Relevant bibliographies by topics / Cerebrovascular disease Patients Australia

Academic literature on the topic 'Cerebrovascular disease Patients Australia'

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Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Cerebrovascular disease Patients Australia"

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De La Mata, Nicole Louise, Maria Alfaro-Ramirez, Patrick J. Kelly, Philip Masson, Rustam Al-Shahi Salman, and Angela C. Webster. "Absolute risk and risk factors for stroke mortality in patients with end-stage kidney disease (ESKD): population-based cohort study using data linkage." BMJ Open 9, no. 2 (February 2019): e026263. http://dx.doi.org/10.1136/bmjopen-2018-026263.

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IntroductionPeople with end-stage kidney disease (ESKD) have up to 30-fold higher risk of stroke than the general population.ObjectiveTo determine risk factors associated with stroke death in the ESKD population.MethodsWe identified all patients with incident ESKD in Australia (1980–2013) and New Zealand (1988–2012) from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) registry. We ascertained underlying cause of death from data linkage with national death registries and risk factors from ANZDATA. Using a competing risks multivariable regression model, we estimated cumulative incidence of stroke and non-stroke deaths, and risk factors for stroke deaths (adjusted sub-HR, SHR).ResultsWe included 60 823 people with ESKD. There were 941 stroke deaths and 33 377 non-stroke deaths during 381 874 person-years of follow-up. Overall, the cumulative incidence of stroke death was 0.9% and non-stroke death was 36.8% 5 years after starting ESKD treatment. The risk of stroke death was higher at older ages (SHR 1.92, 95% CI 1.45 to 2.55), in females (SHR 1.41, 95% CI 1.21 to 1.64), in people with cerebrovascular disease (SHR 2.39, 95% CI 1.99 to 2.87), with ESKD caused by hypertensive/renovascular disease (SHR 1.39, 95% CI 1.09 to 1.78) or polycystic kidney disease (SHR 1.38, 95% CI 1.00 to 1.90), with earlier year of ESKD treatment initiation (SHR 1.93, 95% CI 1.56 to 2.39) and receiving dialysis (transplant vs haemodialysis SHR 0.27, 95% CI 0.09 to 0.84).ConclusionPatients with ESKD with higher risk of stroke death are older, women, with cerebrovascular disease, with hypertensive/renovascular or polycystic kidney disease cause of ESKD, with earlier year of ESKD treatment and receiving dialysis. These groups may benefit from targeted stroke prevention interventions.
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Atkins, Emily R., Elizabeth A. Geelhoed, Lee Nedkoff, and Tom G. Briffa. "Disparities in equity and access for hospitalised atherothrombotic disease." Australian Health Review 37, no. 4 (2013): 488. http://dx.doi.org/10.1071/ah13083.

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Objective. This study of equity and access characterises admissions for coronary, cerebrovascular and peripheral arterial disease by hospital type (rural, tertiary and non-tertiary metropolitan) in a representative Australian population. Methods. We conducted a descriptive analysis using data linkage of all residents aged 35–84 years hospitalised in Western Australia with a primary diagnosis for an atherothrombotic event in 2007. We compared sociodemographic and clinical features by atherothrombotic territory and hospital type. Results. There were 11670 index admissions for atherothrombotic disease in 2007 of which 46% were in tertiary hospitals, 41% were in non-tertiary metropolitan hospitals and 13% were in rural hospitals. Coronary heart disease comprised 72% of admissions, followed by cerebrovascular disease (19%) and peripheral arterial disease (9%). Comparisons of socioeconomic disadvantage reveal that for those admitted to rural hospitals, more than one-third were in the most disadvantaged quintile, compared with one-fifth to any metropolitan hospital. Conclusions. Significant differences in demographic characteristics were evident between Western Australian tertiary and non-tertiary hospitals for patients hospitalised for atherothrombotic disease. Notably, the differences among tertiary, non-tertiary metropolitan and rural hospitals were related to socioeconomic disadvantage. This has implications for atherothrombotic healthcare provision and the generalisation of research findings from studies conducted exclusively in the tertiary metropolitan hospitals. What is known about the topic? Equity and access to hospital care for atherothrombotic disease in a geographically diverse population is poorly characterised. National data show that both fatal and non-fatal coronary heart disease and non-fatal stroke hospitalisations increase with remoteness. Fatal in-hospital stroke is greatest in major cities, whereas peripheral arterial disease hospitalisations are greatest in the inner and outer regional areas. What does this paper add? This study demonstrates that around 13% of atherothrombotic events were treated in rural hospitals with in-hospital case fatality higher than in tertiary and non-tertiary metropolitan hospitals. A greater proportion of atherothrombotic disease cases treated in rural hospitals were in the most disadvantaged Socioeconomic Indices For Area group. What are the implications for practitioners? It is important to consider differences in disadvantage when generalising results of studies generated from tertiary hospital data to non-tertiary metropolitan and rural patients.
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Chan, Samuel, Mark R. Marshall, Robert J. Ellis, Dwarakanathan Ranganathan, Carmel M. Hawley, David W. Johnson, and Martin J. Wolley. "Haemodialysis withdrawal in Australia and New Zealand: a binational registry study." Nephrology Dialysis Transplantation 35, no. 4 (August 9, 2019): 669–76. http://dx.doi.org/10.1093/ndt/gfz160.

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Abstract Background Withdrawal from dialysis is an increasingly common cause of death in patients with end-stage kidney disease (ESKD). As most published reports of dialysis withdrawal have been outside the Oceania region, the aims of this study were to determine the frequency, temporal pattern and predictors of dialysis withdrawal in Australian and New Zealand patients receiving chronic haemodialysis. Methods This study included all people with ESKD in Australia and New Zealand who commenced chronic haemodialysis between 1 January 1997 and 31 December 2016, using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Competing risk regression models were used to identify predictors of dialysis withdrawal mortality, using non-withdrawal cause of death as the competing risk event. Results Among 40 447 people receiving chronic haemodialysis (median age 62 years, 61% male, 9% Indigenous), dialysis withdrawal mortality rates increased from 1.02 per 100 patient-years (11% of all deaths) during the period 1997–2000 to 2.20 per 100 patient-years (32% of all deaths) during 2013–16 (P < 0.001). Variables that were significantly associated with a higher likelihood of haemodialysis withdrawal were older age {≥70 years subdistribution hazard ratio [SHR] 1.77 [95% confidence interval (CI) 1.66–1.89]; reference 60–70 years}, female sex [SHR 1.14 (95% CI 1.09–1.21)], white race [Asian SHR 0.56 (95% CI 0.49–0.65), Aboriginal and Torres Strait Islander SHR 0.83 (95% CI 0.74–0.93), Pacific Islander SHR 0.47 (95% CI 0.39–0.68), reference white race], coronary artery disease [SHR 1.18 (95% CI 1.11–1.25)], cerebrovascular disease [SHR 1.15 (95% CI 1.08–1.23)], chronic lung disease [SHR 1.13 (95% CI 1.06–1.21)] and more recent era [2013–16 SHR 3.96 (95% CI 3.56–4.48); reference 1997–2000]. Conclusions Death due to haemodialysis withdrawal has become increasingly common in Australia and New Zealand over time. Predictors of haemodialysis withdrawal include older age, female sex, white race and haemodialysis commencement in a more recent era.
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Georgieva, Dobrinka, Dobrinka Kalpachka, and Rossen Kalpachki. "Stroke and aphasia rehabilitation: A comparison of international guidelines." Logopedia Silesiana, no. 9 (December 29, 2020): 1–15. http://dx.doi.org/10.31261/logopediasilesiana.2020.09.19.

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Cerebrovascular diseases are the leading cause of morbidity and mortality worldwide. Unfortunately, Bulgaria leads most countries in its incidence of stroke. Furthermore, a substantial number of Bulgarian patients post-stroke present with persisting communication disorders, especially aphasia. The main purpose of the present study is to conduct an evidence-based theoretical review of leading international guidelines for treatment and rehabilitation of adult stroke patients. In particular, this theoretical overview compares the current Bulgarian guidelines with those developed by the United States of America, Europe, Australia, Canada, the United Kingdom, and New Zealand. The Bulgarian guidelines for the prevention, diagnosis, and treatment of cerebrovascular diseases strongly recommends pharmacological treatment, which is commensurate with international standards. Nationally, a range of different language tests are currently used in post-stroke aphasia.
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Blair, Christopher, Angela Firtko, Peter Thomas, Longting Lin, Megan Miller, Lisa Tran, Leon Edwards, Sonu Bhaskar, Mark Parsons, and Dennis J. Cordato. "A Multicentre Study Comparing Cerebrovascular Disease Profiles in Pacific Islander and Caucasian Populations Presenting with Stroke and Transient Ischaemic Attack." Neuroepidemiology 56, no. 1 (December 1, 2021): 25–31. http://dx.doi.org/10.1159/000520058.

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Introduction: In a multicentre study, we contrasted cerebrovascular disease profiles in Pacific Island (PI)-born patients (Indigenous Polynesian [IP] or Indo-Fijian [IF]) presenting with transient ischaemic attack (TIA), ischaemic stroke (IS) or intracerebral haemorrhage (ICH) with those of Caucasians (CSs). Methods: Using a retrospective case-control design, we compared PI-born patients with age- and gender-matched CS controls. Consecutive patients were admitted to 3 centres in South Western Sydney (July 2013–June 2020). Demographic and clinical data studied included vascular risk factors, stroke subtypes, and imaging characteristics. Results: There were 340 CS, 183 (27%) IP, and 157 (23%) IF patients; mean age 65 years; and 302 (44.4%) female. Of these, 587 and patients presented with TIA/IS and 93 (13.6%) had ICH. Both IP and IF patients were significantly more likely to present >24 h from symptom onset (odds ratios [ORs] vs. CS 1.87 and 2.23). IP patients more commonly had body mass indexes >30 (OR 1.94). Current smoking and excess alcohol intake were higher in CS. Hypertension, diabetes, and chronic kidney disease were significantly higher in both IP and IF groups in comparison to CS. IP patients had higher rates of AF and those with known AF were more commonly undertreated than both IF and CS patients (OR 2.24, p = 0.007). ICH was more common in IP patients (OR 2.32, p = 0.005), while more IF patients had intracranial arterial disease (OR 5.10, p < 0.001). Discussion/Conclusion: Distinct cerebrovascular disease profiles are identifiable in PI-born patients who present with TIA or stroke symptoms in Australia. These may be used in the future to direct targeted approaches to stroke prevention and care in culturally and linguistically diverse populations.
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Davis, Wendy A., Eunice Chin, Adelle Jee, Jen Martins, David G. Bruce, John Beilby, and Timothy M. E. Davis. "Apolipoprotein E genotype and mortality in Southern European and Anglo-Celt patients with type 2 diabetes: the Fremantle Diabetes Study." European Journal of Endocrinology 163, no. 4 (October 2010): 559–64. http://dx.doi.org/10.1530/eje-10-0474.

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ObjectiveTo determine whether cardiac and all-cause mortality are lower in Southern European (SE) patients than in Anglo-Celt (AC) patients with type 2 diabetes in an urban Australian setting, and, if so, whether ethnicity-specific differences in apolipoprotein E (APOE) genotypes are contributory.DesignLongitudinal observational cohort study.MethodsWe analysed detailed data from 1057 patients from the community-based Fremantle Diabetes Study, 238 were of an SE migrant background and 819 of AC ethnicity. Cox proportional hazards modelling was used to identify independent predictors of cardiac and all-cause mortality.ResultsDuring 9.8±3.5 years of follow-up, 411 (38.9%) participants died, 161 (39.2%) from cardiac causes. Significant positive baseline independent predictors of cardiac death were age, male gender, coronary heart disease, cerebrovascular disease, peripheral arterial disease, retinopathy and peripheral neuropathy (P≤0.004), while maternal history of diabetes was protective (P=0.014). After adjusting for these variables,APOE4carriage was predictive (hazard ratio (95% confidence interval) 1.61 (1.01–2.58);P=0.048). SE ethnicity did not add significantly to the model either as a single variable or as an interaction term withAPOE4carriage (P≥0.86). Significant independent predictors of all-cause mortality were age, male gender, smoking, coronary heart disease, cerebrovascular disease, peripheral arterial disease, retinopathy, peripheral neuropathy and microalbuminuria (P≤0.047), while overweight/obesity, lipid-lowering therapy and recent exercise were protective (P≤0.008).APOE4carriage, SE ethnicity and their interaction did not add to the model (P≥0.32).ConclusionsSE ethnicity does not confer an independent survival advantage in community-based Australian type 2 diabetic patients, butAPOE4carriers are at higher risk of cardiac death.
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Laupland, Kevin B., Mahesh Ramanan, Kiran Shekar, Felicity Edwards, Pierre Clement, and Alexis Tabah. "Long-term outcome of prolonged critical illness: A multicentered study in North Brisbane, Australia." PLOS ONE 16, no. 4 (April 8, 2021): e0249840. http://dx.doi.org/10.1371/journal.pone.0249840.

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Background Although critical illness is usually of high acuity and short duration, some patients require prolonged management in intensive care units (ICU) and suffer long-term morbidity and mortality. Objective To describe the long-term survival and examine determinants of death among patients with prolonged ICU admission. Methods A retrospective cohort of adult Queensland residents admitted to ICUs for 14 days or longer in North Brisbane, Australia was assembled. Comorbid illnesses were classified using the Charlson definitions and all cause case fatality established using statewide vital statistics. Results During the study a total of 28,742 adult Queensland residents had first admissions to participating ICUs of which 1,157 (4.0%) had prolonged admissions for two weeks or longer. Patients with prolonged admissions included 645 (55.8%), 243 (21.0%), and 269 (23.3%) with ICU lengths of stay lasting 14–20, 21–27, and ≥28 days, respectively. Although the severity of illness at admission did not vary, pre-existing comorbid illnesses including myocardial infarction, congestive heart failure, kidney disease, and peptic ulcer disease were more frequent whereas cancer, cerebrovascular accidents, and plegia were less frequently observed among patients with increasing ICU lengths of stay lasting 14–20, 21–27, and ≥28 days. The ICU, hospital, 90-day, and one-year all cause case-fatality rates were 12.7%, 18.5%, 20.2%, and 24.9%, respectively, and were not different according to duration of ICU stay. The median duration of observation was 1,037 (interquartile range, 214–1888) days. Although comorbidity, age, and admitting diagnosis were significant, neither ICU duration of stay nor severity of illness at admission were associated with overall survival outcome in a multivariable Cox regression model. Conclusions Most patients with prolonged stays in our ICUs are alive at one year post-admission. Older age and previous comorbidities, but not severity of illness or duration of ICU stay, are associated with adverse long-term mortality outcome.
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Koh, Youlin, Julia Stehli, Catherine Martin, Angela Brennan, Diem T. Dinh, Jeffrey Lefkovits, and Sarah Zaman. "Does sex predict quality of life after acute coronary syndromes: an Australian, state-wide, multicentre prospective cohort study." BMJ Open 9, no. 12 (December 2019): e034034. http://dx.doi.org/10.1136/bmjopen-2019-034034.

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ObjectiveWomen have reported higher mortality and major adverse cardiovascular events (MACE) following acute coronary syndromes (ACSs) compared with men. With this in mind, we aimed to identify predictors of poor quality of life (QoL) post-ACS as our primary outcome. We examined predictors of MACE, major cerebrovascular events and major bleeding as our secondary outcome.DesignProspective cohort study.Setting30 metropolitan centres across the Victorian Cardiac Outcomes Registry network.Participants16 517 patients treated with percutaneous coronary intervention (PCI) for ACS (22.9% females). Selection/inclusion criteria: consecutive patients with successful or attempted PCI for ACS from 2013 to 2016, alive at 30 days post-PCI. Exclusion criteria: patients not fulfilling ACS criteria. At 30 days, 2497 (64.7% females) completed the QoL EQ-5D-3L instrument.Primary and secondary outcome measuresQoL, assessed using the EuroQo-5Dimensions (EQ-5D-3L) instrument by telephone at 30 days. Independent predictors of QoL were identified by univariate and multivariate logistic regression analyses.ResultsWomen were significantly older with more diabetes, cerebrovascular disease and renal failure. Regarding the primary outcome, female sex was independently associated with moderate/severe impairment in all EQ-5D-3L domains including mobility (OR 2.38, 95% CI 2.06 to 2.75, p<0.001), personal care (OR 2.14, 95% CI 1.73 to 2.66, p<0.001), activities of daily living (OR 1.84, 95% CI 1.63 to 2.08, p<0.001), pain/discomfort (OR 1.44, 95% CI 1.24 to 1.67, p<0.001) and anxiety/depression (OR 1.49, 95% CI 1.30 to 1.70, p<0.001). Women had significantly lower self-rated Visual Analogue Scale scores (80.0 for both groups, IQR 60-85 vs 70-90, p<0.001). There was no significant difference between the sexes in secondary outcomes.ConclusionsFemale sex was a predictor of poorer QoL following PCI for ACS including significantly higher pain, anxiety and depression. This was independent of age, comorbidities and ACS presentation. There is a clinical need for a tailored approach in female ACS management, for example, emphasis on management of depressive and anxiety symptoms.
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Koshy, Anoop N., Paul J. Gow, Hui-Chen Han, Andrew W. Teh, Robert Jones, Adam Testro, Han S. Lim, et al. "Cardiovascular mortality following liver transplantation: predictors and temporal trends over 30 years." European Heart Journal - Quality of Care and Clinical Outcomes 6, no. 4 (February 26, 2020): 243–53. http://dx.doi.org/10.1093/ehjqcco/qcaa009.

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Abstract Aims There has been significant evolution in operative and post-transplant therapies following liver transplantation (LT). We sought to study their impact on cardiovascular (CV) mortality, particularly in the longer term. Methods and results A retrospective cohort study was conducted of all adult LTs in Australia and New Zealand across three 11-year eras from 1985 to assess prevalence, modes, and predictors of early (≤30 days) and late (&gt;30 days) CV mortality. A total of 4265 patients were followed-up for 37 409 person-years. Overall, 1328 patients died, and CV mortality accounted for 228 (17.2%) deaths. Both early and late CV mortality fell significantly across the eras (P &lt; 0.001). However, CV aetiologies were consistently the leading cause of early mortality and accounted for ∼40% of early deaths in the contemporary era. Cardiovascular deaths occurred significantly later than non-cardiac aetiologies (8.8 vs. 5.2 years, P &lt; 0.001). On multivariable Cox regression, coronary artery disease [hazard ratio (HR) 4.6, 95% confidence interval (CI) 1.2–21.6; P = 0.04] and era of transplantation (HR 0.44; 95% CI 0.28–0.70; P = 0.01) were predictors of early CV mortality, while advancing age (HR 1.05, 95% CI 1.02–1.10; P = 0.005) was an independent predictors of late CV mortality. Most common modes of CV death were cardiac arrest, cerebrovascular events, and myocardial infarction. Conclusion Despite reductions in CV mortality post-LT over 30 years, they still account for a substantial proportion of early and late deaths. The late occurrence of CV deaths highlights the importance of longitudinal follow-up to study the efficacy of targeted risk-reduction strategies in this unique patient population.
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Hsu, Danny, Ibrahim Tohidi-Esfahani, Christina Brown, Scott Dunkley, Stephen Robert Larsen, Phoebe Joy Ho, Harry Iland, John Gibson, and Douglas E. Joshua. "Safety and Efficacy of CEEP (Cyclophosphamide, Epirubicin, Etoposide, Prednisolone) with or without Rituximab in Elderly Patients (>70) with Diffuse Large B-Cell Lymphoma (DLBL): A Retrospective Single Center Experience." Blood 118, no. 21 (November 18, 2011): 4957. http://dx.doi.org/10.1182/blood.v118.21.4957.4957.

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Abstract Abstract 4957 Background Over 40% of patients with the most common lymphoid malignancy worldwide, DLBL, are over the age of 70. Although R-CHOP is inarguably the mainstay of therapy for DLBL patients, a significant number of elderly patients do not tolerate the regimen due to underlying frailty and/or co-morbidities. Most elderly patients with significant co-morbidities have limited treatment options and are not offered anthracycline-containing chemotherapy due to concerns regarding toxicity. Here we describe our single center experience with CEEP, a lower intensity regimen for elderly patients with newly diagnosed or relapsed DLBL whom are deemed inappropriate for CHOP-based chemotherapy. Method All patients >70 years old (median 78.5, range 71 – 85) with histologically proven DLBL treated with CEEP ± Rituximab (R) at Royal Prince Alfred Hospital from 2000 to 2010 were retrospectively reviewed. Modified CEEP, Cyclophosphamide 300mg/m2 Day 1 (D1) and D15, Epirubicin 50mg/m2 D1 and D15, Etoposide 100mg/m2 D1 and D15, and Prednisolone 50mg D1-D5 (reduced dose from original CEEP protocol) was administered every 2 weeks. Rituximab 375mg/m2 (when approved for use in Australia) was administered every 28 days. As per institutional protocol, all patients received Bactrim prophylaxis for Pneumocystis. Baseline characteristics, Charlson Comorbidity Index, Revised International Prognostic Index (RIPI), the number of CEEP cycles, treatment response and toxicity from treatment were identified and reviewed. Results A total of 22 patients were identified, 10 were male. 15 received CEEP as initial therapy, and 7 for relapsed disease. 23% (n=5) had an ECOG score ≥ 2. 55% (n=12) had RIPI ≥ 3. All patients had a Charlson Comorbidity Index ≥ 2, with 23% (n=5) ≥ 5, which was considered sufficient to preclude conventional CHOP-based chemotherapy. Median cardiac ejection fraction was 62% (range 55 – 85%). 73% (n=16) received Rituximab and 50% (n=11) received primary GCSF prophylaxis. The median number of CEEP ± R cycles was 6 (range 2 – 9 cycles). 5% (n=1) required dose reduction and 9% (n=2) required delays in treatment due to haematological toxicity. Median follow-up was 10.0 months (range 1 – 92.7 months). At completion of therapy, complete responses (CR) were demonstrated in 10 patients (45%), with partial responses (PR) seen in 32% (n=7). 18% (n=4) demonstrated progressive disease (PD) despite therapy. Of the 7 patients with relapsed disease prior to CEEP ± R, CR was seen in 2 cases, both of whom had previous exposure to R-CVP (cyclophosphamide, vincristine, prednisolone) chemotherapy. At most recent follow up, 32% (n=7) have remained in CR with a median follow up period of 28.1 months (range 13 – 92.7 months), 36% (n=8) had disease progression, 9% (n=2) demonstrated stable residual disease, while 23% (n=5) have died. Of the 5 deaths, 3 were attributed to progressive DLBL. The other deaths were a result of complications following further salvage chemotherapy. Grade 3 – 4 haematological toxicity was observed in 72% (n=16) of patients. Febrile neutropenia occurred in 41% (n=9). Overall, 50% (n=11) required at least one re-admission to hospital. Non-haematological grade 3 – 4 toxicity was detected in 2 patients, one of whom suffered unstable angina in the setting of anaemia, the other an acute cerebrovascular event in the setting of new atrial flutter post-chemotherapy. Discussion Although limited by a small sample size, our retrospective single center experience demonstrates that CEEP ± R chemotherapy can be administered to elderly patients with significant co-morbidities. Our cohort was all aged >70, with medical co-morbidities leading to the unsuitability of conventional CHOP-based therapy. Whilst an overall response rate of 77% (CR + PR) was observed, on prolonged follow up, 32% of patients remained in CR. Significant haematological toxicity (72%) and infectious complications (41%) were observed, however no deaths were directly attributed to the chemotherapy. Future prospective studies are required to further evaluate the safety and efficacy of R-CEEP in the elderly. Disclosures: No relevant conflicts of interest to declare.
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Dissertations / Theses on the topic "Cerebrovascular disease Patients Australia"

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Hoffmann, Tammy Coral. "Development and evaluation of a computer-generated individualised written education package for patients following stroke and their carers /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18924.pdf.

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Ellis, Graham. "Stroke liaison workers for patients and carers." Thesis, Connect to e-thesis, 2008. http://theses.gla.ac.uk/288/.

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Thesis (MD.) - University of Glasgow, 2007.
MD. thesis submitted to the Division of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, 2007. Includes bibliographical references. Print version also available.
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Kwok, Wing-yee Eunice. "Early supported discharge program for stroke patients." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720883.

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Willats, Lisa. "Improved quantification of perfusion in patients with cerebrovascular disease." Thesis, University College London (University of London), 2008. http://discovery.ucl.ac.uk/1445148/.

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In recent years measurements of cerebral perfusion using bolus-tracking MRI have become common clinical practice in the diagnosis and management of patients with stroke and cerebrovascular disease. An active area of research is the development of methods to identify brain tissue that is at risk of irreversible damage, but amenable to salvage using reperfusion treatments, such as thrombolysis. However, the specificity and sensitivity of these methods are limited by the inaccuracies in the perfusion data. Accurate measurements of perfusion are difficult to obtain, especially in patients with cerebrovascular diseases. In particular, if the bolus of MR contrast is delayed and/or dispersed due to cerebral arterial abnormalities, perfusion is likely to be underestimated using the standard analysis techniques. The potential for such underestimation is often overlooked when using the perfusion maps to assess stroke patients. Since thrombolysis can increase the risk of haemorrhage, a misidentification of 'at-risk' tissue has potentially dangerous clinical implications. This thesis presents several methodologies which aim to improve the accuracy and interpretation of the analysed bolus-tracking data. Two novel data analysis techniques are proposed, which enable the identification of brain regions where delay and dispersion of the bolus are likely to bias the perfusion measurements. In this way true hypoperfusion can be distinguished from erroneously low perfusion estimates. The size of the perfusion measurement errors are investigated in vivo, and a parameterised characterisation of the bolus delay and dispersion is obtained. Such information is valuable for the interpretation of in vivo data, and for further investigation into the effects of abnormal vasculature on perfusion estimates. Finally, methodology is presented to minimise the perfusion measurement errors prevalent in patients with cerebrovascular diseases. The in vivo application of this method highlights the dangers of interpreting perfusion values independently of the bolus delay and dispersion.
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Rau, Marie Therese. "Elderly stroke patients and their partners: a longitudinal study of social support and well-being changes associated with a disabling stroke." PDXScholar, 1986. https://pdxscholar.library.pdx.edu/open_access_etds/478.

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This investigation explored the relationship of demographic, social network, social support, and stroke-related factors to depressive symptomatology and well-being in 50 elderly individuals who had recently suffered a first, completed stroke and their partners. Data were gathered at two points in time, with interviews scheduled six months apart. Outcome measures included the CES-D depression scale and the Index of Psychological Well-Being. Data were analyzed using descriptive statistics, correlational procedures, multiple regression, and change-focused regression analyses. For the caregivers, lower depression levels at Time 1 were associated with better subjective health, less concern about being able to care for the patient in the future, higher levels of patient ADL functioning, greater perceived pre-stroke instrumental support, and greater patient optimism. At Time 2, lower caregiver depression scores were associated with lower levels of perceived burden, fewer health problems or negative changes in health status, fewer negative network interactions, greater network density, greater frequency of network contacts, and fewer perceived personality and behavior changes in the patient. Best predictors of depression score for the caregivers at Time 1 were subjective health rating, the patient's level of ADL functioning, degree of concern about ability to care for the patient in the future, the proportion of the network providing instrumental support, and the percent of reciprocal confiding relationships reported. At Time 2, best predictors of depression were level of perceived caregiver burden, objective health score, and network density. The best predictor of caregiver depression level over time was Time 1 depression level. Perceived caregiver burden was also a strong predictor of depression score. For the patients, higher depression scores at Time 1 were associated with whether they felt they could have done anything to prevent the stroke, higher levels of concern about their partner's ability to care for them in the future, and greater reported frequency of pre-stroke disagreement with their partners. At Time 2, higher levels of depressive symptomatology were associated with decreased satisfaction with amount of social contact, a greater proportion of friends in the post-stroke network, a greater degree of perceived negative health change, and change in employment status.
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Cotter, Paul Eoin. "Cardiac parameters in young patients with cryptogenic stroke." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.648802.

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Sit, Bik-yan Sonia. "Cognitive function in Chinese stroke patients /." View the Table of Contents & Abstract, 2005. http://sunzi.lib.hku.hk/hkuto/record/B31595923.

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Wan, Wai-kuen Christina, and 尹慧娟. "An exploratory design of an empowerment group for the strokesurvivors." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1996. http://hub.hku.hk/bib/B31978228.

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郭穎怡 and Wing-yee Eunice Kwok. "Early supported discharge program for stroke patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720883.

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Tsang, Sai-ling. "Community readjustment of discharged stroke patients : an exploratory study /." [Hong Kong : University of Hong Kong], 1985. http://sunzi.lib.hku.hk/hkuto/record.jsp?B12322490.

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Books on the topic "Cerebrovascular disease Patients Australia"

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Western Australia. Health Information Centre. Hospitalisation incidence for acute cerebrovascular disease in Western Australia, 1989 to 1998: Geographical variations. Perth: Department of Health, 2002.

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Patricia, Carlon. The whispering wall. New York: Soho Press, 1996.

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Senes, Susana. How we manage stroke in Australia. Canberra: Australian Institute of Health and Welfare, 2006.

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Williams, Olajide. Stroke diaries: A guide for survivors and their families. New York: Oxford University Press, 2010.

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Stroke diaries: A guide for survivors and their families. Oxford: Oxford University Press, 2010.

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Williams, Olajide. Stroke diaries: A guide for survivors and their families. New York: Oxford University Press, 2010.

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Mary, Hughes, and Shaffer Constance S, eds. Unprepared!: A husband's story of coping with his wife's stroke. Minneapolis, Minn: Deaconess Press, 1992.

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1950-, Fancher Candis, McDivitt Lindsey 1955-, and Fletcher Jacquelyn B. 1972-, eds. Climbing the mountain: Stories of hope and healing after stroke and brain injury. Minneapolis: Fairview Press, 2008.

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Boyle, Catherine A. Morbidity from cardiovascular disease in Australia. Canberra: The Institute, 1995.

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D, Mason Kristin, ed. Manual of stroke rehabilitation. Boston: Butterworth-Heinemann, 1996.

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Book chapters on the topic "Cerebrovascular disease Patients Australia"

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Moulignier, A. "Cerebrovascular Disease in HIV-Infected Patients." In Cardiovascular Disease in AIDS, 131–45. Milano: Springer Milan, 2009. http://dx.doi.org/10.1007/978-88-470-0761-1_10.

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Zimmerman, Robert D., Norman E. Leeds, and Mark J. Goldman. "Digital Subtraction Angiography in the Evaluation of Patients with Cerebrovascular Disease." In Cerebrovascular Surgery, 343–58. New York, NY: Springer New York, 1985. http://dx.doi.org/10.1007/978-1-4612-5032-6_2.

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Setacci, Carlo, Maria Agnese Mele, Giuseppe Galzerano, Giuseppe de Donato, Domenico Benevento, Massimiliano Walter Guerrieri, Francesco Setacci, and Bruno Amato. "Cerebrovascular Disease and Critical Limb Ischaemia." In Surgical Management of Elderly Patients, 257–70. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-60861-7_16.

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Tarabishy, Abdul R., Maurice M. Miller, and Ansaar T. Rai. "Counseling and Management of Patients with Intracranial Atherosclerosis Disease." In Management of Cerebrovascular Disorders, 445–57. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-319-99016-3_29.

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Hobbs, R. E., and A. J. Furlan. "Detection of Coronary Artery Disease in Patients with Cerebrovascular Disease." In Clinical Medicine and the Nervous System, 357–73. London: Springer London, 1987. http://dx.doi.org/10.1007/978-1-4471-3129-8_19.

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Piepgras, A., P. Schmiedek, G. Leinsinger, R. L. Haberl, C. M. Kirsch, and K. M. Einhäupl. "Follow-up Studies of Cerebrovascular Reserve Capacity in Patients with Cerebrovascular Disease." In Stimulated Cerebral Blood Flow, 263–67. Berlin, Heidelberg: Springer Berlin Heidelberg, 1992. http://dx.doi.org/10.1007/978-3-642-77102-6_29.

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van Niftrik, Christiaan Hendrik Bas, Martina Sebök, Giovanni Muscas, Aimée Hiller, Matthias Halter, Susanne Wegener, Luca Regli, and Jorn Fierstra. "Hemodynamic Evaluation of Paradoxical Blood Oxygenation Level-Dependent Cerebrovascular with Transcranial and MR Perfusion in Patients with Symptomatic Cerebrovascular Steno-occlusive Disease." In Cerebrovascular Reactivity, 89–101. New York, NY: Springer US, 2021. http://dx.doi.org/10.1007/978-1-0716-1763-2_6.

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Díez-Villanueva, Pablo, and Manuel Martínez-Sellés. "End-of-Life Care in Hospitalized Patients with Cardiovascular and Cerebrovascular Disease." In End-of-Life Care in Cardiovascular Disease, 51–69. London: Springer London, 2014. http://dx.doi.org/10.1007/978-1-4471-6521-7_4.

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Savino, Peter J. "Risk of Cerebrovascular Disease in Patients with Anterior Ischemic Optic Neuropathy." In Amaurosis Fugax, 114–17. New York, NY: Springer New York, 1988. http://dx.doi.org/10.1007/978-1-4612-3776-1_9.

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Brenner, M., R. Berberich, A. Haass, G. Huber, and H. Jäger. "Tc-99m-Labeled Autologous Platelets as Screening in Patients with Cerebrovascular Disease." In Clinical Application of Radiolabelled Platelets, 210–13. Dordrecht: Springer Netherlands, 1990. http://dx.doi.org/10.1007/978-94-009-0581-8_18.

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Conference papers on the topic "Cerebrovascular disease Patients Australia"

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Maltri, Rebecca, Fernanda Peronti Marino, Jorge Ygor Gonçalves dos Santos, Nathalia Polliana Rodrigues Melgaço, Vitória Aparecida Cunha, Paola Falcão Moreira Nogueira, Rafaela Charles Correia, and Tiago Silva Carvalho. "Brain stroke in patients with Covid-19 disease." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.625.

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Background: Currently, the world is facing a pandemic caused by the SARSCoV-2, which has already infected millions of people and has accumulated countless deaths. Association has been reported between severe conditions of this disease and the occurrence of neurological manifestations, including stroke. The mechanisms that trigger this cerebrovascular disease in infected people are not defined yet, but it’s believed that they involve inflammatory reaction, vascular endothelial dysfunction and hypercoagulopathy present in SARS-CoV-2 infection. Objectives: Verify the studies which relate the cerebrovascular disorders caused by the infection of SARS-CoV-2, in order to elucidate its performance and determine the patient’s management as a way to avoid outcomes such as stroke and other neurological conditions losses. Methods: The subject is approached through a narrative review of the literature without meta-analysis. A bibliographic survey was made out, from December 2019 to June 2020, in digital databases. Results: The relation between ischemic and hemorrhagic strokes with coronavirus infection shows a possible mechanism of action of the virus related to ACE2, damaging tissues, including the brain. In addition, a huge relation has been identified between coagulopathy induced by the infectious condition and the occurrence of stroke, since the intense inflammatory storm produced raises the risks of occurrence of cerebrovascular events. Conclusions: The activity of this coronavirus against ACE2 has been shown to increase the secretion of pro-inflammatory substances, causing brain damage. Although this is a new disease, it’s possible to establish the stroke as a complication of COVID-19. It should be considered, especially in critically ill patients, and promptly assisted.
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Gramasco, Hendrick Henrique Fernandes, Mateus Felipe dos Santos, Yasmim Nadime José Frigo, Guilherme Drumond Jardini Anastácio, Stella de Angelis Trivellato, Daniel Fabiano Barbosa dos Santos, Ana Cláudia Pires Carvalho, et al. "Diverse clinical presentations of Moyamoya disease: a case series." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.530.

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Context: Moyamoya disease or chronic occlusive cerebrovascular disease is characterized by proximal occlusion of the internal carotid artery and its branches bilaterally, generating an angiographic “smoke” pattern (moyamoya, from Japanese “something hazy”) and by diverse ischemic manifestations. Case report: The sample consists of three female patients, aged between 13 and 46 years, followed in our service due to the diagnosis of Moyamoya Disease. Among the clinical manifestations presented, ischemic cerebrovascular events with neurological deficit predominated, and one of the patients presented two episodes compatible with stroke and one episode compatible with transient ischemic accident. The youngest patient presented with a choreic picture initially interpreted as Sydenham’s chorea. Although the gold standard for the diagnosis of chronic occlusive cerebrovascular disease is cerebral arterial angiography, it was possible to observe a pattern compatible with the disease in other modalities of examination, such as cerebral arterial angiotomography and cerebral arterial angioresonance. From the therapeutic point of view, one of the patients underwent surgical intervention (encephaloduromyosinangiosis), with improvement of symptoms after treatment. Conclusions: In this paper, we emphasize the importance of complementary imaging tests in the evaluation of patients with cerebrovascular syndromes and the diversity of clinical presentation of Moyamoya disease.
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Díaz-Villamarín, X., CL Dávila-Fajardo, D. Blánquez-Martínez, E. Fernández-Gómez, A. Antúnez-Rodríguez, and ÁS Raquel. "5PSQ-009 CYP2C19 SNP’sinfluence on clopidogrel response in cerebrovascular disease patients: final results." In 24th EAHP Congress, 27th–29th March 2019, Barcelona, Spain. British Medical Journal Publishing Group, 2019. http://dx.doi.org/10.1136/ejhpharm-2019-eahpconf.442.

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Martins, Karine Felipe, Flávia Pascoal Teles, Amanda Fernandes de Sousa Oliveira Balestra, and Isadora Rosa Maia. "Cerebrovascular diseases: the importance of recognizing them." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.188.

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Background: Until the 70s, cerebrovascular diseases (CVDs) were neglected to the lack of resources. However, due to the advancement of technology, several imaging tests have appeared, such as magnetic resonance and computed tomography, which facilitated the diagnosis and the understanding of the pathophysiology of each disease. Objectives: The objective of this work is to identify the main CVDs signs and symptoms. Methods: An integrative literature review was carried out based on selected articles from Google Scholar, PubMed and SciELO, using the terms headache, cerebrovascular disease, neurology. Results: CVDs are characterized by causing damage to brain vessels, due to changes in blood flow momentarily or permanently in an area of the brain, allowing them to be classified as ischemic or hemorrhagic. In ischemic there is a blockage of blood flow and, consequently, of oxygen to areas of the brain, in hemorrhagic rupture of a vessel occurs and, with this, blood leakage. Therefore, it is necessary to recognize the signs and symptoms early, in order to prevent loss of neurological function, movements on one side of the body and the presence or absence of headaches in both patients, with ischemic CVD and hemorrhagic CVD prevent rapid loss of consciousness accompanied by severe headache. Such signs and symptoms associated with the patient’s family history and lifestyle can help in the diagnosis of this disease. Conclusion: Therefore, it is important to recognize the signs and symptoms of CVDs, in order to determine the treatment and advise the patient, which will guarantee a better prognosis.
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Oliveira, Francisco Gabriel Cabral, Juliana Paiva Ribeiro Moura, Matheus Henrique Oliveira, and Mylena Teles de Jesus. "The relation between COVID-19 and cerebrovascular diseases." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.740.

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Introduction: Covid-19 is characterized by respiratory syndrome and has symptoms that affect the central nervous system such as headache, anosmia, hypercoagulability, etc. In this sense, it is known that the virus shows tropism by the receptors of the angiotensin-converting enzyme 2 (ACE2), becoming a gateway to the neurological system, which can cause complications. Is to relate the infection by COVID-19 and the increase in cerebrovascular diseases. Methods: A literature review was carried out using search for scientific articles in PubMed, in April / 2021, with a filter in the last 5 years, using the descriptors “Covid”, “Cerebrovascular Diseases” and “Man” associated with the Boolean operator AND. Results: 53 articles were found, of which 19 were selected for research. There is a higher frequency of neurological symptoms in patients with COVID-19 than in patients without the disease. The effect of binding the virus to ACE2 receptors is to activate a cascade of cytokines, which tends to lead to serious complications. For this reason, severe coagulopathies can be caused, increasing products of the degradation of C-reactive protein, D Dimer, fibrinogen and thrombocytopenia. The increase in cerebrovascular events also occurs because the antithrombotic, neuroprotective, antihypertensive effects, among others, of the alternative renin-angiotensin system in the brain are interrupted due to COVID-19. Conclusion: It was seen that cerebrovascular events are related to the course of COVID-19, in which patients may develop several serious complications, such as encephalitis, strokes and vascular thrombosis. Thus, the pathophysiology of this disease is related to an inflammatory process.
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Maia, Jade Menezes, and Karine Gomes Bandeira Desteffani. "Main neurological changes in patients infected with Covid- 19: literature review." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.067.

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Background: The world is experiencing a pandemic caused by COVID-19, which has already led to the death of 3.5 million individuals. In this context, the scientific community has made several discoveries, above all, that COVID-19 can promote other disorders, in addition to respiratory, such as the impairment of the nervous system. Objectives: To analyze the main neurological changes resulting from the infection by COVID-19. Design and setting: Cross-sectional observational study. Methods: Literature review with articles published in 2020, in journals indexed in the PubMed and Scielo databases, using the descriptors “Neurologic Manifestations” AND “covid-19, including articles in Portuguese and English. Results: Neurological symptoms have become increasingly recurrent in patients with COVID-19. SARS-CoV-2 reaches the Central Nervous System (CNS) through hematogenous or retrograde neuronal dissemination. Peripheral neuropathies and cerebrovascular events are associated with the severity of the disease. The elevation of D-dimer in critically ill patients triggers cerebrovasculares events, especially the development of ischemic stroke (stroke), which becomes more evident due to its risk factors. Changes in mental status are not limited to severe cases, and can occur at any stage of the disease, especially neuropsychiatric syndromes, such as anxiety, depression and post- traumatic stress. Conclusion: COVID-19, in an advanced stage, promotes peripheral neuropathies and cerebrovascular events. Furthermore, regardless of the severity stage, it can lead to changes in mental status.
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Fadron, Felani Dio, Stefanus Andang Ides, and Fitriana Suprapti. "Factors Related to Anxiety Level in Family Members of Patients With Cerebrovascular Disease at Siloam General Hospital, Karawaci 2020." In International Conference of Health Development. Covid-19 and the Role of Healthcare Workers in the Industrial Era (ICHD 2020). Paris, France: Atlantis Press, 2020. http://dx.doi.org/10.2991/ahsr.k.201125.013.

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Syrova, Irina, Olga Trubnikova, Irina Tarasova, Anastasia Sosnina, Olga Maleva, Igor Lozhkin, and Olga Barbarash. "LONG-TERM CEREBROVASCULAR OUTCOMES IN PATIENTS WITH CORONARY ARTERY DISEASE WHO UNDERWENT CORONARY BYPASS SURGERY (FIVE-YEAR FOLLOW-UP)." In XVIII INTERNATIONAL INTERDISCIPLINARY CONGRESS NEUROSCIENCE FOR MEDICINE AND PSYCHOLOGY. LCC MAKS Press, 2022. http://dx.doi.org/10.29003/m2950.sudak.ns2022-18/335-336.

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Sabih, Abdul-Hamid, Lynn Lim, Maria Cigolini, Simone I. Strasser, and Ken Liu. "IDDF2020-ABS-0176 Clinician experience and attitudes to palliative care in patients with HCC – an Australia-wide survey." In Abstracts of the International Digestive Disease Forum (IDDF), 22–23 November 2020, Hong Kong. BMJ Publishing Group Ltd and British Society of Gastroenterology, 2020. http://dx.doi.org/10.1136/gutjnl-2020-iddf.162.

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Castro, Kaline dos Santos Kishishita, Amanda Alves Cardoso da Silva, Ana Clara Mota Gonçalo, Camila Ângelo Vidal de Figueiredo, Lorena Menegussi Machado, Mariana Soares, and Mylena Andréa Oliveira Torres. "SARS-CoV-2 and neurology: characteristics of patients with Covid-19 affected by CVA." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.085.

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Introduction: Since the beginning of the pandemic in December 2019, COVID-19 caused by the infection of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), in addition to the clinical manifestations already, can develop changes in the rate of blood clotting, where there are already notifications of Cerebrovascular Accident (CVA) associated with the virus. Objective: To know the characteristics of patients with COVID-19 affected by CVA, documented in the scientific literature. Method: A systematic literature review was carried out, using the MeSH Brower platform descriptors, namely: Stroke and Coronavirus, with an AND expression. The articles were searched in scientific databases: PubMed, MEDLINE Complete and SCIELO. 217 studies were found, of which 04 publications were included in this research. Results: Parallel studies on patient characteristics: elderly, male and comorbidities, such as hypertension, diabetes, heart disease and obesity, all risk factors for stroke. However, there were cases of young patients affected by CVA after the diagnosis of COVID-19. With regard to neurological changes, the researched articles state that most patients have symptoms such as deviation of the labial commissure on the right, dysarthria, aphasia, hemiplegia and hemianesthesia on the left. Conclusion: Although this incidence is not known, CVA is emerging as a complication of the COVID-19 pandemic. In this sense, further studies on the subject are necessary, since the elucidation of thrombotic mechanisms in patients with COVID- 19 can generate complications to prevent complications such as Cerebrovascular Accident.
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Reports on the topic "Cerebrovascular disease Patients Australia"

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Roldán-González, Elizabeth, Carolina Robledo-Castro, Piedad Rocío Lerma-Castaño, and María Luisa Hurtado-Otero. Validity and reliability of the Wolf Motor Function Test -WMFT in patients with Cerebrovascular disease: Scoping review. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, October 2022. http://dx.doi.org/10.37766/inplasy2022.10.0044.

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Review question / Objective: This scoping review aimed to compile the studies that have examined the validity and reliability of the different versions of the Wolf Motor Function Test - WMFT in patients with Cerebrovascular disease. Background: Numerous investigations in rehabilitation have used the WMFT as an instrument for the primary measurement of the results; however, to date, there are no known reviews that have compiled the reliability and validity of the wolf test in its different versions, which is considered of vital importance and constitutes critical information for decision making in the process of evaluation and follow-up of patients with stroke in clinical, academic and research environments.
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Hu, XinYi, JingXuan Hao, and HangYue Wang. Improvement of Environmental enrichment on Cognitive Functions in Patients and animals : A systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, December 2022. http://dx.doi.org/10.37766/inplasy2022.12.0014.

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Review question / Objective: To study the relationship between environmental enrichment and cognitive function through a meta-analysis of the literature, analyze its effects on the improvement of cognitive function in patients and animals, and evaluate the effects of different environmental enrichment measures on cognitive function improvement. Condition being studied: Cognitive decline refers to an individual's memory, language, reasoning and other aspects of cognitive function showing obvious, measurable decline or abnormal. The causes of cognitive decline are various, including neurodegeneration, cerebrovascular disease, infection, trauma, and depression. Alzheimer's disease and stroke are the most common.
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LI, Peng, and Junjun Liu. Effect of statin therapy on moderate-to-severe depression: an updated systematic review and meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, March 2022. http://dx.doi.org/10.37766/inplasy2022.3.0016.

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Review question / Objective: We aim to assess the antidepressant effects of statin therapy among patients complicated with moderate to severe depression. Condition being studied: Depression is one of the major causes of disability worldwide, and major depressive disorders (MDD) contribute to a significant heavy disease burden, which is expected to be second by 2050, only to heart disease. Despite great improvement in therapy, the treatment efficacy remains low. Therefore, alternative therapies have been intensely investigated. A substantial body of researches have suggested that inflammation is one of the operative pathways between MDD and increased risk of somatic comorbidities, and some specific depressive symptoms. Depression occurs in most patients with cardiac and cerebrovascular disease due to the long-term effects, and depression increases the risk of cardiovascular disease in the population as a whole and in patients with coronary artery disease or stroke. Several observational studies have demonstrated reduced rates of depression among patients taking statins, which may be related to its anti-inflammatory effect. However, whether statin improves the depressive symptoms and its associated mechanism is still mixed. Furthermore, there is little evidence about statin treatment effect in those with moderate to severe depression. In addition, whether the effect of statin treatment on depressive symptom changes with time or is affected by baseline depression severity or percentage change of lipid levels has not been explored in previous studies.
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.

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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.
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