Search Results for: Diagnosi, trattamento e follow-up dei pazienti con vescica iperattiva

Stroke, Volume 56, Issue Suppl_1, Page AWP258-AWP258, February 1, 2025. Introduction:Surpass Evolve (SE) is an updated flow diverter stent. While shown to be effective and safe for treating intracranial aneurysms (IA), blood flow analysis is still limited. In this study we constructed IA models with patient-specific internal carotid artery geometry and conducted hemodynamic flow analysis of treatment with implanted SE.Hypothesis:IA neck size affects the flow changes induced by SE.Methods:A model of a patient left internal carotid artery was prepared from the UCLA clinical database. Using computer automated design (CAD) software, two variations of a 4 x 4 mm saccular IA were constructed on the ophthalmic segment: a mid-sized neck (~2 mm) and a wide neck (~5 mm). For each case, a SE device measuring 3.25 mm in diameter and 17 mm in length was added to model treatment, and computational flow dynamic (CFD) simulations of pulsatile blood flow were performed. Post-treatment blood flow was quantitatively compared between IA models, specifically intra-aneurysmal flow velocity, pulsatility index (PI), turbulence, vorticity, and wall shear stress (WSS).Results:Significantly higher flow pulsatility was observed at the neck of the wide neck IA compared to the mid-sized neck IA (PI = 2.96 and 1.66 respectively). Likewise, peak systolic flow velocities were 32.9% and 118% higher at the body and dome respectively in the wide neck case (Fig. 1). Peak systolic WSS values were observed in both cases at the neck facing the direction of blood flow, in which values exceeded 15 Pa for the wide neck case. In the mid-size neck case, WSS in excess of 3 Pa was not observed beyond the neck region, whereas notable propagation of WSS to the body and dome regions were observed in the wide neck case (Fig. 2). Higher flow vorticity was observed in all regions of the IA for the wide-neck case. Flow within the IA of both mid-size and wide neck cases remained mostly laminar with no observable turbulence relative to that in the parent vessel.Conclusion:SE treatment reduced the flow entering the IA at a high curvature area of the ICA. When comparing IA of the same size, increased neck size may reduce the flow reduction effects by 2-fold. We also observed high WSS concentrated at the distal side of the IA neck. As WSS relates to vascular remodeling, following up for distal neck remodeling in post procedure scans could be beneficial to monitor regrowth for SE-treated wide neck IAs.

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.

Stroke, Volume 56, Issue Suppl_1, Page ATMP6-ATMP6, February 1, 2025. Background and Purpose:We report short- and intermediate-term effects on headaches with intra-arterial injection of lidocaine in the middle meningeal artery in patients with severe headaches associated with subarachnoid hemorrhage.Methods:We treated 7 patients with intra-arterial lidocaine in doses up to 50 mg in each middle meningeal artery via a microcatheter bilaterally (except in one patient). We recorded the maximum intensity of headache (graded by 11-point numeric rating scale) prior to procedure and every day for the next 10 days or discharge, whichever came first. We identified changes in the middle meningeal artery pre- and post-intra-arterial lidocaine administration and quantified from Grade 0 (no change) to Grade 5 (severe narrowing or near occlusion of anterior and posterior dural branches or proximal middle meningeal artery that precludes adequate imaging of distal branches).Results:We observed improvement in severity of headaches of headache in all 7 subarachnoid hemorrhage patients. The resolution of headache was immediate and complete in 4 patients, unilateral immediate resolution in one patient, and delayed complete resolution in patient. Only one patient met the definition of severe headache (defined as 2 or more days with maximum pain scores of 8 or greater or need for 3 or more different analgesics for 2 or more days) post treatment on Days 4 and 5. One patient had a relapse in headache with the severity matching pre-treatment severity and required a second treatment. On analysis of angiographic data, there was consistent narrowing of middle meningeal arteries after administration of intra-arterial lidocaine and was graded as 5 in 2 arteries, 4 in 10 arteries, and 3 in 2 arteries.Conclusions:We found that intra-arterial injection of lidocaine can result in consistent amelioration of headache in patients with subarachnoid hemorrhage. The therapeutic benefit may be related to vasoconstriction (reversal of vasodilation) in the middle meningeal arteries after administration of lidocaine.

Stroke, Volume 56, Issue Suppl_1, Page AWP228-AWP228, February 1, 2025. Introduction:Intracerebral hemorrhage (ICH) volume and expansion are important predictors of clinical outcome. Recent results show volumetric thresholds for prediction of poor outcome differ based on the anatomic location (lobar vs deep) of the ICH. In this study we add further atlas-based anatomic detail including lobar and subcortical locations to determine location-specific volume and expansion thresholds for the prediction of poor clinical outcome, hypothesizing that these cut-offs will vary by location.Methods:We analyzed 286 subjects from the MISTIE3 trial that had not undergone surgery prior to imaging analysis. Admission and follow-up CT scans at 24 hours ± 6 hours were analyzed. ICH locations (Basal Ganglia, Thalamus, Frontal, Occipital, Parietal, Temporal) were determined using adjudication and atlas-based methods from day 30 scans. ICH expansion was defined as a 33% or 6ml volume increase. Poor outcome was defined as modified Rankin Scale 4-6. We performed univariate and multivariate analysis using ICH location, age, ICH volumes, time from ictus to scan to identify variables associated with expansion and outcome (P < 0.05). Cutoffs at each location for volume and expansion, and their sensitivity and specificity for predicting outcome were determined using receiver operator characteristic curves.Results:Baseline CT volumes averaged 42.68ml with 41% showing expansion. Multivariate results indicated that the volume in temporal, parietal, occipital and basal ganglia locations and volume expansion in the temporal, parietal, basal ganglia were significant predictors of poor outcome. Volume thresholds for the prediction of poor outcome at the different lobar locations were frontal (46.4ml), temporal (53.7ml), parietal (48.9ml), occipital (57.6ml), basal ganglia (45.0ml). Expansion thresholds for prediction of poor outcome were frontal (13.7ml), temporal (1.20ml), parietal (2.52ml), occipital (6.1ml), basal ganglia (6.20ml). Temporal, parietal and basal ganglia volume and expansion thresholds were significant.Conclusion:Our results add specific lobar locations and their threshold values. Our volumetric expansion associations with outcome suggest that small expansions in the temporal and parietal lobes may be more clinically significant than in other locations. These results indicate that targeting of therapeutic interventions to reduce ICH expansion may have different effects based on specific lobar and deep locations.

Stroke, Volume 56, Issue Suppl_1, Page AWP226-AWP226, February 1, 2025. Objective:Hematoma expansion (HE) predicts disability and death after intracerebral hemorrhage (ICH). Platelet activity is essential for coagulation, and the use of anti-platelet medication (e.g., aspirin, NSAIDs) is associated with increased HE. The impact of pre-ICH anti-platelet medication on HE is incompletely understood. Specific biomarkers of platelet activity would improve our understanding of HE and could point towards targeted treatments. We tested the hypothesis that biomarkers of platelet activity predict subsequent HE.Methods:We prospectively identified patients with spontaneous ICH within 12 hours of symptom onset and measured whole blood with TEG 6s platelet mapping assays to assess platelet function (Hemonetics Inc.). We assessed heparinase kaolin (HKH) to determine the total platelet activation. We measured activated fibrinogen polymerization (ActF) to determine the fibrinogen component. Hematoma volumes for initial and follow-up CTs were calculated using a validated semi-automated method. HE was calculated by measuring the difference in hematoma volume between scans. We calculated the correlation between HE and platelet activity using Spearman’s rank correlation. We constructed a linear regression model to predict HE from ActF and an ActF by pre-ICH anti-platelet interaction term. The interaction term tests the hypothesis that there is an interaction between ActF and HE that varied with pre-ICH anti-platelet medication.Results:There were 38 patients from three metropolitan sites. Fourteen (36.8%) were known to take pre-ICH anti-platelet medication. HKH was negatively correlated with HE (r = -0.30, CI [-0.63, 0.04], P = 0.03), indicating more HKH activity predicted less HE. Results for ActF were dependent upon whether the patient took pre-ICH anti-platelet medication (interaction P = 0.005), where HE was the dependent variable and independent variables included ActF and pre-ICH anti-platelet medication.Discussion:Hemostatic biomarkers predicted subsequent HE in patients with ICH. The association of ActF with HE was dependent on aspirin or NSAIDs use. Potential interventions that improve platelet activity in patients that are high risk for HE deserves further study.Applying for the Mordecai Y. T. Globus New Investigator Award in Stroke

Stroke, Volume 56, Issue Suppl_1, Page ATP56-ATP56, February 1, 2025. Background and Purpose:Stroke is the main cause of disability in the adult population. Only 25% of stroke survivors fully recover their prior level of functioning; 75% survive with some form of impairment, and half of them lose their capacity for self-sufficiency, which has a significantly negative impact on their quality of life. The purpose of this study was to to evaluate the impact of customized training interventions on the experience of the caregiver-stroke survivor dyad during the complex transitional care period.Methods:A critical interpretative meta-synthesis approach was adopted. Sample selection was guided by the SPIDER framework, while identification of eligible studies was informed by the PRISMA criteria. A comprehensive search was conducted across Scopus, PubMed and CINAHL up to October 2023 to identify all studies examining lived experiences and perceptions of caregivers and stroke survivors regarding the suitability of training supports provided during the pivotal transitional care period. The methodological quality and risk of bias were critically evaluated using the authoritative Joanna Briggs Institute Checklist for Quality Assessment and Review Instrument.Results:Out of the 394 articles initially found, only 10 met eligibility criteria and were included. Text analysis revealed two themes that encapsulate the lived experience of caregivers and stroke survivors as related to transitional care supports: 1) acknowledging that life will never be the same and 2) growing recognition of the so-called new normal. The first theme incorporated six significant subthemes. These included the need for information and training, uncertainty about the future, participation, realistic assessments of evolving training needs, coordinated discharge planning; as well as psychological distress. The second one consisted of three interrelated subthemes: variation in perceived roles and responsibility after a stroke, availability and perceived adequacy of post-discharge support, and adapting processes to change.Conclusions:The meta-synthesis provided evidence that a lack of tailored and targeted training support negatively affected both members of the dyad. Unaddressed information and training increased experiences of anxiety, uncertainty, and stress during transitional care. The ability to adapt to post-stroke and achieve a satisfactory quality of life is strongly associated with the informational and training support given during the transitional care period.

Stroke, Volume 56, Issue Suppl_1, Page AWP280-AWP280, February 1, 2025. Background:Effective interventions to lower blood pressure (BP) after stroke are needed, especially for vulnerable populations such as Black individuals and those with post-stroke disability. The TEAMS-BP trial is designed to compare the effectiveness of two evidence-based interventions among stroke survivors with uncontrolled BP.Methods:The Telehealth Enhanced Assessment and Management after Stroke-BP (TEAMS-BP) trial compares Intensive Clinic Management (ICM, in-person medical management with home BP monitoring via daily paper logs and health promotion messaging) vs Intensive Tailored Telehealth Management (ITTM, digital transmission of BP and physical activity, medical management via telehealth, and health coaching) to achieve SBP control (

Stroke, Volume 56, Issue Suppl_1, Page AWP251-AWP251, February 1, 2025. Chronic subdural hematoma (cSDH) represents a relatively treatment-resistant pathologic process with a large impact on quality-adjusted life years. This risk is increased in the elderly, and the prevalence is expected to rise as the population ages. Expectant management and classical surgical treatment are associated with increased recurrence rate as well as complications. Middle meningeal artery (MMA) embolization is being utilized more frequently as adjunctive and primary treatment. It has demonstrated beneficial effects on recurrence and progression of cSDH. Here, we present the outcomes of this technique with different embolic agents in our patient population.IRB approval was obtained for this study. Retrospectively, all patients at a single institution who underwent endovascular MMA embolization with or without open surgical intervention for cSDH were included. Vulnerable populations were excluded. Demographic and medical data were collected at initial, 1-month, and 3-month time points if available and analyzed for differences with unpaired T-test, paired-T test, and chi-square test.Between 2020 and 2024, a total of 50 patients were treated with MMA embolization for cSDH. Mean age was 73 years. Majority were male. Most were on antithrombotic therapy. Of these, 34 had history of prior SDH, and 38 had history of head trauma. Of the 50 patients, 29 patients underwent combined open surgery and MMA embolization, while 21 underwent MMA embolization alone. The cSDH was bilateral in 23 patients and unilateral in 27 (13 right, 14 left) for a total of 73 cSDHs. Surgical evacuation was performed in 44 cSDHs. Liquid embolic agent (Onyx) was utilized for 32 patients, while particulate embolic agents (250-500 um) were utilized for 18 patients. Of the patients who had follow-up CTs at 1 month, there were 21 cSDHs treated with particles and 39 with Onyx. There was no significant difference in the proportions of patients undergoing surgery in addition to MMA embolization between the groups treated with Onyx and those treated with particle embolization. Additionally, there was no significant difference in the proportions of treated hemispheres with ≥ 50% reduction or ≥ 75% reduction between those treated with Onyx and those treated with particles.At our institution, there was no difference in reduction of cSDH with Onyx as compared to particle embolization. MMA embolization was associated with no recurrence or progression of cSDH at 3 months.

Stroke, Ahead of Print. Background:Since treatment with anticoagulants can prevent recurrent strokes, identification of patients at risk for incident AF after stroke is crucial. We aimed to investigate whether the addition of AF polygenic risk scores (PRS) to existing clinical risk predictors could improve prediction of AF after stroke.Methods:Patients diagnosed with ischemic stroke at Massachusetts General Hospital between 2003-2017 were included. Clinical AF risk was estimated using the Re-CHARGE-AF model and genetic risk was estimated using a contemporary AF PRS from 1,093,050 variants. Patients were divided into clinical and genetic risk tertiles. Cox proportional hazards models at different follow-up windows were fit, and C-indices and percentile-based Net Reclassification Index (NRI) were used to determine improvement of clinical risk models with the addition of AF PRS.Results:Of 1004 stroke survivors, 900 (90%) were non-Hispanic White, 413 (41%) were female, and the mean age was 67 (SD 14). Of 1004 survivors, 239 (23.8%) had prevalent AF and 87/765 (11.4%) of the remaining patients developed incident AF during 5 years of follow-up. AF PRS was associated with greater risk of incident AF after stroke (HR 1.16 [95% Confidence Interval (CI) 0.94-1.44] per 1 SD increase), although the association was not statistically significant. PRS improved discrimination in the first month (AUC 0.78 [95% CI 0.70-0.82] vs AUC 0.71 [95% CI 0.60-0.82], p = 0.05), with more modest estimates across longer time windows.Conclusion:Addition of an AF PRS to clinical risk models may improve identification of individuals at risk of AF after stroke, particularly within the first month.

Zani, ‘confidiamo nell’approvazione del Disegno Di Legge’

Isa-Aii, con Stroke Action Plan for Italy obiettivo 90% nel 2030

‘Benefici ancora lontani per i pazienti e tempistiche incerte’

Objective
To examine the prevalence rate of social anxiety disorder (SAD) among university students in Jordan after the COVID-19 pandemic and its associated predictors.

Design
A cross-sectional online survey study that was conducted in Jordan between January and December 2023.
Setting: Universities in Jordan.

Participants
Healthy university students from any specialty currently enrolled at a Jordanian university.

Primary outcome measure
The prevalence rate of SAD, which was assessed using the Social Phobia Inventory.

Results
A total of 851 university students participated in this study. More than half of them (65%) were women. The mean age of the study participants was 21.9 (2.7) years. The majority of them (70.6%) were studying medical fields. The median number of times the study participants got infected with COVID-19 was 1.0 (IQR: 0.0–2.0). The median number of viewing hours spent on social networking sites was 4.0 (IQR: 3.0–6.0). The median SAD score was 19 (IQR: 10–32) out of 68, which represents 27.9% of the maximum attainable score. Up to 45.4% of the study participants were susceptible to SAD, with 12.5% of the study participants reporting severe to very severe SAD symptoms. Students older than 21.9 years were 32% less likely to report SAD symptoms compared with younger students (p

Background
Garment workers are at high risk of musculoskeletal disorders (MSDs) due to repetitive physical tasks, long working hours and varying workstations. As there is no existing epidemiological overview of MSDs among garment workers, this systematic review aimed to evaluate the global evidence on prevalence of MSDs in this population.

Methods
A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus and Web of Science electronic databases were searched to identify studies published in English up to November 2022. Random-effects meta-analysis was used to estimate pooled prevalence.

Results
The search yielded 258 published studies, of which 14 were deemed relevant and were included in this review. The included studies reported prevalence from India (n=3), Bangladesh (n=2), Ethiopia (n=2), Thailand (n=2), Botswana (n=1), Iran (n=1), Sri Lanka (n=1), Cambodia (n=1) and Denmark (n=1) and involved 15 029 garment workers. Most of the included studies (79%) were assessed to be methodologically sound (low risk of bias). The mean age of participants ranged from 24.2 to 40 years. The prevalence of MSDs ranged from 15.5% to 92%. The pooled prevalence of MSDs from nine studies was 65.6% (95% CI 44.5% to 51.9%). Low back pain and neck pain were reported as the common MSDs in the included studies.

Conclusions
The findings highlight the considerable risk of MSDs, especially low back and neck pain, linked to repetitive tasks, extended hours and inconsistent workstations. Given the heavy toll of MSDs on this workforce, targeted interventions and ergonomic improvements are crucial to mitigate the risks and improve garment workers’ well-being.

Objectives
Neonatal pain prevention is not only a humanistic but also an ethical imperative. Fitting with the principles of family-centred care, parental involvement in neonatal pain management plays an active role in infant development and parental well-being. However, the process of parental involvement faces constant challenges. To help structure and implement a family engagement programme in neonatal pain management in the neonatal intensive care unit (NICU), we conducted a scoping review to identify facilitators and barriers to parental involvement in neonatal pain management.

Methods
We conducted the scoping review using the Arksey and O’Malley framework. PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, Wanfang database (Chinese), CNKI (Chinese), VIP database(Chinese) and SinoMed (Chinese) were searched systematically for relevant studies published in English and Chinese from inception up to October 2023. We categorised the facilitators and barriers based on the socioecological model and analysed the results thematically in each category.

Results
Ten English qualitative studies were included in the final analysis. The 34 facilitators and 41 barriers extracted were grouped into 4 domains of the socioecological model framework. Of the 10 facilitator themes, the most critical theme was informational and emotional support. Of the 10 barrier themes, the most frequently reported theme was restricted policies and resources.

Conclusions
Our review highlights the essential roles of intrapersonal and interpersonal factors in parental involvement in pain management while suggesting the interconnectedness of factors in various domains within the context of the socioecological model. It implies that most interventions require development and administration at both intrapersonal and interpersonal levels. Regarding the macrolevel, a broad programme with clear regulatory approaches and targeted guidelines could be developed in the future to drive innovations in NICU pain management mode.

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 (