Advance directives among community-dwelling stroke survivors.

ObjectiveAdvance directives (ADs) are integral to health care, allowing patients to specify surrogate decision-makers and treatment preferences in case of loss of capacity. The present study sought to identify determinants of ADs among stroke survivors.MethodsIn this cross-sectional study (Care Attitudes and Preferences in Stroke Survivors [CAPriSS]), community-dwelling stroke survivors were surveyed on ADs; validated scales were used to query palliative care knowledge and attitudes towards life-sustaining treatments. Logistic regression was used to determine variables associated with ADs.ResultsAmong 562 community-dwelling stroke survivors who entered the survey after screening questions confirmed eligibility, 421 (74.9%) completed survey components with relevant variables of interest. The median age was 69 years (IQR 58-75 years); 53.7% were male; and 15.0% were Black. Two hundred and fifty-one (59.6%) respondents had ADs. Compared to stroke survivors without ADs, those with ADs were more likely to be older (median age 72 vs. 61 years; pConclusionsAge, prior advance care planning discussion with a physician, palliative care knowledge, and attitudes towards life-sustaining treatments were independently associated with ADs

Geographic and Regional Variability in Racial and Ethnic Disparities in Stroke Thrombolysis in the United States

Background and Purpose: Intravenous thrombolysis (IVT) after ischemic stroke is underutilized in racially/ethnically minoritized groups. We aimed to determine the regional and geographic variability in racial/ethnic IVT disparities in the United States. Methods: Acute ischemic stroke admissions between 2012 and 2018 were identified in the National Inpatient Sample. Multivariable logistic regression was used to test the association between IVT and race/ethnicity, stratified by geographic region and controlling for demographic, clinical, and hospital characteristics. Results: Of the 545 509 included cases, 47 031 (8.6%) received IVT. Racially/ethnically minoritized groups had significantly lower adjusted odds of IVT compared with White people in the South Atlantic region (odds ratio [OR], 0.86 [95% CI, 0.82–0.91]), the East North Central region (OR, 0.91 [95% CI, 0.85–0.97]) and the Pacific region (OR, 0.90 [95% CI, 0.85–0.96]). In the South Atlantic region, IVT use in racial/ethnic minority groups was below the national average of all racial/ethnic minority patients ( P =0.002). Compared with White patients, Black patients had lower odds of IVT in the Middle Atlantic region (OR, 0.84 [95% CI, 0.78–0.91]), the South Atlantic region (OR, 0.78 [95% CI, 0.74–0.82]), and the East North Central region (OR, 0.86 [95% CI, 0.79–0.93]). In the South Atlantic region, this difference was below the national average for Black people ( P &lt;0.001). Hispanic patients had significantly lower use of IVT only in the Pacific region (OR, 0.92 [95% CI, 0.85–0.99]), while Asian/Pacific Islander patients had lower odds of IVT in the Mountain (OR, 0.76 [95% CI, 0.59–0.98]) and Pacific region (OR, 0.89 [95% CI, 0.82–0.97]). Conclusions: Racial/ethnic disparities in IVT use in the United States vary by region. Geographic hotspots of lower IVT use in racially/ethnically minoritized groups are the South Atlantic region, driven predominantly by lower use of IVT in Black patients, and the East North Central and Pacific regions. </jats:sec

Additional file 1 of Effect of furosemide in the treatment of high-altitude pulmonary edema

Supplementary Material

STROBE (Strengthening The Reporting of OBservational Studies in Epidemiology) checklist.

STROBE (Strengthening The Reporting of OBservational Studies in Epidemiology) checklist.</p

Response patterns to the items of the general attitudes towards life-sustaining treatments scale in % (n = 421).

Response patterns to the items of the general attitudes towards life-sustaining treatments scale in % (n = 421).</p

Flow diagram indicating the derivation of the study sample.

Flow diagram indicating the derivation of the study sample.</p