Understanding Access to Rehabilitation for Stroke Survivors: Talya Fleming, MD

 'Access' to something that doesn't work is mostly useless. Or don't you even acknowledge all the failures in stroke? Look at all these problems in stroke needing solutions but none exist and no one seems to be working on them.

Check out these 13 problems in stroke with nothing to address them. Survivors are just supposed to accept that stroke is so fucking hard to solve that your disability for life is an acceptable consequence. Everybody in stroke needs to be fired, specially when they put out back patting articles like this.  

Understanding Access to Rehabilitation for Stroke Survivors: Talya Fleming, MD

Talya Fleming, MD Louie PasculliFact checked by: Marco Meglio The medical director of the stroke recovery program at JFK Johnson Rehabilitation Institute at Hackensack Meridian Health provided clinical insights into her presentation focused on expanding rehab care(NOT RECOVERY!) for stroke survivors across settings. [WATCH TIME: 5 minutes](I'm certainly not wasting 5 minutes listening to this.)

Care for Stroke Patients Did Not Falter During the Pandemic

 In other words it was just as big a failure as before.

1. tPA full recovery better than 12%?

2. Full stroke recovery better than 10%? 

   The current state of stroke is a complete failure. None of the following have cures. 

   1. 30% get spasticity NOTHING THAT WILL CURE IT.

   2. At least half of all stroke survivors experience fatigue Or is it 70%?

   Or is it 40%?

   NOTHING THAT WILL CURE IT.

   3. Over half of stroke patients have attention problems.

   NOTHING THAT WILL CURE IT.

   NO PROTOCOLS THAT WILL CURE IT.

   4.  The incidence of constipation was 48%.

   NO PROTOCOLS THAT WILL CURE IT.

   5. No EXACT stroke protocols that address any of your muscle limitations.

   6. Poststroke depression(33% chance)
   

   NO PROTOCOLS THAT WILL ADDRESS IT. 

   7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

   8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

     9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

   10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

   11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

    

   12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

   13.  33% dementia chance post-stroke from an Australian study?

          Or is it 17-66%?

          Or is it 20% chance in this research?

   NO PROTOCOLS THAT WILL ADDRESS THIS

The latest here:

Care for Stroke Patients Did Not Falter During the Pandemic

No large delays in stroke thrombolysis and thrombectomy

by Nicole Lou, Staff Writer, MedPage Today July 1, 2021

Acute stroke care in the U.S. was subject to few disruptions during the COVID-19 pandemic, according to registry data.

Among hospitals participating in the Get With The Guidelines (GWTG)-Stroke registry, patients who experienced an acute ischemic stroke during the pandemic were no worse off in receiving intravenous (IV) alteplase and endovascular therapy, and also had similar door-to-CT, door-to-needle, and door-to-endovascular therapy times, reported Gregg Fonarow, MD, of the University of California Los Angeles, and colleagues.

"Although we expected delays for thrombolysis and thrombectomy in our during COVID-19 cohort due to the need for additional personal protective equipment, the relatively preserved door to diagnosis and door to intervention times suggest the donning of personal protective equipment did not lead to delayed patient care," they wrote in Stroke.

These findings are in contrast to a recent report of a global decline in stroke care (e.g., IV thrombolysis and inter-facility IV thrombolysis transfers) across 70 countries related to the pandemic.

In the present study, weekly stroke presentations dropped by 15.3% on average starting the third week of March 2020 compared with similar months in 2019, a pattern that persisted through the last available stroke entries in the registry in May 2020.

COVID did bring dips in GWTG-Stroke quality measures such as timely IV alteplase administration, prescription of antithrombotics at discharge, dysphagia screening, smoking cessation counseling, stroke education, and rehabilitation consideration.

"Though slightly lower in the during COVID-19 cohort, these quality measures remained above the 85% target, further suggesting maintenance of quality care during the pandemic," Fonarow and co-authors argued.

There was no change in risk-adjusted inpatient mortality or functional outcomes at discharge between the pre-COVID and COVID eras, they added.

As for discharge disposition, stroke patients during the pandemic were more likely to be discharged to hospice or home, and less likely to be discharged to a skilled nursing facility. There were also shorter hospital stays compared with the pre-pandemic period.

"These trends likely reflect patient and provider hesitancy toward prolonged hospital stays and desire to triage patients away from high-risk environments. They may also reflect competing pressures on beds in both hospital and skilled nursing facilities during the pandemic," the authors surmised.

Fonarow and colleagues compared 39,113 stroke patients before the first reported case of COVID-19 in the GWTG-Stroke registry (Nov. 1, 2019 to Feb. 3, 2020) with 41,971 patients after (Feb. 4, 2020 to June 29, 2020).

The two groups shared similar characteristics at baseline (median age 71 years, 48.8% women).

Out of more than 2,000 participating hospitals in GWTG-Stroke, 458 had at least one patient who tested positive for SARS-CoV-2 infection. During the pandemic, 2.7% of stroke patients in the registry also had a diagnosis of COVID-19.

Major limitations to the analysis included its retrospective and observational nature. Fonarow and colleagues also acknowledged that the GWTG-Stroke database is subject to a data lag, due to the administrative burden of the pandemic, which may have affected their analysis of stroke volumes during COVID-19.

"The initial wave of COVID-19 overwhelmed medical systems around the world, raising the possibility that decreased stroke presentations may partially reflect a lack of capacity in overburdened health systems," they wrote. "Shelter in place and social distancing orders, while essential to curb the spread of the disease, may also be contributing to decreases in stroke presentation."

GWTG-Stroke is a voluntary registry from the American Heart Association/American Stroke Association and, as such, the data may not be generalizable to non-participating stroke centers. The accuracy of the database also relied on manual data abstraction, the authors cautioned.

• 

  Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The study was sponsored by a research contract with Genentech.

GWTG-Stroke is supported by Novartis, the Boehringer Ingelheim and Eli Lilly Diabetes Alliance, Novo Nordisk, Sanofi, AstraZeneca, Bayer, and Portola Pharmaceuticals.

Fonarow reported consulting to Abbott, Amgen, CHF Solutions, Janssen, Medtronic, Merck, and Novartis.

Primary Source

Stroke

Source Reference: Srivastava PK, et al "Treatment and outcomes of patients with ischemic stroke during COVID-19: an analysis from Get With The Guidelines-Stroke" Stroke 2021; DOI: 10.1161/STROKEAHA.120.034414.

 

Modifiable Lifestyle Factors and Risk of Stroke

Oh great, more lazy prediction research rather than actually solving the extremely difficult problems of getting to 100% recovery.  And this way you can blame the patient rather than blaming the stroke medical world for not solving stroke,

Try solving these instead. LEADERS tackle the problem they don't

RUN AWAY!

 

Here is a list you can work on.

13 problems with no cure.

The latest here:

Modifiable Lifestyle Factors and Risk of Stroke

A Mendelian Randomization Analysis

Eric L. Harshfield

,

Marios K. Georgakis

,

Rainer Malik

,

Martin Dichgans

,

Hugh S. Markus

Originally published4 Feb 2021https://doi.org/10.1161/STROKEAHA.120.031710Stroke. ;0

Abstract

Background and Purpose:

Assessing whether modifiable risk factors are causally associated with stroke risk is important in planning public health measures, but determining causality can be difficult in epidemiological data. We evaluated whether modifiable lifestyle factors including educational attainment, smoking, and body mass index are causal risk factors for ischemic stroke and its subtypes and hemorrhagic stroke.

Methods:

We performed 2-sample and multivariable Mendelian randomization to assess the causal effect of 12 lifestyle factors on risk of stroke and whether these effects are independent.

Results:

Genetically predicted years of education was inversely associated with ischemic, large artery, and small vessel stroke, and intracerebral hemorrhage. Genetically predicted smoking, body mass index, and waist-hip ratio were associated with ischemic and large artery stroke. The effects of education, body mass index, and smoking on ischemic stroke were independent.

Conclusions:

Our findings support the hypothesis that reduced education and increased smoking and obesity increase risk of ischemic, large artery, and small vessel stroke, suggesting that lifestyle modifications addressing these risk factors will reduce stroke risk.

• Download figure
• Download PowerPoint

 

Impact of the reperfusion status for predicting the final stroke infarct using deep learning

 Damn it all, prediction crapola like this DOES NOTHING FOR SURVIVORS.  Will you please solve stroke instead of beating around the bushes? Here is a list you can work on.

13 problems with no cure.

The latest crapola here:

Impact of the reperfusion status for predicting the final stroke infarct using deep learning

Noëlie Debs,^a Tae-Hee Cho,^a,b David Rousseau,^c Yves Berthezène,^a,d Marielle Buisson,^e Omer Eker,^a,d Laura Mechtouff,^b,e Norbert Nighoghossian,^a,b Michel Ovize,^d and Carole Frindel^a,⁎

Author information Article notes Copyright and License information Disclaimer

Go to:

Graphical abstract

Keywords: Stroke, Prediction, Convolutional neural network, Magnetic resonance imaging, Reperfusion status

Go to:

Abstract

Background

Predictive maps of the final infarct may help therapeutic decisions in acute ischemic stroke patients. Our objectives were to assess whether integrating the reperfusion status into deep learning models would improve their performance, and to compare them to current clinical prediction methods.

Methods

We trained and tested convolutional neural networks (CNNs) to predict the final infarct in acute ischemic stroke patients treated by thrombectomy in our center. When training the CNNs, non-reperfused patients from a non-thrombectomized cohort were added to the training set to increase the size of this group. Baseline diffusion and perfusion-weighted magnetic resonance imaging (MRI) were used as inputs, and the lesion segmented on day-6 MRI served as the ground truth for the final infarct. The cohort was dichotomized into two subsets, reperfused and non-reperfused patients, from which reperfusion status specific CNNs were developed and compared to one another, and to the clinically-used perfusion-diffusion mismatch model. Evaluation metrics included the Dice similarity coefficient (DSC), precision, recall, volumetric similarity, Hausdorff distance and area-under-the-curve (AUC).

Results

We analyzed 109 patients, including 35 without reperfusion. The highest DSC were achieved in both reperfused and non-reperfused patients (DSC = 0.44 ± 0.25 and 0.47 ± 0.17, respectively) when using the corresponding reperfusion status-specific CNN. CNN-based models achieved higher DSC and AUC values compared to those of perfusion-diffusion mismatch models (reperfused patients: AUC = 0.87 ± 0.13 vs 0.79 ± 0.17, P < 0.001; non-reperfused patients: AUC = 0.81 ± 0.13 vs 0.73 ± 0.14, P < 0.01, in CNN vs perfusion-diffusion mismatch models, respectively).

Conclusion

The performance of deep learning models improved when the reperfusion status was incorporated in their training. CNN-based models outperformed the clinically-used perfusion-diffusion mismatch model. Comparing the predicted infarct in case of successful vs failed reperfusion may help in estimating the treatment effect and guiding therapeutic decisions in selected patients.

Go to:

1. Introduction

Early reperfusion, by means of intravenous thrombolysis or thrombectomy, is the main therapeutic goal in acute ischemic stroke (Powers et al., 2019). Acute treatment decisions have increasingly incorporated advanced neuroimaging to estimate patients’ prognosis and likelihood of benefiting from revascularization procedures (Nogueira et al., 2018, Albers et al., 2018). Currently, both computed-tomography (CT) and Magnetic Resonance Imaging (MRI) entail threshold-based methods to delineate the still salvageable brain (i.e. ischemic penumbra) from the already lost tissue (infarct core). Specifically in MRI, criteria for the infarct core is based on Apparent Diffusion Coefficient (ADC) extracted from Diffusion-Weighted Imaging (DWI), and criteria for the ischemic penumbra is based on Time to maximum of the residue function (T_max) extracted from perfusion-weighted imaging. Precisely, infarct core is defined as ADC voxel values < 600~620x10⁻⁶ mm²/s, and ischemic penumbra is defined as T_max voxel values >6 s (Kidwell et al., 2013, Olivot et al., 2009). Patients with a large penumbra and limited ischemic core (so-called ‘target mismatch’ profile) have a high probability of benefiting from reperfusion, even in late time windows (Nogueira et al., 2018, Albers et al., 2018). However, these fixed-threshold methods may fail to capture the significant interindividual heterogeneity observed in stroke progression (Rekik et al., 2012). While the clinical and imaging characteristics of some patients may clearly indicate urgent reperfusion therapies, the benefit/risk balance in others can appear more uncertain. Thus, personalized probability maps of the final infarct would be of high clinical value to guide acute revascularization decisions and possibly help evaluate novel neuroprotective strategies.

Convolutional neural networks (CNNs), a subtype of machine learning, are flexible, data-driven methods capable of automatic non-linear feature extraction, with promising results in stroke lesion segmentation (Qiu et al., 2020). A well-acknowledged limitation of CNNs is the large quantity of data required for their training and validation. Only a limited number of studies, with heterogeneous treatment paradigms and evaluations metrics, have evaluated CNNs for the prediction of the final stroke lesion from baseline MRI (Winzeck et al., 2018, Pinto et al., 2018, Nielsen et al., 2018, Yu et al., 2020) or CT (Robben et al., 2020). Sample size and performance were modest (~50 to ~200 patients, Dice similarity coefficient ~0.50 or lower), illustrating both the inherent difficulty of prediction tasks and scarcity of high-quality data, compared to simpler image segmentation tasks.

In the present work, we evaluated the impact of integrating the reperfusion status on the performance of CNNs for predicting the final infarct in patients with proximal intracranial occlusions treated by thrombectomy. Reperfusion is the single most important clinical metadata known to influence the progression of ischemic lesions from the baseline imaging (used as inputs to CNN) to the final infarct (Tsai and Albers, 2015). Previous studies have investigated direct integration of the reperfusion status during the learning process of CNN-based methods (Pinto et al., 2018, Robben et al., 2020). Another dichotomized the training set according to the reperfusion status with random forest-based methods (McKinley et al., 2017), but has not been evaluated with CNNs. We hypothesized that training CNNs from reperfusion status-specific subcohorts could improve their performance. Our objectives were: (1) to assess the impact of the reperfusion status on CNN-based predictive models; (2) to compare the predictive value of these CNNs against the threshold-based perfusion-diffusion mismatch models. An ancillary objective was to assess the relative predictive importance of the MRI inputs with an ablation study.

More at link

 

We are calling for webinar proposals to build the WSO webinar series for 2021! Deadline; January 31st, 2021

 We need to totally blow this out of the water calling for a strategy to get to 100% recovery for all. They do have stroke in their name so they should be all about helping survivors.  Mine will contain;

rehab full recovery? Only 10%?

tPA full recovery? Only 12%?

13 problems with no cure 

Well never mind, since the button doesn't work, probably because I am not a member. Which goes to show you how fucking useless the WSO is; they care nothing about survivors; NO outreach, NO protocols; I bet they haven't talked to survivors in years.

The latest crapola here:

The World Stroke Academy (WSA) is calling for webinar proposals to build the WSO webinar series for 2021.   

On the initiative of WSA, WSO has been organising a series of international webinars in 2020 to compensate for the loss of face-to-face meetings and conferences and to support clinicians struggling to maintain stroke services and research during the pandemic. 

 

 

Do you have an idea for a webinar topic that

• addresses a literature gap or

• a specific need,
• highlights a recent important guideline or
• gives an update on a controversial/ challenging topic, hence being beneficial to clinicians and allied health professionals working in the field of stroke?
• Or would you like to share your knowledge in a particular subject area? 

 

If so, you are kindly invited to submit your webinar proposal  HERE   

Proposals will be accepted until January 31st.  

Please note: WSO represents stroke throughout the world and is committed to achieve balance and representation with respect to gender, ethnicity, geographical distribution and level of seniority in its webinar programme. Please consider this when you submit your topic and identify speakers.   

Stroke Prevention in Older Adults

This is necessary because of the massive failures in the stroke medical world of being able to successfully treat stroke in any shape or form.

Failures listed here:

13 problems with no cure 

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

The latest crapola here:

 Stroke Prevention in Older Adults

J. David Spence

,

M. Reza Azarpazhooh

,

Susanna C. Larsson

,

Chrysi Bogiatzi

,

Graeme J. Hankey

Originally published30 Oct 2020https://doi.org/10.1161/STROKEAHA.120.031707Stroke. 2020;51:3770–3777

Abstract

The risks of stroke and dementia increase steeply with age, and both are preventable. At present, the best way to preserve cognitive function is to prevent stroke. Therapeutic nihilism based on age is common and unwarranted(But you are a nihilist on stroke rehab, you have NOTHING!) . We address recent advances in stroke prevention that could contribute greatly to prevention of stroke and dementia at a time when the aging of the population threatens to markedly increase the incidence of both. Issues discussed: (1) old patients benefit even more from lipid-lowering therapy than do younger patients; (2) patients with stiff arteries are at risk from a target systolic blood pressure <120 mm Hg; (And those stiff arteries are at higher risk of being perforated during endovascular thrombectomy)(3) the interaction of the intestinal microbiome, age, and renal function has important dietary implications for older adults; (4) anticoagulation with direct-acting oral anticoagulants should be prescribed more to old patients with atrial fibrillation; (5) B vitamins to lower homocysteine prevent stroke; and (6) most old patients in whom intervention is warranted for carotid stenosis would benefit more from endarterectomy than from stenting. An 80-year-old person has much to lose from a stroke and should not have effective therapy withheld on account of age. Lipid-lowering therapy, a more plant-based diet, appropriate anticoagulation or antiplatelet therapy, appropriate blood pressure control, B vitamins to lower homocysteine, and judicious intervention for carotid stenosis could do much to reduce the growing burden of stroke and dementia.

 

Many U.S. Young Adults Not Aware of Stroke Symptoms

And this way the stroke medical world can blame the patients rather than seeing that the blame lies completely on them for not creating stroke protocols leading to 100% recovery.  THE BLAME FOR THIS DISASTER OF STROKE RECOVERY LIES DIRECTLY ON THE STROKE MEDICAL WORLD.

Even if you are aware of stoke symptoms and head to a hospital immediately YOU ARE STILL FUCKING SCREWED. 

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

 

Many U.S. Young Adults Not Aware of Stroke Symptoms

HealthDay News — A considerable proportion of young adults are not aware of stroke symptoms, according to a study published online Oct. 26 in Stroke.

Reed Mszar, M.P.H., from the Yale School of Public Health in New Haven, Connecticut, and colleagues examined awareness of stroke symptoms and response to a perceived stroke among young adults in the United States using data from the 2017 National Health Interview Survey. The study population included 24,769 adults, of whom 9,844 (39.7 percent) were young and included in the primary analysis.

The researchers found that 28.9 percent of young adults were not aware of all five stroke symptoms and 2.7 percent were not aware of a single symptom. Hispanic ethnicity, non-U.S.-born immigration status, and lower education level were significantly associated with lack of symptom awareness after adjustment for confounders (odds ratios, 1.96, 2.02, and 2.77, respectively). The odds of not being aware of all symptoms were increased nearly fourfold for individuals with five high-risk characteristics (non-White, non-U.S.-born, low-income, uninsured, and high school-educated or lower; odds ratio, 3.70).

“While the medical community has made significant improvements to reduce the severity and complications of strokes with early interventions, these efforts are of limited value if patients do not recognize stroke symptoms,” a coauthor said in a statement. “Time is critical for treating stroke. The earlier people recognize symptoms, the better their chances are to reduce long-term disability from stroke.”

 

Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults

Even if you are aware of stroke symptoms and head to a hospital immediately YOU ARE STILL FUCKING SCREWED. 

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults

Reed Mszar

,

Shiwani Mahajan

,

Javier Valero-Elizondo

,

Tamer Yahya

,

Richa Sharma

,

Gowtham R. Grandhi

,

Rohan Khera

,

Salim S. Virani

,

Judith Lichtman

,

Safi U. Khan

, … See all authors

Originally published26 Oct 2020https://doi.org/10.1161/STROKEAHA.120.031137Stroke. ;0

Abstract

Background and Purpose:

Despite declining stroke rates in the general population, stroke incidence and hospitalizations are rising among younger individuals. Awareness of and prompt response to stroke symptoms are crucial components of a timely diagnosis and disease management. We assessed awareness of stroke symptoms and response to a perceived stroke among young adults in the United States.

Methods:

Using data from the 2017 National Health Interview Survey, we assessed awareness of 5 common stroke symptoms and the knowledge of planned response (ie, calling emergency medical services) among young adults (<45 years) across diverse sociodemographic groups. Common stroke symptoms included: (1) numbness of face/arm/leg, (2) confusion/trouble speaking, (3) difficulty walking/dizziness/loss of balance, (4) trouble seeing in one/both eyes, and (5) severe headache.

Results:

Our study population included 24 769 adults, of which 9844 (39.7%) were young adults who were included in our primary analysis, and represented 107.2 million US young adults (mean age 31.3 [±7.5] years, 50.6% women, and 62.2% non-Hispanic White). Overall, 2718 young adults (28.9%) were not aware of all 5 stroke symptoms, whereas 242 individuals (2.7%; representing 2.9 million young adults in the United States) were not aware of a single symptom. After adjusting for confounders, Hispanic ethnicity (odds ratio, 1.96 [95% CI, 1.17–3.28]), non-US born immigration status (odds ratio, 2.02 [95% CI, 1.31–3.11]), and lower education level (odds ratio, 2.77 [95% CI, 1.76–4.35]), were significantly associated with lack of symptom awareness. Individuals with 5 high-risk characteristics (non-White, non-US born, low income, uninsured, and high school educated or lower) had nearly a 4-fold higher odds of not being aware of all symptoms (odds ratio, 3.70 [95% CI, 2.43–5.62]).

Conclusions:

Based on data from the National Health Interview Survey, a large proportion of young adults may not be aware of stroke symptoms. Certain sociodemographic subgroups with decreased awareness may benefit from focused public health interventions.

 

World stroke day campaign - October 29

The only thing this campaign should be saying is: EVERYTHING IN STROKE IS A COMPLETE FUCKING FAILURE. 

To prove that notice nothing in this list has any cure and nobody is working on cures:

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

 

 World stroke day campaign

 

Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register

Oh well, useless. ABSOLUTELY NOTHING ON HOW TO FIX THESE PROBLEMS.

Here is my list of stroke problems needing fixes. Which ones is your stroke hospital solving?

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

But the latest here:

Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register

• Amanda Clery ,
• Ajay Bhalla,
• Anthony G. Rudd,
• Charles D. A. Wolfe,
• Yanzhong Wang

• Amanda Clery, 
• Ajay Bhalla, 
• Anthony G. Rudd, 
• Charles D. A. Wolfe, 
• Yanzhong Wang

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• Published: October 9, 2020
• https://doi.org/10.1371/journal.pmed.1003366

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Methods and findings

Acute stroke impairments often result in poor long-term outcome for stroke
survivors. The aim of this study was to estimate the trends over time in
 the prevalence of these acute stroke impairments.

All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 2018 were included in this cohort study. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted prevalence of 8 acute impairments, across six 3-year time cohorts. Prevalence ratios comparing impairments over time were also calculated, stratified by age, sex, ethnicity, and aetiological classification (Trial of Org 10172 in Acute Stroke Treatment [TOAST]). A total of 4,683 patients had a stroke between 2001 and 2018. Mean age was 68.9 years, 48% were female, and 64% were White. After adjustment for demographic factors, pre-stroke risk factors, and stroke subtype, the prevalence of 3 out of the 8 acute impairments declined during the 18-year period, including limb motor deficit (from 77% [95% CI 74%–81%] to 62% [56%–68%], p < 0.001), dysphagia (37% [33%–41%] to 15% [12%–20%], p < 0.001), and urinary incontinence (43% [39%–47%) to 29% [24%–35%], p < 0.001). Declines in limb impairment over time were 2 times greater in men than women (prevalence ratio 0.73 [95% CI 0.64–0.84] and 0.87 [95% CI 0.77–0.98], respectively). Declines also tended to be greater in younger patients. Stratified by TOAST classification, the prevalence of all impairments was high for large artery atherosclerosis (LAA), cardioembolism (CE), and stroke of undetermined aetiology. Conversely, small vessel occlusions (SVOs) had low levels of all impairments except for limb motor impairment and dysarthria. While we have assessed 8 key acute stroke impairments, this study is limited by a focus on physical impairments, although cognitive impairments are equally important to understand. In addition, this is an inner-city cohort, which has unique characteristics compared to other populations.

Conclusions

In this study, we found that stroke patients in the SLSR had a complexity of acute impairments, of which limb motor deficit, dysphagia, and incontinence have declined between 2001 and 2018. These reductions have not been uniform across all patient groups, with women and the older population, in particular, seeing fewer reductions.

Author summary

Why was this study done?

• Stroke is one of the top 5 causes of disability globally.
• We do not know how the different types of disability caused by stroke have improved or changed over time.

What did the researchers do and find?

• We analysed the changes in the prevalence of 8 different stroke impairments between 2001 and 2018 in a total of 4,683 stroke patients.
• Over time, fewer people experienced limb impairment, dysphagia (swallowing difficulties), and incontinence, but the other 5 impairments did not decline over time. These were visual field defect, neglect, sensory loss, dysphasia, and dysarthria.
• The people who tended to continue experiencing these impairments over time were older and female patients.

What do these findings mean?

• The type and number of disabilities that stroke patients in our study population face has changed over time.
• This has implications for how patients are cared for by clinicians in the short term and how the needs of stroke survivors are addressed by public health policy in the long term.

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Citation: Clery A, Bhalla A, Rudd AG, Wolfe CDA, Wang Y (2020) Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register. PLoS Med 17(10): e1003366. https://doi.org/10.1371/journal.pmed.1003366

Academic Editor: Joshua Z. Willey, Columbia University, UNITED STATES

Received: May 14, 2020; Accepted: August 31, 2020; Published: October 9, 2020

Copyright: © 2020 Clery et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The raw data for this study contain both personally identifiable and confidential clinical data. The participants of the study did not consent to sharing the information publicly, and our ethical approvals require strict information governance procedures. Requests for data access for academic use should be made to the South London Stroke Register, where data will be made available subject to academic review and acceptance of a data-sharing agreement. Information can be found/requested through the following link: https://www.kcl.ac.uk/lsm/research/divisions/hscr/research/groups/stroke.