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  • Ovid Technologies (Wolters Kluwer Health)  (124)
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  • Ovid Technologies (Wolters Kluwer Health)  (124)
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  • English  (124)
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  • 1
    Online Resource
    Online Resource
    Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT)
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Neurology Vol. 86, No. 23 ( 2016-06-07), p. 2138-2145
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 86, No. 23 ( 2016-06-07), p. 2138-2145
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000002459
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1491874-2
    detail.hit.zdb_id: 207147-2
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  • 2
    Online Resource
    Online Resource
    Abstract WMP101: Paramedic Management of Childhood Arterial Ischemic Stroke
    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 and objectives: Ambulance usage is the most important factor resulting in shorter time to hospital arrival in adult stroke. Prenotification and bypass to stroke centres are associated with increased thrombolysis rates. Sensitivity of paramedic stroke identification in adults varies from 44-66% but there are no published data in children. Hypotheses and aims: We hypothesised that emergency medical services call-taker (EMSDCT) and paramedic identification of childhood arterial ischemic stroke (AIS) is suboptimal and contributes to prehospital delays. Our aims were to determine sensitivity of EMSCT and paramedic diagnosis, and to describe patterns and timelines of paramedic care in childhood AIS. Methods: Retrospective study of ambulance transported children 〈 18 years with radiologically confirmed AIS, from 2008-2015. Direct admissions to inpatient units were excluded. Results: Ambulance records were reviewed for 19 children. Four children were excluded because records were unavailable. 58% were female, median age was 8 years (IQR 3-14) and median PedNIHSS score was 8 (IQR 3-16). EMSCT diagnosis was stroke in 21% of children and Code 1 (lights and sirens) ambulance were dispatched for 72% of children. Paramedic diagnosis was stroke in 26% of children. Prenotification occurred in 42% of children and 64% were transported to adult (6) or pediatric (6) hospitals meeting criteria for primary stroke centres. Median prehospital timelines were: onset to 911 call 13 minutes, call to scene 12 minutes, time at scene 14 minutes, call to ED arrival 54 minutes, and total pre-hospital lag time 71 minutes (IQR 60-85). In contrast post-arrival lag time to radiological confirmation of diagnosis was 568 minutes (IQR 144-799). Conclusion: Sensitivity of EMSCT and paramedic childhood AIS diagnosis and pre-notification rates are much lower than those reported in adults. However prehospital factors contribute less to delayed diagnosis than in hospital factors, representing an important difference to adult stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wmp101
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Power Analysis for Ordinal Analyses of the Modified Rankin Scale and an Online and Downloadable Tool for Practical Use
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. 7 ( 2023-07), p. 1750-1760
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. 7 ( 2023-07), p. 1750-1760
    Abstract: Several methods for conducting power analysis of studies with outcomes across the full ordinal modified Rankin Scale are proposed in the literature. No systematic comparison of accuracy, agreement, and sensitivity to small changes in hypothesized effect sizes for these methods is available. Our aim is to conduct such a systematic comparative analysis and to introduce a comprehensive freely available online tool to facilitate appropriate power analyses for ordinal outcomes. METHODS: We performed simulation studies utilizing the control arm modified Rankin Scale distributions from the AVERT (A Very Early Rehabilitation Trial), EXTEND (Extending the Time for Thrombolysis in Emergency Neurological Deficits), and HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) studies, as well as a uniform distribution, in combination with hypothetical treatment effects. We systematically evaluated published power formulas for Ordinal Logistic Regression and Tournament Methods (generalized odds ratio; Win Probability; Win Ratio; and Wilcoxon-Mann-Whitney U test). We also developed an online and downloadable Shiny R app facilitating sample size calculation for, and ordinal analysis of, modified Rankin Scale data. RESULTS: Power formulas for Tournament Methods performed well, while the formula for ordinal logistic regression was inaccurate. Tang’s Wilcoxon-Mann-Whitney U test sample size formula exhibited the highest accuracy. All methods, including ordinal logistic regression, had almost identical empirical power for a given sample size. All power methods exhibited sensitivity to small changes in hypothesized effect size. The developed freely available online app supports analytical and visualization requirements for all investigated methods for power and statistical analyses of ordinal modified Rankin Scale outcomes. CONCLUSIONS: As Tournament Method sample size formulas are assumption-free and accurately calculate power, stroke researchers should use these methods when designing studies with outcomes measured on the full or partially collapsed modified Rankin Scale as well as other ordinal scales, even if they intend to use ordinal logistic regression for analysis. Conducting sensitivity analyses of the effect size assumptions are essential for appropriate sample size estimation. Our developed tool supports both of these recommendations ( https://www.thembc.com.au/tournamentmethods ).
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.122.041260
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Role of Computed Tomography Perfusion in Identification of Acute Lacunar Stroke Syndromes
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 1 ( 2021-01), p. 339-343
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 1 ( 2021-01), p. 339-343
    Abstract: Lacunar syndromes correlate with a lacunar stroke on imaging in 50% to 60% of cases. Computed tomography perfusion (CTP) is becoming the preferred imaging modality for acute stroke triage. We aimed to estimate the sensitivity, specificity, and predictive values for noncontrast computed tomography and CTP in lacunar syndromes, and for cortical, subcortical, and posterior fossa regions. Methods: A retrospective analysis of confirmed ischemic stroke patients who underwent acute CTP and follow-up magnetic resonance imaging between 2010 and 2018 was performed. Brain noncontrast computed tomography and CTP were assessed independently by 2 stroke neurologists. Receiver operating characteristic curve analysis was performed to estimate sensitivity, specificity, and area under the curve (AUC) for the detection of strokes in patients with lacunar syndromes using different CTP maps. Results: We found 106 clinical lacunar syndromes, but on diffusion-weighted imaging, these consisted of 59 lacunar, 33 cortical, and 14 posterior fossa strokes. The discrimination of ischemia identification was very poor using noncontrast computed tomography in all 3 regions, but good for cortical (AUC, 0.82) and poor for subcortical and posterior regions (AUCs, 0.55 and 0.66) using automated core-penumbra maps. The addition of delay time and mean transient time maps substantially increased subcortical (AUC, 0.80) and slightly posterior stroke detection (AUC, 0.69). Conclusions: Analysis of mean transient time and delay time maps in combination with core-penumbra maps improves detection of subcortical and posterior strokes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.030455
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Abstract 37: Pediatric Brain Attacks: Differentiating Between Stroke and Mimics in the Emergency Room.
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Objective: Timely recognition of stroke in the pediatric emergency room (ER) is critical to improving access to hyper-acute therapies. We aimed to identify key clinical features which discriminate between stroke and non-stroke brain attacks (mimics). Methods: Two-hundred and eighty consecutive children presenting to the ER with non-stroke brain attacks, prospectively recruited over 18 months in 2009-2010, were compared to 104 children with stroke, prospectively/retrospectively recruited from 2003-2010. Brain attack was defined as acute onset focal brain dysfunction with ongoing symptoms or signs on arrival to the ER. Exclusion criteria included known epilepsy, hydrocephalus, head trauma and isolated headache. Results: Stroke diagnoses included arterial ischemic stroke (AIS) (55), hemorrhagic stroke (HS) (37), TIA (10) and sinovenous thrombosis (2). The most common mimic diagnoses included migraine (87), first seizure (46), Bell’s palsy (29) and conversion disorder (18). Children with stroke were more likely to have sudden onset of symptoms (85% vs. 71%), arrive by ambulance (63% vs. 33%) and receive higher triage category (43% vs. 23%) than mimics (p 〈 0.001 all variables). Symptoms with good discriminatory value (stroke vs. mimic) included focal weakness (58% vs. 34%), altered consciousness (31% vs. 19%) and speech disturbance (36% vs. 16%) (p 〈 0.001 all variables). Signs with good discriminatory value included focal weakness of the face (45% vs. 14%), arm (47% vs. 13%) or leg (38% vs. 15%), dysarthria (22% vs. 5%), dysphasia (11% vs 3%) and altered consciousness (43% vs. 23%) (p 〈 0.001 all variables). Absence of focal neurological signs (20% stroke vs 35% mimic) on examination predicted mimic (p=0.005). Conclusions: Focal weakness and speech disturbance predict stroke diagnosis in children with brain attack symptoms, findings which are similar to adults. These findings will inform the development of pediatric bedside stroke recognition tools to improve rapid recognition of stroke by emergency physicians.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.37
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 6
    Online Resource
    Online Resource
    Abstract 41: Care Seeking Behaviours in Childhood Arterial Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Abstract: Objective: Taking appropriate action in the pre-hospital setting is important for rapid stroke diagnosis in adults but data are lacking for children. Our objectives were to describe help seeking behaviour and pathways to hospital in pediatric arterial ischemic stroke. Methods: A structured interview was performed to determine carer actions and pathway to hospital. Event driven process modeling techniques were used to develop questions with fundamental objectives being timely and correct recognition of stroke in the pre-hospital setting. Results: Parents of 28 children (61% female) were interviewed. 27 children (96%) were awake at stroke ictus and 26 (93%) had sudden onset symptoms. Child’s location at stroke onset included home 19 (68%), school 3 (11%) or other setting 6 (21%). Carers present included parent 21 (75%), teacher 2 (7%), other adult 4 (14%) or alone 1 (4%). 24 (89%) parents thought symptoms were serious but only 10 (36%) considered the possibility of stroke. Symptoms of most concern to parents included face weakness 14 (54%), speech disturbance 9 (32%), incoordination or difficulty walking 6 (21%), headache 5 (18%) and weakness 4 (14%). Initial actions included calling 911 in 10 (36%), wait and see 6 (21%), calling family member 1 (4%), private transport to emergency room (ER) 7 (25%) or family physician 4 (14%). 22 (85%) carers thought urgent action was required but only 14 (54%) ultimately called 911. First heath professional contact included paramedic 13 (46%), ER physician 8 (29%) or family physician 7 (25%). Median time from onset to ER arrival was 1.8 hours (IQR 0.75-7). Conclusions: Only one-third of carers considered stroke as a possible cause for their child’s neurological symptoms and less than half called 911. Initiatives are required to educate parents about taking appropriate action to improve access to time critical interventions.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.41
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    Subacute Ischemic Stroke Is Associated With Focal 11 C PiB Positron Emission Tomography Retention But Not With Global Neocortical Aβ Deposition
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. 5 ( 2012-05), p. 1341-1346
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 5 ( 2012-05), p. 1341-1346
    Abstract: Conflicting evidence exists as to whether focal cerebral ischemia contributes to cerebral amyloid deposition. We aimed to look at Aβ deposits, detected by N-methyl-2-(4′-methylaminophenyl)-6-hydroxybenzothiazole (PiB) positron emission tomography, in patients with recent ischemic stroke. Specifically, we hypothesized that patients with recent ischemic stroke have higher local and neocortical PiB positron emission tomography retention and that this may be associated with major vascular risk factors. Methods— Ischemic stroke patients were studied using PiB positron emission tomography within 30 days and compared to age-matched controls. Distribution volume ratio maps were created using Logan graphical analysis with the cerebellar cortex as a reference. Results— Among the 21 ischemic stroke patients (median age, 76 years; interquartile range, 68–77), the ipsilateral peri-infarct region PiB retention was higher compared to the contralateral mirror region, with a PiB distribution volume ratio difference of 0.29 (95% CI, 0.2–0.44; P =0.001) at median 10 (interquartile range, 7–14) days after stroke. Two patients also had higher PiB retention within the infarct compared to the contralateral side. There was no difference in the neocortical PiB retention elsewhere in the brain among ischemic stroke patients compared with 22 age-matched normal controls ( P =0.22). Among the risk factors in the ischemic stroke patients, diabetes was associated with a higher neocortical PiB retention (Spearman Rho=0.48; 95% CI, 0.28–0.72). Conclusions— PiB retention was higher in the peri-infarct region among patients with recent ischemic stroke. This did not translate into a higher global neocortical PiB retention except possibly in patients with diabetes. The cause of the focal PiB retention is uncertain and requires further investigation.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.636266
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 8
    Online Resource
    Online Resource
    Abstract TP189: Outcome Differences Between Endovascular Thrombectomy and Medical Management Based on Underlying Stroke Etiology: A Secondary Analysis of SELECT2 Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Introduction: In patients with large core ischemic stroke, potential heterogeneity in EVT treatment effect based on underlying etiology is an important question. We explored differences in clinical outcomes and successful recanalization rates between EVT and MM. Methods: From SELECT2 randomized clinical trial, patients were categorized based on Stroke etiology: Large-artery atherosclerosis (LAA), Cardioembolism (CE), Stroke of other determined etiology (SOE), and Stroke of undetermined etiology (SUE). Procedure success, clinical outcomes and EVT treatment effect was compared based on stroke etiology. Results: Cardioembolic stroke was most frequently observed etiology across the trial (41%), followed by stroke of undetermined etiology (29%), large artery atherosclerosis (23%) and stroke of other determined etiology (6%). Proportion of patients achieving successful reperfusion (mTICI 2b-3) after EVT differed significantly across the categories (CE: 87%, LAA: 82%, SOE: 73%, SUE: 66%, p=0.040). However, treatment effect estimates favored EVT across categories of stroke etiology without significant heterogeneity - CE (ref): aGenOR: 1.83 (1.30-2.59) vs LAA: aGenOR: 2.04 (1.24-3.37), p-int: 0.87 vs SOE: aGenOR: 2.06 (0.80-5.28), p-int: 0.79 vs SUE: aGenOR: 1.20 (0.77-1.88), p-int: 0.17. Conclusion: In patients with large core ischemic stroke, proportion of patients achieving successful reperfusion differed based on stroke etiology. However, EVT was associated with better outcomes without evidence of significant heterogeneity. Further optimization of procedure techniques may help improve successful reperfusion rates and clinical outcomes in patients with SUE. Clinicaltrials.gov registration: NCT03876457
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.TP189
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 80381-9
    detail.hit.zdb_id: 1467823-8
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  • 9
    Online Resource
    Online Resource
    Accessing inpatient rehabilitation after acute severe stroke : age, mobility, prestroke function and hospital unit are associated with discharge to inpatient rehabilitation
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  International Journal of Rehabilitation Research Vol. 35, No. 4 ( 2012-12), p. 323-329
    Details
    In: International Journal of Rehabilitation Research, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 4 ( 2012-12), p. 323-329
    Type of Medium: Online Resource
    ISSN: 0342-5282
    URL: Article
    DOI: 10.1097/MRR.0b013e328355dd00
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 533323-4
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  • 10
    Online Resource
    Online Resource
    Fatal and Nonfatal Events Within 14 days After Early, Intensive Mobilization Poststroke
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Neurology Vol. 96, No. 8 ( 2021-02-23)
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 96, No. 8 ( 2021-02-23)
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000011106
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1491874-2
    detail.hit.zdb_id: 207147-2
    Location Call Number Limitation Availability
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