Race Differences in Gastrostomy Tube Placement After Stroke in Majority-White, Minority-Serving, and Racially Integrated US Hospitals

AbstractWe sought to determine individual and system contributions to race disparities in percutaneous endoscopic gastrostomy (PEG) tube placement after stroke. Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of ethnic/racial minority stroke patients (  50% ethnic/racial minorities [“minority-serving hospitals”]). Logistic regression was used to evaluate the association between ethnicity/race and PEG utilization within and between the different hospital strata. Among 246,825 stroke admissions, patients receiving care in minority-serving hospi tals had higher odds of PEG compared to patients in majority-white hospitals, regardless of individual patient race (adjusted odds ratio [OR] 1.24, 95% CI 1.12–1.38). Ethnic/racial minorities had higher odds of PEG than whites in any hospital strata; however, this discrepancy was largest in majori ty-white hospitals (OR 1.62, 95% CI 1.48–1.76), and smallest in minority-serving hospitals (OR 1.22, 95% CI 1.11–1.33;p for interaction  
Source: Dysphagia - Category: Speech-Language Pathology Source Type: research

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The objective of our study was to investigate whether NIHSS is a reliable instrument of clinical monitoring and correlates with mortality and functional outcome in ICH.MethodsOne hundred fifty-six consecutive subjects with primary ICH were included. We evaluated NIHSS at admission. The functional state after a 30-day and a 3-month-long follow-up was assessed by the modified Rankin Scale (mRS). Spearman ’s rank correlation coefficient analysis was used for statistics. Sensitivity, specificity, positive predictive value, negative predictive value, global accuracy, and ROC curve were computed using the median score 7 as...
Source: Neurological Sciences - Category: Neurology Source Type: research
Intravenous thrombolysis treatment (IVT) and endovascular therapy (EVT) have been proved as fist-line beneficial option for eligible patients who have acute ischemic stroke (AIS) with major safety concern of symptomatic intracranial hemorrhage (sICH). Unfortunately, the emergency management of patients with AIS taking vitamin K antagonists and with international normalized ratio  higher than 1.7 or taking new oral anticoagulants (NOACs) represents a great challenge. We aim to comprehensively determine the safety of EVT in patients under prior-stroke anticoagulants and IVT in patients under NOAC use.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Review Article Source Type: research
Rivaroxaban has previously been tested in experimental and animal models with encouraging results. We prospectively selected 7 patients between May 2017 and January 2018 who underwent isolated mitral valve replacement with a mechanic prosthesis and had unstable INR control at least 3 months after surgery. An intervention of rivaroxaban 15 mg was then administered twice daily for a period of 90 days. No patient presented intracardiac thrombus, reversible ischemic neurological deficit, ischemic or hemorrhagic stroke, hospitalization or death during 3 months of follow-up.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Conclusions: The present study strongly showed that lower GFR is an independently predictor of HT; in addition, large infarct volume, AF, and HA are also important risks of HT for AIS patients without TT, which offered a practical information that risk factors should be paid attention or eliminated to prevent HT for stroke patients though the level of evidence seems to be unstable. PMID: 29998881 [PubMed - in process]
Source: Chinese Medical Journal - Category: General Medicine Authors: Tags: Chin Med J (Engl) Source Type: research
Publication date: August 2018Source: The Lancet Global Health, Volume 6, Issue 8Author(s): Calvin Ke, Rajeev Gupta, Denis Xavier, Dorairaj Prabhakaran, Prashant Mathur, Yogeshwar V Kalkonde, Patrycja Kolpak, Wilson Suraweera, Prabhat Jha, Shazia Allarakha, Dharmappa Basavarajappa, Vikas Dhimar, Harsh Jaiswal, Shrikant Kalaska, Geetha Memon, Saritha Nair, Vishnu Rao, Reeta Rasaily, Damodar Sahu, Shweta SharmaSummaryIntroductionIndia accounts for about a fifth of cardiovascular deaths globally, but nationally representative data on mortality trends are not yet available. In this nationwide mortality study, we aimed to assess...
Source: The Lancet Global Health - Category: International Medicine & Public Health Source Type: research
Authors: Wang H, Wang S, Yi X, Tao Y, Qian H, Jia P, Chen Y, Sun Y Abstract BACKGROUND: Recently, a novel 4-tiered classification of left ventricular hypertrophy (LVH) based on ventricular dilatation (indexed LV end-diastolic volume [EDV]) and concentricity (mass/EDV0.67) has improved all-cause and cardiovascular mortality risk stratification. However, their possible association with ischemic stroke has not been extensively evaluated in the general population. METHODS: We evaluated a cross-sectional study of 11,037 subjects from the general population of China in whom echocardiographic and ischemic stroke data ...
Source: Annals of Medicine - Category: Internal Medicine Tags: Ann Med Source Type: research
AbstractBackgroundTherapeutic uncertainty is inherent in decisions in patients with patent foramen ovale (PFO) and cryptogenic stroke. We aimed to determine clinical implications of PFO identification in transesophageal echocardiography (TEE) after a cryptogenic ischemic stroke.MethodsConsecutive TEE done between 2011 and 2015 in patients with previous cryptogenic stroke was evaluated. Clinical implications of PFO identification (closure and/or medical therapy) were retrieved from the medical records and discharge summaries. Adverse events related to therapy, stroke recurrence and death were analyzed during follow-up.Resul...
Source: Journal of Echocardiography - Category: Cardiology Source Type: research
AbstractTo rationally plan acute services, the proportion of ischemic strokes that may be eligible for revascularization treatments should be estimated. We aimed to estimate the proportion of patients directly admitted to an Italian Comprehensive Stroke Center who may be eligible for intravenous thrombolysis (IVT), combined IVT and endovascular thrombectomy (ET), or direct ET according to the current guidelines. We conducted a retrospective analysis based on data prospectively collected from 876 consecutive adult ischemic stroke patients who were directly admitted to the Stroke Unit of the University Hospital of Verona wit...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Conclusion: Studies indicate a positive trend of effect of exercise for physical recovery of people with LIS after stroke including the improvement of muscle strength, tone, walking ability, and activity in daily living. Mixed physical exercises were used. The effects were not significant. No adverse event has been reported. The quality of the existing evidence is relatively low since the papers were either case series or case studies. Further studies are needed on exercise types and dosages for better prescriptions for people with LIS after stroke. This may help to extend their lives with better control of the complicatio...
Source: Cerebrovascular Diseases Extra - Category: Neurology Source Type: research
We present the first 2 cases of acute ischemic stroke secondary to common carotid ostial disease with tandem intracranial occlusion, treated with intracranial thrombectomy followed by subsequent staged balloon-mounted stenting of the common carotid ostium. We review the pathophysiology of tandem occlusions, the controversy surrounding treatment techniques, and various approaches used in the treatment of ostial occlusive lesions.Key Message: In certain situations where acute carotid stenting is not safe or technically possible, immediate intracranial thrombectomy with a subsequent staged balloon-mounted stenting of the osti...
Source: Interventional Neurology - Category: Neurology Source Type: research
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