Clinical frailty is an important syndrome for clinical care and research, independently predicting mortality and rates of institutionalisation in a range of medical conditions. However, there has ...been little research into the role of frailty in stroke.
This study investigates the effect of frailty on 28-day mortality following ischaemic stroke and outcomes following stroke thrombolysis.
Frailty was measured using the Clinical Frailty Scale (CFS) for all ischaemic stroke admissions aged ≥75 years. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). 28-day mortality and clinical outcomes were collected retrospectively. Analysis included both dichotomised measures of frailty (non-frail: CFS 1-4, frail: 5-8) and CFS as a continuous ordinal scale.
In 433 individuals with ischaemic stroke, 28-day mortality was higher in frail versus non-frail individuals (39 (16.7%) versus 10 (5%), P < 0.01). On multivariable analysis, a one-point increase in CFS was independently associated with 28-day mortality (OR 1.03 (1.01-1.05)). In 63 thrombolysed individuals, median NIHSS reduced significantly in non-frail individuals (12.5 (interquartile range (IQR) 9.25) to 5 (IQR 10.5), P < 0.01) but not in frail individuals (15 (IQR 11.5) to 16 (IQR 16.5), P = 0.23). On multivariable analysis, a one-point increase in CFS was independently associated with a one-point reduction in post-thrombolysis NIHSS improvement (coefficient 1.07, P = 0.03).
Clinical frailty is independently associated with 28-day mortality after ischaemic stroke and appears independently associated with attenuated improvement in NIHSS following stroke thrombolysis. Further research is needed to elucidate the underlying mechanisms and how frailty may be utilised in clinical decision-making.
The usefulness of the implantable loop recorder (ILR) with improved atrial fibrillation (AF) detection capability (Reveal XT) and the factors associated with AF in the setting of unexplained stroke ...were investigated.
A cohort study is reported of 51 patients in whom ILRs were implanted for the investigation of ischemic stroke for which no cause had been found (cryptogenic) following appropriate vascular and cardiac imaging and at least 24 hours of cardiac rhythm monitoring.
The patients were aged from 17 to 73 (median 52) years. Of the 30 patients with a shunt investigation, 22 had a patent foramen ovale (73.3%; 95% confidence interval CI 56.5%-90.1%). AF was identified in 13 (25.5%; 95% CI 13.1%-37.9%) cases. AF was associated with increasing age (p = 0.018), interatrial conduction block (p = 0.02), left atrial volume (p = 0.025), and the occurrence of atrial premature contractions on preceding external monitoring (p = 0.004). The median (range) of monitoring prior to AF detection was 48 (0-154) days.
In patients with unexplained stroke, AF was detected by ILR in 25.5%. Predictors of AF were identified, which may help to target investigations. ILRs may have a central role in the future in the investigation of patients with unexplained stroke.
Radiomics, quantitative feature extraction from radiological images, can improve disease diagnosis and prognostication. However, radiomic features are susceptible to image acquisition and ...segmentation variability. Ideally, only features robust to these variations would be incorporated into predictive models, for good generalisability. We extracted 93 radiomic features from carotid artery computed tomography angiograms of 41 patients with cerebrovascular events. We tested feature robustness to region-of-interest perturbations, image pre-processing settings and quantisation methods using both single- and multi-slice approaches. We assessed the ability of the most robust features to identify culprit and non-culprit arteries using several machine learning algorithms and report the average area under the curve (AUC) from five-fold cross validation. Multi-slice features were superior to single for producing robust radiomic features (67 vs. 61). The optimal image quantisation method used bin widths of 25 or 30. Incorporating our top 10 non-redundant robust radiomics features into ElasticNet achieved an AUC of 0.73 and accuracy of 69% (compared to carotid calcification alone AUC: 0.44, accuracy: 46%). Our results provide key information for introducing carotid CT radiomics into clinical practice. If validated prospectively, our robust carotid radiomic set could improve stroke prediction and target therapies to those at highest risk.
Self-delivered speech therapy provides an opportunity for individualised dosage as a complement to the speech-therapy regime in the long-term rehabilitation pathway. Few apps for speech therapy have ...been subject to clinical trials, especially on a self-delivered platform. In a crossover design study, the Comprehensive Aphasia Test (CAT) and Cookie Theft Picture Description (CTPD) were used to measure untrained improvement in a group of chronic expressive aphasic patients after using a speech therapy app. A pilot study (n = 3) and crossover design (n = 7) comparing the therapy app with a non-language mind-game were conducted. Patients self-selected their training on the app, with a recommended use of 20 minutes per day. There was significant post-therapy improvement on the CAT and CTPD but no significant improvement after the mind-game intervention, suggesting there were language-specific effects following use of the therapy app. Improvements on the CTPD, a functional measurement of speech, suggest that a therapy app can produce practical, important changes in speech. The improvements post-therapy were not due to type of language category trained or amount of training on the app, but an inverse relationship with severity at baseline and post-therapy improvement was shown. This study suggests that self-delivered therapy via an app is beneficial for chronic expressive aphasia.
Although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short- and medium-term ...mortality.
Data from a prospective multicentre study (2009–12) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient-related factors and service characteristics on stroke mortality outcome at 7, 30 and 365 days post stroke, and time to death within 1 year.
A total of 2,388 acute stroke patients (mean (standard deviation) 76.9 (12.7) years; 47.3% men, 87% ischaemic stroke) were included in the study. Among patients characteristics examined increasing age, haemorrhagic stroke, total anterior circulation stroke type, higher prestroke frailty, history of hypertension and ischaemic heart disease and admission hyperglycaemia predicted 1-year mortality. Additional inclusion of stroke service characteristics controlling for patient and service level characteristics showed varying prognostic impact of service characteristics on stroke mortality over the disease course during first year after stroke at different time points. The most consistent finding was the benefit of higher nursing levels; an increase in one trained nurses per 10 beds was associated with reductions in 30-day mortality of 11–28% (P < 0.0001) and in 1-year mortality of 8–12% (P < 0.001).
There appears to be consistent and robust evidence of direct clinical benefit on mortality up to 1 year after acute stroke of higher numbers of trained nursing staff over and above that of other recognised mortality risk factors.
A Test Battery for Inner Speech Functions Geva, Sharon; Warburton, Elizabeth A
Archives of clinical neuropsychology,
2019-Feb-01, 2019-02-01, 20190201, Letnik:
34, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Inner speech, or the ability to talk to yourself in your head, is one of the most ubiquitous phenomena of everyday experience. Recent years have seen growing interest in the role and function of ...inner speech in various typical and cognitively impaired populations. Although people vary in their ability to produce inner speech, there is currently no test battery which can be used to evaluate people's inner speech ability. Here we developed a test battery which can be used to evaluate individual differences in the ability to access the auditory word form internally.
We developed and standardized five tests: rhyme judgment of pictures and written words, homophone judgment of written words and non-words, and judgment of lexical stress of written words. The tasks were administered to adult healthy native British English speakers (age range 20-72, n = 28-97, varies between tests).
In all tests, some items were excluded based on low success rates among participants, or documented regional variability in accent. Level of education, but not age, correlated with task performance for some of the tasks, and there were no gender difference in performance.
A process of standardization resulted in a battery of tests which can be used to assess natural variability of inner speech abilities among English speaking adults.
Vascular calcification is a complex biological process that is a hallmark of atherosclerosis. While macrocalcification confers plaque stability, microcalcification is a key feature of high-risk ...atheroma and is associated with increased morbidity and mortality. Positron emission tomography and X-ray computed tomography (PET/CT) imaging of atherosclerosis using (18)F-sodium fluoride ((18)F-NaF) has the potential to identify pathologically high-risk nascent microcalcification. However, the precise molecular mechanism of (18)F-NaF vascular uptake is still unknown. Here we use electron microscopy, autoradiography, histology and preclinical and clinical PET/CT to analyse (18)F-NaF binding. We show that (18)F-NaF adsorbs to calcified deposits within plaque with high affinity and is selective and specific. (18)F-NaF PET/CT imaging can distinguish between areas of macro- and microcalcification. This is the only currently available clinical imaging platform that can non-invasively detect microcalcification in active unstable atherosclerosis. The use of (18)F-NaF may foster new approaches to developing treatments for vascular calcification.
•Sepsis can lead to cardiac arrhythmias such as atrial fibrillation (AF).•It is estimated that up to 50% of patients have recurrent episodes of AF within 1-year of their episode of sepsis.•These ...patients are at increased risk of ischaemic stroke; three-fold during their inpatient stay and two-fold up to at least 4 years from the initial episode of sepsis.•There are no guidelines on how to prevent stroke in these patients, therefore, many do not receive appropriate treatment to alleviate their ischaemic stroke risk.
Sepsis can lead to cardiac arrhythmias, of which the most common is atrial fibrillation (AF). Sepsis is associated with up to a six-fold higher risk of developing AF, where it occurs most commonly in the first 3 days of hospital admission. In many patients, AF detected during sepsis is the first documented episode of AF, either as an unmasking of sub-clinical AF or as a newly developed arrhythmia. In the short term, sepsis that is complicated by AF leads to longer hospital stays and an increased risk of inpatient mortality. Sepsis-driven AF can also increase an individual's risk of inpatient stroke by nearly 3-fold, compared to sepsis patients without AF. In the long-term, it is estimated that up to 50% of patients have recurrent episodes of AF within 1-year of their episode of sepsis. The common perception that once the precipitating illness is treated or sinus rhythm is restored the risk of stroke is removed is incorrect. For clinicians, there is a paucity of evidence on how to reduce an individual's risk of stroke after developing AF during sepsis, including whether to start anticoagulation. This is pertinent when considering that more patients are surviving episodes of sepsis and are left with post-sepsis sequalae such as AF. This review provides a summary on the literature available surrounding sepsis-driven AF, focusing on AF recurrence and ischaemic stroke risk. Using this, pragmatic advice to clinicians on how to better detect and reduce an individual's stroke risk after developing AF during sepsis is discussed.
Background:
Atrial fibrillation (AF) is a major risk factor for ischaemic stroke (IS) and transient ischaemic attack (TIA). The timely detection of first-diagnosed or “new” AF (nAF) would prompt a ...switch from antiplatelets to anticoagulation to reduce the risk of stroke recurrence; however, the optimal timing and duration of rhythm monitoring to detect nAF remains unclear.
Aims:
We searched MEDLINE, PubMed, Cochrane database, and Google Scholar to undertake a systematic review and meta-analysis of randomized controlled trials (RCT) between 2012 and 2023 investigating nAF detection after IS and TIA. Outcome measures were overall detection of nAF (control; (usual care) compared to intervention; (continuous cardiac monitoring >72 h)) and the time period in which nAF detection is highest (0–14 days, 15–90 days, 91–180 days, or 181–365 days). A random-effects model with generic inverse variance weights was used to pool the most adjusted effect measure from each trial.
Summary of review:
A total of eight RCTs investigated rhythm monitoring after IS, totaling 5820 patients. The meta-analysis of the studies suggested that continuous cardiac monitoring was associated with a pooled odds ratio of 3.81 (95% CI 2.14 to 6.77), compared to usual care (control), for nAF detection. In the time period analysis, the odds ratio for nAF detection at 0–14 days, 15–90 days, 91–180 days, 181–365 days were 1.79 (1.24–2.58); 2.01 (0.63–6.37); 0.98 (0.16–5.90); and 2.92 (1.30–6.56), respectively.
Conclusion:
There is an almost fourfold increase in nAF detection with continuous cardiac monitoring, compared to usual care. The results also demonstrate two statistically significant time periods in nAF detection; at 0–14 days and 6–12 months following monitoring commencement. These data support the utilization of different monitoring methods to cover both time periods and a minimum of 1 year of monitoring to maximize nAF detection in patients after IS and TIA.
Imaging of the carotid artery Evans, Nicholas R; Rudd, James H F; Warburton, Elizabeth A
Lancet neurology,
July 2022, 2022-07-00, 20220701, Letnik:
21, Številka:
7
Journal Article
PDF
