Uncertainty as a Key Influence in the Decision To Admit Patients with Transient Ischemic Attack

Background Patients with transient ischemic attacks (TIA) are at high risk of subsequent vascular events. Hospitalization improves quality of care, yet admission rates for TIA patients vary considerably. Objectives We sought to identify factors associated with the decision to admit patents with TIA. Design We conducted a secondary analysis of a prior study’s data including semi-structured interviews, administrative data, and chart review. Participants We interviewed multidisciplinary clinical staff involved with TIA care. Administrative data included information for TIA patients in emergency departments or inpatient settings at VA medical centers (VAMCs) for fiscal years (FY) 2011 and 2014. Chart reviews were conducted on a subset of patients from 12 VAMCs in FY 2011. Approach For the qualitative data, we focused on interviewees’ responses to the prompt: “Tell me what influences you in the decision to or not to admit TIA patients.” We used administrative data to identify admission rates and chart review data to identify ABCD2 scores (a tool to classify stroke risk after TIA). Key Results Providers’ decisions to admit TIA patients were related to uncertainty in several domains: lack of a facility TIA-specific policy, inconsistent use of ABCD2 score, and concerns about facilities’ ability to complete a timely workup. There was a disconnect between staff perceptions about TIA admission and facility admission rates. According to chart review data, staff at facilities with higher admission rates in FY 2011 reported consistent reliance on ABCD2 scores and related guidelines in admission decision-making. Conclusions Many factors contributed to decisions regarding admitting a patient with TIA; however, clinicians’ uncertainty appeared to be a key driver. Further quality improvement interventions for TIA care should focus on facility adoption of TIA protocols to address uncertainty in TIA admission decision-making and to standardize timely evaluation of TIA patients and delivery of secondary prevention strategies

A Q-methodology study of patients' subjective experiences of TIA

Background. An expanding body of research has focused on a range of consequences of TIA. However, no work has been conducted on the patient’s subjective experience of TIA. Aim. To capture patients’ first-hand experiences of TIA. Method. Using Q-methodology which employs both qualitative and quantitative approaches, 39 statements relating to the clinical, physical, affective, and psychological impact of TIA were distilled from the literature and from patient narratives. Consistent with conventional Q-methodology, a purposive sample of twentythree post-TIA patients sorted these statements into a normally-distributed 39-cell grid, according to the extent to which each represented their experience of TIA. Results. Casewise factoranalysis was conducted on the sorted statements. Eight factors emerged which were labelled: lack of knowledge/awareness of TIA; life impact; anxiety; interpersonal impact; depression; physical consequences; cognitive avoidance/denial; constructive optimism. Conclusions. Five of the eight factors confirmed existing research on the impact of TIA, but three new issues emerged: deep-seated anxiety, denial and constructive optimism. The emerging perspectives highlight areas to target in the management of TIA and could inform health education messages, patient information, individualised caremanagement, and enhancement of coping strategies. With development, the findings could be used as a basis for psychometric risk assessment of TIA patients

Transient neurological symptoms in the older population:report of a prospective cohort study--the Medical Research Council Cognitive Function and Ageing Study (CFAS)

Transient ischaemic attack (TIA) is a recognised risk factor for stroke in the older population requiring timely assessment and treatment by a specialist. The need for such TIA services is driven by the epidemiology of transient neurological symptoms, which may not be caused by TIA. We report prevalence and incidence of transient neurological symptoms in a large UK cohort study of older people

Application of Trend Impact Analysis for predicting future fruit consumption

Knowledge of those aspects that motivate consumers towards more fruit consumption is necessary in order to implement policies to stimulate fruit consumption. To predict future fruit consumption based on such knowledge from experts, and based on historic consumption data, the method of Trend Impact Analysis (TIA) was applied to four countries. From the historic data, a trend or baseline has been estimated. TIA combines this information with expert knowledge to forecast future consumption. A Monte Carlo simulation was used to handle uncertainty in the TIA model thus developed. Despite the disadvantages of TIA, the method is suitable to explain a trend by means of impact factors, and offers an opportunity to deal with uncertain prognoses by experts. TIA is a relatively unknown method and requires more research and experience to judge if it is widely applicable, and if it provides a good alternative to more traditional forecasting methods

Benefit-risk profile of cytoreductive drugs along with antiplatelet and antithrombotic therapy after transient ischemic attack or ischemic stroke in myeloproliferative neoplasms

We analyzed 597 patients with myeloproliferative neoplasms (MPN) who presented transient ischemic attacks (TIA, n = 270) or ischemic stroke (IS, n = 327). Treatment included aspirin, oral anticoagulants, and cytoreductive drugs. The composite incidence of recurrent TIA and IS, acute myocardial infarction (AMI), and cardiovascular (CV) death was 4.21 and 19.2%, respectively at one and five years after the index event, an estimate unexpectedly lower than reported in the general population. Patients tended to replicate the first clinical manifestation (hazard ratio, HR: 2.41 and 4.41 for recurrent TIA and IS, respectively); additional factors for recurrent TIA were previous TIA (HR: 3.40) and microvascular disturbances (HR: 2.30); for recurrent IS arterial hypertension (HR: 4.24) and IS occurrence after MPN diagnosis (HR: 4.47). CV mortality was predicted by age over 60 years (HR: 3.98), an index IS (HR: 3.61), and the occurrence of index events after MPN diagnosis (HR: 2.62). Cytoreductive therapy was a strong protective factor (HR: 0.24). The rate of major bleeding was similar to the general population (0.90 per 100 patient-years). In conclusion, the long-term clinical outcome after TIA and IS in MPN appears even more favorable than in the general population, suggesting an advantageous benefit-risk profile of antithrombotic and cytoreductive treatment

COMMISSIVE ILLOCUTIONARY ACT ACROSS LANGUAGES: JAVANESE AND MANDARESE

Commissive is one of illocutionary acts which mean the speaker commits a certain action in the future. This study examines the realization of commissive of promising across languages in Indonesia (Javanese and Mandarese). The method used in this study is descriptive qualitative based on Searle’s (1976) theory. The sources of the data are based on the researchers’ intuition as native speakers. The procedure of analyzing the data is by identifying the characteristics of commissive of promising in two languages. The result shows that in Javanese, promising can be performed by “ya”, “tenan”, “mengko”, “saestu”, “mangke”, and “sesuk”. Meanwhile, in Mandarese, promising can be performed by “iye”, “mangaku a”, “ya iyo”, “pa”,“manini”,“majanji a”, “manu pa”, “pura pa”, “banda tia”, “penuhi tia”, “pennassai i”, “pelambi’i tia”, and “kalamanna”. Komisif adalah salah satu tindak ilokusi yang berarti penutur berkomitmen untuk melakuka nsesuatu di masa yang akan datang. Penelitian ini membahas realisasi bentuk komisif berjanji antar bahasa di Indonesia (bahasa Jawa dan Bahasa Mandar). Metode yang digunakan dalam penelitian ini adalah deskriptif kualitatif berdasarkan teori Searle (1976). Sumber data diperoleh dari intuisi peneliti sebagai penutur asli. Prosedur analisis data dilakukan dengan mengindetifikasi ciri-ciri komisif berjanji yang ada dalam dua bahasa tersebut. Hasil dari penelitian ini menunjukkan bahwa dalam Bahasa Jawa, komisif berjanji dapat ditunjukkan melalui kata “ya”, “tenan”, “mengko”, “saestu”, “mangke” dan “sesuk”. Sedangkan, pada bahasa Mandar komisif berjanji dapat ditunjukkan melalui ujaran-ujaran “iye”,“mangaku a”,“ya iyo”,“pa”,“manini”,“majanji a”, “manu pa”,“pura pa”,“banda tia”,“penuhi tia”,“pennassai i”,“pelambi’i tia”, dan “kalamanna”

Cohort profile of the UK Biobank: diagnosis and characteristics of cerebrovascular disease

Purpose: The UK Biobank is a large-scale biomedical resource, containing sociodemographic and medical information, including data on a previous diagnosis of stroke or transient ischaemic attack (TIA). We described these participants and their medication usage. Participants: We identified participants who either self-reported or were identified from a nurse-led interview, having suffered a stroke or a TIA and compared them against participants without stroke ort TIA. We assessed their risk factor burden (sex, age, deprivation, waist to hip ratio (WHR), hypertension, smoking, alcohol intake, diabetes, physical exercise and oral contraception use (oral contraceptive pill, OCP)) and medication usage. Findings: to date We studied 502 650 people (54.41% women), 6669 (1.23%) participants self-reported a stroke. The nurse-led interview identified 7669 (1.53%) people with stroke and 1781 (0.35%) with TIA. Hypertension, smoking, higher WHR, lower alcohol consumption and diabetes were all more common in people with cerebrovascular disease (p<0.0001 for each). Women with cerebrovascular disease were less likely to have taken the OCP (p=0.0002). People with cerebrovascular disease did more exercise (p=0.03). Antithrombotic medication was taken by 81% of people with stroke (both self-report and nurse-led responders) and 89% with TIA. For self-reported stroke, 63% were taking antithrombotic and cholesterol medications, 54% taking antithrombotic and antihypertensive medications and 46% taking all 3. For the nurse-led interview and TIA, these figures were 65%, 54% and 46%, and 70%, 53% and 45%, respectively. Future plans: The UK Biobank provides a large, generalisable and contemporary data source in a young population. The characterisation of the UK Biobank cohort with cerebrovascular disease will form the basis for ongoing research using this data source

A systematic review investigating fatigue, psychological and cognitive impairment following TIA and minor stroke:protocol paper

Approximately 20,000 people have a transient ischemic attack (TIA) and 23,375 have a minor stroke in England each year. Fatigue, psychological and cognitive impairments are well documented post-stroke. Evidence suggests that TIA and minor stroke patients also experience these impairments; however, they are not routinely offered relevant treatment. This systematic review aims to: (1) establish the prevalence of fatigue, anxiety, depression, post-traumatic stress disorder (PTSD) and cognitive impairment following TIA and minor stroke and to investigate the temporal course of these impairments; (2) explore impact on quality of life (QoL), change in emotions and return to work; (3) identify where further research is required and to potentially inform an intervention study

The relation between questions indicating transient ischaemic attack and stroke in 20 years of follow up in men and women in the Renfrew/Paisley Study

<b>STUDY OBJECTIVE</b> Transient ischaemic attack (TIA) is often a precursor to stroke, so identification of people experiencing TIA could assist in stroke prevention by indicating those at high risk of stroke who would benefit most from intervention for other stroke risk factors. The objective of this study was to investigate whether answers to a simple questionnaire for TIA could predict the occurrence of stroke in the following 20 years. DESIGNProspective cohort study, conducted between 1972 and 1976, with 20 years of follow up. <b>SETTING</b> Renfrew and Paisley, Scotland. <b>PARTICIPANTS</b> 7052 men and 8354 women aged 45-64 years at the time of screening completed a questionnaire and attended a physical examination. The questionnaire asked participants if they had ever, without warning, suddenly lost the power of an arm, suddenly lost the power of a leg, suddenly been unable to speak properly or suddenly lost consciousness. These four questions were taken as indicators of TIA and were related to subsequent stroke mortality or hospital admission. <b>MAIN RESULTS</b> For women, each question was significantly related to stroke risk, whereas for men only the question on loss of power of arm was significantly related to stroke risk. Men and women answering two or more questions positively had double the relative rate of stroke compared with men and women answering none of the questions positively, even after adjusting for other risk factors for stroke. <b>CONCLUSIONS</b> A simple questionnaire for TIA could help predict stroke over 20 years of follow up. Targeting men and women who report TIA with early treatment could help to prevent strokes from occurring

Papua New Guinea

Undergraduate 3-