GLORIA

GEOMAR Library Ocean Research Information Access

X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
Filter
  • BMJ  (4)
  • Molina, Carlos A  (4)
  • 1
    Online Resource
    Online Resource
    Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis
    BMJ ; 2023
    In:  Journal of NeuroInterventional Surgery
    Details
    In: Journal of NeuroInterventional Surgery, BMJ
    Abstract: The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI− at LSC arrival on variables related to workflows using data from the RACECAT Trial. Objective To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. Methods We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. Results Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69–96) vs VI− 76 (IQR 59–98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26–53) vs VI− 54 (IQR 40–70), P 〈 0.001). Conclusion Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/jnis-2023-020125
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2506028-4
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 2
    Online Resource
    Online Resource
    Patient-reported outcome measures after thrombectomy in patients with acute stroke: fine-tuning the modified Rankin Scale
    BMJ ; 2023
    In:  Journal of NeuroInterventional Surgery Vol. 15, No. 7 ( 2023-07), p. 644-649
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 15, No. 7 ( 2023-07), p. 644-649
    Abstract: In patients with stroke undergoing endovascular treatment (EVT), long-term outcome is usually only evaluated by the modified Rankin Scale (mRS). Patient-reported outcomes (PROMs) are standardized assessments that consider clinical outcomes from the perspective of the patient. We aimed to evaluate PROMs through a smartphone-based communication platform in patients with stroke who received EVT. Methods Consecutive patients with stroke who underwent EVT were offered to participate in the PROMs-through-App program (NORA). A set of standardized PROMs were collected at 7, 30 and 90 days after discharge. Disability was determined by clinicians (mRS) at 90 days. To characterize the potential ceiling effect of mRS in the assessment of different domains, the rate of abnormal PROMs among patients with excellent outcome (mRS 0–1) was calculated. Results From June 2020 to October 2021, 186 patients were included. The median PROMs collection rate per patient was 80% (50–100%). A correlation was consistently seen between disability measured by mRS and the different PROMs. The rate of abnormal PROMs ranged from 20.83% (HADS at 7 days) to 59.61% (Mental PROMIS at 7 days). At 90 days, among patients with an excellent outcome, the rate of abnormal PROMs ranged from 8.7% (HADS) to 47.83% (Physical PROMIS). Conclusions A specifically designed digital platform allows a high collection rate of PROMs among stroke patients who underwent EVT. The mRS score shows a ceiling effect and seems insufficient to fine-tune long-term clinical results. The use of PROMs may allow a better characterization of long-term outcome profiles after EVT.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2022-018840
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2506028-4
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 3
    Online Resource
    Online Resource
    Cost-utility of direct transfer to angiography suite (DTAS) bypassing conventional imaging for patients with acute ischemic stroke in Spain: results from the ANGIOCAT trial
    BMJ ; 2023
    In:  Journal of NeuroInterventional Surgery
    Details
    In: Journal of NeuroInterventional Surgery, BMJ
    Abstract: The ANGIOCAT trial showed a clinical benefit of direct to angiography suite (DTAS) for patients with large vessel occlusion (LVO) stroke admitted within 6 hours after symptom onset in decreased hospital workflow time and improved clinical outcome. However, the impact of DTAS implementation on hospital costs is unknown. This economic evaluation aims to assess the cost-utility of DTAS from the provider (hospital) perspective. Methods A cost-utility analysis was applied to compare DTAS with the standard direct to CT (DTCT) suite approach using direct cost and health outcomes data. The time horizon was 90 days. One-way sensitivity analysis as well as probabilistic sensitivity analysis was performed, varying the model parameters by ±25%. Measures included costs, quality-adjusted life years, and incremental cost-effectiveness ratios. Health outcomes, classified according to the modified Rankin Scale, were obtained from the ANGIOCAT trial. Respective utilities were obtained from the literature. Results DTAS is the dominant strategy. The incremental cost-effectiveness ratio is −€89 110 (−$97 600) with cost saving per patient of –€2848 (–$3120). The improved clinical outcome is directly related with a decrease in costs for the hospital, mainly due to the decrease in costs of hospital stay, improved clinical outcome and fewer complications. Conclusions For patients with LVO admitted within 6 hours after symptom onset, the DTAS not only improves clinical outcome but also decreases the costs (dominant option) compared with the standard DTCT. Multicentric international randomized clinical trials are ongoing to determine the replicability of our findings.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/jnis-2023-020275
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2506028-4
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 4
    Online Resource
    Online Resource
    Systematic CT perfusion acquisition in acute stroke increases vascular occlusion detection and thrombectomy rates
    BMJ ; 2022
    In:  Journal of NeuroInterventional Surgery Vol. 14, No. 12 ( 2022-12), p. 1270-1273
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 14, No. 12 ( 2022-12), p. 1270-1273
    Abstract: In patients with stroke, current guidelines recommend non-invasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols. Methods From April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT, CTA and CTP and were treated accordingly. Hypoperfusion areas defined by time-to-maximum of the tissue residue function (Tmax) 〉 6 s, congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated non-contrast CT and CTA to identify intracranial VO (CTA-VO). Results Of the 338 patients included in the analysis, 157 (46.5%) presented with CTP-VO (median Tmax 〉 6s: 73 (29–127) mL). CTA-VO was identified in 83 (24.5%) of the cases. Overall CTA-VO sensitivity for the detection of CTP-VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with increased CTA-VO detection (OR 1.03; 95% CI 1.02 to 1.04). EVT was performed in 103 patients (30.5%; Tmax 〉 6s: 102 (63–160) mL), representing 65.6% of all CTP-VO. Overall CTA-VO sensitivity for the detection of EVT-VO was 69.9% and specificity was 95.3%. Among patients who received EVT, the rate of false negative CTA-VO was 30.1% (Tmax 〉 6s: 69 (46–99.5) mL). Conclusion Systematically including CTP in acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2021-018241
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2506028-4
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...