Abstract 1122‐000240: The Effect of COVID‐19 on Stroke Treatment in Africa

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Anshul Chiranth
Keyword(s):  
Mechanical Thrombectomy ◽  
Effective Solution ◽  
Neurological Damage ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Time Period ◽  
Receive Treatment ◽  
Survey Responses ◽  
The Impact ◽  
To Receive

Introduction : One of the most common neurological sicknesses in healthcare today is acute ischemic stroke. Stroke is associated with symptoms such as neurological damage, and can only be effectively treated with a few methods. One such treatment is mechanical thrombectomy, and in this study, research was done on how the COVID‐19 pandemic affected stroke treatments (specifically MT) in Africa. Methods : Initially, data of 58 countries in Africa was compiled and put in a spreadsheet. Soon after, the countries that would be most desirable for the study were found. These “target countries” had the highest populations (as of 2020), number of COVID‐19 cases (as of October 2020) and number of incident stroke cases (in 2016) in Africa. This group consisted of countries such as Nigeria, Ethiopia, Egypt, and South Africa. Afterwards, neurologists, neurosurgeons, professors of neurology, and neurointerventionalists from the “target countries” were contacted via email. This email invited these individuals to hold an interview or fill out a survey regarding the impact COVID‐19 on stroke treatment in their hospital. After sending approximately 50 emails, 3 survey responses were received and 3 interviews were held. Results : Following the interviews and after reading survey responses, impairments to mechanical thrombectomy appeared to be the frontrunner of the barriers mentioned. Other important barriers mentioned were: time barriers, rehabilitation barriers, as well as fear of seeking treatment in places of high COVID‐19 concentration. The practice of MT is well‐ established in North America and Europe; however, it is still rather undeveloped in Africa. All doctors interviewed and surveyed indicated that the pandemic practically brought operations to a halt (only one doctor recorded two successful procedures during the pandemic). In Egypt specifically, there has been a lack of equipment and PPE. This is mainly because hospitals are dedicating staff and equipment to COVID‐infected patients. The secondary barriers also contributed to problems in hospitals. Due to more screenings and less staff during the pandemic, time for patients to receive treatment has increased. Rehabilitation for stroke patients has been impacted by a lack of prescriptions from pharmacies. Finally, in certain parts of Africa people are too afraid to visit hospitals due to the risk of possibly being infected with COVID‐19. The barriers imposed by the pandemic have made stroke treatment significantly more difficult. Conclusions : In conclusion, the COVID‐19 pandemic has negatively affected stroke treatment in certain areas of Africa. Doctors have faced several key barriers that has limited the effectiveness of stroke treatment during the time period. Based on doctor recommendations, improving in the practice of mechanical thrombectomy is the most effective solution to ensuring stroke treatment is proficient. This could be done through awareness, education, and better equipment.

Abstract 1122‐000242: Effect of Covid‐19 on Stroke Treatment in Australia and New Zealand

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ela Machiroutu
Keyword(s):  
New Zealand ◽  
Stroke Care ◽  
Small Subset ◽  
Stroke Patients ◽  
Secondary Research ◽  
Stroke Treatment ◽  
Survey Tool ◽  
Early Adoption ◽  
Survey Responses ◽  
The Impact

Introduction : In general, compared to the rest of the world, the impact of Covid‐19 in the Australia and New Zealand regions has been minimal and this may be attributed to their early adoption of social distancing, stable governments, national wealth and geographic isolation. However, this research was designed to validate this perception amongst the stakeholders. Methods : This research included: primary and secondary research. First, secondary research about Covid‐19 and stroke treatment and Australia and New Zealand in particular was conducted and compiled in a Google spreadsheet. Research sources include Stroke Foundation, Brain Foundation, and World Meters. Data collected included the number of stroke and Covid‐19 cases in Australia and New Zealand as well as a list of stakeholders with their contact information. The stakeholders included neurosurgeons, hospitals, neurologists, interventionists, and vascular surgeons. A survey tool and an interview questions were prepared next. The survey request was emailed to stakeholders, requesting the stakeholders for an interview and survey response. Over the following weeks, survey results came in and interviews were conducted. Since only a small subset of stakeholders responded to the survey (6 survey responses and 4 interviews), this study must be considered to be primarily qualitative in nature. The interviews were conducted online using Zoom. After the interviews, I replayed the interviews and took notes of important details. Results : The survey showed that 83% of the doctors worked in a hospital that had a separate stroke unit and that they perform mechanical thrombectomies most often as a treatment for stroke. Most of the doctors suggested that the stroke numbers have not changed significantly since Covid‐19. Yet, 50% of the doctors said that there had been delays in admitting stroke patients. One third believed Covid‐19 may have made an impact on mortality of stroke patients. One of the interviewees revealed that the main barriers to access to stroke care are the time it takes to treat the patient, fewer locations that treat strokes or perform mechanical thrombectomy, and patients’ reluctance to go to the hospital during the pandemic. Another confirmed that she did think there had been delays due to Covid‐19. Conclusions : Counter to widespread perception, Covid‐19 pandemic DID worsen many barriers for stroke treatment in Australia and New Zealand. These regions have insufficient stroke centers and these are not spread out widely enough for accessibility. Stroke deaths have increased during the Covid‐19 pandemic. Barriers such as time, accessibility, and the patient’s fear of hospitals have affected stroke treatment during the pandemic. Several measures can alleviate the impact: stroke awareness is critical. Every hospital needs to have the ability to assess and treat stroke. Hospitals must run simulations to practice and prepare for different scenarios that they could encounter when dealing with stroke patients. In conclusion, stroke treatment has been affected by the Covid‐19 pandemic and it is critical to minimize and overcome these barriers as stroke is one of the leading causes of death in Australia and New Zealand.

Abstract WP282: Protecting Stroke Patients from Aspiration and Mortality through a Bedside Aspiration Screen

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Edith Matesic
Keyword(s):  
Organizational Learning ◽  
Aspiration Pneumonia ◽  
The Body ◽  
Kappa Statistics ◽  
Evidence Based ◽  
Stroke Patients ◽  
Rater Reliability ◽  
Stroke Treatment ◽  
Risk Of Death ◽  
The Impact

Background: Stroke patients initially experience dysphagia approximately 42-76% of the time, putting them at high risk for developing aspiration pneumonia and increasing the risk of death threefold in the first 30 days following onset of the condition. Interventions to identify risk for aspiration pneumonia are key to reducing mortality in hospitalized patients. However, no generally recognized bedside aspiration screen exists, and few have been rigorously tested. The Edith-Huhn-Matesic Bedside Aspiration Screen (EHMBAS) TM was developed as an evidence-based RN bedside aspiration screening protocol. Purpose: This study analyzed the sensitivity and inter-rater reliability of EHMBAS TM , assessed the efficacy of training methods, evaluated patient feedback, and looked at the impact of organizational learning. Methods: RNs were trained to apply the EHMBAS TM . An evaluation study assessed the sensitivity, specificity and predictability of the screen to detect aspiration in the stroke population study group. Cohen’s Kappa statistics was applied to test inter-rater reliability. Pre- and post-implementation Likert surveys examined patient and staff satisfaction on the education plan and screening process, respectively. Lastly, an analysis of organizational learning examined whether changes enhanced adherence to screening requirements. Results: Results showed that the EHMBAS TM demonstrated strong validity (94% sensitivity) and high inter-rater reliability (Kappa = .92, p<.001). Pre- and post- staff training survey results demonstrated a significant positive change in knowledge gained, feelings of preparedness, and satisfaction with teaching methods. Further, 92.3% of patients surveyed had positive screening experiences. The hospital received Silver recognition from The American Heart Association for following stroke treatment guidelines 85% of the time for at least 12 months, demonstrating the positive impact of the protocol on organizational change. Conclusions: This study contributes to the body of work aimed at establishing a reliable evidence-based, bedside aspiration screen. Patient safety is enhanced, because screen results help determine when patients can safely receive medication and nutrition by mouth.

Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care

2018 ◽  
Vol 33 (5) ◽  
pp. 501-507 ◽  
Author(s):  
Timmy Li ◽  
Jeremy T. Cushman ◽  
Manish N. Shah ◽  
Adam G. Kelly ◽  
David Q. Rich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Barriers To Care ◽  
Prehospital Care ◽  
Heart Association ◽  
Living Alone ◽  
Stroke Patients ◽  
Publication Type ◽  
Stroke Treatment ◽  
Significant Difference ◽  
The Impact

AbstractIntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED).MethodsA retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers.ResultsBarriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159).ConclusionsBarriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ.LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med.2018;33(5):501–507.

Abstract P293: Disparate Outcomes for Stroke Patients With Documented Substance Use Compared to Those Without Substance Use

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Leslie Corless ◽  
Tamela L Stuchiner ◽  
Cameron Garvin ◽  
Alexandra C Lesko ◽  
Elizabeth Baraban
Keyword(s):  
Substance Use ◽  
Patient Characteristics ◽  
Stroke Care ◽  
Stroke Patients ◽  
Chi Square ◽  
Stroke Treatment ◽  
Discharge Disposition ◽  
Healthcare Settings ◽  
Medical Histories ◽  
The Impact

Background: Few studies have shown the impact of substance use (SU) on treatment and outcomes of stroke patients. Research suggests stigma related to SU impacts patient experience in healthcare settings. In this study we assessed whether there were differences in patient characteristics and outcomes for stroke patients with SU compared to those with no substance use (NSU). Methods: Retrospective data from two Oregon hospitals included patients admitted with stroke diagnosis, 18 years or older, who discharged between October 2017 and May 2019. Patients with documented SU and specific SU type were compared to patients with NSU with regard to demographics, medical history, stroke subtypes, treatment, discharge disposition and length of stay (LOS). SU was defined as any documented abuse of alcohol (ETOH), methamphetamine (MA), cannabis, opiates, cocaine, benzodiazepines, and Methyl-enedioxy-methamphetamine (MDMA). Non parametric median tests and Pearson’s chi square tests were used. Results: Among 2,030 patients included in the analysis, 13.8% (n=280) were SU and 86.2% (n=1,750) were NSU. Patients with SU were significantly younger, median age (61 vs. 73, p <.001) and less were female (35.4% vs. 53.6%, p <0.001). Those with SU had lower prevalence of dyslipidemia (43.6% vs. 59.5%, p <0.001), AFIB (12.5% vs. 22.2%, p <0.001), and previous TIA (6.1% vs 10.8%, p=0.02), and more smoked (54.3% vs 13.3% p <0.001). More patients with SU arrived via transfer (38.4% vs 27.4%, p=.001). Fewer patients with SU expired or were discharged to hospice (8.9% vs 13.7%) and a greater percent left against medical advice (AMA) (3.2% vs 0.6%) (p<.001). When comparing specific SU types to NSU, all SU groups were younger, had similar medical histories and a greater proportion left AMA. Only MA users had differentiating stroke diagnoses with a higher percent of SAH (14.5% vs 5.6%) (p=.003) in addition to longer LOS (6 vs 4 days, p=.006). No differences were found in acute stroke treatment rates. Conclusion: Patients with SU were demographically different from the NSU population and did differentiate on some stroke care outcomes and processes, potentially indicating opportunities to address stigma around substance use to meet the needs of patients with both stroke and substance use.

Abstract W P340: Emergency Department Nurses Collaborate With Long Term Care Facilities for Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jamie L Strom
Keyword(s):  
Emergency Department ◽  
Long Term Care ◽  
Stroke Patients ◽  
Term Care ◽  
Stroke Treatment ◽  
Emergency Department Nurses ◽  
Senior Services ◽  
To Receive ◽  
Education Initiative

Background and Purpose: Stroke treatment is often delayed before patients reach the emergency department (ED). Some patients arrive in time to receive medication that can reverse new stroke symptoms. Some are not as fortunate. They are either admitted to the palliative unit, or discharged only to live with their new disabilities possibly for the rest of their lives. In 2013, nurses observed many long term care (LTC) patients were not getting to the ED in time to receive tPA (tissue plasminogen activator), a medication used to reverse stroke symptoms. The purpose of this process improvement was to increase the number of LTC patients with stroke symptoms arriving in the ED within the tPA window. Methods: To determine how many patients from nursing homes were missing the tPA window, data from the ED’s records was abstracted from the month of June 2013. The sample size was all patients who presented with possible stroke symptoms, and who were also from LTC facilities. Surprisingly, 100% of LTC patients presenting with stroke symptoms missed the tPA window. With the support of ED leadership, we decided to raise awareness about the tPA window in the LTC facilities. No evidence existed from ED’s related to LTC patients and the tPA window. Approximately 1,000 unused stroke pamphlets were collected. A PowerPoint presentation based on AHA guidelines was used. A lecture occurred at the community’s senior services meeting, and many LTC administrators were willing to adopt this education initiative at their facilities. ED staff became involved and helped conduct the in-services. In exchange for their volunteering, they received credit to help with career ladders at their hospital. Results: The number of possible stroke patients from LTC facilities getting to the ED within eight hours of the last time seen normal (LTSN) has increased from 0% in June 2013, to 25% in March 2014. Conclusions: Stroke education teams of ED nurses showed improvement in LTC patients arriving in the ED within the tPA window. In conclusion, it is encouraged that other ED staff volunteer to teach in LTC facilities in their own communities, in assisting their stroke patients as well.

scholarly journals Role of the Neurosurgeon in Acute Ischemic Stroke Treatment From Triage to Intensive Care Unit

Neurosurgery ◽  
2019 ◽  
Vol 85 (suppl_1) ◽  
pp. S47-S51
Author(s):  
Kimberly P Kicielinski ◽  
Christopher S Ogilvy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Setting ◽  
Stroke Treatment

Abstract As ischemic stroke care advances with more patients eligible for mechanical thrombectomy, so too does the role of the neurosurgeon in these patients. Neurosurgeons are an important member of the team from triage through the intensive care unit. This paper explores current research and insights on the contributions of neurosurgeons in care of acute ischemic stroke patients in the acute setting.

scholarly journals Groin complications in endovascular mechanical thrombectomy for acute ischemic stroke: a 10-year single center experience

2015 ◽  
Vol 8 (6) ◽  
pp. 568-570 ◽  
Author(s):  
Veer A Shah ◽  
Coleman O Martin ◽  
Angela M Hawkins ◽  
William E Holloway ◽  
Shilpa Junna ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Complication Rates ◽  
Artery Pseudoaneurysm ◽  
Stroke Treatment ◽  
Vascular Closure Devices ◽  
Clinical Records ◽  
The Impact ◽  
Groin Hematoma

BackgroundThe increasing utilization of balloon guide catheters (BGCs) in thrombectomy therapy for ischemic stroke has led to concerns about large-bore sheaths causing vascular groin complications.Objective To retrospectively assess the impact of large large-bore sheaths and vascular closure devices on groin complication rates at a comprehensive stroke center over a 10-year period.MethodsRadiological and clinical records of patients with acute ischemic stroke who underwent mechanical endovascular therapy with an 8Fr or larger sheaths were reviewed. A groin complication was defined as the formation of a groin hematoma, retroperitoneal hematoma, femoral artery pseudoaneurysm, or the need for surgical repair. Information collected included size of sheath, type of hemostatic device, and anticoagulation status of the patient. Blood bank records were also analyzed to identify patients who may have had an undocumented blood transfusion for a groin hematoma.ResultsA total of 472 patients with acute ischemic stroke who underwent mechanical thrombectomy with a sheath and BGC sized 8Fr or larger were identified. 260 patients (55.1%) had tissue Plasminogen Activator (tPA) administered as part of stroke treatment. Vascular closure devices were used in 97.9% of cases (n=462). Two patients were identified who had definite groin complications and a further two were included as having possible complications. There was a very low rate of clinically significant groin complications (0.4–0.8%) associated with the use of large-bore sheaths.ConclusionsThese findings suggest that concerns for groin complications should not preclude the use of BGCs and large-bore sheaths in mechanical thrombectomy for acute ischemic stroke.

Public Preferences for New Information on Opioids

2019 ◽  
Vol 45 (2) ◽  
pp. 311-339
Author(s):  
Paul F. Testa ◽  
Susan L. Moffitt ◽  
Marie Schenk
Keyword(s):  
Public Health ◽  
Opioid Epidemic ◽  
Information Campaigns ◽  
New Information ◽  
Health Strategy ◽  
Nationally Representative ◽  
Receive Treatment ◽  
Information Treatment ◽  
The Impact ◽  
To Receive

Abstract Context: Educating the public through information campaigns is a commonly used policy approach to public health problems. Yet, experimental methods that assess the impact of information campaigns may misestimate their effects by failing to account for respondents' willingness to receive new information. Methods: This article uses a doubly randomized survey experiment conducted on a nationally representative sample, where some subjects are randomly assigned to an informational treatment about opioids while other subjects are given the choice of whether to receive treatment or not, to examine how public willingness to seek new information shapes the way they update their preferences about policies related to the opioid epidemic. Findings: Among those likely to receive information, treatment has a large positive effect on increasing support for policies that address the opioid epidemic by about one half of a standard deviation. Among those who would avoid this information, preferences appear to be unmoved by treatment. These effects would be missed by standard experimental designs. Conclusion: While redressing information asymmetries is only one part of a public health strategy for addressing the opioid epidemic, our findings highlight the importance of access to and receptiveness toward new information.

scholarly journals The Impact of Age on Mortality and Disability in Patients With Ischemic Stroke Who Underwent Cerebral Reperfusion Therapy: A Brazilian Cohort Study

2021 ◽  
Vol 13 ◽  
Author(s):  
Natália Eduarda Furlan ◽  
Gustavo José Luvizutto ◽  
Pedro Tadao Hamamoto Filho ◽  
Silméia Garcia Zanati Bazan ◽  
Gabriel Pinheiro Modolo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Hospital Discharge ◽  
Functional Disability ◽  
Mechanical Thrombectomy ◽  
Reperfusion Therapy ◽  
Secondary Outcome ◽  
Stroke Treatment ◽  
Cerebral Reperfusion ◽  
The Impact

Introduction: The main driver for increased stroke prevalence is the aging of the population; however, the best evidenced-based strategies for stroke treatment and prevention are not always followed for older patients. Therefore, the aim was studying the association of age with clinical outcomes (mortality and functional disability) in stroke patients who underwent cerebral reperfusion therapy at hospital discharge and 90 days after ictus.Methods: This was a retrospective (stroke databank analysis) cohort study of participants who had been diagnosed with ischemic stroke and undergone intravenous cerebral reperfusion therapy or mechanical thrombectomy. The variable of interest was patient age, which was categorized into four groups: (1) up to 59 years; (2) 60 to 69 years; (3) 70 to 79 years old; and (4) above 79 years. The primary outcome was mortality at hospital discharge and 90 days after stroke, and the secondary outcome was functional capacity at hospital discharge and 90 days after stroke.Results: A total of 281 patients was included in the study (235 treated by thrombolysis alone, and 46 treated with mechanical thrombectomy). The mean age of the total sample was 67 ± 13.1 years. The oldest patients had the most unfavorable outcomes, except for mortality rate, at hospital discharge (mRS &gt; 2; OR: 1.028; 95% CI 1.005 to 1.051; p = 0.017; mRS &gt; 3; OR: 1.043, 95% CI 1.018 to 1.069; p = 0.001) and 90 days after stroke (mRS &gt; 2; OR: 1.028; 95% CI 1.005 to 1.051; p = 0.017; mRS &gt; 3; OR: 1.043, 95% CI 1.018 to 1.069; p = 0.001).Conclusion: Cerebral reperfusion was a viable treatment for ischemic stroke in both elderly and very elderly patients, as it did not increase mortality. However, it was observed that older individuals had worse functional outcomes at hospital discharge and 90 days after stroke.

scholarly journals Work of a stroke team: experience of transferring ischemic stroke patients from district hospitals to Krasnoyarsk Regional Vascular Center for thrombectomy

2022 ◽  
Vol 20 (4) ◽  
pp. 218-224
Author(s):  
P. G. Shniakin ◽  
N. V. Isaeva ◽  
V. Y. Kuznetsov ◽  
A. V. Protopopov ◽  
E. E. Korchagin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Cerebral Arteries ◽  
Therapeutic Window ◽  
High Tech ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Systemic Thrombolysis ◽  
District Hospitals ◽  
Vascular Center

Modern high-technology methods for ischemic stroke treatment (systemic thrombolysis, mechanical thrombectomy, thrombaspiration, stenting of cerebral arteries) can improve the rehabilitation potential and survival of patients. Important tasks here are selection for reperfusion and its performance on the greatest possible number of peracute patients. Mechanical thrombectomy combined with systemic thrombolysis is the most effective reperfusion strategy in the therapeutic window, but the availability of endovascular methods is limited to highly specialized centres. One way to solve this problem is to organize effective logistics with stroke patients, which will provide high-tech care for patients living far from large treatment centers due to regulated interaction between institutions at different levels.The aim of the study was to improve emergency interaction related to transfer of peracute stroke patients from primary vascular units and district hospitals of the Krasnoyarsk region to Krasnoyarsk Regional Vascular Center for thrombectomy. 

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