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  • Ovid Technologies (Wolters Kluwer Health)  (23)
  • 1
    Online Resource
    Online Resource
    TREAT‐AIS: A Multicenter National Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke: Vascular and Interventional Neurology Vol. 3, No. 5 ( 2023-09)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 5 ( 2023-09)
    Abstract: Endovascular thrombectomy (EVT) is the standard therapy for patients with acute ischemic stroke secondary to large‐artery occlusion. In January 2019, the Taiwan Stroke Society established a nationwide TREAT‐AIS (Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke). Here, we provide the study design, current progress, and baseline data of TREAT‐AIS. Methods TREAT‐AIS is a multicenter prospective registration program in Taiwan. Patients aged ≥20 years who underwent EVT for acute ischemic stroke were recruited. The key items on the registration form were divided into general stroke demographics and EVT‐related sections. The main outcome of effectiveness was functional independence (modified Rankin Scale score, 0–2) at 3 months. The influence of sex on post‐EVT outcomes was also analyzed in the presented study. Results By the end of June 2022, there were 10 medical centers and 9 community hospitals participating in the TREAT‐AIS and a total of 1522 patients (mean±SD age, 71.2±13.6 years; men, 55.6%) being enrolled. The median National Institutes of Health Stroke Scale score on admission was 18 (interquartile range, 12–23). The major cause of stroke was cardioembolism (43.6%), followed by large‐artery atherosclerosis (36.8%) and an undetermined cause (15.4%). Functional independence at 3 months poststroke was achieved in 36.2% of the patients. Male patients were more likely to have functional independence at 3 months compared with female patients (40.4% versus 30.8%; P 〈 0.001). However, the sex difference in functional independence became nonsignificant (odds ratio, 1.12 [95% CI, 0.96–1.46] in men compared with women) after adjusting for age, National Institutes of Health Stroke Scale score at admission, and recanalization status after EVT. Conclusions This study demonstrated the current progress of the TREAT‐AIS in capturing real‐world EVT data in Taiwan. The TREAT‐AIS will provide valuable insights into the real‐world practice of EVT in patients with acute stroke and the related quality of care in Asian patients.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.123.000861
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 3144224-9
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  • 2
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    Natural Language Processing Enhances Prediction of Functional Outcome After Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of the American Heart Association Vol. 10, No. 24 ( 2021-12-21)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 24 ( 2021-12-21)
    Abstract: Conventional prognostic scores usually require predefined clinical variables to predict outcome. The advancement of natural language processing has made it feasible to derive meaning from unstructured data. We aimed to test whether using unstructured text in electronic health records can improve the prediction of functional outcome after acute ischemic stroke. Methods and Results Patients hospitalized for acute ischemic stroke were identified from 2 hospital stroke registries (3847 and 2668 patients, respectively). Prediction models developed using the first cohort were externally validated using the second cohort, and vice versa. Free text in the history of present illness and computed tomography reports was used to build machine learning models using natural language processing to predict poor functional outcome at 90 days poststroke. Four conventional prognostic models were used as baseline models. The area under the receiver operating characteristic curves of the model using history of present illness in the internal and external validation sets were 0.820 and 0.792, respectively, which were comparable to the National Institutes of Health Stroke Scale score (0.811 and 0.807). The model using computed tomography reports achieved area under the receiver operating characteristic curves of 0.758 and 0.658. Adding information from clinical text significantly improved the predictive performance of each baseline model in terms of area under the receiver operating characteristic curves, net reclassification improvement, and integrated discrimination improvement indices (all P 〈 0.001). Swapping the study cohorts led to similar results. Conclusions By using natural language processing, unstructured text in electronic health records can provide an alternative tool for stroke prognostication, and even enhance the performance of existing prognostic scores.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.121.023486
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2653953-6
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  • 3
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    Predicting Factors and Risk Stratification for Return Visits to the Emergency Department Within 72 Hours in Pediatric Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Pediatric Emergency Care Vol. 31, No. 12 ( 2015-12), p. 819-824
    Details
    In: Pediatric Emergency Care, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 12 ( 2015-12), p. 819-824
    Type of Medium: Online Resource
    ISSN: 0749-5161
    URL: Article
    DOI: 10.1097/PEC.0000000000000417
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2053985-X
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  • 4
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    Smoking Paradox in Stroke Survivors? : Uncovering the Truth by Interpreting 2 Sets of Data
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 4 ( 2020-04), p. 1248-1256
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 4 ( 2020-04), p. 1248-1256
    Abstract: The observation that smokers with stroke could have better outcome than nonsmokers led to the term “smoking paradox.” The controversy of such a complex claim has not been fully settled, even though different case mix was noted. Analyses were conducted on 2 independent data sets to evaluate and determine whether such a paradox truly exists. Methods— Taiwan Stroke Registry with 88 925 stroke cases, and MJ cohort with 541 047 adults participating in a medical screening program with 1630 stroke deaths developed during 15 years of follow-up (1994–2008). Primary outcome for stroke registry was functional independence at 3 months by modified Rankin Scale score ≤2, for individuals classified by National Institutes of Health Stroke Scale score at admission. For MJ cohort, mortality risk by smoking status or by stroke history was assessed by hazard ratio. Results— A 〉 11-year age difference in stroke incidence was found between smokers and nonsmokers, with a median age of 60.2 years for current smokers and 71.6 years for nonsmokers. For smokers, favorable outcome in mortality and in functional assessment in 3 months with modified Rankin Scale score ≤2 stratified by the National Institutes of Health Stroke Scale score was present but disappeared when age and sex were matched. Smokers without stroke history had a ≈2-fold increase in stroke deaths (2.05 for ischemic stroke and 1.53 for hemorrhagic stroke) but smokers with stroke history, 7.83-fold increase, overshadowing smoking risk. Quitting smoking at earlier age reversed or improved outcome. Conclusions— “The more you smoke, the earlier you stroke, and the longer sufferings you have to cope.” Smokers had 2-fold mortality from stroke but endured stroke disability 11 years longer. Quitting early reduced or reversed the harms.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.119.027012
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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  • 5
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    “Weekend effect” on stroke mortality revisited : Application of a claims-based stroke severity index in a population-based cohort study
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Medicine Vol. 95, No. 25 ( 2016-06), p. e4046-
    Details
    In: Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 95, No. 25 ( 2016-06), p. e4046-
    Type of Medium: Online Resource
    ISSN: 0025-7974
    URL: Article
    DOI: 10.1097/MD.0000000000004046
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2049818-4
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  • 6
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    The Impact of Timing and Dose of Rehabilitation Delivery on Functional Recovery of Stroke Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Journal of the Chinese Medical Association Vol. 72, No. 5 ( 2009-05), p. 257-264
    Details
    In: Journal of the Chinese Medical Association, Ovid Technologies (Wolters Kluwer Health), Vol. 72, No. 5 ( 2009-05), p. 257-264
    Type of Medium: Online Resource
    ISSN: 1726-4901
    URL: Article
    DOI: 10.1016/S1726-4901(09)70066-8
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 2202774-9
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  • 7
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    Response to Letter by Siegler and Martin-Schild Regarding Article, “Comparison of Risk-Scoring Systems in Predicting Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis”
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 8 ( 2013-08)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 8 ( 2013-08)
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.002205
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Abstract WP374: Validation of a Novel Claims-Based Stroke Severity Index in Patients Hospitalized with Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: Stroke severity, an important outcome predictor after intracerebral hemorrhage (ICH), is usually unavailable in administrative databases. Hypothesis: A claims-based stroke severity index (SSI) with seven predictors is valid for patients with ICH. Methods: Consecutive 1,360 ICH patients of three stroke centers with stroke registry data linked to the National Health Insurance Research Database constituted the study cohort. The admission National Institutes of Health Stroke Scale (NIHSS) and the 3-, 6-, and 12-month modified Rankin Scale (mRS) were the reference standards of concurrent and predictive validity, respectively, and were compared with SSI using Pearson’s correlation coefficient. We fitted base logistic regression models (age, sex, and Charlson’s Comorbidity index) to predict mortality at 3, 6, 12 months, added the NIHSS or the SSI separately to the base models, and compared the model discrimination with the base model. Results: The SSI correlated with the admission NIHSS (r = 0.731, 95% CI: 0.705-0.755) and mRS at 3, 6, and 12 months (r = 0.696, 95% CI: 0.665-0.724; r = 0.685, 95% CI: 0.653-0.715; and r = 0.664, 95% CI: 0.622-0.702, respectively). Adding the SSI or the NIHSS to the base models increased model discrimination. The areas under the curve (AUCs) of the base models for 3-, 6-, and 12-month mortality were 0.694, 0.689, 0.706; they improved after adding either NIHSS (AUCs: 0.905, 0.893, and 0.884) or SSI (AUCs: 0.843, 0.831, and 0.840) to the base model. Conclusions: The SSI might be a valid NIHSS proxy and enable adjustment for severity in ICH outcome studies using an administrative claims database.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp374
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 9
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    Abstract TP321: Is Weekend Admission Associated With Increased 30-day Stroke Mortality? The Effect of Adjustment Using a Claims-Based Stroke Severity Index
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Introduction: Whether weekend admission is associated with increased stroke mortality in Taiwan remains uncertain, partly because of an inadequate case-mix adjustment in other studies using an insurance claims databases. Hypothesis: Adding the 7-item claims-based stroke severity index (SSI) to a multivariate logistic regression model might alter the analysis of the effect of weekend admission on 30-day stroke mortality. Methods: We identified, in the Taiwan Longitudinal Health Insurance Database, which is linked with the National Death Registry, patients hospitalized for acute ischemic stroke between 2001 and 2013. The primary outcome was mortality 30 days post-admission. In base logistic regression models with and without the SSI, we tested the odds ratio (OR) of 30-day mortality in patient admitted on weekends using the covariates of age, sex, year of admission, Charlson’s comorbidity index, brain surgery, physician specialty and surgical volume, hospital ownership, accreditation, and patient volume. Results: We analyzed 46,007 consecutive hospitalized stroke patients (mean age: 68.8 ± 12.0 years; male: 59%), with an SSI of 7.5 ± 5.3 (range: 4.1-27.1), 23.0% were admitted on the weekend, and 4.2% died within 30 days. Patients who died within 30 days were more likely to have been admitted on a weekend (4.9% vs. 4.0%, p 〈 0.001). Nevertheless, patients admitted on a weekend had a higher SSI than those admitted on a weekday (7.8 vs. 7.4, p 〈 0.001). In multivariate logistic regression models, weekend admission was associated with 30-day mortality (OR: 1.22, 95% CI: 1.10-1.35) in the base model but not in the base model plus SSI (OR: 1.07, 95% CI: 0.95-1.20). Conclusions: We confirmed that, after stroke severity had been adjust by adding the SSI, weekend admission did not increase the 30-day mortality of stroke patients in Taiwan. A case-mix adjustment in comparative outcome studies of stroke patients is important when using an insurance claims database.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp321
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Onset Headache Predicts Good Outcome in Patients With First-Ever Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 7 ( 2013-07), p. 1852-1858
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 7 ( 2013-07), p. 1852-1858
    Abstract: The study aimed to assess whether onset headache is an ominous sign in patients with first-ever ischemic stroke. Methods— A large population of ischemic stroke patients was obtained from the Taiwan Stroke Registry. Stroke subtypes were classified by the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. On the basis of the International Classification of Headache Disorders, second version, onset headache was defined as a new headache that developed at the onset of ischemic stroke. Clinical features and impact on stroke outcomes, including in-hospital stroke in evolution, changes in National Institutes of Health Stroke Scale on discharge, and Barthel index and modified Rankin scale ≤6 months after stroke were compared between those with and without onset headache. Results— Among 11 523 patients with first-ever ischemic stroke, 848 had onset headache (7.4%). Patients with specific cause, large-artery atherosclerosis, or cardioembolism were more likely to have onset headache. Patients with onset headache were younger, predominantly female, and more likely to have posterior circulation ischemic lesions. Compared with patients without onset headache, those with onset headache had a lower frequency of stroke in evolution (4.5% versus 6.7%; adjusted relative risk, 0.64; 95% confidence interval, 0.52–0.79), greater improvement in National Institutes of Health Stroke Scale score on discharge (0.08 versus −0.20; P =0.02), higher mean Barthel index scores (86.5±20.0 versus 83.9±23.3; adjusted difference, 1.43; 95% confidence interval, 0.28–2.89), and a lower frequency of modified Rankin scale higher than 2 (27.6% versus 31.5%; adjusted relative risk, 0.85; 95% confidence interval, 0.72–0.95) at 1-month follow-up. There was also a trend for better functional outcome in 3- and 6-month follow-ups. Conclusions— By adopting standard classification criteria, this large-scale study demonstrated that onset headache was associated with modest but significantly better outcomes after ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.677070
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 1467823-8
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