Predictores del estado post-ictus en el alta hospitalaria. Importancia en enfermería / Predictors of the post-stroke status in the discharge from the hospital. Importance in nursing

A menudo, por parte del paciente y de la familia, se solicita a los profesionales de enfermería que predigan los factores que influyen en el estado post-ictus. Se han realizado numerosos estudios para determinar los factores que influyen en el estado neurológico post-ictus en el momento del alta hospitalaria. Sin embargo, las técnicas de aprendizaje automático no se han utilizado para este propósito. Con el objetivo de obtener reglas de asociación del pronóstico neurológico, se ha llevado a cabo un doble análisis, tanto clínico como con técnicas de aprendizaje automático, de las posibles asociaciones de factores que influyen en el estado neurológico de los pacientes post-ictus. El algoritmo Apriori detectó varias reglas de asociación con alta confianza (≥ 95%), con el siguiente patrón: En pacientes en el rango de edad de 50-80 años, la asociación de un NIHSS entre 11 y 15 puntos (NIHSS intermedio/bajo), junto con la trombectomía, conduce a la recuperación ad integrum al alta. Con la técnica de remuestreo SMOTE, se alcanzó el 100% de confianza para la asociación de NIHSS elevado (>20) y afectación de las arterias carótida y basilar, con pronóstico nefasto (exitus). Estas reglas confirman, por primera vez con aprendizaje automático, la importancia de la asociación de algunos predictores, en el pronóstico post-ictus. El conocimiento por parte de las enfermeras de estas reglas puede mejorar los resultados del ictus. Adicionalmente, el papel de la enfermería en los programas de educación sobre los factores de riesgo, y pronóstico de un ictus se torna imprescindible. (AU)

Nurses are often asked to predict factors that influence post-stroke outcome by the patient and family. Many studies have been carried out in order to determine the factors that influence the neurological status of the post-stroke patient at the moment of the discharge from the hospital. However, machine learning techniques have not been used for this purpose. Therefore, with the objective of obtaining association rules of neurological prognosis, a double analysis, both clinical and with machine learning techniques of the possible associations of factors that influence the neurological status of the post-stroke patients has been carried out. The Apriori algorithm detected several association rules with high confidence (≥ 95%), from which the following pattern: In patients in the age range of 50-80 years, the association of a NIHSS between 11 and 15 points (intermediate/low NIHSS), along with thrombectomy, leads to recovery ad integrum at discharge. With the SMOTE resampling technique, the 100% confidence was reached for the association of high NIHSS (>20) and involvement of the carotid and basilar arteries, with a dire prognosis (exitus). These rules confirm, for the first time with machine learning, the importance of the association of some predictors, in the post-stroke prognosis. The knowledge by the nurses of these association rules can successfully improve stroke outcome. In addition, the role of nurses in education programs that teach knowledge of risk factors and stroke prognosis becomes essential. (AU)

Delayed Neurological Improvement After Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke.

Background and Purpose: We aimed to determine the prevalence and predictors of delayed neurological improvement (DNI) after complete endovascular reperfusion in anterior circulation acute ischemic stroke (AIS). Methods: Retrospective analysis of an online multicenter prospective reperfusion registry of patients with consecutive anterior circulation AIS treated with endovascular thrombectomy (EVT) from January 2018 to June 2019 in tertiary stroke centers of the NORDICTUS (NORD-Spain Network for Research and Innovation in ICTUS) network. We included patients with AIS with a proximal occlusion in whom a modified Thrombolysis in Cerebral Infarction 3 reperfusion pattern was obtained. DNI was defined if, despite absence of early neurological improvement during the first 24 hours, patients achieved functional independence on day 90. Clinical and radiological variables obtained before EVT were analyzed as potential predictors of DNI. Results: Of 1565 patients with consecutive AIS treated with EVT, 1381 had proximal anterior circulation occlusions, 803 (58%) of whom achieved a modified Thrombolysis in Cerebral Infarction 3. Of these, 628 patients fulfilled all selection criteria and were included in the study. Mean age was 73.8 years, 323 (51.4%) were female, and median baseline National Institutes of Health Stroke Scale was 16. Absence of early neurological improvement was observed in 142 (22.6%) patients; 32 of these (22.5%) achieved good long-term outcome and constitute the DNI group. Predictors of DNI in multivariable-adjusted logistic regression were male sex (odds ratio, 6.4 [95% CI, 2.1­22.3] P=0.002), lower pre-EVT National Institutes of Health Stroke Scale score (odds ratio, 1.4 [95% CI, 1.2­1.5], P<0.001), and intravenous thrombolysis (odds ratio, 9.1 [95% CI, 2.7­30.90], P<0.001). Conclusions: One-quarter of patients with anterior circulation AIS who do not clinically improve within the first 24 hours after complete cerebral endovascular recanalization will achieve long-term functional independence, regardless of the poor early clinical course. Male sex, lower initial clinical severity, and use of intravenous thrombolysis before EVT predicted this clinical pattern.

Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study.

OBJECTIVES: The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS). BACKGROUND: CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. METHODS: The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs). RESULTS: A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001). CONCLUSIONS: The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.

Congestión nasal como síntoma autonómico acompañante de crisis migrañosas / Nasal congestion as an autonomic symptom accompanying migraine attacks

No disponible

Eficacia y seguridad del cierre percutáneo de orejuela izquierda en pacientes con hemorragia intracraneal / Safety and effectiveness of percutaneous closure of left atrial appendage in patients with intracranial hemorrhage

No disponible

[Email in a dedicated headache clinic: experience gained over a five-year period]. / Correo electronico de una consulta monografica de cefaleas: experiencia durante cinco años.

INTRODUCTION: The use of email can facilitate communication between the different levels of an organisation. Our primary care physicians have had an email service in the dedicated headache clinic (DHC) since November 2009, and our aim is therefore to analyse the use of email over that five-year period. PATIENTS AND METHODS: Data concerning the emails sent up until October 2014 were collected prospectively. The questions were classified as need for referral to the DHC (group 1), progress made by the cases seen in the DHC (group 2), training in headaches (group 3) or the treatment of the headaches suffered by primary care physicians themselves as patients (group 4). RESULTS: A total of 274 email messages were analysed. Monthly consultations have increased (from 1.5 per month during the first year to 7.5 per month during the fifth). Findings showed that 10.2% of the email messages came from rural health centres and 89.8% were sent from urban health centres. Replies were sent within 2 ± 2.8 days (range: 0-24 days). Altogether 130 consultations were classified as belonging to group 1 (47.4%), in which referral through the normal channel was recommended in 60 cases (46.2%), via the preferential channel in 47 (36.2%) and non-referral was suggested in 23 cases (17.6%). Group 2 included 125 emails (45.7%) and in 80 cases there was no need to make a new appointment or to bring forward the existing one (64%). Thirteen visits (4.7%) were classified into group 3 and six (2.2%) in group 4. CONCLUSIONS: Our primary care physicians are using the email of the DHC on an increasingly more frequent basis. Its use makes it possible to detect patients whose appointment -whether the first or a follow-up- needs to be brought forward, as well as allowing issues to be solved without the need for referral. It is effective for the treatment of physicians who themselves have headaches and as a tool for continuing education.

TITLE: Correo electronico de una consulta monografica de cefaleas: experiencia durante cinco años.Introduccion. El correo electronico puede facilitar la comunicacion entre niveles. Nuestros medicos de atencion primaria disponen del correo de la consulta monografica de cefaleas (CMC) desde noviembre de 2009, por lo que se pretende analizar la utilizacion del correo electronico durante cinco años. Pacientes y metodos. Recogimos prospectivamente datos de los correos enviados hasta octubre de 2014. Las preguntas se clasificaron en necesidad de derivacion a la CMC (grupo 1), evolucion de casos atendidos en la CMC (grupo 2), formacion en cefaleas (grupo 3) o tratamiento de la cefalea padecida por el propio medico de atencion primaria como paciente (grupo 4). Resultados. Analizamos 274 correos. Las consultas mensuales se han incrementado (de 1,5 al mes durante el primer año a 7,5 al mes durante el quinto). El 10,2% de los correos provenia de centros de salud rurales y el 89,8% de centros de salud urbanos. Se contestaron en 2 ± 2,8 dias (rango: 0-24 dias). En el grupo 1 se encuadraron 130 consultas (47,4%), y en 60 se recomendo (46,2%) la derivacion por via normal, en 47 (36,2%) la preferente y en 23 (17,6%) la no derivacion. En el grupo 2 se incluyeron 125 correos (45,7%), y en 80 no fue necesaria nueva cita o adelanto de la prevista (64%). Trece consultas (4,7%) se clasificaron en el grupo 3 y seis (2,2%) en el grupo 4. Conclusiones. Nuestros medicos de atencion primaria manejan cada vez mas el correo electronico de la CMC. Permite detectar pacientes en los que procede un adelanto de cita, bien primera visita o revision, o resolver cuestiones sin necesidad de derivacion. Es eficaz para la atencion del medico con cefalea y como herramienta de formacion continuada.

Correo electrónico de una consulta monográfica de cefaleas: experiencia durante cinco años / Email in a dedicated headache clinic: experience gained over a five-year period

Introducción. El correo electrónico puede facilitar la comunicación entre niveles. Nuestros médicos de atención primaria disponen del correo de la consulta monográfica de cefaleas (CMC) desde noviembre de 2009, por lo que se pretende analizar la utilización del correo electrónico durante cinco años. Pacientes y métodos. Recogimos prospectivamente datos de los correos enviados hasta octubre de 2014. Las preguntas se clasificaron en necesidad de derivación a la CMC (grupo 1), evolución de casos atendidos en la CMC (grupo 2), formación en cefaleas (grupo 3) o tratamiento de la cefalea padecida por el propio médico de atención primaria como paciente (grupo 4). Resultados. Analizamos 274 correos. Las consultas mensuales se han incrementado (de 1,5 al mes durante el primer año a 7,5 al mes durante el quinto). El 10,2% de los correos provenía de centros de salud rurales y el 89,8% de centros de salud urbanos. Se contestaron en 2 ± 2,8 días (rango: 0-24 días). En el grupo 1 se encuadraron 130 consultas (47,4%), y en 60 se recomendó (46,2%) la derivación por vía normal, en 47 (36,2%) la preferente y en 23 (17,6%) la no derivación. En el grupo 2 se incluyeron 125 correos (45,7%), y en 80 no fue necesaria nueva cita o adelanto de la prevista (64%). Trece consultas (4,7%) se clasificaron en el grupo 3 y seis (2,2%) en el grupo 4. Conclusiones. Nuestros médicos de atención primaria manejan cada vez más el correo electrónico de la CMC. Permite detectar pacientes en los que procede un adelanto de cita, bien primera visita o revisión, o resolver cuestiones sin necesidad de derivación. Es eficaz para la atención del médico con cefalea y como herramienta de formación continuada (AU)

Introduction. The use of email can facilitate communication between the different levels of an organisation. Our primary care physicians have had an email service in the dedicated headache clinic (DHC) since November 2009, and our aim is therefore to analyse the use of email over that five-year period. Patients and methods. Data concerning the emails sent up until October 2014 were collected prospectively. The questions were classified as need for referral to the DHC (group 1), progress made by the cases seen in the DHC (group 2), training in headaches (group 3) or the treatment of the headaches suffered by primary care physicians themselves as patients (group 4). Results. A total of 274 email messages were analysed. Monthly consultations have increased (from 1.5 per month during the first year to 7.5 per month during the fifth). Findings showed that 10.2% of the email messages came from rural health centres and 89.8% were sent from urban health centres. Replies were sent within 2 ± 2.8 days (range: 0-24 days). Altogether 130 consultations were classified as belonging to group 1 (47.4%), in which referral through the normal channel was recommended in 60 cases (46.2%), via the preferential channel in 47 (36.2%) and non-referral was suggested in 23 cases (17.6%). Group 2 included 125 emails (45.7%) and in 80 cases there was no need to make a new appointment or to bring forward the existing one (64%). Thirteen visits (4.7%) were classified into group 3 and six (2.2%) in group 4. Conclusions. Our primary care physicians are using the email of the DHC on an increasingly more frequent basis. Its use makes it possible to detect patients whose appointment –whether the first or a follow-up– needs to be brought forward, as well as allowing issues to be solved without the need for referral. It is effective for the treatment of physicians who themselves have headaches and as a tool for continuing education (AU)

OnabotulinumtoxinA treatment for chronic migraine: experience in 52 patients treated with the PREEMPT paradigm.

OnabotulinumtoxinA (OnabotA) was approved for treatment of chronic migraine (CM) after publication of PREEMPT trials. Thus, we set out to evaluate the efficacy of OnabotA in a series of patients with CM treated according to the PREEMPT protocol. In May 2012 we began to offer OnabotA to patients with CM who did not respond to topiramate and at least one other preventive therapy (beta blocker and/or calcium channel antagonist). We prospectively recorded demographic data and the characteristics of migraine, and we assessed the modifications in monthly headache and migraine days, as well as the number of days of symptomatic medication and triptan intake. By September 2014 we had treated 52 patients (8 male, 44 female), whose age at treatment onset was 42.8 ± 12.7 years (range: 16-71) and age at migraine onset was 16.8 ± 7.8 years (3-32). In 43 of these patients (82.7%) symptomatic overuse of medication was observed at the onset of treatment. A total of 168 procedures were performed and after the first session, we observed a significant reduction in all the variables considered. Twelve (23.1%) patients failed to perceive a positive effect after the first procedure and it was not repeated in 4 of them. By contrast, there was a significant decreasing in all the variables evaluated compared to the baseline in the 39 patients that received a second series of injections. The use of OnabotA according to the PREEMPT paradigm is an effective treatment in patients with chronic migraine in a real-life setting.