ORCID Profile
0000-0002-2493-628X
Current Organisations
London Business School
,
Fondazione IRCCS Istituto Neurologico Carlo Besta
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Publisher: Springer Science and Business Media LLC
Date: 24-02-2018
DOI: 10.1007/S00415-018-8798-7
Abstract: We investigated whether university education is more likely in cervical artery dissection (CeAD)-patients than in age- and sex-matched patients with ischemic stroke (IS) due to other causes (non-CeAD-IS-patients). Patients from the Cervical Artery Dissection and Ischemic Stroke Patients study with documented self-reported profession before onset of IS due to CeAD (n = 715) or non-CeAD causes (n = 631) were analyzed. In the reported profession, the absence or presence of university education was assessed. Professions could be rated as academic or non-academic in 518 CeAD and 456 non-CeAD patients. Clinical outcome at 3 months was defined as excellent if modified Rankin Scale was 0-1. University education was more frequent in CeAD-patients (100 of 518, 19.3%) than in non-CeAD-IS-patients (61 of 456, 13.4%, p = 0.008). CeAD-patients with and without university education differed significantly with regard to smoking (39 vs. 57%, p = 0.001) and excellent outcome (80 vs. 66%, p = 0.004). In logistic regression analysis, university education was associated with excellent outcome in CeAD-patients (OR 2.44, 95% CI 1.37-5.38) independent of other outcome predictors such as age (OR 0.97, 95% CI 0.84-0.99), NIHSS (OR 0.80, 95% CI 0.76-0.84) and local signs (OR 2.77, 95% CI 1.37-5.57). We observed a higher rate of university education in patients with CeAD compared with non-CeAD patients in our study population. University education was associated with favorable outcome in CeAD-patients. The mechanism behind this association remains unclear.
Publisher: Springer Science and Business Media LLC
Date: 11-09-2014
DOI: 10.1007/S00415-014-7478-5
Abstract: Differential diagnosis between Vegetative State and Minimally Conscious State is a challenging task that requires specific assessment scales, involvement of expert neuropsychologists or physicians and use of tailored stimuli for eliciting behavioural responses. Although misdiagnosis rate as high as 40% has been reported, no clear guidelines are available in literature on the optimal setting for assessment. The present study aims to analyse score differences in behavioural assessments of persons with disorders of consciousness (DOC) with or without family members and to determine whether the presence of caregivers could improve clinical accuracy in diagnostic evaluation. The research was conducted on 92 adults with DOC among 153 consecutive patients enrolled in the Coma Research Centre of the Neurological Institute C. Besta of Milan between January 2011 and May 2013. The results indicate that in almost half of the s le the scoring, thus the performance, observed with caregivers was better than without them. Furthermore, in 16% of the s le, when assessment was performed with caregivers there was a change in diagnosis, from Vegetative to Minimally Conscious State or from that to Severe Disability. Finally, statistical differences were found in relation to diagnosis between mean scores in the "visual function" Coma Recovery Scale revised's subscale obtained by raters plus caregiver and rates only assessment. This study demonstrates how the presence of caregivers can positively affect behavioural assessments of persons with DOC, thus contributing to the definition of the optimal setting for behavioural evaluation of patients, to decrease misdiagnosis rates.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2019
DOI: 10.1161/STROKEAHA.118.021856
Abstract: We sought to explore the effect of genetic imbalance on functional outcome after ischemic stroke (IS). Copy number variation was identified in high-density single-nucleotide polymorphism microarray data of IS patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) and SiGN (Stroke Genetics Network)/GISCOME (Genetics of Ischaemic Stroke Functional Outcome) networks. Genetic imbalance, defined as total number of protein-coding genes affected by copy number variations in an in idual, was compared between patients with favorable (modified Rankin Scale score of 0–2) and unfavorable (modified Rankin Scale score of ≥3) outcome after 3 months. Subgroup analyses were confined to patients with imbalance affecting ohnologs—a class of dose-sensitive genes, or to those with imbalance not affecting ohnologs. The association of imbalance with outcome was analyzed by logistic regression analysis, adjusted for age, sex, stroke subtype, stroke severity, and ancestry. The study s le comprised 816 CADISP patients (age 44.2±10.3 years) and 2498 SiGN/GISCOME patients (age 67.7±14.2 years). Outcome was unfavorable in 122 CADISP and 889 SiGN/GISCOME patients. Multivariate logistic regression analysis revealed that increased genetic imbalance was associated with less favorable outcome in both s les (CADISP: P =0.0007 odds ratio=0.89 95% CI, 0.82–0.95 and SiGN/GISCOME: P =0.0036 odds ratio=0.94 95% CI, 0.91–0.98). The association was independent of age, sex, stroke severity on admission, stroke subtype, and ancestry. On subgroup analysis, imbalance affecting ohnologs was associated with outcome (CADISP: odds ratio=0.88 95% CI, 0.80–0.95 and SiGN/GISCOME: odds ratio=0.93 95% CI, 0.89–0.98) whereas imbalance without ohnologs lacked such an association. Increased genetic imbalance was associated with poorer functional outcome after IS in both study populations. Subgroup analysis revealed that this association was driven by presence of ohnologs in the respective copy number variations, suggesting a causal role of the deleterious effects of genetic imbalance.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-03-2017
DOI: 10.1212/WNL.0000000000003788
Abstract: In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged vs ≥60 years. We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients–Plus consortium). We dichotomized cases into 2 groups, age ≥60 and years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled in idual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated. Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (OR adjusted 0.47 [0.33–0.66]), headache (OR adjusted 0.58 [0.42–0.79]), mechanical trigger events (OR adjusted 0.53 [0.36–0.77]), and migraine (OR adjusted 0.58 [0.39–0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (OR adjusted 1.52 [1.1–2.10]) and hypertension (OR adjusted 3.08 [2.25–4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0–2) was less frequent in the older age group (OR adjusted 0.45 [0.25, 0.83]). In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-11-2019
DOI: 10.1212/WNL.0000000000008654
Abstract: To assess the impact of dissected artery occlusion (DAO) on functional outcome and complications in patients with cervical artery dissection (CeAD). We analyzed combined in idual patient data from 3 multicenter cohorts of consecutive patients with CeAD (the Cervical Artery Dissection and Ischemic Stroke Patients [CADISP]–Plus consortium dataset). Patients with data on DAO and functional outcome were included. We compared patients with DAO to those without DAO. Primary outcome was favorable functional outcome (i.e., modified Rankin Scale [mRS] score 0–1) measured 3–6 months from baseline. Secondary outcomes included delayed cerebral ischemia, major hemorrhage, recurrent CeAD, and death. We performed univariate and multivariable binary logistic regression analyses and calculated odds ratios (OR) with 95% confidence intervals (CI), with adjustment for potential confounders. Of 2,148 patients (median age 45 years [interquartile range (IQR) 38–52], 43.6% women), 728 (33.9%) had DAO. Patients with DAO more frequently presented with cerebral ischemia (84.6% vs 58.5%, p 0.001). Patients with DAO were less likely to have favorable outcome when compared to patients without DAO (mRS 0–1: 59.6% vs 80.1%, p unadjusted 0.001). After adjustment for age, sex, and initial stroke severity, DAO was independently associated with less favorable outcome (mRS 0–1: OR 0.65, CI 0.50–0.84, p = 0.001). Delayed cerebral ischemia occurred more frequently in patients with DAO than in patients without DAO (4.5% vs 2.9%, p = 0.059). DAO independently predicts less favorable functional outcome in patients with CeAD. Further research on vessel patency, collateral status and effects of revascularization therapies particularly in patients with DAO is warranted.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-10-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
DOI: 10.1212/WNL.0000000000006037
Abstract: To assess putative risk factors and outcome of multiple and early recurrent cervical artery dissection (CeAD). We combined data from 2 multicenter cohorts and compared patients with multiple CeAD at initial diagnosis, early recurrent CeAD within 3 to 6 months, and single nonrecurrent CeAD. Putative risk factors, clinical characteristics, functional outcome, and risk of recurrent ischemic events were assessed. Of 1,958 patients with CeAD (mean ± SD age 44.3 ± 10 years, 43.9% women), 1,588 (81.1%) had single nonrecurrent CeAD, 340 (17.4%) had multiple CeAD, and 30 (1.5%) presented with single CeAD at admission and had early recurrent CeAD. Patients with multiple or early recurrent CeAD did not significantly differ with respect to putative risk factors, clinical presentation, and outcome. In multivariable analyses, patients with multiple or early recurrent CeAD more often had recent infection (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.29–2.53), vertebral artery dissection (OR 1.82, 95% CI 1.34–2.46), family history of stroke (OR 1.55, 95% CI 1.06–2.25), cervical pain (OR 1.36, 95% CI 1.01–1.84), and subarachnoid hemorrhage (OR 2.85, 95% CI 1.01–8.04) at initial presentation compared to patients with single nonrecurrent CeAD. Patients with multiple or early recurrent CeAD also had a higher incidence of cerebral ischemia (hazard ratio 2.77, 95% CI 1.49–5.14) at 3 to 6 months but no difference in functional outcome compared to patients with single nonrecurrent CeAD. Patients with multiple and early recurrent CeAD share similar risk factors, clinical characteristics, and functional outcome. Compared to patients with single nonrecurrent CeAD, they are more likely to have recurrent cerebral ischemia at 3 to 6 months, possibly reflecting an underlying transient vasculopathy.
Publisher: Emerald
Date: 04-04-2020
DOI: 10.1108/JSTP-04-2019-0088
Abstract: Robots are predicted to have a profound impact on the service sector. The emergence of robots has attracted increasing interest from business scholars and practitioners alike. In this article, we undertake a systematic review of the business literature about the impact of service robots on customers and employees with the objective of guiding future research. We analyzed the literature on service robots as they relate to customers and employees in business journals listed in the Financial Times top 50 journals plus all journals covered in the cross-disciplinary SERVSIG literature alerts. The analysis of the identified studies yielded multiple observations about the impact of service robots on customers (e.g. overarching frameworks on acceptance and usage of service robots characteristics of service robots and anthropomorphism and potential for enhanced and deteriorated service experiences) and service employees (e.g. employee benefits such as reduced routine work, enhanced productivity and job satisfaction potential negative consequences such as loss of autonomy and a range of negative psychological outcomes opportunities for human–robot collaboration job insecurity and robot-related up-skilling and development requirements). We also conclude that current research on service robots is fragmented, is largely conceptual in nature and focused on the initial adoption stage. We feel that more research is needed to build an overarching theory. In addition, more empirical research is needed, especially on the long(er)-term usage service robots on actual behaviors, the well-being and potential downsides and (ethical) risks for customers and service employees. Our review focused on the business and service literature. Future work may want to include additional literature streams, including those in computer science, engineering and information systems. This article is the first to synthesize the business and service literature on the impact of service robots on customers and employees.
Publisher: Emerald
Date: 14-09-2010
DOI: 10.1108/08876041011072537
Abstract: The purpose of this paper is to highlight important issues in the study of dysfunctional customer behavior and to provide a research agenda to inspire, guide, and enthuse. Through a critical evaluation of existing research, the aim is to highlight key issues and to present potentially worthy avenues for future study. In reviewing recent and past advances in the study of customers behaving badly, an overview of existing research into customers behaving badly and addressing issues of terminology and definition is provided. Thereafter, three perspectives that provide the most opportunity and insight in studying the darker side of service dynamics are outlined. This leads to a review of some of the research design and methodological problems and issues that are faced when rigorously studying these issues. Subsequently, the paper devotes a section to the provocative idea that while dysfunctional customer behavior has many negative influences on customers, employees, and service firms, there are actually some positive functions of customers behaving badly. A research agenda is provided that is believed to identify and discuss a range of projects that comprises not only insightful theoretical contributions but is also practically relevant. The paper identifies a range of issues about which managers should be aware and proactively manage.
Publisher: Emerald
Date: 26-09-2018
DOI: 10.1108/JOSM-04-2018-0119
Abstract: The service sector is at an inflection point with regard to productivity gains and service industrialization similar to the industrial revolution in manufacturing that started in the eighteenth century. Robotics in combination with rapidly improving technologies like artificial intelligence (AI), mobile, cloud, big data and biometrics will bring opportunities for a wide range of innovations that have the potential to dramatically change service industries. The purpose of this paper is to explore the potential role service robots will play in the future and to advance a research agenda for service researchers. This paper uses a conceptual approach that is rooted in the service, robotics and AI literature. The contribution of this paper is threefold. First, it provides a definition of service robots, describes their key attributes, contrasts their features and capabilities with those of frontline employees, and provides an understanding for which types of service tasks robots will dominate and where humans will dominate. Second, this paper examines consumer perceptions, beliefs and behaviors as related to service robots, and advances the service robot acceptance model. Third, it provides an overview of the ethical questions surrounding robot-delivered services at the in idual, market and societal level. This paper helps service organizations and their management, service robot innovators, programmers and developers, and policymakers better understand the implications of a ubiquitous deployment of service robots. This is the first conceptual paper that systematically examines key dimensions of robot-delivered frontline service and explores how these will differ in the future.
Publisher: Springer Science and Business Media LLC
Date: 24-11-2014
DOI: 10.1038/NG.3154
Publisher: Wiley
Date: 12-06-2013
DOI: 10.1111/ENE.12201
Abstract: It has been suggested that inflammation may play a role in the development of cervical artery dissection (CeAD), but evidence remains scarce. A total of 172 patients were included with acute (< 24 h) CeAD and 348 patients with acute ischaemic stroke (IS) of other (non-CeAD) causes from the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study, and 223 age- and sex-matched healthy control subjects. White blood cell (WBC) counts collected at admission were compared across the three groups. Compared with healthy control subjects, CeAD patients and non-CeAD stroke patients had higher WBC counts (P 10 000/μl than non-CeAD stroke patients (38.4% vs. 23.0%, P < 0.001) and healthy controls (38.4% vs. 8.5%, P < 0.001). WBC counts were higher in CeAD (9.4 ± 3.3) than in IS of other causes (large artery atherosclerosis, 8.7 ± 2.3 cardioembolism, 8.2 ± 2.8 small vessel disease, 8.4 ± 2.4 undetermined cause, 8.8 ± 3.1 P = 0.022). After adjustment for age, sex, stroke severity and vascular risk factors in a multiple regression model, elevated WBC count remained associated with CeAD, as compared with non-CeAD stroke patients [odds ratio (OR) = 2.56 95% CI 1.60-4.11 P < 0.001) and healthy controls (OR = 6.27 95% CI 3.39-11.61 P < 0.001). Acute CeAD was associated with particularly high WBC counts. Leukocytosis may reflect a pre-existing inflammatory state, supporting the link between inflammation and CeAD.
Publisher: S. Karger AG
Date: 2016
DOI: 10.1159/000442298
Abstract: b i Background: /i /b The pathogenesis of moyamoya disease (MMD) is still unknown. The detection of inflammatory molecules such as cytokines, chemokines and growth factors in MMD patients' biological fluids supports the hypothesis that an abnormal angiogenesis is implicated in MMD pathogenesis. However, it is unclear whether these anomalies are the consequences of the disease or rather causal factors as well as these mechanisms remain insufficient to explain the pathophysiology of MMD. The presence of a family history in about 9-15% of Asian patients, the highly variable incidence rate between different ethnic and sex groups and the age of onset support the role of genetic factors in MMD pathogenesis. However, although some genetic loci have been associated with MMD, few of them have been replicated in independent series. Recently, i RNF213 /i gene was shown to be strongly associated with MMD occurrence with a founder effect in East Asian patients. However, the mechanisms leading from i RNF213 /i mutations to MMD clinical features are still unknown. b i Summary: /i /b The research on pathogenic mechanism of MMD is in its infancy. MMD is probably a complex and heterogeneous disorder, including different phenotypes and genotypes, in which more than a single factor is implicated. b i Key Message: /i /b Since the diagnosis of MMD is rapidly increasing worldwide, the development of more efficient stratifying risk systems, including both clinical but also biological drivers became imperative to improve our ability of predict prognosis and to develop mechanism-tailored interventions.
Publisher: Wiley
Date: 24-02-2015
DOI: 10.1111/ENE.12687
Abstract: To investigate the association of anemia on admission with ischaemic stroke (IS), stroke severity and early functional outcome in patients with cervical artery dissection (CeAD) or with IS of other causes (non-CeAD-IS patients). The study s le comprised all patients from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) study without pre-existing disability and with documentation of stroke severity and hemoglobin (Hb) concentration on admission. Anemia was classified as mild (Hb < 12 g/dl in women and Hb < 13 g/dl in men) or moderate to severe (Hb < 10 g/dl in women and Hb < 11 g/dl in men). Stroke severity on admission was assessed with the National Institutes of Health Stroke Scale (NIHSS). Outcome after 3 months was assessed with the modified Rankin Scale (mRS-3mo). Unfavorable outcome was defined as mRS-3mo ≥ 3. Amongst 1206 study patients (691 CeAD and 515 non-CeAD), 87 (7.2%) had anemia, which was moderate to severe in 18 (1.5%) patients. Anemia was associated with female sex in both study s les, but no further associations with risk factors or comorbidities were observed. In CeAD patients, anemia was associated with occurrence of stroke (P = 0.042). In both study s les, anemic patients had more severe strokes (CeAD, P = 0.023 non-CeAD, P = 0.005). Functional outcome was not associated with anemia in general, but moderate to severe anemia was significantly associated with unfavorable outcome (P = 0.004). Anemia on admission was associated with stroke in CeAD patients and with more severe strokes in both study s les. Moderate to severe anemia may predict unfavorable outcome.
Publisher: Emerald
Date: 29-11-2019
DOI: 10.1108/JOSM-05-2019-0158
Abstract: Organizations (data gatherers in the context) drown in data while at the same time seeking managerially relevant insights. Academics (data hunters) have to deal with decreasing respondent participation and escalating costs of data collection while at the same time seeking to increase the managerial relevance of their research. The purpose of this paper is to provide a framework on how, managers and academics can collaborate better to leverage each other’s resources. This research synthesizes the academic and the managerial literature on the realities and priorities of practitioners and academics with regard to data. Based on the literature, reflections from the world’s leading service research centers, and the authors’ own experiences, the authors develop recommendations on how to collaborate in research. Four dimensions of different data realities and priorities were identified: research problem, research resources, research process and research outcome. In total, 26 recommendations are presented that aim to equip academics to leverage the potential of corporate data for research purposes and to help managers to leverage research results for their business. This paper argues that both practitioners and academics have a lot to gain from collaborating by exchanging corporate data for scientific approaches and insights. However, the gap between different realities and priorities needs to be bridged when doing so. The paper first identifies data realities and priorities and then develops recommendations on how to best collaborate given these differences. This research has the potential to contribute to managerial practice by informing academics on how to better collaborate with the managerial world and thereby facilitate collaboration and the dissemination of academic research for the benefit of both parties. Whereas the previous literature has primarily examined practitioner–academic collaboration in general, this study is the first to focus specifically on the aspects related to sharing corporate data and to elaborate on academic and corporate objectives with regard to data and insights.
Publisher: Wiley
Date: 10-07-2013
DOI: 10.1111/ENE.12228
Abstract: Risk factors for IS in young adults differ between genders and evolve with age, but data on the age- and gender-specific differences by stroke etiology are scare. These features were compared based on in idual patient data from 15 European stroke centers. Stroke etiology was reported in detail for 3331 patients aged 15-49 years with first-ever IS according to Trial of Org in Acute Stroke Treatment (TOAST) criteria: large-artery atherosclerosis (LAA), cardioembolism (CE), small-vessel occlusion (SVO), other determined etiology, or undetermined etiology. CE was categorized into low- and high-risk sources. Other determined group was ided into dissection and other non-dissection causes. Comparisons were done using logistic regression, adjusting for age, gender, and center heterogeneity. Etiology remained undetermined in 39.6%. Other determined etiology was found in 21.6%, CE in 17.3%, SVO in 12.2%, and LAA in 9.3%. Other determined etiology was more common in females and younger patients, with cervical artery dissection being the single most common etiology (12.8%). CE was more common in younger patients. Within CE, the most frequent high-risk sources were atrial fibrillation/flutter (15.1%) and cardiomyopathy (11.5%). LAA, high-risk sources of CE, and SVO were more common in males. LAA and SVO showed an increasing frequency with age. No significant etiologic distribution differences were found amongst southern, central, or northern Europe. The etiology of IS in young adults has clear gender-specific patterns that change with age. A notable portion of these patients remains without an evident stroke mechanism according to TOAST criteria.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2012
DOI: 10.1161/STROKEAHA.112.662866
Abstract: We compared among young patients with ischemic stroke the distribution of vascular risk factors among sex, age groups, and 3 distinct geographic regions in Europe. We included patients with first-ever ischemic stroke aged 15 to 49 years from existing hospital- or population-based prospective or consecutive young stroke registries involving 15 cities in 12 countries. Geographic regions were defined as northern (Finland, Norway), central (Austria, Belgium, France, Germany, Hungary, The Netherlands, Switzerland), and southern (Greece, Italy, Turkey) Europe. Hierarchical regression models were used for comparisons. In the study cohort (n=3944), the 3 most frequent risk factors were current smoking (48.7%), dyslipidemia (45.8%), and hypertension (35.9%). Compared with central (n=1868 median age, 43 years) and northern (n=1330 median age, 44 years) European patients, southern Europeans (n=746 median age, 41 years) were younger. No sex difference emerged between the regions, male:female ratio being 0.7 in those aged years and reaching 1.7 in those aged 45 to 49 years. After accounting for confounders, no risk-factor differences emerged at the region level. Compared with females, males were older and they more frequently had dyslipidemia or coronary heart disease, or were smokers, irrespective of region. In both sexes, prevalence of family history of stroke, dyslipidemia, smoking, hypertension, diabetes mellitus, coronary heart disease, peripheral arterial disease, and atrial fibrillation positively correlated with age across all regions. Primary preventive strategies for ischemic stroke in young adults—having high rate of modifiable risk factors—should be targeted according to sex and age at continental level.
Publisher: Springer Science and Business Media LLC
Date: 18-04-2012
DOI: 10.1007/S00415-012-6485-7
Abstract: The goal of this work was to explore age-dependent differences in cervical artery dissection (CeAD). This study is based on the Cervical Artery Dissection and Ischemic Stroke Patients population comprising 983 consecutive CeAD patients and 658 control patients with a non-CeAD ischemic stroke (IS), frequency-matched for age and gender. Patients were ided into three age categories: ≤33 (for CeAD, n = 150), 34-54 (n = 688), and ≥55 (n = 145) years, and the youngest and oldest groups were compared. The youngest patients were mostly women and the oldest men. The frequency of internal carotid artery dissection (ICAD) versus vertebral artery dissection (VAD) increased with age from 44 to 75 %. This age-related shift remained significant after adjustment for sex. The frequency of a transient ischemic event as the CeAD symptom declined from 33 % in the youngest age group, to 19 % in the oldest. Vascular risk factors increased in frequency with advancing age in both groups, but for hypertension the increase was steeper for non-CeAD IS patients. For CeAD patients, but not for patients with non-CeAD IS, preceding infection was more common in the oldest group. The youngest non-CeAD IS patients had better functional outcome (modified Rankin Scale 0-1) than the oldest, while the similar trend was not statistically significant among CeAD patients. Younger age seems to be associated with VAD and female gender, and older age with ICAD and male gender. Age-related changes in the frequencies of hypertension and recent infection were different between the CeAD and non-CeAD IS groups. Age does not seem to be an important outcome predictor in CeAD strokes.
Publisher: Informa UK Limited
Date: 28-02-2017
DOI: 10.1080/09602011.2017.1290532
Abstract: Pain assessment in patients with disorders of consciousness (DoC) is a controversial issue for clinicians, who require tools and standardised procedures for testing nociception in non-communicative patients. The aims of the present study were, first, to analyse the psychometric properties of the Italian version of the Nociception Coma Scale and, second, to evaluate pressure pain thresholds in a group of patients with DoC. The authors conducted a multi-centre study on 40 healthy participants and 60 DoC patients enrolled from six hospitals in Italy. For each group an electronic algometer was used to apply all nociceptive pressure stimuli. Our results show that the Italian version of the NCS retains the good psychometric properties of the original version and is therefore suitable for standardised pain assessment in clinical practice. In our study, pressure pain thresholds measured in a group of patients in vegetative and minimally conscious state were relatively lower than pain threshold values found in a group of healthy participants. Such findings motivate additional investigation on possible pain sensitisation in patients with severe brain injury and multiple co-morbidities, and on application of tailored therapeutic approaches useful for pain management in patients unable verbally to communicate their feelings.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
DOI: 10.1212/01.WNL.0000436611.28210.EC
Abstract: We focused on cerebral imaging findings in a large cohort of young patients with a symptomatic ischemic cerebrovascular event (CVE) to extract relevant pathophysiologic and clinical information. We analyzed the scans of 2,979 patients (aged 18-55 years) enrolled in the sifap1 project with clinical evidence of ischemic stroke (IS) or clinically defined TIA in whom MRI, including diffusion-weighted imaging, was obtained within 10 days of the CVE. Age groups were categorized as 18-34, 35-44, and 45-55 years. We compared age- and sex-specific proportions of infarct features, white matter hyperintensities, and old microbleeds. Acute infarcts were identified in 1,914 of 2,264 patients (84.5%) with IS and 101 of 715 patients (14.1%) with TIA. Among patients with IS, younger age was significantly associated with acute infarcts in the posterior circulation, while anterior circulation infarcts and acute lacunar infarcts were more frequent in older age groups. One or more old infarcts were present in 26.8% of IS and 17.1% of TIA patients. This rate remained high even after excluding patients with a prior CVE (IS, 21.7% TIA, 9.9%). The prevailing type of old infarction was territorial in patients younger than 45 years and lacunar in those aged 45 years or older. The frequency of white matter hyperintensities (46.4%) and their severity was positively associated with age. Old microbleeds were infrequent (7.2%). Young adults show a high frequency of preexisting and clinically silent infarcts and a relative preference for acute ischemia in the posterior circulation. Findings suggesting small-vessel disease become apparent at age 45 years and older.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Wiley
Date: 27-04-2016
DOI: 10.1111/ENE.13031
Abstract: Our aim was to investigate whether pulsatile tinnitus (PT) in cervical artery dissection (CeAD) has prognostic significance. All CeAD patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) study with documentation of PT were analysed. The presence of PT was systematically assessed using a standardized questionnaire. Stroke severity at admission was defined according to the National Institutes of Health Stroke Scale (NIHSS). Excellent outcome after 3 months was defined as a modified Rankin Scale of 0-1. Sixty-three of 778 patients (8.1%) reported PT. PT+ patients presented less often with ischaemic stroke (41.3% vs. 63.9%, P < 0.001), more often with dissection in the internal carotid artery (85.7% vs. 64.2%, P = 0.001), less often with vessel occlusion (19.0% vs. 34.1%, P = 0.017) and more often with excellent outcome at 3 months (92.1% vs. 75.4%, P = 0.002). Logistic regression analysis identified PT as an independent predictor of excellent outcome after 3 months [odds ratio (OR) 3.96, 95% confidence interval (CI) 1.22-12.87] adjusted to significant outcome predictors NIHSS on admission (OR 0.82, 95% CI 0.79-0.86), Horner syndrome (OR 1.95, 95% CI 1.16-3.29) and vessel occlusion (OR 0.62, 95% CI 0.40-0.94) and to non-significant predictors age, sex, pain and location of CeAD. The presence of PT in CeAD is associated with a benign clinical course and predicts a favourable outcome.
Publisher: American Medical Association (AMA)
Date: 04-2019
Publisher: Elsevier BV
Date: 06-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-04-2014
Publisher: Bentham Science Publishers Ltd.
Date: 30-01-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-04-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
DOI: 10.1161/STROKEAHA.114.008548
Abstract: Fabry disease (FD) may cause stroke and is reportedly associated with typical brain findings on magnetic resonance imaging (MRI). In a large group of young patients with an acute cerebrovascular event, we wanted to test whether brain MRI findings can serve to suggest the presence of FD. The Stroke in Young Fabry Patients (SIFAP 1) study prospectively collected clinical, laboratory, and radiological data of 5023 patients (18–55 years) with an acute cerebrovascular event. Their MRI was interpreted centrally and blinded to all other information. Biochemical findings and genetic testing served to diagnose FD in 45 (0.9%) patients. We compared the imaging findings between FD and non-FD patients in patients with at least a T2-weighted MRI of good quality. A total of 3203 (63.8%) patients had the required MRI data set. Among those were 34 patients with a diagnosis of FD (1.1%), which was definite in 21 and probable in 13 cases. The median age of patients with FD was slightly lower (45 versus 46 years) and women prevailed (70.6% versus 40.7% P .001). Presence or extent of white matter hyperintensities, infarct localization, vertebrobasilar artery dilatation, T1-signal hyperintensity of the pulvinar thalami, or any other MRI finding did not distinguish patients with FD from non-FD cerebrovascular event patients. Pulvinar hyperintensity was not present in a single patient with FD but seen in 6 non-FD patients. Brain MRI findings cannot serve to suspect FD in young patients presenting with an acute cerebrovascular event. This deserves consideration in the search for possible causes of young patients with stroke. URL: www.clinicaltrials.gov . Unique identifier: NCT00414583.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-04-2011
DOI: 10.1161/CIRCULATIONAHA.110.000125
Abstract: Little is known about the risk factors for cervical artery dissection (CEAD), a major cause of ischemic stroke (IS) in young adults. Hypertension, diabetes mellitus, smoking, hypercholesterolemia, and obesity are important risk factors for IS. However, their specific role in CEAD is poorly investigated. Our aim was to compare the prevalence of vascular risk factors in CEAD patients versus referents and patients who suffered an IS of a cause other than CEAD (non-CEAD IS) in the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study. The study s le comprised 690 CEAD patients (mean age, 44.2±9.9 years 43.9% women), 556 patients with a non-CEAD IS (44.7±10.5 years 39.9% women), and 1170 referents (45.9±8.1 years 44.1% women). We compared the prevalence of hypertension, diabetes mellitus, hypercholesterolemia, smoking, and obesity (body mass index ≥30 kg/m 2 ) or overweightness (body mass index ≥25 kg/m 2 and kg/m 2 ) between the 3 groups using a multinomial logistic regression adjusted for country of inclusion, age, and gender. Compared with referents, CEAD patients had a lower prevalence of hypercholesterolemia (odds ratio 0.55 95% confidence interval, 0.42 to 0.71 P .0001), obesity (odds ratio 0.37 95% confidence interval, 0.26 to 0.52 P .0001), and overweightness (odds ratio 0.70 95% confidence interval, 0.57 to 0.88 P =0.002) but were more frequently hypertensive (odds ratio 1.67 95% confidence interval, 1.32 to 2.1 P .0001). All vascular risk factors were less frequent in CEAD patients compared with young patients with a non-CEAD IS. The latter were more frequently hypertensive, diabetic, and current smokers compared with referents. These results, from the largest series to date, suggest that hypertension, although less prevalent than in patients with a non-CEAD IS, could be a risk factor of CEAD, whereas hypercholesterolemia, obesity, and overweightness are inversely associated with CEAD.
Publisher: Emerald
Date: 03-10-2017
DOI: 10.1108/JOSM-02-2017-0055
Abstract: The purpose of this paper is to accelerate research related to the employee-facets of service management by summarizing current developments in multiple research streams, providing propositions, and articulating new directions for theory and empirical inquiry. Seven scholars provide short reviews of the core topics and findings from four employee-related research streams – collective turnover, service climate, emotional labor, and occupational stress and generate propositions to guide future theoretical and empirical work. Four distinguished service scholars – David Bowen, Ray Fisk, Christian Grönroos, and Jochen Wirtz comment upon these research streams and provide future directions for accelerating employee-related research in service management. All four research-streams yield insights that have the potential to advance service management research. Commentaries from the distinguished scholars further integrate this work with key concerns within service management including technology-enablement, transformative services, and service strategy. This paper is unique in its scope of coverage of management topics related to service and its aim to promote interdisciplinary dialog between service management scholars and researchers conducting employee-related research relevant to services.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Wiley
Date: 02-04-2014
DOI: 10.1111/ENE.12437
Abstract: Patients with ischaemic stroke (IS) caused by a spontaneous cervical artery dissection (CeAD) worry about an increased risk for stroke in their families. The occurrence of stroke in relatives of patients with CeAD and in those with ischaemic stroke attributable to other (non-CeAD) causes were compared. The frequency of stroke in first-degree relatives (family history of stroke, FHS) was studied in IS patients (CeAD patients and age- and sex-matched non-CeAD patients) from the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) database. FHS ≤ 50 and FHS > 50 were defined as having relatives who suffered stroke at the age of ≤50 or >50 years. FHS ≤ 50 and FHS > 50 were studied in CeAD and non-CeAD IS patients and related to age, sex, number of siblings, hypertension, hypercholesterolemia, smoking and body mass index (BMI). In all, 1225 patients were analyzed. FHS ≤ 50 was less frequent in CeAD patients (15/598 = 2.5%) than in non-CeAD IS patients (38/627 = 6.1%) (P = 0.003 odds ratio 0.40, 95% confidence interval 0.22-0.73), also after adjustment for age, sex and number of siblings (P = 0.005 odds ratio 0.42, 95% confidence interval 0.23-0.77). The frequency of FHS > 50 was similar in both study groups. Vascular risk factors did not differ between patients with positive or negative FHS ≤ 50. However, patients with FHS > 50 were more likely to have hypertension and higher BMI. Relatives of CeAD patients had fewer strokes at a young age than relatives of non-CeAD IS stroke patients.
Location: United Kingdom of Great Britain and Northern Ireland
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