Risultati per: Diagnosi, trattamento e follow-up del cancro alla vescica

Per circa il 60% degli studenti delle scuole superiori di Milano che hanno partecipato all’incontro ‘Dal Laboratorio alla vita’

Stroke, Volume 56, Issue Suppl_1, Page ATMP38-ATMP38, February 1, 2025. Background:Randomized clinical trials have demonstrated that IV thrombolysis (IVT) can be administered safely in wake-up stroke (WUS) after MRI- or CT-based imaging selection to improve clinical outcomes. The objective of this study was to evaluate the utilization of IVT to treat WUS using a standardized WUS protocol across a healthcare system.Methods:A WUS protocol using MRI-based imaging selection was implemented across an academic healthcare system with 6 acute care hospitals in the state of Georgia. We prospectively identified all WUS patients who underwent the WUS protocol over a 12 month period through August 15, 2024. Patients were eligible for the WUS protocol if they presented with disabling symptoms identified on awakening, had a CT head without contrast showing no hypodensity to explain clinical symptoms and had CT angiography of the head and neck demonstrating no large vessel occlusion as a cause of symptoms. All patients underwent expedited brain MRI sequences (DWI, T2w FLAIR, GRE) without contrast and IVT was administered at the discretion of the treating neurologist.Results:During the study period, the WUS protocol was activated for 27 patients of which 6 (22%) received IVT (median NIHSS 10, IQR 5-15). Reasons for not receiving IVT included lack of DWI-FLAIR mismatch on MRI (n=11), DWI negative MRI (n=8), IVT declined by patient (n=1) and IVT contraindication (n=1). A modified Rankin scale of 0-1 at 90 days was achieved in 67% of WUS patients treated with IVT and no symptomatic intracerebral hemorrhages. Door-to-needle time within 60 minutes was significantly less likely in WUS compared with non-WUS cases (0% vs 69%, p=0.001). IVT administration in WUS patients made up 2% of all acute ischemic stroke patients receiving IVT.Conclusions:An MRI-based WUS protocol was able to identify a small subset of acute ischemic stroke patients who met eligibility criteria for IVT outside of the 4.5 hour time window. IVT was associated with good clinical outcomes and not associated with any complications.

Stroke, Volume 56, Issue Suppl_1, Page ATP118-ATP118, February 1, 2025. Introduction:Despite advancements in the management of acute ischemic strokes, readmissions continue to impact both healthcare costs and patient outcomes. The objective of our study was to evaluate factors associated with 30- and 90-day readmissions after acute ischemic stroke including the impact of early transitional care outpatient follow-up by a centralized specialty stroke clinic.Methods:We retrospectively identified all acute ischemic stroke patients discharged from the largest healthcare system in the state of Georgia from October 1, 2022 to March 31, 2024; we excluded patients who were discharged to a long-term acute care or hospice facility. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with 30- and 90-day inpatient readmission.Results:Of 2191 acute ischemic stroke patients discharged during the study period, 177 (8.1%) and 304 (13.9%) had 30- and 90-day all cause readmissions to the healthcare system, respectively. Increasing age, Charlson Comorbidity Index score, and history of diabetes were independently associated with 30- and 90-day readmission; history of heart failure, obesity, and discharge to inpatient rehabilitation or skilled nursing facility (versus home) were also independently associated with 90-day readmission. Completion of a subspecialty stroke clinic follow-up within 30 days of discharge was associated with a lower likelihood of 30-day (OR 0.64, 95% CI 0.41-0.96; p=0.04) and 90-day readmission (OR 0.69, 95% CI 0.49-0.94; p=0.02).Conclusion:While acute ischemic stroke patients who are older, have comorbid conditions and disability are at an increased likelihood of 30- and 90-day readmission after acute ischemic stroke, our study found that early (

Stroke, Volume 56, Issue Suppl_1, Page AWP94-AWP94, February 1, 2025. Background:The transition period after hospitalization for stroke is a vulnerable time for patients as all adapt to new physical, cognitive, or emotional changes and destabilized comorbid conditions. Transitional care programs designed for post-stroke care carry the promise of improved outcomes and reduced hospital readmission rates, however attendance rates to these scheduled visits in other stroke early supported discharge programs are reported as low as 35%. In addition to patient specific consequences, missed stroke clinic visits impact system efficiency and workflow which carry broad regional consequences. We sought to understand the impact of our early supported discharge program on hospital length of stay and clinic attendance patterns to prepare for ongoing iteration of this program.Methods:All hospitalized stroke patients who are discharged to home are enrolled in the Joint Stroke Transitional Technology-Enhanced Program (JSTTEP) and seen by a stroke specialist using telemedicine platform within the first 2 weeks of hospital discharge. Following JSTTEP, patients receive usual care which includes a stroke clinic visit 2-3 months after discharge, either by telemedicine or in-person based on patient preference and clinical needs.Results:There has been no change in demographics since the inception of JSTTEP in 2020 with the average age of patients 61 years, 40% female, and nearly 50% black. In calendar year 2023, 309 patients were enrolled in the JSTTEP following hospitalization for acute stroke. Of those, 277 (90%) completed the first JSTTEP telemedicine visit. The mean time from hospital discharge to the first JSTTEP visit was 7.6 days. Hospital length of stay has decreased from 4.5 days prior to JSTTEP to 4.0 days in 2023. Modified Rankin Scale scores at 90 days decreased from 2.2 to 1.1 in a subset of patients with available scores.Conclusion:Since the implementation of JSTTEP, hospital length of stay has decreased for stroke patients who are discharged to home. We note a high show rate to this clinic and suspect that there are a variety of contributors to these successes including close proximity to hospitalization, rapid attention to evolving post-discharge needs, interaction with stroke specialists, and use of telemedicine to facilitate access during a time period where driving is prohibited. The intentional design of the JSTTEP resulting in high level of engagement is likely a strong factor in the early success of the JSTTEP program.

Stroke, Volume 56, Issue Suppl_1, Page ATP154-ATP154, February 1, 2025. Introduction:The initial 1-3 months following a Transient Ischemic Attack (TIA) or acute stroke are critical for patient management and recovery. Timely follow-up care is recommended to reduce the risk of recurrent stroke and address ongoing health issues. Prolonged hospital stays can hinder prompt outpatient follow-up. We present a pilot model of secured slots for urgent stroke referrals and follow-up for TIA and acute stroke patients.Methods:A three-year pilot study was conducted within the Geisinger Medical Center Vascular Neurology and Stroke Clinic from October 2021 to June 2024. Dedicated 3:00 PM time slots were established for urgent referrals and follow-ups of patients with TIA and acute stroke from the Emergency Department(ED). Three neurology physicians shared these slots. The study evaluated slot utilization, including time from discharge to clinic visit, 90-day unplanned stroke readmission rates, and the percentage of inappropriate slot use. An integrated assessment was performed to determine the program’s impact on clinic workflow and patient outcomes.Result:An initial review of the first 200 patients revealed the following utilization of secured slots: 21.5% for urgent referrals, 22% for ED follow-ups, 20.5% at provider discretion, 15% allocated by triage team decision, and 18.5% for routine follow-ups. No-shows and scheduling errors accounted for 2.5% of the slots. For urgent referrals and ED follow-ups, there were no unplanned hospital admissions within 90 days. The time to clinic visits after ED discharge ranged from 1 to 21 days (mean 6.9 days), compared to the national average of 2-8 weeks. Many patients underwent partial stroke workups in the ED or hospital. Outpatient testing such as TTE, and ambulatory rhythm monitoring were coordinated to reduce hospital stays. Limitations included challenges in scheduling appointments within 24-72 hours due to provider availability, weekends, and patient scheduling conflicts.Conclusion:Secured stroke clinic slots provide a timely opportunity for high-risk patients to receive immediate follow-up care after ED visits for stroke or TIA. This model significantly reduces hospital costs and improves patient readmission rates, and burden of prolonged hospital stays, without compromising care. Future studies are encouraged to focus on streamlining referrals, reducing scheduling errors, and integrating this model with other stroke-related services, such as rehabilitation to further enhance overall patient care.

Stroke, Volume 56, Issue Suppl_1, Page A55-A55, February 1, 2025. Introduction:Approved thrombolytic agents are currently only recommended for acute ischemic stroke (AIS) within 4.5 hours from the last known well (LKW). Hence, there remains an unmet need in the treatment of AIS for safer and more effective thrombolytics, which can also be administered to a broader population with an extended treatment window. JX10 is a novel thrombolytic that works by inducing conformational changes in plasminogen to increase downstream fibrin affinity and promote physiological fibrinolysis instead of direct plasminogen activation like that of tissue plasminogen activators (t-PA). JX10 also exerts anti-inflammatory activity through inhibition of soluble epoxide hydrolase, which may suppress hemorrhagic changes associated with cerebral infarction. In a randomized, double-blind, placebo-controlled, dose-escalation phase 2a study conducted in Japan, JX10 increased vessel recanalization and improved neurologic outcomes. This subgroup analysis evaluated the safety and efficacy of JX10 in participants who presented with acute lacunar infarct.Methods:JX10 or placebo was administered as a single intravenous infusion at a dose of 1, 3, or 6 mg/kg to AIS patients who were ineligible for tissue plasminogen activator or thrombectomy within 12 h of LKW. Safety and Efficacy outcomes were assessed at 90 days.Results:Among the 90 patients enrolled in the trial, a total of 25 patients with acute lacunar infarct were dosed (JX10 1 mg/kg group: 1 subject; 3 mg/kg group: 3 subjects; 6 mg/kg group: 7 subjects; and placebo group: 14 subjects). In the JX10 1, 3, 6 mg/kg, pooled groups, and the placebo group, the rates of mRS 0–1 were 0 subject out of 1 (0.0%), 1 subject out of 3 (33.3%), 3 subjects out of 7 (42.9%), 4 subjects out of 11 (36.4%), and 1 subject out of 14 (7.1%), respectively, and those of mRS 0–2 were 0 subjects out of 1 (0.0%), 3 subjects out of 3 (100.0%), 4 subject out of 7 (57.1%), 7 subjects out of 11 (63.6%), and 2 subjects out of 14 (14.3%), respectively. Despite small numbers, patients with acute lacunar infarct who were treated with JX10 showed trend of improved neurologic function at 90 days, as measured by mRS. Symptomatic intracranial hemorrhage was not observed in any JX10 treated patients.Conclusions:JX10 improved functional outcome in patients who presented with lacunar infarct, as measured by mRS at day 90 vs placebo. Findings support further testing of JX10 in larger and broader patient populations.

Stroke, Volume 56, Issue Suppl_1, Page AWP43-AWP43, February 1, 2025. Objective:Recanalized aneurysms may still recanalize despite a second coiling to prevent rupture. Factors related to recanalization following a second coiling for recanalized aneurysms have not yet been fully explored. This study examined a large multicenter dataset accumulated over a 20-year period to identify factors related to major recanalization following a second coiling for recanalized aneurysms.Methods:A total of 185 patients with 188 aneurysms who underwent second coiling for saccular unruptured cerebral aneurysms at three institutions between November 2003 and December 2023 were retrospectively reviewed. Patients were categorized into a group with major recanalization (R group) and a group without major recanalization (NR group). To identify factors related to major recanalization, clinical, anatomic, and procedural factors were comparable between groups by multivariate logistic regression analysis and stepwise selection.Results:During the follow-up period (mean, 62.3 ± 51.2 months), 72 (38.3%) of 188 recanalized aneurysms developed major recanalization. Compared with the NR group, the R group had significantly larger aneurysm size, neck size, and aneurysm volume at initial coiling and significantly lower rates of stent-assisted coiling, use of an intermediate catheter, and complete occlusion at second coiling. Stepwise multivariate logistic regression analysis identified neck size at initial coiling (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.03–1.32) as an independent risk factor for major recanalization and stent-assisted coiling (OR 0.34; 95%CI 0.14–0.85), use of an intermediate catheter (OR 0.38; 95%CI 0.17–0.86), and complete occlusion at second coiling (OR 0.16; 95%CI 0.034–0.72) as independent protective factors for major recanalization.Conclusions:Second coiling of recanalized aneurysms may decrease the risk of major recanalization by using a stent in combination with an intermediate catheter to achieve complete occlusion.

Stroke, Volume 56, Issue Suppl_1, Page AWP124-AWP124, February 1, 2025. Introduction:Long term ( >36 months) recovery after endovascular treatment (EVT) remains largely understudied in acute ischemic stroke (AIS) patients. Previously, we have shown that long-term white matter microstructure damage, iron deposition and atrophy within/remote to the 24-hour stroke lesion could influence long term quality of life. However, the role of baseline and 24-hour lesion characteristics on long term lesion characteristics and the influence of lesion status on recovery to perform daily activities is unknown.Methods:We executed a quantitative 3T MRI protocol (FLAIR, diffusion MRI, R1, R2*, Quantitative Susceptibility Mapping, Arterial Spin Labeling) after 37 (IQR: 28-38) months in patients from the MR CLEAN No-IV trial who received a 24-hour post-EVT MRI (DWI, FLAIR, SWI). Lateral ventricular volume difference was computed at both time-points to quantify atrophy. Long term MRI was also used to quantify iron deposition (R2*) and volume difference in subcortical nuclei relative to the contralateral nuclei. Long term recovery was defined using daily activity scores from EQ5D5 questionnaire. A Bayesian paired T-test of ventricular lateral atrophy between 24-hour and long term MRI was performed, and a Bayesian correlation of baseline clinical and 24-hour lesion characteristics with long term MRI outcomes (Bayes Factor (BF)3: moderate; BF >20: strong evidence).Results:We included 24 patients with a 24-hour and long-term MRI protocol. Median age was 64 (51-75) years, 11 (46%) patients were randomized to receive intravenous thrombolysis (IVT) prior to EVT, and 19 (79%) patients had an MCA occlusion. Functional independence (mRS 0-2) at 90 days (21 (88%) patients) and long term (20 (83%) patients) was comparable. Ventricular lateral atrophy was observed (BF=4.105), and higher baseline blood pressure and poorer collaterals were associated with larger long term lateral ventricular atrophy (BF: 11, 11, 4.3 respectively). Lower ASPECTS and poorer collaterals were associated with higher thalamic volume difference (BF=111, 11 respectively). Lastly, lower hippocampal volume and iron deposition were associated with reduced long term daily activity (BF=26, BF=4).Conclusion:While functional independence in our cohort remains comparable over time, baseline, clinical, and treatment characteristics point to long-term brain degradation, which in turn impacts the ability of patients to perform daily activities.

Stroke, Volume 56, Issue Suppl_1, Page AWP118-AWP118, February 1, 2025. Background:Although long-term management following a stroke is crucial, many patients do not adhere to follow-up appointments, which pose a risk to the integrity of clinical trials. This systematic survey aimed to identify factors and potential impacts linked to lost to follow-up (LTFU) in stroke patients participating in long-term management trials, to enhance trial quality. Understanding LTFU is essential for informing patients, clinicians, and researchers for both clinical and research purposes.Methods:An information specialist completed a comprehensive search of available data sources, including studies published up to June 15, 2024. Eligible articles included randomized trials that involved multimodal post-stroke care programs, initiated within one year after the stroke, with specified and assessed follow-up outcomes. We collected data on general trial characteristics and methodological characteristics for each study. Multiple linear regression analyses were conducted to identify factors associated with LTFU. Additionally, we evaluated the relative risk of several assumptions about the outcomes of participants LTFU on the estimate of effect for the significant binary primary outcome.Results:Of the 57 eligible reports identified, 6 (10.5%) did not specify whether LTFU occurred. The duration of follow-up ranged from 1 to 60 months. The median proportion of subjects LTFU was 7.9% (interquartile range, 0–12.9%). Factors of LTFU increase on regression analysis were more study centers (beta=0.003 per center,P=0.017), higher proportion of females (beta=0.027 per percentage of 10,P=0.006), and non-protocol available (beta=-0.06,P=0.021) (Table 1, Fig.1). Patients were also more likely not to be lost if their providers were therapists (beta=-0.14,P=0.016) or rehabilitation team (beta=-0.12,P=0.038) compared to physician alone. In the trials that provided relevant data, results of 14.3% of trials were no longer significant if we assumed no participants LTFU had the event of interest, and 42.9% of trials were no longer significant if we assumed a worst-case scenario (Table 2).Conclusion:Overall, nearly one-tenth of contemporary stroke trials on longer-term patient management still did not report LTFU. Identified modifiable risk factors may provide targets to improve the continuity of stroke management within these trial settings. Neurologists should pay close attention to how the participants are managed which may change the direction of the entire study.

Stroke, Volume 56, Issue Suppl_1, Page AWP162-AWP162, February 1, 2025. Introduction:Outpatient follow-up within thirty days of discharge home after an ischemic stroke is associated with reduced readmission rates. Current guidelines emphasize a primary care-based approach to follow-up care but provide little information regarding neurology-specific follow-up. This study aims to examine the rates of follow-up with non-neurology care providers and neurologists, and their association with patient outcomes.Methods:We conducted a retrospective cohort study using electronic health records collected of patients discharged home after admission on the neurovascular service from a tertiary care hospital from October 2020 to October 2023 who were then subsequently contacted via guideline-recommended seven-day phone call. Clinical demographics, follow-up with either a non-neurology care provider (e.g., primary care provider, cardiologist, endocrinologist) or neurologist, emergency department (ED) presentations, and mortality were analyzed using a Chi-square analysis.Results:We identified a total of 246 patients for this review, 232 (94.3%) of whom attended follow-up with a non-neurologist compared to 182 (74.0%) with a neurologist an average of 33.9 days and 77.5 days from hospital discharge, respectively. A total of 127 (51.6%) patients presented to the ED within the follow-up timeframe, with 31 (12.6%) patients presenting prior to any follow-up appointment. There was a noted difference in the ED presentation rate between patients who did not attend a neurology appointment (36/62, 58.1%) compared to those that did attend (91/182, 41.9%), however this was not statistically significantly different. Of the 16 (6.9%) deaths in the cohort, they occurred significantly disproportionately in the patients without a neurology follow-up appointment (8/62, 12.9%; p = 0.02).Conclusion:Our findings suggest that patients who do not attend a neurology-specific follow-up appointment after stroke may have worse outcomes, including higher mortality rates. Further research is needed to develop interventions that improve neurology follow-up rates, with the goal of reducing ED visits, hospital readmissions, and mortality in patients with stroke.

Stroke, Volume 56, Issue Suppl_1, Page AWP157-AWP157, February 1, 2025. Background:e-consults for outpatient stroke/TIA care can improve timeliness of neurologic care, however it is unknown whether active implementation of an e-consult impacts the overall volume of outpatient stroke care provided in one healthcare system vs another.Methods:We studied the implementation of an e-consult for outpatient stroke/TIA care in a stepped-wedge trial in 10 VA facilities in the VA National TeleNeurology Program (NTNP). Sites were randomized to one of three sequential 6-month active implementation waves (after 2 months of usual care where the e-consult was available) that included a stroke prevention lecture for primary care (PC) providers, as well as participation in monthly PC meetings to review cases and utilization of the consult. After the 6-month active implementation (sustainability period), no data were presented to PC teams. The primary outcome was whether a consult was placed in the VA versus community care neurology (CCN) for outpatient stroke/TIA care. A generalized linear mixed model (GLMM) with binomial distribution and log link fit to the primary outcome was used to estimate the effect of active implementation with baseline serving as the reference. Other effects in the model includeda prioriselected variables: demographics, site data (stroke volume, median consult wait time, rurality, availability of local neurology, indicator for sustainability), time block (as categorical 2-month blocks) and random site effect. A similar model was fit including 4 control sites, with an added site-level indicator for intervention vs control site.Results:Of the 1545 consults placed for stroke/TIA, 21% (322/1545) were NTNP (within VA). The GLMM model demonstrated that the odds of a stroke/TIA consult being placed within the VA increased during active implementation: OR 1.92 (1.17-3.16, p = 0.01, Table). Adding data from 4 NTNP control sites who had access to the e-consult but did not receive the active implementation showed no trend in consult location over time but added additional variability to the model, resulting in a decrease in the effect (N = 1680, OR 1.48, 95% CI 0.96-2.28, p = 0.07).Conclusion:Active implementation of a stroke/TIA e-consult may increase the likelihood of further outpatient care being provided in that healthcare system. This may be relevant to healthcare systems seeking to improve continuity of care for post-acute stroke follow-up through innovative care models and use of asynchronous telehealth modalities.

Stroke, Volume 56, Issue Suppl_1, Page ATP70-ATP70, February 1, 2025. Introduction:A significant proportion of stroke patients are lost to follow up (LTFU) after discharge, which may be associated with increased risk of morbidity, mortality, and unnecessary hospitalization. We aimed to identify predictors of post-discharge LTFU and unplanned hospitalizations in a cohort of patients with acute stroke from a large academic hospital system.Methods:Using our institutional AHA Get With the Guidelines quality registry, we conducted a retrospective analysis of all patients who were hospitalized for acute stroke between January 1, 2016, and December 31, 2020 at a tertiary-care hospital in New York City. Our primary outcome was post-discharge LTFU, defined as having zero post-discharge encounters within 12 months. Our secondary outcomes included having one or more outpatient visits with a provider, unplanned hospitalizations, and emergency department (ED) visits within 30 days post-discharge. Multiple logistic regression was used to identify factors that were significantly associated with our primary and secondary outcomes, adjusted for confounding demographic and clinical factors.Results:We identified 2,597 patients hospitalized for acute stroke, of which 878 (33.8%) were LTFU. Of the 1,719 patients not LTFU, 974 (56.7%) had a provider visit, 405 (23.6%) had an unplanned admission, and 257 (14.9%) had an unplanned ED visit within 30 days post-discharge. Patients who were LTFU were significantly more likely to be male (52.9% vs. 47.4%); have an intracerebral (12.1% vs. 8.9%) hemorrhage; discharged to a skilled nursing facility (19.8% vs. 17.0%); and transferred from another hospital (48.0% vs. 40.7%). Clinically, these patients are more likely to have a history of DVT/PE (3.9% vs. 1.3%); receive catheter-based treatment (12.8% vs. 10.0%); and have a modified Rankin scale (mRS) score of 3 or greater at discharge. In the multivariable logistic regression, patients who were discharged to an acute care facility (adjusted odds ratio (aOR) 3.3), had a history of DVT/PE (aOR 3.1) or a discharge mRS of 3 (aOR 1.8) had significantly higher odds of LTFU, whereas patients who were discharged to an inpatient rehabilitation facility (aOR 0.65), had a family history of stroke (aOR 0.60) or depression (aOR 0.64) had significantly decreased odds of LTFU.Conclusions:In this study, patients LTFU after a stroke were more likely to have severe clinical conditions and specific discharge dispositions.

Stroke, Volume 56, Issue Suppl_1, Page AWP222-AWP222, February 1, 2025. Background and Aims:Machine learning models have shown promising potential for automated hemorrhage detection and segmentation, alleviating highly time-consuming manual contouring and facilitating rapid clinical diagnosis. External validation is essential to assess model generalizability and performance across new dataset configurations. To this end, we externally validated a novel model for hemorrhage detection and segmentation in an unseen randomized-controlled trial dataset.Methods:A novel segmentation architecture based on denoising diffusion probabilistic models was utilized for segmenting hemorrhage. The model had been trained upon a set of 331 CT scans with manually segmented parenchymal hemorrhage lesions. External validation was conducted using the AcT (Alteplase compared to Tenecteplase) trial in which patients underwent post-thrombolysis follow-up CT scans. Ground truth regarding hemorrhage presence was determined by expert readers blinded to the algorithm’s results who performed manual contouring and graded hemorrhages using the Heidelberg classification. Model performance was then evaluated through using diagnostic performance measures and the Dice coefficient.Results:Among the 1338 patients with follow-up CT scans, two types of hemorrhages were adjudicated: (a) any kind of hemorrhage (230/1338) and (b) remote or local hemorrhages classified as PH1 or worse (170/1338). The algorithm achieved sensitivity of 89.4% (95% CI 84.8-94.1%) for hemorrhages ≥PH1 and 61.7% (95% CI 55.5-68.0%) for any kind of hemorrhage where specificity of 92.8% (95% CI 91.3-94.3%), positive predictive value of 64.0% (95% CI 57.6-70.3%), negative predictive value of 92.1% (95% CI 90.5-93.7%) and accuracy of 87.4% was achieved. Dice was 0.582 (95% CI 0.538, 0.629) for any kind of hemorrhage and 0.611 (0.555, 0.667) for hemorrhages ≥PH1.Conclusions:Our automated model for hemorrhage segmentation demonstrated robust performance in this external clinical trial dataset, achieving high sensitivity for large hemorrhages and high specificity for smaller hemorrhages. Future work will seek to further optimize the algorithm’s performance for detection and segmentation of smaller hemorrhages.

Stroke, Volume 56, Issue Suppl_1, Page ATP53-ATP53, February 1, 2025. Background:Post-discharge phone calls to stroke patients are a valuable tool to assess medication compliance, stroke education retention and prevention of emergency room visits. However, there is no optimal time frame defined by The Joint Commission for post-discharge follow-up calls. The purpose of this study was to determine if there is an optimal time frame to call patients and whether call fatigue affects call completion rate.Methods:Ischemic and hemorrhagic stroke patients discharged to home with and without home health from 2/2024 to 6/2024 were included. Participants received phone calls from a Stroke Certified Registered Nurse at 7 days (Group 1), 14 days (Group 2), and 21 days (Group 3) post-discharge. Two call attempts were made. Data collected included baseline demographics, call completion rates, stroke education and validation of knowledge retention. Call fatigue was assessed by capturing the number of times patient was contacted after discharge by health care team. Patients received a Knowledge Score of 0-6 based on recall of knowledge of diagnosis, stroke type, signs and symptoms of stroke, risk factors, medication knowledge and stroke prevention. R *** was used for data analysis.Results:178 patients were called, 64 (36%) Group 1, 61 (34%) Group 2, 53 (30%) Group 3. There were no differences in baseline demographics. 74% (131) of patients were reached successfully. There were no differences in completion among each group (49 {75%} Group 1, 42 {69%} Group 2, 40 {75%} Group 3) p=0.6 despite more calls being made by healthcare team members early on (7.09±4.55 in Group 1, 4.12±3.27 in Group 2, 3±2.89 in Group 3). There were no differences in Knowledge Score regardless of time phone call was made. Patients who were discharged home with home health had better Knowledge Score than those discharged home without home health (5.87(±0.61) vs 5.48(±1.36)) p=0.03.Conclusion:Implementing a post-discharge phone call program up to 21 days is feasible. There was no difference in call completion rates and retention of stroke knowledge despite a heavier call burden earlier on suggesting no call fatigue.

Objective
To investigate how various morbidities affect older patients’ performance on the Timed Up and Go (TUG) test.

Design
Cross-sectional study.

Setting
The seven government hospitals of Lahore, Pakistan, included are major tertiary care centres, representing an older patient population of Punjab, Pakistan.

Method
160 elderly participants completed the TUG test, frailty evaluations and Charlson Comorbidity Index (CCI) scoring to assess mobility, frailty and comorbidity burden. The Student’s t-test analysed differences between TUG groups (

This Viewpoint discusses California’s new law that will further strengthen tobacco control and whether the FDA and other states will follow California’s example.