Abstract T P144: Rural Stroke System Development and Patterns of Arrival

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
James C Torner ◽  
Erin Rindels ◽  
Angela Overton ◽  
Enrique Leira ◽  
Michael Mueller ◽  
...  

Introduction: The Iowa Stroke Registry (ISR) is one of the Paul Coverdell Registries of the Centers for Disease Control. Its goal is to assess the performance of the Iowa Stroke System and to conduct system improvement to improve stroke care and outcomes. One of the major challenges in rural state is acute intervention in a geographically dispersed population and transport to definitive care. Methods: The Iowa Stroke Registry was established in 2007 with data collection from 32 comprehensive, primary and stroke capable hospitals in Iowa beginning in 2009. To date over 10,000 patients have been enrolled. Arrival to the ISR was characterized as via EMS, private vehicle or transfer from another facility. Factors related to stroke symptoms and presentation and time to arrival from last known well were examined by arrival mode. Categorical analysis was done using a Chi-Square Test with an alpha of 0.05. Results: To date 39% of patients with stroke came directly by ambulance, 35% by private vehicle and 25% transferred from local hospitals. Of EMS transported patients were 94% were admitted through the ER; 13% of private vehicle and 32% of transfer patients were directly admitted to inpatient beds. Admission symptoms were similar regardless of transport mode with 64% of patients with weakness, 10% speech difficulties, 3% vision abnormalities and 28% with aphasia. Ambulation with assistance or unable to ambulate was highest in private vehicle patients (8.6%)(p<.05). Transfer (median=347 minutes) and private vehicle (median=408) were significantly longer than EMS arrivals (median=222). As the system developed, the percentage of transfer patients significantly increased over time. Conclusions: With nearly one-third of patients still arriving by private vehicle there is a need for further public education. Increase in transfers demonstrate the effect of stroke system development. These data from the ISR provide information for a wide-ranging stroke education program by the Coverdell Registry and Stroke Task Force committees and stakeholders in Iowa.

2021 ◽  
Vol 47 (2) ◽  
pp. 116-135
Author(s):  
BRITTNEY BYRD ◽  
HARVEY J. BURNETT

ABSTRACT Our study examined the effects of biased and unbiased lineup instructions verbiage on the accuracy of eyewitness identification in a suspect-absent photographic lineup. Seventy subjects were randomly assigned to either a biased instruction condition or an unbiased instruction condition where they watched a mocked crime video, solved word-search puzzles for five minutes, completed a suspect-absent photographic lineup, and then completed an online post-witness experience feedback questionnaire. The unbiased condition utilized photographic lineup instructions from the State Bar of Michigan's Eyewitness Identification Task Force recommended policy writing guide. For the biased condition, the instructions alluded to subjects that the suspect was present. Subjects in the unbiased condition answered correctly 45.7% of the time compared to 28.6% of those in the biased condition. Chi-square test for independence indicated no significant association between the lineup instructions verbiage and the accuracy of eyewitness identification rates. Binomial logistic regression found that the confidence level in the identification choice made, ease of making an identification, decision making time, ability to recognize the lineup appeinstructions, and group condition were not significant predictors of subjects correctly identifying the suspect. Our results would suggest that the verbiage of the lineup instructions does not increase accuracy of eyewitness identifications.


2018 ◽  
Vol 25 (3) ◽  
pp. 135
Author(s):  
Rizaldy Taslim Pinzon

<p><strong>Pendahuluan: </strong>Stroke bisa menimbulkan gangguan fungsional otak berupa gangguan fungsi kognitif. Insidensi gangguan fungsi kognitif meningkat tiga kali lipat setelah stroke, dan biasanya melibatkan gangguan kemampuan visuospasial, memori, orientasi, bahasa, perhatian, dan fungsi eksekutif.</p><p><strong>Metode: </strong>Penelitian ini menggunakan metode potong lintang. Data yang diambil berupa data primer dengan menggunakan <em>Montreal Cognitive Assessment </em>versi Indonesia (MoCA-Ina) serta <em>Clock Drawing Test </em>(CDT) dan data sekunder dari <em>Stroke Registry </em>(2010-2017)<em> </em>dan rekam medis RS Bethesda Yogyakarta. Data yang didapatkan dianalisis secara deskriptif (univariat), dilanjutkan dengan uji <em>chi-square test</em> untuk analisis bivariat, dan regresi logistik digunakan untuk menganalisis analisis multivariat.</p><p><strong>Hasil: </strong>Sampel yang didapatkan sebanyak 110 sampel, dimana terdapat 72 laki-laki (65%) dan 38 perempuan (34.5%), di mana usia terbanyak 51-60 tahun sebanyak 36 pasien (32.7%). Didapatkan 75 pasien (68.2%) yang mengalami gangguan fungsi kognitif (MoCA &lt; 26) dan 35 pasien (31.8%) yang tidak mengalami gangguan fungsi kognitif (MoCA ³ 26). Pada analisis bivariat didapatkan hipertensi (OR: 1.02; CI: 0.70-1.49; p: 0.823) tidak mempengaruhi terjadinya gangguan fungsi kognitif pada pasien post-stroke iskemik. Pada analisis multivariat didapatkan onset serangan stroke ulangan, jumlah lesi, lesi, dan lesi temporal berhubungan dengan gangguan fungsi kognitif post-stroke iskemik.</p><p><strong>Kesimpulan: </strong>Hipertensi tidak berhubungan dengan gangguan fungsi kognitif pada pasien post-stroke iskemik.</p><p><strong> </strong></p><p><strong>Kata Kunci: </strong>Post-Stroke Iskemik, Hipertensi, Gangguan Fungsi Kognitif, MoCA-Ina, CDT.</p>


Author(s):  
Michael Nathaniel Budiarso ◽  
Linda Suryakusuma ◽  
Luse Luse ◽  
Vetinly Vetinly

   THE CORRELATION BETWEEN DISHAGIA AND ALTERED LEVEL OF CONSCIOUSNESS WITH ASPIRATION PNEUMONIA IN STROKE PATIENTS AT ATMA JAYA HOSPITALABSTRACTIntroduction: Approximately 40-96% of stroke patients will develop complications; the most frequent is pneumonia (33%). This is due to the underlying clinical manifestation of stroke such as dysphagia, immobilization, altered level of consciousness, and immune suppression which increases the risk of aspiration, therefore increases the risk for aspiration pneumonia. Early detection of aspiration pneumonia and its risk factors in stroke patients are essential, but the number of researches regarding this in Indonesia is still limited.Aims: To study the correlation between dysphagia and altered level of consciousness in stroke patients with aspiration pneumonia in Atma Jaya Hospital, Jakarta.Methods: This is a retrospective cohort research with a cross sectional approach towards 263 stroke patients in Atma Jaya Hospital, February 2016 until October 2017. Data was taken from the stroke registry and medical records, and analized with Chi-square test (α=0.05).Results: The incidence for aspiration pneumonia was 16% in the study population, most of which being male (57.8%), age <65 years old (79.5%), and length of education <9 years (71.5%). Age >65, dysphagia and altered level of consciousness were statistically significant with Odds ratio (OR) 2.26, 3.92, and 8.67, respectively.Discussion: Male, age <65 years old, and length of education <9 years were correlated with poor daily life habits which increases the risk of getting a stroke. Age >65 years old, dysphagia and altered level of consciousness can disturb the coordination and swallowing reflex which makes patients more vulnerable to aspiration and develop aspiration pneumonia.Keywords: Altered level of consciousness, aspiration pneumonia, dysphagia, strokeABSTRAKPendahuluan: Sebanyak 40-96% pasien stroke akan mengalami komplikasi, terutama pneumonia (33%). Hal ini dimungkinkan oleh adanya kecenderungan disfagia, imobilitas, penurunan kesadaran, dan supresi imunitas yang mempermudah terjadinya aspirasi hingga terjadi pneumonia aspirasi. Deteksi awal faktor risiko pneumonia aspirasi pada pasien stroke sangat penting, namun penelitiannya masih terbatas di Indonesia.Tujuan: Mengetahui hubungan antara disfagia dan penurunan kesadaran terhadap kejadian pneumonia aspirasi pada pasien stroke di RS Atma Jaya, Jakarta.Metode: Penelitian kohort retrospektif dengan pendekatan potong lintang terhadap 263 pasien stroke di RS Atma Jaya. Penelitian dilakukan mulai Februari 2016-Oktober 2017. Data diperoleh melalui data register stroke dan rekam medis. Analisis dilakukan menggunakan uji Chi-square dengan nilai α=0,05.Hasil: Insiden pneumonia aspirasi pada pasien stroke adalah 16%. Didapatkan mayoritas populasi laki-laki (57,8%) berusia <65 tahun (79,5%), dan berpendidikan <9 tahun (71,5%). Usia >65 tahun, disfagia, dan penurunan kesadaran memiliki hubungan yang bermakna secara statistik terhadap kejadian pneumonia aspirasi dengan rasio Odds (RO) 2,26, 3,92, dan 8,67 kali lipat.Diskusi: Laki-laki, usia <65 tahun, dan pendidikan <9 tahun berkaitan dengan pola kesehatan hidup buruk yang meningkatkan faktor risiko terjadinya stroke. Usia >65 tahun, disfagia, dan penurunan kesadaran dapat mengganggu koordinasi dan refleks menelan, sehingga pasien stroke lebih rentan terjadi aspirasi dan mengalami pneumonia aspirasi.Kata kunci:  Disfagia, penurunan kesadaran, pneumonia aspirasi, stroke


2018 ◽  
Vol 6 (3) ◽  
pp. 647
Author(s):  
Satrianti Totting ◽  
Rizaldy Taslim Pinzon ◽  
Bowo Widiasmoko

Ada setengah pasien post stroke mengalami gangguan fungsi kognitif. Diabetes mellitus merupakan salah satu factor risiko stroke sekaligus factor risiko terjadinya gangguan fungsi kognitif. Tujuan penelitian adalah mengukur pengaruh diabetes mellitus terhadap gangguan fungsi kognitif post stroke iskemik. Penelitian ini menggunakan metode cross sectional. Data diambil dengan melakukan pengukuran fungsi kognitif pasien post stroke iskemik menggunakan instrument MoCA-INA dan CDT, data sekunder diambil dari Stroke Registry di RumahSakit Bethesda Yogyakarta pada tahun 2010-2017. Data dianalisis dengan chi-square test untuk analisis bivariat, serta regresi logistic untuk analisis multivariat. Dari 110 subjek penelitian terdapat pasien dengan gangguan fungsi kognitif (MoCA-INA < 26 dan CDT > 1) sebanyak 75 (68.2%) pasien, dan fungsi kognitif baik (MoCA-INA >= 26 dan CDT = 1) sebanyak 35 (31.8%) pasien. Analisis bivariat menunjukkan bahwa diabetes mellitus tidak berhubungan dengan gangguan fungsi kognitif post stroke iskemik (OR: 1.506, 95% CI: 0.654-3.466, p: 0.334). Analisis multivariate dengan regresi logistik didapatkan usia, onset, serangan stroke berulang, lesi temporal dan parietal sebagai faktor yang paling berpengaruh terhadap terjadinya gangguan fungsi kognitif post stroke iskemik. Simpulan penelitian ini adalah diabetes mellitus tidak mempengaruhi terjadinya gangguan fungsi kognitif post stroke iskemik.


Author(s):  
Everton da Silva Camillo ◽  
Marta Lígia Pomim Valentim

This research aimed to investigate the reasons for users with depression in the Slowly community to get involved with technological information, starting from two hypotheses: null (H0) and alternative (H1). The survey data were collected by accessing the public testimonials page registered on Slowly's official website, indexed under the term depression. Regarding the methodological procedures, the Categorical Analysis technique of the Content Analysis method was applied. The hypotheses were tested using the chi-square test. The first hypothesis (H0) was not rejected, because users with depression in the Slowly community do not wish to obtain only sentimental support from other members of the community. It concludes with the expectation that future studies shall investigate solutions for people with depression and those more likely to relate to others via the Internet to achieve more life quality. It is also desirable that further studies can investigate the mental health of regular users in virtual/online communities, in order to verify whether there are behavioral-depressive trends in users who are intensely involved with the use and production of technological information in virtual spaces.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
John A Oostema ◽  
Todd Chassee ◽  
Mathew J Reeves

Background: Acute ischemic stroke patients that are recognized by Emergency medical services (EMS) receive expedited care are more likely to receive t-PA. In order to study the continuum of acute stroke care and ensure accurate case ascertainment, prehospital and inpatient medical records must be linked. We tested the feasibility of probabilistic matching to link prehospital EMS data and in-hospital records using data from existing de-identified registries, and compared results to manual linkage. Methods: A registry containing all EMS-transported suspect or confirmed stroke cases in Kent County, Michigan was used to identify subjects discharged from either of two primary stroke centers with a diagnosis of stroke or TIA. The registry contains EMS data obtained through direct query of EMS electronic medical record systems which is linked manually to hospital data using patient identifiers (name, date of birth). For the probabilistic match, de-identified data for EMS suspected stroke transports from the EMS information system (EMSIS) was provided by the county medical control authority. Probabilistic linkage between hospital stroke discharges and EMSIS data was done using LinkPlus software. Age, sex, transport agency, and date of service were used as matching variables. Probabilistic match rates were compared to manual registry match rates among EMS suspect stroke cases using a chi square test. Results: Over a 6-month period in 2015, 172 hospital-confirmed stroke and TIA patients arrived by EMS at the target hospitals. Over the same period, 214 EMS suspect stroke cases were identified from the registry and 199 EMS suspect stroke cases were identified in EMSIS. Probabilistic linkage correctly matched 64.5% (111/172) of confirmed strokes to prehospital records in EMSIS, which was not significantly different from the manual registry match rate of 73.8% (127/172, p=0.24). There were 16 cases in the manual match that were missed by the probabilistic match: 5 (2.9%) due to age mismatch and 11 (6.4%) were missing from the EMSIS data. The remaining non-matched cases represented EMS missed stroke cases. Conclusion: Probabilistic matching of de-identified pre-hospital and hospital data is a feasible approach for the evaluation of prehospital stroke care.


2018 ◽  
Vol 6 (3) ◽  
pp. 647
Author(s):  
Satrianti Totting ◽  
Rizaldy Taslim Pinzon ◽  
Bowo Widiasmoko

Ada setengah pasien post stroke mengalami gangguan fungsi kognitif. Diabetes mellitus merupakan salah satu factor risiko stroke sekaligus factor risiko terjadinya gangguan fungsi kognitif. Tujuan penelitian adalah mengukur pengaruh diabetes mellitus terhadap gangguan fungsi kognitif post stroke iskemik. Penelitian ini menggunakan metode cross sectional. Data diambil dengan melakukan pengukuran fungsi kognitif pasien post stroke iskemik menggunakan instrument MoCA-INA dan CDT, data sekunder diambil dari Stroke Registry di RumahSakit Bethesda Yogyakarta pada tahun 2010-2017. Data dianalisis dengan chi-square test untuk analisis bivariat, serta regresi logistic untuk analisis multivariat. Dari 110 subjek penelitian terdapat pasien dengan gangguan fungsi kognitif (MoCA-INA < 26 dan CDT > 1) sebanyak 75 (68.2%) pasien, dan fungsi kognitif baik (MoCA-INA >= 26 dan CDT = 1) sebanyak 35 (31.8%) pasien. Analisis bivariat menunjukkan bahwa diabetes mellitus tidak berhubungan dengan gangguan fungsi kognitif post stroke iskemik (OR: 1.506, 95% CI: 0.654-3.466, p: 0.334). Analisis multivariate dengan regresi logistik didapatkan usia, onset, serangan stroke berulang, lesi temporal dan parietal sebagai faktor yang paling berpengaruh terhadap terjadinya gangguan fungsi kognitif post stroke iskemik. Simpulan penelitian ini adalah diabetes mellitus tidak mempengaruhi terjadinya gangguan fungsi kognitif post stroke iskemik.


Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Erin Rindels ◽  
Angela Overton ◽  

Background: The fourth leading cause of death for all Iowans is stroke. In 2006 the American Heart Association in collaboration with healthcare professionals formed the Iowa Stroke Task Force (ISTF). At that time Iowa had six certified Primary Stroke Centers (PSC). Several stroke coordinators were members of the ISTF; however they discovered that their specific needs were not addressed during ISTF meetings. Purpose: The purpose of the Iowa Stroke Coordinator Consortium (ISCC) is to provide an environment where sharing experiences leads to the collaboration of stroke coordinators to improve stroke care. Methods: The stroke coordinators involved with the ISTF developed a toolkit for stroke care. The toolkit was posted on the Iowa Healthcare Collaborative (IHC) website which is known to all hospitals in Iowa as a resource for promoting improvement in healthcare. After the creation of the toolkit the coordinators created their own group dedicated to addressing needs specific to stroke coordinators. The charter membership consisted of seven members. The ISCC membership is involved with providing guidance to non-PSC hospitals, and participating on several state committees. The ISCC meets quarterly to discuss process improvement and share information. Results: There are currently 17 certified PSCs and one certified Comprehensive Stroke Center (CSC). Informal mentoring is evident through frequent exchanges of ideas occurring via email, phone calls, and at quarterly meetings. The founding members of ISCC serve as board members, and reach out to support new coordinators. ISCC members have conducted mock stroke drills as a statewide public awareness event and utilized a questionnaire at health fairs across the state to assess public knowledge on stroke symptoms and risk factors. Members of ISCC assisted with developing the Iowa Stroke Registry. The registry addresses stroke as a system of care in Iowa. Conclusions: In conclusion, the ISCC has provided an environment where sharing ideas and experiences led to the collaboration of stroke coordinators across the state to improve care through information sharing and increasing the number of certified stroke centers. The future of the group is continued collaboration and formalizing a mentorship program.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11002-11002
Author(s):  
Annie P. Im ◽  
Yana G. Najjar ◽  
Todd Bear ◽  
Devin Dressman ◽  
Kara A. Bernstein ◽  
...  

11002 Background: Challenges for women in science and academic medicine have been well documented, which include gender disparities related to parental and domestic responsibilities that interfere with work or career opportunities. We aimed to evaluate the experiences and working environment at an NCI-designated Cancer Center for current and future parents in the post-COVID era. We hypothesized there would be differences in the experiences of parents between men and women, and between trainees, faculty, and staff. Methods: A 61-question online survey for current and future parents was developed by the Women’s Task Force of the Hillman Cancer Center (HCC) in Pittsburgh, Pennsylvania. Questions focused on perceived attitudes towards parents, the supportive nature of the working environment for parents, experiences with breastfeeding as a working parent, and childcare responsibilities pre- and post-COVID. The survey was sent to 562 scientific faculty, physicians, trainees, and research staff at HCC. Comparisons between groups of interest were performed using a chi-square test. Results: There were 214 respondents (38% response rate) with even representation: 38% were faculty, 27% were trainees, and 35% were research staff; 59% were female. 6% of respondents reported being “discouraged or excluded from participating in specific activities due to having or planning children”, and 24% felt “moderately supported” as a parent at work. Regarding breastfeeding, 58% reported that the decision to breastfeed was moderately impacted by returning to work, and of the women who were currently or recently breastfeeding, 42% reported that there were not enough lactation rooms in their building. Other questions in the survey aimed to evaluate what further support would be helpful for parents. 40% reported that on-site childcare would help better support them as a parent, especially because 47% documented that finding childcare was difficult and 53% documented that they looked at ≥4 daycares or nannies. Further, 49% reported that they did not know where to look for resources in finding childcare. Pre-COVID, 32% reported spending 2-3 hours a day on childcare and/or home responsibilities; post-COVID, 55% reported spending ≥4 hours a day. These effects were more pronounced in women compared to men (p < 0.05). Pre-COVID, 40% reported that they were unable to participate in work events due to childcare responsibilities, which increased to 54% post-COVID, and was most pronounced in faculty and trainees compared to staff (p < 0.05). Conclusions: Our survey describes some of the universal challenges of working parents in Oncology, which have been exacerbated by COVID. The impact of COVID was more pronounced in women. Further studies are needed for systematic interventions or policies that improve support for working parents, including unified resources and working groups for current and expecting parents.


Mathematics ◽  
2021 ◽  
Vol 9 (15) ◽  
pp. 1788
Author(s):  
Katarina Valaskova ◽  
Pavol Durana ◽  
Peter Adamko

The current COVID-19 pandemic has affected every aspect of consumer behavior—their expenses, investments, and financial reserves, as well as their financial and social wellbeing. As a consequence of different restrictions, consumers and their shopping patterns have changed significantly; thus, the factors that influence new purchase patterns need to be identified to help traders, retailers, and marketers develop appropriate strategies to respond to crucial consumer changes in the market. A categorical analysis (Pearson’s chi-square test) and correspondence analysis (simple and multivariate) were applied to a sample of 425 Slovak respondents to reveal the most important factors impacting consumers’ financial situations, as well as the effects on the maintenance of new shopping habits established during the pandemic period. The results revealed that consumers´ income, age, and sector of occupation play important roles in the context of new shopping patterns. These findings are in agreement with other global studies, confirming both the worldwide impact of the pandemic on consumer behavior and the importance of national studies on consumer shopping behavior in order for state authorities, traders, marketers, and entrepreneurs to be able to take necessary measures.


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