The impact of mental practice on stroke patients' postural balance

Introduction: Elevated concentrations of platelet-derived microvesicles are found in cerebrovascular diseases. The impact of acetylsalicylic acid on these microvesicles remains inconsistent, despite its well-established effect on platelet aggregation. High residual platelet aggregation is defined as high on-treatment platelet reactivity, while “treatment failure” is the occurrence of vascular events despite antiplatelet treatment. The aim of this study was to determine whether the antiaggregatory effect of acetylsalicylic acid correlates with platelet-derived microvesicles in convalescent ischaemic stroke patients and cardiovascular risk factor controls as well as to evaluate the association between high on-treatment platelet reactivity and recurrent vascular events with the studied platelet-derived microvesicle parameters. Materials and methods: The study groups consisted of 76 convalescent stroke patients and 74 controls. Total platelet-derived microvesicles, annexino-positive microvesicles number, and platelet-derived microvesicles with surface expression of proinflammatory (CD40L, CD62P, CD31) and procoagulant (PS, GPIIb/IIIa) markers were characterized and quantified using flow cytometry. Cyclooxygenase-1-specific platelet responsiveness, with whole blood impedance platelet aggregation under arachidonic acid stimulation and the serum concentration of thromboxane B2, were evaluated. Results: Neither acetylsalicylic acid intake nor modification of its daily dose caused statistically significant differences in the studied microvesicle parameters. Additionally, no statistically significant differences in the studied microvesicle parameters were revealed between high on-treatment platelet reactivity and non-high on-treatment platelet reactivity subjects in either study subgroup. However, elevated concentrations of PAC-1+/CD61+, CD62P+/CD61+ and CD31+/CD61+ microvesicles were found in stroke patients with treatment failure, defined in this study as a recurrent vascular events in a one-year follow-up period. Conclusions: This study revealed no relationship between circulating microvesicle number and platelet aggregation. The procoagulant and proinflammatory phenotype of circulating platelet-derived microvesicles might contribute to acetylsalicylic acid treatment failure.

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A comparison of feature extraction methods for prediction of neuropsychological scores from functional connectivity data of stroke patients

Brain Informatics ◽

10.1186/s40708-021-00129-1 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Federico Calesella ◽

Alberto Testolin ◽

Michele De Filippo De Grazia ◽

Marco Zorzi

Keyword(s):

Feature Extraction ◽

Functional Connectivity ◽

Dimensionality Reduction ◽

Verbal Memory ◽

Resting State ◽

Component Analysis ◽

Model Complexity ◽

Stroke Patients ◽

Prediction Ability ◽

The Impact

AbstractMultivariate prediction of human behavior from resting state data is gaining increasing popularity in the neuroimaging community, with far-reaching translational implications in neurology and psychiatry. However, the high dimensionality of neuroimaging data increases the risk of overfitting, calling for the use of dimensionality reduction methods to build robust predictive models. In this work, we assess the ability of four well-known dimensionality reduction techniques to extract relevant features from resting state functional connectivity matrices of stroke patients, which are then used to build a predictive model of the associated deficits based on cross-validated regularized regression. In particular, we investigated the prediction ability over different neuropsychological scores referring to language, verbal memory, and spatial memory domains. Principal Component Analysis (PCA) and Independent Component Analysis (ICA) were the two best methods at extracting representative features, followed by Dictionary Learning (DL) and Non-Negative Matrix Factorization (NNMF). Consistent with these results, features extracted by PCA and ICA were found to be the best predictors of the neuropsychological scores across all the considered cognitive domains. For each feature extraction method, we also examined the impact of the regularization method, model complexity (in terms of number of features that entered in the model) and quality of the maps that display predictive edges in the resting state networks. We conclude that PCA-based models, especially when combined with L1 (LASSO) regularization, provide optimal balance between prediction accuracy, model complexity, and interpretability.

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Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching

Brain Sciences ◽

10.3390/brainsci11020161 ◽

2021 ◽

Vol 11 (2) ◽

pp. 161

Author(s):

Chong-Chi Chiu ◽

Jhi-Joung Wang ◽

Chao-Ming Hung ◽

Hsiu-Fen Lin ◽

Hong-Hsi Hsien ◽

...

Keyword(s):

Propensity Score ◽

Functional Status ◽

Propensity Score Matching ◽

Acute Care ◽

Medical Cost ◽

Economic Burden ◽

Stroke Rehabilitation ◽

Stroke Patients ◽

The Impact ◽

Post Acute Care

Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost–illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.

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Effect of early sleep apnoea treatment with adaptive servo-ventilation in acute stroke patients on cerebral lesion evolution and neurological outcomes: study protocol for a multicentre, randomized controlled, rater-blinded, clinical trial (eSATIS: early Sleep Apnoea Treatment in Stroke)

Trials ◽

10.1186/s13063-020-04977-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Simone B. Duss ◽

Anne-Kathrin Brill ◽

Sébastien Baillieul ◽

Thomas Horvath ◽

Frédéric Zubler ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Acute Stroke ◽

Acute Ischaemic Stroke ◽

Sleep Apnoea ◽

Resonance Imaging ◽

Stroke Patients ◽

Adaptive Servo Ventilation ◽

Randomized Controlled ◽

The Impact

Abstract Background Sleep-disordered breathing (SDB) is highly prevalent in acute ischaemic stroke and is associated with worse functional outcome and increased risk of recurrence. Recent meta-analyses suggest the possibility of beneficial effects of nocturnal ventilatory treatments (continuous positive airway pressure (CPAP) or adaptive servo-ventilation (ASV)) in stroke patients with SDB. The evidence for a favourable effect of early SDB treatment in acute stroke patients remains, however, uncertain. Methods eSATIS is an open-label, multicentre (6 centres in 4 countries), interventional, randomized controlled trial in patients with acute ischaemic stroke and significant SDB. Primary outcome of the study is the impact of immediate SDB treatment with non-invasive ASV on infarct progression measured with magnetic resonance imaging in the first 3 months after stroke. Secondary outcomes are the effects of immediate SDB treatment vs non-treatment on clinical outcome (independence in daily functioning, new cardio-/cerebrovascular events including death, cognition) and physiological parameters (blood pressure, endothelial functioning/arterial stiffness). After respiratory polygraphy in the first night after stroke, patients are classified as having significant SDB (apnoea-hypopnoea index (AHI) > 20/h) or no SDB (AHI < 5/h). Patients with significant SDB are randomized to treatment (ASV+ group) or no treatment (ASV− group) from the second night after stroke. In all patients, clinical, physiological and magnetic resonance imaging studies are performed between day 1 (visit 1) and days 4–7 (visit 4) and repeated at day 90 ± 7 (visit 6) after stroke. Discussion The trial will give information on the feasibility and efficacy of ASV treatment in patients with acute stroke and SDB and allows assessing the impact of SDB on stroke outcome. Diagnosing and treating SDB during the acute phase of stroke is not yet current medical practice. Evidence in favour of ASV treatment from a randomized multicentre trial may lead to a change in stroke care and to improved outcomes. Trial registration ClinicalTrials.gov NCT02554487, retrospectively registered on 16 September 2015 (actual study start date, 13 August 2015), and www.kofam.ch (SNCTP000001521).

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The Impact of Loading Dose on Outcome in Stroke Patients Receiving Low-Dose Tissue Plasminogen Activator Thrombolytic Therapy

Drug Design Development and Therapy ◽

10.2147/dddt.s235388 ◽

2020 ◽

Vol Volume 14 ◽

pp. 257-263 ◽

Cited By ~ 1

Author(s):

Yi-Sin Wong ◽

Sheng-Feng Sung ◽

Chi-Shun Wu ◽

Yung-Chu Hsu ◽

Yu-Hsiang Su ◽

...

Keyword(s):

Thrombolytic Therapy ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Low Dose ◽

Loading Dose ◽

Stroke Patients ◽

Tissue Plasminogen ◽

The Impact

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Abstract P850: Four C’s Are Vital in Improving Door to Thrombolytic Administration

Stroke ◽

10.1161/str.52.suppl_1.p850 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Betty A McGee ◽

Melissa Stephenson

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Median Time ◽

Survival Data ◽

Stroke Patients ◽

Eligibility Criteria ◽

Before And After ◽

Administration Time ◽

System Data ◽

The Impact

Background and Purpose: Thrombolytic therapy is a key link in the stroke chain of survival. Data suggests that four components are vital in decreasing door to thrombolytic administration in acute stroke patients eligible for treatment. Analysis of system data, pre and post implementation of a Door to Needle Project, afforded the opportunity to assess. Hypothesis: We assessed the hypothesis that commitment, collaboration, communication, and consistency (referred to as Four C’s) are vital in improving door to thrombolytic administration time in ischemic stroke patients. Methods: In this quantitative study, we utilized case data collected by a quality improvement team serving five emergency departments within a healthcare system. We retrospectively reviewed times of thrombolytic administration from admission to the emergency department in acute ischemic stroke patients. Cases were included based on eligibility criteria from American Heart Association’s Get With the Guidelines. Times from 2019 were compared with times through April 2020, before and after implementation of the project, which had multidisciplinary process interventions that reinforced the Four C’s. Results: The data revealed a 13.5 % reduction in median administration time. Cases assessed from 2019 had a median time of 52 minutes from door to thrombolytic administration, 95% CI [47.0, 59.0], n = 52. Cases assessed through April 2020 had a median time of 45 minutes from door to thrombolytic administration, 95% CI [39.0, 57.5], n = 18. Comparing cases through April 2020 to those of 2019, there were improvements of 38.1% fewer cases for administration in greater than 60 minutes and 27.8% fewer cases for administration in greater than 45 minutes. Conclusion: The hypothesis that Four C’s are vital in improving door to thrombolytic administration was validated by a decrease in median administration time as well as a reduction in cases exceeding targeted administration times. The impact to clinical outcomes is significant as improving administration time directly impacts the amount of tissue saved. Ongoing initiatives encompassing the Four C’s, within a Cerebrovascular System of Care, are essential in optimizing outcomes in acute stroke patients.

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Abstract WP282: Protecting Stroke Patients from Aspiration and Mortality through a Bedside Aspiration Screen

Stroke ◽

10.1161/str.44.suppl_1.awp282 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Edith Matesic

Keyword(s):

Organizational Learning ◽

Aspiration Pneumonia ◽

The Body ◽

Kappa Statistics ◽

Evidence Based ◽

Stroke Patients ◽

Rater Reliability ◽

Stroke Treatment ◽

Risk Of Death ◽

The Impact

Background: Stroke patients initially experience dysphagia approximately 42-76% of the time, putting them at high risk for developing aspiration pneumonia and increasing the risk of death threefold in the first 30 days following onset of the condition. Interventions to identify risk for aspiration pneumonia are key to reducing mortality in hospitalized patients. However, no generally recognized bedside aspiration screen exists, and few have been rigorously tested. The Edith-Huhn-Matesic Bedside Aspiration Screen (EHMBAS) TM was developed as an evidence-based RN bedside aspiration screening protocol. Purpose: This study analyzed the sensitivity and inter-rater reliability of EHMBAS TM , assessed the efficacy of training methods, evaluated patient feedback, and looked at the impact of organizational learning. Methods: RNs were trained to apply the EHMBAS TM . An evaluation study assessed the sensitivity, specificity and predictability of the screen to detect aspiration in the stroke population study group. Cohen’s Kappa statistics was applied to test inter-rater reliability. Pre- and post-implementation Likert surveys examined patient and staff satisfaction on the education plan and screening process, respectively. Lastly, an analysis of organizational learning examined whether changes enhanced adherence to screening requirements. Results: Results showed that the EHMBAS TM demonstrated strong validity (94% sensitivity) and high inter-rater reliability (Kappa = .92, p<.001). Pre- and post- staff training survey results demonstrated a significant positive change in knowledge gained, feelings of preparedness, and satisfaction with teaching methods. Further, 92.3% of patients surveyed had positive screening experiences. The hospital received Silver recognition from The American Heart Association for following stroke treatment guidelines 85% of the time for at least 12 months, demonstrating the positive impact of the protocol on organizational change. Conclusions: This study contributes to the body of work aimed at establishing a reliable evidence-based, bedside aspiration screen. Patient safety is enhanced, because screen results help determine when patients can safely receive medication and nutrition by mouth.

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Abstract P862: Successes and Impact of a Statewide Stroke Education Campaign for Healthcare Providers

Stroke ◽

10.1161/str.52.suppl_1.p862 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Olivia N Jones ◽

Janna Pietrzak ◽

Kylie Picou ◽

Mindy Cook ◽

Adela Santana ◽

...

Keyword(s):

North Dakota ◽

Health Care Providers ◽

Healthcare Professionals ◽

Life Support ◽

Systems Of Care ◽

Everyday Practice ◽

Care Providers ◽

Stroke Patients ◽

Treatment Methods ◽

The Impact

Introduction: The North Dakota Mission: Lifeline Stroke program is a 3-year initiative which aims to improve statewide stroke systems of care. Due to complexities in recognizing and treating stroke patients, effective education of prehospital and hospital health care providers on guideline-based assessments and treatment methods were identified as an essential intervention. In person lectures, conferences, workshops, stroke simulation trainings, online courses, webinars, and a stroke certification program were deployed throughout the project. Purpose: The purpose of the post-education survey was to determine the impact, value, and success of different types of education provided during the project. Methods: North Dakota healthcare professionals (n=221) completed a 20-question online survey about their experiences participating in the stroke trainings provided from 2017 to 2020. Results: Survey respondents consisted of 76 Emergency Medical Service (EMS) providers and 145 hospital-based healthcare professionals. The majority of hospital-based staff respondents were nurses (80.1%), while most EMS-based respondents were paramedics or EMTs (75.0%). Half of all respondents (49.8%) participated in 2 or more educational offerings. Respondents were asked to rank the educational offerings in which they participated in by order of the benefit to their everyday practice. The two highest ranking educational offerings were the Advanced Stroke Life Support Class (mean rank=1.6) and Simulation in Motion (SIM) ND (mean rank=2.3). More than 90% of respondents stated that these trainings were extremely or very applicable to their everyday practice. When asked about the overall impact of all the educational offerings they participated in, almost all (92.6%) respondents indicated they agree that because of the trainings they have a better understanding of the key issues related to caring for stroke patients. Conclusions: Overall, the comprehensive survey provides concrete evidence and feedback that multi-modal education campaigns are well-received and effective in furthering awareness of guideline-based stroke assessments and treatment methods. Activities with a kinesthetic learning approach were found to be especially well-received.

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