Discontinuation of secondary preventive treatment of stroke: An unexplored scenario in India

Das, Krishnapada; Ghosh, Mrinalkanti; Khanna, Bidisha; Banerjee, Mausumi; Mondal, Gobinda; Singh, Om Prakash; Chakraborty, Arindam

doi:10.1016/j.clineuro.2010.06.007

Cited by 9 publications

(4 citation statements)

References 14 publications

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“…Therapy with a statin should be considered for all patients with history of TIA or ischemic stroke. 8 Tertiary prevention involves effective evidence based management of stroke based on guidelines, which includes early hematoma evacuation and decompressive craniectomy for stroke. 24 Decompressive craniectomy for malignant middle cerebral artery territory infarction if done within 48 hours of stroke is associated with a reduction in death or dependency from 76.5% (conservative) to 60.2% (surgery) (absolute risk reduction [ARR], 16.3%; 95% confi dence interval, −0.1 -33.1%).…”

Section: Mortality Could Be Decreased By Early Surgical Interventionmentioning

confidence: 99%

Changing Epidemiology of Stroke in Nepalese Population

Thapa

Shakya

et al. 2018

Nep J Neurosci

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Corrigendum:The article published in Nepal Journal of Neurosciences 2018;15:10-18 by Amit Thapa et al was mistakenlypublished with wrong affi liation of some of the co-authors. The correct affi liation of the co-authors should read asBikram Shakya, MBBS, MS, MChLecturerDepartment of Neurological SurgeryKathmandu Medical College Teaching Hospital (KMCTH)Sinamangal, Kathmandu, NepalDipesh Kumar Yadav, MBBSMedical OfficerDepartment of Neurological SurgeryKathmandu Medical College Teaching Hospital (KMCTH)Sinamangal, Kathmandu, NepalKarjome Lama, MBBSMedical OfficerDepartment of Neurological SurgeryKathmandu Medical College Teaching Hospital (KMCTH)Sinamangal, Kathmandu, Nepal Abstract: We are witnessing changing patterns in stroke in our practice. Documenting changes in epidemiological profile are important for public health policy. We hereby present analysis of patients with stroke to stress upon the dynamics and update the improvement in their care. We retrospectively studied all patients with first time stroke presenting in Kathmandu Medical College Teaching Hospital during June 2012 till November 2015. Diagnosis was made on clinico-radiological basis with prospective follow up for at least 1 year from the event. Risk factors as well outcome in terms of Glasgow outcome score were studied. Statistical analysis was performed on SPSS. A total of 1017 patients of 16260 patients admitted to the hospital during the study period had first time stroke, a hospital based annual incidence of stroke of 64 per thousand admissions was hence calculated. Mean age was 55 years with 60.5% males. 503 patients (49.5%) had infarction with 20 patients having hemorrhagic conversion while 3 had TIA. 50.2% had hemorrhagic stroke. 56.7% females had ischemic stroke whereas 54.9% of males had hemorrhagic stroke (p=0.002). Common risk factors like HTN (54.7%), Smoking (41.5%), Alcohol (39.2%), dyslipidemia (34.1%) and DM (4.8%) were seen with stroke however, active smoker were more at risk of hemorrhagic stroke (p=0.000) while diabetic patients for ischemic stroke (p=0.000). Due to availability of neurosurgical services, 14.6% patient could undergo procedures like decompressive craniectomy, hematoma evacuation, CSF diversion procedures and carotid endarterectomy for stroke. 66.9% patients required surgical intervention within 48 hours of admission. We had 30 days mortality of 0.5% mortality in this series (majority in hemorrhagic stroke), however over 3 years duration of study mortality rose to 8.3% (majority in ischemic stroke). Almost 88.5% patients achieved mRS< Nepal Journal of Neuroscience, Volume 15, Number 1, 2018 11 2 over a period of 3 years. Persistent vegetative state was seen in 7.6% cases after 1 year. We observe a very high incidence of hemorrhagic stroke in general with higher than reported proportion of females being involved with ischemic stroke in our series. Most of the vegetative state conditions occurred in ischemic stroke patients however early mortality was common in hemorrhagic stroke. This change in pattern of stroke as well as need of surgical intervention mandates early involvement of neurosurgical services. Poor long term prognosis in ischemic stroke may be reversed by timely thrombolytic services and prevented by mitigating risk factors. Nepal Journal of Neuroscience 15:10-18, 2018

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Section: Mortality Could Be Decreased By Early Surgical Interventionmentioning

confidence: 99%

Changing Epidemiology of Stroke in Nepalese Population

Thapa

Shakya

et al. 2018

Nep J Neurosci

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“…Discontinuation of secondary preventive treatment due to a variety of socio demographic variables leads to increased recurrence and disabilities among stroke patients (Das et al, 2010). The evaluation of the process of the SPRINT India study will help to explain that when a novel approach to spread secondary stroke awareness is practiced for a large sample group, do all the cogs in the machinery of implementation, work as planned according to the protocol.…”

Section: Discussionmentioning

confidence: 99%

Protocol of Process Evaluation of Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA)Trial

Verma

Gulati

Khatter

et al. 2022

International Journal of Qualitative Methods

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Background and aims Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT India) is a complex intervention delivered across 30 centres in 16 Indian states. The study delivers intervention in 12 languages in the form of workbook, videos and short messaging using cellular device and internet as a tool. Objectives of process evaluation are to assess whether trial was implemented as planned (fidelity and dose); whether, how and why the intervention is effective by looking at the stakeholders’ experiences (effectiveness); to assess reach of intervention in population (reach); how intervention fits into treatment plan to cause behavioural change when adopted (adoption); usefulness for target population and bring behaviour change (maintenance). Methods SPRINT India process evaluation is a prospective, multicentre study conducted with mixed-methods approach. Sample size of centres and stakeholders will be selected by maximum variance purposive sampling strategy. Centres will be stratified primarily for representing the 11 regional language in which the intervention is delivered. Qualitative data will comprise of interviews of patients, care givers and health professionals at these centres using semi structured interview guide. Quantitative data will comprise of all the randomised patients. Process evaluation framework is based on Realist and RE-AIM evaluation models presented according to Medical Research Council’s guidance. The four sections of the framework are context, trial implementation, mechanisms of impact and trial outcomes. Results Interviews of approximately 100 stakeholders and focus group interviews of health professionals and SPRINT India study central coordinating staff will be conducted. Analysis will be done using triangulation methodology. It will incorporate use of both quantitative and qualitative data, data collection techniques, data sources, evaluation models, stakeholders and researchers. Conclusions Process evaluation will identify efficacious factors in intervention package and consolidate use of secondary stroke semi-interactive stroke prevention package into practice and policy to prevent recurrent stroke.

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“…The tendency to cutting back on costs of treatment realized by the poorest patients may be observed worldwide [21,22,23,24]. even in such industrialized countries as the USA [25].…”

Section: Discussionmentioning

confidence: 99%

Realities of ambulatory multi-drug treatment of chronic diseases in rural areas of Lublin Province, eastern Poland – comparison of situations in 2010 and 2013

Kołłątaj

Karwat

Kołłątaj

et al. 2015

Ann Agric Environ Med.

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Introduction. The economic stratification observed for many years among the population in Poland, increasing poverty rates, especially those being effects of the current economic crisis in the country, and the rising prices of medicines, are potential risk factors for medication non-adherence among patients in the poorest class of the Polish population. Materials an method. The subjects were 2 groups of inhabitants of rural areas of Lublin Province in eastern Poland. The first consisted of 209 people aged 52-80 years who were surveyed in 2010, the second-210 people aged 51-88 years, surveyed in 2013. All patients were outpatients who attended the Endocrine Clinic in Poniatowa. The studies were conducted with the use of the standardized survey questionnaire. Results. The problem of medication non-adherence among the surveyed was evident and has risen from 43.1% in 2010 to 54.8% in 2013. Both in 2010 and in 2013, the main reasons for this state of affairs were the financial problems of the surveyed people. During the period 2010-2013, both expenditure on medicine as well as the ratio "patients' expenditure on medicine/ expenditure on food" had increased. In 2010, 25 respondents per 209 (12%) expressed the opinion that they had always had sufficient means to buy necessary medications, in 2013-only 3 per 210 (1.5%). Conclusions. In 2013, most of surveyed patients (54.8%) did not follow prescribed treatment plans (in 2010-43.1%). In most cases, medication non-adherence were the result of financial problems. Current regulations governing refunding of the costs of medicines may make effective ambulatory treatment of chronic diseases impossible.

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Discontinuation of secondary preventive treatment of stroke: An unexplored scenario in India

Cited by 9 publications

References 14 publications

Changing Epidemiology of Stroke in Nepalese Population

Changing Epidemiology of Stroke in Nepalese Population

Protocol of Process Evaluation of Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA)Trial

Realities of ambulatory multi-drug treatment of chronic diseases in rural areas of Lublin Province, eastern Poland – comparison of situations in 2010 and 2013

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