14 results on '"Raj Bathula"'
Search Results
2. Correction: Intensive Care Weaning (iCareWean) protocol on weaning from mechanical ventilation: a single-blinded multicentre randomised control trial comparing an open-loop decision support system and routine care, in the general intensive care unit
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Lucio D'Anna, Ambreen Sheikh, Raj Bathula, Salwa Elmamoun, Adelaide Oppong, Ravneeta Singh, Rebecca Redwood, John Janssen, Soma Banerjee, and Evangelos Vasileiadis
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Medicine - Published
- 2020
- Full Text
- View/download PDF
3. Decreasing referrals to transient ischaemic attack clinics during the COVID-19 outbreak: results from a multicentre cross-sectional survey
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Lucio D'Anna, Ambreen Sheikh, Raj Bathula, Salwa Elmamoun, Adelaide Oppong, Ravneeta Singh, Rebecca Redwood, John Janssen, Soma Banerjee, and Evangelos Vasileiadis
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Medicine - Abstract
Objective The COVID-19 pandemic is having major implications for stroke care with a documented significant fall in hospital acute stroke admissions. We investigated whether COVID-19 has resulted in a decreased number of referrals to the transient ischaemic attack (TIA) clinics across the North West London region.Setting and design All the TIA clinical leads of the North West London region received an invitation by email to participate in an online survey in May 2020. The survey questionnaire aimed to assess the number of patients with suspected TIA consecutively referred to each of the TIA clinics of the North West London region between 1 March and 30 April 2020, the COVID-19 period, and between 1 March and 30 April 2019.Results We had a response rate of 100%. During the COVID-19 period, the TIA clinics of the North West London region received 440 referrals compared with 616 referrals received between 1 March and 30 April 2019 with a fall in the number of the referrals by 28.6%. In April 2020 compared with April 2019, the number of the referrals declined by 40.1%.Conclusions This multicentre analysis documented a significant reduction in the number of patients referred with suspected TIA to the specialised rapid access outpatient clinics in the North West London region during the COVID-19 pandemic. Future studies are needed to confirm our findings and to better characterise the incidence of cerebrovascular disease during the COVID-19 pandemic.
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- 2020
- Full Text
- View/download PDF
4. Microcirculatory rarefaction in South Asians - a potential mechanism for increased cardiovascular risk and diabetes.
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Alun D Hughes, Raj Bathula, Chloe Park, Therese Tillin, Nicholas Wit, Simon McG Thom, and Nish Chaturvedi
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Medicine ,Science - Abstract
People of South Asian descent have an increased risk of cardiovascular disease (CVD) and diabetes, but little is known about the microcirculation in South Asian people despite evidence that this plays an important role in the aetiology of CVD. We compared the retinal microcirculation in a population-based sample of 287 middle-aged adults (144 European 143 South Asian) matched for age and sex. Retinal photographs were taken and analysed using a validated semi-automated program and microvascular measures were compared. Blood pressure, anthropometry and fasting bloods were also measured. South Asians had significantly fewer arteriolar and venular vessels and bifurcations. Arterioles and venules were longer and venules were also more tortuous in South Asians. These differences were not explained by adjustment for traditional risk factors including blood pressure, body mass index, diabetes or measures of insulin resistance. People of South Asian descent have rarefaction of the retinal microcirculation compared to age-sex matched individuals of European descent. Reduced microvascular density could contribute to the elevated risk of CVD and impaired glucose tolerance in South Asian people.
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- 2013
- Full Text
- View/download PDF
5. Stroke admissions: are we being paid enough? A cross-sectional study
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Amedra Basgaran, Knara Harut, Aravinth Sivagnanaratnam, and Raj Bathula
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Objectives: To investigate whether discharge summaries are accurately coding clinical details of patient admissions and to identify whether such differences lead to a loss of financial income for acute trusts. Design: A cross-sectional study of medical records, discharge summaries and financial outcomes. Participants: A review was conducted of two weeks of discharge summaries and patient notes from the stroke unit, totaling 95 patient episodes. Results: The total number of medical details not coded in discharge summaries was 580, resulting in a loss of income of £17,488.38. Extrapolated over the year, this could have led to a missed income of £454,000 for the stroke department. Sub-group analysis identified that 24% of un-coded details were extra primary diagnoses, 45% secondary diagnoses, 14% social factors, 3% investigations performed, and 14% were specialty team reviews. Conclusions: The impact of the quality of discharge summaries has proven to be huge. A major contributor is unawareness of the correct terminology by both clinical and coding teams. Specific measures to introduce standard diagnoses and coding practices to minimise variability will lead to clearer coding and allow for the trust to be accurately paid for the care performed.
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- 2022
6. Can Interventional Cardiologists Help Deliver the UK Mechanical Thrombectomy Interventional Programme for Patients with Acute Ischaemic Stroke? A Discussion Paper from the British Cardiovascular Interventional Society Stroke Thrombectomy Focus Group
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Helen, Routledge, Andrew Sp, Sharp, Jan, Kovac, Mark, Westwood, Thomas R, Keeble, Raj, Bathula, Hany, Eteiba, Iris Q, Grunwald, and Nick, Curzen
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Cardiology and Cardiovascular Medicine - Abstract
There is a willingness among UK interventional cardiologists to contribute to provision of a 24/7 mechanical thrombectomy (MT) service for all suitable stroke patients if given the appropriate training. This highly effective intervention remains unavailable to the majority of patients who might benefit, partly because there is a limited number of trained specialists. As demonstrated in other countries, interdisciplinary working can be the solution and an opportunity to achieve this is outlined in this article.
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- 2021
7. Effects of oral anticoagulation for atrial fibrillation after spontaneous intracranial haemorrhage: a randomised, open-label, assessor-blinded, pilot phase, non-inferiority trial
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Rustam Al-Shahi Salman, Catriona Keerie, Jacqueline Stephen, Steff Lewis, John Norrie, Martin S. Dennis, David E. Newby, Joanna M. Wardlaw, Gregory Y.H. Lip, Adrian Parry-Jones, Philip M. White, Colin Baigent, Dan Lasserson, Colin Oliver, Fiach O'Mahony, Shannon Amoils, John Bamford, Jane Armitage, Jonathan Emberson, Gabriël J.R. Rinkel, Gordon Lowe, Karen Innes, Kasia Adamczuk, Lynn Dinsmore, Jonathan Drever, Garry Milne, Allan Walker, Aidan Hutchison, Carol Williams, Ruth Fraser, Rosemary Anderson, Kate Covil, Kelly Stewart, Jessica Rees, Peter Hall, Alistair Bullen, Andrew Stoddart, Tom J. Moullaali, Jeb Palmer, Eleni Sakka, Joanne Perthen, Nicola Lyttle, Neshika Samarasekera, Allan MacRaild, Seona Burgess, Jessica Teasdale, Michelle Coakley, Pat Taylor, Gordon Blair, William Whiteley, Susan Shenkin, Una Clancy, Malcolm Macleod, Rachel Sutherland, Tom Moullaali, Amanda Barugh, Christine Lerpiniere, Fiona Moreton, Nicholas Fethers, Tal Anjum, Manju Krishnan, Peter Slade, Sharon Storton, Marie Williams, Caroline Davies, Lynda Connor, Glyn Gainard, Carl Murphy, Mark Barber, Derek Esson, James Choulerton, Louise Shaw, Suzanne Lucas, Sarah Hierons, Joanne Avis, Andrew Stone, Lukuman Gbadamoshi, Telma Costa, Lauren Pearce, Kirsty Harkness, Emma Richards, Jo Howe, Christine Kamara, Ralf Lindert, Ali Ali, Jahanzeb Rehan, Sarah Chapman, Maria Edwards, Raj Bathula, David Cohen, Joseph Devine, Mushiya Mpelembue, Priya Yesupatham, Swati Chhabra, Gbadebo Adewetan, Robert Ballantine, Daniel Brooks, Gemma Smith, Gill Rogers, Stuart Marsden, Sarah Clark, Ami Wilkinson, Ellen Brown, Lynsey Stephenson, Khin Nyo, Annie Abraham, Yogish Pai, Gek Shim, Vidya Baliga, Anand Nair, Matthew Robinson, Catherine Hawksworth, Jill Greig, Irfan Alam, Tonicha Nortcliffe, Ridha Ramiz, Ryan Shaw, Stephanie Lee, Tracy Marsden, Jane Perez, Emily Birleson, Rajendra Yadava, Mirriam Sangombe, Sam Stafford, Tom Hughes, Lucy Knibbs, Bethan Morse, Stefan Schwarz, Benjamin Jelley, Susan White, Bella Richard, Heidi Lawson, Sally Moseley, Michelle Tayler, Mandy Edwards, Claire Triscott, Rebecca Wallace, Angela Hall, Amanda Dell, Khalid Rashed, Sarah Board, Clare Buckley, Alfonso Tanate, Tressy Pitt-Kerby, Kate Beesley, Jess Perry, Christine Hellyer, Paul Guyler, Nisha Menon, Sharon Tysoe, Raji Prabakaran, Martin Cooper, Anoja Rajapakse, Inez Wynter, Susan Smith, Nic Weir, Cherish Boxall, Hannah Yates, Simon Smith, Pamela Crawford, James Marigold, Fiona Smith, Jake Harvey, Sue Evans, Laura Baldwin, Sarah Hammond, Paul Mudd, Angela Bowring, Samantha Keenan, Kevin Thorpe, Mohammad Haque, Joanne Taaffe, Natalie Temple, Tracey Peachey, Kim Wells, Fiona Haines, Nicola Butterworth-Cowin, Zoey Horne, Radim Licenik, Hayley Boughton, Timothy England, Amanda Hedstrom, Brian Menezes, Ruth Davies, Venetia Johnson, Simon Whittingham-Jones, David Werring, Sabaa Obarey, Caroline Watchurst, Amy Ashton, Shez Feerick, Nina Francia, Azra Banaras, Daniel Epstein, Marilena Marinescu, Annick Williams, Anna Robinson, Fiona Humphries, Ijaz Anwar, Arunkumar Annamalai, Susan Crawford, Vicky Collins, Lorna Shepherd, Elaine Siddle, Justin Penge, Sam Qureshi, Vinodh Krishnamurthy, Vasileios Papavasileiou, Dean Waugh, Emelda Veraque, Nathan Douglas, Numan Khan, Sankaranarayanan Ramachandran, Peter Sommerville, Anthony Rudd, Sagal Kullane, Ajay Bhalla, Jonathan Birns, Rowshanara Ahmed, Meegan Gibbons, Eva Klamerus, Benjie Cendreda, Keith Muir, Nicola Day, Angela Welch, Wilma Smith, Jennifer Elliot, Salwa Eltawil, Ammad Mahmood, Kim Hatherley, Shirley Mitchell, Harjit Bains, Lauren Quinn, Rachel Teal, Ivie Gbinigie, George Harston, Phil Mathieson, Gary Ford, Ursula Schulz, James Kennedy, Kirubananthan Nagaratnam, Kiran Bangalore, Neelima Bhupathiraju, Chris Wharton, Ken Fotherby, Ahmad Nasar, Angie Stevens, Angela Willberry, Rachel Evans, Baljinder Rai, Chloe Blake, Kamy Thavanesan, Gail Hann, Tanith Changuion, Sara Nix, Amanda Whiting, Michelle Dharmasiri, Louise Mallon, Marketa Keltos, Nigel Smyth, Charlotte Eglinton, John Duffy, Ela Tone, Lucy Sykes, Emily Porter, Carolyn Fitton, Nikolaos Kirkineziadis, Gillian Cluckie, Kate Kennedy, Sarah Trippier, Rebecca Williams, Elizabeth Hayter, James Rackie, Bhavini Patel, Ghatala Rita, Adrian Blight, Val Jones, Liqun Zhang, Lillian Choy, Anthony Pereira, Brian Clarke, Samer Al-Hussayni, Lynn Dixon, Andrew Young, Adrian Bergin, David Broughton, Senthil Raghunathan, Benjamin Jackson, Jason Appleton, Gwendoline Wilkes, Amanda Buck, Carla Richardson, Judith Clarke, Lucy Fleming, Gemma Squires, Zhe Law, Camille Hutchinson, Vera Cvoro, Mandy Couser, Amanda McGregor, Sean McAuley, Susan Pound, Patricia Cochrane, Clare Holmes, Peter Murphy, Nicola Devitt, Mairead Osborn, Amy Steele, Lucy Belle Guthrie, Elizabeth Smith, Jonathan Hewitt, Natalie Chaston, Min Myint, Andrew Smith, Louise Fairlie, Michelle Davis, Beth Atkinson, Stephen Woodward, Valerie Hogg, Michelle Fawcett, Louise Finlay, Anand Dixit, Eleanor Cameron, Breffni Keegan, Jim Kelly, Dónal Concannon, Dipankar Dutta, Deborah Ward, Jon Glass, Susan O'Connell, Joseph Ngeh, Alison O'Kelly, Emma Williams, Suzanne Ragab, Damian Jenkinson, Judith Dube, Laura Gleave, Jacqui Leggett, Nisha Kissoon, Louise Southern, Utpal Naghotra, Maria Bokhari, Beverley McClelland, Katja Adie, Abhijit Mate, Frances Harrington, Ali James, Elizabeth Swanson, Terri Chant, Miriam Naccache, Abbie Coutts, Gillian Courtauld, Sarah Whurr, Sue Webber, Emily Shead, Robert Luder, Maneesh Bhargava, Elodie Murali, Larissa Cuenoud, Kath Pasco, O Speirs, Lianne Chapman, Linda Inskip, Lisa Kavanagh, Meena Srinivasan, Nichola Motherwell, Indranil Mukherjee, Louise Tonks, Denise Donaldson, Heather Button, Rebecca Wilcox, Fran Hurford, Rachel Logan, Andy Taylor, Tracie Arden, Michael Carpenter, Prabal Datta, Tajammal Zahoor, Linda Jackson, Ann Needle, Andrew Stanners, Imran Ghouri, Donna Exley, Salman Akhtar, Hollie Brooke, Shannen Beadle, Eoin O'Brien, Jobbin Francis, Joanne McGee, Elaine Amis, Jennifer Mitchell, Sarah Finlay, Devesh Sinha, Csilla Manoczki, Sam King, James Tarka, Sumita Choudhary, Jegamalini Premaruban, Dorothy Sutton, Pradeep Kumar, Charlotte Culmsee, Caroline Winckley, Holly Davies, Hilary Thatcher, Evangelos Vasileiadis, Basaam Aweid, Melinda Holden, Cathy Mason, Thant Hlaing, Gladys Madzamba, Tanya Ingram, Michelle Linforth, Claire Cullen, Nibu Thomas, John France, Afaq Saulat, Biju Bhaskaran, Pauline Fitzell, Kathleen Horan, Catherine Manyoni, Josie Garfield-Smith, Hannah Griffin, Stacey Atkins, Joan Redome, Girish Muddegowda, Holly Maguire, Adrian Barry, Nenette Abano, Resti Varquez, Joanne Hiden, Susan Lyjko, Alda Remegoso, Kay Finney, Adrian Butler, Martin Strecker, Mary Joan MaCleod, Janice Irvine, Sandra Nelson, German Guzmangutierrez, Jacqueline Furnace, Vicky Taylor, Hawraman Ramadan, Kim Storton, Sohail Hassan, Eman Abdus Sami, Ruth Bellfield, Kelvin Stewart, Outi Quinn, Chris Patterson, Hedley Emsley, Bindu Gregary, Shakeel Ahmed, Shakeelah Patel, Sonia Raj, Sulaiman Sultan, Fiona Wright, Peter Langhorne, Ruth Graham, Terry Quinn, and Kate McArthur
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Adult ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Population ,Minimisation (clinical trials) ,Intracranial haemorrhage ,subarachnoid haemorrhage ,antiplatelet therapy ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Atrial Fibrillation ,Medicine ,Humans ,atrial fibrillation ,Prospective Studies ,education ,Adverse effect ,Stroke ,oral anticoagulation ,education.field_of_study ,business.industry ,Hazard ratio ,intraventricular haemorrhage ,Anticoagulants ,Atrial fibrillation ,intracerebral haemorrhage ,Vitamin K antagonist ,medicine.disease ,United Kingdom ,subdural haemorrhage ,Neurology (clinical) ,business ,Intracranial Hemorrhages ,randomised controlled trial - Abstract
Summary Background Oral anticoagulation reduces the rate of systemic embolism for patients with atrial fibrillation by two-thirds, but its benefits for patients with previous intracranial haemorrhage are uncertain. In the Start or STop Anticoagulants Randomised Trial (SoSTART), we aimed to establish whether starting is non-inferior to avoiding oral anticoagulation for survivors of intracranial haemorrhage who have atrial fibrillation. Methods SoSTART was a prospective, randomised, open-label, assessor-masked, parallel-group, pilot phase trial done at 67 hospitals in the UK. We recruited adults (aged ≥18 years) who had survived at least 24 h after symptomatic spontaneous intracranial haemorrhage, had atrial fibrillation, and had a CHA2DS2-VASc score of at least 2. Web-based computerised randomisation incorporating a minimisation algorithm allocated participants (1:1) to start or avoid long-term (≥1 year) full treatment dose open-label oral anticoagulation. The participants assigned to start oral anticoagulation received either a direct oral anticoagulant or vitamin K antagonist, and the group assigned to avoid oral anticoagulation received standard clinical practice (antiplatelet agent or no antithrombotic agent). The primary outcome was recurrent symptomatic spontaneous intracranial haemorrhage, and was adjudicated by an individual masked to treatment allocation. All outcomes were ascertained for at least 1 year after randomisation and assessed in the intention-to-treat population of all randomly assigned participants, using Cox proportional hazards regression adjusted for minimisation covariates. We planned a sample size of 190 participants (one-sided p=0·025, power 90%, allowing for non-adherence) based on a non-inferiority margin of 12% (or adjusted hazard ratio [HR] of 3·2). This trial is registered with ClinicalTrials.gov (NCT03153150) and is complete. Findings Between March 29, 2018, and Feb 27, 2020, consent was obtained at 61 sites for 218 participants, of whom 203 were randomly assigned at a median of 115 days (IQR 49–265) after intracranial haemorrhage onset. 101 were assigned to start and 102 to avoid oral anticoagulation. Participants were followed up for median of 1·2 years (IQR 0·97–1·95; completeness 97·2%). Starting oral anticoagulation was not non-inferior to avoiding oral anticoagulation: eight (8%) of 101 in the start group versus four (4%) of 102 in the avoid group had intracranial haemorrhage recurrences (adjusted HR 2·42 [95% CI 0·72–8·09]; p=0·152). Serious adverse events occurred in 17 (17%) participants in the start group and 15 (15%) in the avoid group. 22 (22%) patients in the start group and 11 (11%) patients in the avoid group died during the study. Interpretation Whether starting oral anticoagulation was non-inferior to avoiding it for people with atrial fibrillation after intracranial haemorrhage was inconclusive, although rates of recurrent intracranial haemorrhage were lower than expected. In view of weak evidence from analyses of three composite secondary outcomes, the possibility that oral anticoagulation might be superior for preventing symptomatic major vascular events should be investigated in adequately powered randomised trials. Funding British Heart Foundation, Medical Research Council, Chest Heart & Stroke Scotland.
- Published
- 2021
8. Impact of COVID-19 on Stroke Caseload in a Major Hyperacute Stroke Unit
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Fionn Mag Uidhir, Raj Bathula, David Cohen, Aravinth Sivagnanaratnam, Mudhar Abdul-Saheb, and Joseph Devine
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medicine.medical_specialty ,Time Factors ,Coronavirus disease 2019 (COVID-19) ,Clinical Neurology ,Intracranial hemorrhage ,Article ,Unit (housing) ,03 medical and health sciences ,0302 clinical medicine ,Patient Admission ,Pandemic ,London ,Resource utilization ,Medicine ,Humans ,Thrombolytic Therapy ,Suspected stroke ,Stroke ,Thrombectomy ,Health Services Needs and Demand ,Ischemic stroke ,business.industry ,Delivery of Health Care, Integrated ,Rehabilitation ,Epidemiology access to care ,Stroke units ,COVID-19 ,medicine.disease ,Health services ,Hyperacute stroke ,Emergency medicine ,Surgery ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Hospital Units ,030217 neurology & neurosurgery - Abstract
Northwick Park Hospital in London, United Kingdom (UK) is one of the busiest stroke units in the country and is located in one of the areas most heavily affected by the COVID-19 pandemic in the first half of 2020. Admissions to the stroke unit and changes during the peak of COVID-19 were reviewed. Compared with the previous year, mean 96 patients were admitted with suspected stroke during April and May 2020 compared with mean 116 per month in non-COVID periods, ratio 0.82, P = 0.01. This reduction involved both strokes and mimics and was unlikely to have occurred by chance. Numbers of patients thrombolysed and of patients referred for thrombectomy decreased dramatically during this time. Mechanisms by which the COVID-19 pandemic and the March lockdown may have affected admissions to the unit are discussed. Reduced admissions to the stroke unit allowed it to contribute its resources to the care of patients with COVID-19 during the peak of admissions.
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- 2020
9. 131 Acute stroke in ANCA associated vasculitis
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Hasnain Hashim, Raj Bathula, Andrew W Porter, and Shahir Hamdulay
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medicine.medical_specialty ,Acute Cerebrovascular Accidents ,Rheumatology ,business.industry ,Internal medicine ,Medicine ,Pharmacology (medical) ,ANCA-Associated Vasculitis ,business ,Acute stroke - Published
- 2019
10. Therapeutic hypothermia for acute ischaemic stroke:Results of a European multicentre, randomised, phase III clinical trial
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Bernd Kallmünzer, Per Winkel, Kennedy R. Lees, Philip M.W. Bath, Raj Bathula, Nikola Sprigg, Richard J. Perry, Christian Gluud, Istvan Szabo, Risto O. Roine, Derk W. Krieger, Dominik Michalski, Jacques Demotes-Mainard, Hanne Christensen, Joan Montaner, Isabelle Durand-Zaleski, H. Bart van der Worp, Joanna M. Wardlaw, Dimitre Staykov, Rainer Kollmar, Jesper Petersson, Charlotte Cordonnier, Janus Christian Jakobsen, Carlos A. Molina, Geert Vanhooren, Malcolm R. Macleod, Bridget Colam, and Stefan Schwab
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medicine.medical_specialty ,Neurology ,cooling ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Original Research Articles ,Ischaemic stroke ,medicine ,ddc:610 ,Symptom onset ,treatment ,business.industry ,Hypothermia ,randomised trial ,3. Good health ,Clinical trial ,Anesthesia ,Neurology (clinical) ,medicine.symptom ,hypothermia ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
IntroductionWe assessed whether modest systemic cooling started within 6 hours of symptom onset improves functional outcome at three months in awake patients with acute ischaemic stroke.Patients and methodsIn this European randomised open-label clinical trial with blinded outcome assessment, adult patients with acute ischaemic stroke were randomised to cooling to a target body temperature of 34.0–35.0°C, started within 6 h after stroke onset and maintained for 12 or 24 h , versus standard treatment. The primary outcome was the score on the modified Rankin Scale at 91 days, as analysed with ordinal logistic regression.ResultsThe trial was stopped after inclusion of 98 of the originally intended 1500 patients because of slow recruitment and cessation of funding. Forty-nine patients were randomised to hypothermia versus 49 to standard treatment. Four patients were lost to follow-up. Of patients randomised to hypothermia, 15 (31%) achieved the predefined cooling targets. The primary outcome did not differ between the groups (odds ratio for good outcome, 1.01; 95% confidence interval, 0.48–2.13; p = 0.97). The number of patients with one or more serious adverse events did not differ between groups (relative risk, 1.22; 95% confidence interval, 0.65–1.94; p = 0.52).DiscussionIn this trial, cooling to a target of 34.0–35.0°C and maintaining this for 12 or 24 h was not feasible in the majority of patients. The final sample was underpowered to detect clinically relevant differences in outcomes.ConclusionBefore new trials are launched, the feasibility of cooling needs to be improved.
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- 2019
11. The Northwick Park Examination of Cognition: A brief cognitive assessment tool for use in acute stroke services
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Sarah Swan, Patrick J. Murphy, Paul M Williams, Joseph Devine, David Cohen, Caroline Barber, Caroline Johnson, Sebastian J. Crutch, and Raj Bathula
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050103 clinical psychology ,medicine.medical_specialty ,Modalities ,Rehabilitation ,medicine.medical_treatment ,media_common.quotation_subject ,05 social sciences ,Physical Therapy, Sports Therapy and Rehabilitation ,Cognition ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Perception ,medicine ,Dementia ,0501 psychology and cognitive sciences ,Psychology ,Episodic memory ,Stroke ,030217 neurology & neurosurgery ,Brief Cognitive Assessment Tool ,Clinical psychology ,media_common - Abstract
Background/Aims: Assessment of cognitive impairment following stroke forms an important part of diagnosis, treatment and rehabilitation planning. However, none of the available and widely used tools were developed specifically for use in stroke services. Most screening tools were developed for dementia, and consequently are biased toward an evaluation of memory function, provide inadequate assessment of executive function and are mainly verbally administered, limiting their utility in aphasic patients. Methods: One hundred and sixty-six stroke patients admitted to a hyper acute stroke unit and a control sample of 100 healthy participants completed the Northwick Park Examination of Cognition (NPEC). The NPEC includes 22 sub-tests in the domains of reasoning, episodic memory, language, perception and attention/executive function. Multiple input (verbal, visual) and output (spoken, written, gesture) modalities increase accessibility to patients with various deficits/lesion locations. Findings: Mean time from stroke to assessment was 5.6 days (SD=7.9). Seventy five percent of patients gained impaired scores (mild, moderate or severe impairment), which was evident at the group level on all subtests. Left and right cortical stroke patients differed significantly (PL) and spatial attention (L>R) subtests. Sensitivity and specificity for the detection of cognitive impairment (sensitivity=0.90; specificity=0.80; area-under-curve [AUC]=0.93) were equivalent or superior to data reported for established cognitive screening tools (AUC=0.53–0.89). Patients were disproportionately impaired on high vs low attentional demand cancellation tasks (PConclusions: The NPEC is brief, freely available and has good sensitivity and specificity for differentiating stroke patients from controls in terms of cognitive functioning. The inclusion of timed executive function measures and comparable verbal and non-verbal sub-tests permits characterisation of cognitive dysfunction in different stroke subtypes.
- Published
- 2016
12. Decreasing referrals to transient ischaemic attack clinics during the COVID-19 outbreak: results from a multicentre cross-sectional survey
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Salwa Elmamoun, John Janssen, Raj Bathula, Adelaide Oppong, Rebecca Redwood, Ambreen Sheikh, Lucio D'Anna, Ravneeta Singh, Evangelos Vasileiadis, and Soma Banerjee
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Cross-sectional study ,Ambulatory Care Facilities ,0302 clinical medicine ,London ,Preventive Health Services ,Pandemic ,Outpatient clinic ,Medicine ,030212 general & internal medicine ,Referral and Consultation ,Response rate (survey) ,Incidence ,Incidence (epidemiology) ,General Medicine ,Hospitalization ,Neurology ,Ischemic Attack, Transient ,stroke medicine ,Coronavirus Infections ,Life Sciences & Biomedicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,preventive medicine ,1117 Public Health and Health Services ,quality in health care ,Betacoronavirus ,03 medical and health sciences ,Medicine, General & Internal ,General & Internal Medicine ,Humans ,cardiovascular diseases ,Pandemics ,Quality of Health Care ,Preventive healthcare ,Science & Technology ,SARS-CoV-2 ,business.industry ,COVID-19 ,Outbreak ,1103 Clinical Sciences ,Cross-Sectional Studies ,Emergency medicine ,business ,030217 neurology & neurosurgery ,1199 Other Medical and Health Sciences - Abstract
ObjectiveThe COVID-19 pandemic is having major implications for stroke care with a documented significant fall in hospital acute stroke admissions. We investigated whether COVID-19 has resulted in a decreased number of referrals to the transient ischaemic attack (TIA) clinics across the North West London region.Setting and designAll the TIA clinical leads of the North West London region received an invitation by email to participate in an online survey in May 2020. The survey questionnaire aimed to assess the number of patients with suspected TIA consecutively referred to each of the TIA clinics of the North West London region between 1 March and 30 April 2020, the COVID-19 period, and between 1 March and 30 April 2019.ResultsWe had a response rate of 100%. During the COVID-19 period, the TIA clinics of the North West London region received 440 referrals compared with 616 referrals received between 1 March and 30 April 2019 with a fall in the number of the referrals by 28.6%. In April 2020 compared with April 2019, the number of the referrals declined by 40.1%.ConclusionsThis multicentre analysis documented a significant reduction in the number of patients referred with suspected TIA to the specialised rapid access outpatient clinics in the North West London region during the COVID-19 pandemic. Future studies are needed to confirm our findings and to better characterise the incidence of cerebrovascular disease during the COVID-19 pandemic.
- Published
- 2020
13. Renal impairment reduces the efficacy of thrombolytic therapy in acute ischemic stroke
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Neill Duncan, Diane Ames, Arindam Kar, Raj Bathula, David Taube, Daniel Epstein, David Cohen, Joseph Devine, and Albert Power
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Male ,Time Factors ,medicine.medical_treatment ,Comorbidity ,Kidney ,Tissue plasminogen activator ,Brain Ischemia ,Brain ischemia ,Risk Factors ,London ,Odds Ratio ,Thrombolytic Therapy ,Hospital Mortality ,Stroke ,Cause of death ,Aged, 80 and over ,Thrombolysis ,Middle Aged ,medicine.anatomical_structure ,Treatment Outcome ,Neurology ,Tissue Plasminogen Activator ,Cardiology ,Female ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,Intracranial Hemorrhages ,medicine.drug ,Glomerular Filtration Rate ,medicine.medical_specialty ,Risk Assessment ,Fibrinolytic Agents ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Risk factor ,Aged ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,medicine.disease ,Logistic Models ,Multivariate Analysis ,Physical therapy ,Neurology (clinical) ,business ,Fibrinolytic agent - Abstract
Background: Renal impairment is a potent risk factor for stroke, which remains a leading cause of death and disability. Thrombolysis for acute ischemic stroke has transformed patient outcomes, although the safety and efficacy of this approach remain poorly characterized in patients with renal dysfunction, who manifest a higher risk of bleeding due to uremia. We therefore examined the impact of renal impairment on clinical outcomes with thrombolysis within the current 4.5-hour therapeutic window. Methods: This retrospective multicenter cohort study (2009–2011) examined 229 stroke patients receiving thrombolysis with alteplase (0.9 mg/kg; mean age 70 ± 13 years; 59% male, 24% diabetic). Sixty-five patients had an estimated glomerular filtration rate (eGFR) Results: There was no significant difference in mean time to thrombolysis between the groups (221 ± 66 vs. 220 ± 70 min from symptom onset; p = 0.9). An eGFR Conclusions: Our results suggest that renal impairment is associated with reduced efficacy of thrombolysis in acute ischemic stroke without any excess hemorrhagic complications. This may relate to diminished fibrinolysis in the uremic milieu or differences in infarct anatomy. Longer-term prospective studies are required to characterize and improve functional outcomes following stroke in a manifestly high-risk group.
- Published
- 2012
14. 42 * THE IMPLEMENTATION OF INTERMITTENT PNEUMATIC COMPRESSION TO REDUCE DEEP VEIN THROMBOSIS RATES IN STROKE PATIENTS
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Raj Bathula, K. Gananandan, Joseph Devine, S. Fenwick-Elliott, David Cohen, and L. Elliott
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Aging ,medicine.medical_specialty ,Stroke patient ,business.industry ,Deep vein ,Peripheral edema ,Intermittent pneumatic compression ,General Medicine ,medicine.disease ,Thrombosis ,Surgery ,Pulmonary embolism ,medicine.anatomical_structure ,Ischemic stroke ,medicine ,Geriatrics and Gerontology ,medicine.symptom ,business ,Hemostatic function - Published
- 2014
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