Abstract 51: Access to Primary Stroke Centers for Older Adults and Implications for Travel Times, and Mortality

Background: Regionalization of care to primary stroke centers (PSC) may improve outcomes for stroke patients. We evaluated the current access of Medicare stroke patients to PSC, and its potential impact on mortality. Methods: We performed a retrospective cohort study of a 100% sample of Medicare fee-for-service claims data for patients admitted with stroke in 2008-2009, with one-year follow-up through 2010. Population weighted centroids were created, helicopter pad locations were identified, and driving distances were calculated based on real road network data. Driving and flying speeds, dispatch, scene, and pre-hospital times were estimated using validated models, adjusted for population density. The association of 30-day mortality with travel times, and treatment at a PSC was investigated using multivariable regression models. Results: During the study period, 510,822 patients (mean age 79.6 years, 59.7% females) had a stroke. There was significant regional variation in our cohort, (Figure) with 8.6% of stroke patients having ground access to a PSC within 30 minutes, 14.9% from 30 to 45 minutes, 11.1% from 45 to 60 minutes, 43.9% from 1 to 4.5 hours, and 21.5% over 4.5 hours. The latter group could be limited to 0.1% of stroke patients, if existing helicopter services were used optimally. 164,485 (32.2%) patients received treatment in a PSC, and had modestly decreased mortality (OR, 0.97; 95% CI, 0.95-0.99). For this group, actual travel time to the PSC was not associated with mortality for patients within one hour of the PSC. On the contrary, travel times from 1 to 4.5 hours (OR, 1.15; 95% CI, 1.08-1.22), and over 4.5 hours (OR, 1.41; 95% CI, 1.29-1.54) were associated with increased mortality. Conclusions: There is significant regional variation in access to PSC for elderly stroke patients, with a potential impact on outcomes. Optimal use of helicopter services may address these disparities. Funding: NIH (P01-AG19783, and U01-AG046830-01).

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The effect of an intensive exercise programme on leg function in chronic stroke patients: a pilot study with one-year follow-up

Clinical Rehabilitation ◽

10.1177/0269215509335291 ◽

2009 ◽

Vol 23 (9) ◽

pp. 790-799 ◽

Cited By ~ 10

Author(s):

Roland Stock ◽

Paul Jarle Mork

Keyword(s):

Pilot Study ◽

Exercise Programme ◽

Chronic Stroke ◽

Stroke Patients ◽

Intensive Exercise ◽

One Year

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One-Year Follow-Up in Stroke Patients Discharged from Rehabilitation Hospital

Cerebrovascular Diseases ◽

10.1159/000016021 ◽

2000 ◽

Vol 10 (1) ◽

pp. 25-32 ◽

Cited By ~ 32

Author(s):

Stefano Paolucci ◽

Maria Grazia Grasso ◽

Gabriella Antonucci ◽

Elio Troisi ◽

Daniela Morelli ◽

...

Keyword(s):

Stroke Patients ◽

Rehabilitation Hospital ◽

One Year

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Prognostic Factors of Functional Recovery from Left Hemispheric Stroke

The Scientific World JOURNAL ◽

10.1155/2018/4708230 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Siriphan Kongsawasdi ◽

Jakkrit Klaphajone ◽

Kanokwan Watcharasaksilp ◽

Pakorn Wivatvongvana

Keyword(s):

Functional Recovery ◽

Walking Ability ◽

Limited Data ◽

Stroke Patients ◽

Rehabilitation Team ◽

Predictive Variables ◽

Appropriate Treatment ◽

Walking Capacity ◽

Multivariable Regression

Although lateralization of the brain affects some specialized cortical functions, there are still limited data to address its influence on clinically important outcomes. This study aimed to reveal the prognostic variables that relate to functional recovery in stroke patients with a left-sided hemispheric lesion during 6 months of follow-up. Data from 167 left-sided and 183 right-sided hemispheric strokes were reviewed retrospectively. Outcomes in this study included walking capacity and functional recovery, assessed by the modified Rankin Scale (mRS). In order to obtain independent predictive variables, this study used the step-backward method of multivariable regression analysis of parameters. The final model demonstrated that motor function of the hemiparetic leg was the strongest independent predictor for both walking ability and functional recovery (risk ratio (RR) of 2.41, 95% CI: 1.61–3.60, and p<0.001 and RR of 1.83, 95% CI: 1.03–3.26, and p=0.04, resp.). Therefore, lateralization did not seem to be involved. Understanding predictable variables that are associated with recovery can guide the rehabilitation team in setting priority and appropriate treatment for stroke patients.

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Vascular dementia: Clinical and neuroradiological correlation

Medicinski pregled ◽

10.2298/mpns1104152r ◽

2011 ◽

Vol 64 (3-4) ◽

pp. 152-156 ◽

Cited By ~ 2

Author(s):

Dusko Racic ◽

Petar Slankamenac ◽

Zoran Vujkovic ◽

Sinisa Miljkovic ◽

Vlado Djajic ◽

...

Keyword(s):

Vascular Dementia ◽

Neurological Disorders ◽

Brain Lesions ◽

Critical Threshold ◽

Standard Protocol ◽

Stroke Patients ◽

Neuropsychological Examination ◽

Clinical Centre ◽

One Year

All stroke patients admitted to Banjaluka Clinical Centre during one year were evaluated by the standard protocol during the hospitalization and three months after the stroke. It included clinical, functional and neuropsychological examination and neuroimaging. Dementia was diagnosed according to the criteria of National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l?Enseignement en Neurosciences. Demographic and clinical variables were examined. After the exclusion of the patients who died (n=139) and those who refused to be interviewed during the 3-month follow up (n=52) and those with pre-stroke dementia (n=22), a total of 273 (58.8%) patients underwent neuropsychological examination 3 months after the stroke. Fortynine (19.52%) of them met the criteria for vascular dementia. The predictors of vascular dementia were age, atrial fibrillation, cognitive and functional impairment on admission and functional outcome, subcortical lacunar infarctions, leukoaraiosis, multiple and bilateral brain lesions. Dementia is frequent after stroke and it cannot be determined by a single factor. A combination of several factors increases the critical threshold for cognitive decline.

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COVID-19 prevention behaviour over time in Australia: Patterns and long-term predictors from April to July 2020

10.1101/2021.02.04.21251165 ◽

2021 ◽

Author(s):

J Ayre ◽

E Cvejic ◽

K McCaffery ◽

T Copp ◽

S Cornell ◽

...

Keyword(s):

Regression Models ◽

High Adherence ◽

National Public Health ◽

Community Transmission ◽

Multivariable Regression ◽

Components Analysis ◽

Multivariable Regression Models ◽

Over Time

AbstractBackgroundIn Australia in March 2020 a national public health directive required that non-essential workers stay at home, except for essential activities. These restrictions began easing in May 2020 as community transmission slowed.PurposeThis study investigated changes in COVID-19 prevention behaviours from April-July 2020, and psychosocial predictors of these behaviours.Methods1,843 participants in Australia completed a national COVID-19 survey in April, with monthly follow-up over four months. Principal components analysis (PCA) combined self-reported adherence across seven prevention behaviours. Multivariable regression models explored baseline (April) correlates of behaviour in June (a period of low community transmission) and July (a period of increasing community transmission).ResultsOn average, participants agreed with statements of adherence for all behaviours (means all above 4 out of 7). PCA identified two behaviour types: ‘distancing’ (e.g. staying 1.5m away) and ‘hygiene’ (e.g. washing hands), explaining 28.3% and 24.2% of variance, respectively. Distancing declined each month (p’s<.001), whereas hygiene remained relatively stable. For distancing, stronger perceptions of societal risk, self-efficacy to maintain distancing, and greater perceived social obligation at baseline were associated with adherence in June and July (p’s<0.05). For hygiene, the only significant correlate of adherence in June and July was belief that one’s actions could prevent infection of family members (p<.001).ConclusionsHigh adherence to COVID-19 prevention behaviours were reported; however, distancing behaviours tended to decrease over time. Belief in social responsibility may be an important aspect to consider in encouraging distancing behaviours. Different policy approaches may be needed for different behavioural categories.

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A one-year follow-up after modified constraint-induced movement therapy for chronic stroke patients with paretic arm: a prospective case series study

Topics in Stroke Rehabilitation ◽

10.1179/1074935714z.0000000028 ◽

2015 ◽

Vol 22 (1) ◽

pp. 18-25 ◽

Cited By ~ 8

Author(s):

Takashi Takebayashi ◽

Satoru Amano ◽

Keisuke Hanada ◽

Atsushi Umeji ◽

Kayoko Takahashi ◽

...

Keyword(s):

Case Series ◽

Movement Therapy ◽

Chronic Stroke ◽

Stroke Patients ◽

Constraint Induced Movement Therapy ◽

Case Series Study ◽

Prospective Case Series ◽

One Year ◽

Series Study

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Longitudinal Substance Use following an Emergency Department Visit for Cocaine-Associated Chest Pain

Journal of Drug Issues ◽

10.1177/002204260803800401 ◽

2008 ◽

Vol 38 (4) ◽

pp. 929-956 ◽

Cited By ~ 2

Author(s):

Purushottam B. Thapa ◽

Maureen A. Walton ◽

Rebecca Cunningham ◽

Ronald F. Maio ◽

Xiaotong Han ◽

...

Keyword(s):

Emergency Department ◽

Substance Use ◽

Chest Pain ◽

Brief Interventions ◽

Future Studies ◽

Life Threatening ◽

Potential Impact ◽

One Year ◽

Over Time

Substance abuse is a chronic, relapsing condition, yet some individuals over time seem to cease use for factors that are largely unclear. A life threatening episode of cocaine-associated chest pain requiring an emergency department (ED) visit may influence subsequent use. A consecutive cohort (n = 219) of patients who presented to a large, urban ED with cocaine-associated chest pain was interviewed at baseline, three months, six months, and 12 months to evaluate longitudinal rates of subsequent drug use. Overall, there was a significant decrease in cocaine use over time (baseline = 100.0%, three months = 56.5%, six months = 54.2%, and 12 months = 51.7%, p < .05 for baseline versus each follow-up interval). Findings suggest that substance use declines following an ED visit for cocaine-related chest pain. However, about half of the subjects were still using cocaine one year later. Future studies examining the potential impact of brief interventions or case management to intervene with this not-in-treatment ED population are warranted.

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The Sensitivity and Specificity of the Center for Epidemiologic Studies Depression Scale in Screening for Post-Stroke Depression

The International Journal of Psychiatry in Medicine ◽

10.2190/bh75-euya-4fm1-j7qa ◽

1989 ◽

Vol 18 (2) ◽

pp. 169-181 ◽

Cited By ~ 95

Author(s):

Rajesh M. Parikh ◽

Dianne T. Eden ◽

Thomas R. Price ◽

Robert G. Robinson

Keyword(s):

Sensitivity And Specificity ◽

Depression Scale ◽

Screening Instrument ◽

Epidemiologic Studies ◽

Stroke Patients ◽

Post Stroke ◽

Standardized Interview ◽

Post Stroke Depression ◽

One Year

The present study examines the sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for post-stroke depression. Eighty stroke patients were evaluated by a research nurse over a two-year period using the CES-D and also by a trained psychiatrist using a standardized interview for affective, cognitive, physical and social functioning. CES-D scores correlated significantly with DSM-III diagnoses of depression in-hospital and at three months, six months, and one year follow-up but not at two years follow-up, reflecting the natural course of these depressions, as well as the predictive validity of the CES-D. Furthermore, at a cut-off point of 16, the CES-D was found to have a specificity of 90 percent, a sensitivity of 86 percent and a positive predictive value of 80 percent and thus may be a potentially useful screening instrument for post-stroke depression.

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