A systematic review and meta-analysis of acute stroke unit care: What’s beyond the statistical significance?

Sun, Ying; Paulus, Dominique; Eyssen, M; Maervoet, J.; Saka, Ömer

doi:10.1186/1471-2288-13-132

Cited by 47 publications

(33 citation statements)

References 17 publications

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“…This finding confirms the link between GDP and mortality after cerebral infarction and shows that the results of Sposato and Saposnik (2012) are valid at the regional level as well. Many studies have shown that primary and comprehensive stroke units have lower mortality (Sun et al, 2013), but this finding was not replicated in this regional-level analysis. At the national level, benchmarking of healthcare providers has become increasingly common (Oderkirk et al, 2013).…”

Section: Discussioncontrasting

confidence: 69%

Individual and Regional‐level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries

et al. 2015

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Using patient-level data for cerebral infarction cases in 2007, gathered from Finland, Hungary, Italy, the Netherlands, Scotland and Sweden, we studied the variation in risk-adjusted length of stay (LoS) of acute hospital care and 1-year mortality, both within and between countries. In addition, we analysed the variance of LoS and associations of selected regional-level factors with LoS and 1-year mortality after cerebral infarction. The data show that LoS distributions are surprisingly different across countries and that there is significant deviation in the risk-adjusted regional-level LoS in all of the countries studied. We used negative binomial regression to model the individual-level LoS, and random intercept models and ordinary least squares regression for the regional-level analysis of risk-adjusted LoS, variance of LoS, 1-year risk-adjusted mortality and crude mortality for a period of 31-365 days. The observed variations between regions and countries in both LoS and mortality were not fully explained by either patient-level or regional-level factors. The results indicate that there may exist potential for efficiency gains in acute hospital care of cerebral infarction and that healthcare managers could learn from best practices.

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Section: Discussioncontrasting

confidence: 69%

Individual and Regional‐level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries

et al. 2015

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“…The organized inpatient care (stroke unit) is an approach to stroke patients that has shown superiority compared to other approaches (Nimptsch & Mansky, 2014). The core characteristics of stroke unit settings are multidisciplinary staffing (medical, nursing, and therapy staff-usually including physiotherapy, occupational therapy, speech therapy, and social work) and coordinated multidisciplinary team care incorporating meetings at least once a week (Sun, Paulus, Eyssen, Maervoet, & Saka, 2013).…”

mentioning

confidence: 99%

“…Patients who had been treated in the stroke unit are more likely to survive, return home, and regain independence (Sun et al, 2013;Weder, 2015). Using the stroke unit model with interdisciplinary teams is more effective at treating stroke than aspirin/thrombolysis/statin use and lowering blood pressure (Langhorne, de Villiers, & Pandian, 2012).…”

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confidence: 99%

Factors associated with long‐term mortality for stroke unit patients in Latvia

2018

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AimThe aim of this study was to evaluate how pre‐stroke risk factors, neurological symptoms, and the level of disability shortly after stroke are associated with poststroke mortality during a 7‐year period after stroke, for persons treated in a stroke unit.MethodsThe data of 231 patients were included in the study. Patients who were treated in the stroke unit at the Riga East University Hospital between February 1, 2009, and July 20, 2009, were included in this study. Three stepwise Cox proportional hazard analyses were performed to analyze mortality in the 7 years following stroke. Pre‐stroke risk factors (type of stroke, arterial hypertension, diabetes mellitus, atrial fibrillation, smoking, alcohol abuse, obesity, recurrent stroke, age, gender), neurological symptoms (motor deficit, sensory disturbance, aphasia, poststroke urinary incontinence (PSUI), mental status), and limitations of activity (feeding, bathing, grooming, dressing, toilet use, transfers, mobility, stairs) were evaluated as factors associated with mortality after stroke.ResultsA total of 145 (62.8%) patients died during the study period. The final model for each group of factors included only one of the factors used for the analysis. Patients who had alcohol abuse were 40% more likely to die earlier. The hazard for those with PSUI is 1.72 times higher than those without PSUI. The independence in grooming showed a 39% lower likelihood of dying earlier.ConclusionAlcohol abuse as a pre‐stroke risk factor, poststroke urinary incontinence as a neurological symptom, and dependence in grooming as a factor of disability were associated with earlier mortality in the first seven years after stroke.

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“…Identified limitations to an effective implementation include lack of knowledge of the benefits of stroke units, financial barriers, insufficient staffing, lack of protocols and of collaboration between professionals. 29 Likewise, in Lithuania there is no formal requirement to have an organized stroke unit, or formal certification to provide stroke care. Compared with other European countries, Lithuania had higher incidence of stroke, higher prevalence of hypertension and atrial fibrillation, 4 and a poor outcome after stroke.…”

Section: Discussionmentioning

confidence: 99%

Methods of Implementation of Evidence-Based Stroke Care in Europe

Carlo

Pezzella

Fraser

et al. 2015

Stroke

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the implementation process is affected by variables related to communities, providers, and innovations. 3 The significant differences in incidence, mortality, and disability rates of stroke throughout European countries may reflect different degrees of implementation of evidence-based interventions in stroke prevention and care. 4,5 Characteristics of evidence, barriers, and facilitators to changing practice, and Background and Purpose-Differences in stroke care and outcomes reported in Europe may reflect different degrees of implementation of evidence-based interventions. We evaluated strategies for implementing research evidence into stroke care in 10 European countries. Methods-A questionnaire was developed and administered through face-to-face interviews with key informants.Implementation strategies were investigated considering 3 levels (macro, meso, and micro, eg, policy, organization, patients/professionals) identified by the framing analysis, and different settings (primary, hospital, and specialist) of stroke care. Similarities and differences among countries were evaluated using the categorical principal components analysis. Results-Implementation methods reported by ≥7 countries included nonmandatory policies, public financial incentives, continuing professional education, distribution of educational material, educational meetings and campaigns, guidelines, opinion leaders', and stroke patients associations' activities. Audits were present in 6 countries at national level; national and regional regulations in 4 countries. Private financial incentives, reminders, and educational outreach visits were reported only in 2 countries. At national level, the first principal component of categorical principal components analysis separated England, France, Scotland, and Sweden, all with positive object scores, from the other countries. Belgium and Lithuania obtained the lowest scores. At regional level, England, France, Germany, Italy, and Sweden had positive scores in the first principal component, whereas Belgium, Lithuania, Poland, and Scotland showed negative scores. Spain was in an intermediate position. Conclusions-We developed a novel method to assess different domains of implementation in stroke care. Clear variations were observed among European countries. The new tool may be used elsewhere for future contributions.

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A systematic review and meta-analysis of acute stroke unit care: What’s beyond the statistical significance?

Cited by 47 publications

References 17 publications

Individual and Regional‐level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries

Individual and Regional‐level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries

Factors associated with long‐term mortality for stroke unit patients in Latvia

Methods of Implementation of Evidence-Based Stroke Care in Europe

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