Objective Several controversial findings have been reported on treatment outcomes for diabetic stroke patients that received thrombolysis therapy in the hospital. We determined whether the association between telestroke technology, thrombolysis therapy and clinical risk factors in diabetic acute ischemic stroke may result in the inclusion or exclusion or more diabetic ischemic stroke patients for thrombolysis therapy. Methods Retrospective data that comprises of a total of 3202 acute ischemic stroke patients from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke of which 312 were identified as diabetic stroke patients were used in this study. Multivariate logistic regression models were used to determine the associated pre-clinical risk factors, and demographics associated with recombinant tissue plasminogen activator (rtPA) therapy in a subset of diabetic acute ischemic stroke patients in the telestroke and non-telestroke settings. Results In the telestroke, only higher International Normalized Ratio (INR) [odds ratio, OR = 0.063 (0.003–1.347, 95% confidence interval (CI)] was associated with exclusion from thrombolysis. Direct admission [OR, 3.141 (1–9.867), 95% CI] and telestroke [OR, 4.87 (1.834–12.928), 95% CI] were independent predictors in the inclusion for thrombolysis therapy. In the non telestroke, older age (> 80 years) [(OR), 0.955 (0.922–0.989), 95% CI], higher blood glucose level [OR, 0.994 (0.99–0.999); 95% CI], higher INR [OR, 0.113 (0.014–0.944); 95% CI], and renal insufficiency [OR, 0.163 (0.033–0.791); 95% CI] were associated with exclusion while higher NIH stroke scale [OR, 1.068 (1.009–1.13); 95% CI] was associated with inclusion for thrombolysis in the non telestroke. Conclusion The non-telestroke setting admitted more diabetic stroke patients to the hospital, but more were excluded from thrombolysis therapy when compared with the telestroke setting. Measures to improve clinical risk factors that excluded more diabetic ischemic stroke patients in the non telestroke will improve the use of thrombolysis in the treatment of diabetic acute ischemic stroke patients.
The goal of the stroke intervention programs was to increase knowledge in stroke awareness and healthy habits. Most of the existing school-based didactic stroke education intervention programs have not been very effective in improving learned information. We developed a student-centered or active learning educational pedagogy to improve the retention of learned knowledge on stroke issues and healthy habits. Middle school students, ages of 11 to 14 years attending a public school in the stroke belt were recruited to participate in an intervention program to raise stroke awareness and promote healthy habit. The impact of the intervention program on students' knowledge post-test and three weeks following the intervention was evaluated. Middle school students at all grade levels were aware of the cardinal symptoms of stroke, demonstrated basic knowledge of the salty foods in the post-test, and knowledge of learned information increased significantly after three weeks post intervention. The three weeks follow-up test revealed a significant increase in stroke knowledge among the 6th, 7th, and 8th grades [F (2,109) = 134.65, P = 0.001]. Post-hoc pair-wise comparisons analysis revealed a significant difference (P < 0.05) between the 6th, 7th, and 8th grades. In an active learning or a student-centered stroke and healthy life style educational program, middle school students perceived the intervention program as fun, instead of primarily educational and this allowed the learned information to be retained even three weeks after the intervention.
Background: Women and men have a similar incidence for ischemic cerebrovascular disease but women are more frequently hit by stroke later in life than men. It has been shown that women presented with severe stroke symptoms during admission, a poorer prognosis, are likely to have an overall poorer outcome after ischemic stroke when compared with men. However, some studies indicate similarities in outcome for men and women after stroke. Moreover, there is evidence that women treated with tPA benefit at least as much as men. Since a higher diastolic blood pressure increases the risk for a worse prospective functional status in men, but less significance in women, it is not clear whether hypertensive patients with acute ischemic stroke treated will reveal similarity or difference in functional outcome. We investigated this issue in the current study. Method: We performed a retrospective analysis of 4500 acute ischemic stroke patients who presented to a health care system between January 2010 and June 2016 and received rt-PA. We develop a new tool to determine the possibility of erasing any gender difference, and identify the most important factor for the poorer outcomes in women or men and whether thrombolysis may counteract this effect. Results: Our results reveal that poorer outcomes after stroke and the observed gender differences is due to age, at stroke onset, and that thrombolysis may neutralize this effect. Conclusion: The important factor for the poorer outcome and gender differences in hypertensive patients with acute ischemic stroke is mainly due to stroke severity and thrombolysis may play a major role in neutralizing this effect.
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