scholarly journals Validating the Questionnaire to Verify Stroke-Free Status by Patient History and Physical Examination

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 362-362
Author(s):  
William J Jones ◽  
Linda S Williams ◽  
Gayle Redmon ◽  
James F Meschia
Keyword(s):  
Physical Examination ◽  
Predictive Value ◽  
Prior History ◽  
Face To Face ◽  
General Internal ◽  
History Of ◽  
Low Prevalence ◽  
Record Review ◽  
High Degree ◽  
Free Status

P127 Background and Purpose: The Questionnaire to Verify Stroke-Free Status (QVSFS) is an 8-item structured telephone interview designed to identify stroke-free individuals. Previously, the QVSFS was validated with medical record review to identify stroke status in a cohort with a low prevalence (7%) of stroke or TIA. The aim of this study was to evaluate the validity of the QVSFS using a face-to-face history and physical examination in a group with a higher prevalence of stroke. Methods: A research assistant administered the QVSFS to outpatients from VA stroke and general internal medicine clinics. Subjects were defined as QVSFS (-) if responses to all 8 questions were negative. Questions requiring clarification were noted. Neurologists, blinded to QVSFS scores, interviewed and recorded the NIH Stroke Scale in all subjects to determine stroke-free status, defined as no history or examination findings of previous TIA or stroke. Results: Ninety-one subjects were examined, mean age was 69 years, 98% were male. Twenty-five of the subjects were judged stroke-free by the examiners and 66 had a prior history of stroke (63) or TIA (3). The negative predictive value of the QVSFS was 0.93 with positive predictive value 0.86. No question required rephrasing in more than 3 subjects; only 12 subjects (13%) required rephrasing of at least one question. Years of education was not associated with need for question rephrasing. Conclusions: The QVSFS can effectively identify stroke-free individuals with a high degree of accuracy, even in a population including a large proportion of patients with prior stroke or TIA. Accuracy for identifying subjects with stroke is slightly lower but still high. The QVSFS is valid for interviewer administration but, because of the need for question clarification in some subjects, should be further evaluated before using self- or mail-completion.

Abstract 2212: Vitamin D Intake: A Novel Neuroprotectant?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Suzanne E Judd ◽  
Anh Le ◽  
Dawn O Kleindorfer ◽  
Brett Kissela ◽  
Paul Muntner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cognitive Impairment ◽  
Racial Differences ◽  
Prior History ◽  
Black And White ◽  
Vitamin D Intake ◽  
Neurological Functioning ◽  
History Of ◽  
Record Review

Introduction Vitamin D is both a nutrient and hormone and has become increasingly studied as it relates to circulatory and neurological functioning. Vitamin D deficiency has been associated with Parkinson's disease, Alzheimer's disease, stroke, and dementia. It has also been related to hypertension and diabetes. We examined the role of vitamin D intake on incident stroke and incident cognitive impairment in a cohort of middle aged and older adults. Methods The Reasons for Geographic And Racial Differences in Stroke (REGARDS), a cohort of 30,239 participants, was recruited between 2003 and 2007 and is comprised of black and white Americans age 45 and older at baseline. Vitamin D intake was measured by the Block 98 food frequency questionnaire and categorized into tertiles. Participants are surveyed every six months for incident strokes which are adjudicated using medical record review. Cognitive functioning is assessed annually using the Six-item Screener (SIS)(score range 0-6). A score of 4 or below indicates impairment. For the incident stroke analysis, we excluded all people with prior history of stroke, and for the incident cognitive impairment analysis we excluded those with SIS scores<5 at baseline. Results: 26,039 participants were available for this analysis and were followed over a mean of 5 years. Higher intake of vitamin D was more likely for whites but did not differ by gender or age. Compared to the lowest tertile (range: 0-53.1 IU/day vitamin D), the highest tertile (range: 382-1774 IU/day) of vitamin D intake was associated with a 11% reduction in stroke (HR=0.89; 95% CI =0.79, 1.01) and 24% reduction in cognitive impairment (HR=0.76; 95% CI =0.67,0.86) after adjustment for age, race, income, education, hypertension, diabetes, dyslipidemia, history of heart disease, and BMI. When stratifying by race results were similar for both stroke and cognitive decline. Adding dairy intake to the models slightly attenuated the association but did not meaningfully change the interpretation of the results. Discussion: Results suggest a potential role of vitamin D in incident stroke and cognitive impairment. Clinical trials could evaluate the potential of Vitamin D as a neuroprotectant.

Abstract 16705: Prevalence and Outcomes Among Hospitalized Patients With Covid-19 and Atrial Fibrillation or Flutter

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zaniar Ghazizadeh ◽  
Chad Gier ◽  
Avinainder Singh ◽  
Lina Vadlamani ◽  
Maxwell Eder ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Adverse Events ◽  
Cardiac Injury ◽  
Kidney Injury ◽  
Prior History ◽  
New Haven ◽  
History Of ◽  
Record Review

Introduction: The prevalence and outcomes of patients hospitalized with COVID-19 with atrial fibrillation and atrial flutter (AF/FL) remains unclear. Methods: The Yale Cardiovascular COVID Registry is a cohort study of adult patients >=18 years hospitalized with COVID-19 in the Yale New Haven Health System. Retrospective medical record review was performed on consecutive patients from the registry admitted between March and June 2020. We calculated the rates of prior and in-hospital AF/FL and evaluated the unadjusted rates of in-hospital adverse events for both groups; we then calculated the adjusted odds of adverse events using logistic regression. Results: Among 396 patients, the mean age was 68.2, 52.3% were men, 56.4% were Caucasian, 28.4% Black and 16.9% Hispanic. 15.7% of patients had prior history of AF/FL. 19.9% of patients had in-hospital AF/FL, 7.83% of which did not have a prior history of AF/FL. Patients with in-hospital AF/FL had significantly more CV complications compared to those without including cardiac injury (78.5% vs 42.7%, p=0.000), type 2 myocardial infarction (53.3 vs 30.3%, p=0.002), and heart failure (32.9% vs 9.2%, p=0.000). In-hospital AF/FL was associated with significantly worse outcomes related to COVID-19 including ICU survival (OR 0.22 [0.08-0.59], p=0.002), heart failure (5.19 [2.56-10.5], p=0.000), myocardial injury (OR 2.87 [1.49-5.49], p=0.001), acute kidney injury (OR 2.02 [1.09-3.74], p=0.027), dialysis (OR 4.07 [1.38-12.03], p=0.011) and hospice/death (OR 2.47 [1.35-4.53], p=0.004). Conclusion: AF/FL are common in patients hospitalized with COVID-19 and these patients had significantly worse outcomes, including lower odds of ICU survival and higher odds of heart failure, acute kidney injury, dialysis and hospice/death.

scholarly journals Evaluating an Algorithm and Clinical Prediction Rule for Diagnosis of Bone Stress Injuries

2020 ◽  
Vol 12 (5) ◽  
pp. 449-455
Author(s):  
Nathaniel S. Nye ◽  
Carlton J. Covey ◽  
Mary Pawlak ◽  
Cara Olsen ◽  
Barry P. Boden ◽  
...  
Keyword(s):  
Predictive Value ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Prior History ◽  
Clinical Prediction ◽  
Pes Cavus ◽  
Clinical Variables ◽  
Bone Stress ◽  
History Of ◽  
Femoral Condyles

Background: A novel algorithm and clinical prediction rule (CPR), with 18 variables, was created in 2014. The CPR generated a bone stress injury (BSI) score, which was used to determine the necessity of imaging in suspected BSI. To date, there are no validated algorithms for imaging selection in patients with suspected BSI. Hypothesis: A simplified CPR will assist clinicians with diagnosis and decision making in patients with suspected BSI. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: A total of 778 military trainees with lower extremity pain were enrolled. All trainees were evaluated for 18 clinical variables suggesting BSI. Participants were monitored via electronic medical record review. Then, a prediction model was developed using logistic regression to identify clinical variables with the greatest predictive value and assigned appropriate weight. Test characteristics for various BSI score thresholds were calculated. Results: Of the enrolled trainees, 204 had imaging-confirmed BSI in or distal to the femoral condyles. The optimized CPR selected 4 clinical variables (weighted score): bony tenderness (3), prior history of BSI (2), pes cavus (2), and increased walking/running volume (1). The optimized CPR with a score ≥3 yielded 97.5% sensitivity, 54.2% specificity, and 98.2% negative predictive value. An isolated measure, bony tenderness, demonstrated similar statistical performance. Conclusion: The optimized CPR, which uses bony tenderness, prior history of BSI, pes cavus, and increased walking/running volume, is valid for detecting BSI in or distal to the femoral condyles. However, bony tenderness alone provides a simpler criterion with an equally strong negative predictive value for BSI decision making. Clinical Relevance: For suspected BSI in or distal to the femoral condyles, imaging can be deferred when there is no bony tenderness. When bony tenderness is present in the setting of 1 or more proven risk factors and no clinical evidence of high-risk bone involvement, presumptive treatment for BSI and serial radiographs may be appropriate.

Routine Screening for Methicillin-ResistantStaphylococcus AureusAmong Patients Newly Admitted to an Acute Rehabilitation Unit

2002 ◽  
Vol 23 (9) ◽  
pp. 516-519 ◽  
Author(s):  
Farrin A. Manian ◽  
Diane Senkel ◽  
Jeanne Zack ◽  
Lynn Meyer
Keyword(s):  
Relative Yield ◽  
Prior History ◽  
Current Profile ◽  
Rehabilitation Unit ◽  
History Of ◽  
Mrsa Infection ◽  
Low Prevalence ◽  
Time Of Admission ◽  
Acute Rehabilitation ◽  
Mrsa Colonization

Background:Following an outbreak of methicillin-resistantStaphylococcus aureus(MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.Objectives:To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.Methods:Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit.Results:The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987–1988) to 12% (1999–2000) (P= .0009) for newly admitted patients and from 0% to 7% (P< .0001) for in-house transfers. A negative nares culture was highly predictive (98%) of a negative perianal culture. Prior history of MRSA infection or colonization and transfer from outside sources were independently associated with positive MRSA screening cultures.Conclusion:The rate of MRSA isolation from screening cultures of newly admitted patients, including in-house transfers, has increased significantly during the past decade in our acute rehabilitation unit. When paired with nares cultures, perianal cultures were of limited value in this patient population.

scholarly journals Survival Time of Methicillin-Resistant Staphylococcus aureus–Free Status after Institutional Clearance

2014 ◽  
Vol 35 (10) ◽  
pp. 1271-1276 ◽  
Author(s):  
Paula A. Valencia-Rey ◽  
Judith Strymish ◽  
Ernest Robillard ◽  
Martin Evans ◽  
Janice Weinberg ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Use ◽  
Prior History ◽  
Event Analysis ◽  
Free Survival ◽  
Methicillin Resistant ◽  
Contact Precautions ◽  
History Of ◽  
Systemic Antibiotics ◽  
Free Status

Objective.To determine the durability of methicillin-resistant Staphylococcus aureus (MRSA)–free status after patients are removed from contact precautions and the association of specific clearance policy variables with survivalDesign.Retrospective cohort study from October 2007 to April 2013.Setting.Veteran Affairs Boston Healthcare System.Participants.Patients with a prior history of MRSA who were removed from contact precautions after deemed cleared of their MRSA status by infection prevention.Methods.Active nasal screening results and clinical data from acute, long-term, and outpatient care facilities were evaluated to determine survival of MRSA-free status in a time-to-event analysis.Results.A total of 351 unique patients were followed for 107,112 patient-days. The median age was 68 years. Overall, 249 (71%) of patients remained MRSA-free, and 102 (29%) reverted to MRSA positive. The median MRSA-free survival was 880 days. Comorbidities, presence of indwelling devices, and the use of systemic antibiotics at the time of clearance screening were not associated with MRSA-free survival. More than 21,000 days of inpatient isolation days were avoided during the study period.Conclusions.The majority of patients removed from contact precautions remained MRSA-free for more than 2 years. Antibiotic use at the time of clearance was not associated with reductions in MRSA-free survival. These findings can be used to simplify clearance criteria, promote clearance policies, and reduce patient isolation days.

scholarly journals Predictive Value of Mean Platelet Volume in Variceal Bleeding due to Cirrhotic Portal Hypertension

2017 ◽  
Vol 7 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Mehmet A Erdogan ◽  
Ali R Benli ◽  
Serap B Acmali ◽  
Mustafa Koroglu ◽  
Yahya Atayan ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Physical Examination ◽  
Variceal Bleeding ◽  
Predictive Value ◽  
Mean Platelet Volume ◽  
Platelet Volume ◽  
Group I ◽  
History Of ◽  
Cirrhotic Patients ◽  
Group Ii

ABSTRACT Aim To investigate whether mean platelet volume (MPV) is a predictor of variceal bleeding in patients with cirrhotic portal hypertension. Materials and methods This prospective cohort was performed in the internal medicine department of our tertiary care center. Cirrhotic patients were allocated into two groups: Group I consisted of 31 cases without a history of variceal bleeding, whereas group II was made up of 31 patients with a history of variceal bleeding. Data derived from medical history, physical examination, ultrasonography, gastrointestinal system endoscopy, complete blood count, hepatic, and renal function tests were recorded and compared between two groups. On physical examination, encephalopathy and ascites were evaluated and graded with respect to Child–Pugh–Turcotte classification. Results There was no significant difference between the two groups in terms of age, duration of the disease, and gender of the patient. The only remarkable difference was that hemoglobin (p = 0.02) and hematocrit (p = 0.02) values were lower in group II. Neither the etiology of bleeding was different between groups nor did MPV seem to have a noteworthy impact on bleeding. Interestingly, risk of variceal bleeding increased in parallel to the higher grade of varices. Conclusion Our results imply that there is a correlation between the grade of varices and esophageal variceal bleeding in cirrhotic patients. However, association between MPV and variceal bleeding could not be demonstrated. Utilization of noninvasive tests as predictors in these patients necessitates further controlled trials on larger series. How to cite this article Erdogan MA, Benli AR, Acmali SB, Koroglu M, Atayan Y, Danalioglu A, Kayhan B. Predictive Value of Mean Platelet Volume in Variceal Bleeding due to Cirrhotic Portal Hypertension. Euroasian J Hepato-Gastroenterol 2017;7(1):6-10.

Abstract 14240: Thoracic Aortic Calcium for the Prediction of Stroke Mortality: The Coronary Artery Calcium Consortium

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Olufunmilayo H Obisesan ◽  
Albert D Osei ◽  
Daniel Berman ◽  
Zeina Dardari ◽  
S M Iftekhar Uddin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Predictive Value ◽  
Prediction Models ◽  
Prior History ◽  
Stroke Mortality ◽  
History Of ◽  
Traditional Risk Factors

Introduction: Thoracic aortic calcium(TAC) is an important marker of extra-coronary atherosclerosis with known predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium score. Methods: The Coronary Artery Calcium(CAC) Consortium is a retrospectively assembled database of 66,636 patients aged ≥18 years with no prior history of cardiovascular disease, who had CAC scans done for risk stratification and were followed-up for an average of 12±4years. CAC scans capture a view of the adjacent thoracic aorta, enabling us to assess TAC at no extra cost. TAC was analyzed as present or not present and we restricted analysis to those with this information available. To account for competing risks for death from other causes, we utilized multivariable-adjusted competing risk regression models adjusted for traditional cardiovascular risk factors (age, sex, hypertension, hyperlipidemia, cigarette smoking, diabetes, family history of CHD) and CAC score. We report the relationship between TAC and stroke mortality using sub-distribution hazard ratios(SHR) with 95% CI. Results: There were 41,066 patients with information on TAC, 110 of whom had stroke mortality. The mean age of participants was 53.8±10.3 years, with 34.4% female. The unadjusted SHR for stroke mortality among those who had TAC compared to those who did not was 8.80(95%CI:5.97,12.98). After adjusting for traditional risk factors and CAC score, the SHR was 2.21(95%CI:1.39,3.49). The fully adjusted SHR for females was 3.42(95%CI:1.74,6.73) while for males it was 1.55(95%CI:0.83,2.90). Conclusion: TAC was predictive of stroke mortality independent of traditional risk factors and CAC, more so in females. The presence of TAC appears to be an independent marker of stroke mortality risk though further research is needed to study its incremental value over existing cardiovascular risk prediction models.

Screening for haemorrhagic disorders in paediatric patients by means of a questionnaire

2009 ◽  
Vol 29 (S 01) ◽  
pp. S87-S89 ◽  
Author(s):  
I. Music ◽  
M. Novak ◽  
B. Acham-Roschitz ◽  
W. Muntean
Keyword(s):  
Predictive Value ◽  
Laboratory Diagnosis ◽  
Von Willebrand Disease ◽  
Control Group ◽  
Older Children ◽  
Mild Disease ◽  
History Of ◽  
Von Willebrand ◽  
Specific Symptoms ◽  
Infants And Young Children

SummaryAim: In children, screening for haemorrhagic disorders is further complicated by the fact that infants and young children with mild disease in many cases most likely will not have a significant history of easy bruising or bleeding making the efficacy of a questionnaire even more questionable. Patients, methods: We compared the questionnaires of a group of 88 children in whom a haemorrhagic disorder was ruled out by rigorous laboratory investigation to a group of 38 children with mild von Willebrand disease (VWD). Questionnaires about child, mother and father were obtained prior to the laboratory diagnosis on the occasion of routine preoperative screening. Results: 23/38 children with mild VWD showed at least one positive question in the questionnaire, while 21/88 without laboratory signs showed at least one positive question. There was a trend to more specific symptoms in older children. Three or more positive questions were found only in VWD patients, but only in a few of the control group. The question about menstrual bleeding in mothers did not differ significantly. Sensitivity of the questionnaire for a hemostatic disorder was 0.60, while specifity was 0.76. The negative predictive value was 0.82, but the positive predictive value was only 0.52. Conclusions: Our small study shows, that a questionnaire yields good results to exclude a haemostatic disorder, but is not a sensitive tool to identify such a disorder.

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