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Understanding hydration and stroke outcomes in Zambia

了解赞比亚的水合作用和中风结果

基本信息

批准号：
10250547
负责人：
Mona N Bahouth
金额：
$ 16.91万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2024-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10250547
关键词：
Acute Admission activity Adult Africa South of the Sahara Benefits and Risks Blood Circulation Blood Urea Nitrogen Blood Viscosity Brain Brain Edema Caring Cause of Death Cerebral Malaria Cerebrum Cessation of life Child Childhood Clinical Clinical Research Clinical Trials Contracts Country Creatinine Data Dehydration Environment Focus Groups Foundations Frequencies Future Goals Group Interviews Guidelines Health Personnel Heart failure Heterogeneity Hospital Mortality Hospital Referrals Hospitals Hydration status IV Fluid Individual International Intervention Interview Ischemic Stroke Knowledge Laboratory Markers Language Length of Stay Light Link Malaria Measures Morbidity - disease rate Neurology Outcome Outcome Study Participant Patient Care Patient-Focused Outcomes Patients Perception Perfusion Physicians Pilot Projects Population Protocols documentation Rehydrations Research Resources Risk Sampling Sepsis Severities Shoulder Standardization Stroke Structure System Teaching Hospitals Telephone Testing Time Translating United States United States National Institutes of Health Universities Validity and Reliability Work Zambia base clinically relevant comorbidity disability functional disability functional outcomes improved low and middle-income countries mortality neuroimaging pediatric patients post stroke prospective standard of care stroke outcome stroke patient stroke therapy tool treatment guidelines

项目摘要

PROJECT SUMMARY A large percentage of patients are dehydrated (more accurately, in a volume contracted state) at the time of stroke, and there is accumulating evidence that these patients do not recover as well as patients who are not dehydrated. Although administering more intravenous fluids may benefit these patients by increasing circulation to the brain, clinicians are often cautious in light of the risks for heart failure and brain swelling which are common after stroke. Application of US guidelines about rehydration strategies after stroke may not be appropriate seen in prior studies of rehydration in pediatric patients with malaria. Furthermore, no information exists about stroke patients with varying comorbid conditions in low and middle income countries like those in sub-Saharan Africa. In order to advance our knowledge, we need to understand the hydration status of stroke patients in Zambia, explore physician perspectives about rehydration in the early stroke period and create regionally appropriate tools to measure stroke outcomes. In this proposal, we seek to demonstrate that simple and broadly available laboratory markers are capable of quantifying a patient’s volume status at the time of stroke and to explore the relationship between volume status and stroke outcomes using tools adapted for use in local Zambian languages. We will additionally conduct focus group interviews with physicians to understand perspectives and current practices in Zambia. Stroke patients from a single hospital in Zambia will have baseline lab testing to assess for dehydration and quantification of stroke severity and functional outcomes over thirty days. We anticipate that the study will establish the clinical relevance of a surrogate composite of labs to identify dehydration in the early stroke period and explore the connection to stroke outcomes in this population. If dehydration is associated with worsened outcomes after stroke, this research will provide the foundation for implementation of a scalable rehydration intervention in future clinical trials. The long-term goal of this study team is to identify potential interventions to improve morbidity and mortality after stroke that are applicable in both resource-rich and resource-limited settings. This research will provide critical data about dehydration and stroke in sub-Saharan Africa, help establish a sustainable system for clinical research and stroke care in Zambia, and inform a future international trial of rehydration after stroke. Given the high stroke rates and projections that stroke burden in sub-Saharan Africa will continue to substantially increase in coming years, interventions are urgently needed to improve patient outcomes in these countries. Such an intervention should be scalable and feasible to administer in non-tertiary settings, with minimal resources, and by non-physician healthcare workers. Emerging evidence indicates that early rehydration after stroke could be such an intervention.

项目概要很大一部分患者在治疗时处于脱水状态（更准确地说，处于体积收缩状态）中风，并且越来越多的证据表明这些患者的康复效果不如非中风患者脱水。尽管给予更多的静脉输液可能会使这些患者受益鉴于心力衰竭和脑肿胀的风险，临床医生通常持谨慎态度。常见于中风后。美国关于中风后补液策略的指南可能不适用先前对疟疾儿科患者补液的研究中发现了这一点。此外，没有任何信息在低收入和中等收入国家（例如美国），中风患者患有不同的合并症。撒哈拉以南非洲。为了提高我们的知识，我们需要了解中风的水合状态赞比亚的患者，探讨医生对中风早期补液的看法，并创建适合区域的工具来衡量中风结果。在本提案中，我们试图证明简单且广泛可用的实验室标记物能够量化患者中风时的容量状态并探索容量之间的关系使用适合赞比亚当地语言的工具来评估病情和中风结果。我们还将另外对医生进行焦点小组访谈，以了解赞比亚的观点和当前做法。赞比亚一家医院的中风患者将接受基线实验室测试，以评估脱水情况和三十天内中风严重程度和功能结果的量化。我们预计该研究将建立替代实验室组合的临床相关性，以识别早期中风的脱水情况期并探讨该人群与中风结果的关系。如果脱水与中风后的结果恶化，这项研究将为实施可扩展的未来临床试验中的补液干预。该研究小组的长期目标是确定潜在的改善中风后发病率和死亡率的干预措施适用于资源丰富的国家和地区资源有限的设置。这项研究将提供有关撒哈拉以南非洲地区脱水和中风的关键数据，帮助建立一个赞比亚临床研究和中风护理的可持续系统，并为未来的国际试验提供信息中风后补液。鉴于中风发生率较高以及撒哈拉以南非洲地区中风负担的预测未来几年将继续大幅增加，迫切需要采取干预措施来改善患者这些国家的成果。这种干预措施应该是可扩展的并且在非高等教育中实施是可行的由非医师医护人员以最少的资源进行设置。新出现的证据表明中风后早期补液可能就是这样一种干预措施。