scholarly journals Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

2021 ◽  
Author(s):  
Neda Ghadimi ◽  
Nasrin Hanifi ◽  
Mohammadreza Dinmohammadi
Keyword(s):  
Medical Service ◽  
Arrival Time ◽  
Treatment Time ◽  
Stroke Care ◽  
Mortality Rates ◽  
National Institutes Of Health ◽  
Critical Factors ◽  
Time To Treatment ◽  
Factors Influencing ◽  
Maximum Delay

Abstract Background: The results of acute ischemic stroke (AIS) are highly affected by time-to-treatment. This study aimed at determining the factors influencing the in-hospital and pre-hospital delays in the complications and time-to-treatment in AIS. Methods: The present prospective study was carried out on 204 AIS patients referring to the stroke care unit in Zanjan, Iran (2019). To collected the required data, the patients and families were interviewed, as well as using the observations and records. The complication and mortality rates were recorded for 30 days after stroke via call follow-ups. Results: Based on the obtained results, the maximum delay was associated with the onset-to-arrival time (288.19 ±339.02 minutes). The logistic regression results indicated a statistically significant decline in the treatment via consultation after initiating the symptoms, transferring the patient to the hospital via emergency medical service, and the patients’ comprehension regarding the AIS symptoms. It was also found that an increase in the onset-to-treatment time (P <.001) and higher National Institutes of Health Stroke Scale (NIHSS) scores (P< .001) are the most critical factors related to the post-stroke complications. The higher age (P <.044) and NIHSS scores (P < .001) were considerably related to the mortality in AIS patients. Conclusion: It is essential to inform people regarding AIS indicators and referring to AIS treatment units to reduce the treatment time.

scholarly journals Factors affecting pre-hospital and in-hospital delays at time-to-treatment and complications in stroke: A prospective cohort study

2020 ◽  
Author(s):  
Nasrin Hanifi ◽  
Mohammadreza Dinmohammadi ◽  
Neda Ghadimi
Keyword(s):  
Medical Service ◽  
Treatment Time ◽  
Stroke Care ◽  
National Institutes Of Health ◽  
Complication Rates ◽  
Time To Treatment ◽  
Factors Affecting ◽  
Post Stroke ◽  
High Age

Abstract Background: Time-to-treatment affects the outcomes of acute ischemic stroke (AIS). The aim of this study was to determine the factors affecting pre-hospital and in-hospital delays in the time-to-treatment and complication in AIS. Methods: This prospective study was performed on 204 AIS patients referred to the stroke care unit in Iran (Zanjan) in 2019. Data were completed by interviewing the patients, their families, records, and observations. The mortality and complication rates were recorded for 30 post-stroke days through call follow-up. Results: The results showed that the highest delay was related to the onset-to-arrival time (288.19 ±339.02 minutes). Results of logistic regression showed that treatment delay declined significantly by consulting followed by symptoms onset, patient transfer through emergency medical service to the hospital, and patients’ understanding of AIS symptoms. The results also showed that increasing the onset-to-treatment time (P< .001) and high National Institutes of Health Stroke Scale (NIHSS) score (P< .000) were the most important factors associated with post-stroke complications. High age (P< .044) and high NIHSS scores (P< .001) were significantly associated with mortality in patients with AIS. Conclusion: Informing people about AIS symptoms and referring to AIS treatment units are essential in reducing the treatment time.

Abstract WP330: Process Measures and Outcomes in Defuse 3 Trial by Day and Week Time Patterns

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michael Mlynash ◽  
Maarten G Lansberg ◽  
Stephanie Kemp ◽  
Soren Christensen ◽  
Michael P Marks ◽  
...  
Keyword(s):  
Arrival Time ◽  
Stroke Care ◽  
Mortality Rates ◽  
Temporal Variations ◽  
Time Of Day ◽  
Process Measures ◽  
Time Period ◽  
Time Patterns ◽  
Time Of Admission

Introduction: Several studies identified temporal variations in stroke care and suggested that quality of care declines during off-hours and on weekends. Methods: We specified 2 time definitions: a) 8-hour blocks: night (midnight – 7:59), day (8:00 – 15:59), evening (16:00-23:59); b) weekday vs. weekend. We compared process measures and outcomes of the EVT-treated DEFUSE 3 patients based on these definitions. To assign patients to time-blocks, we used date and time of admission to hospital that performed EVT. Results: 92 patients were randomized to EVT treatment: 30% arrived to the treating hospital at night, 49% at day, 21% at evening. Mean age by arrival time 71±14, 70±12, 63±15 (p=0.09); NIHSS 17±5, 15±6, 15±8 (p=0.40); female 39%, 51%, 63% (p=0.27). Weekend admission occurred in 21%. Weekday vs weekend mean age 68±14 vs 72±11 (p=0.19); female 53% vs 37% (p=0.20), higher weekend NIHSS 15±6 vs 18±6 (p=0.04). Onset to arrival at the EVT center varied by time of day: (hrs:mins) 7:04±2:43 night, 8:05±3:01 day, 4:51±2:30 evening, p<0.001. However, day admissions tended to be wake-up/not witnessed strokes more often: 76% vs. 47% evening and 64% night, p=0.09. Transfer times for 57 transfer patients were similar: mean 3:06, 3:09, 3:38. Time from arrival at the treating hospital to groin puncture varied by presenting times: 2:28±1:11 night, 1:45±0:46 day, 2:36±2:32 evening (p=0.02). Time-metrics for weekday vs weekend were similar. Rates of successful reperfusion, 90-day mRS and mRS=0-2 did not differ by time of day or week. There was higher 90-day mortality (32% vs 10%, p=0.02) and in-hospital mortality (21% vs. 4%, p=0.03) on weekend. Symptomatic ICH also occurred more commonly in weekend admits (21% vs 3%, p=0.01). However, after adjustment for age and NIHSS, presenting on weekend was not independently associated with mortality, p=0.13. Conclusions: DEFUSE 3 patients admitted during the day had the longest time from last known well to arrival at the study site due to the high percentage of wake-up strokes admitted during this time period, however, these patients had the shortest arrival to groin puncture times. Although mortality rates were higher for patients who presented on weekends, this may be explained by the fact that these patients were older and had higher NIHSS.

Prognostic value of absolute monocyte count in chronic lymphocytic leukaemia

2015 ◽  
Vol 156 (15) ◽  
pp. 592-597
Author(s):  
László Szerafin ◽  
János Jakó ◽  
Ferenc Riskó
Keyword(s):  
Chronic Lymphocytic Leukaemia ◽  
Prognostic Value ◽  
Lymphocytic Leukaemia ◽  
Treatment Time ◽  
Monocyte Count ◽  
Time To Treatment ◽  
Causes Of Mortality ◽  
The Absolute ◽  
The Impact ◽  
Overal Survival

Introduction: The low peripheral absolute lymphocyte and high monocyte count have been reported to correlate with poor clinical outcome in various lymphomas and other cancers. However, a few data known about the prognostic value of absolute monocyte count in chronic lymphocytic leukaemia. Aim: The aim of the authors was to investigate the impact of absolute monocyte count measured at the time of diagnosis in patients with chronic lymphocytic leukaemia on the time to treatment and overal survival. Method: Between January 1, 2005 and December 31, 2012, 223 patients with newly-diagnosed chronic lymphocytic leukaemia were included. The rate of patients needing treatment, time to treatment, overal survival and causes of mortality based on Rai stages, CD38, ZAP-70 positivity and absolute monocyte count were analyzed. Results: Therapy was necessary in 21.1%, 57.4%, 88.9%, 88.9% and 100% of patients in Rai stage 0, I, II, III an IV, respectively; in 61.9% and 60.8% of patients exhibiting CD38 and ZAP-70 positivity, respectively; and in 76.9%, 21.2% and 66.2% of patients if the absolute monocyte count was <0.25 G/l, between 0.25–0.75 G/l and >0.75 G/l, respectively. The median time to treatment and the median overal survival were 19.5, 65, and 35.5 months; and 41.5, 65, and 49.5 months according to the three groups of monocyte counts. The relative risk of beginning the therapy was 1.62 (p<0.01) in patients with absolute monocyte count <0.25 G/l or >0.75 G/l, as compared to those with 0.25–0.75 G/l, and the risk of overal survival was 2.41 (p<0.01) in patients with absolute monocyte count lower than 0.25 G/l as compared to those with higher than 0.25 G/l. The relative risks remained significant in Rai 0 patients, too. The leading causes of mortality were infections (41.7%) and the chronic lymphocytic leukaemia (58.3%) in patients with low monocyte count, while tumours (25.9–35.3%) and other events (48.1 and11.8%) occurred in patients with medium or high monocyte counts. Conclusions: Patients with low and high monocyte counts had a shorter time to treatment compared to patients who belonged to the intermediate monocyte count group. The low absolute monocyte count was associated with increased mortality caused by infectious complications and chronic lymphocytic leukaemia. The absolute monocyte count may give additional prognostic information in Rai stage 0, too. Orv. Hetil., 2015, 156(15), 592–597.

scholarly journals Evaluating Critical Factors Influencing the Reliability of Emergency Logistics Systems Using Multiple-Attribute Decision Making

Symmetry ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1115 ◽  
Author(s):  
Peng Jiang ◽  
Yixin Wang ◽  
Chao Liu ◽  
Yi-Chung Hu ◽  
Jingci Xie
Keyword(s):  
Decision Making ◽  
Distribution System ◽  
Multiple Attribute Decision Making ◽  
Supply System ◽  
Critical Factors ◽  
Logistics System ◽  
Factors Influencing ◽  
Emergency Logistics ◽  
Multiple Attribute ◽  
Coordination System

The infectious disease COVID-19 has swept across the world in 2020, and it continues to cause massive losses of life and severe economic problems in all countries. Providing emergency supplies such as protective medical equipment and materials required to secure people’s livelihood is thus currently prioritized by governments. Establishing a reliable emergency logistics system is critical in this regard. This paper used the Delphi method to design a formal decision structure to assess emergency logistics system reliability (ELSR) by obtaining a consensus from a panel of experts. Assessing ELSR is a typical multiple-attribute decision making (MADM) problem, and the related MADM methods are usually on the basis of symmetry principles. A hybrid MADM model, called the Decision Making Trial and Evaluation Laboratory (DEMATEL)-based Analytical Network Process (D-ANP), was developed to identify the critical factors influencing ELSR. An analysis of empirical evidence showed that the emergency logistics command and coordination system and the emergency material supply system play important roles in ELSR, while the emergency logistics transportation and distribution system and the emergency information system are not so important. This conclusion is different from previous research about traditional disaster emergency logistics. Moreover, the cause–effect relationships among the key factors indicated that the system of command and coordination for emergency logistics and the supply system for emergency materials should be improved. Accordingly, effective suggestions for emergency logistics services for epidemic prevention are provided in this paper. The main contributions of this paper are (1) establishing a comprehensive and systematic evaluating index of ELSR for epidemic prevention; (2) employing a kind of structured, namely D-ANP, to identify the critical factors with non-commensurable and conflicting (competing) characteristics; and (3) comparing the differences of reliable criteria between the emergency logistics of epidemic prevention and the traditional disaster emergency logistics.

scholarly journals Factors Influencing Costs of Inpatient Ischaemic Stroke Care in Singapore

2010 ◽  
Vol 19 (4) ◽  
pp. 283-291 ◽  
Author(s):  
Wai Leng Chow ◽  
Aung Soe Tin ◽  
Amutha Meyyappan
Keyword(s):  
Ischaemic Stroke ◽  
Stroke Care ◽  
Factors Influencing

Abstract TP73: Transition of ECASS III Results to Clinical Practice: 90 Day Outcomes in a US Cohort

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Carolyn A Cronin ◽  
Patricia Langenberg ◽  
Tara M Dutta ◽  
Steven J Kittner
Keyword(s):  
Clinical Practice ◽  
Functional Outcome ◽  
Treatment Time ◽  
Small Community ◽  
Time To Treatment ◽  
Select Group ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Increased Risk ◽  
The Usa ◽  
Iv Tpa

Introduction: ECASS III showed benefit of IV tPA for acute ischemic stroke (AIS) 3-4.5 hr from onset in a select group of patients from Europe, with this extended treatment subsequently recommended by the AHA/ASA. We prospectively enrolled AIS patients treated with IV tPA as this recommendation was being applied in clinical practice, to determine safety and efficacy in a representative cohort from the USA. Methods: Consecutive AIS patients treated with IV tPA at 18 primary stroke centers throughout Maryland were approached and informed consent obtained during hospitalization. Sites ranged from small community hospitals to large academic medical centers. In-hospital and demographic data were obtained from each site’s GWTG database or directly from the medical record. Study personnel blinded to the treatment time window obtained 90 day modified Rankin Scale (mRS) by structured phone interview. Patients were grouped by time to treatment (≤ 3hr vs. 3-4.5hr) and compared for presence of additional exclusion criteria from ECASS III that are not standard practice in the USA for ≤ 3hr (age >80, history of stroke and diabetes, oral anticoagulant treatment, and NIHSS>25). Good functional outcome (mRS 0-1 and 0-2), mortality, and symptomatic intracerebral hemorrhage (sICH) were analyzed. Results: Patients treated 3-4.5hr were somewhat younger (mean age 62.6 vs. 66.6, p=0.06), and had smaller infarcts (median NIHSS 5 vs. 8, p=0.04). There was only partial adherence to the additional ECASS exclusions (Table 1). There were no significant differences by time to treatment in sICH, mortality, or 90 day functional outcome (Table 2). Conclusion: For US patients treated with IV tPA 3-4.5 hr from onset in every day practice, there is no evidence for increased risk or worse outcomes compared to standard treatment up to 3 hr.

CRITICAL FACTORS INFLUENCING IMPLEMENTATION OF ROAD PROJECTS IN KENYA

2019 ◽  
Vol 4 (2) ◽  
pp. 1-22
Author(s):  
Nelly Jebitok ◽  
DR. Joyce Nzulwa
Keyword(s):  
Project Management ◽  
Survey Design ◽  
Target Population ◽  
Coefficient Of Determination ◽  
Critical Factors ◽  
Policy And Practice ◽  
Water Projects ◽  
Factors Influencing ◽  
The Government ◽  
Resource Support

Purpose: The Purpose of the study was to establish Critical factors influencing implementation of road projects.Methodology: The study adopted a descriptive survey design. The target population of the study was all the road engineers, middle managers in department of KRB. The sample size was 188 respondents. Data collected was cleaned, pretested, validated, and coded, summarized and analyzed using statistical package of SPSS V23.  The study findings were presented using graphs, histograms, bar charts and pie charts.  Conclusions were derived based on the P.value and the coefficient of determination.  Results: The study found that the key significant determinants of sustainability of water projects in Machakos County were capacity of the project management, government policies, monitoring and resource support. The study concluded that project management capacity had the greatest determinant ofsustainabilityofwater projects in Machakos County, followed by resource support, then monitoring while government policy had the least determinant of sustainability of water projects in Machakos County.Contribution to policy and practice: The study recommends that the government should advocate for proper planning with involvement of the benefiting community and timely implementation with the required results. This can be done through making of a policy by the ministry demanding for the practice of the same by the involved organizations. The project committee should set up financial structures considering both rising of funds and dissemination of the same in relation to operating and maintaining of the project. This can be done through learning and training on the same. The study also recommended that water beneficiaries and management should be sensitized to improve their knowledge on conservation and protection of water facilities.

Abstract TMP63: Accuracy of Remote Video Cellphone Evaluation of Stroke Deficits Using California Brief Stroke Scale

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Latisha K Ali ◽  
Sidney Starkman ◽  
Gilda Avila ◽  
Neal M Rao ◽  
Rana Fiaz ◽  
...  
Keyword(s):  
Stroke Care ◽  
National Institutes Of Health ◽  
Large Vessel ◽  
Stroke Severity ◽  
Strongly Correlated ◽  
Mobile Video ◽  
Substantial Agreement ◽  
Stroke Patients ◽  
Item Scale ◽  
Score Evaluation

Background: Availability of 4G cellular network and video cellphone handsets may allow mobile videophone assessment to be employed in prehospital stroke care. The California Brief Stroke Scale (CABSS) is a 4 item scale designed as a mobile videophone test to evaluate a prehospital telemedicine instrument to rate stroke severity. Potential uses include identifying patients who are likely harboring persisting large vessel occlusions and to characterize baseline deficits prior to enrollment in prehospital trials. Methods: One bedside and one remote CABSS score were independently obtained on 15 ischemic stroke patients with persistent neurologic deficits. The bedside examination was performed by a stroke neurologist. The remote examination was performed by a second stroke neurologist through mobile video phone. A CABSS score of 1 or higher (scale 0-7) was an index of global stroke deficit severity. Kappa coefficients were calculated for concordance between bedside and remote scores. Results: The median National Institutes of Health Stroke Scale score was 6 (interquartile range IQR 4-10). On average the CABSS score evaluation took 25 seconds to perform. The median video CABSS was 2, (IQR1-3) and median bedside CABSS was 3, (IQR 1-3). Based on weighted K coefficients, cortical findings (aphasia, gaze deviation/hemineglect) displayed excellent agreement κ=1 (95% CI 1.0) and non-cortical findings (facial droop, arm drift) displayed substantial agreement κ =0.7 (95% CI 0.4-1.0). There was substantial agreement between bedside and remote methods for the total CABSS κ 0.68 (95% CI 0.44-0.92). The CABSS scores obtained by bedside and remote methods were strongly correlated (r= 0.85, P<0.0001). Conclusion: Our prospective study found that mobile videocell phone evaluation using CABSS is a feasible and reliable means of examining hyperacute stroke patients in the field. A physician can rapidly perform an audiovideo examination to increase the accuracy of prehospital identification of patients harboring persisting large vessel occlusions and characterize baseline deficits prior to enrollment in prehospital clinical trials to a clinically important degree.

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