Background: To evaluate the effect of screening for sepsis using an electronic sepsis alert vs. no alert in hospitalized ward patients on 90-day in-hospital mortality. Methods: The SCREEN trial is designed as a stepped-wedge cluster randomized controlled trial. Hospital wards (total of 45 wards, constituting clusters in this design) are randomized to have active alert vs. masked alert, 5 wards at a time, with each 5 wards constituting a sequence. The study consists of ten 2-month periods with a phased introduction of the intervention. In the first period, all wards have a masked alert for 2 months. Afterwards the intervention (alert system) is implemented in a new sequence every 2-month period until the intervention is implemented in all sequences. The intervention includes the implementation of an electronic alert system developed in the hospital electronic medical records based on the quick sequential organ failure assessment (qSOFA). The alert system sends notifications of “possible sepsis alert” to the bedside nurse, charge nurse, and primary medical team and requires an acknowledgment in the health information system from the bedside nurse and physician. The calculated sample size is 65,250. The primary endpoint is in-hospital mortality by 90 days. Discussion: The trial started on October 1, 2019, and is expected to complete patient follow-up by the end of October 2021. Trial registration: ClinicalTrials.gov NCT04078594. Registered on September 6, 2019

Lacunar stroke (LS) is responsible for one-quarter of the overall number of ischemic strokes with long-term complications and carries health and economic issues for patients and health care systems. Therefore, we aimed to investigate lacunar versus non-lacunar strokes in a tertiary academic center. From February 2016 to July 2019, all patients admitted to the stroke unit were retrospectively reviewed. We included LS patients and compared them to other TOAST subtypes. Hemorrhagic stroke and conditions mimicking stroke were excluded. Regression analysis was done to determine LS predictors and outcomes. A 35.5% rate of LS among 989 ischemic stroke patients was found. Most patients (71.9%) were males. Lower National Institutes of Health Stroke Scale (NIHSS) scores at admission and negative history for cardiac diseases were predictors for LS in our population. At discharge, LS patients had low NIHSS scores and shorter hospitalization periods compared to non-LS patients. In conclusion, LS was prevalent among ischemic stroke patients in our cohort. Future studies are highly needed with long follow-up intervals to identify the stroke recurrence, complications, and outcomes.

Objectives: To study the clinical characteristics and outcomes of patients experiencing an ischemic stroke during Ramadan vs. non-Ramadan months in a tertiary academic center in an Islamic country.Methods: We retrospectively reviewed all patients with ischemic stroke (IS) in Ramadan and non-Ramadan months for four consecutive years (February 2016–June 2019). All demographics, vascular risk factors, laboratory results, modified Rankin Scale (mRS) at admission and discharge, National Institute Stroke Scale (NIHSS), and in-hospital complication data were collected for all patients.Results: One thousand and 58 patients were included (non-Ramadan, n = 960; during Ramadan, n = 98). The mean age during Ramadan was 59 ± 13 years. Most non-Ramadan IS patients during Ramadan were male (68.5%; 57.1%, respectively). There was no statistical difference in vascular risk factors and medical history between the two groups. However, Ramadan patients had higher median NIHSS scores at discharge (p = 0.0045). In addition, more ICU admissions were noted among Ramadan patients (p = 0.009). In the gender-specific analysis for Ramadan patients, we found a statistically significant difference in smoking and urinary tract infection (p = 0.006, p = 0.005, respectively).Conclusion: Based on our results, there was no difference, in general, between patients with IS during Ramadan and non-Ramadan months. However, IS patients had higher NIHSS scores at discharge and more ICU admissions during Ramadan. Last, we suggest future studies with larger sample sizes, longer duration, and including all types of strokes.

Background To examine the effect of screening for sepsis using an electronic sepsis alert versus no alert in hospitalized patients admitted to wards on hospital mortality. Methods This study is conducted in 45 medical-surgical-oncology wards in five hospitals. Based on the quick Sequential Organ Failure Assessment (qSOFA), an electronic alert has been developed in the hospital Electronic Medical Record system. The alert system sends notifications of “Possible Sepsis Alert” to the bedside nurse, charge nurse, and primary medical team and requires an acknowledgment in the health information system from the bedside nurse and physician. In addition, data on the alert are displayed on management dashboards for each ward. Initially, all wards had a masked alert for 2 months. Hospital wards are then allocated in a randomized fashion to either active or masked alert, such that the alert is activated in five new randomly selected wards every two months until all wards have the active alert. The primary endpoint is in-hospital mortality by 90 days. Discussion The trial has started in October 2019 and is expected to continue for 22 months enrolling more than 62550 hospitalized patients. Trial registration ClinicalTrials.gov NCT04078594. Registered on September 6, 2019, https://clinicaltrials.gov/ct2/show/NCT04078594