scholarly journals Stroke and Stroke Care in China

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3651-3654 ◽  
Author(s):  
Liping Liu ◽  
David Wang ◽  
K.S. Lawrence Wong ◽  
Yongjun Wang
Keyword(s):  
Stroke Prevention ◽  
Stroke Care ◽  
Prevention Strategies ◽  
Stroke Registry ◽  
Risk Factor Modification ◽  
New Information ◽  
Epidemiological Surveys ◽  
New Findings ◽  
The Status ◽  
Stroke Epidemiology

At the same time as the world recognizes the rapid economic development in China, Chinese healthcare system has also had significant improvement. However, this nation of 1.4 billion faces tough challenges in treating stroke, the leading cause of death in China. The recently completed Chinese National Stroke Registry has provided new information on the status of stroke epidemiology, diagnosis, management, and prevention strategies in China. In this article, we summarized these new findings, described the effort of providing and improving stroke care, and illustrated the challenges in risk factor modification and secondary stroke prevention. Well-designed epidemiological surveys and clinical trials for stroke prevention and management are still urgently needed in China.

Anthology of stroke epidemiology in the 20th and 21st centuries: Assessing the past, the present, and envisioning the future

2019 ◽  
Vol 14 (3) ◽  
pp. 223-237 ◽  
Author(s):  
Valery L Feigin
Keyword(s):  
Risk Factors ◽  
Stroke Prevention ◽  
Prevention Strategies ◽  
Future Directions ◽  
Stroke Incidence ◽  
The Past ◽  
The Future ◽  
Stroke Epidemiology ◽  
Incidence Prevalence

This narrative overview of stroke epidemiology shows dramatic changes in stroke incidence, prevalence, mortality, disability, and the understanding of risk factors and primary stroke prevention strategies over the last few decades. Likely future directions of stroke epidemiology and prevention are outlined.

GDNF Therapy: Can We Make It Work?

2021 ◽  
pp. 1-4
Author(s):  
Anders Björklund
Keyword(s):  
Gene Therapy ◽  
Transcription Factor ◽  
Signaling Pathway ◽  
Therapeutic Potential ◽  
Threshold Level ◽  
New Findings ◽  
The Status ◽  
Interesting Discussion ◽  
Postmortem Studies ◽  
Made In

In two recent postmortem studies, Jeffrey Kordower and colleagues report new findings that open up for an interesting discussion on the status of GDNF/NRTN signaling in patients with Parkinson’s disease (PD), adding an interesting perspective on the, admittedly very limited, signs of restorative effects previously seen in GDNF/NRTN-treated patients. Their new findings show that the level of the GDNF signaling receptor Ret is overall reduced by about 65% relative to non-PD controls, and most severely, up to 80%, in nigral neurons containing α-synuclein inclusions, accompanied by impaired signaling downstream of the Ret receptor. Notably, however, the vast majority of the remaining nigral neurons retained a low level of Ret expression, and hence a threshold level of signaling. Further observations made in two patients who had received AAV-NRTN gene therapy 8–10 years earlier suggest the intriguing possibility that NRTN is able to restore Ret expression and upregulate its own signaling pathway. This “wind-up” mechanism, which is likely to depend on an interaction with dopaminergic transcription factor Nurr1, has therapeutic potential and should encourage renewed efforts to turn GDNF/NRTN therapy into success, once the recurring problem of under-dosing is resolved.

Abstract P252: Discharge Antithrombotic Therapy for Ischemic Stroke Patients With Prior Aspirin Failure

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Haolin Xu ◽  
Deepak L Bhatt ◽  
Gregg C Fonarow ◽  
Eric E Smith ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Prevention ◽  
Antithrombotic Therapy ◽  
Recurrent Stroke ◽  
Oral Anticoagulants ◽  
The United States ◽  
Future Research ◽  
Large Artery ◽  
Secondary Stroke Prevention ◽  
Stroke Registry

Introduction: Aspirin is one of the most commonly used medications for cardiovascular disease and stroke prevention. Many older patients who present with a first or recurrent stroke are already on aspirin monotherapy, yet little evidence is available to guide antithrombotic strategies for these patients. Method: Using data from the American Heart Association Get With The Guidelines-Stroke Registry, we described discharge antithrombotic treatment pattern among Medicare beneficiaries without atrial fibrillation who were discharged alive for acute ischemic stroke from 1734 hospitals in the United States between October 2012 and December 2017. Results: Of 261,634 ischemic stroke survivors, 100,016 (38.2%) were on prior aspirin monotherapy (median age 78 years; 53% women; 79.4% initial stroke and 20.6% recurrent stroke). The most common discharge antithrombotics (Figure) were 81 mg aspirin monotherapy (20.9%), 325 mg aspirin monotherapy (18.2%), clopidogrel monotherapy (17.8%), and dual antiplatelet therapy (DAPT) of 81 mg aspirin and clopidogrel (17.1%). Combined, aspirin monotherapy, clopidogrel monotherapy, and DAPT accounted for 86.8% of discharge antithrombotics. The rest of 13.2% were discharged on either aspirin/dipyridamole, warfarin or non-vitamin K antagonist oral anticoagulants with or without antiplatelet, or no antithrombotics at all. Among patients with documented stroke etiology (TOAST criteria), 81 mg aspirin monotherapy (21.2-24.0%) was the most commonly prescribed antithrombotic for secondary stroke prevention. The only exception was those with large-artery atherosclerosis, in which, 25.3% received DAPT of 81 mg aspirin and clopidogrel at discharge. Conclusion: Substantial variations exist in discharge antithrombotic therapy for secondary stroke prevention in ischemic stroke with prior aspirin failure. Future research is needed to identify best management strategies to care for this complex but common clinical scenario.

scholarly journals Stroke Prevention Strategies in the Developing World

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 3092-3097 ◽  
Author(s):  
Yogeshwar V. Kalkonde ◽  
Suvarna Alladi ◽  
Subhash Kaul ◽  
Vladimir Hachinski
Keyword(s):  
Stroke Prevention ◽  
Developing World ◽  
Prevention Strategies

Towards Prevention and Early Recognition of Stroke: The Australian Context

2011 ◽  
Vol 12 (3) ◽  
pp. 223-230
Author(s):  
Evrim G. March
Keyword(s):  
At Risk ◽  
Stroke Prevention ◽  
Early Recognition ◽  
Public Health Problem ◽  
Risk Groups ◽  
Effective Prevention ◽  
Australian Context ◽  
The Status ◽  
Significant Public Health ◽  
Policies And Programs

AbstractStroke is a preventable disease leading to physical, cognitive and emotional disability. Its high prevalence and poor outcome shifts this disease from the clinical, medical realm to a significant public health problem. This article provides an overview of the problem, and the status of stroke prevention in the Australian context. To achieve this, it first examines the recent Australian surveillance data on stroke, identifying the at-risk groups. It then argues for targeted stroke prevention, assesses relevant policies and programs in the international and Australian contexts, and briefly reviews approaches for increased awareness and recognition of stroke symptoms. The article concludes by emphasising the need to account for the at-risk-groups when developing targeted health promotion campaigns for effective prevention of stroke in Australia.

scholarly journals Accelerating Scientific Publication in Biology

2015 ◽  
Author(s):  
Ronald D Vale
Keyword(s):  
Scientific Community ◽  
Scientific Publication ◽  
Scientific Publications ◽  
Postdoctoral Training ◽  
The Public ◽  
New Information ◽  
Funding Agencies ◽  
New Findings ◽  
Time Required ◽  
Catalytic Effects

Scientific publications enable results and ideas to be transmitted throughout the scientific community. The number and type of journal publications also have become the primary criteria used in evaluating career advancement. Our analysis suggests that publication practices have changed considerably in the life sciences over the past thirty years. More experimental data is now required for publication, and the average time required for graduate students to publish their first paper has increased and is approaching the desirable duration of Ph.D. training. Since publication is generally a requirement for career progression, schemes to reduce the time of graduate student and postdoctoral training may be difficult to implement without also considering new mechanisms for accelerating communication of their work. The increasing time to publication also delays potential catalytic effects that ensue when many scientists have access to new information. The time has come for life scientists, funding agencies, and publishers to discuss how to communicate new findings in a way that best serves the interests of the public and the scientific community.

Abstract T P188: Equivalency in Intravenous Thrombolytic Treatment Rates Between Primary Stroke Centers and Non-Primary Stroke Centers Through the Use of Telestroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Archit Bhatt ◽  
Elizabeth Barban ◽  
Leslie Corless ◽  
Tamela Stuchiner ◽  
Amit Kansara
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Stroke Care ◽  
Bivariate Analysis ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Stroke Registry ◽  
Patient Arrival ◽  
History Of

Background: Research has shown that subjects evaluated at (Primary Stroke Centers) PSCs are more likely to receive rt–PA than those evaluated at non–PSCs. It is unknown if telestroke evaluation affects rt-PA rates at non-PSCs. We hypothesized that with a robust telestroke system rt-TPA rates among PSCs and non-PSCs are not significantly different. Methods and Results: Data were obtained from the Providence Stroke Registry from January 2010 to December 2012. We identified ischemic stroke patients (n=3307) who received care in Oregon and Southwest Washington, which include 2 PSCs and 14 non-PSCs. Intravenous rt–PA was administered to 7.3% (n=242) of ischemic patients overall, 8.4% (n=79) at non–PSCs and 6.9% (n=163) at PSCs (p=.135). Stroke neurologists evaluated 5.2 % (n=172) of all ischemic stroke patients (n=3307) were evaluated via telestroke robot. Our analysis included AIS (Acute Ischemic Stroke) patients, those presenting within 4.5 hours of symptom onset. We identified 1070 AIS discharges from 16 hospitals of which 77.9 % (n=833) were at PSCs and 22.1 % (n=237) non-PSCs. For acute ischemic stroke patients (AIS) patients, those presenting within 4.5 hours of symptom onset, 22.1% (n=237) received rt-PA; 21.5% (n=74) presented at non–PSCs and 23.7% (n=163) presented at PSCs. Among AIS, bivariate analysis showed significant differences in treatment rates by race, age, NIHSS at admit, previous stroke or TIA, PVD, use of robot, smoking and time from patient arrival to CT completed. Using multiple logistic regression adjusting for these variables, treatment was significantly related to admit NIHSS (AOR=1.67, p<.001), history of stroke (AOR=.323, p<.001), TIA (AOR=.303, p=.01) and PVD (AOR=.176, p=.02), time to CT (.971, p<.001), and use of robot (7.76, p<.001). PSC designation was not significantly related to treatment (p=.06). Conclusions: Through the use of a robust telestroke system, there are no significant differences in the TPA treatment rates between non-PSC and PSC facilities. Telestroke systems can ensure stroke patients access to acute stroke care at non-PSC hospitals.

Abstract TP251: It’s All in the Wrist - Integrating EMS, Telestroke and Stroke Registry Data Systems

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Aliza T Brown ◽  
David Vrudny ◽  
Tammie Marshall ◽  
Sanjeeva Onteddu ◽  
Martin Radvany ◽  
...  
Keyword(s):  
Stroke Patient ◽  
Stroke Care ◽  
Data Systems ◽  
Medical Systems ◽  
Educational Training ◽  
Band Placement ◽  
Discharge Data ◽  
Stroke Registry ◽  
Positive Screen ◽  
Get With The Guidelines

Background: States without a recognized directive for stroke care and transport risk the ability to monitor, assess and review stroke patient movement from first medical contact (FMC) to delivery/and/or transfer to hospitals. We are seeking to determine a new tracking program’s efficacy from emergency medical systems (EMS) to telestroke sites and other receiving hospitals utilizing Get-With-The-Guidelines (GWTG) in data reporting. Hypothesis: We hypothesized that all three entities (EMS, telestroke sites and other hospitals) would record suspected and positive strokes into their electronic databases and integrate the process into their standard of practice, protocols and guidelines. Methods: Statewide EMS agencies, receiving hospitals in the Arkansas Stroke Registry and telestroke sites received educational training about placing blue wristbands on all suspected strokes. Stroke bands were to be placed on all patients arriving via EMS or privately owned vehicle. The bands contained a unique number sequence for recording in both EMS and hospital GWTG electronic databases. We retrospectively reviewed all prospectively collected data from January 1, 2019 to May 31, 2019 for wristband placement by the EMS systems and determined the percentage match to hospital emergency department (ED) discharge data using the GWTG data and telestroke data. Results: From the five months of retrospective analysis of prospectively collected data for 5 months showed, 4,668 strokes were seen in hospitals complying with GWTG. Forty-two% of the positive strokes in hospital (EDs) had stroke bands placed. Of these 8.4% had matching stroke wristband numbers to the EMS database. The telestroke system reported 636 consultations with 95% band placement, 39% placed by EMS. Matching telestroke band ID’s to EMS records was 37%. Wristbands placed by EMS were associated with positive screen tests, pre-notification and shortened Door to CT time (p < 0.0021). Conclusions: Wrist-bands were associated with improved EMS response and provided informed response to hospital care teams. For consistent tracking of positive stroke patient data from FMC to discharge both prehospital and hospital, systems must undergo additional training followed by surveys to determine informed training.

Abstract 116: Relationship of Stroke Unit Status With Quality of Care and Outcome for Acute Stroke Patients: Results From China National Stroke Registry II

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Xinmiao Zhang ◽  
Zixiao Li ◽  
Chunjuan Wang ◽  
Caiyun Wang ◽  
Xin Yang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cox Model ◽  
Frailty Model ◽  
Stroke Care ◽  
Estimating Equation ◽  
Composite Score ◽  
Stroke Recurrence ◽  
Stroke Units ◽  
Stroke Registry ◽  
Processes Of Care

Introduction: A key element in modern stroke care is dedicated stroke units. However, it is unclear whether processes of acute ischemic stroke (AIS) care and outcomes are different between hospitals with and without stroke units in China. Methods: We analyzed the China National Stroke Registry II data from June 2012 to January 2013. Processes of care were examined by 13 individual national guideline-recommended indicators and composite score. Patients’ outcomes included all caused death, stroke recurrence, and disability (modified Rankin Score ≥3) at 3, 6 and 12month after discharge. Propensity score matching was used to balance the baseline characteristics. We used cox model with shared frailty model and logistic regression with generalized estimating equation to analysis the relationship between stroke units and clinical outcomes. Results: Among 19 604 AIS patients, there were 11050 (56.4%) patients in 121 hospitals with stroke units, and 8554 (43.6%) patients in 96 hospitals without stroke units. After matching, 8125 pairs of patients were analyzed. Totally, the composite score of processes was higher in hospitals with stroke units than that without(77% versus 74%, p<0.05). Hospitals with stroke units were more likely to conduct anticoagulation for atrial fibrillation, early antithrombotic treatment, smoking cessation, and stroke education (Figure 1). However, there are no differences between patients in hospitals with and without stroke units in clinical outcomes(Table 1). Conclusions: Our study showed that processes of care of AIS were better in patients in hospitals with stroke units. However, patients in hospitals with stroke units didn’t performance differences in clinical outcomes after discharge.

Abstract TP306: Characteristics and Outcomes Among Patients Transferred to Regional Stroke Centers Across the United States for Specialized Stroke Care

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Gregg Fonarow ◽  
Eric Smith ◽  
Li Liang ◽  
Robert Sutter ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Care Hospital ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Stroke Care ◽  
The United States ◽  
Large Sample Size ◽  
Care Hospital ◽  
Stroke Registry ◽  
Front Door

Intro: Many patients are transferred to stroke centers for advanced stroke care, especially after IV tPA. We sought to determine differences in the baseline characteristics and outcomes between AIS cases presenting directly to stroke centers’ front doors vs. transfers-in from another regional acute care hospital. Methods: Using data from the national GWTG-Stroke registry, we analyzed 970,390 AIS cases (01/2010 - 03/14). Patients at hospitals with high transfer-in rates (>15%) were selected (284 hospitals, 303,739 patients). Due to large sample size, instead of p-values, standardized differences were reported. Multivariable model (MV) examined the association of transfer-in vs. front door with the primary and secondary outcomes, adjusting for patient and hospital characteristics including NIHSS. Results: High volume transfer-in hospitals admitted 31% of their patients via transfer. Transfer-in patients were younger, more often white and non-Hispanic. They had similar stroke risk factors except for hypertension and previous stroke/TIA which were less common. Transfer-in had worse initial NIHSS, more often had altered consciousness and language disturbance. Transfer-in patients had longer length of hospital stay, higher mRS at discharge, and were less often discharged home. In-hospital mortality was ∼ 3% higher in transfer-in as compared with front-door. Among tPA treated patients, sICH < 36hr was more common in transfer-in patients. On MV, transfer-in patients had overall worse outcomes as shown by the higher odds of in-hospital mortality, longer length of stay, and not able to ambulate independently at discharge (Table). Conclusion: Many hospitals receive high volumes of stroke patients via transfer. Because transfer-in patients have worse outcomes, these patients have the potential to negatively influence institutional outcomes rates. Transfer-in patients should be carefully accounted for in risk adjusted models of hospital outcomes.

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