RESUMEN
BACKGROUND: Understanding seasonal variations in stroke can help stakeholders identify underlying causes in seasonal trends, and tailor resources appropriately to times of highest needs. We sought to evaluate the seasonal occurrence of stroke and its subtypes. METHODS: We conducted a retrospective cohort study using administrative data from January 1st, 2003, to December 31st, 2017, in Ontario, Canada's most populous province. We evaluated seasonal variations in stroke occurrence by subtype, via age/sex standardized rates and adjusted rate ratios using Poisson regressions. In those with stroke, we evaluated 30-day case fatality risks by season, adjusted for age, sex, stroke type, and comorbid conditions, and then used Cox proportional hazard models to estimate the effect of season on the fatality. The administrative data used in this study were from the Canadian Institute for Health Information's Discharge Abstract Database, the National Ambulatory Care Reporting System Database, the Ontario Registered Persons Database, and the 2006 and 2011 Canada Census and linked administrative databases. RESULTS: During our study period, we observed 394,145 strokes or TIA events, with a decrease in monthly hospitalization/emergency department visits per 100,000 people between January 2003 and December 2017 from 24.22 to 17.43. Compared to the summer, overall stroke occurrence was similar in the spring but slightly lower in the fall (adjusted rate ratio [aRR] 0.97, 95% confidence interval [CI] 0.96-0.98) and winter (aRR 0.94, 95% CI: 0.94-0.95). There were minor variations by stroke subtype. Winter was associated with the highest risk of stroke case fatality compared to the summer (12.4% vs. 11.4%, adjusted hazard ratio 1.10, 95% CI: 1.07-1.13). CONCLUSIONS: We found seasonal variations in stroke occurrence and case fatality, although the absolute differences were small. Further work is needed to better understand how environmental or meteorological factors might affect stroke risk.
RESUMEN
AIM: Sexual dysfunction is an important, and often overlooked, sequela of rectal cancer treatment with significant implications for patients' quality of life. The aim of this study was to explore patients' information needs regarding sexual health after rectal cancer treatment and their experiences accessing information on sexual dysfunction throughout the cancer care continuum. The secondary aim was to explore surgeons' perspectives on patients' information needs and gain insight into their experiences providing information on sexual health following rectal cancer surgery. METHOD: A qualitative study was conducted using semistructured interviews with 10 rectal cancer survivors and six colorectal surgeons from a Canadian tertiary care institution. Transcribed interviews were coded independently by two researchers and thematic analysis was performed. RESULTS: Analysis of patient interviews revealed that patients had limited knowledge of sexual dysfunction symptoms following rectal cancer treatment and received inadequate information on sexual dysfunction from their treating medical team. Patients expressed the desire to receive information on sexual dysfunction in different formats, especially before the start of treatment. The surgeon interviews revealed that colorectal surgeons faced challenges when informing patients about sexual dysfunction. Surgeons did not routinely provide information on sexual dysfunction to all patients; however, they felt that patients should receive high-quality information on sexual dysfunction, both before and after treatment. CONCLUSION: Patients' information needs related to sexual dysfunction after rectal cancer treatment were inadequately met. High-quality informational resources are needed to facilitate communication between patients and physicians and improve patients' understanding of sexual dysfunction.
Asunto(s)
Investigación Cualitativa , Neoplasias del Recto , Disfunciones Sexuales Fisiológicas , Humanos , Neoplasias del Recto/cirugía , Neoplasias del Recto/psicología , Femenino , Masculino , Persona de Mediana Edad , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/psicología , Anciano , Educación del Paciente como Asunto , Calidad de Vida , Cirujanos/psicología , Evaluación de Necesidades , Canadá , Supervivientes de Cáncer/psicología , Adulto , Salud Sexual , Entrevistas como Asunto , Complicaciones Posoperatorias/psicología , Complicaciones Posoperatorias/etiología , Conocimientos, Actitudes y Práctica en SaludRESUMEN
BACKGROUND: Prehospital delays are a major obstacle to timely reperfusion therapy in acute ischemic stroke. Stroke sign recognition, however, remains poor in the community. We present an analysis of repeated surveys to assess the impact of Face, Arm, Speech, Time (FAST) public awareness campaigns on stroke knowledge. METHODS: Four cross-sectional surveys were conducted between July 2016 and January 2019 in the province of Quebec, Canada (n = 2,451). Knowledge of FAST stroke signs (face drooping, arm weakness and speech difficulties) was assessed with open-ended questions. A bilingual English/French FAST public awareness campaign preceded survey waves 1-3 and two campaigns preceded wave 4. We used multivariable ordinal regression models weighted for age and sex to assess FAST stroke sign knowledge. RESULTS: We observed an overall significant improvement of 26% in FAST stroke sign knowledge between survey waves 1 and 4 (odds ratio [OR] = 1.26; 95% CI: 1.02, 1.55; p = 0.035). After the last campaign, however, 30.5% (95% CI: 27.5, 33.6) of people were still unable to name a single FAST sign. Factors associated with worse performance were male sex (OR = 0.68; 95% CI: 0.53, 0.86; p = 0.002) and retirement (OR = 0.54; 95% CI: 0.35, 0.83; p = 0.005). People with lower household income and education had a tendency towards worse stroke sign knowledge and were significantly less aware of the FAST campaigns. CONCLUSIONS: Knowledge of FAST stroke signs in the general population improved after multiple public awareness campaigns, although it remained low overall. Future FAST campaigns should especially target men, retired people and individuals with a lower socioeconomic status.
Asunto(s)
Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Concienciación , Estudios Transversales , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapiaRESUMEN
AIM: Patients are not well informed about sexual dysfunction after rectal cancer surgery and often turn to the Internet for information. The purpose of this study was to assess online information for patients on sexual dysfunction after rectal cancer surgery. METHODS: An online search of Google, Yahoo and Bing was performed using specific (e.g., rectal cancer surgery and vaginal pain) and general (e.g., rectal cancer surgery and sex) search terms. Inclusion criteria were websites in English, designed for patients, and including content regarding sexual dysfunction after rectal cancer surgery. Websites were assessed for readability (nine standardized tests), quality (DISCERN tool), suitability (Suitability Assessment of Materials tool), and content. RESULTS: Of 5040 websites identified, 99 unique websites met inclusion criteria. Three (3%) websites fulfilled the American Medical Association recommendation of a 6th-grade reading level. Using the DISCERN instrument, two (2%) websites were assigned good/excellent quality, nineteen (19%) referenced their sources of information, and thirty-one (31%) fully discussed the impact of sexual dysfunction on quality of life. Using the SAM instrument, three (3%) websites were classified as highly suitable for rectal cancer patients, sixty-five (66%) were adequate, and thirty-one (31%) were inadequate. With regards to content, nine (9%) websites fully discussed the impact of sexual dysfunction on patients partners and fifty-one (52%) websites did not cover prognosis. CONCLUSION: Online health information available to patients on sexual dysfunction after rectal cancer surgery is suboptimal. Websites are not suitable, lack important content, and are written at too complex a reading level for patients.
Asunto(s)
Información de Salud al Consumidor , Neoplasias del Recto , Comprensión , Humanos , Internet , Calidad de Vida , Neoplasias del Recto/cirugíaRESUMEN
INTRODUCTION: Over the last decade, there have been significant advances in treatments for anterior ischemic stroke, most notably endovascular thrombectomy (EVT). Despite the success of EVT on overall outcomes, intracerebral hemorrhage (ICH) is an important post-procedure complication, often associated with mortality and disability. Hence, predicting the risk of ICH can inform EVT decision making. The ASPECT score is used globally to predict patients' prognosis post-reperfusion therapy. Our objective is to perform a systematic review to collect and synthesize data on the association between ASPECT scores on CT, CTP and DWI-MRI (CT-ASPECT, CTP-ASPECT, and DWI-ASPECT) and the risk of symptomatic ICH after EVT for anterior circulation strokes. METHODS AND ANALYSIS: We will conduct a broad search of various electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and the Cochrane Database of Systematic Reviews) to identify studies published after January 1st, 2012 (commonly accepted as the beginning of the modern EVT era based on availability of stent-retrievers). Two independent reviewers will screen and include studies evaluating associations between symptomatic ICH after thrombectomy and baseline CT-ASPECT, CTP-ASPECT and DWI-ASPECT scores. Data will be extracted to quantify the risk of sICH after EVT based on the ASPECT scoring. TRIAL REGISTRATION: PROSPERO registration number: CRD42023459860.
Asunto(s)
Hemorragia Cerebral , Procedimientos Endovasculares , Accidente Cerebrovascular , Revisiones Sistemáticas como Asunto , Humanos , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/etiología , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/etiología , Tomografía Computarizada por Rayos X , Trombectomía/efectos adversos , Trombectomía/métodos , Imagen de Difusión por Resonancia Magnética , PronósticoRESUMEN
PURPOSE: Randomized trials demonstrating the benefits of thrombectomy for basilar artery occlusions have enrolled an insufficient number of patients with a National Institutes for Health Stroke Scale (NIHSS) score <â¯10 and shown discrepant results for patients with an NIHSS >â¯20. Achieving a first pass recanalization (FPR) improves clinical outcomes in stroke. We aimed to evaluate the effect of the FPR on outcomes among basilar artery occlusion patients, characterized by prethrombectomy initial NIHSS score. METHODS: We retrospectively analyzed the Endovascular Treatment in Ischemic Stroke (ETIS) registry of 279 basilar artery occlusion patients treated with thrombectomy from 6 participating centers. We compared the 90-day clinical outcomes of achieving a FPR versus no FPR, categorized by initial clinical severity: mild (NIHSS <â¯10), moderate (NIHSS 10-20) and severe (NIHSS >â¯20). We used Poisson regression with robust error variance to determine the effect of the NIHSS score on the association between FPR and outcomes. RESULTS: The FPR patients with NIHSS <â¯10 or NIHSS 10-20 were more likely to have a favorable clinical outcome (modified Rankin scale, mRS 0-3) than non-FPR patients (relative risk, RRâ¯= 1.32, 95% confidence interval, CI: 1.04, 1.66, p-valueâ¯= 0.0213, and RRâ¯= 1.79, 95% CI: 1.26, 2.53, p-valueâ¯= 0.0011, respectively). A similar benefit was not found in patients with severe symptoms. We found a significantly lower risk of poor clinical outcome (mRS 4-6) in FPR patients with NIHSS 10-20, but not among patients with an NIHSS >â¯20. CONCLUSION: Achieving a FPR in basilar artery occlusion patients with mild (NIHSS <â¯10) or moderate (NIHSS 10-20) symptoms is associated with better clinical outcomes, but not in patients with severe symptoms. These results support the importance of further clinical trials on the benefits of thrombectomy in severe strokes.
Asunto(s)
Sistema de Registros , Índice de Severidad de la Enfermedad , Trombectomía , Humanos , Masculino , Femenino , Estudios Retrospectivos , Anciano , Trombectomía/métodos , Resultado del Tratamiento , Persona de Mediana Edad , Procedimientos Endovasculares/métodos , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/cirugía , Insuficiencia Vertebrobasilar/terapia , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/cirugíaRESUMEN
Patients with acute to subacute multifocal neurologic abnormalities often have a unique presentation, and their diagnosis and management can be challenging. We present the case of a 40-year-old patient who presented with a 4-day history of confusion, bradyphrenia, right facial droop, bilateral lower limb weakness, urinary incontinence, and hypothermia. This case highlights the diagnostic approach to patients with subacute multifocal neurologic abnormalities, the importance of considering coexisting systemic illnesses in the diagnosis, and their management. Readers will explore the diagnostic steps our group has considered to reach our final diagnosis and the importance of management for our leading diagnosis.
Asunto(s)
Encefalopatías , Femenino , Humanos , Adulto , Encefalopatías/complicaciones , Encefalopatías/diagnóstico , Paraparesia/diagnóstico , Paraparesia/etiología , Confusión , Debilidad Muscular/etiología , Razonamiento ClínicoRESUMEN
BACKGROUND AND AIMS: Face, arm, speech, time (FAST) public awareness campaigns improve stroke recognition in the general population. Whether this translates into improved emergency medical services (EMS) activation remains unclear. We assessed the association of five consecutive FAST campaigns with EMS calls for suspected strokes in a large urban area of Quebec, Canada. METHODS: We conducted an observational study to assess data collected between June 2015 and December 2019 by the public EMS agency covering the cities of Laval and Montreal (Quebec, Canada). Five FAST campaigns were held over this period (mean duration: 9 weeks). We compared daily EMS calls before and after all FAST campaigns (2015 vs 2019) with t tests and Mann-Whitney U tests. We used single-group, univariate interrupted time series to measure changes in daily EMS calls for suspected strokes following each FAST campaign (stroke categories: any, symptom onset < 5 h, Cincinnati Prehospital Stroke Scale [CPSS] 3/3). Calls for headache served as negative control. RESULTS: After five FAST campaigns, mean daily EMS calls increased by 28% (p < 0.001) for any suspected stroke and by 61% (p < 0.001) for stroke with symptom onset < 5 h, compared to 10.1% for headache (p = 0.012). Significant increases in daily EMS calls were observed after three campaigns (highest OR = 1.26; 95% CI 1.11, 1.43; p < 0.001). There were no significant changes in calls after individual campaigns for suspected stroke with symptom onset < 5 h, or suspected stroke with CPSS 3/3. CONCLUSIONS: We observed an inconsistent impact of individual FAST campaigns on EMS calls for any suspected stroke, and did not observe significant EMS call changes after individual campaigns for acute (< 5 h) and severe (CPSS 3/3) strokes. These results may help stakeholders identify potential benefits and limitations of public awareness campaigns using the FAST acronym.
RéSUMé: CONTEXTE ET OBJECTIFS: Les campagnes de sensibilisation du public Face, Arm, Speech, Time (FAST) améliorent la reconnaissance des AVC dans la population générale. Si cette amélioration de la reconnaissance des AVC se traduit par une amélioration de l'activation des services médicaux d'urgence (SMU) est encore inconnu. Nous avons évalué l'association de cinq campagnes FAST consécutives avec des appels SMU pour suspicion d'AVC dans une grande zone urbaine du Québec, au Canada. MéTHODES: Nous avons mené une étude observationnelle pour évaluer les données recueillies entre juin 2015 et décembre 2019 par l'agence publique EMS couvrant les villes de Laval et de Montréal (Québec, Canada). Cinq campagnes FAST ont été organisées sur cette période (durée moyenne : 9 semaines). Nous avons comparé les appels SMU quotidiens avant et après toutes les campagnes FAST (2015 vs 2019) avec les tests t et les tests U de Mann-Whitney. Nous avons utilisé des séries temporelles interrompues univariées à groupe unique pour mesurer les changements dans les appels quotidiens aux SMU pour des suspicions d'AVC après chaque campagne FAST (catégories d'AVC : tout, début des symptômes < 5 heures, Cincinnati Prehospital Stroke Scale [CPSS] 3/3). Les appels pour maux de tête ont servi de contrôle négatif. RéSULTATS: Après cinq campagnes FAST, le nombre moyen d'appels quotidiens aux SMU a augmenté de 28 % (p < 0,001) pour toute suspicion d'AVC et de 61 % (p < 0,001) pour les AVC avec une apparition des symptômes < 5 heures, contre 10,1 % pour les céphalées (p = 0,012). Des augmentations significatives des appels quotidiens aux SMU ont été observées après trois campagnes (OR le plus élevé = 1,26 ; IC à 95 % : 1,11, 1,43 ; p < 0,001). Il n'y a pas eu de changements significatifs dans les appels après les campagnes individuelles pour les suspicions d'AVC avec une apparition des symptômes < 5 heures, ou les suspicions d'AVC avec CPSS 3/3. CONCLUSIONS: Nous avons observé un impact irrégulier des campagnes FAST individuelles sur les appels aux SMU pour toute suspicion d'AVC, et nous n'avons pas observé de changements significatifs dans les appels aux SMU après les campagnes individuelles pour les AVC aigus (< 5 h) et sévères (CPSS 3/3). Ces résultats peuvent aider les parties prenantes à identifier les avantages et les limites potentielles des campagnes de sensibilisation du public utilisant l'acronyme FAST.