Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions

Background and Purpose: When the coronavirus disease 2019 (COVID-19) outbreak became paramount, medical care for other devastating diseases was negatively impacted. In this study, we investigated the impact of the COVID-19 outbreak on stroke care across China. Methods: Data from the Big Data Observatory Platform for Stroke of China consisting of 280 hospitals across China demonstrated a significant drop in the number of cases of thrombolysis and thrombectomy. We designed a survey to investigate the major changes during the COVID-19 outbreak and potential causes of these changes. The survey was distributed to the leaders of stroke centers in these 280 hospitals. Results: From the data of Big Data Observatory Platform for Stroke of China, the total number of thrombolysis and thrombectomy cases dropped 26.7% ( P <0.0001) and 25.3% ( P <0.0001), respectively, in February 2020 as compared with February 2019. We retrieved 227 valid complete datasets from the 280 stroke centers. Nearly 50% of these hospitals were designated hospitals for COVID-19. The capacity for stroke care was reduced in the majority of the hospitals. Most of the stroke centers stopped or reduced their efforts in stroke education for the public. Hospital admissions related to stroke dropped ≈40%; thrombolysis and thrombectomy cases dropped ≈25%, which is similar to the results from the Big Data Observatory Platform for Stroke of China as compared with the same period in 2019. Many factors contributed to the reduced admissions and prehospital delays; lack of stroke knowledge and proper transportation were significant limiting factors. Patients not coming to the hospital for fear of virus infection was also a likely key factor. Conclusions: The COVID-19 outbreak impacted stroke care significantly in China, including prehospital and in-hospital care, resulting in a significant drop in admissions, thrombolysis, and thrombectomy. Although many factors contributed, patients not coming to the hospital was probably the major limiting factor. Recommendations based on the data are provided.

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Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

Cerebrovascular Diseases ◽

10.1159/000516309 ◽

2021 ◽

pp. 1-9

Author(s):

Anna Ramos-Pachón ◽

Álvaro García-Tornel ◽

Mònica Millán ◽

Marc Ribó ◽

Sergi Amaro ◽

...

Keyword(s):

Acute Stroke ◽

Functional Outcome ◽

Stroke Care ◽

Care Quality ◽

Point Of View ◽

Stroke Severity ◽

Acute Stroke Care ◽

Vessel Occlusion ◽

Prehospital Delays ◽

The Impact

Introduction: The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. Methods: Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. Results: Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], p 0.015) during the pandemic period. Conclusion: During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

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Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017

Neuroepidemiology ◽

10.1159/000514077 ◽

2021 ◽

pp. 1-6

Author(s):

Silvia Pastor ◽

Elena de Celis ◽

Itsaso Losantos García ◽

María Alonso de Leciñana ◽

Blanca Fuentes ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admissions ◽

Temporal Trends ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Care Organization ◽

Stroke Units ◽

Health Region ◽

Number Of Patients ◽

The Impact

Introduction: Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. Methods: Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. Results: Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. Conclusions: Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.

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Research on Big Data Digging of Hot Topics about Recycled Water Use on Micro-Blog Based on Particle Swarm Optimization

Sustainability ◽

10.3390/su10072488 ◽

2018 ◽

Vol 10 (7) ◽

pp. 2488 ◽

Cited By ~ 64

Author(s):

Hanliang Fu ◽

Zhaoxing Li ◽

Zhijian Liu ◽

Zelin Wang

Keyword(s):

Big Data ◽

Particle Swarm Optimization ◽

Key Words ◽

Water Use ◽

Particle Swarm ◽

Recycled Water ◽

Swarm Optimization ◽

The Public ◽

Key Factor ◽

Important Significance

The public’s acceptance level of recycled water use is a key factor that affects the popularization of this technology; therefore, it is critical to know the public’s attitude in order to make guiding policies effectively and scientifically. To examine the major focuses and hot topics among the public about recycled water use, one of the major platforms for social opinion in China, the micro blog, is used as a source to obtain data related to the topic. Through the “follow-be followed” and “forward-dialogue” behaviors, a network of discussion of recycled water use among micro-blog users has been constructed. Improved particle swarm optimization has been used to allow deep digging for key words. Ultimately, key words about the topic of have been clustered into three categories, namely, the popularization status of recycled water use, the main application, and the public’s attitude. The conclusion accurately describes the concerns of Chinese citizens regarding recycled water use, and has important significance for the popularization of this technology.

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Fertilization the Omission One Test as Determination Limiting Factors for Maize Biomass (Zea mays L.)

AGRINULA: Jurnal Agroteknologi dan Perkebunan ◽

10.36490/agri.v4i2.154 ◽

2021 ◽

Vol 4 (2) ◽

pp. 94-105

Author(s):

Koko Tampubolon ◽

Bagus Fitra Azmi ◽

Perdana Andriano Tamba ◽

Ayu Widya Lestari ◽

Kamaruddin Kamaruddin ◽

...

Keyword(s):

Plant Height ◽

Leaf Growth ◽

Block Design ◽

Relative Yield ◽

Animal Husbandry ◽

Dry Weight ◽

Limiting Factors ◽

Limiting Factor ◽

Test Technique ◽

The Impact

Introduction: The research was aimed to obtain information on the impact of omission one test fertilization as a determination limiting factors for the growth and biomass of maize in variety Bonanza F1. Materials and Methods: The research was located in the experimental field, Faculty of Agriculture and Animal Husbandry, Universitas Tjut Nyak Dhien, Medan from December 2020 until February 2021. The research was applied by Randomized Block Design in non-factorial through fertilization of omission one test that has been converted (urea : SP-36 : KCl = 0.75 : 0.50 : 0.125 g polybag-1). The treatment of this research include P0 = non-fertilization; P1= N+P+K; P2= P+K; P3= N+K; P4= N+P using three replications. The parameters include plant height, leaf growth, total fresh weight, total dry weight, and the percentage of relative yield then processed using ANOVA and continued with DMRT at 5% ± standard error with SPSS v.20 software. Results: Informed that the omission one test technique significantly improved all the characteristics of maize in the variety Bonanza F1. The highest increase in plant height was found in the N+P of 83.65%, meanwhile, the highest leaf and biomass growth characters were found in N+P+K, ranged of 50.00 to 177.81% and 487.60 to 507.37%, respectively. It was obtained that the limiting factor for the maize growth in variety Bonanza F1 was found in the un-fertilization of nitrogen.

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Epilogue

10.5406/illinois/9780252037122.003.0009 ◽

2017 ◽

Author(s):

Inger L. Stole

Keyword(s):

World War Ii ◽

Public Relations ◽

World War ◽

Social Success ◽

The Public ◽

Consumer Activism ◽

Consumer Movement ◽

Key Factor ◽

War Experience ◽

The Impact

This concluding chapter discusses the impact of wartime events on advertising and consumer activism after World War II, and examines their reverse trajectories in the 1950s. With a few notable exceptions, it was not until the later 1960s that advertising came under new scrutiny by a nascent consumer movement. The key factor in the transformation of advertising’s image was the (War) Advertising Council’s tireless work on behalf of the advertising community. Displaying an excellent sense of timing and direction, the WAC coached and chastised individual advertisers, pleading for their compliance in what it believed to be a fantastic public relations opportunity. The war experience had shown that just as advertisers were capable of providing the keys to social success, they were equally adept at guiding the public through issues of political magnitude.

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Abstract W P288: Using “Big Data” Analytics and Visualization for Quality Improvement in Stroke Care

Stroke ◽

10.1161/str.46.suppl_1.wp288 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Sara J Kavanagh ◽

Benjamin Bray ◽

Lizz Paley ◽

James T Campbell ◽

Emma Vestesson ◽

...

Keyword(s):

Big Data ◽

Real Time ◽

Data Analytics ◽

Good Practice ◽

Big Data Analytics ◽

Stroke Care ◽

Care Quality ◽

Stroke Survivors ◽

The Public ◽

Quality Reporting

Introduction: The Sentinel Stroke National Audit Programme (SSNAP) is the new national stroke register of England and Wales. It has been designed to harness the power of “Big Data” to produce near real-time data collection, analysis and reporting. Sophisticated data visualization is used to provide customized analytics for clinical teams, administrators, healthcare funders and stroke survivors and carers. Methods: A portfolio of cutting edge data visualisation outputs, including team level slidedecks, performance charts, dashboards , and interactive maps, was produced. Visualisations for patients and the public were co-designed with stroke survivors. Stakeholder feedback regarding accessibility and usefulness of the resources was sought via online polls. Results: Key SSNAP results are made accessible electronically every three months in a range of bespoke graphical formats. Individualised slidedecks and data summaries are produced for every hospital, funding group, and region to enable provider level performance and quality reporting and regional and national benchmarking. Dynamic maps enhance dissemination and use of results. Real time root cause analysis tools help teams identify areas of improvement. Feedback reports unprecedented utility of these resources for clinical teams, funders, regional and national health bodies, patients and the public in identifying areas of good practice and requiring improvements, highlighting variations, and driving change. Conclusion: SSNAP is a potential new model of healthcare quality measurement that uses recent developments in big data analytics and visualization to provide information on stroke care quality that is more useful to stakeholders. Similar approaches could be used in other healthcare settings and populations.

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Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era

Stroke ◽

10.1161/strokeaha.120.030481 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2315-2321 ◽

Cited By ~ 28

Author(s):

Henrique Diegoli ◽

Pedro S.C. Magalhães ◽

Sheila C.O. Martins ◽

Carla H.C. Moro ◽

Paulo H.C. França ◽

...

Keyword(s):

Hospital Admissions ◽

Statistical Tests ◽

Stroke Care ◽

Population Based ◽

Public Authorities ◽

Stroke Incidence ◽

Stroke Registry ◽

Before And After ◽

Ischemic Attack ◽

The Impact

Background and Purpose: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil. Methods: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019. Results: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 ( P =0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage. Conclusions: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.

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Abstract P385: Stroke-Related Hospital Admissions During Covid-19 Pandemic in the Latin American Stroke Registry (LASE)

Stroke ◽

10.1161/str.52.suppl_1.p385 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Virginia Pujol-Lereis ◽

Alan Flores ◽

Antonio Arauz ◽

Carlos Abanto-Argomedo ◽

Pablo Amaya ◽

...

Keyword(s):

Latin American ◽

Hospital Admissions ◽

Stroke Care ◽

Stroke Work ◽

Term Outcome ◽

Stroke Registry ◽

Undetermined Etiology ◽

The Impact ◽

Work Up ◽

Acute Admissions

Background: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially acute admissions and ancillary tests availability. We assessed the impact of the pandemic and the lockdowns imposed in stroke admissions in Latin America. Methods: A multinational study (7 countries, 18 centers) of patients admitted since the pandemic outbreak (January - June 2020). These cases were compared with the same period in 2019. We also assessed patterns during the strictest lockdown period (March-June 2020). Number of cases, stroke etiology and severity, acute care and functional outcomes were compared per periods, months, centers and countries. Results: There were 1863 stroke cases in 2019 and 1781 cases in 2020 (p=0.02). We found a significant increase in strokes of undetermined etiology due to incomplete studies in 2020 [16.8% vs 27.6%, p<0.001]). Most countries reported decreases in all-type stroke admissions, except México and Brasil (16% and 36% increases in admissions, respectively). There were no significant differences among months. All-type mortality increased (6.2% vs. 12.6%, p<0.001), and poor functional outcome (mRs 3-6) increased from 32.2% to 38.8% (p=0.007) in 2020. During the period of strict lockdown (March-June 2020), ischemic stroke admissions during the first 24 hours of onset (68.3% vs. 64.4%, p=0.1) and in-hospital stroke code activation (35.1% vs. 27.6%, p=0.005) diminished compared to 2019 period. No differences in total reperfusion treatment rates were observed, with similar door-to-needle and door-to-groin times in both periods. Conclusions: All-type stroke admissions diminished only slightly during the first months of the COVID-19 pandemic. However, in this region, we found substantial deficiencies in stroke work-up, poor short-term outcome and increased mortality.

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Assessing the Role of Increasing Choice in English Social Care Services

Journal of Social Policy ◽

10.1017/s004727941000111x ◽

2011 ◽

Vol 40 (2) ◽

pp. 257-274 ◽

Cited By ~ 47

Author(s):

MARTIN STEVENS ◽

CAROLINE GLENDINNING ◽

SALLY JACOBS ◽

NICOLA MORAN ◽

DAVID CHALLIS ◽

...

Keyword(s):

Power Relations ◽

Social Care ◽

Randomised Trial ◽

Limiting Factors ◽

Large Set ◽

The Public ◽

Care Services ◽

Public Nature ◽

The Individual ◽

The Impact

AbstractThis article aims to explore the concept of choice in public service policy in England, illustrated through findings of the Individual Budgets (IB) evaluation. The evaluation tested the impact of IBs as a mechanism to increase choice of access to and commissioning of social care services around the individual through a randomised trial and explored the experiences and perspectives of key groups through a large set of interviews. The article presents a re-examination of these interview data, using three ‘antagonisms of choice’ proposed in the literature – choice and power relations, choice and equity, and choice and the public nature of decisions – as organising themes. The randomised trial found that IB holders perceived they had more control over their lives and appreciated the extra choice over use of services, albeit with variations by user group. However, problems of power relations, equity and the constraints implied by the public nature of decision-making were complicating and limiting factors in producing the benefits envisaged. The focus on choice in policy, especially as implemented by IBs, emphasises an individualistic approach. The findings suggest that addressing broader issues relating to power, equity and an understanding of the public nature of choice will be of value in realising more of the benefits of the policy.

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Yin and yang: why big data needs little data

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.40 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

John Wright

Keyword(s):

Mental Health ◽

Big Data ◽

School Readiness ◽

Early Life ◽

Data Linkage ◽

Routine Data ◽

Research Data ◽

Limiting Factor ◽

Small Data ◽

The Impact

ABSTRACTObjectivesBig data and data linkage offer great potential for improving health, but the shallowness of much routine data is a major limiting factor. We explore how connecting wide routine data (big data) and deep research data (little data) can harness the real potential of data linkage. ApproachWe have linked routine clinical data from education and health (primary and secondary care) for a well-characterised birth cohort (Born in Bradford) with phenotype and genotype data on almost 14,000 families. We explore the potential for this combination of big and small data to address key research priorities in health and education research. ResultsWe present examples of the complementarity of routine and research data linkage in four varied domains: 1) Health care: how does postnatal mental health need (small data) match with mental health demand (big data)?2) Education: how do early life exposures (small data) influence school readiness and standardised assessment tests (big data)?3) Genetics: what is the impact of rare mutations (small data) on health service uptake (big data)?4) Public health: how can big data and small data be used to evaluate the effectiveness of early life interventions? Pros and cons of both big data and small data are identified. Some lifestyle and demographic factors are more likely to accurate from bespoke research data collection, but clinical and educational measures may be better gleaned from routine records. The reliability of the different sources of data is discussed. ConclusionsOur results illustrate the symbiosis of combining research and routine datasets. Opportunities for harnessing this power through combining routine data with cohort studies, clinical trials and national surveys are explored.

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