearing the first-line duty for managing patients. Consequently, less experienced staff having new roles may influence access to care and contribute to adverse outcomes in patients managed at the beginning of academic year - the so-called “July Effect”. for example, increase of medication errors and in-hospital mortality in July has been reported from teaching hospitals.
In our large cohort study, comprising 10,319 stroke patients, 882 (8.5%) were admitted in July. Those patients were 28% less likely to receive thrombolysis (clot-buster treatment) (12% vs. 16%; odds ratio (OR), 0.72; 95% confidence interval (CI), 0.59-0.89) and 22% less likely to receive stroke unit care (62% vs. 68%; 0.78; 0.68-0.90). July admissions were not associated with either of higher death at 30 days (adjusted OR, 95% CI; 0.88, 0.74-1.03) or poor functional outcome (0.92, 0.74-1.14). Results remained consistent in the sensitivity analysis by including both July and August as part of the ‘July effect’.
20 Dec CT Scan Predicts Stroke After TIA
MedicalResearch.com Interview with:
Jeff Perry, MD, MSc, CCFP-EM
Associate Professor, Department of Emergency Medicine
Senior Scientist, Ottawa Hospital Research Institute
Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, The Ottawa Hospital
Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario
Medical Research: What is the background for this study? What are the main findings?
Dr. Perry: Currently it is not well known which patients with a TIA or a non-disabling stroke will have a subsequent stroke or die within the days to weeks following their initial event. This study found that patients with acute ischemia, especially if it is associated with an old infarction or microangiopathy, are at a much higher risk for an early subsequent stroke.
15 Dec Adapting Nintendo Wii To Enhance Stroke Rehabilitation
MedicalResearch.com Interview with:
Dr. Emmanuel Tsekleves
Senior Lecturer in Design Interactions
ImaginationLancaster
LICA |Lancaster University
Medical Research: What is the background for this study? What are the main findings
Dr. Tsekleves: The study was influenced by the anecdotal use of the Nintendo Wii in therapy in NHS physiotherapy clinics back in 2010/11. This led to the need for conducting a study with therapists and patients (33 questionnaires and 10 interviews were completed) to explore the current use of the Nintendo Wii console technology in physical rehabilitation programmes across four NHS Trusts in London. The study revealed that although respondents felt the Wii helped with rehabilitation, over half of them reported difficulty using equipment (such as using the hand-held remote controls). Therapists believed use of standard Wii was limited due to the high level of dexterity, movement and coordination necessary to operate the system.
The results of the aforementioned study informed the development of a personalised stroke treatment, using adapted Wii technology, for arm re-education post-stroke (that is reported in the article http://informahealthcare.com/doi/abs/10.3109/17483107.2014.981874). The developed system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed (Fugl-Meyer Assessment, Nine Hole Peg Test, Motor Activity Log – Amount of Use sub-scale] and the Modified Ashworth Scale), with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated.
13 Dec Complaints of Memory Loss May Signal Increased Stroke Risk
MedicalResearch.com Interview with: M. Arfan Ikram, MD, PhD,and Ayesha Sajjad, MD Department of Epidemiology Erasmus University Medical Center, Rotterdam Rotterdam, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The occurrence of cognitive impairment and dementia after a stroke event are already known. Since these neuro-degenerative processes and stroke share vascular pathways in their pathogenesis such as small vessel disease, we aimed to study whether early cognitive impairment can be predictive of stroke onset in the elderly. We also hypothesized that a higher cognitive reserve (due to higher education attainment) may mask early symptoms of memory loss and thus put these older individuals at a higher risk of stroke. We found that self-reported subjective memory complaints as answered by a single question: “ Do you have memory complaints?” was highly predictive of stroke especially in older persons who were highly educated. In comparison, objective measures of cognitive impairment such as MMSE did not show any association with the risk of stroke.08 Dec CT Scan May Predict Risk of Second Stroke
MedicalResearch.com Interview with Jeff Perry, MD, MSc, CCFP-EM Associate Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Perry: Currently many patients with a TIA or non-disabling stroke have a subsequent stroke which may be very disabling or result in death prior to having all investigations completed and maximal stroke prevention implemented. Prior to this study, the utility of CT findings for predicting subsequent stroke was incompletely understood in this patient population. Dr. Perry: Main findings: Compared to patients without ischemia, the probability of another stroke occurring within 90 days of the initial episode was:- 2.6 times greater if the CT image revealed newly damaged tissue due to poor circulation (acute ischemia);
- 5.35 times greater if tissue was previously damaged (chronic ischemia) in addition to acute ischemia;
- 4.9 times greater if any type of small vessel damage occurred in the brain, such as narrowing of the small vessels in addition to acute ischemia;
- 8.04 times greater if acute and chronic ischemia occurred in addition to microangiopathy.
01 Dec Dedicated Neuro Emergency Department Improves Stroke Outcomes
Stroke Wasserman Perry 006768R PDF
MedicalResearch.com Interview with:
Karen Greenberg, DO, FACOEP
Capital Health Center for Neurologic Emergencies
750 Brunswick Ave, NJ 08638
Medical Research: What is the background for this study?
Dr. Greenberg: Capital Health Regional Medical Center in Trenton, NJ opened the first dedicated Neurologic Emergency Department in the country in January of 2011. Dr. Veznedaroglu, our chief neurosurgeon, recognized the importance and emergent nature of patients with neurologic complaints. He recruited dedicated Emergency Medicine Physicians, one of which is myself, who would be assigned to see patients with neurologic complaints during peak hours of 7a-6p daily seven days a week. Having a section of the ED dedicated to identifying, triaging, and treating patients with neurologic emergencies has led to more advanced and efficient care. Due to the initial success of the neuro ED, 5 dedicated physicians became educated and comfortable in administering IV-tPA to acute ischemic stroke patients. This decision was made to eliminate delays associated with teleneurology or neurology consultation prior to administering thrombolytics in order to improve door-to-needle times and outcomes in acute stroke patients. As far as we know, we are still the only dedicated Neuro ED in the country.
25 Nov Stroke: Golden Hour Thrombolysis Improved Discharge To Home
MedicalResearch.com Interview with: Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger Center for Stroke Research Berlin (CSB) Charité - Universitätsmedizin Berlin | CCM Berlin | Germany Medical Research: What is the background for this study? What are the main findings? Response: Hitherto, little has been known about the effects of thrombolysis (tPA) in ischemic stroke within the first 60 minutes of symptom onset. That's because the so-called golden hour thrombolysis is such a rare event. As James Grotta, Houston, Texas, recently pointed out there were only 2 patients receiving tPA within 60 minutes in the pivotal NINDS trial - both received placebo, and even the latest up-date on randomized trials of tPA includes only two further patients within 60 minutes. In our study, we used the Stroke Emergency Mobile (STEMO) for ultra-early thrombolysis in the pre-hospital setting. STEMO is a specialized ambulance equipped with a CT scanner, point-of-care laboratory, and a telemedicine connection to neuroradiologist on call. Aboard the STEMO, there is a paramedic, a radiology technician and a neurologist. The project was initiated und supervised by Heinrich Audebert from the Charité, Berlin, Germany.The main finding of our study is that we showed a statistically significant association between golden hour thrombolysis and discharge home as opposed to e.g. nursing facilities.31 Oct Age-Related Macular Degeneration: Lucentis Raises Stroke Risk
MedicalResearch.com Interview with: Takashi Ueta, M.D., Ph.D. Assistant Professor, Department of Ophthalmology Graduate School and Faculty of Medicine The University of Tokyo Medical Research: What is the background for this study? What are the main findings? Dr. Ueta: In 2009 we had reported an initial systematic review and meta-analysis which include pivotal RCTs but the number of the included studies were only 3 (MARINA, ANCHOR, FOCUS). During the following several years, more trials comparing different dosages and frequencies of ranibizumab treatment were conducted, which made us to update our meta-analysis. Based on our updated meta-analysis, increase in several systemic vascular adverse events was observed: 86% increase in odds ratio (OR) for the risk of cerebrovascular accident (CVA) when 0,5 mg ranibizumab used. 89% increase in OR for the risk of CVA when monthly ranibizumab of any dosage is used. 57% increase in OR for the risk of non-ocular hemorrhage when ranibizumab of any dosage with any frequency is used.25 Oct How Good Is Stroke Care in Canada?
MedicalResearch.com Interview with: Michael Douglas Hill, MD, MSc The Calgary Stroke Program, Department of Clinical Neurosciences Hotchkiss Brain Institute Associate Professor, University of Calgary Calgary, Alta MedicalResearch: What is the background for this study? Dr. Hill: We conducted an audit of stroke admissions to Canadian hospitals in all provinces. We examined key metrics of quality stroke care focusing on the acute treatment. Use of thrombolysis for stroke is a key quality metric in the Accreditation Canada standards for stroke care. We found that the use of thrombolysis, while better than the past review (CMAJ. 2005 May 10;172(10):1307-12) remains low. This is a marker for the overall quality of acute stroke care in Canada. As expected, larger academic hospitals perform at a higher level than smaller community hospitals. Overall, this study serves to quantify the gaps in the delivery of acute stroke care to Canadians.24 Oct Long-Term Costs of Stroke Remain HIgh
MedicalResearch.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.
17 Oct Coumarin Users at Higher Risk For Cerebral Microbleeds
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.07 Oct Team Management of Stroke Improved Patient Satisfaction, Decreased Hospital Days
Posted at 23:49h
in Stroke
MedicalResearch.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.
07 Oct TIAs, Strokes Decline Over Last Decade
MedicalResearch.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.
03 Oct TIA Increases Risk of PTSD
Posted at 00:11h
in General Medicine
MedicalResearch.com Interview with:
Kathrin S. Utz, PhD
Department of Neurology
University of Erlangen-Nuremberg
Erlangen, German
Medical Research: What are the main findings of the study?
Dr. Utz: A transient ischemic attack is caused when there is a temporary disruption in the blood supply to a person’s brain. It causes the person to experience symptoms, similar to those of a stroke, such as speech and visual disturbance and numbness or weakness in the arms and legs. A transient ischemic attack is only temporary and people make a full physical recovery from it. We found, however, that a TIA is not without cost. Specifically, we found that such persons are at a greater risk of going on to develop the psychiatric condition known as posttraumatic stress disorder (PTSD). We found 1 in 3 patients develop it. PTSD, which is perhaps better known as a problem found in survivors of war zones and natural, can develop when a person experiences a frightening event that poses a serious threat. It leads the person to experience symptoms such as worry, nightmares, flashbacks and social isolation. We found that TIA patients who develop PTSD are also more likely to suffer from depression and anxiety symptoms. Taken together these symptoms pose a significant psychological burden for the affected patients and it therefore comes as no surprise that we also found TIA patients with PTSD have a measurably lower sense of quality of life than TIA patients who do not develop PTSD. We could also identify some potential risk-factors for the development of PTSD following a TIA. Younger patients and patients who overestimate their future stroke risk are more likely to develop PTSD. Also important in this context are the strategies that patients typically adopt to deal with stressful situations. Those patients who use certain types of coping strategies, such as denying the problem, blaming themselves for any difficulties or turning to drugs for comfort, face a greater risk of developing PTSD after TIA.
17 Sep Carotid Stenosis: Using Cerebrovascular Reserve To Assess Stroke Risk
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.
16 Sep 20 Year Drop In Stroke Incidence
MedicalResearch.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.
05 Sep Dietary Potassium Associated With Lower Risk Of Stroke in Postmenopausal Women
MedicalResearch.com Interview with:
Sylvia Wassertheil-Smoller, PhD
Department of Epidemiology and Population Health
Albert Einstein College of Medicine
Bronx, NY 10461.
First author on this paper was Arjun Seth, BS, Dr. Wassertheil-Smoller’s mentee and a medical student at the Albert Einstein College of Medicine.
Medical Research: What are the main findings of the study?
Dr. Wassertheil-Smoller: We found in study of nearly 100,000 postmenopausal women in the Women's Health Initiative that a high intake of dietary potassium was associated with a lower risk of ischemic stroke and death from all causes.
04 Sep Stroke Caregiver Depressive Symptoms Vary by Ethnicity
MedicalResearch.com Interview with: Nenette M. Jessup MPH, CCRP Research Associate/Project Manager TASK II Indiana University School of Nursing Indianapolis, IN 46202 Medical Research: What are the main findings of the study? Dr. Jessup: Similar to others, we found that females and non-African American caregivers experienced more depressive symptoms and females perceived greater task difficulty. Because female caregivers comprise the largest group of caregivers in the United States, the consistency of this finding has implications for continued social policy efforts to improve their plight. However, our results also suggested an interaction effect between race and type of relationship, with African American spouses experiencing the most difficulty with tasks of caregiving. Inconsistencies in the existing literature about this finding signal the need for a greater understanding of group differences. Individualized interventions may also be of benefit for stroke caregivers.27 Aug Only 4% of US Stroke Patients Receive Approved Medication tPA
MedicalResearch.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.
21 Aug Recurrent Hypoglycemia Raises Stroke Risk in Kidney Disease Patients
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.15 Aug Smokers With Low Educational Level Have Greater Stroke Risk
MedicalResearch.com Interview with: Helene Nordahl, MS, PhD Department of Public Health, University of Copenhagen Copenhagen, Denmark. Medical Research: What are the main findings of this study? Dr. Nordahl: The combined effect of low educational level and smoking on the risk of stroke is the most surprising finding of our paper. In other words, we found that...
11 Aug Stem Cells May Give Hope To Patients With Severe Stroke Disability
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.09 Aug Stroke: Lower Cognitive Function Linked to Increase Risk, Mortality
MedicalResearch.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.
23 Jul Moral Judgment Impairment Can Be Seen With Both Dementia and Stroke
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.20 Jul Stroke: Homocysteine Associated With Atherosclerosis of Cerebral Vessels
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.
17 Jul Stroke History Raises Risks of Non-Cardiac Surgery
MedicalResearch.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.