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Table of Content

    20 August 2012, Volume 7 Issue 08
    主编手记
    The Perfect Difference
    WANG Yong-Jun
    2012, 7(08):  597-599. 
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    述评
    Looking at the Improvement Approach of American Stroke Medical Care and Thinking about Chinese Stroke Medical Challenge
    David Z. Wang
    2012, 7(08):  601-605. 
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    论著
    Evaluation of Medical Service Performance in Cerebrovascular Disease Inpatients in Beijing
    LIU Gai-Fen;LI Xian;WANG Yi-Long;et al
    2012, 7(08):  606-610. 
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    Objective To evaluate the medical service performance in cerebrovascular disease inpatients fromLevel 2 to 3 hospitals in Beijing, 2010.Methods The data was obtained from the section of cerebrovascular disease in 'The Database ofInpatient Record' administered by Beijing Public Health Information Center. Beijing DiagnosisRelated Groups(BJ-DRGs) was used as the tool to evaluate the medical service performance.Results There were 122 hospitals in this study. Number of DRGs ranged from 1 to 16, and themedian of DRGs was 5. The case-mix index ranged from 0.75 to 1.86 with a median of 1.00. Themedian was 1.07 for cost consuming index, and 1.21 for time consuming index. Of all the hospitals,54.92% had a cost consuming index higher than 1, and 72.13% had a time consuming index higherthan 1; 52.46% was higher than 1 on both cost and time consuming index. The in-hospital casefatalitywas 0 in the low and mid-low risk group, and 3.0% at median in the mid-high risk group.Conclusions In the medical service of cerebrovascular disease, effective administrative strategyand measurements should be taken to optimize the medical resources utilization, and to decreasethe time and cost consuming indices, therefore to improve medical service performance in Beijing.
    Application Situation and Influencing Factors of Antihypertensive Drugs in Ischemic Stroke Patients at Discharge
    WANG Lin-Yu;WANG Yi-Long;XU Yu-Ming;et al
    2012, 7(08):  611-615. 
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    Objective To evaluate the antihypertensive drugs prescription at discharge in patients withischemic stroke and hypertension, and to identify influencing factors for prescription in 29 hospitalsin China.Methods The investigation was a multicentre cross-sectional study. We prospectively collecteddemographic information, past history, antihypertensive drug prescription at discharge and hospitalmedical resources information.Results We prospectively reviewed the medical records of all patients who were dischargedfrom the neurology department with the diagnosis of ischemic stroke from Mar. 1 to Mar. 31 in2011. Eight hundred and ninety-three ischemic stroke patients with hypertension were assessed.73.35% of patients were prescribed antihypertensive drugs at discharge. Calcium channel blockerprescription ration was the highest(54.54%) in patients who were prescribed one antihypertensivedrug. Multivariate analysis showed atrial fibrillation(OR 0.39; 95%CI 0.22-0.68; P =0.0009)and heart failure(OR 0.32; 95%CI 0.15-0.65; P =0.0017) were related with antihypertensivedrug prescription, while no stroke unit(OR 1.98; 95%CI 1.42-2.75; P <0.0001) and the number ofhospital beds of neurological department <70(OR 1.57; 95%CI 1.12-2.19; P =0.0080) were relatedwith no antihypertensive drug prescription.Conclusion The antihypertensive drug prescription was inadequate in ischemic stroke patients withhypertension in China. Monitoring and improvement should be promoted.
    Analysis of Related Factors on Awareness of Community Residents with Stroke-Related Knowledge in Four Cities in China
    SUN Hai-Xin;WANG Wen-Zhi;JIANG Bin;et al
    2012, 7(08):  618-625. 
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    Objective To analyze the related factors on awareness of community residents with stroke-relatedknowledge in four cities in China.Methods Two communities were respectively selected from Beijing, Shanghai, Changsha andChengdu. We investigated the awareness of community residents with stroke-related knowledgethrough questionnaires. Using systematic sampling and the household as a unit, at least 300households were chosen in one community. One person was selected in each household to fill theself-designed questionnaire. Uniform training of community physicians before the survey, thecommunity physicians completed the survey by face to face indoor-investigation. Questionnaireinclude: ①general information on community residents, including gender, age, education level,etc.; ②stroke-related knowledge, including stroke risk factors, treatment measures of hypertensionand diabetes, early symptoms of stroke, transportation methods of stroke patients to hospital andsources of stroke knowledge.Results Total integral questionnaires were 2519. The investigation showed that ①the awarenesspercentage of the stroke risk factors were 44.2%-87.7%; the awareness percentage of theearly symptoms of stroke were 58.2%-80.2%; ②community residents would prefer to acquirestroke knowledge through health education lectures by doctors(77.7%), television(73.1%),newspapers(59.6%), propaganda video(43.6%) and magazines(39.2%); ③the stroke knowledgescore and education level were positively correlated(rs=0.114, P <0.001), and age was negativelycorrelated(rs=-0.152, P <0.001). ④the knowledge level of women was higher than men.Conclusion At present, the community residents in China are lacking in knowledge about stroke. Goingforward, we should strengthen health education through health education lectures by doctors, television,newspapers, propaganda video and magazines. Targeted educational populations should be directed atthose who are elderly or male and those people with lower education or high stroke risk.
    Clinical Analysis of Puerperium Cerebral Venous Thrombosis
    LU Wei;ZHANG Qian;ZHOU Heng
    2012, 7(08):  626-630. 
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    Objective To discuss the mechanism of the formation, clinical characteristics and treatment ofcerebral venous thrombosis in puerperium female patients.Methods The clinical data of 46 puerperium women with cerebral venous thrombosis from January2000 to December 2011 were analyzed retrospectively.Results The main characteristics of cerebral venous thrombosis in puerperium women containincreased intracranial pressure and focal brain injury. Low molecular weight heparin(LMWH)anticoagulation therapy and symptomatic treatment can improve patients’ symptom.Conclusions Related further examinations should be considered to puerperium patients with riskof cerebral venous thrombosis, making it possible to diagnosis and provide the proper treatmentearlier, in order to improve patients’ prognosis.
    Correlation of Different Obesity Indexes and Intracranial Arterial Stenosis
    WANG An-Xin;ZHOU Yong;ZHAO Xing-Quan;et al
    2012, 7(08):  631-635. 
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    Objective To explore the relationship between different obesity indexes(body mass index[BMI],waist circumference[WC], waist-to-height ratio[WHtR], waist-to-hip ratio[WHpR]) and intracranialarterial stenosis.Methods The cross-sectional method was used and 5440 subjects were selected from 101 510employees including retired ones aging over 40-years old who took part in health examinationfrom July to October 2006 based on Kailuan Group Company. The clinical data collected consist ofdemography information, clinical baseline data and transcranial doppler(TCD) data. The relationbetween different obesity indexes and intracranial arterial stenosis was obtained using univariateand multivariate logistic regression analysis.Results The average age of the subjects is 55.17±11.78 years. Among 5440 subjects, the number ofmale subjects is 3257(59.87%) and female is 2183(40.13%). Intracranial arterial stenosis is foundin 716 subjects and the incidence is 13.16%. The univariate and multivariate logistic regressionanalysis shows that different obesity indexes correlate with intracranial arterial stenosis to acertain degree. The comparison between the second, third, forth quartile and the first quartile ofWHpR are statistically significant(P <0.05). The adjusted odds ratio and 95% confidence intervalare 1.33(1.04-1.70), 1.34(1.05-1.73) and 1.38(1.08-1.76) respectively.Conclusion The prevalence of intracranial arterial stenosis is 13.16%; obesity is an important riskfactor for intracranial arterial stenosis, and WHpR is a better representative index compared withother obesity indexes.
    专题论坛
    Construction of Continuous Quality Improvement System for Thrombolysis Treatment in Acute Ischemic Stroke in China
    WANG Chun-Juan;WANG Yi-Long;XU An-Ding;et al
    2012, 7(08):  637-641. 
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    病例讨论
    Graves’ Disease with Internal Carotid Arteries Stenosis/Occlusion. One Case Report
    CHEN Bin;SONG Tian;ZHANG Yu-Mei;et al
    2012, 7(08):  642-645. 
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    指南与规范
    Revised and Updated Recommendations for the Establishment of Primary Stroke Centers: a Summary Statement from the Brain Attack Coalition
    WANG Chun-Juan;WANG Yi-Long;LI Zi-Xiao;et al
    2012, 7(08):  646-657. 
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    综述
    Analysis of the Establishment of China Stroke Common Database(CSCD)
    CAO He-Qi;SHANG Jing-Wei;ZHU Yuan-Gui;et al
    2012, 7(08):  658-665. 
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    Cerebrovascular disease is one of the major harmful diseases in China, whichendangers the residents' health and safety because of its high morbidity, recurrence rate anddisability rate. Costs of prevention and cure increase every year, which became a huge socialeconomical burden now. However, there are no widely accepted standards for describing thedemography, disease treatment, care process and prognosis. The skimble-scamble methods of datacollection and analysis are frequently applied in different studies, which hamper comparing crossoverstudy, understanding of population differences, data sharing and meta-analysis. So NationalNatural Science Foundation of China(NSFC) called for the establishing of China Stroke CommonDatabase(CSCD) in order to promote the cooperation of various institutions and researchers, thedata sharing, the collection of a large number of patient samples and to facilitate the resolution ofsome unsolved clinical problem. We believe that CSCD will be effective in the treatment of strokepatients, improving patients' quality of life and may lead to a more rapid reduction in the burden ofcerebrovascular disease.
    Analysis of Four Data Capture Models using Case Report Forms in Golden Bridge
    WU Shuo-Lin;WANG Yi-Long;LI Zi-Xiao;et al
    2012, 7(08):  666-670. 
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    A case report form(CRF) is one of the key elements of Golden Bridge(GB)-a hugenationwide clinical trial. Four mainly types of CRF are paper-based records;smart phones; PC-basedrecords through internet; electronic case report combined with CRF. GB mainly uses electronicdata capture(EDC) ways along with the traditional methods. The four types of CRF mean fourdata capture models. They have their own characters through the whole data-producing procedure,including data acquisition, data report and data quality control respectively. The EDC has moremerits than the paper-based one, such as expandability, security, system-stability maintainability,handleability, etc. The electronic case report is the most promising one to be best to guarantee theaccuracy of clinical trials data and be the most economical way. Their real practical values in theclinical trial still need to be test by study in the long run.
    教学园地
    Diversified Health Education in Stroke Patients should be Carry out Actively
    ZHU Li-Li;YIN Xue-Hong;LI Jing;et al
    2012, 7(08):  671-673. 
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