Postural control anomalies in children with Tourette syndrome

The goal of the present study was to determine whether postural control is affected in Gilles-de-la-Tourette syndrome (TS). Center of pressure (COP) displacements were recorded in children with TS and unaffected siblings (7-16 yrs) in three conditions using a force platform: 1) Eyes-Open, 2) Eyes-Closed, 3) One-Leg standing with eyes open. The COP range and velocity were higher in children with TS than in unaffected siblings in all conditions. These differences could not be attributed to age, present tic severity, comorbidities (hyperactivity and compulsions) or medication. The data suggest that sub-clinical postural control anomalies are present in TS

Impact of a theory-informed and user-centered stroke information campaign on the public's behaviors, attitudes, and knowledge when facing acute stroke: a controlled before-and-after study

International audienceBACKGROUND: Public awareness of stroke symptoms is a key factor to ensure access to reperfusion strategies in due time. We designed and launched a regional theory-informed and user-centered information campaign and assessed its impact on emergency medical services (EMS) calls for stroke suspicion, time-to-call, and public attitudes and awareness concerning stroke. METHODS: A controlled before-and-after study was conducted during 3 sequential time-periods in 2 separate counties. Key messages of the campaign were underpinned by stroke representations and the theory of planned behavior, and focused on recognition of stroke warning signs and the need to call EMS urgently. The campaign included posters, leaflets, adverts and films displayed in bus and subway stations, internet, social networks, and local radio. Outcome measures on behavior, attitudes, and knowledge were assessed before the launch of the campaign, at 3 months, and 12 months. RESULTS: The number of EMS calls for stroke suspicion increased by 21% at 12 months in the intervention county and this change was significantly different to that observed in the control county (p = 0.02). No significant changes were observed regarding self-reported attitudes in case of stroke. An 8% significant increase in recognizing at least 2 stroke warning signs was observed in the intervention county (p = 0.04) at 3 months, while it did not change significantly in the control county (p = 0.6). However, there was no significant difference in warning sign recognition between both counties (p = 0.16). CONCLUSION: The campaign significantly improved public's behavior of calling EMS, although stroke knowledge was not improved as much as expected. Repeating these campaigns over time might further help improve timeliness and access to reperfusion strategies. TRIAL REGISTRATION: Clinical Trial Registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02846363

[Adherence to recommendations after comprehensive geriatric assessment by mobile geriatric team during 500 home visits]

International audienceMobile geriatric team making home visit (MGT) were created to reinforce the link between home and hospital. Frail elderly patients can benefit from a comprehensive geriatric assessment (CGA) by a geriatric mobile team during a home visit. MGT at the hospital center of Lyon Sud presents recommendations after a CGA to better adjust healthcare to patients’ needs. There are few studies that have analysed the MGT who treat patients at home. OBJECTIVES: The goal of the study was to determine adherence rate at 2 months and examines the socio-demographic profile of patients assessed by the MGT. We conducted a descriptive and retrospective study in single center, with 500 patients during 2 years (2016-2017). RESULTS: The mean adherence rate was 65,1%. The highest rate concerned recommendations on the future orientation. The lower rate concerned recommendations on lifestyle and environment. Mean age of the 500 patients was 83.5 years, 61% were women. The patients included in this study take an average of seven prescription medications (whitout psychotropic medications). The majority of the patients was GIR 3 and achieved an average score of 3 on ADL scale and 2 of IADL scale. Ninety-six per cent of the patients had a caregiver. It has been proven statistically that, adherence rate of recommendations (more than 65%), reduce unplanned hospitalizations. CONCLUSION: This study with a large sample of patients allows to better describe patients seen at home. It is a vulnerable population presenting a polypathology, dependence, associated with an unstable socio-family context. This work shows that the recommendations must be applied to limit hospitalizations and that the involvement of the team makes it possible to improve the follow-up of the recommendations

Patients' productivity losses and informal care cost related to ischemic stroke in Rhone area, France

Cross-sectional survey, performed along with the STROKE69 prospective population-based cohort study on all IS patients admitted to any emergency department or stroke unit of the Rhône area between November 2015 and June 2016 • At 12 months post-stroke, 2 questionnaires were mailed: one to IS patients and one to their main informal caregivers • PL were valued with the Human Capital Approach and the Proxy Good Method (PGM). • IC was valued according the PGM

Patients' productivity losses and informal care costs related to ischemic stroke: a French population‐based study

Background and purpose Large societal costs of stroke should not be ignored. We aimed to estimate patients' productivity losses and informal care costs during the first year after ischemic stroke. Methods A cross‐sectional survey was performed within the STROKE69 regional population‐based cohort study. At 1 year post‐stroke, each patient and the corresponding main informal caregiver received questionnaires followed by a telephone interview if necessary. Time losses were valued using the human capital approach and proxy good method for patients with and without a professional activity, respectively. Results Among the 222 patients with ischemic stroke (58% men; mean age 68 years; and 86% with a modified Rankin Scale (mRS) score of <3 at 3 months), 54%, 32%, and 25% received informal, formal, and both cares, respectively. Among the 108 main informal caregivers, 63% were women, 74% lived with the patient, and 57% were retired or unemployed. The mean cost of productivity losses was estimated at €7589 ± €12 305 per patient in the first post‐stroke year with 5.4%, 71.2%, and 23.4% of these being attributed to presenteeism, absenteeism, and leisure time, respectively. Informal care was given at an average of 25 h/week. The annual mean estimated total cost of informal care was €10 635 per caregiver. Conclusions Informal care and productivity losses of patients with ischemic stroke during the first post‐stroke year represent a significant economic burden for society comparable to direct costs. These costs should be included in economic evaluations with the adoption of a societal perspective to avoid underestimating the societal stroke economic burden

DRAMATIC IMPROVEMENT OF ACUTE ISCHAEMIC STROKE MANAGEMENT IN THE RHONE AREA BETWEEN 2007 AND 2016: A POPULATION BASED BEFORE AFTER PROSPECTIVE STUDY

International audienc

Evolution de la prise en charge de l'AVC à la phase aiguë en Rhône-Alpes: Etude populationnelle avant-après

En 2007 parmi tous les patients admis pour une suspicion d’AVC dans un service d’accueil des urgences (SAU) ou une unité neurovasculaire (UNV) du Rhône (cohorte AVC 69), seulement 9% des patients victimes d’un infarctus cérébral (IC) avaient eu accès à un traitement thrombolytique. En 2016, nous avons conduit une étude similaire, STROKE 69, pour évaluer l’efficacité de toutes les mesures mises en œuvre entre 2007 et 2016 sur le taux d’accès des patients à un traitement de reperfusion (thrombolyse et/ou thrombectomie) et les délais pré et intra-hospitaliers

Short and long-term impact of four sets of actions on acute ischemic stroke management in Rhône County, a population based before-and-after prospective study

International audienceAbstract Background Optimizing access to recanalization therapies in acute ischemic stroke patients is crucial. Our aim was to measure the short and long term effectiveness, at the acute phase and 1 year after stroke, of four sets of actions implemented in the Rhône County. Methods The four multilevel actions were 1) increase in stroke units bed capacity and development of endovascular therapy; 2) improvement in knowledge and skills of healthcare providers involved in acute stroke management using a bottom-up approach; 3) development and implementation of new organizations (transportation routes, pre-notification, coordination by the emergency call center physician dispatcher); and 4) launch of regional public awareness campaigns in addition to national campaigns. A before-and-after study was conducted with two identical population-based cohort studies in 2006–7 and 2015–16 in all adult ischemic stroke patients admitted to any emergency department or stroke unit of the Rhône County. The primary outcome criterion was in-hospital management times, and the main secondary outcome criteria were access to reperfusion therapy (either intravenous thrombolysis or endovascular treatment) and pre-hospital management times in the short term, and 12-month prognosis measured by the modified Rankin Scale (mRS) in the long term. Results Between 2015–16 and 2006–7 periods ischemic stroke patients increased from 696 to 717, access to reperfusion therapy increased from 9 to 23% ( p < 0.0001), calls to emergency call-center from 40 to 68% ( p < 0.0001), first admission in stroke unit from 8 to 30% ( p < 0.0001), and MRI within 24 h from 18 to 42% ( p < 0.0001). Onset-to-reperfusion time significantly decreased from 3h16mn [2 h54-4 h05] to 2h35mn [2 h05-3 h19] ( p < 0.0001), mainly related to a decrease in delay from admission to imaging. A significant decrease of disability was observed, as patients with mild disability (mRS [0–2]) at 12 months increased from 48 to 61% ( p < 0.0001). Pre-hospital times, however, did not change significantly. Conclusions We observed significant improvement in access to reperfusion therapy, mainly through a strong decrease of in-hospital management times, and in 12-month disability after the implementation of four sets of actions between 2006 and 2016 in the Rhône County. Reducing pre-hospital times remains a challenge

Temporal Trend of Transient Ischemic Attack Management over a 10-Year Period: Data from the Rhône County, France

International audienceBACKGROUND: Timely recognition and management of transient ischemic attack (TIA) offer the greatest opportunity to prevent subsequent stroke. But variability of TIA management quality exists across hospitals. Under the impetus of national plans, measures were adopted to improve TIA management, including a structured local pathway. Our objective was to compare TIA management between two periods over 10 years, before and after the implementation of these measures. METHODS: A before-and-after study was conducted with two identical population-based cohort studies in 2006-2007 (AVC69) and 2015-2016 (STROKE69) including all patients with TIA diagnosis over a 7-month period in six public and private hospitals in the Rhône county in France. The primary outcome was the adequate TIA management defined as brain and vessel imaging within 24 h of admission and the prescription of antithrombotic treatment at discharge. RESULTS: We identified 109 patients TIA patients in 2006-2007, and 458 over the same period in 2015-2016. A higher proportion of patients were adequately managed in 2015-2016 compared to 2006-2007 (14/96 [15%] in 2006-2007 vs. 306/452 [68%] in 2015-2016, p \textless 0.001). This difference was mainly driven by a marked increase of vessel imaging performed within 24 h of admission, most often by computed tomography angiography. Furthermore, patients called more often emergency medical dispatch before admission, were admitted with a shorter delay after symptom onset, and were more likely discharged to home in 2015-2016 compared to 2006-2007. CONCLUSION: Our study demonstrated an increasing rate of adequate TIA management, mainly driven by a marked increase of vessel imaging within 24 h of admission, over a 10-year period in the Rhône county in France