Nurse Led Smartphone Electrographic Monitoring for Atrial Fibrillation after Ischemic Stroke: SPOT-AF

Bernard Yan,Hans Tu,Christina Lam,Corey Swift,Ma Sze Ho,Vincent C.T. Mok,Yi Sui,David Sharpe,Darshan Ghia,Jim Jannes,Stephen Davis,Xinfeng Liu,Ben Freedman 대한뇌졸중학회 2020 Journal of stroke Vol.22 No.3

Background and Purpose Paroxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate. Methods We recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection. Results One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter). Conclusions Nurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.

Material Transportation Problems in Construction Projects under an Uncertain Environment

Fang Yan,Jiuping Xu,Bernard T Han 대한토목학회 2015 KSCE JOURNAL OF CIVIL ENGINEERING Vol.19 No.7

Uncertainty is prevalent and unavoidable in business operations. This paper presents a mathematical model for the optimal routing of shipping raw materials to customers that requires simultaneous pickup and delivery with soft time windows for travel time in a fuzzy random environment. It minimizes total traveling time while maximizing customer satisfaction and meeting constraints characterized by fuzziness and randomness in pickup and travel time. The model is strong NP-hard. Through embedding of customer satisfaction as a constraint and converting fuzzy random variables into deterministic ones using expected values, a viable algorithm is developed using the Global-Local-Neighbor Particle Swarm Optimization (GLNPSO) technique, and tested by solving a real routing problem faced by a large construction project in China. Results are encouraging, both in solution quality and potential savings, to justify the solution method and model formulation.

DIRECT-SAFE: A Randomized Controlled Trial of DIRECT Endovascular Clot Retrieval versus Standard Bridging Therapy

Peter J. Mitchell,Bernard Yan,Leonid Churilov,Richard J. Dowling,Steven Bush,Thang Nguyen,Bruce C.V. Campbell,Geoffrey A. Donnan,Zhongrong Miao,Stephen M, Davis 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.1

Background and Purpose The benefit regarding co-treatment with intravenous (IV) thrombolysis before mechanical thrombectomy in acute ischemic stroke with large vessel occlusion remains unclear. To test the hypothesis that clinical outcome of ischemic stroke patients with intracranial internal carotid artery, middle cerebral artery or basilar artery occlusion treated with direct endovascular thrombectomy within 4.5 hours will be non-inferior compared with that of standard bridging IV thrombolysis followed by endovascular thrombectomy. Methods To randomize 780 patients 1:1 to direct thrombectomy or bridging IV thrombolysis with thrombectomy. An international-multicenter prospective randomized open label blinded endpoint trial (PROBE) (ClincalTrials.gov identifier: NCT03494920). Results Primary endpoint is functional independence defined as modified Rankin Scale (mRS) 0–2 or return to baseline at 90 days. Secondary end points include ordinal mRS analysis, good angiographic reperfusion (modified Thrombolysis in Cerebral Infarction score [mTICI] 2b–3), safety endpoints include symptomatic intracerebral hemorrhage and death. Conclusions DIRECT-SAFE will provide unique information regarding the impact of direct thrombectomy in patients with large vessel occlusion, including patients with basilar artery occlusion, with comparison across different ethnic groups.

Evolution of Endovascular Therapy in Acute Stroke: Implications of Device Development

Adithya Balasubramaian,Peter Mitchell,Richard Dowling,Bernard Yan 대한뇌졸중학회 2015 Journal of stroke Vol.17 No.2

Intravenous thrombolysis is an effective treatment for acute ischaemic stroke. However, vascular recanalization rates remain poor especially in the setting of large artery occlusion. On the other hand, endovascular intra-arterial therapy addresses this issue with superior recanalization rates compared with intravenous thrombolysis. Although previous randomized controlled studies of intra-arterial therapy failed to demonstrate superiority, the failings may be attributed to a combination of inferior intra-arterial devices and suboptimal selection criteria. The recent results of several randomized controlled trials have demonstrated significantly improved outcomes, underpinning the advantage of newer intra-arterial devices and superior recanalization rates, leading to renewed interest in establishing intra-arterial therapy as the gold standard for acute ischaemic stroke. The aim of this review is to outline the history and development of different intra-arterial devices and future directions in research.

Blood Pressure May Be Associated with Arterial Collateralization in Anterior Circulation Ischemic Stroke before Acute Reperfusion Therapy

Beisi Jiang,Leonid Churilov,Lasheta Kanesan,Richard Dowling,Peter Mitchell,Qiang Dong,Stephen Davis,Bernard Yan 대한뇌졸중학회 2017 Journal of stroke Vol.19 No.2

Background and Purpose Leptomeningeal collaterals maintain arterial perfusion in acute arterialocclusion but may fluctuate subject to arterial blood pressure (ABP). We aim to investigate therelationship between ABP and collaterals as assessed by computer tomography (CT) perfusion inacute ischemic stroke. Methods We retrospectively analyzed acute anterior circulation ischemic stroke patients with CTperfusion from 2009 to 2014. Collateral status using relative filling time delay (rFTD) determined bytime delay of collateral-derived contrast opacification within the Sylvian fissure, from 0 seconds tounlimited count. The data were analyzed by zero-inflated negative binomial regression modelincluding an appropriate interaction examining in the model in terms of occlusion location andonset-to-CT time (OCT). Results Two hundred and seventy patients were included. We found that increment of 10 mm Hgin BP, the odds that a patient would have rFTD equal to 0 seconds increased by 27.9% in systolicBP (SBP) (P=0.001), by 73.9% in diastolic BP (DBP) (P<0.001) and by 68.5% in mean BP (MBP)(P<0.001). For patients with rFTD not necessarily equal to 0 seconds, every 10 mm Hg increase inBP, there was a 7% decrease in expected count of seconds for rFTD in SBP (P=0.002), 10% decreasefor rFTD in DBP and 11% decrease for rFTD in MBP. The arterial occlusion location and OCT showedno significant interaction in the BP-rFTD relationship (P>0.05). Conclusions In acute ischemic stroke, higher ABP is possibly associated with improvedleptomeningeal collaterals as identified by decreased rFTD.

7T Magnetic Resonance Imaging Quantification of Brain Glutamate in Acute Ischaemic Stroke

John-Paul Nicolo,Bradford Moffat,David K. Wright,Benjamin Sinclair,Andrew Neal,Elaine Lui,Patricia Desmond,Rebecca Glarin,Kathryn A. Davis,Ravinder Reddy,Bernard Yan,Terence J. O’Brien,Patrick Kwan 대한뇌졸중학회 2021 Journal of stroke Vol.23 No.2

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Effect of the Coronavirus Disease 2019 Pandemic on the Quality of Stroke Care in Stroke Units and Alternative Wards: A National Comparative Analysis

Dominique A. Cadilhac,Joosup Kim,Geoffrey Cloud,Craig S. Anderson,Emma K. Tod,Sibilah J. Breen,Steven Faux,Timothy Kleinig,Helen Castley,Richard I. Lindley,Sandy Middleton,Bernard Yan,Kelvin Hill,Bret 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.1

Background and Purpose Changes to hospital systems were implemented from March 2020 in Australia in response to the coronavirus disease 2019 pandemic, including decreased resources allocated to stroke units. We investigate changes in the quality of acute care for patients with stroke or transient ischemic attack during the pandemic according to patients’ treatment setting (stroke unit or alternate ward). Methods We conducted a retrospective cohort study of patients admitted with stroke or transient ischemic attack between January 2019 and June 2020 in the Australian Stroke Clinical Registry (AuSCR). The AuSCR monitors patients’ treatment setting, provision of allied health and nursing interventions, prescription of secondary prevention medications, and discharge destination. Weekly trends in the quality of care before and during the pandemic period were assessed using interrupted time series analyses. Results In total, 18,662 patients in 2019 and 8,850 patients in 2020 were included. Overall, 75% were treated in stroke units. Before the pandemic, treatment in a stroke unit was superior to alternate wards for the provision of all evidence-based therapies assessed. During the pandemic period, the proportion of patients receiving a swallow screen or assessment, being discharged to rehabilitation, and being prescribed secondary prevention medications decreased by 0.58% to 1.08% per week in patients treated in other ward settings relative to patients treated in stroke units. This change represented a 9% to 17% increase in the care gap between these treatment settings during the period of the pandemic that was evaluated (16 weeks). Conclusions During the first 6 months of the pandemic, widening care disparities between stroke units and alternate wards have occurred.