Abstract P685: Primary Care Utilization for Primary Prevention Continues to Be Lacking in Patients With Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alexander J Senetar ◽  
Daniel A Bonnin ◽  
Hannah E Branstetter ◽  
Alexis N Simpkins ◽  
Keyword(s):  
Primary Care ◽  
Regression Analysis ◽  
Primary Prevention ◽  
Hemoglobin A1c ◽  
Care Utilization ◽  
P Value ◽  
Stroke Severity ◽  
Institutional Review ◽  
And Gender ◽  
Ischemic Attack

Introduction: Primary care plays an essential role in stroke prevention. Yet still, for many stroke patients, a relationship with a primary care provider (PCP) is not established until after stroke. Our goal was to determine if lack of PCP and the consequential differences in management affects stroke severity. Methods: Data was obtained from our Institutional Review Board approved stroke admission database from 2017 to November 2019 of all stroke subtypes (ischemic stroke, transient ischemic attack, subarachnoid and intracerebral hemorrhages). Non-parametric Mann Whitney t-test and regression analysis was used to identify significant differences in medications, stroke risk factors and stroke severity. Results: A total of 559 patients were included, median age 67 (interquartile range (IQR) 58-76), 49% woman, 32% established care with a PCP, 36% on medications for diabetes mellitus (DM), 42% hyperlipidemia, 66% anti-hypertensives, 39% anti-platelet agents, and 10% anticoagulation. More patients with PCP were taking anti-hypertensive medications (80% versus (vs) 60%, p value < 0.0001), DM medications (56% vs 30%, p value < 0.0001), anti-platelet agents (46% vs 35%, p value = 0.0149), and medications for hyperlipidemia (49% vs 39%, p value = 0.0426). Admission NIHSS was lower in patients with a PCP median 6 (IQR 3-11) vs median 9 (IQR 4 -15), p value= 0.0016, and median hemoglobin A1c was higher in patients with a PCP 8 (IQR 5.7- 9.3) vs patients without a PCP prior to their stroke 6 (IQR 5.4 - 8.5), p value= 0.0002. Admitting systolic blood pressure was similar 155 (137-177) vs 152 (134-171). After correcting for age and gender, regression analysis demonstrated a significant association between whether a patient had PCP and antihypertensive medication use (odds ratio (OR) 2.413, 95% confidence interval 1.511 - 3.914) and hemoglobin A1c (OR 1.122, 95% CI 1.037 - 1.215). Also, patients with a PCP were more likely to have a lower NIHSS on admission (OR 0.9679, 95% CI 0.9423 - 0.9930). Conclusions: These result show that patients not followed by a PCP prior to stroke are less likely to be on medications for primary prevention of stroke, contributing to an increased stroke severity on admission. More research is needed to identify barriers to patients establishing care with PCP.

Distance Between the Most Prominent Labial Surface of Maxillary Central Incisors to the Posterior Limit of Incisive Papilla in Various Arch Forms

2019 ◽  
Vol 2 (2) ◽  
pp. 73-77
Author(s):  
Anuj Khanal ◽  
P Parajuli ◽  
SR Niraula ◽  
RK Singh ◽  
P Suwal
Keyword(s):  
Undergraduate Students ◽  
P Value ◽  
Chi Square ◽  
Anterior Teeth ◽  
Institutional Review ◽  
Starting Point ◽  
The Mean ◽  
And Gender ◽  
Arch Forms ◽  
Labial Surface

Introduction: Arranging artificial teeth has always been a challenging work since edentulous alveolar ridges are in a constant verge of physiological resorptive changes. Incisive papilla is a reliable biometric guide which can be used as a reference for arrangement of anterior teeth, since it is a stable intraoral anatomical landmark unless surgically modified. Objective: This study was conducted to determine the mean distance between the most prominent labial surface of maxillary central incisors to the posterior limit of incisive papilla in various arch forms. Materials and Methods: The study was carried out among 170 undergraduate students of BPKIHS, after obtaining ethical clearance from Institutional Review Committee, BPKIHS. Maxillary impressions were made with alginate impression materials and casts were poured with dental stone. Distance from the posterior limit of incisive papilla to maximum convexity of central incisor (Papillo-Incisal Distance, PID) was measured with a Digital Vernier caliper with a precision of 0.01mm. The arch forms were analyzed and classified into ovoid, tapering and squarish arch, subjectively based on morphological parameters. The intra-examiner reliability of the measurement was tested in 17 casts calculating Cronbach’s Alpha. Pearson Chi-square test was applied to explore the relation of the arch forms with age and gender. One-way ANOVA was used to check the association between the mean PID between with different arch forms.(p value = 0.05) Results: The mean distance from the labial surface of maxillary central incisors to the posterior limit of incisive papilla was 11.58±1.32 mm. The mean papillo-incisal distance varied with respect to different arch forms which was statistically significant (P<0.05). The mean PID of oval, squarish and tapering arch forms were 11.86 mm, 10.82 mm and 11.93 mm respectively. Conclusion: Incisive papilla is a valuable starting point in the preliminary location of maxillary incisors during fabrication of dentures. The suggested mean PID for arranging central incisors is 11.58 mm.

scholarly journals Combination of blood biomarkers and stroke scales improves identification of large vessel occlusions

2021 ◽  
Author(s):  
Edoardo Gaude ◽  
Barbara Nogueira ◽  
Sheila Graham ◽  
Sarah Smith ◽  
Lisa Shaw ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Multivariable Analysis ◽  
Large Vessel ◽  
P Value ◽  
Stroke Severity ◽  
Blood Biomarkers ◽  
Suspected Stroke ◽  
Ischemic Attack ◽  
Optimal Set ◽  
D Dimer

Background and Purpose. Acute ischemic stroke caused by large vessel occlusions (LVO) is a major contributor to stroke deaths and disabilities; however, identification for emergency treatment is challenging. Aims. To evaluate the diagnostic accuracy of a panel of biomarkers for LVO prediction. Methods. 170 patients with suspected stroke were recruited retrospectively at one hospital. We analysed the plasma levels of D-dimer, OPN, OPG, GFAP, vWF, and ADAMTS13 in LVO vs non-LVO. Diagnostic performance was estimated by using blood biomarkers alone or in combination with NIHSS-derived stroke severity scales. Results. Our patient cohort comprised 20% stroke mimics, 11% transient ischemic attack, 11% hemorrhagic stroke, 15% LVO ischemic stroke, 28% non-LVO ischemic stroke, and 15% ischemic stroke with unknown LVO status. Multivariable analysis found that the optimal set of blood biomarkers for LVO prediction was D-dimer (OR 15.4, 95% CI 4.9 to 57.6; p-value<0.001) and GFAP (OR 0.83, 95% CI 0.90 to 0.99; p-value=0.03). The combination of D-dimer and GFAP with stroke scales significantly improved LVO prediction, compared to the stroke scales alone (p-value<0.001). The combination of biomarkers with constructed FAST-ED or EMSA scales achieved an AUC of 95% (95% CI 91-100%) or 93% (CI 95% 89-97%), a sensitivity of 91% (95% CI 71-98%) or 86 (95% CI 66-97%), and a specificity of 95% (95% CI 89-98%) or 94% (95% CI 88-98%), for LVO prediction, respectively. Conclusions. The combination of D-dimer, GFAP, and stroke scales could provide a simple and highly accurate tool for identifying LVO patients.

scholarly journals Epicardial adipose tissue differentiates in patients with and without coronary microvascular dysfunction

2021 ◽  
Author(s):  
Ihab Mahmoud ◽  
Iryna Dykun ◽  
Luisa Kärner ◽  
Stefanie Hendricks ◽  
Matthias Totzeck ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Regression Analysis ◽  
Epicardial Adipose Tissue ◽  
Obstructive Coronary Artery Disease ◽  
Age Groups ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Local Inflammation ◽  
And Gender ◽  
Fat Depot

Abstract Background/Objectives Coronary microvascular dysfunction (CMD) is a common disorder, leading to symptoms similar to obstructive coronary artery disease and bears important prognostic implications. Local inflammation is suggested to promote development of CMD. Epicardial adipose tissue (EAT) is a local visceral fat depot surrounding the heart and the coronary arteries, modifying the inflammatory environment of the heart. We compared EAT in patients with and without CMD. Methods We retrospectively included consecutive patients undergoing diagnostic coronary angiography as well as transthoracic echocardiography between March and October 2016. EAT thickness was defined as space between the epicardial wall of the myocardium and the visceral layer of the pericardium and EAT index was calculated as EAT thickness/body surface area. Logistic regression analysis was used to determine the association of EAT index with the presence of CMD. Results Overall, 399 patients (mean age 60.2 ± 14.0 years, 46% male) were included. EAT thickness was significantly higher in patients with CMD compared to patients without CMD (EAT thickness 4.4 ± 1.8 vs. 4.9 ± 2.4 mm, p = 0,048 for patients without and with CMD, respectively). In univariate regression analysis, EAT index was associated with a 30% higher frequency of CMD (odds ratio [95% confidence interval]: 1.30 [1.001–1.69], p = 0.049). Effect sizes remained stable upon adjustment for body mass index (BMI, 1.30 [1.003–1.70], p = 0.048), but were attenuated when ancillary adjusting for age and gender (1.17 [0.90–1.54, p = 0.25). The effect was more pronounced in patients >65 years of age and independent of BMI and sex (1.85 [1.14–3.00], p = 0.013). Conclusion EAT thickness is independently associated with CMD and can differentiate between patients with and without CMD especially in older age groups. Our results support the hypothesis that modulation of local inflammation by epicardial fat is involved in the development of CMD.

scholarly journals Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046638
Author(s):  
Sk Masum Billah ◽  
Abdullah Nurus Salam Khan ◽  
S M Rokonuzzaman ◽  
Nafisa Lira Huq ◽  
Marufa Aziz Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Gestational Hypertension ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Hypertensive Disorders Of Pregnancy ◽  
Cross Sectional ◽  
Hypertensive Disorders ◽  
Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

PTSD symptom clusters associated with physical health and health care utilization in rural primary care patients exposed to natural disaster

2008 ◽  
Vol 21 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Melissa A. Polusny ◽  
Barry J. Ries ◽  
Jessica R. Schultz ◽  
Patrick Calhoun ◽  
Lisa Clemensen ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Physical Health ◽  
Natural Disaster ◽  
Ptsd Symptom ◽  
Symptom Clusters ◽  
Care Utilization ◽  
Rural Primary Care ◽  
Primary Care Patients

scholarly journals Association between preoperative level of hemoglobin A1c and the incidence of acute kindey injury after coronary artery bypass grafting surgery: a cohort study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Ghada Mohamed Samir ◽  
Omar Mohamed Ali Mohamed Omar ◽  
Madiha Metwally Zidan ◽  
Hazem Abd El Rahman Fawzy ◽  
Marwa Mamdouh Mohamed El Far
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Hemoglobin A1c ◽  
Artery Bypass ◽  
Kidney Injury ◽  
P Value ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Abstract Background The development of acute kidney injury (AKI) is an important indicator of clinical outcomes after cardiac surgery. Elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. This study will investigate the association of preoperative HbA1c levels with AKI after isolated coronary artery bypass grafting (CABG). Results Forty patients undergoing elective CABG were enrolled in this cohort study. Patients are divided into 2 equal groups who underwent isolated coronary artery bypass grafting (CABG): patients with preoperative HbA1c 5.7–6.4% (group A) (prediabetics) and patients with preoperative HbA1c > or = 6.5% (group B) (diabetics). Acute kidney injury according to the Kidney Disease: Improving Global Outcomes criteria developed in 11 patients (27.5%). There was a significant difference between the two groups as regards postoperative urinary NGAL, creatinine level on the 1st day, creatinine level on the 2nd day, urine output on the 1st day, and urine output on the 2nd day (p value was 0.001, 0.002, 0.006, 0.0002, and 0.012 respectively). Postoperative ICU stay duration was statistically significant in the diabetic group (P value 0.009). The need for renal replacement therapy was higher in the diabetic group, but it was not statistically significant between the two groups. Roc analysis shows AUC 0.922 with a significant p value (< 0.0001) and cut of value (≥ 7) with sensitivity 81.82 and specificity 93.10. Conclusion This study revealed that elevated preoperative HbA1c level above 7% showed an increase in incidence of post CABG acute kidney injury along with increase length of postoperative ICU stay.

Müller-Weiss Disease: The Descriptive Factors of Failure Conservative Treatment

2021 ◽  
pp. 107110072110028
Author(s):  
Thos Harnroongroj ◽  
Theerawoot Tharmviboonsri ◽  
Bavornrit Chuckpaiwong
Keyword(s):  
Regression Analysis ◽  
Conservative Treatment ◽  
Demographic Characteristics ◽  
Classification Systems ◽  
Clinical Severity ◽  
P Value ◽  
Level Of Evidence ◽  
Factors Associated ◽  
Radiographic Parameters ◽  
Significant Difference

Background: Conservative treatment is the first-line approach for Müller-Weiss disease (MWD). However, factors associated with the failure of conservative treatment have never been reported. Our objectives were to compare the differences in demographic and radiographic parameters between “successful” and “failure” conservative treatment in patients with MWD and identify descriptive factors associated with failure conservative treatment. Methods: We retrospectively reviewed 68 patients with MWD divided into 29 “failure” and 39 “successful” conservative treatment groups. Demographic characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores for pain and walking disability, and radiographic parameters such as calcaneal pitch, lateral Meary, anteroposterior (AP) Meary angle, and talonavicular-naviculocuneiform arthritis were compared. Logistic regression analysis was performed to identify descriptive factors of failure conservative treatment. A P value <.05 was considered a statistically significant difference. Results: We found more severe VAS pain and walking disability scores and FAOS for the pain, activities of daily living, and quality of life subscales in the failure group ( P < .05). Regression analysis demonstrated 2 significant descriptive factors associated with failure conservative treatment: abducted AP Meary angle >13.0 degrees and radiographic talonavicular arthritis. No demographic characteristics were found to be associated with failure conservative treatment. Conclusion: Midfoot abduction (AP Meary angle, >13 degrees) and radiographic talonavicular arthritis were factors associated with failure conservative treatment in MWD and should be determined concurrently with the clinical severity. Classification systems for MWD should include these factors. Level of evidence: Level III, retrospective comparative study.

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