scholarly journals Effect of the COVID-19 pandemic in stroke code activations in the region of Madrid: a retrospective study

2020 ◽  
Author(s):  
Nicolás Riera-López ◽  
Blanca Fuentes-Gimeno ◽  
Jorge Rodriguez-Pardo de Donlebun
Keyword(s):  
Emergency Medicine ◽  
Retrospective Study ◽  
Acute Stroke ◽  
Seasonal Influenza ◽  
Hospital Admissions ◽  
Time Dependent ◽  
Common Time ◽  
Medicine Service ◽  
One Year ◽  
The Impact

ABSTRACTAcute Stroke (AS) is the most common time-dependent disease attended in the Emergency Medicine Service (EMS) of Madrid (SUMMA 112). Community of Madrid has been one of the most affected regions in Spain by the coronavirus disease 2019 (COVID19) pandemic. A significant reduction in AS hospital admissions has been reported during the COVID-19 pandemic compared to the same period one year before. We aimed to examine the impact of the COVID-19 in stroke codes (SC) in our EMS among three periods of time: the COVID-19 period, the same period the year before, and the 2019-2020 seasonal influenza period. Results: We found no significant reduction in SC during the COVID-19 pandemic. The reduction of hospital admissions might be attributable to patients attending to the hospital by their own means. The maximum SC workload seen during the seasonal influenza has not been reached during the pandemic. We detected a non-significant deviation from the SC protocol, with a slight increase in hospitals’ transfers to non-stroke ready hospitals.

scholarly journals Evaluation of determinants of the serological response to the split-inactivated influenza vaccine

2021 ◽  
Author(s):  
Shaohuan Wu ◽  
Ted M. Ross ◽  
Michael A. Carlock ◽  
Elodie Ghedin ◽  
Hyungwon Choi ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Regression Models ◽  
Seasonal Influenza ◽  
Vaccine Dose ◽  
Serological Response ◽  
Linear Regression Models ◽  
Negative Effects ◽  
Categorical Response ◽  
One Year ◽  
The Impact

AbstractThe seasonal influenza vaccine is only effective in half of the vaccinated population. To identify determinants of vaccine efficacy, we used data from >1,300 vaccination events to predict the response to vaccination measured as seroconversion as well as hemagglutination inhibition (HAI) levels one year after. We evaluated the predictive capabilities of age, body mass index (BMI), sex, race, comorbidities, prevaccination history, and baseline HAI titers, as well as vaccination month and vaccine dose in multiple linear regression models. The models predicted the categorical response for >75% of the cases in all subsets with one exception. Prior vaccination, baseline titer level, and age were the strongest determinants on seroconversion, all of which had negative effects. Further, we identified a gender effect in older participants, and an effect of vaccination month. BMI played a surprisingly small role, likely due to its correlation with age. Comorbidities, vaccine dose, and race had negligible effects. Our models can generate a new seroconversion score that is corrected for the impact of these factors which can facilitate future biomarker identification.

Abstract 197: Do the CHADS 2 , CHA 2 DS 2 -VASc and HAS-BLED Scores Predict Recurrent Stroke and GI Bleeding in Patients with Acute Ischemic Stroke or TIA and Atrial Fibrillation?

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Frank L Silver ◽  
Melissa Stamplecoski ◽  
Jiming Fang ◽  
Moira K Kapral
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Major Bleeding ◽  
Hemorrhagic Stroke ◽  
Hospital Admissions ◽  
Recurrent Stroke ◽  
Simple Random Sample ◽  
Major Hemorrhage ◽  
One Year

Background: In patients with atrial fibrillation (AF) the CHADS 2 and CHA 2 DS 2 -VASc score are used to provide a risk for subsequent stroke and the HAS-BLED score for hemorrhage. These scores were derived from large cohorts of patients with AF, however, only 8 - 25% of the patients had a past history of stroke. We wanted to determine whether these prediction scores had utility in patients with AF who have had a recent stroke or TIA. Methods: We selected patients with AF and a first stroke or TIA from the 2002-3, 2004-5, 2008-9 and 2010-11 Ontario Stroke Audits (OSA). The OSA includes data from a simple random sample of 15 - 20% of stroke and TIA patients presenting to all Ontario hospitals identified using ICD-10 diagnostic codes I60, I61, I63, I64, H34.1 and G45. Recurrent ischemic stroke, hemorrhagic stroke and major GI hemorrhage were obtained by linking the OSA data to administrative databases for hospital admissions in the subsequent year. Results: There were 3,960 patients with AF in the OSA who were discharged alive following their first acute stroke or TIA. The median age was 80. At discharge 41% of the patients were prescribed anticoagulants, 24% antiplatelet therapy, 25% both and 9% were prescribed no antithrombotic therapy. The one year readmission rate for stroke was 5.3% (including 0.4% hemorrhagic stroke) and 1.9% for major hemorrhage. Multivariable logistic regression models did not show any significant association between the CHADS 2 and CHA 2 DS 2 -VASc scores and the risk of recurrent stroke. The HAS-BLED score failed to predict hemorrhagic stroke or major bleeding and the risk of major bleeding for the entire group at one year was low (1.9%). Patients prescribed anticoagulants at discharge had fewer recurrent strokes (OR 0.55; 95% CI 0.34 - 0.90, p=0.02), a lower one year mortality (OR 0.42; 95% CI 0.31 - 0.56, p <0.001) and the same risk of major bleeding as compared to patients not receiving anticoagulants. Conclusions: The CHADS 2 , CHA 2 DS 2 -VASc and HAS-BLED scores did not predict recurrent stroke or hemorrhage in patients following an acute stroke or TIA. Anticoagulation at discharge was associated with a lower risk of recurrent stroke and death without a significant increase in the risk of major hemorrhage.

scholarly journals Effects of Pre-Arrival Hospital Notification by Emergency Medicine Service System on Acute Stroke Patients: A New Experience in Kaohsiung City

2015 ◽  
Vol 05 (06) ◽  
Author(s):  
Shih-Chiang Hung ◽  
Chia-Te Kung ◽  
Wen-Huei Lee ◽  
Hsien-Hung Cheng ◽  
Chia-Wei Liou ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Acute Stroke ◽  
Service System ◽  
Stroke Patients ◽  
Medicine Service ◽  
Kaohsiung City

scholarly journals Acute Stroke in Times of the COVID-19 Pandemic

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2224-2227 ◽  
Author(s):  
Carolin Hoyer ◽  
Anne Ebert ◽  
Hagen B. Huttner ◽  
Volker Puetz ◽  
Bernd Kallmünzer ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Hospital Admissions ◽  
Social Distancing ◽  
Admission Rates ◽  
Cerebrovascular Events ◽  
Number Of Patients ◽  
Before And After ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: This study aims to assess the number of patients with acute ischemic cerebrovascular events seeking in-patient medical emergency care since the implementation of social distancing measures in the coronavirus disease 2019 (COVID-19) pandemic. Methods: In this retrospective multicenter study, data on the number of hospital admissions due to acute ischemic stroke or transient ischemic attack and numbers of reperfusion therapies performed in weeks 1 to 15 of 2020 and 2019 were collected in 4 German academic stroke centers. Poisson regression was used to test for a change in admission rates before and after the implementation of extensive social distancing measures in week 12 of 2020. The analysis of anonymized regional mobility data allowed for correlations between changes in public mobility as measured by the number and length of trips taken and hospital admission for stroke/transient ischemic attack. Results: Only little variation of admission rates was observed before and after week 11 in 2019 and between the weeks 1 and 11 of 2019 and 2020. However, reflecting the impact of the COVID-19 pandemic, a significant decrease in the number of admissions for transient ischemic attack was observed (−85%, −46%, −42%) in 3 of 4 centers, while in 2 of 4 centers, stroke admission rates decreased significantly by 40% and 46% after week 12 in 2020. A relevant effect on reperfusion therapies was found for 1 center only (thrombolysis, −60%; thrombectomy, −61%). Positive correlations between number of ischemic events and mobility measures in the corresponding cities were identified for 3 of 4 centers. Conclusions: These data demonstrate and quantify decreasing hospital admissions due to ischemic cerebrovascular events and suggest that this may be a consequence of social distancing measures, in particular because hospital resources for acute stroke care were not limited during this period. Hence, raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated strokes and transient ischemic attacks.

scholarly journals One-Year Readmission and Emergency Department Presentation After an Epilepsy-Related Admission in People with Intellectual Disability: A Registry-Linkage Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Peiwen Liao
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Healthcare Services ◽  
Linkage Study ◽  
Adjusted Incidence Rate ◽  
One Year ◽  
Service Data ◽  
Patients With Epilepsy ◽  
The Impact

IntroductionIntellectual disability (ID) is a neurodevelopmental condition that affects approximately 1-2% of the population, and epilepsy is a common comorbidity in people with ID. Although hospital admission for epilepsy is also common, little is known about the impact of ID on healthcare use following an epilepsy admission. Objectives and ApproachUsing linked administrative health datasets that included hospital admissions and disability service data, we aimed to examine whether the presence of ID led to greater or lesser use of healthcare services following an epilepsy admission, as represented by all-cause unplanned readmissions and emergency department (ED) presentations. Comparing the rate of readmissions and ED presentations within 30, 90 and 365 days of the first epilepsy admission during the study period, the effect of ID was assessed using Poisson regression. ResultsA total of 18,987 patients had an epilepsy admission between 2005 and 2014, and of these, 3,256 (17.1%) had ID. Compared to patients without ID, patients with ID had a higher risk of unplanned readmissions within each follow-up period (adjusted incidence rate ratio (IRR) with 95% CI: 30 days: 1.48 (1.34, 1.65); 90 days: 1.42 (1.31, 1.54); 365 days: 1.49 (1.40, 1.59)). Differences were also found in the reasons for readmission, including more readmissions for neurological disorders. Similarly, the ED presentation risk was elevated in patients with ID (adjusted IRR: 30 days: 1.34 (1.23, 1.46); 90 days: 1.33 (1.24, 1.42); 365 days: 1.38 (1.30, 1.46)). Conclusion / ImplicationsIn patients with epilepsy, the presence of ID appears to increase the chance of a readmission or ED presentation following a hospital admission for epilepsy, with the reasons for readmission also potentially different. This suggests the potential for improvements in post-admission screening and management.

Impact of diabetes and hyperglycemia on health care utilization, infection risk, and survival in patients with cancer receiving glucocorticoids with chemotherapy.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 19-19
Author(s):  
Dylan M. Zylla ◽  
Grace Gilmore ◽  
Justin Eklund ◽  
Sara Richter ◽  
Anders Carlson
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Urgent Care ◽  
Care Utilization ◽  
Intravenous Chemotherapy ◽  
Logistic Regression Models ◽  
Patients With Cancer ◽  
One Year ◽  
The Impact

19 Background: Glucocorticoid (GC) use is commonly used in chemotherapy regimens and may lead to hyperglycemia and increased infection rates. We assessed the impact of diabetes (DM) and hyperglycemia on rates of health-care utilization, infections and survival among patients with cancer receiving chemotherapy. Methods: We performed a retrospective analysis on 1,781 patients who received intravenous chemotherapy with GC between 2010 and 2015. Demographic, clinical, and health-care utilization (HCU) data was obtained using electronic medical record, billing modules, and the tumor registry; HCU included tallies of emergency room, urgent care, and inpatient visits. Logistic regression models were used to compare survival and new infections between patients with and without DM, after adjusting for demographic and cancer-related variables. Results: In the first 12 months following chemotherapy, patients with DM (n = 330) had higher rates of hospital admissions (70.9% vs 57.4%, p< 0.001), more infection-related admissions (37.0% vs 29.2%, p = 0.007), and increased rates of new infections (61.2% vs 49.2%, p < 0.001) when compared to patients without DM (n = 1,451). One-year survival rate was worse among patients with DM (67.3% vs 78.3%, p < 0.001), as well as patients with at least one glucose reading above 300 mg/dL following chemotherapy (60.8% vs 78.5, p < 0.001). After adjusting for cancer stage, age, and gender, we found DM history increased the odds of dying within one year after diagnosis by 86% (OR 1.86, 95% CI (1.37 – 2.52), p < 0.001) and of new infections by 68% (OR 1.68, 95% CI (1.26 – 2.24), p < 0.001). Conclusions: Among patients with cancer receiving intravenous chemotherapy with GC we demonstrate patients with DM have more hospital admissions, increased rates of infections, and worse survival. Prospective studies are urgently needed to elucidate what level of glycemic control is needed to potentially improve outcomes for patients with DM receiving chemotherapy with GC.

scholarly journals Simple In-Hospital Interventions to Reduce Door-to-CT Time in Acute Stroke

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Elyar Sadeghi-Hokmabadi ◽  
Aliakbar Taheraghdam ◽  
Mazyar Hashemilar ◽  
Reza Rikhtegar ◽  
Kaveh Mehrvar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Time Dependent ◽  
Staff Education ◽  
Stroke Patients ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Improvement Interventions ◽  
Quality Improvement Interventions ◽  
One Year

Background. Intravenous tissue plasminogen activator, a time dependent therapy, can reduce the morbidity and mortality of acute ischemic stroke. This study was designed to assess the effect of simple in-hospital interventions on reducing door-to-CT (DTC) time and reaching door-to-needle (DTN) time of less than 60 minutes.Methods. Before any intervention, DTC time was recorded for 213 patients over a one-year period at our center. Five simple quality-improvement interventions were implemented, namely, call notification, prioritizing patients for CT scan, prioritizing patients for lab analysis, specifying a bed for acute stroke patients, and staff education. After intervention, over a course of 44 months, DTC time was recorded for 276 patients with the stroke code. Furthermore DTN time was recorded for 106 patients who were treated with IV thrombolytic therapy.Results. The median DTC time significantly decreased in the postintervention period comparing to the preintervention period [median (IQR); 20 (12–30) versus 75 (52.5–105),P<0.001]. At the postintervention period, the median (IQR) DTN time was 55 (40–73) minutes and proportion of patients with DTN time less than 60 minutes was 62.4% (P<0.001).Conclusion. Our interventions significantly reduced DTC time and resulted in an acceptable DTN time. These interventions are feasible in most hospitals and should be considered.

Abstract 4013: The Impact of Atrial Fibrillation on the outcomes of patients suffering a second Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yingzi Deng ◽  
William J Kostis ◽  
Alan C Wilson ◽  
Nora Cosgrove ◽  
Yu-Hsuan Shao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Hospital Admissions ◽  
Strong Predictor ◽  
Mortality Rates ◽  
Percutaneous Coronary ◽  
History Of ◽  
Short And Long Term ◽  
One Year ◽  
The Impact

In the past 20 years, significant increases in hospital admissions for atrial fibrillation (AF) and in survival of acute myocardial infarction (MI) have been observed. We examined the occurrence of AF and its effect on short and long term outcomes of first MI(FMI) and second MI(SMI). Hospitalized MIs from MIDAS (Myocardial Infarction Data Acquisition System, N=269,110) in New Jersey from 1986 to 2005 were included in the analysis. The rate of the co-exiting MI and AF and 30-day and 1 year mortality were investigated. Approximately 11 %( N=26,631) of FMI patients had a second event. The rate of co-existing AF for the FMI was 9.6% in 1986 and 16.2% in 2005, a 40.9% increase; while AF increased 60.4%, from 7.7% to 20.5% for SMI. Patients with AF were older (76.5 vs 69.3), more likely to be female (43.6% vs 39.4%), to have subendocardial infarction (58.5% vs 49.2%). Patients AF were less likely to be black in racial (4.2% vs 8.4%) and to receive percutaneous coronary interventions (PCI) (6.1% vs 10.4 %). There were more strokes (2% vs 0.9%) and heart failure hospitalizations (HF, 58% vs 39%) in the AF group(p<0.0001). Thirty-day mortality rates (AF vs non-AF) were 20.9% and 13.8% for the FMIs; and 21.5% vs 14.2% for SMIs. One-year mortality rates were 37.4% and 20.5% at FMI, and 43.3% and 28.1% at the SMI, respectively. When adjusting for age, gender, race, MI site, PCI, year of MI, diabetes, stroke and HF, AF increased the 30 day mortality by 36%( OR1.36 95% CI 1.32–1.41) for FMI, and by 33% (OR 1.33(1.22–1.46)] for SMI. The effect of AF on mortality was more pronounced at 1 year [FMI 1.54(1.50 –1.58), SMI:1.44(1.34 –1.55)]. Current AF as well as the history of AF increased both 30-day [OR for current AF: 1.35(1.22–1.50), history of AF: 1.17(1.04 –1.32)] and 1-year mortality [current AF: 1.5(1.4 –1.6), history of AF: 1.21(1.11–1.33)]. The rate of AF in MI patients has increased, especially SMIs. AF remains as a strong predictor of worse outcome for patients suffering a second MI. Both the history of AF and current AF were associated with higher mortality in MI patients.

scholarly journals LO69: Evaluating the impact of night shifts on emergency medicine resident competence in simulated resuscitations

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S51-S52
Author(s):  
S. Edgerley ◽  
C. McKaigney ◽  
D. Boyne ◽  
D. Dagnone ◽  
A.K. Hall
Keyword(s):  
Emergency Medicine ◽  
Assessment Tool ◽  
Night Shift ◽  
Emergency Medicine Resident ◽  
Medicine Resident ◽  
The Difference ◽  
One Year ◽  
Primary Assessment ◽  
The Impact ◽  
Night Shifts

Introduction: Sleep deprivation negatively affects cognitive and behavioural performance. Emergency Medicine (EM) residents commonly work night shifts and are then expected to perform with competence. This study examines the impact of night shifts on EM resident performance in simulated resuscitation scenarios. Methods: A retrospective cohort study was completed at a single Canadian academic centre where residents participate in twice-annual simulation-based resuscitation objective structured clinical examinations (OSCEs). OSCE scores for all EM residents between 2010-2016 were collected, as well as post-graduate year (PGY1-5), gender, and shift schedules. OSCEs were scored using the Queen’s Simulation Assessment Tool (QSAT) evaluating four domains: primary assessment, diagnostic actions, therapeutic actions and communication, and an overall global assessment score (GAS). A night shift was defined as a late evening (beyond 23:00) or overnight shift within the three days before an OSCE. A mixed effects linear regression model was used to model the association between night shifts and OSCE scores while adjusting for gender and PGY. Results: A total of 136 OSCE scores were collected from 56 residents. PGY-5 residents had 37.1% (31.3 to 34.0%; p&lt;0.01) higher OSCE scores than those in PGY-1 with an average increase of 8.8% (7.5 to 10.1%; p&lt;0.01) per year. Working one or more night shifts in the three days before an OSCE reduced the total and communication scores by an average of 3.8% (p=0.04) and 4.5% (p=0.04) respectively. We observed a significant gender difference in the effects of acute shift work (p=0.03). Working a night shift one night prior to an OSCE was not associated with total score among male residents (p=0.33) but was associated with a 6.1% (-11.9 to -0.2; p=0.04) decrease in total score among female residents. This difference was consistent across PGY and was primarily due to an 8.5% (-15.5 to -1.6%; p=0.02) decrease in communication scores and a 6.7% (-13.1 to -0.3%; p=0.04) reduction in GAS. Conclusion: Proximity to night shifts significantly impaired the performance of EM trainees in simulated resuscitation scenarios, particularly in the domain of communication. For female residents, the magnitude of difference in total scores after working such shifts one night prior to a resuscitation OSCE was approximately equal to the difference seen between residents one year apart in training.

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