Abstract WP247: Use and Importance of Emergency Medical Services in Rural Delivery of tPA in Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Phillip A Scott ◽  
Cemal B Sozener ◽  
Benjamin D Hume ◽  
William J Meurer
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Rural Setting ◽  
Metropolitan Statistical Area ◽  
Medical Systems ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Emergency Medical ◽  
Rural Settings ◽  
Rural Patients

Introduction: Data indicate approximately 60% of stroke patients use Emergency Medical Systems (EMS) to access medical care. EMS use is associated with improved door to physician and CT times in stroke treatment. Rural areas, however, may have limited EMS access and its use and impact on tPA delivery in this setting is unknown. Hypothesis: We assessed the hypothesis that EMS use in tPA treated stroke patients would be lower in rural areas compared to urban areas. We also examined important time intervals between groups. Methods: Prospective, observational study using previously collected data from 24 randomly selected Michigan community hospitals in the INSTINCT stroke trial. Hospitals were identified a priori as urban or rural using two models to account for varying rural definitions. Model 1 defined rural hospitals as those outside a Metropolitan Statistical Area (MSA). Model 2 used hospitals outside a major Urban Area (UA > 150 square miles). Descriptive statistics presented; Student’s t and X 2 tests used in the comparisons. Results: All 557 patients treated with tPA for AIS from 2007 - 2010 were included in the analysis. 82% [95% CI: 79%-85%] used EMS to access stroke care. Patients in both urban and rural groups had similar demographics. EMS transport times were significantly longer for rural patients in both models. Model 2, with a more restrictive geographic definition of a rural hospital, identified a significant reduction in EMS use in rural patients compared to the urban group. See Table. Conclusions: Overall EMS use among stroke patients receiving tPA was substantially higher than previously reported in the general stroke population. Lower EMS use in rural settings, however, was confirmed in the restrictive model. EMS transport times were longer in the rural setting, likely reflecting greater travel distances. EMS level interventions to improve tPA delivery would reach a large majority of treated patients in both urban and rural settings.

scholarly journals Stroke profile and outcome between urban and rural regions of Northwest India: Data from Ludhiana population-based stroke registry

2017 ◽  
Vol 2 (4) ◽  
pp. 377-384 ◽  
Author(s):  
Paramdeep Kaur ◽  
Shweta J Verma ◽  
Gagandeep Singh ◽  
Rajinder Bansal ◽  
Birinder S Paul ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Urban Areas ◽  
Multivariable Analysis ◽  
Haemorrhagic Stroke ◽  
Population Based ◽  
Primary Data ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Rural Patients

Introduction The objective of this study is to compare the clinical profile, risk factors, type and outcome of stroke patients in urban and rural areas of Punjab, India. Methods The primary data source was from the Ludhiana urban population-based stroke registry. The data of first-ever stroke patients with age ≥18 years were collected using WHO stepwise approach from all hospitals, general practitioners, physiotherapy and scan centres between 26 March 2011 and 25 March 2013. Results A total of 4989 patients were included and out of 4989 patients, 3469 (69%) were from urban areas. Haemorrhagic stroke was seen more in rural as compared to urban regions (urban 1104 (32%) versus rural 552 (36%); p = 0.01). There were significant differences seen in stroke risk factors; hypertension (urban 1923 (84%) versus rural 926 (89%); p = 0.001) and hyperlipidaemia (urban 397 (18%) versus rural 234 (23%); p = 0.001) between two groups. In the multivariable analysis the rural patients were more likely to be younger (age < 40 years) (OR: 1.82; 95% CI: 1.24–2.68; p = 0.002), Sikhs (OR: 2.57; 95% CI: 1.26–5.22; p = 0.009), farmers (OR: 9.41; 95% CI: 5.36–16.50; p < 0.001), housewives (OR: 2.71; 95% CI: 1.45–5.06; p = 0.002), and consumed alcohol (OR: 1.57; 95% CI: 1.19–2.06; p = 0.001) as compared to urban patients. In addition, use of imaging was higher in rural patients (OR: 1.99; 95% CI: 1.06–3.74; p = 0.03) as compared to urban patients. Discussion and Conclusion In this large cohort of patients, rural and urban differences were seen in risk factors and type of stroke. Stroke prevention strategies need to take into consideration these factors including regional sociocultural practices.

scholarly journals Tackling Rural Health, Energy, … and Technological Issues All at Once: A Call for a Global Interdisciplinary Platform for Strengthening Rural Setting Amid the COVID-19 Pandemic

Challenges ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 16
Author(s):  
Farshad Amiraslani
Keyword(s):  
Rural Communities ◽  
Rural Health ◽  
Rural Areas ◽  
Rural Setting ◽  
Global Challenges ◽  
Rural Settings ◽  
Research Studies

The recent COVID-19 pandemic has revealed flaws in rural settings where most people live without the necessary tools, income, and knowledge to tackle such unprecedented global challenges. Here, I argue that despite the research studies conducted on rural areas, these have not solved rising rural issues, notably poverty and illiteracy. I propound a global institute to be formed by governments that provides a platform for empowering rural communities through better training, skills, and competencies. Such global endeavour will ensure the remaining rural communities withstand future pandemics if they occur.

scholarly journals Smear Positive Tuberculosis Cases in Rajshahi District A Comparison Between Rural and Urban Areas

1970 ◽  
Vol 17 (2) ◽  
pp. 104-105
Author(s):  
W Wasim Hussain ◽  
M Azizul Haque ◽  
Laila Shamima Sharmin ◽  
ARM Saifuddin Ekram ◽  
M Fazlur Rahman
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Detection Rate ◽  
Case Finding ◽  
Sputum Smear ◽  
Case Detection Rate ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Rural Settings ◽  
The City

This study was designed to know the case finding of sputum smear positive tuberculosis in Rajshahi district and also to see whether case finding was different in urban and rural settings. Our study reveals that case finding rate of smear positive tuberculosis cases in the city corporation area and rural areas of Rajshahi district are 52% and 28% respectively. Case detection rate of total Rajshahi district was 33%. Stronger efforts are needed to reach the national target of detecting 70% new smear positive TB cases by the end of 2005.   doi: 10.3329/taj.v17i2.3456   TAJ 2004; 17(2): 104-105

Follow-up of Children With Trait in a Rural Setting

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 876-877
Author(s):  
Herman Harris
Keyword(s):  
Sickle Cell ◽  
Rural Areas ◽  
Urban Areas ◽  
Cost Effective ◽  
Rural Setting ◽  
Urban Centers ◽  
Hb S ◽  
The Individual ◽  
Limited Testing

The Comprehensive Sickle Cell Centers were established in 1972 to test, educate, counsel, and research sickle cell anemia and related hemoglobinopathies. Standards and protocols for testing, education, and research were readily established because similar procedures and methods were already in operation at the institutions where the centers were located. The most difficult and still the most controversial program to provide is counseling. It became evident, early, that there is no universally accepted method for informing carriers of abnormal Hb S about their results. Centers located in large urban areas with a limited testing radius do not face the same problems as centers located in rural areas where the testing radius may cover an entire state or several states. Individual, or one-on-one, counseling of persons with trait results appears to be successful for urban centers where the individual may be called to the center and given information. But, in a rural setting, it is not feasible for the center to ask a person to travel 350 miles to be told he or she has nothing to worry about. And it is not cost-effective to send a caseworker 350 miles to say the same thing. It must, therefore, be concluded that each agency or center must adopt counseling methods that meet its specific needs. Each program must be flexible, imaginative, and creative and must successfully and accurately deliver information about being a carrier for the sickle gene or other hemoglobinopathy and its implication and significance for patients and their future offspring. To do this, we must first look at the problems facing us.

Pediatric Prehospital Care in Urban and Rural Areas

PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 681-690 ◽  
Author(s):  
James S. Seidel ◽  
Deborah Parkman Henderson ◽  
Patrick Ward ◽  
Barbara Wray Wayland ◽  
Beverly Ness
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Pediatric Patients ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Medical Services ◽  
Care Providers ◽  
Emergency Medical

There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10 493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. Use of the emergency medical services system by pediatric patients increased with age, but 12.5% of all calls were for children younger than 2 years. Calls for medical problems were most common for patients younger than 5 years of age; trauma was a more common complaint in rural areas (64%, P = .0001). Frequency of vital sign assessment differed by region, as did hospital contact (P &lt; .0001). Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.

Abstract 93: Trends in Intravenous Alteplase Use and Mortality Among Medicare Beneficiaries With Acute Stroke: A Eight-Year Retrospective Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tong Meng ◽  
Amber Trickey ◽  
Prasanthi Govindarajan
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Systems Of Care ◽  
Medicare Beneficiary ◽  
Functional Dependence ◽  
Cumulative Effect ◽  
Medicare Beneficiaries ◽  
Stroke Treatment ◽  
Intravenous Alteplase ◽  
Iv Tpa

Timely stroke treatment with intravenous alteplase (IV-tPA) reduces functional dependence and mortality. Therefore, communities have taken tremendous efforts to increase IV t-PA use through better access to emergency services and stroke centers and through efficient processes at stroke centers. Our objective is to examine the cumulative effect of these processes over an 8-year period on IV-tPA use and mortality in a national sample of Medicare beneficiaries. Methods: Within a sample of Medicare claims from 2007-2014, we identified patients aged 66+ and evaluated the first hospitalization per patient with primary diagnosis of ischemic stroke. Outcome measures were emergency department (ED) -administered IV-tPA and 30-day mortality. We excluded patients without continuous prior 1-year enrollment in Parts A+B and those not treated in the ED. IV-tPA was identified using ICD-9 procedure 99.10 and CPT 37195. Mortality was derived from the Medicare Beneficiary Summary File. We calculated Cochran-Armitage trend tests to assess outcomes over time and chi-square tests to compare outcomes by patient and hospital characteristics. Results: Among 240,486 patients, there was a significant increase in IV-tPA use from 2.8% to 7.7% (p<0.001). IV-tPA utilization was higher in urban areas (5.5% vs. rural 3.7%, p<0.001) and for patients arriving by ambulance (6.7% vs. 2.5%, p<0.001), with the highest IV-tPA rates observed among urban ambulance-transport patients (Figure). Patient demographics were associated with IV-tPA (all p<0.001); younger (age 66-75) and Non-Hispanic White patients were most likely to receive IV-tPA. During the study period, 30-day mortality decreased from 15.7% to 14.5% (p<0.001). Conclusions: Although we observed tripling of IV t-PA during this period, rural areas had lower use when compared with the urban areas. In this ongoing multi-year study, we will investigate enablers and barriers to IV t-PA use within pre-hospital and hospital systems of care.

A Note on the Efficiency and Effectiveness of Outsider Assistance Programs in Rural versus Non-Rural States

2002 ◽  
Vol 26 (3) ◽  
pp. 67-80 ◽  
Author(s):  
James J. Chrisman ◽  
Elizabeth Gatewood ◽  
Leo B. Donlevy
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Critical Evaluation ◽  
Development Program ◽  
Development Programs ◽  
Assistance Programs ◽  
Rural Settings ◽  
Efficiency And Effectiveness ◽  
Special Programs ◽  
Policies And Programs

Although numerous countries have developed policies and programs to encourage entrepreneurial behavior in rural areas, there have been few attempts to compare the performance of entrepreneurial development programs in rural versus non rural settings. The existing literature led us to expect that such programs will be more efficient and effective in urban areas. However, in this study, virtually no significant relationships were found between urban and rural states—defined by the proportion of the population living in non-metropolitan counties—on the variables used to measure the performance of an entrepreneurship development program. This suggests that the need for special programs tailored to rural entrepreneurs deserves further, more critical, evaluation.

scholarly journals Standard Precautions Among Emergency Medical Services in Urban and Rural Areas

2019 ◽  
Vol 68 (2) ◽  
pp. 73-80
Author(s):  
Riyadh A. Alhazmi ◽  
R. David Parker ◽  
Sijin Wen
Keyword(s):  
West Virginia ◽  
Emergency Medical Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Medical Services ◽  
Cross Sectional Survey ◽  
Standard Precautions ◽  
Cross Sectional ◽  
Emergency Medical ◽  
Rural And Urban

Backround: Emergency medical services (EMS) workers are at risk of exposure to bloodborne pathogens and frequently exposed to blood and bodily fluids through percutaneous injuries. This study aimed to assess the consistency with which standard precautions (SPs) among rural and urban EMS providers were used. Methods: This study consisted of a cross-sectional survey conducted with a sample of certified EMS providers in West Virginia in which we ascertained details about sociodemographic characteristics, and the frequency of consistent SP. An email invitation was sent to a comprehensive list of agencies obtained from the Office of West Virginia EMS. Findings: A total of 248 out of 522 (47%) EMS providers completed the survey. The majority of the EMS providers (76%) consistently complied with SPs; however, more than one third (38%) of urban EMS providers indicated inconsistent use compared with 19% of rural EMS providers ( p = .002). Most EMS providers reported low prevention practices to exposure of blood and body fluids in both areas. Conclusion/Application to Practice: The results emphasize the need to enhanced safe work practices among EMS providers in both rural and urban areas through education and increasing self-awareness. Occupational health professional in municipalities that serve these workers are instrumental in ensuring these workers are trained and evaluated for their compliance with SPs while in the field.

scholarly journals Air-Mobile Stroke Unit for access to stroke treatment in rural regions

2018 ◽  
Vol 13 (6) ◽  
pp. 568-575 ◽  
Author(s):  
Silke Walter ◽  
Henry Zhao ◽  
Damien Easton ◽  
Cees Bil ◽  
Jonas Sauer ◽  
...  
Keyword(s):  
Rural Areas ◽  
Stroke Unit ◽  
Systems Of Care ◽  
Intravenous Thrombolysis ◽  
Rural And Remote ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Remote Areas ◽  
Mobile Stroke Unit ◽  
Rural And Remote Areas

Background In recent years, important progress has been made in effective stroke treatment, however, patients living in rural and remote areas have nil or very limited access to timely reperfusion therapies. Aims Novel systems of care to overcome the detrimental treatment gap for stroke patients living in rural and remote regions need to be developed. Summary of review A possible solution to the treatment disparity between stroke patients living in metropolitan and rural areas may involve the use of specially designed aircrafts equipped with the ability to diagnose and treat acute stroke at remote emergency sites. We describe technical solutions for an Air-Mobile Stroke Unit (Air-MSU) concept, where an aircraft is customized with the ability to perform multimodal computed tomography, in addition to onboard laboratory equipment and telemedicine connection. The Air-MSU is envisioned not only to allow intravenous thrombolysis in the field but also to allow prehospital triage to a comprehensive stroke center through use of contrast intracerebral vascular imaging. Several options for the Air-MSU approach are described, and issues regarding the potential medical benefit, optimal operating environment, technical realization, and integration in pre-existing solutions (e.g., flying doctor service) are addressed. Conclusion The Air-MSU may represent a novel tool to reduce treatment disparity for stroke patients in rural and remote areas. However, this approach requires further implementation research to determine the overall benefit to these communities.

Water consumption patterns in a rural setting in Ngamiland district, Botswana: the case of Boro village

2014 ◽  
Vol 4 (4) ◽  
pp. 720-726 ◽  
Author(s):  
Itumeleng Oageng ◽  
Gagoitseope Power Mmopelwa
Keyword(s):  
Water Use ◽  
Significant Relationship ◽  
Rural Areas ◽  
Urban Areas ◽  
Resource Planning ◽  
Rural Setting ◽  
Demand Model ◽  
Use Patterns ◽  
Per Capita ◽  
Water Use Patterns

Water is a precious resource with a variety of uses, which include drinking, cooking, bathing, recreation, gardening, agriculture, hydropower generation, industry and maintenance of the environment. The focus of many empirical studies has been the identification of factors that determine demand for water in urban and semi-urban areas, with the aim of improving water resource planning and development. However, studies on water use patterns in rural areas, especially where water is obtained from open sources, are limited. This study aims to describe water use patterns and demand in the rural settlement of Boro in the Ngamiland district in Botswana. Data were collected from rural households using a structured questionnaire. The average per capita water use was estimated at 20.6 litres per person per day. Estimation of the water demand model showed a significant relationship between annual household income and per capita water consumed (PWC). Both the regression model and the scatter plot did not reveal any significant relationship between PWC and distance to the water source. The study recommends further work be done on the relationship between PWC and distances beyond the ‘threshold’ distance.

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