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Delayed Hospital Arrival for Acute Stroke
- Maureen A. Smith, MD, MPH;
- Eyal Shahar, MD, MPH; and
- Russell V. Luepker, MD, MS
- University of Minnesota School of Public Health; Minneapolis, MN 55454-1015 (Smith) University of Minnesota School of Public Health; Minneapolis, MN 55454-1015 (Shahar) University of Minnesota School of Public Health; Minneapolis, MN 55454-1015 (Luepker)
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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IN RESPONSE:
Dr. Lacy's comments underscore the importance of developing and testing new interventions to shorten delays from the onset of stroke symptoms to hospital admission. Their 1997 data are similar to our data for 1991 to 1993 and suggest that current limited approaches to public and provider education have not reduced delay. Comprehensive public and professional education programs seem to be effective (1), but the amount of education needed may be considerable. Patients at highest risk for stroke are a population of particular interest. However, a recent study suggested that persons at risk for stroke were generally unaware of their increased risk, and those at highest risk (the very elderly) were least knowledgeable (2). Strategies that target these high-risk persons should be examined, including interventions at the level of the community, the patient, and the provider. The cost-effectiveness of identifying and targeting high-risk patients should also be compared with the cost-effectiveness of broader efforts that target the general public.
Maureen A. Smith, MD, MPH
University of Minnesota School of Public Health; Minneapolis, MN 55454-1015
Eyal Shahar, MD, MPH
University of Minnesota School of Public Health; Minneapolis, MN 55454-1015
Russell V. Luepker, MD, MS
University of Minnesota School of Public Health; Minneapolis, MN 55454-1015
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
