scholarly journals Screening and follow-up care for cognitive and emotional problems after transient ischaemic attack and ischaemic stroke: a national, cross-sectional, online survey among neurologists in the Netherlands

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046316
Author(s):  
Jos Slenders ◽  
Renske Van den Berg-Vos ◽  
Johanna Visser-Meily ◽  
Caroline van Heugten ◽  
Vincent Kwa
Keyword(s):  
Clinical Practice ◽  
Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Online Survey ◽  
Emotional Problems ◽  
Information Provision ◽  
Cross Sectional ◽  
Follow Up Care ◽  
Ischaemic Attack

BackgroundAfter stroke, many patients experience cognitive and/or emotional problems. While national guidelines recommend screening for these problems, actual screening rates might be limited.ObjectiveThis study aimed to examine the clinical practice at neurology departments regarding screening, information provision and follow-up care for cognitive and emotional problems after transient ischaemic attack (TIA) and ischaemic stroke.MethodsA nationwide, cross-sectional, online survey was conducted between October 2018 and October 2019 among neurologists in all hospitals in the Netherlands.ResultsNeurologists in 78 hospitals were invited to join the survey, and 52 (67%) of them completed it. Thirty-one (59%) neurologists reported that screening for cognitive problems after TIA and ischaemic stroke was mostly or always performed. When cognitive screening was performed, 42 (84%) used validated screening instruments. Twenty-nine (56%) of the respondents reported that screening for emotional problems was mostly or always performed. When emotional screening was performed, 31 (63%) reported using validated screening instruments. Timing of screening and information provision was highly variable, and the majority reported that there was no protocol for follow-up care when cognitive or emotional problems were found.ConclusionsThis study demonstrates that clinical practice at neurology departments is highly variable regarding screening, information provision and follow-up care for cognitive and emotional problems in patients after TIA or ischaemic stroke. Approximately half of the participating neurologists reported that screening was performed only sometimes or never for cognitive and emotional problems after TIA and ischaemic stroke.

scholarly journals Decreasing referrals to transient ischaemic attack clinics during the COVID-19 outbreak: results from a multicentre cross-sectional survey

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e041514
Author(s):  
Lucio D'Anna ◽  
Ambreen Sheikh ◽  
Raj Bathula ◽  
Salwa Elmamoun ◽  
Adelaide Oppong ◽  
...  
Keyword(s):  
Transient Ischaemic Attack ◽  
Online Survey ◽  
Stroke Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Future Studies ◽  
North West ◽  
The North ◽  
Number Of Patients ◽  
Ischaemic Attack

ObjectiveThe COVID-19 pandemic is having major implications for stroke care with a documented significant fall in hospital acute stroke admissions. We investigated whether COVID-19 has resulted in a decreased number of referrals to the transient ischaemic attack (TIA) clinics across the North West London region.Setting and designAll the TIA clinical leads of the North West London region received an invitation by email to participate in an online survey in May 2020. The survey questionnaire aimed to assess the number of patients with suspected TIA consecutively referred to each of the TIA clinics of the North West London region between 1 March and 30 April 2020, the COVID-19 period, and between 1 March and 30 April 2019.ResultsWe had a response rate of 100%. During the COVID-19 period, the TIA clinics of the North West London region received 440 referrals compared with 616 referrals received between 1 March and 30 April 2019 with a fall in the number of the referrals by 28.6%. In April 2020 compared with April 2019, the number of the referrals declined by 40.1%.ConclusionsThis multicentre analysis documented a significant reduction in the number of patients referred with suspected TIA to the specialised rapid access outpatient clinics in the North West London region during the COVID-19 pandemic. Future studies are needed to confirm our findings and to better characterise the incidence of cerebrovascular disease during the COVID-19 pandemic.

scholarly journals Outcomes of Medicare beneficiaries hospitalised with transient ischaemic attack and stratification using the ABCD2 score

2020 ◽  
pp. svn-2020-000372
Author(s):  
Shreyansh Shah ◽  
Li Liang ◽  
Durgesh Bhandary ◽  
Saga Johansson ◽  
Eric E Smith ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Intracranial Haemorrhage ◽  
Haemorrhagic Stroke ◽  
Medicare Beneficiaries ◽  
Ischaemic Attack

BackgroundLong-term outcomes for Medicare beneficiaries hospitalised with transient ischaemic attack (TIA) and role of ABCD2 score in identifying high-risk individuals are not studied.MethodsWe identified 40 825 Medicare beneficiaries hospitalised from 2011 to 2014 for a TIA to a Get With The Guidelines (GWTG)-Stroke hospital and classified them using ABCD2 score. Proportional hazards models were used to assess 1-year event rates of mortality and rehospitalisation (all-cause, ischaemic stroke, haemorrhagic stroke, myocardial infarction, and gastrointestinal and intracranial haemorrhage) for high-risk versus low-risk groups adjusted for patient and hospital characteristics.ResultsOf the 40 825 patients, 35 118 (86%) were high risk (ABCD2 ≥4) and 5707 (14%) were low risk (ABCD2=0–3). Overall rate of mortality during 1-year follow-up after hospital discharge for the index TIA was 11.7%, 44.3% were rehospitalised for any reason and 3.6% were readmitted due to stroke. Patients with ABCD2 score ≥4 had higher mortality at 1 year than not (adjusted HR 1.18, 95% CI 1.07 to 1.30). Adjusted risks for ischaemic stroke, all-cause readmission and mortality/all-cause readmission at 1 year were also significantly higher for patients with ABCD2 score ≥4 vs 0–3. In contrast, haemorrhagic stroke, myocardial infarction, gastrointestinal bleeding and intracranial haemorrhage risk were not significantly different by ABCD2 score.ConclusionsThis study validates the use of ABCD2 score for long-term risk assessment after TIA in patients aged 65 years and older. Attentive efforts for community-based follow-up care after TIA are needed for ongoing prevention in Medicare beneficiaries who were hospitalised for TIA.

scholarly journals Delay in patients suspected of transient ischaemic attack: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e027161 ◽  
Author(s):  
L Servaas Dolmans ◽  
L Jaap Kappelle ◽  
Marie-Louise EL Bartelink ◽  
Arno W Hoes ◽  
Frans H Rutten
Keyword(s):  
Ischaemic Stroke ◽  
Antiplatelet Therapy ◽  
Median Time ◽  
Symptom Onset ◽  
Transient Ischaemic Attack ◽  
Preventive Treatment ◽  
Patient Delay ◽  
Cross Sectional ◽  
Ischaemic Attack ◽  
First Contact

ObjectivesSuspected transient ischaemic attack (TIA) necessitates an urgent neurological consultation and a rapid start of antiplatelet therapy to reduce the risk of early ischaemic stroke following a TIA. Guidelines for general practitioners (GPs) emphasise the urgency to install preventive treatment as soon as possible. We aimed to give a contemporary overview of both patient and physician delay.MethodsA survey at two rapid-access TIA outpatient clinics in Utrecht, the Netherlands. All patients suspected of TIA were interviewed to assess time delay to diagnosis and treatment, including the time from symptom onset to (1) the first contact with a medical service (patient delay), (2) consultation of the GP and (3) assessment at the TIA outpatient clinic. We used the diagnosis of the consulting neurologist as reference.ResultsOf 93 included patients, 43 (46.2%) received a definite, 13 (14.0%) a probable, 11 (11.8%) a possible and 26 (28.0%) no diagnosis of TIA. The median time from symptom onset to the visit to the TIA service was 114.5 (IQR 44.0–316.6) hours. Median patient delay was 17.5 (IQR 0.8–66.4) hours, with a delay of more than 24 hours in 36 (38.7%) patients. The GP was first contacted in 76 (81.7%) patients, and median time from first contact with the GP practice to the actual GP consultation was 2.8 (0.5–18.5) hours. Median time from GP consultation to TIA service visit was 40.8 (IQR 23.1–140.7) hours. Of the 62 patients naïve to antithrombotic medication who consulted their GP, 27 (43.5%) received antiplatelet therapy.ConclusionsThere is substantial patient and physician delay in the process of getting a confirmed TIA diagnosis, resulting in suboptimal prevention of an early ischaemic stroke.

Investigation on emotion and behavior of children aged 1-11 during the pandemic of COVID-19: A Cross-sectional study in Guizhou, China (Preprint)

2020 ◽  
Author(s):  
Yushi Mo ◽  
Yan Luo ◽  
Hong Li ◽  
Dewei Xiao ◽  
Shuqing Liu ◽  
...  
Keyword(s):  
Behavioral Problems ◽  
Prevention And Control ◽  
Online Survey ◽  
Sleep Problems ◽  
Emotional Problems ◽  
Control Measures ◽  
Emotional And Behavioral Problems ◽  
Guizhou Province ◽  
Cross Sectional ◽  
And Control

BACKGROUND In face of the sudden epidemic of COVID-19, strict prevention and control measures had been urgently carried out all over China. Because of the long-term home quarantine, all kinds of people were affected by it. OBJECTIVE In order to understand the mental health of children during the pandemic of COVID-19, this study investigated the prevalence and characteristics of emotional and behavioral problems of children aged 1-11 in Guizhou. METHODS Based on the online survey platform, the survey link was pushed through Wechat in April 2020. Electronic questionnaires were used to investigate children's demographic characteristics, emotional or behavioral problems. RESULTS A total of 3505 valid questionnaires were received from 9 prefectures and cities in Guizhou Province. 39.67% of the children in the 1-2-year-old group had emotional problems. 17.63% of the children agd 3-5 years had behavioral or emotional problems. And 23.57% of the children agd 6-11 years havd behavioral problems. CONCLUSIONS During the home quarantine period of prevention and control of COVID-19, even young children were adversely affected. The prevalence of emotional and behavioral problems in children was high, which was mainly manifested as anxiety, difficulty in concentration and sleep problems.

scholarly journals Secondary prevention medication persistence and prognosis of acute ischaemic stroke or transient ischaemic attack

2021 ◽  
pp. svn-2020-000471
Author(s):  
Lei Zhang ◽  
Junfeng Shi ◽  
Yuesong Pan ◽  
Zixiao Li ◽  
Hongyi Yan ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Recurrent Stroke ◽  
Medication Persistence ◽  
Level Ii ◽  
Composite Events ◽  
Ischaemic Attack ◽  
Level I

IntroductionThe risk of disability and mortality is high among recurrent stroke, which highlights the importance of secondary prevention measures. We aim to evaluate medication persistence for secondary prevention and the prognosis of acute ischaemic stroke or transient ischaemic attack (TIA) in China.MethodsPatients with acute ischaemic stroke or TIA from the China National Stroke Registry II were divided into 3 groups based on the percentage of persistence in secondary prevention medication classes from discharge to 3 months after onset (level I: persistence=0%, level II: 0%<persistence<100%, level III: persistence=100%). The primary outcome was recurrent stroke. The secondary outcomes included composite events (stroke, myocardial infarction or death from cardiovascular cause), all-cause death and disability (modified Rankin Scale score=3–5) from 3 months to 1 year after onset. Recurrent stroke, composite events and all-cause death were performed using Cox regression model, and disability was identified through logistic regression model using the generalised estimating equation method.Results18 344 patients with acute ischaemic stroke or TIA were included, 315 (1.7%) of whom experienced recurrent strokes. Compared with level I, the adjusted HR of recurrent stroke for level II was 0.41 (95% CI 0.31 to 0.54) and level III 0.37 (0.28 to 0.48); composite events for level II 0.41 (0.32 to 0.53) and level III 0.38 (0.30 to 0.49); all-cause death for level II 0.28 (0.23 to 0.35) and level III 0.20 (0.16–0.24). Compared with level I, the adjusted OR of disability for level II was 0.89 (0.77 to 1.03) and level III 0.82 (0.72 to 0.93).ConclusionsPersistence in secondary prevention medications, especially in all classes of medications prescribed by the physician, was associated with lower hazard of recurrent stroke, composite events, all-cause death and lower odds of disability in patients with acute ischaemic stroke or TIA.

scholarly journals Transient ischaemic attack and ischaemic stroke: constructing episodes of care using hospital claims data

2013 ◽  
Vol 6 (1) ◽  
Author(s):  
Janet K Sluggett ◽  
Gillian E Caughey ◽  
Michael B Ward ◽  
Elizabeth E Roughead ◽  
Andrew L Gilbert
Keyword(s):  
Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Claims Data ◽  
Episodes Of Care ◽  
Ischaemic Attack

scholarly journals Rotator cuff disorders: a survey of current (2016) UK physiotherapy practice

2017 ◽  
Vol 10 (1) ◽  
pp. 52-61 ◽  
Author(s):  
Julie Bury ◽  
Chris Littlewood
Keyword(s):  
Clinical Practice ◽  
Rotator Cuff ◽  
Management Strategy ◽  
Online Survey ◽  
Exercise Prescription ◽  
Current Evidence ◽  
Positive Finding ◽  
Cross Sectional ◽  
Initial Management ◽  
Physiotherapy Practice

Background Shoulder pain is a common musculoskeletal presentation, with disorders of the rotator cuff (RC) regarded as the most frequent cause. Conservative treatment is often the initial management; however, findings from a previous survey showed considerable variations in clinical practice, including the use of modalities that are not supported in the literature, suggesting that research is not impacting on practice. The present study aimed to survey current UK physiotherapy practice for the management of RC disorders and to determine whether this has changed over the 5-year period since the last survey was conducted. Methods A cross-sectional online survey of UK physiotherapists was conducted. Results One hundred and ninety-one respondents completed the survey which showed that advice/education and some form of exercise therapy are most commonly used as a management strategy for RC disorders. There is a lack of agreement however regarding exercise prescription. The survey suggests less use of passive modalities, indicating that practice has advanced over the last 5 years in line with the current evidence. Conclusions The present study has highlighted that the clinical practice of the survey respondents was in line with current recommendations from research. Hence, in contrast to the survey conducted 5 years previously, research appears to be impacting on practice, which is a positive finding.

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