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Objectives
To determine patient-reported symptoms and clinical factors associated with mimics and differences in health-seeking behaviour versus stroke.

Design
This is a post-hoc analysis of a cross-sectional survey of interviews on patient-reported factors in patients admitted with suspected stroke. Patients were categorised as genuine stroke or mimic. The surveys were conducted from February 2018 to January 2019.

Setting
Two non-comprehensive stroke centres in Denmark.

Participants
Patients≥18 years (no upper age limit) admitted with symptoms of stroke to one of the non-comprehensive stroke centres or transferred from a comprehensive- or primary stroke centre were eligible for inclusion. 592 patients were included.

Outcome measures
Symptoms or clinical factors associated with stroke mimics. Logistic regression analysis was performed to identify factors associated with mimics. Secondarily, the number of strokes versus mimics presenting at a healthcare facility within 3 hours contacted the emergency medical service (EMS) and arrived by ambulance.

Results
Of 592 suspected patients with stroke, 113 (19.1%) were mimics; most frequently peripheral vertigo (24.7%) and migraine (11.5%). Factors associated with a higher likelihood of mimics were female sex (OR 1.79, 95% CI 1.14 to 2.79), high Scandinavian Stroke Scale scores (OR 1.05, 95% CI 1.02 to 1.09, per point increase), and vertigo (OR 1.86, 95% CI 1.18 to 2.95). Factors associated with a lower likelihood of mimics were increasing age (OR 0.96, 95% CI 0.95 to 0.98 per year increase), reported limb weakness (OR 0.52, 95% CI 0.30 to 0.89) and difficulty steering (OR 0.51, 95% CI 0.28 to 0.93).
There was no difference between groups in the proportion of patients for whom time from symptom onset to healthcare services contact exceeded 3 hours (52.2% vs 53.7%, p=0.78). Fewer mimics contacted the EMS first, were accepted at a primary stroke centre and arrived by ambulance (p

Iniziativa presa dall’Unità operativa di Oncologia del profili

Dal 3,4% si arriverebbe al 5 (media Ue), Lancet raccomanda il 10

This JAMA Patient Page describes community-acquired pneumonia (CAP) and its risk factors, symptoms, diagnosis, treatment, and prevention measures.

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Objectives
Given China’s low fertility rate, assisted reproductive technology (ART) can be used assist infertile patients in having children. This study aimed to analyse patients’ preferences for ART and to determine the relative importance (RI) and willingness to pay (WTP) of key attributes.

Design
We identified six attributes of ART and used a D-efficient design to generate choice sets for conducting a discrete choice experiment. Patients were asked to choose between two scenarios that differed in participation in treatment decision-making (TDM), clinical pregnancy rate, live birth rate, risk of maternal and neonatal complications, and out-of-pocket cost.

Setting
Jiangsu province, China. The anonymous survey was carried out between December 2022 and February 2023.

Participants
Female patients aged 20–45 years, with low fertility or experience of ART treatment. We recruited 465 participants.

Outcomes measures
Patient-reported preferences for each attribute were estimated using a mixed logit model. The latent class model was also used to investigate preference heterogeneity.

Results
All attributes were associated with patient preferences. Patients considered the live birth rate as the most important attribute (RI=29.05%), followed by participation in TDM (RI=21.91%). The latent class model revealed two distinct classes named ‘outcome driven’ and ‘cost driven’. Preferences varied according to their age, monthly household income and location.

Conclusions
This study investigated the preferences of infertile patients when seeking medical assistance for infertility. The study outcomes can contribute to evidence-based counselling and shared decision-making and provide an empirical basis for creating and implementing future policies.

Introduction
As one means to avoid waste in research investment, involving patients as full partners in research has become increasingly frequent. There is clearly a low level of investment in palliative care research. Following the guidance from the James Lind Alliance and the UK public consultation (‘Palliative and End of Life Care Research Priorities Project’), we developed a 3-step protocol aimed at prioritising 10 unanswered questions in palliative care (PC) research in France, from the viewpoint of patients, volunteers, healthcare professionals and family caregivers.

Methods and analysis
To identify unanswered questions in PC (stage 1), an unstructured questionnaire will be used. This questionnaire will be tested on patients and healthcare professionals and modified, if necessary, before being made available online for a period of 6 months. A multidisciplinary steering committee including board-certified PC physicians, methodologists, nurses, a sociologist, an anthropologist and an information specialist will analyse the data collected in order to delete duplicate questions, do a thematic and population classification of the responses, modify questions using the PICO (patient problem, intervention, comparison and outcome) format and perform a literature review on each question to identify any relevant systematic review.

Ethics and dissemination
We expect the results to have wide-ranging benefits, for example, by prompting investment in the 10 prioritised research questions. There are also potential benefits for patients and caregivers, by including them as partners in future research. Regarding the current bill being examined by the government planning to legalise euthanasia and assisted suicide in France, this study will provide new insights into how patients and caregivers are prioritising those themes. The major benefit of this study is to involve patients and family caregivers as partners in PC research. They will be consulted and their choices will be valuable resources and may prompt researchers to focus on different topics. In view of the limited funding available, PC research needs to prioritise major issues and raise its visibility.
The second stage of the study is the first-round prioritisation using a fixed format questionnaire, which will last 4 months. The third stage will consist of reaching a consensus regarding the top 10 unanswered questions in PC research, using the nominal group technique. A secondary objective during this third step is to study the reasons for the prioritisation.

A man in his 70s with myelodysplastic syndrome presented with a painful violaceous eruption on his left lower leg accompanied by low-grade fever and fatigue for 1 week. What is your diagnosis?

Stroke, Volume 56, Issue Suppl_1, Page ATMP18-ATMP18, February 1, 2025. Background and Issues:Timely identification and intervention are critical for positive outcomes in acute intracerebral hemorrhage (ICH) patients. The 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association states that we should control blood pressure, reverse anticoagulation, and get the patient to a specialized inpatient stroke unit. Unlike multiple clearly defined target goals for ischemic stroke, there are no established measurable goals for ICH. The absence of specific target times for ICH leads to delays in identification and treatment, resulting in poor outcomes.Purpose:This project aimed to rapidly identify and aggressively manage ICH patients with clearly defined treatment times to reduce mortality and 30 day readmissions.Methods:The implementation of measurable goals for ICH in the Emergency Department (ED) was an approach to improve ICH patient outcomes by facilitating faster identification and treatment. The stroke team reviewed existing performance data and outcomes to determine reasonable times for completing the following interventions: Cat Scan imaging within 30 minutes of being ordered, blood pressure medications given within 30 minutes of diagnosis, reversing anticoagulation within 45 minutes of diagnosis, and moving patients to the Neuro ICU within 90 minutes of diagnosis. The ED team was educated on the new performance goals. The stroke team collected, analyzed, and reported the performance metrics of the ED team throughout implementation. Outcomes were measured using data for when the goals were being met versus not being met.Results:Outcomes were measured from 111 ICH patients from 2022-2023. When treatment time goals were not met, the mortality rate for ICH patients was 18.42% with an observed/expected (O/E) ratio of 1.25. The 30 day readmission rate was 12.9%. When treatment goals were met, the mortality rate decreased to 12.68% with an O/E ratio of 0.86. 30 day readmission rate dropped to 3.23%Conclusions:Having measurable goals for ICH has demonstrated a significant improvement in outcomes. Establishing clear time targets for getting imaging, initiating blood pressure control, reversing anticoagulation, and admission to Neuro ICU led to a reduction in mortality and 30 day readmissions. It is recommended to use clearly defined time goals to ensure prompt intervention and improved prognosis for patients with ICH.

Stroke, Volume 56, Issue Suppl_1, Page ATMP21-ATMP21, February 1, 2025. Background:A post-pandemic culture without interdisciplinary rounds has led to a lack of communication between providers and nurses. This has negatively impacted patient experience and resulted in a perceived lack of collaboration among team members.Purpose:To demonstrate the positive impact of nurse navigator (NN) facilitated interdisciplinary rounds on patient experience scores, as well as nursing and provider opinions of communication respectivelyMethods:Six months of Press Ganey© patient experience data for focus item ‘Staff worked together to care for you’was collected for our neuroscience floors (N9 and N11) prior to starting a new rounding process. NN developed a protocol for interdisciplinary rounds and communicated this with nursing, providers, and unit secretaries. NN educated nurses and providers about the evidence-based benefits of team rounds. Unit secretary announced teams overhead as they arrived on the floor. NN facilitated introductions and in-person information sharing between nurses and providers. A survey was administered to nurses and providers to evaluate their opinions about quality of communication and perceived barriers to communication during floor rounds both in the pre- and post-implementation phase.Results:Press Ganey© scores for ‘Staff worked together to care for you’improved on both floors post-implementation. The hospital designated Top Box Score for N9 was met 3/6 months (50%) following the initiation of interdisciplinary rounds compared to 2/6 months (33%) prior. The average six-month Top Box Score for N9 improved from 59% to 67% and that of N11 improved from 65% to 74%. Twenty nursing surveys and 15 provider surveys were received pre- and post-implementation. Post-implementation surveys showed 40% of nurses rated the quality of Neurology provider communicationVery Goodcompared to 15% prior. Nurses reported an increased comfort level in approaching Neurology providers with questions and concerns (80%Very/Extremely comfortablecompared to 62% prior). An overwhelming 80% of providers endorsed being able to identify patient’s nurse asVery Easy/Somewhat Easyvs 39% prior and reported discussing patient’s plan of care with the nurse in person during roundsOften/VeryOften40% of the time vs 17% prior.Conclusions:Instituting nurse navigator facilitated interdisciplinary rounds is an effective way to improve patient experience and promote communication and a collaborative work milieu among team members.

Stroke, Volume 56, Issue Suppl_1, Page ADP9-ADP9, February 1, 2025. Background:Stroke is the fifth leading cause of death in Minnesota and in the United States. Stroke is a leading cause of long-term disabilities and is largely preventable (80%). Evidence indicates that patients receiving care from stroke specialized nurses, including nurse-led stroke prevention, show better outcomes. Stroke program leaders at a Primary Stroke Center identified this as an opportunity to improve stroke program education, quality of nursing care, and stroke patient outcomes.Purpose:The primary focus area was improving stroke-patient education to include individualized stroke risk factors. As our project progressed, the initial goal remained. The secondary focus was to see if the effect of in-person, hands-on (escape room) nurse education would improve individualized stroke-patient education compliance compared to eLearning and poster board education.Methods:All stroke cases from June 2023 – June 2024 were audited for documentation of individualized stroke-patient education. Utilizing stroke guidelines and scientific statements, a standardized practice of individualizing stroke-patient education was developed. Staff learning modules were developed including eLearning, unit poster board, and in-person learning (escape room). Throughout the project, completion rates of individualized stroke-patient education were compared. A nursing survey was conducted to evaluate confidence and knowledge post multimodality learning modules.Results:Prior to initiation of nursing learning modules, 24 hospitalized stroke-patient charts from June and July 2023 were audited for individualized stroke education (40%). After initiation of nursing learning modules, 183 hospitalized stroke-patient charts from August 2023 to June 2024 were audited for individualized stroke education (poster board 44%, eLearning 45%, escape room 75%). The post nursing learning module survey responses demonstrated improved learners’ knowledge for the interactive escape room (poster board average-good 77%, eLearning average-good 83%, escape room good-excellent 89%).Conclusion:By identifying educational gaps, we were able to enhance nursing education; which improved stroke-patient education and outcomes. In conclusion, nursing confidence and knowledge increased with the in-person escape room education. This suggests engaging in-person learning could be more effective in developing nursing knowledge, improving patient care, and positive patient outcomes.

Stroke, Volume 56, Issue Suppl_1, Page ATP126-ATP126, February 1, 2025. Background:Stroke survivors face functional changes that may alter their quality of life. Although these changes are significant for the stroke survivor, they are consequential for the caregiver of the stroke patient as well. Psychological burden of stroke caregivers has been investigated, but its association with level of disability and quality of life of the stroke patient has been less studied.Objective:To determine if worse 90-day patient stroke outcomes result in greater caregiver strain and worse caregiver mental health in a multiethnic sample.Methods:Using data from the Brain Attack Surveillance in Corpus Christi project, we prospectively determined 90-day ischemic and hemorrhagic stroke outcome from 2019-2023. Patient function based on ADLs/IADLs (higher scores worse) along with patient quality of life based on SS-QOL (higher scores better) were used to measure patient outcome. Stroke caregivers’ depression was measured using the PHQ-8 (higher scores worse) and strain was measured by mCSI (higher scores worse). Generalized propensity scores (GPS) were calculated for the main exposures using caregiver and patient demographics, dyad characteristics, and clinical variables as predictors. Caregiver outcomes were modeled with linear regression, with caregiver depression and strain as main outcomes, unadjusted and adjusted for GPS.Results:During this time period, 339 strokes were identified and their caregivers subsequently interviewed. The median age of interviewed caregivers was 55, with 46% being the sole informal caregiver. A majority of the caregivers interviewed were either the spouse of the stroke patient (42.2%) or the child of the stroke patient (38.1%). In adjusted analyses, functional status for stroke patients was not associated with caregiver depression (p=0.12), higher stroke patient quality of life was strongly associated with lower odds of any depression symptoms among caregivers (p

Stroke, Volume 56, Issue Suppl_1, Page ATP124-ATP124, February 1, 2025. Value-based medicine places the patient and their health status at the center of the intervention through the use of Patient-Reported Outcome Measures (PROMs). The ideal would be that these outcome measurements were answered directly by the patient but in many cases it is a caregiver or a healthcare professional who collects the person’s health status perception. This reason could lead to a bias in the results.Our aim was to compare whether there were differences in the perception of health status depending on who answered these questionnaires.Stroke patients discharged from six European hospitals were included in a 1-year follow-up program based on a holistic communication tool (web platform for professionals and app for patients/caregivers) called NORA. PROMs at 7-90 days were collected through NORA-app. In case that the patient or caregiver didn’t have access to a smartphone, the data collection was carried out by a professional healthcare who contacted them to manage PROMs by a phone call.Main outcome measures include: HAD-depression and HAD-anxiety (defined as pathological by a score ≥10 points in each of the subscales) and PROMIS-10 (cut-offs raws values of normality were defined as: Physical-PROMIS >13 and Mental-PROMIS >11). Median scores per collector were compared. In addition, a social questionnaire was collected from app-users’.Over two years, 5116 stroke patients were included in Harmonics project, 60% were men with a mean age of 70.2 years and median mRS of 2(1- 3) at hospital discharge. From them, 2432 were actively monitored and 1498 reported PROMs (428 patients (28.6%), 376 (25.1%) caregivers and 694 (46.3%) professionals). P-value < 0.05 was considered significant for all tests at 90 days. Median PROMs results are shown in Table-1.The social questionnaire (Figure-1) showed significant differences between male and female patients. From the total, 26.6% women and 11.7% men leave alone (p-value = 0.005).At the patients group 77.9% women considered they can take care of their basic needs’ vs 85.9% men (p-value= 0.036).Significant differences were found between the three groups of collectors, with professionals being the ones who perceive a better state of patient health through the collected PROMs collected. Among patients and caregivers groups, worse outcomes were reported by the last one.When using PROMs the collector should avoid bias in reporting the results and direct patient response should be encouraged.

Stroke, Volume 56, Issue Suppl_1, Page ATP116-ATP116, February 1, 2025. Background and aims:Conventional approaches for stroke rehabilitation primarily involve static muscle strengthening exercises, weight bearing and shifting by therapists. Robot-assisted gait training facilitates the learning of reproducible symmetric gait patterns and reduces expenditure. The GTR-A (HUCASYSTEM, Korea), a robotic gait rehabilitation device for both upper and lower limbs, utilizes end-effector-based movement and provides training to enhance gait function. In this study, we aim to elucidate the clinical efficacy of rehabilitation therapy using GTR-A in subacute/chronic stroke patients.Methods:This study was a prospective, randomized, controlled clinical trial. There were 14 participants in total, with 7 in each of the experimental and control groups (table. 1). The gait abilities were evaluated using the berg balance scale (BBS), 6-minute walk test (6MWT) and cardiopulmonary exercise testing. Over period of 4 weeks, the experimental group underwent 10 sessions of robot-assisted rehabilitation for 30minutes/day, 3times/week in addition to conventional physical therapy for 30min/day, 5times/week. The control group received 10 sessions of only conventional physical therapy for 60minutes/day, 5times/week.Results:In the experimental group, significant improvements were observed in both BBS and 6MWT. However, there was no significant increase in maximal oxygen consumption. In contrast, the control group did not show significant functional improvements (table. 2).Conclusion:The combination of conventional rehabilitation therapy and robotic gait training using GTR-A showed superior outcomes in the recovery of gait function compared to conventional therapy alone.

Stroke, Volume 56, Issue Suppl_1, Page ATP372-ATP372, February 1, 2025. Introduction:Ischemic stroke is highly heterogeneous, with patient-to-patient differences in infarct location, severity, and degree of reperfusion, among other factors. Incorporating this variability in preclinical stroke models is useful to more comprehensively recapitulate the patient population. Prior studies employ Longa (complete reperfusion) or Koizumi (chronic hyporeperfusion) murine models of stroke interchangeably over a range of ischemic durations. These models represent distinct stroke phenotypes, but the unique features of each model warrant further definition. Therefore, we sought to differentiate the pathology of these models to more accurately model patient heterogeneity.Methods:Transgenic mice expressing a fluorescent neutrophil marker (Ly6G-TdTomato) were subject to the Longa or Koizumi temporary middle cerebral artery occlusion (tMCAO) model of ischemic stroke. Ischemic duration was varied to model strokes of mild (30 min), moderate (60 min) and high (90 min) severity (n = 6-10 per experimental model). Laser speckle contrast imaging (LSCI) was performed at baseline, prior to and after reperfusion, and at endpoint to quantify cerebral blood flow (CBF) using a custom-made pixel assignment algorithm. Brains were collected at 24h or 72h and imaged via confocal microscopy to evaluate neutrophil infiltration in the ischemic hemisphere.Results:Mortality significantly increased with ischemic duration in the Koizumi model at 24h, 48h, and 72h, but did not differ across the Longa models. LSCI demonstrated a 2-to-5-fold increase in the area of profound ischemia (lowest quintile of pixel values) in the Koizumi model compared to the Longa model and with increasing ischemic duration. Additionally, the Koizumi model exhibited less restoration of CBF following reperfusion and more variability in CBF within the ischemic hemisphere regardless of ischemic duration. The number of infiltrating neutrophils increased 10-fold between the 30- and 90-min Longa and Koizumi models, but the Koizumi model demonstrated increased variability in the number of neutrophils at 24h and 72h.Conclusions:Our findings demonstrate differences in mortality, CBF, and immune response between stroke models of varying ischemic duration and reperfusion status. These unique pathological features can be linked to the physiological perturbations defining each model to establish a phenotypic spectrum that can be exploited to more thoroughly represent human stroke patient heterogeneity.

Stroke, Volume 56, Issue Suppl_1, Page A10-A10, February 1, 2025. Introduction:CTP is used to distinguish core infarct from penumbral tissue in the 6-24 hour time window from last known well time (LKW). In addition, routine use of CTP inside of 6 hours may increase the sensitivity of detecting medium vessel occlusion (MeVO) as compared with CTA alone. Therefore, some centers apply a strategy of using CTP/CTA routinely in the first 6 hours from LKW while others reserve CTP for the 6-24 hour delayed time window. We hypothesized that use of CTP/CTA inside of 6 hours from LKW is associated with increased EVT especially for MeVO.Methods:This is a retrospective analysis of acute ischemic stroke (AIS) patients from a multi-state stroke registry between Jan 2018 and Mar 2024 who presented within 6 hours of LKW. The incidence of EVT by triage imaging modality (CTA or CTA/CTP) was analyzed overall and also by occlusion location (Large vessel occlusion (LVO), MeVO) through linear mixed models (LMM). Multivariable models were used to adjust for confounding factors. A two-tailed p value of