Stroke Mimics on the Stroke Unit - Temporal trends 2008-2017 at a large Norwegian university hospital.

OBJECTIVES: The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case-mix at a general hospital's stroke unit (SU). MATERIALS & METHODS: All SU admissions (n = 11240) of patients aged 15 or older to Haukeland University Hospital between 2008-2017 were prospectively included and categorized as CVA or SM. Logistic regression was used to estimate time trends in the proportion of SMs among the admissions. Poisson regression was used to estimate time trends in age- and sex-dependent SM incidence. RESULTS: SMs were on average younger thaan CVA patients (68.3 vs. 71.4 years) and had a higher proportion of females (53.6% vs. 44.5%). The total proportion of SM admissions was 51.0%. There was an increasing time trend in the proportion of SM admissions, odds ratio 1.150 per year (p < 0.001), but this trend appears flattening, represented by a significant quadratic time-term, odds ratio 1.009 (p < 0.001). A higher SM proportion was also associated with the time period of a Mass Media Intervention (FAST campaign) in 2014. There was also an increasing trend in SM incidence, that remains after adjusting for age, sex, and population; also, for incidence the trend appears to be flattening. CONCLUSIONS: SMs account for approximately half of the SU admissions, and the proportion has been increasing. A FAST campaign appears to have temporarily increased the SM proportion. The age- and sex-dependent incidence of SM has been increasing but appears to flatten out.

Fewer ischemic strokes, despite an ageing population: stroke models from observed incidence in Norway 2010-2015.

BACKGROUND: Stroke incidence rates have fallen in high-income countries over the last several decades, but findings regarding the trend over recent years have been mixed. The aim of the study was to describe and model temporal trends in incidence of stroke by age and sex between 2010 and 2015 in Norway, and to generate incidence projections towards year 2040. METHODS: All recorded strokes in Norway between 2010 and 2015 were extracted from the National Patient Registry and the National Cause of Death Registry. We report incidence by age, sex, and year; in raw numbers, per 100,000 person-years, by WHO and European standard populations; and generated statistical models by stroke type, age, sex, and year; and projected stroke incidence toward year 2040. RESULTS: The data covered 30.1 million person-years at risk, 53431 unique individuals hospitalized with a primary stroke diagnosis, and 6315 additional individuals registered as dead due to stroke. From 2010 to 2015, individuals suffering stroke per 100,000 person-years dropped from 239 to 195 (208 to 177 excluding immediate deaths). The decline was driven by ischemic strokes, with a statistically non-significant time trend for hemorrhagic stroke. CONCLUSIONS: The age-dependent incidence of ischemic strokes in Norway is declining rapidly, and more than compensates for the growth and ageing of the population. Comparisons with historic incidence statistics show that the reduction in incidence rates has accelerated over the last two decades.

Fast track hip fracture care and mortality - an observational study of 2230 patients.

BACKGROUND: Hip fracture patients are frail and have a high mortality. We investigated whether the introduction of fast track care reduced the 30-day mortality after hip fractures. METHODS: Fast track hip fracture care was established at our institution in October 2013. Data from the Norwegian Hip Fracture Register and electronic hospital records were merged for 2230 hip fracture patients operated in our department from January 2012 through December 2015. 1090 of these patients were operated before (conventional treatment group) and 1140 patients were operated after the introduction of fast track care (fast track group). Data were analysed by univariate analysis and binary logistic regression. RESULTS: Mortality did not differ significantly between the conventional treatment group and the fast track group at 30 days (7.9% vs. 6.5%), 90 days (13.5% vs. 12.5%) and one year (22.8% vs. 22.8%). Median admission time and time to surgery were significantly shorter in the fast track group than in the conventional treatment group (1.1 h vs. 3.9 h and 23.6 h vs. 25.7 h, both p <  0.0001). The 30-day reoperation rate was significantly lower in the fast track group compared to the conventional treatment group (odds ratio = 0.35 (95% CI: 0.15-0.84), p = 0.019). A composite 30-day outcome (reoperation, surgical site infection and/or death) was significantly less frequent in the fast track group (8.1%) than in the conventional treatment group (10.7%) in unadjusted analysis (p = 0.006), but not after adjusting for age, gender, cognitive impairment and ASA score (odds ratio = 0.85 (95% CI: 0.63-1.16), p = 0.31, 8.0% missing). Reoperations within 1 year, surgical site infections, 30-day readmissions and length of hospital stay did not differ significantly between the conventional treatment group and the fast track group. CONCLUSIONS: Fast track hip fracture care is safe. However, we observed no statistically significant change in 30-day, 90-day or 1-year mortality after the introduction of fast track hip fracture care. TRIAL REGISTRATION: The study was registered retrospectively at ClinicalTrials.gov (Protocol Record 284907 ) 6 December 2016.

Trolley Dilemmas Fail to Predict Ethical Judgment in a Hypothetical Vaccination Context.

We investigated whether the responses of 68 ethics committee members and staff to trolley dilemmas could predict their responses to research ethics problems concerning vaccine trials. Trolley dilemmas deal with the issue of sacrificing some for the benefit of many, which is also a core issue in the vaccination trial dilemmas. The subjects' responses to trolley dilemmas showed no statistically significant correlation with their responses to our vaccination trial dilemmas. We concluded that, if there is a component of transferable intuition between the contexts, it must be small and dominated by other factors. Furthermore, the willingness to sacrifice some for many was larger in the trolley context, despite a more favorable risk/reward ratio and the voluntary participation of the subjects at risk in the vaccination situations. We conclude that one's general willingness to trade lives in the trolley context may be an artifact that is due to its unrealistic setting.

Pre-contact by telephone increases response rates to postal questionnaires in a population of stroke patients: an open ended randomized controlled trial.

BACKGROUND: A follow-up study on a cohort of stroke patients through a postal survey questionnaire 3 and 12 months after discharge from hospital was performed. The response rate at 3-months follow-up was lower than desired, and pre-contact by phone as a measure for increasing the response rate at 12 months was studied. METHODS: The study design was a randomized controlled trial on a cohort of 3 months follow-up-non-responders where the intervention group was pre-contacted with an aim to obtain an informal 'consent to receive' the questionnaire before the 12-months survey was mailed, and the control group was not. The primary outcome was 45 days response rate; secondary outcome was 365 days response rate. The main analysis followed the intention to treat principle. A secondary, per-protocol analysis (i.e. subjects who were not reached by phone were reassigned to the control group) is included. Also included is a rudimentary cost-utility analysis, where we estimated the cost per additional response. RESULTS: Of the 235 subjects, 116 were randomized to the intervention group and 119 to the control group. 10 were excluded due to death (7 in the IG and 3 in the CG), 6 due to dementia (3 in the IG and 3 in the CG), and 2 (1 in the IG and 1 in the CG) for other reasons. The primary outcome was a response rate of 42.9 % in the intervention group, and 26.8 % in the control group, giving p =0.014, with estimated OR of 2.04 (95 % CI [1.16,3.64]). The secondary outcome had p =0.009 with OR 2.10 (95 % CI [1.20,3.70]). The as-per-protocol analyses gave stronger results with p =0.001 and p =0.003, respectively. The cost-utility analysis gave a time cost of 1 working hour per additional response. CONCLUSIONS: The results are in line with previous research, and show that pre-contact has a positive effect on response rate also for a population of elderly with reduced health. Given the importance of high response rate in surveys, a cost of 1 working hour per additional response is likely to be worth while. TRIAL REGISTRATION: Registration with ISRCTN initiated on 05/21/2013 and finalised on 06/30/2014 with http://www.isrctn.com/ISRCTN31304930 . Following the prospective submission in May 2013, there were no subsequent changes to the protocol. The recruitment started on 01/06/13, after initiation of public registration.

Specialist physicians' sensitivity to patient affect and satisfaction.

BACKGROUND: Studies indicate that physicians do not respond adequately to patients' emotional issues. Physician sensitivity to patient affect has not been much explored. OBJECTIVES: To describe specialist physicians' sensitivity to patient affect and satisfaction. RESEARCH DESIGN: Cross-sectional study of physicians' and patients' postvisit questionnaire statements about patient affective states and satisfaction. SUBJECTS: A representative sample of 71 physicians covering nonpsychiatric clinical specialties in a general teaching hospital were observed during 497 encounters with patients (outpatient, inpatient on rounds, emergency room, maximum 8 encounters per physician). MEASURES: Standardized correlations between physician and patient statements. RESULTS: Physician statements about patient negative affect were moderately correlated with patient self-report of negative affect [r=0.379 (0.301; 0.452)]. Physician statements about patient positive affect and patient satisfaction were weakly correlated with patient self-report of positive affect [r=0.238 (0.153; 0.319)] and satisfaction [r=0.219 (0.134; 0.301)]. Internists [r=0.300 (0.161; 0.428)] were significantly less sensitive to negative affect than surgeons [r=0.500 (0.360; 0.618), P=0.038] and neurologists [r=0.621 (0.432; 0.758), P=0.007]. Physicians previously known by the patient were significantly more sensitive to negative affect than those who were not known [r=0.509 (0.391; 0.611) vs. 0.293 (0.189; 0.390), P=0.006]. We could not find differences in affective sensitivity between male and female physicians. CONCLUSIONS: Specialist physicians have moderate ability to identify patient negative affect and poor ability to identify patient positive affect and patient satisfaction.