Browsing by Subject "Neurology"
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Item Open Access A paradoxical relationship between hemoglobin A1C and in-hospital mortality in intracerebral hemorrhage patients.(Heliyon, 2019-05-06) Dandapat, Sudeepta; Siddiqui, Fazeel M; Fonarow, Gregg C; Bhatt, Deepak L; Xu, Haolin; Matsouaka, Roland; Heidenreich, Paul A; Xian, Ying; Schwamm, Lee H; Smith, Eric EObjectives:The relationship between prior glycemic status and outcomes in intracerebral hemorrhage (ICH) is not established. We hypothesized that higher hemoglobin (Hb) A1c is associated with worse outcomes in ICH. Patients and methods:Using the GWTG-Stroke registry, data on patients with ICH between April 1, 2003 and September 30, 2015 were harvested. Patients were divided into four ordinal groups based on HbA1c values of <5.7%, 5.7-6.4%, 6.5-8.0% and >8.0%. Outcomes (mortality, modified Rankin Scale (mRS), home discharge and independent ambulatory status) were analyzed for patients overall and separately for patients with or without history of diabetes using multivariable regression models. Results:Among 75,455 patients with ICH (with available HbA1c data), patients with lower HbA1c (<5.7%) had higher rates of in-hospital mortality in the entire cohort (15.5%; 3947/25473); as well as those with history of diabetes (19.0%; 542/2852). Among those without history of diabetes, both lower HbA1c (15.1%; 3405/22621) and higher HbA1c (>8.0%), (15.0%; 205/1364) were associated with higher in-hospital mortality. Lower HbA1c was also associated with higher mRS, less chance of going home, and lower likelihood of having independent ambulatory status in patients with prior history of diabetes. Conclusions:Among patients with no reported history of diabetes, both very low and very high HbA1c were directly associated with higher in-hospital mortality. Only very low HbA1c was associated with higher mortality in known diabetic patients. Further studies are needed to better define the relationship between HbA1c and outcomes, for it may have important implications for care of ICH patients.Item Embargo An Assessment Study to Determine the Feasibility, Appropriateness, and Usability of Mobile Clinics to Provide Neurosurgery and Neurology Care in Uganda(2023) Mukumbya, BenjaminNeurosurgical and neurological conditions account for a significant disease burden worldwide, with low- and middle-income countries bearing more than 90% of the burden. Uganda is a low-income nation with a high demand for neuro care services but limited access, especially in rural and remote areas. Mobile health clinics, which have proven to be effective in other specialties, could be adapted to provide neurological care in such regions. The objective of this research was to establish the feasibility, appropriateness, and usability of mobile neuro clinics for providing neurological care to people in Uganda's rural and remote communities. Participants who met the inclusion criteria were invited to participate in an education session. Following the education session, the participants participated in an interview session to evaluate the feasibility, appropriateness, and usability of mobile neuro clinics. The education and interview tools were developed using the Consolidated Framework for Implementation Research (CFIR). To weight provider views, a sentiment weighted scale was used, with total aggregate sentiment scores greater than 42 in each CFIR domain indicating high feasibility, acceptability, and usability. All the assessed CFIR domains scored above sentiment score of 49. The implementation process domain (167) received the best overall sentiment score, followed by the implementation climate structure (141), inner setting domain (102), innovation domain (59), and outer setting domain (55). According to the findings of the research, mobile neuro clinics are feasible, appropriate, and usable in Uganda. To achieve the best results, however, careful planning and integration involving stakeholders from conceptualization to execution are required.
Item Open Access Implementation Strategies to Improve Evidence-Based Bathing Practices in a Neuro ICU.(Journal of nursing care quality, 2019-04) Reynolds, Staci Sue; Sova, Chris; McNalty, Bridget; Lambert, Suzanne; Granger, BradiBackground
Evidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line-associated bloodstream infections (CLABSIs). However, implementation of this practice is inconsistent. Using multifaceted strategies to promote implementation is supported in the literature, yet there is a gap in knowing which strategies are most successful.Purpose
Using the Grol and Wensing Model of Implementation as a guide, the purpose of this study was to determine whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU.Methods
An observational pre-/postdesign was used.Results
Following implementation, infection rates decreased (P = .031). Statistically significant improvements were also seen across all process measures: bathing documentation, nursing knowledge, and perceived importance of CHG bathing.Conclusions
This study assists in closing the research-practice gap by using tailored, multifaceted implementation strategies to increase use of evidence-based nursing care for infection prevention practices.Item Open Access Survey of current practices among US epileptologists of antiepileptic drug withdrawal after epilepsy surgery.(Epilepsy Behav, 2013-02) Swisher, Christa B; Sinha, Saurabh RIn order to identify the current practices of antiepileptic drug (AED) withdrawal after epilepsy surgery, a survey was administered to 204 adult and pediatric epileptologists. The responses from 58 epileptologists revealed wide variations regarding the time course and extent of AED withdrawal after successful epilepsy surgery. For most of the epileptologists, the likelihood of the surgery being successful is an important factor in determining whether or not AEDs are tapered. Most of the respondents started to taper AEDs more rapidly than suggested by previous reports. The majority of the epileptologists were able to stop all AEDs completely in a substantial number of patients. The most important factors considered when deciding to taper AEDs were the presence of ongoing auras and the occurrence of postoperative seizures prior to seizure remission. In the absence of data from well-designed prospective trials, such survey results can inform practice and, hopefully, aid in the design of future trials.