This week we have continued to collect patient files and enter their data into the spreadsheet (about 70% have been filled in now). We have also started going into the other two health record sites at the hospital that we hadn’t yet visited. It can be quite difficult to actually get the key to these sites sometimes though (with there being only one copy of each) and walking across the hospital site with a wobbly trolley and piles of files can be quite an effort when it’s hot (at least for me!). Luckily the file classification systems are the same as within the site that we’ve already visited so our searches for patient files have been quite easy. We have also been making a list of the files that other staff are using for research so hopefully we can ask to borrow them for a day once we finish collecting those stored in record sites and hopefully minimise our finishing amount of missing data. However, there’s still some files that we just can’t seem to find even after double checking their location.
In regards to the data itself we noticed that often patients’ 3 month follow up letters (and thus 3 month mRS scores) often aren’t included within their files. We have therefore started searching for the results of these follow-up clinics using an online database. Even so, some patients still don’t seem to have attended a clinic, meaning that these patients will have to be phoned up in order to establish their current levels of independence. It’s interesting to see how these clinic letters can be used for another function, having previously used them within the OSA project to establish TIA symptomology. Clinicians also appear to use some stroke classification systems more often than others when writing inpatient notes – although I’m not sure that there’s much that we can do to fill in these gaps post- patient discharge. For example, the Oxford classification system is almost always recorded. This consists of ‘total anterior circulation infarcts’, ‘partial anterior circulation infarcts’, ‘lacunar infarcts’ and ‘posterior circulation infarcts’. It is assigned based on the initial presentation of a patient’s stroke in order to predict factors such as its prognosis. On the other hand, the TOAST classification system also requires information from further testing and seems to be recorded less often. This system is used to describe the cause of a stroke (see below for examples) and consists of ‘atherosclerosis of a large artery’, ’embolism of cardiac origin’, ‘occlusion of a small blood vessel’, ‘other determined cause’ and ‘undetermined cause’.
In regards to the OSA project, after having matched patients that had both attended the neurovascular clinic with a TIA and had been giving a diagnosis of OSA last week we have now been looking at these patients in more detail. All of the TIA patients that we’ve looked at (around 250) have now been entered into one spreadsheet and any queries in regards to categorizations (such as how to define their recurrent episodes) have been highlighted. The sleep study results from those patients who also have a diagnosis of OSA has additionally been entered alongside in order to more specifically detail their AHI results and OSA severity. There still seems to currently be a number of gaps in patient AHI figures however, which may mean that further investigation needs to be done in order to clarify the relationship between patients’ OSA and TIA presentations.
Although I only have a few days till the end of my placement we’ve decided to stay on longer than the initial eight weeks in order to finish data collection and carry out the statistical analyses. Hopefully it will be very fulfilling to see all this work come to fruition (and will keep me busy whilst looking for my next job!).
Image retrieved from: http://www.medtogo.com/stroke