Differential impact of unrecognised brain infarction on stroke outcome in non-valvular atrial fibrillation

2014 ◽  
Vol 112 (12) ◽  
pp. 1312-1318 ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Hye Sun Lee ◽  
Chung Mo Nam ◽  
Hyo Seok Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcome ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Brain Infarction ◽  
Stroke Severity ◽  
Stroke Outcome ◽  
Poor Outcome ◽  
Acute Infarction ◽  
The Impact

SummaryThere has been little information regarding the impact of unrecognised brain infarctions (UBIs) on stroke outcome in patients with nonvalvular atrial fibrillation (NVAF). By using volumetric analysis of ischaemic lesions, we evaluated the potential impact of UBIs on clinical outcome according to their presence and categorised type. This study enrolled 631 patients with NVAF having no clinical stroke history. UBIs were categorised into three types as territorial, lacunar, or subcortical. We collected stroke severity, functional outcome at three months, and the total volume of UBIs and acute infarction lesions. We investigated the association between clinical outcome and the type or volume of UBI, using a linear mixed model and logistic regression analysis. UBIs were detected in 285 (45.2 %) patients; territorial UBIs were observed in 24.4 % of patients (154/631), lacunar UBIs in 25 % (158/631), and subcortical UBIs in 15.7 % (99/631). Although initial stroke severity was not different between patients with UBIs and those without, those with UBIs had less improvement during hospitalisation, leading to poorer outcome at three months. Among the three types of UBIs, only territorial UBIs were associated with poor outcome, especially in patients with relatively smaller acute infarction volume. UBIs, in particular, territorial UBIs, may be considered as predictors for poor outcome after ischaemic stroke in patients with NVAF. Our results suggest that the impact of UBIs on clinical outcome differs according to the type of UBIs and the acute stroke severity.

scholarly journals Influence of Including Patients with Premorbid Disability in Acute Stroke Trials: The HeadPoST Experience

2021 ◽  
Vol 50 (1) ◽  
pp. 78-87
Author(s):  
Xia Wang ◽  
Tom J. Moullaali ◽  
Menglu Ouyang ◽  
Laurent Billot ◽  
Else Charlotte Sandset ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Impairment ◽  
Treatment Effect ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Linear Trend ◽  
Poor Outcome ◽  
Head Positioning ◽  
Trial Treatment ◽  
The Impact

<b><i>Background:</i></b> Patients with premorbid functional impairment are generally excluded from acute stroke trials. We aimed to determine the impact of including such patients in the Head Positioning in acute Stroke Trial (HeadPoST) and early additional impairment on outcomes. <b><i>Methods:</i></b> Post hoc analyses of HeadPoST, an international, cluster-randomized crossover trial of lying-flat versus sitting-up head positioning in acute stroke. Associations of early additional impairment, defined as change in modified Rankin scale (mRS) scores from premorbid levels (estimated at baseline) to Day 7 (“early ΔmRS”), and poor outcome (mRS score 3–6) at Day 90 were determined with generalized linear mixed model. Heterogeneity of the trial treatment effect was tested according to premorbid mRS scores 0–1 versus 2–5. <b><i>Results:</i></b> Of 8,285 patients (38.9% female, mean age 68 ± 13 years) with complete data, there were 1,984 (23.9%) with premorbid functional impairment (mRS 2–5). A significant linear association was evident for early ∆mRS and poor outcome (per 1-point increase in ΔmRS, adjusted odds ratio 1.20, 95% confidence interval 1.14–1.27; <i>p</i> &#x3c; 0.0001). Patients with greater premorbid functional impairment were less likely to develop additional impairment, but their risk of poor 90-day outcome significantly increased with increasing (worse) premorbid mRS scores (linear trend <i>p</i> &#x3c; 0.0001). There was no heterogeneity of the trial treatment effect by level of premorbid function. <b><i>Conclusions:</i></b> Early poststroke functional impairment that exceeded premorbid levels was associated with worse 90-day outcome, and this association increased with greater premorbid functional impairment. Yet, including premorbid impaired patients in the HeadPoST did not materially affect the subsequent treatment effect. <b><i>Clinical Trial Registration:</i></b> HeadPoST is registered at http://www.ClinicalTrials.gov (NCT02162017).

scholarly journals Clinical implementation of a 3D4K-exoscope (Orbeye) in microneurosurgery

2021 ◽  
Author(s):  
Judith Rösler ◽  
Stefan Georgiev ◽  
Anna L. Roethe ◽  
Denny Chakkalakal ◽  
Güliz Acker ◽  
...  
Keyword(s):  
User Satisfaction ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Intraoperative Complications ◽  
Rank Test ◽  
User Group ◽  
Clinical Implementation ◽  
Physical Strain ◽  
Conventional Microscope ◽  
The Impact

AbstractExoscopic surgery promises alleviation of physical strain, improved intraoperative visualization and facilitation of the clinical workflow. In this prospective observational study, we investigate the clinical usability of a novel 3D4K-exoscope in routine neurosurgical interventions. Questionnaires on the use of the exoscope were carried out. Exemplary cases were additionally video-documented. All participating neurosurgeons (n = 10) received initial device training. Changing to a conventional microscope was possible at all times. A linear mixed model was used to analyse the impact of time on the switchover rate. For further analysis, we dichotomized the surgeons in a frequent (n = 1) and an infrequent (n = 9) user group. A one-sample Wilcoxon signed rank test was used to evaluate, if the number of surgeries differed between the two groups. Thirty-nine operations were included. No intraoperative complications occurred. In 69.2% of the procedures, the surgeon switched to the conventional microscope. While during the first half of the study the conversion rate was 90%, it decreased to 52.6% in the second half (p = 0.003). The number of interventions between the frequent and the infrequent user group differed significantly (p = 0.007). Main reasons for switching to ocular-based surgery were impaired hand–eye coordination and poor depth perception. The exoscope investigated in this study can be easily integrated in established neurosurgical workflows. Surgical ergonomics improved compared to standard microsurgical setups. Excellent image quality and precise control of the camera added to overall user satisfaction. For experienced surgeons, the incentive to switch from ocular-based to exoscopic surgery greatly varies.

scholarly journals The influence of xylanase on the fermentability, digestibility, and physiochemical properties of insoluble corn-based fiber along the gastrointestinal tract of growing pigs

2021 ◽  
Author(s):  
Amy L Petry ◽  
Nichole F Huntley ◽  
Michael R Bedford ◽  
John F Patience
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Nutrient Digestibility ◽  
Growing Pigs ◽  
Neutral Detergent Fiber ◽  
Adaptation Period ◽  
High Fiber ◽  
Gross Energy ◽  
Digesta Viscosity ◽  
The Impact

Abstract In theory, supplementing xylanase in corn-based swine diets should improve nutrient and energy digestibility and fiber fermentability, but its efficacy is inconsistent. The experimental objective was to investigate the impact of xylanase on energy and nutrient digestibility, digesta viscosity, and fermentation when pigs are fed a diet high in insoluble fiber (&gt;20% neutral detergent fiber; NDF) and given a 46-d dietary adaptation period. Three replicates of 20 growing gilts were blocked by initial body weight, individually housed, and assigned to 1 of 4 dietary treatments: a low-fiber control (LF) with 7.5% NDF, a 30% corn bran high-fiber control (HF; 21.9% NDF), HF+100 mg xylanase/kg [HF+XY, (Econase XT 25P; AB Vista, Marlborough, UK)] providing 16,000 birch xylan units/kg; and HF+50 mg arabinoxylan-oligosaccharide (AXOS) product/kg [HF+AX, (XOS 35A; Shandong Longlive Biotechnology, Shandong, China)] providing AXOS with 3-7 degrees of polymerization. Gilts were allowed ad libitum access to fed for 36-d. On d 36, pigs were housed in metabolism crates for a 10-d period, limit fed, and feces were collected. On d 46, pigs were euthanized and ileal, cecal, and colonic digesta were collected. Data were analyzed as a linear mixed model with block and replication as random effects, and treatment as a fixed effect. Compared with LF, HF reduced the apparent ileal digestibility (AID), apparent cecal digestibility (ACED), apparent colonic digestibility (ACOD), and apparent total tract digestibility (ATTD) of dry matter (DM), gross energy (GE), crude protein (CP), acid detergent fiber (ADF), NDF, and hemicellulose (P&lt;0.01). Relative to HF, HF+XY improved the AID of GE, CP, and NDF (P&lt;0.05), and improved the ACED, ACOD, and ATTD of DM, GE, CP, NDF, ADF, and hemicellulose (P&lt;0.05). Among treatments, pigs fed HF had increased hindgut DM disappearance (P=0.031). Relative to HF, HF+XY improved cecal disappearance of DM (162 vs. 98g; P=0.008) and NDF (44 vs. 13g; P&lt;0.01). Pigs fed xylanase had a greater proportion of acetate in cecal digesta and butyrate in colonic digesta among treatments (P&lt;0.05). Compared with LF, HF increased ileal, cecal, and colonic viscosity, but HF+XY decreased ileal viscosity compared with HF (P&lt;0.001). In conclusion, increased insoluble corn-based fiber decreases digestibility, reduces cecal fermentation, and increases digesta viscosity, but supplementing xylanase partially mitigated that effect.

scholarly journals The Use of Telehealth Technology in Assessing the Accuracy of Self-Reported Weight and the Impact of a Daily Immediate-Feedback Intervention among Obese Employees

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Nicolaas P. Pronk ◽  
A. Lauren Crain ◽  
Jeffrey J. VanWormer ◽  
Brian C. Martinson ◽  
Jackie L. Boucher ◽  
...  
Keyword(s):  
Body Weight ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Controlled Trial ◽  
Intervention Group ◽  
Study Groups ◽  
Outcome Variable ◽  
Control Group ◽  
Immediate Feedback ◽  
The Impact

Objective.To determine the accuracy of self-reported body weight prior to and following a weight loss intervention including daily self-weighing among obese employees.Methods.As part of a 6-month randomized controlled trial including a no-treatment control group, an intervention group received a series of coaching calls, daily self-weighing, and interactive telemonitoring. The primary outcome variable was the absolute discrepancy between self-reported and measured body weight at baseline and at 6 months. We used general linear mixed model regression to estimate changes and differences between study groups over time.Results.At baseline, study participants underreported their weight by an average of 2.06 (se=0.33) lbs. The intervention group self-reported a smaller absolute body weight discrepancy at followup than the control group.Conclusions.The discrepancy between self-reported and measured body weight appears to be relatively small, may be improved through daily self-monitoring using immediate-feedback telehealth technology, and negligibly impacts change in body weight.

scholarly journals O003 The impact of wind farm noise in a laboratory setting on objective and subjective sleep efficiency

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A1-A2
Author(s):  
T Liebich ◽  
L Lack ◽  
G Micic ◽  
K Hansen ◽  
B Zajamsek ◽  
...  
Keyword(s):  
Sleep Disturbance ◽  
Wind Farm ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Sleep Efficiency ◽  
Self Report ◽  
Sleep Diary ◽  
Noise Condition ◽  
Subjective Sleep ◽  
The Impact

Abstract Introduction Well-controlled studies of wind farm noise (WFN) on sleep are lacking despite complaints and known effects of other noise types on sleep. This laboratory-based study investigated the impact of continuous full-night WFN exposure replicated from field recordings on polysomnography-measured (objective) and sleep diary-determined (subjective) sleep efficiency compared to a quiet control night. Methods Based on residential location and self-report data, 50 participants were categorised into three groups (14 living &lt;10km from a wind farm and self-reporting sleep disturbance; 19 living &lt;10km from a wind farm and self-reporting no sleep disturbance and 18 controls living in a quiet rural area). Participants underwent full in-laboratory polysomnography during exposure to continuous WFN (25 dB(A)) throughout the night and a quiet control night (background noise 19 dB(A)) in random order. Group and noise condition effects were examined via linear mixed model analysis. Results Participants (30 females) were aged (mean±SD) 54.9±17.6 range: 18–80 years. Sleep efficiency in the control condition was (median [interquartile range]) objective: 85.5 [77.4 to 91.2]%; subjective: 85.7 [69.2 to 92.7]%) versus the WFN condition (objective: 86.1 [78.6 to 91.7]% subjective: 85.8 [66.2 to 93.8]%) with no significant main or interaction effects of group or noise condition (all p’s &gt;0.05). Conclusion These results do not support that WFN at 25 dB(A) significantly impacts objective or subjective sleep efficiency in participants with or without prior WFN exposure or self-reported WFN-related sleep disturbance. Further analyses to investigate potential sleep micro-structural changes remain warranted.

scholarly journals THE IMPACT OF HOSPITAL BASED INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS TRAINING ON PEDIATRIC NURSE COMPETENCY

2018 ◽  
Vol 4 (1) ◽  
pp. 16-23
Author(s):  
Fitri Haryanti ◽  
Mohammad Hakimi ◽  
Yati Sunarto ◽  
Yayi S Prabandari
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Integrated Management ◽  
Well Being ◽  
Childhood Illness ◽  
Internal Conflict ◽  
Child Health Services ◽  
Management Support ◽  
The Impact

Background: Although the WHO strategy integrated management of childhood illness (IMCI) for primary care has been implemented in over 100 countries, there is less global experience with hospital-based IMCI training. Until recently, no training had been done in Indonesia, and globally there has been limited experience of the role of IMCI in rebuilding health systems after complex emergencies.Objective: We aimed to examine the effect of hospital-based IMCI training on pedicatric nurse competency and explore the perception of Indonesian doctors, nurse managers and paediatricians about IMCI training and its development in West Aceh, a region that was severely affected by the South-Asian tsunami in December 2004.Methods: This study used stepped wedge design. Training was conducted for 39 nurses staff, 13 midwifes, 6 Head nurses, 5 manager of nurses, 5 doctors, 1 paediatricians, and 3 support facilities  (nutritionist, pharmacist, laboratory) in Cut Nyak Dien (CND) Hospital in Meulaboh, West Aceh, Indonesia. The IMCI training was developed based on the WHO Pocketbook of Hospital Care for Children. A nurses competency questionnaire was used based on the guideline of assessment of the quality of child health services at the first level reference hospitals in districts / municipalities issued by the Ministry of Health in 2007. A linear mixed model was used for data analysis.Results: The hospital based IMCI training improved the competences of nurses paediatric in assessing emergency signs of the sick children, management of cough and difficulty breathing, diarrhoea, fever, nutritional problems, supportive care, monitoring, discharge planning and follow up.  The assessment highlighted several problems in adaptation process of material training, training process and implementation in an environment soon after a major disaster.Conclusion: Hospital based IMCI training can be implemented in a setting after major disasters or internal conflict as part of a rebuilding process.  The program requires strong management support and the emergency phase to be subsided.  Other pre-requisites include the existence of standard operating procedures, adequate physical facilities and support for staff morale and well-being.  Improving the quality of paediatric care requires more than just training and clinical guidelines; internal motivation and health worker support are essential.

scholarly journals The SARS-CoV-2 Alpha variant is associated with increased clinical severity of disease

2021 ◽  
Author(s):  
David J Pascall ◽  
Guy Mollett ◽  
Rachel Blacow ◽  
Naomi Bulteel ◽  
Robyn Campbell ◽  
...  
Keyword(s):  
Growth Rate ◽  
Cohort Study ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Transmission Rate ◽  
Severe Disease ◽  
Positive Association ◽  
Clinical Severity ◽  
Generalised Linear Mixed Model ◽  
The Impact

Background The Alpha (B.1.1.7) SARS-CoV-2 variant of concern has been associated with increased transmission and increased 28-day mortality. We aimed to investigate the impact of infection on clinical severity of illness, including the need for oxygen or ventilation in a national cohort study. Methods In this prospective clinical cohort study, 1475 SARS-CoV-2 sequences were obtained from patients infected in Scotland, UK between the 1st November 2020 and 30th January 2021 and matched to clinical outcomes as the lineage became dominant in Scotland. We modelled the association between B.1.1.7 infection and severe disease using a cumulative generalised linear mixed model employing a 4-point scale of maximum severity based on requirement of respiratory support at 28 days. We also estimated the growth rate of B.1.1.7-associated infections as it emerged in Scotland using a phylogenetic exponential growth rate population model. Results The B.1.1.7 lineage was responsible for a third wave of SARS-CoV-2 infection in Scotland in association with a transmission rate 5-fold higher than the preceding second wave B.1.177 lineage. Of 1475 patients, 364 were infected with B.1.1.7, 1030 with B.1.177 and 81 with other lineages. Our analysis found a positive association between increased clinical severity and lineage (B.1.1.7 versus non-B.1.1.7; cumulative odds ratio: 1.40, 95% CI: 1.02, 1.93). Viral load was higher in B.1.1.7 samples than in non-B.1.1.7 samples, as measured by cycle threshold (Ct) value (mean Ct change: -2.46, 95% CI: -4.22, -0.70). Conclusions The B.1.1.7 lineage was associated with more severe clinical disease in Scottish patients than co-circulating lineages.

Abstract NS10: Patients with Mild and Moderate Stroke Have Frequent, Severe, and Persistent Impairment in Information Processing Speed

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Susan Alderman ◽  
Terri Armstrong ◽  
Geri Wood ◽  
Sean Savitz ◽  
Joshua Breier
Keyword(s):  
Information Processing ◽  
Processing Speed ◽  
Memory Impairment ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Stroke Recovery ◽  
Stroke Severity ◽  
Information Processing Speed ◽  
Significant Difference ◽  
Mild Stroke

Background: One year after stroke 50-70% of survivors have information processing speed (IPS) impairment. IPS is a complex, elemental cognitive function with close but separate relationships with memory, attention, executive function, reading, and writing. IPS impairment can be devastating, even without physical deficits. Hypothesis: The frequency and severity of IPS impairment in patients with acute stroke is unrelated to stroke severity. Methods: In a longitudinal study, 30 adults with acute mild (NIHSS <5) versus moderate stroke (NIHSS 5-12) were assessed for IPS and memory impairments at three time points (< 72 hours, Week 3, and Week 12). The Symbol Digit Modalities Test (SDMT) was the primary IPS instrument, scores below the norm (51-62 points) indicate impairment. Results: Using linear mixed model regression, no significant difference was noted between patients with mild and moderate stroke in frequency and severity of IPS impairment (p=0.2). All patients had baseline abnormal SDMT scores, improving 21% by Week 12 (p=.005) with one patient scoring as unimpaired (51 points). Patients with mild stroke (n=18) had baseline scores on average 53% lower than SDMT norm (mean score 24 (12), [95% CI] 6 [18, 30], Standard Error (SEM) 3) and 32% lower at Week 12 (mean 34 (11), [95% CI] 5 [29, 40], SEM 3). Patients with moderate stroke (n=12) had baseline SDMT scores 60% lower than norm (mean 21 (11), [95% CI] 6 [15, 27], SEM 3) and 39% lower by Week 12 (mean 31 (12), [95% CI] 7 [25, 38], SEM 3). Memory impairment at enrollment (<72 hours post stroke) was noted in 100% of patients with moderate stroke and 78% of patients with mild stroke; at Week 12 the frequency of memory impairment was equal in both groups (67%). Conclusion: IPS were critically impaired, in both mild and moderate stroke, with minimal spontaneous recovery at Week 12. IPS impairment is clinically significant during stroke recovery. IPS impairment should be considered in the planning of healthcare of stroke victims even with mild stroke.

Abstract T P158: Albuminuria Is Associated With Neurological Deterioration and Poor Outcome in Acute Stroke Patients With Non-valvular Atrial Fibrillation: The SAMURAI-NVAF Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Takayuki Matsuki ◽  
Masatoshi Koga ◽  
Shoji Arihiro ◽  
Kenichi Todo ◽  
Hiroshi Yamagami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Reperfusion Therapy ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Multicenter Observational Study ◽  
Spot Urine ◽  
Poor Outcome ◽  
The Impact

Background and purpose: The impact of albuminuria on clinical outcomes in acute cardioembolic stroke is not fully investigated. We assessed whether high spot urine albumin/creatinine ratio (ACR) was associated with clinical outcomes in acute stroke with non-valvular atrial fibrillation (NVAF). Methods: From 2011 to 2014, we enrolled acute ischemic stroke/TIA patients with NVAF in the SAMURAI-NVAF study, which is a multicenter, observational study. Patients with complete ACR values were included in the analysis. They were divided into the N (normal, ACR < 30mg/g) and the H (high, ACR ≥ 30mg/g) groups. Clinical outcomes were neurological deterioration (an increase of NIHSS ≥1 point during the initial 7 days) and poor outcome (mRS of 4-6 at 3 months). Results: Of 558 patients (328 men, 77±10 y) who were included, 271 and 287 were assigned to the H group and the N group, respectively. As compared with patients in the N group, those in the H group were more frequently female (52 vs 31%, p < 0.001) and older (80±10 vs 75±10 y, p < 0.001). On admission, patients in the H group more frequently had diabetes (28 vs 17%, p = 0.003), less frequently had paroxysmal AF (68 vs 57%, p = 0.009), had higher levels of SBP (157±28 vs 151±24 mmHg, p = 0.003), NIHSS score (11 vs 5, p < 0.001), CHA2DS2-VASc score (6 vs 5, p < 0.001), plasma glucose (141±62 vs 132±41 mg/dL, p = 0.04), and brain natriuretic peptide (348±331 vs 259±309 pg/mL, p = 0.002), and had lower levels of hemoglobin (13±2 vs 14±2 g/dL, p = 0.02), and estimated glomerular filtration ratio (eGFR) (60±24 vs 66±20 mL/min/1.73m2 p = 0.002). On imaging studies, patients in the H group more frequently had large infarct (29 vs 20 %, p = 0.02) and culprit artery occlusion (64 vs 48%, p < 0.001). Neurological deterioration (14 vs 4%, p < 0.001) and poor outcome (49 vs 24%, p < 0.001) were more frequently observed in the H group. On multivariate regression analysis adjusted for significant confounders and reperfusion therapy, the H group was associated with neurological deterioration (OR 2.43; 95% CI 1.14-5.5; p = 0.02) and poor outcome (OR 2.75; 95% CI 1.45-5.2; p = 0.002), although eGFR was not significantly related to either. Conclusion: High ACR, a marker of albuminuria, was independently associated with unfavorable outcomes in acute stroke patients with NVAF.

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