Number Of Stroke Patients Research Articles

The Investigation on the Burden of Neurology Residents to Manage the Patient who Received Thrombolytic Treatment in the Emergency Department with Hyperacute Stroke

Background: Because Korea is the fastest aging country, the stroke incidence is increasing rapidly. We investigate the trend of the number of patients with acute stroke in recent years and estimate the burden of the neurologist to treat the acute stroke patient visited the emergency department.Methods: We requested a questionnaire survey to all teaching hospitals on the number of hospital beds, the number of stroke patients who visited the emergency department, the number of stroke patients in charge of the neurologist, and the number of days on duty of residents from 2016 to 2019.Results: Of 69 teaching hospitals, 41 hospitals answered the survey. The average hospital beds per hospital were increased annually from 909 to 916. The average patients who visited the emergency department with stroke and were in charged to neurologists were rapidly increased from 799 to 867 per hospital. In particular, the number of patients with hyperacute cerebral infarction requiring the thrombolytic administration or mechanical thrombectomy were rapidly increased from 105 to 131. On the other hand, the average number of residents per hospital was decreased from 5.1 to 4.8. Therefore, the days on duty per resident were increased from 74 to 77.Conclusions: The number of acute stroke patients, especially, hyperacute stroke required the rapid cooperation and high labor were increasing rapidly in recent years. However, because the number of residents were decreased, the burden was increasing. To improve the quality of acute stroke treatment, it is necessary to increase the number of residents.

Multi-point surface FES hand rehabilitation system for stroke patients based on eye movement control

Recently, the number of stroke patients has increased greatly. Most of them suffer from hand motor impairment, which creates the need for effective rehabilitation systems. Functional electrical stimulation (FES) is a neurorehabilitation method based on brain plasticity, which is widely accepted because it is non-invasive and convenient. However, it is still a challenge to achieve fine finger control by using surface FES. Here, we use multi-point surface FES to achieve individual finger motion. Besides, simple FES does not engage the subjects' attention, and an optimal stimulation position is difficult to identify. Hence, we try to integrate FES with sensory control by presenting a multi-point FES system based on eye movement control. By programming the electrodes display interface and establishing communication with the FES device and the eye tracker, subjects can change stimulation points via their eye movements. Experiments were performed to test the validity and safety of the proposed system. Feedback data was obtained using a 3D motion capture device. The results indicate that achieving individual finger motion is possible and stimulation points can be changed via eye movements. The system is practical and can be used in hand motor training for stroke patients to shorten the rehabilitation period.

Comparative Analysis of COVID-19 Outbreak and Changes in Neurosurgical Emergency Patients.

ObjectiveCOVID-19 has spread worldwide since the first case was reported in Wuhan, China, in December 2019. Our institution is a regional trauma and emergency center in the northern Gyeonggi Province. The changing trend of patient care in the emergency room of this hospital likely reflects the overall trend of patients in the area. In the present study, whether changes in the surrounding social environment following the outbreak of COVID-19 changed the incidence of neurosurgical emergency patients and whether differences in practice existed were investigated. MethodsThe overall trend was analyzed from January 2020 which is before the outbreak of COVID-19 to September 2020. To remove bias due to seasonal variation, the previous 2 year's records during the same period were reviewed and compared. Confirmed COVID-19 patients in the northern Gyeonggi Province were identified using data released by the government. And patients who came to the emergency department with head trauma and stroke were identified. ResultsBased on the present study results, the total number of neurosurgery emergency patients decreased over the study period. In the trauma patient group, the number of patients not involved in traffic accidents significantly decreased compared with patients involved in traffic accidents. Among the stroke cases, the rate of ischemic stroke was lower than hemorrhagic stroke, although a statistically significant difference was not observed. Meanwhile, an increase in the risk of mortality associated with trauma or stroke cases was not observed during the COVID-19 outbreak compared with the same time period in the previous year. ConclusionDue to the occurrence of COVID-19, non-essential activities have decreased and trauma cases not associated with traffic accidents appeared to decrease. Due to the decrease in overall activity, the number of stroke patients has also decreased. This trend is expected to continue even in the post-COVID-19 era, and accordingly, the results from the present study are relevant especially if the current situation continues.

Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India

BackgroundAs the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected. AimsThe present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019. MethodsThe COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points. ResultsA total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods. ConclusionsAlthough stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.

Abstract P360: Clot Burden Score and Collateral Score: Emerging Predictors of Outcome

Introduction: With the recent advancement, there are still large number of stroke patients who end up with poor outcome despite getting thrombectomy. Clot extent, location, and collateral integrity are found to be important determinants of outcome in acute stroke. The CBS is a scoring system (0-10) to define the extent of thrombus on CTA. The collateral grading system is scored on a scale of 0-3 on CTA. The purpose of this study is to compare the relationship of clot extent and collaterals with clinical and radiological outcome. Hypothesis: A novel clot burden score (CBS) and collateral score (CS) are important determinants of outcomes and serve as useful additional stroke outcome predictors. Methods: One hundred and twenty eight stroke patients with large vessel occlusion who underwent endovascular thrombectomy in our institution were reviewed retrospectively. CBS and CS were calculated on CTA by a neuroradiologist and a vascular neurologist and reached a consensus who were blinded about clinical information. Patients were dichotomized using collateral scores as good (>/=2) vs bad collaterals (0-1). Univariate and multivariate analysis is performed. Results: A total of 128 patients included in the study. Poor collateral is found to be associated with prior history of Afib (47% vs 32%) whereas smoking is found to be associated with good collaterals (38% vs 29%). Low CBS (higher clot burden) is associated more with poor collaterals (70% vs 46%). Poor collateral is associated with higher inhouse mortality (23% vs 9%) and increase number of patients with mRS of 5-6 at 3 months (42% vs 21%). Revascularization rate TICI 2b-3 is not found to be significantly associated with the degree of collaterals (93% with good collaterals whereas 78% in poor collaterals) Conclusions: CBS and CS are useful additional markers predicting clinical and radiologic outcomes and could be potentially used clinically as an adjunct to other imaging and clinical features to stratify patient risk better.

RETRACTED: Impact of the COVID-19 Pandemic on Stroke Epidemiology and Clinical Stroke Practice in the US

IntroductionTo examine the impact of the COVID-19 pandemic on stroke, the number of stroke patients, time since last known well (LKW), morbidity, and mortality of stroke patients in Southwest Healthcare System (SHS), California (CA) and the United States (US) were analyzed during 2019 and compared to 2020. Our hypothesis is that there are regional differences in stroke outcome depending on location during the COVID-19 study period which influences stroke epidemiology and clinical stroke practice.MethodsThe American Heart Association's ‘Get with the Guidelines’ (GWTG) database was used to evaluate the following categories: code stroke, diagnosis of stroke upon discharge, inpatient mortality, modified Rankin Score (mRS) upon discharge (morbidity), and time since last known well (LKW). Stroke registry data from February through June 2019 and 2020 were collected for retrospective review.ResultsThe total number of strokes decreased in the US and CA, but increased in SHS during the COVID-19 study period. The US and SHS demonstrated no change in stroke mortality, but CA demonstrated a higher stroke mortality during the COVID-19 pandemic. There was greater loss of independence with increased stroke morbidity in the US during the COVID-19 pandemic. There was a significant increase in time since LKW in the US and SHS, and an increase trend in time since LKW in CA during the COVID-19 study period.DiscussionTo understand the impact of the COVID-19 pandemic on stroke epidemiology, we propose that all stroke inpatients should receive a SARS-CoV-2 detection test and this result be entered into the GWTG database. We demonstrate that the regional distribution of stroke mortality in the US changed during the COVID-19 study period, with increased stroke mortality in CA. Stroke morbidity throughout the US was significantly worse during the COVID-19 pandemic. We propose methods to address the impact of the COVID-19 pandemic on clinical stroke practice such as the use of mobile stroke units, clinical trials using anti-inflammation drugs on SARS-CoV-2 positive stroke patients, and COVID stroke rehabilitation centers.

An observational study to analyze the risk factors associated with stroke in West Rajasthan, India

Background: The recent years have witnessed a surge in the incidence of stroke cases worldwide. Stroke is the most common neurological emergency. It is the second most known common cause of death and one among the major cause of disability worldwide. Aim and Objectives: The main aim of this study is to analyze the major associated risk factors in stroke and assess the awareness among the survivors for the same. Material and Methods: This was a prospective, cross-sectional, observational study, conducted among 100 patients in both sexes in the age group of 25–75 years admitted in Neurology and General Medicine ward at Mathura Das Mathur Hospital, Dr. Sampurnanand Medical College, Jodhpur. The information was collected by previously designed questionnaire. The data were collected and analyzed using appropriate statistical tests. Results: In our study, 100 patients with stroke were included. Out of these 100 patients, 72% of patients suffered an ischemic stroke and 28% a hemorrhagic stroke. The incidence of stroke was predominant in male with 55% followed by females (45%). With increasing age, the number of stroke patients also increased. Among the 100 selected, 37 patients were below 50 years of age and out of these, 26 showed ischemic and 11 showed hemorrhagic type of stroke. In patients above 50 years, 63 patients were found, in them, 46 showed ischemic and 17 showed hemorrhagic type of stroke. About 63% of stroke patients were found >50 years age group. It was found that the most common comorbid condition in stroke patients was hypertension (47%) followed by diabetes (21%). Family history of stroke was seen in 18% and dyslipidemia in 17%. Fourteen patients have IHD and 10% of patients have a family history of cardiovascular disease. Conclusion: This study concluded that with increasing age, the number of stroke patients also increases and hypertension is the most common cause or risk factor for disease.

Treatment Outcome and Its Determinants among Patients Admitted to Stroke Unit of Jimma University Medical Center, Southwest Ethiopia.

Background Stroke is a public health problem in Ethiopia. Despite the high prevalence of stroke in Ethiopia, there is a paucity of data with regard to drug treatment, treatment outcome, and risk factors of poor treatment outcome of stroke. Hence, this study is aimed at assessing treatment outcome and its determinants among patients admitted to stroke unit of Jimma University Medical Center (JUMC). Methods A two-year hospital-based retrospective cross-sectional study was employed to analyze the medical records of patients admitted with stroke to stroke unit of Jimma University Medical Centre from February 1st, 2016 to March 30th, 2018. Data was entered by Epidata manager version 4.0.2 and analyzed by SPSS version 24. Multivariable logistic regression analysis with the backward stepwise approach was done to identify independent predictors of poor treatment outcome of stroke. Variables with P value less than 0.05 were considered as statically significant determinants of poor treatment outcome. Results Of 220 patients with stroke admitted to the Jimma University, 67.30% were male. Nearly two thirds (63.18%) of them had poor treatment outcomes. Dyslipidimics were administered to 60% of the patients, and the most popular antiplatelet used was aspirin, which was prescribed to 67.3% the patients. Age ≥ 65 adjusted odd ratio ((AOR): 2.56; 95% CI: 1.95-9.86, P = 0.001), presence of comorbidity (AOR: 5.25; 95% CI: 1.08-17.69, P < 0.001), admission with hemorrhagic stroke (AOR: 18.99; 95% CI: 7.05-42.07, P < 0.001), and admission to the hospital after 24 hour of stroke onset (AOR: 4.98; 95% CI: 1.09-21.91, P = 0.03) were independent predictors of poor treatment outcomes. Conclusion Substantial numbers of stroke patients had poor treatment outcomes. Elderly patients, patients diagnosed with hemorrhagic stroke, patients with comorbidity, and those with delayed hospital admission were more likely to have poor treatment outcome. Hence, frequent monitoring and care should be given for the aforementioned patients. Awareness creation on the importance of early admission should be delivered particularly for patients who have risk factors of stroke (cardiovascular diseases).

Cardiology cathlab-based management of thrombotic carotid stenoses in acute ischaemic stroke en route to full interventional stroke service: tools, techniques, challenges and patient outcomes

Abstract Background Shortage of endovascular operators able to deliver manual thrombectomy in acute ischemic stroke (AIS) on a 24/7/365 basis is a main challenge in many health care settings around the world. Another fundamental barrier is getting multispecialy teams to work collaboratively with each other in AIS as is already done (albeit on an elective rather than acute basis and in absence of “territorial” issues) in managing stroke mechanistic pathologies such as atrial fibrillation (pharmacology/ablation) or PFO (diagnosis/closure). Purpose To establish a practical path towards a clinically and orranizationally effective cardiology cathlab-based acute ischaemic stroke service, including intracranial manual thrombectomy, in a large multi-specialty hospital with a high-volume stroke unit but absence of neuroradiology service. Methods Withn a symptomatic and increased-stroke-risk asymptomatic carotid stenosis all-comer endovascular revascularization study (NeuroVascular Team decision-making) we have treated, on an emergent basis, 17 patients (13 men, age 58–75 years, median 67 years) with AIS caused by severe thrombotic carotid artery stenoses. All cases were performed as part of our pathway towards a full 24/7 thrombectomy stroke service. Results All lesions (100%) were thrombotic (mobile thrombus - 29%). Proximal neuroprotection (flow reversal using a common carotid artery±external carotid artery occlusive balloon/s) was used in 15/17 patients (88%). In 2 patients (12%) filter protection was applied as proximal system use was unfeasible for anatomic or clinical reasons. All cases were done under activated clotting time control and using a micronet-covered embolic prevention stent system that was routinely optimized -under an effective neuroprotection- with large balloons/high pressures. There were no procedure- or device-related complications. TIMI/TICI-3 was achieved in all cases. Vascular access closure device use was 76%. A 30-day good clinical outcome (mRS of 0–2) rate was 94%. One patient had a haemorrhagic stroke transformation that finally led to death. By 30 days no new stroke, stent thrombosis, myocardial infarction or other SAE occurred Conclusions Cardiologists skilled in carotid interventions are naturally positioned to deliver AIS treatment. 24/7 interventional services and networks for acute myocardial infarction have long been established and, as demonstrated in our centre, the services and skills can be translated -in collaboration with a local stroke unit/neurology- to AIS. Breaking away from traditionally-perceived “territories” towards working as a multispecialy AIS team is a logical concept that provides an effective healthcare solution for large numbers of stroke patients currently needing -and not receving- thrombectomy. Working hand in hand with neurology and radiology in managing acute carotid syndromes is thus part of a natural evolution towards full interventional stroke services including thrombectomy. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Jagiellonian University Medical College

Social Network Simulation Identifies Persistent Racial Disparities Of Delay To Hospital In Acute Ischemic Stroke Patients

Background Delayed arrival to the hospital remains the major reason for not deploying stroke therapies. In the United States, minority patients have longer delays that have not been adequately understood nor acted upon. Social context plays a key role, because most strokes occur in front of witnesses who influence decision-making. We created a social network simulation to understand the interpersonal factors that influence decision-making following acute stroke, particularly in minority patients. Methods We developed an interactive microsimulation model of individual traits and social contextual factors that contribute to decision-making. The inputs into this parsimonious model were based on the largest empirical studies and included: stroke severity, use of Emergency Medical Services (EMS), race, and social network size. The model outputs were the number of stroke patients who arrived at the hospital early (≤3 hours) and late (>3 hours). For each run of the model, 1,000 stroke patients decided to go to the hospital early or late based on individual and social contextual factors. Two sample t-tests were used to compare means between white and non-white patients. Results In 1.03 million simulations, the model reproduced observed population trends of delay. The overall mean percent of early arrivers was 25.2% (SD 0.02), which matched national metrics showing good calibration of the model. Race predicted delay and modified the relationship of the main effects. 17.9% of non-white patients arrived early compared to 28.3% of white patients (p Conclusion A social network simulation reproduced persistent racial disparities of delayed arrival allowing for novel interventions to be tested on this platform.

Radiology workload in clinical implementation of thrombectomy for acute ischemic stroke: experience from The Netherlands.

To investigate the number of acute stroke patients undergoing CT angiography (CTA) for suspected large vessel occlusion (LVO) and those eligible for thrombectomy in relation to the population. Consecutive patients in a Western population who underwent CTA for suspected LVO of the proximal anterior circulation between January and August 2019 were included. The date and time of CTA and the number of patients eligible for thrombectomy were assessed. Our hospital's service area population was estimated using the Central Bureau for Statistics data. One-way analysis of variance with post-hoc tests and chi-squared tests were used for statistical analyses. Of 520 patients (49% males, mean age of 72years) undergoing CTA, 84 (16.2%) were eligible for thrombectomy. Our hospital's service area population was estimated at 420,000. Therefore, 3.6 CTA scans were performed and 0.6 patients were eligible for thrombectomy per 100,000 people per week. The number of patients undergoing CTA and the number of patients eligible for thrombectomy both did not significantly differ between any days of the week (P > 0.05). A total of 236 (45%) and 284 patients (55%) underwent CTA during office and on-call hours, respectively. The percentage of patients eligible for thrombectomy did not significantly differ between office and on-call hours (P = 0.834). Our study estimated the number of stroke patients undergoing CTA for suspected LVO and those eligible for thrombectomy in relation to the population. Numbers were essentially the same throughout the week, and during office and on-call hours. Our data can be used to make adequate staffing plans.

Inverse National Trends in Decompressive Craniectomy versus Endovascular Thrombectomy for Stroke

Endovascular thrombectomy (ET) for acute large vessel occlusion reduces infarct size, and it should hypothetically decrease the incidence of major ischemic strokes requiring decompressive craniectomy (DC). The aim of this retrospective cohort study is to determine trends in the utilization of ET versus DC for stroke in the United States over a 10-year span. We extracted data from the Nationwide Inpatient Sample using International Classification of Diseases-9/10 codes from 2006-2016. Patients with a primary diagnosis of stroke were included. Baseline demographics, outcomes, and hospital charges were analyzed. The study cohort comprised 14,578,654 patients diagnosed with stroke. During the study period, DC and ET were performed in 124,718 and 62,637 patients, respectively. The number of stroke patients who underwent either ET or DC increased by 266% from 2006 to 2016. During that time period, the ET utilization rate increased (0.19% in 2006 to 14.07% in 2016, P < 0.0004), whereas the DC utilization rate decreased (7.07% in 2006 to 6.43% in 2016, P < 0.0001). In 2015, the utilization rate of ET (9.73%) exceeded that of DC (9.67%). ET-treated patients had shorter hospitalization durations (mean 8.8 vs. 16.8 days, P < 0.0001), lower mortality (16.2% vs. 19.3%), higher likelihood of discharge home (27.1% vs. 24.1%, P < 0.0001), and reduced hospital charges (mean $189,724 vs. $261,314, P < 0.0001). We identified an inverse relationship between national trends in rising ET and diminishing DC utilization for stroke treatment over a recent decade. Although direct causation cannot be inferred, our findings suggest that ET curtails the necessity for DC.

Incidence of oral anticoagulant interruption among stroke patients with atrial fibrillation and subsequent stroke.

We analyzed the incidence and causes of oral anticoagulant (OAC) cessation and subsequent stroke after OAC withdrawal in a cohort of Korean stroke patients with atrial fibrillation. The Korean Atrial Fibrillation Evaluation Registry in Ischemic Stroke patients (K-ATTENTION) is a multicenter cohort study, merging stroke registries from 11 tertiary centers in Korea. The number of OAC interruption episodes and the reasons were reviewed from hospital records. Stroke after OAC withdrawal was defined when a patient experienced ischaemic stroke within 31days after OAC withdrawal. Clinical variables were compared between patients who experienced stroke recurrence during OAC interruption and those who did not experience recurrence. Among 3213 stroke patients with atrial fibrillation, a total of 329 episodes of OAC interruption were detected in 229 patients after index stroke (mean age 72.9±8.3years, 113 female patients). The most frequent reason for OAC withdrawal was poor compliance [103 episodes (31.3%)] followed by extracranial bleeding [96 episodes (29.2%)]. Stroke after OAC withdrawal was noted in 13 patients. Mean age, vascular risk factor profile and mean CHA2 DS2 -VASc score were not significantly different between patients with and without recurrent stroke. A considerable number of stroke patients with atrial fibrillation experienced temporary interruption of OAC after index stroke, which was associated with stroke recurrence of 4.0 cases per 100 interruption episodes.

Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport.

Background: Mobile stroke units (MSUs) are the latest approach to improving time-sensitive stroke care delivery. Currently, there are no published studies looking at the expanded value of the MSU to diagnose and transport patients to the closest most appropriate facility. The purpose of this paper is to perform a cost consequence analysis of standard transport (ST) vs. MSU.Methods and Results: A cost consequence analysis was undertaken within a decision framework to compare the incremental cost of care for patients with confirmed stroke that were served by the MSU vs. their simulated care had they been served by standard emergency medical services between July 2014 and October 2015. At baseline values, the incremental cost between MSU and ST was $70,613 ($856,482 vs. $785,869) for 355 patient transports. The MSU avoided 76 secondary interhospital transfers and 76 emergency department (ED) encounters. Sensitivity analysis identified six variables that had measurable impact on the model's variability and a threshold value at which MSU becomes the optimal strategy: number of stroke patients (>391), probability of requiring transfer to a comprehensive stroke center (CSC, >0.52), annual cost of MSU operations (<$696,053), cost of air transfer (>$8,841), probability initial receiving hospital is a CSC (<0.32), and probability of ischemic stroke with ST (<0.76).Conclusions: MSUs can avert significant costs in the administration of stroke care once optimal thresholds are achieved. A comprehensive cost-effectiveness analysis is required to determine not just the operational value of an MSU but also its clinical value to patients and the society.

Abstract TMP49: Social Network Simulation Identifies Persistent Racial Disparities of Delay to Hospital in Acute Ischemic Stroke Patients

Introduction: Delayed arrival to the hospital remains the major reason for non-use of stroke therapies. Minority patients have longer delays that have not been adequately understood nor acted upon. Social context plays a key role, because most strokes occur in front of witnesses who influence decision-making. We created a social network simulation to understand the interpersonal factors that influence decision-making, particularly in minority patients. Methods: We developed an agent-based computer simulation of individual traits and social contextual factors that contribute to decision-making. The inputs into this parsimonious model were based on the largest empirical studies (e.g., Get With The Guidelines) and included: stroke severity, use of Emergency Medical Services (EMS), race, and social network size. The model outputs were the number of stroke patients who arrived at the hospital early (≤3 hours) and late (&gt;3 hours). For each run of the model, 1,000 stroke patients decided to go to the hospital early or late based on individual and social contextual factors. Two sample t-tests were used to compare means between white and non-white patients. Results: In 1.03 million simulations, the model reproduced observed population trends of delay. The overall mean percent of early arrivers was 25.2% (SD 0.02), which matched national metrics showing good calibration of the model. Race predicted delay and modified the relationship of the main effects. 17.9% of non-white patients arrived early compared to 28.3% white patients (p&lt;0.0001) (Fig 1-A). 17.6% of non-white patients with moderate strokes arrived early compared to 39.8% of white patients (p&lt;0.0001) (Fig 1-B). 18.8% of non-white patients with a social network size of 10 arrived early compared to 31.5% of white patients (p&lt;0.0001) (Fig 1-C). Conclusion: A social network simulation reproduced persistent racial disparities of delayed arrival allowing for novel interventions to be tested on this platform.

Benefit of a Stroke Management Program.

Hospital participation in stroke bundle programs presents financial risk. There are limited comparative data on the success of such programs. The authors aimed to assess the success of a management program in reducing the number of patients admitted to a skilled nursing facility (SNF), average length of stay, and the number of patients discharged to inpatient rehabilitation units. Three program metrics included reduction in number of stroke patients admitted to SNF, reduction in length of stay at SNFs, and reduced 90-day hospital readmission rates. The program was implemented during a 3-year period from October 1, 2015, through September 30, 2018, included 803 patients in the data, and demonstrated financial gain with positive patient outcomes. There was a 0.5% reduction in the number of stroke patients admitted to SNF. Sending patients home with a high-quality home care agency for rehabilitation and navigation assistance were the goals for this metric. A 1.65-day reduction in length of stay for overall SNF providers was noted. This was achieved by utilizing a preferred network of skilled facilities and community partners that the nurse navigator interfaced with weekly. The proportion of patients discharged to inpatient rehabilitee units was 2.2% less than in the baseline years. With the implementation of a stroke nurse navigator, hospital readmissions as a percentage of admissions for stroke decreased by 4%. Overall return on investment was greater than 400% after accounting for additional staffing and data/license fees.

Aplikasi Model Cox Proportional Hazard pada Pasien Stroke RSD Balung Kabupaten Jember

&lt;p&gt;According to the World Health Organization (WHO) cardiovascular disease is a disease caused by impaired heart and blood vessel function. There are many types of cardiovascular disease, but the most common and most well-known are coronary heart disease and stroke. Stroke is a syndrome characterized by symptoms and / or rapidly developing clinical signs in the form of focal and global brain functional disorders lasting more than 24 hours (unless there are surgical interventions or bringing death), which are not caused by other causes besides vascular causes. The number of stroke patients in Indonesia in 2013 based on the diagnosis of health personnel (Nakes) was 1.236.825 (7,0%), while based on the diagnosis of symptoms was 2.137.941 (12,1%). In this study the factors that can affect the survival of stroke sufferers were analyzed using the Cox proportional hazard regression model, the dependent variable was the length of time the patient was treated and the independent variables were gender, age, hypertension status, cholesterol status, Diabetes Militus (DM) status, stroke type, and Body Mass Index (BMI). The result showed that age, DM status, and type of stroke were the most influential factors on the survival of stroke patients at Balung Regional Hospital.&lt;/p&gt;&lt;strong&gt;Keywords : &lt;/strong&gt;stroke disease, survival analysis, Cox proportional hazard model

Post-stroke rehabilitation robot for knee: a compact design and manufacture

The number of stroke patients is increasing every year. Many studies have been carried out to rehabilitate post-stroke patients; one of them is using robotic assistance. However, rehabilitation robots, especially for lower limbs, are usually large, so they are less active. This study aims to design and manufacture compact lower limb rehabilitation robots, which focus on the knee so that the rehabilitation process can run effectively. After being designed and manufactured, the rehabilitation robot is also tested whether it can run well. Based on measurements between the motion sensor and the actual movement, there is almost no difference in distance. Besides, from the graph of position, speed, and acceleration, the rehabilitation robot runs well.

Cases presented with diagnosis of stroke in period 2016-2017 in emergency of regional hospital Durres, Albania

In Albania, a complete epidemiological study has not yet been conducted across the country, but the number of stroke patients is considered relatively high, comparable to the countries of eastern Europe due to the high risk factors such as hypertension, hyperlipidemia diabetes mellitus, fibrillation. In 2016-2017, in Emergency of Durres Hospital, 870 cases were diagnosed with Stroke. Of all cases, 802 were diagnosed by emergency physicians and 69 by family physicians. In the total number with Stroke 228 patients (26%) were recurrent and 642 (74%) were new cases. Are classified as Ischemic Stroke 574 cases (66%) and 296 cases (34%) classified as haemorrhagic Stroke. In hemorrhagic cases 29 patients (9.8%) were diagnosed with HSA, of which 18 cases were subjected to neurosurgical intervention. Were presented within the first 3 hours of starting ischemic Stroke only 54% (309), of these 115 patients (37.2%) are sent for thrombolysis and 12 cases (6.1%) for thrombectomia in Universitary Hospital of Tirana. By gender 53% of cases (457) were female and 47% of cases (413) were males. The average age of patients was 64.7 years for ischemic Stroke and 56.4 years for haemorrhagic Stroke. The main risk factor in all cases was HTA 61% (530), the second most frequent factor being smoking (55%) (482), with hyperlipidemia 54% (477), 17% (173) atrial fibrillation, 18% (187) diabetes mellitus, (92) 10.5% alcohol consuming, post myocardial infarction 9% (89). First risk factor in our study was Hypertension and by gender females had higher prevalence in front of males

Parametric Features of Regional Cerebral Blood Flow in Venous Ischemic Stroke

The lecture is devoted to the peculiarities of changes in tissue and cell perfusion of the brain with a rare pathology – venous ischemic stroke. Venous stroke, being a “relatively unknown cerebrovascular disease”, occurs up to 5 % of all cases of stroke. The terms “venous ischemia” and “venous stroke” have long been used in the literature and the definition of the venous nature of stroke should lead to a change in therapeutic tactics. Neuroimaging should ensure the verification of stroke and cerebral venous sinus thrombosis, which are the main cause of such a stroke. A certain “alertness” to the venous nature of the stroke with the expansion of the volume of radiologic methods of investigation and the performance of angiographic and perfusion CT and MR techniques, diffusion MRI allowed to increase the number of diagnosed and verified venous strokes from 0.4 % of the total number of stroke patients to 2.4 %. A distinctive feature of venous ischemic stroke from the arterial is moderate hyperemia in the central part in cases where necrosis does not develop and perifocal hyperperfusion in the development of necrosis. Moderate plethora, defined by perfusion parameters (up to 30 % CBF, CBV, MTT) of CT, MRI and SPECT techniques, and not oligemia is the primary damaging factor of the pathogenesis of venous stroke in contrast to the arterial and hyperemia patterns should be the reference points in emergency diagnosis venous stroke along with tomoangiographic symptoms of cerebral venous sinustrombosis.