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Practice patterns a...
Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study.
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Langhorne, Peter (author)
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O'Donnell, Martin J (author)
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Chin, Siu Lim (author)
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Zhang, Hongye (author)
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Xavier, Denis (author)
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Avezum, Alvaro (author)
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Mathur, Nandini (author)
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Turner, Melanie (author)
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MacLeod, Mary Joan (author)
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Lopez-Jaramillo, Patricio (author)
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Damasceno, Albertino (author)
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Hankey, Graeme J (author)
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Dans, Antonio L (author)
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Elsayed, Ahmed (author)
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Mondo, Charles (author)
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Wasay, Mohammad (author)
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Czlonkowska, Anna (author)
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Weimar, Christian (author)
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Yusufali, Afzal Hussein (author)
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Hussain, Fawaz Al (author)
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Lisheng, Liu (author)
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Diener, Hans-Christoph (author)
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Ryglewicz, Danuta (author)
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Pogosova, Nana (author)
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Iqbal, Romana (author)
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Diaz, Rafael (author)
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Yusoff, Khalid (author)
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Oguz, Aytekin (author)
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Wang, Xingyu (author)
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Penaherrera, Ernesto (author)
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Lanas, Fernando (author)
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Ogah, Okechukwu S (author)
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Ogunniyi, Adesola (author)
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Iversen, Helle K (author)
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Malaga, German (author)
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Rumboldt, Zvonko (author)
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Magazi, Daliwonga (author)
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Nilanont, Yongchai (author)
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- Rosengren, Annika, 1951 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Oveisgharan, Shahram (author)
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Yusuf, Salim (author)
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(creator_code:org_t)
- 2018
- 2018
- English.
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In: Lancet (London, England). - 1474-547X. ; 391:10134, s. 2019-2027
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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https://gup.ub.gu.se...
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Abstract
Subject headings
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- Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels.We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month.We obtained full information for 12342 (92%) of 13447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14-1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12-1·72) irrespective of other patient and service characteristics.Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes.Chest, Heart and Stroke Scotland.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Aged
- Case-Control Studies
- Developed Countries
- Developing Countries
- Evidence-Based Medicine
- Female
- Health Services Accessibility
- Humans
- Male
- Middle Aged
- Patient Outcome Assessment
- Poverty
- Practice Patterns
- Physicians'
- Stroke
- therapy
- Surveys and Questionnaires
- Survival Analysis
- Treatment Outcome
- transient ischemic attack
- unit care
- income countries
- global burden
- risk-factors
- riks-stroke
- quality
- management
- mortality
- register
Publication and Content Type
- ref (subject category)
- art (subject category)
Find in a library
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- By the author/editor
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Langhorne, Peter
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O'Donnell, Marti ...
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Chin, Siu Lim
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Zhang, Hongye
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Xavier, Denis
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Avezum, Alvaro
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show more...
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Mathur, Nandini
-
Turner, Melanie
-
MacLeod, Mary Jo ...
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Lopez-Jaramillo, ...
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Damasceno, Alber ...
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Hankey, Graeme J
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Dans, Antonio L
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Elsayed, Ahmed
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Mondo, Charles
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Wasay, Mohammad
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Czlonkowska, Ann ...
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Weimar, Christia ...
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Yusufali, Afzal ...
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Hussain, Fawaz A ...
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Lisheng, Liu
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Diener, Hans-Chr ...
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Ryglewicz, Danut ...
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Pogosova, Nana
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Iqbal, Romana
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Diaz, Rafael
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Yusoff, Khalid
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Oguz, Aytekin
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Wang, Xingyu
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Penaherrera, Ern ...
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Lanas, Fernando
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Ogah, Okechukwu ...
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Ogunniyi, Adesol ...
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Iversen, Helle K
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Malaga, German
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Rumboldt, Zvonko
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Magazi, Daliwong ...
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Nilanont, Yongch ...
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Rosengren, Annik ...
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Oveisgharan, Sha ...
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Yusuf, Salim
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Health Sciences
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and Health Care Serv ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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Lancet (London, ...
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The Lancet
- By the university
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University of Gothenburg