5 results on '"Ana Felix"'
Search Results
2. Patient Preferences for Stroke Rehabilitation
- Author
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Sharon Wallace Williams, Ana Felix, Patricia C. Gregory, Keturah R. Faurot, and Lloyd J. Edwards
- Subjects
Adult ,Male ,medicine.medical_specialty ,Mental Status Schedule ,medicine.medical_treatment ,Rehabilitation Centers ,Physical medicine and rehabilitation ,Surveys and Questionnaires ,medicine ,Humans ,Stroke ,Aged ,Acute stroke ,Community and Home Care ,Patient discharge ,Rehabilitation ,business.industry ,Age Factors ,Stroke Rehabilitation ,Discharge disposition ,Patient Preference ,Recovery of Function ,Length of Stay ,Middle Aged ,medicine.disease ,Functional recovery ,Patient preference ,Patient Discharge ,Logistic Models ,Treatment Outcome ,Physical therapy ,Female ,Neurology (clinical) ,business - Abstract
Early aggressive rehabilitation therapies maximize functional recovery. We examined patient-reported preferences for their initial rehabilitation therapy setting during their acute stroke hospitalization and whether there was an association between their preferences and their actual discharge destination.Eligible stroke patients were surveyed during their acute hospital stay at either a primary stroke center or a rural community hospital in North Carolina. Patients were questioned about their knowledge of inpatient rehabilitation, preferences for the initial rehabilitation therapy setting and intensity, and how far from home they were willing to travel to receive therapies. The primary outcome was their actual discharge destination. The exposure variable was their preference for initial rehabilitation therapy setting. Logistic regression models assessed the relationship between the outcome and exposure while controlling for other variables of interest.Among 53 patients surveyed in the study, 85% preferred to be discharged home. After controlling for other factors, discharge to the actual destination of home was associated with a preference for an initial rehabilitation therapy setting of home (OR, 7.19; 95% CI, 1.10-46.89).Patient preference for the initial rehabilitation therapy setting is home. Providers should inquire about patient preference and provide information about treatment options to help inform decision making.
- Published
- 2010
3. Early diffusion weighted MRI as a negative predictor for disabling stroke after ABCD2 score risk categorization in transient ischemic attack patients
- Author
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Wayne D. Rosamond, Carol Murphy, Marlow F. Price, Anna M. Johnson, Kathryn M. Rose, Charles H. Tegeler, Ana Felix, and Andrew W. Asimos
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Male ,medicine.medical_specialty ,Time Factors ,Risk Assessment ,Severity of Illness Index ,Central nervous system disease ,Cohort Studies ,Disability Evaluation ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,ABCD2 ,Humans ,Prospective Studies ,Risk factor ,Stroke ,Aged ,Advanced and Specialized Nursing ,Aged, 80 and over ,medicine.diagnostic_test ,biology ,Cerebral infarction ,business.industry ,Vascular disease ,Medical record ,Magnetic resonance imaging ,Cerebral Arteries ,Middle Aged ,medicine.disease ,Diffusion Magnetic Resonance Imaging ,Early Diagnosis ,Ischemic Attack, Transient ,biology.protein ,Physical therapy ,Disease Progression ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose— The prognostic value early diffusion-weighted magnetic resonance imaging (DWMRI) adds in the setting of transient ischemic attack (TIA), after risk stratification by a clinical score, is unclear. The purpose of this study is to evaluate, after ABCD 2 score risk categorization in admitted TIA patients, whether negative DWMRI performed within 24 hours of symptom onset improves on the identification of patients at low risk for experiencing a disabling stroke within 90 days. Methods— At 15 North Carolina hospitals, we enrolled a prospective nonconsecutive sample of admitted TIA patients. We excluded patients not undergoing a DWMRI within 24 hours of admission and patients for whom a dichotomized (≤ or >3) ABCD 2 score could not be calculated. We conducted a medical record review to determine disabling ischemic stroke outcomes within 90 days. Results— Over 35 months, 944 TIA patients met inclusion criteria, of whom 4% (n=41) had a disabling ischemic stroke within 90 days. In analyses stratified by low versus moderate/high ABCD 2 score, the combination of a low risk ABCD 2 score and a negative early DWMRI had excellent sensitivity (100%, 95% CI 34 to 100) for identifying low-risk patients. In patients classified as moderate to high risk, a negative early DWMRI predicted a low risk of disabling ischemic stroke within 90 days (sensitivity 92%, 95% CI 80 to 97; NLR 0.11, 95% CI 0.04 to 0.32). Conclusions— After risk stratification by the ABCD 2 score, early DWMRI enhances the prediction of a low risk for disabling ischemic stroke within 90 days. Further study is warranted in a large, consecutive TIA population of early DWMRI as a sensitive negative predictor for disabling stroke within 90 days.
- Published
- 2009
4. A Multicenter Evaluation of the ABCD2 Score's Accuracy for Predicting Early Ischemic Stroke in Admitted Patients With Transient Ischemic Attack
- Author
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Carol Murphy, Ana Felix, Andrew W. Asimos, Marlow F. Price, Diane J. Catellier, Kathryn M. Rose, Anna M. Johnson, Charles H. Tegeler, Sam Singh, and Wayne D. Rosamond
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Male ,medicine.medical_specialty ,Population ,Risk Assessment ,Sensitivity and Specificity ,Severity of Illness Index ,Brain ischemia ,Modified Rankin Scale ,Intensive care ,Internal medicine ,Severity of illness ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,education ,Stroke ,Aged ,education.field_of_study ,business.industry ,Cerebral infarction ,Middle Aged ,medicine.disease ,Surgery ,Early Diagnosis ,ROC Curve ,Ischemic Attack, Transient ,Emergency Medicine ,Cardiology ,Regression Analysis ,Female ,business - Abstract
Study objective We evaluate, in admitted patients with transient ischemic attack, the accuracy of the ABCD 2 (age [A], blood pressure [B], clinical features [weakness/speech disturbance] [C], transient ischemic attack duration [D], and diabetes history [D]) score in predicting ischemic stroke within 7 days. Methods At 16 North Carolina hospitals, we enrolled a prospective, nonconsecutive sample of admitted patients with transient ischemic attack and with no stroke history, presenting within 24 hours of transient ischemic attack symptom onset. We conducted a medical record review to determine ischemic stroke outcomes within 7 days. According to a modified Rankin Scale Score, strokes were classified as disabling (>2) or nondisabling (≤2). Results During a 35-month period, we enrolled 1,667 patients, of whom 373 (23%) received a diagnosis of an ischemic stroke within 7 days. Eighteen percent (69/373) of all strokes were disabling. We were unable to calculate an ABCD 2 score in 613 patients (37%); however, our imputed analysis indicated this did not significantly alter results. The discriminatory power of the ABCD 2 score was modest for ischemic stroke in 7 days ( c statistic 0.59), and fair for disabling ischemic stroke within 7 days ( c statistic 0.71). Patients characterized as low risk according to ABCD 2 score (≤3) were at low risk for experiencing a disabling stroke within 7 days, with a negative likelihood ratio of 0.16 (95% confidence interval [CI] 0.04 to 0.64) with missing values excluded and 0.34 (95% CI 0.15 to 0.76) when missing values were imputed. Conclusion Our analysis suggests the best application of the ABCD 2 score may be to identify patients at low risk for an early disabling ischemic stroke. Further study of the ability to determine an ABCD 2 score in all patients is needed, along with validation in a large, consecutive population of patients with transient ischemic attack.
- Published
- 2010
5. 179: Ability of the ABCD2 Score to Predict Early Stroke and DWI Positive MRI in Admitted Transient Ischemic Attack Patients Without a History of Prior Stroke
- Author
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Ana Felix, Charles H. Tegeler, Wayne D. Rosamond, Carol Murphy, Anna M. Johnson, Kathryn M. Rose, Marlow F. Price, and Andrew W. Asimos
- Subjects
medicine.medical_specialty ,biology ,business.industry ,medicine.disease ,Internal medicine ,Emergency Medicine ,medicine ,Cardiology ,ABCD2 ,biology.protein ,Physical therapy ,Transient (computer programming) ,business ,Stroke - Published
- 2008
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