Closing the Sex-Based Differences in Stroke Care: Insights from a Large Telestroke Network on Treatment and Postacute Management.

Background: The evolution of ischemic stroke is different accordin'g to sex and is one of the main causes of death in women. Previous studies have shown that women are less likely to receive acute treatment, and stroke center type is an important predictor of door-to-needle times. We investigated whether women are attended in a similar way to men in the telestroke network with specialized stroke physicians. Methods: A prospective registry of ischemic strokes recorded in the centralized Andalusian telestroke network was analyzed, focusing on sex differences. Demographic data, clinical characteristics, neuroimaging data, treatment intervals, follow-up visits, and clinical outcomes were collected. Results: A total of 3009 suspected stroke patients were attended to in the telestroke network from 2019 to 2023, of which 42.74% were women. Women were older (p < 0.001) and less independent upon arrival (p = 0.006) than men. There was no difference in the treatment received or in the treatment time intervals between the groups. Importantly, there was no difference in modified Rankin scale scores at 3 months between sexes. At 3 months post-stroke follow-up, women had fewer imaging tests (p = 0.018) and fewer outpatient visits (p < 0.001) than men. Conclusions: No significant difference between men and women has been found in the acute treatment of stroke in a large telestroke network. However, the same is not true for the follow-up and management of patients after the acute phase. This fact supports that strict adherence to protocols and specialization of care lead to equal care that avoids sex differences in stroke treatment and functional outcomes.

Potential Food Availability Influences Social Interactions of Young Individuals in a Neotropical Primate (Alouatta palliata).

Deforestation is widely recognised as an agent of human disturbance that causes widespread destruction of species habitats and can result in animals occupying forest patches with limited food resources. When animals are forced to change habitats, they must also adjust their diet, activity budgets and social behaviour in response to facing new ecological and environmental conditions. Only a few studies have analysed the influence of habitat conditions on social interactions of immature howler monkeys. In this study, we examined the effects of variation in food availability on social interactions of young howler monkeys (Alouatta palliata mexicana). This was accomplished by observing infant and juvenile members of two groups inhabiting a continuous forest habitat (640 ha) and three groups living in different-sized forest fragments (4, 42 and 93 ha) for a 15-month non-consecutive period. We quantified the Potential Food Availability Index (PFAI) for each habitat type based on the basal area, the Shannon-Wiener diversity index and abundance of food tree species. We used 15-min focal animal sampling to record the occurrence and/or duration of affiliative and agonistic behaviours. In habitats with higher PFAI, we observed more social play and proximity in infants aged 4-7 months, grooming in infants aged 8-14 months and social play in juveniles. Conversely, juveniles' grooming rates and 0- to 3-month-old infants' proximity rates decreased as PFAI increased. Our results suggest that food resource variation influences young howler monkeys' social interactions. The reduction in social interactions due to low food availability may represent an energy-saving strategy to cope with limited resources in habitats disturbed by anthropogenic activities.

Quality improvement initiative increases total paracentesis and early paracentesis rates in hospitalised cirrhotics with ascites.

OBJECTIVE: Early paracentesis (EP) for rapid diagnosis of spontaneous bacterial peritonitis is considered best practice in the care of admitted patients with cirrhosis and ascites, but inpatient paracentesis is frequently not performed or delayed. We developed a quality improvement (QI) initiative aimed at increasing the proportion of admitted patients with cirrhosis who undergo paracentesis and EP. DESIGN: Pre-post study of a QI initiative. SETTING: A tertiary care hospital in a major metropolitan area. PATIENTS: Hospitalised patients with cirrhosis and ascites. INTERVENTIONS: We targeted care providers in the emergency department (ED) by raising awareness of the importance of EP, developing criteria to identify patients at highest risk of SBP who were prioritised for EP by ED providers and restructuring the ED environment to enable timely paracentesis. RESULTS: 76 patients meeting inclusion criteria were admitted during the postintervention 9-month study period. Of these, 91% (69/76) underwent paracentesis during admission versus 71 % (77/109) preintervention (p=0.001). 81% (56/69) underwent EP within 12 hours of presentation or after a predefined acceptable reason for delay versus 48% (37/77) preintervention (p=0.001). There were no significant differences in in-hospital mortality or length of stay before and after intervention. CONCLUSION: A multidisciplinary QI intervention targeting care in the ED successfully increased the proportion of patients with cirrhosis and ascites undergoing diagnostic paracentesis during admission and EP within 12 hours of presentation.