Telehealth Stroke Dysphagia Evaluation Is Safe and Effective

2017 ◽  
Vol 44 (3-4) ◽  
pp. 225-231 ◽  
Author(s):  
Kate Morrell ◽  
Megan Hyers ◽  
Tamela Stuchiner ◽  
Lindsay Lucas ◽  
Karissa Schwartz ◽  
...  
Keyword(s):  
Stroke Care ◽  
Liquid Diet ◽  
Stroke Severity ◽  
Kendall’S Tau ◽  
Kendall's Tau ◽  
Logistic Regression Models ◽  
Signed Rank ◽  
Barriers To Implementation ◽  
And Gender ◽  
The Impact

Background: Rapid evaluation of dysphagia poststroke significantly lowers rates of aspiration pneumonia. Logistical barriers often significantly delay in-person dysphagia evaluation by speech language pathologists (SLPs) in remote and rural hospitals. Clinical swallow evaluations delivered via telehealth have been validated in a number of clinical contexts, yet no one has specifically validated a teleswallow evaluation for in-hospital post-stroke dysphagia assessment. Methods: A team of 6 SLPs experienced in stroke care and a telestroke neurologist designed, implemented, and tested a teleswallow evaluation for acute stroke patients, in which 100 patients across 2 affiliated, urban certified stroke centers were sequentially evaluated by a bedside and telehealth SLP. Inter-rater reliability was analyzed using percent agreement, Cohen's kappa, Kendall's tau-b, and Wilcoxon matched-pairs signed rank tests. Logistic regression models accounting for age and gender were used to test the impact of stroke severity and stroke location on agreement. Results: We found excellent agreement for both liquid (91% agreement; kappa = 0.808; Kendall's tau-b = 0.813, p < 0.001; Wilcoxon signed rank = -0.818, p = 0.417) and solid (87% agreement; kappa = 0.792; Kendall's tau-b = 0.844, p < 0.001; Wilcoxon signed rank = 0.243, p = 0.808) dietary textures. From regression modeling, there is suggestive but inconclusive evidence that higher National Institute of Health Stroke Scale (NIHSS) scores correlate with lower levels of agreement for liquid diet recommendations (OR [95% CI] 0.895 [0.793-1.01]; p = 0.07). There was no impact of NIHSS score for solid diet recommendations and no impact of stroke location on solid or liquid diet recommendations. Qualitatively, we identified professional, logistical, technical, and patient barriers to implementation, many of which resolved with experience over time. Conclusions: Dysphagia evaluation by a remote SLP via telehealth is safe and effective following stroke. We plan to implement teleswallow across our multistate telestroke network as standard practice for poststroke dysphagia evaluation.

scholarly journals High association of COVID-19 severity with poor gut health score in Lebanese patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258913
Author(s):  
Imad Al Kassaa ◽  
Sarah El Omari ◽  
Nada Abbas ◽  
Nicolas Papon ◽  
Djamel Drider ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Models ◽  
Equal Proportion ◽  
Gut Health ◽  
Kendall’S Tau ◽  
High Association ◽  
Kendall's Tau ◽  
Health Score ◽  
Logistic Regression Models ◽  
The Impact

Background Coronavirus disease 2019 (COVID-19) has affected millions of lives globally. However, the disease has presented more extreme challenges for developing countries that are experiencing economic crises. Studies on COVID-19 symptoms and gut health are scarce and have not fully analyzed possible associations between gut health and disease pathophysiology. Therefore, this study aimed to demonstrate a potential association between gut health and COVID-19 severity in the Lebanese community, which has been experiencing a severe economic crisis. Methods This cross-sectional study investigated SARS-CoV-2 PCR-positive Lebanese patients. Participants were interviewed and gut health, COVID-19 symptoms, and different metrics were analyzed using simple and multiple logistic regression models. Results Analysis of the data showed that 25% of participants were asymptomatic, while an equal proportion experienced severe symptoms, including dyspnea (22.7%), oxygen need (7.5%), and hospitalization (3.1%). The mean age of the participants was 38.3 ±0.8 years, and the majority were males (63.9%), married (68.2%), and currently employed (66.7%). A negative correlation was found between gut health score and COVID-19 symptoms (Kendall’s tau-b = -0.153, P = 0.004); indicating that low gut health was associated with more severe COVID-19 cases. Additionally, participants who reported unhealthy food intake were more likely to experience severe symptoms (Kendall’s tau-b = 0.118, P = 0.049). When all items were taken into consideration, multiple ordinal logistic regression models showed a significant association between COVID-19 symptoms and each of the following variables: working status, flu-like illness episodes, and gut health score. COVID-19 severe symptoms were more common among patients having poor gut health scores (OR:1.31, 95%CI:1.07–1.61; P = 0.008), experiencing more than one episode of flu-like illness per year (OR:2.85, 95%CI:1.58–5.15; P = 0.001), and owning a job (OR:2.00, 95%CI:1.1–3.65; P = 0.023). Conclusions To our knowledge, this is the first study that showed the impact of gut health and exposure to respiratory viruses on COVID-19 severity in Lebanon. These findings can facilitate combating the pandemic in Lebanon.

scholarly journals Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

2021 ◽  
pp. 1-9
Author(s):  
Anna Ramos-Pachón ◽  
Álvaro García-Tornel ◽  
Mònica Millán ◽  
Marc Ribó ◽  
Sergi Amaro ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Care Quality ◽  
Point Of View ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Prehospital Delays ◽  
The Impact

<b><i>Introduction:</i></b> The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. <b><i>Methods:</i></b> Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. <b><i>Results:</i></b> Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], <i>p</i> 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], <i>p</i> 0.015) during the pandemic period. <b><i>Conclusion:</i></b> During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

scholarly journals Agreement of the mMRC and NYHA scales for assessing the impact of self-rated breathlessness in cardiopulmonary disease

2021 ◽  
pp. 00460-2021
Author(s):  
Zainab Ahmadi ◽  
Helena Igelström ◽  
Jacob Sandberg ◽  
Josefin Sundh ◽  
Magnus Sköld ◽  
...  
Keyword(s):  
Heart Failure ◽  
Respiratory Disease ◽  
Concurrent Validity ◽  
Patient Reported Outcomes ◽  
Chronic Respiratory Disease ◽  
Chronic Obstructive ◽  
Kendall’S Tau ◽  
Kendall's Tau ◽  
Patient Reported ◽  
The Impact

BackgroundFunctional impact of breathlessness is assessed using the modified Medical Research Council (mMRC) scale in chronic respiratory disease and with the New York Heart Association Functional Classification (NYHA) scale in heart failure. We evaluated agreement between the scales and their concurrent validity with other clinically relevant patient-reported outcomes in cardiorespiratory disease.MethodsOutpatients with stable chronic respiratory disease or heart failure were recruited. Agreement between mMRC and NYHA was analysed using Cramer's V and Kendall's Tau B. Concurrent validity was evaluated using correlations with clinically relevant measures of breathlessness, anxiety, depression and health-related quality of life. Analyses were conducted in all participants and separately in chronic obstructive pulmonary disease (COPD) and heart failure.ResultsIn a total of 182 participants with cardiorespiratory disease, agreement between mMRC and NYHA was moderate (Cramer's V: 0.46; Kendall's Tau B: 0.57,) with similar results in COPD (Cramer's V: 0.46; Kendall's Tau B: 0.66) and in heart failure (Cramer's V: 0.46; Kendall's Tau B: 0.67). In the total population, the scales correlated in similar ways to the other patient-reported outcomes.ConclusionIn outpatients with cardiorespiratory disease, the mMRC and NYHA scales show moderate to strong correlations and similar associations with other patient-reported outcomes. This supports that the scales are comparable when assessing the impact of breathlessness on function and patient-reported outcomes.

Abstract WP317: The Impact of Post-acute Discharge Disposition on Outcomes in the SWIFT PRIME Trial

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Samir R Belagaje ◽  
Diogo C Haussen ◽  
Jeffrey L Saver ◽  
Mayank Goyal ◽  
David S Liebeskind ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Stroke Care ◽  
Favorable Outcome ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Stroke Treatment ◽  
Discharge Disposition ◽  
The Impact

Intro: Post-acute stroke care in an inpatient rehabilitation facility (IRF) demonstrates better outcomes compared to a skilled nursing facility (SNF). With advancements in endovascular acute stroke, the impact that post-acute care plays is unclear. Here, we analyze a successful endovascular acute stroke trial to demonstrate that more improvement is seen in patients discharged to an IRF compared to a SNF. Methods: From SWIFT PRIME, a prospective, multi-center randomized acute endovascular trial, subject characteristics, and modified Rankin scores (mRS) were obtained. Post-acute hospital discharge was classified as home, IRF, and SNF. A favorable outcome was defined as 90 day mRS ≤ 2 and improvement was defined as ≥ 1 point decrease in mRS score. The effect of each disposition on a favorable outcome was calculated overall and stratified by stroke severity class (defined as discharge mRS 0-3, 4, 5) Results: A total of 165 subjects (mean age 64.8 years, mean initial NIHSS= 16.5, and 50 % male) were analyzed. Discharge disposition included: 51 (31%) going home, 92 (56%) IRF, 22 (13%) SNF. The baseline characteristics were similar between patients that went to IRF and SNF: age (p =0.76), gender (p= 0.81), baseline NIHSS (p=0.055), final infarct volumes (p=0.20), and recanalization rates (p=0.19). However, IRF subjects had lower NIHSS (p<0.001) and mRS (p=0.017) at day 7. Time to treatment defined as symptom onset to groin puncture was not significantly associated with discharge disposition (p=0.119). Only 1/22 (4.5%) subjects who were discharged to SNF achieved a 90 day mRS ≤2, compared to 41/92 (44.6%) in the IRF group or 48/51 (94.1%) in the home group (p < 0.001). When stratified by stroke severity: for mRS=0-3, there were no differences in favorable outcomes; mRS=4, 1/7 (14.3%) showed improvement at SNF compared to 21/27 (77.8%) at IRF (p=0.008); mRS =5, 5/14 (35.7%) showed improvement at SNF compared to 28/37 (75.7%) at IRF (p=0.013). Conclusions: Despite having similar characteristics following acute stroke treatment, not only did subjects who went to SNF compared to IRF have more unfavorable outcomes, they were less likely to make improvement. These findings show the continued importance of post-stroke rehabilitation, even in the endovascular era.

scholarly journals Assessing the causal impact of the 3-point per victory scoring system in the competitive balance of LaLiga

2019 ◽  
Vol 18 (3) ◽  
pp. 69-88
Author(s):  
C Soto-Valero ◽  
M. Pic
Keyword(s):  
Scoring System ◽  
Competitive Balance ◽  
Professional Football ◽  
Arima Models ◽  
Kendall’S Tau ◽  
Kendall's Tau ◽  
Credible Intervals ◽  
Causal Impact ◽  
The Impact ◽  
New Scoring

Abstract Competitive balance is a key concept in sport because it creates an uncertainty on the outcome that leads to increased interest and demand for these events. The Spanish Professional Football League (LaLiga) has been one of the top European leagues in the last decade, and it has given rise to a particular research interest regarding its characteristics and structure. Since season 1995/96, LaLiga changed the number of points given to the winning teams, by awarding three points per victory instead of two. In this paper, we assess the impact of such a change on the competitive balance of LaLiga. Our analysis focuses on teams with varying levels of performance and follows a three-step approach. First, we cluster the teams according to their historical performance using an adjusted measure based on their credible intervals of winning ratios. Second, we calculate Kendall’s tau coefficient (according to our adjusted measure) in order to obtain the overall ranking turnover of teams between consecutive seasons. Third, we assess the causal impact of the adoption of the new scoring system, based on Kendall’s tau coefficients, for each cluster of teams. Our results show that the overall competitive balance decreased after the adoption of the new scoring system. However, the impact was not the same for all teams, being more significant for top teams and less significant for bottom teams. Moreover, our predictions using adjusted ARIMA models indicate that this difference in the competitive balance will persist for future seasons.

scholarly journals Assessing the Impact of Older Americans Act–Funded Services on Caregiver Stress

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 356-356
Author(s):  
Racheal Chubb ◽  
Janet Wilmoth
Keyword(s):  
Care Recipient ◽  
Older Americans ◽  
Caregiver Support ◽  
Race And Gender ◽  
Logistic Regression Models ◽  
Caregiver Health ◽  
Care Recipients ◽  
Older Americans Act ◽  
And Gender ◽  
The Impact

Abstract Funding for OAA programs that support caregivers and care recipients has steeply declined since 2010. This is potentially problematic given these programs provide services that may reduce caregiver stress. To better understand what and for whom caregiving services reduces stress, we used data from the National Survey of Older Americans Act Participants (NSOAAP) to estimate logistic regression models predicting caregiver stress. These models include the following measures: services provided to the care recipient, services received by the caregiver, and caregiver satisfaction with services received; caregiver health, age, race, and gender; and care recipient health, age, gender, relationship to the caregiver, and coresidence with the caregiver. The results indicate that caregivers who were satisfied with services were less likely to be stressed compared to those who are not satisfied with services. Those who received respite care and counseling services were less likely to be stressed than those who attended classes and training. Consistent with the literature, caregivers who reported better health or cared for someone in better health were less likely to be stressed. Caregivers were also more likely to be stressed if they provided help with medical care compared to ADLs or if they lived with the care recipient. Overall, the results underscore the importance of continued, and possibly expanded, OAA funding for caregiver support services, especially those that provide respite and counseling to individuals who are providing care to frail and co-residential older adults.

scholarly journals Individual Capacities of Hellwig’s Information Carriers and the Impact of Attributes in the Szczecin Algorithm of Real Estate Mass Appraisal

2019 ◽  
Vol 27 (1) ◽  
pp. 15-24 ◽  
Author(s):  
Mariusz Doszyń
Keyword(s):  
Real Estate ◽  
Statistical Method ◽  
Econometric Model ◽  
Real Data ◽  
Ordinal Scale ◽  
Kendall’S Tau ◽  
Kendall's Tau ◽  
Explanatory Variables ◽  
The Impact ◽  
Selection Of

Abstract A statistical method of defining the impact of real estate attributes based on individual capacities of Hellwig’s information carriers was proposed in the paper. The method may be used for defining the impact of attributes in the Szczecin algorithm of real estate mass appraisal. The proposed procedure refers to the so-called Hellwig’s method, used for the selection of explanatory variables in an econometric model. In the case of real estate attributes, we typically deal with variables measured on an ordinal scale. Therefore, Kendall’s tau coefficients (tau a, tau b, tau c) will be applied in order to determine the strength and direction of a relation between variables. These coefficients enable the measuring of the strength and direction of a relation between variables measured on an ordinal scale. After valuating proper matrices of Kendall’s tau coefficients, individual capacities of Hellwig’s information carriers were determined, on the basis of which the impact of attributes in the Szczecin algorithm of real estate mass appraisal was defined. The proposed procedure was supported with an empirical example using a real data base that comprises 99 undeveloped land properties of industrial designation, including depots, storehouses, warehouses, and yards. After determining the impact of each attribute, the Szczecin mass appraisal algorithm was used to evaluate values. The obtained real estate values were very close to the values obtained by real estate experts.

Final results of the UGT1A1-based dose modification of irinotecan and its impact on rates of severe neutropenia and hospitalization.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 461-461
Author(s):  
Benjamin R. Tan ◽  
Ningying Wu ◽  
Andrea Wang-Gillam ◽  
Rama Suresh ◽  
Joel Picus ◽  
...  
Keyword(s):  
African Americans ◽  
Fold Increase ◽  
Hospitalized Patients ◽  
Severe Neutropenia ◽  
Kendall’S Tau ◽  
Kendall's Tau ◽  
Dose Modification ◽  
Grade 3 ◽  
The Impact

461 Background: UGT1A1 7/7 genotype has been associated with a 3-fold increase in severe neutropenia for patients treated with irinotecan (IRI) (Mcleod 2010, Liu 2013). UGT1A1 determination may tailor IRI therapy and reduce toxicities. However, the impact of the FDA-recommended IRI dose modification on outcomes is unclear. Methods: UGT1A1 genotyping was done for patients with various cancers wherein IRI therapy was planned and who consented to 1 of 3 IRB-approved registries. For patients with UGT1A1 7/7, a reduction in IRI doses was recommended per FDA and toxicities monitored during the first 2 doses. Results: 323/341 patients registered had UGT1A1 determined, of which 13% (42/323) had the 7/7 or 7/8 genotypes. Notably, a significantly higher proportion of African-Americans (AA) harbor these genotypes compared to Caucasians (C) (26.32% vs 10.08%, p=0.001). Among the 251 evaluable for toxicities, the incidence of grade 3-5 ANC for patients with 7/7 was not significantly different than those with 6/6 or 6/7 (Kendall's Tau-b coefficient p=0.494) (see Table). Among the 7/7 patients, 23/33 were treated at IRI doses of 150 mg/m2 or higher. 30% of patients treated at the higher dosages still developed grade 3-5 neutropenia compared to 17-21% for those with other genotypes. 38 of 251 patients were hospitalized during their first 2 cycles of therapy. The proportion of hospitalized patients with 7/7 genotype was not significantly different than those with 6/6 or 6/7 (15% vs 17% vs 12.6%). Conclusions: UGT1A1 can be used to tailor IRI therapy and reduce toxicities. The incidence of severe neutropenia and rate of hospitalization is comparable among patients with all UGT1A1 genotypes when IRI dose is adjusted for those with UGT1A1 7/7. There is a higher incidence of UGT1A1 7/7 genotype among African-Americans comnpared to Caucasians, which warrants further evaluation. [Table: see text]

Abstract W P212: The Effect Of Pre-hospital Notification On Time To Head Ct, Stroke Specialist Arrival, And Tpa Administration For Hispanic Patients With Acute Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jonathan McCoy ◽  
Ralph Fader ◽  
Colleen Donovan ◽  
Robert Eisenstein ◽  
Pamela Ohman-Strickland ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Independent Effect ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Head Ct ◽  
Logistic Regression Models ◽  
Hispanic Patients ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Hispanics have an increased incidence of ischemic stroke but may be less likely to use Emergency Medical Services (EMS) for stroke care. Objective: To examine disparities in pre-hospital triage and emergent evaluation of Hispanic stroke patients. We hypothesized that Hispanic stroke patients with pre-hospital notification experience less delay in emergent evaluation but the reduction may not be as pronounced as general stroke patients. Methods: Retrospective cohort study of all emergency department patients alerted as Brain Attack (BAT) between January 1, 2009 and August 31, 2012, at an urban comprehensive stroke center. We collected demographics, co-morbidities, and stroke severity from a quality assurance database. Outcome variables included EMS utilization, pre-hospital BAT activation, head CT timing & tissue plasminogen activator (TPA) timing. Effects of ethnicity and pre-hospital notification on evaluation and treatment times were measured using multivariate logistic regression models. The study was IRB approved. Results: During the study period, 832(64 Hispanic) patients were alerted as Brain Attacks. Hispanic patients were younger 56±17 vs. 68±16 years (p<0.0001), had trends for less EMS utilization (walk-in 35% vs. 22%) and lower NIHSS 9.3±4.3 vs. 12.8±8.3 (p=0.06), but did not differ in comorbidities. Patients with pre-hospital notification had significantly shorter times to stroke specialist arrival, door to head CT, and door to TPA irrespective of ethnicity. However, ethnicity did have independent effect on time to TPA administration. Please see Table 1. Conclusion: Pre-hospital notification is associated with faster stroke evaluation and treatment, including among Hispanic patients with acute stroke. Further study is needed to examine if outreach to increase EMS utilization will decrease disparities in this population.

Self-Compassion and Quality of Life in Adults Who Stutter

2020 ◽  
Vol 29 (4) ◽  
pp. 2097-2108
Author(s):  
Robyn L. Croft ◽  
Courtney T. Byrd
Keyword(s):  
Quality Of Life ◽  
Social Connectedness ◽  
The Self ◽  
Future Research ◽  
Self Compassion ◽  
Adults Who Stutter ◽  
And Gender ◽  
Relationship Of ◽  
The Impact

Purpose The purpose of this study was to identify levels of self-compassion in adults who do and do not stutter and to determine whether self-compassion predicts the impact of stuttering on quality of life in adults who stutter. Method Participants included 140 adults who do and do not stutter matched for age and gender. All participants completed the Self-Compassion Scale. Adults who stutter also completed the Overall Assessment of the Speaker's Experience of Stuttering. Data were analyzed for self-compassion differences between and within adults who do and do not stutter and to predict self-compassion on quality of life in adults who stutter. Results Adults who do and do not stutter exhibited no significant differences in total self-compassion, regardless of participant gender. A simple linear regression of the total self-compassion score and total Overall Assessment of the Speaker's Experience of Stuttering score showed a significant, negative linear relationship of self-compassion predicting the impact of stuttering on quality of life. Conclusions Data suggest that higher levels of self-kindness, mindfulness, and social connectedness (i.e., self-compassion) are related to reduced negative reactions to stuttering, an increased participation in daily communication situations, and an improved overall quality of life. Future research should replicate current findings and identify moderators of the self-compassion–quality of life relationship.

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