Tenecteplase real-world data: A three phase sequential comparison.

INTRODUCTION: The New Zealand (NZ) Central Region Stroke Network, serving 1.17 million catchment population, changed to tenecteplase for stroke thrombolysis in 2020 but was forced to revert to Alteplase in 2021 due to a sudden cessation of drug supply. We used this unique opportunity to assess for potential before and after temporal trend confounding. PATIENTS AND METHODS: In NZ all reperfused patients are entered prospectively into a national database for safety monitoring. We assessed Central Region patient outcomes and treatment metrics over three time periods: alteplase use (January 2018-January 2020); during switch to tenecteplase (February 2020-February 2021) and after reverting to alteplase (February 2021-December 2022) adjusting regression analyses for hospital, age, onset-to-needle, NIHSS, pre-morbid mRS and thrombectomy. RESULTS: Between January 2018 and December 2022, we treated 1121 patients with Alteplase and 286 with tenecteplase. Overall, patients treated with tenecteplase had greater odds of favorable outcome ordinal mRS [aOR = 1.43 (95% CI = 1.11-1.85)]; shorter door-to-needle (DTN) time [median 52 (IQR 47-83) vs 61 (45-84) minutes, p < 0.0001] and needle to groin (NTG) times [118 (74.5-218.5) vs 185 (118-255); p = 0.02)]. Symptomatic intracerebral hemorrhage (sICH) rate was lower in tenecteplase group [aOR 0.29 (0.09-0.95)]. Findings similarly favored tenecteplase when comparing tenecteplase to only the second alteplase phase. There was no inter-group difference when comparing the two alteplase phases. CONCLUSIONS: Our results suggest that previously reported benefits from tenecteplase in a real-world setting were not likely attributable to a temporal confounding.

Estimated prevalence of fatigue following stroke and transient ischemic attack is dependent on terminology used and patient gender.

INTRODUCTION: The prevalence of fatigue following stroke and Transient Ischaemic Attack (TIA) is disputed, with prevalences ranging from 30% to 72% reported. We hypothesized that methods and descriptors used may substantially affect the prevalence reported. METHODS: Subjects completed validated assessments of fatigue and sleepiness (the Fatigue Severity Scale [FSS] and Epworth Sleepiness Scale [ESS]) as well as 5-point Likert scores on frequency of symptoms using the 5 statements of fatigue derived from patient interviews. RESULTS: Among the 91 subjects, the mean FSS score was 3.8. FSS score correlated more strongly with the statement "I have a lack of energy" (r=0.470; ρ<0.001; Spearman's rho) than with the statement "I feel physical fatigue" (r=0.349; ρ=0.001). The statement "I have a lack of energy" also produced the highest prevalence of severe symptoms, with 37% agreeing that they had the symptom "often" or "always." Agreement between Likert scales was only fair, the best being that for "I have a lack of energy" and "I feel physical fatigue" (κ=0.50). There was a gender difference in simple expression of fatigue, with the statement "I feel physical fatigue" correlating strongly with FSS score in males (r=0.61; ρ<0.001) but not correlating in females (r=0.039; ρ=0.29). Depending on which definition of fatigue was used, the prevalence of fatigue varied between 13% and 63%. FSS score correlated weakly with ESS score (r=0.287; ρ=0.008). Our data indicate significant variation in the prevalence of fatigue among subjects with stroke and transient ischemic attack depending on the descriptors and methods used to define it. CONCLUSION: There is a significant difference between the genders in how fatigue is expressed.

Mounier-Kuhn syndrome in an older patient.

Respiratory problems in older adults are frequently labelled as being due to chronic obstructive airways disease (COAD). However where the presentation may be suggestive of another pathology due to the clinical history or type of pathogen isolated from the sputum, then consideration should be given to appropriate imaging. We describe a case of an older lady labelled for many years as COAD but who was a lifelong non-smoker and had Pseudomonas in her sputum. A CT of thorax for suspected bronchiectasis revealed tracheobroncomegaly (Mounier-Kuhn syndrome). This is the oldest case of Mounier-Kuhn syndrome at presentation and highlights the importance of appropriate history taking and investigation of older people.

Profiling disability within nursing homes: a census-based approach.

BACKGROUND: a significant minority of older people live in residential care. While disability is often a major contributory factor, it may not be measured or managed adequately by health and social services. At present there is little information comparing levels of disability within nursing homes and the community, and no mechanisms for monitoring changes in this disability ratio longitudinally. OBJECTIVE: to examine the prevalence of disability among older nursing home residents compared to its prevalence among older people in the community using a census-based approach. DESIGN: nationwide census over one night in 2002. SETTING: all homes and dwellings in the Republic of Ireland. METHOD: disability was measured using a six-item questionnaire embedded in a census form. Prevalence of disability was quantified among the general population and nursing homes residents aged 65 and over. Comparisons were made of sex, and number and type of disabilities between nursing home residents and their age-matched peers living within the community. RESULTS: the results showed a high level of disability within nursing homes with almost 90% of residents having a recorded disability compared with less than 30% of those aged 65 and over, living in the community. Nursing home residents had on average 4.5 disabilities ranging from hearing and visual problems to difficulties remembering and concentrating. CONCLUSION: there is a very high level of physical, sensory and cognitive disability among nursing home residents. Strategic health and functional questions in national censuses may be helpful in planning appropriate services for older people in residential care, as well as tracking trends in disability.