This document summarizes a presentation on chronic kidney disease (CKD) in ischemic stroke patients. It provides background on CKD and ischemic stroke, then outlines the presentation's hypotheses and specific aims, which are to determine the associations between CKD and stroke severity, risk factors, interventions, and discharge disposition. The materials and methods describe the data sources and variables. The results sections finds that CKD is associated with diabetes, hypertension, and hyperlipidemia in stroke patients, but not with greater stroke severity or different discharge disposition. Patients with CKD had lower odds of intervention. The conclusions summarize the results and limitations, and suggest future directions.
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The goal of the study was to identify the most significant prognostic clinical criteria for the survival of patients with ischemic stroke (IS) within 1 year of observation.
Methods and Materials: The object of the clinical prospective study was 1421 patients with IS hospitalized in 2002-2015 in the neurological (stroke) departments of the 5th Minsk City Clinical Hospital and the Minsk Emergency Hospital. Analyzing the obtained data, we adhered to the prospective-specimen-collection, retrospective evaluation design of the study. The primary endpoint of the study was the patient's death from any reason within one year of the development of IS. Information on poststroke all-cause mortality was obtained through linkages to the official source - the centralized archive of deaths of residents of the city of Minsk. Patients without a confirmed death date were censored at the date last known alive. All patients that were alive at one year are assumed to be censored at that time. The collection of clinical, demographic, neuroimaging, laboratory data, as well as the final determination of the stroke outcome, was performed blindly with respect to survival data.
Results: To build the model, 22 multivariate clinical indicators were used that demonstrated the relationship with post-stroke survival at the stage of preliminary data analysis: stroke subtype according the Oxfordshire Community Stroke Project, age, gender, the severity of the neurological deficit according to the NIHSS scale at hospitalization, previous stroke or TIA, the presence of arterial hypertension, atrial fibrillation, myocardial atherosclerosis, congestive heart failure, diabetes mellitus, peripheral arterial diseases, alcohol abuse, level of creatinine, glucose, urea, potassium, sodium in blood, amount of hemoglobin, erythrocytes and leukocytes on the 1st day of treatment, the level of systolic and diastolic blood pressure in the hospital admission department.
In the construction of a survival decision tree of patients with IS, of the 22 initially embedded parameters, only 6 independent predictors were finally included in the prognostic model: the stroke subtype according to the OCSP, the presence of a lacunar infarction, the severity of neurologic deficit at hospitalization according NIHSS, level of urea and glucose in the blood, and the presence of congestive heart failure.
29 June 2010 - National End of Life Care Programme / NHS Improvement
This document sets out to raise awareness of the supportive and palliative care needs of people living or dying with progressive heart failure, to facilitate the commissioning of services specifically tailored to meet those needs.
Publication by the National End of Life Programme and NHS Improvement which became part of NHS Improving Quality in May 2013
Irina Gontschar and Igor Prudyvus
Abstract
Introduction: The goal of the study was to identify the most significant prognostic clinical criteria for the survival of patients with ischemic stroke (IS) within 1 year of observation.
Methods and Materials: The object of the clinical prospective study was 1421 patients with IS hospitalized in 2002-2015 in the neurological (stroke) departments of the 5th Minsk City Clinical Hospital and the Minsk Emergency Hospital. Analyzing the obtained data, we adhered to the prospective-specimen-collection, retrospective evaluation design of the study. The primary endpoint of the study was the patient's death from any reason within one year of the development of IS. Information on poststroke all-cause mortality was obtained through linkages to the official source - the centralized archive of deaths of residents of the city of Minsk. Patients without a confirmed death date were censored at the date last known alive. All patients that were alive at one year are assumed to be censored at that time. The collection of clinical, demographic, neuroimaging, laboratory data, as well as the final determination of the stroke outcome, was performed blindly with respect to survival data.
Results: To build the model, 22 multivariate clinical indicators were used that demonstrated the relationship with post-stroke survival at the stage of preliminary data analysis: stroke subtype according the Oxfordshire Community Stroke Project, age, gender, the severity of the neurological deficit according to the NIHSS scale at hospitalization, previous stroke or TIA, the presence of arterial hypertension, atrial fibrillation, myocardial atherosclerosis, congestive heart failure, diabetes mellitus, peripheral arterial diseases, alcohol abuse, level of creatinine, glucose, urea, potassium, sodium in blood, amount of hemoglobin, erythrocytes and leukocytes on the 1st day of treatment, the level of systolic and diastolic blood pressure in the hospital admission department.
In the construction of a survival decision tree of patients with IS, of the 22 initially embedded parameters, only 6 independent predictors were finally included in the prognostic model: the stroke subtype according to the OCSP, the presence of a lacunar infarction, the severity of neurologic deficit at hospitalization according NIHSS, level of urea and glucose in the blood, and the presence of congestive heart failure.
29 June 2010 - National End of Life Care Programme / NHS Improvement
This document sets out to raise awareness of the supportive and palliative care needs of people living or dying with progressive heart failure, to facilitate the commissioning of services specifically tailored to meet those needs.
Publication by the National End of Life Programme and NHS Improvement which became part of NHS Improving Quality in May 2013
In patients with carotid artery stenosis what is the best method of approaching carotid repair, surgical or minimally invasive?
After research including medical journals such as AHA, ACC guidelines and Cochrane library the answer is inconclusive.
download link : https://www.dropbox.com/s/a8ug16pfkvv1bzp/Cardiorenal%20syndrome.ppt?m
Join us on our facebook group: NephroTube...............Follow our blog: www.nephrotube.blogspot.com
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
In patients with carotid artery stenosis what is the best method of approaching carotid repair, surgical or minimally invasive?
After research including medical journals such as AHA, ACC guidelines and Cochrane library the answer is inconclusive.
download link : https://www.dropbox.com/s/a8ug16pfkvv1bzp/Cardiorenal%20syndrome.ppt?m
Join us on our facebook group: NephroTube...............Follow our blog: www.nephrotube.blogspot.com
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
Running head MEDICAL CARE PLANNING FOR PATIENTS WITH CHRONIC KIDN.docxjeanettehully
Running head: MEDICAL CARE PLANNING FOR PATIENTS WITH CHRONIC KIDNEY DISEASE
Medical care planning for patients with Chronic Kidney DiseaseNorys GilSouth University
Medical care planning for patients with Chronic Kidney Disease
Introduction
Chronic Kidney is a disorder that disturbs the correct working of the kidney, which is increasingly becoming a challenge to the health care sector. Just like any other chronic disease, CKD comes with the responsibility of ensuring that a patient gets maximum medical treatment facilities and attention as much as possible. “The definition and classification of chronic kidney disease (CKD) have evolved, but current international guidelines define this condition as decreased kidney function as shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m2 or markers of kidney damage, or both, of at least three months duration, regardless of the underlying cause”, Morton & Masson, 2017.
Morbidity and comorbidity of chronic Kidney disease
Weak/low results are closely associated with CKD; this is because of the burdens that are so high when it comes to comorbidity. Many pieces of research have indicated that CKD relates to diabetes and hypertension conditions. Intense conditions of chronic kidney disease also lead to heart complications. There is little information on the mental difficulties that come with CKD.
“Chronic kidney disease (CKD) can be associated with adverse clinical outcomes, poor quality of life, and high health-care costs; clinicians need to understand that these observations result from a high burden of comorbidity among CKD patients”, (Manns &Hemmelgarn 2010). Key morbidities of CKD, therefore, include pulmonary complications, diabetes, hypertension, and atrial fibrillation. CKD, to a very high degree, leads to characteristics such as myocardial infarction, dementia, hypothyroidism, depression, and stroke. All comorbidities remain classified as concordant others that closely relate with CKD but ranked as discordant include; asthma, constipation, lymphoma dementia, etc.
Impacts of chronic kidney disease
Various medical reports by the health care agencies and organizations, including the World Health Organization show that CKD is a growing complication that has become a big concern of the public health care sector not just in the United States but around the globe. An estimation of over 26 million people is affected by CKD in the country. Annual reports have shown that this number is likely to increase if serious investments are in the health care sector. Hypertension and diabetes are proven, leading causes of kidney complications. To an individual, CKD can lead to other primary complications such as nephropathy, lupus, and continuity of kidney failure. The country invests billions of money annually, something that is becoming hard to sustain because of the annual increase in population and the number of those affected by CKD.
As of 2006, over $23 billion was spent on C ...
Introduction: Chronic Kidney Disease (CKD) is a worldwide public health problem and it is increasing over time. Cardiovascular disease is a major concern for patients with end stage renal disease, especially those on hemodialysis. It is the leading cause of death among patients with chronic kidney
disease, particularly in dialysis population.
This is a detailed lecture note on 'Investigating the Heart Failure Patient'.
It was delivered in the Internal Medicine Department, Cardiology 1 Unit of Jos University Teaching Hospital (JUTH), by Dr Kimto Oche Emmanuel (24/09/2020)
Supervised by Dr G. A Amusa (Consultant Cardiologist, JUTH)
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Class presentation at Pokhara University, MPH program
Point wise data on situation of cardiovascular disease focused on ischemic heart disease in Nepal.
RCVS is usually a benign cerebral vascular dysregulation induced clinico-radiological syndrome presents typically with recurrent thunderclap headache with or without ischemic/hemorrhagic stroke or cerebral edema with vasoconstriction. Various risk factors are responsible for this syndrome.
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasSean M. Fox
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One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
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Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
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Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
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Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
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Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
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Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
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1. Chronic Kidney Disease in
Ischemic Stroke
Carlee Oakley
University of Kansas Medical Center
PVRM 868 Biomedical Informatics Driven Clinical
Research
2017
3. Ischemic Stroke
• A stroke occurs if the blood flow to a portion of the
brain is blocked. Without oxygen, brain cells start to
die after a few minutes. Symptoms then occur in the
parts of the body that these brain cells control.1
• More than 690,000 adults experience an ischemic
stroke in the United States each year.2
• Stroke is an enormous source of morbidity due to
the interplay between the resulting neurological
impairment, the emotional and social consequences,
and the high risk for recurrence.
4.
5. Chronic Kidney Disease
• CKD is defined as decreased kidney function that persists for three or
more months. This diagnosis encompasses a continuum of diseases.
• CKD is a significant global health concern with a prevalence of 15% in
developed countries.3
• In long-term dialysis patients stroke has a prevalence of 17% compared to
10% for non-dialysis CKD patients and 4% for the general population.4
• Over 30% of ischemic stroke patients meet criteria for CKD. 5
• Yet studies investigating the effect of renal dysfunction on stroke severity
and outcomes are limited and have provided conflicting results.
6. Explicit Guidelines
• Hypertension
• Dyslipidemia
• Glucose Disorders
• Atrial Fibrillation
• Obesity/Inactivity
• Malnutrition
• Sleep Apnea
• Carotid Disease
• Intracranial Atherosclerosis
• Hypercoagulative States
Notice: CKD is not included
in this list
7. Hypotheses & Specific Aims
First Aim: Determine the association between CKD and stroke severity on
presentation
*We hypothesized that patients with CKD would present with greater stroke
severity, as evidenced by higher NIH Stroke Scale scores.
Second Aim: Determine the association between CKD and common stroke
risk factors
*We hypothesized that patients with CKD would have increased risk for comorbid
DM, HTN, HLD, A-fib and tobacco use.
Third Aim: Determine the association between CKD and vascular
intervention for ischemic stroke management
*We hypothesized that patients with CKD would have increased risk for undergoing
stroke intervention.
Fourth Aim: Determine the association between CKD and disposition
following ischemic stroke
*We hypothesized that patients with CKD would have increased risk for hospital
discharge to a non-home facility.
8. NIH Stroke Scale
Score Description
0 No stroke
1-4 Minor stroke
5-15 Moderate stroke
15-20 Moderate/severe stroke
21-42 Severe stroke
The National Institutes of Health Stroke Scale (NIHSS) is a 15-item
impairment scale used to measure stroke severity. It was originally
developed in 1989 and is now widely used. In the current National
Stroke Foundation guidelines, the NIHSS is recommended as a
valid tool to assess stroke severity in emergency departments. 6
9. Catheter Interventions
• Transcatheter therapy, arterial or venous infusion for
thrombolysis
• Percutaneous transluminal mechanical thrombectomy
with intraprocedural pharmacological thrombolytic
injection
• Tissue plasminogen activator (tPA): dissolves blood
clots and reestablishes blood flow to the brain—
administered within 4.5 hours of symptom onset7
• Endovascular thrombectomy: removes large blood
clots by sending a wired-caged device to the site of
the blocked blood vessel in the brain
10. Materials
• HERON: The Healthcare Enterprise Repository for
Ontological Narration
• REDCap: Research Electronic Data Capture
• SQLite
• Microsoft Excel
• SAS 9.4
12. Timeline
Stroke Encounter
Stroke Diagnosis
AND
NIHSS Evaluation
Disposition
Intervention
Atrial Fibrillation
Diabetes
Hypertension
Hyperlipidemia
Tobacco Use
*Diagnosed previously or
< 2 weeks following stroke*
Chronic Kidney Disease
eGFR < 60 mL/min per 1.73m2
for > 90 days
*eGFR does not improve to
> 60 during this window*
13. ICD9: Occlusion of Cerebral Arteries
ICD9: Transient Cerebral Ischemia
ICD9: Occlusion and Stenosis of Pre-cerebral Arteries
ICD10: Cerebral Infarction
4,330
ICD9: Occlusion of Cerebral Arteries
ICD9: Transient Cerebral Ischemia
ICD9: Occlusion and Stenosis of Pre-cerebral Arteries
ICD10: Cerebral Infarction
4,009
Stroke Diagnosis
‘Billing Diagnosis - Admit Primary‘
or
'Billing Diagnosis - Discharge Primary'
1,718
NIH Stroke Scale Score
in Same Encounter
as
Stroke Diagnosis (Primary)
1,494 patients
1,567 encounters
27. Conclusions
• CKD is not associated with greater stroke severity upon
hospital presentation at KUMC.
• CKD is strongly associated with diabetes, hypertension,
and hyperlipidemia in ischemic stroke patients.
• The odds of undergoing catheter intervention are
lower in patients with CKD than in those with normal
kidney function.
• There is no association between CKD and discharge
disposition at KUMC.
30. References
1. What Is a Stroke? - NHLBI, NIH. https://www.nhlbi.nih.gov/health/health-topics/topics/stroke.
Accessed December 11, 2017.
2. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2014 update: a report from
the American Heart Association. Circulation. 2014;129(3):e28-e292.
doi:10.1161/01.cir.0000441139.02102.80.
3. Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global
burden of major noncommunicable diseases. Kidney Int. 2011;80(12):1258-1270.
doi:10.1038/ki.2011.368.
4. Bugnicourt J-M, Godefroy O, Chillon J-M, Choukroun G, Massy ZA. Cognitive disorders and dementia
in CKD: the neglected kidney-brain axis. J Am Soc Nephrol JASN. 2013;24(3):353-363.
doi:10.1681/ASN.2012050536.
5. Hayden D, McCarthy C, Akijian L, et al. Renal dysfunction and chronic kidney disease in ischemic
stroke and transient ischemic attack: A population-based study. Int J Stroke Off J Int Stroke Soc.
2017;12(7):761-769. doi:10.1177/1747493017701148.
6. Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother. 2014;60(1):61.
doi:10.1016/j.jphys.2013.12.012.
7. Stroke Treatments. http://www.strokeassociation.org/STROKEORG/AboutStroke/BLS/Stroke-
Treatments_UCM_310892_Article.jsp#. Accessed December 11, 2017.
