Abstract WP366: Exploring the Association Between Physician Trust and Recurrent Stroke and Transient Ischemic Attack (TIA)

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Anita Venkatesan ◽  
Bernadette Boden-Albala ◽  
Nina Parikh ◽  
Emily Goldmann
Keyword(s):  
Sex Education ◽  
Medication Compliance ◽  
Recurrent Stroke ◽  
Controlled Trial ◽  
National Study ◽  
Stroke Severity ◽  
Positive Health ◽  
Physician Trust ◽  
Ischemic Attack ◽  
The Impact

Purpose: More positive health behaviors, fewer symptoms, higher quality of life, and greater treatment satisfaction have been reported among those with greater physician trust. This study assessed the relationship between physician trust and recurrent stroke/TIA within 1 year of discharge among stroke survivors in Northern Manhattan. Methods: This study used data from the Stroke Warning Information and Faster Treatment (SWIFT) study, a randomized controlled trial conducted from 2005-2012 in a multiethnic cohort of 1,193 mild/moderate ischemic stroke and TIA survivors. The goal was to assess the impact of a stroke preparedness educational intervention on emergency department arrival time after subsequent stroke symptom onset. Physician trust, assessed at baseline, was measured with one item: “What percentage of the time do you trust doctors?”. For the analysis, it was dichotomized with the cutoff at 80%. Recurrent stroke/TIA was assessed at 1 month and 1 year. The association between recurrent stroke/TIA and patient trust was evaluated using multivariate logistic regression adjusted for sociodemographics and comorbidities. Results: In the analytic sample (n=1108), those who answered both exposure and outcome, the prevalence of recurrent stroke/TIA and lack of physician trust was 10.75% and 36.46%, respectively. Consistent with the literature, Hispanics compared to whites had a higher prevalence of lack of physician trust (42.71% vs. 34.11%, p<0.001). Adjusting for race/ethnicity, intervention status, age, sex, education, marital status, smoking, insurance, hypertension, diabetes, body mass index, physical activity, and depression, those who lacked trust had greater odds of recurrent stroke/TIA (OR=1.36, 95% CI:0.86-2.18) than those who had trust. When observing the association among Hispanics and Blacks, those who lacked trust had (OR=1.27, 95% CI: 0.66-2.42) and (OR=1.26, 95% CI: 0.36-4.38) respectively, greater odds of a recurrent episode than those who had trust. Conclusion: Despite insignificant findings, a national study with a greater range of stroke severity and additional measures such as medication compliance may be warranted to provide greater insight on the effects of physician trust on stroke outcomes.

scholarly journals Estimating the Impact of Growth Mindset on High School Mathematics Performance and Course-Taking

2020 ◽  
Author(s):  
Soobin Kim ◽  
Barbara Schneider ◽  
John Yun
Keyword(s):  
Controlled Trial ◽  
School Context ◽  
Growth Mindset ◽  
National Study ◽  
Control Activity ◽  
9Th Grade ◽  
Nationally Representative ◽  
The Impact ◽  
Growth Mindset Intervention ◽  
Mindset Intervention

Using a randomized controlled trial in a nationally representative sample of 65 public high schools (N = 13,660), we tested the effects of a growth mindset intervention on math course- taking patterns and student achievement and explored whether school context was related to the success of the intervention. Students were randomly assigned to complete either the growth mindset intervention or a control activity during two 25-minute sessions. After participating in the growth mindset program used in the National Study of Learning Mindsets, students’ 9th- grade mathematics GPA increased by an average of 0.05 grade points on a 4.3-point scale. We found distinct patterns of treatment effects that depend on level of math preparation, course intensity, school context, and changes in students’ mindset.

scholarly journals Historic Stroke Motor Severity Score Predicts Progression in TIA/Minor Stroke

2014 ◽  
Vol 41 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Marie-Christine Camden ◽  
Michael D. Hill ◽  
Andrew M. Demchuk ◽  
Alexandre Y. Poppe ◽  
Nan Shobha ◽  
...  
Keyword(s):  
Severity Score ◽  
Recurrent Stroke ◽  
Minor Stroke ◽  
Motor Deficits ◽  
Stroke Severity ◽  
Early Improvement ◽  
Stroke Population ◽  
Early Neurological Deterioration ◽  
Ischemic Attack ◽  
Symptom Progression

Background:transient ischemic attack (tIA) and minor stroke have a high risk of early neurological deterioration, and patients who experience early improvement are at risk of deterioration. We generated a score for quantifying the worst reported motor and speech deficits and assessed whether this predicted outcome.Methods:510 tIA or minor stroke (NIHSS>4) patients were included. the Historical Stroke Severity Score (HSSS) prospectively quantified the patient's description of the worst motor or speech deficits. the HSSS was rated at the time of first assessment with more severe deficits scoring higher. Motor HSSS included assessments of arm and leg motor power (score total 0-5). Speech HSSS assessed severity of dysarthria and aphasia (total 0-3). the association between motor and speech HSSS and symptom progression was assessed during the 90-day follow-up period.Results:the proportion of patients in each category of the motor HSSS was 0: 43% (216/510), 1: 22%(110/510), 2: 17% (89/510), 3: 7% (37/510), 4: 5% (28/510) and 5: 6% (30/510). Motor HSSS was associated with symptom progression (p=0.004) but not recurrent stroke. Speech HSSS was not associated with either progression or recurrent stroke. Motor HSSS predicted disability (p=0.002) and intracranial occlusion (p=0.012). Disability increased with increasing motor HSSS.Conclusions:taking a detailed history about the severity of motor deficits, but not speech, predicted outcome in tIA and minor stroke patients. A score based on the patient's description of the severity of motor symptoms predicted symptom progression, intracranial occlusion and functional outcome, but not recurrent stroke in a tIA and minor stroke population.

Sex differences in predictors for cognitive decline and dementia in people with stroke or transient ischemic attack in the PROGRESS trial

2021 ◽  
pp. 174749302110592
Author(s):  
Jessica Gong ◽  
Katie Harris ◽  
Christophe Tzourio ◽  
Stephen Harrap ◽  
Sharon Naismith ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sex Differences ◽  
Cognitive Decline ◽  
Transient Ischemic Attack ◽  
Treatment Effects ◽  
Multinomial Logistic Regression ◽  
Recurrent Stroke ◽  
Controlled Trial ◽  
Lower Odds ◽  
Ischemic Attack

Background Stroke and transient ischemic attack confer greater risk of cognitive decline and dementia. Aims We used data from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a blood pressure-lowering randomized controlled trial in stroke/transient ischemic attack. We evaluated overall and sex-specific differences in treatment effects for cognitive decline/dementia, as well as associations with vascular and stroke-specific predictors,considering death as a competing risk. Methods Multinomial logistic regression was used to estimate overall and sex-specific odds ratios (OR) (95% confidence intervals (CI)) for treatment effects and predictors associated with the risk of cognitive decline/dementia, and the women-to-men ratio of odds ratio (RORs). Results Over a median four years, 763 cognitive decline/dementia (30.9% women) were recorded in 5888 participants. Women had lower odds of cognitive decline/dementia than men (OR 0.78, 95%CI 0.63–0.95). Active treatment was associated with lower odds of cognitive decline/dementia (0.84, 0.72–0.98), with no evidence of sex difference. Higher education (0.96,0.94–0.98 (per year)) and baseline Mini-Mental State Examination (MMSE)) were associated with lower odds of cognitive decline/dementia (0.84,0.82–0.86 (per point higher)). Higher diastolic blood pressure (1.11,1.02–1.20 (per 10 mmHg)), low estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (1.27,1.03–1.58), and peripheral arterial disease (1.78,1.26–2.52) were associated with higher odds of cognitive decline/dementia. APOE ɛ4 was not associated with cognitive decline/dementia (1.05 (0.85–1.30)). Low eGFR was more strongly associated with cognitive decline/dementia in women than men (RORs, 1.60 (1.03–2.48)). Diabetes was more strongly associated with men than women. Conclusions Several risk factors were associated with cognitive decline/dementia in people with prior stroke/transient ischemic attack, with notable sex differences. Long-term cognitive sequelae of stroke should be considered to strengthen joint prevention strategies for stroke, cognitive decline, and dementia. Trial Registration: This trial was not registered because enrolment began before 1 July 2005.

Abstract T P292: Baseline Infarct Volume Predicts Disability in TIA and Minor Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Negar Asdaghi ◽  
jonathan Coulter ◽  
Jayish Modi ◽  
Abdul Qazi ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Infarct Volume ◽  
Recurrent Stroke ◽  
Multivariable Analysis ◽  
National Institutes Of Health ◽  
Minor Stroke ◽  
Predicting Outcome ◽  
Ischemic Attack ◽  
Symptom Progression ◽  
The Impact

BACKGROUND: Despite their mild presenting neurological deficit, over one third of patients with transient ischemic attack (TIA) and minor stroke are dead or disabled at the time of hospital discharge. This is predominantly related to either symptom progression or recurrent stroke, although predicting outcome can be difficult. We sought to determine whether baseline radiographic MR characteristics could predict disability at 3months in this population. METHODS: Consecutive TIA/minor stroke (National Institutes of Health Stroke Scale<4) that were not disabled at baseline and had an MRI within 24 hours of symptom onset were prospectively included. Disability was assessed at 90 days using the modified Rankin Scale (mRS). The impact of perfusion (PWI) and diffusion (DWI) variables on disability (mRS≥2) at 90 days was assessed. RESULTS: 418 patients were included; 55.5% had positive DWI lesions. 292 patients had PWI imaging of whom 35% had PWI deficit (Tmax≥2s) and 26.5% had mismatch (Tmax≥4s-DWI) at baseline. The median DWI, PWI and mismatch volumes were 1.14 ml (IQR=3.43), 9.8 ml (IQR=29.8) and 9 ml respectively. A total of 56/418 (13.4%) patients were disabled at 90days. In multivariable analysis we adjusted for baseline predictors of disability (age, DM, premorbid mRS 1, ongoing symptoms, baseline NIHSS, CT/CT angiography-positive metric and DWI or PWI volume). DWI volume (OR=1.05, p=0.007), and age (OR=1.03, p=0.003) remained independent predictors of disability. PWI or mismatch volume did not predict functional outcome. CONCLUSIONS: A substantial proportion of patients with TIA and minor stroke are disabled at 90days. The degree of tissue injury as measured by DWI volume is an independent predictor of disability regardless of the mechanism of disability.

scholarly journals Assessment of the Influence of Active Rehabilitation on the Recovery of Motor Disorders in the Scheme of Comprehensive Treatment after Cerebral Hemispheric Ischemic Stroke

2021 ◽  
Vol 6 (3) ◽  
pp. 182-191
Author(s):  
O. O. Pushko ◽  
Keyword(s):  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Cerebral Stroke ◽  
Comprehensive Treatment ◽  
Stroke Severity ◽  
Motor Disorders ◽  
Comprehensive Therapy ◽  
Vital Functions ◽  
Active Rehabilitation ◽  
The Impact

Cerebral stroke is a «global epidemic», which occupies the leading place in the structure of the causes of disability of the adult population in most countries, having great medical, social, and economic significance. Therefore, this problem is urgent worldwide, being a priority area of the research, which is constantly explored. The earliest possible start of rehabilitation measures improves functional output and reduces the risk of recurrent stroke. Activation and rehabilitation of patients with stroke should begin from the first days of the patient’s stay at the stroke department, immediately after stabilization of the basic vital functions (breath and hemodynamics). The use of international standardized scales is recommended to assess the functional status of the patient, screening, and dynamic diagnosis of motor disorders. The purpose of the study was to evaluate the impact of active rehabilitation treatment in the scheme of comprehensive therapy of patients with cerebral hemispheric ischemic stroke on the dynamics of recovery of motor disorders, and to study their correlations. Materials and methods. The study enrolled 138 patients: 30 healthy individuals (n = 30) and 108 people with cerebral hemispheric ischemic stroke (n = 108), who were divided into two groups: the first group (n = 48), whose treatment generally followed the «classical» measures with the use of medicinal therapy in accordance with the current clinical protocol of medical care for patients with ischemic stroke and the second group (n = 60), in which patients were additionally prescribed and given two courses of rehabilitation using active rehabilitation methods after the first and the third examinations. Results and discussion. The screening was performed using standardized diagnostic scales to determine: stroke severity (National Institutes of Health Stroke Scale), post-stroke functional capacity (Modified Rankin Scale), index of daily activity and self-care ability (Barthel Activities of Daily Living Index), balance impairment (Berg Balance Scale), clinical assessment of spasticity (Modified Ashworth Scale) after acute ischemic cerebrovascular accident. Verification of indicators was performed on days 3-7, day 30, day 90, day 180 after cerebral hemispheric ischemic stroke. In the course of the research, we used modern statistical methods and analyzed the structure of motor disorders before and after treatment, determined the reliability of changes in indicators that demonstrate the dynamics of functional recovery under the influence of active rehabilitation, examined the correlations of motor disorders in the study groups. Conclusion. The obtained results show that the use of active rehabilitation methods in the scheme of comprehensive treatment of patients in acute and recovery periods of cerebral hemispheric ischemic stroke significantly increases the efficiency of recovery of motor functions after the acute cerebral accident

scholarly journals Sooner Than Later If Not Right After Stroke

2019 ◽  
pp. 927-950
Author(s):  
Amy K. Dadisman ◽  
Noah D. Andrews ◽  
Reena Mehra ◽  
Irene L. Katzan
Keyword(s):  
Restless Legs Syndrome ◽  
Cerebral Autoregulation ◽  
Recurrent Stroke ◽  
Controlled Trial ◽  
Central Sleep Apnea ◽  
Restless Legs ◽  
Post Hoc ◽  
The Impact ◽  
First Time ◽  
Very High

The case involves a patient with interrelated sleep symptoms related to central hypersomnia, restless legs syndrome, and sleep disordered breathing (SDB) occurring after stroke. The prevalence of SDB after stroke has been noted to be very high, up to 70%, and consists of a higher contribution of central sleep apnea compared to the general population. Recurrent stroke is associated with a higher prevalence of SDB compared to first-time stroke. Contributions to SDB as related to stroke do not appear to have consistencies in terms of location and size of stroke. Untreated SDB can also contribute to stroke risk, with mechanisms involving increased systemic inflammation, prothrombotic biochemical markers, and dysfunction of cerebral autoregulation. Although there are post-hoc subgroup data in a randomized controlled trial suggesting reduction in stroke outcomes when SDB is treated with positive airway pressure, overall there are few studies that have rigorously examined the impact of treatment. Hypersomnia can be treated with modafinil and restless legs syndrome may become manifest due to sleep fragmentation.

Zinc Depletion Increases Readmission in Older Patients: An Example of Interactions Between Nutrition and Disease

2017 ◽  
Vol 87 (1-2) ◽  
pp. 10-16 ◽  
Author(s):  
Salah Gariballa ◽  
Awad Alessa
Keyword(s):  
Nutritional Status ◽  
Inductively Coupled Plasma ◽  
Older Patients ◽  
Controlled Trial ◽  
Prognostic Indicators ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Co Morbidity ◽  
The Impact ◽  
Poor Nutrition

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

Reducing the Social Stigma Associated with Obsessive Compulsive Disorder: A Controlled Trial of an Intervention Program in a Turkish Community Sample

2020 ◽  
Vol 20 (2) ◽  
pp. 101-120
Author(s):  
Ayça Aktaç Gürbüz ◽  
Orçun YORULMAZ ◽  
Gülşah DURNA
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Intervention Program ◽  
Controlled Trial ◽  
Community Sample ◽  
Case Vignette ◽  
Control Group ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Significant Difference ◽  
The Impact

Scientific research into the reduction of stigmatization, particularly related to specific problems such as Obsessive-Compulsive Disorder (OCD), is scarce. In the present study, we examine the impact of a video-based antistigma intervention program for OCD in a pretest-posttest control group research. After being randomly assigned to either an intervention (n= 101) or control group (n= 96), the participants reported their attitudes on a hypothetical case vignette before and after OCD vs. Multiple Sclerosis (MS) videos, and again six months later as a follow up assessment. The mixed design analyses for the group comparisons indicated that although there was no significant difference in the measures of the control group, the participants watching the anti-stigma OCD video, in which the focus was psychoeducation and interaction strategies, reported significantly lower scores on social distances and negative beliefs for the case vignettes they read, and this difference was maintained six months later. Then, the present results indicate the effectiveness of our anti-stigma intervention program for OCD. Interventions to reduce stigmatization can also be viewed as effective tools for changing the attitudes of people toward OCD, although further research and applications are needed related to specific disorders if a longlasting impact is to be achieved.

The impact of patient narratives on medical students’ perceptions of shared decision making: A randomized controlled trial

2020 ◽  
Author(s):  
Martina Bientzle ◽  
Marie Eggeling ◽  
Simone Korger ◽  
Joachim Kimmerle
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Shared Decision Making ◽  
Medical Training ◽  
Controlled Trial ◽  
Future Research ◽  
Shared Decision ◽  
Randomized Controlled ◽  
Information Text ◽  
The Impact

BACKGROUND: Successful shared decision making (SDM) in clinical practice requires that future clinicians learn to appreciate the value of patient participation as early as in their medical training. Narratives, such as patient testimonials, have been successfully used to support patients’ decision-making process. Previous research suggests that narratives may also be used for increasing clinicians’ empathy and responsiveness in medical consultations. However, so far, no studies have investigated the benefits of narratives for conveying the relevance of SDM to medical students.METHODS: In this randomized controlled experiment, N = 167 medical students were put into a scenario where they prepared for medical consultation with a patient having Parkinson disease. After receiving general information, participants read either a narrative patient testimonial or a fact-based information text. We measured their perceptions of SDM, their control preferences (i.e., their priorities as to who should make the decision), and the time they intended to spend for the consultation.RESULTS: Participants in the narrative patient testimonial condition referred more strongly to the patient as the one who should make decisions than participants who read the information text. Participants who read the patient narrative also considered SDM in situations with more than one treatment option to be more important than participants in the information text condition. There were no group differences regarding their control preferences. Participants who read the patient testimonial indicated that they would schedule more time for the consultation.CONCLUSIONS: These findings show that narratives can potentially be useful for imparting the relevance of SDM and patient-centered values to medical students. We discuss possible causes of this effect and implications for training and future research.

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