ORCID Profile
0000-0003-4635-3322
Current Organisations
Imperial College London
,
College of Southern Nevada
,
The University of Edinburgh
,
Royal College of Physicians of Edinburgh
,
Royal College of Physicians
,
Organisation
,
Imperial College Healthcare NHS Trust
,
Hong Kong College of Physicians
,
Hong Kong Academy of Medicine
,
Cornell University
,
Cleveland Clinic London
,
Southern New Hampshire University
,
University of Nevada Las Vegas
,
Nevada Health and Human Services
,
University of Bristol
,
University of Southampton
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Publications
Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited
Publisher: Springer Science and Business Media LLC
Date: 30-11-2011
Prevalence and correlates of abuse screening items among community‐dwelling H ong K ong C hinese older adults
Publisher: Wiley
Date: 02-12-2015
DOI: 10.1111/GGI.12655
Abstract: The present study aims to describe the prevalence of potential elder abuse, and to examine correlates of abuse screening items among Chinese community-dwelling older adults. We analyzed the data of 3435 older persons aged ≥60 years who had first applied for the long-term care services in Hong Kong and completed the screening tool (Minimum Data Set-Home Care) in 2006. For each of the five abuse screening items ("fearful of a family member/caregiver," "unexplained injuries/broken bones/burns," "physically restrained," "unusually poor hygiene" and "neglected/abused/mistreated"), we examined its relationship with four types of factors: older person, perpetrator, relationship and environment. The rates of in idual abuse screening items ranged from 3.9% for physically restrained to 0.03% for unexplained injures/broken bones/burns. Physically restrained was positively associated with activities of daily living impairments, instrumental activities of daily living impairments, perceived poor health, physically abusive behavior and caregiver mental health. Unusually poor hygiene was positively associated with socially inappropriate behavior and actively resisted care. "Fearful of a family member/caregiver" was positively associated with perceived poor health, conflicting relationship and mental health, and negatively with care activities. Neglected/abused/mistreated was positively associated with age and informal care, and negatively with care activities. We identified a number of associated factors of different abuse screening items among older adults. Our findings could inform healthcare practitioners in identifying those older persons who might be at higher risk of abuse, and provide a knowledge base on which to develop effective preventive measures in the Chinese population. Geriatr Gerontol Int 2017 17: 150-160.
Impact of COVID-19 Pandemic on a Regional Stroke Thrombectomy Service in the United Kingdom
Publisher: S. Karger AG
Date: 11-12-2020
DOI: 10.1159/000512603
Abstract: b i Introduction: /i /b We examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on our regional stroke thrombectomy service in the UK. b i Methods: /i /b This was a single-center health service evaluation. We began testing for COVID-19 on 3 March and introduced a modified “COVID Stroke Thrombectomy Pathway” on 18 March. We analyzed the clinical, procedural and outcome data for 61 consecutive stroke thrombectomy patients between 1 January and 30 April. We compared the data for January and February (“pre-COVID,” i n /i = 33) versus March and April (“during COVID,” i n /i = 28). b i Results: /i /b Patient demographics were similar between the 2 groups (mean age 71 ± 12.8 years, 39% female). During the COVID-19 pandemic, (a) total stroke admissions fell by 17% but the thrombectomy rate was maintained at 20% of ischemic strokes (b) successful recanalization rate was maintained at 81% (c) early neurological outcomes (neurological improvement following thrombectomy and inpatient mortality) were not significantly different (d) use of general anesthesia fell significantly from 85 to 32% as intended and (e) time intervals from onset to arrival, groin puncture, and recanalization were not significantly different, whereas internal delays for external referrals significantly improved for door-to-groin puncture (48 [interquartile range (IQR) 39–57] vs. 33 [IQR 27–44] minutes, i /i = 0.013) and door-to-recanalization (82.5 [IQR 61–110] vs. 60 [IQR 55–70] minutes, i /i = 0.018). b i Conclusion: /i /b The COVID-19 pandemic has had a negative impact on the stroke admission numbers but not stroke thrombectomy rate, successful recanalization rate, or early neurological outcome. Internal delays actually improved during the COVID-19 pandemic. Further studies should examine the effects of the COVID-19 pandemic on longer term outcome.
Association between functional status and ocular surface disease among local elderly population in Hong Kong
Publisher: Informa UK Limited
Date: 19-02-2021
Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack:
Publisher: Elsevier BV
Date: 04-2021
The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1111/J.1538-7836.2011.04486.X
Abstract: Deep vein thrombosis (DVT) is an important complication of stroke, but the evidence to support commonly used prophylactic strategies is conflicting. To describe the incidence, extent, associated clinical features and evolution of DVT after stroke. The CLOTS trials 1 and 2 together randomized 5632 immobile stroke patients in 135 hospitals in nine countries. We screened patients for asymptomatic DVT with compression duplex ultrasound (CDU) at about 7-10 days and again at about 25-30 days after enrollment. Six hundred and forty-one (11.4%) of 5632 patients had DVT detected on the first CDU scan at a median of 8 days (interquartile range [IQR] 7-10 days) after enrollment, and an additional 176 (3.1%) had a DVT on the second CDU scan at a median of 28 days (IQR 26-30 days). Of the 817 with DVTs, 289 (35%) were symptomatic and 39 (5%) had pulmonary embolism (PE) confirmed by imaging. Six hundred and seventy-six (83%) were unilateral, 141 (17%) were bilateral, 322 (39%) were limited to calf veins, 172 (21%) were popliteal, and 323 (40%) were femoral. Among the 542 patients with DVT and a weak leg, the DVT affected the weaker leg in 396 (73%), the stronger leg in 59 (11%), and was bilateral in 87 (16%). Among the 318 patients with a DVT detected on the first CDU scan who had a second scan, the DVT regressed in 148 (47%), stayed the same in 140 (44%), and progressed in only 30 (9%). Although most DVTs develop within the first week, some develop later, and some early DVTs progress. Any prophylaxis needs to be started early but ideally continued for at least 4 weeks.
Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT)
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-02-2016
Factors Associated with Poor Eye Drop Administration Technique and the Role of Patient Education among Hong Kong Elderly Population
Publisher: Hindawi Limited
Date: 26-03-2019
DOI: 10.1155/2019/5962065
Abstract: Objectives . To identify the risk factors for poor eye drop application technique in treatment-naïve subjects and to assess if patient education can benefit these subjects. Methods . Chinese subjects above 60 years were recruited. Questionnaires, including Barthel index Lawton’s instrumental activities of daily living (ADL) Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale and Montreal Cognitive Assessment (MoCA), were used to correlate with eye drop application technique (before and after patient education) using Spearman correlation analysis. A multiple linear regression was conducted to determine the predictors of successful administration technique and the improvement of technique after education. Results . The data from 26 subjects (mean age 72) were analyzed. Eye drop instillation technique score improved from 5.42 at baseline to 7.33 after clear instructions. FRAIL score was an independent predictor of baseline score ( p = 0.003 ), as well as the improvement after patient education ( p = 0.012 ). Age, sex, education level, visual acuity, Barthel index, MoCA, and ADL score were not correlated with eye drop instillation technique, before nor after patient education. Discussion . In patients with poor functional status as reflected by FRAIL score, eye drop application is prone to be ineffective. Education with step-by-step instructions could effectively improve the success of eye drop application.
Low Ambient Temperature and Intracerebral Hemorrhage: The INTERACT2 Study
Publisher: Public Library of Science (PLoS)
Date: 09-02-2016
Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-12-2015
The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised contr
Publisher: Elsevier BV
Date: 06-2012
Factors Associated With the Trend of Physical and Chemical Restraint Use Among Long-Term Care Facility Residents in Hong Kong: Data From an 11-Year Observational Study
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.JAMDA.2017.06.018
Abstract: Negative effects of restraint use have been well-documented. However, the prevalence of restraints use has been high in long-term care facilities in Hong Kong compared with other countries and this goes against the basic principles of ethical and compassionate care for older people. The present study aimed to review the change in the prevalence of physical and chemical restraint use in long-term care facilities (LTCFs) over a period of 11 years in Hong Kong and to identify the major factors associated with their use. This is an observational study with data obtained from the Hong Kong Longitudinal Study on LTCF Residents between 2005 and 2015. Trained assessors (nurses, social workers, and therapists) used the Minimum Data Set Resident Assessment Instrument to collect the data from 10 residential LTCFs. Physical restraint was defined as the use of any of the following: full bedside rails on all open sides of bed, other types of bedside rails used, trunk restraint, limb restraint, or the use of chair to prevent rising during the past 7 days. Chemical restraint was defined as the use of any of the following medications: antipsychotic, antianxiety, or hypnotic agents during past 7 days, excluding elder residents with a diagnosis of psychiatric illness. Annual prevalence of restraint use over 11 years and factors that were associated with the use of physical and chemical restraints. We analyzed the data for 2896 older people (978 male in iduals, mean age = 83.3 years). Between 2005 and 2015, the prevalence of restraint use was as follows: physical restraint use increased from 52.7% to 70.2% chemical restraint use increased from 15.9% to 21.78% and either physical or chemical restraint use increased from 57.9% to 75.7%. Physical restraint use was independently associated with older age, impaired activities of daily living or cognitive function, bowel and bladder incontinence, dementia, and negative mood. Chemical restraint use was independently associated with older age, falls, bladder incontinence, use of feeding tube, dementia, poor cognitive function, delirium, behavioral problems, and negative mood. The increasing time-trend of physical but not chemical restraint use remained significant after adjusting for other factors as mentioned above (coefficient = 0.092, P < .001). Use of physical and chemical restraint was highly prevalent among LTCF residents in Hong Kong, with an increasing trend over a period of 11 years, especially targeting the most physically and cognitively frail older people. Appropriate healthcare staff education and policy change are urgently needed to ensure personal care that is characterized by respect, dignity, empathy, and compassion for the older generation.
Level of Amyloid-β (Aβ) Binding Leading to Differential Effects on Resting State Functional Connectivity in Major Brain Networks
Publisher: MDPI AG
Date: 19-09-2022
DOI: 10.3390/BIOMEDICINES10092321
Abstract: Introduction: Amyloid-β protein (Aβ) is one of the biomarkers for Alzheimer’s disease (AD). The recent application of interhemispheric functional connectivity (IFC) in resting-state fMRI has been used as a non-invasive diagnostic tool for early dementia. In this study, we focused on the level of Aβ accumulated and its effects on the major functional networks, including default mode network (DMN), central executive network (CEN), salience network (SN), self-referential network (SRN) and sensory motor network (SMN). Methods: 58 participants (27 Hi Aβ (HiAmy) and 31 low Aβ (LowAmy)) and 25 healthy controls (HC) were recruited. [18F]flutemetamol PET/CT was performed for diseased groups, and MRI scanning was done for all participants. Voxel-by-voxel correlation analysis was done for both groups in all networks. Results: In HiAmy, IFC was reduced in all networks except SN. A negative correlation in DMN, CEN, SRN and SMN suggests high Aβ related to IFC reduction However, a positive correlation in SN suggests high Aβ related to an increase in IFC. In LowAmy, IFC increased in CEN, SMN, SN and SRN. Positive correlation in all major brain networks. Conclusion: The level of Aβ accumulated demonstrated differential effects on IFC in various brain networks. As the treatment to reduce Aβ plaque deposition is available in the market, it may be an option for the HiAmy group to improve their IFC in major brain networks.
Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
Publisher: Elsevier BV
Date: 07-2019
Distinguishing Between Stroke and Mimic at the Bedside
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2006
DOI: 10.1161/01.STR.0000204041.13466.4C
Abstract: Background and Purpose— The bedside clinical assessment of the patient with suspected stroke has not been well studied. Improving clinical skills may accelerate patient progress through the emergency department. We aimed to determine the frequency and nature of stroke mimics and to identify the key clinical features that distinguish between stroke and mimic at the bedside. Methods— Consecutive presentations to an urban teaching hospital with suspected stroke were recruited. A standard bedside clinical assessment was performed. The final diagnosis was determined by an expert panel, which had access to clinical features, brain imaging, and other tests. Univariate and multivariate analyses determined the bedside features that distinguished stroke from mimic. Results— There were 350 presentations by 336 patients. The final diagnosis was stroke in 241 of 350 (69%) and mimic in 109 (31%). The mimics included 44 events labeled “possible stroke or TIA.” Eight items independently predicted the diagnosis in patients presenting with brain attack: cognitive impairment and abnormal signs in other systems suggested a mimic, an exact time of onset, definite focal symptoms, abnormal vascular findings, presence of neurological signs, being able to lateralize the signs to the left or right side of the brain, and being able to determine a clinical stroke subclassification suggested a stroke. Conclusions— The bedside clinical assessment can be streamlined substantially. This has important implications for teaching less experienced clinicians how to assess the patient with suspected stroke.
Effect of addition of titanium dioxide nanoparticles on the antimicrobial properties, surface roughness and surface hardness of polymethyl methacrylate: A Systematic Review [version 1; peer review: 2 approved, 1 approved with reservations]
Publisher: F1000 Research Ltd
Date: 31-05-2023
DOI: 10.12688/F1000RESEARCH.130028.1
Abstract: Background: Polymethyl Methacrylate (PMMA) denture-base resins have poor surface properties that facilitates microbial adhesion causing denture stomatitis. This systematic review aims to evaluate the effect of different sizes and percentages of titanium dioxide nanoparticles (TiO2NP) on the antimicrobial property, surface roughness and surface hardness of PMMA denture base resin. Methods: A systematic search of English peer-reviewed articles, clinical trial registries, grey literature databases and other online sources was performed using the PRISMA-S Guidelines for In-Vivo and In-Vitro studies. Qualitative data synthesis was performed to analyse s le dimensions, acrylic used, treatments of nanoparticles, methods used for testing and effect of size and percentage of nanoparticle. Risk of bias assessment was done using modified Cochrane risk of bias tool. Results: Out of 1376 articles, 15 were included. TiO 2 NP of size less than 30 nm was most frequently used. Both antimicrobial property and surface hardness improved irrespective of the size of the added TiO 2 NP. Three studies reported increase in the surface roughness with less than 50 nm TiO 2 NP. 3% TiO 2 NP was most frequently used. On increasing the percentage, three studies reported an increase in antimicrobial property, while two studies found no change. With TiO 2 NP greater than or equal to 3%, six studies reported an increase in surface hardness, while two reported increase in surface roughness. Large methodological variations were observed across studies. All studies except one were of moderate quality. Conclusions: On addition of TiO 2 NP to heat polymerized PMMA, the antimicrobial property and surface hardness improved irrespective of the size of the TiO 2 NP, however, addition of nanoparticles less than 50 nm increased the surface roughness. Increasing the percentage of TiO 2 NP increased the surface hardness but did not always increase the antimicrobial property. Addition of 3% TiO 2 NP provided optimum results with regards to antimicrobial effect and surface hardness, but increase in the surface roughness.
AVERT2 (a very early rehabilitation trial, a very effective reproductive trigger): retrospective observational analysis of the number of babies born to trial staff
Publisher: BMJ
Date: 11-12-2015
DOI: 10.1136/BMJ.H6432
Abstract: To report the number of participants needed to recruit per baby born to trial staff during AVERT, a large international trial on acute stroke, and to describe trial management consequences. Retrospective observational analysis. 56 acute stroke hospitals in eight countries. 1074 trial physiotherapists, nurses, and other clinicians. Number of babies born during trial recruitment per trial participant recruited. With 198 site recruitment years and 2104 patients recruited during AVERT, 120 babies were born to trial staff. Births led to an estimated 10% loss in time to achieve recruitment. Parental leave was linked to six trial site closures. The number of participants needed to recruit per baby born was 17.5 (95% confidence interval 14.7 to 21.0) additional trial costs associated with each birth were estimated at 5736 Australian dollars on average. The staff absences registered in AVERT owing to parental leave led to delayed trial recruitment and increased costs, and should be considered by trial investigators when planning research and estimating budgets. However, the celebration of new life became a highlight of the annual AVERT collaborators' meetings and helped maintain a cohesive collaborative group. Australian New Zealand Clinical Trials Registry no 12606000185561. Participation in a rehabilitation trial does not guarantee successful reproductive activity.
Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial
Publisher: Elsevier BV
Date: 07-2015
Global Impact of COVID-19 on Stroke Care and IV Thrombolysis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-03-2021
DOI: 10.1212/WNL.0000000000011885
Abstract: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] −11.7 to −11.3, p 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI −13.8 to −12.7, p 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI −13.7 to −10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2–9.8, p 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.
Cost-Effectiveness of Thrombolysis With Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke Assessed by a Model Based on UK NHS Costs
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2004
DOI: 10.1161/01.STR.0000126871.98801.6E
Abstract: Background and Purpose— Thrombolytic therapy is licensed for use in highly selected patients with acute ischemic stroke. We aimed to model the health economic impact of limited use of thrombolytic therapy and to assess whether it was likely to be cost-effective when used more widely in the UK National Health Service (NHS). Methods— The authors formed a discussion panel to develop the decision-analysis model of acute stroke care. It consisted of Markov state-transition processes, with probabilities of different health states determined by certain key variables. The range of estimates of efficacy of recombinant tissue plasminogen activator (rt-PA) was taken from an update to a Cochrane systematic review of randomized trials of thrombolysis. Data on outcome after stroke were taken from our hospital-based stroke register, supplemented by data derived from relevant literature sources. Results— The model suggested that compared with standard care, if eligible patients were treated with rt-PA up to 6 hours, there was a 78% probability of a gain in quality-adjusted survival during the first year, at a cost of £13 581 per quality-adjusted life-year (QALY) gained. Over a lifetime, rt-PA was associated with cost-savings of £96 565 per QALY. However, the estimates were imprecise and highly susceptible to the assumptions used in the economic model under several plausible assumptions, rt-PA was much less cost-effective than standard care, and under others, a great deal more cost-effective. Conclusions— The estimates of effectiveness and cost-effectiveness were imprecise. Although the benefits appeared promising, the data did not support the widespread use of thrombolytic therapy outside the terms of the current restricted license in routine clinical practice in the NHS. There is a case for new large-scale randomized trials comparing thrombolytic therapy with control up to 6 hours to determine more precisely the effects of rt-PA on short-term and long-term survival and its cost-effectiveness when used in a wider range of patients.
Interobserver Agreement for the Bedside Clinical Assessment of Suspected Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2006
DOI: 10.1161/01.STR.0000204042.41695.A1
Abstract: Background and Purpose— Stroke remains primarily a clinical diagnosis, with information obtained from history and examination determining further management. We aimed to measure inter-rater reliability for the clinical assessment of stroke, with emphasis on items of history, timing of symptom onset, and diagnosis of stroke or mimic. We explored reasons for poor reliability. Methods— The study was based in an urban hospital with an acute stroke unit. Pairs of observers independently assessed suspected stroke patients. Findings from history, neurological examination, and the diagnosis of stroke or mimic, were recorded on a standard form. Reliability was measured by the κ statistic. We assessed the impact of observer experience and confidence, time of assessment, and patient-related factors of age, confusion, and aphasia on inter-rater reliability. Results— Ninety-eight patients were recruited. Most items of the history and the diagnosis of stroke were found to have moderate to good inter-rater reliability. There was agreement for the hour and minute of symptom onset in only 45% of cases. Observer experience and confidence improved reliability patient-related factors of confusion and aphasia made the assessment more difficult. There was a trend for worse inter-rater reliability among patients assessed very early and very late after symptom onset. Conclusions— Clinicians should be aware that inter-rater reliability of the clinical assessment is affected by a variety of factors and is improved by experience and confidence. Our findings have implications for training of doctors who assess patients with suspected stroke and identifies the more reliable components of the clinical assessment.
Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-10-2022
DOI: 10.1212/WNL.0000000000201426
Abstract: Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1–6.9] p 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1–4.6] p 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4–5.8] p 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6–0.9] p = 0.49). Stroke was diagnosed in 1.3% [1.31–1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82–2.97], 5,656/195,539) of all stroke hospitalizations. There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. This study is registered under NCT04934020 .
Perceptions of Dental Undergraduates Towards Online Education During COVID-19: Assessment from India, Nepal and Sri Lanka
Publisher: Informa UK Limited
Date: 10-2021
DOI: 10.2147/AMEP.S328097
Outcome After Conservative Management or Intervention for Unruptured Brain Arteriovenous Malformations
Publisher: American Medical Association (AMA)
Date: 23-04-2014
Abstract: Whether conservative management is superior to interventional treatment for unruptured brain arteriovenous malformations (bAVMs) is uncertain because of the shortage of long-term comparative data. To compare the long-term outcomes of conservative management vs intervention for unruptured bAVM. Population-based inception cohort study of 204 residents of Scotland aged 16 years or older who were first diagnosed as having an unruptured bAVM during 1999-2003 or 2006-2010 and followed up prospectively for 12 years. Conservative management (no intervention) vs intervention (any endovascular embolization, neurosurgical excision, or stereotactic radiosurgery alone or in combination). Cox regression analyses, with multivariable adjustment for prognostic factors and baseline imbalances if hazards were proportional, to compare rates of the primary outcome (death or sustained morbidity of any cause by Oxford Handicap Scale [OHS] score ≥2 for ≥2 successive years [0 = no symptoms and 6 = death]) and the secondary outcome (nonfatal symptomatic stroke or death due to bAVM, associated arterial aneurysm, or intervention). Of 204 patients, 103 underwent intervention. Those who underwent intervention were younger, more likely to have presented with seizure, and less likely to have large bAVMs than patients managed conservatively. During a median follow-up of 6.9 years (94% completeness), the rate of progression to the primary outcome was lower with conservative management during the first 4 years of follow-up (36 vs 39 events 9.5 vs 9.8 per 100 person-years adjusted hazard ratio, 0.59 95% CI, 0.35-0.99), but rates were similar thereafter. The rate of the secondary outcome was lower with conservative management during 12 years of follow-up (14 vs 38 events 1.6 vs 3.3 per 100 person-years adjusted hazard ratio, 0.37 95% CI, 0.19-0.72). Among patients aged 16 years or older diagnosed as having unruptured bAVM, use of conservative management compared with intervention was associated with better clinical outcomes for up to 12 years. Longer follow-up is required to understand whether this association persists.
Related Organisations
Imperial College London
Location: United Kingdom of Great Britain and Northern Ireland
Hospital Of St John & St Elizabeth
Location: United Kingdom of Great Britain and Northern Ireland
The University Of Edinburgh
Location: United Kingdom of Great Britain and Northern Ireland
Royal College Of Physicians Of Edinburgh
Location: United Kingdom of Great Britain and Northern Ireland
Royal College Of Physicians
Location: United Kingdom of Great Britain and Northern Ireland
Organisation
Location: United Kingdom of Great Britain and Northern Ireland
Imperial College Healthcare NHS Trust
Location: United Kingdom of Great Britain and Northern Ireland
Cleveland Clinic London
Location: United Kingdom of Great Britain and Northern Ireland
Bournemouth University School Of Health And Social Care
Location: United Kingdom of Great Britain and Northern Ireland
University Of Bristol
Location: United Kingdom of Great Britain and Northern Ireland
University Of Southampton
Location: United Kingdom of Great Britain and Northern Ireland
Related Funding Activities
No related grants have been discovered for Joseph Kwan.