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Jaigobin, Cheryl S. "Survival, stroke recurrence and functional outcome after lacunar stroke." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ58705.pdf.
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Mohan, Keerthi Michelle. "The natural history of stroke recurrence after first-ever stroke." Thesis, King's College London (University of London), 2016. http://kclpure.kcl.ac.uk/portal/en/theses/the-natural-history-of-stroke-recurrence-after-firstever-stroke(530e5d24-437f-43a0-9555-eb45f374e278).html.
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Background - The natural history, predictors and outcomes of stroke recurrence after first-ever stroke have been insufficiently investigated. The available evidence shows great variation and does not provide a consensus of key predictors of stroke recurrence or a critical time-period for stroke recurrence occurring after initial stroke. This thesis uses data collected from the population-based South London Stroke Register to estimate the natural history of stroke recurrence after first-ever stroke. Methods - Data were collected over 12 years from all individuals known to have had an initial and first recurrent stroke from the South London Stroke Register. The cumulative risk and predictors of stroke recurrence up to 12 years after first stroke were identified using survival analyses, taking into account the effect of temporal changes in stroke management. The effect of stroke recurrence on risk of death after first stroke was estimated up to 15 years after initial stroke. A systematic review and meta-analysis of studies of the risk and cumulative risk of stroke recurrence after first stroke was also conducted. Results - The risk of stroke recurrence was estimated to be up to 25% at 12 years after first stroke. Cardiovascular risk factors were found to be important predictors of stroke recurrence, however differences in risk of recurrence were noted between the aetiological subtypes. Stroke recurrence was demonstrated to increase risk of death at all time-points up to 15 years after first stroke. Conclusions – The risk of stroke recurrence is considerable and is associated with increased risk of death up to 15 years after first stroke. Further research is needed to examine the effect of secondary prevention on risk of recurrence. Recurrence in the first year after stroke may also be associated with the biggest increase in risk of death identifying a potentially important time-period for stroke management to be targeted.
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Maniva, Samia Jardelle Costa de Freitas. "Elaboration and validation of educational technology on stroke for prevention of recurrence." Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=18306.
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nÃo hÃA prevenÃÃo da recorrÃncia do Acidente Vascular Cerebral (AVC) à uma medida fundamental para reduzir novos episÃdios em indivÃduos jà acometidos pela doenÃa. Acredita-se que a construÃÃo e validaÃÃo de uma tecnologia educativa do tipo cartilha sobre AVC seja de grande relevÃncia. O objetivo do estudo foi elaborar e validar uma tecnologia educativa do tipo cartilha sobre AVC para prevenÃÃo da recorrÃncia. O estudo foi realizado em duas etapas. Na primeira etapa, ocorreu a elaboraÃÃo e validaÃÃo de conteÃdo da cartilha. Na elaboraÃÃo da cartilha, os assuntos foram selecionados por meio de uma revisÃo integrativa e avaliados por onze especialistas. Em seguida, realizou-se a validaÃÃo de aparÃncia da cartilha com dez pacientes hospitalizados com AVC. Para anÃlise dos dados, foi utilizado o Ãndice de Validade de ConteÃdo (IVC). Na segunda etapa, conduziu-se um estudo quase-experimental, do tipo antes e depois. A cartilha validada foi aplicada a um grupo de 87 pacientes com AVC. Esta etapa foi desenvolvida na Unidade de AVC do Hospital Geral de Fortaleza (CearÃ), no perÃodo de fevereiro a abril de 2016. Foi utilizado o inquÃrito CAP, elaborado pela pesquisadora e previamente validado, para avaliar o conhecimento, a atitude e prÃtica dos pacientes sobre AVC, antes da implementaÃÃo da cartilha (prÃ-teste), imediatamente apÃs (pÃs-teste imediato) e apÃs quatro semanas (pÃs-teste tardio), via contato telefÃnico. Os dados foram apresentados por meio de tabelas e grÃficos, e discutidos com base na literatura pertinente. Foram calculadas as medidas estatÃsticas mÃdia, mediana e desvio padrÃo das variÃveis: idade, n de anos de estudo, renda, tempo de inÃcio dos sintomas e comparaÃÃo das mÃdias de pontuaÃÃo do CAP nos trÃs momentos. Todos os aspectos Ãticos foram respeitados, conforme a ResoluÃÃo 466/12, do Conselho Nacional de SaÃde. A cartilha educativa intitulada âCartilha do AVC: o que Ã, o que fazer e como prevenirâ, foi constituÃda por sete domÃnios: definiÃÃo da doenÃa, sinais e sintomas, aÃÃo emergencial, tratamento, fatores de risco, recorrÃncia de AVC e medidas preventivas. Na validaÃÃo de conteÃdo, a mÃdia do IVC para cada um dos aspectos avaliativos da cartilha obteve valor superior a 0,85 e a mÃdia global do IVC foi 0,94, indicando excelente grau de concordÃncia entre os especialistas. Com relaÃÃo à aplicaÃÃo da cartilha no grupo de pacientes, a mÃdia de idade dos pacientes foi de 51,6 anos (Â16,1), variando de 19 a 81 anos. A maioria foi composta por mulheres (51,7%), era casada (74,7%) e exerciam atividade laboral (67,8%), com renda mÃdia de um salÃrio mÃnimo. Quanto ao tipo de AVC, 94,% tiveram AVC isquÃmico. Os principais fatores de risco relatados para AVC foram: sedentarismo (86%), hipertensÃo arterial (66,3%) e diabetes mellitus (24,4%). AVC prÃvio ocorreu em 17,3% dos pacientes. No que diz respeito à comparaÃÃo das mÃdias das pontuaÃÃes do CAP, no prÃ-teste, conhecimento foi 3,31 (IC=3,02-3,61); atitude 0,63 (IC=0,43-0,83) e prÃtica 5,12 (IC=4,61-5,62). No pÃs-teste imediato, conhecimento foi 5,95 (IC=5,74-6,16), atitude 1,98 (IC=1,93-2,02) e prÃtica 11,64 (IC=11,49-11,79). No pÃs-teste tardio, conhecimento foi 5,25 (IC=5,02-5,49), atitude 2,00 (IC=2,00-2,00) e prÃtica 9,91 (IC=9,59-10,23). Diante de tais achados, pode-se afirmar que a cartilha educativa promoveu conhecimento, atitude e prÃtica adequada em pacientes sobre AVC, com vistas à prevenÃÃo da recorrÃncia.
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Pennlert, Johanna. "Recurrent stroke : risk factors, predictors and prognosis." Doctoral thesis, Umeå universitet, Medicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-127304.
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Background Many risk factors for stroke are well characterized and might, at least to some extent, be similar for first-ever stroke and for recurrent stroke events. However, previous studies have shown heterogeneous results on predictors and rates of stroke recurrence. Patients who survive spontaneous intracerebral hemorrhage (ICH) often have compelling indications for antithrombotic (AT) treatment (antiplatelet (AP) and/or anticoagulant (AC) treatment), but due to controversy of the decision to treat, a large proportion of these patients are untreated. In the absence of evidence from randomized controlled trials (RCTs), there is need for more high- quality observational data on the clinical impact of, and optimal timing of AT in ICH survivors. The aims of this thesis were to assess time trends in stroke recurrence, to determine the factors associated with an increased risk of stroke recurrence – including socioeconomic factors – and to determine to what extent ICH survivors with and without atrial fibrillation (AF) receive AT treatment and to determine the optimal timing (if any) of such treatment. Methods The population-based Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) stroke incidence register was used to assess the epidemiology and predictors of stroke recurrence after ischemic stroke (IS) and ICH from 1995 to 2008 in northern Sweden. Riksstroke, the Swedish stroke register, linked with the National Patient Register and the Swedish Dispensed Drug Register, made it possible to identify survivors of first-ever ICH from 2005 to 2012 with and without concomitant AF to investigate to what extent these patients were prescribed AP and AC therapy. The optimal timing of initiating treatment following ICH in patients with AF 2005–2012 was described through separate cumulative incidence functions for severe thrombotic and hemorrhagic events and for the combined endpoint “vascular death or non-fatal stroke”. Riksstroke data on first-ever stroke patients from 2001 to 2012 was linked to the Longitudinal Integration Database for Health Insurance and Labour market studies to add information on education and income to investigate the relationship between socioeconomic status and risk of recurrence. Results Comparison between the cohorts of 1995–1998 and 2004–2008 showed declining risk of stroke recurrence (hazard ratio: 0.64, 95% confidence interval (CI): 0.52-0.78) in northern Sweden. Significant factors associated with an increased risk of stroke recurrence were age and diabetes. Following ICH, a majority (62%) of recurrent stroke events were ischemic. The nationwide Riksstroke study confirmed the declining incidence, and it further concluded that low income, primary school as highest attained level of education, and living alone were associated with a higher risk of recurrence beyond the acute phase. The inverse effects of socioeconomic status on risk of recurrence did not differ between men and women and persisted over the study period. Of Swedish ICH-survivors with AF, 8.5% were prescribed AC and 36.6% AP treatment, within 6 months of ICH. In patients with AF, predictors of AC treatment were less severe ICH, younger age, previous anticoagulation, valvular disease and previous IS. High CHA2DS2-VASc scores did not seem to correlate with AC treatment. We observed both an increasing proportion of AC treatment at time of the initial ICH (8.1% in 2006 compared with 14.6% in 2012) and a secular trend of increasing AC use one year after discharge (8.3% in 2006 versus 17.2% in 2011) (p<0.001 assuming linear trends). In patients with high cardiovascular event risk, AC treatment was associated with a reduced risk of vascular death and non-fatal stroke with no significantly increased risk of severe hemorrhage. The benefit appeared to be greatest when treatment was started 7–8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within three years was 17.0% when AC treatment was initiated eight weeks after ICH and 28.6% without any antithrombotic treatment (95% CI for difference: 1.4% to 21.8%). For high-risk men, the corresponding risks were 14.3% vs. 23.6% (95% CI for difference: 0.4% to 18.2%). Conclusion Stroke recurrence is declining in Sweden, but it is still common among stroke survivors and has a severe impact on patient morbidity and mortality. Age, diabetes and low socioeconomic status are predictors of stroke recurrence. Regarding ICH survivors with concomitant AF, physicians face the clinical dilemma of balancing the risks of thrombosis and bleeding. In awaiting evidence from RCTs, our results show that AC treatment in ICH survivors with AF was initiated more frequently over the study period, which seems beneficial, particularly in high-risk patients. The optimal timing of anticoagulation following ICH in AF patients seems to be around 7–8 weeks following the hemorrhage.
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Johansson, Elias. "Carotid stenosis." Doctoral thesis, Umeå universitet, Institutionen för folkhälsa och klinisk medicin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-46396.
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Carotid stenosis is one of several causes of ischemic stroke and entails a high risk of ischemic stroke recurrence. Removal of a carotid stenosis by carotid endarterectomy results in a risk reduction for ischemic stroke, but the magnitude of risk reduction depends on several factors. If the delay between the last symptom and carotid endarterectomy is less than 2 weeks, the absolute risk reduction is >10%, regardless of age, sex, or if the degree of carotid stenosis is 50–69% or 70–99%. Thus, speed is the key. However, if many patients suffers an ischemic stroke recurrence within the first 2 weeks of the presenting event, an additional benefit is likely be obtained if carotid endarterectomy is performed even earlier than within 2 week after the presenting event. Carotid endarterectomy for asymptomatic carotid stenoses carries a small risk reduction for stroke. Screening for asymptomatic carotid stenosis requires a prevalence of >5% in the examined population, i.e., higher than in the general population; however, directed screening in groups with a prevalence of >5% is beneficial. The aims of this thesis were to investigate the length of the delay to carotid endarterectomy, determine the risk of recurrent stroke before carotid endarterectomy, and determine if a calcification in the area of the carotid arteries seen on dental panoramic radiographs is a valid selection method for directed ultrasound screening to detect asymptomatic carotid stenosis. Consecutive patients with a symptomatic carotid stenosis who underwent a preoperative evaluation aimed at carotid endarterectomy at Umeå Stroke Centre between January 1, 2004–March 31, 2006 (n=275) were collected retrospectively and between August 1, 2007–December 31, 2009 (n=230) prospectively. In addition, 117 consecutive persons, all preliminarily eligible for asymptomatic carotid endarterectomy and with a calcification in the area of the carotid arteries seen on panoramic radiographs, were prospectively examined with carotid ultrasound. The median delay between the presenting event and carotid endarterectomy was 11.7 weeks in the first half year of 2004, dropped to 6.9 weeks in the first quarter year of 2006, and had dropped to 3.6 weeks in the second half year of 2009. The risk of ipsilateral ischemic stroke recurrence was 4.8% within 2 days, 7.9% within 1 week, and 11.2% within 2 weeks of the presenting event. For patients with a stroke or transient ischemic attack as the presenting event, this risk was 6.0% within 2 days, 9.7% within 1 week, and 14.3% within 2 weeks of the presenting event. For the 10 patients with a near-occlusion, the risk of ipsilateral ischemic stroke recurrence was 50% at 4 weeks after the presenting event. Among the 117 persons with a calcification in the area of the carotid arteries seen on panoramic radiographs, eight had a 50–99% carotid stenosis, equalling a prevalence of 6.8% (not statistically significantly over the pre-specified 5% threshold). Among men, the prevalence of 50–99% carotid stenosis was 12.5%, which was statistically significantly over the pre-specified 5% threshold. In conclusion: The delay to carotid endarterectomy was longer than 2 weeks. Additional benefit is likely to be gained by performing carotid endarterectomy within a few days of the presenting event instead of at 2 weeks because many patients suffer a stroke recurrence within a few days; speed is indeed the key. The finding that near-occlusion entails an early high risk of stroke recurrence stands in sharp contrast to previous studies; one possible explaination is that this was a high-risk period missed in previous studies. The incidental finding of a calcification in the area of the carotid arteries on a panoramic radiograph is a valid indication for carotid ultrasound screening in men who are otherwise eligible for asymptomatic carotid endarterectomy.
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Chong, Boon Hor, and 鍾文一. "Risk of ischemic stroke and recurrent hemorrhagic stroke in Chinese population." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47323450.
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Stroke is a devastating, neurological dysfunction due to brain blood supply disturbance. It is responsible for increasingly high rate of mortality and disability worldwide. This thesis comprises two original studies involving 868 patients at risk of ischemic stroke and/or hemorrhagic stroke.
The first study investigated aspirin’s effect among patients with intracranial hemorrhage. Unlike Caucasians which hemorrhagic strokes account for 10-15% of all strokes; in Chinese, intracranial hemorrhages strike up to 35%. After such, anti-platelet agent like aspirin is often avoided for fear of recurrent intracranial hemorrhages, despite compelling indications. However, clinical data is limited. In this single-centered observational study, we included 440 consecutive Chinese patients with a first spontaneous intracranial hemorrhage surviving the first month performed during 1996-2010. 56 patients (12.7%) of these 440 patients were prescribed aspirin after intracranial hemorrhage (312 patient-aspirin years). After a mean follow-up of 62.2 ± 1.8 months, 47 patients had recurrent intracranial hemorrhage(10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have higher risk of recurrent intracranial hemorrhage compared with those without (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years and hypertension as independent predictors for recurrent intracranial hemorrhage. In a subgroup analysis: the incidence of combined vascular events including recurrent intracranial hemorrhage, ischemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than without (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). Implications of the results: despite having a substantial risk for recurrent intracranial hemorrhage, post-intracranial hemorrhage ones are at risk for thrombotic vascular events and management goal should thus focus on ameliorating overall cardiovascular risk instead of preventing recurrent intracranial hemorrhage. Hence, thrombo-prophylaxis should still be considered.
The second study investigated the relation between premature atrial complexes and new-onset atrial fibrillation together with other cardiovascular events. Premature atrial complexes though taken as benign phenomenon, are common in patients with underlying conditions such as coronary heart disease, chronic rheumatic heart disease. While prompt management of atrial fibrillation may prevent ischemic stroke, atrial fibrillation is often unfound until ischemic stroke occurs. In this study, 428 patients without atrial fibrillation but complained of palpitations, dizziness or syncope were recruited. 107 patients with >100 premature atrial complexes/day were defined to have frequent premature atrial complexes. After a mean follow-up of 6.1 ±1.3 years, 31 patients (29%) with frequent premature atrial complexes developed atrial fibrillation compared with 29 patients (9%) with premature atrial complexes?100/day (p<0.01). Cox regression analysis revealed: frequent premature atrial complexes, age>75 years and coronary artery disease were independent predictors. In secondary endpoint (ischemic stroke, congestive heart failure, and death), patients with frequent premature atrial complexes were more at risk than those without (34.5% vs. 19.3%) (Hazard ratio: 1.95, 95% confidence interval: 1.37-3.50, p=0.001). Cox regression analysis showed: age> 75 years, coronary artery disease and frequent premature atrial complexes were independent predictors. These permit early identification of high risks patients of new atrial fibrillation and other events, thus promoting appropriate preventive treatment.published_or_final_version
Medicine
Master
Master of Philosophy
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Lilly, Flavius R. W. "Severe Mental Illness among Stroke Survivors| Post-Stroke Non-Psychiatric Hospitalizations, Recurrent Stroke and Mortality Over Five Years." Thesis, University of Maryland, Baltimore County, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3707293.
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BACKGROUND AND PURPOSE: This study sought to examine the association of severe mental illness (SMI) among stroke survivors treated in Veteran Administration (VA) hospitals with medical (non-psychiatric) hospitalizations, recurrent stroke hospitalization and mortality risk over a five year period after the initial stroke. Additionally, this study used administrative data to explored inpatient stroke treatment differences between patients with and without SMI.
METHODS: This retrospective cohort study included 523 veterans who survived an initial stroke hospitalization in a VA medical center during fiscal year 2003. This cohort of stroke survivors was followed from discharge in 2003 through 2008 using administrative data documenting patient demographics, disease co-morbidities, subsequent VA hospital admissions, recurrent stroke admissions, and death. Multivariate Poisson regression with log link functions was used to examine the relationship between SMI status and non-psychiatric hospitalizations after stroke. Cox proportional hazards regression was used to examine the relationship between SMI status and recurrent stroke and post-stroke mortality. The differences in compliance with inpatient stroke treatment guidelines between patients with and without SMI was assessed using logistic regression.
RESULTS: The study cohort of 523 veterans included 100 with SMI comorbidity and 423 without SMI comorbidity. It was found that stroke survivors with SMI do not have significantly increased risk for non-psychiatric hospitalizations, recurrent stroke or mortality at any time period post-stroke after adjustment for covariates. It was also found that there was no significant difference in the delivery of guideline concordant inpatient stroke care between patients with and without SMI.
CONCLUSIONS: The finding that SMI had little impact on the post-stroke outcomes of hospitalization, recurrent stroke and mortality among veterans who receive their care at VA hospitals was surprising. It was hypothesized that SMI would continue to disadvantage individuals even after having survived a stroke. These findings may be partially explained by the highly integrated nature of care for the mentally ill in the VA system, which may equalize disparities associated with SMI post-stroke. This study offers preliminary evidence of this in VA hospital inpatient settings where acute stroke treatment did not significantly vary between patients with and without SMI.
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Viitanen, Matti. "Long-term effects of stroke." Doctoral thesis, Umeå universitet, Rehabiliteringsmedicin, 1987. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100559.
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Stroke, which has an increasing incidence with age, causes an irreversible brain damage which may lead to impairment, disability and decreased life satisfaction or death. Risk factors for death, recurrent stroke and myocardial infarction, were analyzed in 409 stroke patients treated at the Stroke Unit, Department of Medicine, Umeå University Hospital, between Jan. 1, 1978 and Dec. 31, 1982. The causes of death were related with the time of survival. In fully co-operable (n=62) 4-6 year stroke survivors, the occurrence of motor and perceptual impairments, of self-care (ADL) disability and of self-reported decreased life satisfaction due to stroke was determined. The probability of survival was 77% three months after stroke, 69% after one year, and 37% after five years. Multivariate statistical analysis indicated that impairment of consciousness was the most important risk factor for death followed by age, previous cardiac failure, diabetes mellitus, intracerebral hemorrhage and male sex. During the first week, cerebrovascular disease (90%) was the most dominant primary cause of death, from the second to the fourth week pulmonary embolism (30%), bronchopneumonia during the second and third months and cardiac disease (37%) later than three months after stroke. The risk of recurrence was 14% during the first year after stroke and the accumulated risk of stroke recurrence after 5 years was 37% after stroke. The estimated probability of myocardial infarction was 7% at one year and 19% at 5 years. High age and a history of cardiac failure increased the risk of recurrent stroke. The risk of myocardial infarction was associated with high age, angina pectoris and diabetes mellitus. The highest risk of epilepsy was found between 6 and 12 months after stroke. Motor impairment prevailed in 36% of the long-term survivors, perceptual impairments in up to 57% and decreased ADL-capacity in 32%. As regards ecological perception, perceptual function variables were distinctly grouped into low and high level perception which together with motor function explained 71% of the variance of self-care ADL. While levels of global and of domain specific variables of life satisfaction appeared stable in clinically healthy reference populations aged 60 and 80 years, the stroke had produced a decrease in one or more aspects of life satisfaction for 61% of the long-term survivors. Although significantly associated with motor impairments and ADL disability, these changes could not only be attributed to physical problems.S. 1-48: sammanfattning, s. 49-114: 5 uppsatser
digitalisering@umu
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Irewall, Anna-Lotta. "Recurrent events and secondary prevention after acute cerebrovascular disease." Doctoral thesis, Umeå universitet, Medicin, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-130505.
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Background Patients who experience a stroke or transient ischemic attack (TIA) are at high risk of recurrent stroke, but little is known about temporal trends in unselected populations. Reports of low adherence to recommended treatments indicate a need for enhanced secondary preventive follow-up to achieve the full potential of evidence-based treatments. In addition, socioeconomic factors have been associated with poor health outcomes in a variety of contexts. Therefore, it is important to assess the implementation and results of secondary prevention in different socioeconomic groups. Aims The aims of this thesis were to assess temporal trends in ischemic stroke recurrence and evaluate the implementation and results of a nurse-led, telephone-based follow-up program to improve blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels after stroke/TIA. Methods In study I, we collected baseline data for unique patients with an ischemic stroke event between 1998 and 2009 (n=196 765) from the Swedish Stroke Register (Riksstroke). Recurrent ischemic stroke events within 1 year were collected from the Swedish National Inpatient Register (IPR) and the cumulative incidence was compared between four time periods using the Kaplan-Meier survival analysis and the logrank test. Implementation (study II) and 1-year results (study III-IV) for the secondary preventive follow-up were studied in the NAILED (Nurse-based Age-independent Intervention to Limit Evolution of Disease) study. Between 1 Jan 2010 and 31 Dec 2013, the baseline characteristics of consecutive patients admitted to Östersund Hospital for acute stroke or TIA were collected prospectively (n=1776). Consenting patients in a condition permitting telephone-based follow-up were randomized to nurse-led, telephone-based follow-up or follow-up according to usual care. Follow-up was cunducted at 1 and 12 months after discharge and the intervention included BP and LDL-C measurements, titration of medication, and lifestyle counseling. In study II, we analyzed factors associated with non-participation in the randomized phase of the NAILED study, including association with education level. In addition, we compared the 1-year prognosis in terms of cumulative survival between participants and non-participants. In study III, we compared differences in BP and LDL-C levels between the intervention and control groups during the first year of follow-up and, in study IV, in relation to level of education (low, ≤10 years; high, >10 years). Results The cumulative 1-year incidence of recurrent ischemic stroke decreased from 15.0% to 12.0%. Among surviving stroke and TIA patients, 53.1% were included for randomization, 35.7% were excluded mainly due to physical or cognitive disability, and 11.2% declined participation in the randomized phase. A low level of education was independently associated with exclusion, as well as the patient’s decision to abstain from randomization. Excluded patients had a more than 12-times higher risk of death within 1 year than patients who were randomized. After 1 year of follow-up, the mean systolic BP, diastolic BP, and LDL-C levels were 3.3 mmHg (95% CI 0.3 to 6.3), 2.3 mmHg (95% CI 0.5 to 4.2), and 0.3 mmol/L (95% CI 0.1 to 0.4) lower in the intervention group than among controls. Among participants with values above the treatment goal at baseline, the differences in systolic BP and LDL-C levels were more pronounced (8.0 mmHg, 95% CI 4.0 to 12.1; 0.6 mmol/L, 95% CI 0.4 to 0.9). In the intervention group, participants with a low level of education achieved similar or larger improvements in BP and LDL-C than participants with a high level of education. In the control group, BP remained unaltered and the LDL-C levels increased among participants with a low level of education. Conclusion The 1-year risk of ischemic stroke recurrence decreased in Sweden between 1998 and 2010. Nurse-led, telephone-based secondary preventive follow-up is feasible in just over half of the survivors of acute stroke and TIA and achieve better than usual care in terms of BP and LDL-C levels, and equality in BP improvements across groups defined by education level. However, a large proportion of stroke survivors are in a general condition precluding this form of follow-up, and their prognosis in terms of 1-year survival is poor. Patients with a low education level are over-represented within this group and among patients declining randomization for secondary preventive follow-up.
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Popara, Nikola. "Využití umělé inteligence k monitorování stavu obráběcího stroje." Master's thesis, Vysoké učení technické v Brně. Fakulta strojního inženýrství, 2021. http://www.nusl.cz/ntk/nusl-444960.
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This thesis is focus on monitoring state of machine parts that are under the most stress. Type of artificial intelligence used in this work is recurrent neural network and its modifications. Chosen type of neural network was used because of the sequential character of used data. This thesis is solving three problems. In first problem algorithm is trying to determine state of mill tool wear using recurrent neural network. Used method for monitoring state is indirect. Second Problem was focused on detecting fault of a bearing and classifying it to specific category. In third problem RNN is used to predict RUL of monitored bearing.
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Hsiao, Yu-Tien, and 蕭育恬. "Association between rehabilitation frequency and stroke recurrence." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/11429075731346755513.
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碩士中國醫藥大學
醫務管理學系碩士在職專班
100
Background: Cerebrovascular disease, the third of the top ten leading causes of death in Taiwan in 2009, made great impacts on the medical cost and the load of health care. Prior research indicated that rehabilitation treatments might stabilize the physiological functions of patients and thus improve the activities of daily living. Rehabilitation may be linked to stroke recurrence. Objective: This study sought to explore the association between rehabilitation frequency and stroke recurrence among patients with stroke. Methods: With a retrospective cohort design, the current study analyzed the medical claims data extracted from 1,000,000 randomly sampled beneficiaries recorded in the 2002-2009 Taiwan National Health Insurance Research Database. A total of 18,517 patients diagnosed as stroke (ICD-9-CM: 430.xx-437.xx) were identified. Descriptive statistics, Chi-square, and logistic regression were conducted in SAS 9.1. The rehabilitation frequency was coded as high, medium high, medium low, and low by statistical quartile. Other factors associated with stroke recurrence were controlled in the multivariate models. Results: Of all the subjects, patients with ischemic and hemorrhage stroke account for 87.51% (16,205) and 12.49% (2,312) respectively. 46.77% (8,661) of the stroke patients received rehabilitation. Totally, 10.62% (1,967) suffered from recurrent strokes. Patients with rehabilitation were more likely to report stroke recurrence compared to those without. The factors significantly associated with recurrent stroke among patients receiving rehabilitation were gender, age, stroke type, comorbidity (including diabetes, atrial fibrillation, and chronic kidney disease), hospital level, hospital ownership, interval between first stroke and first rehabilitation, and rehabilitation frequency. The odds of stroke recurrence increased with each increment of rehabilitation frequency (P<.0001). Conclusions: This study found a positive relationship between rehabilitation frequency and stroke recurrence. Rehabilitation frequency can be an effective predictor for stroke recurrence. The association between rehabilitation frequency and stroke recurrence should be more valued. The potential causes of stroke recurrence under the high frequency of rehabilitation justify further research.
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Ke, Yu Hao, and 葛宇浩. "Association between Drug Therapy Use and Stroke Recurrence." Thesis, 2019. http://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi/login?o=dnclcdr&s=id=%22107CGU05396032%22.&searchmode=basic.
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Juang, Hsiao-Ting, and 莊筱婷. "Using Antidepressants and the Risk of Stroke Recurrence." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/27061659359192217791.
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碩士國立臺灣大學
流行病學與預防醫學研究所
101
Background - The evidence about the association between use of antidepressants and stroke recurrence was scanty. This study evaluated the risk of stroke recurrence of using antidepressants in patients with stroke from a national representative cohort. Methods – This cohort study followed 18884 patients aged 20 years who had an incident stroke from 2000 to 2009 from National Health Insurance Research Database in Taiwan. Records of each antidepressant prescription were obtained during follow-up. The types of antidepressants were categorized by Anatomical Therapeutic Chemical classification system: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and other antidepressants. The main outcome was a recurrent stroke during the follow-up period. A time-dependent Cox proportional hazards model was used in the analyses. Results – During 61892 person-years of follow-up, we documented 4450 events for stroke recurrence. Antidepressants use was associated with an increased risk of stroke recurrence (adjusted hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.24-1.61]), especially in ischemic stroke (HR, 1.47; 95% CI, 1.28-1.68), but not in hemorrhagic stroke (HR, 1.23; 95% CI, 0.89-1.71). The increased risk for stoke recurrence was found in TCAs (HR, 1.52; 95% CI, 1.24-1.87), the group of other types (HR, 1.42; 95% CI, 1.12-1.80), or multiple types (HR, 1.87; 95% CI, 1.06-3.30). Conclusions – We demonstrated that use of antidepressants was associated with an increased risk of stroke recurrence, especially in ischemic stroke among Taiwanese. Further studies are warranted to confirm the possible underlying mechanisms of these findings.
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Hsiao, Pei-Min, and 蕭佩敏. "Multivariate analysis of stroke risk factor, sleep apnea and Neurosonology to predict stroke recurrence." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/gt6zpp.
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Wang, Chih Chi, and 王芝淇. "Development of Risk Score for Ischemic Stroke Recurrence in Taiwan." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/zq87yq.
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碩士臺北醫學大學
公共衛生學系暨研究所
102
Stroke patients who received the treatment in acute phase still have the chance to be recurrent. Stroke recurrence increases the probability of disability, cognitive decline, longer hospital days, neurology damage and mortality. The risk factors and mechanism of stroke recurrence are multiple. In order to give stroke patients property and accurate treatment and health teaching to prevent risk of recurrent stroke, doctors need a prediction model with high calibration to identify the high risk patients. Up to now, the available models for recurrent stroke are not used in clinical practice, due to poor prediction ability and hard measurement. There were limited studies focusing on Asian population and there also not a stroke recurrence prediction model for Taiwanese. So, we are going to conduct a retrospective cohort study to develop an ischemic stroke recurrence prediction model. The study resource is Taiwan Stroke Registry database (TSR) and National Health Insurance database (NHI). We follow the incident ischemic stroke patients 1- year recurrent event. Then we randomize the eligible patients to two groups including model development and validation, respectively. The model development group is used to analyze the association between basic characteristics, risk factors and 1- year stroke recurrence by Cox proportional hazard model. We further calculate the predicting score and estimated risk of the model by Points system. We use the Goodness- of- fit to test the calibration for the model. In addition, Area Under Receiver Operating Characteristic (AUROC) was used to elucidate the discrimination. Final, Kaplan- Meier survival curve and Log- rank test are used to compare the cumulative recurrence rate between the lowest risk, medium risk and highest risk group. The result is that prediction model''s score range from 0 to 18. There are five risk factors in the model. The factors include diabetes, atril fibrillation, chronic kidney disease, non- SVO TOAST subtype and headache symptom. The estimated risk of 0 score is 8.82%; 1 score is 9.68%; greater than 14 score is more than 30.38%. The correlation coefficient for estimated risk and observation incidence of model development group and model validation group is 0.98788 (P<.0001) and 0.98333 (P<.0001). AUROCs are 0.564 in the development group and 0.580 in the validation group. Compared with the lowest risk group, both medium and highest risk group have the significant higher risk for stroke recurrence in the development group (HRmedium= 1.35, 95%C.I.= 1.20- 1.52; HRhigh=3.13, 95%C.I.= 2.41- 4.06) and validation group (HRmedium= 1.55, 95%C.I.= 1.22- 1.98; HRhigh= 2.73, 95%C.I.= 1.52- 4.92), and trend test are significant in two group. We have derived and validated a simple prediction model with five risk factors to predict the risk for ischemic stroke recurrence within 1 year. The prediction model range from 0 to 18 score with good calibration. Doctors can use this model to assess the patient''s situation and expect their risk of stroke recurrence. Through the accurate treatment and health teaching, doctors can help their patients to prevent the stroke recurrence.
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Carioca, Filipa. "Blood markers and recurrence of stroke in patients with transient ischemic attack." Master's thesis, 2014. http://hdl.handle.net/10451/23987.
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Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014Background: Several clinical and imaging predictors were proposed to identify the risk of stroke recurrence in patients with transient ischemic attacks (TIA). Recently, blood biomarkers were suggested for this purpose. Our main goal was to carry out a systematic review of the literature to find biomarkers evaluated as prognostic predictors in TIA cohorts. Methods: We searched PubMed (1974 to December 2013) aiming to find studies measuring blood biomarkers in TIA patients (<72h) and assessing the recurrence of stroke. We planned to perform a meta-analysis provided that blood concentrations were given. Results:The electronic search yielded 937 studies and seven met our inclusion criteria. These were heterogeneous and small (mean 155 patients). Five of them adjusted the effect of blood biomarkers for other outcome predictors (ABCD2 score, medical history of hyperlipidemia and large-artery atherosclerosis). The biomarkers assessed were CRP, Lp-PLA2 mass and activity, D-dimers, copeptin, cortisol, aPS/PT (IgG and IgM), aβ2GPI (IgG, IgA and IgM; D4/5 IgA; D1 IgG) and aCL (IgG, IgA and IgM). Copeptin was associated with recurrence of stroke or TIA at 90 days. Lp-PLA2 activity was associated with risk of TIA or stroke at 7 and 30 days, and of stroke or death at 90 days. aPS/PT IgG antibodies showed an association with stroke or death at 90 days. The results for CRP were ambiguous, therefore the association between the CRP and stroke recurrence could not be established. The remaining biomarkers were not associated with stroke recurrence in TIA patients. Conclusion: Lp-PLA2 activity, copeptin, CRP and aPS/PT IgG were targeted as possible predictors of stroke recurrence in TIA patients. More studies, with larger samples and standardized designs, are required to confirm their usefulness in order to import their results to clinical practice.
Introdução: Vários preditores clínicos e imagiológicos são utilizados para avaliar o risco de recorrência de acidente vascular encefálico (AVC) após acidente isquémico transitório (AIT). Recentemente foi sugerido que biomarcadores sanguíneos poderiam ser utilizados com este propósito. O nosso objectivo foi realizar uma revisão sistemática da literatura para encontrar biomarcadores avaliados como preditores de prognóstico em doentes com status pós-AIT. Métodos: Pesquisa na PubMed (1974 até Dezembro de 2013) com objectivo de encontrar estudos que quantificavam biomarcadores sanguíneos em doentes com status pós-AIT (<72h) e avaliavam a recorrência de AVC. Posterior realização de meta-análise dos dados obtidos se todos os dados necessários fossem fornecidos. Resultados: A pesquisa electrónica obteve 937 estudos, dos quais sete correspondiam aos critérios de inclusão. Estes estudos eram heterógenos e tinham amostras pequenas (média de 155 doentes). Cinco ajustaram o efeito dos biomarcadores a outros preditores de outcome (score ABCD2 e história de hiperlipidémia e aterosclerose de grandes vasos). Os biomarcadores avaliados foram: proteína C reactiva (PCR); massa e actividade da Lp-PLA2; D-dímeros; copeptina; cortisol; aPS/PT (IgG e IgM); aβ2GPI (IgG, IgA e IgM; D4/5 IgA; D1 IgG) e aCL (IgG, IgA e IgM). A copetina foi associada com a recorrência de AVC ou AIT a 90 dias. A actividade da Lp-PLA2 foi associada com o risco de AVC aos 7 e 30 dias e de AVC ou morte aos 90 dias. As imunoglobulinas IgG aPS/PT mostraram associação com a ocorrência de AVC ou morte aos 90 dias. Foram obtidos resultados ambíguos relativamente à PCR. Os restantes biomarcadores não se associaram com o outcome estabelecido. Conclusão: A actividade da Lp-PLA2, a copeptina, a PCR e as imunoglobulinas IgG aPS/PT são possíveis preditores de recorrência de AVC em doentes com AIT recente. Mais estudos, com amostras maiores e protocolos uniformizados são necessários para confirmar a sua utilidade e importar os seus resultados para a prática clínica.
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Lai, Yi-Ching, and 賴怡青. "Factors Affecting Mortality of Patients Survived from First Stroke---Is Recurrence an Only Surrogate Endpoint?" Thesis, 2009. http://ndltd.ncl.edu.tw/handle/38735857954017531239.
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碩士國立臺灣大學
流行病學研究所
97
Background Surrogate endpoints of cerebrovascular death, including stroke recurrence and biological factors of cerebrovascular disease for long-term prognosis, were barely address and qualified. Aim To identify significant prognostic factors (including recurrence and biological markers) responsible for long-term prognosis of first ischemic stroke, and to evaluate where recurrence and other biological markers are good surrogate endpoints for long-term prognosis by using conventional Cox regression model and also multi-state stochastic models. Method A total of 466 patients with first stroke that were the study population designed for a randomized controlled trial on the comparison of treatment efficacy using aspirin in reducing recurrence was used. A series of predictors for long-term prognosis of death from cerebrovascular were collected. Cox regression model with or without time-dependent covariate of recurrence was used to model the proportion of treatment effect explained (PTE) for surrogate endpoint. The multi-state stochastic model with the incorporation of regressions was used to assess the role of surrogate endpoint on recurrence, other biological factors and treatment. Result By using multivariate analysis, we identified four predictors for long-term prognosis of first ischemic stroke, including recurrence, treatment, total cholesterol, and serum glucose. By using PTE method, we found the latter 3 factors were independent factors for long-term prognosis after adjustment for recurrence. The multi-state model found recurrence is a strong surrogate endpoint for long-term prognosis of cerebrovascular death. In addition, treatment, total cholesterol and glucose were three another surrogate endpoints. Conclusion Surrogate endpoints with recurrence and other factors without recurrence were qualified and identified for long-term prognosis of first ischemic stroke. Keywords Cerebrovascular death, multi-state Markov model, stroke recurrence, surrogate endpoint
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Maier, Ilko. "Risikoprädiktion für sehr frühen Reinfarkt, Tod und Progression nach ischämischem Schlaganfall." Doctoral thesis, 2013. http://hdl.handle.net/11858/00-1735-0000-0022-60A6-F.
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Faure, Mareva. "Caractérisation des profils de traitements pour accident vasculaire cérébral et événements cliniques associés." Thèse, 2017. http://hdl.handle.net/1866/20548.
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Cheng, Hsin-ling, and 鄭信鈴. "Predicting Recurrent Stroke via ANN Model." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/00905313255978962661.
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碩士國立成功大學
工業與資訊管理學系專班
95
Stroke is one of the life-threatening neuropathy. It is the key factor to increase mortality rate over the world. Two thousands five hundred million people suffered from stroke on earth. Among these figures, one hundred sixty thousand people died of stroke in America and ten thousand people died each year in Taiwan. Patients who had Transient ischaemic attack(TIA) suffered from recurrent stroke is ten times more. Their mortality rate is higher than one-fourth. Additionally, stroke recurrence is a significant concern with regard to an increase in mortality, disability, and length of hospital stay. Thus, correlation analysis can be used to look at the relationships between stroke risk factors and the severity score of recurrent stroke. This built system assist the physicians in diagnosis. To predict the stroke recurrence is a complex task and it is a nonlinear relationship among many variables. We developed an ANN model to assist the physicians to predict the possibility of stroke recurrence. The study is retrospective by using information from a database of medical inpatients. Three hundred and thirty one patients’ records were used as sample. To achieve optimum performance, we use a three-fold cross validation procedure. Furthermore, we compared the performance of ANN against the logistic regression approach on the same dataset. Our results show that patients with well control blood pressure will have lower severity score. Finally, we evaluated the performance of models according to prediction accuracy, sensitivity and specificity.
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LI, JIA-SHAN, and 李佳珊. "Effects of Antiplatelet Therapy on Recurrent Stroke in the Stroke Patients." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/45kuss.
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碩士國立雲林科技大學
工業工程與管理系
107
Cerebrovascular disease is the main cause of death and disability in many countries. Many studies have confirmed that ischemia accounts for the highest proportion of stroke types. Most patients with ischemic stroke use antiplatelet drugs to prevent the risk of re-stroke.In CAPRIE trial found Clopidogrel in the prevention of cardiovascular disease and reduce bleeding problems better than the current clinically used Aspirin.This study used patients with ischemic stroke to evaluate the effectiveness of Clopidogrel and Aspirin in re-stroke. The study used retrospective analysis to observe a total of 226 cases from September 1, 2015 to November 20, 2018, with patients with ischemic stroke accompanied by multiple chronic diseases,so in response to the effects of Clopidogrel and Aspirin on the recurrence of stroke, bleeding phenomenon and death cases, The factors of Multimorbidity (such as Hypertension, Diabetes Mellitus, Dyslipidemia, and Chronic kidney disease) were listed as the key research directions. Research data showed that the subjects took Clopidogrel (N=50) and Aspirin (N=176), which lasted 1 year. Cox regression analysis of side effects, the results showed that the rate of recurrent stroke in Clopidogrelgl (6 patients, 12%) was higher than that of Aspirin (17 patients, 9.7%); Aspirin (8 patients, 4.5%) Gastrointestinal hemorrhage was Higher than Clopidogrel (1 patients, 2%), and there was no significant difference; A total of Multimorbidity and side effect Only Diabetes Mellitus had significant correlation with recurrent stroke (p > 0.05) and Chronic kidney disease had a significant correlation with death ( p>0.05), while Hypertension and Dyslipidemia had no significant difference (p < 0.05). This study to understand the effectiveness of Clopidogrel and Aspirin for prevention of recurrence of stroke, this study is consistent with the results of real-world.Clopidogrel and Aspirin are effective in preventing the recurrence of stroke; Aspirin gastrointestinal hemorrhage phenomenon is higher than Clopidogrel. If patients with Diabetes Mellitus and Chronic kidney disease history have side effects, they are associated with significant effect.The most important is to understand the main cause of stroke, medical team give appropriate medication treatment, and do the regular health examination to reduce the risk of recurrent stroke.
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Hu, Yao Wen, and 胡耀文. "Model Development of Alert System for Recurrent Stroke." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/77921708836708316490.
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碩士長庚大學
資訊管理學研究所
97
In the top ten causes of death, stroke has been ranked the top three cause over the past twenty years in Taiwan. Many studies about stroke reported that the most of patients who have experienced a stroke would occur again within five years, and it would bring patients bigger hurt. For this reason, we propose a model of alert system preventing recurrent stroke. CBR can mean adapting old solutions to meet new demands, using old cases to explain new situations, or reasoning from precedents to interpret a new situation. CBR is appropriate in medicine for some important reasons; cognitive adequateness, explicit experience, duality of objective and subjective knowledge, automatic acquisition of subjective knowledge, and system integration. Linear regression model is to use the past historical data to predict the future trend. A moving average is commonly used with time series data to smooth out short-term fluctuations and highlight longer-term trends or cycles. In this study, the use of case-based reasoning method to identify users of similar cases and to calculate the blood pressure alert threshold, when patient‘s blood pressure more than alert threshold that it issued a alert. Method of moving average provides users what observed blood pressure changes in the short-term trend. Linear regression models to predict blood pressure of users changes in the long-term trend. Integrating Linear regression and Moving average with Case-based reasoning to develop model of alert systems for recurrent stroke.
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Chien, Li-Jen, and 簡立蓁. "A Study of Factors Associated with Recurrent Ischemic Stroke." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/34819883700906033826.
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碩士國立陽明大學
醫務管理研究所
94
STUDY ABSTRACT Objectives The main purpose of this study is to explore risk factors and medical utilization of recurrent ischemic stroke in patients with first stroke in Taiwan so that treatment guidelines of recurrent ischemic stroke can be made by applying clinical practice data. Methods This is a retrospective study. Patients who were admitted to the studied hospital due to recurrent ischemic stroke during January 2002 to December 2005 were included into this study. The follow-up period was 12 months after first ischemic stroke for each patient. We collected clinical data, including characteristics, stroke subtype, risk factors, anti-hypertensive agents, anticoagulant agents, and medical direct cost. Chi-square test, t test, Fisher’s exact test and Logistic Regression were used to compare clinical parameters among the study patients. Results A total of 2,069 patients with stroke were available during the study period. Total 262 eligible patients were randomized into this study. Among 45 patients with recurrent ischemic stroke in group A, 97 patients with first-ever ischemic stroke in group B. Most of study patients were on aging of 65-74 years and 75-84 years, and more prevalent in men (59.15%) than in women (40.85%). Partial anterior circulation infarct (PACI) was the most frequent ischemic stroke subtype (65.49%). The top three prevalence rate of risk factors were hypertension (group A:82.22%, group B:68.04%)、diabetes mellitus (group A:44.44%, group B:29.90%)、cardiovascular diseases(group A: 51.11%, group B: 32.99%). Cardiovascular diseases are a major independent risk factor of recurrent ischemic stroke with a significant correlation by Logistic Regression. Every intake of antihypertensive and anticoagulant drugs for a month can reduce 10-12% possibility of recurrent ischemic stroke(OR=0.88；OR=0.87)。 A significant difference of total medical costs were NT$ 277,965 and NT$ 137,608 in recurrent and first-ever ischemic patients, respectively (p=0.013). Conclusions This study has demonstrated a significant correlation between cardiovascular diseases and the duration of receiving antihypertensive and anticoagulant drugs and recurrent ischemic stroke. Optimal control of risk factors and drug compliance are an important issue in prevention of recurrent ischemic stroke.
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Chen, Hui-Fang, and 陳慧芳. "A Correlational Study of Continuity of Care and Recurrent Stroke in Taiwanese Young Stroke Patients." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/65760912132738250307.
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碩士長榮大學
護理學系碩士班
103
Background: The mortality of stroke is the top three in Taiwan since 1972. The proportion of young stroke is 13.72%, and the proportion of recurrent stroke occurs up to 30%. Continued treatment and control can prevent stroke recurrence. It is lack of research regarding the relationship between continuity of care and recurrence in young stroke patients. Objective: To explore the correlations of continuity of care, risk factors of young stroke, and recurrent stroke in Taiwanese young stroke patients. Method: This study is a secondary analysis, and retrospective longitudinal cohort study. "National Health Insurance database" is the analysis source. Data was analyzed using SAS 9.2 statistical software. Descriptive statistic and logistic regression analyses were conducted. The controlled variables included gender, risk factors, stroke type and length of hospital stay. Samples were selected from the NHI database between 2005-2010 years BC and first stroke (ICD-9: 430-438). Moreover, the age of the patients was 15-45 years old. Continuity of care (COC) index was used to measure the continuity of care for young stroke. Multiple logistic regression analysis was then applied to estimate the association between continuity of care and the recurrence of young stroke. Result: The results show that the higher "continuity of care" cannot prevent the recurrence of young stroke. The important risk factors are high blood pressure, high cholesterol, and diabetes. These factors were associated with affect recurrence. How to effectively prevent and control chronic disease risk factors is an important factor in the prevention of young stroke recurrence. Conclusion: Conclusion: Although the higher "continuity of care" cannot prevent the recurrence of young stroke, but there are significant correlations of hypertension, high cholesterol, and diabetes and the recurrences among young stroke patients. Therefore, the management of chronic diseases should be included in health insurance database to provide health practitioners important information about preventing stroke recurrence. The results of this study may help health professionals improve treatment and recurrence prevention.
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CHEN, KAN-HENG, and 陳侃亨. "Assessment of Recurrent Ischemic Stroke Risk Among the First Ever Stroke Patients Using Hypolipidemic Drugs." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/93fbmd.
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碩士國防醫學院
藥學研究所
107
Background: Brain stroke is a very prevalent disease in developed countries. Among the top ten causes of death in Taiwan, cerebrovascular disease ranked fourth in 2017. Statistics show that the incidence of stroke is about three-thousandths. About three-quarters of them are ischemic strokes; according to the World Health Organization, a total of 15.2 million deaths were caused in 2016, which is a highly prevalent disease. There are many reasons for the occurrence of stroke. Many times, it has a lot to do with life style. It relates to hyperlipidemia caused by high fat dietary habits. Therefore, controlling hyperlipidemia is a very important key. At present, the more commonly used drugs for lowering blood lipid are statins and non-statin lipid lowering medication(fibrates), which can effectively control blood lipids to avoid vascular occlusion, and statins can effectively prevent people from occurrence of stroke. However, considering the health insurance differs among a variety of statins, and the efficacy of statins relatively lacks for local investigation, what’s more, the lack of comparison between statins and fibrates matters as well. Therefore, it is particularly important to compare the risk of re-hospitalization of ischemic stroke after taking the prescribed. Method: This study is a retrospective cohort study, with data provided by National Health Insurance Administrations 2005-2010 national health insurance claim data for the entire population. The patients of this period from 2005 to 2010 were diagnosed hyperlipidemia, they had have been hospitalized for the first time due to ischemic stroke, and had taken a single lipid-lowering drug over 90 days, more than one year had they been tracked. Exclusion criteria were those who were hospitalized because of car accidents, were younger than 45 years old, and died of illness and suicide. The primary outcome of rehospitalization is aimed at ischemic stroke. This study used cumulative hazard ratios to analyze the results. Result: 9098 people in total were included in the analysis, with 8016 in the statins group and 1082 in the non-statin lipid lowering medication(fibrates) group. The number of patients using high intensity statin was 6479, the number of patients using low intensity statin was 1537, the number of patients with diabetes was 3080, and the number of heart failure was 661. The number of patients with re-ischemic stroke in the statin group was 477, and in the non-statin lipid lowering medication group was 91. In the COX model regression analysis (95% confidence interval, p value), the adjusted hazard ratios of the non-statin lipid lowering medication to the low intensity statin group was 1.32(0.96-1.79, p=0.054) for the re-ischemic stroke, the risk ratio of rosuvastatin to atorvastatin was 0.64 (0.50-0.87, p=0.001) for the re-ischemic stroke, and the risk ratio for simvastatin was 1.07 (0.75-1.36, p=0.608); according to the studies of hypolipidemic drugs, rosuvastatin has the best effect, whose p value of 0.001 was statistically significant. Conclusion: This study revealed that there are trending statins better than fibrates to prevent patients from rehospitalization of ischemic stroke. Of all statins, rosuvastatin contains a lower risk when compared with atorvastatin.
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Hung, Yu Hui, and 洪于惠. "The Medical Resources Utilization And One-Year Recurrent Stroke Risk Among Ischemic Stroke Patients Using Aspirin v.s Clopidogrel." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/xvfz4q.
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Liu, Yu-Fang, and 劉羽芳. "Effect of Time Interval Between Previous Stroke and the Following Surgical Procedure on Recurrent Stroke during Perioperative Period." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/32047881826035056254.
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碩士中國醫藥大學
醫務管理學系碩士在職專班
99
Background and Purpose: As one of the most costly diseases, stroke is also a major cause of morbidity and mortality in the general population. American Heart Association reported in 2010 that approximately 795,000 people in US suffered from new or recurrent stroke yearly. Recurrent stroke accounted for 25~30% of all strokes, and therefore, prevention of stroke recurrence is important to both individual and public health. History of stroke and symptoms of cerebrovascular insufficiency are the significant predictors of perioperative stroke. Elective surgery should be considered pending if a stroke or transient neurologic deficit has occurred recently. However, data are lacking on the safe time interval between previous stroke and the following surgical procedure (stroke-to-surgery time interval). This research sought to investigate a reasonable time interval between the previous stroke and the following surgical intervention that is considered safe among patients with history of stroke. Methods: Data source is the longitudinal National Health Insurance Research Database (NHIRD) 2002~2009 with original claims data for 1,000,000 randomly sampled beneficiaries. In the design of retrospective cohort study, a total of 9,414 first-time stroke patients (ICD-9-CM codes 430-438) who subsequently underwent any surgical procedures one months later were included in the sample. Emergent surgeries, cardio-vascular and any related neurosurgical surgeries were excluded. SAS 9.1 was used to perform descriptive and inferential statistics, including Chi-square, bivariate and multivariate logistic regressions to generalize the effects of time-interval and related factors on perioperative recurrent stroke. Result: Of all the sample, 626 (6.65%) experienced stroke recurrence. Female (OR=0.744; 95% CI=0.627-0.881; p=0.0006) showed lower odds of perioperative stroke recurrence, while hypertension (OR=1.584; 95% CI=1.253-2.001; p=0.0001), atrial fibrillation (OR=2.648; 95% CI=1.789-3.920; p<0.0001), and hypercholesterolemia (OR=3.398; 95% CI=2.497-4.622; p<0.0001) exhibited higher, among first-time stroke patients receiving elective surgeries. Chi-square and logistic regression results both proved that longer stroke-to-surgery time interval was significantly associated with lower odds of perioperative stroke recurrence. Stroke-to-surgery time interval at 10-12 months (OR=0.625; 95% CI=0.425-0.919; p=0.0170) and ≧12 months (OR=0.645; 95% CI=0.501-0.830; p=0.0007) showed evidence of lower perioperative stroke recurrence. Conclusion: A safe ≧10 months of stroke-to-surgery time interval significantly lowered the likelihood of perioperative stroke recurrence. Therefore, elective surgeries with no urgency should not be performed until 10 months of stroke-to-surgery time interval is reached. We also suggest that the implication of stroke-to-surgery time interval on preventive medicine merits more attention among stroke practitioners.
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Zhu, Yijie. "Localizing interseismic deformation around locked strike-slip faults." Thesis, 2020. http://hdl.handle.net/1828/12055.
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Localized geodetic deformation of an approximately arctangent shape around locked strike-slip faults is widely reported, but there are also important exceptions showing distributed interseismic deformation. Understanding the controlling mechanism is important to the interpretation of geodetic observations for hazard assessment and geodynamic analysis. In this thesis, I use simple finite element models to separately study the two major contributors to the deformation: far-field loading and previous earthquakes. The models feature a vertical strike-slip fault in an elastic layer overlying a viscoelastic substrate of Maxwell or Burgers rheology, with or without weaknesses representing extensions of the fault either along strike or to greater depth. If the locked fault is loaded only from the far field without the effects of previous earthquakes, localized deformation occurs only if local mechanical weaknesses below the fault and/or somewhere along strike are introduced. I first show that the effects of far-field loading are rather limited even in the presence of extreme weaknesses. Then I use idealized earthquake cycle models to investigate the effects of past seismic events in a viscoelastic Earth. I demonstrate that, after a phase of fast postseismic deformation just after the earthquake, the localization of interseismic deformation is controlled mainly by the recurrence interval of past earthquakes. Given viscosity, shorter recurrence leads to greater interseismic localization, regardless of the rheological model used. The presence of a low-viscosity deep fault zone does not change this conclusion, although it tends to lessen localization by promoting faster postseismic stress relaxation. Distributed interseismic deformation, although less reported in the literature, is a natural consequence of very long recurrence and in theory should be as common as localized deformation. The apparent propensity of the latter is likely associated with the much greater quantity and better quality of geodetic observations from higher-rate and shorter-recurrence faults. Using viscoelastic earthquake-cycle models, I also explore the role of nearby earthquakes and creeping segments along the same fault. For faults of relatively short recurrence, frequent ruptures of nearby segments, modelled using a migrating rupture sequence with or without temporal clustering, further enhance localization. For faults of very long recurrence, faster near-fault deformation induced by a recent earthquake may give a false impression of localized interseismic deformation.Graduate
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Chang, Ya-Ting, and 張雅婷. "Cost-Effectiveness Analysis of Antiplatelet Therapy in the Prevention of Recurrent Stroke in Taiwan." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/69272776287261887291.
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碩士臺北醫學大學
藥學研究所
96
Background： Antiplatelet agents can prevent recurrent stroke. Aspirin is the most widely studied one and, until recently, it was the only drug used broadly for this purpose. Now, clinical trials indicate that ticlopidine, clopidogrel, and a combination regimen, aspirin plus modified-release dipyridamole (ASA+MR-DP), are also effective for prevention of recurrent stroke. However, these new antiplatelet agents are more expensive than aspirin. In Taiwan, their cost-effectiveness ratios relative to aspirin have not been estimated. Method： Markov model is developed to measure the clinical benefit and economic consequences of the following strategies to treat high-risk patients aged 65 years or older: (1) aspirin 100mg once a day; (2) aspirin 25mg plus modified-release dipyridamole 200mg (ASA+MR-DP) twice a day; and (3) clopidogrel 75mg once a day. Input data were obtained from literature review. Cost and quality-adjusted life-year (QALY) are primary outcomes measured. The time frame is two years. Results： The use of aspirin combined with dipyridamole was slightly effective and more costly compared the use of aspirin: direct cost per one patient is NTD 45,310, and estimated QALY for one patient is 1.948 years; in aspirin group: direct cost per one patient is NTD 33,623, and estimated QALY for one patient is 1.946 years. The Incremental cost-effectiveness ratio (ICER) between aspirin and ASA+MR-DP is NTD 1,889,544 per QALY. The comparison between aspirin and clopidogrel: The incremental cost-effectiveness ratio between aspirin and clopidogrel is NTD 9,699,399 per QALY. In sensitivity analyses, the efficacy and drug prices of antiplatelet agents are key factors to determine the ICER compared with aspirin. Conclusion： Comparing new antiplatelet agents to aspirin, our results show that using new drugs is cost-effective, it means using new drug has better outcome, but induces highly medical direct cost.
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jargalsaikhan, Monkhsaikhan, and 木莎涵. "A Study on Exploring Related Factors among Recurrent Stroke Patients-an Example of Mongolian Hospital." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/tk2547.
Full textAbstract:
碩士中臺科技大學
醫療暨健康產業管理系碩士班
106
Purpose: Stroke is one of the most important health problem in the world. Stroke is leading cause of death and disability in the world (Dubow & Fink, 2011). The first aim of the present study was to evaluate the rate of recurrent stroke events in the secondary general hospital in Mongolia. The second aim of the present study is to determine the most effective contributor factors for recurrent stroke. Method: The design of this study is a retrospective study with secondary data analysis. A total of 310 first-ever and recurrent stroke patients were enrolled in this study from the 1st of January 2015 to 31st of December 2017 in Baynzurkh district's hospital which is the secondary hospital of Mongolia. The descriptive statistics and logistic regression, chi-square testing were used to analyze the influencing factors that affect the recurrent stroke. Results: Recurrent stroke occurred in 112 patients (36%). Furthermore, this study demonstrated the types of recurrent stroke that intracerebral hemorrhage (55%) was higher than ischemic stroke (45%). The rate among male patients with recurrent stroke (69%) were higher than female patients (31%) with recurrent stroke. Logistic regression result showed that recurrent stroke was predicted by cerebral small vessel disease (OR= 6.095, CI 95% = 2.153 to 17.257), atrial fibrillation (OR= 10.518, CI 95% = 3.944 to 28.053), hypertension period (OR= 48.242, CI 95% = 4.749 to 490.110), hypertension stage (OR= 3.393, CI 95% = 1.125 to 10.235), length of smoking period (OR= 5.011, CI 95% = 1.33 to 22.161) and alcohol consumption (OR= 28.879, CI 95% = 4.740 to 175.960). In addition to commonly recognized individual risk factors, hypertension stages, length of hypertension period and alcohol consumption play a signicant role for recurrent stroke. Conclusions: Compared with the world epidemiology of recurrent stroke, the rate of recurrent stroke in this study is higher. In according to these risk factors, we recommend that lifestyle changing will be more useful to prevent recurrent stroke such as quitting smoke, stopping drinking and doing more exercise. Furthermore, when doing preventive care department of ministry of health , we could strenghten the health promotion and intervention on the risk groups ( such as male, older patients who had occurred first-ever stroke prevent cardiovascular disease and life-style changing) in the future. Keywords: Recurrent stroke, Risk factors.
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Ταλέλλη, Πηνελόπη. "Η προγνωστική αξία του πάχους του ενδοθηλίου των κοινών καρωτίδων στην έκβαση και τις επιπλοκές των αγγειακών εγκεφαλικών επεισοδίων." 2005. http://nemertes.lis.upatras.gr/jspui/handle/10889/354.
Full textAbstract:
Σκοπός είναι να ερευνηθεί αν οι μετρήσεις του Πάχος του Ενδοθηλίου των Κοινών Καρωτίδων (ΠΕΚΚΑ) σε ασθενείς με Αγγειακό Εγκεφαλικό Επεισόδιο (ΑΕΕ) σχετίζονται με την άμεση ή μακροπρόθεση έκβαση του ΑΕΕ, με την μελλοντική εμφάνιση νοητικής έκπτωσης ή κατάθλιψης και με την υποτροπή του ΑΕΕ. ΜΕΘΟΔΟΙ: 284 ασθενείς με πρώτο ισχαιμικό ΑΕΕ που υποβλήθηκαν σε υπερηχογραφική μέτρηση του ΠΕΚΚΑ στην οξεία φάση, παρακολουθήθηκαν για ένα χρόνο. Η άμεση έκβαση εκτιμήθηκε κατά την έξοδο, ενώ η μακροπρόθεσμη έκβαση, η νοητική και συναισθηματική κατάσταση εκτιμήθηκαν μετά από 12 μήνες. Επίσης καταγράφηκαν οι υποτροπές στη διάρκεια του πρώτου χρόνου. ΑΠΟΤΕΛΕΣΜΑΤΑ: το ΠΕΚΚΑ δε συσχετιζόταν με την άμεση ή μακροπρόθεσμη έκβαση του ΑΕΕ ούτε με την ύπαρξη κατάθλιψης ένα χρόνο αργότερα. Αντίθετα, αυξημένες τιμές ΠΕΚΚΑ σχετίζονταν σημαντικά και ανεξάρτητα τόσο με την ύπαρξη νοητικής έκπτωσης 12 μήνες αργότερα όσο και με τoν κίνδυνο υποτροπής του ΑΕΕ κατά τη διάρκεια του πρώτου χρόνου. ΣΥΜΠΕΡΑΣΜΑ: οι μετρήσεις του ΠΕΚΚΑ αμέσως μετά από ισχαιμικό ΑΕΕ μπορεί να χρησιμεύουν στην αναγνώριση ασθενών με αυξημένο κίνδυνο για μελλοντική νοητική έκπτωση ή υποτροπή του ΑΕΕ.Thesis objective is to investigate whether the measurements of Common Carotid Artery Intima Media Thickness (CCA-imt) in patients with acute stroke are associated with the stroke outcome, either short term or long term, with the future development of post stroke cognitive impairment and post stroke depression and with stroke recurrences within the first year after the stroke. METHODS: 284 consequent patients with first ever ischaemic stroke that underwent carotid ultrasonographic measurement of CCA-imt in the acute phase, were followed-up for one year. The short-term outcome was assessed at discharge. The long-term outcome and the presence of cognitive impairment and depressive symptoms were assessed 12 months later. The number of recurrences within the first year was also recorded. RESULTS: CCA-imt values were not associated with the short- or long-term stroke outcome or the presence of depression one year after the ictus. On the contrary, increased CCA-imt values were significantly and independently associated with cognitive impairment and with the risk of recurrence during the first year. CONCLUSION: measurements of CCA-imt right in the acute phase after an ischaemic stroke can help with the identification of patients in higher risk for future cognitive impairment and stroke recurrence.
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Rodrigues, Inês Tello Rato Milheiras. "Recuperação da linguagem após AVC : o caso particualr dos estereotipos verbais e da visual word from area." Doctoral thesis, 2014. http://hdl.handle.net/10400.14/18349.
Full textAbstract:
Within the last decade, the use of fMRI and neuromodulation systems in patients
with aphasia has substantially advanced the understanding of the mechanisms
underlying functional language reorganization in response to a brain lesion.
Neuroplasticity research yields numerous outcomes for the differential
contribution of perilesional and contralesional brain areas to language recovery
in aphasia. Research to the date, refer that the potential for functional
reorganization critically depends on preserved left regions and connections that
offer the anatomical substrate supporting language recovery. If language
functioning is unable to return to the left hemisphere because of the extent or
specific local of damage, language functioning remains in the right hemisphere
but retains dysfunctional elements.
This thesis aims to explore brain plasticity mechanisms that sustain language
recovery, in the particular case of aphasia patients with recurring utterances and
also in patients with severe alexia. The nature of these deficits was explored
across different modalities and techniques, namely, fMRI and rTMS.
Our results emphasized that the right hemisphere activity reflects an increased,
but ultimately ineffective search and selection process, in patients with chronic
aphasia. Essentially, in accordance with previous investigations, our data
highlight the less capability of the right hemisphere as an alternative when
damage severity prevents the ultimate return of language processes to the left
hemisphere.Na última década, a utilização de Ressonância Magnética Funcional e de sistemas de Neuromodulação em pessoas com afasia, tem permitido uma maior compreensão dos mecanismos subjacentes à reorganização funcional da linguagem após lesão cerebral. A reactivação das áreas perilesionais é apontada por diversos estudos como a forma mais eficiente na recuperação da afasia. O presente trabalho pretendeu explorar os mecanismos de neuroplasticidade que sustêm a recuperação da linguagem nos casos particulares de pessoas com afasia e estereótipo verbal e em casos de alexia. A natureza dos diferentes defeitos linguísticos foi explorada com distintas metodologias e técnicas, nomeadamente através de Ressonância Magnética Funcional e da Estimulação Magnética Transcraniana. Os resultados obtidos estão de acordo com a literatura e enfatizaram a menor capacidade de compensação das áreas do hemisfério direito para o processamento da linguagem e a ocorrência de uma compensação disfuncional em casos de lesões extensas que impede a reactivação das áreas perilesionais e consequentemente uma recuperação mais eficaz da alterações linguísticas.