Elizabeth Wooster

Public health campaigns and their effect on stroke knowledge in a high-risk urban population: A five-year study

Background The level of knowledge of stroke risk factors and stroke symptoms within a population may determine their ability to recognize and ultimately react to a stroke. Independent agencies have addressed this through extensive awareness campaigns. The aim of this study was to determine the change in baseline knowledge of stroke risk factors, symptoms, and source of stroke knowledge in a high-risk Toronto population between 2010 and 2015. Methods Questionnaires were distributed to adults presenting to cardiovascular clinics at the University of Toronto in Toronto, Canada. In 2010 and 2015, a total of 207 and 818 individuals, respectively, participated in the study. Participants were identified as stroke literate if they identified (1) at least one stroke risk factor and (2) at least one stroke symptom. Results A total of 198 (95.6%) and 791 (96.7%) participants, respectively, completed the questionnaire in 2010 and 2015. The most frequently identified risk factors for stroke in 2010 and 2015 were, respectively, smoking (58.1%) and hypertension (49.0%). The most common stroke symptom identified was trouble speaking (56.6%) in 2010 and weakness, numbness or paralysis (67.1%) in 2015. Approximately equal percentages of respondents were able to identify ≥1 risk factor (80.3% vs. 83.1%, p = 0.34) and ≥1 symptom (90.9% vs. 88.7%, p = 0.38). Overall, the proportion of respondents who were able to correctly list ≥1 stroke risk factors and stroke symptoms was similar in both groups.(76.8% vs. 75.5%, p = 0.70). The most commonly reported stroke information resource was television (61.1% vs. 67.6%, p = 0.09). Conclusion Stroke literacy has remained stable in this selected high-risk population despite large investments in public campaigns over recent years. However, the baseline remains high over the study period. Evaluation of previous campaigns and development of targeted advertisements using more commonly used media sources offer opportunities to enhance education.

Fishing for BASS: Surveying Primary Physicians in the Barriers to Aortic Screening Study

Introduction In response to published guidelines for abdominal aortic aneurysm (AAA) screening, primary care physicians were surveyed to determine attitudes and identify barriers to screening. Methods Six hundred standardized, structured surveys were distributed to all primary care practitioners in a defined geographic area. Participation was voluntary, and results were anonymous. Results A total of 10.7% of surveys were returned. All questions were answered by >93% of respondents. A total of 71.9% of respondents were general practitioners; 94.4% worked in a community setting. 60.9% saw >11 male patients per week who were older than 65 years of age. Responses indicated support for identifying asymptomatic AAAs; only 4.7% thought their patients were too sick to undergo repair, 0% felt their patients would be unwilling to undergo repair, and 0% felt the risk of rupture was too small to justify repair. Access to vascular surgical services was available to more than 75% in the hospital closest to them, and to 100% in the city in which they practice. A total of 42.2% were aware of recommendations regarding AAA screening, and 65.6% of physicians routinely screened eligible patients for AAAs. Screening for other diseases was more frequent. Respondents routinely screened their patients for breast cancer (79.1%), prostate cancer (80.5%), colon cancer (80.9%), and hypertension (83.7%); 42.9% routinely screened for peripheral artery disease. Conclusion Screening for AAAs lags significantly behind other major screening programs. Although primary practitioners are routinely exposed to the target population, a minority of patients are screened. Neither access to a vascular surgeon nor knowledge about the importance of AAAs appears to be limiting factors. Despite recent publicity, almost 60% of primary care physicians remain unaware of screening guidelines for AAAs. Of those who were aware of guidelines, only one third follow them. Further research and education is required to increase the efficacy of screening.

Pattern Analysis of Lower Extremity Venous Thrombosis: Implications for Point of Care Ultrasound (POCUS) Protocols:

Introduction Emergency department point-of-care ultrasound (POCUS) can identify lower extremity venous thrombosis (LEVT) with a published accuracy is 85–90%. The aim of this study was to compare the patterns of LEVT with protocol results and determine the clinical impact of the study results. Methods Patterns of superficial venous thrombosis(SVT) and deep venous thrombosis (DVT) were collated from positive venous duplex ultrasound (VDU) studies. Each pattern was mapped to the potential findings by the described POCUS protocols. Analysis of the literature was used to identify the potential clinical impact of the findings and the functional efficacy of each strategy and a numerical result was developed. Results One hundred six studies were positive for DVT (42), SVT (44), or both (20) on VDU. Patterns for DVT (single or multiple levels and unilateral or bilateral) and SVT (great saphenous vein above and/or below knee or small saphenous vein in single, multiple or bilateral and juxta-junctional) were noted. The patterns covered by the “two-area” protocol showed DVT = 80% and SVT = 38%, and by “three-point compression” DVT = 74% and SVT = 0%. Particular areas not covered included proximal disease (iliac and vena cava) and calf DVT and SVT in all areas except juxta-junctional. The potential impact for DVT is high, whereas for SVT it is moderate to low. The functional efficacy of the “two-area” protocol (5.9) exceeds the “three-point compression” strategy (3.7) but falls short of the “gold standard” VDU (10). Conclusion Pattern analysis of venous thrombosis identifies weakness in POCUS strategies; the clinical implications allow for an assignment of the functional efficacy of each study. Knowledge of these findings should inform emergency room POCUS strategies.