ORCID Profile
0000-0003-1211-9087
Current Organisations
University of Central Lancashire
,
University of New South Wales
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Health Economics | Applied Economics | Neurology And Neuromuscular Diseases | Public Health And Health Services Not Elsewhere Classified
ANZSRC Socio-Economic Objective (SEO)
Health and support services not elsewhere classified | Nervous system and disorders | Work not elsewhere classified |
Related Links
Publications
Selective Serotonin Reuptake Inhibitors for Stroke Recovery
Publisher: American Medical Association (AMA)
Date: 11-09-2013
Abstract: Are selective serotonin reuptake inhibitors (SSRIs) associated with better recovery after stroke? SSRIs may be associated with improved recovery after stroke, even in persons without depression. However, much of the evidence is of poor quality. Large, high-quality trials are needed to evaluate the validity of the current evidence and improve precision of estimates of any treatment benefits.
Low blood pressure and adverse outcomes in acute stroke: HeadPoST study explanations.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-09-2021
Facilitators and barriers to participation in mental well-being programs by older Australians with vision impairment: community and stakeholder perspectives
Publisher: Springer Science and Business Media LLC
Date: 28-05-2020
Pharmaceutical Interventions for Emotionalism After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2010
Health-Related Quality of Life Among Long-Term Survivors of Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2000
Abstract: Background and Purpose —The consequences of stroke are a major health concern. This study was conducted to compare the health-related quality of life among long-term survivors of stroke with that of the general population. Methods —Our data are taken from a population-based case-control study of all 6-year survivors of stroke with an age- and sex-matched control population. SF-36 mean scores for cases were compared with raw and standardized control and New Zealand norm mean scores. Results —Of the original 1761 registered cases, 639 were still alive at 6-year follow-up, and all of these participated in the study. Case patients were more likely than control subjects to be dependent in all basic activities of daily living. Crude mean scores were lower for women as age increased for those living in institutions when the SF-36 was completed by proxy and when help was required with the activities of daily living. Cases had statistically lower mean scores than both the control group and New Zealand norms for physical functioning and general health. After standardization for age and sex, no differences were found between cases and controls in mental health and bodily pain. Conclusions —Health-related quality of life appears to be relatively good for the majority of patients 6 years after stroke. Despite significant ongoing physical disability, survivors of stroke appear to adjust well psychologically to their illness.
Depression screening in stroke: A comparison of alternative measures with the structured diagnostic interview for the diagnostic and statistical manual of mental disorders, fourth edition (major depressive episode) as criterion standard
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2012
DOI: 10.1161/STROKEAHA.111.643296
Abstract: Screening tools for depression and psychological distress commonly used in medical settings have not been well validated in stroke populations. We aimed to determine the accuracy of common screening tools for depression or distress in detecting caseness for a major depressive episode compared with a clinician-administered structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition as the gold standard. Seventy-two participants ≥3 weeks poststroke underwent a diagnostic interview for major depressive episode and completed the Patient Health Questionnaire-2 and -9, Hospital Anxiety and Depression Scale, Beck Depression Inventory-II, Distress Thermometer, and Kessler-10. Internal consistency, sensitivity, specificity, likelihood ratios, and posttest probabilities were calculated. Each measure was validated against the gold standard using receiver operating characteristic curves with comparison of the area under the curve for all measures. Internal consistency ranged from acceptable to excellent for all measures (Cronbach α=0.78–0.94). Areas under the curve (95% CI) for the Patient Health Questionnaire-2, Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale depression and total score, Beck Depression Inventory-II, and Kessler-10 ranged from 0.80 (0.69–0.89) for the Kessler-10 to 0.89 (0.79–0.95) for the Beck Depression Inventory-II with no significant differences between measures. The Distress Thermometer had an area under the curve (95% CI) of 0.73 (0.61–0.83), significantly smaller than the Beck Depression Inventory-II ( P .05). Apart from the Distress Thermometer, selected scales performed adequately in a stroke population with no significant difference between measures. The Patient Health Questionnaire-2 would be the most useful single screen given free availability and the shortest number of items.
How Are Household Economic Circumstances Affected After a Stroke? The Psychosocial Outcomes In StrokE (POISE) Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2012
DOI: 10.1161/STROKEAHA.112.666453
Abstract: Stroke is associated with severe economic consequences. This is the first study to investigate in younger survivors the household economic burden of stroke. A multicenter, 3-year prospective cohort study was conducted of younger (18–65 years) survivors in Australia. Pre- and poststroke patterns of income and hardship were evaluated and multivariable logistic regression identified the predictors of economic hardship after stroke. Four hundred fourteen participants were followed up over 12 months after stroke. The variables that independently predicted economic hardship after stroke were: female (OR, 2.94 95% CI, 1.52–5.70), hazardous alcohol consumption (OR, 2.28 95% CI, 1.00–5.20), manual occupation (OR, 1.88 95% CI, 1.07–3.30), lack of health insurance (OR, 2.01 95% CI, 1.12–3.60), and prior hardship (OR, 3.93 95% CI, 2.12–7.29), whereas concessional status (OR, 0.50 95% CI, 0.26–0.95) and more social contacts per week (OR, 0.99 95% CI, 0.98–1.00) reduced hardship likelihood. Higher prestroke income did not buffer hardship after stroke nor did clinical, health service, or disability factors. Policies to reduce inequalities after stroke would be best aimed at socioeconomic targets.
Update on the EFFECTS study of fluoxetine for stroke recovery: a randomised controlled trial in Sweden
Publisher: Springer Science and Business Media LLC
Date: 28-02-2020
DOI: 10.1186/S13063-020-4124-7
Abstract: Studies have suggested that fluoxetine might improve neurological recovery after stroke, but the results remain inconclusive. The EFFECTS (Efficacy oF Fluoxetine – a randomisEd Controlled Trial in Stroke) reached its recruitment target of 1500 patients in June 2019. The purpose of this article is to present all amendments to the protocol and describe how we formed the EFFECTS trial collaboration in Sweden. In this investigator-led, multicentre, parallel-group, randomised, placebo-controlled trial, we enrolled non-depressed stroke patients aged 18 years or older between 2 and 15 days after stroke onset. The patients had a clinical diagnosis of stroke (ischaemic or intracerebral haemorrhage) with persisting focal neurological deficits. Patients were randomised to fluoxetine 20 mg or matching placebo capsules once daily for 6 months. Seven amendments were made and included clarification of drug interaction between fluoxetine and metoprolol and the use of metoprolol for severe heart failure as an exclusion criterion, inclusion of data from central Swedish registries and the Swedish Stroke Register, changes in informed consent from patients, and clarification of design of some sub-studies. EFFECTS recruited 1500 patients at 35 centres in Sweden between 20 October 2014 and 28 June 2019. We plan to unblind the data in January 2020 and report the primary outcome in May 2020. EFFECTS will provide data on the safety and efficacy of 6 months of treatment with fluoxetine after stroke in a Swedish health system setting. The data from EFFECTS will also contribute to an in idual patient data meta-analysis. EudraCT 2011-006130-16 . Registered on 8 August 2014. ISRCTN, ISRCTN13020412 . Registered on 19 December 2014. ClinicalTrials.gov: NCT02683213 . Retrospectively registered on 2 February 2016.
Pharmaceutical Interventions for Emotionalism After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2004
Management of Depression After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2005
DOI: 10.1161/01.STR.0000162391.27991.9D
Abstract: Background and Purpose— Although depression may affect recovery and outcome after stroke, it is often overlooked or inadequately managed, and there is uncertainty regarding the benefits of antidepressant therapy in this setting. We aimed to assess the effectiveness of antidepressants for the treatment and prevention of depression after stroke. Methods— We undertook a systematic review using Cochrane methods of randomized placebo-controlled trials of antidepressants for the treatment or prevention of depressive illness and “abnormal mood” after stroke. Treatment effects on physical and other outcomes were also examined. Results— Outcome data were available for 7 treatment trials including 615 patients and 9 prevention trials including 479 patients. Because of the considerable variation in research design, trial quality, and method of reporting across studies, we did not pool all the outcome data. In the treatment trials, antidepressants reduced mood symptoms but had no clear effect on producing a remission of diagnosable depressive illness. There was no definitive evidence that antidepressants prevent depression or improve recovery after stroke. Conclusions— There is insufficient randomized evidence to support the routine use of antidepressants for the prevention of depression or to improve recovery from stroke. Although antidepressants may improve mood in stroke patients with depression, it is unclear how clinically significant such modest effects are in patients other than those with major depression. There is a pressing need for further research to better define the role of antidepressants in stroke management.
Prevalence of Driving and Traffic Accidents among People with Seizures: A Systematic Review
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000500599
Abstract: b i Background and Objectives: /i /b Epilepsy influences the ability to drive. We undertook a systematic review to determine the prevalence of driving or holding a driver’s license among people with seizures, the prevalence of traffic accidents among those who drive, and factors that may explain heterogeneity in these point estimates. b i Method: /i /b We followed MOOSE and PRISMA guidelines in searching 8 databases from inception to June 27, 2018. All published observational studies were included, with the exception of case-control studies where prevalence could not be determined, case reports, and studies with fewer than 50 participants. We assessed external and internal validity and quality of studies, produced forest plots, and conducted meta-regression in “Stata 13.” b i Results: /i /b Data were available from 67 studies published between 1967 and 2018. Across the studies there was a wide range in the prevalence of driving (3–90%) and holding a driver’s license (8–98%). Up to 39% of people with epilepsy drove in violation of restrictions. Prevalence of traffic accidents ranged from 0 to 61% following seizure onset, or in the past 1–5 years. The percentage of people with seizures who drove decreased as time since diagnosis increased ( i /i = 0.01, adjusted i R /i sup /sup = 31%). The number of people with seizures who drove or held a driver’s license appears to have increased over time ( i /i = 0.02, adjusted i R /i sup /sup = 7%) but without a corresponding increase in the number of traffic accidents. There was considerable heterogeneity between studies related to definitions, design, and population differences. b i Conclusions: /i /b There is considerable variation in the prevalence of driving after a diagnosis of epilepsy and in reported motor vehicle accidents. Further efforts are required to better understand the impact of epilepsy, and epilepsy surgery, on driving and road safety, especially where driving continues in violation of restrictions. Policy changes are needed to encourage the introduction of available and affordable alternatives for driving, for ex le, developing public transport networks, and promoting subsidy schemes to encourage use of public transport, taxis, Uber, and Lyft, among people experiencing seizures.
Cognitive Impairment After Stroke and Treatment With Fluoxetine
Publisher: Elsevier BV
Date: 12-2022
Systematic Review and Meta-Analysis of Psychosocial Risk Factors for Stroke
Publisher: Georg Thieme Verlag KG
Date: 06-2017
Abstract: Several studies have assessed the link between psychosocial risk factors and stroke however, the results were inconsistent. We have conducted a systemic review and meta-analysis of cohort or case-control studies to ascertain the association between psychosocial risk factors (psychological, vocational, behavioral, interpersonal, and neuropsychological) and the risk of stroke. Systematic searches were undertaken in MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Database of Systematic Reviews between 2000 and January 2017. Two reviewers independently screened titles, abstracts, and full texts. One reviewer assessed quality and extracted data, which was checked by a second reviewer. For studies that reported risk estimates, a meta-analysis was performed. We identified 41 cohort studies and 5 case-control studies. No neuropsychological papers were found. Overall, pooled adjusted estimates showed that all other psychosocial risk factors were independent risk factors for stroke. Psychological factors increased the risk of stroke by 39% (hazard ratio [HR], 1.39 95% confidence interval [CI], 1.27–1.51), vocational by 35% (HR, 1.35 95% CI, 1.20–1.51), and interpersonal by 16% (HR, 1.16 95% CI, 1.03–1.31), and the effects of behavioral factors were equivocal (HR, 0.94 95% CI, 0.20–4.31). The meta-analyses were affected by heterogeneity. Psychosocial risk factors are associated with an increased risk of stroke.
A systematic review and meta-analysis of placebo versus no treatment for insomnia symptoms.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.SMRV.2017.03.006
Abstract: This systematic review and meta-analysis aimed to determine the size of the placebo effect for insomnia symptoms when comparing placebo treatment with no treatment. PsycINFO, MEDLINE, and CINAHL databases were systematically searched for studies allocating participants with insomnia symptoms (diagnosed or self-reported) to receive a placebo that they were led to believe was an active treatment or to a no treatment control group. Thirteen independent studies (n = 566) met inclusion criteria. Meta-analysis indicated a reliable placebo effect whereby placebo treatment led to improved perceived sleep onset latency (SOL Hedges g = 0.272), total sleep time (TST Hedges g = 0.322), and global sleep quality (GSQ Hedges' g = 0.581), when compared with no treatment. There was no effect on objective assessment of SOL, however only a few studies reported this outcome and there were insufficient s le sizes to meta-analyse other objective outcomes. Moderator analysis indicated that the placebo effect for perceived insomnia symptoms was quite consistent across different variables. The present findings provide strong evidence for placebo effects for perceived insomnia symptoms, but not on the only objective measurement with sufficient s le size to meta-analyse, namely objective SOL. This has important implications for the treatment of insomnia symptoms and the design and interpretation of clinical trials for insomnia symptoms.
Effectiveness and Safety of Antibiotics for Preventing Pneumonia and Improving Outcome after Acute Stroke: Systematic Review and Meta-analysis
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.JSTROKECEREBROVASDIS.2018.07.001
Abstract: Pneumonia is a common complication after stroke which increases morbidity and mortality. This systematic review was conducted to evaluate the efficacy and safety of antibiotics for the prevention of pneumonia after acute stroke. Medline, EMBASE, and Cochrane databases were searched for randomized controlled trials comparing preventive antibiotics to placebo or no antibiotics after acute stroke. The primary outcome was poststroke pneumonia. Secondary outcomes were all infections, urinary tract infections, death, dependency, length of hospital stay, and adverse events. Treatment effects were summarized using random effects metaanalysis. Six trials (4111 patients) were eligible for inclusion. The median National Institute of Health Stroke Scale score in included trials ranged from 5 to 16.5. The proportion of dysphagia ranged from 26% to 100%. Preventive antibiotics were commenced within 48hours after acute stroke. Compared to control, preventive antibiotics reduced the risk of poststroke pneumonia (RR .75, 95%CI ·.57-.99), and all infections (RR .58, 95%CI .48-.69). There was no significant difference in the risks of dependency (RR 0.99, 95%CI 0·80-1·11), or mortality (RR .96, 95%CI .78-1.19) between the preventive antibiotics and control groups. Preventive antibiotics did not increase the risk of elevated liver enzymes (RR 1.20, 95% CI .97-1.49). Preventive antibiotics had uncertain effects on the risks of other adverse events. Preventive antibiotics reduced the risk of post-stroke pneumonia. However, there is insufficient evidence to currently recommend routine use of preventive antibiotics after acute stroke.
Who is driving and who is prone to have traffic accidents? A systematic review and meta-analysis among people with seizures
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.YEBEH.2019.03.032
Abstract: Epilepsy influences the ability to drive. We aimed to systematically summarize factors associated with driving, holding a driver's license, and traffic accidents among people with seizures. Eight databases were searched (from their inception to 27 June 2018). We included all published observational studies, except for case reports and studies with fewer than 50 participants. Pooled mean differences and pooled risk ratios (pRRs) with corresponding confidence intervals (CIs) were calculated using random effects. Data were available from 18 studies, reporting a wide range of factors. There were frequent biases associated with cross-sectional study designs, selection bias, poor statistical quality, small s les, and lack of validation of models. The following six variables were consistently associated with driving: male gender (pRR: 1.42 95% CI: 1.23 to 1.64), being in paid work (pRR: 1.72 95% CI: 1.46 to 2.03), married (pRR: 1.26 95% CI: 1.01 to 1.57), older age at seizure onset or diagnosis (pooled mean difference: 4.83 95% CI: 0.48 to 9.18 years), less frequent seizures (fewer than monthly, pRR: 1.32 95% CI: 1.12 to 1.56), and taking one or no antiepileptic drug (pRR: 1.34 95% CI: 1.09 to 1.63). Lower seizure frequency was also protective for avoiding traffic accidents (pRR: 0.26 95% CI: 0.10 to 0.66). Stable multivariate models to predict driving or traffic accidents among people with seizures have not yet been developed. Current evidence shows that the likelihood of driving is associated with demographic and epilepsy-related factors, while the risk of traffic accidents is associated with seizure frequency.
Repeated Measures of Modified Rankin Scale Scores to Assess Functional Recovery From Stroke: AFFINITY Study Findings
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-08-2022
Abstract: Function after acute stroke using the modified Rankin Scale (mRS) is usually assessed at a point in time. The analytical implications of serial mRS measurements to evaluate functional recovery over time is not completely understood. We compare repeated‐measures and single‐measure analyses of the mRS from a randomized clinical trial. Serial mRS data from AFFINITY (Assessment of Fluoxetine in Stroke Recovery), a double‐blind placebo randomized clinical trial of fluoxetine following stroke (n=1280) were analyzed to identify demographic and clinical associations with functional recovery (reduction in mRS) over 12 months. Associations were identified using single‐measure (day 365) and repeated‐measures (days 28, 90, 180, and 365) partial proportional odds logistic regression. Ninety‐five percent of participants experienced a reduction in mRS after 12 months. Functional recovery was associated with age at stroke years no prestroke history of diabetes, coronary heart disease, or ischemic stroke prestroke history of depression, a relationship partner, living with others, independence, or paid employment no fluoxetine intervention ischemic stroke (compared with hemorrhagic) stroke treatment in Vietnam (compared with Australia or New Zealand) longer time since current stroke and lower baseline National Institutes of Health Stroke Scale & Patient Health Questionnaire‐9 scores. Direction of associations was largely concordant between single‐measure and repeated‐measures models. Association strength and variance was generally smaller in the repeated‐measures model compared with the single‐measure model. Repeated‐measures may improve trial precision in identifying trial associations and effects. Further repeated‐measures stroke analyses are required to prove methodological value. URL: www.anzctr.org.au Unique identifier: ACTRN12611000774921.
Validation of the simplified modified Rankin scale for stroke trials: Experience from the ENCHANTED alteplase-dose arm
Publisher: SAGE Publications
Date: 22-01-2020
Abstract: The structured, simplified modified Rankin scale questionnaire (smRSq) may increase reliability over the interrogative approach to scoring the modified Rankin scale (mRS) in acute stroke research and practice. During the conduct of the alteplase-dose arm of the international ENhanced Control of Hypertension ANd Thrombolysis StrokE stuDy (ENCHANTED), we had an opportunity to compare each of these approaches to outcome measurement. Baseline demographic data were recorded together with the National Institutes of Health Stroke Scale (NIHSS). Follow-up measures obtained at 90 days included mRS, smRSq, and the 5-Dimension European Quality of life scale (EQ-5D). Agreements between smRSq and mRS were assessed with the Kappa statistic. Multiple logistic regression was used to identify baseline predictors of Day 90 smRSq and mRS scores. Treatment effects, based on Day 90 smRSq/mRS scores, were tested in logistic and ordinal logistic regression models. SmRSq and mRS scores had good agreement (weighted Kappa 0.79, 95% confidence interval (CI) 0.78–0.81), while variables of age, atrial fibrillation, diabetes mellitus, pre-morbid mRS (1 vs. 0), baseline NIHSS scores, and imaging signs of cerebral ischemia, similarly predicted their scores. Odds ratios for death or disability, and ordinal shift, 90-day mRS scores using smRSq were 1.05 (95% CI 0.91–1.20 one-sided P = 0.23 for non-inferiority) and 0.98 (95% CI 0.87–1.11 P = 0.02 for non-inferiority), similar to those using mRS. This study demonstrates the utility of the smRSq in a large, ethnically erse clinical trial population. Scoring of the smRSq shows adequate agreement with the standard mRS, thus confirming it is a reliable, valid, and useful alternative measure of functional status after acute ischemic stroke. URL: www.clinicaltrials.gov . Unique identifier: NCT01422616.
Sex differences in treatment and outcome after stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-11-2019
DOI: 10.1212/WNL.0000000000008615
Abstract: To explore the sex differences in outcomes and management after stroke using a large s le with high-quality international trial data. In idual participant data were obtained from 5 acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment, and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis. There were 19,652 participants, of whom 7,721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3–6 months (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70–0.97), higher likelihood of disability (OR 1.20, 95% CI 1.06–1.36), and worse quality of life (weighted mean difference −0.07, 95% CI −0.09 to 0.04). For management, women were more likely to be admitted to an acute stroke unit (OR 1.17, 95% CI 1.01–1.34), but less likely to be intubated (OR 0.58, 95% CI 0.36–0.93), treated for fever (OR 0.82, 95% CI 0.70–0.95), or admitted to an intensive care unit (OR 0.83, 95% CI 0.74–0.93). For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13–1.31) and lower odds of being prescribed antiplatelets (OR 0.86, 95% CI 0.79–0.93), glucose-lowering agents (OR 0.86, 95% CI 0.78–0.94), or lipid-lowering agents (OR 0.85, 95% CI 0.77–0.94). This analysis suggests that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.
Lithium and Stroke Recovery: A Systematic Review and Meta-Analysis of Stroke Models in Rodents and Human Data
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2022
DOI: 10.1161/STROKEAHA.122.039203
Abstract: Lithium has neuroprotective effects in animal models of stroke, but benefits in humans remain uncertain. This article aims to systematically review the available evidence of the neuroprotective and regenerative effects of lithium in animal models of stroke, as well as in observational and trial stroke studies in humans. This systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched Medline, Embase, and PsycINFO for preclinical and clinical studies published between January 2000 and September 2021. A random-effects meta-analysis was conducted from observational studies. From 1625 retrieved studies, 42 were included in the systematic review. Of those, we identified 36 rodent models of stroke using preinsult or postinsult treatment with lithium, and 6 studies were conducted in human s les, of which 4 could be meta-analyzed. The review of animal models was stratified according to the type of stroke and outcomes. Human data were sub ided into observational and intervention studies. Treatment of rodents with lithium was associated with smaller stroke volumes, decreased apoptosis, and improved poststroke function. In humans, exposure to lithium was associated with a lower risk of stroke among adults with bipolar disorder in 2 of 4 studies. Two small trials showed equivocal clinical benefits of lithium poststroke. Animal models of stroke show consistent biological and functional evidence of benefits associated with lithium treatment, whereas human evidence remains sparse and inconclusive. The potential role of lithium in poststroke recovery is yet to be adequately tested in humans.
Comparison of Treatment Rates of Depression After Stroke Versus Myocardial Infarction: A Systematic Review and Meta-Analysis of Observational Data
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2018
DOI: 10.1097/PSY.0000000000000632
Abstract: Depression after stroke and myocardial infarction (MI) is common but often assumed to be undertreated without reliable evidence being available. Thus, we aimed to determine treatment rates and investigate the application of guidelines in these conditions. Databases MEDLINE, EMBASE, PsycInfo, Web of Science, CINAHL, and Scopus were systematically searched without language restriction from inception to June 30, 2017. Prospective observational studies with consecutive recruitment reporting any antidepressant treatment in adults with depression after stroke or MI were included. Random-effects models were used to calculate pooled estimates of treatment rates. Fifty-five studies reported 32 stroke cohorts ( n = 8938 pooled frequency of depression = 34%, 95% confidence interval [CI] = 29%–38%) and 17 MI cohorts ( n = 10,767 pooled frequency of depression = 24%, 95% CI = 20%–28%). In 29 stroke cohorts, 24% (95% CI = 20%–27%) of 2280 depressed people used antidepressant medication. In 15 MI cohorts, 14% (95% CI = 8%–19%) of 2381 depressed people used antidepressant medication indicating a lower treatment rate than in stroke. Two studies reported use of psychosocial interventions, indicating that less than 10% of participants were treated. Despite the high frequency of depression after stroke and MI and the existence of efficacious treatment strategies, people often remain untreated. Innovative strategies are needed to increase the use of effective antidepressive interventions in patients with cardiovascular disease.
Improved survival after stroke: Is admission to hospital the major explanation? Trend analyses of the Auckland Regional Community Stroke studies
Publisher: S. Karger AG
Date: 16-11-2007
DOI: 10.1159/000097054
Abstract: i Background: /i There is uncertainty regarding the impact of changes in stroke care and natural history of stroke in the community. We examined factors responsible for trends in survival after stroke in a series of population-based studies. i Methods: /i We used statistical models to assess temporal trends in 28-day and 1-year case fatality after first-ever stroke cases registered in 3 stroke incidence studies undertaken in Auckland, New Zealand, over uniform 12-month calendar periods in 1981–1982 (n = 1,030), 1991–1992 (1,305) and 2001–2002 (1,423). Cox proportional hazards regression was used to evaluate the significance of pre-defined ‘patient’, ‘disease’ and ‘service/care’ factors on these trends. i Results: /i Overall, there was a 40% decline in 28-day case fatality after stroke over the study periods, from 32% (95% confidence interval, 29–35%) in 1981–1982 to 23% (21–25%) in 1991–1992 and then 19% (17–21%) in 2002–2003. Similar relative declines were seen in 1-year case fatality. In regression models, the trends were still significant after adjusting for patient and disease factors. However, further adjustment for care factors (higher hospital admission and neuroimaging) explained most of the improvement in survival. i Conclusions: /i These data show significant downwards trends in case fatality after stroke in Auckland over 20 years, which can largely be attributed to improved stroke care associated with increases in hospital admission and brain imaging during the acute phase of the illness.
The impact of vicarious trauma on Aboriginal and/or Torres Strait Islander health researchers
Publisher: The Sax Institute
Date: 2021
The FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke: a study protocol for three multicentre randomised controlled trials
Publisher: Springer Science and Business Media LLC
Date: 20-08-2015
DOI: 10.1186/S13063-015-0864-1
Abstract: Several small trials have suggested that fluoxetine improves neurological recovery from stroke. FOCUS, AFFINITY and EFFECTS are a family of investigator-led, multicentre, parallel group, randomised, placebo-controlled trials that aim to determine whether routine administration of fluoxetine (20 mg daily) for 6 months after acute stroke improves patients’ functional outcome. The three trial investigator teams have collaboratively developed a core protocol. Minor variations have been tailored to the national setting in the UK (FOCUS), Australia and New Zealand (AFFINITY) and Sweden (EFFECTS). Each trial is run and funded independently and will report its own results. A prospectively planned in idual patient data meta-analysis of all three trials will subsequently provide the most precise estimate of the overall effect of fluoxetine after stroke and establish whether any effects differ between trials and subgroups of patients. The trials include patients ≥18 years old with a clinical diagnosis of stroke, persisting focal neurological deficits at randomisation between 2 and 15 days after stroke onset. Patients are randomised centrally via web-based randomisation systems using a common minimisation algorithm. Patients are allocated fluoxetine 20 mg once daily or matching placebo capsules for 6 months. Our primary outcome measure is the modified Rankin scale (mRS) at 6 months. Secondary outcomes include the Stroke Impact Scale, EuroQol (EQ5D-5 L), the vitality subscale of the Short-Form 36, diagnosis of depression, adherence to medication, adverse events and resource use. Outcomes are collected at 6 and 12 months. The methods of collecting these data are tailored to the national setting. If FOCUS, AFFINITY and EFFECTS combined enrol 6000 participants as planned, they would have 90 % power (alpha 5 %) to detect a common odds ratio of 1.16, equivalent to a 3.7 % absolute difference in percentage with mRS 0–2 (44.0 % to 47.7 %). This is based on an ordinal analysis of mRS adjusted for baseline variables included in the minimisation algorithm. If fluoxetine is safe and effective in promoting functional recovery, it could be rapidly, widely and affordably implemented in routine clinical practice and reduce the burden of disability due to stroke. FOCUS: ISRCTN83290762 (23/05/2012), AFFINITY: ACTRN12611000774921 (22/07/2011). EFFECTS: ISRCTN13020412 (19/12/2014).
Process evaluation of a primary healthcare validation study of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people: study protocol
Publisher: BMJ
Date: 11-2017
DOI: 10.1136/BMJOPEN-2017-017612
Abstract: Process evaluations are conducted alongside research projects to identify the context, impact and consequences of research, determine whether it was conducted per protocol and to understand how, why and for whom an intervention is effective. We present a process evaluation protocol for the Getting it Right research project, which aims to determine validity of a culturally adapted depression screening tool for use by Aboriginal and Torres Strait Islander people. In this process evaluation, we aim to: (1) explore the context, impact and consequences of conducting Getting It Right, (2) explore primary healthcare staff and community representatives’ experiences with the research project, (3) determine if it was conducted per protocol and (4) explore experiences with the depression screening tool, including perceptions about how it could be implemented into practice (if found to be valid). We also describe the partnerships established to conduct this process evaluation and how the national Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research is met. Realist and grounded theory approaches are used. Qualitative data include semistructured interviews with primary healthcare staff and community representatives involved with Getting it Right. Iterative data collection and analysis will inform a coding framework. Interviews will continue until saturation of themes is reached, or all participants are considered. Data will be triangulated against administrative data and patient feedback. An Aboriginal and Torres Strait Islander Advisory Group guides this research. Researchers will be blinded from validation data outcomes for as long as is feasible. The University of Sydney Human Research Ethics Committee, Aboriginal Health and Medical Research Council of New South Wales and six state ethics committees have approved this research. Findings will be submitted to academic journals and presented at conferences. ACTRN12614000705684 .
Too Much and Too Little: Antidepressant Treatment in Stroke Survivors during the First Year
Publisher: IMR Press
Date: 06-2022
Abstract: Post-stroke depression (PSD) is the most frequent mental illness after stroke, affecting about 30% of stroke survivors and h ering rehabilitation outcome. While current guidelines recommend monitored antidepressant treatment (ADT) in PSD, the limited precision between the use and need of ADT in clinical practice remains underassessed and poorly understood. Depression according to DSM criteria and ADT was assessed in After one, 6 and 12 months, 36.7%, 31.1% and 25.5% of stroke survivors fulfilled the criteria for depression. Across all measurement occasions, 53% of depressed stroke survivors did Depression occurred in one in three stroke survivors. Among these, only one in two received ADT, irrespective of PSD severity after discharge. In contrast, one in eight stroke survivors without depressive disorder received ADT, about half of them in the absence of earlier PSD. In conclusion, we found evidence of both under- and overtreatment of PSD with ADT, which emphasizes the need for a more stringent implementation of current PSD guideline recommendations.
Very long-term outcome after stroke in Auckland, New Zealand
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2004
DOI: 10.1161/01.STR.0000133130.20322.9F
Abstract: Background and Purpose— Limited information exists on the long-term outcome from stroke. We aimed to determine survival and health status at 21-year follow-up of patients who participated in a population-based stroke incidence study undertaken in Auckland, New Zealand. Methods— During 12 months beginning March 1, 1981, half of all residents of Auckland with acute first-ever or recurrent stroke (n=680) were assessed and followed up prospectively during the next 2 decades. In 2002, their vital status and health-related quality of life (HRQoL) using the 36-item short-form questionnaire (SF-36) were determined by telephone interviews. Kaplan–Meier survival probabilities for the stroke cohort were compared with life table estimates for the New Zealand population. The SF-36 profile of 21-year stroke survivors was compared with a standardized New Zealand population. Results— Overall, 626 of the original cohort had died and 4 were lost to follow-up, leaving 50 (7%) in iduals (57% male mean age 70 years) available in 2002, of whom 12% were residents of an institutional care facility and 19% required help with everyday activities. The stroke cohort had nearly twice the mortality rate of the New Zealand population, but the SF-36 profile of very long-term stroke survivors was broadly similar to the general population. Conclusions— Because stroke is generally a disease of older people and has a high case fatality, it is not surprising that in 10 people survive 2 decades after onset. However, of those who do, their HRQoL profile suggests that they meld relatively successfully within the general population, despite ongoing disability and a higher mortality risk.
Frequency, management, and predictors of abnormal mood after stroke: The Auckland Regional Community Stroke (ARCOS) study, 2002 to 2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2006
DOI: 10.1161/01.STR.0000231387.58943.1F
Abstract: Background and Purpose— Mood disorders are an important consequence of stroke. We aimed to identify significant, clinically useful predictors of abnormal mood after stroke. Methods— The Auckland Regional Community Stroke (ARCOS) study was a prospective population-based stroke incidence study conducted in Auckland, New Zealand, over a 12-month period from 2002 to 2003. All patients were followed up 6 months after stroke onset and abnormal mood was assessed using the 28-item General Health Questionnaire (GHQ-28) administered as part of a structured telephone interview. Multivariate stepwise logistic regression was used to develop a predictive model for “caseness” (score of ≥5 on the GHQ-28) based on several premorbid patient and clinical variables assessed at baseline and 28 days of follow up. Results— Of patients available at 6 months (n=1172), complete data on mood was available from 739 (60%) patients and 27% (95% confidence interval, 24 to 30%) were defined as cases. Key baseline predictors of abnormal mood were disability and history of depression after adjustment for sex, age, and comorbidity, but the model failed to predict a large amount of the variation in caseness ( C statistic 0.587). Conclusion— This study emphasizes the complex nature of mood disturbance after stroke and that multiple factors are likely to contribute to mood disorders. A simple, clinically applicable, predictive model in stroke care appears difficult to develop.
Psychosocial experiences and needs of Australian caregivers of people with stroke: Prognosis messages, caregiver resilience, and relationships
Publisher: Informa UK Limited
Date: 07-2013
DOI: 10.1310/TSR2004-356
Abstract: Despite stroke being the most common form of cerebrovascular disease, there has been relatively little attention paid to the psychosocial experiences and needs of Australian caregivers of people who have had a stroke. Twenty Australian informal caregivers and 10 stroke survivors participated in in idual semi-structured qualitative interviews covering all aspects of caregiving, including stroke survivors' views on their caregiver's experiences. The 5 interrelated topics most discussed were changes in relationships and support services, including being told to expect a poor outcome caregiver attributes and coping strategies stroke survivor limitations external employment and financial stressors and unexpected positive changes in relationships and priorities. Caring for a stroke survivor involves a complex interaction of these factors that appear to be moderated by the quality of the pre-existing stroke survivor-caregiver relationship and the poststroke coping strategies used. Particular attention should be paid to how prognosis is conveyed and whether appropriate outpatient services are available. Clinicians should also consider discussing appropriate caregiver coping strategies and the quality of the relationship between the stroke survivor and caregiver.
Correction to: Update on the EFFECTS study of fluoxetine for stroke recovery: a randomised controlled trial in Sweden
Publisher: Springer Science and Business Media LLC
Date: 07-05-2020
DOI: 10.1186/S13063-020-04327-W
Abstract: Following publication of the original article [1], we were notified that one of the corresponding author’s affiliations was omitted.
Angular Domain Channel Estimation for mmWave Massive MIMO With One-Bit ADCs/DACs
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 02-2021
Frequency of post-stroke pneumonia: Systematic review and meta-analysis of observational studies
Publisher: SAGE Publications
Date: 22-10-2018
Abstract: Post-stroke pneumonia and other infectious complications are serious conditions whose frequency varies widely across studies. We conducted a systematic review to estimate the frequency of post-stroke pneumonia and other types of major infection. MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched for prospective studies with consecutive recruitment of stroke patients. The primary outcome was post-stroke pneumonia. Secondary outcomes were any infection and urinary tract infection. Quality assessment was done using Newcastle Ottawa scale. Heterogeneity of estimates across study populations was calculated using Cochran's Q (heterogeneity χ 2 ) and I 2 statistics. A total of 47 studies (139,432 patients) with 48 s le populations were eligible for inclusion. Mean age of patients was 68.3 years and their mean National Institute of Health Stroke Scale score was 8.2. The pooled frequency of post-stroke pneumonia was 12.3% (95% confidence interval [CI] 11%–13.6% I 2 = 98%). The pooled frequency from 2011 to 2017 was 13.5% (95% CI 11.8%–15.3% I 2 = 98%) and comparable with earlier periods (P interaction = 0.31). The pooled frequency in studies in stroke units was 8% (95% CI 7.1%–9% I 2 = 78%) and significantly lower than other locations (P interaction = 0.001). The pooled frequency of post-stroke infection was 21% (95% CI 13%–29.3% I 2 = 99%) and of post-stroke urinary tract infection was 7.9% (95% CI 6.7%–9.3% I 2 = 96%). Approximately 1 in 10 stroke patients experience pneumonia during the acute period of hospital care. The frequency of post-stroke pneumonia has remained stable in recent decades but is lower in patients receiving stroke unit care compared to management in other ward settings.
Frequency and predictors of psychological distress after a diagnosis of epilepsy: A community-based study
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.YEBEH.2017.07.044
Abstract: The objective of the study was to determine the frequency and predictors of psychological distress after a diagnosis of epilepsy. The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people of all ages with newly diagnosed epilepsy in Sydney, Australia. Analyses involved multivariate logistic regression and multinomial logit regression to identify predictors of psychological distress, assessed using the Hospital Anxiety and Depression Scale (HADS) and the Strengths and Difficulties Questionnaire (SDQ), as part of structured interviews. Psychological distress occurred in 33% (95% confidence interval [CI] 26 to 40%) and 24% (95% CI 18 to 31%) of 180 adults at baseline and 12months, respectively, and 23% (95% CI 14 to 33%) of 77 children at both time points. Thirty adults and 7 children had distress at baseline who recovered at 12months, while 15 adults and 7 children had new onset of distress during this period. History of psychiatric or behavioral disorder (for adults, odds ratio [OR] 6.82, 95% CI 3.08 to 15.10 for children, OR 28.85, 95% CI 2.88 to 288.60) and higher psychosocial disability (adults, OR 1.17, 95% CI 1.07 to 1.27) or lower family functioning (children, OR 1.80, 95% CI 1.08 to 3.02) were associated with psychological distress (C statistics 0.80 and 0.78). Psychological distress is common and fluctuates in frequency after a diagnosis of epilepsy. Those with premorbid psychological, psychosocial, and family problems are at high risk of this adverse outcome.
EMPOWERED trial: protocol for a randomised control trial of digitally supported, highly personalised and measurement-based care to improve functional outcomes in young people with mood disorders
Publisher: BMJ
Date: 10-2023
Generating sustainable collective action: Models of community control and governance of alcohol supply in Indigenous minority populations
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.DRUGPO.2018.09.011
Abstract: Restrictions on the supply of alcohol are amongst the most effective and cost effective interventions to address harmful use. However, despite international human rights bodies recognising that self determination must be pre-eminent in efforts to improve Indigenous health, little is known about the role of Indigenous communities in designing and implementing alcohol controls as well as the degree to which government resourcing and/or regulation is utilised. This commentary explores Australian ex les of the governance models used to ensure Indigenous participation and leadership when developing regulatory interventions for alcohol control within communities. We identify four models of Indigenous governance: alcohol control interventions that were community conceived and implemented, government-facilitated community-led, community coalitions backed by government intervention and government initiated community partnerships. Each model is underpinned by specific governance arrangements which incorporate rules and processes that determine authority, accountability and Indigenous participation in decision-making. The aim of this paper is to benchmark these models of governance along a spectrum of community engagement beginning with forms of non-participation and ending with full citizen control. In addition, we put forward recommendations for governments at all levels to facilitate culturally acceptable and robust models of Indigenous governance that have the potential to improve health and social outcomes.
Disability income support design and mental illnesses: a review of Australia and Ontario
Publisher: The Sax Institute
Date: 2017
DOI: 10.17061/PHRP2721715
Abstract: Mental illnesses have many distinctive features that make determining eligibility for disability income support challenging - for ex le, their fluctuating nature, invisibility and lack of diagnostic clarity. How do policy makers deal with these features when designing disability income support? More specifically, how do mental illnesses come to be considered eligible disabilities, what tools are used to assess mental illnesses for eligibility, what challenges exist in this process, and what approaches are used to address these challenges? We aimed to determine what evidence is available to policy makers in Australia and Ontario, Canada, to answer these questions. Ten electronic databases and grey literature in both jurisdictions were searched using key words, including disability income support, disability pension, mental illness, mental disability, addiction, depression and schizophrenia, for articles published between 1991 and June 2013. This yielded 1341 articles, of which 20 met the inclusion criteria and were critically appraised. Limited evidence is available on disability income support design and mental illnesses in the Australian and Ontarian settings. Most of the evidence is from the grey literature and draws on case law. Many documents reviewed argued that current policy in Australia and Ontario is frequently based on negative assumptions about mental illnesses rather than evidence (either peer reviewed or in the grey literature). Problems relating to mental illnesses largely relate to interpretation of the definition of mental illness rather than the definition itself. The review confirmed that mental illnesses present many challenges when designing disability income support and that academic as well as grey literature, especially case law, provides insight into these challenges. More research is needed to address these challenges, and more evidence could lead to policies for those with mental illnesses that are well informed and do not reinforce societal prejudices.
Stroke in Africa: A systematic review and meta-analysis of the incidence and case-fatality rates
Publisher: SAGE Publications
Date: 14-01-2023
DOI: 10.1177/17474930221147164
Abstract: The burden of stroke (a leading cause of disability and mortality) in Africa appears to be increasing, but a systematic review of the best available data to support or refute this observation is lacking. To determine the incidence and 1-month case-fatality rates from high-quality studies of stroke epidemiology among Africans. We searched and retrieved eligible articles on stroke epidemiology among indigenous Africans in bibliographic databases (MEDLINE, ScienceDirect, Google Scholar, and Cochrane library) using predefined search terms from the earliest records through January 2022. Methodological assessment of eligible studies was conducted using the Newcastle–Ottawa scale. Pooling of incidence and case-fatality rates was performed via generalized linear models (Poisson-Normal random-effects model). Of the 922 articles retrieved, 14 studies were eligible for inclusion. The total number of stroke cases was 2568, with a population denominator (total s le size included in population-based registries or those who agreed to participate in door-to-door community studies) of 3,384,102. The pooled crude incidence rate of stroke per 100,000 persons in Africa was 106.49 (95% confidence interval (CI) = 58.59–193.55), I 2 = 99.6%. The point estimate of the crude incidence rate was higher among males, 111.33 (95% CI = 56.31–220.12), I 2 = 99.2%, than females, 91.14 (95% CI = 47.09–176.37), I 2 = 98.9%. One-month case-fatality rate was 24.45 (95% CI = 16.84–35.50), I 2 = 96.8%, with lower estimates among males, 22.68 (95% CI = 18.62–27.63), I 2 = 12.9%, than females, 27.57 (95% CI = 21.47–35.40), I 2 = 51.6%. The burden of stroke in Africa remains very high. However, little is known about the dynamics of stroke epidemiology among Africans due to the dearth of high-quality evidence. Further continent-wide rigorous epidemiological studies and surveillance programs using the World Health Organization STEPwise approach to Surveillance (WHO STEPS) framework are needed.
Qualitative study of psychosocial factors impacting on Aboriginal women’s management of chronic disease
Publisher: Springer Science and Business Media LLC
Date: 13-01-2020
DOI: 10.1186/S12939-019-1110-3
Abstract: Aboriginal women are frequently called upon to support their families and other community members. At times, such supporting roles can be burdensome for these women. Many Aboriginal women live with chronic conditions. We explored the ways in which the women’s caring roles impacted on how they maintained their own health. The aim of this manuscript is to explore the psychosocial factors associated with the management of health and chronic disease in Aboriginal women. An interpretive phenomenological approach was used for the analysis of 72 in-depth semi-structured interviews. These interviews were conducted in four community controlled Aboriginal health services, in urban, rural and remote settings, across two states and a territory in Australia. Women living with chronic disease experience multiple challenges while caring for family, such as intergenerational trauma, mental health issues relating to addiction, domestic and family violence and incarceration. When these women become ill, they also have to take care of themselves. These women provided informal and unfunded care in response to a range of complex family and community problems. This continuous caring for family affected the women’s ability to maintain their health and manage their own chronic conditions. The caring roles and responsibilities Aboriginal women have in their community impact on their health. Aboriginal women provide much needed refuge and support to family and the wider community. Underfunded and over-burdened formal support services are not meeting the needs of many Aboriginal women. Improved culturally secure resources and social services are required within communities to support Aboriginal women to successfully manage their own health.
Effects of Fluoxetine on Outcomes at 12 Months After Acute Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2021
DOI: 10.1161/STROKEAHA.121.034705
Abstract: The EFFECTS (Efficacy of Fluoxetine—a Randomised Controlled Trial in Stroke) recently reported that 20 mg fluoxetine once daily for 6 months after acute stroke did not improve functional outcome but reduced depression and increased fractures and hyponatremia at 6 months. The purpose of this predefined secondary analysis was to identify if any effects of fluoxetine were maintained or delayed over 12 months. EFFECTS was an investigator-led, randomized, placebo-controlled, double-blind, parallel group trial in Sweden that enrolled adult patients with stroke. Patients were randomized to 20 mg oral fluoxetine or matching placebo for 6 months and followed for another 6 months. The primary outcome was functional outcome (modified Rankin Scale), at 6 months. Predefined secondary outcomes for these analyses included the modified Rankin Scale, health status, quality of life, fatigue, mood, and depression at 12 months. One thousand five hundred patients were recruited from 35 centers in Sweden between 2014 and 2019 750 were allocated fluoxetine and 750 placebo. At 12 months, modified Rankin Scale data were available in 715 (95%) patients allocated fluoxetine and 712 (95%) placebo. The distribution of modified Rankin Scale categories was similar in the 2 groups (adjusted common odds ratio, 0.92 [95% CI, 0.76–1.10]). Patients allocated fluoxetine scored worse on memory with a median value of 89 (interquartile range, 75–100) versus 93 (interquartile range, 82–100) P =0.0021 and communication 93 (interquartile range, 82–100) versus 96 (interquartile range, 86–100) P =0.024 domains of the Stroke Impact Scale compared with placebo. There were no other differences in secondary outcomes. Fluoxetine after acute stroke had no effect on functional outcome at 12 months. Patients allocated fluoxetine scored worse on memory and communication on the Stroke Impact Scale compared with placebo, but this is likely to be due to chance. URL: www.clinicaltrials.gov Unique identifier: NCT02683213.
Development of an electronic health message system to support recovery after stroke
Publisher: Informa UK Limited
Date: 07-2018
DOI: 10.2147/PPA.S154581
Is Regular Screening for Intracranial Aneurysm Necessary in Patients with Autosomal Dominant Polycystic Kidney Disease? A Systematic Review and Meta-analysis
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000476073
Abstract: b i Background: /i /b The prevalence of intracranial aneurysm in patients with autosomal dominant polycystic kidney disease (ADPKD) is higher than that among the general population. We performed a systematic review and meta-analysis on the prevalence and natural history of intracranial aneurysm among patients with ADPKD. b i Methods: /i /b Medline, Embase, Web of Science and Scopus, from inception to July 2016, were searched for studies reporting the occurrence of intracranial aneurysms among participants with ADPKD. Two authors independently assessed the eligibility of all retrieved studies and extracted data. Information on the prevalence of intracranial aneurysms and their natural history in participants with ADPKD was collected from all included studies. b i Results: /i /b Fifteen studies with 1,490 participants with ADPKD were pooled to study about the prevalence of intracranial aneurysm in participants with ADPKD, and the prevalence rate was found to be 10% (95% CI 7-13%). Studies from China, Japan and Europe (Germany, Poland) reported a higher prevalence of intracranial aneurysm. Having a family history of haemorrhagic stroke or intracranial aneurysm was a risk factor for aneurysm occurrence. Twenty-three percent (95% CI 15-31%) of the participants had multiple aneurysms. Most of the aneurysms were small ( mm) and located in the anterior circulation. Five studies with 171 participants (83 with 106 aneurysms at baseline and 88 without) were analyzed to understand the natural history of aneurysms, with an incidence of aneurysm growth, new aneurysm and aneurysm rupture of 1.84% (followed up for 435 person-years), 0.57% (1,227 person-years) and 0.13% (792 person-years) respectively. b i Conclusions: /i /b Screening for intracranial aneurysm is recommended in patients with ADPKD when there is a family history of haemorrhagic stroke or intracranial aneurysm and when they are from China, Japan or Europe (Germany, Poland). Based on existing data, regular imaging follow-up is not supported. High-quality, prospective studies are needed in the future.
Control intervention design for preclinical and clinical trials: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable
Publisher: SAGE Publications
Date: 14-10-2023
Text messages to reduce depressive symptoms: Do they work and what makes them effective? A systematic review
Publisher: SAGE Publications
Date: 08-10-2021
Abstract: In this systematic review and meta-analysis, we aimed to quantify the effects of text messaging interventions to reduce depressive symptoms and identify variables that might influence the effectiveness of the intervention. Electronic databases including EMBASE, CENTRAL, MEDLINE, CINAHL, PsycINFO and SCOPUS, as well as Clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) were searched for randomised controlled trials that sent one or more text messages with health-related content to adults who had been identified by a healthcare provider. Seven trials (nine comparisons), with 1,918 participants, were included in the review, and the pooled analysis revealed a borderline statistically significant reduction in depressive symptom scores between the text messaging intervention and control groups (standardised mean difference [SMD], −0.27 95% confidence interval [CI], −0.54 to 0.00 p = .00) favouring intervention at the end. Statistically significant reductions were shown in important subgroups, for ex le, where the primary aim of the messages was to reduce depressive symptoms in those using the Beck Depression Inventory (BDI) or 9-item Patient Health Questionnaire (PHQ-9) questionnaires where text message content was targeted at mental well-being, mood improvement and cognitive behavioural therapy information and when the message frequency was ⩾2 times per week. Text messaging has potential to reduce depressive symptoms. The results of this review should be interpreted with caution, however, due to the methodological limitations of included trials. More research is required before recommendations can be made about the routine use of text messaging for the management of depressive symptoms.
Response to Letter by Chen et al
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2006
Getting it Right: validating a culturally specific screening tool for depression (aPHQ-9) in Aboriginal and Torres Strait Islander Australians
Publisher: AMPCo
Date: 30-06-2019
DOI: 10.5694/MJA2.50212
Abstract: To determine the validity, sensitivity, specificity and acceptability of the culturally adapted nine-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander people. Prospective observational validation study, 25 March 2015 - 2 November 2016. 500 adults (18 years or older) who identified as Aboriginal or Torres Strait Islander people and attended one of ten primary health care services or service events in urban, rural and remote Australia that predominantly serve Indigenous Australians, and were able to communicate sufficiently to respond to questionnaire and interview questions. Criterion validity of the aPHQ-9, with the depression module of the Mini-International Neuropsychiatric Interview (MINI) 6.0.0 as the criterion standard. 108 of 500 participants (22% 95% CI, 18-25%) had a current episode of major depression according to the MINI criterion. The sensitivity of the aPHQ-9 algorithm for diagnosing a current major depressive episode was 54% (95% CI, 40-68%), its specificity was 91% (95% CI, 88-94%), with a positive predictive value of 64%. For screening for a current major depressive episode, the area under the receiver operator characteristic curve was 0.88 (95% CI, 0.85-0.92) with a cut-point of 10 points its sensitivity was 84% (95% CI, 74-91%) and its specificity 77% (95% CI, 71-83%). The aPHQ-9 was deemed acceptable by more than 80% of participants. Indigenous Australians found the aPHQ-9 acceptable as a screening tool for depression. Applying a cut-point of 10 points, the performance characteristics of the aPHQ were good.
Wireless Consumer Electronic Devices: The Effects of Impulsive Radio-Frequency Interference
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 07-2019
Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial
Publisher: SAGE Publications
Date: 19-02-2021
Abstract: An indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST). Data were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as “poor outcome,” scores 3–6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates. Overall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13–1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59–2.18). The number exposed to IUC for poor outcome was 13. IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC.
Parallel-Serial Memoing
Publisher: SAGE Publications
Date: 09-07-2016
Abstract: The mechanisms by which talking therapies exert their beneficial effects are largely unknown. In exploring the process of a talking therapy, motivational interviewing (MI), when used to treat and prevent low mood in stroke survivors, we developed, what we believe to be, a novel approach to analyzing transcripts. We illustrate the method using qualitative data from MI sessions with 10 stroke survivors. The approach, drawing on grounded theory, incorporated processes of parallel and serial memoing among a team of researchers to allow a process of validation. This enabled us to describe session content and to develop theoretical interpretations of what was occurring in and across MI sessions. We found that this process can be used to integrate different perspectives in theory building, allowing for a richer description and more robust theoretical interpretation. Others can use and adapt this approach to develop insights into their own inquiry.
Is urban green space associated with lower mental healthcare expenditure?
Publisher: Elsevier BV
Date: 2022
Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery
Publisher: Wiley
Date: 14-11-2012
Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery
Publisher: Wiley
Date: 26-11-2019
Control intervention design for preclinical and clinical trials: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable
Publisher: SAGE Publications
Date: 12-10-2023
Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery
Publisher: Wiley
Date: 15-11-2021
“I tried to get help about my addiction but he just gave me tablets:” male Aboriginal drug and alcohol rehabilitation clients’ experiences and preferences speaking about substance use in primary care
Publisher: Springer Science and Business Media LLC
Date: 21-01-2023
DOI: 10.1186/S12875-023-01983-0
Abstract: Primary healthcare (PHC) services are crucial in supporting people who use substances. The aims of this study were to explore the experiences of Aboriginal males in NSW in treatment for substance use about speaking about their substance use with PHC staff, and their preferences for accessing PHC about their substance use. Semi-structured interviews with residential drug and alcohol rehabilitation treatment service clients. Thematic analysis was used to develop themes inductively and deductively. Two interviews were independently double coded by an Aboriginal researcher and the project was supported by an Aboriginal Advisory Group. Twenty male adults who self-identified as Aboriginal participated (mean age 27 years). Half reported visiting PHC and talking about their substance use before their residential service stay. Two major themes developed: (1) speaking up about substance use or mental health problems linked with substance use, (2) ways to improve access to PHC about substance use. Although some males were offered treatment, some were not, and others had concerns about the treatments offered. This research highlights opportunities to improve access and to better support Aboriginal males who use substances in PHC. Focus on culturally appropriate PHC and providing staff with training around substance use and treatment options may improve access. It is important to foster culturally appropriate services, develop PHC staff knowledge around substance use, focus on therapeutic relationships and have a range of treatment options available that can be tailored to in idual circumstances.
Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a
Publisher: BMJ
Date: 2012
Air Pressure, Humidity and Stroke Occurrence: A Systematic Review and Meta-Analysis
Publisher: MDPI AG
Date: 05-07-2016
Interventions for Treating Depression After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Prevalence of, Factors Associated with and Level of Dependence of Psychoactive Substance Use among Mekelle University Students, Ethiopia
Publisher: MDPI AG
Date: 29-01-2020
Abstract: Background: Psychoactive substance use is a major public health concern globally. Though youth attending higher education institutions are considered particularly vulnerable to psychoactive substances, there is a paucity of evidence in Ethiopia. We aimed to determine the prevalence of psychoactive substance use, factors associated with psychoactive substance use and level of dependence among Mekelle University undergraduate students in Ethiopia. Methods: An institution-based quantitative cross-sectional survey was used to randomly (using multistage s ling) invite 1220 undergraduate students in April and May 2017 to participate. Multinomial logistic regression was used to identify factors associated with psychoactive substance use. Level of dependence was determined using the WHO’s Alcohol, Smoking and Substance Involvement Screening Test classification. Results: Among the eligible students approached, 1214 participants completed the survey, which yields a 99.5% response rate. The lifetime prevalence of psychoactive substance use was 66.5% (95% Confidence Interval (CI) = 64% to 69%) while the current prevalence was 49% (95% CI = 46% to 52%). A history of, but not current, psychoactive substance use was reported by 18%, while 33.5% reported never having used psychoactive substances. The current prevalence of alcohol use was 35.5%, tobacco 7.8% and khat 5.7%. Of the current users, 17% (95% CI = 14% to 20%) were at a moderate to high risk of dependency. Being over 21 years of age (adjusted odds ratio (AOR) = 1.6, 95% CI = 1.37 to 2.25), male (AOR = 3.13 95% CI = 2.26 to 4.34), living in urban areas (AOR = 2.39, 95% CI = 1.77 to 3.23), an Orthodox Christian (AOR = 7.55, 95% CI = 4.56 to 12.48), and being in their 3rd year (AOR = 2.3, 95% CI = 1.49 to 3.55), 4th year (AOR = 2.0, 95% CI = 1.2 to 3.51) and 5th year (AOR = 4.0, 95% CI = 2.81 to 7.67) at university were associated with currently using psychoactive substances. Being male and Orthodox Christian was associated with being an ex-smoker. Conclusions: Approximately half of Mekelle University undergraduate students were using psychoactive substances with almost one in five at risk of dependency. The likelihood of use increased with seniority. Evidence-based strategies are needed to prevent school-aged children from using psychoactive substances and university students becoming dependent on substances. Interventions designed to stop current psychoactive substance use may also have promise for reducing dependency.
Evaluation of carotid plaque vulnerability in vivo: Correlation between dynamic contrast-enhanced MRI and MRI-modified AHA classification
Publisher: Wiley
Date: 24-01-2017
DOI: 10.1002/JMRI.25637
Abstract: To noninvasively monitor carotid plaque vulnerability by exploring the relationship between pharmacokinetic parameters (PPs) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and plaque types based on MRI-modified American Heart Association (AHA) classification, as well as to assess the ability of PPs in discrimination between stable and vulnerable plaques suspected on MRI. Of 70 consecutive patients with carotid plaques who volunteered for 3.0T MRI (3D time-of-flight [TOF], T Significant positive correlation between K K 1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017 :870-876.
Frequency of depression after stroke: A systematic review of observational studies
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2005
DOI: 10.1161/01.STR.0000165928.19135.35
Abstract: Background and Purpose— Although depression is an important sequelae of stroke, there is uncertainty regarding its frequency and outcome. Methods— We undertook a systematic review of all published nonexperimental studies (to June 2004) with prospective consecutive patient recruitment and quantification of depressive symptoms/illness after stroke. Results— Data were available from 51 studies (reported in 96 publications) conducted between 1977 and 2002. Although frequencies varied considerably across studies, the pooled estimate was 33% (95% confidence interval, 29% to 36%) of all stroke survivors experiencing depression. Differences in case mix and method of mood assessment could explain some of the variation in estimates across studies. The data also suggest that depression resolves spontaneously within several months of onset in the majority of stroke survivors, with few receiving any specific antidepressant therapy or active management. Conclusions— Depression is common among stroke patients, with the risks of occurrence being similar for the early, medium, and late stages of stroke recovery. There is a pressing need for further research to improve clinical practice in this area of stroke care.
No benefit of flat head positioning in early moderate-severe acute ischaemic stroke: A HeadPoST study subgroup analysis
Publisher: BMJ
Date: 25-06-2020
Abstract: Although the Head Positioning in acute Stroke Trial (HeadPoST) showed no effect of the flat head position (FP vs sitting up head position (SUP)) on functional outcome, we hypothesised that it could still offer benefits if commenced early in those with acute ischaemic stroke (AIS) of at least moderate severity. Subgroup analysis of HeadPoST in participants with National Institutes of Health Stroke Scale (NIHSS) scores ≥7, ≥10 and ≥14, randomised to FP or SUP .5 hours of AIS onset on functional outcomes defined by a shift in scores on the modified Rankin scale (mRS) and death/disability (mRS scores 3–6), and any cardiovascular serious adverse event. Logistic regression analyses were undertaken adjusted for study design and baseline risk factors. There was no significant differential treatment effect in patient subgroups defined by increasing baseline NIHSS scores: adjusted OR and 95% CI for ordinal shift and binary (3–6) mRS scores: for NIHSS ≥7 (n=867) 0.92 (0.67 to 1.25) and 0.74 (0.52 to 1.04) NIHSS ≥ 10 (n=606) 0.80 (0.58 to 1.10) and 0.77 (0.49 to 1.19) NIHSS ≥14 (n=378) 0.82 (0.54 to 1.24) and 1.22 (0.69 to 2.14). Early FP had no significant effect in patients with moderate–severe AIS. NCT02162017 .
Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial
Publisher: Elsevier BV
Date: 2019
Selective Serotonin Reuptake Inhibitors for Stroke Recovery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2020
Getting it Right: Study protocol to determine the diagnostic accuracy of a culturally-specific measure to screen for depression in Aboriginal and/or Torres Strait Islander people
Publisher: BMJ
Date: 12-2016
Pharmaceutical Interventions for Emotionalism After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2023
The economic impact of epilepsy: A systematic review
Publisher: Springer Science and Business Media LLC
Date: 25-11-2015
Risk factors common to leading eye health conditions and major non-communicable diseases: a rapid review and commentary
Publisher: F1000 Research Ltd
Date: 10-11-2022
DOI: 10.12688/F1000RESEARCH.123815.1
Abstract: Background : To gain an understanding of the intersection of risk factors between the most prevalent eye health conditions that are associated with vision impairment and non-communicable diseases (NCDs). Methods: A series of rapid reviews of reviews reporting on non-modifiable risk factors, age and sex, and modifiable risk factors, including social determinants, were conducted for five common eye health conditions that are the leading causes of vision impairment globally (refractive error including uncorrected refractive error, cataract, age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy) and five prevalent NCDs (cancer, cardiovascular disease, chronic respiratory disease, dementia, and depressive disorders). Articles published within approximately 5 years to the end of 2019 were identified through expert recommendation, PubMED, Ovid Medline, the Lancet Global Burden of Disease series, the International Agency for Research on Cancer and World Cancer Research Fund. Results: Of 9,213 records identified, 320 records were eligible. Eye health conditions and NCDs share many risk factors. Increased age was found to be the most common shared risk factor, associated with increased risks of AMD, cataract, diabetic retinopathy, glaucoma, refractive error, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and dementia. Other shared risk factors included smoking, obesity, alcohol consumption (mixed results), and physical activity was protective, though limited evidence was found for eye conditions. Social determinants are well documented as risk factors for NCDs. Conclusion: There is substantial overlap in common established risk factors for the most frequent vision impairing eye conditions and leading NCDs. Increasing efforts should be made to integrate preventative and risk reduction interventions to improve health, with greatest shared benefits for initiatives which aim to reduce smoking, improve diet, and promote physical activity.
Protocol of a randomized controlled trial investigating the effectiveness of Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS)
Publisher: SAGE Publications
Date: 14-06-2021
DOI: 10.1177/17474930211022678
Abstract: To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and baseline disability. Outcomes assessments: Collected at 90 days and 12 months following randomization. Primary outcomes include hospital emergency presentations/admissions within 90 days of randomization. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months. S le size: To test our primary hypothesis, we estimated a s le size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α = 0.05. Given uncertainty for the effect size of this novel intervention, the s le size will be adaptively re-estimated when outcomes for n = 668 are obtained, with maximum s le capped at 1100. We will provide new evidence on the potential effectiveness, implementation, and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.
The effectiveness of interventions to reduce the household economic burden of illness and injury: a systematic review
Publisher: WHO Press
Date: 18-11-2014
The FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke: statistical and health economic analysis plan for the trials and for the individual patien
Publisher: Springer Science and Business Media LLC
Date: 12-2017
DOI: 10.1186/S13063-017-2385-6
Abstract: Small trials have suggested that fluoxetine may improve neurological recovery from stroke. FOCUS, AFFINITY and EFFECTS are a family of investigator-led, multicentre, parallel group, randomised, placebo-controlled trials which aim to determine whether the routine administration of fluoxetine (20 mg daily) for six months after an acute stroke improves patients’ functional outcome. The core protocol for the three trials has been published (Mead et al., Trials 20:369, 2015). The trials include patients aged 18 years and older with a clinical diagnosis of stroke and persisting focal neurological deficits at randomisation 2–15 days after stroke onset. Patients are randomised centrally via each trials’ web-based randomisation system using a common minimisation algorithm. Patients are allocated fluoxetine 20 mg once daily or matching placebo capsules for six months. The primary outcome measure is the modified Rankin scale (mRS) at six months. Secondary outcomes include: living circumstances the Stroke Impact Scale EuroQol (EQ5D-5 L) the vitality subscale of the 36-Item Short Form Health Survey (SF36) diagnosis of depression adherence to medication serious adverse events including death and recurrent stroke and resource use at six and 12 months and the mRS at 12 months. Minor variations have been tailored to the national setting in the UK (FOCUS), Australia, New Zealand and Vietnam (AFFINITY) and Sweden (EFFECTS). Each trial is run and funded independently and will report its own results. A prospectively planned in idual patient data meta-analysis of all three trials will provide the most precise estimate of the overall effect and establish whether any effects differ between trials or subgroups. This statistical analysis plan describes the core analyses for all three trials and that for the in idual patient data meta-analysis. Recruitment and follow-up in the FOCUS trial is expected to be completed by the end of 2018. AFFINITY and EFFECTS are likely to complete follow-up in 2020. FOCUS: ISRCTN , ISRCTN83290762 . Registered on 23 May 2012. EudraCT, 2011-005616-29. Registered on 3 February 2012. AFFINITY: Australian New Zealand Clinical Trials Registry, ACTRN12611000774921 . Registered on 22 July 2011. EFFECTS: ISRCTN , ISRCTN13020412 . Registered on 19 December 2014. Clinicaltrials.gov, NCT02683213 . Registered on 2 February 2016. EudraCT, 2011-006130-16 . Registered on 8 August 2014.
Effects of Fluoxetine on Functional Recovery after Acute Stroke (AFFINITY): A Randomised, Double-Blind, Placebo-Controlled Trial
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3559565
Neuropsychiatric outcomes after stroke – Authors' reply
Publisher: Elsevier BV
Date: 12-2014
Pharmacological, psychological and non-invasive brain stimulation interventions for preventing depression after stroke
Publisher: Wiley
Date: 11-05-2020
Responses to the primary health care needs of Aboriginal and Torres Strait Islander women experiencing violence: A scoping review of policy and practice guidelines
Publisher: Wiley
Date: 10-2020
DOI: 10.1002/HPJA.417
Abstract: It is demonstrated that primary health care (PHC) providers are sought out by women who experience violence. Given the disproportionate burden of violence experienced by Aboriginal and Torres Strait Islander women, it is essential there is equitable access to appropriate PHC services. This review aimed to analyse whether Australian PHC policy accounts for the complex needs of Aboriginal and Torres Strait Islander women experiencing violence and the importance of PHC providers responding to violence in culturally safe ways. Using the Arskey and O’Malley framework, an iterative scoping review determined the policies for analysis. The selected policies were analysed against concepts identified as key components in responding to the needs of Aboriginal and Torres Strait Islander women experiencing violence. The key components are Family Violence, Violence against Aboriginal and Torres Strait Islander Women, Social Determinants of Aboriginal and Torres Strait Islander Health and Wellbeing, Cultural Safety, Holistic Health, Trauma, Patient‐Centred Care and Trauma‐and‐Violence‐Informed Care. Following a search of Australian government websites, seven policies were selected for analysis. Principally, no policy embedded or described best practice across all key components. The review demonstrates the need for a specific National framework supporting Aboriginal and Torres Strait Islander women who seek support from PHC services, as well as further policy analysis and review. Aboriginal and Torres Strait Islander women disproportionately experience more severe violence, with complex impact, than other Australian women. PHC policy and practice frameworks must account for this, together with the intersection of contemporary manifestations of colonialism and historical and intergenerational trauma.
Interventions for preventing depression after stroke
Publisher: Wiley
Date: 16-07-2008
Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke
Publisher: Massachusetts Medical Society
Date: 22-06-2017
Returning to Unpaid Work after Stroke: The Psychosocial Outcomes in Stroke Cohort Study.
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000496399
Abstract: b i Background: /i /b While returning to paid work is a crucial marker of stroke recovery, little is known about the differences in unpaid work by sex following stroke. We aimed to determine the sex differences in participation in unpaid work 12 months after stroke. b i Methods: /i /b Psychosocial outcomes in stroke were a prospective, multicentre observational study that recruited in iduals, 18–64 years, within 28 days of stroke from New South Wales, Australia. Unpaid work was defined as ≥5 h per week of one or more of: unpaid domestic work for the household unpaid care of others looking after own children without pay or looking after someone else’s children without pay. Data was collected before stroke, 28 days (baseline), 6 and 12 months follow-up. b i Results: /i /b Eighty per cent of women and 52% of men engaged in ≥5 h per week of unpaid work before stroke. At 12 months after, 69% of women and 53% of men completed ≥5 h of unpaid work per week. For women, there was a significant association between participation in unpaid work at 12 months and having financially dependent children (OR 2.67 95% CI 1.08–6.59). A return to unpaid work in men was associated with participation in unpaid work before stroke (OR 3.74 95% CI 2.14–6.53). b i Conclusions: /i /b More women are engaged in unpaid work before and at 12 months after stroke, but there is a reduction in the proportion of women returning to unpaid work at 12 months not seen in men. Consideration may need to be given to the development of rehabilitation strategies targeted at the specific needs of stroke survivors.
Fluoxetine and Fractures After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2019
DOI: 10.1161/STROKEAHA.119.026639
Abstract: The FOCUS trial (Fluoxetine or Control Under Supervision) showed that fluoxetine did not improve modified Rankin Scale scores (mRS) but increased the risk of fractures. We aimed to describe the fractures, their impact on mRS and factors associated with fracture risk. A United Kingdom, multicenter, parallel-group, randomized, placebo-controlled trial. Patients ≥18 years with a clinical stroke and persisting deficit assessed 2 to 15 days after onset were eligible. Consenting patients were allocated fluoxetine 20 mg or matching placebo for 6 months. The primary outcome was the mRS at 6 months and secondary outcomes included fractures. Sixty-five of 3127 (2.1%) patients had 67 fractures within 6 months of randomization 43 assigned fluoxetine and 22 placebo. Fifty-nine (90.8%) had fallen and 26 (40%) had fractured their neck of femur. The effect of fluoxetine on mRS (common odds ratio =0.951) was not significantly altered by excluding fracture patients (common odds ratio =0.961). Cox proportional hazards modeling showed that only age year (hazard ratio =1.97 95% CI, 1.13–3.45 P =0.017), female sex (hazard ratio =2.13 95% CI, 1.29–3.51 P =0.003), and fluoxetine (hazard ratio =2.00 95% CI, 1.20–3.34 P =0.008) were independently associated with fractures. Most fractures resulted from falls. Although many fractures were serious, and likely to impair patients’ function, the increased fracture risk did not explain the lack of observed effect of fluoxetine on mRS. Only increasing age, female sex, and fluoxetine were independent predictors of fractures. URL: www.controlled-trials.com . Unique identifier: ISRCTN83290762.
Living clinical guidelines for stroke: updates, challenges and opportunities
Publisher: Wiley
Date: 15-05-2022
DOI: 10.5694/MJA2.51520
Incidence of Thymoma in Myasthenia Gravis: A Systematic Review
Publisher: Korean Neurological Association
Date: 2012
Health outcomes 1 year after subarachnoid hemorrhage: An international population-based study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-09-2000
DOI: 10.1212/WNL.55.5.658
Abstract: There is limited information about the long-term consequences of subarachnoid hemorrhage (SAH). Data were obtained from a population-based study of aneurysmal SAH conducted in Australia and New Zealand between 1995 and 1998. The authors report health outcomes for survivors 1 year after the onset of SAH. From a total of 432 first-ever cases of SAH (76% due to confirmed cerebral aneurysm rupture) registered in four cities in Australia and New Zealand, 242 (56%) were alive approximately 1 year later (mean time 1.2 years), with 230 (95%) available for interview. Of those interviewed, 105 (46%) reported an incomplete recovery, with ongoing problems with memory (50%), mood (39%), speech (14%), and self-care (10%). Compared with age- and sex-adjusted Australian population norms, health-related quality of life, as determined by Short Form-36, was significantly lower for cases in the domains of role limitations that result from physical problems. However, there were no patient or disease characteristics that predicted complete recovery from SAH. A high proportion of long-term survivors of SAH experience ongoing deficits in high level (neuropsychological) functioning. These deficits result in impairment in social roles.
ImProving Outcomes after STroke (POST): Results from the Randomized Clinical Pilot Trial
Publisher: SAGE Publications
Date: 18-10-2012
DOI: 10.1111/J.1747-4949.2012.00913.X
Abstract: One in three patients experience depression after stroke. An effective strategy to prevent depression after stroke that could be economically delivered to most patients with a low likelihood of adverse events is needed. In a randomized trial conducted in New South Wales, Australia, a postcard was sent monthly to participants ( n = 100) for five-months following hospital discharge after stroke (plus usual care) and compared with usual care ( n = 101). Ethical approval was obtained to withhold information about the intervention and primary outcome from participants during the consent process. No significant difference was seen in the proportion of participants with depression in the intervention group (1/88) vs. the control group (3/76) (relative risk 0·29, 95% confidence interval 0·03–2·71) at six-months. No significant differences were seen on Hospital Anxiety Depression Scale (HADS) depression and anxiety sub-scale scores, quality of life, or activities of daily living however, many (47/100) responded positively to the postcards. Although this simple postcard intervention did not significantly reduce the proportion of participants experiencing high HADS depression sub-scale scores after stroke, it may be an effective way to engage with people after stroke following hospital discharge.
Family-led rehabilitation in India (ATTEND)—Findings from the process evaluation of a randomized controlled trial
Publisher: SAGE Publications
Date: 25-07-2018
Abstract: Training family carers to provide evidence-based rehabilitation to stroke patients could address the recognized deficiency of access to stroke rehabilitation in low-resource settings. However, our randomized controlled trial in India (ATTEND) found that this model of care was not superior to usual care alone. This process evaluation aimed to better understand trial outcomes through assessing trial implementation and exploring patients’, carers’, and providers’ perspectives. Our mixed methods study included process, healthcare use data and patient demographics from all sites observations and semi-structured interviews with participants (22 patients, 22 carers, and 28 health providers) from six s led sites. Intervention fidelity and adherence to the trial protocol was high across the 14 sites however, early supported discharge (an intervention component) was not implemented. Within both randomized groups, some form of rehabilitation was widely accessed. ATTEND stroke coordinators provided counseling and perceived that sustaining patients’ motivation to continue with rehabilitation in the face of significant emotional and financial stress as a key challenge. The intervention was perceived as an acceptable community-based package with education as an important component in raising the poor awareness of stroke. Many participants viewed family-led rehabilitation as a necessary model of care for poor and rural populations who could not access rehabilitation. Difficulty in sustaining patient and carer motivation for rehabilitation without ongoing support, and greater than anticipated access to routine rehabilitation may explain the lack of benefit in the trial. Nonetheless, family-led rehabilitation was seen as a concept worthy of further development.
Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis
Publisher: BMJ
Date: 05-2018
Fluoxetine for Improving Functional Outcome After Stroke: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
Publisher: Elsevier BV
Date: 2018
DOI: 10.2139/SSRN.3264978
Abstract MP3: Low Dose versus Standard Dose Alteplase in Acute Lacunar Ischemic Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2021
DOI: 10.1161/STR.52.SUPPL_1.MP3
Abstract: Objective: To identify any differential efficacy and safety of low- versus standard-dose intravenous alteplase for lacunar versus non-lacunar acute ischemic stroke (AIS) in the alteplase dose-arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Methods: In a cohort of 3297 ENCHANTED participants, we identified those with lacunar or non-lacunar AIS with different levels of confidence (definite robable ossible) according to pre-specified definitions based on clinical and adjudicated imaging findings. Logistic regression models were used to determine associations of lacunar AIS with 90-day outcomes (primary, modified Rankin scale [mRS] scores 2-6 secondary, other mRS scores, intracerebral hemorrhage [ICH], and early neurologic deterioration [END] or death) and treatment effects of low- versus standard-dose alteplase across lacunar and non-lacunar AIS with adjustment for baseline covariables. Results: Of 2588 participants with available imaging and clinical data, we classified cases as definite or probable lacunar (n=490) or non-lacunar AIS (n=2098) for primary analyses. Regardless of the alteplase dose received, lacunar AIS participants had favorable functional (mRS 2-6, adjusted odds ratio [95% CI] 0.60 [0.47-0.77]) and other clinical or safety outcomes, compared to participants with non-lacunar AIS. Overall, low-dose alteplase (compared to standard) had no differential effect on the functional outcome (mRS 2-6, 1.04 [0.87-1.24]) but reduced the risk of ICH. There were no differential treatment effects of low- versus standard-dose alteplase on all outcomes across lacunar and non-lacunar AIS (all P interaction ≥0.07). Conclusions: We found no clear evidence from the ENCHANTED trial that low-dose alteplase had any advantages over standard-dose for definite robable lacunar AIS.
Moving the Ambulance to the Top of the Cliff: Reducing the Burden of Depressive Symptoms after Stroke
Publisher: SAGE Publications
Date: 06-2009
Family-led rehabilitation after stroke in India: the ATTEND trial, study protocol for a randomized controlled trial
Publisher: Springer Science and Business Media LLC
Date: 07-01-2016
The Course and Impact of Poststroke Insomnia in Stroke Survivors Aged 18 to 65 Years: Results from the Psychosocial Outcomes In StrokE (POISE) Study
Publisher: S. Karger AG
Date: 03-02-2017
DOI: 10.1159/000455751
Abstract: b i Background: /i /b Insomnia symptoms are common in the population and have negative psychosocial and functional sequelae. There are no prospective studies of the course of such symptoms and their impact, if any, in stroke survivors. This prospective cohort study investigated insomnia after stroke in working-age adults and evaluated its impact on psychological and functional outcomes over the subsequent year. b i Methods: /i /b We prospectively recruited 441 young (& #x3c years) consecutive stroke survivors from 20 public hospitals in the New South Wales Stroke Service network. Participants were assessed by self-report and interview at 28 days, 6 months, and 12 months after stroke. Insomnia was defined using a common epidemiological measure of sleep disturbance and daytime consequences. Depression, anxiety, disability, and return to work were assessed through standardized measures. b i Results: /i /b The point prevalence of insomnia at each time point in the year after stroke was stable at 30–37% and more common in females. Fifty-eight (16%) of all participants reported “chronic” insomnia, with symptoms at both baseline and 6 months later. At 12 months, this group was more likely to be depressed (OR 6.75, 95% CI 2.78–16.4), anxious (OR 3.31, 95% CI 1.54–7.09), disabled (OR 3.60, 95% CI 2.07–6.25), and not have returned to work, compared to those without insomnia over the same period. b i Conclusions: /i /b Chronic insomnia has a negative effect on disability and return to work 1 year after stroke even after adjusting for demographic, psychiatric, and disability factors. Identifying and appropriately targeting insomnia through known effective treatments may improve functional outcomes after stroke.
Phase Transformation-Induced Improvement in Hardness and High-Temperature Wear Resistance of Plasma-Sprayed and Remelted NiCrBSi/WC Coatings
Publisher: MDPI AG
Date: 17-12-2020
DOI: 10.3390/MET10121688
Abstract: The remelting method is introduced to improve the properties of the as-sprayed NiCrBSi coatings. In this work, tungsten carbide (WC) was selected as reinforcement and the as-sprayed and remelted NiCrBSi/WC composite coatings were investigated by X-ray diffraction, scanning electron microscopy, hardness test and tribology test. After spraying, WC particles are evenly distributed in the coating. The remelting process induced the decarburizing reaction of WC, resulting in the formation of dispersed W2C. The dispersed W2C particles play an important role in the dispersion strengthening. Meanwhile, the pores and lamellar structures are eliminated in the remelted NiCrBSi/WC composite coating. Due to these two advantages, the hardness and the high-temperature wear resistance of the remelted NiCrBSi/WC composite coating are significantly improved compared with those with an as-sprayed NiCrBSi coating the as-sprayed NiCrBSi coating, as-sprayed NiCrBSi/WC composite coating and remelted NiCrBSi/WC composite coating have average hardness of 673.82, 785.14, 1061.23 HV, and their friction coefficients are 0.3418, 0.3261, 0.2431, respectively. The wear volume of the remelted NiCrBSi/WC composite coating is only one-third of that of the as-sprayed NiCrBSi coating.
Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial
Publisher: Elsevier BV
Date: 08-2017
We Need to Talk about Depression and Dialysis: but What Questions Should We Ask, and Does Anyone Know the Answers?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-01-2017
DOI: 10.2215/CJN.13031216
Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: a protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial
Publisher: BMJ
Date: 06-2016
Stroke Survivors Who Score Below Threshold on Standard Depression Measures May Still Have Negative Cognitions of Concern
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
DOI: 10.1161/STROKEAHA.109.571729
Abstract: Background and Purpose— There has been an increase in screening for depression in the physically ill. We explored whether important negative cognitions may be missed by conventional approaches to screening for depression in 2 independently conducted stroke studies with similar methods. Methods— The Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based stroke incidence study conducted in Auckland, New Zealand, for 12 months in 2002 to 2003. The Stroke Outcomes Study was a prospective, hospital cohort study conducted in Leeds and Bradford, United Kingdom, for 33 months in 2002 to 2005. Symptoms of abnormal mood were assessed at 6 months in ARCOS with a single simple question, “Do you often feel sad and depressed?” and the 28-item General Health Questionnaire administered as part of a structured interview and in the Stroke Outcomes Study with the 28-item General Health Questionnaire and a single question about depressed mood taken from the Present State Examination. Results— Mood data were available at 6 months from 770 ARCOS and 492 Stroke Outcomes Study participants. A significant proportion (up to 28%) of people who did not meet study criteria for depression reported important negative cognitions such as hopelessness, worthlessness, or suicidality. People who were older, dependent in activities of daily living, or not partnered were more likely to report negative cognitions. Conclusions— Important negative cognitions, including suicidal thoughts, may be missed when people are screened for depression after stroke. Screening alone is not an adequate substitute for a sensitive exploration of the psychological impact of stroke on the survivor.
Quantifying regional variations in components of acute stroke unit (ASU) care in the international HeadPoST study
Publisher: Elsevier BV
Date: 12-2020
Development of a set of mobile phone text messages designed for prevention of recurrent cardiovascular events
Publisher: Oxford University Press (OUP)
Date: 17-05-2012
Abstract: Supporting lifestyle change is an effective way of preventing recurrent events in people with cardiovascular disease (CVD). However, there is a need to develop innovative strategies that increase access to programmes for in iduals at high risk of CVD. This study aimed to develop a bank of text messages designed to provide advice, motivation, and support for decreasing cardiovascular risk. Iterative development process with mixed methods An initial bank of 120 text messages was drafted based on behaviour change techniques, guidelines, and input from clinicians and public health experts. A questionnaire was then administered to participants (n = 53) for evaluation of message content, usefulness, and language. To test the process of delivery, a pilot study was conducted using a specifically designed computer programme that delivered messages to multiple mobile phones according to a pre-specified schedule. Data were collected regarding message timing, delivery, and usefulness. In the qualitative questionnaire, 92% of participants found the messages easy to understand and 86% found the messages contained useful information. Positive feedback was also obtained from the pilot study. Based on these results, together with suggestions provided, several messages were reworded and an additional 44 were written. The need for semi-personalization was also identified and a random set of 103 in idualized messages was created. A final bank of 137 mobile telephone text messages designed to support behaviour change and decrease cardiovascular risk have been developed through a multistep iterative process. This provides a scientific approach for future developers of health-related text messages.
Study protocol for POSITIF, a randomised multicentre feasibility trial of a brief cognitive-behavioural intervention plus information versus information alone for the treatment of post-stroke fatigue
Publisher: Springer Science and Business Media LLC
Date: 15-06-2020
DOI: 10.1186/S40814-020-00622-0
Abstract: Approximately, half of stroke survivors experience fatigue. Fatigue may persist for many months and interferes with participation in everyday activities and has a negative impact on social and family relationships, return to work, and quality of life. Fatigue is among the top 10 priorities for ‘Life after Stroke’ research for stroke survivors, carers, and clinicians. We previously developed and tested in a small uncontrolled pilot study a manualised, clinical psychologist-delivered, face-to-face intervention, informed by cognitive behavioural therapy (CBT). We then adapted it for delivery by trained therapists via telephone. We now aim to test the feasibility of this approach in a parallel group, randomised controlled feasibility trial ( P ost S troke I ntervention T rial I n F atigue, POSITIF). POSITIF aims to recruit 75 stroke survivors between 3 months and 2 years post-stroke who would like treatment for their fatigue. Eligible consenting stroke survivors will be randomised to either a 7-session manualised telephone-delivered intervention based on CBT principles plus information about fatigue, or information only. The aims of the intervention are to (i) provide an explanation for post-stroke fatigue, in particular that it is potentially reversible (an educational approach), (ii) encourage participants to overcome the fear of taking physical activity and challenge negative thinking (a cognitive approach) and (iii) promote a balance between daily activities, rest and sleep and then gradually increase levels of physical activity (a behavioural approach). Fatigue, mood, quality of life, return to work and putative mediators will be assessed at baseline (just before randomisation), at the end of treatment and 6 months after randomisation. POSITIF will determine the feasibility of recruitment, adherence to the intervention and the resources required to deliver the intervention in a larger trial. The POSITIF feasibility trial will recruit until 31 January 2020. Data will inform the utility and design of a future adequately powered randomised controlled trial. ClinicalTrials.gov, NCT03551327 . Registered on 11 June 2018.
Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial
Publisher: Public Library of Science (PLoS)
Date: 18-02-2020
Return to driving after a diagnosis of epilepsy: A prospective registry study
Publisher: Wiley
Date: 16-01-2018
DOI: 10.1111/EPI.14001
Abstract: To determine the frequency and predictors of return to driving within 1 year after a diagnosis of epilepsy. SEISMIC (the Sydney Epilepsy Incidence Study to Measure Illness Consequences) was a prospective, multicenter, community-wide study of people of all ages with newly diagnosed epilepsy in Sydney, Australia. Demographic, socioeconomic, and clinical characteristics and driving status were obtained as soon as possible after baseline registration with a diagnosis of epilepsy. Multivariate logistic regression was used to determine predictors of return to driving at 12-month follow-up. Among 181 (76%) adult participants (≥18 years old) who reported driving before an epilepsy diagnosis, 152 provided information on driving at 12 months, of whom 118 (78%) had returned to driving. Driving for reasons of getting to work or place of education (odds ratio [OR] = 4.70, 95% confidence intervals [CI] = 1.87-11.86), no seizure recurrence (OR = 5.15, 95% CI = 2.07-12.82), and being on no or a single antiepileptic drug (OR = 4.54, 95% CI = 1.45-14.22) were associated with return to driving (C statistic = 0.79). More than half of participants with recurrent seizures were driving at follow-up. Early return to driving after a diagnosis of epilepsy is related to work/social imperatives and control of seizures, but many people with recurrent seizures continue to drive. Further efforts are required to implement driving restriction policies and to provide transport options for people with epilepsy.
Depression after stroke and cerebrovascular disease
Publisher: Cambridge University Press
Date: 28-02-2013
Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self‐management of people living with stroke: Inspiring virtual enabled resources following vascul
Publisher: Wiley
Date: 23-08-2022
DOI: 10.1111/HEX.13584
Abstract: Despite digital health tools being popular for supporting self‐management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self‐management after stroke. The 4‐week trial incorporated facilitated person‐centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial. Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open‐text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth. Overall, 27/54 trial participants completed the survey (13 intervention: 52% 14 control: 48%) and 5/8 invited participants in the intervention group attended the focus group. Goal setting : The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person‐centred goals. Electronic messages (intervention) : Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the benefits of receiving messages as a ‘reminder’ to act. Overall trial satisfaction : Messages were acceptable for educating about stroke (77%). Having options for short message services or email to receive messages was considered important. Feedback on the length of the intervention related to specific goals, and benefits of receiving the programme earlier after stroke was expressed. The participant experience has indicated acceptance and utility of iVERVE. Feedback from this evaluation is invaluable to inform refinements to future Phase II and III trials, and wider research in the field. Two consumer representatives sourced from the Stroke Foundation (Australia) actively contributed to the design of the iVERVE programme. In this study, participant experiences directly contributed to the further development of the iVERVE intervention and future trial design.
Regional variation in acute stroke care organisation
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.JNS.2016.10.026
Abstract: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13% P<0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5% P=0.002) compared to MIC hospitals. Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes.
Predictors associated with stroke after coronary artery bypass grafting
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.JNS.2015.07.006
Abstract: Stroke is a major cause of morbidity and mortality after coronary artery bypass grafting (CABG). The purpose of this systematic review was to evaluate the predictors of perioperative stroke after CABG. We reviewed the published literature on prognostic factors for perioperative stroke after CABG in articles using multivariate regression models. The statistical validity of prognostic models and a qualitative synthesis were performed. We identified 14 studies. The methodological quality of study reporting was variable. Overall, the incidence of stroke after CABG was 1.1-5.7%. About 37-59% of strokes occurred early (intraoperatively). No validated stroke outcome scale was used to assess morbidity and mortality in any of the included studies. Advanced age, prior (before CABG) cerebrovascular disease/stroke, prior carotid artery stenosis, prior peripheral vascular disease, prior unstable angina, and prolonged cardiopulmonary bypass time were found to be the most consistent independent predictors of perioperative stroke after CABG. Postoperative atrial fibrillations were found to be the most consistent independent variables associated with postoperative stroke after CABG. No association was found with hypercholesterolemia, prior myocardial infarct, and smoking. Other risk factors, such as gender, prior hypertension, diabetes mellitus, congestive heart failure, and chronic renal failure, showed inconsistent results. Seven variables (advanced age, prior cerebrovascular disease/stroke, prior carotid artery stenosis, prior peripheral vascular disease, prior unstable angina, prolonged cardiopulmonary bypass time, and postoperative atrial fibrillation), representing and high atherosclerotic burden, were found to be associated with more perioperative stroke events. Stroke assessment scales should be included to enable a detailed description of stroke morbidity post CABG. Lessons learned from the present study should also help to improve the quality and relevance of future studies on prognostic factors in stroke after CABG.
Sex differences in risk factors for cognitive decline and dementia, including death as a competing risk, in individuals with diabetes: Results from the ADVANCE trial
Publisher: Wiley
Date: 04-05-2021
DOI: 10.1111/DOM.14391
Abstract: To estimate the associations between risk factors and cognitive decline (CD)/dementia, and the sex differences in these risk factors in in iduals with type 2 diabetes, while accounting for the competing risk of death. The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial of 11,140 in iduals with type 2 diabetes was used to estimate the odds of CD/dementia using multinomial logistic regression. During a median 5‐year follow‐up, 1827 participants (43.2% women) had CD/dementia (1718 with CD only 21 with dementia only 88 with CD and dementia), and 929 (31.0% women) died without CD/dementia. Women had lower odds of CD/dementia than men (odds ratio [OR] [95% confidence interval], 0.88 [0.77, 1.00]) older age, higher total cholesterol, HbA1c, waist circumference, waist‐to‐height ratio, moderately increased albumin‐creatinine ratio, stroke/transient ischaemic attack and retinal disease were each associated with greater odds of CD/dementia higher years at education completion, baseline cognitive function, taller stature and current alcohol use were inversely associated. Higher waist circumference (women‐to‐men ratio of ORs [ROR], 1.05 [1.00, 1.10] per 5 cm) and presence of anxiety/depression (ROR, 1.28 [1.01, 1.63]) were associated with greater ORs for CD/dementia in women than men. Several risk factors were associated with CD/dementia. Higher waist circumference and mental health symptoms were more strongly associated with CD/dementia in women than men. Further studies should examine the mechanisms that underlie these sex differences.
The effectiveness of postpartum interventions aimed at improving women’s mental health after medical complications of pregnancy: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 03-11-2022
DOI: 10.1186/S12884-022-05084-1
Abstract: Postpartum mental disorders including depression and anxiety are common. Medical complications of pregnancy, such as preecl sia and gestational diabetes, are thought to increase the risk of mental disorders postpartum. However, it is unclear which interventions may be effective for preventing and/or treating postpartum mental disorders following a medically complicated pregnancy. We aimed to systematically review published literature on the effectiveness of postpartum interventions to improve women’s mental health after medical complications of pregnancy. Systematic review (PROSPERO: CRD42021220030) was performed. Eligibility criteria: (1) randomized controlled trials (RCTs), published 1st Jan 2001-12th August 2021 (2) outcome measures reported on postpartum mental disorders (3) participants had ≥ 1 medical complication during pregnancy (4) intervention entirely postpartum or contained a postpartum component (5) full-text available in English or Chinese. Risk of bias was assessed using the Revised Cochrane Criteria Risk of Bias. Random effects inverse-variance weighted meta-analysis was used to pool the in idual standardized mean differences (SMD) in depression or anxiety scores between intervention and control groups. Of 5928 studies screened, 9 met inclusion criteria, and were based on non-pharmaceutical, combined lifestyle interventions that began shortly after childbirth, or as part of extended care packages beginning during pregnancy. Of these, 2 were rated as low risk of bias, 1 with some concerns, and 6 were at high risk. Meta-analysis was performed for 8 studies using standardized measures of depression and 7 for anxiety. There were statistically significant reductions in depression (SMD − 1.48 95%CI: -2.41 to -0.55), and anxiety scores (SMD − 1.98 95%CI: -3.03 to -0.94) in intervention versus control groups. Considerable heterogeneity was noted for pooled depression (I 2 = 97.9%, p 0.05), and anxiety (I 2 = 96.8%, p 0.05) results. Limited intervention studies aimed at improving postpartum mental disorders after medically complicated pregnancy were found, most with a high risk of bias. There was some evidence to suggest that postpartum depression and anxiety scores improved after early intervention. However, in general the current quality of evidence is low. Further, high-quality, interventional research is required in this understudied field.
Prevalence and Predictors of 6-Month Fatigue in Patients With Ischemic Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2012
DOI: 10.1161/STROKEAHA.112.660886
Abstract: Although persistent and significant fatigue affects the daily life of stroke survivors, there are no population-based studies examining the prevalence of fatigue in 6-month survivors of ischemic stroke and few studies of predictors of poststroke fatigue. This article examined data from the Auckland Regional Community Stroke study conducted in Auckland, New Zealand, in 2002 to 2003. Presence of fatigue was evaluated at 6 months in 613 patients with ischemic stroke using a Short Form 36 Vitality Score (energy and fatigue) of ≤47. Multivariate logistic regression analysis was used to determine predictors of fatigue development 6 months poststroke. The prevalence of fatigue was 30% (28% in men and 33% in women). There was a clear association between increased prevalence of fatigue and advancing age. The only baseline variables independently associated with an increased risk of developing fatigue at 6 months poststroke were prestroke incontinence and being of New Zealand European ethnicity. Being independent and living alone at baseline were associated with significant reduction in the risk of being fatigued at 6 months poststroke. Severe depression at 6 months was significantly and independently associated with being fatigued. The prevalence of fatigue found in our study is at the lower level of range reported in other studies. The prevalence of fatigue increased with advancing age, as found in most previous studies. Because fatigue can have a negative impact on stroke recovery, particular attention needs to be paid to those who are older, incontinent before stroke, and those who report severe symptoms of depression at 6 months after stroke.
Helicobacter pylori treatment and antibiotic susceptibility: results of a five‐year audit
Publisher: Wiley
Date: 08-1999
DOI: 10.1111/J.1445-5994.1999.TB00752.X
Abstract: Helicobacter pylori eradication treatment has been a rapidly evolving field. Audit of treatment results provides reassurance that trial data can be translated into routine clinical practice. Data were collected prospectively over five years. Patients were given four different treatment regimens over the audit period 'standard' triple therapy, two types of clarithromycin-based treatment or ranitidine, amoxycillin and metronidazole. Eradication was proven by a urea breath test at least four weeks after completing treatment. Eradication treatment for H. pylori was given to 665 patients 89% had follow-up data. H. pylori eradication was significantly associated with treatment type (p<0.0001) and smoking (p=0.04) by univariate analysis, but was not associated with sex, age, alcohol consumption, endoscopic diagnosis, recent treatment with anti-secretory drugs or NSAIDs. By logistic regression analysis, only treatment type was significant (p=0.0001). H. pylori culture and sensitivities were available for 255 patients. Metronidazole resistance was shown for 84 isolates (32%) and clarithromycin resistance for 18 isolates (6.8%). Metronidazole resistance was significantly associated with younger age (p=0.02), ethnicity (p=0.02), female sex (p=0.02), and year of endoscopy (p=0.04), but was not associated with clarithromycin resistance. Clarithromycin resistance was not associated with age, sex, or ethnicity. Metronidazole resistance significantly affected H. pylori eradication for regimens containing metronidazole without clarithromycin. Eradication with metronidazole without clarithromycin was achieved in 90% of sensitive strains but only 55% of resistant strains (p<0.001). Metronidazole resistance was not significantly associated with treatment failure when metronidazole was combined with clarithromycin. Eradication with metronidazole and clarithromycin was achieved in 86% of sensitive strains and 78% of resistant strains (p=0.42). Treatment type and antibiotic susceptibility are the most important determinants of treatment success.
Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke: An international multicenter study
Publisher: SAGE Publications
Date: 21-06-2020
Abstract: Dysphagia is associated with aspiration pneumonia after stroke. Data are limited on the influences of dysphagia screen and assessment in clinical practice. To determine associations between a “brief” screen and “detailed” assessment of dysphagia on clinical outcomes in acute stroke patients. A prospective cohort study analyzed retrospectively using data from a multicenter, cluster cross-over, randomized controlled trial (Head Positioning in Acute Stroke Trial [HeadPoST]) from 114 hospitals in nine countries. HeadPoST included 11,093 acute stroke patients randomized to lying-flat or sitting-up head positioning. Herein, we report predefined secondary analyses of the association of dysphagia screening and assessment and clinical outcomes of pneumonia and death or disability (modified Rankin scale 3–6) at 90 days. Overall, 8784 (79.2%) and 3917 (35.3%) patients were screened and assessed for dysphagia, respectively, but the frequency and timing for each varied widely across regions. Neither use of a screen nor an assessment for dysphagia was associated with the outcomes, but their results were compared to “screen-pass” patients, those who failed had higher risks of pneumonia (adjusted odds ratio [aOR] = 3.00, 95% confidence interval [CI] = 2.18–4.10) and death or disability (aOR = 1.66, 95% CI = 1.41–1.95). Similar results were evidence for the results of an assessment for dysphagia. Subsequent feeding restrictions were related to higher risk of pneumonia in patients failed dysphagia screen or assessment (aOR = 4.06, 95% CI = 1.72–9.54). Failing a dysphagia screen is associated with increased risks of pneumonia and poor clinical outcome after acute stroke. Further studies concentrate on determining the effective subsequent feeding actions are needed to improve patient outcomes.
Effects of continuous positive airway pressure on depression and anxiety symptoms in patients with obstructive sleep apnoea
Publisher: Elsevier BV
Date: 05-2019
Pharmaceutical interventions for emotionalism after stroke
Publisher: Wiley
Date: 19-03-2019
Integrating Trauma and Violence Informed Care in Primary Health Care Settings for First Nations Women Experiencing Violence: A Systematic Review
Publisher: SAGE Publications
Date: 12-02-2021
Abstract: It is imperative that access to primary health care services is equitable as health care practitioners are often the first responders to women who experience violence. This is of particular importance for First Nations women who disproportionately experience interpersonal and structural violence when compared to non-First Nations women, as well as the ongoing impact of colonization, racism, and intergenerational trauma. To understand how primary health care services can provide equitable and effective care for First Nations women, we explored how trauma and violence informed care is integrated in primary health care settings through the lens of an equity-oriented framework. A systematic search of electronic databases included Medline (via Ovid), Scopus, Informit, and PubMed and grey literature. Six studies were included in the review and we undertook a narrative synthesis using the equity-oriented framework to draw together the intersection of trauma and violence informed care with culturally safe and contextually tailored care. This review demonstrates how equity-oriented primary health care settings respond to the complex and multiple forms of violence and intergenerational trauma experienced by First Nations women and thus mitigate shame and stigma to encourage disclosure and help seeking. Key attributes include responding to women’s in idual contexts by centering family, engaging elders, encouraging community ownership, which is driven by a culturally competent workforce that builds trust, reduces retraumatization, and respects confidentiality. This review highlights the importance of strengthening and supporting the workforce, as well as embedding cultural safety within intersectoral partnerships and ensuring adequate resourcing and sustainability of initiatives.
Update to the FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke: statistical analysis plan for the trials and for the individual patient data meta-analysis.
Publisher: Springer Science and Business Media LLC
Date: 25-11-2020
DOI: 10.1186/S13063-020-04875-1
Abstract: Three large trials of fluoxetine for stroke recovery (FOCUS (fluoxetine or control under supervision), AFFINITY (the Assessment oF FluoxetINe In sTroke recovery) and EFFECTS (Efficacy oF Fluoxetine—a randomisEd Controlled Trial in Stroke)) have been collaboratively designed with the same basic protocol to facilitate an in idual patient data analysis (IPDM). The statistical analysis plan for the three in idual trials has already been reported in Trials , including a brief description of the IPDM. In this protocol, we describe in detail how we will perform the IPDM. Data from EFFECTS and AFFINITY will be transferred securely to the FOCUS statistician, who will perform a one-stage IPDM and a two-stage IPDM. For the one-stage IPDM, data will be combined into a single data set and the same analyses performed as described for the in idual trials. For the two-stage IPDM, the results for the three in idual trials will be combined using fixed effects meta-analyses. The primary and secondary outcome domains for the IPDM are the same as for in idual trials. We will also perform analyses according to several subgroups including country of recruitment, ethnicity and trial. We will also explore the effects of fluoxetine on our primary and secondary outcomes in subgroups defined by combinations of characteristics. We also describe additional research questions that will be addressed using the combined data set, and published subsequently, including predictors of important post-stroke problems such as seizures, low mood and bone fractures. An IPDM of our three large trials of fluoxetine for stroke recovery will allow us to provide the most precise estimates of any risks and benefits of fluoxetine vs placebo, to detect reliably a smaller overall effect size than those detectable by the in idual trials, to better determine the effects of fluoxetine vs placebo in subgroups of patients and outcomes and to broaden the generalisability of the results. Also, we may identify differences in treatment effects between studies. FOCUS: ISRCTN ISRCTN83290762 . Registered on 23 May 2012. EudraCT 2011-005616-29 . Registered on 3 February 2012. AFFINITY: Australian New Zealand Clinical Trials Registry ACTRN12611000774921 . Registered on 22 July 2011. EFFECTS: ISRCTN ISRCTN13020412 . Registered on 19 December 2014. ClinicalTrials.gov NCT02683213 . Registered on 2 February 2016. EudraCT 2011-006130-16 . Registered on 8 August 2014.
Pilot randomised clinical trial of an eHealth, self-management support intervention (iVERVE) for stroke: feasibility assessment in survivors 12–24 months post-event
Publisher: Springer Science and Business Media LLC
Date: 07-11-2020
DOI: 10.1186/S40814-020-00706-X
Abstract: Electronic communication is used in various populations to achieve health goals, but evidence in stroke is lacking. We pilot tested the feasibility and potential effectiveness of a novel personalised electronic self-management intervention to support person-centred goal attainment and secondary prevention after stroke. A phase I, prospective, randomised controlled pilot trial (1:1 allocation) with assessor blinding, intention-to-treat analysis, and a process evaluation. Community-based survivors of stroke were recruited from participants in the Australian Stroke Clinical Registry (AuSCR) who had indicated their willingness to be contacted for research studies. Inclusion criteria include 1–2 years following hospital admission for stroke and living within 50 km of Monash University (Melbourne). Person-centred goals were set with facilitation by a clinician using a standardised template. The intervention group received electronic support messages aligned to their goals over 4 weeks. The control group received only 2–3 electronic administrative messages. Primary outcomes were study retention, goal attainment (assessed using Goal Attainment Scaling method) and satisfaction. Secondary outcomes were self-management (Health Education Impact Questionnaire: 8 domains), quality of life, mood and acceptability. Of 340 invitations sent from AuSCR, 73 responded, 68 were eligible and 57 (84%) completed the baseline assessment. At the goal-setting stage, 54/68 (79%) were randomised (median 16 months after stroke): 25 to intervention (median age 69 years 40% female) and 29 to control (median age 68 years 38% female). Forty-five (83%) participants completed the outcome follow-up assessment. At follow-up, goal attainment (mean GAS-T score ≥ 50) in the intervention group was achieved for goals related to function, participation and environment (control: environment only). Most intervention participants provided positive feedback and reported that the iVERVE messages were easy to understand (92%) and assisted them in achieving their goals (77%). We found preliminary evidence of non-significant improvements between the groups for most self-management domains (e.g. social integration and support: β coefficient 0.34 95% CI − 0.14 to 0.83) and several quality-of-life domains in favour of the intervention group. These findings support the need for further randomised effectiveness trials of the iVERVE program to be tested in people with new stroke. ANZCTR, ACTRN12618001519246 . Registered on 11 September 2018—retrospectively registered.
Measures Associated With Early, Late, and Persistent Clinically Significant Symptoms of Depression 1 Year After Stroke in the AFFINITY Trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-03-2022
DOI: 10.1212/WNL.0000000000200058
Abstract: To determine the sociodemographic and clinical factors associated with early, late, and persistent clinically significant symptoms of depression during the first year after a stroke. This cohort study included 1,221 men and women recruited within 2 weeks of stroke onset in Australia, New Zealand, and Vietnam. The NIH Stroke Scale (NIHSS) was used to assess stroke severity. Other study measures included age, sex, marital status, living arrangements, function before the stroke, depression before the stroke, modified Rankin Scale (mRS) score, and treatment with fluoxetine or placebo for 26 weeks. Clinically significant symptoms of depression during the 52 weeks after baseline was the outcome of interest, and the presence of depression was defined by a total Patient Health Questionnaire (PHQ-9) score of ≥9 at week 4, 12, 26, or 52 a clinician diagnosis of depression between assessments or pharmacologic or psychological treatment of depression during follow-up. Participants were classified as not depressed or as having early (initial 12 weeks), late (12–52 weeks), or persistent (before and after 12 weeks) depression. We used multinomial logistic regression to assess depression risk, with all listed measures entered simultaneously into the model. The mean age of participants was 63.8 (SD 12.3) years, and 775 (63.5%) were male. At baseline, 48 (3.9%) participants had previous treated depression, and 228 (18.7%) had clinically significant symptoms of depression (PHQ-9 score ≥9). Seven hundred thirty-four (63.3%) participants showed no evidence of depression in the year after the stroke 208 (17.9%) had early, 86 (7.4%) had late, and 131 (11.3%) had persistent depression. Increased stroke severity, as measured by doubling of the NIHSS scores, was associated with an increased risk of early (risk ratio [RR] 2.08, 95% CI 1.65–2.62), late (RR 1.53, 95% CI 1.14–2.06), and persistent (RR = 2.50, 95% CI 1.89–3.32) clinically significant symptoms of depression. Similar findings were apparent for the mRS, a measure of functional disability. Past depression was associated with increased risk of persistent clinically significant symptoms of depression (RR = 6.28, 95% CI 2.88–13.71), as was being married or partnered (RR = 3.94, 95% CI 2.42–6.41). The risk of clinically significant symptoms of depression was higher in Australia and New Zealand than in Vietnam. The severity of neurologic and functional deficits increases the risk of poststroke clinically significant symptoms of depression early and persistently. Depression before stroke, personal relationships, and cultural context contribute to mediate depression risk. Interventions that minimize the severity of neurologic and functional deficits should decrease the risk of poststroke clinically significant symptoms of depression. Clinical trial registration number ACTRN12611000774921.
Trauma and Violence Informed Care Through Decolonising Interagency Partnerships: A Complexity Case Study of Waminda’s Model of Systemic Decolonisation
Publisher: MDPI AG
Date: 09-10-2020
Abstract: Through the lens of complexity, we present a nested case study describing a decolonisation approach developed and implemented by Waminda South Coast Women’s Health and Welfare Aboriginal Corporation. Using Indigenous research methods, this case study has unfolded across three phases: (1) Yarning interviews with the workforce from four partner health services (n = 24) (2) Yarning circle bringing together key informants from yarning interviews to verify and refine emerging themes (n = 14) (3) Semi-structured interviews with a facilitator of Waminda’s Decolonisation Workshop (n = 1) and participants (n = 10). Synthesis of data has been undertaken in stages through collaborative framework and thematic analysis. Three overarching themes and eight sub-themes emerged that centred on enhancing the capabilities of the workforce and strengthening interagency partnerships through a more meaningful connection and shared decolonisation agenda that centres Aboriginal and Torres Strait Islander families and communities. Health and social services are complex systems that function within the context of colonisation. Waminda’s innovative, model of interagency collaboration enhanced workforce capability through shared language and collective learning around colonisation, racism and Whiteness. This process generated in idual, organisational and systemic decolonisation to disable power structures through trauma and violence informed approach to practice.
Pharmaceutical interventions for emotionalism after stroke
Publisher: Wiley
Date: 17-11-2022
Frequency, determinants, and effects of early seizures after thrombolysis for acute ischemic stroke: The ENCHANTED trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-07-2017
DOI: 10.1212/CPJ.0000000000000384
Abstract: Seizures after ischemic stroke have not been well-studied. We aim to determine the frequency, determinants, and significance of early seizures after thrombolysis for acute ischemic stroke. Data are from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), an international, multicenter, randomized controlled trial where patients with acute ischemic stroke were randomized to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) IV alteplase. The protocol prespecified prospective data collection on in-hospital seizures over 7 days postrandomization. Logistic regression models were used to determine variables associated with seizures and their significance on poor outcomes of death or disability (modified Rankin scale scores 3–6), symptomatic intracerebral hemorrhage (sICH), and European Quality of Life 5-Dimensions questionnaire [EQ-5D] over 90 days. Data were available for 3,139 acute ischemic stroke participants, of whom 42 (1.3%) had seizures at a median 22.7 hours after the onset of symptoms. Baseline variables associated with seizures were male sex (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.07–4.50), severe neurologic impairment (NIH Stroke Scale score ≥10 OR 2.16, 95% CI 1.06–4.40), and fever (OR 4.55, 95% CI 2.37–8.71). Seizures independently predicted poor recovery: death or major disability (OR 2.88, 95% CI 1.28–6.47), unfavorable ordinal shift of mRS scores (OR 1.94, 95% CI 1.10–3.39), and lower than median EQ-5D health utility index score (OR 3.50, 95% CI 1.37–8.91). There was no association of seizures with sICH in adjusted analysis. In thrombolysis-treated patients with acute ischemic stroke, seizures are uncommon, occur early, and predict poor recovery. NCT01422616.
Selective Serotonin Reuptake Inhibitors for Stroke Recovery A Systematic Review and Meta-analysis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2013
Upper gastrointestinal endoscopy: Are preparatory interventions effective?
Publisher: Elsevier BV
Date: 10-1998
DOI: 10.1016/S0016-5107(98)70001-X
Abstract: This study was designed to examine the effects of preparatory cognitive and behavioral information on self-confidence, anxiety, and negative affect elicited by an impending upper gastrointestinal endoscopy. Forty-eight male and female out-patients, between 18 and 65 years of age, scheduled for a first-time, non-emergency, endoscopic examination were randomly assigned to receive one of four experimental interventions: cognitive, behavioral, combination, or attention-control. Measures of self-reported anxiety and self-reported self-confidence were obtained. Cognitive and combination intervention subjects were statistically younger than behavioral and attention-control subjects. A credibility assessment revealed that subjects who were taught visualization used it during their procedure. Results indicated that subjects in the cognitive and combination interventions experienced significant reduction in anxiety and increase in self-confidence from pre- to post-intervention. Self-confidence did not increase for subjects receiving the behavioral-only or the attention-control interventions. The results of this study show that preparatory information in general is effective in reducing anxiety and in increasing self-confidence before an upper gastrointestinal endoscopy. Results suggest that teaching subjects visualization before a procedure increases their use of visualization during a procedure.
Leg ulceration and perceived health: a population based case-control study
Publisher: Oxford University Press (OUP)
Date: 05-2004
Delivering motivational interviewing early post stroke: standardisation of the intervention.
Publisher: Informa UK Limited
Date: 23-12-2022
DOI: 10.1080/09638288.2020.1864035
Abstract: We applied Motivational Interviewing (MI) techniques, early after stroke, to facilitate psychological adjustment to life post-stroke. In our trial, MI-plus-usual-care increased the likelihood of normal mood at 3-months post-stroke, compared to usual-care alone. Whilst appropriate training, manuals, and supervision may increase adherence to core principles of this complex intervention, unintended variability in implementation inevitably remains. We aimed to explore the impact of variability on participant outcome. Using our trial data (411 participants), we explored variation in MI delivery, examining: therapist characteristics (stroke care expertise/knowledge, psychology training) MI content (fidelity to MI techniques assessed with Motivational Interviewing Treatment Integrity code, describing therapist behaviours as MI-consistent, MI-neutral or MI-inconsistent) and MI dose (number/duration of sessions). The four MI therapists (two nurses/two psychologists) had varying expertise and MI delivery. Across therapists, mean average session duration ranged 29.5-47.8 min. The percentage of participants completing the per-protocol four sessions ranged 47%-74%. These variations were not related to participant outcome. There were uniformly high frequencies (>99%) of MI-consistent and MI-neutral interactions, and low frequencies (<1%) of MI-inconsistent interactions. Variation in therapist characteristics and MI dose did not affect participant outcome. These may have been tolerated due to high fidelity to MI principles.IMPLICATIONS FOR REHABILITATIONMotivational Interviewing (MI) can help reduce depression in stroke survivors when delivered early after stroke.The effectiveness of our MI intervention depends on the delivery of high quality MI in particular, interactions with low levels of MI-inconsistency, and high global MI ratings, ideally delivered over more than one session, each lasting at least 30 minutes.Provided high quality MI is being delivered, the intervention can still have a beneficial effect on participant outcome, even with flexibility and variation in therapist characteristics, and duration and number of sessions, which may be inevitable in a clinical context.
Predictors of depression after stroke: A systematic review of observational studies
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2005
DOI: 10.1161/01.STR.0000183622.75135.A4
Abstract: Background and Purpose— Although depression is common after stroke, there is uncertainty over its etiology and risk factors, which complicates management. Knowledge of the predictors of depression associated with stroke may allow for the better targeting of therapy, both prevention and treatment. Methods— We undertook a systematic review of all published, nonexperimental, population-, hospital-, and rehabilitation-based stroke studies (to June 2004) with prospective, consecutive patient recruitment undertaken to identify variables associated with depressive symptoms (or “illness”) after stroke. Assessments were made of the quality of studies including the validity of prognostic models. Results— Data were available from 3 population-based studies including 492 patients, 8 hospital-based studies including 15 272 patients, and 9 rehabilitation-based studies including 2170 patients. Physical disability, stroke severity and cognitive impairment were consistently associated with depression. In addition to the common problem of selection bias, major limitations of these studies included variable selection and poor statistical quality and reporting small s le sizes meant that only a limited range of variables were analyzed in multivariate models. Conclusions— There is a paucity of well-designed studies of sufficient size to allow stable multivariate predictive models of depression after stroke to be developed. Other than showing that depression is associated with more severe strokes, current evidence does not allow for ready identification of patients most at risk of developing this important complication of stroke.
Early predictors of remission in newly diagnosed epilepsy: a systematic approach to reviewing prognostic factor studies
Publisher: Informa UK Limited
Date: 23-10-2013
Perspectives of people with late age‐related macular degeneration on mental health and mental wellbeing programmes: a qualitative study
Publisher: Wiley
Date: 11-01-2021
DOI: 10.1111/OPO.12779
Abstract: People with age‐related macular degeneration (AMD) experience high rates of depression, but rarely engage in or have access to tailored mental wellbeing programmes. This qualitative study investigated the perspectives of those primarily with late AMD on mental health and mental wellbeing programmes. Twenty‐eight people with late AMD in at least one eye, and one person with early AMD in both eyes, aged 56–87 years (mean age 78 years) attending a private eye clinic between December 2019 and January 2020 in Sydney, New South Wales, Australia, participated. In idual semi‐structured interviews were conducted and analysed deductively using content analysis, following the in idual level factors for health promotion interventions in the behaviour change wheel: Capability (Physical & Psychological) , Opportunity (Physical & Social) , and Motivation (Reflective & Automatic) . Six major themes were identified: Capability: (1) Impact of vision loss on mobility and leisure pursuits (2) Adjustment to living with vision loss Opportunity : (3) Program considerations for those with AMD (4) Stigma and self‐perception of vision loss and mental health Motivation: (5) Accumulation of vision‐related issues as a barrier to participation (6) Ex les of others living with vision loss. General personal factors relevant to delivery of a programme in this age group were also identified: Comorbidities Limitations using technology Isolation Financial concerns and Beliefs that undesired effects of aging are inevitable. Complex in idual, environmental and social factors influence the perspectives of people with late AMD on mental health, and potential participation in mental wellbeing programmes. These factors should be considered when developing and implementing mental wellbeing programmes to improve the emotional and functional rehabilitation outcomes for people with AMD.
Process evaluations of primary care interventions addressing chronic disease: a systematic review
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJOPEN-2018-025127
Abstract: Process evaluations (PEs) alongside randomised controlled trials of complex interventions are valuable because they address questions of for whom, how and why interventions had an impact. We synthesised the methods used in PEs of primary care interventions, and their main findings on implementation barriers and facilitators. Systematic review using the UK Medical Research Council guidance for PE as a guide. Academic databases (MEDLINE, SCOPUS, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE and Global Health) were searched from 1998 until June 2018. We included PE alongside randomised controlled trials of primary care interventions which aimed to improve outcomes for patients with non-communicable diseases. Two independent reviewers screened and conducted the data extraction and synthesis, with a third reviewer checking a s le for quality assurance. 69 studies were included. There was an overall lack of consistency in how PEs were conducted and reported. The main weakness is that only 30 studies were underpinned by a clear intervention theory often facilitated by the use of existing theoretical frameworks. The main strengths were robust s ling strategies, and the triangulation of qualitative and quantitative data to understand an intervention’s mechanisms. Findings were synthesised into three key themes: (1) a fundamental mismatch between what the intervention was designed to achieve and local needs (2) the required roles and responsibilities of key actors were often not clearly understood and (3) the health system context—factors such as governance, financing structures and workforce—if unanticipated could adversely impact implementation. Greater consistency is needed in the reporting and the methods of PEs, in particular greater use of theoretical frameworks to inform intervention theory. More emphasis on formative research in designing interventions is needed to align the intervention with the needs of local stakeholders, and to minimise unanticipated consequences due to context-specific barriers. CRD42016035572.
Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial
Publisher: Elsevier BV
Date: 08-2020
Sydney epilepsy incidence study to measure illness consequences: The SESIMIC observational epilepsy study protocol
Publisher: Springer Science and Business Media LLC
Date: 09-01-2011
Dual diagnosis of epilepsy and psychogenic nonepileptic seizures: Systematic review and meta-analysis of frequency, correlates, and outcomes
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.YEBEH.2018.10.010
Abstract: Comorbid epilepsy and psychogenic nonepileptic seizures (PNES) represent a serious challenge for the clinicians. However, the frequency, associations, and outcomes of dual diagnosis of epilepsy and PNES are unclear. The aim of the review was to determine the frequency, correlates, and outcomes of a dual diagnosis. A systematic review of all published observational studies (from inception to Dec. 2016) was conducted to determine the frequency, correlates, and outcomes of dual diagnosis. We included studies of in iduals of any age reporting a dual diagnosis of epilepsy and PNES. All observational study designs were included with the exception of case reports and case series with fewer than 10 participants. The mean frequency of epilepsy in patients with PNES across all studies was 22% (95% confidence intervals [CI] 20 to 25%, range: 0% to 90%) while the mean frequency of PNES in patients with epilepsy was 12% (95% CI 10 to 14%, range: 1% to 62%). High heterogeneity means that these pooled estimates should be viewed with caution. A number of correlates of dual diagnosis were reported. Some studies delineated differences in semiology of seizures in patients with dual diagnosis vs. PNES or epilepsy only. However, most of the correlates were inconclusive. Only a few studies examined outcome in patients with dual diagnosis. Dual diagnosis is common in clinical practice, especially among patients referred to specialized services, and requires careful diagnosis and management.
Influence of Including Patients with Premorbid Disability in Acute Stroke Trials: The HeadPoST Experience
Publisher: S. Karger AG
Date: 2021
DOI: 10.1159/000512608
Abstract: b i Background: /i /b Patients with premorbid functional impairment are generally excluded from acute stroke trials. We aimed to determine the impact of including such patients in the Head Positioning in acute Stroke Trial (HeadPoST) and early additional impairment on outcomes. b i Methods: /i /b Post hoc analyses of HeadPoST, an international, cluster-randomized crossover trial of lying-flat versus sitting-up head positioning in acute stroke. Associations of early additional impairment, defined as change in modified Rankin scale (mRS) scores from premorbid levels (estimated at baseline) to Day 7 (“early ΔmRS”), and poor outcome (mRS score 3–6) at Day 90 were determined with generalized linear mixed model. Heterogeneity of the trial treatment effect was tested according to premorbid mRS scores 0–1 versus 2–5. b i Results: /i /b Of 8,285 patients (38.9% female, mean age 68 ± 13 years) with complete data, there were 1,984 (23.9%) with premorbid functional impairment (mRS 2–5). A significant linear association was evident for early ∆mRS and poor outcome (per 1-point increase in ΔmRS, adjusted odds ratio 1.20, 95% confidence interval 1.14–1.27 i /i & #x3c 0.0001). Patients with greater premorbid functional impairment were less likely to develop additional impairment, but their risk of poor 90-day outcome significantly increased with increasing (worse) premorbid mRS scores (linear trend i /i & #x3c 0.0001). There was no heterogeneity of the trial treatment effect by level of premorbid function. b i Conclusions: /i /b Early poststroke functional impairment that exceeded premorbid levels was associated with worse 90-day outcome, and this association increased with greater premorbid functional impairment. Yet, including premorbid impaired patients in the HeadPoST did not materially affect the subsequent treatment effect. b i Clinical Trial Registration: /i /b HeadPoST is registered at www.ClinicalTrials.gov (NCT02162017).
Disability patterns over the first year after a diagnosis of epilepsy
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.CLINEURO.2019.02.022
Abstract: To determine the patterns and predictors of disability over the first 12 months after a diagnosis of epilepsy. The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people with newly diagnosed epilepsy in Sydney, Australia. Disability was assessed using the World Health Organization's, Disability Assessment Schedule (WHODAS) 2.0 12-item version, at baseline (i.e. within 28 days of diagnosis) and 12 months post-diagnosis. Demographic, socioeconomic, clinical and epilepsy-related data, obtained through structured interviews, were entered into multivariable linear regression and shift analysis to determine predictors of greater disability. Of 259 adults (≥18 years), 190 (73%) had complete WHODAS at baseline (mean ± SD scores 4 ± 6) and follow-up (4 ± 8). After adjustment for age, sex and co-morbidity, greater overall disability at 12 months was associated with lower education (P = 0.05), economic hardship (P = 0.004), multiple antiepileptic medications (P = 0.02) and greater disability (P < 0.001) at the time of diagnosis these variables explained 38.3% of the variance. Among the 12 WHODAS items, "being emotionally affected by health problems" was the most frequent disability problem identified at both time points (all P < 0.0001). The proportion of participants without problems in that domain improved over 12 months (from 24% to 50%, P < 0.0001), whereas the other 11 items remained relatively stable. Independent baseline predictors of a worse emotional outcome at 12 months were severe/extreme emotional distress (odds ratio [OR] 4.52, 95% confidence intervals [CI] 1.67-12.24), economic hardship (OR 2.30, 95% CI 1.24-4.25) and perceived stigma (OR 2.02, 95% CI 1.03-3.93). Most people report problems with emotional health after a diagnosis of epilepsy but many recover over the next 12 months. Services addressing the social and psychological impact of diagnosis may be needed to improve outcome.
Pharmacological, Psychological, and Noninvasive Brain Stimulation Interventions for Treating Depression After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2020
“It's hard for me to tell my story” the experiences of Aboriginal and Torres Strait Islander male clients at a residential drug and alcohol rehabilitation centre using primary health care
Publisher: Wiley
Date: 18-01-2021
DOI: 10.1002/HPJA.452
Abstract: Aboriginal males who use drug and alcohol may experience unique barriers accessing primary health care. This study explores the perceptions of Aboriginal males in treatment for drug and alcohol use around their experiences accessing primary health care, and barriers to access. Twenty male Aboriginal clients at a fee‐paying residential drug and alcohol rehabilitation centre completed semi‐structured interviews about their primary health care experiences before their stay. Interpretative phenomenological analysis was used to inductively develop themes. About half the males had regular General Practitioners at a mainstream primary health care service or Aboriginal Medical Service. Positive experiences included having medical needs met or understanding the health information provided and negative experiences included inefficient health service or system processes or experiencing cultural bias or racism. Barriers included limited access to appointments or to the same GP regularly, long wait times, lack of access to transport, worry or fear about their health or the visit or their complex lives taking priority. This research showed that the participants sought out health care and identified barriers to accessing care and potential improvements. Access to a regular General Practitioner, continuity of care and culturally appropriate and comprehensive communication techniques are important to facilitate access to primary health care by Aboriginal males. Efforts to enhance access may focus on inherent strengths within Aboriginal communities including focusing on relationships between clinicians and families, providing a welcoming environment and encouraging clients to bring a trusted family member to appointments.
inVestIgating the pSychologIcal and ecONomic impAct of cataRact surgerY in Vietnam: The VISIONARY observational study protocol
Publisher: Springer Science and Business Media LLC
Date: 12-09-2011
Driving in stroke survivors aged 18-65 years: The Psychosocial Outcomes In StrokE (POISE) Cohort Study
Publisher: SAGE Publications
Date: 09-07-2016
Abstract: There is limited information regarding return to driving after stroke. To determine the frequency and predictors of return to driving within 1 month of acute stroke in younger (age 18–65 years) adults. POISE (Psychosocial Outcomes In StrokE) was a cohort study conducted in Australia between October 2008 and June 2010. Consecutive patients (age 18–65 years) with a recent (≤28 days) acute stroke were recruited. Validated demographic, clinical, mental health, cognitive, and disability measures including return to driving were obtained. Multivariable logistic regression was used to determine factors associated with return to driving within 1 month of stroke. Among 359 participants who were legally able to drive before stroke, 96 (26.7%) returned to driving within 1 month. Compared to those without an early return to driving ( n = 263), drivers were more often male, the main income earner, in paid work before stroke and without symptoms of depression or fatigue. Independence in activities of daily living (odds ratio (OR) 30.05, 95% confidence interval (CI) 3.85–234.45), not recalling receiving advice on driving cessation (OR 5.55, 95% CI 2.86–11.11), and having returned to paid work (OR 3.93, 95% CI 1.94–7.96) were associated with early return to driving. One in four young adults resumed driving within a month, contrary to guideline recommendations. These data reinforce the importance of deciding who is responsible for determining fitness to drive after stroke, when, and whether it is reasonable to enforce driving restrictions on those with minimal disability who are fit to return to work. Australian New Zealand Clinical Trials Registry ANZCTRN 12608000459325.
Returning to Paid Employment after Stroke: The Psychosocial Outcomes In StrokE (POISE) Cohort Study
Publisher: Public Library of Science (PLoS)
Date: 25-07-2012
Global systematic review of Indigenous community-led legal interventions to control alcohol
Publisher: BMJ
Date: 03-2017
Examining the use of process evaluations of randomised controlled trials of complex interventions addressing chronic disease in primary health care-a systematic review protocol
Publisher: Springer Science and Business Media LLC
Date: 15-08-2016
imProving Outcomes after STroke Clinical Pilot Trial Protocol
Publisher: SAGE Publications
Date: 02-2010
DOI: 10.1111/J.1747-4949.2009.00388.X
Abstract: One in three patients experience depression after stroke and this risk is consistent over time. A strategy to prevent depression that could be economically delivered to most stroke patients and ideally which also has a low likelihood of adverse events needs to be developed and evaluated. POST aims to determine whether a simple intervention (postcards) prevents depression (Hospital Anxiety and Depression rating Scale, HADS depression subscale score ≥8) in patients with a recent stroke. Secondary end-points include reduced anxiety (HADS anxiety subscale score ≥8) and improved health-related quality of life in patients with a recent stroke. A single-centre randomised, double-blind, pilot trial to prevent depression in patients with a recent (within 8 weeks) stroke presenting to hospital. Patients will be enrolled over 12 months and randomised to receive three trial-specific assessments (baseline, 3- and 6-month assessments of mood, HRQoL and social functioning), or three trial-specific assessments plus a postcard sent centrally in a sealed envelope at 1, 2, 3, 4 and 5 months after discharge from hospital. Blinded follow-up telephone assessments will be conducted for both groups. For the primary end-point the POST trial will have 80% power to detect a relative risk of 0·4 given an incidence of depression of 30%. For the secondary aims POST has 90% power to detect a difference of 3 points on the HADS depression subscale (assuming a standard deviation of 6 points) between randomised groups. This includes an inflation factor of 15% to account for patients lost to follow-up. Evidence of efficacy will determine whether a multi-centre, international trial is warranted.
Ambient Temperature and Stroke Occurrence: A Systematic Review and Meta-Analysis
Publisher: MDPI AG
Date: 12-07-2016
Neuropsychiatric outcomes of stroke
Publisher: Elsevier BV
Date: 05-2014
Are the symptoms of calcific tendinitis due to neoinnervation and/or neovascularization
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-02-2016
DOI: 10.2106/JBJS.O.00417
Letter by mead et al regarding article, selective serotonin reuptake inhibitors for stroke: More trials are needed
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS): a randomised, double-blind, placebo-controlled trial
Publisher: Elsevier BV
Date: 08-2020
Ethnic disparities in incidence of stroke subtypes: Auckland Regional Community Stroke Study, 2002–2003
Publisher: Elsevier BV
Date: 02-2006
Ethnicity and Other Determinants of Quality of Functional Outcome in Acute Ischemic Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
DOI: 10.1161/STROKEAHA.119.027639
Abstract: Patient-centered outcomes are important. We aimed to determine predictors of health-related quality of life (HRQoL) and develop utility-weighted modified Rankin Scale (mRS) scores in thrombolyzed acute ischemic stroke patients from both arms of ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). ENCHANTED was an international quasi-factorial clinical trial of different doses of intravenous alteplase and intensities of blood pressure control in acute ischemic stroke patients, with outcomes on the 5-Dimensional European Quality of Life Scale and mRS assessed at 90 days post-randomization. Logistic regression models were used to identify baseline predictors of poor HRQoL (≤mean 5-Dimensional European Quality of Life Scale utility scores). Ordinary least squares regression derived utility-weighted mRS scores. In 4016 acute ischemic stroke patients with complete 5-Dimensional European Quality of Life Scale and mRS data, independent predictors of poor HRQoL were older age (odds ratio, 1.19 [95% CI, 1.12–1.27], per 10-year increase), non-Asian ethnicity (1.91 [1.61–2.27]), greater stroke severity on the National Institutes of Health Stroke Scale (1.11 [1.09–1.12]), diabetes mellitus (1.41 [1.18–1.69]), premorbid disability (mRS score 1 versus 0 1.62 [1.33–1.97]), large vessel atheromatous pathogenesis (1.32 [1.12–1.54]), and proxy respondent (2.35 [2.01–2.74]). Sensitivity analyses indicate the ethnicity influence on HRQoL was driven by the high proportion of Chinese (62.9% of Asian) participants with better HRQoL compared with non-Chinese or other Asian groups. Derived utility values across mRS scores 0 to 5 were 0.977, 0.885, 0.748, 0.576, 0.194, and −0.174, respectively. Correlations between mRS and 5-Dimensional European Quality of Life Scale scores were stronger in Asians. HRQoL is worse after thrombolyzed acute ischemic stroke in the elderly, non-Asians, with greater initial severity, diabetes mellitus, premorbid disability, due to large vessel atheroma, and proxy assessment. The broader significance of better HRQoL in Asians is tempered by Chinese participants dominating analyses. From utility-weighted mRS scores indicating the greatest steps in mRS scores are between 5 and 3, treatments to avoid major disability provide the greatest benefits for patients. URL: www.clinicaltrials.gov . Unique identifier: NCT01422616.
The influence of psychiatric morbidity on return to paid work after stroke in younger adults: The auckland regional community stroke (ARCOS) study, 2002 to 2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2008
DOI: 10.1161/STROKEAHA.107.503219
Abstract: Background and Purpose— Few data exist on the determinants of return to paid work after stroke, yet participation in employment is vital to a person’s mental well-being and role in society. This study aimed to determine the frequency and determinants of return to work, in particular the effect of early psychiatric morbidity, in a population-based study of stroke survivors. Methods— The third Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based, stroke incidence study undertaken in Auckland, New Zealand during 2002 to 2003. After a baseline assessment early after stroke, data were collected on all survivors at 1 and 6 months follow-up. Multiple variable logistic regression was used to determine predictors of return to paid work. Data are reported with odds ratios (OR) and 95% confidence intervals (CI). Results— Among 1423 patients registered with first-ever strokes, there were 210 previously in paid employment who survived to 6 months, of whom 155 (74%) completed the GHQ-28 and 112 (53%) had returned to paid work. Among those cognitively competent, psychiatric morbidity at 28 days was a strong independent predictor of not returning to work (Odds Ratio 0.39 95% CI 0.22 to 0.80). Non–New Zealand European ethnicity (OR 0.40 95% CI 0.17 to 0.91), prior part-time, as opposed to full-time, employment 0.36 (0.15 to 0.89), and not being functionally independent soon after the stroke 0.28 (0.13 to 0.59) were the other independent age- and gender-adjusted predictors of not successfully returning to paid work. Conclusions— About half of previously employed people return to paid employment after stroke, with psychiatric morbidity and physical disability being independent, yet potentially treatable, determinants of this outcome. Appropriate management of both emotional and physical sequelae would appear necessary for optimizing recovery and return to work in younger adults after stroke.
Statistical analysis plan for the Head Position in Stroke Trial (HeadPoST): An international cluster cross-over randomized trial.
Publisher: SAGE Publications
Date: 24-03-2017
Abstract: There is evidence to indicate that the lying flat head position increases cerebral blood flow and oxygenation in patients with acute ischemic stroke, but how these physiological effects translate into clinical outcomes is uncertain. The Head Position in Stroke Trial aims to determine the comparative effectiveness of lying flat (0°) compared to sitting up (≥30°) head positioning, initiated within 24 h of hospital admission for patients with acute stroke. An international, pragmatic, cluster-randomized, crossover, open, blinded outcome assessed clinical trial. Each hospital with an established acute stroke unit (cluster) site was required to recruit up to 140 consecutive cases of acute stroke (one phase of head positioning before immediately crossing over to the other phase of head positioning), including both acute ischemic stroke and intracerebral hemorrhage, in each randomized head position as a ‘business as usual’ policy. To outline in detail the predetermined statistical analysis plan for the study. All accumulated data will be reviewed and formally assessed. Information regarding baseline characteristics of patients, their process of care and management will be outlined, and for each item, statistically relevant descriptive elements will be described. For the trial outcomes, the most appropriate statistical comparisons are described. A statistical analysis plan was developed that is transparent, verifiable, and predetermined before completion of data collection. We developed a predetermined statistical analysis plan for Head Position in Stroke Trial to avoid analysis bias arising from prior knowledge of the findings, in order to reliably quantify the benefits and harms of lying flat versus sitting up early after the onset of acute stroke. ClinicalTrials.gov identifier NCT02162017 ANZCTR identifier ACTRN12614000483651
Interventions for Preventing Depression After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
A mixed-methods feasibility study of a new digital health support package for people after stroke: the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (
Publisher: Springer Science and Business Media LLC
Date: 19-11-2022
DOI: 10.1186/S40814-022-01197-8
Abstract: Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Re covery-focused C ommunity support to A void readmissions and improve P articipation after S troke (ReCAPS) trial. We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Between November 2018 and October 2019, 312 patients were screened 37/105 (35%) eligible patients provided consent (mean age 61 years 32% female) 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018) Universal Trial Number: U1111-1206-7237
Australian Aboriginal and Torres Strait Islander-focused primary healthcare social and emotional wellbeing research: a systematic review protocol
Publisher: Springer Science and Business Media LLC
Date: 12-2015
The Impact of Stroke on Unpaid Caregivers: Results from the Auckland Regional Community Stroke Study, 2002–2003
Publisher: S. Karger AG
Date: 2008
DOI: 10.1159/000131673
Abstract: i Background: /i Few studies have assessed the longitudinal impact of providing unpaid care for stroke survivors. We aimed to describe the positive and negative impact of providing unpaid care and to identify independent predictors of poor carer outcome. i Methods: /i The Auckland Regional Community Stroke study was a prospective population-based stroke incidence study conducted in Auckland, New Zealand, over a 12-month period in 2002–2003. Stroke survivors and their unpaid carers were assessed at 6 and 18 months after stroke onset using the Short Form 36 questionnaire and the Bakas Caregiving Outcomes Scale. i Results: /i Data were available from 167 stroke survivor–carer pairs at 6 months and 62 pairs at 18 months. Unpaid carers reported lower health-related quality of life at 6 months after stroke than their age- and sex-matched counterparts in the New Zealand population. The impact of providing care was predominantly negative however, approximately one third of the carers had improved relationships with the stroke survivor. No reliable predictors of carer burden were identified. i Conclusions: /i This study re-emphasises the heavy burden of stroke on unpaid carers but was unable to identify factors that predicted carers at the greatest risk of experiencing a poor outcome. Effective strategies are needed to reduce the burden of providing unpaid care.
Stroke in India: A systematic review of the incidence, prevalence, and case fatality
Publisher: SAGE Publications
Date: 02-07-2021
DOI: 10.1177/17474930211027834
Abstract: The burden of stroke is increasing in India stroke is now the fourth leading cause of death and the fifth leading cause of disability. Previous research suggests that the incidence of stroke in India ranges between 105 and 152/100,000 people per year. However, there is a paucity of available data and a lack of uniform methods across published studies. To identify high-quality prospective studies reporting the epidemiology of stroke in India. A search strategy was modified from the Cochrane Stroke Strategy and adapted for a range of bibliographic databases from January 1997 to August 2020. From 7717 identified records, nine studies were selected for inclusion three population-based registries, a further three population-based registries also using community-based ascertainment and three community-based door-to-door surveys. Studies represented the four cities of Mumbai, Trivandrum, Ludhiana, Kolkata, the state of Punjab, and 12 villages of Baruipur in the state of West Bengal. The total population denominator was 22,479,509 and 11,654 (mean 1294 SD 1710) people were identified with incident stroke. Crude incidence of stroke ranged from 108 to 172/100,000 people per year, crude prevalence from 26 to 757/100,000 people per year, and one-month case fatality rates from 18% to 42%. Further high-quality evidence is needed across India to guide stroke policy and inform the development and organization of stroke services. Future researchers should consider the World Health Organization STEPwise approach to Surveillance framework, including longitudinal data collection, the inclusion of census population data, and a combination of hospital-registry and comprehensive community ascertainment strategies to ensure complete stroke identification.
Protocol for process evaluation of a randomised controlled trial of family-led rehabilitation post stroke (ATTEND) in India
Publisher: BMJ
Date: 09-2016
DOI: 10.1136/BMJOPEN-2016-012027
Abstract: We are undertaking a randomised controlled trial (fAmily led rehabiliTaTion aftEr stroke in INDia, ATTEND) evaluating training a family carer to enable maximal rehabilitation of patients with stroke-related disability as a potentially affordable, culturally acceptable and effective intervention for use in India. A process evaluation is needed to understand how and why this complex intervention may be effective, and to capture important barriers and facilitators to its implementation. We describe the protocol for our process evaluation to encourage the development of in-process evaluation methodology and transparency in reporting. The realist and RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) frameworks informed the design. Mixed methods include semistructured interviews with health providers, patients and their carers, analysis of quantitative process data describing fidelity and dose of intervention, observations of trial set up and implementation, and the analysis of the cost data from the patients and their families perspective and programme budgets. These qualitative and quantitative data will be analysed iteratively prior to knowing the quantitative outcomes of the trial, and then triangulated with the results from the primary outcome evaluation. The process evaluation has received ethical approval for all sites in India. In low-income and middle-income countries, the available human capital can form an approach to reducing the evidence practice gap, compared with the high cost alternatives available in established market economies. This process evaluation will provide insights into how such a programme can be implemented in practice and brought to scale. Through local stakeholder engagement and dissemination of findings globally we hope to build on patient-centred, cost-effective and sustainable models of stroke rehabilitation. CTRI/2013/04/003557.
Effect of text messaging on depression in patients with coronary heart disease: a substudy analysis from the TEXT ME randomised controlled trial
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-022637
Abstract: We aimed to evaluate the effects on depression scores of a lifestyle-focused cardiac support programme delivered via mobile phone text messaging among patients with coronary heart disease (CHD). Substudy and secondary analysis of a parallel-group, single-blind randomised controlled trial of patients with CHD. A tertiary hospital in Sydney, Australia. The Tobacco, Exercise and dieT MEssages programme comprised four text messages per week for 6 months that provided education, motivation and support on diet, physical activity, general cardiac education and smoking, if relevant. The programme did not have any specific mental health component. Depression scores at 6 months measured using the Patient Health Questionnaire-9 (PHQ-9). Treatment effect across subgroups was measured using log-binomial regression model for the binary outcome (depressed/not depressed, where depressed is any score of PHQ-9 ≥5) with treatment, subgroup and treatment by subgroup interaction as fixed effects. Depression scores at 6 months were lower in the intervention group compared with the control group, mean difference 1.9 (95% CI 1.5 to 2.4, p .0001). The frequency of mild or greater depressive symptoms (PHQ-9 scores≥5) at 6 months was 21/333 (6.3%) in the intervention group and 86/350 (24.6%) in the control group (relative risk (RR) 0.26, 95% CI 0.16 to 0.40, p .001). This proportional reduction in depressive symptoms was similar across groups defined by age, sex, education, body mass index, physical activity, current smoking, current drinking and history of depression, diabetes and hypertension. In particular, the rates of PHQ-9 ≥5 among people with a history of depression were 4/44 (9.1%) vs 29/62 (46.8%) in intervention vs control (RR 0.19, 95% CI 0.07 to 0.51, p .001), and were 17/289 (5.9%) vs 57/288 (19.8%) among others (RR 0.30, 95% CI 0.18 to 0.50, p .001). Among people with CHD, a cardiac support programme delivered via mobile phone text messaging was associated with fewer symptoms of mild-to-moderate depression at 6 months in the treatment group compared with controls. ACTRN12611000161921.
What are the resourcing requirements for an Aboriginal and Torres Strait Islander primary health care research project?
Publisher: The Sax Institute
Date: 09-2020
Operational challenges in the implementation of an anti-stigma campaign in rural Andhra Pradesh, India
Publisher: Oxford University Press (OUP)
Date: 10-2021
Abstract: Despite of literature available on mental health-related stigma interventions, little is reported about the operational challenges faced during the planning, implementation and evaluation phases. The Systematic Medical Appraisal, Referral and Treatment Mental Health Project was implemented in 42 villages of the West Godavari district in India. Andersen’s Behavioural Model for Health Services Use was adopted to understand the factors influencing anti-stigma c aign delivery and the strategies identified to overcome these challenges. The challenges faced during the planning and implementation phase included distance and time taken for travel by the field staff, inadequate mental health services and infrastructure within communities, engagement of community with the field staff and community’s poor mental health literacy and knowledge. Strategies used to overcome these challenges were regular engagement with community stakeholders, understanding mental health literacy levels and seeking inputs from the community regarding c aign design, organizing live drama shows at community’s preferred time and place and screening of recorded drama video clips where lives shows were difficult. The evaluation phase posed challenges such as non-availability of key stakeholders and inadequate time and funding to evaluate the entire study population. The reported findings can help in planning and scaling up of the anti-stigma c aign in large trials in similar settings.
Are rehabilitation services following stroke accessed equitably in Australia?: findings from the psychosocial outcomes in stroke (POISE) cohort study
Publisher: Springer Science and Business Media LLC
Date: 24-09-2013
Trends in Ethnic Disparities in Stroke Incidence in Auckland, New Zealand, During 1981 to 2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2006
DOI: 10.1161/01.STR.0000195131.23077.85
Abstract: Background and Purpose— Although geographical variations in stroke rates are well documented, limited data exist on temporal trends in ethnic-specific stroke incidence. Methods— We assessed trends in ethnic-specific stroke rates using standard diagnostic criteria and community-wide surveillance procedures in Auckland, New Zealand (NZ) in 1981 to 1982, 1991 to 1992, and 2002 to 2003. Indirect and direct methods were used to adjust first-ever (incident) and total (attack) rates for changes in the structure of the population and reported with 95% CIs. Ethnicity was self-defined and categorized as “NZ/European,” “Maori,” “Pacific peoples,” and “Asian and other.” Results— Stroke attack (19% 95% CI, 11% to 26%) and incidence rates (19% 95% CI, 12% to 24%) declined significantly in NZ/Europeans from 1981 to 1982 to 2002 to 2003. These rates remained high or increased in other ethnic groups, particularly for Pacific peoples in whom stroke attack rates increased by 66% (95% CI 11% to 225%) over the periods. Some favorable downward trends in vascular risk factors, such as cigarette smoking, were counterbalanced by increasing age, body mass index, and diabetes in certain ethnic groups. Conclusions— Divergent trends in ethnic-specific stroke incidence and attack rates, and of associated risk factors, have occurred in Auckland over recent decades. The findings provide mixed views as to the future burden of stroke in populations undergoing similar lifestyle and structural changes.
Fluoxetine for stroke recovery: Meta-analysis of randomized controlled trials.
Publisher: SAGE Publications
Date: 17-10-2020
Abstract: To determine whether fluoxetine, at any dose, given within the first year after stroke to patients who did not have to have mood disorders at randomization reduced disability, dependency, neurological deficits and fatigue improved motor function, mood, and cognition at the end of treatment and follow-up, with the same number or fewer adverse effects. Searches (from 2012) in July 2018 included databases, trials registers, reference lists, and contact with experts. Co-primary outcomes were dependence and disability. Dichotomous data were synthesized using risk ratios (RR) and continuous data using standardized mean differences (SMD). Quality was appraised using Cochrane risk of bias methods. Sensitivity analyses explored influence of study quality. The searches identified 3414 references of which 499 full texts were assessed for eligibility. Six new completed RCTs (n = 3710) were eligible, and were added to the seven trials identified in a 2012 Cochrane review (total: 13 trials, n = 4145). There was no difference in the proportion independent (3 trials, n = 3249, 36.6% fluoxetine vs. 36.7% control RR 1.00, 95% confidence interval 0.91 to 1.09, p = 0.99, I This class I evidence demonstrates that fluoxetine does not reduce disability and dependency after stroke but improves depression.
Blood pressure variability and outcome in acute ischemic and hemorrhagic stroke: a post hoc analysis of the HeadPoST study
Publisher: Springer Science and Business Media LLC
Date: 20-03-2019
Part I: Frequency of Depression after Stroke: An Updated Systematic Review and Meta-Analysis of Observational Studies
Publisher: SAGE Publications
Date: 12-08-2014
DOI: 10.1111/IJS.12357
Abstract: Approximately 15 million people who suffer a stroke globally each year are at risk of developing depression. To update our systematic review and meta-analysis of the frequency of depression after stroke published in 2005, including studies published before July 2004. We included all published observational studies (to 31 May 2013) with prospective consecutive recruitment and quantification of the proportion of people with depression after stroke. We included studies of adult ( years) patients with a clinical diagnosis of stroke, where an assessment of depression or depressive symptom burden was performed at a pre-specified time-point for all study participants. Data were available from 61 studies including 25 488 people. The proportional frequency of depression varied considerably across studies however, the pooled frequency estimate of 31% (95% confidence interval 28% to 35%) was not significantly different from the 33% (difference of 2%, 95% confidence interval % to 3%) reported in the 2005 review. The proportion with depression between one and five-years (25% 95% confidence interval 16 to 33%) and at five years after stroke (23% 95% confidence interval 14 to 31%) was significantly lower. Despite systematic review evidence describing validated depression screening tools and effective treatment and prevention strategies for depression after stroke, there has not been a significant reduction in the proportion of people experiencing depression after stroke. There is a pressing need for increased clinical uptake of evidenced-based strategies to screen for, prevent, and treat depression after stroke.
FAmily-Led RehabiliTaTion aftEr Stroke in INDia: The ATTEND Pilot Study
Publisher: SAGE Publications
Date: 09-03-2015
DOI: 10.1111/IJS.12475
Abstract: The aim of this pilot study was to determine the feasibility of a multicenter, randomized, controlled trial in India of a family-led, trained caregiver-delivered, home-based rehabilitation intervention vs. routine care. A prospective, randomized (within seven-days of hospital admission), blinded outcome assessor, controlled trial of structured home-based rehabilitation delivered by trained and protocol-guided family caregivers (intervention) vs. routine care alone (control) was conducted in patients with residual disability. Key feasibility measures were recruitment, acceptance and adherence to assessment procedures, and follow-up of participants over six-months. CTRI/2014/10/005133. A total of 104 patients from the stroke unit at Christian Medical College, Ludhiana were recruited over nine-months. Recruitment was feasible and accepted by patients and their carers. Important observations were made regarding potential unblinding of the participants, contamination of therapy between the randomized groups, organization of home visits, and resources required for a multicenter study. The pilot study established the feasibility of conducting a large-scale study of family-led, trained caregiver-delivered, home-based stroke rehabilitation in a low resource setting. The main phase of the trial ‘ATTEND’ is currently underway in over 10 centers in India.
Part II: Predictors of Depression after Stroke and Impact of Depression on Stroke Outcome: An Updated Systematic Review of Observational Studies
Publisher: SAGE Publications
Date: 26-08-2014
DOI: 10.1111/IJS.12356
Abstract: We previously published a systematic review in 2005 on factors associated with the development of depression in people with stroke. To update and expand that review to include published data on the impact of depression on stroke outcome. We included all published observational studies (to May 31, 2013) with prospective consecutive recruitment of people with a clinical diagnosis of stroke where an attempt was made to assess the variables associated with, or predictive of, the development of depression. We included data from 23 studies including 18 374 people. Depression after stroke was associated with prestroke depression, more severe neurological deficit and physical disability in the acute phase, and later after stroke. No consistent relationship between depression and demographic parameters or stroke features was identified. The review of the impact of depression on stroke outcome included data from 14 cohorts, including 4498 people, and found that depression was negatively associated with functional outcome in stroke survivors. Early identification of patients at high risk of depression after stroke, those with a history of depression and physical disability after stroke, would enable the early implementation of effective management and prevention strategies for depression. The reciprocal relationship between depression and physical disability highlights the need for interventions that reduce disability after stroke, which may in turn improve mood and overall recovery for an increasingly large number of stroke survivors.
'We're here to listen and help them as well': A qualitative study of staff and Indigenous patient perceptions about participating in social and emotional wellbeing research at primary healthcare services
Publisher: Springer Science and Business Media LLC
Date: 07-10-2019
DOI: 10.1186/S12888-019-2263-8
Abstract: Research can inform culturally-appropriate care to strengthen social and emotional wellbeing (SEWB) among Aboriginal and Torres Strait Islander (hereafter, the term ‘Indigenous Peoples’ is respectfully used and refers to all Aboriginal and/or Torres Strait Islander Peoples of Australia). We acknowledge the cultural ersity of Australia’s Indigenous First Peoples and they do not represent a homogenous group.) (hereafter Indigenous) Peoples. We explore the perspectives of primary healthcare staff and Indigenous patients about their willingness to and experiences participating in SEWB research. Process evaluation using grounded theory approaches of Getting it Right : The validation study , a national validation designed Indigenous SEWB research project ( N = 500). Primary healthcare staff ( n = 36) and community members ( n = 4) from nine of ten primary healthcare services involved with the research project completed qualitative semi-structured interviews. Interview data were triangulated with participant feedback (responses to structured questions and free-text feedback collected during Getting it Right ), study administrative data (participant screening logs, communication logs, study protocol, deviation logs and ethics correspondence) and interviewer field notes. Three themes about staff, patient and community perspectives concerning research participation developed: (1) considering the needs, risk, preferences and impact of participation in research for staff, patients and community (2) building staff confidence speaking to patients about research and SEWB problems and (3) patients speaking openly about their SEWB. Some staff described pressure to ensure patients had a positive experience with the research, to respond appropriately if patients became upset or SEWB problems were identified during interviews, or due to their dual role as community member and researcher. Patients and staff reported that patients were more likely to participate if they knew the staff outside of the service, especially staff with a shared cultural background, and they perceived SEWB as a community priority. Staff reported their skills speaking to patients about the research and SEWB improved during the research, which built their confidence. Contrary to staff preconceptions, staff and patients reported that many patients appreciated the opportunity to speak about their SEWB and contributing to research that may eventually enhance SEWB in their community. Our research project was considered acceptable by most staff and patients. The positive outcomes reported by staff and feedback from patients highlights the importance of providing opportunities for people to speak about their SEWB and for research-informed SEWB PHC care. Getting it Right is registered on ANZCTR12614000705684 .
Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
DOI: 10.1161/STR.0000000000000113
Abstract: Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. In iduals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council’s Scientific Statements Oversight Committee and the American Heart Association’s Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice.
The quality of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review
Publisher: The Sax Institute
Date: 2017
Abstract: Objectives and importance of the study: Primary health care research focused on Aboriginal and Torres Strait Islander (Indigenous) people is needed to ensure that key frontline services provide evidence based and culturally appropriate care. We systematically reviewed the published primary health care literature to identify research designs, processes and outcomes, and assess the scientific quality of research focused on social and emotional wellbeing. This will inform future research to improve evidence based, culturally appropriate primary health care. Systematic review in accordance with PRISMA and MOOSE guidelines. Four databases and one Indigenous-specific project website were searched for qualitative, quantitative and mixed-method published research. Studies that were conducted in primary health care services and focused on the social and emotional wellbeing of Indigenous people were included. Scientific quality was assessed using risk-of-bias assessment tools that were modified to meet our aims. We assessed community acceptance by identifying the involvement of community governance structures and representation during research development, conduct and reporting. Data were extracted using standard forms developed for this review. We included 32 articles, which reported on 25 studies. Qualitative and mixed methods were used in 18 studies. Twelve articles were judged as high or unclear risk of bias, four as moderate and five as low risk of bias. Another four studies were not able to be assessed as they did not align with the risk-of-bias tools. Of the five articles judged as low risk of bias, two also had high community acceptance and both of these were qualitative. One used a phenomenological approach and the other combined participatory action research with a social-ecological perspective and incorporated 'two-way learning' principles. Of the 16 studies where a primary outcome was identified, eight aimed to identify perceptions or experiences. The remaining studies assessed resources, or evaluated services, interventions, programs or policies. We were unable to identify primary outcomes in eight studies. Conducting Indigenous-focused primary health care research that is scientifically robust, culturally appropriate and produces community-level outcomes is challenging. We suggest that research teams use participatory, culturally sensitive approaches and collaborate closely to plan and implement high-quality research that incorporates local perspectives. Research should result in beneficial outcomes for the communities involved.
Effects of Low-Dose and Very Low-Dose Ketamine among Patients with Major Depression: a Systematic Review and Meta-Analysis
Publisher: Oxford University Press (OUP)
Date: 17-11-2015
DOI: 10.1093/IJNP/PYV124
Psychosocial Outcomes in StrokE: the POISE observational stroke study protocol
Publisher: Springer Science and Business Media LLC
Date: 12-06-2009
Frequency of Autoimmune Diseases in Myasthenia Gravis: A Systematic Review
Publisher: Informa UK Limited
Date: 13-12-2010
DOI: 10.3109/00207454.2010.539307
Abstract: The course of myasthenia gravis (MG) may get complicated by the development of other autoimmune diseases. Estimates of the frequency of autoimmune diseases will help inform patients and physicians, direct health policy discussion, provide etiologic clues, and optimize the management of MG. However, the frequency of autoimmune diseases in people with MG is still uncertain. A systematic search for English language studies was conducted by MEDLINE and EMBASE from 1960 through 2010. Incidence studies and case series of all MG subtypes with information about autoimmune diseases were included 25 studies met the inclusion criteria. Although there was considerable heterogeneity, the pooled estimate of the coexisting autoimmune diseases in MG was 13% (95% confidence interval, 12%-14%). Autoimmune thyroid disease seems to occur more frequently than other autoimmune conditions in MG patients. Heterogeneity in study estimates could be explained by ascertainment bias and case mix. Furthermore, autoimmune diseases occurred significantly more often in females and anti-acetylcholine receptor seropositive MG patients. Patients with MG have an increased frequency of coexisting autoimmune diseases. Autoimmune diseases seem to occur more often in female and seropositive MG patients. Further research is needed to expand our understanding of these associations.
Statistical analysis plan for the family-led rehabilitation after stroke in India (ATTEND) trial: A multicenter randomized controlled trial of a new model of stroke rehabilitation compared to usual ca
Publisher: SAGE Publications
Date: 22-10-2016
Abstract: In low- and middle-income countries, few patients receive organized rehabilitation after stroke, yet the burden of chronic diseases such as stroke is increasing in these countries. Affordable models of effective rehabilitation could have a major impact. The ATTEND trial is evaluating a family-led caregiver delivered rehabilitation program after stroke. To publish the detailed statistical analysis plan for the ATTEND trial prior to trial unblinding. Based upon the published registration and protocol, the blinded steering committee and management team, led by the trial statistician, have developed a statistical analysis plan. The plan has been informed by the chosen outcome measures, the data collection forms and knowledge of key baseline data. The resulting statistical analysis plan is consistent with best practice and will allow open and transparent reporting. Publication of the trial statistical analysis plan reduces potential bias in trial reporting, and clearly outlines pre-specified analyses. India CTRI/2013/04/003557 Australian New Zealand Clinical Trials Registry ACTRN1261000078752 Universal Trial Number U1111-1138-6707.
Low-Dose vs Standard-Dose Alteplase in Acute Lacunar Ischemic Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-03-2021
DOI: 10.1212/WNL.0000000000011598
Abstract: To determine any differential efficacy and safety of low- vs standard-dose IV alteplase for lacunar vs nonlacunar acute ischemic stroke (AIS), we performed post hoc analyzes from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) alteplase dose arm. In a cohort of 3,297 ENCHANTED participants, we identified those with lacunar or nonlacunar AIS with different levels of confidence (definite/according to prespecified definitions based on clinical and adjudicated imaging findings. Logistic regression models were used to determine associations of lacunar AIS with 90-day outcomes (primary, modified Rankin Scale [mRS] scores 2–6 secondary, other mRS scores, intracerebral hemorrhage [ICH], and early neurologic deterioration or death) and treatment effects of low- vs standard-dose alteplase across lacunar and nonlacunar AIS with adjustment for baseline covariables. Of 2,588 participants with available imaging and clinical data, we classified cases as definite robable lacunar (n = 490) or nonlacunar AIS (n = 2,098) for primary analyses. Regardless of alteplase dose received, lacunar AIS participants had favorable functional (mRS 2–6, adjusted odds ratio [95% confidence interval] 0.60 [0.47–0.77]) and other clinical or safety outcomes compared to participants with nonlacunar AIS. Low-dose alteplase (versus standard) had no differential effect on functional outcomes (mRS 2–6, 1.04 [0.87–1.24]) but reduced the risk of symptomatic ICH in all included participants. There were no differential treatment effects of low- vs standard-dose alteplase on all outcomes across lacunar and nonlacunar AIS (all p interaction ≥0.07). We found no evidence from the ENCHANTED trial that low-dose alteplase had any advantages over standard dose for definite robable lacunar AIS. This study provides Class II evidence that for patients with lacunar AIS, low-dose alteplase had no additional benefit or safety over standard-dose alteplase. Clinicaltrials.gov identifier NCT01422616.
Multisite prospective investigation of psychological outcomes following cataract surgery in Vietnam
Publisher: BMJ
Date: 2017
Effect of mood on long-term disability in younger stroke survivors: results from the Psychosocial Outcomes In StrokE (POISE) study
Publisher: Informa UK Limited
Date: 21-05-2021
DOI: 10.1080/10749357.2021.1922802
Abstract: Anxiety and depression are common among stroke survivors, and their effect on long-term outcome remains unknown in those under 65 years of age. We investigated the association between early anxiety/depression after stroke and 12-month disability, and whether this is modified by sex. The Psychosocial Outcomes In StrokE (POISE) study was a prospective observational cohort study that recruited 441 younger (< 65 years) stroke survivors ≤28 days of acute stroke. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and disability using the World Health Organization Disability Assessment Scale version II (WHODAS-II). Associations between baseline anxiety/depression, and disability at 12-months was tested using analysis of covariance. Subgroup analysis was conducted using interaction term. 92 (25%) had anxiety and 53 (14%) depression at baseline. Multivariable models showed significant association between baseline anxiety and 12-month disability (WHODAS-II score 15.24 vs. 11.49, Post-stroke anxiety has an adverse effect on disability at one year among young stroke survivors.
Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm
Publisher: S. Karger AG
Date: 2020
DOI: 10.1159/000509226
Abstract: b i Background and Purpose: /i /b The influence of specific brain lesions on health-related quality of life (HRQoL) after acute ischemic stroke (AIS) is uncertain. We aimed to identify imaging predictors of poor HRQoL in alteplase-treated participants of the alteplase dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). b i Methods: /i /b ENCHANTED was an international trial of low- versus standard-dose intravenous alteplase in AIS patients, with functional outcome (modified Rankin scale [mRS]) and HRQoL on the 5-dimension European Quality of Life Scale (EQ-5D) assessed at 90 days post-randomization. Brain images were analyzed centrally by trained assessors. Multivariable logistic regression was undertaken in the study population randomly ided (2:1) into training (development) and validation (performance) groups, with age (per 10-year increase), ethnicity, baseline National Institutes of Health Stroke Scale (NIHSS) score, diabetes mellitus, premorbid function (mRS score 0 or 1), and proxy respondent, forced into all models. Data are presented with odds ratios (ORs) and 95% confidence intervals (CIs). b i Results: /i /b Eight prediction models were developed and validated in 2,526 AIS patients (median age 67.5 years 38.4% female 61.7% Asian) with complete brain imaging and 90-day EQ-5D utility score data. The best performance model included acute ischemic changes in the right (OR 1.69, 95% CI: 1.24–2.29) and deep (OR 1.50, 95% CI: 1.03–2.19) middle cerebral artery (MCA) regions. Several background features of brain frailty – atrophy, white matter change, and old infarcts – were significantly associated with adverse physical but not emotional HRQoL domains. b i Conclusions: /i /b In thrombolysed AIS patients, right-sided and deep ischemia within the MCA territory predict poor overall HRQoL, whilst features of old cerebral ischemia are associated with reduced physical HRQoL.
The conduct of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review
Publisher: The Sax Institute
Date: 2018
Abstract: Objectives and importance of study: Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research (Values and ethics) describes key values that should underpin Aboriginal and Torres Strait Islander (Indigenous)-focused health research. It is unclear how research teams address this document in primary health care research. We systematically review the primary health care literature focusing on Indigenous social and emotional wellbeing (SEWB) to identify how Values and ethics and community preferences for standards of behaviour (local protocols) are addressed during research. Systematic review in accordance with PRISMA Guidelines and MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. We searched four databases and one Indigenous-specific website for qualitative, quantitative and mixed-method studies published since Values and ethics was implemented (2003). Included studies were conducted in primary health care services, focused on Indigenous SEWB and were conducted by research teams. Using standard data extraction forms, we identified actions taken (reported by authors or identified by us) relating to Values and ethics and local protocols. A total of 25 studies were included. Authors of two studies explicitly mentioned the Values and ethics document, but neither reported how their actions related to the document's values. In more than half the studies, we identified at least three actions relating to the values. Some actions related to multiple values, including use of culturally sensitive research processes and involving Indigenous representatives in the research team. Local protocols were rarely reported. Addressing Values and ethics appears to improve research projects. The academic community should focus on culturally sensitive research processes, relationship building and developing the Indigenous research workforce, to facilitate acceptable research that affects health outcomes. For Values and ethics to achieve its full impact and to improve learning between research teams, authors should be encouraged to report how the principles are addressed during research, including barriers and enablers that are encountered.
Motivational Interviewing Post-Stroke
Publisher: SAGE Publications
Date: 22-04-2015
Abstract: Our earlier research demonstrated that participation in four sessions of motivational interviewing (MI) early post-stroke has a positive impact on stroke survivors’ mood. However, the theoretical underpinnings of MI in supporting adjustment (rather than its traditional use in supporting behavior change) require clarification. This article describes a content analysis of MI transcripts for 10 participants in our previous study, to identify the focus of discussions (patient “concerns”) and potential effective components of our MI approach. Patients’ post-stroke concerns were shown in 16 categories, including frustration, family impact, and getting well. There was a pattern of change discourse across sessions: “Sustain talk” (reasons for not changing) reduced from Session 1 onward, “change talk” (intent to change) increased then reduced, and “change expressed” (changes achieved) increased from Sessions 1 to 4. MI facilitates healthy adjustment post-stroke in some patients, in turn affecting mood, but clarification of how this effect is achieved requires further exploration.
Twelve-Month Outcomes of the AFFINITY Trial of Fluoxetine for Functional Recovery After Acute Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2021
DOI: 10.1161/STROKEAHA.120.033070
Abstract: The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported that oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. After trial medication was ceased at 6 months, survivors were followed to 12 months post-randomization. This preplanned secondary analysis aimed to determine any sustained or delayed effects of fluoxetine at 12 months post-randomization. AFFINITY was a randomized, parallel-group, double-blind, placebo-controlled trial in adults (n=1280) with a clinical diagnosis of stroke in the previous 2 to 15 days and persisting neurological deficit who were recruited at 43 hospital stroke units in Australia (n=29), New Zealand (4), and Vietnam (10) between 2013 and 2019. Participants were randomized to oral fluoxetine 20 mg once daily (n=642) or matching placebo (n=638) for 6 months and followed until 12 months after randomization. The primary outcome was function, measured by the modified Rankin Scale, at 6 months. Secondary outcomes for these analyses included measures of the modified Rankin Scale, mood, cognition, overall health status, fatigue, health-related quality of life, and safety at 12 months. Adherence to trial medication was for a mean 167 (SD 48) days and similar between randomized groups. At 12 months, the distribution of modified Rankin Scale categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio, 0.93 [95% CI, 0.76–1.14] P =0.46). Compared with placebo, patients allocated fluoxetine had fewer recurrent ischemic strokes (14 [2.18%] versus 29 [4.55%] P =0.02), and no longer had significantly more falls (27 [4.21%] versus 15 [2.35%] P =0.08), bone fractures (23 [3.58%] versus 11 [1.72%] P =0.05), or seizures (11 [1.71%] versus 8 [1.25%] P =0.64) at 12 months. Fluoxetine 20 mg daily for 6 months after acute stroke had no delayed or sustained effect on functional outcome, falls, bone fractures, or seizures at 12 months poststroke. The lower rate of recurrent ischemic stroke in the fluoxetine group is most likely a chance finding. URL: www.anzctr.org.au/ Unique identifier: ACTRN12611000774921.
Process evaluation of the Getting it Right study and acceptability and feasibility of screening for depression with the aPHQ-9
Publisher: Springer Science and Business Media LLC
Date: 18-09-2019
DOI: 10.1186/S12889-019-7569-4
Abstract: The Getting it Right study determined the validity, sensitivity, specificity and acceptability of the culturally adapted 9-item Patient Health Questionnaire (aPHQ-9) as a screening tool for depression in Aboriginal and Torres Strait Islander (hereafter referred to as Indigenous) people. In this process evaluation we aimed to explore staff perceptions about whether Getting it Right was conducted per protocol, and if the aPHQ-9 was considered an acceptable and feasible screening tool for depression in primary healthcare. This process evaluation will provide information for clinicians and policy makers about the experiences of staff and patients with Getting it Right and what they thought about using the aPHQ-9. Process evaluation using grounded theory approaches. Semi-structured interviews with primary healthcare staff from services participating in Getting it Right were triangulated with feedback (free-text and elicited) from participants collected during the validation study and field notes. Data were thematically analysed according to the Getting it Right study protocol to identify the acceptability and feasibility of the aPHQ-9. Primary healthcare staff ( n = 36) and community members ( n = 4) from nine of the ten participating Getting it Right services and Indigenous participants ( n = 500) from the ten services that took part. Most staff reported that the research was conducted according to the study protocol. Staff from two services reported sometimes recruiting opportunistically (rather than recruiting consecutive patients attending the service as outlined in the main study protocol), when they spoke to patients who they knew from previous interactions, because they perceived their previous relationship may increase the likelihood of patients participating. All Getting it Right participants responded to at least six of the seven feedback questions and 20% provided free-text feedback. Most staff said they would use the aPHQ-9 and most participants said that the questions were easy to understand (87%), the response categories made sense (89%) and that they felt comfortable answering the questions (91%). Getting it Right was predominantly conducted according to the study protocol. The aPHQ-9, the first culturally adapted, nationally validated, freely available depression screening tool for use by Indigenous people, appears to be acceptable and feasible to use. Australian New Zealand Clinical Trial Registry ANZCTR12614000705684 , 03/07/2014.
Depression Outcomes Among Patients Treated With Fluoxetine for Stroke Recovery
Publisher: American Medical Association (AMA)
Date: 09-2021
Pharmacological, psychological, and non-invasive brain stimulation interventions for treating depression after stroke
Publisher: Wiley
Date: 28-01-2020
Oxygen desaturation and adverse outcomes in acute stroke: Secondary analysis of the HeadPoST study
Publisher: Elsevier BV
Date: 08-2021
DOI: 10.1016/J.CLINEURO.2021.106796
Abstract: Uncertainty exists over the prognostic significance of low arterial oxygen saturation (SaO Post-hoc analyzes of HeadPoST, a pragmatic cluster-crossover randomized trial of lying flat versus sitting up head positioning in 11,093 patients (age ≥18 years) with acute stroke at 114 hospitals in 9 countries during 2015-2016. Associations of the lowest recorded SaO There was an inverse J-shaped association between SaO Any change in SaO HeadPoST is registered at ClinicalTrials.gov (NCT02162017).
Impact of Evidence‐Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-07-2019
Abstract: The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence‐based processes of care for acute ischemic stroke ( AIS ) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. Use of 8 AIS processes of care were considered: reperfusion therapy in eligible patients acute stroke unit care antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation dysphagia assessment and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0–2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or “defect‐free” care, was associated with improved outcome (odds ratio, 1.40 95% CI, 1.18–1.65) and better survival (odds ratio, 2.23 95% CI , 1.62–3.09). Defect‐free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0–1) (odds ratio, 1.22 95% CI , 1.04–1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and in idual rates. Use of evidence‐based care is associated with improved clinical outcome in AIS . Strategies are required to address regional variation in the use of proven AIS treatments. URL : www.clinicaltrials.gov . Unique Identifier: NCT 02162017.
The influence of design and definition on the proportion of general epilepsy cohorts with remission and intractability
Publisher: S. Karger AG
Date: 2011
DOI: 10.1159/000327497
Abstract: Remission while on anti-epileptic drug (AED) therapy and remission off AED are the only prognostic criteria defined by the International League against Epilepsy (ILAE), defining remission as 5 seizure-free years. Prognosis studies in epilepsy have investigated other prognostic categories using different designs and definitions. This systematic review explores factors that explain discrepancies in the proportion of patients reported with commonly studied prognostic categories in general epilepsy cohorts. Thirty publications (reporting 37 studies) were included. The outcome categories were classified as immediate remission (5 studies), remission off medication (7 studies), remission on or off medication (15 studies), intractability (9 studies) and no remission after relapse (1 study). The findings show the importance of qualifying estimates specifically by how they were defined in each study, study design, setting and patient population as these have implications for patient management and counselling. The ILAE should define the outcome measures and terminology to which researchers should be required to adhere in subsequent updates of their guidelines on research related to remission and intractability.
Wishing to die or self-harm after stroke: A planned secondary analysis of the AFFINITY Randomised Controlled Trial
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.MATURITAS.2022.08.011
Abstract: We investigated the cumulative prevalence of self-harm ideation among stroke survivors of the AFFINITY trial. We assessed these thoughts with the last item of the PHQ-9, and functional impairment with the modified Rankin Scale (mRS). Of 1221 participants (age 63.9 ± 12.3 years, 775 men), 11 reported wishing to die or self-harm at baseline. By week 52, 36 of 1159 surviving participants had reported wishing to die or self-harm. Treatment with fluoxetine for 26 weeks did not change the prevalence of these thoughts compared with placebo. Clinically significant symptoms of depression were present in 95 % of participants with recurrent self-harm thoughts. The study was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12611000774921.
Interventions for treating depression after stroke
Publisher: Wiley
Date: 08-10-2008
A Multicenter Prospective Cohort Study of Quality of Life and Economic Outcomes after Cataract Surgery in Vietnam
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.OPHTHA.2014.05.014
Abstract: To measure the change in quality of life and economic circumstances after cataract surgery and identify the predictors of an improvement in these outcomes. A multicenter, prospective, longitudinal cohort study. Participants aged 18 years were recruited to the study if the clinical assessment of their best uncorrected vision was <= 6/18 in the better eye because of cataract [Corrected]. Cataract surgery. Data were collected on quality of life and a multidimensional assessment of household economic circumstances (work status, income, asset ownership, household economic hardship, and catastrophic health expenditure). At 12 months follow-up, 381 of 480 participants were re-interviewed, and all had undergone surgery. There was a significant improvement in quality of life. Household economic circumstances also improved (mean change paid work participation/month: 44.5 hours, P < 0.0001 mean change unpaid work participation/month: 89.5 hours, P < 0.0001 change in proportion with hardship: -17%, P < 0.0001 and change in proportion with catastrophic health expenditure: -7%, P = 0.02). Improvements were most likely in near-poor households and were related to the type of surgery and complications after surgery. This research showed that cataract surgery is associated with meaningful improvements in quality of life and household economic circumstances that are indicative of positive transitions out of poverty. Given the unmet need for cataract surgery in low- and middle-income countries where cataract impairment is substantial, this research demonstrates the potential of a relatively simple, low-cost health intervention to greatly improve household economic circumstances.
Prognostic factors of remission in myasthenia gravis after thymectomy
Publisher: Oxford University Press (OUP)
Date: 09-08-2014
DOI: 10.1093/EJCTS/EZU309
Abstract: Thymectomy has become an increasingly popular procedure for myasthenia gravis. Knowledge of factors associated with a good outcome (remission) or those most likely to benefit from surgery can help clinical decision-making. A systematic review search was conducted in Medline and Embase for English language studies from 1985 through to February 2014. Studies which evaluated variables associated with, or predictive of, remission in adult (≥18 years) myasthenic patients after thymectomy and using multivariable regression models were included. Statistical pooling was not appropriate due to methodological heterogeneity. From 128 potentially relevant studies, 18 reports of 19 studies met the inclusion criteria. Preoperative mild disease classification (i.e. studies reported this variable as Osserman classification 1, 2A or MGFA I-II) showed the most consistent association with remission. Evidence for several other prognostic factors was inconclusive, or no evidence was found. Gender, age and absence of thymoma (or hyperplasia) were not associated with remission following thymectomy. Patients with mild disease preoperatively may have a better chance of remission of MG after thymectomy.
Course and impact of sleep disturbance in newly diagnosed epilepsy: A prospective registry study
Publisher: Elsevier BV
Date: 08-2020
Patterns of Psychoactive Substance Misuse in Undergraduate University Students: The Case of Mekelle University, Ethiopia
Publisher: MDPI AG
Date: 25-10-2022
Abstract: Background: Substance misuse is a public health concern among University students. Understanding the critical times and places for substance misuse among University students helps to inform effective preventive strategies. However, there is a dearth of studies in Ethiopian Universities on this topic. Here, we aimed to explore the patterns of psychoactive substance misuse, specifically about time and places, among undergraduate students at Mekelle University. Subject and Methods: An explorative qualitative study design was conducted in 2017. Five focus-group discussions among substance user students followed by eleven in-depth interviews with the user and non-user students, proctors, and a bar owners were conducted. In addition, four key informant researchers were involved. Participants were purposefully selected. The data were audio taped, transcribed verbatim and imported into Atlas.ti qualitative data analysis software version 7.5 for coding and analysis. Data were analyzed inductively to capture the emerging themes. Results: Our study showed that students consume alcohol in the evenings, on weekend days, holidays, after exams and at celebrations smoke cigarettes after waking in the morning and after eating lunch. Concurrent substance use like smoking cigarettes, chewing Khat and drinking alcohol was evident. Khat chewing was reported mainly around noon, in the afternoon and on weekends. Substance use generally peaks at weekends, at the start and end of academic semesters, and when graduation approaches. However, students who become addicted may continue using substances. Students easily accessed and used substances around and inside the gates of the c uses. Conclusion: Event-specific celebrations are linked with substance misuse among University students. The ease with which students can access substances around the c uses increases the likelihood of substance misuse. Proactive interventions that include the provision of alcohol-free recreational alternatives to events on c us, high-risk substance misuse surveillance, tobacco cessation interventions, and promoting plain packaging are recommended.
Falls After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2008
DOI: 10.1161/STROKEAHA.107.509885
Abstract: Background and Purpose— Falls are an important issue in older people. We aimed to determine the incidence, circumstances, and predictors of falls in patients with recent acute stroke. Methods— The Auckland Regional Community Stroke (ARCOS) study was a prospective population-based stroke incidence study conducted in Auckland, New Zealand (NZ) during 2002 to 2003. Among 6-month survivors, the location and consequences of any falls were ascertained by self-report as part of a structured interview. Multivariable logistic regression was used to establish associations between risk factors and “any” and “injurious” falls. Results— Of 1104 stroke survivors who completed an interview, 407 (37%) reported at least 1 fall, 151 (37% of fallers, 14% of stroke survivors) sustained an injury that required medical treatment, and 31 (8% of fallers, 3% of stroke survivors) sustained a fracture. The majority of falls occurred indoors at home. Independent factors associated with falls were depressive symptoms, disability, previous falls, and older age. For injurious falls, the positively associated factors were female sex and NZ/European ethnicity and dependence before the stroke, whereas higher levels of activity and normal cognition were negatively associated factors. Conclusions— Falls are common after stroke, and their predictive factors are similar to those for older people in general. Falls prevention programs require implementation in stroke services.
Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with type 2 diabetes: the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controll
Publisher: Springer Science and Business Media LLC
Date: 18-08-2009
DOI: 10.1007/S00125-009-1484-7
Abstract: The relationship between cognitive function, cardiovascular disease and premature death is not well established in patients with type 2 diabetes. We assessed the effects of cognitive function in 11,140 patients with type 2 diabetes who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Furthermore, we tested whether level of cognitive function altered the beneficial effects of the BP-lowering and glycaemic-control regimens in the trial. Cognitive function was assessed using the Mini Mental State Examination at baseline, and defined by scores 28-30 ('normal', n = 8,689), 24-27 ('mild dysfunction', n = 2,231) and <24 ('severe dysfunction', n = 212). Risks of major cardiovascular events, death and hypoglycaemia and interactions with treatment were assessed using Cox proportional hazards analysis. Relative to normal function, both mild and severe cognitive dysfunction significantly increased the multiple-adjusted risks of major cardiovascular events (HR 1.27, 95% CI 1.11-1.46 and 1.42, 95% CI 1.01-1.99 both p < 0.05), cardiovascular death (1.41, 95% CI 1.16-1.71 and 1.56, 95% CI 0.99-2.46 both p <or= 0.05) and all-cause death (1.33, 95% CI 1.16-1.54 and 1.50, 95% CI 1.06-2.12 both p < 0.03). Severe, but not mild, cognitive dysfunction increased the risk of severe hypoglycaemia (HR 2.10, 95% CI 1.14-3.87 p = 0.018). There was no evidence of heterogeneity of treatment effects on cardiovascular outcomes in subgroups defined by cognitive function at baseline. Cognitive dysfunction is an independent predictor of clinical outcomes in patients with type 2 diabetes, but does not modify the effects of BP lowering or glucose control on the risks of major cardiovascular events. ClinicalTrials.gov NCT00145925.
Trends in Stroke Incidence in Auckland, New Zealand, During 1981 to 2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2005
DOI: 10.1161/01.STR.0000181079.42690.BF
Abstract: Background and Purpose— Long-term trends in stroke incidence in different populations have not been well characterized, largely as a result of the complexities associated with population-based stroke surveillance. Methods— We assessed temporal trends in stroke incidence using standard diagnostic criteria and community-wide surveillance procedures in the population (≈1 million) of Auckland, New Zealand, over 12-month calendar periods in 1981–1982, 1991–1992, and 2002–2003. Age-adjusted first-ever (incident) and total (attack) rates, and temporal trends, were reported with 95% confidence intervals (CIs). Rates were analyzed by sex and major age groups. Results— From 1981 to 1982, stroke rates were stable in 1991–1992 and then declined in 2002–2003, to produce overall modest declines in standardized incidence (11% 95% CI, 1 to 19%) and attack rates (9% 95% CI, 0 to 16%) between the first and last study periods. Some favorable downward trends in vascular risk factors such as cigarette smoking were counterbalanced by increasing age and body mass index, and frequency of diabetes, in patients with stroke. Conclusions— There has been a modest decline in stroke incidence in Auckland over the last 2 decades, mainly during 1991 to 2003, in association with ergent trends in major risk factors.
Selective Serotonin Reuptake Inhibitors for Stroke Recovery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2022
Australia's appointment to the UN Human Rights Council means it must deliver on Indigenous engagement in alcohol control
Publisher: Elsevier BV
Date: 08-2018
Fluoxetine to improve functional outcomes in patients after acute stroke: the FOCUS RCT
Publisher: National Institute for Health and Care Research
Date: 05-2020
DOI: 10.3310/HTA24220
Abstract: Our Cochrane review of selective serotonin inhibitors for stroke recovery indicated that fluoxetine may improve functional recovery, but the trials were small and most were at high risk of bias. The Fluoxetine Or Control Under Supervision (FOCUS) trial tested the hypothesis that fluoxetine improves recovery after stroke. The FOCUS trial was a pragmatic, multicentre, parallel-group, in idually randomised, placebo-controlled trial. This trial took place in 103 UK hospitals. Patients were eligible if they were aged ≥ 18 years, had a clinical stroke diagnosis, with focal neurological deficits, between 2 and 15 days after onset. Patients were randomly allocated 20 mg of fluoxetine once per day or the matching placebo for 6 months via a web-based system using a minimisation algorithm. The primary outcome was the modified Rankin Scale at 6 months. Patients, carers, health-care staff and the trial team were masked to treatment allocation. Outcome was assessed at 6 and 12 months after randomisation. Patients were analysed by their treatment allocation as specified in a published statistical analysis plan. Between 10 September 2012 and 31 March 2017, we recruited 3127 patients, 1564 of whom were allocated fluoxetine and 1563 of whom were allocated placebo. The modified Rankin Scale score at 6 months was available for 1553 out of 1564 (99.3%) of those allocated fluoxetine and 1553 out of 1563 (99.4%) of those allocated placebo. The distribution across modified Rankin Scale categories at 6 months was similar in the two groups (common odds ratio adjusted for minimisation variables 0.951, 95% confidence interval 0.839 to 1.079 p = 0.439). Compared with placebo, patients who were allocated fluoxetine were less likely to develop a new episode of depression by 6 months [210 (13.0%) vs. 269 (16.9%), difference –3.78%, 95% confidence interval –1.26% to –6.30% p = 0.003], but had more bone fractures [45 (2.9%) vs. 23 (1.5%), difference 1.41%, 95% confidence interval 0.38% to 2.43% p = 0.007]. There were no statistically significant differences in any other recorded events at 6 or 12 months. Health economic analyses showed no differences between groups in health-related quality of life, hospital bed usage or health-care costs. Some non-adherence to trial medication, lack of face-to-face assessment of neurological status at follow-up and lack of formal psychiatric diagnosis during follow-up. 20 mg of fluoxetine daily for 6 months after acute stroke did not improve patients’ functional outcome but decreased the occurrence of depression and increased the risk of fractures. These data inform decisions about using fluoxetine after stroke to improve functional outcome or to prevent or treat mood disorders. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) (Australasia/Vietnam) and Efficacy oF Fluoxetine – a randomisEd Controlled Trial in Stroke (EFFECTS) (Sweden) trials recruited an additional 2780 patients and will report their results in 2020. These three trials have an almost identical protocol, which was collaboratively developed. Our planned in idual patient data meta-analysis will provide more precise estimates of the effects of fluoxetine after stroke and indicate whether or not effects vary depending on patients’ characteristics and health-care setting. Current Controlled Trials ISRCTN83290762. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment Vol. 24, No. 22. See the NIHR Journals Library website for further project information. The Stroke Association (reference TSA 2011101) funded the start-up phase.
Ethnicity and Functional Outcome After Stroke
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
DOI: 10.1161/STROKEAHA.110.605139
Abstract: There is limited information on the influence of ethnicity on functional outcome after stroke. We examined functional outcomes among European New Zealanders, Māori, Pacific, and Asian people 6 months after stroke in a population-based context. This was a prospective incidence and 6-month outcomes study of all new stroke patients (excluding subarachnoid hemorrhage) that occurred over 1 year in a defined geographical area in Auckland, New Zealand, during 2002 to 2003. Ethnicity was self-defined. Outcome measures included the Frenchay Activities Index, 36-item Short Form questionnaire, independence, death, composite of death and dependence, and living situation. Functional measures were available in 1127 patients 6 months after stroke. Frenchay Activities Index scores were associated with ethnicity on both univariable and multivariable analysis, with Asian and Pacific people having worse scores. Physical Component Summary score of the 36-item Short Form was associated with ethnicity on univariable (scores for Pacific, Māori, and Asian people were higher than those for Europeans) but not multivariable analysis. Asian people were less likely to be dead compared to Europeans, and Pacific people were more likely to be dependent on others for help than Europeans. Pacific people were more likely to be dead or dependent than Europeans. Asian and Pacific people were more likely to be living at home than Europeans. Ethnicity was associated independently with functional outcomes. The association was attenuated when adjusted for stroke severity and other covariates. The direction of the relationship was not consistent between measures for in idual ethnic groups.
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