Inequities in acute stroke care and outcomes among rural versus urban populations in Canada: a literature review
Bibliographic record
Abstract
In acute stroke evaluation, rapid intervention and rehabilitation is critical. Canada’s vast geography innately creates barriers for efficient transport to stroke centres, thus delaying treatment. The purpose of this literature review is to investigate potential inequities in acute stroke care and outcomes, and to understand the causes and consequences of inequities in access to diagnostic investigations, acute stroke care management, and overall post stroke mortality in rural versus urban populations in Canada. A literature search using PubMed database was performed using keywords ischemic stroke, hemorrhagic stroke, Canada, and rural or urban. Three articles met the inclusion criteria and were included in the review. One additional related report was included by consulting primary sources in reference lists of relevant articles. Literature suggests that rural residence is associated with limited access to stroke centres and rehabilitation services, decreased acquisition of neuroimaging, increased hesitancy to treat with tPA, and impeded access to timely revascularization intervention via EVT. These disparities may in part be explained by time required to access appropriate healthcare facilities, variations in resource allocation and level of expertise of treating health care providers. There is contrasting findings regarding usage of tPA and 30-day post stroke mortality rates. Acute stroke care management is substandard in rural compared to urban populations in Canada. This gap in care may be addressed by focusing on minimizing existing barriers including access to stroke centres and rehabilitation services, neuroimaging, comfort administering tPA and timely revascularization intervention. Implementing telestroke and regionalization of stroke care may be of value.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.018 | 0.038 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".