Stroke awareness and factors influencing hospital arrival time: a prospective observational study
Wongwiangjunt, S.; Komoltri, C.; Poungvarin, N.; Nilanont, Y.
Journal of the Medical Association of Thailand 98(3): 260-264
2015
ISSN/ISBN: 0125-2208 PMID: 25920295 Document Number: 16821
To evaluate the efficacy ofprobiotics, Lactobacillus casei (Shirvta strain), in reducing the incidence ofventilator- associated pneumonia (VAP) in medical patients who received mechanical ventilation at Siriraj Hospital. A prospective, randomized, open-label controlled trial was conducted in 150 adult hospitalized patients in medical wards who were expected to receive mechanical ventilation for 72 hours or longer: The patients were randomized to the probiotics group or the control group. All patients received regular care for mechanical ventilation. The patients in the probiotics group received 80 ml of Lactobacillus casei (Shirota strain) for oral care after having standard oral care once daily and additional 80 ml of the aforementionedfermented dairy product was given via enteralfeeding once daily. The primary outcomes were incidence of VAP and incidence rate of VAP episodes per 1,000 ventilator-days. The secondary outcomes were length ofhospital stay, mortality at day 28 and 90, incidence ofdiarrhea, andpresence of resistant bacteria in oropharyngeal and rectal swab samples taken from the patients at baseline, day 7 and day 28 after enrollment. The baseline characteristics of the patients in the probiotics group (75) and the control group (75) were not significantly different. The patients in the probiotics group were less likely to develop VAP compared with the control group (24% vs. 29.3%, p = 0.46), respectively. The incidence rates of VAP in the probiotics and control groups were 22.64 and 30.22 episodes per 1,000 ventilator-days, respectively (p = 0.37). A trend of lower prevalence of some resistant bacteria cultured from oropharyngeal swabs in the probiotics group than that in the control group was observed. Overall 28- and 90-day mortality and length of hospital stay of the patients in both groups were not significantly different. Administration of probiotics containing Lactobacillus casei (Shirota strain) has a tendency to reduce the incidence of VAP and colonization with resistant bacteria in oropharyngeal cavity without significant effects on mortality and length of hospital stay. Data concerning stroke awareness and factors associated with time of hospital arrival for acute stroke patients in Thailand are still lacking. To assess stroke awareness and to identify factors influencing hospital arrival time after an acute stroke. This is aprospective study comprising consecutive acute stroke patients admitted in Siriraj Hospital, Bangkok, Thailand between August 2010 and December 2011. Demographic data, stroke severity using the NIHSS, diagnosis and stroke awareness questionnaire were collected. Of 217 acute stroke patients, mean age was 66 ± 13.7 years. Mean stroke severity was 10 ± 7.6. Patients arrived at the Emergency Department within 4.5 hours (early hospital arrival: EHA) in 38.2% of the cases, 16.6% by ambulance. Only 34.6% of patients recognized that they were having stroke. Factors associated with EHA were 1) stroke awareness (OR 1.96, 95% CI 1.07-3.60, p = 0.030), 2) arrival by ambulance (OR 2.23, 95% CI 1.03-4.81, p = 0.042), and 3) NIHSS >15 (OR 2.26, 95% CI 1.17-4.35, p = 0.015). Only one-third of patients were aware of stroke symptoms. Only one in six patients used emergency transportation. Public educational campaign is needed to increase the community awareness of stroke warning symptoms and the urgent emergency medical services.
Document emailed within 1 workday
