Abstract 054: Mortality Decline After Ischemic Stroke-the Medicare Cohort From 2009 to 2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Shumei Man ◽  
Jesse D Schold ◽  
Ken Uchino
Keyword(s):  
Ischemic Stroke ◽  
Cause Of Death ◽  
Stroke Prevention ◽  
System Of Care ◽  
Mortality Decline ◽  
Medicare Beneficiaries ◽  
American Hospital ◽  
The Past ◽  
One Year ◽  
The One

Objectives: After a declined in mortality by 25.4% from 1996 to 2005, stroke became the fifth leading cause of death in men and the second leading cause of death in women. Stroke mortality decline in the past was mainly attributed to the improvement of stroke prevention. Stroke system of care has gone through evolutional changes in the past decade in both acute stroke treatment, preventing complications, identifying stroke etiology and stroke prevention. This study is to examine whether there was greater decline of mortality after ischemic stroke hospitalization from 2009 and 2013. Methods: We examined the one-year mortality in Medicare beneficiaries aged ≥65 years who were hospitalized between January 1, 2009 and December 31, 2013 with a primary discharge diagnosis of ischemic stroke. The data of the patient information were obtained from the Medicare Provider Analysis and Review (MEDPAR) file. The list and characteristics of hospitals were obtained from the American Hospital Association Annual Survey Database. All statistical analyses were performed using SAS Version 9.4 software. Results: A total of 1165,960 Medicare Beneficiaries was hospitalized for ischemic stroke between 2009 and 2013. The one-year mortality showed a steady declined by 17.6 % over the five years period. The one-year mortality declined by 17.4% in female, 17.8% in male, 17.0% in black,17.6 % in white, 22.6% in Hispanic, and 20.3% in Asian. Among the ten-year age group, people aged 65 to 74 years had the greatest decline in mortality, 22.5%, followed by 19.2% decline in the group 75 to 84 years, and 14.7% in the group 85 years and over. Conclusion: The one-year mortality among Medicare beneficiaries after ischemic stroke hospitalization showed a dramatic decline from 2009 to 2013. Further study is needed to determine whether this is attributable to the change of stroke system of care in the past decade.

scholarly journals Opioid overdose in public libraries: Results from a five state survey

2020 ◽  
Author(s):  
Rachel Feuerstein-Simon ◽  
Margaret Lowenstein ◽  
Roxanne Dupuis ◽  
Xochitl Luna Marti ◽  
Abby Dolan ◽  
...  
Keyword(s):  
Substance Use ◽  
Public Libraries ◽  
Public Library ◽  
Opioid Overdose ◽  
Cross Sectional ◽  
Public And Private ◽  
The Past ◽  
Library Staff ◽  
One Year ◽  
The One

AbstractIntroductionPublic libraries are increasingly impacted by the overdose crisis. A 2017 survey of public librarians in the state of Pennsylvania revealed that 12% had reported an on-site overdose in the previous year. There are increasing public and private efforts to equip public libraries with the opioid overdose antidote, naloxone.MethodsWe conducted a cross-sectional web-based survey of all public library branches in Colorado, Connecticut, Florida, Michigan, and Virginia. Survey questions. We used descriptive statistics to report frequencies of responses and crude odds ratios were calculated to predict the dichotomized variable of endorsement of naloxone uptake.ResultsLibrary staff reported witnessing on-site alcohol (45%) and injection drug (14%) use in the past month. The one-year cumulative incidence (12% overall) of on-site overdose ranged from a low of 10% in MI, to a high of 17% in FL. Among libraries with on-site overdoses, a minority (21%) stocked naloxone, and 12% had administered naloxone. Overall, 11% of libraries stocked naloxone on-site. Although 24% of respondents reported attending at least one training regarding SUD in the past year, 91% wanted more training on the topic.ConclusionsPublic library staff routinely address issues related to substance use and overdose in their institutions. This work highlights the importance of including public libraries as part of a comprehensive public health strategy to address substance use-related morbidity and mortality in the U.S.

482Direct oral anticoagulant rivaroxaban in very old and frail patients: A one-year prospective follow-up of a large-scale cohort (SAFIR-AC)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O Hanon ◽  
J Vidal ◽  
E Chaussade ◽  
J P David ◽  
N Boulloche ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Large Scale ◽  
Bleeding Risk ◽  
Geriatric Population ◽  
Very Old ◽  
The Mean ◽  
One Year ◽  
The One

Abstract Background/Introduction Age is one of the strongest predictors/risk factors for ischemic stroke in subjects with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) have been shown to be effective in the prevention of this condition; however, clinical evidence on bleeding risk with this therapeutic strategy in very old and frail geriatric patients is poor. Purpose To assess bleeding risk in French geriatric patients aged ≥80 years and diagnosed with AF newly treated with rivaroxaban. Methods Subjects, presenting to one of 33 geriatric centers, with non-valvular AF and recent initiation of a treatment with rivaroxaban were enrolled in the study and followed-up every 3 months for 12 months. Clinical and routine laboratory data and evaluation scores, such as HAS-BLED, HEMORR2HAGES, ATRIA, and CHA2DS2-VASc, as well as comprehensive geriatric evaluation were reported. Major bleeding, as defined in ROCKET AF study, was reported at each visit, and this primary outcome was adjudicated by an independent committee. Results of this cohort were compared with findings from a similar cohort treated with vitamin K antagonists (VKAs) from the same centers (n=924). Results A total of 1045 subjects were enrolled in the study of whom 995 (95%) had a one-year follow-up (analyzed population). The mean (standard deviation (SD)) age was 86.0 (4.3) years, with the majority of patients being female (61%), 23% aged 90 years or older, and 48% having an estimated glomerular filtration rate (eGFR) <50 mL/min. The main comorbidities were hypertension in 77% of subjects, malnutrition 49%, anemia 43%, dementia 39%, heart failure 36%, and falls 27%. The mean (SD) score for CHA2DS2-VASc was 4.8 (1.4), HAS-BLED 2.4 (0.9), Mini-Mental State Examination (MMSE) 21.5 (6.9), Activities of Daily Living (ADL) 4.4 (1.9), and Charlson Comorbidity Index 6.7 (2.0). The one-year rate of major bleeding events was 6.4% of which 0.8% were fatal and 1.1% intracranial hemorrhages (ICH), whereas the one-year rate of ischemic stroke was 1.4% and all-cause mortality 17.9%. Computed with VKA cohort findings and adjusted for age, gender, eGFR and Charlson score, this would result in a hazard ratio of 0.54 (95% confidence interval [CI], 0.38 to 0.78) for major bleeding, 0.36 (0.17 to 0.76) for ICH, 0.62 (0.29 to 1.33) for ischemic stroke, and 0.82 (0.65 to 1.02) for all-cause mortality, in favor of rivaroxaban. Conclusions This is the first large-scale prospective study in geriatric population in AF subjects treated with DOAC (rivaroxaban) Major bleeding risk appeared higher in very old than younger population, however major bleeding and ICH rates were significantly lower with rivaroxaban than with VKAs when used in the same geriatric population. This study indicates that Rivaroxaban can be used in very old and frail patients for the treatment of non-valvular AF. Acknowledgement/Funding Unrestricted grant from Bayer

The One Hundred and Fourth Annual Report of the Council 1968

1969 ◽  
Vol 73 (700) ◽  
pp. 311-332
Keyword(s):  
Annual Report ◽  
The Past ◽  
Joint Policy ◽  
One Year ◽  
The One ◽  
Policy Committee

Although the past year cannot be classed as an outstanding one, nevertheless, there are some items which are worthy of noting and recording. The number of Fellows elected was the largest ever elected in one year, and the total number of members increased steadily if not spectacularly. It is of much concern to the Council that the number of Graduates and Students diminishes, and in the oncoming year efforts will be made to counteract this tendency. A Joint Policy Committee has been formed with the Institution of Mechanical Engineers and Institution of Production Engineers to investigate all possibilities of cooperation in establishing joint policies and activities and even administration. At present, the Committee is investigating areas of such co-operation.

Suicide by burning as an epidemic phenomenon: an analysis of 82 deaths and inquests in England and Wales in 1978–9

1981 ◽  
Vol 11 (4) ◽  
pp. 735-739 ◽  
Author(s):  
John R. Ashton ◽  
Stuart Donnan
Keyword(s):  
Index Case ◽  
Married Women ◽  
Death Certificates ◽  
England And Wales ◽  
Code Of Practice ◽  
The Past ◽  
The Media ◽  
One Year ◽  
The One ◽  
The Uk

SynopsisAn epidemic of suicide by burning in England and Wales occurred during the one-year period October 1978 to October 1979, following a widely publicized political suicide. For the 82 cases, death certificates were obtained and coroners' inquest reports sought. The victims were predominantly young single men or older married women; both groups had strong psychiatric histories; and there were no suicides which had political overtones, apart from the index case. Compared with suicides by this method in the past, a higher proportion of victims were born in the UK. It is proposed that a code of practice for the reporting of suicides by the media is required.

Abstract P699: Trends in Ischemic Stroke Risk Factors and Outcomes in a Rural Population in the United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Durgesh Chaudhary ◽  
Ayesha Khan ◽  
Shima Shahjouei ◽  
Mudit Gupta ◽  
Clare Lambert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Stroke Recurrence ◽  
Stroke Mortality ◽  
One Year ◽  
The One

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the trends in stroke risk factors and outcomes among a rural population in the United States between 2004 and 2018. Methods: We built a comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” for this study. Clinical data were extracted from multiple sources, including electronic health records and quality data. Results: Our cohort comprised of 8,561 consecutive ischemic stroke patients (mean age: 70.1±13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The rate of hypertension, diabetes, dyslipidemia, and history of stroke increased significantly over the fifteen years window. The one-year recurrence and mortality rates were 6.3% and 15.8%, respectively. Although the one-year stroke recurrence increased from 2004 to 2018 (Cochran-Armitage test Z = -3.66, p<0.001), the one-year stroke mortality rate decreased significantly (Cochran-Armitage test Z = 2.39, p=0.008). Age >65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Fine-Gray competing risk model, diabetes mellitus and age <65 years was found to be associated with one-year ischemic stroke recurrence. In the logistic regression, chronic kidney disease (CKD), diabetes, and prior ischemic stroke were predictors of one-year recurrence while age >65 years, atrial fibrillation or flutter, CKD, heart failure, prior hemorrhagic and ischemic stroke, history of neoplasm, myocardial infarction, and rheumatic diseases were predictors of one-year mortality. Conclusion: Although stroke mortality has decreased, stroke recurrence and several vascular risk factors have significantly increased in our rural population between 2004-2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes mellitus and age less than 65 years were predictors of ischemic stroke recurrence.

Abstract 251: The Association Between Receipt of Healthcare Services and Post-stroke Hypertension Control

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Dhanashri Kohok ◽  
Jason J Sico ◽  
Fitsum Baye ◽  
Laura Myers ◽  
Kamalesh Masoor ◽  
...  
Keyword(s):  
Primary Care ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Hypertension Management ◽  
Stroke Patients ◽  
Post Discharge ◽  
Post Stroke ◽  
Care Services ◽  
One Year ◽  
The One

Hypertension is a known risk factor for primary as well as recurrent stroke. Improving blood pressure (BP) control has been associated with decreased risk of recurrent stroke. Several factors have been associated with poor BP control among stroke patients such as non-compliance and clinical inertia. We examined the receipt of health care services by patients in the one-year period following discharge for ischemic stroke. This was a retrospective cohort study of patients who were admitted for acute ischemic stroke at a Veterans Affairs hospital during year 2011 and who were discharged with a BP >140/90 mmHg. The following were reviewed: primary care visits; sub-specialty clinic visits; emergency department (ED) visits; hospitalizations; utilization of ancillary care (i.e., telehealth, pharmacy, nutrition services); medications upon discharge; adherence to medications and occurrence of recurrent stroke during the one-year post-discharge period. The cohort included 124 patients with an average age of 66.4 years (± standard deviation of10.3); 123 were male; 62.9% were white; diabetes mellitus was present in 32.5%; and 13.0% had history of coronary artery disease. The average BP at the time of discharge from the index stroke hospitalization was 149.5/82.6 (±11.3/9.8) mmHg. Only 38.7% of patients had an average BP over the one year period of <140/90 mmHg. The average number of primary care visits during this period was 2.8 (±1.6). The overwhelming majority of patients had at least one primary care visit (N=119, 95.9%) however the median time from discharge to the first primary clinic visit was 32 days (IQR 59). Forty four percent of patients were seen as outpatient by neurology, 19.4% by cardiology, 9.7% by nephrology, 5.7% by nutrition, 23.4% by clinical pharmacy, and 9.7% by the telehealth service. BP monitors were issued to or being used by 39.5% patients. Non-adherence was documented in the medical record as an interfering issue in 25.8% of patients. More than two antihypertensive agents were prescribed at discharge in 50.8% patients. During the one-year post-discharge period 29.0% of patients were hospitalized at least once and 24.2% had at least one ED visit. Recurrent stroke occurred in 3.2% of patients. The stroke rate was 4.23% among patients with uncontrolled BP compared with 2.08% among patients with well-controlled BP (p=0.40). This indicates that patients with elevated BP at the time of discharge from an ischemic stroke hospitalization remain with poorly controlled BP in the year post-discharge. Although patients appear to be receiving primary care services, these visits are not successfully achieving BP control. Relative underuse of certain resources for hypertension management such as ancillary services and home BP monitoring is observed.Future intervention studies seeking to improve the hypertension management of post-stroke patients should address these observed gaps in care.

scholarly journals Prolonged concussion effects: Constellations of cognitive deficits detected up to year after injury

2021 ◽  
Vol 5 ◽  
pp. 205970022110065
Author(s):  
Daniel D Leeds ◽  
Annie Nguyen ◽  
Christopher D’Lauro ◽  
Jonathan C Jackson ◽  
Brian R Johnson
Keyword(s):  
Cognitive Abilities ◽  
Cognitive Testing ◽  
Support Vector ◽  
Cognitive Measures ◽  
Post Injury ◽  
The Past ◽  
Neurocognitive Assessment ◽  
Non Linear ◽  
One Year ◽  
The One

Concussions are associated with an array of physical, emotional, cognitive, and sleep symptoms at multiple timescales. Cognitive recovery occurs relatively quickly – five-to-seven days on average. Yet, recent evidence suggests that some neurophysiological changes can be identified one year after a concussion. To that end, we examine more nuanced patterns in cognitive tests to determine whether cognitive abilities could identify a concussion within one-year post injury. A radial-basis (non-linear boundary) support vector machine classifier was trained to use cognitive performance measures to distinguish participants with no prior concussion from participants with prior concussion in the past year. After incorporating only 10 cognitive measures, or all 5 composite measures from the neurocognitive assessment (Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)), over 90% accuracy was achieved in identifying both participants without prior concussions and participants with concussions in the past year, particularly when relying on non-linear patterns. Notably, classification accuracy stayed relatively constant between participants who had a concussion early or late in the one-year window. Thus, with substantial accuracy, a prior concussion can be identified using a non-linear combination of cognitive measures. Cognitive effects from concussion linger one-year post-injury, indicating the importance of continuing to follow concussion patients for many months after recovery and to take special note of constellations of cognitive abilities.

A 1-week online self-compassion training reduces self-criticism and pain endurance in people with non-suicidal self-injury ideation – a randomized-waitlist controlled study

2021 ◽  
Author(s):  
Sukriti Drabu ◽  
Oliver Sündermann ◽  
Ryan Y. Hong
Keyword(s):  
Training Group ◽  
Controlled Study ◽  
Control Group ◽  
Single Session ◽  
The Past ◽  
Self Compassion ◽  
Self Injury ◽  
One Year ◽  
The One

Self-criticism has been identified as a key underlying vulnerability that lowers of one’s positive self-regard and pain barriers that prevent individuals from engaging in non-suicidal self-injury (NSSI). Additionally, research suggests that self-compassion may serve as a protective tool in counteracting self-criticism. This study examined the efficacy of a brief online self-compassion training on past year NSSI engagers and ideators in reducing (a) explicit self-criticism, (b) implicit self-criticism, (c) pain endurance and (d) the inclination to engage in NSSI. Sixty-three Singaporean adults who reported the presence of self-injurious thoughts or behaviors in the past one year were randomly assigned to either a 1-week self-compassion training group or a waitlisted control group. As compared to the control group (n = 33), the training group (n = 30) yielded significantly greater reduction in explicit self-criticism after a single session and significantly greater reduction in self-criticism, pain endurance, as well as the explicit inclination to self-injure after the one-week online training. The reduction in explicit self-criticism and inclination to self-injure was maintained at the 2-week follow-up. These findings provide novel evidence supporting the efficacy of using a brief online self-compassion intervention to reduce NSSI correlates and symptoms.

Editorial

2021 ◽  
Vol 65 (2) ◽  
pp. 34
Author(s):  
Mary Beth Weber
Keyword(s):  
Speaking Up ◽  
Small Talk ◽  
The Past ◽  
Work From Home ◽  
Working From Home ◽  
One Year ◽  
The One ◽  
The University

This past week marked the one-year anniversary of my staff and me working from home. When we packed up our cubicles and offices in March 2020, no one expected to be working remotely from home for long. We honestly expected to return in a few weeks or at least by the end of April. In the meantime, the university kept extending our work-from-home agreements. During the past year, we have acquired new skills and ways of working. For example, we have mastered how to use WebEx and Zoom for meetings and have realized that this technology can make our meetings more effective. Although some people complain of Zoom fatigue, we have found that our meetings are shorter, and no one lingers afterward. We may start meetings with small talk, but when we are done, people are ready to sign off. Participants who may have difficulty speaking up can choose to use the chat box, and entering terms like “stack” in the chat box helps to ensure that everyone gets a chance to speak and in a predetermined order. It avoids having everyone try to speak at once and ensures all have a chance to speak.

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