Risultati per: Follow-up ottimale dopo embolia polmonare acuta

Ritirato l’emendamento che estendeva l’incompatibilità al 2026

Purpose
The Kharameh cohort study (KHCS) is one branch of the ‘Prospective Epidemiological Research Studies in Iran’, located in the south of Iran. The enrolment phase of KHCS spanned from April 2015 to March 2017, during which urban and rural residents of Kharameh were enrolled in the study. KHCS aims to investigate the incidence of non-communicable diseases (NCDs) such as hypertension, diabetes mellitus, cardiovascular diseases and cancer, and its related risk factors in a 15-year follow-up.

Participants
KHCS was designed to recruit 10 000 individuals aged 40–70 years old from both urban and rural areas of Kharameh. Thus, a total of 10 800 individuals aged 40–70 years of age were invited and, finally, 10 663 subjects were accepted to participate, with a participation rate of 98.7%.

Findings to date
Of the 10 663 participants, 5944 (55.7%) were women, and 6801 (63.7%) were rural residents. The mean age of the participants was 51.9±8.2 years. 41.8% of the participants were aged 40–49, 35.2% were aged 50–59 and the remaining 23% were 60–70 years old. Until March 2020 (first 3 years of follow-up), the total number of patients diagnosed with NCDs was 1565. Hypertension, type 2 diabetes and acute ischaemic heart disease were the most common NCDs. Furthermore, the total number of deaths during the first 3 years of follow-up was 312, with cardiovascular diseases (38.7%) as the most common cause of death, followed by cerebrovascular diseases (11.8%) and cancer (16.2%).

Future plans
The remaining 12 years of follow-up will inevitably shed light on the genetic, lifestyle/socioeconomic status, and environmental risk and protective factors of NCDs.

Objectives
The study aimed to conduct a follow-up of all broad-based training (BBT) trainees who participated in the original evaluation completed in 2017. The follow-up study explored the impact of BBT on career decisions, sustained benefits and unintended disadvantages of the programme, and views on the future of training.

Design
Scoping interviews informed the design of an online survey. The interview transcripts were analysed thematically. The survey was piloted with six volunteers and sent out to all former BBT trainees. Data from the survey were transferred to Excel and SPSS for analysis. The open-text comments on the survey were subject to a thematic content analysis.

Setting
Participants were working in general practice, paediatrics, psychiatry or medicine.

Participants
Eight former BBT trainees participated in the scoping interviews. Interview participants were selected to ensure a diversity of current specialties and to represent all three BBT cohorts. All former BBT trainees were invited to complete the survey (n=118) and 70 replied.

Results
The benefits of BBT were sustained over time: participants were confident in their career decisions, took a holistic approach to care and capitalised on their experiences in other specialties in their current roles. A minority of trainees also experienced temporary challenges when they joined a specialty training programme after completing the BBT. Whatever their specialty, experience in core medicine, paediatrics, psychiatry and general practice was valued. Disadvantages were short-lived (catching up on transition specialty training) or affected a minority (impact on sense of belonging).

Conclusions
The BBT programme supported the development of generalist doctors. Greater attention needs to be given to training secondary care doctors who take a holistic view of the patient and navigate their specialist care.

Introduction
This article presents the study design of the qualitative part of the VersKiK study (Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence: study protocol of a large scale multi-methods non-interventional study) aiming to explore actual follow-up needs of childhood and adolescence cancer survivors and their informal caregivers, gaps in current follow-up care provision and trajectories of cancer survivors’ transition from paediatric to adult healthcare.

Methods and analysis
We will conduct up to 30 interviews with survivors of childhood and adolescence cancer and their informal caregivers with up to 20 participant observations of follow-up appointments. The results of these will be discussed in up to four focus groups with healthcare professionals and representatives of self-help groups. The study design aims to evaluate follow-up care after childhood cancer considering perspectives from survivors, their informal caregivers as well as healthcare providers. The combination of different data sources will allow us to get an in-depth understanding of the current state of follow-up care after paediatric cancer in Germany and to suggest recommendations for care improvement.

Ethics and dissemination
The VersKiK study was approved by the Ethics Committee Otto von Guericke University on 2 July 2021 (103/21), by the Ethics Committee of Johannes Gutenberg University Mainz on 16 June 2021 (2021-16035), by the Ethics Committee University of Lübeck on 10 November 2021 (21-451), by the Ethics Committee University of Hospital Bonn on 28 February 2022 (05/22). For each part of the qualitative study, a separate written informed consent is prepared and approved accordingly by the ethics committees named above.

Trial registration number
Registered at German Clinical Trial Register, ID: DRKS00026092.

Screening women for human papillomavirus (HPV) every 5 years might reduce more cervical cancer deaths in a more cost-effective way than other screening methods like colposcopies, according to 2 studies involving women from 78 low- and lower-middle–income countries.

Objective
To assess the Clinical Characteristics and Outcomes of Traumatic Brain Injury in Patients Admitted to the Surgical Ward of Jimma Medical Center, Southwest Ethiopia from January to July 2022.

Design and setting
A hospital-based prospective observational study was conducted among 175 patients admitted with Traumatic Brain Injury at Jimma Medical Center from January to July 2022. Data were collected by structured questionnaires and a convenient sampling technique was used. For data entry, Epidata V.4.6.0.5 software was used and exported to Stata V.14.0.2 for analysis. The Cox regression model was fitted to evaluate the predictors of mortality and variables with a p value

Stroke, Volume 55, Issue Suppl_1, Page A118-A118, February 1, 2024. Background:Persistent post-stroke impairment of the arm and hand is debilitating after stroke. Pairing vagus nerve stimulation (VNS) with upper extremity (UE) rehabilitation improves such deficits after 5 months and was approved by the FDA in 2021. Here, we present 1-year outcomes from the VNS-REHAB pivotal trial.Methods:Stroke participants with moderate-to-severe UE impairment were randomized to task-specific rehabilitation plus either active VNS (n=53, VNS) or sham VNS (n=55, Control). After baseline assessment (Pre-therapy), both groups did 6 wk. of in-clinic therapy followed by a 3-mo. home exercise program combined with active or sham VNS (post90). Controls then crossed over to receive 6 wk. of active VNS followed by a 3-mo. home exercise program (Cross-over post90). Both groups continued active VNS with a home exercise program through 1 year, after which change from Pre-therapy baseline in Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT) scores were obtained. To determine whether participants made additional gains, 1 year outcome scores (n=70) were also compared to post90 (n=38, VNS) and Cross-over post90 (n=32, Control) scores. Data was available from 74 participants at one year, with others not available mainly due to COVID-19.Results:At 1-year, both FMA-UE and WMFT scores improved from Pre-therapy baseline by 5.3±6.9 (CI=3.7-6.9, p

Stroke, Volume 55, Issue Suppl_1, Page A137-A137, February 1, 2024. Introduction:Within 5 years of a stroke, approximately 25% of patients will have a recurrent event. Blood pressure (BP) reduction can reduce this risk; every 10 mmHg decrease in systolic BP is associated with a 20% risk reduction. Despite this benefit, 50% of patients with hypertension remain uncontrolled after a stroke. Reasons for poor control may be related to poor post-stroke follow up care. We aim to quantify post-stroke BP control and follow up in a large health system.Methods:We performed a retrospective analysis of patients with stroke admitted to Yale New Haven Health System (YNHHS) between 2013-2021. YNHHS has 5 hospitals and a large outpatient network. Eligible patients included those who received primary care within YNHHS, were discharged alive, and not on dialysis. We analyzed patient features, time to outpatient encounter, and vital signs. The primary outcome was uncontrolled BP ( >140/90) obtained during the office visit closest to and before 6 months from the date of discharge.Results:During the study period 12,561 patients were admitted with stroke to YNHHS. After exclusions, the final cohort was 2,867 patients. Among these patients, 48 % were male, 65% non-Hispanic White, 22% non-Hispanic Black, 9% Hispanic, and 4% other. Mean (standard deviation) age was 68 (12) years. Approximately 25% of patients had uncontrolled BP. When the updated ACC/AHA (2017) BP goal (2 follow up visits. The median (interquartile range [IQR]) number of days to first visit with a PCP or neurologist was 30 (10-97) days and 45 (27-99) days, respectively. The median (IQR) number of visits with either a PCP or neurologist was 0 (0-2).Conclusion:Among patients with recent stroke, more than half do not achieve BP control per current guidelines. The majority of patients do not engage with a PCP or neurologist within 6 months following a stroke, even though they have an established provider within the system. Gaps in follow up represents a notable opportunity for improving post-stroke care.

Stroke, Volume 55, Issue Suppl_1, Page AWP16-AWP16, February 1, 2024. Introduction:Trials using advanced imaging have shown a benefit from intravenous thrombolysis in patients with wake-up stroke, but real-world data is limited. This study presents data on outcomes in patients presenting with wake-up stroke at a comprehensive stroke center comparing those who received thrombolysis to those who did not.Methods:In February 2022, our institution implemented a wake-up stroke protocol utilizing emergent MRI-based evaluation for possible thrombolysis. The protocol combines clinical criteria (suspected ischemic stroke with disabling neurologic deficits; last known normal within 12 hours; time from symptom discovery to arrival within 4.5 hours) and imaging criteria (absence of proximal large vessel occlusion; FLAIR-DWI mismatch; signal intensity ratio < 1.15 in those able to receive perfusion imaging). In this study, we compared discharge outcomes and hospital length of stay for patients with ischemic stroke selected for wake-up protocol with vs. without thrombolytic therapy. In addition, we assessed the proportion of patients with reversibility of diffusion restriction, defined as a decrease in infarct volume on ADC sequence between the pre-treatment to 24-hour post-treatment MRI.Results:Between February 2022 & June 2023, there were 31 wake-up stroke activations (~2 per month). Median admission NIHSS was 6. 30% had medium or distal vessel occlusions. 71% of stroke activations had a final diagnosis of ischemic stroke; 32% of cases were eligible per protocol and treated with thrombolysis. Compared to patients diagnosed with ischemic stroke but not eligible for treatment, those treated with thrombolysis were more likely to be discharged home (70% vs. 17%, p = 0.02) and had a shorter hospital stay by ~1.5 days (mean LOS 3.6 days vs. 4.8 days; median LOS 3 days vs. 4.5 days; p

Stroke, Volume 55, Issue Suppl_1, Page A12-A12, February 1, 2024. Background:Socioeconomic deprivation is associated with an increased risk of stroke. However, there is scant evidence on its impact on long-term stroke outcomes. We investigate its long-term impact on stroke incidence, mortality, functional outcome, quality-of-life and life-expectancy.Methods:In a prospective population-based cohort, deprivation (based on residential postcode and stratified into quartiles using the national cut-points for England) was related to incident stroke, 10-year mortality, disability (modified Rankin Scale >2), institutionalisation in long-term care facilities, quality of life (Euroqol-5Dimensions), and life expectancy (including disability-free and quality-adjusted) after first-ever stroke. Cox, logistic and ordinary least squares regression were used to adjust for age, sex, urban-rural mix, previous comorbidity/disability, risk factors, stroke severity and type.Findings:Out of a population of 94,567 people (~1.5 million people years), 2,429 had a first-ever stroke. Higher deprivation was associated with stroke risk in those aged 55 to 74. Compared to the most affluent (quartile 1), stroke risk was higher in those living in quartile 2 (incidence rate ratio: 1.28, p=0.0019), quartile 3 (1.37, p=0.005) and quartile 4 (1.81, p=0.001). Mean follow-up after stroke was 5.2 (S.D. 4.0) years. After multivariable adjustment, increasing deprivation was associated with mortality (p=0.046), disability (p=0.013) and reduced quality of life (p=0.028), but not with institutionalisation (p=0.23). 10-year quality-adjusted life-expectancy was 4.85 (95%CI: 4.67 to 4.04 years) in stroke patients in quartile 1, with life expectancy reducing by 0.46 (-0.75 to -0.16) in quartile 2, 1.10 (-1.58 to -0.67) in quartile 3 and 1.25 (-2.06 to -0.48) years in quartile 4.Interpretation:We show that incidence of stroke, as well as 10-year health outcomes, are worsened with increasing deprivation. Consequently there remains considerable scope for improvements in at risk deprived communities.

Stroke, Volume 55, Issue Suppl_1, Page ATP185-ATP185, February 1, 2024. Introduction:The Resolute Onyx stent has shown promise as an effective treatment for symptomatic intracranial atherosclerotic disease (sICAD), with positive clinical outcomes and low procedural complication rates. However, previous studies were limited by small sample sizes and lacked long-term follow-up.Methods:In this retrospective analysis, we examined patients who underwent Resolute Onyx stent placement for sICAD. Primary outcomes included stroke, intracerebral hemorrhage (ICH), and mortality rates at 1-, 6-, 12-, and 18-month follow-ups, and in-stent restenosis. Multivariable logistic regression identified predictors of stroke and mortality. Subgroup analyses assessed patients who underwent stenting at least 8 days after the qualifying event to ensure comparability with WEAVE registry data.Results:Our study included 77 patients with 84 procedures. The mean age was 61.9±13.0, with 35% being female. The median time from qualifying event to procedure was 5 days (IQR: 2-11). Among adherent patients, no disease-related deaths occurred after the first month. However, one ICH and two strokes occurred within 6 and 12 months, respectively. Comparison of WEAVE-matched and non-matched patients revealed no significant difference in complications during short- and long-term follow-up. Postprocedural complications within 72 hours were

Stroke, Volume 55, Issue Suppl_1, Page AWP130-AWP130, February 1, 2024. Background:Hemorrhagic foci surrounding the lacune in the long-term evolution of recent single subcortical infarcts (RSSIs) remains largely unexplored. We aimed to determine the prevalence, characteristics, and predictors of hemorrhagic foci in patients with RSSI.Methods:From a prospective, longitudinal study of RSSIs, we recruited patients who underwent multimodal MRI assessments at baseline and approximately one year after stroke onset. Hemorrhagic foci were identified using susceptibility-weighted imaging (SWI).Results:Among 72 patients with RSSI, nearly half (n = 35, 48.6%) had hemorrhagic foci within the index RSSI lesions on follow-up SWI. RSSIs with hemorrhagic foci formation were associated with a longer time to follow-up imaging (median 484 versus 425 days, P = 0.008) and higher likelihood of being located in the anterior circulation compared to those without hemorrhagic foci (100.0% versus 75.7%, P = 0.001). Hemorrhagic foci were also associated with larger lesion size (P < 0.001), higher proportion of cavitation formation (P = 0.042), and poorer functional outcome (P = 0.036). In the subset of RSSIs in the LSA territory, after adjustment for covariates, larger initial lesion volume (OR 1.63, 95% CI 1.06-2.53; P = 0.027) and greater reduction in LSA total length (OR 0.60, 95% CI 0.37-0.97; P = 0.035) were independently associated with hemorrhagic foci formation.Conclusion:Half of RSSI patients developed hemorrhagic foci within the lacunes during follow-up SWI. This hemorrhagic feature might represent hemosiderin deposits from a previously thrombosed perforating artery. The pathophysiologic mechanism and clinical implications remain to be determined.

Stroke, Volume 55, Issue Suppl_1, Page ATP176-ATP176, February 1, 2024. Background:High-risk non-stenosing carotid plaque features are emerging as a possible source of embolism in the setting of ESUS. Unless there is a hemodynamically significant stenosis, neuroradiology reports tend to be rarely descriptive of these features.Methods:In our previous study published in September 2022, we analyzed a patient sample drawn from the stroke registry of the HFHS between June 2016 and June 2021. Our results showed a higher incidence of high-risk plaque features including plaque ulceration (19.08% vs 5.26%, p3mm: (19.08% vs 7.24%, p=0.001), and length >1cm (13.16% vs 5.92%, p=0.0218) ipsilateral to ESUS. In this subsequent study, we utilized the same patient dataset and used CTA reports on EPIC to explore how frequently neuroradiologists had mentioned those features. We utilized Fisher’s exact test to compare the frequencies of reporting each plaque characteristic.Results:We analyzed 152 CTA reports in depth. Our findings indicate that the frequency of reporting plaque ulceration compared to the frequency of reporting plaque calcification was significantly different (8.1% vs 100%, p< 0.00001), this is also noticed with plaque length (4.6%, p< 0.00001) and soft plaques (72.1%, p< 0.00001). Notably, none of the CTA reports had commented on any plaque thickness or the presence of any “high-risk” features when encountering stroke ipsilaterally.Conclusion:When carotid plaques are not causing hemodynamically significant stenosis, neuroradiology reports frequently mention the density of plaques, but unfortunately overlook other characteristics. It is essential to conduct algorithms, scoring systems and prediction models to determine which plaque features are highly associated with embolism. These models should help prioritize the description of these features, alongside commonly reported metrics such as plaque density and the degree of stenosis.

Stroke, Volume 55, Issue Suppl_1, Page AWP50-AWP50, February 1, 2024. Introduction:Transition of care (TOC) to home for many stroke patients is suboptimal. Recent studies estimate 30-day all-cause readmission of stroke patients at 17.4%. The Wisconsin (WI) Coverdell Stroke Program partnered with the Milwaukee Fire Department- Mobile Integrated Health Program (MFD-MIH) and Milwaukee County hospitals three times since January 2019. The aim of our MIH focused partnership was to improve follow up care and care coordination after an acute stroke hospitalization to a vulnerable urban population.Methods:A charter, project algorithm, and referral forms were created to guide our work. Patient referral forms and MFD-MIH home visit summaries were sent via secure email. Upon receiving a home visit referral from the hospital MFD-MIH attempted to engage the patient within two business days. After a completed visit, MFD-MIH sent a summary form to the referring hospital mimicking post-discharge data metrics in Get With The Guidelines® (GWTG). Upon receiving the summary form, hospital abstractors entered the data into GWTG. The data was then analyzed by the Coverdell team.Results:As of May 2023, 73 stroke patients have received a home visit from MIH-MFD with data entry in GWTG. Analysis of the third iteration of the program will occur after it ends in April 2024. We compared our first two MIH projects to all Wisconsin hospitals entering into the GWTG Post-Discharge tab. Our results showed:• Coverdell MIH hospitals outperform WI hospitals inBlood Pressure Monitoring by PatientandAppointment Scheduled Prior to Discharge• Coverdell MIH hospitals underperform WI hospitals inED Visits,Falls Reported by Patient,Medication StoppageandTobacco UseConclusions:Many factors influenced our data. First, the population in the Coverdell MIH program was from an urban environment with more proximate post-discharge resources. All WI hospitals do not share this setting. Secondly, MIH data collection involves an in-person home visit. Conversely, WI hospitals data collection occurred via a phone call or chart review. The Coverdell MIH method facilitates a collegial environment where more truthful disclosures may result.

Stroke, Volume 55, Issue Suppl_1, Page ATP92-ATP92, February 1, 2024. Introduction:Large cohort studies show substantial variability in poststroke care. We developed a guideline-based poststroke without-fail care rate (PWR) to measure rehabilitation and follow-up care quality (Table 1). Our primary aim was to test PWR feasibility to measure guideline-concordant poststroke care among individuals discharged from an urban safety net hospital. Secondarily, we evaluated socioeconomic strain’s (SES) relationship with PWR.Methods:We reviewed electronic medical records of individuals with acute ischemic stroke (AIS) admitted to an urban safety net hospital from July 1 – August 31, 2022. Individuals were given a pass/fail or ineligible for each process. The PWR, calculated per individual, was passes/total number of eligible processes (score 0-1.0).Results:Out of 30 persons with AIS, 20 were eligible for PWR assessment (Table 2). Mean PWR was 0.598 (SD .210, range .273-.900). Most processes were readily available, with no observable floor or ceiling effects. Lowest pass rates were seen in therapy continuance, PCP follow-up, blood pressure control, and exercise. The PWR difference between individuals with SES (M = .443, SD =.135) and without SES (M = .634, SD = .246) lacked statistical significance but demonstrated a high effect size; t(10) = 1.66, p = .064, d = .961.Conclusion:The PWR is a feasible tool to assess quality of poststroke care and may be useful to identify and evaluate interventions to improve equity and quality of poststroke care. The high effect size of SES warrants further examination in a larger sample.

Stroke, Volume 55, Issue Suppl_1, Page A31-A31, February 1, 2024. Introduction:Stroke patients often require complex post-discharge management in an outpatient setting. At this Comprehensive Stroke Center, stroke patients are to receive a 30-day, 90 day, and 1 year follow up with the stroke clinic. Post-acute follow up appointments are typically established after discharge, leading to scheduling delays for the 30-day appointment, patients lost to follow up, or no showing to appointments. Stroke Navigators are an emerging role that can bridge the gap between acute and post-acute care settings and integral to ensuring stroke patients receive optimal follow up care.Methods:In 2022, a Stroke Navigator was added to the care team and collaborated with the Stroke Clinic to project volume of clinic slots needed for ischemic and TIA hospital discharges. The Stroke Navigator implemented follow up scheduling with patient/family prior to discharge and emphasized the importance of the 30-day appointment. Pre and postintervention data was then collected and analyzed from Q2 2022 to Q1 2023 regarding timeliness of scheduling, appointment type, and rate of no shows for all ischemic stroke/TIA patients.Results:The pre-intervention scheduling process resulted in an average wait time of 19 days to schedule appointments. Post intervention, no wait time identified as appointments were scheduled prior to discharge. Pre-intervention data on 30-day appointments showed only 23% of patients were scheduled and attended their provider visit, while post-intervention data showed 60% (Table 1). The clinic no show rate went from 19%, down to 10% in the post intervention phase.Conclusion:The Stroke Navigator has made a significant impact on the number of patients with 30-day visits, eliminated the wait time for appointments due to scheduling prior to discharge, and decreased the no show rate for patients at 30 days. Further financial analysis will be critical to validate the impact of a Stroke Navigator, as they are critical to closing the gap in post-acute care.