Care Of Stroke Patients Research Articles

67 A BLENDED MODEL OF CARE USED IN THE ROLLOUT OF AN EARLY SUPPORTED DISCHARGE FOR STROKE SERVICE DURING COVID-19

BackgroundThe Health and Social Care Professionals budget was augmented to develop rehabilitation services that facilitated hospital discharges. Early Supported discharge (ESD) for stroke is a proven model of best care for stroke patients with mild to moderate disability (Langhorne et al., 2005). A pilot was implemented with the team consisting of an Occupational Therapist, Speech and Language Therapist, Physiotherapist and Medical Social Worker.MethodsThe service facilitated an early discharge from the hospital with the delivery of specialist stroke rehabilitation in the home. Therapy is provided with the same intensity and expertise that would be received in hospital and is available for up to 8 weeks, it was provided using a blended model of domiciliary care and the introduction of telehealth in response to COVID 19.Data was recorded for 100 service users using an excel spreadsheet. Data was recorded to measure number of new referrals, length of stay, bed days released back into the hospital system, mode of service delivery and functional outcomes. A cost analysis was completed. Service user experience was captured using questionnaires.ResultsFrom September 2020 to July 2021, 100 patients accessed ESD with a reduction of 7.2 days in hospital stay per patient. Improvements in pre- and post- rehabilitation scores on the FIM/FAM were evident. Very positive feedback regarding the rehabilitation experience was captured within the patient satisfaction questionnaire. Therapy delivery was 60% face to face, 37% via telehealth and 3% outpatient appointments. Telehealth received good compliance but with varying reports of experience in comparison to face to face.ConclusionESD provided in the home environment facilitated earlier discharge from hospital with positive outcomes for the hospital and service users. Telehealth ensured that rehabilitation was maintained throughout the pandemic. Telehealth increased access for patients residing outside of the catchment area. However service user preference remains face to face.

Система надання невідкладної медичної допомоги хворим на мозковий інсульт у м. Києві: оцінка клінічної ефективності тромболітичної терапії та біофлавоноїду кверцетину в лікуванні гострого ішемічного інсульту в різні періоди після його розвитку

Актуальність. Проведено аналіз системи надання невідкладної медичної допомоги хворим із гострим ішемічним інсультом з урахуванням директивних документів, наказів, уніфікованих клінічних протоколів медичної допомоги Міністерства охорони здоров’я України, а також настанов Департаменту охорони здоров’я Київської міської державної адміністрації. Мета: провести аналіз еволюції неврологічного/функціонального відновлення на тлі тромболітичної терапії, оцінити наслідки в ранній і пізній періоди спостереження, терапевтичну ефективність застосування водорозчинної форми біофлавоноїду кверцетину (Корвітину) в лікуванні хворих із гострим ішемічним інсультом, особливості та закономірності відновлення втрачених неврологічних функцій у ранній і віддалений періоди (10 років), а також якість життя пацієнтів у віддалений період. Матеріали та методи. Були проведені клініко-неврологічні та нейровізуалізаційні обстеження 102 хворих із гострим ішемічним інсультом. Залежно від застосованої терапії пацієнти були рандомізовані на дві групи: 1-шу становили 25 пацієнтів (15 чоловіків і 10 жінок) віком від 42 до 80 років (середній вік — 61,7 ± 1,8 року), які отримували внутрішньовенно рекомбінантний людський активатор плазміногену тканинного типу (альтеплаза) — препарат Актилізе; 2-га група — 41 хворий (21 чоловік і 20 жінок) віком від 44 до 63 років (середній вік — 55,1 ± 5,3 року), яким призначали внутрішньовенно водорозчинну форму кверцетину (препарат Корвітин) додатково до стандартної терапії. До контрольної групи, рандомізованої методом випадкової вибірки, увійшли 36 пацієнтів (19 чоловіків і 17 жінок) віком від 40 до 64 років (середній вік — 54,2 ± 5,5 року), які отримували лише стандартну терапію. Результати. Парні порівняння функціональних наслідків між групами кверцетину і стандартної терапії показали, що використання водорозчинного кверцетину зумовлювало статистично вищий показник повного відновлення неврологічних функцій (р < 0,05) у пізній період спостереження, статистично значущими були також наслідки у віддалений період порівняно зі стандартною терапією. Висновки. Отримані результати свідчать про доцільність застосування препарату кверцетин (Корвітин) і тим хворим, яким проводитимуть системний тромболізис, що може значно нівелювати ушкоджувальну дію реперфузії та реперфузійне ушкодження ішемізованої тканини мозку, поліпшуватиме колатеральний кровообіг.

Abstract 10319: Community Socioeconomic and Urban-Rural Differences in Emergency Medical Services Time Intervals for Suspected Stroke Patients in North Carolina

Introduction: Rapid emergency medical services (EMS) response, care, and transport of acute stroke patients increases the likelihood of receiving time-sensitive treatment. There is limited research on the relationship of community factors with prehospital delays in EMS management of stroke. We compared EMS prehospital time intervals for suspected stroke patients by community socioeconomic status (SES) and urban-rural status in North Carolina (NC). Methods: We analyzed 2019 NC EMS encounter data collected in the National EMS Information System Version 3 standard. Eligible patients were adults requiring a 911 call response by EMS for stroke-like symptoms and transport to the hospital. Incident street addresses were geocoded to census tracts using ArcGIS Pro and linked to SES data from the American Community Survey and rural-urban commuting area (RUCA) codes. Community SES was defined as high, medium, or low based on tertiles of the AHRQ SES index. Urban, suburban, and rural tracts were defined by RUCA codes 1, 2-6, and 7-10, respectively. Differences in mean times by community SES and urban-rural status were evaluated using Kruskal Wallis tests. Results: We identified 17,117 eligible EMS encounters of suspected stroke (65% (11,121 of 17,117) 65+ years old; 55% (9,330 of 17,117) female; 70% (11,839 of 17,117) White) from 2,028 tracts. Median response, scene, and transport times were 8 (interquartile range, IQR 6-11) min, 16 (IQR 12-20) min, and 14 (IQR 9-22) min, respectively. Mean transport times were shorter in low SES (16 min) than in medium and high SES communities (17 min, p<.0001). Mean transport times were longer in rural (21 min) and suburban (19 min) than in urban tracts (14 min, p<.0001). Conclusions: EMS transport times were on average longer for suspected stroke patients in rural but not in low SES tracts. Further research is needed on the role of community socioeconomic deprivation and rurality in contributing to delays in prehospital stroke care.

Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials.

IntroductionInfection after stroke is associated with unfavorable outcome. Randomized controlled studies did not show benefit of preventive antibiotics in stroke but lacked power for subgroup analyses. Aim of this study is to assess whether preventive antibiotic therapy after stroke improves functional outcome for specific patient groups in an individual patient data meta-analysis.Patients and methodsWe searched MEDLINE (1946–7 May 2021), Embase (1947–7 May 2021), CENTRAL (17th September 2021), trial registries, cross-checked references and contacted researchers for randomized controlled trials of preventive antibiotic therapy versus placebo or standard care in ischemic or hemorrhagic stroke patients. Meta-analysis was performed by a one-step and two-step approach. Primary outcome was functional outcome adjusted for age and stroke severity. Secondary outcomes were infections and mortality.Results4197 patients from nine trials were included. Preventive antibiotic therapy was not associated with a shift in functional outcome (mRS) at 3 months (OR1.13, 95%CI 0.98–1.31) or unfavorable functional outcome (mRS 3–6) (OR0.85, 95%CI 0.60–1.19). Preventive antibiotics did not improve functional outcome in pre-defined subgroups (age, stroke severity, timing and type of antibiotic therapy, pneumonia prediction scores, dysphagia, type of stroke, and type of trial). Preventive antibiotics reduced infections (276/2066 (13.4%) in the preventive antibiotic group vs. 417/2059 (20.3%) in the control group, OR 0.60, 95% CI 0.51–0.71, p < 0.001), but not pneumonia (191/2066 (9.2%) in the preventive antibiotic group vs. 205/2061 (9.9%) in the control group (OR 0.92 (0.75–1.14), p = 0.450).Discussion and conclusionPreventive antibiotic therapy did not benefit any subgroup of patients with acute stroke and currently cannot be recommended.

Traditional Dietary Therapy for Prevention and Management of Hypertension and Stroke in Africa. What Next?

Hypertension and Stroke are non-communicable diseases that have affected millions of people globally. In Africa, the prevalence of these diseases has increased tremendously. Globally, stroke is the second leading cause of death and in SubSaharan Africa its mortality rate has increased. Poor management and poor access to health care of stroke patients is also a reason for the high mortality rate. About 70% and 40% fatal rate a case in Mozambique and Ghana has been attributed to poor management of stroke. The prevalence of stroke in Sub- Saharan Africa has been estimated to be 14 per 1000 population and a monthly fatality rate of about 40%. Hypertension is one of the comorbidities of cardiovascular disease, stroke, diabetes mellitus, dyslipidemia and heart failure

PENERAPAN LATIHAN RANGE OF MOTION (ROM) PADA KEKUATAN OTOT EKSTREMITAS DENGAN PENDERITA STROKE DI WILAYAH BINAAN PUSKESMAS GUNUNG PATI SEMARANG

The provision of passive ROM therapy in the form of range of motion exercises on the part of extremities experiencing weakness and decubitus, this motion exercise is very useful to avoid complications due to lack of movement such as joint stiffness.. This study aims to knowing the ROM description in nursing care in stroke patients with impaired physical mobility. This case study uses descriptive method. This case study was conducted in 12 – 28 april 2021 by comparing two respondents with the same case and given the same action. The results of the case study conclude the application of passive ROM techniques performed in non– hemorrhagic stroke patients there is a weakness in proximity there is an effective an ineffective,. The results of of increasing muscle strength on Subject I from 5151 to 5352, meanwhile in Subject II from 5151 to 5252, this is because the first patient and his family are very enthusiastic and eager to exercise independently while the second patient have an obesity and his family also have motivation but it still difficult due to the severity of the deases. Application of ROM in both non hemorrhagic stroke patients gave different responses.

PENERAPAN LATIHAN RANGE OF MOTION (ROM) PADA KEKUATAN OTOT EKSTREMITAS DENGAN PENDERITA STROKE DI WILAYAH BINAAN PUSKESMAS GUNUNG PATI SEMARANG

The provision of passive ROM therapy in the form of range of motion exercises on the part of extremities experiencing weakness and decubitus, this motion exercise is very useful to avoid complications due to lack of movement such as joint stiffness.. This study aims to knowing the ROM description in nursing care in stroke patients with impaired physical mobility. This case study uses descriptive method. This case study was conducted in 12 – 28 april 2021 by comparing two respondents with the same case and given the same action. The results of the case study conclude the application of passive ROM techniques performed in non– hemorrhagic stroke patients there is a weakness in proximity there is an effective an ineffective,. The results of of increasing muscle strength on Subject I from 5151 to 5352, meanwhile in Subject II from 5151 to 5252, this is because the first patient and his family are very enthusiastic and eager to exercise independently while the second patient have an obesity and his family also have motivation but it still difficult due to the severity of the deases. Application of ROM in both non hemorrhagic stroke patients gave different responses.

Abstract 1122‐000035: Is Age Critical in Determining Stroke Severity Within the Telestroke Network?

Introduction : Age is the single most important risk factor for stroke and an estimated 75% of all strokes occur in people &gt;65 years of age. In addition, adults &gt;75 years’ experience more hospitalization stays and higher mortality rates with an estimated 50% in the occurrence of all strokes. Several comorbidities have been linked to an increased risk and severity of acute ischemic stroke (AIS). How these factors differentially contribute to the severity of stroke in patients ages &gt;65 and &lt;75 as well as those ≥75 is not known. In this study, we aim to investigate how age, coupled with various clinical risk factors, affects AIS severity within these two age categories. Methods : This retrospective data analysis study was conducted using the data collected from the PRISMA Health Stroke Registry between 2010 and 2016. Baseline clinical and demographic data for patients ages &gt;65 and &lt;75 as well as those ≥75 was analyzed using univariate analysis. Receiver operating characteristic (ROC) curve analysis and multivariate regression models were used to examine the association of specific baseline risk factors or comorbidities associated with worsening or improving neurologic functions. The primary functions were risk factors associated with improving or worsening neurologic outcome in each age category. Results : Adjusted multivariate analysis showed that AIS population of patients &gt;65 and &lt;75 experiencing heart failure (OR = 4.398, 95% CI, 3.912 – 494.613, P = 0.002) and elevated HDL levels (OR = 1.066, 95% CI, 1.009 – 1.126, P = 0.024) trended towards worsening neurologic functions while patients experiencing obesity (OR = 0.177, 95% CI, 0.041 – 0.760, P = 0.020) exhibited improving neurologic functions. For the patients ≥75 years of age, direct admission (OR = 0.270, 95% CI, 0.085 – 0.856, P = 0.026) was associated with improvement of patients treated in the telestroke. Conclusions : Age is a strong risk factor for AIS, and aged stroke patients have higher morbidity and worsening functional recovery than younger patients. In this study, we observed differences in stroke risk factor profiles for &gt;65 and &lt;75 and ≥75 age categories. Heart failure and elevated HDL levels were significantly associated with worsening neurologic functions among AIS for patients aged &gt;65 and &lt;75. Obese patients and individuals ≥75 years who were directly admitted were most likely to exhibit improving neurologic functions. Most importantly, findings from this study reveal specific risk factors that can be managed to improve the care in older stroke patients treated in the telestroke network.

Impact of excessive supraventricular ectopic activity detected in the acute phase of stroke or TIA on AF detection and death within 24 months – results of the prospective MonDAFIS study

Abstract Background/Introduction Detection of atrial fibrillation (AF) and subsequent initiation of oral anticoagulation remain key goals in the care of stroke patients. The European Society of Cardiology guideline recommend continuous ECG monitoring for at least 72 hours in stroke patients without previously known AF. Excessive supraventricular ectopic activity (ESVEA) has been identified as a marker for patients at risk for AF in the general population. Robust data on the clinical relevance of ESVEA detected in the acute phase of ischemic stroke or transient ischemic attack (TIA) are lacking. Purpose To assess the impact of ESVEA (defined as presence of supraventricular beats ≥480/day or at least one atrial run of ≥10 and &amp;lt;30 seconds during continuous ECG monitoring for 72 hours) in patients with acute ischemic stroke/TIA without (previously) known AF on recurrent stroke, all-cause death and detection of a first episode of AF within 24 months. Methods The investigator-initiated, prospective, open, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke study randomized 3,465 acute stroke patients without known AF 1:1 to usual diagnostic procedures for AF detection or additive Holter-ECG recording for up to seven days in-hospital (NCT02869386). ECG core-lab analysis included the number of atrial ectopic beats per day, the number of atrial runs as well as the duration of the longest atrial run per 24 hours. Patients were followed-up for two years. Secondary study objectives include the comparison of recurrent stroke, myocardial infarction, major bleeding and all-cause death in ESVEA patients, patients with newly diagnosed AF vs. non-ESVEA patients with sinus rhythm at baseline. Data were analyzed using Fisher's exact test. Results In 1,714 patients randomized to the intervention group, 1,693 (98.8%) had analyzable ECG recordings of a median duration of 121 hours (IQR 73–166). 1,435 (84.8%) patients had continuous ECG monitoring for the first 72 hours. At this time, ESVEA was detected in 363 (25.3%) of 1,435 patients, while a first episode of AF was detected in 48 (3.3%). At 24 months, AF was newly detected in 57 (15.7%) ESVEA patients vs. 53 (6.2%) non-ESVEA patients (p&amp;lt;0.001) with available follow-up. At 24 months, 68 (24.5%) ESVEA patients vs. 77 (9.0%) non-ESVEA patients were on oral anticoagulation (p&amp;lt;0.001). The composite of recurrent stroke, myocardial infarction, major bleeding and death at 24 months did not differ significantly between ESVEA patients vs. non-ESVEA patients (14.3% vs. 11.6%; p=0.389). However, all-cause death was higher in ESVEA patients (6.6% vs. 3.1% in non-ESVEA patients; p=0.01). Conclusions ESVEA detected after acute ischemic stroke/TIA identifies patients at high-risk for AF and may be used to guide prolonged ECG monitoring. The higher risk of death in ESVEA patients vs. non-ESVEA patients within 24 months after stroke/TIA deserves further investigation. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Bayer Vital GmbH, Bayer HealthCare Pharmaceuticals, Germany.

Impact of COVID-19 pandemic on acute stroke care-data analysis from the RES-Q registry 2020 in N. Macedonia

Since 2017, the Department of Urgent Neurology at the University Clinic of Neurology in N. Macedonia has implemented the Angels Initiative and the RES-Q Registry, in order to evaluate and optimize the quality of care of acute stroke patients. The aim was to analyze acute stroke data in 2020 and evaluate the impact of COVID-19 pandemic on acute stroke care.

CLINICAL AND ORGANIZATIONAL QUALITY INDICATORS IN THE ACUTE PHASE FOR OPTIMAL STROKE MANAGEMENT IN ADULTS: A SCOPING REVIEW

<h3>BACKGROUND/PURPOSE</h3> Optimal interdisciplinary care and services for stroke patients and their caregivers are critical factors in recovery and quality of life following the initial event. In order to measure current practices in organizations, several indicators have been developed and are used to monitor quality of care for people who had a stroke. However, few studies have been conducted on the identification and the measurement of these indicators in the stroke acute phase. The purpose of this scoping review is to identify clinical and organizational indicators relevant to monitor quality of post-stroke care during this important phase for patients, family caregivers, health professionals and managers. <h3>METHODS/RESULTS</h3> A scoping review based on the 6 steps of Arskey and O'Malley methodological framework was conducted in electronic databases (Medline, CINHAL, EBSCO, Cochrane Library, Google Scholar and Google). Grey literature and all scientific studies conducted and published between 2015 and 2021, in French and English, have been selected based on inclusion criteria. A second independent reviewer participated in study selection and data extraction. All identified indicators have been classified to measure concepts of care performance (accessibility, equity of access, efficiency, safety, patient and family responsiveness, continuity of care, efficiency and viability). A final list of indicators will be revised by a panel of clinical and scientific experts using a Delphi process. These experts will give their opinion on the relevance, validity, reliability, feasibility, usability and comparability of the identified indicators. A total of 3562 references has been identified. Of these, 25 were included in the review, but only 8 of them are research studies. A total of 242 indicators have been identified. Most of them are from grey literature and guidelines. Majority of the indicators have been classified according to the concept of safety and relate to the management of stroke complications. Few indicators relate to the concepts of equity of care and patient responsiveness. <h3>CONCLUSION/IMPLICATIONS FOR PRACTICE</h3> This scoping review highlights clinical and organizational indicators that should be monitored to improve stroke management and clinical practice in the acute phase. It also justifies the need to conduct further studies to improve the measurement of quality indicators in clinical practice during this key phase of the stroke trajectory.

POST STROKE DEPRESSION AND ANXIETY: PREVALANCE AND CORRELATES

Objectives: The objective of the study is to evaluate the prevalence of depression and anxiety in post-stroke patients and identify its predictors. Materials and Methods: This study was conducted for a period of 6 months among 81 patients admitted with stroke in SSIMS and RC, Davangere. The information compiled from patient data collection form was assessed for comorbid conditions and type of stroke. Assessment for depression and anxiety was conducted using Hamilton D (HAM-D) and HAM-A scale and information of location of lesion was obtained from patient’s neuroimaging results. Quality of life (QOL) of post-stroke was assessed using stroke and aphasia QOL (SAQOL) questionnaire. Follow-up was conducted for patients who were diagnosed with depression and anxiety within 1 to 3 months. Results: Depression was more prevalent as compared to anxiety in post-stroke patients and was predominant in males and between the ages 61 and 70 years. Hypertension and diabetes were found to be a major comorbid conditions in such patients. Factors contributing to increased risk of depression and anxiety after stroke include age, sex, comorbidities, lesion location, and type of stroke. Post-stroke depression (PSD) and anxiety showed statistically significant association with left-sided lesion. Conclusion: PSD and anxiety are a relatively common complications and can result in poor QOL in stroke patients. Early detection of depression and anxiety symptoms may assist functional recovery and improve QOL in stroke patients. Careful evaluation of PSD and post-stroke anxiety should be integrated into clinical care of stroke patients.

Effect of Caregivers Training Program on Stroke Patients' Self-Efficacy

Background: Stroke is a major cause of disability in adults and elderly. Chronic complications arising from this disease have impact on the affected patients' reduced self- efficacy. Aim: Evaluate the effectiveness of caregiver training program on stroke patient's self-efficacy. Quasi-experimental design was utilized. Setting: The study conducted in the departments and outpatient clinics of neuropsychiatric diseases and neurosurgery hospital at Assiut University Hospitals. Sample: Caregivers and their patients admitted to neuropsychiatric diseases and neurosurgery hospital, during 6 months (equal number of 125 for both). Tools: Include four tools. Tool 1 structured interview questionnaires. Tool II: Caregivers’ knowledge about stroke. Tool III: Caregivers' practices regarding stroke patients' care. Tool IV: Stroke Self-Efficacy Questionnaire (SSEQ). Results: 95.2% of caregiver's have unsatisfactory knowledge about stroke in pre-program, compared to 84.8% and 76.0% have satisfactory knowledge at post program and follow up; respectively. Also, caregiver practices levels of patient's care were 100% inadequate in pre-program. These levels improved to adequate practice in post program and follow up (72.0% & 75.2%); respectively. A statistically significant difference of stroke patient's self-efficacy through training program p =0.000. Conclusion: A caregivers training had a positive effect on stroke patient's self‐efficacy. Recommendations: Continues caregivers training regarding care of stroke patients.

A full year of the COVID-19 pandemic with two infection waves and its impact on ischemic stroke patient care in Germany.

Background and purposeMany countries worldwide, including Germany, reported that the first wave of the coronavirus disease 2019 (COVID‐19) pandemic in early 2020 influenced the care of acute ischemic stroke (AIS) patients, but data are lacking for further pandemic wave periods.MethodsWe conducted a nationwide, retrospective, cross‐sectional study of all hospitalized patients with the main diagnosis of AIS in 2019 and 2020. Primary outcomes were the number of hospitalizations for AIS, the application of stroke unit care, intravenous thrombolysis (IVT), and mechanical thrombectomy (MT), as well as the in‐hospital mortality during the different pandemic periods in 2020 compared to the corresponding periods in 2019. Secondarily, we analyzed differences in outcomes between patients with and without concurrent COVID‐19.ResultsWe included 429,841 cases with AIS, of which 1268 had concurrent COVID‐19. Hospitalizations for AIS declined during both pandemic wave periods in 2020 (first wave: −10.9%, second wave: −4.6%). MT rates were consistently higher throughout 2020 compared to 2019, whereas the IVT rate dropped during the second wave period (16.0% vs. 17.0%, p < 0.001). AIS patients with concurrent COVID‐19 frequently received recanalization treatments, with an overall MT rate of 8.4% and IVT rate of 15.9%. The in‐hospital mortality was high (22.8% vs. 7.5% in noninfected AIS patients, p < 0.001).ConclusionsThese findings demonstrate a smaller decline in hospitalizations for AIS in the more severe second wave of the COVID‐19 pandemic. AIS patients with and without concurrent COVID‐19 who did seek acute care continued to receive recanalization treatments in Germany.

Association Between Weight Loss and Activities of Daily Living in Obese and Overweight Patients after Stroke: A Cross-Sectional Study

ObjectiveWhether weight loss during hospitalization is associated with improvement in activities of daily living (ADL) in overweight and obese stroke patients remains unclear. This study investigated the association between decreases in body mass index (BMI), fat-free mass (FFM), and fat mass (FM) and ADL improvement. Materials and methodsIn this cross-sectional study, we analyzed data of patients admitted to acute care hospitals with stroke. Patients were classified into two groups based on their change in BMI during their hospital stay (i.e. decreased or nondecreased group). To control and adjust for patient characteristics and confounders, we created an inverse probability-weighted (IPW) model using propensity scoring, which was used to compare the Functional Independence Measure Motor (FIM-M) efficacy between the two groups. We also compared FFM and FM between admission and discharge in each group. ResultsA total of 556 patients were analyzed, among whom 391 (70.3%) had a decrease in BMI and 165 (29.7%) had a nondecrease. After IPW adjustment, efficiency of FIM-M was significantly higher in the nondecreased group as compared to that in the decreased group (median: 0.44 vs. 0.29, P < 0.001). FFM and FM were significantly decreased from admission to discharge in the decreased group, but there was no significanct difference observed in the nondecreased group. Preserving BMI during hospitalization was associated with a positive improvement in ADL in overweight and obese stroke patients undergoing rehabilitation. ConclusionsRisks and benefits of weight loss should be balanced in nutritional care and rehabilitation for overweight and obese stroke patients.

Quality assurance data for regional drip-and-ship strategies- gearing up the transfer process

BackgroundStroke patients with large vessel occlusion (LVO) require endovascular therapy (EVT) provided by comprehensive stroke centers (CSC). One strategy to achieve fast stroke symptom ‘onset to treatment’ times (OTT) is the preclinical selection of patients with severe stroke for direct transport to CSC. Another is the optimization of interhospital transfer workflow. Our aim was to investigate the dynamics of the OTT of ‘drip-and-ship’ patients as well as the current ‘door-in-door-out’ time (DIDO) and its determinants at representative regional German stroke units.MethodsWe determined the numbers of all EVT treatments, ‘drip-and-ship’ and ‘direct-to-center’ patients and their median OTT from the mandatory quality assurance registry of the federal state of Hesse, Germany (2012–2019). Additionally, we captured process time stamps from primary stroke centers (PSC) in a consecutive registry of patients referred for EVT in our regional stroke network over a 3 months period.ResultsAlong with an increase of the EVT rate, the proportion of drip-and-ship patients grew steadily from 19.4% in 2012 to 31.3% in 2019. The time discrepancy for the median OTT between ‘drip-and-ship’ and ‘direct-to-center’ patients continuously declined from 173 to 74 min. The largest share of the DIDO (median 92, IQR 69–110) is spent with the organization of EVT and consecutive patient transfer.Conclusions‘Drip-and-ship’ patients are an important and growing proportion of stroke patients undergoing EVT. The discrepancy in OTT for EVT between ‘drip-and-ship’ and ‘direct-to-center’ patients has been reduced considerably. Further optimization of the DIDO primarily aiming at the processes after the detection of LVO is urgently needed to improve stroke patient care.

Stroke and COVID-19 Pandemic: The Dilemma

Background: While the COVID-19 pandemic affected more than thirty million people world-wide, still the true link between COVID-19 and the incidence of stroke remains to be elucidated. Methods: Herein, we briefly discuss virology of COVID-19 and approaches for diagnosis and treatment of COVID-19 patients, as well as the mechanisms that link stroke and COVID-19. Results: Many pathophysiologic and immunologic mechanisms have been implicated in stroke occurring among patients with COVID-19. COVID-19 pandemic has, in different ways, negative impacts on the care of stroke patients world-wide, and still, neurologists have to face many challenges to improve the care of stroke patients during such crisis. Conclusions: Although the control of the COVID-19 is of crucial importance, at the same time, the management of stroke must not be neglected. Therefore, preserving care for critical conditions such as stroke, and providing strategies to ensure this continues, have a priority even during the crisis. Till vaccine is available for COVID-19, strategies for rapid diagnosis and those for treating patients with that disease are evolving. Further studies are warranted.

Update of the World Stroke Organization Activities.

Update of the World Stroke Organization Activities.

Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (MRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.