Reliability and validity of the polish version of the vulnerability to Abuse Screening Scale (VASS).

Our aim was to assess the psychometric properties and reliability of a Polish version of the VASS. This cross-sectional validation study involved 228 patients above 65 years of age. Authors-Designed Questionnaire, the Geriatric Depression Scale, and the Activities of Daily Living Scale were used to assess construct validity. Psychometric properties, reliability and repeatability were assessed. Cronbach's alpha coefficient for the VASS scale was 0.89. Almost all items showed a high correlation value in relation to the others (R > 0.45). A high coefficient of repeatability and narrow limits of agreement were observed in the Bland-Altman analysis. All items analyzed had excellent intraclass correlation coefficient (ICC>0.9) and weighted kappa (κ > 0.9) scores. Very strong, significant correlations with other tools confirm the accuracy of the VASS scale. Our research shows promising validity and reliability Polish version of the VASS scale to assess the risk of elder abuse and neglect.

The Impact of Motor Disability and the Level of Fatigue on Adherence to Therapeutic Recommendations in Patients with Multiple Sclerosis Treated with Immunomodulation.

Aim: The aim of the study was to clarify whether the motor disability and the fatigue-related syndrome affect the level of compliance with therapeutic recommendations. Methods: Prospective studies were conducted among 165 patients treated under the drug program - Treatment of Multiple Sclerosis (MS) at the Department of Neurology and Clinical Neuroimmunology of the Regional Specialist Hospital in Grudziadz (Poland). The research was carried out by the method of diagnostic survey, questionnaire technique with the use of standardized research tools. The Adherence in Chronic Diseases Scale (ACDS) was used to assess the level of compliance with therapeutic recommendations. The Expanded Disability Status Scale (EDSS) was used to assess the degree of disability, and the Modified Fatigue Impact Scale (MFIS) was used to assess the degree of disability. The Chi-square test, Shapiro-Wilk test and Kruskal-Wallis were used. Results: The statistical analysis showed that there is a relationship (p=0.0055) between the patient's motor disability assessed in the EDSS scale and the level of compliance with therapeutic recommendations assessed in the ACDS scale. The higher the patient's disability level (EDSS 4.5-6.5), the lower the treatment adherence rate. The conducted research shows that the average score in the MFIS scale for individual levels of compliance with therapeutic recommendations expressed in the ACDS scale is, respectively: for the low level - 38.3 MFIS points, for the medium level - 34.4 MFIS points and for the high level- 33.2 MFIS points. The obtained results were not statistically significant (p=0.6098). Conclusion: It was found that the level of adherence to therapeutic recommendations in patients with relapsing-remitting multiple sclerosis treated with immunomodulation in the study group remained high. There is a relationship between the patient's disability and the level of adherence to therapeutic recommendations.

Multifactorial Background for a Low Biological Response to Antiplatelet Agents Used in Stroke Prevention.

Effective platelet inhibition is the main goal of the antiplatelet therapy recommended as a standard treatment in the secondary prevention of non-embolic ischemic stroke. Acetylsalicylic acid (aspirin) and clopidogrel are commonly used for this purpose worldwide. A low biological response to antiplatelet agents is a phenomenon that significantly reduces the therapeutic and protective properties of the therapy. The mechanisms leading to high on-treatment platelet reactivity are still unclear and remain multifactorial. The aim of the current review is to establish the background of resistance to antiplatelet agents commonly used in the secondary prevention of ischemic stroke and to explain the possible mechanisms. The most important factors influencing the incidence of a low biological response were demonstrated. The similarities and the differences in resistance to both drugs are emphasized, which may facilitate the selection of the appropriate antiplatelet agent in relation to specific clinical conditions and comorbidities. Despite the lack of indications for the routine assessment of platelet reactivity in stroke subjects, this should be performed in selected patients from the high-risk group. Increasing the detectability of low antiaggregant responders, in light of its negative impact on the prognosis and clinical outcomes, can contribute to a more individualized approach and modification of the antiplatelet therapy to maximize the therapeutic effect in the secondary prevention of stroke.

The Phenomenon of Clopidogrel High On-Treatment Platelet Reactivity in Ischemic Stroke Subjects: A Comprehensive Review.

Clopidogrel is increasingly being used for the secondary prevention of ischemic stroke according to the updated guidelines on acute stroke management. Failure to achieve a drug response is referred to as clopidogrel resistance. Similarly, a higher activation of platelets during clopidogrel therapy-high on-treatment platelet reactivity-is equivalent to a reduced effectiveness of a therapy. Clopidogrel resistance is considered to be a common and multifactorial phenomenon that significantly limits the efficacy of antiplatelet agents. The aim of the current study is to review the latest literature data to identify the prevalance and predictors of clopidogrel high on-treatment platelet reactivity among stroke subjects and to establish the potential impact on clinical outcomes and prognosis. Clinical databases were searched by two independent researchers to select relevant papers on the topic, including all types of articles. Several important predictors contributing to clopidogrel resistance were identified, including genetic polymorphisms, the concomitant use of other drugs, or vascular risk factors, in particular nonsmoking and diabetes. Clopidogrel high on-treatment platelet reactivity has a negative impact on the clinical course of stroke, worsens the early- and long-term prognoses, and increases the risk of recurrent vascular events. Platelet function testing should be considered in selected stroke individuals, especially those predisposed to clopidogrel resistance, for whom an improvement in the efficacy of antiplatelet therapy is essential. This particular group may become the greatest beneficiaries of the modification of existing therapy based on platelet function monitoring.

Are Depression and Dementia a Common Problem for Stroke Older Adults? A Review of Chosen Epidemiological Studies.

Stroke is the second leading cause of death in the world. It is often associated with various long-term physical and neuropsychological consequences. The aim of this article is to present the results of research on the occurrence of dementia and post-stroke depression. Using the keywords: post-stroke dementia, post-stroke depression, post-stroke cognitive impairment, stroke, Polish and foreign bibliographic databases were searched: PubMed, Science Direct, Wiley, Google Scholar. Documents that met the eligibility criteria were selected for inclusion in this review. After the conducted analyses, 7 Polish articles and 13 English-language articles were qualified for the review. In the group of people after stroke, there is an increased risk of depression and dementia. According to the data, up to every third person can deal with one of these neuropsychiatric disorders. The presented research analyses indicate that the results obtained by the respondents, at any time after the stroke, indicate the presence of mild cognitive impairment or slight degree dementia among the majority of respondents. It was also shown that people with a stroke in the dominant hemisphere are more likely to experience post-stroke depression. Depression and post-stroke dementia are a common and significant complication of stroke that negatively affects the functional outcome. The huge focus on neuropsychiatric disorders occurring after stroke in modern research is very important because of their negative impact on recovery, quality of life and survival after stroke.

Assessment of the relationship between platelet reactivity, vascular risk factors and gender in cerebral ischaemia patients.

AIM: Excessive activation and platelet aggregation play important roles in the aetiopathogenesis of cerebral ischaemia. The aim of this study was to assess the relationship between platelet reactivity, gender and vascular risk factors in cerebral ischaemia patients. CLINICAL RATIONALE FOR THE STUDY: The research is useful because we found high risk groups of inefficient aspirin treatment in cerebral ischaemia patients. MATERIAL AND METHODS: The study involved 101 patients, including 69 patients with ischaemic stroke and 32 patients with transient ischaemic attack. The assessment of platelet reactivity was made within 24 hours of the disease onset using two aggregometric methods: impedance and optical. RESULTS: Resistance to acetylsalicylic acid among people with cerebral ischaemia was estimated at 30.69% using impedance aggregometry and 9.2% using optical aggregometry. There were no differences in platelet reactivity or ASA resistance between the groups of patients with stroke and TIA in either method. In the whole group of patients (p = 0.04), and in the group of patients with stroke (p = 0.0143), higher reactivity of platelets was observed by impedance aggregometry in men than in women. In the whole group of patients (p = 0.0229), and in the subgroup with stroke (p = 0.0123), it was shown that aspirin resistance is significantly more common in the subgroup of men than in women. In patients suffering from nicotine addiction, significantly higher platelet reactivity was found in the whole group of patients (p = 0.004), as well as in the subgroup of patients with stroke (p = 0.0135). CONCLUSIONS: There are no differences between platelet reactivity and the incidence of aspirin resistance in patients with stroke and TIA. Male gender and smoking are associated with greater reactivity of platelets and more frequent occurrence of acetylsalicylic acid resistance in patients with cerebral ischaemia. CLINICAL IMPLICATIONS: Dual antiplatelet therapy or clopidogrel treatment should be considered in smoking males with cerebral ischaemia due to the high risk of aspirin inefficiency.

[Seizures--symptom or cause of stroke]. / Napady padaczkowe- objaw albo nastepstwo udaru mózgu.

The most frequent reason of seizures in elderly are vascular diseases of the brain. The early-onset seizures occur in first 7 days after stroke, and the late-onset seizures occur after 7 days after stroke. The aim of the study was to estimate the frequency of seizures in patients who have taken a stand in acute period of stroke, the incidence of seizures in different types of stroke, the frequency of the types of seizures and the risk of death depending on the type of seizure. One hundred and sixty seven patients with ischemic stroke and seizures were enrolled in this retrospective study. Patients have been divided into 2 groups: group I-with early-onset seizures and group II- with late-onset seizures. In our study seizure was the first symptom of acute stroke in 2.4% of ischemic stroke and 3.2% among patients with cerebral hemorrhage. Seizures occurred in 3.9% of patients with PACI stroke. The primary tonic-clonic generalised seizures occurred in 46.7% patients with early-onset seizures. In the group with early-onset seizures the mortality was 13.3%. In the group of poststroke epilepsy the mean time from stroke to seizure was 21 month. The early-onset seizures occurred in 2.5% patients with acute stroke. The early-onset seizures are most related to PACI stroke and cerebral hemorrhages. The primary tonic-clonic generalised seizures are most common in both groups. The highest mortality among early-onset seizures is related to primary tonic-clonic generalized and focal complex seizures.

[The role of chronic venous insufficiency in the pathogenesis of brain diseases]. / Rola przewleklej niewydolnosci ukladu zylnego mózgu w patogenezle chorób mózgu.

Recent data from the literature suggest a greater role of chronic venous insufficiency in the pathogenesis of a variety of brain disorders than previously thought. The more perfect method of imaging the structure and brain function contributed to it. The method of choice in the diagnosis of cerebral venous insufficiency are: Color Doppler of neck vessels, TCCD (transcranial color coded duplex) and TOF (time of flight) MR angiography of the brain and carotid vessels. Under physiological conditions, the flow in veins of the brain is one-way, to the heart. In pathological conditions, there is a reverse blood flow to the brain, which is the essence of the chronic venous insufficiency of brain. It is considered that cerebral venous disorders may underlie a number of diseases of the nervous system. This paper describes the role of venous circulatory disorders of the brain in pathogenesis of multiple sclerosis, the total transient amnesia, Alzheimer's disease, Parkinson's disease, transient monocular blindness, headaches, spontaneous intracranial hypertension. It seems that the correct function of the venous system plays an important role in maintaining brain function. We need further research in this area to better understanding the relationship between the venous pathology of the brain and diseases of the nervous system.

How Does Aphasia Affect Quality of Life? Preliminary Reports.

Aphasia leads to disability, which, in turn, limits and can result in a complete breakdown of roles and social bonds. Thus, the aim of this study was to assess the impact of aphasia disorders on the quality of life of patients after an ischemic stroke. A prospective study among 116 patients with an ischemic stroke (the study group: 68 participants, 38.25% female, included patients with aphasia after a stroke; the control group: 48 patients, 37.5% female, without aphasia) was conducted at the Neurological Department of the Provincial Specialist Hospital in Wloclawek. The patients were assessed twice: the first assessment was conducted during hospitalization using the Aphasia Dynamics Assessment Scale and the Aphasia Test Method of Jadwiga Szumska, and the second assessment of the quality of life after six months was conducted using the WHOQOL-BREF questionnaire. The patients from the control group rated their overall quality of life more highly than the patients from the study group. Statistically significant differences were observed in the physical domain, the psychological domain, and the environmental domain. The analysis of sociodemographic factors indicated a negative impact on the quality of life of the following variables: female gender, 55-64 years of age, vocational education, and place of residence-rural area. The degree and type of aphasia influenced the overall quality of life. Studies with larger samples are necessary.

Analysis of the Level of Stress and Methods of Coping with Stress among the Nursing Staff.

In general, "stress" is the reaction of the body to mental and physical demands placed on it. Stress disrupts mental balance, and reduces the ability to work and function, which negatively affects the performance of duties. The aim of this study was to analyse the level of stress and ways of coping with it among nursing staff. The study covered 220 nurses employed at the Provincial Specialist Hospital in Wloclawek. The research tool was the Perceived Stress Scale (PSS-10) and the Brief-COPE. The results of this survey showed the occurrence of average and high levels of experiencing stress in 36% and 40%of staff, respectively. Brief-COPE scale results show that substance use/gender (men) and use of emotional support/place of work (internal medicine department) are significant at p < 0.01. Considering the impact of the workplace on the use of psychoactive substances, it can be seenthat people working in the surgical ward are more likely to use psychoactive substances. Furthermore, nurses in the surgical ward find it easier to think and plan what to do when faced with a difficult life situation. Most often, the respondents with the highest work experience, i.e., the elderly, declared a return to religion. The results of the research indicate that the nursing community experiences stress to an average or significant degree. The strategies are mainly based on active coping and seeking emotional and instrumental support. Further research is needed in this field. This study was not pre-registered on a publicly accessibly registry.

Burnout Levels in Nurses and Associated Factors during the COVID-19 Pandemic-A Cross-Sectional Study.

Previous studies have shown that sudden changes in the nature of nursing work and their work environment related to the COVID-19 pandemic have affected the professional experience of nurses, and consequently led to an increase in professional burnout in this professional group. Thus, the aim of the study was to measure occupational burnout among nurses working during the COVID-19 pandemic in Poland. A cross-sectional study was conducted with pediatric and surgery female nurses (N = 110, mean age 51 ± 6.92) from the Provincial Specialist Hospital in Wloclawek, Poland. The participants completed the Link Burnout Questionnaire (LBQ) and the Socio-Demographic Questionnaire (SDQ). The data were analyzed using Spearman's rank correlation and Mann-Whitney U test. The study showed that high burnout affected 6.4% of nurses. The level of professional burnout for the subscales of psychophysical exhaustion, relationship deterioration, professional inefficacy and disappointment was 28.2%, 26.4%, 11.8% and 13%, respectively (mean score: 19.85 ± 6.51, 18.03 ± 5.15, 13.74 ± 4.07 and 17.61 ± 5.85, respectively). The results show that surgical nurses were statistically more likely to experience professional burnout. In sum, burnout among nurses has become a serious problem, especially considering the COVID-19 pandemic, which is why it is so important to continue research in this area. Hospital management needs to take urgent action to address the systemic and professional issues that contribute to the suboptimal mental health of nurses.

Thermal Energy Analysis of Projectiles during Ricochetting Using a Thermal Camera.

This paper presents the results of a study of the hazards of ground ignition and/or explosion when various small-calibre projectiles struck various solid materials placed on a test stand in environments at risk of ignition (fire) or explosion (ricochets and projectile penetration of obstacles). For projectile ricochetting tests, the following were used: an armour plate, concrete, sidewalk and granite slabs, etc., and various small-calibre projectiles: 7.62 × 51 mm SWISS PAP, 7.62 × 51T, 7.62 × 51 mm M80, 7.62 × 54R B-32, 7.62 × 54R LPS and .308 Win. Norma Ecostrike. Projectiles impacts were recorded with a high-speed camera (50,400 fps) and thermal cameras (660 fps) and (2615 fps). The ignition capability of solid flammable materials during projectile ricochetting was studied, and the temperatures and surface areas of isotherms were measured as a function of time. From the spherical distribution of thermal energy radiation in space, their volumes, masses of air occupying the studied area, masses of projectile disintegrating into fragments (after impact), thermal energies during projectile ricochetting, histograms of area temperatures and temperatures were calculated. This energy was compared with the minimum ignition energy of the selected gases and liquid vapours, and the ignition temperature were determined. The probabilities of some of the selected gases and liquid vapours which can ignite or cause an explosion were determined. The thermal energies of the 7.62 × 54R B-32 (3400-9500 J) and 7.62 × 51T (2000-3700 J) projectiles ricochetting on the Armox 600 plate was sufficient to ignite (explode) propane-butane gas. The thermal energy of 7.62 × 54R B-32 projectiles ricochets on the non-metallic components (800-1200 J) was several times lower than that of projectiles ricochets on an Armox 600 plate (3400-9500 J). This is due to the transfer of much of the kinetic energy to the crushing of these elements.

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania.

Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics' hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics' prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics' demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8−57.6) vs. 28.1% (95% CI 20.1−27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5−90.5) vs. 69.8% (60.0−78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8−77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0−68.0), brain tumors (56.3%, 95% CI 48.5−63.8), and seizures (54.4%, 95% CI 46.7−62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4−11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusions: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount.

Correction: Validation of a Polish version of the National Institutes of Health Stroke Scale: Do moderate psychometric properties affect its clinical utility?

[This corrects the article DOI: 10.1371/journal.pone.0249211.].

Analysis of job burnout, satisfaction and work-related depression among neurological and neurosurgical nurses in Poland: A cross-sectional and multicentre study.

AIM: This study investigated the status of job burnout, work-related depression and job satisfaction among neurological and neurosurgical nurses in Poland. DESIGN: A cross-sectional and multicentre study. METHODS: The sample consisted of 206 neurological and neurosurgical nurses, all of whom completed a self-report questionnaire designed by the authors. RESULTS: The results revealed a work-related burnout incidence of 32%, colleague-related burnout incidence of 44.2% and patient-related burnout incidence of 22.8%. Nurses working in neurological departments were statistically over three times more likely to struggle with colleague-related burnout than nurses working in neurosurgical departments were. Further, work-related burnout was higher in people aged above 54 years than those in the youngest age category. Nonetheless, 71.8% of the nurses expressed satisfaction with their work. In sum, our results indicated that job burnout is common among registered nurses and that personal (age) and workplace (type of ward, distance to work, experience and shift work) factors contributed to symptoms of burnout.

Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time.

Background and Purpose: Acute stroke treatment outcomes are predicated on reperfusion timeliness which can be improved by better prehospital stroke identification. We aimed to assess the effect of interactive emergency medical services (EMS) training on stroke recognition and prehospital care performance in a very high-risk cardiovascular risk population in Lithuania. Methods: We conducted a single-center interrupted time-series study between March 1, 2019 and March 15, 2020. Two-hour small-group interactive stroke training sessions were organized for 166 paramedics serving our stroke network. We evaluated positive predictive value (PPV) and sensitivity for stroke including transient ischemic attack identification, onset-to-door time, and hospital-based outcomes during 6-months prior and 3.5 months after the training. The study outcomes were compared between EMS providers in urban and suburban areas. Results: In total, 677 suspected stroke cases and 239 stroke chameleons (median age 75 years, 54.8% women) were transported by EMS. After the training, we observed improved PPV for stroke recognition (79.8% vs. 71.8%, p = 0.017) and a trend of decreased in-hospital mortality (7.8% vs. 12.3, p = 0.070). Multivariable logistic regression models adjusted for age, gender, EMS location, and stroke subtype showed an association between EMS stroke training and improved odds of stroke identification (adjusted odds ratio [aOR] 1.6 [1.1-2.3]) and onset-to-door ≤ 90 min (aOR 1.6 [1.1-2.5]). The improvement of PPV was observed in urban EMS (84.9% vs. 71.2%, p = 0.003), but not in the suburban group (75.0% vs. 72.6%, p = 0.621). Conclusions: The interactive EMS training was associated with a robust improvement of stroke recognition, onset to hospital transport time, and a trend of decreased in-hospital mortality. Adapted training strategies may be needed for EMS providers in suburban areas. Future studies should evaluate the long-term effects of the EMS training and identify optimal retraining intervals.

Safety and efficacy of intravenous thrombolytic treatment in wake-up stroke: Experiences from a single center.

OBJECTIVES: Wake-up stroke is an important clinical problem that may account for a quarter of all ischemic strokes. This study aimed to establish the safety and efficacy of intravenous thrombolytic treatment of wake-up strokes by comparing it to the standard thrombolysis treatment in strokes with clear onsets and wake-up strokes that did not receive reperfusion therapy. METHODS: This retrospective study enrolled 95 patients with ischemic strokes who underwent thrombolytic treatment with alteplase, including nine patients with wake-up strokes. The safety profile (mortality and intracranial bleeding) and efficacy (clinical and functional outcomes on admission, discharge, and 90 days after stroke onset) were evaluated. RESULTS: When assessed using the modified Rankin scale (mRs), the patients with wake-up strokes had significantly more favorable functional outcomes on discharge when compared to those who received standard thrombolysis (p = .0289). No significant differences were noted when the favorable outcome rate (mRs score = 0-2) at three months post-thrombolysis (Odds ratio [OR] = 2.07; 95% confidence interval [CI] = 0.41-10.6; p = .3807) and safety outcomes (death during hospitalization: OR = 0.49; 95% CI = 0.03-9.11; p = .6295 and intracranial bleeding 24 hr after treatment: OR = 0.43; 95% CI = 0.02-7.58; p = .5707) were compared between the two groups. The Cochran-Mantel-Haenchel shift analysis showed a significantly more favorable distribution of the mRs scores at three months after the stroke onset in the patients with wake-up strokes who were treated with alteplase compared to those who did not receive thrombolysis (OR = 1.42; 95% CI = 1.01-1.82; p = .0426). CONCLUSIONS: Our study demonstrated that in patients who awaken with stroke symptoms, intravenous thrombolytic treatment is a safe procedure that may lead to favorable outcomes. Further studies should be performed to increase the size of the group of patients with wake-up strokes who can be treated with reperfusion therapy.

Multifactorial Predictors of Late Epileptic Seizures Related to Stroke: Evaluation of the Current Possibilities of Stratification Based on Existing Prognostic Models-A Comprehensive Review.

Background: Epilepsy associated with strokes is a significant clinical and public health problem and has a negative impact on prognosis and clinical outcome. A late epileptic seizure occurring seven days after stroke is actually equated with poststroke epilepsy due to the high risk of recurrence. Predictive models evaluated in the acute phase of stroke would allow for the stratification and early selection of patients at higher risk of developing late seizures. Methods: The most relevant papers in this field were reviewed to establish multifactorial predictors of late seizures and attempt to standardize and unify them into a common prognostic model. Results: Clinical and radiological factors have become the most valuable and reproducible predictors in many reports, while data on electroencephalographic, genetic, and blood biomarkers were limited. The existing prognostic models, CAVE and SeLECT, based on relevant, readily available, and routinely assessed predictors, should be validated and improved in multicenter studies for widespread use in stroke units. Conclusions: Due to contradictory reports, a common and reliable model covering all factors is currently not available. Further research might refine forecasting models by incorporating advanced radiological neuroimaging or quantitative electroencephalographic analysis.

Introducing Adam's Scale of Posterior Stroke (ASPOS): A Novel Validated Tool to Assess and Predict Posterior Circulation Strokes.

BACKGROUND: Assessing the severity of posterior circulation strokes, due to the variety of symptoms, is a significant clinical problem. Current clinimetric scales show lower accuracy in the measurement of posterior stroke severity, compared with that of anterior strokes. The aim of the study was to design a validated tool, termed Adam's Scale of Posterior Stroke (ASPOS), for better assessment and prediction of posterior stroke. METHODS: This prospective, observational study involved 126 posterior circulation ischemic stroke subjects. Four researchers, previously trained in ASPOS, randomized the stroke severity using a novel tool and other appropriate stroke scales (The National Institute of Health Stroke Scale-NIHSS, modified Rankin Scale-mRS, Glasgow Coma Scale, Barthel Index, or Israeli Vertebrobasilar Stroke Scale-IVBSS) to assess the psychometric properties, reliability, and validity of ASPOS and investigate its predictive value. RESULTS: ASPOS reached a Cronbach's alpha coefficient of 0.7449, indicating good internal consistency. The Bland-Altman analysis showed a good coefficient of repeatability (CR) of 0.46, a 95% confidence interval (CI) of 0.41-0.53, and excellent intraclass correlation coefficients or weighted kappa values (>0.90), reflecting high reliability and reproducibility. Highly significant correlations with other scales confirmed the construct and predictive validity of ASPOS. A total ASPOS score of three points indicated a significantly increased probability of severe stroke based on the NIHSS, compared to a total ASPOS of 1-2 points (odds ratio (OR) 141; 95% CI: 6.72-2977.66; p = 0.0014). CONCLUSIONS: We developed a novel, valid, and reliable tool to assess posterior circulation strokes. This can contribute to a more comprehensive estimation of posterior stroke and, additionally, due to its predictive properties, it can be used to more accurately select candidates for specific treatments.

A Combination of Aspirin and Clopidogrel Predict More Favorable Dynamics of Platelet Reactivity versus Clopidogrel Alone in the Acute Phase of Minor Stroke.

BACKGROUND: The combined use of clopidogrel and aspirin is recommended for the short-term (21 days) therapy of minor stroke or transient ischemic attack. Previous studies have demonstrated its efficacy and superiority over treatment with a single antiplatelet agent. However, there is insufficient support for the advantages of such therapy based on platelet function testing. We aimed to compare the effect of the concomitant use of clopidogrel and aspirin versus clopidogrel alone on the dynamics of platelet reactivity over time to determine the appropriate antiplatelet treatment strategy for minor strokes. METHODS: We enrolled 74 ischemic stroke subjects, including 38 minor strokes. Platelet reactivity was assessed by impedance aggregometry (Multiplate Analyzer) 48 and 96 h after a first 75 mg dose of clopidogrel, using the acetylsalicylic acid platelet inhibition (ASPI) test and the adenosine diphosphate (ADP) test. Dual antiplatelet therapy was strictly reserved only to minor strokes, as the other strokes received clopidogrel alone in the secondary prevention. The dynamics of platelet reactivity refer to the difference between two assessments, and a decrease in values over time was considered favorable. RESULTS: The incidence of clopidogrel non-responsiveness was 64.8%, and this was similar in the group of minor strokes and the group of more disabling strokes. We indicated diabetes mellitus as an independent predictor of high on-clopidogrel platelet reactivity (Odds ratio OR 5.69 95% Confidence Interval CI 1.13-41.26, p = 0.0386). Among minor strokes treated with dual antiplatelet therapy, in relation to clopidogrel, we reported a trend toward more favorable dynamics of platelet reactivity over time compared to the group using clopidogrel alone (p = 0.0652 vs. p = 0.3384, respectively). We identified five predictors (sex, female; small-vessel disease; no diabetes; no hyperlipidemia; and no alcohol abuse) related to a significant decrease in platelet reactivity over time with respect to clopidogrel. No significant dynamics of platelet reactivity when using aspirin were found. CONCLUSIONS: Our findings, based on the favorable dynamics of platelet reactivity over time in relation to clopidogrel, confirm the usefulness of dual antiplatelet therapy in minor strokes and support the continuation of the secondary prevention with clopidogrel alone rather than aspirin, particularly among identified beneficiaries of such a strategy.