Scientific Article | imprecision in the study estimates (i.e. the proportion giving the incorrect answer in the population could be anywhere between 17% and 44%, or even outside of these interval limits). However, the goal of this exploratory study was to estimate a proportion different from the most conservative guess of 50% (essentially a coin flip) given that this proportion was previously unknown, and our power calculations were based on this goal. The relatively low response rate could have also introduced non-respondent bias, although this response rate is comparable to another recent random survey examining a similar topic. 8 The results may also not be applicable to countries outside of the United <strong>State</strong>s, and regional differences may exist. There may also have been some bias introduced by the fact that deception was not employed in the study design (i.e. callers were told that this call was part of a research project). However, the decision was made to not employ deception to yield results similar to the study by Jarrell et al. 2 in which healthline operators affiliated with academic neurology programs were also informed of the research nature of the call prior to participating. The fact that both studies still found an incorrect advice answer in approximately one fourth to one third of the calls is concerning given the vast amount of research confirming that stroke patients who access the emergency medical services system arrive at the ED faster, which contributes to less overall presentation delay. 8,9-14 Conclusion Despite the majority of PCP office respondents being able to name one stroke sign or symptom, almost one third recommended scheduling an appointment later in the day for a hypothetical stroke case. In contrast, 100% gave the correct answer of ‘call 911’ to a classic heart attack scenario. Triaging potential stroke patients away from emergent care may result in stroke patient presentations outside of the therapeutic treatment windows. These results suggest that stroke education with specific emphasis on the need to call 911 may be needed for PCP office receptionists. Further studies should also examine the advice given by other healthcare ‘entry points’, such as pharmacies and the internet. References 1. Hills NK, Johnston SC. Why are eligible thrombolysis candidates left untreated Am J Prev Med. 2006 Dec;31(6 Suppl 2): S210-6. Epub 2006 Nov 7. 2. Jarrell B, Tadros A, Whiteman C, Crocco T, Davis SM. National healthline responses to a stroke scenario: implications for early intervention. Stroke. 2007 Aug;38(8):2376- 8. Epub 2007 Jul 5. 3. California Acute Stroke Pilot Registry (CASPR) Investigators. Prioritizing interventions to improve rates of thrombolysis for ischemic stroke. Neurology. 2005 Feb 22;64(4):654-9. 4. Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med. 1999 Apr;33(4):373-8. 5. Wein TH, Staub L, Felberg R, Hickenbottom SL, Chan W, Grotta JC, Demchuk AM, Groff J, Bartholomew LK, Morgenstern LB. Activation of emergency medical services for acute stroke in a nonurban population: the T.L.L. Temple Foundation Stroke Project. Stroke. 2000 Aug;31(8):1925-8. 6. Moser DK, Kimble LP, Alberts MJ, et al. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart <strong>Association</strong> Council on Cardiovascular Nursing and Stroke Council. Circulation 2006;114:168--82. 7. Zerwic J, Hwang SY, Tucco L. Interpretation of symptoms and delay in seeking treatment by patients who have had a stroke: exploratory study. Heart Lung. 2007 Jan-Feb;36(1):25-34. 8. Mandelzweig L, Goldbourt U, Boyko V, Tanne D. Perceptual, social, and behavioral factors associated with delays in seeking medical care in patients with symptoms of acute stroke. Stroke. 2006 May;37(5):1248-53. Epub 2006 Mar 23. 9. Jurkowski JM, Maniccia DM, Dennison BA, Samuels SJ, Spicer DA. Awareness of necessity to call 9-1-1 for stroke symptoms, upstate New York. Prev Chronic Dis. 2008 Apr;5(2):A41. Epub 2008 Mar 15. 10. Rossnagel K, Jungehülsing GJ, Nolte CH, Müller-Nordhorn J, Roll S, Wegscheider K, Villringer A, Willich SN. Out-of-hospital delays in patients with acute stroke. Ann Emerg Med. 2004 Nov;44(5):476-83. 11. Kothari R, Jauch E, Broderick J, Brott T, Sauerbeck L, Khoury J, Liu T. Acute stroke: delays to presentation and emergency department evaluation. Ann Emerg Med. 1999 Jan;33(1):3-8. 12. Bohannon RW, Silverman IE, Ahlquist M. Time to emergency department arrival and its determinants in patients with acute ischemic stroke. Conn Med. 2003 Mar;67(3):145-8. 13. Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S. Prehospital and emergency department delays after acute stroke: the Genentech Stroke Presentation Survey. Stroke. 2000 Nov;31(11):2585-90. 14. Lacy CR, Suh DC, Bueno M, Kostis JB. Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke. 2001 Jan;32(1):63-9. OFFICE MANAGERS ASSOCIATION OF HEALTHCARE PROVIDERS, INC. www.officemanagersassociation.com We invite you to join our organization which consists of members who manage the daily business of healthcare providers. Our objectives are to promote educational opportunities, professional knowledge and to provide channels of communication to office managers in all areas of healthcare. We currently have eleven chapters in <strong>West</strong> <strong>Virginia</strong>. OFFICE MANAGERS ASSOCIATION OF HEALTHCARE PROVIDERS, INC. www.officemanagersassociation.com We invite you to join our organization which consists of members who manage the daily business of healthcare providers. Our objectives are to promote educational opportunities, professional knowledge and to provide channels of communication to office managers in all areas of healthcare. We currently have eleven chapters in <strong>West</strong> <strong>Virginia</strong>. We invite you to join our organization which consists of members who manage the daily business of healthcare providers. Our objectives are to promote educational opportunities, professional knowledge Visit us on and our website for to more provide information or contact channels of communication to office managers in all areas of healthcare. Donna Zahn (President) at 740-283-4770 ext. 105 or Tammy Mitchell (Membership) at 304-324-2703. We currently have eleven chapters in <strong>West</strong> <strong>Virginia</strong>. Visit us on our website for more information or contact Donna Zahn (President) at 740-283-4770 ext. 105 or Tammy Mitchell (Membership) at 304-324-2703. 28 <strong>West</strong> <strong>Virginia</strong> <strong>Medical</strong> Journal
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