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Copyright of Nővér is the property of Chamber of Hungarian Health Care Professionals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and aims: Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay. Methods: A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed. Results: The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, p <.001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor's visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40–64 years (OR 1.63 (95% CI 1.06–2.52); compared to age 18–39), age more than 64 years (OR 2.84 (95% CI 1.18–6.80); compared to age 18–39), loss of appetite (OR 2.86 (95% CI 1.64–4.98)), fever (OR 1.66 (95% CI 1.08–2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15–3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32–3.53)). Age 40–64 years (OR 2.41 (95% CI 1.50–3.88)), age more than 64 years (OR 8.79 (95% CI 2.19–35.36)), fever (OR 1.83 (95% CI 1.15–2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14–3.14)) were also risk factors for complicated appendicitis. Conclusions: Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis. [ABSTRACT FROM AUTHOR]

Background: Stroke is a non-communicable disease whose prevalence continues to increase in both young and old age groups. Stroke patients require immediate treatment at the hospital to prevent disability and death. Delayed treatment may result in a worse prognosis. Aims: To analyze the relationship between family knowledge and response with pre-hospital delay in stroke patients in Cirebon Regency, Indonesia. Methods: This cross-sectional study was conducted at Waled General Hospital, Cirebon Regency, Indonesia. The sampling technique used was consecutive sampling of patients hospitalized with stroke diagnosis from May 2024 to July 2024. Patients with recurrent stroke were excluded. Data were collected from medical records and questionnaires administered to the patient's families. The Indonesian version of Stroke Recognition Questionnaire (SQR) was used to explore family knowledge, while family responses were explored using the Stroke Action Test (STAT). Results: There were 61 stroke patients recruited in this study. Majority of the sample were delivered to hospital late (78.7%). Most of the patients’ families had poor knowledge (47.5%) and inadequate attitudes (85.2%). In the bivariate analysis, there was a strong correlation between family knowledge of stroke symptoms and pre-hospital delay (p=

Abstract Background Pre-hospital delay in China is a serious issue with unclear relevant reasons, seriously impeding the adoption of appropriate measures. Herein, we analyzed the onset-to-door time (ODT) in Chinese patients with acute ischemic stroke (AIS) and its influencing factors. Methods We prospectively recruited 3,459 patients with AIS from nine representative tertiary general hospitals in China between January and June 2022. Patients were divided into ODT ≤ 3 h and ODT > 3 h groups. Following single-factor analysis, binary logistic regression analysis was performed to evaluate the risk factors leading to pre-hospital delay. Results In total, 763 (21.83%) patients arrived at the hospital within 3 h of onset. After adjusting for confounding factors, the risk factors for ODT were residence in rural areas (odds ratio [OR]: 1.478, 95% credibility interval [CI]: 1.024–2.146) and hospital transfer (OR: 7.479, 95% CI: 2.548–32.337). The protective factors for ODT were location of onset ≤ 20 km from the first-visit hospital (OR: 0.355, 95% CI: 0.236–0.530), transportation by emergency medical services (OR: 0.346, 95% CI: 0.216–0.555), history of atrial fibrillation (OR: 0.375, 95% CI: 0.207–0.679), moderate stroke (OR: 0.644, 95% CI: 0.462–0.901), and severe stroke (OR: 0.506, 95% CI: 0.285–0.908). Conclusions Most patients with AIS fail to reach a hospital within the critical 3-h window. The following measures are recommended to reduce pre-hospital delays: reasonable distribution of hospitals accessible to nearby residents, minimizing interhospital transfer, paying attention to patients with mild stroke, and encouraging patients to use ambulance services. Pre-hospital delays for patients can be reduced by implementing these measures, ultimately improving the timeliness of treatment and enhancing patient prognosis. This study was carried out amid the COVID-19 pandemic, which presented challenges and constraints.

Objective To analyze the factors influencing in-hospital and post-discharge mortality within 180 days in patients with acute aortic dissection （AAD）. Methods There were 739 patients diagnosed with AAD for the first time, among which 159 deaths within the hospital and within 180 days after discharge were recorded as the death group, and 580 survivors within the hospital and within 180 days after discharge were recorded as the survival group. The general data of the two groups were collected and compared, including basic information, past medical history, pre-hospital time, morbidity-related information, and transfer-related information, and the risk factors for in-hospital and post-discharge death within 180 days of discharge in patients with AAD were analyzed by Logistic regression analysis. Based on the pre-hospital time and in-hospital and within 180 days after discharge outcomes of AAD patients, we plotted the receiver operating characteristic (ROC) curves, calculated the Jordon index, and used the prehospital time corresponding to the Jordon index as the cut-off value to define whether there was a pre-hospital delay in AAD patients. According to whether there was pre-hospital delay or not, AAD patients were divided into the delayed group and the undelayed group. The survival rates and survival time of patients in hospital and within 180 days after discharge were compared between the two groups. Results Significant differences were found in the pre-hospital time, aortic dissection classification, symptoms at onset, heart rate at onset, upper extremity systolic blood pressure at onset, mode of admission, the number of referrals, and mode of referral between the death group and survival group （all P<0. 05）. Logistic regression analysis showed that the prolonged pre-hospital time, the aortic dissection classification of A, the sense of near-death at onset, heart rate at onset of >100 beats/min, referral on foot, public transportation referral and more than two referrals were independent risk factors for in-hospital and post-discharge death within 180 days in patients with AAD. The area under the ROC curve was 0. 777（95% CI 0. 742- 0. 812）, indicating that the pre-hospital time had good validity in predicting the outcomes of AAD patients in-hospital and within 180 days after discharge, and its Yoden index was 0. 473, at which time the pre-hospital time was 9. 25 h, i. e., the pre-hospital delay time of the patients with AAD was 9. 25 h. The survival rate was 64. 50% in the delayed group and 96. 60% in the undelayed group （both P<0. 05）. Conclusions The prolonged pre-hospital time, aortic dissection classification as type A, near-death sensation at onset, heart rate >100 beats/min at onset, walk-in referrals, public transportation referrals, and more than two referrals were independent risk factors for in-hospital and post-discharge deaths within 180 days in patients with AAD. The pre-hospital delay in patients with AAD was 9. 25 h, and the survival rate and survival time of patients whose pre-hospital time exceeded this node would decrease significantly. [ABSTRACT FROM AUTHOR]

Diabetic foot infection is one of the most severe complications of diabetes mellitus. Immediately seeking medical attention is vital after foot ulcers occur; however there are often delays in seeking treatment. This study used a qualitative descriptive approach to explore the perceptions of delay in people seeking medical help for foot ulcers in three villages in Baise, rural areas of southwest China. Fifteen patients were recruited in this study. In-depth interviews were performed to collect data from August to October 2022, and thematic analysis was used to analyze the data. This study identified four main themes: personal estimation; supernatural and traditional power; health service expertise, cost and access to hospital care; and psychological and complementary care. Inadequate awareness of potential ulcers and a preference for alternative methods significantly contributed to delays in medical foot care. Additionally, a shortage in community healthcare services impeded the timely initiation of proper foot care actions. It was worth noting that the preference for Traditional Chinese Therapy was relevant to the delay in seeking medical attention on foot, yet it was not perceived before. These findings serve as crucial evidence for developing interventions and future policy adjustments. Further consideration of the multifaceted impacts is necessary to incentivize prompt treatment decisions for diabetic foot ulcers. Nurse specialists should be concerned regarding psychological care, and dual-way support between nurses and families is vital for prompt medical care-seeking. Nursing education should emphasize knowledge of pathophysiology integrating prayer merits and Chinese therapies for patient empowerment. [ABSTRACT FROM AUTHOR]

Introduction: The rate of potentially preventable deaths (PPD) and preventable deaths (PD) can reach more than 20% of overall trauma mortality. Bleeding is the leading cause of preventable mortality. The aim of our study is to define the independent factors of preventable or potentially preventable mortality in our mature trauma system. Materials and methods: We conducted a single-center retrospective study in the Sainte Anne Military Teaching Hospital, Toulon, France, including all severe trauma patients admitted to our trauma center and discharged alive as well as all severe trauma patients who died with a death considered preventable or potentially preventable from January 2013 to December 2020. We matched the two groups using a propensity score and searched for independent factors using a generalized linear model. Results: 846 patients were included and analyzed. After matching, our cohort consisted of 245 patients in the survivor group and 49 patients in the preventable deaths group. Pre-hospital delays (73 min vs 54 min P = 0.003) as well as delays before incision in the operating room (80 min vs 52 min P < 0.001) were significantly longer in the PD group. These delays were independent factors of preventable mortality OR 10.35 (95% CI [3.44–31.11] P < 0.001) and OR 37.53 (95% CI [8.51–165.46] P < 0.001) as well as pelvic trauma OR 6.20 (95% CI [1.53–25.20] P = 0.011). Conclusion: Delays in pre-hospital care, delays in access to the operating room from arrival at the trauma center, and pelvic injuries are independent factors associated with an increased risk of preventable mortality in trauma. [ABSTRACT FROM AUTHOR]

Background and Aim: First minutes of a medical emergency are the most crucial ones, and the first aid must be given as soon as possible. Identifying this issue, we aimed to develop a mobile app that connects all individuals who have first aid knowledge and notifies them if there is a nearby emergency. Methods: The development of the system took over eight months. Within this time, we developed the app and started working in collaboration with OncoGen Institute to receive expert medical advice related to our app's first aid guide but also providing valuable advice regarding the app features. Results: Until this moment, the app can notify nearby certified first aid responses if there is an incident nearby, providing details about it. Furthermore, the app displays a map of all defibrillators in Romania and has an integrated interactive first aid guide for revisioning the steps if necessary. For identifying incidents, we are looking forward collaborating with Romanian Special Telecommunication Service to receive all on-street emergencies. Conclusion: Initial feedback has been a positive one, suggesting that AidLink will have a significant impact on society, reducing the time a victim receives first aid.

Youli Jiang, Yao Xiong, Yue Chi, Fu Lin, Qingshi Zhao, Yanfeng Li Department of Neurology, People’s Hospital of Longhua, Shenzhen, 518109, People’s Republic of ChinaCorrespondence: Qingshi Zhao; Yanfeng Li, Email 66327285@qq.com; 308114251@qq.comPurpose: Timely medical attention is crucial for patients with Acute Ischemic Stroke (AIS), as delays can significantly impact therapeutic outcomes. These delays are influenced by a combination of socio-cultural, educational, and clinical factors.Patients and Methods: An in-depth analysis was conducted to assess the prevalence and median duration of healthcare-seeking delays in AIS patients. The study specifically investigated the independent impacts of sociocultural and clinical determinants on these delays, with a focus on immigrant status, gender disparities, and educational levels. Multivariate regression analysis was employed to identify these independent effects while controlling for potential confounding factors.Results: Among 1419 AIS patients, 82.52% (n = 1171) experienced delays exceeding 2 hours from symptom onset of symptoms to hospital arrival. The median delay was 12.3 hours. Immigrant populations encountering longer delays compared to native groups. Younger males (< 45 years) and elderly females were more prone to delay in healthcare-seeking. Identified independent risk factors for delay included male gender (OR = 1.65 [95% CI:1.14− 2.48]), self-acknowledged diabetes (OR = 2.50 [95% CI:1.21– 5.17]), small vessel (OR = 2.07 [95% CI:1.27– 3.36]), and wake stroke (OR = 7.04 [95% CI:3.69– 13.44]). Educational background (high school and above), GCS score with 3– 8 points (OR = 0.52 [95% CI:0.09– 0.69]), understanding stroke-related knowledge (OR = 0.26 [95% CI:0.09– 0.44]), conscious disturbance (OR = 0.25 [95% CI:0.10– 0.62]) and limb weakness (OR=0.21[95% CI:0.21– 0.49]) are protective factors for timely treatment.Conclusion: Immigrant populations experienced longer delays from symptom onset to hospital arrival. The crucial roles of education and knowledge about stroke underscore the need for enhanced health literacy campaigns and public awareness, with a targeted focus on younger males and elderly females.Keywords: healthcare-seeking behavior, immigrant population, educational disparity, pre-hospital delay, AIS

Abstract Background Implementing training programs to educate patients on the prodromal symptoms of acute coronary syndrome (ACS) may assist patients in accurately recognizing these symptoms, and ultimately decrease their time delay in seeking emergency medical services (EMS). However, the effectiveness of this approach remains uncertain, particularly among the Chinese population. Methods A cross-sectional study was conducted within 22 communities in Beijing, China between 2015 and 2018, with a total of 1099 participants recruited. The study utilized a standardized questionnaire to evaluate the presence of intentional decision delay in turning to EMS under a hypothetical chest pain, the participants’ knowledge of ACS prodromal symptoms, and whether they had ever received any training programs aimed at increasing their symptom knowledge. Mediation analysis was performed with regression models and bootstrapping methods, and gender difference was further analyzed through moderated mediation analysis. Results A total of 1099 participants (58.2% female, median [IQR] age 34 [20]) were included in the study. The results of the mediation analysis indicated that training programs were associated with a decrease risk in decision delay, with increased knowledge playing a mediating role (mediation effect/total effect = 36.59%, P 0.05), even though they did improve women’s knowledge of ACS prodromal symptoms (β = 0.57, P = 0.012). Conclusion The results suggested a relationship between prior training programs and reduced decision delay, with increased knowledge of prodromal symptoms of ACS serving as a mediator. However, the effect was only observed in male participants and not in female participants. This highlights the notion that mere transfer of knowledge regarding ACS prodromal symptoms may not be sufficient to mitigate decision delay in the female population. Further research is needed to corroborate these results and to gain deeper insights into the gender-specific barriers encountered in this study.

Abstract Background Despite advancements in acute stroke care, acute stroke patients present late for care resulting in high mortality and poor functional outcomes. This study determined the prevalence of pre-hospital delay and associated factors among adult acute stroke patients in Uganda. Methods In a hospital based, cross-sectional study, one hundred and forty-three study participants with confirmed acute stroke presenting to the emergency units of Mulago and Kiruddu national referral hospitals were enrolled. Using an interviewer-administered questionnaire, details on sociodemographics, onset of stroke, arrival at the tertiary facility, health system and clinical factors were collected. Descriptive statistics and modified Poisson regression analyses were performed to determine factors associated with prehospital delay. Results Among the 143 study participants, nearly two-thirds (79/146) had ischemic stroke while a third (59/143) had haemorrhagic stroke. The mean age was 59 years (SD 16) and 51.7% of acute stroke patients were males. Ninety one percent (130/143) presented to the emergency unit after 3 hours. The majority (124/143) reported visiting lower-level facilities prior to referral to the tertiary facility. Staying outside Kampala district (PR: 1.28 (1.22–1.34), p

Objectives: Intravenous thrombolysis is an effective treatment of acute ischemic stroke but has a narrow therapeutic time window of 3-4.5 h. Pre-hospital delay is a major barrier to patients becoming eligible for thrombolysis. This single-center study assessed the factors causing longer onset-to-door (OTD) time to identify measures that will help decrease the delay. Materials and Methods: Patients with acute ischemic stroke presenting to the emergency department from August to October 2022 were included in the study. The data were collected using a structured questionnaire and was completed by interviewing the patient or the caregivers. Patients were classified as early and late arrivers with the cutoff being 3.5 h. We then analyzed the relationship between early arrival and demographic factors, clinical factors, patient response factors, and logistic factors. Results: Our study consisted of 153 patients. The average OTD time was 674.33 ± 812.713 min (median: 300; interquartile range: 151-885). The prehospital delay was present in 66% of patients. 16.9% of patients came beyond 24 h. In the multivariate analysis, the odds of early arrival were higher among patients who perceived their symptoms as serious (odds ratio [OR]: 18.801; confidence interval [CI]: 3.728-94.803) and lower among patients who experienced a delay in reaching due to traffic (OR: 0.085; CI: 0.008-0.873). Lack of knowledge about stroke centers among both patients and health professionals also contributed to longer OTD times. Out of 52 early arrivers, 24 received thrombolytic therapy after excluding wake-up strokes and contraindications. Conclusion: Pre-hospital delay continues to stand in the way of patients receiving thrombolysis. Comprehensive stroke education, increasing awareness regarding stroke centers, and promoting ambulance services are some of the interventions which could help tackle the issue. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the psychosocial markers associated with pre‐hospital delay among patients with diabetic foot (DF). Design: This study has a cross‐sectional design. Methods: The participants completed a questionnaire including pre‐hospital time, demographic characteristics, Social Support Rate Scale, Brief Illness Perception Questionnaire and Type D Personality Scale‐14. Bivariate and multivariate analyses were conducted to explore independent associations with pre‐hospital delay. Results: Only 1.8% (3/164) of participants arrived at the hospital for medical care in 24 h of symptom onset. Patients with low utilization of social support (p = 0.029), low negative illness perceptions (p = 0.014) and high levels of negative affectivity (p = 0.009) are likely to arrive late at the clinic. Medical staff should pay attention to identifying diabetic patients' Type D personalities and take actions to improve their social support as well as illness perception, so as to reduce the occurrence of hospital delay. Implications for the Profession and/or Patient Care: Psychosocial factors play a vital role in the delay in seeking medical treatment for patients with DF. Medical staff need to improve patients' illness perception as well as self‐management ability through health education. Importantly, key family members provide an emotional and psychological support system for diabetic patients. Therefore, nurses need to work with family members together to give information and psychological support during family visits. Additionally, building and maintaining trust with patients is crucial to encouraging individuals to express their concerns and worries. In this case, nurses may identify patients' negative emotions and conduct timely intervention, so as to achieve favourable outcomes. Patient or Public Contribution: This study used a convenience sample of 164 participants with DF recruited from the wound clinic of Northern Jiangsu People's Hospital and Yangzhou Hospital of TCM in China. [ABSTRACT FROM AUTHOR]

Background: Implementing training programs to educate patients on the prodromal symptoms of acute coronary syndrome (ACS) may assist patients in accurately recognizing these symptoms, and ultimately decrease their time delay in seeking emergency medical services (EMS). However, the effectiveness of this approach remains uncertain, particularly among the Chinese population. Methods: A cross-sectional study was conducted within 22 communities in Beijing, China between 2015 and 2018, with a total of 1099 participants recruited. The study utilized a standardized questionnaire to evaluate the presence of intentional decision delay in turning to EMS under a hypothetical chest pain, the participants' knowledge of ACS prodromal symptoms, and whether they had ever received any training programs aimed at increasing their symptom knowledge. Mediation analysis was performed with regression models and bootstrapping methods, and gender difference was further analyzed through moderated mediation analysis. Results: A total of 1099 participants (58.2% female, median [IQR] age 34 [20]) were included in the study. The results of the mediation analysis indicated that training programs were associated with a decrease risk in decision delay, with increased knowledge playing a mediating role (mediation effect/total effect = 36.59%, P < 0.0001). Gender modified this mediation effect, with it being observed only in the male group. Specifically, training programs were not found to significantly decrease decision delay among females (P > 0.05), even though they did improve women's knowledge of ACS prodromal symptoms (β = 0.57, P = 0.012). Conclusion: The results suggested a relationship between prior training programs and reduced decision delay, with increased knowledge of prodromal symptoms of ACS serving as a mediator. However, the effect was only observed in male participants and not in female participants. This highlights the notion that mere transfer of knowledge regarding ACS prodromal symptoms may not be sufficient to mitigate decision delay in the female population. Further research is needed to corroborate these results and to gain deeper insights into the gender-specific barriers encountered in this study. [ABSTRACT FROM AUTHOR]

我国急性缺血性卒中发病率高，院前延误形势严峻，疾病救治负担重。但相关影响因素及可采取的措施还不甚清楚或存在矛盾的报道，这不利于政府部门的决策制定。本综述发现受教育程度低、卒中发作时独处或独居、新型冠状病毒感染疫情、位于农村者易引起院前延误，而有高血压、TIA和缺血性卒中既往史以及构音障碍、肌力下降、前循环卒中、经救护车转运的患者院前延误较少。加强卒中宣传和教育、建设移动卒中单元和提高信息化水平是缩短院前延误的有效措施。这些研究发现可以为进一步减少院前延误，提高急救效率，辅助政府决策制定提供参考依据。 Abstract: he incidence of acute ischemic stroke in China is high, the situation of pre-hospital delay is severe, and the burden of treatment is heavy. However, the relevant influencing factors and measures that can be taken are not clear or contradictory reports exist, which is not conducive for the government departments' decision-making. This review found that people with low education, living alone or alone during a stroke attack, the COVID-19 epidemic and being located in the countryside were more likely to cause pre-hospital delay. Patients with a history of hypertension, transient ischemic attacks, and ischemic stroke, or patients had dysarthria, decreased muscle strength, anterior circulation stroke, and ambulance transfer had fewer pre-hospital delays. Effective and feasible measures to shorten pre-hospital delay include strengthening propaganda and education on stroke, implementing mobile stroke units and raising the level of informatization. These findings provide a reference for further reducing pre-hospital delay, improving the efficiency of first aid, and assisting government decision-making.

Abstract Aim This study aimed to determine the psychosocial markers associated with pre‐hospital delay among patients with diabetic foot (DF). Design This study has a cross‐sectional design. Methods The participants completed a questionnaire including pre‐hospital time, demographic characteristics, Social Support Rate Scale, Brief Illness Perception Questionnaire and Type D Personality Scale‐14. Bivariate and multivariate analyses were conducted to explore independent associations with pre‐hospital delay. Results Only 1.8% (3/164) of participants arrived at the hospital for medical care in 24 h of symptom onset. Patients with low utilization of social support (p = 0.029), low negative illness perceptions (p = 0.014) and high levels of negative affectivity (p = 0.009) are likely to arrive late at the clinic. Medical staff should pay attention to identifying diabetic patients' Type D personalities and take actions to improve their social support as well as illness perception, so as to reduce the occurrence of hospital delay. Implications for the Profession and/or Patient Care Psychosocial factors play a vital role in the delay in seeking medical treatment for patients with DF. Medical staff need to improve patients' illness perception as well as self‐management ability through health education. Importantly, key family members provide an emotional and psychological support system for diabetic patients. Therefore, nurses need to work with family members together to give information and psychological support during family visits. Additionally, building and maintaining trust with patients is crucial to encouraging individuals to express their concerns and worries. In this case, nurses may identify patients' negative emotions and conduct timely intervention, so as to achieve favourable outcomes. Patient or Public Contribution This study used a convenience sample of 164 participants with DF recruited from the wound clinic of Northern Jiangsu People's Hospital and Yangzhou Hospital of TCM in China.

Background: Despite advancements in acute stroke care, acute stroke patients present late for care resulting in high mortality and poor functional outcomes. This study determined the prevalence of pre-hospital delay and associated factors among adult acute stroke patients in Uganda. Methods: In a hospital based, cross-sectional study, one hundred and forty-three study participants with confirmed acute stroke presenting to the emergency units of Mulago and Kiruddu national referral hospitals were enrolled. Using an interviewer-administered questionnaire, details on sociodemographics, onset of stroke, arrival at the tertiary facility, health system and clinical factors were collected. Descriptive statistics and modified Poisson regression analyses were performed to determine factors associated with prehospital delay. Results: Among the 143 study participants, nearly two-thirds (79/146) had ischemic stroke while a third (59/143) had haemorrhagic stroke. The mean age was 59 years (SD 16) and 51.7% of acute stroke patients were males. Ninety one percent (130/143) presented to the emergency unit after 3 hours. The majority (124/143) reported visiting lower-level facilities prior to referral to the tertiary facility. Staying outside Kampala district (PR: 1.28 (1.22–1.34), p < 0.001), and using hired or government ambulance for transport to tertiary facility (PR: 1.17 (1.13–1.20), p < 0.001) were associated with pre-hospital delay. Conclusions: Prevalence of pre-hospital delay among acute stroke patients presenting to public tertiary hospitals in Uganda is very high. The causes of pre hospital delay should be further explored qualitatively. Efforts to reduce prehospital delay should include improving pre-hospital transport systems for stroke patients. [ABSTRACT FROM AUTHOR]

To study the causes of pre‐hospital delay in Chinese patients with diabetic foot ulcers (DFUs). A retrospective study, investigating a case series of 46 DFUs treated at a single hospital, was conducted to evaluate wound condition, wound treatment, costs, and patients' complete medical records, and analyse the reasons causing the pre‐hospital delay. We assessed 46 DFUs aged between 53 and 92 years old. The average pre‐hospital delay was 5 months, with nearly 20% being delayed for more than 1 year. The average length of hospital stay in China was 21 days, with an average cost of $8672. Recurrence rate of DFUs was 21%, and three patients were recommended to transfer to upper‐level hospital. Besides, the intervention was limited and homogenous and medical records were incomplete. Medical service users' limited understanding of diseases, high costs that patients need to afford, and unsatisfactory treatment by medical service providers are the main reasons for patients' delay in seeking treatment. Recommendations are offered to reduce the pre‐hospital delay of Chinese patients with DFUs. [ABSTRACT FROM AUTHOR]

Aims Pre-hospital delay refers to the time span from the onset of symptoms to arrival at a hospital ≥ 3 h and is the main limitation of stroke reperfusion therapies. Family factors and stroke-related stigma may influence pre-hospital delay. However, few studies have confirmed the influence of stigma on pre-hospital delay or explored the relationships between family function, stigma, and pre-hospital delay among patients with recurrent stroke. This study aimed to explore the relationship between family function and pre-hospital delay among patients with recurrent stroke and examine the mediation role of stigma in this relationship. Methods and results A cross-sectional study was performed at the neurology departments of two hospitals in Guangzhou, China between July 2021 and April 2022. A total of 115 patients with recurrent stroke completed questionnaires and were included in the analysis. Data were collected using the Short Form Family Assessment Device, the Stroke Stigma Scale, and the Stroke Knowledge Questionnaire. Spearman's correlation and a structural equation model were used for data analysis. Family function directly influenced pre-hospital delay [ β =0.27, P = 0.033, 95% CI = (0.02–0.51)] and indirectly influenced pre-hospital delay [ β =0.17, P = 0.038, 95% CI = (0.02–0.34)] through stigma. Moreover, stigma partially mediated the effect of family function on pre-hospital delay. Conclusion Family function and stigma directly and indirectly influenced pre-hospital delay among patients with recurrent stroke. Future health education and interventions need to focus on strengthening and improving emotional support from family members to improve family function and reduce stigma, thereby reducing pre-hospital delay among patients with recurrent stroke. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

院前延迟是急性缺血性卒中患者错过再灌注治疗时机的主要原因，常因患者不合理的就医行为决策导致。既往研究多探讨就医延迟、转运延迟等外在影响因素，较少从患者自身决策的角度进行院前延迟的分析。本文从缺血性卒中患者就医行为决策的概念、现状及其影响因素这3个方面进行总结，分析目前急性缺血性卒中患者就医行为决策中存在的问题，讨论认知、环境、心理等因素对患者就医行为决策的影响及原因，为制订针对性的干预措施提供参考。 Abstract: Pre-hospital delay is the main cause of missing reperfusion opportunity in patients with acute ischemic stroke, which is often caused by unreasonable seeking medical services decision-making. Previous studies mostly discussed the external factors such as delay in medical treatment and transport, and rarely analyzed the patient and family's own factors. Therefore, this article summarized the concept, status and influencing factors of seeking medical service decision-making for stroke patients and their families, analyzed the existing problems of seeking medical services decision-making, discussed the influence and cause of cognitive, environmental and psychological factors on patients' seeking medical service decision-making, to provide reference for making out the corresponding measures.

Objective: To identify and statistically evaluate pre-hospital delaying factors for thrombolysis in Acute Ischemic Stroke (AIS). Study Design: Cross-sectional study. Place And Duration OF Study: Emergency/Neurology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Dec 2020 to Mar 2021. Methodology: Patients older than 18 years and who reported to the emergency/Neurology clinic with stroke symptoms were included in the study. The patients or their relatives were interviewed with a detailed questionnaire that recorded patients' National Institute of Health Stroke Scale and other socio-demographic variables. In addition, the patients were grouped based on time of arrival to the hospital: Early (4.5 hours), and the variables recorded were compared with each other. Results: Of 98 patients, 71(72.5%) arrived early, and 27(27.5%) arrived late. Seventy patients (72%) were male, and 28(28%) were female. Only 18 patients availed of the ambulance service, whereas the rest of the study participants reached the hospital using private transportation. Conclusion: Female gender, NIHSS score of 10 or below and using transport other than ambulance adversely affect the hospital arrival time of acute ischemic stroke patients.

ObjectiveTo investigate the influencing factors associated with delayed time in pre-hospital emergency medical care in patients with hypertensive emergency in the main urban area of Chongqing.MethodsA total of 1 246 patients with hypertension in the main urban area of Chongqing from March 2018 to August 2021 were included in this study. The delayed time in the pre-hospital emergency medical care was determined. A multivariate linear regression model was used to analyze the influencing factors.ResultsThe delayed time in the pre-hospital emergency medical care for the patients with hypertensive emergency was concentrated in 0‒12 h， with the average of （5.89±1.96） h. The delayed time differed significantly by gender， age， history of atrial fibrillation， diabetes， educational level， time of onset， mode of transportation， awareness of hypertensive emergency， blood pressure at the onset， and presence of persons at the onset of emergency （P

Objective: The purpose was to explore the alertness of premonitory symptoms in stroke patients with prehospital delay, and to analyze the influencing factors. Design and Sample: A cross‐sectional study using the convenience sampling method was conducted in the neurology department of a general hospital between November 2018 and July 2019. A total of 352 stroke patients were participated in the survey. Measures: A hierarchical multiple regression was performed to analyze the factors related to the alertness of premonitory symptoms (0–9 scores) in stroke patients with prehospital delay. Results: The alertness score was 6.53 ± 2.377. The lowest score of 0.55 ± 0.498 was for "Continuous yawning occurs continuously despite no tiredness or lack of sleep is okay, and need not be treated." The hierarchical regression results revealed that symptom onset, symptom change before admission, knowledge, social support were the influencing factors delaying the alertness of premonitory symptoms. Knowledge and support from friends could improve the alertness, while support from family and other support had a notable negative impact. Conclusions: Stroke patients need to be more alert toward premonitory symptoms. This alertness is related to stroke knowledge and social support. Nurses should formulate interventions and advise stroke patients to improve their stroke knowledge and expand their social network. [ABSTRACT FROM AUTHOR]

Contemporary data on the epidemiology of acute myocardial infarction (AMI) in Vietnam are extremely limited. We established population-based registries of residents from 2 provinces in a northern urban (Hai Phong), and a central rural (Thanh Hoa), province of Vietnam hospitalized with a validated first AMI in 2018. We described patient characteristics, in-hospital management and clinical complications, and estimated incidence rates of AMI in these two registries. A total of 785 patients (mean age = 71.2 years, 64.7% men) were admitted to the two hospitals with a validated first AMI. Approximately 64% of the AMI cases were ST-segment-elevation AMI. Patients from Thanh Hoa compared with Hai Phong were more likely to delay seeking acute hospital care. The incidence rates (per 100,000 population) of initial AMI in Thanh Hoa and Hai Phong were 16 and 30, respectively. Most patients were treated with aspirin (Thanh Hoa: 96%; Hai Phong: 90%) and statins (both provinces: 91%) during their hospitalization. A greater proportion of patients in Hai Phong (69%) underwent percutaneous revascularization than those in Thanh Hoa (58%). The most common in-hospital complications were heart failure (both provinces:12%), cardiogenic shock (Thanh Hoa: 10%; Hai phong: 7%); and cardiac arrest (both provinces: 9%). The in-hospital case-fatality rates for patients from Thanh Hoa and Hai Phong were 6.8% and 3.8%, respectively. The incidence and hospital case-fatality rates of AMI were low in two Vietnamese provinces. Extent of pre-hospital delay and in-hospital use of evidence-based therapies were suboptimal, being more prominent in the rural province. • Contemporary data on the epidemiology of acute myocardial infarction (AMI) in Vietnam are extremely limited. • A registry of residents from 2 provinces in northern and central Vietnam hospitalized with an AMI during 2018 was established. • The incidence and hospital case-fatality rates of AMI were low in two large Vietnamese provinces. • Extent of pre-hospital delay and in-hospital use of evidence-based therapies were suboptimal. [ABSTRACT FROM AUTHOR]

Aims A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response. Methods and results A multicentre cross-sectional self-report survey study was completed at five Swedish hospitals representing geographic diversity. The 521 patients were divided into three groups based on their time to respond to symptoms: early (<20 min), intermediate (20–90 min), and late responders (>90 min). Only one out of five patients both responded early and called an ambulance within 20 min. Believing symptoms were cardiac in origin [odds ratio (OR) 2.60], male sex (OR 2.40), left anterior descending artery as culprit artery (OR 1.77), and bystanders calling an ambulance (OR 4.32) were factors associated with early response and correct action. Associated symptoms such as dyspnoea (OR 1.67) and weakness (OR 1.65) were associated with an early action (<20 min), while chest pain was not independently associated with response time. Cold sweat (OR 0.61) prevented late care-seeking behaviour as did a high symptom burden (OR 0.86). Conclusion Misinterpretation of symptoms delays correct care-seeking behaviour because patient expectations may not be aligned with the experience when stricken by Myocardial infarction. Therefore, it is imperative to continuously enhance public awareness in correct symptom recognition and appropriate care-seeking behaviour and to make efforts to educate individuals at risk for STEMI as well as their next of kin. [ABSTRACT FROM AUTHOR]

Background: For ST-segment elevation myocardial infarction (STEMI) patients presenting 24 to 48 hours from symptom onset, whether early invasive strategy should be performed still remains controversial.Methods: This is a prospective, open-label, multicenter, investigator initiated, randomized controlled trial (NCT04962178) to evaluate the efficacy of early invasive strategy for STEMI patients within 24 to 48 hours of symptom onset. A total of 366 patients will be included from 10 hospitals in mainland China. They will be randomly (1:1) divided into 2 groups: the early invasive strategy group (primary percutaneous coronary intervention, PPCI) and conservative strategy group (optimal medical therapy with primary PCI not performed). All patients will be followed for 1 month. The primary end point is myocardial infarction size on cardiac magnetic resonance (CMR). The secondary end points are as follows: (1) major adverse cardiovascular events (MACE), which is defined as a composite of cardiac death, recurrent myocardial infarction, ischemic driven target vessel revascularization and stroke; (2) other CMR end points, including microvascular obstruction, intramyocardial hemorrhage, myocardial area at risk, left ventricular ejection fraction, left ventricular end diastolic volume and left ventricular end systolic volume.Discussion: This study is designed to evaluate the efficacy of early invasive strategy for STEMI patients within 24 to 48 hours of symptom onset and will add more evidence for clinical practice.Trial Registration: ClinicalTrials.gov Identifier: NCT04962178. Registered on July 14, 2021. [ABSTRACT FROM AUTHOR]

Background and objectives: The time interval between stroke onset and hospital arrival is a major barrier for reperfusion therapies in acute ischemic stroke and usually accounts for most of the onset-to-treatment delay. The present study aimed to analyze the pre-hospital delays for patients with acute ischemic stroke admitted to a tertiary stroke center in Romania and to identify the factors associated with a late hospital arrival. Material and methods: The study population consisted of 770 patients hospitalized with the diagnosis of acute ischemic stroke in the University Emergency Hospital Bucharest during a 6-month period, between 1 January and 30 June 2018. Data regarding pre-hospital delays were prospectively collected and analyzed together with the demographic and clinical characteristics of the patients. Results: In total, 31.6% of patients arrived at the hospital within 4.5 h from stroke onset and 4.4% in time intervals between 4.5 and 6 h from the onset, and 28.7% of the patients reached the hospital more than 24 h after onset of symptoms. Transport to hospital by own means was the only factor positively associated with arrival to hospital > 4.5 h from stroke onset and more than doubled the odds of late arrival. Factors negatively associated with hospital arrival > 4.5 h after stroke onset were prior diagnosis of atrial fibrillation, initial National Institute of Health Stroke Scale (NIHSS) score ≥ 16 points, presence of hemianopsia, facial palsy and sensory disturbance. Factors increasing the odds of hospital arrival after 24 h from stroke onset were living alone and living in rural areas. Conclusions: Almost one in three ischemic stroke patients presenting to our center reaches hospital more than 24 h after onset of symptoms. These findings highlight the need for urgent measures to improve not only stroke awareness but also pre-hospital protocols in order to provide timely and appropriate care for our stroke patients. [ABSTRACT FROM AUTHOR]

Pre-hospital delay is the major cause of stroke treatment delay, and behavioral intention is considered to be the most direct predictor of behavior. Therefore, to effectively reduce stroke pre-hospital delay, it is essential to further understand the relationship between stroke pre-hospital delay intention (SPDBI) and its social-psychological influencing factors, namely personality traits, social support and coping style. This study aims at examining the relationships among personality traits, coping style, social support, and SPDBI. A cross-sectional, self-administered questionnaire was distributed to 845 residents. The content of the questionnaire included demographic information, the knowledge of "Stroke 120", Ten-Item Personality Inventory-Chinese version, Simplified Coping Style Questionnaire, Perceived Social Support Scale and SPDBI Scale. Path analysis was used to investigate the relationship among SPDBI and its psychosocial influencing factors. The final path model showed a good fit to the data (χ2/df = 2.981, RMSEA = 0.048, GFI = 0.936, CFI = 0.941). Extroversion (β = 0.106), positive coping (β = −0.110), negative coping (β = 0.150) and the knowledge of "Stroke 120" (β = −0.152) had only direct effects on SPDBI. While agreeableness (β = 0.113), openness (β = −0.121) and social support (β = −0.118) had direct effects on SPDBI, they also had indirect effects (β = −0.009; −0.022; −0.049) on SPDBI though positive coping. Adequate social support and positive coping of health threat may reduce residents' SPDBI. Meanwhile, the interventions to reduce SPDBI should take personality differences into consideration. • Social support is one of most significant influencing factor of stroke pre-hospital delay behavioral intention (SPDBI). • Extroversion and agreeableness increase SPDBI, and openness decrease SPDBI. • Positive coping mediates the effects of agreeableness, openness and social support on SPBBI. [ABSTRACT FROM AUTHOR]

Colorectal cancer is one of the leading cancers among Thai people. Delay in cancer diagnosis can lead to poor prognosis and survival, and one concern is pre-hospital delay. The purpose of this study aimed to describe time delays in diagnosis including pre-hospital and in-hospital delays and examine predictors of pre-hospital delay. From June to August 2021, two hundred and forty people with colorectal cancer were recruited from three regional hospitals in Thailand. Data were collected using the Personal Information Sheet, Colorectal Cancer Knowledge Questionnaire, Modified Illness Perception Questionnaire, Healthcare Seeking Behavior Questionnaire, and Perceived Seriousness of Warning Signs and Symptoms Questionnaire. Descriptive statistics, Pearson's and Spearman's correlation coefficients, and multiple regression analysis were used in data analysis. Results revealed that total time delays in diagnosis were between 4 to 656 days. Pre-hospital delay varied between 1 to 632 days, and in-hospital delay ranged from 2 to 315 days. Medians of total time delays in diagnosis, pre-hospital delay, and in-hospital delay were 87.50 days, 32 days, and 28.50 days, respectively. Knowledge about the colorectal cancer screening method was the strongest predictor, and jointly with healthcare seeking behavior about self-medicating, illness perception including consequence of disease and symptoms, and rehappened symptoms significantly predicted and explained 48.70% of the variances in pre-hospital delay. Implications for nursing practice should focus on improving knowledge of the disease, modifying illness perceptions, and enhancing healthcare seeking behaviors to decrease pre-hospital delay. This intervention should be tested through an experimental study. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: Pese a los recientes avances en el manejo agudo del ictus, se aplican terapias de reperfusión a menos de un 10% de los pacientes. Una de las causas es el retraso en la búsqueda de atención médica por el paciente y sus familiares, que analizaremos a continuación. Métodos: Se realizó un estudio observacional, prospectivo, en pacientes consecutivos con ictus o accidente isquémico transitorio. Se recogieron parámetros sociodemográficos y clínicos, y datos sobre el retraso en la decisión, retraso prehospitalario y el tipo de contacto médico seleccionado. Se realizaron análisis descriptivo, bivariante y multivariante para determinar los factores relacionados con la búsqueda de atención médica en los primeros 15 minutos. Resultados: Se recogieron 382 pacientes. Un 24,9% decidió solicitar atención médica en los primeros 15 minutos. Lo favorecieron la severidad del evento (OR: 1,08; IC 95%: 1,04-1,13; p

Abstract Background Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). This study aimed to investigate the significant factors associated with prolonged pre-hospital delay and the impact of this delay on in-hospital mortality among patients with MI in Northern Bangladesh. Methods This cross sectional study was conducted in December 2019 in cardiology ward of a 1000-bed tertiary care hospital of Bangladesh. Patients admitted in the ward with the diagnosis of myocardial infarction were included in the study. Socio demographic data, clinical features and patients’ health seeking behavior was collected in a structured questionnaire from the patients. Median with interquartile range (IQR) of pre hospital delay were calculated and compared between different groups. Chi-square (χ2) test and binary logistic regression were used to estimate the determinants of pre-hospital delay and effect of pre-hospital delay on in-hospital mortality. Results Three hundred thirty-seven patients was enrolled in the study and their median (IQR) pre-hospital delay was 9.0 (13.0) hours. 39.5% patients admitted in the specialized hospital within 6 h. In logistic regression, determinants of pre-hospital delay were patients age (for

Within cardiac research, an overwhelming number of studies have explored factors related to pre-hospital delay. However, there is a knowledge gap in studies that explore the bystander's experiences or significance when an individual is affected by acute coronary syndrome (ACS). We conducted an interview study with 17 individuals affected by ACS and the bystander(s) involved and performed a qualitative thematic analysis. In the pre-hospital phase, the bystander moved from suspicion of illness to recognition of illness while trying to convince the individual affected by ACS (p-ACS) to respond to bodily sensations. This led to conflicts and dilemmas which affected the bystander both before and after the p-ACS was hospitalized. Bystanders may influence pre-hospital delay in both positive and negative direction depending on their own knowledge, convictions, and the nature of their interaction with the p-ACSs. The bystander's influence during the pre-hospital delay is more extensive than previously recognized. [ABSTRACT FROM AUTHOR]

Introduction: stroke is a cerebrovascular disease. Early reperfusion in neurovascular units can reduce its morbidity and mortality. Even when neurovascular units exist, patients usually arrive late in the emergency department. to the purpose of this study was to determine prehospital delay in patients with acute ischemic stroke and associated factors. Methods: we conducted a retrospective cross-sectional study in the neurology department of the Fann University Hospital in Dakar from January 1st to June 30th, 2020. We included patients younger than 80 years seen in the emergency unit for ischemic stroke. The median time to presentation was calculated based on the time of stroke onset and that of arrival at the hospital. Multivariate analysis was used to determine factors associated with prehospital delay. Results: a total of 56 patients were enrolled, among whom 58.6% arrived at the hospital in less than 3 hours. Of them, 37.5% presented to a level 3 or 4 hospital first. Less than 34% of our patient presented to a level 2-3 hospital in less than 3 hours. Based on bi- and multivariate analysis, being married (OR = 7.2 [CI à 95%: 1.5 - 35.8]), being a female (OR = 5.5 [CI à 95%: 1.5 -19.8]) and having stroke during week days (OR = 4.3 [CI à 95%: 1.3-13.9]) were associated with prehospital delay. Conclusion: most of our patients arrived late at a level 2 or 3 hospital. Being a married woman increased the risk of late arrival. This study highlights the importance of improving awareness in order to increase the proportion of patients potentially eligible for revascularization. [ABSTRACT FROM AUTHOR]

Background: Pre-hospital delays contribute to late arrival for acute ischemic stroke (AIS) treatment in the emergency department and are an important barrier preventing people from receiving thrombolytic therapy. This study looked into the factors causing pre-hospital delay in a tertiary care centre in South India with the aim of identifying measures to decrease pre-hospital delay. Methods: Consecutive cases of AIS from October 2018 to June 2019 were included. A structured questionnaire was used to collect data regarding demographic details, presenting symptoms, time of stroke onset and arrival, mode of transport and knowledge about stroke and thrombolysis. Pre-hospital delay was defined as > 4 h (Considering our door-to-needle time of 30 min) between stroke onset or the time point of wake‐up and the time of arrival. Results: Overall, 505 patients were enrolled. Prehospital delay was observed in 352patients (69.7%). The median pre-hospital delay was 9.5 h. In the multivariable analysis, the odds of early arrival were increased in patients who perceived the initial symptoms as serious (OR: 45.57; 95%CI, 11.43–181.63), those with prior knowledge of stroke symptoms (OR: 4.64; 95% CI, 1.86–11.55), those using ambulance services (OR: 3.11; 95% CI, 1.39–6.95), and those developing hemiparesis (OR: 2.50; 95% CI, 1.25–4.97). The odds of early arrival were lower in those visiting their family doctor after the stroke (OR: 0.17; 95%CI, 0.05–0.51). Conclusions: Modifiable factors related to stroke recognition and response behavior continue to cause significant pre-hospital delay in India. There is an immediate need for a strong education campaign focusing on stroke specific knowledge to decrease pre-hospital delay.

Background: Health literacy (HL) is a risk factor for adverse outcomes in patients with cardiovascular disease, and shorter pre-hospital delay time is crucial for successful treatment of acute myocardial infraction (AMI) patients. Most previous studies focused on the influencing factors of pre-hospital delay but ignore the essential contribution of decision delay.Aims: Therefore, the purpose of this study was to explore the effect of HL on decision delay.Methods: Continuously included AMI patients admitted to a grade A class three hospital in Chongqing. HL level was assessed using Brief Health Literacy Screen and categorized as adequate or inadequate. Mann-Whitney U-test and Chi-square test were used to compare the differences between groups, and binary logistic regression was used to analyze the association between HL and decision delay.Results: A total of 217 AMI patients were enrolled in this study, including 166 males (76.5%) and 51 females (23.5%), with the median age was 68 years old; 135 (62.2%) patients had delayed decision-making while 82 (37.8%) did not; 157 (72.7%) patients had inadequate HL and 59 (27.3%) had adequate HL. The total HL score of non-delayed group was higher than that in delayed group (9.22 vs. 7.02, P < 0.000).Conclusion: After adjusting for covariates, HL was significantly negatively associated with decision time. AMI patients with inadequate HL were more likely to delay seeking timely medical care.

Introduction: Incidence of chest pain and discomfort varies in general population between 2 % and 5 %. Total prehospital delay involves two components: the time it takes for patients to recognise their symptoms as severe and seek medical attention, ie the decision-making time, and the time from seeking help to hospital admission, ie the transport time. Scope of the study was to analyse time loss in patients with chest pain hesitating to contact healthcare services, as well as distribution of acute myocardial infarction (AMI) and angina pectoris (AP) among them. Methods: Retrospective analysis of medical records of physicians working at the emergency medical services (EMS) Department of the City of Belgrade, Serbia, from 20 April 2006 to 22 July 2013 on a total of 5,310 completed field interventions. When placing a call to the EMS, 10.43 % of patients cited chest pain as a major symptom. After deducting all those ones who denied having the symptom on examination thereafter and those for whom there were no data, 349 patients remained, ie 6.57 % of the total number of calls available for analysis. Results: The average time between the onset of chest pain and the decision to call the EMS was 11.97 h, median 2 h and mode 1 h. Patient's minimum prehospital delay was 2 min and the maximum was 20 days. Most patients who experienced chest pain or discomfort waited less than an hour before calling the EMS. Most commonly diagnoses made for a symptom of chest pain were AMI and AP, ie AMI with 12.32 % of the total diagnoses, as well as the elevated arterial pressure. There were more female patients, with no difference found among the age groups. Conclusion: For the majority of patients with chest pain and discomfort presented in this paper the decision-making time was up to one hour, with cardiovascular causes being the at the top of the list.

Abstract Background Intravenous thrombolysis has been recently introduced in Nepal for the management of acute ischemic stroke. Pre-hospital delay is one of the main reasons that hinder thrombolytic therapy. The objective of this study was to evaluate the status of prehospital delay and thrombolysis in Nepal. Methods Data were prospectively collected from patients of both genders, age > 18 years who arrived at the emergency department (ED) with symptoms and neuroimaging findings consistent with an ischemic stroke. Patient data were obtained from ED form and standard questionnaires were used to assess factors resulting in prehospital delay. Modified Rankin scale and National Institute of Health stroke scale were used to assess the degree of disability and severity of stroke respectively. Results A total of 228 patients were enrolled in the study between August 2017 and August 2018. Only 46 (20.17%) patients arrived within the time frame for thrombolysis. Onset at daytime (OR: 4.07; 95% CI: 1.65–10.1; p = 0.001), stroke symptoms facial deviation (OR: 5.03; 95% CI: 2.47 to 10.26; p = 0.000) and speech disturbances (OR: 2.34; 95% CI: 1.06 to 5.1; p = 0.021), identification of stroke (OR: 22.36; 95% CI: 9.42–53.04;p = 0.000), rushing to ED after onset of symptoms (OR: 2.93; 95% CI: 1.5–5.7; p = 0.001), awareness of treatment of stroke (OR: 10.21; 95% CI: 4.8–21.6; p = 0.000), direct presentation (OR: 4.2; 95% CI: 2.09–8.66; p = 0.000), the distance less than 20 km (OR: 7.9; 95% CI: 3.8–16.5; p = 0.000), and education above high school (OR:4.85; 95% CI: 2.2–10.5; p = 0.000) were associated with early arrival. Heavy traffic, income below 1000 USD per annum and diabetes mellitus were associated with delayed arrival to ED. Out of 46 early arrival patients, only 30 patients (13.15%) received tissue plasminogen activator during the study period, while others were deprived because of their inability to afford the treatment cost. Conclusion Community-based intervention to spread awareness, establishing comprehensive stroke centers, training specialists, improving emergency services, establishment of telestroke facilities and encouraging the use of low-cost tenecteplase as an alternative to alteplase can help improve care for stroke patients in Nepal.

Background and objectives: The time interval between stroke onset and hospital arrival is a major barrier for reperfusion therapies in acute ischemic stroke and usually accounts for most of the onset-to-treatment delay. The present study aimed to analyze the pre-hospital delays for patients with acute ischemic stroke admitted to a tertiary stroke center in Romania and to identify the factors associated with a late hospital arrival. Material and methods: The study population consisted of 770 patients hospitalized with the diagnosis of acute ischemic stroke in the University Emergency Hospital Bucharest during a 6-month period, between 1 January and 30 June 2018. Data regarding pre-hospital delays were prospectively collected and analyzed together with the demographic and clinical characteristics of the patients. Results: In total, 31.6% of patients arrived at the hospital within 4.5 h from stroke onset and 4.4% in time intervals between 4.5 and 6 h from the onset, and 28.7% of the patients reached the hospital more than 24 h after onset of symptoms. Transport to hospital by own means was the only factor positively associated with arrival to hospital > 4.5 h from stroke onset and more than doubled the odds of late arrival. Factors negatively associated with hospital arrival > 4.5 h after stroke onset were prior diagnosis of atrial fibrillation, initial National Institute of Health Stroke Scale (NIHSS) score ≥ 16 points, presence of hemianopsia, facial palsy and sensory disturbance. Factors increasing the odds of hospital arrival after 24 h from stroke onset were living alone and living in rural areas. Conclusions: Almost one in three ischemic stroke patients presenting to our center reaches hospital more than 24 h after onset of symptoms. These findings highlight the need for urgent measures to improve not only stroke awareness but also pre-hospital protocols in order to provide timely and appropriate care for our stroke patients.

Background and objective Khyber Pakhtunkhwa is the third largest province of Pakistan by population and has a high incidence of ischemic stroke. We evaluated all patients who presented to the largest tertiary care facility in the province to learn about the current trends in the management of ischemic stroke and explore future opportunities in this regard.  Materials and methods This prospective observational research was carried out at the Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, in the province of Khyber Pakhtunkhwa (KP). The hospital's ethics committee granted the required permissions for the research. Any patient with an ischemic stroke diagnosis, regardless of age, met the inclusion criteria if their diagnosis was confirmed by clinical assessment, imaging (such as CT or MRI), or both. The clinical parameters that were evaluated included the duration since the patient's reported onset of symptoms, the patient's first mode of transfer to the hospital (such as ambulance, private vehicle, or other means), and the date and time of admission to the hospital. A structured database containing the data was utilized, and IBM SPSS Statistics for Windows, Version 25 (released 2017; IBM Corp., Armonk, New York, United States) was used for statistical analysis. Results One hundred fifty-six stroke patients were diagnosed throughout the study period, with 76 of them having an ischemic stroke, accounting for 49% of all stroke cases. Approximately 43% (n = 33) of the patients were from Peshawar, with the remaining patients coming from adjacent districts. There was only a small percentage (19%, n = 15) of patients who were eligible for any thrombolytic therapy, and the majority (93%) were brought by private vehicles. There was a significant association between age and arrival in the emergency room (p = 0.003). Conclusion The study reveals subpar ischemic stroke management in Khyber Pakhtunkhwa, requiring coordinated efforts, modernization of treatment methods, and increased public awareness to improve patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Review Board issued approval 175/23. Permission was granted to Dr. Sami Ullah Khan for conducting the study presenting with ischemic stroke patients at the Lady Reading Hospital Medical Teaching Institute (MTI), Peshawar. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mehmood et al.)

INTRODUCTION We sought to identify predictors for a prolonged delay from first medical contact to revascularisation (FMC-R) in ST-segment elevation myocardial infarction (STEMI) patients at our institution and to assess the impact of a prolonged treatment delay on 3-year clinical outcome. MTHODS EVALFAST is a prospective and retrospective registry enrolling all patients admitted directly from pre-hospital care to the catheterisation laboratory at Fribourg Hospital for suspected STEMI, starting in June 2008. Relevant patient and procedural data were collected retrospectively and prospectively. Clinical follow-up was performed by phone or clinic visit. Patients were divided into two groups: FMC-R interval

Abstract Background Stroke is a leading cause of death and disability with effective treatment, including thrombolysis or thrombectomy, being time-critical for favourable outcomes. While door-to-needle time in hospital has been optimized for many years, little is known about the ambulance on-scene time (OST). OST has been reported to account for 44% of total alarm-to-door time, thereby being a major time component. We aimed to analyse ambulance OST in stroke patients eligible for thrombolysis and identify potential areas of time optimization. Methods A study-specific registration form was developed to record detailed information about OST consumption in cases where the Emergency Medical Services (EMS) suspected a stroke from July 2014–May 2015. Registration forms were completed by ambulance personnel and included details on estimated time spent: 1) localising patient, 2) clinical examination, 3) consulting with the on-call neurologist, 4) mobilising patient to the ambulance, 5) treatment in ambulance before departure. Additionally, estimated total OST was noted. For patients found eligible for further evaluation at a stroke centre, time points were analysed using multivariate Poisson regressions. Results A total of 520 cases were included. The median OST was 21 min (Interquartile Range (IQR) 16–27). Time consumption was significantly lower (17 vs 21 min, p = 0.0015) when electrocardiography (ECG) was obtained in-hospital instead of on-scene, when intravenous (IV) access was established during transportation instead of before transportation (17 vs 21 min, p

Background and Purpose: This study tests the hypothesis that middle school and high school students can improve their stroke knowledge using Stroke 1-2-0, a stroke educational tool, and pass this knowledge on to their family members.Methods: A total of 625 students and 198 parents/grandparents participated in learning about stroke using Stroke 1-2-0. After a group training session for the students by a neurologist at school, the students took educational material to home and educated their parents/grandparents. A questionnaire was given to students, parents/grandparents before, immediately after, and 1 year after the educational event.Results: All participants agreed that Stroke 1-2-0 was a much easier tool to remember than FAST. Almost all the students (96.4%) remembered the meaning of Stroke 1-2-0 as compared to 7.3% from the base line (p < 0.001). The rate of complete Stroke 1-2-0 mastery from 96.3% fell to 84.4% at 3 months and 63.8% at 1 year after training (p < 0.001). Following education from children, the proportion of parents/grandparents who mastered Stroke 1-2-0 was significantly higher than baseline (79.9 vs. 24.8%).Conclusion: Middle school and high school students can effectively use Stroke 1-2-0 to improve their stroke knowledge and pass this knowledge to their family members. Sustained educational efforts and repeated educational events are needed though.

Objective. To explore the explanatory factors for ambulance response time. Methods. Four area quarters were delimited in the city geographical territory, based on natural barriers and large crossover roads. These zones were further considered for analysis of the call data over the year 2018, in a cross-sectional study design. The data collected by the Ambulance Service of Timis County on all solved cases comprised the city streets with: (a) the total number of calls and the four-level emergency number of calls for each; (b) minimum, maximum, and average response time. Additionally, for each street, the geographical coordinates (latitude and longitude) were approximated and the distance to the corresponding dispatch center was calculated based on the equirectangular approximation. Descriptive statistics and a multi-variable GLM model were applied for data analysis, with further Bonferroni adjustments for post-hoc comparisons. Results. Although the number of calls and the patterns of priority were indistinctive within the four zones, we found significant differences between the response times in the northern and southern zones, with differences of up to 3 minutes in the estimated arrival time. Statistically significant area-related differences were observed in the predictive factors for the response time: distance to the dispatch center and emergency code. Conclusions. A supplementary dispatch center in the northern area would help improving the ambulance time to arrival and compensating the differences between North and South of Timisoara.

Abstract Background The characteristics of patients with on-going myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients. Methods This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014. Results A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66±11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (p

Background and purpose: Treatment time is one of the main issues in myocardial infarction. The aim of this study was to investigate the factors affecting the time to treatment in patients with acute myocardial infarction in Zanjan hospitals. Materials and methods: A descriptive-correlational study was performed in 200 patients with myocardial infarction admitted to educational hospitals in Zanjan, Iran, 2016. Demographic data and time intervals between the pain onset and treatment were collected using a researcher-made questionnaire. Data were analyzed in SPSS V16 applying t-test and linear regression model. Results: Median time between onset of pain and hospital arrival was 330.68±411.55 minutes and Door to Balloon Time or Door to Needle Time was 75.15±181.64 minutes. The time to treatment was found to have a significant association with residence in rural areas (P= 0.04), misinterpretation of symptoms (P= 0.01), inadequate income (P 60 years of age and living in villages. In fact, this would help such patients to receive appropriate treatments at a significantly shorter time.

Acute Coronary Syndrome (ACS) is a cardiac emergency condition that requires fast and precise action while a pre-hospital delay in a patient to come to the ED is still common. This pre-hospital delay is related to the socioeconomic and knowledge factor. The purpose of this study is to determine the relationship of socioeconomic and knowledge with the pre-hospital delay of ACS patients to come to Integrated Heart Service in Emergency Department of Sanglah General Hospital, Denpasar. This research is a quantitative research with cross-sectional design and purposive sampling as data collection technique with 292 patients. The results showed that 55.8% of patients have low socioeconomic status and there are 71.6% of patients who do not know ACS. The pre-hospital delay, in this case, is associated with low socioeconomic status and knowledge of ACS so that health workers need to provide counseling to patients and families about ACS signs and symptoms, healthy lifestyles, and the importance of coming to theemergency department when signs of ACS are felt.

Objectives: To assess the various delays in the timeline of STEMI, its determinants, and impact on in-hospital outcomes. Methodology: In this study we included STEMI patients who were either presented late to ER or procedure was delayed. Pre-hospital delay was defied as chest pain (CP) to ER arrival time ≥120 minutes and hospital delay was defined as ER to procedure time ≥90 minutes. Reasons for prehospital and hospital delays and in-hospital complications and outcomes were recorded. Results: A total of 103 patients, 72.8%(75) male, with mean age of 54.75±11.8 years were enrolled. Median duration between CP and ER arrival 240[420-144.5] minutes with ≥120 minutes for 89.3%(92). Procedure was performed in 120[180-60] minutes of ER arrival with ≥90 minutes for 61.2% (63). Pre-hospital delay was caused by unawareness of symptoms (53.3%) followed by unavailability of transportation (29.3%), while, hospital delayed was caused by unavailability of resources (69.8%). Pre-hospital delay of ≥360 minutes was associated with higher rate of LV thrombus, 21.4% vs. 1.3%; p<0.001, and in-hospital re-current ischemia, 32.1% vs. 12%; p=0.017. Conclusions: In this study we observed that the most common causes of pre-hospital delay in our population are unawareness of symptomology and unavailability of transportation, while, the major cause of hospital delay was unavailability resources. Pre-hospital delay was associated with significantly higher rate of LV thrombus and in-hospital re-current ischemia. [ABSTRACT FROM AUTHOR]

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Background: Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). This study aimed to investigate the significant factors associated with prolonged pre-hospital delay and the impact of this delay on in-hospital mortality among patients with MI in Northern Bangladesh.Methods: This cross sectional study was conducted in December 2019 in cardiology ward of a 1000-bed tertiary care hospital of Bangladesh. Patients admitted in the ward with the diagnosis of myocardial infarction were included in the study. Socio demographic data, clinical features and patients' health seeking behavior was collected in a structured questionnaire from the patients. Median with interquartile range (IQR) of pre hospital delay were calculated and compared between different groups. Chi-square (χ2) test and binary logistic regression were used to estimate the determinants of pre-hospital delay and effect of pre-hospital delay on in-hospital mortality.Results: Three hundred thirty-seven patients was enrolled in the study and their median (IQR) pre-hospital delay was 9.0 (13.0) hours. 39.5% patients admitted in the specialized hospital within 6 h. In logistic regression, determinants of pre-hospital delay were patients age (for < 40 years aOR 2.43, 95% CI 0.73-8.12; for 40 to 60 years aOR 0.44, 95% CI 0.21-0.93), family income (for lower income aOR 5.74, 95% CI 0.89-37.06; for middle income aOR 14.22, 95% CI 2.15-94.17), distance from primary care center ≤5 km (aOR 0.42, 95% CI 0.12-0.90), predominant chest pain (aOR 0.15, 95% CI 0.05-0.48), considering symptoms as non-significant (aOR 17.81, 95% CI 5.92-53.48), referral from primary care center (for government hospital aOR 4.45, 95% CI 2.03-9.74; for private hospital OR 98.67, 95% CI 11.87-820.34); and not having family history of MI (aOR 2.65, 95% CI 1.24-5.71) (R2 = 0.528). Risk of in-hospital mortality was almost four times higher who admitted after 6 h compared to their counterpart (aOR 0.28, 95% CI 0.12-0.66); (R2 = 0.303).Conclusion: Some modifiable factors contribute to higher pre-hospital delay of MI patients, resulting in increased in-hospital mortality. Patients' awareness about cardiovascular diseases and improved referral pathway of the existing health care system may reduce this unexpected delay. [ABSTRACT FROM AUTHOR]