Stroke Research and Treatment最新文献

{"title":"Determinants of Stroke Mortality through Survival Models: The Case of Mettu Karl Referral Hospital, Mettu, Ethiopia.","authors":"Dereje Gebeyehu Ababu,&nbsp;Azmeraw Misganaw Getahun","doi":"10.1155/2022/9985127","DOIUrl":"https://doi.org/10.1155/2022/9985127","url":null,"abstract":"<p><strong>Introduction: </strong>Every year worldwide, between five to six million deaths are associated with stroke; on average, one stroke-related death occurs every four minutes. In Ethiopia, stroke is a frequent cause of mortality and morbidity from noncommunicable diseases. Therefore, this study was aimed at determining factors associated to stroke mortality through survival models in Mettu Karl Referral Hospital.</p><p><strong>Methods: </strong>This study was conducted from September 1, 2014, to April 1, 2017, and encompassed 202 stroke patients at Mettu Karl Referral Hospital. The Cox semiparametric regression was used for analyzing survival analysis of stroke patients using R software.</p><p><strong>Results: </strong>A total of 202 stroke patients were included in the study, and among those patients, 72.8% and 27.2% were censored and died, respectively. According to the result of Cox semiparametric regression model, sex of patients, hypertension, baseline complication, and stroke type had significant effect on survival of the stroke patient at 5% significance level.</p><p><strong>Conclusion: </strong>The results from Cox semiparametric regression model indicated that sex of patients, hypertension, baseline complication, and stroke type were major factors related to the survival time of stroke patients. The researcher recommends that the people should be aware on the burden of those risk factors and well informed about the disease.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8856786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39814803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Neurophysiological Impact of Subacute Stroke: Changes in Cortical Oscillations Evoked by Bimanual Finger Movement.","authors":"Ana Dionísio,&nbsp;Rita Gouveia,&nbsp;João Castelhano,&nbsp;Isabel Catarina Duarte,&nbsp;Gustavo C Santo,&nbsp;João Sargento-Freitas,&nbsp;Miguel Castelo-Branco","doi":"10.1155/2022/9772147","DOIUrl":"https://doi.org/10.1155/2022/9772147","url":null,"abstract":"<p><strong>Introduction: </strong>To design more effective interventions, such as neurostimulation, for stroke rehabilitation, there is a need to understand early physiological changes that take place that may be relevant for clinical monitoring. We aimed to study changes in neurophysiology following <i>recent</i> ischemic stroke, both at rest and with motor planning and execution.</p><p><strong>Materials and methods: </strong>We included 10 poststroke patients, between 7 and 10 days after stroke, and 20 age-matched controls to assess changes in cortical motor output via transcranial magnetic stimulation and in dynamics of oscillations, as recorded using electroencephalography (EEG).</p><p><strong>Results: </strong>We found significant differences in cortical oscillatory patterns comparing stroke patients with healthy participants, particularly in the beta rhythm during motor planning (<i>p</i> = 0.011) and execution (<i>p</i> = 0.004) of a complex movement with fingers from both hands simultaneously. <i>Discussion</i>. The stroke lesion induced a decrease in event-related desynchronization in patients, in comparison to controls, providing evidence for decreased disinhibition.</p><p><strong>Conclusions: </strong>After a stroke lesion, the dynamics of cortical oscillations is changed, with an increasing neural beta synchronization in the course of motor preparation and performance of complex bimanual finger tasks. The observed patterns may provide a potential functional measure that could be used to monitor and design interventional approaches in subacute stages.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8831071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39915100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evaluation of the Neuroprotective Effect of a Single High-Dose Vitamin D₃ in Patients with Moderate Ischemic Stroke.","authors":"Omid Hesami, Setare Iranshahi, Shima Zareh Shahamati, Mohammad Sistanizd, Elham Pourheidar, Rezvan Hassanpour","doi":"10.1155/2022/8955660","DOIUrl":"10.1155/2022/8955660","url":null,"abstract":"<p><strong>Introduction: </strong>Vitamin D insufficiency is highly prevalent and is a negative predictor for survival in ischemic stroke patients. We evaluated the effect of a high dose of vitamin D₃ on the Neuron-Specific Enolase (NSE) level, National Institute of Health Stroke Scale (NIHSS), and Barthel Index (BI) scoring system in moderate ischemic stroke patients.</p><p><strong>Methods: </strong>This prospective, double-blind, randomized clinical trial (RCT) study was conducted from April 2020 to March 2021. Patients with moderate ischemic stroke (NIHSS 5 to 15) who had vitamin D deficiency (serum 25-OH vitamin D ≤30 ng/mL) were recruited and randomized into intervention and control groups. Subjects in the intervention group received a single dose, intramuscular (IM) injection of 600000 international unit (IU) vitamin D₃, in addition to the standard treatment. NSE level and NIHSS were evaluated at baseline and 48 hours after the intervention. The BI was monitored three months after discharge.</p><p><strong>Results: </strong>During the study period, 570 patients were assessed; finally, forty-one patients completed the study. Except for the age which was higher in the control group (<i>p</i> = 0.04), there were no statistically significant differences in other baseline characteristics between the two groups. After 48 hours, the NIHSS score was significantly lower in the intervention group (median 8 vs. 6.5, <i>p</i> = 0.008 in the control and intervention groups, respectively), but there was no significant difference in the NSE level (<i>p</i> = 0.80). Three months after discharge, the BI was significantly higher in the intervention group (median 8 vs. 9, <i>p</i> = 0.03 in the control and intervention groups, respectively).</p><p><strong>Conclusions: </strong>Administration of a single 600000 IU of vitamin D₃ could have neuroprotective effects in patients with moderate ischemic stroke, according to its significantly positive effects on functional clinical outcomes (NIHSS and BI), but this effect on the biomarker related to neural damage (NSE) was not significant.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8786504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39862129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, Severity, and Predictors of Poststroke Depression in a Prospective Cohort of Jordanian Patients.","authors":"Majdi Al Qawasmeh, Belal Aldabbour, Amal Abuabada, Khalid Abdelrahman, Samah Elamassie, Mays Khweileh, Mohammad Zahran, Khalid El-Salem","doi":"10.1155/2022/6506326","DOIUrl":"10.1155/2022/6506326","url":null,"abstract":"<p><p>Poststroke depression (PSD) is common and remains a significant risk factor for poor outcomes. This prospective study is aimed at assessing the prevalence, severity, and predictors of PSD among Jordanian stroke survivors. A total of 151 patients who were consequently admitted to a tertiary teaching hospital with ischemic or hemorrhagic strokes were enrolled. Participants were screened on admission for premorbid depression using the PHQ-9 questionnaire; then, screening for PSD was repeated one and three months after stroke using the same tool. Depression prevalence at each screening was reported, and logistic regression analysis was conducted to evaluate for significant predictors. PHQ-9 scores suggestive of depression were reported by 15%, 24.83%, and 17.39% of respondents on admission and after one and three months, respectively. Scores suggesting severe depression were reported by 0.71%, 2.13%, and 6.52% of respondents, respectively. Significant predictors of PSD were having chronic kidney disease, current smoking status, moderate or severe disability (mRS score) at stroke onset, and severe dependence (BI) after one month (<b>p</b> values 0.007, 0,002, 0.014, and 0.031, respectively). Patients with secondary and high school education levels were less likely to get depression compared with illiterate patients (<b>p</b> 0.042). This study showed that nearly one in four Jordanian stroke survivors experienced PSD after one month. In contrast, while the overall PSD prevalence declined towards the end of follow-up period, patients who remained depressed showed a tendency towards higher PSD severity.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39825216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poststroke Erectile Dysfunction in Cameroon: Prevalence, Associated Factors, and Quality of Life.","authors":"Daniel Gams Massi,&nbsp;Gervais Ngoupayou Mountap,&nbsp;Hervé Edouard Moby,&nbsp;Frantz Guy Epoupa Ngalle,&nbsp;Sidick Mouliom,&nbsp;Jacques Doumbe,&nbsp;Njankouo Yacouba Mapoure","doi":"10.1155/2021/9988841","DOIUrl":"https://doi.org/10.1155/2021/9988841","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a severe disease due to its morbidity-mortality. It is the first cause of acquired disability including erectile dysfunction (ED). The purpose of this study was to determine the prevalence of ED in stroke patients at the Douala General Hospital, to identify associated factors and to evaluate their quality of life.</p><p><strong>Materials and methods: </strong>A cross-sectional study was conducted over a period of seven months from November 2016 to May 2017 on two groups of patients in neurology, cardiology, and endocrinology units of the Douala General Hospital (Cameroon): stroke patients (stroke+) and nonstroke patients (stroke-). We collected sociodemographic and clinical data using a preestablished questionnaire. Erectile function was assessed using International Index of Erectile Function (IIEF-5). Associated and predictive factors were determined using univariate and multivariate analyses. Results were significant for a <i>p</i> value < 0.05.</p><p><strong>Results: </strong>A total of 269 patients were included, among them 87 stroke+ (32.34%) and 182 stroke- (67.66%) (controlled group). The mean age was 56.37 ± 12.89 years and 57.18 ± 10.24 years of stroke+ and stroke-, respectively (<i>p</i> = 0.608). Prevalence of poststroke ED was 64.4% (OR = 3.41, 95% CI: 1.99-5.82, <i>p</i> < 0.001). The average time of occurrence of the poststroke ED was 5 ± 5.85 months. Diabetes and dyslipidemia were the predictive factors of occurrence of poststroke ED. Depression was found both in stroke+ with ED and stroke+ without ED with no difference (<i>p</i> = 0.131).</p><p><strong>Conclusion: </strong>About two-thirds of stroke patients developed ED. Diabetes and dyslipidemia were predictive factors of ED in stroke patients.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39582099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of the Presence of Hyperdense Middle Cerebral Artery Sign in Determining the Subtypes of Stroke Etiology.","authors":"Suchada Sangpetch,&nbsp;Chayasak Wantaneeyawong,&nbsp;Atiwat Soontornpun,&nbsp;Nantaporn Tiyapun,&nbsp;Surat Tanprawate,&nbsp;Kitti Thiankhaw","doi":"10.1155/2021/6593541","DOIUrl":"https://doi.org/10.1155/2021/6593541","url":null,"abstract":"<p><strong>Background: </strong>Identifying stroke subtypes is crucial in choosing appropriate treatment, predicting outcomes, and managing recurrent stroke prevention.</p><p><strong>Objectives: </strong>To study the association of hyperdense middle cerebral artery sign (HMCAS) on noncontrast computed tomography (NCCT) brain and subtypes of stroke etiology.</p><p><strong>Methods: </strong>This is a retrospective hypothesis testing study. Patients aged 18 or over who had middle cerebral artery occlusion symptoms with HMCAS with verification on brain NCCT and received intravenous thrombolysis between January 2016 and June 2019 were enrolled. The demographic data, clinical outcomes, stroke subtypes, and characteristics of HMCAS were collected from medical records.</p><p><strong>Results: </strong>Ninety-nine out of 299 enrolled patients presented with HMCAS. The most common stroke subtype was cardioembolism (59%). Of the baseline characteristics, hypertension was more common in cases of large-artery atherosclerosis (LAA) (86.4%), and atrial fibrillation (AF) was the highest in cardioembolism (44.8%). HMCAS disappearance in cardioembolism was lowest compared to LAA and others (63% vs. 91% vs. 94.7%, respectively). The univariable analysis found that HMCAS disappearance is significantly associated with all stroke subtypes (Odds ratio, 95% confidence interval 10.58, 1.31-85.43; <i>P</i> = 0.027 for other and 5.88, 1.24-27.85; <i>P</i> = 0.026 for LAA). Multinomial logistic regression found that body weight and hypertension were associated with the LAA subtype. AF and intracranial hemorrhage (ICH) were associated with cardioembolism.</p><p><strong>Conclusion: </strong>The most likely diagnosis from the presence of HMCAS is cardioembolism, but the definite stroke etiologic subtype can not be identified. Combining the patient risk factors, including body weight, hypertension, and AF, with HMCAS and its characteristics will predict stroke subtypes more accurately.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8612777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39673976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes after Intravenous Alteplase in Elderly Patients with Acute Ischaemic Stroke: A Retrospective Analysis of Patients Treated at a Tertiary Neurology Centre in England from 2013 to 2018.","authors":"Xuya Huang,&nbsp;Phillip Nash,&nbsp;Vafa Alakbarzade,&nbsp;Brian Clarke,&nbsp;Anthony C Pereira","doi":"10.1155/2021/3738017","DOIUrl":"https://doi.org/10.1155/2021/3738017","url":null,"abstract":"<p><p>Intravenous thrombolysis with alteplase within 4.5 hours from symptom onset is a well-established treatment of acute ischaemic stroke (AIS). The aim was to compare alteplase for AIS between patients aged >80 and ≤80 years in our registry data, from 2013 to 2018. Mechanical thrombectomy cases were excluded. We assessed clinical outcomes over the six-year period and between patients aged over 80 and ≤80 years, using measures including the discharge modified Rankin Scale (mRS), 24-hour National Institutes of Health Stroke Scale (NIHSS) improvement, and symptomatic intracerebral haemorrhage (sICH) rate. Of a total of 805 AIS patients who received intravenous alteplase, 278 (34.5%) were over 80 years old, and 527 (65%) were younger. 616 (76.5%) received thrombolysis ≤ 3 hours after symptom onset and 189 (23.5%) within 3-4.5 hours. Median baseline mRS and NIHSS of the elderly cohort were 1 (IQR 0-5) and 13 (IQR 2-37), respectively, compared to the younger cohort 0 (IQR 0-5) and 9 (IQR 0-29). The sICH rate was 7.2% in the elderly and 4.6% in those ≤80 years, <i>p</i> = 0.05. NIHSS improved within 24 hours in 34% of the elderly cohort compared to 35% in the younger cohort. At hospital discharge, the mortality rate was 9% in the elderly cohort compared to the 6% in the younger cohort, <i>p</i> = 0.154. 25% of patients aged >80 years had mRS ≤ 2 compared to 47% in the younger patients (<i>p</i> < 0.0001). In conclusion, thrombolysis in elderly patients results in clinical improvement comparable to younger patients.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39693491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Oral Pathology, Carotid Stenosis, and Oral Bacterial DNA in Cerebral Thrombi of Patients with Stroke.","authors":"Olli Patrakka,&nbsp;Helena Mehtonen,&nbsp;Sari Tuomisto,&nbsp;Juha-Pekka Pienimäki,&nbsp;Jyrki Ollikainen,&nbsp;Heini Huhtala,&nbsp;Tanja Pessi,&nbsp;Niku Oksala,&nbsp;Terho Lehtimäki,&nbsp;Jorma Järnstedt,&nbsp;Mika Martiskainen,&nbsp;Pekka J Karhunen","doi":"10.1155/2021/5402764","DOIUrl":"https://doi.org/10.1155/2021/5402764","url":null,"abstract":"<p><strong>Methods: </strong>Thrombus aspirates and control arterial blood were taken from 71 patients (70.4% male; mean age, 67.4 years) with acute ischemic stroke. Tooth pathology was registered using CT scans. Carotid stenosis was estimated with CTA and ultrasonography. The presence of bacterial DNA from aspirated thrombi was determined using quantitative PCR. We also analyzed the presence of these bacterial DNAs in carotid endarterectomies from patients with peripheral arterial disease.</p><p><strong>Results: </strong>Bacterial DNA was found in 59 (83.1%) of the thrombus aspirates (median, 8.6-fold). Oral streptococcal DNA was found in 56 (78.9%) of the thrombus aspirates (median, 5.1-fold). DNA from <i>A. actinomycetemcomitans</i> and <i>P. gingivalis</i> was not found. Most patients suffered from poor oral health and had in median 19.0 teeth left. Paradoxically, patients with better oral health had more oral streptococcal DNA in their thrombus than the group with the worst pathology (<i>p</i> = 0.028). There was a trend (OR 7.122; <i>p</i> = 0.083) in the association of ≥50% carotid artery stenosis with more severe dental pathology. Oral streptococcal DNA was detected in 2/6 of carotid endarterectomies.</p><p><strong>Conclusions: </strong>Stroke patients had poor oral health which tended to associate with their carotid artery stenosis. Although oral streptococcal DNA was found in thrombus aspirates and carotid endarterectomy samples, the amount of oral streptococcal DNA in thrombus aspirates was the lowest among those with the most severe oral pathology. These results suggest that the association between poor oral health and acute ischemic stroke is linked to carotid artery atherosclerosis.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8440111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39426615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Study of Cost-Effectiveness of Rivaroxaban versus Warfarin in Patients with Atrial Fibrillation Who Developed Ischemic Stroke.","authors":"Neda Jaberi,&nbsp;Zahra Kavosi,&nbsp;Etrat Hooshmandi,&nbsp;Nasrin Moradi,&nbsp;Khosro Keshavarz,&nbsp;Afshin Borhani-Haghighi","doi":"10.1155/2021/5534873","DOIUrl":"https://doi.org/10.1155/2021/5534873","url":null,"abstract":"<p><strong>Introduction: </strong>Rivaroxaban is a new anticoagulant providing benefits for the treatment of patients with atrial fibrillation (AF). This study is aimed at evaluating the cost-effectiveness of rivaroxaban compared to warfarin in patients with AF.</p><p><strong>Method: </strong>This economic evaluation study was conducted among 144 selected nonrandomly patients who were treated with rivaroxaban or warfarin and suffered from AF leading to stroke, in the stroke ward of Shiraz Nemazee Hospital in 2019. The final and clinical (intermediate) outcomes were QALYs and no bleeding and prevention of ischemic stroke, respectively. The study was performed from the social perspective, and a deterministic one-way sensitivity analysis was conducted to identify the effects of uncertainty. The analysis of the collected data was carried out using SPSS18 and TreeAge software.</p><p><strong>Results: </strong>Patients who received rivaroxaban had lower costs ($ 25275 vs. $ 26554) and higher QALYs (0.5 vs. 0.33) compared to those taking warfarin. Bleeding and stroke occurred in (9 vs. 40) and (1 vs. 3) patients in the rivaroxaban and warfarin groups, respectively, and there was a significant decrease in the incidence of bleeding in the rivaroxaban group (81.9% vs 44.4%). Thus, rivaroxaban in all the outcomes was cheaper and more effective than warfarin. The one-way sensitivity analysis confirmed the robustness of the results.</p><p><strong>Conclusions: </strong>Considering the incremental cost-effectiveness ratio, rivaroxaban is more cost-effective and can be a dominant alternative. Therefore, it is suggested to use rivaroxaban as the first priority in AF patients because rivaroxaban reduces costs and increases clinical outcomes compared with warfarin.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8440110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39426616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Predictive Tool for Hospital Discharge Disposition of Patients Poststroke with 30-Day Readmission Validation.","authors":"Jin Cho, Krystal Place, Rebecca Salstrand, Monireh Rahmat, Misagh Mansouri, Nancy Fell, Mina Sartipi","doi":"10.1155/2021/5546766","DOIUrl":"10.1155/2021/5546766","url":null,"abstract":"<p><p>After short-term, acute-care hospitalization for stroke, patients may be discharged home or other facilities for continued medical or rehabilitative management. The site of postacute care affects overall mortality and functional outcomes. Determining discharge disposition is a complex decision by the healthcare team. Early prediction of discharge destination can optimize poststroke care and improve outcomes. Previous attempts to predict discharge disposition outcome after stroke have limited clinical validations. In this study, readmission status was used as a measure of the clinical significance and effectiveness of a discharge disposition prediction. Low readmission rates indicate proper and thorough care with appropriate discharge disposition. We used Medicare beneficiary data taken from a subset of base claims in the years of 2014 and 2015 in our analyses. A predictive tool was created to determine discharge disposition based on risk scores derived from the coefficients of multivariable logistic regression related to an adjusted odds ratio. The top five risk scores were admission from a skilled nursing facility, acute heart attack, intracerebral hemorrhage, admission from \"other\" source, and an age of 75 or older. Validation of the predictive tool was accomplished using the readmission rates. A 75% probability for facility discharge corresponded with a risk score of greater than 9. The prediction was then compared to actual discharge disposition. Each cohort was further analyzed to determine how many readmissions occurred in each group. Of the actual home discharges, 95.7% were predicted to be there. However, only 47.8% of predictions for home discharge were actually discharged home. Predicted discharge to facility had 15.9% match to the actual facility discharge. The scenario of actual discharge home and predicted discharge to facility showed that 186 patients were readmitted. Following the algorithm in this scenario would have recommended continued medical management of these patients, potentially preventing these readmissions.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8390171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39366978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}