Stroke Characteristics in a Cohort of Hmong American Patients.

Background Prior studies have indicated high rates of vascular risk factors, but little is known about stroke in Hmong. Methods and Results The institutional Get With The Guidelines (GWTG) database was used to identify patients discharged with acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage between 2010 and 2019. Hmong patients were identified using clan names and primary language. Univariate analysis was used to compare Hmong and White patients. A subarachnoid hemorrhage comparison was not conducted because of the small sample size. We identified 128 Hmong patients and 3084 White patients. Hmong patients had more prevalent hemorrhagic stroke (31% versus 15%; P<0.0016). In the acute ischemic stroke cohort, compared with White patients, Hmong patients were younger (60±13 versus 71±15 years; P<0.0001), presented to the emergency department almost 4 hours later; and had a lower thrombolysis usage rate (6% versus 14%; P=0.03496), worse lipid profile, higher hemoglobin A1C, similar stroke severity, and less frequent discharge to rehabilitation facilities. The most common ischemic stroke mechanism for Hmong patients was small-vessel disease. In the intracerebral hemorrhage cohort, Hmong patients were younger (55±13 versus 70±15 years; P<0.0001), had higher blood pressure, and had a lower rate of independent ambulation on discharge (9% versus 30%; P=0.0041). Conclusions Hmong patients with stroke were younger and had poorer risk factor control compared with White patients. There was a significant delay in emergency department arrival and low use of acute therapies among the Hmong acute ischemic stroke cohort. Larger studies are needed to confirm these observations, but action is urgently needed to close gaps in primary care and stroke health literacy.

Hmong Stroke Knowledge Survey.

The Hmong are an ethnic group from Southeast Asia who migrated in large numbers to the United States after the end of the Vietnam War and are now clustered in several parts of the country, including our city. Based on a retrospective review of medical records and on our anecdotal experience, we suspected that there was a gap in stroke knowledge in our Hmong patients. This stroke knowledge survey was intended to uncover any knowledge gaps within the Hmong community before engaging in community awareness activities. Not only did the survey identify a knowledge gap, it also revealed significant linguistic and cultural gaps that we believe are important to share with the reader.

Hmong Cross-Cultural Adaptation of Stroke Educational Material.

BACKGROUND: The presence of significant cultural and language barriers can affect timely, effective dissemination of stroke education for Hmong patients. Our aim was to design stroke educational material suitable for the Hmong community, using culturally sensitive strategies and patient education best practices. METHODS: We collaborated with the American Heart Association/American Stroke Association to adapt existing English educational material for use among Hmong patients. A team of experts in stroke care, patient education, and interpreter services-along with Hmong community members and health care providers-modified the original documents for health literacy and cultural relevance. The revised materials were translated into Hmong. Final edits were made using feedback from the Hmong community. RESULTS: Eight patient education documents on stroke-related topics were disseminated throughout our health care system and shared with various regional community partners for Hmong patients. DISCUSSION: Incorporating cultural humility principles is key to providing effective patient education tools for reducing disparities and engaging at-risk populations in disease prevention.

A Successful Quality Improvement Project for Detection and Management of Acute Stroke in Hospitalized Patients.

BACKGROUND: The incidence rate of stroke in hospitalized patients ranges between 2% and 17% of all strokes-a higher rate than in the community. Delays in recognition and management of stroke in hospitalized patients lead to worse outcomes. At our hospital, the existing in-hospital stroke (IHS) code showed low usage and effectiveness. In a quality improvement (QI) project, we aimed to improve the identification of and the quality of care for inpatient strokes. METHODS: A nurse-driven IHS protocol was implemented, which alerted a specialized stroke team and cleared the computed tomography (CT) scanner. The protocol focused on prioritizing staff education, simplifying the process, empowering staff to activate an IHS code, ensuring adequate support and teamwork, identifying well-defined quality metrics (eg, time to CT and documentation tool use), and providing feedback communication. We analyzed 2 years of postimplementation IHS data for impact on stroke detection and outcomes. RESULTS: In the 2 years post QI, there was a more than 10-fold increase in IHS (pre-QI, n = 8; first year post QI, n = 94; second year post QI, n = 123). In the post-QI cohort, after excluding patients with missing information (n = 26), 69 cases had new stroke diagnoses (63 ischemic, 6 hemorrhagic), and 148 were stroke mimics. The mean (SD) time from IHS to CT was 18.7 (7.0) minutes. Of the 63 new ischemic stroke cases, 25 (39.7%) were treated with thrombolytic therapy and/or mechanical thrombectomy. CONCLUSION: The new IHS protocol has led to a marked increase in cases identified, rapid evaluation, and high utilization rate of acute stroke therapies.

Prevention of incontinence-related skin breakdown for acute and critical care patients: comparison of two products.

Perineal protection products were compared for their efficacy in preventing skin breakdown in the hospitalized patient with urinary and/or fecal incontinence. Each product was used for the duration of the hospital stay with daily observations for perineal skin condition. Results indicated the spray product and wipe product were comparable in rate of skin breakdown prevention. Findings suggest the wipe product is more cost-effective for use during hospitalization, and the spray product preserves skin integrity over a longer period of time, beyond average hospitalization duration.

Temperament and fatigue management in persons with chronic rheumatic disease.

BACKGROUND: In persons with chronic conditions, fatigue is often a disruptive symptom with a devastating impact on overall well-being. Descriptions of experiences with fatigue contribute to advancing knowledge and improving health outcomes. AIM: To describe the influence temperament has on fatigue representation, self-care strategies, and strategy success. METHOD: A secondary analysis of an existing database of personal characteristics and symptom experiences of adults with chronic rheumatic diseases was conducted. All participants who reported fatigue at least once during the first week of participation in the study were included. Relationships were examined among demographic variables, temperamental dispositions, and symptom representation. RESULTS: Significant relationships were demonstrated between perceived symptom seriousness, interference and helpfulness of selected strategies, and both demographic variables and temperamental dispositions. CONCLUSIONS: When choosing interventions for the individual experiencing fatigue, be aware of demographic data and use assessment techniques to promote positive health practices.