scholarly journals Current state of acute stroke care in Southeast Asian countries

2018 ◽  
Vol 25 (3) ◽  
pp. 291-296
Author(s):  
Justin Christopher Ng ◽  
Anchalee Churojana ◽  
Sirintara Pongpech ◽  
Luu Dang Vu ◽  
Cindy Sadikin ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Endovascular Therapy ◽  
Stroke Care ◽  
Southeast Asian ◽  
Asian Countries ◽  
Acute Stroke Care ◽  
The Past ◽  
Current State ◽  
Care Systems ◽  
Southeast Asian Countries

Acute stroke care systems in Southeast Asian countries are at various stages of development, with disparate treatment availability and practice in terms of intravenous thrombolysis and endovascular therapy. With the advent of successful endovascular therapy stroke trials over the past decade, the pressure to revise and advance acute stroke management has greatly intensified. Southeast Asian patients exhibit unique stroke features, such as increased susceptibility to intracranial atherosclerosis and higher prevalence of intracranial haemorrhage, likely secondary to modified vascular risk factors from differing dietary and lifestyle habits. Accordingly, the practice of acute endovascular stroke interventions needs to take into account these considerations. Acute stroke care systems in Southeast Asia also face a unique challenge of huge stroke burden against a background of ageing population, differing political landscape and healthcare systems in these countries. Building on existing published data, further complemented by multi-national interaction and collaboration over the past few years, the current state of acute stroke care systems with existing endovascular therapy services in Southeast Asian countries are consolidated and analysed in this review. The challenges facing acute stroke care strategies in this region are discussed.

Abstract 184: Drivers of Costs Associated With Reperfusion Therapy in Acute Stroke: The IMS III Trial

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kit N Simpson ◽  
Annie N Simpson ◽  
Patrick D Mauldin ◽  
Michael D Hill ◽  
Sharon D Yeatts ◽  
...  
Keyword(s):  
Acute Stroke ◽  
General Anesthesia ◽  
Endovascular Therapy ◽  
Stroke Care ◽  
Reperfusion Therapy ◽  
Hospital Charges ◽  
Acute Stroke Care ◽  
Initial Hospital ◽  
Initial Hospitalization ◽  
Mean Cost

Importance: The annual costs of stroke to the nation have been estimated to be over $38 billion, with nearly $22 billion attributed to direct medical costs. Objective: To understand cost drivers during the initial hospitalization for acute ischemic stroke subjects in the IMS III Trial. Design, Setting and Participants: Prospective cost analysis of subjects from U.S. centers treated with IV t-PA alone or IV t-PA followed by endovascular therapy in the IMS III trial. Cost of initial hospital admission was estimated from the actual hospital charges on UB04 billing forms provided by the treating hospitals. Cost profiles of the IMS III treatment groups were compared to profiles of a sample of US patients from the HCUP National Inpatient Sample (NIS) for 2010. Interventions: IV t-PA alone as compared to IV t-PA followed by endovascular therapy. Main Outcome Measure: Costs of hospitalization for acute stroke subjects. Results: The adjusted cost of a stroke admission in the study was $35,130 for subjects treated with endovascular therapy following IV t-PA and $25,630 for subjects treated with IV t-PA alone (p<0.0001). The higher cost in the endovascular therapy following IV t-PA treatment arm was largely explained by the costs of the devices. Significant factors related to costs included treatment group (higher costs with endovascular therapy), baseline NIH Stroke Scale (higher costs with higher severity), time from stroke onset to IV t-PA (lower costs with earlier treatment), age (higher costs with older age), stroke location (higher cost with right hemispheric location) and comorbid diabetes (higher costs with diabetes). The mean cost for subjects who had routine use of general anesthesia as part of endovascular therapy was $46,444 as compared to $30,350 for those who did not have general anesthesia. The costs of embolectomy for IMS III subjects and patients from the NIS cohort exceeded the Medicare DRG payment in more than 75% of hospitalized patients. Conclusions and Relevance: Changing the processes of acute stroke care, such as minimizing the time to start of IV t-PA and decreasing the use of routine general anesthesia, may improve the cost-effectiveness of medical and endovascular therapy for acute stroke.

Abstract WP248: Methods to Achieving a 9-minute Door to TPA Time

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Deepak S Nair ◽  
Arun Talkad ◽  
Clayton McNeil ◽  
Jan Jahnel ◽  
Teresa Swanson-Devlin ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Time Of Day ◽  
National Average ◽  
Acute Stroke Care ◽  
Stroke Treatment ◽  
The Past ◽  
Stroke Center

Introduction Despite guidelines recommending “door to needle times” (DTN) of ≤60 minutes and the Target: Stroke program, the national average for stroke treatment is 79 minutes. We present the factors that have reduced DTN in our Stroke Center. Methods We retrospectively identified all patients who received IV rt-PA using our acute stroke code database, from 2007 to 2012. The patients were organized by their DTN into four groups: <20min, 20-39min, 40-59min, and ≥60min. Median NIHSS scores were calculated, along with median DTN per group and annually. We also specified median lab times, the source of the stroke code (EMS or ED), and time of day for the code. Results There were 180 patients that received IV rt-PA: 7 patients in <20min, 49 in 20-39min, 52 in 40-59min, and 72 in ≥60min. Median DTN was 14min, 30min, 46.5min, and 76min, respectively, with the overall fastest DTN being 9 minutes. Median NIHSS scores were 7, 12, 13, and 8, respectively. EMS initiated the code in 100% of the <20min cases, 45% in 20-39min, 44% in 40-59min, and 40% in ≥60min. Eighty-six percent of the <20min cases arrived during the day, as did 84% of the 20-39min, 65% of the 40-59min, and 42% of the ≥60min cases. When rt-PA was given before labs were resulted, the median DTN was 30min; otherwise, the median DTN was 54min. All cases with <20min DTN presented after May 2011, when the first such case occurred. The median DTN was 65.5min in 2007, 51min in 2008, 61min in 2009, 59.5min in 2010, 47min in 2011, and 35min in 2012. Conclusions Our experience suggests that the “Target: Stroke” strategies (EMS initiation of stroke codes, rapid triage, rt-PA before labs) can significantly reduce the time to thrombolysis. However, our significant improvement over the past two years followed a singular 13-minute DTN, which demonstrated that teamwork and passion for acute stroke care can catalyze the consistent delivery of efficient stroke treatment.

Abstract 2317: A Multidisciplinary Team Approach to Improving Laboratory Results and Thrombolytic Treatment in Acute Code Stroke Patients.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Debbie Tay ◽  
Connie Boyd ◽  
Andrew Imbus ◽  
Arbi Ohanian ◽  
Jessica Graves ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Median Time ◽  
Stroke Care ◽  
Lean Six Sigma ◽  
Phase Iii ◽  
Team Approach ◽  
Medical Systems ◽  
Acute Stroke Care ◽  
The Past

Despite improvement in acute stroke care, stroke remains the third major cause of death and leading cause of disability nationwide. An increase in the number of certified Primary Stroke Centers (PSC) over the past years has been credited for the improvement. Los Angeles County proactively implemented the Approved Stroke Center Network in which Emergency Medical Systems may passes non-certified PCS for acute stroke treatments. Our hospital’s journey towards building a stroke program began in early 2008, and in 2009 a CODE STROKE algorithm was implemented. Over the past two years, the team has strived to continuously improve ‘door to needle’ times. Opportunity to improve door-to-lab results was recognized so we sought to investigate and identify barrier(s)/reason(s) for delays. Methods The LEAN Six Sigma team guided our multidisciplinary committee for identifying contributing delays. A review of the clinical pathway from the patient’s arrival time (door) and activation of Code Stroke are time-stamped at every step. Phase I identified delays with phlebotomist transit times. The laboratory management addressed this issue by reinforcing the need to expedite the specimen collection, transit time and processing. Some improvement was noted in the door-to-lab results time but significant delays remained a problem. Phase II incorporated lab draws being performed prior to the patient going for their CT scan. Phase III involves utilization of an iStat unit within the emergency department for analysis of a CHEM 8 panel. Results Analysis of data initially showed door-to-lab results had a median time of 52 minutes, with 38% having results within 45 minutes. Ten patients received tPA within median times of 66 minutes, with 53% receiving tPA within 60 minutes. In 2010 action plans initiated yielded significant improvements with door-to-lab results median times of 44 minutes, 64% having lab results within 45 minutes. Twenty one patients received tPA within a median time of 55 minutes, and 70% having received tPA within 60 minutes. Conclusion The multidisciplinary stroke team identified barriers and implemented process changes yielding improvements in door-to-lab results that in turn resulted in overall improvements in tPA treatment times. Data collection and process evaluation continue.

Suicide Attempt and Associated Factors Among Adolescents in Five Southeast Asian Countries in 2015

Crisis ◽  
2020 ◽  
Vol 41 (4) ◽  
pp. 296-303 ◽  
Author(s):  
Supa Pengpid ◽  
Karl Peltzer
Keyword(s):  
Suicide Attempt ◽  
Parental Support ◽  
Soft Drink ◽  
The Philippines ◽  
Southeast Asian ◽  
Asian Countries ◽  
Soft Drink Consumption ◽  
The Past ◽  
Timor Leste ◽  
Southeast Asian Countries

Abstract. Background: Suicide is a major cause of death among adolescents. Aims: The study aimed to report on the prevalence and correlates of suicide attempt among in-school adolescents in five Southeast Asian countries. Method: Cross-sectional data from the 2015 Global School-Based Student Health Survey (GSHS) included 33,004 middle-school children (mean age = 14.3 years, SD = 1.6) that were representative of all students in secondary school in Indonesia, Laos, Philippines, Thailand, and Timor-Leste. Results: The overall prevalence of past 12-month suicide attempt was 9.0%, ranging from 3.9% in Indonesia to 16.2% in the Philippines. Among those with a suicide attempt in the past 12 months, almost half (49.0%) had suicidal ideation and 47.7% had a suicide plan in the past 12 months. In adjusted Poisson regression analysis, female gender, residing in Laos, Philippines, Thailand, and Timor-Leste, no close friends, loneliness, anxiety, bullying victimization, physical attack, lack of parental support, lack of peer support, current alcohol use, lifetime cannabis use, lifetime amphetamine use, soft drink consumption, truancy, and injury were associated with suicide attempt. Limitations: The correlational nature of the study limits the implications of the findings. Conclusion: Almost one in 10 students had attempted suicide in the past 12 months and several factors associated with suicide attempt were identified among adolescents in five Southeast Asian countries.

scholarly journals Between Fear and Hope: Belt and Road Initiative in Southeast Asia

2020 ◽  
Vol 02 (01) ◽  
pp. 2050003
Author(s):  
Cahyo Pamungkas ◽  
Saiful Hakam ◽  
Devi Tri Indriasari
Keyword(s):  
Southeast Asia ◽  
Southeast Asian ◽  
Unintended Consequences ◽  
Belt And Road Initiative ◽  
Asian Countries ◽  
Poor Countries ◽  
Chinese Investment ◽  
The Past ◽  
Belt And Road ◽  
Southeast Asian Countries

This paper aims to describe the reason of China to change its governance of investment mainly the Belt and Road Initiative (BRI) in Southeast Asia. Although many countries in this region need huge investment to improve and build their infrastructure as well as infrastructure’s connectivity between countries, there is some fear involving China’s investment in the past. These are unintended consequences of China’s investment on environmental, social, and debt-trap in certain poor countries. Nevertheless, there is still hope for better Chinese investment such as consideration of local people’s aspirations and more transparency. At the regional level, the BRI can synergize with local connectivity initiatives, such as the Master Plan on ASEAN Connectivity (MPAC) and Indonesia’s Global Maritime Fulcrum, and encourage the integration of the ASEAN Economic Community. Different from the previous studies, this paper also uses the historical approach by learning the relation between China and Southeast Asian countries in the past. Our argument is Southeast Asian countries do not need to fear Chinese economic expansions based on history that China is not a political threat in the region. However, China should change the governance of BRI to accommodate the interest of people in Southeast Asian countries.

scholarly journals Experiences of Religious Pluralism in Thailand: Lessons for Southeast Asian Countries

2019 ◽  
Vol 2 (1) ◽  
pp. 68-77
Author(s):  
Montri Kunphoommarl
Keyword(s):  
Cultural Capital ◽  
Religious Pluralism ◽  
Research Work ◽  
Past Research ◽  
Southeast Asian ◽  
Asian Countries ◽  
Social And Cultural Capital ◽  
The Past ◽  
Thai People ◽  
Southeast Asian Countries

This paper used the historical approach to overview the patterns and practices of religious pluralism in Thai context. The past research work on religious pluralism will be examined in order to find out what concepts and approaches have been used and how they could implement in reality. Most Thai people practice in Buddhism, and they do not have any conflicts with other Thai Muslims or Christian. They live peacefully and harmoniously in co-existence among different religious adherents. The case of Thai Buddhist and Thai Muslim live together happily in the Southern communities will be employed and discussed using social and cultural capital analytical approach. The factors and conditions concerning with religious pluralism are analyzed more in details. The applications of religious pluralism in the study to other Southeast Asian countries will also recommend.

scholarly journals Long-run Determinants of Private Saving Behaviour in Pakistan

1995 ◽  
Vol 34 (4III) ◽  
pp. 1057-1066 ◽  
Author(s):  
Aasim M. Husain
Keyword(s):  
Growth Performance ◽  
Southeast Asian ◽  
Domestic Saving ◽  
Domestic Investment ◽  
Asian Countries ◽  
Private Saving ◽  
The Past ◽  
Long Run ◽  
The Difference ◽  
Southeast Asian Countries

Compared to the rapidly-growing economies of Southeast Asia, the growth performance of the Pakistan economy was significantly weaker during the 1970s and 1980s. While the Southeast Asian countries made substantial progress in improving living standards, the average standard of living, as measured by the GNP per capita, was virtually stagnant in Pakistan over this period. Much of the difference in economic performance between Pakistan and the Southeast Asian countries is often attributed to the low rates of saving and investment in Pakistan.1 Indeed, the differences in rates of domestic investment are often attributed to the differences in rates of domestic saving. Hence, the disparity in the growth performance between Pakistan and the Southeast Asian countries over the past two decades relates to the differences in saving rates, and an understanding of the fundamental determinants of saving in Pakistan assumes critical importance. This paper reviews trend developments in the private saving behaviour in Pakistan, and compares these trends with those seen in the Southeast Asian economies during the period since 1970. Using co-integration analysis, the long-run properties of Pakistan’s saving rate are examined, with a view to identifying the main determinants of saving. The principal finding is that about one-half of the trend increase in saving appears to be related to financial development and deepening. In contrast to the results obtained by Faruqee and Husain (1994) and Husain (1995) for the Southeast Asian countries, demographics appear not to have played an important role in determining saving behaviour in Pakistan, possibly because high rates of population growth during the past three decades resulted in a virtually unchanged demographic structure of the population.

China’s Development Assistance in Southeast Asia

Asian Survey ◽  
2020 ◽  
Vol 60 (2) ◽  
pp. 323-346 ◽  
Author(s):  
Raymond Yamamoto
Keyword(s):  
Southeast Asia ◽  
Development Assistance ◽  
Southeast Asian ◽  
Asian Countries ◽  
The Past ◽  
Alternative Perspective ◽  
Southeast Asian Countries

China’s growing development assistance has become commonly perceived as a threat to the autonomy and development of Southeast Asian countries that had promoted by Japan in the past. This paper challenges that understanding by comparing China’s development assistance with Japan’s engagement in the region. The comparison supports an alternative perspective, which sees Chinese development assistance as favorable for Japan’s interests.

scholarly journals Issues in Acute Stroke Care Systems in Japan with a Special Emphasis on Implementation of Comprehensive Stroke Centers

2013 ◽  
Vol 22 (9) ◽  
pp. 678-687
Author(s):  
Koji Iihara ◽  
Kunihiro Nishimura ◽  
Akiko Kada ◽  
Jyoji Nakagawara ◽  
Kuniaki Ogasawara ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Care Systems

PATTERNS AND DETERMINANTS OF INTRA-INDUSTRY TRADE IN SOUTHEAST ASIA: EVIDENCE FROM THE AUTOMOTIVE AND ELECTRICAL APPLIANCES SECTORS

2018 ◽  
Vol 63 (03) ◽  
pp. 647-665
Author(s):  
RUHUL SALIM ◽  
AMIRUL ISLAM ◽  
HARRY BLOCH
Keyword(s):  
Southeast Asia ◽  
Southeast Asian ◽  
Asian Countries ◽  
Industry Trade ◽  
The Past ◽  
Specific Factors ◽  
Disaggregated Data ◽  
Two Sectors ◽  
Southeast Asian Countries

Using finely disaggregated data at six-digit harmonized code classification level, this paper examines the patterns and determinants of horizontal and vertical intra-industry trade in the automobile and electrical appliances sectors during the past few decades among the six major Southeast Asian countries. It is found from the analysis of the data that intra-industry trade is much higher than the inter-industry trade in each of these two sectors. Further, the determinants of these two types of trade are found to differ somewhat in terms of sign and magnitude across the sectors, implying the importance of sector-specific factors as influences on the pattern of trade.

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