GLORIA

GEOMAR Library Ocean Research Information Access

Ihre E-Mail wurde erfolgreich gesendet. Bitte prüfen Sie Ihren Maileingang.

Leider ist ein Fehler beim E-Mail-Versand aufgetreten. Bitte versuchen Sie es erneut.

Vorgang fortführen?

Exportieren
  • 1
    In: International Journal of Stroke, SAGE Publications, ( 2019-10-25), p. 174749301988452-
    Kurzfassung: Limited national-level information on temporal trends in comprehensive stroke center capabilities and their effects on acute ischemic stroke patients exists. Aims To examine trends in in-hospital outcomes of acute ischemic stroke patients and the prognostic influence of temporal changes in comprehensive stroke center capabilities in Japan. Methods This retrospective study used the J-ASPECT Diagnosis Procedure Combination database and identified 372,978 acute ischemic stroke patients hospitalized in 650 institutions between 2010 and 2016. Temporal trends in patient outcomes and recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy usage were examined. Facility comprehensive stroke center capabilities were assessed using a validated scoring system (comprehensive stroke center score: 1–25 points) in 2010 and 2014. The prognostic influence of temporal comprehensive stroke center score changes on in-hospital mortality and poor outcomes (modified Rankin Scale: 3–6) at discharge were examined using hierarchical logistic regression models. Results Over time, stroke severity at admission decreased, whereas median age, sex ratio, and comorbidities remained stable. The median comprehensive stroke center score increased from 16 to 17 points. After adjusting for age, sex, comorbidities, consciousness level, and facility comprehensive stroke center score, proportion of in-hospital mortality and poor outcomes at discharge decreased (from 7.6% to 5.0%, and from 48.7% to 43.1%, respectively). The preceding comprehensive stroke center score increase (in 2010–2014) was independently associated with reduced in-hospital mortality and poor outcomes, and increased rt-PA and mechanical thrombectomy use (odds ratio (95% confidence interval): 0.97 (0.95–0.99), 0.97 (0.95–0.998), 1.07 (1.04–1.10), and 1.21 (1.14–1.28), respectively). Conclusions This nationwide study revealed six-year trends in better patient outcomes and increased use of rt-PA and mechanical thrombectomy in acute ischemic stroke. In addition to lesser stroke severity, preceding improvement of comprehensive stroke center capabilities was an independent factor associated with such trends, suggesting importance of comprehensive stroke center capabilities as a prognostic indicator of acute stroke care.
    Materialart: Online-Ressource
    ISSN: 1747-4930 , 1747-4949
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2019
    ZDB Id: 2211666-7
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 2
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Kurzfassung: Introduction: Reports on hospital-specific, risk-standardized outcomes using claims data on acute ischemic stroke are increasing. However, these reports sometimes fail to account for stroke severity. Hypothesis: Hospital-specific, risk-adjusted mortality rating without accounting for stroke severity are altered after including initial severity for ischemic strokes. Methods: The health insurance claims data known as the Japanese Diagnosis Procedure Combination/Per Diem Payment Systems between April 1, 2013 and May 31, 2014 was obtained from 332 certified training institutions in Japan. The hospital-specific, risk-adjusted 30-day mortality rate was calculated using a hierarchical logistic regression model. We developed two models, with and without initial levels of consciousness (LOC), and compared them to assess the impact of stroke severities on hospital-specific mortalities. The hospital-specific mortalities with and without LOC were ranked and groped into 3 categories (top 20%, middle 60%, and bottom 20%), and then compared across the two models. We used an integrated discrimination improvement (IDI) index to measure how the model with LOC reclassified patients compared with the model without LOC. Patients with deep comas were excluded from the analyses. Results: We analyzed 64,569 acute ischemic stroke patients. Crude 30-day mortality was 3.9% , the mean age was 74.1±1.3 years, 41.2% were women, 70.8% had hypertension, 29.2% had diabetes mellitus, 79.9% had a Charlson comorbidity index score greater than 5, 3.7% had severe LOC (coma/semi-coma) and 8.1% had modestly impaired LOC. Among hospitals ranked in the top 20% of performers without LOC, 26.9% were ranked in the middle 60% when LOC was adjusted. Among the bottom 20% of performers without LOC, 21.2% were ranked in the middle 60% when LOC was adjusted. The hospital-specific, risk-adjusted 30-days mortality model with LOC had a significantly better IDI index score than the model without LOC (IDI, 0.09; P 〈 0.001). Conclusions: Adding the metric of stroke severity to a hospital-specific, risk-adjusted 30-day mortality model based on claims data was associated with model improvement and changes of mortality-based performance rankings.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2017
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 3
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Kurzfassung: Background and Purpose: The effects of the clipping or coiling treatment on patients with subarachnoid hemorrhage (SAH) remain elusive. We performed a nationwide study to compare the effects of clipping with those of coiling in patients with SAH by using the Japanese Diagnosis Procedure Combination (DPC) database. Materials and methods: We analyzed data obtained from patients who were hospitalized for SAH in 427 certified training institutions of the Japan Neurosurgical Society between April 2012 and March 2013. Outcomes regarding in-hospital mortality, modified Rankin Scale (mRS) scores, cerebral infarction, and complications were compared between clipping and coiling groups using mixed model analysis and propensity score matching analysis. In addition, we conducted a questionnaire-based survey regarding comprehensive stroke center (CSC) capabilities. The questionnaire elicited data regarding the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs in 749 professional training institutions on February 2011. Results: Data obtained from a total of 5214 patients with SAH (3624 clipping, 1590 coiling) were analyzed. Mixed model analysis (OR=1.30, P=0.013) and propensity score matching analysis (OR=1.35, P=0.022) revealed that the in-hospital mortality was significantly higher in the coiling group, while both analyses revealed that the discharge mRS was not significantly different between groups. Clipping of intracranial aneurysms (IAs) and operating rooms staffed 24/7 were available in 91.5% and 60.4% of 749 hospitals, respectively. Coiling of IAs and interventional services coverage 24/7 were available in 48.1% and 37.3% of 749 hospitals, respectively. Conclusions: This study demonstrated that clipping is superior to coiling for SAH patients. In Japan, the number of hospitals where coiling is available is still considerably lower than the number of hospitals where of clipping is available. The differences among hospitals may be associated with the increased in-hospital mortality in the patients undergoing coiling. This nationwide database study can complement the findings of prospective clinical trials, and reflect real-world practice.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 4
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Kurzfassung: Introduction: Organized stroke care is an integrated approach to managing stroke to improve outcomes. However, the effectiveness of organized stroke care on mortality and morbidity remains uncertain. This study aimed to examine whether Organized stroke care index (OCI), which graded 0-3 based on the presence of rehabilitation, stroke team assessment, and admission to a stroke unit, developed to assess the accessibility to stroke care by Saposnik (Neurology 2010) influenced stroke outcomes in a nation wide hospital cohort. Hypothesis: OCI influenced mortality and morbidity of patients with ischemic and hemorrhagic stroke. Methods: Of the 1369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding comprehensive stroke care capacities. Among the institutions that responded, data on patients hospitalized between April 1, 2010 and March 31, 2014, because of stroke were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality morbidity was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, Charson Score and the number of OCI fulfilled in each component and in total. Results: Data from 265 institutions and 220,027 emergency-hospitalized patients were analyzed. Patients fulfilled the criteria for admission to a SCU, stroke team assessment and the presence of rehabilitation were 29.9%, 41.2% and 66.5%, respectively. Mortality adjusted for age, sex, Charson score and level of consciousness was significantly correlated with admission to a SCU (OR=0.83, p 〈 0.001), SCU team assessment (OR=0.84,P 〈 0.001), and rehabilitation (OR=0.36, p=0.031). OCI was significantly associated with decreased mortality (OR=0.45, p 〈 0.001) and the highest OCI score was associated with 89.4% decrease of mortality. (OR=0.104, p 〈 0.001) Modified ranking scale 0 to 2 rate were also associated significantly with SCU admission (p 〈 0.001). These association holds for ischemic stroke and subarachnoid hemorrhage. Conclusion: A strong association between organized stroke care and lower mortality was apparent. These data suggest that organized stroke care should be provided to stroke patients regardless of stroke subtype.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 5
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Kurzfassung: Background: Evaluation of the overall clinical outcomes of stroke care is important for improving institutional quality of care. We performed a nationwide survey in Japan to analyze cases of unruptured cerebral aneurysms using the diagnostic procedure combination (DPC). Methods and Results: Certified neurosurgical training institutions in Japan provided data from the DPC database on patients hospitalized with neurosurgical diseases between April 1, 2012 and March 31, 2013. Patients hospitalized owing to unruptured cerebral aneurysms were identified from the DPC database based on the International Classification of Diseases (ICD)-10 diagnosis code (I671). We excluded patients with emergency admissions. We compared the mortality rates, modified Rankin Scale (mRS) scores, postoperative complications of patients who underwent clipping and coiling. With respect to postoperative complications, we evaluated the ratio of an event of complication (brain infarction, brain hemorrhage and cardiac infarction) and the number of complications (scored using patient safety indicators: PSIs and hospital-acquired conditions: HACs). We used hierarchical logistic regression models to estimate the odds ratios (ORs) for in-hospital mortality and complications. We identified 6329 patients with unruptured cerebral aneurysms (3710 clipping, 2619 coiling). Patient characteristics, mortality rates, and mRS were similar between groups. Patients who underwent coiling had a significantly lower number of complications than patients who underwent clipping (PSIs: OR = 0.40; P 〈 0.001, HACs: OR = 0.47; P = 0.001). Adversely, there was an increased likelihood of ischemic stroke in coiling patients compared with clipping patients (coiling: 7.2%; clipping: 4.7%; OR = 1.37; P = 0.011). 83.2% of coiling patients underwent MRI after the operation, compared with 37.3% of clipping patients. Conclusions: Our data demonstrated that coiling patients had lower number of post-operative complications and higher number of ischemic stroke than clipping patients. But the cause that higher number of coiling patients had ischemic stroke than clipping patients because higher number of coiling patients were underwent MRI after operation compared with clipping patients.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 6
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Kurzfassung: Background and purpose: The outcomes of subarachnoid hemorrhage (SAH) in aged patients are more severe than those in non-aged patients. There are few reports about the relationship between the age and the effect of perioperative care for SAH patients. We performed a nationwide survey in Japan to determine the relationship between perioperative care and SAH outcomes in aged and non-aged patients. Methods: We analyzed 17,343 subarachnoid hemorrhage (SAH) patients treated with clipping or coiling in 579 hospitals who participated in the J-ASPECT study. Data between 2010 and 2013 were obtained from the Japanese Diagnosis Procedure Combination Database. We stratified patients into two groups according to their age (aged group 〉 75 y.o., n=3885; non-aged group 〈 75 y.o., n=13,458) and analyzed the association between perioperative care and poor outcome (modified Rankin Scale score 3-6 at the time of discharge). With respect to perioperative care, we evaluated time from onset to surgery (days), treatment (clipping or coiling), and drugs delivered after surgery (fasudil hydrochloride, ozagrel sodium, cilostazol, statin, EPA, edaravone). Results: In the non-aged group, coiling (OR=0.84; P 〈 0.01) and treatment with fasudil hydrochloride (OR=0.59; P 〈 0.01), statin (OR=0.83; P 〈 0.01), and EPA (OR=0.83; P 〈 0.01) significantly improved the outcomes and cilostazol treatment tended to improve the outcomes (OR=0.91; P=0.07). In both groups, edaravone treatment was associated with poor outcome (aged group: OR=2.34, P 〈 0.01; non-aged group: OR=2.33, P 〈 0.01). Although no factor that could improve outcome in the aged group was identified, JCS scores less than 30, coiling (OR=0.80; P=0.03), and EPA treatment (OR=0.74; P=0.02) were statistically significant prognosis improvement factors. Conclusion: Coiling and treatment with fasudil hydrochloride, statins, and EPA improved outcomes of non-aged patients. Although perioperative care did not improve the outcome of aged SAH patients, in cases of relatively mild SAH, perioperative care had the potential to improve the outcome.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2017
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 7
    In: BMJ Open, BMJ, Vol. 6, No. 3 ( 2016-03), p. e009942-
    Materialart: Online-Ressource
    ISSN: 2044-6055 , 2044-6055
    Sprache: Englisch
    Verlag: BMJ
    Publikationsdatum: 2016
    ZDB Id: 2599832-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 8
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 90, No. 13 ( 2018-03-27), p. e1143-e1149
    Kurzfassung: This cross-sectional survey explored the characteristics and outcomes of direct oral anticoagulant (DOAC)–associated nontraumatic intracerebral hemorrhages (ICHs) by analyzing a large nationwide Japanese discharge database. Methods We analyzed data from 2,245 patients who experienced ICHs while taking anticoagulants (DOAC: 227; warfarin: 2,018) and were urgently hospitalized at 621 institutions in Japan between April 2010 and March 2015. We compared the DOAC- and warfarin-treated patients based on their backgrounds, ICH severities, antiplatelet therapies at admission, hematoma removal surgeries, reversal agents, mortality rates, and modified Rankin Scale scores at discharge. Results DOAC-associated ICHs were less likely to cause moderately or severely impaired consciousness (DOAC-associated ICHs: 31.3%; warfarin-associated ICHs: 39.4%; p = 0.002) or require surgical removal (DOAC-associated ICHs: 5.3%; warfarin-associated ICHs: 9.9%; p = 0.024) in the univariate analysis. Propensity score analysis revealed that patients with DOAC-associated ICHs also exhibited lower mortality rates within 1 day (odds ratio [OR] 4.96, p = 0.005), within 7 days (OR 2.29, p = 0.037), and during hospitalization (OR 1.96, p = 0.039). Conclusions This nationwide study revealed that DOAC-treated patients had less severe ICHs and lower mortality rates than did warfarin-treated patients, probably due to milder hemorrhages at admission and lower hematoma expansion frequencies.
    Materialart: Online-Ressource
    ISSN: 0028-3878 , 1526-632X
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2018
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 9
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Kurzfassung: Objective: This study aimed to investigate recent nationwide trends in the epidemiology of acute ischemic stroke (AIS) in Japan. Methods: We analyzed 328,147 acute ischemic stroke patients in 350 certified training hospitals in Japan using data obtained from the Japanese Diagnosis Procedure Combination Database. Data between the period April 1, 2010 and May 31, 2014 were used. We divided patients into three treatment groups: medical treatment only (group M), intravenous t-PA infusion only (group IVT), and endovascular treatment (group ET). Outcome was assessed by in-hospital mortality and modified Rankin Scale (mRS) score at discharge, and poor outcome was defined as a mRS score of 3-6. Results: The patient proportion in groups M, IVT, and ET changed from 94.3%, 3.2%, and 1.6% in 2010 to 90.9%, 4.3%, and 3.7% in 2014, respectively (P 〈 0.0001). In all AIS patients, in-hospital mortality significantly decreased from 6.5% in 2010 to 5.3% in 2014 (p 〈 0.0001) and poor outcome at discharge also decreased from 42.7% in 2010 to 41.6% in 2014 (p 〈 0.0001). In groups M and IVT, in-hospital mortality significantly decreased from 6.3% and 12.0% in 2010 to 5.0% and 9.1% in 2014, respectively (p 〈 0.0001), and poor outcome at discharge also decreased from 42.1% and 60.7% in 2010 to 40.7% (P 〈 0.0001) and 55.4% (p 〈 0.005) in 2014, respectively. In contrast, in group ET, both in-hospital mortality (from 11% in 2010 to 9.5% in 2014) and poor outcome at discharge (from 53.4% in 2010 to 54.0% in 2014) were not significantly different between the two time points. Conclusion: In Japan, during the 5-year period before the guidelines concerning proper use of ET for AIS were revised in 2015, a significant improvement in in-hospital mortality and functional outcomes of AIS patients undergoing medical treatment and intravenous rt-PA infusion was observed. This was probably due to a gradual increase in the proportion of patients undergoing IVT; the outcomes of ET, however, remained the same.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2017
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 10
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Kurzfassung: Introduction: Certification system of the primary and comprehensive stroke center (PSC and CSC) is still under discussion in Japan. This study attempts to examine associations between the variation of stroke center capabilities and the improvement of outcomes for acute ischemic stroke on a national scale. Hypothesis: Improvements in hospital stroke center capabilities leads to better outcome of acute ischemic stroke patients. Methods: Using a validated score for evaluating CSC capabilities, which consists of 5 categories (personnel, diagnostic techniques, specific expertise, infrastructure, and education) on a 25 point scale, we assessed CSC capabilities for 137 certified training hospitals in 2011 and 2015 (Kada et al. BMC Neurol 2017). A consecutive health insurance claims data known as the Japanese Diagnosis Procedure Combination/Per Diem Payment Systems of 2011 and 2015 was obtained from the hospitals. The proportion of favorable outcome—score 0 to 1 on the modified Rankin Scale (mRS)—at discharge was quantified as the primary outcome. The change in CSC score with more than two points over time was quantified as an independent variable. We regressed the change of CSC score on morbidity with adjustment of average age and sex in the hospitals. Results: In total, 18,658 in 2011 and 29,999 in 2015 ischemic stroke patients were admitted to 137 hospitals. Median annual number of ischemic stroke patients per hospital increased from 115 to 183 over time. Mean age (74.5 year vs 74.2 years) and proportions of men (56.8% vs 58.2%) were almost the same. The mean CSC scores increased from 15.9±4.0/25 to 17.2±4.2/25 point. The mean hospital mortality decreased from 6.1% to 4.3%. The mean proportion of patients with the favorable outcome at discharge increased from 39.2% to 45.5%. We selected random-effect model based on Housman test. In regression analyses, the increase of CSC score over time was significantly associated with the increasing proportion of the favorable outcome at discharge (coefficient, 2.76; 95% CI, 0.04-5.47; p-value, 0.047). Conclusions: Improvements in CSC capabilities overtime was significantly related to the improvement of functional outcome at discharge in ischemic stroke patients.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2018
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
Schließen ⊗
Diese Webseite nutzt Cookies und das Analyse-Tool Matomo. Weitere Informationen finden Sie hier...