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1.
J Stroke Cerebrovasc Dis ; 31(6): 106466, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35390730

RESUMEN

OBJECTIVES: The purpose of this quality improvement project is to understand the burden of acute care, including inpatient readmission and emergency department (ED) visits, in the month following hospital discharge after stroke. MATERIALS AND METHODS: We identified patients discharged from our hospitals between 2015 and 2018 with any stroke diagnosis who had an unplanned readmission or ED visit within the first month after discharge, and those who had primary care (PC) visits before or after their stroke. Patients were compared regarding demographics, clinical characteristics, and PC visits. Independent predictors of acute care encounters were examined using logistic regression. RESULTS: A total of 166 patients (19%) had an acute care encounter one month after discharge. Eighty-eight (10%) patients were readmitted and 78 (9%) patients had an ED visit. Encounter diagnoses were different between the two groups; inpatient readmission had more frequent acute stroke/TIA and pneumonia/pulmonary indications, while ED visits had more non-specific neurologic symptoms and more frequent cardiovascular complaints. Independent predictors of any acute care encounter and inpatient readmission were younger age, longer length of stay (LOS), and lack of PC visit after discharge. Predictors of ED visits were the same except for LOS. CONCLUSIONS: 30-day acute care encounters after stroke hospitalization are common, affecting 19% of patients and usually occurring in the first week after discharge. Post discharge PC visit was associated with a decreased need for acute care. Efforts should be made to facilitate a PC visit within a week after discharge, especially in high risk patients.


Asunto(s)
Alta del Paciente , Accidente Cerebrovascular , Cuidados Posteriores , Servicio de Urgencia en Hospital , Humanos , Readmisión del Paciente , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia
2.
J Stroke Cerebrovasc Dis ; 31(1): 106170, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34700234

RESUMEN

OBJECTIVES: Recent case-reports have described an atypical cerebral microbleed (CMB) topography after extracorporeal membrane oxygenation (ECMO). The objective of this study was to examine the prevalence, radiographic patterns, and clinical correlates of possibly-ECMO-related (PER) CMB. MATERIALS AND METHODS: We performed a retrospective study of 307 consecutive patients receiving ECMO support at our tertiary-care University Hospital (2013-2018). PER CMB were defined as CMB present in corpus-callosum and/or middle cerebellar peduncle with/without involvement of other lobar/deep structures. Leukoaraiosis was quantified using the Wahlund age-related white matter changes scale. Patient characteristics were compared between cohorts with and without PER CMB. RESULTS: Forty patients (median age 60 years; 33% vv-ECMO and 67% va-ECMO) received at-least one MRI-brain within 3 months of ECMO support. CMB were present in 77.5% (n = 31) patients with 39% (n = 12), 17% (n = 5), and 44% (n = 14) having low (< 10 CMB), moderate (10-30 CMB), and high (> 30 CMB) burden respectively. Among CMB-positive patients, 71% (n = 22) had PER CMB, with 91% of such cases demonstrating involvement of splenium. Leukoaraiosis did not corelate to PER CMB presence (p = 0.267) or burden (ρ = 0.09). Patients with PER CMB had higher rates of ischemic stroke (50 vs. 33%), intracranial hemorrhage (41 vs. 17%), and all-cause mortality (27 vs. 17%); with survivors demonstrating no differences in their discharge disposition or modified Rankin Score. CONCLUSIONS: Post-ECMO cerebral microbleeds have a distinct distribution pattern that commonly involves the splenium of corpus-callosum. Their etiopathogenesis may be independent of microvascular lipohyalinosis. This requires further study in a larger sample-size.


Asunto(s)
Hemorragia Cerebral , Oxigenación por Membrana Extracorpórea , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/epidemiología , Oxigenación por Membrana Extracorpórea/efectos adversos , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
3.
Appl Opt ; 60(12): 3452-3457, 2021 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-33983251

RESUMEN

Absolute distance measurement is crucial for many applications including metrology, large-scale manufacturing, range finding, and surveying. In this paper, a novel, to the best of our knowledge, technique is introduced for precise distance measurement by including the distance under measurement in a soliton mode-locked fiber ring laser (SMFRL). Consequently, the measured distance can be calculated from the change in the repetition rate of the emitted pulses due to the laser cavity length change. The SMFRL technique is implemented here to measure distances up to 57.4 m with precision of less than 9 µm. Therefore, we believe that the SMRFL technique provides a relatively simple and precise technique to measure relatively long distances.

4.
Pediatr Cardiol ; 42(5): 1010-1017, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33738510

RESUMEN

The influx of Syrian refugees to Lebanon that began in 2012 created new health-care and financial stressors on the country with an increase in communicable and non-communicable diseases. This study aims to describe the presentations, diagnoses, management, financial burden, and outcomes among Syrian refugees with congenital heart disease (CHD) in Lebanon. This is a retrospective study that was conducted through reviewing the charts of all Syrian pediatric patients referred to the Children's Heart Center at the American University of Beirut Medical Center for evaluation between the years 2012 and 2017. We reviewed the charts of 439 patients. The mean age at presentation was 3.97 years, and 205 patients (46.7%) were females. 99 Patients (22.6%) were found to have no heart disease, 69 (15.7%) had simple, 146 (33.3%) had moderate, and 125 (28.5%) had complex heart diseases. 176 (40.1%) Patients underwent interventional procedures, with a surgical mortality rate of 10.1%, compared to a rate of 2.9% among non-Syrian children. The average cost per surgical procedure was $15,160. CHD poses a significant health and financial burden on the Syrian refugee population in Lebanon, a small country with very limited resources. The Syrian cohort had a higher frequency of complex cardiac lesions, presented late with additional comorbidities, and had a strikingly elevated surgical mortality rate. Securing appropriate funds can improve the lives of this population, ease the financial burden on the hosting country, provide adequate health-care services, and improve morbidity and mortality.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías Congénitas/epidemiología , Refugiados/estadística & datos numéricos , Procedimientos Quirúrgicos Cardíacos/economía , Procedimientos Quirúrgicos Cardíacos/mortalidad , Niño , Preescolar , Femenino , Humanos , Lactante , Líbano/epidemiología , Masculino , Estudios Retrospectivos , Siria/etnología , Centros de Atención Terciaria/estadística & datos numéricos
5.
Appl Opt ; 59(21): 6417-6423, 2020 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-32749308

RESUMEN

Electronic distance meters (EDMs) are widely used in different applications, such as surveying and civil engineering. In order to calibrate an EDM, different techniques can be used, including displacement interferometers and reference baselines. In this paper, an indoor baseline is designed and then accurately measured using femtosecond laser pulses from an optical frequency comb to be used for EDM calibration. The baseline consists of 13 fixed bases that cover 58 m distance. In order to accurately measure the distances between the bases, autocorrelation between femtosecond laser pulses is employed. The measurement shows a maximum precision of 14 µm over the 13 bases. Although this deviation is dominated mainly by the placement of the target mirror, the system capability is much more sufficient to safely calibrate the best available commercial EDM. The stability of the baseline is also investigated by measuring the interbase distances over long periods of time.

6.
Neuroradiology ; 60(5): 557-563, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29574600

RESUMEN

PURPOSE: The phenomenon of futile recanalization, defined as lack of clinical benefit despite angiographic recanalization, is an important limitation of endovascular treatment for acute ischemic stroke. We aim to characterize the occurrence and predictors of futile recanalization in the endovascular arm of the Interventional Management of Stroke (IMS) III trial. METHODS: Patients with near complete or complete recanalization (TICI grades 2b and 3) were divided according to functional outcome at 3 months into "meaningful recanalization," defined as mRS score 0-2, and "futile recanalization," mRS score 3-6. Multivariate analysis was performed to identify predictors of futile recanalization. RESULTS: Futile recanalization was observed in 61 (47%) of 130. Compared to meaningful recanalization group, the futile recanalization group had higher proportion of women (62.3 vs. 43.5%; p = 0.032), higher incidence of diabetes mellitus (29.5 vs. 8.7%; p = 0.004) and coronary artery disease (27.9 vs. 13%; p = 0.05), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (median [range] 19 [11-31] vs. 15 [8-26], p < 0.001), higher baseline serum glucose (7.6 ± 2.6 vs. 6.7 ± 1.7 mmol/L; p = 0.039), and longer onset-to-start of endovascular treatment time (265.8 ± 48.3 vs. 239.2 ± 47.7 min; p = 0.007). In multivariate analysis, NIHSS (OR 1.3; 95% CI 1.1-1.4), female gender (OR 3.0; 95% CI 1.1-8.2), and onset-to-start of endovascular treatment time (OR 1.2; 95% CI 1.1-1.3) were independent predictors of futile recanalization. CONCLUSION: In IMS III, futile recanalization was common. Delay in endovascular treatment is the only modifiable risk factor. Additional strategies for non-modifiable risk factors-female gender and high NIHSS-need to be identified.


Asunto(s)
Isquemia Encefálica/cirugía , Revascularización Cerebral/métodos , Accidente Cerebrovascular/cirugía , Insuficiencia del Tratamiento , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Accidente Cerebrovascular/diagnóstico por imagen
7.
J Stroke Cerebrovasc Dis ; 27(3): 677-681, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29108804

RESUMEN

BACKGROUND: The study aims at examining the changes in endovascular procedures utilization after the publication of the clinical trials showing their benefit in patients with acute ischemic stroke (AIS). METHODS: Minnesota Hospital Association database from 137 member hospitals was used to calculate the statewide utilization rates for 2 periods: prior to (calendar year 2014) and after (calendar year 2015) the publication of multiple randomized clinical trials showing the efficacy of endovascular therapy. Patients were identified using International Classification of Disease, Clinical Modification, 9th revision (ICD-9) or ICD-10 codes (ICD-10 started October 2015). Utilization rates for endovascular treatment were calculated monthly, quarterly, and annually. RESULTS: Of the 13,043 patients admitted with AIS, 434 patients (mean age 68.5 ± 15.5 years; 51.2% women) received endovascular treatment. The number of procedures increased from 194 in 2014 to 240 in 2015. Utilization rate was 3.4% in the first quarter of 2014, gradually declined to reach its lowest value (2.6%) the last quarter of 2014, then steadily increased to reach its peak (4%) in the last quarter of 2015. Procedures performed at comprehensive stroke centers increased from 52% of total procedures in 2014 to 57.5% in 2015, whereas those performed at primary stroke centers decreased from 22.6% to 19.5%. In 2015, fewer patients had hypertension (50.4% versus 60.3%; P = .039) and more patients had chronic kidney disease (28.3% versus 15.5%; P = .001) compared with 2014. Intracranial hemorrhage, mortality rate, and rate of home discharge were similar between the 2 years. CONCLUSION: Utilization of endovascular procedures for treatment of AIS has been rapidly influenced by medical literature.


Asunto(s)
Isquemia Encefálica/terapia , Procedimientos Endovasculares/tendencias , Hospitales/tendencias , Pautas de la Práctica en Medicina/tendencias , Evaluación de Procesos, Atención de Salud/tendencias , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatología , Bases de Datos Factuales , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/estadística & datos numéricos , Medicina Basada en la Evidencia/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
8.
Nicotine Tob Res ; 19(7): 871-876, 2017 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-28339617

RESUMEN

BACKGROUND: Inconsistent evidence supports better outcome in smokers after stroke. Our study examines this association in a large sample of ischemic stroke treated with intravenous thrombolysis. METHOD: Virtual International Stroke Trials Archive (VISTA) database, composed of individual patient data of multiple clinical trials, was queried. The primary outcome was functional independence at 3 months noted by modified Rankin Scale (mRS; a 7-point scale ranging from 0 [no deficit] to 6 [death]) score≤ 2. The secondary outcomes were National Institutes of Health Stroke Scale (NIHSS; stroke severity measure, ranging from 0 [no deficit] to 42 [most severe]) score at 24 hours and the occurrence of symptomatic intractracranial hemorrhage. RESULTS: A total of 5383 patients were included: 1501 current smokers and 3882 nonsmokers. Smokers were younger (60 ± 13 vs. 71 ± 12 years, p < .0001) and had lower median NIHSS score at baseline (12 [8-17] vs. 13 [9-18], p < .0001). The rate of favorable functional outcome (mRS ≤ 2) at 3 months was significantly higher among current smokers (49.7% vs. 39.5%, p < .0001) and with crude ORs of 1.52, 95% CI 1.33-1.72. The association became non-significant after adjusting for age (OR 1.11, 95% CI 0.97-1.27). Subgroup analysis by age/gender strata showed that current smoking was associated with favorable outcome only in women ≥ 65 years. Current smoking was also associated with lower rates of symptomatic intracranial hemorrhage (adjusted OR 0.55, 95% CI 0.39-0.79). CONCLUSION: Smokers experience their first ever stroke 11 years younger than nonsmokers. This age difference explains the association between current smoking and favorable functional outcome. IMPLICATIONS: Smoking is associated with occurrence of first ever stroke at a younger age, therefore, focus should be on smoking prevention and treatment. The decision to treat ischemic stroke patients with intravenous thrombolysis should not be influenced by the patients' smoking status.


Asunto(s)
Fumadores , Accidente Cerebrovascular/mortalidad , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Factores de Edad , Anciano , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores Sexuales , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/administración & dosificación , Resultado del Tratamiento
11.
Emerg Infect Dis ; 21(5): 750-9, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25897712

RESUMEN

Variant Creutzfeldt-Jakob disease (vCJD) is a rare, fatal prion disease resulting from transmission to humans of the infectious agent of bovine spongiform encephalopathy. We describe the clinical presentation of a recent case of vCJD in the United States and provide an update on diagnostic testing. The location of this patient's exposure is less clear than those in the 3 previously reported US cases, but strong evidence indicates that exposure to contaminated beef occurred outside the United States more than a decade before illness onset. This case exemplifies the persistent risk for vCJD acquired in unsuspected geographic locations and highlights the need for continued global surveillance and awareness to prevent further dissemination of vCJD.


Asunto(s)
Síndrome de Creutzfeldt-Jakob/diagnóstico , Síndrome de Creutzfeldt-Jakob/epidemiología , Adulto , Animales , Biopsia , Encéfalo/metabolismo , Encéfalo/patología , Bovinos , Síndrome de Creutzfeldt-Jakob/transmisión , Electrocardiografía , Femenino , Salud Global , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Vigilancia de la Población , Tomografía Computarizada por Rayos X , Estados Unidos/epidemiología
12.
Neurocrit Care ; 20(3): 470-5, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23609118

RESUMEN

BACKGROUND: We ascertained the occurrence of global cerebral edema manifesting as increased brain volume in subjects with intracerebral hemorrhage (ICH) and explored the relationship between subject characteristics and three month outcomes. METHODS: A post-hoc analysis of a multicenter prospective study that recruited patients with ICH, elevated SBP ≥170 mm Hg, and Glasgow Coma Scale (GCS) score ≥8, who presented within 6 h of symptom onset was performed. Computed tomographic (CT) scans at baseline and 24 h, submitted to a core image laboratory, were analyzed to measure total brain, hematoma, and perihematoma edema volumes from baseline and 24-h CT scans using image analysis software. The increased brain volume was determined by subtracting the hematoma and perihematomal edema volumes from the total brain volume. RESULTS: A total of 18 (44 %) of 41 subjects had increased brain volume that developed between initial CT scan and 24-h CT scan. The median increase in brain volume among the 18 subjects was 35 cc ranging from 0.12 to 296 cc. The median baseline GCS score was 15 in both groups of subjects who experienced increased brain volume and those who did not, and the median hematoma volume was 10.18 and 6.73, respectively. Three of the 18 subjects with increased brain volume underwent concurrent neurological deterioration and one subject died during hospitalization. CONCLUSIONS: We found preliminary evidence of increased cerebral brain volume in subjects with good grade and small ICHs, which may be suggestive of global cerebral edema.


Asunto(s)
Antihipertensivos/uso terapéutico , Encéfalo/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Adulto , Anciano , Encéfalo/patología , Edema Encefálico/diagnóstico por imagen , Edema Encefálico/tratamiento farmacológico , Femenino , Hematoma/diagnóstico por imagen , Hematoma/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Proyectos Piloto , Pronóstico , Estudios Prospectivos , Índice de Severidad de la Enfermedad
13.
ScientificWorldJournal ; 2014: 842062, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25136694

RESUMEN

Influence of laser treatment on mechanical properties, wear resistance, and Vickers hardness of aluminum alloy was studied. The specimens were treated by using Nd:YaG laser of energy 780 mj, wavelength 512 nm, and duration time 8 ns. The wear behavior of the specimens was studied for all specimens before and after treatment by Nd:YaG laser and the dry wear experiments were carried out by sing pinon-disc technique. The specimens were machined as a disk with diameter of 25 mm and circular groove in depth of 3 mm. All specimens were conducted by scanning electron microscopy (SEM), energy-dispersive X-ray fluorescence analysis (EDS), optical microscopy, and Vickers hardness. The results showed that the dry wear rate was decreased after laser hardening and increased Vickers hardness values by ratio of 2.4:1. The results showed that the values of wear rate for samples having circular grooves are less than samples without grooves after laser treatment.


Asunto(s)
Aleaciones/química , Aluminio/química , Rayos Láser , Microscopía , Microscopía Electrónica de Rastreo
14.
J Stroke Cerebrovasc Dis ; 23(10): 2687-2693, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25307431

RESUMEN

Vasospasm after aneurysmal subarachnoid hemorrhage was noted in some studies to be less frequent and less severe in older age. One hypothesis is that atherosclerosis makes arteries too stiff to spasm. The objective of this study was to assess the association between intracranial calcification, a marker for atherosclerosis, and vasospasm. Charts and nonenhanced computed tomography scans of patients with subarachnoid hemorrhage were retrospectively reviewed. Transcranial Doppler studies were used to categorize vasospasm using mean flow velocity: mild vasospasm 120-199 cm/second and severe ≥ 200 cm/second. Calcification of the intracranial internal carotid artery was quantified by calculating the volume and density of the calcified lesions. A total of 172 patients met study criteria (mean age, 54 ± 13 years; 88 women). Patients who had calcification (n = 90; 52%) were significantly older (61 ± 12 years vs. 46 ± 10 years; P < .0001). Mean calcification score was 532 ± 853. Calcification score was directly associated with age (P < .0001) and inversely associated with mean flow velocity (P = .0027). Only the highest tertile was independently associated with less vasospasm (odds ratio, .34; 95% confidence interval, .12-.93). There was an interaction between calcification score and age in which age greater than 65 years was only protective of vasospasm when combined with the highest calcification tertile. We conclude that intracranial calcification is associated with lower rates of vasospasm. The amount of visualized calcification inversely influences the severity of vasospasm. Calcification, and the underlying presumed atherosclerosis, maybe 1 mechanism by which vasospasm has lower frequency and severity in older age.


Asunto(s)
Arteria Carótida Interna/fisiopatología , Aneurisma Intracraneal/complicaciones , Hemorragia Subaracnoidea/etiología , Calcificación Vascular/fisiopatología , Vasoespasmo Intracraneal/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Arteria Carótida Interna/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Hemorragia Subaracnoidea/diagnóstico por imagen , Tomógrafos Computarizados por Rayos X , Ultrasonografía Doppler Transcraneal , Calcificación Vascular/diagnóstico por imagen , Vasoespasmo Intracraneal/diagnóstico por imagen
15.
BMJ Case Rep ; 17(1)2024 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-38272522

RESUMEN

We report an elderly woman with vascular risk factors and recurrent cardioembolic strokes in whom the stroke aetiology was finally ascertained to be a calcified amorphous tumour of the heart after repeated negative investigations for embolic aetiology over 2 years. This report discusses the clinical and imaging characteristics of calcified amorphous tumours of the heart with emphasis of recent advances in cardiac imaging.


Asunto(s)
Accidente Cerebrovascular Embólico , Embolia , Neoplasias Cardíacas , Accidente Cerebrovascular , Femenino , Humanos , Anciano , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/patología , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Embolia/etiología , Embolia/complicaciones , Factores de Riesgo
16.
Artículo en Inglés | MEDLINE | ID: mdl-38937114

RESUMEN

Cerebral amyloid angiopathy (CAA) is a progressive neurodegenerative small vessel disease that is associated with intracranial hemorrhage and cognitive impairment in the elderly. The clinical and radiographic presentations have many overlapping features with vascular cognitive impairment, hemorrhagic stroke, and Alzheimer disease (AD). Amyloid-ß-related angiitis (ABRA) is a form of primary CNS vasculitis linked to CAA, with the development of spontaneous autoimmune inflammation against amyloid in the vessel wall with resultant vasculitis. The diagnosis of ABRA and CAA is important. ABRA is often fatal if untreated and requires prompt immunosuppression. Important medical therapies such as anticoagulation and antiamyloid agents for AD are contraindicated in CAA. Here, we present a biopsy-proved case of ABRA with underlying occult CAA. Initial 1.5T and 3T MR imaging did not suggest CAA per the Boston Criteria 2.0. ABRA was not included in the differential diagnosis due to the lack of any CAA-related findings on conventional MR imaging. However, a follow-up 7T MR imaging revealed extensive cortical/subcortical cerebral microbleeds, cortical superficial siderosis, and intragyral hemorrhage in extensive detail throughout the supratentorial brain regions, which radiologically supported the diagnosis of ABRA in the setting of CAA. This case suggests an increased utility of high-field MR imaging to detect occult hemorrhagic neuroimaging findings with the potential to both diagnose more patients with CAA and diagnose them earlier.

17.
Stroke ; 44(1): 237-9, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23233387

RESUMEN

BACKGROUND AND PURPOSE: The reliability of hematoma volume (HV) measurement using the ABC/2 method in multicenter clinical trials is unknown. We determined the accuracy of ABC/2 method as an on-site test in comparison with the gold standard central HV-assessment and semiautomatic HV-assessment. Method- We analyzed data from an acute intracerebral hemorrhage multicenter clinical trial. HV was measured by site investigators to determine enrollment eligibility (<60 cm(3)) using the ABC/2 method (on-site HV), and independently by the core-imaging laboratory using computer-based analysis (Medical Image Processing, Analysis, and Visualization [MIPAV] HV). HV was also measured by ABC/2 method (central HV) at the core-imaging laboratory to assess the difference in measurements between on-site (multiple raters with variable experiences) and central (single experienced rater) HVs. RESULTS: Fifty-six subjects were analyzed (mean age 62±15 years; 45% women). On-site HV values showed a significantly lower correlation with the MIPAV HV (r=0.63) than central HV and MIPAV HV (r=0.93) values. The correlation between on-site HV and central HV values was modest (r=0.51). A total of 73% of the central HVs were within 25% of the corresponding MIPAV HVs, whereas only 46% of the on-site HVs were within 25% of the corresponding MIPAV HVs (P<0.001). One protocol violation occurred as a result of inaccuracy of on-site HV measurement. CONCLUSIONS: On-site HV measurements showed high variability, but the impact on the eligibility determination was small. Centralized remeasurements of HVs with feedback to the sites may increase the reliability of the on-site HV measurements.


Asunto(s)
Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/epidemiología , Hematoma Intracraneal Subdural/diagnóstico por imagen , Hematoma Intracraneal Subdural/epidemiología , Tomografía Computarizada por Rayos X/normas , Enfermedad Aguda , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados
18.
Health Serv Res Manag Epidemiol ; 10: 23333928231192830, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37641649

RESUMEN

Introduction: This analysis is a part of ongoing quality improvement efforts aiming at improving hypertension control among various racial minority groups seen in a large outpatient practice with a special focus on two war refugee populations, the Hmong and the Somali populations. Method: Deidentified medical records were reviewed for adult hypertensive patients who had an outpatient encounter with a hypertension diagnosis during the years 2015 through 2019. The study outcome was the rate of uncontrolled hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, and stratified by race, age, and gender. Results: There were 752,504 patient records representing 259,824 unique patients (mean age 61 ± 13 years) with 49.1% women, 82.1% white 8.3% African American, 4% Asian, 1.6% Hispanic, Somali 0.6%, and 0.2% Hmong. Hmong men had the highest rate of uncontrolled HTN (33.6%) followed by African American (31.3%) then Somali (29.2%). Among women, African Americans had the highest rate (28.6%) followed by Hmong (28.5%) then Somali (25.7%). In all races except Somali, the rate of uncontrolled hypertension was highest in the 18-29 age group, decreased progressively over the next several decades, then increased again in the ≥70 age group. Conclusion: Hmong, African American, and Somali groups have the highest rates of uncontrolled hypertension. Efforts to address hypertension management need to be tailored to the specific characteristics of each racial group and to target young adults.

19.
J Am Heart Assoc ; 12(15): e026763, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-37466390

RESUMEN

Background Prior studies have indicated high rates of vascular risk factors, but little is known about stroke in Hmong. Methods and Results The institutional Get With The Guidelines (GWTG) database was used to identify patients discharged with acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage between 2010 and 2019. Hmong patients were identified using clan names and primary language. Univariate analysis was used to compare Hmong and White patients. A subarachnoid hemorrhage comparison was not conducted because of the small sample size. We identified 128 Hmong patients and 3084 White patients. Hmong patients had more prevalent hemorrhagic stroke (31% versus 15%; P<0.0016). In the acute ischemic stroke cohort, compared with White patients, Hmong patients were younger (60±13 versus 71±15 years; P<0.0001), presented to the emergency department almost 4 hours later; and had a lower thrombolysis usage rate (6% versus 14%; P=0.03496), worse lipid profile, higher hemoglobin A1C, similar stroke severity, and less frequent discharge to rehabilitation facilities. The most common ischemic stroke mechanism for Hmong patients was small-vessel disease. In the intracerebral hemorrhage cohort, Hmong patients were younger (55±13 versus 70±15 years; P<0.0001), had higher blood pressure, and had a lower rate of independent ambulation on discharge (9% versus 30%; P=0.0041). Conclusions Hmong patients with stroke were younger and had poorer risk factor control compared with White patients. There was a significant delay in emergency department arrival and low use of acute therapies among the Hmong acute ischemic stroke cohort. Larger studies are needed to confirm these observations, but action is urgently needed to close gaps in primary care and stroke health literacy.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Hemorragia Subaracnoidea , Humanos , Hemorragia Subaracnoidea/epidemiología , Hemorragia Subaracnoidea/terapia , Hemorragia Subaracnoidea/complicaciones , Asiático , Accidente Cerebrovascular Isquémico/diagnóstico , Accidente Cerebrovascular Isquémico/epidemiología , Accidente Cerebrovascular Isquémico/terapia , Accidente Cerebrovascular/etiología , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/complicaciones , Isquemia Encefálica/epidemiología , Isquemia Encefálica/terapia , Isquemia Encefálica/complicaciones
20.
Am J Phys Med Rehabil ; 102(11): 1014-1019, 2023 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-37104643

RESUMEN

OBJECTIVE: The aim of the study is to identify causes and risk factors for potentially preventable readmissions of patients discharged from an inpatient rehabilitation facility. DESIGN: Our hospital billing database was used to identify patients discharged from our inpatient rehabilitation facility between 2013 and 2018 and experienced a potentially preventable readmission within 90 days ( n = 75). Retrospective chart review was completed to obtain clinical data. Of the patients discharged from the inpatient rehabilitation facility who did not experience a potentially preventable readmission, a group of age- and sex-matched controls ( n = 75) was randomly selected. The two study groups were compared using univariate and multivariate analyses. RESULTS: Our study found that individuals who discharged from acute inpatient rehabilitation were more likely to be readmitted with a potentially preventable readmission if they have a greater number of comorbidities, were admitted initially with a spinal cord injury, or have lower admission or discharge Functional Independence Measure motor scores. The most common potentially preventable readmission diagnoses were sepsis, renal failure, respiratory problems, and urinary tract infection. CONCLUSIONS: Identifying patients with the common causes for potentially preventable readmissions, in addition to the noted risk factors, is an important consideration for inpatient rehabilitation discharge planning.

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