Browsing by Author "Botelho, Ana"
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- Organizational factors determining access to reperfusion therapies in Ischemic Stroke-Systematic literature reviewPublication . Botelho, Ana; Rios, Jonathan; Fidalgo, Ana Paula; Ferreira, Eugénia; Nzwalo, HipólitoBackground: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.
- Tratamento endovascular no acidente vascular cerebral isquémico: “Urgência na redução das assimetrias”Publication . Nzwalo, Hipólito; Botelho, Ana; Gil, Inês; Baptista, Alexandre; Fidalgo, Ana PaulaLemos com bastante satisfação o estudo de Dias et al1 publicado na Acta Médica Portuguesa que revelou as assimetrias nacionais no acesso ao tratamento endovascular (TEV) no acidente vascular cerebral (AVC) isquémico por oclusão de grande vaso proximal (OVP). Felizmente, no período em análise houve melhoria nacional das taxas de TEV, mais evidente nos distritos próximos de hospitais com TEV (HCTEV), tendo-se demonstrado a disparidade regional nos tempos de atraso da TEV. Nesse sentido, realçamos que a mediana do tempo AVC - primeira porta de entrada na via verde foi 13 minutos inferior nos doentes transferidos num hospital sem TEV (HSTEV) em comparação com os doentes cuja primeira porta foi um HCTEV. É um dado que possivelmente reflete a pressão de seleção com prejuízo dos doentes que chegam no limite temporal para TEV nos HSTEV.