A national economic and clinical model for ischemic stroke care development in Saudi Arabia: A call for change

Background Stroke is a significant burden in Saudi Arabia and the Saudi Ministry of Health's stroke committee has identified an urgent need to improve care. Aim The purpose of this study was to undertake a health-economic analysis to quantify the impact of developing stroke care in the country. Methods An economic model was developed to assess the costs and clinical outcomes associated with an ischemic stroke care development program compared with current stroke care. Based on Saudi epidemiological data, cohorts of ischemic stroke patients enter the model each year for the first 10 years based on increasing incidence. Four treatment options were modeled including reperfusion and non-reperfusion treatments. The development scenario estimates the impact of gradually increasing uptake of more effective treatments over 10 years. Changes in the stroke care organization are considered along with resources required to increase capacity, allowing more patients to be admitted to stroke hospitals and access effective treatments. Results The stroke care development program is associated with an increase in functionally independent patients and a decrease in disabling strokes compared with current stroke care. Additionally, the development program is associated with estimated cost savings of $602 million over 15 years ($255 million direct costs, $348 million indirect costs). Conclusions The model predicts that the stroke care development program is associated with improved patient outcomes and lower overall costs compared with the current stroke care program.

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The stroke mothership model survived during COVID-19 era: an observational single-center study in Emilia-Romagna, Italy

Neurological Sciences ◽

10.1007/s10072-020-04754-2 ◽

2020 ◽

Vol 41 (12) ◽

pp. 3395-3399

Author(s):

Andrea Zini ◽

Michele Romoli ◽

Mauro Gentile ◽

Ludovica Migliaccio ◽

Cosimo Picoco ◽

...

Keyword(s):

Ischemic Stroke ◽

Treatment Time ◽

Combined Treatment ◽

Temporal Trends ◽

Stroke Care ◽

Minor Stroke ◽

Care Organization ◽

Stroke Patients ◽

Stroke Center ◽

The Impact

Abstract Introduction A reduction of the hospitalization and reperfusion treatments was reported during COVID-19 pandemic. However, high variability in results emerged, potentially due to logistic paradigms adopted. Here, we analyze stroke code admissions, hospitalizations, and stroke belt performance for ischemic stroke patients in the metropolitan Bologna region, comparing temporal trends between 2019 and 2020 to define the impact of COVID-19 on the stroke network. Methods This retrospective observational study included all people admitted at the Bologna Metropolitan Stroke Center in timeframes 1 March 2019–30 April 2019 (cohort-2019) and 1 March 2020–30 April 2020 (cohort-2020). Diagnosis, treatment strategy, and timing were compared between the two cohorts to define temporal trends. Results Overall, 283 patients were admitted to the Stroke Center, with no differences in demographic factors between cohort-2019 and cohort-2020. In cohort-2020, transient ischemic attack (TIA) was significantly less prevalent than 2019 (6.9% vs 14.4%, p = .04). Among 216 ischemic stroke patients, moderate-to-severe stroke was more represented in cohort-2020 (17.8% vs 6.2%, p = .027). Similar proportions of patients underwent reperfusion (45.9% in 2019 vs 53.4% in 2020), although a slight increase in combined treatment was detected (14.4% vs 25.4%, p = .05). Door-to-scan timing was significantly prolonged in 2020 compared with 2019 (28.4 ± 12.6 vs 36.7 ± 14.6, p = .03), although overall timing from stroke to treatment was preserved. Conclusion During COVID-19 pandemic, TIA and minor stroke consistently reduced compared to the same timeframe in 2019. Longer stroke-to-call and door-to-scan times, attributable to change in citizen behavior and screening at hospital arrival, did not impact on stroke-to-treatment time. Mothership model might have minimized the effects of the pandemic on the stroke care organization.

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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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Management of acute ischemic stroke

BMJ ◽

10.1136/bmj.l6983 ◽

2020 ◽

pp. l6983 ◽

Cited By ~ 15

Author(s):

Michael S Phipps ◽

Carolyn A Cronin

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Treatment Time ◽

Recurrent Stroke ◽

Time Windows ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Developed Countries ◽

Future Research ◽

The Impact

ABSTRACT Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset. We also review protocols for management of patient physiologic parameters to minimize infarct volumes and recent updates in secondary prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high risk period immediately after stroke. Finally, we discuss emerging therapies and questions for future research.

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English K-12 Teacher Experiences in Saudi Arabia in the Pandemic Era: A Follow-up Study of One Khbrat University Program

Arab World English Journal ◽

10.24093/awej/covid.1 ◽

2021 ◽

pp. 3-20

Author(s):

Ahlam Daraghmeh ◽

Hilary Mead ◽

Kathleen Copeland

Keyword(s):

Professional Development ◽

Saudi Arabia ◽

English Education ◽

Research Question ◽

Development Program ◽

Integrated Analysis ◽

English Teacher ◽

Teacher Experiences ◽

K 12 ◽

The Impact

A mixed-methods study examines the impact of the pandemic-driven move to virtual learning on K-12 (kindergarten through twelfth grade) English teacher experiences in Saudi Arabia to inform future development of the teaching of English in the country. Research is limited in K-12 English instruction in the country, and it is just emerging on the pandemic’s impact on education in the MENA region. The 35 subjects were English educators who completed the Saudi government-sponsored professional development program, Khbrat, at one U.S. university. Contextualized within the literature on technology in instruction, leadership frameworks, and Vision 2030 education reforms, the study explores the convergence of technological, institutional, and socio-cultural factors affecting innovation in English education to address the research question of how the pandemic has impacted Khbrat graduates as EFL teachers and as change agents in their country. Integrated analysis of survey and interview data reveals patterns of both acceleration and constraint. Findings suggest pathways to leverage virtual technology and acquired knowledge and skills of Khbrat English teacher graduates to deliver EFL professional development with a more pedagogical focus and to build coalitions among EFL educators to sustain the forward movement of innovation in English education in post-pandemic Saudi Arabia. The study concludes with recommendations for future applications.

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Emergency Medicine Pharmacist Impact on Door-to-Needle Time in Patients With Acute Ischemic Stroke

The Neurohospitalist ◽

10.1177/1941874417729982 ◽

2017 ◽

Vol 8 (2) ◽

pp. 60-65 ◽

Cited By ~ 5

Author(s):

Joshua S. Jacoby ◽

Heather M. Draper ◽

Lisa E. Dumkow ◽

Muhammad U. Farooq ◽

G. Robert DeYoung ◽

...

Keyword(s):

Emergency Medicine ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Length Of Hospital Stay ◽

Stroke Care ◽

Neurological Status ◽

National Institutes Of Health ◽

Discharge Disposition ◽

Scale Scores ◽

The Impact

Background and Purpose: Decreased door-to-needle (DTN) time with tissue plasminogen activator (tPA) for acute ischemic stroke is associated with improved patient outcomes. Emergency medicine pharmacists (EMPs) can expedite the administration of tPA by assessing patients for contraindications, preparing, and administering tPA. The purpose of this study was to determine the impact of EMPs on DTN times and clinical outcomes in patients with acute ischemic stroke who receive tPA in the emergency department. Methods: A retrospective, single-center, cohort study of patients who received tPA between August 1, 2012, and August 30, 2014, was conducted to compare DTN times with or without EMP involvement in stroke care. Secondary outcomes included changes in neurological status as measured by the National Institutes of Health Stroke Scale (NIHSS), length of hospital stay, discharge disposition, symptomatic intracranial hemorrhage, and in-hospital all-cause mortality. Results: A total of 100 patients were included. The EMPs were involved in the care of 49 patients. The EMP involvement was associated with a significant improvement in DTN time (median 46 [interquartile range IQR: 34.5-67] vs 58 [IQR: 45-79] minutes; P = .019) and with receiving tPA within 45 minutes of arrival (49% vs 25%, odds ratio [OR]: 2.81 [95% confidence interval [CI]: 1.21-6.52]). National Institutes of Health Stroke Scale scores were significantly improved at 24 hours post-tPA in favor of the EMP group (median NIHSS 1 [IQR: 0-4] vs 2 [IQR: 1-9.25]; P = .047). Conclusions: The EMP involvement in initial stroke care was associated with a significant improvement in DTN time.

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Impact of COVID-19 on ischemic stroke care in Hungary

GeroScience ◽

10.1007/s11357-021-00424-z ◽

2021 ◽

Author(s):

Péter Pál Böjti ◽

Géza Szilágyi ◽

Balázs Dobi ◽

Rita Stang ◽

István Szikora ◽

...

Keyword(s):

Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Significant Decline ◽

Collateral Damage ◽

Linear Relationships ◽

Reimbursement Database ◽

The Mean ◽

The Impact ◽

Operative Measures

AbstractData about the coronavirus disease 2019 (COVID-19) pandemic’s collateral damage on ischemic stroke (IS) care during the second epidemic wave in Central Europe are limited. We sought to evaluate the impact of the COVID-19 outbreak on Hungarian IS care during the two epidemic waves. This retrospective observational study was based on a nationwide reimbursement database that encompasses all IS admissions and all reperfusion interventions, i.e., intravenous thrombolysis (IVT) and endovascular therapy (EVT) from 2 January 2017 to 31 December 2020 in Hungary. COVID-19 pandemic’s effect on the number of IS admissions and reperfusion interventions were analyzed using different statistics: means, medians, trends, relative rates, and linear relationships. The mean and median values of IS admissions and reperfusion interventions decreased only in some measure during the COVID-periods. However, trend analysis demonstrated a significant decline from the trends. The decline’s dynamic and amplitude have differed for each variable. In contrast to IVT, the number of IS admissions and EVTs negatively correlated with the epidemic waves’ amplitude. Besides, the decrease in the number of IS admissions was more pronounced than the decrease in the number of reperfusion interventions. Our study demonstrated a significant disruption in IS care during the COVID-19 epidemic in Hungary, in which multiple different factors might play a role. The disproportionate reduction of IS admission numbers could partially be explained by the effect of health emergency operative measures and changes in patients’ social behavior. Further studies are needed to evaluate the causes of our observations.

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A cross-sectional study of awareness regarding dog bite and its management in rural community of Maharashtra, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20203593 ◽

2020 ◽

Vol 7 (9) ◽

pp. 1307

Author(s):

Mohammed Alqwaifly

Keyword(s):

Saudi Arabia ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Stroke Care ◽

Cross Sectional Study ◽

Sectional Study ◽

Acute Stroke Care ◽

Cross Sectional ◽

Stroke Treatment

Background: Stroke is a major cause of morbidity and disability worldwide. However, its outcomes have improved in the last few years with advancement in acute stroke treatment, including the use of tissue plasminogen activator (t-PA) within 4.5 hours of onset, which led several international guidelines to adopt it as the standard of care. In this study, authors sought to assess the knowledge, practices, and attitudes of emergency and medicine staff in Qassim, Saudi Arabia toward acute ischemic stroke care.Methods: A quantitative observational cross-sectional study involving 148 physicians from emergency and medicine departments (only three neurologists) was conducted in three main hospitals of the Qassim region, Saudi Arabia. Information was obtained from a self-administered questionnaire. A logistic regression model was used to control for potential confounding factors.Results: Ninety-two percent of participants were aware of t-PA. Eighty-seven percent of participants thought that t-PA was an effective treatment for acute ischemic stroke. Only 20% of participants had given t-PA or participated in the use of t-PA in acute ischemic stroke. Moreover, 64% of participants believed that allowing blood pressure to remain high was the most appropriate action in the first 24 hours in acute ischemic stroke patients who presented outside the t-PA window.Conclusion: Most of the emergency and medicine staff are well informed about t-PA, but the majority of these physicians have never given t-PA or participated in the administration of t-PA to a stroke patient. The main finding here is the positive outlook among emergency and medicine physicians in Qassim toward training in acute stroke care and administering t-PA for stroke, which will positively impact patient outcomes.

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English K-12 Teacher Experiences in Saudi Arabia in the Pandemic Era: A Follow-up Study of One Khbrat University Program

10.31235/osf.io/c3qxp ◽

2021 ◽

Author(s):

Ahlam Daraghmeh ◽

Hilary Mead ◽

Kathleen Copeland

Keyword(s):

Professional Development ◽

Saudi Arabia ◽

English Education ◽

Research Question ◽

Development Program ◽

Integrated Analysis ◽

English Teacher ◽

Teacher Experiences ◽

K 12 ◽

The Impact

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Abstract WP383: An Economic Model of Improved Acute Stroke Care in the Management of Acute Ischemic Stroke From A State Medicaid Perspective

Stroke ◽

10.1161/str.44.suppl_1.awp383 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Zheng-Yi Zhou ◽

Liangyi Fan ◽

Er Chen ◽

Jipan Xie ◽

Eric Q Wu

Keyword(s):

Ischemic Stroke ◽

Nursing Home ◽

Nursing Homes ◽

Acute Ischemic Stroke ◽

Economic Model ◽

Stroke Care ◽

The United States ◽

Absolute Increase ◽

Medicaid Spending ◽

The Impact

Background: Stroke is a leading cause of long-term disability in the United States. Approximately one in four stroke survivors is admitted to a nursing home, accounting for a significant portion of Medicaid spending on stroke. Objective: To assess the impact of increasing access to primary stroke centers (PSCs) and implementing an emergency medical services (EMS) system on disability and Medicaid spending on nursing homes for ten geographically representative states. Methods: An economic model was developed to estimate potential reductions in stroke-related disability and corresponding reductions in Medicaid spending on nursing homes among Medicaid enrollees with acute ischemic stroke (AIS), due to improved stroke care infrastructure. The model assessed the increased use of intravenous (IV) thrombolysis as a result of a higher proportion of AIS treated in PSCs, or as a result of integrating an EMS system with PSCs. Based on published literature, more patients received IV thrombolysis in PSCs vs. non-PSCs (6.5 vs. 0.9%) and PSCs with an EMS routing protocol vs local services (10.5 vs. 2.5%). State-specific model inputs included the incidence of first-ever AIS in Medicaid enrollees, nursing home costs, and Medicaid spending on stroke-related care. Results: A 20% absolute increase in the proportion of AIS patients treated at PSCs will lead to 111 to 2004 more patients receiving IV thrombolysis; 9 to 160 fewer patients with disability; and a reduction in Medicaid nursing home spending of $299,442 to $5.6 million per year across the ten states analyzed (Table). The integration of an EMS system with PSCs will lead to 791 to 14,314 more patients receiving IV thrombolysis; 63 to 1145 fewer patients with disability; and a reduction in Medicaid nursing home spending of $2.1 to $40.0 million per year across the ten states (Table). Conclusions: States may achieve substantial savings through legislative policies that improve PSC access and integration of an EMS system with PSCs.

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Abstract P887: Lack of Racial, Ethnic, and Sex Disparities in Ischemic Stroke Care Metrics Within a Telestroke Network

Stroke ◽

10.1161/str.52.suppl_1.p887 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Sujan T Reddy ◽

Tzu-Ching Wu ◽

Jing Zhang ◽

Mohammad H Rahbar ◽

Christy Ankrom ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Missing Values ◽

Stroke Care ◽

Vessel Occlusion ◽

Mt Evaluation ◽

Sex Disparities ◽

Get With The Guidelines ◽

The Impact ◽

Racial Ethnic

Introduction: Little is known on the impact of telestroke in addressing disparities in acute ischemic stroke care. Methods: We conducted a retrospective review of acute ischemic stroke patients evaluated over our 17-hospital telestroke network in Texas from 2015-2018. Patients were described as Non-Hispanic White (NHW) male or female, Non-Hispanic Black (NHB) male or female, or Hispanic (HIS) male or female. Single imputation using fully conditional specification was conducted to impute missing values in NIHSS (N=103). We compared frequency of tPA and mechanical thrombectomy (MT) utilization, door-to-consultation times, door-to-tPA times, and time-to-transfer for patients who went on to MT evaluation at the hub after having been screened for suspected large vessel occlusion at the spoke. Results: Among 3873 patients (including 1146 NHW male (30%) and 1134 NHW female (29%), 405 NHB male (10%) and 491 NHB female (13%), and 358 HIS male (9%) and 339 HIS female (9%) patients) (Table 1), we did not find any differences in door-to consultation time, door-to-tPA time, time-to-transfer, frequency of tPA administration or incidence of MT utilization (Table 1 & 2). Conclusion: There was a lack of racial, ethnic, and sex disparities in ischemic stroke care metrics within our telestroke network. In order to fully understand how telestroke alleviates disparities in stroke care beyond our single-network review, collaboration among networks is needed to formulate a multicenter telestroke database similar to the Get-With-The Guidelines.

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